Early insulin glargine initiation in iranian people with uncontrolled type 2 diabetes: Glycemic control, and adverse events

To explore glycemic control, and adverse events of Iranian people with uncontrolled type 2 diabetes after initiation of long-acting basal insulin, glargine. People with uncontrolled type 2 diabetes that was on at least two oral anti-diabetic drugs (OAD) were enrolled in this observational prospective study. Insulin glargine was prescribed by physicians in the course of routine clinical practice. Patients were followed for 24 weeks. Insulin doses were titrated to reach fasting blood sugar (FBS) target between 90 mg/dl and 130 mg/dl. HbA1c and adverse events were recorded at baseline, week 12, and week 24. Form a total of 292 participants, 243 patients completed the study. HbA1c, FBS, postprandial glucose, total cholesterol, triglycerides, and low-density lipoprotein cholesterol, but not body mass index decreased during the study. The proportion of poorly controlled patients (HbA1C>9) decreased from 172 (58.9) to 39(13.4), and 21(7.2) during follow up. Controlled glycemia (HbA1C<7) was detected in 7(2.4), 48 (16.4) and 56 (19.2) of patients at baseline, week 12 and week 24. Hypoglycemia was reported in 5.1 and 3.4 of the participants in the week at 12 and 24, respectively. Patients felt more satisfied with their blood glucose control, timing and choices of meals, and hypo/hyperglycemic experiences. Insulin glargine initiation in people with uncontrolled type 2 diabetes on 2 OADs is associated with significant improvement in metabolic control. Insulin glargine has good safety profile and well tolerated by the patients. © 2018 Tehran University of Medical Sciences. All rights reserved

Dry eye disease in type 2 diabetes mellitus; comparison of the tear osmolarity test with other common diagnostic tests: A diagnostic accuracy study using STARD standard

Background: To determine the diagnostic performance of tear osmolarity in diagnosis of dry eye disease by using tear lab osmolarity system in people with type 2 diabetes, and to compare it with common diagnostic tests already available in clinical practice. Methods: Two hundreds forty three people with type 2 diabetes were included. Tear osmolarity was measured with the tear osmolarity system. The 308 mOsm/L cutoffwas used to diagnose dry eye disease. The following tests were also performed: Ocular Surface Disease Index (OSDI) questionnaire, Tear Film Break up Time (TFBUT), Schirmer I test, Rose Bengal and Fluorescein staining. The results of these tests were compared to the tear osmolarity measurement. Results: The prevalence of dry eye disease detected by the tear osmolarity test was 27.7. It was as follows for the other common diagnostic tests: OSDI (17.7), Schirmer I test (33), TFBUT (41), Rose Bengal (11), and Fluorescein staining (4). Fluorescein staining had the highest specificity (97). With the cutoffscore >12, the positive likelihood ratio for the OSDI questionnaire was the highest (1.78). The sensitivity was poor for all common diagnostic tests. ROC curve analysis could not determine optimal cut offs for the common diagnostic tests. Conclusions: The available common diagnostic tests underestimate the presence of dry eye disease in people with type 2 diabetes. Moreover, they could not discriminate tear hyperosmolarity from normal. Tear osmolarity could be considered as the best single test for detection of dry eye disease in people with type2 diabetes. © 2015 Najafiet al

Psychometric properties of the Iranian version of the diabetes numeracy test�15

Background: Low health literacy (HL) of patients has obtained more attention as a risk factor for poor adherence to treatment and adverse outcomes in chronic disease�s management particular in diabetes care. Diabetes Numeracy Test-15 (DNT-15) has been developed specifically for this purpose. The objective of the current study is to evaluate psychometric properties of Iranian (Persian) version of the DNT-15. Methods: The shortened version of the DNT (15-items) was completed by 120 patients with diabetes. The Kuder�Richardson Formula 20 for internal consistency was conducted. Content validity, criterion-related validity, and construct validity were also evaluated. Results: The average score on the DNT was 72 and took an average of 25 minutes to complete. The DNT-15 had a very good internal reliability (KR-20 = 0.90) and also content validity (content validity ratio: 089 and content validity index: 0.86). Conclusions: The DNT-15 (Persian version) is a reliable and valid measure of diabetes-related numeracy skills for Iranian patients with diabetes; however, additional studies are needed to further explore the association between diabetes-specific numeracy and acculturation and their impact on diabetes-related outcomes in Iranian population. © 2016 International Journal of Preventive Medicine

Depression and diabetes in Iranian patients: a comparative study

Objective: The aim of the present study was determine the rate of depression in people with diabetes in an Iranian population. Method: A hospital-based prospective study with a comparison group was conducted in Firozgar Teaching Hospital in Tehran, Iran. The condition of depression and relationship to diabetes was assessed among 375 individuals (206 people with diabetes and 169 without diabetes) who consecutively presented for this prospective study. Results: Of the total participation, 206 (54.9) had diabetes (type 1 = 66 and type 2 = 140). Female made up 63.7 (n = 239). The mean age of entire study was 47.2 years (SD = 16.3 range, 15-87 years). Major depression was present among 71.8 of this sample with diabetes (both types; type 1 and type 2). Depression was more prevalent among women with diabetes than men (Adjusted OR = 2.1 (95 CI 1.4-3.2)). Of the 375 participants, 135 (36) had BID scores lower than 11 and 240 (64) had BDI scores indicating moderate to severe depression (> 16). Conclusions: Diabetes appears to increase the risk of developing depression; therefore early detection and treatment intervention provide the best protective mechanisms available against the effects of depression on diabetes outcomes, and a psychological service provision for people with diabetes is needed. © 2007, Baywood Publishing Co., Inc

Knowledge and practice of foot care in Iranian people with type 2 diabetes

The aim of this study was to determine the knowledge and practice of foot care in people with type 2 diabetes. We carried out a cross-sectional study. A questionnaire was completed by 148 patients with type 2 diabetes in Tehran, Iran. Knowledge score was calculated and the current practice was determined. The mean knowledge score was 6.6 (standard deviation ±3.0) out of a possible 16. Illiterate patients were the least knowledgeable (P = 0.008). Lack of adequate knowledge includes the following: 56 not aware of the effect of smoking on the circulation to the feet, 60 failed to inspect their feet and 42 did not know to trim their toenails. High risk practices including use of irritants to water (66.5) and walking barefoot (62). The results of this study highlight the patients' inadequate knowledge of self-care about their foot and lack of optimal podiatry service in Iran. These findings have implications for further evaluation, planning and management of patient care in diabetic foot disease. © 2007 Blackwell Publishing Ltd and Medicalhelplines.com Inc

Prehypertension; patient awareness and associated cardiovascular risk factors in an urban population in Iran

Background: This study was to estimate the frequency of prehypertension and to characterize patient awareness and associated cardiovascular risk factors in an urban population in Iran. Methods: During a hypertensive awareness program, a cross-sectional study was conducted on 2036 people. All participants completed a questionnaire about their demographic and anthropometric indices and were asked about symptoms, risk factors and preventive measures of hypertension. Data were compared between prehypertensive and non-hypertensive groups. Results: Prehypertension was detected in 30 (n=611) of the subjects. Previous CHD, diabetes, and hyperlipidemia were more prevalent in low prehypertension group compared to high normal blood pressure. The male sex, increasing age and body weight were positively associated with the rate of prehypertension. Only 8 of participants with prehypertension were aware about the symptoms of hypertension, 12 correctly mentioned at least three risk factors of hypertension, and 48 explained appropriate preventive measures. Conclusion: Prehypertension was prevalent in this population. Age, body weight, male sex, and previous CHD were the major determinants. Furthermore, hypertension awareness was alarmingly poor. Therefore, hypertension prevention programs focused on increasing public awareness are essential

Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education

Background: To explore the impact of an online continuing medical education (CME) program on physicians� knowledge about the management of type two diabetes. Methods: An online CME program was designed and uploaded in the CME platform, Department of Education, Ministry of health, Iran. A 28-item questionnaire was used for the assessment. In the beginning, a case scenario was introduced. Then, participants were asked to follow and answer to a pretest assessment. Details of the educational content were provided afterward. Finally, the participants took part in the same post-test exam 4 weeks later. The Wilcoxon matched-pairs signed-ranks test was used to compare the measurements. In addition, the Mann-Whitney test was applied to compare knowledge indices between the general practitioners (GPs) and internists. Results: Five hundred twenty-six primary care physicians participated in this study. There was a significant positive effect regarding diagnosis confirmation (10.3 difference, P = 0.0001). Moreover, a smaller effect was observed in relation to the importance of glycosylated hemoglobin (HbA1c) at diagnosis (5.2 difference, P = 0.0006). The effect was positive in relation to the self-reported HbA1c testing frequency: more than 90 of the participants answered correctly in the post-test exam (7.6 difference, P = 0.0001). Considering improved knowledge in the treatment of diabetes, there was a very significant difference in response to questions targeting advice on a healthy diet, and physical activity; 27.7 (P = 0.000), and 18.7 (P = 0.000), respectively. In addition, the program had a positive impact on various aspects of treatment with oral glucose-lowering drugs (OGLDs). Moreover, the intervention difference was 25, and 34.4 for the questions targeting the appropriate type of insulin, and insulin initiation regimen after OGLD failure. Subgroup analyses revealed that the intervention increased the rate of correct responses among the GPs in various domains of knowledge in diagnosis and treatment. The initial differences between the GPs and internists no longer remained significant after the intervention. Conclusion: Knowledge of Iranian primary health care professionals in diabetes management has significant shortcomings. This is concerning because they are at the front line of patient care. We demonstrate the effectiveness of online CME on improving GPs knowledge in the management of type 2 diabetes. © 2020, The Author(s)

Toe-brachial index is beyond a peripheral issue in patients with type 2 diabetes

Background Atherosclerosis is the leading cause of death in patients with diabetes. We aimed to evaluate the association between ankle-brachial index (ABI) and toe-brachial index (TBI) with carotid intima-media thickness (CIMT) in patients with type 2 diabetes (T2DM). Methods This cross sectional study included 296 patients with T2DM who met the American Diabetes Association criteria for the assessment of peripheral arterial atherosclerosis. The ABI � 0.9 and TBI � 0.7 were considered as abnormal values. Linear and logistic regression analyses were performed to evaluate the association between TBI/ABI and CIMT. Results Right CIMT was significantly greater in the low TBI group (p = 0.03) while, left CIMT did not show a significant difference. Each 0.1-unit decrease in TBI value was independently associated with 0.017 mm increase in the right CIMT (β ± SE; -0.017 ± 0.005, p = 0.002) and with odds of the presence of increased CIMT odds ratio and 95% confidence interval: 1.21 (1.02, 1.44) after adjustment with all traditional risk factors. There was not any significant association between ABI and increased CIMT. Conclusions Beyond a suitable tool for the diagnosis of peripheral artery disease in patients with T2DM, TBI can be applied for prediction of subclinical carotid atherosclerosis. © 2021 Darban Hosseini Amirkhiz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Typical chest CT features can determine the severity of COVID-19: A systematic review and meta-analysis of the observational studies

Background: It remains unclear whether a specific chest CT characteristic is associated with the clinical severity of COVID-19. This meta-analysis was performed to assess the relationship between different chest CT features and severity of clinical presentation in COVID-19. Methods: PubMed, Embase, Scopus, web of science databases (WOS), Cochrane library, and Google scholar were searched up to May 19, 2020 for observational studies that assessed the relationship of different chest CT manifestations and the severity of clinical presentation in COVID-19 infection. Risk of bias assessment was evaluated applying the Newcastle-Ottawa Scale. A random-effects model or fixed-effects model, as appropriately, were used to pool results. Heterogeneity was assessed using Forest plot, Cochran's Q test, and I2. Publication bias was assessed applying Egger's test. Results: A total of 18 studies involving 3323 patients were included. Bronchial wall thickening (OR 11.64, 95 CI 1.81�74.66) was more likely to be associated with severe cases of COVID-19 infection, followed by crazy paving (OR 7.60, 95 CI 3.82�15.14), linear opacity (OR 3.27, 95 CI 1.10�9.70), and GGO (OR 1.37, 95 CI 1.08�1.73). However, there was no significant association between the presence of consolidation and severity of clinical presentation (OR 2.33, 95 CI 0.85�6.36). Considering the lesion distribution bilateral lung involvement was more frequently associated with severe clinical presentation (OR 3.44, 95 CI 1.74�6.79). Conclusions: Our meta-analysis of observational studies indicates some specific chest CT features are associated with clinical severity of COVID-19. © 202

Challenging Issues in the Management of Cardiovascular Risk Factors in Diabetes During the COVID-19 Pandemic: A Review of Current Literature

The COVID-19 outbreak was declared a pandemic on March 2020. Many patients with SARS-CoV-2 infection have underlying chronic medical conditions such as diabetes, cardiovascular disease (CVD), and hypertension. Patient-related outcomes are worse if there are associated comorbidities. We do not have enough evidence regarding the most appropriate management of patients with diabetes during COVID-19 infection. Insulin resistance and CVD together increase the inflammatory state of the body, which can contribute to and perhaps mediate the increase of COVID-19 severity. Hence, in addition to management of dysglycemia, other CVD risk factors should be targeted. We explore the possible pathophysiologic links between diabetes and COVID-19 and discuss various options to treat dysglycemia, hypertension, and dyslipidemia in the era of COVID-19. © 2020, The Author(s)