Serum and urinary magnesium in young diabetic subjects in Bangladesh.

BACKGROUND: Magnesium imbalance, implicated in diabetes mellitus both as a cause and a consequence, has not yet been investigated in subgroups of subjects with malnutrition-related diabetes mellitus. which is prevalent in young patients in tropical developing countries such as Bangladesh. OBJECTIVE: The present study evaluated the serum and urinary magnesium concentrations in groups of young diabetic subjects in Bangladesh. DESIGN: Forty patients newly diagnosed with diabetes [13 with fibrocalculus pancreatic diabetes (FCPD), 13 with protein-deficient diabetes (PDDM), and 14 with type 2 diabetes mellitus] were studied along with 13 healthy control and 13 malnourished control subjects [body mass index (in kg/m2) < 19]. Magnesium was measured by atomic absorption spectrophotometry. RESULTS: Malnutrition itself was not related to the serum glucose (fasting: 3.68+/-0.74 and 4.11+/-0.29 mmol/L; postprandial: 6.30+/-0.41 and 6.00+/-0.24 mmol/L for healthy and malnourished control subjects, respectively) or serum or urinary magnesium (serum: 0.73+/-0.03 and 0.75+/-0.05 mmol/L: urinary: 232+/-124 and 243+/-88 mmol Mg/mol creatinine for healthy and malnourished control subjects, respectively) concentration. Subjects with FCPD and PDDM had significantly lower serum magnesium concentrations (PDDM: 0.68+/-0.06 mmol/L, FCPD: 0.66+/-0.07 mmol/L) than those in both control groups. In contrast with 0% of healthy and 7.7% of malnourished control subjects, 42.85% of type 2 diabetic subjects, 61.54% of those with PDDM, and 69.23% of those with FCPD were hypomagnesemic. Subjects with FCPD and PDDM had significantly higher urinary excretion of magnesium than the healthy and malnourished control subjects and the type 2 diabetic subjects. Hypermagnesuria paralleled hypomagnesemia. CONCLUSIONS: Malnutrition may not itself give rise to glucose intolerance, and serum magnesium deficiency seems to be a consequence rather than a cause of diabetes mellitus.

Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country.

The cost-effectiveness of home monitoring of blood glucose (HMBG) in Type-2 diabetes in a developing country was evaluated. A total of 64 uncomplicated Type-2 diabetic individuals of higher middle class to rich socio-economic status were studied. Thirty-two were allocated to conventional monthly hospital visits group-I (Gr-I) and 32 to HMBG with hospital visits at 3 monthly intervals group-II (Gr-II). In Gr-I, compared to baseline, HbA1c values decreased by 0.76% (95% CI 0.11-1.42) after 9 months and by 0.95% (95% CI 0.12-1.77) after 15 months but lost significance after 18 months follow-up. On the other hand, in Gr-II patients, HbA1c decreased significantly from baseline from 3 months and remained so at 18 months when it was decreased by 1.37% (95% CI 0.25-2.49). Hypoglycaemic episodes per patient year follow-up were significantly lower among Gr-II patients (0.172 vs. 0.354, P = 0.03). Considering the cost for conveyance, wage loss, investigation, institutional cost, glucometer and test strips, the total cost per patient was quite similar in both groups. The present study suggests that HMBG with proper diabetes education may be cost-effective at least in selected groups of individuals with Type-2 diabetes, even in a developing country such as Bangladesh.

TSH assay using dried blood samples: a screening method for congenital hypothyroidism.

Capillary blood samples from three hundred healthy, full-term newborn within 48 and 120 hours of delivery, were collected on filter paper for analysis of thyroid-stimulating hormone (TSH). Blood was collected by pricking the heel of the newborn and spotted and dried on filter paper cards. The samples were analysed by immunoradiometric assay (IRMA) to determine the TSH level. Some fifteen percent of a total 1928 deliveries at two hospitals during a period of one year were included in the study. Male:female ratio was 1.1:1. There was no maternal history of thyroid disease. None of the babies had any clinical feature of hypothyroidism. On analysis, TSH level ranged from 0.6-19.3 microU/ml with a mean (SD) of 7.19 (4.21) microU/ml. TSH assay from dried filter paper blood spot is technically possible and is a cost-effective and reliable method for a screening programme. This is the first time in Bangladesh that this method has been successfully carried out.

Relationship of prolactin and gonadotrophic hormones in regulation of the ovarian function.

Circulating concentration of the LH, FSH, prolactin (PRL), oestradiol-17 beta (E2) and progesterone (P) in serum were investigated in women with normal cycles and proven fertility, with irregular cycles and infertility and with primary or secondary amenorrhea in order to understand the relationship of the prolactin and gonadotrophic hormens in regulation of the ovarian function. The results indicate that hyperprolactinemia inhibits the pituitary to release the midcycle LH surge in response to the positive feedback action of the elevated oestrogen at the midcycle. The elevated LH and FSH levels found in the cases of the secondary amenorrhea is the indication of the absence of the steroid negative feedback due to the ovarian failure. Prolactin does not seem to play a role on the manifestation of either primary or secondary amenorrhea.

Metabolic and hormonal profile of the offsprings of conjugal diabetics.

Oral glucose tolerance response to blood glucose, serum immunoreactive insulin (IRI) and plasma free fatty acid (FFA) levels were studied on 159 offsprings of both parent diabetics (connubials). Fasting serum cholesterol, triglyceride, phospholipid and total lipids were also measured in these subjects. We detected 6 diabetics out of 159 connubials at the time of our study. FFA level in 6 diabetic connubials were higher all time intervals than 153 non-diabetics connubials. Fasting and one hour post glucose response were less in 6 diabetic connubial but two hours post glucose IRI response to both 6 diabetic connubials and 153 non-diabetic connubials were same indicating a delayed insulin secretion in response to oral glucose level in 6 diabetic connubials.