Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts

INTRODUCTION

Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH.

METHOD

The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH.

RESULT

& Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.

Cryopreservation of pollen of Abelmoschus moschatus Medik. subsp. moschatus as an aid to overcome asynchronous flowering for wide hybridization with cultivated Okra [A. esculentus (L.) Moench]

BACKGROUND

Asynchronous flowering is one of the major constraints for hybridization between Abelmoschus moschatus subsp. moschatus, a wild species closely related to cultivated okra [A. esculentus (L.) Moench]. Availability of viable pollen is a prerequisite to facilitate breeding in these species.

OBJECTIVES

Pollen cryopreservation was attempted in A. moschatus subsp. moschatus, to overcome the asynchronous flowering barrier during wide hybridization with A. esculentus.

MATERIALS AND METHODS

Viability of fresh pollen of A. moschatus subsp. moschatus was assessed using acetocarmine and triphenyl tetrazolium chloride (TTC) test and in vitro germination by sitting drop culture method. Pollen of 10 accessions were stored at four temperatures (25, 4, -20 and -196 degree C), in the dark and periodically monitored for viability. The standardized cryopreservation protocol was applied to 24 accessions of A. moschatus subsp. moschatus over three months. In vivo pollen germination of 24 accessions of cryopreserved pollen and its efficacy on fertilizing A. esculentus cv 'Pusa Sawani' were recorded and pollen was utilized for hybridization with A. esculentus.

RESULTS

Brewbaker and Kwack medium with 15% sucrose was optimal for in vitro pollen germination. Pollen viability assessed by in vitro germination (60-90 %) was more reliable compared to acetocarmine (90-99 %) and TTC (85-99 %) staining tests. Significant negative correlation was found between pollen germination, storage time and temperature (25, 4 and -20 degree C) in all the accessions. Cryopreserved (-196 degree C) pollen showed significantly higher viability compared to all the other storage conditions, without viability loss. Successful pollination, fruit and seed set was observed in four out of 24 cross combinations attempted.

CONCLUSION

The cryopreservation of pollen of A. moschatus subsp. moschatus and its fertilizing ability offers great potential for a successful wide hybridization programme in okra.

Glucodynamics and glucocracy in type 2 diabetes mellitus: clinical evidence and practice-based opinion on modern sulfonylurea use, from an International Expert Group (South Asia, Middle East & Africa) via modified Delphi method

Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions.

Determination of Steroidal Saponins and Fixed Oil Content in Fenugreek (Trigonella foenum-graecum) Genotypes

Trigonella foenum-graecum, commonly called fenugreek, is a leguminous plant native to many Asian, Middle Eastern and European countries. Fenugreek oil is very effective in digestion. Identification of fenugreek genotype rich in saponins and fixed oil will be useful for pharmaceutical industries. In the present study, steroidal saponin and fixed oil content was analysed in 46 diverse fenugreek genotypes on dry weight basis. Significant differences were observed in the total saponin and fixed oil content among the genotypes. Saponin and fixed oil content ranged from 0.92 g to 1.68 g and 3.25 to 6.88 g with corresponding mean value of 1.34 g and 5.19 g/100 g dw, respectively.

Molecular Evidence for Occurrence of Tomato leaf curl New Delhi virus in Ash Gourd (Benincasa hispida) Germplasm Showing a Severe Yellow Stunt Disease in India

An evaluation of 70 accessions of ash gourd germplasm grown at National Bureau of Plant Genetic Resources, New Delhi, India during Kharif season (2010) showed natural occurrence of a yellow stunt disease in three accessions (IC554690, IC036330 and Pusa Ujjwal). A set of begomovirus specific primers used in PCR gave expected amplicon from all the symptomatic plants; however no betasatellite was detected. Complete genome of the begomovirus (DNA-A and DNA-B), amplified through rolling circle amplification, was cloned and sequenced. The begomovirus under study shared high sequence identities to different isolates of Tomato leaf curl New Delhi virus (ToLCNDV) and clustered with them. Among those isolates, the DNA-A and DNA-B of the present begomovirus isolate showed highest 99.6 and 96.8 % sequence identities, respectively with an isolate reported on pumpkin from India (DNA-A: AM286433, DNA-B: AM286435). Based on the sequence analysis, the begomovirus obtained from ash gourd was considered as an isolate of ToLCNDV. Thus, the present findings constitute the first report of occurrence of a new yellow stunt disease in ash gourd from India and demonstrated the association of ToLCNDV with the symptomatic samples. Occurrence of ToLCNDV in ash gourd germplasm not only adds up a new cucurbitaceous host of this virus but also raises the concern about the perpetuation of this virus in absence of its main host tomato and thus has an epidemiological relevance for understanding the rapid spread of this virus in tomato and other hosts in Indian sub-continent.