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BACKGROUND: COVID-19 pandemic has led to an increase in various psychological problems for people in India. AIM: The aim of this research was to assess the psychological impact of COVID-19 on people living with Type 2 Diabetes Mellitus evaluating their stress, anxiety, and depression levels during pandemic. MATERIALS AND METHOD: The study used validated Hindi version of GASS-21 questionnaire, It was handed out to 1143 eligible and consenting patients across eight secondary care centres in Lucknow. RESULTS: The study enrolled 1143 participants and out of that, 8% were depressed, 19% were anxious, and 6% were stressed. The significant psychological drivers were family members who tested positive for COVID 19, death of a first degree family member, post covid infections and vaccination status. Patients who were not vaccinated for COVID were significantly more affected psychologically. CONCLUSION: COVID-19 and associated morbidity and mortality, post covid complications and vaccinations on apprehensions were significantly associated COVID-19 related psychological impacts that were studied.

Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular exercise and lifestyle measures. Exercise is an important strategy in the management of diabetes. Regular exercise is necessary for good Glycaemic control and Metabolic health. Newer methods like WhatsApp-based communication are now finding their way into diabetes care. It can assist to maintain a regular exercise program and reduce blood sugar levels. Materials and Methods: A total of 262 patients were selected by random sampling. They were of age 15-65 years with DM. Inclusion Criteria: 1. Known case of DM 2. Consent to share data. 3. Ability to use WhatsApp. Exclusion criteria: 1. Inability to use WhatsApp 2. Any condition which impairs movement. Randomly allocated to two groups of 131 persons. The first group participants were added to a WhatsApp group and asked to send their exercise and blood glucose data to the clinic over WhatsApp. The other group was treated as usual. Participants were monitored for HBA1C at 3 and 6 months and surveyed for exercise patterns by a questionnaire at 3 and 6 months. The results were analyzed using SPSS. Result: After excluding, 2 dropped patients from both groups remaining 258 patient data shows: HBA1C reduction in the WhatsApp group of 1.9% as compared to 1% in the routine care group. The number of patients achieving the target goal of 7% HBA1C in the WhatsApp group (74%) as compared to the routine group (56%) . 77% of patients in the WhatsApp group did regular exercise as compared to 42% in the routine group. Discussion: With newer modalities, the ways and means to communicate with patients have improved. This has paved way for newer messaging platforms like WhatsApp for better patient-centric communication. These tools if used correctly can reduce in-person follow-ups but increase the connection between caregiver and patients and can result in better patient outcomes and will lead to reduced complications and financial implications. Disclosure B.Saboo: None. A.Shrivastava: None. A.Tewari: None. A.V.Inamdar: None. S.Saboo: None. B.D.Saboo: None.

Introduction: As per the recent International Diabetes Federation (IDF) atlas, there are 537million adults living with diabetes. Indians with the same body mass index (BMI) have higher central adiposity and insulin resistance compared to Caucasians. High insulin resistance in people with diabetes predisposes them to Nonalcoholic Fatty Liver Disease (NAFLD) . TG/HDL ratio is emerging as a sensitive marker of insulin resistance. Liver stiffness measurements predict advanced fibrosis in people with diabetes. The current study aims to correlate TG/HDL ratio and liver stiffness measurements using fibro scans in people with diabetes. Material and Methods: A total of 181 people with diabetes coming for the first time at our center underwent liver stiffness measurements using fibro scans after taking consent, people on prior lipid-lowering therapy and thiazolidinedione therapy were excluded from the study. Results: Median stiffness ranged from 2.3kpa to 34.8kpa (median of 8.0kpa) , TG/ HDL ratio values ranged from 0.5-29.3 (median of 4.5) . Median stiffness, correlated with TG/HDL ratio correlation coefficient, was 0.2 (p 0.01) . Further 26.5% subjects had advanced fibrosis (Liver stiffness measurement (LSM) >9.1) , 23.7% of male subjects and 30% of female subjects had advanced fibrosis. Males and females with LSM >9.1 had high TG/ HDL ratio, mean 4.9 in males (range 2.5-13.7) and 4.9 in females (range 1.0-17) . These values were much higher than TG/HDL values of 0.9 and 1.2 used in females and males respectively, as cutoffs to predict insulin resistance. Discussion: Previous studies have correlated TG/HDL ratio with NAFLD in nondiabetic individuals using ultrasonography. Fibro scan is a more sensitive and specific modality to screen for NAFLD. Median stiffness predicts liver fibrosis. There is a high incidence of advanced fibrosis in the index study, which correlated with TG/HDL ratio. All male and female subjects with advanced fibrosis had a high TG/HDL ratio. Disclosure A.Tewari: None. R.Choudhury: None. V.Tewari: None. J.Tewari: None. B.Saboo: None. A.Shrivastava: None. S.S.Dariya: None. V.Chavda: None. D.Hasnani: None. A.V.Inamdar: None.

Nonalcoholic fatty liver disease (NAFLD) and Type 2 diabetes mellitus (T2DM) are common conditions that often coexist and can act synergistically to cause adverse effects. The presence of both NAFLD and T2DM increases the likelihood of developing diabetes complications (including both macro and microvascular complications), and enhances the risk of cirrhosis, hepatocellular carcinoma and death. NAFLD screening is often neglected in routine clinical practice. Fibro scan is a more sensitive modality for diagnosis of liver fibrosis and scarring. Liver stiffness measurements predict advanced fibrosis in people with diabetes The current study aims to correlate liver stiffness measurements and coronary artery disease risk scores in people with type 2 diabetes in a tertiary care centre Material and Methods: - A total of 181 people with diabetes coming for the first time at our centre underwent liver stiffness measurements using fibro scan after taking consent, people on prior lipid-lowering therapy and thiazolidinedione therapy were excluded from the study. We used the risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes [ https://paperpile.com/c/XKqsdv/PpmxP 1 ] because it was easy to use, specific for Asian population and validated with coronary computed tomographic angiography (CCTA) in asymptomatic people with type 2 diabetes. Out of the total of 181 subjects 51% were males and 49% were females, mean age was 50.2 years, duration of diabetes was 7.6years, Hba1c values ranged from 6. 0%-15%(mean 8.5%), median stiffness ranged from 2.3kpa to 34.8kpa (median of 8. 0kpa).50 out of 181(27.62%) had advanced fibrosis(liver stiffness measurements(LSM values of >9. 0). Advanced fibrosis had a significant(p BIBLIOGRAPHY 1. http://paperpile.com/b/XKqsdv/PpmxP. Park G-M, An H, Lee S-W, Cho Y-R, Gil EH, Her SH, et al. Risk Score Model for the Assessment of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes. Medicine [Internet]. 2015 Jan [cited 2020 Oct 14];94(4): e508. Available from: https://journals.lww.com/md-journal/Fulltext/2015/01040/Risk_Score_Model_for_the_Assessment_of_Coronary.44.aspx Presentation: No date and time listed

Introduction Current evidence demonstrates that people with type 2 diabetes (T2D) are at a higher risk of developing chronic kidney disease (CKD) with greater morbidity and mortality. We, therefore, aimed to document and categorize demographic, anthropometric, and physiological risk factors of CKD in people with T2D in India. Additionally, we also attempted to evaluate the magnitude of each risk factor, namely age, duration of diabetes, HbA1c, and body mass index (BMI) in its etiology. Methods This observational, single-center, and cross-sectional study was performed at a diabetes care center in Lucknow, India. Out of a total of 504 eligible patients, we could get the required data from 435 patients. The following data were collected: demographic data, estimated glomerular filtration rate (eGFR), serum creatinine, urinary albumin creatinine ratio (UACR), and HbA1c levels. Appropriate statistical tests were applied. Result The 435 eligible people with diabetes had a mean age (SD) of 51 (±10.52) years; female 48.02%, duration of diabetes 7 (±5.4) years; HbA1c 8.6 (±2.3)% and eGFR values 80.2 (±26.6) mL/min/1.73m2 at the time of presentation. The eGFR values correlated negatively with age and duration of diabetes, and positively with increasing BMI. The Spearman correlation coefficient showed that clinical parameters such as age, duration of diabetes, and BMI have a weak, but statistically significant correlation with eGFR while eGFR did not correlate with HbA1c level in the study. Further, we did not find a correlation between eGFR and UACR. Conclusion In people with T2D, age and duration of diabetes are important risk factors for the development of CKD based on the eGFR. Hence, even in the absence of high UACR values, a low eGFR should prompt periodic monitoring to reduce the risk of progression of CKD, especially, in older people with long-standing T2D. Our study did not find HbA1c as a suitable tool to assess the CKD progression risk, but historical glycaemic control over longer periods revealed by sequential values of HbA1c over the duration of disease may correlate with the progression of CKD.

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes share a bidirectional relationship. NAFLD can increase the severity of diabetic microvascular and macrovascular complications. Ultrasonography, the most commonly used method of assessment of NAFLD in India, is associated with intra-operator variability and false positives. Transient elastography and Liver Stiffness Measurement (LSM) have emerged as one of the best modalities to screen NAFLD in people with diabetes. Aim: Screening for NAFLD in people with Type 2 Diabetes and its association with age, Body Mass Index (BMI) and duration of diabetes. Materials and Methods: This was a prospective cross-sectional study conducted on patients with known Type 2 Diabetes Mellitus (T2DM) who visited the study center between July 2019 and November 2019 for consultation. A total of 287 people with diabetes were subjected to FibroScan test and LSM was done. The other variables-age, gender, duration of diabetes, height, weight, BMI and HbA1c were recorded for all subjects and the collected data was correlated using Spearman rho test. Results: The study population included 61% males and 39% females. The mean age was 46.96 years and the mean duration of diabetes was 10.98 years. The mean Glycated haemoglobin (HbA1c) value was 9.28%. The median value of LSM by M probe was 7.16. Out of the total, 78 (27.2%) were identified with advanced fibrosis with LSM >9.6. Advanced fibrosis was strongly correlated with HbA1c (r=0.820), age (r=0.562) and duration of diabetes (r=0.596) and moderately with BMI (r=0.375). Conclusion: The screening of people with type 2 diabetes for NAFLD using LSM revealed 27.2% subjects with advanced fibrosis, it correlated positively with age, BMI and duration of diabetes.

Coronavirus disease (COVID-19) is an infectious disease caused by the newly discovered SARS-COV-2. Older people and people with pre-existing medical conditions, such as diabetes and obesity, appear to have the worst outcomes with the COVID-19 virus. In response to the COVID-19 pandemic, many countries enforced stringent lockdowns to prevent the spread of the disease. India had a lockdown of 68 days between 21st March and 31st May 2020. In this background, we undertook this study to assess the effect of the lockdown on the glycemic status and weight of people with diabetes, which was indirectly an opportunity to assess the self-care practices of people with diabetes. Material and Methods: The subjects included in the study were people with type 2 diabetes identified from electronic medical records who had attended the Jai Clinic and Diabetes Care Centre in Lucknow and were tested for HbA1c between 20th Feb 2020 and 20th March 2020. A total of 313 people with diabetes were identified meeting the inclusion criteria, out of which 171 were females and 142 were males. They were again tested for HbA1c between 1st June 2020 and 1st July 2020 after lockdown. Their pre- and post-lockdown HbA1c and weight were analyzed statistically. Results: HbA1c was increased in 195 patients, which was statistically significant. A total of 151 patients had an increase in weight compared to their prelockdown weights, but it was not statistically significant. Furthermore, an increase in weight correlated with an increase in HbA1c and a decrease in weight correlated with a decrease in HbA1c. Both were statistically significant. Conclusion: Optimum diabetes control and adherence to good self-care practices is the need of hour, and contingency plans for medicines and diabetes care supplies are of utmost importance in these testing times.

Introduction: Erectile dysfunction (ED) is an important complication of diabetes which is under-reported with well known association with CAD. ED is also considered as one of the earliest markers of endothelial dysfunction. Material and Method: 458 sexually active males of age >18 Years, with diabetes were enrolled. The English and Hindi (regional language) translated version of The International Index of Erectile Function (IIEF) Questionnaire was used. Subjects were to respond to IIEF based on their subjective feeling related to ED, Orgasmic function, Sexual desire, Intercourse satisfaction and overall satisfaction in past 4 weeks. Study was conducted from August 2018 to April 2019 at 11 centers of a large metropolitan city, Lucknow in North India after ethics committee approval. Result: Mean age of the patients was 47.64 years (±9.59), weight 74.6 Kg (± 13.2) BMI 26.8 Kg/M2 (±3.97) and abdominal circumference 97.06cm (±10.79). The prevalence of ED and Orgasmic function defect (OFD) was found to be 32% and 43.8% respectively.27.8% had both and 48.4% either ED or OFD. ED was found to be significantly associated with age (p=0.0006), duration of diabetes (p=0.0101), age of onset of diabetes (p=0.0096), macrovascular complications (p=0.0032), serum creatinine (p=0.0141) and use of beta blocker (p=0.032). ED was not significantly associated with hypertension (p=0.091), hypoglycaemia (p=0.2066), HbA1c (p=0.305), statin (p=0.2044), mean platelet volume (p=0.5822) and microvascular complications of diabetes (p=0.0865). Conclusion: ED was present in nearly one third subjects with diabetes. Nearly half subjects have ED/OFD. Patients with longer duration of diabetes, higher age and with macrovascular complications should proactively be asked about their sexual function and an objective assessment should be done with IIEF questionnaire to unearth this complication. These subjects should be considered for other macrovascular complication screening. Disclosure M. Gupta: None. K. Chandra: None. A. Pande: None. R. Awasthi: None. A. Tewari: None. V. Agarwal: None. D. Kumar: None. N.R. Gupta: None. S.K. Chaubey: None. S. Chowdhary: None. M.S. Ansari: None.

Cardiovascular disease is the biggest driver of mortality in people with diabetes. Cardiovascular disease and diabetes share the same risk factors, the so-called “common soil” hypothesis. Asians and more specifically Indians are predisposed to cardiovascular disease, that too at an earlier age. The cost of management of cardiovascular disease in India is prohibitive. Thus, screening for asymptomatic coronary artery disease in people with type 2 diabetes and referring them for further evaluation will go a long way in preventing cardiovascular mortality. 560 consenting previously diagnosed people with type 2 diabetes, undergoing treatment for type 2 diabetes at our center, were recruited in the study. We used the risk score model for the assessment of coronary artery disease in asymptomatic patients with type 2 diabetes (1) because it was easy to use, specific for Asian population and validated with coronary computed tomographic angiography in asymptomatic people with type 2 diabetes. Questions regarding smoking, past history of stroke and duration of diabetes were recorded as per the risk score and accordingly the subjects were labelled low, intermediate and high risk. Anthropometric measurements were recorded, lipid profile was measured, neuropathy assessment was done using the DNS score. Results: 48.9%subjects were females,51.1% were males, mean duration of diabetes was 3.5 years, mean HbA1c was 8.5%, mean BMI 26.5kg/m2, mean age was 51.4 years, mean CAD score was 4.1 44.2% of the subjects were in a low risk category, 44.9% were in the intermediate risk category and 10.9% in the high-risk category. The maximum people had intermediate to high risk and were in the age group of 50–60 years (21.3%), followed by 13% in the 60–70 age group. Surprisingly, 12.6% people in the 40-50year age group had an intermediate to high risk score for ASCVD. The high prevalence of intermediate to high risk in relatively younger populations with shorter duration of diabetes (mean duration of diabetes 3.5 years) mandates universal screening for asymptomatic coronary artery disease in all people with type 2 diabetes mellitus. Our study highlights the importance of identifying asymptomatic coronary artery disease using locally relevant risk models and their timely referral to prevent excessive cardiovascular mortality in people with type 2 diabetes mellitus. This would ensure optimum utilization and prioritization of scarce resources in resource crunch situations. Keywords: Screening, asymptomatic CAD, type 2 diabetes mellitus. References: 1. Park G-M, An H, Lee S-W, Cho Y-R, Gil EH, Her SH, et al. Risk Score Model for the Assessment of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes. Medicine [Internet]. 2015 Jan [cited 2020 Oct 14];94(4):e508. Available from: https://journals.lww.com/md-journal/Fulltext/2015/01040/Risk_Score_Model_for_the_Assessment_of_Coronary.44.aspx

Objective To investigate the histological and histochemical changes in placenta of diabetic pregnant females and compare them with normal placenta. Methods The histological and histochemical features of 60 placenta, 30 obtained from normal pregnant females and 30 from diabetic pregnant females, were studied. These placenta were obtained from Department of Obstetrics and Gynaecology, GSVM Medical College Kanpur and ERA's Lucknow Medical College and Hospital Lucknow. Results On histological examination, the diabetic placenta showed increased syncytial knots, fibrinoid necrosis, trophoblastic basement membrane thickening, villous stromal fibrosis, villous oedema, crowding of villi, thickening of vessel wall and fibrin deposition. On histochemical study it was found that the PAS reactivity was stronger in diabetic placenta as compared to normal. Sudan Black reactivity was higher among diabetic placenta in comparison to normal placenta. Conclusions It is concluded that distinct histological and histochemical changes could be seen in placenta of diabetic pregnant females.

The World Health Organization has declared tuberculosis a global emergency in 1993. It has been estimated that one third of the world population is infected with Mycobacterium tuberculosis, the causative agent of tuberculosis. The emergence of TB/HIV co-infection poses an additional challenge for the control of tuberculosis throughout the world. The World Health Organization is supporting many developing countries to eradicate tuberculosis. It is an agony that one fifth of the tuberculosis patients worldwide are in India. The eradication of tuberculosis is the greatest public health challenge for this developing country. The aim of the present population based study on Mycobacterium tuberculosis is to test a large set of tuberculosis cases for the presence of statistically significant geographical clusters. A spatial scan statistic is used to identify purely spatial and space-time clusters of tuberculosis. Significant (p < 0.05 for primary clusters and p < 0.1 for secondary clusters) high rate spatial and space-time clusters were identified in three areas of the district. There is sufficient evidence about the existence of statistically significant tuberculosis clusters in Almora district of Uttaranchal, India. The spatial scan statistics methodology used in this study has a potential use in surveillance of tuberculosis for detecting the true clusters of the disease.

Objective: To investigate the presence of statistically significant geographical clusters of tuberculosis (TB) using Geographical Information System and spatial scan statistics in Dehradun, India. Methods: The spatial scan statistic implemented with a software program, SaTScan v6.1, was used to test the presence of statistically significant spatial clusters of TB and to identify their approximate locations (P＜0.05 for primary clusters and P＜0.1 for secondary clusters). Geographical Information System was used for geographical analysis. Results: Significant high rate spatial clusters were identified in seven wards of the Dehradun Municipal area. Conclusions: There is sufficient evidence about the existence of statistically significant TB clusters in seven wards of Dehradun, India. The purely spatial scan statistics methodology used in this study has a potential use in surveillance of TB for detecting the true clusters of the disease.