Habitual sleep deprivation is associated with type 2 diabetes: a case-control study

Objectives: It is suggested that a minimum of eight hours of sleep per night is needed for metabolism to work normally. The aim of the study was to determine the association of habitual sleep deprivation and type 2 diabetes mellitus [T2DM]

Methods: We conducted a case-control study comparing patients with T2DM with age and sex matched healthy controls. Standard sleep questionnaires [the Berlin and Epworth Sleepiness Scale] and a weekly diary were used by patients to self-report habitual sleep

Results: A total of 172 diabetics and 188 healthy controls were enrolled in the study. There was a significant difference between T2DM and healthy controls in nocturnal sleep duration [p = 0.033]. There was a significant association between nocturnal sleep duration of fewer than six hours and T2DM [X[2] = 14.0; p = 0.0001]. There was no significant difference in daytime sleepiness and daytime naps between the T2DM and control groups [p = 0.452; p = 0.581, respectively]

Conclusions: A nocturnal sleep duration < 6 hours is associated with T2DM

Quality of diabetes care at outpatient clinic, Sultan Qaboos University Hospital

To assess the clinical care of type 2 diabetes mellitus [T2D] patients at Sultan Qaboos University Hospital [SQUH], a countrywide tertiary referral center in Muscat, Oman. We performed a retrospective, observational, cross-sectional study using a total of 673 Omani T2D patients from the Diabetes and Family Medicine Clinics at SQUH. We collected patient data from June 2010 to February 2012 from the Hospital Information System [HIS]. Patients had to be Omani, aged more than 18 years old, and have T2D with active follow-up and at least three visits within one year to be included in the study. Ninety-three percent of the patients [n=622] were on oral hypoglycemic drugs and/or insulin, and 70% were on statins. Patients' anthropometric data, biochemical investigations, blood pressure, and duration of diabetes were recorded from the HIS. Using the recommended standards and guidelines of medical care in diabetes [American Diabetes Association and the American National Cholesterol Education Program III NCDP NIII standards], we observed that 22% of the patients achieved a HbA1C goal of <7%, 47% achieved blood pressure goal of <140/80 mm Hg, 48% achieved serum low density lipoprotein cholesterol goal of <2.6 mmol/L, 67% achieved serum triglycerides goal of <1.7 mmol/L, 59% of males and 43% of females achieved high density lipoprotein cholesterol goals [males>1.0; females >1.3 mmol/L]. Almost 60% of the patients had urinary microalbumin/creatinine ratio within the normal range. The clinical outcomes of the care that T2D patients get at SQUH were lower than those reported in Europe and North America. However, it is similar to those reported in other countries in the Arabian Gulf

Familial clustering of type 2 diabetes among Omanis

The aim of this study was to screen Omani individuals for the familial aggregation of type 2 diabetes mellitus. A random cohort of 1182 Omani individuals visiting the Family Medicine Clinic at Sultan Qaboos University Hospital [SQUH], Muscat, Oman, for regular medical checkup, aged >/= 40 years, were sampled. Patients were categorized into three groups: [1] individuals who claim not to have diabetes and had no family history of diabetes; [2] individuals who claim not to have diabetes but had family history of diabetes; [3] individuals with diabetes. Only 16% of these Omani individuals had no diabetes and no family history of diabetes. Another separate random cohort of 234 Omani type 2 diabetes mellitus patients, from the Diabetes Clinic at SQUH, were interviewed and questioned about their family history of type 2 diabetes mellitus. Ninety five percent of the patients had a family history of diabetes. Eighty percent had first degree relatives with diabetes and 46% had second degree relatives with diabetes. At least one parent with diabetes was reported among 55% of these diabetics, while maternal diabetes [55%] was found to be higher than paternal diabetes [47%]. However, only 15% had both parents with diabetes. Furthermore, almost half of the 234 diabetics were having at least one of the following relatives with diabetes: brother, sister, aunt or an uncle. The findings of this study confirm familial aggregation of diabetes among the Omani population. Compared to other populations, familial aggregation of type 2 diabetes mellitus among Omanis is relatively very high, and is perhaps due to the very high degree of consanguinity among Omanis. Since almost everyone seems to have a genetic predisposition to diabetes, the dramatic lifestyle changes over the past 25 years, could tip the population into an epidemic of type 2 diabetes mellitus

Impaired fasting glucose in Omani adults with no family history of type 2 diabetes

The aim of this study was to estimate the prevalence of impaired fasting glucose [IFG] among Omani adults with no family history [FH] of diabetes and to investigate the factors behind the risk of developing type 2 diabetes [T2D], while excluding a FH of diabetes. A total of 1,182 Omani adults, aged >40 years, visited the Family Medicine and Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D. Only 191 [16%] reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 [26%] had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A[1c] and blood pressure [BP], were significantly higher among individuals with IFG [P <0.01, P <0.05, P <0.01 and P <0.01, respectively]. In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices [P <0.05]. Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor. Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman

Cushing's disease. Sustained remission in five cases induced by medical therapy with the dopamine agonist cabergoline

We report five cases of Cushing's disease where the patients were given a therapeutic trial of cabergoline. Morning serum cortisol, adrenocorticotrophic hormone [ACTH], and sleeping cortisol concentrations were significantly raised. Magnetic resonance imaging [MRI] scans revealed pituitary microadenomas in 3 patients but were normal in the others. Ectopic ACTH production was excluded in the 2 patients with normal MRI scans. All were given a therapeutic trial of cabergoline [1 mg daily]. Four patients responded with a prompt fall in serum cortisol levels and had a sustained clinical and biochemical remission for 378, 44, 28 and 14 days, respectively. One patient failed to respond. In conclusion, we suggest that all patients with Cushing's disease should undergo a therapeutic trial of cabergoline. Responders can then be prepared for surgery or, if needed, treated medically in the long term

Vitamin D status in pregnant Omanis. A disturbingly high proportion of patients with low vitamin D stores

The objective of this study was to determine the vitamin D status of pregnant Omanis by measurement of their circulating 25 hydroxy vitamin D levels. Blood samples were obtained from a cohort of 103 consecutive healthy pregnant Omanis at the Armed Forces Hospital, Muscat, on their first antenatal visit. The study took place in May, June and July 2010. Vitamin D deficiency was present in 34 [33%] of patients [25OHD3 <25 nmol/L], 'at risk' levels were found in 67 [65%] patients [25OHD3 25-50 nmol/L]; two patients [1.9%] had values between 50 and 75 nmol/L, and no patients in the optimal range >75 nmol/L. If confirmed, these findings indicate the need for vitamin D replacement during pregnancy and lactation. Although not evidence based we recommend at least 1000 IU of cholecalciferol, [vitamin D3] daily

Atherosclerosis and physical activity

Atherosclerosis and coronary heart disease have been considered as major health problem worldwide. Abnormalities in lipids and lipoprotein metabolism and impairment of endothelial function have been implicated as the main contributing factors in atherosclerosis and its progression. Physical activity has been recognised as a preventive measure for atherosclerosis

case of disseminated tuberculosis with adrenal insufficiency

We present the case of a 37 year-old female who had disseminated tuberculosis [TB] with bilateral adrenal involvement resulting in primary adrenal failure [Addison's disease] with refractory hyponatraemia and possible extrapontine 'myelinolysis'. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB