type-II Diabetes Mellitus Patients Research Articles

COMPARING STAGES OF DIABETIC RETINOPATHY WITH SYSTEMIC VASCULAR STATUS USING FINGER PHOTOPLETHYSMOGRAPHY.

To evaluate systemic vascular fitness measured by finger photoplethysmography (PPG) in diabetic retinopathy (DR). This was a cross sectional observational study on type-II Diabetes Mellitus patients from October 2020 to May 2021. Data collected include systolic/diastolic blood pressure (BP), visual acuity, HbA1c, and central macular thickness (CMT). DR severity was categorised using the ETDRS classification. PPG signals were acquired using pulse-oximeter modules (OEM-60, Dolphin Medical Inc) measured for 90 seconds at 275Hz sampling rate and 16-bits resolution which records photoplethysmography fitness index (PPGF), vascular-risk prediction index (VRPI) and vascular age (VascA). One-hundred-and-forty-one patients were equally distributed into six DR categories. Mean age was 58.8±9.9 years, with female-to-male ratio of 1.27. There were significant differences in mean systolic (125.5±10.0mmHg, p=0.007) and diastolic-BP (80.0±8.8mmHg), mean HbA1c (7.6±1.9%, p=0.005), median LogMAR (0.3, IQR:0.2-0.5, p<0.001) and CMT (p=0.003) across DR severity. Significant differences were also seen in PPGF (p=0.001), VRPI (p<0.001) and VascA (p=0.001), with poorer values in severe compared to mild/moderate DR. After adjusting for age, BP and HbA1c, PPGF reduces by 3.3% (regression coefficient, b= -3.27, p<0.001), VascA increases by 2.5 years (b=2.54, p=0.002) and VRPI increases by 3.1 (b= 3.08, p<0.001) with every DR worsening. More severe DR were associated with poorer PPG vascular markers.

Clinical Biomarkers of Dyslipidemia in Diabetes Mellitus Type II Patients

Background. This study aims to comparatively investigate the clinical biomarkers of diabetic dyslipidemia in type II diabetes mellitus (TIIDM) patients and healthy controls with no clinical diabetic history. Method. A cross-sectional study was conducted on 100 TIIDM patients age-matched with 100 control subjects. They were evaluated from January 2021 to July 2022 in Narowal, Pakistan. Various biomarkers including total cholesterol (TL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were measured for each subject. Results. The results showed significantly higher levels of TC (238 ± 30 mg/dl), triglycerides (201 ± 72 mg/dl), and LDL (141 ± 47 mg/dl) in TIIDM patients as compared to control groups’ levels of TC (167 ± 23 mg/dl), triglycerides (175 ± 75 mg/dl), and LDL (95 ± 30 mg/dl). However, HDL level was significantly lower (46 ± 21 mg/dl) in TIIDM patients as compared to control group (54 ± 27 mg/dl). Conclusion. The clinical biomarkers of dyslipidemia are effective risk predictors for cardiovascular diseases in low-income countries such as Pakistan.

Prevalence and Severity of Periodontal Disease and its Association with Type-II Diabetes Mellitus and Smoking by Using Periodontal Screening and Recording: A Retrospective Study.

Periodontal screening recording (PSR) is considered a quick, reliable, reproducible valuable screening tool for periodontal disease. This study aims to find the prevalence and severity of periodontal disease and its association with self-reported diabetic status and smoking history of the patients by using PSR codes over a period of 2 years. This was a cross-sectional retrospective study in a dental hospital in Chandigarh. Data of 10,882 patients comprising self-reported history of smoking (893) and diabetes (725) patients were assessed for the prevalence of periodontal disease by using PSR codes. Pearson Chi-Square test was used for statistical evaluation of PSR codes data. Out of a total of 65,292 sextants assessed, the maximum and minimum reported PSR codes were 2 and 4, respectively. Gingivitis was found to be the most prevalent, followed by periodontitis and periodontal health in the total assessed population (P < 0.001). Mucogingival problems and complete edentulism were found to be more prevalent in posterior sextants in comparison to anterior sextants. Both self-reported smokers and type-II diabetes mellitus patients presented gingivitis as the most common clinical presentation, with the highest prevalence seen in the 55-74-year age group, which also comprised the group with maximum mucogingival problems and edentulism. This study gives an overview of patients' general oral health status and reflects the burden of periodontal disease in the Chandigarh region, thus contributing to the national oral health data.

A prospective observational study on safety and efficacy of metformin and its combination used in type-ii diabetes mellitus patients

Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. This study was carried out with an objective to determine the efficacy of Metformin with other oral hypoglycemic agents, to educate the patients about the disease and use of drugs in diabetes mellitus and to evaluate which class of drugs in oral hypoglycemic agents with Metformin shows more effectiveness. The patients in each group received the medication for 8 weeks duration. A study was carried out about the comparative, efficacy of glimepiride and metformin in type-2 DM which was a meta-analysis of randomized controlled trials. The results of the study were that metformin alone does not show the efficacy than with Metformin+ Teneligliptin and Metformin + Glimepiride in overall efficacy of controlling FBS and PPBS. Combination of Metformin+ Glimepiride is more effective than Metformin+ Teneligliptin and Metformin alone. The findings from the study observed the combination of metformin efficacy to some extent.

Effectiveness of two photosensitizer-mediated photodynamic therapy for treating moderate peri-implant infections in type-II diabetes mellitus patients: A randomized clinical trial

PurposeThis study evaluated the impact of Fox Green (FG) against methylthioninium chloride (MTC)-facilitated photodynamic therapy (PDT) as an adjunctive to manual scaling (MS) on the peri‑implant clinical and cytokine parameters in type-2 diabetes mellitus (DM) patients with peri‑implantitis. MethodsPatients were divided into group-A comprising 13 patients who received adjunctive FG-PDT using a diode laser (wavelength: 810 nm; irradiation power: 300 mW; irradiation time: 30 s; fluence: 56 Jcm−2), group-B comprising 12 patients who received adjunctive MTC-PDT using a diode laser (wavelength: 660 nm; irradiation power: 100 mW; irradiation time: 120 s/site; fluence: 30 Jcm−2), and group-C comprising 13 patients who received MS alone [control group]). After diagnosing the diabetics with peri‑implantitis (established on eligibility criteria), a structured questionnaire was used to gather the information of the participants. Plaque (PS) and bleeding scores (BS), along with peri‑implant probing scores (PPS) and peri‑implant bone loss (PIBL), together with immunological variables (interleukin [IL]-6, tumor necrosis factor-alpha [TNF-α], and advanced glycation end products [AGEs]) were measured in all study group participants at baseline, 3-month, and 6-month follow-ups. ResultsA significant reduction was observed for PS, BS, and PPS within all tested groups at each follow-up visits compared from their baseline values (p<0.05). However, a substantial decrease in PIBL was observed in all study group patients at 6-month follow-up as compared to 3-month follow-up (p<0.05). Regarding the levels of IL-6 and TNF-α, a substantial reduction was observed in all study groups until 6-month from their baseline scores (p<0.05). However, no changes were observed in the levels of AGEs in any group at either visit (p>0.05). ConclusionIn DM patients with periimplantitis, adjunctive FG-PDT and MTC-PDT exhibited comparable outcomes in terms of peri‑implant clinical as well as pro-inflammatory characteristics than MS alone among peri‑implantitis patients with DM.

ASSOCIATION OF SERUM VITAMIN D WITH GLYCOSYLATED HEMOGLOBIN LEVELS AND DURATION OF DISEASE IN TYPE-II DIABETES MELLITUS PATIENTS

Objective: To find a possible association between levels of vitamin D and glycosylated hemoglobin levels in patients with type II diabetes mellitus. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Peshawar over six months. Diagnosed cases of Type-II diabetes mellitus were recruited through non-probability consecutive sampling. The levels of glycosylated hemoglobin and serum vitamin D levels were assessed in 219 selected patients enrolled in the study through Cobas Integra 800 and Enzyme-Linked Immunosorbent Assay respectively. Patients were divided into three categories based on increasing levels of glycosylated hemoglobin. The trend in the levels of vitamin D levels in these categories of increasing HbA1c was identified. Results: Out of 219 Type II diabetic patients, 30.1% (66) were men while 69.9% (153) were women. The mean age was 59.48 ± 9.29 years. Similarly, HbA1c and serum vitamin D, were 9.47 ± 2.88 and 18.63 ± 16.54, respectively. Overall, 59% of the patients were Vitamin D deficient. The decrease in Vitamin D levels was associated with an increase in glycosylated hemoglobin levels (p-value 0.002). CONCLUSION: Vitamin D deficiency in Type-II diabetes mellitus patients increases with increasing levels of glycosylated hemoglobin. KEYWORDS: Diabetes Mellitus, Type II Diabetes, HBA1c, Vitamin D.

Frequency of microalbuminuria and its relation to HbA1C in type 2 Diabetes mellitus patients.

Objective: To determine frequency of microalbuminuria and relative determination of glycated hemoglobin (HBA1C) in Type II diabetes mellitus patients. Study Design: Descriptive Cross Sectional. Study Setting: Three Different Hospitals Based in Sindh Pakistan. Study Period: March-August 2021. Material &amp; Methods: After selection through non-probability purposive sample technique, demographic details of all patients were noted in a written questionnaire. All the confirmed patients of type-II diabetes mellitus were then tested for microalbuminuria and glycated hemoglobin in parallel with the disease progression. All the collected information was analyzed in SPSS ver. 22. Results: Among 165 enrolled cases, 89 (54%) type II diabetic patients were normoalbuminuric, 53 (32 %) Microalbuminuria and 14 % macroalbuminuria. Males were at greater risk (65%) of developing type II diabetes mellitus in comparison to females (35%). In total 46 type II diabetes mellitus cases with microalbuminuria represent raised HBA1C levels AT95% CI. Conclusion: Prevalence of microalbuminuria among type II diabetic patients visiting the tertiary care hospital is 32.1%. Patients with higher HbA1c or poor glycemic control are present with microalbuminuria.

Comparative Evaluation of Effectiveness of Triphala and Chlorhexidine in One Stage Full Mouth Disinfection Treatment of Stage-II and III Periodontitis in Type-II Diabetes Mellitus Patients- A Research Protocol

Introduction: The idea of Full-Mouth Disinfection (FMD) was presented in the early 1990s, the traditional method of treating periodontal disease, quadrant by quadrant over several visits. The FMD method has been recommended with a number of changes over time. Triphala, Ayurvedic medicinal herbal formulations is also useful in dentistry as antiplaque, antimicrobial, antioxidant, analgesic, antipyretic and antiinflammatory agent. As Chlorhexidine (CHX) is used from past years for full mouth disinfection, there is need to evaluate the efficacy of CHX as well as Triphala in diabetic mellitus patients. Need of the study: As CHX has been used for years to disinfect the entire mouth, a study comparing the effectiveness of CHX and Triphala in individuals with Diabetes Mellitus (DM) for full mouth disinfection will be done. Aim: To evaluate and compare the efficacy of triphala and CHX in the treatment of Stage-II and III periodontitis with one stage complete mouth disinfection in Type-IIDM patients. Materials and Methods: This experimental study will be done in Sharad Pawar dental College, department of Periodontics after obtaining the ethical clearance during September 2021 to September 2022. About 24 type 2 diabetic subjects with StageII and Stage-III periodontitis, will be randomly divided into test Group-And control group with 12 in each group. In Group-A, Full mouth disinfection will be done using CHX and in Group-B full mouth disinfection will be done using Triphala. After full mouth subgingival scaling and root planning, patient will brush the dorsum of the tongue for one minute with gel, the mouth will be rinsed two times with mouthwash for one minute, the pharynx will be cleaned with a spray, and all periodontal pockets will be irrigated (thrice within 10 minutes) with a gel. Clinical parameters will be evaluated at baseline and six months. The clinical parameters are Probing Pocket Depth (PPD), Plaque Index (PI), Clinical Attachment Level (CAL), Papillary Bleeding Index (PBI). Paired t-test will be used to compare data within group for before and after treatment and unpaired t-test will be used to compare between the groups.

Effectiveness Of Glimepiride And Glimepiride + Vitamin-C In Type-2 Diabetes Mellitus Patients Associated With SOD2 Gene Polymorphism

Introduction: Diabetes mellitus (DM) is characterized by hyperglycemia, usually associated with the rise in oxidative stress. Oxidative stress plays a major role in diabetes and its complications. Methods: 40 newly diagnosed type-II DM patients were recruited after measuring glycolated hemoglobin (HbA1c), fasting blood sugar (FBS) &amp; postprandial blood sugar (PPBS) &amp; malondialdehyde (MDA) &amp; total antioxidant capacity (TAC). Genetic test was done for detecting SOD2gene polymorphism (Superoxide dismutase). Patients were divided into two groups, group-A (n=20) &amp;B (n=20). Group–A patients were given Glimepiride (1mg) and group-B patients were given Glimepiride (1mg) + vitamin C (1000 mg) OD for 3 months. After the commencement of the study glycemic level and oxidative stress were measured and compared with basal values. Results: 3 genotypes were identified, such as CC, CT and TT. After 3 months of study, there was a significant reduction in mean HbA1c, FBS and PPBS (p&lt;0.05) in all genotypes of both group-A&amp; B, but overall the mean reduction was more in CC genotype followed by CT and then TT genotype. Oxidative stress was reduced significantly in the CC and CT genotype (p&lt;0.05) but not in the TT genotype of the group–B, whereas group-A (all 3 genotypes) had shown elevation of oxidative stress. Conclusion: Vitamin C supplementation have better control over the glycemic level and oxidative stress.

Quasi-experimental study to assess the effectiveness of yoga asana on blood sugar level among type-II diabetes mellitus patients from selected area of Pune City

Type-II diabetes mellitus has emerged as major health concern of Indians as well of world population. The patient with type-II diabetes mellitus can control the blood sugar level by incorporating various complimentary therapies. Aim of the study: To assess the effectiveness of yoga asana on blood sugar level among type-II diabetes mellitus patient from selected area of Pune city. Material and methods: The research approach adopted for this study was quantitative approach and the research design was quasi-experimental Non-Randomized Control Group Design. 88 patients with type-II diabetes mellitus were selective by purposive sampling. Out of those 88 patients, 44 were kept in experimental group and 44 were kept in control group. Demographic variable, clinical profile and assessment of fasting, postprandial blood sugar level was carried out among patient with Type-II diabetes mellitus on Day 1. Experimental group received intervention in terms of yoga asana and blood sugar level were assessed on Day 15 and Day 31. Result: Finding of the study stated that in experimental group, the Mean+SD of Fasting Blood Sugar Level (in mg/dL) on Day1 was 157.5+10.52, on Day 15 it was reduced to 154.84+6.97 and on Day 31 further reduced to 153.91+8.81.

Effect of different antidiabetic medications on atherosclerotic cardiovascular disease (ASCVD) risk score among patients with type-2 diabetes mellitus: A multicenter non-interventional observational study

ObjectiveThe aim of this study was to compare the clinical outcomes associated with different combinations of oral diabetic drugs among patients with type 2 diabetes mellitus.MethodA prospective multicenter longitudinal, noninterventional observation study design was applied. At baseline (0 month), clinical parameters including glucose profile, renal function, lipid profile and risk assessment for cardiovascular risks were calculated. Mean Weighted difference (MWD) with heterogeneity and effect z was calculated to determine the risk reduction at the end of the study.ResultsA total of 1,657 were enrolled to different cohorts with response rate of 75.5%. The distribution of patients was based on prescribed drug. A total of 513 (30.9%) in G1 (metformin alone), 217 (13.09%) in G2 (metformin with Glimepiride), 231 (12.85%) in G3 (Metformin with Gliclazide), 384 (23.17%) in G4 (metformin with Sitagliptin) and 312 (18.89%) in G5 (Metformin with Saxagliptin). There was no significant different in all clinical and social variables at baseline. The Intergroup analysis showed significant differences with all the primary outcome variables except BMI (p = 0.217) and eGFR (p = 0.782) among patients using sulphonylurea (SU) combination (G2 & G3). Findings also showed significant high frequency of emergency visit and hospitalization in G1 (78.16% & 30.8%) as compared to SU (70.1% & 28.3%, p = 0.001) and DPP-4 (56.6% & 20.4%, p = 0.001). The overall reported effect was z = 2.58, p = 0.001 for ASCVD risk reduction assessment.ConclusionThe study concluded that significant effect of Dipeptidyl peptidase-4 inhibitor on reduction of hospitalization, lipid profile and also ASCVD risk score of type-II diabetes mellitus patients regardless of clinical comorbidities. Also, sulfonylurea combinations have showed significant reduction in LDL and triglycerides values.

Correlation of Estimated-Glomerular Filtration Rate (e-GFR) with diabetic nephropathy and non-nephropathy patients in a tertiary care hospital

The estimated glomerular filtration (e-GFR) and serum creatinine is the screening methods of reduced renal function in patients with type-II diabetes (T2DM) in both patient with diabetic nephropathy and with no diabetic nephropathy. The objective of this study was to evaluate the clinical significance of e-GFR in type-II diabetes mellitus patients with diabetic nephropathy and without diabetic nephropathy.This cross-sectional study was conducted from March 2020 to February 2021 in the Department of Laboratory Medicine in collaboration with Department of Nephrology, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka involving 60 patients from the department of Nephrology, BSMMU. Among 60 patients, 30 were with diabetic nephropathy and 30 were without nephropathy. Both nephrop- athy and without nephropathy group were selected according to selection criteria. Random blood sugar (RBS), Glycated hemoglobin (HbA1c), serum creatinine and e-GFR level were measured in all patients. After data collection and processing, all statistical analysis was done by using SPSS Version 26.0. In this study, the mean(}SD) age was 50.5}11.71 in group-I and 45.53}9.97 in group-II. The difference was statistically not significant(p=0.082). It was observed that 20(66.7%) were male and 10(33.3%) were female in group I and 13(43.3%) were male and 17(56.7%) were female in group-II. Age group 51-60 years had highest percentage of nephropathy patients 9(30.0%) and 31-40 years of age group had highest percentage of diabet- ic patient without nephropathy 13(43.3%). The mean e-GFR in Group I was 47.56}35.48 and in Group II was 93.75}31.29 which was statistically significant (p=0.001). There was a signifi- cant negative correlation between serum e-GFR and serum creatinine in between Group I (r=-0.809, p&lt;0.001) and Group II (r=-0.715, p&lt;0.001). In conclusion, serum creatinine was higher in type 2 diabetes mellitus patients with nephropathy group and mean e-GFR was significantly reduced in type 2 diabetes mellitus patients with nephropathy group than without nephropathy. BSMMU J 2021; 14(4): 109-113

Association between family behaviors and self-care activities among type-II diabetes mellitus patients at a teaching hospital in Kathmandu, Nepal.

BACKGROUND:Self-care activities are associated with prognosis of type-II diabetes mellitus patients and include medication adherence, dietary adherence, physical activity, self-monitoring of blood glucose (SMBG), and appropriate foot care. The behaviors of a patient's family members can influence the patient's self-care activities, but little data exist on this association. The objective of this study was to assess the extent of the association between behaviors of family members of Type-II diabetes patients and the patients' self-care activities.MATERIALS AND METHODS:We conducted a cross-sectional study at a teaching hospital in Kathmandu, Nepal, and interviewed 411 outpatients with Type-2 diabetes mellitus. We used exploratory factor analysis to group family members' behaviors into 3 domains (”authoritarian,” “supportive,” and “planning” behaviors) and graded the level of the behavior into 3 categories (”high” vs. “medium” vs. “low”) according to its ranking distribution in each domain. We assessed the association between domains of family behavior and self-care activities using multivariate logistic regression with Bonferroni correction.RESULTS:High (vs. low) level of supportive behavior was associated with compliance to SMBG (58% vs. 11%; adjusted odds ratio [OR] =7.44; 95% confidence interval [CI] =2.41, 23.01). High (vs. low) level of planning behavior was associated with high level of foot care adherence (64% vs. 21%; adjusted OR = 6.03; 95% CI = 3.01, 12.11).CONCLUSIONS:We found associations between behaviors of diabetes patients' family members and the patients' own self-care behaviors. However, the incongruence between the family behavior measurement questions and the self-care of interest limited the implications of the findings.

208.4: Outcomes of Simultaneous Kidney-Pancreas Transplantation in Patients With Type-1 and Type-2 Diabetes Mellitus

Background: UNOS approved simultaneous kidney-pancreas transplantation (SKPT) for type-II diabetes mellitus (DM) in Oct 2014. In Jan 2015, we actively listed type-II DM patients with ESRD or e-GFR ≤ 20 ml/min/m2 for SKPT if they met the following criteria: age < 55 years, on insulin ≤ 1 unit/kg body weight, and a maximum allowable body mass index (BMI ≤ 30 kg/m2). The two major advantages for the type-II DM patients receiving SKPT as compared with kidney transplant alone are a much shorter waiting time and usually a better-quality kidney. There is limited data comparing outcomes of SKPT in type-I versus type-II DM. The aim of this study was to measure the change in volume of SPKT since UNOS approved it for type-II DM patients and compare death-censored 5-year graft and patient survival between type-I and type-II DM patients undergoing SKPT. Methods: We conducted a retrospective chart-review study on SKPT patients from Jan 2010 to Nov 2020 and collected data on patient demographics such as age, gender, and race. BMI, c-peptide, HbA1c, and e-GFR were noted pre-transplant and 1-year post-transplant. Outcome variables included volume of SKPT pre-and post-approval of SKPT for type-II DM patients, death-censored 5-year pancreas and kidney graft survival, and 5-year patient survival. Student’s t-test for continuous variables, Chi-square test for categorical variables, and Mantel-Cox test for survival analysis was done using SPSS. Results: As compared to type-I DM patients, type-II DM patients were older [47.4 vs 40.2 years, p-value = <0.01] and had higher BMI [32.0 vs 26.7 kg/m2, p-value = <0.01] and eGFR [76.7 vs 62.0 ml/min/1.73m2, p-value = 0.04] 1-year post-transplant (Figure 1). Among 89 SKPT, 18 (all type-I DM) were done before the approval of SKPT in type-II DM patients and 71 (41 type-I and 30 type-II DM) were done after the approval. This translated to an increase in SKPT from 3.6/year to 11.8/year (228% increase). There were no differences in death-censored 5-year kidney and pancreas graft survival and 5-year patient survival (Figure 2).Conclusion: Approval of SKPT for type-II DM by UNOS led to an increase in SKPT with no differences in kidney and pancreas graft survival or patient survival between patients with type-I and type-II DM. Obesity should be carefully screened and managed post-transplantation in type-II DM patients undergoing SKPT.

Association of Genetic Polymorphism in Apolipoprotein A5 and Lipoprotein Lipase Genes with Type Ii Diabetes Mellitus Patients in Rural South Western Maharashtra

The most commonly found type of diabetes in India is type II diabetes mellitus (T2DM), which is characterized by decrease in insulin secretion and decrease in insulin sensitivity. Several environmental factors, genetic factors, socio-economic factors, life style, dietary habits have contributed to the surge of T2DM cases in India. Numerous genes involved in lipid metabolism are likely to be candidates as the markers for obesity and T2DM. In the present study, single nucleotide polymorphism (SNP) of two genes namely Apolipoprotein A5 (APOA5) and Lipoprotein lipase (LPL) involved in triglyceride metabolism were investigated using polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). The control group comprised of non-obese, non-diabetic subjects (n=120) and T2DM cases were divided into obese (n=120), and non-obese (n=120) groups based on their body mass index (BMI). The demographic features between the control and cases were compared using Chi-square distribution. The genotype frequencies of control and cases were compared using analysis of variance (ANOVA) and binary logistic regression analysis (Odds’ ratio (OR) and adjusted Odds’ ratio). It was observed that APOA5 rs3135506 (OR = 0.46 (0.27-0.79); p = 0.007) was negatively associated, while APOA5 rs662799 (OR = 2.22 (1.28-3.84); p = 0.006) was significantly associated in non-obese diabetic patients. APOA5 rs3135506 (OR = 0.03 (0.01-0.06); p &lt; 0.001) was negatively associated and rs662799 (OR = 4.68 (1.47-14.93); p = 0.01) was significantly associated in obese diabetic patients. Both LPL SNPs (rs285 and rs320) were found not to be associated with T2DM. The association of Apo A5 variants with T2DM may be because of post transcriptional inhibition leading to reduced Apo A5 expression or these alleles may be in linkage disequilibrium with alleles which directly affect the functioning of APOA5. The observations indicated that T2DM is a multi-factorial disease with a large number of gene-gene and gene-environment interactions.

A Study of Cardiac Autonomic Neuropathy among Type-II Diabetic Patients

Background: Though very common, CAN is a least understood complication of diabetes which is often under diagnosed. In diabetes mellitus patients, CAN leads to silent myocardial infarction and sudden death. So by identifying CAN early, which is asymptomatic will help to delay or arrest its progression.&#x0D; AIM: To find out the prevalence and the associated risk factors of Cardiac autonomic neuropathy (CAN) among type-II Diabetes Mellitus patients in a tertiary care hospital.&#x0D; Materials &amp; Methods: A total of 273 type-II diabetic participants were selected after taking into consideration of inclusion &amp; exclusion criteria. The prevalence of CAN was assessed by ewings and clarkesnon invasive cardiac autonomic neuropathy reflex tests. The association of risk factors with the presence of CAN was analysed by using Pearson’s chi square test. Data were analysed by using SPSS 16. The accepted level of significance was set below 0.05 (P&lt;0.05).&#x0D; Results: The prevalence of CAN among type-II diabetic patients in this study was found to be 34%. Prevalence of CAN increased in the participants with male gender, increased age, and increased BMI, increased duration of diabetes, poor glycaemic control,dyslipidimea, smokers and hypertension and it is statistically significant.&#x0D; Conclusion: In this study it is observed that the prevalence of CAN increased with old age, male gender, poor glycemic control, increased duration of diabetes, Dyslipidemia, higher BMI, Hypertension &amp; smoking. So risk factors associated with the CAN be detected and treated at an early stage to further reduce morbidity and mortality.

Co-morbidity pattern among type-II diabetes mellitus patients attending outpatient department of a rural tertiary care institute of North India

Background: Diabetes mellitus (DM) describes a group of metabolic disorders characterized by high blood glucose levels. People with diabetes have an increased risk of developing a number of serious life-threatening health problems resulting in higher medical care costs, reduced quality of life and increased mortality. Knowledge of the prevalence about coexisting medical conditions in specific population groups helps healthcare providers and policymakers to allocate health resources efficiently and tailor diabetic care management to effectively utilize healthcare programs while decreasing healthcare expenditure.&#x0D; Aims and Objectives: To find out the pattern of comorbidity burden among Type-II diabetes mellitus patients attending outpatient department of a rural tertiary care institute of North India.&#x0D; Materials and Methods: Study setting: Outpatient department (OPD) of General Medicine of Rural Tertiary Care Institute in North India. Study design: Descriptive, cross-sectional. Study population: Patients who had already been diagnosed by a physician of having Type 2 diabetes mellitus (T2DM) and attended OPD for follow-up during study period i.e. 1st November 2019 to 31st January 2020.&#x0D; Results: Among 82 study participants, 36 were males and 46 females. A total of sixty-six study participants had co-morbidities along with diabetes mellitus. Most common co-morbidity recorded was related to cardiovascular system and neuropathies. Adherence to treatment was followed by 46 (56%) and dietary advice by 42 (51%) study participants.&#x0D; Conclusion: In light of the chronicity of the disease and increasing prevalence of diabetes with associated comorbid conditions, there is a need for clearcut guidelines to address health risks of diabetes with other comorbid conditions. There should be provision for regular formal health education sessions to address co-morbidities, complications due to diabetes.

Periodontitis activates the NLRP3 inflammasome in serum and saliva.

Nod-like receptor family pyrin domain-containing protein-3 (NLRP3) complex inflammasome has potentially been shown to play an important role in the development of periodontitis and diabetes. The objective of this study was to analyze the association between serum and salivary NLRP3 concentrations in patients with periodontitis and type-II diabetes mellitus (DM) and to evaluate whether this association was influenced by potential confounders. For the present study, a cohort of healthy controls (n=32), and patients with periodontitis (n=34), type-II DM (n=33), and a combination of periodontitis + type-II DM (n=34) were enrolled. Patients were characterized on the basis of their periodontal status and analyzed for demographic characteristics, serum mediators, and for serum and salivary concentrations of NLRP3. A uni- and multivariate model was established to analyze whether periodontitis, type-II DM, and CRP influenced serum and salivary NLRP3 concentrations. In comparison to type-II DM patients and healthy controls, patients with periodontitis (serum, P=0.003; saliva P=0.012) and periodontitis + type-II DM (serum, P=0.028; saliva, P=0.003) had elevated serum and salivary NLRP3 concentrations. The multivariate regression model showed that periodontitis (P=0.029) and HDL-cholesterol (P=0.012) were significant predictors of serum NLRP3 concentrations whereas periodontitis (P=0.036) and CRP (P=0.012) were significant predictors of salivary NLRP3. The results of the present study showed that periodontitis and periodontitis + type-II DM patients had higher serum and salivary NLRP3 concentrations in comparison to healthy controls and patients with type-II DM. Periodontitis was demonstrated to be a significant predictor of both serum and salivary NLRP3 concentrations.

STUDY ON EFFECT OF VITAMIN-C AS ADD ON THERAPY WITH ANTIDIABETIC DRUGS IN TYPE-2 DIABETES MELLITUS PATIENTS ASSOCIATED WITH SOD2 GENE POLYMORPHISM

Diabetes is a metabolic disorder; affect the metabolism of carbohydrates, proteins and lipids. Superoxide dismutase (SOD) is a major antioxidant scavenging enzyme it helps in removal of superoxide. Polymorphism of SOD2 gene may affect the scavenging effect of SOD enzyme which results in rise of oxidative stress in Type-II DM. The present study has been designed to study the effect of vitamin-C as add on therapy with antidiabetic drugs in type-2 diabetes mellitus patients associated with SOD2 gene polymorphism. A total of 64 type-II diabetes mellitus patients associated with SOD2 gene polymorphism (Ala16Val) were enrolled in present study and divided in to two groups i.e. Group A8 B. There are three genotypes in each such as CC, CT8 TT. Group-A8 B patients were treated with metformin1000mg/day+ teneligliptin-20mg/day and metformin 1000mg/day+ teneligliptin 20mg/day+ vitamin C-1000mg/day respectively for 6 months. Glycemic control and oxidative stress was compared before and after 6 months of treatment in both groups. SPSS software was used to analyze the data. All the genotypes of both the groups had shown significant glycemic control (p less than 0.05). Significant reduction of TAC and elevation of MDA level was found in CT, TT genotype and CC, CT 8 TT genotype of group-A patients respectively (p less than 0.05). CC and CT genotype of group-B patients had shown significant elevation of TAC and reduction of MDA level as compared to baseline values (p less than 0.05). Good glycemic control and reduction of oxidative stress can be achieved with supplementation of vitamin-C along with antidiabetic drugs.

Awareness and Lifestyle Practices among Type-II Diabetics Pertaining to the Disease Attended at Outpatient Clinics of Nawabshah, Shaheed Benazirabad

Diabetes is a disorder that affects metabolism of carbohydrates, fats, and proteins. It has appeared as one of the deadliest pandemics causing 3.2 million deaths per year. The objective of current study was to assess the level of awareness and practice of diabetic patients who were diagnosed with Type-II diabetes mellitus (DM). A prospective, observational study was designed, and subjects of the study were the patients visiting the clinics of Nawabshah Shaheed Benazirabad. The study was conducted from September 2019 to February 2020 among 300 Type-II DM patients with minimum of 34 years of age, who had been diagnosed according to the set criteria of World Health Organization (WHO). The criteria for the sampling were set to be done by non-probability convenient sampling technique. For the collection of the data, diabetes knowledge questionnaire was used, and SPSS 25 software was used for the analysis of the collected data. The statistical analysis generated was descriptive in nature. Majority of participants were male patients (n=158, 52.7%) and major age group was &gt;65 (n=136, 45.33%). The patients with family history of the disease were 253 (84.3%) of the total cases. The patients having poor knowledge of the disease and those with satisfactory practice and routine follow up were 207 (69.0%) and 160 (53.3%) respectively. The results show that the patients had poor knowledge of the diabetes. The practice regarding diabetes falls under the category of average routine practice. It can be concluded from the results that for the awareness of the diabetes there should be arrangements of the campaigns for the general population and with the involvement of the clinical pharmacist and endocrinologist, and by that diabetes could be managed effectively.