Study of the Prevalence of Type 2 Diabetes Mellitus in Patients with Heart Failure in a Tertiary Care Hospital in Eastern India

Heart Failure and Type 2 Diabetes Mellitus are closely related. Diabetic patients have an increased risk of developing Heart Failure and those with Heart Failure are at higher risk of developing diabetes. The objective of the study was to estimate the prevalence of Type 2 Diabetes Mellitus in patients with heart failure. This analytical observational type of epidemiological study with case control design was conducted at in patient department of General Medicine of RG Kar Medical College & Hospital, Kolkata, West Bengal, India from July, 2019 to June, 2020. 100 study subjects by purposive sampling method were taken as per inclusion and exclusion criteria. Data were collected based on History, Clinical examination, relevant investigations and review of records. In this study proportion of Diabetes was much higher among cases with Heart Failure (30%) than controls (10%), among cases with NYHA class IV (56.3%) and among cases with reduced Ejection Fraction (100%). Thus pre-existing or newly development of Type 2 Diabetes Mellitus should be kept in mind in all hospitalized Heart Failure Patients.

A case of severe hypothyroidism presenting only with bleeding diathesis.

Hypothyroidism can present with the variety of clinical features; however, bleeding manifestations as a sole presentation of hypothyroidism is extremely rare. Hemostatic disorder may be a manifestation of several underlying etiology. Here, we report a case of a 14 year old girl who initially presented with bleeding diathesis without any other symptoms suggestive of thyroid dysfunction but later on investigations was found to be suffering from severe hypothyroidism.

A study to find out the proportion of prediabetes in patients with acute coronary syndrome in a medical college of Kolkata.

Prediabetes is now considered as a definite entity for increased incidence of cardiovascular disease and a potent risk for progression to type 2 diabetes mellitus. As macrovascular disease is the commonest cause of increased mortality in dysglycaemic individuals (prediabetes and diabetes) by 2-4 times as opposed to normal individuals, clinicians do encounter patients with cardiovascular disease of varying severity regularly. There are increased constellation of other cardiovascular risk factors (hypertension, dyslipidaemia, etc), in prediabetes as compared to normal population. Here a study was carried out among 62 acute coronary syndrome patients who were admitted in a tertiary care hospital in Kolkata to find out the proportion of prediabetes in them. Majority of the patients (54.8%) were in the age group of 45-64 years and were males (77.4%). The study showed 48.4% of all acute coronary syndrome patients were prediabetic and 25% were diabetic. The proportion of impaired fasting glucose and impaired glucose tolerance were 19.4% and 22.6% respectively. So, altogether 72.4% patients were dysglycaemic. Out of all acute coronary syndrome patients, non-ST elevated myocardial infarction group had 50% prediabetic patients, ST elevated myocardial infarction group had 50% prediabetic patients and unstable angina group have 45.8% prediabetic patients. So, all patients of acute coronary syndrome should be screened to detect hyperglycaemia in early stage to prevent further development of diabetes mellitus and also further cardiovascular events.

Metabolic emergencies in diabetes.

Hypoglycaemia is the commonest metabolic abnormality faced by diabetic patients on hypoglycaemic therapy including insulin. Diabetic keto-acidosis (DKA) requires prompt diagnosis and all patients arriving emergency with dehydration, shock, coma, severe respiratory difficulty and evidence of any major illness should be tested for capillary blood glucose (CBG) and urinary ketones urgently not to miss DKA. Hyperosmolar non-ketotic state complicates elderly type 2 diabetes with intercurrent infections (respiratory tract infection is commonest) characterised by severe dehydration, severe hyperglycaemia and absence of acidosis and vomiting. Lactic acidosis is extremely rare; may be compounded with comorbidities like tissue hypoxia, septic shock, heart failure--metformin usage inadvertently may precipitate the condition.