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.

Association of Hepcidin levels in Type 2 Diabetes Mellitus treated with metformin or combined anti-diabetic agents in Pakistani population.

Objective: To evaluate the impact of hepcidin and ferritin in pathogenesis and prognosis of type 2 diabetes mellitus subjects taking only metformin or combined anti-glycaemic agents. METHODS: The observational case-control study was conducted at the Department of Physiology, Baqai Medical University, Karachi, from August 2019 to October 2020, and comprised subjects from both genders who categorised into equal groups as non-diabetic controls, newly-diagnosed type 2 diabetes mellitus patients without any treatment, type 2 diabetes mellitus patients with exposure to metformin only, type 2 diabetes mellitus patients taking oral hypoglycaemic agents along with metformin, type 2 diabetes mellitus patients taking only insulin, and type 2 diabetes mellitus patients taking insulin and oral hypoglycaemic agents. Fasting plasma glucose was determined using glucose oxidase-peroxidase method, glycated haemoglobin by high performance liquid chromatography, high-density lipoprotein and low-density lipoprotein by direct methods, cholesterol by cholesterol oxidase phenol 4-amino antipyrine peroxidase and triglycerides by glycerol phosphate oxidase-phenol 4-amino antipyrine peroxidase method. Serum levels of ferritin, insulin and hepcidin were evaluated using Enzyme-linked immunosorbent assay. Insulin resistance was assessed using homeostasis model assessment for insulin resistance. Data was analysed using SPSS 21. RESULTS: Of the 300 subjects, there were 50(16.66%) in each of the 6 groups. Overall, there were 144(48%) males and 155(51.66%) females. The mean age was significantly lower in the control group 34.72±7.87 compared to all the diabetic groups (p<0.05), and the same was the case with respect to all the parameters (p<0.05) except high-density lipoprotein (p>0.05). Besides, hepcidin level was significantly higher in the control group (p<0.05). Ferritin levels were significantly increased in newly-diagnosed T2DM subjects compared to the controls (p<0.05) while all other groups showed decreased ferritin levels (p<0.05). Hepcidin gave inverse correlation with glycated haemoglobin only in diabetics taking only metformin (r = -0.27, p=0.05). CONCLUSIONS: Anti-diabetes drugs not only addressed type 2 diabetes mellitus, but also reduced levels of ferritin and hepcidin that are found to play a role in diabetes development.

Change in pulmonary function tests and their relation to the serum levels of ceruloplasmin, copper and superoxide dismutase in patients suffering from Type-1 and Type-2 diabetes.

Objective: To correlate the serum levels of ceruloplasmin (Cp), copper (Cu), and superoxide dismutase (SOD) with pulmonary function tests (PFTs) in non-diabetics (controls) and patients suffering from Type-1 and Type- 2 diabetes. Methods: The comparative cross-sectional study of 348 participants was performed at the Baqai Institute of Diabetes and Endocrinology (BIDE) - Karachi, Pakistan, from February 2019 to September 2020. Individuals having diabetes-related complications, asthma, chronic obstructive pulmonary disease, chest infection, pregnant women and smokers were excluded. A total of 348 participants were included into three groups after signing informed consent. The control group had 107 non-diabetic participants, with an age range of 6 to 60 years. The diagnosed T1D group (n=107) had an age range of 6 to 25 years. While diagnosed T2D group (n=134) had an age range of 26 to 60 years. During the fasting state, anthropometric parameters, blood pressure, spirometry, and a venous blood sample (5ml) were collected to measure serum Cp, serum Cu, serum SOD, and HbA1c levels by using commercially available kits. The SPSS, version 21, was used for data analysis. Results: The reduced FVC (p-value <0.001), FEV1 (p-value <0.001), and PEFR (p-value <0.001) were found in both groups of diabetes. However, the lower levels of serum Cu (p-value <0.001), SOD (p-value <0.001), and significantly increased values of FEV1/ FVC (p-value <0.001) and Cp levels (p-value 0.030) were found only in T2D group as compared to T1D and controls. The study found no significant correlation of PFTs and serum Cp, Cu, and SOD levels in patients suffering from T1D and T2D. Conclusion: Hyperglycemia leads to more non-enzymatic glycosylation of tissue proteins that reflects reduced PFTs and increased Cp; particularly in T2D, which may alter lung tissue's physiology. Moreover, the study showed no correlation of PFTs with the Cp, Cu, and SOD in patients suffering from T1D and T2D.

Clinically significant endoscopic findings in a dyspeptic rural population cohort of Sindh, Pakistan: Are we over-investigating?

Objectives: To discuss the clinically significant endoscopic findings of the upper GI tract and their association with different age groups in a dyspeptic rural population of Gadap town, Sindh. Methods: This was a retrospective secondary data analysis of 806 patients conducted in the medical ward of Fatima Hospital, Baqai Medical University from December 2016 to May 2019. It was approved by the University Ethics Committee. Patients' demographics and other data related to the procedure were recovered from patients' records. SPSS version 20 was used for statistical analysis. Results: There were marginally more women suffering from dyspepsia as opposed to men (51.5% vs 48.5% respectively). Majority of the patients were less than 45 years of age, with most procedures being performed as outpatients. Nearly 40% of the patients did not have clinically relevant endoscopic findings. Most common significant finding on endoscopic examination was gastritis followed by hiatal hernia. Conclusion: Normal upper gastrointestinal endoscopy, regardless of age, is a common finding in patients suffering from dyspepsia in our setting. Therefore, in a resource constraint environment like ours, expensive endoscopic procedures should be reserved for those patients who are not responding to medical therapy or those who have alarm symptoms.

Effects of varying levels of gonadotropins and estrogen in adolescent females having type 1 diabetes with their impact on health-related quality of life in Karachi Pakistan.

The purpose of this study is to evaluate quality of life, the gonadotropins and estrogen levels in type 1 diabetic adolescent females. This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE). The Diabetes quality of life for youth questionnaire (DQOLY) was used to evaluate quality of life. FSH was found to be significantly lower in Type 1 Diabetes. HbA1c had a significant inverse moderate correlation with FSH(-0.300*).In Type 1 Diabetes, FSH had a positive moderate correlation with LH(0.415*), (P-value<0.05). LH and estradiol levels were almost similar in both groups. Overall mean percentage score of DQOLY questionnaire for Type 1 Diabetes was 26.94±1.36. Low QOL score was observed on the basis of impact on activities. Adolescent females with Type 1 Diabetes were found to be shorter and underweight than non-diabetic adolescent females. Lower height and weight of the diabetes as compared to controls cannot be attributed to only metabolic control, suggesting other mechanisms for short stature. Control on metabolism has always been the target for diabetes treatment for ensuring the improved prognosis of disease but also for the quality of life in Type 1 diabetes.

Association of fibrinogen and plasminogen activator inhibitor-1 with diabetes mellitus.

As the state of hyperfibrinogenemia in diabetes patients occurs due to hyperglycemia which also activates the coagulative cascade ultimately stimulating hepatic fibrinogen synthesis and thus increases clotting factors and PAI-1 levels in the blood. Therefore, in present study our aim is to correlate between type of diabetes and plasma fibrinogen level and plasminogen activator inhibitor-1. This cross sectional study was conducted at Baqai Medical University (BMU) with the collaboration of Baqai Institute of Diabetology and Endocrinology, Karachi. Data was collected from 161 subjects, out of which 51 were control and 55 were subjects in each type 1 diabetes, type 2 diabetes simultaneously. Anthropometric measurements included measurement of weight, height, BMI and blood pressure which were done for each participant. Blood sugar levels and glycated hemoglobin, lipid profile, PAI-1 and fibrinogen were measured in cases and controls. Out of 161 subjects, 80 (49.7%) were male and 81 (50.3%) were female with mean age of 37.75±1.25 years. Fibrinogen level was significantly decreased in healthy subjects as compared to type 1 and type 2 diabetes subjects P-value<0.0001, however no significant difference was observed in fibrinogen level of type 1 diabetes subjects and type 2 diabetes subjects. Plasminogen activator inhibitor-1 of type 2 diabetes subjects was significantly increased as compared to type 1 diabetes subjects (P-value<0.05) but not significantly different to healthy subjects (P-value>0.05). Since, fibrinogen and plasminogen activator inhibitor type 1 was increased in diabetes patients this predisposed them to increased risk of coronary artery disease, our study further supports the clinical observation that diabetes is a thrombophillic condition.

Upper gastrointestinal endoscopy; A study from a rural population of Sindh, Pakistan.

OBJECTIVE: To discuss common indications and findings on upper gastrointestinal endoscopy as well as to correlate these findings with alarm symptoms in the rural population of Gadap town, Sindh. METHODS: This was a retrospective study on 1288 patients conducted in the medical ward of Fatima Hospital, Baqai Medical University. Patients' demographics and other data related to the procedure were recovered from patients' records. SPSS version 20 was used for statistical analysis. RESULTS: Ratio of male and female patients was approximately 1:1. Majority of the patients were young, and most procedures were done as outpatients without the requirement of conscious sedation. Epigastric pain was the primary indication for upper GI endoscopy (62.6%). One third of the procedures performed did not report any pathological finding. Probability of a positive finding was more likely if a patient presented with dysphagia, heart-burn, hematemesis, vomiting, or for screening endoscopy (for varices). Patients who were diagnosed with esophageal candidiasis, esophageal varices or esophageal growth/ ulcer had reported one or more alarm symptoms in their history. CONCLUSIONS: Upper gastrointestinal endoscopy is a useful test to diagnose disorders of the esophagus, stomach and duodenum. However, it is an expensive procedure and therefore referring physicians should keep appropriate clinical indication and ethical considerations in mind before recommending such an investigation to their patients.

Association of IL-6 & IL-1ß (pro-inflammatory cytokines) and related biochemical indexes in newly diagnosed diabetics subjected to glucose tolerance test.

The study proposed to find out the association of pro-inflammatory cytokines (IL-6 & IL-1ß) and related biochemical indexes in newly diagnosed diabetes (NDD) subjects as compared to healthy subjects. This clinical prospective research was done with collaboration of University of Karachi and Baqai Institute of Diabetology and Endocrinology between November 2018 to May 2019. Demographics and anthropometric details were noted on predesigned questionnaire. Subjects were identified on the basis of Oral Glucose Tolerance Test (OGTT). Samples of blood at baseline were gained for IL-6 & IL-1ß (pro-inflammatory cytokines) and related biochemical indexes. Total of 34 subjects were included both males 19 (55.9%) and females 15 (44.1%) having mean age 49.65±1.95 years. On the basis of OGTT, 17(50%) were healthy subjects and 17(50%) were NDD. Mean ± SE value of IL-1ß was 208.56±23.53 in healthy subjects and 1510.47±494.16 in NDD subjects, while, IL-6 was 57.51±13.02 and 119.51±36.60, respectively. Non-significant correlation was observed between IL-6 and IL- 1ß (r= 0.20, P=0.475) among healthy subjects. While, significant correlation was observed between IL- 6 and IL- 1ß (r=0.774, P<0.0001) among NDD subjects. With increased levels of both IL-6 and IL-1ß in NDD subjects only IL-1ß showed significant correlation as compared to IL-6. In addition, significant correlation of IL-1ß with various biochemical parameters as compared to IL-6 were also observed to be involved in progression from normoglycemia to type 2 DM.

Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries.

OBJECTIVE: Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries. METHODS: We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices. RESULTS: Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively. CONCLUSIONS: Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.

Prevalence and contributing risk factors for hypertension in urban and rural areas of Pakistan; a study from second National Diabetes Survey of Pakistan (NDSP) 2016-2017.

Aim: To assess the prevalence and its associated risk factors for hypertension in urban and rural areas of Pakistan.Methods: This study is the part of second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a large community-based epidemiological survey. Hypertension was determined for urban/rural areas of all four provinces of Pakistan. Known hypertensives were considered as individuals with self-reported history of hypertension and/or taking any antihypertensive drug and newly diagnosed hypertension is defined; as systolic blood pressure was ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Detailed information of the survey participants were obtained from the second NDSP 2016-2017 predesigned questionnaire, which has been published earlier.Results: Overall, age adjusted weighted prevalence of hypertension was 46.2%, of which 24.9% had self-reported hypertension and 21.3% were newly diagnosed hypertensive. Prevalence of hypertension in urban and rural areas was 44.3% and 46.8%, respectively. Highest weighted prevalence of hypertension was observed in Punjab 49.2% followed by Sindh 46.3%, Baluchistan 40.9%, and Khyber Pakhtunkhwa 33.3%. Hypertension was more prevalent in rural areas compared to urban areas except in Khyber Pakhtunkhwa where it was more prevalent in urban areas. Age, female gender, marital status, positive family history of hypertension, low physical activity, positive family history of diabetes, obesity, and dyslipidemia were significantly associated with hypertension.Conclusion: This study concludes that 46.2% prevalence of hypertension is alarming in Pakistan with its associated risk factors. Hence, implementation laws with lifestyle changes and educating people are required on urgent basis to control or reduce hypertension prevalence.

Diabetes Registry of Pakistan.

Diabetes registries can be used to monitor the prevalence and incidence of diabetes. Diabetes registries are used in many countries for population management of diabetes, outcomes management, and development of Clinician finding Support Structure, for example, National Diabetes Registry (NDR) in Sweden and Singapore diabetes registry. According to 2nd National Diabetes Survey of Pakistan (NDSP) 2016-2017, overall 26.3% adult (≥20) suffer from diabetes (27.4 million people). Health Research Advisory Board (HRAB) of Pakistan has initiated the mission of developing disease registries countrywide. Diabetes Registry of Pakistan (DROP) under the supervision of Prof. Abdul Basit and Dr. Asher Fawwad to enumerate the degree of the national disease burden. For type 1 diabetes, Diabetes Registry of Pakistan for type 1 (DROP-1) has already started. DROP-1 can be a good pilot arm for developing the robust methodology for DROP. The upcoming and the ongoing research is periodically being linked with the registry to ensure its modernization. This registry is a useful tool for tracking the status of patient, in order to limit the burden of data collection. A web-based data entry system and automated random sampling has enabled useful data collection and tracking with relatively minimal effort.

Prevalence of tobacco use in urban and rural areas of Pakistan; a sub-study from second National Diabetes Survey of Pakistan (NDSP) 2016 - 2017.

OBJECTIVE: To assess age standardized prevalence of tobacco use in urban and rural areas of Pakistan. METHODS: This is a sub-study of second National Diabetes Survey of Pakistan (NDSP) 2016-2017. Prevalence of tobacco, ex-tobacco and non-tobacco users was determined in urban/rural areas of four provinces (Punjab, Sindh, Khyber Pakhtunkhwa, and Baluchistan) of Pakistan amongst people aged greater than or equal to 20 years. Information regarding tobacco and non-tobacco users were obtained from second NDSP (2016-2017) predesigned questionnaire. Detailed methodology for demographic, anthropometric and biochemical parameters remained same as reported in second NDSP (2016-2017). RESULTS: The age-standardized prevalence of tobacco use in Pakistan was found to be 13.4%. Tobacco use in urban areas was 16.3% and rural areas was 11.7%. Tobacco use in urban and rural males was 26.1% and 24.1%, while in females was 7.7% and 3.1%, respectively. The age-standardized prevalence of ex-tobacco use in Pakistan was found to be 2.3%. Ex-tobacco use in urban areas was 2.6% and rural areas was 2.3%. Similarly, ex-tobacco use in urban and rural males was 4.6% and 4.6%, while in females was 0.7% and 0.5%, respectively. Multinomial logistic regression analysis shows that increasing age does not relate towards addiction of tobacco. Males were found to be 7 times (OR 6.94, 95% CI 5.68-8.49) and urban residents twice (OR 2.09, 95% CI 1.73-2.52) more tobacco users than females and those living in rural areas, respectively. From the likelihood ratio test, all variables were found to be statistically significant except for dysglycemia, dyslipidemia and hypertension. CONCLUSION: The prevalence of tobacco use is high. As a sub paper of a large national survey, this evidence is expected to serve as an important tool to plan larger studies leading in turn to develop strategies for a successful tobacco control program in the country.

Relationship of C-peptide levels to duration of Type 1 diabetes - A study from Sindh, Pakistan.

OBJECTIVE: To determine the relationship of C-peptide levels with duration of type 1 diabetes mellitus. METHODS: This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from December 2013 to December 2015. A total of 184 subjects were recruited during the study period, 100 in Group-A and 84 in Group-B. Subjects clinically diagnosed with type 1 diabetes Mellitus (T1DM) were categorized into two groups based on duration of diabetes: Group-A (with ≤1-year duration of diabetes) and Group-B (with >1-year duration of diabetes). Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study. Blood samples were drawn for biochemical parameters. Data for baseline characteristics and clinical parameters (HbA1c and C-peptide) were obtained from hospital management system of BIDE. RESULTS: Fifty-seven (57.6%) subjects in Group-A, and 39 (46.4%) in Group-B were males. Mean±SD duration of diabetes (years) was 0.64±0.6 (range 0-1) in Group-A, and 7.65±5.5 (range 1-23) in Group-B. Family history of T1DM and T2DM was 1(1%) and 27(27.3%) in Group-A, and 8(9.52%) and 21(25%) in Group-B, respectively. Twenty-one (21.2%) subjects presented in diabetic ketoacidosis (DKA) in Group-A and 18(21.4%), in Group-B. Mean±SD for HbA1c was non-significantly higher in Group-A 11.12±2.31 compared to Group-B 10.42±1.45. Mean±SD for C-peptide was 1.91±1.53 ng/mL (0.60±0.481 nmol/L) in Group-A, and 1.82±1.01 (0.57±0.32 nmol/L) in Group-B (p=0.984). CONCLUSION: The study found that subjects with longer duration of T1DM had non-significantly decreased C-peptide levels compared to a group in which C-peptide was measured at or soon after diagnosis. Furthermore, C-peptide levels in many subjects with longer duration were higher than expected in classic T1DM.

Glucagon-like peptide 1 and its association with dipeptidyl peptidase IV in subjects with various degrees of glucose tolerance.

Dipeptidyl peptidase IV (DPP-4) and Glucagon like peptide 1 (GLP-1) has profound effect on insulin and glucagon secretion; ultimately decreasing glucose levels. We find out the association of GLP-1 levels and DPP-4 in normal, impaired and newly diagnose type 2 diabetic glucose tolerance. Prospective case control study was conducted at Department of Physiology, Baqai Medical University by the collaboration of Baqai Institute of Diabetology and Endocrinology; Karachi-Pakistan. Study groups were categorized into three groups Control, Impaired glucose tolerant (IGT) and newly diagnose type 2 diabetes mellitus (NDD). Biochemical parameters were estimated by international standard protocols. Logistic regression analysis and Chi square test with statistical significance at p value <0.05 were applied. DPP-4 concentrations were significantly lower in NDD participants compared to control and IGT participants (p=0.01), whereas GLP-1 levels were significantly higher in Control than Impaired glucose tolerant and NDD (p = 0.013). GLP1 levels and SBP were also found to be positively correlated with serum DPP4 levels in NDD group (p<0.05). GLP1 and DPP4 levels in NDD group (p<0.05) and in controls (p<0.001) respectively showed strong significant positive correlation. Effective correlation between GLP1 and DPP4 was found as both contribute to control hyperglycemia in NDD and impaired glucose tolerant people.

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.

Comparison of ankle-brachial index (ABI) measured by an automated oscillometric apparatus with that by standard hand-held doppler in patients with Type-2 diabetes.

OBJECTIVE: To compare the difference between an automated oscillometric ABI measurement as compared to standard hand-held doppler ABI in patients with Type-2 diabetes. METHODS: This prospective study was conducted at foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), a tertiary care unit, Karachi-Pakistan. The duration of study was February 2018 to March 2018. Patients with Type-2 diabetes attending the outpatient department (OPD) of foot clinic, irrespective of their symptoms were included. Baseline demographic, anthropometric measurements and biochemical parameters were recorded. The ABI was calculated with both devices by an automated oscillometric machine and standard hand-held doppler with the same investigator. RESULTS: Total of 93 patients with Type-2 diabetes, 18 (19.4%) females and 75(80.6%) males were recruited. Mean age was 54.67±9.59 years and mean systolic/diastolic blood pressure was 131.38±20.2/ 80.36±10.23mmHg. Most of the patients had poor glycemic control at presentation with a mean HbA1c of 9.56±2.44%. Mean standard handheld doppler ABI and automated oscillometric ABI was 1.28±1.08 and 1.07±0.23 for right foot (mean difference = 0.21; P= 0.075), and 1.14±0.45 and 1.1±0.25 for left foot (mean difference =0.04; P=0.434), respectively. Similarly, sensitivity and specificity between two modalities was observed 60% and 93.90% for right foot, meanwhile, 60% and 97.40% for left foot, respectively. CONCLUSION: An automated oscillometric method is comparable with standard handheld-doppler method. It is cost effective, convenient and less time consuming, can be widely used to measure ABI without special training.

Frequency of urinary tract infection and antibiotic sensitivity of uropathogens in patients with diabetes.

OBJECTIVE: To determine the frequency of urinary tract infections and antibiotic sensitivity among patients with diabetes. METHODS: This observational study was carried out in Microbiology Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University from April 2015 to June 2016. All patients with diabetes having symptoms of UTI attending out patients department of BIDE were analyzed. All samples received in the laboratory were processed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Antimicrobial susceptibility pattern was determined by disc diffusion method. RESULTS: A total number of 199 urine specimens, frequency of UTI were 24 (12.06%) in male and 175 (87.94%) in female. UTIs were highly found in (age group 51-60) 70 (35.18%). Escherichia coli was the most frequent pathogen (71%), followed by Klebsiellapneumoniae (7.48%), Proteus mirabilis (1.87%), Staphylococcus aureus (9.35%), Candida (5.61%) and Candidaalbicans were (2.80%). Majority of gram negative uropathogens were shown high sensitivity towards Imipenem and Piperacillin / Tazobactam followed by Nitrofurantion, Ceftriaxone, Levofloxacin, Ofloxacine, Ciprofloxacin, Norfloxacin, Cefixime, Nalidixic acid and Cephradine. Gram positive was most sensitive to Nitrofurantionand Vancomycin followed by Piperacillin / Tazobactam, Imipenem, Cephradine, Ceftriaxone, Norfloxacin and Cefixime. CONCLUSION: We observed the higher frequency of UTIs in female as compared to male participants due to poor hygiene. E.coli was the most frequent pathogen responsible for UTI in patients with diabetes, followed by Staphylococcus aureus.

Incidence of microvascular complications of type 2 diabetes: A 12 year longitudinal study from Karachi-Pakistan.

OBJECTIVES: To estimate the incidence of microvascular complications among subjects with type 2 diabetes at a tertiary care hospital. METHODS: This retrospective longitudinal follow-up study assessed the data records of type 2 diabetic subjects who visited the outpatient department of Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, from January 2005 to April 2016. Subjects with gestational diabetes, type 1 diabetes and with history of any microvascular complication were excluded. Medical records were obtained through electronic database (Health Management System). Statistical analyses were conducted using STATA version 14 and SPSS version 20. RESULTS: The incidence of microvascular complications was 92.8, 106.2, and 130.2 per 1000 person per years for retinopathy, neuropathy and nephropathy respectively. Retinopathy, neuropathy and nephropathy were significantly high among diabetic patients with duration of diabetes >10 years followed by 5-10 years. Incidence of retinopathy and nephropathy was significantly higher in patients who had HbA1c>7% than patients with HbA1c≤7% (p-value<0.05). Higher incidence rate of all three microvascular complications were seen in subjects with hypertension than subjects without hypertension. CONCLUSION: A high incidence of microvascular complications is found in subjects with type 2 diabetes. Poor glycaemic control, longer duration of diabetes and hypertension was found to be associated with the occurrence of these complications.

Association of serum liver enzyme Alanine Aminotransferase (ALT) in patients with type 2 diabetes.

OBJECTIVES: To assess the association of raised serum liver enzyme (ALT) with type 2 diabetic subjects. METHODS: This retrospective data was accessed at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2005 to May 2016. A total of 1966 subjects with type 2 diabetes were included in the study. Subjects were divided into two groups; in group A 1284 subjects had ALT within the normal range (ALT≤35iu/l) and in Group-B 682 subjects had elevated ALT (ALT>35iu/l). Details of demographics, anthropometric measurements and biochemical results at baseline were extracted from the health management system of BIDE. Data analysis was conducted on Statistical Package for Social Sciences (SPSS) version 20. RESULTS: Out of 1966 type 2 diabetic subjects 1284(65.4%) were observed with normal value of ALT (≤35) and 682(34.6%) with elevated ALT (>35). Overall mean age of subjects was 54.66±10.98 years and mean BMI was 27.34±5.99 kg/m2. Significant difference was observed between the groups in age (if ALT>35), gender (more likely to be male) and triglyceride (higher if ALT>35).Whereas no significant difference was found between the groups in HbA1c, cholesterol, HDL and LDL. CONCLUSION: High frequency of elevated ALT suggests the association of liver disease with type 2 diabetes. The type 2 diabetic subjects need to be routinely screened and further studies to assess the possible associations with NAFLD and insulin resistance are required to further clarify the disease process.

Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country.

OBJECTIVE: To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a tertiary care hospital Karachi, Pakistan. METHODS: This descriptive study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), from January 2013 to March 2014. Bone, pus and tissue samples were collected from 342 patients with diabetic foot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. RESULTS: A total of 671 aerobic bacteria were isolated from 473 specimens with an average of 1.45 isolates per specimen. Poly-microbial infection was 56.87%. Gram- negative isolates were predominant 76.27%.Staphylococcus aureus was most frequent among Gram-positive 20.7% and Escherichia coli 15.72% in Gram negative isolates. MRSA was found in 26.76% Staphylococcus aureus. About 33.48% of antimicrobial resistant isolates were observed. CONCLUSIONS: In our study, Gram negative aerobes were predominant in the diabetic foot infections. A significant number of MDR isolates were also observed in this cohort. Delayed referral and inappropriate use of broad spectrum antibiotics may be the main cause of increase in the frequency of MDR isolates.