Imeglimin: Finding a Place in Modern Diabetes Pharmacotherapeutics

Type 2 diabetes mellitus (T2DM) is a multifactorial disease. Newer facets of its causation, clinical course, complications and therapy are being unraveled regularly. This editorial describes imeglimin, a first-of-class oxidative phosphorylation inhibitor, that has been approved for T2DM in Japan and India

STAR (Survey for ManagemenT of DiAbetes with FibeR-rich Nutrition Drink): A Pan India Survey to Understand the Physician and Patient Perspective Regarding the Role of Dietary Fiber Supplement in the Management of Type 2 Diabetes

Objectives: The aim of the STAR survey was to understand the physicians’ knowledge, attitude and perception regarding the role of nutritional dietary fiber supplements in the daily management of type 2 diabetes mellitus (T2DM). It also aimed to compare the changes in glycemic parameters as well as energy and satiety levels between patients taking a high-fiber supplement and those not taking a fiber supplement. Methods: Two cross-sectional pan-India surveys were conducted. The first was among 152 physicians who had >5 years of experience in treating patients with T2DM and treated >50 patients with T2DM per month. A self-administered paper-based questionnaire was used for the survey. The other survey was conducted among 3,042 patients with T2DM who were receiving treatment with antidiabetics. These patients were further categorized into the Horlicks Diabetes Plus (HDP) group, which consisted of 1,524 patients who had consumed the HDP fiber supplement for a minimum of 3 months and the non-HDP group, which included 1,518 patients who had never consumed HDP. Results: Almost all physicians prescribed fiber-rich nutritional supplements to their patients with T2DM and believed that dietary fiber has an important role in managing glycated hemoglobin (HbA1c) values, healthy weight and cholesterol levels. Among the main benefits of HDP seen by physicians were improvement in satiety levels and increase in physical activity, reduction in HbA1c, fasting and postprandial glucose, and reduction in dose and/or number of hypoglycemic medications. All physicians recommended that it was important to increase awareness among patients as well as doctors regarding the benefits of HDP in patients with T2DM. Patients in the HDP group reported a mean decrease of 0.72 in their HbA1c value which was statistically significant at 3 months (8.04 at baseline to 7.32 at 3 months). In contrast, the non-HDP group showed a non-statistically significant decrease of 0.61 in HbA1c from a baseline value of 8.15. Furthermore, patients reported a significant decrease in weight of 3 kg in 3 months from baseline value of 72.11 kg to 69.11 kg. This reduction in weight was observed in 82% patients in the HDP group, while the non-HDP group showed an insignificant weight reduction from a baseline value of 72.14 kg to 71.46 kg in 3 months. About 83% of patients reported feeling full for longer periods of time and 92.62% reported feeling more energetic after starting HDP. The compliance and satisfaction rates with HDP were 96% and 75%, respectively. Conclusion: A high-fiber supplement taken along with patients’ existing antidiabetic treatment plan has the potential to decrease glycemic parameters and weight while increase the satiety and energy levels among patients with T2DM. However, these results need to be evaluated further with long-term clinical studies conducted in the real world.&nbsp

Imeglimin: Finding a Place in Modern Diabetes Pharmacotherapeutics

Type 2 diabetes mellitus (T2DM) is a multifactorial disease. Newer facets of its causation, clinical course, complications and therapy are being unraveled regularly. This editorial describes imeglimin, a first-of-class oxidative phosphorylation inhibitor, that has been approved for T2DM in Japan and India

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective

Background There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. Methods This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. Results The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$18.78, normal delivery US$ 84.61, newborn care US$16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$45.50, Normal Delivery US$ 148.43, assisted delivery US$167.43, C-section US$ 183.34, Newborn Care US$41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. Conclusions The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting

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

Preparing for the Ramadan Fast During the Month of Shabaan

GUEST EDITORIA

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

Operability, acceptability, and usefulness of a mobile app to track routine immunization performance in rural Pakistan: Interview study among vaccinators and key informants

Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers

Vitamin D in Clinical Practice: Current Perspectives

India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen

Vitamin D in Clinical Practice: Current Perspectives

India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen