RESUMO
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.
RESUMO
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.
RESUMO
Prevention and timely management of cardiovascular (CV) complications like myocardial infarction, heart failure (HF), stroke and renal complications, like chronic kidney disease (CKD) and end-stage renal disease, are important to improve the quality of life and survival in people with type 2 diabetes mellitus (T2DM). The multifaceted action of sodium-glucose co-transporter 2 inhibitors (SGLT2i) results in effective glycemic control with benefits on CV and renal risk factors, like body weight, blood pressure, uric acid and albuminuria. Robust CV and renal event reduction is reflected in the outcomes of large CV outcome trials, meta-analyses and real-world studies. Recent evidence has proven cardiac and renal benefits with SGLT2i in subjects with HF and CKD irrespective of their T2DM status. Until recently, SGLT2i was used as a glucose-lowering molecule with pleiotropic benefits, mainly by primary care practitioners and diabetologists. The potential for cardiac and renal protection in people with and without T2DM has shifted an interest in cardiologists and nephrologists to view it as a cardiac and renal molecule, respectively. Thus, the role of SGLT2i in the management of T2DM is undergoing a paradigm shift—straddling the interfaces of diabetology, cardiology, nephrology and primary care—moving away from being considered a pure antidiabetic molecule. We conducted a literature review of SGLT2i in management of T2DM along with their protective effects on CV and renal parameters in patients with or without baseline comorbidities.
RESUMO
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.