This study aims to examine the projected HIP prevalence in 2030 and 2045 using multiple methods. Methods: The International Diabetes Federation Diabetes Atlas 2019 prevalence was projected to 2030 and 2045 by: (1) carrying forward the 2019 age-adjusted prevalence rates; (2) applying a linear regression of the past four editions of the IDF Diabetes Atlas; (3) applying a regression of the previous editions with the most consistent trend, followed by extrapolation from the 9th edition HIP estimate. Results: Respectively, for 2030 and 2045, Method 1 projected a declining HIP rate with prevalences of 14.0% and 13.3%, Method 2 projected an increasing HIP prevalence at 16.5% and 18.3%, Method 3 predicted stabilisation of the rate from 16.0% to 15.8%. Conclusion: Assuming other factors remain unchanged, our best estimation of age-adjusted HIP will show stabilisation between 2019 and 2045 of 15.8% to 16.0%. However, this estimate is confounded by the heterogeneity of studies and the influence of different gestational diabetes mellitus diagnostic criteria. To provide accurate future comparisons we recommend standardising the diagnostic criteria to the International Association of Diabetes in Pregnancy Study Groups.

Type 2 diabetes mellitus is characterized by insulin resistance and progressive β cell failure; therefore, β cell secretagogues are useful for achieving sufficient glycemic control. Glimepiride is a second-generation sulfonylurea that stimulates pancreatic β cells to release insulin. Additionally, is has been shown to work via several extra pancreatic mechanisms. It is administered as monotherapy in patients with type 2 diabetes mellitus in whom glycemic control is not achieved by dietary and lifestyle modifications. It can also be combined with other antihyperglycemic agents, including metformin and insulin, in patients who are not adequately controlled by sulfonylureas alone. The effective dosage range is 1 to 8 mg/day; however, there is no significant difference between 4 and 8 mg/day, but it should be used with caution in the elderly and in patients with renal or hepatic disease. In clinical studies, glimepiride was generally associated with lower risk of hypoglycemia and less weight gain compared to other sulfonylureas. Glimepiride use may be safer in patients with cardiovascular disease because of its lack of detrimental effects on ischemic preconditioning. It is effective in reducing fasting plasma glucose, post-prandial glucose, and glycosylated hemoglobin levels and is a useful, cost-effective treatment option for managing type 2 diabetes mellitus.

Objectives:To find out the various factors associated with non-adherence to diet, physical activity and insulin among patients with type 1 diabetes. (T1DM). Methods: This cross sectional study was conducted among T1DM subjects attending the Baqai Institute of Diabetology & Endocrinology (BIDE) and Diabetic Association of Pakistan (DAP), from July 2011 to June 2012.Clinical characteristics, anthropometric measurements, knowledge regarding type 1 diabetes along with adherence to dietary advice, physical activity and insulin were noted on a predesigned questionnaire and score was assigned to each question. Patients were categorized as adherent or non-adherent on the basis of scores obtained. Statistical Package for Social Sciences (SPSS) for windows version 17.0 was used to analyze the data. Results: A total of 194 patients (Male 94, Female 100), with mean age of 17.9± 6.4 years, mean duration of diabetes 5.37±4.96 years (38.1% > 5 yrs, 61.9% < 5 yrs) were included in the study. One hundred and fourteen (58.5%) patients were non adherent to dietary advice, 82(42.3%) non adherent to physical activity while 88.1% respondents were non adherent to their prescribed insulin regimen. Factors associated with non-compliance were family type, occupation & educational level of respondent's parents, duration of T1DM, family history of diabetes, frequency of visits to diabetic clinic, knowledge regarding diabetes, lack of family support and fear of hypoglycemia. Conclusion: Non adherence to prescribed treatment regimen in patient with TIDM is quite high. There is need to design strategies to help patients and their family members understand their treatment regimen in order to improve their adherence.KEY WORD: Non-adherence, Patients with type 1 diabetes.

Objectives Dyslipidemia is a major risk issue for the development of cardiovascular disease. The aim of our study was to observe the pattern and prevalence of dyslipidemia in Pakistani population. Methodology This is a sub analysis of a population based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 in adults aged 20 years or above, carried out from February 2016 to August 2017 across Pakistan. Multi stage sampling technique was used for the stratification of population, based on rural and urban domains. District wise clusters and sub clusters were selected i.e. 27 and 46 in number. Subjects, consented to participate were requested to come after an overnight fast for anthropometric measurements, oral glucose tolerance test and fasting lipid profile (except for subjects with self-reported diabetes). Dyslipidemia was identified using Adult Treatment Panel III guidelines. Results A total of 10,834 subjects (43.8% male and 56.2% female) having mean age of 43.8 ± 14.0 years, participated in the survey. Of the subjects studied, 39.3% had hypercholesterolemia, 48.9% had hypertriglyceridemia, 39.7% had high LDL-C levels while 83.9% men and 90% women had low HDL levels. High cholesterol and triglyceride levels were highest in 50-59 years age group, while high LDL and low HDL was most common in 40-49 years age group. Diabetes, obesity and hypertension were found to be the significant determinants for dyslipidemia. Conclusion Prevalence of dyslipidemia seems to be very high in Pakistan, necessitating an urgent call for early screening and effective management through lifestyle intervention and appropriate lipid lowering drugs to prevent this important cardiovascular risk factor.

The aim of this questionnaire based survey was to assess the glycaemic control care and management of our fasting diabetic subjects. This retrospective study was carried out at Baqai Institute of Diabetology and Endocrinology, its affiliated centers and Memon Diabetic Centre of Karachi. Data was collected by a questionnaire including socio-demographic data, duration of diabetes, life style, diet and treatment during and preceding Ramadan of year 2004. All Known diabetic Muslim subjects except children below 10 years were included. The subjects were asked if they had observed any of the hypoglycemic or hyperglycemic symptoms. The major severity of the symptoms was assessed depending upon the assistance needed. The plasma glucose level during these episodes was recorded where it was available. During the month of Ramadan 327 out of 453 subjects (72.5%) fasted. Mean age of subjects was 50.3 +/- 12.6 years. Average duration of diabetes was 9.3 +/- 7.3 years. Majority of the subjects (96.3%) fasted with type 2 diabetes while only 3.7% fasted with type I diabetes. Subjects fasted for an average of 25 days. Overall prevalence of hypoglycemia and hyperglycemia was 21.7 and 19.8%, respectively. Only 4.0% had major hypoglycemic episodes, while 8% had major hyperglycemic episodes. The present study suggests that all diabetic subjects who intend to fast should be counseled before Ramadan about change in medication timings and dose, dietary changes and pattern of physical activity and about role of self-monitoring of blood glucose especially during acute symptoms.

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Objective: To determine the frequency and characteristics of dengue fever (DF) in patients of acute febrile illness presenting at a secondary care hospital. Methodology: The observational cross sectional study was carried out from May to October 2010 in Remedial Centre Karachi and included patients above the age of 12 years who presented with acute febrile illness. The WHO classification and case definitions were used to classify the disease as Dengue Fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Clinical, hematological and biochemical findings were recorded serially until discharge. Results: During the study period, 90 (34.75%) presented with typical features of DF, 28 (31.11%) were dengue proven, seven (7.7%) proved to be of malaria in which malarial parasites were found positive in the peripheral blood, while the remaining 55 (61.11%) patients were dengue probable. Age of the patients ranged from 13 to 76 years. Fever was the most common clinical presentation (100%) followed by vomiting 50 (55.56%), body ache 31 (34.44%) abdominal pain 17 (18.89%) and headache 9 (10%). Maculopapular rash was seen in 4(4.44%) patients. Laboratory findings included thrombocytopenia, leucopenia and raised alanine aminotransferase levels. Eighty one patients (90%) improved clinically and hematologically and were discharged in stable condition. Conclusion: Fever and thrombocytopenia were the most common presentation of dengue fever (DF). The overall mortality of DF is low, if treated appropriately. Awareness of health care professionals and public regarding preventive strategies is essential to fight against this disease.

Objective:There is a strong positive association between increased low-density lipoprotein cholesterol (LDL-C) and coronary heart disease (CHD). The accuracy of LDL-C estimation is essential and critically important. The aim of present study was to compare calculated LDL-C with direct homogeneous assay in patients with type 2 diabetes.Methods:This observational study was carried out at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2011 to December 2013. A total of 9620 patients with type 2 diabetes were included in the study. Fasting blood glucose, total Cholesterol, triglyceride, HDL cholesterol and LDL cholesterol were obtained using standard methods. Calculated LDL-C was obtained by Friedewald formula.Results:Mean difference of measured and calculated LDL-C was found to be -0.25, 6.63 and 46.55 mg/dl at triglyceride levels < 150 mg/dl, 150 - 400 mg/dl and ≥ 400 mg/dl, respectively. The result shows that the difference between measured and calculated LDL-C increases as the triglyceride level increases.Conclusions:The findings of our study suggested that calculated LDL-C was lower, as compared to measured LDL-C, which may cause misclassifications that may have an impact on therapeutic decisions in patients with diabetes. Calculated LDL-C may depend on triglyceride levels so LDL-C should be measured by direct assay in routine clinical laboratories.