Adherence of healthcare professionals to American diabetes association 2004 guidelines for the care of patients with type 2 diabetes at peripheral diabetes clinics in Karachi, Pakistan

Objective: To observe the adherence of Healthcare Professionals to American Diabetes Association [ADA] 2004 guidelines for the care of patients with type 2 diabetes at Peripheral Diabetes Clinics [PDCs] in Karachi, Pakistan

Methodology: The study was conducted using a retrospective medical chart review of patients with type 2 diabetes at four PDCs in four townships of Karachi district from January 2005 to December 2006. Entire medical records of patients were evaluated for the evidence of documentation of testing and treatment

Results: Medical records of 691 patients [332 males and 359 females] with type 2 diabetes were reviewed. Mean age of the patients was 50.79 +/- 10.75 years. Deficiencies were observed in most areas of diabetes care. Blood pressure was documented in 85.81% patients, whereas, serum creatinine, HbA1c and lipid profile were noted in 56%, 44.57% and 40.08% of the patients respectively. Similarly, lower leg examination was registered in 44% patients, while in 30.53% of the patients fundoscopic examination was recorded. Co-morbid conditions like hypertension and hyperlipidemia were documented in 92.7% and 84.6% patients respectively. HbA1c < 7% was achieved by 59.04% patients, while 27.50% of the patients attained the recommended level of serum cholesterol. Likewise, ADA recommended goal for blood pressure and LDL was achieved by13.02% and 12.16% patients respectively

Conclusions: The study showed that adherence of healthcare professionals to ADA guidelines was suboptimal. Moreover, insufficient documentation of medical records reflected inadequate care of patients with type 2 diabetes

Ethnic differences in metabolic syndrome among South Asians of Pakistan

To determine the prevalence of metabolic syndrome in different ethnic subgroups of urban population of Karachi, Pakistan. This cross sectional study was conducted in Lyari Town. Data of 856 adults >25 years old was available in terms of ethnic subgroups for analysis; 363 of these subjects gave blood samples. Their anthropometric, demographic and biochemical data was collected. Distinct ethnic subgroups- Muhajir, Punjabi, Sindhi, Baluchi and Pushtun were defined on the basis of mother tongue. Out of 856 subjects, 73% were females. Mean age of the subjects was 40.7 +/- 14.1 years. Metabolic syndrome was found in 34.8% subjects according to the IDF criteria. In terms of ethnic groups the highest prevalence of metabolic syndrome was seen in Pushtuns [41.3%] and the lowest in Muhajirs [32.5%]. Statistically significant differences were seen in the age adjusted waist circumference, waist-hip ratio, fasting triglycerides, insulin and HOMA levels among ethnic subgroups. Prevalence of metabolic syndrome in the studied population was found to be significantly high but there was no statistical difference seen among various ethnic subgroups. Further large scale studies are needed to confirm these findings

Frequency of insulin resistance in patients with polycystic ovary syndrome: a study from Karachi, Pakistan

To assess frequency of insulin resistance [IR] in patients, presenting with polycystic ovarian syndrome using simple indices of insulin resistance and to determine the association of clinical manifestations of PCOS with insulin resistance indices. This cross sectional study was carried out at Baqai Institute of Diabetology and Endocrinology [BIDE]. One hundred patients fulfilling the revised 2003 Rotterdam diagnostic criteria for PCOS were included. Descriptive statistics were calculated using frequency and mean with standard deviation. Insulin resistance [IR] was calculated using fasting insulin levels [> 10 IU/ml], fasting glucose: insulin ratio [> 4.5]. Different surrogate marker of IR like HOMA-IR [> 2.6], QUICKI [< 0.357] and McAuley [< 5.8] were calculated. The value for HOMA-IR, QUICKI and McAuley in patients of PCOS were 65%, 88% and 51.2% respectively. Patients having fasting insulin level [> 10 iu/ml] were 75.32%. Menstrual irregularities were the commonest presentation followed by obesity, hirsutism and infertility. There was a strong association of BMI with various menstrual irregularities, hyperinsulinemia and insulin resistance. A significant high rate of hyperinsulinemia and insulin resistance has been observed in our patients of polycystic ovarian syndrome. Majority of clinical manifestation are found to be associated with insulin resistance indices