Management Of Diabetes In India Research Articles

Fixed-Dose Combination of Canagliflozin and Metformin as an Adjunct to Diet and Exercise in Indian Adults with Type 2 Diabetes Mellitus: Results from a Multicentric, Open-Label, Single-Arm, Phase IV Study.

Canagliflozin and metformin fixed-dose combination (CANA/MET FDC), an approved treatment for type 2 diabetes mellitus (T2DM) in India, effectively lowers glycated hemoglobin (HbA1c), promotes weight loss, and improves patient adherence. As a regulatory requirement, we aimed to evaluate the safety and efficacy of CANA/MET FDC in Indian patients with T2DM. This prospective, multicenter, open-label, single-arm, phase IV study included Indian patients with T2DM (aged 18-65 years) inadequately controlled on diet and exercise. Patients received CANA/MET (50/500 and 50/1000 mg) immediate-release (IR) FDC twice daily for 24 weeks. The primary endpoint was safety assessment, including adverse events (AEs) and serious AEs (SAEs). The secondary endpoint included a change in HbA1c from baseline to weeks 12 and 24. Descriptive statistics were used for all continuous safety variables and efficacy parameters. Of the 310 patients screened, 276 were enrolled. 114/274 (41.6%) patients had ≥1 treatment-emergent AE [treatment-emergent AEs (TEAEs), among which 29 (10.6%) were related to study intervention]. The most common TEAEs were dyslipidemia (4.7%), pyrexia (4.7%), genital infections (3.3%), hypoglycemia (3.3%), and urinary tract infections (2.6%). Three (1.1%) patients had serious TEAEs, and all cases were resolved. No deaths were reported. The mean change in HbA1c from baseline was -0.92 and -0.93% at weeks 12 and 24, respectively. The study demonstrates the safety and efficacy of CANA/MET FDC in Indian patients with T2DM, presenting a safe therapeutic option for diabetes management in India.

Clinicians perspectives on the utilization of antidiabetics for the management of diabetes in India

Background: Diabetes is a potentially epidemic health problem that is spreading rapidly throughout the low- and middle-income nations like India. On the other hand, the economic and social costs of diabetes in India are substantial, underscoring the urgent need for effective diabetes management strategies. So, this study was conducted to assess the opinions of clinical experts on the preference of antidiabetic agents in the management of type 2 diabetes among Indian patients. Methodology: A cross-sectional, questionnaire based study was conducted to collect opinion among physicians involved in managing diabetes mellitus 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: About 323 doctors involved in this study, providing valuable insights into diabetes management and treatment preferences in the Indian healthcare landscape. It was observed that majority of clinicians (64%) reported that they observed 31-60% of diabetes patients in their clinical practice and 77% of physicians indicated their preference for dipeptidyl peptidase-4 (DPP4) inhibitors. Most of the respondents (56%) considered DPP4 inhibitors + metformin as the first-line therapy followed by 53% of respondents prioritizing medications with proven cardiovascular benefits. About 83% of responders selecting metformin sustained release, it was evident that majority of medical professionals preferred sustained release and only 17% favoured the immediate release form of metformin. Conclusion: This study concluded that the most commonly recommended and prescribed drug for the management of diabetes was sitagliptin with a more emphasis on the effectiveness and dosage flexibility in diabetes management.

Diabetes Mellitus - An Ayurvedic Perspective

Diabetes mellitus is one of the most common non-communicable diseases in the world. Diabetes management in India confronts various obstacles, including increased incidence in urban and rural regions, a lack of disease awareness among the general public, inadequate health care facilities, high treatment costs, inefficient glycemic control, and an increase in the prevalence of diabetic complications. Diabetes insulin therapy is often administered via subcutaneous injections up to four times per day. Long-term insulin therapy, along with the intrusive aspect of its administration, has resulted in issues with patient compliance, impacting patient outcomes. Diabetes is a chronic condition that arises when the pancreas does not create enough insulin or when the body cannot adequately use the insulin that is produced. Insulin is a hormone that regulates blood glucose levels. Ayurvedic preventive practises can help to keep the disease at bay. Sedentary lifestyle and eating habits are thought to be the primary causes. It is characterised in Ayurveda as Vataja pramehas, which can be managed conservatively with exercise, nutrition, and internal treatment.

The LongitudinAl Nationwide stuDy on Management And Real-world outComes of diabetes in India over 3 years (LANDMARC trial).

LANDMARC (CTRI/2017/05/008452), a prospective, observational real-world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan-India regions over a period of 3 years. Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. Of the 6234 participants enrolled, 5273 completed 3 years follow-up. At the end of 3-years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3-years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c <7%, respectively. At 3-years, population with macrovascular and microvascular complications had higher proportion of participants with uncontrolled glycemia (78.2% [79/101] and 70.3% [463/659], respectively) than those without complications (61.6% [1839/2985]). Over 3-years, majority (67.7%-73.9%) of the participants were taking only OADs (biguanides [92.2%], sulfonylureas [77.2%] and DPP-IV inhibitors [62.4%]). Addition of insulin was preferred in participants who were only on OADs at baseline, and insulin use gradually increased from 25.5% to 36.7% at the end of 3 years. These 3-year trends highlight the burden of uncontrolled glycemia and cumulative diabetes-related complications, emphasizing the importance of optimizing diabetes management in India.

1423-P: Glycemic Status at Three-Year Follow-up in LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India

Glycemic change from baseline to 3 years was examined in LANDMARC — a prospective observational study (CTRI/2017/05/008452) — that included participants with type 2 diabetes (T2D) taking ≥2 antihyperglycemic medications (with/without glycemic control). Of 6222 evaluable participants (mean baseline values - age: 52.1 years, T2D duration: 8.6 years and A1C: 8.05%), 5273 completed 3-year follow-up visit. All glycemic parameters improved significantly (p&amp;lt;0.0001) from baseline (A1C: -0.68% [1.65]; FPG: -16.51 mg/dL [55.38]; and PPG -27.07 mg/dL [80.10]). The number of participants in the 7-7.9% A1C subgroup increased from baseline to the end of 3 years; 21.79% (1356/6222) achieved optimum glycemic control of A1C &amp;lt;7%. Glycemic control was not affected by cardiovascular risk factors; while in the subgroups of complications, participants with myocardial infarction, heart failure, and unstable angina showed suboptimal glycemic control (Table). In conclusion, although there was a significant improvement in all the glycemic parameters from baseline, a large majority of the participants remained uncontrolled in terms of achieving target HbA1c. This emphasizes the need for optimizing diabetes management in India. Disclosure S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. K.Kumar: None. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. H.Thacker: None. B.Sethi: None. S.Chowdhury: None. Funding Sanofi India

A Review on Diabetics

One of the most prevalent non-communicable diseases in the world is "diabetes mellitus". Diabetes management in India is complicated by a number of factors, such as an increase in both urban and rural incidence, a lack of public awareness of the condition, a lack of available healthcare resources, a high cost of care, and subpar treatment outcomes. management of blood sugar and an increase in the frequency of diabetes complications. Insulin treatment is the most common type of Up to four times each day, subcutaneous injections are typically used for delivery. Long-term insulin therapy has a negative impact on patient outcomes because of issues with patient compliance and the invasiveness of its administration. The prevalence of type 1 diabetes has also increased, however Type 2 diabetes mellitus is the primary contributor to the diabetic epidemic and affects more than 90% of all cases of diabetes. A dangerous and prevalent chronic condition that results from a complicated set of interaction between the environment and inheritance as well as additional risk factors like obesity and sedentary behaviour.

The Implication of Time-in-Range for the Management of Diabetes in India: A Narrative Review

Introduction: In recent times, traditional self-monitoring of blood glucose (SMBG) using fingerstick capillary samples is moving to continuous glucose monitoring (CGM) due to inherent limitations of the traditional methods. CGM displays current glucose level, trends, rate of change, time-in-range (TIR), and glucose variability (GV) over a period of several days. It detects episodes of hyperglycemia and hypoglycemia, which allows immediate response to prevent these episodes. It also allows physicians to provide a personalized glycemic response to the patients. Materials and methods: Though CGM systems have been available for more than 20 years, their use is quite low. It is challenging for clinicians to invest time in learning and understanding the diverse reports of the various CGM devices. Moreover, there is a lack of consensus on the frequency of TIR measurement. Hence. a review of the literature was performed and existing guidelines from India and abroad were reviewed for a need for CGM and its frequency of measurements in DM patients. Results: TIR is inversely correlated to the risk of microvascular and macrovascular complications. CGM is recommended by expert clinician consensus and national and international medical organizations. For the patients use of CGMs involves cost. Besides, there is the discomfort and inconvenience of wearing the device. Hence, defining the implications of using CGM in practice is important. According to the 2020 recommendations by the Research Society for the Study of Diabetes in India (RSSDI) — Endocrine Society of India (ESI) and the 2019 recommendations by an expert group of endocrinologists and diabetologists, in the Indian context, CGM could be suggested for patients with Type 2 Diabetes who encounter severe hyperglycemia or hypoglycemia, repeated hypoglycemia, asymptomatic hypoglycemia, nocturnal hypoglycemia, refractory hyperglycemia, or large blood glucose excursions. Conclusions: The role of CGM to achieve better glycemic control and prevention of complications in T1D and T2D is well established. Significant education and awareness on CGM needs to be provided to physicians as well as patients with high GV and those on insulin therapy.

1115-P: Does Spouse’s Diabetes Status Impact the Diabetes Care Cascade? A National Study of Couples in India

Background: Diabetes detection and treatment in married couples presents opportunities for designing dyadic interventions to improve screening and management. Methods: Using data from 59237 heterosexual married couples (women: 18-49y, men: 21-54y) assessed in India’s National Family Health Survey (2015-16) , we estimated the diabetes care cascade as the percent diagnosed, treated, and controlled with measured high blood glucose (BG) by spouse’s diabetes status. Results: The prevalence of high BG was 8.8% (men) and 14.2% (women) . In adults with high BG, the percent diagnosed, treated, and controlled was 22.6%, 18.7%, and 9.2% (men) and 22.5%, 18.0%, and 8.5% (women) , respectively. Of adults with high BG, the prevalence of diabetes diagnosis was higher in men (prevalence ratio [PR]: 1.85 [1.37, 2.49]) and women (PR: 2.03 [1.47, 2.8]) whose spouse was diagnosed (ref=spouse undiagnosed) . Among the diagnosed, the prevalence of being treated for diabetes did not differ by their spouse’s diagnosis status in men or women. Among the treated, the prevalence of blood glucose control was higher in women (PR: 1.45, [0.93, 2.25]) , but not men (PR: 0.96 [0.66, 1.40]) , whose spouse was diagnosed (ref=spouse undiagnosed) . Conclusions: Spouse’s diabetes was associated with higher probability of detection of diabetes but not with treatment. Outreach among couples may improve medical management of diabetes in India. Disclosure J.Varghese: None. S.A.Patel: Research Support; Johnson &amp; Johnson.

1244-P: Glycemic Trend in the Second Year of LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India

Glycemic change from baseline to 2-years was examined during the second year of LANDMARC, a 3-year prospective observational study (CTRI/2017/05/008452) , which included participants with T2D taking ≥2 antihyperglycemic medications (with/without glycemic control) . Out of 6234 evaluable participants (mean baseline values - age: 52.1 years, T2D duration: 8.59 years and A1C: 8.05%) , 5318 completed 2-year follow-up visit. All glycemic parameters improved significantly (p&amp;lt;0.0001) from baseline (A1C: -0.58 % [1.67]; FPG: -14.60 mg/dL [54.54]; and PPG -21.96 mg/dL [78.99]) . From baseline to the end of 2 years, the number of participants in the 7-7.9% A1C subgroup increased in comparison to higher A1C subgroups; but only 20.8% (1297/6234) achieved optimum glycemic control of A1C &amp;lt;7%. Suboptimal glycemic control was observed in the subgroups with cardiovascular risk factors, and microvascular and macrovascular complications (Table) . In conclusion, although there was a marked improvement in all the glycemic parameters from baseline, a large majority of the participants remained uncontrolled. This emphasizes the need for optimizing diabetes management in India. Disclosure S. Joshi: Advisory Panel; Abbott, Boehringer Ingelheim International GmbH, Dr. Reddy’s Laboratories Ltd., Eli Lilly and Company, Novo Nordisk, Roche Diabetes Care. Consultant; Biocon, Glenmark Pharmaceuticals, Sanofi, USV Private Limited. A.K. Das: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Roche Diagnostics, Sanofi. Speaker's Bureau; Dr. Reddy’s Laboratories Ltd., Lupin Pharmaceuticals, Inc., USV Private Limited. K. Kumar: None. A. Mithal: Advisory Panel; Eris Lifesciences Ltd. Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited. Speaker's Bureau; Abbott Diabetes, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Dr. Reddy’s Laboratories Ltd., Novartis AG, Novo Nordisk, Sanofi. S. Kalra: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. A. Unnikrishnan: Advisory Panel; Intas Pharmaceuticals Ltd. Speaker's Bureau; Abbott, AstraZeneca, Boehringer-Ingelheim, Sanofi. Other Relationship; Novo Nordisk, Serdia Pharmaceuticals (India) Pvt. Ltd., Torrent Pharmaceuticals Ltd. H. Thacker: None. B. Sethi: None. S. Chowdhury: None. A. Nair: None. S. Mohanasundaram: Employee; Sanofi. V. Salvi: Employee; Sanofi. D. Chodankar: Employee; Sanofi. C. Trivedi: None. S. Wangnoo: None. A.H. Zargar: Advisory Panel; Sanofi. Speaker's Bureau; AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Intas Pharmaceuticals Ltd., Janssen Pharmaceuticals, Inc., Lupin Pharmaceuticals, Inc., Novo Nordisk, USV Private Limited. N. Rais: None. Funding Sanofi, India

Abstract 137: Improved glycemic control among people with type 2 diabetes with a digital therapeutics approach in collaboration with clinicians

Background: Due to poor diabetes self-management awareness as well as heavy patient burden, management of diabetes in India is challenging for clinicians. Digital therapeutics platforms provide accessible and cost-efficient care through evidence-based guidance for lifestyle and behavioural modifications.Aim and Objectives: To evaluate the effectiveness of Diabefly® digital therapeutics platform for glycemic control among people with type 2 diabetes.Results: De-identified data of 144 participants referred by physicians (mean age: 46.42 years, 54.54 % females) on the 90 days Diabefly® program was analyzed. A mean significant reduction in HbA1C was observed by 1.56% (P< 0.001) from baseline 8.59%. Similarly, mean weight and BMI significantly reduced by 2.39 kg and 0.84 kg/m2 (P<0.001 for both) from a baseline of 75.63 kg and 27.34 kg/m2 respectively. Complete FBS and PPBS readings were provided by 56 and 39 participants respectively. A mean reduction in FBS and PPBS was observed by 53.93 mg/dL and 99.25 mg/dl (P < 0.001 for both) from a baseline of 168.2 mg/dL and 234.7 mg/dl respectively.Conclusion: Significant reduction in HbA1c, weight, BMI, FBS and PPBS was observed after participation in the Diabefly® program. The study thus showed significant improvement in glycemic control in people with diabetes after participation.

Review on Plants for Management of Diabetes in India: An Ethno- Botanical and Pharmacological Perspective

Background: Diabetes mellitus is a prevalent chronic disease, which is recognized as a common threat to health in the last decade, especially in Asia. It is a lifestyle disease which may cause a number of complications in the body of humans like cardiac failure and dysfunctioning of urinary tract. Materials and Methods: The data is obtained from various search tools and electronic databases like, scientific literature, Google scholar, Google, Pubmed, Web of science and Scopus. Results: Major therapy for diabetes is insulin, oralantidiabetic drugs, and herbal treatment. However, insulin and oral anti-diabetic drugs come with a number of side effects and cannot be afforded by people with below poverty line. The herbal medicines have performed a satisfactory clinical practice for the management of diabetes mellitus. Moreover, pharmacological & phytochemical screening of medicinal plants has also witnessed the hypoglycaemic effects of these plants in treating diabetes mellitus. Majority of the modern drugs like metformin, atropine, digitalis, etc. are also originated from plants. Conclusion: The current paper presents a review of medicinal plants used for diabetes management in India. The therapeutic potential, ethnobotanical use, and their pharmacological evaluations are highlighted for harnessing the anti-diabetic potential of these plants by the Indian healthcare system.

2279-PUB: High Prevalence and Suboptimal Management of Diabetes in India: Findings from a Community-Based Study

Purpose: Diabetes is rapidly increasing in India. This study aimed to determine the current prevalence of diabetes and its management in rural and urban India. Methods: We conducted a large population based cross-sectional survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using a multistage cluster random sampling technique. Trained personnel collected the data using a questionnaire, measured blood pressure, conducted anthropometry and collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment. Control was defined as HbA1C &amp;lt; 7%. Results: The mean (±SD) age of participants was 49.2 (±12.6) years, women comprised 53% of the sample. The age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1). The prevalence was higher among men [19.3% (18.3-20.3)], elderly i.e., ≥ 60 years [26.8% (25.1-28.6)], urban residents [23.1% (22.1-24.2)] and in those with higher socioeconomic status [22.5% (21.0-24.1)]. Nearly, one-third participants had prediabetes [29.7% (28.9-30.5)] and there were no rural-urban, gender or socioeconomic differences. The awareness and treatment [49.1% (46.8-51.4), 43.3% (41.0-45.5)] rates respectively, were poor among diabetics, who were young (41.9%, 36.0%), rural residents (37.8%,31.5%) and those with lower socioeconomic status (30.1%,28.4%). Overall control rate was 45.5% (42.9-48.1) with no significant differences between the aforementioned groups. Conclusions: Despite the increasing burden of both diabetes and prediabetes in India, the awareness, treatment and control rates remain suboptimal. Active screening and tailored public education to increase awareness, are essential for promoting early detection and improving management, especially among poor rural populations. Disclosure S. Mohan: None. P. Jarhyan: None. G. Sharnngadharan: None. D. Prabhakaran: None.

1608-P: Suboptimal Management of Diabetes in India: Findings from a Large Community-Based Study

Over the past few decades diabetes prevalence has rapidly increased across India. However, limited information is available on the levels of awareness, treatment and control, particularly in epidemiologically transitioning communities. We estimated the prevalence, awareness, treatment and control rates of diabetes in a large representative population sample aged ≥ 30 years, selected using a multistage cluster random sampling technique, residing in rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples to estimate fasting plasma glucose (FPG) and HbA1C. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-report of physician diagnosis or being on treatment. Participants were considered to be aware of diabetes if they reported a diagnosis or being on treatment. Control was defined as HbA1C &amp;lt; 7%. In total 12243 participants (6208 in North and 6035 in South) were surveyed. The mean (±SD) age was 47.7 (±12.5) years. Women constituted 54%. The age-standardized prevalence of diabetes was 14.2 (95% CI: 13.6 - 14.9), with significant difference between urban (21.4%; 20.4-22.5) and rural (7.5%; 6.8-8.2) areas. Among those with diabetes, the awareness, treatment and control rates were 49.4% (46.6-52.2), 38.6% (35.9-41.3) and 12.6% (10.9-14.5) respectively. Compared to urban residents, rural counterparts were less likely to be aware (35% Vs. 55%), treated (26% Vs. 43%) and controlled (8% Vs. 14%). Similarly, patients in the lowest tertile of wealth index had lower awareness (33% Vs. 55%), treatment (22% Vs. 43%) and control rates (5% Vs. 15%) compared to those in the highest tertile. Despite a high burden, management of diabetes is sub-optimal in India. Health system strengthening to better manage diabetes with a focus on rural residents and the poor is imperative to stem the rising burden and improve diabetes related health outcomes. Disclosure S. Mohan: None. N.S. Venkateshmurthy: None. P. Jarhyan: None. G. Sharnngadharan: None.

A 2018 clinical practice pattern in the management of diabetes in India and Nepal: a three-city study

Knowledge, awareness, and practices with regard to diabetes management in south Asia are not known. This study aimed to determine current clinical practices with regard to managing diabetes in Nepal and India. Doctors attending conferences in Delhi, Guwahati, and Kathmandu were evaluated regarding their diabetes treatment preferences using a standardized questionnaire having 34 multiple-choice questions. The questionnaire evaluated doctor’s preferences on therapeutic lifestyle modification, pharmacotherapy, and insulin injection practices. From a total of 409 filled questionnaires which were collected, 261, 75, and 73 questionnaires from New Delhi, Guwahati, and Kathmandu, respectively, which fulfilled all criteria, were analyzed. The mean age of doctors was 42.26 ± 11.99 years. Low carbohydrate, high protein was the most frequently recommended diet plan. The use of carbohydrate counting in practice was non-existent. Self-monitoring of blood glucose (SMBG) is commonly used in practice with 1–2 times per day checking. The preferred second, third, and fourth oral agents after metformin were sulfonylureas (53.05%), glucosidase inhibitors (37.16%), and dipeptidyl-peptidase-4 inhibitors (DPP4i) (42.79%) respectively. Glimepiride (73.83%) and gliclazide (28.60%) were the most preferred sulfonylureas. Teneligliptin (31.54%), sitagliptin (23.71%), linagliptin (22.24%), and vildagliptin (16.38%) were the preferred DPP4i. Dapagliflozin (30.56%), empagliflozin (20.29%), and canagliflozin (8.85%) were the preferred sodium-glucose co-transporter-2 inhibitor (SGLT2i). Insulin use was delayed in type-2 diabetes, typically initiated only after glycemic control not adequate with five oral anti-diabetes agents (OADs) (50.36%). The most preferred insulin was basal insulin analogue (47.68%) followed by neutral protamine hagedorn (NPH) insulin (22.24%). Most patients received < 20 U of insulin/day (56.96%). The most commonly used short-acting insulin in pregnancy was lispro (204; 49.88%). The preferred long-acting insulin in pregnancy was NPH insulin (180; 44.01%). Lack of use of digital technology, less use of lifestyle modifications, delayed use of insulin, preference for multiple OADs, popularity of sulfonylureas and alpha-glucosidase inhibitors (AGIs), and late use of SGLT2i were some of the key highlights of diabetes practice in south Asia.

Recommendations for in-clinic PoCT for diabetes management in India

A panel of expert diabetologist clinicians developed consensus standards to address the quality gaps inclinic point of care testing (PoCT) especially pertaining to diabetes care and management in India. The following summarized principles were established- 1. PoCT definition, 2. Advantages and critical aspects of PoCT including guideline recommendations and accreditations, analytical factors (pre &post analytical included) and consensus reached for an ideal PoC analyzer and 3. Key recommendations on in-clinic PoCT implementation by the panel. The experts suggested next steps that included key comparative (PoCT vs NGSP accredited lab) and patient benefit studies on PoCT.

Influx of recombinant insulin and its analogues for management of diabetes in India

Influx of recombinant insulin and its analogues for management of diabetes in India

Innovation in capacity building of primary-care physicians in diabetes management in India: a new slant in medical education

India is home to more than 69 million individuals with diabetes, and this fi gure is expected to rise to 123 million by 2040.1 In view of the low doctor-to-population ratio (1:1800),2 uneven distribution of specialists (most of whom are in urban areas), and the fact that most initial diagnoses of dia betes (about 70%) are made by nonspecialists, one key to eff ectively tackling the challenge of diabetes is to strengthen primary health care

Guidelines for ethno-centric psychosocial management of diabetes mellitus in India: The north east consensus group statement

Recently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9 th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.

The second Diabetes Attitudes Wishes and Needs (DAWN2) study: Insights into nutritional management of diabetes in India

The second Diabetes Attitudes Wishes and Needs (DAWN2) study: Insights into nutritional management of diabetes in India

Guidelines for ethno-centric psychosocial management of diabetes mellitus in India: The north east consensus group statement

AbstractRecently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.