ABSTRACT
Background: Diabetes mellitus is an endocrine and metabolic disorder, characterized by hyperglycemia. Metformin is the first line pharmacotherapy recommended by ADA. It has been recognized that metformin use is associated with serum vitamin B12 deficiency. The objective of this study is to determine the prevalence of serum vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are not on metformin.Methods: Here, 90 patients of type 2 diabetes mellitus of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. They were divided into two groups; Group A of 60 subjects of type 2 diabetes mellitus on metformin therapy >1 year and group B of 30 subjects of type 2 diabetes mellitus not on metformin or had stopped taking metformin 6 months back. Serum vitamin B12 levels were measured using a Chemiluminescence method. Data was statistically analysed.Results: The serum vitamin B12 levels were 190.02�.75 pmol/l in group A (metformin users) and 586.9�3.69 pmol/l in group B (not metformin users) (p value=0.002). A significant negative correlation existed between the serum vitamin B12 and duration and dose of metformin use (r? -0.676) and (r -0.855) by using Pearson抯 correlation coefficient in group A.Conclusions: Metformin is associated with decrease in serum vitamin B12 levels. Annual screening of serum vitamin B12 is recommended for patients of type 2 diabetes mellitus who are on metformin therapy for longer duration and /or in higher doses.
ABSTRACT
Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77�.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6�67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.
ABSTRACT
Background: Diabetes Mellitus is a condition known for itschronic complications such as retinopathy, neuropathy andnephropathy. The objective of this study was to evaluate serumhomocysteine levels in patients of diabetes mellitus and tocorrelate serum homocysteine levels with albuminuria indiabetics.Methods: The study was single centric study undertaken in theDepartment of Medicine at SGRD Institute of Medical Sciencesand Research, Amritsar. It was a case control study with 100patients diagnosed as type 2 diabetes mellitus as per theAmerican Diabetic Association guidelines and attendingDepartment of Medicine, SGRDIMSR, Vallah, Sri Amritsar. Thepatients were divided into two groups. Study group consisted of50 patients with type 2 diabetes having albuminuria & controlgroup comprised of 50 patients of type 2 diabetes mellituswithout albuminuria. Serum homocysteine levels weremeasured in the patients of both the groups.Results: It was observed that Serum homocysteine levelswere significantly raised in diabetic patients with albuminuria (pvalue = <0.001). In the study, serum homocysteine levels wereincreased in patients with macroalbuminuria in comparison tomicroalbuminuria (p value = 0.001).Conclusions: Our study demonstrated that a significantelevation in serum homocysteine levels was seen in patientswith diabetic nephropathy. The increase in homocysteine levelsis proportional to decline in creatinine clearance and to thedegree of albuminuria.
ABSTRACT
Background: Microalbuminuria is an early, less expensive and easily available parameter of detecting microvascular angiopathy of kidneys in diabetic patients and angiopathy may also involve retinal, coronary, cerebral and peripheral vessels in these patients. The present study was done to find the association of microalbuminuria with intimal medial thickness of the superficial femoral artery in type 2 diabetes mellitus. Methods: The study included two groups of 100 individuals each. Group 1 having type 2 diabetes mellitus and group 2 non-diabetic control persons. Statistical analysis was done by standard statistical methods. It revealed significant association of microalbuminuria with intimal medial thickness of superficial femoral artery in type 2 diabetes mellitus. Results: Mean age of group 1(diabetic) was 50.73+SD8.48 years. Mean age of group 2(non-diabetic) was 49.57+SD 7.677 years. Majority of patients were in age group 40-50 years in both group 1 and group 2. Mean microalbuminuria in group 1 (diabetic), was 214.74+71.174 and that in group 2 (non diabetic), was 41.500+23.837. Difference in mean microalbuminuria, in both groups was highly significant (p<0.001). Mean intimal media thickness (IMT) of superficial femoral artery( SFA) in group 1 (diabetic), patients was 0.0836+0.0167 cm and that of group 2 (non diabetic), was 0.059 + 0.00464 cm. Difference in mean IMT of SFA, in both groups was highly significant(p<0.001). Conclusion: There is highly significant correlation between microalbuminuria and intimal-medial thickness (IMT) of superficial femoral artery (SFA) in type 2 diabetes mellitus.