Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Glycaemic control and avenues for improvement among people with type 2 diabetes mellitus from rural Sri Lanka – a retrospective cohort study(Elsevier, 2023) Mettananda, C.; Chathuranga, U.; Rathnayake, T.; Luke, N.; Meegodavidanage, N.BACKGROUND The majority of Sri Lankans and South Asians are rural dwellers but follow-up data on glycaemic control and its associations in rural communities are sparse. We followed up a cohort of hospital-based rural Sri Lankans with diabetes from diagnosis up to 24-months. METHODS We conducted a retrospective cohort study of people with type-2 diabetes (T2DM) diagnosed 24 months before enrolment who were being followed up at Medical/Endocrine clinics of five hospitals selected by stratified random sampling in Anuradhapura, a rural district of Sri Lanka from June 2018 to May 2019 and retrospectively followed them up to the diagnosis of the disease. Prescription practices, cardiovascular risk factor control and their correlates were studied using self-administered and interviewer-administered questionnaires and perusing medical records. Data were analysed using SPSS version-22. FINDINGS A total of 421 participants [mean age 58.3 ± 10.4 years, female 340 (80.8%)] were included in the study. Most participants were started on anti-diabetic medications in addition to lifestyle measures. Of them, 270 (64.1%) admitted poor dietary-control, 254 (60.3%) inadequate medication-compliance and 227 (53.9%) physical inactivity. Glycaemic control was assessed mainly on fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) data were available in only 44 (10.4%). Target achievements in FPG, blood pressure, body mass index and non-smoking at 24-months following initiation of treatment were 231/421 (54.9%), 262/365 (71.7%), 74/421 (17.6%) and 396/421 (94.1%) respectively. INTERPRETATION In this cohort of rural Sri Lankans with type-2 diabetes mellitus, all were started on anti-diabetic medications at the diagnosis, but glycaemic target achievement was inadequate at 24 months. We identified the major patient-related reasons for poor blood glucose control were poor compliance with diet/lifestyle and/or medications and misconceptions about antidiabetic medications.Item High prevalence of Diabetes Mellitus in Sri Lankan urban population – Data from Colombo Urban Study(Endocrine Society of Sri Lanka, 2019) Somasundaram, N.P.; Ranathunga, I.; Gunawardana, K.; Ediriweera, D.S.BACKGROUND: In recent decades, Sri Lanka has experienced rapid urbanization, with approximately 30% of the population currently residing in urban areas. We report the age- and sex-specific prevalence of dysglycaemia in an urban population in Colombo, Sri Lanka. METHODS: Using a stratified random sampling method, 463 subjects (139 men; 324 women) aged 18 years and above were included. Physical activity was quantified using international physical activity questionnaire (IPAQ). Bio impedence was used to estimate body fat. Insulin sensitivity was estimated using the HOMA calculations. Prevalence was estimated using weighted age standardized calculations. Multiple logistic regression analyses were used to study associations to diabetes and prediabetes. RESULTS: There were 124 adults in the 18-40 age group (70% female), 209 adults in the 41-60 age group (73% female) and 130 adults in the > 60 age group (63% female). The overall prevalence of diabetes was 27.6% (95% CI: 23.7-31.4). The prevalence of diabetes in those aged 18-40 was 12.4% (95% CI: 6.4 -18.4), 36.1% (95% CI: 29.8 – 42.4) in those aged 41 – 60 and 48.3% (95% CI: 40.7 – 55.8) in those aged >60. Pre-diabetes was detected in 30.3% (95% CI 25.9-34.8) of the population (with either an HbA1c of 5.7-6.4%, FPG of 110-125 mg/dl or 2 Hr PPG of 140-199 mg/dl). Cumulative prevalence of diabetes and pre-diabetes in the population was 57.9%. CONCLUSIONS: This urban study demonstrates that along with the changes in the socio-demographic status, the metabolic profile of the Sri Lankan adult has transformed, with a high prevalence of dysglycaemia and obesity.Item The drug compliance among patients with diabetes in Sri Lankan setting(Endocrine Society of Sri Lanka, 2017) Gunathilake, G.; Kottahachchi, D.; Siyambalapitiya, S.INTRODUCTION: Diabetes mellitus is a chronic non-communicable disease that is associated with vascular complications. Treatment of diabetes complications are expensive and it is much more expensive than the treatment for the disease itself. However, most of these vascular complications can be prevented with good glycaemic control and to achieve this, compliance to medication is essential. Similar to most of the other chronic diseases, drug compliance has been poor among patients with diabetes. The objective of this study was to assess the level of drug compliance and the factors that influence the drug compliance among Sri Lankan patients with diabetes. METHOD: Three sets of patients were recruited from three different clinical settings, the diabetes clinic, the medical clinics and the general practitioner clinics in the community. Data were collected using an interviewer administered questionnaire. RESULTS: There were 247 patients recruited for the study and majority were females (80.2%). The majority (79.4%) attended the clinics regularly. However, a good compliance to medication was seen in 38.4% of patients. The large number of tablets that they need to swallow, fear of side effects with long-term drug intake and unclear instructions are the main reasons for poor drug compliance among our patients. CONCLUSIONS: Similar to most of the previously done studies, drug compliance is poor among our patients with diabetes. However, the compliance can be improved by avoiding polypharmacy by using combined pills and with proper patient education regarding drug intake and the side-effects.Item Diabetes and Alzheimer's disease: Can tea phytochemicals play a role in prevention?(IOS Press, 2017) Binosha, F.W.M.A.D.; Somaratne, G.; Williams, S.; Goozee, K.G.; Singh, H.; Martins, R.N.Dementia and diabetes mellitus are prevalent disorders in the elderly population. While recognized as two distinct diseases, diabetes has more recently recognized as a significant contributor to risk for developing dementia, and some studies make reference to type 3 diabetes, a condition resulting from insulin resistance in the brain. Alzheimer's disease, the most common form of dementia, and diabetes, interestingly, share underlying pathological processes, commonality in risk factors, and, importantly, pathways for intervention. Tea has been suggested to possess potent antioxidant properties. It is rich in phytochemicals including, flavonoids, tannins, caffeine, polyphenols, boheic acid, theophylline, theobromine, anthocyanins, gallic acid, and finally epigallocatechin-3-gallate, which is considered to be the most potent active ingredient. Flavonoid phytochemicals, known as catechins, within tea offer potential benefits for reducing the risk of diabetes and Alzheimer's disease by targeting common risk factors, including obesity, hyperlipidemia, hypertension, cardiovascular disease, and stroke. Studies also show that catechins may prevent the formation of amyloid-β plaques and enhance cognitive functions, and thus may be useful in treating patients who have Alzheimer's disease or dementia. Furthermore, other phytochemicals found within tea offer important antioxidant properties along with innate properties capable of modulating intracellular neuronal signal transduction pathways and mitochondrial function.Item Diabetes mellitus in pregnancy(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Motha, M.B.C.; Dias, T.D.