Journal of Diabetes and Endocrine Practice

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Context: Diabetic foot ulcer (DFU) is one of the most dreaded complication of diabetes which often affects the morbidity and mortality of a diabetic. Biomarkers are required for follow-up of these patients to prevent further complications to the affected limb. Aim: The aim of this study is to evaluate ischemia-modified albumin (IMA), fibrinogen in relation with high sensitive-C-reactive protein (hs-CRP) in patients with DFUs. Methods: a hospital-based cross-sectional study was carried out among 30 patients with DFU admitted in the surgery department of tertiary care teaching hospital. The duration of the study was 2 months. Serum IMA, hs-CRP, and plasma fibrinogen levels were measured. Results: The present study has demonstrated that IMA levels (P < 0.05) and fibrinogen levels (P < 0.05) are statistically significantly elevated in patients with DFU and had significant correlation with albumin and hs-CRP (P < 0.05). Conclusions: The use of IMA, hs-CRP, and fibrinogen may be incorporated during the follow-up of type 2 diabetes mellitus patients and may probably prevent the development of DFU and also possibly prevent lower limb amputation. Further studies with a larger number of patients with DFU are necessary to reach a definitive judgment.

Background and Objectives: Thyroid disorders are very common in the general population, and it is second only to diabetes as the most common condition to affect the endocrine system. In this study, we try to observe the prevalence of the type of thyroid dysfunction in patients with type 2 diabetes mellitus (T2DM). and its effect on glycemic parameters and the prevalence of autoimmune thyroid disorder in patients with T2DM. Settings and Design: This study included adults having T2DM. Patients were explained about the nature of the study and consent was obtained. Materials and Methods: Clearance was taken from the ethics committee. All participants who met the inclusion criteria were subjected to detailed clinical examination and relevant investigation. Statistical Analysis: Chi-square test was used for the analysis. Results: Two hundred and thirty-four patients (112 males and 122 females) were included in the study. The mean body mass index was high (26.21 ± 3.13 kg/m²). The mean hemoglobin (Hb) A1c was 8.81% ± 1.96%, whereas mean HbA1c in patients with both T2DM and thyroid dysfunction was 9.68% ± 1.35%. Thyroid dysfunction was found in 84 cases (35.8%), out of which the most common thyroid abnormality was overt hypothyroidism (61.9%) followed by subclinical hypothyroidism (27.3%). Out of 84 cases with thyroid dysfunction anti-thyroid peroxidase (TPO) was found positive in 45 cases (53.5%), and the most common thyroid dysfunction associated with positive anti-TPO was subclinical hypothyroidism (44%). Conclusions: The study shows a high prevalence of thyroid dysfunction among patients with T2DM and its association with poor glycemic control. The study also shows the prevalence of anti-TPO among patients and its significant correlation with thyroid dysfunction.

BAckground and Objectives: Thyroid cancer incidence is increasing globally. There is limited data regarding the epidemiology of thyroid cancer in the Middle East and North Africa region. This region has also experienced socioeconomic changes recently that have influenced the histopathological and epidemiological pattern of thyroid cancer. The aim of this study is to evaluate the histological, epidemiologic, and surgical factors of thyroid cancer patients who underwent thyroidectomy at Cleveland Clinic Abu Dhabi. Materials and Methods: A retrospective review of patients who underwent thyroidectomy and found to have thyroid cancer over a 2-year period from July 2015 - July 2017. The histopathological data were reviewed based on the College of American Pathologists Protocol for Carcinomas of Thyroid Gland (American Joint Committee on Cancer, 7^th edition, 2010). Results: One hundred patients underwent surgery for thyroid carcinoma in our patient population. In these cancer patients, the female to male ratio was 5.25:1 and 71 patients (71%) were below 45 years of age. The most common surgery performed was total thyroidectomy at 75.7%. Papillary thyroid carcinoma (PTC) was the most common pathology in 89%, followed by follicular thyroid carcinoma (FTC) in 9%, one case of mixed papillary follicular carcinoma, and one case of Hurthle cell carcinoma. Hypocalcemia was the most common postoperative complication (20.6%). Conclusion: PTC, traditionally seen in iodine sufficient regions, is the most common histologic subtype of thyroid cancer and its rates are increasing in the United Arab Emirates (UAE). Female gender and age <45 were associated with thyroid carcinoma in our UAE patient cohort.

Background and Objective: Chronic hepatitis C infection can affect glycemic control in patients with diabetes mellitus (DM). This study was done to assess the influence of hepatitis C viral infection compared to hepatitis B viral infection and noninfected cases on the occurrence of secondary oral anti-hyperglycemic drugs (OADs) failure in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: This prospective study was conducted on 1293 T2DM patients who had their hepatitis B and C status checked by the enzyme-linked immunosorbent assay method. Glycemic management was done according to the standard guidelines, and glycemic control was reviewed after 6 months of enrollment. Patients who had hemoglobin HbA1c >7.5% in spite of taking >75% of the maximum dosage of three OADs, that is, metformin, sulfonylurea, and thiazolidinediones were selected. Those who were already taking insulin therapy regardless of HbA1c were also considered as secondary OADs failure. The status of secondary OADs failure was analyzed in three groups: hepatitis C virus (HCV) positive, hepatitis B virus (HBV) positive, or noninfected patients. Results: Of selected 1293 cohorts, DM with HCV positive was 152 (11.7%), and DM with HBV positive was 111 (8.5%). Among 152 HCV-positive patients, secondary OADs failure was detected in 64 (42.1%), and in those with 111 HBV-positive patients, it was detected in 30 patients (27.02%), whereas it was 177 of 1030 noninfected patients (17.1%). Conclusion: Hepatitis C infection is more common than hepatitis B infection among diabetes patients. Secondary OADs failure is significantly associated with HCV-infected diabetes patients compared to other groups, and timely consideration of insulin initiation is important in these cases.

Background: Preclinical and clinical studies have shown the importance of calorie restriction diet in weight reduction and cardiovascular risk factors. In this study, our objective is to compare the naturopathic-based short-term fasting therapy with low-calorie diet (LCD) on anthropometric and lipid profile among obese and overweight persons. A total number of subjects (n = 100) with body mass index (BMI) ≥25 were randomly allocated into either fasting therapy intervention (n = 48) or a LCD (n = 52). Materials and Methods: Participants underwent very LCD (288–904 kcal) in fasting therapy and a LCD (1234 kcal) in the other group respectively for 10 days. Individuals in both the groups were assessed with anthropometric parameters such as BMI, weight, waist circumference, hip circumference and waist-hip ratio, serum lipid profile, and serum leptin levels at the baseline and after 10 days. Results: The anthropometric measurements were decreased significantly in the fasting group when compared with the LCD group (P < 0.05). The decrease in mean serum total cholesterol (TC) (−27.43%), triglycerides (TGs) (−13.05%), and low-density lipoprotein (LDL) (−20.9%) in the treated group were statistically significant (P < 0.001), whereas serum high density lipoprotein (2.32%) was increased but insignificantly (P > 0.001) when compared with the nontreated group. Conclusions: Our findings support that short-term fasting therapy is beneficial in anthropometric measures and reducing leptin level among obese or overweight person compared to LCD. However, long-term adherence of weight loss with these interventions should be tested in future studies with bigger sample size.

Online since 29^th Sep 2017.