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.

Glucometric Guardianship

This communication conceptualizes, defines and describes glucometric guardianship, as a means of ensuring optimal glycemic management. We define glucometric guardianship as the process of ensuring appropriate measurement, monitoring and analysis of glucose levels, so as to ensure alertness in glycemic management, and agility in anticipating and detecting suboptimal glycemic parameters, and responding to them. This paper hopes to draw attention to the need for glucometric science, encourage debate and discussion and facilitate research on the topic.

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.

The Expanding Role of Dapagliflozin Beyond the Glucose-lowering Effect

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have varied metabolic effects beyond increasing glycosuria. This consensus review examines the role of dapagliflozin in health promotion, particularly its benefits in patients with and without type 2 diabetes mellitus (T2DM) and in cardiorenal rehabilitation post-coronavirus disease 2019 (COVID-19). Consensus recommendations were developed by subject experts in Endocrinology and Diabetology based on the online meeting held on 27 June 2020 to review the available evidence related to the role of SGLT2 inhibitors, with a focus on cardiovascular and renal metabolic therapy. Evidence suggests that dapagliflozin has a direct role in improving clinical outcomes in patients with chronic kidney disease (CKD) or heart failure (HF). These benefits of dapagliflozin were independent of reduction in blood pressure, glycemic control and weight, and also extend to patients without diabetes. The use of dapagliflozin in metabolic syndrome was endorsed by the majority of the experts; however, this would be off-label. It was opined that the role of dapagliflozin would currently be limited to treating T2DM with a focus on preventing HF or kidney disease progression. The need for conducting multidisciplinary academic meetings to have a balanced approach regarding the use of dapagliflozin among nondiabetic patients and the need for detailed evaluation of the role of SGLT2 inhibitors in vasculometabolic and cardiorenal rehabilitation post-COVID was also suggested.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India

Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Hormone Dust Exposure – A Reversible Cause of Precocious Pseudopuberty in Siblings.

A seven year old female child presented with two episodes of vaginal bleding and bilateral breast development. Examination showed normal anthropometric measurements and external genitalia of prepubertal type. Her 5-year old younger brother and her father had gynaecomastia. Search for a structural cause for precocious puberty was negative. Occupational exposure of her father to hormonal dust was identified as the cause. All pubertal changes reverted to normal after observing suitable precautions.

Lifestyle modification in management of diabetes mellitus.

India has the largest diabetic population in the world. Change in eating habits, increasing weight and decreased physical activity are major factors leading to increased incidence of type 2 diabetes. Obesity is the most important modifiable risk factor. Smoking is an independent risk factor for type 2 diabetes mellitus. Diet and exercise are primary therapeutic options for its management. Dietary management should not only aim to achieve glycaemic control but to normalise dyslipidaemia. Smoking cessation reduces the risk of morbidity and mortality in CAD. Exercise improves the condition of a diabetic patient. Exercise includes yoga practices which have a role to play in the prevention of type 2 diabetes.