Aim: The aim of this study is to evaluate the knowledge of gestational diabetes mellitus (GDM), including risk factors, importance of screening and post-partum follow-up, amongst pregnant women attending antenatal care in maternity clinics in South India. Methodology: The study participants were recruited from two antenatal clinics in Chennai and a few primary healthcare centres in South India. A detailed questionnaire was used to obtain basic data regarding general awareness and knowledge about GDM and other issues related to screening, risk factors, monitoring, long-term consequences and post-partum follow-up. Education status was graded as illiterate, primary education, secondary education and graduates. A composite score for knowledge of GDM was calculated. Results: A total of 100 pregnant women attending antenatal clinics were interviewed, of whom 59 were from urban Chennai and the rest from Kanchipuram district. Regarding risk factors of GDM, 48.8% of rural women were unaware of any risk factor while 55.9% of urban women reported a family history of diabetes as a risk factor. 49.2% of urban women and 75.6% of rural women did not know the long-term consequences of GDM to babies born to GDM women. 50.8% (urban women) said GDM could lead to type 2 diabetes mellitus in future while only 45% of rural women were aware of this. Mean composite score increased with higher education with graduates in both urban and rural areas, scoring the highest. Conclusion: Knowledge about GDM is poor amongst pregnant women, especially in rural areas. This highlights the need for training physicians, paramedical people and the public regarding GDM.

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Background: Vernonia amygdalina (VA) is used in the traditional management of diabetes in Nigeria. Previous scientific verification of VA is on Type-1 diabetes model, in spite of the continuous increase in Type-2 diabetes (T2D) among adults. This study aimed to validate the antidiabetic effects of VA leaf fraction (VALF) in a unique T2D rat model. Materials and Methods: Methanol crude extract of VA leaf was fractionated with solvents of increasing order of polarity (n-hexane, chloroform, ethyl-acetate, n- butanol and water). The antidiabetic activities of the fractions were evaluated in vivo in T2D model rats. Albino Wistar rats were induced with T2D and treated with the VALF. Several T2D-related parameters were measured. Results: T2D rats showed significant increase in serum levels of fasting blood glucose (FBG), liver and kidney biomarkers. At 28-day post-oral treatment with the VALF, FBG levels were significantly (P < 0.05) reduced (n- hexane [29.3%], chloroform [66.7%], ethyl acetate [36.2%], n- butanol [45.59%] and aqueous [39.3%]). The glucose tolerance ability was significantly improved in the chloroform fraction (Vernonia amygdalina chloroform fraction [VAc])-treated groups compared to the other fractions-treated group and diabetic control group. Furthermore, the VAc was found to be most effective as it ameliorates most of the alterations caused in the studied parameters in diabetic rats when compared with n- hexane, ethyl acetate, n- butanol and aqueous fractions. Conclusion: The study validates the anti-diabetic effects of VALF in fortified diet-fed streptozotocin-treated rat model of T2D, and suggests that the VAc is a potential candidate for development of a more effective drug for the management of T2D.

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HIV has remained a major global public health concern for more than three decades. While global efforts are coalesced in the fight against HIV, the number of people living with HIV (PLHIV) is continuously increasing due to the rollout of antiretroviral therapy (ART). This relates, in part, to the intensified efforts in HIV prevention and control strategies through extensive HIV testing. Consequently, more and new people have learnt their HIV-positive status, implying that more are at risk of suffering the negative effects of HIV and ART. HIV has been implicated in the development of many non-communicable diseases such as cardiovascular diseases and type 2 diabetes mellitus (T2DM). This study conducted a critical review of the literature on the mechanisms through which HIV and ART cause metabolic syndrome, and the implications such understanding has to the care provided to PLHIV. The findings of this review suggest that HIV induces metabolic syndrome through stimulation of immune cells which, in turn, trigger an inflammatory response. ART also triggers the inflammatory response. The inflammatory response suppresses adiponectin and causes impaired insulin action on skeletal muscles. Since the presence of metabolic syndrome greatly increases the risk of non-communicable diseases, particularly T2DM, there is a need for metabolic syndrome screening and prevention among PLHIV. Conducting routine body mass index and waist circumference measurement with periodical triglycerides measurement is necessary for the early detection of metabolic syndrome and the prevention of T2DM and cardiovascular conditions. There is also a need for a model of care for PLHIV that will provide guidance on the prevention of metabolic syndrome hence prevent the development of T2DM with its dire effects on the quality of life.

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Background: Vitamin D deficiency is known to be involved in the development of insulin resistance and type 2 diabetes (T2D), and the functions of Vitamin D are mediated through Vitamin D receptor (VDR). Only a few reports are available in the Asian Indian population highlighting the role of VDR polymorphism in diabetes. We aimed to investigate the association of VDR gene polymorphisms (TaqI, BsmI and FokI) with prediabetes (PD) and T2D and their relationship with anthropometric and biochemical parameters in Asian Indians. Subjects and Methods: In this study, 454 participants including 147 with normal glucose tolerance (NGT), 145 with PD, and 162 with T2D were enrolled in this study. Genetic variants of the VDR were genotyped using polymerase chain reaction-restriction fragment length polymorphism method. Anthropometric measurements were done in all participants. Results: The most common genotypes for TaqI, BsmI, and FokI were TC, GA, and CC, respectively. The allele distribution of TaqI differed significantly when compared between NGT and T2D group. A significant protection was shown against T2 in VDR TaqI genotypes after adjusting for age, gender, and Body Mass Index. The levels of homeostatic model assessment for insulin resistance, fasting insulin, and the waist-hip ratio were significantly higher in TT genotype when compared with TC + CC genotype of TaqI polymorphism in NGT. In PD group, the levels of serum cholesterol and low-density lipoprotein cholesterol were significantly higher in AA genotype when compared with GA + GG genotype in BsmI polymorphism. Conclusions: The study indicates VDR TaqI, and BsmI polymorphisms seem to influence anthropometric and biochemical parameters, and in particular, VDR TaqI polymorphism offers protection against T2D in Asian Indians.

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We have numerous technologies that can help keep a close watch on an individual's glycaemic status and thereby assist in developing successful diabetes management strategies. For more than five decades, self-monitoring of blood glucose (SMBG) has remained as the gold standard tool to manage glycaemic status and has gained huge acceptance. Rigorous research further led to the development of more and more advanced technologies such as continuous glucose monitoring and flash glucose monitoring. These novel technologies are more promising in terms of revealing the complete glycaemic picture and even more user-friendly than the already established blood glucosemetres. However, they are yet to achieve remarkable accuracy and performance. There will also be a subgroup of patients who will be using these technologies only occasionally and thus will definitely require SMBG at other times. Again, with regard to the retrospective ones, glucose data can be obtained only once they are downloaded to the system and hence, real-time values will still have to be procured with the help of an SMBG. In future when the accuracy and performance of these newer technologies become equal to that of glucometres, the glucometres might vanish. Until then, all these technologies will definitely go hand-in-hand and supplement each other than competing each other. All the related literature were retrieved from various databases including 'PubMed' and 'Cochrane Database of Systematic Reviews' using specific search terms that were relevant to the topics discussed this manuscript.

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Epidemiological studies show an emergence of diet- and lifestyle-related diseases; Cardio-metabolic diseases (CMD) and neuropsychiatric diseases (classified as non-communicable diseases or chronic diseases). Diet and lifestyle factors can cause adverse effects on autonomic function resulting in decreased heart rate variability (HRV). Low HRV is a risk factor for CMDs. There is a need to find out new methods of early diagnosis for prevention and treatment of these problems because the neurohormonal dysfunction could be the earliest manifestation. It is possible that HRV could be a marker for the early diagnosis of these problems, because it is characterised with increased sympathetic and reduced parasympathetic activity. Several studies indicate that increased unhealthy diet, mental stress, sedentary lifestyle, tobacco, insomnia and alcoholism may be associated with neurohormonal dysfunction, which may cause decline in HRV. Majority of the chronic diseases (e.g., diabetes, hypertension, heart attack, neuropsychiatric disease and cancer) are associated with decreased HRV. The studies also indicate that solar and geomagnetic activities may influence circadian clock and hypothalamus resulting in the oxidative stress and inflammation with alteration in HRV. It is possible that reduced HRV will correlate with various stages of autonomic dysfunction, associated with chronic diseases. Simple methods need to be developed to measure HRV for early diagnosis of neurohormonal dysfunction, which may be important for early management. This review aims to find out available evidence on the role of HRV in the early diagnosis of chronic disease (with specific focus on Type 2 diabetes) and the factors affecting HRV.

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Background and Objective: Incidence of gestational diabetes mellitus (GDM) varies globally from 2% to 14%. These cases in India are also increasing and emerging as a major public health problem. The prevalence of GDM among urban population of India has been reported as 16% and 17.8%, respectively. We conducted this study at three different regions of North India to estimate the prevalence of GDM. Materials and Methods: This pilot prospective cross-sectional study was conducted at three centres of North India with a base at Max Super Speciality Hospital, Saket, New Delhi, over a period of 10 months (December 2015–October 2016). Pregnant females attending gynaecology clinic at these centres were screened and enrolled as per the study inclusion criteria, after taking informed consent. Medical records were reviewed for recent haemoglobin levels, fasting blood sugar levels and other clinical parameters. Results: A total of 230 participants were enrolled in this study with 65 from Muzaffarpur, 65 from Bhilai and remaining 100 from Delhi, which include a mixed population. The overall prevalence of GDM was observed as 10%, with a regional prevalence of 10.77% at Bhilai, lower prevalence at Muzaffarpur (3.07%) and 14% in Delhi with a mixed population. A significant difference (P < 0.01) was observed in the mean age and body mass index of participants at Bhilai, Muzaffarpur and Delhi. Conclusion: Although there was a variable sample size at these three centres, we could conclude from this pilot study that there is a high prevalence of GDM at Bhilai district while very low prevalence at Muzaffarpur and Bihar. Large-scale studies are required to be done to estimate the prevalence in these regions, which would ultimately create awareness among clinicians to screen all females for GDM.

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Background: Currently, 93 million people are estimated as living with diabetic retinopathy (DR) worldwide. The incidence, retinopathy-free survival time and associated factors of DR in developed countries have been well documented; but in Ethiopia, national data on incidence and associated factors of DR are lacking. Objective: The objective of this study is to determine incidence and factors associated with the development of DR among diabetic patients at Arbaminch General Hospital, Ethiopia. Materials and Methods: Longitudinal follow-up data analysis with record review of 400 diabetic patients was conducted at Arbaminch General Hospital. Among 400 diabetic patients, 270 diabetic patients with baseline information and without a history of hypertension at baseline were included in this study. Whereas, pregnancy induced diabetes and patients with retinopathy at baseline were excluded from this study. Consecutive sampling technique was applied to select study participants. Data of cohorts were extracted from medical record using pre-tested structured extraction checklist. Data cleaning, coding, categorising, merging and analysis carried out by STATA version 12. Descriptive statistics was done and summarised accordingly. Bivariate Cox proportional hazard regression analysis was done to select potential candidates for the full model atP ≤ 0.25 and multivariable Cox proportional hazard regression analysis was made to estimate the independent effect of predictors on the incidence of DR. Model diagnostic tests were performed and final model fitness was checked by Cox and Snell residuals; finally, statistical significance was tested atP < 0.05. Results: Overall incidence of DR at Arbaminch General Hospital among diabetic patients ever enrolled since 1990 E.C. was ~36 cases per 1000 patients per year and an estimated median time to develop was approximately 10 years. The incidence of diabetic retinopathy was high among patients whose disease duration was >12 years. Adjusted analysis showed that the hazard of developing DR was statistically and positively associated with baseline age, baseline systolic blood pressure (SBP) level and fasting blood glucose (FBG) level. Conclusion: In the current study, the incidence of DR was high. Since baseline age, baseline SBP level and high FBG level were statistically and positively related with the development of DR; special care should be given in addition to routine care.

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Dipeptidyl-peptidase-4 inhibitors (DPP-4Is) are very commonly prescribed antidiabetic agents in the treatment of type 2 diabetes owing to its modest ability to reduce blood glucose without ensuing any hypoglycemia and weight gain. Many experts have advised continuing DPP-4Is in patient with type 2 diabetes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). In addition, several researchers have proposed DPP-4Is to be used as a repurposed agent for COVID-19 not only for the patients with diabetes but also for those without diabetes. We aimed to review as to what could be the reason behind this approach and how does the use of DPP-4Is alter the outcome in patients with type 2 diabetes and COVID-19.

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Background: Several single-nucleotide polymorphisms (SNPs) have been associated with the metabolism of Vitamin B12, folic acid, homocysteine and lipids. However, the interaction between SNPs involved in the one-carbon metabolism pathway and macronutrient intake on cardiovascular risk factors in the Brazilian population has not yet been investigated. Hence, the present study examined whether the association of ten SNPs involved in the one-carbon metabolism pathway with Vitamin B12, folic acid, homocysteine and lipid levels is modified by dietary factors and physical activity in adolescents with cardiovascular risk. Materials and Methods: A total of 113 adolescents (10–19 years old), from a public school in the city of Goiânia, Goiás, Brazil, underwent anthropometric, biochemical and food consumption evaluations and genetic tests. Results: After adjusting for potential confounders, SNPs rs4633 (catechol-O-methyltransferase, COMT), rs602662 (fucosyltransferase 2, FUT2) and rs1801394 (5-methyltetrahydrofolate-homocysteine methyltransferase reductase) showed significant associations with folic acid (P = 0.042), Vitamin B12 (P = 0.009) and oxidised low-density lipoprotein (ox-LDL) (P = 0.041) concentrations, respectively. The COMT SNP rs4680 showed a significant interaction with carbohydrate intake on ox-LDL concentrations (P_interaction = 0.005). In addition, the FUT2 SNP rs602662 showed a significant interaction with protein intake on homocysteine concentrations (P_interaction = 0.007). However, after correction for multiple testing, none of these associations and interactions were statistically significant. Conclusions: For the first time, we provide evidence for the interactions between COMT SNP rs4680 and carbohydrate intake on ox-LDL levels and the FUT2 SNP rs602662 and protein intake on homocysteine concentrations. However, replication of our results in a larger sample size is required to confirm our findings.

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Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes mellitus that occurs in the first 6 months of life. It is a rare condition with a prevalence of 1 in 100,000–500,000 live births. We report a 3-month-old girl child with high blood glucose levels. She was diagnosed with diabetes mellitus during the 28^th day of life and was on treatment with insulin. She was admitted for the control of high blood glucose levels during which she was started on multiple daily insulin treatment, but the control had been poor. As the age of onset is <6 months of life, genetic analysis has been done. It revealed the presence of a heterozygous mutation p. Gly334Val (p. G334V) in KCNJ11 gene which confirmed the diagnosis of NDM. The child was successfully shifted from insulin to sulfonylureas, and the blood glucose levels are well maintained.

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The world is suffering from a pandemic of coronavirus disease-2019 (COVID-19), and people with diabetes mellitus (DM) are more vulnerable to the serious effects of the COVID-19. This interaction is alarming, considering the high transmission rate of COVID-19 and the global prevalence of DM. Considering the importance of the link between COVID-19 and DM, Bangladesh Diabetic Association has formed a panel of national and international experts in the field of public health, diabetes, and endocrinology to provide some evidence-based guidance for the prevention and care of people with DM during the COVID-19 pandemic.

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Background: Nigeria had the highest number of people living with diabetes mellitus in the African region in year 2013. Previous researchers have found that patients with knowledge of their diseases including their treatment methods have a high likelihood to succeed in managing the disease conditions. Many pharmaceutical care programmes which have been successfully applied in various countries to enhance clinical outcomes and health-related quality of life are not very common in Nigeria. Objective: This study was to evaluate pharmacist's educational and counselling impact on diabetic patients' outcomes in a diabetic setting. Materials and Methods: The 4-month randomised controlled study involved 150 elderly Type 2 diabetic patients. Sociodemographic and clinical parameters were measured. We educated and counselled the 75 patients in our intervention group at least four times during the study period, but the control group was deprived of the pharmacist's intervention. Results: Female to male participants was in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority (>40%) of the patients in both groups had primary education. Baseline and 4-month mean fasting blood sugar in the control group was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825), whereas the intervention group had 156.7 ± 30.5 and 131.8 ± 40.4, respectively (P < 0.001). Mean systolic blood pressure in both groups was 146.4 ± 13.9 and 133.8 ± 18.5 (P < 0.001), respectively. Adherence levels to medication taking in both groups were 42.7%:94.7%, respectively (P = 0.001). Conclusion: This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.

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Background: Diabetes mellitus (DM) is recognised as an important risk factor for tuberculosis (TB). India has high-TB burden, along with rising DM prevalence. Aim: This study was conducted to document the co-existence of DM and TB in persons with established TB and difference in clinical presentation. Type of Study: This was a cross-sectional, descriptive observational study conducted at selected directly observed treatment (DOT) centre in Gwalior North-Central India. Materials and Methods: A total of 550 patients of confirmed diagnosis of TB and on treatment were recruited. The study participants were screened for DM and diagnoses were made on the basis of the World Health Organization criteria. Clinical parameters were compared between persons with DM and those without DM. Results: DM/TB comorbidity was noted in 85 persons, and these made up 15.4% of the study population. Mean age was higher in DM patients with TB (43.4 ± 15.4 vs. 33.1 ± 16.2 years, P = 0.000); the mean duration of symptoms of TB with DM was more (124 ± 16.4 vs. 107.49 ± 10.3 days). Majority of the patients (63.5% dysglycaemic and 43.6% normoglycaemic TB patients) were presented with a cough with or without expectoration and significantly found more in dysglycaemic TB patients (odds ratio = 2.2, P = 0.007). The frequency of reporting symptoms was higher among dysglycaemic TB patients as compared to normoglycaemic TB patients. This difference in both groups was found to be statistically significant (P < 0.05) for pleural effusion, fever, shortness of breath, chronic abdominal pain, fatigue/weakness and in other non-specific symptoms. Conclusions: Given the substantial burden of DM and TB co-morbidity, this study makes a contribution for re-echo the need to raise awareness on screening for DM in persons with TB.

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The economic burden of human immunodeficiency virus (HIV) and diabetes shows the need to design interventions to delay the development of type 2 diabetes in HIV-positive population. In 2015 alone, approximately US$19 billion was spent in the HIV/acquired immunodeficiency syndrome response in low- and middle-income countries. Approximately 57% of the total HIV resources in low- and middle-income countries come from the local government budgets. Rising numbers of new HIV infections in many countries mean that US$26.2 billion will be required for the response to the epidemic in 2020. On the other hand, the cost of diabetes mellitus alone is projected to be US$745 billion by 2030 and approximately US$300 billion is estimated to be the cost incurred in low- and middle-income countries. People diagnosed with diabetes at the age of 40 years spent US$124,600 more than those without diabetes over their remaining lifetime. The co-occurrence of type 2 diabetes and HIV increases the economic burden at patient and country level, hence there is a need to identify interventions for preventing diabetes among people living with HIV. This review has shown that both lifestyle and pharmacologic interventions are proven effective and cost-effective. Lifestyle modification, metformin intervention, and diabetes surveillance among people living with HIV are cost-effective strategies that can effectively prevent the development of diabetes in this population. There is also a need for the health policy to support the implementation of these strategies. Health and social policies should support the funding of intensive lifestyle and metformin interventions for diabetes prevention in high-risk groups.

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South Asians are reported to have a higher risk of developing macrovascular complications of Diabetes, i.e., coronary artery and cerebrovascular diseases as compared to Caucasians. Literature evidence has shown that among the currently available agents, the sodium/glucose cotransporter 2 inhibitors (SGLT2i) offer a rational approach for management of T2DM over other glucose lowering therapies because of their insulinindependent action, modest weight loss, mild reduction in BP and low risk of hypoglycaemia. Recently, CVDREAL 2 study was conducted across six countries (Israel, Canada, South Korea, Japan, Singapore and Australia) to determine the CV benefits of various SGLT2i in >400,000 T2DM patients in a realworld scenario. Around 75% of the patients in this study were from the AsiaPacific region. Among all the available SGLT2i, most of the study population was exposed to dapagliflozin, contributing to 75% of the total exposure time. The CVDREAL 2 study favoured SGLT2i over other glucose lowering drugs for lower risk of death, HHF, MI and stroke. All these points suggest that the results of CVDREAL 2 study can be incorporated in the high CVD risk Indian population who need much more aggressive treatment for diabetes than other patient populations.

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Objective: Diabetes and depression are two major non-communicable diseases that have increased in epidemic proportion globally. Depression is common in participants with diabetes causing increased morbidity and mortality. This article aimed to review co-morbid depression in participants with type 2 diabetes (T2D) in Southeast Asia. Methods: We conducted a systematic review of published literature on the prevalence of depression among adult patients with T2D in Southeast Asia. A comprehensive search was performed using PubMed, Google Scholar and BanglaJOL for published studies between 1990 and 2014 with full text available in English. Study selection and data extraction were conducted independently by two researchers. A formal meta-analysis was not performed, and only summary findings of the relevant studies were presented. Results: A total of six studies including 3837 participants were included. The prevalence of depressive symptoms among participants with T2D ranged from 14% to 41%, with the highest prevalence of 60.8% among female T2D patients in Pakistan. The pooled prevalence of depressive symptoms in participants with T2D was 27.7% (95% confidence interval 21.4%–34.0%). Depressive symptoms were higher among females in four studies and associated with increasing age. Conclusion: Our review shows a high prevalence of depressive symptoms among participants with T2D in Southeast Asia. Further research is needed to clarify the association between depressive symptoms and diabetes in this population group, and efforts for prevention, early diagnosis and optimum management through innovative mechanisms of both conditions are warranted.

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Aims: The aim is to study the effect of glycaemic control by canagliflozin and its effect on insulin resistance (IR) and plasma ketone in type 2 diabetes mellitus (DM). Settings and Designs: The study was done at the Diabetes Clinic, General Medicine Department of the hospital. The study designed to be a prospective observational open-label study. Subjects and Methods: The study was conducted in 60 patients for 3 months. The patients were divided into two groups test and standard. Canagliflozin is given to test over- and above-standard treatment, and standard group is given to the standard treatment. Blood samples are collected at the beginning and at the end of the study. Parameters such as body weight, waist circumference, fasting blood glucose, haemoglobin A1c (HbA1c), plasma ketone and homeostatic model assessment-IR (HOMA-IR) were analysed. Statistical Analysis Used: Data obtained from the present studies were collected and analysed statistically using software IBM SPSS version 21. Results: Various parameters such as HbA1c and weight loss showed a significant difference before and after the study in both standard and test group, respectively. Whereas, other parameters such as HOMA-IR, waist circumference and fasting blood sugar levels showed significant difference only in the test group. Conclusions: Canagliflozin provided better glycaemic control in type 2 DM patients along with decreased IR and marked weight loss. Increased plasma ketone levels were noted during the course of the therapy to an extent which can be used up by the body as a fuel and not cause ketoacidosis.

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Background: There is a paucity of literature on epidemiology of type 1 diabetes (T1D) in Sri Lanka. This study reviews the characteristics of patients registered in an insulin bank programme in Sri Lanka. Materials and Methods: Data were collected and analysed from records of all 672 patients diagnosed with T1D registered in the insulin bank with dates of the diagnosis ranging from 1971 to 2016. Results: Of the 672 patients, age at the diagnosis ranged from the day of birth to 44 years. The majority of patients, 526 (78.3%) were diagnosed before 15 years of age, with 7 (1.0%) cases diagnosed before 6 months. Females accounted for 56.8% of cases. The ethnic distribution of T1D in the study population was consistent with the overall population. Conclusion: This study gives some insight into the epidemiological features of T1D in young people in Sri Lanka. The peak age at the diagnosis is similar to studies in the western countries. This study also demonstrated a slight female predominance and a small but significant number of cases diagnosed in infancy. Further epidemiological and clinical research would help guide organisation of care and distribution of resources in the management of T1D in Sri Lanka.

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Background: Peripheral neuropathy (PN) is a risk factor for foot disease in type 2 diabetes mellitus (T2DM). There are scanty data on prevalence of PN and its clinical correlates in Nigerian T2DM subjects without neuropathic symptoms. Objectives: To evaluate the prevalence and clinical correlates of PN diagnosed using objective methods in T2DM subjects without symptoms of PN. Materials and Methods: This is a cross-sectional study involving T2DM subjects at the Diabetes Clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. History was obtained and physical examination done on subjects. Fasting plasma glucose (FPG) done on the day of assessment and values of glycated haemoglobin (HbA1c), and fasting lipid profile done within the preceding three months- were obtained from subjects' clinic folders. Diabetic Neuropathy Symptom Score (DNSS) was used to identify subjects without neuropathic symptoms. PN was diagnosed using tuning fork, and two biothesiometers. Data collection was done using researcher-administered study proforma. Data were analyzed using SPSS version 20. Results: 524 subjects [244 (46.6%) males and 280 (53.4%) females] were recruited for the study. 223 (42.6%) of these subjects did not have neuropathic symptoms and PN tested further with 3 objective methods. PN prevalence with tuning fork, analog and digital biothesiometers were 71.5%, 14.8% and 14.8% respectively. All clinical variables evaluated were poor predictors of PN (P > 0.05). Conclusion: PN diagnosed by objective methods is present in South-Eastern Nigerian T2DM subjects who do not have symptoms of PN. Tuning fork diagnosed PN much more than the other methods reflecting its subjectivity.

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Context: Professional continuous glucose monitoring (P-CGM) has been approved for use in adults and adolescents with type 1 diabetes mellitus (T1DM). There is dearth of data on its use and feasibility in children <10 years of age. Aims: The aim is to study feasibility and acceptability of P-CGM with iPro™2 in children (<10 years) with T1DM. Settings and Design: Prospective observational study was conducted in out-patient setting of Paediatric Diabetes clinic at tertiary care Paediatrics centre. Subjects and Methods: The study was conducted among 42 children (2–10 years) with T1DM. Children underwent P-CGM (iPro™2 Professional CGM, Medtronic, USA) for 3–5 days after informed consent. P-CGM data was analysed to guide diabetes management. Pre-defined criteria for feasibility and acceptability of P-CGM were assessed. Statistical Analysis Used: Frequencies and proportions (expressed as percentages) of children with specific outcomes related to feasibility and acceptability were calculated. Results: A total of 47 sensors were used for 42 patients. Three patients underwent repeat P-CGM as recording was <48 h on the first attempt. Two sensors were damaged while insertion. Average duration of P-CGM recording was 84.6 h. Premature accidental sensor removal occurred in 2 (4.8%) among 7 (16.7%) children who reported fixing and stability problems. Three calibrated paired glucometer readings per day (for quality of P-CGM data) were seen in 40 (95.2%). Mean absolute difference of <28% was seen in 35 (83.3%) and correlation coefficient of >70% was seen in 31 (73.8%) children. Common adverse events were local redness in 11 (26.2%), local irritation in 16 (38.1%) and parental anxiety in 12 (28.5%) children. Conclusions: There were no significant adverse effects noticed with Professional CGM (using iPro™2) and is feasible and acceptable to children (2–10 years) with T1DM as well as their caregivers.

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The International Diabetes Federation is divided into seven regions, Africa (AFR), Europe (EUR), Middle East and North Africa (MENA), North America and Caribbean (NAC), South and Central America (SACA), South East Asia (SEA) and Western Pacific (WP), with the aim of enhancing the work of national diabetes associations and strengthening the collaboration between them. In the MENA region, adult population (aged 20–79 years) was estimated 387 million in 2015 from which 35.4 million were suffering from diabetes and is expected to increase up to 72.1 million in 2040. Of the 35.4 million people affected by diabetes, nearly 40.6% were estimated to be undiagnosed. Therefore, at considerable risk of diabetes complications and poor health outcomes. The importance of glycemic control in preventing and delaying the progression of diabetes complications is well well-known. Diabetes poses extreme financial load to diabetic subjects. Local guidelines help to upgrade management strategies. It provides ideas for health care providers to improve quality of life of patient. Guidelines were prepared reviewing the literature, reviewing the available guidelines, consultative meetings between the experts and country representatives from the region.

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