Baqai Institute Of Diabetology And Endocrinology Research Articles

Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan.

Pregnancy in women diagnosed with Type-1 diabetes mellitus poses a higher risk of experiencing complications related to the health of the fetus, the mother, and the newborn, along with potential obstetric issues. The objective of this study was to examine the maternal and fetal outcomes, as well as complications faced by pregnant women with type-1 diabetes, and to identify potential preventable factors. This retrospective cohort study, conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan (January 2022 - January 2023), focused on registered pregnancies of women with Type-1 diabetes. A predesigned questionnaire recorded demographic information, diabetes and obstetric history, clinical details, treatment specifics, maternal, perinatal, and neonatal outcomes. This study included 100 women with pre-existing Type-1 diabetes (mean age: 15.11 ± 5.64 years at diabetes diagnosis). Of these, 72% reported unplanned pregnancies, with a mean HbA1C at conception 8.29%. Median gestational age at delivery was 32.15 ± 10.82 weeks. Delivery outcomes included 40% normal vaginal deliveries and 60% C-sections (9% emergency, 51% elective). Stillbirths occurred in 14 cases, while 16 women experienced one miscarriage, seven had two, and 10 had three miscarriages. Glycemic targets (fasting) were achieved in 55 women, and post-meal targets only in 29, whereas, neonatal complications included hypoglycemia in 13 and low birth weight in 12 neonates. The high frequency of unplanned pregnancies and cesarean sections along with poor management of pre-pregnancy care and poor glycemic control results in compromised maternal and perinatal outcomes in this high-risk group.

Features and Frequency of Complications Among Pilgrims with Diabetes During Hajj

AbstractAim and Objective:To observe the features and frequency of complications among pilgrims with diabetes during Hajj.Materials and Methods:This retrospective observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE). People with diabetes who visited the outpatient department of BIDE after Hajj were invited to participate in the study between August and September 2018 and 2019, respectively. Those who were not willing to participate or perform Hajj have been excluded. The data collection was done by using a predesigned, close-ended questionnaire, including demographic and clinical parameters, practice compliance toward management, and the frequency of complications that occurred during Hajj.Results:In this study, a total of one hundred and forty-one people with diabetes participated with a mean age of 55.41 ± 10.6 years. Out of these, 111 (78.7%) had visited their health care professionals for pre-Hajj consultation and education, 134 (95%) received their recommended vaccination, and 92 (65.2%) of the people had checked their HbA1c before going to perform Hajj. Diabetic foot problems were recorded in 27 (19.1%), and respiratory diseases were found in 18 (12.8%). A total of 38 (27%) of the study population have reported hypoglycemia, and 51 (36.4%) have reported hyperglycemia.Conclusion:In this study, a higher frequency of glycemic as well as foot complications was observed among pilgrims with diabetes. Pre-Hajj education is mandatory to prevent these avoidable problems.

Frequency of Cardiometabolic Risk Factors Among Young People with Type 2 Diabetes Mellitus at Tertiary Care Unit Karachi, Pakistan

Objective: To determine the frequency of Cardiometabolic Risk Factors (CMRF) among young people with T2DM presenting at the Tertiary Care Unit in Karachi, Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Baqai Institute of Diabetology and Endocrinology (BIDE), a Tertiary Care Unit, KarachiPakistan, from Jan 2000 to Dec 2019. Methodology: The data of participants with diabetes (PWD) aged 18-45 years on the first visit was extracted from the computerized Health Management System (HMS). The demographics, anthropometric, biochemical, and medical information on obesity, smoking, hypertension, dyslipidemia, HbA1c, and family history of diabetes were gathered. Results: The study comprised 5336 participants with diabetes with a mean age of 31.94±5.52 years. High frequency of obesity, hypertension, dyslipidemia, cigarette smoking, poor glycemic control, and a positive family history of diabetes were observed, and their associations were statistically significant. Out of these, 4114(77.1%) were obese, 1663(31.4%) were hypertensive, 585(11%) were smokers, 4162(78%) had a positive family history of diabetes, 2519(47.2%) had HbA1c >10%, 2113(39.6%) had HbA1c between 7-10%. For dyslipidemia, 3383(63.4%) had high triglycerides, 3202(60%) had high LDL-C, 4578(85.8%) had low HDL-C, and 1729(32.4%) had high total cholesterol. Conclusion: The results validate the importance of early screening for CMRF in young diabetics for management and complications prevention in the early stages of the disease and advocate screening for CMRF in health care policy.

Effect of single-dose oral vitamin D (200,000 IU) for the treatment of painful diabetic neuropathy

Abstract Objective: To assess the effect of a single-dose, oral vitamin D supplementation (soft gel capsule of 200,000 IU) in subjects with painful diabetic neuropathy (PDN) in Pakistan. Design: Randomized control trial. Materials and Methods: This randomized control trial was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Pakistan from November 2021 to August 2022. Subjects with diabetes without any signs of vitamin D deficiency were included. Baseline details were obtained by a predesigned questionnaire. Douleur neuropathy 4 (DN4) score was used for diagnosing PDN. Biochemical tests include serum 25-hydroxyvitamin D (OH)D and HbA1c for screening at baseline and at 3 months follow-up were analyzed. Subjects were categorized into two: a control group and an intervention group. The intervention group was given a single soft gel vitamin D capsule (200,000 IU) after screening by expert paramedical staff. Based on baseline serum vitamin D levels, the intervention group was further categorized into insufficient vs. deficient groups, and the control group was categorized into insufficient vs. sufficient. Results: Of 159 participants, 19.5% vs. 44.7% subjects were with insufficient vs. deficient vitamin D levels in the intervention group, and 10.7% vs. 25.1% were with insufficient vs. sufficient vitamin D levels in the control group, respectively. Though the findings are insignificant, DN4 score at follow-up in intervention groups and control groups was reduced compared to the baseline DN4 score. Furthermore, we observed a reduction in post-HbA1c levels in both the intervention groups (insufficient vs. deficient) and the control-sufficient group. Conclusion: Treatment with vitamin D supplementation in people with PDN helps to improve vitamin D levels, DN4 score, and HbA1c levels, though dose-response is yet to be compared.

Outcomes of heel ulcers in people with diabetes visiting tertiary care diabetes center of Karachi, Pakistan

Abstract Objective: To determine the outcome of heel ulcers in people with diabetes. Materials and Methods: This retrospective cohort study was conducted at the Diabetic Foot Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi. Ethical approval was obtained from the Institutional Review Board of BIDE. Relevant records of all patients of both genders with diabetes aged 18–80 years and ulcer over the heel visiting the Diabetic Foot Clinic from January 2016 to December 2020 were retrieved from the hospital management system of BIDE for evaluation. Pre-designed proformas were filled and Statistical Package for Social Science version 20 was used to analyze data. Results: Overall data of 1073 diabetic people with heel ulcers was retrieved, among them the mean age was 57.95 ± 11.96 years, and 715(66.6%) participants were male. Type 2 diabetes was found in 821 (97.9%) participants and 548 (65.6%) had >10 years duration of diabetes. In regard to type of ulcer, 876 (81.6%) were neuropathic ulcers, 91 (8.5%) were ischemic, and 89 (8.3%) were neuroischemic ulcers. According to university of Texas classification wound classification, 725 (67.6%) fell in stage B followed by 238 (22.2%) in stage A. Regarding heel ulcer outcome, a majority of 459 (95.8%) healed without amputation and only 15 (3.1%) healed with major amputation. Conclusion: We found that the majority of the people with heel ulcers had a favorable outcome and healed without an lower extremity amputation.

Linear Growth and Final Height in People With Type 1 Diabetes: A Study From Karachi, Pakistan.

ObjectiveIn this study, we aimed to determine the linear growth and final height in children/adolescents with type 1 diabetes mellitus (T1DM) at a tertiary care hospital.MethodologyThis observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan. All children/adolescents diagnosed with T1DM of either gender aged between 8-18 years visiting the outpatient department of BIDE were included after obtaining informed consent. A predesigned questionnaire was developed to record data. The Centers for Disease Control and Prevention (CDC) growth chart was plotted and growth velocity was checked every six months to observe the linear growth. The final height was compared with the targeted height of the respective participants.ResultsA total of 66 people participated in the study (24 males and 42 females); among them, the mean age at diagnosis was 11.17 ± 4.77 years, and the duration of diabetes [median (IQR)] at the first visit was one year (0-3). The mean age at menarche was noted to be 13.56 ± 1.41 years. The overall height [standard deviation score (SDS)] at the first visit was -0.62 ± 2.58 and it was -1.34 ± 0.94 at the last visit; the overall weight at the first visit (SDS) and at the last visit was -1.23 ± 2.77 and -1.14 ± 1.25 respectively. Furthermore, the overall mid-parental height was 160.9 5 ± 10.28 cm, and 50% of males and 85.7% of females achieved genetic target height with a significant difference between them (p = 0.002).ConclusionA large number of people with TIDM were not able to achieve their target height. Therefore, it is imperative to monitor metabolic control along with monitoring of growth in young people with T1DM.

Evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories

AimTo identify evidence-based risk factors for major complications during Ramadan fasting in people with diabetes grouped under IDF-DAR risk categories. MethodsThis prospective observational multicenter study was conducted by Baqai Institute of Diabetology and Endocrinology (BIDE) between April-June 2019. People with diabetes having intention to fast during Ramadan were recruited. Demographic data collection along with risk categorization was done during pre-Ramadan visit. Structured education was given on one- to-one basis to each of the study participants. Assessment of complications was done during post Ramadan visit. ResultsA total of 1045 people with diabetes participated with near equal gender distribution. Two thirds of study population was grouped into very high- and high-risk categories. Frequencies of major hypoglycemia, major hyperglycemia, hospitalization & need to break the fast were 4.4%, 10.8%, 0.8% & 3.1% respectively.On multivariate analysis, the risk factors found for major hypoglycemia during Ramadan were male gender, use of sedatives & antidepressants & having type1 diabetes mellitus, history of DKA/HHS during last 3 months for major hyperglycemia, major hypoglycemia & hospitalization for breaking of fast while older age, acute illness, and major hypoglycemia were identified factors for hospitalization. ConclusionIn this prospective study evidence-based risk factors for fasting related major complications were identified in people with diabetes. It is imperative to recognize these factors during pre-Ramadan risk assessment visit.

OUTCOMES OF PREGNANCY IN WOMEN WITH TYPE 1 DIABETES MELLITUS: A STUDY FROM RESOURCE CONSTRAINTS SOCIETY

OBJECTIVE: To evaluate the outcomes of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS: This prospective cohort study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi-Pakistan from January 2007 to December 2020. All women diagnosed with T1DM and pregnancy, visiting the outpatient department of BIDE were included after written informed consent. Predesigned questionnaire was developed for data records. It includes demographic details, diabetes mellitus & obstetric history, clinical examination, treatment details, maternal, perinatal and neonatal outcomes. RESULTS: There were 31 pregnancies in which mean age of women was 35.03±9.70 years, duration of diabtes before pregnancy was 128.46±75.50 months and median gestational age at delivery was 34.30±3.9 weeks. Only 5 (16.1%) pregnancies were planned and 7 (22.6%) women have HbA1c <7%. Furthermore, 26 (83.9%) women received folic acid in first trimester. Moreover, 27 (87.1%) live birth and 4 (12.9%) miscarriages occurred, 16 (51.6%) women required assisted delivery/cesarean section and 5 (16.1%) neonates are of low birth weights. Hypoglycemia was noted in 6 (19.4%) neonates and jaundice in 2 (6.5%). One (3.2%) neonate required intensive care unit admission and 14 (45.2%) women breasts fed their child. CONCLUSION: In our study, majority of unplanned pregnancies in women with T1DM rendering this high-risk group into more complications. Prenatal counselling regarding conception may improve the pregnancy outcomes.

Assessment of Factors Associated With Non-Compliance to Self-Management Practices in People With Type 2 Diabetes.

Aim and objectiveDiabetes mellitus is a chronic metabolic disorder that requires continuous self-management practices. The aim of our study is to assess the factors resulting in non-compliance with self-management practices in people with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care center in Karachi, Pakistan, from March 2019 to May 2019. People with T2DM diagnosed for at least six months were included. A predesigned questionnaire was used to assess various components of self-management such as the use of oral hypoglycemic agents (OHAs) and insulin, self-monitoring of blood glucose (SMBG), physical activity, and daily foot care. Certified diabetes educators conducted interviews on a one-to-one basis. Data were entered and analyzed by using SPSS (version 20; IBM Corp., Armonk, NY).ResultsBetter glycated hemoglobin (HbA1c) levels were observed in compliant persons and a statistically significant difference was noted in those who were compliant with insulin use. Good compliance with self-management was observed in people who were given diabetes education previously.A total of 205 people with T2DM were included in the study, with a mean age of 52.66 ± 11.2 years and a mean duration of diabetes of 8.9 ± 7.5 years. There were 62.9% males and 37.1% females. Oral hypoglycemic agents (OHAs) were prescribed to 62.9% while 33.9 % were on both OHAs and insulin. Non-compliance with the intake of OHAs was 33.3%, insulin injection 21%, SMBG 25.7%, physical activity 69.5%, and foot care practice 34.3%. Various reasons identified for non-compliance included forgetfulness (negligence) (88%), fear of hypoglycemia (10.6%), time constraints (48%), and lack of foot care knowledge (84.8%).ConclusionNon-compliance with T2DM self-management is multifactorial and needs continuous reinforcement of structured diabetes education sessions. The study showed that the provision of diabetes education is directly proportional to self-management compliance levels.

Diabetes and Its Complications; Knowledge, Attitude, and Practices (KAP) and Their Determinants in Pakistani People with Type 2 Diabetes

Objective: To assess the knowledge, attitude, and practices (KAP) regarding diabetes and its associated complications in people with type 2 diabetes. Materials and Methods: This prospective observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi, Pakistan. The duration of the study was from January 2019 to June 2019. Ethical approval was obtained from the Institutional Review Board (IRB) of BIDE. People with type 2 diabetes aged older than 25 years, with more than two years’ duration of diabetes were included. A self-structured questionnaire was designed to assess KAP. Results: The mean age of the study participants was 53.14±11.62 years, and the mean duration of diabetes was 10.76±7.65 years. Knowledge and attitude showed higher mean percentage scores of 85.5% and 88.6% as compared with a practice score of 40.7%, which revealed good knowledge and attitude of the participants and poor practice. Education showed a significant association with knowledge and attitude, triglyceride level toward knowledge, LDL-C level toward practice, and HDL-C level toward knowledge and practice. Conclusion: A good knowledge and attitude score of the participants toward diabetes but a poor practice score was found. Individualized programs as well as group education programs still needed to be planned to enable better prevention and management techniques in diabetes. Behavioral therapy and counseling should be considered as a priority in subjects with low practice.

Psychometric Analysis for fear of COVID-19 Scale (FCV-19S) and its association with depression in patients with diabetes: A cross sectional study from a Tertiary Care Centre in Karachi, Pakistan

Background and aimsTo assess the psychometric properties of the Fear of COVID-19 (FCV–19S) scale and to determine its associated factors among the Pakistani patients with diabetes. MethodsThis observational study was conducted in 24-h helpline service, a department of Baqai Institute of Diabetology and Endocrinology (BIDE). Study duration was from August to September 2020. The target population was registered adult patients with type 2 diabetes aged >16 years. Baseline demographic details were obtained from hospital management system of BIDE. Forward-backward translation method was used to translate the existing Fear scale (FCV–19S). Symptoms of depressive disorder were assessed through Patient Health Questionnaire (PHQ9). ResultsTotal of 380 participants with mean age 51.93 ± 12.03 years contributed in the study. Three factors loading and item correlation of fear COVID-19 explained 96% of total variance having unidimensional Cronbach’s alpha of 0.881. All demographic indicators that showed significance in univariate model were included in multivariate model. Females had more fear for COVID-19 compared to males (OR = 1.73, 95% CI (1.15–2.6)), whereas current smokers had also showed 4 times more fear than non-smokers (OR = 4.19, 95% CI (1.18–14.83). Depression assessed by PHQ9 showed maximum fear of COVID-19 in participants with moderate depression. ConclusionFCV-19S had adequate psychometric properties for assessing effects of pandemic in people with diabetes attending tertiary care center.

Frequency and risk factors of UTI and susceptibility pattern of uropathogen and impact of glycaemia control among diabetic patients.

Objectives: The present study is designed to determine the frequency and risk factor of urinary tract infection in patients with or without diabetes, and to determine antimicrobial susceptibility among type 2 subjects with controlled and uncontrolled glycemia. Study Design: Retrospective Study. Setting: Department of Microbiology, Baqai Institute of Diabetology and Endocrinology (BIDE). Period: October 2016 to September 2018. Material & Methods: Ethical approval was obtained from the institutional review board of BIDE. Total 549 patients were included in the study. Results: A total of 117 (28.96%) and 287 (35.52%) uropathogens were isolated from patients with and without diabetes respectively. Percentage of positive culture was high which was 62.30% and 38.25% in female in both patients with and without diabetes respectively. E. coli was found to be the most frequently isolated bacteria from both patients with diabetes and without diabetes, as 50.43% and 52.26% respectively. Since, Patients with diabetes have a higher prevalence of UTI than non-diabetics. Conclusion: Hence, preventive measures should be taken and patients should be properly guided about the complications of diabetes and recurrent infections.

Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan

ObjectiveTo determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. MethodologyThis retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. ResultOut of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92–3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. ConclusionDiabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

Association of Zinc Transporter-8 Autoantibody (ZnT8A) with Type 1 Diabetes Mellitus.

Background: Zinc transporter 8 autoantibody (ZnT8A), discovered through bioinformatics, is identified as another major biomarker for type 1 diabetes mellitus (T1DM), expanding the panel of diagnostic autoantibodies. The absence of standard autoantibodies in T1DM patients and the presence of ZnT8A in individuals before disease development has led the researchers to evaluate ZnT8A to gather information about the frequency and its association. Therefore, we aim to find out the concentration of ZnT8A and its association with T1DM.Methods: A case-control study with 25 type 1 diabetes mellitus patients and 25 first-degree relatives of cases as controls was conducted at Ziauddin University in collaboration with the Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi. Demographic data were collected from patients on a standard questionnaire. Blood samples were collected, after approval from Ziauddin Ethics Review Committee, from subjects and serum was separated to estimate ZnT8A by using sandwich enzyme-linked immunosorbent assay (ELISA).Results: The mean age at diagnosis of T1DM patients was 13.40±5.05 years, and the duration of diabetes was 7.74±5.85 years. The frequency of ZnT8A was found higher in cases (19 (76%)) compared to controls (6 (24%)). ZnT8A concentrations were significantly higher in cases (13.82 ng/ml) compared to the controls (8.78 ng/ml; p= 0.024). The cut-off value of 9 ng/ml was selected for measuring sensitivity, specificity, and accuracy, which were determined as 76%, 76%, and 76%, respectively.Conclusions: ZnT8A was found significantly associated with T1DM. Subjects with ZnT8A values ≥ 9 ng/ml are 10 times more at risk to develop T1DM (p = 0.000).

Relationship of C-peptide levels to duration of Type 1 diabetes - A study from Sindh, Pakistan.

Objective:To determine the relationship of C-peptide levels with duration of type 1 diabetes mellitus.Methods:This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from December 2013 to December 2015. A total of 184 subjects were recruited during the study period, 100 in Group-A and 84 in Group-B. Subjects clinically diagnosed with type 1 diabetes Mellitus (T1DM) were categorized into two groups based on duration of diabetes: Group-A (with ≤1-year duration of diabetes) and Group-B (with >1-year duration of diabetes). Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study. Blood samples were drawn for biochemical parameters. Data for baseline characteristics and clinical parameters (HbA1c and C-peptide) were obtained from hospital management system of BIDE.Results:Fifty-seven (57.6%) subjects in Group-A, and 39 (46.4%) in Group-B were males. Mean±SD duration of diabetes (years) was 0.64±0.6 (range 0-1) in Group-A, and 7.65±5.5 (range 1-23) in Group-B. Family history of T1DM and T2DM was 1(1%) and 27(27.3%) in Group-A, and 8(9.52%) and 21(25%) in Group-B, respectively. Twenty-one (21.2%) subjects presented in diabetic ketoacidosis (DKA) in Group-A and 18(21.4%), in Group-B. Mean±SD for HbA1c was non-significantly higher in Group-A 11.12±2.31 compared to Group-B 10.42±1.45. Mean±SD for C-peptide was 1.91±1.53 ng/mL (0.60±0.481 nmol/L) in Group-A, and 1.82±1.01 (0.57±0.32 nmol/L) in Group-B (p=0.984).Conclusion:The study found that subjects with longer duration of T1DM had non-significantly decreased C-peptide levels compared to a group in which C-peptide was measured at or soon after diagnosis. Furthermore, C-peptide levels in many subjects with longer duration were higher than expected in classic T1DM.

Mobile SMS: A tool for management of diabetes via patients-relative’s knowledge and belief

Aim/backgroundTo assess the effectiveness of mobile SMS as a tool for behavior and life style modification in management of diabetes. MethodsThis interventional study was conducted from July 2014 to April 2015 at Baqai Institute of Diabetology and Endocrinology (BIDE). Demographical and clinical information of subjects (patients and relatives) along with their knowledge and beliefs regarding diabetes was recorded using questionnaire. In Short Message Service (SMS) and non-SMS groups, education regarding diabetes was given. Two messages per day were sent to SMS group for two months. ResultsTotal 648 subjects, SMS (n = 376) and non-SMS (n = 276) groups, were included in study. Mean age of patients and relatives was 45.41 ± 15.13 and 34.58 ± 11.91 in SMS group, while 47.06 ± 14.83 and 31.02 ± 11.51 in non-SMS group, respectively. No significant difference regarding level of knowledge and beliefs among both groups was observed at baseline. After SMS intervention, level of knowledge (p ≤ 0.0001) and beliefs (p ≤ 0.0001) were found to be significantly higher in SMS groups Non-SMS group. ConclusionMobile SMS are an effective tool to deliver behavior and lifestyle modification advice and support for better management of diabetes and its prevention in people who are at high risk. Education intervention through SMS is found to be an important variable which enhances the knowledge and beliefs of the subjects.

Frequency and risk factors of diabetic retinopathy in patients with type 2 diabetes presenting at a tertiary care hospital

To evaluate frequency and risk factors of diabetic retinopathy in patients with type 2 diabetes. This prospective observational study was conducted from January 2017 to June 2017 at the outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE) and Baqai Medical University a tertiary care diabetes hospital of Karachi, Pakistan. Convenience sampling was done. Demographic, anthropometric, clinical, and biochemical data were collected, and ophthalmic screening was performed by funduscopy at a slit lamp biomicroscopy with the help 90 D fundus lens. Grading of diabetic retinopathy was done according to the modified Early Treatment Diabetic Retinopathy Disease Severity Scale (ETDRS) criteria. Retinopathy was present in 17.5% of patients. Non-sight-threatening retinopathy was found in 15.2% and sight-threatening retinopathy was found in 17.6%. In table 4, logistic regression analysis determined the relationship between retinopathy and its possible risk factors. In univariate logistic regression model, Age, poor glycemic control and longer duration of diabetes were found to be significant risk factors for developing retinopathy. In multivariate logistic regression model, duration of diabetes remained significantly associated with the development of retinopathy. Additionally, gender was not significantly associated in univariate analysis but it became significant after adjustment in multivariate model. An early screening program reduces the risk of incidence of diabetic retinopathy. Hence, screening of retinopathy should be done once in a year.

Insulin-associated Weight Gain in Type 2 Diabetes and Its Relation with Caloric Intake.

ObjectiveThe aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake.MethodsThis retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study.ResultsGroup B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain.ConclusionIt is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.

Thyroid dysfunction in subjects with type 1 diabetes at a tertiary care unit of Karachi, Pakistan

BackgroundGenetic factors are involved in the development of T1D and studies have shown that the development of T1D also increases the risk of development of other autoimmune diseases. ObjectiveTo assess the frequency of thyroid dysfunction in subjects with type 1 diabetes. MethodologyThis study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes center of Karachi Pakistan from January 2005 to March 2017. Subject with type 1 diabetes (T1D) of all ages and both genders were included in the study. T1D was diagnosed on the basis of History, physical examination and relevant laboratory tests. The data of all registered patients was entered in a specially designed software. Thyroid stimulating hormone (TSH) was used as a screening test to assess thyroid dysfunction in subjects with type 1 diabetes. Further evaluation included FT4, T3 and thyroid antibodies where indicated. The data was analyzed on SPSS version 20. ResultsA total of 153 T1D subjects (67 male and 86 female) were included in the study. Out of 153 subjects, 23 (15.0%) had thyroid dysfunction of which 17 (11.1%) were found to have hypothyroidism (subclinical or clinical), 6 (3.9%) were hyperthyroid while 130(84.96%) subjects were having normal thyroid function. Statistical differences were found in body mass index and serum creatinine level among the different categories of thyroid dysfunction. The required dose of insulin was higher (but not significant) in subjects having hypothyroidism as compared to hyperthyroid or subjects with normal thyroid function. ConclusionHigh frequency of thyroid dysfunction was observed in subjects with T1D. Hypothyroidism was more common than hyperthyroidism. All subjects with T1D should be screened with TSH to evaluate for thyroid dysfunction.

Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center.

Background & Objective:Anemia is common finding in people with diabetes and diabetic foot ulcers. Therefore, our objective was to observe and compare the association of anemia in people with diabetic foot ulcers (DFUs) with age and sex matched people without DFUs.Method:This prospective case control study was undertaken at a multidisciplinary diabetic foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE) between October 2014 and October 2015. Participants were categorized into two groups; Case group (people with DFUs) and Control group (people without DFUs). Baseline demographic characteristics, biochemical and hematological parameters were recorded. University of Texas (UT) classification system was used to grade and stage DFU in case group. Subjects with other apparent causes of anaemia were excluded. Age and sex matched controls were taken from diabetic clinic presented during same time period. Data was analyzed by using statistical package for social science (SPSS) version 20.Results:Total of 161 participants in case group were compared with similar number of age and sex matched participants of control group. Most of the participants were males 119(73.9%). Age and sex matched case and control groups were comparable except for duration of diabetes, BMI and HDL levels. Overall, 85.67% case group (males 64.56%); females 21.11%) and 35.3% control group (males 22.9%; females12.4%) have anemia. Mean Hb level was 10.49g/dl in case group and 13.39g/dl in control group. Significant differences were also noted in other blood parameters.Conclusion:Our study concludes that anaemia is strongly associated with DFU disease. Anaemia should be considered and treated as co-morbidity while managing patients with foot ulcers.