Glucose-dependent insulin-releasing peptide [GIP] in patients with type 2 diabetes mellitus with and without autonomic neuropathy

This study was conducted to investigate the role of glucose-dependent insulin-releasing peptide or gastric inhibitory polypepetide [GIP] in the control of glycemic state in patients with type 2 diabetes mellitus in the presence and absence of autonomic neuropathy. Twenty patients with type 2 jiabetes mellitus and 10 healthy normal subjects were studied. The diabetic patients were divided into 2 equal groups: one group with autonomic neuropathy [AN] and the other without AN according to cardiovascular autonomic function tests. Patients and controls were subjected to clinical examination and determination of HbA[1c]%, fasting blood sugar and basal insulin level. One-hour after ingestion of standard mixed meal [50 gm carbohydrate and 8% amino acid in 400 ml water] blood samples were collected for determination of glucose, insulin, and GIP plasma levels. Insulin resistance index was calculated from the homeostasis model assessment equation [HOMA]. A significantly impaired postprandial GIP and insulin levels as well as their responses to the ingestion of the mixed meal in the type 2 diabetics with AN was observed compared to those without AN. Postprandial GIP level was found to be correlated negatively with postprandial glucose level [r=-0.54] and positively with postprandial insulin level [r=-0.45], P < 0.05 for all diabetic patients. In diabetic patients with AN, significant -negative correlations were detected between duration of diabetes and postprandial GIP level [r= -0.66], absolute GIP response [r= -0.74], as well as% GIP response [r=- 0.71] [P < /= 0.05 for all.]. GIP plays an important role in the physiologic control of postprandial glucose homeostasis. GIP responses were lower in the diabetics as a group compared with healthy subjects despite similar basal levels. Moreover, In diabetic patients with autonomic neuropathy, there was a delayed and impaired GIP response to the mixed meal. Their absolute and% GIP responses were significantly lower than those of control subjects and patients without autonomic neuropathy

Quality assessment of primary health care services provided for diabetes mellitus control in Alexandria

The present study was conducted aiming at: assessment of the quality of primary health care [PHC] services provided for the control of diabetes mellitus [DM] in Alexandria; and opportunistic screening of high risk individuals attending PHC facilities for DM. Accordingly, the availability of human and non-human resources for DM control in two r h and two urban PHC centers in Alexandria [one of them was sewing a desert area] was assessed by a pre-designed checklist 920 adult PHC attendants were screened for risk factors of DM. Individuals having more than one of the following risk factors: age above 50 years, overweight [body mass index >27 kg/m2], family history of DM in first degree relatives, history of hypertension, hypertension [systolic blood pressure >140 mm Hg and /or diastolic blood pressure >90 mm Hg], history of hyperlipidemia and history of gestational diabetes or birth of a large sized baby in females- were subjected to random capillary blood glucose [RCBG] testing. Cases were considered likely diabetic if RCBG was >200 mg/dl. The performance of all PHC physicians examining and managing 560 diabetic patients was observed over a period of two months. One fourth of the diabetic cases were checked for the level of glycaemic control by fasting capillary blood glucose testing

role of primary health care in patient education for diabetes control

The aim of the present work was to study the role of primary health care [PHC] in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all PHC physicians [88] and nurses [104] working in 2 rural health centers and 2 randomly chosen urban health centers of Alexandria Governorate were assessed by a pre-designed self-administered questionnaire. All diabetic patients [560] over 20 years of age attending the study health facilities over a period of 2 months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. It may be concluded that there is a serious gap in the provision of basic education services to the majority of diabetic patients attending PHC facilities in Alexandria