Adult anthropometry in Type 2 diabetic population: A case-control study.

OBJECTIVES: This study was aimed to compare the body mass index (BMI) and waist-to-hip ratio (WHR) in their ability to predict type 2 diabetes risk in a large prospective cohort of men and women in Pakistan. METHODS: This was a case-control study conducted at Diabetic and medical OPD of GTTH. Anthropometric measures including BMI and WHR were analyzed. Student's t-test, Chi-squared test along with Cramer's V value, was applied to evaluate association between variables. Receiver operating curve (ROC) was used to assess anthropometric measures. RESULTS: The study included 804 diabetics and 396 non-diabetics between 30-60 years of age. Comparing the BMI parameters it was found that 717 (89.2%) in diabetic group were overweight or obese (p-value < 0.001). On comparing the WHR, 97.9% diabetics had increased WHR (p-value <0.001). Both BMI & WHR were further compared using ROC curve which found out that WHR had an area under ROC of 0.720 & BMI has 0.680, suggesting that WHR is more better predictor of diabetes as compared to BMI. CONCLUSIONS: Both BMI and WHR were strong discriminators of T2DM but WHR was found superior according to ROC value. Family history is significantly associated in patients with diabetes.

Practical implementation of ADA/EASD consensus algorithm in patients with type 2 diabetes in Pakistan.

OBJECTIVE: To ascertain the effectiveness of implementing the American Diabetes Association/European Association for the Study of Diabetes 2009 consensus algorithm in achieving glycaemic control in patients with type 2 diabetes. METHODS: The prospective, observational, open label, product registry was conducted at 38 sites across 7 cities in Pakistan between July 2011 and February 2014. Uncontrolled type 2 diabetes patients were either initiated on or switched to insulin glargine from other basal insulin. Glycated haemoglobin and fasting blood glucose were measured at baseline, 3 and 6 months. RESULTS: Of the 307 patients, 166(54%) were males. At baseline, the overall mean age was 49.5 ± 8.7 years. Mean duration of diabetes was 7.1 ± 4.5 years. Both fasting blood glucose and glycated haemoglobin levels significantly reduced from baseline to 3 months to 6 months (p<0.01). At 6 months, 18(5.8%) patients reported 41 hypoglycaemic episodes of which 19(46.3%) were asymptomatic and 22(53.6%) were symptomatic. No severe hypoglycaemic episodes were reported. CONCLUSIONS: Insulin initiation and titration as per American Diabetes Association/European Association for the Study of Diabetes guidelines helped in achieving glycaemic targets without increasing the risk of hypoglycaemia.

Reduction of microalbuminuria by using losartan in normotensive patients with type 2 diabetes mellitus: A randomized controlled trial.

Type 2 diabetes mellitus (T2DM) is a worldwide pandemic that may lead to diabetic kidney disease (DKD), a complication which is the single most important and globally prevalent cause of chronic kidney disease. Microalbuminuria has been shown to be an early indicator of DKD and data suggest that angiotensin receptor blockers (ARBs) reduce urinary albumin excretion and retard the progression of renal disease in hypertensive T2DM patients. However, the effects of ARBs on preventing microalbuminuria and ensuing DKD in normotensive patients with T2DM is yet to be fully established. The objective of this study is to assess the anti-microalbuminuric effects of losar-tan therapy versus placebo in normotensive T2DM patients. This randomized single blinded controlled trial was performed at the Diabetic Clinic, Jinnah Hospital, Lahore over a period of 10 months. A total of 361 normotensive patients with T2DM and microalbuminuria were selected; of them, 171 patients were randomly allocated to the test group and 190 enrolled into the control group. The patients in the test group were started on losartan 50 mg/day for a six month period while those in the control group were put on vitamin B-12 500 mcg/day. The patients as well as the primary attending phy-sicians/lab evaluators were blinded to the study. All study patients were followed up on a monthly basis. Quantitative microalbuminuria was tested at the beginning and at the end of the study. Out of the 171 patients in the test group, 149 (87.1%) had significant reduction of albuminuria by > 30% of their baseline (mean 101.9 +/- 21.7 baseline and, 47.5 +/- 12.9 post-therapy). The corresponding values for albuminuria in the 190 patients in the control group was mean 104.7 +/- 26.3 baseline and post 6-month mean 103.9 +/- 22.9, with P< 0.0001. The anti-albuminuric effect of losartan was reversible as seen on re-checking the urinary albumin two months after discontinuation of treatment. Our study shows that losartan was well tolerated and demonstrated significant anti-proteinuric effects in patients with T2DM with early nephropathy independent of hypertension.

Foetomaternal outcome of pregnancy with cardiac disease.

INTRODUCTION: To study the prevalence of cardiac disease in pregnancy and to assess the foetomaternal outcomes. METHODS: It was a 5 year descriptive study. All pregnant females with a known or newly diagnosed congenital or acquired cardiac lesion on echo cardiography were included in the study. RESULTS: There were 17,056 births during the study period, of whom 160 were cardiac patients giving a prevalence of 1%. Out of these 36% patients were diagnosed to have cardiac disease during current pregnancy. Acquired valvular heart lesions were found in 132 (82%) patients with mitral stenosis being the commonest (55%), others were congenital. Of the group, 43% patients were in class III & IV according to NYHA. Majority delivered vaginally and only 29% had c/section, 9% had therapeutic termination of pregnancy and 45% babies were low birth weight. Ten babies expired. Maternal mortality was low (3.8%), while 55(35%) had obstetric complications. Poor functional class (III & IV) was the key determinant of adverse footomaternal outcome (p<0.0001). CONCLUSION: The good results of this study can be attrihuted to the team efforts of between obstetricians, cardiologists and patients. Adverse foetomaternal outcome was related to poor functional class III and IV of NYHA.