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With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.

Objectives: Children with type 1 diabetes (T1D) need a supportive, non-stigmatizing school environment for self-care activities such as checking blood glucose (BG) and taking pre-meal insulin. Data about T1D self-care in schools in developing countries are scarce. We looked at diabetes self-care activities at school, and attitudes of school staff toward diabetes care. Material and Methods: We interviewed, over an 8-week period, consecutive patient-parent dyads attending T1D clinics in North (Delhi, Gurgaon, and Kanpur), West (Aurangabad), and South (Hyderabad) India. Results: We received responses from 397 patients, 51% of boys. Mean age was 11.7 years (SD: 3.7), mean age at diagnosis 7.2 years (SD: 3.7), and mean diabetes duration 4.5 years (SD: 3.5). A majority (69.8%) were attending private (fee paying) schools (PS) and the rest were studying at government (subsidized/free) schools (GS). More than half of the parents had high educational status: graduate or more (mothers: 52.1%, fathers: 56.9%). Parents visited school daily in 17.1%, significantly more if they had high educational status and if the child was Conclusion: Half of our children were able to manage T1D self-care in school, as schools were often supportive, whether private or government. Parental educational status was positively associated with better care. Although self-care was better in PS and they had better infrastructure, there is much scope for improvement.

India is passing through a significant impact of Wuhan origin coronavirus disease 2019 (COVID-19) pandemic in the second wave. Mucormycosis is emerging as a larger problem for our patients as compared to the first wave. Several plausible explanations have been put forth –but none has been proven as yet. We herein report eight cases of COVID-19-associated rhino-orbital mucormycosis diagnosed and managed at our center. We observed a higher risk among middle-aged men, with known or covert diabetes who received high-dose steroids and/or prolonged oxygen for COVID-19 management.

Type 1 diabetes mellitus (T1DM) is a lifelong disorder that mostly happens any time during childhood. It needs constant care and attention. Self-management becomes very essential as there are multiple factors that influence management of blood glucose levels and good outcomes. Diabetes education1 is essential for this and it involves the process of providing the person with the knowledge and skills needed to perform diabetes self-care, manage crises, and to make lifestyle changes to successfully manage their life. It begins with teaching of survival skills and continues with higher learning to fit diabetes into lives of people with diabetes rather than changing the lives to manage diabetes. Although parents are responsible for this initially, children must be part of this learning and journey as they are the one who must deal with diabetes in their life.Although knowledge transfer from scientific (truth and fact based) and narrative story (experience and meaning based) is fundamentally different but narrative or stories are better absorbed and retained. Storytelling and experience sharing are rapidly developing fields in medical education, but its potential has yet to be realized in medical education. The Changing Diabetes in Children program focused at reaching out to the economically underprivileged children with T1DM has implemented the use of stories to help the T1DM child learn to take insulin injections and understand the basic do’s and don’t’s for proper diabetes management and motivate them to become self-reliant and independent adults in long run.

Background: Diabetes self-management education (DSME) is globally recognized as an integral part of diabetes management and in majority of the developed countries, it is delivered by trained diabetes educators. Unfortunately, in India, it is still not considered an essential part of diabetes management. Materials and Methods: A self-structured diabetes education program, of a 75-min duration, was developed over a period of six months. To assess the knowledge, before and after the implementation of the education program, a validated questionnaire, Diabetes Knowledge Questionnaire 24 (DKQ24) was used. Results: A total of 50 patients (34 males; 74%) were recruited in the study. The mean age of the study participants was 54.98 ± 12.02years, with a mean duration of diabetes 12.34 ± 8.76years and mean HbA1c 8.1 ± 1.49%. A statistically significant (P < 0.05) improvement in the proportion of correct responses (14 out of 24 questions; 58.3%) was seen after the implementation of the DSME program. Conclusion: There is limited research available in India on DSME. To meet the need of a structured diabetes education program in India, we have evolved one such program (duration of 75 min) within a period of six months. We anticipate this program to have enough potential in developing countries in the long run.

Background: Strict isolation measures imposed during the coronavirus disease (COVID-19) pandemic have confined families in their homes, interrupted functioning of schools and colleges, and disrupted play and exploration time. Aim: The aim was to analyze psychological stress and its determinants among Indian adolescents and young adults during the COVID-19 pandemic. Methodology: A cross-sectional, observational study design was adopted. A semi-structured survey including demographic details, COVID-19 awareness, Perceived Stress Scale (PSS-10), and coping methods was distributed among 12–24 year olds, and analyzed to study the determinants of stress. Results: Out of a total of 235 (112 males; 19.4 ± 4.0 years) participants, nearly half of the participants (53%) reported moderate stress; low stress was perceived by 42.3% and severe stress was observed in 4.7%. The mean PSS score was 13.4 ± 8.9. Higher PSS score was associated with age (r = 0.194, P = 0.003), female gender (mean rank = 132.0, P = 0.001), higher education (mean rank = 154.5, P = 0.006), salaried occupation (mean rank = 143.79, P = 0.047), dissatisfaction with the available information (mean rank = 155.64, P = 0.009), and accessing information multiple times a day (mean rank = 133.51, P = 0.041). On multivariate linear regression analysis, age, gender, dissatisfaction with the available information, and higher frequency of accessing information were identified as significant correlates of mean PSS-10 score. Conclusion: Stress was highly prevalent among the Indian adolescents and young adults during the pandemic. Older age, female gender, higher education, salaried job, dissatisfaction toward the available information, and a tendency to view updates frequently were associated with higher stress levels.

Subclinical hypothyroidism is common in children and adolescents with obesity and has been considered to be its effect with no need for treatment. Its metabolic impact has not been evaluated. Therefore the present study was conducted to determine the metabolic impact of obesity related subclinical hypothyroidism. Retrospective record review of obese children and adolescents between 5 and 18 y of age presenting to pediatric endocrine clinic was done. Four hundred four obese children and adolescents [251 boys, 11.8 (3.2); 5.1–18 y, BMI SDS 2.4 (0.7); 1.4–6.6] were assessed regarding thyroid functions, adiposity (clinical and DXA derived) and metabolic complications. Subclinical hypothyroidism was observed in 122 (30.2%) and was associated with higher fat percentage [49.2 (5.8) vs. 47.2 (6.4) p = 0.009], android to gynoid ratio [1.1 (0.1) vs. 1.0 (0.1), p = 0.007] and alanine aminotransferase (ALT) levels [49.3 (31.5) vs. 40.8 (38.1), p = 0.04]. Subjects with subclinical hypothyroidism had 1.9 times greater odds of having non-alcoholic steatohepatitis (47.3% vs. 31.8%, p = 0.005) with no difference in the prevalence of dyslipidemia, dysglycemia or hypertension. Subclinical hypothyroidism was the only determinant of non-alcoholic steatohepatitis on binomial logistic regression (WALD = 11.04, p = 0.001) with no impact of BMI SDS, waist circumference SDS, fat percentage or android to gynoid ratio. Thyroid stimulating hormone (TSH) was the most important determinant of ALT on linear regression (B = 3.027, p

ImportanceContinuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths.ObjectiveTo assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes.Design, Setting, and ParticipantsThis multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use.ExposuresType 1 diabetes and the use of CGM with or without an insulin pump.Main Outcomes and MeasuresProportion of individuals in each treatment modality group achieving recommended CGM clinical targets.ResultsAmong the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P P P Conclusions and RelevanceIn this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.

This paper proposes and evaluates an integrated method for real-time, head-tracked, 3D binaural audio with synthetic reverberation. Virtual vector base amplitude panning is used to position the sound source and spatialize outputs from a scattering delay network reverb algorithm running in parallel. A unique feature of this approach is its realization of interactive auralization using vector base amplitude panning and a scattering delay network, within acceptable levels of latency, at low computational cost. The rendering model also allows direct parameterization of room geometry and absorption characteristics. Varying levels of reverb complexity can be implemented, and these were evaluated against two distinct aspects of perceived sonic immersion. Outcomes from the evaluation provide benchmarks for how the approach could be deployed adaptively, to balance three real-time spatial audio objectives of envelopment, naturalness, and efficiency, within contrasting physical spaces

To develop and validate a mobile application-based tool for the management guidance of children and adolescents with diabetic ketoacidosis (DKA).The study involved the development of a mobile application-based tool for DKA management in accordance with the International Society of Pediatric and Adolescent Diabetes (ISAPD) guidelines, 2018. The impact of the mobile application in preventing protocol deviation and resultant complications was assessed. Case records of 70 children and adolescents [39 boys, 8.9 (4.1) y of age] with severe DKA managed in the authors' intensive care unit were examined. The application guidance and real-time management were compared to the standard protocol.Protocol deviations were observed in 58 (82.9%), with two or more errors in 28 (40%). These included lack of initial fluid bolus (4, 5.7%), excessive fluid supplementation (8, 11.4%), inadequate initial fluid (25, 35.7%) and potassium supplementation (13, 18.6%), delayed response to fall in potassium (15, 21.4%) and glucose levels (24, 34.3%), and erroneous insulin administration (19, 27.1%). These errors contributed to 42.1% of severe hypokalemia and 56% of significant hypoglycemia episodes. The mobile application guidance was in accordance with the protocol in all the case scenario.Deviation from the management protocol is common in DKA and associated with adverse outcomes. Mobile application guidance is expected to reduce the protocol deviation with a potential of improving outcomes.

Aim The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs. Conclusions Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes. Funding Sanofi India. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0651-1) contains supplementary material, which is available to authorized users.

We introduce a novel approach for personalisation of an efficient 3D binaural rendering system designed for mobile, auditory mixed reality use cases. A head-related transfer function (HRTF) ranking method is outlined for users of real-time, interactive sound and music applications. Twenty participants tested the approach and its impact on their capacity to locate a continuous musical sound rendered in varying 3D positions. Analysis of HRTF rankings across three separate sessions reveal encouraging levels of reliability amongst some participants. Patterns of interaction show a significant benefit to horizontal precision that results from the selection process. In contrast, length of system exposure (rather than HRTF preference) demonstrates a significant degree of improvement to aspects of vertical perception and overall speed of response, with no detriment to horizontal accuracy. These findings provide an initial basis from which to consider priorities in the design of audio-only immersive applications and accompanying methods for effective user controlled personalisation.

To compare the predictive value of the IAP and WHO criteria in identifying obesity complications in Indian children and adolescents.Blood pressure and body mass index was measured in 4434 children and adolescents [2539 boys; mean age 11.9 (3.0), 5.1-18 y] from affluent schools. The predictive accuracy of IAP 2015 and WHO BMI criteria in identifying hypertension was assessed.IAP 2015 BMI criteria labelled 203 more children obese than the WHO reference (649 as against 446). Hypertension was present in 75 (37%) of these. The difference in the prevalence of hypertension in subjects obese as per IAP 2015 criteria and their nonobese counterparts (50.2% as against 10.8%, p 0.0001) was greater than that between subjects obese only by IAP 2015 or by both the criteria (36.9% as against 56.3%, p 0.0001). The difference in the proportion of subjects with hypertension between two consecutive IAP 2015 BMI SDS category was highest for + 1.5 in boys (32.3% as against 49.8%, p 0.0001) and + 2 in girls (25.9% as against 59.3%, p 0.00012).IAP BMI criteria better predict hypertension in Indian children than WHO cutoffs and should be used in clinical practice to predict obesity complications.

Objectives Lack of systematic evaluation of short stature results in unnecessary work-up on one hand while missing pathology on the other. We have developed a mobile application that guides work-up based on age, auxology (height, BMI, and corrected standard deviation score), and skeletal maturation with an aim of reducing the diagnostic errors. Aim of this study is to develop and validate a mobile application for point of care evaluation of short stature. Methods The application was developed (n=400) and validated (n=412) on children and adolescents (2–18 years of age) presenting to our Pediatric Endocrinology Clinic with short stature. Height standard deviation score thresholds determining the need for workup were derived from Receiver Operating Characteristics (ROC) curve. Student’s t-test and ROC curves were used to identify the most appropriate parameter differentiating constitutional delay of growth and puberty (CDGP) from pathological and nutritional from endocrine causes. The validation of the application involved comparing the application predicted and clinical diagnosis at each step of the algorithm. Results The mobile application diagnosis was concordant with clinical diagnosis in 408 (99.0%) with discordance in four (two with CDGP labeled as growth hormone deficiency [GHD] and two with GHD labeled as CDGP). Conclusions Mobile application guided short stature assessment has a high concordance with the clinical diagnosis and is expected to help point of care short stature evaluation.

To compare the diagnostic accuracy of IAP 2015, WHO and IAP 2007 growth charts in identifying pathological short stature in Indian children. The predictive value of the growth charts for pathological short stature was assessed in 500 (266 boys) short subjects (age 5–17.9 years) presenting to our pediatric endocrine clinic. WHO, IAP 2015, IAP 2007 criteria classified 500, 410 (82%) and 331 (66.2%) subjects short respectively. A total of 218 (43.6%) subjects had a pathological cause. Two out of 90 subjects short by WHO criteria but normal as per IAP 2015 had a pathological cause (2.2%) whereas 38 out of 79 subjects short as per WHO and IAP 2015 criteria but normal by IAP 2007 had pathological short stature. The diagnostic measures of IAP 2015 and IAP 2007 charts in identifying pathological short stature showed a sensitivity 99.1% and 81.7%, negative predictive value 97.8% as against 76.3%, positive predictive value 52.7% and 53.8%, and specificity of 31.2% and 45.7%, respectively. IAP 2015 growth charts are superior in identifying pathological growth failure compared to WHO and IAP 2007.

To study determinants and predictors of body fat in Indian children and adolescents. In this cross-sectional study, 5175 children and adolescents [3014 boys, age 12.8 (3) y, 5–18 y] participated. Determinants and predictors of body fat were assessed using partial correlation (corrected for age, and gender) and linear regression. Fat percentage correlated negatively with the duration of physical activity (r = −0.091, p

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.

Objectives The objectives of this study are to describe the incidence and age range of presentation of lateral neck cysts, to evaluate a management algorithm for adults presenting with lateral neck cystic lesions and to report the age incidence at which malignant cystic lesions in the neck have clinically presented as lateral neck cysts. Design A retrospective review of histologically diagnosed branchial cysts between 1995 and 2014 at a single centre. Setting Oxford University Hospitals NHS Foundation Trust. Participants A single senior head and neck pathologist and the ENT head and neck team. Main outcome measures Does a dedicated pathway help to identify malignancy in lateral neck cysts earlier in the diagnostic pathway? Results When using a random investigative pathway the sensitivity in distinguishing malignant from non-malignant was 93%, specificity 12% with a PPV of 83% and NPV 28%. When using a defined investigative protocol, the sensitivity was 94%, specificity 67%, PPV of 85% and NPV 86%. Conclusions This study conveys that using a structed pathway when working up patients with a lateral neck cyst results in a greater sensitivity, specificity, PPV and NPV in distinguishing malignancy compared to an unstructured workup. Key points 1) Establishing a lateral neck cyst as a benign structure is a diagnosis of exclusion 2) There is no established protocol for this pathway. 3) The need for a diagnostic pathway is important given the impact of COVID-19 4) The diagnostic challenge is differentiating benign from malignant 5) For lateral neck cysts a cut off age of 35 may not be appropriate

To estimate the time trend and prevalence of celiac disease in 208 children with type 1 diabetes by retrospective case review. Tissue transglutaminase (TTG IgA) levels were done within the first six months of diagnosis and annually on follow-up. Celiac disease was diagnosed in 35 (16.8%; 3 before diagnosis, 18 at initial screening and 14 on follow-up). 14 subjects with negative TTG serology at presentation, developed celiac disease after 3.9 (2.9) years (range 1.4 - 12.6 years, 85.7% within 5 years). Celiac disease is common in Indian children and adolescents with type I diabetes, developing in most within five years of diagnosis.

Background Strict isolation measures and interrupted health care services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as type 1 diabetes (T1D). Methods A cross-sectional, observational study was done to assess determinants of stress and its impact on glycemic control in adolescents and young adults (aged 12–24 years) living with T1D in India. An online, semi-structured survey including Perceived Stress Scale (PSS-10) was distributed and results were analyzed. Results A total of 89 participants (46 males, mean age 19.61 ± 3.8 years) with T1D completed the survey. Age (r = 0.325, p = 0.005) and HBA1C level within the preceding 3 months (r = 0.274, p = 0.036) correlated positively with PSS-10 scores. There was a statistically significant difference in PSS-10 score based on gender (t(70) = − 2.147; p = 0.035), education (F (4,67) = 4.34, p = 0.003), and occupation (F(3,68) = 4.50, p = .006). On multiple linear regression, gender, occupation, and HbA1C were the significant determinants of PSS-10 (F(3,55) = 12.01, p

Background - Strict isolation measures and interrupted healthcare services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as Type 1 Diabetes (T1D).Objective- To evaluate perceived stress towards COVID-19 among T1D individuals.Study Design - A cross-sectional, observational study. Participants - Adolescents and young adults (aged 10 - 25), living with T1D; and age, gender matched controls.Interventions - An online, semi-structured survey including Perceived Stress Scale. Outcomes - Determinants of stress and its impact on glycemic control.Results - A total of 97 cases (49 males; mean age 18.8 ± 4.5 years), diagnosed with T1D (mean diabetes duration 8.0 ± 5.0 years; mean HBA1C 8.1 ± 1.5%) completed the survey. Among cases, 53.6% reported moderate stress; 41.2% low stress and 5.2% severe stress. No significant difference was observed in the mean PSS score between the cases and controls. Cases with higher PSS scores tracked pandemic-related updates with significantly lesser frequency than those with lower scores (mean rank 78.75; p = 0.01). High PSS score was significantly associated with HbA1C over last 6 months (r 0.276; p = 0.015) and worsened glycemic control (mean rank 63.97 p = 0.012). Conclusion- An increased apprehension was seen regarding the acquisition of optimal diabetes management and care during the current infectious outbreak. Tele-medicine could emerge as an effective tool and a promising initiative to manage T1D patients during the pandemic.

To evaluate the time course and predictors of cerebral edema in diabetic ketoacidosis (DKA). Review of hospital records of 107 episodes of DKA between January 2013 to March 2019. Cerebral edema was identified in 26 (24.3%; 22 at presentation and 4 during treatment). Cerebral edema at presentation was associated with lower (

Aromatase deficiency is a rare autosomal recessive disorder characterized by impaired androgen to estrogen conversion. We report a 13.5-year-old girl initially misdiagnosed as simple virilising 21 hydroxylase deficiency who presented with delayed puberty. Work-up showed aromatase deficiency due to novel mutation in the aromatase gene. Estradiol replacement was associated with increased growth, skeletal maturation, bone density and adiposity. Early estrogen treatment in our case may have prevented metabolic complications and ovarian cysts.

Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.

As injectable therapies such as human insulin, insulin analogs, and glucagon-like peptide-1 receptor agonists are used to manage diabetes, correct injection technique is vital for the achievement of glycemic control. The forum for injection technique India acknowledged this need for the first time in India and worked to develop evidence-based recommendations on insulin injection technique, to assist healthcare practitioners in their clinical practice.

SMALL EFFORTS, BIG RESULTS: IMPACT OF AWARENESS AND TRAINING BY DIABETES EDUCATORS ON T1DM PATIENTSAUTHORSRishi Shukla1,2,3, Praveen Sachdeva 1,3, Ranjana Saxena 1,3, Deepak Yagnik 1,3, Sangeeta Shukla 1,2,3, Bhaskar Ganguli 1, P.C.bajpai 1, Ashok Taneja 1, Saurabh Mishra 1,2,3 and Manisha Gupta 1,2,3INSTITUTION1. Society for Prevention and Awareness of Diabetes (SPAD), Kanpur, India 2. Department of Endocrinology, Regency Hospital, Kanpur, India3. Center for Diabetes and Endocrine Diseases, Kanpur, IndiaBACKGROUNDI am Praveen and I have had Type1 diabetes for last 30 years. I was devastated after the diagnosis. I was admitted 3 times with ketoacidosis in the initial 2 years of my diabetes.I joined a non-government organization called