Role of ambulatory glucose profile in identifying and managing a patient with disparity between FPG, PPG and HbAlc levels: a case report

This case report describes the management of a patient with mismatch/disparity between his Fasting Plasma Glucose (FPG)/ Postprandial Glucose (PPG) levels with that of Glycosylated Haemoglobin (HbA1c) levels. This 43-year-old male patient with Type 2 Diabetes Mellitus (T2DM) was presented with increased urination and tiredness, especially in the evening hours, along with a tingling sensation in bilateral feet on and off, with leg pain since past 4 months. The patient was obese with a family history of cardiovascular disease. In this patient, SGLT2 inhibitors were found to be effective in addressing glycaemic variability without triggering hypoglycaemic risk. Continuous glucose monitoring system aided in understanding the blood glucose fluctuations caused by the diet. This case study indicated that careful evaluation and appropriate management using Ambulatory Glucose profile would aid in preventing complications in such patients and improve the overall clinical outcomes

Democracy in Diabetes Care: Acting Upon the Three A’s – Accessibility, Affordability and Awareness

Diabetes care is the right of every individual living with diabetes. In this communication, we describe the epidemiology of diabetes in India, draw parallels between democracy and diabetes, and call for the democratization of diabetes care. We highlight the three A’s – Accessibility, Affordability and Awareness—that are essential for democratic diabetes care and share best practices towards this end

Democracy in Diabetes Care: Acting Upon the Three A’s – Accessibility, Affordability and Awareness

Diabetes care is the right of every individual living with diabetes. In this communication, we describe the epidemiology of diabetes in India, draw parallels between democracy and diabetes, and call for the democratization of diabetes care. We highlight the three A’s – Accessibility, Affordability and Awareness—that are essential for democratic diabetes care and share best practices towards this end

The Journey and Excitement Following the Development of the First Peptide in a Pill: A Brief Overview of Pharmacology and Clinical Trials of Oral Semaglutide

Oral semaglutide is the newest discovery, the first in class peptide in a pill. Sodium N-(8-[2-hydroxybenzoyl]amino)caprylate (SNAC), a small fatty acid, has been co-formulated with semaglutide, which facilitates its absorption from the gastric mucosa. It has 94% homology with human glucagon-like peptide 1 (GLP-1). It comes in three dose forms – 3 mg, 7 mg and 14 mg. It is given as once daily dosing and is recommended in adult type 2 diabetes mellitus patients as monotherapy when metformin is contraindicated or not tolerated and in combination with other oral antidiabetic drugs (OADs). In a phase 3 trial, it has been shown to reduce glycated hemoglobin (HbA1c) up to 1.5%, with weight reduction up to 5 kg with a 14 mg dose. There was nonsignificant risk reduction of 21% in 3-point major adverse cardiovascular events (MACE) and 51% and 49% risk reduction in cardiovascular (CV) deaths and all-cause mortality, respectively. Oral semaglutide was found to be superior to empagliflozin, sitagliptin and liraglutide in both glycemic control and weight reduction. It also exhibits many pleiotropic effects – reduced energy intake, anti-inflammatory and anti-atherosclerotic effect, to name a few. Nausea was the most common side effect which was experienced by only 15% to 20% of patients. It was mild-to-moderate and transient. Overall, oral semaglutide has shown its efficacy both early and late in the management of diabetes, irrespective of renal and hepatic impairment

Patient Counseling for Finerenone

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist, which is used to retard the progression of chronic kidney disease in persons with type 2 diabetes. This communication describes the various aspects of patient counseling needed to ensure safe and effective usage of the molecule. It utilizes the 5C checklist: Confirmation of clinical indication; Caveats and contraindications; Concerns and checkpoints; Caution and use with concomitant medication; and Constraints and cost, to create a simple, yet comprehensive tool for clinical use

Characteristics and Prevalence of Latent Autoimmune Diabetes in Adults (LADA)

Diabetes, one of the most commonly seen metabolic disorders, is affecting a major area of population in many developing as well as most of the developed countries and is becoming an alarming concern for the rising cost of the healthcare system. Latent Autoimmune Diabetes in Adults (LADA) is a form of diabetes which is less recognized and underdiagnosed type of diabetes which appears to have characteristics of both type 1 (autoimmune in nature) and type 2 diabetes (adult age at onset and initial response to oral hypoglycemic agents). An epidemiological study was carried out on 500 patients in the western region of India. Various parameters such as age at onset, duration of diabetes, gender, basal metabolic index (BMI), type of diabetes, family history, HbA1c levels, cholesterol levels, and current treatment regimen were evaluated and correlated with type 1 and type 2 diabetes. Moreover, diagnostic markers for LADA, namely, GAD autoantibodies and C-peptide levels, were determined for 80 patients selected from the epidemiological study. Some of the results obtained were found to be consistent with the literature whereas some results were found to be contradictory to the existing data

International Consensus on Use of Continuous Glucose Monitoring.

Measurement of glycated hemoglobin (HbA1c) has been the traditional method for assessing glycemic control. However, it does not reflect intra- and interday glycemic excursions that may lead to acute events (such as hypoglycemia) or postprandial hyperglycemia, which have been linked to both microvascular and macrovascular complications. Continuous glucose monitoring (CGM), either from real-time use (rtCGM) or intermittently viewed (iCGM), addresses many of the limitations inherent in HbA1c testing and self-monitoring of blood glucose. Although both provide the means to move beyond the HbA1c measurement as the sole marker of glycemic control, standardized metrics for analyzing CGM data are lacking. Moreover, clear criteria for matching people with diabetes to the most appropriate glucose monitoring methodologies, as well as standardized advice about how best to use the new information they provide, have yet to be established. In February 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address these issues. This article summarizes the ATTD consensus recommendations and represents the current understanding of how CGM results can affect outcomes

Key elements of successful intensive therapy in patients with type 1 diabetes

An intensified diabetes management approach (including increased education, monitoring, and contact with diabetes team) should be used for adolescents and also for younger children if glycaemic control is not achieved by insulin therapy. Treatment options may include increased frequency of injections (e.g. the patients on 2 bolus may require 3 or 4 bolus injections), change in the type of basal and/or bolus insulin depending on multiple times monitoring for adolescents and for younger children, and change to continuous subcutaneous insulin infusion pump therapy. Results of epidemiology of diabetes interventions and complications (EDIC) Research Group, where the Diabetes Control and Complications Trial patients were further followed up almost for a period of 7 years or more showed that intensive therapy significantly reduced and maintained glycated hemoglobin with relative risk reduction of microvascular complications in the intensive therapy group. In addition, intensive treatment reduced the risk of any cardiovascular disease (CVD) event by 42% and the risk of nonfatal myocardial infarction, stroke, or death from CVD by 57%. The reduction of microvascular and macrovascular events in the intensively-treated group persisted due to the "legacy effect" or "metabolic memory" of early intensive glycemic control. The main advantage of intensive insulin therapy is that it reduces the rate of diabetes complications, in the long run. Furthermore, it offers flexibility as the doses can be adjusted according to the activity and food consumed. The main disadvantage of intensive insulin therapy is the risk of hypoglycemia especially in type 1 diabetes mellitus and weight gain

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Gujarat cohort of the A 1 chieve study

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Gujarat, India. Results: A total of 812 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 502), insulin detemir (n = 89), insulin aspart (n = 155), basal insulin plus insulin aspart (n = 45) and other insulin combinations (n = 21). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 8.9%) and insulin user (mean HbA 1 c: 9.1%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −2.2%, insulin users: −2.5%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia

Continuous subcutaneous insulin infusion: practical issues

The growing number of individuals with diabetes mellitus has prompted new way of treating these patients, continuous subcutaneous insulin infusion (CSII) or insulin pump therapy is an increasingly form of intensive insulin therapy. An increasing number of individuals with diabetes mellitus individuals of all ages have started using insulin pump therapy. Not everyone is a good candidate for insulin pump therapy, and the clinician needs to be able to determine which patients are able to master the techniques required and to watch for the adverse reactions that may develop. Insulin pump increases quality of life of patient with diabetes mellitus with increasing satisfaction with treatment and decrease impact of diabetes mellitus. Manual errors by insulin pump users may lead to hypo or hyperglycemia, resulting into diabetic ketoacidosis (DKA) sometimes. Some of practical aspect is associated with insulin pump therapy such as selection of candidates, handling of pump and selection of site, and pump setting, henceforth this review is prepared to explore and solve the practical problems or issues associated with pump therapy