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Background: A variety of screening tools and criteria are used for the diagnosis of gestational diabetes mellitus (GDM). As a result, the prevalence rate of GDM varied from 4.41% to 57.90% among studies from Pakistan. Beside this disagreement, similar multi-centric studies, community surveys and pooled evidence were lacking from the country. Therefore, this first systematic review and meta-analysis aimed to measure the overall and subgroup pooled estimates of GDM and explore the methodological variations among studies for any inconsistency. Methods: Using the PRISMA guidelines, seventy studies were identified from PubMed, ScienceDirect, Google Scholar and PakMediNet database. Of them, twenty-four relevant studies were considered for systematic review and nine eligible studies selected for meta-analysis. AXIS was used for measuring quality of reporting, I^2 statistics for heterogeneity among studies and subgroups, funnel plot for reporting potential publication bias and forest plot for presenting pooled estimates. Results: The pooled sample of nine studies was 27,034 (126 – 12,450) pregnant women, of any gestational age, from all four provinces of Pakistan. Overall pooled estimate of GDM was 16.7% (95% CI 13.1 – 21.1). The highest subgroup pooled estimate of GDM observed in studies from Balochistan (35.8%), followed by Islamabad (23.9%), Khyber Pakhtunkhwa (17.2%), Sindh (13.2%), and Punjab (11.4%). The studies that adopted 75g 2-h OGTT had a little lower pooled estimate (16.3% vs. 17.3%); and that adopted diagnostic cut-off values [≥ 92 (F), ≥ 180 (1-h) and ≥ 153 (2-h)] had a greater pooled estimate (25.4% vs. 15.8%). The studies that adopted Carpenter criteria demonstrated the highest subgroup pooled estimate of GDM (26.3%), after that IADPSG criteria (25.4%), and ADA criteria (23.9%). Conclusions: Along with poor quality of reporting, publishing in non-indexed journals and significant disagreement between studies, the prevalence rate of GDM is high in Pakistan. Consensus building among stakeholders for recommended screening methods; and continuous medical education of the physicians are much needed for a timely detection and treatment of GDM. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a genetic and endocrine system disease that creates injurious health effects not in Pakistan but throughout the world. Several functional compounds are present in buckwheat which has distinct biological properties of cholesterollowering, anti-hypertension, improving constipation and obesity. The recent research was directed to study the nutritional and hypoglycemic effect of buckwheat in Type 2 diabetic rats induced by alloxan. Methods: Two varieties of buckwheat were examined for their nutritional composition and mineral content according to the methods of AACC (2000) while antioxidant activity was measured by using DPPH and a spectrophotometer. Alloxan induced diabetic mice were applied to investigate the blood-glucose-lowering effect of common buckwheat extract (CBE) and Tartary buckwheat extract (TBE). After type 2 diabetic induced rats were separated randomly into three groups. Results: The results revealed that Common buckwheat flour (CBF) contains12. 93% crude protein, 2.39% crude fat, 9.42% crude fiber and 2.90% ash content, while Tartary buckwheat flour (TBF) contains14.88% crude protein, 3.47% crude fat, 12.03% crude fiber, and 2.86% ash content. TBF contains significantly higher minerals as compared to CBF and also exhibited higher antioxidant activity. The results for diabetes-induced mice showed a significant difference for fasting blood glucose level, glucose tolerance test and body weight among control diabetic mice (group I) and diabetic mice given the CBE (group II) and TBE (group III). The fasting blood glucose level of group I increased while it decreased in group II and group III over time. Group II and group III had more glucose tolerance as compared to group I. Conclusion: The present study demonstrated that TBF contains higher nutritional contact as compared to CBF. Furthermore, it was indicated that the oral administration of CBE and TBE could lower the blood glucose level and can increase glucose tolerance effectively. [ABSTRACT FROM AUTHOR]

Background and Aim: To observe the glycemic status among individuals with undiagnosed diabetes in urban and rural areas of all four provinces of Pakistan., Methods: The findings of this study are obtained from the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a nationwide epidemiological survey. Out of 12,486 individuals approached, 10,834 participants agreed to be included in the second NDSP. An oral glucose tolerance test was used to assess undiagnosed diabetes individuals according to World Health Organization criteria., Results: The overall weighted prevalence of undiagnosed diabetes was 7.1% (2.4% in urban and 4.7% in rural areas). Based on isolated fasting plasma glucose or 2-h post 75 gm glucose load or combining both, the weighted prevalence of undiagnosed diabetes was 43.5%, 17.6%, and 38.9%, respectively. Out of the 43.5% of individuals, 15.3% had fasting plasma glucose higher than 250 mg/dl at the time of presentation. Among all the individuals, 23.7% were found to be of less than 40 years of age, 29.2% had a positive family history of diabetes, 80.8% were abdominal obese, 53.8% were hypertensive, and 98% were dyslipidemic. In comparison to the elder group, poor glycemic control of ≥10% HbA1c was observed in most of the younger age groups (p < 0.05)., Conclusion: A significant number of people remain undiagnosed in this part of the world. The glycemic status along with the other associated risk factors at the time of presentation is alarming. Thus, for the early detection of diabetes, awareness and education in the community are crucial. Hence, long-term complications of diabetes can be prevented., (Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Aim: Glycated hemoglobin (HbA1c) cut-off values as diagnostic tool in diabetes and prediabetes with its concordance to oral glucose tolerance test (OGTT) in Pakistani population., Methodology: Data for this substudy was obtained from second National Diabetes Survey of Pakistan (NDSP) 2016-2017. With this survey, 10 834 individuals were recruited and after excluding known subjects with diabetes, 6836 participants fulfilled inclusion criteria for this study. Demographic, anthropometric and biochemical parameters were obtained. OGTT was used as standard diagnostic tool to screen population and HbA1c for optimal cut-off values. Participants were categorized into normal glucose tolerance (NGT), newly diagnosed diabetes (NDD) and prediabetes., Results: Out of 6836 participants, 4690 (68.6%) had NGT, 1333 (19.5%) had prediabetes and 813 (11.9%) had NDD by OGTT criteria with median (IQR) age of 40 (31-50) years. Optimal HbA1c cut-off point for identification of diabetes and prediabetes was observed as 5.7% ((AUC (95% CI)=0.776 (0.757 to 0.795), p<0.0001)) and 5.1% ((AUC (95% CI)=0.607 (0.590 to 0.624), p<0.0001)), respectively. However, out of 68.6% NGT subjects identified through OGTT, 24.1% and 9.3% participants were found to have prediabetes and NDD, respectively by using HbA1c criteria. By using both OGTT and HbA1c criteria, only 7.9% and 7.3% were observed as prediabetes and diabetes, respectively., Conclusion: Findings from second NDSP demonstrated disagreement between findings of OGTT and HbA1c as diagnostic tool for Pakistani population. As compared with international guidelines, HbA1c threshold for prediabetes and NDD were lower in this part of world. HbA1c as diagnostic tool might require ethnic or regional-based modification in cut-off points, validated by relevant community-based epidemiological surveys., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The clinical and methodological diversity observed in national and regional diabetes surveys, emphasized on the need of the weighted average prevalence of diabetes., Objective: To measure the pooled prevalence of type 2 diabetes mellitus in the adult population of Pakistan., Methods: The prospective cross-sectional studies reporting adult diabetes in Pakistan and published on any date were retrieved from PubMed, ScienceDirect and PakMediNet databases. In the meta-analysis, PRISMA guidelines were used for reporting; the AXIS tool for assessing quality and risk of bias within studies; I 2 statistics for measuring heterogeneity between studies and subgroups; and Tableau Public 10.4 for geographic mapping of included studies. Using Meta-Analyst 3.13 βeta, overall and subgroup pooled estimates were measured by random effects model., Results: The pooled sample of twelve studies included 42,051 adults (≥20 years) comprised of both sexes from urban and rural Pakistan. The pooled prevalence of diabetes was 13.7% (95% CI, 10.7-17.3). None of the twelve studies was of poor quality (<10 scores). Ten studies were published in ISI indexed journals, and nine of them were indexed for Medline. The level of heterogeneity observed across studies and between subgroups was moderate (<50%). The subgroup analysis revealed a higher pooled estimate of diabetes in males than in females (13.1 vs. 12.4%). It was also higher in urban than in rural patients (15.1 vs. 1.6%), and in HbA1c than in OGTT tests (23.9 vs. 14.4%). However, pooled estimates of the WHO and the ADA criteria were similar (13.8 vs. 13.5%)., Conclusions: The prevalence of diabetes is on the rise in the adult population of Pakistan. The heterogeneity across studies observed in the meta-analysis suggested that the design of future diabetes surveys should be efficient and purposeful, and that valid tools and methods should be used to generate more precise data. Moreover, harmony between the stakeholders is much needed to seek a true picture of the diabetes burden in the country., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Objectives: We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan., Design, Settings and Participants: Multistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models., Main Outcome Measures: Prevalence of prediabetes and type 2 diabetes., Results: Of 18 856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51-60 years (26.03%, p<0.001), no formal education (17.66%, p<0.001), class III obese (35.09%, p<0.001), family history (31.29%, p<0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT., Conclusions: The prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pre-diabetes is a state of intermediate hyperglycaemia. Helicobacter (H) pylori infection is an established risk factor for pre-diabetes. This comparative cross-sectional study was done in Mayo Hospital Lahore from November 2015 to August 2016 in which 270 patients underwent upper gastrointestinal endoscopy with antral biopsy. An oral glucose tolerance test was done half to one hour after endoscopy. Patients were diagnosed having pre-diabetes according to American Diabetic Association criteria. Cases were divided into Group A and B based on the presence or absence of histopathological evidence of H. pylori respectively. Comparison was done to see the occurrence of pre-diabetes in H. pylori positive versus helicobacter negative dyspeptic patients. Results showed that 79 (58.52%) in Group-A and 62 (45.93%) in Group-B had pre-diabetes while remaining 56 (41.48%) in Group-A and 73 (54.07%) in Group-B had no findings of this morbidity, p value was calculated as 0.03 showing a significant difference. It was concluded that H. pylori infection is significantly associated with pre-diabetes.

Aim: To compare HbA 1c and fasting plasma glucose assessment, with the 2-h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis., Methods: Individuals (N=268) with newly diagnosed smear-positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA 1c and ≥7.0mmol/l for fasting plasma glucose., Results: The proportion of participants diagnosed with diabetes was 4.9% (n =13) by oral glucose tolerance test, while 11.9% (n =32) and 14.6% (n =39) were diagnosed with diabetes using HbA 1c and fasting plasma glucose criteria, respectively. The area under the receiver-operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA 1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests (P=0.07)., Conclusions: HbA 1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA 1c may be a more reliable test in individuals with transient hyperglycaemia., (© 2017 Diabetes UK.)

Aims/hypothesis: To determine the extent to which gestational fasting and postload levels of glucose explain differences in infant fat mass between UK-born Pakistani and white British infants., Methods: Analyses were undertaken in a prospective pregnancy cohort study of 1,415 women and their singleton live-born infants (629 white British and 786 Pakistani). Infant fat mass was assessed by cord-blood leptin levels and fetal insulin secretion by cord-blood insulin levels. Maternal OGTTs were completed at 26-28 weeks of gestation., Results: Pakistani women had higher fasting and postload glucose levels and greater incidence of gestational diabetes than white British women. Higher fasting and postload glucose levels were associated with higher cord-blood levels of insulin and leptin in all participants, irrespective of ethnicity. Cord-blood leptin levels were 16% (95% CI 6, 26) higher in Pakistani than in white British infants. After adjustment for fasting glucose levels, this difference attenuated to 7% (-3, 16), and with additional adjustment for cord-blood insulin levels it attenuated further to 5% (-4, 14). Path analyses supported the hypothesis that fasting glucose levels mediate the relationship of Pakistani ethnicity to greater fat mass at birth, as measured by cord-blood leptin levels; on average, 19% of this mediation involved fetal insulin secretion. Postload glucose levels did not act as an important mediator of ethnic differences in cord-blood leptin levels. Results were very similar when 130 women with gestational diabetes were removed., Conclusions/interpretation: These novel findings suggest a role of maternal pregnancy glycaemia in mediating differences in fat mass between Pakistani and white British infants.