Asian Journal of Diabetology

Insulin is Essential: The National List of Essential Medicines, India, 2022

2024-04-02T05:01:53+00:00

GUEST EDITORIAL

Diabetes Risk Score in Indian Population: Experience from Central India

2024-04-02T05:15:55+00:00

Diabetes is a major health problem in the world causing significant morbidity
and mortality. Currently, 77 million people in India and 463 million people are living with
diabetes across the world, and this number is expected to rise to 101 million in India and 578
million globally by 2030. The key to reduce the morbidity and mortality is early diagnosis and
management. The Madras Diabetes Research Foundation (MDRF) has developed an Indian
Diabetes Risk Score (IDRS) to identify people who are at risk of developing diabetes or are
undiagnosed. Thus, we conducted a study to calculate the IDRS of people from Central India
and identify those who are at risk of getting diabetes. Methods: A total of 1,500 patients or
attendants, aged 18 to 60 years (mean age 41.2 years), visiting the Endocrinology clinic, and
not diagnosed with diabetes earlier were included in the study after taking proper consent
and IDRS was calculated. Results: The male-to-female ratio was 914:586. The mean IDRS was
51.29 in our population with 35.93%, 18.2% and 45.87% of screened subjects having a score of
<30, 30-60 and ≥60, respectively. Conclusion: Forty-five percent people of the population was
at high risk of diabetes as estimated by IDRS, which proved to be an effective and economical
tool to identify persons at increased risk of diabetes and diagnose the undiagnosed cases and
start early management to reduce the morbidity and mortality.

Insulin Initiation with Insulin Degludec/Insulin Aspart versus Insulin Glargine in Oral Antidiabetic Drugs Failure Patients with Type 2 Diabetes Mellitus: A Real-World Study from India

2024-04-02T05:37:55+00:00

Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, but
there is still a dilemma as to whether basal insulin or a premixed/co-formulation analog should
be the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/
insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjects
with type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting and
design: Retrospective study. Methods and material: Data was retrieved from the author’s
clinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100,
n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasma
glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) from
baseline and at last follow-up visits were collected. Statistical analysis used: Baseline
characteristics and change in study parameters during the follow-up period were computed
between two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively.
ANCOVA test was used to compute percentage reduction in body weight, body mass index
(BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results:
IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared to
the IGlar U100 arm. There was no significant difference in the proportion of patients with
hypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severe
hypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD in
T2DM patients indicated that both were relatively safe but the former controlled FPG and
PPG levels more effectively.

Association of Fructose Enriched Foods with Metabolic Syndrome and Cardiovascular Diseases

2024-04-02T05:58:36+00:00

Cardiovascular diseases (CVDs) are the major causes of mortality and morbidity worldwide
as well as in the Indian subcontinent, causing more than 25% of deaths. It has been predicted
that these diseases will increase rapidly in India, making it a host to more than half the
cases of heart disease in the world within the next 15 years. The World Health Organization
(WHO) reports that in the year 2005 CVDs caused 17.5 million (30%) of the 58 million deaths
that occurred worldwide. In the recent times, the association of metabolic syndrome (MS)
is strongly linked with CVDs. MS is defined as a constellation of metabolic disorders in an
individual. The main components of MS are dyslipidemia (higher triglyceride, low-density
lipoproteins [LDL] and low high-density lipoproteins [HDL]), elevated blood pressure (BP),
dysregulated glucose homeostasis, abdominal obesity and insulin resistance. Being one of the
most widespread diseases in the world, almost half of the population of specific age groups
in developed countries is affected by it. Studies have shown that the independent risk factors
associated with MS increase the likelihood of CVDs. It has been postulated that excess intake
of fructose promotes cell dysfunction, inflammation, intra-abdominal (visceral) adiposity,
atherogenic dyslipidemia, weight gain, insulin resistance, hypertension thereby aggravating
the chances for developing MS, type 2 diabetes and coronary heart disease

Transition Care in Type 1 Diabetes. Five Questions and Five Principles

2024-04-02T06:46:34+00:00

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is among
the most challenging in the field of diabetes care. At around the age of 18 there is a physical transfer
of care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility of
self-care from parents to the patient over a period of time. Unique medical problems encountered in
this age group include puberty induced increase in insulin requirements, an increase in psychiatric
comorbidities including substance use and abuse, disconnect with health care teams, and problems related
to reproductive care and contraception. This is reflected in the poorer outcomes seen in this age group
including an increase in acute complications, increase in hospitalizations with diabetic emergencies, poor
glucose control and an increase in loss to follow. The poor metabolic control during this period leads to
establishment of early chronic macro and microvascular complications. A structured transition care is
a planned purposeful process that address these unique medical, psychological, and vocational needs
among these patients that smoothens out the process of transfer to adult care teams. The models that
have been proven to be useful in improving outcomes include the use of separate transition clinics, use of
transition coordinators and enrollment into young patients support groups. Regardless of the model used
there are five overarching principles that define this process of transition care. They can be summarized
in five Cs which include: appropriate communication, assessment of self-care needs, building competence,
using collaborative teams, and finally providing care and counseling for psychological issues

Cocktail Inferno – Multiple Sclerosis with Type 2 Diabetes Mellitus in a Patient with Lepromatous Leprosy

2024-04-02T06:17:03+00:00

Co-occurrence of multiple sclerosis with type 2 diabetes mellitus with lepromatous leprosy
is rare. We hereby report a case of multiple sclerosis with type 2 diabetes mellitus with lepromatous
leprosy in a middle-aged female. She was clinically diagnosed as having multiple sclerosis with
type 2 diabetes mellitus and presented with fever, ENL and neuritis. Her MRI reports were normal
but she had a positive slit-skin smear and skin biopsy as lepromatous leprosy. Proceeding with
this diagnosis, she was treated with baclofen for spastic bladder, antibiotics for urinary tract
infection, oral hypoglycemic agents and oral steroids with multibacillary treatment for leprosy
with type 2 reactions. She responded well and currently is being followed-up

Motivating Persons Living with Diabetes for Insulin/Injectable Therapy

2024-04-02T06:29:41+00:00

Motivating patients to initiate or intensify insulin is a challenging aspect of diabetes practice.
This paper reviews certain motivational strategies and methods used for insulin initiation/
intensification. It places various domains of motivational interviewing in perspective, under a
single umbrella, making it easier for practitioners to understand the art and science of insulin
motivation

Failure to Timely Diagnose and Intervene in a Known Complication of a Procedure

2024-04-02T06:43:32+00:00

MEDICOLEGAL