Positive Family History Of Diabetes Mellitus Research Articles

Evaluation of Ophthalmoscopic Findings in Type 2 Diabetic Patients at a Tertiary Level Hospital

Diabetes mellitus (DM) is a global burden of disease. Long standing disease causes macrovascular and microvascular complications. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and it remains a leading cause of blindness and visual impairment in the working-age population in both developing and developed world. Patients with diabetes often developed other ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and maculopathy. The study was carried out to evaluate the ophthalmoscopic changes in type-2 diabetes mellitus (T2DM) patients. This hospital based cross-sectional study was conducted in the department of Medicine, Shaheed Suhrawardy Medical College Hospital, Dhaka, from September 2018 to March 2019. Patients with T2DM attended at the department of medicine within the mentioned period were enrolled after fulfilling the selection criteria. Patients with dense, lentalopacities and other media opacities which prevented posterior segment examination were excluded from the study. Sample was selected by purposive sampling method. Detail demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigations were done meticulously. Then pupil was dilated and ophthalmoscopic examination was done. Among the 50 diabetic patient’s male was 54%, middle aged (49-60 years) was 54% and sedentary workers was 84.0% with a positive family history of DM was 56.0%. Most of the patients were known hypertensive (64.0%) at the time of enrolment and almost all (94.0%) were taking antihypertensive drug. Retinal photography was performed in all patients and retinopathy was detected in 29 (58%) patients. Fundoscopic findings revealed that cotton-wool spots detected in 32.0% patients, Flame-shaped hemorrhages was 16.0% patients; Arteriovenous nipping was is 18.0% patients and opticdisc swelling (Papilloedema) in 26.0% patients. In this study 21 (42%) patients had normal fundoscopic findings. Retinopathy was more common in smoker (70.0%). Uncontrolled and long-standing diabetes and high HbA1c was major risk factors for the development of retinopathy (P < 0.001). In conclusion, diabetic retinopathy is more common in male smoker with uncontrolled and long-standing diabetic patients. T2DM is a major cause of blindness as it affects microvasculature of retina. Bangladesh Med J. 2021 Sept; 51(1): 33-40

Diabetes mellitus associated with type A insulin resistance

Insulin resistance type A is a monogenic disorder with insulin action defect, observed in females with acanthosis nigricans (AN), hyperandrogenism, hyperinsulinemia, insulin resistance (IR) without obesity. We present a family case of diabetes mellitus (DM) with IR in two sisters with obesity and positive family history of DM in three generations. Hyperglycemia was identified at the age of 13 in the older sister and at 11 in the younger sister after COVID-19. Type 2 diabetes (DM2) was diagnosed in mother in the same time with children. Maternal grandmother was diagnosed with DM2 in 58 years old. Patients were examined in 6 months after diagnosis hyperglycemia in Endocrinology Research Centre. The older sister had obesity, AN, and striae distensae. Glycosylated hemoglobin (HbA1c) 6.2%. Impaired glucose tolerance (IGT), hyperinsulinemia and IR, hyperandrogenism, non-alcoholic fatty liver disease (NAFLD), arterial hypertension were diagnosed. The younger sister had obesity, striae distensae. HbA1c — 6.0%. Impaired fasting glucose (IFG), IGT, hyperinsulinemia, IR, NAFLD were diagnosed. Antibodies (AAb) to ZnT8A, IA2, GAD absented in both sisters. A genetic test was provided, a heterozygous mutation in the INSR gene p.V167M was identified in both sisters, mother and grandmother. IR type A was identified in a family with the phenotype of DM2 in this case. This case demonstrated that children with carbohydrate metabolism disorders and obesity without Islet cell autoantibodies have to reffered for a genetic testing. Disordered carbohydrate metabolism was diagnosed in the same time after a COVID-19 in three family members who did not previously have disordered carbohydrate metabolism. We suppose that SARS-CoV-2 can be a trigger for the development of carbohydrate metabolism disorders in IR type A.

The incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients: A single-center study

Background: Coronavirus disease 2019 (COVID-19) infection may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is not clear whether the virus induces type 1 or type 2 diabetes or instead causes a novel form of diabetes. Precise mechanism of diabetes onset in COVID-19 patients remains unresolved. Aims and Objectives: The aims of this study were to know the incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients and association of disease severity and occurrence of new-onset diabetes in post-COVID-19 Patients. Materials and Methods: Patients age more than 18 years, not known diabetic, tested positive with rapid antigen test or reverse transcription polymerase chain reaction admitted to a tertiary care hospital were included in the present prospective observational study. The patients who developed new-onset diabetes during the 3 months follow-up and, the risk factors associated with new-onset diabetes are assessed. Patients with hemoglobin (HbA1c) >6.5% were diagnosed with new-onset diabetes. Results: Total 246 patients were non-diabetics at admission, at 1 week 188 were non-diabetics and 49 were diabetics, and nine were prediabetics. Patients were within the age range of 21–95 years with mean age of 49.46±17.02 years and male predominance (59.76%). Out of 188 non-diabetics, 19 (10.10%) developed new-onset diabetes, and 2 (1.06%) developed new-onset prediabetes after 3 months. Out of 49 diabetics, 19 (38.77%) became non-diabetic, 30 (61.22%) remained diabetic, and out of nine prediabetes 2 (22.22%) developed new-onset diabetes, 5 (55.55%) reversed to non-diabetic, and 2 (22.22%) remained prediabetic after 3 months. In total, from HbA1c at admission and 3 months, 51 subjects had new-onset diabetes (20.73%). Most common risk factors found with occurrence of new-onset diabetes were those on high dose of steroid (P=0.0001), family history of diabetes mellitus (DM) (P=0.001), over weight and obesity (P=0.0001), fungal infection (P=0.0001), and need of oxygen and intensive care unit requirement (P=0.0001). The patient with increased laboratory markers of inflammation such as ferritin, neutrophil leukocyte ratio, lactate dehydrogenase, and C-reactive protein D-dimer had strong association with occurrence of new-onset diabetes (P=0.0001). Conclusion: COVID-19 infection confers an increased risk for type 2 diabetes. Patients of all ages and genders had an elevated incidence and risk for occurrence of new-onset diabetes. Moreover, it was strongly associated with overweight and obesity, steroid dosage, and its duration, disease severity, positive family history of DM, and increased laboratory markers of inflammation. Hence, particular attention should be paid during the first 3 months after COVID-19 infection and patients need to be under follow-up for blood glucose monitoring.

IDF21-0084 Role of serum copeptin levels in Type II Diabetes Mellitus patients with progressive stages of diabetic nephropathy

Background: Type II Diabetes mellitus (DM) is one of the leading metabolic diseases. It has multiple serious complications. Diabetic nephropathy is one of them. Progressive deterioration in renal functions due to DM makes the patient’s life completely handicapped. Thus, patients start depending on dialysis and ultimately develop its complications. Arginine Vasopressin (AVP) maintains glucose hemostasis and therefore, plays an important role in the pathophysiology of DM and its related complications such as diabetic nephropathy. Copeptin is an inactive analogue of AVP and considered as a reliable surrogate biomarker of AVP. Therefore, it is hypothesized that changes in the levels of copeptin can be correlated with diabetic and renal markers and thus may have potential role in predicting progressive stages of DM and diabetic nephropathy. Aim: The aim of the study is to find out the relation of copeptin with different diabetic and renal function biomarkers and to find out a potential role of copeptin as a predictive biomarker in DM and its associated progressive diabetic nephropathy. Method: It was a comparative cross-sectional study. A total number of 120 individuals were recruited into four groups i.e. controls, pre- diabetes, DM without nephropathy and DM with nephropathy as per the criteria of American Diabetes Association (ADA) 2018 and National Kidney Foundation/ Kidney Disease Outcome Quality Initiative (NKF/ KDOQI) 2018 guidelines. All cases were controlled hypertensive. Serum copeptin levels were measured by sandwich ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c), urine micro albumin (UAE) and urinary creatinine were got done using spectrophotometry on Abbott Architect c8000 and electrolytes (Na+, K+ and Cl−) by iso electric method from Dow Diagnostic Research and Reference Laboratory (DDRRL), Dow University of Health Sciences. Statistical analysis was done using Analysis of Variance (ANOVA) and Pearson’s correlation tests on SPSS. Confounders were controlled using univariate linear regression. Results: The average copeptin levels of the study population were 215.096 pg/ml. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes patients (252.85pg/ml) as compared to other groups. Copeptin levels were positively correlated with HbA1c r=0.171 (p=0.101), urea r=0.244 (p=0.007), creatinine r=0.215 (p=0.018), UAE r=0.310 (p=0.001), UACR r=0.375 (p=< 0.001). No significant correlation of copeptin was found with major electrolytes of the body. However, copeptin is found to be significantly associated with progressive stages of albuminuria and declining Glomerular Filtration Rate (GFR). Discussion: The raised levels of copeptin in subjects with positive family history of DM recommends its role in the early prediction of DM. Moreover, significant association of copeptin with progressive stages of albuminuria and declining GFR suggest the contribution of copeptin in the worsening of renal functions in DM and its associated nephropathy.

Consanguinity and Diabetes in Saudi Population: A Case-Control Study.

Background and Aim: Diabetes mellitus (DM) of both types is a genetically determined disorder and is prevalent in the Saudi population. Furthermore, the rate of consanguineous marriages is also high among Saudis. Therefore, we aimed to determine the prevalence of consanguinity among people with DM and investigate the effect of consanguinity on the occurrence of diabetes at different levels.Methods: A descriptive cross-sectional study was carried out at the Obesity, Metabolism and Endocrine Center of King Fahad Medical City in Riyadh, Saudi Arabia in January 2021. Information on patients’ demographics (age, gender), family history of DM, and presence of consanguinity, and degree of consanguineous marriage were collected.Results: We included 324 people with DM, 143 (44.1%) with type 1 diabetes (T1DM), and 181 (55.9%) with type 2 diabetes (T2DM). We included 201 people without DM for T1DM control and 300 people for T2DM control. The mean age was 26.6 ± 11.1 years for the T1DM group and 57.8 ± 11.6 years for the T2DM group. Consanguinity was noted among 73 (51.4%) T1DM patients, but T1DM was not significantly related to consanguinity. T2DM was significantly correlated with consanguinity (r=0.132, p=0.004) particularly among patients with a degree of consanguinity as first-cousins for both paternal and maternal sides (odds ratio [OR]=1.151 and 1.476). Gender and positive family history for DM and consanguineous marriage between cousins were significant factors for T2DM. After controlling for gender and a positive family history of DM, consanguineous marriage between cousins from both the paternal and maternal sides remained significant.Conclusion: T2DM occurrence increases in presence of consanguinity in the Saudi population. This relationship might contribute to the higher risk of DM prevalence. Further studies are needed to elucidate this relationship deeply. It’s unclear whether lowering consanguineous marriages would decrease the prevalence of diabetes or not. However, a clear message about this correlation has to be delivered to the public.

Study on Socio-Demographic and Anthropometric Profile among Newly Detected Diabetic Patients Attending in a Tertiary Care Teaching Hospital, Dhaka, Bangladesh

Background: Diabetes Mellitus (DM) has become a modern epidemic as a non-communicable disease showing rising trend all over the world. In Bangladesh a large number of diabetic patients encounter every day to the various diabetic clinics for treatment purpose.&#x0D; Objective: This study aims to observe the socio-demographic and anthropometric profile among newly detected diabetic patients attending to our tertiary care teaching hospital.&#x0D; Methods: This is a hospital-record based cross sectional descriptive study executed in a tertiary care teaching hospital, Dhanmondi, Dhaka. The study group comprises 165 newly detected diabetic patients enrolled in our Bangladesh Medical College Hospital from July 2019 to June 2020. Analysis of data was done by using SPSS 15 software. Prevalence of newly detected diabetes among study population was calculated by using percentage and the strength of association between socio demographic and anthropometric factors were evaluated in our study.&#x0D; Results: Among the 165 study participants, we found that 62 were males and 103 were females. Newly detected DM was more common among 36-50 years of age group followed by 51-65 years. Majority of the participants belonged to urban areas (53.94%) and were graduates (38.18%). Positive family history of DM was found among 93 patients. Nearly 55.76% diabetic patients were overweight followed by 23.63% were obese with moderate to low levels of physical activities were observed mostly.&#x0D; Conclusion: In Bangladesh DM has been emerging as one of the biggest health problems with majority of the patients were unaware about its consequences and morbidity. We need to observe the socio-demographic and anthropometric factors to create the awareness among diabetic patients and prevent its fatal complications.

Metoprolol-induced hyperkalemia – A case report

Hyperkalemia is a condition that increased serum potassium levels, which can lead to life-threatening cardiac conditions. A 59-year-old female patient admitted to an emergency medicine ward with complaints of gradually progressive retrosternal chest pain. She was a known case of diabetes mellitus (DM), hypertension, and ischemic heart disease with a positive family history of DM and hypertension. She has treated with tablet metoprolol 12.5 mg twice daily from 20 days. On examination, the patient was restless due to unstable angina BP in the range of 110/70–180/90 mm of Hg, PR range 84–86 bpm, and SPO2 – 98%. Laboratory investigation revealed that the HbA1c was 7.19, and mean blood glucose of the past 90 days was in average control. Ultrasonography shows the Grade I renal parenchymal disease. The serum blood sugar level was elevated. Serum troponin I was 0.91 ng/ml. Ultrasonography abdomen was normal. Electro cardiogram: Sinus tachycardia suspected left inferior hemiblock, poor R-wave progression, inverted T- wave, and slide ST segments elevation and 2D-echocardiogram: IHD and RWMA at rest (basal inferior moderate left ventricle dysfunction). On hospital admission, the patient was treated with antiplatelet agents, anticoagulant, insulin, anti-ischemic agents, hypolipidemic agents, and potassium binder resins and diuretics. Patients with diabetes and kidney dysfunction have a higher risk of hyperkalemia in concomitants therapy with beta-blockers, so the health care workers should be aware of life-threatening events due to hyperkalemia secondary to beta-blockers. This case-report adds the evidence on the electrolyte related adverse drug reactions due to the beta-blockers.

Relation of Copeptin with Diabetic and Renal Function Markers Among Patients with Diabetes Mellitus Progressing Towards Diabetic Nephropathy

Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy. The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM. Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson's correlation tests on SPSS. The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p=0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r=0.171 (p=0.101), BUN r=0.244 (p=0.007), creatinine r=0.215 (p=0.018), UACR r=0.375 (p= <0.001) and GFR r=0.215 (p= <0.019). The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its' role as an early and reliable biomarker of DM and its associated nephropathy.

Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM). Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM. Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household. Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence. Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus.

Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey

Population based studies on diabetes mellitus (DM) are scarce in Nigeria. This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria. This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression. The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking. The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

Risk factors associated with diabetic retinopathy among patients with type 2 diabetes mellitus in central India

Risk factors associated with diabetic retinopathy among patients with type 2 diabetes mellitus in central India - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.080, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Double diabetes in Saudi Arabia: A new entity or an underestimated condition.

AIMTo determine the clinical and biological characteristics of double diabetes (DD) among young people in Saudi Arabia.METHODSThis was a retrospective descriptive chart review study including 312 young newly diagnosed diabetic patients (aged 12-20 years), whom were admitted over a five year period (January 2009 to December 2013). Family history of diabetes mellitus (DM) (first degree), physical body mass index (BMI), acanthosis nigricans, history of auto-immune disease and laboratory information for glycosylated hemoglobin, basal C peptide level and diabetes autoantibody response (anti-GAD, anti-IA2 and anti-ICA) were collected from medical report. A mean follow-up of 3 years for these patients was performed.RESULTSPatients were categorized into 4 groups, based on the autoantibody response (Ab+ or Ab-) and C-peptide secretion (β+ for fasting level 0.4-2.1 ng/mL and β- if < 0.4 ng/mL). Group1 (type 1a): Ab+ β- (21%), group 2 (type 1b): Ab- β- (9%), group 3 (DD): Ab+ β+ (31%) and group 4 (classic type 2 DM): Ab- β+ (39%). The mean age of the DD patients in our study was 15.1 ± 6.4 years. A total of 41% of the study population presented with diabetic ketoacidosis and 61% of the study population presented with positive family history of DM. The mean BMI was 26.8 kg/m2 with 64% of overweight or obese patients. Ninety two percent of the patients were started on insulin at the time of diagnosis. During a mean follow-up of 3 years, only 32% of the patients with DD required insulin and 78% were on metformin alone or with insulin.CONCLUSIONOur findings enable us to arrive at the conclusion that almost one-third of the young Saudi diabetic patients reveal atypical forms of DM (double diabetes) expressing features resulting from both T1D and T2D.

Reference values for hemoglobin A1cin males living in Khartoum State: Pilot study 2016

Objective: The objective of this study was to establish the normal values of hemoglobin A 1c in Sudanese healthy adult males living in Khartoum State and compare the result with the international values. Materials and Methods: A cross-sectional study was conducted during 2016 in Khartoum State on adult males of ages between 35 and 45 years and not known to be diabetic or suffering from any chronic illness. Twenty participants were assessed by a questionnaire covering age, family history of diabetes mellitus (DM), physical activity, daily caloric intake and smoking history, and body mass index (BMI) was calculated by measuring weight and height by weight and height measuring devices (scale). A sample of 3 ml venous blood was taken for fasting blood glucose to exclude DM and measurement of HbA 1c using modified ELISA reader known as Nycocard © machine. Correlations between the variables were estimated and P Results: The mean of HbA 1c was 3.8% ± 1.17 with a range of 1.2-5.4%. There was no correlation between Hb level, daily caloric intake, and the level of HbA 1c ( r = 0). There was intermediate correlation between body mass index and Hb A 1c - ( r = 0.32). All the participants in this study had normal body mass index (18.5-25) with mean (23.6). There was weak statistical correlation between age and HbA 1c ( r = 0.07), but the family history, smoking, and physical activity were found to be positive statistically significant to HbA 1c ( P 1c in smokers was 3.8% (±1.4%) and in nonsmokers was 3.1% (±1.0). The mean HbA 1c of those with positive family history of DM 4% (±0.8%) was significantly higher than those with negative family history 3.5% (±1.3%). The mean of HbA 1c in physically active participants was 3.9% (±0.9) and in the nonactive participants was 3.1% (±1.3). Conclusion: The results of this study indicate that there is a difference in values of HbA 1c between the international values and Sudan, so the normal values for HbA 1c in Sudanese need to be established from a large sample.

Clinical profile of diabetes mellitus in tuberculosis

ObjectiveThe objective is to document the clinical profile of diabetes mellitus (DM) in tuberculosis (TB).Type of studyThis was a descriptive observational study.MethodsA total of 4000 persons aged above 12 years...

Risk Factors of Pre-Diabetes among Adult Nigerians with Essential Hypertension in a Resource-Constrained Setting of a Primary Care Clinic in Eastern Nigeria

Background: As the case detection of pre-diabetes(PD) increases worldwide, screening for its risk factors which overlap with those of type 2 diabetes mellitus(DM) is an important primary care challenge that is often neglected especially in under-resourced setting. Aim: This study was designed to determine the prevalence and risk factors of pre-diabetes among adult Nigerians with essential hypertension in a resource-constrained setting of a primary care clinic in Eastern Nigeria. Materials and Methods: A cross-sectional study carried out on 320 consecutive adult Nigerians with essential hypertension who were screened for PD and 106 of them who had PD and met the inclusion criteria were age and sex matched with 106 non-hypertensive and non-diabetic control. Demographic and some risk factors of PD were obtained using a pretested, structured and interviewer-administered questionnaire. Pre-diabetes was defined as fasting plasma glucose of 100-125 mg/dL and /or plasma glucose level of 140-199 mg/dL two hours after a 75g oral glucose load. Results: One hundred and six (33.1%) out of the 320 hypertensive patients screened had PD. Obesity (P=0.001), positive family history of DM (P=0.001) and inadequate physical activity (P=0.001) were significantly associated with PD. The most significant predictor of PD was obesity(OR=12.50(2.38-34.48), P=0.001).The obese patients were twelve and half times more likely to have PD compared to their non-obese counterparts. Conclusion: There was high prevalence of PD in adult hypertensive study population. Obesity, family history of DM and inadequate physical activity were proximate independent risk factors. The presence of these risk factors should therefore provide guide for screening adult Nigerians with essential hypertension for PD in primary care.

Thyroid function and stress hormones in children with stress hyperglycemia

The purpose of the study is to determine the prevalence of stress hyperglycemia and to investigate how thyroid and stress hormones alter during stress hyperglycemia in children admitted to pediatric emergency wards. A prospective cross-sectional study was conducted in children, less than 19 years old, who were admitted to pediatric emergency wards of Nemazee and Dastgheib Hospitals, Shiraz, Southern Iran. Those patients taking steroids, beta-agonists or intravenously administered glucose before venipuncture, and patients with diabetes mellitus (DM) or thyroid diseases were excluded. Children with blood glucose ≥ 150 mg/dL during admission were regarded as cases. The controls were age- and- sex- matched, euglycemic children. Stress hormones including cortisol, insulin, growth hormone, and prolactin were measured, and thyroid function was tested with a radioimmunoassay (RIA) method in all cases and controls. The results showed that among 1,054 screened children, 39 cases (3.7 %) had stress hyperglycemia and 89 controls were included in the study. The occurrence of hyperglycemia was independent of sex, but it occurred mostly in children under 6 years old. Hyperglycemia occurred more frequently in patients with a positive family history of DM (odds ratio = 3.2, 95 % CI = 1.3-7.9, and P = 0.009). There were no significant differences between cases and controls regarding any hormones except higher cortisol, and lower total T3 and T4 in cases compared with controls. Neither of cases developed diabetes in the 24-month follow-up period. These findings led us to the conclusion that stress hyperglycemia is occasionally seen in critically ill patients. Among the stress hormones measured, only cortisol increased during hyperglycemia. It seems that hyperglycemia is not an important risk factor for future diabetes.

Stress Hyperglycemia: A Sign of Familial Diabetes in Children

Stress hyperglycemia in children is considered a benign condition that usually does not mandate further investigation. In some clinical settings it might be the first sign of diabetes mellitus (DM). Two unrelated boys, one aged 2 years 7 months and the other aged 5 days, were evaluated in the emergency department for a febrile infection and found to have elevated blood glucose levels (238 and 150 mg/dL [preprandial], respectively). In both cases the elevated hemoglobin A1c levels (6.5% and 6.6%, respectively) combined with a history of gestational DM in the mother and positive family history for DM suggested maturity-onset diabetes of the young. Genetic analysis revealed 2 known heterozygote mutations in the glucokinase gene: c.697T→C p.C233R in the first case and c.616A→C p.T206P in the second case. Our findings suggest that stress hyperglycemia during early childhood in association with a positive family history of DM might be a sign of monogenic diabetes.

Clinical characteristics at presentation of type 1 diabetes mellitus in children younger than 15 years in Croatia

The aim of the study was to determine the clinical and biochemical characteristics of type 1 diabetes mellitus (DM) at presentation in children younger than 15 years in Croatia during a 9-year period, with special attention to diabetic ketoacidosis (DKA) incidence. The registered data set comprised blood glucose, pH, serum bicarbonate levels, and clinical symptoms at disease manifestation. During the study period, 692 children were diagnosed with type 1 DM. Polydipsia (96.7%), polyuria (96.05%), and weight loss (82.7%) were the most frequent symptoms anticipating disease detection. Enuresis was recorded in 11.55%. A total of 36.41% patients had DKA (pH < 7.3) at disease onset. During the 9-year period, the percentage of children presenting with DKA at time of diagnosis decreased from 41.67% to 33.33% (z = 1.68, p = 0.046). A positive family history of DM, the only factor with an impact on the DKA incidence rate in our population, lowers the probability of the development of ketoacidosis. This study confirms the importance of the detection of the classic symptoms of polyuria, polydipsia, and weight loss in patients with new-onset type 1 DM. The percentage of patients with DKA at diabetes onset decreased during the observed period but is still high and includes one-third of all patients. This is why in every acutely ill child, especially at a younger age, one should evaluate the possibility of type 1 DM to avoid the development of ketoacidosis.

Progression to impaired glucose regulation, diabetes and metabolic syndrome in Chinese women with a past history of gestational diabetes

To examine the risk of developing impaired glucose regulation (IGR), diabetes mellitus (DM) and metabolic syndrome (MetS) in Chinese women with history of gestational diabetes. 203 Chinese women enrolled in a previous study were followed up at a median of 8 (range 7-10) years of whom 136 had normal glucose tolerance (NGT) and 68 had gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT). In women with a history of gestational diabetes (n = 4), GIGT (n = 63) and NGT (n = 136), 2 (50%), 19 (30.2%) and 21 (15.4%) developed IGR while 2 (50%), 4 (6.3%), 3 (2.2%) developed DM respectively. Most women developed IGR (86%, n = 36) or DM (78%, n = 7) were undiagnosed. MetS occurred in 16 (7.9%) women with similar rates between those with and those without a history of gestational diabetes (7.5% vs 8.1%; p = 0.85). History of gestational diabetes [OR: 3.8 (95% CI 1.9-7.8)] and body mass index (BMI) >/= 23 kg/m(2) [OR: 3.4 (95% CI 1.7-6.8)] at first antenatal visit were predictors for IGR or DM. Family history of DM [OR: 5.0 (95% CI 1.5-16.4)] and BMI >/= 23 kg/m(2) [OR: 28.3 (95% CI 3.6-223)] at first antenatal visit were predictors for MetS. Chinese women with a history of gestational diabetes have a high risk of IGR or DM. Overweight at the first antenatal visit is a common risk factor for IGR, DM and MetS. A prior history of gestational diabetes was predictive of IGR and DM while a positive family history of DM was predictive of MetS.

Low serum insulin values in children with multiple lesions of granuloma annulare: a prospective study

The relationship between granuloma annularae (GA) and diabetes mellitus (DM) is controversial. To investigate the relationship between multiple lesions of GA and carbohydrate metabolism in children. Fifteen children (seven boys, eight girls, mean age 4.8 years) with five or more lesions of GA were evaluated. A personal and family history of DM or other autoimmune diseases was obtained and the glycaemic and insulin response during an oral glucose tolerance test (OGTT) was determined. Thirteen children with a negative personal and family history of DM served as controls for the OGTT and 100 other children as 'clinical controls'. At the 30-min sampling of the OGTT the mean insulin values were comparable in GA children and controls (P=0.1), while the mean glucose values were significantly higher in GA children than in controls (P=0.005). All other insulin values during the OGTT were significantly lower in GA children than in controls, while all other glucose values were comparable in GA children and controls with all indices applied. Eleven out of 15 GA children had a positive family history of DM (73.3% vs. 16% of the clinical controls; P<0.0001). Multiple lesions of GA in children are associated with significantly lower serum insulin values than in controls and mildly impaired glucose tolerance.