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BackgroundPoor sleep quality can exacerbate many other physiological functions, such as obesity, cardiovascular disease, and high blood pressure. Although primary studies were conducted in Ethiopia, no studies concluded the pooled prevalence of poor sleep quality in Ethiopia. Therefore, this study was conducted to determine the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia.ObjectiveAssess the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia.MethodsThe studies were searched systematically using international databases from PubMed, Google Scholar, Cochrane Library, Embase, and CINAHL. The quality of the articles searched was assessed using the New Castle Ottawa scale for a cross-sectional study design. Statistical analysis was performed using STATA version 14 and a systematic review was performed using a random effect model method. The Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline was followed for reporting results.ResultsFrom the total of 728 records screened, 8 studies with 2,471 participants who met the inclusion criteria were included in this systematic review. The estimated pooled prevalence of poor sleep quality in Ethiopia was 48.54%.ConclusionAlmost half of diabetes patients had poor sleep quality. The preparation of brochures on diabetic information and the organization of health education about the negative impact of poor sleep quality on patients are among the best modalities to improve the problem of poor sleep quality.

Introduction: Diabetes mellitus is a comorbidity that is often found in Covid-19 patients with a 3.9-fold risk of death. Data from the Malang City Health Office shows an increase in the number of diabetes patients by 1.2% each year. In Indonesia, 3J (right amount, type, and eating time) has become the principle of diabetes diet therapy, but in practice, it is still challenging to apply independently. Aims: Investigating the T-Plate Model as a simple eating guide for people with diabetes mellitus. Methods: This pilot study included 18 diabetic patients at some Primary Health Care who were 50–70 years old and had a BMI more than 23 kg/m2. The participant was split into two groups, with nine people in the (C) group eating according to the T-Plate Model, and others in the (T) group eating according to the T-Plate Model after eating fruit. After a 3-month treatment period, BMI, blood pressure, carbohydrate, and fiber consumption were assessed. Mean BMI and blood pressure were examined using paired sample t-tests (p 0.05). Results: Both groups' BMIs fell into the category of obesity level 1 before to treatment periods: C group (26.09+3.13 kg/m2) and T group (27.15+ 4.15). We discovered significant blood pressure and BMI variations in the T group at the end of intervention periods (p 0.05). Nevertheless, systolic blood pressure was different in the C group (p 0.05). Conclusions: It may be inferred that using the T-Plate Model with the addition of fruit initially can lower blood pressure and BMI.

Abstract Background Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them. Methods The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services. Results Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49–0.85; P

Abstract Background Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life. Methods From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis. Results (1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life." Conclusions Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

This study adopted a qualitative research method aiming to investigate the self-care behaviors among diabetic patients to delay chronic kidney disease. This study was conducted in patients who had diabetes for more than 10 years, both with or without comorbidity for less than 5 years, and were treated in a non-communicable disease clinic in Na Si Nuan Sub-District Health Promoting Hospital. Data were obtained through in-depth interviews and were analyzed with content analysis. The results showed that all information providers practiced dietary self-care, where they cooked their meals at home and then seasoned them separately with other members of the family. They were non-smokers, most of them did not drink alcoholic beverages but some people drsnk beer during hard work days. Everyone performed exercises such as Jogging, walking, arm swinging, and non-formal exercises that work until you get tired or sweat, such as farming, walking, raising cows. They were aware of taking medication both orally and by injecting insulin. They ate or injected before cooking then took breakfast after about 30 minutes. Some people ate breakfast more than 30 minutes after taking the drug on some days.

Background: Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them. Methods: The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services. Results: Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49–0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24–3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61–13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21–2.22; P < 0.05). Conclusion: Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas. [ABSTRACT FROM AUTHOR]

Aims To investigate the prospective associations of the loneliness and social isolation scales with cardiovascular disease (CVD) risk in diabetes patients and compare the relative importance of loneliness and social isolation with traditional risk factors. Also, the interactions of loneliness or isolation with the degree of risk factor control in relation to CVD risk were evaluated. Methods and results A total of 18 509 participants diagnosed with diabetes from the UK Biobank were included. A two-item scale and a three-item scale were used to assess loneliness and isolation levels, respectively. The degree of risk factor control was defined as numbers of glycated hemoglobin (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and kidney condition controlled within the target range. During a mean follow-up of 10.7 years, 3247 total CVD incidents were documented, including 2771 coronary heart disease and 701 strokes. In the fully adjusted model, compared with participants with the lowest loneliness score (zero), hazard ratios (95% confidence interval) for CVD were 1.11 (1.02 and 1.20) and 1.26 (1.11 and 1.42) for participants with a loneliness scale of 1 and 2, respectively (P -trend < 0.001). No significant associations were observed for social isolation. Loneliness ranked higher in relative strength for predicting CVD than the lifestyle risk factors in diabetes patients. A significant additive interaction between loneliness and the degree of risk factor control on the risk of CVD was observed (P for additive interaction = 0.005). Conclusion Among diabetes patients, loneliness, but not social isolation scale, is associated with a higher risk of CVD and shows an additive interaction with the degree of risk factor control. [ABSTRACT FROM AUTHOR]

Abstract Background: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. Methods: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients’ medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients’ health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. Results: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient’s annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient’s annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient’s annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn’t change. Conclusion: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.

ObjectiveDepression in diabetes patients is caused by their own disease or the surrounding social environment. How to cope with changes in mentality and adjust psychological stress responses, especially under China’s dynamic zero COVID-19 policy, is worth further discussion. The researchers constructed a moderated mediation model to test the effect of psychological resilience during dynamic zero COVID-19 on depression in diabetes patients and the mediating role of stigma and the moderating effect of medication burden.MethodFrom June to September, 2022, data were collected in Jinghu District, Wuhu City, Anhui Province, by multi-stage stratified sampling. Firstly, we selected a tertiary hospital randomly in Jinghu District. Secondly, departments are randomly chosen from the hospital. Finally, we set up survey points in each department and randomly select diabetes patients. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma, medication burden was measured by the Diabetes Treatment Burden Scale (DTBQ), and depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). We used SPSS (version 23.0) and PROCESS (version 4.1) for data analysis.Results(1) Psychological resilience was negatively correlated with stigma, medication burden, and depression. Stigma was positively associated with medication burden and depression. Medication burden and depression are positively correlated, (2) The mediation analysis showed that psychological resilience had a direct predictive effect on depression, and stigma partially mediated the relationship, and (3) Medication burden moderates the direct pathway by which psychological resilience predicts depression; Medication burden moderates the first half of “psychological resilience → stigma → depression.”ConclusionUnder the mediating effect of stigma, psychological resilience can improve depression. Medication burden has a moderating effect on the relationship between psychological resilience and depression, and it also has a moderating effect on the relationship between psychological resilience and stigma. These results facilitate the understanding of the relationship mechanisms between psychological resilience and depression.

Background: Blood pressure (BP) readings taken at a doctor's office or clinic have historically served as the foundation for the diagnosis, treatment, and estimation of mortality risk for patients with hypertension. Objective: The present study aimed to measure the relative predictive value of office-based BP versus ambulatory BP for cardiovascular complications in diabetes patients. Patients and Methods: This cohort study included 48 adult diabetic patients from Cardiology Department, Zagazig University. The examined cases had at least two consecutive BP clinic measures with a validated automatic oscillometric instrument or the conventional approach using a sphygmomanometer. Results: Office systolic blood pressure ranged from 107 to 138 mmHg with a mean of 126.88 mmHg. Office diastolic blood pressure ranged from 53 to 79 mmHg with a mean of 71.98 mmHg. Mean 24-hour systolic blood pressure ranged from 105 to 147 mmHg with a mean of 122.69 mmHg. Mean 24-hour diastolic blood pressure ranged from 51 to 90 mmHg with a mean of 70.5 mmHg. There was statistically significant positive correlation between office SBP and both daytime and night ambulatory systolic blood pressure. There was statistically significant positive correlation between office DBP and both daytime and night ambulatory diastolic blood pressure. There was statistically significant positive correlation between office MBP and both ambulatory mean 24-hour systolic and diastolic blood pressure Conclusion: Ambulatory blood pressure monitoring (ABPM) is linked to the development of cardiovascular problems from diabetes and diabetic retinopathy at a mean ambulatory BP level of less than 122.5/70.5 mmHg. [ABSTRACT FROM AUTHOR]

Xi-yu Liu Department of Endocrinology, Dongyang People’s Hospital, Dongyang, Zhejiang, People’s Republic of ChinaCorrespondence: Xi-yu Liu, Email csuliuxiyu@163.comIntroduction: The relationship between diabetes and cancer is uncertain. However, tumor markers in diabetic patients are significantly elevated. The prevalence of diabetic inpatients with elevation of tumor markers and its relationship to blood glucose is needed to be studied.Methods: A total of 102 diabetic inpatients were included in this study. We collected information from diabetic inpatients and tested tumor markers. Patients with elevation of tumor markers were rechecked.Results: We found that up to 73.3% of diabetic inpatients had one or more tumor markers elevated. The proportion of diabetic inpatients with higher than normal cytokeratin 19 fragment (CYFRA 21– 1) was 54.5%. Most of them did not return to normal after controlling the blood glucose. A short-term elevation of carcinoembryonic antigen (CEA) was present in 15.8% of diabetic inpatients, and 19.8% of diabetic inpatients had a short-term elevation of carbohydrate antigen. CEA and carbohydrate antigen including CA19-9, CA72-4, CA125 and CA15-3 returned to normal or became significantly reduced within 2 weeks after good control of blood glucose.Conclusion: Our study showed that the elevation of tumor markers was common in diabetic inpatients, especially those with poor blood glucose control. It indicated that re-checking the tumor markers after controlling blood glucose might be better than conducting large-scale test for cancer.Keywords: diabetes patients, tumor markers, carcinoembryonic antigen, carbohydrate antigen

Background: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. Methods: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients' medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients' health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. Results: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient's annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient's annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient's annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn't change. Conclusion: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally. [ABSTRACT FROM AUTHOR]

Self-care management is the way to prevent the complication in diabetes. However, adherence to self-care management is low. This study aims to assess the association of personal characteristics, supports the system, including families and community, with the self-care behavior among diabetes patients. A cross-sectional study was used in this research. 158 participants were randomly selected based on the primary health care database in Malang City, Indonesia. There are eight parts of the questionnaire as the instruments in this study. Multivariate logistic regression was used to analyze the association of all independent variables with self-care behavior as a dependent variable. This study showed that 60.80% of respondents had complications while the less practicing self-care behavior was 46.84%. Furthermore, the ordinal regression logistic showed that duration of DM (OR:4.347, 95%CI 1.671-11.310), illness perception (OR: 0.028, 95%CI 6.090- 51.346), family supports (OR: 3.295, 95%CI 1.325-8.192), and community supports (2.802, 95%CI 1.209-6.493) were associated with self-care behavior among diabetes Mellitus. This finding can support the primary health care to involved family and community around diabetes patients to success the self-care management. [ABSTRACT FROM AUTHOR]

Self-care management is the way to prevent the complication in diabetes. However, adherence to self-care management is low. This study aims to assess the association of personal characteristics, supports the system, including families and community, with the self-care behavior among diabetes patients. A cross-sectional study was used in this research. 158 participants were randomly selected based on the primary health care database in Malang City, Indonesia. There are eight parts of the questionnaire as the instruments in this study. Multivariate logistic regression was used to analyze the association of all independent variables with self-care behavior as a dependent variable. This study showed that 60.80% of respondents had complications while the less practicing self-care behavior was 46.84%. Furthermore, the ordinal regression logistic showed that duration of DM (OR:4.347, 95%CI 1.671-11.310), illness perception (OR: 0.028, 95%CI 6.090- 51.346), family supports (OR: 3.295, 95%CI 1.325-8.192), and community supports (2.802, 95%CI 1.209-6.493) were associated with self-care behavior among diabetes Mellitus. This finding can support the primary health care to involved family and community around diabetes patients to success the self-care management.

Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers' QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers' psychological onuses and physical actions/reactions). The relation between these variables was significant, X2 (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels. [ABSTRACT FROM AUTHOR]

Background and Aims: The self-management behavior of patients with diabetes involves a complex set of actions involving medication therapy, lifestyle changes, and management of complications in the daily routine. Our study aims to explore adherence to self-management behaviors by patients with type 2 diabetes and the potential factors influencing those behaviors. Methods: This qualitative study used semi-structured interviews conducted with patients who have type 2 diabetes and who were recruited from the department of endocrinology in a tertiary teaching hospital. Data were analyzed thematically using the interview framework. Results: Overall, 28 patients with type 2 diabetes were recruited and interviewed. Three types of medication noncompliance behaviors were coded. In particular, blindly optimistic attitudes toward the condition in younger patients who had a short duration of diabetes and fear of or pain from medication therapy were key influencing factors. Irregular monitoring and missed follow-up visits were the most frequently mentioned noncompliance behaviors. Poor understanding of blood glucose monitoring, selective ignorance due to pressure of uncontrolled blood glucose, and blindly optimistic attitudes were also identified as key influencing factors. Dietary behaviors were characterized by an overemphasis on the amount of food in the diet and the preference or declination for particular types of food; ignorance of the dietary structure was present. Misconceptions about dietary and exercise practices were the main types of lifestyles' noncompliance. Conclusion: Our study showed the complex picture of noncompliance with self-management behaviors by patients with type 2 diabetes. Noncompliance covered disordered and arbitrary changes in medication therapy, blood glucose monitoring with poorest adherence, lifestyle modifications and complication management. The study findings identify clear challenges to self-management behavior and identify potential key influencing factors. Future interventions and strategies should aim to help patients translate healthcare provider's information and instructions into action that improve compliance. [ABSTRACT FROM AUTHOR]

Addisu Tadesse Sahile,1 Tennyson Mgutshini,2 Solomon Muluken Ayehu3 1Department of Public Health, Unity University, Addis Ababa, Ethiopia; 2Department of Public Health, University of South Africa, Pretoria, South Africa; 3Department of Emergency, Menelik II Referral Hospital, Addis Ababa, EthiopiaCorrespondence: Addisu Tadesse Sahile Tel +2519 1209 6667Email sahdis91@gmail.comObjective: The study assessed the oral health screening status of diabetes patients and its associated factors in selected public hospitals of Addis Ababa, 2018.Patients and Methods: An institutional-based cross-sectional study was conducted on 388 diabetes patients selected on the bases of a systematic random sampling method from March to May 2018 at two selected public hospitals in Addis Ababa. Data were collected with a pre-tested, structured, and translated questionnaire. Bi-variable and multivariable logistics regression were undertaken to identify predictors of oral health screening among diabetes with their respective 95% CI and a p-value of less than 5% level of significance.Results: The oral health screening status among diabetes patients in this study was 21.1%. The odds of having had an oral health screening was 82.4% higher in those with an educational status of college and above than those who cannot read and write and it was ten and five folds higher in participants with a monthly income of less than 750 birr than those with above 2,000 birr and those who brushed their tooth twice or more times a day than occasionally, respectively. The odds of having had an oral health screening was 17, four, and five folds higher among participants with perceived susceptibility, perceived severity, and benefit, respectively, whilst it was 8.8% lower in participants with a perceived barrier and it was as high as 19.782 times among participants with malocclusion.Conclusion: A lower level of oral health screening was observed. A higher educational level, a lower monthly income, a higher frequency of tooth brushing per day, positive perceptions of susceptibility, severity, and benefits, and presence of malocclusions were statistically associated with a higher frequency of oral health screening. Concerned bodies were recommended to work on the identified predictors and improve the oral health screening of diabetes patients.Keywords: oral health screening, diabetes patients, associated factors

Background and AimsThe self-management behavior of patients with diabetes involves a complex set of actions involving medication therapy, lifestyle changes, and management of complications in the daily routine. Our study aims to explore adherence to self-management behaviors by patients with type 2 diabetes and the potential factors influencing those behaviors.MethodsThis qualitative study used semi-structured interviews conducted with patients who have type 2 diabetes and who were recruited from the department of endocrinology in a tertiary teaching hospital. Data were analyzed thematically using the interview framework.ResultsOverall, 28 patients with type 2 diabetes were recruited and interviewed. Three types of medication noncompliance behaviors were coded. In particular, blindly optimistic attitudes toward the condition in younger patients who had a short duration of diabetes and fear of or pain from medication therapy were key influencing factors. Irregular monitoring and missed follow-up visits were the most frequently mentioned noncompliance behaviors. Poor understanding of blood glucose monitoring, selective ignorance due to pressure of uncontrolled blood glucose, and blindly optimistic attitudes were also identified as key influencing factors. Dietary behaviors were characterized by an overemphasis on the amount of food in the diet and the preference or declination for particular types of food; ignorance of the dietary structure was present. Misconceptions about dietary and exercise practices were the main types of lifestyles’ noncompliance.ConclusionOur study showed the complex picture of noncompliance with self-management behaviors by patients with type 2 diabetes. Noncompliance covered disordered and arbitrary changes in medication therapy, blood glucose monitoring with poorest adherence, lifestyle modifications and complication management. The study findings identify clear challenges to self-management behavior and identify potential key influencing factors. Future interventions and strategies should aim to help patients translate healthcare provider’s information and instructions into action that improve compliance.

Objective: To measure the economic risk of diseases in Chinese middle-aged and elderly patients with diabetes. Methods: The economic risk of diseases in Chinese middle-aged and elderly patients with diabetes was comprehensively analyzed using the family economic risk of diseases, catastrophic health expenditure, and relative risk of the disease. Results: The proportions of families with low, medium, and high family economic risk of diseases were 64.73%, 8.56%, and 26.71%, respectively. When the defining criteria are 15%, 25%, and 40%, the incidences of catastrophic health expenditure were 66.71%, 60.07%, and 54.59%, respectively. The health expenditure of diabetic patients was 1.80 times that of non-diabetic patients when the difference in patients' income was eliminated. Conclusion: In general, Chinese middle-aged and elderly patients with diabetes face a large economic risk of diseases, which will seriously hinder the improvement of their family life quality. The sociodemographic characteristics related to diabetics will aggravate the patient's economic risk, such as smoking, drinking, and low household income. Moreover, diabetes patients with different basic medical insurance have different economic risk of diseases. [ABSTRACT FROM AUTHOR]

Recently, it was estimated that visual problems affecting individuals aged above 50 years account for more than 80% of blindness in world. Eye care facilities in general are underutilized as evident by studies reporting that almost half of persons with visual loss did not have eye checks in the preceding 5 years. Diabetes mellitus (DM) is a growing health problem worldwide. This study aims to assess and determine the awareness of patients with DM about need of periodic eye checkups and their awareness of retinal involvement. This is a cross sectional study done in medical outpatient clinic from 01/01/2018 to 31/12/2018. A total of 341 patients with DM were selected randomly and filled a questionnaire about the following variables: gender, age, type of DM, educational level, duration of diabetes, awareness of eye involvement, awareness of need of regular eye exam, current diabetes treatment, method to monitoring diabetes control, last time of eye examination, and also assessed the source of awareness. Statistical analysis done by SPSS 22. A total of 341 patients were included in the study, the mean age was 54 ± 6 years old, mean duration of diabetes was 6.6 ± 4.3 years, mean level of Hb A1c was 7.97 ± 1.3. Female patients were 54.3%, 85% of patients were with type 2 diabetes, and educational level of patients was 35.2% with university and 41.6% secondary school degree. There was significant association between awareness of retinal involvement in diabetes and duration of diabetes, education level and age groups, there was significant association between awareness for need of regular eye exams and duration of diabetes, type of diabetes, education level and age groups. Awareness of diabetics toward regular eye checkup is low despite the high knowledge of the presence of eye complications in DM. In addition, there was a problem of how and when to do examination, which was more in patients with longer duration of DM, and more in type 2 DM, education level is a major determinant of awareness. Most of the patients derive their knowledge from their physicians. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality can exacerbate many other physiological functions, such as obesity, cardiovascular disease, and high blood pressure. Although primary studies were conducted in Ethiopia, no studies concluded the pooled prevalence of poor sleep quality in Ethiopia. Therefore, this study was conducted to determine the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia., Objective: Assess the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia., Methods: The studies were searched systematically using international databases from PubMed, Google Scholar, Cochrane Library, Embase, and CINAHL. The quality of the articles searched was assessed using the New Castle Ottawa scale for a cross-sectional study design. Statistical analysis was performed using STATA version 14 and a systematic review was performed using a random effect model method. The Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline was followed for reporting results., Results: From the total of 728 records screened, 8 studies with 2,471 participants who met the inclusion criteria were included in this systematic review. The estimated pooled prevalence of poor sleep quality in Ethiopia was 48.54%., Conclusion: Almost half of diabetes patients had poor sleep quality. The preparation of brochures on diabetic information and the organization of health education about the negative impact of poor sleep quality on patients are among the best modalities to improve the problem of poor sleep quality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abate, Azagew, Nega, Birru and Mekonnen.)

Introduction: Urinary C-peptide creatinine ratio (UCPCR) measured in urine collected at home after a meal has been shown to correlate strongly with stimulated blood C-peptide in European populations. This association and the clinical utility of UCPCR in a sub-Saharan African clinical setting has not been described before. We aimed to assess the performance of UCPCR as a measure of endogenous insulin secretion in Cameroon.Methods: UCPCR was measured on two separate days before and after a standard mixed-meal tolerance test (MMTT), after lunch and after supper in 14 patients with diabetes and 14 healthy control individuals. Blood C-peptide was measured serially during a standard 75g oral glucose tolerance test (OGTT) every 30 minutes, on a separate day. The primary outcome was the correlation between stimulated blood C-peptide levels and post-meal UCPCR values.Results: stimulated blood C-peptide was significantly lower in participants with diabetes vs controls; median (IQR) 719 (110-999) pmol/l vs 1080 (934-1820) pmol/l, p=0.04. Fasting and post-MMTT UCPCR correlated strongly with stimulated blood C-peptide measurement in participants with diabetes (r= 0.71, p= 0.005) and (r=0.71, p=0.004) respectively. Post-meal UCPCR showed a moderate or poor correlation with stimulated blood C-peptide levels (supper r=0.56, p=0.04, lunch r=0.31, p=0.29). In participants without diabetes, UCPCR showed no relationship with stimulated blood C-peptide (supper r= -0.03, p=0.92, lunch r= -0.06, p=0.83). Conclusion: these results suggest that post-meal UCPCR performs less well in this population compared to European populations and may not be useful to assess endogenous insulin secretion in participants without diabetes in Cameroon.

Diabetes is a chronic disease with a high incidence rate. In the context of health care in China, an intelligent monitoring system combining medical care with old-age care has been established based on the service model of combining medical care with old-age care, in view of the reality of diabetes patients, while accurately and effectively identifying the nursing problems of patients with diabetes, a scientific and reasonable individualized nursing plan will be formulated, and the relatively limited nursing resources will be fully utilized, to improve the quality of nursing care for the aged with diabetes mellitus. Based on the model of medical care combined with old-age care, combined with diabetes patients, a comprehensive management model was put forward.

A clear understanding of factors affecting patients' perception of the quality of life (QoL) would be useful for improving continuous care in diabetic patients with the early stage of chronic kidney disease (CKD). The early stage of CKD is defined as an estimated glomerular filtration rate (eGFR) of above 30 mL/min per 1.73 m2, that can return to a normal stage. Thus, this research aims to assess and determine the factors predictive of the QoL among diabetic patients with the early stage of CKD. A cross-sectional survey using a stratified random sampling method was administered between March and May 2018. The participants were 335 diabetic patients with the early stage of CKD selected from 24 sub-district health promoting hospitals in Sakon Nakhon province. The data collected, using questionnaires, descriptive statistics, and a stepwise multiple regression analysis for the factors related to and predictive of the QoL, were analyzed. The results revealed that: the factors that could predict the QoL consisted of health condition satisfaction, self-care behavior, age, personal monthly income, CKD classification, and marital status. The best predictors for QoL in diabetic patients with the early stage of CKD were health condition satisfaction (β = 0.305, p<0.001), followed by self-care behavior (β = 0.280, p<0.001). Based on the findings of this study, health care providers should pay more attention to patients with low levels of health condition satisfaction and self-care behavior. All these features negatively affect the QOL. To improve a patient's QoL, the focus should be on different variables. [ABSTRACT FROM AUTHOR]

BackgroundAlthough patients with diabetes may benefit from physical activity, few studies have examined sustained walking in this population.ObjectiveTo examine the factors associated with sustained walking among managed care patients with diabetes.DesignLongitudinal, observational cohort study with questionnaires administered 2.5 years apart.ParticipantsFive thousand nine hundred thirty-five patients with diabetes walking at least 20 minutes/day at baseline.MeasurementsThe primary outcome was the likelihood of sustained walking, defined as walking at least 20 minutes/day at follow-up. We evaluated a logistic regression model that included demographic, clinical, and neighborhood variables as independent predictors of sustained walking, and expressed the results as predicted percentages.ResultsThe absence of pain was linked to walking behavior, as 62% of patients with new pain, 67% with ongoing pain, and 70% without pain were still walking at follow-up (p = .03). Obese patients were less likely (65%) to sustain walking than overweight (71%) or normal weight (70%) patients (p = .03). Patients > or =65 years (63%) were less likely to sustain walking than patients between 45 and 64 (70%) or < or =44 (73%) years (p = .04). Only 62% of patients with a new comorbidity sustained walking compared with 68% of those who did not (p < .001). We found no association between any neighborhood variables and sustained walking in this cohort of active walkers.ConclusionsPain, obesity, and new comorbidities were moderately associated with decreases in sustained walking. Whereas controlled intervention studies are needed, prevention, or treatment of these adverse conditions may help patients with diabetes sustain walking behavior.

OBJECTIVE: HCV infection is more common among adults with type 2 diabetes and possibly it can affect the glycemic control in patients with diabetes. This study was conducted to find whether eradication of CHC infection with direct acting antiviral (DAA) agents is associated with good glycemic control in patients with type 2 diabetes or otherwise. MATERIAL AND METHODS: Among 545 patients with diabetes who were treated with DAA (Interferon & Ribavirin free regimen) for chronic HCV infection, were included in the study. Changes in average (HbA1c) levels and use of ant diabetic medication 6 months before and after DAA treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not achieve SVR. RESULTS: In patients with high base line HbA1c, the drop in HbA1c in reference to DAA treatment was greater in those who achieved SVR (1.99%) in comparison to those who did not (1.70%) (Adjusted mean difference 0.29, p=0.02). The doses of anti diabetic agents decreased more in subjects who achieved SVR in comparison to those who met treatment failure. This was evident for those who were using Insulin for control of their diabetes, which dropped significantly from 46.4% to 41.3% in patients achieving SVR compared with a slight increase from 48.7% to 50.2% in those who were in treatment failure group. CONCLUSION: It is hereby concluded that improved glycemic control is associated with eradication of HCV with DAA based regimens evidenced by decrease in mean HbA1c and decreased insulin as well as oral anti diabetic agents use in SVR achievers. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is a global public health emergency in the twenty-first century. Diabetes patients who had to adhere to good self-care recommendation can prevent the complication associated with diabetes mellitus. Self-care management of diabetes mellitus in Sub-Saharan Africa was poor including Ethiopia. The aim of this study was to assess factors influencing diabetes self-care practice among type 2 diabetes patients at Debre Tabor General Hospital, Northwest Ethiopia diabetes clinic follow up unit. Methods: An institutional based cross-sectional survey was conducted on systematically sampled 405 type 2 diabetes patients at Debre Tabor General Hospital diabetes clinic from June 02/2018 to June 30/2018. Bivariate and multivariable logistic regression was fitted to identify independent predictors of diabetes self-care practice. A p value of less than 0.05 was used to declare statistical significance. Results: A total of 385 type 2 diabetes patients participated with a response rate of 95%, of which 243 (63.1%) study participants had good self-care practice. The mean ± SD age of the respondents and the duration of diagnosed for diabetes mellitus was 52.28 ± 12.45 and 5.09 ± 3.80 years respectively. Type 2 diabetes patients who had a glucometer at home (AOR = 7.82 CI (3.24, 18.87)), getting a diabetes education (AOR = 2.65 CI (1.44, 4.89)), and having social support (AOR = 2.72 CI (1.66, 4.47)) were statistically associated with good self-care practice. Conclusion: Despite, the importance of diabetes self-care practice for the management of diabetes and preventing its complications, a significant number of type 2 diabetes patients had poor diabetes self-care practice. So, to enhance this poor practice of diabetes self-care, provision of diabetes self-care education and counseling on self-monitoring blood glucose should be promote by health care providers during their follow up. [ABSTRACT FROM AUTHOR]

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This paper aims to reveal the value of metaphorical content obtained from users as an inspiration source for designers. Studies related to metaphors within design research predominantly focus on how designers generate and utilize metaphors in design processes and it appears that the user's side has not yet been explored. Our research started by relying on the relevant findings of another domain, health sciences, where studies revealed the value of metaphor in easing communication, enhancing understanding of patients, and creating therapeutic effects. By transferring this knowledge, it is assumed that the metaphorical content provided from users can improve communication between users and designers and inspire designers during the ideation process. This hypothesis is examined in a two-staged study including diabetes patients and designers: an online survey about living with diabetes is conducted within an online diabetics' community and then individual designers are asked to interpret the outcomes of the survey to develop ideas that can improve the lives of diabetics. Through a qualitative content analysis, it is found that participant designers prefer to focus on user expressions with rich metaphorical contents and utilize these metaphorical contents to generate initial design concepts by providing deeper insights into users' understanding. [ABSTRACT FROM AUTHOR]

Type I diabetes is described by the destruction of the insulin‐producing beta‐cells in the pancreas. Hence, exogenous insulin administration is necessary for Type I diabetes patients. In this study, to estimate the states that are not directly available from the Bergman minimal model a high‐order sliding mode observer is proposed. Then fractional calculus is combined with sliding mode control (SMC) for blood glucose regulation to create more robustness performance and make more degree of freedom and flexibility for the proposed method. Then an adaptive fractional‐order SMC is proposed. The adaptive SMC protect controller against disturbance and uncertainties while the fractional calculus provides robust performance. Numerical simulation verifies that the proposed controllers have better performance in the presence of disturbance and uncertainties without chattering. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) and thyroid dysfunction (TD) often present together and complicate each other at many levels. Methodology: In this prospective study, we determined the prevalence of TD among 700 patients with T2DM attending the diabetes clinic of a tertiary care hospital who were recruited. Various sociodemographic factors such as age, gender, marital status, literacy status, and habits and clinical profile were assessed. Results: In all, 68% of male and 31% of female patients were enrolled in this study. About 33.5% of males and 66.4% of females were found with TD. One hundred and fifty-two (21.7%) patients were having TD. Diabetes and TD were more common among females, with advancing age, 45–70 years, sedentary, overweight patients and having familial history. Twenty-five percent of the patients were having prehypertension. About 10.5% of the patients were suffering with hyperthyroidism and 9% were suffering from subclinical hyperthyroidism. Forty-two percent were suffering from hypothyroidism, while 36% had subclinical hypothyroidism. Ten percent had higher T3 hormone levels, 11% had higher T4 hormone levels, and 69% had increased thyroid-stimulating hormone levels. Three percent of patients with diabetes and TD were having cardiovascular diseases. Conclusions: Out of 700 patients with T2DM, 21% were having different kinds of TD. More females with advancing age and sedentary lifestyle were having TD. Screening for TD among diabetes patients could improve case detection and early treatment, indirectly leading to better thyroid-specific treatment outcomes and prevention of DM complications. [ABSTRACT FROM AUTHOR]

• The combined effects of multiple air pollutants may differ from those of single air pollutants. • The combined exposure to air pollutants was positively associated with the incidence of ischemic heart disease. • The association was more pronounced among individuals with diabetes compared to those without. Air pollution and type 2 diabetes (T2D) are both associated with an increased risk of ischemic heart disease (IHD). Little is known about the combined effects of multiple air pollutants on IHD risk, especially among individuals with T2D. We sought to assess the association of combined exposure to multiple air pollutants with incident IHD and examine the modification effect of T2D. This study included 388 780 individuals (20 036 individuals with T2D) free of cardiovascular disease and cancer from the UK Biobank. The combined exposure to multiple air pollutants, including particulate matter (PM) with diameters ≤ 2.5 μm (PM 2.5), PM with diameters between 2.5 and 10 µm (PM coarse), PM with diameters ≤ 10 μm (PM 10), nitrogen dioxide (NO 2), and nitrogen dioxides (NO x), was assessed by creating a weighted air pollution score (APS), with a higher APS representing a higher level of air pollution exposure. Hazard ratios (HR) and 95 % confidence intervals (CI) for incident IHD were assessed by multivariable-adjusted Cox proportional hazard models. During a median of 12.9 years of follow-up, 27 333 incident IHD cases were observed. Compared with the lowest tertile of the APS, the multivariable-adjusted HR (95 % CI) of IHD risk for the highest tertile was 1.13 (1.03–1.23) among individuals with T2D, while the HR was 1.06 (1.03–1.10) among individuals without T2D. Additionally, the associations between APS and IHD incidence showed a linear relationship among individuals with T2D (nonlinearity: P = 0.37), whereas a non-linear relationship was observed among individuals without T2D (nonlinearity: P = 0.02). For the joint analysis, individuals in the highest tertile of APS and with T2D had a 54 % higher risk of IHD compared to individuals in the lowest tertile of APS and without T2D, with a significant additive interaction (P interaction < 0.01). The proportion of relative excess risk was 17 % due to the interaction in categorical analyses. The combined exposure to multiple air pollutants has been associated with an elevated risk of incident IHD, and the association is more pronounced among individuals with T2D. [ABSTRACT FROM AUTHOR]

Background: Type 2 Diabetes mellitus (T2DM) and Tuberculosis (TB) often manifest together leading to complications at various levels. Methods: In this prospective study, we determined the incidence of TB among 1200 patients with type 2 diabetes attending the Capital Hospital of Bhubaneswar. Various socio-demographic factors like age, gender, marital status, literacy status, locality, habits, etc. and clinical profile were assessed. Results: Out of 1200 patients with type 2 diabetes mellitus, only 13 were having active TB disease, the incidence being 1.08%. Further, 12 were having pulmonary TB. More males with advancing age and sedentary life style were having Diabetes. About 23% of patients had familial history, high BMI levels, hypertension, high FBG levels, cholesterol and triglyceride levels. 30% of T2DM patients were having metabolic syndrome. In our study, age, literacy status, occupation, life style, familial history, habits and stress appeared to be significant risk factors among patients with diabetes. The HbA1C levels were higher among 51% of the diabetes patients. It was observed that while 84% of the patients were taking oral hypoglycemic drugs only 8% were taking Insulin injections. These patients were addicted to either smoking, drinking alcohol and/or chewing tobacco / gutka. The HbA1C levels were higher among 69% of the DM-TB patients indicating poorer glycemic control which is a proven risk factor for TBDM co-morbidity. Conclusions: Screening for DM in TB patients could improve case detection of diabetes and early treatment, which in turn will lead to better TB-specific treatment outcomes and prevention of diabetes related complications.

Cardiovascular disease (CVD) is the primary cause of death all over the world, especially due to myocardial ischemia caused by atherosclerosis that blocks cardiac arteries and leads to arrhythmia and other cardiac diseases. Meanwhile, diabetes mellitus (DM) and elevated cholesterol level are the risk factors for cardiovascular (CV) disease. This noncommunicable disease has become a main concern for us as cardiovascular disease develops in a slow manner without any symptoms in the early stage. Early prevention and intervention have a major impact on improving the outcome of cardiovascular health in diabetic patients. Controlling cholesterol level by administering statin has shown some beneficial impacts in reducing the risk of cardiovascular disease in patients with DM. This study used a systematic literature review (SLR) approach to give an overview of the current literature and to analyze the effects of statin therapy on cardiovascular outcomes in patients with DM. The literature search was conducted in PubMed and Google Scholar databases. The total number of articles included in the present review is six, obtained from reputable journals published between 2013 and 2023, and we only focused on reviewing six articles for in-depth analysis. The evidence we collected showed a positive outcome in terms of cardiovascular health in persons with DM after statin therapy. However, there are several risk factors that interfere with the effectiveness of statin in diabetic patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Usman et al.)

This study The study was descriptive (Descriptive Study) for the purpose of self-care of diabetic patients type II in the Tambon Najan health promoting hospital, Na Yia district, Ubon Ratchathani province. The population of 107 was used in this study and analyzed using the calculation of a computer program statistics to determine percentages, median and standard deviation. Results of the study population were diabetics mostly percent female 61.70 average age of 58 years, mainly a marital partner of 79.40 Most graduate elementary level of 93.30 was mainly engaged in agriculture. 87.90 percent, with the median monthly income of 2,000 baht most revenue. Adequate cost of 67.30 time that diabetes, with an average 8.57 years, most have been treated with oral tablets of 80.00 Most blood glucose was in control, not good. 130 mg% 72.00 percent of disease complications, hypertension 24.50 percent majority to gain knowledge about diabetes from a public health official 94.40 percent. The study of knowledge about diabetes found that the most knowledgeable in a moderate percentage 73.80. The answer was most diabetes was a disease that transmits genetic 96.00 percent. The response was minimal diuretics, anticonvulsants, oral contraceptives were the cause of diabetes 30.80 percent of the overall awareness about diabetes. At a high level (Mean = 2.90, SD = 0.19), most have recognized the benefits of treatment and prevention of diabetes. At a high level (Mean = 2.95, SD = 0.12), the practice of self-care found that, overall, was moderate (Mean = 2.31, SD = 0.33), mainly to take care of the body was moderate (Mean = 2.25, SD = 0.32), taking care to prevent complications. At a high level (Mean = 2.37, SD = 0.32), the treatment was moderate (Mean = 2.21, SD = 0.30) for the care of mental, emotional, social diabetic patients at a high (Mean = 2.39, SD =. 0.40). Therefore, it is correct knowledge about the causes of diabetes issues concerning knowledge of birth control pills, diuretics, anticonvulsants harms of smoking. The body care diabetes treatment to the patient population studied and to practice in self-care appropriately in the future. [ABSTRACT FROM AUTHOR]

The study assessed: (1) the prevalence of exclusive use of complementary and alternative medicine (CAM), exclusive use of modern medicine and combined use; (2) the factors associated with exclusive CAM use; and (3) the expenditure for CAM use among type-2 diabetes patients in rural Kerala. We surveyed 400 diabetes patients selected by multi-stage cluster sampling. Exclusive CAM use was reported by 9%, exclusive modern medicine by 61% and combined use by 30%. Patients without any co-morbidity were four times, those having regular income were three times and those who reported regular exercise were three times more likely to use exclusive CAM compared with their counterparts. Expense for medicines was not significantly different for CAM compared with modern medicine both in government and private sector. Patients with any co-morbidity were less likely to use CAM indicating that CAM use was limited to milder cases of diabetes. [ABSTRACT FROM AUTHOR]

Objective: Depression in diabetes patients is caused by their own disease or the surrounding social environment. How to cope with changes in mentality and adjust psychological stress responses, especially under China's dynamic zero COVID-19 policy, is worth further discussion. The researchers constructed a moderated mediation model to test the effect of psychological resilience during dynamic zero COVID-19 on depression in diabetes patients and the mediating role of stigma and the moderating effect of medication burden., Method: From June to September, 2022, data were collected in Jinghu District, Wuhu City, Anhui Province, by multi-stage stratified sampling. Firstly, we selected a tertiary hospital randomly in Jinghu District. Secondly, departments are randomly chosen from the hospital. Finally, we set up survey points in each department and randomly select diabetes patients. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma, medication burden was measured by the Diabetes Treatment Burden Scale (DTBQ), and depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). We used SPSS (version 23.0) and PROCESS (version 4.1) for data analysis., Results: (1) Psychological resilience was negatively correlated with stigma, medication burden, and depression. Stigma was positively associated with medication burden and depression. Medication burden and depression are positively correlated, (2) The mediation analysis showed that psychological resilience had a direct predictive effect on depression, and stigma partially mediated the relationship, and (3) Medication burden moderates the direct pathway by which psychological resilience predicts depression; Medication burden moderates the first half of "psychological resilience → stigma → depression.", Conclusion: Under the mediating effect of stigma, psychological resilience can improve depression. Medication burden has a moderating effect on the relationship between psychological resilience and depression, and it also has a moderating effect on the relationship between psychological resilience and stigma. These results facilitate the understanding of the relationship mechanisms between psychological resilience and depression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mei, Yang, Gui, Li, Zhang, Wang, Chen, Chen, Liu and Zhang.)

Aims: The study aimed to assess diabetes health literacy, adherence to diabetes medication, and its associated factors in Kerala, India, the most advanced Indian state in epidemiological transition with the highest literacy level in India., Materials and Methods: We conducted a community-based cross-sectional study among 280 diabetes patients (mean age 62 years, male 42%) selected by multistage cluster sampling. Information on sociodemographic variables was collected using a pretested structured interview schedule. Diabetes health literacy was assessed using the revised Michigan Diabetes Knowledge test. Adherence to diabetes medication was assessed using the Hill-Bone subscale. Binary logistic regression analysis was done to find out the factors associated with diabetes health literacy and medication adherence., Results: Good diabetes health literacy was reported by 35.7% [95% confidence interval (CI): 30.1-41.6] of the patients. Perfect adherence to diabetes medication was reported by 33.2% of patients (CI: 27.7-39.1). Patients who reported regular newspaper reading [adjusted odds ratio (AOR) 3.16; CI: 1.57-6.30], using the internet (AOR 2.23; CI: 1.11-4.50) and insulin use (AOR 2.60; CI: 1.35-5.00) were more likely to report good diabetes health literacy compared to their counterparts. Patients who reported reading health magazines (AOR 2.75; CI: 1.01-7.60) were more likely to report perfect medication adherence compared to those who did not., Conclusion: Why diabetes health literacy and medication adherence were low among diabetes patients in the most literate state needs further investigation. Interventions to enhance diabetes health literacy and medication adherence may be undertaken among diabetes patients encouraging them to read newspapers and health magazines regularly and use the internet., Competing Interests: Conflict of interest: None