Cases Of Diabetes Mellitus Type Research Articles

Clinical, Demographic, and Oral Presentations of COVID-19Associated Mucormycosis from a Tertiary Care Hospital in India: A Cross-Sectional Study.

The black fungus, mucormycosis, is on the list of lethal complications reported in recent times in COVID patients. This cross-sectional study included all cases of post-COVID-19 mucormycosis. Patients' demographics, clinical presentations, and general health information were collected using a pre-designed form. The study included 171 participants with the mean (SD) age as 49 (10) years with the sex distribution as 71% (122/171) male and 29% (49/122) females. About half of the admitted patients (47%) were known cases of Diabetes Mellitus type II with a median (IQR) Glycosylated Haemoglobin (HbA1c) of 9.1% (7-11.1%). Only 28% (48/171) had received the first COVID vaccination, and 2.9% (5/171) were fully vaccinated with two doses. During COVID-19, 76% (130/171) required hospitalisation for a mean (SD) stay of 11 (6.4) days. Eighty percent of the patients (136/171) received steroids during therapy, while 87% (150/171) and 51% (88/171) received antibiotics and antivirals, respectively. Oxygen was administered to 71% of hospitalised patients (120/171), with 39.1% (47/120) receiving it for more than 7days. About the development of the first symptoms of mucormycosis (headache, nasal congestion, black crusts in the nose, facial pain, swelling in cheeks and eyes, and loss of vision) after being diagnosed with COVID-19, 16% (28/171) reported it within 7days, 75% (127/171) between 8 and 30th days and 9% (16/171) after a month. On examination, 20% of mucor patients had hard palate findings, eschars, fistulas, and perforations, 38% had periodontal abscesses, and 5% reported tenderness to percussion. Generally, oral manifestations involved the palate and included varying degrees of mucosal discolouration, swelling, ulcers, superficial necrotic areas, and bone exposure and necrosis with dark eschars.

Sporobolomyces salmonicolor Infection in a Type 2 Diabetic Patient with a History of Rhino Orbital Mucormycosis and Stroke: A Rare Case Report from Maharashtra, India

Fungal infections are a worrisome threat to public health. We report a rare case of a 75-year-old male patient presented to the Ear, Nose, and Throat (ENT) Outpatient Department (OPD) with chief complaints of pus discharge from the left nose. The patient was already diagnosed with rhino orbital mucormycosis in July 2021. The patient had a history of stroke 1 year ago and is a known case of diabetes mellitus type 2 and systemic hypertension and is on medications. This case is extremely rare in Indian healthcare settings and can have an extensive impact on multiple organs.

Design of a Mobile App to Monitor and Control in Real Time Type 2 Diabetes Mellitus in Peru

Diabetes in the world is a big problem. In addition, in Peru there are high cases of diabetes mellitus type 2, this happens due to insulin resistance, which causes damage to muscle, liver. In addition to the fact that the fat cells do not generate insulin correctly is because the body needs to generate more insulin so that glucose can enter the cells. Due to the problem that exists, a solution to the problem was sought with the objective of developing the design of a mobile application to monitor in real time, in such a way that it helps patients with diabetes to have a good monitoring plan. The methodology developed in the research is Design Thinking as it fits perfectly to the solution of the problems of society which was successfully developed using the phases of empathizing, defining, ideating, prototyping and finally testing. As a result, the design of the mobile application to monitor and control in real time patients with diabetes mellitus type 2 in Peru was obtained. In addition, obtained data on diabetes in Peru verified by the Ministry of Health, such as the results of registered cases of diabetes in Peru 2022, type of diabetes that develop in Peru on a large scale, type of diabetes in men and women. The complications that arise in the progression of the disease in addition to the cases of records according to sex and period of the year 2020 to 2022. Also, the cases presented diabetes throughout Peru therefore a survey was conducted where professors of the Universidad de Ciencias y Humanidades were conducted to qualify the prototypes for development which returned favorable results for implementation.

Hubungan Perilaku dengan Kejadian Diabetes Melitus Tipe 2 di Puskesmas Kota Ende Tahun 2021

Diabetes mellitus is a serious and chronic (prolonged) disease that causes metabolic intrusion and obstruction, indicated by high blood sugar beyond the normal level. Unhealthy lifestyles, such as smoking, drinking alcohol, bad dietary habit and obesity, lacking of physical activities, and stress, are some of the main contributors or causes of diabetes mellitus. The purpose of this research is to find the direct connection and relation between the behaviour or lifestyle and the case of Diabetes Mellitus Type 2 at Ende City Health Center. The design of this research is a survey analytic research using a case-control approach. The total sample in this research is 86 respondents, with a 1:1 (one-to-one) comparison. The sampling technique used in this study is simple random sampling. The data is taken by doing a guided interview with a questionnaire for test statistic chi-square and odd ratio value. The result of this research shows that the variable of dietary habit (p-value = 0,017 < 0,05 and OR = 3,168 (1,309 – 7,665 and 95% CI), physical activities (p-value = 0,028 < 0,05 and OR = 2,971 (1,212 – 7,279 and 95% CI), consumption of alcohol (p-value = 0,023 < 0,05 and OR = 3,285 (1,273 – 8,478 and 95% CI) directly connected with the case of Diabetes Mellitus Type 2. The variable of knowledge (p-value = 0,829 > 0,05 and OR = 1,206 (0,516 – 2,816 and 95% CI) does not have any connection with the case of Diabetes Mellitus Type 2. Suggestion for the healthcare workers in the Ende City Health Center to always improve and maintain good service of the health care and for the people to have regular check-ups and to develop healthy lifestyle such as having proper dietary habits, doing physical activities and controlling the consumption of alcohol to control the level of blood sugar.

Procena rizika za oboljevanje od dijabetes melitusa tipa 2 u opštini Golubac

Introduction. There are approximately 17.000 new cases of diabetes mellitus type 2 (DM2) in Serbia each year. A third of the newly diagnosed already has some late disease complications and almost half of them are over 65. Objective. We aimed at determining the level and risk factors for DM2 in respondents of different gender, age, and lifestyle in the Municipality of Golubac. Method. The study was conducted using the DM2 questionnaire. The sample had 404 participants who were screened in the Municipality of Golubac. Significant statisti-cal methods were used in the study: frequency, t-test, ANOVA test, and correlation analysis. Results. The study showed the majority of participants (40.1%) had slightly elevated risk for DM2, high risk was found in 14.9%, and very high risk in 3.2%. Moderate risk was found in 27.5% of the participants and 14.4% had low risk. Women had a higher percentage of high and very high risk for DM2 than men but no statistically significant difference was found between men and women concerning the risk of developing the disease. With age, as well as obesity, the risk for DM2 increases. The participants who practiced regular physical activity, as well as those who regularly consumed fruits and vegetables, had a lower risk for DM2. Conclusion. The study showed almost every fifth participant had a high or very high risk for DM2, 81.7% were overweight, and 75% had previously diagnosed cardiovascular problems. Registration of persons with an elevated risk for DM2 and further follow-up is a very important task for GPs (general practitioners).

Initial experience with laparoscopic revisional single anastomosis duodeno-ileal bypass (SADI-S) after failed sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG. To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up. This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery - revisional SADI-S - in 2021 at a secondary referral public hospital. All patients' follow-up was completed 1 year after. 14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96-77.16) kg/m2, BMI before SADI-S was 43.09 (41.64-48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29-39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25-21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18-41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension. SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.

Type 1 Diabetes Mellitus Comorbid with Malnutrition in Siblings

Background: Diabetes mellitus is a disorder of the metabolic homeostasis controlled by insulin, resulting in abnormalities of carbohydrate and lipid metabolism. Type 1 diabetes mellitus is one of the most common chronic conditions in children. This study aims to describe two cases of type 1 diabetes mellitus accompanied by malnutrition in children at Dr. M. Djamil General Hospital Padang.
 Case presentation: The case series describes two cases of diabetes mellitus type one with comorbid undernutrition. Both patients had a family history of diabetes mellitus. And their sibling died because of diabetes type 1. Grandmother and grandfather from the father's side had diabetes. The management of this disease consists of the management of type 1 diabetes mellitus and its complications and accompanying malnutrition.
 Conclusion: The management of type 1 diabetes mellitus includes the administration of insulin according to the monitoring of blood sugar levels and the management of comorbid diseases that accompany it. Education about the use of insulin and diabetes diet patterns is very important for parents and children with type 1 diabetes mellitus.

Заболеваемость мочекаменной болезнью в Российской Федерации с 2005 по 2020 гг.

Introduction. Urolithiasis is a polyetiological, polypathognomonic metabolic disease characterized by the formation of kidney stones. The study of trends in the urolithiasis prevalence is of fundamental importance in practical medicine. The study of endemic territories allows us to analyze all possible risk factors for the development of urolithiasis from genetic to nutritional. The aim of our study is a comparative analysis of the urolithiasis prevalence in the Russian Federation for different periods. Materials and methods. We analyzed urolithiasis prevalence and incidence in the entire population of Russia from 2005 to 2020. The work is based on official statistics of the Ministry of Health of the Russian Federation. Statistical analysis of the data was carried out using the SPSS Statistics 21 software package. Results and discussion. Urolithiasis prevalence in the Russian Federation is considered in detail from 2005 to 2020. We did a comparative analysis of the data on the general urolithiasis prevalence, the incidence of urolithiasis, urolithiasis prevalence separately in the adult and children's population of Russia in the period from 2005 to 2020 out. We gave the leading regions in the Russian Federation in terms of the number of urolithiasis cases. We spent correlation analysis of the urolithiasis incidence with the number of cases of diabetes mellitus type 2, obesity and the level of meat consumption in the Russian population. Conclusion. Urolithiasis incidence and prevalence among the adult population is steadily growing in all regions of the Russian Federation, while the incidence among children remains stable. The relationship between the prevalence of urolithiasis and incidence of diabetes mellitus type 2 and obesity was noted.

Co-Relation of HBA1C Level with Diabetic Retinopathy on Fundoscopy in Patients Suffering from Type-II DM for more than 10 years Duration

Defects in insulin secretion or its metabolic functionality results in increased levels of glucose causing metabolic disorders. Aims: To check the Co- relation of HbA1c level with diabetic retinopathy on fundoscopy in patients suffering from Type II DM for more than 10 years duration. Study Design: Cross sectional study. Methodology: Patients (n=61) who were diagnosed cases of diabetes mellitus type II according to American diabetes association guidelines for the past 10 years were included into the study. HbA1c was assessed on autoanalyzer from Roche and NGSP certified using turbidimetric inhibition immunoassay (TINIA) method of hemolyzed blood samples. Eye examination of patients were carried out by expert ophthalmologist after proper pupillary dialatation was carried out. After proper fundoscopy patients were classified into four stages of diabetic retinopathy based on ETDRS levels. Statistical analysis: Data was analyzed using SPSS version 26. Results were presented as frequency and percentage. Age was presented as mean± SD. Results: Out of 61 patients 38 (62.3%) were male and 23 (37.7%) were female. HbA1c levels and diabetic retinopathy showed a statistically significant association when assessed using chi square test (p=0.001). Comparison of HbA1c levels among various groups based on diabetic retinopathy grading revealed a statistically significant difference (p=0.001). Conclusion: It was concluded that HbA1c levels and diabetic retinopathy were significantly associated. Higher levels of HbA1c which reflected the poor glycemic control that can be used as a predictor for the severity of developing retinopathy. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Fundoscopy, Microvascular Complication and Type-II Diabetes Mellitus

The First Case of the Subretinal Abscess After Sars-CoV2 Infection

Ever since the new coronavirus has become the cause of the COVID-19 pandemic; it has manifested with unknown and new presentations. In this report, we are presenting a 46-year-old female infected with COVID-19 (confirmed by Reverse transcription polymerase chain reaction (RT-PCR) nasal swab test) and a known case of Diabetes mellitus type 2 who had a history of Intensive care units (ICU)admission due to COVID-19 with uncontrolled diabetes mellitus. In the second admission after recovery, she had blurred vision. Fundus examination revealed multiple yellow-white well-demarcated nonpigmented masses. Diagnosis of the multiple subretinal abscesses was confirmed. KOH-Calcofluor staining of vitreous fluid was negative for fungal infections of the eye. No polymorphonuclear leukocytes (PMN), epithelial cells, nor any organisms were detected. The patient was treated with an injection of the intravitreal Amphotericin B 10 µg/0.1 cc. To our knowledge, the presented case is the first case of the subretinal abscess after COVID-19 infection.

A Case of Diabetes Mellitus Type 2 Complicated with Malignant Melanoma Misdiagnosed as Diabetic Foot Ulcer

A Case of Diabetes Mellitus Type 2 Complicated with Malignant Melanoma Misdiagnosed as Diabetic Foot Ulcer

EARLY PULMONARY REHABILITATION APPROACH TOWARDS COMPLICATED CASE OF ACUTE RESPIRATORY FAILURE: ENHANCING QUALITY OF LIFE

Acute Respiratory failure often refers to the inability of the body system to maintain optimum arterial and tissue oxygen levels or to optimally expel out carbon dioxide. It is, therefore, hypoxemic or hypercapnia in nature or both depending on the root pathogenesis. A 72-year-old female patient was admitted to the hospital with complaints of breathlessness at rest with NYHA grade 4, dry cough (nonproductive), and orthopnea. The patient is a known case of Diabetes Mellitus type 2 for the last 5 years. On the day of examination patients were breathless using accessory muscles for respiration. The patient was tachypnea. The chest expansion, as well as excursion, was significantly reduced. On auscultations in Coarse crackles were heard. X-ray showed pneumonitis changes. ABG showed respiratory acidosis without compensation initially. Physiotherapy intervention included patients and their family members counseling, airway clearance techniques, energy conservation methods, and adaptation to complex positions with the maintenance of Spo2. Outcome measures have shown enhancement in functional independence and bedside daily activities. Pulmonary Rehab with efficient family counseling is effective in the overall improvement of the patient’s condition with acute respiratory failure.

Cross sectional study of sensorineural hearing loss in type 2 diabetes mellitus

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the prevalence of sensorineural hearing loss in type 2 diabetes mellitus and to figure out a relation between age, sex, duration of diabetes and diabetic control.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional study was conducted at Geetanjali Medical College and Hospital for 1.5 years. Patients were known case of diabetes mellitus type 2 without any other systemic illness included in the study. A total of 115 patients were involved in the study and the informed consent was taken. A detailed examination and history related to hearing loss and diabetes status with treatment was elicited. All basic blood investigations were performed on all the patients. All the patients were subjected to pure tone audiometry and impedance audiometry in a sound proof room. </p><p class="abstract"><strong>Results:</strong> The total prevalence of sensorineural hearing loss in the study subjects was found to be 80% with most of them having mild degree of sensorineural deafness. Increase in age, longer duration and uncontrolled diabetes are the factors which had higher risk of developing sensorineural hearing loss in the study subjects.</p><p class="abstract"><strong>Conclusions:</strong> There is a strong association between sensorineural hearing loss and duration of diabetes mellitus-2. The threshold of hearing loss is increased mainly at the higher frequencies with diabetes.</p>

THE PARACLINICAL EVOLUTION OF OBESE HYPERTENSIVE PATIENTS

Objective: to assess paraclinical evolution in obese patients with essential systemic hypertension Design and method: 150 patients older than 40 years, with SH (more than 7 years, diagnosed between 35 and 42 years age) and obesity (BMI>30 kg/m2) were included. It was a retrospective study. All the patients with systolic heart failure NYHA II-IV and coronary major events were excluded. In all patients were recorded retrospective data regarding clinical findings, blood tests (lipid profile, glycemia, uric acid, TSH, microalbuminuria), ECG, blood pressure monitoring (at least one in the last 2 years) and echocardiography (performed in the last year). The patients were divided into two groups: the study group (n = 72) with hyperuricemia – and the control group (n = 78): patients without hyperuricemia. In all patients were assessed LV function and rest heart rate. In both groups were included only patients with heart rate <90b/min, in sinus rhythm and with EF>55%. Results: The mean age was 48.9 years and 52.9% were men. The patients from the two groups had the same profile of risk factors and associated comorbidities (except hyperuricemia). The treatment and the level of blood pressure control were the same (average BP was 141.5/84.8 in study group and 141.6/84.9 in control group). The median duration of systemic hypertension was 8.4 years (between 7 and 12 yrs). The heart rate was slowly increased in the study group (76.4 vs 70.2). The echocardiography showed an increased end diastolic left ventricle diameter in study group (57.2 vs 56.7 mm) and left atrium diameter (41.5 vs 40.5 mm). In the study group were registered during SH evolution 9 new cases of diabetes mellitus type 2 and 11 patients with microalbuminuria. In the control group were registered during SH evolution 4 new cases of diabetes mellitus type 2 and 7 patients with microalbuminuria. Conclusions: Hyperuricemia could be considered an independent risk factor for patients with systemic hypertension. Its presence accelerates the deterioration of clinical parameters of these patients in spite of the control of hypertension and similar clinical profile. Further studies are needed to confirm.

TYPE 2 DIABETES MELLITUS

Developing countries like Pakistan have many sufferers of Diabetes Mellitus Type 2 still unprepared and unaware of the disastrous implications and complications of the disease. Local population must be aware about all factors that may worsen the disease or that may be monitored to keep them in a better status of health. Objectives: To assess the correlation between blood glucose and various parameters of lipid profile alongwith levels ofMagnesium in Type 2 diabetic patients. The aim was to help in better management of patients by monitoring dyslipidemia and mineral levels in Type2 diabetics. Study design: Cross sectional study. Setting: Madinah Teaching Hospital, Faisalabad. Period: 6 months from July to December 2017. Subjects and methods: The study was executed at Madinah Teaching Hospital Faisalabad on 50 known cases of diabetes mellitus type 2 as well as 30 healthy subjects. Estimations included Fasting blood glucose, Lipid profile and Serum Magnesium. All parameters were performed by Cobas C311 analyzer. Statistical analysis was done using SPSS version 20. Results: There was significant positive correlation between fasting blood sugar andserum cholesterol, triglycerides and LDL while a highly significant negative correlation existed between HDL and FBS. There was negative correlation among fasting blood sugar and serum Magnesium. The control group also showed low HDL and Magnesium levels. Conclusion: Hypercholesterolemia, hypertriglyceridemia, high LDL is associated with type 2 diabetes mellitus along with low HDL and hypomagnesaemia. The low levels in control group may be due to heredity or dietary factors.

A study to assess the efficacy of medical nutritional therapy in reducing blood sugar level in type 2 diabetic patients

Background: Physicians in India have less time for Diet consultation, despite the fact that diet planning plays an important role in management of diabetes mellitus type II. Medical nutritional therapy is defined as Nutritional diagnostic therapy, and counseling services for the purpose of disease management. The objective of the study was to study the efficacy of medical nutrition therapy in type 2 diabetics.Methods: A study was done on residents of Fatehgarh and Shaheed Nagar area of Bhopal. 44 patients with known history of diabetes with age 45 years or above were selected by house to house visit using purposive sampling. Subjects were divided in 2 groups. 1. Intervention group- known cases of diabetes mellitus type 2 with medical nutritional therapy. 2. Non Intervention group- known cases of diabetes mellitus type 2 without medical nutritional therapy. Diet plan according to the calorie requirement on the basis of the desired body weight was prepared and prescribed to the subjects of group 1. Monthly home visits for blood glucose monitoring was done.Results: The mean RBS of group 1 was 200mg and of group 2 was 194. The mean RBS of group 1 decreased by 6.5% in second reading and 8.2% in third reading.Conclusions: Only 19 out of 22 Diabetics belonging to intervention group adhered to the prescribed medical nutrition therapy. The reason being poor patient compliance because of casual attitude towards health. Better results could be obtained if the study duration was longer and HbA1c was considered.

An Unusual Case of Nosocomial Trichosporon asahii Fungemia in a Patient with Tuberculous meningitis

Introduction: Invasive Trichosporon species have been documented mostly in neutropenic patients with underlying hematological malignancies with high mortality, and in critically ill patients exposed to multiple invasive medical procedures. This fungus has been recognized as the second or third most common agent of yeast fungemia. Case Presentation: This study reports on invasive infection with Trichosporon asahii in a non-neutropenic patient with Tuberculous meningitis, who was a known case of diabetes mellitus type II. Conclusions: Although fungemia due to Trichosporon species is an opportunistic pathogen in granulocytopenic patients, there is a steady increase in the number of such cases in non-neutropenic and non-hematological malignant patients. Thus, clinicians as well as microbiologists should be aware of such infections in critically ill patients as early diagnosis and timely management with appropriate antifungal drugs could decrease morbidity and mortality rate.

小児発症1型糖尿病症例 : 家族の問題と医療のあり方 : 生活習慣病の難治化予防における心身医学の関わり : 糖尿病を中心に

小児発症1型糖尿病症例 : 家族の問題と医療のあり方 : 生活習慣病の難治化予防における心身医学の関わり : 糖尿病を中心に

DIABETES MELLITUS

Objectives: To determine the frequency of hypophosphatemia in patientswith diabetes mellitus. Study Design: Cross sectional study. Period: Six months. Setting:Liaquat University Hospital Hyderabad. Patients and methods: All the patients of ≥35 yearsof age, either gender with known cases of diabetes mellitus type 2 for one year duration wererecruited, enrolled and evaluate for serum phosphate level. The data was analyzed in SPSS 16and the frequency and percentage was calculated. Results: During six months study period,total one hundred patients with type 2 diabetes mellitus were studied for serum phosphatelevel. The mean age ±SD for overall population was 53.85±7.63 whereas it was 54.53±6.87and 55.93±6.94 in male and female populations respectively while the mean ±SD for serumphosphate in male and female population was 1.52±0.74 and 1.90±0.93 respectively. Thehypophosphatemia was observed in 67% patients of which 37(55%) were males and 30(45%)were females (p=0.03) statistically significant. The HBA1c was raise in 72% patients of which52 cases had hypophosphatemia (p=0.05) statistically significant. Conclusion: One hundreddiabetic patients were studied and 67% shown significantly decreases serum phosphate level incontext to age and gender while raised HBA1c, shown inversely proportional relationship withHBA1c respectively.

English

Objectives: To determine the frequency of hypophosphatemia in patientswith diabetes mellitus. Study Design: Cross sectional study. Period: Six months. Setting:Liaquat University Hospital Hyderabad. Patients and methods: All the patients of ≥35 yearsof age, either gender with known cases of diabetes mellitus type 2 for one year duration wererecruited, enrolled and evaluate for serum phosphate level. The data was analyzed in SPSS 16and the frequency and percentage was calculated. Results: During six months study period,total one hundred patients with type 2 diabetes mellitus were studied for serum phosphatelevel. The mean age ±SD for overall population was 53.85±7.63 whereas it was 54.53±6.87and 55.93±6.94 in male and female populations respectively while the mean ±SD for serumphosphate in male and female population was 1.52±0.74 and 1.90±0.93 respectively. Thehypophosphatemia was observed in 67% patients of which 37(55%) were males and 30(45%)were females (p=0.03) statistically significant. The HBA1c was raise in 72% patients of which52 cases had hypophosphatemia (p=0.05) statistically significant. Conclusion: One hundreddiabetic patients were studied and 67% shown significantly decreases serum phosphate level incontext to age and gender while raised HBA1c, shown inversely proportional relationship withHBA1c respectively.