Postprandial Blood Sugar Levels Research Articles

Real-World Effectiveness of Oral Semaglutide in Indian Adult Diabetic Patients: Evaluation of EMR-based Data

Abstract Introduction: Diabetes is increasingly becoming a significant health concern globally, including in India, where its prevalence continues to increase. Being overweight often acts as a catalyst for developing diabetes, exacerbating the condition and increasing the risk of other serious health complications such as heart disease, kidney problems, and nerve damage. Peptide-based molecules like semaglutide have proved their efficacy in controlling glycated hemoglobin (HbA1c) levels and body weight in diabetic patients. Objective: The present study aims to determine the effectiveness of oral semaglutide in a real-world setting. Materials and Methods: This retrospective study included patients ≥18 years of age prescribed oral semaglutide with a follow-up visit between 80 and 160 days post-prescription and had baseline body mass index (BMI) ≥ 30 kg/m2 and HbA1c levels ≤10.0%. The primary endpoints were to assess changes in HbA1c level, BMI, and body weight from the baseline. The secondary endpoints were to determine the changes in postprandial blood sugar (PPBS), fasting blood sugar (FBS), and blood pressure. The analysis also encompassed data on comorbid conditions and concomitant medications prescribed. Results: A total of 188 patients met the study eligibility criteria. At the follow-up visit, a statistically significant mean reduction of 0.34% in HbA1c levels and a weight loss of 1.83 kg were observed. The average duration between baseline and follow-up visit was 114.14 ± 21.5 days. The mean reduction in the BMI was 0.73 kg/m2 (P < 0.001). During the follow-up visit, the PPBS level decreased by 9.95 mg/dL and the FBS level decreased by 5.02 mg/dL. Additionally, the effect of semaglutide on blood pressure was evident, with a reduction in systolic blood pressure by 1.69 mm Hg and diastolic blood pressure by 1.30 mm Hg. The most common comorbid condition was dyslipidemia (66.49%), followed by hypertension (51.60%) and obesity (39.36%). Conclusion: Semaglutide demonstrated significant reductions in glycemic parameters, body weight, and blood pressure.

Correlation of Serum Electrolyte Imbalances With Diabetic Duration and Medication Use: A Cross-Sectional Comparative Study.

Certain anti-diabetic medications may exacerbate electrolyte imbalances, potentially complicating glycemic control in diabetic patients. The present study aimed to correlate the serum electrolyte imbalances such as Na+, K+, Ca+2, Cl-, and Mg+2 with the duration of disease, glycemic control, and medication regimens. In this cross-sectional study, 31 patients with type 2 diabetes mellitus (T2DM) and 30 healthy controls, with mean ages of 52.06 and 48.5 years, respectively, were recruited based on eligibility criteria. Data on demographic information, medication history, and duration of diabetes were collected. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1C), and serum electrolytes were measured. The data were statistically analyzed. The mean differences in serum electrolytes between T2DM patients and non-diabetic participants were compared using the Mann-Whitney U test, and correlation analysis was performed. A p-value of <0.05 was considered statistically significant. Around 9.6% of participants had diabetes duration of less than one year, while the majority (45%) fell within the 1-5-year duration range. Most diabetic patients (61.2%) exhibited poor glycemic control. Statistically significant differences were observed between the mean FBS, PPBS, and HbA1C levels of T2DM (150, 249, and 8.82, respectively) and control group (95, 114, and 5.52, respectively). Analysis of serum electrolytes showedstatistically significant differences with regard toNa+, K+, andCl-between the diabetic and control groups. Mean sodium and chloride levels were lower and potassium levels were higher in diabetic patients compared to the control group. Negative correlations were observed between sodium and chloride levels and duration of diabetes and HbA1C levels. The study reveals significant electrolyte imbalances in patients with T2DM, characterized by reduced sodium and chloride levels and elevated potassium levels compared to healthy controls. These alterations are closely associated with poor glycemic control and longer disease duration, emphasizing the importance of regular electrolyte monitoring in T2DM management to mitigate potential complications.

Evaluating Blood Pressure Variability in Type 2 Diabetic Patients: An Insight into Non-Dipping Patterns and Their Clinical Implications.

Hypertension (HTN) is prevalent in individuals with type 2 Diabetes Mellitus (T2DM), doubling the risk of developing chronic complications. Despite normal routine checks, many patients with diabetes exhibit abnormal blood pressure (BP) profiles identified by 24-hour ambulatory Blood Pressure monitoring (ABPM). This study aimed to analyse blood pressure variability in patients with diabetes to enhance current knowledge and improve clinical practice. This cross-sectional study obtained ethical approval from Jazan University and involved 58 patients with type 2 Diabetes Mellitus (T2DM) who adhered to the strict inclusion and exclusion criteria. Comprehensive clinical and laboratory data, including demographic, clinical, and essential laboratory parameters, were collected using a standardized form. Blood Pressure (BP) was meticulously monitored using the Sun Tech Oscar 2 ABPMR device, with measurements commencing between 8 am and 10 am, extending over 24hours. The study calculated averages and evaluated systolic and diastolic percentage dipping during 24-hour, daytime, and night-time intervals. Participants classified as "dippers" experienced a BP reductions of at least 10%. Fifty-eight normotensive T2DM patients, with a mean age of 45.51 ± 6.7 years, were monitored over 24 months. Among the 58 individuals assessed using ABPM, a non-dipping pattern was observed in 45 participants (77.58%), whereas 13 (22.41%) exhibited a dipping pattern. Postprandial and fasting blood sugar levels were distinct; the dipper group demonstrated better post-meal glucose control (p=0.02), whereas the non-dipper group had superior fasting glucose control (p=0.04). The dipper group showed a higher 24-hour average systolic BP (p=0.00) and increased dipping percentages for systolic and diastolic BP during sleep. Over 77% of ABPM-evaluated individuals showed non-dipping patterns, with a higher BMI being strongly associated. Laboratory findings revealed distinct variations in the postprandial and fasting blood sugar levels, suggesting a potential genetic predisposition.

Exploring Factors Influencing Stroke Risk: Insights From a Predictive Analysis.

Introduction Stroke is a serious medical condition characterized by the sudden interruption of blood flow to the brain, resulting in the death of brain cells. It is a leading cause of long-term disability and mortality worldwide. Stroke has some associated risk factors, both modifiable and non-modifiable ones.As for non-modifiable risk factors, these are age, gender (men are more vulnerable), and family history of stroke.The controllable or adjustable risk factors include hypertension (high blood pressure), diabetes, smoking, high cholesterol levels, obesity, and insulin resistance. Methods In our study, we collected data from 229 patients which were originally collected for clinical purposes and were retrospectively analyzed. These data contain features such assex and age, the presence of ischemic heart disease (IHD) or stroke history, and different blood sugar readings. These measurements include fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c%, and insulin levels (fasting and postprandial).Furthermore, cholesterol was also tested, such as total cholesterol, triglycerides (TGL), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). Surprisingly, stroke was observed in 24of the 205 patients. This contrast permits us to be concerned with the chance of the association between stroke and insulin levels. Given the imbalanced nature of our outcome variable (stroke occurrence), the primary analytical method will be logistic regression. Results In this cross-sectional study, we investigated the association between high insulin levels (both fasting and postprandial) and the occurrence of stroke within a dataset of 229 patients. Out of the 229 included cases, 102 individuals were female (44.5%) and 127 individuals were male (55.5%). Twenty-four cases have ischemic heart disease (10.5%). Among the analyzed cases, 24 individuals have a history of stroke. The average age of the sample is approximately 57 years ± 14.87. There was no significant difference between the males and females in most of the descriptive statistics. However, females experienced significantly higher levels of postprandial glucose level and significantly lower levels of postprandial insulin. According to our predictive model, we found that an increase in fasting insulin levels was linked to a lower risk of stroke occurrence. On the other hand, increasing insulin postprandial levels and age were associated with an increased risk of stroke. Conclusion Our study identified age, fasting insulin, and postprandial insulin as key factors influencing stroke risk. Higher fasting insulin levels were associated with reduced risk, while increased postprandial insulin and age were linked to higher risk. Blood glucose, cholesterol, and triglycerides had minor effects. Notably, higher total cholesterol and triglyceride levels were slightly associated with lower stroke occurrence. Further research with larger samples is needed for validation.

A novel konjac rice formula with glucomannan and tapioca starch improve postprandial glycemic response – a randomized single-blind clinical trial

PurposeDue to white rice’s association with diabetes and other chronic diseases in many Asian countries, many industries are working to develop high-fiber rice substitutes with similar organoleptic characteristics. Konjac rice (KR) is a promising option, but maintaining its optimal fiber content for health benefits while preserving its ideal sensory profile remains a challenge. This study aims to investigate whether a KR formula, combining tapioca flour and glucomannan gel, possesses similar organoleptic attributes to white rice while preventing glycemic response elevation.Design/methodology/approachIn a six-week randomized single-blind clinical trial, 13 normoweight nondiabetic subjects received varying konjac-based rice and white rice ratios. Blood glucose levels were measured at intervals, and glycemic response was assessed using incremental area under the curve (iAUC). Visual analog scale gauged satiety, and organoleptic properties were evaluated.FindingsSubstituting white rice with pure and partial konjac-based rice significantly lowered postprandial blood sugar levels and glycemic response (p = 0.002). iAUC for pure KR and KR 1:1 was notably lower than white rice (p = 0.002). Subjects reported a sense of fullness comparable to white rice, with no significant organoleptic score differences (p = 0.260).Research limitations/implicationsThe study’s generalizability is compromised due to the limited number of participants, impacting external validity. The examined parameters offer a rough understanding of konjac grain’s impact on postprandial glycemic responses but do not elucidate underlying mechanisms or the duration of its inhibitory effect on glucose absorption. Long-term effects on metabolic, hormonal parameters and the colon’s microbial flora composition and function remain unexplored, constraining comprehensive insights into konjac grain’s extended implications.Practical implicationsThis study introduces a novel KR formula to address the escalating diabetes risks associated with white rice consumption. Substituting white rice with KR significantly reduces postprandial blood sugar levels, highlighting its potential in preventing type 2 diabetes (T2D). Tapioca flour enhances palatability, making KR a viable option. While promising, long-term effectiveness and safety require further research, emphasizing comprehensive lifestyle interventions. The study contributes valuable insights to innovative dietary strategies for prevalent health conditions, emphasizing the need for ongoing efforts in public health.Social implicationsWhite rice, a staple in Asian societies, is linked to a heightened risk of T2D due to increased production and inadequate dietary fiber. This connection contributes to the economic burden on governments through health insurance and lost productivity. Encouraging alternatives rich in fiber can mitigate this burden, offering a socioeconomically beneficial solution to preventable chronic diseases.Originality/valueThis trial demonstrates konjac-based rice’s potential in curbing glycemic responses, hinting at its role in preventing T2D. Glucomannan’s viscosity, satiety induction and potential gut health impact are highlighted. Further research is warranted for long-term effectiveness and safety. These findings contribute to the growing evidence supporting glucomannan as a valuable tool in addressing prevalent health conditions.

Systemic Vascular Parameters in Ocular Pseudoexfoliation.

Background Pseudoexfoliation syndrome (PEX) is characterized by a dandruff-like substance in the anterior chamber, composed of various glycoproteins that have an unclear origin. Its deposition is observed on the pupillary margin, lens zonules, and trabecular meshwork. Proteomic studies have identified numerous proteins in the affected individuals, suggesting associations with systemic conditions like heart disease, stroke, and Alzheimer's disease. However, the systemic associations of PEX remain inconclusive, particularly in regions like southern India. Materials and methods A cross-sectional study was conducted on 114 participants. Pseudoexfoliation was graded as mild, moderate, and severe as per standard photographic grading. Systemic examinations included blood pressure measurements, electrocardiography (ECG), and blood investigations for serum lipid profile, fasting and postprandial blood sugar levels, and serum C-reactive protein levels. Small incision cataract surgery was performed for all the patients. Intraoperative complications and postoperative status were recorded. Results Thirty-eight patients (33.3%) had mild PEX, 44 (38.6%) had moderate PEX, and 32 (28.1%) had severe PEX. Hypertension was present in 54 participants (47.4%), diabetes in 21 (18.4%), coronary artery disease in nine (7.9%), and cerebrovascular accidents in three (2.6%). The mean systolic blood pressure was 140.39 mmHg and the mean diastolic blood pressure was 90.37 mmHg. Systolic blood pressure exceeded 140 mmHg in 29 participants (90.6%) with severe PEX, while diastolic blood pressure surpassed 90 mmHg in 26 participants with severe PEX, both with a p-value of 0.001. Mean fasting and postprandial blood sugar levels were 103.80 ± 31.81 mg/dl and 131.72 ± 48.24 mg/dl, respectively. Serum lipid profiles showed mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), cholesterol, and triglyceride levels of 103.00 ± 34.49 mg/dl, 29.04 ± 15.51 mg/dl, 172.73 ± 43.34 mg/dl, and 129.33 ± 64.65 mg/dl respectively. Electrocardiographic results indicated that 54 participants (47.37%) had abnormal ECG including rate abnormality in 13.2%, conduction defects in 12.3%, ischemic changes in 10.5%, and structural defects in 11.4%. Eighty-seven percent of patients had non-dilating pupils and iris atrophy, 13.2% had zonular dialysis and intraoperatively, 78% had capsulorhexis extension, 49.12% had difficult nucleus prolapse, and 28.95% had posterior capsular rent. Conclusion This study highlights the significantly elevated parameters of systemic vascular diseases in PEX patients, like elevated blood pressure and more frequent cardiac anomalies, emphasizing the need for comprehensive systemic evaluation and careful preoperative assessment for ocular comorbidities.

Vildagliptin-Associated Bullous Pemphigoid: A Case Report

Objective: Bullous pemphigoid is a rare autoimmune skin disorder characterized by blistering, urticarial lesions, which are sometimes associated with adverse drug reactions. Vildagliptin is an oral anti-diabetic agent that selectively inhibits the dipeptidyl peptidase-4 (DPP-4) enzyme Materials and Methods: A 75-year-old female with a known case of type 2 Diabetes Mellitus, hypertension, and hypothyroidism for the last 10 years presented with pruriginous tense bullous skin lesions over her both palms and soles. There was no mucosal involvement. Further interrogation revealed that she started taking Vildagliptin 5 days ago which was prescribed due to high levels of post-prandial blood sugar level despite already intake of Glimepiride-4 mg and Metformin-3 gm. Results: Vildagliptin was immediately advised to be stopped. She was treated with antihistamines, steroids, and conservative management which led to remission of the blisters Conclusion: Vildagliptin is the probable causative drug for developing bullous pemphigoid skin lesion which shows temporal association in this case as other concomitant drugs has no direct correlation. Therefore physicians must be aware of this rare life-threatening side effect of this medicine and advice patients to visit the hospital even the slightest cutaneous manifestation. Bullous pemphigoid can result in fatal life-threatening conditions if not treated early.

Evaluation of Inflammatory Markers and Demographic Profile of Type 2 Diabetes Mellitus Patients among the Ethnic Communities Attending Central Referral Hospital, East Sikkim.

Type 2 diabetes mellitus (T2DM) is the most common metabolic disorder and inflammation plays a key role in the pathogenesis of the disease. Ethnic variations have been linked with an increased prevalence of diabetes. This pilot study was designed to evaluate the inflammatory markers and demographic characteristics in T2DM patients among the ethnic group of Sikkim. A total of 100 type 2 diabetic patients and 50 healthy controls were enrolled in the study. Demographic characteristics were recorded among the patients and inflammatory markers [high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6)], body mass index (BMI), glycemic status, fasting blood sugar (FBS), and postprandial blood sugar (PPBS) level were compared between the cases and controls. Inflammatory markers were correlated with BMI, glycemic status, and duration of diabetes. Type 2 diabetes mellitus was found to be highest in between the age-group of 45 and 55 years with males being mostly affected. Among the ethnic group, Nepalis (57%) comprised the highest with diabetes. No significant correlation was found between inflammatory markers with BMI, glycemic status, and duration of diabetes. Our study showed that T2DM increases as age progresses with males being mostly affected. The Nepalese community showed a high proportion of the disease mostly living in the urban residences. Though we included patients on statin therapy, its specific roles and relationship were not in the scope of the current study, but further studies should be conducted at the community level to understand the role and relationship of statins among type 2 diabetic patients and the possibilities of ethnic differences in the levels of biomarkers due to variation in the body fat distribution.

A Study of Platelet Parameters in Patients of Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus is a heterogenous group of disorders characterized by variable degree of insulin resistance, impaired insulin secretion and excessive hepatic glucose production. Diabetic thrombocytopathy is a condition that affects the platelet function in diabetic individuals. The aim of this research is to study the platelet parameters in type 2 diabetics. Method: In this cross sectional study we studied fasting blood sugar level, post prandial blood sugar, HbA1c and platelet parameters in relation with HbA1c and blood sugar levels in 115 patients of type 2 diabetes mellitus. Results: Present study shows that there is statistically significant correlation between BSL (Fasting) ,BSL (Post prandial) and HbA1c; BSL (Post Prandial) and Plateletcrit and no statistically significant correlation between the other platelet parameters and HbA1c, fasting blood sugar level and post prandial blood sugar level in type 2 diabetics.

Effect of Bergenia ligulata (Wall.) in type 2 diabetes mellitus: A randomized placebo-controlled trial

IntroductionGlobally 8.8 % of people aged 20–79 years have diabetes. Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. Bergenia ligulata (Wall.) is a small, perennial, rhizomatous flowering herb used medicinally in India.The present study aimed to evaluate the effect of B. ligulata rhizome as an adjuvant in decreasing blood glucose levels in type-II diabetes mellitus. MethodsForty patients were enrolled in a single-blind, randomized, placebo-controlled study; twenty patients were assigned to each of the test and control groups. Only those currently using 2 or less oral hypoglycaemic agents were included. Subjects took B. ligulata (4 gm) or placebo in capsule form, orally, for 8 weeks. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were measured at baseline, fourth week, and end of the trial. Haemoglobin A1c (HbA1c) and quality of life (Asian Diabetes Quality of Life; ADQOL) scores were measured at baseline and the end of the trial. Data were statistically analyzed using analysis of variance (ANOVA), student's t-test, chi-square, and Fisher exact test to assess the effect of the intervention. ResultsAfter 8 weeks of treatment, the decrease in mean fasting blood sugar (FBS) level showed a significant difference between groups (Cohen's d= -0.457, 95 % confidence intervals (CIs) -0.174 to -1.082). PPBS level was significantly reduced in the test group compared to the control group (Cohen's d= -1.457, 95 % confidence interval (CIs) -0.749 to -2.150). There was a statistically significant reduction in HbA1c level in the test group compared to the control group (Cohen's d= -0.798, 95 % confidence interval (CIs) -0.148 to -1.438). B. ligulata was found to be more effective in improving ADQOL scores than placebo (Cohen's d = 0.762, 95 % confidence interval (CIs) 0.115 to 1.400). No B. ligulata related adverse events were observed. ConclusionB. ligulata appears to be an effective adjuvant treatment for type 2 diabetes mellitus. It reduced FBS, PPBS, and HbA1c and improved ADQOL scores significantly compared to the placebo. However, for more valid results, larger samples are needed. Clinical trial registration noCTRI /2019/05/019087.

COST-EFFECTIVENESS OF METFORMIN-GLIMEPIRIDE COMBINATION COMPARED TO SINGLE METFORMIN USE IN DECREASING 2 H POST PRANDIAL BLOOD GLUCOSE

Objective: Complications related to diabetes could reduce the quality of life. In Indonesia, the costs incurred for diabetes mellitus annually will increase as complications of the disease increase. This study explored the cost-effectiveness therapy of metformin-glimepiride combination on post-prandial blood glucose.&#x0D; Methods: Glimepiride is added to the first category for diabetes mellitus receiving metformin to improve blood sugar levels and reduce costs. An observational study was conducted retrospectively to analyze post-prandial blood sugar levels with the total direct medical costs at Universitas Andalas Hospital. The study involved 114 medical records of patients referred during 2021. The combination of Metformin HCL and Glimepiride was compared to Metformin alone in measuring cost and effect parameters. The categorical dependent-independent groups were statistically analyzed using Chi-square, while the cost and effect parameters were calculated to get the Incremental Cost-Effectiveness Ratio (ICER) value.&#x0D; Results: There were no significant differences between groups on sociodemographic characteristics (p&lt;0.05). An incremental cost value of IDR 43,291 was obtained for reducing post-prandial blood sugar by 21.92 mg/dl.&#x0D; Conclusion: Increasing cost and effect parameters require further analysis to determine the trade-off point.

The Impact of Time-Restricted Meal Intake on Glycemic Control and Weight Management in Type 2 Diabetes Mellitus Patients: An 18-Month Longitudinal Study.

This study aimed to investigate the impact of time-restricted meal intake (TRM) on anthropometric and biochemical parameters in patients with type 2 diabetes mellitus (T2DM). A total of 400 patients diagnosed with T2DM were selected from the Endocrinology Department at King George's Medical University (KGMU), Lucknow, based on the American Diabetes Association (ADA) guidelines and specific criteria. A total of 127 patients were lost to follow-up, resulting in 273 patients who completed the study. The patients were randomly assigned to two groups: the TRM group (consenting to have an early dinner at 7 pm) and the control group (non-TRM/late-night eater group). Baseline data were recorded, and follow-up assessments were conducted at six months, 12 months, and 18 months. Informed consent was obtained, and a diet chart was regularly maintained and updated. The TRM group experienced a significant weight loss of 3.88 kg (5.45%) and a substantial reduction in BMI by 1.5 units (5.26%). In contrast, the non-TRM/control group had smaller reductions in weight (1.36 kg, 1.77%) and BMI (0.5 units, 1.65%). TRM group showed significant reductions in fasting blood sugar levels by 33.9 mg/dl (21.17%), postprandial blood sugar levels by 94.6 mg/dl (38.88%), andglycosylated hemoglobin (HbA1c) levels by 1.37 (15.87%). These improvements were significantly greater than the reductions observed in the control group, which had decreases of 29.3 mg/dl (17.85%) in fasting blood sugar levels, 41.6 mg/dl (16.84%) in postprandial blood sugar levels, and 0.59 (6.89%) in HbA1c levels. Our findings underscore the potential of TRM as an effective strategy for weight management and glycemic control in patients with T2DM, even in a long-term context. These results supporttime-restricted eating as a sustainable lifestyle modification for managing chronic metabolic diseases.

Endothelial Dysfunction in Type 2 Diabetes Patients and its Association with Microvascular Complications: A Cross-sectional Study

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing worldwide. Microangiopathic and macroangiopathic complications are the main causes of morbidity and mortality in diabetes. Endothelial dysfunction is important in the early pathophysiology of vascular complications. Screening is very important in order to prevent these complications. Aim: To investigate endothelial dysfunction, as measured by Flow Mediated Vasodilation (FMD) of the brachial artery, in diabetic individuals. It also aims to explore the correlation between FMD and Glycated Haemoglobin (HbA1c), as well as the association between FMD and microvascular complications such as diabetic neuropathy, diabetic retinopathy, and albuminuria. Materials and Methods: This cross-sectional study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, between 2020 and 2021 on 160 patients. All patients diagnosed with T2DM, attending the Outpatient Department (OPD) or admitted to the ward, were enrolled in the study using consecutive sampling. FMD was measured for each patient, and Urine Albumin Creatinine Ratio (UACR) was also assessed. Diabetic retinopathy was evaluated through fundus examination, and diabetic neuropathy was screened using the monofilament test. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27.0 to determine the correlation between FMD and these variables. Results: A total of 160 patients were enrolled in this study, including 104 (65%) males and 56 (35%) females. The median age was 52 years, and the participants had a median Body Mass Index (BMI) of 29.5 kg/m2 . The median HbA1c was 8.7%. The median Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) levels were 145 mg/dL and 242 mg/dL, respectively. The median FMD among all patients was 5.6%, with an Interquartile Range (IQR) of 4.9% to 6.6%. There was an inverse correlation between HbA1C and FMD values, with a correlation coefficient of -0.718 (p-value &lt;0.01), indicating a strong and significant inverse correlation. Patients with significant macroalbuminuria had a lower median FMD compared to non albuminuric patients, and this difference was statistically significant. The median FMD was also lower in patients with diabetic neuropathy and retinopathy. Conclusion: The study findings suggest that endothelial dysfunction, as measured by FMD, is significantly impaired in patients with elevated HbA1c and microvascular complications of diabetes mellitus.

A study of effect of iron deficiency anemia on glycosylated hemoglobin in non-diabetic patients

Background: Diabetes mellitus is a rapidly increasing global health concern, having a substantial impact on morbidity and mortality. Glycated hemoglobin (HbA1c) is the primary measure of diabetes control, reflecting glycemic levels over the past 3 months. However, hemoglobin (Hb) abnormalities, such as those seen in iron deficiency anemia (IDA), can theoretically affect HbA1c levels. IDA, affecting over 30% of the global population, results from inadequate iron intake, hemorrhage, or poor iron absorption, leading to reduced Hb production. This study aims to evaluate the impact of IDA on HbA1c levels in non-diabetic patients, providing insights into accurate HbA1c interpretation in anemic patients. Aims and Objectives: The study aimed to determine the impact of IDA on HbA1c levels in non-diabetic individuals. Materials and Methods: This cross-sectional study was conducted over 6 months at Trichy SRM Medical College Hospital and Research Center. There were a total of 100 IDA patients and 100 age- and sex-matched healthy controls. Hb levels below 10 g/dL with a microcytic image suggestive of iron deficiency, postprandial blood sugar (PPBS) levels below 140 mg/dL following an oral glucose tolerance test (OGTT), and fasting blood sugar (FBS) levels below 100 mg/dL were the inclusion criteria. Exclusion criteria included Hb levels above 10 g/dL, altered FBS or PPBS values post-OGTT, diagnosed Type 2 diabetes mellitus, individuals younger than 18 years, and those with conditions such as hemoglobinopathies, hemolytic anemia, hypothyroidism, pregnancy, or abnormal renal function tests. Ethical approval and informed consent were obtained. Data collection included demographics, medical history, and laboratory investigations. Statistical analysis was performed using SPSS version 26, with t-tests, mean, and standard deviation (SD) for association analysis, and Chi-square tests for sex comparisons. Correlations were assessed through t-test. The significance level was kept at 0.05. Results: The study confirmed that both groups met the inclusion criteria for non-diabetic status. The control group exhibited normal Hb levels, whereas the study group had Hb levels indicative of IDA. General and systemic examination findings were normal in both groups. Significant differences were observed across all measured parameters, with Hb levels, serum ferritin, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, and red cell distribution width significantly lower in the study group. HbA1c levels were significantly elevated in the study group compared to the control group (5.87 ± 1.25 vs. 4.97 ± 1.59, P &lt; 0.001), supporting the hypothesis that IDA is associated with elevated HbA1c levels in non-diabetic patients. Conclusion: The study’s findings align with previous research indicating that IDA leads to elevated HbA1c levels. The prolonged erythrocyte survival and altered Hb glycation processes in IDA are likely contributors to this elevation. These results emphasize the need to consider anemia status when interpreting HbA1c values to avoid misdiagnosis and inappropriate management of diabetes. Clinicians should ensure comprehensive evaluations, including iron status assessments when encountering unexpectedly high HbA1c levels in non-diabetic individuals.

Effect of Teneligliptin in comparison with Voglibose as an add on therapy in reducing microvascular complications in type II Diabetes Mellitus patients – A Prospective randomized control trial

Background: The strict glycaemic control postpones all the microvascular and macrovascular complications. In type 2 diabetes the initiation of metformin is the cornerstone in reducing blood sugar. The next option is either insulin or oral hypoglycaemic agents. The DPP-4 inhibitors like gliptins have the advantages of less incidence of hypoglycaemia, good safety profile and can be combined to any oral hypoglycaemics. The meta-analysis showed that teneligliptin has less adverse profile in number of Japanese and Korean studies. It was proved that the fasting glucose and postprandial glucose substantially reduced with a potential benefit of reducing cholesterol, thereby reducing the risk of cardiovascular diseases. The advantage of using this drug as is does not worsen the hepatic and renal status. Voglibose an α-glycosidase inhibitors delay the glucose absorption from GIT hence effective in reducing postprandial hyperglycaemia. Methods: This prospective randomized controlled study was designed to compare the efficacy of teneligliptin and voglibose as an add on therapy on patients with uncontrolled blood sugar in addition to metformin 500mg BD and glimepiride 2 mg OD. Totally 80 patients were included between the age groups of 40 to 70 years. Patients were divided into two groups 40 patients each, group A were given teneligliptin and group B patients were given voglibose for a period of 6 months. At the end of 3rd month and 6th month investigations were done for FBS, PPBS and HbA1c.Statisticalmethods: Data were tabulated and results were analysed by using Analysis of Variance. AP value of &lt;0.05 was considered as statistically significant. Results: At the end ofsix months group II showed significant reduction in fasting blood sugar and post-prandial blood sugar level. A significant reduction in FBS, PPBS, HbA1c is seen in both the groups, where teneligliptin has a favourable glucose reduction along with voglibose. Conclusions: Our study concludes that teneligliptin is better than voglibose as the 2nd line add on therapy to sulphonylureas, metformin or insulin.

AUDITORY ACUITY IN DIABETES MELLITUS TYPE II: A CASE–CONTROL STUDY

Objectives: The objective of the study was to analyze the status of auditory acuity in patients with Type II diabetes mellitus (DM) as compared to healthy individuals of comparable age groups using pure tone audiometry. Methods: This was a case–control study in which 80 known cases of DM were enrolled as cases (Group D) and a similar number of age-matched healthy individuals were included as the control group (Group N). Demographic details such as age and gender were compared. A detailed history was taken and a general and systemic examination was done. Pure tone audiometry (250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz, 6000Hz, and 8000 Hertz frequencies) was done in all the patients, and air conduction and bone conduction of both the ears were determined. SSPE 21 software was used for statistical analysis. p&lt;0.05 was considered to be statistically significant. Results: Both groups were found to be comparable in terms of gender and age distribution with no statistically significant difference (p&lt;0.05). Mean fasting and postprandial blood sugar levels as well as HbA1c were found to be higher in Group D as compared to Group N and the difference was highly significant (p&lt;0.0001). In Group D (Diabetic patients), mild, moderate, and severe sensorineural hearing loss (SNHL) at speech frequency was seen in 31 (38.75%) whereas moderate and severe SNHL was seen in 22 (27.50%) and 18 (22.50%) patients. In Group N (Non-diabetic), 5 (6.25%) patients had mild SNHL and moderate and severe hearing loss was not seen in any of the patients. The mean hearing threshold (Both Ears) for bone as well as air conduction was found to be more in Group D as compared to Group N at all frequencies and the difference was statistically significant (p&lt;0.05). Conclusion: Individuals with Type II DM are found to have an increased incidence of subclinical hearing loss. This subtle hearing loss may go undetected for a considerable period of time and hence regular audiometric evaluation is required for early diagnosis of subclinical hearing loss in patients of DM.

Psychosocial and sociodemographic factors associated with gestational blood glucose levels in women attending public hospitals: Results from baseline of MAASTHI cohort.

Understanding psychosocial environment is important for improving maternal and fetal health outcomes during pregnancy. We aimed to identify the association between gestational blood glucose levels and psychosocial and demographic factors in pregnant women. In the MAASTHI pregnancy cohort in Bengaluru, we assessed depressive symptoms, and social support using validated scales at baseline in first trimester. A 2-hour 75 g oral glucose tolerance test (OGTT) was administered between 24-36 weeks of gestation. We examined the relation between psychosocial factors assessed at baseline and gestational blood glucose levels in second/third trimester using multivariate linear regression and explored association between serum cortisol and gestational blood glucose levels in subgroup samples. We found that 9% of pregnant women had depressive symptoms and 14.3% had Gestational Diabetes Mellitus (GDM). Psychosocial factors, including depressive symptoms, have a significant correlation with gestational fasting(β = 0.12, p-value<0.05) and postprandial blood sugar level(β = 0.23, p-value<0.05) and poor social support were found to have a significant association with gestational fasting blood glucose levels(β = 1.45, p-value <0.05) and postprandial blood sugar levels(β = 2.60, p-value <0.05). The sociodemographic factors such as respondent education, occupation, social and economic status were associated with gestational blood sugar after adjusting for potential confounder variables. Depressive symptoms and poor social support earlier in pregnancy were significantly associated with increased gestational blood glucose levels. Early detection and recognition of modifiable psychosocial risk factors can reduce glucose intolerance during pregnancy. Evaluating the benefits of screening for psychosocial factors and timely management of gestational diabetes mellitus can be helpful in India.

Leptin Rs7799039 polymorphism is associated with type 2 diabetes mellitus Egyptian patients

Background Leptin (LEP) is an anti-obesity hormone that regulates food intake, energy expenditure, and glucose metabolism. The genetic variants in LEP and the LEP receptor (LEPR) gene may play an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and obesity. The current study aimed to investigate the association of serum LEP levels, and LEP polymorphisms in LEP (rs7799039, 2548 G/A) with T2DM in Egyptian patients. Methods A total of 205 subjects were included in the present case-control study, consisting of 100 T2DM patients and 105 healthy controls. The anthropometric, psychometric, and biochemical measurements were taken from all the subjects. The genotyping of LEP gene variants was carried out by polymerase chain reaction TaqMan technology. Serum LEP levels were measured by the ELISA technique. Results T2DM patients had significantly elevated levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), international normalisation ratio (INR), creatinine, urea, cholesterol, triglyceride (TG), and low-density lipoproteins (LDL) and significantly decreased high-density lipoprotein (HDL) compared to healthy subjects. serum LEP levels were significantly decreased p (<0.001) as compared to the control group. LEP gene SNP rs7799039 was associated with an increased diabetic risk with A allele being more frequent in T2DM patients than control subjects. The distribution of the AA genotype and GA genotype of LEP SNP rs7799039 was higher in the diabetic group than control one. In addition, AA + GA genotype carriers had significantly elevated HbA1c, FBS, PPBS, TG, and LDL levels and on the contrary, decreased serum LEP levels compared to GG homozygotes. Conclusion The genetic polymorphism rs7799039 showed a highly significant correlation with blood LEP. The co-dominant and dominant models of the LEP genetic polymorphism (rs7799039, 2548 G/A) were shown to have a significant correlation with complicated and uncomplicated diabetes individuals, but we have found that serum LEP levels were inversely related with control and diabetes patients. A positive significant association was found between LEP genetic polymorphism (rs7799039, 2548 G/A) and serum LEP in patients and controls. LEP levels and its rs7799039 genetic variant may play a vital role in increasing T2DM susceptibility.

Efficacy of Polyherbal Formulation (&lt;i&gt;Phalatrikadi Vati&lt;/i&gt;) in the Management of Type 2 Diabetes Mellitus through Metabolic Correction – A Clinical Study

Background: Diabetes mellitus is a prevalent metabolic disorder worldwide; its incidents have grown notably in recent years. Over the last 50 years, lifestyle changes have led to a dramatic increase in the prevalence of type 2 diabetes around the world. India has been projected as the diabetic capital of the world. Diabetes and its complications pose a major threat to future public health resources throughout the world and are the major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation. In the southern part of India, the mortality rate due to diabetes mellitus is in fifth rank amongst the ten vital causes of death. Despite recent advances in knowledge, preventing and controlling diabetes remain a major challenge. So the present study has focused on the disease pathogenesis and its regulation through Polyherbal formulation (Phalatrikadi Vati). Objectives: To determine the efficacy of Polyherbal formulation in reducing the subjective complaints in Type 2 Diabetes Mellitus by metabolic corrections and thereby controlling the blood glucose level in the body. Methods: A single arm open labeled trial with 1 month in duration. Participants: 25 patients of Diabetes Mellitus Type 2 with diagnosed, high fasting blood sugar and postprandial blood sugar levels. 500mg tablet was given in twice a day after food. Results: A total of 30 patients enrolled in the study and 25 patients completed the treatment. Significant relief of 68% in polyuria, 56% in urine turbidity, 84% in polyphagia, and 76% in polydipsia seen. There was a highly significant reduction in FBS with a mean difference of 31.84 mg and PPBS with a mean difference of 63.92 mg. Conclusion: The polyherbal formulation is a safe intervention and can be expected to reduce the symptoms of Type 2 Diabetes Mellitus and blood sugar levels. Future studies with larger sample sizes, longer duration of intervention and follow up needed for more accurate and reliable results.

Lavandula stoechas L. subsp. stoechas, a New Herbal Source for Ursolic Acid: Quantitative Analysis, Purification and Bioactivity Studies.

In this study, methanol, ethanol, dichloromethane:methanol (1:1, v/v), acetone, ethyl acetate, diethyl ether, and chloroform extracts of lavender (Lavandula stoechas L. subsp. stoechas) were prepared by maceration, and the ursolic acid contents in the extracts were determined quantitatively by HPLC analyses. The present results show that the methanol-dichloromethane (1:1, v/v) solvent system is the most efficient solvent system for the extraction of ursolic acid from the plant sample with the highest yield (2.22 g/100g plant sample). In the present study, a new practical method for the isolation of ursolic acid from polar extracts was also demonstrated for the first time. The inhibition effects of the extracts and ursolic acid were also revealed on α-glycosidase, acetylcholinesterase, butyrylcholinesterase, and human carbonic anhydrase I and II enzymes by determining IC50 values for the first time. The extracts and ursolic acid acted as potent antidiabetic agents by strongly inhibiting the α-glycosidase activity, whereas they were found to be very weak neuroprotective agents. In view of the present results, L. stoechas and its major metabolite, ursolic acid, can be recommended as a herbal source to control postprandial blood sugar levels and prevent diabetes by delaying the digestion of starch in food.