2. tipa cukura diabēta riska faktoru salīdzinājums zināmiem diabēta pacientiem Šrilankā un Latvijā

Abstract

Background. Type 2 Diabetes mellitus (T2DM) is a chronic progressive disease which could lead to debilitating complications if not managed well. Therefore long term use of anti diabetic medication is essential; this could eventually lead to increased health burden. In this industrialized era T2DM prevalence had raised rapidly and additionally the onset of disease has become at an early age. Latvia and Sri Lanka are developing countries which are greatly affected by T2DM but unfortunately have limited financial aid towards the health sector. Therefore it is important to find a method that is both, optimizing patient health and is cost effective. Therefore in such circumstance identifying the risk groups in each demographic area and focusing on them would be the best option regarding the treatment plan. Aims. Main objective was to determine the prevalence of risk factors of T2DM among known diabetics in Sri Lanka and Latvia and to compare between the 2 different ethnic groups. Furthermore the research is focused to assess difference in the age of onset of T2DM between parent and offspring. Thereby elaborate on recommendations when considering treatment and prevention of T2DM in each country. Materials and methods. 430 T2DM patients, 224 from Sri Lanka (SL) and 206 from Latvia (LV) took part in face to face interviews which were conducted using a structured questionnaire followed by the measurement of waist and hip circumference. Results. Significant association with a dominance in Sri Lanka was found in maternal family history: SL vs. LV (37% vs.18 %, p<0.0001), paternal family history: SL vs. LV (20% vs. 9 %, p=0.0001) and other family history: SL vs. LV (40% vs.10%, p<0.0001). The factors that were predominant in Latvia were obesity, which was measured by BMI: LV vs. SL (33.6±6.5 vs. 24.2±3.6, p<0.0001) or Waist to hip ratio: LV vs. SL (0.96±0.09 vs.0.92 ±0.07, p<0.0001) and associated diseases, patients with hypertension and dyslipidemia: LV vs. SL (58% vs. 30 %, p<0.0001). There was a significant difference among the alcohol consumption and smoking between the 2 countries, for example, those who didn’t take alcohol in LV vs. SL (59% vs. 73%, p=0.001), smoking in LV vs. SL (31% VS. 21%, p=0.02). There was a significant difference regarding treatment with oral antidiabetic drugs: SL vs. LV (81 % vs.29 %, p<0.0001), whereas insulin: SL vs. LV (7% vs. 38 %, p<0.0001). If positive maternal family history, the age of onset of type 2 diabetes in offspring was earlier than in mother 44.6 ±11.4 vs. 55.2±10.5, p<0.0001 in SL and the similar finding in LV: 51.6±8.4 vs. 58.2±15.3, p=0.003. In Sri Lanka age of onset of father (57.49±11.88) and the age of onset of child (42.33 ±10.61) showed significance p<0.0001 and Latvia age of onset of father (56.22±10.52) and age of onset of child (47.67±8.77) p=0.01.Overall maternal transmission vs. paternal transmission SL (36.6% vs. 25.1 %) p=0.0001, LV (18.4% vs. 9.6%) p=0.04 which was nearly significant. Conclusions- There is significant demographical differences in the distribution of risk factors of T2DM.Generally Sri Lanka seem to be affected at an earlier age when compared to Latvia. Familial clustering is predominant with a prominent maternal influence in transmission to the offspring. In Latvia obesity seem to be the predominant risk factor among T2DM. To prevent the burden of diabetes and control diabetes-related complications and to improve the quality of life for persons with T2DM, we should educate the general public about life style modification programs, but most importantly screening should be focused on those with a family history in Sri Lanka and those with a BMI >30kgm² in Latvia so that we could get the maximum patient benefit from the limited financial resources in preventing the progression of this disease and its complications.

Celonis. 2. tipa cukura diabets (T2DM) ir hroniska, progresejoša slimiba, kas atbilstoši nearsteta var novest pie novajinošam komplikacijam. Tadel ilglaiciga antidiabetisko medikamentu lietošana ir arkartigi svariga; tas galu gala var novest pie palielinata sloga uz veselibu. Musdienu industrializetaja laikmeta T2DM izplatiba strauji pieaugusi, bez tam slimibas sakums tiek noverots agra vecuma. Latvija un Šrilanka ir attistibas valstis, ko specigi ietekmejis T2DM, tacu diemžel šis valstis spej pieškirt visai ierobežotu finanšu palidzibu veselibas aizsardzibas sektoram. Tadel ir svarigi atrast metodi, kas palidzetu gan optimizet pacientu veselibas stavokli, gan ari butu rentabla. Šados apstaklos riska grupu identificešana katra demografiskaja apgabala un koncentrešanas uz tam butu labakais veids ka izstradat arstešanas planu. Merki. Galvenais merkis ir noteikt T2DM riska faktoru izplatibu starp zinamajiem diabetikiem Šrilanka un Latvija un izdarit salidzinajumu starp 2 atškirigam etniskam grupam. Turklat petijuma merkis ir novertet atškiribu vecuma, kad sakas T2DM, starp vecaku un vina atvasi. Tas dos iespeju izstradat ieteikumus, aplukojot T2DM arstešanas un noveršanas iespejas katra no valstim. Materiali un metodes. 430 T2DM pacienti, 224 no Šrilankas (SL) un 206 no Latvijas (LV) nema dalibu personiskas intervijas, kas tika organizetas, izmantojot strukturizetu anketu, pec tam, kad tika izmeriti vidukla un gurnu apkartmeri. Rezultati. Butiska saikne parsvaram Šrilanka tika rasta mates gimenes vesture: SL pret LV (37 % pret 18 %, p < 0,0001), teva gimenes vesture: SL pret LV (20 % pret 9 %, p = 0,0001) un cita gimenes vesture: SL pret LV (40 % pret 10 %, p < 0,0001). Latvija dominejošie faktori bija tuklums, ko merija BMI: LV pret SL (33,6 ± 6,5 pret 24,2 ± 3,6, p < 0,0001) vai vidukla pret gurniem proporcija: LV pret SL (0,96 ± 0,09 pret 0,92 ± 0,07, p < 0,0001) un ar to saistitas saslimšanas, pacienti ar hipertoniju un dislipidemiju: LV pret SL (58 % pret 30 %, p < 0,0001). Tapat starp šim 2 valstim tika noverota butiska atškiriba alkohola paterina un smekešana, piemeram, tie, kas nelietoja alkoholu LV pret SL (59 % pret 73 %, p = 0,001), smekeja LV pret SL (31 % pret 21 %, p = 0,02). Pastav butiska atškiriba attieciba uz arstešanu ar oralam antidiabetiskam zalem: SL pret LV (81 % pret 29 %, p < 0,0001), kamer insulins: SL pret LV (7 % pret 38 %, p < 0,0001). Ja ir pozitiva mates gimenes vesture, 2. tipa diabeta sakuma vecums atvasei ir agraks neka matei 44,6 ± 11,4 pret 55,2 ± 10,5, p < 0,0001 SL un lidzigi LV: 51,6 ± 8,4 pret 58,2 ± 15,3, p = 0,003. Šrilanka teva saslimšanas vecuma (57,49 ± 11,88) un berna saslimšanas sakuma vecuma (42,33 ± 10,61) noverota nozime p < 0,0001, un Latvija teva saslimšanas sakuma vecums (56,22 ± 10,52) un berna saslimšanas sakuma vecums (47,67 ± 8,77) p = 0,01. Vispareja mates slimibas parnešana pret teva slimibas parnešanu SL (36,6 % pret 25,1 %) p = 0,0001, LV (18,4 % pret 9,6 %) p = 0,04, kas ir ieverojami. Secinajumi. T2DM riska faktoru izplatiba ir noverojamas butiskas demografiskas atškiribas. Visa visuma Šrilanka cilveki saslimst agraka vecuma salidzinajuma ar Latviju. Gimenes pulcešanas ir dominejoša ar ieverojamu mates ietekmi slimibas parnešana atvasei. Latvija tuklums, škiet, ir butiskakais faktors T2DM saslimšana. Lai noverstu diabeta slogu un kontroletu ar diabetu saistitas komplikacijas, ka ari lai uzlabotu dzives kvalitati cilvekiem, kas sirgst ar T2DM, mums nepieciešams izglitot plašas laužu masas par dzivesveida mainas programmam, tacu vissvarigak ir nodrošinat, lai skriningošana koncentretos uz personam ar gimenes vesturi Šrilanka un personam ar BMI > 30 kgm² Latvija ta, lai mes varetu sniegt maksimalu labumu pacientam ar ierobežotiem finanšu resursiem, noveršot šis slimibas progresešanu un komplikacijas