Determinants of diabetes in Bangladesh using two approaches: an analysis of the Demographic and Health Survey 2011.

This cross-sectional study analysed data from the Bangladesh Demographic and Health Survey 2011 to investigate factors associated with diabetes in Bangladesh. Data were analysed using logistic and log-binomial regressions to estimate odds ratios (ORs) and prevalence ratios (PRs), respectively. Among the 7544 respondents aged ≥35 years, the estimated prevalence of diabetes was 11.0%. In the adjusted analysis, survey participants in the age group 55-64 years (adjusted PR [APR]: 1.8, 95% Confidence Interval (CI): 1.4, 2.2; adjusted OR [AOR]: 1.9, 95% CI: 1.5, 2.5) and those with at least secondary education level (APR: 1.3, 95% CI: 1.0, 1.6; AOR: 1.3, 95% CI: 1.0, 1.7) were more likely to have diabetes than those in the age group 35-44 years and those with no education. Furthermore, respondents living in Khulna (APR: 0.5, 95% CI: 0.4, 0.6; AOR: 0.4, 95% CI: 0.3, 0.6) were less likely to have diabetes than people living in Barisal. While adjusted estimates of PR and OR were similar in terms of significance of association, the magnitude of the point estimate was attenuated in PR compared with the OR. Nevertheless, the measured factors still had a significant association with diabetes in Bangladesh. The results of this study suggest that Bangladeshi adults would benefit from increased education on, and awareness of, the risk factors for diabetes. Focused public health intervention should target these high-risk populations.

Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India.

INTRODUCTION: Although the prevalence of underweight is declining among Indian women, the prevalence of overweight/obesity is increasing. This study examined the prevalence and factors associated with underweight and overweight/obesity among reproductive-aged (i.e., 15-49 years) women in India. METHODS: This cross-sectional study analyzed data from the 2015-16 National Family Health Survey. The Asian and World Health Organization (WHO) recommended cutoffs for body mass index (BMI) were used to categorize body weight. The Asian and WHO BMI cutoffs for combined overweight/obesity were ≥ 23 and ≥ 25 kg/m2, respectively. Both recommendations had the same cutoff for underweight, < 18.5 kg/m2. After prevalence estimation, logistic regression was applied to investigate associated factors. RESULTS: Among 647,168 women, the median age and BMI was 30 years and 21.0 kg/m2, respectively. Based on the Asian cutoffs, the overall prevalence of underweight was 22.9%, overweight was 22.6%, and obesity was 10.7%, compared to 15.5% overweight and 5.1% obesity as per WHO cutoffs. The prevalence and odds of underweight were higher among young, nulliparous, contraceptive non-user, never-married, Hindu, backward castes, less educated, less wealthy, and rural women. According to both cutoffs, women who were older, ever-pregnant, ever-married, Muslims, castes other than backwards, highly educated, wealthy, and living in urban regions had higher prevalence and odds of overweight/obesity. CONCLUSION: The prevalence of both non-normal weight categories (i.e., underweight and overweight/obesity) was high. A large proportion of women are possibly at higher risks of cardiovascular and reproductive adverse events due to these double nutrition burdens. Implementing large-scale interventions based on these results is essential to address these issues.

Understanding the Trauma/Acute Care Surgery Workforce.

As the roles of trauma/acute care surgeons continue to evolve, it is imperative that health-care systems adapt to meet workforce needs. Tailoring retention strategies that elicit workforce satisfaction ensure continued coverage that is mutually beneficial to surgeons and health-care systems. We sought to elicit factors related to career characteristics and expectations of the trauma/acute care surgery (ACS) workforce to assist with such future progress. In this study, 1552 Eastern Association for the Surgery of Trauma members were anonymously surveyed. Data collected included demographics, career expectations, and motivators of trauma/ACS. Four hundred eight (26%) Eastern Association for the Surgery of Trauma members responded. Respondents were 78 per cent male and had a median age of 47.3 years. Forty-six per cent of surgeons reported earning $351K-$475K and 23 per cent >$475K. At this point in their career, 49 per cent of surgeons felt quality of life was "most important", followed by 31 per cent career ambitions and 13 per cent salary. Prominent career satisfiers were patient care and teaching. Greatest detractors were burnout, bureaucracy, and work environment. Eighty per cent would change jobs in the final 10 years of practice, 31 per cent because of family/retirement, 29 per cent because of professional growth, 24 per cent because of workload, and 7 per cent because of salary. This study could be used to help develop trauma/ACS workforce strategies. This workforce remains mobile into late career; personal happiness and patient ownership overshadow financial rewards, and most prefer a total and shared patient care model compared with no patient ownership. Burnout, bureaucracy, and work environment are dominant detractors of job satisfaction among surveyed trauma/ACS surgeons.

Factors associated with low birth weight in Afghanistan: a cross-sectional analysis of the demographic and health survey 2015.

OBJECTIVES: This study aimed to investigate the factors associated with low birth weight (LBW) in Afghanistan. DESIGN: Cross-sectional study. SETTING: This study used data collected from the Afghanistan Demographic and Health Survey 2015. PARTICIPANTS: Facility-based data from 2773 weighted live-born children enrolled by a two-stage sampling strategy were included in our analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was LBW, defined as birth weight <2.5kg. RESULTS: Out of 2773 newborns, 15.5% (n=431) had LBW. Most of these newborns were females (58.3%, n=251), had a mother with no formal schooling (70.5%, n=304), lived in urban areas (63.4%, n=274) or lived in the Central region of Afghanistan (59.7%, n=257). In multivariable analysis, residence in Central (adjusted OR (AOR): 3.4; 95% CI 1.7 to 6.7), Central Western (AOR: 3.0; 95% CI 1.5 to 5.8) and Southern Western (AOR: 4.0; 95% CI 1.7 to 9.1) regions had positive association with LBW. On the other hand, male children (AOR: 0.5; 95% CI 0.4 to 0.8), newborns with primary maternal education (AOR: 0.5; 95% CI 0.3 to 0.8), birth interval ≥48 months (AOR: 0.4; 95% CI 0.1 to 0.8), belonging to the richest wealth quintile (AOR: 0.2; 95% CI 0.1 to 0.6) and rural residence (AOR: 0.3; 95% CI 0.2 to 0.6) had decreased odds of LBW. CONCLUSIONS: Multiple factors had association with LBW in Afghanistan. Maternal, Neonatal and Child Health programmes should focus on enhancing maternal education and promoting birth spacing to prevent LBW. To reduce the overall burden of LBW, women of the poorest wealth quintiles, and residents of Central, Central Western and South Western regions should also be prioritised. Further exploration is needed to understand why urban areas are associated with higher likelihood of LBW. In addition, research using nationally representative samples are required.

Estimated Change in Prevalence and Trends of Childhood Blood Pressure Levels in the United States After Application of the 2017 AAP Guideline.

INTRODUCTION: Childhood hypertension is associated with higher risks of cardiovascular disease during adulthood. This study estimated the prevalence of hypertension and high blood pressure among children aged 8 to 17 years in the United States per the 2017 American Academy of Pediatrics (AAP) guideline and compared that with the 2004 National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI) guideline's prevalence estimate during 2005-2008 and 2013-2016. METHODS: This cross-sectional study analyzed the National Health and Nutrition Examination Survey data. High blood pressure included hypertension and elevated blood pressure (per the 2017 AAP guideline)/prehypertension (per the 2004 NIH/NHLBI guideline). RESULTS: The analysis included 3,633 children in 2005-2008 and 3,471 children in 2013-2016. Per the 2004 NIH/NHLBI guideline, 3.1% (95% confidence interval [CI], 2.3%-4.3%) had hypertension in 2005-2008 and 1.9% (95% CI, 1.4%-2.6%) had hypertension in 2013-2016. Per the 2017 AAP guideline, prevalence was 5.7% (95% CI, 4.6%-7.1%) in 2005-2008 and 3.5% (95% CI, 2.7%-4.5%) in 2013-2016. About 2.5% (95% CI, 2.0%-3.1%) children in 2005-2008 and 1.5% (95% CI, 0.9%-2.0%) children in 2013-2016 were reclassified as hypertensive. We observed a similar change in prevalence for high blood pressure after application of the new guideline. The prevalence of high blood pressure also declined from 2005-2008 to 2013-2016 per both guidelines. CONCLUSION: Although the new guideline would reclassify a small proportion of children as having hypertension or high blood pressure, the prevalence declined from 2005-2008 to 2013-2016.

Sex differences in prevalence and associated factors of prehypertension and hypertension among Bangladeshi adults.

Globally, complications of raised blood pressure are fundamental public health issues. There has been limited research if prevalence and risk factors vary by sex in many countries, including Bangladesh. We stratified the prevalence and associated factors of prehypertension and hypertension according to sex in Bangladesh. This cross-sectional study analyzed the Bangladesh Demographic and Health Survey 2011 data. After estimating prevalence according to sex, multilevel logistic regression was applied to obtain associated factors. This study analyzed data of 3876 males and 3962 females aged ≥35 years. The prevalence of hypertension was 19.4% (95% confidence interval [CI]: 18.0-21.0) among males and 31.9% (95% CI: 30.1-33.6) among females. Among both males and females, prevalence and odds of hypertension increased with age, overweight/obesity, diabetes, upper wealth status, and residence in some divisions. Education level was a significant positive correlate of hypertension for males only. Males and females had similar prevalence of prehypertension, 27.2% (95% CI: 25.6-28.8) and 27.6% (95% CI: 26.0-29.2), respectively. Characteristics such as older age, overweight/obesity, and diabetes were associated with higher prevalence and odds of prehypertension among females; prehypertension among males was associated with advancing age, overweight/obesity, education level, wealth status, and division of residence. In Bangladesh, almost half of the males and females could have increased risks of complications resulting from hypertension and prehypertension. Addressing the characteristics associated with higher prevalence or odds of these conditions is crucial. Several common risk factors indicate that a common prevention and control strategy could work for both sexes.

Differences in prevalence and determinants of hypertension according to rural-urban place of residence among adults in Bangladesh.

This cross-sectional study analysed Bangladesh Demographic and Health Survey 2011 data with the aim of investigating the prevalence of, and risk factors for, hypertension in individuals aged over 35 by rural-urban place of residence. After estimation of the stratified prevalence of hypertension by background characteristics, multivariable logistic regression analysis was conducted to calculate the adjusted odds (AORs) and 95% confidence intervals (CIs) for selected factors. Of the 7839 participants, 1830 were from urban areas and 6009 from rural areas. The overall prevalence of hypertension was 32.6% (95% CI: 30.5-34.8) in urban areas and 23.6% (95% CI: 22.5-24.7) in rural areas. The prevalence and odds of hypertension increased with increasing age, female sex, concomitant diabetes and overweight/obesity and richer wealth status in both urban and rural regions. Although residence in Khulna and Rangpur divisions and higher education level were associated with increased odds of hypertension in urban regions, this was not the case in rural regions (p>0.05). Residence in Sylhet and Chittagong divisions had lower odds of hypertension in rural regions. Furthermore, the proportions of overweight/obese, diabetic and higher wealth status participants were higher in urban than in rural regions. The prevalence and odds of hypertension were found to be associated with several common factors after stratifying by place of residence. Some of these factors are more concentrated in urban regions, so urban residents with these risk factors need to be made more aware of these in order to control hypertension in Bangladesh. Public health programmes also need to be tailored differently for urban and rural regions, based on the different distribution of these significant factors in the two areas.

Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines.

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2-3.0), 55-64 years (AOR: 1.6, 95% CI: 1.4-1.9), and 45-54 years (AOR: 1.4, 95% CI: 1.3-1.6) age groups, females (AOR: 2.0, 95% CI: 1.7-2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0-2.8), diabetes (AOR: 1.4, 95% CI: 1.2-1.6), secondary (AOR: 1.2, 95% CI: 1.1-1.4), or college education level (AOR: 1.8, 95% CI: 1.4-2.3), middle (AOR: 1.3, 95% CI: 1.1-1.6), richer (AOR: 1.5, 95% CI: 1.2-1.8) or richest (AOR: 2.0, 95% CI: 1.6-2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2-1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3-2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.

An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis.

BACKGROUND: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. OBJECTIVE: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). METHODS: We used commercial claims data from 2006 to 2010 linked to enrolled patients' medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. RESULTS: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. CONCLUSIONS: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. TRIAL REGISTRATION: ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj).

The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh.

We analyzed the Bangladesh Demographic and Health Survey 2011 data to examine absolute differences in hypertension prevalence according to the hypertension definition of the "2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" and "Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7)" 2003 guidelines. Among 7839 participants ≥35 years, the JNC7 and 2017 ACC/AHA classified 25.7% (95% confidence interval (CI): 24.5-27.0%) and 48.0% (95% CI: 46.4-49.7%) people hypertensive, respectively. The JNC7 prevalence was 19.4% (95% CI: 18.0-21.0%) among males and 31.9% (95% CI: 30.1-33.6%) among females. The prevalence was 41.4% (95% CI: 39.4-43.5%) among males and 54.5% (95% CI: 52.4-56.4%) among females as per the 2017 ACC/AHA guideline. From JNC7 to 2017 ACC/AHA, the overall difference in prevalence was 22.3% (95% CI: 19.8-24.8%). Males and females had similar differences, 22.0% (95% CI: 18.3-25.7%) and 22.6% (95% CI: 19.4-26.0%), respectively. As per the 2017 ACC/AHA guideline, >50% prevalence was observed among people with body mass index ≥25 kg/m2, college-level education, co-morbid diabetes, richest wealth quintile, females, age ≥55 years, urban residence, or living in Khulna, Rangpur or Dhaka divisions; the absolute difference was >20% in most categories. We found a substantial increase in the prevalence of hypertension due to change in blood pressure thresholds as per the 2017 ACC/AHA guideline. We recommend conducting more comprehensive population-based studies to estimate the recent burden of hypertension in Bangladesh. Future studies should estimate similar prevalence in other countries.

Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood Glucose: Mixed Methods Analysis.

BACKGROUND: Successful treatment of diabetes includes patient self-management behaviors to prevent or delay complications and comorbid diseases. On the basis of findings from large clinical trials and professional guidelines, diabetes education programs and health providers prescribe daily regimens of glucose monitoring, healthy eating, stress management, medication adherence, and physical activity. Consistent, long-term commitment to regimens is challenging. Mobile health is increasingly being used to assist patients with lifestyle changes and self-management behaviors between provider visits. The effectiveness of mobile health to improve diabetes outcomes depends on patient engagement with a technology, content, or interactions with providers. OBJECTIVES: In the current analysis, we aimed to identify patient engagement themes in diabetes messaging with diabetes providers and determine if differences in engagement in the Mobile Diabetes Intervention Study (MDIS) influenced changes in glycated hemoglobin A1c (HbA1c) over a 1-year treatment period (1.9% absolute decrease in the parent study). METHODS: In the primary MDIS study, 163 patients were enrolled into 1 of 3 mobile intervention groups or a usual care control group based on their physician cluster randomization assignment. The control group received care from their physicians as usual. Participants in each intervention group had access to a patient portal where they could record monitoring values for blood glucose, blood pressure, medication changes, or other self-management information while also assigned to varying levels of physician access to patient data. Intervention participants could choose to send and receive messages to assigned certified diabetes educators with questions or updates through the secure Web portal. For this secondary analysis, patient engagement was measured using qualitative methods to identify self-care themes in 4109 patient messages. Mixed methods were used to determine the impact of patient engagement on change in HbA1c over 1 year. RESULTS: Self-care behavior themes that received the highest engagement for participants were glucose monitoring (75/107, 70.1%), medication management (71/107, 66.4%), and reducing risks (71/107, 66.4%). The average number of messages sent per patient were highest for glucose monitoring (9.2, SD 14.0) and healthy eating (6.9, SD 13.2). Compared to sending no messages, sending any messages about glucose monitoring (P=.03) or medication (P=.01) led to a decrease in HbA1c of 0.62 and 0.72 percentage points, respectively. Sending any messages about healthy eating, glucose monitoring, or medication combined led to a decrease in HbA1c of 0.54 percentage points compared to not sending messages in these themes (P=.045). CONCLUSIONS: The findings from this study help validate the efficacy of the mobile diabetes intervention. The next step is to determine differences between patients who engage in mobile interventions and those who do not engage and identify methods to enhance patient engagement. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6wh4ekP4R).

Trends in cardiovascular risk factor management in type 1 diabetes by sex.

AIMS: DCCT showed that intensive type 1 diabetes management reduces complication incidence but did not focus on other cardiovascular disease risk factors, whose control in type 1 diabetes has not been well-studied. We assessed trends in cardiovascular risk factors in type 1 diabetes and attainment of concurrent American Diabetes Association (ADA) guidelines/recommendations (for HbA1c, blood pressure, LDL cholesterol, triglycerides) for complication prevention. METHODS: Individuals with childhood-onset type 1 diabetes (n = 658; 49.4% women; baseline (1986-1988) median age 27 and duration 19 years) were followed biennially for up to 25 years, with surveys and/or examinations. RESULTS: At the latest recorded follow-up, achievement of concurrent ADA recommendations increased for HbA1c (from 9.7 to 25.6%, p < .0001); was unchanged for blood pressure (from 89.7% to 87.4%, p = .36); and decreased for LDL cholesterol (from 62.3 to 39.7%, p < .0001). Adoption of intensive insulin therapy (from 5.9 to 64.4%, p < .0001) and hypercholesterolemia (from 67.3 to 78.9%, p = .0006) also increased. Overall, the proportion meeting all four recommendations was essentially unaltered (from 6.8% to 7.6%) (p = .69). Results were similar by gender. CONCLUSIONS: Although the adoption of intensive insulin therapy and obtaining ADA HbA1c recommendations are increasing, overall cardiovascular risk factor compliance remains low and merits further intervention.

Prevalence and associated factors of pre-hypertension and hypertension in Nepal: Analysis of the Nepal Demographic and Health Survey 2016.

OBJECTIVES: Hypertension is the leading risk factor for cardiovascular diseases and develops faster among pre-hypertensive individuals. However, there is a lack of nationally representative studies that investigate the prevalence and determinants of these two conditions in many developing countries, including Nepal. This study investigates the prevalence and determinants of pre-hypertension and hypertension in Nepal. METHODS: The present cross-sectional analysis used data from the 2016 Nepal Demographic and Health Survey, collected from June 2016 to January 2017. After calculating the weighted prevalence (with 95% confidence interval [CI]), simple and multivariable analyses were performed to estimate odds ratios. RESULTS: A total of 14 857 individuals (6247 males and 8610 females) aged ≥15 years who had their blood pressure measured during the survey were included in this study. The prevalence for pre-hypertension and hypertension were 26.0% (95% CI: 25.3-26.3, n = 3856) and 19.5% (95% CI: 18.8-20.2, n = 2899), respectively. The prevalence of both conditions was greater among males. In multivariable analyses, older age, male sex, higher body mass index, and residents of Provinces 4 and 5 had significantly increased odds of pre-hypertension and hypertension (P < .05). Additionally, higher education level was found to be positively associated with hypertension. CONCLUSIONS: The combined higher prevalence of pre-hypertension and hypertension indicates that nearly half (45.5%) of the respondents are at a greater risk of cardiovascular and other non-communicable diseases due to these two conditions. Older people, males, obese people, and individuals living in Provinces 4 and 5 require more awareness to control blood pressure levels.

Estimated Change in Prevalence of Hypertension in Nepal Following Application of the 2017 ACC/AHA Guideline.

Importance: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults lowered the systolic and diastolic blood pressure thresholds for hypertension to 130 and 80 mm Hg, respectively. This represents a reduction of 10 mm Hg in both systolic and diastolic blood pressure levels used to define hypertension compared with previous guidelines, such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Objectives: To estimate the prevalence of hypertension among adults aged 18 years or older in Nepal per the 2017 ACC/AHA guideline and to determine the absolute difference in hypertension prevalence comparing the 2017 ACC/AHA and JNC 7 guidelines. Design, Setting, and Participants: The cross-sectional analysis used data from the population-based 2016 Nepal Demographic and Health Survey. Data were collected from June 2016 to January 2017 using a multistage stratified sampling procedure that was applied in urban and rural areas, using wards as the primary sampling units. Individuals aged 15 years or older from selected households were interviewed. The survey had an overall response rate of approximately 97%. Main Outcomes and Measures: The primary outcome was the prevalence of hypertension. Blood pressure was measured 3 times for each participant with 5-minute intervals between. Hypertension was present if blood pressure was greater than or equal to 130/80 mm Hg for the 2017 ACC/AHA guideline, and greater than or equal to 140/90 mm Hg for the JNC 7 guideline. Results: Among 13 519 participants (median [interquartile range] age, 38 [26-53] years; 7821 [57.9%] female), 44.2% (95% CI, 43.4%-45.0%; n = 5977) had hypertension according to the 2017 ACC/AHA guideline compared with 21.2% (95% CI, 20.5%-21.9%; n = 2869) by the JNC 7 guideline. The new prevalence was associated with an absolute increase of 23.0% (95% CI, 22.3%-23.7%) from the JNC 7 guideline. When estimating the proportion of hypertension by background characteristics, the new 2017 ACC/AHA guideline definition increased the prevalence to 50% or greater for some categories, with the highest prevalence among those with a body mass index (calculated as weight in kilograms divided by height in meters squared) greater than or equal to 30 (71.6%; 95% CI, 67.7%-75.3%) and between 25 and 29.9 (62.1%; 95% CI, 60.1%-64.1%). Conclusions and Relevance: For adults in Nepal, the new 2017 ACC/AHA guideline reveals a greater estimated prevalence of hypertension compared with the JNC 7 guideline. Because of the public health significance of hypertension, higher prevalence rates confirm the importance of developing effective prevention and control methods in this country.

The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial.

BACKGROUND: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients' emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. OBJECTIVE: The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). METHODS: A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA1c was also studied. RESULTS: There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA1c (P=.91) over the treatment period. CONCLUSIONS: Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes. TRIAL REGISTRATION: Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF).