RESUMO
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
RESUMO
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
RESUMO
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