Characteristics and Ramadan-specific diabetes education trends of patients with diabetes (CARE): a multinational survey (2014).

AIMS: To observe characteristics of fasting patients, trends of Ramadan-specific diabetes education and implementation of diabetes management recommendations in patients with diabetes during Ramadan. METHODOLOGY: This observational study was conducted in seven countries. Patients were recruited in the study immediately after the end of Ramadan (August 2014) until December 2014. Standardized questionnaire-based, face-to-face interview conducted on one-to-one basis. An identical questionnaire used in each country. RESULTS: A total of 6610 patients with diabetes participated in the survey. Ramadan-specific diabetes education was received by 3142 (47.5%) patients, drug dosage and timings altered in 4371 (66.1%) patients and dietary advice received by 4636 (70.1%) patients with diabetes before Ramadan. Severe hypoglycaemia observed in 29 (1.0%) patients and severe hyperglycaemia noticed in 44 (1.7%) patients with diabetes during Ramadan. Patients who received Ramadan-specific diabetes education before Ramadan were significantly better (p < 0.0001) in following Ramadan-specific diabetes management recommendations during Ramadan. On further analysis, patients who received Ramadan-specific diabetes education through any mode i.e. one to one session, group session or written education material were found to be significantly better (p < 0.05) in following Ramadan-specific diabetes management recommendations during Ramadan compared with patients who did not receive education. CONCLUSION: It was observed that patients who received Ramadan-specific diabetes education followed Ramadan-specific diabetes management recommendations better compared with patients who did not receive education. Ramadan-specific diabetes management recommendations are still not completely implemented.

Ramadan Prospective Diabetes Study: the role of drug dosage and timing alteration, active glucose monitoring and patient education.

AIMS: To observe the effects of active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education in the occurrence of acute diabetic complications in fasting individuals with diabetes during the month of Ramadan. METHODS: This prospective study was conducted at the outpatient department of the Baqai Institute of Diabetology and Endocrinology. Two educational sessions, one about drug dosage and timing alteration and glucose monitoring, and the other about dietary and lifestyle modifications, were given to the patients by a doctor and a dietician, respectively. Patients who had been recruited were advised to note their blood glucose readings on a chart for at least 15 fasting days, twice a day with at least one reading in the fasting state. RESULTS: A total of 3946 readings were obtained in 110 subjects; 82 readings were in the hypoglycaemic range, and there were 22 episodes of symptomatic hypoglycaemia and 60 episodes of biochemical hypoglycaemia observed in 27 patients. Seven patients experienced symptomatic hypoglycaemia, whereas 20 patients had biochemical hypoglycaemia. Symptomatic hypoglycaemic episodes showed a downward trend from weeks 1 to 4. The highest frequencies of hypo- and hyperglycaemic episodes were observed pre-dawn. None of the patients developed diabetic ketoacidosis or hyperglycaemic hyperosmolar state. CONCLUSION: We observed that, with active glucose monitoring, alteration of drug dosage and timing, dietary counselling and patient education, the majority of the patients did not have any serious acute complications of diabetes during Ramadan.

The personal cost of diabetic foot disease in the developing world--a study from Pakistan.

AIMS: The aim of the present study was to estimate the direct cost of treatment of diabetic foot ulcer at a tertiary care hospital in Karachi, Pakistan in order to assess the extent of the economic burden which it imposes. METHODS: Out of 383 patients seen at Foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), records of 214 patients were analyzed while 169 patients left against medical advice (LAMA). The UT system was used to classify ulcer types. Information was retrieved on resource consumption (physician services, chiropody, investigations, medicines, hospital care and surgical procedures). Interventions were summed and multiplied by the unit price of each resource, using charges levied at BIDE in the year 2005, in order to calculate the total cost of treatment. RESULTS: 64% were male, with mean age 52.7 +/- 10.2 years. Mean duration of diabetes was 16.2 +/- 6.6 years. Majority (62.1%) were Grade 2 ulcer. The estimated direct cost of management increased from 2700 +/- 250 rupees (21 +/- 2 pounds) for a UT grade 1, stage B ulcer to 37,415 +/- 24,125 rupees (288 +/- 186 pounds) for UT grade 2, stage D and 49,058 +/- 30,144 rupees (378 +/- 232 pounds) for UT grade 3, stage D ulcers, respectively. The mean direct cost of major amputation (transtibial or transfemoral) was 46,182 +/- 30,742 ( 356 +/- 237 pounds) whilst the cost of a minor amputation was 50,494 +/- 30,488 rupees (389 +/- 235 pounds). CONCLUSIONS: This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.

Efficacy of Dongsulin (rDNA human insulin) in a normal clinical practice setting.

The aim of this study was to evaluate the effectiveness ofDongsulin (rDNA, insulin) in maintaining HbA1c level in a normal clinical practice setting and secondly to assess weight gain, episodes of hypoglycaemia, insulin dose change and its safety. Fifty two diabetic patients already on human insulin (rDNA) were enrolled to a 12 week of treatment. Patients with HbA1c level between 6-8% were switched to Dongsulin on same dosage. The compliance of the patient regarding dietary pattern, physical activity and insulin dosages were assessed. HbA1c was checked after 12 weeks. Patient known to have either of the noncompliance factors during the study period were grouped as group B (non compliant) while, patients who were compliant were grouped as group A (compliant). Thirty nine patients completed the study. No significant difference was found between the HbA1c of two visits in group A (p = 0.32) while, HbA1c in group B was significantly raised as compared to first visit (p = 0.000). In group B patients missed the doses, changes in their diets and decreased their physical activity significantly. The mean insulin dose and weight of the patient remained the same in both groups. No major episode of hypoglycemia was observed. This study has shown that patients who remained compliant during the study period, switched over to Dongsulin had no significant change in the glycaemic control as measured by HbA1c.

Renal carcinoma presenting as cardiac tamponade: a case report and review of literature.

Pericardial involvement in an advanced malignancy is common but malignancy presenting as cardiac tamponade is rather uncommon. Review of English literature using Medline CD ROM revealed 131 cases since 1935, who have presented with this life threatening emergency. Lung is the most common primary site followed by lymphomas and leukemias. We report a case of transitional cell carcinoma of kidney presenting as cardiac tamponade. Such a presentation of transitional cell carcinoma of kidney has never been reported.