A. Bashier, Dileep Kumar, F. Alalawi, Hind Al Nour, Amna Al Hadari, Azza Abdulaziz Bin Hussain
The prevalence of diabetes and diabetic nephropathy is increasing, especially in middle eastern countries. Many patients reach end-stage renal disease and either start dialysis or consider preemptive transplantation. Even a higher number of patients develop post-transplant diabetes, which imposes an even higher risk on graft survival and outcomes post-transplantation. Recently, in the UAE, a renal transplant service has been initiated. Because the population is considered at high risk for post-transplant diabetes, we wrote this review article to discuss the prevalence, risk factors, diagnostic criteria, and management, including lifestyle interventions, manipulation of immunosuppressant agents, and suggested algorithms for the use of oral hypoglycemic agents used in the management of post-transplantation diabetes mellitus. We also discussed the specific indications for each of the oral hypoglycemic agents.
{"title":"Post-Transplant Diabetes: Prevalence, Risk, and Management Challenges","authors":"A. Bashier, Dileep Kumar, F. Alalawi, Hind Al Nour, Amna Al Hadari, Azza Abdulaziz Bin Hussain","doi":"10.1159/000522092","DOIUrl":"https://doi.org/10.1159/000522092","url":null,"abstract":"The prevalence of diabetes and diabetic nephropathy is increasing, especially in middle eastern countries. Many patients reach end-stage renal disease and either start dialysis or consider preemptive transplantation. Even a higher number of patients develop post-transplant diabetes, which imposes an even higher risk on graft survival and outcomes post-transplantation. Recently, in the UAE, a renal transplant service has been initiated. Because the population is considered at high risk for post-transplant diabetes, we wrote this review article to discuss the prevalence, risk factors, diagnostic criteria, and management, including lifestyle interventions, manipulation of immunosuppressant agents, and suggested algorithms for the use of oral hypoglycemic agents used in the management of post-transplantation diabetes mellitus. We also discussed the specific indications for each of the oral hypoglycemic agents.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"32 1","pages":"79 - 92"},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78359495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salwa Seddik Hosny El-khwaga, D. A. Marwan, N. Adly, Marina El-Amir Hakim, A. Bahaaeldin
Introduction: Subclinical hypothyroidism (SHT) is characterized by a normal range of free thyroxin concentrations together with increased serum TSH levels. SHT is defined as serum thyroid-stimulating hormone (TSH) concentration above the upper limit of the reference range in the face of normal free FT4 and FT3 levels. The effect of SHT on cognitive function has been investigated in several preclinical studies, and a growing body of evidence has suggested a relevant link between thyroid hormones and the central nervous system. Objectives: This study aimed to investigate the effect of levothyroxine replacement on cognitive impairment in a sample of Egyptian patients with SHT. Methods: A prospective cohort study conducted on 30 patients with cognitive impairment and SHT attending an endocrine outpatient clinic at the Ain Shams University Hospital to study the effect of levothyroxine supplementation on cognitive impairment in patients with SHT. The study was conducted on 30 patients. All participants were subjected to a full history taking; thorough clinical examination; laboratory investigations including thyroid profile (FT3, FT4, TSH), anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and lipid profile; imaging tests as neck ultrasound, echocardiography, and carotid duplex; and finally Addenbrooke’s questionnaire used to diagnose mild cognitive impairment. Results: A highly statistically significant difference was found before, 3 months and 6 months after treatment with levothyroxine regarding all clinical data, TSH, LDL, T. cholesterol, FT3, FT4 and HDL, carotid intima-media thickness, and Addenbrooke’s questionnaire. Our study showed a statistically significant inverse correlation between TSH level and mild cognitive impairment before and after treatment with levothyroxine at 3 and 6 months intervals as when TSH increased, results of Addenbrooke’s questionnaire decreased and, so, cognitive impairment increased, while when TSH decreased in response to thyroxine replacement, cognitive impairment improved as detected by an increase in the patient’s score. Conclusion: SHT has a great effect on cognitive impairment, as normalization in TSH level results in improvement in cognitive function. Also, there was a significant reduction in carotid intima-media thickness, which may contribute to improvement of cognitive function in addition to a great improvement in lipid profile, which in turn positively affects cardiac and cognitive function.
{"title":"Effect of Levothyroxine Replacement on Cognitive Function Impairment in a Sample of Egyptian Population with Subclinical Hypothyroidism","authors":"Salwa Seddik Hosny El-khwaga, D. A. Marwan, N. Adly, Marina El-Amir Hakim, A. Bahaaeldin","doi":"10.1159/000525609","DOIUrl":"https://doi.org/10.1159/000525609","url":null,"abstract":"Introduction: Subclinical hypothyroidism (SHT) is characterized by a normal range of free thyroxin concentrations together with increased serum TSH levels. SHT is defined as serum thyroid-stimulating hormone (TSH) concentration above the upper limit of the reference range in the face of normal free FT4 and FT3 levels. The effect of SHT on cognitive function has been investigated in several preclinical studies, and a growing body of evidence has suggested a relevant link between thyroid hormones and the central nervous system. Objectives: This study aimed to investigate the effect of levothyroxine replacement on cognitive impairment in a sample of Egyptian patients with SHT. Methods: A prospective cohort study conducted on 30 patients with cognitive impairment and SHT attending an endocrine outpatient clinic at the Ain Shams University Hospital to study the effect of levothyroxine supplementation on cognitive impairment in patients with SHT. The study was conducted on 30 patients. All participants were subjected to a full history taking; thorough clinical examination; laboratory investigations including thyroid profile (FT3, FT4, TSH), anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, and lipid profile; imaging tests as neck ultrasound, echocardiography, and carotid duplex; and finally Addenbrooke’s questionnaire used to diagnose mild cognitive impairment. Results: A highly statistically significant difference was found before, 3 months and 6 months after treatment with levothyroxine regarding all clinical data, TSH, LDL, T. cholesterol, FT3, FT4 and HDL, carotid intima-media thickness, and Addenbrooke’s questionnaire. Our study showed a statistically significant inverse correlation between TSH level and mild cognitive impairment before and after treatment with levothyroxine at 3 and 6 months intervals as when TSH increased, results of Addenbrooke’s questionnaire decreased and, so, cognitive impairment increased, while when TSH decreased in response to thyroxine replacement, cognitive impairment improved as detected by an increase in the patient’s score. Conclusion: SHT has a great effect on cognitive impairment, as normalization in TSH level results in improvement in cognitive function. Also, there was a significant reduction in carotid intima-media thickness, which may contribute to improvement of cognitive function in addition to a great improvement in lipid profile, which in turn positively affects cardiac and cognitive function.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"53 1","pages":"93 - 101"},"PeriodicalIF":0.0,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76354775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hassanein, Saud N Al Sifri, F. A. Al Awadi, T. Alessa, A. Shaaban
Introduction: The safety and effectiveness of gliclazide modified release (MR) in patients with type 2 diabetes mellitus (T2DM) who fasted during Ramadan were previously published. Here, we carried out a regional analysis among patients living in Gulf Cooperation Council (GCC) countries. Patients and Methods: DIA-RAMADAN was a real-world, observational, international, noncomparative study conducted in nine countries that included >1200 T2DM adults receiving gliclazide MR for at least 90 days before inclusion. The study comprised 2 visits: at inclusion, 6–8 weeks before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1). The primary endpoint was the proportion of patients reporting ≥1 symptomatic hypoglycemic event as collected using a patient diary. Changes in HbA1c, fasting plasma glucose (FPG), and weight were also analyzed. This manuscript represents data collected in GCC countries (Kuwait, Saudi Arabia, and United Arab Emirates). Results: Data from 161 patients were analyzed: mean (SD) age 56.8 (10.6) years, 30.4% women, body mass index 29.1 (3.7) kg/m2, T2DM disease duration 6.7 (3.3) years, baseline HbA1c 7.9% (0.8). The proportions of patients reporting ≥1 symptomatic hypoglycemic event or confirmed hypoglycemia during Ramadan were 4.3% and 0.6%, respectively. No cases of severe hypoglycemia were reported. Significant reductions in main variables were observed before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1): HbA1c (from 7.9 [0.8] to 7.6 [0.7]%; p value <0.001), FPG (from 143.5 [24.3] to 137.9 [25.2] mg/dL; p value = 0.031), and weight (from 79.0 [73.0–86.0] to 78.0 [72.0–85.0] kg; p value = 0.018). Conclusions: These real-world data indicate that patients with T2DM treated with gliclazide MR during Ramadan in the selected GCC countries have a low risk of hypoglycemia and maintain glycemic control and weight while fasting.
{"title":"A Real-World Study in Patients with Type 2 Diabetes Treated with Gliclazide Modified Release during Fasting in Gulf Cooperation Council Countries: An Analysis from the International DIA-RAMADAN Study","authors":"M. Hassanein, Saud N Al Sifri, F. A. Al Awadi, T. Alessa, A. Shaaban","doi":"10.1159/000525074","DOIUrl":"https://doi.org/10.1159/000525074","url":null,"abstract":"Introduction: The safety and effectiveness of gliclazide modified release (MR) in patients with type 2 diabetes mellitus (T2DM) who fasted during Ramadan were previously published. Here, we carried out a regional analysis among patients living in Gulf Cooperation Council (GCC) countries. Patients and Methods: DIA-RAMADAN was a real-world, observational, international, noncomparative study conducted in nine countries that included >1200 T2DM adults receiving gliclazide MR for at least 90 days before inclusion. The study comprised 2 visits: at inclusion, 6–8 weeks before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1). The primary endpoint was the proportion of patients reporting ≥1 symptomatic hypoglycemic event as collected using a patient diary. Changes in HbA1c, fasting plasma glucose (FPG), and weight were also analyzed. This manuscript represents data collected in GCC countries (Kuwait, Saudi Arabia, and United Arab Emirates). Results: Data from 161 patients were analyzed: mean (SD) age 56.8 (10.6) years, 30.4% women, body mass index 29.1 (3.7) kg/m2, T2DM disease duration 6.7 (3.3) years, baseline HbA1c 7.9% (0.8). The proportions of patients reporting ≥1 symptomatic hypoglycemic event or confirmed hypoglycemia during Ramadan were 4.3% and 0.6%, respectively. No cases of severe hypoglycemia were reported. Significant reductions in main variables were observed before the start of Ramadan (V0) and 4–6 weeks after the end of Ramadan (V1): HbA1c (from 7.9 [0.8] to 7.6 [0.7]%; p value <0.001), FPG (from 143.5 [24.3] to 137.9 [25.2] mg/dL; p value = 0.031), and weight (from 79.0 [73.0–86.0] to 78.0 [72.0–85.0] kg; p value = 0.018). Conclusions: These real-world data indicate that patients with T2DM treated with gliclazide MR during Ramadan in the selected GCC countries have a low risk of hypoglycemia and maintain glycemic control and weight while fasting.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"16 1","pages":"102 - 111"},"PeriodicalIF":0.0,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86418656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Okada, Junichi Okada, K. Kikkawa, Eijiro Yamada, Kazuya Okada, Kihachi Ohshima
Introduction: CA19-9 is the most reliable tumor marker for pancreatic cancer, with 70–90% sensitivity, 90% specificity, 69% positive predictive value, and 90% negative predictive value. However, increased CA19-9 levels have been observed in benign conditions, pancreatitis, pulmonary disease, smoking, and hepatobiliary system disease. Numerous studies have reported that circulating CA19-9 levels are elevated during hyperglycemia in diabetes mellitus (DM) and have been associated with hemoglobin A1c (HbA1c). However, the precise mechanism behind increased serum CA19-9 levels in diabetes remains still unclear. Here, we report a case of type 2 DM (T2DM) accompanied by elevated serum CA19-9 levels due to not pancreatic cancer but interstitial pneumonitis. Case Report: The patient, a 73-year-old Japanese woman, was taking metformin (1,500 mg/day), repaglinide (1.5 mg/day), and sitagliptin (50 mg/day). Over the past year, she also took atorvastatin (5 mg/day) and azilsartan (40 mg/day). The patient had been followed up for systemic scleroderma (with low-dose steroid therapy) and mild interstitial lung disease (ILD) (without treatment) for a number of years at a different hospital. The patient’s peripheral blood laboratory findings were normal range. Her HbA1c level fluctuated between 7.0% and 8.0% in the past 6 months. Her CA19-9 level was fluctuated between 562.7 and 823.2 U/mL (normal <37), and her KL-6 level was fluctuated between 516 and 557 U/L (normal <500) in the past 6 months. Due to the marked increase in the CA19-9 level, an extensive screening examination was performed for malignancy, including abdominal ultrasound scan, computed tomography (CT), and magnetic resonance cholangiopancreatography, revealing no malignancy. We observed bilateral pulmonary lesions (bottom of lungs) and ground-glass opacity on the chest CT. The pancreatic monoclonal antigen type 2 (DU-PAN-2) level was <25 U/mL. Conclusions: In our case, CA19-9 levels were increased in association not with pancreatic cancer but with ILD. Thus, when T2DM is accompanied by elevated serum CA19-9 levels, attention needs to be paid not only to the presence of pancreatic cancer but also to the possible ILD. Especially, when diabetes and ILD are treated in different hospitals, diabetologists need to pay attention about the presence of hidden ILD besides DM.
{"title":"Patients with Type 2 Diabetes Mellitus Accompanied by Elevated Serum CA19-9 Associated Not with Pancreatic Cancer but Interstitial Lung Disease","authors":"S. Okada, Junichi Okada, K. Kikkawa, Eijiro Yamada, Kazuya Okada, Kihachi Ohshima","doi":"10.1159/000524603","DOIUrl":"https://doi.org/10.1159/000524603","url":null,"abstract":"Introduction: CA19-9 is the most reliable tumor marker for pancreatic cancer, with 70–90% sensitivity, 90% specificity, 69% positive predictive value, and 90% negative predictive value. However, increased CA19-9 levels have been observed in benign conditions, pancreatitis, pulmonary disease, smoking, and hepatobiliary system disease. Numerous studies have reported that circulating CA19-9 levels are elevated during hyperglycemia in diabetes mellitus (DM) and have been associated with hemoglobin A1c (HbA1c). However, the precise mechanism behind increased serum CA19-9 levels in diabetes remains still unclear. Here, we report a case of type 2 DM (T2DM) accompanied by elevated serum CA19-9 levels due to not pancreatic cancer but interstitial pneumonitis. Case Report: The patient, a 73-year-old Japanese woman, was taking metformin (1,500 mg/day), repaglinide (1.5 mg/day), and sitagliptin (50 mg/day). Over the past year, she also took atorvastatin (5 mg/day) and azilsartan (40 mg/day). The patient had been followed up for systemic scleroderma (with low-dose steroid therapy) and mild interstitial lung disease (ILD) (without treatment) for a number of years at a different hospital. The patient’s peripheral blood laboratory findings were normal range. Her HbA1c level fluctuated between 7.0% and 8.0% in the past 6 months. Her CA19-9 level was fluctuated between 562.7 and 823.2 U/mL (normal <37), and her KL-6 level was fluctuated between 516 and 557 U/L (normal <500) in the past 6 months. Due to the marked increase in the CA19-9 level, an extensive screening examination was performed for malignancy, including abdominal ultrasound scan, computed tomography (CT), and magnetic resonance cholangiopancreatography, revealing no malignancy. We observed bilateral pulmonary lesions (bottom of lungs) and ground-glass opacity on the chest CT. The pancreatic monoclonal antigen type 2 (DU-PAN-2) level was <25 U/mL. Conclusions: In our case, CA19-9 levels were increased in association not with pancreatic cancer but with ILD. Thus, when T2DM is accompanied by elevated serum CA19-9 levels, attention needs to be paid not only to the presence of pancreatic cancer but also to the possible ILD. Especially, when diabetes and ILD are treated in different hospitals, diabetologists need to pay attention about the presence of hidden ILD besides DM.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"137 1","pages":"65 - 68"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73321186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kikkawa, Kazuya Okada, Junichi Okada, Kihachi Ohshima, S. Okada
Introduction: The macromolecular complex formed by creatine phosphokinase (CPK) is most probably an immune complex. Most of the macro-CPK migrates between CPK-MM and CPK-MB, exhibiting an atypical band on isozyme electrophoresis. Either IgA or IgG has been identified with its CPK link (termed as macro-CPK type 1). However, the biological and pathological significance of these complexes found in patients with wide-ranging disease states remains unclear. Herein, we first report a case of type 2 diabetes mellitus associated with hypercreatinekinasemia caused by macro-CPK type 1, with CPK levels negatively correlated with blood glucose control. Case Presentation: A 53-year-old Japanese woman with no complaints of muscle weakness, myalgia, and numbness of the extremities was diagnosed with hypercreatinekinasemia. Over the past years, she received empagliflozin, mitiglinide, voglibose, vildagliptin, metformin, methyl thiazide, and ezetimibe. Serum biochemistry revealed elevated CPK levels. The highest CPK value was 1,063 U/L, and the three major isozymes CPK-BB, CPK-MB, and CPK-MM accounted for 0%, 2%, and 98%, respectively. Notably, CPK isozyme electrophoresis performed on a cellulose acetate membrane detected an additional band that migrated between the CPK-MB and CPK-MM bands, suggesting macro-CPK type 1, which occupied 82% of the total CPK. The densitometric profile of the electrophoresis pattern revealed that CPK-BB, CPK-MB, and CPK-MM constituted 0%, 2%, and 16%, respectively. Moreover, serum CPK levels combined with macro-CPK showed a significant negative correlation with the HbA1c values (r = −0.498, p < 0.001). Conclusions: Serum CPK levels accompanied with macro-CPK type 1 negatively correlate with plasma glucose control. Although the pathophysiological role of macro-CPK remains unclear, our case report may provide a new viewpoint regarding macro-CPK etiology.
{"title":"Creatine Phosphokinase Level Accompanied with Macro-Creatine Phosphokinase Type 1 Negatively Correlates with Plasma Glucose Control in a Patient with Type 2 Diabetes Mellitus","authors":"K. Kikkawa, Kazuya Okada, Junichi Okada, Kihachi Ohshima, S. Okada","doi":"10.1159/000524604","DOIUrl":"https://doi.org/10.1159/000524604","url":null,"abstract":"Introduction: The macromolecular complex formed by creatine phosphokinase (CPK) is most probably an immune complex. Most of the macro-CPK migrates between CPK-MM and CPK-MB, exhibiting an atypical band on isozyme electrophoresis. Either IgA or IgG has been identified with its CPK link (termed as macro-CPK type 1). However, the biological and pathological significance of these complexes found in patients with wide-ranging disease states remains unclear. Herein, we first report a case of type 2 diabetes mellitus associated with hypercreatinekinasemia caused by macro-CPK type 1, with CPK levels negatively correlated with blood glucose control. Case Presentation: A 53-year-old Japanese woman with no complaints of muscle weakness, myalgia, and numbness of the extremities was diagnosed with hypercreatinekinasemia. Over the past years, she received empagliflozin, mitiglinide, voglibose, vildagliptin, metformin, methyl thiazide, and ezetimibe. Serum biochemistry revealed elevated CPK levels. The highest CPK value was 1,063 U/L, and the three major isozymes CPK-BB, CPK-MB, and CPK-MM accounted for 0%, 2%, and 98%, respectively. Notably, CPK isozyme electrophoresis performed on a cellulose acetate membrane detected an additional band that migrated between the CPK-MB and CPK-MM bands, suggesting macro-CPK type 1, which occupied 82% of the total CPK. The densitometric profile of the electrophoresis pattern revealed that CPK-BB, CPK-MB, and CPK-MM constituted 0%, 2%, and 16%, respectively. Moreover, serum CPK levels combined with macro-CPK showed a significant negative correlation with the HbA1c values (r = −0.498, p < 0.001). Conclusions: Serum CPK levels accompanied with macro-CPK type 1 negatively correlate with plasma glucose control. Although the pathophysiological role of macro-CPK remains unclear, our case report may provide a new viewpoint regarding macro-CPK etiology.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"10 1","pages":"69 - 73"},"PeriodicalIF":0.0,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83787753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bikila Regassa Feyisa, G. Mosisa, Bayise Biru, Sidise Debelo, M. Dufera
Background: The risk of diabetes mellitus (DM) is remarkably increasing globally, and it is alarmingly increasing in developing countries including Ethiopia, especially in urban residents. The present study was aimed at uncovering the magnitude of type 2 DM (T2DM) among adults residing in the selected towns of western part of Ethiopia. Methods: A community-based cross-sectional study design was conducted in towns of western Ethiopia from June 1 to June 30, 2019. Multistage and systematic random sampling techniques were employed. The data were collected using structured interviewer-administered questionnaire based on the World Health Organization STEPwise approach. Data were entered into EpiData 3.1, cleaned, and analyzed by the statistical package for social sciences software version 24. Descriptive statistics and logistic regression were used for the analysis. Results: The prevalence of T2DM was 7.0% (95% confidence interval [CI] 5.4–8.8) with 8.5% (95% CI 5.6–11.0) and 6.0% (95% CI 3.9–8.1) among males and females, respectively. Being married (AOR = 4.0, 95% CI 1.1–14.7) and divorced (AOR = 6.2, 95% CI 1.1–34.4), consumption of inadequate fruits and vegetables per day (AOR = 2.8, 95% CI 1.1–6.8), physical inactivity (AOR = 5.0, 95% CI 2.5–10.0), hypertension (AOR = 2.9, 95% CI 1.3–6.2), overweight (AOR = 2.3, 95% CI 1.1–4.9), and obesity (AOR = 19, 95% CI 4.5–50.1) were factors independently associated with T2DM. Conclusion: The prevalence of DM in the study area was found to be substantially higher than the national prevalence and other pocket studies in the country. Sociodemography and modifiable risk factors were affecting the prevalence of DM.
背景:糖尿病(DM)的风险在全球范围内显著增加，在包括埃塞俄比亚在内的发展中国家，特别是在城市居民中，糖尿病的风险正在惊人地增加。本研究旨在揭示居住在埃塞俄比亚西部选定城镇的成年人中2型糖尿病(T2DM)的程度。方法:于2019年6月1日至6月30日在埃塞俄比亚西部城镇进行基于社区的横断面研究设计。采用多阶段系统随机抽样技术。数据的收集采用基于世界卫生组织STEPwise方法的结构化访谈问卷。将数据输入EpiData 3.1，使用社会科学软件版本24的统计软件包进行清理和分析。采用描述性统计和逻辑回归进行分析。结果:T2DM的患病率在男性和女性中分别为7.0%(95%可信区间[CI] 5.4-8.8)、8.5% (95% CI 5.6-11.0)和6.0% (95% CI 3.9-8.1)。结婚(AOR = 4.0, 95% CI 1.1-14.7)和离婚(AOR = 6.2, 95% CI 1.1-34.4)、每天摄入水果和蔬菜不足(AOR = 2.8, 95% CI 1.1-6.8)、缺乏运动(AOR = 5.0, 95% CI 2.5-10.0)、高血压(AOR = 2.9, 95% CI 1.3-6.2)、超重(AOR = 2.3, 95% CI 1.1-4.9)和肥胖(AOR = 19, 95% CI 4.5-50.1)是与T2DM独立相关的因素。结论:研究区糖尿病患病率明显高于全国患病率和其他袖珍研究。社会人口学和可改变的危险因素影响糖尿病的患病率。
{"title":"Community-Based Findings of Magnitude of Type 2 Diabetes Mellitus among Adults in Selected Towns of Western Ethiopia","authors":"Bikila Regassa Feyisa, G. Mosisa, Bayise Biru, Sidise Debelo, M. Dufera","doi":"10.1159/000522563","DOIUrl":"https://doi.org/10.1159/000522563","url":null,"abstract":"Background: The risk of diabetes mellitus (DM) is remarkably increasing globally, and it is alarmingly increasing in developing countries including Ethiopia, especially in urban residents. The present study was aimed at uncovering the magnitude of type 2 DM (T2DM) among adults residing in the selected towns of western part of Ethiopia. Methods: A community-based cross-sectional study design was conducted in towns of western Ethiopia from June 1 to June 30, 2019. Multistage and systematic random sampling techniques were employed. The data were collected using structured interviewer-administered questionnaire based on the World Health Organization STEPwise approach. Data were entered into EpiData 3.1, cleaned, and analyzed by the statistical package for social sciences software version 24. Descriptive statistics and logistic regression were used for the analysis. Results: The prevalence of T2DM was 7.0% (95% confidence interval [CI] 5.4–8.8) with 8.5% (95% CI 5.6–11.0) and 6.0% (95% CI 3.9–8.1) among males and females, respectively. Being married (AOR = 4.0, 95% CI 1.1–14.7) and divorced (AOR = 6.2, 95% CI 1.1–34.4), consumption of inadequate fruits and vegetables per day (AOR = 2.8, 95% CI 1.1–6.8), physical inactivity (AOR = 5.0, 95% CI 2.5–10.0), hypertension (AOR = 2.9, 95% CI 1.3–6.2), overweight (AOR = 2.3, 95% CI 1.1–4.9), and obesity (AOR = 19, 95% CI 4.5–50.1) were factors independently associated with T2DM. Conclusion: The prevalence of DM in the study area was found to be substantially higher than the national prevalence and other pocket studies in the country. Sociodemography and modifiable risk factors were affecting the prevalence of DM.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"25 1","pages":"56 - 64"},"PeriodicalIF":0.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77308193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dhanya Soodhana Mohan, Vani Hebbal Nagarajappa, S. Sathyanarayana, S. Srinivas, Raghupathy Palany
Insulin is the cornerstone of type 1 diabetes mellitus (T1DM) treatment. Insulin allergy in patients with T1DM on insulin is an uncommon problem that might manifest itself as immediate or delayed symptoms after injections. We present 2 cases: the first is a 17-year-old girl who was diagnosed with T1DM at the age of 14 and has had several skin lesions at injection sites over the past 2 months that have not responded to antibiotics. The second case involves a 4-year-old boy who was diagnosed with T1DM at the age of 15 months and had non-tender, erythematous, and indurated lesions. Insulin hypersensitivity was detected in both cases, thus newer analogues were administered instead of regular and isophane insulin, and the lesions dramatically reduced.
{"title":"Insulin Therapy: “When Saviour Turns Hostile”","authors":"Dhanya Soodhana Mohan, Vani Hebbal Nagarajappa, S. Sathyanarayana, S. Srinivas, Raghupathy Palany","doi":"10.1159/000522562","DOIUrl":"https://doi.org/10.1159/000522562","url":null,"abstract":"Insulin is the cornerstone of type 1 diabetes mellitus (T1DM) treatment. Insulin allergy in patients with T1DM on insulin is an uncommon problem that might manifest itself as immediate or delayed symptoms after injections. We present 2 cases: the first is a 17-year-old girl who was diagnosed with T1DM at the age of 14 and has had several skin lesions at injection sites over the past 2 months that have not responded to antibiotics. The second case involves a 4-year-old boy who was diagnosed with T1DM at the age of 15 months and had non-tender, erythematous, and indurated lesions. Insulin hypersensitivity was detected in both cases, thus newer analogues were administered instead of regular and isophane insulin, and the lesions dramatically reduced.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"79 1","pages":"74 - 78"},"PeriodicalIF":0.0,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77792164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hassanein, Walid Al Dahi, H. Radhi, Abdulraouf AIMahfouz, J. Al Kaabi, Abdulmuhsen Alshammari, Abdullah Alfutaisi, Mussa H. Almalki, R. Malik
The type 2 diabetes mellitus (T2DM) management represents a major challenge in the Gulf region. Hyperglycemia is a major risk factor for microvascular and macrovascular complications and increased mortality. Early dietary and lifestyle changes alongside a step-wise targeted pharmacological approach to achieve a glycated hemoglobin (HbA1c) level of <7% are recommended to limit these complications. However, achievement of this HbA1c target remains a major challenge, especially in the Gulf region. Both physician and patient-led barriers limit timely initiation and titration of insulin. An expert-group advisory committee reviewed the current guideline recommendations, strategized best practice, and curated clinical practical advices to enable primary-care physicians to optimally initiate and titrate insulin in patients with T2DM.
{"title":"Expert-Group Practical Advice on Insulin Initiation and Titration for Patients with Type 2 Diabetes in the Gulf Region","authors":"M. Hassanein, Walid Al Dahi, H. Radhi, Abdulraouf AIMahfouz, J. Al Kaabi, Abdulmuhsen Alshammari, Abdullah Alfutaisi, Mussa H. Almalki, R. Malik","doi":"10.1159/000521437","DOIUrl":"https://doi.org/10.1159/000521437","url":null,"abstract":"The type 2 diabetes mellitus (T2DM) management represents a major challenge in the Gulf region. Hyperglycemia is a major risk factor for microvascular and macrovascular complications and increased mortality. Early dietary and lifestyle changes alongside a step-wise targeted pharmacological approach to achieve a glycated hemoglobin (HbA1c) level of <7% are recommended to limit these complications. However, achievement of this HbA1c target remains a major challenge, especially in the Gulf region. Both physician and patient-led barriers limit timely initiation and titration of insulin. An expert-group advisory committee reviewed the current guideline recommendations, strategized best practice, and curated clinical practical advices to enable primary-care physicians to optimally initiate and titrate insulin in patients with T2DM.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"30 8 1","pages":"45 - 55"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82747363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Budoor Alemadi, Maryam Ahmad Alsaeed, Fatima Alsayyah, Salma Rahma, F. A. Al Awadi, Fauzia Rashid
Objective: The aim of this study is to assess the correlation between the findings in preoperative localization studies and biochemical parameters with the surgical outcome in patients with primary hyperparathyroidism. Design and Methods: In patients with hyperparathyroidism, preoperative localization imaging studies are considered important for their role in surgical cure, operative length, and extent of surgical incision. Sometimes discordant imaging studies lead to further extensive diagnostic work-up to avoid operative risks and may result in delay to surgical referral. In this single-center retrospective study at a tertiary referral center in Dubai, we evaluated the concordance of presurgical imaging modalities in primary hyperparathyroidism with the surgical outcome after parathyroidectomy. Results: This study included n = 59 patients. 74.6% were female, and the mean age was 52.59 years (SD = 13.6). Preoperative parathyroid sestamibi scans were done on n = 50 patients with 68% having a positive result. A radiology department neck ultrasound was done on n = 42 patients, 52% of whom had a positive finding for a parathyroid adenoma, while n = 17 patients required an endocrinology department neck ultrasound scan with 71% having a positive finding. Complete concordance of findings with the postoperative pathology result was found in 78% of patients who had a preoperative parathyroid sestamibi, 78% of patients who had a preoperative radiology department neck ultrasound, and 86% of patients with a preoperative endocrinology department ultrasound. There was no correlation between the preoperative laboratory values of calcium and PTH with the scan findings based on our data. Conclusion: Our results showed a high degree of complete concordance between the usual imaging modalities and surgical findings.
{"title":"Correlation between Surgical Outcomes of Primary Hyperparathyroidism with Neck Ultrasound and Parathyroid Scan-Tc99m/MIBI Localization Studies in Dubai Hospital","authors":"Budoor Alemadi, Maryam Ahmad Alsaeed, Fatima Alsayyah, Salma Rahma, F. A. Al Awadi, Fauzia Rashid","doi":"10.1159/000522194","DOIUrl":"https://doi.org/10.1159/000522194","url":null,"abstract":"Objective: The aim of this study is to assess the correlation between the findings in preoperative localization studies and biochemical parameters with the surgical outcome in patients with primary hyperparathyroidism. Design and Methods: In patients with hyperparathyroidism, preoperative localization imaging studies are considered important for their role in surgical cure, operative length, and extent of surgical incision. Sometimes discordant imaging studies lead to further extensive diagnostic work-up to avoid operative risks and may result in delay to surgical referral. In this single-center retrospective study at a tertiary referral center in Dubai, we evaluated the concordance of presurgical imaging modalities in primary hyperparathyroidism with the surgical outcome after parathyroidectomy. Results: This study included n = 59 patients. 74.6% were female, and the mean age was 52.59 years (SD = 13.6). Preoperative parathyroid sestamibi scans were done on n = 50 patients with 68% having a positive result. A radiology department neck ultrasound was done on n = 42 patients, 52% of whom had a positive finding for a parathyroid adenoma, while n = 17 patients required an endocrinology department neck ultrasound scan with 71% having a positive finding. Complete concordance of findings with the postoperative pathology result was found in 78% of patients who had a preoperative parathyroid sestamibi, 78% of patients who had a preoperative radiology department neck ultrasound, and 86% of patients with a preoperative endocrinology department ultrasound. There was no correlation between the preoperative laboratory values of calcium and PTH with the scan findings based on our data. Conclusion: Our results showed a high degree of complete concordance between the usual imaging modalities and surgical findings.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"42 1","pages":"136 - 142"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81343164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Diabetes mellitus (DM) is known to negatively affect quality of life (QoL), yet very few studies have been done on QoL of patients with diabetes in the United Arab Emirates population. Objectives: The aim of this study was to assess the impact of DM on health-related QoL (HRQoL) of patients with diabetes of Emirati nationality. Methods: Two hundred and forty Emirati patients with diabetes, treated at the Dubai Diabetes Center, were randomly selected and interviewed using the Short Form-36 questionnaire to assess HRQoL domains. Appropriate statistical measures were performed to associate HRQoL domains with diabetes-related factors. Results: HRQoL satisfaction scores for physical and mental health domains were very high for the majority of participants. Male participants ranked significantly higher median scores in all HRQoL domains than females (77.36 vs. 65.28, p = 0.004). There was a significant (p < 0.001) negative correlation between diabetes duration and the total averaged score for all sub-domains, and significant (p < 0.001) negative correlations between glycated hemoglobin percentage (HBA1c%) and all sub-domains of HRQoL. Patients without complications had significantly better scores in all HRQoL sub-domains than patients suffering from any complications. Median total HRQoL score for those with neuropathy compared to those without neuropathy was 63.9 versus 82.6 (p < 0.001), for nephropathy was 43.6 versus 72.5 (p < 0.001), for retinopathy 50.7 versus 76.0 (p < 0.001), for ischemic heart disease 54.1 versus 77.3 (p < 0.001), and for cerebrovascular disease 36.7 versus 72.4 (p < 0.001). Multiple regression showed 3 significant predictors for the total averaged score from all HRQoL sub-domains; these were age (p = 0.007), HbA1c% (p < 0.001), and the number of complications related to DM (p = 0.001). Conclusion: HRQoL in Emirati patients with diabetes was significantly associated with the presence of diabetes-related complications, glycemic control, and age of the patient. The assessment of QoL in patients with diabetes can be a valuable measure for the healthcare providers to assess patient’s well-being.
{"title":"The Effect of Diabetes on Health-Related Quality of Life in Emirati Patients","authors":"Zainab Al-Abadla, T. Elgzyri, M. Moussa","doi":"10.1159/000520599","DOIUrl":"https://doi.org/10.1159/000520599","url":null,"abstract":"Background: Diabetes mellitus (DM) is known to negatively affect quality of life (QoL), yet very few studies have been done on QoL of patients with diabetes in the United Arab Emirates population. Objectives: The aim of this study was to assess the impact of DM on health-related QoL (HRQoL) of patients with diabetes of Emirati nationality. Methods: Two hundred and forty Emirati patients with diabetes, treated at the Dubai Diabetes Center, were randomly selected and interviewed using the Short Form-36 questionnaire to assess HRQoL domains. Appropriate statistical measures were performed to associate HRQoL domains with diabetes-related factors. Results: HRQoL satisfaction scores for physical and mental health domains were very high for the majority of participants. Male participants ranked significantly higher median scores in all HRQoL domains than females (77.36 vs. 65.28, p = 0.004). There was a significant (p < 0.001) negative correlation between diabetes duration and the total averaged score for all sub-domains, and significant (p < 0.001) negative correlations between glycated hemoglobin percentage (HBA1c%) and all sub-domains of HRQoL. Patients without complications had significantly better scores in all HRQoL sub-domains than patients suffering from any complications. Median total HRQoL score for those with neuropathy compared to those without neuropathy was 63.9 versus 82.6 (p < 0.001), for nephropathy was 43.6 versus 72.5 (p < 0.001), for retinopathy 50.7 versus 76.0 (p < 0.001), for ischemic heart disease 54.1 versus 77.3 (p < 0.001), and for cerebrovascular disease 36.7 versus 72.4 (p < 0.001). Multiple regression showed 3 significant predictors for the total averaged score from all HRQoL sub-domains; these were age (p = 0.007), HbA1c% (p < 0.001), and the number of complications related to DM (p = 0.001). Conclusion: HRQoL in Emirati patients with diabetes was significantly associated with the presence of diabetes-related complications, glycemic control, and age of the patient. The assessment of QoL in patients with diabetes can be a valuable measure for the healthcare providers to assess patient’s well-being.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"9 1","pages":"35 - 44"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79577827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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