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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 13 | Issue 4
Page Nos. 317-384

Online since Wednesday, December 21, 2022

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REVIEW ARTICLES  

Interpretation of urine routine report of a diabetic patient: A review p. 317
Prabhat Agrawal, Shoorvir Singh, Mudit Khurana, Kanika Agarwal, Nikhil Pursnani, Ashish Gautam
DOI:10.4103/jod.jod_89_22  
Introduction: Diabetic patients are at an increased risk of multiple complications, among which one of the most dreaded complications is diabetic nephropathy. Early diagnosis and appropriate management will at least prolong the life of the kidney and prevent the development of end-stage renal failure. Materials and Methods: Simple urinalysis is a useful tool for early diagnosis of diabetic kidney disease and helps differentiate between diabetic and nondiabetic kidney diseases. In this review, we have discussed the usefulness of urinalysis for a diabetic patient. Results: Early detection of an abnormality can be an alarming sign, and we can diagnose treatable causes of renal failure in diabetic patients. Conclusions: History, examination, and urinalysis are sufficient in most of the cases for diagnosing diabetic kidney disease. Renal biopsy is indicated in special situations where diagnosis cannot be made even after appropriate non-invasive investigations. Few limitations of the study are resource settings and knowledge of this simple test to predict an alarming sign of the kidney disease.
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A systematic review approach in understanding the COVID-19 mechanism in diabetes and its progression to diabetic microvascular complications p. 322
Gyanendra Kumar Sonkar, Sangeeta Singh, Satyendra Kumar Sonkar
DOI:10.4103/jod.jod_87_22  
Introduction: In uncontrolled hyperglycemia, lungs, tongue, oropharyngeal and nasopharyngeal airways having increased glycosylated angiotensin-converting enzyme 2 (ACE2) can serve as good viral binding sites for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to a greater tendency and considerable risk of prolonged life-threatening disease. This review was written with the objective to extract the recent advances, updates, and discoveries about the effects of coronavirus disease-2019 (COVID-19) on patients with diabetes and its microvascular complications. It was further written with the aim to discuss the current state of knowledge that has not yet been confirmed or unconfirmed, leading to various debatable issues about COVID-19-associated with microvascular complications in diabetes mellitus. Materials and Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched scientific sites related to our review article such as Web of Science, Embase, PubMed, Scopus, Google Scholar, and MEDLINE of last nearly two and half years. Results: The individuals who are suffering from type 2 diabetes mellitus experience more organ damage by SARS-Cov-2 due to cytokine storm. The pro-inflammatory state, lower primary immune system response, and increased ACE2 level with dysregulation of vascular function and the prothrombic state in patients with diabetes may increase the vulnerability for COVID-19 and worsened prognosis. The patients have reduced prognosis leading to microvascular complications such as diabetic nephropathy, neuropathy and retinopathy. In diabetes retinopathy, it induces the changes in the vasculature of the retinal veins. These viruses can directly affect the nervous tissue and/or can indirectly via activating the immune system-mediated mechanisms leading to diabetic neuropathy as well. Conclusions and Implications: During the cytokine storm the amount of D-dimer in the serum gets significantly increased, due to increased activating plasmin at the early stage of inflammation. Uncontrolled hyperglycemia leads to diabetic complications leading to increased mortality rate in patients with COVID-19. Thus, diabetes and its associated microvascular complications may lead to the severity and mortality in the patients with COVID-19. More of clinical practice and further studies should be implicated through this review article. Laboratory findings and clinical records are of much help in patients with diabetes and COVID-19. Worldwide studies from different countries apart from China should be considered to reach a conclusion about the conditions of patients with diabetes and microvasculature complications around the world.
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Association of circulatory adiponectin with the parameters of Madras Diabetes Research Foundation-Indian Diabetes Risk Score p. 331
Mohd D Khan, Mohammad K Ahmad, Roshan Alam, Saba Khan, Geeta Jaiswal, Mohammad M Khan
DOI:10.4103/jod.jod_86_22  
Introduction: Adiponectin (APN) is an adipose-derived protein. It has shown a variety of functions such as anti-inflammatory, anti-atherogenic, antidiabetic, and insulin-sensitizing and lipid-oxidation-enhancing activities. The APN levels have shown a significant relationship with the risk factors for type 2 diabetes mellitus (T2DM). As per the Madras Diabetes Research Foundation-Indian Diabetes Risk Score (MDRF-IDRS), Asian Indians have high risk factors for T2DM and its complications. APN levels influence the risk factors for T2DM and its complications. Its circulatory level also varied with the age, family history of T2DM, waist circumference, and level of physical activity. Aim: The purpose of this narrative review is to find the association of circulatory APN with the parameters of MDRS-IDRS. Materials and Methods: Articles were searched by various databases such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar. Abstract, free full-text, and full-text articles were searched from the year 2003 to 2022. For this review, observational study, original articles, narrative review, systematic review, and meta-analysis articles published in the English language were included. It is needed to establish the association between the APN levels and the parameters of MDRF-IDRS. The modifiable risk factors of MDRF-IDRS may play a significant role to regulate the level of APN. The non-modifiable risk factors of MDRF-IDRS may help in the better management of APN levels and reduce the prevalence of T2DM. It is needed to clear that the APN levels influence the disease severities or not. It is also needed to improve the physical activity to regulate the APN level and to reduce the systemic inflammation and insulin resistance in Asian Indian population. Conclusion: Improvement in modifiable risk factors of MDRF-IDRS and level of APN may play a significant role in the therapeutic approach to prevent and/or delay the development of T2DM and its complications.
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ORIGINAL ARTICLES Top

Built environment correlates of diabetes and obesity: Methodology p. 340
Garudam R Aarthi, Rajendra Pradeepa, Viswanathan Mohan, Padma Venkatasubramanian, Ranjit M Anjana
DOI:10.4103/jod.jod_93_22  
Background: A city’s planning, design, and construction can have a profound influence on health, specifically on non-communicable diseases such as diabetes and obesity, which are often referred to as “diabesity.” This study describes the designs and methods to understand the relationship between food and physical activity environments on diabesity. Materials and Methods: This study was a community-based cross-sectional door-to-door survey conducted as part of a large National Institute of Health and Care Research-funded surveillance project. For this study, two wards in Chennai were selected randomly. In each ward, five community enumeration blocks were selected using systematic random sampling technique. A consecutive sampling approach was used to select the study participants. Two categories of data were collected: (1) health data and (2) built environment (BE) data. Health and lifestyle questionnaires, anthropometric, and biochemical data were collected from all the study participants. For categorizing BE, an online questionnaire was developed using the KoBo toolbox to collect information about food and physical activity environments, as well as geographic locations. Expected Outcome: This study is expected to reveal data on the relationship between food and physical activity environments and diabesity. It will help policy-makers to understand the importance of access to healthy foods and spaces for physical activity in prevention and control of diabesity. It can also enable community-based interventions to improve health outcomes and help urban planners to plan cities that promote active lifestyles for its residents.
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Comparison of the efficacy of oral methylcobalamin tablets vs. nasal spray (NASO B12) in diabetic patients on metformin therapy p. 347
Syed Salman Farookh, CR Jayanti, A Geetha
DOI:10.4103/jod.jod_92_22  
Context: Metformin is known to increase in the risk of developing vitamin B12 deficiency. This study aimed to compare the effectiveness of nasal spray of methylcobalamin (NASO B12) and methylcobalamin tablets for treating vitamin B12 deficiency in diabetic patients receiving metformin. Materials and Methods: In this parallel-group, comparative, open-label clinical study, patients (n = 100) were assigned to two groups: nasal spray of methylcobalamin (NASO B12) (methylcobalamin 250 µg/spray), sprayed in each nostril every alternate day for a total of seven doses (Group 1: a total of 3500 µg methylcobalamin per patient) and oral methylcobalamin tablets, a single daily dose of 1500 µg for a total of seven doses (Group 2: a total of 10,500 µg methylcobalamin per patient). The assessment of efficacy was carried out by measuring serum vitamin B12 levels at baseline, day 7, and day 14. Statistical Analysis Used: The analysis used is Student’s unpaired t-test. Results: NASO B12 treatment resulted in vitamin B12 levels of ≥400 pg/mL (recently updated normal levels as per American Academy of Family Physicians) in 86% and 92% of patients, on day 7 and day 14, respectively, whereas no patient attained ≥400 pg/mL with oral therapy. NASO B12 therapy resulted in higher mean vitamin B12 levels of 485.88 and 570.16 pg/mL when compared with 172.26 and 185.44 pg/mL with oral tablets on day 7 and day 14, respectively. Conclusion: NASO B12 provided much superior absorption of vitamin B12 when compared with oral vitamin B12 tablets and can be used as an effective alternative.
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A study of musculoskeletal manifestations of diabetes mellitus and their association with HbA1C among diabetic patients p. 353
Vaibhav S Bellary, Satyanarayana N Shetty, Srinivas O Bellary, Nishkala U Rao
DOI:10.4103/jod.jod_91_22  
Background: The prevalence of diabetes mellitus (DM) is increasing significantly throughout the world. While the vascular complications of diabetes are well recognized and account for the principle mortality and morbidity from the condition, the musculoskeletal manifestations of diabetes are common and not life-threatening, which are an important cause for morbidity, pain, and disability. The most common reported forms of various musculoskeletal manifestations of DM include adhesive capsulitis, hand syndromes such as limited joint mobility syndrome (LJMS), Dupuytren’s contracture (DC), and carpal tunnel syndrome (CTS), flexor tenosynovitis, reflex sympathetic dystrophy, diffuse idiopathic skeletal hyperostosis (DISH), Charcot’s joints, diabetic amyotrophy (DA), and osteoarthritis. Materials and Methods: The study was conducted on a total of 150 patients with type 2 DM for a duration of at least 5 years in Bangalore during the study period from January 2020 to June 2021. The patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. Detailed history was taken and general physical examination was done to determine the musculoskeletal manifestations of DM. The Disability of Arm Shoulder and Hand (DASH) questionnaire was also completed as per the patient’s responses. Laboratory reports were collected, data compiled, and the data were analyzed. Results: Of the 150 cases enrolled, the maximum number of cases belonged to the age group of 36–50 years. About 64% of the diabetic cases were suffering from musculoskeletal disorders (MSDs) (LMJS, CTS, shoulder capsulitis, DC, trigger finger, DISH, DA). Among the MSDs, the highest prevalence was by LJMS (28%). There was a positive correlation among the duration of diabetes, HbA1C, and the DASH score among patients with MSDs in this study and this is statistically significant (P < 0.05). We also see that MSDs are present in 72.7% of the females and 57.1% of the males in the study and this was statistically significant (P = 0.048). Conclusion: MSDs have a high prevalence in diabetic patients. With advancing age and uncontrolled HbA1C levels, the number of MSDs was more as well as the severity as indicated by the DASH score. Early and better glycemic control in diabetic patients can reduce the morbidity associated with MSDs as evidenced by the reduced intensity of DASH score in well-controlled patients.
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Women and diabetes: Risk profiling of young working women using Indian Diabetes Risk Score: A study from Northern India p. 363
Monika Suri, Payal Mahajan
DOI:10.4103/jod.jod_64_22  
Background: Prevalence of undiagnosed diabetes is 53.1% in India as reported by the International Diabetes Federation in 10th Diabetes Atlas 2021. Diabetes is affecting people of all ages and gender. Very high prevalence of abdominal obesity and large percentage of women in Haryana with elevated body mass index (BMI) make it crucial to screen them for type 2 diabetes. Indian Diabetes Risk Score (IDRS) is a proven tool to identify the people at risk of becoming diabetic in future. Early detection and primary prevention are the most effective ways to prevent the rising numbers among women. Objective: This study was conceived to estimate the risk of type 2 diabetes in young working women (25–40 years) using the IDRS tool. Materials and Methods: A descriptive, cross-sectional observational study was followed through with 504 working females in the age bracket 25–40 years. Data were taken down using a structured questionnaire administered through personal interview procedure. Demographics and parameters listed in IDRS such as age, waist circumference, family history of diabetes, and physical activity were itemized in the questionnaire. A purposive random sampling procedure was utilized for getting the numbers. Known cases of diabetes and subjects who refused to sign informed consent were excluded from the survey. Results: About 504 working women completed the survey questionnaire. IDRS scores revealed 18%, 53%, and 29% of the subjects in high-, moderate-, and low-risk brackets, respectively. Waist circumference, sedentary lifestyle, family history, and age were found to be significantly associated with the risk level. Conclusion: The research study brings forward the need for early detection though screening of young women at risk of becoming diabetic in future and necessary steps for primary prevention for the same. It remains imperative to device a comprehensive communication strategy for responsive transitional progression from high risk to absolute healthiness among the young working women.
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Effect of gamma irradiation on shelf life, nutritional, and glycemic properties of three indian brown rice varieties p. 368
Shobana Shanmugam, Jayanthan Mathiyazhagan, Vijayalakshmi Parthasarathy, Raman Ganesh Jeevan, Rajagopal Gayathri, Parkavi Karthikeyan, Priyanka Bakshi, Nagappa Gurusiddappa Malleshi, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Kamala Krishnaswamy, Sahayog N Jamdar, Viswanathan Mohan, Sudha Vasudevan
DOI:10.4103/jod.jod_83_22  
Brown rice (whole grain, BR) has lower glycemic index (GI), is a healthy replacement for white rice (WR). However, BR has a short shelf life, is susceptible to pest infestation. Gamma irradiation is a safe approach to prevent the latter. This study examines effect of gamma irradiation on the physical, cooking, nutritional, shelf life and glycemic properties of three Indian parboiled BR. Parboiled BR of ADT-43, BPT-5204, and Swarna rice varieties were packed in polyester and polypropylene pouches (60 µ thickness) and subjected to gamma irradiation [750–820 Gy] (IR). Appropriate controls without irradiation (NIR) were maintained. Irradiation did not induce major changes in the physical and nutritional properties, except for resistant starch which significantly increased after irradiation in ADT-43 and BPT-5204. Irradiation reduced the cooking time, increased loss of solids in the cooking water and decreased apparent water uptake (particularly in BPT-5204). IR varieties exhibited longer shelf life (8–9 months) compared to 6 months shelf life of NIR varieties. The shelf stability of IR Swarna rice was superior in terms of delayed rancidity development compared to all other rice. All BR samples exhibited the ranking of ‘like moderately’ in the sensory acceptability tests at 6 months of storage and scores decreased subsequently. Irradiation did not affect GI [all showed medium GI, except a high GI for IR BPT 5204] and helped in shelf life extension of parboiled BR by preventing insect infestation.
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CASE REPORT Top

Glycemic treatment effect of oral semaglutide plus other antidiabetic medications: An Indian experience p. 377
Manoj Chawla, Debmalya Sanyal, Supratik C Bhattacharyya
DOI:10.4103/jod.jod_71_22  
A long-acting oral glucagon-like peptide-1 (GLP-1) receptor agonist, semaglutide is a new armamentarium to glycemic treatments. The Peptide Innovation for Early Diabetes Treatment (PIONEER) 3, 4, 5, 6, and 10 provided the necessary evidence on the efficacy of semaglutide in type 2 diabetes. The American Diabetes Association considers GLP-1 receptor agonists and insulin a high glycemic efficacy therapy. Further, a GLP-1 receptor agonist is recommended when there is a need for minimizing weight gain or promoting weight loss. There are no reports or clinical trials on oral semaglutide in Indian subjects with type 2 diabetes. We present seven case reports where semaglutide was initiated with other antidiabetic medications to bring the glycated hemoglobin (HbA1c) under target and promote weight loss. Between 45 days and 60 days of treatment with antidiabetic drugs, including semaglutide, resulted in a 1.5% reduction in HbA1c. A reduction in body weight ranged from 1.7 kg to 10 kg. Large-scale randomized trial in Indian patients is warranted to confirm our findings.
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