Showing papers in "Indian Journal of Endocrinology and Metabolism in 2018"
TL;DR: The psychological reactions experienced by the patient upon diagnosis of diabetes have been reviewed in this article with a focus on typical emotional distress at different levels.
Abstract: Diabetes is a chronic metabolic disorder that impacts physical, social and mental including psychological well-being of people living with it Additionally, psychosocial problems that are most common in diabetes patients often result in serious negative impact on patient's well-being and social life, if left un-addressed Addressing such psychosocial aspects including cognitive, emotional, behavioral and social factors in the treatment interventions would help overcome the psychological barriers, associated with adherence and self-care for diabetes; the latter being the ultimate goal of management of patients with diabetes While ample literature on self-management and psychological interventions for diabetes is available, there is limited information on the impact of psychological response and unmanaged emotional distresses on overall health The current review therefore examines the emotional, psychological needs of the patients with diabetes and emphasizes the role of diabetologist, mental health professionals including clinical psychologists to mitigate the problems faced by these patients Search was performed using a combination of keywords that cover all relevant terminology for diabetes and associated emotional distress The psychological reactions experienced by the patient upon diagnosis of diabetes have been reviewed in this article with a focus on typical emotional distress at different levels Identifying and supporting patients with psychosocial problems early in the course of diabetes may promote psychosocial well-being and improve their ability to adjust or take adequate responsibility in diabetes self-management - the utopian state dreamt of by all diabetologists !
145 citations
TL;DR: The principle behind the management of NAFLD with T2 DM involves an indirect effect through improvement in IR and glycemia and thus is used for the treatment of T2DM as well.
Abstract: Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) commonly exist together It has been regarded as a manifestation of the metabolic syndrome The presentations of NAFLD range from simple steatosis (NAFL), nonalcoholic steatohepatitis (NASH), and cirrhosis NAFLD has a prevalence of 70% among T2DM patients Overweight/obesity and insulin resistance (IR) have been strongly linked with NAFLD Noninvasive assessment and staging of disease are based on clinical parameters such as age, sex, liver function test, platelet count, lipid profile, BMI, and imaging modalities such as USG, transient elastography (TE), and magnetic resonance imaging mass spectroscopy Such clinical scoring systems and TE are useful in the early detection of NAFLD and predicting fibrosis The principle behind the management of NAFLD with T2DM involves an indirect effect through improvement in IR and glycemia and thus is used for the treatment of T2DM as well
97 citations
TL;DR: The proinflammatory cytokine levels except IL-6 were significantly increased and antioxidant markers were significantly reduced in GDM group with maternal and foetal complications and GDM worsens the oxidative stress and weakens anti-oxidant state.
Abstract: Background: Prevalence of Gestational Diabetes Mellitus in India is increasing. In addition to performing physiological role in fetoplacental unit during pregnancy, cytokines also play pathophysiological role if expressed in abnormal amounts or sites. Objective: To estimate Proinflammatory Cytokines TNF-α, IL-6, IL-8 and anti-oxidants Glutathione Peroxidase (GTX), Superoxide dismutase (SOD), uric acid and Bilirubin levels in GDM and correlate with pregnancy outcome. Results: Pregnant women were screened for GDM using Diabetes In Pregnancy Study group, India criteria. The subjects with elevated glucose were grouped into cases (n = 30) and with normal values were taken as controls (n = 30). Mean Uric acid in cases was 4.53 ± 1.2 mg% whereas in controls 3.13 ± 0.58 mg%, mean TNF-α among cases was 6.06 ± 3.6 pg/ml and controls 2.81 ± 1.03 pg/ml. Antioxidants SOD and GTX were markedly decreased with mean value of 4979.21 ± 1006.3 and 13.68 ± 1.5 in cases and 9625.10 ± 1074.1 and 15.86 ± 1.2 in controls. Cytokines IL-6 (2.96 + 1.37 vs 2.88 + 1.21) and IL-8 (7.76 + 3.86 vs 2.60 + 1.45) were increased in subjects with GDM. Those with GDM developed preeclampsia (5%), Preterm labour (2%) and Polyhydromnios (5%). Foetal complications Macrosomia (13.3%) and intra uterine death (3.3%) were observed in GDM mothers. The proinflammatory cytokine levels except IL-6 were significantly increased and antioxidant markers were significantly reduced in GDM group with maternal and foetal complications. Conclusion: GDM worsens the oxidative stress and weakens anti-oxidant state. Uric acid, TNF-α and IL-8 were higher with foeto-maternal complications in GDM. Serum bilirubin, GTX and SOD is significantly lower in foeto-maternal complications. TNF-α significantly associated with preeclampsia in GDM mothers.
56 citations
Osmania Medical College1, Bangabandhu Sheikh Mujib Medical University2, Zagazig University3, Jahra Hospital4, Kathmandu5, University of Colombo6, Tribhuvan University7, Alexandria University8, YARSI University9, Kathmandu University10, Kenyatta National Hospital11, University of Yaoundé12, Kazakh National Medical University13, All India Institute of Medical Sciences14, University of Delhi15, Pondicherry Institute of Medical Sciences16
TL;DR: The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.
Abstract: For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.
52 citations
TL;DR: Factors including personal hygiene, menopause, and circumcision might have a possible role in reported events of genital infections among T2DM patients on SGLT2i therapy.
Abstract: Diabetes is a metabolic disorder characterized by hyperglycemia and is associated with several comorbidities and complications. Genital infection is one such complication that is often associated with diabetes mellitus (DM). Even though abnormalities in immune system, high urine glucose, and bladder dysfunction are important contributors for the increased risk of genitourinary symptoms, yet the possible role of pharmacologically induced glucosuria cannot be completely overlooked in such patients. There are various classes of medications to control blood glucose levels. A new therapeutic option to manage hyperglycemia is to increase renal glucose excretion by inhibiting sodium-glucose cotransporter-2 (SGLT2) glucose transport proteins. SGLT2 inhibitors (SGLT2i) represent a novel class of oral antidiabetic drugs which are associated with drug-induced glucosuria. Currently, canagliflozin, dapagliflozin, and empagliflozin are the three SGLT2i approved for therapy in Type 2 DM (T2DM). Safety studies with these three SGLT2i have reported events of mild-moderate genital infections in patients on SGLT2i therapy. However, most of the reported infections responded to standard treatment. Apart from SGLT2i, factors including personal hygiene, menopause, and circumcision might have a possible role in reported events of genital infections among T2DM patients on SGLT2i therapy. The present review identifies the occurrence of genital infections in diabetic patients on SGLT2i therapy, factors affecting the incidence of genital infections, and management strategies in patients with T2DM on SGLT2i therapy.
47 citations
TL;DR: In Indian men, a low T-score compared to women indicates higher susceptibility to osteoporosis, therefore, both Indian men and postmenopausal women require adequate measures to prevent osteopOrosis during later years in life.
Abstract: Purpose: The aim of study was to assess the prevalence of osteoporosis and changes in bone mass with increasing age and compare bone health status of apparently healthy men, premenopausal and postmenopausal women. Methods: Data were collected on anthropometric and sociodemographic factors in 421 apparently healthy Indian adults (women = 228), 40–75 years of age, in a cross-sectional study in Pune city, India. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at two sites-lumbar spine (LS) and left femur. Individuals were classified as having osteoporosis or osteopenia based on the World Health Organization criteria of T-scores. Results: Mean age of study population was 53.3 ± 8.4 years. Of the total women, 44.3% were postmenopausal with 49.2 ± 3.5 years as mean age at menopause. Postmenopausal women showed a rapid decline in BMD with age till 50 years while men showed a gradual decline. Premenopausal women showed no significant decline in BMD with age (P > 0.1). Significantly lower T-scores were observed at LS in men compared to premenopausal (P 0.1). The prevalence of osteoporosis in men at LS was lower than postmenopausal women but higher than premenopausal women. Conclusion: In Indian men, a low T-score compared to women indicates higher susceptibility to osteoporosis. In women, menopause causes a rapid decline in BMD. Therefore, both Indian men and postmenopausal women require adequate measures to prevent osteoporosis during later years in life.
46 citations
TL;DR: Age >70 years, low androgen, steroid use, and low Vitamin D were independent risk factors of male osteoporosis, and Vitamin D supplementation, androgen replacement, and bisphosphonate therapy had beneficial effect on bone mineral density (BMD).
Abstract: Context: The number of men afflicted with osteoporosis is unknown. Aims: This study aims to determine the prevalence of osteoporosis in men. Settings and Design: This was a prospective, observational study. Subjects and Methods: A total of 200 male attendants of patients attending endocrine outpatient department and who were >55 years were recruited for the study. All the patients with osteopenia and osteoporosis were advised lifestyle interventions, supplementation with calcium carbonate (1000–1500 mg/day) and 25-hydroxyl-Vitamin D (400–600 IU/day) and bisphosphonates if indicated. Vitamin D3 60,000 IU once a week for 8 weeks and once a month thereafter was prescribed to Vitamin D-deficient patients. Androgen-deficient patients were given replacements of either injectable testosterone or oral testosterone undecanoate. Statistical Analysis Used: Two sample t-test and paired t-test were used to compare pre- and post-test parameters. Results: Overall 80 (40%) subjects had low bone mass, 93 (43.5%) had Vitamin D deficiency/insufficiency, and 39 (19.5%) had androgen deficiency. Osteoporosis was found in 8.5% patients. All patients were above 70 years (Mean age: 73.82 ± 2.79 years). Seventy percentage of these patients had low serum testosterone and 70% of patients had Vitamin D deficiency/insufficiency. About 31.5% of patients had osteopenia (mean age of 67.47 ± 6.35 years). Thirty-five percentage of these patients were androgen deficient and 25% were Vitamin D-deficient/insufficient. Age >70 years, serum testosterone 70 years, low androgen (
44 citations
TL;DR: Level of FT3, FT4, and TSH also correlate with the severity of liver disease, level of FT2 can be used as prognostic marker for liver cirrhosis patients, and FT3 and FT4 were negatively correlated, but TSH level was positively correlated with total leukocyte counts.
Abstract: Introduction: Liver plays an important role in the metabolism of thyroid hormones, as it is the most important organ in the peripheral conversion of tetraiodothyronine (T4) to triiodothyronine (T3) by Type 1 deiodinase. Materials and Methods: This case–control study included 100 decompensated liver cirrhosis patients (71 males and 29 females) and 100 apparently healthy controls (71 male and 29 female). Serum FT3, FT4, and thyroid-stimulating hormone (TSH) levels were measured using electrochemiluminescence immunoassay and analyses between cases versus healthy controls (Group 1) and further analyses in subgroups, cirrhosis with hepatic encephalopathy (HE) cases (n = 38) versus cirrhosis without HE cases (Subgroup 1), cirrhosis survivors (n = 84) versus cirrhosis nonsurvivors (Subgroup 2), HE survivors (n = 23) versus HE nonsurvivors (Subgroup 3). Results were also analyzed for severity of liver disease according to Child–Turcotte–Pugh (CTP) (Class A, B, and C), model for end-stage liver disease (MELD) score, and HE grades. Results: Most common etiology was alcohol (46%) and presentation was gross ascites (74%). Cirrhosis patients had statistically significant lower level of FT3 (P
36 citations
TL;DR: Overall, the current study demonstrated that vitamin D supplementation among hypothyroid patients for 12 weeks improved serum TSH and calcium concentrations compared with the placebo, but it did not alter serum T3, T4, ALP, PTH, and albumin levels.
Abstract: Background: Data on the effects of vitamin D supplementation on thyroid function in hypothyroid patients are scarce Objective: This study was done to evaluate the effects of vitamin D supplementation on thyroid function in hypothyroid patients Material and Methods: This randomized double-blind, placebo-controlled trial was conducted on 201 hypothyroid patients aged 20–60 years old Subjects were randomly assigned into two groups to intake either 50,000 IU vitamin D supplements (n = 102) or placebo (n = 99) weekly for 12 weeks Markers of related with thyroid function were assessed at first and 12 weeks after the intervention Results: After 12 weeks of intervention, compared to the placebo, vitamin D supplementation resulted in significant increases in serum 25-hydroxyvitamin D (+265 ± 116 vs 00 ± 00 ng/mL, P
33 citations
TL;DR: A simple and inexpensive ultrasonography screening of visceral fat may identify women who have adverse metabolic profile and enhanced CV risk in patients with polycystic ovary syndrome.
Abstract: Aim of the Study: This study aimed to compare the different adiposity parameters, namely visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between patients with polycystic ovary syndrome (PCOS) and controls. In addition, it aimed to correlate these adiposity indices with hormonal parameters as well as cardiovascular (CV) risk factors in patients with PCOS. Materials and Methods: Newly diagnosed PCOS patients of reproductive age group according to Rotterdam criteria were included. Age- and body mass index (BMI)-matched healthy females with normal menstrual cycles were taken as controls. All the study participants underwent detailed clinical, biochemical, and hormonal evaluation. Transabdominal ultrasound (US) was performed for detailed ovary imaging and assessment of adiposity (SAT and VAT) parameters. Results: A total of 58 PCOS patients and 40 age- and BMI-matched controls were included. PCOS patients had significantly higher levels of androgens (P
32 citations
TL;DR: Treatment of HD may be difficult as many antihyperglycemic therapies are associated with increased risk of complications in cirrhosis, particularly hypoglycemia.
Abstract: The prevalence of diabetes mellitus in cirrhotic patients is much higher than that in the general population. Two types of diabetes are usually seen in patients with cirrhosis: type 2 diabetes mellitus and hepatogenous diabetes (HD). The HD is an acquired condition which is believed to be caused by impaired insulin clearance and pancreatic β-cell dysfunction in cirrhotic patients. Increased levels of advanced glycation end products and hypoxia-inducible factors have been implicated in the pathogenesis of HD. Patients with HD typically present with normal fasting glucose, but abnormal response to an oral glucose tolerance test, which is required for the diagnosis. Because the level of glycated hemoglobin is often falsely low in patients with cirrhosis, it does not help in the early diagnosis of HD. HD is associated with an increased rate of complications of cirrhosis, decreased 5-year survival rate, and increased risk of hepatocellular carcinoma. The major complications of cirrhosis associated with HD include hepatic encephalopathy (HE), spontaneous bacterial peritonitis, sepsis, variceal hemorrhage, and renal dysfunction. Treatment of HD may be difficult as many antihyperglycemic therapies are associated with increased risk of complications in cirrhosis, particularly hypoglycemia. Biguanides, alpha-glucosidase inhibitors, and new medications such as dipeptidyl peptidase-4 inhibitors and sodium-glucose co-transporter 2 inhibitors appear to be safe in patients with cirrhosis. Though insulin therapy is currently advocated, requirement of insulin is variable and is difficult to predict. The liver transplantation usually results in reversal of HD. This review article provides an overview of magnitude, patients' characteristics, clinical implications, pathophysiological mechanisms, diagnosis, and management of HD.
TL;DR: In this article, the authors analyzed the serum levels of adiponectin and leptin in the participants with type 2 diabetes mellitus and obesity and their correlation with hypertension and dyslipidemia.
Abstract: Introduction: Indian phenotype includes higher waist circumference despite lower body mass index, thereby making Indians more prone to diabetes and its complications. Aim: The present study aimed to analyze the serum levels of adiponectin and leptin in the participants with type 2 diabetes mellitus (T2DM) and obesity and their correlation with hypertension and dyslipidemia. Materials and Methods: In the study, 50 diabetics and 50 controls aged between 40 and 60 years were included in the study. Results: Adiponectin levels were significantly higher in diabetics than in nondiabetic participants irrespective of gender (P ≤ 0.04 in males, P ≤ 0.02 in females). Leptin levels were significantly higher in diabetics compared to nondiabetics (P ≤ 0.001) in both males and females. Conclusion: Adiponectin and leptin levels may be used as important clinical markers for T2DM and obesity.
TL;DR: Patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Abstract: Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
TL;DR: Assessment of the effectiveness of an audio-visual foot care patient education module in outpatient setting is an effective means to improve foot care knowledge and practice in patients with diabetes.
Abstract: Background: A large number of patients with diabetes mellitus are unaware of foot care and are at risk of developing foot ulcer and amputation. This increases healthcare burden due to preventable complication of diabetes. Aims: We conducted this study to assess the effectiveness of a foot care education module for diabetes developed by us. Materials and Methods: One hundred and twenty-seven patients with diabetes mellitus attending our outpatient were randomized into intervention (n = 63) and control groups (n = 64). At first visit, 1 and 3 months later, both groups filled a questionnaire regarding foot care knowledge and practice. The intervention group was administered foot care education module and the control group received routine care at baseline and 1 month. Patient education module consisted of an audio-visual display and a pamphlet on diabetes foot care. Change in score at 3 months was assessed by Student's t-test. Results: Knowledge scores in the intervention group at first, second, and third visits were 9.8 ± 1.8, 10.2 ± 1.6, and 11.0 ± 1.7, respectively. The knowledge scores in the control group at first, second, and third visits were 9.9 ± 1.7, 9.8 ± 1.6, and 10.0 ± 1.8, respectively. The change in knowledge score was statistically significant (P
TL;DR: The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence and it be can be safely assumed that FNAC can be at least deferred in patients having TIR ADS 2 nodules, which contribute to majority of newly detected cases.
Abstract: Background: In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology. Materials and Methods: This prospective study includes 184 patients studied over a period of 2 years (April 2015–April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests. Results: Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant.The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies. Conclusion: The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.
TL;DR: FT3 was the strongest predictor of ICU mortality compared to all other parameters included in the study, and the combination of fT3 levels and APACHE-II scores provided for a higher probability for predicting mortality in ICU patients.
Abstract: Background: Patients suffering from critical illness admitted to the Intensive Care Unit (ICU) exhibit alterations in their thyroid hormone levels, collectively termed as euthyroid sick syndrome or nonthyroidal illness syndrome. Our study was conducted to determine the correlation between these changes in thyroid hormone levels and the prognosis of ICU-admitted patients. Methods: A total of 270 ICU-admitted patients without previous history of thyroid disorder were included in the study. We recorded their baseline characteristics, acute physiology and chronic health evaluation (APACHE-II) score, thyroid hormone levels, lactate, and other parameters on admission. ICU mortality was the primary outcome. We analyzed the ability of each parameter to predict mortality in the participants. Further, we also evaluated whether the combination of thyroid hormone levels with APACHE-II score could improve the mortality prediction. Results: The mean age of the study population was 38.99 ± 18.32 years. A total of 81 patients (30%) expired during their ICU treatment. Both fT3 and fT4 levels were lower in nonsurvivors compared to survivors. Among the thyroid hormones, fT3 had the highest predictive value for ICU mortality, as seen by the largest area under the curve (AUC) value (0.990 ± 0.007) which was even greater than AUC of APACHE-II score (0.824 ± 0.051) and fT4 (0.917 ± 0.049). Univariate logistic regression analysis showed that fT3 (β = 140.560) had the highest predictive potential for ICU mortality compared with APACHE-II score (β = 0.776), fT4 (β = 17.62) and other parameters. Multivariate logistic regression analysis revealed that the combination of fT3 and APACHE-II (R2 = 0.652) was superior in predicting mortality than APACHE-II alone (R2 = 0.286). Conclusion: We observed that fT3 was the strongest predictor of ICU mortality compared to all other parameters included in our study. Further, the combination of fT3 levels and APACHE-II scores provided for a higher probability for predicting mortality in ICU patients.
TL;DR: There is a need to formulate interventions to prevent and correct metabolic syndrome among school-age children for reducing early onset of cardiovascular disease during adulthood.
Abstract: Introduction: Recently, an increasing trend in the prevalence of pediatric metabolic syndrome (PMS) among school-age children has been documented in different parts of India There is lack of data on the prevalence of PMS and its associated risk factors among school-age children living in district Shimla, Himachal Pradesh Hence, to fill in the gap in the existing knowledge, the present study was conducted Methodology: A cross-sectional study was conducted during 2015–2016 Thirty clusters (schools) were identified from a list of all schools using population proportionate to size sampling methodology From each school, 70 children in the age group of 10–16 years were selected Data was collected on the sociodemographic characteristics, anthropometry, waist circumference, blood pressure, and physical activity Fasting venous blood samples were collected for estimation of blood glucose, triglycerides, and high-density lipoprotein levels Results: The prevalence of PMS using International Diabetes Federation classification was 33% and using modified-adult treatment panel classification criteria was 35% Risk factors identified to be associated with PMS among school-age children were (i) male gender, (ii) high family monthly income, (iii) sedentary lifestyle, (iv) consumption of evening snack, (v) television/computer viewing, and (vi) motorized transportation for commuting to school Conclusion: The PMS prevalence was 33% in school-age children residing in District Shimla There is a need to formulate interventions to prevent and correct metabolic syndrome among them for reducing early onset of cardiovascular disease during adulthood
TL;DR: More than half (65%) of children and adolescents with Type 1 diabetes mellitus with T1DM had dyslipidemia, among them high LDL was the most common, and these findings emphasize the screening of lipid profile in T1 DMChildren and adolescents.
Abstract: Introduction: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. Methods: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10–18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study.Results: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2–21.4] vs. 19.5 [17.3–21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9–15.2] vs. 10.6 [7.9–12.6] (P
TL;DR: Despite existence of poor or no relationship with maternal blood glucose levels, prolonged sedentary behavior and decreased physical activities, especially domestic, are potential risk factors for GDM, a major finding of the study.
Abstract: Aims: The present study evaluates association between physical activity and Gestational Diabetes Mellitus (GDM), for it can be an effective intervention for its management Though physical activity helps maintain glucose homeostasis, evidences of GDM risk are less extensive Therefore, this study also identifies its correlation with maternal blood glucose levels Materials and Methods: A prospective case-control study was carried out among pregnant women attending regular antenatal clinic at two private hospitals The study comprised of 100 cases and 273 matched controls Data was collected by personal interviews using a standard questionnaire Physical activity was assessed using long form of International Physical Activity Questionnaire (IPAQ) reported as Metabolic Equivalent-Minutes per week (MET-Minutes/Week) Statistical Package for Social Sciences (SPSS) was used for analysis Results: Results shows high exposure rates for low-to-moderate physical activity among cases, across all domains and sub-activities The odds of GDM engaged in domestic and gardening activities for
TL;DR: A high prevalence of Vitamin D insufficiency in school-children aged 6–12 years, from a semirural setting, is reported, and it is demonstrated that duration of sunlight exposure and body fat percentage are the two important determinants of serum 25(OH)D concentrations in these children.
Abstract: Introduction: Due to the high prevalence of Vitamin D deficiency in spite of abundant sunshine and scarcity of studies investigating Vitamin D status in Indian children from rural and semirural areas, the objectives of this cross-sectional study were to: (1) assess the Vitamin D status of school-children in a semi-rural setting and (2) identify the determinants of Vitamin D status in these children. Materials and Methods: Data collected included anthropometric measurements (height and weight), body composition, three-one-day dietary recall method, demographic data, and sunlight exposure. Serum 25-hydroxyVitamin D (25(OH)D) was estimated by enzyme-linked immunosorbent assay (ELISA) technique. SPSS software was used for statistical analysis. Results: Anthropometric characteristics of the children were similar and mean serum 25(OH)D concentration was 58.5 ± 10.3 nmol/L with no significant differences between genders. Around 80% children reported sunlight exposure of 2 h or more. A majority (71%) of children were Vitamin D insufficient with serum 25(OH)D concentrations between 50 and 74.9 nmol/L. Determinants of Vitamin D identified were duration of sunlight exposure and body fat percent. Significant (P 2 h of sunlight exposure. We have also demonstrated that duration of sunlight exposure and body fat percentage are the two important determinants of serum 25(OH)D concentrations in these children.
TL;DR: Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can achieve near-normal maternal and neonatal outcome.
Abstract: Background: Gestational diabetes mellitus (GDM) is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control The baseline characteristics (age, body mass index, religion, and socioeconomic status) were noted in all cases Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required Maternal and perinatal outcome was noted in all womenResults: The prevalence of GDM was 572% (170/2970) Most patients (7941%) could be controlled on diet alone However, 21 (1235%) needed insulin and 14 (823%) needed oral hypoglycemic agents Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (135%) than in control (63%) (P = 0019) Mode of delivery was not different in two groups Instrumental deliveries and postpartum hemorrhage were also similar However, mean birth weight was significantly higher in GDM (2848 ± 539 g) than in control (2707 ± 641 g) (P = 0004) Incidence of large-for-date babies was also higher (282%) in GDM than control (194%) (P = 0005) In neonatal complication, hypoglycemia was significantly higher in GDM (206%) than in control (52%) (P = 0001) However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups Conclusion: The prevalence of GDM was 572% in this study Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can achieve near-normal maternal and neonatal outcome
TL;DR: This article provides a brief overview regarding how various CV safety evidence of DPP-4 inhibitor evolved over time that highlights possible implication in clinical practice and translates them into effective diabetes management.
Abstract: The U.S. Food and Drug Administration issued a guidance for pharmaceutical industry defining preapproval and postapproval requirements for the demonstration of cardiovascular (CV) safety for all new medications developed for glycemic management in type 2 diabetes. However, results published from the studies of dipeptidyl peptidase-4 (DPP-4) inhibitors are conflicting with regard to different CV endpoints. Upcoming CV outcome studies perhaps will be able to provide additional insights related to diabetes management and help to provide the answers to some of these concerns. This article provides a brief overview regarding how various CV safety evidence of DPP-4 inhibitor evolved over time that highlights possible implication in clinical practice and translates them into effective diabetes management.
TL;DR: A high prevalence of CA was observed in T2DMPN patients who presented to the endocrinology department of a tertiary care South Indian hospital, belonging to Indian population amongst whom type 2 diabetes is on the rise in alarming proportions.
Abstract: Aims: Available literature on the prevalence of Charcot arthropathy (CA) represents mainly Western population. No study has been reported from India so far. Hence we attempted to study the prevalence of CA in patients with type 2 diabetes mellitus and severe peripheral neuropathy (T2DMPN), belonging to Indian population amongst whom type 2 diabetes is on the rise in alarming proportions. Materials and Methods: Medical records of 3387 patients who performed an objective vibration perception threshold test during the year 2015 were screened for T2DMPN. Out of these, 1475 T2DMPN patients above 50 years were selected and analyzed in detail for CA. CA was diagnosed based on clinical features and/or radiological investigations. The anatomical localization of the disease distribution of the affected foot was done according to Brodsky's classification. Results: The prevalence of CA in T2DMPN patients was found to be 9.8%. The mean age of patients diagnosed with CA was 63 ± 8.36 years, and mean duration of DM for CA to develop was 18.01 ± 8.23 years. About 62.5% of the patients were male and 37.5% female. Bilateral presentation of CA was observed in 20.8% of patients. Multiple sites of the foot were affected in 48.6% of patients and belonged to type 4 classification of Brodsky. Conclusions: A high prevalence of CA (9.8%) was observed in the present study conducted on T2DMPN patients who presented to the endocrinology department of a tertiary care South Indian hospital. In the majority of patients, the area of foot affected belonged to type 4 classification of Brodsky.
TL;DR: This study showed that higher glycemic gap levels were associated with an increased risk of MODS, ARDS, shock, UGI bleed, AKI, and ARF, which can be used to determine prognosis in patients with diabetes admitted to the ICU.
Abstract: Objectives: Glycemic excursions are commonly seen in patients admitted to the Intensive Care Unit (ICU) and are related to adverse outcomes. Glycemic gap is a marker of this excursion in patients with diabetes. It can be used to predict adverse outcomes in patients with diabetes admitted to the ICU. It is calculated by subtracting A1C-derived average glucose (ADAG) = ([28.7 × HbA1c]-46.7) from plasma glucose at admission. Objective of this study was to correlate glycemic gap and adverse outcomes in patients with type 2 diabetes mellitus (DM) admitted to the ICU. Materials and Methods: We conducted an ambispective study to include patients with type 2 DM admitted to the ICUs from July 2015 to June 2016. The following adverse outcomes were recorded: Multiorgan dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), shock, upper gastrointestinal (UGI) bleed, acute kidney injury (AKI), and acute respiratory failure (ARF). Results: A total of 200 patients were enrolled, with a mean age ± standard deviation of 62 ± 11.24 years, and 64.5% were males. The median (interquartile range) duration of hospital stay and ICU stay were 8 (6–12) days and 4 (3–7) days, respectively. The most common primary diagnosis was cardiovascular (39.5%) followed by neurological (16.5%), infection at diagnosis (16.5%), respiratory (14%), gastrointestinal (7.5%), and others (6%). A higher glycemic gap was associated with occurrence of MODS (P
TL;DR: In urban Indian men, >1 h of casual midday sunlight exposure daily was required to maintain serum 25(OH)D concentrations above 50 nmol/L, and >2h of casual sunlight exposure was needed to maintain 25( OH)D concentration above 75 nmol /L.
Abstract: Objectives: To investigate the duration of casual sunlight ultraviolet-B (UVB) exposure required to maintain optimal Vitamin D status (25-hydroxyvitamin-D [25(OH)D]) >50 nmol/L in urban Indian men, using polysulfone (PSU) dosimeters and a sunlight exposure questionnaire. Methods: In healthy men (aged 40–60 years) from Pune (18.52° N, 73.86° E), India, serum 25(OH)D was measured using enzyme-linked immunosorbent assay. Sunlight exposure was assessed using PSU dosimeter and by questionnaire. Results: Of 160 men (48.3 ± 5.6 years), 26.8% were deficient and 40.6% had insufficient Vitamin D concentrations. A hyperbolic function for the relationship between PSU measured sunlight exposure in standard erythema dose (SED) and serum 25(OH)D concentrations (r = 0.87, P 5 SED) did not increase 25(OH)D concentrations above 90 nmol/L. Receiver operating curve analysis confirmed that 1 SED-UV exposure was sufficient to maintain 25(OH)D concentrations over 50 nmol/L. Based on the questionnaire data, >1 h of midday casual sunlight exposure was required to maintain serum 25(OH)D concentrations above 50 nmol/L. Duration of sunlight exposure assessed by questionnaire and PSU dosimeter showed a significant correlation (r = 0.517, P 1 h of casual midday sunlight exposure daily was required to maintain serum 25(OH)D concentrations above 50 nmol/L, and >2 h of casual sunlight exposure was needed to maintain 25(OH)D concentrations above 75 nmol/L. Excess sunlight did not increase 25(OH)D linearly. The sunlight exposure questionnaire was validated for use in clinical studies and surveys.
TL;DR: Results of various studies have shown that 18F-FCH is a promising upcoming tracer for the detection of parathyroid adenomas, especially when multiple, or having low size.
Abstract: To give an overview of the potential clinical utility of 18F-fluorocholine PET/CT (FCH PET/CT) in imaging of parathyroid adenoma. Available studies have provided preliminary results of 18F-FCH PET/CT in primary and secondary hyperparathyroidism. Results of various studies have shown that 18F-FCH is a promising upcoming tracer for the detection of parathyroid adenomas, especially when multiple, or having low size. FCH PET/CT has the potential to be a standard investigation in the detection of parathyroid lesions.
TL;DR: Age and sex wise normative data for pituitary measurements derived from Indian population are provided and no significant difference was observed between male and female in any of the parameters (height, length, width and volume).
Abstract: Aim: To establish normative measurements of pituitary gland in Indian population. Material and Methods: In this cross-sectional study, we measured dimensions of pituitary gland in 482 (213 females and 269 males) Indian subjects with apparently normal pituitary gland function. Mid-sagittal T1-weighted image (T1-WI) on magnetic resonance imaging (MRI) was used to measure height and length of pituitary gland. Pituitary gland width was measured using coronal T1-WI and pituitary gland volume was calculated. Results: Mean height, length and calculated volume of pituitary gland was significantly higher in females compared to males (p =
TL;DR: Proactive management of diabetes with SMBG can improve treatment outcomes and reduce morbidity and mortality associated with this disease, along with an improved quality of life.
Abstract: Objectives: The objective of the study was to understand the role of self-monitoring of blood glucose (SMBG) for better management of glycemic fluctuations, reducing the risk of complications, and the associated cost benefits for diabetes patients in India. Materials and Methods: An Excel-based Cost Impact Model was developed to analyze the impact of SMBG by calculating the savings over a 10-year time period. A literature review was undertaken to model the impact of SMBG on the risk of complications and cardiovascular morbidities. The model was developed based on inputs from previous studies. Results: In the base case, SMBG cohort was associated with a 10-year discounted cost of INR 718,340, resulting in an estimated saving of INR 120,173 compared to no SMBG cohort. Implementation of a once-daily SMBG protocol, for a decade, can reduce the complication-related costs. More frequent SMBG and tri-monthly hemoglobin A1c tests along with lifestyle changes can significantly reduce the financial burden on the patient over the lifespan. Conclusion: Our study has shown that proactive management of diabetes with SMBG can improve treatment outcomes and reduce morbidity and mortality associated with this disease. Near-normal blood glucose levels can bring in cost savings in the form of reduced long-term complications and avoidance of repeated hospitalization for the management of such complications, along with an improved quality of life.
TL;DR: A literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities, however, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association.
Abstract: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, which negatively affects various health systems. There is an extensive literature regarding the association of PCOS and other systemic conditions such as diabetes mellitus, cardiovascular disease, and psychological disorders. However, there is a lack of literature in associating PCOS and periodontal disease. Hence, PubMed search was done for various articles related to PCOS and its association with other comorbidities, including periodontal diseases. Analysis was done and data were synthesized and compiled in a sequential and presentable paradigm. This literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities. However, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association.
TL;DR: The study reported the high prevalence and significantly high unawareness for DR in T2DM patients and the association of DR with risk factors, calculated by Pearson Chi-Square method of analysis was found statistically significant.
Abstract: Background: Diabetic retinopathy (DR) is leading cause of visual impairment in working-age adults. Macular edema can occur with or without other signs of retinopathy. Methods: This was a single-center, retrospective study conducted over 2 years in patients (>40 years of age) having type 2 diabetes mellitus (T2DM). Outcome measures were to analyze awareness and prevalence of DR and association of DR with identified risk factors. Results: Overall 6000 T2DM patients over 2 years were retrospectively evaluated. Almost 63% (n = 3780) of patients were unaware that diabetes affects the retina. Almost 65% (n = 3894) of patients were reported to have DR. Total 78.98% of males, and 69.50% of females had DR. There was a significant increase in the incidence of DR with age (P 9% (P