Etude de la variation de l'épaisseur centrale de la cornée au cours d'une hyperglycémie de novo / Study of the variation of the central thickness of the horn during de novo hyperglycemia

Introduction : L'épaisseur centrale de la cornée peut être modifiée au cours d'une hyperglycémie chronique. En dehors d'une hyperglycémie chronique, nous pensons que les modifications de l'épaisseur cornéenne surviennent également lors des hyperglycémies de novo.Objectif: Déterminer la variation de l'épaisseur centrale de la cornée au cours d'une hyperglycémie de novo.Patients et Méthodes : Il s'agissait d'une étude observationnelle et transversale à visée analytique réalisée de juillet à novembre 2021, auprès de 222 personnes (444 yeux) présentant une hyperglycémie récente. L'ECC a été comparée entre le moment du diagnostic (J0) et 30 jours (J30) après l'initiation du traitement hypoglycémiant (Chi-2). La variation de l'ECC entre J0 et J30 a été corrélée à celle de la glycémie (Spearman ; p<0,05).Résultats : A J0, la moyenne de l'ECC était de 552,5±39,2 µm contre 538,0±34,2 µm à J30 (p=0,001) et celle de la glycémie de 18,1±8,2 mmo/L contre 6,9±3,0 mmol/L (p = 0,001). A J0, 57,0% avaient une ECC > 550µm et à J30, 19,4% avaient diminué cette épaisseur entre 520 et 550 µm et 3,4% à moins de 520 µm. Sur un effectif de 444 yeux, 28,2% (n = 125) ont diminué leur ECC de 25 µm et plus après initiation du traitement hypoglycémiant. Aucune corrélation n'existait entre la variation de l'ECC et celle de la glycémie (r=0,018; p=0,704).Conclusion : Ces résultats montrent qu'il existe une variation de l'ECC en cas de déséquilibre glycémique récent

Introduction : The central thickness of the cornea can be changed during chronic hyperglycemia. Apart from chronic hyperglycemia, we believe that changes in corneal thickness also occur during de novo hyperglycemia.Objective: To determine the variation in the central thickness of the cornea during de novo hyperglycemia.Patients and Methods: This was an observational and cross-sectional analytical study conducted from July to November 2021, involving 222 people (444 eyes) with recent hyperglycemia. ECC was compared between the time of diagnosis (D0) and 30 days (Day 30) after initiation of hypoglycemic (Chi-2) therapy. The change in ECC between J0 and J30 was correlated with that of blood glucose (Spearman ; p<0,05).Results: ON D0, the mean ECC was 552.5±39.2 µm versus 538.0± 34.2 µm on D30 ( p=0.001) and the blood glucose mean was 18.1±8.2 mmo/l versus 6.9±3.0 mmol/l ( p=0.001). On D0, 57.0% had an ECC ˃ 550µm and on D30, 19.4% had decreased this thickness between 520 and 550 µm and 3.4% to less than 520 µm. On a population of 444 eyes, 28.2% ( n=125) decreased their ECC by 25 µm and more after initiation of hypoglycemic therapy. There was no correlation between the change in ECC and the change in blood glucose (r=0.018; p=0.704).Conclusion : These results show that there is a variation in ECC in case of recent glycemic imbalance

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo

Context and objective. Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke. Methods. A multicenter (6 ICUs) prospective cohort study including consecutive patients with acute stroke was undertaken from July 15th, 2017 to March 15th, 2018.The Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis. Results. Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS < 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05). Conclusion. More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors

Clinical profile and outcome of hyperglycaemic emergencies at a rural hospital in southern Nigeria

We have documented the clinical pattern of hyperglycaemic emergencies (HGEs) and predictors of outcome at a tertiary hospital in a rural setting in Nigeria. In a 2-year retrospective review, we identified 88 patients with HGEs. Fifty-four (61%) were females, and mean age was 55 years. Forty-seven (53%) had hyperglycaemic hyperosmolar states (HHS), 34 (39%) had diabetic ketoacidosis (DKA), and 7 (8%) had a mixed type of HGE. The commonest precipitating factor was infection and was seen in 39 (44.3%) patients; 28 (32%) were newly diagnosed with diabetes. The mortality rate overall was 34% and the case fatality rate of DKA, HHS, and mixed-type HGE was 23%, 38%, and 57% respectively. Elevated urea was a predictor of poor outcome; while age, gender, and the presence of chronic diabetes complications were not predictors of outcome. We conclude that the mortality rate in HGEs is high, and that elevated urea is a predictor of poor outcome.Effective diabetes education, prompt recognition of symptoms, and treatment of metabolic derangements in HGEs may reduce morbidity and mortality

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital

Metabolic syndrome components correlation with colorectal neoplasms: A systematic review and a meta-analysis

Background : Patients with metabolic syndrome (MetS) have a higher risk of developing colorectal neoplasms (CRN) including colorectal adenoma (CRA) and colorectal cancer (CRC). Nonetheless, the role and implication of each component of the syndrome, i.e. (hyperglycemia, hypertension, dyslipidemia, and visceral obesity) are not well ascertained. Aims: We conducted a systematic review and a meta-analysis in order to assess the association between MetS components and CRN. Methods and Material: A systematic literature search using the PubMed database was performed with the objective of identifying relevant English studies. Effect estimates were measured. Heterogeneity, subgroup, sensitivity analyses, and publication bias analyses were performed. Results: Thirty-one studies met our inclusion criteria. Generally, subjects with hyperglycemia (RR = 1.33; 95% CI 1.14-1.54), high waist circumference (RR = 1.30; 95% CI 1.19-1.42), high triglycerides (RR = 1.30; 95% CI 1.13-1.49), and hypertension (RR = 1.26; 95% CI 1.17-1.36) showed a stronger positive significant association with CRA formation risk. A similar pattern was found between high fasting blood glucose (RR = 1.35; 95% CI 1.23-1.47) and high blood pressure (RR = 1.28; 95% CI 1.20-1.37) with CRC incidence. A moderate association was found between hypertriglyceridemia and visceral obesity with CRC risk. Conversely, no significant association was found between low high-density lipoprotein-cholesterol (HDL-C) with both outcomes. Conclusions: Our results indicate that hyperglycemia, hypertension, visceral obesity, and hypertriglyceridemia increases CRA and CRC risk. Low HDL-C has no significant effect on those outcomes

Decreased total antioxidant levels and increased oxidative stress in South African type 2 diabetes mellitus patients

Background: Chronic hyperglycaemia in diabetes mellitus leads to increased lipid peroxidation in the body, followed by the development of chronic complications due to oxidative stress.Objective: The aim of this study was to compare total antioxidant (TAO) levels and oxidative stress in type 2 diabetes mellitus (T2DM) patients with that of healthy controls without diabetes.Methods: A total of 98 participants (57 T2DM and 41 healthy people) gave their consent and participated in the study. Routine biochemical methods were used for fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c) and lipid profile measurements. Serum TAO levels, malondialdehyde (MDA), oxidised low-density lipoprotein (ox-LDL) levels and superoxide dismutase (SOD) activity were analysed using standard commercial reagent kits.Results: A significant rise in FPG, HbA1c, triglycerides, MDA and ox-LDL, and a significant reduction in TAO and high-density lipoprotein cholesterol (HDL-C) was observed in T2DM patients compared with controls. A significant negative relationship was observed between TAO levels and MDA levels in the T2DM group. Increased lipid peroxidation and reduced antioxidant levels were observed in T2DM patients.Conclusion: Early management through an antioxidant-rich diet and lifestyle changes in T2DM patients would help to avert the debilitating complications of diabetes

Prevalence of hyperglycaemia in children seen at a paediatric emergency unit

Hyperglycaemia is known to be of common occurrence in paediatric emergency units, particularly in patients with severe disease. This study aimed to determine its prevalence and describe the disease conditions and clinical features associated with hyperglycaemia among children presenting to an emergency unit. A total of 1000 children aged 1 month to 14 years were enrolled in a cross-sectional study of prevalence of hyperglycaemia in two paediatric emergency units. In all cases, blood glucose (BG) level was determined, as well as clinical information. Hyperglycaemia was defined as blood glucose ≥7.8 mmol/l. The BG levels ranged between < 0.6 and 27.4 mmol/l (mean±standard deviation (SD): 6.5±3.0 mmol/l). Fever was seen in 84%, polyuria and polydypsia in 3%, cough in 33%, vomiting in 35%, and diarrhoea in 33% of patients. Hyperglycaemia was observed in 16.5% of the study children. The mean age of hyperglycaemic patients was 56±48 months. Children older than 6 years had the highest frequency of hyperglycaemia (33%), while infants had the lowest (14%). The only factor significantly associated with hyperglycaemia was a history of fever (p=0.001). Study subjects with gastroenteritis had the highest frequency of hyperglycaemia (4.4%), followed by severe malaria with 2.7%, and protein energy malnutrition (PEM) 2.3%. The mortality in hyperglycaemic children was higher than that in children with no hyperglycaemia (22.4% vs 7.5%, p=0.001). In conclusion, hyperglycaemia is not uncommon in emergency paediatric admissions, and it occurs more in patients with severe acute diseases. Children with hyperglycaemia should be monitored closely since they are at increased risk of death

Plasma Micronutrients (magnesium, zinc, selenium) Status and Lipid Profile in Type II Diabetes Mellitus Patients in Sagamu, Southwestern Nigeria

Background: Diabetes mellitus (DM) is a group of metabolic disorders characterised by hyperglycemia with secondary derangements in micronutrient status. Various studies had given conflicting reports of increased or decreased levels of micronutrients in Type II DM.Objective: To measure the plasma micronutrient levels and lipid profile in adults with Type II DM.Method: Plasma magnesium, zinc and selenium levels were measured among 100 subjects comprising 50 people with DM (age range 36-70 years) and 50 control subjects without DM (age range 29-70 years). The anthropometric parameters were measured; fasting blood glucose, plasma cholesterol, triglycerides, and high-density lipoprotein cholesterol, micronutrients (magnesium, zinc and selenium) levels were also measured using standard methods.Result: There were statistically significant (p < 0.05) higher plasma glucose, blood pressure (systolic and diastolic), LDLC, and lower levels of plasma magnesium, zinc, selenium, HDLC levels among the patients with DM (cases) compared with the normal control subjects. No significant difference was observed in the plasma total cholesterol and triglyceride between the two groups. A significant negative correlation was found between the plasma levels of the trace metals (magnesium, zinc and selenium) and triglycerides (r = - 0.36, r = - 0.43, r = - 0.51 respectively).Conclusion: Plasma levels of magnesium, zinc and selenium are reduced in Type II DM with associated hyperglycaemia-driven dyslipidaemia

Hyperglycaemic emergencies in pregnancy: case reports and literature review

Two cases are presented of diabetic ketoacidosis (DKA) occurring in newly presenting gestational diabetes mellitus (GDM) in Nigeria. Both were associated with foetal death; and the cases emphasise the need for efficient GDM screening and patient education. GDM is increasing in frequency; and the 2013 World Health Organization (WHO) Guidelines give simple and applicable guidelines for screening; diagnosis; and management. Even glycosuria testing can be helpful at a primary care level. The reoccurrence of GDM is also high (up to 50% of cases); and such women should be encouraged to seek early antenatal care in subsequent pregnancies

Association of elevated Factor VII activity with hyperglycaemia, dyslipidaemia and obesity in a rural black community in Limpopo Province, South Africa

Metabolic disorders are some of the major sources of complications in the body. About 1.7 million people worldwide have obesity-related problems that include hyperglycaemia; dyslipidaemia and haemostatic defects. The purpose of the study was to determine the association of elevated Factor VII (FVII) activity with hyperglycaemia; dyslipidaemia and obesity in a rural black population living in Ga-Mothapo village. This cross-sectional study consisted of 286 females and 96 males aged 18-65 years. Fasting blood samples were analysed for glucose; triglycerides; total cholesterol; high density lipoprotein cholesterol (HDL-C) and FVII. Low density lipoprotein cholesterol (LDL-C) was calculated from total cholesterol; triglycerides and HDL-C using the Friedewald formula. Weight and height were measured using a weighing scale and the Seca telescopic height-measuring rod; respectively. Body mass index was calculated from weight and height. Statistical analysis was done using Statistical Package for Social Sciences version 21.0. The following results were obtained: correlation between elevated FVII activity and hyperglycaemia (p=0.000); hypercholesterolaemia (p=0.000); LDL-C (p=0.000); obesity (p=0.000); hypertriglyceridaemia (p=0.572) and low HDL-C (p=0.201). In conclusion; elevated FVII activity was found to be significantly associated with hyperglycaemia; hypercholesterolaemia; high LDL-C and obesity. The association with hypertriglyceridaemia and a low HDL-C level was not significant

Glycaemic Control and Cardiovascular Outcomes in Diabetes : Review

While type 1 diabetes mellitus (DM) is characterised by insulin deficiency due to pancreatic beta-cell destruction; type 2 DM is characterised by a state of longstanding insulin resistance (IR); compensatory hyperinsulinaemia and varying degrees of elevated plasma glucose levels (PG); associated with clustering of cardiovascular (CV) risk and the development of macrovascular disease prior to the diagnosis of DM. Coronary artery disease (CAD) accounts for 70of mortality and morbidity in patients with diabetes. Studies in diabetes care have helped prevent or reduce microvascular complications in type 1 and 2 diabetes. However the same cannot be said about macrovascular disease. Despite all data concerning the association between diabetes and cardiovascular disease (CVD); the exact mechanism by which diabetes is linked to atherosclerosis is incompletely understood; and this is especially true in the case of hyperglycaemia. The positive effect of intensive glucose management in comparison to non-intensive glucose control is far from proven. The DCCT and UKPDS studies have shown that while glycaemic control is important for preventing long-term macrovascular complications; early glucose control is far more rewarding (metabolic memory). Later trials such as ACCORD; ADVANCE and VADT do not advocate tight glycaemic control. In fact; the ACCORD trial has shown increased mortality with tight glucose control. Tight glucose control may be beneficial in selected patients with short disease duration; long life expectancy and no CVD. In critically ill patients; a blood glucose target of 140-180 mg is fairly reasonable and achievable. The ESC/EASD guidelines of October 2013; like those of the ADA; AHA and ACC; continue to endorse a treatment target for glucose control in diabetes of HbAlc level 7; based predominantly on microvascular disease with acknowledged uncertainty regarding the effect of the intensive glucose control on CVD risk. Management of hyperglycaemia in diabetics should not be considered in isolation; diabetics require multifactorial intervention for hypertension; dyslipidaemia and microalbuminuria besides hyperglycaemia. In fact; the combined use of antihypertensives; aspirin and lipid-lowering agents makes it difficult to discern the beneficial effects of antihyperglycaemic therapy

Diabetes Mellitus and the Brain : Special Emphasis on Cognitive Function : Review

Diabetes mellitus (DM) is a major public health problem. Cognitive deficits are common with DM which range from subclinical or subtle to severe deficits such as dementia. Both hypoglycaemia and hyperglycaemia are causes of cognitive impairment with DM. In patients with DM; not only severe hypoglycaemia but also recurrent mild or moderate hypoglyacemia have deleterious effect on the brain. Recurrent mild/moderate hypoglycaemia is associated with intellectual decline; reduced attention; impaired mental abilities and memory deficits. Hypoglycaemia may result in abnormalities of neuronal plasticity; synaptic weakening and scattered neuronal death in the cerebral cortex and hippocampus. Chronic hyperglycaemia in type 1 and type 2 DM is associated with low IQ (verbal; performance and total) and abnormalities in testing for different domains of cognitive function such as verbal relations; comprehension; visual reasoning; pattern analysis; quantitation; memory; learning; mental control; psychomotor efficiency; mental and motor processing speed and executive function. The suggested mechanisms incriminated in the pathogenesis of hyperglycaemia-related cognitive dysfunction include; macro- and microvascular disease or vasculopathy; hyperlipidaemia; hypertension; insulin resistance and hyperinsulinaemia; stress response; direct toxic effect of chronic hyperglycaemia on the brain; advanced glycation end-products; inflammatory cytokines and oxidative stress. Hyperglycaemia causes oxidative stress; amyloidosis; angiopathy; abnormal lipid peroxidation; accumulation of ?-amyloid and tau phosphorylation; neuro-inflammation; mitochondrial pathology; apoptosis and neuronal degeneration in the cortex and hippocampus. Depression has been identified as a risk for accelerated cognitive decline with DM. The knowledge that diagnosis at an early age; frequency of hypoglycaemia; poor glycaemic control and presence of risk factors negatively affect cognitive functions in DM will have important implications for treatment and research purposes

Correlation between Retinopathy; Nephropathy and Peripheral Neuropathy among Adult Sudanese Diabetic Patients

Diabetes Mellitus is a worldwide common metabolic disorder. Increasing prevalence of diabetes; lack of proper education about the nature and course of the disease and necessary control are the main factors for an early onset of micro vascular complications. Objective: To correlate between retinopathy; nephropathy and neuropathy; among adult Sudanese diabetic patients at Elshaab Teaching hospital; Ahmed Gasim Teaching hospital and Gabber Abu Eleaz centre; from December 2006 to September 2008. were included. Result: Male to female ratio was1.4:1.Common age group affected was 60-69 (32.4).Common duration of diabetes mellitus was 20-24 years (23.9).All patients who had diabetes for 25 years or more had developed complications (19.7).The commonest long term microvascular complication was found to be retinopathy (71.2); followed by neuropathy (69) and nephropathy (50.7).It was found that (47.6) of our patients had the three complications. Conclusion: Long-term micro vascular complications affect male more than female; with average age of onset 60-69 years. All patients who had diabetes for 25 years or more had developed complications. Retinopathy is the most common micro vascular complication; followed by neuropathy. There is a significant correlation between retinopathy; nephropathy and neuropathy in association with the duration and control of blood glucose level

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE

Variation in fasting in blood sugar levels of pregnant and non-pregnant women attending Federal Medical centre, Yenagoa, Bayelsa State, Nigeria

This is a descriptive study on variation in fasting blood sugar level of pregnant and non-pregnant women attending Federal Medical Centre (FMC) Yenagoa, Nigeria in March 2008. Blood sample was taken under strict aseptic technique and tested for fasting blood sugar. The findings were analyzed using t-test and correlation method of statistics. The results showed that fasting blood sugar level for pregnant women was 3.869±0.823 while those of non-pregnant women was 3.784±0.725. The t-test (cal) and t (α) for both pregnant and non-pregnant women were 0.484 and 1.670 respectively. Fasting blood sugar level increases with increasing age and the calculated α value for pregnant and non-pregnant women were 0.77 and 0.0653 respectively, which showed a negative correlation level. However the correlation was independent of pregnancy and the r values for pregnant and non-pregnant women were 0.9976 for both groups. This research showed that no significant difference in fasting blood sugar level exist between pregnant and non-pregnant women used for this study although blood sugar levels correlated with age, weight and level of education

Fasting of Ramadan in Peoples with Diabetes in Benghazi; Libya: an Exploratory Study

Background: The epidemiology of diabetes and Ramadan fasting was reported from many Muslim countries; but not from Libya. Methodology: We interviewed 493 consecutive diabetic patients at Benghazi Diabetes and Endocrine Center for the potential complications of fasting during Ramadan. Results: We found 70of diabetic patients completed the 30 days of Ramadan fasting. Hypo- and hyperglycemia was the most commonly reported complications especially during the first two weeks of Ramadan month. Conclusion: It seems majority of diabetic patients in Libya manage to fast during Ramadan month. Patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan month

Care for People with Diabetes during Haj

Haj is one of the five cardinal components of Islam commonly known as the five pillars of Islam. Approximately two million Muslims perform it each year. Haj involves travel to the holy sites in and around Mecca and Medina during a specified short period of time in a limited space; not usually inhabited by such a large number of people. This article deals with the effects of this event on diabetes and its management. The importance of this arises from the fact during Haj; the person's life routine changes as he travels to a different place of his own for a period of 4-6 weeks where geography; weather; diet; and habits are different. During Haj most people live what is effectively a very basic life in very crowded places. Therefore; medical conditions; such as diabetes; whose management depends on a stable routine; would predictably be affected significantly. People with diabetes should have enough time to consider a management plan for their diabetes. The objectives are to achieve a good control and avoid any complications that may be particularly associated with the conditions faced during Haj