RESUMEN
Background: Pre-diabetes is a mounting health problem occurring worldwide. Microvascular complications are prone to occur during this stage. Early diagnosis and treatment delay progression to diabetes mellitus and microvascular complications. Aims and objectives of the study was to determine the prevalence of microalbuminuria, c-peptide and fundal changes in pre-diabetics.Methods: 125 pre-diabetic patients those who visited MGMCRI General Medicine OPD and admitted in wards were taken into the study after fulfilling the inclusion criteria and after obtaining written informed consent. All those study patient抯 urine and blood sample were sent for analysis of microalbuminuria and C-peptide respectively. Fundus was examined for retinopathic changes.Results: Among 125 prediabetic participants, prevalence of microalbuminuria was 12.8%, c-peptide levels was elevated in 46.4 %, but none of the study participants had fundal diabetic retinopathy changes.Conclusions: The microvascular complications like microalbuminuria starts in the pre-diabetic stage itself. Prevalence of increased c-peptide levels and microalbuminuria was more in individuals who had both IFG and IGT. Elevated C peptide level and microalbuminuria were found to appear much earlier than retinopathy in prediabetes. Hence its use can enhance for early diagnosis of prediabetes
RESUMEN
HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested.