Uncontrolled Diabetes Mellitus Research Articles

Dermatological manifestations in diabetes mellitus and its relation with HbA1c levels – An observational study

Diabetes Mellitus is a chronic, metabolic disease characterised by elevated levels of blood glucose, which over time leads to serious damage. The most common is type 2 diabetes which occurs when body becomes resistant to insulin or doesn’t make enough insulin. Skin manifestations are seen generally in pre-diabetes, undiagnosed, long-term and uncontrolled diabetes mellitus. Skin symptoms may help in diagnosing a denovo case and may give an insight into the patient's diabetic status. This is a cross-sectional, observational study conducted in patients attending the outpatient departments of Dermatology, General Medicine and those admitted under these departments over a period of four months. Clearance from Institutional Ethics Committee was taken before the start of the study. A sample population of 100 was selected randomly based on inclusion and exclusion criteria. Glycaemic profiles including HbA1c were done. Infections (35%) were the most common cutaneous symptoms, followed by papulosquamous illnesses (19%), autoimmune diseases (7%), obesity-related (6%), diabetic vasculopathy-related (5%) and miscellaneous conditions (28%), which included generalised pruritus and xerosis etc. The majority of infections were superficial fungal infections, followed by bacterial and viral infections. Dermatophytosis accounted for a majority of superficial fungal infections. Significant correlation was found between higher HbA1c levels and infections, papulo-squamous diseases, auto-immune diseases, obesity-related manifestations.Higher HbA1c levels were found to be significantly associated with a variety of cutaneous symptoms such as infections, papulosquamous illnesses, autoimmune disorders, and obesity-related manifestations.

Uncontrolled Diabetes Mellitus Type II Prevalence among Young, Middle, and Old-Aged Adults in Perambalur District Population of Tamil Nadu, India.

This study is aimed to approximate the prevalence of uncontrolled diabetes mellitus among Perambalur District population of South TamilNadu. Diabetes mellitus (DM) is a chronic metabolic disorder due to insulin deficiency or resistance which can affect multiple organs of the body such as heart, kidneys and eyes. Uncontrolled diabetes mellitus (DM), refers to having high blood sugar levels (hyperglycemia). Uncontrolled diabetes is at a greater risk of diabetic complications and a significant health concern in Perambalur District of Tamil Nadu, Southern India, India. A study conducted in Dhanalakshmi Srinivasan Institute of Medical Sciences & Hospital, Perambalur district of Tamil Nadu, Southern India, India. The study included 454 uncontrolled diabetes mellitus subjects of which 60.35% uncontrolled diabetes mellitus in female population and 39.65% uncontrolled diabetes mellitus in male population. The study included 274 female subjects was further divided into three age groups, age group I (25 to 44 years) of 23.38% uncontrolled diabetes mellitus population, age group II (45 to 60 years) of 47.46% uncontrolled diabetes mellitus population, and age group III (61 to 85 years) of 29.20% uncontrolled diabetes mellitus population. The 180 uncontrolled diabetes mellitus male subjects was further divided into three age groups: age group I (25 to 44 years) of 32.22% uncontrolled diabetes mellitus population, age group II (45 to 60 years) of 42.22% uncontrolled diabetes mellitus population, and age group III (61 to 85years) of 25.56% uncontrolled diabetes population. This uncontrolled diabetes mellitus was confirmed by estimating glycated hemoglobin (HbA1C) in these diabetes mellitus population. Our study confirmed that there may be a significant burden of diabetes mellitus related both micro vascular and macro vascular complications in this Perambalur district region of Tamil Nadu, Southern India, India.

The Potential Risk: Evaluation of HgA1c Levels Prior to Dental Implant Surgery in Patients without a Diagnosis of Diabetes Mellitus.

Diabetes Mellitus (DM) poses a significant global health concern, with approximately one in two affected individuals remaining undiagnosed. The failure to diagnose or inadequately control DM can lead not only to systemic complications but also to decreased dental implant survival rates, increased marginal bone loss, and increased susceptibility to peri-implantitis. This study aims to evaluate glycated hemoglobin (HbA1c) levels in patients who have not been diagnosed with DM but exhibit oral DM symptoms prior to dental implant surgery. This study was designed as a retrospective cohort. It was conducted on patients who previously presented to the Department of Oral and Maxillofacial Surgery for dental implant surgery and had not been diagnosed with DM. The inclusion criteria included the need for dental implants and augmentation, presence of oral DM symptoms, and having blood tests that included HbA1c. Patients with a prior diagnosis of DM were excluded from the study. A retrospective analysis was conducted on data from 253 patients who applied for dental implant surgery. Among them, 72 patients underwent HbA1c levels assessment through blood tests. Patients with previously uncontrolled DM (n:21) and those whose blood tests were performed at different institutions (n:8) were excluded from the study. Consequently, the study encompassed a cohort of 43 patients. Among the participants, 55% were female and 45% were male. The HbA1c values of the patients ranged from 5.1 to 10.9, with an average value of 6.57±1.44. Of the patients, 41.8% were diagnosed with DM, 30.2% were prediabetic (preDM), and 27.9% did not receive any diagnosis. There was no statistically significant relationship between the combinations of xerostomia, delayed wound healing, oral infection, burning sensation in the mouth, periodontitis, and dental caries with HbA1c levels (p>0.05). In this study, patients presenting to the clinic for dental implant surgery were directed based on oral symptom findings, and the rates of diagnosed DM and preDM were determined to be 7.11% and 5.14%, respectively. Considering the negative effects and prevalence of uncontrolled DM, it may be recommended to assess the HbA1c levels in patients with oral symptoms before dental implant surgery.

SIADH secondary to rhino-orbito-cerebral mucormycosis: A case report.

Invasive fungal mucormycosis and its outcome as SIADH and orbital apex syndrome is uncommon. Mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Early diagnosis and prompt treatment with antifungal, endoscopic surgery, and controlling of diabetes can be beneficial. Mucormycosis is an opportunistic invasive fungal infection which is rare and fatal and can even cause intracranial invasion leading to SIADH. The infrequency with which mucormycosis with SIADH is encountered makes it a formidable diagnostic challenge. 70-year-old women uncontrolled diabetes mellitus presented with bilious vomiting and persistent headache with ptosis, proptosis, absence of extraocular movement, pupillary light reflex, and light perception of left eye. Radiographic investigation, KOH mount, and Biopsy showed mucormycosis in sinus with intracranial extension leading to SIADH. Further investigation revealed hyponatremia, decreased plasma osmolality. Then, when diabetes was controlled and hydrocortisone and amphotericin was given along with Endoscopic sinus debridement, SIADH was well controlled. This case illustrates the potential of mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Prompt diagnosis through clinical history, radiological investigation, and laboratory parameters are important and its treatment is crucial for the better prognosis.

Analysis of Risk Factors for the Occurrence of Diabetic Foot Ulcers in Patients with Type II Diabetes Mellitus

Background: Diabetes Mellitus (DM) has become a prevalent disease, imposing a significant burden on public health due to its widespread occurrence and association with numerous disabilities and fatalities. Uncontrolled DM can lead to severe metabolic complications and long-term vascular issues, including microangiopathy and macroangiopathy. Additionally, individuals with DM are highly susceptible to foot infections, which can escalate into gangrene if not properly managed. Purpose: This study aimed to determine the risk factors for diabetic foot ulcers in patients with Type II Diabetes Mellitus at the Hospital Infatil e Maternidade Jardim Amalia Methods: The research employed an analytical survey method with a case-control study design. Purposive sampling was utilized to select a total of 134 participants, comprising 67 individuals in the case group (those with diabetic foot ulcers) and 67 in the control group (those without diabetic foot ulcers). Data collection was conducted using a structured questionnaire, and the results were analyzed using the Odds Ratio (OR) test to identify significant risk factors. Findings: The findings of the study indicated that age is a risk factor for developing diabetic foot ulcers in patients with Type II DM, with an OR of 3.15 (95% CI: 0.43-17.216). The duration of diabetes also emerged as a significant risk factor, with an OR of 3.13 (95% CI: 0.62-14.12). Furthermore, foot care practices were identified as a crucial risk factor, with an OR of 4.13 (95% CI: 0.72-12.45). Conclusion: this study demonstrates that age, the length of time a patient has had diabetes, and their foot care routines are significant risk factors for the development of diabetic foot ulcers in patients with Type II Diabetes Mellitus at Hospital Infatil e Maternidade Jardim Amalia. These findings underscore the importance of early intervention and targeted patient education to mitigate these risks and improve patient outcome

Acute Myocardial Infarction in the Context of Diabetic Ketoacidosis: Pathophysiological Interactions, Clinical Manifestations, and Therapeutic Considerations

Acute myocardial infarction (AMI) and diabetic ketoacidosis (DKA) are two critical conditions that can coexist with significant morbidity and mortality. AMI is a leading cause of cardiovascular death, while DKA is a severe complication of uncontrolled diabetes mellitus, characterized by hyperglycemia, metabolic acidosis, and ketonemia. The convergence of these conditions presents unique challenges in diagnosis and management, as the metabolic disturbances of DKA can exacerbate myocardial ischemia and contribute to poor clinical outcomes. This article aims to explore the pathophysiological interplay between AMI and DKA, focusing on their shared risk factors, metabolic derangements, and the impact of hyperglycemia and ketosis on myocardial oxygen supply and demand. Furthermore, we discuss the clinical presentation, diagnostic strategies, and therapeutic approaches tailored to this dual pathology. Early recognition and prompt intervention are crucial to improving prognosis in patients with coexisting AMI and DKA. Multidisciplinary management involving cardiologists, endocrinologists, and intensivists is essential to mitigate the adverse outcomes of this complex clinical scenario.

Long-term clinical implications of routine follow-up coronary angiography of asymptomatic patients with long-duration diabetes mellitus after percutaneous coronary intervention in drug-eluting stent e

Abstract Background Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD), significantly contributing to mortality in affected patients. There are concerns about the adequacy of clinical follow-up for post-percutaneous coronary intervention (PCI) surveillance, especially in uncontrolled DM, due to potential asymptomatic CAD. This study assesses whether routine follow-up coronary angiography (FUCAG) offers a surveillance advantage over clinical follow-up in uncontrolled DM post-PCI. Methods From 2014 to 2020, a study was conducted on patients with DM who underwent PCI at our university medical. Poorly controlled DM was defined as a mean HbA1c of 9 or higher during the index PCI and follow-up period. Out of a total of 2,864 individuals, after excluding 538 individuals with a follow-up period of less than 4 years and 232 individuals who experienced an event within a year, a total of 2,094 was enrolled. Follow-up coronary angiography (FUCAG) was defined as angiography performed between 6- and 18-months post-index PCI for lesion evaluation. To adjust for any differences in baseline characteristics between the groups, propensity score matching (PSM) was implemented. The primary outcome was defined as Major Adverse Cardiac Events (MACE), comprising all-cause death, myocardial infarction, and target-lesion revascularization. Results PSM was conducted to correct the difference in baseline characteristics between the two groups. In the Kaplan-Meier analysis, there was no difference between FUCAG and clinical follow-up for MACE (Log-rank: P=0.770). Cox proportional regression analysis revealed a hazard ratio (HR) of 0.77 with a 95% confidence interval (CI) of 0.70-1.63, indicating no statistically significant difference. Conclusions Even in poorly controlled DM patients, there was no apparent clinical benefit of FUCAG compared to clinical follow-up. Particularly considering concerns such as renal function deterioration in DM patients, post-PCI surveillance through clinical follow-up may be advantageous.

Efficacy of Autologous Platelet Rich Plasma For Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer (DFU) is a common complication of long standing uncontrolled diabetes mellitus. There are different types of treatment commonly practiced among the clinicians to treat DFU. Among them, autologous platelet rich plasma (PRP) application is getting popularity day by day throughout the western world. Methodology: It was a prospective, randomized, controlled study that was carried out among 40 DFU patients in the Department of Surgery, Dhaka Medical College Hospital. Among them, 20 patients were treated by autologous PRP and another 20 patients were treated by conventional method. They were followed up for 12 weeks period. Data collected from the participants were analyzed to compare the healing rate among two groups. Result: In PRP treated ulcers, healing rate was significantly faster and better in comparison to conventionally treated ulcers. After 10th weeks follow up, in PRP group 14 ulcers were completely healed whereas in control group,4 ulcers were completely healed. On the contrary, 3 ulcers in control group showed further deterioration. At the end of 12th weeks follow up, 19 ulcers in PRP group were completely healed whereas 13 ulcers in control group were completely healed. In PRP group no patient showed any complication during treatment, whereas in control group 7 patients experienced local complications. Conclusion: Treatment of diabetic foot ulcer with autologous platelet rich plasma results in faster and better ulcer healing in comparison to conventional treatment. PRP accelerates the healing rate and keep the ulcer area safe from external pathogens. Hence, autologous PRP is a better selection for DFU treatment. J Dhaka Med Coll. 2023; 32(1) : 38-42

LncRNA LYPLAL1, miR-204-5p, and SIRT1: novel signatures for risk assessment of diabetic macrovascular complications

Long-term, uncontrolled diabetes mellitus can lead to micro- and macrovascular problems. The protective function of lncRNA LYPLAL1 is to reduce endothelium cell inflammation by upregulating sirtuin 1 (SIRT1) and reducing microRNA (miR)-204-5p. This work attempted to examine the lncRNA LYPLAL1/miR-204-5p/SIRT1 molecules as diagnostic biomarkers for diabetic MVC and to assess their clinical correlations. The study enrolled 32 controls, 32 patients with diabetes alone, and 32 patients with diabetic MVC. RT-qPCR, or quantitative real-time PCR, was utilized to determine the expression levels of lncRNA and miR. SIRT1 was measured by ELISA. When comparing cases with MVC to those without MVC, the lncRNA LYPLAL1 and SIRT1 values were significantly lower. Conversely, patients with MVC had significantly higher miR-204-5p levels than those without MVC. The LncRNA LYPLAL1 performed best in terms of detecting MVC. It attained 90.6% specificity and 96.9% sensitivity. A combination of three markers (lncRNA LYPLAL1, miR-204-5p, and SIRT1) yielded the best accuracy at 98.4%. LYPLAL1 expression appeared to be an independent MVC predictor. Adjusted OR for LYPLAL1 expression was 405 (95% CI: 1.4–1200) (p = 0.039). When we compared cases with MVC to those without MVC, the lncRNA LYPLAL1 and SIRT1 values were significantly lower. Patients with MVC had significantly higher miR-204-5p levels than those without MVC. LYPLAL1 LncRNA demonstrated the best performance characteristics. LncRNA LYPLAL1 expression is an independent predictor of MVC.

7518 A Case of Delayed Diagnosis of Acromegaly Associated with Uncontrolled Diabetes

Abstract Disclosure: A. Mahmoudabadi: None. S. Patel: None. Background: Acromegaly is a rare disorder characterized by an excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) levels, typically due to a GH-secreting pituitary adenoma. This consequently leads to complications such as acral and soft tissue overgrowth, visual disturbance, insulin resistance, and dyslipidemia. In this case, we describe a patient who presented to the endocrinology clinic for uncontrolled diabetes and was subsequently diagnosed with acromegaly. Clinical Case: This is a 47-year-old male with a history of heart failure, hypertension, and type 2 diabetes mellitus (DM) who presented to the clinic with uncontrolled DM. He had failed to achieve adequate blood sugar control despite being compliant with metformin, dapagliflozin, and insulin degludec. Physical examination revealed frontal bossing, prognathism, macroglossia, and a deep voice. On further questioning, he had noticed these changes since five years prior. Anthropometry and laboratory tests were as follows: Height, 180 cm; body weight 107.5 kg; body mass index (BMI), 33.05 kg/m2 and A1c level of 15.0%. Suspicion of acromegaly was confirmed based on biochemical and imaging findings. Fasting growth hormone (GH), at 58 mU/L (reference range 0-10), and insulin-like growth factor 1 (IGF-1), at 857 nmol/L (reference range 81-263), were markedly elevated. Pituitary magnetic resonance imaging (MRI) showed a sellar and suprasellar mass (2.6 × 2.2 × 2.2 cm) extending and compressing the optic chiasm. He eventually underwent a transsphenoidal adenomectomy with neurosurgery. Following surgery, his insulin requirements went from a total daily dose of about 100 units to an inpatient dose of 30 units by his last day of admission. Conclusion: Acromegaly is prevalent in less than 3% of patients with DM, but higher rates of DM are seen in acromegalic patients with higher IGF-1 levels and longer duration of disease. The diagnosis of acromegaly can often be delayed due to missed findings on routine physical examination. This can lead to increased morbidity, mortality, and complications such as uncontrolled DM, witnessed in our patient. Surgical management of acromegaly is the mainstay of treatment and can lead to improvement of glycemic control and insulin sensitivity. Fortunately, our patient could undergo surgery, but delayed diagnosis can prevent patients from surgery if the pituitary tumor becomes too large or unresectable. Ultimately, this case highlights the importance of a thorough physical examination and keeping a wide differential diagnosis when evaluating patients with uncontrolled DM, as failure to diagnose acromegaly at an early stage may have devastating consequences on patient outcomes. Presentation: 6/3/2024

7335 Myxedema Coma in an Adolescent Patient: A rare, lethal manifestation of profound hypothyroidism

Abstract Disclosure: C. Rodriguez: None. E.M. Mejias: None. L.R. Berrios: None. C. Currais: None. Myxedema coma is a rare, life-threatening condition that represents the most severe manifestation of profound hypothyroidism. It is characterized by extensive end-organ dysfunction. Therefore, it is crucial to have a high index of suspicion in order to identify it promptly and initiate treatment. We report a case of an adolescent patient with past medical history of Type 1 Diabetes Mellitus and hypothyroidism who was initially admitted to pediatric wards due to hypertension, constipation and acute kidney injury (AKI). The patient was transferred to the pediatric intensive care unit (PICU) after he developed multi-organ failure secondary to myxedema coma. His laboratory work up was remarkable for severe hypothyroidism with a thyroid-stimulating hormone (TSH) > 679, uncontrolled diabetes mellitus (Glycosylated Hemoglobin 13.1%) and chronic kidney disease (Creatinine 2.56). During his hospital course, he required long term hemodialysis, mechanical ventilation and underwent cardiorespiratory resuscitation multiple times. Since myxedema coma is an uncommon manifestation of pediatric hypothyroidism, pediatric guidelines are not available. We aim to reinforce the awareness of myxedema coma and encourage physicians to have a high index of suspicion as the widespread availability of TSH assays and its use can aid in the diagnosis and treatment of these patients. Furthermore, we emphasize an interdisciplinary approach to avoid mortality and long-term complications. Presentation: 6/1/2024

8746 Primary Prevention and Early Intervention for Cardiovascular Disease in Polyglandular Autoimmune Syndrome Type 2

Abstract Disclosure: V.N. Flores-Robles: None. Y. Fuentes-Rosa: None. M. Sanchez-Cordero: None. D.A. Lopez: None. M. Carrero-Quinones: None. Introduction: Polyglandular autoimmune syndrome type 2 (PAS-2) is an autoimmune syndrome that is known for lymphocytic infiltration causing organ-specific damage. It can include primary adrenal insufficiency (Addison's disease), type 1 diabetes mellitus (T1DM), autoimmune thyroid disease-causing Grave’s disease, or hypothyroidism, and can be diagnosed when two out of these three pathologies are present. Carpenter syndrome, a type of PAS-2, is described as the triad of Addison's disease, autoimmune thyroid disease, and T1DM. Its initial manifestation can be associated with non-endocrine and endocrine disorders as in autoimmune thyroid disease, T1DM, primary hypogonadism, and diabetes insipidus. It is well documented that uncontrolled diabetes mellitus can accelerate the progression of cardiovascular disease of co-existing coronary artery disease, but documentation that Addison’s disease may accelerate the progression is scant with only ten cases documented. On the other hand, there are no documented cases of the presence of coronary artery disease in patients with PAS-2. Case report: This case involves a 66-year-old Hispanic male with a past medical history of hypertension, and PAS-2, presenting with Addison’s disease, type 1 diabetes mellitus, and hypothyroidism. The initial presentation at the hospital was that of a complete atrioventricular block that required pacemaker placement. Cardiology services were consulted as the patient also had a positive stress test and eventually cardiac catheterization was done as further workup. Cardiac catheterization showed obstruction of the left main coronary artery of 80% and left circumflex with mild disease, that required coronary artery bypass (CABG). A 2D ECHO was done for further evaluation of cardiac function and findings were pertinent for an ejection fraction of 65-70%, mild concentric hypertrophy of the left ventricular wall, and left ventricular diastolic function with impaired relaxation pattern. The patient underwent the CABG procedure without any complications. He has been followed up outpatient and remains without any symptoms or pertinent presentation. Early intervention in this patient with PAS-2 prevented any further cardiovascular complications. Conclusion: Patients with PAS-2 may have a predisposition to developing coronary artery disease due to concomitant endocrinopathies that independently increase the risk of cardiovascular disease. This promotes further investigation into the primary prevention of cardiovascular disease in patients presenting with PAS-2. Taking into consideration the increased risk and/or progression of cardiovascular disease in these patients, early intervention and evaluation by cardiology services should be suggested as it may decrease their morbidity or mortality. Presentation: 6/2/2024

Hypoglycemia-Induced Loss of Consciousness in an Immobilized Geriatric Patient: A Case Report

Introduction : Hypoglycemia in geriatric people is a less well recognized condition and have been correlated with acute outcomes such as seizure, coma, and cardiac arrhythmia. Symptoms of hypoglycemia tend to be less specific with ageing, where diagnosing these conditions in geriatric patient potentially becomes more difficult. Case Report : A 77-year-old man was brought to the ER due to unresponsive since 2 hours before admission. He was hypoglycemic with a plasma glucose level of 70 mg/dL, hypoalbuminemia (2,6 g/dL), and hyponatremia (121 mmol/L). After receiving intravenous dextrose, he regained consciousness and his plasma glucose level increased to 120 mg/dL. Electrolyte abnormalities were corrected, plasma glucose level monitored every 2 hours and titrated according to hypoglycemia standard procedure. He has been in total bed rest and immobilized for 5 years due to inferior paraparesis with decubitus ulcer, had a history of uncontrolled hypertension and diabetes mellitus. Physical examination showed reduced motor function in his lower extremities. The patient had significant recovery during the treatment course and was discharge 4 days after initial presentation. Discussion : Hypoglycemia is a low plasma glucose concentration state that could leads to defective glucose counter-regulation and hypoglycemia unawareness. The patient’s long immobilized state potentially leads to a catabolic state that results in muscle wasting. While his reduced intake leads to geriatric anorexia and become the potential cause of hypoglycemia. Mainstay of hypoglycemic treatment is the detection and treatment using interventions that rapidly increased blood sugar to a safe level, eliminating injury risks and quickly relived symptoms. Conclusion : Diabetes in geriatric has a higher risk for hypoglycemia and should be considered in treating an elderly patient presenting with unresponsiveness or loss of consciousness.

6486 Gastroparesis Exacerbation by a GLP-1 Agonist

Abstract Disclosure: J.M. Deirmenjian: None. C. Dagher: None. Gastroparesis is characterized by a delay in gastric emptying that may present with nausea, vomiting, satiety, abdominal pain, and anorexia. The most common cause of gastroparesis is diabetes mellitus due to vagal autonomic neuropathy which prevents coordinated gastric contractions. Medications may also induce gastroparesis. Glucagon-like peptide (GLP)- 1 agonists such as semaglutide are being prescribed for diabetes control but also due to benefits of cardiovascular disease and weight loss. Concerns of GLP-1 agonists causing gastroparesis are valid as the mechanism of action includes delaying gastric emptying, especially with newly developed analogs that are more potent with longer half-lives. Patient is a 43-year-old female with a history of hypertension, uncontrolled diabetes mellitus type 2, diabetic gastroparesis, diabetic neuropathy, hyperlipidemia, and obesity who presented with a one-month history of postprandial abdominal pain, nausea, vomiting, and a 40-pound unintentional weight loss with decreased oral intake. Her abdominal pain was sharp and was exacerbated with eating. While she had several gastroparesis flares in the past, she was in remission for almost two years until she was transitioned from dulaglutide to semaglutide after which she had a recurrent flare after two doses. On physical examination, her abdomen was diffusely tender to palpation.On admission, her hemoglobin A1c was 9.7%. She was made NPO, started on peripheral fluids, and initiated on scheduled metoclopramide given high suspicion of a gastroparesis flare. She underwent a gastric emptying study with the gastric amount retained as follows: 97% (at 1 hour), 88% (at 2 hours), and 79% (at 4 hours). Her hospital course was complicated by persistent symptoms of gastroparesis. Gastroenterology recommended scheduled metoclopramide and erythromycin for motility and dietary adjustments including small volume liquid calories. Her oral intake was insufficient and she opted for total peripheral nutrition until symptoms improved. She was advised to never take a GLP-1 agonist again and should her symptoms not improve the next step would be to pursue a gastric pacemaker. The etiology of the patient’s gastroparesis was uncontrolled diabetes. The proximity between starting semaglutide and symptom onset is compelling as an inciting factor in this flare. This admission’s gastric emptying study results showed higher gastric retention for a longer period of time, which may shed light to the potency of these new GLP-1 analogs. The patient tolerated maximum dose dulaglutide for months but not even two doses of semaglutide. With the race to invent more potent GLP-1 agonists for diabetes control and weight loss on the horizon, knowing their side effects and mechanism of action is crucial. While not listed as a contraindication, there should be hesitancy to offer these agents to anyone with significant gastroparesis. Presentation: 6/2/2024

6536 National Trends in Prevalence of Prediabetes and Diabetes Among Women With Low Bone Mineral Density: 2009-2018

Abstract Disclosure: A. Atri: None. C. Anastasopoulou: None. Introduction: In recent years, bone fragility has emerged as a complication of prediabetes (preDM) and diabetes mellitus (DM), resulting in reduced bone mass and increased fracture risk, and is an important, though under-studied risk factor for osteoporosis. However, the converse relationship, trends in prevalence of preDM and DM in women with low bone mineral density (BMD) in the United States, are not well established. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) for the years 2009-10, 2013–14 and 2017–18 to include U.S. women aged ≥ 50 years with T-score ≤ -1. Osteoporosis assessment in NHANES was not completed in 2011–12 and 2015–16, and therefore not included in the analysis. Osteopenia and osteoporosis were defined by a femoral neck BMD ≤1 to 2.5, and ≤2.5 standard deviations (SDs) below the BMD of a young female adult mean (T-score). Femur neck BMD was measured by dual energy x-ray absorptiometry (DEXA). PreDM and DM were defined using HbA1c values of 5.7 - 6.4% and ≥ 6.5% respectively. Participants with missing HbA1c and BMD data were excluded. Descriptive statistics were used for comparing means and medians. The Cochran-Armitage test was utilized for trend analysis. Results: In this nationally representative sample of US women with low BMD, the median (IQR) T-score at femoral neck worsened from -1.74 (-1.4 to -2.17) in 2009-10 to -1.87 (-1.43 to -2.32) in 2017-18 (trend p = 0.001). Similarly, the prevalence of osteoporosis increased from 13.7% to 16.9% (trend p = 0.001). Overall, in this cohort, the national prevalence of both preDM and DM decreased from 40% to 32.9% and 9.6% to 9%, respectively (trend p = 0.001). Along with a reduction in the overall prevalence of osteopenia (86.3% to 83.1%, p=0.001), the prevalence of both preDM and DM decreased from 39.2% to 32.6% and 10% to 9% (p = 0.001). In those with osteoporosis, the prevalence of preDM decreased from 45.2% to 34.4% (p trend=0.001), however, the prevalence of DM increased from 7.5% to 8.7% (p trend =0.001). Overall rates of uncontrolled DM (HbA1c > 7%) in women with osteoporosis showed significant improvement (5.8% to 3.5%, p = 0.001). Discussion Despite worsening trend in femoral neck BMD among US women age ≥ 50 years from 2009-10 to 2017-18, the overall prevalence of preDM and DM improved by 7.1% and 0.6% respectively. However, this favorable trend was not observed among women with osteoporosis, where the overall prevalence of DM increased by 1.2%, though the rate of uncontrolled DM significantly decreased by 2.3%. Targeted interventions to improve blood glucose control among women with low BMD, especially those with osteoporosis are warranted, to improve bone health, as well as reduce fall and fracture risk. Presentation: 6/2/2024

Improving Hypertension and Diabetes Mellitus Control with a Dedicated Patient Navigator.

Hypertension and diabetes mellitus (DM) are the leading causes of cardiovascular, cerebrovascular, and chronic kidney diseases. They affect an estimated 47% and 11% of Americans, respectively. In this study, we assessed whether a dedicated patient navigator embedded within a patient-centered medical home (PCMH) using a structured panel management and patient outreach strategy could improve blood pressure and glycemic control in primary care patients with uncontrolled hypertension and DM. We performed a prospective study comparing blood pressure and glycemic control in primary care patients before and after implementation of a patient navigator executing a hypertension and DM-focused panel management plan. From January 2014 to October 2019, inclusion criteria were met 5164 times, which comprised 1958 unique patients within a PCMH. Multivariate regression analysis reveals a significant decrease in uncontrolled systolic blood pressure (SBP) over time, with an actual decrease of roughly 40% of uncontrolled episodes of SBP becoming controlled by 12 months. Multivariate regression analysis reveals a significant decrease in uncontrolled hemoglobin A1c (HbA1c) over time for each plot (P < 0.0001), with an actual decrease of roughly 30% of uncontrolled episodes of HbA1c becoming controlled by 12 months. This study demonstrated the benefit of a dedicated patient navigator embedded within a PCMH on improving BP and glycemic control in primary care patients with uncontrolled hypertension and DM. Glycemic control was achieved, with 30% of episodes reaching an HbA1c of <8% and BP control achieved for 40% of episodes with SBP <140 mm Hg at 12 months. There were no differences by the social determinants of race and poverty.

Prevalence and Determinants of Uncontrolled Diabetes Mellitus: A Community-Based Study from Karnataka, India

Background: Uncontrolled diabetes mellitus is a significant health challenge, especially in developing countries. Factors contributing to it vary by region, making it crucial to understand them for effective blood sugar control. The study’s objectives were to estimate the prevalence of uncontrolled diabetes mellitus and its determinants among residents of selected areas of Dakshina Kannada, Karnataka. Methodology: This study was conducted from October 2021 to May 2023 among adult diabetics residing in the Jokatte and Madani Nagar areas of Dakshina Kannada. The required sample size was estimated at 180 and 90 diabetic patients were randomly selected from each study area. Data were collected by field workers using a pre-tested questionnaire, and a lab technician obtained blood samples for HbA1c. Data analysis was performed using SPSS Ver 27. Results: The study enrolled 180 diabetics with a mean (± S.D) age of 56.9 (±10.3) years. Uncontrolled diabetes was noted in 75.6% of diabetics. Significant determinants for uncontrolled diabetes were longer duration of diabetes, poor knowledge of blood sugar tests, irregular testing and insufficient physical activity. Conclusion: The study observed an alarming prevalence of uncontrolled diabetes and identified its key determinants. Healthcare providers must implement targeted interventions addressing these factors to achieve effective diabetes control.

Effect of Diabetes Mellitus Type 2 on the Correlation of Vitamin D with Lipid Profile in Iraqi Patients

Vitamin D deficiency has been linked to several conditions, including type 2 diabetes. The purpose of this study is to determine if there is an effect of type 2 diabetes on the association between vitamin D level, glycemic indices, and lipid profiles. The study was conducted at Al-Noamman Hospital, included 257 patients with type 2 diabetes and 40 healthy participants of both sexes with matching ages ranging from 26 to 80 years. The lipid profile, postprandial glucose (PPG), HbA1C, and serum vitamin D were measured. The results showed that 89 (34.6%) of diabetics have vitamin D insufficiency (less than 30 ng/mL). 155 diabetic patients (uncontrolled glycemic) with elevated HbA1C (9.07% ± 2.5), and from those, about 33.5% have vitamin D insufficiency; they are of age ≥ 55 years, 58.1% female, and 41.9% male, and they have a significant correlation (r = 0.17, P &lt; 0.05) between HbA1C and vitamin D. All diabetic patients who are classified according to HbA1C subgroups have highly significant correlations (P &lt; 0.01) among age and vitamin D; cholesterol with VLDL and LDL; and TG with VLDL. In controlled diabetes patients (HbA1C ˂ 5.7%), a highly significant correlation was found between HDL and vitamin D (r = 0.50, P ˂ 0.01(. We conclude that vitamin D level is highly significantly related to age and sex in diabetic patients who displayed highly significant dyslipidemia and were associated with 34.6% vitamin D insufficiency (significantly with uncontrolled diabetes mellitus patients).

An Unusual Case of Pulmonary Mucormycosis

ABSTRACT We report the case of a female who presented with nonresolving pneumonia and was found to have uncontrolled diabetes mellitus. She was given multiple antibiotics and antivirals from multiple hospitals. No organism was isolated from sputum/bronchoalveolar lavage/pleural fluid. Finally, she underwent Video assisted thoracoscopic surgery (VATS) and drainage of lung abscess and was diagnosed to have pulmonary mucormycosis.

The effect of psychoeducation with health coaching method on HbA1c levels Among Type 2 Diabetes Mellitus

Different dangerous and life-threatening complications, such as hypoglycemia, hyperglycemia, and metabolic ketoacidosis are caused by uncontrolled Diabetes Mellitus (DM). Therefore, this study aimed to analyze the effect of psychoeducation with health coaching methods in type 2 DM patients on HbA1c levels.In this context, a quasi-experimental design was adopted with pre-and post-test control group methods. The sample size for the intervention and control groups was 30 type 2 DM patients who were routinely controlled at the Kalijudan Surabaya Community Health Center between March to April 2023 using a simple random sampling method. The intervention group received psychoeducational intervention using the health coaching method with six sessions through 3 meetings and module media, while the control only received module education media. Furthermore, the HbA1c level was taken before and after intervention, and the effect was measured using the t-test.The results showed that pre-test and post-test HbA1c levels were decreased (mean 9.06; 5.98) and increased (mean 9.13; 10.59) in the intervention and control groups, respectively. Psychoeducation with the health coaching method and provision of modules to patients was more effective compared to groups only given modules (0.000).In conclusion, this intervention motivated patients subjected to treatment, facilitated increased personal control, and built confidence in managing diabetes independently. The implication obtained was an increase in the ability of patients to make self-care decisions.