Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan

To investigate the prevalence of thyroid dysfunction and autoimmunity in type 2 diabetic patients. The study was conducted at the National Center for Diabetes, Endocrinology and Genetics, Jordan University Hospital, Amman, Jordan, between March 2000 and September 2000. A group of 908 type 2 diabetic patients [T2DM] were recruited in the study and underwent investigations for thyroid functions; free thyroxine [FT4], free tri-iodothyronine [FT3] and thyroid stimulating hormone [TSH]. Six hundred had performed thyroid autoantibodies, thyroid peroxidase antibodies [TPOab] or antimicrosomal antibodies [AMA] and thyroglobulin antibodies [Tgab]. They were compared with 304 non-diabetics, of those 282 had performed thyroid antibodies. Fifty-three [5.9%] of diabetic patients were known to have thyroid disease. As a direct result of screening, new thyroid disease cases were diagnosed in 6.6% of the patients. Thus, the overall prevalence of thyroid disease was found to be 12.5%. The most common was subclinical hypothyroidism [4.1%]. In the control group, the prevalence of thyroid disease was 6.6%. The most common was subclinical hypothyroidism [5%]. There was a significant difference between diabetics and control subjects p=0.0064. Positive TPOab was found in 8.3% of T2DM patients [N=600] versus 10.3% in the control group [N=282] p=0.412. Positivity for both TPOab and Tgab was found to be 2.5% of T2DM versus 6% of the control subjects p=0.0155. This study suggests that diabetic patients should be screened for asymptomatic thyroid dysfunction

Prevalence and predictors of diabetic foot syndrome in type 2 diabetes mellitus in Jordan

To detect feet changes and to identify risk factors leading to amputation among type 2 diabetics. A total of 1142 patients with type 2 diabetes mellitus; 595 males [52%], and 547 females [48%] were seen between January and December 2001 at the National Center for Diabetes, Endocrinology, and Genetics [NCDG] Amman, Jordan. The mean age was 56.1 years [SD=10.2] and the mean duration of diabetes was 9 years [SD=7.1]. All patients had a complete medical assessment including history, physical examination, glycosylated hemoglobin [HbA1c] [the mean of the last 4 readings] and microalbuminuria. Statistical analysis were performed to identify significant risk factors leading to amputation using Epi info, version 6 software. Mean HbA1c was 7.4% [SD=1.4]. The prevalence of hypertension was 52%, retinopathy 45% and microalbuminuria 33%. Impaired vibration, position and protective sense were found in 19%, 13%, and 18%. The prevalence of all amputations was 5%. The following were strong predictors of amputation; duration of diabetes [P= 0.04], smoking [P=0.01], microalbuminuria [P=0.02], retinopathy [P=0.008], legs hair loss [P=0.003], neurological deficit [P=0.0001], ulceration [P=0.00001] absent dorsalis pedis [P=0.0006] and insulin therapy [P=0.0001]. The rate of amputation was directly proportional to high HbA1c >= 8% [P=0.01]. Age and gender were not found to have an impact on prevalence of amputation. Prevalence of amputation correlates with duration of diabetes, poor glycemic control, smoking, neurological impairment, peripheral vascular disease and microalbuminuria