Clinical features, biochemistry and HLA-DRB1 status in youth-onset type 1 diabetes in Pakistan.

Published information on diabetes in Pakistani youth is limited. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting children and adolescents <22 years of age. The study was conducted at Baqai Institute of Diabetology and Endocrinology in Karachi from June 2013-December 2015. One hundred subjects aged <22 years at diagnosis were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C-peptide, glutamic acid decarboxylase 65 (GAD65) and islet antigen 2 (IA-2) autoantibodies) were measured. DNA from 100 subjects and 200 controls was extracted and genotyped for HLA-DRB1 using high-resolution genotyping technology. Ninety-nine subjects were clinically diagnosed as type 1 diabetes (T1D) and one as type 2 diabetes (T2D). Of the 99 with T1D, 57 (57.6%) were males and 42 (42.4%) females, with mean age at diagnosis 11.0 ±â€¯5.2 years (range 1.6-21.7 years) and peaks at six and fifteen years. Fifty-seven subjects were assessed within one month of diagnosis and all within eleven months. For the subjects diagnosed as T1D, mean C-peptide was 0.63 ±â€¯0.51 nmol/L (1.91 ±â€¯1.53 ng/mL), with 16 (16.2%) IA2 positive, 53 (53.5%) GAD-65 positive, and 10 (10.1%) positive for both autoantibodies. In T1D patients, the allele DRB1*03:01 demonstrated highly significant T1D association (p < 10-16), with no apparent risk conferred by DRB1*04:xx alleles. CONCLUSIONS: Heterogeneous forms of T1D appear more common in children and youth in Pakistan than in European populations. Individual understanding of such cases could enable improved management strategies and healthier outcomes.

Glycemic control, hypertension and chronic complications in type 2 diabetic subjects attending a tertiary care centre.

BACKGROUND: This study was carried out to assess the association of glycemic control and hypertension with chronic complications in type 2 diabetic subjects attending a tertiary care centre in Karachi, Pakistan. METHODS: This was a cross sectional analytical study. First visit of type 2 diabetic subjects to the outpatient department of Baqai Institute of Diabetology and Endocrinology, from September 1996 to December 2001, were analyzed for this study. Sociodemographic attributes and clinical profiles were obtained from the computerized records of these patients retrospectively. Odds ratio with 95% confidence interval were reported for independent variables associated with outcome variables. RESULTS: Records of 2199 subjects (48.5% males, 51.5% females) were analyzed. Mean age of the male and female subjects was 52.2 and 50.6 years respectively. Hypertriglyceridemia [OR: 1.74; 95% CI (1.18-2.57)] and diabetic foot ulcers [OR: 2.32; 95% CI (1.14-4.01)] were significantly associated with poor glycemic control according to HbA1c. Whereas hypertriglyceridemia [OR: 2.39; 95% CI (1.42-4.03)] and hypertension [OR: 1.65; 95% CI (1.13-2.41)] were significantly associated with poor glycemic control according to FPG. Obesity [OR: 1.44; 95% CI (1.18-1.75)], Retinopathy [OR: 1.95; 95% CI (1.49-2.53)], nephropathy [OR: 1.99; 95% CI (1.45-2.75)], neuropathy [OR:1.40; 95% CI (1.15-1.71)] and presence of coronary arterial disease [OR: 1.33; 95% CI (1.02-1.72)] were found to be significantly associated with systolic blood pressure. Obesity [OR:2.07; 95% CI (1.69-2.54)], hyperglycemia [OR: 1.40; 95% CI (1.04-1.90)] and nephropathy [OR: 1.92; 95% CI (1.39-2.64)] had significant association with high diastolic blood pressure. CONCLUSION: In conclusion this study shows the association of chronic complications with glycemic control and hypertension amongst type 2 diabetics in Karachi. This information needs to be verified by multicentred large scale studies in order to be helpful in planning healthcare and treatment strategies.

Comparison of risk factors for diabetes in children of different socioeconomic status.

OBJECTIVE: To compare the risk factors for diabetes in children of two different socioeconomic status. DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: Visits to one government (low income) and two private (middle income) schools of Karachi in 1999 and 2000. PATIENTS AND METHODS: A total of 260 children; 157 children (mean age 12.10 +/- 4 years) from low-income group and 103 children (mean age 10.6 +/- 0.9 years) from middle-income group were surveyed. Data of physical fitness score (PFS) and BMI was calculated. Dietary records were taken by 24 hours self-reported diet recall charts of two weekdays. Knowledge about health was obtained by a questionnaire given to children and mothers. RESULTS: A significant difference was found in the mean age of low-income and middle-income groups (p-value < 0.001). Significant association was seen in low-income group compared to middle-income group on the basis of TV viewing (p-value = 0.04). BMI (p-value = 0.011) and positive family history of diabetes (p-value < 0.001). Forty-seven percent (n=74) of children from low-income group while 51% (n=53) of middle-income group had poor knowledge about health. The children in both the groups also consumed inadequate amount of calories, the diet being poor in fruit, vegetables and milk and high in the fat content. CONCLUSION: Although children in both the groups had increased risk factors for diabetes the difference between the two socioeconomic groups was significant in terms of middle-income children having more risk. Thus, changes in lifestyle and behaviour including diet is needed in this high risk group to prevent future generations from developing diabetes.

Frequency of chronic complications of type II diabetes.

OBJECTIVE: To assess the frequency of chronic complications of type II diabetes in subjects attending a tertiary care unit in Karachi, Pakistan. DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: First visit of all type II diabetic subjects attending the outpatient department of Baqai Institute of Diabetology and Endocrinology from September 1996 to December 2001. SUBJECTS AND METHODS: Computerized clinical records of 2199 type II diabetic subjects were analyzed for this study. The clinical and laboratory variables were statistically evaluated with significance at p. RESULTS: Means of glycosylated hemoglobin HbA1c, fasting and random plasma glucose levels, systolic blood pressure, triglycerides and high density lipoproteins (HDL) were higher than the risk indicator value for both genders (p <0.005). Mean body mass index and total blood cholesterol was higher for females only. Hyperglycemia was present in 88%, high HbA1c in 81%, low HDL in 81%, obesity in 66% and hypertriglyceridemia in 54%, neuropathy in 36%, proteinuria in 28% and hypertension in 50% of the subjects. Frequency of obesity, low HDL and hypertension was higher among females (p < 0.001 in each case). Retinopathy (p<0.05), nephropathy (p<0.005), neuropathy (p<0.005) and foot ulcers (p<0.001) were higher among males. Frequency of obesity was significantly higher among those with shorter duration and in younger group while frequency of other complications was higher among those with longer duration and in the older groups. CONCLUSION: Higher rates of complications were observed compared to previous studies. Certain variables showed significant association with gender and age as described above.