Prevalence of Type 2 Diabetes Mellitus in Adult Population of Pakistan: A Meta-Analysis of Prospective Cross-Sectional Surveys

Nationwide prevalence of type 2 diabetes mellitus and pre-diabetes in Pakistan: A systematic review and meta-analysis

Type 2 diabetes mellitus (T2DM) and pre-diabetes (pre-DM) are significant health concerns in Pakistan. This systematic review and meta-analysis estimate the prevalence of T2DM and pre-DM, assessing regional, gender, and urban-rural differences. We searched PubMed, Scopus, Cochrane, and PakMediNet databases, identifying 3478 articles. After screening, 17 studies from 1995 to 2018 were included. The pooled prevalence of T2DM and pre-DM in Pakistan was found to be 10.0 % and 11.0 %, respectively. This equates to approximately 24 million individuals with T2DM and 26 million with pre-DM, totaling 50 million affected. Rural areas showed higher T2DM prevalence post-2000, with an odds ratio (OR) of 1.25 (95 % CI: 0.73 to 2.14). Gender analysis revealed a slightly higher, though statistically insignificant, prevalence of T2DM in females and a significantly higher prevalence of pre-DM in males (OR: 0.79, 95 % CI: 0.63 to 0.98). Regionally, Punjab had the highest T2DM prevalence (16 %), followed by Baluchistan (15 %), Sindh (14 %), and Khyber Pakhtunkhwa (KPK) (11 %). There is a substantial burden of T2DM and pre-DM in Pakistan, with significant regional and gender differences. Targeted interventions and resource allocation are needed to address the rising prevalence of diabetes, focusing on early detection and lifestyle modifications.

Piecing together Pakistan's health system and global health security

Pakistan's health system has a critical role to play in global health security, however, it faces numerous structural and systemic challenges while contributing to international health efforts. Understanding the dynamics of health system is essential for developing effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability, and the overall global health security This paper documents the strengths and weaknesses of Pakistan's health systems, the impact of the COVID-19 pandemic, challenges such as funding constraints and fragmented healthcare delivery, threats including antimicrobial resistance, and the importance of international collaboration. Anti-microbial particularly multi-drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety at the health care facilities to curtail healthcare associated infections, and strengthening the points of entry are still the areas that need special attention. To optimise the system's performance, governance and accountability mechanisms are necessary to be put in place under the auspices of national public health agency. Pakistan has the potential to transform its health system by addressing these critical areas and improve its preparedness and readiness for any future health emergency of this scale.

Cardiovascular Health and Disease in the Pakistani American Population

PURPOSE OF REVIEW

This narrative review seeks to elucidate clinical and social factors influencing cardiovascular health, explore the challenges and potential solutions for enhancing cardiovascular health, and identify areas where further research is needed to better understand cardiovascular issues in native and American Pakistani populations.

RECENT FINDINGS

The prevalence of cardiometabolic disease is high not only in Pakistan but also among its global diaspora. This situation is further complicated by the inadequacy of current cardiovascular risk assessment tools, which often fall short of accurately gauging the risk among Pakistani individuals, underscoring the urgent need for more tailored and effective assessment methodologies. Moreover, social determinants play a crucial role in shaping cardiovascular health. The burden of cardiovascular disease and upstream risk factors is high among American Pakistani individuals. Future research is needed to better understand the heightened risk of cardiovascular disease among Pakistani individuals.

Assessment of knowledge, attitude, and practices regarding the relationship of obesity with diabetes among the general community of Pakistan

This study sought to evaluate the influence of knowledge, attitude, and practices assessment on diabetes related to obesity in Pakistani society. Data was collected both through door to door and online survey approaches from 518 participants by using a pre-validated questionnaire. A total of 15.6% were underweight, 61.2% were normal weight, 17.2% were overweight and 5.8% were in obesity class I and 2.9% were classified as obesity class II. The co-occurrence of obesity and diabetes was 29% (n = 22) among diabetic individuals (n = 84). A majority of the residents (59.1%) were from cities. While 94% of the participants responded to what obesity was, 83.8% knew what diabetes was. Fast food, soft drinks, and mayonnaise were deemed to be healthy by 75.1% of the respondents. Obesity was viewed as a disease by 94.8%, a major health issue by 78.2%, and a weight-loss necessity by 44.6% of participants. Only 24.9% exercised every day, and 23.9% engaged in any physical activity daily. The majority of respondents (50.6%) never tried to lose weight and 23.2% ate junk food daily. The sociodemographic variables showed that the age ranges of 25-34 years (P < 0.001; OR 0.531), 45-54 years (P < 0.05; OR 0.527), and urban residency (P < 0.001; OR 0.128) had a significant association with knowledge. The factors of urban residency (P < 0.001; OR 3.996), being unmarried (P < 0.001; OR 1.95), and having an income of 51,000-70,000 (P < 0.001; OR 11.29) showed a very highly significant association with a good attitude regarding the relationship of obesity with diabetes (P < 0.05). Similarly, practices of the participants showed significant association with BMI range of 18.5-24.9 and 25-29.9 (P < 0.001). Our study revealed significant knowledge and understanding of the relationship between obesity with diabetes. However, it was observed that majority of respondents exhibited fundamental knowledge regarding obesity and diabetes, there was a notable absence of understanding regarding crucial elements, such as the significance of maintaining a healthy body weight, participating in physical activity, and implementing appropriate dietary strategies for weight control. We recognize the necessity for education initiatives and strongly encourage them to assist individuals in managing diabetes resulting from obesity.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Association of Hematological Parameters and Diabetic Neuropathy: A Retrospective Study

Background

Diabetic neuropathy (DN) is a common complication of type 2 diabetes (T2DM) and is characterized by persistent inflammation. Hematological parameters have emerged as a novel marker for detecting chronic inflammatory conditions, including diabetes.

Aim

We aim to examine the association between HbA1c levels, which can indicate the presence of diabetic neuropathy, and hematological parameters to explore the possibility of using hematological parameters as a new indicator for DN in T2DM patients.

Methods

This was a retrospective study of 768 (483 males and 284 females) medical records of adult T2DM patients with or without neuropathy who attending the outpatient neuromuscular clinic at King Abdul-Aziz University Hospital from January 2016 to December 2021.

Results

The results showed significant increases in HbA1c levels (p=0.000), lymphocyte levels (p=0.028), and the neutrophil-lymphocyte ratio (NLR) (p=0.011). In the T2DM group, HBA1C levels were found to be positively correlated with age (r=0.306, p=0.000), neutrophil (NEUT) (r=0. 287, p=0.000), platelet (PLT) (r=0. 148, p=0.039), and neutrophil-lymphocyte ratio (NLR) (r=0.306193, p=0.0007), and negatively correlated with gender (r=-0.306193, p=0.0007). In the T2DMN group, HBA1C levels showed a positive correlation with hemoglobin (HB) (r=0.084, p=0.045), PLT (r=0.087, p=0.037), and PLT/mean corpuscular hemoglobin (MCH) ratio (PLT/MCH ratio) (r=0.12, p=0.004), and a negative correlation with age (r=-0.204, p=0.000), gender (r=-0.086, p=0.041), weight (WT) (r=-0.113, p=0.007), Body Surface Area (BSA) (r=-0.09, p=0.031), mean corpuscular volume (MCV) (r=-0.292, p=0.000), and MCH (r=-0.186, p=0.000).

Conclusion

Our study found a significant association between HbA1c, a biomarker for diabetic neuropathy, and various hematological parameters (HB, MCV, MCH, PLT, PLT/MCH ratio) in T2DMN patients. By effectively controlling and monitoring these variables, it may be feasible to prevent or delay the progression of peripheral neuropathy in diabetic patients. However, further research is needed to validate these findings.

Diabetes and its associated factors: A Retrospective cohort analysis of a large database at Indus Hospital Health Network

Objectives

This is a retrospective cohort analysis of diabetes and its associated factors from Electronic Medical Record (EMR) of 2020-2022 of Indus Hospital Health Network (IHHN), Korangi campus Karachi.

Methods

Retrospective cohort study was conducted at Indus Hospital & Health Network (IHHN), Korangi Karachi. Out-patient records of adult patients of 2020-2022 were extracted from EMR of IHHN in March 2023. Descriptive statistics were presented as median (IQR) and frequency and percentage. Chi-square test determined association of risk-factors with diabetes and Wilcoxon-sign-rank test compared change in HbA1C from baseline.

Results

Data of 460,799 adult patients were extracted and analyzed. Median age of patients was 38.71 (27.87-52) years. Female preponderance was observed in our study. Out of 460,799, HbA1C was seen in 42,638 (9.25%) patients. Among these 29,596 (69.4%) had a HbA1C ≥ 6.5% while 13,042 (30.6%) had a HbA1C in the pre-diabetes range. Significant association was found between age, baseline creatinine, LDL and diabetes with no association depicted between gender, BMI, blood pressure, triglycerides, HDL and diabetes status. Patients in general had higher HbA1C at baseline as compared to last visit (p-value<0.001).

Conclusion

High blood pressure, obesity, increased creatinine, micro albuminurea, high LDL and Triglycerides were important risk factors for diabetes. This study reports a snap shot of the status of diabetes and associated risk-factors in the Pakistani population. This was the first time that a large data was extracted and analyzed from a healthcare institution in Pakistan, which would guide physicians and public health practitioners to take evidence-based decisions for prevention and management of diabetes.

Effect of PENN-DIABEX, a novel polyherbal formulation, in high fat diet streptozotocin-induced diabetic rats

Diabetes, a chronic metabolic disorder affecting millions worldwide, presents a significant health challenge characterized by impaired glucose regulation and potential complications. This study examines the antidiabetic effects of a polyherbal formulation (PENN-DIABEX) prepared from five different medicinal plant extracts. The objective is to ascertain its efficacy in managing streptozotocin (STZ) induced diabetes in rats. To accomplish this, six distinct groups of rats were involved five with induced diabetes and one serving as a normal control. Among the diabetic groups, one received no treatment, functioning as the diabetic control group. The remaining three groups were administered PHF in three different doses while the 6th group was given metformin. On the last day of the experiment, all rats were sacrificed, and blood samples were taken in collecting tubes to analyze blood biochemical parameters. Additionally, tissue samples from the liver, kidney, and pancreas were preserved in formalin solution for subsequent histopathological activity. The results of the study revealed that treatment with PHF in diabetic rats led to a significant (P < 0.01) improvement in fasting blood glucose levels (FBG), glycated hemoglobin (HbA1c), and various biochemical markers including LFTs, RFTs, and lipid profiling. Furthermore, the histology of the liver, kidney, and pancreas indicated that the formulation did not induce any metabolic toxicity. Comparative analysis of the antidiabetic effects of PHF with those of metformin, revealed that the PHF showed better results than the standard drug. This suggests its potential utilization as a safer and alternative approach in the treatment of diabetes.

Exploring the Indications, Levels, and Outcomes of Lower Extremity Amputation at a Tertiary Care Hospital in Pakistan

BACKGROUND

Lower extremity amputation (LEA) is a surgical procedure performed to remove either a part or the entire lower limb due to medical conditions such as trauma, infection, peripheral vascular disease, or malignancy. The procedure is becoming increasingly common in Pakistan, with a bulk of patients presenting from rural areas in tertiary care centers. Understanding the indications, levels, and outcomes of LEA is essential for improving patient care and adopting preventive strategies, especially in developing countries.

METHODOLOGY

This study was conducted at Dow University Hospital in Karachi, Pakistan. Retrospective data of 384 patients who underwent non-traumatic lower extremity amputations between January 2016 and December 2020 was collected to include relevant history and characteristics, amputation indication and level, type of anesthesia used, and outcome within hospital stay. The data was analyzed using descriptive statistics.

RESULTS

The data is composed of a wide age range (18 to 91 years) of patients, including a male majority (76.3%, n = 293). The employment status of the patients was taken into consideration, with a reported high number of unemployed individuals (60.4%, n = 232). Diabetes mellitus (84.4%, n = 324) was a commonly reported past medical condition, followed by hypertension (4.4%, n = 17). Indications for amputation exceedingly recorded were diabetic foot ulcers (84.4%, n = 324), followed by infections (9.4%, n = 36) and peripheral arterial disease (3.6%, n = 14). The anesthetic approach that was observed most in these patients was regional anesthesia (74.7%, n = 287). Right-sided amputations (52.9%, n = 203) were dominant, with below-knee amputations leading by the level of amputation performed (42.5%, n = 163). Many patients delayed seeking treatment (71.6%, n = 275) and indicated denial of severity (18%, n = 69) as a reason for the delay. Regarding outcome, many patients were successfully discharged following treatment (85.9%, n = 330).

CONCLUSION

Overall, LEAs are being frequently performed in developing countries, such as Pakistan, especially with a large population living with diabetes mellitus. The implications of this disease are reflected in this study population, with the majority of patients reporting delays in treatment due to reasons such as the unknown severity of the disease or financial burdens. The challenges faced by these individuals, especially in this country, can be tackled with widespread affordability and availability of care and education on early management.

South Asian Endocrinology: Challenges and Concerns, Collaboration and Consolidation

The practice of endocrinology in South Asia poses many challenges but simultaneously offers unique opportunities. The population in this region is predisposed to diabetes and cardiovascular disease at a much lower body mass index compared to Caucasians. Dietary deficiencies, higher prevalence of infection and distinct environmental and genetic factors further complicate the presentation of endocrine disorders. Over the past few decades, important breakthroughs have been made to confront these challenges. Collaboration among the endocrine fraternity of the South Asian countries will help to consolidate these gains and pave the way forward for a healthier region.

Prospective Nutraceutical Effects of Cinnamon Derivatives Against Insulin Resistance in Type II Diabetes Mellitus-Evidence From the Literature

Apart from advances in pharmaceutical antidiabetic agents, efforts are being made toward hypoglycemic agents derived from natural sources. Cinnamon has been reported to have significant benefits for human health, particularly as an anti-inflammatory, antidiabetic, and anti-hypertriglyceridemic agent. The phytochemicals in cinnamon can be extracted from different parts of plant by distillation and solvent extraction. These chemicals help in decreasing insulin resistance and can act against hyperglycemia and dyslipidemia, inflammation and oxidative stress, obesity, overweight, and abnormal glycation of proteins. Cinnamon has shown to improve all of these conditions in in vitro, animal, and/or human studies. However, the mechanism of action of active ingredients found in cinnamon remains unclear. The current review presents the outstanding ability of cinnamon derivatives to control diabetes by various pathways modulating insulin release and insulin receptor signaling. It was also found that the type and dosage of cinnamon as well as subject characteristics including drug interactions are likely to affect the response to cinnamon. Future research directions based on this review include the synergistic usage of various cinnamon derivatives in managing and/or preventing diabetes and possible other relevant chronic diseases.

Risk factors of previously undiagnosed and known untreated hypertension among patients with Type-2 diabetes mellitus

Objectives

To find the risk factors of previously undiagnosed and known untreated hypertension among patients with Type- 2 diabetes mellitus.

Methods

The cross-sectional analytical study was conducted at Diabetes Clinic of Sir Ganga Ram Hospital Lahore during Oct-Dec 2021. Total 153 known diabetics were enrolled using convenience sampling. Patients (n=24) with ischemic heart disease, hepatitis or missing information excluded. Data from 129 cases of Type-2 diabetes presenting with and without hypertension analyzed using SPSS. Binary logistic regression analyses were performed to calculate the adjusted odds ratios.

Result

Mean age of all diabetics (n=129) was 49.0±10.7 years. The participation of females was higher than males (65.1% vs. 34.9%). The frequency of hypertension, previously undiagnosed hypertension and known untreated hypertension was 58.1%, 25.3% and 19.6%, respectively. Among risk factors, frequency of high intake of salt was 67.4%, sedentary lifestyle was 65.1%, obesity was 37.2%, and poor glycemic control was 58.9%. Young age [aOR=2.01, 95.0% CI 0.53-7.61], low family income <20000 PKR/month [aOR=2.70, 95.0% CI 0.92-7.96], high intake of salt [aOR=3.22, 95.0% CI 0.98-10.61], elevated total cholesterol [aOR=3.68, 95.0% CI 0.85-15.85], poor glycemic control [aOR=3.28, 95.0% CI 0.51-21.13], and overweight/ obesity [aOR=9.07, 95.0% CI 1.6-51.39] had higher risk of previously undiagnosed or known untreated HTN.

Conclusions

Prevalence of previously undiagnosed and known untreated hypertension is high among Type-2 diabetics. Strict compliance to diabetes care guidelines is much needed to minimize the risk of undiagnosed and untreated hypertension.

Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016

BACKGROUND

Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified.

METHODS

Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using "wealth index" and "weight perception" as additional variables.

RESULTS

There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged "60 years or older" with a wealth index of "rich" or "richer", followed by participants from the same age group who were "poor" or "poorer" and participants aged "40-59 years" with a wealth index of "rich" or "richer". Subsequently were participants from the age group "15-39 years" with a weight perception of "overweight" or "obese".

CONCLUSION

Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.

Novel 5-(Arylideneamino)-1H-Benzo[d]imidazole-2-thiols as Potent Anti-Diabetic Agents: Synthesis, In Vitro α-Glucosidase Inhibition, and Molecular Docking Studies

A novel series of multifunctional benzimidazoles has been reported as potent inhibitors of α-glucosidase. The procedure relies on the synthesis of 5-amino-1H-benzo[d]imidazole-2-thiol 5 via the multistep reaction through 2-nitroaniline 1, benzene-1,2-diamine 2, 1H-benzo[d]imidazole-2-thiol 3, and 5-nitro-1H-benzo[d]imidazole-2-thiol 4. Further treatment of 5 with aromatic aldehydes 6a-m provided access to the target 5-(arylideneamino)-1H-benzo[d]imidazole-2-thiols 7a-m. The results of the bioactivity assessment revealed all the compounds as excellent inhibitors of the enzyme (IC₅₀ range: 0.64 ± 0.05 μM to 343.10 ± 1.62 μM) than acarbose (873.34 ± 1.21). Among them, 7i was the most active inhibitor (IC₅₀: 0.64 ± 0.05 μM) followed by 7d (IC₅₀: 5.34 ± 0.16 μM), 7f (IC₅₀: 6.46 ± 0.30 μM), 7g (IC₅₀: 8.62 ± 0.19 μM), 7c (IC₅₀: 9.84 ± 0.08 μM), 7m (IC₅₀: 11.09 ± 0.79 μM), 7a (IC₅₀: 11.84 ± 0.26 μM), 7e (IC₅₀: 16.38 ± 0.53 μM), 7j (IC₅₀: 18.65 ± 0.74 μM), 7h (IC₅₀: 20.73 ± 0.59 μM), 7b (IC₅₀: 27.26 ± 0.30 μM), 7k (70.28 ± 1.52 μM) and finally 7l (IC₅₀: 343.10 ± 1.62 μM). Molecular docking revealed important interactions with the enzyme, thereby supporting the experimental findings.

Eid-al-Fitr festivity and Ramadan fasting attitude among individuals with diabetes from Saudi Arabia and Pakistan: a cross-sectional study

OBJECTIVES

The present study aimed to assess the attitude of Saudi and Pakistani individuals with diabetes regarding Eid-al-Fitr festivities, exploring diabetes care during the month of Ramadan and these individuals' dietary patterns on Eid day.

DESIGN

Cross-sectional study.

SETTING

Jeddah (Saudi Arabia) and Karachi (Pakistan).

PARTICIPANTS

Of the total 405 subjects, 204 individuals with diabetes from Saudi Arabia (SA) and 201 from Pakistan (Pak) were enrolled.

DATA COLLECTION AND ANALYSIS

This survey-based study was carried out in SA and Pak after Eid-al-Fitr 2020. An online questionnaire was circulated via various social media platforms. The data analyses were performed using SPSS V.26.

RESULTS

There were 80 subjects with type 1 diabetes mellitus (DM) and 325 subjects with type 2 DM. Among our study subjects, 73 were on insulin, 260 were on oral antidiabetics (OADs) and 72 were taking both OADs and insulin. Two-thirds of the participants, 276 (68%) visited their physicians before Ramadan. Many participants (175, 43.2%) broke their fast a day or more because of diabetes. Many participants consumed sugary food on Eid day. The use of chocolates, sugary foods and fresh juices on Eid-al-Fitr was higher in Saudi subjects than in Pakistani ones (p<0.001). Saudi subjects with diabetes adhered more strictly to medications during Ramadan than Pakistani subjects (p=0.01). Saudi participants were more compliant with monitoring DM during Eid-al-Fitr compared with Pakistani subjects. Many participants in both groups felt stressed or depressed and stated that their Eid celebrations were restrictive because of their DM conditions.

CONCLUSIONS

Most Saudi and Pakistani participants enjoyed Eid celebrations by abstaining from dietary restrictions. The sugar consumption attitude during Eid day was not up to the mark. Many subjects broke their fasts for a day or more because of diabetes. Saudis were more vigilant in monitoring DM than Pakistanis during Eid-al-Fitr. Individuals with diabetes should consult their physicians before Ramadan for checkups and counselling.

Frequency distribution and association of Fat-mass and obesity (FTO) gene SNP rs-9939609 variant with Diabetes Mellitus Type-II population of Hyderabad, Sindh, Pakistan

BACKGROUND/AIM

Diabetes Mellitus (DM) is one of the important public health issues worldwide. The Fat mass obesity (FTO) gene rs-9939609 variant identified single nucleotide polymorphism (SNP) with the T to A missense mutation, and has a strong association with T2DM. FTO gene is present on chromosome "16q12.2" comprising of nine exons. FTO gene rs-9939609 a variant is commonly found in the Pakistani Population. The purpose of the study was to alert the population about the rs-9939609 variant SNP, having a strong association with T2DM.

MATERIAL AND METHODS

Total of 190 participants were included in the present cross-sectional study. To collect the samples non-probability convenience technique was used. subjects were recruited and divided into three groups, normal healthy subjects, obese and T2DM. The patients were selected from the Medicine department Jamshoro/Hyderabad by filling the pre-designed proforma, as well as verbal and written consent taken from study participants. To analysed the data ANOVA Post hoc (Tukey-test) was applied for comparison among groups (P < 0.05) and "SNP-STAT" online software was used for frequencies.

RESULTS

The BMI, neck circumference, waist circumference and lipid profile, fasting blood sugar and HbA1c was found significant (p < 0.001) in both genders as compared to control. Homozygous and heterozygous distribution of allelic and genotyping frequency was found in study participants. 37.9 %T/A, 57.4% T/T, and A/A were 4.7%. The FTO gene rs-9939609 variant amplified and have an increased risk of developing T2DM in the Sindh population. Codominant model odd ratio of T/A showed 2.42 (CI)1.23-3.84, with significant p < 0.032.

CONCLUSION

The present study concluded that the FTO gene SNP rs-9939609 variant was found in the population of Hyderabad, Sindh and having strong association with T2DM and obese individuals. Increase BMI, neck and waist circumference are the biomarkers of obesity and causative factors of T2DM.

Association of Low Magnesium Level With Duration and Severity of Type 2 Diabetes

Introduction: Type 2 diabetes mellitus can give rise to several complications in the body, including electrolyte imbalance. In this study, we aim to find the association of hypomagnesemia with the duration and severity of diabetes. Understanding the association between magnesium and diabetes may assist in the early detection of hypomagnesemia and help manage the complications associated with electrolyte imbalance.

Methods: This cross-sectional study was conducted in the internal medicine department of a tertiary care hospital in Pakistan from January to March 2021. Three hundred (n = 300) patients with a confirmed diagnosis of type 2 diabetes were enrolled in the study after informed consent via consecutive convenient non-probability sampling. Three hundred (n = 300) patients were included in the study as a reference group. Blood was drawn via phlebotomy and sent to the laboratory to assess glycated hemoglobin (HbA1c) and magnesium levels.

Results: In uncontrolled diabetic patients, mean magnesium level was significantly lower as compared to diabetic patients with good glycemic control (1.34 ± 0.3 mg/dL vs. 1.81 ± 0.5; p-value: <0.0001). Prevalence of hypomagnesemia was significantly more in patients with uncontrolled diabetes, compared to the controlled diabetic group (65.8% vs. 50.8%; p-value: 0.009). In patients with a duration of diabetes of more than 10 years, the mean magnesium level was significantly lower, compared to patients with less than 10 years of diabetes (1.32 ± 0.3 mg/dL vs. 1.78 ± 0.5; p-value: <0.0001). Prevalence of hypomagnesemia was significantly more in patients with diabetes for more than 10 years (64.7% vs. 51.9%; p-value: 0.02).

Conclusion: Hypomagnesemia is prevalent in diabetes and is directly related to the severity and duration of diabetes. It is important to include electrolyte screening as a part of routine screening in diabetic patients for early detection and management of electrolyte imbalance, including hypomagnesemia.

Noninvasive exploration of Cardiac Autonomic Neuropathy by heart rate and blood pressure variability analysis in Type 2 Diabetic patients

Objectives

To determine the prevalence of asymptomatic cardiac autonomic neuropathy and its association with risk factors among patients with Type-2 diabetes mellitus (T2DM).

Methods

The present case-control study was conducted at Department of Medicine, Civil Hospital, Dow University of Health Sciences (DUHS), Karachi, Pakistan during the period September` 2016 to May` 2017. After taking informed consent, subjects from both genders, 72 healthy controls and 72 clinically diagnosed T2DM diabetic patients, age between 30-65 years were selected by non-probability sampling technique. After taking medical history and demographics, Cardiac Autonomic Neuropathy (CAN) was identified by using Ewing`s cardiac autonomic reflex tests (CARTs) and association of risk factors was also investigated.

Results

Severe CAN was identified in 13.9% of T2DM patients while in none of the healthy controls. HR response to deep breathing test was most sensitive (sensitivity= 90%) among all tests. The most common symptoms were Numbness (75.9%) and constipation (69%), resting heart rate and diabetes duration was significantly associated with DCAN.

Conclusions

CAN was highly prevalent in diabetic population that may lead to nephropathy and retinopathy in future. It is highly recommended to use sensitive and simple CARTs in clinics for early detection and early treatment of CAN.

Effect of roux-en Y gastric bypass surgery on patients with type 2 diabetes mellitus: A protocol of systematic review and meta-analysis

BACKGROUND

Previous studies have reported that roux-en Y gastric bypass surgery (RYGBS) can benefit patients with type 2 diabetes mellitus (T2DM). However, their conclusions are still inconsistent. Thus, this study will aim to assess the effect of RYGBS for patients with T2DM.

METHODS

In this study, the electronic databases of MEDLINE, EMBASE, CENTRAL, CINAHL, AMED, and CNKI from inceptions to the present without any limitations to language and publication status. All randomized controlled trials on assessing the effect of RYGBS for patients with T2DM will be included in this study. Two independent authors will carry out study search and selection according to the previous designed inclusion and exclusion criteria. At the same time, 2 authors will independently evaluate the risk of bias assessment by Cochrane risk of bias tool. Any disagreements between 2 authors will be solved by a third author through discussion. RevMan 5.3 software will be utilized for statistical analysis.

RESULTS

This study will summarize the most recent studies and will provide a deeper understanding about using the effect of RYGBS for patients with T2DM.

CONCLUSIONS

The findings of this study will present the existing evidence for the effect of RYGBS for patients with T2DM.

SYSTEMATIC REVIEW REGISTRATION

INPLASY202040127.