Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study.

OBJECTIVES: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour. METHODS: A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded. RESULTS: A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P < 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%). CONCLUSIONS: Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.

Relationship among fatness, blood lipids, and insulin resistance in Pakistani children.

Observations on associations between fatness and metabolic risks among South-East Asian adults have resulted in devising lower thresholds of body mass index (BMI) for them. Metabolic abnormalities, including type 2 diabetes, are now also appearing in children and are associated with obesity. There has not been much work done to identify indicators of metabolic risks among South Asian children. This study was undertaken to observe the relationship among fatness, blood lipids, and insulin resistance in Pakistani children. Fatness, lipids, and insulin resistance were assessed in 92 middle-class Pakistani school children aged 8-10 years. Height, weight, waist, hips, mid-arm circumference, and triceps skin-fold, measured in school, were used for calculating various indicators of fatness, i.e. BMI, waist hip ratio (WHR), and arm-fat percentage. Fasting blood samples were analyzed for total lipids, triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and insulin levels. Homeostasis model assessment (HOMA) index was calculated to assess insulin resistance. Two separate multiple regression models of various risk indicators (family history, sex, BMI, WHR, arm-fat percentage) showed that only arm-fat percentage had a significant positive association both with insulin levels (b = 2.04, p = 0.044) and LDL (b = 2.11, p = 0.037). Only five children were overweight (BMI-for-age > 85th percentile according to National Center for Health Statistics 2000 reference). Neither overweight children nor those who were in the uppermost tercile of BMI-for-age differed significantly from other children in terms of presence of higher-than-desirable values of lipids or insulin. However, compared to those in the lowest tercile, children who were in the uppermost tercile of armfat percentage had a significantly higher frequency of high blood cholesterol (40% vs 67%, p = 0.027), high LDL (33.3% vs 61.3%, p = 0.026), and markedly higher proportion above average insulin levels (16.7% vs 35.5%, p = 0.083). Arm-fat percentage could be developed as a practical tool for determining the risk status of children. However, further cross-sectional assessments are needed to ascertain accurate relationships among arm-fat percentage, lipid profiles, and insulin resistance in larger and varied groups of children.

Frequency of statin use in type 2 diabetics having macrovascular disease- at a Tertiary Care Hospital of Karachi.

BACKGROUND: During the last two decades with the introduction of statins large reductions in cholesterol concentrations were easily and safely achievable and this led to studies that demonstrated benefits of statin use. But only fewer than one fourth of adults with coronary heart disease were receiving lipid-lowering drugs in a cross sectional health survey done in England. Thus this study was designed to evaluate the frequency of statin use in type 2 Pakistani diabetic subjects with macrovascular disease attending a tertiary care unit in Karachi, Pakistan. METHODS: Records of type 2 diabetic subjects coming to the outpatient department of Baqai Institute of Diabetology and Endocrinology from September 1996 to December 2001 was analyzed for their anthropometric and biochemical characteristics. Patients having any macrovascular disease were identified and frequency of statin use by these subjects was studied. RESULTS: Out of a total of 2152 patients 502 (252 males, 250 females) having macrovascular disease were identified. Only 16.5% of them (44 males, 39 females) were taking statins. Use of statins was higher amongst those who had angina (20%) or myocardial infarction (17%) compared to those who had stroke (10%). Sixty two percent of the users while 52% of the non-users had elevated blood cholesterol. CONCLUSION: Frequency of statin use in the subjects studied was much lower than was warranted with respect to their disease status. Presence of elevated blood cholesterol despite using statins suggested inappropriate treatment in these subjects. Further studies are required to identify the factors leading to low use of statins in type 2 diabetic subjects with macrovascular symptoms.

Fatness, lipids, insulin sensitivity, and life style of children from high and low risk families.

BACKGROUND: Children show variation in certain diabetes related risk factors according to the family history. Early detection of high risk groups could prevent or delay the onset of diabetes. Insulin level and fatness of Pakistani children has never been compared according to family history. This study was designed to observe the differences in insulin sensitivity, lipids and fatness in children from high and low risk families. METHODS: Two groups of 8-10 year old school children were assessed for the differences in insulin sensitivity, lipids, fatness, food and activity habits. The first group had no family history for diabetes (low risk group, n = 40) in any first or second degree relative. The second group had positive family history of diabetes (high risk group n = 40) Data were collected through questionnaire sent to parents and children's interview. Blood test and anthropometric assessments were done at the schools by a physician. RESULTS: The two groups of children had similar level of insulin sensitivity. Children having positive family history for diabetes had markedly higher mean values for BMI, and arm fat % as compared to the controls. Though the low risk group had markedly higher level of total lipids and triglycerides the high risk group had markedly lower HDL and significantly higher LDL (p = 0.008) and HDL-LDL (p = 0.009) ratio than the low risk group. There was no significant difference in food and activity habits of the two groups. CONCLUSION: Marked variations in lipid profile of children from high and low risk families are evident at an early age. Presence of these differences in the absence of differences in food and activity habits and insulin sensitivity suggests that variation in lipid storage and metabolism could precede the appearance of reduced insulin sensitivity in children from high-risk families. Measures to control excessive fat deposition in childhood could be an initial step towards the prevention of diabetes and heart disease in adult life.