Non-insulin-dependent Diabetes Mellitus Patients Research Articles

Frequency of Peripheral Arterial Disease in Type-II Diabetic Patients presenting with Diabetic Retinopathy

Background: Type-II Diabetes Mellitus (T2DM) often leads to Diabetic Retinopathy (DR), but the prevalence of coexisting Peripheral Arterial Disease (PAD) in these patients is unclear, creating controversy in existing literature. This study aims to fill this gap by investigating the frequency of PAD in T2DM patients with DR, enhancing our understanding of diabetes-related complications. Objective: To determine frequency of peripheral arterial disease in T2DM patients presenting with diabetic retinopathy. Study Design: It was a cross sectional study. Settings: This study was conducted at the Department of Medicine, DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat Pakistan. Duration: Six months from 05-01-2022 to 04-07-2022. Methods: A total 165 T2DM patients presenting with diabetic retinopathy and meeting inclusion criteria were enrolled in this study after taking informed written consent. Ankle brachial pressure index was measured. Two blood pressure readings were taken 5 minutes apart and average was calculated for analysis. Peripheral arterial disease was labeled. SPSS version 26.0 was used for data analysis. Results: The mean age of the participants was 51.1±14.69. There were 63 (38.2%) females and 102 (61.8%) males. Mean BMI was 26.87±3.73 kg/m2. The mean duration of diabetes in the participants was 6.43±2.36 years. As regards type of retinopathy, 62 (37.6%) had Proliferative Diabetic Retinopathy (PDR), and 103 (62.4%) had Non-Proliferative Diabetic Retinopathy (NPDR). Mean Ankle Brachial Pressure Index (ABPI) among the participants was 1.01±0.25. Peripheral arterial disease was noticed in 28.5% of the T2DM patients presenting with diabetic retinopathy. Stratification of frequency of PAD for various sub groups of age, gender, BMI, duration of disease and type of retinopathy produced insignificant difference between sub groups (p-value>0.05). Conclusion: In conclusion, our investigation of Type 2 diabetic patients with diabetic retinopathy uncovers a significant 28.5% prevalence of peripheral arterial disease (PAD). Stratification across age, gender, BMI, disease duration, and retinopathy type reveals no substantial differences. These results underscore the systemic nature of vascular complications, emphasizing the importance of comprehensive care strategies.

Outcome of Percutaneous Coronary Intervention with Drug Eluting Stent in Ischemic Heart Disease with Insulin Dependent and Noninsulin Dependent Diabetic Patients

Background: Coronary artery diseases in diabetic patients are challenging because these patients represent about 25% of surgical coronary revascularization and percutaneous coronary intervention (PCI) procedures and have worse outcomes than patients without diabetes mellitus (DM) irrespective of the invasive management they receive. Patients and Methods: 53 insulin-dependent diabetic patients (ID) and non-insulin-dependent diabetic patients (NID) who underwent PCI with deployment of at least 1 drug-eluting stent (DES) in coronary arteries. Patients were divided into 2 groups: 18 ID patients & 35 NID patients. A comprehensive clinical work-up was planned one month and twelve months following the surgery, with angiographic follow-up scheduled 6-12 months thereafter. Results: Hyperlipidemia was more prevalent in the NID patients, while Coronary Artery Bypass Grafting (CABG) and multi-vessel disease were found more prevalent in the ID group than NID (p-value < 0.05). One-month follow-up showed no variations in the frequency of in-hospital mortality, Q-wave MI, or vascular sequelae. On the other hand, the rate of Target Lesions Revascularization (TRL), Non-Target Lesions Revascularization (NTLR), Nonfatal MI, and Cardiac death were high in ID patients. Conclusion: DES deployment, in comparison to coronary restenosis (ISR) following DES deployment, which remained considerably more prevalent in individuals with IDDM than in NIDDM patients, was observed to enhance angiographic and clinical results for IDDM and NIDDM patients. Long-term efficacy in those with IDDM was reduced due to an increased risk of revascularization.

Efficacy of GSR Biofeedback Relaxation on Aggression and Blood Pressure in Patients with Type II Diabetes Mellitus: A Randomized Controlled Trial

To verify the effect of GSR biofeedback (GSR-BF) relaxation training on aggression, blood pressure, and blood glucose levels, we conducted a randomized controlled trial among type II diabetes patients (TIIDPs). 228 TIIDP were selected from the various hospitals of Raipur, Chhattisgarh. Sixty participants who were found to have scores above the 75th percentile on the aggression inventory were included in the sample. Participants with higher aggression were invited for intervention and out of them, 50 randomly divided into two groups: the biofeedback relaxation group and the sham-control group. The 25 TIIDPs in the treatment group were given training on the use of the GSR-BF device for the management of stress parameters, with a total of 20 sessions (30 minutes each). The 25 TIIDPs in the control group didn’t receive any training on biofeedback relaxation. Aggression, blood pressure, and blood glucose were assessed before and after the intervention. Aggression was recorded on follow-up too. The SPSS 16th version was used for the analysis. The GSR-BFgroup reported a significant change in systolic blood pressure (p = 014), blood glucose levels (P = 005) and in the dimensions of aggression (p = 001) on the post-intervention test. On the other hand, the control group reported a moderate increase in aggression. The biofeedback group had a significant reduction in the levels of aggression and blood pressure, while the control group had a significant increase in aggression. These findings will be helpful for the promotion of overall health in hyperglycemic TIIDPs.

Improving Healthcare Providers’ Adherence to Foot Exams for Type-II Diabetic Patients in a Primary Care Clinic

Foot wounds are complications of type II diabetes mellitus (T2DM), which may be prevented with proper foot assessments. Diabetic foot exams are not consistently performed despite evidence-based screening tools available. Objective: To determine if the implementation of an electronic medical record (EMR) alert using Inlow’s 60-Second Diabetic Foot Screen would impact the number of diabetic foot exams performed among T2DM patients at a primary care level. Method: A quantitative quasi-experiment design was used to implement an electronic medical record (EMR) alert using Inlow’s 60-Second Diabetic Foot Screen to impact the frequencies of diabetic foot exams. Sample size was 65, n=35 in the comparative group and n= 30 in the implementation group. Population consisted of male and female patients ages 18 years and older, diagnosed with T2DM within the last two years, no previous diabetic foot exams or received foot care education, did not perform self-reported foot inspections, and were able to read, write, and speak English. A chi square test was run to analyze the frequencies of foot exams between groups. Results: A Pearson’s chi-square showed a statistically significant increase in the foot exams X2 (1, N=65) = 5.286, p= 0.02 using an EMR alert with Inlow’s 60-Second Diabetic Foot screen. Conclusion: EMR alerts increase performance of diabetic foot exams. Recommendations include sustainment of the program, dissemination of results, and further investigation of the impact of EMR alerts. Keywords: Diabetes, Foot screening, EMR alert

Retinal nerve fiber layer thickness in diabetes mellitus versus normal population using optical coherence tomography

Background: Diabetes mellitus is a micro vascular disorder that is on a rapid increase in number of diagnosed and undiagnosed cases, and it is estimated that approximately 191 million people may be suffering from this disorder by year 2030. It affects major vital organ and organ systems of the body, and is frequently accompanied with neuropathy, nephropathy, cardiovascular disorders and retinopathy. The quality of life of diabetic patients is significantly impacted by diabetic neuropathy. Aims and Objectives: To investigate the difference in peripapillary retinal nerve fibre layer (RNFL) thickness between normal population and Type-II diabetic patients without diabetic retinopathy using optical coherence tomography. Materials and Methods: Between May 2021 and May 2022, this case control research was conducted at Skims MCH Bemina SRINAGAR. Out of 400 eyes, 200 eyes belonged to healthy people and 200 eyes to Type II diabetics who did not have diabetic retinopathy. Age and gender were the same for both groups. Results: Mean age of study population was 47.05±5.47 years. Mean peripapillary RNFL thickness was 126.98±10.07 μm in Group-A (normal persons), and 120.77±5.41 μm in Group-B (Type-II diabetes). Between the two groups, there was a statistically significant difference in mean RNFL thickness as well as RNFL thicknesses in each quadrant (P=0.001). Conclusion: The diagnosis of any disease based on RNFL thinning must take into consideration the fact that diabetic patients have thin RNFL in comparison to normal persons.

Diabetes Prediction using Decision Tree, Random Forest, Support Vector Machine, K-Nearest Neighbors, Logistic Regression Classifiers

One of the world's deadliest diseases is diabetes. It is an additional creator of different assortments of problems. Ex: Coronary disappointment, Visual impairment, Urinary organ illnesses, and so forth. In such cases, the patients are expected to visit a hospital to get a consultation with doctors and their reports. They must contribute their time and cash every time they visit the hospital. Yet, with the development of AI techniques, we have the adaptability to search out a response to the present problem. We have progressed an advanced framework for handling data that can figure regardless of whether the patient has polygenic sickness. In addition, being able to foresee the onset of the disease is crucial for patients. Data withdrawal has the adaptability to eliminate concealed information from an enormous amount of diabetes-related data. The most important outcomes of this research are the establishment of a theoretical framework that can reliably predict a patient's level of risk for developing diabetes. We have utilized the existing categorization methods such as DT (Decision Tree), RF (Random Forest), SVM (Support vector Machine), LR (Logistic Regression) as well as K-NN (K-Nearest Neighbors) for predicting the severity of Type-II Diabetes patients. We got an accuracy of 99% for the Random Forest, 98.40% for the Decision Tree, 78.54% for Logistic Regression, 77.94% for SVM (Using RBF Kernal SVM), and 77.64% for KNN.

EE467 Prescription Patterns and Estimation of Cost of Illness of Type-II Diabetic Patients in a Tertiary Care Hospital Nepal

The impact of diabetes on health care expenditures has been increasingly recognized. Number of ‘cost of illness’ studies has shown a threefold increase in the direct costs of diabetic patients compared with non-diabetic patients. This study aimed to evaluate the prescription patterns and cost of illness of type II diabetic patients along with the trends in anti-diabetic and antihypertensive drug use patterns among patients with type II diabetes patients with and without comorbidities.

Prevalence and Risk Factors of Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study at a Tertiary Care Center

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging concern among patients with Type 2 Diabetes Mellitus (DM). This study was designed to evaluate the prevalence of NAFLD in Type 2 DM patients and to identify associated factors that may contribute to its occurrence. Methodology: Conducted in a tertiary care center's general medicine department from May 2020 to June 2021, this cross-sectional study enrolled 400 type-II diabetic patients, aged 35 years and above. Comprehensive interviews were performed to determine disease duration and medication usage and to exclude alternative causes of NAFLD. Physical examinations, including measurements of BMI and waist-hip circumference, along with abdominal ultrasonography, were utilized to detect and grade fatty liver. Results: The sample consisted of 217 females (59.8%) and 146 males (40.2%), with 67.2% having a diabetes diagnosis for over 10 years. NAFLD was identified in 69.1% of patients, more frequently in females (69%). A significant relationship was established between NAFLD occurrence and the duration of DM, BMI, and waist-hip ratio (p < 0.05). Conclusion: NAFLD was found in a striking majority of the diabetic population studied, approximately 70%, with a higher prevalence in females. Factors significantly linked to NAFLD incidence included the duration of diabetes and elevated measures of obesity and waist circumference. These findings underscore the need for heightened awareness and targeted interventions for this patient population. Keywords: Non-Alcoholic Fatty Liver Disease (NAFLD), Type-II Diabetes Mellitus (DM), prevalence, risk factors.

Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis.

There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA. Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed. A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI. In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.

Evaluation of oral health in different types of diabetes mellitus: A cross-sectional retrospective study

ObjectiveIt was aimed to compare the relationship between oral health and two types of diabetes mellitus (DM) using laboratory findings and oral health parameters. Material and methodThis retrospective study was conducted between 2021 and 2022. Type-I and Type-II diabetic patients who had laboratory findings and panoramic radiograph taken on the same day was included to the study. HbA1c, glucose, urea, LDL, HDL, AST, ALT, triglyceride, creatinine, positive and negative microalbuminuria levels on laboratory tests and, the number of root canal treated, missing, filled and decayed tooth on the panoramic radiograph were recorded. The obtained data were compared statistically to evaluate the association between diabetes type and oral health. ResultsA total of 101 patients, 51.5 % (n = 52) with Type-I diabetes and 49.5 % (n = 49) with Type-II diabetes, were included. The number of males (53.8 %) in Type-I DM group and the number of females (67.3 %) in Type-II DM group were statistically higher. The mean age of Type-II diabetic patients was higher than Type-I diabetic patients (p < 0.05). While the average number of teeth with caries per patient in the Type-1 diabetes group was 5, the average number of tooth loss per patient in the Type 2 group was 9. ConclusionsWhile Type-I diabetes could be a predisposing factor for dental caries, Type-II diabetes could be a predisposing factor for tooth loss.

Genetic Polymorphism in Patients with Diabetic Nephropathy and Retinopathy: A Cross-sectional Study

Introduction: The chronic persistence of diabetes leads to microvascular complications, such as Diabetic Nephropathy (DN) and Diabetic Retinopathy (DR). Both of these are progressive disorders involving pathological changes in capillaries. A few biochemical pathways have been suggested to link hyperglycaemia and microvascular complications. The probability of developing and progressing DN and DR is associated with the duration of diabetes. These complex disorders are strongly influenced by both genetics and environmental factors. Several candidate genes have been reported to be associated with DN and DR in different populations. Aim: To determine the co-existence of DN and DR in relation to gene polymorphisms of Angiotensin-Converting Enzyme (ACE), Angiotensinogen (AGT), Receptor for Advanced Glycation End-products (RAGE), Aldose reductase (ALR2), and Vascular Endothelial Growth Factor (VEGF). Materials and Methods: The present DN and DR cross-sectional study was conducted at the Department of Endocrinology, University College of Medical Sciences, University of Delhi and GTB, New Delhi, India, and the Discipline of Biochemistry, Indira Gandhi National Open University, New Delhi, India. The study was conducted from October 2019 to August 2022. All the participants under uniform diabetes management were divided into two groups (100 in each group): Group 1 included Type-II diabetic patients with DN and DR, and Group 2 comprised Type-II diabetic patients with DN only. Polymorphisms in all genes were determined using Polymerase Chain Reaction (PCR), followed by digestion with restriction enzymes and visualisation through an ultraviolet transilluminator. The analysis of biochemical parameters and association of gene polymorphisms was performed using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: There were 57 males and 43 females in the DN+DR group, and 51 males and 49 females in the DN-DR group. The mean age of study subjects in the DN+DR group was 52.60±9.08 years, compared to the DN-DR group (47.33±10.68 years). The DN+DR group had a significantly higher mean duration of diabetes (11.78±6.86 vs. 5.13±4.78, p≤0.001) and a significantly lower mean waist circumference (91.30±13.99 vs. 95.11±9.95 cm, p≤0.02). The DN+DR group also had significantly higher urea (34.34±16.32 vs. 26.43±12.34 cm, p≤0.001), creatinine (1.34±0.90 vs. 0.89±0.25 cm, p≤0.03) and significantly lower estimated Glomerular Filtration Rate (eGFR) levels compared to the DN-DR group. The distribution of genotypes of ALR2 (p≤0.04) and VEGF genes (p≤0.001) showed a significant difference between both DN+DR and DN-DR groups. The frequency of the D allele of the VEGF gene (p≤0.02) (OR=1.94, 95% Confidence Interval (CI)=1.10-3.40) was higher in the DN+DR group. The DN+DR group also had a significantly lower frequency of the CT+TT dominant model of the ALR2 gene (p≤0.04) as well as an increased frequency of the ID+DD dominant model of the VEGF gene (p≤0.002). No significant differences were found in genotypic as well as allelic frequencies of ACE, AGT, and RAGE gene polymorphisms between the two groups. Conclusion: The D allele of the VEGF (I/D) gene polymorphism is significantly associated with DR in patients with DN. It can be concluded that the VEGF gene plays an important role in the development of retinopathy in DN patients.

Green synthesis for the treatment of type-II diabetes

Type-II diabetes mellitus (T2DM) is a serious threat to human life as till the year 2019, approximately 463 million individuals of age between 20-79 years are suffering with diabetes and it will rise to 700 million by the year 2045. For the testing and diagnosis of diabetes, The WHO and the ADA are using various clinical and laboratory characteristics. Diabetes is a silent killer which cannot be cured, however by changing the lifestyle, losing fat, using low blood sugar medications, and using metformin (biguanide) which helps in reducing insulin resistance, one can control diabetes to an extent. Metformin is widely used medicine to treat obesity. Various short- and long-term problems including premature death occurs in type-II diabetic patients. Due to the late diagnosis and poor medical facilities for type-II diabetes in countries like Africa, they are susceptible to developing diseases that lead to death. This article mainly discusses type-II diabetes mellitus (T2DM) and the drugs used for its cure. It also gives a green synthesis of one of the diabetes drug done in our lab.

Role of distal motor latency (M), F-wave latency (F), and M/F ratio in type-II diabetes mellitus

Background: Diabetic neuropathy is a common complication of diabetes mellitus and early diagnosis is crucial to prevent its progression. Aims and Objective: This study aimed to assess the distal motor latency (DML), F-wave latency, and M/F ratio in type-II diabetic patients. Materials and Methods: It was a cross-sectional study with comparison group conducted in the department of neurology in collaboration with the department of physiology in a tertiary care hospital. A total of 120 diagnosed patients were enrolled in this study. A thorough clinical evaluation, including neurological examinations, assessment of neuropathic symptoms, and relevant biochemical tests, were done in all participants. Nerve conduction studies were performed to measure DML and F-wave latency, whereas the M/F ratio was calculated for each participant. Results: Based on the findings, 66 patients had no signs or symptoms of neuropathy and were considered the control group whereas 54 patients having signs and symptoms of neuropathy were considered cases. The results were compared in both the groups (diabetic patients without neuropathy as control and diabetic patients with neuropathy as cases). The results of this study showed significantly prolonged DML and F-wave latency in diabetic patients with neuropathy (cases) as compared to the control group (P &lt; 0.05). In addition, the M/F ratio was significantly lower in diabetic patients with neuropathy compared to controls (P &lt; 0.05). Conclusion: These non-invasive nerve conduction parameters can aid in the early detection of neuropathic changes in diabetic patients, allowing for timely intervention and improved management of the condition.

Visceral fat loss by whole-body electromyostimulation is attenuated in male and absent in female older Non-Insulin-Dependent diabetes patients.

Type 2 diabetes and its reversal correlate with increases and decreases in visceral fat (VF). Resistance exercise reduces VF in healthy persons, but little is known in type 2 diabetes. Muscle contractions induced by whole-body electromyostimulation (WB-EMS) provide a very effective form of resistance training. We hypothesized that WB-EMS reduces VF and improves plasma glucose measures in older non-insulin dependent diabetes mellitus (NIDDM) males and females. A four-arm age-matched case control study was done on WB-EMS twice a week in older NIDDM patients (27 males, 18 females) compared with controls (15 males, 15 females). VAT area (VAT, cm2 ), total fat mass (TFM, kg) and lean body mass (LBM, kg) were assessed by DEXA-scanning. HbA1c, fasting glucose and plasma lipoproteins were measured at baseline and after 4months. Baseline control VAT was higher in males than females (140.5 ± 35.6 vs. 96.7 ± 42.3, p< .001). In NIDDM, VAT was higher with no significant sex difference (206.5 ± 65.0 vs. 186.5 ± 60.5). In controls, WBEMS reduced VAT in males and females to similar extent (-16.9% and -16.4%, p< .001 vs. baseline) and in preference to TFM (-9.2% and -3.6%) or body weight loss (-2.8 and -2.1%). In NIDDM, VF loss was attenuated in males (-7.3%, p< .01) but completely absent in females. WBEMS reduced HbA1c and cholesterol and increased HDL levels (all p< .05) only in male NIDDM CONCLUSIONS: WBEMS induced VF loss in healthy older males and females an effect strongly attenuated in male and completely absent in female NIDDM patients. This questions the effectiveness of muscle contraction-induced VF lipolysis in NIDDM. Sex differences may dictate the success of resistance training in NIDDM, a subject that needs to be addressed in future studies.

Prevalence of Microalbuminuria and Cardiovascular Risk Factors in Patients With Diabetes Mellitus Type-II in Al-Khobar, Kingdom of Saudi Arabia.

Background Type 2 diabetes mellitus (T2DM) is a common disorder worldwide. Impaired control of glucose levels predisposes to renal dysfunction, detected by a diagnosis of microalbuminuria. Several other risk factors have been identified in the development of microalbuminuria, such as hypertension, smoking, dyslipidemia, and obesity. Objective Assessment of microalbuminuria and cardiovascular risk factors in type-II diabetic patients who attended the outpatient clinic for the internal medicine department at King Fahd University Hospital, Al-Khobar. Methods A retrospective cross-sectional and an observational study included data from 2014 to 2022 collected from medical records. Patients with diabetes type-II and aged ≥18 years were included. The following were reviewed (age, sex, height, weight, body mass index, waist, hip, waist-hip ratio, systolic and diastolic blood pressure, smoking, sedentary lifestyle, diagnosis of dyslipidemia/hypertension, diabetes duration in years) and laboratory results (fasting blood glucose, HbA1C%, estimated glomerular filtration rate, serum creatinine, serum cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides). Microalbuminuria was measured by the urine albumin to creatinine ratio and was diagnosed if levels were 30-300 mg/g. Results Among 301 studied patients, the prevalence of microalbuminuria was found at 36.8%. The mean age was 57.8 ± 12.6 years, and females were 45%. The mean ± SD fasting blood glucose was 165.9 ± 71.9 mg/dL, while HbA1C% was 8.8 ± 5.6. Microalbuminuria was significantly associated with age, diabetes duration, systolic blood pressure, HbA1C%, fasting blood glucose, and triglyceride levels (p≤0.05). Conclusion Microalbuminuria in T2DM patients was high in this study, which emphasizes the need for early detection of microalbuminuria. The study suggests the need for effective diabetes control and the prevention of associated cardiovascular risk factors.

LEFT VENTRICULAR DIASTOLIC FUNCTION ABNORMALITIES IN PATIENTS WITH NON-INSULIN DEPENDENT DIABETES MELLITUS

Objectives: Left ventricular diastolic dysfunction (LVDD) is a prevalent condition among patients with non-insulin dependent diabetes mellitus (NIDDM). The aim of this study was to determine the frequency of the LVDD in patients with NIDDM at a tertiary care cardiac center of Karachi, Pakistan. Methodology: This descriptive cross-sectional study included NIDDM patients without history of ischemic heart disease, on anti-hypertensive medication, diagnosed with valvular heart disease, congenital heart disease, arrhythmias, chronic respiratory illness, or with clinically overt heart failure (HF) or history of HF or concomitant systolic dysfunction. Transthoracic echocardiography was performed and LVDD was diagnosed. Results: A total of 114 patients with NIDDM of less than five years were included in this study. Most of the patients were 41 to 60 years of age with mean age of the 52.23±10.85 years. Out of 114 cases, 58(50.9%) were male. Frequency of LVDD was observed to be 61.4% (70/114). With respect to age groups, rate of LVDD was high in above 60 years of age patients that is 90% (18/20) and it was observed 64.9% (24/37) in 51 to 60 years of age. Rate of LVDD was also high in male patients than female with frequency of 70.7% (41/58) vs. 51.8% (29/56). Conclusion: A significant number of patients with NIDDM were found to have LVDD. Increased frequency of LVDD was observed to be associated with male gender and increased age of the patients.

Relationship of Glycemic Control with Level of Blood Pressure amongst Type 2 Diabetic Patients

Introduction: Inadequate control of glycemia in type-II diabetic patients is an important community health issue and a risk factor for the progression of problems among diabetic patients. Hypertension is a common disease accompanying diabetes. Among patients with diabetes mellitus; high blood pressure is an important factor involved in poor glycemic control which has not been adequately assessed in Pakistan. Aim: The main goal was to evaluate the glycemic control status in type II diabetic patient depending on the basis of blood pressure levels. Place and Duration: In Medicine Department of Islamic International Hospital and Medical College, Islamabad for the duration of six months from January 2021 to June 2021. Methods: 220 adult patients &gt;18 years of age with type-II diabetes mellitus were included. Patients with conditions such as liver cirrhosis, systemic infection, pregnant females, end-stage renal disease and those who were not observing diabetes treatment, counting exercise, dietary restrictions and medication, they were omitted from the anlaysis. By evaluating medical records; the patient’s demographic information was obtained which includes medical history, patient age, clinical history, gender, hypertension and type of DM in addition to the assessment of blood sugar level control. Statistical analysis was performed by using the SPSS 20.0. Results: The patients mean age was 58.10 ± 10.94 years with 35-80 years of age range. Of 220 patients, 145 (65.9%) had hypertension and 75 (34.1%) had normal blood pressure, and 7.72 ± 1.28 years was the patient’s mean duration of hypertension. The males have the HbA1c levels of 7.11 ±1.34 and 7.81 ±1.58 in females. In the hypertensive group of patients; mean HbA1c was higher significantly in comparison to the normal blood pressure group (p = 0.003). The HbA1c mean levels were also higher significantly among hypertensive patients with duration for over ten years (p = 0.04) and in subjects using diuretics (p = 0.03) and beta-blockers (p = 0.006) as an antihypertensive drug. Among patients with normal body mass index and nutritional recommendations, the mean (± SD) HbA1c in patients with hypertension was 5.13 ± 0.03 compared with patients with normal blood pressure (p = 0.00007). Conclusions: The control of Glycemia in type II diabetic patients is poor with hypertension. There is a complex relation of various factors, including gender, age, hypertension duration, and drugs that strongly effect control of glycemia among hypertensive patients and type-II diabetes mellitus. Keywords: Hypertension, Type 2 diabetes, HbA1c

EFFECT OF STRICT GLYCEMIC CONTROL ON PERIODONTITIS IN NON INSULIN DEPENDENT PATIENTS: A QUASI EXPERIMENTAL STUDY

Objectives: To evaluate the eff ect of strict glycemic control on pocket depth (PD), bleeding on probing (BOP), fasting blood sugar (FBS), C reactive protein (CRP), and HbA1c.Methods and materials: This quasi-experimental design study was conducted from March to September 2021 taking 32 cases (A) and equal controls (B) with non-insulin uncontrolled diabetes (HbA1c more than 8, whereas the eff ect of strict glycemic control on clinical periodontitis was carried out. Pocket Depth (PD), bleeding on probing (BOP), fasting blood sugar (FBS), C reactive protein (CRP), and HbA1c levels were assessed before and after the intervention.Results: Most of the variables HbA1c (p=0.03), CRP (p=0.007), PD (p=0.006), and BOP (p=0.023) showed improvement showing a better glycemic control in the post-intervention stage; particularly for patients recruited in Group A. HbA1c levels at 3 months post-intervention showed significant reduction (p=0.03) to 8.1 ± 1.7 in Group A in comparison to 9.9 ± 2.3 in the pre-intervention stage with a mean difference of -1.8 showing improvement in the glycemic control. PD (mm) for Group A was reduced from 2.4 ± 0.5 mm to 2.2 ± 0.5. Whereas the PD ≥ 4mm (%) also showed a signifi cant reduction from 27.9 ± 28.4 in the pre-intervention to 19.4 ± 27.0 in the post-intervention stage for Group A. Group B also showed reduction but this was more prominent in group A. Bleeding on Probing (%) in group A was also signifi cantly reduced from 29.4 ± 21.4 in pre-intervention stage to 23.1 ± 23.2 in the post-intervention stage.Conclusion: The present study concludes that strict glycemic control (group A) has a role in clinically correcting/improving periodontitis in non-insulin dependent diabetic patients. It can be further concluded that periodontal treatment has a role in the improvement of glycemic control in type 2 diabetic patients at 3 months.

Prevalence and antibiotic sensitivity of uropathogens isolated from type-ii diabetic patients having urinary tract infection (UTI): A retrospective study from a rural tertiary care hospital

Background: Patients with Diabetes Mellitus are more prone to Urinary tract infection (UTI) than non-diabetic patients. Diabetes Mellitus has certain negative effects on the genital system and increases the incidence of urinary tract infection in diabetic patients. Design: Record based retrospective study. Methods: Records of patients with type-II diabetes having symptoms of UTI were reviewed from August 2021 to January 2022. Result: Out of 210 diabetic patients, the UTI rate was higher in females 59% than male 41%. The most common agents for causing UTI were E.coli followed by Pseudomonas aeruginosa, Klebsiella spp., Candida albicans and Candida non-albicans, Enterococcus, S.aureus and other organisms. About 70.68% Gram-negative isolates were resistant against ampicillin, 75.17% resistant against gentamycin, and 48.16% resistant against amoxicillin-clavulanic acid. Gram-positive isolates were 83.33% resistant against penicillin and 83.33% resistant against ciprofloxacin. However, both gram-negative and gram-positive were susceptible to nitrofurantoin. The overall multidrug resistance was observed in 201 out of 210 (95.71%) bacterial and candiduria isolates, while 3.33% of the isolates were resistant to one only antibiotic. Conclusion: Most common etiological agent is E.coli with high drug resistance to ampicillin and susceptible to nitrofurantoin. Therefore, performing urine culture and regular monitoring of UTI is essential.

Assessment of Eye Care Behavior among Non-Insulin Dependent Diabetic Patients

Assessment of Eye Care Behavior among Non-Insulin Dependent Diabetic Patients