BACKGROUND Type 2 Diabetes Mellitus (T2DM) is an endocrine disorder and a heterogeneous group of syndromes characterised by an elevation of fasting blood glucose that is caused by a relative or absolute deficiency in insulin. Serum vitamin B12 levels have been reported to be inversely associated with the dose and duration of metformin use. Vitamin B12 deficiency is a treatable condition. However, there is insufficient data regarding prevalence of vitamin B12 deficiency in the South Indian population. Hence, the study was undertaken to evaluate serum vitamin B12 levels in T2DM on metformin therapy. MATERIALS AND METHODS A total of 100 T2DM patients attending Outpatient Department (OPD) or admitted under Department of General Medicine of KIMS, Hubli, during the time period of 2 years were taken for study considering the inclusion and exclusion criteria. Qualifying patients underwent detailed history, clinical examination, routine investigation and vitamin B12 estimation. RESULTS Majority were in the age group of 45-59 years making 42% of the total. The age group in most patients having vitamin B12 deficiency was >60 years. Males had more vitamin B12 deficiency forming 54.5%. Vitamin B12 deficiency was more in hypertensive group accounting for 71.4%, which was statistically significant. Most of the vitamin B12 deficiency patients had diabetes duration >10 years. Most of the vitamin B12 deficient patients were taking metformin therapy for longer years (≥10 years) and in higher dose (>2 g/day). Most of the vitamin B12 deficient diabetes patients were overweight forming 52.5% of the total. CONCLUSION Longer duration of diabetes increases the risk of developing vitamin B12 deficiency on metformin therapy. The higher dose of metformin intake had inverse relation with vitamin B12 levels. Longer duration of metformin intake causes vitamin B12 deficiency and hence should be screened for vitamin B12 deficiency and can be supplemented with vitamin B12.
BACKGROUND DM is characterized by insulin resistance and dyslipidaemia, in particular, high levels of total cholesterol, triglycerides and LDL, and low levels of HDL-C, which confers increased risk for CAD that may manifest as life threatening ACS. We wanted to study the correlation between HbA1c & total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) in diabetic patients presenting with acute coronary syndrome and also their correlation with severity of ACS independently. METHODS Blood samples of 50 known diabetic patients presented to emergency with ACS were sent for HbA1c & lipid profile estimation. All patients underwent coronary angiography. Obtained results were statistically analysed & correlated. RESULTS Statistically significant direct co-relationship was found between HbA1c, LDL, Total cholesterol, ACS severity (SVD/MVD) & inverse co-relationship with HDL. CONCLUSIONS In our study we concluded that there is strong correlation between HbA1c and dyslipidaemia, with severity of coronary artery disease. HbA1c, total cholesterol, LDL cholesterol are directly proportional and HDL cholesterol is inversely proportional to the severity of coronary artery disease. Hence incidence of ACS can be minimized with adequate glycaemic control.
Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function by influencing the Nitric Oxide (NO) production. In Acute Coronary Syndrome (ACS) inflammation disrupts plaque which stimulates thrombosis, coagulation, activation of sympathetic system and release of cytokines mainly Interleukin 6 (IL-6), which is a pleotropic and pro-inflammatory cytokine, which exerts inhibitory effect on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU)under the Department of Cardiology, Karnataka institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients were taken for the study and all underwent Coronary Angiography (CAG). Severity of CAD was assessed with the help of Gensini risk scoring system. The patients were divided based on thyroid function status. Low T3 syndrome was defined as <0.846 ng/ mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinominal logistic regression analysis demonstrated LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of euthyroid group (n=71, 59.1%), with all the groups’ (p-value=0.047). Multinominal logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of CAD for moderate (Odds ratio=2.34, 95%CI: 0.47-11.39, p<0.02) and severe (Odds ratio=8.56, 95%CI: 1.52-47.9, p<0.015) lesions. Conclusion: The patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.
BACKGROUND Dyslipidaemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. It has been seen in many trails and studies that good glycaemic control has prevented the cardiovascular morbidity and mortality. The rationale of this study was to detect the lipid abnormality in diabetic patients. MATERIALS AND METHODS This cross-sectional observational study was conducted to estimate prevalence of dyslipidaemia among diabetic patients of KIMS, Hubli. A total of 100 patients were included out of which 62 were males and 38 females. RESULTS There was a positive correlation between PPBS and dyslipidaemia with p value=0.01. However, when correlation between dyslipidaemia and duration of diabetes was compared, it was not significant with p value of 0.64. CVS status, elevated urea and elevated creatinine were not significant when compared to dyslipidaemia. Parameter correlated between capillary and venous estimate showed that the total cholesterol, triglyceride, LDL, VLDL and HDL were highly significant with p value <0.001. CONCLUSION Our study showed that there is increased incidence of dyslipidaemia in diabetes patients. Hence, constant monitoring of lipid profile is required in diabetes patients to reduce the risk of CVS diseases.
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