Series of Endocrinology, Diabetes and Metabolism

Volume 1, Issue 2 | JSEDM

Research Article

Diabetic Foot Ulcers in a Kenyan Referral and Teaching Hospital: Risk Factors, Patient Characteristics and Clinical Outcomes

Mutonga DM*, Mureithi MW, Ngugi NN and Otieno FC

Diabetic Foot Ulcers in a Kenyan Referral and Teaching Hospital: Risk Factors, Patient Characteristics and Clinical Outcomes Read More »

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Mutonga DM, Mureithi MW, Ngugi NN, et al. Diabetic foot ulcers in a Kenyan referral and teaching hospital: risk factors, patient characteristics and clinical outcomes. Series Endo Diab Met. 2019;1(2):41-51.
Introduction: The burden of diabetes mellitus (DM) is increasing in resource-poor settings leading to a rise in diabetic complications. Foot complications result in almost half of all hospital admissions among diabetic patients and may result in amputations or death. Objective: To investigate the sociodemographic, clinic-laboratory characteristics and clinical outcomes of patients with diabetic foot ulcers (DFU) in a clinical setting. Materials and Methods: A cross-sectional study of 84 adult consecutive inpatients and outpatients at Kenyatta National Hospital (KNH) with any type of DM and having active DFU was conducted over 12 months. History and physical examinations findings were recorded through a structured questionnaire. Relevant data on the most recent blood tests and clinical outcomes for patients with foot ulcers were retrieved from the patients’ medical notes and analysed. Results: Majority (68%) were inpatients. The mean age was 60.30 years with 68% living in urban areas and 60% having minimal or no formal education. 8% were newly diagnosed with DM. The median duration of DM was 6.5 years. A majority (96%) had type 2 diabetes mellitus (T2DM). 45% were on insulin only, 18% on oral drugs only and 32% on a combination of both. The median random blood sugar was 9.60 mmol/L and glycated haemoglobin was 8.80%. Although 61% of patients had co-morbid hypertension, only about 40% had elevated systolic blood pressure (BP) while 23% had elevated diastolic pressures. A majority of the patients had good lipid profile, 85% with desirable total cholesterol and 70% having ideal low-density lipoproteins. The mortality rate among patients with DFU was 11%. Conclusion: There are poor outcomes for patients with DFU in this setting such as poor wound healing, high recurrence rates, increased amputations and mortality compared to previous studies. However, the prevalence of uncontrolled hypertension, dyslipidaemia and neuropathy was much lower than earlier local reports.
Article DOI: 10.54178/jsedmv1i2004
Case Report

Sclerosteosis: A Rare, Sclerosing Bone Dysplasia in a Bangladeshi Male

Morshed S*, Jahan S, Hasan M, Yadav A, Faisal I, Hasanat MA and Fariduddin M

Sclerosteosis: A Rare, Sclerosing Bone Dysplasia in a Bangladeshi Male Read More »

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Morshed S, Jahan S, Hasan M, et al. Sclerosteosis: a rare, sclerosing bone dysplasia in a Bangladeshi male. Series Endo Diab Met. 2019;1(2):35-40.
We report a 26-year-old male who was initially diagnosed as osteopetrosis and referred for endocrine evaluations. But due to specific clinical features supported by investigations, we diagnosed the case as sclerosteosis. The patient was managed by a multidisciplinary team approach. Sclerosteosis may be erroneously diagnosed as osteopetrosis. However, many unique features make it a separate entity.
Article DOI: 10.54178/jsedmv1i2003
Short Communication

How to Classify Type 2 Diabetes Mellitus and Approach its Treatment in View of Associated Diabetes and Complications-A Short Communication

Kaur KK*, Allahbadia G and Singh M

How to Classify Type 2 Diabetes Mellitus and Approach its Treatment in View of Associated Diabetes and Complications-A Short Communication Read More »

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Kaur KK, Allahbadia G, Singh M. How to classify type 2 diabetes mellitus and approach its treatment in view of associated diabetes and complications-a short communication. Series Endo Diab Met. 2019;1(2):29-34.
With the increase in epidemic of obesity, the incidence of type 2 diabetes mellitus (T2DM) is increasing globally so much that the need has arisen for treating the two diseases together with the term diabesity getting coined. Here, we have tried to sub-classify T2DM stage-wise and how the treatment should be aimed keeping in view the use of weight-neutral anti-diabetic drugs. Preferably, insulin needs to be avoided due to its weight gaining effects and use of liraglutide should be preferred in the heavily obese diabetics due to its weight lowering effects. If the patient is in stage 4 group where insulin is practically non-existent, one can try using anti-obesity drugs along with insulin or see which works better with the influence of bariatric surgery seen on controlling diabetes in morbidly obese subjects.
Article DOI: 10.54178/jsedmv1i2002
Perspective

Gestational Diabetes Mellitus a Dysfunctional Metabolic State-A Perspective

Sheriff DS*

Gestational Diabetes Mellitus a Dysfunctional Metabolic State-A Perspective Read More »

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Sheriff DS. Gestational diabetes mellitus a dysfunctional metabolic state-a perspective. Series Endo Diab Met. 2019;1(2):24-28.
Pregnancy is considered as a test for beta cell reserve. If there is a good function, insulin resistance will overcome. If not, gestational diabetes will occur. Insulin resistance (IR) present in normal pregnancy is required to provide nutrients to the growing fetus. There is a rapid increase of insulin in such an insulin resistant state. The possibility of lipid deposition in muscle fibers (intramyocellular) could be one of the possible mechanism of IR in gestational diabetes mellitus (GDM). The poor response of insulin release, possible fat deposition in the skeletal muscle or ectopic fat deposition may cause dysfunctional homeostasis in GDM. This will definitely influence the fine tuning of metabolic machinery of a growing fetus. Children born with such subtle metabolic state will probably be more prone to glucose intolerance and ectopic lipid deposition. The finding that children born to GDM mothers are prone to glucose intolerance may be an eye-opener to monitor such children for beta cell function.
Article DOI: 10.54178/jsedmv1i2001
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