Uncontrolled Diabetes Mellitus Research Articles

Diabetic Myonecrosis: A Single-Center Experience

Abstract Diabetic myonecrosis is an infrequent complication of long-standing, uncontrolled diabetes mellitus. It usually involves the muscles of the lower limbs presenting with acute onset pain and swelling. It is often seen in association with chronic kidney disease. We present a case series of seven episodes seen over 5-year duration. All these patients had a long duration of poorly controlled diabetes associated with other microvascular complications. They were treated conservatively with bed rest, analgesics, vasodilators, and aspirin. The diagnosis is often missed due to its uncommon presentation and a lack of awareness. The disease resolves spontaneously but with poor long-term prognosis.

Prevalence of Candida Species Isolated from Immuno-Compromised Patients

Background: Resistance to fungal infections is increasing worldwide, which is highly relevant in immunosuppressed individuals. Candida fungi infection constitutes one of the most common causes of fungal infections in such patients, and it can lead to complications and death. The current study sought to examine the prevalence and species diversity of Candida in samples received by the Microbiology Laboratory over a two-year period.
 Methods: The study involved 674 immunocompromised patients. Candida was isolated from clinical samples using wet mount, gram stain, and SDA culture. To further identify the organisms, several tests were conducted, including the germ tube test, cornmeal agar morphology, sugar assimilation, fermentation tests, and BACT/ALERT 3D.
 Results: Candida species were found to be present in 6.5% of the population. Candida tropicalis was found to be the most common isolate 20 (45.45%), followed by Candida albicans 9 (20.45%), Candida glabrata 7 (15.9%), Candida parapsilosis 4 (9.09%), and Candida krusei 4 (9.09%). Diabetes, leukaemia, chronic kidney disease, and AIDS were the most common predisposing factors for candidiasis.
 Conclusion: Men had a relatively high candidemia prevalence of 68.18%. Uncontrolled diabetes mellitus (DM) and chronic kidney disease (CKD) have been found to be the most common co-morbidities with candidemia in people aged 51 to 70.

Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction

BackgroundRenin-angiotensin-aldosterone system inhibitors (RAASi) are commonly used medications. Renal adverse events associated with RAASi are hyperkalemia and acute kidney injury. We aimed to evaluate the performance of machine learning (ML) algorithms in order to define event associated features and predict RAASi associated renal adverse events. Materials and MethodsData of patients recruited from five internal medicine and cardiology outpatient clinics were evaluated retrospectively. Clinical, laboratory, and medication data were acquired via electronic medical records. Dataset balancing and feature selection for machine learning algorithms were performed. Random forest (RF), k-nearest neighbor (kNN), naïve Bayes (NB), extreme gradient boosting (xGB), support vector machine (SVM), neural network (NN), and logistic regression (LR) were used to create a prediction model. Results409 patients were included, and 50 renal adverse events occurred. The most important features predicting the renal adverse events were the index K and glucose levels, as well as having uncontrolled diabetes mellitus. Thiazides reduced RAASi associated hyperkalemia. kNN, RF, xGB and NN algorithms have the highest and similar AUC (≥ 98%), recall (≥ 94%), specifity (≥ 97%), precision (≥ 92%), accuracy (≥ 96%) and F1 statistics (≥ 94%) performance metrics for prediction. ConclusionRAASi associated renal adverse events can be predicted prior to medication initiation by machine learning algorithms. Further prospective studies with large patient numbers are needed to create scoring systems as well as for their validation.

Diabetic Fibrous Mastopathy: Imaging Features With Histopathologic Correlation.

Diabetic fibrous mastopathy (DFM) is a rare benign fibrotic disease of the breast that develops in patients with longstanding and often uncontrolled diabetes mellitus. Clinically, patients may present with an irregular, firm, palpable mass, which may be solitary or multiple, occurring in one or both breasts. Diabetic fibrous mastopathy occurs most often in premenopausal women with heterogeneously or extremely dense breasts; mammography may show focal asymmetry or, less often, a noncalcified mass with indistinct or obscured margins, but there are usually no discrete findings. On US, DFM may have marked hypoechogenicity and posterior shadowing secondary to extensive fibrosis. Diabetic fibrous mastopathy features on contrast-enhanced MRI are also nonspecific, with gradual persistent nonmass enhancement reported. Because the clinical presentation and US features of DFM overlap with those of breast cancer, histopathologic correlation is needed to confirm diagnosis and exclude malignancy. These findings include collagenous stroma often with keloidal features and chronic perilobular and perivascular inflammation. Histopathologic findings of lymphocytic lobulitis and perivascular inflammation are common to other autoimmune conditions.

The Case Files

The Case Files

A rare presentation of central pontine myelinolysis secondary to hyperglycaemia

BackgroundCentral pontine myelinolysis (CPM) is a rare demyelinating disorder caused by the loss of myelin in the center of the basis pontis. CPM typically occurs with rapid correction of severe chronic hyponatremia and subsequent disturbances in serum osmolality. Although hyperglycaemia is recognized as a pathogenetic factor in serum osmolality fluctuations, CPM is rarely seen in the context of diabetes.Case presentationA 66-year-old Chinese male presented with a history of gait imbalance, mild slurred speech and dysphagia for two weeks. MRI showed the mass lesions in the brainstem, and laboratory examinations showed high blood glucose and HbA1c, as well as increased serum osmolality. The patient was diagnosed with CPM secondary to hyperosmolar hyperglyceamia and received insulin treatment as well as supportive therapy. After six weeks of followup, the patient had fully recovered to a normal state.ConclusionCPM is a potentially fatal neurological condition and can occur in uncontrolled diabetes mellitus. Early diagnosis and timely treatment are crucial for improving the prognosis.

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.

Barriers of Good Glycemic Control Of Known Diabetic Patients in a Tertiary Care Hospital

Introduction: uncontrolled Diabetes mellitus is a growing cause of disability and premature death. HbA1C is an indicator of glycemic control status over the previous three months. Therefore, to minimize the morbidity and mortality of diabetic patients, it would be necessary to identify the factors associated with poor glycemic control, which may not be similar to developed countries. Objective: To identify factors acting as a barrier to reasonable glycemic control of known diabetic patients in Bangladesh Materials and methods: This is a hospital-based descriptive cross-sectional study among diabetic patients with poor glycemic control in the indoor and outdoor Medicine and Endocrinology departments of Dhaka medical college hospital, Dhaka, from July 2019 to December 2019 (6 months). For at least three months, patients who had uncontrolled Diabetes were selected by purposive and convenient sampling method. Results: One hundred and six patients with poor glycemic status were included in the analysis. Aged persons were at risk for poor glycemic control, especially age range of 50-69 years (65.0%) P-value was .004. Duration of Diabetes and educational status were significantly associated with poor glycemic control. P values were 0.001 and .003, respectively. Conclusion: Patient education plays a pivotal role in controlling glycemic control, favoring treatment success, reducing adverse drug events, and preventing further complications of Diabetes. J Dhaka Med Coll. 2022; 31(1) : 9-14

Uncontrolled Acromegaly, Diabetes Mellitus and Metabolic Syndrome are the Main Risk Factors of Colon Polyposis Recurrence in Patients with Acromegaly

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Cross-sectional study to describe the severity, bio-chemical associations, and final outcomes of COVID-19-associated rhino-orbital-cerebral mucormycosis in a tertiary hospital of East India

The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality.This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome.There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03).Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.

Management of Chronic Truncal Wall Type-I Complex Regional Pain Syndrome in a Patient with Uncontrolled Diabetes Mellitus: Case Report

Complex regional pain syndrome (CRPS) is a chronic pain syndrome associated with sensory, vasomotor, sudomotor, motor and trophic changes commonly affecting the upper and lower extremities; however, we report a case of truncal wall CRPS in an uncontrolled type 2 diabetes mellitus patient. A male in his late fifties presented with right lower chest and upper abdominal wall burning, sharp and stabbing type of pain for 5 years associated with hyperalgesia and allodynia. The extensive evaluation ruled out any underlying pathology and the symptoms were increasing with time. He failed to respond to conservative pharmacological, non-pharmacological treatment and rehabilitation measures. In our institute, he underwent alcohol neurolysis of subcostal transversus abdominis plane and rectus sheath nerves with rehabilitation measures and reported significant relief in his symptoms. It has now been 6 months since the procedure was done and he has complete relief in pain. Hence, if sympathetic block is difficult to do, peripheral nerve block with alcohol and rehabilitation measures provide desirable effect in abdominal wall CRPS.

Rhinocerebral Mucormycosis Case Report and Brief Review of the Literature

The purpose of this paper is to present a case report of rhinocerebral mucormycosis in the setting of uncontrolled diabetes mellitus in which the patient underwent aggressive surgical and medical treatment. The outcome of the case was a success with the patient surviving despite having intracranial involvement which was left untouched. In addition to presenting the case, we will review the literature in regards to invasive fungal infections of the maxillofacial region, its various presentations, therapeutic modalities, and outcomes of treatment. Our goal is to share our experience and provide a review of literature to help provide a foundation of knowledge upon which clinicians can identify and rapidly treat maxillofacial cases of mucormycosis.

Evaluation of risk factors, clinico-radiographic presentations of COVID-associated mucormycosis in the maxillofacial region reporting to a tertiary care dental facility.

To evaluate the prevalence of risk factors associated with COVID-associated mucormycosis (CAM) in the maxillofacial region with emphasis on clinical and radiological characteristics of the disease reporting to the dentists. Archival records of the patients diagnosed with rhino-cerebral mucormycosis through histopathology or culture, were screened and 266 records were included. These records were divided into three groups-previously diabetic (PD, n=122), recently diagnosed diabetic (RD, n=105) and non-diabetic (ND, n=39). All the records were evaluated and compared among the three groups for the duration of presentation, history of co-existing medical conditions, the association of treatment given during COVID-19, and the clinical and radiographic presentations of the disease. The results confirmed uncontrolled diabetes mellitus as the major risk factor for the disease. The prevalence of steroid administration was lower in our study in contrast to previous literature. The risk factors and treatment rendered during COVID-19 did not differ significantly among the three groups (p>0.05). The findings indicate that the disease was milder and progressed more slowly in the ND group, both clinically and radiographically, and it had close resemblance to odontogenic infection. Patients with early CAM mimicked the odontogenic infection and were more likely to report in a dental setup. Hence, a multidisciplinary and holistic management approach is necessary.

Study of Lipid Profile in Type 2 Diabetes Mellitus Patients in South Chennai Population.

Diabetes Mellitus is caused by the decreased utilization of glucose by tissues and is attributed either to hypoinsulinemia or hyperinsulinemia induced by the overstimulation of insulin-secreting beta cells. Patients with diabetes mellitus, obesity and dyslipidemia are prone to Metabolic syndrome. The study aims to estimate and compare the lipid profile in type 2 diabetes mellitus patients and healthy individuals. This case-control study was undertaken in type II Diabetic patients, where 48 were male, and 45 were female. The diabetic subjects were compared with 33 male and 55 Healthy female subjects who volunteered as controls. Venous blood samples from healthy and diabetic subjects were collected and used to measure routine parameters such as fasting blood sugar (FBS), post-prandial blood sugar(PPBS), Total cholesterol, HDL, and TGL. The Fasting Plasma Glucose and post-prandial glucose were significantly increased among diabetic subjects than the healthy controls. The triglyceride levels in cases had elevated levels in comparison to controls. HDL showed a marginal decrease in the diabetic group than the control group. Mean LDL levels in people with diabetes increase compared to the healthy controls. Besides, the VLDL levels also significantly increased among people with diabetes. There was a substantial increase in FBS and PPBS levels among the diabetic subjects compared to the healthy controls. The lipid profile constituting Total cholesterol, Triglycerides, HDL, LDL and VLDL levels showed the following changes: There was a significant increase in Total cholesterol, TGL, VLDL, and LDL levels, whereas the HDL levels were decreased among the diabetic subjects. Patients with type 2 diabetes mellitus must keep their blood sugar levels under control through follow-ups because uncontrolled diabetes mellitus leads to lipid dysfunction, which ultimately increases the risk of coronary artery disease. Keywords: , , Triglyceride (TGL), Low-Density Lipoprotein (LDL).

Retrospective Analysis of Dental Implant Failure Rates in Patients with Compromised Health.

The goal of the current research was to compare the failure rate of dental implants in medically compromised patients to healthy individuals. In this seven years retrospective study, 50 patients from Group A who were medically compromised had 63 implants, while 50 patients from Group B who were healthy had 67 implants. Over 1 mm of bone loss around the implant in the first year and over 0.2 mm of bone loss per year after that were considered failure rates. Two (2.9%) of the dental implants in Group B and 18 (28.6%) in Group A, both failed. The average bone loss around the implant in Group A during the first year was 1.21 mm, compared to 0.3 mm in Group B. Uncontrolled diabetes mellitus group had greater implant failure.

Clinical profile of COVID-19-associated mucormycosis patients and the clinical suspects: a descriptive audit

BackgroundIndia witnessed a massive surge of rhino orbital cerebral mucormycosis (ROCM) cases during the second wave of COVID-19, recording the highest number of cases in the world, indeed, an epidemic within the pandemic.ObjectivesTo describe the clinical profile of patients with COVID-19-associated mucormycosis (CAM) and the clinical suspects for mucormycosis.MethodsThis single-center descriptive, observational study/audit was done at Indira Gandhi Medical College, Pondicherry, South India. This study is about the clinical profile of 7 CAM patients and 14 COVID-19 patients who were suspects of CAM, based on their risk factors and clinical symptoms, and were referred to the ENT department.Statistical analysisAll the descriptive variables were summarized as mean, frequency, and percentages for qualitative data.ResultsAll 7 CAM patients were COVID-19 positive and were not vaccinated against COVID-19, All 7 were known diabetic, all 7 had steroid therapy for their COVID status, and 5 out of 7 (71%) had uncontrolled diabetes mellitus at the time of diagnosis. Facial pain, nasal discharge, and eye swelling were the presenting symptoms of CAM. Maxillary and ethmoid sinuses were the most commonly involved para nasal sinuses. Four out of seven (57.1%) CAM patients survived after 16 months of follow-up, after surgical and medical treatment for CAM. Of the 14 clinical suspects who were negative for CAM, 2 were negative for COVID-19, their risk factors were brought under control, 3 expired due to COVID complications, and 9 patients are alive till date.ConclusionUncontrolled diabetes is a risk factor for ROCM/CAM, another possible risk factor is steroid therapy, and we hypothesize that COVID infection could also be a possible risk factor that needs to be studied more extensively in a larger sample. Early clinical suspicion, withdrawal of steroids, rapid control of diabetes mellitus, appropriate investigations, and early surgical intervention combined with medical treatment offers better outcome.

The Many Manifestations of Rhino-Orbital-Cerebral Mucormycosis: An Illustrative Case Report (P10-10.003)

<h3>Objective:</h3> To describe and illustrate with neuroimaging the progression of rhino-orbital-cerebral mucormycosis leading to orbital apex syndrome, cranial neuropathies, cavernous sinus thrombosis, and strokes from internal carotid artery steno-occlusive disease. <h3>Background:</h3> A 67-year old female with uncontrolled diabetes mellitus presented with progressive vision loss in the right eye and right sided facial weakness, associated with fatigue and fevers. She underwent intranasal debridement, and hematoxylin and eosin staining showed broad-based, branching, non-septate hyphae, consistent with mucormycosis. She was treated with antifungals. She sought care again 3 months later, at which point she had no vision in the right eye, and was unable to open or move the right eye. Her examination at this point was notable for no light perception in the right eye with mid-size, unreactive pupil; complete ptosis and ophthalmoplegia of the right eye; and right facial weakness in a lower motor neuron pattern. Magnetic resonance imaging of the brain demonstrated inflammation at the orbital apex, as well as thromboses of the right superior ophthalmic vein and right cavernous sinus. Despite treatment with systemic antifungals and anticoagulation, the patient later developed sudden-onset lethargy associated with a right gaze deviation. She was found to have severe stenosis of the bilateral intracranial internal carotid arteries on cerebral angiogram. Magnetic resonance imaging showed interval development of bilateral deep watershed territory infarcts. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> Mucormycosis is a rare but devastating fungal infection caused by mucormycetes, which are ubiquitous in nature. Most patients with invasive mucormycosis are immunocompromised, classically due to poorly controlled diabetes or hematologic malignancies. Mucormycosis spreads contiguously through the sinuses, and is also angioinvasive. Because the infection typically begins as a rhinosinusitis, the fungus spreads intracranially through direct invasion of the cavernous sinus. This case and the associated imaging illustrates the stepwise progression of mucormycosis due to contiguous spread intracranially. <b>Disclosure:</b> Dr. Trenz has nothing to disclose. Dr. Tetreault has nothing to disclose.

A Payer-Provider Partnership for Endocrine Targeted Automatic eConsults: Implementation and Early Impact on Diabetes and Cost Outcomes.

In the United States, many individuals with diabetes mellitus (DM) do not achieve treatment goals despite the availability of effective interventions. Provider clinical inertia is one cause of these unfavorable outcomes. Targeted automatic eConsults (TACos) are an emerging technology-based intervention with potential to address clinical inertia in primary care (PC). TACos prospectively identify at-risk patients and use unsolicited specialist recommendations to prompt treatment intensification. Through a payer-provider collaboration, a TACos intervention was piloted for adults with uncontrolled DM (HbA1c >8%) to understand impact on DM clinical inertia and outcomes. Clinical inertia was assessed by measuring whether a PC provider implemented recommended therapeutic changes. Six-month changes in HbA1c and health care costs per member per month were evaluated using an observational matched design and intention-to-treat (ITT) analysis. The analysis included 196 individuals who received a TACos between February 2021 and August 2021 (ITT group) matched to 392 controls based on clinical and demographic criteria. TACos recommendations were implemented 65% of the time. Median percent change in HbA1c was significantly greater for the ITT group versus controls (-10.9% vs. -10.2%; P = 0.0359). Median total costs were 7.9% lower in the ITT group (P = 0.0900). A per protocol analysis was done to examine effects between ITT group individuals with an implemented TACos recommendation (n = 126) and controls. Median percent change in HbA1c was significantly greater (-19.5% vs. -10.2%; P < 0.0001), but there was no difference in total costs (-7.9%; P = 0.1753). TACos may feasibly address clinical inertia in PC and improve HbA1c for uncontrolled DM.

RETROSPECTIVE COMPARATIVE STUDY OF RHINOORBITOCEREBRALMUCORMYCOSIS IN COVID PATIENTS WITH DIABETES MELLITUS AND COVID PATIENTS WITHOUT DIABETES MELLITUS.

Background: Rhinoorbitocerebralmucormycoisis(ROCM) is a lethal, angioinvasive, opportunistic fungal infection involving the nasal cavity, paranasal sinuses, orbit and the brain predisposed mainly by immune compromised states, most importantly being uncontrolled dibetes mellitus and use of systemic steroids in the treatment of covid 19 respiratory distress. To study the association of ROCM with diabetic covid 19 patients. Objectives: Material And Methods: We conducted a retrospective study on patients with RTPCR proved Covid 19 infection with uncontrolled diabetes mellitus. Medical records of 35 patients with a diagnosis of ROCM (23 men and 12 women) among the 2000 patients with COVID 19 admitted in our tertiary care centre in 2020 and 2021 were reviewed. There w Result: as association of ROCM with diabetic covid 19 patients. Uncontrolled diabetes mellitus and the severit Conclusion: y of COVID 19 infection was one of the factors for the infection of ROCM. Retrospective comparative study of rhinoorbitocerebralmucormycosis in covid patients with diabetes mellitus and covid patients without diabetes mellitus.

Study of C - reactive protein, D-dimer in correlation with HbA1C levels in patients with diabetes mellitus type 2

: Diabetes Mellitus is a chronic metabolic disease presented with chronic hyperglycemia, which causes abnormalities in the endothelial cells, proinflammatory state, altered platelet function &amp; plasma coagulation factors that lead to a hypercoagulable state &amp; thrombotic incidents. D-dimer is an indirect marker of thrombotic activity. C-reactive protein (CRP) is an important risk factor for systemic inflammation, so the present study aimed to determine the relationship between CRP, D-dimer in correlation with HbA1C in patients with Diabetes Mellitus. The present study is undertaken to evaluate the study of D-dimer, C-reactive protein in correlation with HbA1C levels in Type 2 Diabetes Mellitus. : A total of one hundred &amp; twenty subjects aged 30-70 years were included. The patients were selected from those who attended the medical OPD at Gandhi Medical College &amp; hospital, Secunderabad, &amp; their samples are analyzed by Beckmann Coulter Fully Automatic Analyzer AU5800. CRP is estimated by rate turbidimetry method &amp; D-dimer is estimated by rate turbidimetry method. HbA1C by HPLC in Bio-rad-D-10: The prospective of elevated D-dimer, CRP levels are in correlation with increased HbA1C levels. So screening of inflammatory &amp; hemostatic markers must be done in patients with uncontrolled Diabetes Mellitus.