Controlled Diabetes Mellitus Research Articles

Diffusion‐weighted magnetic resonance imaging of parotid glands in diabetes mellitus: A preliminary study

AbstractObjectiveThis retrospective study aimed to assess the parotid glands in diabetes mellitus (DM) using diffusion‐weighted magnetic resonance imaging (DW‐MRI).MethodsWe investigated 54 patients aged between 38 and 83 years, with DM (DM group) and without DM (control group), who underwent magnetic resonance imaging (MRI) in the facility between November 2006 and January 2021. We calculated the median apparent diffusion coefficients (ADCs) of the parotid glands in the control group and DM group. These groups were compared using the Mann–Whitney U tests. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of the ADC to predict DM. Statistical significance was set at p < 0.05.ResultsThe median ADCs of parotid grands in the control group and DM group were 0.83 × 10−3 mm2/s and 0.74 × 10−3 mm2/s, respectively (p < 0.01). ROC analysis revealed a cut‐off ADC value of 0.81 to distinguish between the control and DM group. Sensitivity, specificity, accuracy, and area under the ROC curve were 0.7, 0.67, 0.69, and 0.71, respectively.ConclusionThe ADC was significantly higher in DM groups than in the control group. This suggests that DW‐MRI may be able to quantitatively distinguish parotid glands between normal and DM patients.

The Management of Diabetes Mellitus Using Medicinal Plants and Vitamins.

Diabetes mellitus (DM) is a serious chronic metabolic disease that is associated with hyperglycemia and several complications including cardiovascular disease and chronic kidney disease. DM is caused by high levels of blood sugar in the body associated with the disruption of insulin metabolism and homeostasis. Over time, DM can induce life-threatening health problems such as blindness, heart disease, kidney damage, and stroke. Although the cure of DM has improved over the past decades, its morbidity and mortality rates remain high. Hence, new therapeutic strategies are needed to overcome the burden of this disease. One such prevention and treatment strategy that is easily accessible to diabetic patients at low cost is the use of medicinal plants, vitamins, and essential elements. The research objective of this review article is to study DM and explore its treatment modalities based on medicinal plants and vitamins. To achieve our objective, we searched scientific databases of ongoing trials in PubMed Central, Medline databases, and Google Scholar websites. We also searched databases on World Health Organization International Clinical Trials Registry Platform to collect relevant papers. Results of numerous scientific investigations revealed that phytochemicals present in medicinal plants (Allium sativum, Momordica charantia, Hibiscus sabdariffa L., and Zingiber officinale) possess anti-hypoglycemic activities and show promise for the prevention and/or control of DM. Results also revealed that intake of vitamins C, D, E, or their combination improves the health of diabetes patients by reducing blood glucose, inflammation, lipid peroxidation, and blood pressure levels. However, very limited studies have addressed the health benefits of medicinal plants and vitamins as chemo-therapeutic/preventive agents for the management of DM. This review paper aims at addressing this knowledge gap by studying DM and highlighting the biomedical significance of the most potent medicinal plants and vitamins with hypoglycemic properties that show a great potential to prevent and/or treat DM.

Glycemic Control Determinant of Diabetes Mellitus Patients

Diabetes Mellitus (DM) is a chronic disease that cannot be cured. Complications in DM are the main cause of blindness, kidney failure, heart attacks, strokes, and amputations of the lower limbs. Various problems in DM can be prevented by controlling DM. DM control is influenced by individual factors and external factors. This study aims to determine the determinants of DM control on DM control parameters. The study was carried out with a cross-sectional design on 31 DM patients who were taken consecutively in July 2022 at the Ubud I Gianyar Health Center. The data collected in this study were HbA1c levels, blood glucose levels (fasting and 2 hours post-prandial), systolic and diastolic blood pressure. The results obtained are factors of age, gender, duration of DM, and dietary adherence together had a significant effect of 75.6% (p-value = 0.00) on HbA1c control. There is a significant contribution of 39.5% to systolic control. Has a significant effect (p-value omnibus test = 0.013) of 45.2% on controlling fasting glucose levels. The conclusion is that DM control by intervening modifiable factors such as emphasizing the importance of dietary adherence.

The Case Files

The Case Files

Mauriac Syndrome: A Rare Complication of Type 1 Diabetes Mellitus

The Mauriac syndrome is a rare complication of poorly controlled diabetes mellitus in adolescence. It is characterized by hepatomegaly, growth and puberty delay, and the presence of elevated transaminases and serum lipids. We report the case of a 17-years-old patient with type 1 diabetes who got admitted for evaluation of growth retardation. The clinical examination showed failure to thrive, hepatomegaly and abdominal distension. Blood sugar was very high. Blood transaminases were also high. Abdominal ultrasound showed homogeneous hepatomegaly. Viral hepatitis serologies and autoimmune study were negative. Liver histology analysis after liver biopsy comfirmed the hepatic glycogenosis. After glycaemic control was improved, liver enzymes normalized and the adbominal distension regressed.

A-28 | Prognostic Impact of Blood Glucose Level in Patients Undergoing PCI

High blood glucose values at the time of percutaneous coronary intervention (PCI) may be due to poorly controlled diabetes mellitus (DM) or other conditions. We aimed at assessing the frequency and prognostic impact of high blood glucose values in patients undergoing PCI. Patients undergoing PCI at a large-volume tertiary-care center (Mount Sinai Hospital, New York) between 2012 and 2019 were stratified based on their blood glucose at time of PCI into 3 groups: normal (70-126 mg/dL), high (127-199 mg/dL), and very-high (≥200 mg/dL) values. Outcomes included all-cause death, myocardial infarction (MI), or stroke and major bleeding at 1-year after PCI. Among 16,193 included patients, 61% had normal, 26% high and 13% very-high blood glucose values. In these groups, 27%, 76% and 93% of patients had DM, respectively. All-cause death, MI, or stroke occurred more frequently with high (5.4%, HR 1.76, 95% CI 1.47 – 2.12) and very high blood glucose values (8.7%, HR 2.89, 95% CI 2.37 - 3.52) as compared to patients with normal values (3.1%, reference group). Similarly, there was a stepwise increase of major bleeding across the three groups (Figure). Among patients undergoing PCI, high and very high blood glucose levels were frequent, not always associated with known DM, and were related with significantly higher rates of complications at 1-year.

Assessment of perceived fear of coronavirus disease 2019 and its relationship to health-related quality of life among type one diabetic children and adolescents during the pandemic in Ismailia City

Background Coronavirus disease 2019 (COVID-19) pandemic affected the world especially those with chronic diseases. Diabetes mellitus (DM) is considered one of the most prevalent noncommunicable diseases. Type 1 diabetes (T1D) is one of the most common endocrine metabolic disorders around the world. This study aimed to assess the perceived fear of COVID-19 and its relationship to HRQoL among children and adolescents with T1D during the pandemic in Ismailia City. Methods This is a retrospective study carried out on T1D children and adolescents during pandemic in Ismailia City and conducted at Suez Canal University endocrinology outpatient clinic, Ismailia City, Egypt from June 30, 2021, to December 31, 2021. All participants were interviewed using a semi-structured demographic and clinical checklist, fear of COVID-19 Scale, and the short form 36 (SF-36) health survey. Blood samples were taken to analyze HbA1c for all patients. Results This study analyzed data from 68 children and adolescents with T1D with age ranged from 10 to 14 years, 58.8% were females and 55.9% had preparatory school education. 38% had BMI more than 30, 38.2% had DM for more than 5 years. HbA1C was more than 8 among 41.2%. 59% had low FCV-19 and 41% had high FCV-19. Mean PCS was 39.1±9.6 and 82% had poor PCS. MCS was ranging from 19 to 36 with a median of 28. Older age, preparatory educated, and larger BMI children had higher fears of COVID-19. Poor DM control, and poor adherence to glucose and diet showed higher FCV-19 scores. Higher PCS was associated with higher FCV-19 score. Using univariate logistic regression, age, HbA1C, type of insulin regimen, family history of DM, and FCV-19 score are predictors for PCS. While age, grade, BMI, HbA1C, adherence to glucose testing, type of insulin regimen, adherence to diet control, and PCS are predictors for FCV-19. Conclusion This study suggested that children and adolescents with T1D showed above-average levels of fear of COVID-19, and it may be associated with lower quality of life, especially physical aspects.

Diabetes Mellitus Related Anterior Uveitis – An Overlooked Clinical Entity

ABSTRACT Background This study aimed to evaluate the characteristics of anterior uveitis in patients presenting with poorly controlled diabetes mellitus and with no other identifiable cause for their uveitis. Methods A retrospective study of 121 eyes in 89 patients who presented at Auckland District Health Board with idiopathic acute anterior uveitis and uncontrolled diabetes between September 2009 and January 2022. Results The diagnosis of diabetes mellitus was known prior to presentation in 80 subjects (89.9%) and was discovered as a result of screening tests in the remainder. Mean HbA1c at presentation was 117.3 mmol/mol. Most uveitis was severe with 3+ (30 eyes, 25.4%) or 4+ cells (30 eyes, 25.4%) in the anterior chamber. Recurrence occurred in 22 eyes (18.2%) and was associated with elevated HbA1c. The visual prognosis was good with median visual acuity at 12 months of 6/7.5. Conclusion Poorly controlled diabetes can be associated with acute anterior uveitis.

Determinants Related to Oxidative Stress Parameters in Pediatric Patients with Type 1 Diabetes Mellitus

Adequate glycemic management is one of the main goals in treating type 1 diabetes mellitus (T1DM) and preventing the early onset of diabetic complications. Improperly controlled diabetes mellitus (DM) will result in oxidative stress (OS) and lead to further related health issues. Therefore, the aim of this study was to evaluate the body’s ability to defend against OS depending on the duration of T1DM, metabolic management, antioxidant intake and modern glycemic monitoring systems (GMS). The study included 103 adolescents with T1DM aged 10–17 years. The control group consisted of 65 healthy peers. The patients’ blood was assayed for antioxidant enzymes, minerals and toxic elements. In addition, their dietary intake of antioxidant components was assessed. The T1DM group had higher total oxidant status, oxidative stress index and Cu/Zn ratio values, higher concentrations of malondialdehyde and lower total antioxidant status (TAS) and chromium, zinc, superoxide dismutase and catalase levels than their healthy peers. The comparison between GMS types revealed favorable changes in OS parameters for the flash and continuous systems. Furthermore, an effect of vitamin A and C dietary intake on serum TAS concentrations was detected. More than 82% of the patients with high TAS fulfilled the estimated average requirement norm for vitamin A, and more than 60% fulfilled the vitamin C requirement. In youths with T1DM, it is advisable to observe the antioxidant activity of the body to prevent the accelerated development of diabetic complications.

P094 Prevalence of fibromyalgia syndrome among patients with type 2 diabetes mellitus

Abstract Background/Aims Fibromyalgia syndrome (FMS) is a non-autoimmune rheumatological disorder characterized by chronic widespread pain, and often tenderness, with additional symptoms such as fatigue, lack of sleep, anxiety, and cognitive problems which are considered significant features in this syndrome. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia that develops as a consequence of insulin deficiency [type1 DM T1DM)] and/or insulin resistance [type2 DM (T2DM)]. Methods A descriptive cross-sectional study was conducted at Endocrine and Rheumatology unit at Baghdad Teaching Hospital during the period from November 2021 till April 2022. A total random sample of 200 Iraqi patients with Diabetes mellitus type 2 diagnosed according to the WHO criteria for diagnosis of diabetes mellitus (females 128 and males 72) and a total random sample of 200 healthy persons (126 females and 74 males) were involved in this study as controls. A special questionnaire designed for the purpose of the study was used for recording information from the patients and controls, which include demographical data for both group in addition information about current treatment for DM and duration of disease. The 2016 revision of American College of Rheumatology (ACR) criteria was used for the diagnosis of FMS. Results There was increase in the risk of developing FMS among diabetes mellitus patients compared to normal individuals (31% vs. 14.5%). Moreover, widespread pain, symptom severity score, and depression were significantly higher [P. Value (0.012, 0.007, 0.019)] respectively among diabetes mellitus patients compared to healthy individuals. It was found that there was a significant increase of having HbA1c increased by 1.38 among fibromyalgia patients compared to healthy individuals. Conclusion The prevalence of fibromyalgia among the studied sample with type 2 diabetes mellitus was high and there was correlation between the prevalence rate of FMS and poor DM control. Disclosure S. Salman: None. H. Abdali: None.

Nonketotic Hyperglycemic Hemichorea in an Elderly Male: A Case Report

BackgroundNonketotic hyperglycemic hemichorea is a rare complication of diabetes mellitus seen in the emergency department. It is most commonly reported in elderly women, predominantly of Asian race, with poorly controlled diabetes mellitus. Patients present with a triad of nonketotic hyperglycemia, hemichorea, and contralateral basal ganglia abnormality on imaging. Its exact pathophysiology is still not known. However, it has a very good prognosis with early diagnosis and treatment. Case ReportWe report a case of hemichorea involving the right upper and lower limbs due to nonketotic hyperglycemia. The patient's symptoms resolved after normalization of blood glucose. Why Should an Emergency Physician Be Aware of This?Nonketotic hyperglycemic hemichorea should be included in the differential of a patient presenting with chorea and high blood glucose levels. It has an excellent prognosis with both symptoms and imaging abnormalities typically resolving completely with restoration of normoglycemia.

The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking

BackgroundTo investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking.MethodsFrom December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains.ResultsNo differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (− 21.86 ± 4.14 vs. − 24.49 ± 4.47, p = 0.001), RVGCS (− 13.16 ± 3.86 vs. − 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138–0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002–0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028–0.855).ConclusionsIn the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.

Calciphylaxis: A Rare Clinical Presentation in a Patient with End-Stage Renal Disease (ESRD)

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), affects small arteries of the skin in patients with end-stage renal failure, dialysis patients, and patients with hypercalcemia. The condition is characterized by the calcification of small blood vessels leading to skin necrosis without inflammation. It is frequently complicated by superimposed infection and bleeding and has a high mortality rate.
 The rare condition is yet to be documented on the islands of Saint Vincent and the Grenadines. The authors have, therefore, made efforts to document, educate, and discuss this rare presentation in a 65-year-old local Vincentian male with 30 years history of poorly controlled diabetes mellitus and hypertension who commenced hemodialysis two years prior to the presentation for end-stage chronic renal failure. With the increasing incidence and prevalence of diabetes mellitus, hypertension, and complications of chronic kidney disease, and renal failure, this article is written as a case study with a concise literature review on calciphylaxis to provide continuing medical education and increase the level of awareness among medical students and index of suspicion among healthcare providers.

Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil

Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n=18) or usual care (n=17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. This study was registered in ClinicalTrials.gov. (NCT05660928).

POST COVID JAW OSTEOMYELITIS WITH MUCORMYCOSIS - AN INSTITUTIONAL STUDY

Mucoraceae are ubiquitous fungi and are found in, soil, air, contaminated water and hospital environments too. These fungi usually gain entry into host through respiratory tract and sinuses either by direct spread or by angioinvasion. Major sites of infection are sinuses, lungs, skin, brain, and gastrointestinal tract. From sinus it may invade maxilla causing osteomyelitis of jaw. Mucormycosis is an opportunistic infection and the major risk factors include poorly controlled diabetes mellitus (DM), iron overload, prolonged corticosteroid use and immunocompromised status. CORONA virus disease 2019 (Covid-19) is an infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The majority of patients have a good prognosis, but some patients become critically ill and even deaths occur. Disease itself decreases cell mediated immunity and increases iron load in covid patients. For treatment of Covid-19 corticosteroids, antiviral drugs and immunomodulatory drugs are being used. Steroid reduces inflammation in covid 19 patients, but it pushes up the blood sugar which causes ketoacidosis, increases iron load, affects cell mediated immunity and favours the mucor mycosis growth. So, there are reported increasing cases of mucormycosis in post COVID-19 patients. Present study includes 25 reported cases of mucormycosis with jaw osteomyelitis in post covid patients with respect to clinical characteristics, past medical history, comorbidities medication received during covid 19, radiographic feature, lab diagnostic methods, histopathological reports, and treatment. So as to gain an insight of this disease as early diagnosis of mucor mycosis and treatment which can significantly reduce the mortality and morbidity of mucormycosis patients

Diabetes mellitus in patients with type 1 autoimmune pancreatitis at diagnosis and after corticosteroid therapy

BackgroundA high prevalence of diabetes mellitus (DM) coexisting with autoimmune pancreatitis (AIP) is observed. However, evidence on the circumstances under which corticosteroid therapy (CST) for AIP improves or worsens DM is scarce. This study aimed to demonstrate and identify predictors of DM control under the influence of CST. MethodsPatients diagnosed with type 1 AIP were enrolled from a prospectively maintained cohort and were classified into three groups according to the chronology in which AIP and DM were diagnosed: pre-existing DM (pDM), concurrent DM (cDM), and non-DM (nDM). The responses of DM to CST were assessed when corticosteroid was ceased or tapered to a maintenance dose and classified as ‘improvement’ and ‘non-improvement’ (including ‘no change’ and ‘exacerbation’). ResultsAmong 101 patients with type 1 AIP, 52 (51.5%) patients were complicated with DM at the time of AIP diagnosis, with 36 patients in the cDM group and 16 patients in the pDM group. The incidences of diffuse pancreatic swelling (72.2%) and pancreatic body/tail involvement (91.7%) were significantly higher in the cDM group than in both the pDM and nDM groups. Of the 52 patients with DM, CST was administered in 48 cases. Multivariate logistic analysis identified that elevated serum gamma-glutamyl transferase (GGT) level at AIP diagnosis [odds ratio (OR) = 0.032, 95% confidence interval (CI): 0.003-0.412, P = 0.008] and pancreatic atrophy after CST (OR = 0.027, 95% CI: 0.003-0.295, P = 0.003) were negatively associated with DM control improvement. ConclusionsPatients with diffuse pancreatic swelling and pancreatic body/tail involvement in pancreatitis tended to be complicated with cDM at AIP diagnosis. CST exerted a beneficial effect on the clinical course of DM in nearly half of the AIP patients complicated with DM at diagnosis, particularly in those without elevated serum GGT levels at diagnosis and who did not experience pancreatic atrophy after CST.

Pre-Procedure Blood Sugar Levels in Diabetic and High-Risk Patients Visiting King Abdulaziz University Dental Hospital: The Role of the Dentist in Diabetes Screening.

Diabetes mellitus (DM) is a widespread problem. Satisfactory control of DM is essential for maintaining oral health and optimizing the outcomes of dental treatment; DM patients with poor glycaemic control have a high risk of dental treatment-related complications. Furthermore, the dentist and dental office can play an important role in DM screening. Therefore, this study aimed at measuring random blood glucose (RBG) levels in patients with established DM or high risk of DM seeking dental treatment at the King Abdulaziz University Dental Hospital to avoid treatment complications and execute an immediate physician referral. This cross-sectional study included patients presenting to our institution for dental treatment, who were categorized as diabetic (established diagnosis) or at high risk of DM according to the American Diabetes Association criteria. Participants' pre-procedure RBG level was assessed via a glucometer. High-risk participants were classified as per their blood glucose level into two groups (<200 mg/dL and >200 mg/dL), while the diabetic participants were placed into four groups (<140 mg/dL; 140 to <200 mg/dL; 200-300 mg/dL; and >300 mg/dL). This study included 695 patients (361 females and 334 males), of which 354 (52%) had established DM and 341 (48%) were high-risk patients. Around 31% of patients in the high-risk group were potentially diabetic but unaware of it; 46% of the diabetic patients had RBG levels >200 mg/dL. For the high-risk participants, age had a statistically significant association (P-value 0.03) with the RBG level. Pre-procedure RBG measurement in diabetic and high-risk patients undergoing dental treatment is crucial for the prevention of DM-related complications. Dental health-care professionals have a vital role in screening, early detection, and referral of these patients.

Cardiovascular Risk Among Patients with Controlled and Uncontrolled Type 2 Diabetes: A Sub-Cohort Analysis from the Heart Health Promotion (HHP) Study.

This study aimed to estimate the risk of cardiovascular disease (CVD) among patients with and without diabetes mellitus (DM) using the Framingham risk score (FRS) and to investigate the effect of DM control on CVD risk. A total of 2432 participants who had their glycosylated hemoglobin (HbA1c) measured within the last three months were included in this study. The study cohort was divided into three categories: non-diabetic, participants with controlled DM (HbA1c<7%), and uncontrolled DM (HbA1c≥7%). The World Health Organization's stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements. The Framingham Coronary Heart Risk Score (FRS) was used to calculate the 10-year cardiovascular risk (CVR). The groups were compared concerning the prevalence of metabolic, socioeconomic, and cardiac risks. Out of 2432 participants, 149 had controlled DM (6.1%), 286 had uncontrolled DM (11.8%), and 1997 participants were normoglycemic (82.1%). Compared to healthy participants, diabetic participants showed more high-risk characteristics across all CVR parameters. Uncontrolled diabetic patients had a graver laboratory and clinical profiles compared to the controlled DM group. As measured by FRS, nearly half of patients with controlled DM (49.9%) and two-thirds of patients with uncontrolled DM (63.3%) were classified as intermediate and high-risk compared to 4.6% of the healthy participants. Compared to healthy participants, patients with controlled DM showed a threefold increased CVR (OR = 3.02, 95% C.I. = 1.41-7.24) while this risk catapulted to 13 times among those with uncontrolled DM (OR = 13.57, 95% C.I. = 6.99-26.36). Participants with DM are at moderate to high CVR. Individuals with uncontrolled DM showed higher CVR profiles as measured by FRS and have a higher prevalence of obesity, unhealthy diet, and physical inactivity.

Predictors of Abnormal Sleep Duration in Older Adults With Hip Fracture and Diabetes

Abnormal sleep duration affects recovery in older adults with hip fracture and diabetes mellitus (DM) negatively. However, the predictors of abnormal sleep duration in this population remain unknown. This study was designed to explore the predictors of abnormal sleep duration among older adults with hip fracture and DM within 6 months of hospital discharge. A longitudinal study using secondary data from a randomized controlled trial was implemented. Data on fracture-related factors (diagnosis, surgical methods) were collected from medical charts. Information on the duration of DM, methods of DM control, and diabetes-related peripheral vascular disease was collected by asking simple questions. Diabetic peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument. Sleep duration outcomes were determined using data collected from a SenseWear armband. Having more comorbidities (OR = 3.14, p = .04), having undergone open reduction (OR = 2.65, p = .005), having undergone closed reduction with internal fixation (OR = 1.39, p = .04), and having DM (OR = 1.18, p = .01), diabetic peripheral neuropathy (OR = 9.60, p = .02), or diabetic peripheral vascular disease for a longer duration (OR = 15.62, p = .006) were all associated with a higher risk of abnormal sleep duration. The findings indicate that patients with more comorbidities or who had undergone internal fixation, had a long DM history, or had complications are more likely to have abnormal sleep duration. Thus, greater attention should be focused on the sleep duration of diabetic older adults with hip fracture who are affected by these factors to achieve better postoperative recovery.

A clinico-radiological study of Peripheral Arterial Disease in patients with type 2 Diabetes Mellitus using ankle-brachial index and peripheral arterial doppler

Background: Peripheral Arterial Disease (PAD) is an important complication of Diabetes Mellitus (DM). PAD is a part of systemic illness caused by atherosclerosis, resulting in arterial narrowing. Hence PAD is a marker of atherosclerosis in other parts of the vascular system, especially in the arteries supplying the brain and heart. Over two - third of the patients with PAD are asymptomatic, resulting in inadequate treatment of their risk factors. There is a need to screen every DM patient for effective treatment of PAD and the risk factors. Ankle-brachial Index (ABI) is a useful test for the same. Objective: The objective of the study was to find out the incidence of PAD in DM and the factors affecting it. Materials and Methods: It was a hospital-based prospective observational study. In all, 200 diabetic patients from tertiary care hospital (outpatient and indoor) were screened for PAD using ABI, and those showing ABI &lt; 0.9 were further confirmed using Duplex Ultrasonography (DUS). Smokers and patients with a previous history of lower limb surgery, vasculopathy, or trauma were excluded from the study. Factors affecting the incidence of PAD were also studied. Results: Overall incidence of PAD was 10% using ABI as a screening test, confirmed with DUS. Male gender, aging, obesity, duration of DM, poor control of DM, hypertension, coronary artery disease, cerebrovascular disease, hyperlipidemia, and presence of retinopathy were found to be adversely affecting risk factors for PAD. Conclusion: ABI is a bedside, simple, reliable, non-invasive, and cost-effective clinical test for diagnosing PAD, a marker of atherosclerosis in the body. There is a need to screen for PAD, even in asymptomatic patients, for its early detection and management of risk factors.