ABSTRACT
Introduction Due to normal physiological changes in various anthropometric indices during pregnancy, the routine measurements of body weight, height, waist circumference, and waist-to-hip ratio are deemed inappropriate in predicting obesity and risk of gestational diabetes mellitus in pregnancy. Neck circumference is a novel marker to determine the risk of gestational diabetes in pregnancy. We conducted this study to determine the correlation between neck circumference and gestational diabetes mellitus and its associated risk factors. Methods This was an observational, cross-sectional study conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/ Jinnah Hospital, Lahore from July 2017 to March 2018. Pregnant females at 16 weeks of gestation underwent measurement of weight, height, body mass index, neck, and waist circumference. At the 24th gestational week, an oral glucose test was conducted and fasting lipid profile, serum albumin, and uric acid were measured. Pearson's correlation was used to see any correlation between neck circumference and gestational diabetes and its associated risk factors. Results There were 90 subjects in the study with a mean age 30.8 ± 3.2 (range: 26 - 34) years. The waist and neck circumference at 16 weeks of gestation measured 104.2 ± 9.0 cm and 36.1 ± 2.8 cm, respectively. Age, weight, waist circumference, and body mass index were positively and significantly correlated with neck circumference (p-value < 0.05). After adjusting for age, the correlation between neck circumference and weight, waist circumference, and body mass index (BMI) was statistically significant with a p-value < 0.05. Analysis of the receiver operating curve revealed that the cut-off value of neck circumference for predicting gestational diabetes was 35.70 cm with a sensitivity of 51.4% and specificity of 81.2%. Conclusion Neck circumference at the 16th gestational week is a reliable and valid tool to predict gestational diabetes mellitus at 24 weeks of gestation.
ABSTRACT
Postural hypotension, as a manifestation of autonomic neuropathy is a very sinister long-term debilitating complication of diabetes, is usually irreversible and tough to manage with medications. The treatment of this condition following the standard treatment protocols can be contraindicated in the patients with underlying heart conditions. We report the case of a patient at our hospital who presented with full-blown symptomatic dysautonomia secondary to long-standing diabetes, with bedside testing positive for autonomic dysfunction. Treating this patient with the standard protocol of adrenergic agonist could have worsened his underlying coronary artery disease. So, we moved a step aside to go out of the box and we have a trial of the ß1-selective beta-blocker, with astonishing results and significant improvement in the quality of life and symptoms of postural hypotension. We report here the use of alternative treatment option in managing a patient with severe postural hypotension secondary to diabetes-related autonomic neuropathy when adrenergic drugs are contraindicated.
