Background Oral semaglutide is the first oral glucagon-like peptide-1 (GLP-1) receptor agonist for glycaemic control in patients with type 2 diabetes. Type 2 diabetes is commonly associated with renal impairment, restricting treatment options. We aimed to investigate the efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment. Methods This randomised, double-blind, phase 3a trial was undertaken at 88 sites in eight countries. Patients aged 18 years and older, with type 2 diabetes, an estimated glomerular filtration rate of 30-59 mL/min per 1•73 m², and who had been receiving a stable dose of metformin or sulfonylurea, or both, or basal insulin with or without metformin for the past 90 days were eligible. Participants were randomly assigned (1:1) by use of an interactive web-response system, with stratification by glucose-lowering medication and renal function, to receive oral semaglutide (dose escalated to 14 mg once daily) or matching placebo for 26 weeks, in addition to background medication. Participants and site staff were masked to assignment. Two efficacy-related estimands were defined: treatment policy (regardless of treatment discontinuation or rescue medication) and trial product (on treatment without rescue medication) in all participants randomly assigned. Endpoints were change from baseline to week 26 in HbA1c (primary endpoint) and bodyweight (confirmatory secondary endpoint), assessed in all participants with sufficient data. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered on ClinicalTrials.gov, number NCT02827708, and the European Clinical Trials Registry, number EudraCT 2015-005326-19, and is now complete.

in contrast to developed countries 8 , leisure time physical activity in Bangladesh 13 is more prevalent in the lower SES group. Thus, adverse health-related behaviors might mediate the relationship between low SES and poor glycemic control. Among the comorbid conditions, being overweight/obese was generally associated with an increased likelihood of poor glycemic control in type 2 diabetics 15. Studies also noted that comorbid conditions such as hypertension 16 and depressive symptoms 17 are correlated with poorer glycemic control. Besides, hypertension, obesity, and depressive symptoms often exhibit socioeconomic patterning 18,19 , low prevalence of hypertension and overweight/obesity 18 and high prevalence of depressive symptoms 19 were observed in the low SES group. Therefore, these comorbid conditions may potentially mediate the relationship between low SES and poor glycemic control. Apart from adverse-health related behaviors and comorbid conditions, non-adherence to essential health service-related practices including irregular scheduled visits to diabetes clinic, not practicing self-monitoring of blood glucose concentrations, and reliance on alternative medicine have been known to contribute to poor glycemic control 14,20-22. Several observational studies found that underuse of recommended preventive services associated with poor glycemic control 20,21. Studies also indicated that patients who were not self-monitored their blood glucose 14 and rely on alternative medicine 22 had higher odds of having poorly controlled blood glucose compared to those who self-monitored their blood glucose and do not rely on alternative medicine. Furthermore, these essential health service-related practices vary by SES. In comparison to the high-SES group, people in the low-SES group are more likely to use low-cost and often less-effective alternative medicines and to experience barriers in the timely use of health care services according to their need 23. Accordingly, non-adherence to essential health service-related practices has been proposed as potential mediators of the association between low SES and poor glycemic control. To our knowledge, there has been only a single study regarding to examine the mediators contributing to socioeconomic inequality in glycemic control 24 , which showed that avoidance coping during a stressful event related to their diabetes (eg, to give up trying to deal with the event or to refuse to believe it is happening) and depressive symptoms mediated the relationship between SES and glycemic control. However, the contributions of mediators relating low SES to poorer glycemic control may differ according to context, suggesting the need for research in different settings. To date, there have been no studies in developing countries to assess the mediators relating low SES to poorer glycemic control. Therefore, evidence on socioeconomic disparities in glycemic control and potential mediators to mitigate this relationship is required. This study was performed to examine potential modifiable factor...

Introduction The prevalence of periodontal disease is high in diabetes patients worldwide, including Bangladesh. Although associations of periodontal disease outcomes and clinical determinants of diabetes have been investigated, few studies have reported on the relationship between periodontal diseases outcomes with modifiable factors, such as self-care and oral hygiene practices, in patients with diabetes. Moreover, in order to develop targeted strategies, it is also important to estimate their aggregated contribution separately from that of the established sociodemographic and diabetics related clinical determinates. Therefore, this study was performed to elucidate 1) the relationship of diabetes patients’ self-care and oral hygiene practices to periodontal disease and 2) the relative contributions of selected factors to periodontal disease outcome in type 2 diabetes patients. Methods The data were obtained from the baseline survey of a multicentre, prospective cohort study. A total of 379 adult patients with type 2 diabetes from three diabetic centres in Dhaka, Rajshahi and Barishal, received periodontal examinations using the community periodontal index (CPI) probe, glycated haemoglobin examination, other clinical examinations, and structured questionnaires. Multiple logistics regression analyses were performed to assess the associations between selected factors and prevalence of any periodontal disease and its severity. Results More than half of the participants were female (53.8%) and 66.8% of the total participants was 21–50 years old. The prevalence of any (CPI code 2+3+4; 75.7%) and severe form (CPI code 4; 35.1%) of periodontal disease were high in type 2 diabetes patients. In multivariate analysis, the odds of periodontal disease increased with unfavourable glycaemic control indicated by HbA1c ≥ 7%, and decreased by 64%, 85% and 92% with adherence to recommended diet, physical activity, and oral hygiene practices, respectively. Diabetes self-care practice explained the highest proportion of the variance (13.9%) followed by oral hygiene practices (10.9%) by modelling any periodontal disease versus no disease. Variables of diabetes conditions and oral hygiene practices explained 10.9% and 7.3% of the variance by modelling severe (CPI code 4) or moderate (CPI code 3) forms of periodontal disease versus mild form of periodontal disease. Findings also conferred that while poor diabetes control had an individually adverse association with any form of periodontal diseases and its severity, the risk of diseases was moderated by oral hygiene practices. Conclusions This study suggested that, in addition to diabetes-related clinical determinants, self-care practices, and oral hygiene practices must be taken into consideration for prevention and control of periodontal disease in patients with diabetes.

No abstract

BACKGROUND: There is a paucity of research on knowledge/attitudes regarding the dangers of exposure to secondhand smoking (SHS) among women. The relationship between exposure to SHS, socioeconomic status (SES) and knowledge/attitudes regarding the risks of SHS has often been ignored. We therefore aimed to examine (1) whether SES and exposure to SHS were independently associated with knowledge/attitudes regarding the risks of SHS; and (2) whether women with low SES and exposure to SHS were uniquely disadvantaged in terms of deficient knowledge and more dismissive attitudes towards the risks of SHS. DESIGN AND SETTING: Cross-sectional study in the Rajshahi district, Bangladesh. METHODS: A total of 541 women were interviewed. Knowledge of and attitudes towards the risks of SHS were the outcomes of interest. RESULTS: A majority of the respondents were exposed to SHS at home (49.0%). Only 20.1% had higher levels of knowledge, and only 37.3% had non-dismissive attitudes towards the risks of SHS. Participants in the low SES group and those exposed to SHS had lower odds of higher knowledge and their attitudes towards the risks of SHS were more dismissive. Regarding deficient levels of knowledge and scores indicating more dismissive attitudes, women in the low SES group and who were exposed to SHS were not uniquely disadvantaged. CONCLUSIONS: Exposure to SHS and low SES were independently associated with deficient knowledge and scores indicating more dismissive attitudes. Regarding knowledge/attitudes, the negative effect of exposure to SHS extended across all socioeconomic backgrounds and was not limited to women in either the low or the high SES group.