ABSTRACT
BACKGROUND: Patients with type 1 diabetes mellitus (DM) require intensive monitoring, which was adversely affected during coronavirus disease 2019 (COVID-19) restrictions. METHODS: We evaluated the management of type 1 DM and the role of telephonic consultation and follow-up in 46 patients (10 on insulin pump) with type 1 DM at our centre from 1 February 2020 to 31 January 2021. Patients were telephonically counselled fortnightly. Web-based diabetes education sessions for the patients and parents were conducted. Finally, change in HbA1c during the period of the study, frequency of severe hypoglycaemia, hospital admissions for hyperglycaemic emergencies and degree of satisfaction with care rendered by the treating team were assessed by ratings scored by the patients. RESULTS: Five episodes of severe hypoglycaemia were noted in three patients. Two patients had diabetic ketoacidosis. Patients on insulin pump showed a mean baseline HbA1c of 7.8%. Nine of these patients (90%) showed an improvement in Hba1c during the study period compared to 64.3% of patients on conventional regimen. There were no episodes of severe hypoglycaemia or hospitalization with DKA noted in these patients. Only two patients had COVID-19 disease with mild manifestations. Overall satisfaction levels with therapy were high. CONCLUSION: This study illustrates the role played by teleconsultation and video conferencing during the period of the COVID-19 pandemic in ensuring optimal healthcare delivery to patients with type 1 DM. Some of these methods can be used even after the pandemic to improve patient convenience and reduce the out-patient burden on the hospitals.
ABSTRACT
INTRODUCTION: Ankylosing Spondylitis (AS) with non-steroidal anti-inflammatory drug (NSAID) therapeutic failure is treated with biologics. AIM: To compare the clinical outcomes of different biologics for Asian Indian patients with AS who have NSAID therapeutic failure. MATERIALS AND METHODS: Thirty-five AS patients with NSAID failure were administered Etanercept (n=15) (50mg SQ, weekly) or Infliximab (n=20) (5mg/kg IV every 2(nd) month) based on patient convenience or physician discretion as per 2015 ACR/SAA/SPARTAN recommendations. Baseline demographic details, time to diagnosis, disease duration, presence of low backache, early morning stiffness, peripheral joint and extraarticular involvement, ESR, CRP values and HLA-B27 score were obtained. Baseline values of scores of BASMI-3 and MASES were calculated. To monitor the disease activity, BASDAI and ASDAS-ESR scores were recorded at baseline, and after 6 months and 12 months of therapy initiation. STATISTICAL ANALYSIS: Comparison of means: independent samples t-test; comparison of parameters over time: repeated measures ANOVA. RESULTS: Both groups were comparable in all parameters at therapy initiation except in the baseline BASMI-3 score which was significantly higher in patients who received Etanercept. Over 12 months of treatment, the reduction in disease activity, as evidenced by reduction in the mean BASDAI and ASDAS-ESR scores was statistically significant for all patients when considered together, as well as when Etanercept and Infliximab were considered separately (p<0.0001 in all cases). However, there was no statistically significant difference in the magnitude of reduction in the mean BASDAI and ASDAS-ESR scores between patients who received Etanercept and those who received infliximab (p=0.696 and 0.618 respectively). CONCLUSION: Etanercept and Infliximab offer statistically similar reduction in disease severity in Asian Indian AS patients with NSAID failure. Further studies with larger sample size are warranted.
