Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years’ summary and future direction

BMC Research Notes, Dec 2017

Objective The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings were reviewed. The objective is to summarize research outcomes and itemize limitations as they constitute basis of future directions. Results Affordability and availability are major confounding behavioural change wheel factors in the rural community. 4.9% prevalence of prediabetes, which may be lower or non-significantly different in urban areas. Hyperglycaemia co-morbidity with dyslipidaemia (5.0%), obesity (3.1%) and hypertension (1.8%) were observed. Limitation of the study includes participants being mostly over 60 years old, which has created impetus for the Global Alliance on Chronic Diseases agenda on vulnerability of older adults to diabetes being a new direction of the collaboration. Other directions in Australia and Nepal focus on patients with chronic kidney disease with or without cardiovascular complications. This report highlights the need to translational research.

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Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years’ summary and future direction

Nwose et al. BMC Res Notes Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years' summary and future direction E. U. Nwose 0 1 2 R. S. Richards 0 P. T. Bwititi 7 E. O. Igumbor 2 E. J. Oshionwu 1 6 K. Okolie 1 I. C. Onyia 1 5 A. Pokhrel 4 P. Gyawali 9 J. N. Okuzor 1 8 V. M. Oguoma 3 F. W. Gardiner 0 10 L. Wang 7 0 School of Community Health, Faculty of Sciences, Charles Sturt University , Orange Campus, Leeds Parade, Orange, NSW , Australia 1 Global Medical Research & Development Organization, Catholic Hospital Abbi , Albury, NSW , Australia 2 Public & Community Health Department, Novena University , Ogume, Kwale , Nigeria 3 School of Psychological & Clinical Sciences, Charles Darwin University , Wagga Wagga, NSW , Australia 4 Nepal Medical College & Teaching Hospital , Kathmandu , Nepal 5 Onyx Hospital & Maternity , Lagos , Nigeria 6 California Department of State Hospital , Stockton, CA 95215 , USA 7 School of Biomedical Sciences, Faculty of Sciences, Charles Sturt University , Wagga Wagga, NSW , Australia 8 Laboratory Department, Texas Health Resources (HMH-HEB) , Bethesda, TX 76022 , USA 9 University of Montreal , Montreal , Canada 10 Calvary Public Hospital , Bruce, ACT , Australia Objective: The prediabetes and cardiovascular complications studies proposes to develop a screening protocol for diabetes cardiovascular risk, and strategies for holistic management amongst others. Over 500 participants were recruited in the first 2 years of rural community research screening. Specific for this report, various published findings were reviewed. The objective is to summarize research outcomes and itemize limitations as they constitute basis of future directions. Results: Affordability and availability are major confounding behavioural change wheel factors in the rural community. 4.9% prevalence of prediabetes, which may be lower or non-significantly different in urban areas. Hyperglycaemia co-morbidity with dyslipidaemia (5.0%), obesity (3.1%) and hypertension (1.8%) were observed. Limitation of the study includes participants being mostly over 60 years old, which has created impetus for the Global Alliance on Chronic Diseases agenda on vulnerability of older adults to diabetes being a new direction of the collaboration. Other directions in Australia and Nepal focus on patients with chronic kidney disease with or without cardiovascular complications. This report highlights the need to translational research. Cardiovascular complications; Diabetes mellitus; Early identification and intervention; Holistic healthcare management; Low-mid income countries; Prediabetes; Public health Introduction The original research proposal Cardiovascular risk assessment in prediabetes and undiagnosed diabetes mellitus study has been identified as necessary, especially for low-mid income communities [ 1 ]. To substantiate the discussion of prediabetes and cardiovascular disease (CVD), a systematic review had been performed that provided insight, for instance, the need to study rural communities where lifestyles are different from the urban areas [ 2 ]. Suffice to say that some of the burdens or deaths associated with CVD are preventable since they are due to avoidable risk factors such as unhealthy diet, physical inactivity and smoking [ 3 ]. In particular, the global burdens of CVDs is rife (Fig.  1) [ 4–6 ]. As published [ 1 ], the aims of the ‘prediabetes and cardiovascular complications studies (PACCS) collaboration initiative are: 1. Diagnosis, management and monitoring of diabetes mellitus (DM) pathogenesis by laboratory methods. 2. Early and holistic intervention in DM pathogenesis in the perspective of health education as well as lifestyle changes. 3. Support system for allied healthcare professionals’ integration in the prediabetes care team. The proposed research design The study is designed to be in three phases. The first phase is to identify prediabetes and undiagnosed diabetes through population screening exercise. The second and third phases will be longitudinal studies involving participants identified in the first phase as having prediabetes without dyslipidaemia, or clinically established cardiovascular disease. The second phase shall focus on preventive management including evaluation of the use of exercise, and nutrition. The third phase will include probing the development of diabetes and CVD with a view to develop a model chart for the assessment of CVD risk in prediabetes [ 1 ]. In terms of significance of the research agenda, suffice to highlight with the quote that “Diabetes is a main ticking time bomb out there in low- and middle-income countries … that don’t have the health-care infrastructure … need to start to tackle these problems now” [ 7 ]. That is, given the lack of data on the burden of disease, especially among the unsearched rural communities of low-mid income countries (LMIC) means lack of evidence for policy makers to make the h (...truncated)


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E. U. Nwose, R. S. Richards, P. T. Bwititi, E. O. Igumbor, E. J. Oshionwu, K. Okolie, I. C. Onyia, A. Pokhrel, P. Gyawali, J. N. Okuzor, V. M. Oguoma, F. W. Gardiner, L. Wang. Prediabetes and cardiovascular complications study (PACCS): international collaboration 4 years’ summary and future direction, BMC Research Notes, 2017, pp. 730, Volume 10, Issue 1, DOI: 10.1186/s13104-017-3017-7