Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)

Optimizing dialysis modalities for diabetic end-stage kidney disease: A focus on personalized care and resource-limited settings

Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide. While both haemodialysis (HD) and peritoneal dialysis (PD) are commonly used treatment options for ESKD, the choice of dialysis modality in diabetic ESKD patients remains a critical decision influenced by various patient-related, healthcare system, and socio-economic factors. This article examines the factors influencing the selection of dialysis modalities for diabetic patients, with a focus on the challenges and opportunities in low-resource settings. Key considerations include the impact of comorbidities such as peripheral arterial disease and CKD-related mineral bone disorder (MBD), as well as patient preferences, caregiver burden, and the availability of healthcare infrastructure. The article highlights the need for personalized approaches to dialysis selection, considering both clinical outcomes and quality of life. It also emphasizes the potential benefits of home dialysis, including home HD and PD, in improving patient autonomy and long-term survival. The article advocates for better government policies, increased awareness, and improved support systems to enhance the accessibility and efficacy of dialysis treatments, particularly in underserved populations. Further research comparing the outcomes of different dialysis modalities across diverse settings is essential to guide global treatment strategies for diabetic ESKD patients.

Call to action for clinicians in the South-East Asian regions on primary prevention of diabetes in people with prediabetes- A consensus statement

Primary prevention of diabetes still remains as an unmet challenge in a real world setting. While, translational programmes have been successful in the developed nations, the prevailing social and economic inequities in the low and middle income countries, fail to integrate diabetes prevention into their public health systems. The resulting exponential increase in the prevalence of diabetes and the cost of treatment has put primary prevention in the back seat. As a call to action, an expert group was formed to lay down practical guidelines for clinicians in the South East Asian regions to implement primary prevention programmes at an individual or at a community level. The guideline was developed based on the outcomes of the evidence based prevention programmes conducted in India. This decentralised self-guided approach for primary prevention of diabetes follows a three step implementation process of screening, diagnosis of intermediate hyperglycaemia and design and delivery of personalized interventions. Recommendations provided on dietary intake and physical activity can be tailored by the clinician to suit individual needs. Initiation of pharmacological treatment to achieve desired targets has also been addressed. A personalised approach by the clinician may be effective and offer a sustainable solution to curb the rising epidemic.

Effectiveness and Safety of Vildagliptin Sustained Release in the Management of Type 2 Diabetes Mellitus: Real-World Evidence in Indian Patients [NOVELTY Study]

BACKGROUND AND OBJECTIVE

Vildagliptin sustained release (XR), a formulation that provides vildagliptin 100 mg with a once-daily dose administration, is a recent introduction to manage type 2 diabetes mellitus in India. This study aimed to evaluate the effectiveness and tolerability of vildagliptin XR in patients with type 2 diabetes in real-world clinical settings.

METHODS

This was an observational, prospective, multicenter, cohort study conducted in India, which included patients with type 2 diabetes uncontrolled on metformin XR monotherapy with glycated hemoglobin (HbA1c) > 7.00%. Vildagliptin XR was added to their ongoing treatment. The primary endpoint was a change in HbA1c from baseline to 3 months. Secondary endpoints were changes in fasting plasma glucose, postprandial plasma glucose, percentage of patients achieving HbA1c < 7.00% at 3 months, and assessment of efficacy, tolerability, and safety.

RESULTS

A total of 1691 patients from 118 centers were enrolled in this study, having a mean (standard deviation) age of 53.10 (11) years and a mean (standard deviation) HbA1c of 8.44 (1.35) %. At the end of the study, vildagliptin XR significantly reduced the mean HbA1c by 1.02% points (95% confidence interval 0.93-1.12; p < 0.001) from baseline. The mean fasting plasma glucose and postprandial plasma glucose levels were significantly reduced by 28.44 mg/dL (95% confidence interval 26.64-30.25; p < 0.001) and 48.45 mg/dL (95% confidence interval 45.91-50.99; p < 0.001), respectively, with vildagliptin XR, at the end of study. During the study duration, 34.7% of patients achieved their glycemic target (HbA1c < 7.0%) and there were three reported adverse events (all mild in severity).

CONCLUSIONS

Results demonstrated that vildagliptin XR (100 mg once daily) significantly improved HbA1c and other glycemic parameters in Indian patients with type 2 diabetes and was well tolerated.

CLINICAL TRIAL REGISTRATION

The study was registered under the Clinical Trials Registry India (CTRI/2022/01/039112).

Insights into the Age-Dependent Variation in Nutrition-Related Trace Elements in Diabetes Blood Using Total Reflection X-Ray Fluorescence

The prevalence of diabetes has reached alarming levels in India, making it essential to understand the concentration of nutritional-trace elements (Fe, Cu, Zn, Cr. and Se) in blood samples from diabetic adults. In this study, 208 whole blood samples from diabetic (n = 104) and non-diabetic (n = 104) adults across various age groups were analyzed using total reflection X-ray fluorescence (TXRF) spectroscopy with a sample dilution method. Statistical analysis was performed to assess descriptive statistics and determine a significant correlation between elemental concentrations in the blood samples of diabetic and non-diabetic adults. The mean concentration of nutritional-related trace elements in diabetic blood was as follows: Fe (46 ± 5) > Zn (1.28 ± 0.14) > Cu (0.10 ± 0.01) > Cr (0.05 ± 0.004) > Se (0.013 ± 0.001) in mg/L, respectively. Additionally, this study investigated the influence of nutrition-related trace element concentrations across various age groups such as 25-40 years (young adults), 41-55 years (middle-aged adults), and 56-70 years (older adults). In this investigation, Zn (p < 0.001) and Cr (p < 0.05) concentrations differed significantly between diabetic and non-diabetic adults aged 56-70 years. These findings will help us to understand age-dependent changes in element concentrations, clarify their role in diabetes, and improve risk factor management associated with diabetes.

Comparison of the Effect of Teleconsultations, Hybrid Visits, and In-Person Visits on Glycemic and Metabolic Parameters Among Individuals With Type 2 Diabetes in India

AIM

We compared biochemical and clinical data of individuals with type 2 diabetes (T2D) who opted for only teleconsultation (ie, no in-person visit at all), hybrid visits (combining home blood tests and in-person consultation), and fully in-person visits (both tests and consultation in person) at a tertiary care diabetes center.

METHODS

In this observational cohort study, we retrieved demographic, anthropometric, and biochemical data of 8197 individuals with T2D who sought diabetes care between 2021 and 2023 (384 participants with only teleconsultations, 721 with hybrid visits, and 7092 with fully in-person visits) from the electronic medical records of a chain of tertiary diabetes care centers across India.

RESULTS

Individuals who opted for teleconsultation had a shorter duration of diabetes compared with those who opted for hybrid or fully in-person visits. Although participants who opted for a teleconsultation had better glycemic and lipid control at baseline, those who underwent hybrid and in-person visits showed greater improvements in fasting plasma glucose, glycated hemoglobin (A1c), and LDL cholesterol (LDL-C) during follow-up. Improvements in overall ABC target achievement (A1c, Blood pressure, and LDL-C) were greater in participants who had in-person visits compared with the other two groups.

CONCLUSION

While teleconsultation is a useful complement to in-person visits, the latter results in better glycemic and lipid control, perhaps due to more effective engagement with the diabetes care team.

Nuclear regulatory disturbances precede and predict the development of Type-2 diabetes in Asian populations

To identify biomarkers and pathways to Type-2 diabetes (T2D), a major global disease, we completed array-based epigenome-wide association in whole blood in 5,709 Asian people. We found 323 Sentinel CpGs (from 314 genetic loci) that predict future T2D. The CpGs reveal coherent, nuclear regulatory disturbances in canonical immune activation pathways, as well as metabolic networks involved in insulin signalling, fatty acid metabolism and lipid transport, which are causally linked to development of T2D. The CpGs have potential clinical utility as biomarkers. An array-based composite Methylation Risk Score (MRS) is predictive for future T2D (RR: 5.2 in Q4 vs Q1; P=7x10 -25 ), and is additive to genetic risk. Targeted methylation sequencing revealed multiple additional CpGs predicting T2D, and synthesis of a sequencing-based MRS that is strongly predictive for T2D (RR: 8.3 in Q4 vs Q1; P=1.0x10 -11 ). Importantly, MRS varies between Asian ethnic groups, in a way that explains a large fraction of the difference in T2D risk between populations. We thus provide new insights into the nuclear regulatory disturbances that precede development of T2D, and reveal the potential for sequence-based DNA methylation markers to inform risk stratification in diabetes prevention.

Elucidating the therapeutic efficacy of polyherbal formulation for the management of diabetes through endogenous pancreatic β-cell regeneration

Diabetes mellitus is characterized by the progressive loss of pancreatic β-cells. Owing to the adverse side effects of conventional antidiabetic, ethnopharmacological agents have emerged as adjunct therapies for their management. The present study aims to validate the antidiabetic activity of an aqueous polyherbal extract (APE) via in silico, in vitro, and in vivo models. UHPLC-Q-TOF-MS and HPLC analysis of APE were performed to identify bioactive secondary plant metabolites. In silico approaches implemented to predict the binding efficacy of the active phytoconstituents. Biochemical estimation, antioxidant activity, and in vitro and in vivo antidiabetic activities of APE were performed. Histomorphological and immunohistological studies of the pancreatic islets were carried out in diabetic animals for microarchitectural study. UHPLC-Q-TOF-MS identified a total of 60 compounds in APE, of which 39 were reported to have antidiabetic activity, and 16 marker compounds were identified via high-performance liquid chromatography (HPLC). An in silico study revealed a strong interaction of verbacoside B with the target proteins. APE is characterized by high flavonoid and phenolic contents with strong antioxidant properties. In an in vitro enzymatic assay, APE significantly inhibited α-amylase and α-glucosidase enzymes, with calculated IC50 values of 54.26 ± 0.14 and 26.47 ± 0.12 μg/ml, respectively. An in vitro glucose uptake assay revealed increased uptake with APE treatment in a dose-dependent manner. APE significantly decreased blood glucose and HbA1c levels and had no side effects on liver or kidney function, as measured from blood parameters. Immunohistological observation revealed 47% regeneration of pancreatic β-cells with APE treatment in diabetic animals.

Assessing type-2 diabetes risk based on the Indian diabetes risk score among adults aged 45 and above in India

Millions of Indian adults are pre-diabetic with a greater risk of developing type-2 diabetes mellitus (T2DM). We conducted this study to assess the prevalence of type-2 diabetes risk among non-diabetic adults aged 45 years and above and identify the correlates for diabetes risk. We conducted a secondary analysis of Longitudinal Ageing Study in India (LASI) wave 1 data. A sample of 51,315 non-diabetic adults was extracted from LASI data and analysed. Type-2 diabetes risk was assessed based on the Indian Diabetes Risk Score (IDRS) by using four risk factor variables [i.e., (1) age of the respondent, (2) waist circumference, (3) family history of diabetes, and (4) physical activity]. A diabetes risk score of ≥ 60 was considered a high risk for diabetes. Descriptive statistics and multivariate analysis were conducted to assess the prevalence and correlates of diabetes risk respectively. About 41.2% had a high risk of diabetes. Among major Indian states, Kerala leads with 64.4% of its adults 45 years and above at high risk of diabetes. Obese level BMI (AOR  4.17; 95% CI 3.59-4.84), High cholesterol (AOR  1.51; 95% CI 1.22-1.87), History of heart disease and stroke (AOR  1.85; 95% CI 1.60-2.13), and males (AOR 1.25; 95% CI 1.16-1.34) had positive odds for high risk of diabetes. Individuals from scheduled tribes (AOR  0.85; 95% CI 0.76-0.96) had lower odds of diabetes risk. Obese individuals with a history of heart disease/stroke had a significantly higher (AOR  5.30; 95% CI 4.39-6.41) risk for diabetes. The findings suggest that it is essential to establish population-level interventions to tackle the modifiable risk factors for diabetes. Educational programs on diet and physical activity, creation of public spaces conducive to physical activity, promotion of fruit and vegetable intake, and discouragement of processed and ultra-processed diets can directly address inadequate physical activity and obesity, the two primary modifiable risk factors for type-2 diabetes. Additionally, strengthening health systems for early screening and management of diabetes and pre-diabetes is needed to prevent the diabetes epidemic.

Generalizability of machine learning models for diabetes detection a study with nordic islet transplant and PIMA datasets

Diabetes Mellitus (DM) is a global health challenge, and accurate early detection is critical for effective management. The study explores the potential of machine learning for improved diabetes prediction using microarray gene expression data and PIMA data set. Researchers utilizing a hybrid feature extraction method such as Artificial Bee Colony (ABC) and Particle Swarm Optimization (PSO) followed by metaheuristic feature selection algorithms as Harmonic Search (HS), Dragonfly Algorithm (DFA), Elephant Herding Algorithm (EHA). Evaluated the performance of a system by using the following classifiers as Non-Linear Regression-NLR, Linear Regression-LR, Gaussian Mixture Model-GMM, Expectation Maximization-EM, Bayesian Linear Discriminant Analysis-BLDA, Softmax Discriminant Classifier-SDC, and Support Vector Machine with Radial Basis Function kernel-SVM-RBF classifier on two publicly available datasets namely the Nordic Islet Transplant Program (NITP) and the PIMA Indian Diabetes Dataset (PIDD). The findings demonstrate significant improvement in classification accuracy compared to using all genes. On the Nordic islet transplant dataset, the combined ABC-PSO feature extraction with EHO feature selection achieved the highest accuracy of 97.14%, surpassing the 94.28% accuracy obtained with ABC alone and EHO selection. Similarly, on the PIMA Indian diabetes dataset, the ABC-PSO and EHO combination achieved the best accuracy of 98.13%, exceeding the 95.45% accuracy with ABC and DFA selection. These results highlight the effectiveness of our proposed approach in identifying the most informative features for accurate diabetes prediction. It is observed that the parametric values attained for the datasets are almost similar. Therefore, this research indicates the robustness of the FE and FS along with classifier techniques with two different datasets.

Effect of exercise training on cardiac autonomic function in type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise's effect on cardiac autonomic function using CARTs in T2DM.

METHODS

The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, using the random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and the ROBINS-I tool for non-RCT for risk of bias assessment were used.

RESULTS

Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis with a low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence.

CONCLUSION

The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023445561.

Efficacy of Dapagliflozin + Sitagliptin + Metformin Versus Sitagliptin + Metformin in T2DM Inadequately Controlled on Metformin Monotherapy: A Multicentric Randomized Trial

INTRODUCTION

A slower adoption rate of fixed dose combinations (FDC) in diabetes management is partly due to insufficient data. This study evaluates the safety and efficacy of an FDC of dapagliflozin + sitagliptin + metformin hydrochloride extended release (XR), compared to a dual FDC of sitagliptin + metformin hydrochloride XR among patients with type 2 diabetes mellitus (T2DM) with poor glycemic control when treated with metformin monotherapy.

METHODS

A total of 274 patients with T2DM were randomized (1:1) to either arm X, receiving FDC of dapagliflozin (10 mg) + sitagliptin (100 mg) + metformin hydrochloride XR (1000 mg) (Dapa + Sita + Met) tablets, or arm Y, receiving sitagliptin phosphate (100 mg) + metformin hydrochloride XR (1000 mg) (Sita + Met) tablets, and treated for 16 weeks. The outcome measures included changes in hemoglobin A1c (HbA1c)(%), fasting plasma glucose (FPG), 2-h post-prandial glucose (PPG), weight, and the proportion of patients achieving target HbA1c levels of < 7.0% by week 16 of the study period.

RESULTS

The reduction in HbA1c at week 16 was significantly higher in arm X than in arm Y [estimated treatment difference (ETD), - 0.65% (95% CI - 0.76 to - 0.53; P < 0.0001)]. Arm X showed a marked decrease in FPG [ETD - 15.42 mg/dl; 95% CI (17.63, 13.22; P < 0.0001)], PPG [ETD - 30.39 mg/dl; 95% CI (35.59, 25.19; P < 0.0001)], and weight [ETD - 1.47 kg; 95% CI (1.59, 1.28; P < 0.0001)] after 16 weeks. In arm X, 54% of patients reached HbA1c < 7.0% compared to 29.9% in arm Y. The incidence of adverse events was comparable [13.14% (arm X) vs 12.4% (arm Y)]. There was no severe hypoglycemia-led treatment discontinuation.

CONCLUSION

Among patients with T2DM who have poor glycemic control with metformin monotherapy, triple FDC (Dapa + Sita + Met) effectively helped achieve better glycemic response compared to dual FDC (Sita + Met), with a comparable safety and tolerability profile.

TRIAL REGISTRATION

CTRI/2022/01/039857.

Lessons Learned From Epidemiology of Type 2 Diabetes in South Asians: Kelly West Award Lecture 2024

South Asia has high prevalence rates of type 2 diabetes (T2D). Until the 1990s, the prevalence of T2D within South Asia was low but much higher in the South Asian diaspora living abroad. Today, high prevalence rates of T2D are reported among those living in South Asia. T2D in South Asians presents with unique clinical features described as the "South Asian phenotype" that include younger age at onset of diabetes than in White Europeans, much lower BMI, hyperinsulinemia and greater insulin resistance, rapid decline in β-cell function resulting in low insulin reserve, low muscle mass, and greater ectopic fat deposition, especially in the liver. Also, prevalence of impaired fasting glucose is higher among South Asians than prevalence of impaired glucose tolerance. Genetic predisposition combined with intrauterine fetal programming (low vitamin B12 intake and high folate intake) increases susceptibility to T2D, from birth. In later life, overnutrition, especially a high carbohydrate intake with refined grains of higher glycemic index, coupled with low physical activity likely triggers the T2D epidemic in South Asians. Additionally, there are emerging risk factors like air pollution. Preventing T2D in South Asians requires a multifactorial approach, including improvements in maternal and fetal nutrition with special reference to vitamin B12 and folate intake, decreasing refined carbohydrate and increasing protein and fiber intake in the diet, increasing physical activity, and control of air pollution. Lessons learned from epidemiology of T2D in South Asians could be useful to other developing countries that are in earlier stages of epidemiological transition.

Integrating Polygenic Risk Scores (PRS) for Personalized Diabetes Care: Advancing Clinical Practice with Tailored Pharmacological Approaches

The rising global prevalence of diabetes poses a serious threat to public health, national economies, and the healthcare system. Despite a high degree of disease heterogeneity and advancing techniques, there is still an unclear diagnosis of patients with diabetes compounded by the array of long-term microvascular and macrovascular complications associated with the disease. In addition to environmental variables, diabetes susceptibility is significantly influenced by genetic components. The risk stratification of genetically predisposed individuals may play an important role in disease diagnosis and management. Precision medicine methods are crucial to reducing this global burden by delivering a more personalised and patient-centric approach. Compared to the European population, genetic susceptibility variants of type 2 diabetes mellitus (T2DM) are still not fully understood in other major populations, including South Asians, Latinos, and people of African descent. Polygenic risk scores (PRS) can be used to identify individuals who are more susceptible to complex diseases such as diabetes. PRS is selective and effective in developing novel diagnostic interventions. This comprehensive predictive approach facilitates the understanding of distinct response profiles, resulting in the development of more effective management strategies. The targeted implementation of PRS is especially advantageous for people who fall into a higher-risk category for diabetes. Through early risk assessment and the creation of individualised diabetes treatment plans, the integration of PRS in clinical practice shows potential for reducing the prevalence of diabetes and its complications. Diabetes self-management depends significantly on patient empowerment, with behavioural monitoring emerging as a vital facilitator. The main aim of this review article is to formulate a more structured intervention strategy by advocating for increased awareness of the clinical utility of PRS and counseling among healthcare practitioners, patients, and individuals at risk of diabetes.

Effect of Premeal Pistachio Supplementation on Cardiometabolic Risk Factors among Asian Indian Adults with Prediabetes: A Randomized Controlled Trial

BACKGROUND

Asian Indians are susceptible to developing type 2 diabetes at a lower age and often consume diets that are high in glycemic load and low in healthy fats.

OBJECTIVES

This study aimed to evaluate the effect of 30 g prebreakfast and 30 g predinner supplementation of pistachios for 12 wk on glycated hemoglobin (HbA1c), other glycemic markers, anthropometry, and lipid profile of Asian Indians with prediabetes.

METHODS

In a 12-wk parallel arm, randomized controlled trial, we recruited 120 participants with prediabetes based on American Diabetes Association criteria. The intervention group (n = 60) consumed 60 g pistachios (30 g prebreakfast and predinner) whereas the control group (n = 60) followed a routine diet that excluded nuts. At baseline and 12 wk, we collected blood samples for biochemical analysis, anthropometrics, and 24-h recalls. Participants wore a continuous glucose monitoring (CGM) sensor during the trial's first and last 2 wk. Urinary N-methyl-trans-4-hydroxy-l-proline (MHP) was measured as a marker of pistachio consumption.

RESULTS

A total of 109 participants completed the study (follow-up rate = 90.8%). Compared with participants in the control group, those in the intervention group had significant reductions in HbA1c (mean between-group difference: -0.2; 95% confidence interval: -0.3, -0.1; P < 0.001] with no significant changes in fasting or 2-h post glucose load plasma glucose. Compared with the control group, the intervention group had significant reductions in serum triglyceride, waist circumference, lipid accumulation product, visceral adiposity index, and atherogenic index. Urinary MHP (mg/g creatinine) showed a 62% increase in the intervention compared with the control group (P < 0.05). CGM data revealed significant decreases in the incremental area under the curve, 2-h after breakfast (28%, p=0.01) and after dinner (17%, P = 0.002) in the intervention group compared to the control group.

CONCLUSIONS

A 12-wk, premeal load of 60 g pistachios lowers HbA1c and improves cardiometabolic profile among Asian Indians with prediabetes. This is among the first studies to investigate these effects in this ethnic group. This study was registered in the Clinical Trial Registry of India as CTRI/2020/11/029340.

Use of Machine Learning to Predict Individual Postprandial Glycemic Responses to Food Among Individuals With Type 2 Diabetes in India: Protocol for a Prospective Cohort Study

BACKGROUND

Type 2 diabetes (T2D) is a leading cause of premature morbidity and mortality globally and affects more than 100 million people in the world's most populous country, India. Nutrition is a critical and evidence-based component of effective blood glucose control and most dietary advice emphasizes carbohydrate and calorie reduction. Emerging global evidence demonstrates marked interindividual differences in postprandial glucose response (PPGR) although no such data exists in India and previous studies have primarily evaluated PPGR variation in individuals without diabetes.

OBJECTIVE

This prospective cohort study seeks to characterize the PPGR variability among individuals with diabetes living in India and to identify factors associated with these differences.

METHODS

Adults with T2D and a hemoglobin A1c of ≥7 are being enrolled from 14 sites around India. Participants wear a continuous glucose monitor, eat a series of standardized meals, and record all free-living foods, activities, and medication use for a 14-day period. The study's primary outcome is PPGR, calculated as the incremental area under the curve 2 hours after each logged meal.

RESULTS

Data collection commenced in May 2022, and the results will be ready for publication by September 2025. Results from our study will generate data to facilitate the creation of machine learning models to predict individual PPGR responses and to facilitate the prescription of personalized diets for individuals with T2D.

CONCLUSIONS

This study will provide the first large scale examination variability in blood glucose responses to food in India and will be among the first to estimate PPGR variability for individuals with T2D in any jurisdiction.

TRIAL REGISTRATION

Clinical Trials Registry-India CTRI/2022/02/040619; https://tinyurl.com/mrywf6bf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59308.

Perceived influences of fruit and vegetable consumption among Indian adolescents - A qualitative inquiry

BACKGROUND

Fruits and vegetables are primary sources of vitamins and minerals that may alleviate the risk of chronic illnesses. However, Indian adolescents consume inadequate amounts of fruits and vegetables, with less than 10% meeting recommendations. Micronutrient deficiencies are a major public health problem in India. For example, the prevalence of iron-deficiency anemia and Vitamin A deficiency in adolescents is 28.5% and 14.4%, respectively. To promote fruit and vegetable consumption among Indian adolescents, we need to identify the factors which may influence the consumption. The aim of this qualitative inquiry was to explore perceived influences of fruit and vegetable consumption among Indian adolescents.

METHODS

Using purposive sampling, adolescents aged 10-19 years were recruited from two public and two private (independent) schools in Varanasi, India. Face-to-face interviews along with the 'draw and tell' technique were used for data collection. Interviews were conducted in English as well as in Hindi depending on the preferences of the adolescents. The conversations were digitally recorded and transcribed verbatim. The transcribed data were subjected to thematic analysis. Data were coded inductively, and themes were extracted using NVivo software program.

RESULTS

A total of 58 adolescents (53% female; 74% urban) with mean age 13.6 years completed the interviews. Nine major themes and associated sub-themes emerged, including: (i) Sensory properties (i.e., taste, color, flavor, texture); (ii) Health and immunity; (iii) Allergy; (iv) Home food environment (i.e., influence of mothers, availability and accessibility of fruits and vegetables); (v) Cost; (vi) Food preparation; (vii) Influence of peers; (viii) School food environment; (ix) Proclivity for energy-dense, nutrient-poor foods and beverages.

CONCLUSIONS

The emerging themes and sub-themes show that multiple factors are likely to affect fruit and vegetable consumption in adolescents, aligning with literature on adolescent fruit and vegetable consumption in international settings. Behavioral interventions should be designed to create enabling environments to encourage fruit and vegetable consumption in Indian adolescents by removing barriers at the individual, household, and community levels, thereby reducing the enduring prevalence of micronutrient deficiencies.

Glucose-Responsive Insulin Delivery via Surface-Functionalized Titanium Dioxide Nanoparticles: A Promising Theragnostic against Diabetes Mellitus

Glucose-dependent insulin delivery systems have been recognized as a promising approach for controlling blood sugar levels in individuals with diabetes mellitus (DM). Recently, titanium dioxide nanoparticles have garnered huge attention in scientific research for their small size and effective drug delivery capabilities. In this study, we developed alizarin (AL)-capped phenylboronic acid (PBA)-functionalized titanium dioxide nanoparticles (TiO2) for glucose-sensitive insulin delivery (TiO2-PBA-INS-AL) aiming to manage both blood sugar levels and its associated organ pathology in DM. The synthesized nanoparticles demonstrated favorable loading capacity as well as high insulin encapsulation efficiency. Initial studies demonstrated glucose-responsive insulin release from TiO2-PBA-INS-AL in a cell-free environment upon exposure to different glucose concentrations. Notably, in vitro experiments revealed that insulin release from TiO2-PBA-INS-AL was more effective in muscle cells (primary glucose storage cells) compared to lung cells when subjected to different glucose concentrations (5.5-25 mM), indicating a glucose-sensitive intracellular insulin delivery mechanism. Furthermore, treatment with TiO2-PBA-INS-AL significantly enhanced GLUT4 translocation and glucose utilization in muscle cells treated with sodium palmitate (PA, 0.75 mM), compared to treatments with TiO2 or insulin alone. In diabetic animal models, a single oral dose of TiO2-PBA-INS-AL maintained normoglycemia for up to 12 h, indicating a significant improvement over subcutaneous or oral insulin treatment. Oral administration of TiO2-PBA-INS-AL also increased insulin bioavailability in both serum and muscle tissue compared to other administration methods. Besides, TiO2-PBA-INS-AL treatment showed no toxicity against both in vitro and in vivo models. Taken together, this nanocarrier-based drug delivery system mimics the natural regulation of insulin secretion in a noninvasive manner, enhancing patient adherence, reducing the risk of hyperglycemia, and improving diabetes management.

Unhealthy behaviours associated with uncontrolled hypertension among adults in India- Insights from a national survey

BACKGROUND

Non-communicable diseases (NCDs) are governed by a cluster of unhealthy behaviours and their determinants, like tobacco and alcohol, unhealthy diet, lack of physical activity, overweight and obesity, pollution (air, water, and soil), and stress. Regulation of these unhealthy behaviours plays a crucial role in blood pressure control among individuals on hypertensive treatment, especially those suffering from uncontrolled hypertension. Hence, the present study aims at identifying the unhealthy behaviours associated with uncontrolled hypertension.

MATERIALS AND METHODS

We did a secondary data analysis of the National Family Health Survey (NFHS) -5 data (2019-2021). Among those taking prescribed medication to lower blood pressure levels, SBP ≥140 mm Hg or DBP ≥90 mm Hg were considered uncontrolled hypertension. The other socio-demographic variables and unhealthy behaviours were used as independent variables for analysis.

RESULTS

The proportion of uncontrolled hypertension was 49·5% (95% CI: 45·5-53·4) and 36·8% (95% CI: 35.8-37.8) among males and females, respectively. Alcohol consumption, clean fuel usage, and high BMI (≥30kg/m2) were the behavioural characteristics significantly associated with uncontrolled hypertension among males. In contrast, tobacco usage, alcohol consumption, coverage by Health insurance, presence of Diabetes, heart disease, usage of clean fuel, and high BMI (≥30kg/m2) were the behavioural characteristics significantly associated with uncontrolled hypertension among females. Regression results portrayed that higher age groups (45 and above) have found higher odds for men (OR: 7.6, CI: 4.6-12.3) and women (OR: 6.08, CI: 4.0-6.0) compared with 30 years and below age groups. Similarly, higher odds were found among the wealthiest wealth quintile than the poorest wealth quintile among men and women.

CONCLUSION

The current study reported a high proportion of uncontrolled hypertension. Providing opportunistic health education during blood pressure monitoring, regular screening, and targeted interventions will not only help to reduce its prevalence but also reduce the risk of developing related health implications.

Increase in comorbidities with age among patients with psoriatic arthritis: a multicenter observational study

BACKGROUND

Psoriatic arthritis (PsA) significantly contributes to increased morbidity, reduced life expectancy, and higher healthcare costs due to the burden of comorbidities. This study assessed the prevalence of comorbidities in PsA patients in India and explored the influence of age and disease duration on these comorbidities.

METHODS

The prospective, multicenter observational study was conducted across seven centers in India, utilizing data from the Indian Rheumatology Association. Data were collected using expert-validated proformas, with comorbidities classified according to the ICD-10 Charlson Comorbidity Index. Participants were divided into two age groups: <40 years and ≥ 40 years.

RESULTS

The study included 533 participants (median age: 50 years, range: 17-81). Comorbidities were more common among older patients (median age: 54 years, range: 41-79). About 38% had at least one comorbidity, with hypertension (17.07%) and diabetes (15.19%) being most prevalent, followed by thyroid disorders (10.13%) and hyperlipidemia (3.94%). Comorbidities were significantly more common in patients ≥ 40 years (45.04%) compared to those < 40 years (18.57%) (P < 0.001). The older group also had higher rates of hyperlipidemia (4.83% vs. 0.71%, P = 0.035) and hypertension (22.14%). Logistic regression revealed a significant association between age and the prevalence of diabetes, hypertension, and thyroid disorders (P = 0.003). Among patients over 40, 44.27% had at least one comorbidity.

CONCLUSION

The study underscores the significant association between age and the prevalence of comorbidities in PsA patients, particularly in those over 40 years. These findings highlight the importance of targeted screening and management in older PsA patients.

Developing and assessing the "MultiLife" intervention: a mobile health-based lifestyle toolkit for cardiometabolic multimorbidity in diabetes and hypertension management - a type 1 hybrid effectiveness-implementation trial protocol

BACKGROUND

Cardiometabolic multimorbidity (CMM), characterized by the coexistence of diabetes, hypertension, and cardiovascular disease, poses a major health challenge in India, particularly in rural areas with limited healthcare resources. Lifestyle interventions can manage cardiometabolic risk factors, yet adherence remains suboptimal. Mobile health (mHealth) interventions offer a scalable approach for managing CMM by promoting behaviour change and medication adherence. We will develop and evaluate the MultiLife intervention, a mHealth-based lifestyle toolkit aimed at improving CMM management among individuals receiving primary care in Eastern India in the year 2025.

METHODS

This study is a two-arm, cluster-randomized controlled trial with a hybrid Type 1 design involving 840 participants across 18 primary health centres in Odisha and Jharkhand. Using the Health Belief Model as a conceptual framework, the MultiLife intervention will deliver daily digital reminders, weekly health education broadcasts, and ongoing primary care support in the intervention arm, while the control group will receive the standard ongoing primary care support care. The trained healthcare workers will recruit 50 CMM patients, with a 6-month intervention period, during routine visits in each cluster. Primary outcomes include changes in HbA1c from baseline (T0) to end-line (T6). Secondary outcomes include blood pressure, body mass index, physical activity, and dietary habits. Qualitative assessments will explore intervention barriers and facilitators. Implementation outcomes, assessed through the RE-AIM QuEST framework, will evaluate MultiFrame's acceptability, adoption, fidelity, and maintenance. A random-effects regression model will be used for difference-in-difference analysis, adjusting for covariates and within-cluster correlations.

DISCUSSION

The MultiLife trial may provide valuable insights into how mHealth-enabled primary care can enhance patient engagement, adherence, and cardiovascular risk reduction in resource-constrained settings. By integrating patient perspectives, this study could inform scalable digital health strategies for comprehensive CMM management, providing a model for future interventions in similar contexts.

TRIAL REGISTRATION

CTRI.nic.in, CTRI/2024/10/074559, Registered on 1 October 2024.

A retrospective study of 5S behaviours of Physical Activity (PA) among suburban Mumbai population with Type 2 Diabetes Mellitus (T2DM)

Background

T2DM is a chronic metabolic disorder to manage the same lifestyle modification is cornerstone. In 2022, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a consensus report targeting the management of Type 2 Diabetes Mellitus (T2DM), which emphasised the importance of regular aerobic and resistance exercise. Both forms of physical activity (PA) can improve blood glucose, HbA1C levels, flexibility and balance. The ADA and EASD has categorised PA behaviours into 5 S. The 5 S stands for:- Sitting, Stepping, Sleep Sweating, Strengthening. The current study aims at auditing these 5S behaviours in suburban Mumbai population with its impact on HbA1C and body mass index (BMI).

Methodology

A Retrospective, questionnaire-based study was conducted in the Endocrinology outpatient department of tertiary care institute in Mumbai suburban district. The demographic details, anthropometric measurements, HbA1C levels, sleep cycle and daily PA schedule including the 5S behaviours were recorded. The data generated was then statistically analysed using the IBM SPSS software v. 23.

Results

The study included a total of 356 T2DM participants. Prolong sitting had a statistically significant correlation with BMI (P value = 0.003) and HbA1c levels (P value = 0.001), similarly strength training had a positive correlation with HbA1c (P value = 0.048) as well as with total sleep hours (P value < 0.0001). Behaviour like drowsiness was positively correlated with changing shift duty. Additionally, in the present study, it was also observed that more than half of the study population (55.8%) did not track their daily steps.

Conclusion

The findings of the present study emphasize the importance of reducing sedentary time, promoting strength training and enhancing sleep quality in T2DM management. Targeted interventions in these areas can help improve health outcomes and quality of life for T2DM patients.

Diabetes in China: epidemiology, pathophysiology and multi-omics

Although diabetes is now a global epidemic, China has the highest number of affected people, presenting profound public health and socioeconomic challenges. In China, rapid ecological and lifestyle shifts have dramatically altered diabetes epidemiology and risk factors. In this Review, we summarize the epidemiological trends and the impact of traditional and emerging risk factors on Chinese diabetes prevalence. We also explore recent genetic, metagenomic and metabolomic studies of diabetes in Chinese, highlighting their role in pathogenesis and clinical management. Although heterogeneity across these multidimensional areas poses major analytic challenges in classifying patterns or features, they have also provided an opportunity to increase the accuracy and specificity of diagnosis for personalized treatment and prevention. National strategies and ongoing research are essential for improving diabetes detection, prevention and control, and for personalizing care to alleviate societal impacts and maintain quality of life.

Identifying Drug Prescription in Newly Diagnosed Hypertension Patients in India

This study evaluated initial antihypertensive drug prescription patterns in Indian healthcare settings. An observational, cross-sectional, prospective prescription registry analyzed prescriptions for 4723 newly diagnosed hypertension patients. Additionally, it investigated the extent to which physicians adhered to either European or Indian hypertension guidelines. Angiotensin receptor blockers (ARBs) were the most commonly prescribed drugs, given to 79% of patients, followed by calcium channel blockers (CCBs) at 55%. Diuretics and beta-blockers (BBs) were prescribed to 27% and 17% of patients, respectively. Monotherapy was administered to 35% of patients, while combination therapies were more prevalent, with dual therapy at 51% and regimens involving three or more drugs prescribed to 14%. Among multi-drug treatments (n = 3082, 65%), 98% received fixed-dose combination tablets. The most common combinations were ARB + CCB (26%), ARB + diuretic (12%), and ARB + CCB + diuretic (8%). Key predictors for an increasing number of prescribed drugs included statin use/dyslipidemia, age, blood pressure level, and diabetes. Non-adherence to hypertension guidelines was evident as 1364 patients classified from moderate to very high risk received monotherapy. Of these, 496 patients had grade 2 or 3 hypertension. Additionally, 88 patients received the undesirable combination of ACEi + ARB, and 267 (15.9%) type 2 diabetes mellitus (T2DM) patients did not receive RAS-blockers (146 on monotherapy). The findings reveal a trend toward utilizing ARBs, CCBs, and combination tablets, indicating improved adherence to guidelines. However, a significant number of patients did not receive appropriate treatment, highlighting areas for improvement in prescription practices.

Insights into the systemic risk factors associated with diabetic retinopathy in the Indian population: A comprehensive systematic review and meta-analysis

Diabetic retinopathy (DR) is a predominant cause of vision impairment globally. Understanding risk factors is crucial for effective planning. The aim of this study is to comprehensively investigate the risk factors in the Indian population contributing to the increased incidence of DR, which is a potentially sight-threatening complication among diabetic individuals. A comprehensive literature search was done on PubMed, Embase, and Google Scholar databases for epidemiological studies reporting risk factors in the adult Indian population in the English language. Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included studies. Analysis was performed using R studio. I2 statistic was used for the assessment of heterogeneity. Results are expressed as odds ratio (OR) and standardized mean difference (SMD) along with a 95% confidence interval (CI). Overall, 20 studies enrolling 4,12,421 patients with 1,04,104 DR-positive and 3,08,317 DR-negative adults were analyzed. Being male (OR: 1.38, 95% CI: 1.11-1.72), intake of insulin (OR: 2.05, 95% CI: 1.02-4.14), higher HbA1c levels (MD: 0.50, 95% CI: 0.06-0.94), higher random (MD: 0.32, 95% CI: 0.10-0.55), and fasting blood glucose levels (MD: 0.51, 95% CI: 0.10-0.93) were found to be significantly associated with increased risks of DR among diabetic patients, while age, body mass index, hypertension, lipid profile, and smoking status did not indicate any association with DR. Good glycemic control remains the most important modifiable risk factor to reduce the risk of progression of DR and vision loss.

Genetic variants and type 2 diabetes in India: a systematic review and meta-analysis of associated polymorphisms in case-control studies

Background

India, with the largest population and second-highest type 2 diabetes mellitus (T2DM) prevalence, presents a unique genetic landscape. This study explores the genetic profiling of T2DM, aiming to bridge gaps in existing research and provide insights for further explorations.

Methods

We conducted a systematic review and meta-analysis of literature published up to September 2024 using databases like PubMed, Web of Science, Scopus, and Google Scholar to identify SNPs associated with T2DM in case-control studies within the Indian population. Data extraction followed a rigorously designed checklist independently verified by two reviewers. The quality of the studies assessed by utilizing Newcastle Ottawa scale, and heterogeneity through Cochran's Q, τ2, H2 and I 2 statistics. Fixed effect and random effect model was employed for meta-analysis based on heterogeneity, and publication bias was assessed by funnel plot analysis, Egger's and Begg's statistical test. In SNPs with adequate studies meta-regression was used to assess source of heterogeneity. Statistical analyses were performed using Stata 18.0 software.

Findings

Our search identified 1309 articles, with 67 included in the systematic review and 35 in the meta-analysis. These 67 case-control studies, involving 33,407 cases and 30,762 controls, analyzed 167 SNPs across 61 genes. Of these, 89 SNPs mapped to 46 genes showed significant associations with T2DM risk (P < 0.05), including 67 linked to increased risk and 16 with protective effects. Geographical analysis highlighted inter- and intra-regional variations. Meta-analysis of 25 SNPs revealed 12 SNPs with high T2DM risk compatibility. TCF7L2 gene exhibited a strong compatibility with an overall OR of 1.44 (95% CI 1.36-1.52) and S-value 112.41, while TCF7L2 variants rs7903146 and rs12255372, with OR 1.56 (95% CI 1.43-1.66) and S-value 89.036, OR of 1.36 (95% CI 1.17-1.35) with an S-value of 15.45 respectively.

Interpretation

Our study highlights the importance of considering the diverse ethnic groups of India for development of targeted and effective T2DM management strategies.

Funding

Department of Biotechnology (DBT) and Indian Council of Medical Research (ICMR), Government of India.

Study of a panel of genetic mutations in fibrocalcific pancreatic diabetes (FCPD): SPINK1 (N34S) mutation unlikely to be relevant

Panel of known genetic mutations (SPINK1, PRSS1, PRSS2, CTRC, and CFTR) in patients with Fibrocalcific pancreatic diabetes (FCPD)compared to Type 2 Diabetes (T2DM) and healthy controls with emphasis on SPINK1 (N34S) mutations. Whole blood samples were used to detect mutations by PCR followed by Sanger sequencing. In-silico analysis of N34S performed, to explore role in pathogenesis. Isolated SPINK1 N34S mutations found in 5.88%, 6% and 2% in FCPD, T2DM, controls respectively (p = ns). In-silico analysis of N34S variant: conflicting role. 2/51 (3.92%) SPINK1 (IVS1-37 T > C) positive, 2/51 (3.92%) SPINK1 P55S positive, 1/51 (2%) SPINK 1 (IVS3 + 2 T > C) positive and none of them SPINK1 (IV3-69insTTT) positive and none of these variants found in T2DM & healthy individuals. PRSS1, CTRC exon 2-3 mutation was found 4/51 (7.8%) and 1/51 (2%) patients of FCPD respectively. None of the patient had mutations in PRSS2, CTRC Promoter region & exon 1, CTRC exon 4-5, CTRC exon 6, CTRC exon 7-8, CFTR ΔF508, CFTR G551D, CFTR G542X, CFTR R117H and CFTR W1282X. Different variants of SPINK1, PRRS1 and CTRC were found in FCPD. Isolated SPINK1 N34S unlikely to cause disease by itself.

A prospective, multicentre study evaluating safety and efficacy of a fixed dose combination of Remogliflozin etabonate, Vildagliptin, and Metformin in Indian patients with type 2 diabetes mellitus (Triad-RMV)

AIMS

The ICMR INDIAB-17 study revealed a diabetes prevalence of 11.4% in India, emphasizing the need for effective treatment for glycemic control. A Phase IV study was conducted to evaluate the safety and efficacy of a Fixed Dose Combination (FDC) of Remogliflozin, Metformin and Vildagliptin (RMV) in Type 2 Diabetes Mellitus (T2DM) patients uncontrolled on Metformin plus SGLT2 inhibitor or Metformin plus DPP4 inhibitor dual therapy.

METHODS

A total of 215 patients (mean age: 46.4 years; 64% male, 36% female) were enrolled across multiple centers in India. The study population included patients with a baseline HbA1c ≥ 8% at the time of screening. The primary objective was to assess safety based on treatment-emergent adverse events (TEAEs), while the secondary. aim was to evaluate effectiveness in terms of glycemic (HbA1c, fasting plasma glucose, postprandial glucose) and extra-glycemic measures (renal and lipid parameters). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank test for within-group comparisons, and the Bonferroni correction was applied to adjust for multiple comparisons. Effectiveness was evaluated at baseline, week 12, and week 24.

RESULTS

The study demonstrated statistically significant reductions in mean HbA1c levels from baseline to both week 12 and week 24 (p < 0.00001). At 24, weeks, 45.1% of patients achieved target HbA1c levels of ≤ 7%. Significant reduction was also observed in fasting plasma glucose (FPG) and postprandial glucose (PPG) levels. Renal parameters remained stable or improved, and lipid profile parameters, including LDL-C and triglycerides, showed favorable changes. Adverse events of special interest, including hypoglycemia and urinary tract infections, were reported in 4.7% of patients, with no serious adverse event recorded.

CONCLUSIONS

The twice daily triple FDC of RMV was well tolerated, safe and effective in patients with Type 2 Diabetes Mellitus uncontrolled on dual drug therapy of Metformin plus SGLT2i or Metformin plus DPP4i. The treatment led to significant improvements in glycemic control and other metabolic parameters over 24 weeks, without compromising renal function or causing serious adverse events.

TRIAL REGISTRATION

CTRI, CTRI/2022/05/042581. Registered 17 May 2022, https//ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=68,757&EncHid=36127.16500&modid=1&compid=19.

The dual challenge of diabesity: pathophysiology, management, and future directions

Diabesity, the concurrent occurrence of obesity and type-2 diabetes mellitus (T2DM), represents a pressing global health challenge characterized by intricate pathophysiological mechanisms and a wide range of associated comorbidities. Central to its development are insulin resistance, metabolic syndrome, and chronic low-grade inflammation mediated by dysregulated adipokine secretion and systemic metabolic dysfunction. These mechanisms underpin the progression of diabesity and its complications, including cardiovascular disease and hypertension. Management strategies encompass lifestyle interventions focusing on tailored dietary modifications and structured physical activity, pharmacological treatments targeting both glycemic control and weight loss, and surgical interventions such as bariatric surgery, which have demonstrated efficacy in achieving durable outcomes. Clinical trials and meta-analyses underscore the comparative advantages of different treatment modalities in terms of efficacy, safety, and sustainability. Moreover, long-term follow-up studies emphasize the critical need for sustained multidisciplinary interventions to prevent relapse and enhance patient outcomes. Future advancements in management include exploring precision medicine approaches that integrate individual metabolic profiles, lifestyle factors, and emerging therapeutic innovations. A multidisciplinary approach combining advanced therapeutic strategies and patient-centered care remains pivotal for optimizing management and improving prognoses for individuals with diabesity. This review highlights the complex interplay between obesity and T2DM, offering comprehensive insights into their pathophysiology, clinical presentation, and management paradigms.

Assessment of front and back of pack nutrition labels of selected convenience food products and snacks available in the Indian market

Nutrition labels on packaged food items provide at-a-glance information about the nutritional composition of the food, serving as a quick guide for consumers to assess the quality of food products. The aim of the current study is to evaluate the nutritional information on the front and back of pack labels of selected packaged foods in the Indian market. A total of 432 food products in six categories (idli mix, breakfast cereals, porridge mix, soup mix, beverage mix and extruded snacks) were investigated by a survey. Nutritional profiling of the foods was done based on the Food Safety and Standards Authority of India (FSSAI) claims regulations. The healthiness of the packaged foods was assessed utilising nutritional traffic light system. The products were classified into 'healthy', 'moderately healthy' and 'less healthy' based on the fat, saturated fat, and sugar content. Most of the food products evaluated belong to healthy' and 'moderately healthy' categories except for products in extruded snacks. Reformulation of 'extruded snacks' are necessary to decrease the total and saturated fat content. The nutrient content claims were classified using the International Network for Food and Obesity / NCDs Research, Monitoring and Action Support (INFORMAS) taxonomy. Protein, dietary fibre, fat, sugar, vitamins and minerals were the most referred nutrients in the nutrient content claims. Breakfast cereal carried highest number of nutritional claims while porridge mix had the lowest number of claims. The overall compliance of the nutrient content claims for the studied food products is 80.5%. This study gives an overall view about the nutritional quality of the studied convenience food products and snacks in Indian market.

Association between child marriage and high blood glucose level in women: A birth cohort analysis

Objectives

Child marriage prematurely forces girls (<18 years of age) to perform adult roles prior to physical and psychological maturity. Such precocious transitions to young adulthood can have consequences on their long-term health, however, limited work has examined such relationships to date. As such, this study examines whether child marriage is associated with the risk of having hyperglycemia, or high blood glucose, in adulthood.

Study design

Observational study using repeated cross-sectional data.

Methods

Using data from the 2015-16 and 2019-21 waves of the India National Family Health Survey, we matched 432,080 and 418,409 women, aged 20-49 years, by birth year and month to create birth cohorts. Fitting multivariable binomial and multinomial logistic models, we compared the odds of having hyperglycemia across groups by marriage age (i.e., before or after age 18 years) within respective birth cohorts.

Results

We found that the adjusted odds of having high blood glucose among women married as children were 1.12 (95 % CI: 1.07-1.16) times that of their peers married as adults in the full-sample. The adjusted relative risks of having blood glucose levels higher than normal but lower than diabetic and diabetic ranges were 1.09 (95 % CI: 1.04-1.14) and 1.23 (95 % CI: 1.15-1.31), respectively, in comparison to blood glucose within normal range. These results were persistent across sub-groups of different birth cohorts.

Conclusion

Our findings suggest that child marriage was associated with higher risk of having high blood glucose in women, later in life.

Health disparity at the intersection of religion and caste: Evidence from India

Objective

The provisions and recognition of Schedule Castes (SCs), the constitutional term for the Dalits in India, have been exclusively extended to Hindus, Buddhists, and Sikhs (HBS). Omission of Dalit Muslims and Christians (MC) from the SC category stripped them of the affirmative action benefits tied with the SC status. This study aimed to explore how such differential treatment might play a role in differential health outcomes in Dalit women in India.

Methods

Drawing data on 177,346 Dalit women, aged 20 to 49 years, from two successive nationally representative surveys, we assessed the differential likelihood of hypertension and diabetes, between MC- and HBS- Dalit women. Accounting for birth cohort-, survey wave-, and state of residence- fixed effects, along with socioeconomic conditions and cardiometabolic risk factors, we obtained adjusted odds of having hypertension and diabetes in MC women. To check the validity of our results, we conducted similar analyses using data on 170,889 Scheduled Tribe (ST) women, another marginalized group, whose ST-status recognition were not tied to religion.

Results

We found that Dalit MC women were 1.13 (95% CI: 1.03-1.25) and 1.19 (95% CI: 1.05-1.36) times more likely to have hypertension and diabetes, respectively, compared to Dalit HBS women. Conversely, no statistically significant differential likelihood of these conditions was observed between MC and HBS women in the ST sample.

Conclusion

Our investigation thus, indicated a potential link at the crossroads of religion and caste that may contribute to the health disparities among marginalized women in India.

Computational insights into marine natural products as potential antidiabetic agents targeting the SIK2 protein kinase domain

Diabetes mellitus (DM) affects over 77 million adults in India, with cases expected to reach 134 million by 2045. Current treatments, including sulfonylureas and thiazolidinediones, are inadequate, underscoring the need for novel therapeutic strategies. This study investigates marine natural products (MNPs) as alternative therapeutic agents targeting SIK2, a key enzyme involved in DM. The structural stability of the predicted SIK2 model was validated using computational methods and subsequently employed for structure-based virtual screening (SBVS) of over 38,000 MNPs. This approach identified five promising candidates: CMNPD21753 and CMNPD13370 from the Comprehensive Marine Natural Product Database, MNPD10685 from the Marine Natural Products Database, and SWMDRR053 and SWMDRR052 from the Seaweed Metabolite Database. The identified compounds demonstrated docking scores ranging from -7.64 to -11.95 kcal/mol and MMGBSA binding scores between -33.29 and -68.29 kcal/mol, with favourable predicted pharmacokinetic and toxicity profiles. Molecular dynamics simulations (MDS) revealed stronger predicted binding affinity for these compounds compared to ARN-3236, a known SIK2 inhibitor. Principal component (PC)-based free energy landscape (FEL) analysis further supported the stable binding of these compounds to SIK2. These computational findings highlight the potential of these leads as novel SIK2 inhibitors, warranting future in vitro and in vivo validation.

Effect of low vs high dietary-advanced glycation end products on insulin-sensitivity and inflammatory- markers among overweight/obese Asian-Indian adults-A randomised controlled trial

The present study investigated the effect of low vs high-dietary-Advanced Glycation End products-based diets on oral disposition index-(DIo)-a marker of islet β-cell function and cardiometabolic risks factors in 38-overweight and obese Asian Indian-adults (aged 25-45 years with body-mass-index (BMI) ≥23kg/m2) through 12-week isocaloric crossover feeding trial. Biochemical-measures included-glucose tolerance test (GTT), Insulin assay (0,30 and 120 min), lipid-profile, serum-adiponectin, serum-AGE and serum-Thiobarbituric acid reactive substances-(TBARS) assessed both at baseline and end of each intervention. Generalised linear models showed that low-dAGE diet significantly improved in oral disposition index [Least Square Mean (SE), +0.3 (0.1); p = 0.03] compared to high-dAGE diet. The low-dAGE diet also showed a significant reduction in 30-minutes plasmapost-glucose-challenge-value:(-8.1[3.8] (mg/dl) vs 3.8 [3.8] (mg/dl); p = 0.01), serum-AGEs-(-3.2 [0.2] (μg/ml) vs -0.8 [0.2] (μg/ml); p = <0.0001) compared to high-dAGE diet. In summary, low-dAGE diets exhibited improvement in the insulin-sensitivity and reduction in the inflammatory levels compared to high-dAGE diets. Hence, study first time in India revealed that low dAGE diets could be a potential strategy to reduce diabetes risk.

Non-Alcoholic Fatty Liver Disease Among Newly Diagnosed Type 2 Diabetes Mellitus in North Bihar and Missed Opportunities for Early Diagnosis

BACKGROUND

There are no studies investigating missed opportunities for earlier diagnosis in newly/recently detected Type 2 Diabetes Mellitus and Non-alcoholic Fatty Liver Disease in the region of Bihar, India.

METHODS

This study is a single-center cross-sectional study undertaken at the Research Centre for Diabetes Hypertension and Obesity, Samastipur, Bihar, India. The study collected data from newly/recently diagnosed persons with T2DM. The study was conducted between December 2022 and May 2023.

RESULTS

A total of 148 people with newly diagnosed T2DM were included (median age 47, 46.6% female), and 109 patients with liver disease on ultrasound evaluation. The majority of the persons detected with diabetes were symptomatic. The commonest group of typical symptoms were excessive hunger, urinary frequency, excessive thirst, and evening fatigue, which were present in 46 individuals with liver disease. The best pathway includes a group of persons who visited specialists and MBBS doctors once they felt their symptoms should be evaluated by them and diagnosed within two months of their symptom onset. Unfavorable pathways causing delays in diagnosis and hindering efficient care involve individuals with diabetes seeking help from village doctors, pharmacists, and Aayush doctors, thereby contributing to missed opportunities.

CONCLUSION

NAFLD is prevalent in new T2DM, especially among those with high fat intake and obesity markers. This study could initiate future research aiming to improve NAFLD management and decrease associated complications in newly diagnosed persons with T2DM.

Sleep problems and their predictors in community-dwelling older adults with diabetes in India: Evidence from the Longitudinal Ageing Study in India

Objectives

To ascertain the prevalence and predictors of sleep disorders and poor sleep quality among older adults with Diabetes (DM) in India, and to assess the relationship between sleep quality and DM.

Methods

Data was utilized from the nationally representative Longitudinal Ageing Study in India (Wave-1, 2017-18), with a total sample of 66606 older adults (≥45 years) selected for the study. Sleep problems and sleep quality score were assessed using an adaptation based on the Jenkins Sleep Scale. Multivariate linear and logistic regressions were conducted to determine the effect of sociodemographic and clinical factors on sleep quality. Mediation analysis (Karlson-Holm-Breen) was done to assess the direct and indirect effects of independent variables on the sleep quality scores. Further, Propensity score matching (PSM) was done to assess the impact of diabetes on sleep problems.

Results

The prevalence of DM was 12.34% (n = 8564, 95% CI: 11.54, 13.20) among whom 24.38% (95% CI: 21.38, 27.65) reported sleep problems. On adjusted analysis, sleep problems were significantly associated with increasing education, higher wealth quintile, lack of physical activity, and multimorbidity. Mediation analysis showed adherence to anti-diabetes medication improved sleep quality (aB = -0.28 (95% CI: -0.54, -0.02)), while comorbidities worsened sleep quality (aB = 0.79 (95% CI: 0.67, 0.92)). Analysis from PSM indicated that DM was associated with a 6.2% higher chance of sleep problems.

Conclusions

Poor sleep quality is present in nearly one in four individuals diagnosed with DM in India and linked with certain adverse social determinants. Focused interventions to improve assessment and treatment of sleep problems in resource-limited primary care settings require prioritization.

High-quality haplotype-resolved chromosome assembly provides evolutionary insights and targeted steviol glycosides (SGs) biosynthesis in Stevia rebaudiana Bertoni

Stevia rebaudiana Bertoni is popular source of plant-derived low/no-calorie natural sweeteners (LNCSs), collectively known as steviol glycosides (SGs). Nevertheless, genetic predisposition for targeted biosynthesis of SGs is complex due to multi-substrate functionality of key uridine diphosphate glycosyltransferases (UGTs). Here, we created a high-quality monoploid assembly of 1.34 Gb with N50 value of 110 Mb, 55 551 predicted protein-coding genes, and ~80% repetitive regions in Rebaudioside-A (Reb-A) enriched cultivar of S. rebaudiana. Additionally, a haplotype-based chromosome assembly consisting of haplotype A and haplotype B with an overall genome size of 2.33Gb was resolved, harbouring 639 634 variants including single nucleotide polymorphisms (SNPs), indels and structural variants (SVs). Furthermore, a lineage-specific whole genome duplication analysis revealed that gene families encoding UGTs and Cytochrome-P450 (CYPs) were tandemly duplicated. Additionally, expression analysis revealed five tandemly duplicated gene copies of UGT76G1 having significant correlations with Reb-A content, and identified key residue (leu200val) in the glycosylation of Reb-A. Furthermore, missense variations identified in the acceptor region of UGT76G1 in haplotype resolve genome, transcriptional and molecular docking analysis were confirmed with resequencing of 10 diverse stevia genotypes (~25X). Gene regulatory network analysis identified key transcription factors (MYB, bHLH, bZIP and AP2-ERF) as potential regulators of SG biosynthesis. Overall, this study provides haplotype-resolved chromosome-level genome assembly for genome editing and enhancing breeding efforts for targeted biosynthesis of SGs in S. rebaudiana.

Expert Opinion on the Role of Sacubitril/Valsartan in the Management of Hypertension in India

Hypertension, a key modifiable risk factor for cardiovascular diseases (CVD), significantly contributes to premature death and morbidity worldwide. Despite stabilization in age-adjusted global prevalence, the absolute number of hypertensive individuals doubled from 2000 to 2010, largely due to increases in low- and middle-income countries. In 2021, only 21% of hypertensive individuals globally had effective blood pressure (BP) control. In India, hypertension is the leading risk factor for death and disability, with prevalence rates of 24% in men and 21% in women, as reported by the 2019-2020 National Family Health Survey (NFHS-5). Alarmingly, just 25% of rural and 38% of urban hypertensive Indians are undergoing treatment, with only 10% and 20% achieving BP control, respectively. This highlights the hypertension paradox, where clinical inertia and hesitancy in intensifying BP-lowering therapy persist despite the availability of antihypertensive drugs. This expert opinion paper aims to provide a comprehensive evaluation of sacubitril/valsartan in hypertension management, leveraging insights from its approved use in heart failure and examining its benefits and challenges across diverse hypertensive populations. The formulation of this expert opinion involved employing evidence-based methodologies and utilizing all available data. The document underwent scrutiny by expert cardiologists, whose clinical experiences and examination of the evidence and guidelines informed the formation of the expert opinion. This expert opinion paper provides a thorough and informed evaluation of sacubitril/valsartan, highlighting its potential to address unmet needs in BP control, particularly in challenging cases such as resistant hypertension and chronic kidney disease.

Leveraging Artificial Intelligence for Diabetic Retinopathy Screening and Management: History and Current Advances

AIM

Regular screening of large number of people with diabetes for diabetic retinopathy (DR) with the support of available human resources alone is a global challenge. Digital health innovation is a boon in screening for DR. Multiple artificial intelligence (AI)-based deep learning (DL) algorithms have shown promise for accurate diagnosis of referable DR (RDR). The aim of this review is to evaluate the use of AI for DR screening and the various currently available automated DR detection algorithms.

METHODS

We reviewed articles published up to May 15th 2024, on the use of AI for DR by searching PubMed, Medline, Embase, Scopus, and Google Scholar using keywords like diabetic retinopathy, retinal imaging, teleophthalmology, automated detection, artificial intelligence, deep learning and fundus photography.

RESULTS

This narrative review, traces the advent of AI and its use in digital health, the key concepts in AI and DL algorithm development for diagnosis of DR, some crucial AI algorithms that have been validated for detection of DR and the benefits and challenges of use of AI in detection and management of DR. While there are many approved AI algorithms that are in use globally for DR detection, IDx-DR, EyeArt, and AEYE Diagnostic Screening (AEYE-DS) are the algorithms that have been approved so far by USFDA for automated DR screening.

CONCLUSION

AI has revolutionized screening of DR by enabling early automated detection. Continuous advances in AI technology, combined with high-quality retinal imaging, can lead to early diagnosis of sight-threatening DR, appropriate referrals, and better outcomes.

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

BACKGROUND

Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.

METHODS

We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.

FINDINGS

In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).

INTERPRETATION

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

Developmental Origins of Non-Communicable Chronic Diseases: Role of Fetal Undernutrition and Gut Dysbiosis in Infancy

There is an increasing prevalence of non-communicable chronic diseases (NCCDs) like obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), hypertension, allergic asthma, and neuro-developmental/psychiatric problems in many parts of the world. A suboptimal lifestyle as an adult is often blamed for the occurrence of NCCDs. This review discusses the developmental origin of health and disease theory and how suboptimal nutrition in intrauterine life and the establishment of a suboptimal gut microbiome during infancy can influence the predisposition to NCCDs.

Incidence and Progression of Diabetic Retinopathy in Urban India: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study, 15yr Follow up

Purpose: To evaluate the 15 year incidence and progression of Diabetic Retinopathy (DR) and identify risk factors among Indian population.Methods: From a cross-sectional study of 1425 subjects, 911 participants took part in the 4-year follow-up. Out of these 911 participants, 140 returned for the 15-year follow-up, with baseline examinations conducted between 2003 and 2006, and subsequent follow-ups occurring from 2007 to 2011 and the current 15-year follow-up from 2018 to 2021. Of the 140 participants, 112 were eligible for analysis after excluding individuals with ungradable fundus photographs.Results: The 15-year incidence of any diabetic retinopathy (DR) was 5%, with mild NPDR and moderate NPDR at 1.57% and 2.7%, respectively. Proliferative DR was observed in 0.71% of cases, while diabetic macular edema (DME) and sight-threatening diabetic retinopathy (STDR) rates were 0.48% and 1.10%, respectively. Age-standardized rates revealed a significant association with increasing age and incident any DR and STDR. DR progression over 15 years included 7.5% one-step and 1.75% two-step progressions, while regression was limited to 1.75% one-step regression. Multiple logistic regression analyses revealed that baseline duration of diabetes, systolic blood pressure, HbA1c levels, and the presence of anemia influenced the incidence of any DR, DME, and STDR. Smoking and higher HbA1c were identified as risk factors for one-step progression of DR.Conclusion: This study provides crucial insights into the long-term incidence, progression, and regression of DR among individuals with Type 2 diabetes in India.

Prediabetes and diabetes in India: An HbA1c based epidemiology study

BACKGROUND

The relentless rise in Type 2 diabetes mellitus (T2DM) and prediabetes presents a complex challenge to India's healthcare system. This study analyses the prevalence and trends of these conditions in adults across Indian states using laboratory data collected during 2023.

METHODS

HbA1c values from 19,66,449 samples from adults alongside demographic and geographic details were retrospectively analysed. Data were stratified by state, age, and gender and evaluated against national statistics parameters such as food consumption and socio-economic status.

RESULTS

Substantial regional variation was seen across the country where 22.25% of the tested population was considered having prediabetes, and 27.18% with diabetes. Odisha had the highest rates, while J&K reported the lowest. Gender-specific trends indicate an increase in prevalence of diabetes among males compared to females. Age-wise data stratification shows a significant burden of prediabetes and diabetes in the economically productive age groups. Correlations between disease prevalence and state-specific grain consumption were observed, suggesting dietary influences.

CONCLUSIONS

The reported prevalence of prediabetes and diabetes higher than previous studies highlights the importance of regular screening. The use of HbA1c for estimation as a long-term average blood sugar marker helps to identify previously undiagnosed diabetes. The correlation of prevalence with food production underscores the importance of diet in disease management.

Diabetes Risk Factors in People With HIV Receiving Pitavastatin Versus Placebo for Cardiovascular Disease Prevention : A Randomized Trial

BACKGROUND

REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) led to new guidelines for statin use among people with HIV (PWH) with low to moderate risk for atherosclerotic cardiovascular disease (ASCVD). Little is known about the natural history of diabetes mellitus (DM) or mechanisms contributing to statin effects on DM among this population.

OBJECTIVE

To determine the contribution of known DM risk factors to excess risk for DM with pitavastatin in REPRIEVE.

DESIGN

Phase 3, primary ASCVD prevention trial over a median of 5.6 years of follow-up. (ClinicalTrials.gov: NCT02344290).

SETTING

Global, multicenter trial.

PARTICIPANTS

7731 PWH aged 40 to 75 years with low to moderate ASCVD risk (by the pooled cohort equations from the American College of Cardiology and American Heart Association) without DM at study entry.

INTERVENTION

Random 1:1 assignment to pitavastatin, 4 mg daily, or placebo.

MEASUREMENTS

New-onset DM was determined at each visit by clinical diagnosis requiring initiation of medication treatment for DM. The incidence of new-onset DM was assessed in relation to predefined demographic and metabolic risk factors, stratified by treatment group. Treatment effects of pitavastatin on progression to new DM in key subgroups were determined.

RESULTS

Participants with at least 3 DM risk factors (vs. no risk factors) had increased risk for DM in each treatment group (incidence rate, 3.24 per 100 person-years [PY] vs. 0.34 per 100 PY [pitavastatin] and 2.66 per 100 PY vs. 0.27 per 100 PY [placebo]). The incidence of DM was highest in South Asia. In adjusted analyses, high body mass index, prediabetes, and metabolic syndrome components were strongly associated with new-onset DM (all P < 0.005).

LIMITATION

Pitavastatin was the only statin assessed; DM was assessed clinically.

CONCLUSION

Metabolic risk factors, including prediabetes and obesity, contributed to new-onset DM in statin- and placebo-treated participants. A clinically significant effect of pitavastatin on DM was seen primarily among those with multiple risk factors for DM at entry. Strategies targeting key metabolic risk factors, like obesity and prediabetes, may help protect against DM among PWH.

PRIMARY FUNDING SOURCE

National Heart, Lung, and Blood Institute of the National Institutes of Health.

Novel genomic variants related to visceral adiposity index (VAI) and body adiposity index (BAI) in Indian sib-pairs

BACKGROUND

Obesity is among the leading public health threats globally. Over the last few years, visceral adiposity index (VAI), and body adiposity index (BAI), derived from anthropometric, and biochemical measures, have gained importance as a measure of obesity. However, unlike other common indices like body mass index, and waist circumference, the genetic predisposition of VAI, and BAI under-examined.

METHODS

2265 sib-pairs from Indian Migration Study were used for examining the association of genetic variants from the Cardio-Metabochip array with VAI, and BAI. Mixed linear regression models were run, and all inferences were based on the within-sib component of the Fulker's association models. Gene-environment/lifestyle interaction analyses were also undertaken.

RESULTS

rs6659428 at LOC400796 | SEC16B (β = 0.26, SE = 0.05), and rs7611535 at DRD3 | LOC645180 (β = 0.18, SE = 0.04) were associated with VAI at suggestive significance value of <8.21 × 10-6. For BAI, rs73300702 at JAZF1-AS1 (β = 0.27, SE = 0.06), was the top hit at p value < 8.21 × 10-6. Further, rs6659428 showed marginal effect modification with rural/urban location (β = 0.26, SE = 0.13, p value = 0.047), and rs73300702 with physical activity (β = -0.29,SE = 0.14, p value = 0.034).

CONCLUSION

We report three novel genetic loci for VAI, and BAI in Indians that are important indicators of adiposity. These findings need to be replicated and validated with larger samples from different ethnicities. Further, functional studies for understanding the biological mechanisms of these adiposity indices need to be undertaken to understand the underlying pathophysiology.

ICMR-MDRF Diabetes Biosamples: Cohort profile

Background & objectives Biobanks are crucial for biomedical research, enabling new treatments and medical advancements. The biobank at the Madras Diabetes Research Foundation (MDRF) aims to gather, process, store, and distribute biospecimens to assist scientific studies. Methods This article details the profile of two cohorts: the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study and the Registry of people with diabetes in India with young age at onset (ICMR-YDR). The ICMR-INDIAB study is the largest epidemiological study on diabetes in India, encompassing a nationally representative sample of individuals aged 20 yr and older from urban and rural areas in every State across the country. The ICMR-YDR is the first national-level, multicentric clinic-based registry focusing on youth-onset diabetes in India, aiming to understand the disease patterns and variations in youth-onset diabetes across different country regions. Results Key operations at the MDRF biobank include collecting and processing samples, where serum and whole blood samples are aliquoted and transferred through a cold chain to the central laboratory, and then stored in Siruseri (29 km from the capital city of Chennai, Tamil Nadu). Samples are barcoded, linked to subject information, and stored in freezers or liquid nitrogen (LN2) vessels, with inventory tracked via software for easy retrieval. A register records access to the biobank, ensuring sample integrity and compliance with regulatory requirements. The biobank adheres to the ICMR's National Ethical Guidelines for Biomedical and Health Research involving human participants. Interpretation & conclusions The biobank enables the analysis of biomarkers in stored samples, aiding in scientifically sound decisions, treating patients, and potentially curing diabetes.

Effectiveness of Oral Semaglutide in Management of Type 2 Diabetes: A Real-World Study from India

Introduction

Oral Semaglutide (Sema-o) is the first oral glucagon like peptide-1 receptor analogue (GLP-1RA) commercially available for the treatment of type 2 diabetes (T2D). This study aimed to evaluate the efficacy of Sema-o in patients with T2D when added to the existing therapy.

Methods

This retrospective real-world study enrolled adult patients with diabetes taking Sema-o, with at least one follow-up (from February 2022 till October 2023). A proforma recorded baseline and follow-up date, medications, body composition, laboratory and clinical parameters. Data is presented as median (interquartile range) and was analysed using SPSS.

Results

A total of 351 patients followed up once, while 56 patients had 4 follow-up visits. Baseline parameters were as follows: age 53 years (43-61), duration of diabetes 10 years (5-16), weight 91 kg (79-103), body mass index (BMI) 32.7 kg/m2 (29.3-36.6) and HbA1c 7.9% (6.9-9). The addition of Sema-o in the existing therapy for diabetes resulted in a significant reduction in HbA1c {follow-up: 1st 0.5%, 2nd 0.9%, 3rd 1.1% and 4th 1.1% (all, P < 0.001)} and % weight reduction {follow-up: 1st 2%, 2nd 3.3%, 3rd 4.1% and 4th 4.3% (all, P < 0.001)} from baseline. Reductions in BMI, glucose (fasting/post-prandial), lipids, liver enzymes and body composition parameters were significant. Gastro-intestinal side-effects (299 events in 52.4% of patients) were frequent. A total of 34/9.7% patients discontinued Sema-o.

Conclusion

Intensification of existing therapy with Sema-o in obese patients with moderately uncontrolled diabetes proved to be an effective and relatively safe strategy. Achieving normoglycemia and reductions in weight, lipids and body fat/visceral fat with Sema-o may confer a much needed cardiometabolic benefit in these patients.

Position statement on hypertension by Indian Society of Hypertension, 2023

The Indian Society of Hypertension (InSH) highlights the urgency for India-specific guidelines on hypertension management. Hypertension affects over one billion people worldwide, with India bearing a significant burden due to its population, diversity, and demographics. In India, hypertension affects 21% of women and 24% of men, while pre-hypertension affects 39% of women and 49% of men. The prevalence of hypertension increases in the population with obesity. Even 7% of school-going children in India have hypertension, especially in urban and overweight children. However, awareness and control of hypertension in India are inadequate. Only 57% of women and 38% of men have been diagnosed with hypertension; among them, only a fraction receive appropriate medication. The overall control of hypertension stands at 15%, with regional variations. Hypertension significantly contributes to cardiovascular and renal diseases, and better detection and treatment could reduce their impact in India. At the total population level, reducing systolic blood pressure (SBP) by 2 mm Hg may significantly affect cardiovascular disease. Considering the unique challenges faced in India, the InSH stresses the importance of a tailored approach to hypertension management. They plan to disseminate guidelines through practitioner training and patient awareness campaigns. These guidelines will cover screening, diagnosis, management, handling hypertension with other conditions, long-term follow-up, and patient education. In conclusion, this position paper calls for immediate action to improve hypertension management in India and alleviate the associated disease burden and mortality.

Prevalence and Predictors of Adverse Events Associated With Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetic Patients: A Cross-sectional Study

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India.

Objective

To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM).

Research design and methods

This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike's information criterion and highest PseudoR 2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1.

Results

Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006-1.020)], alkaline phosphatase [OR: 1.004 (1.001-1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012-1.366)] were significant predictors for AEs with DPP-4 inhibitors.

Conclusion

The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.