bluuebunny/crossref_metadata_2025 huggingface dataset:
A Proposed Evaluation Plan for the Diabetes Prevention and Control Program
Authors: Ramani Vinod K
Published: March 2023

Introduction:

India is projected to be the diabetes capital by the next decade, and Asians are predisposed to central obesity and visceral adiposity which puts them at additional risk for diabetes.

Materials and Methods:

The proposed evaluation plan draws reference from the non-communicable disease prevention and control program, implemented by the Karnataka Health Systems Development & Reforms Project (KHSDRP), Directorate of Health Services, Government of Karnataka (GoK) in collaboration with the World Bank, New Delhi, during the period 2012 to 2016. This evaluation will be conducted by an external agency in consultation with the Medical Officer/Investigator.

Results:

The relevant reports will officially benefit the District Program Officer and District Health Officer of Davangere and Dakshina kannda districts, Karnataka, India, where the program is being implemented.

Conclusion:

The results of this plan will benefit health promotion planning by the Health Department including building of community advocacy for the promotional initiatives.
Journey from EMPA-REG to CARMELINA to EMPEROR-Preserved
Authors: Gadve Sharvil S. , Chavanda Sneha , Gogate Yashpal V. , Harale Vinayak , Dasgupta Arundhati , Patwardhan Milind
Published: March 2023

Diabetes mellitus is present in more than two-fifths of the patients suffering from heart failure (HF), with the incidence being more than twice that found in the non-diabetic population. It doubles the risk of hospitalization and increases the risk of fatal outcomes, thus negatively affecting the prognosis in HF patients. The available pharmacological treatment options are limited, particularly in HF with preserved ejection fraction (EF). Empagliflozin is a sodium-glucose transporter-2 inhibitor, which has shown a protective effect against cardiomyocyte dysfunction through various mechanisms. The benefits of empagliflozin has been seen in multiple studies: EMPA-REG (April 2015), EMPRISE (June 18, 2019), EMPIRE-HF (2019), EMPA-AHF-RESPONSE (January 7, 2020), The EMPEROR Reduced (May 28, 2020), The RECEDE-CHF (November 3, 2020), SUGAR-DM (February 9, 2021), and EMPEROR-Preserved (April 26, 2021). Empagliflozin reduced the risk of all-cause mortality, HF hospitalizations, and biomarkers in patients with HF both with reduced and preserved EF in prospective and retrospective studies, regardless of the presence of diabetes. Linagliptin is a DPP-4i that has demonstrated renal safety with potential albuminuria benefits as well. Both these agents in combination have shown favorable effects on elevated blood pressure and intima-media thickness. Unlike some other gliptins, linagliptin was not associated with an increased risk of HF, rather a nominal reduction noted in CARMELINA (January 18, 2018). When added to the standard of care, it reduced the dose of insulin in high-risk diabetic patients with HF. The risk of hypoglycemia is significantly less in patients treated with linagliptin compared with sulfonylurea regimen as seen in CAROLINA (August 21, 2018). Thus, considering the plethora of clinical benefits demonstrated, a combination of empagliflozin and linagliptin in patients of diabetes at high risk of HF may be a suitable option for primary and secondary prevention.
Correlation of Plasma Magnesium with Insulin Resistance in Type 2 Diabetes
Authors: Adeleye Jokotade , Esan Arinola , Azeez Taoreed Adegoke , Sonuga Oyebola Oluwagbemiga
Published: March 2023

Introduction:

Insulin resistance (IR) is a core component of the pathophysiology of type 2 diabetes mellitus (DM). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is the most commonly used marker of IR. Plasma magnesium is a relatively cheap analyte and has been linked with the pathophysiology of IR. This study primarily was aimed at evaluating the possible use of plasma magnesium as a surrogate marker of IR in type 2 diabetes.

Materials and Methods:

The study was a hospital-based cross-sectional study carried out at a tertiary hospital in South-western Nigeria between March and September 2018. The study was conducted on 70 persons with diabetes, and age- and sex-matched 70 controls who met the eligibility criteria were recruited into the study. Ethical approval was obtained and informed consent was obtained from the participants. Fasting plasma glucose, fasting plasma insulin, and plasma magnesium were measured using standard protocols. HOMA-IR was determined using the appropriate formula. Data analysis was carried out using the Statistical Package for Social Sciences software, (SPSS) version 22.

Results:

The mean age of the participants was 53.34 ± 9.57 years and that of the gender-matched controls was similar. Frequency of hypomagnesemia was significantly higher in the participants compared with controls (25.7% vs. 5.7%; P < 0.001). Similarly, a significantly greater proportion of the study participants (62.9%) had IR as expected compared with just 8.7% of the controls. The mean plasma magnesium (mg/dL) among the participants was significantly lower than that of the controls (1.73 ± 0.16 vs. 1.87 ± 0.14; P < 0.001). As expected, the mean HOMA-IR in the participants was significantly higher than that of the controls (2.64 ± 0.91 vs. 1.71 ± 0.32; P<0.001). There was a statistically significant negative correlation between plasma magnesium and IR among the participants (r=−0.443; P<0.001). However, among the controls, there was no statistically significant correlation between plasma magnesium and HOMA-IR (r=−0.034; P = 0.778).

Conclusion:

Plasma magnesium was found to correlate significantly with IR and may be used as a surrogate marker of IR in persons with type 2 DM but not in the general population.
Vitamin D Deficiency and Diseases
Authors: Mahmood Yasir , Waris Nazish , Fawwad Asher , Basit Abdul
Published: March 2023

Objective:

Vitamin D deficiency is claimed to be associated with many diseases in the world population. Many studies reported that vitamin D deficiency is quite prevalent in Pakistan. The aim of this review is to describe the current status of vitamin D deficiency in healthy individuals and in different disease conditions in this country.

Materials and Methods:

Search engines such as “Google Scholar,” “Medline,” and “PubMed” were used by applying key words such as vitamin D deficiency and different disease conditions in the Pakistani population. In this study, people with vitamin D levels less than 30 ng/mL were reported as being vitamin D deficient.

Results:

A total of 82 studies were included: Among these, 12 studies showed vitamin levels less than 30 ng/mL in healthy individuals (male and female) and 70 studies in different disease conditions. It was found that about 64.6% of healthy subjects had vitamin D levels less than 30 ng/ml. Moreover, 70 studies showed vitamin D deficiency in some diseases, such as musculoskeletal, bone, and periodontal problems, nursing mothers and children, tuberculosis (TB), diabetes, cardiovascular problems, and some type of cancers.

Conclusion:

The current status of vitamin D deficiency in the healthy population and in several diseases and conditions is thoroughly discussed in this review. This review could be helpful in understanding the status of vitamin D and the different aspects of vitamin D research in this population.
Prevalence of Thyroid Dysfunction and Anti–thyroid Peroxidase Antibody in Gestational Diabetes Mellitus
Authors: Karat Arun , Radhakrishnan Chandni , Thulaseedharan Nallaveetil K. , Kalam Suneetha
Published: March 2023

Background:

Gestational diabetes mellitus (GDM) and thyroid dysfunction are the two common endocrine disorders affecting pregnancy. Some association was hypothesized between GDM and thyroid dysfunction in the literature. The main aim of this study was to unveil this metabolic interplay as better understanding may facilitate early diagnosis and intervention thereby limiting major fetal and maternal adverse events. Here we estimated the prevalence of abnormal thyroid function and anti–thyroid peroxidase (anti-TPO) antibody and also studied the risk factors for thyroid disorders in patients with GDM.

Materials and Methods:

This cross-sectional study was conducted between February 2014 and January 2015. A total of 100 consecutive pregnant women diagnosed to have GDM as per the American Diabetes Association 2013 recommendations were recruited and thyroid stimulating hormone, free triiodothyronine (T3), free thyroxine (T4), and anti-TPO antibody assays were done. Details regarding pregnancy outcome and any complications if present were also obtained and analyzed. The prevalence is expressed as proportions, and the statistical significance of risk factors was assessed using the chi-square test and independent t-test.

Results:

Abnormal thyroid function was detected in 31 (31%) patients, which includes 17 cases of subclinical hypothyroidism (54%), 10 hypothyroidism (32%), 2 (6%) subclinical hyperthyroidism, and one case each of isolated low T3 and isolated low T4. Anti-TPO antibody was positive in 35 patients (35%). History of GDM in previous pregnancy, family history of diabetes mellitus, presence of clinically detectable thyroid gland enlargement, and presence of anti-TPO antibody in serum were found to increase the risk of thyroid dysfunction. Majority of the subjects had uneventful delivery, and no significant increase in maternal or fetal complications was reported.

Conclusions:

This study showed a high prevalence of thyroid dysfunction and anti-TPO antibody in GDM patients. The significant thyroid abnormalities detected were subclinical hypothyroidism and hypothyroidism. The risk of thyroid dysfunction is elevated in patients with the presence of anti-TPO antibody. This scenario provides a strong ground to recommend meticulous assessment of thyroid function in GDM patients.
Non-communicable Disease Risk Factors among Garment Factory Workers in Bangladesh
Authors: Bhowmik Bishwajit , Kamruzzaman Md , Siddiquee Tasnima , Samad Mohammad A. , Khan Farook A. , Rashid Habibur , do Moreira Nayla C. V. , Alim Abdul , Khan Fazla A. , Milon Sarowar U. , Robed Mohammad A. , Hossain Abul H. , Hussain Akhtar , Khan Abul K. A.
Published: March 2023

Aim:

Many studies identified numerous health problems among industrial workers, in general, and garment workers. But a health problem with a specific focus on non-communicable disease (NCD) risk factors for Bangladeshi garment workers is lacking.

Objective:

The aim of this article is to investigate the NCD risk factors among garment workers in Bangladesh.

Materials and Methods:

A total of 4736 randomly selected garment workers aged ≥15 years in the Gazipur district of Bangladesh were investigated in a cross-sectional study from April 2014 to November 2014. Sociodemographic, anthropometric, and clinical details, including type 2 diabetes mellitus (T2DM) and hypertension (HTN), and albuminuria were collected by using a structured interviewer-administered questionnaire.

Results:

Among the study participants, the mean age was 27.6 ± 8.0 years. About 16.1% of the participants were underweight (body mass index <18.5 kg/m2), 15.8% were overweight (≥23.0–24.9 kg/m2), and 21.2% (≥25.0 kg/m2) were obese. The prevalence of central obesity based on waist circumference (male ≥90 cm and female ≥80 cm) and waist–hip ratio (male ≥0.90 and female ≥0.80) was 24.9% and 62.1%, respectively. The prevalences of T2DM (random blood glucose: ≥11.1 mmol/L), HTN (≥140/90 mmHg), and albuminuria (≥1+) were 7.0%, 13.9%, and 5.1%, respectively. The rates of general obesity and central obesity were significantly higher in females, and smoking habits, albuminuria, T2DM, and HTN were significantly higher in males. Increased age, male gender, general obesity, and central obesity were significantly associated with T2DM and HTN.

Conclusion:

The prevalences of T2DM, HTN, obesity, and albuminuria were common in study participants. Long-term follow-up studies of these workers are therefore warranted.
Diabetes Care During 50 Years of Bangladesh
Authors: Bhowmik Bishwajit , Siddiquee Tasnima , Ahmed Tareen , Afsana Faria , Samad M. A. , Pathan Md Faruque , Moreira Nayla Cristina do Vale , Alim Abdul , Milon Sarowar Uddin , Rahman Mohammad Mahbubur , Ozaki Rie , Khan Farook Azam , Hossain AHM Enayet , Mahtab Hajera , Hussain Akhtar , Khan Enayet
Published: March 2023

Similar to many other countries around the world, Bangladesh is also suffering from a pandemic of diabetes. It makes the most significant contribution to morbidity and mortality in this country. Despite the high burden of diabetes, health care is still geared toward episodic care. The government has not yet invested substantial efforts into developing a national policy to detect, prevent, and control diabetes. Still, diabetes care is restricted to capital and other big cities. More than 60% of people with diabetes usually sought treatment and advice from private facilities, including the Diabetic Association of Bangladesh. For the past six decades, the Association has been trying to develop a proper organizational framework, health care, educational institutions, rehabilitation facilities for poor people with diabetes, appropriate diabetes prevention, and education programs. To address the pandemic, the country should focus on nationwide diabetes prevention and control programs, such as creating community awareness and changing lifestyle practices through well-designed public health programs. The country also needs public–private partnerships and multi-sectoral approaches to overcome the diabetes burden.
Medical Nutrition Therapy in Gestational Diabetes Mellitus
Authors: S. Sindhu , Uma Mageshwari S.
Published: March 2023

Aim:

The aim of this study was to elicit information on the perception of dietitians about gestational diabetes mellitus (GDM) and their dietetic practices.

Materials and Methods:

A survey was conducted among dietitians working in hospitals, maternity centers, and other clinics using the purposive sampling criterion. A validated questionnaire was used to obtain details about the perception of GDM, guidelines used, dietetic screening, assessment, interventions and follow-up. Descriptive statistics were reported as frequency of total number of responses for each question. Fisher's exact test on perception of GDM, operating guidelines and topics discussed in diet consultations with respect to the years of clinical experience, age group and educational qualification of the participants were performed.

Results:

Perception of dietitians on family history of type2 DM as an associated risk factor of GDM had significant association with their clinical experience. Majorly discussed topic in diet consultation was carbohydrate distribution followed by protein requirement, fiber and small frequent meal pattern. On the basis of clinical experience of dietitians, difference was observed in discussed topics such as hypoglycemia, food groups, post-natal diet, and breast feeding. A major inconsistency observed was the nonavailability or lack in the use of pregnancy specific screening tool.

Conclusion:

Specific screening tools for pregnancy should be brought into practice. There is also the need for sustainable protocols in hospitals for uniformity in management of GDM.
Management of Gestational Diabetes Mellitus with Medical Nutrition Therapy
Authors: Salis Sheryl , Vora Natasha , Syed Shefa , Ram Uma , Mohan Viswanathan
Published: March 2023

Gestational diabetes mellitus (GDM) also referred to as hyperglycemia during pregnancy is posing to be a big health concern for women and is emerging as a major public health problem in India. Early diagnosis and tight glycemic control during pregnancy play a pivotal role in improving pregnancy outcomes in women with GDM. Once diagnosis is made, lifestyle behavioral changes with medical nutrition therapy (MNT) and physical activity form the first choice of therapy for the management of GDM. Failure to meet glycemic goals with these requires the addition of medication/insulin. Regular blood glucose monitoring and record keeping must be encouraged to improve adherence and review treatment efficacy. MNT for GDM is defined as a “carbohydrate-controlled” meal plan that provides adequate nutrition along with appropriate weight gain and fetal well-being to meet increased requirements of energy, protein, and micronutrients, achieve normoglycemia, and prevent nutritional ketosis. Choosing nutrient-dense carbohydrate sources which are low to moderate in glycemic index and glycemic load with focus on the correct amount and distribution of carbohydrates at meals helps control postprandial glucose excursions which is the biggest challenge in GDM. Blood glucose levels can be difficult to control in the morning due to increased insulin resistance secondary to dawn phenomenon seen in women with GDM. Splitting meals at breakfast has shown to improve post-breakfast blood glucose levels. This article is a comprehensive review of guidelines and scientific literature for the dietary management of GDM aimed at achieving normoglycemia, ensuring fetal and maternal wellbeing, and preventing adverse outcomes in pregnancy. The literature has been retrieved from various databases such as “Google Scholar,” “PubMed,” and “Cochrane Database of Systematic Reviews” using relevant keywords related to the topics discussed in this manuscript.
Quantitative and Qualitative Assessment of Indian Research Yield in Type 1 Diabetes during 1996–2020
Authors: Dayal Devi , Gupta Brij Mohan , Gupta Saniya
Published: March 2023

Background:

Type 1 diabetes (T1D) is a well-researched disease globally. The Indian contribution to global T1D research is unknown.

Objective:

The aim of this study was to provide a comprehensive assessment of publication output of Indian authors in the field of T1D.

Materials and Methods:

Scopus database was used to retrieve Indian publications on T1D during 1996–2019. The extracted data included the number of publications, citation metrics, top productive organizations and authors, research collaborations, most cited papers, and active journals, and were analyzed using appropriate bibliometric indicators.

Results:

Globally, the USA leads the ranking, of about 100 countries which participated in T1D research, with 29.3% of publication share, followed by UK (11.4%), and Germany, Italy, and Australia (6.9%–5.0%). India contributed only 1.7% (513 publications) share of global output, registered annual growth of 26.3% and averaged 9.7 citations per paper (CPP). Only 21.6% of publications involved international collaboration and 15.7% received funding. The two most productive organizations were PGIMER, Chandigarh and AIIMS, New Delhi with 51 and 43 papers, respectively. Indian Journal of Endocrinology and Metabolism (42 papers) and International Journal of Diabetes in Developing Countries (24 papers) were the two leading Indian journals, which published research on this topic.
Evaluation of the Association Between Social Determinants and Health-related Quality of Life among Diabetic Patients Attending an Outpatient Clinic in the Warangal Region, Telangana, India
Authors: Syed Wajid , Menaka Muthukkaruppan , Parimalakrishnan Sundararajan , Yamasani Vamshi Vishnu
Published: March 2023

Objective:

The present study aims to evaluate the association between sociodemographic characteristics and health-related quality of life (HRQoL) among diabetic patients attending a clinic situated in the Warangal region of Telangana, India.

Materials and Methods:

A cross-sectional study was conducted for 8 months in the diabetes outpatients’ clinic in the Warangal region, Telangana, India. A total of 402 patients were included in that study. The patients were assessed for QoL using the HRQoL-8-dimensional scale, which covers mainly Role Restriction Due to Physical Illness (6 items), Strength and Stamina (6 items), Health in General (3 items), Satisfaction with the Treatment (4 items), Symptoms Botherless (3 items), Financial Worries (3 items), Mental Health (5-items), and Satisfaction with Diet (2 items). All the items were assessed on a five-point Likert scale.

Results:

The mean age of the patients was 52.39 ± 11.01 (mean±SD). There was a statistically significant association between education and physical health (P=0.015), treatment satisfaction (P=0.006), emotional health (P=0.038), and diet satisfaction domain of HRQoL (P=0.006). The type of medication is associated with treatment satisfaction, financial worry, emotional health, and diet satisfaction (P=0.001). The patient's employment status is significantly different from the general health, financial, and emotional health of HRQoL (P=0.001). However, treatment satisfaction (P=0.044) alone was significantly associated with years of having diabetes.

Conclusion:

Adhering to treatment guidelines and provider recommendations helps patients to lead a healthy lifestyle.
Use of Telemedicine for the Management of Type 1 Diabetes in Children and Adolescents in Bangladesh During the COVID-19 Pandemic
Authors: Zabeen Bedowra , Bhowmik Bishwajit , Huda Kamrul , Naz Farzana , Tayyeb Samin , Azad Kishwar
Published: March 2023

Background:

Telemedicine has been an option for healthcare during the COVID-19 pandemic time. According to the COVID-19 forum on the International Society for Pediatric and Adolescent Diabetes, telemedicine is now the reality for all pediatric diabetes centers around the globe. We report here the analysis of telemedicine care provided to children and adolescents with type 1 diabetes by our diabetes team during the first phase of lockdown in Bangladesh.

Materials and Methods:

The Diabetic Association of Bangladesh (BADAS) is providing a highly structured and organized system of diabetes care as an extended arm of the government. Since the lockdown, diabetes care for children was started through telemedicine by the diabetes team in our center.

Results:

We analyzed our phone calls, text messages from March 26 to April 30, 2020. During lockdown, more than 645 calls, including text messages and WhatsApp messages, were received. A total of 235 patients were given advice over the phone in 1 month. Fifty-two percent of phone calls were from the capital city Dhaka and rest from other districts of Bangladesh. While analyzing the problems, three of our patients noticed mild fever, but there was no history of contact with infected persons, and they recovered within 2–3 days. No laboratory test was done for the confirmation of COVID-19. Most of the patients developed hyperglycemia during this period. None of them required hospital admission during this month. Free insulin from CDiC (Changing Diabetes in Children) and LFAC (Life for a Child) programs was sent to the BADAS centers in different districts through courier service even during the lockdown. So, there was no patient without access to insulin during pandemic time.

Conclusion:

Telemedicine service has been found to be a useful medium for the care of children with diabetes in Bangladesh during COVID-19 crisis. In the future, telemedicine service could be a solution for routine care of diabetic children who are unable or unwilling to travel long distances to a clinic.
Perspectives from Training the Care Coordinators—A New Cadre to Support Team-Based Diabetes and Depression Care in India
Authors: Sundari Balasundaram Bhavani , Poongothai Subramani , Anjana Ranjit Mohan , Rao Deepa , Tandon Nikhil , Sridhar Gumpeny R. , Sosale Aravind R. , Shankar Radha , Sagar Rajesh , Ali Mohammed K. , Mohan Viswanathan , Chwastiak Lydia
Published: March 2023

Purpose:

Comorbid depression and type 2 diabetes are associated with poor glycemic control, increased complications, and poor self-management, compared to either condition alone. The Integrating Depression and Diabetes Treatment (INDEPENDENT) clinical trial demonstrated the effectiveness of an integrated care model in improving diabetes and depression outcomes, in diabetes-specialty clinics in India. The INDEPENDENT model used task sharing to address the shortage of mental health professionals in India. Care coordinators (CCs) who were dietitians or counsellors were a key component of this care model. This article details the training and support provided to the CCs during the INDEPENDENT trial.

Materials and Methods:

CCs were nonphysician and nonpsychiatrist health specialists who supported patients in self-management of diabetes and depression, helping them set achievable goals and monitored progress. During the clinical trial, the CCs underwent both offsite and on-site trainings. The trainings equipped them with various lifestyle management tools for self-care, including one-on-one education sessions and motivational interviewing for self-monitoring, adherence to medication, diet, exercise regimes, and cessation of smoking, among others.

Results:

Nine CCs from the four sites were trained effectively during the course of the INDEPENDENT study from 2014 to 2018.

Conclusions:

Given the paucity of mental health professionals in India, the use of collaborative care and a team of well-trained CCs may be an effective strategy for the management of comorbid depression and diabetes. This model of care could help fill deficiencies in the delivery of care for comorbidity of depression and diabetes care in India.
Out-of-Pocket Expenditure for Diabetes Mellitus and Its Determinants in Recent Times in India
Authors: Ghosh Pritam , Dasgupta Aparajita , Paul Bobby , Roy Soumit , Ghose Sauryadripta , Yadav Akanksha
Published: March 2023

Introduction:

Diabetes is one of the major disease burdens in the world. Globally around 463 million people (at a prevalence of 9.3%) suffered from diabetes recently. Apart from morbidity and mortality, diabetes poses high economic burden on healthcare systems, especially on national economies in developing countries like India. Estimation of the cost burden of diabetes can help decision-makers to understand the magnitude of the problem, prioritize research efforts and interventions, and plan resource allocation, especially in resource-poor settings. The focus of our review was to summarize cost burden of diabetes and its determinants from existing literature in the last 10 years in India.

Materials and Methods:

All literatures published in the period 2010–2020 were accessed through two databases: PubMed and Google Scholar. Reference lists of the article were again searched for further literatures. Cost calculated in different times was converted to current price in 2020 for ease of comparison.

Results:

Studies reported a wide range of expenditures in different settings of care. Inequity of expenses across income quintiles among patients was found. Complication of diabetes, insulin therapy, treatment in private facility, and events of hospitalization were the factors associated to high expenditure burden.

Conclusion:

Financial risk protection for vulnerable people and control over medicine market price will reduce out-of-pocket expenditure for diabetes. Comprehensive strategy to delay onset of complication as well as its early detection can be an opportunity to cut down diabetes-related economic burden.
A Prospective Study to Evaluate the Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Type 2 Diabetic Patients with Chronic Kidney Disease
Authors: Saldanha Neil , Shah Mita , Dalal Monika S. , Virani Zaheer Amin , Parekh Ishan , Vora Hepal , Rajput Prashant , Tapiawala Shruti , Shah Bharat V.
Published: March 2023

Introduction:

Recent studies suggest that sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective at slowing the progression of kidney disease and lowering the risk of kidney failure in people with kidney disease and type 2 diabetes. There is no such study from India. The present study was performed to evaluate the effects of SGLT2i in Indian patients with diabetes and chronic kidney disease (CKD).

Materials and Methods:

This prospective study included 86 patients with diabetes and chronic kidney disease and with an estimated creatinine clearance of >30 mL/minute. Forty-one patients received SGLT2i and 45 patients did not receive SGLT2i. Patients were followed up for at least 12 months. Body mass index (BMI), blood pressure, HbA1c, urine protein to creatinine ratio (UPCR), doubling of serum creatinine and rate of decline of the estimated creatinine clearance were compared between the two groups.

Results:

The two groups were comparable at baseline in terms of age, sex, blood pressure, BMI, HbA1c, and degree of renal impairment. Over 12 months the UPCR decreased by 0.03 in SGLT2i group and increased by 1.1 in non SGLT2i group (P < 0.05). Doubling of serum creatinine occurred in 4.8% of patients in the SGLT2i group as compared to 18% in the control group (P < 0.05). The rate of decline of the estimated creatinine clearance in the SGLT2i group was 4.9 ml/min/year as compared to 9.4 ml/min/year in the non SGLT2i group (P < 0.05). At 12 months the BMI in the SGLT2i group decreased by 1.49 as compared to 0.12 in the non SGLT2i group (P < 0.05). The blood pressure and HbA1c control were similar in both groups during the study period suggesting that the observed effect was due to SGLT2 inhibition itself and not due to blood pressure or blood glucose control.

Conclusion:

Our study showed that treatment with SGLT2i had significant renoprotective effects, as shown by a reduction in urinary protein excretion, less percentage of patients developing doubling of serum creatinine, and a slower rate of decline in creatinine clearance.
Sitagliptin-Induced Hiccups
Authors: Agrawal Prabhat , Gautam Ashish , Pursnani Nikhil
Published: March 2023

Background:

Hiccups are a normal physiological response, but sometimes they become a cause of social embarrassment.

Materials and Methods:

A 72-year-old male who is a known case of type II diabetes mellitus for the last 6 years came to our outdoor department with complaints of hiccups. Currently, he was on Glimipride 2 mg daily for the last 6 years and on Sitagliptin 100 mg daily for the last 6 months.

Results:

On stopping Sitagliptin himself, his hiccups stopped.

Conclusion:

Hiccups are regarded as a normal behavior and time-limited symptom but if prolonged or intractable, a thorough history and investigation must be done to find out the cause which might lead to serious consequences. Most probably, this is the first case report showing that Sitagliptin is the cause of hiccups.
An Expert Opinion on the Management of Type 2 Diabetes Mellitus in Children and Adolescents
Authors: Rajput Rajesh , Jha Sujeet , Panda Jayanta Kumar , Subrahmanyam Appalavenkata Kandregula , Das Sambit
Published: March 2023

Type 2 diabetes mellitus (T2DM) is an emerging epidemic among children and adolescents. There is a lack of comprehensive guidance to clinicians for the management of T2DM in this patient population. An expert panel of diabetes specialists from India reviewed the available literature, discussed, and proposed six recommendations on the identification of risk factors leading to the development of T2DM, diagnosis of T2DM, and non-pharmacological and pharmacological management of T2DM in children and adolescents. According to these recommendations, the most common risk factors leading to T2DM in children are obesity, metabolic syndrome, insulin resistance, family history, puberty, and genetic abnormalities. Diagnosis of T2DM in children and adolescents should be based on plasma glucose levels, with recommendation to test glycated hemoglobin levels quarterly. Lifestyle modifications may help in improving outcomes. Among pharmacological treatments, insulin and metformin are currently the approved first-line therapies and liraglutide is recommended if glycemic targets are no longer met with metformin or insulins. Early identification of risk factors, along with early diagnosis and initiation of insulin therapy with lifestyle modifications, may help in delaying the chronic complications associated with T2DM in children and adolescents.
Serious Adverse Effects Following use of Liraglutide in Individuals with Type 2 Diabetes
Authors: Easow Benjamin M. , Mathew Milly , Rajagopalan Urjitha , Nagarajan P. , Abraham Georgi
Published: March 2023

Glucagon-like peptide-1 (GLP-1) analog liraglutide is extensively used for type 2 diabetes mellitus, especially in those with overweight and cardiovascular risk factors. The risk benefit ratio favors their use. The life-threatening complications such as cholecystitis and pancreatitis are infrequently reported. Here we report two patients who developed recurrent gallstone diseases with cholestatic jaundice and acute pancreatitis in a male patient and an asymptomatic large gallstone stone in a female kidney transplant patient with no previous evidence of gallstone disease. This highlights the importance of surveillance screening in patients on liraglutide to prevent the development of complications.
Assessment of Diabetes Risk Using Indian Diabetes Risk Score Among Medical Students at a Medical College in Telangana, India
Authors: Kokiwar Prashant Ramdas
Published: March 2023

Objective:

The aim of this article is to assess the risk of diabetes among medical students in one medical college using IDRS (Indian Diabetes Risk Score) and to study the association between risk of diabetes and various factors.

Materials and Methods:

An institution-based cross-sectional study was carried out among 246 medical students at Mall Reddy Institute of Medical Sciences, Hyderabad, Telangana, India from June to July 2019. Questions pertaining to modified IDRS and measurements such as waist circumference were recorded.

Results:

The mean IDRS (34.15±11.57) indicated that this population was at moderate risk of diabetes. Majority (78%) were at moderate risk. IDRS was not found to be associated with blood pressure (mean systolic blood pressure for IDRS <30=117.51±6.25; for 30–50=115.72±6.65; and for >60=117.78±6.06; mean diastolic blood pressure for IDRS <30=75.55±6.15; for 30–50=75.39±6.26; for >60=73.33±6.14). Being female (mean IDRS =35.55±11.48 vs. 30.93±11.62 for males) and being overweight or obese (mean IDRS =36.84±11.56 vs. 33.07±11.54 for normal weight) were significantly associated with IDRS (P < 0.05).

Conclusion:

This population was at moderate risk of developing diabetes. Overweight or obese patients and females had higher IDRS and thus they were at more risk of developing diabetes in future.
Research Design for a Randomized Control Trial to Assess the Effects of Almond Supplementation on Insulin Resistance, Glycemic Markers, and Inflammation Among Overweight Asian Indians
Authors: Gayathri Rajagopal , Kalpana Natarajan , Manasa Valangaiman Sriram , Sudha Vasudevan , Shobana Shanmugam , Jeevan Raman Ganesh , Anjana Ranjit Mohan , Unnikrishnan Ranjit , Gokulakrishnan Kuppan , Krishnaswamy Kamala , Beatrice D. Annette , Pradeepa Rajendra , Mattes Richard , Salas-Salvadó Jordi , Willett Walter , Mohan Viswanathan
Published: March 2023

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.
Association of Stress, Depression and Anxiety among Individuals with Microvascular Complications in Type 2 Diabetes
Authors: Vidyulatha Jayaram , Pramodkumar Thyparambil Aravindakshan , Pradeepa Rajendra , Poongothai Subramani , Thenmozhi Somasundaram , Venkatesan Ulagamathesan , Jebarani Saravanan , Anjana Ranjit Mohan , Mohan Viswanathan
Published: March 2023

Background and Aims:

The impact of a chronic illness like diabetes on physical and mental wellbeing has been gaining more focus in the last few decades. This study aimed to investigate the association of stress, depression, and anxiety among individuals with type 2 diabetes mellitus (T2DM) and microvascular complications.

Materials and Methods:

This cross-sectional study included 315 participants aged ≥20 years with T2DM seen at a tertiary care diabetes centre who were screened for diabetic retinopathy, nephropathy, and neuropathy and assessed for stress, depression, and anxiety using the Depression, Anxiety Stress Scale 21 (DASS 21). Diabetic retinopathy was classified according to the Early Treatment Diabetic Reinopathy Study grading system diagnosed using retinal photography [Early Treatment DR Study grading system] i.e., presence of at least one distinct microaneurysm; nephropathy, if urinary albumin excretion was ≥30 mg/μg of creatinine; and neuropathy, if vibration perception threshold of the big toe using biothesiometry was ≥20 V.

Results:

Prevalence of stress was higher in those with neuropathy (60% vs 40%, P < 0.001), nephropathy (61% vs 39%, P < 0.001) and retinopathy (57% vs 43%, P < 0.05) compared to those without. Prevalence of depression was also higher in individuals with neuropathy (66% vs 34%,P < 0.001), nephropathy (58% vs 42%, P < 0.001) and retinopathy (55% vs 45%, P < 0.05). In multiple regression analysis, stress was significantly associated with retinopathy (OR=3.13,CI:1.75–5.58, P < 0.000), neuropathy (OR=2.50, CI:1.42–4.39,P < 0.001) and nephropathy (OR=2.06,CI:1.19–3.56, P < 0.010),depression was also significantly associated with retinopathy (OR=1.97,CI:1.04–3.73, P < 0.037), neuropathy (OR=2.77,CI:1.45–5.30,P < 0.002) and nephropathy (OR=2.59,CI:1.42–4.70,P < 0.002).

Conclusions:

Individuals with microvascular complications of diabetes should be screened for stress, depression, and anxiety so that proper counselling can be given.
Sweetening Sixteen
Authors: Phatak Sanjeev R. , Saboo Banshi , Dwivedi Shivangi , Zinzuwadia Padmanabh , Panchal Dharmendra , Ganguli Abhilasha , Hasnani Dhruvi
Published: March 2023

As the epidemic of type 2 diabetes continues to grow, newer pathophysiologic mechanisms of diabetes are being unraveled in quick succession. From a simplistic model of insulin deficiency and insulin resistance, researchers have moved to a multipronged explanation of the disease. In addition to the ominous octet, eight other players, such as catecholamines, vitamin D deficiency, renin–angiotensin system, testosterone deficiency, melatonin, renal gluconeogenesis, intestinal sodium-glucose cotransporter 1, and gut microbiota, seem to participate in the etiopathogenesis of glucose intolerance and type 2 diabetes. Collectively, these 16 players comprise a cluster of interrelated etiologies implicated in the pathogenesis of diabetes, prompting the authors to address them as the “sweetening sixteen.” While exploring these factors, the authors wish to emphasize that diabetes treatment should focus on the reversal of these proposed pathogenetic defects and not simply reduction of hemoglobin A1C.
Postpartum Abnormal Glucose Tolerance and Predictive Factors Among Women with Gestational Diabetes Mellitus in Gampaha District, Sri Lanka
Authors: Sudasinghe Buddhika Hemali , Wijeyaratne Chandrika Neelakanthi , Ginige Samitha P.
Published: March 2023

Context:

Gestational diabetes mellitus (GDM) is a recognized risk for abnormal glucose tolerance (AGT) long-term.

Aims:

The aim of this study is to determine the prevalence of postpartum diabetes and AGT and predictive factors among Sri Lankan women with GDM.

Settings and Design:

The follow-up study was conducted in Gampaha District, Sri Lanka.

Materials and Methods:

Pregnant women with GDM were identified by a community-based longitudinal study (n = 1200) by WHO 1999 criteria and followed up till 1 year postpartum. Study instruments were interviewer-administered questionnaire, anthropometric measurements, and fasting 75 gOGTT.

Statistical Analysis Used:

χ2 tests with P-values and odds ratios (ORs) with 95% confidence interval (CI) were used to assess the statistical significance and strength of the associations. Predictive factors of postpartum AGT were identified by the multivariate analysis.

Results:

Of those identified with GDM (194), 169 participated in postpartum follow-up at 2 months (87.1%). Of the 169, 59 participated at 1 year. At 2 months, 17/169 (10.1%) had diabetes and 55/169 (32.5%) had AGT (diabetes=17, impaired glucose tolerance= 36, impaired fasting glucose=2). At 1 year, 11/59 (18.6%) had diabetes and 28/59 (47.5%) had AGT. Predictive factors of postpartum AGT at 2 months were 2-h postprandial blood sugar (2-h PPBS) before 12 weeks ≥97.5 mg/dL (adjusted OR (aOR)=2.8; 95% CI=1.3–6.0), GDM diagnosis before 16 weeks (aOR=7.7; 95% CI=1.5–39.7), and 1-h oral glucose tolerance test (OGTT) ≥179 mg/dL (aOR=3.1; 95% CI=1.5–6.4). Predictive factors of postpartum AGT at 1 year were 2-h PPBS before 12 weeks ≥97.5 mg/dL (aOR=8.4; 95% CI=2.3–30.3) and physical activity (aOR= 0.2; 95% CI=0.1–0.8).

Conclusion:

Postpartum AGT following GDM is high among Sri Lankan women. Long-term follow-up is recommended.
Management of Pterygium Using Autologous Blood for Conjunctival Graft Fixation
Authors: Gupta Anushree , Verma Anil Kumar
Published: March 2023

Aims and Objectives:

This study aimed to study the efficacy and surgical outcome of using autologous blood for conjunctival autografting in pterygium excision.

Materials and Methods:

A prospective, interventional hospital-based study was carried out over 17 eyes of 17 patients having primary or recurrent pterygium. Pterygium excision followed by conjunctiva autografting was performed in all the patients. Conjunctiva graft was fixed to the host bed using autologous blood which was followed by bandaging for 24 h. The patients were followed up postoperatively on day 1, week 1, week 2, month 1, month 3, and for recurrence up to 6 months. They were examined for any complications or recurrence.

Results:

There were a total of 17 patients, of which 13 were females and 4 were males. The mean age of all the patients was 54.76 ± 8.55 years, range: 41–70 years. Graft-related complication was mild decentration in 1 eye, graft edema in 9 eyes, and lost graft seen in 2 eyes. Recurrence occurred in one eye. No other complication was noted. Good postoperative cosmesis was achieved.

Conclusion:

Fixation of conjunctival autograft using autologous blood in pterygium surgery is a safe and economical method. The main disadvantage of this procedure is the loss of graft that can occur in the immediate postoperative period.
Chloroquine and hydroxychloroquine in the environment and aquatic organisms: a review
Authors: Ferreira Marina Tauche , Carvalho Cleoni dos Santos
Published: March 2023

Chloroquine and hydroxychloroquine are aminoquinolines used in the treatment of endemic diseases in Latin America such as malaria and non-endemic with wide prevalence such as rheumatoid arthritis and lupus erythematosus. Described as persistent, bioaccumulative, and dangerous for aquatic biota, chloroquine and hydroxychloroquine are considered emerging pollutants intensified by the COVID-19 pandemic, occurring in low concentrations that are not totally removed in wastewater treatment plants and are not covered by legislation. This article presents a theoretical approach based on literature review following a semi-systematic methodology covering detection strategies of the chloroquine and hydroxychloroquine drugs in effluent and receiving water bodies; estimates of environmental concentrations during the pandemic; methods that use degradation and removal of compounds from water; and toxic effects on aquatic biota. Concentrations previously detected and estimated in the aquatic environment can lead to significant changes in animal physiology analyzed from biomarker changes, behavior and mortality in studies with native and non-native species. Studies are necessary to reproduce and understand possible environmental scenarios adopting the indiscriminate use of drugs to serve as standards for environmentally safe concentrations when there is no specific legislation.

Keywords: COVID-19, emerging pollutants, toxicity.
Hydrologic and hydraulic modeling to assess the efficiency of structural flood control measures: case study of Audi-União District in the city of Curitiba, Brazil
Authors: Cruz Letícia Giese de Andrade , Andrade Fernando Oliveira de , Prestes Márcia Ferreira , Bezerra Stella Maris da Cruz , Polli Simone Aparecida
Published: March 2023

The objective of this study is to assess the efficiency of flood control measures implemented in the Audi-União District, located on the Iguaçu River floodplain in the city of Curitiba, Brazil, by the application of hydrological-hydraulic modeling using HEC-HMS and HEC-RAS software packages. The scenarios of the years of 2014, 2024 and 2034 with return periods of 10, 25, 50 and 100 years were analyzed. It was observed that the set of hydraulic structures located upstream of Audi-União District can reduce the peak flow at the beginning of the Iguaçu River by 31.4% and the flood area by 35.1%, considering the period of return of 100 years and the land use of 2014. Regarding the measures implemented directly by the Audi-União District, it was observed that the built levee can control floods in the area, except for a small area that is not protected by the levee, in both 2014 and future scenarios. The creation of the Iguaçu Environmental Protection Area and the relocation of families, which were non-structural measures implemented in the region, also proved to be efficient, considering that these areas would suffer from flooding even for rainfall events with a period of return of 10 years.

Keywords: Flood control, HEC-HMS, HEC-RAS.
Cluster patterns in Landau and leading singularities via the amplituhedron
Authors: Gürdoğan Ömer , Parisi Matteo
Published: March 2023

We advance the exploration of cluster-algebraic patterns in the building blocks of scattering amplitudes in

\mathcal{N}=4

super Yang–Mills theory. In particular, we conjecture that, given a maximal cut of a loop amplitude, Landau singularities and poles of each Yangian invariant appearing in any representation of the corresponding leading singularities can be found together in a cluster. We check these adjacencies for all one-loop amplitudes up to 9 points. Along the way, we also prove that all (rational)

N{^2}MHV

Yangian invariants are cluster adjacent, confirming original conjectures.
A formula for the minimal perimeter of clusters with density
Authors: Scattaglia Vincenzo
Published: March 2023

This paper deals with the isoperimetric problem for clusters in a Euclidean space with double density. In particular, we show that a limit of an isoperimetric minimizing sequence of clusters with volumes

\mathbf{V}

is always isoperimetric for its own volumes (which may be smaller than

\mathbf{V}

). In particular, if it is strictly smaller, we provide an explicit formula.