Epidemiology of type 2 diabetes in India

Modified risk calculator for the Pakistani population based on perceived versus actual risk factors for developing type 2 diabetes mellitus

Purpose

The purpose of this study was to develop the modified risk calculator for the Pakistani population based on differences in perceived versus actual risk factors for developing type 2 diabetes mellitus (T2-DM).

Design/methodology/approach

A cross-sectional study design was developed to assess the study sample of 296 individuals from the Pakistani population. The data was collected using a questionnaire divided into three parts: general health, the validated Risk Perception Survey for Developing Diabetes (RPS-DD) and actual T2-DM risk assessment.

Findings

The study findings showed that among the total participants, 70.27% reported a low perceived risk of developing T2-DM, whereas 29.72% reported a high perceived risk when considering their family history. Regarding actual risk, males showed a 59% higher likelihood of developing T2-DM than females, who have a 50% higher risk. The modified calculator includes physical activity, fatty food consumption, age 34–65 and over 65, depression and artificially sweetened beverages.

Research limitations/implications

This study experienced limited representativeness; many participants provided incomplete nutritional and knowledge information. It involved 296 individuals, mostly from one province and a few from other provinces of Pakistan. Therefore, the results can be generalized to the whole Pakistani population.

Practical implications

This study underscores the need for targeted interventions to enhance risk perception, inform preventive strategies and further investigate the interplay between perceived and actual risks in T2-DM in Pakistan.

Social implications

The outcomes of this study can help Pakistani individuals who perceive themselves at an elevated risk of developing T2-DM. There is a general awareness among the Pakistani population regarding T2-DM. In contrast to perceived risk, the data on actual risk reveals a significant disconnect.

Originality/value

In Pakistan, there is a lack of research on perceived versus actual risk factors for developing T2-DM. To the best of the authors’ knowledge, this is the first study that evaluates the actual risk factors of developing T2-DM based on culture and dietary diversity in Pakistan.

Corporate genome screening India (CoGsI) identified genetic variants association with T2D in young Indian professionals

Rising cases of type 2 diabetes (T2D) in India, especially in metropolitan cities is an increasing concern. The individuals that were most affected are young professionals working in the corporate sector. However, the corporate sector has remained the least explored for T2D risk predisposition. Considering corporate employees' lifestyles and the role of gene-environment interaction in T2D susceptibility, the study aims to find genetic variants associated with T2D predisposition. In this first kind of study, 680 young professionals (284 T2D cases, and 396 controls) were diagnosed and screened for 2658 variants on an array designed explicitly for the CoGsI study. The variant filtering was done at Bonferroni p-value of 0.000028. The genetic data was analysed using PLINK v1.09, SPSS, R programming, VEP tool, and FUMA GWAS tool. Interestingly, 42 variants were associated with the T2D risk. Out of 42, three missense variants (rs1402467, rs6050, and rs713598) in Sulfotransferase family 1 C member 4 (SULT1C4), Fibrinogen Alpha Chain (FGA), and Taste 2 Receptor Member 38 (TAS2R38) and two untranslated region (UTR) variants (rs1063320 and rs6296) in Major Histocompatibility Complex, Class I, G (HLA-G) and 5-Hydroxytryptamine Receptor 1B (HTR1B) were associated with the T2D risk. CoGsI identified potential genomic markers increasing susceptibility to the early onset of T2D. Present findings provide insights into mechanisms underlying T2D manifestation in corporate professionals due to genetics interacting with occupational stress and urban lifestyles.

Improving Clinical Preparedness: Community Health Nurses and Early Hypoglycemia Prediction in Type 2 Diabetes Using Hybrid Machine Learning Techniques

OBJECTIVES

The aim of the study was to analyze the data of diabetic patients regarding warning signs of hypoglycemia to predict it at an early stage using various novel machine learning (ML) algorithms. Individual interviews with diabetic patients were conducted over 6 months to acquire information regarding their experience with hypoglycemic episodes.

DESIGN

This information included warning signs of hypoglycemia, such as incoherent speech, exhaustion, weakness, and other clinically relevant cases of low blood sugar. Researchers used supervised, unsupervised, and hybrid techniques. In supervised techniques, researchers applied regression, while in hybrid classification ML techniques were used. In a 5-fold cross-validation approach, the prediction performance of seven models was examined using the area under the receiver operating characteristic curve (AUROC). We analyzed the data of 290 diabetic patients with low blood sugar episodes.

RESULTS

Our investigation discovered that gradient boosting and neural networks performed better in regression, with accuracies of 0.416 and 0.417, respectively. In classification models, gradient boosting, AdaBoost, and random forest performed better overall, with AUC scores of 0.821, 0.814, and 0.821, individually. Precision values were 0.779, 0.775, and 0.776 for gradient boosting, AdaBoost, and random forest, respectively.

CONCLUSION

AdaBoost and Gradient Boosting models, in particular, outperformed all others in predicting the probability of clinically severe hypoglycemia. These techniques enable community health nurses to predict hypoglycemia at an early stage and provide the necessary therapies to patients to prevent complications resulting from hypoglycemia.

Computational profiling and pharmacokinetic modelling of Febuxostat: Evaluating its potential as a therapeutic agent for diabetic wound healing

BACKGROUND

Diabetic wounds, a significant complication of Type 2 Diabetes Mellitus (T2DM), face delayed healing due to impaired inflammation, angiogenesis, and collagen synthesis. This study explores Febuxostat, a xanthine oxidase inhibitor for its therapeutic potential in wound healing. Combining computational approaches and in-vitro assays, the study evaluates its effects on key wound healing pathways, cell viability, migration.

METHODOLOGY

The potential of Febuxostat in diabetic wound healing was studied using in-silico tools for Molecular docking and ADMET profiling, alongside Molecular dynamics (MD) simulations. Toxicity was assessed with OSIRIS Explorer, and biological activity was predicted using the PASS tool. In-vitro MTT and scratch assays on L929 cells further validated cytotoxicity and wound healing efficacy.

RESULTS

Docking analysis revealed strong binding affinities to key wound healing targets, including VEGF (-9.11 kcal/mol) and NFKβ (-8.62 kcal/mol). Pharmacokinetic studies highlighted favorable skin permeability, supporting topical applications. Toxicity predictions indicated a safe profile. Molecular dynamics simulations demonstrated stable protein-ligand complexes, particularly with VEGF. Cytotoxicity studies on L929 cells revealed an IC50 of 6.08 μM and the scratch assay demonstrated significant wound healing activity, highlighting its effectiveness in promoting cell migration and closure.

CONCLUSION

Febuxostat shows remarkable potential in enhancing diabetic wound healing by promoting cell migration, targeting wound-healing proteins, as demonstrated through in-silico and in-vitro studies. This drug is poised to effectively treat diabetic wounds, accelerating healing and reducing complications. Rigorous pre-clinical and clinical evaluations are essential to validate its safety, efficacy, and therapeutic potential.

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.

Mechanistic insights of diabetic wound: Healing process, associated pathways and microRNA-based delivery systems

Wounds that represent one of the most critical complications can occur in individuals suffering from diabetes mellitus, and results in the need for hospitalisation and, in severe cases, require amputation. This condition is primarily characterized by infections, persistent inflammation, and delayed healing processes, which exacerbate the overall health of the patients. As per the standard mechanism, signalling pathways such as PI3K/AKT, HIF-1, TGF-β, Notch, Wnt/β-Cat, NF-κB, JAK/STAT, TLR, and Nrf2 play major roles in inflammatory, proliferative and remodelling phases of wound healing. However, dysregulation of the above pathways has been seen during the healing of diabetic wounds. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate the expression of various genes and signalling pathways which are associated with the process of wound healing. In the past few years, there has been a great deal of interest in the potential of miRNAs as biological agents in the management of a number of disorders. These miRNAs have been shown to modulate expression of genes involved in the healing process of wounds. There have been previous reviews pertaining to clinical trials examining miRNAs in several disorders, but only a few clinical studies have examined involvement of miRNAs in healing of wounds. Considering the therapeutic promise, there are several obstacles concerning their instabilities and inefficient delivery into the target cells. Therefore, this review is an attempt to discuss precise roles of signalling pathways and miRNAs in different phases of wound healing, and their aberrant regulation in diabetic wounds, particularly. It has also compiled a range of delivery mechanisms as well as an overview of the latest findings pertaining to miRNAs and associated delivery systems for improved healing of diabetic wounds.

Efficient synthesis of promising antidiabetic triazinoindole analogues via a solvent-free method: investigating the reaction of 1,3-diketones and 2,5-dihydro-3H-[1,2,4]triazino[5,6-b]indole-3-thione

Diabetes poses a significant global health challenge, driving the search for effective management strategies. In the past years, α-amylase inhibitors have emerged as promising candidates for regulating blood sugar levels. In this concern, we have synthesized a series of novel 3-methyl-2-aroylthiazolo[3',2':2,3][1,2,4]triazino[5,6-b]indole derivatives via the regioselective reaction of 2,5-dihydro-3H-[1,2,4]triazino[5,6-b]indole-3-thione and 1,3-diketones in the presence of NBS under solvent-free conditions. Subsequently, the inhibitory potential of the newly synthesized 3-methyl-2-aroylthiazolo[3',2':2,3][1,2,4]triazino[5,6-b]indole derivatives was assessed against the α-amylase enzyme to probe their antidiabetic properties. In vitro studies revealed moderate to excellent α-amylase inhibitory activity, with IC50 values ranging from 16.14 ± 0.41 to 27.69 ± 0.58 μg ml-1. Furthermore, SAR analysis showed that compounds containing halogen groups exhibited superior inhibition potential, surpassing the standard drug Acarbose (IC50 = 18.64 ± 0.42 μg ml-1), particularly derivatives substituted with 4-fluoro and 2,4-dichloro groups, with IC50 values of 16.14 ± 0.41 μg ml-1 and 17.21 ± 0.15 μg ml-1, respectively. Additionally, molecular docking unveiled the binding modes of ligands with the active site of A. oryzae α-amylase. Encouragingly, the theoretical analyses closely mirrored the experimental findings, further underlining the promise of these synthetic molecules as potent α-amylase inhibitors.

Bayesian analysis of non-communicable diseases risk factors: a focus on the lower-educated population in Bangladesh

BACKGROUND

This study investigates non-communicable disease (NCD) risk factors, specifically hypertension and diabetes, among Bangladeshi adults with lower educational attainment. With an increasing global burden of NCDs, understanding the dynamics in lower-educated populations becomes crucial for targeted interventions and achieving Sustainable Development Goal 3.4-curtailing premature mortality from non-communicable diseases by one-third by 2030 through prevention and treatment.

METHODS

Utilizing data from the Bangladesh Demographic and Health Survey (2017-2018), a two-stage stratified sampling design identified 7287 lower-educated individuals. Bayesian logistic regression was applied for risk factor analysis.

RESULTS

The prevalence of hypertension and diabetes among lower-educated people was 31% and 9.3%, respectively. NCD prevalence (37.3%) underscored a significant health burden. Factors such as gender, age, wealth status, working status, residence and region showed significant associations with NCDs. Bayesian analysis revealed that females were 1.30 times more likely to develop NCDs, while older age groups demonstrated 4.30 times greater likelihood. Employed individuals exhibited a 43% lower risk. Wealthier households showed higher NCD likelihood and residence in the central region was associated with an 11% lower risk.

CONCLUSIONS

This study highlights the high risk of developing NCDs among lower-educated females, particularly those ≥35 y of age in Bangladesh. Therefore, targeted interventions for this group are critical to reducing NCD risks, supporting national health objectives and advancing progress toward the Sustainable Development Goals.

Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India

BACKGROUND

Globally, obesity and diabetes mellitus (DM) are emergent public health concerns in the adolescent population. India, home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization, with accompanying unhealthy nutritional transition, and sedentary lifestyle.

AIM

To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents (15-19 years) in India.

METHODS

This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India (2019-2021). The survey employed stratified two-stage sampling, with systematic random sampling in rural and urban areas. Statistical analysis included descriptive statistics, bivariate, and multivariable logistic regression, employing generalized linear models.

RESULTS

The weighted prevalence of DM was 1.09% including 0.77% [95% confidence interval (CI): 0.72-0.83] previously diagnosed and 0.32% (95%CI: 0.29-0.35) newly diagnosed cases detected on survey screening. On adjusted analysis, increasing age, higher education levels, higher wealth index, and overweight/obesity were the factors significantly associated with presence of DM. Only 61% of the adolescents with previously diagnosed DM were on anti-diabetes treatment. The weighted prevalence of overweight/obesity among older adolescents was 6.9% with significantly higher odds in the male sex, having higher educational levels, urban residence, and those with a higher wealth index.

CONCLUSION

Nearly one in hundred older adolescents in India have diabetes, with one in three undiagnosed. Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

Managing drug therapy-related problems and assessment of chronic diabetic wounds

Type 2 diabetes mellitus (T2DM), responsible for most diabetes cases recorded worldwide, increases the risk of chronic wounds and amputation. Patients with T2DM appear to be more susceptible to delayed wound healing due to their treatment adherence. This review explores the specifics of polypharmacy, side effects, possible drug interactions and the importance of medication adherence for therapeutic efficacy. We discuss the effects of anti-diabetes medications on wound healing as well as the role that biofilms and microbial infections play in diabetic wounds. Inconsistent use of medications can lead to poor glycaemic control, which negatively affects the healing process of diabetic foot ulcers. Managing chronic wounds represents a substantial portion of healthcare expenditures. Biofilm-associated infections are difficult for the immune system to treat and respond inconsistently to antibiotics as these infections are slow growing and persistent. Additionally, we emphasize the critical role pharmacists play in enhancing patient adherence and optimizing diabetes treatment by offering comprehensive coverage of drugs associated with problems related to pharmacological therapy in type 2 diabetes.

Unveiling the utility of artificial intelligence for prediction, diagnosis, and progression of diabetic kidney disease: an evidence-based systematic review and meta-analysis

OBJECTIVE

The purpose of this study was to conduct a systematic investigation of the potential of artificial intelligence (AI) models in the prediction, detection of diagnostic biomarkers, and progression of diabetic kidney disease (DKD). In addition, we compared the performance of non-logistic regression (LR) machine learning (ML) models to conventional LR prediction models.

METHODS

Until January 30, 2024, a comprehensive literature review was conducted by investigating databases such as Medline (via PubMed) and Cochrane. Research that is inclusive of AI or ML models for the prediction, diagnosis, and progression of DKD was incorporated. The area under the Receiver Operating Characteristic Curve (AUROC) served as the principal outcome metric for assessing model performance. A meta-analysis was performed utilizing MedCalc statistical software to calculate pooled AUROC and assess the performance differences between LR and non-LR models.

RESULTS

A total of 57 studies were included in the meta-analysis. The pooled AUROC of AI or ML model was 0.84 (95% CI = 0.81-0.86, p < 0.0001) for analyzing prediction of DKD, 0.88 (95%CI = 0.84-0.92, p < 0.0001) for detecting diagnostic biomarkers, and 0.80 (95% CI = 0.77-0.82, p < 0.0001) for analyzing progression of DKD. The pooled AUROC of LR and non-LR ML models exhibited no significant differences across all categories (p > 0.05), except for the random forest (RF) model, which displayed a statistically significant increase in predictive accuracy compared to LR for DKD occurrence (p < 0.04).

CONCLUSION

ML models showed solid DKD prediction effectiveness, with pooled AUROC values over 0.8, suggesting good performance. These data demonstrated that non-LR and LR models perform similarly in overall CKD management, but the RF model outperforms the LR model, particularly in predicting the occurrence of DKD. These findings highlight the promise of AI technologies for better DKD management. To improve model reliability, future study should include extended follow-up periods as well as external validation.

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.

Pathological insights into cell death pathways in diabetic wound healing

Diabetic foot ulcers (DFUs) are a microvascular complication that affects almost 21 % of the diabetic population. DFUs are characterized by lower limb abnormalities, chronic inflammation, and a heightened hypoxic environment. The challenge of healing these chronic wounds arises from impaired blood flow, neuropathy, and dysregulated cell death processes. The pathogenesis of DFUs involves intricate mechanisms of programmed cell death (PCD) in different cell types, which include keratinocytes, fibroblasts, and endothelial cells. The modes of cell death comprise apoptosis, autophagy, ferroptosis, pyroptosis, and NETosis, each defined by distinct biochemical hallmarks. These diverse mechanisms contribute to tissue injury by inducing neutrophil extracellular traps and generating cellular stressors like endoplasmic reticulum stress, oxidative stress, and inflammation. Through a comprehensive review of experimental studies identified from literature databases, this review synthesizes current knowledge on the critical signaling cascades implicated in programmed cell death within the context of diabetic foot ulcer pathology.

Clinical Profile, Comorbidities and Therapies in Type 2 Diabetes Patients on Sitagliptin-Based Therapy in Indian Outpatient Setting

Objectives The study was conducted to generate real-world data on prescription patterns and patient profiles for sitagliptin-based therapies in real-world outpatient settings across India. Method A cross-sectional, observational, multicenter, real-world prescription event monitoring (PEM) study was conducted at 1058 sites across India over six months, from 1 August 2023 to 16 January 2024. Adult type 2 diabetes patients receiving sitagliptin-based mono or combination therapies were included in the study. Primary outcomes assessed included the dosage of sitagliptin and other medications and the specific drugs combined with sitagliptin. Secondary outcomes included demographic profiles, medication history, comorbidities, and glycemic parameters. Results A total of 10210 patients (n=6398 males; n=3812 females) completed the study. Duration of diabetes was available for 5422 patients, of which nearly half of the patients had diabetes for 1-5 years, while around 42.3% (n=2294) of the patients had diabetes for more than five years. Comorbidities were present in 36.02% (n=3678) of the patients. Hypertension and dyslipidemia were the most common comorbidities reported in 25.3% (n=2584) and 10.42% (n=1064), respectively. Sitagliptin was administered as monotherapy or in combination with other medications. Dual combination therapy was most common, with sitagliptin 50 mg+metformin 500 mg being the predominantly prescribed regimen. Triple combination therapy with sitagliptin+dapagliflozin+metformin was also prescribed in a substantial proportion of the patients. Variations in preferred regimens were observed among patients with different comorbid conditions, with sitagliptin 100 mg+dapagliflozin 10 mg being preferred in patients with established cardiovascular disease and heart failure and sitagliptin 50 mg+metformin 500 mg in diabetic patients with hypertension, dyslipidemia, and renal disease. Conclusion The study findings highlighted the preferences for the use of sitagliptin and its dual as well as triple combinations as integral components of diabetes management strategies in clinical practice in Indian outpatient settings. The study also found that diabetes with ASCVD and CV risk factors influence the use of sitagliptin and dapagliflozin in combination.

Metabolic perturbations associated with hIAPP-induced insulin resistance in skeletal muscles: Implications to the development of type 2 diabetes

The human islet amyloid polypeptide (hIAPP) tends to misfold and self-assemble to form amyloid fibrils, which has been associated with the loss of function and viability of pancreatic β-cells in type 2 diabetes mellitus (T2DM). The role of hIAPP in the development of insulin resistance (a hallmark of T2DM) in skeletal muscles - the major sites for glucose utilization - needs further investigation. Even though, insulin-resistant conditions have been known to stimulate hIAPP aggregation, the events that lead to the development of insulin resistance due to hIAPP aggregation in skeletal muscles remain unidentified. Here, we have attempted to identify metabolic perturbations in L6 myotubes that were exposed to increasing concentrations of recombinant hIAPP for different time durations. It was observed that hIAPP exposure was associated with increased mitochondrial and cellular ROS levels, loss in mitochondrial membrane potential and viability of the myotubes. Metabolomic investigations of hIAPP-treated myotubes revealed significant perturbations in o-phosphocholine, sn-glycero-3-phosphocholine and dimethylamine levels (p < 0.05). Therefore, we anticipate that defects in glycerophospholipid metabolism and the associated oxidative stress and membrane damage may play key roles in the development of insulin resistance due to protein misfolding in skeletal muscles. In summary, the perturbed metabolites and their pathways have not only the potential to be used as early biomarkers to predict the onset of insulin resistance and T2DM but also as therapeutic targets for the effective management of the same.

Effectiveness of health education on insulin injection technique in patients with type 2 diabetes mellitus: A quasi-experimental Pre-test post-test research

Introduction

Type 2 Diabetes Mellitus (T2DM) patients often exhibit gaps in knowledge and improper practices regarding insulin injection techniques. This quasi-experimental study aimed to assess the effectiveness of tailored health education in bridging these gaps and improving insulin injection practices among T2DM patients.

Objectives

The study aimed to evaluate baseline knowledge and practices related to insulin injection techniques among T2DM patients, implement a tailored health education intervention, and assess the impact of this intervention on knowledge and practices.

Methodology

Participants included T2DM patients attending rural health centers. A structured questionnaire was utilized to assess baseline knowledge and practices. Tailored health education sessions were then conducted, incorporating video-based teaching, mock demonstrations, and handouts in the local language. Post-intervention assessments were performed using the same questionnaire. Data were analyzed using appropriate statistical methods.

Results

At baseline, a significant knowledge gap and improper insulin injection practices were identified among participants. Following the tailored health education intervention, a substantial improvement in participants' knowledge of insulin storage, handling, and administration was observed. The intervention also positively impacted insulin injection practices, emphasizing key areas such as handwashing, site cleansing, and needle disposal.

Conclusion

This quasi-experimental study highlights the effectiveness of tailored health education in enhancing insulin injection practices among T2DM patients. The findings emphasize the potential for structured health education programs to address knowledge gaps, improve healthcare standards, and enhance the overall quality of life for individuals with T2DM. The study underscores the importance of individualized educational approaches to meet patient needs better.

Serum megalin levels in type-2 diabetes mellitus with and without cardiovascular disease

Background

Low-density lipoprotein receptor-related protein-2 (LRP2), also called megalin, is a multi-ligand receptor of the LDL receptor gene family mediating reabsorption of ligands like Apo-A1. Type 2 diabetes mellitus (T2DM) may possibly disrupt megalin functions as it is found to be regulated by insulin. This might cause cardiovascular complications due to derangement in lipoprotein metabolism. The current study was carried out to assess the serum megalin levels among T2DM individuals with cardiovascular complications in the Indian population.

Methods

This was a cross-sectional study involving 80 patients with T2DM. 40 T2DM patients with known cardiovascular disease were selected as cases and 40 of those without evidence of cardiovascular disease were selected as controls. Demographic details, DM duration and class of oral hypoglycemic agents (OHA) used were collected from medical records while details of lipid profile, fasting glucose, serum creatinine and urea were collected from laboratory information system. Serum megalin levels were estimated using left-over samples by ELISA.

Results

The study groups showed no statistical significance in baseline laboratory parameters except for serum creatinine and low density lipoprotein cholesterol (LDL-c). Mean serum megalin levels were statistically insignificant between cases and controls (0.91 ± 0.78 ng/mL vs. 0.85 ± 0.69 ng/mL, P 0.74).The subgroup analysis of serum megalin levels based on OHA consumption among cases was also statistically insignificant (P 0.056). Pearson's correlational analysis was statistically insignificant between serum megalin and lipid profile parameters among cases (P > 0.05).

Conclusion

Serum megalin alone may not serve as a biomarker for cardiovascular disease.

Uncovering the hidden burden: A mixed methods study on the implementation of depression screening among persons with type 2 diabetes mellitus seeking health care in an urban primary health center of South India

BACKGROUND

Diabetes is linked with depression, but screening rates for depression are low, indicating a need for periodic assessments among those with diabetes. The study aimed to determine depression prevalence and associated factors in persons with type 2 diabetes mellitus (T2DM) in an urban primary care setting of Karnataka, as well as implementation challenges in depression screening for persons with T2DM as perceived by healthcare providers.

MATERIAL AND METHODS

A mixed-methods study was performed for 6 months in 2022-2023 at an Urban Primary Health Centre (UPHC) in Bengaluru. The sample size was calculated to be 110, and convenience sampling was applied to select persons with T2DM. The participants were screened for depression using Patient Health Questionnaire-9. Key informant interviews were performed among various health care providers of the UPHC. Data were captured using EpiCollect Version 5.0. Univariate logistic regression was performed to find the factors associated with depression.

RESULT

Of the 110 participants, 60 (54.5%) screened positive for depression. Men had 0.474 (95% Confidence Intervals-CI: 0.126, 1.782) lesser odds of depression when compared with women (P = 0.269). Those with comorbidities had 1.975 more odds (95% CI: 0.538, 7.252) when compared with absence of comorbidities (P = 0.305). Statistically significant associations were not found with any of the factors. Key facilitators for screening were willingness to implement screening, empathetic attitude, and awareness of mental health, whereas the challenges included lack of training in mental health assessment and patient reluctance to adhere to treatment due to stigma.

CONCLUSION

The study found that 54.5% of persons with T2DM seeking heath care at the UPHC screened positive for depression. Several challenges in implementing depression screening for T2DM in primary care settings were noted.

Role of Yoga in Modulating Vascular Aging in Type 2 Diabetes Mellitus

BACKGROUND

Diabetes is one of the top 10 global causes of mortality, with considerable contributions to cardiovascular disease (CVD), respiratory illness, and cancer. Yoga is a traditional Indian mind-body practice that has been linked to improved cardiovascular health, diabetic management, and reduced stress.

OBJECTIVE

The purpose of this study was to assess the effect of yoga on vascular aging in patients with type 2 diabetes mellitus (T2DM).

MATERIAL AND METHODS

From September 2021 to July 2024, Shri B M Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), in Vijayapura carried out hospital-based prospective research. Two groups of 70 T2DM patients were created: 35 patients in Group Y (yoga practice) and 35 patients in Group NY (routine without yoga). Age, gender distribution, and baseline glycemic control were similar in both groups. HbA1c, postprandial and fasting blood glucose, and vascular aging using a periscope were determined at baseline and three months later as part of the data-gathering process.

RESULTS

Three months later, Group Y's mean random blood sugar (RBS) and HbA1c levels were considerably lower than those of Group NY (p<0.05). Furthermore, there were notable declines in the brachial-ankle pulse wave velocity and the carotid-femoral pulse wave velocity in Group Y, suggesting a decreased arterial stiffness (p<0.05).

CONCLUSION

The study concludes that yoga practice significantly improves glycemic control and reduces arterial stiffness in patients with T2DM.

Effects of Revascularization on Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus Patients With Chronic Stable Angina

BACKGROUND

Type 2 diabetes mellitus (T2DM) leads to cardiac autonomic neuropathy (CAN), affecting blood flow and heart rate regulation eventually causing chronic stable angina (CSA). Percutaneous coronary intervention (PCI) can correct autonomic dysfunctions and improve myocardial perfusion. This study aimed to assess CAN using heart rate variability (HRV) and cardiovascular reflex tests in T2DM patients with CSA before and after PCI.

MATERIAL AND METHODS

From cardiology outpatient clinics, 30 patients with T2DM with CSA were recruited. Before and after PCI, the following HRV parameters like low frequency (LF), high frequency (HF), LF:HF ratio, total power (TP), square root of mean square differences of successive R-R intervals (RMSSD), standard deviation of normal R-R intervals (SDNN), and percentage of adjacent NN intervals that differ from each other by more than 50 seconds (pNN50) were measured for every patient. Cardiovascular reflex tests, including the deep breathing test, the isometric handgrip test, the 30:15 ratio, the Valsalva ratio, and the lying-to-standing test (LST), were performed on the patients both before and after PCI. SPSS version 21.0 (IBM Corp., Armonk, NY), a licensed statistical program, was used to compile and analyze the data.

RESULTS

When compared to the pre-PCI group, 30 patients with T2DM with CSA, age range between 45 and 70 years, both genders demonstrated a significant increase in post-PCI HRV frequency domain parameters, such as LF (239.52±67.21ms2 vs. 307.62±74.17 ms2) and HF (249±25.21 ms2 vs. 379.67±76.55 ms2). The time domain parameters showed a significant increase in post-PCI values compared to pre-PCI values. These included RMSSD (33.97±3.96 ms vs. 8.005±3.25 ms), SDNN (41.4±9.78 vs. 31.74±7.04ms), NN50 (13.241±3.07 vs. 5.20±6.63), and TP (1130.08±320.10 ms2 vs. 754.54±96.93 ms2). In cardiovascular reflex tests, pre-PCI groups had significantly lower delta HR (DBT) (10.47±1.76 bpm vs. 14.20±2.09), E:I ratio (DBT) (1.14±0.042 vs. 1.20±0.026), and Valsalva ratio (1.10±0.071 vs. 1.22±0.084) than post-PCI groups. The pre-PCI group showed a substantial decrease in both the systolic blood pressure (LST) (-6.13±4.85 mmHg vs. -1.01±3.63 mmHg) and the 30:15 ratio (1.13±0.074 vs. 1.09±0.067) when compared to the post-PCI group. The handgrip test (18.73±4.31 mmHg vs. 15.31±4.27 mmHg) did not yield statistically significant results.

CONCLUSIONS

Before PCI, T2DM patients with CSA experienced autonomic dysfunction, but after revascularization, their functions improved by reestablishing basal cardiac autonomic tone and autonomic reactivity. HRV and cardiovascular reflex tests are useful noninvasive tools for assessing CAN and stratifying a prospective risk factor for estimating the morbidity and death from cardiovascular illnesses in T2DM with CSA.

Association of Low Vitamin D Status With Adiponectin and Fibroblast Growth Factor-21 in Newly Diagnosed Type 2 Diabetes Mellitus Patients

INTRODUCTION

Adiponectin and fibroblast growth factor-21 (FGF-21) have important roles in metabolic regulation and insulin sensitivity. Vitamin D is linked to metabolic dysregulation, inflammation, and oxidative stress in chronic type 2 diabetes mellitus (T2DM). The present study aimed to assess the relationship of vitamin D levels with adiponectin and FGF-21 in newly diagnosed T2DM.

METHODS

A descriptive study was conducted on 47 patients with newly diagnosed T2DM recruited based on the American Diabetes Association criteria. Fasting plasma glucose and insulin were measured, and the homeostatic model assessment for insulin resistance was calculated. The serum levels of metabolic regulators such as vitamin D, adiponectin, and FGF-21; inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-α, and high-sensitivity C-reactive protein; and oxidative stress markers such as malondialdehyde (MDA) and total antioxidant status were measured.

RESULTS

The mean serum vitamin D concentration was 17.49±7.10 ng/ml, and all patients had low vitamin D levels (<30 ng/ml). Vitamin D was positively correlated with adiponectin (r=0.331, p=0.023), and it was negatively correlated with FGF-21 (r=-0.356, p=0.014), IL-6 (r=-0.411, p=0.004), and MDA (r=-0.515, p<0.001).

CONCLUSION

There was a reduction in vitamin D concentration in all subjects. Vitamin D showed a positive association with adiponectin and a negative association with FGF-21 and inflammatory and oxidative stress markers. Vitamin D deficiency might increase the risk of progression of T2DM in these subjects.

"Emerging clinical approaches in diabetic cardiomyopathy: insights from clinical trials and future directions"

AIM

We aim to explore the potential of diverse treatments, including perhexiline, calcium channel blockers, anti-hypertensives, PDE5 inhibitors, anti-anginal drugs, aldose reductase inhibitors, and SGLT-2 inhibitors, supported by clinical evidence. Additionally, this review seeks to identify novel therapeutic targets and future avenues for improving cardiovascular outcomes in diabetic populations.

METHOD

We performed a comprehensive literature review of English-language studies across multiple electronic databases, such as PubMed, ScienceDirect, Scopus, and Google Scholar, focusing on clinical trials. The search utilized keywords including 'Anti-hyperglycaemic drug,' 'Diabetic cardiomyopathy,' 'DPP-4 inhibitors,' 'GLP-1 receptor agonists,' 'Heart failure,' and 'SGLT-2 inhibitors.'

RESULT

We assessed clinical investigations in the treatment of cardiomyopathy and diabetes mellitus (DM) that are enhancing our understanding through trials evaluating the Polypill, Perhexiline, Eplerenone, IMB-1018972, AT-001, tadalafil, and dapagliflozin inhibitors. The development of new targeted interventions is of paramount importance due to the overlooked early symptoms, the complexity of the cellular and molecular pathways involved, and the absence of effective drug therapies.

CONCLUSION

Pharmacological treatments like GLP-1 agonists, SGLT-2 inhibitors, NHE-1, NHE-3, and PPAR-γ agonists show promise for treating DCM. These treatments improve myocardial glucose absorption, address dysregulated glucose and lipid metabolism, and lower heart failure and cardiovascular events. Further research is needed to confirm effectiveness and safety.

Prevalence of peripheral arterial disease among individuals with type 2 diabetes mellitus in India - A systematic review and meta-analysis

BACKGROUND

Peripheral arterial disease (PAD) is a prevalent complication of type 2 diabetes mellitus (T2DM). As India ranks second in the population afflicted by T2DM, and the objective of this systematic review was to estimate the pooled prevalence of PAD in individuals living with T2DM in India.

METHODS

Five databases (Cochrane (CENTRAL), MEDLINE (via PubMed), CINAHL (via EBSCO), PEDro, and Scopus) were searched using database-specific search terms from inception to August 2023. Inclusion criteria included studies reporting the prevalence of PAD in Indian adults diagnosed with T2DM of either or both sexes, employing ankle brachial index measurements with a Doppler test or sphygmomanometer. The risk of bias was evaluated using the JBI checklist, and the certainty of evidence was determined via the GRADE approach.

RESULTS

Twenty-three articles met the inclusion criteria which comprised of 196,883 individuals with T2DM aged between 30 and 70 years from nine states and one union territory. Utilizing a random effects model, the meta-analysis revealed that the pooled prevalence of PAD among individuals with T2DM in India was 18 % (95 % confidence interval: 10-28 %), with statistically significant heterogeneity observed between studies (I2 = 100 %, P < 0.001). Overall certainty in the evidence was low.

CONCLUSION

The combined prevalence of PAD among individuals with T2DM in India is 18 %, indicating a significant portion of the Indian population has been affected. Epidemiological studies utilizing precise assessment tools can enhance the early detection and prevention of PAD in T2DM and improve the certainty of findings.

Individualized homeopathic medicines in preventing the progression from pre-diabetes to diabetes: A double-blind, randomized, placebo-controlled, parallel-arm trial

CONTEXT

Pre-diabetes is a significant public health problem worldwide. India has a very high rate of progression from pre-diabetes to diabetes, 75-78 per thousand persons per year.

OBJECTIVE

To study the efficacy of individualized homeopathic medicinal products (HMPs) against placebos in preventing the progression from pre-diabetes to diabetes.

DESIGN

Six-month, double-blind, randomized (1:1), two parallel arms, placebo-controlled trial.

SETTING

Outpatient departments of D. N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India.

PATIENTS

Sixty participants with pre-diabetes.

INTERVENTIONS

Verum: HMPs plus yoga therapy (YT; n = 30); control: identical-looking placebos plus YT (n = 30).

MAIN OUTCOME MEASURES

The primary efficacy endpoint was the proportion of participants progressing from pre-diabetes to diabetes, measured after three and six months. Secondary outcomes comprised of fasting blood glucose (FBS), oral glucose tolerance test (OGTT), glycated hemoglobin percentage (HbA1c%), lipid profile, liver enzymes (alanine transaminase, aspartate transaminase), urea and creatinine, and Measure Yourself Medical Outcome Profile version 2 (MYMOP-2); all measured after 3 and 6 months.

RESULTS

The proportion of participants converted from pre-diabetics to diabetics (n/N; n = diabetics, N = prediabetics) was significantly less in the verum group than control: HbA1C% (month 3: verum - 2/30 versus control - 11/30, p = 0.003; month 6: 3/30 vs. 2/30, p = 0.008), OGTT (month 3: 0/30 vs. 8/30, p = 0.015; month 6: 0/30 vs. 1/30, p = 0.008), but not according to FBS (month 3: 1/30 vs. 1/30, p = 0.779; month 6: 1/30 vs. 3/30, p = 0.469). Several secondary outcomes also revealed significant improvements in the verum group than in placebo: HbA1C% (p < 0.001), OGTT (p = 0.001), serum ALT (p = 0.031), creatinine (p = 0.012), and MYMOP-2 profile scores (p < 0.001). Sulphur, Bryonia alba, and Thuja occidentalis were the most frequently indicated medicines. Thus, HMPs outperformed placebos by successfully preventing the progression of pre-diabetes to diabetes.

TRIAL REGISTRATION

Clinical Trials Registry - India CTRI/2022/04/042,026; UTN: U1111-1277-0021.

Diabetes Driven Oncogenesis and Anticancer Potential of Repurposed Antidiabetic Drug: A Systemic Review

Diabetes and cancer are two prevalent disorders, pose significant public health challenges and contribute substantially to global mortality rates, with solely 10 million reported cancer-related deaths in 2020. This review explores the pathological association between diabetes and diverse cancer progressions, examining molecular mechanisms and potential therapeutic intersections. From altered metabolic landscapes to dysregulated signaling pathways, the intricate links are delineated, offering a comprehensive understanding of diabetes as a modulator of tumorigenesis. Cancer cells develop drug resistance through mechanisms like enhanced drug efflux, genetic mutations, and altered drug metabolism, allowing them to survive despite chemotherapeutic agent. Glucose emerges as a pivotal player in diabetes progression, and serving as a crucial energy source for cancer cells, supporting their biosynthetic needs and adaptation to diverse microenvironments. Glycation, a non-enzymatic process that produces advanced glycation end products (AGEs), has been linked to the etiology of cancer and has been shown in a number of tumor forms, such as leiomyosarcomas, adenocarcinomas, and squamous cell carcinomas. Furthermore, in aggressive and metastatic breast cancer, the receptor for AGEs (RAGE) is increased, which may increase the malignancy of the tumor. Reprogramming glucose metabolism manifests as hallmark cancer features, including accelerated cell proliferation, angiogenesis, metastasis, and evasion of apoptosis. This manuscript encapsulates the dual narrative of diabetes as a driver of cancer progression and the potential of repurposed antidiabetic drugs as formidable countermeasures. The amalgamation of mechanistic understanding and clinical trial outcomes establishes a robust foundation for further translational research and therapeutic advancements in the dynamic intersection of diabetes and cancer.

Thirty-year trends of triple burden of disease in the adult population of Pakistan

BACKGROUND

The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages.

METHODS

The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio.

RESULTS

A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively.

CONCLUSION

Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

Obstructive sleep apnea risk among adults with type 2 diabetes mellitus in an urban primary care setting of Mangalore, India

Background

Obstructive sleep apnea (OSA) is an under-evaluated and under-treated problem, particularly among individuals with type 2 diabetes mellitus (T2DM). Therefore, in this study, we aim to determine the risk of OSA among adults with T2DM residing in an urban area of Mangalore and to elucidate the determinants of OSA among the study participants.

Materials and Methods

A cross-sectional study was conducted for a period of 2 months among adult patients (≥ 18 years) with T2DM seeking health care at a primary care setting located in an urban area of Mangalore. Face-to-face interviews were conducted using a semi-structured proforma. STOP-BANG questionnaire was used to assess the risk of OSA among the study participants. The measurements, such as height, weight, and neck circumference, were conducted using standard techniques.

Results

The mean age of the study participants was 58.12 ± 11.60 years. The majority, (58.30%), were males, and 45.0% reported a family history of T2DM. A total of 108 (60.0%) experienced loud snoring while asleep, while 149 (82.80%) experienced tiredness during daytime. The mean body mass index (BMI) was 24.64 ± 4.9 kg/m2, while a neck circumference of >40 cms was found in 28.90%. A total of 69 (38.30%) had a high risk of OSA with a STOP-BANG score ranging from 5 to 8, while 71 (39.40%) had a score ranging from 3 to 4 (intermediate risk). The statistically significant associations were found between age >50 years, male gender, and diabetes for ≥ 7 years and high risk of OSA (P < 0.001).

Conclusion

More than a third of the study participants had a high risk of OSA. Age > 50 years, male gender, and diabetes for ≥7 years were the factors associated with OSA.

Exploring the rare variants associated with Type 2 Diabetes Mellitus in Indian population and its disease-drug association studies: an in-silico approach

The diversified eating habits and religious culture of Indian population may be one of the reasons they largely contribute to the global diabetes burden. In the present investigation, an in-silico approach was carried out to explore hub genes in the Indian population with Type 2 Diabetes Mellitus (T2DM) that are scantily reported in the GWAS catalogue and probable potential anti-diabetic drugs from plants. This computational approach unwrapped LEP (leptin) as the hub gene among 170 genes analyzed with 14 non-synonymous single nucleotide polymorphisms (nsSNPs) with MAF < 0.01. The mutation of the LEP gene leads to a decrease in leptin concentration, which increases the risk of obesity and T2DM. According to the DUET webserver, 11 of 14 mutations examined were found to destabilize the LEP protein. Among 14, four barely reported LEP variants rs781301976 (I45N), rs776443424 (S52F), rs200915360 (D76Y), and rs1191666811 (D162N) were unzipped to be associated with T2DM, which may be the probable potential drug targets. The virtual screening revealed Vescalagin as having the highest binding energy among 336 natural compounds. Molecular docking of Vescalagin depicted higher binding energy (-9.0 kcal/mol) against mutated LEP [rs200915360 (D76Y)] compared to wild (-8.9 kcal/mol) and LEP-Metformin complexes. The trajectory analysis of MD simulations revealed that Vescalagin was more effective than Metformin in stabilizing the system. The present study suggests that the associations of the investigated nsSNPs in LEP [rs200915360 (D76Y)] and others can be key factors in the predominant role of T2DM morbidity in the Indian population that can be used as potential markers and drug targets for T2DM therapeutics.Communicated by Ramaswamy H. Sarma.

Identification of challenges and leveraging mHealth technology, with need-based solutions to empower self-management in type 2 diabetes: a qualitative study

INTRODUCTION

Effective diabetes management relies mainly on an individual's ability to perform self-care tasks. However, this process is influenced by a complex interplay of factors. This study explores the multifaceted influences on Diabetes Self-Management (DSM), examining both factors influencing and affecting DSM. Understanding these influences is crucial for developing targeted Digital Health Interventions that empower individuals with diabetes to achieve successful self-management.

OBJECTIVES

To identify problems faced by Type 2 Diabetes Mellitus (T2DM) individuals in self-managing diabetes and leveraging mHealth technology, with need-based solutions to Empower Self-Management in T2DM.

METHODOLOGY

In-depth semi-structured interviews were conducted among ten patients with T2DM visiting the outpatient department of a tertiary care hospital in coastal Karnataka. Additionally, six healthcare professionals (HCPs) working closely with T2DM patients were interviewed to understand their perspectives on using mHealth to manage T2DM effectively. The themes for the solutions described were analyzed using ATLAS-TI software.

RESULTS

Our research examined certain factors that might have influenced effective diabetes self-management and investigated patient perspectives on using digital health solutions in diabetes self-management. This study found that technology skills, duration of diabetes, knowledge, and personal beliefs were all significant factors affecting self-management in participants with T2DM. Additionally, socioeconomic factors were also seen to influence effective diabetes self-management. The Google search engine was used by 50% of the participants interviewed to learn about T2DM. Diet management through Google searches was used by a minority (30%) of the patients. None of the participants had previously used any mobile health applications (mHealth apps) to manage T2DM. 20% of the participants expressed limited knowledge about using smartphones or wearables to track health parameters. The study also identified potential non-technological barriers to mHealth adoption. To address these concerns, researchers used an empathy map to develop solutions that promote mHealth use.

CONCLUSION

Several challenges and need-based mHealth solutions were identified to empower diabetes self-management education among T2DM patients. Implementing need-based mHealth solutions such as data tracking, personalized feedback, and access to educational resources can lead to better disease control and a higher quality of life for those with T2DM. Further research and development in mHealth interventions, and collaborative efforts among healthcare providers, patients, and technology developers, hold a promising future for the healthcare sector in providing efficient, effective, and accessible care.

An exploratory study to understand the relationship between diabetes and various pulpal conditions: An Indian perspective

Aim

Diabetes mellitus (DM) affects an estimated 100 million Indians, ranking second globally in diabetic prevalence. Despite this, the correlation between DM and specific pulpal diagnoses remains underexplored. This study compares pulpal conditions in DM patients and nondiabetic controls.

Designs

The study was started after taking ethical approval.

Subjects and Methods

Two thousand and five hundred and sixty teeth were examined over 4 months at the institute, evenly distributed between diabetic and nondiabetic cases, we assessed diagnoses - normal pulp, reversible pulpitis (RP), symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis (PN), missing teeth (MT), and root canal-treated teeth (RCT). Statistical analysis used the Chi-square test.

Results

PN and MT prevalence in DM patients significantly exceeded the control group. Conversely, the control group showed higher RP prevalence in the older subgroup.

Conclusions

PN prevalence was higher in diabetics, suggesting reduced pulp sensitivity in individuals over 60 years. This diminished sensitivity might lead to delayed dental treatment, increasing PN prevalence.

Out-of-pocket direct cost of ambulatory care of type 2 diabetes in Delhi: Estimates from the Delhi diabetes community-II (DEDICOM-II) survey

BACKGROUND & AIM

Much of the cost data from India is restricted to patients recruited purely from healthcare institutions and do not explore determinants. Therefore, the out of pocket expenditure for ambulatory diabetes care was evaluated in Delhi.

METHODS

The DEDICOM-II survey used a two-stage probability-proportionate-to-size(systematic) cluster design. Thirty clusters were chosen to recruit 25 to 30 subjects per area. We used questionnaires to estimate the direct out-of-pocket expenditure (OOPE) on drugs, investigations, consultation and travel, excluding hospitalization, and then analysed its determinants and impact on quality of care.

RESULTS

We enrolled 843 subjects with a mean age of 53.1 years. The annual direct OOPE on ambulatory care of diabetes was US$ 116.3 (95 % CI 93.8-138.9) or INR 8074.8 (95 % CI 6512.9-9636.7), corresponding to 3.6 %(95 % CI 2.9-4.3) of the yearly family income. The burden of expenses was disproportionately higher for those visiting private providers from lower-income groups(19.1 %). Duration of disease and treatment with insulin predicted higher annual OOPE while care at public facilities was less expensive. Cost was higher for those adhering to the recommended processes of care. Quality of care was better for institutional care and worse for alternative medicine or self-care.

CONCLUSIONS

The study provides representative estimates of the high cost of diabetes management in Delhi across the socio-economic and care provider spectra. Poorer patients suffer a high financial burden from diabetes, highlighting the need for enhancing equity in diabetes care.

Urban-Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18)

INTRODUCTION

Diabetes is a multifactorial disease with far-reaching consequences. Environmental factors, such as urban or rural residence, influence its prevalence and associated comorbidities. Haryana-a north Indian state-has undergone rapid urbanisation, and part of it is included in the National Capital Region (NCR). The primary aim of the study is to estimate the prevalence of diabetes in Haryana with urban-rural, NCR and non-NCR regional stratification and assess the factors affecting the likelihood of having diabetes among adults.

METHODS

This sub-group analysis of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study (a nationally representative cross-sectional population-based survey) was done for Haryana using data from 3722 participants. The dependent variable was diabetes, while residence in NCR/non-NCR and urban-rural areas were prime independent variables. Weighted prevalence was estimated using state-specific sampling weights and standardized using National Family Health Survey-5 (NFHS-5) study weights. Associations were depicted using bivariate analysis, and factors describing the likelihood of living with diabetes were explored using a multivariable binary logistic regression analysis approach.

RESULTS

Overall, the weighted prevalence of diabetes in Haryana was higher than the national average (12.4% vs. 11.4%). The prevalence was higher in urban (17.9%) than in rural areas (9.5%). The prevalence of diabetes in rural areas was higher in the NCR region, while that of prediabetes was higher in rural non-NCR region. Urban-rural participants' anthropometric measurements and biochemical profiles depicted non-significant differences. Urban-rural status, age and physical activity levels were the most significant factors that affected the likelihood of living with diabetes.

CONCLUSIONS

The current analysis provides robust prevalence estimates highlighting the urban-rural disparities. Urban areas continue to have a high prevalence of diabetes and prediabetes; rural areas depict a much higher prevalence of prediabetes than diabetes. With the economic transition rapidly bridging the gap between urban and rural populations, health policymakers should plan efficient strategies to tackle the diabetes epidemic.

Harnessing the medical undergraduate human resource for screening of sight-threatening diabetic retinopathy

PURPOSE

To assess whether medical undergraduates can be trained to effectively screen diabetic retinopathy (DR) by statistical comparison with a retina specialist at a tertiary eye care center in India.

METHODS

Three final-year undergraduate medical students, having completed ophthalmology department rotation, received training from a retina specialist for grading DR, following which they were asked to grade a set of 50 fundus photographs centered on the macula with a view of 50° as sight-threatening DR (STDR), diabetic macular edema, and grade of DR. Agreement among the undergraduates and retina specialist was determined with the help of Cohen's Kappa coefficient.

RESULTS

Kappa coefficient between undergraduates for detection of STDR ranged from 0.695 to 0.817 and between each student and the retina specialist ranged from 0.663 to 0.712. The sensitivity and specificity for undergraduates' and retina specialist's detection of STDR were 93.93%-96.96% and 60%, respectively.

CONCLUSION

There was substantial agreement among the undergraduates as well as between the undergraduates and the retina specialist for the detection of STDR. Undergraduates also detected STDR with a high sensitivity. This study outlines the feasibility of training undergraduate students for screening DR.

Charting Wellness in India: Piloting the iTHRIVE's Functional Nutrition Approach to Improve Glycaemic and Inflammatory Parameters in Prediabetes and Type 2 Diabetes Mellitus

Introduction Type 2 diabetes mellitus (T2DM) is characterized by elevation of blood glucose levels due to underlying insulin resistance and inflammation. Multiple modifiable risk factors such as unhealthy dietary habits, physical inactivity, obesity, smoking and psychological stress contribute to T2DM. We investigated the efficacy of a comprehensive functional nutrition approach aimed at mitigating T2DM using the iTHRIVE approach which encompassed anti-inflammatory and elimination diets, micronutrient supplements, physical activity, stress management and environmental modifications through a pre-post study design. The research assessed changes in blood glucose and inflammatory markers following the implementation of the functional nutrition program. Methods A prospective pre-post intervention pilot study was conducted at ThriveTribe Wellness Solutions Pvt Ltd. (iTHRIVE), where 50 study participants from urban areas of Pune city, India (n=25 each group) were recruited voluntarily in the age group of 20-60 years. The participants were subjected to 90 days of the iTHRIVE functional nutrition approach which consisted of eliminating certain inflammatory foods and adding a combination of nutritious organic foods, adding dietary supplements like magnesium, vitamin D, alpha lipoic acid, chromium picolinate, berberine and biogymnema, physical activities like resistance training, stress reduction techniques like meditation and deep breathing exercises along with environmental changes. The blood parameters like fasting blood glucose, postprandial blood glucose, glycated haemoglobin (HbA1C), fasting serum insulin, post-prandial serum insulin, high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), vitamin D, body weight and waist circumference were measured before and after the intervention. The changes were statistically analyzed using a paired t-test. Results The mean age of the participants was found to be 43.76±10.58 years. Around 68% of the participants were prediabetic (HbA1c: 5.7-6.4%) and 32% had T2DM (HbA1c ≥6.5%). A significant reduction was observed in the average HbA1c (13.75% reduction, p<0.0001), average post-prandial blood glucose levels (14.51% reduction, p<0.048), average post-prandial serum insulin (34.31% reduction, p<0.017) and average ESR levels (34.51% reduction, p<0.006). The hs-CRP levels were reduced by 6.6%, but not statistically significant. The average body weight of the participants dropped from 78.59±15.18 kg to 75.20±14.20 kg with a mean loss of 2.91 kg (p<0.05) whereas the waist circumference decreased from 37.54±5.09 to 35.97±4.74 inches with an average loss of 1.19 inches (p<0.0004). Conclusions Following the intervention, several health indicators indicated significant improvements. Particularly, there was a significant drop in HbA1c levels, suggesting better long-term blood glucose control. Blood glucose and serum insulin levels after a meal dropped significantly, indicating enhanced insulin sensitivity. There was a decrease in systemic inflammation as evidenced by the decrease in ESR levels. These results imply that the iTHRIVE functional nutrition approach used in this investigation might be beneficial for enhancing glycemic control and insulin sensitivity, along with reducing inflammatory markers in people with prediabetes and T2DM. Larger sample sizes and longer periods of monitoring would be useful in subsequent research to validate and build on these encouraging findings.

Expression of advanced glycation end products and their receptors in diabetic periodontitis patients

AIM

The systematic review aimed to compare the levels of advanced glycation end products (AGEs) and RAGE (AGE receptors) expression in diabetic periodontitis patients with non-diabetic periodontitis patients and to identify the relationship of AGE and RAGE levels with periodontal disease severity.

MATERIALS AND METHODS

The literature search was carried out according to PRISMA guidelines by two independent researchers using four online databases: PubMed, Scopus, Web of Science Core Collection, and Pro-Quest. Relevant studies published between 2000 and March 2023 were included in this review. The association of diabetes and AGE/RAGE levels on periodontal health, periodontal pocket depth (PPD), and clinical attachment loss (CAL) was studied.

RESULTS

Sixteen cross-sectional studies, including 2794 patients (age range 15-75 years), were identified in the final stage. An elevated AGE level was observed among patients with diabetes and chronic periodontal disease compared to the non-diabetic group. Furthermore, the levels of AGE and RAGE are associated with CAL and PPD. Potential confounding factors like genetic and methodological differences were also responsible for AGE and RAGE variation.

CONCLUSION

Levels of AGEs and RAGE expressions in diabetic periodontitis patients differ from non-diabetic periodontitis patients. The differences may impact the course and severity of periodontal disease.

Intraocular lens selection in diabetic patients: How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Assessment of Quality of Life Among Type 2 Diabetes Mellitus Patients in an Urban Health Center of Tiruvallur District, Tamil Nadu

Introduction Diabetes mellitus (DM) is one of the leading causes of death and disability, in addition to its rapidly increasing prevalence in developing countries. The key element of managing diabetes is quality of life (QoL). It is a factor that is positively related to treatment adherence, and QoL motivates the patient to manage their disease and achieve health and happiness in the long term. We undertook this study in a district of South India among patients with type 2 diabetes mellitus (T2DM) to assess their QoL. Methodology A cross-sectional study was conducted among T2DM patients registered in a noncommunicable disease (NCD) clinic in an urban health center in Tiruvallur District, Tamil Nadu. Participants were selected using a systematic random sampling method from the NCD clinic register. Sociodemographic details of the participants were collected using a pretested, semistructured questionnaire, following which the World Health Organization Quality of Life-Brief Version Scale (WHOQOL-BBREF) questionnaire was used to assess the QoL. Data was entered in MS Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Results The mean age of the study participants was 53.5 ± 9.2 years. Females constituted 63.81% of the study population compared to males (36.19%). Domain-wise, 55.83% had good physical QoL, 49.1% had good psychological QoL, 49.69% had good social QoL, and 57.1% had good environmental QoL. Overall, 52.8% had a good QoL across all the domains. Conclusion The current study found that patients with diabetes had a good QoL with the exception in educational category. However, it is essential to create an awareness among the diabetic patients about the QoL and also the measures that they can practice to improve their QoL, which should be emphasized through health education, information education communication (IEC), and counselling in NCD clinics.

Progress in experimental models to investigate the in vivo and in vitro antidiabetic activity of drugs

Diabetes mellitus is one of the world's most prevalent and complex metabolic disorders, and it is a rapidly growing global public health issue. It is characterized by hyperglycemia, a condition involving a high blood glucose level brought on by deficiencies in insulin secretion, decreased activity of insulin, or both. Prolonged effects of diabetes include cardiovascular problems, retinopathy, neuropathy, nephropathy, and vascular alterations in both macro- and micro-blood vessels. In vivo and in vitro models have always been important for investigating and characterizing disease pathogenesis, identifying targets, and reviewing novel treatment options and medications. Fully understanding these models is crucial for the researchers so this review summarizes the different experimental in vivo and in vitro model options used to study diabetes and its consequences. The most popular in vivo studies involves the small animal models, such as rodent models, chemically induced diabetogens like streptozotocin and alloxan, and the possibility of deleting or overexpressing a specific gene by knockout and transgenic technologies on these animals. Other models include virally induced models, diet/nutrition induced diabetic animals, surgically induced models or pancreatectomy models, and non-obese models. Large animals or non-rodent models like porcine (pig), canine (dog), nonhuman primate, and Zebrafish models are also outlined. The in vitro models discussed are murine and human beta-cell lines and pancreatic islets, human stem cells, and organoid cultures. The other enzymatic in vitro tests to assess diabetes include assay of amylase inhibition and inhibition of α-glucosidase activity.

The Patient Population at Homeopathic Outpatient Clinics across India: A Clinical Data Collection Study

BACKGROUND

 Even though several initiatives have been undertaken in different locations worldwide to collect clinical data in homeopathy, it is important to further investigate these aspects in the context of health care in India.

OBJECTIVE

 The study aimed to gather and analyze patients' clinical data and to derive insights into homeopathic treatment using an internet-based software program for data storage, retrieval and repertorization.

METHODS

 A multi-center observational study was conducted across 14 homeopathy outpatient clinics in India that are affiliated with the Central Council for Research in Homoeopathy (CCRH). Patient symptoms and demographic details were documented anonymously, and prescriptions were guided by repertorial suggestions from the Vithoulkas Compass software. During follow-up visits, treatment outcome was also recorded using an online assessment form. A retrospective analysis of data on patients' demographics, follow-up visits, morbidity (International Classification of Diseases 11th Revision), rubrics used, prescribed medicines and the level of improvement was achieved using Microsoft Excel-generated pivot tables.

RESULTS

 Throughout the study duration of one year a total of 2,811 patients attended the 14 outpatient clinics, of whom 2,468 were new patients with a total of 2,172 initial homeopathic prescription entries. Across the study, there were 3,491 prescriptions and 1,628 follow-up consultations for 868 follow-up patients, all of which data were thoroughly analyzed. The highest frequency of patients was in the 20-49 age group, and a higher proportion of the patients overall was female. Musculoskeletal, dermatological and respiratory complaints were the most frequently reported. The rubrics "Desire for sweets" and "Desire for spices" emerged as the most commonly used in the repertorizations. Further, Sulphur stood out as the most commonly prescribed medicine overall. With homeopathic treatment, some degree of clinical improvement was reported in 86% of the follow-up cases.

CONCLUSION

 Homeopathy is prescribed in CCRH outpatient clinics for a wide range of ailments in people across India, with at least some clinical improvement noted in a high proportion of those patients. The large-scale systematic data collection in these clinics has provided clear insights into the use and clinical value of homeopathy in India, with the potential to build a substantive nationwide data inventory over time.

Socioeconomic gradient of lean diabetes in India: Evidence from National Family Health Survey, 2019-21

Diabetes is a global public health challenge, particularly in India, affecting millions. Among diabetic patients, lean type 2 diabetes is a severe subtype with higher microvascular complication risks. While studies on the prevalence, variations and risk factors of diabetes are increasingly available, there has been limited research on the prevalence, variations, and socioeconomic disparities of lean diabetes in India. This study used NFHS-5 microdata, and lean diabetes is defined as those with a BMI level of under 25 and random blood glucose levels of over 200 or under diabetic medication. Descriptive and multivariate analyses were conducted to understand lean diabetes variations and related factors. Socioeconomic disparities were measured using concentration curves and the concentration index. The study unveiled important insights into lean diabetes in India. 8.2% of men and 6.0% of women had elevated blood glucose levels, indicating a significant diabetes burden. Notably, 2.9% of men and 2.4% of women were diagnosed with lean diabetes. Among type 2 diabetics, 52.56% of males and 43.57% of females had lean type 2 diabetes. Lean diabetes prevalence varied from 11.6% in the poorest quintile to 1.1% in the richest. The odds of lean type 2 diabetes among those in the poorest quintile was 6.7 compared to the richest quintile. The concentration index of lean type 2 diabetes was -0.42 for men and -0.39 for women, suggesting a disproportionate impact on lower socioeconomic groups. This study advances our understanding of the complex interplay between socioeconomic factors and lean type 2 diabetes in India. To address the rising burden of lean diabetes among lower socioeconomic strata, policymakers and healthcare professionals must prioritise initiatives enhancing healthcare access, promoting healthy lifestyles, and ensuring effective diabetes management. By addressing socioeconomic disparities and implementing interventions for vulnerable populations, India can reduce diabetes-related mortality and enhance its citizens' overall health.

Evaluation of Glycosylated Hemoglobin Levels and Effect of Tobacco Smoking in Periodontally Diseased Non-Diabetic Patients

Background and Objective

Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers.

Methods

The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups.

Results

The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant.

Conclusion and Global Health Implications

This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.

Interplay Between the American Diabetes Association's ABC Targets for Diabetes, Insulin Resistance Indices, and Dyslipidemia in Indian Type 2 Diabetes Patients

Background The increasing incidence of type 2 diabetes (T2D) in India underscores the pressing need for effective management strategies. Meeting the American Diabetes Association (ADA) ABC targets for diabetes (glycated hemoglobin (HbA1c), blood pressure, and serum low-density lipoprotein cholesterol (LDL-C)) is crucial for effectively managing T2D, as it reflects the optimal control of key metabolic parameters. Insulin resistance (IR) and impaired beta cell function (BCF) have been found to have a significant impact on glycemic control, lipid metabolism, and hypertension, contributing to the complex cardiovascular risk profile of patients with T2D. This study aimed to explore the association between ABC targets for diabetes, IR, BCF, and dyslipidemia in a cross-sectional cohort of T2D patients. Methods This retrospective study examined data from 681 T2D patients with comorbid hypertension and dyslipidemia. The patients were part of a one-year online lifestyle intervention program for diabetes management at the Freedom from Diabetes Clinic in Pune, India, between January 2021 and December 2022. Baseline data (at the time of enrollment in the program) on medical history and anthropometric and biochemical parameters were retrospectively extracted from medical records and used to assess ABC targets and other clinical parameters. The ABC targets for diabetes include three goals: an HbA1c level of less than 7.0%, a blood pressure level of less than 140/90 mmHg, and an LDL-C level of less than 100 mg/dL. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Homeostatic Model Assessment of Beta Cell Function (HOMA-B), and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated using standard formulas. Results Cross-sectional analysis at baseline showed that 152 (22.3%) participants met all three ABC targets, 306 (45.0%) and 183 (26.8%) participants met two or one targets, respectively, and 40 (5.9%) did not meet any of the ABC targets. Participants meeting all three targets showed significantly lower IR, higher sensitivity (HOMA-IR, median 2.1; QUICKI, median 0.34), higher BCF (HOMA-B, median 62.9), and healthier lipid profiles (mg/dL) (total cholesterol, median 126; triglycerides, median 114; and non-high-density lipoprotein (HDL), median 84) than those who did not meet any of the ABC targets (HOMA-IR, median 3.4; QUICKI, median 0.31; HOMA-B, median 31.7; total cholesterol, median 221; triglycerides, median 187; and non-HDL, median 182) (p < 0.01). A significant association was observed between lower BMI (< 25 kg/m2), lower IR (HOMA-IR <2.5), and meeting all three ABC targets (p < 0.01). No significant association was observed between the duration of diabetes and ABC target status (p > 0.1). Lower IR was identified as a predictor of achievement of all three ABC targets (p < 0.01). Conclusion This study highlights the significance of meeting ABC targets for diabetes in relation to not only a better lipid profile but also lower IR and higher BCF. These preliminary findings provide novel insights into the interplay between IR, BCF, dyslipidemia, and meeting ABC targets in an Indian T2D population. These findings highlight the need for effective diabetes management strategies and improved patient outcomes, considering factors such as BMI and IR indices.

Hyperactive behaviour of growth differentiation factor- 15 (GDF-15) in conjunction with iron trafficking transporters and suppression of Nrf-2 gene in diabetes and metabolic syndrome

Multiple parallel factors are frequently interrogated with various toxic radicals which are abundantly generated in the liver, heart, and pancreas in stress conditions. They are actively involved in the development of diabetes and metabolic aberrations. However, whether over-activation of GDF-15mRNA and influxes of iron-by-iron trafficking genes are directly suppressing the Nrf-2 gene in patients with diabetes and metabolic aberrations in context with undiagnosed individuals with diabetes and metabolic aberrations? Therefore, we have investigated inter and intra- related Zip8/14 mRNA, GDF-15mRNA, and Nrf-2 mRNA expressions in diabetes and metabolic syndrome as it is expected to be up to 134 million by 2045 in India. We recruited 120 subjects from the Department of Medicine, Endocrinology and Metabolic Clinic, All India Institute of Medical Sciences, New Delhi, India. Various investigations related to anthropometry, nutritional, hematological, biochemical, cytokine, and oxidative stress were measured in diabetes, metabolic syndrome, diabetes with metabolic aberration, and healthy controls. Relative expression of GDF-15, ZIP8, ZIP14, Nrf-2, and housekeeping genes was done in all subjects. Stress-responsive cytokines are highly expressed in patients with metabolic aberration with respect to body weight, IR, waist circumference, and fat mass. IL-1β, TNF-α, and IL-6 levels were significantly higher in metabolic syndrome, whereas Adiponectin levels were profoundly lower side. MDA levels were significantly raised in diabetes with metabolic syndrome while SOD activities were lowered (p = 0.001). GDF-15 mRNA expression was 1.79-fold upregulated in group III as compared with Group I while 2-threefold down-regulation of Nrf-2 expression was observed in diabetes with metabolic aberration groups. Zip 8 mRNA expressions were downregulated (p = 0.014), and Zip 14 mRNA expressions were upregulated (p = 0.06) in diabetes and metabolic aberrations. The association of GDF-15 and Nrf-2 mRNA expression was found contradictory and highly interlinked with ROS. Zip 8/14mRNA expressions were also dysregulated in diabetes and metabolic-associated complications.

A Review on Affordable Combinations in Type 2 Diabetes Care: Exploring the Cost-Effective Potential of Glipizide + Metformin and Glimepiride + Metformin + Pioglitazone

Management of type 2 diabetes mellitus (T2DM) largely relies on medication adherence of individuals with diabetes to achieve optimal glycemic control. The economic burden of diabetes could impede adherence, leading to a reduction in treatment efficacy and increased risk of complications. Furthermore, monotherapy in diabetes is losing traction due to its ineffectiveness in achieving early and sustained optimal glycemic control in a significant proportion of the population. Hence, clinicians prefer combination treatment due to their improved efficacy and safety. Considering these factors, the current review highlights the safety and efficacy of the affordable combination therapies, a dual therapy, glipizide + metformin, and a triple-drug combination of glimepiride + metformin + pioglitazone and its applicability in the management of T2DM among individuals with diabetes in India.

Beyond the assembly line: An assessment of diabetes risks among Indian male industrial workers

Background

Diabetes mellitus is a chronic non-communicable disease that imposes a significant burden on affected individuals and the community. Considerable attention has been given to industrial accidents and ergonomics, however, lifestyle-related diseases among industrial workers have often been neglected. Therefore, the present study was conducted with the aim to assess the prevalence of obesity/overweight and ascertain the risk of diabetes mellitus among male employees of an industrial unit in South Mumbai.

Methods

The cross-sectional study was conducted among male employees of an industrial unit in South Mumbai. Family history, exercise patterns, anthropometric measurements and physical vital parameters were recorded. Body composition was assessed using bioelectrical impedance analysis (BIA). The Indian Diabetes Risk Score (IDRS) was employed to evaluate the risk of diabetes mellitus.

Results

In total, 3791 industrial workers participated in the study and 44.5% of participants were above 40 years. Mean height, weight, body mass index (BMI), Waist Circumference (WC) and waist to hip ratio (WHR) were 1.67 m, 71.33 kg, 25.99, 90.81 cm and 0.91 respectively. 56.1% individuals had WC more than 90 cm and 79.1% had WHR more than 0.90. 1846 (53%) and 927 (26.6%) participants had moderate and high diabetes risk respectively. The relationship between age, weight, BMI, WC, WHR, body fat mass and fat percentage, and IDRS was statistically significant.

Conclusion

A substantial proportion of industrial workers were identified as overweight and at high risk of diabetes mellitus. Consequently, it becomes imperative to offer health education and implement interventions to encourage regular exercise, adopt an active lifestyle, and promote healthy dietary habits among industrial workers.

Novel PLGA-encapsulated-nanopiperine promotes synergistic interaction of p53/PARP-1/Hsp90 axis to combat ALX-induced-hyperglycemia

The present study predicts the molecular targets and druglike properties of the phyto-compound piperine (PIP) by in silico studies including molecular docking simulation, druglikeness prediction and ADME analysis for prospective therapeutic benefits against diabetic complications. PIP was encapsulated in biodegradable polymer poly-lactide-co-glycolide (PLGA) to form nanopiperine (NPIP) and their physico-chemical properties were characterized by AFM and DLS. ∼ 30 nm sized NPIP showed 86.68% encapsulation efficiency and - 6 mV zeta potential, demonstrated great interactive stability and binding with CT-DNA displaying upsurge in molar ellipticity during CD spectroscopy. NPIP lowered glucose levels in peripheral circulation by > 65 mg/dL compared to disease model and improved glucose influx in alloxan-induced in vivo and in vitro diabetes models concerted with 3-folds decrease in ROS production, ROS-induced DNA damage and 27.24% decrease in nuclear condensation. The 25% increase in % cell viability and inhibition in chromosome aberration justified the initiation of p53 and PARP DNA repairing protein expression and maintenance of Hsp90. Thus, the experimental study corroborated well with in silico predictions of modulating the p53/PARP-1/Hsp90 axis, with predicted dock score value of - 8.72, - 8.57, - 8.76 kcal/mol respectively, validated docking-based preventive approaches for unravelling the intricacies of molecular signalling and nano-drug efficacy as therapeutics for diabetics.

Exploring the burden of mixed dyslipidemia in patients with type 2 diabetes mellitus: A cross-sectional study in Kashmir, India

BACKGROUND

Diabetes-related dyslipidemia is a multifaceted, complicated disorder characterized by an abnormal lipid profile in individuals with diabetes. The incidence of different types of dyslipidemia, however, was not a focus of prior investigations. The patients were characterized into three categories of dyslipidemia. Different patterns of dyslipidemia were combined into single dyslipidemia (7 patterns), mixed dyslipidemia (16 patterns), and triple dyslipidemia (4 patterns).

METHODS

In this cross-sectional study, 586 people suffering from type 2 diabetes mellitus (T2DM) were included. We assessed the serum lipid profile and used log (TG/HDL-C) to determine the atherogenic index of plasma (AIP). Dyslipidemia was examined as a categorical variable, and the findings were presented as percentages and numbers. To compare categorical variables, we either utilized Fisher exact tests or Chi square tests.

RESULTS

The study comprised of 586 T2DM patients, with 310 (52.9%) women and 276 (47.1%) men. Women have significantly higher hypertension (33.6%) as compared to men (23.2%). 18.94% (111) of patients were having coronary artery disease (CAD) history consisting of 12.28% (72) females and 6.66% (39) males, a difference which is statistically significant. 98.12% of total individuals had as a minimum of one lipid abnormality. 4.61% (27) of study subjects were having isolated dyslipidemia and 93.51% (548) had dual or triple pattern of dyslipidemia (mixed dyslipidemia). High AIP >0.24 (94.8%) was the most predominant trend of dyslipidemia. The dual combination of AIP (>0.24) and HDL (<50 mg/dL in Females and <40 mg/dL in Males) was found to be the most common pattern of mixed dyslipidemia (68.08%). The most prevalent trend of isolated dyslipidemia was found to be high AIP (>0.24), In patients with CAD history. Among the mixed dyslipidemia, the common pattern of dyslipidemia (71.17%) was the dual combination of high AIP (>0.24) and low HDL (<50 mg/dL women and <40 mg/dL males). The triple combination of TG (≥200 mg/dL) and HDL (<40 and <50 mg/dL) and LDL (≥100 mg/dL) was only found in females.

CONCLUSION

In conclusion, dyslipidemia is highly prevalent in T2DM patients, with mixed dyslipidemia being the most common type observed in the community of Kashmir valley, India. High AIP was the most prevalent pattern in the current investigation.