No abstract

Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.

Background: Type 2 diabetes mellitus (T2DM) is a progressive chronic disease with high prevalence all over the world. It is expected to have 693 million people affected by diabetes by 2045. Many body systems are affected due to complications of DM with major effect on the cardiovascular system. Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. Malondialdehyde (MDA) is a highly toxic end product formed by lipid oxidation that mediates its toxic effects due to its high reactivity particularly towards proteins and DNA. Malondialdehyde interacts both irreversibly and reversibly with proteins and phospholipids causing profound effects, especially in the collagen of the cardiovascular system. Normally, MDA level remains within normal values due to antioxidant effects, but in DM these protective effects are disrupted. Objective: Measure serum Malondialdehyde level as a marker of lipid peroxidation in type 2 diabetic patients and its association with other cardiovascular risk factors. Patients and methods: The study included 40 diabetic patients recruited from Outpatient Diabetes Clinic at Alexandria Main University Hospital in addition to healthy 40 healthy subjects as a control group. Basic data, clinical examination and laboratory analysis were obtained from all the subjects within the two groups. Serum Malondialdehyde (MDA) was measured in the participants within the two groups by using ELISA kit. Results: The mean serum MDA level was statistically significant higher in the diabetic cases as compared to the controls (Median MDA was 30.72nmol /ml in cases and 25.16 nmol /ml in the control). There is a significant increase in serum MDA level with increasing the risk of CV disease in the whole study subjects and in the diabetic cases. In the cases group MDA shows positive correlation with all the study parameters except high density lipoproteins (HDL) where it revealed negative correlation. BY ROC curve analysis, a cutoff point more than > 26.57 had 62.5% sensitivity, 70% specificity, 66.4 % positive predictive value (PPV) and 72.5% negative predictive value (NPV). Conclusion: Malondialdehyde is a non-invasive biomarker that could be utilized in differentiation of T2DM cases form healthy controls in addition for identifying the high-risk diabetic patients for cardiovascular disease (CVD). However, further large-scale studies are recommended to accurately determine its sensitivity and specificity.