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January 2019, Volume 69, Issue 1

Letter to the Editor

Comments on Nabeea Junaid et al (JPMA 68: 1171; 2018) Early diagnosis of type 2 diabetes mellitus and its risk factor a worth full issue

Ayesha Afridi  ( Bahria University Medical and Dental College,Karachi,Pakistan )
Rooma Rouf Chughtai  ( Bahria University Medical and Dental College,Karachi,Pakistan )

We have read the article “Prevalence of undiagnosed type 2 diabetes mellitus in Pakistan: Results of screendiabetes disease registry”1 we highly appreciate the authors point of view for early diagnosis, early management along with life style interventions in diabetes mellitus type 2 patients. No doubt diabetes could be treated more effectively in early stage as compare to late stages associated with numerous complications. Not only on early diagnosis should further researches be conducted in Pakistan on predetermination of diabetes mellitus type 2. Previous researchers have estimated that children with obesity at age 7 which remain continued in adulthood are more likely to be associated with the risk of development of type 2 diabetes mellitusor people with elevated glucose levels (impaired glucose tolerance) for at least 30 minutes are at high risk of development of diabetes mellitus type 22 early management of newly diagnosed diabetes and pre-diabetics mainly with exercise can effectively help to impede cardiovascular, renal, neuropathic consequences of type 2 diabetes mellitus by inducing glycemic control and lowering the HbA1c levels of diabetic patients3 and can help to overcome those financial burdens on diabetic patients which are mainly associated with these diabetic complications as indicated by Khalid Mehmood et al1. More over exercise training has been proved as an effective tool for the improvement of
vascular functions in patients of type 2 diabetes mellitus,normal vascular functions established due to adequate amount of physical activity will ultimately help maintaining endoneurium blood flow there would brighter chances to prevent diabetic peripheral neuropathy in patients4 which shows high prevalence in diabetic patients of Pakistan.5 Early diagnosis and early management of type 2 diabetes mellitus with diet and physical activity will ultimately help doctors to put patients on reduced dosage of medications especially those who are already suffering from liver and kidney disease and can develop lactic acidosis a fatal condition due to diabetic medications i.e. metformin6. Recent study has shown that gestational diabetes is the risk factor in development of type 2 diabetes mellitus in women but with adequate amount of physical activity and exercises during pregnancy can prevent development of gestational diabetes. Early diagnosis of type 2 diabetes mellitus and its risk factors can help to manage and prevent type 2 diabetes mellitus more easily when its associated complications have not appeared in patients and can help to overcome the increasing mortality and morbidity rates associated with type 2 diabetes mellitus7.

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Disclosure: None to declare.


1. Mehmood K, Junaid N. Prevalence of undiagnosed type 2 diabetes mellitus in Pakistan: Results of screen-diabetes disease registry. J Pak Med Assoc. 2018;68:1171-78.
2. Bjerregaard LG, Jensen BW, Ängquist L, Osler M, Sørensen TI, Baker JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. NEJM. 2018;378:1302-12.
3. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Jama. 2001;286:1218-27.
4. Maiorana A, O’Driscoll G, Cheetham C, Dembo L, Stanton K,
Goodman C, et al. The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes. J Am Coll Cardiol. 2001;38:860-6.
5. Shamim A, Haq A, Ali M. Prevalence of Peripheral diabetic Neuropathy and its Association with patients related factors.Pak J Med Health Sci. 2017;11:1130-2.
6. Nasri H, Rafieian-Kopaei M. Metformin: current knowledge. Journal of research in medical sciences: the official journal of Isfahan Uni Med Sci. 2014;19:658.
7. Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLoS medicine. 2018;15:e1002488.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: