Zahid Miyan

Trends of type 1 diabetes in Karachi, Pakistan.

Objective:  Our study aims to assess the presentation, prevalence, and associations of acute and chronic complications in subjects with type 1 diabetes mellitus (T1DM) at their first visit to outpatient departments.

Characteristics of a large cohort of patients with diabetes having at-risk feet and outcomes in patients with foot ulceration referred to a tertiary care diabetes unit

To identify in a large population cohort the clinical and biochemical characteristics of patients with diabetes at risk of foot ulceration and outcomes in those with foot ulcers. All patients with diabetes attending Baqai Institute of Diabetology and Endocrinology from January 2004 to April 2012 included in the study. Clinical, biochemical and socio‐demographic data were collected and patients were categorised into those at no risk of ulceration, at risk of ulceration and those with foot ulcer, according to the University of Texas classification. Patients with foot ulceration followed for their final outcome, that is complete healing, persisted non‐healed ulcer, lower extremity amputation, lost to follow‐up or death. A total of 18 119 patients with diabetes underwent assessment, 3576 (19·7%) patients defined as at high risk for foot ulceration and 3731 (20·6%) presented with foot ulcer. Age, male gender, hypertension, higher glycated haemoglobin (HbA1c), history of smoking and presence of neuropathy were risk factors (P < 0·000) for foot ulceration. Amputation rate in patients with foot ulceration was significantly related to severity of ulceration at presentation. Preventive foot care practices were followed by 19·02% patients. One thousand eight hundred seventy three (50·2%) patients completely healed, 293 (11%) patients underwent amputation and 397 (10·1%) patients continued to be treated in the foot clinic. All patients with diabetes should be screened for neuropathy to identify those at risk of foot ulceration, as it is the major contributory factor for foot ulceration. The final outcome of foot ulceration was determined by the severity and grade of ulcer at presentation.

Characteristics and Outcomes of Subjects With Diabetic Foot Ulceration

Foot ulcers are a major cause of morbidity and hospitalization in patients with diabetes. The incidence of diabetic foot ulceration is higher in developing countries because of various sociocultural factors. The majority of amputations in patients with diabetes are preceded by foot ulceration; hence it is important to identify patients at risk for this complication. Studies show that the prevalence of diabetic foot ulceration is between 4 and 10% in Pakistan (1), and the amputation rate following foot ulceration is 8–21% (1,2), depending on the methodology used for treating foot ulceration. We identified diabetic patients at risk for ulceration and compared the clinical and metabolic characteristics of patients with and without foot ulceration together with an analysis of outcomes following ulceration. We included 8,989 patients with diabetes attending the Baqai Institute of Diabetology and Endocrinology, a tertiary …

Use of locally made off‐loading techniques for diabetic plantar foot ulcer in Karachi, Pakistan

The aim of this study was to evaluate the effectiveness of applying locally made pressure off‐loading techniques on plantar foot ulcer in individuals with diabetes. This prospective study of 70 diabetic patients was conducted at the foot clinic of Baqai Institute of Diabetology & Endocrinology. Plantar foot ulcer, stages 1A and 2A according to the University of Texas classification, was treated by using three off‐loading techniques: modified foot wear (sandal), modified plaster of Paris cast with plywood platform and Scotchcast boot. The outcome was assessed at either complete wound healing (defined as complete epithelialisation) or at 12 weeks, whichever came first. Of the 70 patients, 24 were in modified foot wear group, 23 in modified plaster of Paris cast and 23 in Scotchcast boot group. There was almost equal proportion of patients healed within 12 weeks period treated with these three off‐loading techniques, i.e. 22 (95·7%) for modified foot wear group, 19 (95%) for modified plaster cast and 18 (94·7%) for Scotchcast boot group. No significant difference was observed in median healing time and cumulative wound survival at 12 weeks in the three off‐loading techniques. Modified foot wear group was the most cost effective (

Protein requirement and its intake in subjects with diabetic foot ulcers at a tertiary care hospital

7) amongst the three off‐loading techniques. It is concluded that in this cohort, no significant difference in healing time was observed in the three off‐loading techniques, although modified foot wear (sandal) was found to be a more cost‐effective treatment modality.

Role of wound classification in predicting the outcome of diabetic foot ulcer.

Objective: To assess the protein intake and requirement among subject with type 2 diabetes having foot ulcers. Methods: This study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary care diabetes centre of Karachi, Pakistan among people with type 2 diabetic foot ulcer attending foot clinic from January 2012 to March 2015. The baseline characteristics, dietary intake and laboratory investigations of the study participants were obtained through electronic hospital database “Health Management System” (HMS) based on the 24 hours dietary recall interview. Total grams of protein were calculated from each food group consumed by the subject. Protein intake of the subjects was recorded in mean grams and the protein requirement was calculated according to their body weight. The comparison of intake and requirement of protein choices was done through comparing the mean of both variables. SPSS version 13 was used for analysing the results. Results: A total of 542 subjects were included in the study, 365 (67.2%) were males and 178 (32.8%) were females. Mena age of the subject was 54.61±10.51 (yrs) with the duration of diabetes and mean body mass index were 14.22±7.98 (yrs) and 26.65±5.38 (kg/m2), respectively. The dietary records showed the protein intake of subjects with diabetic foot ulcer is not appropriate when compared to daily requirement. Mean grams of protein intake is 76.87gms in males and 56.84gms in females. On the other-hand protein requirement is much higher than the intake, which is 219.5gms in males and 130.2gms in females. Conclusion: Dietary counselling should be a part of the treatment among subjects with diabetic foot ulcer to identify their nutritional needs and suggesting them better option to fulfil their protein requirement essential for wound healing process.