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

VIPoma Crisis: Immediate and life saving reduction of massive stool volumes on starting treatment with octreotide

We report the case of a 57-year-old male physician who presented with a life threatening secretory and refractory diarrhoea of around 20 L/day. This was complicated by severe hypotension, hypokalaemia, hypercalcaemia, renal failure requiring dialysis, metabolic acidosis, cardiorespiratory arrest and ventilation for 12 days. His diarrhoea responded immediately to the first dose of a therapeutic trial of subcutaneous octreotide 100 mcg 8 hourly which was started on clinical grounds alone before any investigations were carried out. After one day he was extubated and his blood pressure returned to normal. When a functioning neuroendocrine tumour is suspected clinically, the use of octreotide can, as in this case, be life saving

Quality of diabetes care: a cross-sectional observational study in Oman

The objective of this study was to evaluate the quality of diabetes care in Oman. This was a cross-sectional observational study. Fifty percent of all those attending six general health centers in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data. A total of 430 diabetic subjects were included. Just over 61% percent of the subjects were female [n = 263]. The overall mean age of the cohort was 52 +/- 12 years ranging from 6 to 84 years. Only 40% [n = 171] and 39% [n = 169] of the diabetics had their random blood sugar [RBS] and fasting blood sugar [FBS] documented, respectively. However, 79% [n = 339] had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% [n = 317] for HbA1c and low density lipoproteins-cholesterol [LDL] to 95% [n = 409] for systolic and diastolic blood pressure [SBP/DBP] readings. A total of 58% [n = 249] of patients had non-missing values of HbA1c, SBP/DBP, total cholesterol, LDL-cholesterol, high density lipoproteins-cholesterol [HDL], and triglycerides. Only 2.4% [6 out of 249 diabetics] were simultaneously within goal for HbA1c [<7%], SBP/DBP [<=130/80 mmHg], total cholesterol [<5.2 mmol/L], LDL-cholesterol [<3.3 mmol/L], HDL-cholesterol [>1.1 - <1.68 mmol/L], and triglycerides [<1.8 mmol/L]. There was good documentation of values for the indicators used in the assessment of quality. However, the proportion [2.4%] of those meeting internationally recognised goals for the three diabetes-related factors was extremely low

Insulinoma: a rare cause of a common metabolic disorder - hypoglycaemia

We describe the first patient diagnosed with an insulinoma in Oman and successfully managed with a distal laparoscopic pancreatectomy. The importance of obtaining a good history from the patient and/or his family is stressed. All patients with loss of consciousness must have a Reflow check carried out and, if hypoglycaemic, this should be documented in the laboratory and a simultaneous serum sample stored for measurement of insulin, C-peptide proinsulin and sulphonylurea levels, if subsequently indicated. If magnetic resonance imaging fails to locate the tumour, endoscopic ultrasound of the pancreas, or indium 111 labelled octreotide scanning is indicated if the patient's hypoglycaemia has previously responded to treatment with octreotide

Graves' disease following interferon therapy for chronic hepatitis C infection

We describe the first case of Graves' disease occurring at Sultan Qaboos University Hospital, Oman, in a patient who was under treatment with interferon alfa for HCV infection. INF-? is now being widely used to treat patients with a variety of disorders including infection with hepatitis C virus. Clinical thyroid disease, hypo and hyperthyroidism can occur in up to 15% of patients. We emphasize the need for thyroid function screening before and during therapy to identify patients early in the course of their disease

Cushing's disease: Pituitary surgery versus adrenalectomy

We describe two patients of the Department of Medicine at Sultan Qaboos University Hospital, Muscat, Oman, with Cushing's disease. Their magnetic resonance imaging scans of the pituitary were negative. One patient was treated by transsphenoidal surgery and the other by bilateral endoscopic adrenalectomy. Both procedures were successful and the patients cured. The advantages and disadvantages of these two approaches are discussed