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Aims: Despite their established benefits, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remain underutilized for type 2 diabetes mellitus (T2DM) management, which indicates that subcutaneous injection is an unfavorable mode of delivery from the patient's perspective. This review summarizes existing challenges related to medication adherence and the use of antihyperglycemia injectables, revisits the established safety and efficacy of oral semaglutide, and explores its features and considerations for use among the Indian T2DM population., Methods: We performed a literature search using MEDLINE and the National Institutes of Health Clinical Trials Registry from July 1, 2016, to July 1, 2021, to identify publications on oral semaglutide approval, T2DM treatment guidelines, and clinical evidence for oral drug formulation., Results: Oral semaglutide is the first oral GLP-1 RA approved for T2DM patients based on phase 3, randomized PIONEER trials. The multitargeted action of this drug offers glycemic control, weight control, and cardiovascular, renal, and additional benefits, including patient convenience and enhanced medication adherence. In addition to achieving glycemic control, the cost of semaglutide is reported to be lower than other GLP-1 RA in the West, thus potentially mitigating the economic burden that appears to be high among the Indian population., Conclusions: Currently, there is no data available on oral semaglutide in Indian clinical settings. However, significant improvements in glycemic control, cardiac and renal benefits, as well as weight loss across clinical trials should encourage clinicians to prioritize oral semaglutide over other antidiabetic agents., Competing Interests: Declaration of competing interest VM acted as consultant and speaker, received research or educational grants from Novo Nordisk, Johnson & Johnson, USV Private Limited, Abbott, Biocon, Astra Zeneca, Boehringer Ingelheim, Dr. Reddy's Laboratories, LifeScan, Lilly, MSD, Novartis, Roche Diabetes Care India Pvt. Ltd, Sanofi-Aventis, and other Indian pharmaceutical companies. AGU, AKS, GB, and JK received honoraria from Novo Nordisk. SJ, AD, BS, and SG received speaker honoraria from Novo Nordisk for conducting medical education lectures. No potential conflict of interest was reported by SC and RR. Novo Nordisk neither influenced the content of this publication nor was it involved in the study design, data collection, analysis, interpretation, or review., (Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: As the Coronavirus disease 2019 (COVID-19) pandemic unravels rapidly, there is a glut of confusing and divergent scientific information emanating from differing sources, including the Indian National Task Force for COVID-19. Thus, a web-based survey was conducted to decipher the approach of Indian doctors to the various options for treatment of COVID-19., Methods: A web-based questionnaire among one lakh doctors across India through email and social media was circulated. After data quality and internal validation, 826 responses were included for analysis. Basic demographic and comparative analysis were performed using the Python3.8.2 software (Windows 10 64 bit, USA)., Results: Amongst all the states of India most respondents hailed from the top ten affected states. Overall 76.15% of doctors would either prescribe or consider prescribing hydroxychloroquine (HCQ) as prophylaxis for health-care providers (HCP). Doctors with experience of managing COVID-19 were more likely to advocate use of HCQ as prophylaxis for HCP (χ2 = 4.357, P = 0.037). Intensivists were more likely to advocate HCQ as prophylaxis (χ2 = 14.588, P < 0.001) as well as for management of mild to moderate COVID-19 (χ2 = 3.91, P = 0.048). In COVID-19, 65.8% doctors overwhelmingly preferred using anti-viral agents in severe cases, continuing ACEi/ARB (60.9%), and routinely screening for COVID-19 as a pre-operative strategy (73.85%)., Conclusions: Indian doctors are largely following the scientific guidance provided by Indian National Task Force for COVID-19 and would consider prescribing HCQ as prophylaxis for COVID-19. They would also consider using it in mild to moderate COVID-19., Competing Interests: Declaration of competing interest The authors do not have any conflict of interest to declare for this article., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Lockdown due to the Coronavirus disease 2019 (COVID 19) pandemic may cause weight gain and enhance the risk of type 2 diabetes mellitus (T2DM). We aimed to determine this risk in apparently non-diabetic individuals., Material Methods: Baseline demographic and clinical data from 100 apparently non-diabetic household members (related or unrelated) of patients with type 2 diabetes mellitus were collected until 49 days of lockdown and analyzed using the XL-STAT statistical software. A two-pronged analytical strategy was employed. First, the metabolic risk profile related to age, sex, weight, family history, and exercise pattern was analyzed. This was followed by an assessment of the risk of developing type 2 diabetes using an established risk assessment engine., Results: There was a trend towards weight gain seen in 40% of the cohort, with 16% of the population experiencing a 2.1-5 kg weight increment. When all the risk parameters were analyzed together using the ADA risk engine, there was an increase in the ADA diabetes risk score in 7% of the population, with 6.66% in the high-risk group. There was a further increase in weight among 3% of the population who were already obese at baseline., Conclusion: We show an increased risk of T2MD consequent to weight gain during 49 days of lockdown in India., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Introduction: and Aims: No valid treatment or preventative strategy has evolved till date to counter the SARS CoV 2 (Novel Coronavirus) epidemic that originated in China in late 2019 and have since wrought havoc on millions across the world with illness, socioeconomic recession and death. This analysis was aimed at tracing a trend related to death counts expected at the 5th and 6th week of the COVID-19 in India., Material and Methods: Validated database was used to procure global and Indian data related to coronavirus and related outcomes. Multiple regression and linear regression analyses were used interchangeably. Since the week 6 death count data was not correlated significantly with any of the chosen inputs, an auto-regression technique was employed to improve the predictive ability of the regression model., Results: A linear regression analysis predicted average week 5 death count to be 211 with a 95% CI: 1.31-2.60). Similarly, week 6 death count, in spite of a strong correlation with input variables, did not pass the test of statistical significance. Using auto-regression technique and using week 5 death count as input the linear regression model predicted week 6 death count in India to be 467, while keeping at the back of our mind the risk of over-estimation by most of the risk-based models., Conclusion: According to our analysis, if situation continue in present state; projected death rate (n) is 211 and467 at the end of the 5th and 6th week from now, respectively., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Introduction and Aims: Retarding the spread of SARS-CoV-2 infection by preventive strategies is the first line of management. Several countries have declared a stringent lockdown in order to enforce social distancing and prevent the spread of infection. This analysis was conducted in an attempt to understand the impact of lockdown on infection and death rates over a period of time in countries with declared lock-down., Material and Methods: A validated database was used to generate data related to countries with declared lockdown. Simple regression analysis was conducted to assess the rate of change in infection and death rates. Subsequently, a k-means and hierarchical cluster analysis was done to identify the countries that performed similarly. Sweden and South Korea were included as counties without lockdown in a second-phase cluster analysis., Results: There was a significant 61% and 43% reduction in infection rates 1-week post lockdown in the overall and India cohorts, respectively, supporting its effectiveness. Countries with higher baseline infections and deaths (Spain, Germany, Italy, UK, and France-cluster 1) fared poorly compared to those who declared lockdown early on (Belgium, Austria, New Zealand, India, Hungary, Poland and Malaysia-cluster 2). Sweden and South Korea, countries without lock-down, fared as good as the countries in cluster 2., Conclusion: Lockdown has proven to be an effective strategy is slowing down the SARS-CoV-2 disease progression (infection rate and death) exponentially. The success story of non-lock-down countries (Sweden and South Korea) need to be explored in detail, to identify the variables responsible for the positive results., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Introduction: and aims: To prevent the spread of coronavirus disease (COVID19) total lockdown is in place in India from March 24, 2020 for 21 days. In this study, we aim to assess the impact of the duration of the lockdown on glycaemic control and diabetes-related complications., Materials and Methods: A systematic search was conducted using Cochrane library. A simulation model was created using glycemic data from previous disasters (taken as similar in impact to current lockdown) taking baseline HBA1c and diabetes-related complications data from India-specific database. A multivariate regression analysis was conducted to analyse the relationship between the duration of lockdown and glycaemic targets & diabetes-related complications., Results: The predictive model was extremely robust (R2 = 0.99) and predicted outcomes for period of lockdown up to 90 days. The predicted increment in HBA1c from baseline at the end of 30 days and 45 days lockdown was projected as 2.26% & 3.68% respectively. Similarly, the annual predicted percentage increase in complication rates at the end of 30-day lockdown was 2.8% for non-proliferative diabetic retinopathy, 2.9% for proliferative diabetic retinopathy, 1.5% for retinal photocoagulation, 9.3% for microalbuminuria, 14.2% for proteinuria, 2.9% for peripheral neuropathy, 10.5% for lower extremity amputation, 0.9% for myocardial infarction, 0.5% for stroke and 0.5% for infections., Conclusion: The duration of lockdown is directly proportional to the worsening of glycaemic control and diabetes-related complications. Such increase in diabetes-related complications will put additional load on overburdened healthcare system, and also increase COVID19 infections in patients with such uncontrolled glycemia., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Both screen time and metabolic syndrome (MetS) are associated with health outcomes. However, limited data exist on the association between screen time and MetS among expatriate adolescents living in United Arab Emirates (UAE)., Methods: We conducted a cross-sectional school-based study on 473 expatriate adolescents (47% girls) aged 12-18 years in Al-Ain district of Abu Dhabi Emirates in the UAE. Data was collected with the expertise of trained nurses & IDF criteria was used to define MetS. Information on screen time (computer, television, and video game use combined) during a regular day was self-reported, and divided into two categories: <2, or ≥2 h per day. Using logistic regression analyses, adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between screen time and MetS., Results: A high proportion of adolescents (75.3%) spent ≥2 h daily on screen. The prevalence of MetS was 8.5% in those with <2 h per day of screen time compared with 13.5% in those who reported ≥2 h per day. There was a graded positive association between screen time and MetS (P-trend = 0.01). Each hour increase in screen time was associated with 21% (OR, 1.21; 95% CI, 1.08-1.35) greater likelihood of having MetS. The adjusted OR value associated with ≥2 h of daily screen time was 2.20 (95% CI, 1.04-4.67), compared with adolescents who spent less than 2 h of daily screen time., Conclusion: Higher screen time by expatriate adolescents was associated with increased likelihood of having MetS., (Copyright © 2019. Published by Elsevier Ltd.)

Lipid modification holds the key to effective secondary prevention of cardiovascular disease (CVD). However there is a controversy on whether it's all about targeting specific lipid sub fractions to a particular level or a direct effect of the agent(s) used or both. This review intends to look into these important issues from an evidence-based perspective. What is the appropriate timing of testing for lipid profile after a cardiovascular event? What is the rationale behind initiating with a high dose statin after an acute coronary event? What is the role of targeting lipid sub fractions beside LDL cholesterol? Is there any role for non-statin based therapy after an acute cardiovascular event? What constitutes a long-term lipid modification strategy in patients post CVD? These are very important questions, which needs to be addressed adequately as well as scientifically. The secondary CVD preventive strategies form a lipid perspective, which requires a thorough review., (Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare the changes in various glycemic parameters in insulin-naïve type 2 diabetes mellitus (DM) patients who were initiated on insulin glargine or insulin degludec in a real world setting., Methods: Retrospective data were analyzed in consecutive type 2 DM patients in a real world setting, who failed oral therapy (at least 2 oral anti-diabetic drugs) and were initiated with either insulin glargine or insulin degludec. The parameters assessed were the changes in HbA1c, fasting plasma glucose, body weight, dose of Insulin and the total number of patient reported hypoglycemic episodes up to 6 months after initiation., Result: At baseline, insulin glargine and insulin degludec groups were similar in terms of gender, age, weight, HbA1c and duration of diabetes. After 6 months follow up the change in HbA1c (-1.09 versus -1.45 P=0.124), change in FPG (-72.81mg/dl [-4mmol/L] versus -75.88mg/dl [-4.2mmol/L] P=0.755), and the change in body weight (+1.65 versus +0.85 P=0.082) were similar in glargine and degludec groups, respectively. Patients in insulin degludec group experienced significantly lesser patient reported hypoglycemic episodes (12 versus 40) and required significantly lesser dose (25.68Units versus 18.61Units per day; P=0.002) compared to insulin glargine. 41% of the patients reached HbA1C target of ≤7% with insulin glargine compared to 69% with insulin degludec within the specified time period., Conclusion: Results from this real world analysis suggest that among type 2 DM patients who were initiated on insulin degludec as compared to insulin glargine may be associated with significantly lesser patient reported hypoglycemic episodes and lesser dose of insulin while achieving similar glycemic control. This study is however limited by the retrospective nature of the data collection., (Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Hypoglycemia is an established complication of diabetes management. It has been related to numerous adverse outcomes including dementia, falls, cognitive dysfunction, coma, cardiovascular and cerebrovascular events and many more. Of all these adverse cardiovascular outcomes is the most discussed and reported complication related to hypoglycemia. There have been several mechanistic case reports and retrospective data linking hypoglycemia with adverse CVD outcomes. However, hard-core cause and effect relationship remains elusive. This review looks into the available data and where we stand as of now on this issue of hypoglycemia and adverse CVD outcomes., (Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

In the month of June 2013 the Government of India suddenly suspended three drugs for use. The suspension of the anti-diabetic agent came as a rude shock to the medical community who has been utilizing this insulin sensitizer for more than a decade. We took a close look at the controversies surrounding this agent, the current state in the global scenario and how India has reacted in this mini review. Like most of the drugs utilized in the management of medical disorders pioglitazone also has been under the scanner for quite some time. However no definitive cause and effect association with any of the adverse events namely bladder cancer, anemia, fractures and heart failure was found. The international community responded with caution and refrained from banning the drug outright except for France. The ban in India in the absence of incriminating data on the Indian population seems out of place., (Copyright © 2014. Published by Elsevier Ltd.)

Over the last few years a number of important drugs like rofecoxib, rosiglitazone, gatifloxacin (in diabetics) have lost their position in disease management. The newest controversy revolves around Pioglitazone, a thiozolidindione, which improves insulin sensitivity and is reputed to have cardioprotective actions, but is riddled with several controversies related to weight gain, distal fractures of long bones, recent reports of bladder cancer and others. There are now new groups of drugs, which have been introduced with stringent FDA approval. These include DPP-4 inhibitors, GLP-1 analogues and bromocriptine (old wine in a new bottle). Early in 2013 we are also looking at the launch of another new agent - SGLT-2 inhibitors. These newer agents are associated with not only a significant glucose lowering effect but also positive extra-glycaemic benefits principally in the areas of hypoglycaemia and weight gain. This raises a very important question - do we really need such a controversial agent when such a plethora of agents are available to us with possibly better metabolic profile than pioglitazone? This review addresses this highly contentious area dissecting the pros and cons as we see it., (Copyright © 2013. Published by Elsevier Ltd.)

Over the last few years a number of important drugs like rofecoxib, Rosiglitazone, and Gatifloxacin (in diabetics) have lost their position in disease management. The newest controversy revolves around Pioglitazone, a thiozolidindione, which improves insulin sensitivity and is reputed to have cardioprotective actions, but is riddled with several controversies related to weight gain, distal fractures of long bones, recent reports of bladder cancer and others. There are now new groups of drugs, which have been introduced with stringent FDA approval. These include DPP-4 inhibitors, GLP-1 analogues and bromocriptine (old wine in a new bottle). Early in 2013 we are also looking at the launch of another new agent--SGLT-2 inhibitors. These newer agents are associated with not only a significant glucose lowering effect but also positive extra-glycemic benefits principally in the areas of hypoglycemia and weight gain. This raises a very important question--do we really need such a controversial agent when such a plethora of agents are available to us with possibly better metabolic profile than Pioglitazone? This review addresses this highly contentious area dissecting the pros and cons as we see it., (Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Aims: The aim was to compute a normative data of VPT [Vibration Perception Threshold], compare results of VPT among type 2 diabetes patients with and without neuropathy, validate VPT taking NDS [Neuropathy Disability Scores] as gold standard and suggest a cut off value for the Indian population., Materials and Methods: A clinic based case-control study was conducted at Nightingale Hospital (NH) in Kolkata for 2 months duration. Fifty type 2 diabetes patients (who were detected with by fasting plasma glucose or on medication) reporting at OPD (Out Patent Department) were randomly selected and informed consent was obtained. The age range was 20-65 years and other common causes of neuropathy were excluded. Same number of control patients without diabetes and reporting at the same hospital during the study period in the similar age range were selected., Results: The normative data of VPT for mean of 4 sites (malleoli and great toe) was 11.3±4.9mV. The VPT value was significantly higher among diabetic patients with neuropathy compared to non-neuropathic and non-diabetic patients. Considering NDS score as gold standard lowering the cutoff value of VPT from 25mV to 20mV increased the sensitivity from 50% to 62.5% in detecting diabetic neuropathy compared to NDS taken as a gold standard., Conclusions: It was found that lowering the cut off value of VPT in Indian population increased the sensitivity of the test to detect diabetic neuropathy without hampering the specificity. There is however no indication that a lower cut off VPT value is justified as of now., (Copyright © 2012 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Recent publications indicate a possible association between newer analogue insulin Glargine and cancer. However all these data were observational in nature and subject to lot of methodological errors. It is practically impossible to derive at a cause and effect relationship based on these observational studies. There are several confounding factors like hyperinsulinemia, obesity and smoking, which independently can be associated with cancer risk. This review looks into the recently published observational studies from the methodological point of view and whether such a negative association can indeed be drawn as a conclusion. Several methodological defects were identified in the process of scrutiny and we concluded it is not possible to conclude that there is an association between Glargine use and cancer. However long-term prospective data is required to come to definite conclusion., (Copyright © 2012 Diabetes India. Published by Elsevier Ltd. All rights reserved.)