Risk stratification of persons on premixed insulin in Ramadan.

The International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance, has recently published practical guidelines on the management of diabetes and Ramadan .The risk stratification categorizes all persons wishing to fast into three groups, based upon potential risk. In spite of evidence to the contrary, all persons using premixed insulin are categorized as having high risk. In this article, we present data from randomized controlled trials, and discuss the placement of premixed insulin in the risk stratification framework.

South Asian consensus guideline: Use of GLP-1 receptor agonists during Ramadan: Update 2016 Revised Guidelines on the use of GLP-1A in Ramadan.

This guidance is an update to the South Asian Consensus Guideline: Use of GLP1RA in Diabetes during Ramadan, published in the Indian Journal of Endocrinology and Metabolism in 2012. A five country working group has collated evidence and experience to suggest guidelines for the safe and rational use of glucagon-like peptide1 receptor agonists during Ramadan. The suggestions contained herewith are based upon recently published evidence as well as available basic pharmacological data.

Update to South Asian consensus guideline: Use of newer insulins in diabetes during Ramadan Revised Guidelines on the use of insulin in Ramadan.

This guidance is an update to the South Asian Consensus Guideline: Use of Insulin in Diabetes during Ramadan, published in the Indian Journal of Endocrinology and Metabolism in 2012. A five country working group has collated evidence and experience to suggest guidelines for the safe and rational use of insulin degludec (IDeg) and insulin degludec aspart (IDegAsp) during Ramadan. The suggestions contained herewith are based on the pharmacokinetic and pharmacodynamics properties of these novel insulins.

Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. METHODS: This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. RESULTS: We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. CONCLUSION: EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.

Microvascular complications and their associated risk factors in type 2 diabetes mellitus.

AIMS: The aim of this study was to determine the prevalence of microvascular complications and to identify the various risk factors related to these complications in subjects with diabetes. MATERIALS AND METHODS: The study was cross-sectional and conducted in Outdoor of BIRDEM, from July 2014 to December 2014. Subjects were considered at age 30 to 60 years and duration of diabetes was 2-10 years. Investigations included socio-demographic, anthropometry and blood pressure. Blood samples were collected for HbA1c, fasting plasma glucose (FBG), 2-h after breakfast (2-hBG), total cholesterol (chol), triglyceride (TG), LDL, HDL, Hb% and serum creatinine. All the complications were taken from the medical record books which was diagnosed by physician. RESULTS: A total of 400 type 2 diabetes mellitus patients were investigated in this study. The mean and SD of age was 50.05±7.54. The male and female subjects were 41.5% and 58.5% respectively. The prevalence of diabetic retinopathy, nephropathy, neuropathy was 12.3%, 21.3% and 16.8% respectively. Logistic regression model estimated that increasing age (age>50y; OR=3.04; p=<0.001), female participants (OR=1.35; p=<0.04), rural patients (OR=3.75; p=<0.001), housewife (OR=1.89; p=<0.01) and retired patients (2.50; p=<0.03), lack of physical exercise, increasing HbA1c (p=<0.001), FBG (p=<0.001), 2-hBG (<0.001) and blood pressure (p=0.000) had independent significant risk factors for any of three microvascular complications. CONCLUSION: This study observed that about all the microvascular complications were developed from first three years after registration at BIRDEM. Increasing age, HbA1c, FBG, 2-hBG and blood pressure had significant risk factors for any type of microvascular complications.

Neck Circumference as a Marker of Overweight and Obesity and Cutoff Values for Bangladeshi Adults.

OBJECTIVE: There are several methods of assessing overweight and obesity. Several studies conducted in different populations indicate that neck circumference (NC) can be used as a simple measure of overweight and obesity. This study was conducted to evaluate NC as a marker of overweight and obesity and to determine respective cutoff values for Bangladeshi male and female participants. RESEARCH DESIGN/MATERIALS AND METHODS: This cross-sectional observational study was conducted with during July 2013-June 2014 among randomly selected 871 Bangladeshi participants (male = 496 [56.9%], female = 375 [43.1%], aged >18 years) who visited Outpatient Department of United Hospital, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders, primary health-care centers located in Dhaka, Savar, Gazipur. NC of participants was taken in centimeter to the nearest 1 mm, using plastic tape measure. Main outcome included NC, waist circumferences (WC), body mass index (BMI), and waist: hip ratio (WHR). RESULTS: Pearson's correlation coefficients indicated a significant association between NC and height (men, r = 0.33; women, r = 0.28; P < 0.0001), weight (men, r = 0.61; women, r = 0.55; P < 0.0001), BMI (men, r = 0.51; women, r = 0.41; P < 0.0001), WC (men, r = 0.61; women, r = 0.46; P < 0.0001), hip circumference (men, r = 0.61; women, r = 0.44; P < 0.0001), WHR (men, r = 0.22; women, r = 0.18; P < 0.0001). Receiver operating characteristic curve analysis showed that NC ≥34.75 cm in men (area under curve [AUC]: 0.77; P < 0.001) and ≥31.75 cm in women (AUC: 0.62; P < 0.001) were the best cutoff value for BMI ≥23 (overweight). NC ≥35.25 cm in men (AUC: 0.82; P < 0.001) and NC ≥34.25 cm in women (AUC: 0.76; P < 0.001) were the best cutoff value for BMI ≥27.5 (obesity). NC ≥35.25 cm in male (AUC: 0.83; P < 0.001) and NC ≥31.25 cm in women (AUC: 0.65; P < 0.001) were the best cutoff value for WC >90 cm in men and > 80 cm in women, respectively. NC ≥34.45 cm in male (AUC: 0.59; P = 0.001) and NC ≥31.25 cm in women (AUC: 0.66; P = 0.008) were the best cutoff value for WHR >0.9 in men and >0.8 in women, respectively. CONCLUSION: NC measurement is a simple, convenient, inexpensive screening measure to identify overweight and obese participants. Men with NC ≥34.75 cm and women with NC ≥31.75 cm are to be considered overweight while men with NC ≥35.25 cm and women with NC ≥34.25 cm are to be considered obese. NC ≥35.25 cm in male and NC ≥31.25 cm in women were the best cutoff value for abdominal obesity.

Choice of Insulin in Type 2 Diabetes: A Southeast Asian Perspective.

Southeast Asia faces a diabetes epidemic, which has created significant challenges for health care. The unique Asian diabetes phenotype, coupled with peculiar lifestyle, diet, and healthcare-seeking behavior, makes it imperative to develop clinical pathways and guidelines which address local needs and requirements. From an insulin-centric viewpoint, the preparations prescribed in such pathways should be effective, safe, well tolerated, nonintrusive, and suitable for the use in multiple clinical situations including initiation and intensification. This brief communication describes the utility of premixed or dual action insulin in such clinical pathways and guidelines.

Diabetes and Anemia: International Diabetes Federation (IDF) - Southeast Asian Region (SEAR) position statement.

Anemia is often associated with diabetes mellitus and is known to intensify the risk of developing diabetes-related microvascular and macrovascular complications. There is paucity in understanding of co-existence of these conditions, especially in Southeast Asian countries. Iron and/or erythropoietin deficiencies are the major causes of anemia in diabetes, and diabetic kidney disease plays a key role. Patients with diabetes need to be screened for anemia along with other risk factors and anemia should be corrected appropriately to improve overall clinical outcomes. This position statement aims to provide a comprehensive overview and an algorithm for appropriate management of anemia in patients with diabetes.

Bangladesh national guidelines on the management of tuberculosis and diabetes mellitus co-morbidity (summary).

Tuberculosis (TB) and diabetes mellitus (DM) have synergetic relationship. People with diabetes are 2-3 times at higher risk of getting active TB disease. On the other hand, TB or anti-TB treatment may cause glucose intolerance. The dual disease of DM and TB is more likely to be associated with atypical disease presentation, higher probability of treatment failure and complications. In most of the health-care delivery systems of the world, DM and TB are managed separately by two vertical health-care delivery programs in spite of clear interaction between the two diseases. Thus, there should be a uniform management service for TB-DM co-morbidity. Realizing this situation, Bangladesh Diabetic Samity (BADAS), a nonprofit, nongovernment organization for the management of diabetes in Bangladesh, with the patronization of TB CARE II Project funded by U.S. Agency for International Development (USAID), launched a project in 2013 titled BADAS-USAID TB Care II, Bangladesh with the goal of "Integrated approach to increase access to TB services for diabetic patients." One of the project objective and activity was to develop a national guideline for the management of TB-DM comorbidity. Thus, under the guidance of National Tuberculosis Control Program, of the Directorate General of Health Services, Government of the People's Republic of Bangladesh and World Health Organization (WHO), this guideline was developed in 2014. It is based on the existing "National Guidelines and Operational Manual for TB Control" (5th edition) and guidelines for management of DM as per WHO and International Diabetes Federations. Along with that, expert opinions from public health experts and clinicians and "Medline"-searched literature were used to develop the guidelines. These guidelines illustrate the atypical presentation of the TB-DM co-morbidity, recommendations for screening, treatment, and follow-up of these patients and also recommendations in case of management of TB in patients with kidney and liver diseases. Thus, these guidelines will be a comprehensive tool for physicians to manage TB in diabetic patients.

Comparison of National/Regional Diabetes Guidelines for the Management of Blood Glucose Control in non-Western Countries.

INTRODUCTION: Development of higher standards for diabetes care is a core element of coping with the global diabetes epidemic. Diabetes guidelines are part of the approach to raising standards. The epidemic is greatest in countries with recent rises in income from a low base. The objective of the current study was to investigate the availability and nature of locally produced diabetes guidelines in such countries. METHODS: Searches were conducted using Medline, Google, and health ministry and diabetes association websites. RESULTS: Guidelines were identified in 33 of 75 countries outside North America, western Europe, and Australasia. In 25 of these 33 countries, management strategies for type 1 diabetes were included. National guidelines relied heavily on pre-existing national and international guidelines, with reference to American Diabetes Association standards of medical care and/or other consensus statements by 55%, International Diabetes Federation by 36%, European Association for the Study of Diabetes by 12%, and American Association of Clinical Endocrinologists by 9%. The identified guidelines were generally evidence-based, though there was some use of secondary evidence reviews, including other guidelines, rather than original literature reviews and evidence synthesis. In type 1 diabetes guidelines, the option of different insulin regimens (mostly meal-time + basal or premix regimens) was recommended depending on patient need. Type 2 diabetes guidelines either recommended a glycosylated hemoglobin target of <7.0% (<53 mmol/mol) (70% of guidelines) or <6.5% (<47 mmol/mol) (30% of guidelines) as the ideal glycemic target. Most guidelines recommended a target fasting plasma glucose that fell within the range of 3.8-7.2 mmol/L. Most guidelines also set a 2-h post-prandial glucose target value within the range of 4.0-8.3 mmol/L. CONCLUSION: While only a first step in achieving a high quality of disease management, national guidelines of quality and with fair consistency of recommendations are becoming prevalent globally. A further challenge is implementation of guidelines, by integration into local care processes.

Safety and effectiveness of biphasic insulin aspart 30 in a Bangladeshi subgroup of type 2 diabetic patients switched from biphasic human insulin 30: a sub-analysis of the A1chieve study.

AIM: To determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) therapy in Bangladeshi type 2 diabetes (T2D) patients switched from biphasic human insulin (BHI) as a sub-analysis of the A1chieve study. METHODS: Bangladeshi patients switched from BHI to BIAsp 30 at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia. Secondary outcomes comprised changes from baseline to Week 24 in the number of hypoglycaemic events, glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), systolic blood pressure and body weight. Quality of life (QoL) was evaluated at baseline and Week 24 using the EQ-5D questionnaire. RESULTS: A total of 82 patients (mean age ± SD: 52.3 ± 12.2 years; body mass index: 25.6 ± 3.3 kg/m(2)) with a mean diabetes duration of 9.5 ± 5.5 years and mean duration on insulin of 2.5 ± 2.4 years were included. The mean BIAsp 30 dose was 0.49 ± 0.20 U/kg at baseline and 0.47 ± 0.17 U/kg at Week 24. No SADRs were reported. No events of hypoglycaemia (overall, major, minor or nocturnal) were reported at Week 24. Mean HbA1c, FPG and PPPG levels improved by -2.5 ± 1.3%, -65.0 ± 31.8 mg/dL and -119.3 ± 48.7 mg/dL, respectively, over 24 weeks. QoL also improved (mean change from baseline: +28.5 ± 12.9 points). CONCLUSION: Switching from BHI to BIAsp 30 therapy improved blood glucose control and was well-tolerated in this Bangladeshi subgroup.