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OBJECTIVE Reduction of atherosclerotic cardiovascular disease (ASCVD) risk in patients with diabetes requires proper management of lipid parameters. This study aimed to find the pattern of dyslipidemia and scope of ASCVD risk reduction in patients with diabetes by lipid management. METHODS Clinical, biochemical, and medication profiles of all patients with diabetes attending a tertiary diabetes care hospital over a 2-year period were collected. The prevalence of various lipid abnormalities was determined after excluding patients with thyroid dysfunction and those on lipid-lowering medications. Patients were stratified according to LDL cholesterol, HDL cholesterol, and triglyceride levels, and other clinical parameters were compared among the groups. The adequacy of statin treatment was assessed based on American Diabetes Association guidelines. RESULTS Nine hundred and seventy-one patients were included. The prevalence of hyperlipidemia was 40.0%, of whom 14.6% were newly diagnosed. The most common lipid abnormality was elevated LDL cholesterol. Higher A1C and fasting blood glucose values were found to be associated with higher LDL cholesterol levels. Twenty-seven percent of patients with indications for treatment with statins were receiving them. Of those being treated with statins, 42.6% had an LDL cholesterol level ≥100 mg/dL. CONCLUSION In South Indian patients with type 2 diabetes and fair glycemic control, high LDL cholesterol is the predominant lipid abnormality. There remains a huge potential for ASCVD risk reduction in this population if the knowledge practice gap is addressed.

Studies on thyroid disorders in type 2 diabetes mellitus (DM) are fewer than those in type 1 diabetes, but data from different parts of the world have shown conflicting results. To look at the prevalence of thyroid disorders in type 2 DM and nondiabetic controls separately in a community cohort and a hospital cohort from the same locality in South India. Thyroid function tests and thyroid autoantibodies were done in 986 people in the community (258 diabetics and 634 nondiabetics). In the hospital cohort of 194 people (147 diabetics and 47 nondiabetics), an ultrasonography of the neck was done in addition. Thyroid dysfunction was more common in the community compared to the hospital cohort 15.9 vs 9.6% but there was no difference in the proportion of people with thyroid dysfunction in diabetics and nondiabetics in both the community and the hospital cohorts. (15.6 vs 16.2% in the community and 9.6 vs 6.3% in the hospital in diabetics and nondiabetics respectively). Clinical goiter and sonographically detected goiter were also similar in diabetics and nondiabetics in the community and the hospital cohorts respectively. Females had more prevalence of goiter irrespective of the presence of diabetes. Commonest thyroid dysfunction was hypothyroidism and subclinical hypothyroidism in both cohorts. This unique study conducted in a community and hospital cohort from the same locality showed that the prevalence of thyroid disorders is similar in type 2 diabetic and nondiabetic subjects in our population.

In the original manuscript, the Figure 2 a-i is inadvertently repeated as Figure 2 a-ii. This mistake has been rectified and the corrected Figure 2 is presented below.

In the original manuscript, the Fig. 7, the in vitro cellular uptake studies of rhodamine 123 conjugated TCS-NPs in L929 (a–f) and MCF7 (m–r) were provided incorrectly. Now we have provided the correct cellular uptake images of rhodamine 123 conjugated TCS-NPs in L929 (a–f) and MCF7 (m–r) and the corrected Fig. 7 is presented below. In addition, incorrect scale bars were given for the NIH3T3 cells (g–l) in the original manuscript. This has been also corrected in Fig. 7. Here the control cells are shown in 10x magnification [(a,d), (g, j) and (m, p)]. The rhodamine 123 conjugated TCS-NPs treated cells were shown in 60x [(b,e), (h,k) and (n, q)] and 100× [(c,f), (i, l) and (o, r)] magnifications. [Figure presented] Fig. 7 Cell uptake studies of rhodamine conjugated TCS-NPs in L929 (a–c, bright field and d–f, fluorescent images), NIH3T3 (g–i, bright field and j–l, fluorescent images) and MCF-7 (m–o, bright field and p–r, fluorescent images) cells. These changes in the figures would not affect the conclusion from the figure nor the overall conclusion of the whole manuscript. The authors would like to apologise for any inconvenience caused.

The potential effects of inhibitory immunoglobulins to insulin were first described in insulin-treated patients many decades ago (1). This antibody response is thought to occur in at least 40% of patients on insulin therapy (2). Subsequent case reports documented glycemic excursions in the form of markedly increased insulin requirements and unpredictable hypoglycemic episodes, both of which were attributable to insulin autoantibodies (3). Autoantibodies to insulin also can occur occasionally in patients who have not been previously exposed to insulin. Autoimmune hypoglycemia resulting from high titers of insulin autoantibodies have been reported, mostly from Japan, as a rare cause of hyperinsulinemic hypoglycemia (4). There has only been one confirmed case of autoimmune hypoglycemia reported from India (5). The estimation of insulin autoantibodies is an integral part of the diagnosis in such cases. Apart from insulin, other inciting agents implicated include sulfahydryl group–containing drugs and alpha-lipoic acid (ALA). Autoimmune hypoglycemia also has been reported to be associated with autoimmune disorders and plasma cell dyscrasias (6). Spontaneous resolution has been reported in a few cases of autoimmune hypoglycemia, and a dramatic response to steroids was seen in some other cases that manifested both hypoglycemia and hyperglycemia. In this article, we describe our experience with patients who presented with glycemic excursions resulting from insulin autoantibodies from a single university referral teaching center in South India. ### Case Presentation At the Department of Endocrinology of Amrita Institute of Medical Sciences in Kochi, Kerala, India, a large tertiary care center, between 2008 and 2014, we diagnosed eight cases in which insulin autoantibodies could be implicated as the etiological factor responsible for spontaneous hyperinsulinemic hypoglycemia. One patient presented exclusively with postprandial hypoglycemia–related symptoms, whereas the others presented with a combination of fasting and postprandial symptoms. During the same time period, there were only seven cases of histopathologically proven insulinomas …

About Coronavirus and Coronavirus Disease 2019 Coronavirus belongs to a large family of single-stranded RNA viruses Elderly people, and those with medical conditions such as hypertension, cardiac problems or diabetes, chronic obstructive airway disease, are more likely to develop serious illness [[2]] Thyroid Disorders in India Thyroid diseases are common worldwide The prevalence of hypothyroidism in T2DM and hypertension in India was found to be about 33% [[6]] Hypothyroidism and Coronavirus Disease 2019 There is no information on how it affects individuals with hypothyroidism [Extracted from the article] Copyright of Thyroid Research & Practice is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Both type 2 diabetes and hypothyroidism are highly prevalent disorders in the community. The existing data regarding prevalence of hypothyroidism in patients with diabetes comes mostly from small studies. There are only two studies with a sample size of more than 1000 diabetic patients, none of which have been done in South Asians. The present study evaluated patients with type 2 diabetes for presence of hypothyroidism and the clinical factors associated with it. The demographic, anthropometric, clinical, and biochemical parameters of consecutively enrolled patients with diabetes were systematically collected and analyzed. A total of 1152 middle aged patients with type 2 diabetes with a mean duration of diabetes of around 10 years were enrolled. Nearly 40 percent of the patients were obese and overweight, respectively, for South Asian standards and abdominal obesity was seen in around 90% patients. Clinical hypothyroidism (TSH>10 mIU/ml) was present in 113 of patients (9.83%) and another 68 patients (5.9%) had subclinical hypothyroidism (TSH 5-10 mIU/ml). Anemia (odds ratio : 2.19), overweight/obese status (odds ratio 2.07), and known dyslipidemia (odds ratio : 1.99) were found to have independent association with clinical hypothyroidism. HbA1c, abdominal obesity, poor control of hypertension, lipid parameters, microalbuminuria, and renal dysfunction showed no difference among patients with hypothyroidism when compared with euthyroid patients. Subclinical hypothyroid patients had no difference in any of the above analyzed parameters when compared to the euthyroid patients. This study shows that a significant proportion of type 2 diabetes patients suffer from clinical or subclinical hypothyroidism and screening for the same may be appropriate.

In the original article, the image of Figure 8B was inadvertently repeated as Figure 8D2. Both images were from the control PTH 1-34-treated group. Therefore, the original D2 panel has been removed from Figure 8, and now, only three images appear as D1-D3 (not D1-D4). The corrected figure and the corresponding legend are presented here. (Figure Presented).

Polycystic ovary syndrome (PCOS) is the most common metabolic abnormality occurring in young women of reproductive age. Low vitamin D levels were found to be associated with the development of obesity and insulin resistance in young women with PCOS. The study was conducted as a prospective observational study involving 121 women with PCOS. The diagnosis of PCOS cases were based on the revised Rotterdam consensus criteria. Vitamin D levels were compared in the obese and non obese PCOS groups and also with the controls. In the PCOS group, sixty subjects were obese with BMI of ≥25 kg/m 2 and forty seven subjects were found to be non obese. In the control group, sixteen subjects were obese and sixty five subjects were non obese. The mean vitamin D level in the PCOS group was 15.45±7.88 ng/ml and in the control group was 12.83±5.76ng/ml. The mean vitamin D levels in the obese and non obese group with PCOS were 16.11±8.9ng/ml and 14.61±6.1ng/ml respectively. Majority of the patients and controls had vitamin D deficiency and there was no difference in the vitamin D levels in PCOS group and controls as well as obese and non obese groups.

Aim: The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA) of foot in terms of clinical and radiological parameters. Material and Methods: Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC). Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot

The magnitude of diabetic foot ulcers (DFUs) and the amputation rates due to DFUs remain high even in developing and developed countries. Yet, the influence of knowledge, attitude, and practice (KAP) of diabetic foot care (DFC) on DFU incidence is not studied much.To study causal relationship between knowledge, attitude and practice (KAP) on DFC between diabetic patients with and without DFUs; and the risk factors associated with DFUs.A consecutive of 203 diabetic patients (103 with DFU and 100 without DFU) were included in the study. Their demographic details, medical history, and personal habits were recorded. KAP on DFC was assessed using a questionnaire. Responses were recorded, scored, and analyzed.Of the cohort, 67.5% were males, mean age: 59.9 ± 11.4 years. Patients without DFU had good knowledge on DFC compared to those with DFU (86% versus 69.9%) (p0.001). Incidence of DFU was 9% and 39.8% (p0.001) among patients who practiced and not practiced DFC respectively. 88% patients with and without DFUs; showed favorable attitude toward adopting DFC. Risk factors - diabetic peripheral neuropathy, peripheral vascular disease, retinopathy, nephropathy, smoking, tobacco chewing and alcohol consumption were significantly (p0.001) associated with DFUs.An inverse relationship between DFU and foot care knowledge as well as practice was observed. Apart from tight glycemic control, diabetic patients must be educated and motivated on proper foot care practice and life style modifications for preventing DFUs.

Chitosan, a natural polymer, is a biomaterial which is known to be osteoconductive but lacking in mechanical strength. In this work, to further enhance the mechanical property and biocompatibility of chitosan, we combined it with both chondroitin sulfate, a natural glycosaminoglycan found in bone, and nano-SiO2. The composite scaffold of chitosan/chondroitin sulfate/nano-SiO2 was fabricated by lyophilization. The nanocomposite scaffold showed enhanced porosity, degradation, mechanical integrity, biomineralization and protein adsorption. Biocompatibility and cell attachment-proliferation studies performed using MG-63 cells, advocate its better performance in vitro. To improve the cell seeding efficiency, we coated the scaffold surface with fibrin, which enhanced the initial cell attachment. The cumulative results suggest this novel nanocomposite scaffold to be a suitable candidate for bone tissue engineering.

The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority. Despite compelling evidence that tight glycemic control is crucial for delaying disease progression, increased risk of hypoglycemia associated with such control underscore the complexity of diabetes management. In most cases, hypoglycemia results from an excess of insulin, either absolute or relative to the available glucose substrate and the factors perhaps exacerbating the risk are pharmacokinetic imperfections, behavioral, co-morbidities etc. Additionally, many patients remain undiagnosed, and many diagnosed patients are not treated appropriately. In this article, the challenges of hypoglycemia, confronting health care providers and their patients with diabetes, are discussed for making treatment decisions that will help minimize risk of hypoglycemia and eventually overcome formidable barriers to optimal diabetes management. Strategies to treat and minimize the frequency and severity of hypoglycemia without compromising on glycemic goals are also presented.

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare recessive disorder resulting from mutations in the autoimmune regulator (AIRE) gene. There is no information on AIRE mutations in Indians. In a cross-sectional study, nine patients (eight families), from four referral hospitals in India, were studied for AIRE mutations by direct sequencing. We screened for new mutations in 150 controls by allele-specific PCR. The patients had 1-7 known components of APECED. Three patients had unusual manifestations: presentation with type 1 diabetes; chronic sinusitis and otitis media; and facial dysmorphism. All patients carried homozygous, probably recessive, AIRE mutations. Two unrelated patients from a small in-bred community (Vanika Vaisya) in south India carried an unreported missense mutation, p.V80G, in the N-terminal caspase recruitment domain. Another unique mutation, p.C302X, resulting in a truncated protein with deletion of both zinc-finger domains, was detected in a patient from Gujarat. Neither mutation was detected in controls. Other mutations, previously described in Caucasians, were: 13 base pair deletion (p.C322fsX372) in 4 (38%), and Finn-major (p.R257X) and p.R139X (Sardinian) mutation in one subject each. In conclusion, in this first series of APECED in Indians, we detected AIRE mutations previously reported in Caucasians, as well as unique mutations. Of these, p.V80G is possibly an ancestral mutation in an in-bred community.

Type 1 diabetes (T1D) is the most common form of diabetes in children in Western countries. There have been no large studies of childhood diabetes from India. We undertook the MEDI study (Multicenter Survey of Early Onset Diabetes in India) to assess the proportion of various subtypes of diabetes among the young subjects presenting to the endocrinology divisions of seven large teaching hospitals in different regions of India. In addition, we compared the clinical features of T1D and type 2 diabetes (T2D) in Indian subjects. Patients with onset of disease at younger than 20 years of age were included in this study. Six hundred and three subjects (603) were studied of whom 535 subjects (89%) had T1D, 36 (6%) had T2D, 18 (3%) had diabetes related to tropical pancreatitis or other forms of chronic pancreatitis, while other subtypes accounted for the rest. Compared to those with T2D, subjects with T1D were younger, had a lower C-peptide level, higher prevalence of ketosis, lower prevalence of acanthosis nigricans, and lower LDL and triglyceride levels. When compared with that of T2D, a higher proportion of patients with T1D were positive for GAD-65 and IA-2 antibodies, and this difference was statistically significant for GAD-65 antibodies. Overall, this large multicenter study showed that T1D is the commonest form of diabetes in childhood. T2D is the next most common kind, while chronic pancreatitis-related diabetes is uncommon.