Impact of COVID-19 Pandemic on the Glycemic Status of a Large Cohort in Patients with Diabetes

There is a general notion that glycemic control has deteriorated since the onset of COVID-19 pandemic. This study aimed to compare the glycemic status of a very large cohort of Persons with diabetes (PWD) prior to COVID-19 outbreak with that of a similar cohort post onset of the outbreak. Materials and methods : In this retrospective study, entire data of glycated hemoglobin (HbA1c)% available in the hospital database from 3rd October, 2017 till 31st May, 2020 were collected and segregated into two cohorts namely on or prior to (ie, pre COVID-19) and after (ie, post COVID-19) 15th March, 2020 respectively. Results : Total 20575 HbA1c values (12081 in the pre COVID-19 arm and 8494 in the post COVID-19 arm) were available for analysis. Mean (±SD) and Median HbA1c% in the pre COVID-19 arm (7.74±1.33, 7.5) was significantly (P<0.05) lower compared to those of the post COVID-19 arm (8.28± 1.9, 7.8). Such a difference was mainly driven by significantly higher numbers in the subgroup of HbA1c >10% (P<0.05). The Mean (±SD) and Median HbA1c% of the subgroups namely; males, females, age <65 years and age >65 years in the post COVID-19 arm (8.33±1.9, 7.8; 8.21±1.9, 7.7; 8.23±1.9, 7.7 and 8.13±1.8, 7.4 respectively) were significantly higher than the pre COVID-19 arm (7.73±1.3, 7.4; 7.75±1.2, 7.5; 7.72±1.2, 7.5 and 7.9±1.5, 7.6 respectively). Conclusion : Onset of COVID-19 pandemic has adversely impacted glycemic control amongst PWD in general.

A STUDY ON THE GLYCEMIC STATUS AND OUTCOME OF PATIENTS WITH COVID ASSOCIATED MUCORMYCOSIS.

Background:A surge of mucormycosis during the second wave of COVID intrigued the doctors in India to look for the epidemiology of the illness.Diabetes is the most common risk factor for mucormycosis.COVID can cause hyperglycemia due to various reasons.In this study,we describe the outcome of post COVID mucormycosis with respect to the glycemic status of the patient. (1)To describe the glycemic parameters of patients with COVID-19 Associated M Objectives: ucormycosis.(2)To describe the one month outcome of the patients.(3)To compare patients with Newly Diagnosed Diabetes Mellitus Post COVID-19 and patients having preexisting diabetes mellitus. 75 patients with probable or proven mucormycosis wit Methodology: h history of COVID atleast 2 weeks before were randomly selected from the mucor ward of Rajiv Gandhi Government General Hospital and their glycemic profile assessed.They were followed up for one month and the results were statistically analyzed. Regarding the prior CO Results: VID illness,patients had a median hospital stay of 7 days,received 5 days of intravenous steroids and 3.48 days of supplemental oxygen.Patients who had hyperglycemia during COVID also had statistically significantly higher iv steroid use and higher need for oxygen.There was a statistically very significant(p<0.001) increase in the number of diabetics post COVID(from 57.3% prior to COVID to 90.7% post COVID).Majority of the Mucormycosis patients(69.3%) had severe hyperglycemia during presentation.Pre-existing diabetics had a statistically significant higher incidence of sepsis and renal failure during treatment for mucormycosis.Otherwise,there was no significant difference in outcome between various grades of severity of hyperglycemia,and no distinction was found between pre-existing diabetics and newly diagnosed diabetics

Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study / 生物医学与环境科学（英文）

Objective@#The relationship between serum uric acid (SUA) levels and glycemic indices, including plasma glucose (FPG), 2-hour postload glucose (2h-PG), and glycated hemoglobin (HbA1c), remains inconclusive. We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.@*Methods@#The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study. A total of 105,922 community-dwelling adults aged ≥ 40 years underwent the oral glucose tolerance test and uric acid assessment. The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.@*Results@#A total of 30,941 men and 62,361 women were eligible for the current analysis. Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels, but with different inflection points in men and women. The thresholds for FPG, 2h-PG, and HbA1c for men and women were 6.5/8.0 mmol/L, 11.0/14.0 mmol/L, and 6.1/6.5, respectively (SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).@*Conclusion@#An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes, while the inflection points were reached earlier in men than in women.

A study of lipid profile and glycemic status in patients with chronic kidney disease of unknown etiology in Sri Lanka

Background: Dyslipidemia and impaired glucose tolerance are common complications of chronic kidney disease (CKD) and are responsible for increased cardiovascular risk. Studies on lipid profile and glycemic status in CKD of unknown origin (CKDu) are scarce. The objective of this study was to evaluate the lipid profile and glycemic status of the patients with CKDu and to aid in preventing morbidity and mortality.Methods: The descriptive, cross sectional study was conducted in a rural CKDu endemic area, Girandurukotte.  Data was collected from February 2018 to June 2019. For the diagnosis of CKDu, history and clinical features with supportive biochemical, renal biopsy and radiological evidence were taken as criteria. Blood samples were taken for serum creatinine, lipid profile and HbA1C. Already diagnosed patients with diabetes mellitus and dyslipidemia were excluded.Results: A total of 168 patients within the age range of 32-66 years (mean 50.3±7.7) were participated. There were 106 males (63%) 46.4% were farmers. Majority of the patients (65.5%) had normal body mass index (BMI) (mean 22.9 kg/m2, normal range 18.5-23.5%) followed by overweight (23.5-30 kg/m2) in 55 (32.7%) patients. The prevalence of dyslipidemia in CKDu was found to be 55.9%.  Majority of the abnormality was seen in the HDL group with 68 (40.5%) patients having low HDL cholesterol (mean 44.7 mg/dl, SD=12.3).  There was a significant rise in the serum triglyceride concentration (>150 mg/dl) in 53 (31.5%) (mean 152.4 mg/dl, SD=73.5) and total cholesterol (>200 mg/dl) in 30 (18%) patients (mean 182 mg/dl, SD=36.9). LDL cholesterol abnormality (>130 mg/dl) was seen in only 9 patients (mean 88.7 7658mg/dl, SD=25.4). From the total, 144 (85.7%) patients had abnormal HbA1C levels; 27 (16.1%) patients had HbA1C levels between 5.7% and 6.4% (pre-diabetes), and 117 (69.6%) patients had HbA1C level more than 6.5% (diabetes mellitus). There was no statistically significant association between HbA1C levels and BMI (p=0.29) or HbA1C and lipid abnormalities (p=0.32)Conclusions: The high prevalence of dyslipidemia, pre-diabetes and diabetes mellitus in patients with CKDu may accelerate the progression of chronic kidney disease and increase the risk of cardiovascular disease. Early detection, initiation of appropriate medication and early referral to the expertise will ameliorate morbidity and mortality.

Serum Zinc Level in Persons with Prediabetes and it’s Relation with Glycemic Status Attending Tertiary Care Hospital in Bangladesh

Background: Type 2 diabetes mellitus is becoming one of themajor health problems worldwide. Especially in South EastAsia, type 2 diabetes has gained critical significance. Asprediabetes prevalence is increasing worldwide, it has becomean important concern to prevent diabetes at an early stage inBangladesh.Objectives: Estimation of serum zinc level and establishmentof its relation with glycemic status in individuals with prediabetes.Materials and Methods: This cross-sectional studyencompassed 126 (age: 35.09±9.96 years, mean ± SD; Sex:16/110, M/F) subjects with prediabetes and 126(age:29.08±9.28 years, mean ± SD; Sex: 22/104, M/F) healthynondiabetic controls from the out-patient department ofEndocrinology, BSMMU consecutively. Serum zinc wasmeasured by using Atomic Absorption Spectrophotometry.Height, weight, waist circumference, acanthosis nigricans,hypertension, SGPT& serum creatinine were recorded asconfounding variables.Results: Serum zinc level in persons with prediabetes waslower than that in control (0.76±0.01 vs. 0.78±0.01mg/L,M±SEM, p=0.28). There was statistically significant differencefor zinc level in gender groups (M vs. F: 0.84±0.02 vs.0.75±0.01 mg/L, M±SEM, p<0.001) and monthly family incomegroups (p=0.02). Also zinc level was statistically similar amongglycemic status groups apart from zinc level in between controland combined glucose intolerance (CGI) groups (control vs.CGT: 0.78±0.01 vs. 0.72±0.02mg/L, M±SEM, p=0.03). Amongcases comparisons between groups with or without risk factorslike: smoking (0.72±0.03 vs. 0.76±0.10 mg/L, p=0.42),smokeless tobacco (0.73±0.03 vs. 0.76±0.01mg/L, p=0.46),hypertension (0.80±0.03 vs. 0.75±0.01 mg/L, p= 0.14), familyhistory of DM (0.75±0.02 vs. 0.77±0.02mg/L, p=0.52), familyhistory of CVD (0.74±0.02vs.0.77±0.01mg/L,p=0.28), overweight (0.76±0.01 vs.0.74±0.05mg/L, P=0.59), waistcircumference (0.75±0.01 vs. 0.79±0.04mg/L, p=0.40) andacanthosis nigricans (0.75±0.02 vs. 0.76±0.02mg/L, p=0.70),showed no statistically significant difference. None of thevariables like age (r= -0.02, p=0.19), BMI (r= 0.14, p=0.12),FPG (r= -0.05, p=0.60) and PG 2h after 75g glucose (r=0.10,p=0.28), HbA1c (r=0.04, p=0.64), serum creatinine (r=0.01,p=0.87) showed significant relationship with the level of zincexcept SGPT which showed significant relation with zincamong cases (r= 0.28, p=0.002) and among all participants(r=0.17, p=0.008) but not in control group (r=0.07, p=0.43).Conclusion: It is concluded that persons with prediabetes hadserum zinc level within normal limit and there was found nostatistically significant relationship between HbA1c and zinc

Hypovitaminosis D and effect of vitamin D supplementation in type 2 diabetes mellitus: a rural population based study

Background: Deficiency of Vitamin D in general population and its association with various disease conditions have been studied worldwide. Type 2 Diabetes mellitus is increasing at an alarming rate in Indian subcontinent, contributing to increased morbidity and mortality. This study aimed to estimate level of Vitamin D and its association with patients with type 2 diabetes mellitus of rural origin. This study objective was to estimate the Vitamin D level of patients with Type 2 Diabetes mellitus and the effect of Vitamin D supplementation on glycemic statusMethods: This study was conducted at the Department of General medicine for a period of 1 year. Eighty patients with type 2 Diabetes mellitus were recruited in the study and baseline parameters of glycemic control and Vitamin D levels were assessed. Only 36 patients complied with the recommendation and evaluated further.Results: All the patients included in the study had insufficient or deficient levels of Vitamin D. The mean vitamin D levels before and after supplementation were 17.75±6.30 and 29.33±6.34 respectively. The mean plasma HbA1c level before and after supplementation were 7.78 and 7.30 respectively. Patients after vitamin D replacement showed significant improvement in their glycaemic status.Conclusions: Vitamin D supplementation of 2000 IU/day had shown to improve the glycaemic status. The beneficial effect of Vitamin D on diabetes was evident in a short period of supplementation

A study on serum lipid and malondialdehyde levels among diabetic patients

Background: Elevated levels of lipid peroxide in diabetes mellitus may be due to the alteration of function of erythrocytes membrane. This inhibits the activity of superoxide dismutase enzyme leading to accumulation of superoxide radicals which cause the maximum lipid peroxidation and tissue damage in diabetes. The objectives was to study was done with the objectives of assessing the serum lipid and malondialdehyde levels among diabetic population and matched control group.Methods: This study was done among 50 NIDDM, 50 IDDM and 50 controls at Thanjavur Medical College, Tamil Nadu, India for a period of one year at the Department of Diabetology after getting the informed consent and IEC clearance. This study included all ambulatory NIDDM and IDDM patients without any complications. The following investigations like serum malondialdehyde, blood sugar, HBA1C, serum lipid profile, blood urea, serum creatinine, urine albumin and sugar were done by standardized procedures and reagents after getting the detailed history and examination.Results: Among NIDDM group 78% were between 6.4 to 8 categories whereas in IDDM group only 28% were in this 6.4 to 8 category (HBA1C). Comparison of serum MDA values among three groups were done by ANOVA with two groups separately and it was highly significant. Multiple comparison of mean difference of MDA and lipid values among all the three groups showed statistically significant results with p value at 0.05.Conclusions: Lipid profile is increased in poor glycemic controlled patients (both IDDM and NIDDM patients) and it is reflected in high serum malondialdehyde levels.

The Impact of Glycemic Status and Metformin Administration on Red Blood Cell Indices and Oxidative Stress in Type 2 Diabetic Patients

@#Background: Most guidelines all over the world recommended metformin as the first-line treatment for in type 2 diabetic patients. Therefore, the present study was suggested to assess the outcome of metformin administration and glycemic status on alterations in red blood cell (RBCs) indices as well as the oxidative stress in type 2 diabetic patients. Methods: Between December 2016 and October of 2017, a total of 158 eligible individuals were classified as 50 healthy subjects and 108 diabetic patients who were subdivided into six groups according to the type of anti-diabetic treatments. Results: Overall, the results elucidated that hemoglobin concentration was markedly diminished, while red cell distribution width (RDW) value was significantly (P < 0.001) elevated in all diabetic groups as compared to control. Moreover, in all diabetic groups, malondialdehyde (MDA) concentration was elevated noticeably (P < 0.001), while reduced glutathione (GSH) revealed a lower concentration (P < 0.001) than that of control. Conclusion: The present study exhibited the amelioration effect of metformin administration on oxidative stress and glycemic status which reflected on some RBCs indices. However, hemoglobin concentration showed a noticeable diminution in all metformin-treated groups in spite of the improvement in glycemic and oxidative stress status which indicated that the metformin-induced anemia is independently from diabetic complications.

Metformin as a safe and cost effective alternative to insulin in women with Diabetes in pregnancy.

There is a substantial rise in diabetes complicating pregnancies in south Asian countries especialy India. Until many decades, insulin eras thought to be the only management option to maintain euglycemia in these cases. But metformin can be a safe and convenient alternative in such cases. In this background we have conducted a study I 40 women with diabetes complicating pregnancies and studied the outcome of the mother and neonate in important parameters. Metformin was found to be a safe, effective and cheap alternative to insulin therapy in pregnant diabetic women.

A Study of the Association of Abdominal Obesity,Dyslipidemia and Glycemic Status in Pre-hypertensive Young Adults of a Medical University.

Aim : To study the co-relation between pre-hypertension and abdominal obesity, dyslipidemia and glycemic status in young adults of a medical university. Objective : 1) To study the prevalence of pre-hypertension among the young adults of a medical university. 2) To co-relate prehypertension with other factors such as abdominal obesity, dyslipidemia and glycemic status. Methods : This study was conducted in Acharya Vinoba Bhave Rural Hospital, JN Medical College, Wardha .The students of Jawaharlal Nehru College were the participants for this study. Each participant was examined only after the undertaking of their informed consent. Students who fulfilled the criteria of prehypertensives as per the criteria of JNC, 7 where included in this study. A total of 55 students who were prehypertensive were included in the study. These 55 participants where further examined for anthropometric parameters like height, weight, body mass index (BMI) and waist hip ratio (WHR). For statistical analysis Chi - Square statistic method was employed. Results : The study showed that the prevalence of pre-hypertension was quite high (75%). There was a strong co-relation of pre-hypertension with BMI and WHR, and pre-hypertension was more prevalent in males as compared to females (49.8% versus 46.7%). Conclusion :Medical students are advised to adopt lifestyle changes to prevent the risk of future cardiovascular morbidity.

Assessment of overweight, obesity and metabolic variables among students of a private medical college in Dhaka city.

Background: Overweight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most non-communicable diseases. Few recent studies have indicated the presence of increase in overweight and obesity among children and adolescent but there is no study among adult groups. Method and material: This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Result: Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP and SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg and 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status (p<.286) and lipid profile (p<.347) with central obesity. Conclusion: Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student’s awareness therefore should be increased to reduce central obesity and BP within normal range.

A Hospital-based Observational Study of Type 2 Diabetic Subjects from India.

Aim: The aim of this study was to describe the profile of the subjects with type 2 diabetes mellitus (T2DM) to obtain a clear picture from Western India, that would help in management of diabetes. Methods: An observational study was conducted with newly diagnosed 622 type 2 diabetic subjects attending Dept. of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya), Ahmedabad during the period from August 2006 to January 31, 2009. Subjects completed an interviewer-administered comprehensive questionnaire, which included variables such as sociodemographic presenting symptoms, risk profile (hypertension, obesity, dyslipidemia and glycemic status), family history of diabetes, physical activity and behavioral profile. Blood pressure, body mass index (BMI), glycosylated hemoglobin (HbA1C) and fasting lipid profile were measured. Descriptive and bivariate analyses were carried out using SPSS version 11.5. Results: A total of 622 T2DM cases with mean age (years) 47.7 ± 10.9 were studied. Of these, 384 (62%) were male. The majority of T2DM subjects were obese (68%) and 67% had positive family history of diabetes. Renal dysfunctions and vision impairment were found in 10% (62/622) and 9% (57/622), respectively in T2DM subjects. The mean HbA1C level was 9.02% ± 1.67 and good glycemic control (HbA1C level <7%) was achieved only in 7.4% T2DM subjects. The Chi-square (χ2) analysis showed that higher BMI (≥25 kg/m2) is significantly associated with hypertension among T2DM subjects (p < 0.01). There were statistically significant differences between male and female study subjects with respect to mean age, BMI, waist and hip circumference and mean low-density lipoprotein (LDL) level (p < 0.05). Conclusions: The present study revealed that obesity, family history of diabetes, dyslipidemia, uncontrolled glycemic status, sedentary lifestyles and hypertension were more prevalent in T2DM subjects. Hence, the overall risk profile was very poor and needs improvement. The characterization of this risk profile will contribute in defining more effective and specific strategies for screening and controlling T2DM in Western India.

Trace elements status in type 2 diabetes.

Background: The metabolism of several trace elements has been reported to alter in diabetes mellitus and these elements might have specific roles in the pathogenesis and progress of this disease. Objective: The aim of the present study was to investigate serum levels of copper, zinc, chromium, magnesium and manganese in type 2 diabetic patients and their possible association with age, glycemic status and duration of diabetes. Methodology: The comparative study included 116 type 2 diabetic patients and 40 non-diabetic subjects. Fasting plasma glucose and HbA1c were determined by the glucose oxidase method and affinity chromatography respectively. The element concentrations were measured by means of an atomic absorption spectrophotometer after microwave-induced acid digestion. Results: Mean (±SD) Mg and Zn levels were significantly reduced in blood samples of diabetic patients as compared to control subjects (p<0.0001-<0.05). The alterations observed in serum levels of copper and manganese was not significant among diabetic and normal subjects. Glycemic status, duration of diabetes and age did not effect the trace elements concentrations. Conclusion: The results confirm that deficiency and efficiency of some essential trace metals may play a role in the development of diabetes mellitus.