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   Table of Contents - Current issue
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July-September 2021
Volume 12 | Issue 3
Page Nos. 239-382

Online since Thursday, September 30, 2021

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REVIEW ARTICLES  

IMPACT India: A novel approach for optimum diabetes care p. 239
Ashok K Das, Viswanathan Mohan, Shashank Joshi, Siddharth Shah, Abdul Hamid Zargar, Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Ajay Kumar, Ambrish Mithal, Nikhil Tandon
DOI:10.4103/JOD.JOD_100_20  
India has the second largest population with diabetes mellitus in the world. Long-term, uncontrolled diabetes is associated with increased microvascular and macrovascular (commonly cardiovascular) complications and death. The large burden of uncontrolled diabetes in India could be because of lack of treatment adherence, limited access to laboratory testing, lack of physical activity, and poor dietary habits. This creates a compelling need for a greater involvement of healthcare professionals (HCPs) in improving societal awareness and regular monitoring of glycemic control, which is limited in patient outreach programs. IMPACT India, launched in November 2018, is a diabetes control program with a three-pronged approach aimed at creating an impact at the level of HCPs, society, and individuals living with diabetes. The India Diabetes Care Index (iDCI®), a quarterly aggregate index of glycated hemoglobin, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG), forms the backbone of IMPACT India. The program uses iDCI® to evaluate glycemic control at periodic intervals, sensitize HCPs about the glycemic control status, and optimize diabetes care by escalating pharmacotherapy including insulin whenever required. Societal awareness will be created by social media to achieve actionable awareness based on the iDCI® reports. At baseline (January 2018 to June 2018), the database (2.39 million) revealed an average glycated hemoglobin of 8.56%, FPG of 172 mg/dL, and PPG of 253 mg/dL. Also, 74% of the patients had HbA1c >7% and FPG >130 mg/dL and >83% of the patients had PPG >160 mg/dL. The IMPACT India program aims to positively impact diabetes care in India by achieving at least 1% glycated hemoglobin reduction in 1000 days.
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High-fructose corn syrup effects on metabolic parameters and malignancy p. 246
Yasin Simsek, Ulaş Serkan Topaloğlu, Oguzhan Sitki Dizdar
DOI:10.4103/JOD.JOD_49_20  
In the last century, eating habits have changed. Refined, unnatural, including high-carbohydrate and high-calorie, which have many chemical additives foods, are becoming our dietary habits. High-fructose corn syrup (HFCS) is one of the most commonly used new generation foods, which is produced by enzymatic hydrolysis of corn starch. It is increasingly used more frequently because it is cost-effective and gives a more sugary taste than sucrose. There are many doubts about the effects of HFCS on human health, especially obesity, diabetes mellitus, metabolic syndrome, nonalcoholic fatty-liver disease, and malignancy. This review will specifically explore the links between increased dietary fructose consumption and development of these diseases.
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Impact of COVID-19 on noncommunicable diseases (NCDs) p. 252
Manoj Arajanbhai Suva, Viraj Ramesh Suvarna, Viswanathan Mohan
DOI:10.4103/JOD.JOD_75_20  
Since December 2019, a novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemic has affected more than 18.6 million people worldwide. Male gender, older age, obesity, and comorbid noncommunicable diseases (NCDs) like diabetes, hypertension, cardiovascular disease (CVD), chronic respiration illnesses, and cancer have higher risk and fatal outcome of COVID-19. India has a huge burden of NCDs and their associated risk factors which could act in harmony with COVID-19 to produce severe and fatal outcome. Till date the specific treatment options for COVID-19 are elusive and as NCDs are reported as the main causative risk factors for COVID-19 which can worsen the outcome, the focus should be made on continuing and improving the healthcare facilities related to the prevention, management, and control of NCDs. The management of NCDs in the context of SARS-CoV-2 infection are quite challenging. The restrictive measures imposed by governments all over the world such as complete or partial lockdown, travel restrictions, and physical distancing to contain the spread of SARS-CoV-2 infection have affected the people with NCDs by limiting their access to healthcare facilities, physical activity access to healthy food, and even to medicines and essential supplies. These factors increase the risk of developing obesity, diabetes, and CVDs. This article reviews the burden of NCDs in India, the cross-connection between NCDs and COVID-19, disruptions of healthcare services for NCDs, and proposes research priorities during COVID-19 for effective management and control of NCDs.
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Mechanism of physical activity in the prevention and management of type 2 diabetes mellitus: A short review p. 257
Jintu Kurian, Ramesh Mavathur Nanjundaih, Guru Deo
DOI:10.4103/JOD.JOD_68_20  
Background: Pre-diabetes (PDM) is a state with impaired glucose tolerance and/or impaired fasting glucose where people are at risk for diabetes. In less than 3 years, PDM gets converted to diabetes. Physical activity (PA) is a boon to PDM and diabetes to gain control over the glycemic variability and insulin secretion, reduction in cardiometabolic risk, and improvement in overall health. Increasing PA helps delay or prevent the conversion of PDM to diabetes mellitus (DM), as well as helps prevent complications of diabetes effectively. Materials and Methods: The aim of the review was to understand the mechanism by which PA can help to prevent and manage DM. Research papers, manuscripts, and review papers on PA and its mechanism of action on prevention and management of diabetes were searched and relevant contents were studied. One hundred and twelve papers were chosen from online sources like Google Scholar, Scopus, PubMed, Sci-Hub, and Library Genesis. Fifty-seven articles were shortlisted and out of them 54 included in this mini-review comprising of meta-analysis, systematic review, and randomized control trials. Fifty-seven articles were excluded due to irrelevant content in the contexts of diabetes and its mechanism. Result: The review resulted in getting a better understanding of the possible mechanisms by which PA works in prevention and management of DM and delaying the onset of diabetes in PDM. In addition to that, the highest known risk factors for diabetes in this current scenario are understood as physical inactivity among youngsters, along with low nutrition high-quality diet, stress, low-quality sleep, and associated fat and glucose metabolism. Conclusion: During pandemics like coronavirus disease 2019 (COVID-19), physically being active also has its role in reducing resistance power and metabolism of fat and glucose, thereby increasing the risk for diabetes. It is always better to keep oneself with some exercise daily to maintain surface immunity high and strong to avoid diseases. This is possible by modification of lifestyle with yoga, exercises, and proper diet. Periodic incorporation of indoor–outdoor activities aiming at cutting short period of inactivity will help prevent and manage diabetes and other metabolic endocrine disorders to a large extent.
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Role of wireless motility capsule in diagnosing diabetic gut autonomic neuropathy: A narrative review p. 263
Ravi Kant, Poonam Yadav
DOI:10.4103/JOD.JOD_97_20  
Gastroparesis is known as delayed gastric emptying in the absence of mechanical obstruction, typical symptoms being nausea, vomiting, bloating, early satiety, and upper abdominal pain. Gastroparesis is much prevalent in type 2 diabetes mellitus patients. Currently, methods used for the assessment of gastrointestinal (GI) motility involve radiation and invasiveness and are mostly limited to regional assessment, with a lengthy hospital stay, and most of the tests are even not standardized. Gastric emptying scintigraphy (GES) using a radiolabeled meal is the gold standard diagnostic test used to detect and quantify gastroparesis. The advantages of this test are physiological, economical, and non-invasive characteristics. However, lack of standardization poses radiation exposure. As diabetic patients already suffer from diabetic complications and comorbidities, availability of diagnostic tests by offering a non-radioactive, standardized, and ambulatory investigation may be a better alternative to GES to prevent unnecessary radiation exposure. This review summarizes the role of wireless motility capsule (WMC) in diagnosing gut diabetic autonomic neuropathy. The WMC is a novel technology that allows the physician to measure GI motility in a convenient, ambulatory, relatively non-invasive way, without exposing the patient to radiation. The WMC also established its diagnostic utility to assess diabetic gastroparesis in many multicentric studies; although it has some contraindications and limitations, it is the best available novel technology for diagnosing gut diabetic autonomic neuropathy.
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Type 2 diabetes mellitus in Saudi Arabia: A review of the current situation p. 270
Muhammad Saad Tanveer, Muhammad Hassan Tanveer, Mamoona Javed
DOI:10.4103/JOD.JOD_92_20  
Objectives: To review the effectiveness of current clinical interventions and integrated care program, and the cost-effectiveness of currently available pharmaceutical interventions in the management of Type 2 Diabetes Mellitus in Saudi Arabia. Data Sources and Methods: A systematic search of MEDLINE, EMBASE, ScienceDirect, CENTRAL, and Google Scholar was conducted to identify the relevant articles. A detailed inclusion–exclusion criterion was developed and implemented to screen the abstracts and full-texts. We extracted study data from eligible studies into a data extraction form and categorized into various themes to answer our research question. Study Selection and Themes: Seventeen studies categorized into three themes were included in this review. The evidence was compiled to report the effectiveness of current clinical interventions, integrated care program, and cost-effectiveness of pharmaceutical interventions. Conclusions: There is strong evidence of safety and efficacy of BIAsp 30 in T2DM patients. In addition, BIAsp 30 with or without OADs is more cost-effective compared with other pharmaceutical interventions. The integrated care program is more effective in reducing HbA1c in diabetic patients compared with usual care programs; however, the evidence is small and more studies are required. Recommendations: Most of the available studies are small cross-sectional studies. There is a dire need to conduct extensive and high-quality studies, with the sample size representative of Saudi T2DM populations, to generate larger data with high-quality evidence to provide more robust evidence in the future.
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Understanding glycemic variability: Focus on diabetic kidney disease p. 275
Vedavati Bharat Purandare, Charan Bale, Arjun Kakrani, Ambika Gopalakrishnan Unnikrishnan
DOI:10.4103/JOD.JOD_3_21  
Purpose of Review: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease globally. Hyperglycemia, hypertension, and family history are the traditional risk factors for the initiation and progression of DKD. Glycemic variability (GV) has also been considered as a risk factor for diabetes complications. Studies have already shown that GV increases the risk of macrovascular complications. The purpose of this review is to study the association of GV with DKD. Journal articles related to this topic were reviewed to get the data for this article. Summary In the setting of DKD, a higher GV has been observed. However, evidence to suggest GV as a risk factor for the development and progression of DKD is not sufficient. The data seem to suggest that the link between GV and diabetic microvascular complications has remained a hypothetical one, yet to be proven or disproven by appropriate studies. Randomized controlled trials using continuous glucose monitoring data will clarify the impact of GV and its management in DKD.
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REVIEW ARTICLE Top

Systematic review and scientific rating of commercial apps available in India for diabetes prevention p. 285
Harish Ranjani, Sharma Nitika, Raveendran Hariharan, Harikrishnan Charumeena, Nick Oliver, Rajendra Pradeepa, John Campbell Chambers, Ranjit Unnikrishnan, Viswanathan Mohan, Parizad E Avari, Ranjit Mohan Anjana
DOI:10.4103/JOD.JOD_68_21  
Objectives: We aimed to evaluate the quality of currently available health apps for prevention of type 2 diabetes among Asian Indians using validated rating scales. Materials and Methods: Using the keywords, “diabetes prevention,” “healthy lifestyle,” and “fitness,” a total of 1486 apps available in India via Google Play were assessed for eligibility by two independent reviewers. After initial screening using specific inclusion and exclusion criteria, 50 apps underwent a pre-specified rating based on user reviews, number of downloads, and app size. Sixteen apps that scored ≥ 9 were shortlisted for further review using the Mobile App Rating Scale (MARS). The mean MARS scores (for categories I and II) were used to identify the top ranked apps. Results: The mean score for Category I of MARS rating was highest for “Google Fit: Health and Activity Tracking” (4.55/5). This was followed by “Healthifyme—Diet Plan, Health, and Weight Loss” (4.45/5). For Category II of MARS, “Diabetes M,” “Google Fit: Health and Activity Tracking,” “Calorie Counter—My Fitness Pal,” and “Healthifyme—Diet Plan, Health, and Weight Loss” all scored equally well. On comparing the advantages and disadvantages of each of these applications, “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” again ranked the best. Conclusion: Our review identifies two commercially available apps “Google Fit: Health and Activity Tracking” and “Healthifyme—Diet Plan, Health, and Weight Loss” as being user friendly and good quality. Although encouraging, further research is needed to evaluate the efficacy of these apps for the prevention of diabetes.
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ORIGINAL ARTICLES Top

Diabetes and its complications; Knowledge, attitude, and practices (KAP) and their determinants in Pakistani people with type 2 diabetes p. 293
Nazish Waris, Anum Butt, Saima Askari, Asher Fawwad, Abdul Basit
DOI:10.4103/JOD.JOD_79_20  
Objective: To assess the knowledge, attitude, and practices (KAP) regarding diabetes and its associated complications in people with type 2 diabetes. Materials and Methods: This prospective observational study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi, Pakistan. The duration of the study was from January 2019 to June 2019. Ethical approval was obtained from the Institutional Review Board (IRB) of BIDE. People with type 2 diabetes aged older than 25 years, with more than two years’ duration of diabetes were included. A self-structured questionnaire was designed to assess KAP. Results: The mean age of the study participants was 53.14±11.62 years, and the mean duration of diabetes was 10.76±7.65 years. Knowledge and attitude showed higher mean percentage scores of 85.5% and 88.6% as compared with a practice score of 40.7%, which revealed good knowledge and attitude of the participants and poor practice. Education showed a significant association with knowledge and attitude, triglyceride level toward knowledge, LDL-C level toward practice, and HDL-C level toward knowledge and practice. Conclusion: A good knowledge and attitude score of the participants toward diabetes but a poor practice score was found. Individualized programs as well as group education programs still needed to be planned to enable better prevention and management techniques in diabetes. Behavioral therapy and counseling should be considered as a priority in subjects with low practice.
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Knowledge on diabetes and its determinants among type 2 diabetic subjects in a low-resource setting: A cross-sectional study in a tertiary care hospital in Bangladesh p. 299
Mohammad Wahiduzzaman, Sharmin Hossain, Sahidul Md Islam, Friederike Banning, Liaquat Ali, Andres Lechner
DOI:10.4103/JOD.JOD_87_20  
Background: Knowledge about diabetes is the cornerstone of self-management, which is crucial for diabetes care. Improving patients’ knowledge and self-management toward their condition can achieve better control, delay complications, and improve their quality of life. However, there are great variations in the level of knowledge from population to population and this needs to be explored in different ethnic and sociocultural groups for designing appropriate preventive strategies. Due to lack of adequate studies in Bangladesh, this study aimed at assessing diabetes-related knowledge, its determinants and examined which subgroups of patients have the largest knowledge deficits. Materials and Methods: This cross-sectional study was carried out among 504 study participants with type 2 diabetes in the outpatient clinic of the Bangladesh Institute of Health Sciences (BIHS) hospital, a tertiary care center in Dhaka, Bangladesh. Sociodemographic information, anthropometric knowledge about diabetes were collected by semistructured, interviewer-administered questionnaires by the face-to-face interview technique. Respondents who achieved a 50% or higher score from a 16-item diabetic knowledge assessment questionnaire were considered to have good knowledge and their counterparts were considered as possessing poor knowledge about diabetes. Descriptive statistics was used to estimate the prevalence of knowledge. A univariate and multivariate logistic regression was carried out to identify significant factors associated with diabetic knowledge. Results: The participants’ mean age (±SD) was 52 ± 11years; among them, 57.3% were women, 17.1% were illiterate, and 31.5% belonged to a lower-income family. About one-third of them (29.2%) had good knowledge, and male participants were more educated and had higher diabetes knowledge compared with their counterparts. In particular, gender, education, occupation, monthly family income, and duration of diabetes showed a significant correlation with overall knowledge. On multivariate regression, age, education, duration of diabetes, and family members correlated independently with knowledge. Conclusions: On the basis of the current study, it is suggested that about two-third of the patients attending a tertiary care hospital had poor knowledge about diabetes. These results highlight the need for a coordinated educational program with a prioritized focus on older, newly diagnosed, and less educated groups, which reinforces the necessity for patient education.
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The extent of use of SGLT2 inhibitors in patients with type 2 diabetes in clinical practice: A study from India p. 305
Rutul Gokalani, Dharmendra Panchal, Banshi Saboo, Padmanabh Zinzuwadia, Dishank Patel, Rupam Chaudhury, Vipul Chavda, Sanjeev Phatak, Renuka Prasad, SS Dariya, Arun Shnakar, Ajay Prajapati, Dipak Chudasama, Nitesh Patel
DOI:10.4103/JOD.JOD_81_20  
Background and Aim: The cost of diabetes complication management is always much higher than the cost of diabetes treatment, even with novel and expensive molecules available. Thus, it is better to halt complications in the initial phase of the disease, rather than just treating hyperglycemia. Sodium-glucose co-transporter-2 inhibitor (SGLT-2i) is marking a new era in the management of type 2 diabetes mellitus (T2DM), showing significant benefits for mortality, hospitalization due to heart failure, and renal complications. The usage of SGLT2 inhibitors in clinical practice is still low. The aim of our study to know the prevalence and reasons for not prescribing SGLT-2i among Indian diabetologists. Materials and Methods: A cross-sectional survey was conducted in 10 states of India from 15 March to 31 July 2019. The primary question was asked to a doctor for the next 20 new patients at the clinic, “Was the patient initiated with SGLT-2i treatment?” If it was “Yes” the patient was excluded and if the marked option was “No” then the reason was selected for not prescribing the drug. Results: Out of 1132 patients, 687 (60.69%) patients were not prescribed SGLT2 inhibitors. Among them, the main reason for not prescribing SGLT-2i was cost (41.45%), followed by catabolic state (19.62%). Conclusion: It was found that cost is the major reason for not prescribing SGLT2 inhibitors. In spite of promising glycemic and extra glycemic benefits, it is the need of an hour to increase awareness and abetting physicians to prescribe SGLT-2 inhibitors in all appropriate patients at early stage of the disease to prevent the complications and its higher expenditure at the later stage of the disease.
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Knowledge, practice, and barriers regarding self-monitoring of blood glucose among patients with type 2 diabetes mellitus in Enugu State, Nigeria p. 310
Chigozie Gloria Anene-Okeke, Adaobi Uchenna Mosanya, Ogonna Osakwe
DOI:10.4103/JOD.JOD_99_20  
Aims: Self-monitoring of blood glucose can improve treatment adherence and clinical outcomes. The aim of this study is to assess knowledge, practice, and barriers to self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes mellitus (T2DM) in Enugu State, Nigeria. Settings and Design: This study was a cross-sectional survey of 340 patients with type 2 diabetes at the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (Park Lane) in August 2017. Materials and Methods: The data collection tool was a 26-item, four-sectioned questionnaire: the socio-demographic and clinical characteristics, 11 items on knowledge, seven on practice, and eight on barriers regarding SMBG. The questionnaires were self-administered. Statistical Analysis Used: Data were analyzed using SPSS version 20. Descriptive, χ2, Spearman’s correlation, and logistics regression statistics were reported at P < 0.05. Results: Majority of the patients were 46–55 years old (27.9%). Female respondents were 53.5%. Patients with good knowledge and practice were 35.9% and 46.2%, respectively. Knowledge of SMBG was negatively correlated to barrier against SMBG (r = ‒0.178, P=0.001) and positively correlated with practice of SMBG (r = 0.138, P=0.011). Those who were not taught SMBG were less likely to have good practice of SMBG than those who were taught (adjusted odd ratio 0.122, 95% confidence interval: 0.044–0.338). Conclusions: Patients with T2DM in Enugu State have poor knowledge and practice SMBG.
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Prevalence of polycystic ovarian syndrome among adolescents and young women in India p. 319
Thaharullah Shah Mehreen, Harish Ranjani, Rajan Kamalesh, Uma Ram, Ranjit Mohan Anjana, Viswanathan Mohan
DOI:10.4103/JOD.JOD_105_20  
Background: There is little epidemiological data from India on the prevalence of polycystic ovarian syndrome (PCOS). The objectives of the present study were to estimate the prevalence of PCOS using different criteria among adolescents and young women and to evaluate risk factors associated with PCOS. Materials and Methods: A total of 518 participants, adolescents (12–17 years, n = 246) and young women (18–30 years, n = 272), were recruited. Participants who were overweight and having menstrual disorders or biochemical abnormalities were invited for ultrasonographic examination. A standardized questionnaire assessed the regularity of menstrual cycles, body hair growth, skin, body weight, sleep, and androgen excess. The ovarian volume and follicular size were assessed transabdominally. Prevalence of PCOS was assessed by the Rotterdam, AE-PCOS, and NIH criteria. Results: The mean age of participants with PCOS was 19.7±4.2 years and those without PCOS was 18.4±4.2 years. Mean body weight, body fat %, body mass index, waist circumference, systolic and diastolic blood pressures, and fasting insulin were significantly higher in the PCOS group. Prevalence of polycystic ovaries on ultrasonography was observed in 78.6% of the women with PCOS as against 5% in women without PCOS. Obesity (odds ratio (OR): 3.09, 95% confidence interval (CI): 1.32–7.21), insulin resistance (OR: 2.12, 95% CI: 1.12–4.0), and hypertension (OR: 4.46, 95% CI: 1.52–13.06) were significantly associated with PCOS (P < 0.05). The overall prevalence of PCOS was highest with 8.1% according to the Rotterdam criteria followed by AE-PCOS (2.9%) and NIH (2.1%). Irrespective of the criterion used, the prevalence increased with age. Conclusion: There is a high prevalence of PCOS in urban India, which emphasizes the need for urgent preventive and control measures. Early diagnosis is therefore crucial in incorporating lifestyle and dietary modifications for weight reduction and better control of blood pressure at a younger age to further prevent long-term reproductive and metabolic disorders.
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A community-based cross-sectional study on self-care and its role in the management of diabetes among patients with type 2 diabetes mellitus p. 326
Dinesh Peraje Vasu, Annarao Gunderao Kulkarni, Namratha Kurunji Gangadhar
DOI:10.4103/JOD.JOD_13_21  
Introduction: Type 2 diabetes mellitus is one of the most common non-communicable diseases in India. Self-care practices in diabetes are essential for the control of the disease and improvement of quality of life. The objective of this study was to assess the proportion of study subjects practicing self-care practices and to study their influence on glycemic control. Materials and Methods: This is a community-based cross-sectional study on 400 diabetic patients selected by probability proportionate to sample size to assess the self-care practices with the help of a semistructured questionnaire after obtaining institutional ethical clearance. Results: Majority of the study population were males (62.75%) and belonged to the age group of 40–60 years (60.25%). About 51% of the respondents were diabetic for less than 6 years; 24% and 16% followed a healthful eating plan and exercised regularly, respectively. About 46% were regular in taking medications and 71% checked their blood sugars regularly. Only 0.5% checked their foot and inside of their foot wear regularly. Conclusion: Self-care practices were found to be unsatisfactory in most of the domains that were studied. As these practices are essential for the prevention of complications and to provide a better quality of life, more efforts are needed to educate the people about self-care practices.
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Association of high-density lipoprotein cholesterol subfractions with insulin resistance in Nigerians with type 2 diabetes mellitus p. 331
Chikezie Hart Onwukwe, Nkiru Ifeoma Chikezie, Kalu Okorie, Paul Osemeke Nwani, Augustine Efedaye Ohwovoriole
DOI:10.4103/JOD.JOD_18_21  
Background: There are conflicting reports on the relationship of each of the two subfractions of high-density lipoprotein cholesterol (HDL-C) with insulin resistance in patients with type 2 diabetes mellitus (T2DM). Information on the relationship between HDL-C subfractions and insulin resistance in Nigerian patients with T2DM is not available in the literature. Aim: The aim of this article is to determine the association between subfractions of HDL-C and insulin resistance in Nigerian patients with T2DM. Materials and Methods: Patients with T2DM who were being managed by the Endocrinology, Diabetes, and Metabolism unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria were recruited for this study, whereas individuals with normal glucose tolerance (NGT) were recruited from Nnewi town. The study was carried out within a 5-month period. History was taken and physical examination was done on study participants. Fasting venous samples were collected for plasma glucose, plasma total HDL-C, plasma HDL-C phenotypes, serum C-peptide, serum creatinine, and serum alanine transferase estimation. Homeostasis Model Assessment for Insulin Resistance (HOMA2-IRC-peptide) score was determined using plasma glucose and serum C-peptide concentrations. Data were analyzed using appropriate statistical software. Results: A total of 616 participants consisting of 400 participants with T2DM and 216 participants with NGT were recruited for the study. Difference in age, sex, and blood pressure was not statistically significant between participants with T2DM and those with NGT. There were statistically significant differences in body mass index, fasting plasma glucose, C-peptide, HOMA-IR, total HDL-C, and HDL-C subfractions between subjects with T2DM and those with NGT. There was a significant negative correlation between HOMA-IR score and each of HDL2-C (rs= −0.513, P < 0.01), HDL3-C (rs= −0.471, P < 0.01), and HDL2-C/HDL3-C ratio (rs= −0.416, P < 0.01) in subjects with T2DM. Total HDL-C (odds ratio (OR)=3, P = 0.02), HDL2-C (OR=3.87, P = 0.01), and HDL3-C (OR=2.54, P = 0.02) were significant predictors of insulin resistance in individuals with T2DM after univariate and multivariate logistic regressions. Conclusion: This study showed a negative correlation between insulin resistance and each of the HDL-C subfractions in Nigerian patients with T2DM with HDL2-C having the strongest correlation with HOMA-IR score.
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Effect of personalized human-centered dietary decision support system (PHCDDSS) on dietary knowledge, attitude, practice (KAP), and mean fasting blood sugar (FBS) among participants with type 2 diabetes mellitus (T2DM) in community-based settings of northern state of India p. 338
Dinesh Kumar, Ashish Joshi, Ashoo Grover, Sunil Raina, Ashok Kumar Bhardwaj, Bhavya Malhotra, Shruti Sharma
DOI:10.4103/JOD.JOD_21_21  
Introduction: Acknowledging the promising role of information and technology, a study was planned to determine the effect of personalized human-centered dietary decision support system (PHCDDSS) on dietary knowledge, attitude, practice (KAP), and mean fasting blood sugar (FBS) among participants with type 2 diabetes mellitus (T2DM). Materials and Methods: A community-based randomized control trial was conducted among 400 individuals with T2DM randomized into the 12-month intervention group (PHCDDSS) and 400 to the control (usual care) group. Results: In the control and intervention groups, 84.7% and 87.0% participants completed the follow-up at the end of 12 months. Mean knowledge score showed a significant (P = 0.00) declining trend (from 28.3 to 22.2) in the control group, but increasing (from 28.9 to 35.4) in the intervention group. Unlike knowledge, mean attitude score observed a significant declining trend in both the groups but less in the intervention group. The mean FBS (in mg/dL) trend was found to be insignificantly declining in control (199.2–195.4) and intervention (194.8–183.1) groups but the decline was relatively less in control when compared with the intervention group. Conclusion: In study participants, PHCDDSS proved to be effective in improving knowledge and attitude toward role of diet in managing T2DM. The intervention showed promising effect in reduction of mean FBS and proportion of individuals with sugar control.
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Living with type 2 diabetes in COVID-19: Exploring the challenges faced p. 344
Neha Agarwal, Rishi Shukla, Manisha Gupta, Mandara Muralidhar Harikar, Anurag Bajpai
DOI:10.4103/JOD.JOD_28_21  
Background: The COVID-19 pandemic seems to have influenced lifestyle behaviors and diabetes self-management practices. The aim of the present study is to determine the impact of psychological stress on various lifestyle behaviors, diabetes self-management practices, and glycemic control among Indian adults with type 2 diabetes (T2D), amidst the COVID-19 pandemic. Materials and Methods: This was a cross-sectional observational study. The data pertaining to psychological stress, lifestyle behaviors, diabetes self-management practices, and glycemic control were collected at two time-points (before and after lockdown). Results: A total of 252 T2D patients (145 males, 57.5%) with mean age 51.2 ± 9.8 years and mean diabetes duration of 8.5 ± 6.3 years participated in the study. A statistically significant decrease in body mass index (27.68 vs. 27.22 kg/m2; P < 0.0001) and an increase in HbA1c was noted in the post-lockdown period (8.31% vs. 8.70%; P < 0.0001). The mean Impact of Event Scale-Revised (IES-R) score was 19.3 ± 11.6. No significant correlation of mean IES-R score was observed with the age of the participants (r =−0.077, P = 0.224) and diabetes duration (r = 0.002, P = 0.970). Female gender (mean rank 140.4; P = 0.007) and co-existing hypertension (mean rank 132.18; P = 0.016) were associated with significantly higher IES-R score. No impact of total IES-R score was seen on the various lifestyle behaviors, diabetes self-management practices, and glycemic control. Conclusion: Psychological stress was higher among female gender and those with co-existing hypertension. Further, glycemic control worsened despite preserved diabetes self-management practices.
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Bibliometric analysis of diabetes research in relation to the COVID-19 pandemic p. 350
Brij Mohan Gupta, Rimesh Pal, Latika Rohilla, Devi Dayal
DOI:10.4103/JOD.JOD_30_21  
Background: Diabetes is a common co-morbid condition that influences morbidity and mortality in patients with COVID-19 and has been a focus of intense research. However, a systematic assessment of global diabetes research concerning COVID-19 is unavailable. Aim: We aimed to provide a bibliometric assessment of research output on diabetes concerning the COVID-19 pandemic. Materials and Methods: Publications on diabetes in relation to COVID-19 were retrieved from the Scopus database and analyzed using appropriate bibliometric indicators. Results: The publications indexed till January 6, 2021 numbered 762. The share of the top 10 of the 82 countries was 90.6%. The USA, China, India, Italy, and the UK were the most productive countries, with publication share ranging from 11.4% to 17.8%. Brazil, China, Germany, Australia, France, and India registered higher publication impact. The average citations per paper were 7.3, and 19.4% of the publications were funded. The share of publications on type 2 diabetes, type 1 diabetes, and gestational diabetes was 23.2%, 16.5%, and 4.1%, respectively. Diabetic complications, clinical studies, and epidemiology were the most researched aspects of diabetes concerning COVID-19, with 47.9%, 23.3%, and 14.0% share, respectively. Publications on pathophysiology numbered only 93 (12.2%). The most productive organizations were Tongji Medical College, China, Huazhong University, China, Postgraduate Institute of Medical Education and Research, India, and INSERM, France. Obesity and Cholesterol Foundation, India, Imperial College, UK, and The Central Hospital of Wuhan, China were the most impactful organizations. R. Pal, A. Ceriello, and B. Cariou were the most productive authors, whereas A. Misra, R. Gupta, and A.K. Singh were the most impactful. The most active journals were Diabetes Research and Clinical Practice, Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Journal of Diabetes Science and Technology, and Diabetes Care. Conclusion: Extensive high-quality research has been conducted on diabetes in relation to the COVID-19 pandemic in developed and developing countries. There is a need to focus on pathophysiological studies to elucidate further the underlying mechanisms that predispose COVID-19-affected diabetes patients to severe disease and death. Our scientometric assessment may help understand the research gaps and guide future research in this field.
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Frequency of sexual dysfunction in women with diabetes mellitus: A cross-sectional multicenter study p. 357
Shabeen Naz Masood, Saira Saeed, Nusrat Lakho, Yasir Masood, Mahnoor Rehman, Saleh Memon
DOI:10.4103/JOD.JOD_31_21  
Objectives: Female sexual dysfunction (FSD) with chronic diseases such as diabetes has received little attention globally. The aim of this study is to assess the frequency of sexual dysfunction (SD) in women with diabetes; an aspect of female health that has not been explored in our population. Materials and Methods: This cross-sectional observational study using non-probability convenient purposive sampling technique was carried out at three health facilities of Karachi, for a duration of 1 year. One hundred women with diabetes who consented to participate in the study were included. Pregnant, divorced, widowed, and unmarried females were excluded. Modified female sexual function index (FSFI) was used to gather information. Results: Out of 100 women, 88 women with diabetes completed the interviewer-based modified FSFI survey questionnaire. Among 88 women, 38 (43.2%) reported to have SD, whereas 50 (56.8%) were found to have no significant sexual issues. Partner’s age and occupation were significantly associated with FSD. All parameters of modified FSFI, i.e., sexual desire, arousal, lubrication, orgasm, and dyspareunia, were significantly associated (P < 0.001) with diabetes. Conclusion: Women with diabetes are at increased risk of SD and often do not volunteer information about their sexual issues. The most common cause of SD was dyspareunia, followed by lubrication, orgasm, lack of sexual arousal, and sexual desire. The healthcare providers should be aware to initiate and facilitate the discussion and need to develop their own comfort to talk about sexual issues.
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COMMENTARY Top

Angiotensin converting enzyme (ACE)-2: Beyond just the entry point for the SARS-CoV-2: A commentary p. 363
Viraj Suvarna, Shashank Joshi
DOI:10.4103/JOD.JOD_66_20  
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CASE REPORTS Top

Pitfalls in estimation of glycosylated hemoglobin: A rare hemoglobin variant—Hb Hope p. 368
Anu Mathew, Ashok Rajagopal, Jasjeet Singh Wasir
DOI:10.4103/JOD.JOD_2_21  
Hemoglobin (Hb) Hope is a rare Hb variant which is clinically silent but causes spuriously high glycated hemoglobin (HbA1c). We report a case of a 45-year-old gentleman, planned for elective total hip replacement, who presented with very high HbA1c with normal blood glucose and fructosamine levels. With the suspicion of erroneous HbA1c, an Hb electrophoresis was done, and he was found to have a rare hemoglobin variant called Hb Hope. We also reviewed almost all case reports of Hb Hope variant causing spuriously high HbA1c levels from India.
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Partial lipodystrophy of limbs in type 2 diabetes: A case report p. 371
Meet Shah, Banshi Saboo
DOI:10.4103/JOD.JOD_15_21  
Rationale: On account of the diversity and rarity of lipodystrophy, this condition may be frequently unrecognized or misdiagnosed. This tends to be concerning as it is progressive and has potentially life-threatening complications. Patient Concerns: The patient was referred to our clinic with chief complaints of uncontrolled glycemia and an increased frequency of urination since last 3 months. The patient complained of weakness that led to thinning of upper limb muscles, loss of fat from face, neck, and upper thorax with simultaneous increase in abdominal girth, flattening of buttocks, and reduction in girth of lower limb muscles. Diagnosis: The patient was diagnosed with partial lipodystrophy of limbs (PLL) based on unique clinical features, blood investigations, and a DEXA fat scan. Interventions: The patient was treated with basal insulin glargine, metformin 1.5 g, dapagliflozin 10 mg, pioglitazone 7.5 mg, and atorvastatin 40 mg. He was vigorously educated to follow a strict diet and an exercise plan with necessary lifestyle modifications. Outcomes: After 3 months, the patient achieved better glycemic control with a reduction in HbA1c from 9.5% to 7.2%, as well as an improvement in lipid profile. He additionally achieved a weight reduction of 12 kg, with reduction in his abdominal girth from 130 to 118 cm. Lessons: The recognition of PLL in patients with type 2 diabetes can help better clinical management by alerting physicians to the associated comorbidities. Many a times, PLL goes unnoticed on account of the slow progression. Our case highlights the need for greater recognition of PLL as it has specific metabolic features that help in guiding appropriate clinical management.
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Left-sided massive hydrothorax in a DKD patient on CAPD using icodextrin p. 376
Maithrayie Kumaresan, Sandra Babu, Milly Matthew, Palaniappan Nagarajan, Georgi Abraham
DOI:10.4103/JOD.JOD_52_21  
We report a case of a 51-year-old male patient with end-stage kidney disease secondary to diabetic kidney disease who presented with an atypical left-sided pleural effusion within 2 weeks of commencement on continuous ambulatory peritoneal dialysis (PD) using icodextrin dialysis solution. PD was withheld for the time being and the patient was switched to temporary hemodialysis and started on high-dose diuretics which led to the resolution of his symptoms. Here we discuss the clinical presentation, diagnostic techniques, and management options for treating hydrothorax in the PD population.
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LETTERS TO THE EDITOR Top

Percutaneous electric neurostimulation of dermatome T7 as a potential adjunct therapy for decreasing insulin resistance and improving glycemic control in patients with type 2 diabetes p. 379
Chidiebere Emmanuel Okechukwu
DOI:10.4103/JOD.JOD_98_20  
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Diabetes: The set stage for mucormycosis post COVID-19 p. 381
Tarun Kumar Suvvari, Nithya Arigapudi, Naga Alekhya Garikipati, Sri Harsha Boppana
DOI:10.4103/JOD.JOD_70_21  
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