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A 15-year-old boy was admitted to the intensive care unit of our hospital with complaints of increased urination, extreme tiredness, and nausea for the past 15 days. He had also lost 6.5 kg of weight (almost 10% of total body weight) in 1 month. On admission, his plasma glucose was 780 mg/dL, glycated haemoglobin (HbA1c) 11.6%, serum ketones >10.0 mmol/L, osmolality 346 mosm/kg, arterial pH 7.28, and bicarbonate 9 mEq/L. The C-peptide report initially indicated poor pancreatic beta cell reserve (fasting: 0.41 pmol/mL and stimulated: 0.46 pmol/mL). He was diagnosed with diabetic ketoacidosis and responded well to treatment, after which time he was switched to subcutaneous insulin. Ten days later, in the outpatient clinic, his fasting blood glucose was 132 mg/dL, postprandial blood glucose was 183 mg/dL, and C-peptide had improved to fasting: 0.89 pmol/mL and stimulated: 1.42 pmol/mL. Considering the presence of acanthosis nigricans on the neck, a body mass index in the overweight range, a positive family history of diabetes, and negative tests for pancreatic autoantibodies, an early onset diagnosis of type 2 diabetes mellitus was considered. Insulin was gradually withdrawn, and he was switched to metformin. Sustained recovery of C-peptide in this case indicates that lack of insulin at admission was due to beta cell stunning, rather than a total and irreversible loss of beta cells as expected in type 1 diabetes mellitus. Beta cell stunning is often reversible, as shown in this case.

The classification of diabetes into type-1 (T1D) and type-2 (T2D) is a critical step in tailoring effective treatment strategies. This distinction relies on a nuanced evaluation of clinical and biochemical features. While age at diagnosis, autoimmune markers, and beta-cell function are among the crucial clinical parameters, biochemical indicators like C-peptide levels and antibody analyses play a pivotal role. This review comprehensively examines the utility of these features in accurately categorizing individuals into T1D and T2D subtypes, providing valuable insights for clinical practice. This scoping review systematically analyses 32 studies aimed at classifying T1D and T2D using various predictor variables. Clinical parameters including family history of diabetes, age at diagnosis, sex, history of insulin use, percent desirable weight or body mass index, waist, and blood pressure emerge as pivotal diagnostic tools. C-peptide measures, encompassing urinary C-peptide to creatinine ratio (UCPCR), and serum fasting and stimulated C-peptide levels further augment classification. Biochemical markers beyond C-peptide, such as serum level of adiponectin, triglycerides (TG), high-density lipoprotein–cholesterol (HDL-C), low-density lipoprotein (LDL-C), Total cholesterol, fasting and postprandial plasma glucose, and glycated hemoglobin (HbA1c), provide supplementary information for classification. Ketonuria and postglucagon or meal-stimulated C-peptide measurements contribute to nuanced classification, particularly in insulin-treated populations. Antibody analyses, particularly presence of GAD65, Zinc Transporter, and IA2 antibodies, highlight the autoimmune nature of T1D. In conclusion, this scoping review underscores the importance of a comprehensive approach that integrates clinical, biochemical, and immunological markers in accurately differentiating between T1D and T2D in clinical practice.

Abstract Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes which is detected by genetic testing. We looked at clinical and biochemcial variables that could help detect possible MODY among Asian Indians with youth-onset diabetes. From the diabetes electronic medical records of a diabetes care centre in Chennai in southern India, demographic, anthropometric, and biochemical details of 34 genetically confirmed MODY participants were extracted. They were compared with patients with type 1 diabetes (T1D) (n = 1011) and type 2 diabetes (T2D) (n = 1605), diagnosed below 30 years of age. Clinical and biochemical variables including body mass index (BMI), glycated hemoglobin, HDL cholesterol, and C-peptide (fasting and stimulated) were analyzed to determine whether cut points could be derived to identify individuals who could be sent for genetic testing to diagnose or rule out MODY in this ethnic group. The age at diagnosis was higher for T2D (26.5 ± 4.0 years) compared to T1D (18.2 ± 6.1 years) and MODY (17.8 ± 6.0 years). Individuals with MODY had BMI, glycated hemoglobin, total cholesterol, triglycerides, HDL cholesterol, and C-peptide levels which were intermediate between T1D and T2D. The identified probable parameters and their cut points to identify cases for MODY genetic screening were BMI 21.2–22.7 kg/m2, glycated hemoglobin 7.2–10%, HDL cholesterol 43–45 mg/dl, fasting C -peptide, 1.2–2.1 ng/ml and stimulated C-peptide, 2.1–4.5 ng/ml. Asian Indians with MODY have clinical features that are intermediate between T1D and T2D and selected biochemical parameters, especially stimulated C peptide cut points were the most useful to diagnose MODY.

Background: The nutritional importance of brown rice (BR) is well established. Despite several nutritional benefits of BR, its consumption remains limited due to long cooking time and limited shelf-life. BR can be subjected to processing to improve shelf-life. Gamma irradiation is one such strategy, but it could induce changes in the grain and thus affect its glycemic properties. Aims and objectives: The aim of this study was to look at the 24-h glycemic response of irradiated and non-irradiated BR-based iso-caloric diets in Asian Indians. Methods: Fifteen (mean body mass index: 24 ± 2.6 kg/m2) Asian Indian adults without diabetes, aged 25–39 years, participated in this randomized cross-over study. Iso-caloric diets were prepared with two varieties (ADT 43 and Swarna) of parboiled gamma-irradiated brown rice with 750–820 Gy dosage (IBR) and non-irradiated brown rice (NIBR). After the participants consumed these diets, 24-h glycemic responses were recorded using a continuous glucose monitoring system. The mean positive change from baseline glucose concentration was calculated as the incremental area under the curve (IAUC) for both the diets. Results: The percentage difference in 24-h average IAUC was 10% lower in the IBR diets when compared with NIBR diets, irrespective of the variety of BR (P = 0.56). In the case of ADT 43 rice variety, both IBR and NIBR diets showed similar IAUC (P = 0.68). However, the IBR of Swarna rice variety showed 21% lower IAUC when compared with the NIBR diet (P = 0.21). Comparing the IBR varieties, Swarna showed 21% lower IAUC than ADT 43 (P = 0.21), whereas between NIBR varieties, only 0.79% difference was observed between ADT 43 and Swarna (P = 0.93). Conclusions: Gamma irradiation of parboiled BR did not produce significant differences in the 24-h glycemic responses for BR-based diets. Swarna variety was better than ADT 43 with regard to glycemic response. Judicious application of radiation technology to BR varieties may help in shelf-life extension without affecting the glycemic properties.

A clinical trial is the most foolproof method to evaluate the efficacy of a new intervention. Successful completion of clinical trials depends on the retention of the participants enrolled. Poor participant retention can lead to significant time and cost burden and have potentially adverse biases on the results. A high retention rate of participants is an important criterion for the validity and credibility of randomized controlled clinical trials. Many long-term trials fail due to low retention of study participants. Efforts at participant retention should start even before the first participant is recruited into the study. Retention is not only the responsibility of the investigators but also all other stakeholders in a clinical trial. In recent years, retention materials, participant camps, and introduction of national study coordinators have helped in improving retention. Quality of the relationship developed between the research staff and the study participant is a key factor for success of any trial. In our experience, in the context of resource-challenged low- and middle-income countries, we have found that it is possible to achieve high retention rates, 95%–100%. The rapport built between the investigating team and the participant plays a vital role in retention. In addition, personalized care, including listening to the participant's problems and enabling to contact investigators or study team at any time of the day, has shown benefits in retention.

Brown rice (whole grain, BR) has lower glycemic index (GI), is a healthy replacement for white rice (WR). However, BR has a short shelf life, is susceptible to pest infestation. Gamma irradiation is a safe approach to prevent the latter. This study examines effect of gamma irradiation on the physical, cooking, nutritional, shelf life and glycemic properties of three Indian parboiled BR. Parboiled BR of ADT-43, BPT-5204, and Swarna rice varieties were packed in polyester and polypropylene pouches (60 µ thickness) and subjected to gamma irradiation [750–820 Gy] (IR). Appropriate controls without irradiation (NIR) were maintained. Irradiation did not induce major changes in the physical and nutritional properties, except for resistant starch which significantly increased after irradiation in ADT-43 and BPT-5204. Irradiation reduced the cooking time, increased loss of solids in the cooking water and decreased apparent water uptake (particularly in BPT-5204). IR varieties exhibited longer shelf life (8–9 months) compared to 6 months shelf life of NIR varieties. The shelf stability of IR Swarna rice was superior in terms of delayed rancidity development compared to all other rice. All BR samples exhibited the ranking of ‘like moderately’ in the sensory acceptability tests at 6 months of storage and scores decreased subsequently. Irradiation did not affect GI [all showed medium GI, except a high GI for IR BPT 5204] and helped in shelf life extension of parboiled BR by preventing insect infestation.

Background and Objectives: Beaten or flattened rice (flakes) is very popular in India for preparing the meal “upma.” Commonly marketed rice flakes are fiber depleted, starchy, and may be nutritionally poor. Hence, this study aimed at preparing brown rice flakes (BRF) for such “upma” preparation and compared the nutritional and glycemic properties of it with those of white rice flakes (WRF). Materials and Methods: Flakes were prepared from brown rice (BR, ADT-45 variety) by steaming and flattening using a roller flaker. The BRF and commercial WRF were analyzed for nutrient composition, and upma prepared from both the flakes was evaluated for glycemic index (GI) in normal healthy volunteers by using a validated protocol. Results: BRF contained significantly higher (6.2 g%) dietary fiber as compared with WRF (1.8 g%, P < 0.001). Stereo-zoom microscopic examination of BRF revealed retention of bran and germ. BRF was thicker, firmer, and had a lower surface area compared with WRF. BRF upma exhibited medium GI (63.3 ± 6.2), whereas WRF upma showed high GI (70.4 ± 5.6), though the GI values were not statistically significant. Interpretation and Conclusions: BRF upma, a medium GI category meal choice, could be considered a healthier option compared to high GI WRF upma considering the nutritional profile. The BRF described in the study is easy to cook and suitable enough to replace WRF. More trials are required to design and devise innovative protocols for the preparation of BRF with significantly lower glycemic properties.

Diabetes is a chronic disease and to see the long-term glycemic control, most commonly glycosylated hemoglobin (HbA1c) is estimated. Presently, the most common method used to do HbA1c is high-performance liquid chromatography (HPLC) method. But in some cases unusually, low HbA1c is recorded by the HPLC method if hemoglobin variants are present. So in those cases, alternative methods of HbA1c estimation can be used to see the long-term glycemic status. So the presence of variants must be kept in mind and should be investigated properly so that when similar cases are encountered, it can be taken care appropriately.

Aim: Diabetes is a chronic progressive disease. A healthy eating pattern is essential to achieve good glycemic control (HbA1c 7%) which aids in delaying and preventing diabetes-related complications. The pivotal role of diet, a modifiable risk factor for type 2 diabetes has not been understood completely especially in India where carbohydrate consumption is high. This study, therefore, aims to identify major dietary patterns associated with uncontrolled diabetes by using data reduction methods. Objective: To study and compare the association of dietary patterns with elevated HbA1c among known diabetic adults using three data reduction methods (principal component analysis (PCA), reduced rank regression (RRR), and partial least-squares (PLS) regression). Materials and Methods: The Chennai Urban Rural Epidemiological followed up study (CURES) was completed in 2410 adults. Adults with diabetes (both genders, aged >20years), 573 were selected for the present analysis. Dietary intake was assessed using food frequency questionnaire. Results: The PCA derived the non-vegetarian and vegetarian pattern. Both showed positive association with the risk of high HbA1c. The first pattern of RRR and PLS showed a positive association with many foods especially those contributing to increased intakes of total calories. Whereas the 2nd pattern of RRR and PLS scores both showed an inverse association with HbA1c especially with the reduction in rice-based recipes and total calories. Conclusions: The low intake of certain foods, especially white rice, directly decreased the total calories, total carbohydrate, glycemic load, and glycemic index which has a beneficial effect on glycemic control among those with diabetes.

BackgroundAsian Indians have an increased susceptibility to type 2 diabetes and premature coronary artery disease. Nuts, like almonds, are rich in unsaturated fat and micronutrients with known health benefits.ObjectivesThis study aimed to assess the efficacy of almonds for reduction of insulin resistance and improving lipid profile in overweight Asian Indian adults.MethodsThis parallel-arm, randomized, controlled trial was conducted in Chennai, India on 400 participants aged 25–65 years with a body mass index ≥ 23 kg/m2. The intervention group received 43 g of almonds/day for 12 weeks, while the control group was advised to consume a customary diet but to avoid nuts. Anthropometric, clinical, and dietary data were assessed at periodic intervals. Glucose tolerance, serum insulin, glycated hemoglobin, C-peptide and lipid profile were assessed at baseline and end of the study. Insulin resistance (homeostasis assessment model-HOMA IR) and oral insulin disposition index (DIo) were calculated.ResultsA total of 352 participants completed the study. Significant improvement was seen in DIo [mean (95% CI) = + 0.7 mmol/L (0.1, 1.3); p = 0.03], HOMA IR (−0.4 (−0.7, −0.04; p = 0.03) and total cholesterol (−5.4 mg/dl (−10.2, −0.6); p = 0.03) in the intervention group compared to the control group. Incremental area under the curve (IAUC) and mean amplitude of glycemic excursion (MAGE) assessed using continuous glucose monitoring systems were also significantly lower in the intervention group. Dietary 24-h recalls showed a higher significant reduction in carbohydrate and increase in mono unsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake in the intervention group compared to the control group.ConclusionDaily consumption of almonds increased the intake of MUFA with decrease in carbohydrate calories and decreases insulin resistance, improves insulin sensitivity and lowers serum cholesterol in Asian Indians with overweight/obesity. These effects in the long run could aid in reducing the risk of diabetes and other cardiometabolic disease.

Abstract The advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

Aims: To evaluate the psychological impact of COVID-19 on teens in a small WhatsApp group from Chennai. Materials and Methods: The study population comprised of teenagers, aged 12 to 20 years, who belong to a WhatsApp group. The questions were framed and developed based on the transitional impact scale which has high test–retest reliability. Through the WhatsAppgroup, the teens were informed about the survey. Those who were willing to participate were provided the website link to fill the questionnaire. Fisher’s exact tests were used to assess differences in proportions wherever applicable. Results: Among the 320 participants, 16.7% of them were boys and 83.3% were girls, and the mean age of boys and girls was 16.2 ± 2.1years and 15.6 ± 1.8 years, respectively. More than 40% of teens expressed that they often felt stressed out. Teens of both the genders reported getting irritated by small normal things (34.1%), thought they were helpless (32.8%), sometimes they felt like a burden to people around them (27.8%), and 36.9% reported feeling lonely or left out often. Regarding usage of electronic devices, 47.7% of girls and 58.5% of boys were always on any one of the electronic devices like mobiles, tabs, laptops, television, etc. Similarly, more than 50% of the boys and 60% of the girls slept 6–8h during this pandemic situation. Conclusion: This study shows that this life-changing transitional event has made a massive impact on the daily routine of these teenagers. Parents, health care professionals, and educators have to make sure that the teens come to terms with the current realities of the situation and to make use of the government support programs.

Objectives: We aimed to evaluate the quality of currently available health apps for prevention of type 2 diabetes among Asian Indians using validated rating scales. Materials and Methods: Using the keywords, “diabetes prevention,” “healthy lifestyle,” and “fitness,” a total of 1486 apps available in India via Google Play were assessed for eligibility by two independent reviewers. After initial screening using specific inclusion and exclusion criteria, 50 apps underwent a pre-specified rating based on user reviews, number of downloads, and app size. Sixteen apps that scored ≥ 9 were shortlisted for further review using the Mobile App Rating Scale (MARS). The mean MARS scores (for categories I and II) were used to identify the top ranked apps. Results: The mean score for Category I of MARS rating was highest for “Google Fit: Health and Activity Tracking” (4.55/5). This was followed by “Healthifyme—Diet Plan, Health, and Weight Loss” (4.45/5). For Category II of MARS, “Diabetes M,” “Google Fit: Health and Activity Tracking,” “Calorie Counter—My Fitness Pal,” and “Healthifyme—Diet Plan, Health, and Weight Loss” all scored equally well. On comparing the advantages and disadvantages of each of these applications, “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” again ranked the best. Conclusion: Our review identifies two commercially available apps “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” as being user friendly and good quality. Although encouraging, further research is needed to evaluate the efficacy of these apps for the prevention of diabetes.

Background: Fatty acids play an important role in health and well-being; almonds have the highest amount of monounsaturated fatty acids (MUFAs) among the nuts. Western studies have shown positive health effects of almonds. However, well-designed studies are sparse on Asian Indians who have a unique phenotype with higher predisposition to diabetes and cardiovascular disease (CVD). Hence, the present study describes the design and methods of a clinical trial to assess the effect of almond supplementation on insulin resistance, glycemic markers, and inflammation in overweight Asian Indians. Methods and Outcome Assessments: Parallel-arm open-labeled, randomized controlled trial was conducted in Chennai, India. The study included 400 overweight and obese volunteers of age 25–65 years with a body mass index ≥23 kg/m2 and with some having cardiometabolic risks. The participants in the intervention group received 43 g of almonds per day as recommended by the American Heart Association for 12 weeks, whereas the participants in the control arm followed their habitual dietary patterns and were advised not to consume any nuts. All other lifestyle habits were similar. The anthropometric, clinical, biochemical, and diet data of the participants were assessed periodically. Dietary 24-hour recalls and plasma percent fatty acid of the participants were assessed at the baseline and end of the study as a measure of participant compliance to protocol. This study also assessed gut hormone levels as a marker for satiety. The effects of almonds supplementation on anti-inflammatory and inflammatory markers such as adiponectin, monocyte chemoattractant protein-1, and tumor necrosis factor-α were also assessed. Discussion: The study findings, if benefits are found, would help to improve the MUFAs intake by a single supplementation of almonds daily to meet the dietary guidelines of 15% of total calories of MUFAs. In addition, it might aid in the prevention of obesity-related chronic diseases such as diabetes and CVDs by reducing the cardiometabolic risk factors. Trial Registration: The trial was registered in the clinical trial registry of India CTRI201710010251.

Ever since the coronavirus disease (COVID) pandemic started hitting the world, the connection between diabetes and coronavirus disease-2019 (COVID-19) started becoming more clear. In this article, we asked the question whether people with diabetes are more prone to COVID-19 and whether they also are likely to get more severe form with the disease and have worse outcomes than people without diabetes. We also discussed the mechanisms by which diabetes worsens COVID-19 and also possible changes to the treatment of diabetes in the presence of COVID-19. Finally, we discuss preventive strategies that need to be taken in people with diabetes to prevent COVID-19.

Background: Both the quantity and the quality of fat are major determinants of chronic diseases risk. This paper looks at the fatty-acid composition of Indian foods reported in the diets of urban Asian Indians and its association with type 2 diabetes. Materials and Methods: Adults aged 20–80 years (n = 1688) were selected from the Chennai Urban Epidemiological Study. The dietary intake of the study subjects was assessed using a validated food frequency questionnaire. The fatty-acid profile of common foods reported by the population was measured from pooled food samples and substituted in nutrient database for calculation of daily foods, nutrient, and fatty-acid intake. Statistical analysis was performed using Statistical Package for the Social Sciences software. Results: Of the foods tested potato chips and Indian sweet mysorepak had the highest amount of fat 46.7g and 42.2g/100g, respectively, whereas the Indian sweet sweet pongal had the lowest fat of 3.9g/100g. Palmitic acid in saturated fatty acid (SFA), oleic acid in monounsaturated fatty acid (MUFA), and linoleic among poly unsaturated fatty acids (PUFA) were commonly reported fatty acids in most foods. Dietary fats provided almost 1/4th of the daily caloric intake of the subjects. Compared to national recommendations, the intake of MUFA and α linolenic acid was very low. Higher intake (>median) of calories (%E) from SFA (P = 0.007) and PUFA (P = 0.008) were associated with an increased risk of type 2 diabetes, whereas MUFA (P = 0.017) showed an inverse association. Conclusion: Improvement of the dietary fat profile in our population can be achieved by formulating and propagating guidelines on the selection and appropriate use of cooking oils, and increased consumption of nuts and oilseeds.

Hydroxychloroquine (HCQ) is a drug, which has long been used in the treatment of malaria, rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome. Recently with the COVID-19 pandemic hitting the world, there have been studies suggesting that hydroxychloroquine may be useful both in the prevention and the treatment of COVID-19, although the evidence so far has been conflicting. This article reviews the available evidence for the use of hydroxychloroquine in COVID-19 and also mentions some of the ongoing trials in this field.

Background: Several speciality rice with health claims are emerging in the south Indian market. The study aims to examine the nature of speciality rice with health claims available in the Chennai market. Methodology: A market survey was conducted in randomly selected outlets from 4 zones of the Chennai city urban market (100 stores including supermarkets/hypermarkets/departmental stores/pharmacies were visited and rice samples were collected). The product label information, claims declared on the pack and morphological features of the rice samples were examined and recorded using stereo-zoom microscope. Results: Fifteen rice samples of different categories including whole-grain rice (8), semi-polished rice (2) and polished white rice (5) were evaluated. Three samples had low-glycaemic index claims among whole-grain rice and 2 among polished white rice. The health claims were not supported with scientific evidence and were sometimes misleading as revealed by stereo-zoom microscopic examination. Conclusions: The authenticity of many of the health claims declared on the rice packs is questionable due to the lack of scientific evidence. The awareness about the quality of rice would be helpful for the consumer to make a wise choice about which cereal staple to purchase.

Background: Impaired insulin secretion and insulin resistance are the underlying pathophysiological defects in Type 2 diabetes (T2DM) that lead to hyperglycaemia. The β-cell defect in T2DM is usually progressive, leading to eventual β-cell exhaustion and dependence on insulin. It is known that glucotoxicity and lipotoxicity contribute to the initial decreased insulin secretion at the time of diagnosis of T2DM. Therefore, an aggressive approach early in the course of the disease to correct these defects could possibly alter the natural history of T2DM. Objectives: Our aim was to study the effect of administration of a short course of insulin therapy at the onset of T2DM on glycaemic parameters and pancreatic β-cell function as assessed by C-peptide estimation. Materials and Methods: Treatment-naïve T2DM patients (n = 426) with known duration of diabetes of

Background: Dietary modifications have been shown to lower the risk for gestational diabetes mellitus (GDM). However, there is little evidence whether dietary modifications during pregnancy can improve neonatal outcomes in women with GDM, particularly in low-resource settings. Aim: The aim of the study is to assess the effect of a dietary modification delivered through a low-cost model of care (MOC), on neonatal outcomes in women with GDM in India. Methodology: Dietary intake was assessed in 133 women with GDM enrolled under the women in India with GDM strategy-MOC (WINGS-MOC), from six maternity centres in Chennai, in South India. The WINGS-MOC dietary intervention included one-on-one monthly antenatal diet counselling, providing a dietary guideline booklet and healthy recipe demonstrations. Dietary intake was assessed using 24-h dietary recall and an open-ended diet questionnaire. A ‘healthy diet score’ was derived from the reported intake of whole grains, dairy products and dietary fibre. The effect of healthy diet score on neonatal outcomes (macrosomia, hyperbilirubinaemia, congenital anomalies and neonatal intensive care unit admissions) was evaluated. Results: A six-fold increase in the intake of whole grains (30 vs. 5.1g) and 20% increase in consumption of dairy products (265.4 vs. 225g) and dietary fibre (22.3 vs. 18.2g) were observed after the MOC intervention. Higher consumption of whole grain, dairy products and dietary fibre was inversely associated with adverse neonatal outcomes. Those with the highest healthy diet score had lower risk for adverse neonatal outcomes (odds ratio: 0.2, [95% confidence interval: 0.04–0.9]; P = 0.04) even after adjusting for potential confounders. Conclusions: A low-cost dietary intervention helps to improve neonatal outcomes in women with GDM.

Background. Foods rich in protein and dietary fibre could potentially improve lipid profile in overweight or obese diabetic patients with dyslipidemia and, thereby, mitigate their risk of cardiovascular disease (CVD). In this study, the effect of providing high-protein high-fibre (HPHF) nutritional supplement in addition to standard care of type 2 diabetes mellitus (T2DM) on lipid profile was evaluated. Methods. In this open-label, parallel-arm, prospective, randomized study, a total of 100 overweight/obese participants with T2DM were randomized to either an intervention group (25 g HPHF nutritional supplement given twice daily along with a standard care of T2DM) or a control group (standard care of T2DM) for 24 weeks. Change from baseline in lipid parameters such as total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) was assessed between the intervention and control group at week 12 and week 24. Participant compliance was assessed using the dietary 24-hour recall. Statistical analysis was performed to assess the main effects on within- and between-group changes from baseline to end of 24 weeks. Results. Participants in the HPHF nutritional supplement group showed a statistically significant improvement in HDL-C levels by the end of 24 weeks (p=0.04) and a significant increase in protein and total dietary fibre intake (p=0.002 and p=0.00, respectively) compared to the control group. The TChol/HDL-C ratio was significantly lower (p=0.03) in the HPHF group from baseline to 24 weeks. Conclusion. Twice-daily consumption of a HPHF nutritional supplement significantly improved HDL-C levels. Inclusion of the HPHF supplement would be a useful effective aid for managing dyslipidemia in overweight/obese individuals with T2DM.

Introduction Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering.Research design and methods From a network of 50 diabetes centers across nine states of India, we selected 19 084 individuals with type 2 diabetes (aged 10–97 years) with diabetes duration of less than 5 years at the time of first clinic visit and performed k-means clustering using the following variables: age at diagnosis, body mass index, waist circumference, glycated hemoglobin, serum triglycerides, serum high-density lipoprotein cholesterol and C peptide (fasting and stimulated). This was then validated in a national epidemiological data set of representative individuals from 15 states across India.Results We identified four clusters of patients, differing in phenotypic characteristics as well as disease outcomes: cluster 1 (Severe Insulin Deficient Diabetes, SIDD), cluster 2 (Insulin Resistant Obese Diabetes, IROD), cluster 3 (Combined Insulin Resistant and Deficient Diabetes, CIRDD) and cluster 4 (Mild Age-Related Diabetes, MARD). While SIDD and MARD are similar to clusters reported in other populations, IROD and CIRDD are novel clusters. Cox proportional hazards showed that SIDD had the highest hazards for developing retinopathy, followed by CIRDD, while CIRDD had the highest hazards for kidney disease.Conclusions Compared with previously reported clustering, we show two novel subgroups of type 2 diabetes in the Asian Indian population with important implications for prognosis and management. The coexistence of insulin deficiency and insulin resistance seems to be peculiar to the Asian Indian population and is associated with an increased risk of microvascular complications.

In this case report, we present a young patient with type 1 diabetes who had hereditary chronic pancreatitis. We evaluated him for the cause of pancreatitis, but it was inconclusive and finally the genetic testing was done for him, which revealed heterozygous missense mutation in exon 3 of the PRSS1 gene (protease serine 1 gene) on chromosome 7. Hence, we were able to make the diagnosis of hereditary chronic pancreatitis. Chronic pancreatitis secondary to any cause can lead to permanent diabetes, which is typically difficult to control. However, in this case, the episodes of recurrent pancreatitis were present after the onset of type 1 diabetes as compared to the usual presentation of diabetes after the advancement of chronic pancreatitis.

The explosive increase in the prevalence of diabetes mellitus in resource-strapped regions of the world demands innovative solutions in healthcare. Advances in information technology, diagnostics and food technology have the potential to make diagnosis and treatment of diabetes simpler, cost-effective and patient-friendly. Newer methods of glucose testing such as the ambulatory glucose profile promise to make clinical decision-making easier and more robust. More advanced modes of insulin delivery are likely to help larger proportions of patients achieve their glycaemic goals with minimal risk of hypoglycaemia. Use of telemedicine and electronic medical records represents a significant advance in improving delivery of diabetes care and monitoring its outcomes. Efforts are also on to harness the wide penetrance of mobile phones in spreading awareness about diabetes and its prevention as well as in screening for retinopathy. Advances in technology also promise to favourably alter the food habits of the population, with the advent of the novel high-fibre white rice being a case in point. This narrative review aims to discuss some of the ways in which emerging technologies are making diabetes monitoring and treatment easier, more effective and pleasant for the patient.

Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes mellitus that occurs in the first 6 months of life. It is a rare condition with a prevalence of 1 in 100,000–500,000 live births. We report a 3-month-old girl child with high blood glucose levels. She was diagnosed with diabetes mellitus during the 28th day of life and was on treatment with insulin. She was admitted for the control of high blood glucose levels during which she was started on multiple daily insulin treatment, but the control had been poor. As the age of onset is

Summary: Background: The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: The number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016. Interpretation: The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Aim: To study the postpartum conversion of gestational diabetes mellitus (GDM) to different types of diabetes among Asian Indian women. Materials and Methods: Using data from electronic medical records, 418 women with GDM seen at a tertiary diabetes care center for diabetes in Chennai in South India between 1991 and 2014 were evaluated for development of diabetes postpartum. Results: Of the 418 GDM women followed up postpartum, 388 progressed to diabetes. Of these 359 (92.5%) developed type 2 diabetes (T2DM) and 29 women (7.5%) developed type 1 diabetes (T1DM). The median time to development of T1DM was 2 years (interquartile range 2 [IQR]) while for T2DM it was 5 years (IQR 6). Women who developed T1DM had significantly lower mean body mass index (BMI) (20.4 ± 2.8 vs. 27.5 ± 4.4 kg/m 2 , P = 0.001), and higher fasting plasma glucose (222 ± 105 vs. 165 ± 62 mg/dl P = 0.008) and glycated hemoglobin levels (10.2 ± 2.7 vs. 8.5 ± 2.1% P < 0.001) compared to those who developed T2DM. Glutamic acid decarboxylase (GAD) autoantibodies were present in 24/29 (82.7%) of women who developed T1DM. Conclusion: A small but significant proportion of women with GDM progress to T1DM postpartum. Measurement of GAD antibodies in leaner women with more severe diabetes could help to identify women who are likely to develop T1DM and thus prevent their presentation with acute hyperglycemic emergencies after delivery.

Aim: To obtain information on existing practices in the diagnosis and management of gestational diabetes mellitus (GDM) among physicians/diabetologists/endocrinologists and obstetricians/gynecologists (OB/GYNs) in India. Methods: Details regarding diagnostic criteria used, screening methods, management strategies, and the postpartum follow-up of GDM were obtained from physicians/diabetologists/endocrinologists and OB/GYNs across 24 states of India using online/in-person surveys using a structured questionnaire. Results: A total of 3841 doctors participated in the survey of whom 68.6% worked in private clinics. Majority of OB/GYNs (84.9%) preferred universal screening for GDM, and screening in the first trimester was performed by 67% of them. Among the OB/GYNs, 600 (36.7%) reported using the nonfasting 2 h criteria for diagnosing GDM whereas 560 (29.4%) of the diabetologists/endocrinologists reported using the same. However, further questioning on the type of blood sample collected and the glucose load used revealed that, in reality, only 208 (12.7%) and 72 (3.8%), respectively, used these criteria properly. The survey also revealed that the International Association of Diabetes and Pregnancy Study Groups criteria was followed properly by 299 (18.3%) of OB/GYNs and 376 (19.7%) of physicians/diabetologists/endocrinologists. Postpartum oral glucose tolerance testing was advised by 56% of diabetologists and 71.6% of OB/GYNs. Conclusion: More than half of the physicians/diabetologists/endocrinologists and OB/GYNs in India do not follow any of the recommended guidelines for the diagnosis of GDM. This emphasizes the need for increased awareness about screening and diagnosis of GDM both among physicians/diabetologists/endocrinologists and OB/GYNs in India.

Aim: The Women In India with GDM Strategy (WINGS) project was conducted with the aim of developing a model of care (MOC) suitable for women with gestational diabetes mellitus (GDM) in low- and middle-income countries. Methodology: The WINGS project was carried out in Chennai, Southern India, in two phases. In Phase I, a situational analysis was conducted to understand the practice patterns of health-care professionals and to determine the best screening criteria through a pilot screening study. Results: Phase II involved developing a MOC-based on findings from the situational analysis and evaluating its effectiveness. The model focused on diagnosis, management, and follow-up of women with GDM who were followed prospectively throughout their pregnancy. An educational booklet was provided to all women with GDM, offering guidance on self-management of GDM including sample meal plans and physical activity tips. A pedometer was provided to all women to monitor step count. Medical nutrition therapy (MNT) was the first line of treatment given to women with GDM. Women were advised to undergo fasting blood glucose and postprandial blood glucose testing every fortnight. Insulin was indicated when the target blood glucose levels were not achieved with MNT. Women were evaluated for pregnancy outcomes and postpartum glucose tolerance status. Conclusions: The WINGS MOC offers a comprehensive package at every level of care for women with GDM. If successful, this MOC will be scaled up to other resource-constrained settings with the hope of improving lives of women with GDM.

Context: There is limited literature on the dietary fat intake of rural Indian populations, particularly in relation to the risk of metabolic syndrome (MS). Aim: This study aims to assess the dietary fat intake and analyze its association with the risk of selected components of the MS among rural population in the state of Tamil Nadu. Settings and Design: Adults (n = 27012) ≥20 years of age were recruited from the rural component of the Chennai Urban Rural Epidemiological Study, a cross-sectional study conducted in 42 villages in Kanchipuram District of Tamil Nadu. Subjects and Methods: Using a validated food frequency questionnaire, data were obtained on the fat intake among 6907 adults. Anthropometric and clinical measures were collected using standard methods. The components of the MS assessed were abdominal obesity, hypertension, and impaired fasting glucose. All analyses were performed using SPSS software (version 20). Results: Prevalence of abdominal obesity, hypertension, and impaired fasting glucose were significantly higher in the highest quintile of fat intake (33%, P < 0.001; 39%, P = 0.04, and 23.3%, P = 0.003, respectively). Highest intake of fat was also significantly associated with risk of abdominal obesity ( P < 0.001), hypertension ( P = 0.04), and impaired fasting glucose ( P = 0.01). Sunflower oil as the main cooking oil was significantly associated with a higher risk of these components of the MS ( P for trend

BACKGROUND:The incidence and prevalence of diabetes is increasing worldwide and it is the fifth leading cause of mortality accounting for over 3.8 million deaths annually. Despite the enormity of the diabetes-related health burdens, very few studies have evaluated the factors associated with mortality among people with diabetes in India. We sought to study the causes and predictors of mortality among urban Asian Indians with and without diabetes. METHODS AND FINDINGS:Of 2273 adults (27,850 person-years of follow-up) from the 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES), the cause of death could be ascertained in 552 individuals out of the 671 who had died (response rate 82.3%). Verbal autopsy was obtained from the family members of the deceased and this was adjudicated by trained physicians. The age-standardized mortality rate was 28.2 (95%CI 25.9-30.6) per 100,000 population. Mortality rates were significantly higher in individuals with diabetes compared to those without [27.9(95% CI 25.5-30.6) vs. 8.0 (6.6-9.9) per 1000 person years]. Compared to individuals of normal body mass index, underweight individuals had higher risk of mortality (Hazard ratio 1.49; 95% CI 1.11-2.0), whereas overweight and obese individuals did not show a higher risk. The population-attributable risk for all-cause mortality in the entire study cohort was highest for ischemic heart disease and diabetes. The excess mortality attributable to diabetes was highest in the age group of 51 to 70 years, and was mostly accounted for by renal disease (Rate ratio 5.68, 95%CI 2.43-6.23), ischemic heart disease (4.23,2.78-6.67), and cerebrovascular disease (4.00,1.87-9.81). CONCLUSION:Underweight (but not overweight or obesity) was strongly associated with mortality in this Asian Indian population. Ischemic heart disease and diabetes contributed the most to risk for all cause mortality. Excess mortality due to diabetes was higher in relatively younger individuals and was mostly accounted for by renal disease.

Context: There is little data correlating dietary fibre (DF) intake and cardiovascular risk in Asian Indians with diabetes. Aim: To assess the DF intake and its association with lipid profile (total serum cholesterol and low density lipoprotein [LDL] - cholesterol levels) in urban Asian Indians with diabetes. Subjects and Methods: Dietary assessment using validated Food Frequency Questionnaire was conducted in 1191 free-living adults with known diabetes in the Chennai Urban Rural Epidemiology Study. Subjects taking medication for dyslipidemia, and those with cardiovascular disease and implausible energy intake (n = 262) were excluded, leaving 929 participants. Anthropometric and relevant biochemical parameters were measured using standardized techniques. Results: Diabetic individuals who consumed DF < median intake (29 g/day) had a higher prevalence of hypercholesterolemia (49.5% vs. 40.1% [P = 0.01]) and higher LDL cholesterol (46.2% vs. 35.5% [P = 0.001]) than those in the > median intake of DF group. The risk of hypercholesterolemia (odds ratio [OR] =1.38 [95% confidence interval [CI]: 1.02-1.85], P = 0.04), and high LDL cholesterol (OR: 1.43 [95% CI: 1.06-1.94], P = 0.02) was higher among those whose DF intake was less than the median. Serum triglycerides and high density lipoprotein cholesterol were not associated with DF intake. The main sources of DF were vegetables and legumes. Conclusion: In urban Asian Indians with diabetes, lower DF intake is positively related to total cholesterol and LDL cholesterol levels.

Clinical trials are emerging as an important activity in India as it is an essential component of the drug discovery and development program to which India is committed. The only robust way to evaluate a new medicine is by doing properly designed clinical trials. In addition to advancing science, clinical trials offer myriad benefits to the participants. The recent hue that created in India about clinical trials is probably an exaggeration of facts. However, these points to the need for ensuring proper compliance with the regulatory norms and proper training of concerned personnel in good clinical practice (GCP). This will ensure that India continues to reap the benefits of clinical trials and also become a world leader in this field.

Diabetes has emerged as a disease of major public health importance in India affecting the rich and the poor alike. Conventionally, comprehensive diabetes management is aimed at preventing micro and macro vascular complications. However, morbidity and mortality due to infections are also significant. In developing countries like India, the concept of adult immunization is far from reality. Recently the H1N1 pandemic has triggered the necessity for considering immunization in all age groups for the prevention of vaccine-preventable fatal infectious diseases. Considering the economics of immunization in a developing country, providing free vaccines to all adults may not be a practical solution, although the free universal immunization program for children is in existence for several decades. There is no consensus on the use of vaccines in diabetes subjects in India. However, there are some clinics offering routine pneumococcal, influenza and other vaccinations. Patients with diabetes have a deranged immune system making them more prone for infections. Hospitalization and death due to pneumococcal disease and influenza are higher in diabetes patients. They, like other healthy individuals, have a normal humoral response to vaccination with clinically significant benefits. The American Diabetes Association, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, World Health Organization, United Kingdom Guidelines and a number of other scientific organizations have well defined guidelines for vaccination in diabetes. In this article we make some suggestions for clinicians in India, regarding use of vaccines in subjects with diabetes.

Glycated hemoglobin (HbA1c) is an important indicator of glycemic control in diabetes mellitus, based on which important diagnostic and therapeutic decisions are routinely made. However, there are several situations in which the level of HbA1c may not faithfully reflect the glycemic control in a given patient. Important among these is the use of certain non-diabetic medications, which can affect the HbA1c levels in different ways. This review focuses on the non-diabetic medications which can inappropriately raise or lower the HbA1c levels, and the postulated mechanisms for the same.

Large volumes of biomedical data are being produced every day. Leveraging such voluminous amount of patient data using data science approaches help to uncover hidden patterns, unknown correlations, and other insights of the disease. Integration of diverse genomic data with comprehensive electronic health records (EHRs) exhibit challenges, but essentially, they provide a feasible opportunity to better understand the underlying diseases, treatment patterns and develop an efficient and effective approach to identify biomarkers for diagnosis and improve therapy. Here, we describe a big data solution for diabetes, providing an efficient and responsive scientific discovery platform for researchers. Clinical phenotype data was collected from EHR of a tertiary care diabetes centre across 20 locations in India. It encompasses >20 million data points on 323,145 patients registered over 25 years. The biomedical data includes diverse collection of information such as well characterized clinical phenotypes, biochemical investigations, drug prescriptions, genotype mapping, micro- macrovascular complications of diabetes, pedigree charts. Additionally, more than 3 million genomic variants from high-throughput next generation sequencing (NGS) were analyzed, annotated and integrated into the respective patient phenotype data. Statistical methods such as t-test, ANOVA were used to describe the significance of clinical variables between subject groups. Time based visualization methods for showing temporal patterns in key clinical variables such fasting glucose, HbA1c, Albuminuria, etc. are provided. It provides a novel clinical database of information on 323,145 patients with type 2 diabetes (n=294,371), type 1 diabetes (n=1,945), gestational diabetes (n=645), prediabetes (n=7,363), patients with miscellaneous forms of diabetes including monogenic forms of diabetes (n=4,601) and normal glucose tolerance (n=12,579). It has about 144,926 diabetes patients (44.8% of total) with microvascular complications and 15,008 (4.6%) patients with macrovascular complications. It offers analytical tools to compute descriptive statistics of clinical variables for cohorts as well as visualizations to understand the disease progression of diabetes, uncover key event patterns such as episodes of high glucose levels, or drug treatments and their association with progression of disease over time. Thus, the database portal promotes practice of precision medicine and therefore useful to researchers, clinicians and pharmaceutical industry.

AIM: To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. METHODS: Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. RESULTS: Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. CONCLUSION: The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.

Kidney failure is common in patients with Coronavirus Disease-19 (COVID-19), resulting in increased morbidity and mortality. In an international collaboration, 284 kidney biopsies were evaluated to improve understanding of kidney disease in COVID-19. Diagnoses were compared to five years of 63,575 native biopsies prior to the pandemic and 13,955 allograft biopsies to identify diseases that have increased in patients with COVID-19. Genotyping for APOL1 G1 and G2 alleles was performed in 107 African American and Hispanic patients. Immunohistochemistry for SARS-CoV-2 was utilized to assess direct viral infection in 273 cases along with clinical information at the time of biopsy. The leading indication for native biopsy was acute kidney injury (45.4%), followed by proteinuria with or without concurrent acute kidney injury (42.6%). There were more African American patients (44.6%) than patients of other ethnicities. The most common diagnosis in native biopsies was collapsing glomerulopathy (25.8%), which was associated with high-risk APOL1 genotypes in 91.7% of cases. Compared to the five-year biopsy database, the frequency of myoglobin cast nephropathy and proliferative glomerulonephritis with monoclonal IgG deposits was also increased in patients with COVID-19 (3.3% and 1.7%, respectively), while there was a reduced frequency of chronic conditions (including diabetes mellitus, IgA nephropathy, and arterionephrosclerosis) as the primary diagnosis. In transplants, the leading indication was acute kidney injury (86.4%), for which rejection was the predominant diagnosis (61.4%). Direct SARS-CoV-2 viral infection was not identified. Thus, our multi-center large case series identified kidney diseases that disproportionately affect patients with COVID-19 and demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney., (Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate the risk of type 2 diabetes (T2DM) among the combinations of BMI categories and metabolic syndrome in Asian Indians., Materials and Methods: Individuals from the Chennai Urban Rural Epidemiology Study cohort (n = 1,368), free of diabetes at baseline were stratified by BMI and metabolic health as metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically obese non-obese (MONO) and metabolically obese obese (MOO). Phenotypic obesity was defined as BMI ≥ 25 kg/m 2 and metabolic obesity as presence of any two of the metabolic abnormalities: hyperglycemia, high blood pressure, high triglyceridemia or low HDL cholesterol. Hazard ratios for progression to diabetes were estimated using Cox proportional hazard regression., Results: During median 9.1 years of follow-up, incident cases of diabetes were highest among MOO-45.1%, followed by MONO-41.3%, MHO-27.1% and MHNO-15.9%. Incidence rates of diabetes among MOO, MONO, MHO and MHNO were 57.8, 50.9, 30.4 and 18.1 per 1000 person years, respectively. Hazard ratio for diabetes development were 1.71 in MHO, 2.87 in MONO, and 3.39 in MOO compared with MHNO., Conclusions: Increased BMI and metabolic risk factor clustering independently contribute to the increased risk of T2DM in obese individuals. Screening for metabolic abnormalities should be performed routinely in clinic to identify high-risk individuals and institute appropriate preventive measures., (© 2021. Springer-Verlag Italia S.r.l., part of Springer Nature.)