Safety of fasting in diabetic and non-diabetic patients with stable chronic kidney disease during Ramadan.

Objective: To assess the safety of fasting in diabetic and non-diabetic patients with stable CKD during Ramadan. Methods: This prospective observational study was conducted at three secondary and tertiary care hospitals of Karachi during the month of Ramadan from 25th March to 7th May 2022. Patients who met the eligibility criteria were assessed pre-Ramadan, and their baseline blood pressure, serum urea, creatinine, electrolytes, uric acid, and estimated glomerular filtration rate (eGFR) were documented and tracked over the course of Ramadan and up to one week post-Ramadan. Deterioration in renal functions (defined as a rise of ≥30% in serum creatinine from the baseline or the decline of ≥25% in eGFR from the baseline) was observed during the month of Ramadan. Results: A total of 68 patients (34 males and 32 females) with the mean age 58.7±12.16 years were included in the study. Out of 66 patients, 38 were diabetic and 28 were non diabetic. Majority 23(34.8%) were stage-3a and 23(34.8%) were stage-4 followed by stage-3b in 14(21.2%), stage-2 in 3(4.5%) and stage-5 in 3(4.5%) patients respectively. Statistically significant improvement in pre and post Ramadan values of systolic and diastolic blood pressure, serum creatinine and uric acid levels were found in both diabetic and non-diabetic group (P value <0.0001). Conclusion: Our study shows no worsening of renal functions in both diabetic and non-diabetic patients with stable CKD who intended to fast.

Unveiling the spectrum: A cross-sectional exploration of hirsutism causes in women.

Background and Objective: Hirsutism is a common endocrine disorder and its etiology varies from benign and idiopathic disorders to serious malignant diseases. Hirsutism creates negative impact on quality of life and considerable effects on fertility. Our objective was to determine the various causes of hirsutism in women presenting at two endocrine clinics. Method: This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology, Karachi and at Jinnah hospital, Lahore from August 2020 to December 2021 women between 12-45 years of age with complains of hirsutism were included in the study. Severity of Hirsutism was evaluated using modified Ferriman-Gallwey score (FG). Patients with modified FG score of 8 or more were considered having hirsutism. Results: The study had 113 patients with a mean age of 15.50+7.29 years with 89% having moderate hirsutism (FG score 16-25). Polycystic ovaries was the most common cause of hirsutism. Common sites for hirsutism included back (83%), arms (74%), buttocks (70%), and upper abdomen (47%). High BMI (p-value <0.01) and high Dehydroepiandrosterone levels were positively associated with the severity of hirsutism (p-value of 0.006.). Conclusion: The various causes of hirsutism identified were polycystic ovaries, followed by idiopathic, thyroid dysfunction, congenital adrenal hyperplasia, and hyperprolactinemia; therefore, all women presenting with hirsutism should be evaluated for potential serious and curable etiologies, before embarking on a treatment plan.

Effect of COVID-19 lockdown on health of women in Pakistan - Socioeconomic perspective.

Objectives: This study investigates the dimensions of women's experiences during the COVID-19 lockdown in Pakistan, considering their historical vulnerability to natural disasters. Methods: A cross-sectional study was conducted in Pakistan from May to September 2020 at Services institute of medical Sciences, Lahore. An online survey collected socio-demographic data, household responsibilities, and access to medical services using a self-designed questionnaire. Women aged 18 years and above (n=1307) were included through convenience sampling. Data analysis utilized SPSS 20.0. Results: Of the surveyed women, 10 (14.9%) experienced improved health outcomes, while 39 (58.27%) faced poor health outcomes. Proper access to medical services was reported by 29 (43.3%) participants, while 38 (57.1%) had no access. Two women (3.0%) conceived during the lockdown. 45 (67.2%) women lived in nuclear families, and 21 (31.3%) in joint family systems. Additionally, 46 (68.7%) women were significantly burdened with household chores, while 21 (31.3%) had a normal routine. Among COVID-19-positive respondents, 70% reported weight gain from increased screen time and sedentary lifestyle. Difficulties in managing children's online classes were reported by 34.6% of participants. Moreover, 84% had a monthly income below one hundred thousand PKR. Among women aged 23-28 years, 30.9% had adverse effect on their husband's income, and 4.7% experienced unemployment. Unfortunately, 16% of respondents lost a relative due to COVID-19. Even with access to health facilities. Conclusion: The COVID-19 lockdown in Pakistan led to adverse socioeconomic and health outcomes for women. These findings highlight the measures needed to address women's challenges amid pandemic impact.

Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan.

Objective: To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital. Methods: This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent. Results: A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years. Conclusion: Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.

Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan.

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group-A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group-B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P-value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.

Frequency of depression among patients with Type-I diabetes in a developing country, Pakistan.

OBJECTIVE: To determine the frequency of depressive symptoms among young people with Type-I diabetes. METHODS: This cross sectional study was conducted at Baqai Institute of Diabetology & Endocrinology, Karachi, Pakistan from February to December 2015. All People aged between 12-20 years with Type-I diabetes for at least 1 year attending the OPD were included in the study. Information about participants' demographic characteristics, co morbidities and Complications, current treatment and medications were obtained. Acylated hemoglobin (HbA1C) levels were checked in all People. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess the depressive symptoms in the study participants. A cut off value of ≥ 16 was used to screen for depression. SPSS 19 was used to analyze the results. RESULTS: Out of 104 people with Type-I diabetes, depressive symptoms were observed in 44 (42.3%) participants. Depressive symptoms were more frequent in females (28/55, 50.9%). Depressed people had more episodes of DKA (11/44, 25%), hypoglycemia (12/44, 27.3%) or hospitalization (7/44, 15.9%) in the last six months which were not statistically significant. CONCLUSION: Depressive symptoms are quite common in people with Type-I diabetes. Health care professionals should consider screening youth with diabetes for depression regularly. Further large scale studies are needed to validate our findings.

Impact of 24-hour helpline service for people with diabetes.

OBJECTIVE: To evaluate the impact and effectiveness of 24-hour helpline service in providing information and educating patients about self-management of diabetes. METHOD: The study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary diabetes care center, Karachi, Pakistan. People with diabetes attending the outpatient department from November 2012 to October 2014 were included in this study. After providing diabetes education, a helpline number was provided for emergency situations. Calls of registered patients were received by diabetes educators stationed at the BIDE around the clock. Data was collected through specially designed interface of HMS (health management system) in which the current complaint of caller and the advice of educator was recorded. RESULT: A total of 4842 calls were received. Out of those, 4268 (88%) were made by Type-2 diabetics and 526 calls (10%) were made by Type-1 diabetics. The average age of patients was 47.6 years. Three seventy-four calls (7.7%) were received with complaint of Hypoglycemia (72-80mg/dl). Six hundred and ninety-eight calls (14.4%) were received with complaint of hyperglycemia (>200mg/dl). Insulin dose was adjusted on 935 calls (19.3%). Calls regarding other special situations such as (insulin handling, technique, medicine information) 2014 (41.6%) were received. CONCLUSION: Station based 24-hour telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self-management of diabetes. It can help in the management of various acute complication of diabetes, thereby preventing unnecessary hospital visits and admission.

Integrating GDM management in public health: Pakistan perspective.

Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

Characteristics of a large cohort of patients with diabetes having at-risk feet and outcomes in patients with foot ulceration referred to a tertiary care diabetes unit.

To identify in a large population cohort the clinical and biochemical characteristics of patients with diabetes at risk of foot ulceration and outcomes in those with foot ulcers. All patients with diabetes attending Baqai Institute of Diabetology and Endocrinology from January 2004 to April 2012 included in the study. Clinical, biochemical and socio-demographic data were collected and patients were categorised into those at no risk of ulceration, at risk of ulceration and those with foot ulcer, according to the University of Texas classification. Patients with foot ulceration followed for their final outcome, that is complete healing, persisted non-healed ulcer, lower extremity amputation, lost to follow-up or death. A total of 18 119 patients with diabetes underwent assessment, 3576 (19·7%) patients defined as at high risk for foot ulceration and 3731 (20·6%) presented with foot ulcer. Age, male gender, hypertension, higher glycated haemoglobin (HbA1c), history of smoking and presence of neuropathy were risk factors (P < 0·000) for foot ulceration. Amputation rate in patients with foot ulceration was significantly related to severity of ulceration at presentation. Preventive foot care practices were followed by 19·02% patients. One thousand eight hundred seventy three (50·2%) patients completely healed, 293 (11%) patients underwent amputation and 397 (10·1%) patients continued to be treated in the foot clinic. All patients with diabetes should be screened for neuropathy to identify those at risk of foot ulceration, as it is the major contributory factor for foot ulceration. The final outcome of foot ulceration was determined by the severity and grade of ulcer at presentation.

Measured versus calculated LDL-cholesterol in subjects with type 2 diabetes.

OBJECTIVE: There is a strong positive association between increased low-density lipoprotein cholesterol (LDL-C) and coronary heart disease (CHD). The accuracy of LDL-C estimation is essential and critically important. The aim of present study was to compare calculated LDL-C with direct homogeneous assay in patients with type 2 diabetes. METHODS: This observational study was carried out at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2011 to December 2013. A total of 9620 patients with type 2 diabetes were included in the study. Fasting blood glucose, total Cholesterol, triglyceride, HDL cholesterol and LDL cholesterol were obtained using standard methods. Calculated LDL-C was obtained by Friedewald formula. RESULTS: Mean difference of measured and calculated LDL-C was found to be -0.25, 6.63 and 46.55 mg/dl at triglyceride levels < 150 mg/dl, 150 - 400 mg/dl and ≥ 400 mg/dl, respectively. The result shows that the difference between measured and calculated LDL-C increases as the triglyceride level increases. CONCLUSIONS: The findings of our study suggested that calculated LDL-C was lower, as compared to measured LDL-C, which may cause misclassifications that may have an impact on therapeutic decisions in patients with diabetes. Calculated LDL-C may depend on triglyceride levels so LDL-C should be measured by direct assay in routine clinical laboratories.

Evaluation of Diabetes Conversation Map™ Education Tools for Diabetes Self-Management Education.

Objective. To evaluate the efficacy of Diabetes Conversation Maps™ education tools for people with type 2 diabetes attending a diabetes self-management education program. Design and methods. This cross-sectional study was conducted with patients with type 2 diabetes who were recruited from Baqai Institute of Diabetology & Endocrinology, a tertiary care diabetes center of Karachi, Pakistan, from May 2010 to June 2011. Groups of 10-12 participants were given a pre-session questionnaire. Four sessions using Diabetes Conversation Maps™ education tools were conducted, and the same questionnaire was then completed again. Results. A total of 172 people (82 males, 90 females, mean age 60 years, average duration of diabetes 15 ± 4 years) participated in the study. Confidence in diabetes self-management: before the sessions, 52.3% of participants believed that the doctor is the most influential person in the management of their type 2 diabetes, whereas after the sessions, 97.1% acknowledged that they were responsible for diabetes self-management. Before, 15% said they knew what to do to manage their diabetes, whereas 75% indicated this after the sessions. Empowerment: before the sessions, 32% said they understood those aspects of their diabetes self-management that were in need of improvement, whereas 75.6% indicated this after the sessions. Willingness, ability, and preparedness for diabetes self-management: before the sessions, 22% said they understood the importance of diabetes self-management; this increased to 63.4% afterward. Before, 20.3% agreed that they will start making changes in their lives, whereas 65.7% agreed with this after the sessions. Satisfaction: 61% found the map sessions very effective, 72.1% found this format to be better than individual education, and 52.8% agreed that map tools helped in goal-setting. Conclusion. Diabetes Conversation Maps™ education tools are effective for diabetes self-management education and facilitating behavior change in people with type 2 diabetes. This, in turn, may improve patients' chances of attaining desirable diabetes control.

Factors associated with non-adherence to insulin in patients with type 1 diabetes.

OBJECTIVES: To find out the various factors associated with non-adherence to diet, physical activity and insulin among patients with type 1 diabetes. (T1DM). METHODS: This cross sectional study was conducted among T1DM subjects attending the Baqai Institute of Diabetology & Endocrinology (BIDE) and Diabetic Association of Pakistan (DAP), from July 2011 to June 2012.Clinical characteristics, anthropometric measurements, knowledge regarding type 1 diabetes along with adherence to dietary advice, physical activity and insulin were noted on a predesigned questionnaire and score was assigned to each question. Patients were categorized as adherent or non-adherent on the basis of scores obtained. Statistical Package for Social Sciences (SPSS) for windows version 17.0 was used to analyze the data. RESULTS: A total of 194 patients (Male 94, Female 100), with mean age of 17.9± 6.4 years, mean duration of diabetes 5.37±4.96 years (38.1% >5 yrs, 61.9% <5 yrs) were included in the study. One hundred and fourteen (58.5%) patients were non adherent to dietary advice, 82(42.3%) non adherent to physical activity while 88.1% respondents were non adherent to their prescribed insulin regimen. Factors associated with non-compliance were family type, occupation & educational level of respondent's parents, duration of T1DM, family history of diabetes, frequency of visits to diabetic clinic, knowledge regarding diabetes, lack of family support and fear of hypoglycemia. CONCLUSION: Non adherence to prescribed treatment regimen in patient with TIDM is quite high. There is need to design strategies to help patients and their family members understand their treatment regimen in order to improve their adherence.

Characteristics and outcome of dengue infection; clinical perspective from a secondary care hospital of Karachi.

OBJECTIVE: To determine the frequency and characteristics of dengue fever (DF) in patients of acute febrile illness presenting at a secondary care hospital. METHODOLOGY: The observational cross sectional study was carried out from May to October 2010 in Remedial Centre Karachi and included patients above the age of 12 years who presented with acute febrile illness. The WHO classification and case definitions were used to classify the disease as Dengue Fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Clinical, hematological and biochemical findings were recorded serially until discharge. RESULTS: During the study period, 90 (34.75%) presented with typical features of DF, 28 (31.11%) were dengue proven, seven (7.7%) proved to be of malaria in which malarial parasites were found positive in the peripheral blood, while the remaining 55 (61.11%) patients were dengue probable. Age of the patients ranged from 13 to 76 years. Fever was the most common clinical presentation (100%) followed by vomiting 50 (55.56%), body ache 31 (34.44%) abdominal pain 17 (18.89%) and headache 9 (10%). Maculopapular rash was seen in 4(4.44%) patients. Laboratory findings included thrombocytopenia, leucopenia and raised alanine aminotransferase levels. Eighty one patients (90%) improved clinically and hematologically and were discharged in stable condition. CONCLUSION: Fever and thrombocytopenia were the most common presentation of dengue fever (DF). The overall mortality of DF is low, if treated appropriately. Awareness of health care professionals and public regarding preventive strategies is essential to fight against this disease.

Linear Growth and Final Height in People With Type 1 Diabetes: A Study From Karachi, Pakistan.

Objective In this study, we aimed to determine the linear growth and final height in children/adolescents with type 1 diabetes mellitus (T1DM) at a tertiary care hospital. Methodology This observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan. All children/adolescents diagnosed with T1DM of either gender aged between 8-18 years visiting the outpatient department of BIDE were included after obtaining informed consent. A predesigned questionnaire was developed to record data. The Centers for Disease Control and Prevention (CDC) growth chart was plotted and growth velocity was checked every six months to observe the linear growth. The final height was compared with the targeted height of the respective participants. Results A total of 66 people participated in the study (24 males and 42 females); among them, the mean age at diagnosis was 11.17 ± 4.77 years, and the duration of diabetes [median (IQR)] at the first visit was one year (0-3). The mean age at menarche was noted to be 13.56 ± 1.41 years. The overall height [standard deviation score (SDS)] at the first visit was -0.62 ± 2.58 and it was -1.34 ± 0.94 at the last visit; the overall weight at the first visit (SDS) and at the last visit was -1.23 ± 2.77 and -1.14 ± 1.25 respectively. Furthermore, the overall mid-parental height was 160.9 5 ± 10.28 cm, and 50% of males and 85.7% of females achieved genetic target height with a significant difference between them (p = 0.002). Conclusion A large number of people with TIDM were not able to achieve their target height. Therefore, it is imperative to monitor metabolic control along with monitoring of growth in young people with T1DM.

Multidimensional impacts of coronavirus pandemic in adolescents in Pakistan: A cross sectional research.

BACKGROUND: COVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents' lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents' everyday lives in Pakistan. METHODS: Following ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic. RESULTS: Among the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6-64.3%). Most of the adolescents (62.0-65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41-51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2-62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5-62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (p<0.05). CONCLUSIONS: Results have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested.

NDSP 06: Prevalence and risk factors for obesity in urban and rural areas of Pakistan: A study from second National Diabetes Survey of Pakistan (NDSP), 2016-2017.

OBJECTIVE: To study the pattern and prevalence of obesity in a large representative sample of Pakistani population aged 20 years and above. METHODOLOGY: This study is a sub analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a large community-based epidemiological survey carried out from February 2016 to August 2017 in all 4 provinces of Pakistan. An estimated sample size of 10,834 people was calculated using a multistage sampling technique. Out of 213 clusters, Twenty-seven clusters were selected from all four provinces of Pakistan. Households were identified and selected members of every 10th household were advised to come to the campsite after an overnight fast. All the study participants underwent anthropometric measurements including height, weight, and waist circumference by using standardized techniques and oral glucose tolerance tests were done. Data were analyzed on the statistical package for social sciences (SPSS), version 20. RESULTS: Overall weighted prevalence of generalized obesity was 57.9% (42% in males and 58% in females) and central obesity 73.1% (37.3% in males and 62.7% in females) as per WHO Asia pacific cutoffs. The highest prevalence of generalized obesity was found in Punjab 60%, followed by Khyber, Pakhtunkhwa 59.2%. Moreever, highest prevalence of abdominal obesity was observed in Baluchistan 82.1%, followed by Punjab 73.3%. Obesity (generalized and abdominal) was found significantly associated with diabetes, hypertension, and dyslipidemia. CONCLUSION: The prevalence of obesity is at epidemic proportions in Pakistan, calling for urgent lifestyle intervention strategies to prevent and manage this important cardiometabolic risk factor.

Assessment of Factors Associated With Non-Compliance to Self-Management Practices in People With Type 2 Diabetes.

Aim and objective Diabetes mellitus is a chronic metabolic disorder that requires continuous self-management practices. The aim of our study is to assess the factors resulting in non-compliance with self-management practices in people with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care center in Karachi, Pakistan, from March 2019 to May 2019. People with T2DM diagnosed for at least six months were included. A predesigned questionnaire was used to assess various components of self-management such as the use of oral hypoglycemic agents (OHAs) and insulin, self-monitoring of blood glucose (SMBG), physical activity, and daily foot care. Certified diabetes educators conducted interviews on a one-to-one basis. Data were entered and analyzed by using SPSS (version 20; IBM Corp., Armonk, NY). Results Better glycated hemoglobin (HbA1c) levels were observed in compliant persons and a statistically significant difference was noted in those who were compliant with insulin use. Good compliance with self-management was observed in people who were given diabetes education previously. A total of 205 people with T2DM were included in the study, with a mean age of 52.66 ± 11.2 years and a mean duration of diabetes of 8.9 ± 7.5 years. There were 62.9% males and 37.1% females. Oral hypoglycemic agents (OHAs) were prescribed to 62.9% while 33.9 % were on both OHAs and insulin. Non-compliance with the intake of OHAs was 33.3%, insulin injection 21%, SMBG 25.7%, physical activity 69.5%, and foot care practice 34.3%. Various reasons identified for non-compliance included forgetfulness (negligence) (88%), fear of hypoglycemia (10.6%), time constraints (48%), and lack of foot care knowledge (84.8%). Conclusion Non-compliance with T2DM self-management is multifactorial and needs continuous reinforcement of structured diabetes education sessions. The study showed that the provision of diabetes education is directly proportional to self-management compliance levels.

NDSP 09: Risk Assessment of Pakistani Individual for Diabetes (RAPID) - Findings from Second National Diabetes Survey of Pakistan (NDSP) 2016-2017.

OBJECTIVE: To elucidate the effectiveness of Risk Assessment of Pakistani individuals with diabetes (RAPID) tool in epidemiological and population-based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 for identifying risk of developing type 2 diabetes. METHODOLOGY: This observational study was a sub-analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016-2017 conducted from February 2016 to August 2017 in all four provinces of Pakistan. Ethical approval was obtained from National Bioethics Committee Pakistan. RAPID score, a validated and published scoring scale to assess risk of diabetes, originally developed from community-based surveys was used. The risk score is assessed by parameters namely: age, waist circumference, and positive family history of diabetes. Subjects with score greater ≥4 were considered at risk of diabetes. RESULTS: A total of 4904 individuals were assessed (2205 males and 2699 females). Mean age of participants was 41.8±14.2 years. Positive family history of diabetes was seen in 1379 (28.1%) people. According to RAPID score 1268 (25.9%) individuals scored ≥4 and were at risk of diabetes. OGTT status of people at risk of diabetes according to RAPID score showed that 18.1% people with diabetes and 29.2% were prediabetic. Whereas, OGTT status of people not at risk of diabetes showed that only 7.6% people with diabetes, 20% were prediabetic. CONCLUSION: A simple diabetes risk score can be used for identification of high-risk individuals for diabetes so that timely intervention can be implemented. Community-based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce risk of diabetes.