A Snapshot of Risk Stratification of Diabetic Patients Fasting during the Month of Ramadan

2021 ◽  
Vol 15 (12) ◽  
pp. 3427-3429
Author(s):  
Asim Hassan ◽  
Wedad Abullah Aldahasai ◽  
Shayma Abdulatif Alsalmi
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Risk Stratification ◽  
Armed Forces ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Clinical Practices ◽  
Oral Hypoglycemic Agents ◽  
Hyperosmolar Hyperglycemic State ◽  
Risk Patients

Objectives: To get a clinical snapshot of the diabetic patients who planned to fast during the month of Ramadan and to determine the ability of the RRR application to effectively risk-stratify patients. Study Design: Observational study. Place and Duration of Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1st April 2018 to 31st May 2018. Methodology: Ninety six patients over 15 years of age with diabetes mellitus were risk stratified using standardized risk criteria were enrolled. Detailed analysis of the information was performed to paint a clinical landscape of the patients who intended to fast. Results: Seventy four percent of the patients were type 2 diabetics, 11% GDM, 31% were between 60-70 years and 17 % had diabetes for more than 20 years. 17% of participants had serious complications during the last three months before Ramadan including hypoglycemia, Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). 59% had chronic diabetic complications. 28 % of patients were on both insulin and oral hypoglycemic agents (OHA) together and 16 % on high risk medications. 25% of patients had an HbA1C of more than 10%. Pertaining to the previous Ramadan experience 19% disclosed having serious complications in the past. 6 % were categorized as low risk individuals, 76% as moderate, 6% high and 12 % as very high risk. Conclusions: Astonishingly all the patients advised to refrain from fasting insisted on fasting. Considering the latest IDF numbers the above calculated percentages would translate into very huge numbers who are in serious jeopardy. In order to prevent serious consequences it is highly recommends that evidence based and validated risk stratification strategies are implemented in routine clinical practices. Keywords: Diabetes mellitus, Fast, Hypoglycemia, High risk patients

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

The Diabetic Surgical Patient

2020 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

The Diabetic Surgical Patient

2021 ◽  
Author(s):  
Cathline Layba ◽  
Lance Griffin
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
The United States ◽  
Postoperative Management ◽  
Hypoglycemic Agents ◽  
Surgical Patient ◽  
Diabetic Patients ◽  
Preoperative Management ◽  
Oral Hypoglycemic Agents ◽  
Intraoperative Management

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations.  This review contains 2 figures, 5 tables, and 21 references Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing

scholarly journals Incidence of Autonomic Neuropathy during Assessment in Diabetes Mellitus Patients in PAC

2021 ◽  
pp. 272-278
Author(s):  
Joseph Swithin Fernando ◽  
Sathesh Kumar
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Autonomic Neuropathy ◽  
Lifestyle Modification ◽  
Clinical Syndrome ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Oral Hypoglycemic Agents

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. Autonomic neuropathy invokes potentially life threatening outcomes especially in poorly controlled diabetic patients. Objectives: The objective of this study is to assess the incidence of autonomic neuropathy in patients with type 2 diabetes mellitus. Materials and Methods: The Study was conducted on 80 Type 2 Diabetes Mellitus patients in Pre Anesthetic Clinic of Department of Anesthesiology, Saveetha Medical College and Hospital during the period of March 2021 to August 2021. Informed consent was obtained from all those who met the inclusion criteria and their BP and Heart Rate variability to various manoeuvres were assessed. Results: According to our study 40% and 30% had borderline and definite autonomic neuropathy respectively. Conclusion: Autonomic neuropathy is common in patients with poorly controlled Diabetes Mellitus, especially those on oral hypoglycemic agents. As nowadays no therapy is able to effectively reverse this process, prevention with strict glycemic control, multifactorial intervention, and lifestyle modification remains essential.

scholarly journals ROLE OF ANTIDEPRESSANT ON THE GLYCAEMIC CONTROL OF UNCONTROLLED TYPE 2 DIABETES MELLITUS PATIENTS

2020 ◽  
pp. 111-114
Author(s):  
ALLU HARSHAVARDHINI ◽  
BHANUKUMAR MUTHAIAH ◽  
TIRIN BABU ◽  
GEORGE MATHEW PANACHIYIL ◽  
SISIRA SANTHOSH ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Sugar ◽  
Rating Scale ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Oral Hypoglycemic Agents ◽  
Glucose Levels

Background: Depression incidence is higher in diabetic patients when compared to the non-diabetic individuals and there exist a two-directional relationship between depression and the development of type 2 diabetes mellitus. Objectives: This study aimed to estimate the frequency of depression and the effect of antidepressant on glycemic control in type 2 diabetes mellitus patients. Methods: This prospective interventional study was conducted in type 2 diabetes mellitus patients with a sample size of 100. These patients were diagnosed with depression using WHO-ICD10 criteria. All study patients had uncontrolled blood glucose levels and were on an optimized maximal dose of combination oral hypoglycemic agents with stable glycoregulation (HbA1c 8.4 ±0.5) were taken up for the intervention with antidepressant. These patients were started on with antidepressant after enrollment and followed up for fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and HbA1c at the end of 3 months and 6 months. And also Hamilton depression rating scale scores were estimated at the beginning of the study and at the end of 6 months. Results: The frequency of depression among the type 2 diabetes mellitus patients was found to be 42%. There were reduction of mean FBS levels from baseline value of 177 mg/dl to follow-up value of 160 mg/dl (p<0.001), mean PPBS levels from 251.16 mg/dl to 217.84 mg/dl (p<0.001), and mean HbA1c dropped from 8.41 to 7.57 (p<0.001) after the treatment with antidepressant. Conclusion: Our study concluded that patient started on antidepressant showed a reduction in the blood sugar levels and HbA1c levels from their baseline values, which was clinically and statistically significant.

scholarly journals A study on lipoprotein(a) in health and type-2 diabetes mellitus

2017 ◽  
Vol 5 (2) ◽  
pp. 639
Author(s):  
Premkumar K. S.
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Oral Hypoglycemic Agents ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetics ◽  
Type 2 Diabetic

Background: Increased lipoprotein (a) [Lp (a)] concentrations are predictive of coronary artery disease (CAD). Type 2 diabetes mellitus also leads to dyslipidemia, which are known risk factors for CAD. This study was designed to investigate the levels of Lp (a) in type 2 diabetic patients and their association with healthy controls and glycemic control.Methods: The study included 87 subjects out of which 20 were healthy volunteers. The remaining 67 were patients with type 2 diabetes from which 3 groups were formed 23 formed newly diagnosed group while those on treatment for diabetes were 44 out of which 22 were type 2 diabetics on oral hypoglycemic agents and the other 22 were type 2 diabetics on insulin. Individuals suffering from HT, renal disease, liver disease, thyroid dysfunction, nephrotic syndrome & cardiac disease, alcoholics, smokers or on lipid lowering drugs were excluded. Statistical analysis was done using the pearsons correlation.Results: Lp(a) levels were found to be significantly increased in the diabetic group irrespective of whether newly diagnosed not on treatment or old cases on treatment with oral hypoglycemic agents or insulin. Lp(a) levels showed no correlation to the degree of glycemic control in these patients. Lp(a) positively correlates with total cholesterol, LDLc and negatively with TGL and VLDLc in diabetics while it does not correlate with any of the lipid parameters in controlsConclusions: The results of the present study suggest that Lp(a) levels are increased in type 2 diabetic patients. The elevated Lp(a) levels do not reflect the glycemic status and correlates with increase in total cholesterol and LDLc suggesting similar metabolic pathways and the genetic connection for LDL and Lp(a).

scholarly journals Awareness of Symptoms and Early Management of Hypoglycemia among Patients with Diabetes Mellitus

2018 ◽  
Vol 1 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Suresh K Sharma ◽  
Ravi Kant
Keyword(s):  
Diabetes Mellitus ◽  
Low Socioeconomic Status ◽  
Cross Sectional Study ◽  
Hypoglycemic Agents ◽  
Good Knowledge ◽  
Diabetic Patients ◽  
Oral Hypoglycemic Agents ◽  
Type 2 Diabetic Patients ◽  
Cross Sectional ◽  
Early Management

Background: Hypoglycemia mostly occurs in diabetic patients on medications. Lack of awareness on hypoglycemic symptoms among patients may delay its identification and treatment. The symptoms of hypoglycemic symptoms among patients may delay its identification and treatment. Neglecting the symptoms of hypoglycemia and delaying treatment could cause poorer outcomes or morbidity. The present study was aimed to assess the awareness of symptoms of hypoglycemia and knowledge in early management of hypoglycemia among patients with diabetes.Methods: A Cross sectional study was done among 500 diabetes mellitus patients attending the outpatient department of AIIMS, Rishikesh, Uttarakhand in 2017. Patient with diabetes for over five years and who were on insulin treatment were included in the study. After obtaining an informed consent, knowledge on the symptoms and early treatment of hypoglycemia were collected. The data were analyzed by frequency and percentage.Results: The study included 500 diabetic patients, of which 55.5% were females. The common symptoms of hypoglycemia known to the study subjects were dizziness (84.4%), weakness (74.1%), and drowsiness (68.1%). Overall, 322 (64.4%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Regarding management of hypoglycemia, 49% patients preferred taking glucose powder or sugar with water as an immediate measure. Higher age, illiteracy, low socioeconomic status was associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia.Conclusion: Although the knowledge on the symptoms, remedial measures, and prevention of hypoglycemic episodes was good among the type 2 diabetic patients in the study, there were gap in knowledge on important aspects like precipitating factors, target levels etc., which need to be addressed by health care workers through regular educational programs.Jour of Diab and Endo Assoc of Nepal 2017; 1(1): 12-17

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