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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.
  5,340 709 3
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.
  3,448 432 1
REVIEW ARTICLE
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
DOI:10.4103/jod.jod_14_17  
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.
  2,803 462 -
ORIGINAL ARTICLES
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.
  2,238 255 1
CASE REPORT
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
DOI:10.4103/jod.jod_16_17  
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.
  2,268 213 -
ORIGINAL ARTICLES
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.
  2,078 342 1
Glycated haemoglobin: A marker of circulating lipids in patients with type 2 diabetes
Sheikh Ishaq, Iram Shabir, Arif A Bhat, Imran Shafi, Saima Mushtaq, Parvaiz A Shah, Azra Baba, Sabhiya Majid
January-April 2017, 8(1):18-21
DOI:10.4103/jod.jod_7_17  
Introduction: Type 2 diabetes mellitus (T2DM) is a group of metabolic disorder and is an independent risk factor for cardiovascular disease and dyslipidaemia. Patients with T2DM have dyslipidaemia at wavering degrees, characterised by increased levels of triglyceride and low-density lipoprotein-cholesterol and decreased levels of high-density lipoprotein (HDL)-cholesterol. In the present study, we evaluated glycated haemoglobin (HbA1c) as a marker of circulating lipids in patients with T2DM. Methods: Two hundred and thirty-nine patients with T2DM were enrolled for the study. A detailed biochemical and lipid profile was done for all patients. Results: Of 239 cases, 96 (40%) were male and 143 (60%) were female. Of 239 patients, 53 (22%) patients with T2DM had controlled glycaemia (HbA1c <6.5) and 186 (78%) patients had uncontrolled glycaemia (HbA1c ≥6.5). Pearson's correlation of HbA1c with all lipid parameters was statistically significant. HbA1c, however, had an inverse correlation with HDL and had a significant direct correlation with fasting blood glucose. Conclusion: The study reveals that HbA1c is not only a reliable glycaemic index but can also be used as an important indicator of dyslipidaemia in patients with T2DM.
  2,026 356 -
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
DOI:10.4103/jod.jod_8_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.
  2,013 328 -
EDITORIAL
Diabetes in Asia: Special challenges and solutions
Akhtar Hussain
September-December 2018, 9(3):69-72
DOI:10.4103/jod.jod_22_18  
  1,646 521 -
ORIGINAL ARTICLES
Compliance to dietary counseling provided to patients with type 2 diabetes at a tertiary care hospital
A Siddiqui, A Gul, MY Ahmedani, Q Masood, Z Miyan
February-May 2010, 1(1):3-3
Objectives: To observe the compliance to dietary counseling b y trained dietitians provided to subjects with type 2 diabetes at a tertiary care hospital. Method: Compliance to dietary counseling of 72 type 2 diabetics attending BIDE was assessed through comparison of food habits at first and second visit (made after three months). Compliance was indicated by decrease in number of dietary modifications needed in diet at second visit as compared to that at first visit. Results: Fifty percent of the subjects were males. Mean age of the subjects was 52.3 ±10.7 years. On the first visit 66.7% had very inadequate and 29.2 % had poor diets while at 2nd visit only 19.4% had very inadequate and 1.4% had poor diet. Overall compliance to dietary counseling was very good by 19.4% good by 37.5%, fair by 33.3% and poor by 9.7 % of the subjects. Diet quality improved for 94.5% of subjects. Conclusion: Compliance rates were sufficiently high to bring positive changes in diets of people with diabetes. Universal availability of dietary counseling to diabetics has potential to improve patients' diet and thus can contribute to controlling diabetes complications rate
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
  1,383 717 -
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.
  1,775 216 1
REVIEW ARTICLES
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.
  1,730 256 -
ORIGINAL ARTICLES
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
DOI:10.4103/jod.jod_28_17  
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.
  1,537 440 -
COMMENTARY
Different non-pharmacological approaches for management of type 2 diabetes
V Kumar, MK Tripathi, PK Chauhan, PK Singh
February-May 2013, 4(1):1-1
Diabetes mellitus is a syndrome characterized by chronic hyperglycemia, due to absolute or relative deficiency or diminished effectiveness of circulating insulin. It is the most common serious metabolic disease. Diabetes mellitus has been recognized as a clinical syndrome since ancient times and remains a crippling global health problem today. Diabetes may be divided into type 1 and type 2. Type 1 diabetes is caused by deficiency of insulin production, while type 2 diabetes is characterized by insulin resistance. The high medicinal treatment cost of diabetes, has led to a growing interest in alternative therapies for diabetes management. All the findings of this review paper highlighted the effectiveness of medicinal plants, the effectiveness of exercise therapy, diet and other lifestyle treatments for preventing type 2 diabetes and reducing mortality and morbidity among persons who are at an increased risk of developing the disease.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
  1,152 816 -
ORIGINAL ARTICLES
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.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
  1,633 322 -
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
DOI:10.4103/jod.jod_10_17  
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.
  1,664 278 -
REVIEW ARTICLES
Hypertriglyceridemia: A new paradigm
Johny J Kannampilly
January-April 2018, 9(1):12-18
DOI:10.4103/jod.jod_22_17  
Low-density lipoprotein cholesterol (LDL-C) has been proven time and again to be independently associated with the risk of cardiovascular diseases (CVD). However, triglycerides (TG) are now also emerging as an important as well as independent risk factor for CVD. International lipid guidelines recommend statins as first-line drugs. However, there always remains a residual risk with statins, especially in the high-risk diabetes subset of patients. The most important reason cited for increased residual CV risk with statins is the non-high density lipoprotein cholesterol component, of which high TGs are an integral part. Several large epidemiological, Mendelian randomisation, population-based and genetic studies are emerging which are pointing towards the fact that high TG leads to CV morbidity and mortality. Pathophysiological basis of hypertriglyceridemia associated with increased CV risk has been attributed to increase circulating chylomicron and TG-rich lipoprotein remnants, increased small dense LDL, heightened risk of endothelial dysfunction and plaque formation. Recent international guidelines recommend TG lowering therapy at TG >200 mg/dl when not controlled by optimal statin therapy. TG levels more than 500 mg/dl, however, require non-statin lipid-lowering agents as primary agents to reduce the risk of acute pancreatitis. Fibrates, niacin and omega 3 fatty acids are recommended as TG-lowering drugs. However, they are not without their share of adverse events. Saroglitazar is a novel dual peroxisome proliferator-activated enzyme agent which has been found to be free of many such adverse events and also adequate in providing dual control over hypertriglyceridemia along with significant glycaemic control.
  1,643 293 -
Androgen Deprivation Therapy Increases the Risk of Diabetes and Non - cancer Mortality in Prostate Cancer patients: A Meta- analysis
MA Tunio, M Rafi, A Qayyum, A Hashmi
June-September 2010, 1(2):5-5
Androgen deprivation therapy (ADT) with Luteinizing hormone releasing hormone analogues or bilateral subcapsular orchiectomy is the mainstay of treatment in high risk localized and metastatic prostate cancer along with other modalities. ADT is associated with increased fat mass and insulin resistance, but the risk of incident diabetes and non-cancer mortality during this treatment has not been well studied. We conducted a meta-analysis to see whether androgen deprivation therapy is associated with an increased incidence of diabetes and cardiovascular diseases. The MEDLINE, CANCERLIT, COCHRANE library database, and the search engines, were searched to identify, prospective, randomized, controlled studies in prostate cancer patients receiving short, long term or no ADT and risk of incident diabetes and non cancer mortality. Comprehensive Meta-analysis software version 2.0 was used for the analysis. Four prospective trials with a total patient population of 1, 15,119 were identified. Pooled results from these trials showed an increase d risk of diabetes in patients treated with long term ADT (p= 0.0001) as well as increased non -cancer mortality (Odds ratio 1.69; p < 0.001. Main cause of non-cancer death was sudden cardiac death (SCD). The resultant funnel plot of meta- analysis showed lack of publication bias. This meta-analysis shows increased risk of diabetes and cardiovascular diseases in prostate cancer patient on long term androgen deprivation therapy; already existing diabetes also deteriorated. The results of this study warrants active surveillance of patients on androgen deprivation therapy.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
  1,104 825 -
ORIGINAL ARTICLES
Glucose intolerance and insulin resistance in non-alcoholic fatty liver disease: A Hospital-based Cross-sectional Study from Southern Karnataka, India
Thomas Mathew, Sudha Vidyasagar, Muralidhar Dantuluru Varma, B Nandakrishna, Avinash Manjunath Holla, VS Binu
September-December 2017, 8(3):68-73
DOI:10.4103/jod.jod_12_17  
Context: Non-alcoholic fatty liver disease (NAFLD) is associated with hepatic insulin resistance (IR) and glucose intolerance. Indian data in this area are sparse, and hence, we undertook this study to find the relationship between NAFLD and diabetes. Objective: The objective of this study is to find the relationship between NAFLD and various levels of glucose intolerance and IR. Settings and Design: A cross-sectional study on 150 patients aged 18 or above and diagnosed to have NAFLD by ultrasonography from October 2013 to June 2015 who were admitted or outpatients in the Department of General Medicine, Kasturba Medical College, Manipal. Methodology: NAFLD was graded as mild, moderate or severe by a single radiologist using high-resolution B-mode ultrasonography system. Basic anthropometric, clinical examination and relevant biochemical investigations were done for all patients. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and post-load plasma glucose (PG) were measured in all subjects, fasting insulin levels were measured in all subjects by chemiluminescence method to determine IR and it was calculated using homeostasis model assessment model. Statistical Analysis Used: Data were analysed using SPSS software version 15 and P < 0.05 considered as statistically significant. Results: The percentage of pre-diabetes and diabetes in NAFLD patients were 52.7% and 30.7% respectively, There was a greater proportion of pre-diabetics and diabetics in the higher grades of NAFLD (P < 0.001). We observed mean FPG, PG and HbA1c levels increased as the severity of NAFLD increased in this study. The overall mean HOMA-IR score in our subjects was found to be 4.68 ± 2.81 and 76.7% of patients had IR was significantly (P < 0.001) higher in Grade 2 and Grade 3 NAFLD. Conclusions: There is a high prevalence of pre-diabetes and diabetes in patients with NAFLD, and this is associated with increasing IR in higher grades of NAFLD.
  1,657 242 -
REVIEW ARTICLES
Diabetes in Pakistan: Epidemiology, Determinants and Prevention
R Hakeem, A Fawwad
October-January 2010, 1(3):3-3
Epidemiology and determinants of diabetes in Pakistan have peculiar combination of risk factors. Strong gene and environment interplay along with in-utero programming in context of low birth weight and gestational diabetes are the main contributors of a high prevalence of type 2 diabetes in Pakistan. The real burden of diabetes is due to its chronic complications leading to increased morbidity and mortality. The unique combination of various risk factors necessitates research studies to make appropriate risk assessment tools to control this diabetes pandemic. Better understanding of aetio-pathological genetic and environmental factors are suggesting prevention should begin much before the start of disease process and interventions in high-risk subjects alone will not be sufficient. It is necessary to initiate population based programmes for primary prevention of diabetes including a range of activities targeted at different age groups from fetal life to old age. Synchronized and coordinated efforts from public and private sectors are needed to combat this mammoth health and economic issue.
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLE
Risk Factors for Type 2 Diabetes in Bangladesh: A Systematic Review
T Sal-sabil, A Islam, SM Shariful Islam
June-September 2016, 7(2):5-5
Diabetes is one of the most significant public health challenge in developing countries. The risk factors for diabetes are poorly understood among the Bangladeshi population. This study aimed to explore the potential risk factors for type 2 diabetes in Bangladesh. A systematic review was performed. Studies describing the risk factors for type 2 diabetes in Bangladesh published between 1994 to 2014 were included and summarized. Of the 35 studies identified, we included 14 studies that met the inclusion criteria. The prevalence of diabetes was higher among females compared to males. Fourteen common risk factors for diabetes in Bangladesh were identified, namely increased age, obesity, waist- hip ratio, social class, hypertension, family history, sedentary life style among others. The p otential risk factors differed by urban-rural areas and by gender. Several risk factors contribute to the increasing prevalence of type 2 diabetes. Our reviews suggest "metabolically-disadvantageous" body composition of more abdominal and visceral fat in Bangladeshi adults might cause higher diabetes risk at a lower BMI compared to Western population. Preventive strategies targeting to control risk factors for diabetes is a priority public health issue and should be considered for early intervention by clinicians and policy makers.
[ABSTRACT]   Full text not available  [PDF]
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CONSENSUS GUIDELINES
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
DOI:10.4103/jod.jod_45_18  
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ORIGINAL ARTICLES
Vitrectomy in advanced diabetic eye disease: A seremban experience
Pushpa Raman, Bethel Indira Livingstone
May-August 2017, 8(2):45-48
DOI:10.4103/jod.jod_11_17  
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
DOI:10.4103/jod.jod_17_17  
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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REVIEW ARTICLES
Factors influencing self-management of Diabetes Mellitus; a review article
G Kisokanth, S Prathapan, J Indrakumar, J Joseph
October-January 2013, 4(3):6-6
To review recent data to identify the factors influencing the effective self-management of Diabetes Mellitus (DM). A review of the published literature on self-management of diabetes was performed. This involved searching databases using the search terms Self -management of Diabetes Mellitus, DM and its management, management of type 2 DM, prevalence of diabetes and risk factors for DM. Included studies were conducted in different parts of the world between 1993 and 2013. An attempt was made to contact corresponding authors for further information for this study. We included 34 articles in our review. Self-management of diabetes were consistent with those found in several studies, i.e. individuals most regularly followed their prescribed medication regimen and least regularly followed recommendation for lifestyle changes of diet and exercise. The import ant determinants of self- management are transient situational factors such as environmental factors, psychological factors and social factors. Interventions to promote better self-management have reported in several studies. Initial improvement in better glucose control can be achieved by self-management education. Successful self-management of DM requires that individuals with DM frequently monitor their blood glucose levels and take required action in order to keep blood sugar within a physiological level . This can be achieved by self -management education, self-monitoring and social support. Cultural influences also have interfered with successful diabetes self-management. The chronic care model is recommended for the self-management of DM.
[ABSTRACT]   Full text not available  [PDF]
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