Good Diabetic Control Research Articles

BHSeP5 Implementing a pre-optimisation pathway in a tertiary hernia centre

Abstract Incisional hernias can affect up to 20% of patients after midline laparotomy. Those at higher risk include patients with obesity, a smoking history, and poor glycaemic control. These individuals often experience poorer outcomes in elective hernia repair. Pre-optimizing these patients can decrease the risk of post-operative complications and hernia recurrence. This paper examines the benefits of a pre-optimization pathway for patients with complex abdominal wall hernias requiring repair. Recognizing the importance of pre-optimization, each patient was assessed for modifiable risk factors at their initial consultation, focusing on diabetes, smoking, and weight. Targets were established collaboratively between patient and clinician, aiming for weight loss, good diabetic control, smoking cessation, or a combination of these. Patients were then enrolled in a pre-optimization program, which included tri-monthly telephone clinics with an advanced clinical practitioner. Resources were provided to support goal achievement, such as healthy lifestyle advice, exercise and diet guidance, and referrals to specialists like weight management services or diabetic teams. Over the past year, 49 patients were enrolled in the pre-optimization program: 8 for smoking cessation, 45 for weight loss, and 13 for diabetes control, with some patients needing multiple interventions. During the same period, 42 patients underwent surgery; 22 required pre-optimization—19 for weight loss, 2 for diabetes control, and 6 for smoking cessation, some needing a combination of interventions. The majority of patients undergoing incisional hernia repair will need some form of pre-optimisation. Close follow-up increases the likelihood of patients achieving pre-surgery goals, thus reducing the risk of post-operative complications.

Predictors of glycemic control among type 1 pediatric diabetes patients—Northeast Ethiopia

IntroductionType 1 diabetes mellitus is the most common endocrine–metabolic disorder in children and adolescents worldwide. This study aims to determine the metabolic glycemic control levels and predictors among pediatric type 1 diabetes patients.MethodsAn institution-based prospective cross-sectional study was conducted from July 01, 2022 to October 30, 2022 among patients attending pediatric chronic follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Patients on follow-up for more than 3 months and aged under 18 years were enrolled in the study consecutively based on their visits. Data were entered into Epidata version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariate analyses were done to identify the factors affecting glycemic control.ResultAmong 203 patients with type 1 diabetes, the average age was 8.72 ± 4.25 years, with the largest group of participants being over 10 years old (77 patients, 37%). The majority of the patients were female, totaling 126 (62.1%), and about 69 (34.0%) were in grades 7–10. Retinopathy, nephropathy, and diabetic ketoacidosis were commonly observed diabetic-related complications in this study. More than half of the patients, 107 (52.7%), had good diabetic control, while 96 (47.3%) had poor diabetic control. Factors significantly associated with poor glycemic control include having diabetes for more than 5 years (aOR: 1.45; 95% CI: 0.47, 0.91), being a third-born child (aOR: 0.22; 95% CI: 0.05, 0.92), having a comorbid disease condition (aOR: 1.84; 95% CI: 0.29, 0.92), and experiencing diabetes-related complications (aOR: 0.26; 95% CI: 0.08, 0.97).ConclusionThe study found that glycemic control is significantly poor among pediatric patients with type 1 diabetes. As a result, these patients require special attention to prevent the long-term consequences of diabetes.

Prevalence of sensorineural hearing loss in patients with Diabetes Mellitus

Background & Objectives: Various kinds of auditory involvement are reported in diabetic subjects. One of them is that of gradual onset of bilateral sensorineural deafness, involving mainly higher frequencies in elderly patients. This study was aimed to access the prevalence of sensorineural hearing loss (SNHL) in a patient with Diabetes Mellitus and its relation to age, sex, duration of DM, and control of DM. Results: Diabetic patients had insidious onset, gradually progressive, bilaterally symmetrical SNHL. SNHL is prevalent in 72% of type 2 diabetes patients compared to 18% of controls. It is correlated with the increasing age and duration of diabetes. Poor control of diabetes showed an increased prevalence of SNHL compared to good control of diabetes. Conclusion: There was an increased prevalence of SNHL in type 2 diabetes patients and it is more evident in patients with long duration of diabetes and more pronounced in patients with poor diabetic control.

Management of diabetic retinopathy in pregnancy

Introduction The onset and development of diabetic retinopathy are more common during pregnancy. Pregnancy has no long-term effect on diabetic retinopathy; however, in 50-70% of cases, changes in retinopathy continues. The probability of worsening is highest in the second trimester and up to one year postpartum. Additional factors that have been associated with disease progression include duration of diabetes, the degree of retinopathy at the time of conception, management of hyperglycemia, anemia, and development of associated hypertension. In cases of severe non-proliferative retinopathy, it is recommended to promptly initiate laser photocoagulation rather than wait for early proliferative changes. Maintaining good diabetic control before and during pregnancy can help prevent disease progression and serious vision loss. Material and methods Diabetic retinopathy management in pregnancy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: „Diabetic retinopathy”; „pregnancy”; „laser photocoagulation”; „intravitreal steroids”; „anti-vascular endothelial growth factor”. Results It is suggested that women with diabetes receive pre-conception and post-pregnancy counselling from a multidisciplinary team including an ophthalmologist, endocrinologist, and perinatologist, as diabetic retinopathy may worsen during pregnancy. The risk of progression of the disease and the importance of appropriate metabolic control before and during pregnancy should be clearly explained to the patient. Careful monitoring is required in patients with advanced gestation, significant retinopathy, concomitant hypertension, and nephropathy. Conclusion The risk of retinopathy development may increase during pregnancy. Serious effects can arise for both the mother and the fetus, even though retinopathy is not common during pregnancy. It is possible to avoid significant retinopathy by carefully planning a young diabetic woman's pregnancy and proceeding promptly to laser photocoagulate in cases of severe non-proliferative retinopathy. A tendency for regress is frequently seen in diabetic retinopathy during the post-natal period. Subsequent pregnancies do not significantly increase the risk of progression if the retinopathy is stable before pregnancy.

Transition from Paediatric to Adult Diabetes Care in People with Type1 Diabetes: An Online Survey from France.

The transition from paediatric to adult diabetes care (TPA) of children/adolescents with type1 diabetes (T1D) represents a unique challenge and remains a critical phase in the T1D care pathway. This study aims to describe and understand the experience of the transition process from a participant's perspective in young adults who are living in France with T1D and to measure their satisfaction. An online questionnaire was presented to people with T1D in France on a global online participant community platform. The questionnaire was developed by a scientific committee including paediatric and adult diabetologists and refined by a group of participants. Thematic qualitative analysis was performed on the responses. A total of 104 respondents were included in the survey (mean age 24.4years [95%CI 23.8-25.0]; 61.5% female). The mean age at the time of transition was 18.4years (95%CI 17.8-18.9), and 56% of respondents had their first adult diabetology follow-up in the same institution. During TPA, of the 76 participants who experienced personal issues, 74% experienced at least one issue with their diabetes management in the months following the transition. In the following months, 61% experienced new or unexpected problems in monitoring their diabetes after transition and 44% reported unusual glycaemic imbalances, including hypoglycaemia (8%) and hyperglycaemia (9%) requiring hospitalisation. Presence of personal issues during TPA was significantly associated with occurrence of problems with diabetes management or glycaemic imbalance. Three factors identified for a successful transition were (i) early meeting with the 'adult' diabetes care team, (ii) letting the participants choose the right age to leave paediatric clinic and (iii) having good diabetes control at the beginning of the TPA process. Most young adults with T1D report experiencing issues around TPA with significant consequences on their disease management. Hence, it is necessary to identify these issues to better support them and improve diabetes management during this phase.

Therapeutic patient education and treatment intensification of diabetes and hypertension in subjects with newly diagnosed type 2 diabetes mellitus: a longitudinal study.

The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients. A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment. The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline. TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes.

The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia.

The COVID-19 pandemic disrupted healthcare worldwide, potentially impacting disease management. The objective of this study was to assess the self-management behaviors of Saudi patients with diabetes during and after the COVID pandemic period using the Arabic version of the Diabetes Self-Management Questionnaire (DSMQ). A cross-sectional study was conducted in patients aged ≥18 years diagnosed with type 2 diabetes mellitus who had at least one ambulatory clinic visit in each of the specified time frames (Pre-COVID-19: 1 January 2019-21 March 2020; COVID-19 Time frame: 22 March 2020 to 30 April 2021) utilizing the DSMQ questionnaire, with an additional three questions specifically related to their diabetes care during the COVID pandemic. A total of 341 patients participated in the study. The study results revealed that the surveyed patients showed moderately high self-care activities post-COVID-19. Total DSMQ scores were significantly higher in patients aged >60 years versus younger groups (p < 0.05). Scores were significantly lower in patients diagnosed for 1-5 years versus longer durations (p < 0.05). Patients on insulin had higher glucose management sub-scores than oral medication users (p < 0.05). Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that, while COVID-19 negatively impacted some self-management domains, the Saudi patients surveyed in this study upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises.

Ayurvedic management of diabetic wound: A case study

Diabetic patients are vulnerable to develop non healing ulcers. Treatment modilities like conservative, good diabetic control, wound toileting seem to be incomplete by looking at prevalence rate of amputation in diabetic patients. This case management of diabetic foot ulcer in 65 years male. Complete wound healing was achieved in 30 to 40 days with unit healing time (UHT) of 5.88 days/cumm. Local cleaning by Triphala Kwatha has showed antimicrobial effect which augmented the healing process while Vranshodhak Taila application enhanced tissue debridement. Internal Ayurveda medication like Arogyavardhini vati and Rakta pachak yog with pathya-apathya (prescribed diet and regimen) pacified vitiated kapha-vata pradhan Tridosha and enhanced tissue rejuvenation and repair by their pharmacological properties.

Significant Promising Effects of Bariatric Surgery on the Biochemical Control of Glycemia and Lipidemia in Diabetic Patients in Western Saudi Arabia: A Tertiary Center Experience and a Retrospective Study.

The prevalence of obesity has increased globally and is associated with many comorbidities such as type 2 diabetes and fatty liver and cardiovascular diseases. Bariatric surgery is considered an effective intervention for achieving weight loss and controlling lipidemia and glycemia. This Saudi retrospective observational studyevaluates the clinical and biochemical benefits following bariatric surgery to obese diabetic patients. Methodology: After gaining ethical committee approval, data was collected from the patients' medical records at a tertiary medical center (King Fahad General Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia). The total sample size was 61 patients, of whom 78.33% (n=48) had a body mass index (BMI) of 40 or greater (obese class III). Following bariatric surgery, there were statistically significant reductions (p<0.001) in BMI and HbA1C (decreased from 45.53±7.791 kg/m2 and 7.9±1.82% to 33.42±6.18 kg/m2 and 6.06±1.35%, respectively, after surgery).Likewise, significant reductions (p<0.001) occurred to serum total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides that decreased from 234.4±26.7 mg/dl, 152.2±19.4 mg/dl, and 187.3±24.6 mg/dl to 158.4±17.3 mg/dl, 95.6±15.7 mg/dl, and 132.5±19.5 mg/dl, respectively. Interestingly, serum high-density lipoprotein (HDL) significantly increased (p<0.001) from 43.8±6.2 mg/dl to 52.3±4.6 mg/dl.Using the novel clinical therapeutic index, bariatric surgery decreased BMI by about 26.6%. Using the novel biochemical therapeutic index, bariatric surgery decreased HbA1C, serum total cholesterol, serum LDL cholesterol, and serum triglycerides by about 22.99%, 32.42%, 37.18%, and 29.26%, respectively, while serum HDL increased by about 19.4%. Bariatric surgery is an effective intervention for obese diabetic patients resulting in weight loss, better control of diabetes and hyperlipidemia, and the metabolic profile. It is also recommended in Saudi Arabia for the high prevalence of obesity and diabetes mellitus.

Glycemic Control in Patients with Type 1 Diabetes: Comparison of Holidaysversus Schooldays.

To examine the influence of school life in children and adolescents with type 1 diabetes (T1D) by comparing the glycemic control and Ambulatory Glucose Profile (AGP) between the holidays and schooldays. This is a retrospective study conducted on 147 patients with T1D (14-19 years) who used an intermittently scanned Continuous Glucose Monitoring (isCGM) system to self-test their glucose levels during the periods of school time and holiday time. A record was maintained of the Continuous Glucose Monitoring (CGM) metrics i.e., Glucose Variability (GV) (%), mean Time in Range (TIR), Time above Range (TAR), Time below Range (TBR), and average time period of the hypoglycemic events during schooldays and the holidays. The study revealed differences between the recorded values during the holidays and schooldays, in % in target 70-180 mg/dL (38.2 vs. 49.5; p = 0.039), mean glucose (194 vs. 185; p = 0.048), frequency of low glucose events (9.2 vs. 5.1; p = 0.036), mean duration of low glucose levels (117 vs. 65; p = 0.021), % TBR below 70 mg/dL (2.9 vs. 1.45; p = 0.023), % TBR below 54 mg/dL (1.1 vs. 0.51; p = 0.031), TAR 181-250 mg/dL (21.1 vs. 16.5; p = 0.037) and TAR >250 mg/dL (8.9 vs. 6.5; p = 0.043). On comparing the HbA1c levels of the study population recorded during the holidays (8.34%) with those recorded during the schooldays (8.13%), the HbA1c values during the school days were observed to be lower; however, no significant changes were noted in the HbA1c level between the holidays and schooldays. Concerning the FreeStyle Libre (FSL) scanning, the frequency during the holidays (n = 6.2) was significantly lower than during the schooldays (n = 9.5) (p = 0.042). From the findings, it appears that children with T1D have good diabetes control during schooldays rather than during the holidays. To improve their glucose control during the holidays, these patients may also benefit from receiving greater attention and guidance.

CATALYST: A Phase 4 Study of Hypercortisolism in Patients with Difficult-to-Control Type 2 Diabetes Despite Receiving Standard-of-Care Therapies Assessing Prevalence and Treatment with Mifepristone

The prevalence of hypercortisolism in persons with difficult-to-control type 2 diabetes (T2D) may be higher than currently appreciated, particularly in persons who require a greater number of antihyperglycemic agents and/or have more comorbidities. To better understand the prevalence and whether treatment of hypercortisolism may result in better control of diabetes and other hypercortisolism-associated comorbidities, we have designed CATALYST, a prospective phase 4 study in adults with difficult-to-control T2D (HbA1c 7.5–11.5%) despite receiving multiple antihyperglycemic agents. CATALYST is being conducted at about 30 sites in the United States. In Part 1, about 1000 persons with difficult-to-control T2D will be screened with a 1-mg dexamethasone suppression test (cutoff: serum cortisol >1.8 µg/dL; dexamethasone ≥140 ng/dL). Patients with ACTH-dependent hypercortisolism will be referred out of the study. The primary study endpoint—the prevalence of ACTH-independent hypercortisolism—will be evaluated in Part 1. Patients with ACTH-independent hypercortisolism may advance to Part 2, a prospective, 2:1 randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of treatment with the competitive glucocorticoid receptor antagonist mifepristone. Patients will be randomized (stratified by the presence/absence of adrenal adenomas on CT) and receive treatment for 24 weeks. The mifepristone dose will be 300 mg QD for 4 weeks, then increased to 600 mg QD for 20 weeks based on glycemic efficacy and tolerability (option to increase to mifepristone 900 mg). Secondary endpoints include changes in HbA1c from baseline to 24 weeks and changes in hypercortisolism-related comorbidities (e.g., blood pressure, weight, waist circumference, quality of life).

Visual impairment and blindness caused by retinal diseases: A nationwide register-based study.

Retinal disorders cause substantial visual burden globally. Accurate estimates of the vision loss due to retinal diseases are pivotal to inform optimal eye health care planning and allocation of medical resources. The purpose of this study is to describe the proportion of visual impairment and blindness caused by major retinal diseases in China. A nationwide register-based study of vitreoretinal disease covering all 31 provinces (51 treating centres) of mainland China. A total of 28 320 adults diagnosed with retinal diseases were included. Participants underwent standardised ocular examinations, which included best-corrected visual acuity (BCVA), dilated-fundus assessments, and optical coherence tomography. Visual impairment and blindness are defined using BCVA according to the World Health Organization (WHO) (visual impairment: <20/63-≥20/400; blindness: <20/400) and the United States (visual impairment: <20/40-≥20/200; blindness: <20/200) definitions. The risk factors of vision loss were explored by logistic regression analyses. Based on the WHO definitions, the proportions for unilateral visual impairment and blindness were 46% and 18%, respectively, whereas those for bilateral visual impairment and blindness were 31% and 3.3%, respectively. Diabetic retinopathy (DR) accounts for the largest proportion of patients with visual impairment (unilateral visual impairment: 32%, bilateral visual impairment: 60%) and blindness (unilateral blindness: 35%; bilateral blindness: 64%). Other retinal diseases that contributed significantly to vision loss included age-related macular degeneration, myopic maculopathy, retinal vein occlusion, and rhegmatogenous retinal detachment and other macular diseases. Women (bilateral vision loss: P = 0.011), aged patients (unilateral vision loss: 45-64 years: P < 0.001, ≥65 years: P < 0.001; bilateral vision loss: 45-64 years: P = 0.003, ≥65 years: P < 0.001 (reference: 18-44 years)) and those from Midwest China (unilateral and bilateral vision loss: both P < 0.001) were more likely to suffer from vision loss. Retinal disorders cause substantial visual burden among patients with retinal diseases in China. DR, the predominant retinal disease, is accountable for the most prevalent visual disabilities. Better control of diabetes and scaled-up screenings are warranted to prevent DR. Specific attention should be paid to women, aged patients, and less developed regions.

FRI183 Phase 4 Study Of Hypercortisolism In Patients With Difficult-to-Control Type 2 Diabetes Despite Receiving Standard-of-Care Therapies: Prevalence And Treatment With Mifepristone

FRI183 Phase 4 Study Of Hypercortisolism In Patients With Difficult-to-Control Type 2 Diabetes Despite Receiving Standard-of-Care Therapies: Prevalence And Treatment With Mifepristone

THU152 HbA1c Control Of Pediatric Patients With Diabetes In The Urban Community Hospital Representing Underserved, Minority Population: Can The Frequent Encounters With Multi-Disciplinary Diabetes Team Overcome Patient-Related Adverse Variables In Improving Their Glycemic Control?

Abstract Disclosure: S. Velasquez: None. O. Ozcan: None. S. Dave-Sharma: None. Introduction: The American Diabetes association’s established goal for HbA1C across all age groups is as &amp;lt;7%. As the prevalence of diabetes continues to increase, its control in the pediatric population has become more challenging. Studies have shown controlling diabetes is especially challenging in minority ethnic groups of low income neighborhoods. Our hospital, located in the Mott Haven community, serves the minority population of mostly Hispanics and Blacks with an average household income of &amp;lt; $ 20 000 (poverty rate 39%). Objectives: This study aimed to identify different variables among patients with controlled and uncontrolled HbA1c in our unique pediatric population. Our goal was to learn from the group of patients with good diabetes control to improve the control of patients with poor glycemic control by changing the protocols involving our multi-disciplinary care team. Results: We collected data from 86 patients with diabetes (type 1 and 2) from our pediatric endocrinology clinic and divided them into 3 groups based on their HbA1c levels. 1. Good control: HbA1c &amp;lt;7.5 % in 33/86 (38%) patients, 2. Poor control: HbA1C 7.5%-10% with 34/86 (40%), and 3. Very poor control: HbA1C &amp;gt;10% with 19/86 (22%) patients. We studied the data for variables such as gender, age, ethnicity, insurance, type of diabetes, duration of diabetes, BMI, frequency of encounters with the multi-disciplinary team, and more. Of 86 patients, the average age was 15.65 (51% were females, and 49% were males). 43% had type 1 diabetes, and 57% had type 2 diabetes. The type 1 vs. Type 2 diabetes ratio among different groups was 12% Type 1 vs. 88% type 2 in the group with good control, 73.5% Type 1 vs. 26.5% Type 2 in the poor control group, and 42% type 1 vs. 58% type 2 in the group with very poor control. Obesity was found in 50% of our patients; in the good control group, it was 57%. In the poor control group, 38%, and in the very poor control group, 58%. A correlation study run between the HbA1c levels and duration of diabetes found significantly correlated (R 0.38) in the good control group. Other groups were found positively correlated yet found statistically insignificant. Conclusion: We found that Type 2 Diabetes with Obesity was more prevalent than Type 1 in our pediatric population. Patients with poor and very poor diabetes control had a longer duration of diabetes compared to patients with good control. Frequent visits with the diabetes team improved HbA1C in our patients. 84% of patients in the good control group were seen by the diabetes team more frequently (at least every 3-6 months) compared to patients with higher HbA1c. The group with very poor glycemic control patients were more obese with Type 2 Diabetes and were less frequently coming for the scheduled appointments. More efforts must be made to design the protocols to overcome patient-related obstacles to improve diabetes control. Presentation: Thursday, June 15, 2023

QUALITY OF LIFE AND GLYCAEMIC CONTROL AMONG OLDER POPULATION WITH DIABETES IN THREE DISTRICTS OF PENINSULAR MALAYSIA

The older population is increasing in numbers worldwide. Most of them have multiple comorbidities including diabetes. The diabetic control in elderly is usually challenging. Their quality of life and socioeconomic condition either in rural or urban area could affect their disease progress. This study aims to measure the diabetic control and its associated factors, including quality of life among the older population with diabetes in three different districts of Malaysia. The patients’ health and background details were recorded. Validated Malay version of diabetes quality of life questionnaire was used. 485 elderly diabetic patients were recruited based on two proportion formula comprising all clinics in those districts representing urban vs rural area. Data were analyzed using simple and multiple logistic regression for the association. Only 30.5% of the patients have good diabetic control with patients in Kuala Terengganu district achieved better sugar control (p &lt; 0.001). However, the only significant diabetic control predictor is the quality of life of the elderly patients (OR = 1.32, CI 1.047 – 1.224). Level of diabetes control in these three districts are poor, concomitant with the poor control of the elderly non-communicable disease profiles. It is essential to embark on holistic approach in dealing with the elderly diabetic management and identify measures to improve quality of life in those with poor glycaemic control in order to have better disease outcome.

Behavioral Risk Score for Predicting Well-Controlled HbA1c Level in Diabetes Type 2 Patients

Background: Diabetes Type 2 is chronic disease that can progress from simple hyperglycemia to severe complications. Many behavioral risks have been discovered for blood sugar prediction. Objective: To develop a simple behavioral risk scoring to predict well-controlled HbA1c level in diabetes type 2 patients. Materials and Methods: A total of 140 diabetes type 2 patients were recruited. Patients were interviewed about behavioral factors affecting blood sugar in three months retrospectively. To develop the risk score, risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk scoring scheme was developed from behavioral predictors: eating desserts and soft drinks, regular exercise and strict medication intake. The scoring scheme was applied in bootstrap internal validity test to test the model performance. Results: The scheme explained, by area under the receiver operating characteristic curve (AuROC), 91.6% (95% CI 0.87 to 0.96) of being good diabetic control (HbA1c ≤7%) with good calibration (Hosmer-Lemeshow χ²=3.61; p=0.61). The likelihood ratio of being good diabetic control (scores greater than or equal to 1) and poor diabetic control (score lower than 1) were 3.83 (95% CI 2.69 to 5.46) and 0.11 (95% CI 0.05 to 0.21), respectively. When applied in bootstrap internal validity test, the score showed good performance with AuROC 88.7% (95% CI 0.81 to 0.93). Conclusion: A simple and non-invasive scoring scheme of three predictors provides good prediction indices for being good and poor diabetic control patients. This scheme may help clinicians in order to take further appropriate action for diabetic control. Keywords: Diabetes type 2; HbA1c controlling level; Prediction; Risk scoring

Uncontrolled Diabetes Mellitus during Lockdown period of Covid 19 pandemic

Background: Nepal Government had declared a lockdown from 24th March till 21st July 2020 for prevention and control of spread of Covid 19 pandemic. This has made patients with diabetes mellitus unable to do their physical activity outside home, not able to visit physicians or healthcare workers on time, buy medicines on time, check blood sugar as scheduled. In this study we aimed to study the effect of lockdown on glycemic control of Diabetes patients. Methods: This study was done at National Academy of Medical sciences, Bir Hospital-Endocrine Unit outpatients department. After the ease of lockdown certain patients visited us with past and new reports of Blood glucose and HbA1c. We kept a record of variation of glycemic control, lack of physical activities, continuation of medications and daily food habits. Results: Total of 91 Diabetes Mellitus patients visited our OPD in 3 weeks period after lockdown was eased. 58% were Female and 42 % were Male. Only 7% of patients had good control of Diabetes, 32% had fairly controlled Diabetes and 61% had poorly controlled Diabetes in males. In females 3% had good control of Diabetes, 27% had fairly controlled and 70% had poorly controlled Diabetes. 46-65 age group in both male and female had uncontrolled blood sugar. Among males 49% had increased food habits, 32% had decreased physical activity and 10% of them left or decreased medicine. In similar among females 23% had increased food habits, 39% decreased physical activity, 38% had left or decreased medicines. Conclusion: Lockdown during Covid 19 pandemic had adverse effect on glycemic control of patients. This will lead to further complications of diabetes mellitus. Patients must do normal physical activities. They can do normal exercise inside their house and increase activities with family members in a small area, where possible. We must advice our patients to learn how to perform self glucose monitoring and self adjustment of Insulin and diet. Learning how to access to physicians, healthcare workers and pharmacist through telemedicine is very important during lockdown period.

APRI and FIB-4 - a simple predictor of fibrosis in NAFLD/NASH at the primary care level - A case report

The importance of simple investigations like platelets, AST (Aspartate aminotransferase) and ALT (Alanine aminotransferase) when managing patients with NAFLD (non-alcoholic fatty liver disease) and NASH (non-alcoholic steatohepatitis) in primary care should not be overlooked, as this would predict the progression to fibrosis and cirrhosis. A better control of diabetes, metabolic syndrome and the reduction of bodyweight at an early stage when the APRI (AST to Platelet ratio index) and/or FIB-4 score is significant, would have delayed/aborted the progression to fibrosis and cirrhosis is highlighted by this case report. Physicians in primary care should be aware of the significance of low platelet count and high AST (a ‘red flag’) in a case of NAFLD and NASH, and should provide intense control of diabetes, obesity and metabolic syndrome followed by a referral to a gastroenterologist/hepatologist at an early stage. Key words: Primary Care, General Practice, NASH, NAFLD, FIB-4, APRI, Red flag, low platelet, cirrhosis, primary prevention

Health literacy, self‐management and glycaemic control in persons living with type 2 diabetes mellitus: a cross‐sectional study

Abstract Aims. The aim of this study was to explore the relationship between health literacy and diabetes self‐management and control among adults living with type 2 diabetes.Methods. Convenience sampling was used to recruit 381 participants from diabetes clinics. The European Health Literacy Survey Questionnaire and the Diabetes Self‐Management Questionnaire‐Revised were used to collect data. HbA1c levels provided a measure of blood glucose control. Multiple regression and Spearman's correlation coefficient were used to identify the predictors of health literacy and its relationship with diabetes self‐management and HbA1c.Results. Nearly half (47%; n=179) the participants had inadequate health literacy; 40% (n=154) had sufficient health literacy. The most significant predictors of health literacy were educational level, household monthly net income and family history of diabetes. Medication taking was the strongest aspect of self‐management. Only 27% of participants had good glycaemic control; 26% had poor glycaemic control. Health literacy was significantly positively related to diabetes self‐management and negatively related to HbA1c levels.Conclusions. Health literacy is important in encouraging self‐management and maintaining good diabetes control. All health care professionals coming in contact with persons living with diabetes should assess health literacy to identify those at risk of experiencing challenges with self‐management and glycaemic control. Copyright © 2023 John Wiley &amp; Sons.

A PROSPECTIVE STUDY OF EPIDEMIOLOGICAL FACTORS AND OUTCOME IN PATIENTS OF DIABETIC FOOT WOUND ATTENDING J.A. GROUP OF HOSPITALS: A TERTIARY CARE CENTRE

Objectives: To study about epidemiological factors related to diabetic foot wound such as age, sex, duration of diabetes, relation to ongoing retinopathy, and nephropathy. Methods: After obtaining approval from ethical committee, the present study is to be conducted on 100 patients of diabetic foot in the Department of Surgery, JA Group of Hospitals and GR Medical College, Gwalior (MP) during January 2020 to June 2021 after getting written informed consent from the patients. Results: In our study, out of 100 cases, most of the diabetic foot wound cases observed were in the 50–59 years age group with a mean age of 52.23 and a standard deviation of ±14.92. Out of 100 cases, 82 (61.%) were male and 29 (38.66%) were female. Therefore, male: female ratio was 4.5:1. In our study of 100 patients, 70 (70%) presented with ulcer with or without necrotic patch, gangrene and 30 (30%) with cellulitis with or without abscess. Among all patients of diabetic foot, wound 62 (62%) were associated with retinopathy and 47 (47%) were associated with diabetic nephropathy. Conclusion: Diabetic foot wound is more common in men due to their increased susceptibility to trauma and occupation. Diabetic patients at risk for foot complication must be educated about risk factors and the importance of foot care, including the need for self-inspection and surveillance, monitoring, daily foot hygiene, use of proper footwear, good diabetes control, and prompt recognition and early standard treatment of newly discovered lesions.