Background: Diabetes mellitus (DM) is often associated with a myriad of complications as the disease progresses. These cause significant morbidity and mortality among diabetic patients. There is a ...limited published data in this part of the country regarding the hospitalization patterns of diabetic patients, the reasons for admissions due to development of acute or chronic complications. Objective: To identify the type of diabetes related complications, their prevalence among indoor diabetic patients in a tertiary care hospital. Method: It was an observational - prospective study. Results: Out of Total 589 patients enrolled in the study, 366 (62.2%) patients were having microvascular complications, followed by macrovascular complications in 111(18.8%) patients and both microvascular and macrovascular complications in 60 (10.2%) patients. Conclusion: Most of the patients presented with microvascular complications, neuropathy being commonest. The patients of heart failure constituted a significant number followed by CAD. Most of the patients were having hypertension as an associated disease. The complications, duration of stay in the hospital and mortality was more in the patients having duration of stay more than 10 years.
Title of the article: High prevalence of hypovitaminosis D among schoolchildren of Shimla in Himachal Pradesh. Context: Acquisition of optimal bone mineral health in childhood and adolescence is ...essential for adequate bone mass during adulthood and old age, as 40-50% of total skeletal mass is accumulated so early in life. Aims: To estimate the prevalence of vitamin D deficiency among the school children of Shimla Settings and Design: A total of 300 children and adolescents of class V1 to X11 of various schools in Shimla were enrolled during July 1, 2015 to September 30, 2015. Methods and Material: After written informed consent, blood samples for 25(OH) D were collected and measured by radioimmunoassay. Statistical analysis: Data analyzed the data using EpiInfo 7.0.9.7 for windows. Results: Among all enrolled cases, 151(50.33%) were girls and 149 (49.76%) boys. Serum 25(OH) D level was significantly lower in girls 11.70± 4.03ng/ml as compared to boys 13.57 ±7.06ng/dl (p=0.0000001). Hypovitaminosis D was present in 98.66% cases, out of which 93.33% had deficient and 5.33% had insufficient 25 (OH) D levels. A total of 34.33% children had severe deficiency, however 4 (1.33%) had sufficient levels and were boys. Conclusions: Prevalence of hypovitaminosis D in apparently healthy schoolchildren in India is high. Awareness needs to be generated about benefits accrued by direct sunlight exposure.
Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and ...inter-regional variations.
The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines.
A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1.
The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India.
Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Objective: To study the frequency of macrovascular and microvascular complications in elderly with type 2 diabetes mellitus and its correlation with major cardiovascular risk factors. Research Design ...and Methods: 64 patients attending outpatient clinic who fulfilled the inclusion criteria of age more than 60 years with type 2 diabetes were studied during one year. Vascular complications and their risk factors were identified using a standardized questionnaire, blood and urine analysis. Results: The mean age of the patients was 67.62 ± 5.05 years. Middle age onset diabetes was seen in 43.75% of the study group, while 56.25% had elderly onset diabetes. The most prevalent cardiovascular risk factor was dyslipidemia (75.00%) followed by hypertension (71.87%), smoking (37.50%) and obesity (34.37%). Coronary artery disease, cerebrovascular disease and peripheral vascular disease were seen in 17.19%, 17.19% and 12.50% respectively, while diabetic retinopathy, diabetic nephropathy and neuropathy was seen in 31.25%, 25.00% and 28.13% respectively. 45.31% had no vascular complications. As compared to elderly onset diabetes those with middle age onset diabetes had higher mean HbA1C levels(8.94% vs 7.96%) and more prevalence of obesity (42.86% vs 27.78%), dyslipidemia (85.71% vs 66.67%), macro vascular (39.29% vs 25.00%) and micro vascular complications (50.00% vs 33.33%). Conclusion: The longer duration of diabetes and presence of multiple cardiovascular risk factors in elderly with type 2 diabetes mellitus makes them susceptible to vascular complications thereby increasing morbidity and mortality. Moreover, middle age and elderly onset diabetes appear to be two distinct groups with a difference in burden of cardiovascular risk factors and vascular complications. Future studies of diabetes in elderly may need to consider such difference while defining the treatment goals for this group.
Type 2 diabetes (T2D) is a progressive disease characterized by relentless deterioration of pancreatic β-cell function. Traditionally, insulin is used in later stages of T2DM. This study looks at use ...of insulin at time of diagnosis of T2DM and its effect on glycemic control and beta cell function.
This is a prospective observational study conducted in symptomatic newly diagnosed type 2 diabetes adults (>18 years) who presented with glycated hemoglobin (A1C) levels > 9%. For the initial 8 weeks, patients were treated with pre-mix insulin after which they were changed over to oral agents, and followed up for next three years.
Amongst 122 study participants, who completed the study, 50% were female and 90% were from rural areas. Average age of participants was 51.4 ± 9.6 years. Baseline mean fasting plasma glucose (FPG), post prandial plasma glucose (PPPG) and A1C were 267 ± 76 mg/dl, 408 ± 101 mg/dl and 11.5 ± 1.4% respectively. At the end of insulin therapy (8 weeks), the mean FPG, PPG and A1C reduced to 107 ± 10 mg/dl, 145 ± 24 mg/dl and 7.3 ± 0.8% respectively all of which were highly significant. The mean post-prandial C-peptide significantly increased from 1.8± 0.6 to 2.8± 0.9 ng/dl. An average of 1.7 kg weight gain and 0.97 episodes of mild to moderate hypoglycemia were observed. At the end of study (156 weeks), the mean FPG, PPG and A1C were 99 ± 14 mg/dl, 152 ± 12 mg/dl and 6.7 ± 0.4%.
Early insulin therapy in treatment naïve patients with type 2 diabetes results in rapid improvement of glycaemia thus helps to maintain long term normoglycemia and improves β-cell function.
To compare the safety and efficacy of combination of Glimepiride - Metformin with Vildagliptin - Metformin in type 2 diabetic patients with HbA1c between 7.5to10.
A randomized, prospective, ...comparative and interventional study was conducted at Indira Gandhi Medical College, Shimla. The level of hemoglobin A1c (HbA1c), fasting blood sugar (FBS) and postprandial blood sugar (PP) were the primary outcomes, whereas, the evidence of hypoglycemia, quality of life and weight gain were recorded as secondary outcomes. 215 patients newly diagnosed with type 2 diabetes mellitus were randomized into Glimepiride-Metformin group (Group1) having 111 patients and Vildagliptin-Metformin group (Group 2) having 106 patients. Patients were followed up at 3 month, 12 month, 24 month and then after completion of 30 month of treatment.
A comparable FPG, PPPG and HbA1c were observed from baseline at the end of 12 weeks in both groups. However, at the 130-week endpoint a significantly more pronounced reduction in HbA1c was observed in vildagliptin-metformin (1.96%) arm compared to Glimepiride-metformin (1.67%) arm. A similar significant more pronounced reduction was demonstrated in both FPG (48.25% vs. 41.70%) and PPPG (49.40% vs. 42.95%) in vildagliptin-metformin group compared to Glimepiride-metformin group. The proportion of patients who achieved an A1C < 7% at 130-weeks was 49% in the vildagliptin group and 41% in the Glimepiride group. Statistically significant more weight gain was observed in Glimepiride arm compared to vildagliptin arm (2.09 kg vs. 0.69 kg) and 8-fold lower incidence was observed in vildagliptin group. Conclusion: Vildagliptin -metformin represent a more effective combination in terms of number of patients achieving guidelines recommended A1C target of less than 7% at the end of 30 months, less weight gain, and a lower risk of hypoglycemia in newly diagnosed type 2 diabetic patients with moderate hypoglycemia.
Vildagliptin -metformin represent a more effective combination in terms of number of patients achieving guidelines recommended A1C target of less than 7% at the end of 30 months, less weight gain, and a lower risk of hypoglycemia in newly diagnosed type 2 diabetic patients with moderate hypoglycemia.
To assess the effect of migration (rural-to-urban and vice versa) on prevalence of diabetes and metabolic disorders in Asian Indians participating in the Indian Council of Medical Research-India ...Diabetes (ICMR-INDIAB) study.
The ICMR–INDIAB study is a national study on diabetes and associated cardiometabolic disorders in individuals aged ≥20 years from 28 states and 2 union territories of India. Individuals who moved to a different place from their place of birth and had resided in the new location for at least one year were considered as migrants. Anthropometric measurements, blood pressure estimation and a capillary oral glucose tolerance test were performed.
Of the 113,043 participants, 66.4% were non-migrant rural dwellers, 19.4% non-migrant urban dwellers, 8.4% rural-urban migrants, 3.8% multiple migrants and 2.0% urban-rural migrants. Weighted prevalence of diabetes was highest in rural-urban migrants followed by urban dwellers, urban-rural migrants and rural dwellers 14.7%, 13.2%, 12.7% and 7.7% respectively (p < 0.001). Rural-urban migrants had highest prevalence of abdominal obesity (50.5%) compared to the other three groups. The risk for diabetes was 1.9 times higher in rural-urban migrants than among rural dwellers. Five risk factors hypertension, abdominal and generalized obesity, physical inactivity and low fruit and vegetable intake together explained 69.8% (partial population attributable risk) of diabetes among rural-urban migrants and 66.4% among non-migrant urban dwellers.
Rural-to-urban migration is associated with increased risk of developing diabetes and other cardiometabolic abnormalities. Adoption of healthier lifestyle patterns among migrants could help prevent/delay onset of these abnormalities in this population.
•Increased rural-urban migration in India during the last decade may increase the risk of diabetes,obesity, and hypertension.•Prevalence/risk of diabetes, obesity and hypertension are higher in non-migrant urban dwellers and rural-urban migrants.•Prevention programmes emphasizing healthy lifestyle for those living in the urban settings are the need of the hour!
Background: The aim of the study was to study the clinical profile of patients presenting with adverse drug reaction.Methods: The study was conducted in the Department of Medicine, IGMC Shimla from ...01 July 2015 to 30 June 2016. A total of 129 patients were included in this study. A detailed history was taken followed by examination of patients. The routine investigations were done and special investigations as per need. For analysis patients detail, suspected drugs and the adverse drug reactions caused by them were used.Results: Bleeding from various sites was the most common event (39.5%), followed by symptomatic hypoglycemia 22.5% of events and symptomatic hyponatremia in 16.3% events. Amongst various drug classes anticoagulants were the most commonly involved drug class followed by oral hypoglycaemic agents, diuretics and antiplatelets. Type A was predominant ADR constituting (97.7%) of total ADRs and only (2.3%) of ADRs were of type B. After causality assessment, majority 86 (66.6%) were probable related and large number 127 (98.3%) of ADRs were serious which recovered after hospitalization.Conclusions: Our study revealed that ADRs are frequent and are easily recognized in clinical practice and are mostly preventable. Most ADRs are due to the use of drugs with high toxicity for example, warfarin often results in bleeding. It also shows that careful drug monitoring in hospitals may lead to reduction of many such ADRs, suggesting that some type A, ADRs may be due to inadequate monitoring of therapies and doses. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.
Background: Early surgical menopause increases risk of cardiovascular disease, osteoporosis, fracture, cognitive impairment and sexual dysfunction than women with late menopause. Estrogen therapy ...(ET) remains the most effective therapy for vasomotor symptoms related to surgically induced menopause. Meterials and Methods: It was a prospective cross-section study. Result: Amongst 255 symptomatic women, 163 (63.92%) women had severe vasomotor symptoms and 54 (33.12% of 163 women) of them had very incapacitating symptoms with marked reduction in their quality of life. 59 (23.13%) women had moderate symptoms with mild disturbances in their sleep while 33 (12.94%) women had only mild symptoms. Conclusion: It is agreed that women who undergo bilateral oophorectomy before the onset of natural menopause should be considered for estrogen therapy for the management of vasomotor symptoms until the average age of natural menopause.
Insulin use on the top of the world Mokta, JatinderKumar; Kalra, Sanjay; Mokta, KiranK ...
Journal of Diabetology,
2017, Letnik:
8, Številka:
2
Journal Article
PDF
