An Expert Group Consensus Statement on “Approach and Management of Prediabetes in India”

The prevalence of prediabetes, a forerunner of diabetes is very high, and its conversion to diabetes is also more rapid among Asian Indians. Prediabetes also predisposes to the development of macrovascular and to a lesser extent of microvascular complications of diabetes. In a large community-based epidemiological study, the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB), data reported an overall prevalence of prediabetes of 10.3%, derived from 15 Indian states. This shows that the diabetes epidemic is far from over as many of them may soon convert to diabetes. Prediabetes, however, should not be considered a path to diabetes rather it should be a window of opportunity for the prevention of diabetes. This early screening, detection, and treatment of prediabetes should be made a national priority. Several countries have introduced lifestyle programs to prevent diabetes and, when indicated, pharmacological intervention with metformin as well. This consensus statement outlines the approaches to screening and lifestyle and pharmacological management of prediabetes in Asian Indians.

Post-partum recurrent hypoglycemia

Hypoglycemia can be effortless to treat. Its evaluation on the other hand, needs a thorough appraisal. The studied patient had recurrent episodes of hypoglycemia post-delivery which were unprovoked. These conspicuous episodes of hypoglycemia prompted an evaluation and a swift arrival at the diagnosis. In hindsight, she had multiple, typical risk factors predisposing her to develop a Sheehan’s syndrome. This was an acute presentation of a familiar disease

A myriad of fat

Hypertriglyceridemia is a familiar issue a physician and his patients face. Writing a prescription for the same may be effortless, but without a thorough evaluation, we may miss out on a number of concealed diseases. Treating the underling secondary disease, avoids an unnecessary pill burden, eventually decreasing healthcare costs also. Unearthing prevalent diseases like diabetes mellitus (DM) is rewarding in its own way and pays dividends multifold. The physician must be aware that secondary causes of hypertriglyceridemia manifesting as lipemia can commonly be seen in disorders like obesity, primary hypothyroidism and DM. The studied patient presented to us obviously shaken with a long history of weight gain and lipemia during a blood draw. She turned out to have the commonest risk factors for hypertriglyceridemia - Obesity, hypothyroidism and DM causing the alarming lipemia. It was an oddly interesting presenting symptom of hypertriglyceridemia, obesity, hypothyroidism and DM which resulted in an appropriate and prompt management of her underlying diseases.

Efficacy and safety of pregabalin versus amitriptyline in patients with painful diabetic neuropathy

Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.