BACKGROUND Type 2 diabetes mellitus is associated with chronic tissue damage, reduction in function, failure of multiple organs and its complications are preferably caused by macrovascular and microvascular damages. The aim of the study was to assess the effects of chronic hyperglycaemia on lung functions, which focused on mechanical aspects of lung dysfunction, maximal forced spirometric pulmonary function tests like FVC, FEV1, FEV1/FVC to be specific. MATERIALS AND METHODS This study is a cross sectional study conducted among 50 people with type 2 diabetes and 50 people with non-diabetes without having risk factors that affect the lung functions.
Background: Experimental studies have shown that an increase in serum osmolality (Osm) of even 10 mOsm/kg significantly contributes to progressive hyperglycemia by increasing hepatic glucose output and suppressing peripheral glucose utilization. The Osm increases parallel to the increase in blood glucose (BG) and vice versa. This is not therapeutically exploited yet.
Aim: To assess the effect of pre-treatment with IV 0.9% saline (NS) on glycemic control and medication requirement in type 2 diabetes mellitus (T2DM) patients presenting with subcritical hyperglycemia (SCH) -hyperglycemia not amounting to DKA or HHS.
Method: A retrospective comparative data analysis of T2DM patients (198) with SCH, pre-treated with NS before diabetic specific therapy (group 1) and compared with those who were not pre-treated with NS (group 2). Differences in glycemic control and drug dosage were assessed.
Results: In group 1, 1500ml of NS administration reduced the BG from a baseline of 496.3±67.1 to 283.3±83.8 (mg/dL), p=0.000 with a mean reduction of 43% and reduced the Osm by 11mOsm/kg [313.8±8.1 to 302.9±8.5, p<0.001]. There was a significant correlation between BG and Osm (r=0.322, p=0.001). Fluid pre-treatment enabled a better reduction in BG during 4 weeks of follow up in group 1{[FBS- 298.9±73.7 to 158.9±58.7 in group 1 v/s 265.6±70.7 to 171.48±66.5 in group 2, p=0.00] and [RBS- 496.3±67.1 to 228.3±80.7 in group 1 v/s 450.5±47 to 282±112.4 in group 2, p=0.001]}. There was a general trend of decrease in the dosages of antidiabetic medications in group 1 and increase of the same in group 2.
Conclusions: IV fluid pre-treatment reduced the BG and the drug dosage in T2DM patients presenting with SCH and the benefit persisted for a minimum of 4 weeks.
Disclosure
P. Sureshkumar: None.
INTRODUCTION:
Diabetic foot ulcers (DFU) are a serious complication of diabetes mellitus that can have significant medical and socioeconomic impact as well as increase in mortality rates. Healing of ischemic or neuro ischemic foot ulcers is most challenging as conventional therapies often fail to achieve adequate vascularity. Ulcers of the heel area can be very severe and strenuous to treat and can eventually end up in the amputation of the limb due to poor vascularity. So optimization of therapies to improve vascularity should be a major objective in successfully treating such cases.
CASE PRESENTATION:
Here we report two cases of chronic non-healing ischemic ulcers of the heel area of the foot. Patients approached us after the conventional medical treatments had failed to achieve healing. We treated them with a cocktail (Diabcare protocol) that we formulated using existing medications along with appropriate wound care and antibiotics. Diabcare protocol comprises plaque regression agents (statins), antiplatelet drugs (Aspirin), novel oral anticoagulant (Rivaroxaban) and vasoactive agents [PDE3 inhibitor (Cilostazol) and PDE5 inhibitor (Tadalafil)]. On Serial measurements, ulcers showed progressive healing and wound contraction. Vascularity improved significantly and fresh granulation appeared within days to weeks of initiation of therapy. Ulcers healed completely, with spontaneous epithelialization in the first case and after SSG in the second case, within a mean period of three months.
CONCLUSION
The ‘Diabcare protocol’ is found to be effective in healing difficult-to-heal ischemic foot ulcers where conventional treatment fails.
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