B. Onyenekwe, E. Young, C. Nwatu, C. Okafor, C. V. Ugwueze
Background: Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. Objectives: The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. Methods: The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. Results: There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA1C level. Conclusion: DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.
背景:糖尿病窘迫(DD)是糖尿病患者普遍存在的世界性问题，与年龄和治疗方式无关。在DAWN 2研究(糖尿病态度、愿望和需求)中，44.6%的参与者报告了DD。目的:本研究的目的是评估尼日利亚东南部成年糖尿病患者中DD的患病率和水平及其相关因素。方法:本研究采用横断面和描述性方法。参加成人糖尿病诊所的患者被纳入研究。调查问卷由调查人员填写。所有患者均符合条件。获得他们的人口学和临床资料。使用DD量表(DDS)-2和DDS-17对患者进行DD筛查。数据采用SPSS version 21进行制表和分析。结果:110例受试者(男38例，女72例)，年龄36 ~ 85岁(60.5±10.0)。只有9例(8.2%)患有1型糖尿病(DM)，其余为2型糖尿病(DM)。25例(22.7%)接受胰岛素注射。72%的患者同时患有高血压，在评估时，他们服用了3-10种药物(5.9±1.5种)。男性和女性受试者具有可比性。51.9%出现中度至重度DD (DDS-17)。dds - 2.3.1分;DDS-17 2.3;情感负担，2.9分;与医生有关的苦恼，1.4分;与治疗相关的痛苦，2.5，以及人际痛苦，2.2。苦恼与年龄小、T1DM、糖尿病持续时间长、胰岛素注射使用和HbA1C水平显著相关。结论:DD是糖尿病患者的常见后果，损害了糖尿病患者的自我护理行为和血糖控制。积极筛查DD应该是糖尿病护理的一个组成部分。糖尿病自我管理教育和支持应在诊断时实施，并在诊断后根据需要实施，特别是在诊断出DD时。
{"title":"Diabetes Distress and Associated Factors in Patients with Diabetes Mellitus in South East Nigeria","authors":"B. Onyenekwe, E. Young, C. Nwatu, C. Okafor, C. V. Ugwueze","doi":"10.1159/000508706","DOIUrl":"https://doi.org/10.1159/000508706","url":null,"abstract":"Background: Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. Objectives: The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. Methods: The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. Results: There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA1C level. Conclusion: DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"23 1","pages":"31 - 37"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73899679","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: Progression of type 2 diabetes will necessitate the use of injectable therapies in a significant number of people. Co-formulations of degludec with liraglutide (IDegLira) and glargine with lixisenatide (IGlarLixi) are currently recommended for intensification in people with type 2 diabetes on basal insulin or glucagon-like peptide receptor agonist (GLP-1RA) alone or in people with type 2 diabetes who are naïve to insulin with very high glycated haemoglobin. Co-formulation of aspart with degludec (IDegAsp) is recommended as a substitute for premixed insulin. The aim of this article is to review the evidence in the use of co-formulations as the first injectable in type 2 diabetes and its clinical implications. Summary: In people with type 2 diabetes who are naïve to insulin or GLP-1RA, IDegLira and IGlarLixi achieved stable and durable glycaemic control over a wide range of baseline glycated haemoglobin (HbA1c) levels. People on IDegLira and IGlarLixi had lesser risk of hypoglycaemia and weight gain in studies compared to basal insulin and lesser gastrointestinal adverse effects in comparison to GLP-1RA. IDegAsp achieved similar glycaemic control to basal and premixed insulin with lesser risk of nocturnal hypoglycaemia. Key Messages: IDegLira, IGlarLixi, and IDegAsp can be used as the first injectable in people with type 2 diabetes with very high glycated haemoglobin on oral antidiabetic drugs. These co-formulations combine efficacy and durability with lesser injection burden. The components of these agents have proven cardiovascular and renal safety. Their limitations in flexibility of dosing, renal and cardiovascular considerations, and adverse effects are discussed.
{"title":"Co-Formulations as the First Injectable in Type 2 Diabetes: A Review of Efficacy, Safety, and Implications in Clinical Practice","authors":"M. John, D. Gopinath, T. Oommen","doi":"10.1159/000509045","DOIUrl":"https://doi.org/10.1159/000509045","url":null,"abstract":"Background: Progression of type 2 diabetes will necessitate the use of injectable therapies in a significant number of people. Co-formulations of degludec with liraglutide (IDegLira) and glargine with lixisenatide (IGlarLixi) are currently recommended for intensification in people with type 2 diabetes on basal insulin or glucagon-like peptide receptor agonist (GLP-1RA) alone or in people with type 2 diabetes who are naïve to insulin with very high glycated haemoglobin. Co-formulation of aspart with degludec (IDegAsp) is recommended as a substitute for premixed insulin. The aim of this article is to review the evidence in the use of co-formulations as the first injectable in type 2 diabetes and its clinical implications. Summary: In people with type 2 diabetes who are naïve to insulin or GLP-1RA, IDegLira and IGlarLixi achieved stable and durable glycaemic control over a wide range of baseline glycated haemoglobin (HbA1c) levels. People on IDegLira and IGlarLixi had lesser risk of hypoglycaemia and weight gain in studies compared to basal insulin and lesser gastrointestinal adverse effects in comparison to GLP-1RA. IDegAsp achieved similar glycaemic control to basal and premixed insulin with lesser risk of nocturnal hypoglycaemia. Key Messages: IDegLira, IGlarLixi, and IDegAsp can be used as the first injectable in people with type 2 diabetes with very high glycated haemoglobin on oral antidiabetic drugs. These co-formulations combine efficacy and durability with lesser injection burden. The components of these agents have proven cardiovascular and renal safety. Their limitations in flexibility of dosing, renal and cardiovascular considerations, and adverse effects are discussed.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"2013 1","pages":"139 - 151"},"PeriodicalIF":0.0,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86319352","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}
F. Alawadi, M. Hassanein, E. Suliman, H. Hussain, H. Mamdouh, G. Ibrahim, Waleed Hassan Al Faisal, N. Monsef, Mohammad Farghaly
Background: Diabetes mellitus is a leading cause of morbidity and mortality worldwide, imposing a considerable burden on health systems and societies as it affects both individuals and their families and has a large impact on the economic and social development of a country. Objectives: The purpose of this study was to study the prevalence of diabetes and pre-diabetes among the Dubai population and associations with diabetes risk factors. Methodology: A cross-sectional Diabetes Household Survey was carried out in the Emirates of Dubai during 2017 as a complementary stage of the Dubai Household Survey, 2014, which was a randomly selected, multistage, stratified, cluster survey. The sampling technique was selected to assess the rates of undiagnosed diabetes as well as the rates of pre-diabetes through screening with HbA1c. The size of the 2017 survey sample was estimated at 300 individuals for Emirati and 300 for non-Emirati. An additional 200 individuals were added to address non-response cases. These were added to those who were identified as diabetics in the 2014 Household Health Survey and then weighted to give a representative sample for the Dubai population. Results: The study revealed that the prevalence of diabetes in Dubai among UAE nationals was 19%, and it was 14.7% for expats. Consequently, the overall prevalence of diabetes in Dubai is 15.2%. Undiagnosed diabetes was 10% in UAE nationals and 10.9% in expats. Pre-diabetes in UAE national males was lower than in females, although this pattern was not observed among expats. Younger age, normal weight, and exercise were associated with lower rates of diabetes and pre-diabetes in UAE nationals and expats. Hypertension was associated with higher rates of diabetes regardless of nationality. Conclusions: The study concluded that the prevalence of diabetes among the Dubai population is alarmingly high and that a large proportion of the population are not aware of their diagnosis. A higher prevalence of diabetes is associated with multiple factors, such as age, male gender, hypertension, higher BMI, lack of exercise, and lower level or no education, as well as a family history of diabetes mellitus. Many of these factors can be easily modified, which could lead to a decrease in the burden of the disease.
{"title":"The Prevalence of Diabetes and Pre-Diabetes among the Dubai Population: Findings from Dubai Household Health Surveys, 2014 and 2017","authors":"F. Alawadi, M. Hassanein, E. Suliman, H. Hussain, H. Mamdouh, G. Ibrahim, Waleed Hassan Al Faisal, N. Monsef, Mohammad Farghaly","doi":"10.1159/000508833","DOIUrl":"https://doi.org/10.1159/000508833","url":null,"abstract":"Background: Diabetes mellitus is a leading cause of morbidity and mortality worldwide, imposing a considerable burden on health systems and societies as it affects both individuals and their families and has a large impact on the economic and social development of a country. Objectives: The purpose of this study was to study the prevalence of diabetes and pre-diabetes among the Dubai population and associations with diabetes risk factors. Methodology: A cross-sectional Diabetes Household Survey was carried out in the Emirates of Dubai during 2017 as a complementary stage of the Dubai Household Survey, 2014, which was a randomly selected, multistage, stratified, cluster survey. The sampling technique was selected to assess the rates of undiagnosed diabetes as well as the rates of pre-diabetes through screening with HbA1c. The size of the 2017 survey sample was estimated at 300 individuals for Emirati and 300 for non-Emirati. An additional 200 individuals were added to address non-response cases. These were added to those who were identified as diabetics in the 2014 Household Health Survey and then weighted to give a representative sample for the Dubai population. Results: The study revealed that the prevalence of diabetes in Dubai among UAE nationals was 19%, and it was 14.7% for expats. Consequently, the overall prevalence of diabetes in Dubai is 15.2%. Undiagnosed diabetes was 10% in UAE nationals and 10.9% in expats. Pre-diabetes in UAE national males was lower than in females, although this pattern was not observed among expats. Younger age, normal weight, and exercise were associated with lower rates of diabetes and pre-diabetes in UAE nationals and expats. Hypertension was associated with higher rates of diabetes regardless of nationality. Conclusions: The study concluded that the prevalence of diabetes among the Dubai population is alarmingly high and that a large proportion of the population are not aware of their diagnosis. A higher prevalence of diabetes is associated with multiple factors, such as age, male gender, hypertension, higher BMI, lack of exercise, and lower level or no education, as well as a family history of diabetes mellitus. Many of these factors can be easily modified, which could lead to a decrease in the burden of the disease.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"62 1","pages":"78 - 84"},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84721254","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}
Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. Methods: We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. Results: A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15–20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. Conclusion: Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction.
{"title":"Comparison of Various Glucocorticoid Replacement Regimens Used in Chronic Adrenal Insufficiency: A Systematic Review","authors":"N. Kiko, A. Kalhan","doi":"10.1159/000508321","DOIUrl":"https://doi.org/10.1159/000508321","url":null,"abstract":"Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. Methods: We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. Results: A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15–20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. Conclusion: Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"211 1","pages":"50 - 68"},"PeriodicalIF":0.0,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75731498","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}
Profound hypothyroidism has been linked to mild bleeding diathesis such as easy bruising and menorrhagia. Bleeding tendency depends on the severity of hypothyroidism. Those with moderate disease are prone to thrombotic events, while those with profound hypothyroidism are prone to bleeding. This paper reports a case of severe intraoperative bleeding during elective rhinoplasty in a patient with missed profound hypothyroidism. The clinical and laboratory findings are presented with a review of the literature. A 43-year-old female was admitted for an elective rhinoplasty. In the theater, the patient developed massive bleeding at the beginning of surgery. On the next day, the patient was discharged home for further assessment with a massive bruise all over her face. Upon history taking, the patient denied any drug abuse or previous bleeding episode or family history of bleeding disorder. Surprisingly, a transverse scar was noted at the lower part of the neck. The patient admitted that she had thyroidectomy done 2 years ago, and she was kept on thyroxine replacement and stopped it by herself 18 months ago. Thyroid-stimulating hormone (TSH) was 70 mU/L, and von Willebrand factor antigen/ristocetin cofactor was normal. A diagnosis of acquired von Willebrand syndrome type 1 was made. The patient was kept on thyroxine 150 µg/day. Six weeks later, TSH was 0.8 mU/L, and all bleeding parameters were corrected. A careful history taking and general examination looking for hypothyroidism is crucial in the preoperative assessment. It might be prudent to include thyroid function test in the routine preoperative investigation of all patients.
{"title":"An Unexpected Cause of Catastrophic Bleeding: A Case Report","authors":"M. Alabbood","doi":"10.1159/000508707","DOIUrl":"https://doi.org/10.1159/000508707","url":null,"abstract":"Profound hypothyroidism has been linked to mild bleeding diathesis such as easy bruising and menorrhagia. Bleeding tendency depends on the severity of hypothyroidism. Those with moderate disease are prone to thrombotic events, while those with profound hypothyroidism are prone to bleeding. This paper reports a case of severe intraoperative bleeding during elective rhinoplasty in a patient with missed profound hypothyroidism. The clinical and laboratory findings are presented with a review of the literature. A 43-year-old female was admitted for an elective rhinoplasty. In the theater, the patient developed massive bleeding at the beginning of surgery. On the next day, the patient was discharged home for further assessment with a massive bruise all over her face. Upon history taking, the patient denied any drug abuse or previous bleeding episode or family history of bleeding disorder. Surprisingly, a transverse scar was noted at the lower part of the neck. The patient admitted that she had thyroidectomy done 2 years ago, and she was kept on thyroxine replacement and stopped it by herself 18 months ago. Thyroid-stimulating hormone (TSH) was 70 mU/L, and von Willebrand factor antigen/ristocetin cofactor was normal. A diagnosis of acquired von Willebrand syndrome type 1 was made. The patient was kept on thyroxine 150 µg/day. Six weeks later, TSH was 0.8 mU/L, and all bleeding parameters were corrected. A careful history taking and general examination looking for hypothyroidism is crucial in the preoperative assessment. It might be prudent to include thyroid function test in the routine preoperative investigation of all patients.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"15 1","pages":"44 - 46"},"PeriodicalIF":0.0,"publicationDate":"2020-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000508707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72545008","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}
Objectives: Type 1 diabetes mellitus (T1DM) is one of the most common pediatric endocrine diseases. India alone is home to around 97,700 children with T1DM. This paper evaluates the efficacy, safety, and quality of life with continuous subcutaneous insulin infusion (CSII) in patients treated for a protracted time period of 1 year in a retrospective study versus multiple-dose insulin (MDI). Methods: CSII was offered to patients with poor metabolic control (HbA1c >8.5%) on MDI, patients needing flexible timing of meals, or patients with hypoglycemia unawareness/nocturnal hypoglycemia/high blood sugar fluctuations. Continuous blood glucose monitoring (CGM) was done using the Medtronic CGM system gold/iPro 2 in all patients. Data were collected through a questionnaire completed by patients with the help of a pediatric endocrinologist. Results: A total of 45 patients completed the study evaluation period. The results demonstrated better glycemic control, reduced hypoglycemia on CGM, and no events of diabetic ketoacidosis noted on CSII. The hypoglycemic events were few and nonsevere. The patients in the CSII group reported better quality of life on the Pediatric Quality of Life Inventory 3.2 Diabetic Module diabetes score than the MDI group. Conclusions: This study is the first of this kind in India in the field of pediatric endocrinology. The clinical outcomes validate the use of CSII as the desirable intensive insulin therapy.
{"title":"Real-World Efficacy and Safety of Continuous Subcutaneous Insulin Infusion (CSII) Therapy and Comparison of Treatment Satisfaction between CSII and Multiple Daily Injection Therapy","authors":"I. Kochar, A. Sethi, Smita Ramachandran","doi":"10.1159/000507391","DOIUrl":"https://doi.org/10.1159/000507391","url":null,"abstract":"Objectives: Type 1 diabetes mellitus (T1DM) is one of the most common pediatric endocrine diseases. India alone is home to around 97,700 children with T1DM. This paper evaluates the efficacy, safety, and quality of life with continuous subcutaneous insulin infusion (CSII) in patients treated for a protracted time period of 1 year in a retrospective study versus multiple-dose insulin (MDI). Methods: CSII was offered to patients with poor metabolic control (HbA1c >8.5%) on MDI, patients needing flexible timing of meals, or patients with hypoglycemia unawareness/nocturnal hypoglycemia/high blood sugar fluctuations. Continuous blood glucose monitoring (CGM) was done using the Medtronic CGM system gold/iPro 2 in all patients. Data were collected through a questionnaire completed by patients with the help of a pediatric endocrinologist. Results: A total of 45 patients completed the study evaluation period. The results demonstrated better glycemic control, reduced hypoglycemia on CGM, and no events of diabetic ketoacidosis noted on CSII. The hypoglycemic events were few and nonsevere. The patients in the CSII group reported better quality of life on the Pediatric Quality of Life Inventory 3.2 Diabetic Module diabetes score than the MDI group. Conclusions: This study is the first of this kind in India in the field of pediatric endocrinology. The clinical outcomes validate the use of CSII as the desirable intensive insulin therapy.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"32 1","pages":"85 - 92"},"PeriodicalIF":0.0,"publicationDate":"2020-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76166928","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}
Introduction: Diabetes risk estimation is essential for the implementation of preventive measures. Objectives: We aimed to assess the diabetes risk among medical students in Tabuk, Saudi Arabia. Methods: This cross-sectional study was conducted among 169 medical students in the Medical College, University of Tabuk, Saudi Arabia, from October 2017 to April 2018. Participants signed a written informed consent and then responded to a questionnaire modified from the Finnish and the ARABRISK diabetes score. The questionnaire consisted of eight components inquiring about age, BMI, central adiposity, fruit and vegetable consumption, physical activity if found to have high blood pressure or blood sugar, and family history of diabetes mellitus. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Results: Out of 169 students (68% with a family history of diabetes), obesity and overweight were found in 21.3 and 26.6%, respectively, 45.6% had central adiposity, more than half were not practicing exercise daily, and 60.4% were not consuming fruits and vegetables daily. A significant percentage was found to have high blood sugar (9.5%) and high blood pressure (4.7%). The diabetes risk score was high or moderate in 16% of the students. Conclusion: Medical students in Tabuk City were at high risk for diabetes mellitus. Obesity, overweight, central adiposity, physical inactivity, and less consumption of fruits and vegetables substantially contributed to the risk. Measures to prevent obesity, improving fruit and vegetable consumption, and exercise are needed.
{"title":"Diabetes Risk among Medical Students in Tabuk City, Saudi Arabia","authors":"H. Mirghani, Abdelmoneum Saleh","doi":"10.1159/000507245","DOIUrl":"https://doi.org/10.1159/000507245","url":null,"abstract":"Introduction: Diabetes risk estimation is essential for the implementation of preventive measures. Objectives: We aimed to assess the diabetes risk among medical students in Tabuk, Saudi Arabia. Methods: This cross-sectional study was conducted among 169 medical students in the Medical College, University of Tabuk, Saudi Arabia, from October 2017 to April 2018. Participants signed a written informed consent and then responded to a questionnaire modified from the Finnish and the ARABRISK diabetes score. The questionnaire consisted of eight components inquiring about age, BMI, central adiposity, fruit and vegetable consumption, physical activity if found to have high blood pressure or blood sugar, and family history of diabetes mellitus. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Results: Out of 169 students (68% with a family history of diabetes), obesity and overweight were found in 21.3 and 26.6%, respectively, 45.6% had central adiposity, more than half were not practicing exercise daily, and 60.4% were not consuming fruits and vegetables daily. A significant percentage was found to have high blood sugar (9.5%) and high blood pressure (4.7%). The diabetes risk score was high or moderate in 16% of the students. Conclusion: Medical students in Tabuk City were at high risk for diabetes mellitus. Obesity, overweight, central adiposity, physical inactivity, and less consumption of fruits and vegetables substantially contributed to the risk. Measures to prevent obesity, improving fruit and vegetable consumption, and exercise are needed.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"3 1","pages":"27 - 30"},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89878135","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}
Aims: This study aims to compare the Apgar scores (at different time points after birth) and their changes between the newborns of gestational diabetes mellitus (GDM) patients treated with metformin and glyburide, respectively. Methods: Electronic databases were searched for randomized controlled trials that compared these outcomes between the above-depicted intervention groups. The data about the study design, the population characteristics, the interventions compared, and the outcomes of interest were extracted from the eligible trials. Then, these trials were critically appraised by the Cochrane tool. After that, the effect of the tested interventions on the respective outcomes of interest was reported narratively. Results: The literature search produced 4 single-center trials sourcing data from about 538 participants in the USA, Brazil, and Israel. The risk of detection and performance bias was unclear in the respective trials. The trials primarily reported about the Apgar scores at 1 and 5 min after birth. These scores were not different between glyburide- and metformin-treated GDM patients in any trial. No trial reported the Apgar score at 10 min after birth or the changes in Apgar score between 1, 5, or 10 min after birth. Conclusion: In all trials, the Apgar scores at 1 and 5 min after birth did not vary between the newborns of GDM mothers treated with metformin and glyburide, respectively.
{"title":"A Comparison of Apgar Scores and Changes in the Neonates of Gestational Diabetes Mellitus Patients Treated with Metformin versus Glyburide: A Systematic Review","authors":"S. Saha, Sujata Saha","doi":"10.1159/000507244","DOIUrl":"https://doi.org/10.1159/000507244","url":null,"abstract":"Aims: This study aims to compare the Apgar scores (at different time points after birth) and their changes between the newborns of gestational diabetes mellitus (GDM) patients treated with metformin and glyburide, respectively. Methods: Electronic databases were searched for randomized controlled trials that compared these outcomes between the above-depicted intervention groups. The data about the study design, the population characteristics, the interventions compared, and the outcomes of interest were extracted from the eligible trials. Then, these trials were critically appraised by the Cochrane tool. After that, the effect of the tested interventions on the respective outcomes of interest was reported narratively. Results: The literature search produced 4 single-center trials sourcing data from about 538 participants in the USA, Brazil, and Israel. The risk of detection and performance bias was unclear in the respective trials. The trials primarily reported about the Apgar scores at 1 and 5 min after birth. These scores were not different between glyburide- and metformin-treated GDM patients in any trial. No trial reported the Apgar score at 10 min after birth or the changes in Apgar score between 1, 5, or 10 min after birth. Conclusion: In all trials, the Apgar scores at 1 and 5 min after birth did not vary between the newborns of GDM mothers treated with metformin and glyburide, respectively.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"77 1","pages":"21 - 26"},"PeriodicalIF":0.0,"publicationDate":"2020-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83960904","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: Diabetic foot ulcers are an increasingly common complex problem and are associated with a very considerable health care burden. Diabetic foot ulcer with Alcaligenes faecalis infection is rarely reported in the literature. We report a case series of diabetic foot ulcer with A. faecalis infection treated at our facility. Methods: We conducted a retrospective analysis of all patients with diabetic foot ulcer with A. faecalis infection seen from January 2014 to April 2019. We analyzed the clinical characteristics, ulcer lesion classification, comorbidities, prior intravenous antibiotic use within 3 months, wound culture, antibiotics sensitivity test, and clinical outcomes of these patients. Results: Eight cases of diabetic foot ulcer with A. faecalis infection were seen in 5 males and 3 females. Mean age was 54.6 years. All patients had other comorbidities, and all ulcer lesions were of chronic duration (>14 days). All wound cultures revealed polymicrobial infection, with 2 cases of diabetic foot with extensive drug-resistant A. faecalis infection found in 2019. All patients needed intravenous antibiotic therapy and surgical interventions for the chronic ulcer lesion. The wound failed to heal in 3 patients. Conclusions: All diabetic foot ulcers with A. faecalis infection were of chronic duration (>14 days) and had polymicrobial infection. Extensive drug-resistant A. faecalis emerged in 2019. Definitive antibiotic therapy is necessary for all infected wounds and should be based on both the culture results and susceptibility data. All patients will need appropriate wound care, and most will need rapid surgical intervention for an optimal outcome.
{"title":"Diabetic Foot Ulcer with Alcaligenes faecalis Infection","authors":"Chienhsiu Huang","doi":"10.1159/000508094","DOIUrl":"https://doi.org/10.1159/000508094","url":null,"abstract":"Background: Diabetic foot ulcers are an increasingly common complex problem and are associated with a very considerable health care burden. Diabetic foot ulcer with Alcaligenes faecalis infection is rarely reported in the literature. We report a case series of diabetic foot ulcer with A. faecalis infection treated at our facility. Methods: We conducted a retrospective analysis of all patients with diabetic foot ulcer with A. faecalis infection seen from January 2014 to April 2019. We analyzed the clinical characteristics, ulcer lesion classification, comorbidities, prior intravenous antibiotic use within 3 months, wound culture, antibiotics sensitivity test, and clinical outcomes of these patients. Results: Eight cases of diabetic foot ulcer with A. faecalis infection were seen in 5 males and 3 females. Mean age was 54.6 years. All patients had other comorbidities, and all ulcer lesions were of chronic duration (>14 days). All wound cultures revealed polymicrobial infection, with 2 cases of diabetic foot with extensive drug-resistant A. faecalis infection found in 2019. All patients needed intravenous antibiotic therapy and surgical interventions for the chronic ulcer lesion. The wound failed to heal in 3 patients. Conclusions: All diabetic foot ulcers with A. faecalis infection were of chronic duration (>14 days) and had polymicrobial infection. Extensive drug-resistant A. faecalis emerged in 2019. Definitive antibiotic therapy is necessary for all infected wounds and should be based on both the culture results and susceptibility data. All patients will need appropriate wound care, and most will need rapid surgical intervention for an optimal outcome.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"2013 1","pages":"128 - 133"},"PeriodicalIF":0.0,"publicationDate":"2020-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82663647","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}
F. Alawadi, S. Abusnana, B. Afandi, Khaled M. Aldahmani, Omniyat Alhajeri, Khaled Aljaberi, J. Alkaabi, Abdulrazzaq Almadani, A. Bashier, S. Beshyah, B. B. Bin Belaila, Mohammad Fargaly, M. Farooqi, Khadija Hafidh, M. Hassanein, A. Hassoun, A. Jabbar, Iyad Ksseiry, H. Mustafa, H. Saadi, Sara Suliman
Rapid urbanisation and socioeconomic development in the United Arab Emirates (UAE) have led to the widespread adoption of a sedentary lifestyle and Westernised diet in the local population and consequently a high prevalence of obesity and diabetes. In 2019, International Diabetes Federation statistics reported a diabetes prevalence rate of 16.3% for the adult population in the UAE. In view of the wealth of recent literature on diabetes care and new pharmacotherapeutics, the Emirates Diabetes Society convened a panel of experts to update existing local guidelines with international management recommendations. The goal is to improve the standard of care for people with diabetes through increased awareness of these management practices among healthcare providers licensed by national health authorities. These consensus guidelines address the screening, diagnosis and management of type 2 diabetes mellitus in adults including individuals at risk of developing the disease.
{"title":"Emirates Diabetes Society Consensus Guidelines for the Management of Type 2 Diabetes Mellitus – 2020","authors":"F. Alawadi, S. Abusnana, B. Afandi, Khaled M. Aldahmani, Omniyat Alhajeri, Khaled Aljaberi, J. Alkaabi, Abdulrazzaq Almadani, A. Bashier, S. Beshyah, B. B. Bin Belaila, Mohammad Fargaly, M. Farooqi, Khadija Hafidh, M. Hassanein, A. Hassoun, A. Jabbar, Iyad Ksseiry, H. Mustafa, H. Saadi, Sara Suliman","doi":"10.1159/000506508","DOIUrl":"https://doi.org/10.1159/000506508","url":null,"abstract":"Rapid urbanisation and socioeconomic development in the United Arab Emirates (UAE) have led to the widespread adoption of a sedentary lifestyle and Westernised diet in the local population and consequently a high prevalence of obesity and diabetes. In 2019, International Diabetes Federation statistics reported a diabetes prevalence rate of 16.3% for the adult population in the UAE. In view of the wealth of recent literature on diabetes care and new pharmacotherapeutics, the Emirates Diabetes Society convened a panel of experts to update existing local guidelines with international management recommendations. The goal is to improve the standard of care for people with diabetes through increased awareness of these management practices among healthcare providers licensed by national health authorities. These consensus guidelines address the screening, diagnosis and management of type 2 diabetes mellitus in adults including individuals at risk of developing the disease.","PeriodicalId":34679,"journal":{"name":"Dubai Diabetes and Endocrinology Journal","volume":"47 1","pages":"1 - 20"},"PeriodicalIF":0.0,"publicationDate":"2020-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76782308","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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