Background: Marriage is an integral part of Indian society. In spite of the large number of people with diabetes mellitus (DM) in India, India is not a diabetes-friendly society. This survey ...highlights perceptions of diabetes patient population with regards to marriage, associated diabetes distress, and suggests potential solutions. If Diabetic patients consider them unfit to marry and think that people don’t accept diabetics as a bride or groom and they can’t have a family, it’s a serious issue. There is no survey till date on this topic with surveyed population.
Methods: 68 randomly selected unmarried diabetes patient, males and females, from rural and urban areas of central India were asked to fill a survey questionnaire online. The inclusion criteria were age 18-35, having T1DM or T2DM and no history of mental disorder.
Results: Responses were analyzed and plotted. Most of the respondents (85 %) were not willing to accept a diabetic groom or bride, the acceptability was more in males, in urban dwellers, with higher academic qualification, and parents without diabetes. Most were worried about the complication of the disease. Majority of responders (76 %) think diabetes affect future progeny. (87 %) think they will become burden for their life partner, (T1DM > T2DM).
Conclusion: Misconception regarding social, occupational, marital abilities, fertility, genetics, quality of life in young people living with DM raises major barriers to marriage, People with DM are wrongly assumed to be sick, disabled, dependent persons, unsuitable for marriages, and likely to have complicated pregnancies with the possibility of having children with diabetes. Diabetes distress and psychological issues are major problems related to marriage in young people with DM. Counseling of patients, family, relatives, prospective spouse, and increasing social awareness regarding diabetes through mass communication will serve as the keys to their resolution.
Disclosure
B. Saboo: None. A. Shrivastava: None. B. D. Saboo: None.
The year 2021 will mark 100 years since the discovery of insulin. Insulin, the first medication to be discovered for diabetes, is still the safest and most potent glucose-lowering therapy. The major ...challenge of insulin despite its efficacy has been the occurrence of hypoglycemia, which has resulted in sub-optimal dosages being prescribed in the vast majority of patients. Popular devices used for insulin administration are syringes, pens, and pumps. An artificial pancreas (AP) with a closed-loop delivery system with > 95% time in range is believed to soon become a reality. The development of closed-loop delivery systems has gained momentum with recent advances in continuous glucose monitoring (CGM) and computer algorithms. This review discusses the evolution of syringes, disposable, durable pens and connected pens, needles, tethered and patch insulin pumps, bionic pancreas, alternate controller-enabled infusion (ACE) pumps, and do-it-yourself artificial pancreas systems (DIY-APS).
Measurement of glycated hemoglobin (HbA
) has been the traditional method for assessing glycemic control. However, it does not reflect intra- and interday glycemic excursions that may lead to acute ...events (such as hypoglycemia) or postprandial hyperglycemia, which have been linked to both microvascular and macrovascular complications. Continuous glucose monitoring (CGM), either from real-time use (rtCGM) or intermittently viewed (iCGM), addresses many of the limitations inherent in HbA
testing and self-monitoring of blood glucose. Although both provide the means to move beyond the HbA
measurement as the sole marker of glycemic control, standardized metrics for analyzing CGM data are lacking. Moreover, clear criteria for matching people with diabetes to the most appropriate glucose monitoring methodologies, as well as standardized advice about how best to use the new information they provide, have yet to be established. In February 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address these issues. This article summarizes the ATTD consensus recommendations and represents the current understanding of how CGM results can affect outcomes.
Background: India is predicted to have over 27 million children with obesity, representing over half of the children with obesity in the region and 1 in 10 of all children globally.
Aim: To study ...Obesity prevalence in Adolescents and making timely interventions for healthier lifestyle adoption in urban and rural Ahmedabad.
Methodology: A team of physician, nurse, pediatrician, educator took up the task of collecting data from schools in the rural and urban areas of Ahmedabad and periphery of 50kms during months of March-May 2022 with prior consent from guardians at 4 schools. Data including height, weight, abdominal girth, neck circumference was collected along with survey on food intake, type, exercise and habits. Adolescents of age category 14-18 yrs were included. Menstrual history was taken. Obesity was defined using the National Center for Disease Control definitions. We used the NHANES proposed cutoff of ≥90th percentile of Waist Circumference for identifying central obesity and Neck Circumference ≥ 50th percentile for identifying obesity. BP measurement and acanthosis assessment was also done. We conducted seminars on healthy eating and physical activity for all kids irrespective of their health status.
Results: Total Cohort: 800, 14-18 years with a 1:1 ratio of girls:boys and same in rural and urban areas. There was higher prevalence of overweight in girls compared with boys (16%vs 12%), but the prevalence of obesity is higher in boys than girls (8%vs6%), the prevalence of underweight is slightly higher in boys than girls (21%vs9.5%). Underweight is more prevalent in rural areas vs obesity in urban areas.
Conclusion: Screening adolescents for obesity, and making timely interventions for the prevention of disorders through education and appropriate lifestyle interventions can be one step towards a healthy future of the country. There lies necessity for expanding these screening and education programs through ROOTS ie Recognition, Obesity monitoring, Obesity prevention, Treatment and System based approach.
Disclosure
V.Chavda: None. D.Hasnani: None. S.Hasnani: None. B.Saboo: None. V.Abichandani: None. A.Shrivastava: None. S.Jha: None. B.D.Saboo: None.
Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular exercise and lifestyle measures. Exercise is an important strategy in the management of ...diabetes. Regular exercise is necessary for good Glycaemic control and Metabolic health. Newer methods like WhatsApp-based communication are now finding their way into diabetes care. It can assist to maintain a regular exercise program and reduce blood sugar levels.
Materials and Methods: A total of 262 patients were selected by random sampling. They were of age 15-65 years with DM. Inclusion Criteria: 1. Known case of DM 2. Consent to share data. 3. Ability to use WhatsApp. Exclusion criteria: 1. Inability to use WhatsApp 2. Any condition which impairs movement. Randomly allocated to two groups of 131 persons. The first group participants were added to a WhatsApp group and asked to send their exercise and blood glucose data to the clinic over WhatsApp. The other group was treated as usual. Participants were monitored for HBA1C at 3 and 6 months and surveyed for exercise patterns by a questionnaire at 3 and 6 months. The results were analyzed using SPSS.
Result: After excluding, 2 dropped patients from both groups remaining 258 patient data shows: HBA1C reduction in the WhatsApp group of 1.9% as compared to 1% in the routine care group. The number of patients achieving the target goal of 7% HBA1C in the WhatsApp group (74%) as compared to the routine group (56%) . 77% of patients in the WhatsApp group did regular exercise as compared to 42% in the routine group.
Discussion: With newer modalities, the ways and means to communicate with patients have improved. This has paved way for newer messaging platforms like WhatsApp for better patient-centric communication. These tools if used correctly can reduce in-person follow-ups but increase the connection between caregiver and patients and can result in better patient outcomes and will lead to reduced complications and financial implications.
Disclosure
B.Saboo: None. A.Shrivastava: None. A.Tewari: None. A.V.Inamdar: None. S.Saboo: None. B.D.Saboo: None.
Aim: To study the trend of prevalence of diabetes in different age groups.
Method: We have retrospectively analyzed diabetes patient coming to OPD in term of their age of onset and year of onset of ...diabetes in type 2 diabetes patients from 1st January 2018 to 31st December 2018. There were total 976 patients with type 2 diabetes who visited OPD.
Result: Age distribution of patients with type 2 diabetes attending OPD from 1st January 2018 to 31st December 2018 was as below:
Table: age distribution of patients with type 2 diabetes attending OPD from January 2018 to December 2018.
Conclusion: Average age of onset of type 2 diabetes is still mostly between 35 to 45 years. As the time advances the graph continue to affect more and more younger people in their productive age group which is 35 to 45 years. It not only affects individual’s productivity but also has power to affect any strong economy. There is a strong need to improve our lifestyle and behavior to food and physical activity to fight with this tsunami.
Figure 1. Age Distribution Over the Years for Onset of Type 2 Diabetes.
Figure 2. Average Age of Onset of Type 2 Diabetes.
Disclosure
D. Panchal: None. B.D. Saboo: None. R. Goklani: None.
There is scarce data on the long-term safety and efficacy of IDegAsp in Asian Indians in a real-world (RW) setting. IDegAsp is a co-formulation of an ultra-long-acting insulin Degludec and a rapid ...acting insulin Aspart. A multi-centric, retrospective observational study was conducted to evaluate long-term efficacy and safety of IDegAsp in T2D on regular follow up for >5 years. Baseline clinical data of 535 T2D (78.7% males; avg. age= 53.41 ± 12.yrs; HbA1c= 8.88 ±1.96 %; avg. duration of diabetes: 11.34 ± 7.57yrs) , previously on treatment (90.1 %) which included various OADs±insulin regimen, or treatment-naive (9.9 %) , who were switched to or initiated on IDegAsp respectively, from December 2014 - 2021 were analyzed. Significant improvements (P<0.05) in clinical parameters were observed from baseline (Table 1) . The TDD was 15.45 ± 10.53 units/day (at 3 months) which increased (p<o.oo1) to 20.03 ± 11.units/day post-treatment (67 months) . 65.2 % continued twice daily IDegAsp and 3.9 % switched from twice daily to once daily IDegAsp during treatment. 30.9% continued once daily IDegAsp. A total of non-severe hypoglycemic episodes were observed. In this RW study involving T2D from Asia, IDegAsp significantly improved A1C and a range of clinical profiles, with negligible hypoglycemia. Unlike conventional premix/basal bolus regimen, IDegAsp offers a less complex, more physiological, safe and effective solution for glycemic control.
Disclosure
J.Kesavadev: None. B.D.Saboo: None. A.Shankar: None. G.Krishnan: None. A.Basanth: None. A.Ashik: None. A.David: None. S.Jothydev: None.
Though TIR is a predictive marker of diabetic complications, there is paucity of data evaluating the association of TIR with therapeutic regimens. We investigated the association of CGM-derived ...metrics, with presence of complications and therapeutic regimen in T2D. We analyzed AGP of T2D who underwent 14-day p-CGM between 2015 and 2021. Clinical parameters were extracted from EMR. Data of 1218 T2D (baseline age=53.14±15.03 yrs; 69.2% male, avg. duration of diabetes: 14.44±9.48 yrs) on different therapeutic regimen (OHAs±insulin; namely basal only, biphasic, basal plus, basal bolus regimen) were analyzed. A regression model was run with % TIR as dependent variable and age, duration, insulin regimen, complications, and BMI as independent variables. Spearman’s correlation coefficient was calculated between lab A1C and eA1c. On analysis, age was found to have a statistically significant relation with TIR. A moderate correlation (0.60) between A1C and eA1C was observed. 68.4% achieved a target TIR of >70% in T2D without complications. 69.5% with CAD/CKD achieved target TIR of >50%. Among the different therapeutic regimens analyzed, use of analogue basal-bolus regimen was associated with statistically significant (p<0.05) TIR target of >50% and TBR<1% in T2D with CAD/CKD (Figure 1) . In T2D with vascular complications, analogue basal bolus regimen could be a superior choice in reaching optimal TIR with insignificant time below range.
Disclosure
J.Kesavadev: None. B.D.Saboo: None. A.Shankar: None. G.Krishnan: None. G.Sanal: None. A.Basanth: None. S.Jothydev: None.
An acceleration in the adoption and use of telemedicine (TM) was necessitated by the COVID-19 pandemic. A more nuanced view emerged, including the importance of accommodating patient choice, ...appropriately matching encounter type to visit the platform, acknowledging the hazards associated with care delivered remotely, and adapting existing models of advanced team-based care. We have been practicing TM in diabetes since 1997. Diabetes Tele Management System, DTMS® is a structured diabetes management program integrated with electronic medical records, that enables telecommunication via telephone, email, and internet. To study the pros and cons of TM across a wider group a web-linked survey was conducted among doctors, allied healthcare professionals (aHCPs). The link was sent to doctors, aHCPs across India (Sept 2022-December 2022) via email and WhatsApp. The survey received 654 responses, 65% being doctors and HCPs out of which 89% had not received training prior to engaging in telemedicine consultations. Summary of responses from doctors and HCPs in Table 1. Though the majority of patients may be satisfied with TM, the prevailing practices should be periodically evaluated and upgraded incorporating the feedback from the users. It is essential to understand both pros and cons of TM in the view of doctors and aHCPs, to enable the policymakers to devise policies that enhance the scope of quality patient care.
Disclosure
J.Kesavadev: None. A.Shankar: None. B.D.Saboo: None. 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.Basanth: None. G.Krishnan: None. S.Jothydev: None.
Diabetes technology (DT) has accomplished tremendous progress in the past decades, aiming to convert these technologies as viable treatment options for the benefit of patients with diabetes (PWD). ...Despite the advances, PWD face multiple challenges with the efficient management of type 1 diabetes. Most of the promising and innovative technological developments are not accessible to a larger proportion of PWD. The slow pace of development and commercialization, overpricing, and lack of peer support are few such factors leading to inequitable access to the innovations in DT. Highly motivated and tech-savvy members of the diabetes community have therefore come up with the #WeAreNotWaiting movement and started developing their own do-it-yourself artificial pancreas systems (DIYAPS) integrating continuous glucose monitoring (CGM), insulin pumps, and smartphone technology to run openly shared algorithms to achieve appreciable glycemic control and quality of life (QoL). These systems use tailor-made interventions to achieve automated insulin delivery (AID) and are not commercialized or regulated. Online social network megatrends such as GitHub, CGM in the Cloud, and Twitter have been providing platforms to share these open source technologies and user experiences. Observational studies, anecdotal evidence, and real-world patient stories revealed significant improvements in time in range (TIR), time in hypoglycemia (TIHypo), HbA1c levels, and QoL after the initiation of DIYAPS. But this unregulated do-it-yourself (DIY) approach is perceived with great circumspection by healthcare professionals (HCP), regulatory bodies, and device manufacturers, making users the ultimate risk-bearers. The use of the regularized CGM and insulin pump with unauthorized algorithms makes them off-label and has been a matter of great concern. Besides these, lack of safety data, funding or insurance coverage, ethical, and legal issues are roadblocks to the unanimous acceptance of these systems among patients with type 1 diabetes (T1D). A multi-agency approach is necessary to evaluate the risks, and to delineate the incumbency and liability of clinicians, regulatory bodies, and manufacturers associated with the use of DIYAPS. Understanding the potential of DIYAPS as the need of the present time, many regional and international agencies have come with strategies to appraise its safety as well as to support education and training on its use. Here we provide a comprehensive description of the DIYAPS—including their origin, existing literature, advantages, and disadvantages that can help the industry leaders, clinicians, and PWD to make the best use of these systems.
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