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Background: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a notable influence on mental well-being, contributing to elevated morbidity and mortality rates. Depression and anxiety disorders are the most common mental health concerns among patients with T2D worldwide. Therefore, the present study aimed to assess the impact of an online intensive lifestyle intervention (ILI) on mental health outcomes (depression and anxiety) in patients with T2D in India., Materials and Methods: This retrospective pre-post analysis included adult patients (aged > 18 years) diagnosed with T2D who were enrolled in a diabetes management program in India between June 2021 and June 2023. The intervention consisted of lifestyle modifications such as a customized plant-based diet, regular physical activity, psychological support through group and individual therapy, and medical management. Data were extracted from the electronic database of the clinic, including anthropometry, medical history, biochemical parameters, symptoms of depression, and anxiety (assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale) at the start and end of the six-month intervention period., Results: Of the 1061 eligible patients (177 with prediabetes), 40.3% were female. The mean age, duration of diabetes, and HbA1c levels were 52 ± 10.4 years, 9.8 ± 7.8 years, and 8 ± 1.7%, respectively. The prevalence of symptoms of depression and anxiety (ranging from mild to severe) was 46% and 44.3%, respectively, which reduced to 28.7% and 29.2%, respectively, post-intervention., Conclusion: Integrated ILI successfully improved the symptoms of anxiety and depression, highlighting the importance of a multidisciplinary approach that includes diet, physical activity, psychological support, and medical management in enhancing mental health outcomes among patients with T2D. Future prospective studies are needed to explore the long-term effects of such interventions and develop effective strategies for promoting mental health in diverse populations., Trial Registration: The study was approved by the Freedom from Diabetes Research Foundation Institutional Ethics Committee (approval number FFDRF/IEC/2024/7) and registered in the Clinical Trials Registry of India (CTRI/2024/03/064596, registered on March 21, 2024)., (© 2024. The Author(s).)

Background: Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM)., Methodology: An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists ( n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement., Results: Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol., Conclusion: Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation., (© Journal of the Association of Physicians of India 2024.)

Introduction: People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia., Research Design and Methods: We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site., Results: The mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m 2 . The overall mean eGFR slope was -1.33/mL/min/1.73 m 2 /year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: -2.11; 95% CI: -3.45 to -0.77), previous cardiovascular disease (-1.93; 95% CI: -3.45 to -0.40), and statins use (-0.87; 95% CI: -1.65 to -0.10) were associated with faster eGFR decline., Conclusions: People with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications., Trial Registration Number: NCT01212328., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India., Research Design and Methods: A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023., Results: Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet., Conclusions: One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In India and the Southeast Asian population, hypertension and type 2 diabetes mellitus (T2DM) are the leading lifestyle-related diseases, responsible for a majority burden of morbidity and mortality. Multiple population-spanning studies have revealed the staggering prevalence of both diseases in India, and the prevalence of both will only increase further due to factors such as an aging population, rapid urbanization, increased obesity, and sedentary lifestyles. More than 50 percent of hypertensive patients in India are also diagnosed with T2DM, and a detailed management protocol for the same is required, especially when a major portion of the disease is managed at the primary care level. The Association of Physicians of India (API) guidelines for the management of hypertension in patients with T2DM have been formulated based on consultation with leading physicians, cardiologists, diabetologists, and endocrinologists of India and Southeast Asia, keeping in mind the challenges faced by the patients in these countries and the appropriate management protocols that will be beneficial. While standard office-based blood pressure (BP) measurement forms the cornerstone of hypertension diagnosis and demands a uniform methodology to be followed, home blood pressure monitoring (HBPM) is recommended for long-term follow-up with validated devices. Ambulatory blood pressure monitoring (ABPM) offers comprehensive insights crucial for cardiovascular (CV) risk stratification. The complications of diabetic hypertension can span from increased CV risk, heart failure (HF), and renal dysfunction, and nonpharmacological and pharmacological management should be aimed toward not only control of the BP values but also protecting the end organs. While nonpharmacological measures include a focus on nutrition and diet, they also focus on approaches to weight loss, including a novel section covering the benefits of yoga. The guideline also focuses on a novel section of factors influencing CV risk, especially in the Indian population. For the pharmacological management, the guidelines address each of the categories of antihypertensive drugs, emphasizing the significance of combination therapies in the management of diabetic hypertension. In line with leading global guidelines for the management of hypertension in T2DM, for diabetic patients who often struggle with BP management and carry a high CV risk, the recommended dual combination antihypertensive therapy is particularly crucial and should be considered as first-line management therapy. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) play a highly beneficial role in the management of diabetic hypertension, a combination of ACEi or ARB with dihydropyridine calcium channel blockers (DHP-CCBs) is recommended to reduce the risk of complications and enhance patient adherence. To achieve the target of effective BP control and end-organ protection, it is beneficial and recommended to include newer CCBs (e.g., cilnidipine) in the management protocol in combination with ACEi/ARBs. Combination therapy including ARBs and DHP-CCBs should be preferred over β-blockers and thiazides. Among the CCBs, cilnidipine, a novel molecule, is a more effective and safer option for diabetic hypertensive patients in India. β-blockers should be used if there is a history of myocardial infarction (MI), HF, coronary artery disease (CAD), or stable angina along with the initial hypertensive regimen. The guideline also focuses on the novel reno- and cardioprotective molecules such as finerenone and sodium-glucose cotransporter 2 inhibitors (SGLT2i) and their benefits in the management of diabetic hypertension., (© Journal of the Association of Physicians of India 2024.)

Introduction: Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are linked to the global diabetes epidemic, leading to increased disease progression and adverse health outcomes. The renaming of NAFLD to metabolic dysfunction-associated steatotic liver disease (MASLD) at the 2023 European Association for the Study of the Liver Congress highlights the complex relationship between metabolic disorders and liver health. Taking this into consideration, we aimed this study to identify prevalence and risk factors associated with the stages of NAFLD in individuals with T2DM in the Indian population., Materials and Methods: This observational, cross-sectional study was conducted on 1,521 T2DM patients at Dr Panikar's Speciality Care Centre, Mumbai, between September 1, 2022 and October 31, 2022. Demographic parameters such as age, gender, height, weight, and anthropometric parameters such as body mass index (BMI) and waist circumference were measured. Liver fibrosis and steatosis stages were identified by vibration-controlled transient elastography (VCTE) using FibroScan®., Results: The prevalence of liver steatosis was 75.1% among the 1,521 diabetes cases [S0 (24.9%), S1 (15.1%), S2 (24%), and S3 (36%)], whereas the prevalence of liver fibrosis was 28.0% [F0 (72%), F1 (19%), F2 (5%), F3 (1.5%), and F4 (3.4%)]. The S1 ( p = 0.012), S3 ( p = 0.001), F1 ( p = 0.001), and F2 ( p = 0.001) grades showed significant gender-related changes, demonstrating a positive connection. Furthermore, waist circumference was associated with disease severity in both liver steatosis and fibrosis stages ( p = 0.001), but BMI was solely associated with the degree of steatosis ( p = 0.001). The mean age differences between these categories, however, did not reach statistical significance ( p -values of 0.149 and 0.078, respectively, for the steatosis and fibrosis grades)., Conclusion: The study reveals a high prevalence of NAFLD (steatosis and fibrosis) in T2DM patients, increasing the risk of advanced fibrosis. In T2DM patients with risk factors including waist circumference and BMI, appropriate screening and intervention are required., (© Journal of the Association of Physicians of India 2024.)

Background: Recent research has shown that low serum levels of magnesium are often linked to both microvascular and macrovascular complications in individuals with diabetes mellitus. Hence, monitoring of serum magnesium levels is needed in diabetic patients. Furthermore, the addition of magnesium through supplementation may present a novel therapeutic strategy for mitigating vascular complications in individuals with diabetes., Objectives: To assess the prevalence of hypomagnesemia in type 2 diabetes mellitus patients and to assess the association between hypomagnesemia and microvascular complications of diabetes mellitus in a tertiary care hospital in North Kerala., Materials and Methods: An analytical cross-sectional study was conducted at a tertiary care hospital involving 230 diabetic patients receiving outpatient and inpatient care in the Department of Internal Medicine at Government Medical College, Kozhikode, Kerala. The study took place from January 2018 to December 2018, during which serum magnesium levels were assessed and analyzed in relation to the patients' microvascular complications and glycemic control., Results: We observed that 19.13% of the participants had hypomagnesemia. This condition was found to be more common among older individuals with diabetes, as indicated by a p -value of 0.022. However, there were no significant differences in serum magnesium levels based on gender ( p -value 0.18), body mass index (BMI) ( p -value 0.223), or the duration of diabetes ( p -value 0.36). The prevalence of diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy was higher in diabetics with hypomagnesemia than their counterparts with normal magnesium, with a p -value of 0.001, 0.001, and 0.001, respectively. There was a significant negative correlation obtained between serum magnesium and glycated hemoglobin (HbA1C) values (Pearson coefficient = -0.240 and p -value = <0.01) and fasting blood sugar (FBS) values (Pearson coefficient = -0.265 and p -value = <0.01)., Conclusion: Hypomagnesemia is negatively correlated with HbA1C and FBS but not related to duration of diabetes and gender. The prevalence of microvascular complications was higher among the diabetics with hypomagnesemia., (© Journal of the Association of Physicians of India 2024.)

Introduction: The coexistence of diabetes mellitus (DM) (both type 1 and type 2) and thyroid dysfunction, two common endocrine problems, is scientifically predictable. The prevalence of thyroid disorders among type 2 diabetics (more prevalent in India) was studied among patients visiting the outpatient department (OPD) of a district hospital in West Bengal to assess its relation with different characteristics of type 2 DM., Materials and Methods: A total of 120 patients suffering from type 2 DM (already diagnosed and on treatment) were randomly selected from the OPD (irrespective of their glycemic status). The thyroid status of all those patients was assessed. All diabetic patients were studied with a predesigned schedule and lab investigations for the prevalence of thyroid dysfunction and its association with pertinent variables from January to December 2019., Results: This study found a 28.3% prevalence of thyroid dysfunction among diabetics. It was significantly associated with poor glycemic control [rising hemoglobin A1c (HbA1c) level] (actual p -value for HbA1c vs abnormal thyroid status = 2.4 E -21 ) but not with other variables, including the duration of diabetes., Conclusion: Screening for thyroid dysfunction among diabetic persons should be routine, and strict glycemic control is essential., (© Journal of the Association of Physicians of India 2024.)

Background: Diabetes mellitus (DM) has affected over 387 million patients globally, expected to reach 592 million by the end of 2035. It is a metabolic disorder characterized by chronic hyperglycemia caused by either insulin deficiency, insulin resistance, or both., Materials and Methods: The present study was designed to estimate the levels of different bone markers; serum Vitamin D, alkaline phosphatase, phosphorus, and calcium in patients with type 2 DM (T2DM). The study was conducted on patients aged 20-50 years diagnosed with T2DM, who were attending the outpatient/inpatient department of internal medicine., Results: The levels of calcium were decreased in the patients with diabetes and also the study proved a negative correlation between calcium and random plasma glucose (RPG). There was a significant negative correlation between RPG and serum 25(OH)D3., Conclusion: We conclude that Vitamin D insufficiency is frequent in Moradabad, Uttar Pradesh. Sunshine exposure daily for 15 min on the face and hands is necessary to elevate the sunlight Vitamin D levels., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Background: Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial., Methods and Findings: This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c ≥8% and systolic BP ≥140 mm Hg and/or LDL-cholesterol ≥130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c <7% plus BP <130/80 mm Hg and/or LDL-cholesterol <100 mg/dL) and first macrovascular endpoints (nonfatal myocardial infarction, nonfatal stroke, death, revascularization [angioplasty or coronary artery bypass graft]), which were co-primary outcomes. We also examined secondary outcomes, namely, single risk factor control, first microvascular endpoints (retinopathy, nephropathy, neuropathy), and composite first macrovascular plus microvascular events (which also included amputation and all-cause mortality) by treatment group and whether QI strategy implementation was continued over 6.5 years. At 6.5 years, assessment data were available for 854 participants (74.5%; n = 417 [intervention]; n = 437 [usual care]). In terms of sociodemographic and clinical characteristics, participants in the intervention and usual care groups were similar and participants at sites that continued were no different to participants at sites that discontinued intervention implementation. Patients in the intervention arm were more likely to exhibit sustained multiple risk factor control than usual care (relative risk: 1.77; 95% confidence interval [CI], 1.45, 2.16), p < 0.001. Cumulatively, there were 233 (40.5%) first microvascular and macrovascular events in intervention and 274 (48.0%) in usual care patients (absolute risk reduction: 7.5% [95% CI: -13.2, -1.7], p = 0.01; hazard ratio [HR] = 0.72 [95% CI: 0.61, 0.86]), p < 0.001. Patients in the intervention arm experienced lower incidence of first microvascular endpoints (HR = 0.68 [95% CI: 0.56, 0.83), p < 0.001, but there was no evidence of between-group differences in first macrovascular events. Beneficial effects on microvascular and composite vascular outcomes were observed in sites that continued, but not sites that discontinued the intervention., Conclusions: In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes., Trial Registration: ClinicalTrials.gov NCT01212328., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MKA has received research support (to Emory University) from Merck and consulting fees from Bayer and Eli Lilly, all outside the scope of this work. SP received research funding in the area of CVD implementation sciences. All other authors have declared that no competing interests exist., (Copyright: © 2024 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: To assess the performance of smartphone based wide-field retinal imaging (WFI) versus ultra-wide-field imaging (UWFI) for assessment of sight-threatening diabetic retinopathy (STDR) as well as locating predominantly peripheral lesions (PPL) of DR., Methods: Individuals with type 2 diabetes with varying grades of DR underwent nonmydriatic UWFI with Daytona Plus camera followed by mydriatic WFI with smartphone-based Vistaro camera at a tertiary care diabetes centre in South India in 2021-22. Grading of DR as well as identification of PPL (DR lesions beyond the posterior pole) in the retinal images of both cameras was performed by senior retina specialists. STDR was defined by the presence of severe non-proliferative DR, proliferative DR or diabetic macular oedema (DME). The sensitivity and specificity of smartphone based WFI for detection of PPL and STDR was assessed. Agreement between the graders for both cameras was compared., Results: Retinal imaging was carried out in 318 eyes of 160 individuals (mean age 54.7 ± 9 years; mean duration of diabetes 16.6 ± 7.9 years). The sensitivity and specificity for detection of STDR by Vistaro camera was 92.7% (95% CI 80.1-98.5) and 96.6% (95% CI 91.5-99.1) respectively and 95.1% (95% CI 83.5-99.4) and 95.7% (95% CI 90.3-98.6) by Daytona Plus respectively. PPL were detected in 89 (27.9%) eyes by WFI by Vistaro camera and in 160 (50.3%) eyes by UWFI. However, this did not translate to any significant difference in the grading of STDR between the two imaging systems. In both devices, PPL were most common in supero-temporal quadrant (34%). The prevalence of PPL increased with increasing severity of DR with both cameras (p < 0.001). The kappa comparison between the 2 graders for varying grades of severity of DR was 0.802 (p < 0.001) for Vistaro and 0.753 (p < 0.001) for Daytona Plus camera., Conclusion: Mydriatic smartphone-based widefield imaging has high sensitivity and specificity for detecting STDR and can be used to screen for peripheral retinal lesions beyond the posterior pole in individuals with diabetes., (© 2024. The Author(s).)

Introduction: Diabetes prevalence is increasing rapidly; estimates from the International Diabetes Federation put the number at 381 million people have diabetes. Hypoglycemia is a commonly encountered complication in diabetic patients, which, in the short-term, can lead to mortality and, in the long-term, precludes maintenance of euglycemic control. Over 65.2 % of patients have reported at least one incidence of severe and nonsevere hypoglycemia when on oral hypoglycemic agents (OHA) at an annual crude incidence density of 35.1 events per year per person. Insulin more commonly causes hypoglycemia than OHA. However, this study was done with the aim of studying the hypoglycemia specifically caused by OHAs-clinical profile of patients, medications causing hypoglycemia, and the outcome., Materials and Methods: This prospective observational study was conducted in the Department of Medicine at a tertiary care hospital in Western Maharashtra. Data was collected over a period of 18 months from Indoor patients on admission having hypoglycemic symptoms with strip blood sugar levels of <70 and on OHAs. Patients on insulin were excluded from the study., Results: There were 60 patients with hypoglycemia with a mean age of 53.65 years and a higher incidence of hypoglycemia in females, 35 (58.3%) compared to males. There was a statistically significant difference between outcome (i.e., discharged or death) and urine protein-creatinine ratio (UPCR), a deranged liver function, that is, serum albumin, serum glutamic oxaloacetic transaminase (SGOT)/aspartate transaminase, and serum glutamic pyruvic transaminase (SGPT)/alanine transaminase ( p < 0.05). However, there was no statistically significant difference between outcome (discharged or death) and mean age, gender, mean duration of diabetes mellitus (DM), GCS scoring, and drug type of study subjects ( p > 0.05)., Conclusion: The risk factors for hypoglycemia were middle-aged patients. Females are at higher risk of hypoglycemia than men. Hypoglycemia due to OHAs is known to have a recurrence of hypoglycemia due to the long half-life of the drug; however, patients who were hospitalized were well monitored and did not have any recurrence of hypoglycemia. Deranged liver function or raised UPCR have high mortality after OHA-induced hypoglycemia., (© Journal of the Association of Physicians of India 2024.)

Objectives: Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM., Methods: We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI)., Results: The time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=-0.437, p=0.002) and AI (r=-0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis., Conclusions: Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes., Competing Interests: Author Disclosures Conflicts of interest: None., (Copyright © 2023 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Background: Type 2 diabetes mellitus (DM) is a known systemic risk factor for periodontitis. An increased expression of CD44 has been suggested in type 2 diabetics and periodontitis patients., Objectives: The present study aimed to assess the expression of CD44 antigen in patients with chronic periodontitis (CP) and type 2 DM in a South Indian urban population. Additionally, the relationships between the expression of CD44 antigen in gingival tissues, periodontal clinical parameters, and the random blood sugar (RBS) and glycated hemoglobin (HbA1c) levels were assessed., Material and Methods: A total of 63 subjects were divided into 3 groups: systemically and periodontally healthy controls (group H); CP patients, otherwise healthy (group CP); and CP patients with type 2 DM (group CP+DM). Periodontal parameters were recorded for all groups, and additionally the RBS and HbA1c levels for group CP+DM. Gingival tissue samples were obtained and subjected to immunohistochemical analysis for CD44., Results: The expression of CD44 was significantly higher in the diseased groups. Epithelial CD44 expression was significantly stronger in group CP+DM as compared to groups CP and H (p < 0.001), whereas connective tissue CD44 expression was similar in groups CP and CP+DM (p = 0.657). Furthermore, an inverse relationship was observed between blood glucose parameters and CD44 expression in the epithelium and connective tissue., Conclusions: The expression of CD44 increased with the severity of periodontal disease. Additionally, glycemic control in patients with CP and type 2 DM had an impact on CD44 expression. Our findings indicate a possible destructive role of CD44 in the pathogenesis of periodontal diseases in individuals with type 2 DM.

Background/aims: Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India., Methods: 400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria., Results: Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month., Conclusion: Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early., (© 2023. The Author(s).)

Objective: Diabetic retinopathy is a serious complication of diabetes mellitus that may lead to vision loss. Retinal problems are more likely to occur as the illness advances. Micro- and macro-vascular angiopathy is both linked to diabetes mellitus. Examining the impact of diabetes on blood vessels is one approach to understanding the disease's outward symptoms. The purpose of this research is to evaluate the morphology and breadth of conjunctival vessels in people with type 2 diabetes mellitus and to establish a correlation between these alterations and clinical retinal changes., Patients and Methods: A case-control study was conducted in the Department of Ophthalmology, KIMS, Koppal, Karnataka. The study included diabetic patients who voluntarily participated and were assessed at the Ophthalmology Outpatient Department (OPD). The general and ophthalmic history was taken for both cases and control. The best corrected visual acuity was estimated. Each subject, including cases and controls, had a general and ophthalmic history recorded. The anterior segment was evaluated with a slit lamp. After completing the clinical examination, the subjects underwent a conjunctival vessel imaging study using the slit lamp. The imaging included the study of conjunctival vessel morphology using ImageNet., Results: Both the test and control groups are comparable in terms of age and gender. The severity of diabetic retinopathy was shown to correlate with the conjunctival width range. Mild diabetic retinopathy is characterized by a conjunctival width of 30-34 microns (mean: 34.9), moderate diabetic retinopathy by 35-39 microns (mean: 37.3), severe diabetic retinopathy by 40-44 microns (mean: 42.4), and proliferative diabetic retinopathy by 50-54 microns (mean: 45.6)., Conclusions: Diabetes mellitus patients have larger conjunctival arteries as the disease becomes more severe. Dilated and tortuous conjunctival arteries are visible indicators that correlate with worsening diabetic retinopathy. This could be used for screening to ensure timely referral.

Objectives: Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS., Methodology: This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson's Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS.Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows., Results: Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent ( p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001)., Conclusion: The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS., Competing Interests: The authors declared no conflict of interest., (© 2024 Journal of the ASEAN Federation of Endocrine Societies.)

Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF., (© Journal of the Association of Physicians of India 2024.)

We read with great interest the article "the deadly duo of hypertension and diabetes in India: further affirmation from a new epidemiological study" by Metri et al. 1 They rightly pointed out that the prevalence of hypertension in Indian patients with type 2 diabetes patients is high and therefore early screening and management of hypertension should be included in the treatment of patients with type 2 diabetes. We wish to share our study findings on the prevalence of hypertension in newly onset diabetes mellitus (DM). We find that the prevalence of hypertension in all males and females with DM was 44.59, 44.34, and 45.16%, respectively. 2 ., (© Journal of the Association of Physicians of India 2023.)

We read with great interest the article "the deadly duo of hypertension and diabetes in India: further affirmation from a new epidemiological study" by Metri et al. 1 They rightly pointed out that the prevalence of hypertension in Indian patients with type 2 diabetes patients is high and therefore early screening and management of hypertension should be included in the treatment of patients with type 2 diabetes. We wish to share our study findings on the prevalence of hypertension in newly onset diabetes mellitus (DM). We find that the prevalence of hypertension in all males and females with DM was 44.59, 44.34, and 45.16%, respectively. 2 ., (© Journal of the Association of Physicians of India 2023.)

Rapidly progressive renal failure (RPRF) is not typical of diabetic nephropathy and suggests non-diabetic kidney disease (NDKD). We conducted an analysis of the data of RPRF patients (28 diabetic and 88 non-diabetic patients) with doubled creatinine over 2 weeks to 3 months and/or presented with >4 mg serum creatinine without prior renal disease to ascertain the types of lesions and compare the patients' histopathology. The primary outcome was dependence on dialysis at 1 year. Anti-neutrophilic cytoplasmic antibody-associated pauci-immune glomerulonephritis was the most common cause of RPRF in both groups. No particular lesion was more frequent in either group. Dependence on dialysis at 1 year was similar in both groups and was associated with dependence on dialysis at presentation but not diabetes. Crescentic glomerulonephritis was the most common in non-diabetic patients (57.9 vs. 25%, P = 0.002), and acute tubular necrosis (ATN) was seen in diabetic patients (21.4 vs. 11.4%, P = 0.179). Both factors were associated with adverse renal outcomes. Diffuse global glomerulosclerosis at presentation suggested a poor outcome in both groups. Diabetic nephropathy was seen in 14.29%, and its presence did not affect the outcome. The etiology of RPRF in diabetic patients has changed and is similar to that in non-diabetic patients, with no specific lesions predominating. Diabetic nephropathy does not alter the outcome for those with RPRF. Diffuse global glomerulosclerosis, being on dialysis at presentation, and ATN in a diabetic patient indicate a poor outcome and need close follow-up. Diabetic retinopathy should not prevent us from investigating for NDKD., (Copyright © 2023 Copyright: © 2023 Saudi Journal of Kidney Diseases and Transplantation.)

Problem: Despite high prevalence and ethnic susceptibility, limited published estimates are available on long term complication risks among known diabetes patients in India. Hence, we undertook evaluation of the cardiovascular risk of known diabetes patients from Delhi., Methods: The community-survey was conducted using a probability-proportionate-to-size(systematic) 2-stage cluster design. Thirty areas were selected for a house-to-house survey to recruit 25 to 30 subjects (known diabetes ≥1 year; 35-65 years of age) per area. Scores from the UKPDS 2.1, UKPDS 2.0, Framingham, ASCVD, WHO, NHS and SCORE studies were used for 10-year risk calculation., Results: We enrolled 843 subjects of which 800 consented for blood sampling. The mean age of the subjects was 53.0(52.1-54.0) years, the mean duration since diagnosis was 7.1(6.7-7.5) years, with 49.8 % women. 61.8 % were hypertensive, 81.5 % were dyslipidaemic and 53.3 % had poor glycaemic control. Although variable, risk engines estimates were consensual in projecting a high ten-year Coronary-Heart-Disease risk of 10-16 %, a stroke risk of 3.7-5.0 %, and a 5.0-5.7% risk of cardiovascular fatality. These risks were 1.5-3 times the 'risk at target levels' suggesting mitigability. Only 9.3 %, 16.0 %, and 30.0 % were taking aspirin, lipid lowering drugs and antihypertensives respectively., Conclusion: The study highlights the impending impact of, and the scope for improvement in the cardiovascular risk profile of diabetes patients in Delhi, including the use of cardioprotective medications. It strengthens the case for developing and testing potential interventions for improvement., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr JITENDER NAGPAL reports financial support was provided by Indian Council of Medical Research., (Copyright © 2023 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Aims: We aimed to assess the prevalence of pancreatic exocrine insufficiency (PEI) in Indian patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) using a unique diagnostic criterion., Methods: This multicenter study included patients aged ≥18 years with diabetes for at least 5 years. The sociodemographic characteristics, lifestyle habits, and clinical characteristics of patients were assessed. Patients were administered the PEI questionnaire (PEI-Q), and fecal elastase-1 (FE) concentration was measured. Patients were diagnosed to have PEI if they satisfied any two of the following three criteria: (a) a PEI-Q total symptom score of ≥0.60; (b) presence of malnutrition using the European Society of Clinical Nutrition and Metabolism diagnostic criteria for malnutrition; or (c) FE concentration &lt;100 μg/gm stool., Results: This multicenter study included patients aged ≥18 years with diabetes for at least 5 years. The sociodemographic characteristics, lifestyle habits, and clinical characteristics of patients were assessed. Patients were administered the PEI questionnaire (PEI-Q), and fecal elastase-1 (FE) concentration was measured. Patients were diagnosed to have PEI if they satisfied any two of the following three criteria: (a) a PEI-Q total symptom score of ≥0.60; (b) presence of malnutrition using the European Society of Clinical Nutrition and Metabolism diagnostic criteria for malnutrition; or (c) FE concentration &lt;100 μg/gm stool., Conclusions: Pancreatic exocrine insufficiency (PEI) was found to be prevalent in nearly one-fourth of Indian patients with diabetes, using composite diagnostic criteria., (© Journal of the Association of Physicians of India 2011.)

Purpose: The study was conducted to compare the compliance to intravitreal injection treatment and follow-up in patients with center-involving diabetic macular edema (CI-DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center., Methods: A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12., Results: A review of 136 patients treated for CI-DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12-month follow-up, only 29.16% came for a follow-up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non-compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82-1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02-1.29; P = 0.020)., Conclusion: The follow-up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow-up can be improved in people with DME., Competing Interests: None

Background Sexual complications of people with diabetes mellitus (DM) are often neglected by the patients as well as clinicians. The neglect is more in women due to the associated stigma and taboo. Indian studies are scanty, varied and inconsistent, regarding the impact of DM on sexual functioning in women. We studied the patterns and predictors of sexual dysfunction in women with DM. Methods We did a cross-sectional questionnaire-based study comprising 50 participants in both the study (women with DM1 and DM2) and control groups (relatives/caregivers of patients and the hospital staff), selected randomly from the medicine outpatient department from May to August 2016. Approval from the institutional ethics committee was obtained. Clinical anxiety and depression were screened using the hospital anxiety and depression scale. Sexual dysfunction was assessed through female sexual function index scale (FSFI), and predictors were assessed by correlating FSFI scores with sociodemographic and clinical parameters. Results We found that 44% of women with DM had sexual dysfunction compared with 20% in the control group (p<0.01). The pattern of sexual dysfunction was seen across the domains of desire, arousal, lubrication and orgasm. High body mass index, higher age, duration of DM, treatment with insulin and complications of DM predicted a greater degree of sexual dysfunction among women. Conclusion Sexual dysfunction is common in women with DM, irrespective of the type of DM and coexisting psychological factors such as depression and anxiety.

Purpose: The study was conducted to evaluate occurrence of dry eye disease (DED) in type 2 diabetes mellitus (DM) and its association with diabetic retinopathy (DR) in the affected patients in western India., Methods: One hundred and five type 2 diabetic patients referred to a tertiary eye care center were consecutively selected. A detailed systemic history was evaluated. DED was assessed by Ocular Surface Disease Index questionnaire, Schirmer's test, tear breakup time (TBUT), and fluorescein staining of cornea and conjunctiva, graded according to the National Eye Institute workshop grading. All patients underwent detailed fundus evaluation and DR, if present, was graded according to Early Treatment Diabetic Retinopathy (ETDRS) criteria., Results: Prevalence of DED in type 2 diabetics was 43.81% (92/210 eyes). The prevalence and severity of DED was found to be more in patients having higher glycosylated hemoglobin levels (P < 0.0001). Prevalence of DED was found to be high in those not taking any treatment (P < 0.0001). A statistically significant association was found between duration of DM and presence of DED (P = 0.02). Among the patients with DED, a majority had proliferative diabetic retinopathy (PDR; 57/92 eyes, 61.96%)., Conclusion: The study highlights a significant correlation between DED and DM, and hence, examination for DED with fundus examination should be an integral part of the assessment of type 2 diabetics., Competing Interests: None

Ectopic fat deposition is more strongly associated with obesity-related health problems including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), hypothyroidism, arthritis, etc. Our study aimed at identifying the cumulative role of several risk factors in developing obesity and the role of ectopic fat (visceral fat) in predicting cardiovascular disease risk in varied age groups among urban adult academic professionals in West Bengal. 650 adults (Male = 456; Female = 194) associated with the academic job (age 20-65 years) in urban West Bengal were randomly selected for anthropometric, blood biochemical, and questionnaire-based analyses. Body Mass Index and Visceral Fat% exhibited comparable association with all the other anthropometric parameters (e.g. Whole body Subcutaneous fat%: male-Linear Regression Comparison: F = 11.68; P < 0.001; female-F = 6.11; P < 0.01). Therefore, VF% acts as a risk factor alongside BMI in instances where BMI fails alone. The presence of T2DM, hypertension, and hypothyroidism in the case groups confirmed their obesity-associated longitudinal pattern of inheritance. Unhealthy diet pattern indicates improper liver function, vitamin D deficiency, and increased erythrocytic inflammation. An overall sedentary lifestyle with parental history of obesity was found to be significant in the longitudinal transmission of the disease., (© 2023. The Author(s).)

Background: Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factorsObjectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 monthsMethodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the studyInclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)-80-130 mg/dL and postprandial blood sugar (PP2BS) test-&lt;180 mg/dL] over a period of 3 months from the outpatient departmentExclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our studyDetailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p &lt; 0.01). There is a negative correlation between Hb and HbA1c (p &lt; 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p &lt; 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of &lt;0.01)Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia., (© Journal of the Association of Physicians of India 2011.)

In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians., Competing Interests: Conflict of interest Raman Puri: Boehringer Ingelheim, Novartis Vimal Mehta: Institutional research grants from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, LIB Therapeutics, Novo Nordisk, Torrent P Barton Duell: Advisory activities: Akcea/Ionis, Esperion, Novo Nordisk, Regeneron, Kaneka. Institutional grants: Regeneron, Regenxbio, Retrophin/Travere V Mohan: Research or educational grants from Abbott, AstraZeneca, Boehringer Ingelheim, Dr. Reddy's Lab, Johnson and Johnson, Lifescan, MSD, Novartis, Novo Nordisk, Roche Diabetes Care India Private Ltd, Sanofi-Aventis, USV, other Indian pharmaceutical companies S. S. Iyengar: Dr. Reddy's Lab, Amgen, Emcure, Glenmark, Boehringer Ingelheim, Pfizer, Novartis Vinod Mittal: Boehringer Ingelheim, USV, Cipla, Intas, Emcure, MacLeods S N Narasingan: USV, Novo Nordisk, Eris, Glenmark, Torrent, Boehringer Ingelheim J.B. Chemicals and Pharmaceuticals Nathan D. Wong: Amgen, Amarin, Novartis, Esperion SK Wangnoo: Sanofi- Aventis, Nova Nordisk, Boehringer Ingelheim, Astra Zeneca The other authors report no conflict of interest., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: Baseline knowledge and attitudes regarding diabetic retinopathy (DR) have not been previously reported for type 2 diabetes mellitus adults (T2DM) in Dharavi, one of the largest slums in Mumbai. Furthermore, a pre- and post-intervention survey study regarding this topic has not been conducted to date in Dharavi. This pre- and post-intervention survey study analyzes the impacts of DR counseling sessions administered individually on the knowledge and attitudes of T2DM participants recruited from Dharavi., Methods: Potential subjects (>30 years old) from Dharavi were enrolled by community workers and screened for T2DM. Those with confirmed T2DM were each registered for an individual DR counseling session. A survey was distributed to participants before the counseling session to determine their baseline knowledge and attitudes. The same survey was distributed after the counseling session, and changes in pre- and post-survey responses were analyzed., Results: Exactly 1718 T2DM study participants were given pre- and post-surveys. Before the counseling, T2DM participants showed low baseline knowledge and attitudes regarding DR, with only 30.8% (530/1718) participants being aware that diabetes can affect the eye. Participants showed significant improvements after the counseling session, with more participants showing willingness to attend DR screenings (pre: 38.3.%, post: 56.8%; P < 0.0001) and more becoming aware that diabetes can affect the eye (90.4%, 1553/1718; P < 0.0001)., Conclusion: Targeted educational interventions for T2DM individuals from the slums of western India, such as Dharavi, can lead to significant improvements in knowledge and attitudes, representing a promising avenue in tackling the burden of avoidable blindness caused by DR in India., Competing Interests: None

Purpose: Diabetes-related retinopathy is the leading cause of blindness in India. The study was carried out with the purpose of studying the association of sight-threatening diabetic retinopathy (STDR) with socioeconomic factors and demonstrating the impact of STDR on the affected individual., Methods: A mixed methods (quantitative and qualitative) research design was used. The study participants were divided into two groups for quantitative analysis. The control group consisted of non-sight-threatening diabetic retinopathy, whereas the study group consisted of sight-threatening diabetic retinopathy. Apart from demographics, data on comorbidities, type and duration of diabetes mellitus (DM), health insurance status, and socioeconomic data were collected from each individual. A statistical test (Chi-square) was performed to study the association between socioeconomic (SE) classes and STDR. For the qualitative part, a few people were chosen. Face-to-face interviews were conducted in depth., Results: A total of 207 individuals, were recruited, of which 69 had STDR and the remaining 138 had non-STDR. The incidence of STDR was high among patients with lower socioeconomic class (SEC) (upper lower and lower), and univariate analysis revealed a strong association between STDR and SEC, the presence of comorbidities, presence of health insurance, type and duration of DM, and P value <0.05. SEC, in contrast, emerged as an independent risk factor for STDR in multivariate analysis. STDR had a devastating effect on all patients interviewed. The financial impact was most likely the most severe., Conclusion: People with lower SEC are more likely to suffer from STDR-related vision loss. The impact of such vision loss on individuals is multifaceted, including a negative impact on social and work life, psychological well-being, and, most importantly, a significant financial impact., Competing Interests: None

Introduction: As per the World Health Organization, in 2005, more than 180 million people had diabetes worldwide. This figure will be more than double by 2030. Neuropathy is common and late complication of diabetes mellitus (DM). Sensory neural hearing loss which is severe at higher frequencies has been reported in Type 2 DM patients. Auditory nerve tract damage increases the latency and reduces the amplitude of the response. Evoked potential recordings evaluate the neural pathways in the central nervous system. Brainstem auditory evoked potentials (BAEP) localize anatomic structures using different waves and detect acoustic and central neuropathy (CN). Hence, brainstem evoked response of audiometry (BERA) is used widely in clinical set up., Aims: Primary: 1. To record BERA waves in normal subjects with normal blood sugar levels (hemoglobin A 1 C [HbA1C] <5.4. 2. To record BERA waves in Type 2 DM patients. (HbA1C >6.5)., Secondary: To study the BERA parameters with the normal subjects with blood sugar subjects and compare them with Type 2 DM patients., Materials and Methods: n = 30, Type 2 DM patients between the age of 35-50 years of either sex were chosen from the Diabetic Clinic of GMC, Aurangabad, Maharashtra. HbA 1 C test for glycemic control and BERA waves to assess CN were recorded. n = 30 normal subjects with normal blood sugar with age and sex-matched above tests were performed., Statistical Analysis: Unpaired Student's t-test., Results: Mean ± Standard deviation of the absolute latency and interpeak latency of BERA waves at 2, 4, and 6 KHz at 80 dB in Type 2 DM patients were delayed and found to be significant as compared to control group., Conclusion: The above study explains that if BAEP is recorded at higher frequencies like 6 KHz and at 80 dB, CN involvement can be detected earlier in diabetic patients. Hence, it is recommended to carry out BERA in diabetic patients at least once in a year., Competing Interests: None

Introduction: Metabolic syndrome (Syndrome X, insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease and diabetes mellitus. Serum uric acid and end product of purine metabolism, has been shown to be associated with an increased risk of hypertension, cardiovascular disorder and chronic kidney disease. Excess of intra abdominal or visceral adipose and not the amount of subcutaneous abdominal fat which is the key correlate of the metabolic abnormalities observed in overweight/obese patients. It is well documented that high level of insulin are associated with elevated "connecting peptide"(c-peptide) levels as both are produced in equimolar Amounts since metabolic syndrome is a well established major risk factor preceding the onset of type 2 diabetes mellitus, pre and post prandial c peptide and itís correlation with serum uric acid further strengthens this understanding and may help take preventive measures to delay/reverse the onset of type 2 diabetes mellitus., Materials: This is a cross sectional study conducted on 60 patients with metabolic syndrome satisfying inclusion and exclusion criteria admitted in hospitals attached to Bangalore Medical College & Research Institute. All necessary investigations were done. The patients with other co-morbid condition that could affect nutritional status (diabetes mellitus, sepis, congestive heart failure, cancer) and pregnant females were excluded. Anthropometric measures, biochemical parameters were used for correlation with fasting c-peptide and post prandial c-peptide with serum uric acid in metabolic syndrome., Result: Patients with metabolic syndrome We can observe that the Blood urea level showed positive correlation with uric acid level (p value 0.276), uric acid showed positive correlation with fasting c-peptide (p value 0.001) and post prandial c-peptide with (p value &lt; 0.023), very low density lipoprotein showed positive correlation with post prandial c-peptide (p value &lt; 0.022), very low density lipoprotein showed positive correlation with uric acid (p value&lt; 0.002) triglyceride showed postive correlation with uric acid (p value &lt; 0.001,) body mass index showed positive correlation with post prandial c peptide (p value &lt; 0.002), body mass index showed positive correlation with uric acid (p value &lt; 0.006)., Conclusion: Patients diagnosed as Metabolic syndrome after clinical, biochemical and anthropometric findings should be investigated for c-peptide in them which can be used as additional diagnosis factor in metabolic syndrome post prandial cpeptide being a better investigation when compared to fasting c-peptide. References Iliesiu A, Campeanu A, Dusceac D. Serum uric acid and cardiovascular disease. Maedica (Bucur) 2021;5(3):186-192. Abdullah A, Hasan H, Raigangar V, et al. C-Peptide versus insulin: relationships with risk biomarkers of cardiovascular disease in metabolic syndrome in young arab females. Int J Endocrinol 2012;2012:420792., (© Journal of the Association of Physicians of India 2011.)

Background: Diabetes has a negative impact on patient's quality of life (QoL). Comorbidities and polypharmacy further worsen their QoL. Thus, in addition to glycemic control, assessment of QoL is also gaining importance., Objective: The objective of this study was to evaluate QoL in patients of type 2 diabetes mellitus (T2DM) with hypertension after add-on empagliflozin to triple drug therapy (metformin, teneligliptin, and glimepiride)., Materials and Methods: A prospective research was done on T2DM patients with hypertension, who visited a tertiary care referral institute's endocrine outpatient clinic. For 3 months, empagliflozin, 25 mg once daily, was administered as an add-on treatment with metformin, teneligliptin, and glimepiride. In addition to clinical assessment, an Urdu-translated QoL instrument for Indian diabetes patients was used to conduct QoL study. The QoL outcomes prior to empagliflozin add-on were compared with those obtained at the conclusion of the 3 months of treatment., Results: Empagliflozin as an add-on therapy significantly improved various aspects of QoL like role limitation due to physical health, physical endurance, general health, symptom botherness, financial worries, emotional/mental health, and diet satisfaction (P < 0.001). It also improved glycemic and blood pressure parameters significantly., Conclusion: QoL is an essential measure with respect to patient-centered treatment approach. Empagliflozin, as an add-on medication, improved QoL, glycemic parameters and blood pressure in T2DM patients with hypertension. It can be recommended as an add-on, but more research with a larger sample size is required., Competing Interests: None

Aim: To assess the a) prevalence, b) factors associated, and c) effect on self-care practices (SCP) of diabetes related distress (DRD) among patients with Type 2 Diabetes Mellitus (T2DM) in rural Punjab, India., Methods: Amongst the cohort of 700 patients, the Diabetes Distress Scale-17 (DDS-17) was used to assess DRD and the Summary of Diabetes Self Care Activities scale (SDSCA) for diabetes SCP. Multivariable logistic regression identified the factors associated with DRD., Results: DRD was universal [severe or moderate in 391 (56%) and 309 (44%) patients, respectively]. Hypertension increased the odds of severe DRD [aOR 3.47; 95% CI:2.48-4.87, p-<0.01] whereas living in a joint family reduced the odds of severe DRD [aOR 0.68; 95% CI: 0.47-0.97, p- 0.03]. Patients with severe DRD were less likely to perform DM SCPs [aOR 0.53; 95% CI:0.32-0.85, p-0.01]., Conclusions: The burden of DRD was alarmingly high. There is an urgent need to screen, prevent and treat DRD to improve selfcare in T2DM., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To determine the associations of predominant peripheral lesions (PPLs) with systemic comorbidities in individuals with diabetic retinopathy., Methods: This is a multicenter cross-sectional observational study conducted across three tertiary eye care centers in south India between January 2019 and July 2021. Ultra-widefield fundus images of consecutive patients with varying severity of diabetic retinopathy with data on systemic comorbidities were classified based on the presence or absence of PPL. Systemic comorbidities (hypertension, diabetic kidney disease, coronary artery disease, dyslipidemia, and anemia) were compared between the two groups., Results: A total of 879 participants (70.1% males) were included in the study, of which 443 (50.4%) patients had PPL. The mean age of the study participants was 56 ± 10 years, mean age of onset of diabetes was 41.24 ± 11.6 years, and mean duration of diabetes was 15.39 ± 7.6 years. The number of PPL increased with increasing severity of DR. Of all the systemic comorbidities analyzed, we found that coronary artery disease (CAD) had a significant association with PPL (Odds ratio [OR]-1.69; 95% confidence interval [CI], 1.12-2.55; P = 0.013) after adjusting for diabetic retinopathy severity, duration of diabetes, and age of onset of diabetes., Conclusion: The presence of PPL is a marker for coronary artery disease and early referral to cardiology is warranted., Competing Interests: None

Introduction: Hypertension is highly prevalent in patients with type II diabetes mellitus. India has some of the highest rates of diabetes and hypertension worldwide, but there is a lack of local data on the coexistence of these two risk factors. This study determined the prevalence of hypertension in patients with, or at high risk of, type II diabetes mellitus from across India., Methods: Data came from a nationwide trial evaluating the effects of yoga-based lifestyle modification for the prevention/management of type II diabetes. Participants were recruited based on randomized house-to-house screening in urban and rural areas from 65 districts of 29 states/union territories. Eligible individuals were aged 20-80 years and had diabetes or were at high risk of diabetes (IDRS ≥ 60). Anthropometric and demographic data were obtained, and resting blood pressure and blood glucose levels were recorded., Results: This analysis included data from 14,135 individuals. Of these, 25% had self-reported diabetes, 19% were diagnosed with diabetes during the trial, and 26.8% were at high risk for type II diabetes. In these three patient groups, hypertension prevalence rates were 58%, 41.0%, and 35.8%, respectively. The prevalence of hypertension was highest in the North East region and lowest in the North West., Conclusion: The high prevalence of hypertension in patients with, or at risk of diabetes, highlights the urgent need for policies to manage this population, who are at high risk of cardiovascular disease and death., (© Journal of the Association of Physicians of India 2011.)

Background: People living with HIV have greater diabetes (T2DM) than the general population despite lower prevalence of overweight/obesity. Both insulin resistance (IR), a T2DM precursor, and HIV are independently associated with chronic inflammation. Inflammation may be a pathophysiological link explaining IR in people living with HIV who are not overweight but is not well understood., Aims: To study the association between inflammation and IR in non-overweight and overweight people living with HIV., Methods: In a cohort of adult people living with HIV with undetectable viral load in Pune, India, we measured fasting insulin, glucose, and 9 inflammatory markers. IR was defined as HOMA-IR ≥2, and non-overweight as BMI ≤23 kg/m 2 . We used modified Poisson regression to evaluate the association between inflammatory markers and IR in overweight and non-overweight., Results: Of 288 participants, 66% (n = 189) were non-overweight. Among non-overweight, prevalence of IR was 34% (n = 65). Each doubling of MCP-1 and leptin was associated with IR on univariate analysis (prevalence ratio (PR) 1.29, 95%CI 1.07-1.53, p < 0.01; PR 1.13 95%CI 1.01-1.26, p = 0.03). Leptin remained associated with IR after adjustment for age, MCP-1, gender, cholesterol, and waist circumference (adjusted PR 1.20 95%CI 1.06-1.36, p < 0.01). Among overweight, prevalence of IR was 69% and no markers were associated with IR., Conclusions: One in 3 non-overweight people living with HIV in India with controlled viremia have IR. Leptin was associated with IR among non-overweight people living with HIV and may provide insight into the pathophysiology of metabolic disease in this population., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A systematic review and meta-analysis were conducted to estimate the prevalence of diabetic retinopathy (DR) in India's urban and rural areas. Medline, Scopus, and ScienceDirect databases were searched for population-based studies published in English between January 1990 and April 2021, wherein the prevalence of DR among Indian residents with type 2 diabetes mellitus (DM) was reported. A random-effects model was used to estimate the overall, rural, and urban prevalence. Data from 10 eligible studies were aggregated for meta-analysis. The prevalence of DR was 17.44% (95% confidence interval [CI], 14.33-20.55) in urban and 14.00% (95% CI: 9.13-18.86) in rural population (P = 0.24). The overall DR prevalence was 16.10% (95% CI: 13.16-24.32), and the population prevalence was 1.63% [95% CI: 0.94-2.32]. Prevalence of DR in people with diabetes was lower in the age group of 40-49 years [13.57% (95% CI: 7.16-19.98)] than in the age group of 50-59 years [16.72% (95% CI: 12.80-20.64)] and the age group of 60 years and above [16.55% (95% CI: 12.09-21.00)]. Variability in studies was high: urban (I 2 = 88.90%); rural (I 2 = 92.14%). Pooled estimates indicate a narrow difference in DR prevalence among people with diabetes in rural and urban India. The fast urbanization and increasing diabetes prevalence in rural areas underscore the need for providing equitable eye care at the bottom of the health pyramid., Competing Interests: None

Diabetes mellitus (DM) is a clinical syndrome associated with deficiency of insulin secretion or action. It is considered one of the largest emerging threats to health in the 21st century. Besides the classical complications of the disease, DM has been associated with reduced response of T cells, neutrophil function, and disorders of humoral immunity. Consequently, DM increases the susceptibility to infections, both the most common ones as well as those that almost always affect only people with DM (e.g. rhinocerebral mucormycosis). The present study was done with an objective to study the infections in type 2 Diabetes Mellitus., Material: The study was conducted in Padmashri DY Patil Hospital and Research centre, Pimpri, Pune from Sept 2020 to Aug 2021. A total of 100 patients of Type 2 Diabetes Mellitus were included and their infections associated with type 2 Diabetes Mellitus were studied., Observation: Infections associated with Diabetes Mellitus were Urinary Tract Infections, Dental caries, Skin infections like Tinea, Carbuncle and furuncle, Pneumonia, Emphysematous pyelonephritis, Diabetic foot., Conclusion: The results of present study showed that many patients with Diabetes Mellitus is associated with urinary tract infections. This was corresponding with studies conducted by Ludwig E. The most common infections associated with type 2 Diabetes Mellitus were Urinary Tract Infections, Skin infections, Pneumonia, Emphysematous pyelonephritis, Diabetic foot., (© Journal of the Association of Physicians of India 2011.)

Carotid atherosclerosis is increased 3 fold in people with DM. Several theories have been proposed that increased Urinary Albumin Excretion Rate (UAER) is associated with impairment of endothelial function leading to atherosclerosis. Calf circumference is considered a surrogate marker of lean mass. Visceral fat gene expression is considered more proatherogenic than subcutaneous adipocytes. It is newly proposed that waist-to-calf circumference ratio(WCR) is one of the best anthropometric measures indicative of carotid atherosclerosis., Material: This cross sectional study was conducted in the hospitals attached to Bangalore medical college and research institute. Relevant history taken, clinical examination and laboratory investigations was done on 140 patients of type 2 diabetes mellitus, correlation of waist-calf ratio and urine albumin creatinine ratio(UACR) with carotid intima media thickness (CIMT) was done in these individuals. Chi square/Fischer exact test has been used to find the significance of study parameters on categorical scale between 2 or more groups. Pearson correlation between study variables is performed to find the degree if relationship., Observation: Among 140 patients in our study 86 were females and 54 were males with mean age 54.05+/- 11.29 years. Mean +=- SD of HbA1c was 9.04+/- 2.67. Mean +/- SD of WCR was 3.09+/- 0.32. It was observed that 48, 65 and 27 patients were having normoalbuminuria, microalbuminuria and macroalbuminuria respectively. Mean avg CIMT was 0.78+/- 0.075. Pearon's correlation coefficient used in our study was showing strong positive correlation between WCR and CIMT (0.841) and also between UACR and CIMT. There was a linear correlation between WCR and UACR with CIMT and the correlation was statistically significant P value &lt;0.001., Conclusion: Cardiovascular complications are an important cause of mortality and morbidity in type 2 DM. Screening of all diabetics for carotid atherosclerosis by carotid ultrasonography is cumbersome and not cost effective. Hence simple anthropometric measurements of body fat distribution like WCR can be used when assessing vascular risk profile. Microalbuminuria now-a-days is considered to be an atherosclerosis risk factor and predicts future cardiovascular complications in diabetic patients. In our study, it was found that WCR and UACR were strongly positively correlated with carotid atherosclerosis as measured by CIMT., (© Journal of the Association of Physicians of India 2011.)

Background: To estimate the prevalence of optical coherence tomography (OCT)-defined diabetic macular oedema (DME) in urban South Indian population and to elucidate their associated risk factors., Methods: Of 911 participants from the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study-II (SN-DREAMS-), 759 who underwent OCT were analysed. The participants underwent a comprehensive examination and retinal photography following a standard protocol for diabetic retinopathy (DR) grading. The subjects were categorized into centre-involving DME (CI-DME), non-centre involving DME (NCI-DME), and No-DME based on the mean retinal thickness at the central 1 mm, inner and outer ETDRS subfields., Results: The prevalence of CI-DME and NCI-DME in the Chennai population was 3.03% (95% CI: 3.01-3.05) and 10.80% (95% CI: 10.7-11.02). NCI-DME was found to be higher by 9.5% (95% CI: 0.07-0.11) in the early stages of DR. A greater number of subjects with CI DME were aged >60 years and had diabetes mellitus (DM) for >10 years. The significant risk factors for NCI-DME are diastolic blood pressure, serum total cholesterol, serum triglyceride, insulin use and neuropathy (OR (95% CI): 0.97 (0.94-100), 1.00 (1.00-1.01), 0.99 (0.98-0.99), 2.32 (1.15-4.68) and 4.24 (1.22-14.69), respectively) and for CI DME are duration of diabetes, anaemia, neuropathy and insulin use (OR (95% CI): 2.49 (0.96-6.40), 3.41 (1.34-8.65), 10.58 (1.68-66.56) and 3.51 (1.12-10.95), respectively)., Conclusions: The prevalence of NCI-DME was found to be higher than that of CI-DME in patients with DR.

Objective: Type 2 diabetes mellitus (T2DM) and hypertension commonly coexist; however, underlying primary aldosteronism (PA) can lead to worsening of hypertension, glycemia and cardiovascular risk. We aim to screen patients with T2DM and hypertension for PA by conducting a prospective monocentric study from Western India, which included adults with T2DM and hypertension from the outpatient diabetes clinic., Design: Prospective study., Patients and Measurements: Patients with an aldosterone renin ratio of ≥1.6 ng/dl/µIU/ml with plasma aldosterone concentration (PAC) ≥ 10 ng/dl were considered to be positive on a screening test. A PAC ≥ 6 ng/dl on seated saline suppression test (SST) was used to confirm the diagnosis of PA., Results: Four hundred and eighty-six patients were included in this study. Seventy-six (15.6%, 95% confidence interval [CI]: 12.7%-19.1%) patients had a positive screening test with positive confirmatory test in 20 of the 36 (55.5%, 95% CI: 39.3%-71.7%) screen-positive patients who underwent SST. Patients with positive screening test had a higher proportion of females (65.8% vs. 50%; p = .011), frequent history of hypertensive crises (21.1% vs. 8%; p = .001), uncontrolled blood pressure (51.3% vs. 34.6%; p = .006), diagnosis of hypertension before diabetes (32.9% vs. 21.7%; p = .035) and higher systolic (137.6 ± 6.9 vs. 131.2 ± 17.8 mmHg; p = .004) and diastolic (85.3 ± 11.1 vs. 81.7 ± 10.7 mmHg; p = .007) blood pressures. Patients with positive confirmatory test had longer duration of diabetes (108 [60-162] vs. 42 [24-87] months; p = .012), hypertension (84 [42-153] vs. 36 [15-81] months; p = .038) and higher creatinine (1.16 [1.02-1.42] vs. 0.95 [0.84-1.12] mg/dl; p = .021)., Conclusions: PA is prevalent (at least 4.1%) in Asian Indian patients with T2DM and hypertension. Further studies are needed to assess the cost-effectiveness of routine screening., (© 2021 John Wiley & Sons Ltd.)

Diabetes mellitus (DM) is a chronic metabolic disease with debilitating complications. Diabetic Patients should follow self-care activities like healthy diet, physical activity, self-monitoring of blood glucose, treatment compliance in order to achieve good glycaemic control, control the progression of the disease, reduce complications, and quality of life improvement. We aimed to assess the effect of diabetes self-management education program on HbA1c levels in patients with diabetes., Material: The present study was conducted at a tertiary care centre in central Rajasthan after written consent. Adults with 18 years and above age with Diabetes were included. Patients who refused to give consent, critically ill patients, pregnant females, patients with severe cognitive impairment and whose HbA1c targets were achieved were excluded. It was an open label randomised control study. Simple randomization was done. Cases were then provided with Diabetes self-management education (DSME). The information was provided in local language. One twenty patients were studied during the period from 01/12/2020 to 1/12/2021. All patients underwent complete history taking, physical examination, routine laboratory examination and HbA1c levels. After providing the cases with DSME, all patients were followed up at 6 months. HbA1c level was measured again at 6 months. Pre and post test data of both control and intervention arm were collected. Data was analysed using Statistical package for social science (SPSS) software ver. 2021 and student t test and chi square tests were applied., Observation: The mean age of participants was 49.07 years, male patients represented 57.5%. About two-thirds were from urban areas. 59.16% were diabetics for 5-10 years. After the DSME program, there was a statistically significant decrease in HbA1c level in intervention group compared to controls (p value&lt;0.05). 56% used oral hypoglycaemic agents, 24% used insulin and 20% used combination therapy of oral hypoglycaemic agents and insulin. Hypertension was the most common co-morbidity followed by dyslipidaemia among patients. There was no significant difference in age, gender and duration of diabetes between the two groups., Discussion: DSME plays a significant role in enabling patients to undertake self-management activities to combat their diabetes-related complications and potential premature deaths., Conclusion: DSME may prevent the onset and the progression of diabetic complications. It is important and promising to raise the self-management capacity of Type 2 Diabetes mellitus patients in low-resource settings., (© Journal of the Association of Physicians of India 2011.)

Background: Type 2 diabetes mellitus (T2DM) worldwide continues to increase, in particular in India. Early T2DM diagnosis followed by appropriate management will result in more cardiovascular event free life years. However, knowledge of the cardiovascular profile of newly diagnosed T2DM patients is still limited. The aim of this study was to understand the extent of cardiovascular disease (CVD) risk of newly diagnosed T2DM patients in India., Methods: A cross sectional observational study was conducted to evaluate clinical laboratory and socio-demographic parameters of 5,080 newly diagnosed T2DM patients (48.3 ± 12.8 years of age; 36.7% female). In addition, we determined their cardiovascular risk according to the guidelines of the Lipid Association of India (LAI) and the criteria of the QRISK3 score., Results: Of the newly T2DM diagnosed patients in India 2,007(39.5%) were classified as "High risk" and 3,073 (60.5%) were classified as "Very high risk" based on LAI criteria. On average, patients had 1.7 ± 0.9 major atherosclerotic cardiovascular disease (ASCVD) risk factors. Low HDL-C value was the most frequent major risk (2,823; 55.6%) followed by high age (2,502; 49.3%), hypertension (2,141; 42.1%), smoking/tobacco use (1,078; 21.2%) and chronic kidney disease stage 3b or higher (568; 11.2%). In addition, 4,192 (82.5%) patients appeared to have at least one cholesterol abnormality and, if the latest LAI recommendations are applied, 96.5% (4,902) presented with lipid values above recommended targets. Based on the QRISK3 calculation Indian diabetes patients had an average CVD risk of 15.3 ± 12.3%, (12.2 ± 10.1 vs. 17.1 ± 13.5 [p<0.001] for females and males, respectively)., Conclusions: Newly diagnosed Indian T2DM patients are at high ASCVD risk. Our data therefore support the notion that further extension of nationwide ASCVD risk identification programs and prevention strategies to reduce the occurrence of cardiovascular diseases are warranted., Competing Interests: The authors have declared that no competing interests exist.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that has a major impact on health-related quality of life (HRQOL). The economic burden of the disease, along with its complications, negatively impact the individual, family, and society of Indian diabetic patients. This study explored the perception of the diabetic HRQOL of South Indian type2diabetic patients. METHODS: This study was a cross-sectional descriptive quantitative study conducted in a tertiary care hospital in Chennai, Tamil Nadu, South India. Using the simple random sampling technique, we collected data from 352 T2DM patients aged ≥ 30 years of age who were diagnosed for a minimum of one year. Data collection occurred from June to August 2017. Data were analysed using IBM SPSS, Version 22. RESULTS: Overall, 90% of patients with T2DM perceived poor HRQOL. The total and the domainspecific mean scores of HRQOL were high indicating poor HRQOL in energy mobility, diabetes control, anxiety and worry, social burden, and sexual functioning domains. Being female, increasing age, lower education levels, lower family income, and uncontrolled fasting blood glucose levels predicted poor HRQOL of patients with T2DM. CONCLUSIONS: T2DM impacted the HRQOL in all measured domains of participants. A patient-centred approach to diabetes management can be incorporated to improve or enhance the health-related quality of patients' lives. Improved HRQOL also may lead to fewer hospitalizations, and hence, reduce healthcare costs.

Aim: To assess the prevalence of diabetic retinopathy (DR) and associated risk factors in Asian Indians with prediabetes., Methods: In a cross-sectional study conducted at two tertiary care diabetes centres in Chennai, India, clinical and biochemical assessment and nonmydriatic ultra-wide field fundus photography was performed in individuals with prediabetes (impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]) based on oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c) between 5.7% and 6.4% in 2019. The retinal photographs were graded by certified ophthalmologists. Systemic risk factors associated with DR in prediabetes were assessed., Results: The mean age of the 192 individuals with prediabetes was 48 ± 13 years (55.2% were males). DR was present in 12 (6.3%) individuals of which nine (4.7%) had mild non-proliferative DR (NPDR) and three (1.6%) had moderate NPDR. None had severe sight-threatening DR. The Poisson multiple regression analysis showed that after adjusting for other systemic covariates, HbA1c values ≥ 6% (6-6.4%) was associated with 2 times higher relative risk of DR (Risk ratio 1.95 (95% CI 1.07-3.545, p = 0.028) in comparison to HbA1c < 6%)., Conclusion: DR was present in about 6% of the Asian Indians with prediabetes. Higher HbA1c values among individuals with prediabetes was associated with twice the relative risk for DR. Robust control of HbA1c should be encouraged even before the diagnosis of diabetes is established., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)