bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.