Indian Diabetic Patients Research Articles

Nutrition interventions in Indian diabetes patients: Recommendations from a panel of experts

Nutrition interventions in Indian diabetes patients: Recommendations from a panel of experts

Current status of percutaneous coronary interventions in diabetics with multivessel disease - is it time to challenge FREEDOM?

Diabetes mellitus (DM) and coronary artery disease (CAD) are the leading causes of death in the world. Over the last two decades, clinical trials have indicated that DM patients with CAD have poorer cardiac outcomes than non-diabetic patients with CAD. The pivotal findings of the FREEDOM trial greatly impacted the way clinicians approached revascularisation in diabetic patients with multivessel disease (MVD). However, since the publication of the FREEDOM trial, much has changed both in percutaneous coronary intervention (PCI) technology, as well as in the management of diabetes. This review provides insights into advancements in stent technology, enhanced patient management strategies, improved clinical outcomes with newer hypoglycaemic agents, current approaches to antiplatelet therapy, and advances in lipid management in diabetic patients. The influence of patient-specific factors such as comorbidities and anatomical complexities on treatment decisions in diabetic patients with MVD is also discussed. The ongoing TUXEDO-2 India trial was designed to primarily compare the clinical outcomes of PCI with the new-generation ultrathin-strut Supraflex Cruz stent, compared to the second-generation XIENCE stent in the setting of contemporary optimal medical therapy in Indian diabetic patients with MVD. The secondary objective of this study is to compare clinical outcomes in the combined group from both study arms against a performance goal derived from the coronary artery bypass grafting (CABG) arm of the FREEDOM trial (historical cohort). The tertiary objective is to compare the efficacy and safety of ticagrelor versus prasugrel in diabetic patients with MVD. In view of recent advances in PCI and medical therapy since the FREEDOM trial, now is an appropriate time to revisit the results of CABG versus PCI in diabetic patients with MVD.

Effect of Urban and Rural Population Lifestyle on Quality of Life in Diabetes Miletus Patients by Using Body Composition Device and Quality of Life Instrument for Indian Diabetes Patients (QOLID): A Comparative Study

Background: Diabetes Mellitus is one of the major non-communicable diseases in the world. It is a well-recognized cause for premature death and disability as it increases the risk of vascular, renal, retinal and neuropathic complications. Lifestyle modification, changing dietary habits and rapid urbanization may be the most important factors for the increasing prevalence of this disease. In this project we measure the quality of life in diabetes patient by using body composition device. It was calculating the body mass, bone mass, muscle as well as visceral mass. By that we calculate BMR of each individual that will differentiate the effect of urban and rural lifestyle on patients. Aim: To study the Quality of life in Diabetes Miletus patients in urban and rural population. Methodology: After obtaining ethical Committee approval a comparison study was conducted on 100 Diabetic patients between age group 35-60 years. All participants were screen for the inclusion and exclusion criteria. All included participants were explained about this study and they included after consent form signing. Then BMR and QOL are check by using the Body composition device and Quality of life in Indian diabetes patient (QOLID). Result: Result showed that the Quality of life is better in urban population than rural but BMR is better in rural population. p value is >0.001 so study is extremely significant. Conclusion: This study concluded that Rural population has better BMR, Bone mass than Urban population but there is no such difference in Muscle mass of both population Diabetes Patients. This study also concluded that QOL is more in urban population than rural population on basis of emotional/mental health, prevalence of diabetes, general health diet satisfaction, education and treatment satisfaction.

Comparison of Clinical Outcomes of Implantation of Foldable Hydrophobic Acrylic Intraocular Lens With and Without Heparin Surface Modification in Indian Diabetic Patients.

Background This study aimed to compare the clinical outcomes of a heparin surface-modified (HSM) hydrophobic acrylic foldable intraocular lens (IOL) (CT LUCIA 601PY) and non-heparin-modified hydrophobic acrylic foldable IOL (AcrySof IQ SN60WF) in diabetic patients undergoingphacoemulsification. Methodology Thisrandomized, single-surgeon, double-masked controlled trial was conducted at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. In this randomized controlled trial, 100 eyes of 100 diabetic patients with or without mild-to-moderate diabetic retinopathy were enrolled (HSM IOL, n = 50; non-HSM IOL, n = 50). Outcome measures were aqueous flare, visual acuity, and anterior chamber depth (ACD). These were measured preoperatively as well as one day, one week, one month, three months, six months, and one year postoperatively. Results The HSM IOL group had significantly lower anterior chamber aqueous flare values (photon count/ms) than the non-HSM IOL group on postoperative day one (9.97 ± 5.2 vs. 17.56 ± 11.3, p < 0.001), postoperative week one (11.47 ± 7.78 vs. 17.06 ± 9.4, p = 0.02), and postoperative month three (7.7 ± 4.1 vs. 12.5 ± 5.6, p = 0.004) of phacoemulsification. The corrected distance visual acuity (CDVA) was significantly better in the HSM IOL group on postoperative day one (uncorrected distance visual acuity: p = 0.022; CDVA; p = 0.005), but there was no significant difference at any other follow-ups. ACD was significantly longer in the HSM IOL group at all follow-ups. Conclusions Theimplantation of HSM IOL resulted in significantly lower inflammatory reactions in the early postoperative period in diabetics.

PERSPECTIVES OF CLINICAL EXPERTS ON THE CURRENT USAGE PATTERNS AND THE PREFERENCE OF VILDAGLIPTIN IN THE TREATMENT OF TYPE 2 DIABETES

Objective: Although the efficacy and safety of vildagliptin have been proven in randomized clinical trials, data regarding the improved and up-to-date understanding on the management of Type 2 diabetes mellitus from the context of Indian diabetic patients, are scarce. This study was conducted to assess the opinions of clinical experts on the current usage patterns of vildagliptin in the management of Type 2 diabetes among Indian patients. Methods: A cross-sectional, questionnaire-based study was conducted to collect opinion among physicians in endocrinology across India between June 2022 and December 2022. Convenient sampling method was used. Descriptive statistics were used to summarize the characteristics of the study by employing frequencies and percentages. Results: It was observed that 95 out of 188 clinicians preferred dipeptidyl peptidase-4 (DPP4) inhibitors (DPP4i) and only 35 out of 188 clinicians (18.6%) opted a combination of Metformin and DPP4 inhibitors as the first hypoglycemic agent for newly detected diabetes. In addition, 141 out of 188 (75%) prescribed vildagliptin only as their preferred drug in the class of DPP4 inhibitors. Further, the reason behind such a high-yielding response for vildagliptin among clinicians and their patients, was its weight-neutral property primarily and posing a low risk of adverse effects. Nearly, half of the clinicians reported a 0.6–1% drop in glycosylated hemoglobin (HbA1c) levels in patients within 3 months of vildagliptin use. Conclusion: This study concluded that the majority of the specialists preferred using vildagliptin among other DPP4 inhibitors and pointed out that vildagliptin lowered HbA1c within 3 months of use.

Expert’s preference on escitalopram and clonazepam for treating depression and anxiety in Indian diabetic and hypertensive patients

Expert’s preference on escitalopram and clonazepam for treating depression and anxiety in Indian diabetic and hypertensive patients

A Pipeline -based Framework for Early Prediction of Diabetes

Introduction: Diabetes is a chronic disease worldwide, with an increasing annual death rate. Many health professionals seek innovative ways to detect and treat it early. Rapid advances in machine learning have improved disease diagnosis. However, because of the small amount of labeled data, the frequency of null and missing values, and the imbalance of databases, creating an optimal predictor for disease diagnosis has become a great challenge. This study aimed to present a pipeline -based classification framework for predicting diabetes on two datasets of Indian diabetic patients with two classes (patient and healthy groups) and Iraqi with three classes (patient, healthy, and prediabetes groups). Method: An important part of this framework is preprocessing. Different ML models based on the One -Vs -One approach for the three -class mode are implemented in the framework. Because of the imbalance of the data set, besides the accuracy evaluation criterion, the area under the receiver operating characteristic (ROC) curve is also used. To increase the level of these two criteria, the Hyper -parameters of each model are optimized using optimization methods to build a powerful model with less training and testing time through various feature selection methods. Results: The proposed framework was assessed for diabetes prediction on two datasets of Indian and Iraqi diabetic patients. It was revealed that using AdaBoost for the Indian dataset (ACC=89.98, AUC=94.11) and random forest for the Iraqi dataset (ACC=98.66, AUC= 98.62), good accuracy and performance were obtained. Conclusion: Regarding ACC parameters, precision, accuracy, recall, and F1 -Score, the pipeline -based framework has an optimal performance in predicting diabetes, therefore, it can be used in clinical decision support systems.

Untargeted metabolomics reveals altered branch chain amino acids, glucose and fat metabolism contributing to coronary artery disease among Indian diabetic patients.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterised by increased blood glucose levels. Patients with T2DM have a high risk of developing atherosclerotic coronary artery disease (CAD). CAD with T2DM has a complex etiology and the understanding of the pathophysiology of coronary artery disease (CAD) in the presence of diabetes is poor. Here, we have used LC-MS/MS-based untargeted metabolomics to unveil the alterations of metabolites in the serum of South-Indian patients diagnosed with T2DM, CAD and T2DM along with CAD (T2DM-CAD) compared with the healthy subjects (CT). Using untargeted metabolomics and network-based approaches, a set of metabolites highly co-expressed with T2DM-CAD pathogenesis were identified. Our results revealed that these metabolites belong to essential pathways such as amino acid metabolism, fatty acid metabolism and carbohydrate metabolism. The candidate metabolites identified by metabolomics study are branch chain amino acids, L-arginine, linoleic acid, L-serine, L-cysteine, fructose-6-phosphate, glycerol, creatine and 3-phosphoglyceric acid, and explain the pathogenesis of T2DM-assisted CAD. The identified metabolites could be used as potential prognostic markers to predict CAD in patients diagnosed with T2DM.

Clinico-Mycological Study of Onychomycosis in Indian Diabetic Patients

Background: Onychomycosis (OM) is the most common nail disorder accounting for 40–50% of all onychopathies. Onychomycosis is caused by dermatophytes in majority, mostly Trichophyton (T.) rubrum followed by T. mentragrophytes var. interdigitale. However, there is a variation in the etiological profile with the subset of population, time, and geographical location. In immunocompromised hosts, non-dermatophytic molds (NDMs) and yeasts like Candida albicans and Candida parapsilosis are the main causative agents. Diabetes mellitus (DM) is a well-established risk factor for OM. Aim and Objectives: This study was conducted to determine the clinical and mycological characteristics of OM in diabetic patients and to evaluate the clinico-etiological correlation, if any. Materials and Methods: Three hundred consecutive diabetic patients were screened, of whom 102 (34%) patients were diagnosed with OM based on clinical, mycological, dermoscopic, and histological criteria. Results: Distal lateral subungual onychomycosis was the most common clinical variant seen in 80 (78.43%) patients. Fungal culture was positive in 57 (55.88%) of which NDMs constituted approximately half (47.61%) of the isolates, followed by Candida species (30.15%) and dermatophytes (22.22%). The clinico-mycological correlation was performed to look for the association of various fungi with the clinical type of OM. Distal lateral subungual onychomycosis was majorly caused by NDMs (51.02%), followed by Candida species (28.57%), and dermatophytes (20.40%). Conclusion: Non-dermatophytic molds are increasingly incriminated as the causative organisms for OM in DM and must be considered as potential pathogens in the present scenario, thus necessitating the change in the treatment options accordingly.

Rationale and design of the TUXEDO-2 India study: Ultra-Thin strUt Supraflex Cruz versus XiencE in a Diabetic pOpulation with multi-vessel disease–2

The role of percutaneous coronary interventions (PCI) in patients with diabetes mellitus and multi-vessel disease has been questioned by the results of the FREEDOM trial, which showed superiority of coronary artery bypass graft(CABG) over first generation drug-eluting stents (DES) including a reduction in mortality. In the light of safer and more efficacious stents and significantly better medical management, those results that date back to 2012 need to be revisited. TUXEDO-2 is a study designed to compare two contemporary stents in Indian diabetic patients with multi-vessel disease. The primary objective of the TUXEDO-2 study is to compare the clinical outcomes of PCI with ultra-thin Supraflex Cruz vs Xience when combined with contemporary optimal medical therapy (OMT) in diabetic patients with multi-vessel disease. The secondary objective is to compare clinical outcomes between a pooled cohort from both arms of the study (Supraflex Cruz+Xience; PCI arm) vs CABG based on a performance goal derived from the CABG arm of the FREEDOM trial (historical cohort). The tertiary objective is a randomized comparison of ticagrelor vs prasugrel in addition to aspirin for the composite of ischemic and bleeding events. In this prospective, open-label, multi-centre, 2×2 factorial, randomized, controlled study, 1,800 patients with diabetes mellitus and multi-vessel disease (inclusion criteria similar to FREEDOM trial) with indication for coronary revascularization will be randomly assigned to Supraflex Cruz or Xience stents and also to ticagrelor- or prasugrel- based antiplatelet strategies. All patients will receive guideline directed OMT and optimal PCI including image- and physiology-guided complete revascularization where feasible. The patients will be followed through five years to assess their clinical status and major clinical events. The primary endpoint is a non-inferiority comparison of target lesion failure at one-year for Supraflex Cruz vs Xience (primary objective) with an expected event rate of 11% and a non-inferiority margin of 4.5%. For PCI vs CABG (secondary objective), the primary endpoint is major adverse cardiac events (MACE), defined as a composite of all cause death, nonfatal myocardial infarction, or stroke at one-year and yearly up to five years, with a performance goal of 21.6%. For ticagrelor vs prasugrel (tertiary objective), the primary endpoint is composite of death, myocardial infarction, stroke, and major bleeding as per the Bleeding Academic Research Consortium (BARC) at one-year with expected event rate of 15% and a non-inferiority margin of 5%. The TUXEDO-2 study is a contemporary study involving state-of-the-art PCI combined with guideline directed OMT in a complex subset of patients with diabetes mellitus and multi-vessel disease. The trial will answer the question as to whether a biodegradable polymer coated ultra-thin Supraflex Cruz stent is an attractive option for PCI in diabetic patients with multi-vessel disease. It will also help address the question whether the results of FREEDOM trial would have been different in the current era of safer and more efficacious stents and modern medical therapy. In addition, the comparative efficacy and safety of ticagrelor vs prasugrel in addition to aspirin will be evaluated. (CTRI/2019/11/022088).

A Step Toward the Exploration of Better Spirometric Parameters for Early Diagnosis of Pulmonary Dysfunction in Persons With Type 2 Diabetes Mellitus.

Objectives: This study aims to determine the forced vital capacity (FVC) and slow vital capacity (SVC) along with other pulmonary functions in Indian diabetic patients for early diagnosis of pulmonary function reduction and to compare the ratios of forced expiratory volume in one second (FEV1) with FVC and SVC (FEV1/FVC and FEV1/SVC) in diabetic patients.Materials and methods: A prospective observational study was carried out in the physiology department for two years after the approval of the institutional ethics committee. The study included 90 type 2 diabetes mellitus patients previously diagnosed by the physician and 90 age and sex-matched controls for spirometric tests. Medspiror having Helios 401 software (Recorders & Medicare Systems Pvt. Ltd., Panchkula, India) was used to assess the pulmonary function in all subjects. A comparison of dynamic pulmonary function parameters among non-diabetic and diabetic groups and non-obese vs. overweight/obese individuals of the diabetic group has been done. FEV1/FVC ratio vs. FEV1/SVC ratio comparison was conducted between the non-obese vs. the overweight/obese group in diabetic patients.Results: A significant variation in FEV1 and FVC was observed in the type 2 diabetic group as compared to the non-diabetic group. However, in the case of type 2 diabetic subjects, FEV1/FVC ratio was almost constant in both BMI groups, whereas the FEV1/SVC ratio increased in the overweight/obese group.Conclusion: Type 2 diabetes mellitus accounts for a predictive factor for worsening pulmonary function. SVC, particularly the FEV1/SVC ratio, can be an earlier diagnostic marker for pulmonary dysfunction in diabetic subjects as this ratio changes even with a constant FEV1/FVC ratio.

Prevalence of Hyperuricemia and the Relationship Between Serum Uric Acid and Hypertension in New Onset Diabetic Patients: A Cross-Sectional Indian Study.

ObjectivePrevalence of hyperuricemia (HU) is increasing and it is associated with hypertension, metabolic syndrome, diabetes mellitus (DM), obesity, chronic kidney disease, gout and cardiovascular disease. Elevated level of serum uric acid (SUA) has been shown to be associated with hypertension and diabetes in many countries but there is lack of evidence from India. The aim of this study is to know the prevalence of HU and to know the relationship between SUA and hypertension in newly onset DM.MethodsThis is a cross-sectional study from a tertiary center. A total of 305 (males: 212; females: 93) newly diagnosed diabetic patients were enrolled. All patients were categorized as normotensive (<140/90) and hypertensive (≥140/90) based on ADA criteria. Based on SUA level participants were grouped into 3 tertile (T1: <4.52; T2: 4.52–5.64; T3: >5.64 mg/dl).ResultsThe mean age, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the patients were 46.76 ±0.61 years, 130.6±1.06 mmHg and 84.11±0.63 mmHg, respectively. The mean level of SUA was 5.14±0.073 mg/dl and level was significantly higher in males compared with females (P <0.000). Overall prevalence of HU and hypertension was 12.13% and 44.59%, respectively. There was an increase in the prevalence of hypertension across the SUA tertile. SBP and DBP significantly increased across the SUA tertile (P <0.014 and <0.001, respectively). A multiple logistic regression analysis revealed that SUA tertile was independently associated with presence of hypertension (P <0.01).ConclusionThis first report on the population of the eastern part of India indicates a significant positive relationship between SUA and hypertension among the newly onset Indian diabetic patients. Therefore, routine measurement of SUA is recommended in newly onset hypertensive diabetic patients to prevent HU and its related complications.

Cardiovascular risk in newly diagnosed type 2 diabetes patients in India.

Type 2 diabetes mellitus (T2DM) worldwide continues to increase, in particular in India. Early T2DM diagnosis followed by appropriate management will result in more cardiovascular event free life years. However, knowledge of the cardiovascular profile of newly diagnosed T2DM patients is still limited. The aim of this study was to understand the extent of cardiovascular disease (CVD) risk of newly diagnosed T2DM patients in India. A cross sectional observational study was conducted to evaluate clinical laboratory and socio-demographic parameters of 5,080 newly diagnosed T2DM patients (48.3 ± 12.8 years of age; 36.7% female). In addition, we determined their cardiovascular risk according to the guidelines of the Lipid Association of India (LAI) and the criteria of the QRISK3 score. Of the newly T2DM diagnosed patients in India 2,007(39.5%) were classified as "High risk" and 3,073 (60.5%) were classified as "Very high risk" based on LAI criteria. On average, patients had 1.7 ± 0.9 major atherosclerotic cardiovascular disease (ASCVD) risk factors. Low HDL-C value was the most frequent major risk (2,823; 55.6%) followed by high age (2,502; 49.3%), hypertension (2,141; 42.1%), smoking/tobacco use (1,078; 21.2%) and chronic kidney disease stage 3b or higher (568; 11.2%). In addition, 4,192 (82.5%) patients appeared to have at least one cholesterol abnormality and, if the latest LAI recommendations are applied, 96.5% (4,902) presented with lipid values above recommended targets. Based on the QRISK3 calculation Indian diabetes patients had an average CVD risk of 15.3 ± 12.3%, (12.2 ± 10.1 vs. 17.1 ± 13.5 [p<0.001] for females and males, respectively). Newly diagnosed Indian T2DM patients are at high ASCVD risk. Our data therefore support the notion that further extension of nationwide ASCVD risk identification programs and prevention strategies to reduce the occurrence of cardiovascular diseases are warranted.

Abstract 148: Preoperative determinants of length of stay in people with type 2 diabetes mellitus undergoing an elective CABG: An observational single centre study

Background: 22-48% of the CABG performed are attributed to diabetic patients suffering from CAD. There is a paucity of Indian studies on the influence of preoperative HbA1c on postoperative CABG outcome, in T2DM patients. Some discord exists among studies looking at the above associations.Aims and Objectives: Aim of the study was to find any association between HbA1c and total length of stay (LoS) in hospital and other perioperative outcomes in Indian diabetic patients following CABG.Results: It was retrospective study including 229 patients within six month. The mean duration of T2DM was 8.4 years and mean HbA1c was 8.2. There was statistically significant difference (p <0.05) found between the groups divided based on total LoS (≤10 and >10 days) with HbA1c, duration of T2DM, haemoglobin and insulin requirement on the day of surgery. Age, mean insulin requirement preoperatively, DM duration, Hb, hypothyroidism and other macrovascular complications as preoperative parameters showed a significant correlation with total LoS. On linear regression, age, other macrovascular complications and preoperative insulin requirement were found to be predictors for LoS.Conclusion: This retrospective study revealed that preoperative HbA1c would be associated with prolonged hospital stay following CABG surgery, paving way for further prospective studies.

Impact of empagliflozin add-on therapy on quality of life in patients of type 2 diabetes mellitus with hypertension: A prospective study.

Diabetes has a negative impact on patient's quality of life (QoL). Comorbidities and polypharmacy further worsen their QoL. Thus, in addition to glycemic control, assessment of QoL is also gaining importance. The objective of this study was to evaluate QoL in patients of type 2 diabetes mellitus (T2DM) with hypertension after add-on empagliflozin to triple drug therapy (metformin, teneligliptin, and glimepiride). A prospective research was done on T2DM patients with hypertension, who visited a tertiary care referral institute's endocrine outpatient clinic. For 3 months, empagliflozin, 25 mg once daily, was administered as an add-on treatment with metformin, teneligliptin, and glimepiride. In addition to clinical assessment, an Urdu-translated QoL instrument for Indian diabetes patients was used to conduct QoL study. The QoL outcomes prior to empagliflozin add-on were compared with those obtained at the conclusion of the 3 months of treatment. Empagliflozin as an add-on therapy significantly improved various aspects of QoL like role limitation due to physical health, physical endurance, general health, symptom botherness, financial worries, emotional/mental health, and diet satisfaction (P < 0.001). It also improved glycemic and blood pressure parameters significantly. QoL is an essential measure with respect to patient-centered treatment approach. Empagliflozin, as an add-on medication, improved QoL, glycemic parameters and blood pressure in T2DM patients with hypertension. It can be recommended as an add-on, but more research with a larger sample size is required.

Quality of life of diabetes patients in North India

Background: India is witnessing a dramatic rise in the prevalence of diabetes mellitus. In this study, quality of life (QOL) of patients with diabetes and its determinants were assessed. Second, the valuation of QOL using different methods of measurement was examined. Methods: A community-based survey comprising 306 adults diagnosed with diabetes was undertaken in an urban slum area of Chandigarh city. Direct methods of QOL assessment such as time trade-off (TTO) and Visual Analog Scale (VAS) along with indirect like EuroQol 5-Dimensional 5-Level Instrument (EQ-5D-5L) and the QOL Instrument for Indian Diabetes Patients (QOLID) were used. Multiple linear regression was used to compute coefficients to assess point estimate of QOL using the Indian QOLID tool. Results: Overall, health utility scores for a person with diabetes were 0.68 (with TTO method), 0.60–0.64 (with VAS) analog scale, and EQ-5D-5L method, respectively. Valuation of QOL using direct methods yielded utility values which were significantly higher than indirect methods (EQ-5D-5L). Conclusion: Overall, this study found that diabetes is responsible for physical, psychological, and social role disturbance among the patients. In addition, choice of using direct or indirect methods of utility estimation may have practical implications while calculating incremental cost-effectiveness ratios.

Multimodal ayurvedic approach in the management of moderate SARS-COV2 infection with co-morbidities – A case report

Introduction:The World Health Organization (WHO) declared COVID-19 a pandemic which has claimed more than 1.4 million lives as of today. This unprecedented period demands greatly for the traditional and native medical systems which are time-tested and holistic. Some of the recent studies have reported severe infection in individuals with comorbidities such as obesity, diabetes mellitus, old age, etc. Ayurveda understands this condition as Agantuja Jwara of Sannipatika origin. Madhumeha (diabetes mellitus) is basically a disease of depleted Ojus (immunity) as per Ayurveda.Methods:Here, we report a case of COVID-19 in an elderly overweight patient with diabetes, which was managed successfully with Ayurvedic medicines, diet, lifestyle, yoga, and rejuvenative therapy.Case Description:A 70-year-old male consulted our physician through phone call and willfully wanted to take Ayurvedic management for COVID-19. On the 1st day of treatment, the patient complained of fever at 103 F, headache, and severe body ache. Later on, started with a cough, headache, shortness of breath, excessive thirst, etc. Based on the symptom cluster and food-exercise routine, Kapha and Pitta were the vitiated body humors.Results:After thorough Ayurvedic assessment, the patient was administered with Langhana, Pachana (procedures to improve digestive metabolism), anti-pyretic, and antidiabetic medications followed by yoga and pranayama. The patient was also advised rejuvenative therapy to prevent further post-COVID complications. Quality of Life was assessed with Quality of Life Instrument for Indian Diabetes Patients (QOLID) and EuroQol five-dimensional (EQ-5D). The patient was completely relieved from major symptoms in 4 days and tested negative after 12 days, with considerable improvement in QOL. The case was followed up for 60 days, and no post-COVID symptoms were reported.

Pre-Emptive and Non-Pre-Emptive Goal Programming Problems for Optimal Menu Planning in Diet Management of Indian Diabetes Mellitus Patients.

Diet management or caloric restriction for diabetes mellitus patients is essential in order to reduce the disease’s burden. Mathematical programming problems can help in this regard; they have a central role in optimal diet management and in the nutritional balance of food recipes. The present study employed linear optimization models such as linear, pre-emptive, and non-pre-emptive goal programming problems (LPP, PGP and NPGP) to minimize the deviations of over and under achievements of specific nutrients for optimal selection of food menus with various energy (calories) levels. Sixty-two food recipes are considered, all selected because of being commonly available for the Indian population and developed dietary intake for meal planning through optimization models. The results suggest that a variety of Indian food recipes with low glycemic values can be chosen to assist the varying glucose levels (>200 mg/dL) of Indian diabetes patients.

Early detection of cutaneous complications of insulin therapy in type 1 and type 2 diabetes mellitus

BackgroundSubcutaneous insulin therapy is associated with important injection site complications, which can influence insulin pharmacokinetics resulting in glycemic fluctuations above and below target levels for blood glucose. ObjectiveOur objective was to assess the prevalence and risk factors of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy (LH). MethodsThis was a cross-sectional study conducted at a tertiary care center in India, wherein 500 patients injecting insulin for ≥2 years were randomly enrolled and evaluated for the presence of cutaneous complications of insulin therapy through clinical examination, ultrasonography and punch biopsy of skin. ResultsClinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P < 0.001) and insulin syringe reusage for more than five times (P < 0.001) significantly increased the risk of LH. Skin biopsy was performed in 100 cases, out of which two patients showed apple green birefringence and its association with insulin was confirmed by positive staining with anti insulin antibody in these two patients. ConclusionImproper rotation of sites and reuse of needles were the leading causes of LH in Indian diabetic patients. Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought.

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.