Prevalence of diabetes distress and its psychosocial determinants among Indian population with type II diabetes

Background: Diabetes distress (DD) refers to the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes, regardless of the type of diabetes. In addition to the chronic treatment of diabetes, patients with type 2 diabetes mellitus (T2DM) often experience psychosocial difficulties which can go unnoticed. Hence, it is necessary to identify DD at an early stage to prevent its effect on the patients� long-term self-care and management plan. This study was conducted to assess the prevalence of DD and its psychosocial determinants among T2DM at a tertiary care centre. Methods: This was a cross sectional, observational study which included patients of either gender, who were between 18-65 years of age with T2DM for more than 3 months to 12 years. DD was assessed using the diabetes distress scale (DDS17) scale. In addition, association between the level of DD with the sociodemographic and clinical characteristics of the patients was assessed. Results: The prevalence of DD in type II diabetic patients in suburban population was found to be 17.69%. The psychosocial determinants which influence DD were found to be age, treatment modality, hypothyroidism, hypertension, and smoking. Conclusions: This study signifies the importance of identifying DD by the primary care physician which often remain unrecognized in clinical practice and to implement the interventions at early stages to improve the quality of life of diabetic patients.

Implementing an antibiotic cycle program to reduce antimicrobial resistance while optimizing antibiotic usage: a sobering experience from a tertiary care facility in northern Mumbai

Background: The increase of antimicrobial resistance and the scarcity of new broad-spectrum antibiotics is a major challenge. Antibiotic cycling is one tactic that increases antibiotic homogeneity to the greatest extent possible and can aid in controlling resistance pattern, but this approach has not undergone a thorough evaluation. The study’s objective was to examine the effects of an antibiotic cycling strategy on the antimicrobial susceptibility profile by avoiding and alternately using beta lactam/beta lactamase inhibitors over a period of many years. Methods: During the four-year trial period, from January 2018 to December 2021, an antibiotic cycling protocol was applied for indoor patients. Piperacillin/tazobactam and cefoperazone/sulbactam were alternately rotated and withheld for the full year. Using the hospital’s antibiogram as a guide, antibiotics were chosen for cycling. Data obtained from positive clinical cultures were used for preparing antibiogram. Results: The general susceptibility profile of the most prevalent species remained stable or showed a minor increase in sensitivity. While piperacillin/tazobactam susceptibility failed to approach statistical significance, the antibiogram for cefoperazone/sulbactam indicated a 4% increase in susceptibility with a shift to the left of the minimum inhibitory concentration (MIC). Conclusions: Antibiotic cycling is a controversial idea, yet it can be a successful technique to achieve either stability or a continuous decrease in resistance to a chosen antibiotic. Additionally, for meaningful outcomes, the antibiotic selected and the length of cycling must be in accordance with the hospital’s antibiogram.