Mean Duration Of Diabetes Mellitus Research Articles

Prevalence of Hypertension in Patients with Type-2 Diabetes Mellitus

Background: Hypertension contributes enormously to the global disease burden and mortality. The prevalence of hypertension among type 2 diabetes mellitus (DM) patients is higher than that of age- and sex-matched patients without diabetes, ranging from 32% to 82%. Diabetes mellitus is a global health issue, about 9% of adults have diabetes, and an estimated 1.5 million people die due to diabetes worldwide each year. Increasing age, trend of obesity and worsening renal function increasing the prevalence of hypertension in people with type-2 diabetes mellitus. Objective: To assess the prevalence of hypertension in patients with type-2 diabetes mellitus. Methods: This was a cross-sectional study which was conducted in the Department of Medicine, 250 Beded Mohammad Ali Hospital, Bogura, Bangladesh during the period from January to December 2023. In total 100 patients with type-2 diabetes mellitus attended to the mentioned hospital with proper documents were finalized as the study people. Besides data regarding type 2 diabetes mellitus, data of blood pressure and macro-vascular as well as micro-vascular complications were collected. A predesigned questioner was applied to collect patient data. All data were processed, analyzed and disseminated by MS Office and SPSS version 20. Results: In this study, a total of 100 type-2 diabetic patients (56 male, 44 female) were observed. The mean age of the patients was 53.86 years with Standard deviation (SD) of ±11.54 years. The mean duration of diabetes mellitus was 7.08 SD ± 5.95 years. In analyzing the duration of type 2 diabetes among participant we observed 46%, 25%, 18% and 11 % participants suffered from T2DM for 1-5, 6-10, 11-15 and >15 years respectively. Finally, among total participants in analyzing the prevalence of hypertension we observed out of 100patients with T2DM only 32 were with hypertension which was 32%. On the other hand, in analyzing the stages of hypertension among total participants we found, 32% were with normal and pre-hypertension (in total 68%) respectively. On the other hand, among 32% hypertensive participants, 20% (n=20) were with stage I HTN whereas 12% (n=12) were with stage II HTN. Conclusion: In this study, the prevalence of hypertension among type 2 diabetes patients was found some higher than that in normal. But if we consider the number of pre-hypertensive patients as a potential concern, then it is alarming. The findings of this study may be helpful in the treatment arena of diabetes and in similar further studies.

Effect of online infographics for enhancing health literacy among patients with type 2 diabetes in primary care unit during the COVID-19 pandemic: a randomized controlled trial

BackgroundHealth literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM.MethodsThis randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher’s exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar’s chi-square tests were used.ResultsThe median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups.ConclusionsNovel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion.Trial registrationThe Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

Ankle Brachial Index as Diagnostic Marker for Asymptomatic Peripheral Arterial Disease in Diabetes Mellitus

Objective: To determine ankle brachial index (ABI) as a diagnostic marker for asymptomatic peripheral arterial disease (PAD) in diabetes mellitus (DM). Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Hyderabad, Pakistan from Jan to Sep 2022. Methodology: A total of one hundred and seventy (n=170) asymptomatic patients with DM were included. Specific details were recorded, which include HbA1c levels, duration of diabetes and ankle brachial index. Results: There were 60.0% male and 40.0% female patients. With the mean age of 50.60±11.55 years. The mean duration of diabetes mellitus was 4.20±1.97 years. Mean HbA1c was 7.41±1.27%, mean ABI was 1.03±0.13. Peripheral arterial disease was observed in 17.05% of asymptomatic cases using ABI, with ABI sensitivity of 82.86% and specificity of 97.24% in detecting asymptomatic PAD patients. It was significantly associated with an increase in the duration of diabetes. Conclusion: Asymptomatic peripheral arterial disease diagnosed through the ankle brachial index showed that it is a reliable source for diagnosing patients with asymptomatic PAD in diabetes mellitus reported in routine clinical visits.

A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study.

Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic. This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001). The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

PREVALENCE OF LATENT TUBERCULOSIS IN DIABETIC AND NON-DIABETIC INDIVIDUALS IN A TERTIARY CARE CENTER: A COMPARATIVE STUDY

Aims and Objectives: The aims of this study were as follows: (1) To study the prevalence of latent tuberculosis (TB) in diabetic and non-diabetic population attending the tertiary care hospital. (2) To investigate the association between diabetes mellitus (DM) and latent TB, evaluating the prevalence of positive tuberculin tests and assessing glycemic parameters in diabetic patients with latent TB. Methods: This was a single-center, hospital-based, observational, and comparative study conducted in the department of general medicine of a tertiary care medical college. One hundred and thirty-six diabetic patients of either gender or 137 healthy individuals acting as control group were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were evaluated by detailed history and clinical examination. The diagnosis of latent TB was based on a positive tuberculin test without any clinical features of active TB. The prevalence of latent TB infection was compared in both the groups. p&lt;0.05 was taken as statistically significant. Results: Patients in both the groups were found to be comparable in terms of gender distribution and mean age. Predominant patients were found to have type 2 DM. The mean duration of DM was noted to be 91.58±60.68 months. The most common diagnoses of patients in non-diabetes group were COVID-19 (9.49%), neurological diseases (8.76%), infections (7.3%), acute myocardial infarction (6.57%), and iron deficiency anemia (5.84%). About 21.32% of cases in DM group were noted to have latent TB, while the proportion of latent TB was noted to be 7.30% in the non-diabetes group. The mean fasting blood sugar, mean post-prandial blood sugar, as well as mean HbA1c were significantly higher (p&lt;0.05) in the subgroup with latent TB versus the subgroup without latent TB. Conclusion: Individuals with diabetes mellitus were found to have increased risk of latent TB infection. In addition, male gender and elevated glycemic parameters were found to be key factors associated with latent tuberculous infection in diabetes.

STUDY TO EVALUATE CLINICAL PROFILE AND OUTCOME OF PATIENTS IN DIABETIC FOOT IN A TEACHING HOSPITAL

Objective: The objective is to investigate the clinical characteristics and results of individuals who present with diabetic foot infections (DFI). Methods: This was a prospective study conducted in collaboration with the DFID Department of General Surgery at the Arundhati Institute of Medical Sciences and Hospital in Gandhimaisamma, Hyderabad, involving patients aged 20–80 years. Results: There were 55 patients in the current investigation, with a mean age of 61.78±11.75 years and a preference for males (n=45, 81.8%) over girls (n=10, 18.2%). The study’s largest number of patients (n=27, 49.1%) were observed in the 61–80 year age range. The average hemoglobin A1c (HBA1c) was 10.74±1.60 years, while the mean duration of diabetes mellitus was 10.87±2.681 years. Our patients’ microbiological profiles revealed that 32.7% of them were Gram positive and 67.3% were Gram negative. Gram-negative bacillus Escherichia coli was the most often found bacterium in our investigation (67.3%), followed by Pseudomonas (29.1%), Klebsiella (18.2%), and Staphylococcus aureus (5.5%). Conclusion: Since DFIs are the most prevalent consequence of diabetes mellitus that surgeons are notified about, managing them needs a multidisciplinary approach. It is crucial to do extensive, repeated examinations, as well as any required investigations to determine the infection severity at the time of presentation.

To study the role of hematological biomarkers in type 2 diabetes patients with diabetic retinopathy

Abstract Background: Diabetic retinopathy (DR) is the most common and severe microvascular complication of diabetes mellitus (DM). It is the leading cause of irreversible blindness, and the prevalence is expected to double by 2030. Aim of this study was to compare the hematological biomarkers in diabetics with and without retinopathy. And also, as the grade of retinopathy increased. Methods: The study comprised three groups: DR (n = 66), NDR (n = 33), and controls (n = 33). Detailed workup included HbA1c levels, platelet indices (mean platelet volume (MPV), platelet distribution width (PDW), platelet count, and plateletcrit. Results: The mean age was 54 years. The mean duration of DM was 10 and 4 years in the DR and NDR groups, respectively. MPV values were significantly higher in the DR group (10.77 ± 1.2) than NDR (9.2 ± 1.1) and least in controls (8.3 ± 0.89) (P = 0.00). These values increased significantly with increasing severity of retinopathy (P = 0.04). There was a 6.13 times increased risk of developing diabetic retinopathy with increased mean platelet volume (MPV). Mean PDW was significantly higher in the DR group (19.22 ± 2.5) than NDR (13.89 ± 2.9) and least in controls (11.3 ± 2.5) (P = 0.00). These values increased significantly with increasing severity of retinopathy (P = 0.00). Other markers were not significant. Conclusion: MPV and PDW are important biomarkers which can predict the development and severity of retinopathy. Therefore, it is suggested that platelet indices be routinely done in diabetic workup. Furthermore, these are conveniently obtained from automated cell counters.

Which factors affect phenoconversion in isolated rapid eye movement sleep behavior disorder?

AimIsolated REM sleep behavior disorder (IRBD) is characterized by loss of the normal atonia of REM sleep. Patients with IRBD are at substantial risk of developing the synuclein-related neurodegenerative diseases (NDD). Few predictors of phenoconversion (from IRBD to NDD) have been identified such as age >65 years, hyposmia, constipation, elevated Epworth sleepiness scale (ESS). We aimed to detect rate and risk factors of phenoconversion. MethodThe study designed as retrospectively. NDD was developed in 18 (27.27%) patients while NDD wasn’t developed in 48 (72.73%) patients after ten years. The data of the first visit (age, gender, hyposmia, constipation, ESS, comorbidities, physical/neurological examinations, laboratory, and polysomnography) were compared between NDD (n:18) and IRBD (46) groups. The statistical program IBM SPSS Statistics Version 20.0 was used for all analyzes. The threshold for statistical significance for each test was set at 0.05. ResultsAlthough, most first-visit data (age, gender, hyposmia, constipation, ESS, laboratory, polysomnography) were not different between NDD (n:18) and IRBD (n:48) groups, diabetes mellitus (DM) frequency (p:0.021), mean duration of DM (0.027), chest circumference (p:0.017), and hip circumference (p:0.045) were found higher in NDD than IRBD. If the risk of phenoconversion calculated by logistic regression analysis was different only in terms of DM frequency (p:0.030) [odds ratio: 4.909 (1.17–20.19)]. ConclusionThe present study showed that the phenoconversion rate for ten years is 27.27%, and IRBD patients with diabetes mellitus increase the phenoconversion risk nearly five times.

Effect of exercise in incident atrial fibrillation among diabetes mellitus with different diabetes duration

Abstract Background/Introduction In previous studies, level of exercise and AF risk seems to have nonlinear relationship. Vigorous physical activities have been considered as a risk factor of atrial fibrillation (AF). However, other studies have shown regular exercise to be associated with reduced incidence, symptoms, recurrence, and burden of AF. Conversely, a sedentary lifestyle is an important risk factor for the development of AF. Currently, the effect of exercise amount on the risk of AF among patients with diabetes mellitus (DM) according to diabetes duration has not been examined. Purpose This study aimed to evaluate the effect of exercise amount on incident AF among patients with DM using a nationwide population cohort. Methods The subjects with type 2 DM who underwent the Korean National Health Insurance Service health examination during 2015 and 2016 were identified. The study population was divided into four groups according to DM duration (new onset, less than 5 years, 5 to 10 years, and more than 10 years). Also, they were categorized into four groups according to the amount of exercise (0, &amp;lt;500, 500 to 1000, 1000-1500, and ≥1500 METs-Min per week). The study outcome was incident AF. Results A total of 2,392,486 subjects with a mean follow-up duration of 3.9 ± 0.9 years were enrolled (mean age 59.3 ± 12.0, female 39.8%). The mean DM duration was 5.3 ± 5.1 years, and the mean exercise amount was 643.0 ± 638.0 METs-min/week. 704,732 subjects were new-onset DM, 649,811 subjects had less than 5 years of DM duration, 464,870 subjects had DM duration between 5 to 10 years, and 573,073 subjects had more than 10 years of DM. As the DM duration became longer, age, the prevalence of comorbidities (hypertension, chronic kidney disease, chronic heart failure, prior myocardial infarction, prior stroke, and prior peripheral artery disease), the prevalence of more than three oral anti-diabetes medications, and insulin usage increased sequentially (all p&amp;lt;0.0001). In each DM duration group, the exercise amount of AF risk showed slightly different relationship. The new-onset DM group and DM duration 5 to 10 years groups showed the most reduced AF risk in exercise amounts 1000 -1500 METs-Min/week (adjusted hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.82-0.96 p=0.0016 and adjusted HR 0.83, 95% CI 0.77-0.89, p=0.0098, respectively). The DM duration less than 5 years and more than 10 years groups both showed the lowest risk in exercise ≥1500 METs-Min/week (adjusted HR 0.91, 95% CI 0.85-0.97; adjusted HR 0.85, 95% CI 0.81-0.90, both p&amp;lt;0.001). Conclusions Regular exercise of more than ≥1500 METs-Min/week did not increase the risk of AF risk in DM patients. It was associated with reduced AF risk in all DM patients except new-onset DM. Further study is needed to assess the biophysiological change regarding DM duration that could affect the AF risk.

Periodontal health in adequately controlled and inadequately controlled type 2 diabetes: A cross-sectional study.

Objective: To compare health status in term of clinical attachment loss and pocket depth adequately-controlled vs. inadequately-controlled type 2 diabetes. Study Design: Cross-Sectional study. Setting: Department of Periodontology, Khyber College of Dentistry, Peshawar. Period: 1st May 2021 to 30th January 2022. Material &amp; Methods: A total of 142 participants with Type 2 diabetes mellitus (DM), aged between 35 and 65 years, and with a DM duration exceeding 3 years, along with a minimum of seven teeth per arch determined through clinical examination, were included. Participants with type 1 diabetes mellitus, smokers, pregnant women, those on medications inducing gingival enlargement, those who underwent periodontal therapy in the last six months, and patients undergoing orthodontic treatment were excluded. Pocket depth and clinical attachment loss at six points on each reference tooth (including upper and lower first molars, first premolars, and central incisors) were measured using a Michigan 'O' Probe featuring William markings on a periodontal pocket chart. The arithmetic mean value was then calculated. To compare the two groups (adequately controlled diabetics and inadequately controlled diabetics), the mean pocket depth and mean clinical attachment loss were analyzed separately using an independent samples t-test. Results: The mean duration of DM, age, periodontal pocket depth, clinical attachment were 6.42 ±2.76 years, 50.77 ±9.50 years, 4.03 ±0.74mm, and 4.74 ±0.74mm. The males were 80(56%) and females were 62(44%). The mean PPD was less in well controlled (3.45±0.36mm) than poorly controlled diabetes (4.76±0.36mm) statistically significantly (p&lt;0.001). Similarly mean CAL was less in adequately controlled (4.16±0.36mm) than inadequately controlled diabetes (5.47±0.36mm) statistically significantly (p&lt;0.001). Conclusion: Inadequately controlled diabetes mellitus is associated with adverse periodontal health status.

Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence in the Polish population aged ≥ 65

Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18–1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01–1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42–0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20–1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23–0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28–0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25–0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.Trial registration: NCT03243474.

Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria

Background: Diabetes mellitus (DM) and its complications, continues to pose enormous challenge to health and financial stability. Diabetes has remained a source of national and global economic burden. It has been observed lately that incidence of diabetic foot ulcer (DFU); one of the complications of DM, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among diabetic patients. This is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. The aim was to determine the magnitude of limb loss or lower extremity amputation attributable to DM over a period of 12 months in tertiary institution and to assess the clinical profile of the patients.&#x0D; Method: This is a retrospective study of the records of all patients that were consecutively booked for lower limb amputation and operated upon in the last 12 months at UNIOSUN Teaching Hospital, Osogbo, South-Western Nigeria. Out of these total, cases of DFU were extracted to form another study group and then studied in detail.&#x0D; Results: Atotal of 38 patients had lower limb amputation from July 2021 to May 2022. Twenty three of the total number of amputations had DFU with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) Of the 23 diabetic cases , females were 15 with M:F ratio of 1:1.9. Mean age was 63±11.18 years. Mean duration of DM was 8.06±5.64 years. 78.3% had no foot care education and Doppler USS confirmed atherosclerosis in 100% of the patients. The commonest bacteria isolated was Proteus 34.8%. Length of hospital stay ranged between 6 weeks to 16 weeks. Outcome of admission was largely successful with 95.7% discharged and 4.3% mortality. &#x0D; Conclusion: DFU contributes markedly to morbidity and mortality. Long duration of DM, presence of PAD and DPN as well as advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous DFU. However, larger studies are needed to establish these factors as predictors of amputation in patient with DFU. Outcome was majorly good as majority of the patients were discharged.

Mean Best Corrected Visual Acuity after Intravitreal Bevacizumab in Patients with Diabetic Macular Edema

Purpose: To determine mean best corrected visual acuity after intravitreal bevacizumab in patients with diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Jinnah Hospital, Lahore and Chaudary Muhammad Akram Hospital Lahore from March 2018 to May 2021. Methods: A total of 200 patients of either gender with diabetic macular edema and age between 40 and 60 years were included in this study. Patients with dense cataract, corneal opacity, uncontrolled diabetes mellitus and those who were treated with pan retinal photocoagulation were excluded. Best corrected Visual Acuity (BCVA) was evaluated with Snellen chart and converted to log MAR. A standard protocol of 0.05 mL of Bevacizumab was prepared from injection Avastin, 100 mg/4 mL vial. Bevacizumab injection was given to all patients, using topical anesthesia, under aseptic measures in the operation theater. A total of 03 injections were given at 1-month interval. After three months, BCVA was recorded. Results were presented in number and percentages. Results: Mean age of the participants was 50.42 ± 6.48 years. Male to female ratio was 1:1.6, with 78 (39.0%) men and 122 (61.0%) women. Mean duration of diabetes mellitus was 5.12 ± 2.23 years. Mean pre-treatment BCVA was 0.51 ± 0.05 and mean post-treatment BCVA at three months was 0.26 ± 0.22. Conclusion: Mean BCVA is increased after intravitreal injection of Bevacizumab in patients with diabetic macular edema.

Analysis of Corneal and Lens Densitometry Changes in Patients With Type 1 Diabetes Mellitus

By comparing the densitometry findings of patients with type 1 diabetes mellitus (T1DM) and the healthy group, we aimed to understand the possible changes that may occur in the cornea and lens in those with diabetes mellitus (DM). Prospective, cross-sectional study. A total of 60 eyes of 60 patients with T1DM and 101 eyes of 101 healthy subjects were included in this study. A complete ophthalmologic evaluation was performed in all participants. Scheimpflug tomography was performed to record the corneal and lens densitometry and other tomographic data. Mean glycosylated hemoglobin (HbA1c) and mean DM duration were recorded. The mean age of the patients with T1DM and patients in the control group was 29.93 ± 8.56 years and 27.27 ± 1 4.96 years, respectively. The mean HbA1c was 8.43 ± 1.92, and the mean DM duration was 14.10 ± 7.77 years. Corneal densitometry (CD) values were significantly higher in the 0- to 2-mm zone in all layers and in the anterior and central 6- to 10-mm zone in the diabetic group (P = .03, P = .018, P = .001, P = .000, P = .004). The mean crystalline lens densitometry was higher in the T1DM group (P = .129). There were positive correlations between DM duration and CD in the anterior 0- to 2-mm (P = .043), central 6- to 10-mm (P = .016), posterior 6- to 10-mm (P = .022), and posterior 10- to 12-mm zone (P = .043). CD values were significantly higher in the diabetic group. Diabetes duration and HbA1c values showed correlations with densitometry especially in the 6- to 10-mm corneal zone. Evaluation of the cornea with optical densitometry will be useful in the early diagnosis and follow-up of clinical structural and functional changes in the cornea.

Endothelial Cell Density before and after Phacoemulsification in patients with Diabetes Mellitus

Introduction: Cataract is the leading cause of treatable blindness worldwide. Phacoemulsification with intraocular lens (IOL) implantation is the most common surgical procedure performed for the treatment of cataract. The diabetic cornea has decreased corneal endothelial cell density (CED) due to cell dysfunction and malfunctioning repair systems. Objective: To compare the mean endothelial cell density before and after phacoemulsification in patients with diabetes mellitus. Material and Methods: A total number of 30 patients who presented for cataract extraction were included. Data regarding patients age, gender, duration of diabetes mellitus and side of cataract was collected. One day before surgery, CED was measured in all patients using Specular Microscope. After 2 weeks of surgery, CED was measured again. Results: Mean age of patients included in this study was 48.70±8.39 years. Mean duration of diabetes mellitus was 5.03±2.85 years. There were 16 (53.33%) males and 14 (46.67%) female patients. There were 15 (50.00%) patients with right eye and also 15 (50.00%) with left eye. On comparison of mean ECD between the Groups, the mean pre-operative ECD was 2753.05±126.91 Cells/mm2 and post-operative ECD was 2451.16±160.93 Cells/mm2, this difference was statistically significant with p value &lt;0.0001. Conclusion: Phacoemulsification is associated with significant decrease in endothelial cell density in diabetic patients presenting with cataract. The benefit of this study is that it adds to the existing body of literature on impact of phacoemulsification on endothelial cell density in diabetic patients which can help in the development of advanced surgical techniques and better post operative management in such patients. Keywords: Endothelial cell density, phacoemulsification, diabetes mellitus.

Diabetic Foot Causes and Outcomes A Study in Wassit Province, Iraq

Diabetic foot (DF) as a complication of Diabetes Mellitus (DM) was studied in 88 Iraqi adult patients in Wasit Province at their visit to Al-Karama Teaching Hospital during the period from April 2010 to March 2012.Eighty eight patients were enrolled, 58 males with mean age of 63±8.4 SD years, and 30 females with mean age of 65±4.1 SD years. The mean duration of Diabetes Mellitus was 10.5 years. Uncontrolled hyperglycemia was documented nearly in all patients at presentation.More than 90% of the patients were non-compliant with diet , drugs or both and 88% of them have high body mass index ( BMI &gt;26 Kg/m2) . Other co-morbidities also co-exist, 72.7% of them have peripheral neuropathy (mainly sensory ), 54.5% have hypertension,40.9% of them are active smokers, 39.7% ischemic heart disease, 35% peripheral arterial disease , 34% history of trauma, 29.5% have hyperlipidemia( Table 1). Many of them have more than one risk factor concomitantly. The presenting Diabetic Foot problems were: ulcers in 45 patients, gangrene of the toes and/or the feet in 24 patients, abscess or cellulitis in15 patients and 4 patients presented with miscellaneous conditions (Table 2). Conservative treatment was successful in 95.3% of non-gangrene diabetic foot conditions .But 24 patients who presented with gangrene were in need of some sort of amputation of toes or more proximal ,especially those older than 65 years of age with multiple risk factors. Foot negligence, mis-care, mal-footwear and lack of knowledge about the sequels of diabetic foot by the patient were the main precipitating factors that augment the problem and worsen the outcome. The education programs about Diabetic Foot and correction of risk factors can do a lot to minimize the problem.

Interruption of CGM: Frequency and Adverse Consequences.

Removal of diabetes devices, including insulin pumps and continuous glucose monitoring (CGM), is a common practice due to hospital policies, interference with imaging studies, medications, and surgical interventions. Furthermore, these devices are inherently prone to malfunction, adhesive failure, and issues with insertion that can lead to a reduction in wear time. Prescription and dispensing practices provide an exact number of sensors per month without redundancy to account for the realities of daily CGM use. A RedCap survey was completed by adult patients with type 1 or type 2 diabetes (T1D or T2D) who utilize CGM followed in the Diabetes Center at Washington University in St Louis. Of 384 surveys sent, 99 were completed. Participants had a mean age of 54 years, T1D 69%, female 70%, White 96%, non-Hispanic 96%, and a mean duration of diabetes mellitus (DM) 28 years. Of the cohort, 100% used CGM (80.2% Dexcom, 13.5% Freestyle Libre, 6.3% Medtronic), 61% insulin pump, and 41% Hybrid closed-loop (HCL) systems. CGM-related disruption events included device malfunction (in 85.4% of participants), insertion problems (63.5%), and falling off (61.4%). Medical care-related disruption occurred most frequently in the setting of imaging (41.7%), followed by surgery/procedures (11.7%) and hospitalization (4.4%). Adverse glycemic events attributed to CGM disruption, including hyperglycemia and hypoglycemia, occurred ≥4 times in 36.5% and 12.4% of the cohort, respectively. Disruption in CGM use is common. Lack of redundancy of CGM supplies contributes to care disruption and adverse glycemic events.

Comparison of Point-of-Care and Laboratory Glycated Hemoglobin A1c and Its Relationship to Time-in-Range and Glucose Variability: A Real-World Study.

Introduction The main objective of the current study was to perform a comparison of point-of-care testing for hemoglobin A1c (POCT-HbA1c) versus the standard laboratory method (Lab HbA1c) and their relationship to time-in-range (TIR) and glucose variability (GV) among patients with diabetes mellitus (DM) presented to the outpatient diabetes clinics. Methods This single-center cross-sectional study was carried out on diabetic patients (aged ≥14 years of both genders) who undergo routine follow-up at our institution and whose physicians ordered HbA1c analysis for routine care. The included patients were those using the intermittently scanned continuous glucose monitoring (isCGM) Abbott's FreeStyle Libre system for at least three months and regular CGM users with at least 70% use. Results We included 97 diabetic patients (41 female and 56 male), with a median age of 25 years (Interquartile range= 18) and a mean DM duration of 10.33±5.48 years. The mean values of Lab-HbA1c and POCT HbA1c were 8.82%±0.85% and 8.53%±0.89%, respectively. The TIR, time below range, and time above range were 33.47±14.38 minutes (47.78%±14.32%), 5.44±2.58 minutes (8.41%±4.42%), and 28.8±8.27 minutes (43.81%±13.22%), respectively. According to the Bland-Altman plot analysis, the POCT-HbA1c values are consistent with the standard Lab-HbA1c values (SD of bias= 0.55, and 95% CI= -0.78 to 1.4). The univariate linear regression analysis showed a statistically significant relationship between laboratory HbA1c and POCT HbA1c (R2= 0.637,p<0.001), TIR (R2= 0.406,p<0.001), and GV (R2= 0.048,p= 0.032). After adjusting for age, gender, disease duration, diabetes type, and percentage of sensor data in a multivariable linear regression model, the linear associations remained significant (allp< 0.05). Conclusion The current findings show that TIR and GV can be used as endpoints and valuable parameters for the therapy of DM.

The Frequency of Ischemic Stroke Associated with Atrial Fibrillation at a Tertiary Care Hospital

Acute ischemic stroke is most commonly associated with atrial fibrillation. However, its prognostic impact on patients with acute cerebrovascular accidents is not fully clarified. Stroke associated with AF is associated with the worst outcome as compared to without atrial fibrillation. Atrial fibrillation is present in 20–30% of patients affected by stroke. Also, in Pakistan the prevalence of atrial fibrillation with ischemic stroke patients is still unknown. Objective: To determine the association of atrial fibrillation with acute ischemic stroke. Material &amp; methods: This cross-sectional analytical study was conducted at Neurology ward of Aga Khan University Hospital, Karachi, over eight months from 19th May 2020 to 18th December 2020. A total of two hundred sixteen patients who were admitted with the diagnosis of ischemic stroke were included in the study. Results: The 216 patients with first-ever acute ischemic stroke for more than 24 hours, age range between 30 and 80 years, both male and female were included in the study. The mean systolic blood pressure SBP and diastolic blood pressure DBP was 132.64±17.68 &amp; 84.45±15.01 &amp; mean duration of diabetes mellitus in new onset ischemic stroke patients was 11.1±6.61years male outnumbered females, with 78(36%) women and 138(64%) men. Conclusion: In summary, it was found that incidence of atrial fibrillation with ischemic stroke is most common among Pakistani population. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 91-96

Cognitive impairment in diabetes mellitus: an exploratory study

Background: Present study was conducted to estimate the prevalence and evaluate predictors of cognitive function impairment in patients with type 2 diabetes mellitus.Methods: This prevalence study was conducted over one year at a tertiary care teaching hospital in central India. Known cases of type 2 diabetes mellitus of more than one year of duration of illness were considered eligible. Patients with past history of head injury, seizure episode, stroke, chronic kidney disease, those taking antidepressant/antipsychotic treatment and those with pre-existing dementia were excluded. Mini-mental state examination was employed for estimation of the cognitive function. Clinical history, examination and biochemical findings were also evaluated.Results: In all, total 332 patients with mean age of 61.33±11.33 years were studied. Two hundred patients (60.24%) were below 60 years, and 132 patients (39.76%) were over 60 years of age. Two hundred sixteen patients (65.06%) were males, and 116 (34.96%) were females. The mean duration of diabetes mellitus (DM) was 10.17±4.81 years. The mean MMSE score was 22.69±5.26 and 81 (24.4%) patients were observed to have cognitive impairment. The difference in cognitive function between those below 60 years and above 60 years was statistically significant (p=0.0214). Duration of illness was also a significant factor (p=0.0394). But gender was not observed to affect the cognitive function significantly (p=0.2497).Conclusions: Cognitive impairment is common amongst diabetics and is directly related to age and duration of diabetes amongst them; while gender does not influence the cognitive function amongst diabetics.