Showing papers by "Yashdeep Gupta published in 2022"

Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes

Abstract: This randomized clinical trial examines a lifestyle intervention vs usual care for prevention of glycemic deterioration among South Asian women with recent gestational diabetes.

Overt Diabetes in Pregnancy

Abstract: Overt diabetes in pregnancy is defined as hyperglycemia first recognized during pregnancy which meets the diagnostic threshold of diabetes in non-pregnant adults. This case-based narrative review aims to describe this unique condition and discuss the potential implications for its accurate diagnosis and management.We conducted a literature search in PubMed for relevant articles published in English language up to January 2022. Women with overt diabetes have a higher risk for adverse pregnancy outcomes and postpartum diabetes, compared to their counterparts with gestational diabetes mellitus (GDM). Such women often need aggressive management, including early and prompt initiation of insulin therapy, and a close follow-up during pregnancy and in the postpartum period. Not all pregnant women with overt diabetes have persistent diabetes in the postpartum period. Early diagnosis, especially during the first trimester, and fasting plasma glucose elevation (≥ 126 mg/dl or 7 mmol/L) at the time of initial diagnosis are predictors of postpartum diabetes.Both GDM and overt diabetes in pregnancy are hyperglycemic conditions first recognized during pregnancy, but the two conditions differ in severity; the latter is a more severe form of hyperglycemia associated with worse maternal and fetal outcomes, and a higher risk of postpartum diabetes.

Mild and asymptomatic SARS‐CoV‐2 infection is not associated with progression of thyroid dysfunction or thyroid autoimmunity

Abstract: The novel coronavirus (SARS-CoV-2) pandemic has emerged as a major public health challenge, affecting more than 380 million people globally and causing more than 5.6 million deaths This article is protected by copyright. All rights reserved.

Improving care for hypertension and diabetes in india by addition of clinical decision support system and task shifting in the national NCD program: I-TREC model of care

Abstract: The growing burden of hypertension and diabetes is one of the major public health challenges being faced by the health system in India. Clinical Decision Support Systems (CDSS) that assist with tailoring evidence-based management approaches combined with task-shifting from more specialized to less specialized providers may together enhance the impact of a program. We sought to integrate a technology "CDSS" and a strategy "Task-shifting" within the Government of India's (GoI) Non-Communicable Diseases (NCD) System under the Comprehensive Primary Health Care (CPHC) initiative to enhance the program's impact to address the growing burden of hypertension and diabetes in India.We developed a model of care "I-TREC" entirely calibrated for implementation within the current health system across all facility types (Primary Health Centre, Community Health Centre, and District Hospital) in a block in Shaheed Bhagat Singh (SBS) Nagar district of Punjab, India. We undertook an academic-community partnership to incorporate the combination of a CDSS with task-shifting into the GoI CPHC-NCD system, a platform that assists healthcare providers to record patient information for routine NCD care. Academic partners developed clinical algorithms, a revised clinic workflow, and provider training modules with iterative collaboration and consultation with government and technology partners to incorporate CDSS within the existing system.The CDSS-enabled GoI CPHC-NCD system provides evidence-based recommendations for hypertension and diabetes; threshold-based prompts to assure referral mechanism across health facilities; integrated patient database, and care coordination through workflow management and dashboard alerts. To enable efficient implementation, modifications were made in the patient workflow and the fulcrum of the use of technology shifted from physician to nurse.Designed to be applicable nationwide, the I-TREC model of care is being piloted in a block in the state of Punjab, India. Learnings from I-TREC will provide a roadmap to other public health experts to integrate and adapt their interventions at the national level.CTRI/2020/01/022723.

Continuous glucose monitoring system profile of women diagnosed as gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups criteria and labeled as normoglycemic by alternate criteria in early pregnancy

Abstract: We aimed to evaluate and compare continuous glucose monitoring system (CGMS)‐based glycemic parameters in women in early pregnancy (<20 weeks of gestation) who were classified as: (i) gestational diabetes mellitus (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), but normoglycemia by alternate (UK National Institute for Health and Care Excellence, Canadian Diabetes Association and Diabetes in Pregnancy Study group of India) criteria; and (ii) normoglycemia by both (IADPSG and alternate) criteria.

CGMS profile of women diagnosed as GDM by IADPSG criteria and labelled as normoglycemic by alternate criteria in early pregnancy.

Abstract: AIMS/INTRODUCTION We aimed to evaluate and compare CGMS-based glycemic parameters in women in early pregnancy (<20 weeks of gestation) who were classified as: a) GDM by IADPSG but normoglycemia by alternate (UK NICE, CDA and DIPSI) criteria, and b) normoglycemia by both (IADPSG and alternate) criteria. MATERIAL AND METHODS In this cross-sectional study, eligible women underwent standard 75-g OGTT, followed by the placement of a CGMS. Glycemia-related parameters were calculated using the standard approach for CGMS data in pregnancy. RESULTS We enrolled 96 women at 14.0 ± 3.2 weeks of gestation. Of the women diagnosed as GDM by IADPSG criteria, 34.2%, 26.3% and 44.7% were classified as normoglycemic by UK NICE, CDA and DIPSI criteria, respectively. Mean 1-h postprandial glucose and time above range were significantly higher in women who were GDM by IADPSG, but normoglycemia by CDA criteria, compared to women with normoglycemia using both criteria. Similarly, mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, 1-hr postprandial glucose excursion and time above range were significantly higher in women who were not identified as GDM by UK NICE criteria. Finally, women missed by DIPSI criteria had significantly higher mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, postprandial glucose excursion, 24-h glucose, and time above range parameters. CONCLUSIONS More than a quarter of women diagnosed as GDM by IADPSG criteria are not identified by alternate criteria. Such women are significantly different from normoglycemic women in terms of several CGMS-based glycemic parameters of clinical significance.

Continuous Glucose Monitoring System Profile of Women with Gestational Diabetes Mellitus Missed Using Isolated Fasting Plasma Glucose-Based Strategies Alternative to WHO 2013 Criteria: A Cross-Sectional Study

Abstract: The aim of the study was to evaluate the differences in the continuous glucose monitoring system (CGMS)-based glycemic parameters between women with normoglycemia and early gestational diabetes mellitus (GDM) identified on the basis of mild fasting plasma glucose elevation (FPG, 5.1–5.5 mmol/L) and/or post-load plasma glucose elevation (PLG, 1-h ≥ 10.0 mmol/L or 2-h ≥ 8.5 mmol/L). This cross-sectional study included women with singleton pregnancy (8+0 to 19+6 weeks of gestation) and normoglycemia or GDM per World Health Organization (WHO) 2013 criteria. We evaluated the glycemic parameters of clinical interest using blinded CGMS evaluation and reported them per standard methodology proposed by Hernandez et al. A total of 87 women (GDM, n = 38) were enrolled at 28.6 ± 4.5 years. Among women with GDM, 10 (26.3%) had isolated mild FPG elevation (5.1–5.5 mmol/L), 10 (26.3%) had isolated PLG elevation (1-h ≥ 10.0 mmol/L or 2-h ≥ 8.5 mmol/L), and 7 (18.4%) had a combination of both. The remaining 11 (28.9%) had elevated FPG (≥ 5.6 mmol/L) with or without PLG elevation. Thus, when an isolated FPG cutoff ≥ 5.6 mmol/L is used to diagnose GDM, 27 (71.0%) women would be perceived as normoglycemic. Such women had significantly higher CGMS parameters of clinical interest, such as 24-h mean glucose, fasting glucose, 1-h and 2-h postprandial glucose (PPG), 1-h PPG excursion, and peak PPG. An isolated FPG threshold, especially the higher cutoff ≥ 5.6 mmol/L, can potentially miss a large proportion of women (nearly three-fourths) diagnosed with GDM per WHO 2013 criteria. Eventually, such women fare significantly differently from normoglycemic women in various CGMS parameters of clinical interest.

Comparison of Modified Rose Method of Thyroid Palpation Versus Other Methods for the Detection of Retrosternal and Nodular Goitre

Abstract: Objectives This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography. Methodology This cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot. Results Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three. Conclusion Examination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.

Abstract 192: Clinical and Genetic Profiling of Index Patients with Multiple Endocrine Neoplasia Type 2 Syndrome and Screening for Medullary Thyroid Carcinoma in Asymptomatic First-degree Relatives

Abstract: Background: Multiple endocrine neoplasia type 2 (MEN2) syndrome is a rare disorder with autosomal dominant inheritance, characterised by the presence of two of the following three endocrine manifestations: medullary thyroid carcinoma (MTC), pheochromocytoma (PCC) and primary hyperparathyroidism (PHPT). There is a paucity of data on clinical and genetic profile of MEN2 syndrome in the Indian subcontinent. Objectives: We aimed to evaluate the clinical and genetic profile of index patients with MEN2 syndrome and perform screening for MTC among asymptomatic family members of such patients. Materials and Methods: This was an ambispective study conducted in the department of Endocrinology at AIIMS New Delhi, involving diagnosed patients of MEN2 syndrome between January 2016 and November 2022. MTC screening was performed with measurement of serum calcitonin levels (normal: <10 pg/ml) among family members of index patients. Results: We evaluated a total of 23 index patients with MEN2 syndrome (MEN2A, n=18; MEN2B, n=5). Data were derived retrospectively for 18 patients (MEN2A, n=14; MEN2B, n=4) and prospectively for 5 patients (MEN2A, n=4; MEN2B, n=1). Of the study patients, 16 (MEN2A, n=13; MEN2B, n=3) were females. The mean age at presentation in the two groups was 33 years and 22 years, respectively. Among patients with MEN2A syndrome, 11 (61%) presented with PCC and were synchronously detected to have MTC, while 7 (39%) presented with MTC, of whom 5 metachronously developed PCC. We noted PHPT in 3 (16%) patients with MEN2A syndrome. A total of 177 eligible family members of index patients with MEN2A syndrome were contacted, of whom 83 turned up for screening and 42 (50.6%) had elevated serum calcitonin levels (>10 pg/ml). Of the 5 patients with MEN2B syndrome, 4 (80%) presented with synchronous MTC and PCC and 1 (20%) presented with MTC alone. Of the 26 eligible family members of index patients with MEN2B syndrome, only 9 could be screened and all had normal serum calcitonin levels (<10 pg/ml). Metastatic MTC was noted in 3 (17%) patients with MEN2A syndrome and 3 (60%) patients with MEN2B syndrome Mutational analysis data are available for 7 index MEN2A and 4 MEN2B patients. The most common mutations in MEN2A and MEN2B groups were C634R (exon 11 of RET gene, n=5) and M918T (exon 16 of RET gene, n=4), respectively. Conclusions: MEN2 syndrome should be suspected in patients with MTC and young-onset PCC and all first-degree relatives of index patients with this syndrome should be screened appropriately.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India

Abstract: Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana. Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05. Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Cardiometabolic risk factors in young Indian men and their association with parameters of insulin resistance and beta-cell function

Abstract: BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults, who are not preselected for glycaemia. AIM To evaluate young North Indian men (aged 20-50 years) for burden of cardiometabolic risk factors, in relation to parameters of homeostatic model assessment for insulin resistance (HOMA-IR) and beta-cell function (oral disposition index [oDI]). METHODS Study participants were invited in a fasting state. Sociodemographic, anthropometric, and medical data were collected, and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0, 30, and 120 min. Participants were divided into quartiles for HOMA-IR and oDI (category 1: Best HOMA-IR/oDI quartile; category 3: Worst HOMA-IR/oDI quartile) and composite HOMA-IR/oDI phenotypes (phenotype 1: Best quartile for both HOMA-IR and oDI; phenotype 4: Worst quartile for both HOMA-IR and oDI) were derived. RESULTS We evaluated a total of 635 men at a mean (± SD) age of 33.9 ± 5.1 years and body mass index of 26.0 ± 3.9 kg/m2. Diabetes and prediabetes were present in 34 (5.4%) and 297 (46.8%) participants, respectively. Overweight/obesity, metabolic syndrome, and hypertension were present in 388 (61.1%), 258 (40.6%), and 123 (19.4%) participants, respectively. The prevalence of dysglycaemia, metabolic syndrome, and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles, either alone (category 3 vs 1) or in combination (phenotype 4 vs 1). The adjusted odds ratios for dysglycaemia (6.5 to 7.0-fold), hypertension (2.9 to 3.6-fold), and metabolic syndrome (4.0 to 12.2-fold) were significantly higher in individuals in the worst quartile of HOMA-IR and oDI (category 3), compared to those in the best quartile (category 1). The adjusted odds ratios further increased to 21.1, 5.6, and 13.7, respectively, in individuals with the worst, compared to the best composite HOMA-IR/oDI phenotypes (phenotype 4 vs 1). CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men. Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.

Abstract 153: Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes

Abstract: Background: Increased fracture risk is seen in T2DM despite higher bone mineral density (BMD) due to poor bone microarchitecture. Recent studies suggest bone health may be affected early in the natural history of diabetes and women with prior gestational diabetes mellitus (GDM) would be ideal population to study this as precise information on glycemic status in the near past is available. Objective: The aim of this cross-sectional study was to comprehensively assess bone health in women with prior gestational diabetes mellitus, including bone microarchitecture (TBS), bone mineral density (BMD) and bone turnover (osteocalcin). Results: A total of 240 women (mean age: 33.3 ± 5.0 years; median postpartum duration: 34 [interquartile range 13.0-54.5] months were evaluated. At the current visit, 115 (47.9%) and 36 (15%) women had prediabetes and diabetes, respectively. Women with dysglycemia (diabetes/prediabetes) had a higher BMD at all three sites, compared to those with normoglycemia; however, the difference was not statistically significant. Women with dysglycemia had a significantly lower TBS (1.32 ± 0.09 vs. 1.35 ± 0.09; p = .038). Women with dysglycemia had significantly lower serum osteocalcin levels (18.6 ± 8.5 ng/ml vs. 21.5 ± 9.7 ng/ml; p = .018). HOMA-IR (r = -.285, p < .001) was negatively correlated, while Matsuda index (r = .274, p < .001) and disposition index (r = .159, p = .016) were positively correlated with serum osteocalcin levels. Conclusions: Bone health is affected early in the natural history of diabetes and is associated with an overall low bone turnover state.