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This research work is about collaboration as an important learning skill of the 21st century skill set. Collaboration means to work to gather or to work as team to attain some certain common objectives. This research study highlights different advantages to work as a collaborative team. It covers both quantitative and qualitative aspects of the topic. Detailed interviews are conducted from students and as well a survey was also conducted to check to what extent students are using this skill of collaboration in their learning process. Six students from BS English and BS Education were selected for interview section and 200 students from BS English and BS Education were surveyed in this study. Both quantitative and qualitative results are analysed and conclusion is drawn on the basis of results. Convergent parallel mix method design is used to analyse the data. Data analysed with simple descriptive statics and thematic analysis of the conducted interviews. The results of this study shows that collaborative tasks are used among students in their process of learning but not at a larger scale. Group work and combine projects and assignments are included but just for once or twice in a semester.

This study is about challenges of professional development at govt. post graduate college satellite town Rawalpindi with special focus of teacher’s self-development with reference to their teaching. 30 teachers are selected as sample in this study teaching BS program. 10 open ended questions are asked from these teachers. The focus of this question was about latest trends and methods, reflective practice of teachers on their own teaching, use of ICT in their lectures, communication ways and as well the psychological needs of students. The responses of the teachers are categorized and interpreted in percentage. The result shows that there are several challenges for professional development like teachers are not equipped with latest knowledge, have no reflection on their teaching, and only traditional ways of teaching are followed. Use of ICT is not as proper as it should be. And these challenges are basically threats to the BS program with reference to quality education in this institution. There is deadly need of formal and informal programs of professional development in this institution.

Khalid Abdul Basit,1,2 Asher Fawwad,3,4 Musarrat Riaz,5 Bilal Tahir,4 Maria Khalid,4 Abdul Basit5 1Department of Acute Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, England; 2Department of Population Health, University College London, London, England; 3Department of Biochemistry, Baqai Medical University, Karachi, Pakistan; 4Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan; 5Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PakistanCorrespondence: Abdul BasitDepartment of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Plot No.: 1-2, II-B, Nazimabad No 2, Karachi, PakistanTel +92 21 36707179Email abdulbasit@bide.edu.pkObjective: To elucidate the effectiveness of Risk Assessment of Pakistani individuals with diabetes (RAPID) tool in epidemiological and population-based second National Diabetes Survey of Pakistan (NDSP) 2016– 2017 for identifying risk of developing type 2 diabetes.Methodology: This observational study was a sub-analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016– 2017 conducted from February 2016 to August 2017 in all four provinces of Pakistan. Ethical approval was obtained from National Bioethics Committee Pakistan. RAPID score, a validated and published scoring scale to assess risk of diabetes, originally developed from community-based surveys was used. The risk score is assessed by parameters namely: age, waist circumference, and positive family history of diabetes. Subjects with score greater ≥ 4 were considered at risk of diabetes.Results: A total of 4904 individuals were assessed (2205 males and 2699 females). Mean age of participants was 41.8± 14.2 years. Positive family history of diabetes was seen in 1379 (28.1%) people. According to RAPID score 1268 (25.9%) individuals scored ≥ 4 and were at risk of diabetes. OGTT status of people at risk of diabetes according to RAPID score showed that 18.1% people with diabetes and 29.2% were prediabetic. Whereas, OGTT status of people not at risk of diabetes showed that only 7.6% people with diabetes, 20% were prediabetic.Conclusion: A simple diabetes risk score can be used for identification of high-risk individuals for diabetes so that timely intervention can be implemented. Community-based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce risk of diabetes.Keywords: risk score, diabetes, NDSP, RAPID, Pakistan

Objective In this study, we aimed to determine the linear growth and final height in children/adolescents with type 1 diabetes mellitus (T1DM) at a tertiary care hospital. Methodology This observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan. All children/adolescents diagnosed with T1DM of either gender aged between 8-18 years visiting the outpatient department of BIDE were included after obtaining informed consent. A predesigned questionnaire was developed to record data. The Centers for Disease Control and Prevention (CDC) growth chart was plotted and growth velocity was checked every six months to observe the linear growth. The final height was compared with the targeted height of the respective participants. Results A total of 66 people participated in the study (24 males and 42 females); among them, the mean age at diagnosis was 11.17 ± 4.77 years, and the duration of diabetes [median (IQR)] at the first visit was one year (0-3). The mean age at menarche was noted to be 13.56 ± 1.41 years. The overall height [standard deviation score (SDS)] at the first visit was -0.62 ± 2.58 and it was -1.34 ± 0.94 at the last visit; the overall weight at the first visit (SDS) and at the last visit was -1.23 ± 2.77 and -1.14 ± 1.25 respectively. Furthermore, the overall mid-parental height was 160.9 5 ± 10.28 cm, and 50% of males and 85.7% of females achieved genetic target height with a significant difference between them (p = 0.002). Conclusion A large number of people with TIDM were not able to achieve their target height. Therefore, it is imperative to monitor metabolic control along with monitoring of growth in young people with T1DM.

To assess the health-related quality of life of Pakistani adolescents with type 1 diabetes mellitus and their parents. This cross-sectional study of adolescents with T1DM and their parents was conducted at Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital, Karachi Pakistan from April 2017 to September 2018. Diabetes Quality of Life for Youths (DQOLY) questionnaire (assess possible problems in six dimensions of impact) and WHO QOL-BREF instrument was used to assess quality of life of adolescents with type 1 diabetes and their parents respectively. The data was entered and analyzed using IBM Statistical Package for Social Sciences version 20. Adolescents with T1DM had adverse impact on their quality of life (QOL); overall QOL score was found 20.76 ± 0.83, the maximally reported adverse impact was related to symptoms of diabetes 24.35 ± 1.92 and impact of treatment 24.59 ± 2.12. Females had more adverse impact on QOL score, i.e. 22.49 ± 1.2 (p value = 0.015). Adverse effect on QOL score is strongly correlated with increasing age (p value = 0.006). Overall QOL score of parents/care takers was 56.3 ± 0.98. The worst overall QOL score was noted to be of care takers 53.75 ± 3.4 followed by mothers 54.52 ± 1.25 and fathers 60.56 ± 1.61 respectively (p value = 0.015); the environment domain was associated with statistically significance adverse impact on QOL of mothers (p value = 0.008). It is imperative for health care professionals to be aware of the effect of diabetes on QOL as timely screening is important for better health care outcomes.

The lockdown resulting from COVID-19 outbreak affected individuals and nations equally. It not only harmed the economy but also led to the total shut down of all educational activities resulting in a significant gap in learning and understanding among students worldwide. Institutions, teachers, educators and students all had to quickly respond to an unexpected and ‘forced’ transition from face-to-face to remote teaching. The educational institutions also had to create learning environments for students and teachers in the light of the conditions in which both universities and schools had to operate. Although it leads to a number of challenges, but also provided opportunities that can best be described as blessing in disguise.

Aim and objective Diabetes mellitus is a chronic metabolic disorder that requires continuous self-management practices. The aim of our study is to assess the factors resulting in non-compliance with self-management practices in people with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care center in Karachi, Pakistan, from March 2019 to May 2019. People with T2DM diagnosed for at least six months were included. A predesigned questionnaire was used to assess various components of self-management such as the use of oral hypoglycemic agents (OHAs) and insulin, self-monitoring of blood glucose (SMBG), physical activity, and daily foot care. Certified diabetes educators conducted interviews on a one-to-one basis. Data were entered and analyzed by using SPSS (version 20; IBM Corp., Armonk, NY). Results Better glycated hemoglobin (HbA1c) levels were observed in compliant persons and a statistically significant difference was noted in those who were compliant with insulin use. Good compliance with self-management was observed in people who were given diabetes education previously. A total of 205 people with T2DM were included in the study, with a mean age of 52.66 ± 11.2 years and a mean duration of diabetes of 8.9 ± 7.5 years. There were 62.9% males and 37.1% females. Oral hypoglycemic agents (OHAs) were prescribed to 62.9% while 33.9 % were on both OHAs and insulin. Non-compliance with the intake of OHAs was 33.3%, insulin injection 21%, SMBG 25.7%, physical activity 69.5%, and foot care practice 34.3%. Various reasons identified for non-compliance included forgetfulness (negligence) (88%), fear of hypoglycemia (10.6%), time constraints (48%), and lack of foot care knowledge (84.8%). Conclusion Non-compliance with T2DM self-management is multifactorial and needs continuous reinforcement of structured diabetes education sessions. The study showed that the provision of diabetes education is directly proportional to self-management compliance levels.

doi: https://doi.org/10.12669/pjms.37.4.4555 How to cite this:Ahmed J, Riaz M, Imtiaz R. Glycemic index and Glycemic load values. Pak J Med Sci. 2021;37(4):1246-1247.doi: https://doi.org/10.12669/pjms.37.4.4555 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Genetic factors are involved in the development of T1D and studies have shown that the development of T1D also increases the risk of development of other autoimmune diseases. Objective To assess the frequency of thyroid dysfunction in subjects with type 1 diabetes. Methodology This study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes center of Karachi Pakistan from January 2005 to March 2017. Subject with type 1 diabetes (T1D) of all ages and both genders were included in the study. T1D was diagnosed on the basis of History, physical examination and relevant laboratory tests. The data of all registered patients was entered in a specially designed software. Thyroid stimulating hormone (TSH) was used as a screening test to assess thyroid dysfunction in subjects with type 1 diabetes. Further evaluation included FT4, T3 and thyroid antibodies where indicated. The data was analyzed on SPSS version 20. Results A total of 153 T1D subjects (67 male and 86 female) were included in the study. Out of 153 subjects, 23 (15.0%) had thyroid dysfunction of which 17 (11.1%) were found to have hypothyroidism (subclinical or clinical), 6 (3.9%) were hyperthyroid while 130(84.96%) subjects were having normal thyroid function. Statistical differences were found in body mass index and serum creatinine level among the different categories of thyroid dysfunction. The required dose of insulin was higher (but not significant) in subjects having hypothyroidism as compared to hyperthyroid or subjects with normal thyroid function. Conclusion High frequency of thyroid dysfunction was observed in subjects with T1D. Hypothyroidism was more common than hyperthyroidism. All subjects with T1D should be screened with TSH to evaluate for thyroid dysfunction.

Background Gestational diabetes mellitus [GDM] is associated with adverse maternal and fetal outcome. It is a severe threat to maternal and child health in a resource constraint country like Pakistan. Objective To find out the frequency of GDM in two metropolitan cities of Pakistan using DIPSI criteria. Methodology This cross sectional study was conducted between 2013–2016 in various primary, secondary and tertiary care hospitals of two metropolitan cities namely Karachi and Hyderabad in Pakistan. All pregnant women attending the ante natal clinics of recruitment sites during this period were included in the study. After taking consent patients were given 75g of glucose dissolved in 100ml of water in non-fasting state using Diabetes in pregnancy Study group of India(DIPSI) criteria. Blood samples were collected after two hours. Results A total of 11,430 participants were included in the study. Mean gestational age was 27.12±6.84 weeks with 18.8% and 23.1% having positive family history of diabetes and hypertension respectively. Previous history of GDM was present in only 6.8% of participants. About 1349(11.8%) pregnant women were diagnosed with gestational diabetes out of which 6.2%, 39.9% and 51.1% were diagnosed in 1st 2nd and 3rd trimester respectively. No known risk factor regarding GDM was present in 25.6% women. Conclusion This study shows a high frequency of GDM (11.8%) irrespective of risk factors, and in all trimesters of pregnancy emphasizing the need for universal screening in Pakistan.

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group‐A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group‐B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P‐value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. The aim of this study was to determine the variations in the clinical presentation and frequency of metabolic syndrome (MetS) in women with PCOS. Methods: This cross-sectional study was conducted at the Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan, from April 2019 to March 2020. Women attending the endocrine clinic who satisfied the Rotterdam criteria of PCOS and agreed to participate in the study were included. Detailed personal and family history of menstrual cycle, hirsutism, diabetes, hypertension, dyslipidemia and obesity was noted along with measurement of vitals, anthropometric measures and calculation of the body mass index. Physical examination performed for signs of hyperandrogenism, insulin resistance and biochemical and hormonal evaluation was also carried out in recruited participants. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY). Results: A total of 153 participants with mean age of 27.2±8.13 years were included in this study. Regarding clinical presentation, menstrual irregularity (oligomenorrhea 39.85%, amenorrhea 38.9%), followed by hirsutism 52.3%, was the most common presentation. Polycystic appearance of ovaries was noted in 33.3% of our study participants. MetS was identified in 46.4% participants (obesity was noted at the highest frequency at 82.4% followed by dyslipidemia at 56.2%). Conclusion: We observed a high frequency of MetS in females presenting with PCOS. There is a need to evaluate women with PCOS for various components of MetS to prevent potential complications.

Objective To study the pattern and prevalence of obesity in a large representative sample of Pakistani population aged 20 years and above. Methodology This study is a sub analysis of the second National Diabetes Survey of Pakistan (NDSP) 2016–2017, a large community-based epidemiological survey carried out from February 2016 to August 2017 in all 4 provinces of Pakistan. An estimated sample size of 10,834 people was calculated using a multistage sampling technique. Out of 213 clusters, Twenty-seven clusters were selected from all four provinces of Pakistan. Households were identified and selected members of every 10th household were advised to come to the campsite after an overnight fast. All the study participants underwent anthropometric measurements including height, weight, and waist circumference by using standardized techniques and oral glucose tolerance tests were done. Data were analyzed on the statistical package for social sciences (SPSS), version 20. Results Overall weighted prevalence of generalized obesity was 57.9% (42% in males and 58% in females) and central obesity 73.1% (37.3% in males and 62.7% in females) as per WHO Asia pacific cutoffs. The highest prevalence of generalized obesity was found in Punjab 60%, followed by Khyber, Pakhtunkhwa 59.2%. Moreever, highest prevalence of abdominal obesity was observed in Baluchistan 82.1%, followed by Punjab 73.3%. Obesity (generalized and abdominal) was found significantly associated with diabetes, hypertension, and dyslipidemia. Conclusion The prevalence of obesity is at epidemic proportions in Pakistan, calling for urgent lifestyle intervention strategies to prevent and manage this important cardiometabolic risk factor.

OBJECTIVES: Dyslipidemia is a major risk issue for the development of cardiovascular disease. The aim of our study was to observe the pattern and prevalence of dyslipidemia in Pakistani population. METHODOLOGY: This is a sub analysis of a population based second National Diabetes Survey of Pakistan (NDSP) 2016–2017 in adults aged 20 years or above, carried out from February 2016 to August 2017 across Pakistan. Multi stage sampling technique was used for the stratification of population, based on rural and urban domains. District wise clusters and sub clusters were selected i.e. 27 and 46 in number. Subjects, consented to participate were requested to come after an overnight fast for anthropometric measurements, oral glucose tolerance test and fasting lipid profile (except for subjects with self-reported diabetes). Dyslipidemia was identified using Adult Treatment Panel III guidelines. RESULTS: A total of 10,834 subjects (43.8% male and 56.2% female) having mean age of 43.8 ± 14.0 years, participated in the survey. Of the subjects studied, 39.3% had hypercholesterolemia, 48.9% had hypertriglyceridemia, 39.7% had high LDL-C levels while 83.9% men and 90% women had low HDL levels. High cholesterol and triglyceride levels were highest in 50–59 years age group, while high LDL and low HDL was most common in 40–49 years age group. Diabetes, obesity and hypertension were found to be the significant determinants for dyslipidemia. CONCLUSION: Prevalence of dyslipidemia seems to be very high in Pakistan, necessitating an urgent call for early screening and effective management through lifestyle intervention and appropriate lipid lowering drugs to prevent this important cardiovascular risk factor.

To determine the prevalence of microvascular complications and associated risk factors among subjects with type 2 diabetes reported at a tertiary care unit of Karachi, Pakistan. This retrospective observational study was carried out in the outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes center of Karachi from January 2005 to April 2016. Data records of patients with type 2 diabetes at presentation were analyzed. Selected data was extracted from Health Management System (HMS) including basic demographics, anthropometric measurements, biochemical results, medical information, and microvascular complications results. Data analysis was performed on Statistical Package for Social Sciences (SPSS) version 20.0. Overall, prevalence of at least one microvascular complication was 56.9%, retinopathy 15.8%, nephropathy 31.0%, and neuropathy 48.7% were noted. Male gender, age ≥ 40 years, duration of diabetes > 10 years, obesity, hypertension, HbA1c > 7%, and low HDL were found to be significant risk factors for microvascular complication. Hypertriglyceridemia and hypercholesterolemia were significantly associated with nephropathy and neuropathy, whereas no significant association of high LDL was found with any complication. High prevalence of microvascular complications was observed among type 2 diabetic subjects visited first time at a tertiary care hospital. Early identification and effective management are required at primary and secondary care levels to combat this situation.

Objective To determine accuracy of venous plasma glucose (VPG) and capillary blood glucose (CBG) in Gestational diabetes (GD) detection using Diabetes in Pregnancy Study Group India criteria. Methods It was a prospective single arm intervention study. One thousand thirty pregnant women, in second and third trimesters, recruited between June 2014 to March 2015 were included in the study. Seventy-five gram oral glucose was given, irrespective of last meal; venous and capillary blood samples were collected at 2h. Using World Health Organization (WHO) criteria, 2h VPG level ≥140mg/dl but Result Mean maternal age was 25.8±5.2 years, mean gestational age was 28.9±4.4 weeks and mean body mass index was 25.8±5.1kg/m 2 . By WHO criteria, 78 (7.6%) had GD, 14 (1.4%) had DM. Pearson's correlation between VPG and CBG was 0.761 ( p Conclusion Non fasting CBG is useful for screening of abnormal glucose homeostasis in pregnancy.

Objective To assess the views and feedback of trained Map facilitators on content and usability of the Diabetes Conversation Map™ (DCM) education tools. Methodology This study included Pakistani trained health care Map facilitators from June 2010 to September 2011. Four separate Map sessions on how Diabetes Works, living with Diabetes, eating healthy & exercising, and starting insulin treatment were facilitated by a trained facilitator. Each 60–90-minute session includes 3–12 trained facilitators. Evaluations were performed after the session through a questionnaire having questions about use of DCM for educating people with diabetes, contents of each Map, role of facilitator, and overall impact of DCM education tools on participating respondent. Results Out of 274 HCPs, 94.3% and 96% agreed that it is a better way of patient education and it provides better education as compared to print material respectively. Around 70% and 80% participants agreed that contents of "How Diabetes Works" & "Healthy Eating and exercise" are not difficult for people with type 2 diabetes mellitus (T2DM) respectively while most of the participants (80% and 76.5%) found contents of "Living with Diabetes" and "Starting Insulin" valuable and easy to apprehend. Most of the participants mentioned that self-monitoring of blood glucose, understanding regarding oral hypoglycemic agents, and insulin injecting technique should be included. Majority healthcare providers (80%) were satisfied with facilitation of Expert Trainer. Conclusion Most of the HCPs found DCM as a useful tool for educating people with diabetes. However, some modifications are required to further enhance its effectiveness.

Objective To evaluate the impact and effectiveness of 24-hour helpline service in providing information and educating patients about self-management of diabetes. Method The study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary diabetes care center, Karachi, Pakistan. People with diabetes attending the outpatient department from November 2012 to October 2014 were included in this study. After providing diabetes education, a helpline number was provided for emergency situations. Calls of registered patients were received by diabetes educators stationed at the BIDE around the clock. Data was collected through specially designed interface of HMS (health management system) in which the current complaint of caller and the advice of educator was recorded. Result A total of 4842 calls were received. Out of those, 4268 (88%) were made by Type-2 diabetics and 526 calls (10%) were made by Type-1 diabetics. The average age of patients was 47.6 years. Three seventy-four calls (7.7%) were received with complaint of Hypoglycemia (72-80mg/dl). Six hundred and ninety-eight calls (14.4%) were received with complaint of hyperglycemia (>200mg/dl). Insulin dose was adjusted on 935 calls (19.3%). Calls regarding other special situations such as (insulin handling, technique, medicine information) 2014 (41.6%) were received. Conclusion Station based 24-hour telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self-management of diabetes. It can help in the management of various acute complication of diabetes, thereby preventing unnecessary hospital visits and admission.

Aim Hyperglycaemia in pregnancy (HIP) is one of the most common complications of pregnancy. This study aims to examine the projected HIP prevalence in 2030 and 2045 using multiple methods. Methods The International Diabetes Federation Diabetes Atlas 2019 prevalence was projected to 2030 and 2045 by: (1) carrying forward the 2019 age-adjusted prevalence rates; (2) applying a linear regression of the past four editions of the IDF Diabetes Atlas; (3) applying a regression of the previous editions with the most consistent trend, followed by extrapolation from the 9th edition HIP estimate. Results Respectively, for 2030 and 2045, Method 1 projected a declining HIP rate with prevalences of 14.0% and 13.3%, Method 2 projected an increasing HIP prevalence at 16.5% and 18.3%, Method 3 predicted stabilisation of the rate from 16.0% to 15.8%. Conclusion Assuming other factors remain unchanged, our best estimation of age-adjusted HIP will show stabilisation between 2019 and 2045 of 15.8% to 16.0%. However, this estimate is confounded by the heterogeneity of studies and the influence of different gestational diabetes mellitus diagnostic criteria. To provide accurate future comparisons we recommend standardising the diagnostic criteria to the International Association of Diabetes in Pregnancy Study Groups.

Background: Diabetic foot ulcer is a major cause of morbidity, mortality, hospitalisation, poor quality of life and socio-economic burden in diabetic patients. Educating patients about foot care and improving foot care practices can help in the prevention of foot ulcer and thus reduce the rate of lower extremity amputations. Objective: The aim of this study is to evaluate the knowledge and practices regarding foot care in diabetic patients presenting with foot ulcers in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross-sectional study was conducted at a specialised foot clinic of Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital of Karachi, Pakistan. All patients with type 2 diabetes presenting with a history of foot ulcers were included in the study after taking informed consent. Only those patients with either already diagnosed diabetes mellitus or diagnosed in the clinic according to the American Diabetes Association diagnostic criteria were included in the study. Information regarding history, physical examination, Hba1c levels were collected in all patients through hospital HMS software. Ankle-brachial index and vibration perception threshold were done as part of foot examination in every patient. X-ray and tissue culture/sensitivity were done where indicated. The Nottingham assessment of functional foot care revised 2015 questionnaire was used to evaluate patients’ foot care knowledge and practices before presenting to our institute. The interview was conducted by a trained healthcare professional on one-to-one basis. Patients who scored >70% had good knowledge and practices of foot care, those between 50% and 70% had average and those who scored

Objective: To determine the frequency of depressive symptoms among young people with Type-I diabetes. Methods: This cross sectional study was conducted at Baqai Institute of Diabetology & Endocrinology, Karachi, Pakistan from February to December 2015. All People aged between 12-20 years with Type-I diabetes for at least 1 year attending the OPD were included in the study. Information about participants’ demographic characteristics, co morbidities and Complications, current treatment and medications were obtained. Acylated hemoglobin (HbA1C) levels were checked in all People. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess the depressive symptoms in the study participants. A cut off value of ≥ 16 was used to screen for depression. SPSS 19 was used to analyze the results. Results: Out of 104 people with Type-I diabetes, depressive symptoms were observed in 44 (42.3%) participants. Depressive symptoms were more frequent in females (28/55, 50.9%). Depressed people had more episodes of DKA (11/44, 25%), hypoglycemia (12/44, 27.3%) or hospitalization (7/44, 15.9%) in the last six months which were not statistically significant. Conclusion: Depressive symptoms are quite common in people with Type-I diabetes. Health care professionals should consider screening youth with diabetes for depression regularly. Further large scale studies are needed to validate our findings.

Objective. To explore the impact of maternal body weight on maternal nutrition and micronutrient status in early pregnancy and potential impact on metabolic status in newborns.Methodology. The EU FP7 project GIFTS was conducted from Jan 2012 to May 2014. Demographic details and anthropometric measurements of women in the first trimester of pregnancy were obtained. Blood samples were collected for OGTT, insulin, lipid profile, serum folate, ferritin, vitamin D, vitamin B12, and red cell folate. Newborn anthropometric characteristics were observed. Cord blood samples were collected after delivery for glucose, insulin, and lipid profile of newborns.Results. A total of 301 pregnant mothers, 108 overweight, 63 underweight, and 130 normal weight were included. Prevalence of vitamin D deficiency (P<0.05) for fasting blood glucose, insulin levels, and serum ferritin were observed. No significant difference was observed between vitamin D, serum B12, and red cell folate levels.Conclusion. Prevalence of multiple micronutrient deficiencies was common among Pakistani women during early pregnancy despite the nonvegetarian diet that has important implications for pregnancy care in Pakistan and potentially in expatriate communities living abroad. This trial is registered with ISRCTN number83599025.

Pakistan is a developing country with limited recourses and diverse economic social patterns. Pakistan has high prevalence of diabetes and its complication, which is a huge challenge to the existing health care system. The major contributing risk factors are urbanization and change in lifestyle, maternal and fetal malnutrition and genetic factors. National action plans for control of diabetes have been made since 1995 but actions in this regard were not perfect. Training of primary care physicians and development of multidisciplinary diabetes care teams was initiated. Prioritization strategies were defined according to the International Diabetes Federation (IDF) guidance, mainly focusing on diabetic foot, diabetes education and children with diabetes. Researches for better understanding and management of diabetes in Pakistan were undertaken. Collaboration between various stakeholders was promoted at national and international level. In summary, public private relationships and development of multifaceted approaches is expected to improve the lives of millions of diabetics of Pakistan.

Objective. To evaluate the efficacy of Diabetes Conversation Maps™ education tools for people with type 2 diabetes attending a diabetes self-management education program. Design and methods. This cross-sectional study was conducted with patients with type 2 diabetes who were recruited from Baqai Institute of Diabetology & Endocrinology, a tertiary care diabetes center of Karachi, Pakistan, from May 2010 to June 2011. Groups of 10–12 participants were given a pre-session questionnaire. Four sessions using Diabetes Conversation Maps™ education tools were conducted, and the same questionnaire was then completed again. Results. A total of 172 people (82 males, 90 females, mean age 60 years, average duration of diabetes 15 ± 4 years) participated in the study. Confidence in diabetes self-management: before the sessions, 52.3% of participants believed that the doctor is the most influential person in the management of their type 2 diabetes, whereas after the sessions, 97.1% acknowledged that they were responsible for diabetes self-management. Before, 15% said they knew what to do to manage their diabetes, whereas 75% indicated this after the sessions. Empowerment: before the sessions, 32% said they understood those aspects of their diabetes self-management that were in need of improvement, whereas 75.6% indicated this after the sessions. Willingness, ability, and preparedness for diabetes self-management: before the sessions, 22% said they understood the importance of diabetes self-management; this increased to 63.4% afterward. Before, 20.3% agreed that they will start making changes in their lives, whereas 65.7% agreed with this after the sessions. Satisfaction: 61% found the map sessions very effective, 72.1% found this format to be better than individual education, and 52.8% agreed that map tools helped in goal-setting. Conclusion. Diabetes Conversation Maps™ education tools are effective for diabetes self-management education and facilitating behavior change in people with type 2 diabetes. This, in turn, may improve patients’ chances of attaining desirable diabetes control.

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.

a b s t r a c t Objective: To develop and evaluate a risk score to predict people at high risk of developing type 2 diabetes in Pakistan. Methodology: Cross sectional data regarding primary prevention of diabetes in Pakistan. Diabetes risk score was developed by using simple parameters namely age, waist circumference, and family history of diabetes. Odds ratios of the model were used to assign a score value for each variable and the diabetes risk score was calculated as the sum of those scores. Results: We externally validated the score using two data from 1264 subjects and 856 subjects aged 25 years and above from two separate studies respectively. Validating this score using the first data from the second screening study gave an area under the receive operator characteristics curve [AROC] of 0.758. A cut point of 4 had a sensitivity of 47.0% and specificity of 88% and in the second data AROC is 0.7 with 44% sensitivity and 89% specificity. Conclusions: A simple diabetes risk score, based on a set of variables can be used for the identification of high risk individuals for early intervention to delay or prevent type 2 diabetes in Pakistani population.

Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

Type 2 diabetes mellitus is characterized by insulin resistance and progressive β cell failure; therefore, β cell secretagogues are useful for achieving sufficient glycemic control. Glimepiride is a second-generation sulfonylurea that stimulates pancreatic β cells to release insulin. Additionally, is has been shown to work via several extra pancreatic mechanisms. It is administered as monotherapy in patients with type 2 diabetes mellitus in whom glycemic control is not achieved by dietary and lifestyle modifications. It can also be combined with other antihyperglycemic agents, including metformin and insulin, in patients who are not adequately controlled by sulfonylureas alone. The effective dosage range is 1 to 8 mg/day; however, there is no significant difference between 4 and 8 mg/day, but it should be used with caution in the elderly and in patients with renal or hepatic disease. In clinical studies, glimepiride was generally associated with lower risk of hypoglycemia and less weight gain compared to other sulfonylureas. Glimepiride use may be safer in patients with cardiovascular disease because of its lack of detrimental effects on ischemic preconditioning. It is effective in reducing fasting plasma glucose, post-prandial glucose, and glycosylated hemoglobin levels and is a useful, cost-effective treatment option for managing type 2 diabetes mellitus.

Silicon supplementation was explored to increase salinity tolerance in plants, in the beginning of this cenutury, therefore silica nanoparticles (SiO2 Nps ) can also be used as a trial to improve salinity tolerance in plants. In this study SiO2 Nps have been synthesyzied by some modification in the conventional method of Stober by thermal hydrolysis of Tetraethylorthosilicate. A compound Controlled Release Fertilizer (CRF) was synthesized that carried NPK and SiO2 Nps inside the core and Chitosan as the first semi-permeable coating and Sodium Alginate and Kaolin as an outer most superabsorbent coating. The synthesized SiO2 Nps were characterized by TEM and XRD. The water absorbency of CRF beads showed that they can absorb large amounts of water and double their weight. The Nutrient released rate from CRF beads was very slow and sustained for six months at room temperature. The SiO2 Nps containing superabsorbent CRF was capable of releasing the nutrients slowly, withhold large amounts of water therefore can help plants control salinity and survive better in drought and saline conditions without harming the environment. The synthesized compound fertilizer is biocompatible, biodegradable and nontoxic so ideal for growing plants in drought and salt effected areas.

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.