RESUMO
Objective To assess the role of the 24-hour helpline service in the management of diabetes during the holy month of Ramadan. Methodology This prospective study was conducted at the Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan, between December 2017 and August 2018. Patients with type 1 and type 2 diabetes who were willing to observe the fast in Ramadan 2018 were included. Pre-Ramadan education on a one-to-one basis was given and the 24-hour helpline number was provided to each patient. Details of baseline characteristics, anthropometric measurements, and biochemical parameters (lipid profile, serum creatinine, urine D/R (protein), and glycated hemoglobin A1c pre- and post-Ramadan) were noted. Self-monitoring blood glucose (SMBG) recording books were provided to each patient to record blood sugar levels during Ramadan. Results A total of 102 patients, 41 (40.2%) with type 1 diabetes and 61 (59.8%) with type 2 diabetes were included. The mean age of patients with type 1 diabetes was 17.02±5.22 years and that of patients with type 2 diabetes was 49.48±9.68 years. Most of the patients were male in both groups. By using the 24-hour helpline service, 912 calls were made to patients, 502 calls for type 1, and 410 calls for type 2 diabetes. Mean HbA1c (%) level before and after Ramadan was 8.94±1.72 and 8.70±2.03 in patients with type 1 diabetes and 8.59±1.73 and 7.71±1.27 in patients with type 2 diabetes, respectively. In the last 10 days of Ramadan, the decreasing trends of mean self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes was observed for pre-dawn meal (suhoor), pre-sunset meal (iftar), and before sleeping while this trend in type 2 diabetes was found in the pre-dawn meal (suhoor)and two hours after iftar. Conclusion Pre-Ramadan diabetes education and treatment adjustment by using a station-based, 24-hour helpline service during the holy month of Ramadan have a significant role in controlling blood sugar levels, thus minimizing the complications of diabetes, facilitating timely adjustments in treatment, and reducing unnecessary hospital visits and admissions.
RESUMO
Objective The aim of this study was to observe the weight change in a patient with type 2 diabetes initiated on insulin therapy and the relation of weight gain with caloric intake. Methods This retrospective longitudinal follow-up study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care hospital of Karachi, Pakistan. Records of 917 patients attending the tertiary care diabetic clinic were retrieved from January 2009 to May 2016 from the Hospital Management System (HMS). Subjects were divided into two groups: group A consisted of subjects on oral hypoglycemic agents (OHA), while group B consisted of subjects on insulin therapy with OHA. Change in weight, change in HbA1c, and change in calories intake were calculated by examining data at baseline and end-line visit of the study. Results Group B showed significantly higher weight gain than group A (48.3% vs 24.8%). Insulin therapy with OHA (OR (95% CI = 1.78(1.05-3.02)), increased caloric intake (OR [95% CI = 1.98(1.093.60)]) and decreased HbA1c (OR [95% CI = 0.44(0.24-0.79)]) were the only factors identified as significant predictors of weight gain. Conclusion It is concluded that type 2 diabetic subjects, especially on insulin treatment, gain weight due to increase or unadvised caloric intake. Long-term multicenter studies are needed to ascertain the findings of this study.