RESUMO
Diabetes mellitus is a global health concern associated with significant morbidity and mortality. Inadequate control of diabetes leads to chronic complications and higher mortality rates, which emphasizes the importance of achieving glycemic targets. Although glycated hemoglobin (HbA1c) is the gold standard for measuring glycemic control, it has several limitations. Therefore, in recent years, along with the emergence of continuous glucose monitoring (CGM) technology, glycemic control modalities have moved beyond HbA1c. They encompass modern glucometrics, such as glycemic variability (GV) and time-in-range (TIR). The key advantage of these newer metrics over HbA1c is that they allow personalized diabetes management with person-centric glycemic control. Basal insulin analogues, especially second-generation basal insulins with properties such as longer duration of action and low risk of hypoglycemia, have demonstrated clinical benefits by reducing GV and improving TIR. Therefore, for more effective and accurate diabetes management, the development of an integrated approach with second-generation basal insulin and glucometrics involving GV and TIR is the need of the hour. With this objective, a multinational group of endocrinologists and diabetologists reviewed the existing recommendations on TIR, provided their clinical insights into the individualization of TIR targets, and elucidated on the role of the second-generation basal insulin analogues in addressing TIR.
RESUMO
BACKGROUND: Dupuytren's contracture is one of the manifestations of the hand syndrome in diabetes mellitus (DM). Its occurrence in diabetes mellitus is not commonly reported in this environment. This report aims to highlight the occurrence of Dupuytren's contracture as a rare manifestation of diabetic hand syndrome in a patient with type 2 DM. METHOD: The case note of a patient with type 2 DM who developed Dupuytren's contracture in both hands and the available literature on the subject were reviewed. RESULT: A 62-year-old Nigerian male Islamic Cleric with type 2 DM for sixteen years on follow-up at the Diabetes clinic of the Jos University Teaching Hospital (JUTH), Jos, developed flexion deformity involving both palms. His symptoms had progressed gradually over the preceding nine months before presentation. Physical examination revealed bilateral Dupuytren's contracture of the palms with hyperkeratosis and flexion deformities of the fingers. He was admitted to the surgical ward of JUTH and had surgery in the right hand. He is to have surgery in the left hand on a later date. CONCLUSION: Dupuytren's contracture is a rare presentation of diabetic hand syndrome. A careful hand examination by physicians in all DM patients for early diagnosis and treatment is recommended.