Background Health-related quality of life (HRQoL) is an important indicator for designing care and treatment services for patients with diabetes. This is especially true given its rapid increase among the elderly population in Vietnam. HRQoL data in elderly diabetic Vietnamese are currently limited. This study aimed to 1) measure the HRQoL of elderly patients with type 2 diabetes (T2DM) in Vietnam and 2) identify related factors and their relationship with HRQoL. Patients and methods A cross-sectional study was conducted. We recruited 171 patients aged ≥60 years with T2DM at the Outpatient Department, National Geriatric Hospital from June to November 2015. Patients were asked to evaluate their health status using the EuroQol Five Dimensions Three Levels (EQ-5D-3L) and the Visual Analog Scale (VAS). Sociodemographic, diabetic treatment, and management characteristics were collected. Multivariate Tobit regression was used to determine which factors were associated with HRQoL, and the strength of this relationship. Results Patients reported some problems in all areas of the EQ-5D: pain/discomfort (50.9%), mobility (33.3%), anxiety/depression (24.0%), usual activities (21.1%), and self-care (10.5%). The mean EQ-5D index score was 0.80 (SD=0.20), and the mean EQ-VAS was 57.5 (SD=14.4). Patients who were male, lived in an urban area, could afford treatment, were taking fewer medications, and monitored blood pressure often (1-4 times a week) had a higher EQ-5D index when compared to other groups. Meanwhile, a longer duration of diabetes and older age were negatively associated with the EQ-5D index. Patients with any comorbidity had lower VAS scores than their counterparts. Conclusion The presence of diabetes and comorbidity were responsible for a significant decrease in HRQoL. Screening and identifying health problems, providing prompt treatment, and facilitating self-management among patients have the potential to increase diabetic patients' HRQoL.

/pdf/health-related-quality-of-life-in-elderly-diabetic-3hm2xt73s0.pdf

Health-related quality of life in elderly diabetic outpatients in Vietnam.

Objective: This study was designed to test the diagnostic value of visibility graph features derived from the heart rate time series to predict late onset sepsis (LOS) in preterm infants using machine learning. Methods: The heart rate variability (HRV) data was acquired from 49 premature newborns hospitalized in neonatal intensive care units (NICU). The LOS group consisted of patients who received more than five days of antibiotics, at least 72 hours after birth. The control group consisted of infants who did not receive antibiotics. HRV features in the days prior to the start of antibiotics (LOS group) or in a randomly selected period (control group) were compared against a baseline value calculated during a calibration period. After automatic feature selection, four machine learning algorithms were trained. All the tests were done using two variants of the feature set: one only included traditional HRV features, and the other additionally included visibility graph features. Performance was studied using area under the receiver operating characteristics curve (AUROC). Results: The best performance for detecting LOS was obtained with logistic regression, using the feature set including visibility graph features, with AUROC of 87.7% during the six hours preceding the start of antibiotics, and with predictive potential (AUROC above 70%) as early as 42 h before start of antibiotics. Conclusion: These results demonstrate the usefulness of introducing visibility graph indexes in HRV analysis for sepsis prediction in newborns. Significance: The method proposed the possibility of non-invasive, real-time monitoring of risk of LOS in a NICU setting.

https://hal.archives-ouvertes.fr/hal-03225182/document

Early Detection of Late Onset Sepsis in Premature Infants Using Visibility Graph Analysis of Heart Rate Variability

Famine exposure in early life was associated with type 2 diabetes, non-alcoholic fatty liver disease and metabolic syndrome, etc. But evidence in early famine exposure and insulin resistance and beta cell dysfunction were limited. We aimed to investigate whether the association existed between famine exposure in early life and beta cell dysfunction and insulin resistance in adulthood. In all, 7912 non-diabetic participants were included in this study, based on SPECT-China study. Participants with fetal or childhood famine exposure (birth year 1949–1962) were exposure group. Insulin resistance was estimated by the homeostasis model assessment index of insulin resistance (HOMA-IR). Beta cell function, represented by insulin secretion, was estimated by the disposition index. The associations of famine exposure with HOMA-IR and disposition index were assessed via linear regression. In men, we did not observe a significant association between early life famine exposure and ln(HOMA-IR) in all three models (P > 0.05 for all). However, in women, early life famine exposure were found to have significant association with ln(HOMA-IR) after adjustments for urbanization, severity of famine exposure, current smoker, waist circumference, hypertension, and dyslipidemia (unstandardized coefficients 0.055, 95% confidence interval 0.021, 0.088, P = 0.001). Early life famine exposure was observed to be negatively associated with ln(disposition index) after adjustments for the above potential confounders, both in men (model 3: unstandardized coefficients −0.042, 95% confidence interval −0.072,−0.012, P = 0.006) and women (model 3: unstandardized coefficients −0.033, 95% confidence interval −0.058,−0.009, P = 0.008). In conclusion, exposure to famine in fetal- and childhood- life period is associated with beta cell dysfunction in males and females without diabetes, but early life famine exposure was only associated with insulin resistance in non-diabetic females. These results indicate that malnutrition in early life period may offer a modifiable factor for type 2 diabetes development.

Association between famine exposure in early life with insulin resistance and beta cell dysfunction in adulthood.

Health related quality of life (HRQoL) is a subjective appreciation of how personal characteristics and health influence well-being. This cross-sectional analysis aimed to quantitatively measure the influence of dietary, lifestyle, and demographic factors on HRQoL. A sub-sample of the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort, was analyzed (n = 15,674). Through self-administered questionnaires the relationship between HRQoL and dietary patterns (Mediterranean-diet (MedDiet) and provegetarian food pattern (FP) assessment), lifestyles (sleeping hours, physical activity) and demographic characteristics were measured. Multivariate linear regression and flexible regression models were used to estimate the pondered effect of personal factors on Short Form-36 (SF-36) scores. Coefficients for MedDiet and provegetarian scores (β-coefficient for global SF-36 score: 0.32 (0.22, 0.42); 0.09 (0.06, 0.12) respectively for every unit increase), physical activity (β: 0.03 (0.02, 0.03) for every metabolic equivalent of task indexes (MET)-h/week) had a positive association to HRQoL. The female sex (β: -3.28 (-3.68, -2.89)), and pre-existing diseases (diabetes, β: -2.27 (-3.48, -1.06), hypertension β: -1.79 (-2.36, -1.22), hypercholesterolemia β: -1.04 (-1.48, -0.59)) account for lower SF-36 scores. Adherence to MedDiet or provegetarian FP, physical activity and sleep are associated with higher HRQoL, whereas the female sex, "other" (versus married status) and the presence of chronic diseases were associated with lower SF-36 scores in this sample.

https://www.mdpi.com/1660-4601/17/11/3897/pdf

Nutritional Determinants of Quality of Life in a Mediterranean Cohort: The SUN Study.

Multimorbidity is prevalent for people with myocardial infarction (MI), yet previous studies investigated single-health conditions in isolation. We identified patterns of multimorbidity in MI survivors and their associations with changes in HRQoL. In this national longitudinal cohort study, we analysed data from 9566 admissions with MI from 77 National Health Service hospitals in England between 2011 and 2015. HRQoL was measured using EuroQol 5 dimension (EQ5D) instrument and visual analogue scale (EQVAS) at hospitalisation, 6, and 12 months following MI. Latent class analysis (LCA) of pre-existing long-term health conditions at baseline was used to identify clusters of multimorbidity and associations with changes in HRQoL quantified using mixed effects regression analysis. Of 9566 admissions with MI (mean age of 64.1 years [SD 11.9], 7154 [75%] men), over half (5119 [53.5%] had multimorbidities. LCA identified 3 multimorbidity clusters which were severe multimorbidity (591; 6.5%) with low HRQoL at baseline (EQVAS 59.39 and EQ5D 0.62) which did not improve significantly at 6 months (EQVAS 59.92, EQ5D 0.60); moderate multimorbidity (4301; 47.6%) with medium HRQoL at baseline (EQVAS 63.08, EQ5D 0.71) and who improved at 6 months (EQVAS 71.38, EQ5D 0.76); and mild multimorbidity (4147, 45.9%) at baseline (EQVAS 64.57, EQ5D 0.75) and improved at 6 months (EQVAS 76.39, EQ5D 0.82). Patients in the severe and moderate groups were more likely to be older, women, and presented with NSTEMI. Compared with the mild group, increased multimorbidity was associated with lower EQ-VAS scores (adjusted coefficient: −5.12 [95% CI −7.04 to −3.19] and −0.98 [−1.93 to −0.04] for severe and moderate multimorbidity, respectively. The severe class was more likely than the mild class to report problems in mobility, OR 9.62 (95% confidence interval: 6.44 to 14.36), self-care 7.87 (4.78 to 12.97), activities 2.41 (1.79 to 3.26), pain 2.04 (1.50 to 2.77), and anxiety/depression 1.97 (1.42 to 2.74). Among MI survivors, multimorbidity clustered into three distinct patterns and was inversely associated with HRQoL. The identified multimorbidity patterns and HRQoL domains that are mostly affected may help to identify patients at risk of poor HRQoL for which clinical interventions could be beneficial to improve the HRQoL of MI survivors. ClinicalTrials.gov NCT01808027
 and NCT01819103

/pdf/association-of-multimorbidity-and-changes-in-health-related-1k2g6psoh4.pdf

Association of multimorbidity and changes in health-related quality of life following myocardial infarction: a UK multicentre longitudinal patient-reported outcomes study.

Used the EuroQoL-5 dimension (EQ-5D) to evaluate the health status of 5310 residents who live in East China, and compared the health-related quality of life (HRQoL) with 311 patients with type 2 diabetes as well as to explore the main influence factors to HRQoL in East China. The cohort includes 5310 participants aged 18-89 years old lived in East China. EuroQoL-5 dimension (EQ-5D) scale was used for the assessment of health-related quality of life. The mean age of the cohort was 52.2 ± 13.4 years of which 43.7% were male. A moderate level of health-related quality of life was measured of that EQ-5D index and EQ-VAS scores were 0.939 ± 0.111 and 80.06 ± 11.58, respectively. There was a significant difference between diabetes patients and non-diabetes (p = 0.029, p < 0.001, respectively). The age had an inverse correlation with the EQ-5D scores both in general population and diabetes patients. The EQ-5D Vas was weakly adversely associated with the FPG, HbA1c and HOMA-IR. The overall health-related quality of life of population in East-China was moderate. Diabetes patients had lower score of health-related quality. The healthy-related quality was associated with the age, gender, economic development of region, level of education and marital status.

/pdf/health-related-quality-of-life-in-type-2-diabetes-patients-a-2qelbfkpea.pdf

Health-related quality of life in type-2 diabetes patients: a cross-sectional study in East China.

Wearable inertial sensors have demonstrated their potential to screen for various neuropathies and neurological disorders. Most such research has been based on classification algorithms that differentiate the control group from the pathological group, using biomarkers extracted from wearable data as predictors. However, such methods often lack quantitative evaluation of how much information provided by the wearable biomarkers contributes to the overall prediction. Despite promising results from internal cross validation, their utility in clinical practice remains unclear. In this paper, we highlight in a case study - early screening for diabetic peripheral neuropathy (DPN) - evaluation methods for quantifying the contribution of wearable inertial sensors. Using a quick-to-deploy wearable sensor system, we collected 106 in-hospital diabetic patients' gait data and developed logistic regression models to predict the risk of a diabetic patient having DPN. Adopting various metrics, we evaluated the discriminative information added by gait biomarkers and how much it improved screening. The results show that the proposed wearable system added useful information significantly $(\mathbf{p} to the existing clinical standards, and boosted the C-index significantly $(\mathbf{p from 0.75 to 0.84, surpassing the current survey-based screening methods used in clinics.

/pdf/discriminative-information-added-by-wearable-sensors-for-2byyqk1ldk.pdf

Discriminative Information Added by Wearable Sensors for Early Screening - a Case Study on Diabetic Peripheral Neuropathy

cope
People suffering from famine in early life and overnutrition in adulthood may have an increased risk for liver steatosis. We aimed to investigate the effects and mechanisms of early nutrition restriction and overnutrition on de novo lipogenesis in the liver.

Methods and results
Three-week-old male rats were food restricted for 4 weeks and refed a high-fat or normal-fat diet individually in metabolic cages for 9 weeks. Weight-matched groups were also set up. Fatty acid synthetase expression was measured to estimate de novo lipogenesis in the liver. Parameters of glucose and lipid metabolism were measured with isotope assays. All four groups had comparable body weights. However, the famine-high fat diet group had the highest degree of liver steatosis, the greatest body fat ratio, and insulin resistance. Lipid accumulation, fatty acid synthetase expression and gluconeogenesis in the liver were significantly higher in the famine and high-fat diet groups (P <0.05). Moreover, these groups also had markedly lower muscle glucose uptake.

Conclusion
Under famine and high-fat refeeding stress, rats were extremely susceptible to developing hepatic steatosis. This is presumably a consequence of upregulation of de novo lipogenesis and enhanced glucose flux from muscle to de novo lipogenesis in the liver.

This article is protected by copyright. All rights reserved

Exacerbation of liver steatosis following exposure to famine and overnutrition.

Objective Vitamin D is a multifunctional vitamin for our body. Type 2 diabetes mellitus (T2DM) is a common metabolic disease. Whether T2DM affects the serum 25(OH)D level has not been reported. The objective of this study was to reveal the extent to which vitamin D is present in the population in East China and to explore the relationship between serum 25(OH)D and T2DM. Methods The cohort was selected based on a large investigation named Survey on Prevalence in East China including 12,702 participants aged 21-92 years old. All the participants completed the questionnaire and went through a physical examination. Fasting blood samples were collected to test serum 25(OH)D and other metabolism-related indicators. AVONA was used to test the significance of differences among groups. Multinomial logistic regression was used to assess the association of T2DM with serum 25(OH)D level. Results The overall percentage of vitamin D deficiency was 80.55% (male 74.1%, female 85.0%). Men with lower serum 25(OH)D level had high value in homeostasis model assessment of insulin resistance and HbA1c. The serum 25(OH)D level of those who were diagnosed with T2DM was higher than that in non-diabetics. The serum 25(OH)D level of pre-diabetes was the highest. T2DM patients trended to have higher serum 25(OH)D levels. Conclusion Vitamin D deficiency is common among the people in East-China. T2DM patients had higher levels of serum 25(OH)D. The relationship between vitamin D and T2DM is intriguing. It seemed that vitamin D was either irrelevant directly to T2DM or resisted in T2DM patients.

The Relationship between Vitamin D and Type 2 Diabetes Is Intriguing: Glimpses from the Spect-China Study

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Papers

Health-related quality of life in type-2 diabetes patients: a cross-sectional study in East China.

Discriminative Information Added by Wearable Sensors for Early Screening - a Case Study on Diabetic Peripheral Neuropathy

Exacerbation of liver steatosis following exposure to famine and overnutrition.

The Relationship between Vitamin D and Type 2 Diabetes Is Intriguing: Glimpses from the Spect-China Study