HbA1c levels among primary healthcare patients with type 2 diabetes mellitus in Oman

To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c [HbA1c] levels compared to older patients, and to determine the factors associated with higher HbA1c levels. Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios [OR], and 95% confidence intervals [CI] from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate [eGFR], tobacco use, and healthcare index as predictors of good [HbA1c <7%] vs.poor [>/= 7%] glycemic control. Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old [OR=1.7; 95% CI 1.1 to 2.6] and 60+ year [OR=2.5; 95% CI 1.6 to 4.0], female gender [OR=1.5; 95% CI 1.2 to 2.0] and in patients with eGFR >/= 60 mL/min/1.73 m[2] [OR=1.9; 95% CI 1.1 to 3.3]. Longer duration of diabetes [>/= 5years] and treatment with oral agents or insulin were inversely related to good glycemic control. Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams

Pro-inflammatory cytokines in Omani type 2 diabetic patients presenting anxiety and depression

The relationship of inflammatory cytokines with anxiety and depression has been reported, but their role in diabetic patients has not been fully elucidated. We examined whether an association between prevalence of anxiety and depression in Omani type-2 diabetic patients [n=30] and the levels of inflammatory markers such as IL-1 beta, TNF- alpha, IFN- gamma and C-reactive protein [CRP] exists. Symptoms of anxiety and depression were screened using the Hospital Anxiety and Depression Scale [HADS] through self-rated questionnaires. IL-1 beta, TNF-alpha, IFN-gamma, CRP, anti TPO and anti-GAD65 antibodies were measured in patients' sera using commercially available ELISA assays. In Omani type 2 diabetic patients, high prevalence of anxiety and depression along with high levels of inflammatory markers were detected. However, no correlation was observed between inflammatory markers and anxiety or depression. These results indicate that Omani type 2 diabetic patients are at great risk for developing anxiety and depression. Therefore, these complications need more care and attention. There was no association between scores of anxiety and depression with levels of inflammatory cytokines. This may need to be elucidated in a larger cohort of patients

Glutamic acid decarboxylase [GAD65] and thyroid autoantibodies in Omani patients with type 2 diabetes

Autoimmunity is a common feature in type 1 diabetes mellitus [DM]. Little is known of the role of autoimmunity in type 2 diabetes. Antibodies to glutamic acid decarboxylase [GAD65] and thyroid antigens have been reported with various frequencies in diabetic patients. In this study, we investigated the prevalence and association of antibodies to GAD65, anti-thyroglobulin [A-TG-A], anti-thyroid microsomal [ATMA] antibodies, haemoglobin A[1c] [HbA[1c]] and fasting serum C-peptide in Omani patients with type 2 diabetes mellitus. We studied 100 Omani patients with type 2 diabetes for the presence of serum antibodies to GAD65, A-TG-A and ATMA by the use of commercially available kits. Results were compared with those from fifty patients with type 1 diabetes mellitus [DM] and fifty unaffected individuals who were used as controls. Results showed that type 2 DM had significantly high positivity levels [24%] of anti-GAD65 antibodies than the control group [4% - p < 0.05] though less than that found in type 1 DM [38%]. GAD65 antibodies were more commonly found in older females [> 40 years] with type 2 diabetes [p < 0.05]. A higher prevalence of ATMA was noted in both type 2 and type 1 diabetes [20 and 26% respectively] compared to the levels in the control group [8%]. There was a low prevalence and little difference in A-TG-A values among the three groups studied [9%, 14% and 4%]. Both A-TG-A and ATMA were more often expressed in older females with type 2 diabetes. HbA[1c] did not differ between groups with the duration of disease less or more than three years. When the same groups were tested for fasting serum C-pepticle, those with disease of more than three years duration had significantly higher prevalence [p < 0.05] as compared to those less than three years. This study confirms the presence and association of thyroid and GAD65 antibodies in some Omani patients with clinical diagnosis of type 2 DM

Determination of the levels of anti-thyroid- stimulating hormone receptor antibody with thyroid peroxidase antibody in Omani patients with Graves' disease

A 32 years old lady lactating for 9 months presented with lump in breast for 6 months. Mammography was the only investigation which patient had with her and was not willing for further investigations. Clinical and mammographic assessment was suggestive of cystic lesion of breast probably galactococle. Lumpectomy was done and biopsy report suggested hydatid cyst

Comparison of thyroid microsomal and thyroperoxidase antibody levels in sera from Omani patients with thyroid disorders

Recent literatures suggested that using anti-thyroperoxidase is a more sensitive marker of autoimmune thyroid diseases than anti-thyroid microsomal [ATMA]. We compared serum values of thyroperoxidase [TPO] and ATMA in Omani patients with thyroid disorders. Material and Anti-TPO antibodies and ATMA were assayed on sera from 111 Omani patients with thyroid disorders. Sera from patients with systemic Lupus erythematosus [SLE] and 50 healthy normal subjects were also included as control A significant positive correlation was observed between TPO and ATMA antibody levels [r=0.914, p<0.00001]. There was a significant difference [p< 0.001] between the percentages of positive sera for both TPO [72%] and ATMA [64%] in patients with thyroid disorders when compared to those from SLE [15% and17.5%] and normal controls [6% and 8%] respectively. We conclude that there is a positive correlation between the two assays [TPO and ATMA]. Therefore, TPO can be used as a strong indicator for autoimmune thyroid disorders in Omani patients

Anti-thyroglobulin and anti-thyroid microsomal antibodies in thyroid disorders

High titers of antibodies to thyroglobulin [ATA] and thyroid microsomal antigen [ATMA] are the hallmarks of human autoimmune thyroid diseases. The clinical significance of these autoantibodies in other thyroid disorders is still unclear. The aim of this study was to analyze the prevalence and titres of these antibodies in Omani patients [mean age 32, range 5-81 years] with different thyroid disorders. This was done in order to investigate any correlation regarding clinical manifestations that may be unique to patients attending Sultan Qaboos University Hospital [SQUH]. Serum levels of ATA and ATMA in 400 cases involving four groups of thyroid disorders [one hundred each with Hashimoto's disease, Graves' disease, thyroid cancer and goitre] and 100 cases of non-thyroid disorders were studied. The antibodies were tested using a commercial haemagglutination assay [Thymune-T and Thymune-M]. The overall prevalence of ATA or ATMA antibodies with thyroid disease was 47% and in non-thyroid disorders was 8%. The ATA was positive in 27% of all the patients with thyroid disorders compared to only 4% of those in the non-thyroid groups while ATMA was positive in 42% and 8% respectively. Among all patients, ATA and ATMA were positive in 64% of patients with Graves's disease, 81% in those with Hashimoto's, 30% of goiter patients, and 20% of those with thyroid carcinoma. The prevalence according to the age within each group for the three ranges: less than 20 years, between 20-40 years and over 40 years, showed the following results: within Graves were 12, 49 and 39% respectively; in the goitre group: 23, 55 and 22%; in the Hashimotos' group: 18, 54 and 28% and 7, 56 and 37% among the patients with thyroid carcinoma. The female to male ratio prevalence was 68% and 32% in Graves disease, 92% and 8% in Hashimotos', 75% and 25% in thyroid cancer and 88% and 12% in goiter. This study confirms the prevalence of a high level of thyroid autoantibodies in these Omani patients as in Caucasians, and its correlation to age and gender. It also indicated the importance of screening for ATA and ATMA in non-autoimmune thyroid disorders. Their significance in thyroid cancers needs further elucidation