Uncontrolled Diabetes Mellitus Patients Research Articles

Effects of Dexmedetomidine on Perioperative Glycemic Control in Adult Diabetic Patients Undergoing Cardiac Surgery.

To study the effects of dexmedetomidine (DEX) on perioperative blood glucose levels in adult diabetes mellitus (DM) patients undergoing cardiac surgery. A prospective, observational study was conducted on 100 adult diabetic patients aged between 18 and 75 years undergoing cardiac surgery with cardiopulmonary bypass (CPB). The patients were divided into two groups (group D and group C) of 50 each. Group D patients received DEX infusion, whereas the group C patients received 0.9% normal saline infusion. The blood glucose levels, heart rate, mean arterial pressure, and serum potassium levels at different time points were comparable between the two groups (P > 0.05). The mean dose of insulin required in the combined population as well as in both controlled and uncontrolled DM patients was significantly less in group D than in group C (combined population - 36.03 ± 22.71 vs 47.82 ± 30.19 IU, P = 0.0297; uncontrolled DM - 37.36 ± 23.9 IU vs 48.16 ± 25.15 IU, P = 0.0301; controlled DM - 34.7 ± 21.5 IU vs 47.63 ± 35.25 IU, P = 0.0291). Duration of mechanical ventilation and VIS were comparable between the two groups. The incidence of arrhythmias (20% vs 46%, P = 0.0059) and delirium (6% vs 20%, P = 0.0384) was significantly less in group D than in group C. None of the patients in either group had stroke, myocardial ischemia, and mortality. The results suggested that DEX infusion during the intraoperative period was very effective for perioperative glycemic control and reduction of insulin requirement in DM patients undergoing cardiac surgery.

The Effect of Glycemic Status on P Wave Dispersion.

Background and aim The growing number of people with diabetes mellitus (DM) across the world is a public health concern. The diabetes epidemic involves enormous health costs to the patients, their careers, and society at large. Cardiovascular diseases such as atrial fibrillation (AF) often develop in the diabetic population. An increase in the P wave dispersion (PWD) has been established as an independent risk factor for the occurrence of AF, hence the present study was conducted to establish a possible relationship between PWD and the glycemic status of the individualto predict the occurrence of AF ahead of clinical symptomology. Methodology A comparative cross-sectional study was conducted at a tertiary care hospital after obtaining approval from the institutional ethics committee and written consent of each study subject. The main steps included the selection and categorization of the study population based on their glycemic status, collection of demographic data, performing ECGs calculating PWD using digital calipers, and recording the data systematically for evaluation. Results In this study, 234 patients with a mean age of 53.3 ± 13.1 years were studied, of which 121 (51.7%) were maleand 113 (48.29%) were female. The 234 patients were divided into four groups based on their glycemic status - 74 uncontrolled DM patients (31.62%), 51 type 2 DM (T2DM) patients (21.78%), 56 prediabetespatients (23.93%), and 53 patients in thecontrol group (22.64%; not a known case of diabetes with normal HbA1c and fasting blood sugar (FBS) levels).Minimal correlation was observed between FBS with PWD (r value0.175)and age with PWD (r value0.161), butstatisticalsignificance was observed only between age and PWD (p-value 0.014).The difference in means between the four different study groupswas found to be not statistically significant (p-value- 0.104); hence, no intergroup variation was noted. Conclusion Advancing age and higher fasting blood sugars have shown minimal correlation with widening P-wave dispersion. With further studies involving larger populations, this can be a promising aid in identifying PWD as a probable early predictor of atrial arrhythmias among diabetic patients.

Serum magnesium level and its correlation with sensory nerve conduction in type 2 diabetes mellitus patients

Background: Type 2 diabetes mellitus is a major public health problem. Chronic hyperglycemia in uncontrolled diabetes mellitus patients leads to microvascular and macrovascular complications. Diabetic peripheral neuropathy (DPN) has become the most common chronic diabetic complication, affecting about half of diabetic patients. DPN causes debilitating complications like foot ulcers and gangrene, leading to lower limb amputation and reducing the quality of life in diabetic patients. Serum magnesium has a close relationship with T2DM. It has been shown that lower serum magnesium levels are significantly associated with an increased risk of type 2 diabetes mellitus and with various complications of diabetes, including peripheral neuropathy, cardiovascular disease, nephropathy, retinopathy, and foot ulcers. Aim and Objective: The objective of the study is to compare serum magnesium levels and sensory nerve conduction in type 2 diabetes mellitus patients. Materials and Methods: This is a cross-sectional study that includes 75 participants in the age group of 35–45 years. The participants were divided into 2 groups. Group I: newly diagnosed type 2 DM patients, which included 25 female and 20 male patients. Group II: Type 2 DM patients who were taking treatment for more than 5 years, which included 15 female and 15 male patients. Under aseptic precautions, a blood sample was obtained, and the estimation of serum magnesium was determined by photocolorimetry. Sensory nerve conduction (median and sural nerve) was done using recorders and medicare systems EMG EP MARK II. Statistical analysis was done using IBM SPSS version 20.0 software. Pearson correlation analysis was used to check the correlation between sensory nerve conduction and serum magnesium. P < 0.05 was taken as statistically significant. Results: In this study, the range of serum magnesium in group I was 1.5–2.9 mg/dl with a mean of 2.21 ± 0.3. The range of serum magnesium in group II was 1.4–2.5 mg/dl with a mean of 1.94 ± 0.3. The Pearson correlation between the parameters of sensory nerve conduction (median and sural nerve) and serum magnesium in terms of latency, amplitude, and conduction velocity in group I was -0.533, 0.471, 0.094, and -0.28, 0.029, 0.082, respectively; similarly, for group II, it was −0.27, 0.163, 0.607, and −0.071, 0.177, 0.028. The latency of all nerves was negatively correlated with serum magnesium. The amplitude and conduction velocities of all nerves were positively correlated with serum magnesium. Hence, serum magnesium seems to be a very good indicator of the effect of diabetes mellitus on peripheral nerves. Conclusion: In our study, we found out that serum magnesium seems to be a very good indicator of the effect of diabetes mellitus on peripheral nerves.

Analysis of Serum Chemerin Levels in Type 2 Diabetes Mellitus Patients

Chemerin is an adipokine involved in inflammation, adipogenesis, angiogenesis, and energy metabolism. Diabetes Mellitus (DM) is a group of metabolic diseases with hyperglycemia characteristics that occur due to abnormalities in insulin secretion, insulin action, or both. This study aimed to determine serum chemerin levels in patients with Type 2 Diabetes Mellitus (T2DM) between controlled and uncontrolled groups. This study was an analytical observational study with a cross-sectional approach. The study samples were all patients diagnosed with T2DM who had HbA1c test results and met the inclusion and exclusion criteria. Serum chemerin was measured using the ELISA method. The Kolmogorov-Smirnov, Chi-Square, Pearson, and independent T-test statistically analyzed the data. The subjects were 60 controlled and uncontrolled DM patients, 29 males and 31 females. There was a difference in serum chemerin levels in the controlled and uncontrolled DM group (5.73±2.3 ng/mL with 6.87±1.7 ng/mL, p=0.40). There was a positive correlation between chemerin levels and HbA1c (r=0.266; p=0.040). Serum chemerin levels of patients with uncontrolled DM were higher than in patients with controlled DM. Serum chemerin will increase along with the increase of HbA1c level.

A rare presentation of bilateral emphysematous pyelonephritis with concurrent lung abscess: A case report

Bilateral emphysematous pyelonephritis (EPN) is a rare complication in uncontrolled diabetes mellitus patients and linked to a high patient mortality rate [1]. We present a case of a 62-year-old female patient with bilateral EPN who also developed a concurrent lung abscess. She came with high-grade fever, lethargy, and left flank pain. She had left lumbar tenderness and right-sided chest crepitations. Upon hospitalization, the patient developed septic shock. However, severity of her clinical presentation does not correlate with chest X-ray of right sided pneumonic changes and cavitation of the lungs on admission. Abdominopelvic computed tomography (CT) imaging revealed extensive left EPN (Huang-Tseng CT classification: class 4), early right EPN (Huang-Tseng CT classification: class 2), and right middle lobe lung abscess, which was treated with intravenous antibiotics, drainage, and optimal glycaemic management. This was followed by the resolution of sepsis and improvement in clinical status.

Extensive Sequestration Chronic Maxillary Osteomyelitis in an Uncontrolled Diabetic Patient: Comprehensive Case Management of a Rare Entity.

The hallmark of osteomyelitis was progressive bone destruction and sequestrum formation. In the underlying disease, like diabetes mellitus, osteomyelitis becomes severe and exacerbates the condition. It was essential for the oral and maxillofacial surgeon to comprehend its complex medical and surgical management to achieve complete disease eradication. The aim of this article was to report a rare case and comprehensive management of extensive sequestrating maxillary osteomyelitis with uncontrolled diabetes mellitus patients. A 58-year-old male patient with pain and swelling accompanied by discharge of pus in the sinistra maxilla region. The systemic disease was identified as uncontrolled diabetes mellitus, and had a history of unhealing wounds 1 year ago after upper left molar extraction. Computed tomography scan result showed extensive sequester formation and bony destruction in the right extending to the left maxilla. Microbial culture results were Klebsiella pneumoniae and Morganella morganii. Subsequently, extensive sequestrectomy and multiple extractions of the involved jaw and teeth were performed after diabetes mellitus was regulated. A suspension suture against oral and nasal mucosa was performed to avoid dead space formation. Comprehensive perioperative management in maxillary osteomyelitis in uncontrolled diabetes mellitus includes sequestrectomy, definitive antibiotic therapy based on culture results, and diabetes regulation to improve the successful management of this case.

Diabetes mellitus, malnutrition, and sarcopenia: The bond is not explained by bioelectrical impedance analysis in older adults.

As people age, their risk of diabetes mellitus (DM) and sarcopenia increases due to the decline in muscle mass and strength. Bioelectrical impedance analysis (BIA) is a method used to detect changes in body composition. The primary aim of the study was to determine the distribution of BIA variables among a group of non-DM people and two groups of patients with controlled and uncontrolled DM. The secondary aim was to establish the independent association between BIA-derived data, lipidic assets, and the prevalence of metabolic syndromes with DM. This study included a total of 235 participants who were categorized into three groups based on the presence of diabetes mellitus (DM) and their glycated hemoglobin (HbA1c) levels: non-DM, controlled DM (HbA1c≤7.0%), and uncontrolled DM (HbA1c>7.0%). Waist circumference (p=0.005), bone (p<0.001), muscular (p<0.001), and appendicular skeletal mass (p<0.001) were lower in the non-DM group, while sarcopenic risk (p<0.001), total cholesterol (p<0.001), and LDL (p<0.001), were higher. Grip strength (p<0.001), visceral fat (p=0.01), and phase angle (p=0.04) were significantly lower in non-DM than uncontrolled DM patients, as well as the number of drugs taken (p=0.014). A multivariate analysis highlighted that LDL (coefficient -0.006, p=0.01) was negatively associated, while bone mass (coefficient 0.498, p=0.0042) was positively associated with DM uncontrol. Our study shows that BIA may not be the ideal tool for distinguishing between elderly individuals with and without DM, as it can be affected by numerous covariates, including potential differences in glucometabolic and cardiovascular control.

Effects of diabetes mellitus regulation on antibody response to inactivated virus vaccine: a systematic review

Background: Diabetes mellitus (DM) could hamper the immune responses, including that induced by the vaccine. The aim of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19-19) inactivated vaccines in patients with DM either controlled or uncontrolled through a systematic review approach. Methods: Without regard to time constraints, searches were conducted in ProQuest, Embase, and PubMed to assess the available data on the impact of DM regulation on the immunogenicity of post-vaccinated DM patients. The PRISMA guideline and the PICO criteria were used. The quality of studies was assessed using the National Institutes of Health (NIH) quality assessment tool. There is not enough Available data comparing the immunogenicity of the vaccine in controlled and uncontrolled DM patients is limited. Results: Out of 20,657 articles, five studies were included, of which three had good quality and two had fair quality. Our data suggested that DM patients vaccinated with CoronaVac/SinoVac had lower seroconversion rates significantly lower compared to non-DM patients. The immunogenicity of BBV-152 vaccine in DM patients was also significantly lower than in patients without DM. Studies comparing the immunogenicity of the vaccine between controlled and uncontrolled DM patients are limited. Conclusion: Patients with DM have lower antibody levels than non-DM patients who received inactivated COVID-19 patients. Glycemic management has emerged as critical to maximizing the immunogenicity induced by inactivated vaccines in a small number of patients; however, to support this conclusion, studies with adequate number of patients are critical.

Chronic hyperglycemia drives alterations in macrophage effector function in pulmonary tuberculosis.

Diabetes mellitus (DM) alters immune responses and given the rising prevalence of DM in tuberculosis (TB) endemic countries; hyperglycemia can be a potential risk factor for active TB development. However, the impact of hyperglycemia on TB-specific innate immune response in terms of macrophage functions remains poorly addressed. We assessed macrophage effector functions in uncontrolled DM patients with or without TB infection (PTB+DM and DM), non-diabetic TB patients (PTB), and non-diabetic-uninfected controls. Phagocytic capacity against BCG and surface expression of different pattern recognition receptors (PRRs) (CD11b, CD14, CD206, MARCO, and TLR-2) were measured via flow cytometry. Effector molecules (ROS and NO) required for bacterial killing were assessed via DCFDA and Griess reaction respectively. A systematic dysregulation in phagocytic capacity with concurrent alterations in the expression pattern of key PRRs (CD11b, MARCO, and CD206) was observed in PTB+DM. These altered PRR expressions were associated with decreased phagocytic capacity of macrophages. Similarly, ROS was aberrantly higher while NO was lower in PTB+DM. These altered macrophage functions were positively correlated with increasing disease severity. Our results highlight several key patterns of immune dysregulation against TB infection under hyperglycemic conditions and highlight a negative impact of hyperglycemia with etiology and progression of TB.

Hypertension and diabetes including their earlier stage are associated with increased risk of sudden cardiac arrest

Sudden cardiac arrest (SCA) is a medical disaster for both the victim and the society. Despite intrinsic limitations in the management of SCA, primary prevention has been overlooked and risk factors for SCA are not fully understood. We aimed to evaluate whether hypertension and diabetes mellitus (DM), including pre-hypertension and impaired fasting glucose (IFG), are associated with increased risk of SCA. We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 were enrolled. The risk of SCA was evaluated in people with hypertension and DM with a clinical follow-up through December 2018. A total of 4,056,423 people with 33,345,378 person-years of follow-up and 16,352 SCA events were examined. People with hypertension had 65.4% increased risk of SCA (adjusted hazard ratio [HR] = 1.654 [1.572–1.739]; p < 0.001). Pre-hypertension was also associated with 21.3% increased risk of SCA (adjusted HR = 1.213 [1.158–1.272]; p < 0.001). People who had IFG and DM showed 7.5% (adjusted HR = 1.075 [1.035–1.117]; p < 0.001) and 80.1% (adjusted HR = 1.801 [1.731–1.875]; p < 0.001) increased risk of SCA, respectively. People with DM who took anti-diabetic medication showed significantly lower risk of SCA compared with uncontrolled DM patients (fasting glucose ≥ 200 mg/dL) (adjusted HR = 0.625 [0.533–0.733]; p < 0.001). Coexistence of hypertension and DM was associated with an even higher risk of SCA (adjusted HR = 3.078 [2.877–3.293]; p < 0.001). In conclusion, the risk of SCA is significantly higher in people with hypertension and DM, including pre-hypertension and IFG. Adequate control of blood pressure and serum glucose can have a profound impact for the primary prevention of SCA in the general population.

Analysis of Nursing Management Unstable Blood Glucose Levels in Type 2 Diabetes Mellitus Patients

Background: Diabetes Mellitus (DM) is a clinical syndrome of impaired metabolic secretion, insulin action, or both characterized by hyperglycemia. Various nursing problems can occur due to hyperglycemic conditions that are not handled properly. The instability of blood glucose levels is a major problem that occurs in uncontrolled DM patients. This condition can lead to various complications and complications so comprehensive treatment management is needed.&#x0D; Objectives: This study aims to explore and analyze the nursing management of unstable blood glucose levels in type 2 DM patients who were hospitalized.&#x0D; Methods: This study is a qualitative study using an exploratory case study method in diabetes mellitus patients type 2 who were hospitalized. The data obtained were processed and analyzed based on theories that explain the occurrence of the problem of instability in blood glucose levels and the nursing management carried out in patients with type 2 diabetes mellitus.&#x0D; Results: The results of this study indicate that the main problem in patients with type 2 diabetes mellitus is the instability of blood glucose levels which is characterized by hyperglycemia. Nursing management carried out is monitoring blood glucose level laboratory results, management of hyperglycemia, medication management, nutrition/diet management, treatment, and care education programs can reduce blood glucose levels.&#x0D; Conclusion: The problem of blood glucose instability is a priority problem in type 2 diabetes mellitus and comprehensive nursing management will determine the success of controlling blood glucose levels so that they are normal and stable.

Accuracy of a Point-of Care Hemoglobin A1c Assay - A Community Outreach Project

Glycated hemoglobin (HbA1c) is an invaluable tool in diabetes mellitus (DM) management. Conventionally obtained via venous blood sampling, point-of-care (POCT) capillary HbA1c measurement offers an opportunity for immediate treatment modification, reduced cost & increased patient satisfaction. While previous studies using the POCT HbA1c test A1cNow+ have shown accuracy within a 0.5% range from the gold standard venous HbA1c, we noted discrepancy in our community health clinic & sought to evaluate the accuracy of POCT HbA1c levels compared to venous HbA1c levels to guide our clinical decision-making.In this 2-part study, we compared POCT HbA1c levels measured via a single use A1CNow+ HbA1c monitoring device & venous HbA1c samples measured by a standardized lab. Part1: after retrospective chart review, we identified 262 patients with prediabetes, Type1 or Type2 DM based on ADA guidelines who attended our clinic from January 2019-June 2019 & received POCT HbA1c with A1cNow+ testing during their visit. Of those cases, 47 patients also had a venous HbA1c at a standardized laboratory within 1 month of having their POCT HbA1c performed in our clinic. Part2: We noted variability in the temperature storage of A1CNow+ test strips. Storage was standardized to room temperature as per device instructions in June 2019. We subsequently reviewed charts from June 2019-December 2019 & identified 118 patients who had both POCT HbA1c & venous HbA1c measurement within a 1 month period.Patients was categorized into subgroups per ACP guidelines for DM control: prediabetic (HbA1c 5.7–6.4%), controlled DM (HbA1c 6.5 to 8.0%) & uncontrolled DM (HbA1c >8.0%). The average difference between POCT & venous HbA1c tests was calculated & analyzed for statistical significance using paired t test analysis. Part1: For patients in prediabetic, controlled & uncontrolled DM subgroups, the mean difference between A1cNow+ & standardized venous HbA1c testing was 0.68% (p= 0.004), 1.15% (p= <0.0001) and 1.36% (p= 0.0003) respectively. Part2: After standardization of test strip storage, the mean difference between A1cNow+ & venous HbA1c testing for prediabetic, controlled & uncontrolled DM patients was 0.33% (p= 0.002), 0.41% (p= 0.011) and 1.26% (p= <0.0001) respectively.POCT HbA1c provides a unique opportunity to immediately address glycemic control. Its advantages are especially apparent in a patient population with limited resources & poor follow up, as in our clinic. Although standardizing test storage improved overall concordance between A1cNow+ HbA1c testing & venous HbA1c, there was still a statistically significant larger mean difference in uncontrolled DM patients. In prediabetic & controlled DM patients, however, POCT HbA1c was accurate within previously published reports of a 0.5% range when compared to venous HbA1c. An algorithm has since been developed to guide our clinical decision making with these findings.

Compliance of checking HbA1c in a tertiary care hospital of Pakistan.

Background and Objectives:The prevalence of diabetes mellitus worldwide was 171 million one and half decade ago, while the prediction is 366 million patients by 2030 and more than 640 million people by 2040. HbA1c value represents average blood glucose over the past 2-3 months and accounts for both pre-prandial and post-prandial blood glucose levels. A link between HbA1c and diabetic complications has been confirmed. In general, patients with controlled diabetes mellitus should have at least biannual testing, while patients with uncontrolled diabetes mellitus or unmet glycemic targets should be tested every three months. The objective was to see compliance of checking HbA1c in tertiary care hospital of a developing world.Methods:This was a retrospective observational study done from 1st February 2019 to 31st March 2019 in the Department of Medicine and Surgery, The Aga Khan University Hospital, Karachi. All patients of age 18 years and above, admitted with a diagnosis of diabetes mellitus (DM)from 1st February 2019 to 31st March 2019 were included. If HbA1c was less than 7% the patients were labelled as having controlled DM, otherwise, uncontrolled DM. If HbA1c of patients with controlled DM was not checked in last six months and if HbA1c of patients with uncontrolled DM was not checked in last three months then it was labelled as non-compliance of checking HbA1c.Results:Out of 1732 diabetic patients only 94 patients fulfilled inclusion criteria. Out of these 94 patients 43 (45.7%) were male. Mean HbA1c was 7.90% (1.4) and 69 (73.4%) patients had uncontrolled diabetes mellitus. Overall, the compliance of checking HbA1c was 58.5%. In uncontrolled diabetes mellitus patients, the compliance of checking HbA1c was 45% and in controlled diabetes mellitus patients the compliance was 96%.Conclusion:The compliance of checking HbA1c is inadequate in diabetic inpatients. The considerable prevalence of diabetes and the benefits of timely interventions in diagnosed patients to prevent complications suggest the need for a comprehensive awareness among the doctors for checking HbA1c.

A complex Fistula-In-Ano presenting as an extension in Rt. iliac fossa: A Case study

Background - Systemic diseases like diabetes, hypertension etc are at higher risk of perianal diseases. A complex anal fistula, which is associated with diabetes are high complication rates and healing impairments. Treatment of fistula in ano depends on the location of the fistula, amount of anal sphincter involved in the fistula, and the underlying disease process. Prevention of recurrence and controlling the purulent discharge by surgical method are the definitive treatment of fistula in ano. Here, we present a complex case of Fistula in ano in uncontrolled diabetes mellitus patients which as an extension towards right iliac region and right inguinal region which was treated by surgical intervention.&#x0D; Case presentation – a thirty-year-old diabetic male patient come to us for recurrent fistula in ano with swelling at right iliac and inguinal region. We do surgical intervention and discharged on 9th post operative day. A follow up examination of post operative wound was taken after 2 days interval respectively. After 3 months, fistula track was completely healed.&#x0D; Conclusion: fistula in ano is a complex disease in diabetic patients and imposes challenges to the surgeon. Early diagnosis and appropriate management is the key to success. Proper assessment and mapping of the tract is very important before going in for a definitive surgery.

Study of Glycation of Transferrin and its Effect on Biomarkers of Iron Status in Uncontrolled Diabetes Mellitus Patients

Introduction: Diabetes Mellitus (DM) is a metabolic condition linked by the inability to produce enough insulin and/or to respond to insulin. This can lead to a number of acute and chronic health problems. In erythrocytes, transferrin is the main source of iron. Alterations in transferrin glycation affect transferrin saturation because the affinity of transferrin for Fe3+ is extremely high but it decreases progressively with increasing glycation. Aim: To investigate the influence of uncontrolled diabetes on transferrin glycation and iron metabolism. Materials and Methods: A total of 136 samples from 3 groups of HbA1c levels (&lt;6.0% non-diabetic, 6.4-8% diabetic, &gt;8.0%-uncontrolled DM) were studied for the correlation pattern of iron with other variables. Chi square test and student’s t-test were performed to reveal the association between serum free iron levels and other variables with DM. Results: Serum iron has shown to be depleted significantly (p=0.02) along with percentage saturation (p=0.0006) with increase in diabetic severity. No significant differences were observed in serum ferritin in controlled DM and uncontrolled samples. Total Iron Binding Capacity (TIBC) was found to be significantly increased in uncontrolled DM samples (p=0.01). Abnormal transferrin was observed uncontrolled diabetes with subsequent depletion in transferrin, which in turn results in low serum iron, lower percentage saturation and high TIBC. Conclusion: Uncontrolled diabetes affects the glycation of transferrin also thus perturbating iron metabolism. The present study emphasises the need to monitor transferrin glycation status and iron deficiency anaemia in subjects with uncontrolled diabetes.

Incidence of Acute Myocardial Infarction in Patients with Diabetes and Its Association with Mortality and Cardiopulmonary Complications in Puerto Rico

Diabetes mellitus (DM) patients are at an increased risk of acute myocardial infarction (AMI). Adequate DM control may reduce in-hospital mortality and cardio-pulmonary complications after an AMI. The objective of this study was to determine whether uncontrolled DM in patients with an incidental AMI was associated with an increased risk of in-hospital mortality and selected cardio-pulmonary complications. A secondary data analysis of the Puerto Rican Cardiovascular Surveillance System during 2007, 2009, and 2011 was conducted. The study included men and women living in Puerto Rico who were hospitalized due to an incidental AMI and had information on HbA1c measurement (n=220). Patients were divided according to their HbA1c levels into two groups (i) 7% (uncontrolled). Mortality and complications were defined according to ICD-9 codes. Univariate and multivariate logistic regression models were used to test for associations between HbA1c and mortality and cardio-pulmonary outcomes. The model was adjusted for gender, obesity (BMI >30kg/m2), hyperlipidemia, hypertension, chronic obstructive pulmonary disease, smoking, insurance and age. The results revealed no statistically significant association between the controlled and the uncontrolled DM patients and mortality, respectively cardiopulmonary complications (unadjusted OR 2.1; 95% CI: 0.7-6.4; adjusted OR 2.4; 95% CI: 0.5-10.5). The uncontrolled DM group was statistically significantly younger than those with controlled DM (mean age 65.2 vs. 71.1 years; p-value 0.002). There was no statistically significant difference in the prevalence of uncontrolled DM between patients with complications (80%) and those without complication (66%; p=value 0.203). AMI patients with uncontrolled DM did not have an increased risk of mortality and cardiopulmonary complications compared to patients with controlled DM. This needs further evaluation in a larger study population and DM patients with an AMI should have HbA1c measured to estimate their risk of complications.

P2.15-22 Optimal Glycemic Control Improves Prognosis for Lung Cancer Patients with Diabetes Mellitus

Diabetes mellitus (DM) is a common comorbidity in patients with lung cancer (LC). This study aimed to evaluate the prognostic value of DM comorbidity for LC patients with DM and to assess whether an optimal glycemic control improves survival. A total of 4390 patients diagnosed with LC between 2012 and 2013 at Shanghai Chest Hospital were retrospectively reviewed, 491 patients with DM and 3899 without DM. The relationship between hemoglobin A1c (HbA1c) level and the overal survival (OS) was plotted by a smooth curve. LC patients with DM were subdivided into the well-controlled group (HbA1c < 7%, n=438) and uncontrolled group (HbA1c ≥ 7%, n=53). OS differences among patients without DM, with well-controlled DM, and uncontrolled DM were evaluated by multivariate Cox regression analysis with adjustment for stage, sex, age, histology, smoking history and EGFR mutation status. The survival benefit of well-controlled DM was compared across subgroups. The median follow-up of the entire cohort was 35.8 months. DM patients (11.2%) had a significantly worse OS than nondiabetic patients [median (95% CI): 47.5 (39.0-56.1) vs. 73.6 (54.8-92.4) months, P<0.001]. The risk of mortality increased along with the elevation of HbA1c level. Uncontrolled DM patients tended to be male, elder, non-adenocarcinoma, with smoking history, wide-type EGFR mutations and advanced stage. Well-controlled DM patients had a worse OS [HR (95% CI): 2.3 (1.9-2.7), P<0.001] compared to nondiabetic patients without adjustment but a similar OS with adjustment for stage, sex, age, histology, smoking history and EGFR mutation status [HR (95% CI): 0.9 (0.8-1.1), P=0.185]. Benefit of well-controlled DM was more obviously seen in patients with advanced stage (III-IV) [HR (95% CI): 0.8 (0.6-1.1), P=0.130] or EGFR mutations [HR (95% CI): 1.2 (0.9-1.5), P=0.262]. Elevated glycemic status negatively affected OS for patients with LC. LC patients with DM is recommended to have a glycemic control (HbA1c < 7%) especially for those with advanced stage and EGFR mutations.

Diabetes prevalence and its impact on health-related quality of life in tuberculosis patients.

To determine the prevalence of diabetes mellitus (DM), assess its influence on health-related quality of life (HRQoL) among patients with TB. In this prospective study, eligible patients at three primary healthcare centres in urban slum region of south Delhi, India, underwent blood glucose screening at treatment initiation. HRQoL scores were determined by conducting face-to-face interviews using Dhingra and Rajpal (DR-12) scale at pre-treatment, end of intensive phase and end of the treatment. In 316 patients, the overall DM prevalence was 15.8%, of whom 9.5% were known to have diabetes, and 6.3% were diagnosed at TB treatment initiation. DM was more common among patients of older age (P < 0.001), with higher BMI (P < 0.001), with PTB (P = 0.02) and with poor psychological status. HRQoL was significantly poor in the socio-psychological & exercise adaptation domain in patients with DM ˃50 years of age at each visit. Older age, poor literacy, loss in workdays, alcohol use and socio-economic status significantly predict poor HRQoL scores in patients with DM. Uncontrolled DM patients demonstrated poor HRQoL at the end of the intensive phase (P = 0.04) of treatment and at its completion (P = 0.03) compared to those with controlled DM. Addressing screening measures and glycaemic control along with social determinants such as literacy level and alcohol consumption could be an important means of improving the HRQoL of TB with DM patients.

Four cases of type 1 diabetes mellitus showing sharp serum transaminase increases and hepatomegaly due to glycogenic hepatopathy.

Poorly controlled diabetes mellitus (DM) patients sometimes show serum transaminase elevations due to steatohepatitis. However, we experienced four cases with type 1 DM with sharp elevations in serum transaminases that could not be explained by steatohepatitis alone and showed bright liver. They were diagnosed with glycogenic hepatopathy (GH) clinicopathologically. The four patients had a median age of 22.5years (range, 19-29years) and 12.5 (4-15)-year histories of type 1 DM and showed marked increases in serum transaminases (aspartate aminotransferase, 698U/L [469-2763U/L]; alanine transaminase, 255U/L [216-956 U/L]). Diabetes mellitus control was poor and hemoglobin A1c was 12.7% (11-16.5%). Three cases had a past history of diabetic ketoacidosis. Hepatomegaly and hyperdense liver were seen on computed tomography scans. Magnetic resonance imaging showed low intensity in T2-weighted images. The pathological findings revealed pale and swollen hepatocytes and glycogenated nuclei. The architecture of the liver was preserved, and steatosis and fibrosis were mild. The cytoplasm of hepatocytes stained densely positive with periodic acid-Schiff, and the positive staining disappeared after diastase digestion, suggesting glycogen deposition. No other cause of hepatitis was evident, and the diagnosis was GH. Elevated transaminases improved within 1month with good glycemic control. Transaminase elevations were observed several times in three cases with poor glycemic control. Glycogenic hepatopathy is rare, but extremely high serum elevations of transaminases are important to identify clinically. Despite showing a good clinical course in general, GH sometimes recurs and requires strict glycemic control. Clinicians should be aware of and recognize GH when dealing with uncontrolled DM patients.

MPV in Uncontrolled &amp; Controlled Diabetics- Its Role as an Indicator of Vascular Complication

Platelets are tiny, disc-shaped, non-nucleated structures derived from megakaryocytes. The morphological differences in measuring Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) of platelets have important implications for assessing the functional expressions of platelets. Electron microscopy reveals the presence of glycogen as prominent masses in platelets. MPV values have been generally reported to be very high in individuals with uncontrolled diabetes mellitus (DM). This study aimed to determine and compare the MPV values in uncontrolled and controlled group of Type-2 Diabetics along with healthy non-diabetic people and to correlate MPV values with age, sex and glycosylated haemoglobin (HbA1c) levels in diabetic groups. This study also aimed to determine the prevalence of retinopathy in uncontrolled and controlled group of diabetic patients. This case control study was carried out in our institution for 1 year. The patients were grouped as uncontrolled group of diabetic patients and controlled group of diabetic patients based on their HbA1c levels. 106 uncontrolled diabetic patients and 100 controlled diabetic patients were included, with 100 non-diabetic subjects as controls. Patient's profile which included all demographic particulars and medical history was obtained. Fundus examination and other ophthalmic findings of 50 uncontrolled and 50 controlled diabetic cases were recorded. The findings were analysed statistically using IBM SPSS software. In uncontrolled group of 106 diabetic patients, 54 patients were males and 52 patients were females and the mean age was 51.63±11.04, mean HbA1c was 9.86±1.91% and mean MPV was 8.93±0.90fl. In controlled group of 100 diabetic patients, 49 patients were males and 51 patients were females and the mean age was 47.88±15.17, mean HbA1c was 6.08±0.49% and mean MPV was 8.106 ± 0.72fl. In 100 non-diabetic controls 77 patients were males and 23 patients were females and the mean age was 37.97±9.69 and mean MPV was 8.02±0.86fl. Among 50 cases of uncontrolled DM, 14 uncontrolled DM patients had diabetic retinopathy with an average MPV of about 9.2±0.61fl and mean HbA1c of 10.6±1.98% whereas, 30 uncontrolled patients with no evidence of retinopathy with an average MPV of about 8.39±0.676 fl and mean HbA1C of 9.18±1.91%. MPV values are higher in uncontrolled DM patients when compared with controlled DM patients and a higher percentage of them develop microvascular complications like Diabetic Retinopathy suggesting that mean platelet volume could indicate and play a more important role in the detection of vascular complications of Diabetes.