A prospective, multicentre, randomized, open-label comparison of a long-acting basal insulin analog glargine plus glulisine with premixed insulin in insulin naïve patients with Type 2 diabetes - A study from India.

AIMS: We aimed to compare the effectiveness of Glargine plus Glulisine to premixed insulin analogue, as measured by HbA1c ≤ 7.0% in insulin naive Type 2 Diabetes (T2D) patients with elevated fasting and/or postprandial plasma glucose. METHODS: Insulin-naive T2D patients (116 men, 84 women) on ≥ 2 oral hypoglycemic agents with inadequate glycemic control were randomized either to group 1 (insulin Glargine plus Glulisine, n = 101) or group 2 (Premixed Insulin analogue, n = 99). RESULTS: In the intention to treat analysis, at week 24, percentage of patients with good glycaemic control (HbA1c ≤ 7.0%) was similar between the two groups (16.8% in Group 1 vs. 13.1% in Group 2, χ2 - 0.535, p = 0.47). Significant reductions in fasting and postprandial levels were observed in groups 1 and 2 at both post-baseline time points (Week 12 and 24). In group 1, reduction in HbA1c from baseline to week 12 was 0.6 ± 0.1 and 0.7 ± 0.2 at week 24, p < 0.0001 for all. In group 2, no significant change in HbA1c was observed. In group 1, 83.2% required an additional dose of glulisine and in group 2, 88.9% required an additional dose of premixed insulin. Hypoglycemic events were similar in both groups (0.12 events per person-year in group 1 and 0.13 events per person-year in group 2). Weight gain was non-significant in both groups. CONCLUSIONS: Glargine plus Glulisine, though in higher dose was effective as premixed insulin in lowering HbA1c. Hypoglycemic events per person-year were similar in both groups.

Improvement in glycaemic control in patients with type 2 diabetes with treatment using an interactive mobile application - A pilot study from India.

AIMS: We studied the outcome of glycaemic management using Diahome, a smart-phone application compared to conventional treatment. Overall acceptability of the application among users was also assessed. METHODS: This is a retrospective, case-control study of patients on virtual diabetes care using the Diahome app (n = 441) and those visited the hospital out-patient services (n = 446) between April and June 2021. Men and women aged 45-60 years with type 2 diabetes (T2DM) were selected. RESULTS: A total of 173 records with initial and follow-up visits were analyzed (app users n = 91, non-app users n = 82). Participants were aged 59 ± 12 years and were obese. The two groups were similar by age, gender distribution and duration of T2DM. Fasting blood glucose significantly reduced only among the app-users from a baseline level of 156 ± 70 mg/dl to 129 ± 40 mg/dl at follow-up (p < 0.02). Reduction in HbA1c levels was observed in both groups (p < 0.0001); percentage improvement was better among app (15.8%) than in non-app users (10.4%), p = 0.004. Triglycerides level were higher at both time points among app-users (p < 0.05) as compared to the other group. More than 56% of the users rated the performance of Diahome app as excellent; virtual consultation was rated the highest (71.5%) among the Diahome services. DISCUSSION: Glycaemic management of diabetes using a dedicated mobile application was superior to in-person hospital visits. Its long-term effectiveness and cost savings need to be ascertained.

Serum and salivary adipokines in type 2 diabetes - Results of a pilot study in India.

BACKGROUND AND AIMS: Association of serum and salivary adiponectin, apelin, visfatin and vaspin were studied in type 2 diabetes (T2DM) among Asian Indians. Their concentrations in periodontitis were also studied. METHODS: In this cross-sectional analysis, men and women aged ≥35 years, with no history of diabetes, were screened for ≥3 risk factors for T2DM (n = 615). Eligible persons underwent a 75 gm oral glucose tolerance test and were categorized as Group A (Normal and Impaired Glucose Tolerant, n = 65) and Group B (Incident T2DM, n = 25). Screening for periodontitis was done. Saliva samples were collected in the morning. Participants refrained from food intake for about 2 hours prior to collection . Serum and saliva were stored for analysis. RESULTS: Serum adiponectin was low (p = 0.006) in T2DM and correlated with its salivary levels (r = 0.46, p < 0.001). Serum apelin levels were similar, but salivary concentrations were higher (p = 0.014) in T2DM. Higher serum (p = 0.016) and salivary (p = 0.03) visfatin levels were seen in T2DM. Vaspin levels showed no significant difference in the two groups, either in blood or saliva. Serum adipokines did not differ in the presence of periodontitis. In saliva, higher vaspin (p = 0.034) and lower visfatin (p = 0.018) concentrations were observed. CONCLUSIONS: The selected adipokines were measurable in saliva, in lower concentrations. Salivary adiponectin and visfatin measurements may be useful in studies on T2DM.

Concordance in incidence of diabetes among persons with prediabetes detected using either oral glucose tolerance test or glycated haemoglobin.

AIMS: To study the concordance in the incidence of type 2 diabetes (T2DM) between cohorts with prediabetes, selected either by oral glucose tolerance test (OGTT) or glycosylated haemoglobin (HbA1c) at two years in a real world situation. METHODS: Two cohorts with impaired glucose tolerance (IGT) were selected from the non-interventional arm of the Indian diabetes prevention programmes; a group selected by using OGTT (Cohort 1, n = 498), another selected based on the HbA1c criterion (Cohort 2, n = 504). Clinical and biochemical data collected for 24 months at 6 monthly intervals were used in assessing the cumulative incidence of T2DM using the respective diagnostic criteria. Intra and inter group comparisons were analysed using appropriate statistical tests. A multiple logistic regression analysis was used to identify the variables significantly associated with the incidence of diabetes. RESULTS: Incidence of diabetes in both cohorts were similar at 12 and 24 months with either of the two criteria (25.3% with glucose and 27.5% with HbA1c, p = 0.41 at 24 months). The multivariate analysis confirmed the results. Only baseline waist circumference was positively associated with the incidence. CONCLUSION: Both OGTT and HbA1c have similar utility and validity in identifying persons with IGT. Persons identified with either of the criterion had similar incidence of T2DM among Asian Indians.

Trend in the clinical profile of type 2 diabetes in India - Study from a diabetes care centre in South India.

BACKGROUND AND AIM: Study the changing clinical and therapeutic profiles of type 2 diabetes (T2D) patients during a 10-year period in a diabetes care centre in Southern India. METHODS: Retrospective, cross-sectional data of newly registered and review patients at four periods between 2009 and 2018 were analysed (n = 50,322). Clinical findings, anthropometry, blood pressure (BP), glycaemia, lipids, treatment, and co-morbid conditions were analysed. We studied the trends in age and gender distributions, body mass index (BMI), glycaemia, (Glycosylated haemoglobin A1c (HbA1c) levels), BP, cholesterol, triglycerides and therapeutic regimen during this period. Trend analyses were done. RESULTS: Approximately 60% of patients were men. Percentages in 30-40 years increased, ∼60% were aged 50-69 years and proportion of older patients decreased (p < 0.0001). In 10 years, 85.9% was overweight, obesity increased from 22.1% to 25.0% (p < 0.0001) and <13% maintained normal BMI. HbA1c <7.0% remained approximately at 22%, percentage with moderate glycaemic control (HbA1c 7.0-7.9%) increased significantly, HbA1c of ≥9.0% decreased from 35.1% to 29.1% (p < 0.0001). Use of monotherapy decreased. Prevalence of hypertension increased from 16.2% to 21.6% (p < 0.0001); use of Angiotensin Receptor Blockers (ARB) and calcium channel blockers increased, Angiotensin Converting Enzyme Inhibitors and thiazides decreased (p < 0.0001). Increased use of statins paralleled with reduction in total cholesterol and LDLc. CONCLUSION: Increasing percentages of younger patients and obesity, use of multiple drugs and reduction in HbA1c were the important observations. Rising prevalence of hypertension, increased use of ARB and statins with better control of dyslipidaemia was observed. Achievement of ideal HbA1c and BP were suboptimal.