The LongitudinAl Nationwide stuDy on Management And Real-world outComes of diabetes in India over 3 years (LANDMARC trial).

INTRODUCTION: LANDMARC (CTRI/2017/05/008452), a prospective, observational real-world study, evaluated the occurrence of diabetes complications, glycemic control and treatment patterns in people with type 2 diabetes mellitus (T2DM) from pan-India regions over a period of 3 years. METHODS: Participants with T2DM (≥25 to ≤60 years old at diagnosis, diabetes duration ≥2 years at the time of enrollment, with/without glycemic control and on ≥2 antidiabetic therapies) were included. The proportion of participants with macrovascular and microvascular complications, glycemic control and time to treatment adaptation over 36 months were assessed. RESULTS: Of the 6234 participants enrolled, 5273 completed 3 years follow-up. At the end of 3-years, 205 (3.3%) and 1121 (18.0%) participants reported macrovascular and microvascular complications, respectively. Nonfatal myocardial infarction (40.0%) and neuropathy (82.0%) were the most common complications. At baseline and 3-years, 25.1% (1119/4466) and 36.6% (1356/3700) of participants had HbA1c <7%, respectively. At 3-years, population with macrovascular and microvascular complications had higher proportion of participants with uncontrolled glycemia (78.2% [79/101] and 70.3% [463/659], respectively) than those without complications (61.6% [1839/2985]). Over 3-years, majority (67.7%-73.9%) of the participants were taking only OADs (biguanides [92.2%], sulfonylureas [77.2%] and DPP-IV inhibitors [62.4%]). Addition of insulin was preferred in participants who were only on OADs at baseline, and insulin use gradually increased from 25.5% to 36.7% at the end of 3 years. CONCLUSION: These 3-year trends highlight the burden of uncontrolled glycemia and cumulative diabetes-related complications, emphasizing the importance of optimizing diabetes management in India.

Pathological feature of a giant ileal Meckel's diverticulum with ectopic gastric mucosa.

The ileum generally works well, whereas Meckel's diverticulum (MD) has complications including bleeding, obstruction, intussusception, diverticulitis, and perforation. Our knowledge of the pathological features of the MD muscular layer and mucosa is limited. We report a rare case of giant MD that was diagnosed by double-balloon enteroscopy (DBE). The pathological features of the mucosa were evaluated by investigation for Helicobacter pylori; and the nuclear proliferation antigen Ki-67, the gastrointestinal cancer-associated biomarker TRAK1, synaptophysin, and neurofilament were used to precisely define the mucosa and neuronal and ganglion cell components. The pathophysiology of MD is discussed and a literature review is presented. We believe that this is the first report of a systematic histochemical analysis of the mucosa and myenteric plexus of MD and the normal ileum. The present investigation may provide novel evidence of pathological abnormalities resulting in the complex complications of MD.