Screening For Diabetes Mellitus Research Articles

Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India.

Globally, obesity and diabetes mellitus (DM) are emergent public health concerns in the adolescent population. India, home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization, with accompanying unhealthy nutritional transition, and sedentary lifestyle. To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents (15-19 years) in India. This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India (2019-2021). The survey employed stratified two-stage sampling, with systematic random sampling in rural and urban areas. Statistical analysis included descriptive statistics, bivariate, and multivariable logistic regression, employing generalized linear models. The weighted prevalence of DM was 1.09% including 0.77% [95% confidence interval (CI): 0.72-0.83] previously diagnosed and 0.32% (95%CI: 0.29-0.35) newly diagnosed cases detected on survey screening. On adjusted analysis, increasing age, higher education levels, higher wealth index, and overweight/obesity were the factors significantly associated with presence of DM. Only 61% of the adolescents with previously diagnosed DM were on anti-diabetes treatment. The weighted prevalence of overweight/obesity among older adolescents was 6.9% with significantly higher odds in the male sex, having higher educational levels, urban residence, and those with a higher wealth index. Nearly one in hundred older adolescents in India have diabetes, with one in three undiagnosed. Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

Relationship between Type 2 Diabetes Mellitus and Red Cell Distribution Width

Background and objectives: Type 2 diabetes mellitus is a prevalent health problem in the Kurdistan region/Iraq. Numerous biochemical parameters are important for screening and monitoring of diabetes mellitus, Red Cell Distribution Width is one of them. Methods: A cross-sectional study was conducted in Erbil Teaching Hospital, Rizgary Teaching Hospital, and Layla Qassim primary health care center in Erbil city-Kurdistan region/Iraq from 1st of August, 2022 to 31st of July, 2023 on one hundred and twenty type 2 diabetic patients. Many biochemical and hematological parameters were evaluated and compared with Red Cell Distribution Width in this study. Results: The mean Red Cell Distribution Width of diabetic patients was (16.64%); 61.7% of them had a high Red Cell Distribution Width. A weak positive correlation was observed between Red Cell Distribution Width -CV and each female gender, Body Mass Index, White Blood Cell count, and triglyceride (p?0.05). A potent positive and significant correlation was noticed between Red Cell Distribution Width -CV and fasting blood sugar (r=0.76, p<0.001) as well as HbA1c level (r=0.92, p<0.001). A moderate positive significant correlation was observed between Red Cell Distribution Width -CV and cholesterol, low-density lipoprotein cholesterol as well as serum creatinine levels (p?0.05). A weak negative correlation between Red Cell Distribution Width -CV and HDL (p<0.001). Conclusion: The red blood cell distribution width might be a helpful marker in monitoring and assessing the severity of type 2 diabetes mellitus and could also help in predicting cardiovascular and renal complications.

Impact of the COVID-19 lockdown on the O'Sullivan test and gestational diabetes mellitus diagnosis in pregnant Spanish women

ObjectiveTo analyze the impact of COVID-19 lockdown on serum glucose levels of pregnant women. DesignA retrospective analysis of O'Sullivan test in pregnant women who underwent COVID-19 lockdown compared to controls. SitePoniente Primary Health Care center in Córdoba (Spain). Participants235 pregnant women from 23+0 to 25+0 weeks of gestation without diabetes mellitus. InterventionsGestational diabetes mellitus screening with O'Sullivan test and 3-h oral glucose tolerance test. Main measurementsPregnant women who underwent gestational diabetes mellitus screening with O'Sullivan test before (control group) and during COVID-19 Lockdown (Lockdown group) in Córdoba (Spain) were investigated. Lockdown group was divided in early and late lockdown. An additional, control group from data of the same months of the Lockdown in the previous year were recorded to discarded seasonally (adjusted seasonally control) this group was also divided in early and late seasonally adjusted.A logistic regression model for O'Sullivan test has been performed to analyze potential cofounders. Kolgomorov–Smirnov and Kruskal–Wallis test comparing pregnant women who underwent COVID-19 lockdown with the two types of controls. ResultsStatistically significant differences were found in serum glucose after O'Sullivan test between lockdown group and control group (123.51±26.02mg/dL and 112.86±31.28mg/dL; p=0.017). When early lockdown group and control group were compared no differences were found (119.64±26.18mg/dL vs. 112.86±31.28mg/dL; p>0.05) whereas differences were observed in late lockdown group and control group (127.22±25.59mg/dL vs. 112.86±31.28mg/dL; p=0.009). Statistical trends were also found between lockdown group and seasonally adjusted group and between lockdown and late seasonally adjusted group (p=0.089). A higher proportion of positive O'Suvillan pregnant women who were subsequently diagnosed with GDM were found in lockdown group compared to the seasonally adjusted control group (60% vs. 26.06% respectively; p<0.05). ConclusionsThe COVID-19 lockdown was associated with an increase in serum glucose levels after the O'Sullivan test as well as a higher GDM diagnosis risk in pregnant women. The findings of our study emphasize the essential requirement for comprehensive maternal services and the accessibility to community's health assets during future lockdown scenarios to pregnant women.

Influence of behavioral and genetic variables on the prevalence of type 2 diabetes mellitus in middle-aged monks of Thailand

Diabetes mellitus (DM) and its associated complications present a major health problem for the Thai people, including Buddhist monks. This study aimed to identify the influence of behavioural and genetic variables on the prevalence of type 2 diabetes mellitus in middle-aged monks of Thailand. The study analyzed data from the health data centre of the Department of Public Health, Thailand, focusing on middle-aged monks in 76 provinces across 12 regions. The study recruited 6,408 Thai monks who met inclusion and exclusion criteria between October 2015-November 2019. Multivariable analysis was performed using a generalized linear mixed model, with adjusted odds ratios and 95% confidence intervals reported at a significance level of 0.05. Our study found that among the middle-aged monks of Thailand, 7.12% (95% CI: 6.49-7.78) had diabetes mellitus out of a total of 6,408. The results of our multivariable analysis showed that the following factors were associated with diabetes mellitus in monks of Thailand: respondents’ body mass index (BMI) ≥30 kg/m2 (AOR=4.26, 95% CI: 3.08-5.90, p-value &amp;lt;0.001), respondents with a family history of DM (AOR=3.37, 95% CI: 2.52-4.81, p-value&amp;lt;0.001), and respondent’s age ranges of 55-59 (AOR=2.87, 95% CI: 2.26-3.84, p-value&amp;lt;0.001), respectively. Diabetes millatus is significantly associated with the respondents who were obese, aged, and had a family history of DM. Therefore, a regular DM screening program as well as a timely health monitoring system for monks will enhance the diabetes control program in reducing the DM burden in Thailand.

Prevalence and Determinants of Household Self-Reported Diabetes Mellitus in Gauteng, South Africa.

Diabetes mellitus is one of the leading causes of morbidity and mortality worldwide. Type 2 diabetes mellitus is the most prevalent type of diabetes mellitus, and it is associated with both hereditary and lifestyle risk factors. South Africa is not exempt from this pandemic; hence, this paper aims to assess the prevalence and determinants of household self-reported diabetes mellitus in Gauteng, South Africa. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Bivariate and multivariate logistic regressions were applied. The prevalence of household self-reported diabetes mellitus in Gauteng was 11.1%. The 'other population' group (which included Whites, Coloureds and Indians), as well as older respondents, higher household monthly food expenditure, poor self-perceived health status and household self-reported hypertension were factors that increased the odds of household self-reported diabetes mellitus. Only informal housing decreased the odds of household self-reported diabetes mellitus. Screening of diabetes mellitus among those with poor living conditions, no medical aid and lack of access to healthcare facilities such as Gauteng township and informal settlement residents should be intensified. This secondary disease prevention intervention is crucial, as it will enhance the appropriate referrals and timeous chronic treatment for those with diabetes mellitus.

Genomic variants associated with type 2 diabetes mellitus among Filipinos.

Type 2 diabetes mellitus leads to debilitating complications that affect the quality of life of many Filipinos. Genetic variability contributes to 30% to 70% of T2DM risk. Determining genomic variants related to type 2 diabetes mellitus susceptibility can lead to early detection to prevent complications. However, interethnic variability in risk and genetic susceptibility exists. This study aimed to identify variants associated with type 2 diabetes mellitus among Filipinos using a case-control design frequency matched for age and sex. A comparison was made between 66 unrelated Filipino adults with type 2 diabetes mellitus and 121 without. Genotyping was done using a candidate gene approach on genetic variants of type 2 diabetes mellitus and its complications involving allelic association and genotypic association studies with correction for multiple testing. Nine (9) significant variants, mostly involved in glucose and energy metabolism, associated with type 2 diabetes mellitus in Filipinos were found. Notably, a CDKAL1 variant (rs7766070) confers the highest level of risk while rs7119 (HMG20A) and rs708272 (CETP) have high risk allele frequencies in this population at 0.77 and 0.66, respectively, making them potentially good markers for type 2 diabetes mellitus screening. The data generated can be valuable in developing genetic risk prediction models for type 2 diabetes mellitus to diagnose and prevent the condition among Filipinos.

From Acute Pancreatitis to Diabetes: Risk Factors and Timeline Analysis in a Pediatric Population Study

Abstract Objectives Identify the risk profile for post-pancreatitis diabetes mellitus (PPDM) in children after a single acute pancreatitis (AP) episode, investigate episode severity's association with complications, length of stay (LOS), and intensive care unit (ICU) needs. Methods This cross-sectional study used the Pediatric Health Information System database for patients ≤19 years old with index AP admissions (2011-2020). A query (2012-2021) was performed for diabetes mellitus (DM). Patients were excluded if they had prior DM or pancreatic surgery on or before AP or DM diagnoses. Results Out of 12,822 patients with index AP admissions (median age: 13.4 years, 54% female), 686 (5.4%) developed PPDM, 320 (2.5%) during and 366 (2.9%) at a later admission. The median collective time to PPDM during and after index AP admission was 1.9 months (IQR: 0-20.8). Patients with PPDM experienced extended LOS, heightened ICU needs, and increased complications such as sepsis, pancreatic necrosis, cyst formation, along with higher rates of organ dysfunction and comorbidities. Conclusions Children face DM risks during or following AP episodes. Enhanced DM screening is crucial for patients with existing comorbidities, local or systemic complications or organ dysfunction. Close outpatient follow-up within 3-6 months of discharge from an index AP episode is recommended.

Undiagnosed Diabetes Mellitus is an important risk factor in secondary prevention after an acute coronary syndrome and warrants active screening

Abstract Background/Introduction Previous studies have shown that patients with Diabetes Mellitus (DM) undergoing percutaneous coronary intervention (PCI) for an acute coronary syndrome (ACS) have an increased ischemic risk compared to non-diabetics. This has led to the recommendation to take DM into account when considering extended dual antiplatelet therapy (DAPT) to prevent ischemic events. Although screening for DM can simply be conducted by measuring HbA1c values, the ACS guidelines do not yet recommend to screen for DM de novo. This may lead to undertreatment. Purpose We aimed to determine the ischemic risk of previously diagnosed DM and of DM de novo compared to patients without DM in a real world ACS population. Methods We included patients from the South East (Zuid Oost) Netherlands Heart Registry (ZON-HR) undergoing PCI for ACS without using oral anticoagulants and compared outcomes between DM and non-DM patients. In a subgroup of patients without previously diagnosed DM with available HbA1c measurements at baseline, we compared outcomes between patients with or without DM de novo (HbA1c ≥48 mmol/mol). All analyses were performed using Cox regression analysis. We used multivariate analysis to adjust for known ischemic risk factors. Results Of the 2406 patients included, 426 were previously diagnosed with DM. Additional ischemic risk factors, such as a history of myocardial infarction (MI), multivessel disease and kidney disease, were significantly more often present in patients with DM. Patients with DM showed numerically more major adverse cardiac and cerebral events (MACCE). However, this was not significant (HR: 1.24, 95% CI: 0.92-1.66). All-cause mortality was higher in patients with DM at 30 days (HR: 1.51, 95% CI 1.00-2.29) and 1 year (HR: 1.55, 95% CI 1.10-2.18), which remained significant at 1 year when corrected for additional risk factors. The HbA1c values at baseline were available in 387 patients without previously diagnosed DM. In this subgroup, 69 (18%) patients showed an elevated HbA1c level of ≥48 mmol/mol. Outcomes within this subgroup are presented in table 1. Patients with de novo DM showed significant more ischemic events after one month and one year follow-up compared to patients without DM de novo. Figure 1 depicts the survival from MACCE over time in these subgroups. Conclusion In our real world population of ACS patients undergoing PCI, we found no significant difference in ischemic risk between patients with previously diagnosed DM compared to non-DM. However, all-cause mortality was significant higher in DM patients. Active screening for DM resulted in a large proportion of patients with DM de novo who showed a major increase in ischemic risk. These results demonstrate the importance of screening for DM in ACS patients undergoing PCI.

Barriers and facilitators for universal gestational diabetes Mellitus screening in a low resource setting: a cross-sectional study in Sri Lanka

Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 and 28 weeks) in 2014 and its utilization has not been assessed. This study assessed the utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. A cross-sectional study was carried out in a consecutive sample of 420 postpartum mothers who delivered at three major hospitals in Sri Lanka. Data were collected on socio-demographics, pregnancy, availability and utilization of screening services and logistics using an interviewer-administered questionnaire and a data record sheet. Data was analysed using SPSS software. Chi-square test and binary logistic regression was used to assess the association between variables. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. The median period of amenorrhoea at the first and second screening were 10.0 (inter-quartile range: 2.5) weeks and 28.0 (inter-quartile range: 1.5) weeks. A higher utilization was associated with higher income (OR = 3.4, 95% CI: 1.1–10.5) and planned pregnancy (OR = 4.9, 95% CI: 2.2–10.7) for the first screening test. Primiparity (OR = 0.3, 95% CI: 0.1–0.9) and proximity of the nearest laboratory (OR = 3.5, 95% CI: 1.0–12.0) were positively associated with the second screening test. The timeliness of both screening tests was associated with planned pregnancy (OR = 2.1, 95% CI: 1.1-4.0 and OR = 2.3, 95% CI: 1.1–4.5) and being non-employed during the pregnancy (OR = 2.5, 95% CI: 1.4–4.3 and OR = 2.3, 95% CI: 1.3–4.1). A high utilization of GDM screening was observed. Timeliness should be ensured through improved availability and accessibility of screening facilities.

Early screening and diagnosis of gestational diabetes mellitus (GDM) and its impact on perinatal outcomes

AimsTo compare the maternal and neonatal outcomes following early diagnosis compared with routine diagnosis of gestational diabetes (GDM). MethodsIn this observational study, 3494 women were categorised by weeks of gestation at GDM diagnosis: early GDM (≤20 weeks) and routine GDM (>20 weeks). The early GDM group was further divided by treatment commencement as immediate (<12 weeks) and delayed (12–20 weeks) and by diagnostic fasting blood glucose as higher-FBG (5.3–6.0 mmol/L) and lower-FBG group (FBG 5.1–5.2 mmol/L). Primary outcomes were large for gestational age (LGA) and small for gestational age (SGA). Generalized linear models used to calculate risk ratios and adjusted for confounding. ResultsRisk ratios (RR) for LGA and SGA were similar for early versus routine diagnosis, and immediate versus delayed treatment. The higher-FBG immediate treatment group had a lower risk of newborn respiratory distress (RR 0.52, 95 %CI 0.34, 0.81) and emergency caesarean (RR 0.55, 95 %CI 0.34, 0.88) compared to the higher-FBG delayed treatment group. Among the lower-FBG group, no such benefits were seen. ConclusionsFasting glucose levels modified the effects of early treatment of GDM where a higher-FBG with immediate treatment appears to reduce perinatal complications, but treating women with lower-FBG early has no benefits.

Screening of Pre-Diabetes and Type-II Diabetes Mellitus Among the Personnel of Bangladesh Air Force

Background: Medical Squadron (Med Sqn) of Bangladesh Air Force (BAF) Base Bashar (BSR) has been providing medical support for BAF Base BSR, Air Headquarters, most of the retired officers and their families. It has been observed that the number of Diabetes Mellitus (DM) patient is increasing day by day, and now it becomes a major health problem among the members of BAF, even among the young age group. In view of above, a study was conducted among the BAF uniform members who reported for laboratory investigation to Med Sqn BAF Base BSR. Assessing prevalence of DM among BAF personnel will also help for overall assessment of health problem of BAF personnel to make a preventive guideline. Methods: A descriptive type of cross-sectional study was conducted with available data in the pathological laboratory of Med Sqn BAF Base BSR during the period from 01 July 2021 to 30 Jun 2022. Within this period a total 9269 Air Force uniform members reported for routine as well as diagnostic purpose of checking blood sugar. Associated risk factor like overweight or obesity was also assessed by latest data from personal documents. Age and job pattern wise data were also analyzed. Statistical Package for Social Sciences (SPSS) version 29.0 was used to analyze data. Results: Out of 9269 BAF members a total 683 persons (7.36%) had high (above normal) plasma glucose. Of these 413(60.46%) were diabetic and 270(39.53%) were pre-diabetic (IFG/IGT). Among the 413 diabetic patients 292(42.75%) had fasting plasma glucose (FPG) ≥7 mmol/L as well as post prandial plasma glucose (PPPG) level ≥11.1 mmol/L. Among the 270 pre-diabetic patients 205(30.01%) had FPG level between 6.1-6.9 mmol/L with PPPG level &lt;7.8 mmol/L (Impaired Fasting Glucose/IFG) and 65(9.51%) had FPG level &lt;7 mmol/L with PPPG level between 7.8-11 mmol/L (Impaired Glucose Tolerance/IGT). Conclusion: DM has become a major health concern all over the world. This study attempted to identify the prevalence of age-related factors for DM among BAF uniform members between the ages 30 to 60 years. It has been observed that the prevalence of pre-diabetes is more among the 41 to 45 years age group and Type-II DM among the 46-50 years age group. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 22-27

Firsttrimester Diagnosis and Therapy @11 - 13 +6 Weeks of Gestation - Part 2 : Guideline of the DEGUM, ÖGUM, SGUMGG, DGGG, ÖGG, Gynecologie Suisse, DGPM, DGPGM, BVF, ACHSE (AWMF S2e LL 085-002 1.1.2024) (https://register.awmf.org/de/leitlinien/detail/085-002).

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @11 - 13 +6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus). This guideline deals with the following topics in the context of the 11 - 13 +6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA. Screening for complications of pregnancy can best be carried out @11 - 13 +6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth. In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations). If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. Note: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation - Part 1.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13+6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE:: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation- Part 2.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13+6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

Clinical and imaging predictors for the development of diabetes mellitus following a single episode of acute pancreatitis in youth

BackgroundAcute pancreatitis (AP) increases the risk of diabetes mellitus (DM). Our aim was to identify clinical, laboratory and imaging predictors of preDM/DM in youth post index AP. MethodsThis was a prospective cohort study of patients ≤21 years-old with an index admission for AP and follow up at 3 and/or 12 months. Clinical laboratory values, imaging findings, admission course, and plasma chemokine and cytokine measures collected at index admission were tested for association with preDM/DM development. A multivariable regression model was used to predict preDM/DM. ResultsAmong 187 enrolled participants, 137 (73 %) and 144 (77 %) underwent DM screening at 3 and 12 months respectively, and 137 (73 %) had imaging available. PreDM/DM occurred in 22/137 (16 %; preDM n = 21, DM n = 1) at 3 months and 23/144 (16 %; preDM n = 18, DM n = 5) participants at 12 months. Univariate associations with preDM/DM at 12 months included: severe AP (SAP) (52 % preDM/DM vs. 17 % no DM; p = 0.0008), median [IQR] IL-6 (910 pg/ml [618–3438] vs. 196 pg/ml [71–480], p < 0.05) and CRP (4.16 mg/L [1.67–10.7] vs. 1.55 mg/L [0.4–3.68], p = 0.1) at time of AP attack. The optimal multivariable model to predict preDM/DM included with clinical variables was severe acute pancreatitis (SAP), c reactive protein (CRP), interleukin-6 (IL-6), and age [AUC = 0.80; (0.70, 0.88)]. Including imaging markers, the ideal model included SAP, CRP, IL-6, subcutaneous fat area, age and presence of autoimmune disease with an AUC [0.82 (0.71, 0.90)]. ConclusionsDevelopment of preDM/DM following an index AP episode can be predicted by baseline AP severity, baseline CRP, IL-6 levels, and subcutaneous fat area.

Upper cervical epidural abscess with emphasis on diabetes as a risk factor: a case report

BackgroundAn upper cervical spine epidural abscess (UCEA) is an epidural abscess that develops in the area between the occiput and the second cervical spine (axis). It is a rare diagnosis that carries the risk of instability of the atlantoaxial joint, and its management is not well-defined. It is known that the skin is the most common source of infection, and that diabetes mellitus (DM) is the most frequently reported risk factor. In this case, we present a patient diagnosed with UCEA, who achieved full neurological recovery postoperatively despite having neurological deficits for over five days prior to surgery.Case presentationWe report the case of a 56-year-old male patient with no history of any prior medical conditions, who presented with headache, neck pain, and weakness of the left side. The weakness started approximately three days prior to his presentation. His initial work up revealed hyperglycemia and elevated HbA1c of 86 mmol/mol (10%). Magnetic resonance imaging (MRI) of the cervical spine revealed spondylitis of the C2 spine with an abscess at the craniocervical junction. He underwent a two-staged surgical approach: decompression and stabilisation. The patient achieved full motor recovery approximately three months postoperatively.ConclusionsWe recommend screening for DM when a spinal epidural abscess (SEA) is diagnosed without readily identifiable risk factors. The optimal management in most SEA cases is surgical, which is particularly true for UCEA because of the risk of atlantoaxial joint instability. Full neurological recovery is possible even when the patient has been having deficits for more than five days.

Problems in screening for gestational diabetes mellitus by measurement of casual blood glucose levels at 24-28 gestational weeks.

This study aimed to evaluate the problems in screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) measurements at 24-28 gestational weeks. Overall, 763 pregnant women who underwent the 50-g glucose challenge test (GCT) at 24-28 gestational weeks were enrolled. The preload blood glucose (0-h BG) level of 50-g GCT was considered as CBG. A total of 240 women with BG levels at 1-h after loading (1-h BG) on 50-g GCT ≥140 mg/dL underwent the 75-g oral glucose tolerance test, and 98 (40.8%) were diagnosed with GDM. Of the 99 women with GDM, 71 (71.7%) had 0-h BG on 50-g GCT <100 mg/dL. This study, where pregnant women underwent both CBG and 50-g GCT simultaneously, showed that when CBG at 24-28 gestational weeks ≥100 mg/dL alone was used for screening GDM, many pregnant women with GDM were overlooked.

Elevated risk of pre-diabetes and diabetes in people with past history of COVID-19 in northeastern Nigeria

BackgroundAn increased risk of diabetes mellitus (DM) after COVID-19 has been reported in the United States, Europe, and Asia. The burden of COVID-related DM has yet to be described in Africa, where the overall risk of DM has been increasing rapidly. Our objective was to compare the prevalence of pre-DM and DM in Nigerian individuals with a history of COVID-19 to individuals without known COVID-19 infection.MethodsWe undertook a retrospective cohort study with 256 individuals with a past medical history of COVID-19 with no history of pre-DM or DM and 256 individuals without a history of COVID-19 or pre-DM/DM. Participants were categorized as pre-DM (fasting capillary glucose 100–125 mg/dL) or DM (fasting capillary glucose ≥ 126 mg/dL). We employed univariate and multivariable logistic regression to identify key predictors and adjust for confounders related to hyperglycaemia risk factors. Additionally, we used multinomial logistic regression to analyze the relationship between COVID-19 history and diabetes status, distinguishing between normal, pre-diabetic, and diabetic glucose levels. All models were adjusted for age, gender, hypertension, physical activity, central adiposity, and family history of DM.ResultsCompared to the control group, those with a history of COVID-19 had a similar median age (38 vs. 40 years, p = 0.84), had a higher proportion of men (63% vs. 49%), and had a lower prevalence of central adiposity (waist: hip ratio ≥ 0.90 for males and WHR ≥ 0.85 for females) (48% vs. 56.3%, p = 0.06). Of the 256 with a history of COVID-19, 44 (17%) required in-patient care. The median (interquartile range) time interval between COVID-19 diagnosis and the glycaemic assessment was 19 (IQR: 14, 24) months. Pre-DM prevalence was 27% in the post-COVID-19 group and 4% in the control group, whereas the prevalence of DM was 7% in the post-COVID-19 group and 2% in the control group. After multivariable adjustment, the odds of pre-DM were 8.12 (95% confidence interval (CI): 3.98, 16.58; p < 0.001) higher, and the odds of DM were 3.97 (95% CI: 1.16, 13.63) higher in those with a history of COVID-19 compared to controls. In the adjusted multinomial logistic regression analysis, individuals with a history of COVID-19 exhibited significantly elevated risks for pre-diabetes (RRR = 7.55, 95% CI: 3.76–15.17) and diabetes (RRR = 3.44, 95% CI: 1.01–11.71) compared to those without COVID-19.ConclusionPrevious COVID-19 was found to be a risk factor for prevalent pre-diabetes and diabetes mellitus in Nigeria. More intensive screening for DM in those with a history of COVID-19 should be considered.

High proportion of undiagnosed diabetes in patients surgically treated for infrarenal abdominal aortic aneurysm: findings from the multicentre Norwegian Aortic Aneurysm and Diabetes (ABANDIA) Study

BackgroundThe aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair.MethodsIn this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models.ResultsThe total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005).ConclusionTwenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.

ThP6.5 - Anorectal Abscess and Diabetes Mellitus: An Overlooked Association?

Abstract Aims Patients with anorectal abscesses often require treatment from Emergency General Surgery. Prior European epidemiological studies report 6% of patients with anorectal abscesses have diabetes mellitus (DM). This study primarily quantified prevalence of DM, and secondarily, adherence to the WSES-AAST anorectal emergencies guidelines, which recommend routine HbA1c and serum glucose testing. Methods A retrospective analysis identified all surgically managed patients with anorectal abscesses at an urban DGH over a two-month period from 1st December 2023. Data were collected on demographics, existing DM status, HbA1c and blood glucose testing from the electronic health record. Results The study included 17 patients, 59% male (10/17), with a mean age of 45 years (range 20-72). Among the group, 4/17 (24%) had a known DM diagnosis. Only 2/13 (15%) without a pre-existing DM diagnosis underwent DM testing. No new cases of DM were diagnosed. HbA1c and serum glucose testing were performed more commonly in patients with known DM compared to those without a prior diagnosis, but not significantly (3/4 vs 2/13, p=0.09). Conclusions The proportion of anorectal abscess patients with DM in our study is markedly higher than previously reported in the literature. Compliance with DM testing guidelines is poor, and the causes are uncertain. Routine DM screening for anorectal abscess patients could lead to earlier detection and improved outcomes. The actual incidence of newly detected DM in this patient group remains unknown due to inadequate testing, underscoring the need for further research to evaluate the real-world benefit and cost-effectiveness of following diabetes detection guidelines in these patients.