Poor Diabetic Control Research Articles

Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus.

SummaryA 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team.Learning points:Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss.Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up.For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option.Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary.In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.

Optimizing mHealth Technologies in Real-World Clinical Practices

IN BRIEF Therapeutic inertia and suboptimal treatment adherence remain the key drivers of chronic poor diabetes control. Advances in mHealth technologies have spurred the development of a new generation of blood glucose monitoring systems that enable individuals with diabetes to automatically transfer glucose data and other information from their smartphones to their health care providers for analysis and interpretation via diabetes data-management software. This report discusses key lessons learned from two investigations that assessed the effects of interventions using the Accu-Chek Connect diabetes-management system (Roche Diabetes Care, Indianapolis, Ind.) within diverse diabetes populations.

Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study.

ObjectivePatients with persistent poorly-controlled diabetes mellitus (PPDM) despite engagement in clinic-based care are at particularly high risk for diabetes complications and costs. Understanding this population’s demographics, comorbidities and care utilization could guide strategies to address PPDM. We characterized factors associated with PPDM in a large sample of Veterans with type 2 diabetes.MethodsWe identified a cohort of Veterans with medically treated type 2 diabetes, who received Veterans Health Administration primary care during fiscal years 2012 and 2013. PPDM was defined by hemoglobin A1c levels uniformly >8.5% during fiscal year (FY) 2012, despite engagement with care during this period. We used FY 2012 demographic, comorbidity and medication data to describe PPDM in relation to better-controlled diabetes patients and created multivariable models to examine associations between clinical factors and PPDM. We also constructed multivariable models to explore the association between PPDM and FY 2013 care utilization.ResultsIn our cohort of diabetes patients (n = 435,820), 12% met criteria for PPDM. Patients with PPDM were younger than better-controlled patients, less often married, and more often Black/African-American and Hispanic or Latino/Latina. Of included comorbidities, only retinopathy (OR 1.68, 95% confidence interval (CI): 1.63,1.73) and nephropathy (OR 1.26, 95% CI: 1.19,1.34) demonstrated clinically significant associations with PPDM. Complex insulin regimens such as premixed (OR 10.80, 95% CI: 10.11,11.54) and prandial-containing regimens (OR 18.74, 95% CI: 17.73,19.81) were strongly associated with PPDM. Patients with PPDM had higher care utilization, particularly endocrinology care (RR 3.56, 95% CI: 3.47,3.66); although only 26.4% of patients saw endocrinology overall.ConclusionPPDM is strongly associated with complex diabetes regimens, although heterogeneity in care utilization exists. While there is evidence of underutilization, inadequacy of available care may also contribute to PPDM. Our findings should inform tailored approaches to meet the needs of PPDM, who are among the highest-risk, highest-cost patients with diabetes.

Evaluation of Trace Elements in Malay Women with Type 2 Diabetes Mellitus

Trace elements are essential for human health. This study determines the level of chromium (Cr), zinc (Zn), selenium (Se), copper (Cu), ferrum (Fe) and manganese (Mn) in the hair and nails of married Malay women with type 2 diabetes mellitus from Hulu Langat, Selangor, Malaysia. The trace elements were analysed using inductively coupled plasma mass spectrometry (ICP-MS) after an acid digestion treatment. The levels of all trace elements measured were higher in the hair samples than in nails except for Se. Mean levels of Zn and Se were significantly higher in the hair of non-working women (84.91 ± 10.32 μg/g and 0.42 ± 0.15 μg/g, respectively) compared to working women (64.98 ± 11.10 μg/g and 0.30 ± 0.18 μg/g). Copper levels in hair were significantly higher among women with good and satisfactory diabetes control (20.41 ± 4.20 μg/g) compared to the poor diabetes control group (15.67 ± 4.31 μg/g). However, a contradictory result was obtained from the nails of women with good and satisfactory diabetes control with a Cu level of 3.35 ± 0.46 μg/g and 4.69 ± 0.33 μg/g for the poor diabetes control group. In hair samples, significant positive correlations were obtained with Cr-Cu (r = 0.55), Zn-Mn (r = 0.46) and Se-Mn (r = 0.38). In nails, significant positive correlations were also obtained between Cr-Zn (r = 0.31), Zn-Fe (r = 0.30) and Fe-Mn (r = 0.47). In conclusion, age, educational status, number of children and duration of diabetes did not influence trace elements levels.

Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study.

IntroductionPostoperative delirium (POD) is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. Diabetic patients, especially those with poor diabetes control and long-standing hyperglycemia, may be at risk of developing delirium. The aim of this study was to analyze whether the occurrence of POD in cardiac surgery is associated with diabetes or elevated preoperative glycated hemoglobin (HbA1c) level.Materials and methodsWe performed a cohort analysis of prospectively collected data from a register of cardiac surgery department of a university hospital. Delirium assessment was performed twice a day during the first 5 days after the operation based on Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria.ResultsWe analyzed a cohort of 3,178 consecutive patients, out of which 1,010 (31.8%) were diabetic and 502 (15.8%) were diagnosed with POD. Patients with delirium were more often diabetic (42.03% vs 29.86%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<0.001), no difference was found in patients with insulin treatment. Preoperative HbA1c was elevated above normal (≥6%) in more delirious than nondelirious patients (44.54% vs 33.04%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=0.018). In univariate analysis, the diagnosis of diabetes was associated with an increased risk of developing POD (OR: 1.703, 95% CI: 1.401–2.071, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319–1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161–1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level.ConclusionMore diabetic patients develop POD after cardiac surgery than nondiabetic patients. Elevated preoperative HbA1c level is a risk factor for postcardiac surgery delirium regardless of the diagnosis of diabetes.

Design and rationale of a mixed methods randomized control trial: ADdressing Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve diabetes outcomes.

BackgroundImproving medication adherence is one of the most effective approaches to improving the health outcomes of patients with diabetes. To date, enhancing diabetes medication adherence has occurred by improving diabetes-related knowledge. Unfortunately, behavior change often does not follow knowledge change. Enhancing communication between patients and healthcare professionals through addressing health literacy-related psychosocial attributes is critical.ObjectiveExamine whether a patient-centered intervention augmenting usual care with a health literacy-psychosocial support intervention will improve medication adherence for patients with diabetes, compared to usual care.MethodsThis study is a randomized controlled trial with an intervention mixed methods design. Fifty participants being enrolled are English-speaking, 18–80 years old with diagnosed diabetes, take at least one diabetes medication, have low diabetes medication adherence (proportion of days covered less than 80% or based on clinical notes), and have poor diabetes control (hemoglobin A1c of ≥8%). Participants will be allocated to either a control group receiving usual care (n = 25) or an intervention group (n = 25) receiving usual care and a 6-session intervention focusing on the modifiable psychosocial factors that may influence medication adherence. A questionnaire will be administered at baseline and at the end of the intervention to all participants to assess the effectiveness of the intervention. Fifteen participants from the intervention group will be interviewed to explore participants’ experiences and perceptions of the intervention processes and outcomes.ConclusionsThe trial will examine if a patient-centered intervention that addresses patients’ health literacy and focuses on modifiable psychosocial factors will improve medication adherence among patients with diabetes.

Evaluation of obstructive sleep apnea in metabolic syndrome.

Background:Metabolic syndrome has become one of the most important public health problems with a growing prevalence in both developed and developing countries. Obesity is a major risk factor for obstructive sleep apnea (OSA), which is associated with significant cardiorespiratory morbidity.Aims:The aims of this study were to find out the prevalence of OSA in patients with metabolic syndrome and to highlight the importance of assessment of OSA in these patients.Methods:This cross-sectional analytical study was conducted on 100 subjects aged 30–60 years, comprising 50 cases of metabolic syndrome and 50 controls without metabolic syndrome. Overnight polysomnography was done in all the subjects. Prevalence and severity of OSA were assessed and compared between the two groups.Results:Prevalence of OSA was significantly higher (66%) in patients with metabolic syndrome than in subjects without metabolic syndrome (12%). Out of 33 (66%) OSA patients with metabolic syndrome, 8 (16%) had mild OSA, 11 (22%) had moderate OSA, and 14 (28%) had severe OSA. Increasing severity of OSA was associated with higher mean levels of all the metabolic syndrome parameters except serum high density lipoprotein (HDL).Conclusions:OSA is highly prevalent in patients with metabolic syndrome. Also, the increasing severity of OSA is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome. Therefore, effective treatment of metabolic syndrome can prevent and control OSA in these patients. Similarly, reducing the severity of OSA (by early diagnosis and treatment) in patients with metabolic syndrome might help to optimize control of blood sugar, blood pressure, and serum lipids, thereby reducing the risk of cardiovascular disease. Therefore, the need for screening metabolic syndrome patients for OSA has been reinforced by this study.

Thyroid auto immune antibodies in children with Type-I Diabetes mellitus in relation to diabetes control.

Background & Objective:As an autoimmune disease, Type-1 diabetes mellitus (DM) may be associated with other autoimmune disorders, the presence of thyroid antibodies could be negatively impact the diabetic control. Our objective was to investigate thyroid autoimmunity in a cohort of children and adolescents with Type-1 diabetes and the Influence of the presence of thyroid autoimmune abnormalities on the control of diabetes in group of Iraqi pediatric patients with Type-I D.M.Methods:This study was conducted at the Medical City Complex, Children Welfare Hospital, Baghdad, Iraq. This study was carried out from the first of January 2016 till the end of September 2017. Data were analyzed from 150 patients with Type-1 diabetes, aged 1–18 years who were treated and are coming for regular follow up in the diabetic clinic. Thyroid functions tests, Antibodies to thyroglobulin (anti-TG) and thyroperoxidase (anti-TPO) were measured, documented and correlated with diabetic control according to glycated haemoglobin (HbA1c) level.Results:In the total of 150 patients, positive Antibodies to thyroglobulin (anti TG) were more in ≤3 years duration group of Diabetes mellitus(DM) and negative anti TG was less in the >3 years duration of DM group with statistically significant results (p=0.043), Regarding the distribution of thyroid antibodies (AB) according to HbA1c group, there was progressive positive anti thyroperoxidase (anti TPO) titer with glycemic status, good glycemic control had the lowest positive anti TPO titer and poor glycemic control group had the highest positive anti TPO titer and the result was statistically significant (p=0.048).Conclusions:Thyroid autoimmunity may be associated with poor diabetic control and elevated TSH levels, indicating subclinical hypothyroidism that my affect the diabetic control.

ACE gene Polymorphism on Diabetic Type 2 Patients and their Susceptibility to Diabetic Nephropathy

One of diabetic type 2 (T2D) complications is diabetic nephropathy, the glycated hemoglobin, poor diabetic control, are considered as risk factors for renal damage. current study aim the I/D polymorphism ACE gene and serum ACE levels may increase the diabetic nephropathy complications susceptibility in a sample population of Al-Najaf in Iraq. a total of 90 T2D patients(about 32 without nephropathy and 58 with nephropathy) and 50 healthy persons, all groups age were>45years old. The ACE I/D polymorphism was performed by polymerase chain reaction (PCR) using special primers, followed by electrophoresis on 1.5% agarose gel. we record significant differences between the ACE I/D polymorphism in T2D and control was (P < 0.01). the DD genotype of ACE I/D polymorphism the risk for T2D increased (OR=7.2 fold), as well as, the carriers D allele, the risk (OR=0.55). also T2D patients had a significantly higher level in ACE in diabetic nephropathy(DN) and lower level in T2D without nephropathy if compared with controls (P < 0.01). Our evident show the carriers DD genotype had more serum ACE levels than carriers II genotype in T2D.

Assessment of corrected QT interval in children with type 1 diabetes mellitus

Background Type 1 diabetes mellitus (T1DM) is associated with increased risk for cardiovascular complications. It was reported that children and adolescents with T1DM have a six-fold greater risk for prolongation of the QT interval. QT prolongation has been suggested as an independent marker of increased mortality in patients with T1DM.Objective To study the corrected QT (QTc) interval in children attending the Alexandria University Children’s Hospital with T1DM and its relation to the glycemic control and duration of the disease.Patients and methods The study included 60 children with T1DM (aged 4–15 years) compared with 60 healthy matched children. All children were subjected to thorough history taking and clinical examination. The QT interval was measured on 12-lead resting electrocardiogram and the QTc was calculated using Bazett’s formula, in all cases and controls. The glycosylated hemoglobin (HbA1c%) was measured in all cases and controls.Results One-third of the diabetic children had prolonged QTc interval (≥0.45 s), whereas all controls had normal QTc interval (<0.45 s). The great majority (95%) of the patients with prolonged QTc interval had inadequate glycemic control (HbA1c >7.5%). A significant positive correlation was found between the QTc interval and both the HbA1c% and the duration of diabetes.Conclusion Prolongation of the QTc interval is very prevalent among children with T1DM attending the Alexandria University Children’s Hospital. This is tied to the poor glycemic control and duration of diabetes. Therefore, good glycemic control and follow-up of QTc interval are mandatory to minimize the potential for life-threatening events among our diabetic children.

Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study

ObjectiveThis study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes. MethodsData came from the 2010–2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms. ResultsFood insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1–2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1–2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7–2.4) and longitudinally (OR = 1.5, 95% CI = 1.3–1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014. ConclusionThe relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.

Diabetic ketoacidosis as a reason for hospitalization in adult patients with any type of diabetes mellitus

Introduction. Diabetic ketoacidosis (DKA) is an acute complication of any type of diabetes, but most commonly is associated with type 1 diabetes mellitus (T1D). This condition is a complex metabolic disorder resulting from significant relative or absolute deficiency of insulin, which still leads to excess of mortality and health care burden. The main aim of the study was to assess the direct cause of DKA and to determine population at-risk among patients with greater predisposition to develop DKA, in order to propose methods and range of their education in the future. Materials and methods. This study presents a retrospective analysis of 120 cases of DKA (102 adults with diabetes) hospitalized in the Department of Internal Medicine and Diabetology at the Central Teaching Hospital of Medical University of Lodz between 2014 and 2017. Results. 68.4% of patients with DKA were T1D and LADA, 15.0% were T2D, 5.8% presented other types of diabetes and 10.8% were de novo diabetes. The mean age was 40.5 ± 17.7 years, diabetes duration 11.1 ± 9.74 years, HbA1c was 11.8 ± 2.54%. The main reason for hospitalization of patients for DKA was alcohol abuse (32.5%),followed by infection (23.4%), discontinuation of insulin treatment due to other reasons (13.4%), de novo diabetes (10.8%), lack of compliance (5.8%), mental disorders (5.8%) and complex causes (3.3%). In 5.0% of patients the reason could not be determined. All patients recovered, there was no death resulting of DKA. Conclusions. DKA occurs most frequently in T1D, but may be associated with type 2 or other types of diabetes. Most of our patients had a history of longterm poor control of diabetes. In many cases DKA, e.g. resulting from alcohol abuse or lack of compliance, probably can be avoided when proper patient education was given.

Investigation of Ocular Tear Ferning in Controlled and Uncontrolled Diabetic Subjects.

To investigate the ocular tear film in controlled and uncontrolled diabetes mellitus (DM) subjects and the relationship between dry eye and diabetes. One hundred twenty-four diabetes adults (65 male and 59 female, with 62 controlled and 62 uncontrolled DM) were assessed by McMonnies dry eye questionnaire, tear break-up time (TBUT), phenol red thread (PRT) test. In addition, tear samples were collected from the lower tear meniscus of right eyes and dried onto glass slides under controlled room temperature (25°C) and humidity (40%). The glass slides were observed using a digital microscopy and the tear ferning (TF) patterns observed were graded based on Masmali TF grading scale. Patients with a HbA1c value below 6.5% were defined as "controlled DM" and those with a HbA1c value above 6.5% were defined as "uncontrolled DM." The Spearman's correlation coefficient was used to determine the relationship between various tests. Several subjects having dry eye varied depending on the test used. McMonnies questionnaire scores suggested that 28 subjects (23%) showed dry eye (score >14.5), of whom 23 subjects (82%) showed uncontrolled diabetes. The TF patterns showed that 44 subjects (35.5%) showed dry eyes (Grade ≥2), of whom 32 subjects (72.7%) showed uncontrolled diabetes. Phenol red thread test found that 46 subjects (37%) showed dry eye (wetting <10 mm), of whom 38 subjects (82.6%) showed uncontrolled diabetes. Tear break-up time found that 57 subjects (46%) showed dry eye (time <10 sec), of whom 45 subjects (78.9%) showed uncontrolled diabetes. In controlled diabetic subjects, TF grades showed medium negative correlations with both TBUT and PRT (-0.374 and -0.349, respectively). In uncontrolled subjects, TF grades have a strong negative correlation with TBUT (-0.539) and a medium negative correlation with PRT (-0.410). Dry eye disease is common in diabetic subjects, particularly in people with poor diabetic control. Uncontrolled blood glucose level seemed to be a risk factor for dry eye syndrome. Tear ferning test showed a correlation between diabetes and dry eye in diabetic subjects and can be used as a reliable test to evaluate the quality of the ocular tear film.

PAIT-survey—Prevalence of albuminuria in patients with diabetes and hypertension in Turkey

BackgroundAlbuminuria is an early marker of kidney disease in patients with diabetes and/or hypertension undetected or untreated albuminuria is a leading cause of chronic kidney disease and cardiovascular events, The purpose of the present survey was to assess the prevalence of albuminuria in patients with diabetes and hypertension, treated with a combinations of renin angiotensin aldosterone system inhibitors and dihydropyridine calcium channel blockers. MethodsThe survey was performed in 105 Primary Care Units in Turkey and involved outpatients, routinely visited by either a specialist or a non-specialist physician.Albuminuria was evaluated in a spot morning urine sample, as albumin–creatinine ratio, using the Multistic-Clinitek-device analyzer (Siemens), that has a strong correlation with 24-h urinary albumin excretion. Microalbuminuria was defined as a loss of 3.4–33.9mg albumin/mmol creatinine and macroalbuminuria as a loss of >33.9mg albumin/mmol creatinine. Diabetes was assessed through documented blood glucose concentration or use antidiabetic drugs, whereas hypertension through blood pressure measurement and current antihypertensive treatment. ResultsThe survey enrolled 1708 subjects with a prevalence of type 2 diabetes (87.6%). Albuminuria was detected in 52.0% of patients. Blood pressure was controlled in 37.0% and diabetes in 56.7%. The risk of albuminuria was significantly high in patients with uncontrolled diabetes (p<0.001) and blood pressure (p=0.009). ConclusionsIn a large cohort of treated hypertensive patients with diabetes, albuminuria was present in about 50% and was correlated with poor diabetes and blood pressure control. Systematic screening of albuminuria, particularly in Primary Care, is an important tool for the early diagnosis of nephropathy.

Predictors of glycemic control in type-2 diabetes mellitus: Evidence from a multicenter study in Ghana

BackgroundThe burden of uncontrolled type-2 diabetes (T2DM) sub-Saharan Africa is high, with an increased risk of developing microvascular and macrovascular complications. We sought to identify predictors of poor diabetes control among Ghanaians with T2DM. MethodsA cross-sectional study involving 1226 participants with T2DM enrolled at five health facilities in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-diabetic medications, and treatment adherence were collected. Additional questionnaires on sources of diabetes treatment medications and challenges with accessing these medications were also administered. Glycated hemoglobin was measured and a cut-off value of ≥7.0% used to define poor control. Predictors of diabetes control were assessed using a multivariate logistic regression model. Key resultsThe mean ± SD age of study participants was 57 ± 12.1 years, with a female preponderance (77.5%). The mean HbA1C among all study participants was 8.9 ± 4.9% of which 70% had HBA1C >7%. Duration of diabetes diagnosis (aOR = 1.04; 95% CI 1.02–1.06), the absence of the Ghana National Health Insurance Scheme (aOR = 1.41; 95% CI 1.09–1.82) and the number of diabetes medicines (aOR = 1.73; 95% CI 1.45–2.07) were adversely associated with poor glycemic control while male gender (aOR = 0.66; 95% CI 0.49–0.88), increasing age (aOR of 0.97; 95% CI of 0.96–0.98) and dual diagnosis of diabetes and hypertension (aOR = 0.69; 95% CI 0.50–0.95) had positive associations with good glycemic control. Conclusion7 out of 10 patients with T2DM in Ghana are poorly controlled. Multidisciplinary interventions that improve patient education, quality of care, access to antidiabetics including insulin, are all needed to avert deaths related to diabetes complications associated with uncontrolled T2DM in Ghana.

Modifiable Factors Associated with Uncontrolled Type 2 Diabetes Mellitus: Experience in a Tertiary Care Hospital of Bangladesh

Background: Diabetes mellitus is a non-communicable disease with increasing prevalence worldwide. The present study was done to identify the modifiable factors that were associated with the poor glycemic control in Bangladeshi type 2 diabetic patients attending in a tertiary care hospital.Methods: This cross-sectional study was conducted in the Department of Medicine, Sir Salimullah Medical College &amp; Mitford Hospital (SSMC &amp; MH), Dhaka from July 2014 to June 2015. A total of 140 adult type 2 diabetes mellitus patients were included in this study. Of them 70 patients had uncontrolled diabetes mellitus with glycated haemoglobin ³ 7% (group 1) and 70 patients with controlled diabetes mellitus (HbA1c&lt; 7%) (group 2).Results: The present study demonstrated statistically significant difference regarding the mean age of both group 1 and group 2 [59.26±12.88 years and 55.24±11.52 years respectively (p &lt;0.05)] and mean duration of diabetes [10.44±8.46 years and 5.96±6.39 years (p=0.0006) respectively]. Moderate physical activity was significantly (p=0.018) associated with good glycaemic control (group 1= 15.7% and group 2= 32.9%). Mean body mass index (BMI) of both group 1 and group 2 were almost equal (23.73±4.72 Kg/ m2 and 23.87±4.86 Kg/ m2 respectively) with no statistical significance and waist hip ratio was 0.98±0.07 and 0.95±0.09 respectively which was statistically significant (p=0.013). Poor economic conditions were significantly associated with uncontrolled blood glucose (p &lt;0.05). Poor glycemic control was also significantly associated with smoking (p=0.00038) and frequent visit with specialist physician (p=0.011). Proper counseling was frequently associated with poor glycaemic control. Most of the patients in group 1 were irregular in dietary habit (58.6%) and exercise (67.1%) and intake of refined sugar (60%) were major contributory factors of poor glycaemic control.Conclusions: Low socioeconomic condition, smoking and intake of refined sugar were the significant modifiable factors that contributed to poor glycaemic control of diabetes. Irregular dietary habits and exercise and proper follow up with specialist physician were more frequent with poor blood glucose control. Proper counseling about diabetes and its management was another modifiable factor. Central obesity and longer duration of diabetes were predisposed to uncontrolled diabetes.Birdem Med J 2018; 8(3): 229-234

Efficacy of mustadi yapana basti in Diabetic neuropathy –A case study

Diabetic Mellitus (DM) is a silent killer, which is spreading as an epidemic all over the world. Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It is the most common complication of diabetes. Incidences of diabetic neuropathy are more common in patients with poor diabetes control, overweight, have higher levels of blood fat and blood pressure, and are over the age of 40. In this study, patient’s main complaint was numbness and burning pain in bilateral lower limbs especially in sole. Patient was diagnosed as a case of Diabetic neuropathy (DN) in which according to Ayurvedic principles, there is involvement of Vata and Pitta dosha. Ayurvedic treatment for diabetic neuropathy is one of the most underrated yet powerful treatments because in modern science there is no any proper medicine invented for DN. Ayurveda is beneficial in managing symptoms of diabetic neuropathy without side effects. Panchakarma therapies like Virechana (therapeutic purgation),Basti (therapeutic enema) etc. can be found effective in this disease as according to Ayurveda, there is vitiation of vata and pitta doshas as Basti for vata dosha as well tridosha according to Acharya Sushruta. So in this study, Mustadi yapana basti has been taken as the primary treatment. This case shows the efficacy of Panchakarma specially Mustadi yapana Basti in DN with good follow up results and without any adverse effects. Thus we can say that, Mustadi yapana basti can be used as effective management in case of DN.

Poor Glycemic Control and Abrupt Onset of Diabetes in HCV Patients Receiving direct-acting Antiviral Drugs: Case Series

Aim: Hepatitis C virus (HCV) impairs glucose metabolism and interferes with insulin-signaling pathways. About a third of HCV-infected patients develop Type 2 diabetes mellitus. Several evidences correlated direct-acting antiviral (DAA) based treatment of HCV infection with improved glycemic control. Patients &amp; methods: Disturbance in glucose metabolism of two different HCV patients receiving DAA drugs was noticed. Results: We observed the first evidence of abrupt onset of diabetes and poor glycemic control in two different obese patients respectively, following successful treatment of HCV with sofosbuvir and ribavirin. Conclusion: This case is an evidence of potential glucose intolerance in HCV patients receiving DAA drugs. It further suggests the need for regular screening of patient during DAA therapy for early detection of diabetes or poor glycemic control.

Comparison of serum lipid profile in type 2 diabetes with and without adequate diabetes control in Sudanese population in north of Sudan

BackgroundDiabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. Dyslipidemia is a major complication of diabetes and an important risk factor for cardiovascular disease (CVD). The objective of this study was to determine the prevalence of dyslipidemia and its co-relation with the glycemic control in individuals with diabetes in River Nile State, Sudan. MethodsIndividuals with diabetes attended, Naserudin Karamalla Diabetic (NKDM) Centre, in Atbara teaching hospital during study period, who volunteered to participate were included. Only those on treatment for DM for at least one year were included. Venous samples were collected for cholesterol, triglycerides, HDL, LDL, blood glucose and Glycosylated hemoglobin. Participants were interviewed using standardized pretested questionnaire to record medical history and sociodemographic characteristics. Blood pressure, body mass index (BMI) and waist circumference were measured. ResultsA total of 188 individuals were included. The mean age was 49.5 + 13.9 and (128) 68.1% were females. Most patients were having DM for at least 3–5 years 69 (36.7%). Poor diabetes control (HbA1c >7) was recorded in 87.2%, hypercholesterolemia, hypertriglyceridemia and high LDL were identified in 36.6%, 27.7% and 26.6% respectively. In addition, HDL was low in 61.2% of patients. ConclusionLow HDL is a prominent feature in two thirds of individuals with diabetes, while high cholesterol and high triglyceride were seen in over one quarter.

Perinatal and neonatal morbidity among infants of diabetic mothers at a university hospital in Central Saudi Arabia.

Objectives:To determine the perinatal and neonatal morbidity related to diabetes associated with pregnancy.Methods:This is a prospective cohort study conducted at a tertiary university hospital in Central Saudi Arabia. All neonates born to mothers with pregnancy associated diabetes between July 2014 and June 2015 were recruited for the purpose of this study. Infants born at 23 weeks or less, infants who died within 3 hours of delivery, twins, and unbooked pregnant ladies were excluded from the study.Results:A total of 279 ladies and 289 infants were enrolled in the study. Gestational diabetes was observed in 84.5% of study subjects, type 1 diabetes in 2.8%, and type 2 diabetes in 12.5% of the females that were examined. A variety of neonatal complications were observed in infants of diabetic mothers including macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, and congenital malformations. Macrosomia, hypoglycemia, respiratory distress syndrome, and NICU admission correlate with poor control of diabetes during pregnancy (HbA1c >7%). Moreover, the presence of congenital malformations correlates with poor diabetes control in the first and second trimester, but not in the third trimester.Conclusion:Infants of diabetic mothers in this cohort developed a variety of neonatal events that largely correlates with poor metabolic control during pregnancy.