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   Table of Contents - Current issue
April-June 2022
Volume 13 | Issue 2
Page Nos. 139-187

Online since Friday, July 22, 2022

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Sexual dysfunction in women with type 2 diabetes mellitus: An observational study p. 139
Manisha Gupta, Rishi Shukla, Shivendra Verma, Atul Kalhan
Introduction: There is a dearth of studies evaluating sexual dysfunction in women with Type 2 Diabetes Mellitus (T2DM), despite anecdotal evidence suggesting an association between glycemic control and female sexual health. Materials and Methods: An observational cross-sectional study was carried out in 100 women with T2DM under follow-up at a regional diabetes center. Validated questionnaires, Female Sexual Function Index (FSFI), and Female Sexual Distress Scale (FSDS) were used to collate the prevalence and severity of female sexual dysfunction (FSD) in the subjects. Anthropometric and metabolic parameters were recorded by clinical examination and blood tests, respectively. Results: FSD was reported in 18% (95% CI: 10.5–25.5%) of the women enrolled in the study. The women with FSD were significantly older (50 ± 9.3 years vs. 43.9 ± 8.2 years, P = 0.006). In addition, the mean body mass index (BMI) (31.96 ± 5.5 Kg/m2 vs. 28.98 ± 4.63Kg/m2, P = 0.02) and waist circumference (38.88 ± 6.6 inches vs. 35.54 ± 5.62 inches, P = 0.03) were higher in the women with FSD compared with those without FSD. However, we observed no statistically significant association between FSD and the duration of diabetes, level of glycemic control, and serum testosterone level. Conclusion: Advanced age, higher BMI, and central adiposity were related with the development of FSD, whereas the duration of diabetes and level of HbA1c did not increase FSD risk.
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Expert consensus on triple combination of glimepiride, metformin, and voglibose usage in patients with type 2 diabetes mellitus in Indian settings p. 145
Ashok K Das, Subhash K Wangnoo, Rajeev Chawla, Altamash Shaikh, Ganapathi Bantwal, Pramila Kalra, Shalini Jaggi, Mahesh V Abhyankar, Ashish Prasad, Prashant Sarda
Background: Type 2 diabetes mellitus (T2DM) is a progressive disease affecting a huge chunk of the population globally. Aim: This study aimed to address the existing gaps in knowledge about the triple-drug combination and to provide guidance to the clinicians on the triple-drug combination in Indian settings. Materials and Methods: Doctors’ opinions (n = 2262) were recorded based on surveys and round table meetings. The National Expert Group approved a standard questionnaire that included 13 questions pertaining to T2DM management using a triple combination of glimepiride, metformin, and voglibose, which were prepared, discussed, and evaluated by the experts. After due discussions, the expert group analyzed the result and further recommendations were made and a consensus statement was derived. Results: Out of 2262, 1498 were consulting physicians, 358 were diabetologists, 93 were endocrinologists, 104 were cardiologists, and 209 were family physicians with focus on diabetes practice or had more than 10 years of experience from different regions from India. A strong consensus was observed for targeting postprandial hyperglycemia in the management of T2DM, which may reduce cardiovascular (CV) disease risk. The experts opined that meal pattern was the major factor affecting glycemic variability. The experts recommended early use of triple combination as it improves glycemic control (early aggressive control, beyond three oral drugs are on no benefit, ingrained). More than 90.0% of clinicians believed that this combination is cost-effective. Most agreed (32.0%) that this combination moderately reduces body weight. Additionally, it was felt that triple combination in patients with T2DM is also beneficial during Ramadan. Conclusion: In the present expert opinion-based consensus, most of the healthcare providers believed that triple-drug combination can potentially improve glycemic control and can delay/postpone the microvascular and CV complications. However, more multicentric studies are needed to support these recommendations.
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Association of autoimmune thyroiditis with latent autoimmune diabetes of adults (LADA): A study from North India p. 154
Himalina S Sangma, Anshul Singh, Anubha Srivastava, Ram Siya Singh, Vatsala Misra
Objective: The aim of this work was to study the association of autoimmune thyroiditis (AIT) in the patients of latent autoimmune diabetes of adult (LADA). Materials and Methods: The subjects included were more than 30 years of age, presenting with the deranged glycemic profile. After GAD65 autoantibody testing, they were grouped into LADA positive and LADA negative groups. Simultaneously, a thyroid workup for the presence of AIT was done. Statistical Analysis: The Student’s unpaired t test and chi-square test (χ2 test) were used to test for the significance of the difference in AIT between LADA and type 2 diabetes mellitus (T2DM) subjects as applicable. A value of P < 0.05 was taken as significant. Results: A total of 77 patients were included in the study. The mean age was 48 ± 13 years and M:F ratio was 1:3. A high frequency of AIT was found in the LADA group (80%) when compared to the true T2DM group (35%). Mean values of both anti-thyroid peroxidase antibody (anti-TPO) and anti-thyroglobulin antibody (anti-TG) antibodies were found to be significantly different between LADA and T2DM. Percentage positivity for anti-TPO, anti-TG, as well as combined anti-TPO and anti-TG were also found to be significantly different. Conclusion: Based on the significant association of AIT with LADA found in our study, we recommend all AIT patients to undergo simultaneous screening for LADA for a multimodal treatment.
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Prevalence estimation of diabetes mellitus among tuberculosis cases, its risk factors, and treatment outcome in Rajkot city p. 159
Pooja N Ranpariya, Harsha M Solanki, Rajesh K Chudasama
Background: Tuberculosis (TB) and diabetes mellitus (DM) are the world’s leading public health issues. TB with DM co-morbidity adversely affects prognosis of individual diseases and its treatment outcome. Materials and Methods: A cross-sectional study was conducted at five TB units of Rajkot city for five quarters. Newly registered pulmonary TB (PTB) patients having DM during the study period were included as cases. All cases were followed up at the end of treatment to observe outcomes. Information was collected in a pretested proforma using the interview technique. Results: The prevalence of DM among PTB cases was 5%. Maximum cases were in 51–60 years (34.4%), male: female ratio was 3:1, living in urban slum (53.1%), literate (81.2%), and from middle socio-economic class (65.6%). One-fourth of the cases had family (28.1%) and past history (28.1%) of TB, and more than one-third (37.5%) of the cases had family history of DM. All cases were on daily drug adherence, and most of them (83%) were on regular follow-up. Significant association was observed with urban slum (P = 0.03) and family history of diabetes (P = 0.04) among cases. At the end of continuation phase, 82.8% of the cases were cured and 4.7% of the cases had completed treatment. Conclusion: The study reported 5% of DM among newly registered TB cases and family history of DM as its significant risk factor.
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The reversal model for metabolic syndrome (RMMS) study: The rationale and design p. 166
Subhajyoti Ghosh, Banshi Saboo
Background: Recently, attention is paid on strategies and policies to halt or reverse the forecast type 2 diabetes mellitus (T2DM) epidemic across the globe and in India. Metabolic syndrome (MetS) predisposed us to T2DM along with cardiovascular disease (CVD). Our study aims to develop a reversal model for people with MetS through an education program under observation. This paper will describe the design of the reversal model for metabolic syndrome (RMMS) study along with intervention strategies. Materials and Methods: The RMMS study is a multi-center, parallel arm, quasi-experimental study. The study will be done in western (viz., Ahmedabad) and eastern (viz., Guwahati and Dibrugarh) parts compromising 707 patients from each part. The intervention arm will be part of the “observation cum self-management education program” for a period of 6 months. The non-intervention arm will be followed up to 6 months with routine care. The analysis for the outcome will be done at the end of 6 months. The primary outcome measures will be the reversal of MetS or the components of MetS. The piloting of the study has been done after the ethical clearance, and necessary changes are also done in a proforma. Conclusion: The RMMS is first of its kind among Indian population to study the effectiveness of the reversal model. The results will provide insights into changes in the prevalence of the components of MetS and hence can be used as primary prevention strategies for T2DM and CVD.
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Comparing time to intensification between insulin degludec/insulin aspart and insulin glargine: A single-center experience from India p. 171
Rajiv Kovil
Background and Aims: The objective of the study was to compare the percent of patients with type 2 diabetes (T2D) requiring dose intensification and the time to dose intensification in patients on insulin degludec/insulin aspart (IDegAsp) versus those on basal insulin. Materials and Methods: Data were collected through retrospective chart review of patients with T2D being treated with insulin at a single center in India. The increase from once daily (OD) to twice daily dose or the addition of prandial insulin was considered as dose intensification. Chi-square test was conducted to compare the groups. Results: In the IDegAsp group (n = 515), 455 patients continued on the OD dose, and 60 patients (11.6%) were intensified. In the insulin glargine (IGlar) group (n = 173), 143 patients remained on the initial dose and 30 patients (17.34%) were intensified. Fewer patients on IDegAsp required treatment intensification than those on IGlar (P = 0.05). The time to treatment intensification (±standard deviation) was 11.98 ± 7.81 months in the IDegAsp group and 6.71 ± 6.86 months in the IGlar group. The time to treatment intensification was significantly longer in the IDegAsp than in the IGlar group (P = 0.0023). Conclusions: The study shows that significantly fewer patients on IDegAsp required dose intensification than those on IGlar. Additionally, the time to dose intensification was significantly delayed in patients on IDegAsp as compared to IGlar. However, HbA1c reduction with IGlar (nonintensified) was significant only at 6 months and failed to reach significance at 12 months, thereby pointing toward an early need for treatment intensification.
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Patient reported attitude, practice, satisfaction, and quality of life on insulin degludec/insulin aspart: A single-center survey from India in adult with diabetes p. 177
Rajiv Kovil
Objective: The study aimed to assess the knowledge, attitude, practice, satisfaction, and quality of life (QoL) of adult patients with type 2 diabetes (T2D) on insulin degludec/insulin aspart (IDegAsp). Materials and Methods: Data were collected through an online survey from patients with T2D being treated with IDegAsp at a single center in India. Results: Survey was completed by 247 participants. On the Likert scale, 1 to 5 (1: most difficult and 5: most easy), 41.6% and 26.6% scored 5 and 4, respectively, for ease of increasing or decreasing the dose. Most participants (n = 190) consulted a physician to adjust the dose; 53.3% and 28.8% scored 5 and 4, respectively, for a good experience while injecting IDegAsp; 89.8% of participants felt their QoL improved with a reduction in the number of pricks; 86.7% participants found it comfortable to inject IDegAsp in different social situations; 94.2% reported they could manage their day to day activities better after initiating IDegAsp. After initiating IDegAsp, the oral antidiabetic (OAD) pill burden reduced from three to one or two pills in 70% of patients. Conclusions: Our survey-based study shows the majority of participants found it easy to administer IDegAsp, inject IDegAsp in different social situations, they were able to increase and decrease the dose with ease, and benefited from reduced injection pricks and reduced OAD pill burden. The survey points towards a positive attitude towards achieving glycemic control with IDegAsp.
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A case of regression of insulin lipohypertrophy with correct injection technique p. 184
Dewark Sharma
Lipohypertrophy of the injection site is a common and often-neglected complication of treatment with insulin. It causes unpredictable absorption of the drug, leading to higher glycemic variability. Using the correct injection technique, the lesion may be reversed. Here, we present the case of a patient with type 1 diabetes, whose lipohypertrophy regressed over time. Along with this, the patient also attained better glycemic control and freedom from diabetic ketoacidosis.
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Diabetes prevention through religious leaders p. 187
Bishwajit Bhowmik, Tasnima Siddiquee, Akhtar Hussain, A K Azad Khan
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