European Journal of Molecular & Clinical Medicine

Aims: To compare HbA1c levels with inflammatory markers that include a neutrophilto-
lymphocyte ratio (NLR) and monocyteto-lymphocyte ratio (MLR) in controlled and
uncontrolled diabetics.
Materials and methods: Two hundred type 2 diabetes mellitus (T2DM) patients were
separated into two groups of managed (HbA1c 7%) diabetics. HbA1c (glycated
haemoglobin) levels, leukocyte count (WBC), haemoglobin (Hb), hematocrit (Hct), red
blood cell distribution width (RDW), neutrophils, lymphocytes, and monocytes were all
measured using recent laboratory data. The laboratory results were used to determine
the NLR and MLR.
Results:Controlled diabetics had a mean age of 58.30 years, while uncontrolled diabetics
had a mean age of 55.62 years. The mean NLR in diabetics with and without diabetes
was 2.61 and 4.88, respectively. The distinction was discovered to be statistically
significant (p < 0.05). The mean MLR in diabetics with and without diabetes was 0.2
and 0.24, respectively, however the difference was not statistically significant (p > 0.05).
The data showed a modest positive connection between HbA1c levels and the
haematological indices, but it was statistically insignificant.
Conclusion: The study found a substantial difference in NLR between diabetics who
were well-controlled and those who were not. Although only a slight positive connection
was detected between glycated Hb levels and the haematological indices, the results
revealed a substantial difference in NLR between the two groups. This demonstrates
that these ratios have the potential to be used as inflammatory indicators in T2DM.

Introduction: Carotid intima media thickness (CIMT) is used as a indicator of atherosclerosis, whichcauses Macro-vascular diseases. with risk factors like age, HTN, Raised BMI, duration of uncontrolled DM, may actually have a correlation with CIMT either directly or indirectly influencing the disease processand causes atherosclerosis⁽¹⁾.
Materials and Methods: cross sectional study of 100 patients with type 2 DM admitted in civil hospital over a period of 1 year, age group between 35 to 75 years selected through simple random sampling. Macro vascular complications like CAD/CVD/PVD are dignosed with the help  of echocardiography, CT scan and with the help  of history and clinical examination. CIMT is measured with B mode ultrasound.
Result : 73 percent patients have macrovascular complications who have raised value of CIMT and 68 percent  patients with macrovascular diseases have raised value of CIMT.
Conclusion: increased value of CIMT in diabetic patients has more chances of macrovascular complication hence early detection of atheroscelerosis and early life style modification can prevent macro vascular complication⁽²⁾.

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance occurringfor the first time during pregnancy. The prevalence of GDM varies in direct proportion to theprevalence of Type 2 diabetes for a given ethnic group or population. It is crucial to detectwomen with GDM as the condition is associated with diverse range of adverse maternal andneonatal outcomes. This study aims at determining the incidence of insulin resistance and gestational diabetes mellitus in the antenatal population and for their maternal and foetal outcomes.
Materials& Methods: A hospital based observational prospective study done on all pregnant women attending the antenatal clinic in government district hospital, Sirohi, Rajasthan, India during one year period.Screening for Insulin Resistance was done at the time of booking or the first antenatalvisit if they met the criteria for the high risk group, by Fasting Serum Insulin and FastingPlasma Glucose levels.IR value calculated with HOMA-2IR software and value > 1.8 wastaken as cut off for insulin resistance. Patients labelled GDM were started on specifictreatment with medical nutrition therapy, oral hypoglycaemic agent and insulin therapy. Theywere then followed up till term ensuring adequate glycaemic control with 3 weeklysupervised hospitalized blood sugar profile. Maternal and foetal outcomes were there afterdocumented and studied.
Results:Our study showed that total no. of antenatal patients was 500 during one year study period and 55 (11%) patients detected insulin resistance and gestational diabetes mellitus. So, the incidence of carbohydrate intolerance was 11%.The mean age of these pregnant women was 28.56±4.23 years.Our results shows that positive statistically significant correlationbetween insulin resistance and development of glucose intolerance (p <0.0001).  The present study shows that there is no statistical significant association between development of Gestational Hypertension and Insulin Resistance (P>0.05).
Conclusion: We concluded that early detection and institution of specific treatment of glucose intolerance with MNT/ OHA/ Insulin therapy certainly gives better maternal and neonatal outcomes.The costeffectiveness and simplicity of this model of care makes it suitable for countries with highprevalence of glucose intolerance.

Background: Diabetes mellitus is a clinical syndrome characterized by hyperglycemia
due to absolute or relative deficiency of insulin. Type 2 diabetes (T2D) occurs due to a
progressive decline in the ability of the pancreas to secrete enough insulin as well as
insulin resistance in insulin target tissues. The pathophysiology of T2D is characterized
by excessive accumulation of ectopic fat in the liver, pancreas, and skeletal muscles,
eventually manifesting as insulin resistance in these tissues and pancreatic beta cell
dysfunction that ultimately leads to hyperglycemia.Metabolic abnormalities such as
dyslipidemia, hyperinsulinemia, or insulin resistanceand obesity play key roles in the
induction and progression of type 2 diabetesmellitus (T2DM). Objectives: To estimate
the levels of serum myeloperoxidase, apolipoprotein B and glycated hemoglobin in type
2 diabetic patients and also in healthy controls, to observe the relationship between
serum MPO with apo B and glycated hemoglobin and also between glycated
haemoglobin with apo B in type 2 diabetic patients and healthy controls.
Materials and Methods: Case control study was done taking 30 cases of type 2 diabetes
mellitus and 30 age and sex matched healthy controls. In all the subjects, concentrations
of HbA1c, serum apo B and serum MPO were estimated. HbA1c was measured by
turbidimetric method and serum Apo B by immune turbidimetric method using semi
auto analyser CHEM 5 Plus. Serum MPO was measured by ELISA method using
ELISA reader.

Background and aim: India is one of the 7 countries of the IDF (International Diabetes Federation) SEA (south-east Asia) region. 463 million people have diabetes in the world and 88 million people in the SEA Region; by 2045 this will rise to 153 million. There were over 77,005,600 cases of diabetes in India in 2020.In our study we tried to determine the risk factors for development of Glaucoma, especially in Type-2 diabetics and its magnitude.
Methods: a cross sectional study done in KIMS OPD, Bangalore between January 2018-may 2019. Diabetes was diagnosed by history and measurement of blood sugar levels. Glaucoma was diagnosed by assessing optic disc morphology, visual fields, and intraocular pressure. Systemic blood pressure was also measured for the patients. Statistical significance was indicated by P < 0.05.
Results: Study cohort included 350 patients with Type-2 Diabetes (150 males and 250 females), mean age of 52+/- 9 years. Prevalence of glaucoma was 16% (95% CI; 13.4-18.3). Out of this 16%, 50% had primary open angle glaucoma, 32% primary angle closure, 12.5% neovascular glaucoma, 5.3% other types. 77% diabetics didn’t have Diabetic retinopathy. Presence of glaucoma was significantly associated with the duration of Diabetes (chi-square=5.80 and p<0.015). Presence of Diabetic retinopathy was Not significantly associated to the presence of glaucoma (odds ratio=1.42). Even presence of systemic hypertension did not affect the magnitude of glaucoma in diabetics.
Conclusion: Screening for glaucoma while screening Diabetic cases may yield us more cases of glaucoma and the duration of diabetes is one of the most important determinants for development of glaucoma.

schedule and accurate diagnosis. The research centre danger marker for necrotizing
fasciitis score can be useful for distinguishing between instances of cellulitis, which
ought to react to clinical administration alone, and NSTI, which requires usable
debridement notwithstanding antimicrobial treatment.
Objective: To concentrate on the relationship between clinical, lab boundaries and
imaging in the diagnosis of NSTI. To break down the importance of Wong's LRINEC
rules in assessing NSTI, to distinguish the comorbidities related to NSTI and to decide
the meaning of progress in research centre boundaries after the inception of treatment.
Methods: It is a retrospective report where patients with a clinical diagnosis of
complicated delicate tissue disease were enlisted and exposed to investigations at the
hour of confirmation and assessed according to proforma. Subjects were isolated into
NSTI and SSTI groups because of clinical elements, research facility and imaging
discoveries. An Intergroup examination was done to distinguish factors related to NSTI.
Results: Clinical highlights like tachycardia, tachypnea, hypotension, unbalanced
agony, rankles, skin putrefaction, ulceration and change in shading were all together
(p150mg/L, RBS>180mg/dl, Total count>16500cells/mm3, Calcium1.4mg/dl were
fundamentally connected with NSTI (p<0.05). LRINEC rules had responsiveness of
89.1% and a particularity of 94.3 %. Both X-ray and Ultrasonography are pretty much
similarly explicit, however, ultrasonography was more delicate in diagnosing NSTI.
Genuinely critical contrast was noted between boundaries done at confirmation and the
second post usable period following resurgery.
Conclusion: Previously mentioned clinical highlights and lab boundaries can be utilized
to analyze, visualize and screen patients with NSTI. LRINEC is a decent apparatus for
separating NSTI from SSTI. Ultrasonography is more explicit in diagnosing NSTI than
X rays.

The metabolic syndrome is defined as a clustering of key cardiovascular risk factors,
namely, abdominal obesity, dyslipidemia, hyperglycemia and hypertension in a single
individual. Gerald Reaven introduced the concept of the syndrome in 1988.This crosssectional
study was conducted in 120 in which 60 non diabetic and 60 type 2 diabetic
patients, 2013 to 2015 in the department of biochemistry, Mediciti Institute of Medical
Sciences, Hyderbad. Ethical clearance was obtained for the study. Informed consent
was obtained. 60 subjects with type 2DM were included in the study. Subjects in the age
group of 30-65 yrs in both genders, meeting the Type 2DM, FBS and PLBS meeting the
criteria were taken up in the study. Maximum prevalence of Metabolic syndrome was
observed in diabetic male harmonised criteria (73.3%) and diabetic female WHO
criteria (76.6 ). A fair agreement was observed between WHO and HAR criteria by
Kappa statistics. A two tailed significant correlation were found in diabetic male
patients (using WHO,HAR criteria ) than female patients (using CDS) criteria

Aim: Evaluation of adverse drug reactions in patients of diabetes mellitus on 1^st line Anti-tubercular treatment.
Methods: Patients presenting to the Medicine OPD (Diabetic clinic), and Respiratory medicine OPD, KGMU, on specified days of the week diagnosed to be diabetes mellitus with tuberculosis was screened based on selection criteria. Written informed consent was taken from patients. Demographic details of the participants were recorded in semi-structured proforma. The overall description of the adverse drug effect was done for the selected patients. Seriousness of adverse drug effects were evaluated. Assessment of the severity of adverse drug effects were done. Causality assessment of ADRs was assessed by the WHO-UMC causality assessment system and Naranjo’s causality assessment scale. The severity of ADRs was assessed by Hartwig’s Severity Assessment and scale.
Results: In our study, incidence of Adverse Drug Reactions (ADRs) in diabetes mellitus patients receiving 1st line antitubercular treatment was 61.82% (68). Out of 110 patients, 68 patients developed a total 83 ADRs. Most common system involved was gastrointestinal system (24, 28.92%) followed by hepatobiliary system (21, 25.30%) and dermatological system (17, 20.48%). Least common system involvement was oto-vestibular, musculoskeletal and urinary system. Most common ADRs were Hepatitis/Jaundice (25.30%), Pruritis/rashes (20.48%) and Nausea/Vomiting (14.46%). Epigastric pain, Diarrhoea, Anemia/thrombocytopenia, Peripheral neuropathy and Headache was reported in 7.23%, 6.02%, 7.23%, 3.60% and 3.60% of the subjects respectively. According to WHO causality assessment scale, majority of ADRs were classified as probable (48, 57.83%). Possible ADRs were found in 33.74% of the subjects. Certain ADRs were found in 2.41% of the subjects. According to Naranjo’s causality assessment scale, majority of ADRs were classified as Probable (54, 65.06%). Possible ADRs were found in 30.12% of the subjects. Definite and Doubtful ADRs were reported in 2.41% of the subjects
According to Hartwig’s severity assessment level, mild, moderate and severe ADRs were reported in 80.72%, 15.67% and 3.61% of the subjects respectively. According to kappa analysis, the strength of association between Naranjo’s causality assessment scale and WHO Causality Assessment scale to assess ADR is good (kappa value: 0.72, p value: 0.008).
Conclusion: Most of the ADRs belonged to mild category according to the Modified Hartwig and Siegel scale for severity assessment. ADRs induced by ATT are common, which can result in discontinuation of treatment and development of resistant bacilli.

Aim- To study the prevalence of dry eye disease(DED) and its association with diabetic retinopathy (DR), diabetic neuropathy (DN) and other metabolic parameters in patients with type 2 diabetes mellitus. Materials and methods- Dry eye disease was assessed in 102 patients with type 2 diabetes mellitus using OSDI (Ocular Surface Disease Index) score, tear break up time(TBUT) test and Schirmer’s test. All the subjects underwent indirect ophthalmoscopy, DN screening was done based on Revised NDS score, DR was graded according to Early Treatment Diabetic Retinopathy (ETDRS) criteria. The relation of DED with status of diabetic retinopathy, peripheral neuropathy, dyslipidemia, metabolic control and duration of disease was also assessed. Results- The prevalence of dry eye disease was 37.2%.We observed a significant associationof dry eye disease with diabetic retinopathy (p=0.017) and diabetic neuropathy(p=0.019). Conclusion- As the prevalence of DED among diabetics is high and diabetic retinopathy and neuropathy are often found to be associated with DED, therefore, along with screening for DR and DN, assessment of dry eyes should be routinely included in patients with diabetes in ophthalmology clinics.

Background:Diabetic patients might exhibit dry eye symptoms probably due to neuropathy,
metabolic dysfunction, or abnormal lacrimal secretions. The present study was conducted
to assess prevalence of dry eye diseases in diabetic patients.
Materials & Methods:92 diabetic patients of both genders were enrolled. Ocular
examinations, fasting blood sugar (FBS), postprandial blood sugar, and glycosylated
hemoglobin estimation (HbA1c) were recorded. Dry eye patient was diagnosed with the
help of slit-lamp examination, Schirmer’s test, tear film break-up time (BUT), and Rose
Bengal staining technique. Gradation of dry eye was done by the following standard
protocol.
Results: Dry eye was present in 70 and negative in 22. The mean duration of diabetes was
11.4 years in positive cases and 5.6 years in negative cases. The difference was significant
(P< 0.05).Grade was mild in 32, moderate in 20 and severe in 18 patients. The difference
was significant (P< 0.05). Age group (years)<50 years had 24, 50-60 years had 30 and >60
years comprised of 16 patients. Blood sugarcontrol (HbA1c) was good in 12, fair in 10,
action suggested in 28 and poor in 20 patients. The difference was significant (P< 0.05).
Conclusion: There was high prevalence of dry eyes in diabetic patients. Grade of dry eyes
was mild, moderate and severe.

Background: The role of serum uric acid as a risk factor for ischemic stroke in patients with type 2 Diabetes Mellitus is controversial and there is little information about it.
Aim of the study: This study was done to estimate serum uric acid levels in diabetic patients with ischemic stroke and to assess its risk factor potential.
Methods: It is a case control study carried out in the medical ward at Al Hussein Teaching Hospital at Al Nassiriyah city at southern of Iraq from June 2018 till December 2018, carried on 119 patient mean ages is 61.89 years. 56 of them was diabetic patients with ischemic stroke were enrolled as a case group and compared with 63 non diabetic patients presented with ischemic stroke also as a control group, Serum uric acid levels were measured in cases and controls (within 24 hours of stroke). The results were statistically analyzed and studied with other risk factors.
Results: Mean serum uric acid level in cases was 6.02 mg/dl where as it was 5.34mg/dl in controls. Hyperurecemia found in 25% of cases , with significant statistical association with increase in TG Cholesterol level p value is0.028 , and hyperurecemia was significant only in old age diabetic (p value less than 0.05) .
Conclusions: There was no significant statistical association between Serum uric acid level and stroke in type 2 DM, but it found to increase other risk factor for stroke especially in old age group , so it can be considered as a risk factor for ischemic stroke in type 2 DM.

Background:Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular diseases (CVDs). This study is an attempt to determine the correlation between hemoglobin A1c (HbA1c) and serum lipid profile and to evaluate the importance of HbA1c as an indicator of dyslipidemia with T2DM.
Materials and Methods: This is a prospective and observational study was accomplished at Tertiary care teaching Hospital over a period of 6 months. Patients of either gender with an established diagnosis of T2DM were selected according to the American Diabetes Association criteria (ADA). These criteria set the following as values that are indicative of T2DM: HbA1C ≥6.5%, FPG ≥126 mg/dl, 2-h plasma glucose ≥200 mg/dl during an oral glucose tolerance test (OGTT), or random plasma glucose ≥200 mg/dl.
Results: Blood glucose level was 149.35 ± 13.23 mg/dl and mean HbA1c was 7.96±1.46. Mean total cholesterol was 179.53±16.36, mean total triglyceride was 183.74±17.64, mean LDL was 105.85±8.50, Mean HDL was 36.94±4.28. HbA1c positively and significantly correlated with total cholesterol (r=0.091), LDL (r=0.013), HbA1c negatively and significantly correlated with HDL (r= - 0.126), and did not show any show correlation with VLDL (r=0.024) and total triglycerides (r=0.103).
Conclusion: Our study accomplished that HbA1c has a direct, significant correlation with total cholesterol, triglyceride, VLDL, and LDL among the lipid profile. Significant positive correlation of HbA1c with lipid profiles from our study results implies that HbA1c can also be used as a predictor of dyslipidemia in addition to as a glycemic control parameter for prevention of complication.

Aim: To assess the effect of Platelet Rich Plasma (PRP) in non-healing ulcers.
Material and methods: It was a hospital based prospective cross-sectional &
observational study between July 2020 to June 2021, at Hind institute of medical
sciences, Safedabad, Barabanki. The history and examination were done bedside. In
cases where the condition of patients doesn’t warrant giving history, their relatives or
attendants were interviewed. A predesigned pretested semi-structured questionnaire
was filled by the interviewer. Data was entered in Microsoft Excel sheet. The study area
was General Surgery, Orthopaedics& medicine department, of Hind Institute of
Medical Sciences, Safedabad, Barabanki.Pus culture and sensitivity were sent then after
cleaning the wound with normal saline and betadine solution, already centrifuged
platelet rich plasma was injected subcutaneously inside, in the periphery of wound and
spread over floor of ulcer then dress with non-absorbent dressing. 1st dressing was
changed on the 3rd day of injection then dressing was changed on every 7th day.We
evaluated the effect of 1 dose of platelet rich plasma injection efficacy in wound/ulcer
healing & reduction in wound/ulcer size and follow-up by visual inspection.
Results: At admission, the mean wound area was 388.6±25.35 mm2 which was reduced
to15.54%at3rddayandthisreductionwasfoundtobestatisticallysignificant(p<0.001).
Furtherreductionwasobservedat 14th day (49.66%) and 21st day (64.40%) and these
reductions were statisticallysignificant (p value <0.001).At 21st day the % change in
volume was maximum for venous ulcer (69.25±4.43 %) and minimum for post
traumatic (65.27±9.11 %). No significant difference was found in % change in volume at
21st day among various ulcer types (p value =0.336).
Conclusion: Based on this study observation and result, we proposed that platelet rich
plasma is a safe bio-compatible, cost-effective, less time-consuming procedure and does
not require sophisticated equipment.

Background:Diabetes mellitus has been postulated to alter the morphology of the
cornea.Aim of our study was to compare the morphological characteristics of corneal
endothelial cellsin type 2 diabetic patients with age-matched healthy subjects. We also
determined the association of corneal morphological features with the general
characteristics and laboratory data of diabetic patients, including disease duration,
urine albumin creatinine ratio.
Methods:A case-control study in a tertiary care hospital of northwestern India with a
total of 50 diabetic patients and 50 healthy controls were enrolled in the study. All
participants underwent a complete ophthalmological examination. Corneal endothelial
measurements were performed using a noncontact specular microscopy. Laboratory
data including serum fasting glucose, --HbA1c levels, creatinine levels, and the urinary
albumin-to-creatinine ratio were recorded. Diabetic patients were further subdivided
into 3 groups according to the presence and stage of diabetic retinopathy. Specular
microscopy findings and central corneal thickness of all patients were compared.
Results: The ECD and hexagonal cell ratio were significantly lower, while the average
cell size, CV%, and central corneal thickness were determined to be significantly higher
in diabetic patients than in healthy controls (p = 0.001). With the presence and
advancement of diabetic retinopathy, the ECD and hexagonal cell ratio decreased, while
the average cell size, CV%, and central corneal thickness increased. When correlation
analysis was performed between corneal morphological features and laboratory data of
diabetic patients, ECD showed a significant negative correlation with diabetes duration
(p = 0.028). Urinary albumin-creatinine ratio (p = 0.041), average cell size and CV
showed a positive correlation with these parameters.
Conclusion: In conclusion, keratopathy is an important complication of type 2 diabetes.
With an increase in the stage of diabetic retinopathy, alterations in corneal findings also
increased. In that respect, we can suggest that keratopathy should be evaluated more
cautiously in diabetic patients.

Background:Diabetes in Pregnancy Study Group India (DIPSI) and International
Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations are
general diagnostic criteria utilized in our country for determining gestational diabetes
mellitus (GDM). To diagnosis GDM, the IADPSG following Hyperglycaemia and Adverse
Pregnancy Outcome (HAPO) recommends fasting plasma glucose (FPG) of 92 mg/dL, 1-h
PG of 180 mg/dL, or 2-h PG of 153 mg/dL.
Aims:To compare DIPSI recommended GTT and IADPSG-2 phase strategy in terms of
efficacy for diagnosing GDM.
Materials and methods:The study was undertaken on antenatal women in the Out Patient
Department of our hospital. It was done to compare the efficacy of DIPSI recommended GTT
and IADPSG2-phasestrategyin diagnosing GDM and also to study the neonates of the two
groups in terms birth weight, presence of neonatal hyperbilirubinemia and presence of any
respiratory distress.
Results:The data from 70 women in groups A and B was analysed. There is no statistically
significant difference in the demographic distribution of the study groups. The number of
GDM cases detected by the two diagnostic criteria did not differ significantly. When
comparing the two groups, birth weight, respiratory distress, and neonatal hyperbilirubinemia
are all negligible. When comparing groups, the type of labour and delivery are unimportant.
In both study groups, there is no significant difference in the frequency of GDM patients who
require either MNT or insulin +MNT.
Conclusions:We conclude that application of DIPSIGTT is comparable to the new IADPSG
guidelines recommended by ADA in the diagnosis of GDM Even those who came under lowrisk
category for developing GDM according to ADA were found to develop GDM in the
study population in both the groups.

Background: Blood glucose and electrolytes have a complicated relationship that is
influenced by a number of other factors such as age and concomitant conditions. As
there is paucity of such studies in India, so present study was to determine the most
prevalent electrolyte disturbances among diabetic in-patients and to explore an
association between blood sugar and electrolyte imbalances.
Materials and Methods: The present cross-sectional study was carried for a duration of
two years among 271 adult patients with diabetes mellitus admitted to the wards and
ICU in a tertiary care centre. Patient-specific information was collected in a structured
schedule and blood sample was collected for laboratory investigations after obtaining
written informed consent. All tests were performed at a 5% level of significance; thus,
an association was significant if the p value was less than 0.05.
Results: In present study (Table 1), the mean age of study subjects was 58.92 ± 13.15
years, with nearly equal representation from males (49.4%) and females (50.6%). The
mean duration of diabetes among subjects was 9.72 ± 6.57 years. The mean HbA1C was
7.65 ± 1.23 % which reflect uncontrolled diabetes. The most common electrolyte
imbalance among enrolled subjects was hyponatremia (33.6%). The mean levels of
serum sodium (group A: 132.82 ± 3.99 vs group B: 135.62 ± 5.12), were statistically
different (p<0.05).
Conclusion: The importance of evaluating serum electrolytes in patients with type 2
diabetes was presented in the study. Electrolytes, particularly sodium, chloride, and
potassium, become significantly disturbed as fasting blood glucose rises.

The prevalence of cardiac autonomic neuropathy (CAN) in type 2 DM patients increases with
the duration and poor glycemic control. Patients with CAN are at increased risk for
autonomic dysfunction like resting tachycardia,abnormal systolic and diastolic function
leading to syncope and dizziness, prolonged QT interval, silent ischemia/infarction, lethal
arrhythmias and sudden death.Usage of 5 simple and cheap bed side tests for autonomic
function and corrected QT interval from ECG are helpful in early diagnosis of CAN. Early
recognition of CAN is helpful in delaying effects of CAN by strict control of blood sugar and
following healthy life style. Our study was conducted on100known and newly diagnosedType
2 Diabetes Mellitus patients<60 years whopresentedto Medicine OPD and admitted in IPD
wardsin Maharani LaxmiBai Medical College.Out of total 100 patients,49% had normal
score(0,1); 25% had borderline score(2,3,4); rest 26% had abnormal score ≥5; the prevalence
of CAN was 51%.Among 100 patients 47% patients were foundwith poor glycemic control
(HbA1C ≥ 8),in these 17% had early and 21% had definite CAN. Out of 100 patients of the
study, 55% patients had QTc>440ms out of which 17% had early and 23% had definite CAN.
The CAN also increased with older age group. So it is important to diagnose CAN early in
asymptomatic diabetics. There is significant correlation between CAN and QT prolongation.
QT interval in ECG can be used to diagnose CAN with reasonable sensitivity and specificity.
Usage of 5 bedside autonomic function tests are very helpful in early diagnosis of CAN.Strict
control of blood sugar can delay the early development of CAN. Intensive control of blood
sugar can delay the early development of CAN.

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using
Ultrasonography.
Methodology: This cases control study was conducted among 50 diabetic patients enrolled
from the diabetes clinic of the Medicine Department of Maharishi Markandeshwar medical
college and hospital Kumarhatti, Solan, Himachal Pradesh and 50 healthy patients (control
group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and
functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in
these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126
mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75gm
glucose. An informed consent was taken from all the subjects in the study and control groups.
All the patients were randomly selected for the study among patients regularly attending
diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in
control group. 46% of diabetics were males and remaining 54% were females, whereas in
control group male to female ratio was equal, means 50% males and 50% females. 90% cases
in control group had no gall bladder disease, while only 66% cases in group with diabetes
had no gall bladder disease. In group with DM type 2, 10% had cholelithiasis, 8% had
cholecystitis and 3% had sludge: while in control group, 4% had cholelithiasis, 2% had
cholecystitis and 4% had sludge. The percentage of contraction of gall bladder had reduced
markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value-
0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than
that of controls (28.45 + 4.26) and the difference of values was found to be highly
significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and
decreased percentage of contraction are observed. Therefore, all T2DM patients should
be evaluated using ultrasonography for the presence of increased fasting gallbladder
volumes to assess the risk of progression to gall stone disease.

Aim: To evaluate fatty liver disease and cardiovascular diseases in type 2 diabetic patients
using ultrasonography.
Methodology: The prospective and observational study was conducted in the Department of
Radiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Himachal
Pradesh for the period 9 months. 300 patients diagnosed with type 2 diabetes and ultrasound
abdomen showing fatty changes in liver without any other co-morbidities were included.
Patients were divided in three groups according to the duration of the diagnosis of diabetes.
The distributions of different groups were GROUP A- less than 5 years, GROUP B-in
between 5 to 10 years and GROUP C-more than 10 years. A brief history was taken of the
patient’s complaints and then the patients Random blood sugar and BMI values, as mentioned
in the patient’s case paper were recorded and then ultrasonographic evaluation of the study
subjects was performed by a single radiologist and the following parameters were examined
after obtaining informed consent-Liver echogenicity, Portal Vein Doppler study, Mesenteric
fat pad thickness and Carotid Artery Doppler study. Study method was Interview schedule
questionnaire, OPD records, bedside tickets, physical examination and laboratory
measurements.
Results: Out of the 300 patients, 145 (48.3%) were males, and 155 (51.7%) were females.
Majority (39%) of the patients belonged to 50-60 years of age group followed by 25.7%
patients in the age group of 40-50 years. 18.3% belonged to 60-70 tears of age, 10.7% were
less than 40 years, and 6.3% belonged to more than 70 years of age. Out of the 300 cases, 225
(75%) cases had fatty liver and 75 (25%) cases had non-fatty liver. Out of the included
patients, 33.4% (100) were in group A, 40% (120) were in group B, and 26.6% (80) were in
group C. Out of 300 patients, 70 (23.3%) cases had ischemic changes, but majority of patients
(230, 76.7%) did not have ischemic changes.
Conclusion: Liver ultrasound examination should be considered in every patient with newly
diagnosed type 2 diabetes because the prevalence of NAFLD is extremely high in this group
of patients. It can be said that there was an association between cardiovascular risk factors
and NAFLD in patients with type 2 diabetes mellitus.

Diabetes mellitus is a non-communicable chronic metabolic disorder. The association
between sensorineural hearing loss and diabetes has become an important subject of research.
Pathophysiology of hearing loss in diabetes is not still well explained. Usually gradual,
bilateral, sensorineural hearing loss at high frequency is seen in diabetes mellitus. Our study
aims to know the prevalence of SNHL in DM and its relation to HbA1c. A total of 300
subjects including 150 healthy individuals age and sex matched as control and 150 patients of
type 2 diabetes between 10-50 years age group including 78 males and 72 females were
included in the study. Fasting blood sugar and HbA1c of all the subjects were taken for the
study and after that pure tone audiometry was performed (PTA). By observing the data
degree, type and correlation with HbA1c of hearing loss was concluded. 28% diabetic
patients suffered with SNHL while 72% were found with normal hearing threshold. Among
42 patients 23 mild, 9 moderate, 9 moderately severe and 1 severe degree hearing loss cases
were found in diabetic group. Hearing loss was found on higher frequencies. Association
between hearing loss and HbA1c was observed and it was highest in the 10-13.9% range but
this correlation was not found significant (p value >0.05) in our study.

Diabetes is a major, non-communicable disease with increasing prevalence globally and
will be the seventh leading cause of death worldwide by 2030 as estimated by the WHO
report in 2011. Saudi Arabia is considered to be one of the highest countries in the Middle
East for the incidence of diabetes mellitus. Type 2 diabetes affects the most productive
midlife period but has also started to appear in younger age groups. Type 2 diabetes is now
increasingly diagnosed among adolescents and young adults, data are lacking regarding
knowledge about diabetes mellitus among school students in Saudi Arabia but it is a
potentially preventable disease through a combination of lifestyle modification and
pharmaceutical treatment.

Introduction: Diabetic foot and diabetic ulcers are common complications of diabetes mellitus.
It affects daily life of patients and lead to amputations. The study was conducted to see the
effect and role of superoxidised solution and gel (microdacyn) in promoting the healing and
treatment of diabetic foot ulcer.
Material &Methods: The wound site was cleaned with normal saline followed by application
of superoxidised solution for 30 seconds and then followed by application of wound care
hydrogel. Observations were made during dressing and examination of the patients/ wounds
was done on the day 7,14,21,28 and at follow-up of 15 days. Rate of contraction of wound is
measured in cm2.
Results: Mean age of patients in the study was 50.0687±11.85 years with equal male to female
ratio. Superoxidised solution provides good wound healing and mean hospital stay was
10.49±4.24 days. Significant reduction of wound is seen in cases with short duration of ulcer
and short duration of diabetes (p<.05).
Conclusion: Superoxidised solution was associated with faster healing of ulcers without any
major complications, proving SOS to be safe and efficient as a wound care product in the
management of lower limb ulcers.

Background:There is an increase of risk of coronary artery disease about 4-fold with diabetes
mellitus, and ischemic heart disease is liable for diabetes-related deaths. In this study, we
examined the association between glycemic control, as determined by Hemoglobin A1c, and the
incidence of periprocedural complications in diabetic patients who had coronary artery bypass
graft (CABG) undergoing percutaneous coronary intervention (PCI).
Aim of the study:To assess the effect of control of DM on the outcome of PCI in patients who
underwent CABG.

Background:Coronary artery disease is higher in risk with diabetes mellitus, and diabetesrelated
deaths can lead to ischemic heart disease. We examined the relationship between the
glycemic regulation as determined by Hemoglobin A1c and the occurrence of periprocedural
complications in patients who performed percutaneous coronary intervention (PCI) and had
Coronary artery Bypass Graft (CABG)
Objective: To identify associated complications and their sites with Percutaneous Coronary
Intervention in diabetic patientswho performed Coronary Artery Bypass Graft.
Methods:The cross-sectional analysis was performed at the cardiology department in Zagazig
University Hospital in which all 24 CABG & DM patients were included during the period
between January 2019 and January 2020 divided into 12 patients with controlled
DM(HbA1c>7)&12 patients with uncontrolled DM (HbA1c<7).Both patients had a complete
medical history, a detailed clinical evaluation, and preoperative laboratory work: role of the
renal, completion of blood counts as a marker for regulation of DM, ECG, and ECHO.
Glycosylated Hemoglobin HbA1c was used.

The aim of this study is to retrospectively analyse the prevalence of diabetes mellitus and hypertension among patients undergoing  dental implant treatment in a dental hospital. All the patients reported in the month of June 2019 to March 2020 for implant placement was chosen for the study. Implant placement data of patients with diabetes mellitus and hypertension was collected from the dental hospital record system. Result data was tabulated in excel and statistical analysis was done using Statistical Software for the Social Sciences (SPSS) software. The non parametric Chi square test was done for statistical analysis. The prevalence of diabetes mellitus in patients undergoing implant placement is 4.2%, hypertension is 2.2% and coexisting diabetes mellitus and hypertension is 1.7% with a higher incidence in the male population and more common in the age group of 40 to 60 years. Knowledge about the prevalence of these conditions will be helpful to the clinician for proper management setup and precise diagnosis before implant therapy can prevent surgical and postoperative complications resulting in long term success of dental implants

In today’s world, Diabetes Mellitus is a disease, that is considered to be an extensive noncommunicable disease which has a great effect our day to day living. In the 21st century, changes in natural life style and labor culture are some of the main reasons for India to have 62 million diabetic cases as of today. Analytical Computational Techniques can be applied on clinical immense data, the enormous quantity of data produced in the healthcare schemes, there is a option to form medicinal intelligence which will initiative medical forecast andpredicting in future. By advancing medical intelligence and with the help of development model, prediction and detection of diabetes disease can be done. With the increase in complexity to the problems, the accuracy percentage also varies. LGBM - Light Gradient Boosting Algorithm is one such algorithm that can be used as it depends on decision tree algorithms and it can be used in predicting the accuracy to attain the desired results. With the
existing PIMA Indian Dataset the accuracy is calculated as 95.20% using LGBM Algorithm . Therefore by using the LGBM classifiers, we can develop a data model for diabetes detection and prediction.

Background : This study aims to determine the effect of a combination regimen of
metformin and without metforminon the conversion of sputum smear in new cases
of pulmonary TB patients with type 2 DM.
Materials andMethods: This cross-sectional study was conducted at Wahidin Sudirohusodo
Hospital, Makassar Center for Lung Health, Kasi-Kasi, and Sudiang Community
Health Center from August 2019. This study involved 83 new cases of pulmonary
TB subjects with T2DM. New cases of pulmonary TB patients were obtained by examining AFB sputum in DM patients who had symptoms of pulmonary TB and had no history of suffering or receiving previous anti-TB drug therapy.Pulmonary TB patients receive category 1 anti-TB drugs andDM subjects were divided into 2 groups is metformin and non-metformin. Then, smear sputum is examined in the 2-month intensive phase of anti-TB drug therapy to assess the conversion of AFB sputum.
Results: From a total of 83 new cases of pulmonary TB and T2DM, 44 subjects received a combination regimen of metformin and 39 subjects non-metformin. In this study, there were 42 (95.5%) subjects who conversion sputum smear in the metformin group more higher than in the  non-metformin group but statistically it was not significant (p = 0.282).
Conclusion: There was no significant relationship between the metformin and non-metformin groups on the conversion of AFB sputum smear in new cases of pulmonary TB patients and T2DM.

Diabetes mellitus is a group of physiological dysfunctions characterised by increased blood
glucose level resulting directly from insulin resistance or impaired insulin secretion leading to
micro and macrovascular complications. The oral complications of diabetes mellitus includes
increased incidence of dental caries, dry mouth, burning mouth syndrome and periodontitis.
Assessment of blood glucose levels is essential prior to any specialised procedure to avert any
further oral and systemic complications. Screening of diabetes mellitus condition has become
a necessity in developing countries and study of this nature will have enormous public health
impact. The aim of this study is to assess the prevalence of diabetes mellitus in patients visiting
different outpatient departments of private dental college hospital, Chennai. All the cases
referred from the month of June 2019 to March 2020 for random blood sugar tests were
chosen for the study. Data was collected from the dental hospital record system. Result data
was tabulated in excel and imported to SPSS for correlation and association. P<0.05 was
considered to be the level of statistical significance in this study. Within the limits of the
present study, diabetes mellitus prevalence in random blood sugar tested patients is 33.3 %
with a higher male incidence and more prevalent among the age group of 41 to 60 years.
Knowledge about the prevalence of diabetes mellitus in the patients visiting dental hospital will
be helpful to the clinician to prevent any further complications before any specialised
procedure.

Diabetes mellitus is the most common endocrine disease, therefore it is a priority medical and social problem. Often with diabetes, it is the ocular manifestations that primarily lead to the disability of patients. The review contains an analysis of the morphological experimental and clinical studies of fundus elements in patients with DM - original research, reviews and monographs by domestic and foreign authors, mainly in recent years. Clinical and morphological changes in diabetes are discussed, early diabetic changes in the retina, blood vessels, and macula are described. The important role of changes in the internal plexiform layer and ganglion cells

Background: Calprotectin was identified as an endogenous Toll-liken receptor 4 (TLR4) activator and as a receptor for progressive glycation end products (RAGE), Elevated Calprotectin plasma levels have been recorded in various chronic inflammatory conditions, expecting microvascular alterations in patients with type 2 diabetes (T2DM). Objective: To make an up to date review of Serum level of Calprotectin as a predictor for early diagnosis of peripheral neuropathy in type 2 diabetes patients. Patients and methods: A total number of 90 subjects were included in the study after fulfillment of the inclusion and exclusion criteria. Calprotectin was measured for all the 90 subjects. Results: Serum calprotectin levels were significantly higher in group III “diabetics with neuropathy” compared to group II “diabetics without neuropathy “and group I “healthy controls” Conclusion: In Type 2 diabetes patients with peripheral neuropathy, elevated levels of calprotectin have been identified.

Introduction: Catheter-related bloodstream infection (CRBSI) is a critical problem in dialysis center.
Aim: To study the prevalence of central venous catheter related blood stream infections and to identify the microbiological profile of organisms causing CRBSI.
Materials and Methods: This prospective observational study carried out at Dialysis unit over a period of two years on 145 hemodialysis patients, who had cultures of catheter and blood samples were studied.

To study the clinical profile, etiology and various patterns of Macular Oedema. Materials & Methods: A cross sectional case study was done from December 2018 to May 2020 at Krishna institute of medical sciences, Karad. Detailed history and examination of the patients done including Amsler Grid, Color Vision using Ishihara’s Chart and Slit lamp 90D examination and dilated fundoscopy. Pattern of macular oedema was evaluated and subsequently documented using Fundus camera, OCT and FFA.

Introduction: Catheter-related bloodstream infection (CRBSI) is a critical problem in dialysis
center.
Aim: To study the prevalence of central venous catheter related blood stream infections and to
identify the microbiological profile of organisms causing CRBSI.
Materials and Methods: This prospective observational study carried out at Dialysis unit over
a period of two years on 145 hemodialysis patients, who had cultures of catheter and blood
samples were studied.
Results: A total of 557 haemodialysis catheters (tunnelled and non-tunnelled) were
inserted during the study period, and among them, CRBSIs was seen in 145 cases.Mean
duration of dialysis catheters in situ was 20.6days.99 (68.2%) patients were males, and 46
(31.7%) were females. Diabetes mellitus (76.5 %) was the most common premorbid illness
associated with CRBSI. 81.3% patients found to be below 10 mg/dl of Hb, and
68.3%patients had leucocytosis. Among 145 of CRBSI, blood cultures were positive in 48
patients, and 97 patients were culture negative.45.8% isolates were gram-positive and
52.8% isolates were gram-negative bacteria, and one isolate was found to be fungal
infection.Among gram positive, CONS were most isolated, followed by Enterococcus,
MSSA and MRSA.

Proton pump inhibitors (PPIs) are the commonly recommended treatment for gastric abnormalities. The structural scaffold of PPIs (Pantoprazole; PPZ) provides an incalculable chance of association with diverse biological receptors which indicate a huge possibility of pleiotropic therapeutic impact which needs to be explored. Recently, several studies report the cardioprotective events of PPIs, but the underlying mechanism is not clear. Four groups having six animals in each were considered for this study. STZ (50 mg/kg/i.p) was given to induced chronic diabetes mellitus (DM) and vascular endothelial dysfunction (VED). PPZ (4 mg/kg/p.o/daily for 8 weeks) was evaluated against DM induced VED by measuring endothelial relaxation, aortic/serum nitrite/nitrate concentration, asymmetric dimethylarginine (ADMA), aortic superoxide anion generation, serum thiobarbituric acid reactive substances (TBARS) and dimethylarginine dimethylaminohydrolase (DDAH) in the cell lysate of each animals group. PPZ significantly overcome the perturbed level of hyperglycemia measured by blood glucose level, increase the availability of NO measured by aortic/serum nitrite/nitrate concentration. Treatment with PPZ showed the determinate lessening of tissue injuries as it averted increase expression of VED measured by ACh-induced endothelium-dependent relaxation, and diminution in oxidative stress, plasma ADMA level, and DDAH concentration in the cell lysate. The vascular protective potential of PPZ has a strong correlation with the DDAH/ADMA/eNOS/NO signaling pathway. Furthermore, the study also explored the antioxidant activity of PPZ which may also facilitate this protective pathway by increasing the bioavailability of NO in the endothelium.

Diabetes mellitus is a metabolic disease characterized by an increase in blood sugar levels that cause vascular complications and circulatory disorders. Hot and cold water soaking in the feet can increase blood flow and blood vessel pumping. Objective: to assess the effect of hot and cold water soaking in the foot blood circulation in patients with diabetes mellitus. Methods: A quasi-experimental was conducted with pre-test and post-test approach with control. Respondents were 35 people per group by consecutive sampling. Data were analysed using Wilcoxon signed ranks test and the Mann Whitney Test. Result: there was a significant effect between the average value of Ankle Brachial Index before 0.823 (SD 0.025) and after treatment 0.95 (SD 0.95), p-value = 0.00. The mean difference was obtained p = 0.00, if the p value <0.05, there was a significant difference in the difference in the mean value. Conclusion: it was found that the leg blood circulation was getting better after the hot cold water soaking. It is recommended for nurses to make hot and cold water immersion into one of the independent nursing interventions in providing nursing care to diabetes mellitus patients.

In pathological conditions such as Diabetes Mellitus (DM), increased oxidative stress can cause a decrease in endogenous activity in the body so the body is unable to detoxify free radicals that cause cell damage. Some of natural antioxidant sources are moringa leaves (Moringa oleifera Lamk.) and clove flowers (Syzygium aromaticum Merry & Perril). The purpose of this study was to determine the enzyme activity of Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPx) in a mixture composing of ethanol extract of moringa leaf and clove flower towards animals with DM conditions. This research is an experimental laboratory study using a post test only group design. The subjects of this study were 40 white male Wistar rats (Rattus norvegicus) strain which were DM conditioned by streptozotocin induction. Rats were randomly grouped into 8 groups, and each group consisted of 5 rats. The combined dosage of the ethanol extract of moringa leaves and clove flowers used is a combination I : 150: 40 mg / kg body weight rat, combination II 100: 80 mg / kg body weight rat and III 50: 120 mg / kg body weight rat. The results showed that the combination of ethanol extract of moringa leaves (Moringa oleifera L. and clove flower (Syzygium aromaticum Merry & Perril) increased the antioxidant enzyme activity of SOD and GPx in animals with DM conditions.

The present work was aimed to identify phytochemicals in methanol extract P. brevicaule alba Thom - CC200, obtained from C. cristata , by qualitative and TLC analysis and evaluation of α-amylase inhibitory activity in vitro. It was determined the presence in the extract of glycosides, terpenoids, and saponins. The partitioning of the extract by TLC showed that inhibition of enzyme activity at 50,3% and 37,6% is associated with two compounds of saponin nature.

Abstract: Diabetes mellitus is characterized by loss of glucose homeostasis as a result of impaired secretion and function of insulin. The present study was designed to evaluate the role of flower extractof Bergenialigulataagainst diabetesin Streptozotocin induced diabetic rats. Albino Wistar rats weighing 120-150g of either sex were selected for the study.After a week of acclimatization, the rats were subjected to overnight fasting. Diabeteswas induced by intraperitoneal injection of Streptozotocin, freshly dissolved in citrate bufferpH 4.5.In the present study the STZ control animals showed enhanced gluconeogenic enzymes and diminished glycolytic enzymes there by it disturb the glucose homeostasis and diminished insulin production leads increased serum glucose levels. Treatment with flower extract ofBergenialigulata(AFBL) showed significant balancing of glucose homeostasis through reduction in gluconeogenic enzymes and elevation of glycolytic enzymes.The selected flower extract ofBergenialigulata(AFBL) showed in vivo antioxidant activity, antihyperglycemic activity, hepatoprotective activity, nephroprotective activity and finally glucose homeostatic activity might be due to the potent phytoconstituents present in the selected flower extract

Abstract— Durian seed flour is a source of carbohydrates that has the potential to be used to meet the carbohydrate needs of Type 2 Diabetes Mellitus (DMT-2) sufferers, but before it is used to fulfill carbohydrate needs in diabetes sufferers, an in vivo test is needed to identify the glycemic index (GI) of the flour. This study aims to determine the glycemic index of durian seed flour given orally to Sprague Dawley rats. This research was arranged in 2 steps, namely the manufacture of durian seeds flour and the glycemic index test with 5 repetitions with time variations 0; 30; 60; and 120 minutes at 3 days intervals using a glucometer. Rats were grouped into 3 groups each consisting of 2 rats. Flour was suspended in 0.1% sodium carboxymethyl cellulose (Na-CMC) at a dose of 0.5625 g, positive control was 1.125 g of glucose that given in an oral way. Data in the form of test animal blood glucose levels versus time were analyzed into the Area Under Curve (AUC) glucose levels versus AUC. GI calculations were carried out by comparing AUC of durian seed flour to glucose AUC. The results of the research and calculations carried out obtained the GI of durian seed flour of 10.90 with low criteria category. With this GI value, it can be stated that durian seed flour has the potential as a source of carbohydrates for DMT-2 sufferers.

Diabetes Mellitus (DM) is a chronic disease that has become a major health problem in Indonesia. The Chronic Disease Management Program (Prolanis) developed by BPJS Kesehatan in collaboration with First Level Health Facilities (FKTP) seeks to promote and prevent DM disease control. Efforts made include controlling the glycemic index to prevent microvascular and macrovascular complications that may occur with activities including medical consultation, counseling, home visits, club activities, and monitoring of health status.
Aim : The purpose of this study was to analyze the effect of DM patient adherence in participating in Prolanis activities on the patient's HBA1C profile.
Method:This study is an analytical study using a retrospective cohort design. The research data is secondary data obtained from the Medical Records of DM patients from January-April 2019. The research subjects were 42 DM patients who were registered as active Prolanis participants who had HBA1C data at the April 2019 examination.
Result: The results of this study showed that the mean HBA1C value in 22 patients who routinely followed prolanis activities (7.2 ± 1.48)% was more controlled than the mean HBA1C in 20 patients who did not routinely participate in prolanic activities (9.27 ± 2.06)% .
Conclusion: From this study it can be concluded that there is a significant difference between DM patients who adhere to the schedule of prolanis activities and patients who do not comply with the schedule of prolanist activities at the UPTD Puskesmas Nursing Ngletih Kediri City with a value of p = 0.001 (p <0.05; CI = 95% )

Nowadays, the incidence of Diabetes Mellitus (DM) is growing around the world. In fact, it is one of the most serious diseases among adults in the age of 45 and a life - threatening disease over the age of 50, resulting to be the leading causes of death in which Filipinos are also affected by the disease. One of the most known way to treat DM is using insulin. However, side effect, toxicity, and organ damage may happen due to continuous usage of synthetic anti-hyperglycemic agent. Therefore, finding non-toxic and affordable treatment for Diabetes such as medicinal plants is presented. Present investigation was undertaken to investigate the ability of Passiflora edulis sims (yellow passion fruit) pulp juice as anti-hyperglycemic agent on male Sprague-dawley rats, and to compare and evaluate which concentration used in the study of Passiflora edulis sims pulp juice is significantly better as anti-hyperglycemic agent. Thirty (30) individual rats were used in this experiment, 10 of them are used for toxicity testing and no toxic effect has been observed after 24 hours. The remaining 20 rats were randomly divided into five (5) groups, DM was induced by using Alloxan monohydrate dissolved in 0.5 M buffered citrate at a pH of 4.5 and was injected intraperitoneally. Treatment was done by oral administration of yellow passion fruit pulp juice, 1ml, 1.5ml, 2ml, and 2.5ml respectively. The effectiveness of fruit juice was compared with a control group this include diabetic rats treated with water. Results of the study revealed that 1.5 mL, 2mL and 2.5mL concentration of the fruit juice significantly decrease the blood glucose of the diabetic rats while pre and post blood glucose only shows a significant decrease on group 4 and group 5, the highly evidence of anti-hyperglycemic factor occur. Therefore, the Passiflora edulis sims pulp juice fruit juice can be used as alternative treatment for diabetes mellitus

At present, the important role of comorbid diseases, including diabetes
mellitus, in the course of COPD has been determined. Concomitant diabetes
mellitus accelerates the progression of ventilation disorders and worsens the
prognosis, increasing the risk of mortality from COPD. Diabetes mellitus is
associated with COPD from 2 to 16%. Potential mechanisms underlying the
high incidence of the combined course of COPD and type 2 diabetes mellitus
include: chronic systemic inflammation, oxidative stress, and chronic
hyperglycemia.
Purpose. determination of clinical, functional and radiological features
of COPD in diabetes mellitus.
Materials and methods. We examined 75 patients and studied the
features of the course of COPD in combination with diabetes mellitus in
comparison with the results of examining patients with COPD and patients
with diabetes mellitus by X-ray and MSCT.
Results. Patients with COPD in combination with diabetes mellitus are
characterized by more pronounced respiratory failure and chronic cor
pulmonale, frequent exacerbations and more pronounced hypoxemia in
comparison with patients with COPD. Standard radiography did not reveal
pronounced differences between the examined groups of patients with COPD.
COPD is formed as a result of damage to the small bronchi, which determines
the characteristic clinical and radiological symptom complex. In the structure
of COPD, there is a pulmonary component and systemic manifestations that
aggravate the disease. The manifestations of diabetes mellitus are based on
micro- and macroangiopathies that affect pulmonary microcirculation.
Conclusions. Diagnostically significant for COPD during MSCT is a
symptom of expiratory "air trap", combined with expansion and deformation of
the bronchi, up to bronchioectasis. At MSCT in patients with COPD and
diabetes mellitus, pathognomic changes characterizing microangiopathy:
dilated parenchymal vessels, focal-like shadows of vascular origin with a
diameter of 2-5 mm, a clear-cut shape of the vessels, which are considered as a
consequence of specific microangiopathy and fibrotic changes in COPD.

The aim of the research was to study red blood cells in type II diabetes mellitus (DM),
both an independently occurring disease, and in combination with hypertension, using
innovative research methods (atomic force and scanning electron microscopy with
elemental analysis). In the course of the study, we observed 20 patients aged 40 to 50
years. All of them were divided into groups of 5 people: without somatic and endocrine
pathology and infectious diseases; with moderate type II DM; stage II hypertension;
with a combination of type II DM and hypertension. Each has passed the necessary set
of generally accepted clinical and laboratory examination methods together with related
specialists (therapist, endocrinologist, neurologist, ophthalmologist). Blood was taken
from each patient for subsequent light, atomic force and scanning electron microscopy.
A morphometric analysis of the tissues in the Ntegra-Aura instrument was also
performed. We observed the most pronounced changes in the structure of erythrocytes
in people with a combination of type II DM and hypertension: the number of
degenerative forms increases sharply, and the number of discocytes decreases. In this
regard, such altered red blood cells can’t perform their functions in full. The article
substantiates the possibility and future prospects of using atomic force and scanning
electron microscopy with elemental analysis for independent type II DM, and in
combination with arterial hypertension.

Diabetes Mellitus (DM) is a chronic disease that has become a major health problem in Indonesia. The Chronic Disease Management Program (Prolanis) developed by BPJS Kesehatan in collaboration with First Level Health Facilities (FKTP) seeks to promote and prevent DM disease control. Efforts made include controlling the glycemic index to prevent microvascular and macrovascular complications that may occur with activities including medical consultation, counseling, home visits, club activities, and monitoring of health status. Aim : The purpose of this study was to analyze the effect of DM patient adherence in participating in Prolanis activities on the patient's HBA1C profile. Method:This study is an analytical study using a retrospective cohort design. The research data is secondary data obtained from the Medical Records of DM patients from January-April 2019. The research subjects were 42 DM patients who were registered as active Prolanis participants who had HBA1C data at the April 2019 examination. Result: The results of this study showed that the mean HBA1C value in 22 patients who routinely followed prolanis activities (7.2 ± 1.48)% was more controlled than the mean HBA1C in 20 patients who did not routinely participate in prolanic activities (9.27 ± 2.06)% . Conclusion: From this study it can be concluded that there is a significant difference between DM patients who adhere to the schedule of prolanis activities and patients who do not comply with the schedule of prolanist activities at the UPTD Puskesmas Nursing Ngletih Kediri City with a value of p = 0.001 (p <0.05; CI = 95% )

We examined 60 children from 5 to 17 years old in the regional endocrinological dispensary in Bukhara in the children's department with diabetes mellitus. The program "Healthy Tooth" was developed according to the following parameters: anamnesis of life, the state of the periodontium, the state of the mucous membrane of the oral cavity, the intensity of the spread of caries, the state of occlusion, the state of hygiene of the oral cavity, the state of the tongue. In all children, we took into account the following survey indicators: blood sugar level, age, hygiene index, PMA index and indices kp, KPU + Kp, KPU. At the same time, a comprehensive study of the oral cavity was carried out, which included the identification of patients' complaints, anamnesis, and a visual examination.

Objective: To describe the features and mechanisms of development of metabolic
syndrome (MS), type 2 diabetes melitus (DM2) and intermediate states of glycemia in
psychosis the occurrence of these disorders, the values of total cholesterol (TC),
fractions of high density lipoproteins (HDL), very low density lipoproteins (VLDL),
triglycerides (TG), values of atherogenic coefficient (AC), insulinemia, С-peptidemia,
insulin resistance (IR) the level of glycated hemoglobin (HbA1c) in a sample of patients
with schizophrenia and in mentally healthy individuals.
Materials and methods: The frequency of carbohydrate metabolism disorders (CMD) was
studied. Fasting glycemia was determined, and in the presence of its violation, a glucose
tolerance test was performed. MS components were studied in patients with DM2,
plasma concentrations of TC, HDL, VLDL, TG, C-peptide (CP), insulin and HbA1c were
determined in patients with DM2, AC values and IR indices were calculated using
HOMA-IR and CARO criteria.
Results: CMD in schizophrenia are more common than among mentally healthy subjects,
amounting to 13.1% (p=0.02), and the main condition here is a significant number of
individuals with impaired fasting glycemia (IFG) and impaired glucose tolerance (IGT)
among women (CMD p=0.01; IGT p<0.001; IFG p=0.03). A feature of psychiatric
sampling is a decrease in HDL by 16.4% (p=0.03) and an increase in AC by 52%
(p=0.02). Mentally ill men with MS are characterized by a significantly large value of AC
(p=0.019), insulinemia (p=0.02), CP level (p=0.02), HOMA-IR (p=0.01) and CARO
(p=0.04) values than in mentally ill patients with DM2 without MS. In comparison with
the control, regardless of gender, the schizophrenic patients with DM2 have significantly
lower values of insulin (p=0.03), C-peptidemia (p=0.04) and IR, according to the criteria of
HOMA-IR (p=0.01) and CARO (p=0.03).

The aim of the study was to develop new approaches to the study of modern aspects of
the clinical and morphological features of uterine blood flow in type I diabetes mellitus
(DM) in the mother. Under our supervision, there were 40 pregnant women with type I
DM. Clinical examination methods generally accepted in obstetric practice were used to
assess the condition of the fetus, placenta, and blood flow in the fetal vessels and uterine
arteries. Light microscopy, atomic force microscopy (AFM), and scanning electron
microscopy (SEM) of 2 uterine fragments obtained during cesarean section were
performed. Samples were examined using a FE1 Quanta 200 3D scanning microscope,
analyzed, and morphometric and imaging were performed. Processing AFM images was
formulated using the NOVA software (NT-MDT, Russian Federation). Results obtained
allow us to judge the adverse effect of diabetes on the mother's body during pregnancy
and childbirth. Among the complications of pregnancy, it should be noted: the state of
preeclampsia (8%), fetoplacental insufficiency (88%), the threat of abortion (52%),
polyhydramnios (25%).Morphologically, we revealed plethora of the endometrium. A
change in the shape of the myometrium with the presence of fragmentary destructive
changes in the myometrium, including focal necrosis and damage to the vascular system
of the pregnant uterus. The paper substantiates the possibility of using scanning electron
and atomic force microscopy as express methods for morphofunctional diagnosis of a
woman's condition in pregnancy pathology

The result of Indonesia Basic Health Research in 2018 showed an increase in the percentage of people with diabetes mellitus. This study aimed to analyze economic losses due to diabetes mellitus in National Health Insurance (NHI) participants with insurance fee waiver (IFW) and non-insurance fee waiver (IFW). This research was a quantitative study with a cross-sectional design. The sample of this study was 17 patients with IFW and 15 patients with non-IFW. The instrument used in this study was a questionnaire consisting of questions about the variable characteristics of the respondents and the direct and indirect costs that should be paid for treatment. Economic losses due to diabetes mellitus were analyzed through direct and indirect total costs.The economic loss for patients with IFW was IDR 5,572,366. Meanwhile, the economic loss for patients with non-IFW was IDR 2,989,984. So, the biggest economic loss due to diabetes mellitus was found in patients with IFW. This was very high when compared to their average income of around IDR 634,375. This can happen because the NHI participants have not taken full advantage of the use of NHI.

Abstract. The presence of cardiovascular autonomic neuropathy (CAN) significantly
worsens the prognosis and course of the underlying disease. So in patients with diabetes
mellitus (DM) and CAN, the mortality rate for 5 years is five times higher compared to
patients without this complication. Due to the fact that CAN is closely associated with
cardiovascular pathology, many authors consider CAN as a significant factor in
cardiovascular risk. Purpose. To establish clinical, functional and metabolic changes in
diabetic autonomic cardiovascular neuropathy in children with type 1 diabetes. Materials and
methods research. The total number of patients studied by us was 114 children with type 1
diabetes mellitus aged 4 to 18 years. We conducted laboratory and instrumental research
methods. Laboratory methods: general clinical research (general analysis of blood and urine,
studies of blood sugar), biochemical methods (total blood protein, bilirubin, cholesterol,
triglycerides, creatinine, urea, electrolytes, glycated hemoglobin), 24-hour heart rate
monitoring with circadian index estimation was used and parameters of time and frequency
analysis of heart rate variability. Conclusion diabetic autonomic cardiovascular neuropathy in
children with type 1 diabetes is characterized by the development of tachyarrhythmic rhythm
disturbances, as well as the formation of rigidity of the heart rhythm and a decrease in the
sensitivity of the sinus node to parasympathetic influences according to a temporary analysis
of daily monitoring of heart rhythm.

Orofacial infections of odontogenic origin have long plagued mankind. The discovery of the miracle drug
by fleming in the year 1928 and the routine use of penicillin after the landmark discovery of the powder
form of the antibiotic by florey and chain leading to significant change in the management of odontogenic
infection .The spread of infection is governed by factors such as impaired host defence, the virulence of
microorganism, functional abnormalities of the host and a lack of or delayed treatment. the microbiology
of odontogenic infections in diabetic and non-diabetic individuals has been found to be variable. Though
the effects of diabetes can affect infection severity , length of hospital stay, susceptibility to antibiotics
and outcome of treatment is unassured . Differentiation in antibiotics prescribed is also observed.The aim
of the study was to analyse the prevalence of the use of antibiotics among diabetic and non-diabetic
patients in a south indian dental university clinic . The list of all diabetics and non diabetics patients
treated for pain, dental infections , swelling were retrieved by reviewing 86000 patient records who have
visited the hospital during the study periods from june 2019 to march 2020 from the university
database.Data tabulation was carried out in Excel. The data was imported and transcribed in Statistical
Package for Social sciences version 16(SPSS,IBM corporation). Descriptive analysis was carried out.A
total of 9128 patients were included in the study based on treatment done of which 580 patients(6.3%) had
diabetes mellitus. Only 3.5 % of the male population and 2.8% of the female population has
diabetes.Amoxicillin 93.2% was found to be the most frequently prescribed antibiotics among nondiabetic
patients and diabetics patients 1.6% .A combination of metronidazole and amoxicillin was
prescribed to 0.5% of the whole study population .A combination clavulanic acid and
amoxicillin(augmentin )was prescribed to 4 % of the total diabetic study population and 0.4% of the nondiabetic
study population that is about.The relation between the diabetic status of a patient and the
antibiotic prescribed showed a significant statistical relationship in a Pearson's Chi square test with p value
of 0.001(p<0.005).The prescribing practises in dental offices can be improved by increasing awareness
among dental practitioners about the recommended guidelines for prescribing antibiotics . The most
commonly prescribed antibiotics among diabetic patients was Augmentin (4.08%) and for non diabetics it
was amoxicillin (93.25%). .

This study designed to compare the vital role of the inflammatory immune responses and autoimmunity in development both types of diabetic mellitus by measurement of serum IL-17 , and Anti-Gad levels among patients groups and healthy by using ELISA kits . The study included sixty DM patients were divided into two groups : 30 patients with Type I DM ( 33.7% ) , and 30 patients with Type II DM (33.7%) . In addition to 29 healthy individuals were (32.6 %) . The results indicated an elevated mean serum level of IL-17 and Anti-Gad in both patients groups , as compared with the healthy control with significant difference . Also, the findings recorded a highly significant difference in IL-17 and Anti-Gad sera levels between both types of patient groups at (P< 0. 01) . According to the correlation results between IL-17 and Anti-Gad in patients groups , the data was demonstrated that the expression of IL-17 had a significant positive correlation with expression of Anti-Gad (P< 0.05) among Type I patients . Whereas an inverse very weak correlation was observed between IL-17 and Anti-Gad with no significant (P ˃ 0.05) in Type 2 patients . we concluded the an elevated levels of IL-17A in both types of DM may be as a prognostic factor for development them in Iraqi population. We also conclude that elevated Anti-Gad in Type II DM may be an indication of the rapid development of undiagnosed insulin deficiency in latent autoimmune diabetes in adult patients .

The objective of this article is to provide an overview on the association between Prion proteins and diabetes mellitus which is important so as to understand the aetiology of diabetes mellitus and provide better treatment plans. Prions are misfolded proteins Which have the ability to transmit their misfolded structure to normal variants of the same protein. Prions form abnormal aggregates of protein known as amyloids. Islet amyloid polypeptide, IAPP, is a precursor protein which causes islet amyloid polypeptide amyloidosis, AIAPP, and is said to lead to type two diabetes. Prion aggregates are generally stable and resist proteolysis. Diabetes mellitus is a group of metabolic disorders characterised by high blood sugar level over a long period of time. It is mainly caused by insulin deficiency or resistance. Prion mediated diseases are generally neurodegenerative disorders such as Kuru, Parkinson's disease, Alzheimer's disease etc. There are two isoforms of prions which are PrP and PrPSc. PrPSc is the infective form and is capable of converting PrPC into infective state. In this review, we discuss the association of prion protein with diabetes mellitus, the structure and propagation of Prion proteins and the link between diabetes mellitus and other prion mediated diseases via cross seeding. A review has been done in order to understand and analyse the association between prion protein and diabetes mellitus by retrieving a minimum of 20 articles from various data search engines including pubmed, Google scholar, MESH, core, bioRXiv, Semantic scholar and so on. This review gives a clear understanding of prion proteins, their structure, propagation and disease causing abilities. It is also analyzed that diabetes mellitus could not be just a disease which is caused by insulin deficiency or resistance but could also be the consequence of protein misfolding.

Background:
       Saudi Arabia is considered to be one of the highest countries in the Middle East for the incidence of diabetes mellitus. Data are lacking regarding knowledge about diabetes mellitus among school students in Saudi Arabia. Diabetes mellitus is a major metabolic disorder currently affecting over 350 million people worldwide. Also, another one billion people in the world are pre-diabetic, who may eventually end up with full- blown diabetes. Type 2 diabetes mellitus is fast becoming a global epidemic and the number of individuals with diabetes in the world is expected to reach 330 million by 2030. The rate of T2DM is rapidly increasing in developing countries, particularly among younger age groups a cross-sectional study indicated that Saudi adolescents exhibited more health-related knowledge than the older population; the majority of the adolescents believed that obesity was dangerous and that regular exercise was beneficial for their health. Saudi adolescents are at a high risk of developing diabetes as many suffer from obesity, a sedentary lifestyle and hereditary diabetes. In 2004, almost a quarter (23.7%) of the Saudi population was diagnosed with T2DM; this was 10 times the number of diabetic individuals in 1980.6 The occurrence of T2DM has been linked to the high rate of overweight adults (35.5%) in the Saudi population and the number of overweight and obese Saudi adolescents is high among both genders.
Aim of the study: The study aimed to assess the knowledge of diabetes mellitus among secondary school students at the Makkah in Saudi Arabia 2019.
Method: cross sectional descriptive study conducted among secondary school students at Makkah, during the April to June, 2019, the Sample size of diabetic secondary school students. Our total participants were (500).
Results:knowledge of the participant toward diabetes mellitus study results show the majority of participant had average information were(61.0%) while weak knowledge were (31.0%) the data ranged from (4-13) by mean ±SD (9.011±2.314).
Conclusion: The level of knowledge and awareness of a considerable number of high school students regarding DM was inadequate, and some of them possessed various misconceptions about this particular chronic disease. Health authorities and school authorities in the region should offer special efforts to improve the level of knowledge and awareness of the students through regular health education campaigns.Diabetes Day should be celebrated in all schools and workshops and lectures given by professionals in collaboration with Ministry of Health on this day are recommended to increase the level of awareness of diabetes