A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel

Aim To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner’s toolkit for insulin motivation in the management of diabetes mellitus (DM). Background Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. Review Results After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. Conclusions In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals

Not Available

Not AvailableIn a pilot study, as a prelude for characterization of the entire Trigonella germplasm conserved in the National Gene Bank, National Bureau of Plant Genetic Resources, New Delhi, genetic relatedness among a selection of 49 accessions of fenugreek (Trigonella-foenum-graecum L.) was assessed using 19 morphometric and 186 inter-simple sequence repeat (ISSR) markers. An accession of T. corniculata L. was also assessed as an out-group. The accessions were collected from different eco-geographical sites located in the states of Andhra Pradesh, Himachal Pradesh, Jammu and Kashmir, Madhya Pradesh, Uttar Pradesh, Uttarakhand, Rajasthan, Gujarat, Manipur and Bihar; and one of the accessions was imported from Eritrea. Data for 12 qualitative and seven quantitative morphometric descriptors were recorded. Significant differences within the accessions were found for all the quantitative descriptors except primary branches and seeds/pod. Shannon-Wiener Diversity Index revealed substantial diversity for all the quantitative descriptors. The morphometric data differentiated the fenugreek accessions into two clusters (at similar to 65% similarity). A total of 100 ISSR primers were used for initial screening, out of which only 21 primers were found polymorphic. ISSR analysis was performed with selected 21 primers to generate 186 amplicons, of which 92.4% were polymorphic. Cluster analysis put 47 accessions in a single group at similar to 65% similarity. Though there was no agreement between the groupings based on morphometric and ISSR markers (Mantel statistic 0.096), specific cases of geographic groupings were supported by both the markers. Phylogenetic positioning of the accessions with no passport information was found to be possible. The ISSR markers complemented the morphometric data in understanding the genetic divergence among the fenugreek accessions.NBPGR, New Delh

Counteranion Driven Homochiral Assembly of a Cationic <i>C</i>₃‑Symmetric Gelator through Ion-Pair Assisted Hydrogen Bond

The helical handedness in achiral self-assemblies is mostly complex due to spontaneous symmetry breaking or kinetically controlled random assembly formation. Here an attempt has been made to address this issue through chiral anion exchange. A new class of cationic achiral <i>C</i>₃-symmetric gelator devoid of any conventional gelation assisting functional units is found to form both right- and left-handed helical structures. A chiral counteranion exchange-assisted approach is successfully introduced to control the chirality sign and thereby to obtain preferred homochiral assemblies. Formation of anion-assisted chiral assembly was confirmed by circular dichroism (CD) spectroscopy, microscopic images, and crystal structure. The X-ray crystal structure reveals the construction of helical assemblies with opposite handedness for (+)- and (−)-chiral anion reformed gelators. The appropriate counteranion driven ion-pair-assisted hydrogen-bonding interactions are found responsible for the helical bias control in this <i>C</i>₃-symmetric gelator