Diabetes complications of hypoglycaemia, hypoglycaemia unawareness and neuroglycopenia are often encountered by patients treated with insulin.  It is feared by patients and families often leading to emotional and mental scars and can affect lifestyle and confidence.  Hypoglycaemia can occur in premature babies, persons with hypopituitarism and Addison’s Disease.  Low blood glucose can affect athletes and the elderly leading to falls.   Cases are individual and often difficult for families, clinicians, lawyers and courts to understand. Temporary mental impairment and PTSD injury may occur requiring counselling to overcome hypoglycaemia. 40 years T1D insulin treatment and personal hypoglycaemia experience following wrong insulin care 1987 - 94 led the author to research published reports.  The first hypoglycaemic event was described by Banting, Best and Macleod at the time of insulin discovery as a treatment for diabetes in 1921/22.  This review includes observations from ‘Forensic Aspects of Hypoglycaemia’ by Prof Vincent Marks, 629 case references, February 2019. Complications affecting stable Blood Glucose levels include Otitis Externa, Osteomyelitis, Neuropathy pain, infection treatment by IV antibiotic delivery, periodontal dental link with gum disease, inflammation, chemical change reducing insulin effectiveness, calcium stones in the saliva duct, sodium, calcium, magnesium electrolyte imbalance, Omega 3 deficiency, night saliva duct cortisol secretion, depression.Use of insulin and C Peptide assay is beneficial in forensic investigations following unexplained death or insulin use as a weapon in alleged criminal matters.  Society can learn from this research to provide improved diabetes care for patients to achieve good health and long life despite the daily burden of managing a condition with no cure.A duty of care exists to a person in a state of hypoglycaemia to summons paramedic help when the person is unable to help themselves because of temporary mental hypoglycaemia.

Background: Educational programs in general seem to have a clinically significant beneficial effect among the T2DM population in terms of improved glycaemic control. However, few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken.

Objective: The present study evaluates for the first time, the differences in the effectiveness of the different educational programs [intensive lifestyle modification (Group Education Program, GEP), supervised education through social media (WhatsApp Education Group, WEP) and standard care via PHCCs (Control Group, CG)], among Saudi females with pre-diabetes.

Methods: This was a 6-month, multi-center, 3-arm cluster, randomised, controlled (1:1:1), multi-intervention study conducted from July 2018 until March of 2019 in Riyadh, SA. A total of 1140 females from SA were cluster randomised equally to three groups, out of which only 253 [N=100 GEP, N=84 WEP and N=69 CG] received intervention. Participants completed questionnaires including demographic, dietary and physical activity data. Anthropometrics, blood samples and dietary intake were collected at baseline and 6 months. A total of 120 [37 CG (age 50.9±7.1 years; body mass index (BMI) 31.6±5.8kg/m²), 40 GEP (age 42.9±12.2 years; BMI 34.8±9.0kg/m²) and 43 WEP (age 43.7±8.1 years; BMI 30±5.1kg/m²)] participants completed the study.

Results: Haemoglobin A1c (HbA1c; primary endpoint) significantly improved in all groups over time, with no difference in between-group comparisons. Between group comparisons adjusted for age revealed a clinically significant reduction in BMI in favour of GEP (p=0.02) post-intervention. A clinically significant reduction was also observed in favour of GEP in terms of weight (p=0.003), waist circumference (p=0.017), systolic and diastolic blood pressure (p-values <0.01), triglycerides (p<0.001) and caloric intake (p<0.005) over time.

Conclusion: Prediabetes education programs of 6-month duration, whether delivered through an intensive lifestyle modification, social media or standard care, are equally efficacious in improving HbA1c levels among Saudi women with prediabetes, but intensive lifestyle is superior in terms of weight reduction and over-all cardiometabolic improvement.

Background: The association between obesity and insulin resistance syndromes (IRS) has long been established (1-2). Nevertheless, limited data regarding the effect of physical activity (PA) intensity and its ability to modulate IRS. We aim to determine whether obese individuals would benefit more from engaging in light activity throughout the day compared to single bout of acute exercise of moderate or vigorous activity for a shorter period per day

Methods: A total of 60 obese participants with a BMI ≥ 30 (30 males and 30 females) were enrolled for this study. Activity levels were measured through an accelerometer worn except when bathing for seven consecutive days. Habitual activities were self-reported, and fasting glucose, insulin, and lipid profile were measured. Monocytic inflammatory markers expression was analyzed by flow cytometry analysis and cytokines secretion was investigated by ELISA. Multiple regressions controlling for significant variables in univariate regression were performed to evaluate the association between the actigraphy-assessed activity measures, inflammatory cytokines, and insulin resistance.

Results: The percentage of total individual activity showed a significant negative correlation to lower lipid profile, HOMA-IR and monocytes inflammatory production. A higher daily percentage of moderate to vigorous physical activities was significantly negatively correlated with body fat percentage, yet, only high volume of total activity and  total light activity throughout the day seemed beneficial for better insulin sensitivity (light % P= 0.0042, r= -0.377; moderate % P= 0.962, r= 0.064; vigorous % P= 0.923, r= 0.013). Total physical activity had positive correlation to monocytic expression of M2 marker regardless of physical intensity. Yet, only higher volume of light activity was found negatively correlated to the surface expression of nonclassical monocyte expression (CD14dim CD16++; P =0.01, r = -0.48). in a similar manner all intensities of physical activities were shown to associate negatively with TNF-a secretion. Yet, only IL-17A and MCP-1 were found significantly negatively associated with higher volume of lighter activity through the day.

Conclusions: Maintaining general light movements throughout the day can be beneficial when compared to a short period of stringent workout. This provides a better understanding of how to implement effective approaches to lifestyle change in preventing IRS and T2D.

 

Background: Diabetes mellitus (DM) affects around 8.3% of world’s adult population, and World health organization has predicted the total number of cases of DM to rise from 371 million in 2012 to 552 million in 2030 [1]. Among DM cases, more than 90% of patients have type 2 diabetes mellitus (T2DM), and over 50% of cases are undetected [1]. Hence, there is an emergent need of effective screening instrument to identify “diabetes risk” individuals. Aims: To evaluate and compare the diagnostic accuracy and clinical utility of Indian Diabetes Risk Score (IDRS) and Finnish Diabetes Risk Score (FINDRISC) in detecting undiagnosed T2DM among Kashmiri population.
Settings and Design: This was a cross sectional study carried out on 1530 individuals attending outpatient department of a primary health centre from January 2018 to July 2019.
Subjects and Methods: Each participant was selected using systematic sampling where every third adult patient (age >20 years) attending the Outpatient department of primary health care center was included in the study. Participants with known DM and pregnant women were excluded from the study. We used Finnish Diabetes Risk Score (FINDRISC) and Indian Diabetes Risk Score (IDRS). Total Score of each participant was analysed and compared. After that followed the random blood glucose estimation of each individual.
Statistical Analysis Used: Diagnostic accuracy of IDRS and FINDRISC compared by using receiver operative characteristic curve (ROC). Sensitivity, specificity, likelihood ratio, positive predictive and negative predictive values were compared. Clinical utility index (CUI) of each score also compared.
Results: Out of 1530 individuals, 157 were new diabetics. Odds ratio for high-risk people in FINDRISC for getting affected by diabetes was 12.10. Similarly, it was 6.27 for IDRS. On ROC, area under curves of both scores were indifferent (P = 0.78). IDRS was better sensitivity than FINDRISC while specificity of FINDRISC was found to be higher than IDRS. Bland-Altman plot and Cohen’s Kappa suggested fair agreement between these score in measuring diabetes risk. Conclusions: Diagnostic accuracy and clinical utility of FINDRISC is fairly good than IDRS in Kashmiri Population.