Poor Control Of Diabetes Mellitus Research Articles

Epidemiology and risk factors of diabetic retinopathy in upper Egypt: a 3-year prospective study

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in adult diabetic patients during 3 years. Patients and methods This is a cross-sectional study that was carried out on the adult diabetic population who attended a large private referral ophthalmology center in Assiut City, Upper Egypt for 3 years. All cases were subjected to full history taking, ophthalmological examination, and dilated fundus examination for evidence of DR, and besides, the associated systemic complications were assessed. Results The study included a total of 2178 cases and the prevalence of DR was 18.2%. DR was more prevalent in females than males (67.9% vs. 32.1%). Also, DR was significantly associated with insulin use, moderate and poor control of diabetes mellitus, uncontrolled hypertension (HTN), dyslipidemia, and nephropathy (P<0.01 for all). The risk factors for DR were; older age (adjusted odds ratio (AOR) 1.69; 95% CI =0.91–1.97; P≤0.01), female sex (AOR 1.65; 95% CI =1.21–1.86; P =0.02), smoking (AOR 1.73; 95% CI =1.41–2.11; P =0.02), longer duration of DM (> 15 years) (AOR 2.87; 95% CI =2.48–3.29; P ≤0.01), insulin use (AOR 1.42; 95% CI =0.94–1.65; P=0.03), poor control of DM (AOR 3.98; 95% CI =3.69–5.41; P≤0.01), presence of HTN (AOR 2.62; 95% CI =2.37–2.89; P≤0.01) and dyslipidemia (AOR 1.65; 95% CI =1.42–2.02; P=0.03). Conclusion The prevalence of DR in adult diabetic patients was 18.2% and the significant risk factors for DR (arranged descendingly in power) were; poor control of DM, longer duration of DM (> 15 years), presence of HTN, smoking, high age, dyslipidemia, female sex, and insulin use.

A-224 Comparative Analysis of Clinical and Laboratory Parameters of Different Subtypes of Familial Partial Lipodistrophy

Abstract Background Lipodystrophy is a disease characterized by changes in body fat deposits. They are classified according to the extent of fat loss (generalized or partial) and the form of inheritance (inherited or acquired). Family partial lipodystrophy (FPL) are rare forms characterized by distribution of centripetal body adiposity, poorly controlled diabetes mellitus (DM) and severe dyslipidemia. Methods Fourty-two FPL patients were evaluated, whose were followed in the lipodistrophy outpatient clinic of the Federal University of Ceará/Brazil. Twenty-two had previous positive molecular test for FPL, among which 19 had an LMNA mutation and 3 had a PPARG mutation. Twenty patients had a negative genetic test but met clinical criteria for lipodystrophy, which were thigh skinfold <20 mm for females and <10 mm for males or fat mass ratio (FMR) between trunk and lower limbs >1.2. Eight patients in the negative genotype group met criteria for Köbberling Syndrome (Köb index >3.477). The others 12 patients were classified as FPL indeterminate subtype (FPLX). Results PFL+ patients perceived the lipodystrophic phenotype before the other groups. All groups had high A1c medians, with the Köbberling group having the highest median (9.1%). However, patients with FPL+ had a higher median insulin dose. Diabetic polyneuropathy was the most prevalent complication in the three groups. Median peak triglycerides were similar for the three groups, with the Köbberling group having the greatest variability. There no pancreatitis episodes in the FPL+ group, but Köbberling e FPLX did. The main findings are shown in Table 1. Conclusion FPL is a disease with a broad spectrum of phenotype and genotype. It is usually associated with poor DM control, early DM complications and severe hypertriglyceridemia, as our patients demonstrated. In these cases, metabolic control is still a challenge.

Nationwide Evaluation of Quality of Care Indicators for Individuals with Severe Mental Illness and Diabetes Mellitus, Following Israel's Mental Health Reform.

Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform.We analyzed yearly changes in 2015-2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population.Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61-1.67) and obesity (OR = 2.11; 95% CI: 2.08-2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83-0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI(OR = 1.22; 95% CI: 1.14-1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96-1.09) was not associated with SMI.Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required.

Assessment of perceived fear of coronavirus disease 2019 and its relationship to health-related quality of life among type one diabetic children and adolescents during the pandemic in Ismailia City

Background Coronavirus disease 2019 (COVID-19) pandemic affected the world especially those with chronic diseases. Diabetes mellitus (DM) is considered one of the most prevalent noncommunicable diseases. Type 1 diabetes (T1D) is one of the most common endocrine metabolic disorders around the world. This study aimed to assess the perceived fear of COVID-19 and its relationship to HRQoL among children and adolescents with T1D during the pandemic in Ismailia City. Methods This is a retrospective study carried out on T1D children and adolescents during pandemic in Ismailia City and conducted at Suez Canal University endocrinology outpatient clinic, Ismailia City, Egypt from June 30, 2021, to December 31, 2021. All participants were interviewed using a semi-structured demographic and clinical checklist, fear of COVID-19 Scale, and the short form 36 (SF-36) health survey. Blood samples were taken to analyze HbA1c for all patients. Results This study analyzed data from 68 children and adolescents with T1D with age ranged from 10 to 14 years, 58.8% were females and 55.9% had preparatory school education. 38% had BMI more than 30, 38.2% had DM for more than 5 years. HbA1C was more than 8 among 41.2%. 59% had low FCV-19 and 41% had high FCV-19. Mean PCS was 39.1±9.6 and 82% had poor PCS. MCS was ranging from 19 to 36 with a median of 28. Older age, preparatory educated, and larger BMI children had higher fears of COVID-19. Poor DM control, and poor adherence to glucose and diet showed higher FCV-19 scores. Higher PCS was associated with higher FCV-19 score. Using univariate logistic regression, age, HbA1C, type of insulin regimen, family history of DM, and FCV-19 score are predictors for PCS. While age, grade, BMI, HbA1C, adherence to glucose testing, type of insulin regimen, adherence to diet control, and PCS are predictors for FCV-19. Conclusion This study suggested that children and adolescents with T1D showed above-average levels of fear of COVID-19, and it may be associated with lower quality of life, especially physical aspects.

P094 Prevalence of fibromyalgia syndrome among patients with type 2 diabetes mellitus

Abstract Background/Aims Fibromyalgia syndrome (FMS) is a non-autoimmune rheumatological disorder characterized by chronic widespread pain, and often tenderness, with additional symptoms such as fatigue, lack of sleep, anxiety, and cognitive problems which are considered significant features in this syndrome. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia that develops as a consequence of insulin deficiency [type1 DM T1DM)] and/or insulin resistance [type2 DM (T2DM)]. Methods A descriptive cross-sectional study was conducted at Endocrine and Rheumatology unit at Baghdad Teaching Hospital during the period from November 2021 till April 2022. A total random sample of 200 Iraqi patients with Diabetes mellitus type 2 diagnosed according to the WHO criteria for diagnosis of diabetes mellitus (females 128 and males 72) and a total random sample of 200 healthy persons (126 females and 74 males) were involved in this study as controls. A special questionnaire designed for the purpose of the study was used for recording information from the patients and controls, which include demographical data for both group in addition information about current treatment for DM and duration of disease. The 2016 revision of American College of Rheumatology (ACR) criteria was used for the diagnosis of FMS. Results There was increase in the risk of developing FMS among diabetes mellitus patients compared to normal individuals (31% vs. 14.5%). Moreover, widespread pain, symptom severity score, and depression were significantly higher [P. Value (0.012, 0.007, 0.019)] respectively among diabetes mellitus patients compared to healthy individuals. It was found that there was a significant increase of having HbA1c increased by 1.38 among fibromyalgia patients compared to healthy individuals. Conclusion The prevalence of fibromyalgia among the studied sample with type 2 diabetes mellitus was high and there was correlation between the prevalence rate of FMS and poor DM control. Disclosure S. Salman: None. H. Abdali: None.

A clinico-radiological study of Peripheral Arterial Disease in patients with type 2 Diabetes Mellitus using ankle-brachial index and peripheral arterial doppler

Background: Peripheral Arterial Disease (PAD) is an important complication of Diabetes Mellitus (DM). PAD is a part of systemic illness caused by atherosclerosis, resulting in arterial narrowing. Hence PAD is a marker of atherosclerosis in other parts of the vascular system, especially in the arteries supplying the brain and heart. Over two - third of the patients with PAD are asymptomatic, resulting in inadequate treatment of their risk factors. There is a need to screen every DM patient for effective treatment of PAD and the risk factors. Ankle-brachial Index (ABI) is a useful test for the same. Objective: The objective of the study was to find out the incidence of PAD in DM and the factors affecting it. Materials and Methods: It was a hospital-based prospective observational study. In all, 200 diabetic patients from tertiary care hospital (outpatient and indoor) were screened for PAD using ABI, and those showing ABI < 0.9 were further confirmed using Duplex Ultrasonography (DUS). Smokers and patients with a previous history of lower limb surgery, vasculopathy, or trauma were excluded from the study. Factors affecting the incidence of PAD were also studied. Results: Overall incidence of PAD was 10% using ABI as a screening test, confirmed with DUS. Male gender, aging, obesity, duration of DM, poor control of DM, hypertension, coronary artery disease, cerebrovascular disease, hyperlipidemia, and presence of retinopathy were found to be adversely affecting risk factors for PAD. Conclusion: ABI is a bedside, simple, reliable, non-invasive, and cost-effective clinical test for diagnosing PAD, a marker of atherosclerosis in the body. There is a need to screen for PAD, even in asymptomatic patients, for its early detection and management of risk factors.

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study.

Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines. To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control. This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A p-value <0.05 was considered statistically significant. Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (p-value <0.05) with guidelines' compliant prescriptions. The group of doctors comprised of specialists and consultants wrote significantly (p-value = 0.004) high number of guidelines adherent prescriptions (mean rank = 20.25) than the group comprised of medical officers (mean rank = 11.34). On visit 2, only 39.5% patients were on goal glycemic levels. In MVBLR analysis, suffering from dyslipidemia (OR = 0.134) and CKD (OR = 0.111), receiving sulfonylurea (OR = 0.156) and guidelines' compliant prescription (OR = 4.195) were significantly (p-value <0 .05) associated with glycemic control. Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.

Impact of patients\u2019 beliefs about insulin on acceptance and adherence to insulin therapy: a qualitative study in primary care

BackgroundInsulin therapy forms a cornerstone of pharmacological management of diabetes mellitus (DM). However, there remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy.MethodThis was a qualitative study using grounded theory approach. The study took place from September 2019 to January 2021 at a cluster of primary healthcare clinics in Singapore. Maximum variation sampling was used to recruit adult patients with type 2 DM on basal or premixed insulin for at least 6 months. Semistructured in-depth interviews were conducted using a topic guide and audio recorded. Data collection continued until saturation. Data analysis utilised a constant comparison procedure and a synthesis approach.ResultsTwenty-one participants (mean age 61 years) were interviewed for this study. Data analyses showed that there were 6 main themes that emerged. Four themes influenced both insulin acceptance and adherence. These were concerns about insulin being a lifelong treatment, physical fear of insulin injection, erroneous beliefs about insulin, and perceived fear of DM complications. Two additional themes influenced adherence to insulin therapy. These were socioeconomic concerns, and concerns about side effects of insulin.ConclusionsPatients’ beliefs about insulin impact on the acceptance and adherence to insulin therapy. Health care providers need to elicit and address these beliefs during counselling to improve acceptance and adherence to insulin therapy.

Hemichorea-Hemiballismus Syndrome in Acute Non-ketotic Hyperglycemia

Hemichorea/hemiballismus syndrome secondary to non-ketotic hyperglycemia is a movement disorder induced by long-standing poor control of diabetes mellitus. Diagnosis is based on clinical assessment and imaging. Here we report a rare case of a 56-year-old woman presenting with involuntary movements on the left side secondary to acute hyperglycemia. She received antidiabetic and anti-choreic drugs. The patient's glycemic profile was closely monitored, and she, consequently, responded favorably to therapy.

The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis.

AimThe aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies.Materials and methodsMEDLINE‐PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non‐DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta‐analysis was performed. The quality of the studies was assessed.ResultsA total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta‐analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk‐of‐bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross‐sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America.ConclusionThere is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.

Mucormycosis in patients with COVID-19: A cross-sectional descriptive multicentre study from Iran.

PurposeThe aim of the study was to report clinical features, contributing factors and outcome of patients with coronavirus disease 2019 (COVID‐19)‐associated mucormycosis (CAM).MethodsA cross‐sectional descriptive multicentre study was conducted on patients with biopsy‐proven mucormycosis with RT‐PCR‐confirmed COVID‐19 from April to September 2020. Demographics, the time interval between COVID‐19 and mucormycosis, underlying systemic diseases, clinical features, course of disease and outcomes were collected and analysed.ResultsFifteen patients with COVID‐19 and rhino‐orbital mucormycosis were observed. The median age of patients was 52 years (range 14–71), and 66% were male. The median interval time between COVID‐19 disease and diagnosis of mucormycosis was seven (range: 1–37) days. Among all, 13 patients (86%) had diabetes mellitus, while 7 (46.6%) previously received intravenous corticosteroid therapy. Five patients (33%) underwent orbital exenteration, while seven (47%) patients died from mucormycosis. Six patients (40%) received combined antifungal therapy and none that received combined antifungal therapy died.ConclusionClinicians should be aware that mucormycosis may be complication of COVID‐19 in high‐risk patients. Poor control of diabetes mellitus is an important predisposing factor for CAM. Systematic surveillance for control of diabetes mellitus and educating physician about the early diagnosis of CAM are suggested.

Hyperglicemia at the Admission as Predictor of Severity

Background: Diabetes Mellitus is a factor for the development of micronagiopathies, it is well known at the level of retina, renal and peripheral nervous system. However, it is important to mention that high levels of glucose have deleterious effects on the walls of the vessels, causing microangiopathic damage to the lung, consequently this leads to pulmonary dysfunction. There is local oxidative stress, increased vascular permeability, producing changes in the secretion of the mucus that leads to reduced lung volumes, lung diffusion capacity, decrease bronchodilation.Knowing this complication at the pulmonary level derived from poor control of Diabetes Mellitus, diabetic pulmonary microangiopathy represents a challenge for the COVID-19 pandemic. There is a high prevalence of diabetic patients hospitalized for COVID-19 and the complications derived from this, that is why the idea arose to carry out this review and evaluate the impact that admission glucose levels have on the clinical evolution and prognosis of these patients. Elevated serum glucose levels have deleterious effects on the walls of blood vessels, leading to microangiopathy. Such a destructive process also involves the pulmonary circulation, where it is known as diabetic pulmonary microangiopathy. This hypothesis has been confirmed in histopathological examinations of the lung parenchyma, as well as in lung function tests. However, until now there have been no clinical implications of these findings.1Histopathological evidence of pulmonary involvement in subjects with diabetes mellitus has included thickened pulmonary capillary basal plates and alveolar epithelial plates, the latter suggesting existing pulmonary microangiopathy. Abnormal lung function has been detected in some diabetic patients. Glycosylation-induced non-enzymatic alteration of lung connective tissue is the most likely pathogenetic mechanism underlying mechanical lung dysfunction in diabetic subjects. while the most sustainable explanation for altered pulmonary microangiopathy.2Metodos: This short review looks at the main findings, prospective cross-sectional analytical study, in Guatemala Central America that included 319 patients with COVID 19, hospitalized with comorbidities like type 2 Diabetes Mellitus, hypertension and chronic kidney disease as medical history. These patients did not have a history of pulmonary pathology and who required a low- and high-flow oxygen device since admission, presenting moderate and severe COVID-19. These laboratories were carried out in the first chemistry performed after the onset of respiratory symptoms in the arrival at the hospital. Chi square was used for categorical variables and t student for numeric variables for the rest of the variables. Results: The study showed that in the severe group of patients the median age was 52 years old and in the moderate group it was 51. In the severe group of patients, a male gender predominance with 50.7% and 49.3% in moderate; showing the female sex 46% and 53% respectively. Regarding glucose levels at admission, there was a mean of 189mg / dl for severe patients and 156 mg / dl in moderate patients, with a P: 0.021. Conclusion: The primary point in this study is to see how the correlation was measured since they had to be two numerical variables for it to be correlation. In this case, blood glucose and vascular damage, the most severe cases were related to blood glucose levels greater than 125 mg/dl. In our study, we conclude that the presence of glycemic levels below 125 mg/dl is a protective factor with respect to mortality with an OR 0.521 (CL 0.324–0.835, Po.007). That means, that those patients who are admitted with glycemic levels greater than 126 mg/d have twice the risk to die at 28 days of admission than those who do not have levels greater than 125mg/dl. In the same way, those patients who were admitted with less than 95% saturation were compared and there was no significant difference OR 1.174 (0.492–2.806, p0.822). 1. Kuziemski, Krzysztof Specjalski et a. lEndokrynol Pol. 2011; 62 (2): 171–6. Microangiopatía pulmonar diabética: ¿realidad o ficción? Publicated: Ewa Jassem. https://pubmed.ncbi.nlm.nih.gov/31637580/ 2. Krzysztof Kuziemski et al ¿Es el pulmón un “órgano diana” en la diabetes mellitus? Publicated: 2196023 https://pubmed.ncbi.nlm.nih.gov/19722145/

Surgical Outcomes in Urogynecology—Assessment of Perioperative and Postoperative Complications Relative to Preoperative Hemoglobin A1c—A Fellows Pelvic Research Network Study

Poor control of diabetes mellitus is a known predictor of perioperative and postoperative complications. No literature to date has established a hemoglobin A1c (HbA1c) cutoff for risk stratification in the urogynecology population. We sought to identify an HbA1c threshold predictive of increased risk for perioperative and postoperative complications after pelvic reconstructive surgery. This multicenter retrospective cohort study involving 10 geographically diverse U.S. female pelvic medicine and reconstructive surgery programs identified women with diabetes who underwent prolapse and/or stress urinary incontinence surgery from September 1, 2013, to August 31, 2018. We collected information on demographics, preoperative HbA1c levels, surgery type, complications, and outcomes. Sensitivity analyses identified thresholds of complications stratified by HbA1c. Multivariate logistic regression further evaluated the association between HbA1c and complications after adjustments. Eight hundred seven charts were identified. In this diabetic cohort, the rate of overall complications was 44.1%, and severe complications were 14.9%. Patients with an am HbA1c value of 8% or greater (reference HbA1c, <8%) had an increased rate of both severe (27.1% vs 12.8%, P < 0.001) and overall complications (57.6% vs 41.8%, P = 0.002) that persisted after multivariate logistic regression (odds ratio, 2.618; 95% confidence interval, 1.560-4.393 and odds ratio, 1.931; 95% confidence interval, 1.264-2.949, respectively). Mesh complications occurred in 4.6% of sacrocolpopexies and 1.7% of slings. The average HbA1c in those with mesh exposures was 7.5%. Preoperative HbA1c of 8% or higher was associated with a 2- to 3-fold increased risk of overall and severe complications in diabetic patients undergoing pelvic reconstructive surgery that persisted after adjustments.

Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)

Background: Achieving and maintaining glycemic targets are a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. Methodology: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. Results: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22]; p p = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77]; p = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39]; p p p Conclusion: The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improving their management.

Effects of biologic drugs on the prognosis of rheumatoid arthritis among patients with poor diabetes control.

To investigate the effects of biological disease-modifying antirheumatic drugs (bDMARDs) on diabetes control among patients with rheumatoid arthritis (RA). A total of 296 patients with RA were included in the study. The following background factors were investigated: age, gender, bDMARD type, methotrexate and prednisolone (PSL) dosages, glycated hemoglobin (HbA1c), C-reactive protein, and matrix metalloproteinase-3. We used the simplified disease activity index (SDAI) to evaluate the RA disease activity. Poor diabetes mellitus (DM) control was defined as a HbA1c of 6.0; accordingly, the patients were divided into good and poor DM control groups. SDAI and PSL dosage were the primary endpoints, respectively, 1 year later. HbA1c ranged from 6.6±0.68 to 6.5±0.82 and 5.1±0.29 to 5.4±0.34 in the poor and good DM control groups, respectively. Although the intergroup difference was significant (p=0.000), there was no significant intergroup difference during the treatment period (p=0.084). The SDAI ranged from 27.7±15.6 to 7.1±8.0 in the group with a poor DM control (n=83) and from 22.9±14.0 to 6.3±7.6 in the group with a good DM control (n=213). The bDMARD therapy reduced the RA disease activity regardless of a good or poor DM control.

P191 Real life experience of tocilizumab for the management of giant cell arteritis in Fife, Scotland

Abstract Background Tocilizumab was accepted by the Scottish Medicines Consortium for use in the management of Giant Cell Arteritis (GCA) on 10.09.18. The Fife Rheumatic Diseases Unit is the first Rheumatology unit in Scotland to introduce a structured process for the management of GCA patients with tocilizumab. We describe here our experience of this new service for NHS Fife. Methods All GCA patients considered for tocilizumab are discussed at our weekly Medication Review Meeting by the Consultant Rheumatologists (JSM &amp; SJH) and Rheumatology Pharmacist (SH). By consensus decision, GCA patients deemed appropriate for tocilizumab treatment are then referred to the Vasculitis Nurse Specialist (VNS; PA) for counselling. We have prospectively recorded data on all GCA patients counselled on tocilizumab from 08.11.18 onwards. Patients are followed up closely in a structured manner by the VNS on a fortnightly basis, with both clinical and laboratory assessment at each visit. The VNS ensures that GCA patients follow a rapid steroid taper in line with that used in the GiACTA Trial. Patients also have laboratory assessments performed between each VNS visit at their GP's surgery (to monitor the ESR) to assist in decision making in view of the rapid steroid taper. The VNS also records the cumulative steroid dose along with drug-related side effects (both from steroids and tocilizumab). Results 14 GCA patients have been counselled and commenced on tocilizumab between 08.11.18 and 18.09.19. We have another 2 GCA patients awaiting counselling and due to start tocilizumab soon. Twelve patients have newly diagnosed GCA (5 with unilateral visual loss), 5 with Large vessel vasculitis and 3 patients have refractory GCA. Of the newly diagnosed patients, the reasons for initiating tocilizumab were as follows: poor control of diabetes mellitus on high dose steroids; large vessel vasculitis confirmed on PET scan; previous long-term steroid exposure due to past history of polymyositis; high osteoporotic risk. Conclusion We have successfully introduced a structured process for the use of tocilizumab in Fife GCA patients via a VNS-led GCA clinic. This ensures robust clinical governance around the issues of safety, efficacy and cost. In addition, by collecting real life prospective data, we will add to the existing information available regarding use of this new therapeutic advance for GCA management in routine clinical practice. This initiative is the first of its kind in Scotland and a new service development for NHS Fife. Disclosures P. Allcoat None. S. Hart None. S.J. Hailwood None. J.S. McLaren Honoraria; J.S.M. has received Speaker fees from Roche.

Use of sliding-scale insulin in medical patients at Hamad General Hospital, Qatar – an audit-based study

Poor control of diabetes mellitus (DM) in hospitalised patients is associated with worse clinical outcomes. Despite the lack of evidence of effectiveness of sliding-scale insulin (SSI), it remains a common practice in hospital settings.[1,2][1] The aim of this study was to evaluate current practice

Tear film assessment in sudanese diabetic patients attending Jabir Abu Eliz Diabetic Center, Khartoum, Sudan

Background: Several local and systemic conditions predispose the eye to the development of dry eye disorders due to tear film dysfunction, which is presented in variable degrees of eye irritations and inflammation. Diabetes mellitus (DM) is among the most common risk factors of dry eye disease (DED). It is more common in older females than males. Tear film assessment can be tested with some simple tests such as Schirmer's test (ST), fluorescein strip (FS) (breakup time [BUT]) test, and lissamine green strip (LGS) test. Objective: The aim of this study is to assess the tear film dysfunction in diabetic patients with ST, FS papers, and LGS papers and compare their diagnostic values. Materials and Methods: In a cross-sectional hospital-based study, consecutive 126 diabetic patients were examined at Jabir Abu Eliz Diabetic Center in Khartoum for their tear film dysfunction. All selected patients had simultaneously undergone ST, FS (BUT) test, and LGS test in the same order and equal definite intervals in all patients over a 2-month period (September 1, 2013–November 1, 2013). Clinical and personal information was obtained by direct patients and chart review before complete ophthalmic examinations. Results: The mean age of the study group was 53 ± 12.1 years (30–78 years). Fifty-seven patients (45.2%) were female and 69 (54.8%) were male. In the age group, 11 (8.7%) patients were of type I DM, whereas 115 (91.3%) of type II DM. Forty-four (34.9%) patients had good DM control and 82 (65.1%) had poor DM control. The ST results of the current study demonstrated the presence of 142 patients (56.3%) in the “normal Schirmer's grade,” 49 patients (19.4%) in “mild-to-moderate Schirmer's grade,” and 61 patients (24.2%) in “severe Schirmer's grade.” In the BUT “FS” test, 165 patients (65.5%) gave normal results, whereas 87 patients (34.5%) showed severe tear dysfunction results, with a highly significant difference with P = 0.001. Whereas, in the LGS test, 201 patients (79.8%) were of “normal grade” results and 51 patients (20.2%) were “mild-to-moderate” grade. Conclusion: DED is an important feature of poorly controlled DM, which can be easily detected by performing a variety of simple quick tests such as the ST, fluorescein tear BUT test, and LGS test. There is notable variation among these three tears; therefore, a combination of any two tests is necessary. There is a strong correlation between qualities of the DM control, duration of DM, and severity of DED.

Adiposity contributes to poor glycemic control in people with diabetes mellitus, a randomized case study, in South Kashmir, India.

Background:Diabetes mellitus (DM) is a significant health burden and recent reports suggest that the incidence of diabetes is increasing. Poor knowledge, fear of use of new drugs, and lack of awareness of the importance of the control of the disease are common among primary care physicians caring for diabetes patients. Many diabetes patients continue to be underdiagnosed, undertreated, increased use of expensive acute health-care services, and reduced quality of life.Aims and Objectives:The aim was to study the poor control of DM and the associated risk factors associated with Type 2 DM, to spread awareness about DM, to assess the prevalence, treatment, and control of diabetes, to examine the relationship of obesity with raised blood glucose, and finally, to evaluate the effect of the educational level on glycemic control.Study Material:This study was conducted to evaluate the control of diabetes in South Kashmir, India. It was done among patients in the Outpatient Department of Medicine, MMAB Memorial Hospital (GMC Associated Hospital) Anantnag, Kashmir. A random sampling procedure was adopted for the study, and a total of 300 patients were studied over a period of 5 months, which included 155 men and 145 women. During a period of study, within the age group of 36–50 years with adiposity were assessed for glycemic control.Methodology:All patients underwent anthropometric assessment and blood pressure measurements. Fasting blood sample was obtained for plasma glucose and lipids. Patients were assessed for weight and body mass index.Results:The prevalence of uncontrolled glycemia was more frequent in women as compared to men because of adiposity.

A cross sectional study of cutaneous manifestations in 300 patients of diabetes mellitus

Background: Diabetes Mellitus (DM) is a worldwide problem and one of the most common endocrine disorder. The skin is affected by both the acute metabolic derangements and the chronic degenerative complications of diabetes.Methods: The present study was a one-year cross sectional study from January 2014 to December 2014. All confirmed cases of DM with cutaneous manifestations irrespective of age, sex, duration of illness and associated diseases, willing to participate in the study were included in the study. Routine haematological and urine investigations, FBS, RBS and HbA1c levels were carried out in all patients.Results: A total of 300 patients of diabetes mellitus with cutaneous manifestations were studied. Majority belonged to the 4th decade (33%) and 3rd decade (27.7%) respectively. Males constituted 65% of the cases and male to female ratio was 1.85:1. Type 2 DM was most commonly observed (96%). Among the 300 diabetic patients, 73 patients (24.3%) had good control of DM with HbA1c levels in the range of 6.5-7% while 132 patients (44%) had a poor control of DM with HbA1c levels &gt;8%. Hypertension was the most commonly associated systemic illness (37.6%). Cutaneous infections (63%) were the most commonly observed manifestation of which fungal infections (35.3%) were most frequently observed. Some of the other dermatoses observed were generalized pruritus (15.3%), acrochordons (11%), acanthosis nigricans (6%), diabetic dermopathy (5.33%), diabetic foot (3%), peripheral vascular disease (2.66%), vitiligo (2.66%), xanthelasma palpebrarum (2.33%), diabetic bullae (1%). Cutaneous infections, dermatoses associated with microangiopathy were more common in the uncontrolled diabetic patients which was statistically significant.Conclusions: Infections were the most common cutaneous manifestations in diabetics followed by dermatoses most commonly associated with diabetes. Proper skin care and long-term control of blood glucose levels may reduce the risk of some of the skin diseases.