Background: Among the acute metabolic decompensation states of diabetes mellitus, diabetic ketoacidosis (DKA) is relatively common. It commonly occurs in diabetic patients who have given up taking ...insulin or who have got some sort of infection. Treatment consisted of correction of dehydration, hyperglycaemia, electrolyte imbalance, acidosis and antibiotics for the patients who have some sort of infection or treatment of other precipitating cause, if present.Methods: This cross sectional study was performed in BIRDEM Hospital in 2012 on fifty adult diabetic ketoacidosis patients who fulfilled inclusion and exclusion criteria to find out the total amount of intravenous fluid (normal saline) needed to treat diabetic ketoacidosis.Results: DKA occurred more in previously diagnosed (60%) diabetic patients and frequency was more in poor, village people and there was no significant sex differences. Along with polyuria (24%) and polydipsia (16%), nausea (32%), vomiting (48%), abdominal pain (28%) and feature of infection were common. Infection (38%) and omission of insulin doses (34%) were the main cause. The glycaemic status was poor in most cases. Most patients had mild (32%) to moderate (60%) acidosis and gross electrolyte disturbance was not that much common. Leukocytosis (88%) was invariably present, even without any infection. Outcome (90% survival) was comparable with developing world. In management of DKA 40% patients required 11 liters of fluid, who had increased diuresis. 24% patients required 91-100 units of insulin, and most (32%) patients took 48 hours for correction of acidosisConclusions: Diagnosis and treatment of diabetic ketoacidosis is not difficult if recognized early. Adequate fluid replacement is important to prevent the mortality.J MEDICINE Jan 2018; 19 (1) : 18-21
SMBG is a crucial factor in diabetes management. It offersa quick check of glycemic status, helps to identify hypoglycemia and hyperglycemia. In addition SMBG assists in clinical decision making and ...as such it complements HbA1c. But due to many reasons SMBG is not practiced properly and adequately. In recent years several international guidelines higllighted the importance of SMBG for diabetes management. Very few diabetic patients in Bangladesh actually perform SMBG regularly at home. The awareness of the benefits of SMBG is also low. There is no uniformity in SMBG practice among the patients as there is no local guideline to help the physicians in determining the optimum SMBG frequency for their patients. So a working guideline on SMBG is the call of the day. This article is an attempt in that direction. Exploring international guidelines and evaluating their applicability in local context a number of recommendations have been proposed.J Bangladesh Coll Phys Surg 2014; 32: 218-223
There are several methods of assessing overweight and obesity. Several studies conducted in different populations indicate that neck circumference (NC) can be used as a simple measure of overweight ...and obesity. This study was conducted to evaluate NC as a marker of overweight and obesity and to determine respective cutoff values for Bangladeshi male and female participants.
This cross-sectional observational study was conducted with during July 2013-June 2014 among randomly selected 871 Bangladeshi participants (male = 496 56.9%, female = 375 43.1%, aged >18 years) who visited Outpatient Department of United Hospital, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders, primary health-care centers located in Dhaka, Savar, Gazipur. NC of participants was taken in centimeter to the nearest 1 mm, using plastic tape measure. Main outcome included NC, waist circumferences (WC), body mass index (BMI), and waist: hip ratio (WHR).
Pearson's correlation coefficients indicated a significant association between NC and height (men,
= 0.33; women,
= 0.28;
< 0.0001), weight (men,
= 0.61; women,
= 0.55;
< 0.0001), BMI (men,
= 0.51; women,
= 0.41;
< 0.0001), WC (men,
= 0.61; women,
= 0.46;
< 0.0001), hip circumference (men,
= 0.61; women,
= 0.44;
< 0.0001), WHR (men,
= 0.22; women,
= 0.18;
< 0.0001). Receiver operating characteristic curve analysis showed that NC ≥34.75 cm in men (area under curve AUC: 0.77;
< 0.001) and ≥31.75 cm in women (AUC: 0.62;
< 0.001) were the best cutoff value for BMI ≥23 (overweight). NC ≥35.25 cm in men (AUC: 0.82;
< 0.001) and NC ≥34.25 cm in women (AUC: 0.76;
< 0.001) were the best cutoff value for BMI ≥27.5 (obesity). NC ≥35.25 cm in male (AUC: 0.83;
< 0.001) and NC ≥31.25 cm in women (AUC: 0.65;
< 0.001) were the best cutoff value for WC >90 cm in men and > 80 cm in women, respectively. NC ≥34.45 cm in male (AUC: 0.59;
= 0.001) and NC ≥31.25 cm in women (AUC: 0.66;
= 0.008) were the best cutoff value for WHR >0.9 in men and >0.8 in women, respectively.
NC measurement is a simple, convenient, inexpensive screening measure to identify overweight and obese participants. Men with NC ≥34.75 cm and women with NC ≥31.75 cm are to be considered overweight while men with NC ≥35.25 cm and women with NC ≥34.25 cm are to be considered obese. NC ≥35.25 cm in male and NC ≥31.25 cm in women were the best cutoff value for abdominal obesity.
Tuberculosis (TB) and diabetes mellitus (DM) have synergetic relationship. People with diabetes are 2-3 times at higher risk of getting active TB disease. On the other hand, TB or anti-TB treatment ...may cause glucose intolerance. The dual disease of DM and TB is more likely to be associated with atypical disease presentation, higher probability of treatment failure and complications. In most of the health-care delivery systems of the world, DM and TB are managed separately by two vertical health-care delivery programs in spite of clear interaction between the two diseases. Thus, there should be a uniform management service for TB-DM co-morbidity. Realizing this situation, Bangladesh Diabetic Samity (BADAS), a nonprofit, nongovernment organization for the management of diabetes in Bangladesh, with the patronization of TB CARE II Project funded by U.S. Agency for International Development (USAID), launched a project in 2013 titled BADAS-USAID TB Care II, Bangladesh with the goal of "Integrated approach to increase access to TB services for diabetic patients." One of the project objective and activity was to develop a national guideline for the management of TB-DM comorbidity. Thus, under the guidance of National Tuberculosis Control Program, of the Directorate General of Health Services, Government of the People's Republic of Bangladesh and World Health Organization (WHO), this guideline was developed in 2014. It is based on the existing "National Guidelines and Operational Manual for TB Control" (5th edition) and guidelines for management of DM as per WHO and International Diabetes Federations. Along with that, expert opinions from public health experts and clinicians and "Medline"-searched literature were used to develop the guidelines. These guidelines illustrate the atypical presentation of the TB-DM co-morbidity, recommendations for screening, treatment, and follow-up of these patients and also recommendations in case of management of TB in patients with kidney and liver diseases. Thus, these guidelines will be a comprehensive tool for physicians to manage TB in diabetic patients.
Introduction
Development of higher standards for diabetes care is a core element of coping with the global diabetes epidemic. Diabetes guidelines are part of the approach to raising standards. The ...epidemic is greatest in countries with recent rises in income from a low base. The objective of the current study was to investigate the availability and nature of locally produced diabetes guidelines in such countries.
Methods
Searches were conducted using Medline, Google, and health ministry and diabetes association websites.
Results
Guidelines were identified in 33 of 75 countries outside North America, western Europe, and Australasia. In 25 of these 33 countries, management strategies for type 1 diabetes were included. National guidelines relied heavily on pre-existing national and international guidelines, with reference to American Diabetes Association standards of medical care and/or other consensus statements by 55%, International Diabetes Federation by 36%, European Association for the Study of Diabetes by 12%, and American Association of Clinical Endocrinologists by 9%. The identified guidelines were generally evidence-based, though there was some use of secondary evidence reviews, including other guidelines, rather than original literature reviews and evidence synthesis. In type 1 diabetes guidelines, the option of different insulin regimens (mostly meal-time + basal or premix regimens) was recommended depending on patient need. Type 2 diabetes guidelines either recommended a glycosylated hemoglobin target of <7.0% (<53 mmol/mol) (70% of guidelines) or <6.5% (<47 mmol/mol) (30% of guidelines) as the ideal glycemic target. Most guidelines recommended a target fasting plasma glucose that fell within the range of 3.8–7.2 mmol/L. Most guidelines also set a 2-h post-prandial glucose target value within the range of 4.0–8.3 mmol/L.
Conclusion
While only a first step in achieving a high quality of disease management, national guidelines of quality and with fair consistency of recommendations are becoming prevalent globally. A further challenge is implementation of guidelines, by integration into local care processes.
Southeast Asia faces a diabetes epidemic, which has created significant challenges for health care. The unique Asian diabetes phenotype, coupled with peculiar lifestyle, diet, and healthcare-seeking ...behavior, makes it imperative to develop clinical pathways and guidelines which address local needs and requirements. From an insulin-centric viewpoint, the preparations prescribed in such pathways should be effective, safe, well tolerated, nonintrusive, and suitable for the use in multiple clinical situations including initiation and intensification. This brief communication describes the utility of premixed or dual action insulin in such clinical pathways and guidelines.
Abstract
Background and Aims
Emphysematous pyelonephritis (EPN) is an uncommon, severe, necrotizing infection of the renoureteral unit and is recognized by accumulation of gas within the collecting ...system, renal parenchyma and/or perinephric tissue. Common risk factors for EPN are diabetes mellitus, renal stone, obstructive uropathy and immunosuppression. Principles of treatment include resuscitative measures, antibiotics, strict glycaemic control and interventions in selected cases. This study aimed to describe clinical, laboratory and imaging characteristics of EPN patients with special emphasis on in-hospital outcome.
Method
This cross-sectional study included consecutive 22 EPN patients, managed in the Department of Internal Medicine and the Department of Nephrology of a tertiary care hospital in Dhaka, Bangladesh from January 2013 to December 2019. Patients’ selected socio-demographic, clinical and laboratory parameters and in-hospital treatment-outcome were recorded in case record forms at the time of discharge or death, if were any.
Results
Total patients were 22 (mean age 46.8±12.5, range 34.0–55.0 years) including 16 (72.7%) females. All (22, 100%) were diabetic one (4.5%) patient was newly detected as diabetic during EPN diagnosis. Three (13.6%) patients had renal stones (bilateral in one), two (9.1%) had obstructive uropathy, six (27.3%) had chronic kidney disease, 12 (54.5%) had hyponatreamia and 16 (72.7%) were complicated by acute kidney injury (AKI). Patients presented with fever (22, 100%), loin pain/renal angle tenderness (19, 86.4%), vomiting (19, 86.4%) and dehydration (8, 36.4%). One (4.5%) patient had pneumaturia. One (4.5%) patient presented with uraemic encephalopathy and none had shock. One (4.5%) patient had tender ectopic (pelvic) right kidney. Patients had leukocytosis (mean total white cells 19917±7549, range 10250–37630/cmm of blood) and four (18.2%) patients had thrombocytopaenia. All patients had high erythrocyte sedimentation rate (mean 65.7±20.8, range 35–120 mm in 1st h) and C-reactive protein (mean 68.9±60.3, range 18–209 mg/L). Glycaemic status was poor mean random blood glucose at admission 17.4±6.0, range 10.6–35.5 mmol/L and mean glycated haemoglobin (HbA1c) 9.8±2.1, range 6.9–15.5%. Diagnosis of EPN was confirmed by abdominal ultrasonography and computed tomography scan. One patient had EPN in ectopic right kidney, one patient had EPN along with air in ureter, two patients had associated emphysematous cystitis and one had psoas abscess. Ten (45.5%) patients had EPN in right kidney (including pelvic kidney), 11 (50%) had EPN in left kidney, one (4.5%) had bilateral EPN and three (13.6%) patients had concomitant contralateral pyelonephritis. According to Huang and Tseng classification, one (4.5%) patient had class 4 EPN, three (13.6%) patients had class 3B, five (22.7%) patients had class 3A and thirteen (59.1%) patients had class 2 EPN. Escherichia coli was the most common (13, 59.1%) organism identified on urine culture including four (4/13, 30.8%) cases with extended-spectrum beta-lactamase positive E. coli and four (18.2%) patients were complicated by bacteraemia. Five (22.7%) patients required surgical interventions nephrectomy in three (13.6%) and open drainage in two (9.1%). All patients were treated with intravenous antibiotics and other supportive measures. One patient required three sessions of haemodialysis. Mean hospital stay was 16.1±6.4 (range 7–31) days. AKI resolved in 3 (3/16, 18.8%) patients and in others renal function was improving at the time of discharge and there was no death.
Conclusion
Most EPN patients were successfully managed by conservative approach in this study, two-thirds had AKI, one-fourth required surgical interventions and there was no death. Though conservative approaches for managing EPN is becoming popular, we emphasize interventions should not be delayed, as and when indicated, and may appear life-saving.
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