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  Citation statistics : Table of Contents
   2017| May-August  | Volume 8 | Issue 2  
    Online since October 11, 2017

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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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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.
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Association of depression and its treatment on the outcome of diabetic foot ulcer
Muhammad Yakoob Ahmedani, Shahid Ahsan, Muhammad Saif Ul Haque, Asher Fawwad, Abdul Basit
May-August 2017, 8(2):27-31
Aim: This study aimed to assess depression symptoms among patients with diabetic foot ulcer and to compare the outcome of diabetic foot ulcer between normal participants and participants with depressive symptoms. Methodology: This prospective, observational study was conducted at Baqai Institute of Diabetology and Endocrinology, after getting approval from ethics committee. Patients who were attending the foot clinic were invited to participate in the study. Diabetic foot ulcers were classified according to the University of Texas classification criteria. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Both groups were given standard diabetes and foot care treatment. In addition, antidepressant treatment was given to the participants with depressive symptoms for 3 months. After 3 months, PHQ-9 was again administered to the participants with depressive symptoms, and the outcome of foot ulcer was noted and compared to baseline data. Results: Of the total participants (n = 105), nearly half of them were found to have depressive symptoms (n = 53, 50.4%). At baseline, no significant difference was found in the distribution of hypertension, history of smoking and duration, grading and type of ulcers between normal participants and participants with depressive symptoms. Three months of antidepressant treatment brought significant improvement in the mean depression score (P ≤ 0.05). After 3 months, healing time of ulcers, rate of minor and major amputations, patients on treatment and patients who lost to follow-up were comparable between the groups. Conclusions: In this study, every second patient with diabetic foot ulcer was found to have depressive symptoms. Anti-depressive treatment alleviated depression and made foot ulcer outcome comparable to non-depressed patients.
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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.
  1 8,023 482
Insulin use on the top of the world
Jatinder Kumar Mokta, Sanjay Kalra, Kiran K Mokta, Ramesh Gulepa
May-August 2017, 8(2):58-59
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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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Relationship between vitamin D levels and glycaemic control in Type 2 diabetes mellitus patients in Lagos, Nigeria
Anyanwu Anthony Chinedu, OA Fasanmade, H. A. B. Coker, AE Ohwovoriole
May-August 2017, 8(2):32-36
Background: Studies have reported a relationship between Vitamin D deficiency and type 2 diabetes mellitus (T2DM). There is no information on the Vitamin D status or relationship between Vitamin D and glycaemia in Nigerian patients with T2DM. The objective of this study was to determine the relationship between serum Vitamin D levels and glycaemic control, as determined by glycated haemoglobin (HbA1c) in adult patients with T2DM. Methods: This was a cross-sectional analytical study involving T2DM participants attending the Diabetes Clinic of the Lagos University Teaching Hospital. The study participants consisted of 114 T2DM and sixty healthy controls. Levels of serum Vitamin D, fasting glucose, insulin, HbA1c, calcium, albumin, phosphate, creatinine and alanine transaminase were determined. Insulin resistance and beta cell function were estimated with the homeostasis model assessment (HOMA-IR and HOMA-B, respectively). Statistical analysis was done using Statistical Package for Social Sciences, Version 20. Results: The mean age of the study participants was 52 ± 7.6 years for T2DM patients and 50 ± 8.4 years for controls. The female to male ratio in both T2DM and healthy controls was 3:2. The mean HbA1c was 7.3 ± 1.8%. Poor glycaemic control (HbA1c >6.5%) was present in 67 (58.8%) T2DM controls; forty-five (39.5%) subjects had both low Vitamin D levels and poor glycaemic control. There was a significant inverse correlation between serum Vitamin D concentration and HbA1c levels in T2DM patients (rs= −0.185; P < 0.05) A non-significant inverse association was seen between serum Vitamin D level and HOMA-IR. Conclusion: This study shows an inverse association between serum levels of Vitamin D and glycaemic control, as determined by HbA1c. T2DM patients with poor glycaemic control may need to be assessed for serum Vitamin D levels and possibly treated for Vitamin D deficiency.
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