Diabetes and Ramadan: an update on use of glycemic therapies during fasting

The fasting of Ramadan is observed by a large proportion of Muslims with diabetes. Recommendations for the management of diabetes during Ramadan were last published in 2005 by the American Diabetes Association. Several studies in this field have since been published, some addressing the use of new pharmacological agents in managing diabetes during Ramadan. The incritin memetics are potentially safe during Ramadan; the DPP4 inhibitors vildagliptin and sitagliptin provide an effective and safe therapeutic option, administered either alone or in combination with metformin or sulfonylureas. There are no published studies on the use of GLP-1 receptor agonists during Ramadan. Among the sulfonylureas, gliclazide MR [modified release] and glimepride can be safely used during Ramadan, but glibenclamide should be avoided due to the associated risk of hypoglycemia. In selected patients with type 1 and type 2 diabetes, the long-acting insulin analogues glargine and detemir, as well as the premixed insulin analogues, can be used with minimal risk of metabolic derangement or hypoglycemia; the risk is higher in type 1 diabetes. Insulin pumps can potentially empower patients with diabetes and enable safe fasting during the month of Ramadan. Further clinical trials are needed to evaluate the safety and efficacy of new antidiabetic agents and new diabetes-related technologies during Ramadan

Where do we stand? baseline data of Soba University Hospital diabetes clinic population

Soba university hospital recently started structuring diabetes care in the newly established diabetes clinic, the diabetes clinic population is progressively increasing, and the diabetes services are undergoing reform and improvements. We set to collect baseline data about the clinic population to inform clinic improvement process. To collect descriptive data about Soba clinic diabetes population and to determine where we stand compared to published international diabetes control targets and identify priorities for service improvement. One hundred and sixty-two records were randomly selected from the total of 550 records of Soba diabetes clinic population. The following information were extracted; age, gender, weight, BMI, systolic and diastolic BP, HbAlc, and lipid data. We compared variable against the recommendations of the American diabetes association [ADA]. Seventy-six percent of clinic population were female, 82% with type2DM and 4.3% with typelDM, 13.7% missing data, age 51 +/- 0.93 years, weight 75 +/- 0.26 Kg, BMI 27.6 +/- 5.3, HbAlC 8.3 +/- 1.7%, Systolic BP 127 +/- 1.4 mmHg, diastolic BP 76 +/- 0.76 mmHg, total cholesterol 172.2 +/- 0.69 mg/dL, LDL 119.0 +/- 0.68 mg/dL, TGs 126.9 +/- 1.06 mg/dL, HDL 46.7 +/- 1.3 mg/dL. The majority of our patient failed to achieve glycaemic, BP and lipid targets. Our findings indicate major challenges ahead; the majority of patients are not achieving the desired glycaemia, blood pressure and lipid target and the number of missing data is unacceptably high

[Abu-Najma] Syndrome: exogenous steroid induced Cushing's with serious consequences. A report of two cases

We describe and report two cases of what we called Abu-Najma Syndrome, caused by the ingestion of 'Abu-Najma' tablets: dexamethasone containing tablets promoted as [beauty tablets]. We believe the use of Abu-Najma is fast spreading among young ladies in Sudan. The syndrome has very serious consequences; a concerted effort is required to increase public awareness and prevent the problem. The commonest cause for Cushing's syndrome as well as secondary adrenal failure is the use of exogenous steroids. In this setting steroids are almost always prescribed for treatment of a medical condition. Side effects are usually discussed with the patients beforehand. However, self medication with steroids for non-medical reasons puts patients at increased risk of side effects. The use of steroid containing preparation either topical or oral for cosmetic reasons is on the increase. The following case histories illustrate the dangers associated with such a practice