Inpatient management of type 2 diabetes mellitus: does choice of insulin regimen really matter?

To assess inpatient management of non-critically ill type 2 diabetics with different insulin regimen. We reviewed the medical records of all non-critically ill type 2 diabetic patients more than 18 years of age in medical department of civil hospital Karachi and Dow University of Health Sciences from January 2011 to December 2012. We collected the data from case records in data collection sheets that fulfill the inclusion criteria and divided the study subjects into three groups according to insulin regimen they received. A total of 416 patients were analyzed out of which 220 were male. Subjects were divided into three groups according to insulin regimen they received. Majority were put on sliding scale of insulin [44.7%], while 33.1% and 22.1% subjects received basal bolus and pre-mixed insulin regimen respectively. Patients treated with basal bolus regimen had greater improvement in glycaemic control with short duration of hospital stay as compared to other two groups. The mean hyperglycaemic events were higher in sliding scale group while mean hypoglycaemic events were higher in basal bolus group. In non-critically ill type 2 diabetic patients the basal bolus regimen is superior to sliding and pre-mixed insulin regimen. Sliding scale should be discouraged in non-critically ill type 2 diabetic patients

Dietary misconceptions in Pakistani diabetic patients

To find out prevalence of various myths regarding diet of diabetics in local population. This was a cross sectional study conducted at diabetic clinic and medical OPD in Civil Hospital Karachi from January 2008 to December 2008. A total of 409 diabetic patients of either gender, age 18 or above who had given the consent were randomly selected. A pretested semi structured questionnaire regarding sociodemographic profile and various dietary myths regarding diabetes were used to get information from the study group. Out of 409 diabetic subjects 207 [50.6%] were male. Average age was 51.6 +/- 10.4 years. Most of the participant 397 [97.1%] were type 2 diabetics. Large number of subjects 83 [20.3%] were either illiterate or had had primary schooling 112 [27.4%]. Most of the participants 256 [62.6%] never received any diabetic education. Majority of study subjects 348 [85%] believed in special diet for control of blood sugar level while large proportion of study population 335 [81.9%] did not use underground vegetables and same number of participants had strong belief in bitter vegetables as natural remedy. Forty one percent study subjects had myths regarding fruits while 301[73.5%] said that rice is prohibited. Study population who believed in special diet showed significant p-value [<0.005] when compared with those who did not. Similarly the group that had received diabetic education showed significant p-value when compared with those who did not. A large number of diabetic patients especially those who never received any diabetic education have strong dietary misconceptions

Vitamin-D status in a population of healthy adults in Pakistan

To determine the prevalence of hypovitaminosis D and its predictors in healthy adult Pakistanis. This study was conducted at various hospitals in Karachi from April 2007 to September 2007. In this study 244 healthy adults 16-62 years of age, visited hospital as an attendant of the patients and fulfilled the inclusion and exclusion criteria has been enrolled. After taking written consent a questionnaire regarding age, gender, occupation, duration of sun exposure, area of skin exposed, type of residence used, clothing and dietary habits were recorded. Serum 25-OH Vitamin D3 levels were determined by electrochemiluminescence method and Vitamin D deficiency was defined as a level <20micro g/ml. serum calcium. Phosphorus and Alkaline Phosphatase were also measured in all of these subjects. Among 244 subjects ranging from 16-62 years, 193[79%] were female. Subjects were predominantly married [72%], mostly residing in apartments [47.5%] and most of them [41 .8%] only exposed their face and hands while outdoor. Duration of sun exposure in majority was 1 -2 hour /day [42%]. Majority used clothes of variable colour [72%] and fabric [41%]. One hundred and eighty six [76.2%] subjects had deficiency of Vitamin D and significantly correlated with duration of sunlight exposure, large area of skin exposed, vitamin D in diet consumed and colour of clothes worn. Vitamin D was significantly correlated negatively with serum Phosphorus and Alkaline Phosphatase whereas serum calcium correlated positively. Prevalence of hypovitaminosis D among healthy Pakistanis is high and duration of sun exposure is the most common predictor of hypovitaminosis D

Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital

To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation. Cross-sectional descriptive study. Study was conducted at the Department of Medicine, Civil Hospital Karachi, from January 2005 to December 2006. One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated. A majority of subjects had type 2 diabetes [95.7%] with male predominance [66%]. The mean age was 54.29 +/- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 [78.4%] patients, while rest of the 25 [22.6%] had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 [77.7%] patients healed without amputation and 17 [14.7%] patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis [p<0.05]. Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer

Diabetic ketoacidosis - a study of 67 episodes in known type 1 and type 2 diabetic patients

Review and describe the clinical characteristics and outcomes of Diabetic Ketoacidosis [DKA] in type land type 2 Diabetic patients. We reviewed the medical records of all patients with a diagnosis of DKA in known diabetics and followed their clinical course and outcome. We classified patients as "type 1" and "type 2" diabetes mellitus based on their treatment history. DKA with recent onset of diabetes excluded because of uncertainty of type of diabetes. We compared the groups for precipitating factors, clinical characteristics and outcomes. Sixty-seven patients fulfilled criteria for inclusion in the study. Of 67 patients 44 [65.7%] were male. Twenty [30%] patients had type 2 diabetes. Mean age of type 1 diabetics was 21.6 +/- 6.lyears while type 2 Diabetics were older and had 48.7 +/- 9 years mean age. Body Mass Index [BMI] and duration of diabetes were greater in type 2 Diabetes. A history of prior DKA was noted in 28 patients and all of them were type 1 Diabetics. Infections were the most common precipitating factor in total [41.8%] but in type 2 Diabetes noncompliance was the main precipitating factor. There were 8 deaths in total and mortality rate was apparently higher in type 2 Diabetes. DKA could frequently complicate type 2 Diabetes contrary to belief and carries relatively high mortality