On Oral Hypoglycemic Agents Research Articles

Erectile Dysfunction and Depression Prevalence Among Male Patients with Type II Diabetes.

Patients with Type 2 Diabetes (T2D) are at substantial risk for developing erectile dysfunction (ED). The primary goal of this study was to assess the prevalence of ED and depression among T2D patients and the associated risk factors. A cross-sectional study was conducted for adult T2D patients who had a routine clinic visit between January-August 2023. Structured questionnaires formed with two validated questionnaires - the International Index of Erectile Function short form (IIEF-5) and Patient Health Questionnaire (PHQ-9) - were used to screen for ED and depression, respectively. A total of 478 male patients with T2D with a mean age of 59.2 ± 10.8 years, mostly married, with long standing T2D were included. Hyperlipidemia followed by hypertension were the most reported comorbidities. Of the patients, 61.3% had reported no depression and were less likely to have ED or severe ED (p <0.001) and more likely to be physically active and to report no smoking (p <0.0001) when compared to those with depression. Fifty-two percent of the patients reported moderate and severe ED and those were older in age (p = 0.031), had longer duration of T2D diagnosis (p = 0.005), were more likely to have any comorbidities (p <0.05), were less likely to have a university degree and higher income (both p <0.001), were less likely to be on oral hypoglycemic agents (OHA) (p <0.001), had worse glycemic control parameters (p = 0.463), were more likely to have positive urine microalbuminuria (p = 0.019), and were less likely to be physically active (p = 0.048) when compared to patients with no or milder degree of ED. ED is highly prevalent in our study sample, with half of the patients having moderate to severe ED and being more likely to have depression. Older age, long-standing T2D, comorbidities, socioeconomic disadvantage, and sedentary lifestyle were all significantly associated with ED.

Study of Oral Hypoglycemic Agent-induced Hypoglycemia in Type 2 Diabetes Mellitus in a Tertiary Care Center.

Diabetes prevalence is increasing rapidly; estimates from the International Diabetes Federation put the number at 381 million people have diabetes. Hypoglycemia is a commonly encountered complication in diabetic patients, which, in the short-term, can lead to mortality and, in the long-term, precludes maintenance of euglycemic control. Over 65.2 % of patients have reported at least one incidence of severe and nonsevere hypoglycemia when on oral hypoglycemic agents (OHA) at an annual crude incidence density of 35.1 events per year per person. Insulin more commonly causes hypoglycemia than OHA. However, this study was done with the aim of studying the hypoglycemia specifically caused by OHAs-clinical profile of patients, medications causing hypoglycemia, and the outcome. This prospective observational study was conducted in the Department of Medicine at a tertiary care hospital in Western Maharashtra. Data was collected over a period of 18 months from Indoor patients on admission having hypoglycemic symptoms with strip blood sugar levels of <70 and on OHAs. Patients on insulin were excluded from the study. There were 60 patients with hypoglycemia with a mean age of 53.65 years and a higher incidence of hypoglycemia in females, 35 (58.3%) compared to males. There was a statistically significant difference between outcome (i.e., discharged or death) and urine protein-creatinine ratio (UPCR), a deranged liver function, that is, serum albumin, serum glutamic oxaloacetic transaminase (SGOT)/aspartate transaminase, and serum glutamic pyruvic transaminase (SGPT)/alanine transaminase (p < 0.05). However, there was no statistically significant difference between outcome (discharged or death) and mean age, gender, mean duration of diabetes mellitus (DM), GCS scoring, and drug type of study subjects (p > 0.05). The risk factors for hypoglycemia were middle-aged patients. Females are at higher risk of hypoglycemia than men. Hypoglycemia due to OHAs is known to have a recurrence of hypoglycemia due to the long half-life of the drug; however, patients who were hospitalized were well monitored and did not have any recurrence of hypoglycemia. Deranged liver function or raised UPCR have high mortality after OHA-induced hypoglycemia.

Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study.

This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.

Type 2 diabetes progression in an adult Ugandan population with new-onset diabetes: an observational prospective study

BackgroundThe rate of progression of type 2 diabetes following diagnosis varies across individuals and populations. Studies investigating the progression of type 2 diabetes in adult African populations with newly diagnosed diabetes are limited. We aimed to investigate the prevalence and predictors of short-term (one year) diabetes progression in an adult Ugandan population with new-onset type 2 diabetes (type 2 diabetes diagnosed in < 3 months) initiated on oral hypoglycaemic agents (OHA).MethodsTwo hundred and seven adult participants with type 2 diabetes diagnosed within the previous three months were followed up for 12 months. We investigated the association of specific demographic, clinical, and metabolic characteristics, and short-term diabetes progression (defined as glycated haemoglobin or HbA1c ≥ 8% on ≥ 2 OHA and/or treatment intensification).ResultsOne hundred sixteen participants (56%) completed the follow-up period. Sixty-four participants (55.2%, 95% CI 45.7–64.4) showed evidence of diabetes progression during the 12-month period of follow-up. An HbA1c ≥ 8% on ≥ 2 OHA and treatment intensification were noted in 44.8% and 29.3% of the participants, respectively. On multivariate analysis, only the female gender (AOR 3.2, 95% CI 1.1–9.2, p = 0.03) was noted to be independently associated with short-term diabetes progression.ConclusionShort-term diabetes progression was relatively common in this study population and was independently associated with the female gender. Early intensified diabetes therapy in adult Ugandan female patients with new-onset type 2 diabetes should be emphasised to avert rapid short-term diabetes progression.

The coexistence of autoimmune diabetes and maturity-onset diabetes of the young (MODY): a case series.

SummaryThe coexistence of autoimmune diabetes and maturity-onset diabetes (MODY) is rare. The absence of pancreatic autoantibodies is a key factor prompting MODY genetic testing. In this study, we report three cases of young-onset diabetes with progressive beta-cell dysfunction, strongly positive glutamic acid decarboxylase (GAD) antibodies, and genetic confirmation of pathogenic gene variants of HNF-1A, HNF-4A, and ABCC8-MODY. The first case is a woman diagnosed with HNF-1A-MODY diabetes more than 30 years after her diagnosis of adult-onset diabetes at 25 years. She required insulin after her fourth pregnancy. She became ketotic on oral hypoglycaemic agents (OHAs) and subsequently, her GAD antibodies tested positive. The second case is a woman diagnosed with diabetes at 17 years who was subsequently diagnosed with HNF-4A-MODY after many hypoglycaemic episodes on low-dose insulin. GAD antibodies were strongly positive. The last case is a man diagnosed with diabetes at 26 years who was well controlled on OHAs and required insulin years later due to sudden deterioration in glycaemic control. His ABCC8-MODY was diagnosed upon realisation of strong family history and his GAD antibodies tested positive. All subjects are now treated with insulin. Less than 1% of subjects with MODY have positive autoantibodies. These cases highlight individuals who may have two different types of diabetes simultaneously or consecutively. Deterioration of glycaemic control in subjects with MODY diabetes should highlight the need to look for the emergence of autoantibodies. At each clinic visit, one should update the family history as MODY was diagnosed in each case after the development of diabetes in their offspring.Learning pointsThese cases highlight the rare coexistence of autoimmune diabetes and MODY.Deterioration of glycaemic control in subjects with MODY diabetes should highlight the emergence of autoantibodies.One should revise and update the family history as the diagnosis of MODY was made after the development of diabetes in offspring.Understanding the spectrum of diabetes allows for precision medicine.

Childhood and adolescent onset type 2 diabetes mellitus (CAT2DM): The yoke of the young diabetics

AimsTo study the prevalence, clinical characteristics, complications, and treatment pattern of childhood – and adolescent-onset type 2 diabetes among young diabetes patients (<25 years at diagnosis). MethodsWe conducted an observational retro-prospective study among young diabetics at a tertiary care hospital between January 2012 and December 2020. A detailed medical assessment, laboratory evaluation, and screening for complications were done in all patients. ResultsWe analyzed a total of 130 patients, with a mean age of 23 years. Forty-seven (36.2%) had a family history. Osmotic symptoms and weight loss were the predominant features, 4 had ketosis, but 34.65% were detected incidentally. Seventy-two (55.2%) were overweight and obese. Most of the patients were uncontrolled, with a mean HbA1c of 9.4 ± 2.8%. There were 1.5%, 1.5%, and 2.3% of retinopathy, nephropathy, and neuropathy cases detected at evaluation. Seventy-nine (60.8%) patients were controlled on oral hypoglycemic agents (OHAs) alone, and 45 (34.5%) needed insulin at onset for control. ConclusionThis study on CAT2DM emphasizes the fact that diabetes has emerged over the past decade among young adults. Screening may be needed in high-risk groups, and prompt, effective treatment may change prognosis significantly.

Effect of Synchronized Lifestyle Modification Program and Physiotherapy in Improving Type 2 Diabetic Neuropathy patients having Increased Body Mass Index

Background: Prevalence of diabetic neuropathy (DPN) is associated with increased Body Mass Index (BMI). Synchronized lifestyle modification program attempts to synchronize the circadian rhythm of the body through diet and exercise. Objective: Determine the role of Synchronized Lifestyle Modification Program (SLP) and Physiotherapy on fasting blood glucose (FBG), HbA1c, lipid profile, and degree of neuropathy in Type 2 DPN patients on Oral Hypoglycemic Agents (OHAs) having increased BMI. Materials and Methods: Randomized-controlled trial. Evaluation of 120 DPN patients on OHAs included, MNSI, BBS, FBG, HbA1c, Lipid profile and NCS. Participants divided into Group A and B, then divided into A1 and B1, that were overweight and A2 and B2, that were obese. B1 was divided into 1, 2 and 3 and B2 was divided into 4, 5 and 6. Groups 1 and 4 received SLP, Groups 2 and 5 received both SLP and Physiotherapy and Groups 3 and 6 received Physiotherapy for 12 weeks. p≤0.05 was considered significant. Results: MNSI, BBS, FBG, HbA1c, Total Cholesterol, TGs, HDL and LDL were significantly improved in Group 2. Conclusion: Combined Synchronized Lifestyle Modification Program and Physiotherapy is effective in DSPN patients that were overweight. Keywords: Diabetic neuropathy, Synchronized lifestyle modification program, Physiotherapy.

IDF21-0171 Study of renal Profile In diabetic patient: Retrospective study among 48 patients

Background: Diabetes is considered the commonest cause of end-stage renal disease. The increasing incidence of obesity and an ageing population, together, will lead to a greater number of people with diabetes associated with chronic kidney disease that could either be secondary to diabetic nephropathy or of different aetiology. Based on data from the UK and USA, up to 40% of people with diabetes will develop chronic kidney disease. Pooled data from 54 countries reveal that more than 80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of both. Aim: To study of renal profile in diabetic patient. Method: This was a retrospective analytical and descriptive study conducted at internal medicine department on 13 months. The total of 48 diabetic patients were included in this study. Patient data including patient characteristics, and hypertension, duration of diabetes, creatinine level, blood pressure, blood glucose level, HbA1c. The eGFR (Glomerular Filtration Rate) has been determined using the MDRD equation (Modification of Diet in Renal Disease). Renal disease was staged according to the 2012 High Authority of Health France guidelines. The statistical analysis was carried out using Epi-Info7 software. Results: There were 48 diabetic patients with a mean age of 66±10 years with male predilection (77%) compared to females (23%). Mean duration of diabetes mellitus was 15±9 years. Most of patients (93.75%) were type2 mellitus diabetes. The majority of patients were on insulin (42.92%).Ten (20.83%) were on oral hypoglycemic agents (OHA), and eleven patients (22.92%) were on combined insulin and OHA. Hypertension was found in 50% of diabetic patients. Mean duration of hypertension was 11±10years. Metabolic syndrome was found in 80%. The mean GFR (Glomerular Filtration Rate) in diabetic patients according MDRD equation was 69±41 ml/min/1.73m2. There were 44 patients (92%) with chronic renal disease ,with mean of BMI 26±5 kg/m2, mean of diastolic pressure 73±10 mmHg, mean of systolic pressure 125±18 mmHg , mean of Haemoglobin was10±2 g/dl, mean of fasting blood glucose 1.71±0.79g/l, mean of post prandial blood glucose 2.47±0.77g/l, mean of HBA1C 9±3%, mean of creatinine was 19±22 mg/l, mean of creatinine clearance was 69±41 ml/min/1.73m2. There was 32% with CKD1, 27% with CKD2, 14% with CKD4, 9% with CKD3A, 9% with CKD3B, and 9% with CKD5 stage of renal failure. Mean of HBA1C was 9±4 % in patients with CKD1, and patients in CKD5 with a mean HBA1C 13±2. Discussion: Kidney disease is far more common in people with diabetes than in people without diabetes. Diabetes is one of the leading causes of chronic kidney disease (CKD). Diabetes, hypertension and kidney failure are highly interlinked. On the one hand, type 2 diabetes is a leading cause of kidney failure, which is a risk for hypertension, and on the other, hypertension can often precede CKD and contribute to the progression of kidney disease. Both diabetes and CKD are strongly associated with cardiovascular disease (CVD) and therefore, the major component in their management is control of CVD risk factors such as hypertension and high blood glucose (hyperglycaemia). In our study population, advanced age was found. They were older, with overweight, and had a longer diabetes and hypertension duration. Diabetic with CKD patients also had a poor glycemic control. This strongly calls for effective screening for diabetic population at risk.

IDF21-0196 Study of peripheral arterial disease among type 2 diabetes mellitus patients

Background: Diabetes is a complex chronic metabolic disorder, characterized by persistent hyperglycemia because of lack of insulin secretion, insulin resistance, or both. Peripheral arterial disease (PAD) is one of the major recognised diabetic macro vascular complications. It is a marker of generalised systemic atherosclerosis and is closely associated with symptomatic coronary and cerebrovascular disease, hence significant morbidity and mortality. Aim: To study the various risk factors contributing to development of peripheral arterial disease in adult type2 diabetic patients and vasculopathy profile. Method: This was a retrospective analytical descriptive study conducted at internal medicine department on 13 months. Forty-seven type 2 diabetic patients were included. All patients underwent a detailed history which included age, gender, smoking intake, history of diabetes mellitus with duration and treatment. Biochemical characteristics were studied. Diagnosis of PAD was made by using color Doppler ultrasound. The statistical analysis was carried out using Epi-Info7. Results: The study was conducted on 47type2 diabetic patients with a mean age of 66±10 years with male predominance (77%) compared to females (23%). Mean duration of diabetes mellitus was15±9 years. Majority of patients were on insulin (n=22;46.81%). Eleven patients (23.40%) were on combined insulin and OHA. and ten were on oral hypoglycemic agents (OHA) (21.28%). Sixteen (34%) patients were cigarette smokers. Regarding hypertension status, 24 (51.06%) patients were hypertensive. Metabolic syndrome was prevalent in twenty patients, with mean of BMI 25±5 kg/m2. PAD was prevalent in 38(80.85%) patients. Of these, there were 27(57.45%) obliterating arteriopathy of the lower limbs,20(42.55 %) had mediacalcinosis, 10 (21.28 %) had acute arterial occlusion, 8 (17.02%) stenosis, and 2(4.26 %) arterial thrombosis. The prevalence of neuropathy was 46.81% (n=22) and diabetic foot was present in all patients (n=47) of patients. Regarding biochemical parameters: mean of fasting blood glucose was 1.73±0.76g/l, mean of post prandial blood glucose 2.45±0.77g/l, mean of HBA1C 9±3%, mean of HDLc 0.32±0.14 g/l, mean of triglycerides1.56±1.29g/l, mean of creatinine clearance according MDRD equation was 69±41 ml/min/1.73m2, mean of protein C reactive in this population was 88±80mg/l. Discussion: The increasing burden of diabetes is considered as one of the greatest global public health problem of our time. Diabetic patients with PAD are at high risk of increased morbidity and mortality from cardiovascular diseases and a high rate of lower extremity amputation. Various risk factors like age, gender persistant hyperglycemia, increased glycated hemoglobin, smoking and hypertension, and dyslipidaemia are associated with an increased risk of peripheral artery disease. This study documents a high prevalence of PAD among adult type2 diabetic patients. This strongly calls for aggressive screening for PAD be emphasised.

Study of serum lipid profile and serum lipo-protein (a) in type II diabetes mellitus patients compared to non-diabetics

Background: This study helps us in evaluating present Indian scenario of lipid and diabetic portfolio, and advices about how aggressive treatment should be for immediate control of blood sugars and lipids are to minimize the cardiovascular risks. The objective of this study was to evaluate the serum lipid profile and lipo-protein (a) levels in comparison to patients with type II diabetics with non-diabetics.Methods:It was a hospital-based case control study conducted on patients presenting with signs and symptoms of diabetes mellitus and confirmed on doing appropriate investigation. 200 patients of which 100 were non-diabetic (control) and 100 type II diabetic patients, of which fifty were type II diabetics were on oral hypoglycemic agents (OHA) and 50 were on insulin only, were selected after matching for age and sex. Lipid profile, serum lipoprotein (a), ECG, 2D echo was studied in these patients.Results: The males were more (74%) than females (26%) among the cases. Fasting blood sugar, post prandial blood sugar and HbA1c were significantly more in cases. Triglycerides, LDL, VLDL and lipoprotein (a) were significantly more in cases. ST shift (mm) and T wave inversions were significantly more in cases compared to controls (p&lt;0.05). Mean ejection fraction was significantly reduced in cases compared to controls. FBS and PPBS were not significantly different in two groups of OHA and insulin but HbA1c was significantly better controlled in insulin group than OHA group.Conclusions:Lipid profile and lipoprotein (a) as well as ECG and 2D echo parameters were significantly worse in diabetes patients. Hence appropriate management is important to prevent risk of complications.

Estimation of glycemic control in patients with type 2 diabetes mellites with various forms of tuberculosis with dots

Since ancient times people are aware of the association between tuberculosis and diabetes mellitus. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. The present study was conducted to evaluate glycosylated hemoglobin (HbA1c) and blood glucose levels, in patients with Type - 2 diabetes mellitus with various forms of tuberculosis who are on RNTCP DOTS and antidiabetic regimens. The study subjects included Type-2 diabetes mellitus with tuberculosis who are registered under RNTCP DOTS, in Dept of Pulmonology, PESIMSR, Kuppam, Chittoor district. Study groups comprises, 20 cases of type 2 DM WITH TB who are on oral hypo glycemic agents (OHA), 20 cases of Type 2DM WITH TB who are on oral hypoglycemic agents (OHA) with insulin, 20 cases of Type 2 DM WITH TB who are on insulin. HbAc is measured by fully automatic Bio-Rad D10 - HbA1c Analyzer. Blood glucose levels are estimated by auto analyser VITROS 250 in PESIMSR, Kuppam. The mean HbA1c levels showed good control in those patients kept on insulin alone compared to OHA and OHA with insulin groups (P &amp;#60;0.001). The mean HbAC levels were high in OHA alone group compared to other groups (P&amp;#60;0.001). The study revealed that increased levels of Glycosylated haemoglobin (HbA1C) are observed in those patients kept on OHA alone with DOTS as compared with other two groups. There is strong interaction between anti tubercular drugs and OHA which in turn leads to poor glycemic control. Poor glycemic state in diabetic patients is having strong impact on TB treatment outcome.

Knowledge and practice of foot self-care among patients with diabetes attending primary healthcare centres in Kuwait: A cross-sectional study

BackgroundDiabetes mellitus is a major public health issue and is the main cause of morbidity and mortality worldwide. At the time of diagnosis, many patients with type 2 diabetes (T2D) have one or two risk factors for diabetic foot diseases, such as diabetic peripheral neuropathy (DPN) and diabetic foot ulcers (DFUs). Patients can overcome such complications through good knowledge and practice of foot self-care. This study aims to evaluate the knowledge and practice of foot care among patients with diabetes mellitus attending primary healthcare centres (PHCs) in Kuwait and to identify those at risk for developing DPN. MethodsA cross-sectional study was conducted using a pre-tested self-administered questionnaire. The questionnaire included questions on demographic characteristics and patients’ knowledge and practices of foot care. Adult patients (aged 21 and above) with a diagnosis of diabetes mellitus for at least 1 year were randomly selected from PHCs located in the five governorates of Kuwait. Data were analysed using SPSS, version 26. ResultsA total of 357 patients participated in this study, giving a response rate of 87.3%. The overall mean knowledge score of foot care was 12.7 ± 2.7 (equals 81.3%). Most patients (n = 283, 79.3%) showed good knowledge. In comparison, less than one-third of patients (n = 110, 30.8%) practiced good foot care. The overall mean score of patients’ practices was 55.7 ± 9.2 (equals 64.0%). Approximately 17.4% of the patients had a higher risk of developing DPN. University students had lower odds of having good knowledge about foot care [OR: 0.19 (95%CI: 0.04–0.86)]. On the other hand, patients who reported having diabetes for a long duration (10 years and above) [OR: 1.88 (95%CI: 1.11–3.18)] and patients who did not have any other comorbidities [OR: 0.49 (95%CI: 0.26–0.90)] had higher odds of having good foot care knowledge. Patients who were on oral hypoglycaemic agents (OHAs) only had lower odds [OR: 0.63 (95%CI: 0.39–1.00)] of practicing good foot care. Patients who reported having diabetes for a duration between 5 to less than 10 years [OR: 1.75 (95%CI: 1.06–2.90)] and those who are on a diet only [OR: 1.76 (95%CI: 1.06–2.94)] had higher odds of practicing good foot care. Patients who were using combination therapy with OHAs and insulin had a higher risk [OR: 2.67 (95%CI: 1.11–6.41)] of developing DPN. On the other hand, patients who reported that they did not have a previous history of foot ulcer had a lower risk of developing DPN [OR: 0.21 (95%CI: 0.09–0.47)]. ConclusionThe knowledge of patients with diabetes regarding foot care is rated as good, while their self-practice is considered satisfactory. To improve the foot care knowledge and self-care practice of patients, healthcare providers (HCPs) need to support patients through educational programmes and appropriate training.

SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India

Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p <0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.

Analysis of Hypoglycemic Episodes in Out Patient Diabetic in Africans Using Ademolus Classification of Hypoglycemia

The recent grading of severity of hypoglycemia for use in clinical practice using Ademolus Classification of Hypoglycemia (ACH) is opening a new knowledge path and insight in hypoglycemia complicating diabetes mellitus management. In Africa like other parts of the world, hypoglycemia complicates diabetes mellitus management in in and out-patients. This article aims to examine hypoglycemia occurring in African diabetics on out patient pharmacologic management. This is a retrospective study of 200 hypoglycemic episodes occurring in 88 diabetics attending the out patients of the Endocrinology Clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Over 13years and 9 months period. Data were analysed using ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA and American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2018 Classification of Hypoglycemia. Only documented hypoglycemic episodes were studied using a questionnaire. The inclusion criteria includes known diabetics, documented hypoglycemic episodes occurring during out patient pharmacologic management. This study was analysed using SPSS version 17. Of the 200 hypoglycemic episodes studied, 79.5% were grade 1, grade 2 were 18% while 2.5% were grade 3. In all type 2 diabetics (T2DM), 82.9% had grade 1 hypoglycemia, 14.6% had grade 2, while 2.4% had grade 3. The lowest hypoglycemic episode among out patient T2DM was an asymptomatic value of 29mg/dl (grade 3 hypoglycemia!). There is an inverse relationship between hypoglycemic episodes recorded in type 1 and type 2 diabetics as the pearson correlation was -1.000. This denotes a perfect negative correlation between hypoglycemic episodes developed in type 1 compared to type 2 diabetics in Africans. There is no linear relationship between these two variables. With a p-value of 0.000, the null hypothesis is discarded in this study as these findings is not due to chance or error of sampling but rather are statistically significant. ADA/EASD 2018 classification of hypoglycemia is not very sensitive in diagnosing severe hypoglycemia in that it recognized only 1 hypoglycemic episodes while ACH recognizes five. The five cases all have blood sugar of less than 40mg/dl yet ADA/EASD 2018 classification recognizes only one because it developed a severe event from hypoglycemia needing assistance from a third party. The majority of T2DM had mild hypoglycemic episodes irrespective of whether they are on oral hypoglycemic agents (OHA) alone, or on OHA and insulin or on insulin alone. Among African T1DM, grade 1 hypoglycemia is twice as common as grade 2 hypoglycemia while severe hypoglycemia is not common. Grades 1, 2 and 3 hypoglycemia can all occur in African diabetics on out patients basis but with the majority occurring as grade 1. Asymptomatic grade 3 hypoglycemia can occur in out patient African T2DM. A similar study is advised in other regions of the world.

Complicated Gestational Diabetes: A Challenge!

AbstractGestational diabetes is a condition caused by insulin resistance and multiple metabolic abnormalities; the prevalence of gestatinal diabetes mellitus (GDM) has been rising and has almost become parallel to obesity and type 2 diabetes. However, the mechanism and treatment points are still debatable. Hyperglycemia in pregnancy (HIP) is social instability as woman infertility is associated with it. If timely screened and achieved targeted glycemic control, it gives the desired outcome of pregnancy especially in pregestational diabetes. Support of family and thorough understanding of the disease is crucial in such situations as it requires multidisciplinary management, for example, structured self monitoring blood glucose (SMBG), diet and nutrition, multiple daily insulin injections with dose adjustment, avoiding hypoglycemia, and mental stability.Hyperglycemia in pregnancy (HIP) as a whole (pregestational and gestational diabetes) is one of the leading causes of woman infertility, miscarriages, abortions, fetal complications and anomalies3 Diabetes in pregnancy is challenging task for health care professionals, as the opinion on diagnosis differ and the treatment options are limited. Main stream of treatment roam around insulin with lifestyle modification and metformin4 5 (a dilemma for the doctors). It requires more attention and discipline than usual, as it involves two lives and more emotions attached to it.Apart from health, women have to face social instability (e.g., lack of family support, family conflict, violence, and blaming a woman), once detected with GDM, making them feel isolated and unlucky for the family. This poor attitude leads to worsening mental health in the females who are already exposed to anxiety and depression. In addition, gestational diabetes is an economic burned to the common earning man, as the overall cost of the disease is high. In this case, in spite of investing a huge amount of money, the woman has to undergo multiple traumas. Therefore, management of such cases is crucial.One such case is of a 34-year-old woman detected with typical symptoms of type II diabetes since 6.5 years. She was on oral hypoglycemic agents (OHAs) for a long time. Her grandfather and father had a history of type II diabetes. At the time of diagnosis, her HbA1c was 10.8% without ketosis.She belongs to Chanasma, a rural area in Mehsana district in North Gujarat. She is well educated and working as an officer (Patwari) in the government sector. After tying a knot at the age of 23 years, she had history of multiple abortions (7 reported) culprit being hyperglycemia. In year 2017, on her 7th gestational week she was referred to Arogyam Health Care—Diabetes Clinic.

Insulin-associated Weight Gain in Type 2 Diabetes and Its Relation with Caloric Intake.

ObjectiveThe aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake.MethodsThis retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study.ResultsGroup B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain.ConclusionIt is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.

698-P: Factors Significantly Associated with Adherence to Diabetes Medications: Findings from a Large Japanese Claims Database

Poor medication adherence is a well-known barrier to meeting therapeutic goals in diabetes mellitus (DM). We aimed to clarify the status of medication adherence and determine clinical variables significantly associated with medication adherence in Japanese patients with DM using a large claims database. Analyzed were data from 7459 patients with DM whose medical records on oral hypoglycemic agents (OHA) were available for at least 1 y (mean age 53 y, HbA1c 7.2%). Medication adherence was evaluated by the proportion of days covered (PDC); PDC &amp;lt;80% was defined as non-adherent. Multivariate logistic regression model was used to identify clinical variables significantly associated with non-adherence. The mean PDC was 80.4%, and 33.1% of patients were non-adherent. The PDC for sulfonylureas, biguanides, thiazolidines, α-glucosidase inhibitors, glinides, and DPP-4 inhibitors were 82% 82%, 79%, 79%, 73%, and 84%, respectively. The PDC for OHA was negatively correlated with HbA1c, LDL cholesterol, and triglycerides. HbA1c decreased by 0.2% with 25% increases in PDC. Logistic analysis indicated that older age and ≥3 concomitant medications were significantly associated with adherence while male sex and smoking were significantly associated with non-adherence (Figure), implying the necessity for effective strategies to improve medication adherence in patients in these categories. Disclosure Y. Yaguchi: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Kaneko: None. M. Kitazawa: None. M. Harada: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Analysis of risk factors for falls in geriatric patients: a single institutional experience

Background: In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs).Methods: This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients’ department, Iraq, from April 1st to September 30st, 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls.Results: Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient’s age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk.Conclusions: Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients’ age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected.

Perioperative glycemic control and its outcome in patients following open heart surgery.

Background:Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population.Materials and Methods:Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016.Results:Of the 129 patients included in the study, male dominated 101 (78.3%). Most frequent surgery was coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus aortic valve replacement 4 (3.1%), and CABG plus mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on diet control, 112 (86.8%) on oral hypoglycemic agents (OHA), whereas 9 (7%) had control on both insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%) patients did not require insulin and 54 (41.9%) were treated with insulin intraoperatively to keep the blood glucose level less than 200 g/dl. Cardiac arrhythmias were frequent in the insulin group (P < 0.05), which was also associated with increased stay in the cardiac intensive care unit.Conclusion:Inadequate glycemic control during open cardiac surgery can possibly lead to increased perioperative morbidity and mortality and with decreased long-term survival and recurrent ischemic events. Therefore, aiming for blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific glucose ranges for a clearer definition of recommended blood glucose goals in postoperative cardiac patients for the best outcomes in patients with diabetes mellitus.

The relation of Toxoplasma gondii with Tumor Necrotizing Factor-α in type II Diabetic patients

Toxoplasma gondii is an obligate intracellular parasite that can cause variable clinical symptoms or can even be asymptomatic in immuno-competent individuals , whereas more severe symptoms are observed in immuno-compromised patients. Type 2 diabetes mellitus (T2DM) continues to be a major challenge for public health community, many factors play important role in the pathogenesis of diabetes such as obesity, physical inactivity, and dietary patterns.Moreover many infectious agents may play role in the pathogenesis of diabetes. Both toxoplasmosis and diabetes are very common in Iraq. Recently, some reports have spotlighted the probable relevance of diabetes mellitus (DM) and infectious agent as T. gondii, and it has been proposed that as a likely cause of diabetes. Objective: To determine the possible relation between T2DM and Toxoplasm by detection and evaluating IgM and IgG Toxoplasma gondii antibody and investigating the level of TNF-a, HbA1C in diabetic patients whether infected or not infected with Toxoplasma gondii. Methods: This case control study was conducted on 180 patients with T2DM along with 40 healthy age and gender matched individuals who were included as healthy control.All patients were investigated for the presence of Toxoplasma gondii by Rapid chromatographic test and by ECLA(ElectrochemiluminescenceImmunoassay). All samples whether positive or negative for toxoplasma, will be subjected for measuring HbA1C by automated Fluorescence Immunoassay (AFIAS) and TNF-a by ELISA technique. Results: This study showed that 42.2% of diabetic patients were infected with Toxoplasma gondii and 25% of apparently healthy control subjects were infected with Toxoplasma gondii ; moreover 46.4 % of diabetic patients on insulin therapy were infected with T.gondii whereas 37 % of diabetic patients on oral hypoglycemic agents (OHA) were infected with T. gondii. Furthermore IgG level , HbA1c levels and TNF were significantly high in diabetic patients on insulin who were infected with Toxoplasma gondii. Conclusion: Since the incidence of T.gondii in Diabetic patients was higher than in control group thus we may predict that immune disturbance in diabetes had paved the way to Toxoplasma infection or may be due to the parasite itself had direct effect on Beta cell of the pancreas that may lead to diabetes.