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)