Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia.

OBJECTIVES: To determine the prevalence of macrovascular and microvascular complications of type 2 diabetes mellitus and its associated determinants.  Methods: We evaluated the online medical records of patients with type 2 diabetes mellitus who have been seen in chronic disease unit between April and June 2014. Seven hundred and forty-eight participants satisfied the inclusion criteria. Of these, 317 (42.4%) were males with a mean age of 57.9 years, 681 (64.3%) were obese with body mass index (BMI) of greater than 30, while only 9.6% had normal BMI (less than 25).  Results: Only 158 (21.1%) had controlled hemoglobin A1c level. Retinopathy prevalence was 14.8% and neuropathy was 5.6%. Macrovascular complications accounted for 12.1%. Patients' age and duration of diabetes were main predictors of developing complications. Patients with more than 20 years  history of diabetes have 30% more odds of developing the complications when compared to patients with less than 10 years of diabetes history. Each increment in age by one year increases the odds of developing microvascular complications by 4% and macro vascular complication by 2%.  Conclusion: Our results showed diabetic patients with poor glycemic control, and longer duration of diabetic history had higher prevalence of both macrovascular and microvascular.

How well does self-reported adherence fare compared to therapeutic drug monitoring in HAART?

OBJECTIVE: The aim of the study was to determine how well self-reported adherence fares compared to therapeutic drug monitoring in monitoring HAART adherence. METHODS: We administered a validated self-reported adherence (SRA) questionnaire to 925 HIV patients on HAART in a large Malaysian hospital from 2010 to 11. We also performed Therapeutic Drug monitoring (TDM) by concurrently collecting and testing blood samples for Efavirenz, Nevirapine and Lamivudine using Liquid Chromatography/Mass Spectrometry. We compared the SRA against the TDM results. Sensitivity, specificity, positive (PPV) and negative predictive (NPV) and diagnostic accuracy values were computed for each drug. RESULTS: Self-reported adherence (SRA) over-estimates adherence by between 6 and 10 percentage points compared to therapeutic drug monitoring (TDM). SRA is highly sensitive with sensitivity exceeding 0.90 but is not very specific (0.56-0.63). PPV for SRA ranged between 0.76 (Lamivudine) and 0.84 (Efavirenz) while NPV ranged between 0.78 (Lamivudine) and 0.81 (Efavirenz). Overall diagnostic accuracy ranged between 0.76 (Lamivudine) and 0.84 (Nevirapine). CONCLUSION: Self-reported adherence is a surprisingly accurate instrument for measuring HAART adherence compared to TDM and can be reliably used in practice in resource-poor settings.