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Table of Contents
July-September 2022
Volume 13 | Issue 3
Page Nos. 189-316
Online since Monday, September 26, 2022
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REVIEW ARTICLES
Journey from EMPA-REG to CARMELINA to EMPEROR-Preserved: Empagliflozin/linagliptin in heart failure and diabetes
p. 189
Sharvil S Gadve, Sneha Chavanda, Yashpal V Gogate, Vinayak Harale, Arundhati Dasgupta, Milind Patwardhan
DOI
:10.4103/jod.jod_24_22
Diabetes mellitus is present in more than two-fifths of the patients suffering from heart failure (HF), with the incidence being more than twice that found in the non-diabetic population. It doubles the risk of hospitalization and increases the risk of fatal outcomes, thus negatively affecting the prognosis in HF patients. The available pharmacological treatment options are limited, particularly in HF with preserved ejection fraction (EF). Empagliflozin is a sodium-glucose transporter-2 inhibitor, which has shown a protective effect against cardiomyocyte dysfunction through various mechanisms. The benefits of empagliflozin has been seen in multiple studies: EMPA-REG (April 2015), EMPRISE (June 18, 2019), EMPIRE-HF (2019), EMPA-AHF-RESPONSE (January 7, 2020), The EMPEROR Reduced (May 28, 2020), The RECEDE-CHF (November 3, 2020), SUGAR-DM (February 9, 2021), and EMPEROR-Preserved (April 26, 2021). Empagliflozin reduced the risk of all-cause mortality, HF hospitalizations, and biomarkers in patients with HF both with reduced and preserved EF in prospective and retrospective studies, regardless of the presence of diabetes. Linagliptin is a DPP-4i that has demonstrated renal safety with potential albuminuria benefits as well. Both these agents in combination have shown favorable effects on elevated blood pressure and intima-media thickness. Unlike some other gliptins, linagliptin was not associated with an increased risk of HF, rather a nominal reduction noted in CARMELINA (January 18, 2018). When added to the standard of care, it reduced the dose of insulin in high-risk diabetic patients with HF. The risk of hypoglycemia is significantly less in patients treated with linagliptin compared with sulfonylurea regimen as seen in CAROLINA (August 21, 2018). Thus, considering the plethora of clinical benefits demonstrated, a combination of empagliflozin and linagliptin in patients of diabetes at high risk of HF may be a suitable option for primary and secondary prevention.
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Effect of L-carnitine on the lipid profile, glycemic control, oxidative stress, and anthropometric indices of individuals with type 2 diabetes: A systematic review
p. 199
Navideh Khodadadi, Behnood Abbasi
DOI
:10.4103/jod.jod_50_22
Diabetes mellitus is one of the most prevalent metabolic diseases in existence. With more than 536.6 million cases having been diagnosed globally, its prevalence is reported to be 10.5% in 2021. In individuals with diabetes, plasma L-carnitine is low and metabolized abnormally. In this review, we aimed to assess whether L-carnitine supplementation is correlated with a reduction of the risk of cardiovascular diseases in individuals with diabetes by improving the compositions of lipid profiles, indicators of oxidative stress, glycemic control, and anthropometric indices. A literature search in major databases such as Web of Science, PubMed, Google Scholar, Scopus, and Scientific Information Database was conducted until November 2021. This was done in conjunction with a search in Elsevier and SpringerLink databases, resulting in the inclusion of relevant articles in this review. To construct the search strategy, “Carnitine” OR “glycine propionyl carnitine” OR “Acetylcarnitine” in combination with “Diabetes Mellitus” OR “Diabetes Complications” OR “Lipid Profile” and all of its components were used to search for and within the articles and databases. After screening, 10 articles published between 1998 and 2017 were identified. They evaluated the effect of L-carnitine on lipid profile metabolism, glycemic control, anthropometric indices, and oxidative stress markers in individuals with diabetes. In this systematic review, we concluded that L-carnitine had no notable effect on lipid profile as well as glycemic control and anthropometric indices. Therefore, using L-carnitine probably has no notable effect on metabolic status in individuals with diabetes. Meanwhile, some articles suggested that L-carnitine may have positive effects on some oxidative stress indicators.
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Role of Physiotherapy in managing type 2 diabetes mellitus: A systematic review
p. 210
Navjot Kaur, Sandeep Singh
DOI
:10.4103/jod.jod_48_22
Type 2 diabetes mellitus (T2DM) is the most widespread form of diabetes and is becoming a global burden. This disorder distresses almost all of body systems leading to a number of complications such as cardiovascular diseases, diabetic peripheral neuropathy, diabetic nephropathy, musculoskeletal disorders and lower limb amputations which in turn increase the rate of mortality and impoverished life’s quality. This beseeches for better treatment methods, but the pharmacological approaches are limited by their adverse effects. In that context physiotherapy is an emerging non-pharmacological approach. The objective of this review was to systematically review the current evidence on role of physiotherapy in type 2 diabetes patients. A comprehensive search of literature published between 2010 to 2021 was conducted using; PubMed, ScienceDirect and PEDro databeses. 34 RCTs determining the role of different physiotherapy interventions published in peer reviewed English language journal were included in this review. Studies with less than 20 participants and conducted in age less than 18 years were excluded. This review was conducted in compliance with PRISMA guidelines. Study quality was assessed using PEDro scale; data on participant and intervention characteristics, outcome measures and treatment outcomes were extracted based on PICO framework by one reviewer under the supervision of another reviewer. The quality of trials as per PEDro was a mean score of 6. Overall, these studies evaluated the role of physiotherapy interventions such as exercise therapy, electrotherapy and other new and uncommon interventions such as pilates, whole body vibration and mini-trampoline in improving T2DM patients. This was the first systematic review to gather the evidence related to role of physiotherapy as a non-pharmacological approach in managing T2DM. The findings of present review suggested that different physiotherapeutic interventions have a positive role to play in management of T2DM and its associated complications but the literature is mainly focused on exercise therapy although many other physiotherapy interventions also proved to be beneficial.
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REVIEW ARTICLE
Prevalence of diabetes in Odisha, India: A systematic review and meta analysis
p. 227
Sanjeev Supakar, Sachidananda Nayak, Lipika Behera, Jaya Kshatri, Purna Chandra Pradhan
DOI
:10.4103/jod.jod_53_22
Objective:
The objective of this review was to summarize and compare the estimates of diabetes among adults in community and hospital-based settings in Odisha, India.
Introduction:
Diabetes Mellitus (DM) is a major non-communicable disease as well as a risk factor. In a vast and diverse country such as India, where health is a state subject, regional synthesized and up to date estimates of DM burden is necessary for informed policy making. No such estimates are currently available for the state of Odisha.
Materials and Methods:
Peer‑reviewed published original research articles related to prevalence DM in the state of Odisha published between 2011 and 2022 were retrieved from 4 medical databases and analysed. Study screening, selection, data extraction and critical appraisal was done by 2 independent review authors. Data synthesis and assessment of certainty of the evidence was done in meta-analysis of the results.
Results:
A total of 15 studies, that included 17339 participants, with overall good methodological quality were included in the review. The overall prevalence of DM among adults in the state of Odisha based on Community based surveys was 6.8% (95% CI: 2.3–13.4%). The prevalence in older adults aged 60 years or above is higher at 22.2% (95% CI: 8.6–39.9%). The prevalence in studies that relied on self-reported methods of screening was 4.8% (95% CI: 1.7–9.3%) as compared to those that diagnosed participants based on standard criteria (12.1%; 95% CI: 8.1–16.7%).
Conclusions:
We found a high prevalence of DM in the state of Odisha, which was higher than previously available national and regional estimates. This prevalence was much lower in community-based studies and in self-reported surveys pointing towards significant under diagnosis of hypertension in the state of Odisha and highlighting a need for a robust community-based screening program among adults in the state.
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ORIGINAL ARTICLES
Bioequivalence study of two different dapagliflozin tablet formulations in healthy adult Indian volunteers
p. 235
Sanjay Kalra, Supratik Bhattacharya
DOI
:10.4103/jod.jod_129_21
Objective:
To assess the bioequivalence of 10 mg dapagliflozin tablets compared with that of 10 mg Farxiga
®
(dapagliflozin) tablets of AstraZeneca Pharmaceuticals LP, USA in healthy, adult volunteers under fasting conditions.
Materials and Methods:
This was an open-label, balanced, randomized, two-treatment, two-period, two-sequence, single-dose, crossover, oral bioequivalence study. Volunteers were randomized to receive either test product or reference product of 10 mg dapagliflozin tablets under the fasting condition with a nine-day washout period. The primary pharmacokinetic (PK) parameters were maximum plasma concentration (C
max
), area under the curve (AUC) at time t (AUC
t
), and AUC extrapolated to infinity (AUC
inf
). Adverse events were assessed as safety endpoints. The bioequivalence was assessed to evaluate that the two formulations are not different from one another if the 90% confidence interval for the ratio of the geometric least square means falls completely within the predefined range of 80–125%.
Results:
Fifty-two healthy adult volunteers were randomized, and 47 completed the study. The mean values for C
max
, AUC
t
, and AUC
inf
were almost identical for test and reference products after administration to healthy human volunteers under fasting conditions. A total of 14 adverse events were reported by 10 volunteers during the study. All adverse events were mild to moderate in nature and did not cause study withdrawal.
Conclusion:
The test product dapagliflozin 10 mg was bioequivalent with the reference product in healthy, adult, human volunteers under fasting conditions. The availability of the affordable generic dapagliflozin has the potential to improve clinical outcomes in millions of patients in India because of its renoprotective, cardioprotective, and glucose-lowering effects.
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Real-world evidence of generic dapagliflozin: Relevance and results from Indian multicenter retrospective study
p. 242
Bipin K Sethi, Sanjay Kalra, Supratik Bhattacharya, Anand Kumar, Madhukar Rai, Manoj Kumar Srivastava, Srinath A, Ajay Budhwar, Savita Jain, Harish Mohan Rastogi, Pramod Gandhi, G Vijay Kumar, Joe Georje, Mahesh V Abhyankar, Ashish Prasad, Prashant Sarda
DOI
:10.4103/jod.jod_133_21
Objective:
The objective was to evaluate the clinical experience and treatment patterns of generic dapagliflozin usage in different patient profiles in Indian settings.
Materials and Methods:
A retrospective, multicentric, real-world study included patients with type 2 diabetes mellitus (T2DM) (aged >18 years), inadequately controlled by existing antidiabetic therapy and receiving generic dapagliflozin as an add-on to existing oral antidiabetic drug(s) with or without insulin or switch therapy. Baseline characteristics and treatment-related outcomes were retrieved from the medical records and analyzed.
Results:
A total of 1935 patients were included, of which 1279 (66.1%) were males. The mean age was 57.4 years, and around half of the patients (51.4%) were aged from 45 to 60 years. Hypertension (55.9%) and dyslipidemia (19.8%) were the common comorbidities. The majority (
n
= 1122; 60%) of patients received dapagliflozin in combination with one or two antihyperglycemic drugs. More than half of the patients received metformin (56.8%) or sulfonylurea (52.3%) in combination with dapagliflozin. A dose of 10 mg (93.4%) was the most commonly used dose of dapagliflozin. The mean levels of glycated hemoglobin, fasting plasma glucose, and postprandial plasma glucose were significantly reduced to 1.1% (1.0–1.1), 30.5 mg/dL (29.2–31.9), and 57.5 mg/dL (55.1–59.9), respectively, after the initiation of dapagliflozin. A total of 1935 patients experienced weight changes during the treatment, of which 90.5% of patients showed weight loss. Hypoglycemic events were reported in 12.5% of patients. Physician global evaluation of efficacy and tolerability showed a majority of patients on a good-to-excellent scale (97.3% and 97.1%).
Conclusion:
Generic dapagliflozin showed a significant improvement in glycemic parameters and reduced body weight with low hypoglycemic events. The administration of dapagliflozin provided a good-to-excellent efficacy and tolerability profile in patients with T2DM. To the best of our knowledge, this is the first study confirming the efficacy, safety, and usefulness of generic dapagliflozin in patients with T2DM.
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Fasting serum C-peptide level may not be low in young-onset diabetes
p. 249
Mobarak Hosen, Nusrat Sultana, Mashfiqul Hasan, Sharmin Jahan, Mohammad Jahangir-Alam, Shadequl Islam, Saifur Rahman, Noor E Jannat Tanvi, Mohammad Fariduddin, Muhammad A Hasanat
DOI
:10.4103/jod.jod_11_22
Background:
Diabetes mellitus (DM) is one of the growing health problems among the young population. Secretory defect of insulin is an important cause, and it can be assessed by measuring fasting serum C-peptide level.
Aim:
The aim of this article is to assess fasting serum C-peptide in young-onset DM individuals.
Materials and Methods:
This case–control study was conducted in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2015 to February 2017. For this purpose, 40 individuals with DM (irrespective of DM type; age range: 11–29 years) were enrolled as case and an equal number of young healthy individuals as control. Demographic profiles, clinical profiles, and serum C-peptide were recorded in a standard and pre-tested structured datasheet. C-peptide was measured by the chemiluminescent immunometric assay.
Results:
Median fasting C-peptide was 2.67 [interquartile range (IQR) 1.06–4.07, range 0.12–20.0] ng/mL in diabetes individuals, whereas it was 2.19 (IQR 1.36–2.94, range 0.44–9.85) ng/mL in the control group; the difference was insignificant (
P
= 0.331). Waist circumference (WC) was significantly higher in the young diabetes group in comparison to that of control subjects and so were the plasma glucose values and diastolic blood pressure (
P
< 0.05 for all). Diabetic participants with low C-peptide group had significantly lower body mass index (BMI) and WC and higher fasting plasma glucose (FPG) and HbA1c in comparison to others (
P
< 0.05 for all); whereas the high C-peptide group had opposite body indices (higher BMI and WC) and glycemic parameters (lower FPG and HbA1c) (
P
< 0.05 for all). The classic hyperglycemic symptoms were more common in the low C-peptide group (
P
= 0.029). In participants with diabetes, C-peptide positively correlated with BMI and WC, whereas it showed a negative correlation with age (
P
< 0.05 for all). In the control group, C-peptide positively correlated with WC only (
P
= 0.018).
Conclusion:
The level of fasting serum C-peptide in diabetic subjects was similar to healthy controls, and it was higher in those subjects who had higher BMI, WC, and lower age.
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A study on the health and socioeconomic impact of COVID-19 pandemic and barriers to self-management of diabetes during the lockdown among rural residents of South India
p. 255
Natarajan Lakshmi, Ranjit Mohan Anjana, Moneeza Siddiqui, Sait Sonie, Ewan R Pearson, Alexander Doney, Colin N A Palmer, Viswanathan Mohan, Rajendra Pradeepa
DOI
:10.4103/jod.jod_68_22
Aim:
To study the health and socioeconomic impact of the COVID-19 pandemic and to assess the barriers to self-management of diabetes during the lockdown, in rural South India.
Materials and Methods:
Details of demographic, social, economic, migration and health status were collected using a structured questionnaire from participants aged ≥18 years belonging to the 21 villages of Chengalpattu and Kancheepuram districts of Tamil Nadu state in south India as part of the
T
elemedicine p
R
oject for scre
EN
ing
D
iabetes and its complications in rural Tamil Nadu (TREND) study. From the 11,249 TREND participants, a random list of 25% (
n
= 2812) was system-generated using random numbers and 2812 participants were contacted for the study, of whom 2511 individuals participated. Telephonic interviews were conducted during the lockdown from June to August 2020. Further, qualitative interviews(Focus group discussions) were conducted among 27 individuals with diabetes between September and December 2020. Data were analyzed using thematic analysis.
Results:
The mean age of the study population was 43 ± 14 years and 50.4% were women. Diabetes was present in 14.7%, hypertension in 31.9%, generalized and abdominal obesity in 33.3% and 46.5% respectively. When the lockdown was implemented in March 2020, 37% had migrated from urban to rural areas. Lack of daily wage jobs (68%), price of essential commodities (41.7%), social distancing/curfew (34.8%), mental fatigue/depression (14.7%), and loss of job (7.1%) were some reasons stated for their adverse social and financial circumstances. People with diabetes stated that they had to avoid or cut down their regular hospital visits due to travel restrictions. Many of the patients took the same medications for almost a year.
Conclusion:
Unemployment, poor mental health, and reduced household income were the most significant negative impacts faced by rural residents during the lockdown due to COVID-19. People with diabetes experienced disruptions in diabetes management due to the pandemic.
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Non-communicable disease risk factors among garment factory workers in Bangladesh
p. 262
Bishwajit Bhowmik, Md Kamruzzaman, Tasnima Siddiquee, Mohammad A Samad, Farook A Khan, Habibur Rashid, Nayla C V do Moreira, Abdul Alim, Fazla A Khan, Sarowar U Milon, Mohammad A Robed, Abul H E Hossain, Akhtar Hussain, Abul K A Khan
DOI
:10.4103/jod.jod_35_22
Aim:
Many studies identified numerous health problems among industrial workers, in general, and garment workers. But a health problem with a specific focus on non-communicable disease (NCD) risk factors for Bangladeshi garment workers is lacking.
Objective:
The aim of this article is to investigate the NCD risk factors among garment workers in Bangladesh.
Materials and Methods:
A total of 4736 randomly selected garment workers aged ≥15 years in the Gazipur district of Bangladesh were investigated in a cross-sectional study from April 2014 to November 2014. Sociodemographic, anthropometric, and clinical details, including type 2 diabetes mellitus (T2DM) and hypertension (HTN), and albuminuria were collected by using a structured interviewer-administered questionnaire.
Results:
Among the study participants, the mean age was 27.6 ± 8.0 years. About 16.1% of the participants were underweight (body mass index <18.5 kg/m
2
), 15.8% were overweight (≥23.0–24.9 kg/m
2
), and 21.2% (≥25.0 kg/m
2
) were obese. The prevalence of central obesity based on waist circumference (male ≥90 cm and female ≥80 cm) and waist–hip ratio (male ≥0.90 and female ≥0.80) was 24.9% and 62.1%, respectively. The prevalences of T2DM (random blood glucose: ≥11.1 mmol/L), HTN (≥140/90 mmHg), and albuminuria (≥1+) were 7.0%, 13.9%, and 5.1%, respectively. The rates of general obesity and central obesity were significantly higher in females, and smoking habits, albuminuria, T2DM, and HTN were significantly higher in males. Increased age, male gender, general obesity, and central obesity were significantly associated with T2DM and HTN.
Conclusion:
The prevalences of T2DM, HTN, obesity, and albuminuria were common in study participants. Long-term follow-up studies of these workers are therefore warranted.
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Medical nutrition therapy in gestational diabetes mellitus: A survey among dietitians
p. 270
Sindhu S, S Uma Mageshwari
DOI
:10.4103/jod.jod_37_22
Aim:
The aim of this study was to elicit information on the perception of dietitians about gestational diabetes mellitus (GDM) and their dietetic practices.
Materials and Methods:
A survey was conducted among dietitians working in hospitals, maternity centers, and other clinics using the purposive sampling criterion. A validated questionnaire was used to obtain details about the perception of GDM, guidelines used, dietetic screening, assessment, interventions and follow-up. Descriptive statistics were reported as frequency of total number of responses for each question. Fisher’s exact test on perception of GDM, operating guidelines and topics discussed in diet consultations with respect to the years of clinical experience, age group and educational qualification of the participants were performed.
Results:
Perception of dietitians on family history of type2 DM as an associated risk factor of GDM had significant association with their clinical experience. Majorly discussed topic in diet consultation was carbohydrate distribution followed by protein requirement, fiber and small frequent meal pattern. On the basis of clinical experience of dietitians, difference was observed in discussed topics such as hypoglycemia, food groups, post-natal diet, and breast feeding. A major inconsistency observed was the nonavailability or lack in the use of pregnancy specific screening tool.
Conclusion:
Specific screening tools for pregnancy should be brought into practice. There is also the need for sustainable protocols in hospitals for uniformity in management of GDM.
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A study of lifestyle modifications with and without metformin in prediabetic subjects
p. 277
Asha Basavareddy, Narayana Sarala, Venkatarathnamma P Nanjappa, Sumathi M Eshwarappa
DOI
:10.4103/jod.jod_40_22
Purpose:
Prediabetes is a stage in the natural history of impaired glucose metabolism rather than as a distinctive clinical entity. The primary objective was to compare the effect of lifestyle modifications (LSMs) with and without metformin in prolonging the onset of diabetes mellitus in prediabetics.
Materials and Methods:
This study is an open label, parallel group comparative study conducted from 2016 to 2020. One hundred and four prediabetic subjects were assigned to two groups: group I (51) LSM and group II (53) metformin 500 mg along with LSM. Baseline investigations included fasting blood sugar (FBS), post-prandial blood sugar (PPBS), HbA1c, and lipid profile, followed up for 12 months.
Results:
The baseline parameters were comparable between the groups. In both the groups, there was a significant reduction in abdominal circumference, total cholesterol, triglycerides, low-density lipoprotein, FBS, PPBS, and HbA1c between baseline and 1 year. There was no significant difference between groups I and II in reduction of all the above-mentioned parameters. The outcomes of prediabetic subjects after 1 year of treatment in both the groups were comparable. Only one (2.1%) subject had more than 126 mmHg FBS in the LSM group. The adverse effects observed were dizziness, nausea, flatulence, myalgia, abdominal pain, and heart burn, which were mild to moderate in intensity and in most patients it subsided with time.
Conclusion:
LSM alone was equivalent to LSM along with metformin in effective control of blood sugars. Lipid profile and weight may be significantly reduced.
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Evaluation of the association between social determinants and health-related quality of life among diabetic patients attending an outpatient clinic in the Warangal region, Telangana, India
p. 285
Wajid Syed, Muthukkaruppan Menaka, Sundararajan Parimalakrishnan, Vamshi Vishnu Yamasani
DOI
:10.4103/jod.jod_51_22
Objective:
The present study aims to evaluate the association between sociodemographic characteristics and health-related quality of life (HRQoL) among diabetic patients attending a clinic situated in the Warangal region of Telangana, India.
Materials and Methods:
A cross-sectional study was conducted for 8 months in the diabetes outpatients’ clinic in the Warangal region, Telangana, India. A total of 402 patients were included in that study. The patients were assessed for QoL using the HRQoL-8-dimensional scale, which covers mainly Role Restriction Due to Physical Illness (6 items), Strength and Stamina (6 items), Health in General (3 items), Satisfaction with the Treatment (4 items), Symptoms Botherless (3 items), Financial Worries (3 items), Mental Health (5-items), and Satisfaction with Diet (2 items). All the items were assessed on a five-point Likert scale.
Results:
The mean age of the patients was 52.39 ± 11.01 (mean±SD). There was a statistically significant association between education and physical health (
P
=0.015), treatment satisfaction (
P
=0.006), emotional health (
P
=0.038), and diet satisfaction domain of HRQoL (
P
=0.006). The type of medication is associated with treatment satisfaction, financial worry, emotional health, and diet satisfaction (
P
=0.001). The patient’s employment status is significantly different from the general health, financial, and emotional health of HRQoL (
P
=0.001). However, treatment satisfaction (
P
=0.044) alone was significantly associated with years of having diabetes.
Conclusion:
Adhering to treatment guidelines and provider recommendations helps patients to lead a healthy lifestyle.
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Association of stress, depression and anxiety among individuals with microvascular complications in type 2 diabetes
p. 294
Jayaram Vidyulatha, Thyparambil Aravindakshan Pramodkumar, Rajendra Pradeepa, Subramani Poongothai, Somasundaram Thenmozhi, Ulagamathesan Venkatesan, Saravanan Jebarani, Ranjit Mohan Anjana, Viswanathan Mohan
DOI
:10.4103/jod.jod_85_22
Background and Aims:
The impact of a chronic illness like diabetes on physical and mental wellbeing has been gaining more focus in the last few decades. This study aimed to investigate the association of stress, depression, and anxiety among individuals with type 2 diabetes mellitus (T2DM) and microvascular complications.
Materials and Methods:
This cross-sectional study included 315 participants aged ≥20 years with T2DM seen at a tertiary care diabetes centre who were screened for diabetic retinopathy, nephropathy, and neuropathy and assessed for stress, depression, and anxiety using the Depression, Anxiety Stress Scale 21 (DASS 21). Diabetic retinopathy was classified according to the Early Treatment Diabetic Reinopathy Study grading system diagnosed using retinal photography [Early Treatment DR Study grading system] i.e., presence of at least one distinct microaneurysm; nephropathy, if urinary albumin excretion was ≥30 mg/μg of creatinine; and neuropathy, if vibration perception threshold of the big toe using biothesiometry was ≥20 V.
Results:
Prevalence of stress was higher in those with neuropathy (60% vs 40%,
P
< 0.001), nephropathy (61% vs 39%,
P
< 0.001) and retinopathy (57% vs 43%,
P
< 0.05) compared to those without. Prevalence of depression was also higher in individuals with neuropathy (66% vs 34%,
P
< 0.001), nephropathy (58% vs 42%,
P
< 0.001) and retinopathy (55% vs 45%,
P
< 0.05). In multiple regression analysis, stress was significantly associated with retinopathy (OR=3.13,CI:1.75–5.58,
P
< 0.000), neuropathy (OR=2.50, CI:1.42–4.39,
P
< 0.001) and nephropathy (OR=2.06,CI:1.19–3.56,
P
< 0.010),depression was also significantly associated with retinopathy (OR=1.97,CI:1.04–3.73,
P
< 0.037), neuropathy (OR=2.77,CI:1.45–5.30,
P
< 0.002) and nephropathy (OR=2.59,CI:1.42–4.70,
P
< 0.002).
Conclusions:
Individuals with microvascular complications of diabetes should be screened for stress, depression,and anxiety so that proper counselling can be given.
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A prospective study to evaluate the effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetic patients with chronic kidney disease
p. 301
Neil Saldanha, Mita Shah, Monika S Dalal, Zaheer Amin Virani, Ishan Parekh, Hepal Vora, Prashant Rajput, Shruti Tapiawala, Bharat V Shah
DOI
:10.4103/jod.jod_66_22
Introduction:
Recent studies suggest that sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective at slowing the progression of kidney disease and lowering the risk of kidney failure in people with kidney disease and type 2 diabetes. There is no such study from India. The present study was performed to evaluate the effects of SGLT2i in Indian patients with diabetes and chronic kidney disease (CKD).
Materials and Methods:
This prospective study included 86 patients with diabetes and chronic kidney disease and with an estimated creatinine clearance of >30 mL/minute. Forty-one patients received SGLT2i and 45 patients did not receive SGLT2i. Patients were followed up for at least 12 months. Body mass index (BMI), blood pressure, HbA1c, urine protein to creatinine ratio (UPCR), doubling of serum creatinine and rate of decline of the estimated creatinine clearance were compared between the two groups.
Results:
The two groups were comparable at baseline in terms of age, sex, blood pressure, BMI, HbA1c, and degree of renal impairment. Over 12 months the UPCR decreased by 0.03 in SGLT2i group and increased by 1.1 in non SGLT2i group (
P
< 0.05). Doubling of serum creatinine occurred in 4.8% of patients in the SGLT2i group as compared to 18% in the control group (
P
< 0.05). The rate of decline of the estimated creatinine clearance in the SGLT2i group was 4.9 ml/min/year as compared to 9.4 ml/min/year in the non SGLT2i group (
P
< 0.05). At 12 months the BMI in the SGLT2i group decreased by 1.49 as compared to 0.12 in the non SGLT2i group (
P
< 0.05). The blood pressure and HbA1c control were similar in both groups during the study period suggesting that the observed effect was due to SGLT2 inhibition itself and not due to blood pressure or blood glucose control.
Conclusion:
Our study showed that treatment with SGLT2i had significant renoprotective effects, as shown by a reduction in urinary protein excretion, less percentage of patients developing doubling of serum creatinine, and a slower rate of decline in creatinine clearance.
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CASE REPORTS
Diabetic striatopathy: A rare entity
p. 305
Prabhat Kumar Agrawal, Akhilesh Kumar Singh, Nikhil Pursnani, Upendra Kumar Verma
DOI
:10.4103/jod.jod_38_22
Diabetic striatopathy is a rare clinico-radiological phenomenon characterized by hemichorea/hemiballismus, hyperglycemia, hyperosmolarity in the absence of ketoacidosis. It is due to lesion in contralateral basal ganglia which is evident as T1 hyperintensity in MRI brain study. Here we are reporting a case of hemichorea /hemiballismus which was associated with hyperglycemia. Our patient improved significantly once blood glucose was controlled adequately. As it carries good prognosis,
we are reporting this
rare case
to
illustrate the importance of recognition of this rare syndrome.
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Pancreatogenic diabetes mellitus (type 3cDM): Due to chronic alcoholic pancreatitis having hepatitis B antigen positivity presented with ketoacidosis-A case report
p. 309
Jitendra D Lakhani, Kshitij Sanjay Kumat, Archie U Shah, Sachin R Gadiya
DOI
:10.4103/jod.jod_63_22
Pancreatogenic diabetes (T3cDM) is a secondary form of Diabetes mellitus (DM) where exocrine pancreas is the cause of disease. A case of young male, known diabetic and having alcohol use disorder (AUD),with features suggestive of T3cDM is presented here. He had generalized body ache, abdominal discomfort and loss of weight. On presentation he had diabetic ketoacidosis and severe hyperglycemia. His USG abdomen and CECT abdomen showed multiple small foci of calcifications in pancreas which was suggestive of chronic pancreatitis. His random C-peptide level was low and GAD antibodies were negative. He had hepatitis B antigen positivity. He had malabsorption and malnutrition suggestive of exocrine pancreatic dysfunction. The case is presented here for three reasons,(I)to highlight the possibility of misdiagnosis or under diagnosis,(ii) his presentation was with ketoacidosis which is not very usual and (iii)
in view of searching evidence for possible association to hepatitis B antigen positivity.
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Sitagliptin-induced hiccups: A rare side effect
p. 312
Prabhat Agrawal, Ashish Gautam, Nikhil Pursnani
DOI
:10.4103/jod.jod_69_22
Background:
Hiccups are a normal physiological response, but sometimes they become a cause of social embarrassment.
Materials and Methods:
A 72-year-old male who is a known case of type II diabetes mellitus for the last 6 years came to our outdoor department with complaints of hiccups. Currently, he was on Glimipride 2 mg daily for the last 6 years and on Sitagliptin 100 mg daily for the last 6 months.
Results:
On stopping Sitagliptin himself, his hiccups stopped.
Conclusion:
Hiccups are regarded as a normal behavior and time-limited symptom but if prolonged or intractable, a thorough history and investigation must be done to find out the cause which might lead to serious consequences. Most probably, this is the first case report showing that Sitagliptin is the cause of hiccups.
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Serious adverse effects following use of liraglutide in individuals with type 2 diabetes
p. 314
Benjamin M Easow, Milly Mathew, Urjitha Rajagopalan, P Nagarajan, Georgi Abraham
DOI
:10.4103/jod.jod_78_22
Glucagon-like peptide-1 (GLP-1) analog liraglutide is extensively used for type 2 diabetes mellitus, especially in those with overweight and cardiovascular risk factors. The risk benefit ratio favors their use. The life-threatening complications such as cholecystitis and pancreatitis are infrequently reported. Here we report two patients who developed recurrent gallstone diseases with cholestatic jaundice and acute pancreatitis in a male patient and an asymptomatic large gallstone stone in a female kidney transplant patient with no previous evidence of gallstone disease. This highlights the importance of surveillance screening in patients on liraglutide to prevent the development of complications.
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