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.

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Illiterate people are at high risk for inappropriate drug use. We aimed at enabling diabetic patients who were illiterate and/or migrants to understand diet and drugs prescription through the use of Icons. We evaluated two communication tools among 40 migrant patients who were unable to read and speak Italian and had to understand medical prescriptions either by being assisted by a health care provider or by looking at the study tools. Ninety-six percent subjects with study tools and 46% subjects with usual prescription plus operator's aid understood the prescription (P<0.01). At follow up, 90% with study tools vs 60% with usual prescription were still compliant and took drugs appropriately (P<0.01). By using the pictogram , diet and drug advice was simplified , consultation time was accelerated by using pictogram and patient 's compliance was improved.

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Fibrocalculous pancreatic diabetes (FCPD) is a cause of diabetes seen mainly in developing countries. The study was carried out to observe the prevalence of pancreatic calculi among diabetic subjects attending the outpatient department of BIRDEM and to determine their clinical characteristics. An observational study was carried out at the under thirty (18-30 years) clinic of outpatient department , BIRDEM. Four thousand seven hundred and twenty five subjects were studied who reported to the clinic as newly detected diabetes during the period of 2000 to 2007. All subjects were screened for pancreatic calculi by plain X-Ray abdomen at the 1st visit. Among the total 4725 subjects studied 509 (10.77%) were found to have pancreatic calculi. Mean age of the subjects with pancreatic calculi was 23.02 years. Among them 53% were male, 69.7% had body mass index (BMI) below normal (<18.5 kg/ mÆ) and 27.25% had positive family history of diabetes. An increasing trend was observed in BMI in successive years. Among the subjects with pancreatic calculi 51 (10%) subjects had ketonuria at the time of diagnosis. Subjects with pancreatic calculi present ed with diabetes in early twenties. A good percentage of subjects had family history of diabetes. Though most of them w ere lean, but it was observed that there was an increasing trend of BMI among the under thirty diabetic subjects presenting with pancreatic calculi.

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Diabetes mellitus is a risk factor for adverse long-term outcome after medical therapy, PCI, or coronary artery bypass surgery. To assess the validity of this concern, we evaluated the effect of diabetes mellitus on in-hospital mortality and morbidity after coronary artery bypass grafting (CABG). Thirteen thousand eight hundred fifty seven patients (4389 diabetics and 9468 non-diabetics) were retrospectively analyzed after isolated CABG. Demographic and preoperative data and postoperative in-hospital mortality and morbidity were compared in both diabetic and non-diabetic groups. Analysis was performed in both univariate and multivariable logistic regression to compare the results. Diabetic patients were older than the non-diabetic population (mean age 59.2±8.7yrs versus 58.3±9.9yrs), included more women (37.6% vs 19.6%), had more postoperative superficial/deep sternal wound infection (0.6% vs 0.2 %), prolonged ventilation (3.2% vs 1.5%), cardiac arrest (1.3% vs 0.5%), stroke (0.6% vs 0.3%), renal dysfunction (1.5% vs 0.6%), coma (0.5% vs 0.1%), AF (6.5% vs 5.7%), and in- hospital mortality (1.4% versus 0.5%) (all p< 0.05). There were also significant differences for mean aortic cross-clamp and cardiopulmonary bypass times between diabetics and non-diabetics (43.74±14. 37 vs 41.89±15.76 mins and 73.10±24.05 vs 69.97±24.43 mins, respectively) (p<0.05). Logistic regression showed that there was a significant relationship between diabetes and postoperative superficial/deep sternal wound infection as well as prolonged ventilation and cardiac arrest, but it did not show any relationship between diabetes and in-hospital mortality. It seems that diabetes mellitus has a significant impact on postoperative superficial/deep sternal wound infection, prolonged ventilation, and cardiac arrest. But diabetic patients do not necessarily have an increased risk of in-hospital mortality and other complications.

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