ABSTRACT
Objective: To observe the role of Ramadan Specific Diabetes Education [RSDE] in the management of fasting patients with diabetes
Methods: This prospective study was carried out at out-patients department [OPD] of Baqai Institute of Diabetology and Endocrinology [BIDE], in 2012. Recruitment of patients started a month prior to Ramadan. Muslim patients with diabetes whether had their first or on follow up visit to the OPD and showed intention to hold fast in the month of Ramadan, were included. A printed broacher focused on six cardinal areas of fasting and diabetes identified in Ramadan specific guidelines was given to all participants. All patients had their first visit to the OPD [n=32] were also given RSDE on one-to-one basis [Group A]. Whereas patients had follow up visit were advised to attend a group session on RSDE. Those attended [n= 25] and those did not opt [n=45] the group session were included in Group B and Group C respectively. All participants were instructed to visit the OPD after Ramadan. Group D was constituted after Ramadan. It included patients who had not visited the OPD during induction period thus did not receive RSDE [n=76] they however hold fast in the month of Ramadan. Data regarding compliance to structured education through different modes was collected during post Ramadan visit
Results: Comparisons among groups who received education[A with B with C] revealed non-significant difference in self-monitoring of blood glucose, alteration of drug dosage and timing, appreciation of hypoglycemia and action taken on development of hypoglycemic symptoms. However, significant differences were noted when group who received education was compared individually with group who did not receive education
Conclusion: Patients who receive Pre-Ramadan diabetes education were found to be significantly better in following Ramadan specific diabetes management recommendations compared to patients who did not receive education. Further large scale studies are needed to validate our findings
ABSTRACT
Objective: To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate [GFR] in normotensive patient with type 1 diabetes
Methods: A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged >/=18 years and >/= 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula [eGFR] at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration [eGFR >/= 100 ml/min] and normal filtration group [eGFR < 100 ml/min]. All subjects in hyperfiltration group received ACE inhibitor [treatment group] while patients with normal filtration did not receive ACE inhibitor [control group]
Results: Fifty two patients [43%] were in the treatment and sixty nine [57%] were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values
Conclusion: Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range
ABSTRACT
Objective: To determine the acceptance of retinal screening, Laser uptake and subsequent follow-up in diabetic patients attending the Diabetes Centre of Diabetic Association of Pakistan [DAP], Karachi
Study Design: Observational case series
Place and Duration of Study: Diabetic Centre of Diabetic Association of Pakistan [DAP], Karachi, from January 2011 to December 2012
Methodology: All the diabetic patients were screened for Diabetic Retinopathy [DR] with non-Mydriatic Fundus Camera [NMFC]. Patients with DR were examined by the ophthalmologist using fundus lens and slit lamp. DR was graded for severity on the basis of modified Airlie House Classification. Patients with Sight Threatening Diabetic Retinopathy [STDR] were advised Laser treatment. Each patient was followed-up for at least 6 months. The records of patients recommended Laser were retrieved, and called for re-examination
Results: Retinal screening was accepted by all of the 8368 registered diabetics attending DAP Centre. On fundus photography, 21.2% [1777] individuals were found to have DR. Seven hundred and five [39.5%] patients were found to have STDR. Laser was advised to 96.4% [680] of STDR patients; amongst whom 70.5% [480] accepted Laser treatment. Out of 480 patients who had Laser treatment, 21.2% [107] turned out for follow-up after 6 months
Conclusion: Acceptance of retinal screening and Laser application was good; but follow-up was suboptional
ABSTRACT
To determine the frequency, severity and risk indicators of diabetic retinopathy [DR] in patients with diabetes attending a primary care diabetes centre. This observational study was conducted at Diabetic Association of Pakistan - a World Health Organization collaborating center in Karachi, from March 2009 to December 2011. Registered patients with diabetes were screened by two field fundus photographs. Retina specialists graded the signs of retinopathy according to diabetic retinopathy disease severity scale. Of total registered diabetic patients [n=11,158], 10,768 [96.5%] were screened for DR. Overall DR was found in 2661 [24.7%] patients. DR was found in decreasing order of frequency in patients with type 2 [n= 2555, 23.7%] followed by patients with type 1 diabetes [n=101, 0.93%] and patients with gestational diabetes mellitus [GDM] [n=5, 0.46%]. Among patients with DR, signs of non-sight threatening retinopathy was dominant. Females and patients of working age group predominantly had retinopathy. Type 1 patients >16 years and type 2 patients < 5 years of history of diabetes had sign of retinopathy in increased frequency. Every forth patient with diabetes in this large cohort had signs of diabetic retinopathy. Females and patients in working age group predominantly had retinopathy. Type 2 patients with short while type 1 patients with long history of diabetes most frequently had DR. Dissemination of the present study findings may help in increasing the awareness of this serious complication of diabetes
ABSTRACT
Objective: To compare blood pressure lowering effects of angiotensin II type I receptor blocker candesartan cilexetil in comparison with calcium channel blocker amlodipine in essential hypertensive patients
Study design: Randomized, open-labeled, prospective comparative study
Place and duration: The study was carried out in the department of pharmacology and therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi from July 2007 to January 2008
Subjects and methods: In this study [80] newly diagnosed essential hypertensive patients were enrolled and divided into two groups [DR1] and [DR2] respectively. DR1 patients received candesartan 16mg once a day and DR2 patients received Amlodipine 10mg once a day for 3 months duration
Results: The mean systolic blood pressure of DRI was 162.23 on day 0 which decreased to 141.05 on day 90, versus DR2 which decreased from 160.12 on day 0 to 140 on day 90. The mean diastolic blood pressure decreased significantly for DR 1 group from 99.87 mmHg to 87 to 89. mmHg, versus DR2 which decreased from 98.5 to 86.25. All values of blood pressure have been taken in mmHg. The results of this study were observed statistically significant
Conclusions: Candesartan cilexetil is a newer and safer alternative for the treatment of essential hypertensive patients in comparison to conventional antihypertensive treatment