Résumé
Objective: To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate [GFR] in normotensive patient with type 1 diabetes
Methods: A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged >/=18 years and >/= 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula [eGFR] at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration [eGFR >/= 100 ml/min] and normal filtration group [eGFR < 100 ml/min]. All subjects in hyperfiltration group received ACE inhibitor [treatment group] while patients with normal filtration did not receive ACE inhibitor [control group]
Results: Fifty two patients [43%] were in the treatment and sixty nine [57%] were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values
Conclusion: Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range
Résumé
Objective: To determine the visual outcome of laser treatment in clinically significant macular edema
Methods:This interventional and qausi experimental study was carried out at Diabetic Association of Pakistan [DAP] during January 2011 and December 2012. Approval was taken from Research Ethical Committee of Isra Postgraduate Institute of Ophthalmology. Records of 925 eyes of 464 patients with "Clinical Significant macular edema" [CSME], treated with laser photocoagulation were analyzed. Bestcorrected visual acuity [BCVA] at the time of presentation and at the last follow up, minimum of one year and maximum of 45 months was recorded and compared. SPSS version 20.0 was used to analyze the data
Results:Diabetic retinopathy was found in 20.3% [1777] of 8742 diabetic attending DAP Hospital" amongst whom 39.6% [705] had Sight threatening diabetic retinopathy. Laser was advised in 96.4% [680] individuals, accepted by 70.5% [480] individuals. Amongst 960 eyes of 480 patients who accepted laser, 925 eyes had clinically significant macular edema and 35 eyes had PDR who are not included in this study. Amongst 925 eyes with CSME, Grid laser was done in 913 eyes [99%] and focal laser was done in 12 eyes [1%]. After a follow up of 12 to 45 months, it was found that best corrected visual acuity had declined in 2.4% [22] eyes, stabilized in 67% [619] eyes and improved in 30.7% [284] eyes. One line improvement on Snellen's chart was fond in 21.3% [197] eyes, 2 lines in 8% [74] eyes, 3 lines in 1.2% [12] eyes and 4 lines in one [0.1%] eye with p-value of 0.000
Conclusion:Laser therapy is an effective treatment in stabilizing/improving the vision in diabetic macular edema particularly at those centers where only Argon Laser is available and OCF, FFA facilities do not exist
Résumé
Objective: To determine the acceptance of retinal screening, Laser uptake and subsequent follow-up in diabetic patients attending the Diabetes Centre of Diabetic Association of Pakistan [DAP], Karachi
Study Design: Observational case series
Place and Duration of Study: Diabetic Centre of Diabetic Association of Pakistan [DAP], Karachi, from January 2011 to December 2012
Methodology: All the diabetic patients were screened for Diabetic Retinopathy [DR] with non-Mydriatic Fundus Camera [NMFC]. Patients with DR were examined by the ophthalmologist using fundus lens and slit lamp. DR was graded for severity on the basis of modified Airlie House Classification. Patients with Sight Threatening Diabetic Retinopathy [STDR] were advised Laser treatment. Each patient was followed-up for at least 6 months. The records of patients recommended Laser were retrieved, and called for re-examination
Results: Retinal screening was accepted by all of the 8368 registered diabetics attending DAP Centre. On fundus photography, 21.2% [1777] individuals were found to have DR. Seven hundred and five [39.5%] patients were found to have STDR. Laser was advised to 96.4% [680] of STDR patients; amongst whom 70.5% [480] accepted Laser treatment. Out of 480 patients who had Laser treatment, 21.2% [107] turned out for follow-up after 6 months
Conclusion: Acceptance of retinal screening and Laser application was good; but follow-up was suboptional
Résumé
To determine the frequency, severity and risk indicators of diabetic retinopathy [DR] in patients with diabetes attending a primary care diabetes centre. This observational study was conducted at Diabetic Association of Pakistan - a World Health Organization collaborating center in Karachi, from March 2009 to December 2011. Registered patients with diabetes were screened by two field fundus photographs. Retina specialists graded the signs of retinopathy according to diabetic retinopathy disease severity scale. Of total registered diabetic patients [n=11,158], 10,768 [96.5%] were screened for DR. Overall DR was found in 2661 [24.7%] patients. DR was found in decreasing order of frequency in patients with type 2 [n= 2555, 23.7%] followed by patients with type 1 diabetes [n=101, 0.93%] and patients with gestational diabetes mellitus [GDM] [n=5, 0.46%]. Among patients with DR, signs of non-sight threatening retinopathy was dominant. Females and patients of working age group predominantly had retinopathy. Type 1 patients >16 years and type 2 patients < 5 years of history of diabetes had sign of retinopathy in increased frequency. Every forth patient with diabetes in this large cohort had signs of diabetic retinopathy. Females and patients in working age group predominantly had retinopathy. Type 2 patients with short while type 1 patients with long history of diabetes most frequently had DR. Dissemination of the present study findings may help in increasing the awareness of this serious complication of diabetes
Résumé
The main objective of this retrospective study was to observe Ramadan related awareness, practices and experiences of diabetic patients. It is expected that the outcome of this study would assist the healthcare professionals in providing effective fasting related guidance. A total number of 1050 diabetic patients were interviewed post Ramadan. Closed ended questionnaires were administered and responses were recorded by the trained data collectors. Out of 1050 subjects, 33% [n=350] were males and 67% were females [n=700]. About two third of the study participants monitored their blood glucose at home or at health care facilities. Frequency of monitoring blood glucose once a month was the most common pattern. During Ramadan blood glucose level was monitored by 70% of subjects. Majority of the subjects did their blood sugar 1-3 times in a month. Dosage of oral hypoglycemic/insulin was adjusted before Ramadan in 80.8% of the patients with diabetes who planned to fast. Overall 3.1% of subjects broke the fast due to hypoglycemia, while 75% of study population had never experienced symptoms of hypoglycemia during fasting. The majority of diabetic patients were fasting without any adverse events however 15-20% of them were at risk as they continued fasting without checking their blood sugar even when they felt hypoglycemia. Diabetic patients should be counseled about the symptoms of hypoglycemia during fasting and the option for breaking the fast in case of low blood sugar