bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of Diabetologists and Obstetricians’ Practice Patterns Related to Care for Gestational Diabetes Mellitus During the COVID-19 Pandemic in India
Authors: Bhavadharini Balaji , Uma Ram , Anjana Ranjit M. , Mohan Viswanathan 
Published: March 2023

Aim:
There are limited data on the management of gestational diabetes mellitus (GDM) during the coronavirus disease 2019 (COVID-19) pandemic. This survey was carried out in India to understand the practice patterns of diabetologists and obstetricians (OBs) during the pandemic.

Materials and Methods:
An online questionnaire was designed, and the link to the survey was shared with doctors through email. Questions were related to the diagnosis and management of GDM both before and during the COVID-19 pandemic.

Results:
A total of 117 diabetologists and 90 OBs from different parts of India participated in the survey. During the COVID-19 pandemic, diabetologists carried out higher random glucose and HbA1c tests and lower numbers of oral glucose tolerance tests (OGTTs), but differences compared with before COVID-19 were nonsignificant. The OBs reported doing a significantly lower number of OGTTs (85.6% vs. 95.6%, P = 0.02) and significantly more HbA1c tests (16.7% vs. 5.6%, P = 0.03) and self-monitoring of blood glucose (59.4% vs. 37.1%, P < 0.0001) during the pandemic, than earlier. Although 97% of all the doctors surveyed reported using some form of telemedicine, several challenges were identified.

Conclusion:
The COVID-19 pandemic has resulted in changes in the management of women with GDM. The use of digital technologies could help improve the care of women with GDM during such pandemics.
Diabetes Care during Humanitarian Crises due to Floodings and Earthquakes in IDF-MENA Region
Authors: Odhaib Samih A. , Masood Shabeen N. , Belkhadir Jamal , Sandid Mohamad , Shaikh Zaman , Farooq Farah N. , Naz Fizza , Masood Faryal T. , Ayub Ayesha , Bilal Ahmed 
Published: March 2023

Background:
Diabetes care in humanitarian crises after the devastating 2005 earthquake in Pakistani Jammu and Kashmir, and in 2022 huge floodings across Pakistan is challenging due to many topographic reasons related to the terrain and the infrastructure

Materials and Methods:
In this article, 197 articles were reviewed from PubMed and Google Scholar using conveniently related search terms in the titles and abstracts published from (2000-2022). Additional information was retrieved from the official sites of active international aid organizations and news agencies.

Results:
It was found that the preparedness plans for proper diabetes care in disaster and non-disaster settings are unsatisfactory in malfunctioning healthcare infrastructures and the non-availability of life-saving medications like insulins. These plans are not fulfilling the needs of the people living with non-communicable diseases like diabetes and hypertension. The role of the international aid organizations after 2005 was directed toward immediate care of traumatic conditions and their complications, infectious diseases control, mental health, care for the elderly, and orphanage care but not covering the diabetes care.

Conclusions and Recommendations:
The healthcare authorities should adjust a disaster preparedness plan for the country, integrating noncommunicable disease control as a pivotal part and mitigating the current deficit in diabetes care for people in need in different humanitarian crises.
Accessibility and Availability of Insulin
Authors: Saad Michele Abi , Masood Shabeen Naz , Al Bache Nizar , Odhaib Samih Abed , Belkhadir Jamal , Shegem Nadima 
Published: March 2023

Introduction:
One hundred years after its discovery, insulin is still inaccessible for many people living with diabetes. In the recent World Health Organization (WHO) 2021 report on Barriers to Insulin Availability, WHO highlights the alarming state of global access to insulin. According to International Diabetes Federation (IDF), as reported in IDF Atlas, 10th edition, 73 million adult people with diabetes (PWD) live in Middle East and North Africa (MENA) Region.

Materials and Methods:
A survey was conducted in the International Diabetes Federation (IDF) MENA Region through its Member Associations in 2021. Eighteen countries out of 21 participated. Questions were about insulin support, beneficiaries, local production, insurance coverage, average cost, minimum wage, and barriers to access.

Results:
Fifty percent of countries had full government support and 44% had partial. In 56 % of countries, support is limited to human insulin, and the majority is restricted to citizens. Some PWDs have difficulties accessing insulin: low-income persons, refugees, noncitizens, or living in remote areas. Approximately 61% of countries have national social security funds and 61% private insurance coverage for insulin. In five countries, there is a law prohibiting nongovernmental organizations to receive international donations of insulin. Local production exists in only five countries surveyed. There is a wide variation in the cost of insulin from $1.42 to 100 and in the minimum wage ($7–2667). Additional barriers to access were delivery, storage, cost, electricity, war conditions, displacements, and sanctions.

Conclusion:
Although government support is available in the majority of countries, it is still mainly through the provision of human insulin and restricted to citizens. Many barriers affect access to insulin and its costremains unaffordable. Disparities exist between countries within the same classification of income. Mapping the current situation will help to improve it and monitor change. This document can be informative for PWD living or visiting any of these countries and can help understand cross-border travel for medical treatment, and local and regional policies.
Design and Methodology of a Randomized Crossover Trial to Test the Effect of Low and High dAGE Diets on Metabolic Risk Factors and Inflammatory Markers among Overweight and Centrally Obese Asian Indian Adults
Authors: Bai Mookambika Ramya , Vedantham Srinivasan , Shobana Shanmugam , Nagarajan Lakshmi Priya , Rajagopal Gayathri , Gunasekaran Geetha , Nagamuthu Gayathri , Chandrashekaran Anitha , Gokulakrishnan Kuppan , Sandhya Narasimhan , Regin Bhaskaran Sarojam , Ganeshjeevan Ramajeevan , Muthuswamy Balasubramanyam , Anjana Ranjit Mohan , Unnikrishnan Ranjit , Krishnaswamy Kamala , Mohan Viswanathan , Sudha Vasudevan 
Published: March 2023

Background:
Heat processing of foods accelerates the formation of advanced glycation end products (AGEs). Dietary AGEs (dAGEs) could exacerbate the risk for diabetes, by adversely affecting glucose metabolism. Asian Indian diets have not been evaluated for AGEs and their effect on metabolic risk factors.

Objective:
As a proof of concept, we report the dAGE content of Indian foods to further plan the design and methodology of a study that would evaluate the effect of high and low dAGE diets on metabolic risk factors such as insulin resistance, glycemia, lipid profile, and inflammatory markers in overweight and centrally obese Indian adults without diabetes.

Materials and Methods:
This randomized crossover trial includes 50 overweight and centrally obese adults aged 25–45 years with body mass index (BMI) ≥23 kg/m2 and waist circumference (WC) ≥90cm in men and ≥80cm in women. Participants will be provided 12 weeks each of low and high dAGE diets (with the dAGE content being measured by enzyme-linked immunosorbent assay), matched for calories and macronutrients with a 2-week washout period in between the two diets. Low dAGE diets use steaming, boiling, and pressure cooking compared to deep frying, stir frying, and roasting in high dAGE diets. Biochemical measures will be assessed both at baseline and the end of each diet using standard protocols. The difference in outcome measures will be evaluated (analysis of variance and paired t test) using SAS (version 9.2).

Results:
The dAGE content was found to be 49709 ± 5239 vs. 26178 ± 4327 mg/day (mean ± standard deviation [SD]) in high and low dAGE diets, respectively (P < 0.001). Baseline demographic and biochemical characteristics did not differ between low and high dAGE diet interventions.

Conclusion:
The study trial will throw light on the effect of high and low dAGE diets on metabolic risk factors in overweight and centrally obese Indian adults, potentially leading to a novel dietary strategy to prevent diabetes in this population.
An Unusual Side Effect of Metformin—Nightmare and Abnormal Dreams
Authors: Agrawal Prabhat Kumar , Gautam Ashish , Pursnani Nikhil , Parihar Awantika , Singh Boentika 
Published: March 2023

Background and Aims:
Metformin is universally accepted as first-line oral hypoglycemic agent for type 2 diabetics, with a low side effect profile and very few serious complications reported till date.

Materials and Methods:
A 30-year-old male, newly diagnosed diabetic was started sitagliptin + metformin (50/500) combination two times daily and presented with the complaint of nightmare and abnormal dreams.

Results:
On stopping metformin, the patient does not experience nightmares and abnormal dreams.

Conclusion:
We found an unusual side effect of metformin causing nightmare and abnormal dreams.
Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus in Dubai Hospital
Authors: Saquib Shabnam , Tambawala Zenab Y. , Waheed Seema , Hubaishi Nawal M. 
Published: March 2023

Aim and Objectives:
Pregestational diabetes mellitus (PGDM) affects less than 1% of the obstetric population. It has a significant impact on maternal and fetal morbidity and mortality. This study aimed at evaluating antenatal care and pregnancy outcomes in women with PGDM who delivered in Dubai Hospital during 2017–2019.

Materials and Methods:
A retrospective analysis of all women with diabetes mellitus who delivered in a tertiary care hospital at Dubai from January 1, 2017, to December 31, 2019, was conducted. Maternal characteristics, type of diabetes mellitus, prepregnancy and antenatal glycemic control, mode of delivery, birth weight, and perinatal outcomes were evaluated during the study period. We also compared glycated hemoglobin (HbA1c) levels prepregnancy and during the antenatal period in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), with its impact on maternal and fetal outcomes.

Results:
There were 7284 women who delivered during the study period at our hospital, out of whom 28 women (18.8%) had T1DM and 121 women (81.2%) had T2DM. A total of 144 (96.6%) patients were booked in the antenatal-diabetes mellitus combined clinic. Seventy-nine (53%) women had measured HbA1c within six months before pregnancy. Only 53% women preconceptionally had HbA1c levels <6.5%; however, by the third trimester, 74% of women achieved HbA1c <6.5%. Antenatally, 26 women were associated with essential hypertension, 10 with nephropathy, and eight with retinopathy and 12 women developed preeclampsia. Forty-six (30%) women had preterm delivery at less than 37 weeks. This was significantly higher in T1DM versus T2DM (50% vs. 27%, P value = 0.01). The cesarean section rate was 62%, and 50% of them were due to repeat elective cesarean section. Twelve babies born were more than 4kg, and one of them weighed more than 5kg (5.270kg). There were five cases with stillbirth, no neonatal death was recorded within seven days, and the perinatal mortality rate was 30/1000.

Conclusion:
The interval prevalence of PGDM in our cohort was 2%. Achieving HbA1c levels <6.5% in two-third of the women with diabetes mellitus by the third trimester resulted in a prevalence of macrosomia (8%) similar to the general population.
A Study of Lifestyle Modifications with and Without Metformin in Prediabetic Subjects
Authors: Basavareddy Asha , Sarala Narayana , Nanjappa Venkatarathnamma P. , Eshwarappa Sumathi M. 
Published: March 2023

Purpose:
Prediabetes is a stage in the natural history of impaired glucose metabolism rather than as a distinctive clinical entity. The primary objective was to compare the effect of lifestyle modifications (LSMs) with and without metformin in prolonging the onset of diabetes mellitus in prediabetics.

Materials and Methods:
This study is an open label, parallel group comparative study conducted from 2016 to 2020. One hundred and four prediabetic subjects were assigned to two groups: group I (51) LSM and group II (53) metformin 500 mg along with LSM. Baseline investigations included fasting blood sugar (FBS), post-prandial blood sugar (PPBS), HbA1c, and lipid profile, followed up for 12 months.

Results:
The baseline parameters were comparable between the groups. In both the groups, there was a significant reduction in abdominal circumference, total cholesterol, triglycerides, low-density lipoprotein, FBS, PPBS, and HbA1c between baseline and 1 year. There was no significant difference between groups I and II in reduction of all the above-mentioned parameters. The outcomes of prediabetic subjects after 1 year of treatment in both the groups were comparable. Only one (2.1%) subject had more than 126 mmHg FBS in the LSM group. The adverse effects observed were dizziness, nausea, flatulence, myalgia, abdominal pain, and heart burn, which were mild to moderate in intensity and in most patients it subsided with time.

Conclusion:
LSM alone was equivalent to LSM along with metformin in effective control of blood sugars. Lipid profile and weight may be significantly reduced.
A Cross-Sectional Survey of Diabetes Care Providers’ Perceptions and Potential Barriers to the use of Continuous Glucose Monitoring Technology in Singapore
Authors: Yap Phoebe X. C. , Koh Leroy , Gallagher Paul J. , Lum Zheng Kang 
Published: March 2023

Context:
Given the large disease burden of diabetes in Singapore, we felt a need to study the reasons for the low uptake of continuous glucose monitoring (CGM) in Singapore, despite its recognized benefits and international recommendation.

Aims:
The aim of this article is to identify perceptions of diabetes care providers (DCPs) and extent of barriers to promoting CGM uptake in Singapore.

Settings and Design:
This is a cross-sectional study in Singapore.

Materials and Methods:
A cross-sectional online survey of DCPs over 21 years of age, who provided direct outpatient care to diabetes patients in Singapore and spent minimally 50% of their total patient care time on diabetes care services, was conducted.

Statistical Analysis Used:

K-means cluster analyses grouped respondents by their diabetes technology and CGM attitudes, barriers to employing CGM clinically, and perceived barriers by patients for CGM uptake and adherence. Fisher's exact tests and Kruskal–Wallis tests assessed for inter-group demographic differences.

Results:
From a total sample of 47 respondents, analyses formed three clusters, describing DCPs’ willingness to recommend CGM uptake. All respondents agreed cost is the top barrier. Willing (48.9% of sample) and Unwilling (23.4%) DCPs reported minimal and many barriers to employing CGM clinically, respectively, whereas Eager DCPs (27.7%) reported none. Eager and Willing DCPs, who perceived cost as the only barrier by patients, had more positive diabetes technology and CGM attitudes versus the Unwilling DCPs that perceived many barriers by patients.

Conclusion:
Local DCPs agreed on the role of CGM in optimizing glycemic control, and that cost is the top barrier against CGM uptake.
Evaluation of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio as Markers of Diabetic Kidney Disease in Bangladeshi Patients with Type 2 Diabetes Mellitus
Authors: Kamrul-Hasan A.B.M. , Mustari Marufa , Asaduzzaman Md. , Gaffar Md Abu Jar , Chanda Palash Kumar , Rahman Mohammad Motiur , Hannan Mohammad Abdul , Akter Farhana , Saifuddin Mohammad , Selim Shahjada 
Published: March 2023

Background:
The roles of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as novel surrogate markers of diabetic kidney disease (DKD) are promising.

Objective:
The aim of this study was to evaluate whether NLR and PLR can predict DKD in type 2 diabetes mellitus (T2DM).

Subjects and Methods:
This cross-sectional study was conducted from July 2018 to June 2019, among 312 patients with T2DM recruited from eight tertiary hospitals throughout Bangladesh. Complete blood count (CBC) was performed in fully automated hematology analyzers, and NLR and PLR were calculated. The urine albumin-to-creatinine ratio (ACR) was measured in a random single-voided urine sample. The diagnosis of DKD was made based on the presence of albuminuria (ACR ≥30 mg/g) and/or reduced estimated glomerular filtration rate (eGFR <60mL/min/1.73 m2) in the absence of signs or symptoms of other primary causes of kidney damage.

Results:
Among 312 study subjects, 150 (48.1%) had DKD. The mean age (51.9 ± 11.9 vs. 48.6 ± 9.6 years), fasting plasma glucose (10.3 ± 4.1 vs. 9.2 ± 3.0 mmol/L), 2-h postprandial plasma glucose (14.6 ± 5.6 vs. 12.8 ± 4.5 mmol/L), glycated hemoglobin (HbA1c) (9.2 ± 2.1 vs. 8.4 ± 1.9%), and serum triglyceride (213.6 ± 109.9 vs. 185.5 ± 100.8) were higher (P ≤0.05 in each instance) in subjects with DKD in comparison to those without DKD. DKD group had higher mean absolute neutrophil count (6.0 ± 2.0 vs. 5.4 ± 1.9 ×109/L, P = 0.022), platelet count (310.4 ± 87.3 vs. 287.0 ± 78.7 ×109/L, P = 0.013), NLR (2.16 ± 1.1 vs. 1.92 ± 0.96, P = 0.040), and PLR (115.45 ± 57.07 vs. 101.02 ± 40.06, P = 0.010). The levels of hemoglobin, total leukocyte count, absolute lymphocyte count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width were similar in the two groups.

Conclusion:
In this study, we found higher NLR and PLR in subjects with DKD than those without DKD. NLR and PLR may be considered as cheap, readily available alternative markers of DKD in resource-poor settings.
Prevalence of Diabetes in Odisha, India
Authors: Supakar Sanjeev , Nayak Sachidananda , Behera Lipika , Kshatri Jaya , Pradhan Purna Chandra 
Published: March 2023

Objective:
The objective of this review was to summarize and compare the estimates of diabetes among adults in community and hospital-based settings in Odisha, India.

Introduction:
Diabetes Mellitus (DM) is a major non-communicable disease as well as a risk factor. In a vast and diverse country such as India, where health is a state subject, regional synthesized and up to date estimates of DM burden is necessary for informed policy making. No such estimates are currently available for the state of Odisha.

Materials and Methods:
Peer-reviewed published original research articles related to prevalence DM in the state of Odisha published between 2011 and 2022 were retrieved from 4 medical databases and analysed. Study screening, selection, data extraction and critical appraisal was done by 2 independent review authors. Data synthesis and assessment of certainty of the evidence was done in meta-analysis of the results.

Results:
A total of 15 studies, that included 17339 participants, with overall good methodological quality were included in the review. The overall prevalence of DM among adults in the state of Odisha based on Community based surveys was 6.8% (95% CI: 2.3–13.4%). The prevalence in older adults aged 60 years or above is higher at 22.2% (95% CI: 8.6–39.9%). The prevalence in studies that relied on self-reported methods of screening was 4.8% (95% CI: 1.7–9.3%) as compared to those that diagnosed participants based on standard criteria (12.1%; 95% CI: 8.1–16.7%).

Conclusions:
We found a high prevalence of DM in the state of Odisha, which was higher than previously available national and regional estimates. This prevalence was much lower in community-based studies and in self-reported surveys pointing towards significant under diagnosis of hypertension in the state of Odisha and highlighting a need for a robust community-based screening program among adults in the state.
Impact of Glycemic Control in Diabetes Mellitus on Management of COVID-19 Infection
Authors: Bhandari Sudhir , Rankawat Govind , Singh Ajeet , Gupta Vishal , Kakkar Shivankan 
Published: March 2023

Background:
This study was undertaken to evaluate the clinical presentation, laboratory parameters, radiological imaging, management, and outcome of coronavirus disease-2019 (COVID-19) infection in patients of diabetes mellitus and its association with glycemic control.

Materials and Methods:
This study conducted on 80 admitted COVID-19 patients of known diabetes mellitus, who were categorized into two groups: Group 1 had patients with uncontrolled diabetes as indicated by hemoglobin A1c (HbA1c) > 8 gm% and Group 2 had patients with controlled diabetes as indicated by HbA1c < 8 gm%. Information concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome was extracted from medical records for evaluation, interpretation, and association among both the groups.

Results:
COVID-19 patients with uncontrolled diabetes showed a severe symptomatic presentation, excessive uncontrolled inflammatory responses, and hypercoagulable state. Total leukocyte count, neutrophil–lymphocyte ratio, serum levels of interleukin-6 (IL-6), fibrin degradation product (FDP), and D-dimer were significantly raised (P < 0.05) in case of uncontrolled diabetes as compared to controlled diabetes. Radiological findings detected by chest radiograph and computed tomography chest suggested severe lung involvement in uncontrolled diabetes. COVID-19 patients with uncontrolled diabetes required intensive treatment as compared to controlled diabetes group in terms of insulin therapy (P = 0.0226) and noninvasive ventilation (P = 0.0292). Patients with uncontrolled diabetes had higher mortality (P = 0.0375) and required prolonged hospitalization (P = 0.0479) as compared to controlled diabetes group.

Conclusion:
From this study, it can be concluded that uncontrolled diabetes mellitus might be responsible for an overall higher susceptibility for COVID-19 infection and severity in terms of symptomatic presentation, inflammatory storm, rapid pulmonary invasion, requirement of more intensive treatment and a poor outcome.