Transition Care in Type 1 Diabetes. Five Questions and Five Principles

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is amongthe most challenging in the field of diabetes care. At around the age of 18 there is a physical transferof care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility ofself-care from parents to the patient over a period of time. Unique medical problems encountered inthis age group include puberty induced increase in insulin requirements, an increase in psychiatriccomorbidities including substance use and abuse, disconnect with health care teams, and problems relatedto reproductive care and contraception. This is reflected in the poorer outcomes seen in this age groupincluding an increase in acute complications, increase in hospitalizations with diabetic emergencies, poorglucose control and an increase in loss to follow. The poor metabolic control during this period leads toestablishment of early chronic macro and microvascular complications. A structured transition care isa planned purposeful process that address these unique medical, psychological, and vocational needsamong these patients that smoothens out the process of transfer to adult care teams. The models thathave been proven to be useful in improving outcomes include the use of separate transition clinics, use oftransition coordinators and enrollment into young patients support groups. Regardless of the model usedthere are five overarching principles that define this process of transition care. They can be summarizedin five Cs which include: appropriate communication, assessment of self-care needs, building competence,using collaborative teams, and finally providing care and counseling for psychological issue

Failure to Timely Diagnose and Intervene in a Known Complication of a Procedure

MEDICOLEGA

Insulin Initiation with Insulin Degludec/Insulin Aspart versus Insulin Glargine in Oral Antidiabetic Drugs Failure Patients with Type 2 Diabetes Mellitus: A Real-World Study from India

Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, butthere is still a dilemma as to whether basal insulin or a premixed/co-formulation analog shouldbe the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjectswith type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting anddesign: Retrospective study. Methods and material: Data was retrieved from the author’sclinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100,n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasmaglucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) frombaseline and at last follow-up visits were collected. Statistical analysis used: Baselinecharacteristics and change in study parameters during the follow-up period were computedbetween two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively.ANCOVA test was used to compute percentage reduction in body weight, body mass index(BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results:IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared tothe IGlar U100 arm. There was no significant difference in the proportion of patients withhypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severehypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD inT2DM patients indicated that both were relatively safe but the former controlled FPG andPPG levels more effectively

Motivating Persons Living with Diabetes for Insulin/Injectable Therapy

Motivating patients to initiate or intensify insulin is a challenging aspect of diabetes practice.This paper reviews certain motivational strategies and methods used for insulin initiation/intensification. It places various domains of motivational interviewing in perspective, under asingle umbrella, making it easier for practitioners to understand the art and science of insulinmotivatio

Association of Fructose Enriched Foods with Metabolic Syndrome and Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the major causes of mortality and morbidity worldwideas well as in the Indian subcontinent, causing more than 25% of deaths. It has been predictedthat these diseases will increase rapidly in India, making it a host to more than half thecases of heart disease in the world within the next 15 years. The World Health Organization(WHO) reports that in the year 2005 CVDs caused 17.5 million (30%) of the 58 million deathsthat occurred worldwide. In the recent times, the association of metabolic syndrome (MS)is strongly linked with CVDs. MS is defined as a constellation of metabolic disorders in anindividual. The main components of MS are dyslipidemia (higher triglyceride, low-densitylipoproteins [LDL] and low high-density lipoproteins [HDL]), elevated blood pressure (BP),dysregulated glucose homeostasis, abdominal obesity and insulin resistance. Being one of themost widespread diseases in the world, almost half of the population of specific age groupsin developed countries is affected by it. Studies have shown that the independent risk factorsassociated with MS increase the likelihood of CVDs. It has been postulated that excess intakeof fructose promotes cell dysfunction, inflammation, intra-abdominal (visceral) adiposity,atherogenic dyslipidemia, weight gain, insulin resistance, hypertension thereby aggravatingthe chances for developing MS, type 2 diabetes and coronary heart diseas

Insulin is Essential: The National List of Essential Medicines, India, 2022

GUEST EDITORIA

Diabetes Risk Score in Indian Population: Experience from Central India

Diabetes is a major health problem in the world causing significant morbidityand mortality. Currently, 77 million people in India and 463 million people are living withdiabetes across the world, and this number is expected to rise to 101 million in India and 578million globally by 2030. The key to reduce the morbidity and mortality is early diagnosis andmanagement. The Madras Diabetes Research Foundation (MDRF) has developed an IndianDiabetes Risk Score (IDRS) to identify people who are at risk of developing diabetes or areundiagnosed. Thus, we conducted a study to calculate the IDRS of people from Central Indiaand identify those who are at risk of getting diabetes. Methods: A total of 1,500 patients orattendants, aged 18 to 60 years (mean age 41.2 years), visiting the Endocrinology clinic, andnot diagnosed with diabetes earlier were included in the study after taking proper consentand IDRS was calculated. Results: The male-to-female ratio was 914:586. The mean IDRS was51.29 in our population with 35.93%, 18.2% and 45.87% of screened subjects having a score of<30, 30-60 and ≥60, respectively. Conclusion: Forty-five percent people of the population wasat high risk of diabetes as estimated by IDRS, which proved to be an effective and economicaltool to identify persons at increased risk of diabetes and diagnose the undiagnosed cases andstart early management to reduce the morbidity and mortality

Cocktail Inferno – Multiple Sclerosis with Type 2 Diabetes Mellitus in a Patient with Lepromatous Leprosy

Co-occurrence of multiple sclerosis with type 2 diabetes mellitus with lepromatous leprosyis rare. We hereby report a case of multiple sclerosis with type 2 diabetes mellitus with lepromatousleprosy in a middle-aged female. She was clinically diagnosed as having multiple sclerosis withtype 2 diabetes mellitus and presented with fever, ENL and neuritis. Her MRI reports were normalbut she had a positive slit-skin smear and skin biopsy as lepromatous leprosy. Proceeding withthis diagnosis, she was treated with baclofen for spastic bladder, antibiotics for urinary tractinfection, oral hypoglycemic agents and oral steroids with multibacillary treatment for leprosywith type 2 reactions. She responded well and currently is being followed-u

Association of Fructose Enriched Foods with Metabolic Syndrome and Cardiovascular Diseases

oai:ojs2.ojs.ijcp.in:article/1Cardiovascular diseases (CVDs) are the major causes of mortality and morbidity worldwide as well as in the Indian subcontinent, causing more than 25% of deaths. It has been predicted that these diseases will increase rapidly in India, making it a host to more than half the cases of heart disease in the world within the next 15 years. The World Health Organization (WHO) reports that in the year 2005 CVDs caused 17.5 million (30%) of the 58 million deaths that occurred worldwide. In the recent times, the association of metabolic syndrome (MS) is strongly linked with CVDs. MS is defined as a constellation of metabolic disorders in an individual. The main components of MS are dyslipidemia (higher triglyceride, low-density lipoproteins [LDL] and low high-density lipoproteins [HDL]), elevated blood pressure (BP), dysregulated glucose homeostasis, abdominal obesity and insulin resistance. Being one of the most widespread diseases in the world, almost half of the population of specific age groups in developed countries is affected by it. Studies have shown that the independent risk factors associated with MS increase the likelihood of CVDs. It has been postulated that excess intake of fructose promotes cell dysfunction, inflammation, intra-abdominal (visceral) adiposity, atherogenic dyslipidemia, weight gain, insulin resistance, hypertension thereby aggravating the chances for developing MS, type 2 diabetes and coronary heart disease

Motivating Persons Living with Diabetes for Insulin/Injectable Therapy

Motivating patients to initiate or intensify insulin is a challenging aspect of diabetes practice. This paper reviews certain motivational strategies and methods used for insulin initiation/intensification. It places various domains of motivational interviewing in perspective, under a single umbrella, making it easier for practitioners to understand the art and science of insulin motivation