Diabetes Outpatient Department Research Articles

Determinants of Type 2 Diabetes Mellitus among Children and Adolescents Attending A Tertiary Specialized Hospital in Bangladesh

Background: Type 2 diabetes in children and adolescents has increased in frequency around the world over the past two decades. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes in children and adolescents. Objective: To observe the determinants of type 2 diabetes mellitus among children and adolescents attending a tertiary specialized hospital in Bangladesh. Methods: This cross-sectional, descriptive study was done on a total of 151 children and adolescents attending the pediatric diabetic outpatient department (OPD) of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh. The sampling technique was purposive. All patients who came to the hospital between July to December 2017 were included. Data was collected through a structured questionnaire. Results: Among 151 respondents, 98 were in the age group of 10-14 years (64.9%), female to male ratio of 1.22:1. The majority belonged to a high used to lead socio-economic class. Regarding food habits, 55.6% had a history of eating fast food regularly and used to lead a sedentary lifestyle with a lack of exercise. 43.7% of children and adolescents were obese 76.8% had high cholesterol and 84.1% had high triglyceride levels. Most of the children had a positive family history of type 2 diabetes mellitus (74.8%). Conclusion: Our study reflects that determinants like obesity, physical inactivity, eating habits, and family history are important factors in the development of type 2 diabetes mellitus in children and adolescents. Mugda Med Coll J. 2023; 6(2): 51-56

Status of lipid control in Bangladeshi subjects with type 2 diabetes mellitus on lipid-lowering drugs: a multicenter, facility-based, cross-sectional study

BackgroundAchievement of lipid targets is crucial in patients with type 2 diabetes mellitus (T2DM) to mitigate the risk of cardiovascular diseases (CVD). Data on lipid-control status among patients with T2DM in Bangladesh are scarce. This study was conducted to determine the lipid-control status among patients with T2DM who were on lipid-lowering drugs in the country.MethodsThis cross-sectional study was conducted in the diabetes outpatient departments of several tertiary hospitals in Bangladesh from January 2022 to December 2022. Adults of both sexes diagnosed with T2DM for at least one year and were on the lipid-lowering drug(s) for a minimum of 3 months were included in the study by consecutive sampling. Patients’ data were collected by face-to-face interviews, and blood samples were collected for fasting lipid profile. The lipid target was set at < 200 mg/dL for total cholesterol (TC), < 150 mg/dL for triglyceride (TG), < 100 mg/dL for low-density lipoprotein cholesterol (LDL-C), > 40 mg/dL for high-density lipoprotein cholesterol (HDL-C), and < 160 mg/dL for non-HDL cholesterol (non-HDL-C).ResultThree thousand sixty patients (age 44.7 ± 13.3 years, female 57%) with T2DM were evaluated. Overall, almost 81% of the study subjects achieved the LDL-C target. Besides, TC, TG, HDL-C, and non-HDL-C targets were achieved by 40.8, 21.6, 66.3, and 44.1% of patients, respectively. However, all the lipid parameters were under control in only 8.8% of patients. Almost 77.6% of the patients with ischemic heart disease, 81.5% of patients with stroke, and 65% of patients with CKD had LDL levels < 70 mg/dL. Only 10.03% achieved the HbA1c target of < 7%. 7.4% of patients achieved both HbA1c < 7% and LDL < 100 mg/dL and 5% achieved both HbA1c < 7% and LDL < 70 mg/dL. Advanced age (aOR 0.97, 95% CI 0.96, 0.98, p < 0.001), longstanding T2DM (aOR 0.53, 95% CI 0.39, 0.72, p < 0.001), and non-statin therapy (aOR 0.25, 95% CI 0.16, 0.37, p < 0.001) were negatively associated with lipid control (LDL < 100 mg/dL) while using oral hypoglycemic drugs or insulin (aOR 2.01, 95% CI 1.45, 2.77, p < 0.001) and having cardiovascular comorbidity (aOR 3.92, 95% CI 3.00, 5.12, p < 0.001) were positively associated with lipid control.ConclusionThough most patients with T2DM achieved their target LDL level, the prevalence of both glycemic and overall lipid control was low in our study despite lipid-lowering therapy.

Altered Liver Function Test in Type 2 Diabetes Mellitus Subjects and its Association with Dyslipidaemia and Fasting Blood Sugar: A Cross-sectional Study

Introduction: Multiple organ systems are affected due to the metabolic dysregulation associated with Diabetes Mellitus (DM). Altered lipoprotein metabolism and liver enzymes have been identified as independent risk factors for the development of Cardiovascular Disease (CVD). Routine screening of liver function and ultrasound imaging of the liver should be done at the time of diagnosis of type 2 DM and thereafter at regular intervals. Aim: To determine the association between liver function parameters and glycemic status in type 2 diabetics. Additionally, the study aimed to correlate liver enzymes and lipid profiles in Type 2 DM patients. Materials and Methods: A cross-sectional study was conducted from August 23rd, 2021 to October 23rd, 2021 on 100 Type 2 diabetic patients attending the diabetic Outpatient Department of Biochemistry, at Annapoorana Medical College and Hospital, Salem, Tamil Nadu, India. Fasting glucose, total cholesterol, triglyceride, and High-Density Lipoprotein Cholesterol (HDL) were measured using the direct enzymatic method, while LowDensity Lipoprotein Cholesterol (LDL) was calculated using Friedewald’s formula. Total bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), total protein, and albumin were analysed using the ERBA EM-200 auto analyser based-on the wet chemistry principle. Pearson’s correlation analysis was performed to examine the relationship between variables. Results: Among the total of 100 type 2 diabetic patients who participated in present study, 59 were males and 41 were females. The mean±SD age of diabetic patients was 51.23±10.810 years, ranging between 35 and 76 years. The frequency of altered liver enzymes in the study sample was found to be 33, with 25 being males and 8 being females. The mean fasting blood sugar levels with normal liver function and abnormal liver function were observed to be 128.37±13.16 mg/ dL and 133.79±15.68 mg/dL, respectively, but the difference was not statistically significant. The mean values of total cholesterol, triglyceride, and low-density lipoprotein with normal liver function were observed to be 137.18±34.44 mg/ dL, 175.12±65.19 mg/dL, and 75.55±9.78 mg/dL, respectively, while with abnormal liver function, they were observed to be 196.05±52.67 mg/dL, 143.28±47.63 mg/dL, and 138.83±38.11 mg/dL, respectively, showing statistical significance. Conclusion: The present study found a strong association between deranged liver enzymes with fasting blood sugar and dyslipidaemia.

Epidemiological factors affecting outpatient department service utilization and hospitalization in patients with diabetes: A time-series analysis from an Ethiopian hospital between 2018 and 2021.

BackgroundThe burden of diabetes-related deaths reached two million in 2019 globally. Accessibility to health care services and adherence to follow-up and therapy are key to improving outcomes for diabetic patients. We aimed to assess outpatient department (OPD) service utilization and diabetes-related hospitalizations over a period of 44 months.MethodsA retrospective cohort study was conducted on OPD visits and hospitalizations recorded between January 1, 2018, and August 31, 2021, at the St Luke Catholic Hospital (Ethiopia). All diabetic patients were included in the analysis. A linear regression model was used for univariate analysis of OPD visits and hospitalizations and their association with potential predictors. The autoregressive integrated moving average (ARIMA) method was applied to both the time series of OPD visits and hospitalizations. Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature and precipitations.ResultsIn the time series analysis, OPD visits increased over time (P < 0.01) while hospitalizations were stable. The time series model was ARIMA (0,1,1) for OPD visits and ARIMA (0,0,0) for hospitalizations. There were 1685 diabetes OPD patients (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (P < 0.01) and a lower number of hospitalizations per month (P = 0.03). There were 801 patients missing follow-up (48%). The time between follow-up increased with age (P < 0.01). OPD visits decreased differently by geographic area as COVID-19 cases increased (P < 0.01). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. The odds ratio (OR) of new diagnosis at hospitalization was lower in patients with type 2 diabetes (OR = 0.26, 95% CI = 0.14-0.49, P = 0.02).ConclusionsDespite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Female sex, older age, and COVID-19 were associated with impaired OPD service accessibility. Primary health care should be implemented to achieve better health coverage and improve diabetes management.

Epidemiological factors affecting health service utilization in diabetic patients in Ethiopia

Abstract Diabetes-related deaths reached 2 million in 2019. The highest percentage of undiagnosed diabetes (59.7%) was observed in Africa, where accessibility to health services is pivotal to improving the outcome of diabetic patients. The study aims to assess the association between diabetic patients’ epidemiological factors and accessibility to healthcare services in a low-income country. The retrospective cohort study included diabetes-related outpatient department (OPD) visits and hospitalizations from 01/01/2018 to 31/08/2021 at St Luke Hospital (Ethiopia). Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature, and precipitations. The ARIMA method was applied to OPD visits and hospitalizations time series. OPD visits increased over time (p &amp;lt; 0.001) while hospitalizations were stable. The time series model was ARIMA(0,1,1) for OPD visits and ARIMA(0,0,0) for hospitalizations. Diabetes OPD patients were 1,685 (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (p = 0.002). Patients missing follow-up were 801 (48%). The time between follow-ups was longer as age increased (p &amp;lt; 0.001). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. OPD visits decreased differently by geographic area as COVID-19 cases increased (p &amp;lt; 0.001). Hospitalized patients for diabetes were 408, 85 (20.8%) newly diagnosed. The odds ratio (OR) of diagnosis at admission was lower as age increased (OR 0.98, p = 0.009). Compared to type 1 diabetes, hospitalized females with type 2 (117-39.7%) were fewer than males (p = 0.019). Readmissions were 52, 10 (19.2%) within 30 days, without OR difference by sex, age, or diabetes type. Despite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Gender and age influenced service utilization. Females’ access to care is still problematic (concept of “missing women”). Key messages • Primary health care should be implemented to improve access to health services and diabetes management. • Ensuring equity in healthcare accessibility should be a priority in low-income countries.

A Cross-Sectional Study of Electrophysiological Changes Occurring in Type II Diabetes Mellitus.

BackgroundDiabetes is a long-term metabolic condition that results in high blood sugar levels from either reduced insulin production or diminished tissue sensitivity to insulin. Peripheral neuropathy is the most frequent consequence of diabetes. In this research project, with the aid of neurophysiological measures, we conducted a cross-sectional study to examine the impact of glycemic management on the physiological functioning of nerves, regardless of the duration of diabetes.ObjectivesThe main objective of the study was to investigate the association between the degree of glycemic control and the severity of neurological changes. The study also aimed to clarify whether glycemic management, independent of the duration of diabetes, acts as an independent risk factor for the emergence of diabetic neuropathy.MethodologyA total of 150 type 2 diabetic patients visiting the diabetic outpatient department were included in the study. The patients were divided into two groups: group A consisted of 90 subjects with HbA1c levels <10 and group B comprised 60 subjects with HbA1c levels >10. In the neurophysiology lab, an electrodiagnostic exam was conducted on the sensory (sural nerve) and motor (tibial nerve) parameters. Data on the neurophysiological parameters of the two groups were analyzed and compared.ResultsWhen the neurophysiological parameters of the two groups (group A having HbA1c <10 and group B having HbA1c >10) were analyzed, it was observed that group B had lower conduction velocity (CV) and amplitude potential than group A, with a significant statistical difference (p<0.05). It was also observed that sensory parameters were more affected than motor parameters.ConclusionBased on our findings, glycemic control is related to the severity of neuropathic changes.

Association of Age, Gender and Type of Diabetes with Thiamine Level: A Cross-Sectional Analysis

Objective: Diabetes Mellitus has been observed to be related with low thiamine levels in the body, as it affects directly on carbohydrate metabolism. Therefore, this study was intended to assessdemographic characteristics and serum thiamine levels in type I and type II diabetic patients and healthy control group.&#x0D; Methodology: This was a case-control study carried out in diabetic outpatient department (OPD) of Urban Health Center and New Karachi, Hospital. The duration of the study was about six months after approval of synopsis. The study sample included 90 participants and divided into three groups, 30 participants each in the control, type I diabetes and type II diabetes groups. Patients with type I and II diabetes mellitus of both genders with age &lt; 25 to &gt; 46 years were included in the study. One Way ANOVA was applied to find out the significance of differences among the groups.&#x0D; Results: The study results showed that out of 90 participants, 33(36.7%) were males and 57(63.3%) were females; 1(1.1%) of them had low thiamine level, 17(18.9%) had normal thiamine level whereas 72(80.0%) had high thiamine level. It was observed that significant association found between thiamine levels and age groups (p&lt;0.001). Furthermore, 18(60.0%) had Low/Normal thiamine level and 12(40.0%) had high thiamine level in type I diabetes patients while 30(100%) in control group and Type II Diabetic patients had high thiamine level with significant association between them (p&lt;0.001). On the other hand, an insignificant association was found between gender and low and high thiamine levels (p=0.743).&#x0D; Conclusion: This study concluded that both the age and group types were significantly associated with thiamine levels of the participants. Furthermore, type I Diabetes patients had significantly lower thiamine levels as compared to type II Diabetes and controls. On the other hand, there was no significant relationship of gender with thiamine levels.

IDF21-0515 Clinical characteristics of T2DM patients diagnosed with HFpEF: An Indian pilot survey

Background: Heart failure with preserved ejection fraction (HFpEF) represents a significant unmet medical need and is associated with poor outcomes. Registry evidence suggests a mortality-rate of 40.8% at 3 years, in Indian patients with HFpEF. Timely diagnosis of HFpEF in patients with predisposing factors and indicators, is essential in improving care. Aim: The clinical profile of patients with HFpEF, is known to be different in South-Asian patients, as compared to other Asian or global population. This is a real-world analysis of patients with T2DM and co-existing HFpEF, in the Indian diabetes outpatient-setting. Method: A cross-sectional analysis of patient-records was performed across 3 diabetes outpatient departments across the cities of Kolkata and Mumbai, in India. Records of patients with T2DM and HFpEF, as defined in the recent guidelines were included for analysis. Clinical characteristics of patients were descriptively analyzed. For categorical variables, unpaired t-test was used, whereas for non-parametric variables, odds ratio was estimated. Results: Records of 99 patients with HFpEF and T2DM, were available for analysis. The age ranged from 45 to 87 years, with average age being 66.3 (SD 9.3) years. 22% of patients were aged <60 years. 48% of patients were females. Of the 97 patients with available information for duration of diabetes, the average duration was 14.1 (SD 7.6) years. 26% patients had T2DM of <10 years’ duration. The average BMI was 26.7 (SD 4.8) kg/m2. 57% of patients were obese. 34% of females and 50% of males had a history of IHD. History of atrial fibrillation was present in 9% of patients. The average age of patients with and without A-Fib was 72.7 (SD 6.0) years, and 65.7 (SD 9.4) years, respectively; the difference in mean was significant (p = 0.034). Mean SBP was 140.5 (SD 19.0) mmHg. SBP level of ≥130 mmHg was observed in 76% of patients, and ≥140 mmHg was observed in 53.5% of patients. The average NT-proBNP LEVEL was 1235.4 pg/mL. The NT-proBNP levels ranged from 51 to 23000 pg/mL. 44 (47%) had eGFR level <60 mL/min/1.73m2. Average HbA1c level was 8.1% (SD 1.95%). 78% of patients had LDL-c level <100 mg/dL, whereas 46% had LDL-c level <70 mg/dL. Discussion: The analysis represents clinical characteristics of patients with HFpEF, in the clinical setting of T2DM in India. Despite HFpEF being strongly associated with old age, we observed at-least 1 in 5 patients to be <60 years old. Of note, 43% of patients with HFpEF were not obese. Blood-pressure control remained inadequate, despite good control of HbA1c and LDL-cholesterol levels. It is essential to suspect and screen for underlying HFpEF in patients having these comorbidities with T2DM, and to aggressively manage the risk-factors, keeping in mind the possible inconsistencies like younger-age or lower BMI in substantial number of patients.

Bacteriological Profile of Diabetic Foot Ulcers and Detection of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum β-Lactamase Producers in a Tertiary Care Hospital.

IntroductionDiabetic foot infection is the most dreaded complication of diabetes mellitus and the commonest cause of hospitalization and limb amputation. Identification of the causative agent responsible for diabetic foot infection and the earliest initiation of appropriate antimicrobial therapy are vital for the control and prevention of the complication of diabetic foot ulcers. Therefore, we conducted this study to determine the bacteriological profile of diabetic foot ulcers and to detect methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producers in our institute.MethodologyDuring the study period, samples were collected from the foot ulcers of 100 patients at the Diabetic Outpatient Department. The samples were processed according to the standard laboratory protocol, and bacterial isolates were identified. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion technique, and results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (CLSI 2016). A phenotypic test for MRSA detection was performed using cefoxitin (30 μg) disk. ResultsThe highest incidence of diabetic foot ulcers was observed in patients aged 41-50 years. There were 83 men and 17 women, with a male to female ratio of 4.882. Of the 100 collected samples, 73 were positive for microbial growth, and 27 samples showed no growth. Of the 73 positive cultures, monomicrobial infection was found in 48 patients, and polymicrobial infection was found in 25 patients. Gram-positive pathogens were isolated from 34 patients, and gram-negative microbes were isolated from 64 patients. Among all collected isolates (n=100), Staphylococcus aureus was the most predominant organism and Acinetobacter species was the least common (only two isolates). Among the gram-negative bacteria, Pseudomonas aeruginosa was predominant. All the isolated gram-positive bacteria were susceptible to vancomycin. Gram-negative bacteria were highly susceptible to colistin with the exception of Proteus species which is intrinsically resistant to colistin and it is not reported for Proteus species. ESBL producers were primarily found among Klebsiella species isolates (22.22%). Among 29 S. aureus isolates, 8 (27.5%) were found to be MRSA producers.ConclusionBased on the bacteriological profile of diabetic foot ulcers, S. aureus among the gram-positive isolates and P. aeruginosa among the gram-negative isolates were the predominant pathogens. Infections caused by multidrug-resistant bacteria such as MRSA and ESBL producers have been reported with increasing frequency. According to the antibiotic susceptibility pattern, treatment can be initiated, continued, or altered, thereby reducing morbidity in patients with diabetic foot ulcers.

English

BACKGROUND India is one of the countries which has seen a rise in diabetes mellitus type 2 patient in last 2 decade. It is a known fact that patients suffering from diabetes mellitus have risk of developing many diseases like angiopathies and retionopathies. . The purpose of this study was to assess cardiovascular disease (CVD) risk factors and find out current clinical practices for prevention of cardiovascular diseases in diabetes type 2 patient attending diabetes out-patient department (OPD). METHODS This is a cross sectional study on 96 randomly selected patients who were diagnosed for diabetes mellitus type 2 for more than 3 months. CVD risk factors were studied using structured questionnaire about sociodemographic factors such as age, gender, family history, dyslipidaemia, hypertension, inactive physique, unsuitable food, excessive use of alcohol and all types of cigarettes; current medicines [anti-platelet medication, statins, angiotensin blocker, angiotensin converting enzyme inhibitors (ACEI)]; history of diabetes or CVD; time since diabetes is diagnosed; average number of times or frequency of follow-up and physical activity visits to health centres. RESULTS Present study shows abdominal obesity (84 %), unhealthy diet (86 %), physical inactivity (81%), dyslipidaemia (n = 68, 70.83 %), uncontrolled diabetes (63 %), hypertension (50 %) and age more than 60 years (41%) as the major cardiovascular diseases risk factors. Use of anti-platelet was present in 55 %; 74 % of hypertensives were using angiotensin receptor blockers (ARBs)/ACEI; 63 % of dyslipidaemia patients were using atorvastatin. This study showed that lifestyle modification has a sustained effect in preventing cardiovascular risk factors in type 2 diabetes patient. CONCLUSIONS Behavioural risk factors like unhealthy diet, physical inactivity, control of hypertension and hypercholesterolemia is a cause of concern in diabetes patient for preventing cardiovascular risk factor. KEY WORDS Type 2 Diabetes Mellitus, Clinical Practices and CVD Prevention.

Serum Testosterone Level in Type 2 Diabetes Mellitus

Aim: To determine the serum testosterone levels in the type 2 diabetes mellitus and its correlation with biochemical parameters of glycemic and lipid metabolism.&#x0D; Methodology: A cross sectional study was conducted at Department of Biochemistry and Department of Medicine, A cross sectional study was conducted at the Department of Biochemistry, Diabetic outpatient department and Department of Medicine, Liaquat University Hospital. Male type 2 diabetics (n=100) and age matched male (n=100) were included as cases and control for study purpose. Diagnosed cases of type 2 DM, male gender and 40 – 60 years of age were included in the study protocol. Physical examination of male type 2 diabetics was performed by a consultant physician. Sera were separated from blood and stored in refrigerators at – 200C. Blood glucose, A1C, and blood lipids (cholesterol, triglycerides, LDLc and HDLc) were detected by standard laboratory methods. Serum testosterone was measured by ELISA (competitive immuno- assay) assay commercial kit. Data was entered in Statistical software SPSS 21.0 version (IBM, Incorp, USA) for statistical analysis (P≤0.05).&#x0D; Results: Mean±SD age of male type 2 diabetics was 53.2 ± 11.1 years compared to 54.5±10.4 years in control (P=0.056). Serum Testosterone in cases was 10.85±4.7 mmol/L compared to 13.39±3.8mmol/L in control (P=0.0001). Low testosterone level was noted in 46% male.Serum Testosterone shows inverse correlation with RBG (r= -0.31, P=0.003), A1C (r= -0.23, P=0.014), Cholesterol (r= -0.24, P=0.014), TAGs (r= --0.78, P=0.0001) and HDLc(r= -0.70, P=0.0001). Serum testosterone proved positively correlated with LDLc(r= 0.670, P=0.0001).&#x0D; Conclusion: The present study finds low serum testosterone in male type 2 diabetes mellitus patients

Prevalence of Insulin Receptor Substrate-1 Gene (G972R) Polymorphism, Insulin Resistance, and Determination of β-Cell Function among Overweight and Obese Persons with Type 2 Diabetes Mellitus.

BackgroundType 2 diabetes mellitus (T2DM) is the most common metabolic disorder and its pathogenesis is characterized by a combination of peripheral insulin resistance and impaired insulin secretory capacity of pancreatic β cell. Genetic predisposition interacts with environmental factors including diet, physical activity, and age leading to the development of diabetes.ObjectiveTo determine the proportion of overweight and obese persons with type 2 diabetes and to compare the fasting blood sugar, fasting serum insulin, insulin resistance and β-cell function in G972R carrier and non-carrier overweight and obese persons with type 2 diabetes.MethodologyOne hundred overweight and obese patients with T2DM were recruited from persons with diabetes attending the Diabetes Outpatient Department of Yangon General Hospital. History taking and physical examination were done and blood samples were collected. Plasma glucose level was determined by the glucose oxidase method and fasting serum insulin was measured by enzyme linked immunoassay (ELISA) kit method. Polymerase chain reaction and Restriction Fragment Length Polymorphism were done for genetic polymorphism.ResultsAmong 100 overweight and obese subjects with T2DM, 81 patients were of homozygous (G/G) genotype, 18 patients were of heterozygous (G/A) and only one patient of homozygous (A/A) genotype. There was no statistically significant difference in the proportion of genotypes between overweight and obese subjects with T2DM.There was no significant difference in fasting blood sugar (FBS), fasting serum insulin, HOMA-IR, β-cell function, lipid parameters between IRS-1 (G972R) carriers and non-carriers. There is significant negative correlation between insulin resistance and TG level (r2=0.0529, p=0.01).ConclusionIt was concluded that IRS-1 G972R polymorphism was not important in insulin resistance, β-cell function and lipid parameters in overweight and obese T2DM. There could be a number of candidate genes in the pathophysiology of diabetes mellitus, genetic sequencing of IRS-1 and other genes in the insulin signaling pathway, and finding out the alteration in their genetic patterns would provide clues for the association of the site-specific polymorphisms of these genes with insulin resistance in T2DM.

CORRELATION BETWEEN SERUM MAGNESIUM AND LIPID PROFILE IN DIABETIC PATIENTS AND ITS ASSOCIATION WITH COMPLICATIONS.

Background and aim: The present study was conducted to evaluate serum Magnesium and lipid prole in diabetic patients and to nd out any correlation between serum magnesium and lipid prole in diabetic patients and its association with complications. Material and Methods: In the present study, 70 diagnosed Type 2 diabetes mellitus patients aged &gt;30 years attending Diabetic Outpatient and Inpatient Department at Vivekananda Polyclinic giving their consent for inclusion were considered to be included in the study as Cases. Results:In present the study, mean S. magnesium levels of patients with diabetic complications were found to be signicantly lower (1.09±0.22 mg/dl) as compared to that of patients in whom no diabetic complications were seen (2.19±0.71) and this difference was signicant statistically.Conclusions: In the diabetic population correlations of serum magnesium and Total cholesterol, triglyceride, LDL and VLDL were Mild while HDL was of moderate level. Among controls correlations of Serum Magnesium with Total cholesterol, triglyceride, LDL, VLDL, and HDL were found to be weak and not found to be statistically signicant.

Follow-up and treatment pattern during Ramadan and evaluation of the outcome of Ramadan fasting on clinical, biochemical and metabolic parameters in patients with type 2 diabetes mellitus: a realworld, multi-center, prospective observational study

Background: There are variable effects of Ramadan fasting on clinical and biochemical variables of diabetic people. Anti-diabetic agents are often adjusted during this time to reflect changes in lifestyle. The study was conducted to understand the diversity of follow-up, treatment pattern, clinical, and biochemical outcome of Ramadan fasting among type 2 diabetic patients who observed Ramadan fast.&#x0D; Methods: This real-world, multi-center, prospective, observational study was conducted at the diabetes outpatient department of National Healthcare Network (NHN) Uttara Center of Bangladesh Diabetic Somity (BADAS), Dhaka, Bangladesh and outpatient department of MARKS Hormone and Diabetes clinic, MARKS Medical College &amp;Hospital in Dhaka, Bangladesh upon randomly selected type 2 diabetic patients, recruited 1 to 12 weeks prior to the Ramadan and followed up till 12 weeks post-Ramadan period. Finally, a total of 271 participants completed satisfactory follow up. Data was collected before, during, and after Ramadan using a set of questionnaires in a face to face interview.&#x0D; Results: The majority (80.1%) of participants received pre-Ramadan education, counseling, adjustment of medication and other direction to help them cope with Ramadan fasting. A significant reduction of weight, body mass index (BMI)) and blood pressure were reported after Ramadan fast (p&lt;0.001). None of the studied participants experienced severe hyper/hypoglycemia or acute complications requiring hospitalization or an emergency room visit. Metformin was the commonest prescribed anti-diabetic medication. Premixed insulin was the commonest insulin regimen during study period. Three most commonly adjusted oral anti-diabetic drugs were gliclazide, glimepiride, metformin and insulin doses were also adjusted. Mean of fasting and prandial capillary blood glucose decreased from pre-Ramadan period to post-Ramadan period (P&lt;0.05). HbA1c decreased during post-Ramadan period compared to pre-Ramadan visit (P=0.13). A significant reduction in the triglyceride level was observed during post-Ramadan follow up (P&lt; 0.05).&#x0D; Conclusion: The study revealed that a safe fasting can be observed with proper pre-Ramadan work-up. Ramadan fasting resulted into significant reduction of weight, BMI, blood pressure, lipid profile and improved glycemic status in patients with type 2 diabetes.&#x0D; Birdem Med J 2021; 11(1): 30-38

FREQUENCY OF DENTAL CARIES IN TYPE 2 DIABETICS VERSUS NON- DIABETICS A CROSS- SECTIONAL STUDY IN PRIVATE HOSPITALS OF KARACHI

Objective:&#x0D; The current study was conducted to assess the frequency of dental caries in type 2 diabetics versus non-diabetics.&#x0D; Materials and Methods:&#x0D; A cross sectional study was conducted from August2018-October 2018 amongst Type II Diabetics and non- diabetics attending the Diabetic Outpatient Department (OPD) in Baqai Institute of Diabetology, Nazimabad and out -patient Department of Oral Diagnosis, Baqai Dental College. The sample size was estimated using Open Epi version 3.03a by taking 27% prevalence rate with 95% confidence interval and α =5%. The sample size calculated is 300.A consecutive sampling method was done and 150 patients with type II diabetes and 150 non- diabetic patients were examined. Data was analyzed using SPSS (Statistical Package for Social Sciences) version 22.&#x0D; Results:&#x0D; The frequency of dental caries in type II diabetic patients was found to be 42.7% and 42% in non-diabetic patients. The results were statistically significant. &#x0D; Conclusion:&#x0D; There is an association between dental caries and type II diabetes mellitus but there was less difference reported in prevalence of dental caries amongst diabetics and non- diabetics.

Octenidine dihydrochloride dressing versus saline dressing in diabetic foot ulcers: a prospective comparative study

Background: Diabetic foot ulcers (DFU) are commonly encountered during clinical practice and are often difficult to treat. The aim of this study was to evaluate the effectiveness of octenidine dihydrochloride dressing and saline dressing in healing diabetic foot ulcers. Methods: A total of 50 patients (25 patients in each group of octenidine dihydrochloride and saline dressing group) with complaints of chronic diabetic foot ulcer attending surgery outpatient department of Sri Ramakrishna Hospital were included in this prospective comparative study from September 2018 to November 2019. Dressings were done on daily basis for a period of 6 weeks, and the results were compared on 2nd, 4th and 6th week, using reduction in surface area of the wound as parameter of healing process. Other parameters such as age, gender, associated co morbidities were assessed. Results: The mean surface area of wound in saline group was: baseline- 10.2 sq.cm, 2nd week- 9.8 sq.cm, 4th week- 8.6 sq.cm, 6th week- 7.5 sq.cm; While in octenidine dihydrochloride group was: baseline- 11.8 sq.cm, 2nd week- 9.6 sq.cm, 4th week- 6.8 sq.cm, 6th week- 5.2 sq.cm. After 6 weeks, the mean reduction in surface area of wound is more in the octenidine dihydrochloride dressing group compared with the slaine dressing group and the results are statistically significant at a p

Attitude, practice and its associated factors towards Diabetes complications among type 2 diabetic patients at Addis Zemen District hospital, Northwest Ethiopia

BackgroundThis study aimed to assess the level of attitude, practices, and its associated factors towards complications of diabetes mellitus among type 2 diabetes patients.MethodsAn institution-based cross-sectional study was done on type 2 diabetes patients coming to the diabetes outpatient department at Addis Zemen District Hospital in Northwest Ethiopia. Interviewer-administered structured questionnaires were used to collect data from 402 patients. Multivariable logistic regression was employed to decide on factors related to practices and attitudes towards diabetes complications. AOR with 95% CI and p-value under 0.05 was considered to select significantly associated variables.ResultsTwo-thirds of the study participants (65.2% (95% CI: 60.2, 69.4)) had a good attitude level while less than half of study participants (48.8% (95% CI: 44.0, 53.5)) had a good practice on diabetes complications. Educational status of read and write (AOR = 2.32, 95% CI(1.26, 4.27)), primary school (AOR = 4.31, 95% CI(2.06, 9.02)), high school and above (AOR = 2.79, 95% CI (1.41, 5.50)), and urban residence (AOR = 1.80, 95% CI (1.12 2.91)) were significant factors for good attitude while educational status of read and write (AOR = 1.96, 95% CI (1.06, 3.61)), and high school and above (AOR = 2.57, 95% CI (1.32, 5.02)) were associated with diabetes complication practices.ConclusionsA greater proportion of diabetes patients had a relatively good attitude but poor practice towards diabetes complication preventions. Residence was a contributing variable for a good attitude while the level of education was significantly associated with both practice and attitude. The current study suggests the need for structured educational programs about diabetes complications regularly to improve patient’s attitudes and practice.

Association of Periodontitis With Metabolic Syndrome: A Case-Control Study.

ABSTRACTAim:This study was undertaken to assess the association between periodontitis and metabolic syndrome.Materials and Methods:A case-control study was designed among 100 cases as patients with metabolic syndrome aged 35–74 years, and age- and sex-matched 100 controls as apparently healthy relatives or friends accompanying the cases visiting the diabetic outpatient department at Victoria Hospital, Bengaluru, Karnataka, India, using convenience sampling method. Information related to diabetes, hypertension, and oral hygiene practices was collected. Periodontal health status was measured using community periodontal index. Metabolic syndrome was diagnosed based on the criteria of National Cholesterol Education Program Adult Treatment Panel III. Chi-square test and logistic regression were used for analysis.Results:Significantly more number of cases had shallow pockets 4–5 mm, deep pockets ≥ 6 mm, and also more number of loss of attachment code 1, code 2, code 3, and code 4 compared to controls. Bivariate analysis showed significant association between metabolic syndrome and body mass index, smoking, and tobacco chewing. The association between periodontitis and metabolic syndrome was significant with increased risk of developing metabolic syndrome among the subjects with community periodontal index code 3 and code 4 (odds ratio [OR] = 17) and among the subjects having loss of attachment code 1, code 2, code 3, and code 4 (OR = 12). Association remained significant even after adjustment with other variables (adjusted OR = 6).Conclusion:This study showed significant association between periodontitis and metabolic syndrome. Further prospective and randomized control trials are recommended to assess causal association between these two diseases.

Quality of life of patients with type 2 diabetes mellitus: A cross-sectional study

Background: Diabetes mellitus, a chronic noncommunicable disease, is associated with long-term damage of multiple organ system with its long-term complications and significantly impacts upon the quality of life (QoL) of affected patients. Methods: A survey was carried out on 245 patients during thirty sessions of diabetes outpatient department at multispecialty hospitals, among which 228 patients agreed for the participation. A final survey was carried on 200 patients, whereas 28 patients did not fit into the criteria. Further evaluation was carried out using the World Health Organization QoL-BREF questionnaire in Hindi, English, and Marathi versions. The mean score and total score of domains were calculated to check the QoL of the patients. Results: Almost 72% of the participants mentioned good QoL in physical domain with 18% mentioning average QoL. Around 35% mentioned excellent QoL in psychological domain with 46% mentioning good QoL. Around 55% mentioned good QoL in social domain. Majority of participants mentioned good (23%) to excellent (71%) QoL in environmental domain. The physical domain demonstrated a mean score of 66.6 ± 9.303 (min 44, max 94). The psychological domain demonstrated the mean score of 70.9, ±15.558, (min 5, max 94). The social domain demonstrated the mean score of 75.96, ±15.245, (min 31, max 100). The environmental domain demonstrated the mean score of 82.19, ±13.211, (min 31, max 100). Conclusion: Overall patients mentioned average-to-good QoL in physical, psychological, and social domain, and a majority of patients had good QoL in environmental domain.

MICROORGANISMS ASSOCIATED WITH DIABETIC FOOT ULCERS

Background: Non-traumatic lower limb amputation is the most common devastating complication of diabetes, primarily due to diabetic foot ulcers (DFU) and diabetic foot infections (DFI). DFIs are predominantly polymicrobial and multidrug-resistant (MDR) and results in treatment failure. Aims: The main objectives of the study are to identify the microorganisms associated with diabetic foot ulers. Methods: This was a prospective study at a tertiary care hospital. One hundred patients over the age of 18, having chronic diabetic foot ulcer, and attending the diabetic foot outpatient department were included. Samples of pus were collected from deep wounds and processed using standard techniques for culture Results: One hundred samples were processed and 82 yielded positive cultures. Staphylococcus aureus was the predominant organism, followed by Pseudomonas aeruginosa. Then E coli, Klebsiella and Proteus Conclusion: The organisms causing chronic diabetic foot ulcers were commonly Staphylococcus aureus followed by Pseudomonas aeruginosa