DIABETES MELLITUSD iabetes mellitus (DM) is a metabolic disorder resulting from a defect in insulin secretion, insulin action or both [1][2][3][4]. Insulin defi ciency in turn leads to chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism [1][2][3][4]. As the disease progresses tissue or vascular damage ensues leading to severe diabetic complications such as retinopathy [5,6], neuropathy [7,8], nephropathy [9,10], Cardiovascular complications [11,12] and ulceration [13,14]. Th us diabetes covers a wide range of heterogeneous diseases. Diabetes is the most common endocrine disorder and by the year 2010, it was estimated that more than 200 million people worldwide had DM and 300 million will subsequently have the disease by 2025 [15][16][17]. Th e diagnostic criteria and the classifi cation of diabetes was fi rst put forward by the World Health Organization (WHO) in 1965[18] then by the National Diabetes Data Group (NDDG) in 1979 [19] and this was followed by simplifi ed recommendations by the WHO in 1980 [20]. Th ese WHO recommendations were modifi ed slightly in 1985 [21]. Th e latest recommendations have been published by the American Diabetes Association (ADA) in 1997 and by the WHO in 1999. Both groups agree on the recommendations and criteria [2,22].According to the ADA recommendation changes in 1997, the fasting glucose concentration should be used in routine screening for diabetes as well as epidemiological studies; the threshold for fasting glucose was changed from 7.8 mmol/L (140 mg/dl) to 7.0 mmol/L (126 mg/dl); however the 2 hrs glucose criterion remains as 11.1 mmol/L (200 mg/dL). For the diagnosis of diabetes, at least one of the below criteria must apply. Th e WHO diagnosis and classifi cation of diabetes mellitus (1999) are identical to those of ADA, a fasting glucose = 7.0 mmol/L (126 mg/dl) and /or a 2 hrs glucose = 11.1 mmol/L (200 mg/dL). Th e report states that diagnosis should not be based on a single glucose determination but requires confi rmatory symptoms or blood/plasma determination. Ideally therefore, both the 2 hrs and fasting value should be used. Th ese recommendations contrast with those of ADA Expert Committee which gives primacy to the fasting plasma glucose. Th e WHO classifi cation includes both clinical stages (normoglycaemia, impaired glucose tolerance/impaired fasting glucose (IGT/IFG), diabetes and aetiological types of diabetes mellitus, identical to the ADA except that WHO group includes classifi cation formerly known as gestational impaired glucose tolerance (GIGT) and GDM: fasting glucose = 7.0 mmol/L (126 mg/dL) and/or 2 hrs glucose = 7.8 mmol/ L (140 mg/dL) after a 75-g OGTT.Diabetes mellitus may be categorized into several types but the two major types are type I and type II [21,23]. On the basis of aetiology, the term type I and type II were widely used to describe IDDM and NID-DM, respectively. Th e term juvenile -onset diabetes has sometimes been used for IDDM and maturity-onset for NIDDM.Type I (Ia, Ib) ß-cell destruction with litt...

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Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.