RSSDI research retreat is a conference dedicated to research in the field of diabetes. In addition to KOLs presenting their research work, selected authors who have published original work in the field of diabetes are invited to present their work. This conference also has multiple workshops on various aspects of clinical research and manuscript writing.
Role of Molecular Markers in Wound Healing Process of Diabetic Foot Ulcers: Potential Therapeutic Targets (RSSDI Mentorship 2023 Study)
Udyama Juttada1, Satyavani Kumpatla1, Awadhesh.K.Singh2 and Vijay Viswanathan1
1 Prof M.Viswanathan Diabetes Research Centre
2 GD Hospital & Diabetes Institute, Kolkata
Background: The rising prevalence of diabetes is accompanied by a greater incidence of Diabetic Foot Ulcers (DFU). Wound healing is accomplished by an orderly sequence of three phases: inflammation, proliferation and remodelling. Molecular factors in combination with inflammatory biomarkers and genomic markers play a major role in assessing the severity of wound and predicting the risk of DFU development.
Methods: In this prospective observational study a total of 35 participants were divided into 2 study groups, Group 1 type 2 diabetes mellitus (T2DM) but no other secondary complications (n = 8), group 2 T2DM individuals with DFU(n = 27). In DFU participants assessment of the wounds was carried out on the screening visit (week 0), treatment visits (week 4) and post-treatment follow-up visit (month 3 ). Inflammatory biomarkers like C-reactive protein (CRP), Interleukin 6 (IL-6)s, Matrix metalloproteinases (MMP9) levels were measured using ELISA during each visit, alongside genomic markers where gene expression profile of angiogenetic Factors such as Stromal cell-derived factor (SDF), Hypoxia-inducible factor (HIF-1α), and MMP9 were investigated in tissue biopsy samples using qPCR.
Results: The mean age of the study participants was 55.2 ± 9.21 years. A significant difference was observed in age across the groups, in which DFU participants were significantly older compared to T2DM. The biochemical parameters, such as fasting, post prandial, HbA1c, urea, creatinine were significantly higher in DFU groups. The comparison of baseline levels of study participants show IL-6 (48.5 ± 10.25 Vs 16.3 ± 5.2 pg/ml p < 0.0005), CRP (53.8 ± 16.4 Vs 12.5 ± 5.2 mg/dL p = 0.001) MMP-9 (8.1 ± 4.76 Vs 1.25 ± 1.23 p < 0.05)and other traditional inflammatory markers were significantly elevated in DFU compared with non-DFU cases ESR (49.0 ± 9.24 Vs 21.4 ± 5.2 mm/hr, p = 0.034) and WBC (13.6 ± ± 2.9 Vs 10.4 ± 2.4 /dL, p = 0.014) was also elevated among DFU cases. Of note, out of the 27 DFU cases 15 cases healed completely after 3 months of follow up period and CRP and MMP-9 levels at different stages showed drastic decline in values indicating the complete wound healing (189.1 Vs 138.8 Vs 16.13: p < 0.001) (8.03 Vs 5 Vs 1.1 p < 0.05), whereas IL-6, showed a no change in circulating levels with respect to the severity of diabetic foot ulcer
Gene Expression: levels of MMP-9 were significantly decreased in tissue biopsies of participants with T2DM and infected DFU. When gene expression tested at different stages of wound healing it was expressed that the levels of SDF (p < 0.004) and HIF-1 (p < 0.05) increased where as MMP9 levels decreased drastically indicating good healing targeting miRNA (Figure 1). Further, the tissue-specific expressions of miR-23a and miR-23b were found to be low whereas miR-23c was increased in patients with infected DFU.
Conclusion: Our findings from the current study have shown that wound healing is significantly influenced by the inflammatory and angiogenetic factors and MMP-9 expression, so these markers can be considered for the screening of the progression of DFU and can be used as a Potential therapeutic targets .
Evaluation and Determination of Proximal Signalling Gene Variants in Insulin Transduction and its Influence on Insulin Resistance among T2DM Patients
Balaji Ramanathan1 and Kumaravel Velayutham1,2
1 Alpha Health Foundation, Madurai, Tamilnadu, India
2 Alpha Hospital & Research Center, Madurai, Tamilnadu, India
Introduction and Background: Insulin resistance (IR) is a hallmark of T2DM while the mechanism remains unclear. Insulin resistance in T2DM is predominantly in post-receptor but the exact defect in the downstream is not clearly understood. Evidence has shown that any defects in the PI3K-Akt/PKB signalling cascade along with the downstream molecules could lead to insulin resistance. While several candidate genes that participate in the above signalling cascades have been investigated in the past, a precise genetic panel for IR is yet to be validated across the global/Indian population. Hence the present study aims to examine the prevalence and association of polymorphisms in candidate genes involved in the proximal signalling pathway (IRS1, PI3K, AKT2, AMPK and TRB3) in T2DM patients of the south Indian regional population.
Methods: A total of 30; 10 healthy controls and 20 T2DM patients with high HOMA-IR value were enrolled in this study. Peripheral blood samples were obtained, put through pertinent biochemical tests, and used to separate genomic DNA for further PCR amplification of the genomic regions of interest. PCR, PCR product sequencing was carried out to identify genetic variants/ single nucleotide polymorphisms in the proposed candidate genes associated with IR.
Results: The distribution of IR-susceptible gene variants was as follows IRS1(rs1801278 C>T), genotype was distributed as CC, 8 (80%); TT, 1 (10%); and CT,1 (10%) in controls; CC, 13 (65%); TT, 3 (15%); and CT, 4 (20%) in T2DM patients. The PI3K (rs3730089 G>A) genotype was distributed as GG, 8 (80%); AA, 1 (10%); and GA,1 (10%) in controls; GG, 11 (55%); AA, 3 (15%); and GA,6 (30%) in T2DM patients. AKT2 (rs11669332 C>T), genotype was distributed as as CC, 4 (40%); TT, 3 (30%); and CT,3 (30%) in controls; CC, 14 (70%); TT,1 (5%); and CT, 5 (25%) in T2DM patients. AMPK (rs2051040 C>T) genotype was distributed as CC, 7 (70%); TT, 1 (10%); and CT,2 (20%) in controls; CC, 9 (45%); TT, 4 (20%); and CT, 7 (35%) in T2DM patients. TR1B3 (rs2295490 A>G) genotype was distributed as AA, 6 (60%); GG, 1 (10%); and GA,3 (30%) in controls; AA, 5 (25%); GG,6 (30%); and GA,9 (45%) in T2DM patients. Allelic frequency of C allele and T allele of IRS1(rs1801278) was distributed as 17(85%) and 3(15%) in control and 30(75%) and 10(25%) in T2DM Patients, G allele and A allele of PI3K (rs3730089 G>A) was distributed as 17(85%) and 3(15%) in control and 28(70%) and 12(30%) in T2DM Patients, C allele and T allele of AKT2 (rs11669332 C>T) was distributed as 11(55%) and 9(45%) in control and 33(82.5%) and 7(17.5%) in T2DM Patients, C allele and T allele of AMPK (rs2051040 C>T) was distributed as 16(80%) and 4(20%) in control and 25(62.5%) and 15(37.5%) in T2DM Patients, A allele and G allele of TR1B3 (rs2295490 A>G) was distributed as 15(75%) and 5(25%) in control and 19(47.5%) and 21(52.5%) in T2DM Patients. In the recessive model, the AA genotype versus AG + GG genotype was found to be significantly associated with an increased risk of IR in T2DM patients (OR = 4.5; 95% CI = 0.8904-22.7438; χ2 = 3.516; P = 0.05). The G allele was more frequent among T2DM patients (52.5%) than controls (26.6%). The G allele (vs. the A allele) is associated with an increased risk of IR in T2DM (OR = 3.3158, 95% CI = 1.011-10.869, χ2 = 4.1063, p = 0.042).
Conclusion: The TR1B3 gene variant rs2295490 is associated with an increased risk of IR in T2DM patients. Alteration in the insulin secretion/insulin sensitivity interplay appears to underlie this association. This finding implies that the insulin sensitizers that target this genetic variant and its pathogenicity will be helpful in the management of T2DM.
Disclosures: None
Funding: ESTN (Endocrine Society of Tamil Nadu and Puducherry)
Prediction of Age of Onset of Type 2 Diabetes in the Young Using Artificial Intelligence Based Machine Learning
Arul Prakash Rajadurai¹, Jayanth Ranjan¹ and Poongothai¹
1 Indra Diabetes Centre, Thoothukudi, Tamilnadu
Introduction: Type 2 Diabetes in the young is rapidly increasing in India and worldwide. This is caused by Genetic and Environmental factors and accelerated by rapid urbanization, lifestyle changes, and unhealthy diet habits. Simultaneously there is an increasing trend of childhood obesity in India and globally, which seems to be the result of lifestyle changes. We are aware that Type 2 Diabetes (T2D) is a heterogeneous disease needing individualized strategies for prevention and treatment in other words that is precision medicine. So the key question is, can the age of onset of diabetes in the young be reasonably predicted? if so timely preventive measures may be helpful to contain this diabetic epidemic. Artificial intelligence (AI) is coming in a big way to partner with us in research and clinical practice. So, we wanted to study the feasibility of the prediction of the age of onset of T2D in the young below the age of 40 years using Artificial intelligence-based machine learning (ML) algorithms.
Aims and Objectives:
To predict the age of onset of T2D in the young with the clinical parameters including family history of diabetes, life style, and body mass index(BMI) using machine learning algorithms.
To compare the efficiency of various ML models and to choose the best model for the given problem of Prediction.
Material and Methods: It is retrospective study conducted at Indra diabetes Centre, Thoothukudi beween 2022 to 2024. We screened for confirmed patients of T2DM onset below 40 years with the WHO criteria. We recruited 430 patients to the study. We collected the details of family history of diabetes, age of onset among grandparents and parents. Also we obtained details of life style and BMI. Life style was categorized into sedentary and active life style. Data cleaning was done and validated. Appropriate data preprocessing was also done before training the model.
We fed the details to the open source JASP 0.19.03 software supported by the University of Armsterdam. We divided the datasets into 3 groups namely training data to train the system, validation data for improving quality of the data, relevance and bias for fine tuning, and test data to assess the performance of the model. We employed Regression algorithms like Boosting, Decision tree, K nearest neighbors, Random Forest, Linear Regression, and support vector machine.
Results: The prediction of age of onset with accuracy of 54- 56% was achieved with the Boosting, Decision tree, K nearest neighbors, Linear regression and Support vector machine algorithms respectively, whereas the accuracy was 58% with Random Forest model. Model performance metrics including MSE, RMSE, MAE/MAD, MAPE, R² were compared between various models as given in Table-1.
Feature importance metrics were also analysed. Factors like BMI, Lifestyle, age of onset of paternal grandmother, mother and father were detected to be important contributors for the prediction although the order changed a little with different ML models.
Discussion: Diabetes prevention is an important public health strategy. Asian and Indians in particular have different phenotypes with much younger age of onset than other regions of the globe. The age of onset is coming down through generations. So we need current data specific to India. The age of onset of T2D is also very wide ranging from 20 to 75. Hence the age of primary prevention is still a matter of debate throughout the world. Also the heterogeneity of T2D adds more complexity. So, if we are able to predict age of onset in significant proportion of the people at risk, we can target the high risk patient individually well in advance. This may even be termed as precision primary prevention. Our AI models were able to predict the age of onset in more than 50% people which is encouraging. The limitation of this study is that the models were trained with limited fresh data available from a single center. If we are able to pool more current data from many centers from India, we can build a robust system with more accuracy. Mean time we also have to consider ethical aspect of prediction and data privacy.
Conclusion:
Machine learning based models of Artificial intelligence is able to predict the age of onset of T2D in the Young to the tune of 58% which is really encouraging though the training data is small. The accuracy will improve with more data.
It paves the way to practice precision preventive medicine in diabetes prevention.
Disclosures: None
Funding: None
Double Edge Swords of Hereditary Spherocytosis with Diabetes
Josephin Antoniammal J1,2
1 Holy Cross Hospital Kalyan Karnik Road, Kalyan Mumbai India
2 KIMS Hospital Nagercoil Tamil Nadu India
Introduction: Hereditary spherocytosis (HS) is characterized by decreased erythrocyte deformability resulting in hemolytic anemia. This case highlights the importance of understanding the complications in HS along with Diabetes, a real challenge in saving lives, and the limitations of the HbA1c in managing patients with diabetes.
Case History: A 40-year-old male sought medical advice for jaundice, and generalized fatigue with a previous medical history, of anemia, yet not on any medications. He was admitted 1 month back with dengue fever in Dubai where he was working. He had severe dengue with shock, and he was treated with FFP and platelet transfusion. He was sent back to India to clear the disease and follow back for the work. Physical examination revealed the following: pulse 76b/mt, BP 112/68mmhg respiratory rate 20 breaths/ min, conjunctival pallor and icterus; and yellowing of the skin spleen was palpable. The laboratory findings are summarized in Table 1
Other specific blood parameters were done to rule out other causes of hemolytic anemia with jaundice. Peripheral blood Smear: Hypochromic microcytic anisocytosis, High-performance liquid chromatography Normal, DCT – negative, OFT - Osmotic Fragility test was normal, Sickling test – Negative, Serum Ceruloplasmin – normal, PNH - Paroxysmal Nocturnal Hemoglobinuria- Negative USG abdomen - Severe Splenomegaly 21 cm. However, incidentally, sugar was found high, however Hba1c level was not appropriate for the sugar level. He started on insulin and OHA to control sugars. It took a month to regularize medicines and optimize sugar. We can also notice here the indirect bilirubin is high with deranged liver function test.
The patient underwent Splenectomy, however, post-splenectomy on day 3, developed severe pneumonia with type 1 Respiratory failure requirement of oxygen, and sugars was high. Hence sepsis was suspected due to post splenectomy or secondary to high sugars. Patient total counts elevated to 40k and CRP and procalcitonin were high. The CECT chest was reported as consolidation with infective etiology. Sputum blood culture was sent and stated empirically higher antibiotics and antifungal as well. He continued with oxygen supplements occasionally with NIV support for 5 days. Blood culture was reported as no growth, and sputum culture was reported as Pneumococcal. The double-edged sword was after splenectomy and Diabetes uncontrolled, was unable to correlate with the Hba1c level. It was crucial to save the life at this juncture despite the Pneumococcal and meningococcal vaccinations given two months before the surgery.
Patient symptoms improved gradually, making our team breathe, as he breathed without any support. LFT was deranged initially with counts CRP high, progressively all parameters came to normal. Patient went back to work in Dubai after 5 months. Regular basis he sends reports of CBC LFT and Sugar level. He never reported any further infection following splenectomy and living a normal life with well-controlled sugar with diet and minimum OHA. The patient is living a healthy and happy stay without any other complications and is on regular vaccines.
Conclusion: HS adult patients requiring splenectomy in life have had infections, and hospitalizations have been recorded highly. In contrast, the risk of hospitalization for post-splenectomy involving severe infection or infections is low. Vaccines and postoperative antibiotics reduce the risk of hospitalization for infection in splenectomy patients by alleviating the complications of HS.
Conflict of Interest: Nil
Consent: The patient has given consent for the publications.
A Study on Effectiveness of Yoga for Cardiac Rehabilitation in Patients with Chronic Heart Failure
Karthikeyan Govindaraj1
1 Srikamatchi Medical Centre, Tanjore, Tamil Nadu, S. India
Aim: The use of yoga as an effective cardiac rehabilitation in patients with chronic heart failure (CHF) remains controversial. We performed a meta-analysis to examine the effects of yoga on exercise capacity and health-related quality of life (HRQOL) in patients with CHF.
Methods: examining the effects of yoga versus exercise and/or of yoga versus control on exercise capacity (peakVO2) and quality-of-life (HRQOL) in CHF. This above study of regular yoga practice is effective in rehabilitation of patient with heart failure.
Result: After six months of study all base line measurements were repeated. Regarding blood pressure systolic pressure was reduced 10 mm Hg well in study group only 4 with control group. Diastolic pressure reduced 4mm in study group were as no change in control group. Regarding heart rate 18 in study group only 8 in control group. Ejection fraction well improved in study group 9% compared to control group 4% .Regarding Quality of Life Questionnaire showed Quality of life improved 23 % in study group compared 8% in control group.
Conclusion; The shows yoga therapy improve physical wellbeing and left ventricular function among heart failure patients on guideline directed optimal medical therapy.
Triple or Double Combined Therapy is Safer and More Effective for Newly Diagnosed Type 2 Diabetes Mellitus?
Josephin Antoniammal J 1,2
1 Holy Cross Hospital Kalyan Karnik Road, Kalyan Mumbai India
2 KIMS Hospital Nagercoil Tamil Nadu India
Objective: To compare the efficacy and safety of an initial triple therapy using metformin 500 mg, a (DPP4) sitagliptin 100mg, and Dapagliflozin 10mg with a stepwise approach using sulfonylurea and metformin in new-onset, patients with type 2 diabetes.
Research Design and Methods: Among drug-naïve patients with 9.5%–12.0% glycated hemoglobin (HbA1c) but no hyperglycaemic symptoms, 100 subjects who started triple medications (metformin 500mg/day, sitagliptin 100mg/day, and Dapagliflozin 10mg /day) were selected as an initial triple therapy group. Age and body mass index-matched subjects (n = 100) who started glimepiride (≥2mg/day with up-titration) and metformin (≥1000mg/day with up-titration) were selected as a conventional therapy group. We investigated changes in HbA1c level, weight reduction, cardiovascular risk factors, and hypoglycaemia.
Results: After 12 months of treatment, HbA1c levels decreased significantly in both groups: from 10.8% ± 1.0%to 6.8% ± 1.3% in the triple group, and from 10.5% ± 1.0%to 7.5% ± 1.2% in the conventional therapy group. At 12 months, achievement of the HbA1c target, weight reduction, and no risk of cardiovascular events, in the triple therapy group compared to that of the double drug therapy group.
Conclusion: Initial triple combination therapy with the DPP4 inhibitor, metformin, and dapagliflozin showed a higher achievement of the target HbA1c goal with a lower risk of hypoglycemia, better restoration of β-cell function, and multiple metabolic benefits, implying durable glycaemic control. This strategy may be useful for patients presenting with type 2 diabetes and high HbA1c levels.
Exploring the Link Between the Types of Microorganisms and Diabetic Lower Limb Amputations
Manisha Sarah Emmanuel1, Satyavani Kumpatla2, Arutselvi Devarajan3, Udyama Juttada4 and Vijay Viswanathan5
1 Department of Microbiology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, Tamil Nadu, India
2 Department of Biochemistry, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, Tamil Nadu, India
3 Department of Epidemiology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, Tamil Nadu, India
4 Department of Biochemistry and Molecular Genetics, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, Tamil Nadu, India
5 Department of Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, Tamil Nadu, India
Background and Aim: Diabetic foot complications, particularly diabetic foot ulcers (DFUs), are a major cause of morbidity in individuals with type 2 diabetes, often resulting in infections and amputations. One in four individuals with diabetes will develop a DFU in their lifetime, and one in five will undergo an amputation. Although certain microorganisms are commonly found in diabetic foot infections (DFIs), the specific role of these bacteria in the severity of infections remains underexplored. This study aims to identify the predominant microorganisms involved in diabetic foot infections leading to major and minor amputations and to compare the microbial profiles associated with these different levels of amputation in order to develop targeted treatments and improve patient outcomes.
Methods: All microbiological culture reports of individuals who underwent diabetic lower limb amputations at a tertiary healthcare centre from January 2021 to December 2024 were used for the retrospective analysis. Deep infected tissue samples from the site of infection and were collected in the OT, which enabled highly accurate identification of the causative bacteria. Bacteria isolated from both major (above-knee, below-knee, midfoot) and minor (toes) lower limb amputations were characterized. The bacterial infections were further divided into three groups based on the number of bacteria which were isolated from the site of infection, namely, Monomicrobial, Polymicrobial and No Growth. The total bacteria were further grouped according to their gram stain, with each bacterial isolate being either Gram Positive or Gram Negative.
Results: The total number of bacteria(n = 629) were grouped based on the type of Amputation, of which 32.9% were Major (n = 207) and 67.1% were Minor (n = 422). The bacteria was further characterized into three groups based on their Gram Stain. The majority of the bacteria was found to be Gram Negative(n = 409) and made up 65.1% of the bacterial isolates, followed by Gram Positive(n = 162) which made up 25.7% while only 9.2% of the isolates showed No Growth(n = 58). Furthermore, 62.4% of the bacterial isolates were Monomicrobial while just 28% were Polymicrobial. For Major amputations, Proteus mirabilis was linked to the highest percentage of cases, making up 19.3%, closely followed by Klebsiella spp. at 14.9%, and Pseudomonas spp. at 14.4%. For Minor amputations, Enterococcus spp. was linked to the highest percentage at 16.5%, followed by both Proteus mirabilis and E.coli at 14.9%. Among all the bacterial isolates, Enterococcus spp., E.coli and Staphylococcus aureus was found to be highly significant with minor amputations (p < 0.001), while Proteus mirabilis was found to be of significance for both major and minor amputations (p < 0.05). Both Gram Negative (p < 0.000004) and Gram Positive (p < 0.001) bacteria were found to be highly significant with both Major and Minor amputations. Additionally, both Monomicrobial and Polymicrobial cases were found to be highly significant (p < 0.001).
Conclusion: This study brings out the significant bacterial diversity in diabetic foot infections, with Gram-negative bacteria predominating in both major and minor amputations. Proteus mirabilis was notably associated with both amputation types, while Enterococcus spp. and E.coli were more prevalent in minor amputations. These findings demonstrate that efficient microbial profiling can enable targeted treatments, improving recovery and reducing amputation risk.
Disclosures: None
Funding: None
Effectiveness of MNT: Types of Diet for Treating Patients with Diabetes and Dyslipidemia
4 Dia Care – Diabetes Hormone Clinic, Ambawadi, Ahmedabad
Introduction: Diabetes is a rising public health concern in India, specially the cases of Type 2 Diabetes has been rapidly increasing. The co-morbities associated with diabetes is also increase one of which is dyslipidaemia. Dyslipidaemia are characterized by abnormal concentrations of circulating lipids, increasing the risk of atherosclerosis and other serious conditions. Hyperinsulinemia is associated with low HDL cholesterol levels and hypertriglyceridemia in patient with diabetes. Most patients with diabetes are on statin therapy and various other medicines like fibrates or niacin or ezetimibe. But medication alone is not the only factor, dietary and lifestyle factors like excise are crucially important. Many researches show improvement in lipid levels as well as glucose control in patients following medication and medical nutrition therapy in combination. This paper is focused on Nutrition interventions for addressing concurrent elevations in LDL-C and TG include a combination of the strategies described for lowering LDL-C and TG as well as remission of type 2 diabetes.
Aim & Objectives: To study the effect of different diet plans in patient with diabetes and dyslipidaemia.
Inclusion Criteria: Type 2 DM, Continue on same medication for at least 3-month, Age: 18-55 years
Exclusion Criteria: Type 1 DM, Other types of Diabetes, recently changed medication.
Material & Methods: A retrospective interventional study was conducted with 40 participants diagnosed with type 2 diabetes and dyslipidaemia. Subjects were enrolled in a 12-week structured nutritional therapy program involving diet counselling, meal planning, and monitoring by certified dietitians. Primary outcomes included changes in HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, LDL, HDL, and triglyceride levels. Secondary outcomes focused on adherence and patient satisfaction. Two groups were formed, Group 1 followed a Routine Diabetes Diet(RDD) where total calorie intake was between 1500–1600 kcal, carbohydrate 50–55% (188–220 g/day),Proteins: 15–20% (56–80 g/day), Fats: 25–30% (42–53 g/day) and the other group followed a Low Calorie Diet(LCD) with 1100 -1200 kcal, Carbohydrates: 40–45% (120–146 g/day), Proteins: 20–25% (60–81 g/day), Fats: 30–35% (40–50 g/day) and fibre around 20-25g/day was kept same for both the groups.
Results: Finding show that the group following LCD has better results than the group following RDD. The low-calorie diet improved the blood glucose level and lipid profile.
Conclusion: Our study suggests that a low-carbohydrate diet (LCD) yields better results compared to a regular diabetic diet (RDD). However, four participants were unable to adhere to the LCD due to its stricter regimen. Still more research is required to know about the sustainability and various other factors like physical activity and co-morbities need to be considered to show a better result.
Disclosures: None
Funding: None
Figures/Tables:
Parameter
Results
RDD
LCD
Difference
Before
After
Before
After
RDD
LCD
HbA1c
8.6
8.3
8.3
7.8
–0.3
–0.5
PP
174
150
169
146
–24
–23
Weight loss
98.25
95.12
91.43
86.35
–2.13
–4.08
Total cholesterol
201
194
213
199
–7
–14
LDL Level
129
98
123
88
–31
–35
Financial Toxicity among People with Diaetic Foot Complications: A Cross-Sectional Study in India – Evaluating The Comprehensive Score for Financial Toxicity (COST)
Background and Aim: The term “financial toxicity” was first used in 2009 to characterize the financial strain that comes with cancer treatment. It refers to the burden that excessive medical expenses place on patients and their families. A similar issue occurs in individuals with diabetic foot ulcers, a debilitating consequence of chronic diabetes, often complicated by comorbidities. They lose their earning capacity, experience repeated hospital admissions and face high medical bills. In this study, we aim to assess the financial toxicity experienced by people with diabetic foot complications in India using the COST scale.
Material and methods: In this cross-sectional study, a total of 234, Type-2 diabetes patients with foot complications were screened at a tertiary health care centre for diabetes. The male to female ratio was 168:66. Financial toxicity (FT) was measured using The Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST-FACIT) a 12-item validated measure and its scores ranges from 0 – 44, where a higher score indicates better financial well-being. The FT (financial toxicity) scores were classified as follows: Grade 0 (no FT) > 26, Grade 1 (mild FT) 18-26, Grade 2 (moderate FT) 10-17.9, and Grade 3 (high FT) < 10 - the cutoff is determined by calculating one standard deviation below the average. Socio-demographic details, clinical and biochemical parameters (HbA1c, years of diabetes), clinical outcomes (wound grade, amputation status, comorbidities. recurrence), financial parameters (medical expenses, Income, Insurance) were collected. Additionally, a validated 6-item tool RU-SATED measure was used and its score ranges from (0-24), where a higher score indicates better sleep health. Data on Cost coping and non-compliance behaviours were also collected.
Results: The mean age of the participants was 57.8 years and mean duration of diabetes was 14.9 years. The COST-FACIT demonstrated good internal consistency with a Cronbach’s alpha of 0.73. Out of the study population with diabetic foot complications, 15.8% had high FT, 29.4% moderate FT, 41.9% mild FT and 12.8% had no FT. A significant correlation was found between high financial toxicity and poor sleep health. Among the study population, 74.2% did not have health insurance, and 49.6% were in debt due to medical expenses. Additionally, 78.3% of adults over 50 years old were financially dependent on their family. To manage costs, 39.8% sold assets or jewels. Financial barriers impacted treatment adherence, with 13.6% unable to afford medications, 7.7 % delaying doctor visits, and 14% unable to afford for offloading devices. Behavioural factors like non-compliance with doctors’ advice on using offloading both inside and outside the house was observed in 26.4% of participants, among those, 17.7% developed recurrent or non-healing ulcers.
Conclusion: Just about only 1/4 of the individuals with diabetic foot complications were free from financial toxicity, emphasizing the significant burden of healthcare expenditure. Financial toxicity is as critical as any clinical parameter, affecting patient outcomes and adherence. In India, a lack of understanding and awareness about insurance and effective cost-coping strategies is a major issue highlighting the need for financial counselling and insurance support.
Role of Structured Protocol-based Diabetes Care Programs and the BLUE Index in Diabetes Management
Krishn R. Undaviya1, Dharmendra Panchal1, Janak Chokshi1 and Shahid Haideri1
1 M.K. Shah Medical College and Research Centre, Ahmedabad, India
Background and Aim: Diabetes mellitus is a chronic and progressive disease often accompanied by severe complications. Despite the availability of a range of treatments, over 70% of individuals with type 2 diabetes struggle to meet their metabolic targets. This study investigates the effectiveness of a structured protocol-based diabetes care program and assesses the BLUE index as a tool for comprehensive diabetes management.
Materials and Methods: A multidisciplinary team developed and implemented a one-year diabetes management protocol, which included six scheduled visits for patients with type 2 diabetes. The study compared 100 patients enrolled in this structured program with 100 control patients. The BLUE index, a comprehensive diabetes health score incorporating multiple parameters, was utilized to evaluate patient outcomes.
Results: After one year, 72% of participants in the structured program demonstrated a significant improvement in their BLUE index score, moving from <35 to >45, compared to 41% of patients in the control group. Notable improvements were observed in HbA1C levels, with 93% of program participants achieving better glycemic control. However, dietary improvements were less pronounced, with only 51% showing significant progress.
Conclusion: Structured protocol-based diabetes care programs substantially enhance patient outcomes and overall diabetes management. The BLUE index proves to be an effective tool for patient education, motivation, and clinical decision-making. This approach underscores the value of integrated, systematic care strategies in achieving improved metabolic control and better health outcomes for individuals with type 2 diabetes.
Gender-Specific Decline in eGFR Across Age Groups in People with Type 2 Diabetes: Single Center Analysis
Sivakumar K1, Lakshmi B1, Shamir Ali B1 and Surendran R1
1 Karunya Sugalaya Diabetes Care and Research Centre Private Limited, Kumbakonam, India
Introduction: One of the most important complications of Type 2 Diabetes is the development of Chronic Kidney Disease. Estimation of eGFR and Urinary Albumin excretion are important to classify the Diabetic Kidney Disease (DKD). While longevity has improved in People with Diabetes due to improved cardiac care and glycemic control, the decline in Renal function requires more attention which has not significantly improved over decades despite better pathophysiological understanding of Renal dysfunction in People with Diabetes.
Aim and Objectives: This retrospective data from EMR highlights the influence of age and sex on eGFR trajectories. Males are generally observed to have a faster eGFR decline than females. However, there is limited understanding of these patterns in regional populations.
This study aims to examine eGFR decline age group and gender in a regional cohort.
Materials and Methods:
Study Design: This is a single-center, retrospective, observational study conducted over two years. The cohort included patients visiting the center for Diabetes Management. Many have undergone Serum creatinine estimation as one of the screening tests for renal function. Additionally, urine albumin and micro albumin testing was performed to assess as an early indicator of DKD.
Participants: A total of 473 patients were included in this study
Inclusion Criteria: People with Type 2 Diabetes with or without Systemic Hypertension, aged 20–90 years with at least two eGFR six months apart with or without estimation of albuminuria.
Exclusion Criteria: Patients with acute kidney injury (AKI), end-stage kidney disease (ESKD), incomplete follow-up data, or those undergoing renal replacement therapy.
Data Collection: Clinical data, including age, sex and serum creatinine levels, were extracted from electronic medical records. eGFR values were calculated using the CKD-EPI equation and MDRD formulas
Statistical Analysis: Age stratified cross sectional analysis was done in this study to calculate rate of decline in eGFR annually. This compares the mean eGFR across different age groups.
Results: Majority of the patients fall under KDIGO Stage 2 in the study population. Albuminuria staging was not available for all the patients.
Demographics:
Male participants: 52%
Female participants: 48%
Median age: 57 years
Annual eGFR Decline:
Males: -0.76 ml/min/1.73m²/year.
Females: -0.62 ml/min/1.73m²/year.
Age-Specific Observations:
Decline accelerated with age, particularly in males over 60 years.
Conclusion:
This study highlights the significant prevalence of DKD among T2DM patients and confirms that males experience a faster eGFR decline than females.
The observed average eGFR decline (~0.7 ml/min/1.73m²/year) is slightly lower than the globally average (~1 ml/min/1.73m²/year), suggesting a possible population-specific variation in renal function trajectories.
Larger, multi-center studies are necessary to confirm normal and pathological rates of eGFR decline in Indian populations.
Early screening can help in risk stratification and timely interventions.
Footnotes:
Data Sharing Statement: Datasets are available upon request.
Abbreviations:
DKD: Diabetic Kidney Disease
eGFR: Estimated Glomerular Filtration Rate
KDIGO: Kidney Disease Improving Global Outcomes
Decline in eGFR with Age for Both Genders
Correlation of Glycemic Status and Asprosin in Diabetes Mellitus with Nephropathy
Mary Yanglem1, Shetty Sukanya1, Shenoy Pradeep2, Bhandary Roopa1 and Kulkarni Vineet3
1 Dept of Biochemistry, K.S. Hegde Medical Academy, NITTE (Deemed to be University), Mangaluru
2 Dept of Nephrology, Justice K S Hegde Charitable Hospital, Mangaluru
3 Dept of Biochemistry, Tejaswini Institute of Allied Health Science, Mangaluru
Introduction: The worldwide prevalence of Type 2 Diabetes Mellitus (T2DM) and Diabetic Nephropathy(DN) is escalating at an alarming rate. Asprosin, a newly identified marker associated with obesity, has garnered attention in recent epidemiological studies. Despite this, the relationship between Asprosin, T2DM and DN in the Indian context remains relatively unexplored.
Aim and objective: This cross sectional observational study aimed to elucidate the correlation between serum Asprosin level and glycemic status in subjects with T2DM and DN.
Materials and Methods: A total of 162 study subjects were recruited in the study. Serum asprosin level was estimated using Enzyme linked immunosorbent assay (ELISA) and Glycated hemoglobin (HbA1C) was measured by High performance liquid chromatography (HPLC). Urinary albumin to creatinine (UACR), lipid profile and baseline characteristics data were estimated using standard kits. Triglyceride glucose index (TyG) was calculated using standard formula.
Results: Mean asprosin level among total study population was found to be 6.09 ± 2.1 ng/ml. DN subjects had significantly higher asprosin than those with T2DM subjects.Mean asprosin level was found to be elevated among male subjects as compare to female subjects. Asprosin was positively correlated with Age, HbA1c, UACR and total Cholesterol among T2DM subjects. Linear regression analysis suggested independent association between asprosin and T2DM.Based on ROC analysis, the threshold value for asprosin to predict risk of T2DM was 5.7ng/ml.
Conclusion: Present study substantiate the potential of Asprosin as a promising biomarker in the diagnosis of T2DM and DN. However, it is imperative to validate these observations through extensive, multicentric studies to fully establish their clinical implications.
Disclosure: None
Funding: This study has received funding from RSSDI.
The Sandy Pancreas
S K Nagarajan1
1 Department of General Medicine, Madurai Medical College.
Introduction: The “sandy pancreas” refers to pancreatic changes observed in individuals exposed to chronic silica dust, notably seen in mine workers. Silicosis, a known occupational hazard, can have systemic effects beyond pulmonary complications, including its impact on the pancreas. This report discusses a complex case of a 47-year-old male mine worker with multiple co-morbidities, emphasizing the interplay between silicosis, tuberculosis (TB), chronic kidney disease (CKD), and chronic pancreatitis.
Case Report: A 47-year-old male, a mine worker for 25 years, presented with a 3-day history of breathing difficulty. He had a prior history of pulmonary tuberculosis (PTB) treated 6 years ago, along with newly diagnosed type 2 diabetes mellitus (T2DM), systemic hypertension (SHTN), and CKD. His complaints included cough with expectoration, dyspnoea, abdominal pain, and vomiting. Clinical evaluation revealed kyphosis, pallor, clubbing, and tachypnea. Radiological and laboratory investigations showed acute pancreatitis, silicotuberculosis, CKD, and chronic pancreatitis. Notably, he had been treated with dual gliptins (tenegliptin and linagliptin), which may have contributed to the pancreatitis. Opinions from thoracic medicine, medical gastroenterology, and nephrology guided a multi-disciplinary approach. Treatment included oxygen support, renal-safe anti-tubercular therapy (ATT), antibiotics, and supportive care.
Conclusion: This case illustrates the intricate relationship between silicosis, TB, CKD, and pancreatitis in a mine worker. Silicotuberculosis was likely under-treated, and the etiology of pancreatitis remains ambiguous, with possible causes including silicosis-induced changes, drug-induced pancreatitis (due to dual gliptins), or microcholelithiasis. This highlights the diagnostic challenge and need for a holistic approach to patient management, especially in occupational health settings. Further research is required to understand the pathophysiological link between silica exposure and pancreatic dysfunction.
A Case of Cooley’s Diabetes
V. Kavisankar1, M. Natarajan1, V. Palanikumaran1, Vasantha Kalyani1 and Sureshkumar1
1 Madurai Medical College, Madurai
Introduction: Thalassemia is a group of disorders characterized by deficient production of the β-globin sub unit of hemoglobin. Insulin resistance from iron deposition in pancreatic islet cells can affect carbohydrate metabolism and cause glucose intolerance. The mandatory blood transfusions and increased erythroferrone in patients with thalassemia to maintain adequate erythrocyte levels, leads to iron overload
Case Report: A 18 Year old Female Patient A Known Case Of Beta Thalassemia Major Admitted With Complaints Of Polyuria Polydipsia With Weight Loss. Transfusion –Once In two Weeks. Splenectomy done 3 years back. O/E Pallor present, Not Icetric, Frontal Bossing(+),Depressed Nasal Bridge, No hyperpigmentation. Investigations:FBS:430 mg/dl,PPBS:492mg/dl Urine Acetone: Negative ABG: No Acidosis RFT&LFT: Normal,HbA1C: 17%.Serum Ferritin: >1500ng/ml(11-306.8 ng/ml), Anti Gad: Negative And C Peptide – 0.91 (Normal),USG Abdomen & Pelvis:Hepatomegaly, Hepatic MRI With Iron Quantification: Very High Level Liver Iron Overload. Iron Concentration: 492 Micromol/gm dry weight. Pancreas: Signal loss in T2 Weighted Images Suggestive Of Iron Overload.
Conclusion: Based on the above lab investigations patient was diagnosed to have iron overload and diabetes secondary to hemochromatosis. Patient is started on insulin and continuing iron chelators.
Beyond the Canopy: A Case Report of Swietenia Macrophylla (A Common Herbal Anti Diabetic) Induced Liver Injury
Devanathan Vassou¹ and Manokaran Chinnusamy1
1 Department of Internal Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry
Introduction: Herbal medicine is deeply ingrained in Asian culture. However, the complex nature of herbal products necessitates a deeper understanding of their potential effects. Even in India, known for its high diabetes prevalence and traditional medicine use, the quality and safety of herbal products vary, potentially causing harm like liver dysfunction. This case report details a rare case of Herb-Induced Liver Injury (HILI) linked to Swietenia macrophylla seeds (Sky Fruit/ Mahogany seeds/ Thaen kaai), often used for its anti-diabetic properties due to its active component Swietinine.
Aim & Objectives: This case report aims to highlight a case of Swietenia macrophylla-induced hepatotoxicity and contribute to the understanding of its potential adverse effects and raise awareness among healthcare providers and the public.
Material & Methods: This is a descriptive case report documenting a 58-year-old male with a five year history of type 2 diabetes mellitus who presented with jaundice and tea coloured urine after consuming 5-6 Swietenia macrophylla seeds daily for six months. The patient’s history, clinical examination findings, and laboratory results, including complete blood count, liver function tests and viral hepatitis serology, were recorded. Conservative management, including discontinuation of S. macrophylla was implemented. The patient’s clinical progress and liver function parameters were monitored throughout the hospital stay and follow-up period*. A comprehensive literature review was conducted using PubMed and Google Scholar to investigate the hepatotoxic effects of S. macrophylla.
Results: The patient exhibited severe hepatic dysfunction at presentation, demonstrated by markedly elevated AST (668 IU/L), ALT (553 IU/L), and bilirubin (total 5.7 mg/dL, direct 2.3 mg/dL). Prothrombin time// INR at presentation was 23.05 seconds/ 1.75. His Renal function tests, complete blood count, Urine routine examination were normal. His HbA1c was 8.2%, Fasting and Post prandial blood glucose were 232/ 237 mg/dl at presentation. Ultrasonography Abdomen revealed a 12cm Liver, with normal echotexture, no Intra hepatic biliary radical dilatation. Following a comprehensive diagnostic workup that excluded other potential causes, a probable drug-induced liver injury (DILI) related to Swietenia macrophylla was determined using the RUCAM (Roussel Uclaf Causality Assessment Method) scale. Conservative management, including cessation of S. macrophylla consumption and Hepatoprotective drugs (Silymarin, Glutathione, Ursodeoxycholic acid) was administered, which resulted in improvement of Prothrombin time/ INR to 15.78 seconds/ 1.15 after 7 days and a gradual, complete resolution of liver dysfunction within 56 days, as evidenced by normalization of liver function tests.
Conclusion: This case report contributes further evidence to the growing body of literature documenting the potential hepatotoxic effects of Swietenia macrophylla. (Sky Fruit/ Mahogany seeds/ Bitter almonds). Given the increasing prevalence of herbal medicine, healthcare professionals should be aware of its potential adverse effects. While this report focuses on liver dysfunction, further research is warranted to explore the potential effects of S. macrophylla on other organ systems. The unrestricted online availability of this herbal product necessitates educational initiatives targeting both physicians and the public. We strongly advocate for further studies to establish the safety profile of S. macrophylla and for regulatory bodies to consider appropriate guidelines for its sale and use.
Disclosures: None
Funding: None
Figures/Tables: Serial Liver function tests
Revolutionizing Medical Research Writing: Leveraging AI by GPT Tool (PaperCrafter) for Indian Medical Professionals
Harsh Atul Hirani1, Alok Modi2 and Bharat Saboo3
1 Consultant Diabetologist, Life Care Centre for Diabetes – Hyderabad, India
2 Alok Modi’s Diabetes Center & Kevalya Hospital, Thane, Maharashtra, India.
3 Prayas Diabetes Center, Indore, Madhya Pradesh, India
Abstract: This exploratory study examines the potential of PaperCrafter, an AI-driven tool, to transform research publication among Indian medical professionals. Recognizing the global importance of scholarly output, this study addresses the unique challenges faced by Indian doctors and postgraduate (PG) students that limit their contributions to the global medical literature. PaperCrafter leverages the power of GPT technology to automate drafting, formatting, and citation processes, freeing up valuable time and resources. This research investigates the tool’s impact on efficiency, accuracy, and user satisfaction.
Introduction: Scholarly publication is fundamental to advancing medical knowledge, yet Indian medical professionals often struggle to translate their expertise into published research. Common barriers include demanding clinical schedules, unfamiliarity with academic writing conventions, and the labor-intensive nature of manuscript preparation. While the significance of disseminating research findings is globally understood, Indian doctors and PG students require targeted solutions to overcome these obstacles. PaperCrafter emerges as a promising tool, harnessing the capabilities of GPT technology to streamline the writing process. This exploratory study seeks to understand how PaperCrafter addresses these challenges and enhances research output.
Background: Despite the widespread recognition of the importance of research publication, Indian medical professionals encounter specific challenges that hinder their ability to contribute effectively to the global knowledge base. Time constraints, limited exposure to academic writing methodologies, and the complexities of formatting and citation management are significant hurdles. PaperCrafter aims to mitigate these difficulties by automating key aspects of the writing process, thereby allowing users to focus on the intellectual content and scientific merit of their work. The tool leverages the latest advancements in GPT technology to generate high-quality drafts, ensure compliance with citation styles, and improve the overall efficiency of manuscript preparation.
Method: This observational study employed a mixed-methods approach to assess the impact of PaperCrafter on Indian doctors and PG students. A survey was distributed to a sample of medical professionals to gather quantitative data on time savings, accuracy in formatting and citations, and overall user satisfaction. In addition, several case studies were conducted to provide in-depth qualitative insights into the experiences of users with PaperCrafter. The collected data were analyzed to evaluate the tool’s effectiveness in addressing the challenges faced by Indian medical professionals in research publication.
Results: The findings indicate a substantial improvement in research output efficiency among users of PaperCrafter. Quantitative data revealed a significant reduction in the average drafting time, decreasing from approximately 30 hours to less than 5 hours. Moreover, users reported high levels of accuracy in grammar, formatting, and citation compliance. Qualitative data from the case studies highlighted the tool’s ease of use and its ability to reduce the burden of repetitive tasks associated with manuscript preparation. The combined evidence suggests that PaperCrafter has the potential to significantly enhance research productivity among Indian medical professionals.
Conclusion: This exploratory study suggests that PaperCrafter offers a promising solution to the challenges faced by Indian medical professionals in research publication. By simplifying and automating the writing process, the tool empowers doctors and PG students to focus on the intellectual content of their work and contribute more effectively to the global medical literature. The observed reductions in drafting time, coupled with high levels of accuracy and user satisfaction, indicate that PaperCrafter has the potential to transform academic writing practices within the Indian medical community. Further research is warranted to explore the long-term impact of the tool and its broader implications for medical research in India.
Study Implement Yoga on Heart Failure Patients, Analyze their Benefits
G. Karthikeyan Govindaraj1
1 Srikamatchi Medical Centre, Tanjore and Tamil Nadu,S. India
Background: Aim of the study is to implement yoga intervention on heart failure patients, identify yoga’s effects and its potential benefits on heart failure patients In Modern technology, alternative medicine like yoga attained the highest range in biomedical achievements by its clear health benefits. Yoga achieved high beneficial effects, physical mental and spiritual wellbeing.
Methods: Enrolled 39 Heart failure patients age group 35-50 at a tertiary care center with their regular medication. In a non-randomized fashion, 21 as interventional and 18 as non-interventional group.The Interventional group advised regular “Padanjali’s Fundamental Yoga and Meditation” 45 mts /day, weekly five days . Baseline study records and study after nine months,all clinical measurements like blood pressure,heart rate,LVF by ECHO and Quality of life reports were analyzed and recorded .
Conclusion: The interventional group demonstrated significantly greater improvements in nine months practice compare to control group. The finding suggests that yoga can be beneficial complimentary therapy for patients with heart failure and quality of life.
Results: After nine months result were analysed with baseline results. In the study group, systolic pressure reduced 10mmHg Diastolic pressure reduced 4 mm in study group, heart rate reduced 18/mt. . Ejection fraction well improved 9% .Regarding Quality of life by Questionnaire improved 23% The results shows yoga therapy improves physical wellbeing as well as left ventricular function among heart failure patients.
Study Quality of Life & Mental Status of Geriatric Diabetics in Rural Population
Karthikeyan Govindaraj1
1 Srikamatchimedical centre and Tanjore,T.Nadu
Background: Important indicators of health of elderly is quality of life and mental status. Since there is rise of elderly population, we have huge needs to analyze their Quality of Life. Regarding the geriatric population non- communicable diseases like diabetics, shorten their life span and quality. So we conducted a detailed study on health care of age fifty and above by free medical camps.
Methodology: Free medical camps were conducted villages of Delta Districts of Tamilnadu by Srikamatchi Medical Center, Thanjavur. Among them 10% random sample of geriatrics above 50 with vitals, ECG and ECHO. along with Questionnaires about Quality of life and Mental status were recorded. This study conducted in above area with sample of 156 elderly people in nine months.
Results: Regarding risk factors obesity is common and ill habits like tobacco, alcohol plays a major roll. Diabetic drugs are mostly benefitted free from Govt. institution’s supply were more beneficial. Only few received from private sources.. Regarding Quality of Life and mental status only 34 % active with regular life,25 % with low functions, 37%depended others and 25% with full of depression.
Conclusion: Health education targeted for the elderly people to improve their physical and psychological wellbeing will improve their quality of life . Adaptation by the family members and community plays a major roll to improve their confidence and well- being. There has been many factors such as un recognized life style, diet, consumption of tobacco and alcohol, that could be affect the quality of life. Through this study we seek to understand the common causes which affects the quality of the elderly diabetic population
Comparative Effect of Dapagliflozin on Fasting Blood Sugar and HbA1C when Given During Night vs Morning in Individuals with Type 2 Diabetes
Deekshita Sreenivas1, Prashanth Arun1 and Vijay Viswanathan1
1 M V Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre
Introduction: Current guidelines propose metformin as the preferred initial pharmacological agent for Type 2 Diabetes Mellitus. However, many patients do not achieve the Glycemic goal or do not tolerate Metformin and the addition of a Second Oral Agent, a Glucagon-like Peptide 1 (GLP-1) receptor agonist or Insulin, is usually needed. Available oral agents, besides Metformin, include Sulphonylureas, Thiazolidinediones, Dipeptidyl peptidase 4 (DPP-4) inhibitors and the selective inhibitors of sodium–glucose linked transporter type 2 (SGLT2).Dapagliflozin is a selective SGLT2 inhibitor and has been approved for the treatment of patients with Type 2 Diabetes Mellitus. This study aimed to investigate the effect of Dapagliflozin on Fasting blood sugars, HbA1c and weight reduction given after dinner in Type 2 Diabetic subjects as compared to Dapagliflozin given after breakfast and to evaluate the biochemical parameters in Type 2 Diabetic subjects taking Dapagliflozin after dinner.
Methods and Materials: A prospective observational study conducted at MV Hospital for Diabetes among individuals with Type 2 Diabetes Mellitus for a period of three months. Eligible patients who provided consent were included in the study under two groups, Group1: Type2 Diabetic Subjects taking Dapagliflozin after dinner and Group2: Type 2 Diabetic Subjects taking Dapagliflozin after Breakfast. Anthropometric and biochemical parameters were recorded in the baseline and follow-up.
Results: The mean age of study participants was 60.65 ± 9.95 years. Majority of the study participants were male (n = 68, 68%). The baseline mean body weight of study participants was 72.10 ± 13.27 Kg. The baseline mean BMI of the study participants was 27.12 ± 4.44. Mean duration of diabetes of the study participants was 15.59 ± 7.75 years. Mean value of fasting blood glucose in group 1 (night) in baseline and follow-up were 153.80 ± 48.72 and 131.16 ± 42.56 respectively, which is statistically significant (p = 0.013). Mean value of fasting blood glucose in group 2 (morning) in baseline and follow-up were 149.34 ± 45.08 and 141.84 ± 32.54 respectively (p = 0.293). Mean value of HbA1c in group 1 (night) in baseline and follow-up were 8.22 ± 1.29 and 7.62 ± 1.27 respectively, which was statistically significant (p = 0.001). Mean value of HbA1c in group 2 (morning) in baseline and follow-up were 8.32 ± 1.62 and 7.98 ± 1.42 respectively (p = 0.063). In group 1 (night), the prevalence of UTI reduced from 12% to 4%, which was statistically significant (p = 0.001). In group 2 (morning), the prevalence of UTI reduced from 10% to 6% which was also statistically significant (p = 0.012).
Conclusion: The research highlights that administering Dapagliflozin at different times, specifically after dinner versus after breakfast, may yield varying impacts on fasting blood sugar levels, HbA1c, and weight reduction. These findings suggest that optimizing the timing of Dapagliflozin could enhance its effectiveness in managing Type 2 diabetes, potentially offering a new strategy for personalized diabetes care. However, the study also underscores the need for further investigation with larger sample sizes and longer follow-up periods to validate these findings and ensure their generalizability. The results contribute to the ongoing efforts to refine diabetes treatment protocols and improve patient outcomes through evidence-based practices.
Exploring the Knowledge, Attitudes, and Practices of Doctors in Diabetes Mellitus Management: Insights from a Quaternary Care Hospital
Sohan Biswas1, Ajay Kumar Gupta1, Aleena Ivan Theodore1, Kriti Mishra1 and Nishesh Jain1
1 Department of Internal Medicine, Max superspeciality Hospital, Vaishali, Ghaziabad, UP, India
Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder with a rising global prevalence, characterized by hyperglycemia resulting from defects in insulin secretion and/or action. Its long-term complications—including cardiovascular disease, neuropathy, nephropathy, and retinopathy—significantly impact patient quality of life and healthcare costs. Given the pivotal role of healthcare professionals in early diagnosis, prevention, and management, assessing their knowledge, attitudes, and practices (KAP) is essential. This study evaluated the KAP regarding diabetes management among doctors at a quaternary care hospital
Aims & Objectives: This cross-sectional, observational study aimed to assess doctors’ knowledge, attitudes, and practices (KAP) regarding diabetes management at a quaternary care hospital.
Materials and Methods: A cross-sectional, observational study was conducted at Max Super Speciality Hospital, Vaishali, Uttar Pradesh, India using convenience sampling. A validated, structured, self-administered questionnaire was used to assess three domains: knowledge (diagnostic criteria, current treatment guidelines, complications), attitudes (early diagnosis, lifestyle modifications, multidisciplinary care), and practices (screening, evidence-based treatment protocols, patient counselling). Participants included doctors from departments such as surgery, obstetrics and gynaecology, paediatrics, orthopaedics, anaesthesiology, and radiology, while those from internal medicine and allied specialties were excluded
Results: The mean knowledge score was 8.43 (SD-1.29; range: 5–10), attitude score was 6.89 (SD-1.23; range: 5–9), and practice score was 7.86 (SD-1.25; range: 5–10). These findings indicate that while doctors are well-informed, their application of knowledge in clinical practice is suboptimal, warranting strategic interventions.
Conclusion: Although the majority of doctors demonstrated strong theoretical knowledge of diabetes management, notable gaps exist in attitudes and clinical practices. Factors such as time constraints, underutilization of evidence-based guidelines, and limited integration of digital health technologies may hinder optimal patient care. Targeted training, policy initiatives, enhanced multidisciplinary collaboration, and the adoption of digital tools are recommended to bridge these gaps and improve outcomes.
Disclosures: None
Funding: None
Figures/Tables:
Association of VEGF Gene Polymorphisms with the Risk of Diabetic Foot Ulcers among the South Indian Population
Balaji Ramanathan1, Gandhimathi Krishnan1, Gunavathy Nagarajan1 and Kumaravel Velayutham1,2
1 Alpha Health Foundation, Madurai, Tamilnadu, India
2 Alpha Hospital & Research centre, Madurai, Tamilnadu, India
Introduction: Diabetic foot ulcer (DFU) is one of the most frequent complications of T2DM associated with uncontrolled T2DM or lower limb ulcers which may lead to amputation in up to 90% of cases. It results in morbidity in patients with T2DM and affects 15% to 20% of patients worldwide. The aetiology of DFU is multifactorial and involves both genetic and environmental factors, especially the genes related to inflammatory responses. Vascular endothelial growth factor (VEGF) is a most potent endothelial cell mitogen that plays a crucial role in angiogenesis. The alteration in the VEGF sequence due to polymorphism results in an increase of oxidative stress and a decrease of antioxidant glutathione leading to an increase in the risk for DFU. Compared to other diabetic complications, the genetics of DFU remain poorly studied. Hence the present study aims to evaluate the influence of the VEGF gene polymorphisms rs699947 and rs833061 on the risk of DFU in T2DM patients among the South Indian population.
Methods: A total of 50 study participants including 30 T2DM patients with non-healing ulcers (with or without PVD) along with 10 long-standing T2DM patients without ulcers and 10 non-diabetic age and gender-matched controls were enrolled in this study. Peripheral blood samples were obtained, put through pertinent biochemical tests, and used to separate genomic DNA for further PCR amplification of the genomic regions of interest. PCR, PCR product sequencing was carried out to identify genetic variants/ single nucleotide polymorphisms.
Results: The distribution of VEGF gene polymorphism rs833061 prevalence was as follows: in the Control group, CC, 60%; CT, 30%; TT, 10%; in the T2DM without DFU group, CC, 40%; CT, 40%; TT, 20%; and in the T2DM with DFU group, CC, 5%; CT, 65%; TT, 30%. The distribution of rs699947 was as follows: in the Control group, AA, 70%; AC, 20%; CC, 10%; in the T2DM without DFU group, AA, 30%; AC, 50%; CC, 20% and in the T2DM with DFU group, AA, 10%; AC, 70%; CC, 20%. The frequency of AC genotype of rs699947 polymorphism was significantly higher in T2DM with DFU patients (OR = 9.333; 95% CI = 1.5109–57.6557; χ2 = 6.696; P = 0.01) compared to controls. The T allele of rs833061 polymorphism was associated with an increased risk of T2DM with DFU (OR = 5.0; 95% CI = 1.5096–16.5605; χ2 = 7.5; P = 0.01) and The C allele of rs699947 polymorphism was associated with an increased risk of T2DM with DFU (OR = 4.888; 95% CI = 1.3862–17.241; χ2 = 6; P = 0.01) when compared with Controls.
Conclusion: In our study, the T allele of the rs833061 and the C allele of rs699947 single-nucleotide polymorphism in the VEGF gene might be implicated in the pathogenesis of diabetic foot ulcer as it may harbour some functional/regulatory potential in the VEGF gene expression.
Disclosures: None
Funding: ESI (Endocrine Society of India).
Figures/Tables:
A Comparative Study on Atherosclerosis in People with and without Diabetic Retinopathy and Nephropathy using Carotid Intima Media Thickness (CIMT)
Arutselvi Devarajan1, Jasjit S. Suri2 Divyabharathi Samraj1, Satyavani Kumpatla1 and Vijay Viswanathan1
1 MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai-13
2 Diagnostic and Monitoring Division, AtheroPoint, USA
Background: Literature suggests that there is a strong association between CIMT and diabetes and its complications such as diabetic retinopathy and diabetic nephropathy. Recent evidence is less in India on the association of cIMT and diabetic retinopathy and or nephropathy. Hence, we conducted this research to assess and compare the cIMT among people with only diabetes and people with diabetic retinopathy and or diabetic nephropathy.
Methods: A cross-sectional study was conducted from Oct 2021 to Feb 2024 among participants with type 2 diabetes aged between 30 to 65 years who visited a tertiary care centre for diabetes in Chennai and who were willing to participate in the study. The participants were screened for the presence of of retinopathy and nephropathy based on fundus examination and estimated Glomerular filtration rate (eGFR). The participants without any complications were included in Group1 (n = 81) and the participants with confirmed diagnosis of retinopathy and nephropathy were included in Group 2 (n = 78 respectively. Anthropometric, biochemical and clinical details were recorded. Carotid Intima Media Thickness was measured by B - mode ultrasound images. Mann Whitney U test and Kruskal Wallis test with pairwise comparison were performed and the analysis was performed using SPSS version 29.0.
Results: The median age of the participants was 47.5 and 52years(p = 0.006) in group 1 and group 2 respectively. The median left cIMT maximum score was higher in group 2 compared to group1 (0.90 vs. 79; p = 0.015). Group 2 had high median left cIMT average (0.67 vs. 0.63; p = 0.063), minimum values (0.48 vs.0.46; p = 0.069) and left total plague value (TPA) (20.1 vs. 18.5; p = 0.110) compared to group1 but the difference between the groups did not reach statistical significance. The right cIMT maximum score was significantly higher in group2 than group1 (0.88 vs. 0.60; p = 0.005). The median of minimum score (group 2 vs. group1; 0.48 vs.0.43; p = 0.013) and total plaque (group 2 vs. group1; 20.5 vs.17.5; p = 0.007) score of right cIMT also showed significant difference between the groups. A significant gender difference was noted in the total cIMT average (Male vs Female:1.3 vs. 1.2; p = 0.013), cIMT maximum (1.69vs. 1.59; p = 0.007) and TPA (40.2 vs .31.9; p = 0.002 values between the study groups. The total cIMT max (2.0 vs. 1.85vs.1.7; p < 0.05) values were high in people with both retinopathy and nephropathy compared to people with only nephropathy or retinopathy. While the median Total plague area was high in people with nephropathy (44.9) compared to people without any complications (36.6), people with retinopathy (39.1) and people with both retinopathy and nephropathy (42.5) and the difference between these subgroups was statistically significant (p < 0.05).
Conclusion: People with diabetic retinopathy and/ or nephropathy had high cIMT average, max and total plaque area scores compared to people without any diabetic complications.
Access to Foot Examination for People with Type 2 Diabetes: A Cross-Sectional Study from a Tertiary Care Centre for Diabetes
Karan Kumar R1, Arutselvi Devarajan1, Manjula Datta1 and Vijay Viswanathan1
1 MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Royapuram, Chennai, India
Introduction: Foot care is an important aspect of diabetes care, as improper or uncontrolled diabetes can lead to complications such as diabetic neuropathy. It may further result in occurrence of diabetic foot ulcer if proper foot care is not given. Thus, regular foot examination is necessary to detect high risk feet and to prevent severe outcomes like ulcers and amputations. However, access to foot examination varies based on the availability of health care facilities, geographic location, and individual circumstances. Hence this study is aimed to assess the proportion of people with diabetes, who underwent foot examination and to identify the factors influenced foot examination.
Methods: This Cross-sectional study was conducted among 200 study participants at a tertiary care centre for Diabetes from October 2024 to January 2025in Chennai, South India. Socio-demographic details of the participants, profile of diabetes and its’ treatment, history of foot examination and screening for other diabetic complications were collected. The participants were categorized into people treated at general clinics/primary care centres (group 1, n = 51) and diabetes specialty centres (group 2, n = 149). The proportion of people who underwent foot examination and investigated for other complications in the last one-year was assessed in both the groups. Mean (SD) or median (range) and number (%) were shown for continuous and categorical variables respectively. Student T test and chi-square tests were performed to test the difference between the groups.
Results: The median age of the participants in group 1and group 2 was similar(54 vs.58years; p = .107).The proportion of foot examination done among the participants who attended public health facility or private general practitioners (13.7%) compared to those who attended tertiary or specialty centres for their diabetes treatment (86.4%, p < 0.001). First feet examination after the diagnosis of diabetes was done after 9 median years in group 1 and 2 median years in group 2. The difference between the groups was statistically significant (p = 0.012). Around 40% in group2 but none in group 1 had their feet examined within the same year of the diagnosis of diabetes. No significant gender difference was found in the investigations done for feet and other complications. Participants in group 2 had median (range) HbA1c of 8% (6,14) which was significantly less when compared to group 1(HbA1c 9% (6,14), p = 0.007).
Conclusion: Only 14% of the participants who were treated at the general clinics/primary care centres had examined their feet. Even among the diabetologists, foot care happened only years after diabetes was diagnosed. Hence training the primary care health providers to conduct regular feet examination in both public and private primary health facilities will benefit people with diabetes. The importance of foot examination for people with diabetes needs to be stressed even from the medical college curriculum.
Correlation Between Liver Fibrosis and Glycemic Control in Type 2 Diabetes Mellitus in Urban India
Shruti Gangwani1, Purvi Chawla1, Manoj Chawla1 and Aanam Shaikh1
1 Lina Diabetes Care Centre, Mumbai
Objectives: Diabetes mellitus is associated with an increased risk of liver fibrosis, yet routine screening for fibrosis in diabetic patients remains limited. This study evaluates the correlation between glycated hemoglobin (HbA1c) levels and Fibrosis-4 (FIB-4) scores in patients with type 2 diabetes mellitus (T2DM) and explores the impact of glycemic control on liver fibrosis risk.
Materials and Methods: A retrospective study was conducted at an urban specialized diabetes clinic, analyzing clinical records of 450 T2DM patients. Patients were categorized based on HbA1c levels: Normal (<6.5%), Moderate (6.5-7.5%), Poor (7.5–8.5%), and Very Poor (>8.5%). The FIB-4 index, a non-invasive liver fibrosis assessment tool, was used to evaluate fibrosis risk, with scores >2.67 indicating advanced fibrosis. Statistical analysis assessed correlations between HbAlc and FIB-4 scores.
Results:
Patients with very poor glycemic control (HbA1c >8.5%) had the highest FIB-4 scores, suggesting a considerably increased potential for developing high-risk liver fibrosis cases.
A weak positive correlation was found between higher HbA1c levels and increased chances of liver fibrosis risk.
FIB-4 scores increased as HbA1c worsened, with the highest scores seen in patients with very poor glycemic control.
These findings highlight the importance of regular liver health monitoring in diabetes care, especially for those with poor blood sugar control.
Conclusion: Uncontrolled hyperglycemia (HbA1c > 8.5%) is associated with a higher FIB-4 score and, hence, an increased likelihood of liver fibrosis in patients with Type 2 Diabetes Mellitus (T2DM). Routine FIB-4 screening in T2DM patients, particularly those with poor glycemic control, is essential for early detection and intervention. Integrating liver function assessment into diabetes care can potentially improve long-term patient outcomes.
The Effect of Mindfulness Based Stress Reduction Therapy on Sleep Quality and Emotion Regulation among People with Type 2 Diabetes
Manjula Arunraj1, Vaishnavi Vijay1, Satyavani Kumpatla1 and Vijay Viswanathan1
1 MV Hospital for Diabetes & Prof. M. Viswanathan Diabetes Research Centre
Introduction: Diabetes is a chronic disease that requires lifelong treatment and care. Maladaptive emotion regulation can lead to hypoglycemic episodes, elevated Hba1c, and problematic self-care behaviors. Diabetes and sleep are intricately connected and many people with type 2 diabetes (T2DM) experience poor sleep quality or insomnia. Mindfulness Based Stress Reduction (MBSR) is a behavioral intervention that relies on concentrating on self.
Aim & objectives: The aim of this study was to investigate the effectiveness of mindfulness based stress reduction therapy on emotion regulation, sleep quality and glycemic control among people with type 2 diabetes.
Materials and Methods: This randomized interventional study was conducted in a tertiary care centre for diabetes from Dec 2023 to feb2024.A total of 176 participants was screened using Emotion Regulation Questionnaire (ERQ) and Pittsburgh Sleep Quality Index (PSQI). Around 74 participants with poor emotion regulation and poor sleep quality were enrolled into the study and were randomized into Group 1 Control (N = 37) and Group 2 Intervention (N = 37). A trained psychologist administered the Questionnaire to each participant. Socio-demographic, clinical, anthropometric measurements and biochemical details and lipid levels were recorded at baseline and follow up. Body scan meditation is the technique adopted from the whole MBSR therapy and this meditation was taught to the participants in Group 2.The participants were asked to follow the meditation technique regularly using the audio provided for them. The participants in Group 1 were given standard counseling as part of routine diabetes care. The Group 2 participants were followed up to check the compliance through weekly phone call and motivated them to follow the body scan meditation daily. 31 participants from Group 1 (6 dropouts) and 36 (1 dropout) from Group 2 were reported for follow up after 3 months. A post test was conducted in all the pre test measures for both the groups.
Results: The age, educational status, duration of diabetes, occupation of both the study groups was similar at baseline. The Global PQSI mean score showed a significant reduction in group 2 (Baseline Vs.Followup) (16.8 vs. 6.9, P < 0.001) which implies that there was a significant improvement in the sleep quality whereas the group 1 participants showed a significant increase in the mean global PQSI scores(17.5 vs. 19, P < 0.001. In group 2, the ERQ scale Cognitive reappraisal facet showed a significant increase in the mean scores (Baseline vs. Followup) (25.1 vs. 36.5, P < 0.001) and expressive suppression facet showed a significant reduction in the mean scores(18.3 vs. 11.1, p = <0.001).This showed that group 2 participants were regulating their emotions effectively. The group 1 participants had a poor emotion regulation in both the facets such as Cognitive reappraisal facet (35.6 vs. 23.4, p = <0.001) and expressive suppression facet(10.9 vs. 18, p < 0.001).The body scan meditation had a greater impact on Hba1c reduction (pre vs. post)(9.5 vs. 8.1, P < 0.001), fasting glucose (186.3 vs. 152.4, P = 0.041), post parandial glucose (270.2 vs. 224.2, P < 0.001) and total cholesterol (187.1 vs. 165.8, P < 0.001) in the intervention group.
Conclusion: The findings of our study highlighted that Body scan meditation adopted from Mindfulness based stress reduction therapy had a greater impact on improving the sleep quality and emotion regulation among people with Type 2 diabetes. It also helps to achieve good glycemic control.
Keywords: Mindfulness based stress reduction therapy(MBSR), Body scan meditation, sleep quality and Emotion regulation.
Funding: None
Disclosures: None
Tables:
Prevalence of Thyroid Disorders in Diabetes: A Comparative Study Across Various Types of Diabetes Mellitus
Gomathi Panneerselvam1, Nivetha Malaisamy2 and Kumaravel Velayutham1
1 Alpha Health Foundation, Madurai
2 Alpha Hospital and Research Centre, Madurai
Background: Thyroid diseases and diabetes mellitus are the most prevalent endocrine disorders encountered in clinical practice. Emerging studies elucidated the mutual influence between these two conditions. Thyroid hormones play a role in regulating carbohydrate metabolism and pancreatic function, while diabetes mellitus can impact thyroid function tests, resulting in alterations in thyroid hormone homeostasis. However, the prevalence of thyroid disorders across different types of diabetes mellitus remains underexplored. Therefore, the objective of the present study was to investigate the prevalence of thyroid disorders in individuals with Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), and Gestational Diabetes Mellitus (GDM), Pancreatic Diabetes Mellitus (PDM) and Maturity-onset diabetes of the young (MODY).
Methods: This is an observational cross-sectional analysis conducted with 17579 diabetes patients, including 547 with T1DM, 16105 with T2DM, 749 with GDM, 134 with PMD and 44 with MODY who regularly attended the outpatient clinic at Alpha Hospital and Research Centre. All the participants underwent clinical and laboratory assessments as part of the study protocol. The data were analyzed to determine the prevalence and types of thyroid disorders among the different diabetic groups.
Results: The overall prevalence of thyroid disorders in individuals with diabetes was found to be 18.7%, with the highest prevalence observed in the T2DM group (18.93%), followed by GDM (16.8%), T1DM (16.08%), and PDM (16.4%). Hypothyroidism was the most prevalent thyroid disorder across all groups, affecting 7% of T1DM, 11.5% of T2DM, 11.2% of GDM, 14.9 % of PDM, and 34% of MODY patients. A higher incidence of subclinical hypothyroidism was noted in T1DM (4.5%) compared to T2DM (2.6%) and GDM (2.4%). The prevalence of hyperthyroidism including subclinical was higher in T2DM (2.35%) compared to T1DM (1.64%) and GDM (0.93%). The incidence of diffuse goiter was higher in GDM (1.46%) than in T1DM (0.9%) and T2DM (0.46%). Thyroid nodules were detected in 1.9 % of T2DM patients, but T1DM and GDM groups showed 1% and 0.8% respectively. Thyroid cancer was observed only in the T2DM group with 0.13%. The prevalence of thyroid disorder is higher in female as compared to male across all types of diabetes.
Conclusion: This study concludes that thyroid disorders are prevalent among individuals with diabetes, particularly in T2DM. Hypothyroidism was the most common thyroid dysfunction across all groups, while subclinical hypothyroidism was more frequent in T1DM. The prevalence of hyperthyroidism and thyrotoxicosis remained low and comparable across groups. Notably, the incidence of thyroid cancer and solitary thyroid nodules was rare, with a slight increase in multinodular goiter in T2DM. It highlights the importance of monitoring thyroid function in diabetes patients, especially individuals with T2DM and T1DM, to ensure early detection and management of thyroid-related abnormalities.
Disclosures: None
Funding: None
Figures/Tables:
Pink Semen in a Patient with Diabetes Mellitus: An Uncommon Side Effect of a Common Drug
Gomathi Panneerselvam1 and Kumaravel Velayutham1
1 Alpha Health Foundation, Madurai, Tamilnadu, India
We report a unique case of a 47-year-old obese male with a history of Type 2 Diabetes, systemic hypertension, dyslipidemia, and hypothyroidism, who presented with uncontrolled glycaemia. The patient had been on sulphonylurea and biguanide drugs for diabetes management. Upon examination, his blood tests revealed HbA1c of 8.8%, vitals were stable, renal and lipid profiles were within normal limits. Empagliflozin, a Sodium-glucose Cotransporter-2 (SGLT2) inhibitor, was initiated 10 mg daily to improve glycemic control. However, after 10 days, the patient developed symptoms of urinary tract infection, including fever, dysuria, and superficial genital fungal infection. Urine culture result showed Klebsiella count >100,000 IU/ml, which was treated with ofloxacin. One week later, the patient complained of pink semen discharge. Further investigation revealed Serratia marcescens in the semen, sensitive to amikacin. Imaging studies revealed an ectopic kidney but no abnormalities in the reproductive organs. SGLT2 inhibitor was immediately discontinued, and the patient was treated with amikacin, insulin and topical anti-mycotics resulting in complete recovery.
This case study highlights a rare but significant complication of SGLT2 inhibitor therapy: pink semen, associated with genital mycotic infections due to altered glucose excretion and favourable conditions for bacterial growth. This case also underscores the importance of prompt recognition and intervention in managing infections related to SGLT2 inhibitors in diabetic patients. The incidental finding of an ectopic kidney further adds complexity to the patient’s clinical presentation, given its association with potential anatomical and structural abnormalities of the upper urinary tract and seminal vesicles. Our report underscores the importance of vigilant monitoring and timely management of complications associated with SGLT2 inhibitor therapy.
Disclosures: None
Funding: None
The Effectiveness of DSMES (Diabetes Self-Management Education and Support) on the Glycaemic Control and Quality of Life among People Living with Diabetes
1 MV Hospital for Diabetes and M Viswanathan Diabetes Research Centre
Aim: To evaluate the effectiveness of DSMES on glycaemic control and quality of life (QoL) among people with type 2 diabetes (T2DM)
Methods: 180 participants with T2DM were randomly divided in two groups from a tertiary care centre from February 2024 and were followed till July 2024. Group 1 (intervention) underwent a 2 to 3 hour intensive counselling on diet, education, SMBG regular exercise/yoga with stress counselling and followed up after 7th and 45th day. Group 2 underwent standard counselling.
Anthropometric, dietary recall, HbA1c exercise, stress, quality of life was assessed by using DSMES and WHO-QoL questionnaire at baseline and follow up
Result: It is noted that after intervention the number of participants doing exercise, SMBG, and diet intake improved significantly while in the control group the increase was less.
Perceived stress levels decreased significantly in group 1.
The initial HbA1c of group 1 was 10.6 ± 1.4 and it reduced to 7.6 ± 0.85 after intervention (p < 0.0001). In Group 2, it was 10.8 ± 3.41at baseline and it reduced to 9.9 ± 2.85 (p = 0.0.0081).
During the initial counselling the participants were evaluated for their intake of calorie, carbohydrate, protein and fat. They were counselled on high quality proteins available. The results showed that in the study group the intake of protein increased significantly with a decrease in the intake of carbohydrate and fat intake. The difference of intake values in the control group was less.
The quality of life of the participants improved in all four domains which was highly significant. This improvement in the quality of life was seen due to the intense counselling on all aspects of diabetes control as well as the psychological counselling received by the participant in group 1.
Conclusion: This study proved that DSMES resulted in improvement in control of diabetes and quality of life..
Keywords: DSMES, Counselling, T2DM
Enhancing Clinical Diagnosis of Monogenic Diabetes: A Comparative Analysis of Novel and Established Parameters
Pichakacheri Sureshkumar1, Sidharth S Kumar2, Asif Masood3 and Johny Cheriyan4
1 Dr. Suresh’s DiabcareIndia Diabetes Center, Calicut, Kerala; Kerala University of Health Sciences, Thrissur, Kerala
2 Dr. Suresh’s DiabcareIndia Diabetes Center, Calicut, Kerala
3 Department of General Medicine, Malabar Hospital, Manjeri, Kerala
4 Korambayil Hospital and Diagnostic Center, Manjeri, Kerala
Background: Monogenic Diabetes Mellitus (MDM) represents a minority of Diabetes Mellitus (DM) cases but poses diagnostic complexities owing to its clinical overlap with other forms of DM. Preliminary clinical screening is crucial for diagnosis due to the paucity of genetic testing facilities.
Objectives: Our objective is to identify parameters that could enhance the likelihood of genetic positivity in clinically suspected cases of MDM by comparing genetically positive cases with clinically suspected but genetically negative cases.
Methods: We analyzed the demographic, anthropometric, and biochemical details of genetically confirmed MDM participants (n = 10) from our center and compared them with those of clinically suspected patients who tested negative for MDM (n = 67), excluding two neonatal DM (NDM) cases. Using Receiver Operating Characteristic curves, we determined the thresholds for various parameters, prioritizing a sensitivity of ≥ 75%.
Results: The upper cut-off values obtained for identifying individuals with a potential for genetic positivity were age of onset of DM 25.5 years, BMI 23.5 kg/m², visceral fat 7%, waist circumference (irrespective of gender) 86 cm, random C-peptide 1.41 ng/mL, SGOT 31 units/dL, SGPT 41 units/dL, triglyceride 150 mg/dL, and for HDL, the lower cut-off point was 48.5 mg/dL (Table 1).
Conclusion: When diagnosing MDM, incorporating these parameters can further refine case selection, thereby increasing the yield of positive genetic test results. Additionally, they contribute to optimizing resource use and improving overall diagnostic accuracy.
Disclosures: None
Funding: None
Cut-off values for monogenic DM when compared to non-monogenic DM
Parameter
Cut-off
Sensitivity
Specificity
PPV
NPV
AUC
Accuracy
Age of Onset of Diabetes (years)
25.50
75
45
14
94
0.66
0.48
BMI (kg/m²)
23.50
75
51
15
94
0.68
0.53
Visceral Fat (%)
7.00
100
43
16
100
0.73
0.49
Waist Circumference (cm)
86.00
100
34
15
100
0.70
0.41
Triglycerides (mg/dL)
150.00
88
37
16
96
0.68
0.43
SGOT (units/dL)
31.00
100
30
16
100
0.66
0.38
SGPT (units/dL)
41.00
88
33
15
95
0.59
0.40
Random C-Peptide (ng/mL)
1.41
88
65
30
97
0.72
0.69
HDL (mg/dL)
48.50
100
55
24
100
0.73
0.61
Insulin Injection Technique: Assessing the Gaps from Guidelines to Practice
Krishnaveni Niraipandiyan1, Balaji Ramanathan2 and Kumaravel Velayutham1,2
1 Alpha Hospital and Research Center Madurai, Tamilnadu, India
2 Alpha Health Foundation, Madurai, Tamilnadu, India
Introduction and Background: Diabetes mellitus (DM) is one of the major chronic diseases with its prevalence steadily increasing all over the world. India is the home to 69.9 million people with DM. About 3.2 million Indians depend on insulin injections for the management of diabetes. One of the major and modifiable facts of inadequate glycemic control is poor injection technique. Glycemic control improves with an improved insulin injection method.
Aim: The objective of this study was to evaluate the practice of insulin delivery among diabetic patients in a tertiary care facility.
Materials and methods: This observational study was done in the Endocrinology department of a tertiary care centre. The consecutive patients using insulin for at least five years by either syringe or pen were recruited. All of them underwent a survey using the FITTER-Based Insulin Technique Questionnaire which focused on key insulin injection parameters.
Results: 500 patients having diabetes treated with insulin for more than five years were evaluated: The mean age of the subject was 58.4 and their mean HbA1c was 9.11. 72% (360) were female and 28% (140) were male. 67% (335) of them resided in Urban and 33% (165) were from rural, 34% (170) were illiterate and 79% (395) of them fell in the socioeconomic category of 10-20K per month. There were 81% (405) with T2DM, 8% (40) of patients with T1DM and 11% (55) of patients with GDM. Among them, 47% (235) of them don’t know the correct areas of the body for insulin injection. The thigh (61%) was the most common site of insulin injection. 49% (245) of participants knew the importance of rotating injection sites and 67% (335) of study participants were rotating their injection sites occasionally.78% (390) were not aware of the angle for inserting the needle, 71.6% (358) of patients were unaware of the needle length used, 90.2% (451) were not aware of the difference between 40IU/100IU insulin/syringe. The cleaning of the injection site before insulin administration was practised only by 21.6% (108) of subjects. 72.4% (362) of patients reported having painful injections, 15% (75) had bleeding and 12.6% (63) had lipo-hypertrophy in our survey. 62.8% (314) of participants reported that they have never received training on how to inject correctly despite injecting for a mean of nearly 6 years. Overall, 72% (360) of subjects need additional guidance or training to continue the insulin injections.
Conclusion: There was an enormous gap between the insulin administration guidelines and contemporary insulin injection practices. All diabetics should repeatedly receive diabetic education and guidance on proper insulin injection practices for adequate glycemic control.
Genetic Insights and Precision Therapy In Neonatal Diabetes: A Case Series
Dhivya S1, Sreenivasan Pl1, Vasanthiy N1 and Sridhar S1
1 Department Of Endocrinology, Madurai Medical College
Background and Objectives: Neonatal diabetes is a form of Monogenic diabetes having onset within 6 months of life. It can be transient, permanent, or syndromic. Molecular genetic testing has big impact on management. The aim of our study is to implicate the role of genetics in prognosis and treatment of neonatal diabetes.
Methods: Here, we describe the clinical and genetic profile of 5 children with neonatal diabetes, who were followed up over a period of 3 years.
Case 1: A 2-month-old female child presented with DKA and multiple epiphyseal dysplasia. Genetic analysis showed a homozygous EIF2AK3 mutation, suggesting Wolcott-Rallison syndrome. Lifelong insulin therapy was recommended.
Case 2: A 4-day-old VLBW infant with persistent hyperglycemia but without acidosis. Genetic analysis revealed a homozygous GCK mutation, necessitating lifelong insulin therapy.
Case 3: A 2-month/mch with DKA, initially managed with Insulin. Genetic analysis identified a heterozygous KCNJ11 mutation, allowing switch to Glyburide with good glycemic control.
Case 4: A 24-day-old female child presented with DKA and dorsal pancreatic agenesis. A heterozygous KCNJ11 mutation was detected, and blood sugars were controlled after glyburide initiation.
Case 5: A 30-day-old preterm baby with neonatal sepsis, found to have persistent hyperglycemia. Genetic testing confirmed 6q24 methylation defect consistent with transient neonatal diabetes.
Results: Out of 5 children, 4 were diagnosed with permanent neonatal diabetes and 1 with Transient. The age at onset ranges from 4 days to 2 months. Consanguinity was present in 3 patients. DKA was the commonest presentation. KCNJ11 was the commonest mutation. 2 patients were switched to sulphonyl-ureas and 3 patients remained on insulin.
Conclusion: This case series highlights the variability in clinical presentations of neonatal diabetes. Genetic analysis is essential to differentiate transient from permanent cases. Some mutations (ABCC8, KCNJ11) respond to sulfonylurea thus preventing lifelong insulin therapy.
Comparison of Glucose Values Estimated by Glucometer (Capillary Blood) vs Venous Blood Gas Analyzer vs Venous Plasma Glucose
1 Sri Ramachandra institute of higher education and research
2 Department of Endocrinology, Sri Ramachandra institute of higher education and research
3 Department of Community Medicine, Sri Ramachandra institute of higher education and research
Introduction: This study explores to investigate the differences, correlation and consistency between blood glucose levels measured using 3 different techniques such as glucometer, venous blood gas analyser and venous plasma glucose in patients admitted in emergency medicine department.
Aims & Objectives: In this study we intend to check if the glucose value measured by venous blood gas whose result is accessible the earliest and is already part of critical care is accurate and sufficient for measuring blood glucose level compared to that measured using glucometer, we are going to be comparing the values with the gold standard which is the venous lab glucose analysis.
Material & Methods: A total of 60 patients were taken from the emergency department at the Sri Ramachandra Medical Hospital. Inclusion criteria-Patients admitted to the Emergency Department aged 18–70 years old, who’s skin was not cold and peripheral pulses are felt will be enrolled in this study. Exclusion criteria- patients requiring resuscitation, patients in whom resuscitation is unsuccessful, end-stage patients, RTA patients, and patients with a blood pressure greater than 180 mmHg will be excluded from the study.
The patients venous blood glucose was measured using the Roche Cobas B221 blood gas analyser according to the manufacturer’s instructions. The capillary blood glucose level will be measured using a glucometer {freestyle Optium Neo}. The patient’s venous plasma glucose will be measured by collecting a sample at the same time as the venous blood gas sample. The venous sample will, then be used to measure glucose using the hexokinase method on the Roche platform. The data collected using these 3 methods will be analysed and correlated with each other.
Results: The blood sugar was measured from all 3 methods and analysed. The correlation between CBG and RBS was found to be 0.92999, the correlation between VBG and RBS was found to be 0.96624The regression analysis of CBG vs RBS showed a strong correlation of r2 = 0.865 (strong correlation), p value <0.001, CBG is a significant predictor of RBS. VBG vs RBS, R2 = 0.934(very strong correlation), p value <0.001, RBS is a significant predictor of VBG. Bland Altman analysis showed that blood glucose values measured by VBG were higher than RBS and CBG, the blood glucose measured by the two methods did show good agreement with the RBS.
Conclusion: The correlation that was found between the CBG values and the RBS values was found to be lower as compared to the values obtained using the venous blood gas analyser. The values were found to be significant which helps us reach the conclusion that it is not necessary in a clinical care setting to repeat the blood glucose measurement of patients using capillary blood glucose using the glucometer who are getting their blood analysed in the venous blood gas analyser, since the venous blood gas analyser readings were found to be closer to the glucose values as compared to the gold standard, resting blood glucose.
Funding: None
Disclosures: None
Clinical Profile of Type 1 Diabetes Mellitus in Teritary Care Centre, Tamilnadu
Kirankumar P1, A.K.Porkodi1, Udhayabashkaran Kadirvelu1, G Prakash1, S Suresh Kanna1 and D Vijayaraju1
1 Govt Mohan Kumaramangalam Medical College And Hospital Salem, Tamilnadu
Background: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease characterized by immune-mediated destruction of insulin-producing beta cells of the pancreas and its main precipitating factors are genetic susceptibility and environmental insults. Optimum glycemic control is necessary to reduce and even prevent the risk of micro- and macro vascular complications of type 1 diabetes mellitus (T1DM).
Aims & Objectives: This study aimed to assess the incidence of clinical outcome of the T1DM patient and their insulin dosage needed for the effective glycemic control of these patients.
Material and Methods: 172 known type 1 Diabetes mellitus patient who attended diabetology OPD of Government Mohan Kumaramangalam medical college hospital Salem were recruited in this study during the period of January 2024 to June 2024. Data collected includes age, gender, family history of diabetes mellitus both type 1 and type 2, glycemic status of the patient and their TSH, vitamin D and hbA1c levels of the patient and their complications
Results: The gender distribution in our sample data is slightly male predominance of 54.3%. 20.2 % of our patient had family history with T2DM, and 5.8% of our patient had a family history with T1DM. About 23.83% had their disease onset between the age of 5-10 years, followed by 19.76% of had their onset between the age of 11–15 years. Nearly 58.13% patient required more than 1unit/kg body weight /day of insulin dose. Vitamin D deficiency prevalence in our population is about 45%. More than 50 units / day insulin dose is required to achieve glycemic control in 62.2%of type 1 diabetes mellitus patients.
Conclusion: Good glycemic control is necessary to be achieved in all type 1 diabetes mellitus patient to prevent the micro and macro vascular complications. Most of the type 1 diabetes mellitus had the age of onset between 5 – 10 years in our sample population. Also, there is slight male predominance. Patient required higher dose of insulin (more than 1 unit/kg body weight/ day) for glycemic management. Good glycemic control is essential in spite of requirement of higher insulin dose. Screening for vitamin d deficiency is essential in all type 1 diabetes mellitus.
Disclosures: None
Funding: None
Figure/Tables:
Total insulin dose required per day with their HbA1C correlation
No. of patients in y axis and insulin dose in x axis
Neuroendocrine Tumour: As a Rare Presentation of Recurrent Seizures in A Young Male
Prakash Raj.V1, Porkodi.A.K1, Manjula1, Prakash G1 and Suresh Kanna.S1
1 GMKMCH, Salem
Introduction: Neuroendocrine tumours in pancreas are rare tumours characterized by fasting hypoglycemia with recurrent episodes of neuroglycopenic symptoms. The most common neuroendocrine tumour in pancreas is insulinoma. Insulinoma had been misdiagnosed with a neurologic or psychiatric disorder. We report a rare case of Neuroendocrine tumour in a 16 year old male who had been treated initially as seizure disorder.
Methods: Patient was evaluated for neuroglycopenia symptoms (seizures) which occur in early morning hours during fasting state. CGMS recording showed persistent hypoglycemia throughout the day and night. The C peptide done in fasting state was high normal with normal cortisol and TSH levels. Renal and Liver function tests were normal. Ultrasound Abdomen done showed 2.5 2.4 cm well defined heteroechoic lesion noted in head and uncinate process of pancreas, possibility of Neuroendocrine tumour. CECT Abdomen done showed 3.5 * 3.2 * 2.6 hypodense enhancing lesion in the head and uncinate process of pancreas. Endoscopic ultrasound also showed 3.3 2.8 hypoechoic lesion in the head of the pancreas.
Conclusion: Open enucleation of the tumour was done by the surgical gastroenterology department. The postoperative period was uneventful and the patient was discharged without any episodes of hypoglycemia.
Figures. CECT image of the neuroendocrine tumor in pancreas
Screening for Detection of Peripheral Sensory Neuropathy by Biothesiometer and Glycemic control in Persons with T2DM
Naveenkumar.M1, Porkodi.A.K1, Sivakumar S1, Prakash G1 and Suresh Kanna.S1
1 GMKMCH, Salem
Introduction: The cause of foot complications in Diabetes Mellitus leading to amputation is undetected diabetic sensory peripheral neuropathy. Most of the persons with Diabetes sensory peripheral neuropathy are asymptomatic. Early screening in all diabetic patients for sensory neuropathy through biothesiometry and foot education will help in prevention of foot complications. Good glycemic control is essential for prevention of peripheral neuropathy.
Materials and Methods: 500 known Type 2 Diabetes Mellitus patients who attended Diabetology OPD Government Mohan Kumaramangalam Medical College Hospital,Salem were recruited in this study during January 2024 to June 2024. Data collected included age, gender, duration of Diabetes Mellitus,HbA1c and biothesiometry screening.
Results: The gender distribution for peripheral neuropathy were similar. About 43.8% of diabetic patients with duration > 5 years had sensory neuropathy ( p -0.045 ) which is statistically significant (Table 1). Only 28.8% had good glycemic control (HbA1C < 7%) (Table 2). Biothesiometer screening was positive for sensory neuropathy in those who had poor glycemic control (HbA1c >7%).
Conclusion: Good glycemic control has to be achieved in all Diabetic patients to prevent microvascular complications. Periodic monitoring for blood sugar control and education for persons with diabetes will help in achieving glycemic control. Screening for neuropathy from the diagnosis of diabetes mellitus and foot education regarding insensate foot will help in prevention of foot complications.
Disclosures: None
Funding: None
Tables: Table 1:
Screening for Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes Mellitus in a Tertiary Care Center, Salem
Prakash Raj.V1, Porkodi.A.K1, Manjula1, Prakash G4 and Suresh Kanna. S1
1 GMKMCH, Salem
Introduction: Diabetic retinopathy is a microvascular complication of diabetes that can cause permanent blindness if left untreated. Diabetic retinopathy usually does not cause any symptom in earlier stages. Microvascular complications like retinopathy are underdiagnosed and undertreated especially in newly diagnosed type 2 diabetes mellitus patients.
Materials and Methods: The study involved 501 newly diagnosed type 2 diabetes mellitus patients who attended diabetology OPD of Government Mohan Kumaramangalam medical college hospital during the period of January 2024 to June 2024. Data collected includes history of patients, hemoglobin, HbA1c, fasting blood sugar and post prandial blood sugar. These patients underwent fundus examination through direct ophthalmoscope and slit lamp examination.
Result: Among 501 patients, 70% did not attend the clinic for regular eye examination. 61% had good knowledge about diabetes. But only 2.1% had knowledge about retinopathy. 5% of the total population had diabetic retinopathy. Of which mild NPDR was found in 20 patients, moderate NPDR in 2 patients and severe NPDR in 3 individuals. Proliferative Diabetic retinopathy was not seen in any patients. (Table 1)
Conclusion: study emphasizes the screening for diabetic retinopathy at the earliest during diagnosis itself. Earlier screening helps in detecting diabetic retinopathy which is reversible when treated appropriately.
Disclosures: None
Funding: None
Prevalence of Diabetic Retinopathy.
Sex
Cases
Mild Npdr
Moderate Npdr
Severe NPDR
PDR
Male
207
9
1
0
0
Female
294
11
1
3
0
Total
501
20
2
3
0
Genetics at Play: The Role of Mutations in Neonatal Diabetes
Ragupathi1, Natarajan MD1, Palanikumaran1, Vasanthakalyani1 and Sureshkumar1
1 Madurai Medical College
Introduction: Neonatal diabetes mellitus (DM) is characterized by the onset of persistent hyperglycemia within the first six months of life due to impaired insulin function and is frequently caused by a mutation in a single gene affecting pancreatic beta cell function. Management is based on the type of mutation and it includes lifelong insulin therapy or oral sulfonylureas.
Case Report: A 13 year old male presented with fever, swelling of left leg and breathlessness for 7 days. He is a known diabetic since 3 months of life and treated as T1DM with subcutaneous insulin, which he didn’t take for past 3 days. Laboratory reveals Leukocytosis, elevated blood sugar, metabolic acidosis and positive for urine ketones. USG abdomen showed normal study. PTA showed mild SNHL. Fundus examination was normal. Genetic testing done for neonatal diabetes panel, Which turned out to be positive for KCNJ11. He was initially managed with IV Fluids, IV antibiotics, antipyretic and Insulin, which after genetic analysis’ report changed to Tablet Glibenclamide.
Conclusion: For infants presenting with hyperglycaemia, after excluding other causes and once the diagnosis of NDM is made, genetic testing is recommended to guide the treatment plan. Oral sulfonylurea at higher doses in Individuals with mutation in KCNJ11 or ABCC8, eliminates the need for insulin and can reduce neurodevelopmental defects.
The Hunger Gene: The Mystery of Young Onset Diabetes and Morbid Obesity
Aravind Kumar M1, Sreekumar1, Vasanthiy N1 and Sridhar S
1 Department Of Endocrinology, Madurai Medical College, Madurai
Introduction: Obesity and Diabetes are often linked to environmental factors, but in some cases they stem from genetic mutations that disrupt metabolic regulation. The melanocortinergic pathway orchestrates energy homeostasis and impairments in this system leads to hyperphagia and early onset severe obesity. Identification of genetic mutations in this pathway can guide clinical decisions and predict potential complications
Case Report: 12 year girl born of 2nd degree consanguinity presented with excessive weight gain and severe hyperphagia since birth with normal intellect. Family history was unremarkable. She was morbidly obese with BMI of 45.9 kg/sq.m (+ 2.8 SDS). She had almond shaped eyes with severe acanthosis nigricans and bilateral genu varum. Vision and hearing were normal. Diabetes was recently diagnosed with HBA1C of 10.1%.Hyperisulinemia (77.78µIU/ml N(2.62-24.9 µIU/ml) and severe insulin resistance (HOMA-IR-39.40-N(0.5-1.4). were detected biochemically. C-peptide assay (7.92 ng/ml N (0.81-3.65) suggested adequate beta cell reserve. Polysomnogram detected mild sleep apnea. Abdominal imaging showed Grade 3 fatty liver with no other anomalies.
Whole exome sequencing detected a homozygous deletion of size 1.23 kb encompassing the MC4R gene. She was advised calorie restriction with low carbohydrate diet and regular physical activity. She was started on basal bolus insulin therapy with insulin sensitizers.
Conclusion: With the advent of newer therapies for monogenic obesity, molecular diagnosis has become an essential tool in providing accurate diagnosis and enabling timely initiation of personalized therapies preventing future metabolic complications.
Comparative Study of Insulin Adherence and Glycemic Control among Patients with T1DM, T2DM and GDM
Brindha Devi Malaisamy1, Gomathi Panneerselvam2 and Kumaravel Velayutham2
1 Alpha Hospital and Research Centre
2 Alpha Health Foundation.
Background: Insulin adherence plays a crucial role in the management of diabetes, influencing glycemic control and the prevention of long-term complications. While patient with Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), and Gestational Diabetes Mellitus (GDM) are all treated with insulin therapy, there is limited comparative data on adherence rates and glycemic control across these groups. This study aims to evaluate insulin adherence and glycemic control in patients with T1DM, T2DM, and GDM.
Methods: A prospective observational study was conducted at Alpha Hospital and Research Centre involving a total of 90 patients diagnosed with T1DM (n = 30), T2DM (n = 30), and GDM (n = 30), all receiving insulin therapy. Insulin adherence was assessed using the modified of Adherence to diabetes medications questionnaire (ADMQ) and pharmacy refill records. Glycemic control was measured by HbA1c, fasting blood glucose and postprandial levels.
Results: The mean ages of patients with T1DM, T2DM, and GDM were 15.8, 51.8, and 26.4 years, respectively. In the T1DM cohort, 60% of patients were male and 40% were female, while in the T2DM cohort, 33.5% were male and 66.5% were female. The mean duration since diagnosis for T1DM and T2DM patients was 2.2 and 8.8 years, respectively. Adherence levels in T1DM were as follows: 10% of patients were non-adherent, 30% highly adherent, 40% moderately adherent, and 10% had low adherence. For T2DM, 35% were classified as low adherent, 30% as moderately adherent, 20 % as highly adherent and 15%. In the GDM group, 80% of patients were highly adherent, and 20% were moderately adherent. The mean adherence scores were higher in the GDM group compared to both the T2DM and T1DM groups. At baseline, the average HbA1c levels were 10.5% for T1DM and 11.36 % for T2DM, and 7.72% for GDM. By the third month, the average HbA1c levels had decreased to 8.5% for T1DM, 9.7% for T2DM, and 6.12% for GDM, with the greatest reduction observed in the GDM group. Regarding insulin dosage, the mean insulin dose at baseline was 22.8 IU for T1DM, 39.5 IU for T2DM, and 17 IU for GDM. By the third month, these doses had increased to 28.4 IU for T1DM, 48 IU for T2DM, and 31.8 IU for GDM. Insulin doses varied across groups, with T2DM requiring the highest doses at baseline and increased increment dose was observed in GDM.
Conclusion: Insulin adherence was highest in GDM patients and lowest in T2DM patients. Glycemic control was best in GDM patients, likely due to more frequent monitoring and management during pregnancy. The GDM showed the greatest reduction in HbA1c levels, while both T1DM and T2DM groups showed lower adherence and less pronounced improvements in glycemic control. Targeted interventions focusing on improving insulin adherence, especially in T2DM, are crucial for better overall glycemic control. These results highlight the need for personalized care strategies tailored to each diabetes type to enhance patient outcomes.
Disclosures: None
Funding: None
Figures/Tables:
Multi-Modal Deep Learning for Non-Invasive Diabetes Detection Using PPG and ECG Signals: A Survey
Md Basit Azam1 and Farhana Azim2
1 Department of Computer Science & Engineering, School of Engineering, Tezpur University, Napaam, Sonitpur, Assam, India
2 Center for Multidisciplinary Research, Tezpur University, Napaam, Tezpur, Sonitpur, Assam, India
Introduction: Non-invasive diabetes detection is rapidly emerging as a promising alternative to conventional, invasive diagnostic techniques. Advances in wearable technology have enabled continuous monitoring through signals such as photoplethysmography (PPG) and electrocardiography (ECG). These signals, when analyzed using deep learning, can potentially overcome the limitations of routine methods like FPG, HbA1c, and OGTT, which are often invasive, costly, and less accessible in resource-constrained settings.
Aims & Objectives: The primary aim of this review is to synthesize recent advancements in multi-modal deep learning frameworks that integrate PPG and ECG signals for non-invasive diabetes detection. Objectives include comparing single-modal approaches with multi-modal fusion strategies, examining various deep learning architectures—such as CNNs, RNNs/LSTMs, and Transformer-based models—and assessing their diagnostic accuracy, interpretability, and real-world applicability.
Material & Methods: A comprehensive literature review was conducted to evaluate state-of-the-art methods. The materials and methods reviewed include studies utilizing CNNs for extracting PPG waveform features, RNNs for modelling temporal dependencies, and innovative Transformer-based approaches that merge PPG and ECG data. Hybrid models, such as Performer and DiabDeep, have been analyzed for their ability to mitigate motion artifacts and other sensor noise, while also addressing issues such as dataset bias (including underrepresentation of darker skin tones) and regulatory challenges.
Results: Results from the surveyed studies indicate that single-modal methods, while effective to a certain degree (e.g., PPG-based models achieving an AUC around 0.75 and ECG methods showing approximately 87.5% sensitivity), are significantly outperformed by multi-modal fusion approaches. Integration of vascular (PPG) and autonomic (ECG) biomarkers—especially using Transformer architectures—has yielded diagnostic accuracies as high as 95.9%. Additionally, the application of explainable AI (xAI) techniques, such as saliency maps, enhances clinical interpretability and trust.
Conclusion: Deep learning-based multi-modal frameworks present a robust strategy for early, non-invasive diabetes detection. They offer substantial improvements in diagnostic accuracy and real-time monitoring capabilities while paving the way for integration into wearable health platforms. Further research is needed to address computational constraints, standardize datasets, and navigate regulatory pathways for broader clinical adoption.
Visual Outcome Following Intravitreal Injections in Severe NPDR with CME and SRF A Case Report
R. Balamurugan1 and B. Anugraha2
1 Covai Diabetic Centre, Coimbatore, Tamil Nadu, India
2 Mahathma Eye hospital Pvt Ltd, Trichy, Tamil Nadu, India
Background: Diabetic retinopathy remains a leading cause of vision impairment, with cystoid macular edema (CME) and subretinal fluid (SRF) contributing to significant visual decline. Intravitreal anti-VEGF therapy is a widely used treatment modality to manage diabetic macular edema (DME) and associated complications.
Methods: 40-year-old male presented with a visual acuity (VA) of counting fingers at 2 meters (CF2M) in the right eye (RE). Clinical examination revealed severe non-proliferative diabetic retinopathy (NPDR) with CME and SRF. The patient was treated with an intravitreal injection of Bevacizumab. Post-treatment evaluation showed an improvement in VA to 6/60 in the affected eye.
Results: Following a single intravitreal injection of Bevacizumab, the patient exhibited an improvement in visual acuity from counting fingers at 2 meters (CF2M) to 6/60 in the right eye. The treatment outcome highlights the potential efficacy of anti-VEGF therapy in severe NPDR cases with macular involvement. Further follow-up is required to monitor long-term stability and the need for additional interventions.
Conclusion: Intravitreal Bevacizumab demonstrated a functional visual improvement in a case of severe NPDR with CME and SRF. Early intervention with anti-VEGF agents can be beneficial in improving visual prognosis in similar cases. Further studies are warranted to assess long-term outcomes.
Disclosure: None
Funding: None
Various Factors Associated with Prediabetes
Go. Bharani1, Alli Ilango1, Radha Saraswathy1, Aarthi1 and Jayasudha1
1 Mother’s Care Diabetes Centre, Vellore
Introduction: According to ICMR INDIAB study, the overall prevalence of diabetes was 11.4% and prediabetes was 15.3%. The best way to reduce the burden of diabetes is to prevent the prediabetics progressing to diabetes. Studies have shown prediabetes can be reverted to normal if measures are taken.
We have aimed to prevent, reduce, and stop the prediabetic subjects before the prediabetes matures progressively over time into diabetes.
Aims & Objectives: We want to study the various factors associated with prediabetes who are attending Mothers care Diabetes Centre, Vellore.
Material & Methods: Study subjects - A total number of 225 subjects who were not known to be diabetic visited the Mothers Care Diabetes Centre, either accompanying the diabetic patients or attending the clinic for other complaints were screened.
We analyzed the data (from Jan, 24 - Feb, 25) ranging to anthropometric measurements, family history, diet analysis and physical activity. After getting the consent of the subjects we performed an Oral Glucose Tolerance Test (OGTT), and a biochemical (Hb, HbA1C and Lipid profile) parameters. All subjects were advised to a lifestyle modification, including diet counselling, and were advised to walk for an hour daily. We did a Follow up after 6 months.
Results: Of 225 subjects, 125 subjects (55%) were found to have pre-diabetes, 90 subjects (40%) were non-diabetic and 10 subjects (5%) were diabetic.
In the gender ratio of the 125 prediabetic cases, 74 subjects (59%) were female and 51 Subjects (41%) were male.
Age group: The highest percentage of pre-diabetes subjects falls in the age group between 31–40 years (38%) and next in 41–50 years (38%). However even in the age group 20–30 years (7%) were found to be prediabetic.
BMI: Though overweight is prevalent in all categories, 84% of pre diabetics were obese. For the waist circumference it is abnormal in both prediabetic and normal subjects. However 91% of prediabetic subjects have increased waist circumference.
Hypertension: Hypertension is found to be prevalent in both normal and pre-diabetic subjects, the normal being 27% and the prediabetic 22%.
Dyslipidemia: Dyslipidemia also abundant in both subjects. But triglyceride levels (TGL) are higher by 200 mg/dL in prediabetic subjects. LDL seems to be above normal by 100mg/dL in both groups with Prediabetic subjects at 60% and normal subjects at 64%. HDL was analysed to be low in both groups (<50 mg/dL) prediabetic 85%, and normal subjects 73%.
143 subjects were enrolled for follow up I (After 6 months). Among them 62 (43%) came for follow up. Out of 40 prediabetes subjects, 16 (40%) reversed to normal (by following both diet and exercise), 3 (7%) of them became diabetic and 21 (53%) remained as prediabetes on follow up. Of 20 nondiabetic subjects, 3(15%) of them became prediabetes and 17(85%) remained normal. 2 subjects were excluded due to pregnancy.
Conclusion: Prevalence of prediabetes is quite high (55%) in the subjects that were screened. Obesity (both high BMI and increased waist circumference) seems to be the most common association in prediabetes. The Age group of 31–40 years is the age group where more prediabetes picked up. In this screened subjects the carbohydrate consumption is high (>75% of calories) and physical activity is minimum in all groups. Hypertension seems to be the most common comorbidity in the study population.
Disclosures: None
Funding: None
A Case of Syndromic Diabetes
Tharun Varman1
1 Madurai Medical College
Introduction: Alstrom syndrome (AS), also called Alstrom–Hallgren syndrome, is a very rare autosomal recessive genetic disorder characterised by childhood obesity and multiple organ dysfunction. Symptoms include early-onset type 2 diabetes, rod cone dystrophy resulting in blindness, SNHL and dilated cardiomyopathy. Endocrine disorders such as hypergonadotropic hypogonadism and hypothyroidism as well as Acanthosis nigricans from hyperinsulinemia. Developmental delay is seen in almost half of people with Alstrom syndrome.It is caused by mutations in the gene ALMS1
Case Report: A 15 yrs old male came with chief complaints of hematemesis and history of polyuria, nocturia, weight loss and loss of vision since birth.
Birth History: second degree consanguineous marriage and history of developmental delay
On Examination: he was conscious, oriented with hyperpigmented facies and acanthosis nigricans. Microcephaly and bilateral gynaecomastia with absence of facial and upper lip hairs. Spontaneous nystagmus was present. SMR- P3A; SPL-7cm; both testes -8cc each. Our patient fits in with one major and 5 minor criteria for diagnosis. Sample has been sent for genetic testing and reports are awaited.
Conclusion: In young patients of diabetes presenting with additional signs and symptoms, syndromic diabetes should be suspected.
TyG Index: A Silent Predictor of CAD Outcomes in Diabetes
Manoj Prabhu B1, Palanikumaran V1 and Natarajan M1
1 Madurai Medical College
Introduction: Cardiovascular disease (CVD) is influenced by multiple factors, including glycemic abnormalities and lipid disorders. Hypertriglyceridemia (HTG) is commonly associated with elevated glucose levels and metabolic disturbances, contributing to conditions like fatty liver disease and type 2 diabetes mellitus (T2DM). Previous studies suggest that both fasting glucose and triglyceride (TG) levels within the high-normal range may predict CVD risk. The Triglyceride-glucose (TyG) index has emerged as a novel metabolic marker, but its prognostic value in patients with stable coronary artery disease.
Aims & Objectives: This study aims to evaluate the predictive role of the TyG index(Ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2] in cardiovascular outcomes among diabetic patients with stable CAD.
Material & Methods: A nested case-control study was conducted at madurai medical college, Madurai from July 2024 to December 2024. Patients were followed up through direct interviews or telephone calls. Cardiovascular events (CVEs) assessed included all-cause death, non-fatal myocardial infarction (MI), stroke, and post-discharge revascularization (PCI or CABG). Laboratory tests included fasting glucose, lipid profiles, and HbA1c levels. A total of 406 patients enrolled in which 30 non CAD,18 patients with renal failure, 15 with heart failure, 12 liver failure, 7 with thyroid disorder, 10 patient who lost follow up. In which 207 patient without CVEs were taken as controls and was matched with age, sex, and other comorbidities with 107 patients who developed CVEs. The TyG index was calculated using the formula: Ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2]. Statistical analysis was performed using Cox regression models, adjusting for traditional cardiovascular risk factors.
Results: Among 107 patients with CVEs, 15 (14.01%) died, 23 (21.49%) had a stroke, 17 (15.88%) developed non-fatal MI, and 52 (48.59%) underwent unplanned PCI or CABG. p value for TyG index was found to be 0.032. The TyG index was significantly higher in patients with CVEs and demonstrated better predictive value than either TG or glucose alone.
Conclusion: This study suggests that the TyG index is a simple, reliable predictor of cardiovascular events in diabetic patients with stable CAD, outperforming individual lipid or glucose measurements. Given its potential role in identifying metabolic disorders and cardiovascular risk, further large-scale, long-term studies are necessary to validate these findings.
Unravelling The Etiology of Young Onset Lean Diabetes Mellitus with Severe Insulin Resistance
Sreekumar P S1, Palanivel S1, Dhivya S1, Vasanthiy N1 and Sridhar S1
1 Department of Endocrinology, Madurai Medical College, Madurai
Introduction: Lean diabetes in young individuals is a diagnostic challenge as it does not include the traditional risk factors of obesity and insulin resistance in Type 2 Diabetes. Coexistence of acanthosis nigricans and diabetes in a lean individual may indicate severe insulin resistance syndromes. The presentation of early onset hyperglycemia, insulin resistance and preservation of beta cell function makes the classification and diagnosis complicated.
Case Report: An 18-year-old girl, born out of a third-degree consanguineous marriage presented with poor weight gain, primary amenorrhea. Clinically, she had an absence of subcutaneous fat predominantly over her upper and lower limbs with relative preservation over her chest and abdomen, muscular prominence, phlebomegaly. She also had progeroid appearance, small chin with a hypoplastic mandible, beaked nose, elbow contractures, grade III acanthosis nigricans with a body mass index of 11.9 kg/m2 (-4.7 SDS) with short stature (height SDS - 2.8).she had clitoromegaly (clitoral index of 200 mm2, normal<35 mm2) with tanner staging of P3B1 and absent axillary hair. She also had hyperglycemia (Random blood glucose –319 mg/dl and HbA1c -10.1% [Normal <5.6%]), hypertriglyceridemia (217, Normal- <150mg/dl), high insulin levels (43.4, Normal 2.62 – 24.9 µIU/ml), and an elevated HOMA-IR (23.4, Normal <2). Her serum leptin levels were 2ng/dl [Normal 1.5-15.2 ng/dl]. Dual X-ray absorptiometry (DXA) showed severely reduced fat in legs and arms with normal truncal fat. Hearing assessment revealed bilateral moderate sensorineural hearing loss. Her elder twin sister also had diabetes with similar features. Next-generation sequencing detected Mandibular dysplasia with deafness progeroid syndrome [MDPL syndrome] caused by heterozygous mutation c3185A>G in exon 26 of the POLD1 gene inherited as an autosomal dominant trait, located in chromosome 19. The patient was started on subcutaneous insulin (50 units/ day), insulin sensitizers, lipid-lowering agents and transdermal estrogen for pubertal induction.
Conclusion: Unlike in obese patients, acanthosis nigricans in lean individuals may signal more serious metabolic conditions. Detailed clinical, biochemical and genetic workup are needed for identifying the etiology and management
A Case of Latent Autoimmune Diabetes of Adults
M. Boobalan1, Natarajan1 and Palanikumaran1
1 Post graduate Madurai Medical College, Madurai
Background: It’s a type of diabetes that develops in adulthood and is characterized by a gradual decline in insulin production. LADA is called type 1.5 diabetes because it has elements of both type 1 and type 2 diabetes.
Criteria for diagnosis of LADA: Age greater than 35 years, Positive autoantibodies to islet beta cells, Insulin independence for at least the initial 6 months after initial diagnosis.
Case report: A 43 year old male pt who is a known case of LADA for 13 years on insulin therapy, known seizure disorder, presenting with complaints of leg swelling, fever, cough with expectoration, breathing difficulty, reduced urine output. on examination pt was GC FAIR, dyspneic, pallor (+), B/Lpitting pedal edema present, CVS S1 S2 (+), RS BAE(+), bilateral basal crepts, per abdomen soft, CNS conscious oriented, peripheral neuropathy present.
Routine investigation showed Tc 7200, Hb 8.2,hct 27.5,plt 2.37Lakhs,RBS 382mg/dl,fbs154 mg/dl, urea 64 creatinine was 3.2 mg /dl, sr Na 136,k 4.3 meql, sr protein 4.1, sr. albumin 2.5 & globulin 1.6,urine alb 2+, urine spot pcr 2.7, sputum AFB & CBNAAT was done MTB was not detected, Anti Gad 65 ab-1984.73 Iu/ml, ECHO showing ischemic dcm with HFref 35 %, and USG abdomen pelvis showed normal size echoes liver, gb, spleen, Both kidney size increased with cmd lost and altered echoes present, ct chest suggestive of acute pulmonary edema.
Conclusion: Prevention of Latent Autoimmune Diabetes in Adults (LADA) isn’t possible because the autoimmune condition causing it can’t be controlled. However, early diagnosis and immediate treatment can help prevent complications. Treating Latent Autoimmune Diabetes in Adults (LADA) can be challenging because patients may initially respond to oral medications like metformin, but eventually require insulin.
Impact of Digital Interventions on HbA1C and Other Key Metabolic Markers in Diabetes Care
Abinaya. M.R1
1 HealthifyMe
Diabetes management is an ongoing challenge, particularly for individuals with Type 2 Diabetes (T2D) and pre-diabetes. Recent advances in digital health tools, including mobile apps, continuous glucose monitoring (CGM), personalized coaching, and AI-driven interventions, offer the potential to revolutionize diabetes care. This paper presents an in-depth exploration of Healthify’s comprehensive diabetes management program, which integrates meal tracking, exercise logging, sleep monitoring, and regular coach consultations, to improve HbA1c levels, lipid profiles, and overall metabolic health.
Through a highly personalized approach, the Healthify platform combines input from certified diabetes educators, fitness coaches, and doctors to provide targeted diet and fitness plans. These plans are adapted in real-time, allowing for precise management of blood glucose and weight, while also reducing dependency on medications. The program focuses on building healthy, sustainable habits that align with both immediate and long-term goals for diabetes prevention, management, and remission.
In this study, we present outcomes from users at various stages of diabetes: pre-diabetes, Type 2 diabetes with good to poor control, and those in remission. The impact of Healthify’s interventions is tracked across multiple metrics, including HbA1c, blood glucose levels, triglycerides, cholesterol, and body weight. We discuss the effectiveness of digital tools in managing these metrics, with a particular focus on the correlation between consistent use of the app and improvements in glycemic control and metabolic health.
Key data tables to be presented include
HbA1C Reduction: Significant improvements in HbA1c levels were observed, with an average reduction of 1.8% within 3 months, 1.4% within 6 months, and 1.1% over 12 months.
Lipid Profile Improvements: Among users, 71% experienced a notable reduction in triglyceride levels, while 72% showed significant improvement in VLDL levels.
Weight and Body Composition: 63% of users achieved meaningful weight loss, with an average reduction of 4.5 kg within 2 months.
Medication Reduction:
52% of users transitioned from prediabetic to non-diabetic status.
37% experienced a reduction in the number of diabetes medications.
26% saw a decrease in their insulin dosage.
User Engagement: 71% of users actively engage with the app, logging meals, sleep patterns, physical activity, and stress levels, contributing to sustained lifestyle improvements.
Conclusion: This research underscores the potential of digital health interventions, combined with personalized coaching, to drive meaningful improvements in metabolic health. The findings support the scalability and accessibility of such solutions for effective diabetes management.
Hyperinsulinemia before 10 weeks of Pregnancy is a Better Predictor of GDM & NCDs in Future Than Dysglycemia
N.Bhavatharini1, R.Aruyerchelvan1, ARA.Changanidi1, VK.Sanjeev1 and V.Seshiah1
1 SRC Diabetes Care Centre, Erode, Chennai
Background and Aims: India after independence was poor eating less and working more, now became more adorable and sedentary due to exposure to more screens, is moving on wheels than on legs and taking mostly refined foods. Those days T1DM and T2DM were only passing through pregnancy from the beginning with GDM occurring in later trimester purely due to diabetogenic stress of placental hormones. Nowadays there is a paradigm shift with GDM prevailing right from the first trimester along with pre GDM (more T2DM passing through pregnancy and D detected for the first time during pregnancy). This paradigm shift may be also due to late marriage, further delaying child and early age of occurrence of T2DM along with improper life style. All the above has increased HIP more metabolic continuum further continues as NCDs in both the mother and the child. In spite of Indian government early universal screening and management of HIP we were able to detect more and more HIP. So we want to detect still early the IR and HI which is the root cause for all by an easy biomarker to prevent the above.
To show that Hyperinsulinemia (HI) with insulin resistance ( IR) due to improper lifestyle in the present young females is an early and easy predictor of disglycemia and future non communicable diseases (NCDs) in both the mother and child.
Materials and Methods: Out of 154 cases continuously we measured the C-peptide values in all out of which HI present in 117 cases with some was having normal blood sugar (BS). On following this case many had some prenatal complications in spite of managing dysglycemia.
Our center is a referral center for HIP for the referred cases we follow DIPSIs single step procedure which is our National guidelines for diagnosing GDM along with that C-peptide estimation also done to assess the hyperinsulenemic state of the GDM. We did C-peptide also along with GCT in all pregnant, there was high C-peptide with normal BS in those who reported in later weeks may be due to fetal handling of maternal blood sugar giving normal BS in the mother.
Results: To our surprise C- peptide was much high in almost all GDM cases. There was high C-peptide with normal BS in those who reported in later weeks may be due to fetal handling of maternal blood sugar giving normal BS in the mother. Out of 154 cases HI was present in 117 cases with some having normal BS. On following these cases many had some perinatal in spite of managing dysglycemia.
Conclusion: Our study clearly showed HI may be a better predictor of not only GDM but also obesity, metabolic syndrome & NCDs in the Mother & child in the future.
Knowledge, Attitudes, and Practices of Indian Diabetologists on Non-Diarrheal Dehydration and its Management in Persons with Diabetes
Manoj Chawla1, Sanjay Agarwal2, L Sreenivasa Murthy3, Sanjay Kalra4, Harshad Malve5 and Amol Patil5
1 Lina Diabetes Care Center, Mumbai, India
2 Aegle Clinic-Diabetes Care Head, Department of Medicine, Ruby Hall Clinic, Pune
3 Life Care Hospital & Research Center, Bangalore
4 Bharti Hospital Karnal Haryana
5 Medical Safety Sciences, JNTL Consumer Health (India) Private Limited, Mumbai, India
Background: Hydration plays vital role in metabolic health, particularly in diabetes, where factors like osmotic diuresis, polypharmacy, comorbidities increase risk of dehydration. Effective management of fluid, electrolytes and energy (FEE) deficits is crucial, yet gaps persist in current practices in management of dehydration in diabetes.
Objectives: This study assessed the knowledge, attitudes, and practices (KAP) of 525 diabetologists in India regarding oral FEE management in diabetic patients with acute non-diarrheal illnesses.
Materials and Methods: An online, cross-sectional survey evaluated diabetologists’ perspectives on dehydration in diabetes using questionnaire covering knowledge of dehydration in diabetes, attitudes towards oral FEE and current practice. The survey was hosted on the RSSDI website and anonymous aggregated data was shared for analysis.
Results: Overall, 90% and 75% respondents identified osmotic diuresis and SGLT-2 inhibitors as risk factors for dehydration in diabetes respectively, 86.5% agreed that dehydration and energy deficits significantly impact recovery in diabetic patients experiencing acute non-diarrheal illnesses but only 46.5% routinely assessed hydration status.
Slow-release carbohydrates (e.g Isomaltulose, D-Tagatose, Trehalose) were favoured by 68.9% of respondents for metabolic benefits to address energy deficits. Overall, 77.9% diabetologists agreed that Ready-To-Drink (RTD) FEE with slow-release carbohydrate can prevent blood glucose and insulin spikes and provide consistent prolonged energy to persons with diabetes.
78.1% of respondents agreed that RTD FEE drinks could lead to faster recovery in otherwise healthy/ non-complex diabetics with non-diarrheal conditions and perceived an estimated 4.1days improvement in speed of recovery compared to non-RTD FEE drinks. However, only 43% recommend RTD formats to patients.
There are weak correlations between knowledge scores and various hydration practices, with Spearman’s rank correlation values ranging from -0.287 to 0.277.910
Conclusion: Diabetologists are aware that dehydration in persons with diabetes and non-diarrheal illnesses can impact recovery. RTD FEE formats formulated with slow-release carbohydrates can fasten recovery in these patients However, weak correlations between knowledge scores and hydration practices suggest need for targeted educational interventions & standardized recommendations to bridge this gap.
Role of Oral Fluids, Electrolytes, and Energy Management in Persons with Diabetes: An Indian Expert Delphi Consensus Recommendation
Sanjay Agarwal1, Sanjay Kalra2, Sunil Jain3, Rakesh Sahay4, AG Unnikrishnan5, L Sreenivasa Murthy6, Neeta Deshpande7, Banshee Saboo8, Mangesh Tiwaskar9, Manoj Chawla10, Eileen Canday11, Amol Patil12 and Harshad Malve12
1 Aegle Clinic-Diabetes Care; Department of Medicine, Ruby Hall Clinic, Pune
2 Bharti Hospital, Karnal, Haryana
3 TOTALL Diabetes Institute, Indore
4 Osmania Medical College, Osmania General Hospital, Hyderabad
5 Chellaram Diabetes Institute, Pune
6 Life Care Hospital & Research Center, Bangalore
7 Belgaum Diabetes Centre and CentraCare Institute of Diabetes, Obesity and Metabolic Health (CIDOM), Belgaum
8 Diacare, Diabetes Care & Hormone Clinic, Ahmedabad
9 Shilpa Medical Research Centre, Mumbai
10 Lina Diabetes Care Center, Mumbai, India
11 Department of Nutrition and Dietetics, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra
12 JNTL Consumer Health (India) Private Limited, Mumbai, India
Objective: To create evidence-based recommendations for oral Fluids, electrolytes, energy (FEE) management in persons with diabetes.
Materials & Methods: Modified Delphi method with 11 experts to develop consensus using 5-point Likert scale. Statements based on the burden of FEE deficits, assessment of FEE requirements, role of oral FEE in recovery as well as concept of sustained energy requirement in persons with diabetes were sent for voting. These recommendations were also further reviewed by RSSDI experts.
Results: Consensus was achieved for 33/33 statements. 8/11 experts estimated that nearly 50% or more persons with diabetes and non-diarrheal conditions present with symptoms of dehydration and energy deficits. Unanimous agreement on FEE deficits in persons with diabetes have significant impact on recovery from acute non-diarrheal illnesses and screening for dehydration should be part of routine care.
Experts agreed that addressing FEE deficits with electrolyte drinks containing slow-release carbohydrates should be recommended from day 1 in persons with diabetes and non-diarrheal illness. Consensus was achieved on Ready-To-Drink (RTD) electrolyte drinks should be preferred and those with sustained energy can lead to faster recovery in them compared to homemade fluids, coconut water or fruit juices.
Consensus was achieved on ensuring low glycemic variability and stable insulin levels while managing hydration and energy requirements in persons with Diabetes. In low resource settings emphasis to be placed on natural food options like buttermilk, coconut water, rice water, lime water etc.
Conclusion: Screening for dehydration for persons with diabetes should be part of routine clinical practice. RTD formulations with fluid, electrolytes, and slow-release carbohydrates provide a balanced approach to their hydration and energy needs. Incorporating tailored FEE recommendations into existing guidelines as well as awareness on symptoms of dehydration will help persons with diabetes by ensuring optimal rehydration and energy replenishment.
Can hsCRP be a Risk-Stratification Tool in Prediabetes to Predict Atherosclerosis
Pranjali Shah1, Ritu Johari2 and Sailatha Ravi3
1 Apt Diabetes clinic, Mumbai
2 StarMax specialty clinic, Mumbai
3 Medlish communications, Chennai
Background: Prediabetes is a significant public health issue. Rapid urbanization has increased the prevalence of prediabetes in India from 10.3% in 2017 to 15.5% in 2023. A concomitant rise in metabolic disturbances has increased risk for micro and macrovascular complications, majorly atherosclerosis in approximately 10% of the population. High sensitivity C-reactive protein (hsCRP) has been found significantly related with pre-diabetes, abnormal lipid markers but not well-researched yet. Aim The current study attempts to understand association between prediabetes and atherosclerosis based on the marker, hsCRP, for early risk stratification and to evaluate the position of statins as a preventive strategy along with diet and lifestyle interventions.
Methodology: We plan to conduct a pan-India study with more than 15 centres to assess the association between prediabetes, underlying dyslipidemia and associated cardiovascular (CV) conditions. Current intended sample size is approximately 10,000 patients with a follow-up of 3 to 6 months. Study would be planned in three parts. Part A: Screening of individuals with prediabetes and atherosclerotic markers would be done - stratified based on the hsCRP levels. The association of risk factors including age, gender, family history, history of comorbidities, medical history, biochemical parameters will be evaluated. Part B: The influence of statins among the high-risk group will be studied as a longitudinal comparison of hsCRP and glycemic profile at 3 months and 6 months. Part C: A mathematical model to be proposed for a risk-score estimation of prediabetes and atherosclerosis.
Results: On the basis of the study Literature search has given profound statistics on the association of atherosclerosis and prediabetes. The risk of atherosclerosis in prediabetes is associated with an odds ratio (OR) of 2.5 to 2.6. The risk of atherosclerosis with prediabetes and systemic inflammation is associated with an OR of 2.5 (95% CI:1.4-4.2). hsCRP has been linked to both raised glucose levels – causing prediabetes and raised lipid levels, especially triglycerides, leading to atherosclerosis in prediabetes. Statins are widely used to manage prediabetes and reduce the risk of atherosclerosis.
Conclusion: This novel pan-India study aims to unearth the potential of hsCRP as a biomarker in early diagnosis of atherosclerosis in prediabetes and position the use of statins as an early intervention in the preventive strategy along-side diet and lifestyle intervention. The study lends scope for a mathematical modeling for risk stratification of individuals.
Efficacy of Early Versus Late Postpartum DIPSI Test in Gestational Diabetes Mellitus Women for Follow up
Saraswathi S1 and Anjalakshi C1
1 Madras Medical College, Chennai
Background: The present study aimed to evaluate if postpartum gestational diabetes mellitus (GDM) screening can be performed during immediate post-delivery 72 hrs instead of six weeks postpartum for follow-up.
Methods: Total 150 GDM patients were included. The sample size was calculated as 150 with Nimaster 2.0 software. GDM patients are enrolled after meeting the exclusion criteria for the study. The GDM diagnosis was made by DIPSI test and treated as per guidelines. After delivery, the Dipsi test was done on PND-3 (PP1). Furthermore, all were kept on LSM irrespective of the glycaemic level. DIPSI test was repeated in all Patients after 45 days (PP2).They were divided into 3 groups. Group 1. Dipsi test below 140mg%, Group 2. Dipsi test between 140 to 199 mg% (IGT), Group 3. Dipsi test >200 mg%.
Results: All 150 patients had a DIPSI test on 3rd day post-partum (PP1) and repeat test at 45 days (PP2)., Of these, 60 patients (40%) showed negative DIPSI test on P1 and all remained in Group 1, with 63 patients having negative DIPSI test on PP2. 50 patients (33.3%) had blood glucose between 140–199 mg (Group 2) on PP1 and increased to 53 patients in PP2 in 45 days. 40 patients had diabetic (26.6%) value (Group3) in PP1, and out of them 34 (22.6%) remained in group 3 in PP2 after 45 days post-partum.
Conclusion: This pilot study shows that nearly 60% of the GDM patient have either IGT or diabetic value following delivery on 3rd day of PP1 and almost similar results in PP2. Hence, we can do the postpartum screening on the postpartum 3rd day and need not wait for 6 weeks when more than 50% is lost for follow-up. This study shows among GDM 60% of them have underlying beta cell dysfunction. With conventional 6 weeks postpartum follow up >50% of GDM mothers are lost for follow up. For universal coverage third day follow up with the test with which the patients and healthcare providers are accoustomed. will be ideal for follow up.
Background: The global prevalence of diabetes is increasing, prompting a shift in focus towards the primordial prevention of diabetes. Gestational Diabetes Mellitus (GDM) presents an ideal opportunity for this prevention. In 2018 NIH study suggested that BG screening will identify GDM risk at 10 wks and HbA1c 5.3(2hr PPBG>110mg/dl) in the 10th week will predict GDM, but no further work was done. First author conceptualized that 2hr PPBG Should not exceed 110 mg/dl by 10th week of pregnancy to prevent the hyperinsulinaemia in the fetus as the fetal islet cells start secreting insulin around 11th week. Maternal Hyperglycaemia results in fetal hyperinsulinism
Objectives:
To determine the risk for GDM in the first trimester at 8 Weeks
Management of risk for GDM (BG between 110 to 119) at 8–10 weeks of gestation by MNT and Metformin
To compare the maternal-fetal outcomes in both groups.
Methodology: At 8 to 9 weeks of gestation, pregnant women were recruited and divided into 2 groups. Group A included those with a 2-hour postprandial blood sugar (PPBS) of < 110 mg/dL, they received no intervention (82 participants). Group B included women with a 2-hour PPBS of 110–119 mg/dL, and they received MNT and Metformin intervention. The prediction of gestational diabetes mellitus (GDM) is based on a 2-hour PPBS ≥110 mg/dL at 10weeks. Therefore, at the 8th week, (the phenomenon of anticipation) the 2-hour PPBS estimated. If it is < 110 mg/dL, then no intervention is necessary. If the 2-hour PPBS is >110 mg/dL, there is a grace period of 2 weeks to achieve a 2-hour PPBS of < 110 mg/dL by the 10th week with Medical Nutritional Therapy (MNT) and Metformin. It is crucial that maternal 2-hour PPBS should not exceed 110 mg/dL by the 10th week, as fetal beta cells begin secreting insulin by the 11th week of gestation.
Results: Group A, 1 (1.2%) developed GDM in the third trimester as she was a grand multipara, and Group B, 1(1.4%) developed GDM in the third trimester as she discontinued intervention.
Conclusion: Early screening for EGGI (Early Gestational Glucose Intolerance) at 8 weeks of Pregnancy and intervention will benefit in preventing GDM and its sequelae.
Study of Prevalance of Small Fibre Neuropathy among Diabetic Population in Dae Hospital using Diabetic Foot Care Test
Sridevi Sitaraman1
1 Physician Department of Atomic Energy Hospital
Introduction: Diabetic neuropathy is defined as signs and symptoms of peripheral nerve dysfunction in whom other causes of neuropathy are excluded.DM is frequently complicated by neuropathy affecting about 50 percent of diabetic population. It leads to 2 important consequences which is foot ulceration and neuropathic pain. The prevalence in India is between 10.8 percent-32.2 percent. Early detection of neuropathy is important to reduce the complications. The longer the duration of diabetes and poor glycemic control increases the risk. Painful sensory neuropathy (Small Fibre Neuropathy) is a major burden in diabetic population which complicates the situation. Small diameter nerve fibres are the earliest fibres damaged in diabetes. Highly processed foods with added sugars, diary gluten and alcohol are confounding factors in neuropathy. Impaired glucose tolerance exhibited a lower mean nerve conduction velocity. Symptoms of muscle weakness sensation and autonomic neuropathy were found in DM. So the sensations of pinprick, vibration, temperature sensation, autonomic neuropathy test, Doppler and podia scan are done using diabetic foot care testing device which helps to pick up neuropathy at an earlier stage. Treatment would mainly focus on controlling the risk factors so early diagnosis of the same is necessary and strict control of DM is important. As its mostly linked with metabolic syndrome risk factors contributing to the syndrome is addressed for control of neuropathy. So annual screening of neuropathy in diabetic population will help in early diagnosis of the same and initiation of treatment
Study Methodology: This is a retrospective study done in our Institution from March 2024 - January 2025 of 100 patients after obtaining ethical clearance and informed consent from all patients who had symptoms of numbness, pricking sensation, burning sensation in feet with DM on medications
Risk Factors: Factors taken into consideration for the study included age, sex, duration of diabetes mellitus (DM), dyslipidemia, smoking, and family history of metabolic syndrome. Neuropathy testing was done using diabetic foot care testing device which tests the vasculopathy, neuropathy (peripheral, autonomic) and podiatric scan and results were evaluated as negative, positive {high probability for foot ulcers}
Inclusion Criteria: In this study, we included male and female patients who had symptoms of numbness of feet, burning pricking sensation of feet, giddiness with DM on medications
Exclusion Criteria: Patients already having other causes of neuropathy like B12 deficiency, alcohol induced, autoimmune conditions like RA, intake of chemotherapy drugs, conditions like leprosy and very old debilitated patients were excluded
Results: In our study we included 100 DM patients with symptoms and studied for the prevalence of small fibre neuropathy. We found that 48 patients were male and rest 52 were female. 65 pts had numbness of feet as the predominant symptom and 19 had burning pricking sensation of feet and 16 had giddiness. It was found that younger patients were more prone to neuropathy as 51of them were less than 60 yrs and rest 49 were greater than 60 yrs. It was also found that risk factor predominance was associated with neuropathy as 54 patients had risk factors like hypertension dyslipidemia with positive family history 31 patients had only positive family history and no risk factors and 15 had only DM and no risk factors. Regarding prevalence of small fibre neuropathy it was found that all patients with positive risk factors and family history had positive results for vasculopathy and neuropathy (54 patients) and 31 patients had defective neuropathy and podia scan and 15 patients had autonomic and small fibre neuropathy and defective podia scan.
Conclusion: Our study supports the fact that In patients with symptoms like symptoms of numbness of feet, burning pricking sensation of feet and imbalance of gait with positive small fibre neuropathy component is a suspicion of neuropathy which provides an important diagnostic tool for diagnosis and management of peripheral diabetic neuropathy. DIAFOOT CARE testing device is a good test for functional assessment of patients, also an important aid in management of small fibre painful diabetic neuropathy at an earlier stage
