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Bacterial causes of community-acquired and nosocomial urinary tract infection in type 2 diabetes: A comparative approach
E Premprakash Patra, Sonam Karna, Dayanidhi Meher, Srilekha Mishra
September-December 2019, 10(3):102-109
Introduction: Urinary tract infection (UTI) in type 2 diabetes (T2D) is one of the most common infectious diseases diagnosed both in community and in hospital. Due to increased prevalence of disease and rising antibiotic resistance among uropathogens, it is important to have local community- and hospital-based knowledge of the organisms causing UTI in T2D and their sensitivity pattern to choose correct treatment regimen. Methodology: Samples were collected from both Outpatient Department (OPD) and Inpatient Department (IPD) of endocrinology, KIMS. The study was selected to compare the prevalence among the bacterial isolates from community-acquired UTI (CUTI) and nosocomial UTI (NUTI) in T2D individuals and compare the antibiogram pattern. Results: Of the total 92 culture-positive samples, 40 were CUTI and 52 were NUTI. Culture positivity was directly proportional to the presence of increased number of pus cell and glycaemic status. The most commonly isolated bacterium was Escherichia coli both in OPD and IPD followed by Enterococcus, Staphylococcus saprophyticus, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa and Proteus species except the Citrobacter spp. and Candida spp. which were isolated from ward patients. Conclusion: There was no significant difference of resistance pattern between CUTI and NUTI. Inappropriate use of antibiotics results in increase of antibiotic resistance, and hence, proper care should be taken regarding infection treatment guidelines promoting rational antibiotic prescribing in hyperglycaemic UTI cases.
  107,900 526 1
Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu
Balaji Bhavadharini, Mohan Deepa, Sivagnanam Nallaperumal, Ranjit Mohan Anjana, Viswanathan Mohan
January-April 2017, 8(1):22-26
Aim: The aim of this study is to evaluate the knowledge of gestational diabetes mellitus (GDM), including risk factors, importance of screening and post-partum follow-up, amongst pregnant women attending antenatal care in maternity clinics in South India. Methodology: The study participants were recruited from two antenatal clinics in Chennai and a few primary healthcare centres in South India. A detailed questionnaire was used to obtain basic data regarding general awareness and knowledge about GDM and other issues related to screening, risk factors, monitoring, long-term consequences and post-partum follow-up. Education status was graded as illiterate, primary education, secondary education and graduates. A composite score for knowledge of GDM was calculated. Results: A total of 100 pregnant women attending antenatal clinics were interviewed, of whom 59 were from urban Chennai and the rest from Kanchipuram district. Regarding risk factors of GDM, 48.8% of rural women were unaware of any risk factor while 55.9% of urban women reported a family history of diabetes as a risk factor. 49.2% of urban women and 75.6% of rural women did not know the long-term consequences of GDM to babies born to GDM women. 50.8% (urban women) said GDM could lead to type 2 diabetes mellitus in future while only 45% of rural women were aware of this. Mean composite score increased with higher education with graduates in both urban and rural areas, scoring the highest. Conclusion: Knowledge about GDM is poor amongst pregnant women, especially in rural areas. This highlights the need for training physicians, paramedical people and the public regarding GDM.
  15,762 1,450 13
Association of acute pancreatitis in a patient with Type 1 diabetes
Brijendra Kumar Srivastava, M Meera, S Anusha, Viswanathan Mohan
May-August 2017, 8(2):56-57
Background: Both acute pancreatitis and chronic pancreatitis are associated with the type 2 diabetes. Even some drugs used in management of diabetes can cause pancreatitis. However, the association of acute pancreatitis with type 1 diabetes mellitus is uncommon. Here, we present a case of a type 1 diabetic patient who developed acute pancreatitis. Case Presentation: An 18-year-old girl with pre-existing type 1 diabetes presented with complaints of abdominal pain radiating to back associated with nausea and vomiting for two days. She had the same complaints 3 months earlier, for which she was treated at a local hospital and it was diagnosed as acute pancreatitis. She did not have any evidence of gallstones, alcohol abuse, biliary sludge or hyperlipidaemia. Conclusion: This case makes the point that in a type 1 diabetic patient presenting with abdominal discomfort, we should not always relate it to diabetic ketoacidosis. Evaluation of the pancreatic enzymes should be done to rule out any associated evidence of acute pancreatitis, though uncommon.
  13,952 615 1
Validation of the antidiabetic effects of Vernonia amygdalina delile leaf fractions in fortified diet-fed streptozotocin-treated rat model of type-2 diabetes
Stanley Irobekhian Reuben Okoduwa, Ismaila Alhaji Umar, Dorcas Bolanle James, Hajiya Mairo Inuwa
September-December 2017, 8(3):74-85
Background: Vernonia amygdalina (VA) is used in the traditional management of diabetes in Nigeria. Previous scientific verification of VA is on Type-1 diabetes model, in spite of the continuous increase in Type-2 diabetes (T2D) among adults. This study aimed to validate the antidiabetic effects of VA leaf fraction (VALF) in a unique T2D rat model. Materials and Methods: Methanol crude extract of VA leaf was fractionated with solvents of increasing order of polarity (n-hexane, chloroform, ethyl-acetate, n- butanol and water). The antidiabetic activities of the fractions were evaluated in vivo in T2D model rats. Albino Wistar rats were induced with T2D and treated with the VALF. Several T2D-related parameters were measured. Results: T2D rats showed significant increase in serum levels of fasting blood glucose (FBG), liver and kidney biomarkers. At 28-day post-oral treatment with the VALF, FBG levels were significantly (P < 0.05) reduced (n- hexane [29.3%], chloroform [66.7%], ethyl acetate [36.2%], n- butanol [45.59%] and aqueous [39.3%]). The glucose tolerance ability was significantly improved in the chloroform fraction (Vernonia amygdalina chloroform fraction [VAc])-treated groups compared to the other fractions-treated group and diabetic control group. Furthermore, the VAc was found to be most effective as it ameliorates most of the alterations caused in the studied parameters in diabetic rats when compared with n- hexane, ethyl acetate, n- butanol and aqueous fractions. Conclusion: The study validates the anti-diabetic effects of VALF in fortified diet-fed streptozotocin-treated rat model of T2D, and suggests that the VAc is a potential candidate for development of a more effective drug for the management of T2D.
  11,755 876 11
Regional prevalence of gestational diabetes mellitus in North India
Samreen Siddiqui, Swati Waghdhare, Manju Panda, Sangeeta Sinha, Prachi Singh, Shweta Dubey, Sujeet Jha
January-April 2019, 10(1):25-28
Background and Objective: Incidence of gestational diabetes mellitus (GDM) varies globally from 2% to 14%. These cases in India are also increasing and emerging as a major public health problem. The prevalence of GDM among urban population of India has been reported as 16% and 17.8%, respectively. We conducted this study at three different regions of North India to estimate the prevalence of GDM. Materials and Methods: This pilot prospective cross-sectional study was conducted at three centres of North India with a base at Max Super Speciality Hospital, Saket, New Delhi, over a period of 10 months (December 2015–October 2016). Pregnant females attending gynaecology clinic at these centres were screened and enrolled as per the study inclusion criteria, after taking informed consent. Medical records were reviewed for recent haemoglobin levels, fasting blood sugar levels and other clinical parameters. Results: A total of 230 participants were enrolled in this study with 65 from Muzaffarpur, 65 from Bhilai and remaining 100 from Delhi, which include a mixed population. The overall prevalence of GDM was observed as 10%, with a regional prevalence of 10.77% at Bhilai, lower prevalence at Muzaffarpur (3.07%) and 14% in Delhi with a mixed population. A significant difference (P < 0.01) was observed in the mean age and body mass index of participants at Bhilai, Muzaffarpur and Delhi. Conclusion: Although there was a variable sample size at these three centres, we could conclude from this pilot study that there is a high prevalence of GDM at Bhilai district while very low prevalence at Muzaffarpur and Bihar. Large-scale studies are required to be done to estimate the prevalence in these regions, which would ultimately create awareness among clinicians to screen all females for GDM.
  11,335 1,244 5
Consensus and recommendations on continuous glucose monitoring
Manoj Chawla, Banshi Saboo, Sujeet Jha, Sudhir Bhandari, Prasanna Kumar, Jothydev Kesavadev, Yash Pal Munjal, Viswanathan Mohan, Ranjit Unnikrishnan, Vishal Katswar, Nanditha Arun, Bhavana Sosale, Ranjit Mohan Anjana, Dhruvi Hasnani
January-April 2019, 10(1):4-14
  11,051 1,459 3
Can decreased heart rate variability be a marker of autonomic dysfunction, metabolic syndrome and diabetes?
Gunjan Y Trivedi, Banshi Saboo, Ram B Singh, Anuj Maheshwari, Kamal Sharma, Narsingh Verma
May-August 2019, 10(2):48-56
Epidemiological studies show an emergence of diet- and lifestyle-related diseases; Cardio-metabolic diseases (CMD) and neuropsychiatric diseases (classified as non-communicable diseases or chronic diseases). Diet and lifestyle factors can cause adverse effects on autonomic function resulting in decreased heart rate variability (HRV). Low HRV is a risk factor for CMDs. There is a need to find out new methods of early diagnosis for prevention and treatment of these problems because the neurohormonal dysfunction could be the earliest manifestation. It is possible that HRV could be a marker for the early diagnosis of these problems, because it is characterised with increased sympathetic and reduced parasympathetic activity. Several studies indicate that increased unhealthy diet, mental stress, sedentary lifestyle, tobacco, insomnia and alcoholism may be associated with neurohormonal dysfunction, which may cause decline in HRV. Majority of the chronic diseases (e.g., diabetes, hypertension, heart attack, neuropsychiatric disease and cancer) are associated with decreased HRV. The studies also indicate that solar and geomagnetic activities may influence circadian clock and hypothalamus resulting in the oxidative stress and inflammation with alteration in HRV. It is possible that reduced HRV will correlate with various stages of autonomic dysfunction, associated with chronic diseases. Simple methods need to be developed to measure HRV for early diagnosis of neurohormonal dysfunction, which may be important for early management. This review aims to find out available evidence on the role of HRV in the early diagnosis of chronic disease (with specific focus on Type 2 diabetes) and the factors affecting HRV.
  11,578 840 10
Effect of sudden ban of pioglitazone on glycaemic control of type 2 diabetes mellitus patients in a tertiary care hospital in South India
Sheetal Vasundara Mathai, Prabha M Adhikari, Sashidhar M Kotian
May-August 2019, 10(2):87-88
  11,598 383 -
Glucose monitoring technologies - complementary or competitive? Role of continuous glucose monitoring versus flash glucose monitoring versus self-monitoring of blood glucose
Jothydev Kesavadev, Lakshmy Ramachandran, Gopika Krishnan
September-December 2017, 8(3):61-67
We have numerous technologies that can help keep a close watch on an individual's glycaemic status and thereby assist in developing successful diabetes management strategies. For more than five decades, self-monitoring of blood glucose (SMBG) has remained as the gold standard tool to manage glycaemic status and has gained huge acceptance. Rigorous research further led to the development of more and more advanced technologies such as continuous glucose monitoring and flash glucose monitoring. These novel technologies are more promising in terms of revealing the complete glycaemic picture and even more user-friendly than the already established blood glucosemetres. However, they are yet to achieve remarkable accuracy and performance. There will also be a subgroup of patients who will be using these technologies only occasionally and thus will definitely require SMBG at other times. Again, with regard to the retrospective ones, glucose data can be obtained only once they are downloaded to the system and hence, real-time values will still have to be procured with the help of an SMBG. In future when the accuracy and performance of these newer technologies become equal to that of glucometres, the glucometres might vanish. Until then, all these technologies will definitely go hand-in-hand and supplement each other than competing each other. All the related literature were retrieved from various databases including 'PubMed' and 'Cochrane Database of Systematic Reviews' using specific search terms that were relevant to the topics discussed this manuscript.
  10,114 1,094 9
Cardiovascular risk stratification in new-onset diabetes by qrisk2 risk score and conventional risk score within 3 months of diagnosis of diabetes
Sujata Hiran, Anjala Singh, Pooja Sial
May-August 2018, 9(2):39-44
Aims: This study aims to assess the cardiovascular disease (CVD) risk by QRISK2 score and conventional risk score in new-onset diabetes without a history of heart disease or stroke, to find out if patients with diabetes have similar risk of coronary artery disease (CAD) as people with established CAD and to compare the conventional and QRISK2 score for the prediction of CVD. Materials and Methods: A cross-sectional study was conducted at Bhilai over 1 year in 183 newly detected diabetic patients (89 males and 94 females) aged 40–70 years. The probable risk factors were determined by cross-tabulation of cardiometabolic parameters with the 10-year cardiovascular risk level using the QRISK2-2016 and the conventional major risk markers. Results: The mean age in males was 53.5 ± 9.7 years and in females was 54.2 ± 10.1 signifying no gender differences. Mean body mass index in the most of the individuals in both sexes were either in the pre-obese or obese range. The mean value of high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), non-HDLc, total cholesterol and HDLc (total cholesterol/HDLc) ratio was found to be higher in females than in the males. In the conventional risk group, 67.7% of individuals with new-onset diabetes were in high-risk category, 28.9% were in moderate-risk category and 3.2% in low-risk category. The QRISK2 score in new-onset diabetes was 68.8% in high-risk category, 31.1% were in moderate-risk category and none in the low-risk category. Conclusion: Risk stratification is essential for the primary prevention of CVD risks in patients with diabetes as patients with new-onset diabetes cannot be categorised as CAD risk equivalent.
  8,898 1,525 -
Diabetes in Asia: Special challenges and solutions
Akhtar Hussain
September-December 2018, 9(3):69-72
  8,724 1,576 4
Access to diabetes medicines at the household level in eight counties of Kenya
Selam Hailu, Peter C Rockers, Taryn Vian, Monica Onyango, Richard Laing, Veronika J Wirtz
May-August 2018, 9(2):45-55
Background: In 2016, an estimated 872,000 Kenyans were living with diabetes, a country average of 4%. The study objectives were (1) to describe the sociodemographic and geographic characteristics of the households with individuals diagnosed and on treatment for diabetes (2) to describe the medicines available at the household level, monthly household expenditure on medicines, location of diagnosis and treatment and the associated factors of medicines purchase location. Methods: A household survey in eight countries was conducted asking whether a household member had been diagnosed and treated for a non-communicable disease (NCD). Households with at least one member with diabetes were included in this study. Results: Out of the 142 individuals being diagnosed and treated for diabetes, 68 participants (47.9%) were prescribed single and 74 (52.1%) multiple treatments. While 54.9% of the participants were diagnosed at public hospitals, 50% of individuals purchased their medicines from a private pharmacy/chemist or private hospitals. Purchase of medicines in public facilities was associated with being less wealthy and having more than one NCD. Having medicines not available at home was reported by 26.1% of individuals, mostly because the medicines were too expensive to buy. Conclusions: Affordability of diabetes medicines remains an important barrier to access. In addition, essential medicine list restrictions to offer diabetes medicines at public primary care level limit access. Programs to increase access to NCD medicines need to consider that diagnosis and choice of treatment occurs largely in the public sector whereas medicines purchase most frequently takes place in the private sector.
  8,670 587 1
Erectile dysfunction in diabetes mellitus: A review
Deepak K Jumani, Omkar Patil
January-April 2020, 11(1):1-7
The International Diabetes Federation estimates that globally there are 425 million people with diabetes. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% in different studies. Among men with ED, those with diabetes are likely to experience the problem 10–15 years earlier than men without diabetes. This review aims to provide an update of the epidemiology, pathophysiology and management of ED in diabetes patients in India. The proposed mechanisms of ED in diabetic patients include elevated advanced glycation end-products and increased levels of oxygen-free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate-dependent kinase-1. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome and excessive alcohol consumption. Therefore, the promotion of healthful lifestyles would yield great benefits in reducing the burden of ED. The treatment of diabetic ED is multimodal. The treatment of the underlying hyperglycaemia and comorbidities is of utmost importance to prevent the progression of the disease. The peripherally acting oral phosphodiesterase type 5 inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional a non-invasive treatment option. The local administration of vasoactive medication through urethral suppository or intracorporal injection can be effective with minimal side-effects.
  8,337 915 2
Comparison of efficacy of add-on therapy of teneligliptin versus pioglitazone among type 2 diabetes mellitus patients ineptly controlled on dual therapy of metformin plus sulfonylurea
Vanjari Nikhil Kumar, Sandeep Reddy Konyala, Siva Subrahmanyam Bandaru, Goverdhan Puchchakayala
May-August 2019, 10(2):76-82
Aim: The main aim of the study is to compare the efficacy of add-on therapy of teneligliptin (20 once daily) versus pioglitazone (15 mg once daily) among type 2 diabetes mellitus (T2DM) patients inadequately controlled on dual therapy of metformin (MF) plus sulfonylurea (SU). Materials and Methods: It is a prospective, observational, comparative study conducted in patients from the outpatient department of Sri Bhadrakali Hospital located at Warangal, Telangana state, India. The efficacy of pioglitazone and teneligliptin was assessed by measuring the change in the glycated haemoglobin (HbA1c), Fasting Plasma Glucose (FPG), Post Prandial Blood Glucose (PPBH) levels after 12 weeks of treatment. FPG, PPBG and HbA1c levels at baseline and 12 weeks. The primary endpoint was changed in HbA1c levels at 12 weeks as compared to the baseline levels in both groups. The secondary endpoints were changes in FPG, PPBG levels at 12 weeks as compared to baseline levels. Along with, serum cholesterol, triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured both at baseline and after 12 weeks. Results: At study end, HbA1c levels were reduced from baseline by 0.7% (P = 0.0049) in the pioglitazone group and 1% (P = 0.0002) in the teneligliptin group. The mean changes in FPG levels from baseline to week 12 were −39.8 mg/dl (P ≤ 0.0001) in teneligliptin and −11.48 mg/dl (P = 0.00380) in pioglitazone group. The mean PPG levels from −47.8 mg/dl (P = 0.0003) in teneligliptin and −25.5 mg/dl (P = 0015) in pioglitazone group. After 12 weeks of study, the levels of TG, total cholesterol (TC), LDL −71.5 (P = 0.0973), −15 (P = 0.0501), 18.8 (P ≤ 0.0008) mg/dl and −31.38 (P ≤ 0.0001), −21 (P ≤ 0.0001), −11.68 (P = 0.0028) mg/dl in teneligliptin group and pioglitazone group, respectively. There was significant increase in HDL levels 5.3 (P ≤ 0.0001) mg/dl in teneligliptin group and 5.2 (P = 0.0001) mg/dl in pioglitazone group. Conclusion: Both teneligliptin 20 mg and Pioglitazone 15 mg provided additional HbA1c lowering to that achieved with MF and SU. Teneligliptin showed more effective reductions in HbA1c, FPG, PPBG, HDL and LDL levels. Pioglitazone showed significant changes in HbA1c, HDL, TC, triglyceride levels and significant changes in FPG, PPBG and LDL levels. Reduction in HbA1c and plasma lipids slows down the diabetes progression and decreases the risk of microvascular and macrovascular complications.
  8,641 603 -
Management of Type 1 diabetes in a limited resource context: A study of the diabetes research education and management trust model in Nagpur, Central India
Caroline Sarah Zuijdwijk, Sharad Pendsey, James Ron, Kathryn A Williams, Salwa Akiki, Seema Chalkhore, Graham D Ogle, Alexandra Ahmet
May-August 2017, 8(2):37-44
Background/Objective: Diabetes Research Education and Management (DREAM) Trust (DT) is a charitable organisation that offers free insulin and healthcare to children and youth with type 1 diabetes (T1D) in central India. We systematically describe DT's model of care and evaluate medical and sociodemographic factors influencing glycaemic control in this resource-poor setting. Methods: Study of DT patients diagnosed with T1D <16 years old and followed at DT ≥1 year. Participants completed an interview, retrospective chart review and prospective haemoglobin A1c (HbA1c) measurements. Uni- and multi-variate linear regressions determined factors associated with HbA1c. Percentage of underweight patients (as proxy for glycaemic control) was compared at presentation to DT versus time of interview. Results: A total of 102 DT patients (51% female) completed the interview and chart review. 74 had HbA1c measured. Median HbA1c was 10.4% (90.2 mmol/mol). In multivariate regression, higher HbA1c was independently associated with higher insulin dose/kg (P < 0.001) and holding a below the poverty line certificate (P = 0.004). There was no association between HbA1c and age, sex, caste, religion or experience of stigma. However, the psychosocial burden of T1D (expressed as concern about others learning about the diagnosis, and worry about the future), and experience of stigma were substantial. Percentage of patients with underweight body mass index was significantly lower at the time of study vs. presentation to DT (P = 0.005). Conclusions: The DT charitable programme overcomes social status, gender inequalities and experience of social stigma to provide life-saving treatment to children with T1D in central India. Glycaemic control remains inadequate however, with children living in extreme poverty most at risk.
  8,297 491 1
Indian reality of managing type 2 diabetes: an expert review of global and national guidelines for optimum insulin use
Ajay Kumar, Surendra Kumar Sharma, Arvind Gupta, Arundhati Dasgupta, Arthur J Asirvatham, Pradeep G Talwalkar, Ashok Kumar Das, Viswanathan Mohan
September-December 2020, 11(3):148-157
Several guidelines provide recommendations on insulin therapy in people with type 2 diabetes mellitus (T2DM). Major global guidelines have been adapted in multiple countries, and local consensus recommendations have been published giving guidance on insulin therapy considering local realities. This expert review focuses on the recommendations from global and Indian guidelines on insulin therapy in people with T2DM. It emphasizes on a patient-centric approach, including the glycemic parameters, psychosocial aspects, phase of life, and the Indian realities of T2DM management in guiding optimum insulin therapy for initiation and intensification. Therapeutic inertia towards timely insulin initiation needs to be bridged. Owing to the high carbohydrate diet and high postprandial glucose (PPG) excursions, insulin co-formulation and premix insulins offering total glycemic control can be preferred for a timely insulin initiation in Indians with T2DM that is uncontrolled despite multiple oral antidiabetic drugs. They also provide simplicity and convenience for insulin initiation and intensification. Among basal insulins, insulin degludec and glargine U300 are found to be safer, and offer more dosing flexibility than the first-generation basal insulin analogs. Faster-acting insulin aspart has been shown to provide better PPG control and dosing flexibility compared to a rapid-acting insulin analog with a lower risk of hypoglycemia. Thus, based on available evidences, a preferred use of insulin analog over conventional human insulins is suggested, keeping cost considerations in mind. The review also discusses optimum use of concomitant medications with insulin therapy for T2DM management.
  7,944 683 2
Evaluation of pharmacists' educational and counselling impact on patients' clinical outcomes in a diabetic setting
Winifred Aitalegbe Ojieabu, Shakirat Iyabo Bello, John E Arute
January-April 2017, 8(1):7-11
Background: Nigeria had the highest number of people living with diabetes mellitus in the African region in year 2013. Previous researchers have found that patients with knowledge of their diseases including their treatment methods have a high likelihood to succeed in managing the disease conditions. Many pharmaceutical care programmes which have been successfully applied in various countries to enhance clinical outcomes and health-related quality of life are not very common in Nigeria. Objective: This study was to evaluate pharmacist's educational and counselling impact on diabetic patients' outcomes in a diabetic setting. Materials and Methods: The 4-month randomised controlled study involved 150 elderly Type 2 diabetic patients. Sociodemographic and clinical parameters were measured. We educated and counselled the 75 patients in our intervention group at least four times during the study period, but the control group was deprived of the pharmacist's intervention. Results: Female to male participants was in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority (>40%) of the patients in both groups had primary education. Baseline and 4-month mean fasting blood sugar in the control group was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825), whereas the intervention group had 156.7 ± 30.5 and 131.8 ± 40.4, respectively (P < 0.001). Mean systolic blood pressure in both groups was 146.4 ± 13.9 and 133.8 ± 18.5 (P < 0.001), respectively. Adherence levels to medication taking in both groups were 42.7%:94.7%, respectively (P = 0.001). Conclusion: This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.
  7,692 851 3
Technology in the management of diabetes mellitus
Ranjit Unnikrishnan, Nitika Sharma, Viswanathan Mohan, Harish Ranjani
January-April 2018, 9(1):3-11
The explosive increase in the prevalence of diabetes mellitus in resource-strapped regions of the world demands innovative solutions in healthcare. Advances in information technology, diagnostics and food technology have the potential to make diagnosis and treatment of diabetes simpler, cost-effective and patient-friendly. Newer methods of glucose testing such as the ambulatory glucose profile promise to make clinical decision-making easier and more robust. More advanced modes of insulin delivery are likely to help larger proportions of patients achieve their glycaemic goals with minimal risk of hypoglycaemia. Use of telemedicine and electronic medical records represents a significant advance in improving delivery of diabetes care and monitoring its outcomes. Efforts are also on to harness the wide penetrance of mobile phones in spreading awareness about diabetes and its prevention as well as in screening for retinopathy. Advances in technology also promise to favourably alter the food habits of the population, with the advent of the novel high-fibre white rice being a case in point. This narrative review aims to discuss some of the ways in which emerging technologies are making diabetes monitoring and treatment easier, more effective and pleasant for the patient.
  7,637 704 2
The Risks of Repeated Use of Insulin Pen Needles in Patients with Diabetes Mellitus
IV Misnikova, AV Dreval, VA Gubkina, EV Rusanova
February-May 2011, 2(1):2-2
Repeated use of the same needle for insulin injections is a common practice. How ever, after repeated use, the needle can become significantly deformed and this can increase injection morbidity and probably, the risk of lipodystrophy at the site of insulin injection. In the literature, there is evidence that repeated use of insulin needles increases the risk of infection. The aim of our study was to assess the complications of repeated use of BD Micro-Fine Plus insulin pen needles. The parameters measured were the frequency and the nature of contamination of needles with bacterial microflora, the intensity of pain and the presence of local reaction at the site of insulin injection. This was a blinded, randomized study. Forty five hospitalized patients with diabetes mellitus type 1 and 2; over 18 years of ages on a regimen of three injections of short -acting insulin a day and who gave informed consent , were included in the study. The patients were randomized into 3 groups with 15 patients in each group. The first group used their needle once only, the second group used a single needle for 4 days (12 injections), and the third group used a single needle for 7 days (21 injections). Change of needles was carried out by the medical staff. The duration of observation for all groups was 7 days. After use, microbiologic washouts were obtained from needles for aerobic and anaerobic flora and fungi. The intensity of pain after injection was estimated , using the Visual-Analogue Scale (VAS) on day 1, 4 and 7 of the study. The presence of local reaction at insulin injection site was determined by a doctor on days 1, 4 and 7 of the study. Differences were considered statistically significant at p <0.05 (95 % level of significance). Growth of microbe flora (Staphylococcus epidermidis - (Hly +) was found in 26,6 % of the patients, who used a needle once only. The maximum number of needles contaminated by microflora was found in the 3rd group (33.3 %) (Staphylococcus epidermidis - (Hly +) and Gram+ bacilli. The intensity of pain was significantly higher in the 2nd group than in 1st one (p=0,045) on the fourt h day of study, and in the 3rd group pain was considerably more intense than in 1st group (?=0. 03) on day 7 of the study. Hyperemic foci at injection sites on day 4 and 7 of the study were found only in the 2nd and 3d groups (13.3 and 26,6 %, correspondingly). After a single use microbe contamination can be detected on insulin needles. Repeated use of needles amplifies the risk of needle contamination. Patients using insulin needles several times have more pain at injection site.
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  7,012 816 -
HIV and antiretroviral therapy-induced metabolic syndrome in people living with HIV and its implications for care: A critical review
Sakhile Khetsiwe Salome Masuku, Joyce Tsoka-Gwegweni, Ben Sartorius
May-August 2019, 10(2):41-47
HIV has remained a major global public health concern for more than three decades. While global efforts are coalesced in the fight against HIV, the number of people living with HIV (PLHIV) is continuously increasing due to the rollout of antiretroviral therapy (ART). This relates, in part, to the intensified efforts in HIV prevention and control strategies through extensive HIV testing. Consequently, more and new people have learnt their HIV-positive status, implying that more are at risk of suffering the negative effects of HIV and ART. HIV has been implicated in the development of many non-communicable diseases such as cardiovascular diseases and type 2 diabetes mellitus (T2DM). This study conducted a critical review of the literature on the mechanisms through which HIV and ART cause metabolic syndrome, and the implications such understanding has to the care provided to PLHIV. The findings of this review suggest that HIV induces metabolic syndrome through stimulation of immune cells which, in turn, trigger an inflammatory response. ART also triggers the inflammatory response. The inflammatory response suppresses adiponectin and causes impaired insulin action on skeletal muscles. Since the presence of metabolic syndrome greatly increases the risk of non-communicable diseases, particularly T2DM, there is a need for metabolic syndrome screening and prevention among PLHIV. Conducting routine body mass index and waist circumference measurement with periodical triglycerides measurement is necessary for the early detection of metabolic syndrome and the prevention of T2DM and cardiovascular conditions. There is also a need for a model of care for PLHIV that will provide guidance on the prevention of metabolic syndrome hence prevent the development of T2DM with its dire effects on the quality of life.
  6,845 718 9
Expanding the concept of ‘Clinical Inertia’ in diabetes
Viswanathan Mohan
January-April 2019, 10(1):1-3
  6,560 875 3
Diabetic retinopathy awareness and practices in a low-income suburban population in Karachi, Pakistan
Rubina Hakeem, Zahid Awan, Saleh Memon, Munazza Gillani, Sikandar Ali Shaikh, Muhammad Adil Sheikh, Sidra Ilyas
May-August 2017, 8(2):49-55
Purpose: This study presents observations about knowledge, attitude and practices of people with diabetes living in Chanesar Goth, which is a suburban area of Karachi. Methodology: Data were collected by trained lady health workers during their home visits of the families. The responses in most cases were open ended and later categorised according to themes and purpose for asking specific questions. Results: The sample consisted of 59 (31.6%) males and 128 (68.4%) females. The mean age of males and females was 56 years and 49 years, respectively. The mean duration of diabetes for females and males was 6.8 years and 8.34 years, respectively. Frequency of correct answers to question about treatment of diabetes-related eye disease was relatively low (24% male, 20% female). Proportion of patients having good awareness was significantly higher among those who had diabetes for 10 or more years (60%) as compared to those who had diabetes for shorter duration (42%, P < 0.026). Only half of the patients had a firm belief that diabetes is preventable and about one-third had belief that diabetes is treatable. Patients'' eye testing practices were associated strongly with their attitude towards eye testing and their knowledge about the relation of eye problems to diabetes. Proportion of patients who had got their eyes checked more than twice since the diagnosis of diabetes was highest among patients with both knowledge and belief about eye testing (35.3%), followed by those who only had a firm belief (19.7%) and was lowest than among those who neither had belief nor knowledge (9.1%) (P = 0.008). The level of awareness was higher among females and those who had diabetes for a longer duration. Conclusion: Educational interventions should focus on inculcating positive attitudes and firm belief in the importance of self-care.
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Incidence and factors associated with diabetic retinopathy among diabetic patients at arbaminch general hospital, gamo gofa Zone (longitudinal follow up data analysis)
Yilma Chisha, Wondwossen Terefe, Huruy Assefa
January-April 2017, 8(1):1-6
Background: Currently, 93 million people are estimated as living with diabetic retinopathy (DR) worldwide. The incidence, retinopathy-free survival time and associated factors of DR in developed countries have been well documented; but in Ethiopia, national data on incidence and associated factors of DR are lacking. Objective: The objective of this study is to determine incidence and factors associated with the development of DR among diabetic patients at Arbaminch General Hospital, Ethiopia. Materials and Methods: Longitudinal follow-up data analysis with record review of 400 diabetic patients was conducted at Arbaminch General Hospital. Among 400 diabetic patients, 270 diabetic patients with baseline information and without a history of hypertension at baseline were included in this study. Whereas, pregnancy induced diabetes and patients with retinopathy at baseline were excluded from this study. Consecutive sampling technique was applied to select study participants. Data of cohorts were extracted from medical record using pre-tested structured extraction checklist. Data cleaning, coding, categorising, merging and analysis carried out by STATA version 12. Descriptive statistics was done and summarised accordingly. Bivariate Cox proportional hazard regression analysis was done to select potential candidates for the full model atP ≤ 0.25 and multivariable Cox proportional hazard regression analysis was made to estimate the independent effect of predictors on the incidence of DR. Model diagnostic tests were performed and final model fitness was checked by Cox and Snell residuals; finally, statistical significance was tested atP < 0.05. Results: Overall incidence of DR at Arbaminch General Hospital among diabetic patients ever enrolled since 1990 E.C. was ~36 cases per 1000 patients per year and an estimated median time to develop was approximately 10 years. The incidence of diabetic retinopathy was high among patients whose disease duration was >12 years. Adjusted analysis showed that the hazard of developing DR was statistically and positively associated with baseline age, baseline systolic blood pressure (SBP) level and fasting blood glucose (FBG) level. Conclusion: In the current study, the incidence of DR was high. Since baseline age, baseline SBP level and high FBG level were statistically and positively related with the development of DR; special care should be given in addition to routine care.
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Prevalence of glucose intolerance in cirrhotics and risk factors predicting its progression to diabetes mellitus
Pavan Hanchanale, Jayanthi Venkataraman, Mayank Jain, Vijaya Srinivasan, Joy Varghese
January-April 2017, 8(1):12-17
Background: Liver cirrhosis is a unique clinical entity wherein long-standing diabetes mellitus (DM) can predispose an individual to cirrhosis, and on the other hand, a long-standing cirrhosis liver can predispose a cirrhotic to DM, secondary to deranged glucose and insulin metabolism. Aim of the Study: The aim of this study is to determine the prevalence of impaired glucose tolerance (IGT) in patients with liver cirrhosis and risk factors predicting these patients to progression to DM. Materials and Methods: Adult patients above 18 years of age, with a diagnosis of cirrhosis of liver, irrespective of the diabetic status, the aetiology and severity of liver disease, were enrolled for the prospective cross-sectional study. The American Diabetes Association guidelines were followed for classification of DM. Fasting serum insulin assay was done for calculation of homeostatic model assessment insulin resistance (HOMA-IR) with a cut-off of >2.5. Patients with normal baseline glucose tolerance test (GTT) or IGT were followed up prospectively for 6 months at 3 monthly interval. Appropriate statistical tests were applied. Results: Of the 505 cirrhotic patients screened, 158 patients fulfilled the selection criteria. The overall mean age of these 158 patients was 53.3 ± 11.5 years; majority were men (93.7%). As a significant proportion of patients belonged to Child-Turcotte-Pugh (CTP)-C (51.3%) followed by CTP-B and CTP-A. Seventy-four patients had self-reported diabetes (46.8%) at registration. Post-GTT, the prevalence of impaired IGT was 27.4%, and new-onset diabetes mellitus (NODM) was 11.9%. Patients with CTP-C were at greatest risk for either IGT or NODM (P < 0.05). IGT+NODM patients had high median values of 2-h GTT, fasting serum insulin and HOMA-IR compared to non-diabetic participants at admission with a significant trend increase at 3 and 6 months. Conclusion: The prevalence of glucose intolerance is significantly high in individuals with cirrhosis. A 2-h GGT unmasks a significant number of cirrhosis with normal fasting blood sugar and glycated haemoglobin. A trend towards an increase in glucose intolerance and insulin resistance is noted with increasing duration of illness.
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Vitrectomy in advanced diabetic eye disease: A seremban experience
Pushpa Raman, Bethel Indira Livingstone
May-August 2017, 8(2):45-48
Aim: The aim is to study the pre-operative characteristics, outcome and postoperative complications in patients undergoing vitrectomy for advanced diabetic eye disease (ADED) and to identify factors that predict the poor visual outcome. Methods: Retrospective cohort study of 177 consecutive vitrectomies in 168 patients with ADED, with a minimum follow-up of 6 months. Results: At presentation, 101 (61.2%) eyes had visual acuity (VA) of <6/60. Post-vitrectomy, 91.5% had improved or unchanged VA. The mean logMAR VA improved significantly from 1.73 to 0.82 (P = 0.0001). Improvement of at least 0.3 logMAR units was observed in 124 eyes (74.7%) and 15 eyes (9.0%) worsened by at least 0.3 logMAR units. Anatomic success was achieved in 97.7%. Post-operative complications included vitreous cavity haemorrhage in 37 eyes (21%), retinal detachment in 5 eyes (3%), and rubeotic glaucoma in 5 eyes (3%). At the last follow up, 37 eyes (20.9%) had VA of <6/60. Multivariate analysis showed that pre-operative VA <6/60 in either the operated or the unoperated eye, macular detachment and post-vitrectomy rubeosis iridis were predictors of poor post-operative vision. Conclusions: Majority of patients with ADED can expect improved VA or stabilisation of their proliferative retinopathy after vitrectomy. Surgeons should consider the predictors of poor visual outcome in the selection of patients and pre-operative counselling.
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