ABSTRACT
Optimal glycemic control is an important goal in the management of type 1 diabetes mellitus [T1DM]. Although the use of multiple daily injections [MDI] is a common regimen worldwide, its use is not yet universal in many countries. Our aim was to evaluate the effects of switching from a twice daily [BID] to a MDI insulin regimen in children and adolescents with T1DM in order to revisit its benefits in the Omani population. We conducted a retrospective cohort study of children and adolescents with T1DM at Sultan Qaboos University Hospital, Muscat, Oman, between January 2007 and June 2013. Patients using the BID regimen for more than six months who were then switched to MDI were included in the analysis. We compared glycated hemoglobin levels [HbA[1C]] before and after the regimen change. Fifty-three children were eligible for the study. Ten patients were excluded for various reasons. The remaining 43 patients were 58% male and 42% female, with a mean age of 9.4 +/- 3.7 years. There was significant decrease in the overall mean HbA[1C] level from baseline [10.0] compared to three months after switching to MDI [9.5]; p=0.023. Nevertheless, the improvement was not significant in the subsequent follow-up visits at six and nine months. The reduction in HbA1c values was observed mainly in children five to 11 years. Switching from a BID to MDI insulin regimen has favorable effects on the overall control of T1DM in children and adolescents, as assessed by HbA1c levels. In addition, this regimen has been proved to be safe and well tolerated by patients
Subject(s)
Humans , Male , Female , Insulin, Short-Acting , Insulin , Child , Adolescent , Retrospective Studies , Cohort Studies , Glycated HemoglobinABSTRACT
To describe the demographic characteristics and clinical presentation of Omani children with type 1 diabetes mellitus at Sultan Qaboos University Hospital, Muscat, Oman. A retrospective analysis of all children with type 1 diabetes mellitus attending the Pediatric Endocrine Unit at Sultan Qaboos University Hospital, Oman from June 2006 to May 2013. One hundred and forty-four patients were included in the study. The mean +/- SD of age at diagnosis was 6.7 +/- 3.7 years. The median duration of symptoms was 10 days [IQR; 5-14]. The most commonly reported presenting symptoms were polyuria [94%], polydipsia [82%], and weight loss [59%]. Diabetic ketoacidosis at initial presentation was diagnosed in 31% of the patients. Different insulin regimens were prescribed: multiple daily injections in 109 [76%] patients, twice daily insulin regimen in 23 [16%] patients, and insulin pump therapy in 12 [8%] patients. Family history of type 1 diabetes mellitus was present in 31 [22%] patients. There were no significant differences in presenting complaints [polyuria, p=0.182; polydipsia, p=0.848], duration of symptoms [p=0.331], reported weight loss [p=0.753], or diabetic ketoacidosis at presentation [p=0.608] between patients with and without family history of type 1 diabetes mellitus. Polyuria, polydipsia and weight loss are the most common presenting symptoms. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients. Diabetic ketoacidosis was found to be less common in Oman compared to other diabetes centers in the Middle East.
ABSTRACT
Deferiprone is an oral chelating agent that has been recently shown to reduce cardiac siderosis, but is also known to be associated with serious side effects like agranulocytosis which can be fatal. This report is a single centre experience of 5 cases with severe agranulocytosis in amongst 144 patients [3.47%] of thalassemia major on combined chelation therapy with subcutaneous desferrioxamine and oral deferiprone which is much higher than the previous reports