Undiagnosed Diabetes Mellitus Research Articles

Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Mizan Aman town, Southwest Ethiopia: Community-based cross-sectional study.

Diabetes mellitus continues to be a significant global public health concern, and it is currently a public health issue in developing nations. In Ethiopia, about three fourth of adult population with diabetes are unaware of their diabetic condition. However, there is a limited research on this specific topic particularly in the study area. To assess prevalence of undiagnosed diabetes mellitus and its associated factor among adult residents of Mizan Aman town, south West Ethiopia. A community-based cross-sectional study was conducted from May 23 to July 7, 2022, on 627 adult residents of Mizan Aman town. A multi stage sampling technique was used to obtain 646 study units. Interviewer-administered structured questionnaires were employed to gather socio-demographic and behavioral data. Anthropometric measurements were obtained and blood samples were taken from each participants. The fasting blood glucose level was measured after an 8-hour gap following a meal, using a digital glucometer to analyze a blood sample. Data were cleaned and entered into Epi-data v 3.1 and exported to SPSS v. 26 for analysis. Bi-variable analysis was done to select candidate variables and multivariable logistic regression model was fitted to identify independent predictors of undiagnosed diabetes mellitus. Adjusted odds ratio (AOR) with 95% CI was computed and variables with p-value < 0.05 were declared to be predictors of undiagnosed diabetes mellitus. The study revealed that, the overall magnitude of undiagnosed diabetes mellitus was 8.13% (95% CI: 6.1, 10.6). Predictors of undiagnosed diabetes mellitus were; physical activity level less than 600 Metabolic equivalent/min per week (AOR = 3.39, 95%CI 1.08 to 10.66), family history of diabetes mellitus (AOR = 2.87, 95% CI 1.41, 5.85), current hypertension(AOR = 2.9, 95% CI 1.26, 6.69), fruit consumption of fewer than three servings per week(AOR = 2.64, 95% CI 1.18 to 5.92), and sedentary life(AOR = 3.33, 95% CI 1.63 to 6.79). The prevalence of undiagnosed diabetes mellitus was 8.13%. Physical inactivity, family history of diabetes mellitus, current hypertension, sedentary life, and fruit servings fewer than three per week were independent predictors of undiagnosed diabetes mellitus.

Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused

AbstractBackground and AimsDiabetes is recognized as a significant factor in both mortality and morbidity worldwide, affecting various demographics regardless of geographic location, age group, or gender. This correspondence aims to express concern and draw the attention of leaders and policymakers worldwide to this critical public health issue.MethodsA thorough literature search was conducted utilizing various databases, including Google Scholar, PubMed, Science Direct, and the International Diabetes Federation (IDF) website, to collect the required data. Keywords were strategically applied to enhance search results, with preference given to English‐language articles containing pertinent information.ResultsAccording to the 2021 report by the IDF, approximately 537 million individuals globally were affected with diabetes, constituting roughly 10.5% of the world's populace. This condition incurred healthcare expenditures totaling $966 billion. Projections indicate a surge in diabetes cases to 783 million by 2045, with associated healthcare costs estimated to surpass $1054 billion. However, almost half of all people with diabetes are unaware of their medical condition, with the highest prevalence of undiagnosed diabetes Mellitus (DM) found in low and middle‐income countries (LMICs) of the regions of Africa, the Western Pacific, and Southeast Asia.ConclusionCollaborating with the World Health Organization (WHO), LMIC governments should improve healthcare accessibility, including more frequent diabetes screenings for individuals aged ≥ 45 years and younger individuals at elevated risk of having a family history.

Universal Fasting Glucose Screening Before Gastric Emptying Scintigraphy and the High Prevalence of Undiagnosed Diabetes and Prediabetes.

The aim of this study was to assess the rates of undiagnosed diabetes mellitus (DM) and pre-DM in patients undergoing gastric emptying scintigraphy (GES). Diabetes is an epidemic in the United States, and the disease is associated with altered gut motility. As a result, we suspected that a significant number of patients referred for GES may have undiagnosed DM or pre-DM. Given that established procedure standards for GES require all patients to prepare with an 8-h fast, an opportunity is provided to measure the fasting blood glucose (FBG) in all individuals before they undergo the examination. Methods: The charts of patients undergoing GES were reviewed for a history of DM and correlated with FBG and GES results. FBG values, obtained by point-of-care testing, were categorized as normal, pre-DM, or DM. Results: Patients with known DM made up 23% of those referred for GES, and most (55%) had a normal FBG. In those without a history of DM, there were a significant number with undiagnosed pre-DM (12%) and DM (33%). Conclusion: Our study provides the first measure of the likely prevalence of undiagnosed DM and pre-DM and characterizes the different gastric emptying patterns among patients with normal FBG, likely undiagnosed pre-DM, likely undiagnosed DM, and known DM.

Prevalence of type 2 diabetes mellitus and impaired fasting glucose, and their associated lifestyle factors among teachers in the CLUSTer cohort.

Teachers are responsible for educating future generations and therefore play an important role in a country's education system. Teachers constitute about 2.6% of all employees in Malaysia, making it one of the largest workforces in the country. While health and well-being are crucial to ensuring teachers' work performance, reports on non-communicable diseases such as type 2 diabetes mellitus (T2DM) among Malaysian teachers are scarce. Hence, this study focused on the prevalence of T2DM, undiagnosed diabetes mellitus (DM), impaired fasting glucose (IFG), and underlying lifestyle factors associated with these outcomes among Malaysian teachers. This is a cross-sectional study from the CLUSTer cohort. There were 14144 teachers from the Peninsular Malaysia included in this study. The teachers' sociodemographic and lifestyle characteristics were described using a weighted complex analysis. A matched age group comparison was carried out between teachers and the Malaysian general population on T2DM, undiagnosed DM, and IFG status. Next, the researchers examined the association of lifestyle factors with T2DM and IFG using multivariable logistic regression. The prevalence of T2DM, undiagnosed DM, and IFG among the Malaysian teachers were 4.1%, 5.1%, and 5.6%, respectively. The proportions of teachers with T2DM (both diagnosed and undiagnosed) and the IFG increased linearly with age. Teachers had a lower weighted prevalence of T2DM (known and undiagnosed) than the general population. However, teachers were more inclined to have IFG than the general population, particularly those aged 45 years and older. Among all lifestyle indicators, only waist circumference (aOR: 1.14, 95% CI: 1.08, 1.20) was found to be associated with T2DM, whereas waist circumference (aOR: 1.10, 95% CI: 1.05, 1.15) and physical activity [moderately active = (aOR: 0.71, 95% CI: 0.52, 0.98); highly active = (aOR: 0.56, 95% CI: 0.40, 0.80)] were associated with IFG. Modifiable lifestyle factors such as abdominal obesity and physical activity were associated with T2DM and IFG. Intervention programs targeting these factors could help reduce future treatment costs and increase productivity.

Undiagnosed status and associated factors of diabetes mellitus among adults living in eastern Ethiopia: Unmasking a silent killer of prevalence of diabetes mellitus

BackgroundThe global prevalence of diabetes mellitus (DM) is increasing rapidly, with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. It is important to uncover the hidden extent of diabetes in order to identify diabetes-related problems early. Therefore, this study aimed to assess the prevalence of undiagnosed DM and associated factors in Eastern Ethiopia. MethodsA quantitative, community-based cross-sectional study was conducted among 609 adults not known to be diabetic from January 03 to February 23, 2023. A multi-stage sampling technique and a validated standardized instrument were used. Each participant was interviewed to collect socio-demographic and behavioral characteristics data. Anthropometric measurements were recorded. The fasting blood glucose (FBG) test was assessed by samples taken early in the morning, 8 h after night fasting. Undiagnosed DM was defined as not being diagnosed with Diabetes mellitus and an FBG level of ≥126 mg/dl. To identify factors associated with undiagnosed DM, logistics regression was used. The level of statistical significance was set at a value of p < 0.05. ResultsThe prevalence of undiagnosed diabetes mellitus was 8.64 % (95 % CI: 6.7–11.2). The multivariable analysis showed that sedentary behavior, family history of diabetes mellitus, current hypertension, and fruit consumption of fewer than three servings per week were independently associated with undiagnosed DM in studied participants. ConclusionAlmost one in eleven adults living in the study area had undiagnosed DM, and various associated factors identified were modifiable risk factors that could be useful in planning intervention measures for lifestyle modification.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

THU265 A U-Shaped Relationship Between Undiagnosed Diabetes And Thyroid Function

Abstract Disclosure: Z.Z. Alvi: None. R. Karnchanasorn: None. H. Ou: None. L. Chuang: None. A.G. Gianoukakis: None. K.C. Chiu: None. Thyroid dysfunction is present in about 20 million people in the United States, with about 60% percent unaware of their condition. Thyroid hormone is one of the key hormone regulators of energy metabolism, while diabetes mellitus (DM) is a disorder of dysregulated fuel metabolism. Thus, thyroid hormone can affect glucose metabolism. Unfortunately, this area has received little attention over the past few decades. This study investigates the rate of undiagnosed DM in relation to thyroid function. A representative and noninstitutionalized US adult (aged 20 years or older with BMI available) population from the National Health and Nutrition Examination Survey 2007-2012 was used for this study. Subjects with known thyroid diseases and/or diabetes were excluded. This study only included subjects with available TSH, free T4 (FT4), and free T3 (FT3) levels and the defined status of glucose tolerance by HbA1c, fasting, and/or 2-hour post-challenge plasma glucose concentrations (n=6,843). The rates of previously undiagnosed DM were determined for each quintile of TSH, FT4, and FT3 with sample-weighted analysis. The adjusted odds ratio (AOD) with a 95% confidence interval (95%CI) for DM was calculated with the lowest quintile as a reference after consideration of age, gender, BMI, and racial/ethnic groups. Amongst 6,834 subjects in this study, DM was found in 488 subjects. The rates of DM from quintile 1 to quintile 5 were 3.37%, 3.95%, 3.84%, 6.42%, and 7.26 % for TSH quintiles (P&amp;lt;0.0001 by ANOVA); 5.69%, 4.27%, 5.05%, 4.74%, and 6.46% for FT4 quintiles (P&amp;lt;0.0001 by ANOVA); and 4.82%, 4.63%, 5.33%, 5.33%, and 4.93% for FT3 quintiles (P&amp;lt;0.0001 by ANOVA). Although the correlations were imperfect among TSH, FT4, and FT3 quintiles, the U-shaped relationship of DM with thyroid function was confirmed by the lowest AOD of 0.80 (95%CI: 0.80 - 0.80, P&amp;lt;0.0001) for the 3rd quintile of TSH (TSH: 1.321 - 1.771 mIU/L). The association of DM with low thyroid function was confirmed by the AOD of 1.31 (95%CI: 1.30 - 1.32, P&amp;lt;0.0001) for the 5th quintile of TSH (TSH: 2.519 - 80.968 mIU/L). The association of DM with high thyroid function was confirmed by AOD of 2.45 (95%CI: 2.44 - 2.46, P&amp;lt;0.0001) for the 5th quintile of FT3 (FT3: 3.51 - 28.82 pg/mL). FT4 confirmed the U-shaped relationship with the highest AOD of 1.07 (95%CI: 1.07 - 1.08, P&amp;lt;0.0001) for the 5th quintile of FT4 (FT4: 0.91 - 4.80 ng/mL) and the lowest AOD of 0.82 (95%CI: 0.82 - 0.82, P&amp;lt;0.001) for the 2nd quintile of FT4 (FT4: 0.91 - 4.80 ng/mL). Our study revealed a U-shaped relationship between the rates of undiagnosed DM with thyroid function in a representative and noninstitutionalized US adult population without a prior diagnosis of thyroid dysfunction and diabetes. Different underlying mechanisms may be responsible for the association of DM with high and low thyroid function. Further studies are required to elucidate the underlying mechanisms. Presentation: Thursday, June 15, 2023

Predictors of Prediabetes and Undiagnosed Diabetes Mellitus Based on HbA1c Levels in Indonesia

Prediabetes and Undiagnosed Diabetes Mellitus (UDDM) are associated with an increased risk of diabetes complications and other cardiovascular diseases. Early detection of both health problems is expected to reduce the burden of non-communicable diseases in the future. The purpose of this study is to investigate predictors of prediabetes and UDDM based on HbA1c levels among population ≥ 15 years old in Indonesia. This cross-sectional study involved 6,065 respondents of Indonesian Family Life Survey 5 (IFLS 5) who met the inclusion and exclusion criteria. Data associated with sociodemographic characteristics, lifestyle risk factors, hypertension, and obesity were obtained. Prediabetes was defined as HbA1c between 5.7-6.4%, while diabetes was defined as HbA1c ≥ 6.5%. Multinomial logistic regression analysis was performed to estimate adjusted Odds Ratio (aOR). The results showed that predictors of prediabetes were age, gender, marital status, and obesity, while predictors of UDDM were age, hypertension, and obesity. Identification of risk factors and early detection of prediabetes and UDDM is important, so that appropriate intervention can be given immediately to prevent complications.

Median rhomboid glossitis as a sign of undiagnosed diabetes mellitus - a case report

Background: Median Rhomboid Glossitis (MRG) is included in the group of nodular-plaque-like candidiasis, a subtype of chronic hyperplastic candidiasis. A lot of literature suggests that MRG is a manifestation of Diabetes Mellitus (DM), but the association between DM and MRG is unclear until now. This article reports an MRG found in an undiagnosed diabetes mellitus patient. &#x0D; Case: In October 2019, A 71-year-old man came to RSGM Universitas Jember to fix his loose denture. In the oral examination, we found a well-bordering, atrophic oval area surrounded by thick- soft white plaque. In his leg, we found itchy papule, ulcer, and crust multiple lesions. The microscopic examination of the white plaque swab showed that the spore and hyphae were found to fill all fields of view. The direct sugar blood level test showed that the sugar blood level was 390 mg/dL. We diagnosed the patient as having an MRG associated with suspected DM. &#x0D; Case Management: The patient was given miconazole oral gel and recommended to use it after cleaning the tongue three times a day. For diabetes management, the patient was referred to the Unit Medical Center University of Jember. The patient was diagnosed with diabetes mellitus and given oral-antidiabetics. After two weeks, the atrophic area had improved, and the white plaque had disappeared.&#x0D; Conclusion: General practitioners must be aware if they find the MRG in their patients caused a probability of underlying undiagnosed systemic disease, particularly diabetes mellitus on them.

The magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town, northcentral Ethiopia: A community-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a worldwide public health problem. The burden of diabetes has been continuously increasing from day to day, especially in developing countries like Ethiopia. Globally, half of all cases of diabetes mellitus are undiagnosed. Diabetes mellitus can be easily handled if it is detected early. There is limited evidence on the magnitude of undiagnosed diabetics and prediabetes at the community level in Ethiopia, particularly in the study area. ObjectiveTo assess the magnitude of undiagnosed diabetes mellitus, prediabetes, and associated factors among adults living in Debre Tabor town. MethodsA community-based cross-sectional study was conducted in Debre Tabor town from October to December 2021. A total of 407 participants were selected using a multistage sampling technique. A pretested structural questionnaire was used to collect demographic, behavioral, and clinical data. Anthropometric measurements were taken with standardized and calibrated equipment. A fasting venous blood sample was collected for blood glucose level determination. Logistic regression was used to identify risk factors. A P-value ≤0.05 was considered statistically significant. ResultThe magnitude of undiagnosed diabetes mellitus and prediabetes was found to be 4.5% (95% CI: 2.9–7.4) and 14.5% (95% CI: 11.1–18.1), respectively. Older age (AOR: 6.50, 95% CI: 1.82–23.21), abnormal body mass index (AOR: 6.84, 95% CI: 1.91–24.54), systolic hypertension (AOR: 8.74, 95% CI: 2.53–30.19), and family history of diabetes mellitus (FHDM) (AOR: 12.45, 95% CI: 3.63–42.65) were significantly associated with undiagnosed diabetes mellitus. Using saturated oil (AOR: 1.97, 95% CI: 1.09–3.55), having a high waist circumference (AOR: 2.16, 95% CI: 1.20–3.87), and being hypertensive (AOR: 2.26, 95% CI: 1.04–4.96) were all significantly associated with Prediabetes. ConclusionAdults in Debre Tabor town have a high prevalence of undiagnosed diabetes and prediabetes. A variety of modifiable risk factors were also identified. As a result, focusing the prevention strategy on such modifiable risk factors may help to minimize the prevalence of undiagnosed diabetes mellitus and prediabetes as well as future disease complications.

963-P: Near-Infrared Device for Diabetes Screening—ANODE01 Study

Background: Diabetes mellitus (DM) screening is currently complex, inefficient and requires resource-intensive, invasive sampling. Development of affordable, rapid, and precise mass-screening tools is valuable in identifying the millions with undiagnosed DM, especially in lower income countries. Materials and Methods: Accuracy and safety of a novel miniaturized full-spectrum near-infrared (NIR) spectroscopy device intended for DM screening was assessed in a multi-ethnic population with (n=50) or without (n=50) DM. Thirty NIR spectra scans per each middle fingernail and hand were tested for detection of dichotomised DM status based on cut-off values (&amp;lt; HbA1c 6.5% or 6.0 ≥) and specificity (%) of chemometrics outcomes, in assessment of glycated nail keratin versus an HbA1c point-of-care assay as control. Results: The cohort had mean age of 43.6 vs 64.4 years, 42 vs 76% females and 54 vs 68% Caucasians for non-DM and DM participants. Median (IQR) HbA1c % was 5.45 (5.2 - 5.6) and 6.8 (6.3-7.6), respectively. Clinical feasibility for NIR use was confirmed with no adverse device -related events reports for the over 6000 spectral measurements. The NIR-device demonstrated a specificity of 95.2% and 94.1% at HbA1c 6.5 and 6.0% cut-off levels, respectively (Table). Conclusions: Our preliminary results indicate high specificity and potential for clinical implementation of non-invasive NIR technology in detection of those without immediate DM risk. Disclosure P.Choudhary: Advisory Panel; Medtronic, Novo Nordisk, Dexcom, Inc., MannKind Corporation, Insulet Corporation, Research Support; Abbott Diabetes, Speaker's Bureau; Sanofi, Lilly. D.Lazaro-pacheco: Consultant; Glyconics Ltd. J.E.Salter: None. P.M.Paldanius: Consultant; Glyconics Ltd, Speaker's Bureau; Novartis. Funding Glyconics

Turning waiting time into treatment time: Weight reduction by a lifestyle intervention programme for patients with obesity before fertility treatment

AbstractAimTo evaluate the effects of offering a clinic‐driven lifestyle intervention programme in the waiting time before fertility treatment to women and men with obesity (body mass index [BMI] ≥ 30 kg/m2).MethodsThis prospective intervention study was conducted at a public Danish fertility clinic. All consecutive patients, both women and men, referred to the clinic between May 2020 and March 2021 with a BMI ≥ 30 kg/m2 were offered a 6‐month lifestyle intervention programme consisting of monthly motivational dialogues and counselling with a certified nutritionist nurse. Weight loss maintenance was evaluated at a 1‐year follow‐up visit conducted 6‐months after completion of the programme. The primary outcomes were absolute weight loss (kg) and relative weight loss (percent compared with weight at inclusion) upon completing the 6‐month programme and at the 1‐year follow‐up. Secondary outcome measures were effects on biochemical metabolic markers.ResultsForty‐five participants were enroled in the study, of which 38 completed the 6‐months lifestyle intervention programme and 33 participated in the 1‐year follow‐up. The participants' mean weight loss was 5.4 kg (95% confidence interval [CI]: 3.3, 7.5) after the 6‐month programme (30 of 38 participants lost weight) and 4.4 kg (95% CI: 1.4, 7.3) at the 1‐year follow‐up compared with baseline. Previously undiagnosed metabolic conditions were revealed in 61% of the participants, including four cases (11%) of undiagnosed diabetes mellitus type 2.ConclusionA clinic‐driven lifestyle intervention programme offered to patients with obesity in the waiting time for fertility treatment can successfully reduce weight in a high number of patients with stable results at 1‐year follow‐ups. Metabolic conditions, including diabetes mellitus type 2, are likely underdiagnosed in this group of patients, but further studies are needed.

Prevalence and predictors of undiagnosed type 2 diabetes and pre-diabetes among adult Egyptians: a community-based survey

BackgroundThe global prevalence of abnormal glycemic level comprising diabetes mellitus (DM) and pre-diabetes (PDM) is rapidly increasing with special concern for the entity silent or undiagnosed diabetes; those unaware of their condition. Identification of people at risk became much easier with the use of risk charts than the traditional methods. The current study aimed to conduct a community-based screening for T2DM to estimate the prevalence of undiagnosed DM and to assess the AUSDRISK Arabic version as a predictive tool in an Egyptian context.MethodsA cross-sectional study was conducted among 719 Adults aging 18 years or more and not known to be diabetics through a population-based household survey. Each participant was interviewed to fill demographic and medical data as well as the AUSDRISK Arabic version risk score and undergo testing for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT).ResultsThe prevalence of DM and PDM were 5% and 21.7% respectively. The multivariate analysis revealed that age, being physically inactive, history of previous abnormal glycemic level and waist circumference were the predictors for having abnormal glycemic level among the studied participants. At cut off points ≥ 13 and ≥ 9, the AUSDRISK respectively discriminated DM [sensitivity (86.11%), specificity (73.35%), and area under the curve (AUC): 0.887, 95% CI: 0.824–0.950] and abnormal glycemic level [sensitivity (80.73%), specificity (58.06%), and AUC: 0.767, 95% CI: 0.727–0.807], p < 0.001.ConclusionsOvert DM just occupies the top of an iceberg, its unseen big population have undiagnosed DM, PDM or been at risk of T2DM because of sustained exposure to the influential risk factors. The AUSDRISK Arabic version was proved to be sensitive and specific tool to be used among Egyptians as a screening tool for the detection of DM or abnormal glycemic level. A prominent association has been demonstrated between AUSDRISK Arabic version score and the diabetic status.

Association of Undiagnosed Pre-Diabetes and Type-2 Diabetes Mellitus with Interleukin-2 mRNA Expression Among Adults in Bayelsa State, Nigeria

Many cases of hyperglycemia are undiagnosed in Nigeria due to poverty and inadequate access to health care. Although hyperglycemia and type 2 diabetes mellitus (T2DM) are inflammatory conditions, however, the role of inflammatory mediators such as interleukin-2 in hyperglycemia and T2DM is not fully understood. The aim of the present study was to evaluate the prevalence and association of undiagnosed pre-diabetes and T2DM with IL-2 mRNA level among adults in Bayelsa State, Nigeria. A cross sectional design was employed to randomly select 130 adults and they were grouped into three: normal control, prediabetes, and T2DM. Fasting blood glucose concentration was measured using Accu-answer glucometer, while mRNA level of IL-2 was quantified using real time PCR method. The prevalence of undiagnosed pre-diabetes was 43.07% (males, 19.23%; females, 23.85%) while undiagnosed T2DM was 16.15% (males, 6.92%; females 9.23%). The expression of IL-2 mRNA was significantly upregulated in both pre-diabetes and T2DM subjects compared with normal control (p &lt; 0.05), but was significantly higher among T2DM subjects. Age ≥ 50 years, physical inactivity and marriage was significantly associated with hyperglycemia and T2DM (p &lt; 0.05). The present study found a high prevalence of undiagnosed pre-diabetes and T2DM among adults in Bayelsa State, Nigeria. Association of prediabetes and T2DM with IL-2 mRNA expression was found. IL-2 mRNA level might be a useful biomarker for monitoring diabetes mellitus progression. Directing diabetes survey and interventions to rural communities is highly recommended. Keywords: [Undiagnosed Diabetes, pre-diabetes, IL-2, rural communities, Bayelsa State, Nigeria]

Unmasking of Pre-Existent Hyperglycemia and its Association with Ventilation in COVID-19 Patients: Experience at a Tertiary Care Hospital

Objective: To determine the relationship between pre-existent hyperglycemia among patients with COVID-19 pneumonia requiring oxygen supplementation.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: COVID-19 isolation wards, High Dependency Units, and Intensive Care Units of Mayo Hospital Lahore Pakistan, from Apr to May 2021.&#x0D; Methodology: Eighty-one patients with hyperglycemia but without a prior diagnosis of diabetes mellitus were selected for this study. The data was collected from COVID PCR positive patients admitted to the isolation ward and intensive care unit at Mayo Hospital, Lahore. All the patients admitted during a 2-month duration from April to May 2021.&#x0D; Results: A Total of 81 patients were included, of which 54(66.7%) were males. On the basis of HbA1c, 68(84%), 12(14.8%) and 1 (1.2%) patient(s) were diagnosed diabetic, pre-diabetic and non-diabetic respectively. Of the four patients requiring mechanical ventilation, 3(75%) were diabetic, and 1(25%) was pre-diabetic. Of patients who required non-invasive ventilation, 68(84.4%), 12(14.2%) and 1(1.3%) were diabetic, pre-diabetic and non-diabetic, respectively.&#x0D; Conclusion: There is a significant burden of undiagnosed diabetes mellitus and pre-diabetes among patients with severe COVID-19 who require oxygen supplementation or admission to high-dependency units. Therefore, all patients should undergo thorough testing to exclude underlying diabetes mellitus.

Holistic Approach of Periodontitis Patient with Diabetes Mellitus: A Case Report

Diabetes mellitus (DM) is a common risk factor for patients with periodontal disease. Periodontitis patients with poor glycaemic control present with severe and advanced periodontal tissue destruction. A multidisciplinary approach between the periodontist and medical practitioner is clinically proven to maintain the patient's periodontal health and general well-being. This case report aims to raise the awareness and provide a basic guideline for medical and dental practitioners in identifying and managing periodontitis patients with undiagnosed DM particularly if patient is presented with recurrent periodontal abscess. A 34-year-old Malay lady presented with recurrent periodontal abscess and diagnosed with Periodontitis Stage III Grade C was treated holistically by the periodontist and a medical practitioner. The patient's compliance towards the periodontal treatment, routine medical check-ups, and medications has helped the patient achieved better periodontal health and controlled glycaemic level. Following her sixth periodontal re-evaluation in two years improvement in oral hygiene, resolution of gingival swelling and bleeding were seen after sequences of non-surgical, surgical periodontal treatment and patient’s compliance towards her medications and follow-up.

Unmasking a silent killer: Prevalence of diagnosed and undiagnosed Diabetes Mellitus among people living with HIV in rural South Africa.

To document the prevalence of Impaired Glucose Tolerance (IGT) and undiagnosed Diabetes Mellitus (DM) and to identify factors associated with undiagnosed DM in People Living With HIV (PLWH). Cross-sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM. IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average five years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (OR=3.59) and physical inactivity (OR=3.17). The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an aging population with additional cardiovascular disease risk factors. This article is protected by copyright. All rights reserved.

The clinical significance of serum HbA1c to diagnose diabetes mellitus during acute pancreatitis

ABSTRACT Aims To investigate the prevalence of diabetes mellitus (DM) in acute pancreatitis (AP) patients and to explore the extent to which inflammatory stress affects plasma glucose (PG) levels in AP patients. Methods A retrospective analysis of 2163 AP patients was performed. The PG differences among AP patients under differing pancreatic necrosis conditions and inflammation severity were compared. Receiver operating characteristic curves were used to assess whether fasting PG in the inflammatory stage of AP might be used for DM screening. Results The overall DM prevalence was 19.97% in AP patients, 32.41% of whom had newly diagnosed DM (based on HbA1c levels in patients who self-reported no DM). The DM prevalence was 46.93% in hyperlipidemic AP patients, 44.14% of whom had newly diagnosed DM. In patients with and without pancreatic necrosis, the optimal PG thresholds for the screening of newly diagnosed DM were 10.40 mmol/L and 8.21 mmol/L, respectively, with an AUC of 0.959 ± 0.034 (P < 0.001) and 0.972 ± 0.006 (P < 0.001), respectively. Conclusions For hospitalized AP patients and fasting PG levels exceeding 10 mmol/L (with necrosis) or 8 mmol/L (without necrosis) (P < 0.001), HbA1c testing is recommended to investigate the presence of comorbid undiagnosed DM.

Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference?

ObjectivesWe aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. Study designCross-sectional nationally representative household-based survey. MethodsWe used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches—adjusted odds ratio, relative inequality index, and slope inequality index—to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. ResultsIn our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05–3.29) and 1.47 times (95% CI 1.18–1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33–0.77) and 0.55 times (95% CI 0.36–0.85) less likely to have undiagnosed and untreated DM. ConclusionsIn Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.

Prevalence of diabetes mellitus in bullous pemphigoid patients in the absence of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis.

Bullous pemphigoid (BP) has been associated with dipeptidyl peptidase-4 inhibitor (DDP-4i) use in patients with diabetes mellitus (DM). The prevalence and association of DM in BP patients independent of DPP-4i use has not been investigated by meta-analysis. To perform a systematic review and meta-analysis on the association between diabetes and bullous pemphigoid. The goal was to determine the prevalence and pooled odds ratio of BP patients with DM in the absence of DDP-4i use compared to the general population prevalence of diabetes mellitus. OVID Medline, EMBASE, Cochrane Central and Web of Science were searched for relevant studies published from inception to April 2020. Case-control, case-series, cohort, and cross-sectional studies that included the association of BP and DM without DDP-4i's, in any language. PRISMA guidelines were followed for data extraction and the Newcastle-Ottawa Scale for risk of bias evaluation. Three reviewers independently performed data extraction. Pooled odds ratio and prevalence were calculated using the random effects model. The odds ratio and prevalence of BP patients with DM. Overall, 8 studies out of 856 identified publications through data base searches were included. The pooled prevalence of diabetes in patients with BP was 20.0% [95% CI 14%-26%; p = 0.00]. Within the comparative non-BP control population, 13% had diabetes. BP patients were more likely to have diabetes compared to a control population without BP [OR 2.10, 95% CI 1.22-3.60; p = 0.01]. This study found that twice the number of BP patients have DM (20%) compared to the general population reported as 10.5%, warranting monitoring of blood glucose levels in BP patients who may have yet undeclared or undiagnosed DM when initiating systemic steroids.