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      Diagnosed diabetes and optimal disease control of prisoners in Catalonia Translated title: Diabetes diagnosticada y control óptimo de la enfermedad en presos de Cataluña

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          ABSTRACT

          Objectives

          To determine the prevalence of diagnosed diabetes (DD) and its control amongst prisoners in Catalonia.

          Materials and methods

          Transversal study carried out in four Catalan prisons between April and May 2016. The prevalence of DD in inmates was calculated by intentional sampling and collecting the following variables about: a) type of diabetes, value of glycosylated hemoglobin (HbA1c) and treatment; b) comorbidities; c) epidemiological and prison variables; knowledge of hyperglycaemia/hypoglycaemia, and e) participation in educational activities. Optimal control was considered to exist if Hb1A<7.5% and high risk if Hb1Ac >9%. Test x 2 was used in order to study the association among qualitative variables. Multivariate analysis was carried out using logistic regression to determine variables associated with disease control.

          Results

          The study group considered 4,307 male patients, 50.2 years of average age. Ninety-three cases of DD were detected (prevalence 2.16%). 22.6% were treated with insulin, 51.6% with oral antidiabetics (OAD) and 25.8% with both. Type 1 users were younger, thinner, diagnosed at a younger age, heavy drug users and acknowledged to know how to act in the event of hyperglycaemia/hypoglycaemia. Optimal control was more common in type 2 diabetics, but multivariate analysis only associated it with OAD treatment.

          Discussion

          The prevalence observed in DD is much lower than that of the population outside prison and may be underestimated. Optimal control is low, and risk is very high, the results may be biased by the type of population, frequently drug-dependent and with few healthy habits. It is recommended to implement diabetes programmes or improve existing ones in order to increase the diagnosis and management of the disease.

          RESUMEN

          Objetivos

          Determinar la prevalencia de diabetes diagnosticada (DD) y su control en presos de Cataluña.

          Material y métodos

          Estudio transversal realizado en cuatro prisiones catalanas de hombres, entre abril y mayo de 2016. Se calculo la prevalencia de DD mediante un muestreo intencional, recogiéndose: a) datos de diabetes: tipo, valor de hemoglobina glucosilada (HbA1c) y tratamiento; b) comorbilidades; c) variables epidemiológicas y penitenciarias; d) conocimiento sobre hiperglucemia/hipoglucemia; y e) participación en actividades educativas. Se considero un control optimo si la HbA1c era menor del 7,5%; y de alto riesgo si la HbA1c era mayor del 9%. Para estudiar la asociación entre variables cualitativas, se utilice la prueba de chi cuadrado o χ2. Para determinar las variables asociadas al control optimo, se realizo un análisis multivariante mediante una regresión logística.

          Resultados

          Se estudiaron 4.307 pacientes, con una edad media de 50,2 anos. Se detectaron 93 DD (2,16%), 23,7% diabetes tipo 1 (DT1) y 76,3% tipo 2 (DT2). El 22,6% mantenía tratamiento con insulina, el 51,6% con antidiabéticos orales (ADO) y el 25,8% con ambos. Los pacientes con DT1 eran mas jóvenes, delgados, diagnosticados mas jóvenes, mas consumidores de drogas y decían saber actuar ante hiperglucemias/hipoglucemias. El control optimo era mas frecuente en la DT2, pero solo se asocio al tratamiento con ADO.

          Discusión

          La prevalencia de DD es muy inferior a la extrapenitenciaria y posiblemente esta subestimada. El control optimo es bajo, y el de riesgo, muy alto, probablemente por el tipo de población, frecuentemente drogodependiente y con pocos hábitos saludables. Se recomienda aplicar programas de diabetes o mejorar los actuales con objeto de incrementar el diagnostico y optimizar el control de la enfermedad.

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          Most cited references19

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          Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice.

          Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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            Early onset type 2 diabetes: risk factors, clinical impact and management.

            Early onset type 2 diabetes mellitus (T2DM) is increasingly prevalent with a significant impact on the individual, healthcare service delivery and planning. The individuals are likely to be obese, lead a sedentary lifestyle, have a strong family history of T2DM, be of black and minority ethnic (BME) origin and come from a less affluent socioeconomic group. They have a heightened risk of developing microvascular and macrovascular complications, often at an earlier stage and with greater frequency than seen in type 1 diabetes. As such, early and aggressive risk factor management is warranted. Early onset T2DM is complex and impacts on service delivery with a need for multidisciplinary care of complications and comorbidities', in addition to adequate educational and psychological support. This review on the impact of early onset T2DM provides the latest insights into this emerging epidemic.
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              • Article: not found

              Type 2 diabetes in younger adults: the emerging UK epidemic.

              There is an emerging epidemic of type 2 diabetes (T2DM) in younger adults. They represent an extreme phenotype: likely to be obese, lead a sedentary lifestyle, have a strong family history of T2DM, be of black or minority ethnic origin, and come from less affluent socioeconomic groups. An accurate diagnosis of T2DM in younger adults, while essential to guide management, can be challenging even for the experienced diabetologist. Comorbidities such as hypertension, nephropathy and hyperlipidaemia are prevalent in this group, and, despite the lack of longitudinal data, they represent a very high risk group, with a need for aggressive management. This focused review of the epidemiology, aetiology, clinical outcomes, comorbidities and management of younger adults with T2DM will provide the non-specialist with up-to-date insight into the UK's emerging epidemic.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                Jan-Apr 2020
                20 April 2020
                : 22
                : 1
                : 16-22
                Affiliations
                [1 ] originalEAPP Sant Esteve Sesrovires 2. Barcelona. orgnameEAPP Sant Esteve Sesrovires 2 Barcelona, Spain
                [2 ] originalEAP Just Oliveres. l’Hospitalet de Llobregat. Barcelona. orgnamel’Hospitalet de Llobregat orgdiv1EAP Just Oliveres Barcelona, Spain
                [3 ] originalEAPP La Roca del Vallès 1. Barcelona. orgnameEAPP La Roca del Vallès 1 Barcelona, Spain
                [4 ] originalFacultat de Ciències de la Salut Blanquerna. Universitat Ramon Llull. Barcelona. orgnameUniversitat Ramon Llull orgdiv1Facultat de Ciències de la Salut Blanquerna Barcelona, Spain
                Author notes
                Correspondence: Mónica Pagarolas Soler E-mail: monpagarolas@ 123456hotmail.com
                Article
                10.18176/resp.0003
                7307654
                32406477
                2903da3d-6874-4b06-9ca0-8365d4c42458

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 11 December 2017
                : 13 May 2019
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 35, Pages: 07
                Categories
                Original Articles

                diabetes mellitus,prisons,health education,control,prisiones,educación en salud

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