Background: Diabetes is endemic with developing economies contributing to the bulk of this pandemic. Despite the evidence of incremental benefit of glycemic control starting early in life, acceptance of and adherence to modern medications remain suboptimal. Aims: To determine the hemoglobin A1c (HbA1c)-lowering efficacy and safety of nutritional supplement, PreCrea ® , in adult Indians with newly diagnosed hyperglycemia. Materials and Methods: Double-blind, randomized study conducted in six diabetes centers in India. A total of 193 treatment-naïve subjects with newly diagnosed hyperglycemia and fasting plasma glucose (FPG) >100 mg/dL were randomized into either PreCrea ® 600 mg (n = 90) or matched placebo (n = 89) capsules twice daily, along with lifestyle modification, for 12 weeks. The main outcomes were changes in HbA1c and FPG levels, attainment of the American Diabetes Association (ADA)-defined goals for HbA1c, and clinical and biochemical measures of safety. Results: At 12 weeks, mean HbA1c in PreCrea ® group reduced by 0.91% compared with 0.08% increase in the placebo group (P < .001). The reductions in the mean FPG at week 4 (P < .001) and week 12 (P = 0.04) were significant compared to the baseline. ADA goal of HbA1c <7% increased from 15.5% at the baseline to 35.6% at week 12 in PreCrea ® subjects. Clinical safety and biochemical safety did not change. Hypoglycemia and weight gain were not observed with PreCrea ® . Conclusions: Nearly 1% point reduction in HbA1c at week 12 with PreCrea ® is comparable with most first-line glucose-lowering drugs. The safety and tolerability of PreCrea ® highlights its potential as a first-line therapy in newly detected hyperglycemia.
The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population in the Asian region.
Background: There is a bidirectional relationship between COVID-19 and diabetes. New-onset diabetes and severe metabolic complications of pre-existing diabetes in patients with COVID-19 have been observed. Steroids are medications used for treatment of several diseases, including COVID-19. Its pharmacological action increases blood glucose and poses additional challenges in the management. Aim: To study the impact of steroids on newly detected diabetes patients with a history of COVID-19 in a cohort group. Method: 2263 patients from 15 different sites across India were analysed following a specific eligibility criterion. The patients were segregated into three groups - No steroids, Low steroids [less than or equal to the median dose (50mg)], and High steroids [greater than the median dose (50mg)]. Two-way Analysis of Variance (ANOVA) test was used to test the relationship between Diabetes status and Steroid usage. Results: The steroid dosage for the management of COVID-19 in the Newly-Detected Diabetes (NDD) group received higher doses of steroids. All steroid doses were adjusted and standardized to prednisolone 5mg. The average maximum doses of steroids used in the management of COVID-19 for NDD was 86.6 mg/day. Within the NDD group, those who received a lower steroid dose had a higher HRCT score as compared to the No steroid and High steroid groups. Also, amongst all patients who did not receive steroids for management of COVID-19, NDD had a statistically higher HRCT score. Conclusion: The prevailing hypothesis that increased application of steroids causes diabetes-like disease spectrums in patients recovering from COVID-19. The findings however require reconsidering steroid usage as the leading cause of COVID-induced diabetes.
Introduction: Type 1 diabetes (T1D), especially in children, demands continuous attention and support from parents. Managing T1D can be a herculean task, which could even affect parenting. These challenges could become intense when the child reaches adulthood. In this study, we aim to understand the emotional and social dimensions experienced by parents raising children diagnosed with T1D, shedding light on the multifaceted challenges they encounter in fulfilling this crucial caregiving role. Methods: As part of the Kesavadev Trust Type 1 Diabetes Project Sweet Stars initiative, an ongoing project since 2016, a T1D education camp was organized in the Ernakulam district of Kerala, in November 2022. Knowledge, attitude, and practice were assessed using a prestructured questionnaire. A set of 12 questions were assessed on a scale ranging from “not at all” to “to a greater extent.” The camp attendees who were willing to participate were included in the survey. Descriptive statistics were used to summarize the findings of the survey. Categorical variables were presented as frequency (%), while continuous variables were summarized as mean (standard deviation) or median (Q1, Q3) based on the results of the Shapiro–Wilk normality test. SPSS version 27 was used for all the analyses. Results: A total of 64 parents participated in the study. Nearly half of the survey participants did not experience it to be challenging to be the parent of a child with diabetes 46.9%, while 23.4% expressed that to a greater extent, they found it to be challenging. 55.6% of parents stated that their child’s diabetes did not affect their work life, while 20.6% expressed that it affected their work life to a lesser extent. 36.7% of the parents expressed that they were concerned about their child’s risk of low blood sugar to a greater extent. The parent-school relationship was reported as great (50%). The parents expressed that their peers at school are sympathetic to their children to a greater extent (26.7%). 38.1% of the parents reported their child has access to a dietitian during hospital visits. More than half of the parents were satisfied with the doctor’s care and support (51.7%). The majority (37.7%) of parents were also worried to a greater extent regarding the child’s future complications. Conclusion: The study sheds light on the emotional and social dimensions experienced by parents raising children with T1D. Recognizing and addressing these factors is essential for enhancing the overall quality of life for parents who are facing the challenges of raising a child with T1D.
Objective: The escalation of type 2 diabetes (T2D) as a global health crisis necessitates a shift towards personalized medicine to optimize treatment efficacy and minimize adverse drug reactions (ADRs). This review article underscores the significant role of pharmacogenomics in refining T2D management. We explore the influence of genetic variations on the pharmacokinetics and pharmacodynamics of commonly used antidiabetic drugs, including metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, and SGLT2 inhibitors. Materials and methods: A systematic review of existing literature was carried out, concentrating on studies exploring personalized medicine in T2D through pharmacogenomics. The literature search encompassed databases such as Medline, Scopus, Web of Science (WOS), and PubMed. Key insights regarding the role of pharmacogenomics in managing T2D were compiled and analyzed. Results and conclusions: The review highlights how genetic polymorphisms in drug transporters, metabolizing enzymes, and drug targets correlate with variations in drug response and tolerance. We advocate for preemptive genotyping and integration of genetic data into clinical decision-making, which could revolutionize patient care in T2D. The future of diabetes treatment lies in harnessing pharmacogenomic insights to tailor therapeutic regimens, thereby transitioning from a one-size-fits-all approach to a more nuanced, individualized treatment strategy. With advancements in genomic technologies and a reduction in genotyping costs, the implementation of genetic testing in routine clinical practice is becoming increasingly viable, signaling a new era in the personalized management of T2D.
India is facing a triple burden of pre-diabetes, diabetes, and obesity. Unhealthy eating habits and physical inactivity have been linked to the onset and progression of type 2 diabetes mellitus (T2DM). Despite dietary recommendations, individuals consume inadequate amounts or unsuitable type of dietary fiber (DF) which needs correction. An Expert group attempted to review and report on the role and importance of high DF in the management of T2DM and offer practical guidance on high fiber use in daily diet.Twelve diabetologists and two expert dietitians from India were chosen to ensure diversity of the members both in professional interest and cultural background. The authors convened virtually for one group meeting and actively participated in a detailed discussion. Multiple reviews of the draft document followed by focused teleconference calls & email helped to reach consensus on final recommendations between Aug 2021 and Dec 2021.Evidence has shown that medical nutrition therapy (MNT) is a valuable approach and an essential component of T2DM prevention and management. Studies have shown that fiber rich diabetes nutrition (FDN) has multi-systemic health benefits, including, improvement in glycemic control, reduction in glucose spikes, decrease in hyperinsulinemia, improvement in plasma lipid concentrations and weight management in T2DM patients.A high fiber diet is vital for people with diabetes and associated conditions. Increasing fiber intake, preferably through food or through dietary supplement, may help. Fiber rich diabetes nutrition (FDN) is recommended in order to prevent and manage T2DM.
Effective management of diabetes warrants accurate and regular monitoring of glucose levels to prevent serious diabetes-associated complications and long-term health consequences. Hence, achieving target glucose levels and maintaining adequate glycemic control is essential in diabetes to prevent episodes of hypoglycemia. Multiple glucose monitoring tools have been developed over time, each with differing degrees of precision, convenience, and real-time input. The management of diabetes has been considerably improved by using these various glucose monitoring devices, both in terms of treatment outcomes and patient quality of life. However, in India, the lack of awareness, patient education, availability, and affordability of glucose monitoring devices poses a significant concern resulting in poor adherence to glucose monitoring and low medication adherence thereby increasing disease burden. Consequently, there is an urgent need for healthcare professionals and policymakers in India to collaborate and address the challenges associated with glucose monitoring in patients with diabetes, while also providing recommendations to overcome these concerns. This recommendation article offers a comprehensive evaluation of various glucose monitoring tools available for use by patients suffering from different types of diabetes, explores the challenges associated with glucose monitoring in India, and also presents expert panel recommendations to enhance diabetes management effectively.
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