First Diagnosis Of Diabetes Research Articles

Patients' views and experiences of the first community pharmacy-based medication therapy management clinic in the Middle East and North Africa (MENA): A qualitative study.

This qualitative study aimed to describe patients' experiences of a community pharmacy (CP)-based medication therapy management program (MTM). Qualitative, semistructured, face-to-face interviews were conducted with a purposive sample of patients with uncontrolled diabetes who received care at a CP-based MTM clinic. Interviews were conducted in the MTM clinic of Health Kingdom CP in Riyadh City, Kingdom of Saudi Arabia by a research pharmacist using an interview guide. Data collection was continued until data saturation. All interviews were audiorecorded, transcribed verbatim, and analyzed thematically. A total of 16 patients, of whom more than half were male, were interviewed between October 2021 and March 2022. The mean ± standard deviation age of the patients was 52.0 ± 8.9 years, whereas the mean number of years since the first diagnosis of diabetes was 11.2 ± 7.3 years. Three main themes emerged from the interviews: perceived benefits and outcomes of the program, factors driving positive patient experiences, and challenges and recommendations for enhancing MTM service. Generally, patients were satisfied with the quality of advanced care that they received at the clinic and recognized the importance of the pharmacist's role. Furthermore, the program was perceived by patients as an opportunity to transition to a healthier lifestyle. Patients also highlighted a few barriers related to follow-up, such as accessibility, and issues with the service, such as long waiting times. Finally, there were some suggestions for patient improvement. These include expanding the clinic space, initiating educational and follow-up messages, and cooperating with other specialists as required. Patients received the MTM program very positively with noticeable health benefits. Barriers to effective follow-up and care should be addressed before implementing this service in wider community pharmacies in Saudi Arabia and beyond.

Referral Time for Diabetic Retinopathy Screening and Impact on the Visual Acuity of Patients in a Tertiary Hospital

OBJECTIVE: To evaluate the referral time for the screening of diabetic retinopathy (DR) from the initial diagnosis of diabetes to retinal examination. We also compared visual results among groups screened at various duration of referral time.METHODS: This cross-sectional study was conducted retrospectively from medical records for the poorer-seeing eyes of 100 patients with type 2 diabetes from January 2021 to December 2022 at the tertiary eye center. Patients were classified based on the time duration from the initial diagnosis of diabetes to retinal examination or imaging. Visual acuity (VA) and DR stages categorized by the period of referral time were compared among each group.RESULTS: Seventy-five patients (75%) took > 2 months from the first diagnosis of diabetes to DR screening performed by an ophthalmologist. Twenty-three patients (23%) were diagnosed with DR at the first ophthalmic visit; among these, 16 had a referral time of > 2 months. Twelve patients were diagnosed with vision-threatening DR; six of these had diabetic macular edema. The receiver operating characteristic (ROC) curve analysis indicates that patients receiving ophthalmic examination within 91 days from the diagnosis of diabetes likely maintain a best-corrected VA of ≥ 20/50. This recommended period of referral time yielded an area under the ROC curve, sensitivity, and specificity of 70.63%, 61.90%, and 83.33%, respectively.CONCLUSION: In clinical practice, a prolonged period for the first DR screening is relatively common and may result in more patients with vision-threatening DR. Proactive and systematic work should be undertaken to create patient awareness on the importance of detection of asymptomatic and early-stage DR to prevent irreversible visual loss.

6889 Potential Impact of Parental Origin of Inheritance in Presentation of Familial Partial Lipodystrophy

Abstract Disclosure: D. Gilio: None. M.C. Foss de Freitas: Advisory Board Member; Self; PTC Therapeutics. Speaker; Self; Amryt. O. Besci: None. M. Celik Guler: None. A. Neidert: None. I. Yildirim: None. B. Akinci: Advisory Board Member; Self; Amryt. Consulting Fee; Self; Regeneron Pharmaceuticals, Alnylam Pharmaceuticals, Amryt, AstraZeneca, Boehringer Ingelheim, Lilly, MSD, Novartis Pharmaceuticals, Novo Nordisk, Sanofi-Aventis, Servier, Third Rock Ventures. E.A. Oral: Advisory Board Member; Self; Amryt, Regeneron Pharmaceuticals. Consulting Fee; Self; Regeneron Pharmaceuticals, Amryt, Third Rock Ventures. Grant Recipient; Self; Regeneron Pharmaceuticals, Amryt. Research Investigator; Self; Novo Nordisk, Fractyl, Ionis Pharmaceuticals Inc., GI Dynamics, Rhythm Pharmaceuticals. Other; Self; Amryt. Background: Familial partial lipodystrophy Type 2 (FPLD2) caused by autosomal dominant LMNA variants is characterized by partial loss of subcutaneous adipose tissue in the limbs, trunk, and gluteal region with accumulation in other parts of the body, such as the face and neck. It is usually associated with different degrees of insulin resistance and hypertriglyceridemia and body composition patterns. We wanted to know the contributing factors for the different metabolic abnormalities and body composition presentations of FPLD2. We hypothesized that parental inheritance line may be a contributory factor to the expression of the metabolic phenotype and body composition characteristics. Methods: We retrospectively collected clinical data of 77 FPLD2 cases from the Divisions of Metabolism and Endocrinology of 3 different sites: the University of Michigan, the University of São Paulo and The Turkish Lipodystrophy Study Group (TuLip). We further selected 53 published cases curated from 15 studies in the literature. For inclusion of the studies, we used web search tools including PubMed, OMIM and Google Scholar. Only patients where we could assess the genetic inheritance were included in this study. Data collected included demographic information, medical history and laboratory results. Results: 79 patients inherited the LMNA variant from the mother (Group 1; 18 males and 61 females), and 51 patients inherited it from the father (Group 2; 14 males and 37 females). The median age at lipodystrophy diagnosis was lower in Group 1 than in Group 2. Diabetes was reported in more than half of the groups; however, the prevalence rates were not significantly different. The mean age (± SEM) at first diagnosis of diabetes was 30 ± 15 years in Group 1 and 32 ± 11 years in Group 2; the microvascular complications were present in 8 patients with diabetes in Group 1 (36.3%) and in 5 patients in Group 2 (23.8%). Both groups' mean triglycerides levels were >150 mg/dL, with a trend of higher triglycerides in Group 2 than in Group 1. Episodes of acute pancreatitis were identified in 9 patients (19.5%) of Group 1 and 10 patients (31.2%) of Group 2; however, patients in Group 1 showed 1.7 episodes of pancreatitis per person while Group 2 showed 8.1 episodes per person on average. The fatty liver disease was the most common liver abnormality identified and it seemed to be more frequent in Group 2 than in Group 1. There was no difference between the two groups in relation to the body mass index (BMI) and the ratio of percent fat mass of the trunk to percent fat mass of the legs (FMR); however, the DEXA (dual x-ray absorptiometry) showed a higher total fat mass in Group 1 compared to Group 2 (22.2 versus 17.3 Kg, p=0.040) in the presence of comparable total lean mass. Conclusion: Our data suggest that there is a difference in body fat mass according to the genetic inheritance, however the metabolic impact is not completely clear and require more detailed analysis. Presentation: 6/1/2024

Comparison of clinical characteristics and treatment outcomes between initially diagnosed type 1 and type 2 diabetes mellitus patients presenting with diabetic ketoacidosis

ObjectivePatients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) can present with diabetic ketoacidosis (DKA) as the first manifestation. Differentiating types of newly diagnosed diabetes could provide appropriate long-term management. Therefore, we conducted this study to compare clinical characteristics and outcomes between initially diagnosed type 1 and type 2 diabetes mellitus patients presenting with DKA.Materials and methodsA retrospective study was conducted on adult patients who presented with DKA as the first diagnosis of diabetes in our tertiary hospital between January 2005 and December 2019. Demographic data, precipitating causes, laboratory investigations, treatment, and outcomes were obtained by chart review. The primary outcome was to compare the clinical characteristics of initially diagnosed patients with T1DM and T2DM who presented with DKA.ResultsA total of 100 initially diagnosed diabetic patients who presented with DKA were analyzed (85 T2DM patients and 15 T1DM patients). Patients with T1DM were younger than patients with T2DM (mean age 33 ± 16.2 vs. 51 ± 14.5 years, p value < 0.001). Patients with T2DM had a higher body mass index, family history of diabetes, precipitating factors, plasma glucose, and lower renal function than those with T1DM. There was no difference in resolution time or DKA management between T1DM and T2DM patients. The overall mortality rate of DKA was 4%.ConclusionIn this population, most adult patients who presented with DKA had T2DM. Older age, obesity, a family history of diabetes, and the presence of precipitating factors were strong predictors of T2DM. We can implement the same clinical management for DKA in both T1DM and T2DM patients. However, T2DM patients had longer hospitalization than T1DM patients. After DKA resolution for 12 months, more than half of patients with T2DM could discontinue insulin. Therefore, the accurate classification of the type of diabetes leads to appropriate treatment.

Maternal hypertensive disorders during pregnancy and the risk of offspring diabetes mellitus in childhood, adolescence, and early adulthood: a nationwide population-based cohort study

BackgroundMaternal hypertensive disorders during pregnancy (HDP) have been suggested to contribute to the development of offspring cardiovascular disease later in life, but empirical evidence remains inconsistent. This study was aimed to assess the association of maternal overall and type-specific HDPs with diabetes in offspring from childhood to early adulthood.MethodsUsing Danish national health registers, a total of 2,448,753 individuals born in Denmark from 1978 to 2018 were included in this study. Maternal HDP included chronic hypertension, gestational hypertension, and preeclampsia. The outcome of interest was diabetes in offspring (including type 1, type 2, and gestational diabetes). The follow-up of offspring started at birth and ended at the first diagnosis of diabetes, emigration from Denmark, death, or time end on 31 December 2018, whichever came first. Cox proportional hazards regression was used to evaluate the hazard ratios (HRs) with 95% confidence intervals (CIs) of the association between maternal HDP and diabetes (including type 1, type 2, and gestational diabetes) in offspring from birth to young adulthood (up to 41 years), with the offspring’s age as the time scale.ResultsDuring a follow-up of up to 41 (median: 19.3) years, 1247 offspring born to mothers with HDP and 23,645 offspring born to mothers without HDP were diagnosed with diabetes. Compared with offspring born to mothers without HDP, those born to mothers with HDP had an increased risk for overall diabetes (HR=1.27, 95% CI=1.20–1.34), as well as for type 2 diabetes (HR=1.57, 95% CI=1.38–1.78) and gestational diabetes (HR=1.37, 95% CI=1.25–1.49). We did not observe obvious increased risk for type 1 diabetes (HR=1.08, 95% CI=0.98–1.18). Offspring of mothers with gestational hypertension (HR=1.37, 95% CI=1.00–1.88) or preeclampsia (HR=1.62, 95% CI=1.41–1.87) had higher risks of type 2 diabetes. The strongest association was observed for severe preeclampsia, with a 2-fold risk of type 2 diabetes (HR=2.00, 95% CI=1.42–2.82). The association between maternal HDP and type 1 diabetes did not reach statistical significance, except for maternal gestational hypertension (HR=1.41, 95%CI=1.17–1.71). In addition, we found that offspring born to mothers with any subtypes of maternal HDP had higher risk of gestational diabetes, and the corresponding HRs (95%CIs) for chronic hypertension, gestational hypertension, and preeclampsia were 1.60 (1.06–2.41), 1.29 (1.04–1.59), and 1.38 (1.24–1.53), respectively. We also observed stronger associations among offspring of mothers with HDP and comorbid diabetes (HR=4.64, 95%CI=3.85–5.60) than offspring of mothers with HDP or diabetes alone.ConclusionsOffspring of mothers with HDP, especially mothers with comorbid diabetes, had an increased risk of diabetes later in their life. Our findings suggest that timely and effective prevention of HDP in women of childbearing age should be taken into consideration as diabetes prevention and control strategies for their generations.

Demographic and clinical characteristics of a population-based pediatric cohort of type 1 and type 2 diabetes in Western Australia (1999-2019).

To determine demographic and clinical characteristics of youth diagnosed with type 1 (T1D) or type 2 (T2D) diabetes aged ≤15 years from 1999 to 2019 in Western Australia, and examine time to first diagnosis of diabetes complications. A retrospective cohort study was conducted of patients identified from the population-based, prospective Western Australian Children's Diabetes Database and longitudinal data extracted for available demographic and clinical variables. Patients were followed from diagnosis to transition to adult services, death, or December 31, 2019. Cox proportional hazards regression models were used to analyse time to first diagnosis of hypertension, high cholesterol or microalbuminuria, after adjusting for sex, age at diagnosis, time period of diagnosis, hemoglobin A1c , and body max index Z-score. 2438 eligible patients were identified (2209 [91%] T1D: 229 [9%] T2D). The mean age at diagnosis was lower in patients with T1D (8.5 [±4.0] vs. 12.7 [±2.0] years). A higher proportion of patients with T2D were female (58% vs. 47%) and of Aboriginal ethnicity (59% vs. 2%). The median HbA1c (interquartile range) at diagnosis was lower 8.9% [6.7, 11.5] (74 mmol/mol [50, 102]) versus 11.6% [10.1, 13.3] (103 mmol/mol [87, 122]) and mean body max index Z-score higher (2.05 [±0.66] vs. 0.37 [±0.95]), in patients with T2D compared to T1D. Patients with T2D had a higher risk of hypertension, high cholesterol, and microalbuminuria (aHR 3.39 [95%CI:2.04, 5.63], 2.69 [95%CI:1.21, 5.98], and 19.79 [95%CI:10.99, 35.64] respectively).

Midlife and late-life diabetes and sarcopenia in a general older Japanese population: The Hisayama Study.

Aims/IntroductionTo investigate the association between midlife or late‐life diabetes and the development of sarcopenia in an older Japanese population.Materials and MethodsA total of 824 Japanese residents aged 65 to 84 years without sarcopenia were followed up from 2012 to 2017. Sarcopenia was determined following the Asian Working Group for Sarcopenia definition. The time of diabetes diagnosis was classified as midlife or late‐life diabetes by the age at first diagnosis of diabetes (< 65 or ≥ 65 years) based on annual health checkups data over the past 24 years. The duration of diabetes was categorized into three groups of < 10, 10–15, and > 15 years. The odds ratios of incident sarcopenia according to the diabetic status were estimated using a logistic regression analysis.ResultsDuring follow‐up, 47 subjects developed sarcopenia. The multivariable‐adjusted odds ratio for incident sarcopenia was significantly greater in subjects with diabetes at baseline than in those without it (odds ratio 2.51, 95% confidence interval 1.26–5.00). Subjects with midlife diabetes had a significantly greater risk of incident sarcopenia, whereas no significant association between late‐life diabetes and incident sarcopenia was observed. With a longer duration of diabetes, the risk of incident sarcopenia increased significantly (P for trend = 0.002).ConclusionsThe present study suggests that midlife diabetes and a longer duration of diabetes are significant risk factors for incident sarcopenia in the older population. Preventing diabetes in midlife may reduce the risk of the development of sarcopenia in later life.

Transcriptome profiling of microRNAs associated with latent autoimmune diabetes in adults (LADA)

LADA (latent autoimmune diabetes in adults), a special subtype of type 1 diabetes, turns out to exhibit phenotypes mimicking the type 2 diabetes, which results in serious misdiagnosis issues. In order to better distinguish LADA from other diabetes subtypes, specific diagnostic and prognostic biomarkers of LADA are required. Circulating microRNAs (miRNAs) are recently shown to be promising biomarkers for disease diagnosis and subtyping. In this study, serum samples from LADA patients and type 2 diabetes patients were collected during the first diagnosis of diabetes and the miRNA transcriptomes of these patients and healthy individuals were profiled. Comparative analysis shows that the differentially expressed miRNAs between groups and their predicted target genes are enriched for several functions including immune regulation. Besides, a few miRNAs showing distinct expression pattern in LADA patients could discriminate LADA from type 2 diabetes, as validated by further qRT-PCR assay. In all, our study implies potential miRNA biomarkers which would be investigated in further clinical researches.

PDB94 - INITIAL ANTIDIABETIC PHARMACOTHERAPY PRESCRIBED TO PATIENTS WITH NEWLY DIAGNOSED TYPE-2 DIABETES IN A COMMERCIAL HEALTH PLAN IN THE UNITED STATED

In 2010, the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) updated their guidelines for treatment of type-2 diabetic patients. This study assessed the selection of initial antidiabetic pharmacotherapy among newly diagnosed with type-2 diabetes patients from 2010- 2016 in a commercial health plan in the United States. A retrospective cohort study was conducted using a large commercial health plan claims database. Patients with a first diagnosis of diabetes from 2010 to 2016 were identified by the International Classification of Disease, ninth & tenth revisions, Clinical Modification diagnostic codes. We included patients aged ≥18 years, with normal renal and liver function, HbA1C >6.4%, and with at least 1 year of continuous enrollment in the health plan before the first antidiabetic prescription. We excluded pregnant woman. Data were classified based on HbA1C level, pharmacological class, active ingredient, and strength. Differences in utilization of initial antidiabetic pharmacotherapy according to the HbA1C levels were evaluated using Chi-squared test. From 2010 to 2016, 71,739 newly diagnostic type-2 diabetic patients were prescribed antidiabetic pharmacotherapy. A total of 70,228 (97.9%) patients started pharmacotherapy with oral antidiabetic drugs, and 1,697 (2.4%) patients started pharmacotherapy with insulin. Most patients were treated with biguanides class (metformin) (93.1%) and sulfonylurea class (5.5%). The strength of metformin, the use a drug combination and the use of insulin were positively associated with the HbA1C level (p <0.001). Most newly diagnosed type-2 diabetic patients were prescribed metformin which is the preferred agent for initial treatment recommended by the ADA/AACE guidelines. The HbA1C levels influenced the choice of initial antidiabetic pharmacotherapy and strength, and the use of a drug combination.

Study of incidence of microalbuminuria among first diagnosed diabetic patients and its correlation with body mass index and coexisting hypertension in a tertiary care hospital

Background: Diabetes is raising recently more in the developing countries due to sedentary life style and with increase in duration, complications arise affecting renal, retinal, cardiovascular and nervous systems. Diabetic nephropathy poses a great risk of renal failure and is the cause for performing dialysis. Microalbuminuria is the earliest marker for the renal and cardiovascular involvement. This study aims to study the incidence of microalbuminuria in first diagnosed diabetic patients and to correlate it with the body mass index (BMI), hypertension and waist hip circumference. Methods: This study was conducted on 138 first diagnosed diabetic patients in a tertiary care hospital. Microalbuminuria was analyzed using dipstick method and correlation was made with parameters such as blood pressure, body mass index, and waist-hip circumference. Result: The incidence of microalbuminuria in first diagnosed diabetic patients was 17%. Incidence of microalbuminuria is increased in hypertensive diabetic patients (37%) compared with non-hypertensive diabetic patients (10%) which was statistically significant (p=0.001, r=0.292). Incidence of microalbuminuria among first diagnosed diabetic patients was 17%. The correlation of microalbuminuria with hypertension, BMI and waist-hip ratio suggest that microalbuminuria incidence is significantly associated with hypertension than BMI and waist-hip ratio. Conclusion: Microalbuminuria is the earliest indicator for detecting nephropathy. The incidence of microalbuminuria of 17% during first diagnosis of diabetes indicates the inadequacy in the health care system regarding the screening programs in the rural population. Thus, improvements must be made in the health care system to reduce the incidence rate by effective screening program. DOI: 10.21276/APALM.1259

Clinical Characteristics of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes in Addis Ababa, Ethiopia: A Cross-Sectional Study.

BackgroundDiabetic ketoacidosis (DKA) is one of the most serious acute complications of type 1 diabetes (T1D) and the leading cause of morbidity and mortality in children with T1D. This study was aimed at assessing the prevalence and associated factors of DKA in children with newly diagnosed T1D in Addis Ababa.MethodsA hospital based cross-sectional study was conducted in selected hospitals in Addis Ababa. Children below the age of 12 years with DKA who were admitted to the pediatric ward in the selected hospitals between January 2009 and December 2014 and the residence of Addis Ababa were included. DKA was defined as children below the age of 12 years who have blood glucose level ≥250mg/dl, ketonuria, and ketonemia and diagnosed being T1D patient for the first time. Descriptive statistics was performed using frequency distribution, mean, median, tables, and graphs. Logistic regression analysis was used to identify independent factors associated with the prevalence of DKA in children with newly diagnosed T1D.ResultsOf 395 DKA patients who were hospitalized during the five-year period, 142(35.8%) presented with DKA at first diagnosis of diabetes. On the other hand 253 (64.2%) children with DKA had longstanding T1D. Independent factors associated with DKA include: Age category 2–4.49years, 7–9.49 years and ≥9.5years (Adjusted odd ratio (AOR) = 3.14[1.21,8.06]), 3.44(1.39,8.49) and 4.02(1.68,9.60), respectively); parents’ knowledge on the sign and symptoms of DKA (AOR = 0.51[0.27, 0.95]); sign and symptoms of DKA before the onset of DKA (AOR = 0.35[0.21, 0.59]) and infection prior to DKA onset (AOR = 3.45[1.97, 6.04]).ConclusionsThe overall proportion of children diagnosed with DKA and new onset of T1D in Addis Ababa was high. In particular, children between 9–12 years of age and children whose parents did not know the sign and symptoms of DKA had a high risk of DKA at primary diagnosis of T1D.

Life years lost associated with diabetes: An individually matched cohort study using the U.S. National Health Interview Survey data

AimPrevious estimates of life-years lost to diabetes are highly inconsistent. This study provided the updated estimates of life-years lost to diabetes in the United States. MethodsEach of a nationally representative sample of 21,829 adults with diabetes in the U.S. National Health Interview Survey 1997–2009 was individually matched to one without diabetes by age, sex, race, survey year, BMI, smoking status, pre-existing cardiovascular disease and pre-existing cancer. All-cause mortality from original surveys to 31 December 2011 and median survival ages were estimated for those with diabetes and their matched controls. ResultsOverall median survival age for adults with diabetes was 10.5years shorter than that for matched controls without diabetes. Estimated life-years lost associated with diabetes decreased with increasing age at diagnosis from 20.0years for those diagnosed before age 20years to no difference for those diagnosed after 80years. Hazard ratios for mortality decreased from 3.03 (95% CI: 2.41, 3.80) for those with diabetes diagnosed before 20years to 1.04 (95% CI: 0.78, 1.39) for those diagnosed after 80years. The estimate of life-years lost associated with diabetes was much higher among those with pre-existing cardiovascular disease (20.3years) than among those without cardiovascular disease (8.5years). ConclusionsThe effect of diabetes on survival depends on age at first diagnosis of diabetes and the presence of pre-existing diseases. The life-years lost are higher for those with diabetes diagnosed at younger ages. This study provided the updated estimates of life-years lost associated with diabetes in the United States.

Are healthcare costs from obesity associated with body mass index, comorbidity or depression? Cohort study using electronic health records.

SummaryThe objective of this study was to evaluate the association between body mass index (BMI) and healthcare costs in relation to obesity‐related comorbidity and depression. A population‐based cohort study was undertaken in the UK Clinical Practice Research Datalink (CPRD). A stratified random sample was taken of participants registered with general practices in England in 2008 and 2013. Person time was classified by BMI category and morbidity status using first diagnosis of diabetes (T2DM), coronary heart disease (CHD), stroke or malignant neoplasms. Participants were classified annually as depressed or not depressed. Costs of healthcare utilization were calculated from primary care records with linked hospital episode statistics. A two‐part model estimated predicted mean annual costs by age, gender and morbidity status. Linear regression was used to estimate the effects of BMI category, comorbidity and depression on healthcare costs. The analysis included 873 809 person‐years (62% female) from 250 046 participants. Annual healthcare costs increased with BMI, to a mean of £456 (95% CI 344–568) higher for BMI ≥40 kg m−2 than for normal weight based on a general linear model. After adjusting for BMI, the additional cost of comorbidity was £1366 (£1269–£1463) and depression £1044 (£973–£1115). There was evidence of interaction so that as the BMI category increased, additional costs of comorbidity (£199, £74–£325) or depression (£116, £16–£216) were greater. High healthcare costs in obesity may be driven by the presence of comorbidity and depression. Prioritizing primary prevention of cardiovascular disease and diabetes in the obese population may contribute to reducing obesity‐related healthcare costs.

The Awareness and Practices of Foot Care in Adult Diabetic Patients Attending University Hospital

Aim: To determine the awareness and practices of foot care in adult diabetic patients attending Dow university hospital OJHA Campus Karachi, Pakistan. Methodology: This is an observational study was conducted at National Institute of Diabetes and Endocrinology and department of medicine Dow University Hospital, Ojha Campus, Karachi, from October 2015 to December 2015. All demographic data was collected from every diabetic patient like age (years), gender, education level and details of disease and treatment, like age at first diagnosis of diabetes, duration of DM in years, medication and glycaemic control among the study participants. The awareness of diabetic foot care in diabetic patients was assessed by questionnaire. Data was entered and analyzed by using SPSS version 19. Results: Among 384 patients, 186 (48.4%) were males while 198 were females (51.6%). Between ages 22- 40 were 77 patients, 41 to 60 were 245 patients and 61 to 80 were 62 patients. Mean age of individuals were 50.56+10.60. A total of 78.64% (n=302) of patients had Type 2 Diabetes Mellitus, 14.58% (n=58) had Type 1 Diabetes Mellitus while 6.77% (n=26) had gestational diabetes mellitus. 35.7% (n=210) had coexisting hypertension. 126 had history of foot ulcers while 137 had history of amputation. Questions were asked regarding treatment options for diabetes and their awareness and habits about foot care. Conclusion: Regular assessment and emphasis on foot care could reduce the incidence of diabetes related foot problems bringing an era of reduced health care burden of diabetes related issues.

Childhood Bereavement and Type 1 Diabetes: a Danish National Register Study.

Death of a close family member such as a parent or a sibling can cause prolonged stress and changes in the family structure that may have extensive social and health effects on a young child. The aim of this paper is to examine the rate of type 1 diabetes following bereavement due to death of a first-degree family member in early life. We used data from the Danish Civil Registration System (CRS) to identify singleton births in Denmark born 1 January 1980 through 31 December 2005, n = 1 740 245 and their next of kin. We categorised children as exposed to bereavement if they lost a mother, father or sibling from age 5 years onwards, the remaining children were considered unexposed. Children were followed until first diagnosis of diabetes, death, emigration, or 31 December 2010. We estimated incidence rate ratios (IRRs) from birth using log-linear Poisson regression models with person-years as an offset variable. Exposed children were followed up for an average of 9.1 years [standard deviation (SD) 6.7] and unexposed children were followed up for an average of 12.3 years (SD 7.3). In our sample 94 943 children were exposed to bereavement, and 6110 cases of type 1 diabetes were identified. Bereavement was associated with an increased rate of type 1 diabetes when exposure onset began after 11 years of age (adjusted IRR 1.28, 95% confidence interval 1.08, 1.51). We found some evidence to indicate an increase in the rate of type 1 diabetes among children exposed to bereavement when exposure occurred after 11 years of age.

Trends in the Diabetes Epidemic in Korea.

Diabetes mellitus is a leading cause of mortality and increased disability-adjusted life years worldwide. In Korea, the prevalence of diabetes increased from 8.6% to 11.0% in 2001 to 2013 and the prevalence of adult obesity, which is the most important risk factor of diabetes, increased from 29.2% to 31.8% during the same period. There has been a dramatic increase in the number of obese Koreans with diabetes in recent decades and the prevalence of diabetes in people aged 40 years and older also increased in 2001 to 2013. Nevertheless, the mean age at the first diagnosis of diabetes was very similar for men in 2005 and 2013, while the mean age for women decreased slightly. There is an inverse linear relationship between body mass index and age at the diagnosis of diabetes among those who are newly diagnosed. Accordingly, the prevalence of diabetes is increasingly shifting to younger individuals and those who are obese. Therefore, public efforts should focus on healthy lifestyle changes, primary prevention measures, screening for the early detection of diabetes, and long-term management.

Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case–control study

Low serum 25-hydroxyvitamin D [25(OH)D] concentration may increase risk of insulin-requiring diabetes. A nested case-control study was performed using serum collected during 2002-2008 from military service members. One thousand subjects subsequently developed insulin-requiring diabetes. A healthy control was individually matched to each case on blood-draw date (±2days), age (±3months), length of service (±30days) and sex. The median elapsed time between serum collection and first diagnosis of diabetes was 1year (range 1month to 10years). Statistical analysis used matched pairs and conditional logistic regression. ORs for insulin-requiring diabetes by quintile of serum 25(OH)D, from lowest to highest, were 3.5 (95% CI 2.0, 6.0), 2.5 (1.5, 4.2), 0.8 (0.4, 1.4), 1.1 (0.6, 2.8) and 1.0 (reference) (p (trend) <0.001). The quintiles (based on fifths using serum 25(OH)D concentration in the controls) of serum 25(OH)D in nmol/l, were <43 (median 28), 43-59 (median 52), 60-77 (median 70), 78-99 (median 88) and ≥100 (median 128). Individuals with lower serum 25(OH)D concentrations had higher risk of insulin-requiring diabetes than those with higher concentrations. A 3.5-fold lower risk was associated with a serum 25(OH)D concentration ≥60nmol/l.

Increased Risk of Diabetes in Patients With Urinary Calculi: A 5-Year Followup Study

No prospective followup study to date to our knowledge has evaluated the relationship between stone disease and the subsequent risk of diabetes mellitus. In this population based study we examine the relationship between a history of urinary calculi and the risk of diabetes mellitus in Taiwan. A total of 23,569 adult patients with new diagnoses of urinary calculi from 2001 to 2003 were recruited together with 70,707 matched enrollees as a comparison cohort. All patients were tracked for a 5-year period from the index health care encounter to identify those who had a subsequent diagnosis of diabetes mellitus. Cox proportional hazards models were used to compute the risk of diabetes mellitus for the study and comparison cohorts. Of a total of 94,276 patients 2,921 (12.39%) from the urinary calculi group and 6,171 (8.73%) from the comparison group received a subsequent diagnosis of diabetes mellitus during the followup period. The stratified Cox proportional analysis showed that, after censoring individuals who died during followup, and adjusting for patient monthly income, geographic location, urbanization level, hypertension, hyperlipidemia and obesity, the hazard of receiving a first diagnosis of diabetes during the 5-year followup was 1.32 times greater for patients with urinary calculi than for those in the comparison cohort (95% CI 1.26-1.39, p <0.001). Our results suggest that patients who receive a diagnosis of urinary calculi are at increased risk for diabetes mellitus at 5-year followup.

Clues to duration of undiagnosed disease from retinopathy and maculopathy at diagnosis in type 2 diabetes: a cross-sectional study

AimsTo extrapolate, from the proportion of subjects with observable retinopathy at diagnosis of type 2 diabetes mellitus in routine clinical practice, the mean duration of undiagnosed diabetes.MethodsOn 1 October 1999,...

Bridging a cultural divide within medicine: a role for psychiatrists?

In wealthier countries there are currently more psychiatrists than surgeons, and the gap is increasing. A recent President of the UK Royal College of Surgeons has commented that there will be little need for most types of surgeon in ten years, as much of their work will be done less invasively and more effectively by interventional radiologists. There is no prospect of such an outcome with respect to psychiatry for the foreseeable future. As a profession our ultimate aim should be for our expertise and that of our colleagues in other disciplines to evolve to deliver or support interventions that are both less invasive and more effective than those currently in use. One of the criticisms levied at psychiatry by other doctors is that our evidence base is weak and the prognosis of severe mental illness is poor. But surely this is a case of the “pot calling the kettle black”. The science underpinning much of medical practice is weak. The difference may be in the false confidence other doctors have in the utility of their treatments, and the false modesty we psychiatrists have in the effectiveness of our own 1. Take the treatment of cardiac arrhythmias for example, for which ablation of an aberrant pathway in cardiac muscle may be offered, which whilst highly effective for most, carries a risk of serious complications including stroke, heart attack or death in a small percentage. Or consider the fact that prognosis for first diagnosis of diabetes in an adult is worse than the prognosis for first diagnosis of schizophrenia. Does this information help to put our diagnoses more in perspective? I agree with Katschnig that as a profession we must embrace a biopsychosocial approach, but it is a challenge to psychiatric teachers, managers and purchasers of psychiatric services to protect this necessary holistic approach. Attempts by neuropsychiatrists or psychopharma-cologists to claim superiority over social psychiatrists or psychotherapists, and vice versa, are ultimately damaging to our profession and our patients. But some psychiatrists who are focusing on highly specialist aspects of brain research, or some tertiary specialists providing evidence-based technical interventions, may need to leave broader biopsychosocial practice to other colleagues. In my view Katschnig’s conclusion didn’t go far enough. I would like to see psychiatry strengthen its alliances within medicine, and at the same time, strengthen its alliances with patient and advocacy organizations and its understanding and support of the recovery paradigm. Within medicine this means fostering a greater awareness of the link between mental and physical health and the recognition that all of our bodily systems are affected to some extent by dysfunction in another part. There are some fascinating and unexpected challenges to our understanding of cause and effect. For example, it is well known that heart attacks are more common in people who are depressed, but why is it that recovery from depression does not appear to reduce the risk of myocardial infarction 2? These examples explain why I believe that psychiatry should be reintegrated into medicine. This in itself would do much to destigmatize mental illness and psychiatry within the medical profession. At the same time, however, we would be failing in our responsibility if we did not retain and develop our partnerships in the community. This would also enhance our contribution to the wider medical field, where there remains a limited understanding of the importance of personal relationships and environment to good health. A failure to develop ourselves as social psychiatrists would distance us from service users, carers and colleagues in related disciplines. It is imperative that we are able to work in the context of people’s lives and alongside colleagues with more focused skills. And whilst some of our knowledge and skills are shared by other disciplines, none have our medical background and understanding of the link between mental and physical illness. Several years ago C.P. Snow 3 wrote about the “two cultures”, drawing attention to the gulf between the sciences and the humanities. What he argued for was an infusion across the barriers. This would help counter the ignorance of the arts-educated elite, but also the simplistic belief that everything could be explained through natural science. An example is the discredited argument that poor people have poverty in their genes, which was widely believed at the time of the eugenics movement in the early 20th century. As psychiatrists we must resist all such attempts at biological reductionism and do everything we can to bridge the two cultures. Psychiatry needs to continue to attract talented young doctors who bring scientific understanding to the medical profession, but who also bring an understanding of the humanities and of life itself.