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The metabolic changes attributable to diabetes are due to both deficiency of insulin as well as excess glucagon (GC). The glucagon receptor (GCGR) is a G protein-coupled receptor. GC is predominantly found in the liver. GC exerts its action both at the GCGR and the glucagon-like peptide receptor (GLP1R). Knockout studies as well as human mutation analysis have indicated therapeutic potential as well as concerns of modulation of the GCGR as a potential target for diabetes therapies. Three approaches to GCGR antagonism--small molecules, monoclonal antibodies, and antisense oligonucleotides--have demonstrated an impressive reduction in HbA1C in preclinical and clinical studies. However, adverse events such as an increase in weight cholesterol liver enzymes and alpha cell hyperplasia have stalled further clinical development. On the other hand, balancing the hyperglycemic effect of glucagon and retaining their beneficial effects, especially with weight loss and decrease in weight loss and hepatic steatosis by use of unimolecular coagonists with GLP1 and GIP have shown considerable promise in clinical trials. [ABSTRACT FROM AUTHOR]

(1) Background: There is a high burden of poor glycemic control in the Indian population with type 2 diabetes mellitus (T2DM). Currently, the use of metformin sustained-release (SR)–vildagliptin fixed-dose combination (FDC) is very low as compared to metformin immediate-release (IR)–vildagliptin FDC which is associated with higher adverse events (AEs). Here, we present real-world effectiveness of metformin SR–vildagliptin FDC treatment in patients with T2DM; (2) Methods: This retrospective analysis was carried out from the medical records of adult T2DM patients visiting a single study center in India (December 2020–February 2021). A total of 10 patients (aged ≥20 years) were treated with vildagliptin 50 mg and metformin SR 500 mg FDC for 15 days. The treatment response was assessed by the percentage of time spent in the target glucose range (TIR at baseline and 15 days after treatment); (3) Results: The glycated hemoglobin (HbA1c) levels at baseline varied between 6.5% to 12%. The glycemic control improved in 70% of patients (mean increase in TIR: 18.9%). Treatment adherence was 100%. No gastrointestinal symptoms or AEs were reported; (4) Conclusions: Early intervention with metformin SR–vildagliptin FDC in patients with T2DM can ensure therapy compliance in terms of superior efficacy along with safety and tolerability. Key summary points: Early initiation of combination therapy helps in early achievement of glycemic goals; Early initiation of metformin and vildagliptin FDC results in significant glycemic control with good tolerability and compliance; Metformin SR–vildagliptin FDC has lower adverse events, compared to metformin IR–vildagliptin FDC; A case series of ten patients with T2DM treated with metformin SR–vildagliptin FDC is presented to assess the real-world effectiveness of this combination. [ABSTRACT FROM AUTHOR]

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists. [ABSTRACT FROM AUTHOR]

Chronic inflammation is implicated in the pathophysiology of type 2 diabetes (T2D), and therefore targeting inflammation may ameliorate diabetes, slowing its progression and complications. HCQ, an anti-inflammatory agent used since several decades in rheumatology, is approved in India for the management of T2D. We assessed the real-life safety and effectiveness of HCQ in 95 T2D patients uncontrolled on 2 or more OHAs with or without insulin. HCQ was started only in patients with normal retina on fundoscopy, which was repeated again within 52 weeks. Mean duration of diabetes was 9.09 years; 51 and 38 patients were receiving statins and anti-hypertensives, respectively at baseline. There was a reduction in A1c and other glycemic parameters at Week 12 and week 24 from baseline. Total cholesterol and LDL also reduced with HCQ use. Mean body weight reduced from 73.59 kg at baseline to 72.84 kg at Week 24. Reassuringly, there were no cases of HCQ-induced retinopathy in any of the patients followed till week 52; 1 patient was detected with mild NPDR at week 12 and drug was discontinued. Of the 12 AEs reported, 11 were mild in intensity and unlikely related to HCQ. There was no incidence of derangement in hepatic or renal parameters. Thus, HCQ could be a well-tolerated and effective therapeutic option for patients with T2D uncontrolled on 2 or more OHAs. Long term data for safety and efficacy of HCQ needs to be studied from other centers too. Disclosure: M.S. Chawla: Speaker's Bureau; Self; Abbott, Alkem Laboratories, AstraZeneca, Biocon. Speaker's Bureau; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Glenmark Pharmaceuticals Limited, Lupin Pharmaceuticals, Inc., Novartis AG, Novo Nordisk A/S. Speaker's Bureau; Spouse/Partner; Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; Sanofi, Serdia Pharmaceuticals (India) Pvt. Ltd. P.M. Chawla: Speaker's Bureau; Spouse/Partner; Abbott, Alkem Laboratories, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, Lupin Pharmaceuticals, Inc. Speaker's Bureau; Self; Novo Nordisk A/S. Speaker's Bureau; Spouse/Partner; Novo Nordisk A/S. Speaker's Bureau; Self; Sanofi. Speaker's Bureau; Spouse/Partner; Sanofi. A. Sayyed: None. A. Shah: None. N. Murthy: None. [ABSTRACT FROM AUTHOR]

The scientific utility of Self-Monitoring of Blood Glucose (SMBG) has been recently challenged by scientific reports. Therefore, we aimed to understand the utility of FGM in Indian setting. FGM is a standard care of practice at our center to deliver effective metabolic care. We analyzed the FGM reports (Libre Pro) from the LINA cohort (n=102; males 67, females 35), to understand the impact of measures adopted for glycemic control. We compared the baseline HbA1c with the repeat HbA1c when the patients reported for at least one follow-up within six months, of undergoing the FGM and being recommended changes in lifestyle with appropriate therapeutic changes, on the basis of FGM findings. Statistical analysis was performed by student t test. The mean age was 60 years (SD±13, 95% CI 57-62). Mean duration of diabetes 13 years (SD±9.2, 95% CI 11-15). The mean baseline HbA1c 8.5% (SD±1.5, 95% CI 8.2-8.8) significantly reduced to mean HbA1c 8% (SD±1.4, 95% CI 7.7-8.3) (p=0.144). Mean reduction in HbA1c was -0.5% (SD±1.4, 95% CI -0.78 to -0.22). Out of 102 patients for HbA1c comparison for change in HbA1c, 68 reported reductions in HbA1c of which 47 (69%) reported HbA1c reductions greater than 0.5%. We corroborated the reported estimated HbA1c (eHbA1c) from Libre Pro with conventional HbA1c reports at follow-up. The higher mean difference in HbA1c of 0.82%, does not justify the utility of eHbA1c in FGM. This often is a misleading tool and a deterrent to efficacious glycemic care. The greater adoption of FGM in our setting empowered patients to choose a healthy lifestyle and the health care professionals to judiciously customize the therapy, with reduction in glycemic variability and increasing the time in range. The rationality of the utility of eHbA1c, which has been questioned in our real-world data, need to be addressed through a higher level of evidence by a larger, nation- wide prospective multicentric study. Disclosure: M. Chawla: None. P.M. Chawla: None. A. Shah: None. [ABSTRACT FROM AUTHOR]

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk.pThis article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists' recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient's glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient's postprandial glycemic expression and whether their food intake meets the Child-Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux., (© Journal of the Association of Physicians of India 2011.)

Background: Lifestyle modification, along with medication, has improved the quality of life of patients with type 2 diabetes (T2D), but the treatment of diabetes in women still lacks a gender-centric approach., Methods: Expert opinions to improve diabetes management in women were collated from the open discussion forum organized by the sixth Jothydev's Professional Education Forum Diabetes Convention, which included global diabetes care experts and the general public. The review is also based on the studies published in electronic databases such as PubMed and Google Scholar that discussed the problems and challenges faced by the Indian diabetes care sector in treating women with diabetes., Results: The complex interplay of biological, socioeconomic, psychosocial, and physiological factors in women with type 2 diabetes has not been well addressed to date. Biological factors such as neurohumoral pathways, sex hormones, genetic predisposition as well as gender-based environmental and behavioural differences must be considered for modern personalized diabetes treatment. Most importantly, pregnant women with diabetes deserve special attention. This vulnerable phase has a marked impact on the future health of both the mother and the offspring., Conclusion: The review provides an overview of the challenges and issues that exist in the clinical management of diabetes and its complications among women in India. Women-centric clinical approaches should be encouraged for the effective management of diabetes in Indian women., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)