The options for pharmacological management of type 2 diabetes mellitus have exploded over the last decade or so. Availability of a variety of new drugs, oral as well as injectable, has made the ...choice of treatment more complex and challenging. Over a decade or so ago, glycemic (glucometabolic) control was the main target of treatment in patients with type 2 diabetes mellitus - usually with metformin, sulfonylureas (SU), thiazolidinediones, and insulin (the traditional quartet). There is conflicting evidence on the cardiovascular (CV) effects of the traditional quartet of drugs. The almost serendipitous benefit of sodium-glucose transporter 2 (SGLT2) inhibitors on CVD and kidney disease in patients with type 2 diabetes mellitus has revolutionized the way we view the treatment of diabetes. . What the physician needs to remember when prescribing this drug is - right patient and right intent.
Diabetes remission is a concept that is marked by ample attention, but lack of unanimity. This opinion piece explores existing definitions of diabetes remission and proposes a contemporary and ...comprehensive framework to help define this clinical state. Type 2 diabetes remission is defined as a healthy clinical state characterized by achievement of HBA1c below the targeted level, maintained for at least 6 months, with or without continued use of lifestyle modification and/or metformin, provided that this is not due to complications, comorbid conditions or concomitant therapy.
Diabetes Remission: Infographic
Rising prevalence of thyroid disorders Lathia, Tejal
Journal of Mahatma Gandhi Institute of Medical Science/Journal of Mahatma Gandhi Institute of Medical Sciences,
07/2015, Letnik:
20, Številka:
2
Journal Article
Sodium glucose cotransporter-2 inhibitors (SGLT2i) have been evaluated in children with type 2 diabetes mellitus (T2DM), type 1 diabetes mellitus (T1DM), and several other nondiabetic conditions. ...Potential tolerability issues have prevented the routine use of SGLT2i in children with diabetes. However, no meta-analysis to date has evaluated the safety and tolerability of SGLT2i in children. This systematic review and meta-analysis aimed to address this knowledge gap.
Databases were searched for randomized controlled trials (RCTs), case control, and cohort studies involving children receiving SGLT2i in the intervention-arm. Primary outcome was occurrence of treatment emergent adverse events (TAEs). Secondary outcomes were evaluation of glycemic efficacy and occurrence of severe adverse events (SAEs), hypoglycemia, ketosis, genital or urinary infections, and any other adverse events.
From the 27 articles initially screened, data from 4 RCTs (258 children) were analyzed. In children with T2DM, occurrence of TAEs (odds ratio OR, 1.77; 95% confidence interval CI, 0.93-3.36; P=0.08; I2=0%), SAEs (OR, 0.45; 95% CI, 0.08-2.54; P=0.37; I2=0%), ketoacidosis (OR, 0.33; 95% CI, 0.01-8.37; P=0.50), urinary tract infections (OR, 2.34; 95% CI, 0.44-12.50; P=0.32; I2=0%), and severe hypoglycemia (OR, 4.47; 95% CI, 0.21-96.40; P=0.34) were comparable among the SGLTi group and placebo. Compared to placebo, T2DM children receiving SGLTi had significantly lower glycosylated hemoglobin at 24-26 weeks (mean difference MD, -0.79%; 95% CI, -1.33 to -0.26; P=0.004; I2=0%). In T1DM children, β-hydroxybutyrate levels were significantly higher in the SGLTi group than the placebo group (MD, 0.11 mmol/L; 95% CI, 0.05-0.17; P=0.0005; I2=53%). In T1DM, there was not a single report of an SAE, ketoacidosis, or severe hypoglycemia in either the placebo or treatment groups, but time-in-range was considerably greater in the SGLT2i group than the placebo group (68%±6% vs. 50%±13%, P<0.001).
SGLT2i use in children and young adults appears to be both safe and tolerable based on our meta-analyses and review of the literature.
Background and purpose The lockdowns and restrictions enforced periodically during the COVID-19 pandemic posed a serious challenge for non-COVID care, especially in diabetes where telediabetes, the ...utilization of telemedicine consultations for diabetic care, became more necessary than ever before. Although studies have shed light on the perception of patients, there is a paucity of studies from the perspective of healthcare providers, especially in an Indian context. Moving forward, it is imperative to understand the perspectives of telediabetes providers in this domain. Hence, a nationwide survey was carried out to assess providers' practices and perspectives towards using telemedicine for providing diabetes care in India during the COVID-19 pandemic and beyond. Methods An online questionnaire-based, cross-sectional study was carried out involving diabetes care physicians. The study tool was developed after the identification of broad themes and constructs from published literature, national guidelines, and diabetes experts' recommendations, following which, it was validated by six experts and pilot-tested. An online open survey, hosted on a professional platform, was circulated to internists, endocrinologists, and other diabetes care physicians of various institutions, hospitals, and clinics from both public and private sectors across the country through individual and group emails and various mobile messenger services. Results Out of the 239 doctors who responded to the survey, 195 (81.6%) had provided telediabetes services since the COVID-19 outbreak, and 84.1% were actively providing teleconsultations for diabetes at the time of the survey. The majority of participants (63.2%) were private practitioners. Telediabetes engagement was 3.5 hours per day at the peak of the pandemic and reduced significantly to one hour after the end of the pandemic. Video calling was the most preferred modality for consultation, whereas messaging services were preferred for input from the patients. Printed prescription images followed by text messages were the common modalities for sending treatment advice. The overall perception towards telediabetes was positive (50.1%). Most physicians reported being reasonably and somewhat aware (65.6% and 20.5%, respectively) of telemedicine practice guidelines but were not sure about the extent of compliance. Conclusions Our study sheds light not only on the utilization of telediabetes from physicians' perspectives and practices but also on its acceptability while identifying areas requiring clarity and focus moving forward.
Hyperglycemia is a common complication in critically ill patients. It is associated with an increased length of hospital stay, infection, and mortality rate. Hence, management of hyperglycemia in ...critical care settings is important. A literature search from inception till July 2019 using relevant keywords (hyperglycemia and critical illness) was performed with Medline (PubMed), and all the pertinent articles were selected to extract the literature describing the management of hyperglycemia in critically ill patients. Extensive evidence is available, which conclusively demonstrates that hyperglycemia is a marker of severity of illness in critically ill patients. Studies support the use of intensive insulin therapy in critically ill patients both with and without diabetes mellitus (DM). Glycemic variability and hypoglycemia contribute to the worsening condition. Hence, it is important to use the tools that monitor glycemic variability and hypoglycemia in critical care setting. In addition, consideration should be given for an insulin therapy, which lowers the glycemic variability and avoids hypoglycemia. While using insulins, nutrition plays an important role. Evidence supports the use of enteral nutrition over parenteral nutrition due to the low risk of infections and mortality. A transition from intravenous to subcutaneous (SC) insulin is required in certain patients for whom SC basal-bolus insulin therapy is preferred over a sliding-scale insulin regimen. Appropriate glycemic target and determining glycemic threshold for initiating insulin therapy are essential for the management of hyperglycemia in critically ill patients. Moreover, continuous blood glucose monitoring and appropriate medical nutrition therapy improve the patient outcomes.
Background
Lifestyle modification is an integral aspect for the management of type 2 diabetes (T2D). However, it is difficult to ensure the accuracy of personalized lifestyle advice. The study aims ...to analyse the real-world effectiveness of personalized glycemic response based Diabefly-Pro digital therapeutics for better glycemic control.
Methods
Data from continuous glucose monitoring (CGM) of 64 participants with T2D was analysed. All participants were provided with modified lifestyle plan based on their personalized glycemic response. The CGM data was analysed for a period of 7 days, before and after the introduction of modified lifestyle plan. Primary outcome of the study was change in time in range (TIR). Secondary outcomes of the study were change in mean blood glucose, time above range (TAR), time below range (TBR) and glucose management indicator (GMI).
Results
Significant improvement in glycemic control was observed after the introduction of personalized lifestyle plan. Median reduction in mean blood glucose was from 139.5 (118.3 to 169.3) mg/dL to 122.0 (101.5 to 148.8) mg/dL (
p
< 0.0001). TIR and GMI improved from 70.50 (50.75 to 83.50) % to 75.00 (58.25 to 89.00) % (
p
= 0.0001) and 6.64 (6.13 to 7.35) % to 6.23 (5.74 to 6.86) % (
p
< 0.0001) respectively. TAR reduced significantly from 17.00 (4.25 to 38.0) % to 6.00 (1.25 to 26.0) % (
p
< 0.0001). No significant increase in TBR was observed (
p
= 0.198).
Conclusion
Personalized glycemic response-based Diabefly-Pro digital therapeutics program was effective in achieving better glycemic control in people with T2D.
With increasing evidence of emotional well-being disorders associated with polycystic ovary syndrome (PCOS), effective screening processes are of utmost importance. We studied the impact of using ...questionnaires to screen for emotional and psychosexual well-being across different models of care for PCOS. We analysed the data from the surveys to assess the difference in the prevalence of emotional and psychosexual ill-being across ethnicity and region. In this prospective cohort study, we invited all women attending consultations for PCOS in Birmingham, UK, and Bengaluru and Navi Mumbai, India. Those who consented to participate in the study were invited to complete a pre-clinic survey about socio-demographic data, Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), Beliefs about Obese Person scale (BAOP), and Female Sexual Function Index score (FSFI) and a post-clinic survey on clinic experience, lifestyle advice, and specialist referral. A total of 115 women were included in this study. The rate of questionnaire completion was 98.3% (113/115), 97.4% (112/115), 93.04% (107/115), and 84.3% (97/115) for HADS, BICI, BAOP, and FSFI, respectively. In the post-clinic survey, 28.8% reported they were screened for anxiety, 27.1% for depression, and 45.8% for body image concerns. The prevalence of anxiety, depression, and body dysmorphic disorder through pre-clinic survey was 56.5% (50.0% UK vs 59.5% India, P = 0.483), 16.5% (13.9% UK vs 17.7% India, P = 0.529), and 29.6% (36.1% UK vs 26.6% India, P = 0.208), respectively. Surveys with validated questionnaires can improve screening for emotional and psychosexual well-being associated with PCOS which may be missed by ad hoc screening during consultations.
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