Good Glycemic Control Research Articles

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BackgroundThere is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.MethodsWe searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2.ResultsA total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6–32.9). The glycaemic control prevalence ranged from 10–60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.ConclusionSuboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

HbA1c level is associated with the development of heart failure with recovered ejection fraction in hospitalized heart failure patients with type 2 diabetes

BackgroundDue to advances in medical treatments, a substantial proportion of heart failure (HF) patients with reduced left ventricular ejection fraction (EF, HFrEF) have experienced partial or complete recovery of EF, termed HFrecEF, and markedly improved clinical outcomes. In the present study, we sought to investigate the relationship between glycemic control and the incidence of HFrecEF in hospitalized HFrEF patients with type 2 diabetes mellitus (T2DM). MethodsA total of 463 hospitalized T2DM patients with HFrEF were consecutively enrolled. Follow-up echocardiogram was performed after around 12 months. Patients who had an absolute EF improvement ≥10% and a second EF > 40% were classified into HFrecEF, and those who did not meet these criteria were defined as persistent HFrEF. ResultsDuring the 12-month follow-up, 44.5% of T2DM patients developed HFrecEF. Patients with HFrecEF had significantly lower HbA1c level than those with persistent HFrEF (6.5% [IQR 5.8% ∼ 7.2%] vs. 6.7% [IQR 6.1% ∼ 7.8%], P = 0.003), especially in HF of an ischemic etiology. HbA1c levels were inversely correlated with changes in EF during follow-up. After multivariate adjustment, every 1% increase in HbA1c conferred a 17.4% (OR: 0.826 [95% CI 0.701–0.968]) lower likelihood of HFrecEF. Compared to patients with good glycemic control (HbA1c ≤ 6.2%), those with poor glycemic control (HbA1c > 7.1%) had a 52.0% (OR: 0.480 [95% CI 0.281–0.811] decreased likelihood of HFrecEF. ConclusionsThis study demonstrates that uncontrolled HbA1c level is associated with compromised development of HFrecEF in T2DM patients with HF, especially in those with an ischemic etiology.

Average HbA1c in Diabetic Patients in Southern KPK-Pakistan

Abstract Diabetes mellitus is a complex metabolic syndrome characterized by either insulinopenia or insulin resistance. This study is focused on the ever-growing prevalence of diabetes mellitus and its poor glycemic control in southern KPK This descriptive cross-sectional study was conducted at the outdoor unit, Department of medicine DHQ hospital Bannu, over six months, extending from 30th December 2021 to 30th June 2022. The sample size was 91 and was calculated using the standard WHO formula. The confidence interval used was 95%, with a 5% margin of error. P value <0.05 was taken as statistically significant. Consecutive non-probability sampling technique was applied. Diabetic patients under treatment below 70 years were included in the study. HbA1c was used as an assessment tool for glycemic control and divided into three categories: good glycemic control with HbA1c<7%, poor glycemic control with HbA1c>9%, and very poor glycemic control with HbA1c>10%. Data was entered and analyzed using SPSS version 19.0.About 18.6% diabetic patients had HbA1c>6%, 25.6% patients had HbA1c between6-8%, 26.7 % patients had HbA1c between 8-10% and 29.6 % had HbA1c>10%.This study revealed that the majority (55%) of diabetic patients belonging to southern KPK had poor glycemic control, as revealed by HbA1c, more than 8%.

Assessment of accuracy and glycemic control of FGM and CGM and impact on mental well-being

Abstract The incidence of diabetes is increasing globally. Short and long-term effects of diabetes can negatively affect the lives of a person and their relatives. A good glycaemic control is important. Compared to conventional blood glucose measurement with capillary blood, which is obtained by finger pricking, it is now possible to continuously measure glucose using sensors that are placed in the subcutaneous tissue and remain there for several days to weeks. This means that the "tissue sugar" and not the blood sugar directly is determined. For this reason, it is important to determine the accuracy of these sensors. Furthermore, such systems can influence not only the physical but also the psychological/mental health of people with diabetes and their relatives. Reimbursement of sensors differs in Europe. This overview is based on the Austrian health care system.

Identification of a Multi-Messenger RNA Signature as Type 2 Diabetes Mellitus Candidate Genes Involved in Crosstalk between Inflammation and Insulin Resistance.

Type 2 Diabetes Mellitus (T2DM) is a metabolic disease associated with inflammation widening the scope of immune-metabolism, linking the inflammation to insulin resistance and beta cell dysfunction. New potential and prognostic biomarkers are urgently required to identify individuals at high risk of β-cell dysfunction and pre-DM. The DNA-sensing stimulator of interferon genes (STING) is an important component of innate immune signaling that governs inflammation-mediated T2DM. NOD-like receptor (NLR) reduces STING-dependent innate immune activation in response to cyclic di-GMP and DNA viruses by impeding STING-TBK1 interaction. We proposed exploring novel blood-based mRNA signatures that are selective for components related to inflammatory, immune, and metabolic stress which may reveal the landscape of T2DM progression for diagnosing or treating patients in the pre-DM state. In this study, we used microarray data set to identify a group of differentially expressed mRNAs related to the cGAS/STING, NODlike receptor pathways (NLR) and T2DM. Then, we comparatively analyzed six mRNAs expression levels in healthy individuals, prediabetes (pre-DM) and T2DM patients by real-time PCR. The expressions of ZBP1, DDX58, NFKB1 and CHUK were significantly higher in the pre-DM group compared to either healthy control or T2DM patients. The expression of ZBP1 and NFKB1 mRNA could discriminate between good versus poor glycemic control groups. HSPA1B mRNA showed a significant difference in its expression regarding the insulin resistance. Linear regression analysis revealed that LDLc, HSPA1B and NFKB1 were significant variables for the prediction of pre-DM from the healthy control. Our study shed light on a new finding that addresses the role of ZBP1 and HSPA1B in the early prediction and progression of T2DM.

POS-133 CASE REPORT OF DISSEMINATED KLEBSIELLA INFECTION IN T2DM LEADING TO CKD

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. The Klebsiella pneumoniae bacteria usually affects the right upper lung lobe and results in the creation of a cavity, as well as pus-producing tissue death.K. pneumoniae is an aggressive microorganism, accounting for 0.5 to 5% of pneumonia cases. It can lead to cavitation (30-50% of cases) and necrotising pneumonia (NP) within a short period of time (days). Case : 40 year old male with a history of diabetes mellitus (DM) was admitted 20 days back patient was admitted and treated for DKA and LRTI discharged after treatment. Patient readmitted 20 days later with complaints of right sided loin pain, high grade fever of 8 days, cough with expectoration for one month, pyuria for 5 days and anuria for one day. Patient readmitted On admission – P-96/min, BP-140/90 mmhg, RR-26/min, Spo2-96% with O2. On evaluation patient was found to have raised creat (8mg/dl) initiated on hemodialysis. Patient ultrasound showed of left sided bulky kidney with acute pyelonephritis. CXR showed cavitatory lesion in middle lobe of right side lung. 5days Later patient complaint of increased left loin pain repeat USG showed left sided psoas abscess so CT showed no any evidence of communication of pyelonephritis with abscess. Pigtail drain was placed for psoas abscess, culture which was positive for klebsiella. Sputum culture was positive for klebsiella, A diagnosis of dissiminated klebsiella infection was made. In spite of all necessary investigations and treatment patient was dialysis dependent, patient deteriorated over time and could not be saved. Investigations :Tabled 1ParametersValuesHemoglobin9.8 gm/dlTotal leukocyte counts25,500/cummPlatelets2.4 lac/cummUrea104 mg/dlCreatenine4.2 mg/dlSerum Na136 mmol/lSerum K4.5 mmol/lBilirubin1.5 mg/dlSGOT/SGPT45/32Calcium7.6 mg/dlPhosphorus5.8 mg/dlUric acid6.2 mg/dlHbA1c10.5%Urine examinationAlb ++ Sug + Epi cells 1-2/min Pus cells - plenty RBC - 1-2/hpf24 hr urinary protein1.5 gm/day Open table in a new tab Sputum culture & Pus culture – klebsiella Sputum for MTB - negative Fundus – moderate NPDR CXR – Cavitatory lesion in right lung middle zone USG – RK – 12.5*5.9cm, LK – 13.6*6.2cm mod dilation of pelvicalyceal system bilateral bulky kidneys with left acute pyelonephritis. CT abd – left psoas bulky with evidence of 8*2.5 cm well defined hypodense collection within. CT chest – Thick walled cavitatory lesions with surrounding consolidation noted in medial segment of right middle lobe, postero-basal segment of right lower lobe, superior segment of left lower lobe We conclude that patients with immunocompromised state like Diabetes mellitus are more prone to disseminated infections which can lead to high morbidity and mortality. Good glycemic control, early diagnosis and effective management with could be key role in managing a diabetic patient.

Lipid Profile and Glycemic Control in Type 2 Diabetic Patients

Objective: To estimate the prevalence of dyslipidemia in type 2 diabetes mellitus, to investigate the association between dyslipidemia and glycemic control, and to highlight potential determinants of poor glycemic control. Methods: A cross-sectional study was conducted in which 450 patients with type 2 diabetes, attending the National Diabetes Center, Baghdad during 2019, were included. Each participant was interviewed using a data collection form to collect the needed demographic, medical, and social data. All participants were investigated for lipid profile assay comprising of TC, TG, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Data on the patients’ HbA1C levels were recorded. Results: The prevalence of dyslipidemia among patients with type 2 diabetes was 69.8%; poor glycemic control was associated with dyslipidemia. Smoking and lack of regular self-monitoring of blood sugar were associated with poor glycemic control. Increased weight and higher waist circumference were associated with higher HbA1c levels. Higher mean of HbA1c was found in female gender. The glycemic control affects not only the blood sugar levels of the patients but also their lipid profile. Good glycemic control has an important role in controlling dyslipidemia and preventing and reducing diabetic complications. Conclusions: Poor glycemic control is significantly associated with dyslipidemia in type 2 diabetic patients.

P12.15: Dapagliflozin for the Treatment of Post-transplant Diabetes Mellitus After Pancreas Transplantation: A Case Report With A 14-Month Follow-up

Introduction: Post-transplant diabetes mellitus (PTDM) is a common metabolic alteration after transplant. Almost all immunosuppressive (IS) drugs, reduce insulin sensitivity and express cytotoxicity against β-cell. The cause of hyperglycemia in pancreas transplant (PTX) can also be linked to rejection and type 1 diabetes (T1D) recurrence. However, mild hyperglycemia with preserved c-peptide and clear signs of insulin resistance (IR) should be treated using type 2 diabetes therapeutic recommendations, thus taking into account the extra-glycemic effects of the new antidiabetic drugs. In recent years, great attention has been paid to sodium-glucose cotransporter-2 inhibitors (SGLT-2i) for their cardio and renoprotective action. Case presentation: We report the case of a male patient who underwent PTX alone in 2007, initially on IS with tacrolimus, mycophenolate mofetil (MM) and prednisone. PTX was complicated by several episodes of acute rejection and the development of lobar pneumonia. For this reason, steroid was discontinued and MM reduced. The patient is in regular pneumological follow-up and stable. Despite radiological and histological signs of rejection, the patient remained in good glycemic control until 2016 when for the first time altered home blood glucose (BG) and glycated hemoglobin (HbA1c: 6.6%) were found. On this occasion, considering the presence of a robust c-peptide, treatment with metformin was started with beneficial effect. In February 2020, HbA1c was 6.1% with a high glycemic variability and trend for hypoglycemic events secondary to therapy with repaglinide, added by other clinician 4 months before. Fasting BG was 109 mg/dl, c-peptide 1.74 ng/ml (stable for at least 5 years). Mild diabetic nephropathy was found (eGFR: 69 ml/min; albuminuria: 94 mg/L). Considering these data and the patient’s particular condition, repaglinide was discontinued and dapagliflozin 10 mg/day was associated with metformin. On March 2021 patient showed HbA1c 6.8% with normal home BG values and an improved renal function with normalization of albuminuria. No adverse events were reported. Conclusion: Limited data in the literature describe pathophysiological mechanism and frequency of PTDM after PTX. History of T1D influences the choice of insulin as first therapeutic approach in high BG after PTX. The combination of IR and β-cell dysfunction caused by IS, T1D recurrence, and rejection contributes to the worsening of BG control. Sometimes one component prevails over the other, as in the case of our patient, who achieved BG compensation with oral agents only. The use of repaglinide as well as any other secretagogue drug is not recommended due to the rapid β-cell exhaustion after PTX. Use of SGLT-2i has allowed to maintain good glycemic control without hypoglycemia, taking advantage of renal protection and reduced CV risk. Great caution is required in this population, also considering the higher risk of adverse events as ketoacidosis and genitourinary infections.

Benefits and warnings after one year of Minimed 780 G hybrid closed loop pump treatment in type 1 diabetes adults

The benefits of a hybrid closed loop insulin pump system are generally compared to non-automated insulin pump treatment of type 1 diabetics whose glycemic control was often unsatisfactory. Here we report the results of a monocentric cohort of type 1 diabetics with a good glycemic control before the switch to the hybrid system. 83 adult patients were followed up for 12 months after the implementation and training of the hybrid system. We observed a significant improvement in the glycemic mean index at 3 and 6 months but not at 12 months, accompanied by a 10% increase in insulin requirements over the first few months. Surprisingly, the time spent in hypoglycemia did not decrease. An analysis shared with patients leads us to propose several measures to consider before switching to a hybrid closed loop system.

To determine the relation of mean platelet volume with diabetes mellitus

Background: Diabetes mellitus (DM) is a complex metabolic disorder portrayed by chronic hyperglycemia bringing about intricacies influencing the peripheral nerves, kidneys, eyes, and macrovascular structures. Mean platelet volume (MPV) is also considered to impact the advancement of microvascular complications of diabetes mellitus which has been looked for in this study. Aims and Objectives: The aims of this study were as follows: (1) To study association of MPV with Nephropathy and Retinopathy in Diabetes. (2) To Study correlation of MPV with hemoglobin A1c (HbA1C), fasting blood sugar, post-prandial blood sugar, and body mass index (BMI). Materials and Methods: This was an observational study conducted over 18 months period on patients (both males and females) seeking medical attention for newly diagnosed or previously diagnosed DM. Selective sampling technique was used and 200 diabetic patients were enrolled in the study during the study period. Results: (1) The incidence of retinopathy and increased Hba1c was significantly higher in poorly controlled diabetics as compared to controlled diabetics. (2) In good glycemic control group, mean MPV was 8.58 fL and, in poor glycemic control group, mean MPV was 10.21 fL. Conclusion: There was a positive correlation between MPV and HbA1C, microalbuminuria, BMI, fasting, and post-prandial blood sugar levels. There was no significant association between MPV and retinopathy.

The patient-centered diabetes management during the COVID-19 pandemic.

Since December 2019, in the fight against the coronavirus disease 2019 (COVID-19) pandemic, we observed that glycemic control in people with diabetes is easily affected by lifestyle changes. To maintain a good health condition, a patient-centered approach with mental support and close monitoring is required. For these, telemedicine and online continuous glucose monitoring (CGM), are effective systems. Therefore, based on our experience during the two-year period, we reviewed the literature for appropriate actions required for the management of diabetes to prevent COVID-19 infection and avoid unfavorable outcomes in COVID-19 cases. Once infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a high risk of a poor prognosis in patients with diabetes. Glucocorticoid therapy in severe COVID-19 cases leads to further hyperglycemia. Since good glycemic control has been shown to improve outcomes, strict glycemic control using CGM is recommended. Using CGM data, insulin can be adequately titrated without causing hypoglycemia, and remote data monitoring can reduce the risk of infection for health care professionals, by reducing the frequency of patient contact. Among patients with COVID-19, some are found to have newly-diagnosed diabetes at admission. Those newly diagnosed patients present with a higher risk of poor prognosis compared to those with pre-existing diabetes. Therefore, glycemic status should be evaluated in all patients with COVID-19 admitted to hospitals.

COVID-19 and Gestational Diabetes: The Role of Nutrition and Pharmacological Intervention in Preventing Adverse Outcomes.

Pregnant women with GDM affected by COVID-19 seem to be at higher risk of adverse maternal and neonatal outcomes, especially those with overweight or obesity. Good glycemic control seems to be the most effective measure in reducing the risk of GDM and severe COVID-19. For such purposes, the Mediterranean diet, micronutrient supplementation, and physical activity are considered the first line of treatment. Failure to achieve glycemic control leads to the use of insulin, and this clinical scenario has been shown to be associated with an increased risk of adverse maternal and neonatal outcomes. In this review, we explore the current evidence pertaining to the pathogenesis of SARS-CoV-2 leading to the main complications caused by COVID-19 in patients with GDM. We also discuss the incidence of complications caused by COVID-19 in pregnant women with GDM according to their treatment.

A Study On Clinical Profile of Urinary Tract Infection in Diabetes Mellitus in a Tertiary Care Hospital

Background: Diabetic Patients are at high risk of developing various infections especially if the diabetes is uncontrolled. Urinary tract infections (UTI) are one of the common infections in diabetics. Knowledge about the clinical and microbiological profile of UTI in diabetic patients will not only aid in early diagnosis but also helps in early initiation of appropriate empirical antibiotic therapy ensuring early recovery. Material & Methods: Prospective hospital based observational study. The study was conducted in the In-patient department, Department of General medicine at KMCT Medical college, Manassery, Kozhikode, Kerala, India. This study was conducted in 170 Diabetic patients above 18 years of age with symptoms of UTI with significant pyuria who were admitted under department of General Medicine, KMCT medical college, Kerala, who satisfied the inclusion criteria and gave consent for study. study consisted a total of 170subjects. Simple Random sampling method. Results: Fever was the most common clinical presentation followed by dysuria. E. coli was the most commonly isolated organism followed by Klebsiella. Most of the organisms were sensitive to Amikacin. Antibiotic resistance and Pyelonephritis were higher in patients with poor glycaemic control. The most common ultrasonographic abnormality was prostatomegaly. Conclusion: Patients with poor glycaemic control are at high risk of resistant UTI and Pyelonephritis. Good glycaemic control with routine monitoring of HbA1C is mandatory in diabetic patients to prevent UTI and to avoid its complications. E. coli was the most common organism isolated followed by Klebsiella. Most of the organisms were sensitive to Amikacin. Hence, Amikacin can be recommended as empirical antibiotic forDiabetic patients who are admitted with UTI.

Adaptación, fiabilidad y validez de los cuestionarios de calidad de vida relacionada con la salud: DISABKIDS, enfermedad crónica y específico de diabetes, en niños y adolescentes con diabetes mellitus tipo 1

IntroductionIt is recommended to periodically evaluate the health-related quality of life (HRQoL) in children and adolescents with type 1 diabetes mellitus (DM1). Despite this, no specific paediatric HRQoL instrument for DM1 has been validated in Spanish. ObjectivesMulticentre, prospective descriptive study in children and adolescents with DM1 with the aim of carrying out cross-cultural adaptation to Spanish and evaluating the reliability and validity of the DISABKIDS chronic disease and diabetes-specific HRQoL questionnaires, using reverse translation. Material and methodsSociodemographic variables were compiled together with the most recent capillary glycated haemoglobin (HbA1c) value and HRQoL questionnaires were handed out to 200 Spanish children and adolescents with DM1 aged between 8 and 18 years of age under evaluation in 12 different hospitals. ResultsThe mean score on the HRQoL questionnaire (patient version) for chronic disease was 80.32 (13.66), being significantly lower (p = 0.04) in patients with a shorter duration of the disease (≤ 5 years): 78.34 (13.70) vs. 82.60 (13.36). The mean score of the DM1-specific modules was: 60.81 (16.23) for disease impact and 65.59 (26.19) for treatment impact.The mean HbA1c value was 7.08 (0.79), with no differences (p > 0.05) noted in the mean score of the HRQoL instruments in patients with HbA1c ≤ 7% vs. HbA1c > 7%.The Cronbach α value varied between 0.72 and 0.90. ConclusionsThe Spanish versions of the DISABKIDS HRQoL instruments meet the proposed objectives of semantic equivalence and internal consistency, making it possible to periodically assess HRQoL in these patients.The good average glycaemic control presented by the patients may explain why no difference was found in the HRQoL instruments based on the HbA1c value.

METFORMIN OR INSULIN IN GESTATIONAL DIABETES-A CONUNDRUM

Objective: To determine the effectiveness of metformin vs insulin for glycemic control in gestational diabetes mellitus. Methodology: This study was done in the Department of Gynecology and Obstetrics, Saidu Teaching Hospital Swat from November 2019 to May 2020. Ethical approval was taken from the hospital ethical and research com­mittee. A sample of 93 patients in each group was taken as per WHO sample size calculation software. All female patients with singleton pregnancies having gestational diabetes diagnosed for the first time in current pregnancy with an age limit from 16-40 Years were included in this study. The lottery method was used for dividing patients into two groups, group A (Metformin) and group B (Insulin). SPSS 23.0 was used for the data analysis using fre­quencies and percentages and the Chi-Square test was used to compare the efficacy of drugs between the two study groups. Efficacy was checked by measuring 1-hour postprandial sugar levels, i-e; more or less than 140mg/ dl. A p-value less than or equal to 0.05 was considered statistically significant. Results: Total number of patients was 186 (93 in each group). The mean age in group A was 28±3.76 years compared to 27±3.13 years in group B. Good glycemic control out of our total 186 patients (93 in each group) was achieved in 80%(n-74) in Group A compared to 90% (n-84) in Group B with a p-value was 0.0403. Conclusion: The study concludes that metformin is non-inferior to insulin in controlling glucose levels in gesta­tional diabetes mellitus.

Common Pathogens Isolated from Infected Diabetic Foot Ulcers at King Abdulaziz University Hospital, Saudi Arabia: A Retrospective Study

Objectives: To determine the common pathogens isolated from DFI to administer appropriate antibiotic treatment, followed by surgical interventions. Methods: A retrospective study was performed on 260 patients who presented with diabetic foot at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2014 to September 2020. All patients underwent swabs and tissue culture for microbiological evaluation. Patient medical records were reviewed to collect demographic and clinical data, including Glycated Hemoglobin (HgA1C), Diabetes Mellitus (DM) type, duration of diabetes, swab, tissue culture, type of surgery, and type of isolated organism. Results: Escherichia coli was the most common organism isolated from the feet of diabetic patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus agalactiae, and Pseudomonas aeruginosa. Amputations were significantly higher in patients who did not have Staphylococcus aureus or Pseudomonas aeruginosa infection, with no significant relationship between amputation and any other isolated organisms. A significant negative correlation between patient age and HgA1C level was discovered, as well as a significant positive correlation between HgA1C and the number of minor amputations. Patients with major and minor amputations had a significantly higher percentage of non-Multidrug Resistance (MDR), whereas patients with MDR had a significantly higher rate of infection with Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus. Conclusion: DM is a metabolic syndrome that affects all the body systems and impacts both morbidity and mortality. The most common organism isolated from the feet of diabetic patients was Escherichia coli, followed by Staphylococcus aureus. Ulcer specimens should be collected for culture and identification of causative organisms. Preventive measures such as good glycemic control, appropriate foot care, targeted antibiotic therapy, and patient education can reduce the incidence of amputation.

Hypertophic cardiomyopathy in infant diabetic mother and glycated albumin in their mothers

Background: Hypertrophic cardiomyopathy represents a co-morbidity in infants. It is characterized by thickening of one or both of the ventricular walls including the interventricular septum in addition to systolic and diastolic dysfunction.Gestational diabetes mellitus (GDM) with poorly controlled glycemia is associated with poor pregnancy outcomes. However, adequate markers for glycemic control in GDM have not been fully evaluated. Hypertrophic cardiomyopathy represents a co-morbidity in infants. It is characterized by thickening of one or both of the ventricular walls including the interventricular septum in addition to systolic and diastolic dysfunction. Summary: In summary, we demonstrated the clinical usefulness of GA and GA/HbA1c in monitoring GDM in late pregnancy and predicting infant complications of GDM. Our data suggested that the use of GA and GA/HbA1c in combination with conventional glycemic control indices might be useful for good glycemic control during pregnancy, although our results need validation in larger, better-designed studies.

Serum Zinc Level in Children Suffering from Type 1 Diabetes Mellitus and Its Relationship with Glycemic Control: An Experience from A Tertiary Level Specialized Diabetic Hospital in Bangladesh

A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh, between July 2016 and June 2017, to evaluate serum zinc level and its relationship with glycemic control in type 1 diabetic children. A total of 160 participants (all aged between 1 and 18 years) were selected from the outpatient department (OPD) of BIRDEM General Hospital-2, Dhaka – 80 type 1 diabetic children as cases and 80 apparently healthy children as controls. We measured anthropometric parameters all study subjects. Serum zinc level was assessed using colorimetric method. Fasting plasma glucose level was estimated using enzymatic glucose-oxidase method. Glycemic control was evaluated through estimation of HbA1c using a high-performance liquid chromatographic method. The mean serum zinc levels were significantly lower in patient with type 1 DM compared to control (72.5±16.5 vs. 82.4±13.3 μg/dl; P<0.001). Lower levels of zinc were found in subjects with poor glycemic control compared to good glycemic control (62.8±14.6 vs. 78.8±14.6 μg/dl; P<0.001). Moreover, serum zinc levels were significantly lower in patients who have duration of diabetes mellitus for 5 years or more (P<0.05). To summarize, serum zinc level is lower in type 1 diabetic children in comparison to its healthy counterpart and this lower zinc level is strongly associated with poor glycemic control which may potentially contribute to the early development of diabetic complications in children.
 CBMJ 2022 July: vol. 11 no. 02 P: 80-85

Impact of Periodontitis on Glycemic Control and Metabolic Status in Diabetes Patients: Current Knowledge on Early Disease Markers and Therapeutic Perspectives.

Diabetes mellitus and periodontitis are two of the most common chronic diseases affecting the world's population, and they are intimately linked. For several years, in fact, it has been known that there is an interdependent relationship between the two diseases: Diabetes promotes the destruction of periodontal tissues, and periodontal disease negatively affects glycemic control. In relation to the control of dental plaque and oral dysbiosis responsible for periodontal disease, both nonsurgical and surgical therapy associated with proper home hygiene procedures have emerged as essential for good glycemic control. Moreover, several evidences suggest the essential role played by the control of periodontal disease in preventing the onset of the most common complications of diabetes: cardiovascular diseases, retinopathies, and other systemic diseases. The aim of this study is to update the current knowledge on the bi-univocal relationship between diabetes and periodontitis and the impact of therapy in the optimal management of these two disorders. From the information found in the literature, it has emerged that the correct treatment of periodontal disease in diabetic patients represents one of the main mechanisms and means currently established and valid to control periodontal disease and glucose metabolism and prevent the onset or development of diabetic complications.

Longitudinal Pancreatico-gastrostomy, A Quest for a Better Salvage for Chronic Pancreatitis in Bangladesh: An Outcome Analysis of Our Early Cases

Background: Chronic pancreatitis being one of the most distressing medical condition, is often complicated by common bile duct obstruction, fibrosis and acute inflammation of the pancreas. Pain, weight loss and diabetes are common in these patients. Surgery is the ultimate option after medical treatment fails to solve the distress. Longitudinal Pancreatico-jejunostomy is widely practiced all over the world as the option of choice. Pancreatico-gastrostomy is also being practiced by a few surgeons in a few centers. Here we practice Longitudinal Pancreaticogastrostomy (LPG) for chronic pancreatitis patients in our setup. This study was aimed to analyze the outcomes and privileges of LPG. Method: This prospective study was monitored and guided by the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka over a period of 18 months. A total of 36 patients with chronic pancreatitis were allocated for Longitudinal Pancreatico-gastrostomy (LPG) surgery. Study tools included pain gradation, body weight, investigation profiles- serum lipase, blood sugar, USG of abdomen, CT Scan and MRCP. Duration of surgery, blood loss, hospital stay, assessment of post-operative pain relief and surgical complications were the parameters of the study. For pain relief assessment patients were divided into three categories, complete (no complaint pain), satisfactory (mild tolerable pain with normal daily activities) and unsatisfactory (moderate to severe pain requiring medication and hampered daily activities). Results: 36 patients in the group underwent LPG. Mean age in group was 22.94 ± 3.76 years. Majority of the patients had unknown etiology. The mean duration of illness in group was 4.27 ±0.96 years. LPG was easier to perform, took less time, less blood loss and hospital stay was short with less post-operative complications. Pain relief was satisfactory with most patients showing complete pain relief. Diabetes patients got much better glycemic control after surgery. Weight gaining was also significant. Conclusion: LPG is an easier and safer surgery which achieves good pain relief, glycemic control and nutritional improvements. Large volume studies should be done to establish its dominance against other surgical procedures. J Shaheed Suhrawardy Med Coll 2021; 13(1): 58-62