European Journal of Molecular & Clinical Medicine

Diabetes mellitus is characterized by chronic hyperglycaemia with disturbances in carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. Dyslipidaemia in diabetes commonly manifests as raised low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C) levels or elevated triglyceride (TG) levels. Many studies have proposed HbA1c to be used as a biomarker of both glycaemic control and dyslipidaemia in type 2 diabetes mellitus. Study aimed to observe the lipid profile in type 2 diabetes mellitus patients and to find out the correlation between glycated haemoglobin (HbA1c), FBS and lipid profile in type 2 diabetes mellitus patients.

Diabetes puts people at a higher risk for a wide range of microvascular and macrovascular problems.
Aim: The aim of the present was to study the effect of hyperglycemia, HbA1c on total cholesterol (TC) and High-Density Lipoprotein (HDLc) in Type 2 Diabetes mellitus (T2DM) subjects.
Materials &methods: In this case-control study, we compared a group of people with type 2 diabetes (T2DM) with a group of people without T2DM, totaling 200 people. All participants were evaluated at Index Medical College & Research Centre in Indore, India, using the center's outpatient services. The authors of the study have begun their work after receiving approval from the relevant ethics board. Each individual in this study has given their consent before the study began.
Results: Age, BMI, FBS, and HbA1c, were measured. BMI, FBS (t=6.955, d=198), HbA1c (t=10.931, d=198), shown to be significantly higher in T2DM patients compared with healthy controls. This shows that increased glucose levels may hamper the sensitivity of the insulin and as well as glycation of the proteins. On the contrary, the present study did not observe significant difference in case with the age of the subjects present in the study. TC, and HDLc, levels were shown above. TC (t=5.043, d=198) level was significantly higher in T2DM patients compared with healthy controls.
Conclusion: Reducing ROS generation may lower hyperglycemia, dyslipidemia, and oxidative stress. These advancements may result from: However, lowering oxidative stress, which causes hyperglycemia and dyslipidemia, may increase serum insulin levels, according to the study's authors.

     In resource-constrained settings, primary health centers (PHCs) are critical for universal health coverage. Laboratory service is one of its important components. While PHC and its performance are focused, its laboratory service has been neglected in developing countries.
A routine checkup is a general physical evaluation and is not performed for a specific injury, illness or condition. A routine checkup in laboratory service is one of its important components are beneficial for detecting diseases in early stages when treatments are most effective. In the Kingdom of Saudi Arabia (KSA), free-of-charge healthcare services including the analysis to be carried out in laboratories are offered to citizens.  However, studies are consistently finding that Saudi people are not taking advantage of the free routine checkups. 

Background: Several studies undertaken in different parts of the world have shown that hypomagnesemia occur at an increased frequency among patients with type 2 diabetes compared with their counterparts without diabetes. As current data suggest adverse outcomes in association with hypomagnesemia, it is prudent to monitor magnesium routinely in this patient population and treat the condition whenever possible. Therefore, this study was undertaken to determine the serum magnesium levels in type 2 diabetes in this part of our country. Aim & Objective: 1. Serum magnesium level in type 2 Diabetes mellitus and its relationship with glycemic control and diabetic complications.2. To study Clinical profile of type 2 DM. 3. Correlation of Serum magnesium level in type 2 DM with glycemic control and complications. Method: Study design:  Case control study. Study setting:  Department of Medicine at tertiary care centre. Study duration: January 2021 to December 2021. Study population: The study population included 50 diabetics without complications (group I), 50 diabetics with complications (group II) and 100 normal healthy controls (group III). Sample size: 100. Results: Serum magnesium levels were found low in study group as compared to control group. A significant correlation between HbA1C and magnesium levels was seen. The patients with diabetic complications have significantly higher values of serum cholesterol and triglycerides. Conclusions: Hypomagnesemia in type 2 diabetes was associated with poor glycemic control and with increased frequency of long-term complications.

Background: Diabetes mellitus (DM) is a heterogenous group of metabolic disorders with chronic hyperglycemia and glucose intolerance. Satisfactory glycemic and weight control in outpatient diabetic subjects is important. Present study was aimed to study association of BMI with glycemic control in type 2 diabetes mellitus patients at a tertiary hospital.
Material and Methods: Present study was hospital based, cross-sectional study, conducted in subjects (males and females between 26–45 years) attending outpatient department of Medicine, known diabetic patients, underwent BMI calculation and HBa1c estimation.
Results: In present study, total 150 subjects studied, 50 each from group A, B, C (depending on duration of diabetes), in each group 25 male & 25 female. Subjects were divided according to BMI values & compared with gender. There was no significant difference found in male & females according BMI distribution (p – 0.72). According to BMI majority were overweight (72 cases) followed by normal BMI (54 cases) & obese (24 cases). We noticed, HBA1C ≥ 8 commonly in overweight & obese subjects than normal BMI subjects, difference was statistically significant (p<0.01). Descriptive statistics calculated using Pearsons correlation. R values were 0.034, 0.242 & -0.022 for A,B,C groups respectively, which was significant in obese group. When we compared BMI and glycated Hb values within the three groups, a significant correlation was noted between BMI and glycated Hb values.
Conclusion: As BMI value rises, so does the HbA1c level. Majority of diabetic subjects with a BMI > 30 (obese group) had HbA1c levels greater than 8%. Statistical analysis reveals a substantial positive connection between BMI and HbA1c (p value 0.001).

Introduction: Diabetes Mellitus (DM) is a complex, chronic illness requiring continuous medical care with multi factorial risk reduction strategies beyond glycemic control. Globally, the prevalence is expected to further increase to 9.9% that reflects a population of 628.6 million people by the year 2045. To assess the prevalence of diabetes related distress (DRD) among Type 2 diabetics.
 
Material and Method: This was a prospective, observational and descriptive study conducted in the Department of Medicine at Tertiary Care Teaching Hospital over a period of 1 year among T2DM patients who were seen and followed up. Patients who were at least 18 years old, and had all recent laboratory results were included in the study. Patients with T1DM, and those who had untreated hypothyroidism, gestational diabetes, cancer, mental retardation, and psychiatric illness, were excluded from the study.
 
Results: A total of 100 subjects were screened (69 males and 31 females). Their demographic and clinical data are presented. The subjects were aged 35–85 years with a mean ± SD of 50.5 ±8.0 years. The mean age for subjects with T1DM was 51.25±9.36 years and for those with T2DM 50.41±0.642 years. Average scores for T1DM were DDS-2, 3.9 ± 1.3 and DDS-17, 3.0 ± 1.0 and for T2DM, DDS-2, 2.4 ± 1.1 and DDS-17, 1.8 ± 0.8. Scores for the different parameters of distress were graded in terms of severity. DD (score ≥2 or moderate to severe distress) was present in 70.0% for DDS-2, 49.0% for DDS-17, 56.0% for EB, 13.0% for PRD, 51.0% for RRD, and 41.0% for ID.
Conclusion: Among type 2 diabetes patients, diabetic distress is a serious problem and needs to be addressed for better glycemic outcome. Among type 2 diabetes patients, diabetic distress is a serious problem which affects their living. It is necessary as clinicians to address diabetic distress in the patients for better glycemic outcome.

Aim: Using ultrasound to examine individuals with type 2 diabetes having fatty liver disease and cardiovascular diseases.
Methods: The prospective and observational study was carried out during a nine-month period in the Radiology Department of the MGM Medical College, Kishanganj, Bihar. A total of 300 patients with type 2 diabetes who had abdominal ultrasonography that revealed no other co-morbid conditions and fatty alterations in the liver were included. According to how long the patients had been diagnosed with diabetes, the patients were separated into three groups. Interview schedule questionnaire, OPD records, bedside tickets, physical examination, and laboratory measures made up the study's methodology.
Results: 145 (48.3%) of the 300 patients were men, and 155 (51.7%) were women. The majority (39%) of the patients were between the ages of 50 and 60, while 25.7% of them were between the ages of 40 and 50. 18.3% of the population was between 60 and 70 years old, 10.7% was under 40, and 6.3% was older than 70. 75 (25%) of the 300 cases had non-fatty liver, while 225 (75%) of the cases had fatty liver. 33.4% (100) of the patients who were included belonged to group A, 40% (120) to group B, and 26.6% (80) to group C. The majority of patients (230, 76.7%) did not show ischemia alterations, however 70 (23.3%) cases out of 300 patients did.
Conclusion: Every patient with newly diagnosed type 2 diabetes should consider having a liver ultrasound because NAFLD is particularly common in this population of patients. It may be claimed that in those with type 2 diabetes, there was a correlation between cardiovascular risk factors and NAFLD.

Type 2 diabetes, is caused by insulin resistance which is characterized by a decreased effectiveness of insulin. In contrast to type 1 diabetes in which the pancreatic islets are destroyed and no insulin can be synthesized anymore, in type 2 diabetes insulin secretion is normal, elevated or reduced. Unlike in patients with type 1 diabetes, symptoms do not appear abruptly, but set on gradually so that the disease often remains undiagnosed for a long time. The present study included 150 patients of type 2 diabetes mellitus. Patients with Type 2 Diabetes mellitus in outpatient and inpatient departments were study subjects. The present study had diabetic patients ranging from 41 to 80 years of age. Majority of cases were in the 61 to 70 age group. Male cases were 58.7% and female cases were 41.3%. 60% of cases of Type 2 DM were associated with complications of which 66.7% were microvascular and 33.3% were macrovascular complications.

Background: The increasing incidence of type-2 diabetes is a serious health issue worldwide. Its prevalence is associated with poor diet and unhealthy lifestyle choices, and it is characterised by high blood glucose levels that need to be controlled by medication. Metformin is the recommended and most effective first-line drug for type-2 diabetes but its use has also been linked to vitamin B12 deficiency, which increases the risk of peripheral nerve damage.
Aim and Objectives: The aim of the study is to estimate serum levels of Vitamin B12 levels in subjects with Type 2 Diabetes Mellitus. The objectives of the study include to estimate the prevalence of Vitamin B12 deficiency in Type 2 Diabetic subjects and to compare the serum levels Vitamin B12 in Type 2 Diabetic Subjects with or without metformin.
Materials and Methods: We included a total of 140 type 2 Diabetic subjects on metformin therapy for more than 3 years and 60 non-diabetics and non-metformin users. Serum levels of Vitamin B12 was estimated by Chemiluminescence Immuno Assay method.  Serum Vitamin B12 levels of >300 pg/mL was defined as normal, 200-300 pg/mL insufficient and <200 pg/mL as deficient.
Results: We studied a total of 140 type 2 Diabetic metformin users and 60 non-metformin and non-diabetic subjects. We evaluated vitamin B12 levels in both. We found that 6.4% of metformin users had vitamin B12 deficiency, followed by 20.7% had insufficient Vitamin B12 levels and 72.8% had normal vitamin B12 status. Similarly, among non-metformin users 3.33% had deficient vitamin B12 levels, 16.3% had insufficient levels and 80% had normal vitamin B12 levels.
Discussion and Conclusion: Routine screening of Serum Vitamin B12 levels, complete hemogram, and neuropathy status should be done in all diabetic patients at the beginning of metformin therapy, and every 1-2 years thereafter. If any diabetic patient is found to be having low levels of Vitamin B12, they should be well supplemented with the Vitamin before start of metformin therapy.

Background: Using continuous glucose monitoring, compare glycemic variability (GV) indices between patients with fibrocalculous pancreatic diabetes (FCPD) and type 2 diabetes mellitus (T2D) (CGM).
Methods: We calculated GV indices in 61 patients with FCPD and T2D who were matched for HbA1c and diabetes duration. The CGM-derived measures of GV (SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [percent CV]) and hypoglycemia (time spent below 70mg/dL, AUC below 70mg/dL, glycemic risk assessment diabetes equation hypoglycemia, Low Blood Glucose Index), and hyperglycemia (time spent above 180mg/dL at night [TSA > 180], AUC above 180mg/dL [AUC > 180], glycemic risk assessment diabetes equation hyperglycemia, High Blood Glucose Index [HBGI], and J index).The relationship between GV indices and HbA1c, diabetes duration, and demographic and biochemical data was also investigated.
Results: Except for M value, all of the CGM-derived GV parameters (SD, MAGE, CONGA, MODD, and percent CV) were substantially greater in the FCPD group than in the T2D group (P<0.05). The FCPD group had significantly greater levels of hyperglycemia (TSA >180, AUC >180, HBGI, and J index) than the T2D group (P<0.05). The levels of hypoglycemia in the two groups were not significantly different. In both groups, all hyperglycemia markers had a favourable connection with HbA1c.
Conclusions: T2D is linked to lower GV, whereas FCPD is linked to higher GV. Higher postprandial glycemic excursions were discovered in patients with FCPD, which could have treatment implications.

Background: Diabetic retinopathy (DR) is one of micro vascular complications of Diabetes
mellitus and leading cause of blindness. Mean Platelet volume is a marker of average size and
activity of platelets. Larger platelets are younger and exhibit more activity and related to these
complications.Objective:to study the association between mean platelet volume and Type 2
Diabetes, and its correlation with diabetic retinopathy.Methods: In this study, 100 patients with
Type 2 diabetes and without retinopathy, 50 patients with type 2 diabetes and with diabetic
retinopathy and 50 healthy age and gender matched controls were chosen and evaluated
clinically and laboratory data including MPV, platelet count,HbA1C,Fasting and post prandial
blood glucose, lipid profile,creatinine levels were obtained and studied. All study was done by
SPSS software. Results: Mean MPV among subjects with DM with Retinopathy was 11.7 ± 1.3,
among subjects with DM without Retinopathy was 10.7 ± 0.9 and among normal controls was
8.8 ± 0.5. There was significant difference in MPV b/w 3 groups. In the study there was
significant positive correlation between MPV and duration of DM, FBS, PPBS and HbA1c i.e.
with increase in Duration of DM, FBS, PPBS and HbA1c there was increase in MPV and vice
versa

Introduction: The increase in severity of diabetes every year has been linked to patient’s lack of knowledge and practice of proper self-care. Due to its extreme importance, an annual assessment of patients' skills and knowledge has been recommended by The American Diabetes Association.
Objectives:
1. To assess the knowledge, attitude and practice of diabetic patients and to study the impact on glycemic control.
2. To educate the patients about the importance of lifestyle modification in the management of diabetes.
Methods: This study was conducted at the tertiary care level center in latur city of maharashtra. All the patients suffering from type 2 DM for more than one year attending the OPD and at IPD were included in the study irrespective of their age.
Results: On analyzing the data, it is found that only 7.14% participants had knowledge about the insulin deficiency as the cause of DM. only 37.30% of people knew that it is hereditary disease. Participants knowing that DM causes delayed wound healing were 58.73%. Only 50% participants follow the diet plan. Participants examining their feet daily were just 7.14% and only one patient was carrying the diabetic ID card.
Conclusion: The results of the study state that type 2 diabetes patients are deficient of sufficient knowledge on the understanding of causes of DM, risk factors of DM, progress of the disease, complications of DM, different signs and symptoms of complications for early identification, and basic rules of foot care. Practices of eating green leafy vegetables, exercise daily and checking blood sugar regularly are followed well but simple practice of feet examination daily is not followed.

Background: Non-alcoholic steatohepatitis is a clinicopathological syndrome, characterized by the development of histological features comparable to those induced by excessive alcohol intake without alcohol abuse. This study is an attempt to evaluate the clinical, biochemical and histological profile of non-alcoholic steatohepatitis in this tertiary hospital in Rayalasema.
Material and Methods: Present study was single-center, prospective, observational study, conducted in patients of all ages, either gender, who are found to have increased echo texture of liver on routine ultra-sound scan.
Results: The present study was conducted on 60 patients, comprised of 36(60%) males and 24(40%) females. Majority were from the age group of 41 to 50 years there were 22 (36.66%) cases of which 12 (54.54%) were males and 10 (45.46%) were females.  The commonest symptom was fatigability and malaise (66.66%), followed by right upper abdominal discomfort (46.66%), Jaundice (10%), ascites (10%), UGI Bleed (8.3%) patients and 20 (33.33%) patients were asymptomatic at the time of diagnosis and diagnosis was established due to abnormal sonographic finding and abnormal liver function tests during investigations for other causes. Hyperlipidemia (61.67%), diabetes mellitus (58.33%), obesity (46.67%) & overweight (50%) were the most commonly associated risk factors noted. 7 patients underwent biopsy. Of these 4.28% patient showed steatohepatitis, 42.86% patients showed simple fatty change and 14.28% patient had cirrhosis. Other 28.57% had no specific changes.
Conclusion: This study demonstrates that features suggestive of the metabolic syndrome are observed more frequently in patients with non-alcoholic steatohepatitis, share many of the systemic disorders that constitute insulin resistance syndrome, hyperlipidemia, hypertension, obesity, type 2 diabetes and hepatic steatosis.

NAFLD may progress through three different stages, from hepatic steatosis to steatohepatitis and finally to cirrhosis. Hepatic steatosis represents simple increase in accumulation of fat in liver, without evidence of inflammation or liver damage. Inflammation and liver damage is however present in steatohepatitis. NAFLD was defined as any degree of fatty liver in the absence of alcohol intake. NAFLD, if present, was classified based on standard ultrasonographic criteria as: Grade 1 (mild steatosis): slightly increased liver echogenicity with normal vessels and absent posterior attenuation. Prevalence of high Waist circumference, which is important marker of central obesity, according to ATP III guidelines for male waist circumference is(≥102 cms) & for female is (≥88 cms) consider as central obesity. In our study,14(58.33%)males patients had waist circumference is ≥102cms &25(96.15%)females patients had waist circumference is ≥88cms. Mean waist cicumference in male were 102.58cms & in female were 96.5cm

Aim: To evaluate drug utilization pattern of antidiabetic drug in type-2 diabetic patients
attending at private diabetes clinic. So that, this information can be used in assessment of
quality of care provided as well as to facilitate the rational use of drugs in populations
Objective: To evaluate the current trends of prescribing patterns of antidiabetic drug in type
2 diabetic patients
Material and Methods: An observational prospective study undertaken at diabetes clinic from January 2015 to April 2016 after approval from institutional ethic committee. Total 600 patients of type 2 diabetes mellitus were enrolled. Data related to demographic details of the patient (age, gender and BMI, occupation, social status), past history, family history, personal history, all investigations, drug treatment and adverse drug reaction were recorded in suitable case record form. Follow up was carried out for all patients every 3^rd, 6^th, 9^th and 12^th month visit for glycaemic control. Data were entered into Microsoft excel 2010 and analysed by descriptive statistics (percentage, mean, standard deviation) and chi square test.
Results: Out of 600 patients, 58.67% were males and 41.33% were females. The mean age of the patients was 51.85 ± 4.24 years. Hypertension (31%) was most common co-morbid illness.Most common complaint was weakness (18.33%). Majority prescriptions had fixed dose combination (FDC) of two antidiabetic drugs (93.2%). Most commonly prescribed FDC was of sulfonylureas (Gliclazide) and Biguanide group (Metformin)in 552(92%). Average number of drugs per encounter was 3.02, 0.3 % drug was prescribed by generic name, 4.17% drug was antibiotic, 7.7% drug was injectable medicine, 14.27% drugs was prescribed from national list of essential medicine and 11.35% drugs were prescribed from WHO essential list of medicine. Fixed dose combinations were prescribed in 57.27% of patients. Glycaemic controlled was observed in 32.84 % patients.
Conclusion: Sulfonylurea and Biguanide combination most commonly used to treat type 2 DM and among them Gliclazide and Metformin combinations was most commonly prescribed.

To determine the prevalence of refractive errors among the type 2 diabetic population through a community-based study conducted in Lucknow.
Background of the study: Diabetes prevalence is on the increase rapidly the epidemic proportions during development as well as the world developed. Refractive error in the diabetic population is considered a leading cause of visual impairment.
Methods: A total of 437 patients (> 40 years old) with type 2 diabetes were examined via complete eye screening tests, including objective autorefraction. Spherical equivalent refractions of both eyes were reported. Data collected include age, gender, general medical information, and serum biochemistry.
Results: The mean refraction was −0.84 ± 2.59 D. Prevalence rates were determined for astigmatism (63.8%), hyperopia (1.4%) & myopia (0.2%). 34.6% of the patients were emmetropic. Age is an essential factor for all refractive errors. Correlation showed that every increase of one year of age and one percent of HbA1c is associated with 0.05 D (P = 0.003) and 0.14D (P = 0.04) shift in hyperopia, respectively.
Conclusions: This study provides epidemiological data on refractive errors in a North Indian diabetic population in Lucknow, India. The astigmatism prevalence is higher than the reported rates in the diabetic population compared to hyperopia and myopia. The second major finding was emmetropia.Refractive errors, Type 2 diabetes, Prevalence, Community-based stud

1. Background
Diabetic retinopathy (DR) is a well-known complication of diabetes mellitus (DM) and a major cause of
vision loss. Increased knowledge of DR is crucial for the prevention and early diagnosis of the disease and
preservation of vision, diabetes mellitus is a disorder, characterized by an imbalance in blood glucose
levels. The prevalence of diabetes mellitus is increasing globally.The global diabetes prevalence in 2019 is
estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million)
by 2045. Long term, continuous hyperglycemia leads to vasculature-related disorders, including those
affecting the eyes, such as retinopathy, diabetes mellitus is an endocrine disease with chronic elevation in
blood glucose levels. If not managed, it can lead to multi-organ damage also diabetes mellitus is a
metabolic disease that is characterized by distortion in the metabolism of carbohydrates, lipids, and
proteins and involves hyperglycemia. Diabetes mellitus has different types. Several complications are
associated with diabetes including diabetic retinopathy.
This study aimed: This study aims to assess the knowledge of diabetic retinopathy and compliance with
diabetic retinopathy patients in Makkah, Saudi Arabia.
Methods: cross-sectional study was conducted among the diabetic population from May to September 2019
in Makkah, Saudi Arabia. The patients were selected randomly from the general population visiting the
Makkah diabetic center and primary healthcare clinics in Makkah. A self-administered questionnaire was
distributed to assess the knowledge of diabetes and its complication diabetic retinopathy. Our total
participants were (300)
Results: Conclusion: The level of knowledge regarding diabetic retinopathy among participants with
diabetes type 2 in Makkah is relatively high. However, participants’ motivation to attend an ophthalmology
clinic for an eye assessment was poor in the study, thus delay early diagnosis and management.