Assessment of knowledge, attitude and practice of insulin injection among subjects with diabetes mellitus

Background: Diabetes mellitus (DM) is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycemic drugs and insulin along with the dietary and lifestyle modifications. Insulin is administered most subcutaneously. As the insulin injection sites are relatively painless, patients tend to inject in the same area repeatedly rather than moving to a newer site and increase risk for development of injection site reactions like lipodystrophy and impairment of glycemic control. Hence, it is utmost important for every diabetic patient and their relatives who would inject the insulin injection to be aware of appropriate manner of insulin injection. This helps in maintaining adequate glycemic control in diabetic patients. The main objective of this study was to assess the knowledge, attitude and practice of insulin injection technique among the diabetic patients.Methods: A cross-sectional study was conducted in the department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. A validated questionnaire was administered to patients to answer in order to assess their knowledge, attitude and practice about technique of insulin injection.Results: In this study, it was found that 90% of the patients were aware of rotating the injection site, whereas only 40% of the patients were aware of appropriate time duration (5-10 sec for syringes/counting 1-15 for releasing the pen) required for resting the syringe/pen needle inside the skin. Only 48% of the patients used to remove the air bubble prior to injection, 57% pinched the injection site before injecting, 20% rubbed the injection site after injection and 30% used to wash hands prior to injection. Hypoglycemia was the most common adverse effect noted in 54% of patients.Conclusions: It can be concluded from the present study that every patient and his/her attendant needs to be educated and trained appropriately regarding technique of injecting insulin injection for betterment of their health. 

Prevalence of insulin induced lipodystrophy in patients with diabetes mellitus in a tertiary care centre: a cross sectional study

Background: Diabetes Mellitus is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycaemic drugs and insulin along with the dietary and lifestyle modifications. Lipodystrophy is the most neglected adverse drug effect caused by injecting insulin. The main objective of this study was to assess the prevalence of lipodystrophy at the insulin injection sites in patients suffering from diabetes mellitus (Type 1 and Type 2).Methods: A cross-sectional study was conducted in the Department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. The demographic features and anthropometric measurements were noted. Insulin injection sites were examined clinically by inspection and palpation for presence of swelling like lipodystrophy, injection marks and signs of allergy like erythema etc. Lipodystrophy was graded from 0-3 and denoted as lipohypertrophy or lipoatrophy. The results were tabulated and presented accordingly.Results: In this study, out of 250 patients 17 (6.8%) patients presented with insulin induced lipodystrophy. Lipohypertrophy was the most common presentation and only one case presented with lipoatrophy.Conclusions: It can be concluded from the present study that lipodystrophy which is an important adverse effect due to insulin injection needs to be monitored regularly in every patient taking insulin for better control of glucose levels

Methimazole induced lichenoid eruptions: an unusual case

This is a case report of a 31-year-old male presented to the Endocrinology outpatient department of our hospital with hyperthyroidism and was prescribed tablet methimazole 30mg once daily and tablet propranolol 40mg once daily. After 3 months, the patient complained of violaceous papular lesions on both the extensor aspect of the arms and legs. Physical examination was remarkable for acute onset, raised, itchy, violaceous papular lesions over the defined areas. The drug methimazole was suspected to cause lichenoid drug eruptions and was withdrawn. This case illustrates methimazole otherwise an efficacious and widely used anti thyroid drug is an agent capable of inducing lichenoid eruptions. However in future the monitoring of methimazole is essential for such adverse reaction

Indian consensus on durability of glycemic control in type 2 diabetes management and role of oral antidiabetic drugs

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in an alarming way in India as well as across the globe. In order to minimize complications, there is a need to maintain good glycemic control in patients with T2DM and long-term durable glycemic control remains a challenge. Clinically, this challenge was addressed by step-wise intensification of therapy with additional antidiabetic drugs to maintain glycemic control. Various disease and patient-related factors as well as different antidiabetic agents influenced the durability of glycemic control differently. While understanding of the factors that influenced therapeutic outcomes had evolved, there was paucity of information about the durability of glycemic control and the role of oral antidiabetic drugs (OADs) in achieving it. With an objective to understand the role of durability of glycemic response in the management of Indian patients with T2DM, 4 advisory board meetings attended by 48 physicians from across the country were conducted in Mumbai, Delhi, Kolkata and Bengaluru. There was consensus to consider durability of glycemic control as an important goal in the management of T2DM. Personalized approach in T2DM management along with early initiation of dual combination therapy were recommended to achieve durability. Age group of patients, body mass index, glycated hemoglobin levels at diagnosis, presence or absence of comorbidities and complications are important factors that need to be considered before initiating dual combination therapy for patients with T2DM

Glucometric Guardianship

It is a well-known fact that the knowledge of their current glucose readings empowered people with diabetes to evaluate and monitor the trends in glucose fluctuations and take informed decisions on adjusting their medicines, food intake, and physical activity. Glucose monitoring technology has undergone a technological evolution and has improved diabetes care in patients living with type 2 diabetes. This has also made the need to efficiently and effectively utilize blood glucose monitoring tools. Given the above, the article has reviewed the significance of glucometric guardianship. Glucometric checklists offer a standardized approach to glucometric guardianship which is necessary to improve the process of drug choice and dose titration. The stepwise factors included in the glucometric guardianship checklist include procurement, distribution, pre-testing hygiene, testing, recording, action, disposal, quality control, and procedure safety

The Pyramid of Transgender Health Therapeutics

Transgender care needs a multidisciplinary team approach. The awareness about transgender health has increased over the past few years in India. The pyramid of transgender health helps to demystify the care of transgender individuals. The 7 S\u27s of lifestyle modification need to be followed in the routine clinical care of transgender individuals. The individuals also need psychological care and support, metabolic and medical care, endocrine management, and later surgery in some cases. The policy makers can use the pyramid to decide about financial help to the community for their holistic care. The physicians involved in the care of transgender individuals can also take guidance about comprehensive care and management of transgender and gender diverse individuals

Estimation of adiponectin levels in diabetic, non-diabetic fatty liver diseases and healthy controls

Background:Estimation of adiponectin levels in diabetic and non-diabetic fatty liver and healthy controls.Methods:We studied 25 subjects for diabetic fatty liver, 25 subjects for non-diabetic fatty liver and 25 healthy controls. Clinical evaluation included anthropometric measurements, BMI, biochemical investigations and adiponectin estimation by ELISA.Results: There were 15 males (60%) and 10 (40%)females subjects in the DFL group, 18 males (72%) and 7 females (28%) subjects in the NDFL group and 13 males (52%) and 12 females (48%) subjects in the control group. 80% (20) of the DFL patients and 72% (18) subjects of NDFL group had BMI >25kg/m2. 80% (12 males and 8 females) of subjects in the DFL group and 68% (12 males and 5 females) had a waist circumference that indicated central obesity as per Indian cut-offs (>90 cm for females and >80 cm for males). The mean adiponectin (μg/ml) ± SD levels in DFL were 4.03 ± 0.43, NDFL was 5.01 ± 0.55 and in controls was 7.63 ± 0.66, the difference being statistically significant with P <0.001. The difference in the adiponectin levels was statistically significant between each of the three groups with P <0.001. There was no difference in serum adiponectin levels between males and females in all three groups.Conclusion:The chief conclusion of this study are that serum adiponectin levels are lower in subjects with NAFLD than those without it; adiponectin levels are inversely related to the degree of steatosis in NAFLD, with the lowest levels in more severe forms of steatosis.

Peripartum management of diabetes

The peripartum control of diabetes is very important for the well-being of the newborn as higher incidence of neonatal hypoglycemia is seen if maternal hyperglycemia happens during this period. Type of diabetes (type 1, type 2 or gestational diabetes) also has an effect on the glucose concentration during intrapartum period. During the latent phase of labor, the metabolic demands are stable but during active labor there is increased metabolic demand and decreased insulin requirement. After delivery once the placenta is extracted, insulin resistance rapidly comes down and in patients with pre-gestational diabetes there will be a sudden drop in insulin requirement and the insulin may not be required in women with gestational diabetes, but they just need close monitoring. During breast-feeding blood glucose levels fall because of high metabolic demand and women need to take extra calories to maintain the levels and more vigilance especially in type 1 and type 2 diabetic mothers is required. The protocols used for the management of peripartum management of diabetes mostly rely on glucose and insulin infusion to maintain maternal blood sugars between 70 and 110 mg/dl. The data is mostly from retrospective studies and few randomized control trials done mainly in type 1 diabetes patients. The review summarizes guidelines, which are used for peripartum management of blood glucose

Study of effects of gender-affirming hormone therapy on bone mineral density in individuals with gender dysphoria

Introduction: Gender affirming hormone therapy (GAHT) is the mainstay treatment in transitioning individuals and has positive physical and psychological effects. Among the things to monitor in transgender patients on long-term hormones, bone health is an essential consideration. As the calcium intake in the Indian population is less, and many gender-incongruent individuals may not take adequate calcium in their diet, we needed data on the bone health of Indians with gender dysphoria as the information available globally may not apply to our population. Materials and Methods: The study was performed to assess bone mineral density in individuals with gender dysphoria who were on gender-affirming hormonal therapy for at least 6 months. It was a hospital-based cross-sectional study of bone mineral density measured at two sites – hip and spine in individuals with gender dysphoria on GAHT for at least six months. Results: A total of 30 individuals were included in this study. The mean age of individuals with Gender dysphoria was found to be 28.17 ± 6.15 years, and the age range was 19-42 years. Out of the 30 individuals, 14 were transgender males, and the remaining 16 were transgender females. Bone mineral density at the hip and spine in transgender males was 1.047 ± 0.124 g/cm2 and 1.065 ± 0.115 g/cm2, which was better compared to transgender females in whom the bone mineral density at hip and spine was 0.899 ± 0.873 g/cm2 and 0.854 ± 0.099 g/cm2 (P = 0.001 for hip; P = 0.000 for spine). The Z score at hip and spine were better in transgender males as compared to transgender females (P < 0.001 for hip; P < 0.001 for spine) when compared to genetic sex and at the spine (P = 0.001) when compared to affirmed sex. In this study, we observed that the transgender females who underwent orchidectomy had a lower mean Z score at spine compared to individuals who did not undergo the procedure. Conclusions: The current study results indicate that GAHT does have positive effects on bone health in transmen