Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia:A Quality Improvement Project

Introduction To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal–bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. Methods Patients with T1D who were aged ≥ 18 years, were on a basal–bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness. Results Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0–9.3)% [70 (64–78) mmol/mol] to 8.4 (7.9–8.9)% [68 (63–74) mmol/mol]; p < 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7–45.0) to 25.5 (14.0–30.2) units; p < 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs. Conclusion In patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings

Soil Quality Variation under Different Land Use Types in Haramosh Valley, Gilgit, Pakistan

Soil quality is a fundamental component of environmental quality and impact of land use is also a keydetrimental factor in today’s rapid urbanization era. The study aims to evaluate the effects of different land-use type on&nbsp;selected soil quality indicators. Sixty soil samples were collected from various land use types, i.e, pasture, forest and&nbsp;agriculture from a depth of 0-15cm. Analysis of variance (ANOVA) showed that the land use type significantly&nbsp;affected the soil’s physical and chemical properties. The moisture content was significantly higher (p&lt;0.001) in the&nbsp;pasture (41.7%) than the forest (26.2%) and lowest in agricultural land (14.4%). The soil pH was significantly higher or&nbsp;slightly alkaline for agriculture (7.8), while for pasture (6.5) and forest (6.1), it was found to be slightly acidic. Electric&nbsp;conductivity (EC) and bulk density (BD) did not vary significantly with land use type, but the EC followed the&nbsp;decreasing order: forest (203.7μS/cm) &lt; pasture (235μS/cm) &lt; agriculture (328.7μS/cm). The soil organic matter&nbsp;(SOM) and soil organic carbon (SOC) significantly (p&lt;0.05) differed with land use type and found in the order: forest&nbsp;(3.0%, 1.3 %) &gt; pasture land (2.9%, 1.2%) &gt; arable land (2.5%, 1.1%). NO3-N, available P and exchangeable K did not&nbsp;vary significantly across land use types. However, mean values were higher for agriculture (10.2mg/kg, 4.5mg/kg,&nbsp;66mg/kg) than forest (10mg/kg,3.5mg/kg, 60mg/kg) and pasture (9.8mg/kg, 4.3, 60.2mg/kg). Alpine soils are good ecological indicators because of vulnerability to environmental change, therefore, regular monitoring of soil properties&nbsp;along with carbon stocks is essential to maintain soil health, enhance agricultural productivity and sustain agroecosystems

Analyzing Land Cover Change Using Remote Sensing and GIS: A Case Study of Gilgit River Basin, North Pakistan

Mountainous areas of northern Pakistan are rich in biodiversity, glaciers and key watershed of Indus Riversystem which provide ecosystem services for their inhabitants. These regions have experienced extensive deforestationand are presently vulnerable by rapid land cover changes, therefore an effective assessment and monitoring is essentialto capture such changes. The aim of this study is to analyze the observed changes in land cover over a period of thirtynine years, divided into three stages (1976-1999, 1999-2008 and 2008-2015). Four images from Landsat 2Multispectral Scanner System (MSS), Landsat 5 Thematic Mapper (TM), Landsat 7 Enhanced Thematic Mapper andLandsat 8 Operation Land Imager data were obtained to detect land cover change. This study used supervisedclassification-maximum likelihood algorithm in ERDAS imagine to identify land cover changes perceived in GilgitRiver Basin, Pakistan. The result showed that the range land, glaciers, water bodies, built-up/agricultural cover are themajor categories that have been altered by the natural and anthropogenic actions. In 1976, built up/agriculture, rangeland, water bodies and glacier cover was 1.13%, 45.3%, 0.66% and 13.2%, respectively. Whereas in 2015, builtup/agriculture, range land, water bodies and glacier cover was 3.25%, 12.7%, 0.91% and 8.2%, respectively. Thesesland cover shifts posed acute threat to watershed resources. Therefore, a comprehensive watershed resourcemanagement is essential or otherwise, these resources will deplete rapidly and no longer be capable of playing their rolein socioeconomic and sustainable environmental development of the are

Socioeconomic Deprivation and the Risk of Sight-Threatening Diabetic Retinopathy (STDR):A Population-Based Cohort Study in the U.K.

OBJECTIVETo evaluate the associations between socioeconomic deprivation and sight-threatening diabetic retinopathy (STDR) in individuals with type 1 (T1D) and type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSData from 175,628 individuals with diabetes in the Health Improvement Network were used to assess the risk of STDR across Townsend Deprivation Index quantiles using Cox proportional hazard regression.RESULTSAmong individuals with T1D, the risk of STDR was three times higher (adjusted hazard ratio [aHR] 2.67, 95% CI 1.05–7.78) in the most deprived quintile compared with the least deprived quintile. In T2D, the most deprived quintile had a 28% higher risk (aHR 1.28; 95% CI 1.15–1.43) than the least deprived quintile.CONCLUSIONSIncreasing socioeconomic deprivation is associated with a higher risk of developing STDR in people with diabetes. This underscores persistent health disparities linked to poverty, even within a country offering free universal health care. Further research is needed to address health equity concerns in socioeconomically deprived regions

Inequalities in the Management of Diabetic Kidney Disease in UK Primary Care: :A Cross‐Sectional Analysis of A Large Primary Care Database

Aims: To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. Methods: A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. Results: Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin–angiotensin–aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98–0.99), ACR: aRR 0.94 (0.92–0.96), BP: aRR 0.98 (0.97–0.99), HbA 1c: aRR 0.99 (0.98–0.99) and serum cholesterol: aRR 0.97 (0.96–0.98) measured; achieve BP: aRR 0.95 (0.94–0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84–0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90–0.94) or statins: aRR 0.94 (0.92–0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96–0.99); achieve BP: aRR 0.91 (0.8–0.95) or HbA 1c: aRR 0.88 (0.85–0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87–0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85–0.97). Conclusions: There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD

Prevalence of Type 2 diabetes in patients admitted with acute coronary syndrome: the role of easily reproducible non-invasive screening methods

Background: Diabetes mellitus is a major risk factor for cardiovascular disease and mortality. There is increasing recognition of need to assess glucose tolerance in all patients with cardiovascular disease but less agreement about the most appropriate screening methodology. Aims: 1. To determine prevalence of undiagnosed diabetes mellitus and impaired glycaemic state (IGS) and compare WHO 1998 and IEC criteria for diagnosis of T2DM in patients with acute coronary syndrome (ACS). 2. To investigate role of screening algorithm including fasting plasma glucose (6.0%) to accurately define glucose tolerance in patients admitted with ACS. Methods: A prospective 3 year study carried out in two large inner city hospitals in UK. Results: Patients (n=118) were included. Prevalence of diabetes mellitus was 20% and 16% respectively according to W.H.O and IEC criteria at baseline. The prevalence of T2DM remained similar at 3 months at 21%. However two thirds with IGS and a third with DM changed their glycaemic status at 3 months. We also designed diabetes predictor score based on age, fasting plasma glucose and HbA1c and it had excellent sensitivity >80% and negative predictive value of >90%. Conclusion: The W.H.O and IEC diagnostic criteria identify different populations with diabetes at baseline as well as 3 months. This is clinically relevant as we are basing screening in a high risk population on these criteria

The Politics of Religious Extremism in Pakistan: An Analysis

In this study, the connection between Islamic values and country policies has been carefully connected to the foundations that create political legitimating and the basic nature of a country. Islam performs a crucial part in the social fabric of Pakistan and has been integrated as the guiding concept for the constitutional procedure and governmental systems of the country but at the same time produced implicit stress for their future improvements. Various government authorities have used religious beliefs for their quest for governmental authenticity and power. This has consequently brought about politicization of spiritual explanation in Pakistan demonstrated in the form of sectarian disputes, persecution of spiritual unprivileged or disempowerment of certain spiritual organizations and management. Whereas controversy about interpreting religious identity continues pervading the Pakistani community, it is observed that large parts of the Pakistani inhabitants follow pluralistic types of Islam based on heterogeneous spiritual and devotional methods. Islamic political parties should cooperate on federal or provincial levels with national and local political parties to eliminate the religious extremism in Pakistan

International Journal of Social Sciences and Education Migration of Cholistani People from Desert areas toward Irrigated areas: Causes and Consequence (A Case Study of Migration of Cholistani People from Desert areas toward Irrigated areas: Causes and Con

ABSTRACT Economy of Cholistan desert totally depends on the ecological conditions prevailing in the area. Purpose of this study is to describe migration pattern adopted by the people of Cholistan. Their income and expenditures in desert areas and irrigated areas are also described to know their problems with regard to household management. Two hundred samples were selected from the people who having agricultural land or without land and they visit to desert area during rainy season. Primary data on economic conditions and house hold strategies of people of Cholistan desert was collected by interview technique. The analysis of data showed that migration of cholistani people is not only for managing Cholistan desert dry lands but it could support to cultivation in the irrigated areas of cholistan. As people move toward desert for the better health of their livestock&apos;s and migration towards cultivated areas results to increasing the cultivation of crops

Structural, electrical, dielectric and magnetic properties of Mn-Nd substituted CoFeO3 nano sized multiferroics

A series of MnxCo1−xFe1−yNdyO3 (where x=0.0–1.0 & y=0.0–0.1) multiferroic nanocrystals was synthesized via sol-gel auto-combustion technique. The structure was confirmed by X-ray diffraction (XRD) while morphology was investigated by scanning electron microscopy (SEM). The electrical resistivity was observed to increase from 2.14×107 to 8.77×109 Ω-cm and activation energy was found to increase from 0.64 to 0.75 eV, while the drift mobility decreased from 4.75×10−13 to 1.27×10−15 cm2 V−1 S−1 by the substitution of Mn and Nd contents. The dielectric constant, dielectric loss and dielectric loss factor decrease with frequency and Mn-Nd contents. The saturation magnetization was increased from 34 to 70 emu g−1 while the coercivity decreased from 705 to 262 Oe with the increase of substituents. The increase in electrical resistivity and saturation magnetization while decrease in dielectric parameters and coercivity make these nanomaterials suitable for applications in microwave devices and longitudinal magnetic recording media

Pharmacological management of South Asians with type 2 diabetes:Consensus recommendations from the South Asian Health Foundation

South Asians constitute approximately 1.6 billion people from the Indian subcontinent, comprising Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka; and make up the largest diaspora globally. Compared to the White European population, this group is at a higher risk of developing type 2 diabetes along with cardiovascular, renal and eye complications. Over the recent years, a number of new therapies for type 2 diabetes have become available for which cardiovascular outcome trials (CVOTs) have been published. The recent ADA/EASD consensus guidelines on diabetes, pre-diabetes and cardiovascular diseases’ offer a transitional shift in type 2 diabetes management. The new consensus recommendations are based on recent CVOTs, many of which had a representation of South Asian cohorts. In light of this new evidence, there is urgent need for an integrated, evidence-based, cost-effective and individualised approach specific for South Asians. This review takes into consideration the evidence from these CVOTs and provides best practice recommendations for optimal management of South Asian people with type 2 diabetes, alongside the previously published consensus report from South Asian Health Foundation in 2014 [1]