Objective: Our study was designed to explore the frequency of hypoglycemia events in type 2 diabetic patients. We further aimed to correlate the hypoglycemia events with treatment regimes and diabetes duration. Place and Duration: Mayo Hospital Endocrine Outpatient Department. From 1-04-2022 to 30-06-2022. Study type: Clinical based study Methodology: We used the already tested questionnaire from the American Diabetes Association and The Endocrine Society to collect the relevant information. The questionnaire was translated into the local language to facilitate the interview. Copies of the questionnaire were distributed to 1000 patients at the study site. The questionnaire was based on socio-demographic and clinical information including gender, age, duration of diabetes, treatment, frequency of hypoglycemia events, and symptoms. Chi-square was used to analyze the association of risk factors. While odd ratios were also computed at a 95% confidence interval. P-value <0.05 was considered for statistical significance. Results: Total of 360 cases T2DM had hypoglycemic events with a prevalence of 36%. The mean age of patients was reported as 51 years. A total of 200 cases were found in the mentioned age group with a 55.56% prevalence. Elderly age patients were also the secondary target of hypoglycemia with a prevalence ratio of 27.78%. Out of these 360 patients, 320 (86.11%) had mild to moderate hypoglycemia with symptoms of eye tarnishing, tremors, numbness of the tongue, and drowsiness while 15% of cases lost their consciousness and were categorized as severe events of hypoglycemia. Conclusion: The study concluded on a note that insulin-treated patients should be aware of the hypoglycemia events because in these cases the risk is comparatively high than in others. Keywords: Diabetes mellitus, Insulin, Hypoglycemia

IntroductionRheumatoid arthritis (RA) is a chronic autoimmune disorder with variable disease course including periods of flares and remissions. High disease activity in terms of disease activity score-28 (DAS-28) results in significant morbidity. Hypothyroidism is found to be associated with higher DAS-28 scores in RA. This study is planned to determine overt and subclinical hypothyroidism and its correlation with the DAS-28 score in patients with RA. MethodologyThis study was conducted from June 2021 to March 2022 at the department of rheumatology and immunology at Shaikh Zayed Hospital, Lahore, Pakistan. Inclusion criteria were any male and female patients aged between 18 and 70 years. The blood samples of diagnosed patients with RA were sent for thyroid function tests (thyroxine [FT4], thyroid-stimulating hormone [TSH]), and erythrocyte sedimentation rate (ESR), and the patients were categorized as overt hypothyroidism, subclinical hypothyroidism, and nonhypothyroid. The collected data were analyzed on Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). ResultsThe mean age of patients was 38.18 ± 9.78 years. The mean duration of symptoms was 14.65 ± 1.04 months. There were 182 (91%) females and 18 (9%) males. The mean number of swollen joints was 2.26 ± 2.8, and the mean number of tender joints was 4.16 ± 5.11. Sixty patients (30%) had high disease activity, i.e., DAS-28 score > 5.1. Fifty-seven patients (28.5%) with RA had subclinical hypothyroidism, and 19 patients (9.5%) had overt hypothyroidism. Pain visual analog scale (VAS) and DAS-28 were significantly higher in hypothyroid patients. ConclusionIt was concluded that patients of RA with concomitant hypothyroidism had increased disease activity with increased tender joints. Thyroid function tests should be included in the clinical evaluation of RA patients. The evaluation of thyroid functional status must be done during screening in RA patients. This will detect thyroid disorders earlier, with early treatment initiation and possibly a better prognosis.

Objective: This research is specifically designed to compare the efficacy, safety and dosage pattern of DLX and PGB in peripheral neuropathy pain in type 2 diabetic patients . In this clinical trial, we have used a low dosage of both drugs to measure the outcomes. Place and Duration: Mayo Hospital Endocrine Out Patient Department . 01-01-2022 to 31-03-2022 Study type: Randomized controlled clinical trial Methodology: All the patients were randomly divided into two equal groups of pregabalin and duloxetine. For this study, some empty capsules were prepared which were filled with either duloxetine, pregabalin, or starch as a placebo. Initially, patients of the duloxetine group received a placebo capsule once daily as a washout period for ten days. Later on, they received a fixed dose of 30 mg/d duloxetine in the first week of treatment and different doses of 30 mg/d to 60 mg/d were used for the next eleven weeks based on drug efficacy and tolerability. However, the group of pregabalin patients received a placebo capsule twice a day for ten days as a washout period. After that, they received 75 mg/Bd for the first week of treatment and 75 mg/Bd to 150 mg/Bd for eleven weeks of treatment. Results: The current study reported 74% ADRs in the duloxetine group while pregabalin reported 37% adverse reactions to medication. The significant mean difference related to incidents was observed as (p<0.05, =0.01 and <0.001) between both groups. In some cases, mild and tolerable adverse reactions were reported however severe reactions led to discontinuation of the drug. In 19% of cases of the duloxetine group treatment discontinuation was reported while PGB only had a ratio of 7%. Conclusion: In conclusion despite both drugs having equal efficacy still, the DPNP patients had a better tolerability ratio for pregabalin than duloxetine. Keywords: Type 2 diabetes, Duloxetine, Pregabalin, Peripheral neuropathy pain

Background and Aim: Diabetes distress, a term used to describe negative emotions associated with diabetes, is the key factor responsible for the elevated risk of psychological burden and compromised selfmanagement. The aim of this study is to determine the prevalence of diabetes-related distress among adolescent patients with type 1 diabetes (T1D) and to ascertain various factors associated with it.Methodology: In this cross-sectional study, 117 T1D patients with age 12-20 years visiting a diabetic clinic in the Department of Endocrinology and Metabolism, Services Hospital Lahore from February 2022 to August 2022 were enrolled. The patient's demographic and clinical details were noted in a pre-designed proforma. T1D distress scale (T1DDS) was utilized as the tool for measuring diabetes distress and distress was classified as severe, moderate, and no/little distress.Results: Of the total 117 T1D patients, 34.2% (n=40) had diabetes-related distress, out of which 31.6% had moderate and 2.6% had severe distress. The average total distress score was 1.73 ± 0.52 and higher mean scores were of powerlessness, negative social perception, and eating distress. Distress was higher among females, in those with the onset of diabetes in teens rather than in childhood. There is a significant impact of glycated hemoglobin (HbA1c) on the severity of diabetes distress as demonstrated by Pearson's correlation (r=.570, n= 117, p = <.001) Conclusion: The present study highlights the association of diabetes distress in adolescents with various factors, most significantly poor glycemic control, and therefore emphasizes the need for developing psychological interventional strategies in routine diabetes care to improve the mental well-being and selfmanagement of diabetic patients.