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ORIGINAL ARTICLES
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
DOI:10.4103/jod.jod_2_17  
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.
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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
DOI:10.4103/jod.jod_6_17  
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.
  1 2,520 404
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
DOI:10.4103/jod.jod_19_17  
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.
  1 3,586 335
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
DOI:10.4103/jod.jod_31_17  
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.
  1 2,188 270
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
DOI:10.4103/jod.jod_5_17  
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.
  1 3,879 494
REVIEW ARTICLES
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
DOI:10.4103/jod.jod_17_18  
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.
  1 1,603 218
Technology in the management of diabetes mellitus
Ranjit Unnikrishnan, Nitika Sharma, Viswanathan Mohan, Harish Ranjani
January-April 2018, 9(1):3-11
DOI:10.4103/jod.jod_4_17  
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.
  1 2,311 322
* Source: CrossRef