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BACKGROUND: Current international guidelines recommend a pre-Ramadan risk assessment for people with diabetes (PwDM) who plan on fasting during the Holy month. However, a comprehensive risk assessment-based recommendation for the management of PwDM intending to fast is still controversial. Therefore, the Arabic Association for the Study of Diabetes and Metabolism (AASD) developed this consensus to provide further insights into risk stratification in PwDM intending to fast during Ramadan. METHODS: The present consensus was based on the three-step modified Delphi method. The modified Delphi method is based on a series of voting rounds and in-between meetings of the expert panel to reach agreements on the statements that did not reach the consensus level during voting. The panel group comprised professors and consultants in endocrinology (both adult and pediatric). Other members included experts in the fields of cardiovascular medicine, nephrology, ophthalmology, and vascular surgery, affiliated with academic institutions in Egypt. RESULT: In PwDM who intend to fast during Ramadan, risk stratification is crucial to optimize patient outcomes and prevent serious complications. The present consensus provides risk assessment of those living with diabetes according to several factors, including the type of diabetes, presence, and severity of complications, number of fasting hours, and other socioeconomic factors. According to their risk factors, patients were classified into four categories (very high, high, moderate, and low risk). CONCLUSION: Future research is warranted due to the controversial literature regarding the impact of fasting on certain comorbidities.
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PURPOSE: High prevalence of thyroid disorders is more common in type 1 diabetes compared to type 2 diabetes, due to associated autoimmunity. Hypothyroidism is the most common disorder. The objective was to assess the prevalence of thyroid dysfunction among type 2 diabetic Egyptian females and to find the correlation between metabolic syndrome components and autoimmune thyroid dysfunction. MATERIALS AND METHODS: The study included 62 type 2 diabetic Egyptian females and 27 sex- and age-matched controls. All patients in the study were subjected to anthropometric measures, including HbA1c, lipid profile, serum uric acid, thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-thyroid peroxidase (TPO), antithyroglobulin (anti-Tg), and thyroid ultrasound. RESULTS: Hypothyroidism was found in 45.2% of patients (5.49±3.37 µIU/mL) versus 11.1% of controls (1.79±1.21 µIU/mL) (P<0.001). Anti-TPO was found in 75.8% (347.15±244.87 IU/mL) of patients versus 7.4% (32.89±33.26 IU/mL) of controls (P<0.001). Anti-Tg was found in 61.3% (508.03±369.16 IU/mL) of patients versus 0 (51.26±35.53 IU/mL) controls (P<0.001). A significant positive correlation was found between TSH and antithyroid antibodies (anti-Tg, anti-TPO; P=0.002 and P=0.043, respectively) and between TSH and thyroid-gland volume (P=0.002) in diabetic patients. No correlation was found between any components of metabolic syndrome and thyroid antibodies in diabetic patients. CONCLUSION: Autoimmune thyroid disease is more common in Egyptian women with type 2 diabetes than nondiabetic women, and thus points to a role of autoimmunity in the pathogenesis of type 2 diabetes.
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BACKGROUND: to assess the relations among plasma levels of von Willebrand factor (vWf), microalbuminuria and markers of oxidative stress in patients with type 2 diabetes mellitus. MATERIAL/METHODS: We studied 10 healthy subjects without microalbuminuria or history of coronary artery disease (CAD) and 30 patients with type 2 diabetes mellitus who were classified into three groups, each including 10 patients of matched age and sex; group 1: patients without microalbuminuria or history of CAD; group 2: patients with microalbuminuria and no history of CAD, and group 3: patients with microalbuminuria and history of CAD. All subjects underwent laboratory measurements of vWf, albumin excretion rate (AER), malondialdehyde, vitamin C, reduced glutathione and C peptide. RESULTS: vWf was elevated in patients with type 2 diabetes mellitus compared with control subjects. However, levels were higher in patients with than without microalbuminuria and in patients with than without a history of CAD (96+/-12, 124+/-7, 149+/-9, 175+/-7 in the control subjects and the diabetic patients' groups respectively). There was a positive correlation between vWf and AER, MDA and C- peptide (r=0.91, 0.98, 0.96, p<0.0001) and a negative correlation between vWf and both vitamin C and reduced glutathione (r=-0.59 and -0.62 respectively, p<0.001). CONCLUSIONS: vWf levels are elevated in patients with type 2 diabetes mellitus, particularly in the presence of microalbuminuria and history of CAD. vWf levels are associated with markers of increased oxidative stress and therefore reflect the severity of biochemical abnormalities, which contribute to diabetic vascular disease.