Assessment of Achievement of American Diabetes Association (ADA) Targets in Patients with Type 2 Diabetes Mellitus at a Tertiary Care Centre in Eastern Nepal.

BACKGROUND: Management of type 2 diabetes is not limited to blood glucose control, it also addresses blood pressure and lipid levels in order to prevent associated vascular complications and improve the chances of survival and quality-of-life. Although the American Diabetes Association (ADA) has lain specific target levels for glycated hemoglobin, blood pressure and serum low density cholesterol to be achieved by non-pregnant patients with type 2 diabetes mellitus, these are not being achieved in practice. We took on this study to describe the extent of ADA target achievement at our center. METHODS: We analyzed data of type 2 diabetes patients who attended the endocrinology clinic at our hospital within the past 1 year from the start of the study. Data of the pregnant women and patients with mentions of conditions that might interfere with measurement of HbA1c were excluded. RESULTS: We analyzed 336 records, 45.8% (n=154) males and 54.16% (n=182) females. The mean age of patients was 52.28±11.9 years. The percentages of patients who had HbA1c <7%, blood pressure <140/90 mm of Hg, and LDL-c <100 mg/dL were 56.5%, 72%, and 56.3%, respectively. Only 37.8% of patients were found to have achieved all three ADA targets. Our findings show that a higher percentage of patients who were ≥50 years of age met LDL-c goals as compared to those <50 years of age, 61.9% vs 49% (P<0.05) and that blood pressure control was better among younger age group, 78.9% vs 66.7% (P<0.05). CONCLUSION: Our study highlights that a significant proportion of patients missed on achieving the ADA targets. This is worrisome and further studies should be done to find out possible reasons behind this.

Association between vitamin D deficiency and depression in Nepalese population.

Recent studies link vitamin D deficiency with depression; however evidences from the Nepalese population are scarce. The current study explored the association between vitamin D deficiency and depression among 300 adults of 18 years and above age residing in eastern Nepal. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms and a BDI cutoff score of ≥20 was considered as clinically significant depression. Sociodemographic data were collected using semi-structured questionnaire. Blood samples were collected to measure serum 25­hydroxy vitamin D (25(OH)D) and classify vitamin D status (deficient, insufficient and sufficient). We used Chi-square test to identify the association of sociodemographic variables and vitamin D status with clinically significant depression. We found a significant association of gender, geographical location of residence, marital status, religion and vitamin D status with clinically significant depression. Binary logistic regression model was used to examine the likelihood of clinically significant depression among vitamin D deficient individuals. Vitamin D deficiency was significantly associated with increased odds of clinically significant depression even after adjusting for confounding variables. This finding suggests Vitamin D deficient people have increased odds of having clinically significant depression.

Thyroid function and urinary iodine status in primary school age children of the hills and the plains of Eastern Nepal.

The aim of this study is to find out the iodine nutrition and thyroid function status of the school age children of Sunsari and Dhankuta districts. A total of 386 urine and 142 blood samples were randomly collected from four schools of above districts to estimate urinary iodine and thyroid hormones, respectively. Median UIE of Dhankuta and Sunsari were 238.00 ug/L and 294.96 ug/L respectively. Relatively higher percentage (31.8%) of subclinical hypothyroid cases was found in Sunsari than Dhankuta (29.59%).

Iodine deficiency disorders among primary school children in eastern Nepal.

OBJECTIVE: To assess the iodine status among primary school children of Dhankuta and Dharan in eastern Nepal. METHODS: A population based cross sectional study was conducted on schools of Dhankuta and Dharan from January-March 2008. 385 samples of both urine and salt were collected from school children aged 6-11 yrs. Urinary iodine excretion (UIE) was measured in casual urine samples by the ammonium-persulphate digestion microplate (APDM) method and salt iodine content by using a semi quantitative rapid test kit. RESULTS: The median UIEs of school children of Dhankuta and Dharan were 157.1 µg/L and 180.3 µg/L respectively. The percentage of iodine deficient (UIE <100 µg/L) children were 26.6% in Dhankuta and 15.6% in Dharan. The majority of children consumed packet salt. The percentages of salt samples with adequately iodized salt (≥ 15 ppm) were 81.3% in Dhankuta and 89.6% in Dharan. CONCLUSIONS: Eastern Nepal is continuously progressing towards the sustainable elimination of iodine deficiency disease as illustrated by a normal median UIE and the majority of households consuming adequately iodized packet salt. It is necessary to maintain the program continuously to ensure adequate iodine nutrition of the population.