Known History Of Diabetes Mellitus Research Articles

Unlocking Healing Potential: A Case Study on the Management of Diabetic Foot Ulcer

Diabetes stands as one of the most prevalent diseases globally, and diabetic patients are at risk of developing foot ulcers as a microvascular complication. These ulcers stem from diabetic neuropathy or atherosclerosis, leading to ischemia or breakdown of glucose-laden tissue, resulting in inflammation and ulceration. If left untreated, these ulcers can become infected, spreading to the underlying tissues. In Ayurveda, such ulcers are termed as Madhumehajanya Vrana. Sushruta Acharya outlined Anushastra Karma for managing Vrana, which includes Ksharakarma (application of alkalis) and Jalukavacharana (leech therapy). Kshara functions by actions like Chhedana, Bhedana, Lekhana and Ropana. Jalukavacharana possesses anti-inflammatory properties, promotes fresh blood supply by removing vitiated Dosha from the blood, and fosters wound healing by forming healthy granulation tissue. A 65-year-old female patient presented with a non-healing wound on the plantar aspect of her left foot below the greater toe since 8 months, associated with foul-smelling pus discharge for 6 months. She had a known history of diabetes mellitus since 10 years. The ulcer measured 4cm x 3cm x 2.5cm, GRBS was 380mg/dl with HbA1c of 12%. Patient was treated with Ksharataila infiltration, application of Tilwaka pratisaraneeya kshara followed by Lekhana of callosity present over the edges of the ulcer, and Jalukavacharana therapy for four sessions with seven days interval, in addition to internal medications. Glycemic control was achieved by Inj. Insulin Mixtard 30/70 30 units in morning and 15units at night.

A Case Report on Heart Failure in Dengue Patients with Concurrent Capillary Leakage Syndrome: Unveiling a “Leakage-Failure” Co-existence

This case report describes a rare and compelling presentation of Massive Tubercular Pericardial Effusion (MTPE) concomitant with Heart Failure (HF) and Diabetes Mellitus (DM). Tuberculosis, once thought to be a disease of the past, continues to manifest in diverse clinical scenarios, emphasizing the importance of maintaining a high index of suspicion, particularly in endemic regions. The patient, a 60 year old male with a known history of DM and HF, presented with symptoms of worsening dyspnea, fatigue, and peripheral edema. Diagnostic workup revealed a massive pericardial effusion with characteristics suggestive of tubercular etiology, subsequently confirmed by pericardial fluid analysis. The challenges in managing this triad of conditions: MTPE, HF, and DM were addressed through a multidisciplinary approach involving cardiology, infectious disease, and endocrinology specialists. This case underscores the significance of a comprehensive diagnostic evaluation and collaborative management in optimizing outcomes for patients with complex cardiovascular and infectious comorbidities. KYAMC Journal Volume: 14, No: 04, January 2024: 246-248.

Prevalence of Hearing Loss Associated with Diabetes Mellitus and Hypercholesterolemia

Background: The relationship between hearing loss and metabolic disorders, particularly diabetes mellitus and hypercholesterolemia, has emerged as a critical research focus. The intricate interplay between these systemic conditions and auditory health poses significant implications for global public health, warranting comprehensive exploration and intervention strategies. Objective: To determine the prevalence of hearing loss associated with diabetes mellitus and hypercholesterolemia. Study Design: Cross sectional study. Settings: Department of ENT, CMH, Multan Pakistan. Duration: From November 2022 to April 2023. Methods: Total 153 adult patients aged 18 years and above of either gender with known history of diabetes mellitus and hypercholesterolemia although without a history of pre-existing auditory disorders, congenital hearing impairment, or any other systemic conditions known to affect hearing were included. Patients with a history of known auditory disorders, pre-existing hearing impairment, or other systemic conditions such as autoimmune diseases or neurodegenerative disorders affecting hearing were excluded. Written informed consent was obtained from all patients before their inclusion in the study. Fasting blood samples were collected for the assessment of metabolic parameters. Statistical analysis was performed using SPSS version 22. Results: The mean age of the patients was 45.2 ± 8.7 years. Gender distribution revealed that 78 patients (51%) were male, while 75(49%) were female. Of the total patients, 27 (18%) had hearing loss, while the majority, 126(82%), had normal hearing. Mild hearing loss was identified in 15(10%), moderate hearing loss in 8(5%), and severe hearing loss in 4(3%) patients. Regarding the type of hearing loss, sensorineural impairment was the most common, affecting 20(13%), followed by conductive hearing loss in 5(3%), and mixed hearing loss in 2(1%) patients. Conclusion: The prevalence of hearing loss associated with diabetes mellitus and hypercholesterolemia underscores the multifaceted nature of health conditions and their impact on sensory functions.

Assessing Individuals Attending the Family Medicine Clinic for Periodic Health Examinations in Screening of Diabetes Mellitus.

This study aims to evaluate the presence and risk of diabetes mellitus (DM) and the factors affecting the risk in those who visited the family medicine outpatient clinic. The present study included adult patients who presented to the outpatient clinic for periodic health examination between February 4, 2022, and April 4, 2022, and who had no known history of DM and were eligible for screening. Anthropometric measurements of the participants were made and their clinical and familial histories were taken in relation to DM. HbA1c and fasting blood glucose (FBG) tests were conducted for each participant. A total of 125 participants, 87 (69.6%) women and 38 (30.4%) men, were included in the study, and five (4%) participants had diabetes. The analysis of the independent risk factors associated with diabetes by multivariate logistic regression analysis revealed that the presence of DM in the family increased the risk of having HbA1c ≥ 5.7% (OR: 3.441; 95% CI: 1.381-8,574; p=0.008). Among women, the waist circumference being > 95 cm was determined as a discriminating factor for HbA1c ≥ 5.7% (sensitivity: 61.54% and specificity: 68.85%). Accurate patient-centered risk assessments by family physicians can lead to positive lifestyle modifications in patients. For this purpose, family physicians should evaluate the patients for diabetes and its associated risk factors and encourage them to take measures in order to prevent diabetes.

Intriguing case of fistula-in-ano presenting as corpora spongiosum abscess

A 77-year-old male, with a known history of diabetes mellitus for 10 years on alternative medication, known case of chronic constipation with hemorrhoids, and chronic lower urinary tract symptoms for many years, presented to the emergency with fever and chills for 2 days followed by acute urinary retention, which was relieved by insertion of Foley’s catheter. Eventually, he developed pain in the perianal region along with perianal discharge. On clinical examination, fistula-in-ano was evident. Magnetic resonance imaging was done for further evaluation which revealed fistula-in-ano communicating into a large abscess of corpus spongiosum of penis.

ODP169 Challenges with use of HbA1C for Evaluation of Blood Glucose Control

Abstract Background Glycated hemoglobin (A1C) is widely used to diagnose diabetes mellitus and monitor glucose control. It represents a measurement of a proportion of glycated hemoglobin which reflects average glycemia over the lifespan of a red blood cell. Genetic factors that affect A1C values have been extensively studied and there is a growing knowledge of some variants that lead to abnormal fasting glucose-A1C ratio. Still, in some patients, delayed diagnosis or suboptimal treatment of diabetes mellitus remains an existing problem when glycated hemoglobin is underestimating blood glucose levels. Case 69-year-old man was seen in endocrine clinic following a hospital admission for newly diagnosed type 2 DM with hyperglycemic hyperosmolar state and a complicated urinary infection. Prior to admission the patient presented to primary care physician with symptoms of urinary infection and was found to have glucose >500mg/dL on point-of-care test and A1C of 9.5% without known history of diabetes mellitus. After a short hospital course the patient was discharged to home on low dose basal insulin and metformin. His morning glucose in the week after hospital stay was ranging between 140-182mg/dL. At the time of first visit in endocrinology he endorsed symptoms suggestive of peripheral neuropathy and had long standing polyuria, normal BMI and no other medical history or complaints. He was educated about the new diagnosis, diabetic diet, treatment and monitoring and no medication change was made at that time. On the next follow up he reported home glucose readings of 134-191mg/dL and repeated A1C was 5.1%. Urine test was remarkable for microalbuminuria and blood test showed low Hb of 8.7g/dL. Work up for anemia revealed alpha talassemia minor, hemoglobin SC disease and G6PD deficiency. During the following year regular clinic follow up visits were conducted, insulin was discontinued and the patient remained on metformin and empagliflozin over the next 4 years to date. When goal glucose control was achieved with fasting glucose of 90-130mg/dL A1C was 3.8% without any hypoglycemia. Hemoglobin at that time was 9.1g/dL. Over the next 4 years and to date his A1C was still checked 1-2 times a year and remained between 4-4.6%. On review of this patient's chart prior to hospital admission his HbA1C was 5.7% so diabetes mellitus was not suspected before the patient developed diabetic emergency that carries high mortality Discussion: There are known genetic and non-genetic factors that affect HbA1C value. It is very likely that this patient as well as many others have significant delay in diagnosis of diabetes mellitus if only HbA1C is used as screening test. A possibility of genetic variant that affects A1C values, especially in patients of African descent should always be considered when there is a discrepancy between fasting glucose and glycated hemoglobin value. Presentation: No date and time listed

Integrative Management of a Case with a Known History of Diabetes Mellitus with Acute Pancreatitis – A Rare Case Report

Diabetes Mellitus is one of the common causes of Acute Pancreatitis. After Pancreatitis the endocrine functions of the pancreas may still worsen, and hence Diabetes Mellitus may be difficult to treat. If HbA1c gets elevated, it may prone the patient to the risk of complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disorders. There may be a possibility of a recurrent attack of pancreatitis which may further complicate the condition, and it may be difficult to treat the person. Hence, there is a need to increase the dosage of allopathic medicine which may harm the patient. Sometimes Insulin may be required to control the condition. In such cases, an integrated approach can be tried with a complementary system of medicine. This is a case with a known history of Diabetes Mellitus with Acute Pancreatitis, improved with an integrative approach. The blood parameters came within normal limits and acute exacerbation of pancreatitis was also taken care of.

IDF21-0439 Type 2 Diabetes Mellitus History in the Prognosis of Hospitalized COVID-19 Patients – A Prospective Observational Study

Background: COVID-19 is found to affect Type 2 Diabetes Patients drastically. Aim: To evaluate the association between a known history of diabetes mellitus (DM) and its clinical outcomes in hospitalized COVID-19 diabetic patients. Method: This prospective cohort study categorized COVID-19 positive patients admitted to a secondary care hospital in South India into DM patients and Non-DM patients. Data regarding the past medical and medication history was collected on the day of admission and the patients were regularly followed up till discharge or death. The outcome measures including duration of hospital stay, mortality, need for ICU care/mechanical ventilation were compared between the two groups. Data is extracted and statistically analyzed using Pearson correlation. Results: A total of 118 patients were observed, 53 patients were diabetic and 65 were non-diabetic. Out of the 53 hyperglycemic patients, 39 patients were on metformin therapy while 15 patients were on insulin before admission due to COVID-19. A higher mortality rate was observed in the DM group when compared with the Non-DM group [26.4% (14) vs 9.23% (6)]. An increased random blood glucose level at the time of admission had a positive correlation with mortality (p = 0.003). While insulin administration prior to admission had negative correlation with mortality [R value is -0.282 (p = 0.02)], increased insulin requirement during hospitalization is associated with poor outcomes [R value is 0.327 (p = 0.002)]. Discussion: People with diabetes when infected with COVID-19 are at a greater risk of morbidity and mortality. The study highlights the need of rational management of hyperglycemia in COVID patients with a history of diabetes mellitus.

Hs-CRP as an important inflammatory risk marker of CAD in diabetes mellitus patients

Elevation of hs-CRP is associated with increased risk of type 2 diabetes development in patients with all levels of metabolic syndrome. This study aimed to assess the hs-CRP among the patients with CAD in type 2 diabetes mellitus. All the patients admitted under cardiology department of PMSSY Bangalore medical college were included in present case control study, conducted between November 2017 to May 2019. The patients with known history of diabetes mellitus for 5-10yrs of duration and willing to be part of study with age >40 were included in present study. Total 70 patients were included who fulfilled the inclusion criteria. Among them 35 were T2DM with CAD (Group A) and 35 were T2DM without CAD (Group B). Among them 40 were males and 30 were female patients. The mean age of patients was 57.2±9.4 in group A and 58.2±10.4 in group B patients, which was statistically not significantly different. There was a significant higher mean hs-CRP in patients of group A compared to group B patients. Hs-CRP is a reliable marker for the atherosclerotic events, and there is a significant relation of coronary artery disease with the elevated hs-CRP in patients. We suggest that patients with diabetes mellitus should undergo a routine screening for hs-CRP levels to detect risk of CAD at early phase.

DETERMINATION OF REFERENCE INTERVAL OF LIVER FUNCTION TESTS DURING PREGNANCY IN URBAN AREA OF DISTRICT RAWALPINDI PAKISTAN

Objective: To determine the reference Interval of liver function tests during uncomplicated pregnancy inpopulation of Rawalpindi and assess their correlation over first and second trimesters of pregnancy.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Chemical Pathology & Endocrinology Armed Forces Institute ofPathology Rawalpindi from Feb 2017 to Jun 2018.
 Methodology: Seven hundred and fifty four pregnant women with uncomplicated, single intrauterine pregnancy were recruited from Rawalpindi. Thirteen patients with known history of Diabetes Mellitus, hypertension, liver disease, renal disorders and those on anti-epileptics, non-steroidal anti-inflammatory drugs and steroids were excluded from the study. Blood sample was taken from each subject to analyze serum bilirubin, albumin, total alkaline phosphates and alanine aminotransferase on random access discrete auto analyser, ADVIA 1800 Chemistry system manufactured in Japan for Siemens Healthcare Diagnostics Inc. Data for serum bilirubin, albumin, ALP and ALT were expressed as mean ± standard deviation. As the reference data followed the Gaussian distribution, therefore the 2.5th and 97.5th percentiles were estimated by values approximately 2SD on each side of mean.
 Results: After analysis of serum samples of 754 subjects, the reference intervals for bilirubin, albumin, ALP andALT during first trimester were; bilirubin 3-9 µmol/l, albumin 31-45 g/L, ALP 122-224 U/l and ALT 3-35 U/l, while of second trimester were: bilirubin 2- 7µmol/l, albumin 28-45 g/L, ALP131-300U/l and ALT 1-33U/l.
 Conclusion: First and second trimester wise reference values of Liver Function Tests have been determined inpregnancy in this study. This would not only........

Teleophthalmology as a Model for Detecting Ocular Diseases in Tribal Areas of a North West State in India.

Background:Lahaul and Spiti district of Himachal Pradesh, a high altitude tribal district, situated at altitudes varying from 10,000 to 15, 000 ft. above mean sea level is cut off from the rest of the country for nearly 6 months due to heavy snowfall in the mountain passes. In the absence of any ophthalmologist and ophthalmic technician, the provision of eye care is virtually absent. The current study (part of a research project funded by the Indian Council of Medical Research) was conducted with the aim to explore teleophthalmology as a model for detecting posterior segment eye diseases in tribal and inaccessible areas.Materials and Methods:Fundus images (taken through fundus photography) of 1000 individuals above 5 years of age with no improvement in vision to 6/6 on refraction and individuals with known history of diabetes mellitus, systemic hypertension, or long standing headache with features of raised intracranial tension irrespective of whether their vision improved to 6/6 or not were sent to tertiary care center (base hospital) from regional hospital (field hospital). Transmitted images (through internet after attaching the details and patient particulars on the excel sheet) were analyzed by the ophthalmologists and the final diagnosis along with the line of management if any was transmitted back.Results:Eighty-five percent of the images transmitted were of good quality. Retinal, vitreous, optic nerve head, and choroidal diseases could be detected.Conclusions:In the present situation, where trained workforce is unavailable in these areas, teleophthamology is an appropriate tool by which a number of eye diseases can be detected at early stages. Most of them can be treated in these early stages by lifestyle modification and medical management.

Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies

ObjectiveGestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. This study aimed to identify early and reliable GDM predictors that would enable implementation of preventive and management measures. MethodsThe participants were a 28-week prospective cohort of in vitro fertilization (IVF)-conceived pregnant women (≤39 years, body mass index [BMI] 18.5-38 kg/m2) without a known history of diabetes mellitus. Fasting blood samples were analyzed at baseline (pre-IVF) and 12 weeks’ gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin, and lipopolysaccharide-binding protein. At 28 weeks, a 75-g oral glucose tolerance test was used to screen for GDM. ResultsFor the overall group at baseline, 22% had BMI ≥30 kg/m2, 45% had polycystic ovary syndrome, 16% had hemoglobin A1C of 5.7% to 6.1%, and 14% had a past history of GDM. At 28 weeks of gestation (n = 158), 34 women had developed GDM and 124 had not. Significant baseline predictors of GDM onset included greater BMI (29.0 vs 25.8 kg/m2), older age (34 vs 32 years), higher levels of follicle-stimulating hormone/luteinizing hormone ratio (1.2 vs 1.0), hemoglobin A1C (5.5 vs 5.2%), insulin (10.6 vs 7.1 μIU/mL), homeostatic model assessment of insulin resistance (2.2 vs 1.7), total cholesterol (199 vs 171 mg/dL), and low-density lipoprotein cholesterol (123 vs 105 mg/dL), and lower triglyceride levels (74 vs 76 mg/dL). Significant 12-week GDM predictors included greater maternal weight gain (delta: 3.4 vs 1.5 kg) and higher levels of insulin (11.3 vs 7.6 μIU/mL), triglycerides (178 vs 120 mg/dL), and homeostatic model assessment of insulin resistance (2.3 vs 1.5). Twelve-week BMI is a predictor of GDM following adjustment for polycystic ovary syndrome status and maternal age. ConclusionWhile preconception maternal BMI, age, and follicle-stimulating hormone/luteinizing hormone ratio are predictors of subsequent development of GDM, early IVF-conceived gestational weight gain is the best predictor of GDM onset.

The role of insulin-like growth factor in Acrochordon Etiopathology

BackgroundThere are reports that acrochordon (skin tag), the most common fibroepithelial tumor of the skin, may be associated with metabolic syndrome components, particularly insulin metabolism disorders. However, to the best of our knowledge, there is no study examining its association with insulin resistance and tissue levels of insulin-like growth factor 1 receptor (IGF-1R) and insulin-like growth factor 2 receptor (IGF-2R).MethodsThirty patients with at least one acrochordon in their body who had no known history of diabetes mellitus and a control group comprised 30 individuals who had no acrochordon or no known history of diabetes mellitus were included. The tissue expression of IGF-1R and IGF-2R were investigated via immunohistochemical assessment in both groups.ResultsIn the group with acrochordon, IGF-1R and IGF-2R expression was found to be significantly higher compared to the control group (p < 0,01). Using logistic regression analysis, an increase in serum insulin, serum IGF-1 and HOMA-IR levels was found to be associated with the expression levels of IGF-1R and IGF-2R.ConclusionThese findings support the view that insulin metabolism disorders should be evaluated in patients with acrochordon. Our study indicates that IGF receptors may have an effect on acrochordon pathogenesis and that acrochordon etiology and related conditions can be clarified by detection of parameters that influence receptor levels.

The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality.&#x0D; Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects. &#x0D; Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with pre-diabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. &#x0D; Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely. (J Respir Indo. 2020; 40(1): 48-57)

Obesity and its Link to Undiagnosed Diabetes Mellitus and Hypertension in Rural Parts of Western India.

Background:Obesity and overweight are becoming major health concerns worldwide. Hence, we studied the association between overweight and obesity with new-onset diabetes and hypertension in a selected rural population.Methodology:Community health workers made house-to-house visits, inviting adults >20 years of age who were at a higher risk of diabetes, from a predefined rural area of Maharashtra, to visit a mobile diabetes clinic operating in a hub and spoke manner. Sociodemographic data and anthropometric measurements were recorded. BMI and waist circumference was classified according to the WHO recommended cutoffs for Asians. Subjects with capillary blood fasting glucose of ≥126 mg/dL or random glucose of ≥200 mg/dL by glucometer were diagnosed as diabetes and blood pressure of ≥140/90 mmHg by sphygmomanometer were diagnosed as hypertension. Subjects with a known history of diabetes mellitus and hypertension were excluded.Results:Out of 29,324 total population, 16.5% of subjects were overweight and 26.4% were obese. Mean ± SD of BMI of the participants was 22.9 ± 4.1 kg/m2 in males and 22.4 ± 4.2 kg/m2 in females. Around 35% of males and 30.5% of females had a high waist circumference of ≥90 cm and ≥80 cm, respectively, 20.5% of subjects had newly diagnosed hypertension, and 11.4% of subjects had newly diagnosed diabetes mellitus. The occurrence of newly diagnosed hypertension and diabetes showed an increasing trend with increasing BMI.Conclusion:Our community-based screening suggested a high prevalence of overweight and obesity in rural India. There was a high prevalence of newly diagnosed hypertension and diabetes in this population.

Metabolic Syndrome Post Allogeneic STEM CELL Transplantation in Adult Patients Is NOT an Uncommon Complication. a Single Center Experience

Background: The significant advances which have been achieved in the field of allogeneic transplantation (alloHCT) have resulted in better post-transplant outcome and prolonged survival. Therefore, complications other than the Graft vs. Host disease (GvHD) or disease recurrence have become increasingly important. The post-transplant metabolic syndrome (PT-MS), caused by several factors (i.e. immunosuppressive agents, chemo-radiotherapy, anti-viral, and biologic therapies) is a well known post-transplant complication in pediatric allografted long-term survivors however, only a few studies have evaluated the prevalence of the PT-MS in adults. In this retrospective study, we sought to evaluate the incidence, risk factors and impact of the PT-MS on alloSCT outcome. Methods: From 1/2011 to 12/2018, 54 patients (34 males and 20 females) with adequate clinical and laboratory data and a minimum follow-up of 6 months were included in the study. Median age was 35.6 years (range, 16-67) and following a myeloablative (n=34) or reduced intensity (n=20) regimen patients received either a mobilized peripheral blood stem cell (n=45) or marrow (n=9) graft originating from full-matched siblings (n=46) or haploidentical (n=8) donors. Calcineurin inhibitors plus either short-term Methotrexate or Mycophenolate Mofetil were given as GvHD prophylaxis. Diagnosis of PT-MS was based on NCEP-ATPIII criteria; for patients with unknown data for abdominal circumference, a modified criterion of body mass index (BMI) ≥25kg/m2 was utilized instead. The independent t-test, logistic regression analysis and log-rank tests were used for statistical analysis. Results: Twenty-four (44%) patients (14 males, 10 females) fulfilled the criteria for PT-MS. Twenty had been diagnosed after the 1st trimester, 3 patients after the 2nd and in addition 1 after the 3rd trimester post alloSCT. Twenty out of 24 (83%) patients had elevated glucose, 19/24 (80%) had BMI&gt;25kg/m2, 18/24 (75%) elevated triglycerides levels, 14/24 (60%) low HDL levels and 13/24 (55%) hypertension. Six (25%) had a known history of MS before alloSCT (10 patients had no available data to assess for MS diagnosis prior to alloSCT). Interestingly, in 8/24 (33%) patients who had PT-MS diagnosed early, either in the 1st or 2nd trimester, the syndrome was completely reversible beyond the 6-month post alloSCT follow-up period. In the aforementioned statistical models, patients' gender, age, BMI, type of conditioning regimen and GvHD co-existence were evaluated as potential predisposing factors for the PT-MS. In univariate and multivariate analysis only BMI&gt;25kg/m2 and age&gt;35 years were detected as significant risk factors (p&lt; 0.01) for development of PT-MS. The PT-MS did not adversely impact survival or the NRM incidence post alloSCT. Conclusions: In our study, in agreement with other publications, we demonstrate that the PT-MS is not an uncommon complication in the early post-transplant period however, for approximately 1/3 of patients the syndrome was reversible. For patients with high risk features (BMI&gt;25kg/m2, age&gt; 35 years, known history of diabetes-mellitus, dyslipidemia, hypertension) apart of close monitoring, specific diet and encouragement for exercise might help reduce the incidence and severity of PT-MS. Nevertheless, prospective and well design trials are warranted to determine the incidence, severity and impact of PT-MS on alloSCT outcome for adult patients. Disclosures No relevant conflicts of interest to declare.

Development of a Clinical Screening Tool for Undiagnosed Diabetes in a Hospital Observation Unit

Background: While diabetes mellitus (DM) is typically diagnosed in the outpatient setting, 30% of patients in the U.S.A remain undiagnosed, prompting novel approaches to screening. There are 2 million Observation Unit (OU) stays annually in the U.S.A. The OU allows prolonged care for Emergency Department (ED) patients who are not sick enough to be hospitalized. A previous study found 9% of OU patients have undiagnosed DM and therefore our OU practice is to obtain HbA1c on patients without a history of DM. A typical OU stay is 24 hours, allowing adequate time for screening, education and initiation of treatment if warranted. To conserve resources, we developed a screening tool to allow selective HbA1c testing in the OU. Methods: We reviewed OU admissions at a tertiary hospital and included patients with no known history of DM and who had HbA1c assessed during their OU stay. Those with HbA1c ≥ 6.5 were categorized as newly diagnosed DM. Previously validated clinical variables were tested in the model; also included were clinical variables readily available in the OU. A model was developed on 2/3 of the cohort and validated on the remaining 1/3. Results: A total of 2425 patients met inclusion criteria. The final model included: BMI, race, family history of DM, age, serum sodium and potassium, glucose on ED arrival and initial systolic blood pressure. Predictive assessment of the model was strong with a C-statistic of 0.823. The model was validated and findings remained strong with a C-statistic of 0.788. Performance at the optimal cut-point yielded a sensitivity of 0.750 and specificity of 0.771. Conclusions: This screening tool identifies 75% of previously undiagnosed DM patients, while excluding 77% of nondiabetic patients from testing. The model can be used at the bedside or embedded in the electronic medical record to selectively screen for DM. There is potential to identify large numbers of previously undiagnosed DM in the OU and the typical 24-hour stay allows time for education and treatment to be initiated. Disclosure R.M. Noonan: None. W.J. Castillo: None. G.M. Saffran: None. C.B. Montgomery: None. G. Phayal: None. R.H. Seemangal: None. N. Kohn: None. A. Tiberio: None. E. Wolff: None. R. Schulman: None. R. Silverman: None.

ISCHEMIC STROKE;

Background: Patients with acute ischemic stroke frequently test positive forhyperglycemia, which is associated with a poor clinical outcome. This association between poorglycemic control and an unfavorable prognosis is particularly evident in patients with persistenthyperglycemia, patients without a known history of diabetes mellitus (DM), and patients withcortical infarction. Objective: To determine the frequency of raised hemoglobin A1c in patientspresenting with ischemic stroke. Material &amp; Methods: Study design: Retrospective study.Setting: Department of Medicine, Independent University Hospital, Faisalabad. Duration:6 months. Data collection procedure: Reports of 150 patients fulfilling selection criteriawere selected from medical record section of Independent University Hospital, Faisalabad.Demographic details were obtained. Then medical record of patients was assessed for presenceof HbA1c. If HbA1c of patients was reported ≥ 6.5%, then raised HbA1c was labeled. Results:In this study raised HbA1C level in patients presenting with ischemic stroke was 25%. Amongthese patients the most affected age group of patients was 41-60 years. Female patients weremore effected than male patients. Among these patients only 27% were diabetic while 73%were non-diabetic, 54% were smokers, 32% patients were hypertensive and in 14% patientshyperlipidemia was seen. All these factors were not significantly associated with raised HbA1clevel in patients presenting with ischemic stroke. Conclusion: Results of this study demonstratea high frequency of raised HbA1c level in patients presenting with ischemic stroke. i.e. 25%. Sokeeping in mind these findings it is recommended that stroke patients should also be screenedfor hyperglycemia or increased HbA1c so that patients can be prevented from development ofpermanent hyperglycemia or other complications associated with it.

Use of a Screening Questionnaire to Identify Patients at Risk of Hyperglycemia Prior to Steroid Injection Therapy.

Patients with chronic pain considered for steroid injections are not consistently screened for undiagnosed or poorly controlled diabetes mellitus (DM) prior to steroid administration despite the known impact of corticosteroids on glucose control. A quality improvement project was undertaken to identify the prevalence of at-risk patients prior to steroid exposure through the development and implementation of a screening questionnaire. Three hundred and five adult patients with chronic pain who were being considered for an outpatient steroid injection were interviewed. Each patient was asked to complete an American Diabetes Association-validated diabetes mellitus screening questionnaire (ADAQ). In addition, patients responded to a set of nine questions that addressed common signs and symptoms of hyperglycemia. The total prevalence of known DM in the study population was found to be 20% (60 patients), based on a documented history of diabetes mellitus. The ADAQ identified an additional 135 patients (45%) at high risk for undiagnosed DM. The full study questionnaire identified 143 patients (47.3%) who had no known history of diabetes mellitus as being at risk for hyperglycemia. In patients with known diabetes, five of nine symptom-based screening questions occurred with significantly frequency (P < 0.05): excessive thirst, excessive hunger, blurred vision, poor wound healing, and repeated infections. More than 60% of the patients screened had high risk of having inadequately treated DM. Thus, routine screening for DM should be considered in patients prior to treatment involving corticosteroids. The study questionnaire is a potentially cost-effective initial screening tool to determine which patients should undergo laboratory testing.

A Decision Tree Analysis of Diabetic Foot Amputation Risk in Indian Patients.

The aim of this study is to create an evidence-based tool that guides the risk of amputation in diabetic foot patients. Hospital records of 301 diabetic foot patients were examined retrospectively for explanatory variables of foot amputation decisions. The study included all patients with a lower limb ulcer with a known history of diabetes mellitus or those diagnosed post-admission. The dataset was analyzed, and a risk scoring system was constructed using the decision tree algorithm, C5.0. Two classifiers, one simple and another complex, were constructed for predicting amputation outcome. Based on our evaluation, the most influential predictors for a decision to amputate are Doppler flow measurements and the Wagner grading of the ulceration. The simple classifier uses just these two parameters in determining risk. The results obtained show an accuracy of 96.4% in the primary group and an accuracy of 94% in the test group. The second classifier is a more complex computer-derived construct that showed 100% accuracy in the principle group and an accuracy of 96% during testing. In the present era of precision medicine, these two classifiers act as an accurate guide to the prognosis of the limb in patients with diabetic foot and can predict the risk of future amputation.