Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a maj...Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.展开更多
AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age...AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age 45-64 years,mean age,53.9±5.5 years)with T2DM and without atherosclerotic cardiovascular events who underwent typing to determine their apolipoprotein E(apoE)isoforms.The apoE isoforms were determined using isoelectric focusing,followed by immunoblotting.We retrospectively evaluated the charts of the 269 patients,recorded between their first visit to the hospital(the study's start point,between 1987 and 1992)and the occurrence of an atherosclerotic cardiovascular event(the study's endpoint)or January 2004,whichever came first.The age-adjusted mean values and the prevalences of covariates were calculated to compare the laboratory data among the apoE phenotypes.To investigate the association of risk factors with the incidence of coronary heart disease during the follow-up period,monovariate and multivariate Cox regression models were used.RESULTS:At enrollment,the mean serum low density lipoprotein(LDL)cholesterol levels were lowest(2.92± 0.89 mmol/L)among the subjects with apoE2(apoE2/2 or apoE2/3)and highest(3.52±0.77 mmol/L)among the subjects with apoE4(apoE3/4 or apoE4/4).No significant differences in mean age or the percentage of smokers were observed among the three groups.Furthermore,no significant differences were observed in the systolic and diastolic blood pressures,body mass index,HbA1c level or serum triglyceride levels among the three groups.There were 47 cases of coronary heart disease over 3285 person-years of follow-up.An age-adjusted multivariate Cox proportional model identified diabetic retinopathy(hazard ratio,2.38,95% CI:1.28-4.43,P=0.006),a high systolic blood pressure(hazard ratio,1.04,95%CI:1.02-1.06,P<0.001) and high HbA1c values(hazard ratio,1.19,95%CI:1.02-1.38,P=0.0029),but not the LDL cholesterol value at enrollment(hazard ratio,1.01,95%CI:0.97-1.05,P=0.77)nor the specific apoE isoform,as significant predictors of coronary heart disease.CONCLUSION:Under standard medical treatment of diabetes,including the control of LDL cholesterol levels,the apoE4 isoform was not associated with coronary heart disease among T2DM patients.展开更多
In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an import...In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes.Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality.Drugs which inhibit glucose re-absorption in the kidney,sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.展开更多
Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination th...Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination therapy with GLP-1RA plus SGLT-2I have shown a greater reduction in HbA1c,body weight,and SBP compared to either agent alone without any significant increase in hypoglycemia or other side effects.Since several agents from each class of these drugs have shown an improvement in cardiovascular(CV)and renal outcomes in their respective cardiovascular outcome trials(CVOT),combination therapy is theoretically expected to have additional CV and renal benefits.In this comprehensive opinion review,we found HbA1c lowering with GLP-1RA plus SGLT-2I to be less than additive compared to the sum of HbA1c lowering with either agent alone,although body weight lowering was nearly additive and the SBP lowering was more than additive.Our additional meta-analysis of CV outcomes with GLP1RA plus SGLT-2I combination therapy from the pooled data of five CVOT found a similar reduction in three-point major adverse cardiovascular events compared to GLP-1RA or SGLT-2I alone,against placebo.Interestingly,a greater benefit in reduction of heart failure hospitalization with GLP-1RA plus SGLT-2I combination therapy was noted in the pooled meta-analysis of two randomized controlled trials.Future adequately powered trials can confirm whether additional CV or renal benefit is truly exerted by GLP-1RA plus SGLT-2I combination therapy.展开更多
BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown s...BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.展开更多
Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associate...Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related autoantibodies.Diabetic ketoacidosis with normal blood glucose levels has been reported during sodiumglucose co-transporter 2(SGLT2)inhibitor therapy.CASE SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise,thirst,and vomiting.Blood analysis showed high blood glucose levels(428 mg/dL),a mild increase of hemoglobin A1c(6.6%),and increased ketone bodies in urine.The patient was diagnosed with type 2 diabetes mellitus.The patient was initially treated with insulin,which was subsequently changed to an oral SGLT2 inhibitor.Antibodies to glutamic acid decarboxylase were negative.Four days after receiving oral SGLT2 inhibitor,she consulted at Mie University Hospital,complaining of fatigue and vomiting.Laboratory analysis revealed diabetic ketoacidosis with almost normal blood glucose levels.The endogenous insulin secretion was markedly low,and the serum levels of islet-related autoantibodies were undetectable.We made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis.The patient's general condition improved after therapy with intravenous insulin and withdrawal of oral medication.She was discharged on day 14 with an indication of multiple daily insulin therapy.CONCLUSION This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose levels.This case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.展开更多
BACKGROUND The diagnosis of type 2 diabetes(T2D)in younger adults,an increasingly common public health issue,is associated with a higher risk of cardiovascular complications and mortality,which may be due to a more ad...BACKGROUND The diagnosis of type 2 diabetes(T2D)in younger adults,an increasingly common public health issue,is associated with a higher risk of cardiovascular complications and mortality,which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.METHODS A pooled dataset was used,comprised of data from five previous studies of adults with T2D,including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years.Anthropometric and blood biomarker measurements included body weight,body mass index(BMI),waist circumference,body fat percentage,glycaemic control(HbA1c),lipid profile and blood pressure.Univariable and multivariable linear regression models,adjusted for diabetes duration,sex,ethnicity and smoking status,were used to investigate the association between age at diagnosis and each cardiovascular risk factor.RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female,current smokers and treated with glucose-lowering medications,compared to participants diagnosed later in life.Participants diagnosed with T2D under the age of 40 also had higher body weight,BMI,waist circumference and body fat percentage,in addition to a more adverse lipid profile,compared to participants diagnosed at an older age.Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight[95%confidence interval(CI):0.52-0.82 kg],0.18 kg/m^(2) higher BMI(95%CI:0.10-0.25)and 0.32 cm higher waist circumference(95%CI:0.14-0.49),after adjustment for duration of diabetes and other confounders.Younger age at diagnosis was also significantly associated with higher HbA1c,total cholesterol,low-density lipoprotein cholesterol and triglycerides.CONCLUSION The diagnosis of T2D earlier in life is associated with a worse cardiovascular risk factor profile,compared to those diagnosed later in life.展开更多
Diabetes and coronavirus disease 2019(COVID-19)are worldwide pandemics that have had a major impact on public health throughout the globe.Risk factors for developing diabetes and having adverse outcomes of COVID-19 ap...Diabetes and coronavirus disease 2019(COVID-19)are worldwide pandemics that have had a major impact on public health throughout the globe.Risk factors for developing diabetes and having adverse outcomes of COVID-19 appear to be similar;metabolic factors(such as obesity),non-White ethnicity and poorer socioeconomic status appear to be risk factors for both.Diabetes and COVID-19 have a significant effect on populations adversely affected by health inequality.Whilst we hope that COVID-19 will be mitigated by widespread use of vaccines,no such prospect exists for mitigating the pandemic of diabetes.In this brief opinion review,I compare risk factors for diabetes and adverse outcomes of COVID-19 and argue that tackling health and social inequality is likely to play a major role in solving the global diabetes pandemic and improve outcomes of COVID-19.展开更多
Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An indivi...Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An individualised approach to cardiovascular risk estimation and management is needed.Over the past decades,many risk scores have been developed to predict CVD.However,few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice.Currently,guidelines are focused on testing for CVD in symptomatic patients.Atypical symptoms or silent ischemia are more common in the diabetic population,and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy,these guidelines can be difficult to interpret.We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing.The modalities for investigation of CVD are discussed.展开更多
Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through ...Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.展开更多
BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data rega...BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data regarding its efficacy in patients with type 2 diabetes(T2D)after switching are limited.AIM To analyze the efficacy of omarigliptin in Japanese patients with T2D who had previously received treatment with other glucose-lowering agents.METHODS Forty-nine T2D patients treated for the first time with omarigliptin were recruited retrospectively and divided into four groups defined as either add-on or switched from daily DPP-4is:switched from linagliptin,switched from sitagliptin,and switched from vildagliptin.During a 3-mo follow-up,the clinical parameters among these groups were assessed and compared,with the impact of the switch on glycemic variability as measured by continuous glucose monitoring also being evaluated in the switched groups.RESULTS Hemoglobin A1c levels saw a significant decrease of-0.32%±0.41%in the add-on group(P=0.002).However,the other groups’variables depended on the preswitch daily DPP-4i:switched from linagliptin,-0.05%±0.22%;switched from sitagliptin,-0.17%±0.33%;and switched from vildagliptin,0.45%±0.42%,which saw significant worsening(P=0.0007).Multivariate logistic regression analysis revealed that switching from vildagliptin to omarigliptin was independently associated with worsening glycemic control(P=0.0013).The mean and standard deviation of sensor glucose value,the mean amplitude of glycemic excursions,and the mean of daily difference significantly improved when switching the patient from either linagliptin or sitagliptin to omarigliptin.However,in patients switched from vildagliptin,not only did the glucose variability indices see no improvements,the mean of daily difference even underwent significant worsening.CONCLUSION Administering omarigliptin as add-on therapy or switching to it from sitagliptin and linagliptin,but not vildagliptin,improves glycemic control and thus should help in decision making when selecting DPP-4is for T2D patients.展开更多
The effect of nutrition education using self-monitoring of blood glucose on glycemic control was investigated in the present study. Of 36 males and 25 females aged 30 - 69 years under outpatient treatment at 3 hospita...The effect of nutrition education using self-monitoring of blood glucose on glycemic control was investigated in the present study. Of 36 males and 25 females aged 30 - 69 years under outpatient treatment at 3 hospitals in Niigata prefecture, Japan, 61 non-insulin-treated obese type 2 diabetes patients with HbA1c of 6.9% - 9.3% and body mass index of 25 kg/m2 or higher were randomly allocated. Thirty and 31 patients were analyzed in intervention and control groups, respectively. The intervention group performed self-monitoring of blood glucose 2 hours after supper twice a week for 6 months and underwent nutrition education on the association between meals and postprandial blood glucose once every 2 months. The primary outcome was glycated hemoglobin, with the secondary outcome of body mass index. Stages of change for eating the appropriate supper amount were investigated to verify the process of the educational effect, and satisfaction with diabetes treatment and well-being were investigated to verify the continuity of treatment. On intention-to-treat analysis, glycated hemoglobin (mean ± SD) decreased from 7.9% ± 0.6% to 7.7% ± 0.6% in the intervention group but increased from 7.9% ± 0.6% to 8.1% ± 0.6% in the control group, showing a significant difference in the change after intervention between the groups (p = 0.027). In the intervention group, body mass index decreased from 28.9 ± 3.8 to 28.4 ± 3.7 kg/m2 (p = 0.019), the stages of change to learn the appropriate amount of supper progressed (p = 0.026), and satisfaction with diabetes treatment increased (p = 0.031).展开更多
Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) t...Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Fo...BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.展开更多
Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes...Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes. The aim of this pilot study was to evaluate the effects of a Tai Chi program on health indicators in adults with type 1 diabetes. Methods: This was a two-group quasi-randomised controlled trial with 13 participants (six men and seven women, aged 24 - 63 years) with type 1 diabetes. This trial was conducted from May to November 2016. The intervention group attended Tai Chi exercise training for 1 to 1.5 hours, twice a week for 12 weeks, and the control group continued with their usual medical care. Indicators of glycaemic control (HbA1c), depressive symptoms, physical measures (body mass index, waist circumference, blood pressure and leg strength), and health-related quality of life (physical and mental components summary scores) were assessed at baseline and 12 weeks’ post-intervention. Results: There were significant or borderline significant between-group differences in changes over time in favour of the intervention group in depressive symptoms (p Conclusion: In conclusion, there were improvements in mental health and leg strength in these adults with type 1 diabetes. Large studies are needed to further investigate the effects of Tai Chi in people with Type 1 diabetes.展开更多
<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedu...<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedures of drug naive diabetic patients. But in Bangladesh, we have very few research-oriented data regarding the demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients. The aim of this study was to determine the demographic clinical and biochemical characteristics of drug naive type 2 diabetes patients of Bangladesh. <strong>Methods: </strong>This was an open label observational real-life study which was conducted in the chambers of the investigators in several places of Bangladesh as outdoor setting during the period from August 2020 to December 2020. In total, 250 patients with drug naive type 2 diabetes mellitus were enrolled as the study population. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patient data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. <strong>Result:</strong> Two hundred and fifty (250) participants were selected as study population. The male-female ratio of the participants was 1.4:1. The highest number of participants was from 51 - 60 years’ age group (31.20%). The highest number of participants (41%) was with overweight (BMI: 25 - 30 kg/m<sup>2</sup>). Majority (65%) of the patients of this study suffered from diabetes for ≤5 years. The mean (±SD) SBP of the participants was 137.25 ± 17.50 mmHg and the mean (±SD) DBP of the participants was 85.16 ± 13.39 mmHg. We found the mean (±SD) fasting blood sugar (mg/dl), post prandial blood sugar (mg/dl), total cholesterol (mg/dl), triglycerides (mg/dl), HDL-Cholesterol (mg/dl), LDL-cholesterol (mg/dl), VLDL-cholesterol (mg/dl), uric acid (mg/dl), creatinine (mg/dl), urea (mg/dl), total bilirubin (mg/dl), direct bilirubin (mg/dl), SGOT (IU/L) and SGPT (IU/L) were 251.51 ± 112.08, 349.72 ± 128.68, 219.59 ± 68.25, 196.44 ± 94.34, 35.14 ± 11.85, 145.72 ± 64.33, 40.88 ± 18.12, 3.45 ± 1.51, 0.86 ± 0.37, 29.16 ± 9.81, 0.87 ± 0.4, 0.48 ± 0.4, 37.15 ± 10.9 and 35.83 ± 23.04 respectively. <strong>Conclusion:</strong> Obesity and hypertension demand more attention of diabetologists in diagnosis and treatment of patients or suspected patients of diabetes. Patients aged ≥ 50 years are most vulnerable and suspicious for diabetes. Besides age consequence habits of tobacco smoking, family history, smoking and HTN, alcohol intake and presence of nitrites in the urine may be considered as the most potential comorbidities for diabetic patients. Diagnosis of demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients may play a vital role in proper treatment.展开更多
Background: South Asian populations are vulnerable to poor health outcomes associated with climate due to the region’s complex topography, poverty, lack of education, and population density. Physicians, being highly ...Background: South Asian populations are vulnerable to poor health outcomes associated with climate due to the region’s complex topography, poverty, lack of education, and population density. Physicians, being highly trusted members of society, can help mitigate climate change effects in their countries. Objectives: The present study assessed perceptions of physicians from four South Asian countries (Bangladesh, Bhutan, India, and Pakistan). We hypothesized that physicians from these countries will be aware and knowledgeable about health effects of climate change. Methods: We conducted a cross-sectional online survey of physicians between March and July 2022. Data of 201 physicians was analyzed using the Kruskal-Wallis test and Dunn’s post hoc method. Results: Physicians from four South Asian countries were attuned to the health risks associated with climate change. A majority of physicians (86.6%) believed that climate change would make health conditions in their countries more severe or frequent (Bangladesh 83.3%;Bhutan 70%;India 91% and Pakistan 90.8%). The most common health effect related to climate change was illnesses related to reduced outdoor air quality (54.3%). Common barriers to discuss climate change with patients from all four countries were physicians’ lack of knowledge (strongly agree, 13.8%;agree 47.7%) in how to approach the issue with patients, lack of time (strongly agree, 12%;agree, 48%) and their perception that patients were not interested in knowing about climate change (strongly agree, 8.6%;agree, 42.6%). More than half (56.2%) of the physicians reported no training (Bangladesh, 51.7%;Bhutan, 80%;India, 44.6%;Pakistan, 63.1%) and approximately 30% reported less than 20 hours of training (Bangladesh, 28.3%;Bhutan, 15.0%;India, 39.3%;Pakistan, 27.7%) in climate-change-related health effects. Conclusion: While additional large-scale research is needed to understand the trends observed in our pilot study, our findings identify the need to introduce interventions to improve physicians’ knowledge of the health impacts of climate crisis.展开更多
文摘Macrosomia is defined as a term birth weight greater than or equal to 4000 grams, or greater than the 90 percentile of intrauterine growth curves. Excessive weight has harmful consequences for the newborn and is a major health concern. Objectives: To determine the frequency of neonatal macrosomia, describe risk factors and neonatal and maternal complications. Materials and methods: This was a cross-sectional study carried out between January and December 2022, involving newborns whose birth weight was greater than or equal to 4000 grams admitted to the neonatology unit of the Labe regional hospital. Results: 591 deliveries were recorded, 15 of which were macrosomic, representing a frequency of 2.54%. The average age of the women was 30.26 years. History of fetal macrosomia and diabetes was 93.33 and 71.43% respectively. The mean gestational age was 38.71 ± 0.75 SA, the mean antenatal consultation was 3 ± 0.8 and the mode of delivery was caesarean section (66.67%). Third-trimester ultrasound was performed in 53.33% of cases. Macrosomic newborns were male in 80% of cases. Neonatal complications were asphyxia (60%), hypoglycemia (20%) and hypocalcemia (13.33%). Factors associated with neonatal macrosomia were diabetes (P < 0.001), history of macrosomia (P Conclusion: this study shows that the frequency of neonatal macrosomia is 2.54% with high neonatal morbidity among newborns hospitalized in the neonatology unit of the Labé regional hospital. Screening for macrosomia risk factors during pregnancy is essential to prevent perinatal complications.
文摘AIM:To analyze the risk of coronary heart disease in patients with type 2 diabetes mellitus(T2DM)receiving standard medical treatment.METHODS:We performed a retrospective chart analysis of 269 middle-aged patients(age 45-64 years,mean age,53.9±5.5 years)with T2DM and without atherosclerotic cardiovascular events who underwent typing to determine their apolipoprotein E(apoE)isoforms.The apoE isoforms were determined using isoelectric focusing,followed by immunoblotting.We retrospectively evaluated the charts of the 269 patients,recorded between their first visit to the hospital(the study's start point,between 1987 and 1992)and the occurrence of an atherosclerotic cardiovascular event(the study's endpoint)or January 2004,whichever came first.The age-adjusted mean values and the prevalences of covariates were calculated to compare the laboratory data among the apoE phenotypes.To investigate the association of risk factors with the incidence of coronary heart disease during the follow-up period,monovariate and multivariate Cox regression models were used.RESULTS:At enrollment,the mean serum low density lipoprotein(LDL)cholesterol levels were lowest(2.92± 0.89 mmol/L)among the subjects with apoE2(apoE2/2 or apoE2/3)and highest(3.52±0.77 mmol/L)among the subjects with apoE4(apoE3/4 or apoE4/4).No significant differences in mean age or the percentage of smokers were observed among the three groups.Furthermore,no significant differences were observed in the systolic and diastolic blood pressures,body mass index,HbA1c level or serum triglyceride levels among the three groups.There were 47 cases of coronary heart disease over 3285 person-years of follow-up.An age-adjusted multivariate Cox proportional model identified diabetic retinopathy(hazard ratio,2.38,95% CI:1.28-4.43,P=0.006),a high systolic blood pressure(hazard ratio,1.04,95%CI:1.02-1.06,P<0.001) and high HbA1c values(hazard ratio,1.19,95%CI:1.02-1.38,P=0.0029),but not the LDL cholesterol value at enrollment(hazard ratio,1.01,95%CI:0.97-1.05,P=0.77)nor the specific apoE isoform,as significant predictors of coronary heart disease.CONCLUSION:Under standard medical treatment of diabetes,including the control of LDL cholesterol levels,the apoE4 isoform was not associated with coronary heart disease among T2DM patients.
文摘In recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes.Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality.Drugs which inhibit glucose re-absorption in the kidney,sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.
文摘Both GLP-1 receptor agonists(GLP-1RA)and SGLT-2 inhibitors(SGLT-2I)are newer classes of anti-diabetic agents that lower HbA1c moderately and decrease body weight and systolic blood pressure(SBP)modestly.Combination therapy with GLP-1RA plus SGLT-2I have shown a greater reduction in HbA1c,body weight,and SBP compared to either agent alone without any significant increase in hypoglycemia or other side effects.Since several agents from each class of these drugs have shown an improvement in cardiovascular(CV)and renal outcomes in their respective cardiovascular outcome trials(CVOT),combination therapy is theoretically expected to have additional CV and renal benefits.In this comprehensive opinion review,we found HbA1c lowering with GLP-1RA plus SGLT-2I to be less than additive compared to the sum of HbA1c lowering with either agent alone,although body weight lowering was nearly additive and the SBP lowering was more than additive.Our additional meta-analysis of CV outcomes with GLP1RA plus SGLT-2I combination therapy from the pooled data of five CVOT found a similar reduction in three-point major adverse cardiovascular events compared to GLP-1RA or SGLT-2I alone,against placebo.Interestingly,a greater benefit in reduction of heart failure hospitalization with GLP-1RA plus SGLT-2I combination therapy was noted in the pooled meta-analysis of two randomized controlled trials.Future adequately powered trials can confirm whether additional CV or renal benefit is truly exerted by GLP-1RA plus SGLT-2I combination therapy.
文摘BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.
文摘Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβcells.It is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related autoantibodies.Diabetic ketoacidosis with normal blood glucose levels has been reported during sodiumglucose co-transporter 2(SGLT2)inhibitor therapy.CASE SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise,thirst,and vomiting.Blood analysis showed high blood glucose levels(428 mg/dL),a mild increase of hemoglobin A1c(6.6%),and increased ketone bodies in urine.The patient was diagnosed with type 2 diabetes mellitus.The patient was initially treated with insulin,which was subsequently changed to an oral SGLT2 inhibitor.Antibodies to glutamic acid decarboxylase were negative.Four days after receiving oral SGLT2 inhibitor,she consulted at Mie University Hospital,complaining of fatigue and vomiting.Laboratory analysis revealed diabetic ketoacidosis with almost normal blood glucose levels.The endogenous insulin secretion was markedly low,and the serum levels of islet-related autoantibodies were undetectable.We made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis.The patient's general condition improved after therapy with intravenous insulin and withdrawal of oral medication.She was discharged on day 14 with an indication of multiple daily insulin therapy.CONCLUSION This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose levels.This case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.
基金Supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (NIHR201165)by the NIHR Leicester Biomedical Research Centrethe NIHR Applied Research Collaboration East Midlands
文摘BACKGROUND The diagnosis of type 2 diabetes(T2D)in younger adults,an increasingly common public health issue,is associated with a higher risk of cardiovascular complications and mortality,which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.METHODS A pooled dataset was used,comprised of data from five previous studies of adults with T2D,including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years.Anthropometric and blood biomarker measurements included body weight,body mass index(BMI),waist circumference,body fat percentage,glycaemic control(HbA1c),lipid profile and blood pressure.Univariable and multivariable linear regression models,adjusted for diabetes duration,sex,ethnicity and smoking status,were used to investigate the association between age at diagnosis and each cardiovascular risk factor.RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female,current smokers and treated with glucose-lowering medications,compared to participants diagnosed later in life.Participants diagnosed with T2D under the age of 40 also had higher body weight,BMI,waist circumference and body fat percentage,in addition to a more adverse lipid profile,compared to participants diagnosed at an older age.Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight[95%confidence interval(CI):0.52-0.82 kg],0.18 kg/m^(2) higher BMI(95%CI:0.10-0.25)and 0.32 cm higher waist circumference(95%CI:0.14-0.49),after adjustment for duration of diabetes and other confounders.Younger age at diagnosis was also significantly associated with higher HbA1c,total cholesterol,low-density lipoprotein cholesterol and triglycerides.CONCLUSION The diagnosis of T2D earlier in life is associated with a worse cardiovascular risk factor profile,compared to those diagnosed later in life.
文摘Diabetes and coronavirus disease 2019(COVID-19)are worldwide pandemics that have had a major impact on public health throughout the globe.Risk factors for developing diabetes and having adverse outcomes of COVID-19 appear to be similar;metabolic factors(such as obesity),non-White ethnicity and poorer socioeconomic status appear to be risk factors for both.Diabetes and COVID-19 have a significant effect on populations adversely affected by health inequality.Whilst we hope that COVID-19 will be mitigated by widespread use of vaccines,no such prospect exists for mitigating the pandemic of diabetes.In this brief opinion review,I compare risk factors for diabetes and adverse outcomes of COVID-19 and argue that tackling health and social inequality is likely to play a major role in solving the global diabetes pandemic and improve outcomes of COVID-19.
文摘Cardiovascular disease(CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus,who have a risk of cardiovascular mortality two to four times that of people without diabetes.An individualised approach to cardiovascular risk estimation and management is needed.Over the past decades,many risk scores have been developed to predict CVD.However,few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice.Currently,guidelines are focused on testing for CVD in symptomatic patients.Atypical symptoms or silent ischemia are more common in the diabetic population,and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy,these guidelines can be difficult to interpret.We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing.The modalities for investigation of CVD are discussed.
文摘Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.
文摘BACKGROUND Omarigliptin is one of several once-weekly dipeptidyl peptidase-4 inhibitors(DPP-4is).Despite the high frequency of switching from various daily DPP-4is to omarigliptin in actual clinical practice,data regarding its efficacy in patients with type 2 diabetes(T2D)after switching are limited.AIM To analyze the efficacy of omarigliptin in Japanese patients with T2D who had previously received treatment with other glucose-lowering agents.METHODS Forty-nine T2D patients treated for the first time with omarigliptin were recruited retrospectively and divided into four groups defined as either add-on or switched from daily DPP-4is:switched from linagliptin,switched from sitagliptin,and switched from vildagliptin.During a 3-mo follow-up,the clinical parameters among these groups were assessed and compared,with the impact of the switch on glycemic variability as measured by continuous glucose monitoring also being evaluated in the switched groups.RESULTS Hemoglobin A1c levels saw a significant decrease of-0.32%±0.41%in the add-on group(P=0.002).However,the other groups’variables depended on the preswitch daily DPP-4i:switched from linagliptin,-0.05%±0.22%;switched from sitagliptin,-0.17%±0.33%;and switched from vildagliptin,0.45%±0.42%,which saw significant worsening(P=0.0007).Multivariate logistic regression analysis revealed that switching from vildagliptin to omarigliptin was independently associated with worsening glycemic control(P=0.0013).The mean and standard deviation of sensor glucose value,the mean amplitude of glycemic excursions,and the mean of daily difference significantly improved when switching the patient from either linagliptin or sitagliptin to omarigliptin.However,in patients switched from vildagliptin,not only did the glucose variability indices see no improvements,the mean of daily difference even underwent significant worsening.CONCLUSION Administering omarigliptin as add-on therapy or switching to it from sitagliptin and linagliptin,but not vildagliptin,improves glycemic control and thus should help in decision making when selecting DPP-4is for T2D patients.
文摘The effect of nutrition education using self-monitoring of blood glucose on glycemic control was investigated in the present study. Of 36 males and 25 females aged 30 - 69 years under outpatient treatment at 3 hospitals in Niigata prefecture, Japan, 61 non-insulin-treated obese type 2 diabetes patients with HbA1c of 6.9% - 9.3% and body mass index of 25 kg/m2 or higher were randomly allocated. Thirty and 31 patients were analyzed in intervention and control groups, respectively. The intervention group performed self-monitoring of blood glucose 2 hours after supper twice a week for 6 months and underwent nutrition education on the association between meals and postprandial blood glucose once every 2 months. The primary outcome was glycated hemoglobin, with the secondary outcome of body mass index. Stages of change for eating the appropriate supper amount were investigated to verify the process of the educational effect, and satisfaction with diabetes treatment and well-being were investigated to verify the continuity of treatment. On intention-to-treat analysis, glycated hemoglobin (mean ± SD) decreased from 7.9% ± 0.6% to 7.7% ± 0.6% in the intervention group but increased from 7.9% ± 0.6% to 8.1% ± 0.6% in the control group, showing a significant difference in the change after intervention between the groups (p = 0.027). In the intervention group, body mass index decreased from 28.9 ± 3.8 to 28.4 ± 3.7 kg/m2 (p = 0.019), the stages of change to learn the appropriate amount of supper progressed (p = 0.026), and satisfaction with diabetes treatment increased (p = 0.031).
文摘Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.
文摘Objective: Previous studies have shown that Tai Chi may have a role in the management of type 2 diabetes. However, to date, no studies have focused specifically on the effects of Tai Chi in people with type 1 diabetes. The aim of this pilot study was to evaluate the effects of a Tai Chi program on health indicators in adults with type 1 diabetes. Methods: This was a two-group quasi-randomised controlled trial with 13 participants (six men and seven women, aged 24 - 63 years) with type 1 diabetes. This trial was conducted from May to November 2016. The intervention group attended Tai Chi exercise training for 1 to 1.5 hours, twice a week for 12 weeks, and the control group continued with their usual medical care. Indicators of glycaemic control (HbA1c), depressive symptoms, physical measures (body mass index, waist circumference, blood pressure and leg strength), and health-related quality of life (physical and mental components summary scores) were assessed at baseline and 12 weeks’ post-intervention. Results: There were significant or borderline significant between-group differences in changes over time in favour of the intervention group in depressive symptoms (p Conclusion: In conclusion, there were improvements in mental health and leg strength in these adults with type 1 diabetes. Large studies are needed to further investigate the effects of Tai Chi in people with Type 1 diabetes.
文摘<strong>Background:</strong> Although the frequencies of getting drug naive type 2 diabetes patients among all the diabetic patients are very low, nowadays it claims more attention in the treatment procedures of drug naive diabetic patients. But in Bangladesh, we have very few research-oriented data regarding the demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients. The aim of this study was to determine the demographic clinical and biochemical characteristics of drug naive type 2 diabetes patients of Bangladesh. <strong>Methods: </strong>This was an open label observational real-life study which was conducted in the chambers of the investigators in several places of Bangladesh as outdoor setting during the period from August 2020 to December 2020. In total, 250 patients with drug naive type 2 diabetes mellitus were enrolled as the study population. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patient data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. <strong>Result:</strong> Two hundred and fifty (250) participants were selected as study population. The male-female ratio of the participants was 1.4:1. The highest number of participants was from 51 - 60 years’ age group (31.20%). The highest number of participants (41%) was with overweight (BMI: 25 - 30 kg/m<sup>2</sup>). Majority (65%) of the patients of this study suffered from diabetes for ≤5 years. The mean (±SD) SBP of the participants was 137.25 ± 17.50 mmHg and the mean (±SD) DBP of the participants was 85.16 ± 13.39 mmHg. We found the mean (±SD) fasting blood sugar (mg/dl), post prandial blood sugar (mg/dl), total cholesterol (mg/dl), triglycerides (mg/dl), HDL-Cholesterol (mg/dl), LDL-cholesterol (mg/dl), VLDL-cholesterol (mg/dl), uric acid (mg/dl), creatinine (mg/dl), urea (mg/dl), total bilirubin (mg/dl), direct bilirubin (mg/dl), SGOT (IU/L) and SGPT (IU/L) were 251.51 ± 112.08, 349.72 ± 128.68, 219.59 ± 68.25, 196.44 ± 94.34, 35.14 ± 11.85, 145.72 ± 64.33, 40.88 ± 18.12, 3.45 ± 1.51, 0.86 ± 0.37, 29.16 ± 9.81, 0.87 ± 0.4, 0.48 ± 0.4, 37.15 ± 10.9 and 35.83 ± 23.04 respectively. <strong>Conclusion:</strong> Obesity and hypertension demand more attention of diabetologists in diagnosis and treatment of patients or suspected patients of diabetes. Patients aged ≥ 50 years are most vulnerable and suspicious for diabetes. Besides age consequence habits of tobacco smoking, family history, smoking and HTN, alcohol intake and presence of nitrites in the urine may be considered as the most potential comorbidities for diabetic patients. Diagnosis of demographic, clinical and biochemical characteristics of drug naive type 2 diabetes patients may play a vital role in proper treatment.
文摘Background: South Asian populations are vulnerable to poor health outcomes associated with climate due to the region’s complex topography, poverty, lack of education, and population density. Physicians, being highly trusted members of society, can help mitigate climate change effects in their countries. Objectives: The present study assessed perceptions of physicians from four South Asian countries (Bangladesh, Bhutan, India, and Pakistan). We hypothesized that physicians from these countries will be aware and knowledgeable about health effects of climate change. Methods: We conducted a cross-sectional online survey of physicians between March and July 2022. Data of 201 physicians was analyzed using the Kruskal-Wallis test and Dunn’s post hoc method. Results: Physicians from four South Asian countries were attuned to the health risks associated with climate change. A majority of physicians (86.6%) believed that climate change would make health conditions in their countries more severe or frequent (Bangladesh 83.3%;Bhutan 70%;India 91% and Pakistan 90.8%). The most common health effect related to climate change was illnesses related to reduced outdoor air quality (54.3%). Common barriers to discuss climate change with patients from all four countries were physicians’ lack of knowledge (strongly agree, 13.8%;agree 47.7%) in how to approach the issue with patients, lack of time (strongly agree, 12%;agree, 48%) and their perception that patients were not interested in knowing about climate change (strongly agree, 8.6%;agree, 42.6%). More than half (56.2%) of the physicians reported no training (Bangladesh, 51.7%;Bhutan, 80%;India, 44.6%;Pakistan, 63.1%) and approximately 30% reported less than 20 hours of training (Bangladesh, 28.3%;Bhutan, 15.0%;India, 39.3%;Pakistan, 27.7%) in climate-change-related health effects. Conclusion: While additional large-scale research is needed to understand the trends observed in our pilot study, our findings identify the need to introduce interventions to improve physicians’ knowledge of the health impacts of climate crisis.
