Protein requirement and its intake in subjects with diabetic foot ulcers at a tertiary care hospital

Objective: To assess the protein intake and requirement among subject with type 2 diabetes having foot ulcers

Methods: This study was conducted at Baqai Institute of Diabetology and Endocrinology [BIDE], a tertiary care diabetes centre of Karachi, Pakistan among people with type 2 diabetic foot ulcer attending foot clinic from January 2012 to March 2015. The baseline characteristics, dietary intake and laboratory investigations of the study participants were obtained through electronic hospital database ''Health Management System'' [HMS] based on the 24 hours dietary recall interview. Total grams of protein were calculated from each food group consumed by the subject. Protein intake of the subjects was recorded in mean grams and the protein requirement was calculated according to their body weight. The comparison of intake and requirement of protein choices was done through comparing the mean of both variables. SPSS version 13 was used for analysing the results

Results: A total of 542 subjects were included in the study, 365 [67.2%] were males and 178 [32.8%] were females. Mena age of the subject was 54.61 +/- 10.51 [yrs] with the duration of diabetes and mean body mass index were 14.22 +/- 7.98 [yrs] and 26.65 +/- 5.38 [kg/m[2]], respectively. The dietary records showed the protein intake of subjects with diabetic foot ulcer is not appropriate when compared to daily requirement. Mean grams of protein intake is 76.87gms in males and 56.84gms in females. On the other-hand protein requirement is much higher than the intake, which is 219.5gms in males and 130.2gms in females

Conclusion: Dietary counselling should be a part of the treatment among subjects with diabetic foot ulcer to identify their nutritional needs and suggesting them better option to fulfil their protein requirement essential for wound healing process

Frequency of insulin resistance in patients with polycystic ovary syndrome: a study from Karachi, Pakistan

To assess frequency of insulin resistance [IR] in patients, presenting with polycystic ovarian syndrome using simple indices of insulin resistance and to determine the association of clinical manifestations of PCOS with insulin resistance indices. This cross sectional study was carried out at Baqai Institute of Diabetology and Endocrinology [BIDE]. One hundred patients fulfilling the revised 2003 Rotterdam diagnostic criteria for PCOS were included. Descriptive statistics were calculated using frequency and mean with standard deviation. Insulin resistance [IR] was calculated using fasting insulin levels [> 10 IU/ml], fasting glucose: insulin ratio [> 4.5]. Different surrogate marker of IR like HOMA-IR [> 2.6], QUICKI [< 0.357] and McAuley [< 5.8] were calculated. The value for HOMA-IR, QUICKI and McAuley in patients of PCOS were 65%, 88% and 51.2% respectively. Patients having fasting insulin level [> 10 iu/ml] were 75.32%. Menstrual irregularities were the commonest presentation followed by obesity, hirsutism and infertility. There was a strong association of BMI with various menstrual irregularities, hyperinsulinemia and insulin resistance. A significant high rate of hyperinsulinemia and insulin resistance has been observed in our patients of polycystic ovarian syndrome. Majority of clinical manifestation are found to be associated with insulin resistance indices

Effect of simvastatin on insulin sensitivity in type 2 diabetic subjects

To study the effect of Simvastatin therapy on insulin sensitivity in type 2 Diabetes mellitus subjects. This is a randomized case control study, conducted at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. The study was conducted in 100 type 2 diabetes subjects of both sexes. Patients were randomized into two groups. Fifty patients were given Simvastatin 40mg/day for three months while 50 patients were used as controls. Both groups had similar anthropometric [age, duration of diabetes, BMI and Blood pressure] and biochemical [serum creatinine, fasting plasma glucose, fasting insulin level and lipid profile] characteristics. Insulin resistance was assessed by calculating homeostasis model assessment for insulin resistance [HOMA-IR] before and after 3 months of simvastatin treatment [40mg/day]. Simvastatin [40mg/day] markedly decreased cholesterol, triglycerides and LDL levels but did not significantly affect insulin sensitivity as determined by HOMA-IR. However it improved insulin sensitivity in subjects having insulin resistance.[HOMA IR reduction 1.92; p=0.001] Short term simvastatin therapy [3 months] had no effect on insulin sensitivity, but had a significant lipid lowering effect in all the subjects

Role of wound classification in predicting the outcome of diabetic foot ulcer

To compare the effectiveness of Wagner and University of Texas [UT] classification systems of diabetic foot ulcers in directing appropriate therapy and possibly predicting outcomes. A total of 383 patients with foot ulcer were seen. Details of socio-demographic and clinical profiles of 200 patients were completely available. Patients were assessed and classified into different grades and stages according to Wagner's and UT classification systems. Their duration of healing was recorded. The outcome endpoints were defined as complete healing, major or minor amputations, or expired. Out of the 200 subjects, 65% were males and 35% were females. Mean age in males was 53.04 +/- 10.33 years and in females was 51.14 +/- 9.94 years. Average duration of treatment in males was 109.68 +/- 82.26 days and in females was 85.10 +/- 61.97 days. Forty five percent of the subjects had neuropathic ulcers. Median healing time increased with increase in Wagner grade and UT grade and stage. The higher the UT grade and stage at the time of presentation, the less the chances of ulcer to heal within the study period. Our study has shown that grading and staging of diabetic foot ulcer affects and predicts the outcome. Amputation rates increase with increase in grade. Addition of stage to grade in UT classification helps further on assessing the severity of wound at the time of presentation and shows better association with the outcome

Assessment of insulin resistance in type 2 diabetic subjects at a tertiary care hospital of Karachi Pakistan

During the last few decades there has been a surge of interest in the assessment of insulin resistance. Our study aims to identify the insulin resistance in type 2 diabetic population so that we might be able to identify insulin resistance easily in daily routine clinical practice. All type 2 diabetic subjects having age 30 years or more are selected with exclusion criteria [hepatic, renal or cardiac impairment]. After taking informed consent from the patients fasting blood samples were taken. Assessment of insulin resistance was done by homeostasis model assessment HOMA. HOMA-R = Insulin [mu/ml] x glucose [mmol/1]/22.5 All statistical analyses were performed using the statistical program SPSS [version 11] A Total of 118 subjects were recruited in the study. Mean age of subjects was 49.1 +/- 10.2 years. Mean BMI was 27.8 +/- 4.9 kg/m2o Subjects comprising of 62.4% males and 37.6% females. Mean HOMA in our Type 2 diabetic subjects was 4.1 [male 4.41 and female 3.73]. In our study 73.7% subjects has HOMA value of 1. 77 or more, while 57% have HOMA value of 2.8 or more

Comparison of risk factors for diabetes in children of different socioeconomic status

To compare the risk factors for diabetes in children of two different socioeconomic status. A cross-sectional analytical study. Visits to one government [low income] and two private [middle income] schools of Karachi in 1999 and 2000. Patients and A total of 260 children; 157 children [mean age 12.10 +/- 4 years] from low-income group and 103 children [mean age 10.6 +/- 0.9 years] from middle-income group were surveyed. Data of physical fitness score [PFS] and BMI was calculated. Dietary records were taken by 24 hours self-reported diet recall charts of two weekdays. Knowledge about health was obtained by a questionnaire given to children and mothers. A significant difference was found in the mean age of low-income and middle-income groups [p-value < 0.001]. Significant association was seen in low-income group compared to middle-income group on the basis of TV viewing [p-value = 0.04]. BMI [p-value = 0.011] and positive family history of diabetes [p-value < 0.001]. Forty-seven percent [n=74] of children from low-income group while 51% [n=53] of middle-income group had poor knowledge about health. The children in both the groups also consumed inadequate amount of calories, the diet being poor in fruit, vegetables and milk and high in the fat content. Although children in both the groups had increased risk factors for diabetes the difference between the two socioeconomic groups was significant in terms of middle-income children having more risk. Thus, changes in lifestyle and behaviour including diet is needed in this high risk group to prevent future generations from developing diabetes