Baqai Institute of Diabetology and Endocrinology

Abstract Despite the scarcity of data, individuals with type 1 diabetes mellitus (T1D) and diabetic kidney disease (DKD) are considered at moderate to high risk for Ramadan fasting and are individually advised against fasting.This subgroup analysis of the Diabetes and Ramadan (DaR) global survey was conducted to evaluate the outcomes and characteristics of patients with T1D complicated by DKD who observe fasting and to compare their outcomes with those of fasting people living with T1D uncomplicated by DKD.Using a specifically designed SurveyMonkey questionnaire, Muslim individuals with T1D and DKD were surveyed in several countries from different geographical regions and compared statistically to people with T1D without DKD or associated comorbidities.Note that 53.8% (N = 86) of individuals with T1D and DKD fasted during Ramadan in comparison with 74% (N = 1,523) of the control group. Those with DKD experienced higher rates of hypoglycemia (65.1%) and hyperglycemia (69.6%) than the control group (56.5 and 42.5%, respectively). They also had more frequent emergency visits and hospitalizations. Additionally, among individuals with T1D and DKD, nonfasters exhibited significant differences in biochemical markers and demographics compared with those who fasted.Individuals with T1D and DKD are generally older, have multiple diabetes-related complications, and are less likely to fast during Ramadan. For those who do fast, the risks are significant, including higher rates of hypoglycemia and hospital admissions compared with the control group. Ensuring safe fasting in this population requires interdisciplinary collaboration, patient education, and expert medical guidance.

Acute pancreatitis is a potentially life-threatening inflammatory condition with variable clinical presentations. Early risk stratification remains challenging despite existing scoring systems. The red blood cell distribution width-to-albumin ratio (RAR) has emerged as a potential prognostic biomarker in inflammatory conditions. This systematic review and meta-analysis aimed to evaluate the association between admission RAR and outcomes in acute pancreatitis. We conducted a comprehensive literature search and identified five retrospective studies meeting the inclusion criteria. Meta-analysis was performed to assess the relationship between RAR and mortality as well as disease severity in acute pancreatitis patients. Pooled analysis demonstrated that elevated RAR was significantly associated with increased mortality risk (risk ratio (RR): 2.11, 95% confidence interval (95% CI): 1.35-3.30) with moderate heterogeneity (I²: 46%). When comparing disease severity, mean RAR values were significantly lower in mild acute pancreatitis compared to severe cases (mean difference (MD): -1.78, 95% CI: -2.09 to -1.46), also with moderate heterogeneity (I²: 44%).This meta-analysis suggests that RAR, a simple and cost-effective biomarker available from routine blood tests, may serve as a valuable prognostic indicator for mortality and severity in acute pancreatitis. Despite having comparatively lower discriminative ability than conventional scoring systems, RAR offers advantages in terms of rapid assessment and cost efficiency. However, limitations include the small number of included studies, their retrospective nature, and heterogeneity in study settings. Further prospective studies are warranted to validate these findings.

Background Managing diabetes during Ramadan fasting is a challenge due lifestyle changes. We described the characteristics and patterns of care for type 2 diabetes mellitus (T2DM) during Ramadan 2020 and 2022. Methods Our study included multinational Muslims with T2DM who were during routine consultation. We collected data on demographics, fasting characteristics, and complications. Descriptive statistics, chi-square test, and multiple testing were performed. Results 12,529 patients participated. Mean age was 55.2 ± 11.8 years; 52.4% were females. Mean diabetes duration was 9.9 ± 7.4 years; 27.7% were with HbA1c >9% (75 mmol/mol) and 70% had complications. Metformin was the most used medication followed by insulin. 85.1% fasted ≥1 day; fasting mean duration was 27.6 ± 5.6 days. Hypoglycemia occurred in 15.5% of whom 11.7% attended emergency department or were hospitalized; this was significantly associated with age and/or duration of diabetes. Hyperglycemia occurred in 14.9% of whom 6.1% attended emergency department or were hospitalized and was also associated with age or duration of diabetes. 74.2% performed SMBG during fasting. 59.2% were educated on Ramadan fasting, with 89.7% receiving it during routine consultation. Conclusions Ramadan fasting in T2DM is high. Multidisciplinary approach is required to mitigate complications. Our findings support current recommendations for safe fasting.

The objective of the study is mentioned, but it could be further clarified by explicitly stating the aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) specifically in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD).We conducted a thorough electronic search of the literature, encompassing databases such as PubMed, EMBASE, Cochrane Library, and Web of Science from their inception up to March 5, 2024. Furthermore, we meticulously examined the bibliographies of included studies to identify additional relevant literature. The reporting of this meta-analysis adhered to the guidelines outlined in the Preferred Reporting of Systematic Review and Meta-analysisguidelines. The endpoints evaluated in this meta-analysis included all-cause mortality, stroke or systemic embolism, and major bleeding. Data analysis was carried out utilizing RevMan Version 5.4 (Cochrane, London, United Kingdom). Dichotomous outcomes, including all-cause mortality, stroke or systemic embolism, and major bleeding, were presented as risk ratios (RRs) with corresponding 95% confidence intervals (CI). A total of 11 studies were incorporated in this meta-analysis, comprising a pooled sample size of 44,863 participants with AF. The pooled analysis revealed no significant disparity between DOACs and VKAs concerning stroke or systemic embolism (RR: 0.93, 95% CI: 0.77 to 1.14) and all-cause mortality (RR: 0.86, 95% CI: 0.74 to 1.00). However, there was a noteworthy reduction in the risk of major bleeding events associated with DOACs compared to VKAs (RR: 0.84, 95% CI: 0.73 to 0.96). Consequently, DOACs may be considered a viable alternative to warfarin in patients with ESRD. However, we need further larger clinical trials to validate these findings.

Abstract Background and Aim: To observe presentation and outcome of diabetic foot infection (DFI) in hospitalized patients at a tertiary care center. Materials and Methods: This prospective clinical study included all those patients who visited the out-patient department (OPD) of the foot clinic of Baqai Institute of Diabetology and Endocrinology and were admitted to the hospital due to DFI from August 2020 to April 2021. Patients with DFI were assessed and classified into mild, moderate, and severe infections according to the Infectious Disease Society of America (IDSA)/International Working Group On Diabetic Foot guideline protocol. Primary outcome was healing either without amputation, or with minor or major amputation. Results: A total of 2405 patients visited the OPD and 658 got admitted. Of these 211 patients with DFI were included. Males 158 (75%) were predominant. As per IDSA classification, 99 (46.9%) had severe infection, 94 (44.5%) had moderate, while 18 (8.53%) had mild infection. Overall, 150 (71.1%) infected Diabetic Foot Ulcers (DFUs), 67 (44.6%) and 65 (43.3%) DFUs with moderate infection and severe infection respectively were healed without any amputation. Conclusion: Infection was found to be the major cause of amputation in most patients with toe amputation being more common. Early referral of patients to the tertiary care unit and a multidisciplinary approach may help prevent DFI from major and minor amputations.

Inflammatory rheumatological conditions, also known as inflammatory rheumatic conditions (IRC), constitute a category of autoimmune and inflammatory ailments primarily affecting the musculoskeletal system, encompassing the joints, muscles, and connective tissues. The objective of this meta-analysis is to evaluate the impact of inflammatory rheumatological conditions (IRC) on post-acute coronary syndrome (ACS) outcomes.This study was performed as per the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. The PubMed, Web of Science, and Scopus databases were searched by two authors without any language constraints from January 1, 2015, to October 15, 2023. The primary outcome assessed in this meta-analysis was all-cause mortality. Other outcomes included myocardial infarction and revascularization. A total of 11 studies were included in this meta-analysis. The risk of all-cause mortality was significantly higher in patients with IRC compared to non-IRC patients (RR: 1.12, 95% CI: 1.00 to 1.26, p-value: 0.04). There is a significantly higher risk of myocardial infarction and revascularization in patients with IRC as opposed to those without IRC. Furthermore, while there was a higher risk of stroke in the IRC group compared to the non-IRC group, this disparity did not reach statistical significance. Future research should focus on specific inflammatory rheumatoid conditions, a comprehensive evaluation of cardiovascular events, and targeted interventions to enhance patient outcomes in this vulnerable population.

Anthropometric indices are affordable and non-invasive methods for screening metabolic syndrome (MetS). However, determining the most effective index for screening can be challenging. To investigate the accuracy of anthropometric indices as a screening tool for predicting MetS among apparently healthy individuals in Karachi, Pakistan. A community-based cross-sectional survey was conducted in Karachi, Pakistan, from February 2022 to August 2022. A total of 1,065 apparently healthy individuals aged 25 years and above were included. MetS was diagnosed using International Diabetes Federation guidelines. Anthropometric indices were defined based on body mass index (BMI), neck circumference (NC), mid-upper arm circumference (MUAC), waist circumference (WC), waist to height ratio (WHtR), conicity index, reciprocal ponderal index (RPI), body shape index (BSI), and visceral adiposity index (VAI). The analysis involved the utilization of Pearson's correlation test and independent t-test to examine inferential statistics. The receiver operating characteristic (ROC) analysis was also applied to evaluate the predictive capacities of various anthropometric indices regarding metabolic risk factors. Moreover, the area under the curve (AUC) was computed, and the chosen anthropometric indices' optimal cutoff values were determined. All anthropometric indices, except for RPI in males and BSI in females, were significantly higher in MetS than those without MetS. VAI [AUC 0.820 (95% CI 0.78-0.86)], WC [AUC 0.751 (95% CI 0.72-0.79)], WHtR [AUC 0.732 (95% CI 0.69-0.77)], and BMI [AUC 0.708 (95% CI 0.66-0.75)] had significantly higher AUC for predicting MetS in males, whereas VAI [AUC 0.693 (95% CI 0.64-0.75)], WHtR [AUC 0.649 (95% CI 0.59-0.70)], WC [AUC 0.646 (95% CI 0.59-0.61)], BMI [AUC 0.641 (95% CI 0.59-0.69)], and MUAC [AUC 0.626 (95% CI 0.57-0.68)] had significantly higher AUC for predicting MetS in females. The AUC of NC for males was 0.656 (95% CI 0.61-0.70), while that for females was 0.580 (95% CI 0.52-0.64). The optimal cutoff points for all anthropometric indices exhibited a high degree of sensitivity and specificity in predicting the onset of MetS. BMI, WC, WHtR, and VAI were the most important anthropometric predictors for MetS in apparently healthy individuals of Pakistan, while BSI was found to be the weakest indicator.

Aims: To provide global, regional, and country-level estimates of diabetes prevalence and health expenditures for 2021 and projections for 2045. Methods: A total of 219 data sources meeting pre-established quality criteria reporting research conducted between 2005 and 2020 and representing 215 countries and territories were identified. For countries without data meeting quality criteria, estimates were extrapolated from countries with similar economies, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates. Diabetes-related health expenditures were estimated using an attributable fraction method. The 2021 diabetes prevalence estimates were applied to population estimates for 2045 to project future prevalence. The global diabetes prevalence in 20-79 year olds in 2021 was estimated to be 10.5% (536.6 million people), rising to 12.2% (783.2 million) in 2045. Diabetes prevalence was similar in men and women and was highest in those aged 75-79 years. Prevalence (in 2021) was estimated to be higher in urban (12.1%) than rural (8.3%) areas, and in high-income (11.1%) compared to low-income countries (5.5%). The greatest relative increase in the prevalence of diabetes between 2021 and 2045 is expected to occur in middle-income countries (21.1%) compared to high (12.2%)-and low-income (11.9%) countries. Global diabetes-related health expenditures were estimated at 966 billion USD in 2021, and are projected to reach 1.054 billion USD by 2045. Conclusions: Just over half a billion people are living with diabetes worldwide which means that over 10.5% of the world's adult population now have this condition.