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   2011| February-May  | Volume 2 | Issue 1  
    Online since January 6, 2017

 
 
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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.
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SHORT COMMUNICATION
Efficacy of Stability Trainer in Improving Balance in Type II Diabetic Patients with Distal Sensory Neuropathy
MS Ajimsha, JK Paul, S Chithra
February-May 2011, 2(1):7-7
The loss of sensations associated with Diabetic Peripheral Neuropathy is thought to contribute to impaired balance and increased risk of falling. If the measures of balance are improved , incidence of sustaining falls and injuries can be reduced. Stability Trainers are oval shaped colour coded pads, available in three densities for balance training. To find out the efficacy of Stability Trainer in improving functional balance in Type II Diabetic patients, with Distal Sensory Neuropathy, a Randomized controlled single blinded trial was conducted at the Physiotherapy Department of Kottayam Medical College, Kerala, India. Thirty three patients with the diagnosis of Type 2 Diabetes with Distal Sensory Neuropathy participated in the trial. The Control Group received relaxation exercises, range of motion exercises, strengthening exercises and balance training. For Experimental Group, in addition to conventional treatment, balance training on Stability Trainer was given and consisted of 16 sessions per patient over 8 weeks. Main outcome measure: The outcome was measured using Berg Balance Scale (BBS). The pre and post values were taken on the 1st and 8th week of treatment. Results: Both groups showed significant improvement in functional balance performance. The Experimental Group showed statistically significant improvement in functional balance when compared to Control Group. The patients in the Experimental Group showed 28.2% improvement in their BBS scores; whereas Control Group showed 17.4% improvement in their BBS scores, post week 8. Balance training on Stability Trainer seems to be beneficial in improving functional balance in diabetic patients with distal sensory neuropathy
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REVIEW ARTICLE
The role of pharmacists in control and management of type 2 Diabete s Mellitus; a review of the literature
D O g O'Donovan, S Byrne, L Sahm
February-May 2011, 2(1):6-6
Improving glycemic control is the key to reducing both micro-vascular and macro-vascular complications, associated with type 2 Diabetes Mellitus. This review examines the contributions of pharmacists to the long term prognosis of patients with type 2 Diabetes Mellitus by improving their control and management. A systematic literature search was conducted. Twenty-three studies were identified that demonstrated the effect of pharmacist intervention on HbA1c. In all cases, it was reported that pharmacist intervention was successful in reducing HbA1c in patients with type 2 Diabetes Mellitus. The minimum reduction obtained was 0.5% with a maximum reduction of 3.4%. Pharmacist intervention proved successful in improving patients‟ lipid profiles, cardiovascular outcomes, body mass index and other complications associated with type 2 Diabetes Mellitus. It was also reported that there were economic advantages associated with pharmacist management of type 2 Diabetes Mellitus. Pharmacist intervention in type 2 Diabetes Mellitus patients was successful in leading to reductions in mortality, morbidity and cost of treatment.
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COMMENTARY
Primary Prevention of Type 2 Diabetes in practice
P.E.H. Schwarz
February-May 2011, 2(1):1-1
The prevention of type 2 Diabetes is reaching its mature stages. First of all, research to establish the necessary data base for the evidence-based prevention has accum ulated large amount of data from observational studies around the world. Secondly, simple and efficient risk scores for screening for Type 2 Diabetes risk have been developed and used in public health settings. Thirdly, randomised controlled trials have demonstrated that lifestyle interventions, targeting main modifiable risk factors for Type 2 Diabetes in high risk individuals are highly effective, reducing the incidence of Type 2 diabetes by about 50%. Further, nationwide or regional Type 2 Diabetes prevention programmes have been set up in order to translate the research findings into the real-life settings - Finland was the first country to establish such a programme, 10 years ago followed by others. What is needed now, is the implementation of the state of the art diabetes prevention into population based practice with adaptation into local conditions. The IMAGE project is a landmark project developing the state of the art material for the implementation of diabetes prevention into practice. As an output of the IMAGE project, a practical toolkit for diabetes prevention, together with evidence based guidelines and a curriculum for prevention managers has been developed , which needs to be implemented now. This can be achieved, if various bodies and networks of international experts lay down the ground and support the implementation. There actions will be introduced in this article.
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ORIGINAL ARTICLES
Blood Sugar lowering effect of zinc and multi vitamin/ mineral supplementation is dependent on initial fasting blood glucose
P Gunasekara1, M Hettiarachchi, C Liyanage, S Lekamwasam
February-May 2011, 2(1):3-3
To evaluate the effect of zinc and other multi vitamin mineral supplementation on glycemic control and lipid profile in patients with type 2 diabetes mellitus. Diabetes patients (n=96) were randomly allocated to 3 groups; 29 subjects were supplemented with oral zinc sulfate (22 mg/day) and multivitamin mineral (zinc+MVM) preparation; 31 subjects were supplemented with the same preparation, without zinc (MVM) and 36 were given a matching placebo, for a period of 4 months in a single blinded study. Blood samples were taken at the baseline and after 4 months of supplementation, to assess blood glucose (fasting and post prandial) and glycosylated haemoglobin % (HbA1C%)levels. The Zinc+MVM group had a mean change of fasting blood sugar (FBS) -0.33 (SEM, 0.21) mmol/l and was significant (p =0.05) when compared with the other two groups (mean change in the MVM group +0.19 (0.31) and +0.43 (0.23) mmol/l in the control group respectively). When the baseline FBS was >5.56 (>100mg/dL) mmol/l, supplementation either with Zinc+MVM (p<0.001) or MVM (p=0.02) resulted in a significant favourable effect on blood glucose parameters. The HbA1C% level was lowered significantly irrespective of the baseline HbA1C% concentration, only in Zinc+MVM (p=0.01) supplemented individuals. In the other two groups, the change of HbA1C% level was not significant. Zinc supplementation with other multi vitamins daily to adult diabetes patients who had high baseline FBS levels demonstrated better glycemic control.
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Study of Pro-insulin Level and Its Role in a Cohort of Women with Gestational Diabetes in Alexandria, Egypt
FE Amara, ME Meleis, MA Seif, EY Moursy, SA El-Sheikh, MH Megallaa, H Hassan
February-May 2011, 2(1):4-4
To study the levels of serum pro-insulin or pro-insulin/insulin ratio (PIR) in women suffering from gestational diabetes mellitus (GDM), as an additional factor to their insulin resistance state during pregnancy; and to evaluate any change or reversibility of serum pro-insulin or PIR during the postpartum period. The study was conducted on 30 pregnant women in their second or third trimester and 10 age-matched non pregnant , normoglycemic women , as a reference group. The pregnant women were divided into 3 equal groups; normoglycemic women with normal oral glucose tolerance test (OGTT), obese women with GDM and lean women with GDM. Diagnostic OGTT was performed and pro-insulin levels, insulin levels, C-peptide levels, pro-insulin/insulin ratio (PIR) and insulin sensitivity were determined . These tests were repeated after 4-8 weeks of the postpartum period. Serum levels of pro-insulin and the PIR were significantly higher in obese and lean women with GDM than the control and reference groups during pregnancy and after delivery (p=0.0001). Insulin sensitivity index was significantly lower and relative resistance for insulin was significantly higher in GDM women (p<0.0001). After delivery the sensitivity index was significantly higher than during pregnancy in pregnant women, recruited in the study. C-peptide levels were significantly higher in GDM patients versus control and reference groups during pregnancy. After delivery, C-peptide levels were significantly lower in the 3 pregnant groups (p<0.0001). Women with GDM have elevated serum pro-insulin and increased PIR which might serve as a marker for the disease. Moreover, this characteristic profile might be useful for the prediction of gestational diabetes mellitus (GDM).
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Study of the Metabolic Effect and Histopathological Nasal Mucosal Changes after Prolonged Intranasal Insulin Administration
FE Amara, ME Meleis, MA Seif, EY Moursy, SA El-Sheikh, MH Megallaa, H Hassan
February-May 2011, 2(1):5-5
To evaluate the nasal histopathological and metabolic effects of administration of intranasal insulin (INI) in type 2 diabetic (T2D) individuals. A total of 51 adult male T2D patients were divided into 4 groups: group I received INI and azone, group II received INI, azone and polyacrylic acid, group III received INI and polyacrylic acid, and in group IV, every 2 patients received INI, azone or polyacrylic acid separately. Basal nasal mucosal biopsy and oral glucose tolerance test (OGTT) were performed for all patients. On the second day, fasting blood samples were collected, and then intranasal spray was administered. The same intranasal administrations were given before each meal for 4 weeks. A second nasal biopsy was taken at the end of the 4 weeks treatment and a third biopsy, one month after stopping INI. Significant drop of blood glucose and significant rise of plasma insulin were observed in groups I, II and III. However, both of these findings were greater in group II, than group I and group III. The observed histological changes were in the form of local mucosal irritation of variable degrees. The severity of these changes was more marked in group II than group III and I, and least in group IV. However, the third nasal biopsy showed reversal of these changes after stopping INI administration. Intranasal insulin can help in preventing rapid increments of postprandial hyperglycemia in T2D patients. The associated histopathological nasal mucosal changes are generally mild and completely reversible after stopping INI administration.
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