Reversible supraventricular tachycardia complicating diabetic ketoacidosis in an adult patient: A case report

Diabetic ketoacidosis (DKA) is a commonly encountered serious acute metabolic complication of diabetes mellitus (DM) in adolescents and young adults. It is traditionally associated with poorly treated or newly diagnosed type 1 DM, however, in the setting of type 2 DM, inadequate insulin treatment, non-compliance to treatment, newly diagnosed DM, acute illnesses, drugs, and extreme stress can precipitate DKA. We report the case of a 42-year-old known diabetic of 7 years duration with a family history of DM who presented with a two-week history of difficulty in breathing, polyuria, and vomiting. On further examination, pulse rate was 220 beats per minute, respiratory rate 40 cycles per minute, temperature 38.4’C. Random blood sugar was 18.1mmol/l with ketonuria ++. Severe acidosis and mild hypokalemia were noted with her electrocardiogram (ECG) showing supraventricular tachycardia. She was managed and discharged in stable condition with a normal ECG after 20 days on admission to continue basal and pre-meal insulin at home. Adequate diabetic education was conducted and follow-up with endocrinology and cardiology units was advised.

Determinants of diabetes ketoacidosis among diabetes mellitus patients at North Wollo and Waghimra zone public hospitals, Amhara region, Northern Ethiopia

Background Diabetes Mellitus (DM) is a metabolic disorder associated with acute and chronic complications. Diabetic ketoacidosis (DKA) is the most serious diabetic emergency in patients with type one and type two diabetes mellitus. It is the leading cause of mortality in children and young adults. Even though the burden of DKA has increased, no research has been conducted on the determinants of Diabetes ketoacidosis in Ethiopia, particularly in the Amhara region. Thus, this study aimed to identify the determinants of diabetes Ketoacidosis among Diabetes Mellitus patients at North Wollo and Waghimra Zone public Hospitals. Methods An institution-based unmatched case-control study design was employed among 408 patients at North Wollo and Waghimra Zone Public Hospitals from March 1st to April 30th, 2020. A consecutive sampling method was used to select study participants. The data were collected using structured interviewer-administered questioners and reviewing of patient charts. The analysis was done using a binary logistic regression model. Then, P-value < 0.05 was considered statistically significant. Result The mean (±SD) age of the study participants was 46.96 (± 15.175 SD) years. Irregular follow-up in diabetes clinic (AOR:4.19, 95% CI: 2.28–7.71), not received diabetic education (AOR: 2.87, 95% CI:1.44–5.72), alcohol drinking (AOR:2.99, 95% CI: 1.46–6.12), discontinuation of medications (AOR: 4.31, 95% CI:1.92–9.68), presence of comorbidity (AOR:2.57, 95% CI: 1.37–4.84), and being type one of diabetes mellitus (AOR: 2.01, 95% CI:1.11–3.63) were determinant factors of diabetic ketoacidosis . Conclusions This study showed that the behavioral and clinical characteristics of diabetic patients were determinant factors of DKA. Follow-up in the diabetic clinic, diabetic education, discontinuation of medications, alcohol drinking, presence of comorbidities, and type of diabetes mellitus were independent determinants of diabetic ketoacidosis.

An Explorative Qualitative Study on Pharmacist Active Engagement Approach in Primary Healthcare Diabetic Education

The conventional counseling method focuses on imparting knowledge meanwhile active engagement approach would enhance patient’s participation and control in the health management process. This study explored the various elements that affect the pharmacist-patient active engagement during diabetes counseling sessions in primary healthcare settings. A qualitative study using thematic analysis of semi-structured interviews was utilized. Subjects were recruited from five primary healthcare clinics in Kuala Lumpur. Ten pharmacists actively running the diabetes medication therapy adherence clinical (DMTAC) counseling and 15 patients who are currently enrolled under the DMTAC program participated in this study. A combination of computer software ATLAS.ti and hand-written methods were used in the mind mapping to assist with the development of the themes. The qualitative analysis identified themes associated with pharmacist active engagement approach include establish rapport (subthemes: introduction and greetings, ice-breaking, background check, attitude, pharmacist motivation), getting information to explore the patient problems (subthemes: giving attention, communication, the time factor, re-assess patients’ understanding), building relationship (subthemes: sharing of ideas, emotions, relationship, trust, sensitiveness, support and belief), explanation and planning (subthemes: making a decision and mutual discussion) and closing the session (subthemes: accessibility to pharmacists, DMTAC appointments). This study established areas of active engagement namely, shared decision-making, engaging communication, and motivational interview skills that should be imparted to the pharmacists to enhance the current diabetes counseling practice.

Analysis of YouTube as a Source of Information for Diabetic Foot Care

Background: Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube. Methods: YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected. Results: Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P &lt; .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos. Conclusions: This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos.