Food choices during Ramadan

Few studies have assessed the dietary Practices of people with diabetes during Ramadan (1). A sub study of Ramadan prospective diabetes study (2) which was conducted at the outpatient department of Baqai Institute of Diabetology and endocrinology, Karachi Pakistan in 2009 analyzed the food choices of patients with diabetes during Ramadan. Several irregularities regarding dietary intake and food choices were noted among the study participants. Although, the patients were counseled regarding diet before Ramadan, many did not follow the dietary advice. All patients had taken food at Iftar but majority of them preferred fried items like samosas, pakoras (fried snack), chicken rolls etc. these deeply fried items can lead to post Iftar hyperglycemia. Patients were also opted for fruit chat, dahibara and chanachaat at Iftar, higher load of these items can also worsen glycemic control. The striking finding was almost absence of meat (protein) intake at Iftar but study from India showed increment of all three macronutrients during Ramadan (3). This may result in higher intake of items from carbohydrate and fat groups resulting in hyperglycemia after iftar. Intake of vegetables at Iftar was also negligible and hence the diet was not well balanced. The food choices at sahoor included roti, paratha (fried bread), slices, khajla, pheni, meat, egg and milk. Though it is advisable to take complex carbohydrates, protein and fat at sahoor as these are slowly digestible and can prevent hypoglycemia during fasting but khajla pheni are extremely rich in fat and carbohydrate content and should be avoided (4). However, paratha in 2 teaspoon of oil can be taken at sahoor.Patients with diabetes who fast during the month of Ramadan should have pre Ramadan dietary guidance and counseling session in order to modify their food preferences and choices during the holy month of Ramadan (4).</span

Association of depression and its treatment on the outcome of diabetic foot ulcer

Aim: This study aimed to assess depression symptoms among patients with diabetic foot ulcer and to compare the outcome of diabetic foot ulcer between normal participants and participants with depressive symptoms. Methodology: This prospective, observational study was conducted at Baqai Institute of Diabetology and Endocrinology, after getting approval from ethics committee. Patients who were attending the foot clinic were invited to participate in the study. Diabetic foot ulcers were classified according to the University of Texas classification criteria. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Both groups were given standard diabetes and foot care treatment. In addition, antidepressant treatment was given to the participants with depressive symptoms for 3 months. After 3 months, PHQ-9 was again administered to the participants with depressive symptoms, and the outcome of foot ulcer was noted and compared to baseline data. Results: Of the total participants (n = 105), nearly half of them were found to have depressive symptoms (n = 53, 50.4%). At baseline, no significant difference was found in the distribution of hypertension, history of smoking and duration, grading and type of ulcers between normal participants and participants with depressive symptoms. Three months of antidepressant treatment brought significant improvement in the mean depression score (P ≤ 0.05). After 3 months, healing time of ulcers, rate of minor and major amputations, patients on treatment and patients who lost to follow-up were comparable between the groups. Conclusions: In this study, every second patient with diabetic foot ulcer was found to have depressive symptoms. Anti-depressive treatment alleviated depression and made foot ulcer outcome comparable to non-depressed patients