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Objective. To evaluate the association of glycated haemoglobin (HbA 1c ) reduction and wound healing in patients with diabetic foot ulcer (DFU).Methodology. A 12-week prospective, non-controlled, interventional study in suboptimal-controlled T2DM patients with DFU was conducted. Antidiabetic medications were adjusted with the aim of at least 1% in relation to patient's individualised HbA 1c target. The wound area was determined by using specific wound tracing. The daily wound area healing rate in cm 2 per day was calculated as the difference between wound area at first visit and the subsequent visit divided by the number of days between the two visits.Results. 19 patients were included in the study. There was a significant HbA 1c reduction from 10.33 %+1.83% to 6.89%+1.4% (p<0.001) with no severe hypoglycaemia. The median daily wound area healing rate was 0.234 (0.025,0.453) cm 2 /day. There was a strong positive correlation between these two variables (r=0.752, p=0.01). After dividing the patients into four quartiles based on final HbA 1c and comparing the first quartile vs fourth quartile, there was a significant difference in daily wound area healing rates (0.597 vs 0.044 cm 2 /day, p=0.012). Conclusion.There was a positive correlation between HbA 1c reduction and wound healing rate in patients with DFU.Although this is an association study, the study postulated the benefits of achieving lower HbA 1c on wound healing rate in DFU which require evidence from future randomised controlled studies.

A 69-year-old female complained of intermittent left hip pain for the past 3 years. Biochemical tests revealed normal serum calcium and phosphorus with markedly raised alkaline phosphatase. MRI of the hip revealed extensive marrow signal abnormalities at the left pelvic bone, while CT of the thorax revealed a spiculated lung nodule at the left lower lung lobe. In order to diagnose either primary, metastatic bone tumour or Paget's disease of the bone (PDB), an open biopsy of the left iliac bone was performed. The histopathology of bone biopsy of the left iliac bone was consistent with PDB. A CT guided biopsy of the lung mass done later revealed adenocarcinoma of the lung. She had 18 F-FDG PET-CECT Scan for staging evaluation and result was suggestive of new bony metastases. Patient was started on IV Zoledronic acid for treatment of the PDB. In view of the stage 4 lung adenocarcinoma with bony metastases, patient was scheduled for palliative chemotherapy.

Objectives. To compare the prevalence of diabetic complications in young-onset type 2 diabetes (T2DM) with type 1 diabetes (T1DM) patients and to examine the relationship between clinical or metabolic parameters with diabetic complications.Methodology. This is a retrospective, cross-sectional comparative study based on electronic medical records review. Young-onset T2DM patients were defined as those with disease onset before the age of 40 and T1DM patients were included. Data were collected on demographic and clinical parameters, cardiovascular risks factors, macrovascular and microvascular complications.Results. There were 194 young-onset T2DM and 45 T1DM subjects. Despite similar glycaemic profile, more subjects in the T2DM group had unfavourable cardiovascular risk factors and developed complications than the T1DM group (22 vs. 0%, p<0.001 for macrovascular, 68 vs.Ê 27%, p<0.001 for microvascular). After adjustment of the confounders including age, gender, disease duration, HbA1c, obesity, blood pressure and lipid levels; young-onset T2DM instead of T1DM, hypertension, raised HbA1c and longer disease duration were independently associated with occurrence of diabetic complications.Conclusion. Young-onset T2DM appeared to be a more aggressive disease compared to T1DM. An aggressive approach should be adopted in treating young-onset T2DM to optimise the cardiovascular risk factors and glycaemic control to prevent premature mortality and morbidity.

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