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Digital healthcare is on the rise. Paucity of clinical data exists on the efficiency and effectiveness of the applications in diabetes management. We compared glycaemic outcomes at 4 months among type 2 diabetes (T2DM) patients opting virtual care using Diahome® app and in-person hospital visits. Data of 173 (91 app-users, 82 non app-users) were analysed. The two groups were similar by age, gender distribution and duration of T2DM. At follow-up, fasting plasma glucose significantly reduced among app-users alone (156 ± 70 vs.129 ± 40 mg/dl, p Disclosure A.Raghavan: None. A.Nanditha: None. K.Satheesh: None. P.Susairaj: None. R.Vinitha: None. D.Nair: None. S.Jeyaraj: None. V.Sharad: None. A.Ramachandran: None.

This ancillary analysis (STRIDE-I study) compares the prevalence ratio (PR) of type 2 diabetes (T2DM) in persons aged ≤40 and >40 years in 20 and 2016 in Southern India. In 2016, prevalence of T2DM, generalized and abdominal obesity increased in both groups (Table 1) . Hypertension and dyslipidaemia were higher among the older and younger population respectively. Higher intake of fat and protein increased the total calorie consumption in both groups. Sedentary time increased in the younger group in 2016. Poisson regression analysis (Table 2) showed an increase in the PR in 2016 in both groups. However, the increase was significantly higher in the younger group (30%) when compared to the older group (10%) . Disclosure A.Nanditha: None. P.Susairaj: None. A.Raghavan: None. K.Satheesh: None. R.Vinitha: None. D.Nair: None. C.Snehalatha: None. A.Ramachandran: None.

To study the association and possible predictive role of visfatin, resistin, fetuin-A and chemerin with incident type 2 diabetes (T2DM) among Asian Indians with prediabetes. Their association with insulin resistance, β-cell function, glycaemia and anthropometry were also studied. This is a nested case–control study of a large 2-year prospective prevention trial in persons at high risk of developing T2DM. Baseline HbA1c values between 6.0% (42 mmol/mol) and 6.2% (44 mmol/mol) were chosen for this analysis (n = 144). At follow-up, persons with incident T2DM (HbA1c ≥ 6.5%, 48 mmol/mol) were grouped as cases (n = 72) and those reverted to normoglycaemia, (HbA1c p p p p p p

Introduction: Among the oral mucosal infections such as Periodontal Diseases, (PD) there is a strong correlation between systemic metabolic conditions such as type 2 diabetes (T2D). Moreover, there is growing evidence that Diabetic Neuropathy (DN) is associated with increased risk for foot ulceration. However, little is known how DN would correlate with the PD status. Aim: The aim of this study was to determine how the diabetes status as exemplified by the state of HbA1c levels and DN would correlate with the status of PD. Materials and Methods: T2D patients with and without PD, who visited the dental department of a diabetes hospital were included in the study. Patients without PD (n = 494) and with PD (n = 493) were recruited based on probing depth of >4mm/clinical attachment loss of >3mm (mild to moderate PD) according to the diagnostic criteria of the American Academy of Periodontology. Body mass index, fasting blood glucose, postprandial blood glucose and HbA1c were measured. Neuropathy was assessed by biothesiometry. Results: There was a significant difference in the age, duration of diabetes, glycemic levels and presence of neuropathy between the 2 groups (Table). In the regression analysis, neuropathy was highly significant (p Conclusion: The study shows a strong association between PD and DN among T2D patients. Disclosure R. Vinitha: None. A. Ramachandran: None. M. Muthukuru: None. K. Satheesh: None. R. Yogalakshmi: None. A. Rajeswari: None. L. Sundar: None. A. Nanditha: None. A. Raghavan: None. C. Snehalatha: None. Funding India Diabetes Research Foundation

OBJECTIVE The objective of the current study was to assess the secular trends in the prevalence of diabetes, prediabetes, and risk factors from two epidemiological surveys done 10 years apart in three adult populations of different geographic and socioeconomic backgrounds in Tamil Nadu, India. RESEARCH DESIGN AND METHODS This survey was conducted in 2016 using methodology similar to that used in 2006. Persons aged ≥20 years (n = 9,848) were screened for diabetes, prediabetes, and the risk variables. Fasting and 2-h plasma glucose, lipid profile, blood pressure, anthropometry, and socioeconomic and behavioral details were recorded. Comparative analyses of age-standardized prevalence were done. Prevalence ratios (PRs) between 2016 and 2006 of diabetes and also prediabetes were assessed using Poisson regression analyses. RESULTS Prevalence of diabetes increased from 18.6% (95% CI 16.6–20.5) to 21.9 (20.5–23.3) in the city, 16.4 (14.1–18.6) to 20.3 (18.9–21.6) in the town, and 9.2 (8.0–10.5) to 13.4 (11.9–14.8) in the periurban villages (PUVs) (P < 0.0001 in all). The PR showed a nonsignificant 8% rise in diabetes in the city, while significant increases had occurred in the town (39%) and PUVs (34%). Prevalence of prediabetes also increased. Age, family history of diabetes, and waist circumference were common risk determinants among the populations. Though general obesity and abdominal obesity increased, the latter was associated with the increased prevalence. CONCLUSIONS Prevalence of diabetes and prediabetes increased in all locations; the rise was significant only in the town and PUVs. Abdominal obesity is significantly associated with increased trend even among the villagers. Rural populations may be targeted for future public health measures to combat diabetes.

Aim: To compare the effect of vildagliptin versus metformin on pancreatic beta-cell function among newly diagnosed, non-obese Asian Indians with type 2 diabetes (T2D) in 2 years. Methods: Randomized, multicentric, controlled, parallel-group study of 2 years treatment with vildagliptin or metformin in drug-naïve T2D persons (baseline HbA1c - 7.0 - 8.5% and body mass index (BMI) < 25kg/m2). Plasma glucose, insulin, HbA1c and C-peptide were measured at intervals of 6 months for 2 years. We randomised 203 (104 men and 99 women) T2D persons in two groups. Group 1 was treated with metformin, 500mg - 2000mg (n = 100), and group 2, with vildagliptin 100mg (n = 103). Results: In the metformin group 36% and in the vildagliptin group 27.2 % required only monotherapy for a median duration of 48 weeks (25 - 70 weeks). At the end of the study, changes in the area under the curve of insulin to glucose were non-significant in both groups. There were no changes in the postprandial C-peptide. Reduction in insulin resistance (HOMA-IR) was similar in both groups. Insulin sensitivity (Matsuda Index) increased significantly at 6 and 12 months with metformin but no change was seen in the vildagliptin group. The HbA1c level decreased significantly in both groups until 18 months. The fasting plasma glucose decreased significantly till 12 months in both groups. Postprandial plasma glucose decreased only with vildagliptin till 12 months. Occurrences of adverse events were similar in both groups. Higher C-peptide and lower HbA1c values at the baseline predicted better glycemic control with vildagliptin. Lower baseline HbA1c predicted good glycemic control with metformin. Conclusion: Both metformin and vildagliptin had similar protective effects on the beta-cell function, reduced insulin resistance and glycemic levels. Improved insulin sensitivity was seen with metformin. Disclosure K. Satheesh: None. C. Snehalatha: None. A. Nanditha: None. A. Raghavan: None. R. Vinitha: None. P. Susairaj: None. A. Ramachandran: None. Funding India Diabetes Research Foundation

The association of adiponectin, apelin, visfatin and vaspin with different glycaemic states (normal glucose tolerance (NGT), (impaired glucose tolerance (IGT) and type 2 diabetes (T2D)) and in the presence of periodontits were studied in saliva and blood (serum) samples. The utility of saliva and serum in measuring these adipokines was also compared. Prescreening was done to identify persons with ≥ 3 risk factors for T2D among; age 35 -55 years, overweight/obesity, high waist circumference, family history of T2D, hypertension or sedentary habits. They were then categorised as having no diabetes (NGT + IGT, Group A) and having diabetes (T2D, Group B) based on oral glucose tolerance test. Presence of periodontitis was assessed by a periodontist. Samples were analysed using ELISA. Of the 615 persons screened, 136 (22.1%) had 3 or more risk factors. Ninety (14.6%) persons (NGT (n = 48), IGT (n = 17) T2D (n = 25)) were enrolled. Concentrations of adipokines in groups A and B are presented in the table. Higher salivary vaspin and lower visfatin were observed in the presence of periodontitis. The utility of serum and saliva in the measurement of adipokines for diabetes vary considerably. In Asian Indians, lower adiponectin and higher visfatin in serum and increased salivary visfatin and apelin are useful biomarkers of diabetes, illustrating the involvement of inflammation in the pathogenesis of T2D. Disclosure R. Vinitha: None. K. Raghavan: None. V.K. Arun: None. P. Susairaj: None. A. Raghavan: None. A. Nanditha: None. K. Satheesh: None. C. Snehalatha: None. A. Ramachandran: None.

AIM: The increased morbidity and mortality due to type 2 diabetes can be partly due to its delayed diagnosis. In developing countries, the cost and unavailability of conventional screening methods can be a setback. Use of random blood glucose (RBG) may be beneficial in testing large numbers at a low cost and in a short time in identifying persons at risk of developing diabetes. In this analysis, we aim to derive the values of RBG corresponding to the cut-off values of glycosylated hemoglobin (HbA1c) used to define prediabetes and diabetes. METHODS: Based on their risk profile of developing diabetes, a total of 2835 individuals were screened for a large diabetes prevention study. They were subjected to HbA1c testing to diagnose prediabetes and diabetes. Random capillary blood glucose was also performed. Correlation of RBG with HbA1c was computed using multiple linear regression equation. The optimal cut-off value for RBG corresponding to HbA1c value of 5.7% (39 mmol/mol), and ≥ 6.5% (48 mmol/mol) were computed using the receiver operating curve (ROC). Diagnostic accuracy was assessed from the area under the curve (AUC) and by using the Youden's index. RESULTS: RBG showed significant correlation with HbA1c (r=0.40, p

Background and aims We studied the profile and outcome of patients hospitalized for coronavirus disease-19 (COVID-19) infection with and without type 2 diabetes (T2DM). Methods In this observational study, clinical details of patients with COVID-19, identified by Reverse Transcription – Polymerase Chain Reaction admitted to 4 hospitals in Chennai, Tamil Nadu, India were collected from May to November 2020. A total of 845 (n = 423 with diabetes, n = 422 without diabetes) were selected for the analysis. Clinical details, biochemical and radiological investigations, diabetes treatment, intensive care, mortality and other adverse outcomes were recorded. Patients with clinical history of T2DM, glycosylated haemoglobin (HbA1c) of ≥6.5% (48 mmol/mol) and/or random blood glucose ≥200 mg/dl (11.1 mmol/l) were included. Statistical analyses were done using chi-square or ‘t’ test and multiple logistic regression analysis. Results At admission, patients with T2DM were older (p

We appreciate the interest shown by Tonnies et al. (1) in their comment on the prevalence data published by us and for having calculated the incidence based on the data provided in our article (2). In order to properly understand the causes of changes in the prevalence of diabetes, it is essential to assess incidence, as this, not prevalence, is the key index of population risk. Tonnies et al. (1) calculated the mean incidence across the 2006–2016 time period based on mathematical assumptions using the prevalence, temporal changes, mortality rate, etc. This calculation included a number of assumptions, since not all the actual data were available (1). Taking a different analytical approach to the same problem, we have now used the data from …

Aims/hypothesisThis randomised controlled trial was performed in India and the UK in people with prediabetes to study whether mobile phone short message service (SMS) text messages can be used to motivate and educate people to follow lifestyle modifications, to prevent type 2 diabetes.MethodsThe study was performed in people with prediabetes (n = 2062; control:n = 1031; intervention:n = 1031) defined by HbA1c≥42 and ≤47 mmol/mol (≥6.0% and ≤6.4%). Participants were recruited from public and private sector organisations in India (men and women aged 35–55 years) and by the National Health Service (NHS) Health Checks programme in the UK (aged 40–74 years without pre-existing diabetes, cardiovascular disease or kidney disease). Allocation to the study groups was performed using a computer-generated sequence (1:1) in India and by stratified randomisation in permuted blocks in the UK. Investigators in both countries remained blinded throughout the study period. All participants received advice on a healthy lifestyle at baseline. The intervention group in addition received supportive text messages using mobile phone SMS messages 2–3 times per week. Participants were assessed at baseline and at 6, 12 and 24 months. The primary outcome was conversion to type 2 diabetes and secondary outcomes included anthropometry, biochemistry, dietary and physical activity changes, blood pressure and quality of life.ResultsAt the 2 year follow-up (n = 2062; control:n = 1031; intervention:n = 1031), in the intention-to-treat population the HR for development of type 2 diabetes calculated using a discrete-time proportional hazards model was 0.89 (95% CI 0.74, 1.07;p = 0.22). There were no significant differences in the secondary outcomes.Conclusions/interpretationThis trial in two countries with varied ethnic and cultural backgrounds showed no significant reduction in the progression to diabetes in 2 years by lifestyle modification using SMS messaging.Trial registrationThe primary study was registered onwww.ClinicalTrials.gov(India, NCT01570946; UK, NCT01795833).FundingThe study was funded jointly by the Indian Council for Medical Research and the UK Medical Research Council.

Two cross-sectional epidemiological surveys were done in 2006 (Ramachandran A et al, Diabetes Care 2008) and 2016 (Nanditha A et al, Diabetes Care 2019, in press) in the same locations in men and women aged ≥ 20 years. We analyzed the increasing trend in dyslipidaemia among populations of varied levels of urbanization and socio-economic development in a 10 year period. Anthropometric measurements, clinical history, blood glucose and fasting serum lipid parameters were measured. The cut-off value suggested by the World Health Organization for Asian Indians for obesity was used. Prevalence of dyslipidaemia was calculated using the National Cholesterol Education Program criteria (NCEP Executive Summary, JAMA 2001). Prevalence of anthropometric and lipid abnormalities in 2006 and 2016 are shown in the Table. The total number screened were 7066 in 2006 and 9848 in 2016. Significant increases (p Disclosure A. Nanditha: None. A. Raghavan: None. P. Susairaj: None. K. Satheesh: None. M. Simon: None. R. Vinitha: None. C. Snehalatha: None. A. Ramachandran: None.

Aim: To compare the efficacy and safety of initiating Glargine U100 + Glulisine to Premixed insulin in insulin naïve Asian Indian type 2 diabetes (T2D) patients. Method: We randomized 101 patients into Glargine U100 + Glulisine (Group 1) and 99 in premixed insulin (Group 2) from 7 different hospitals in Southern India and followed for 24 weeks. Randomized patients were insulin naïve T2D patients on oral antidiabetic drugs. Results: In both the groups > 80% of patients needed an additional dose of insulin (Glulisine in Group 1 and premixed in group 2). There was a significant reduction in all glycemic levels in both groups (p < 0.05), except for a non-significant reduction in HbA1c in group 2 (Figure 1). The dose at the end of the study was 92 units in Group 1 and 50 units in group 2. There was no clinically significant change in body mass index in both groups. The number of episodes of hypoglycemia was significantly more in premixed insulin BD group compared to Glargine U100 + Glulisine BD group (χ2 - 6.1, p = 0.01). Conclusion: Marginally better (non-significant) reduction in HbA1c was noted with Glargine U100 + Glulisine compared to premixed insulin. However, the dose required was higher in group 1 than group 2. The overall episodes of symptomatic hypoglycemia were significantly less in Glargine U100 + Glulisine when compared with the premixed insulin. There was no clinically significant change in body weight in both groups. Disclosure A. Raghavan: None. A. Nanditha: None. K. Satheesh: None. C. Snehalatha: None. A. Catherin Seeli: None. M. Simon: None. P. Susairaj: None. A. Ramachandran: None. Funding Sanofi India Limited

In this work, we utilize a figure-of-merit ( FOM ) to compare the performance of various phase-change materials (PCMs) in managing short bursts of high-power heat flux, particularly those associated with microprocessors undergoing bursty operation on a time scale of approximately one second. We numerically investigate the FOM for applications that have realistic boundary conditions and lack analytical solutions. We also fabricate microprocessor proxies with integrated PCM compartments mounted in a smartphone package, and experimentally demonstrate the use of a high- FOM PCM to buffer short heat spikes as large as 11 W/cm 2 .

In the article cited above, changes have been made in Table 2 on page 480 (for values under “Self-reported” and “New”) and in …

Computational sprinting activates dark silicon to improve responsiveness by briefly but intensely exceeding a system's sustainable power limit. This article focuses on the energy implications of sprinting. The authors observe that sprinting can save energy even while improving responsiveness by enabling execution in chip configurations that, though thermally unsustainable, improve energy efficiency. Surprisingly, this energy savings can translate to throughput improvements even for long-running computations. Repeatedly alternating between sprint and idle modes while maintaining sustainable average power can outperform steady-state computation at the platform's thermal limit.

The tight thermal constraints of mobile devices, which limit sustainable performance, and the bursty nature of interactive mobile applications call for a new design focus: enhancing user responsiveness rather than sustained throughput. To that end, this article explores computational sprinting, wherein a mobile device temporarily exceeds sustainable thermal limits to provide a brief, intense burst of computation in response to user input. By enabling tenfold more computation within the timescale of human patience, sprinting has the potential to fundamentally change the user experience that an interactive application can provide.

Background: To compare cardio metabolic characteristics of Asian Indians with incident type 2 diabetes diagnosed by Oral Glucose Tolerance Test (OGTT) or by Glycosylated Haemoglobin (HbA1c). Research Design and Methods: Data from two Indian Diabetes Prevention Studies in persons with Impaired Glucose Tolerance (IGT) was used. In 314 persons, diabetes was diagnosed by OGTT and another 67 persons had only HbA1c values ≥ 6.5% (≥48 mmol/mol). Cardiometabolic characteristics were compared in 3 sub-groups-1: Persons with positive OGTT only (HbA1c

Traditional coherence protocols present a set of difficult trade-offs: the reliance of snoopy protocols on broadcast and ordered interconnects limits their scalability, while directory protocols incur a performance penalty on sharing misses due to indirection. This work introduces Patch (Predictive/Adaptive Token-Counting Hybrid), a coherence protocol that provides the scalability of directory protocols while opportunistically sending direct requests to reduce sharing latency. Patch extends a standard directory protocol to track tokens and use token-counting rules for enforcing coherence permissions. Token counting allows Patch to support direct requests on an unordered interconnect, while a mechanism called token tenure provides broadcast-free forward progress using the directory protocol's per-block point of ordering at the home along with either timeouts at requesters or explicit race notification messages. Patch makes three main contributions. First, Patch introduces token tenure, which provides broadcast-free forward progress for token-counting protocols. Second, Patch deprioritizes best-effort direct requests to match or exceed the performance of directory protocols without restricting scalability. Finally, Patch provides greater scalability than directory protocols when using inexact encodings of sharers because only processors holding tokens need to acknowledge requests. Overall, Patch is a “one-size-fits-all” coherence protocol that dynamically adapts to work well for small systems, large systems, and anywhere in between.

CMOS scaling trends have led to an inflection point where thermal constraints (especially in mobile devices that employ only passive cooling) preclude sustained operation of all transistors on a chip --- a phenomenon called "dark silicon." Recent research proposed computational sprinting --- exceeding sustainable thermal limits for short intervals --- to improve responsiveness in light of the bursty computation demands of many media-rich interactive mobile applications. Computational sprinting improves responsiveness by activating reserve cores (parallel sprinting) and/or boosting frequency/voltage (frequency sprinting) to power levels that far exceed the system's sustainable cooling capabilities, relying on thermal capacitance to buffer heat. Prior work analyzed the feasibility of sprinting through modeling and simulation. In this work, we investigate sprinting using a hardware/software testbed. First, we study unabridged sprints, wherein the computation completes before temperature becomes critical, demonstrating a 6.3x responsiveness gain, and a 6% energy efficiency improvement by racing to idle. We then analyze truncated sprints, wherein our software runtime system must intervene to prevent overheating by throttling parallelism and frequency before the computation is complete. To avoid oversubscription penalties (context switching inefficiencies after a truncated parallel sprint), we develop a sprint-aware task-based parallel runtime. We find that maximal-intensity sprinting is not always best, introduce the concept of sprint pacing, and evaluate an adaptive policy for selecting sprint intensity. We report initial results using a phase change heat sink to extend maximum sprint duration. Finally, we demonstrate that a sprint-and-rest operating regime can actually outperform thermally-limited sustained execution.

Although transistor density continues to increase, voltage scaling has stalled and thus power density is increasing each technology generation. Particularly in mobile devices, which have limited cooling options, these trends lead to a utilization wall in which sustained chip performance is limited primarily by power rather than area. However, many mobile applications do not demand sustained performance; rather they comprise short bursts of computation in response to sporadic user activity. To improve responsiveness for such applications, this paper explores activating otherwise powered-down cores for sub-second bursts of intense parallel computation. The approach exploits the concept of computational sprinting, in which a chip temporarily exceeds its sustainable thermal power budget to provide instantaneous throughput, after which the chip must return to nominal operation to cool down. To demonstrate the feasibility of this approach, we analyze the thermal and electrical characteristics of a smart-phone-like system that nominally operates a single core (~1W peak), but can sprint with up to 16 cores for hundreds of milliseconds. We describe a thermal design that incorporates phase-change materials to provide thermal capacitance to enable such sprints. We analyze image recognition kernels to show that parallel sprinting has the potential to achieve the task response time of a 16W chip within the thermal constraints of a 1W mobile platform.

Traditional coherence protocols present a set of difficult tradeoffs: the reliance of snoopy protocols on broadcast and ordered interconnects limits their scalability, while directory protocols incur a performance penalty on sharing misses due to indirection. This work introduces PATCH (Predictive/Adaptive Token Counting Hybrid), a coherence protocol that provides the scalability of directory protocols while opportunistically sending direct requests to reduce sharing latency. PATCH extends a standard directory protocol to track tokens and use token counting rules for enforcing coherence permissions. Token counting allows PATCH to support direct requests on an unordered interconnect, while a mechanism called token tenure uses local processor timeouts and the directorypsilas per-block point of ordering at the home node to guarantee forward progress without relying on broadcast. PATCH makes three main contributions. First, PATCH introduces token tenure, which provides broadcast-free forward progress for token counting protocols. Second, PATCH deprioritizes best-effort direct requests to match or exceed the performance of directory protocols without restricting scalability. Finally, PATCH provides greater scalability than directory protocols when using inexact encodings of sharers because only processors holding tokens need to acknowledge requests. Overall, PATCH is a ldquoone-size-fits-allrdquo coherence protocol that dynamically adapts to work well for small systems, large systems, and anywhere in between.

Hypothesis Efficacious and cost-effective treatment of pediatric empyema can be accomplished following a protocol based on its radiographic appearance. Therapeutic modalities include thoracostomy tube drainage (TTD) with or without fibrinolytic therapy (FT) and video-assisted thoracoscopic debridement (VATD). Design Retrospective case series. Setting Tertiary referral center. Results From 1995 through 1999, 31 children were treated ranging in age from 11 months to 18 years (mean age, 5.1 years). Twenty-seven (87.1%) underwent TTD; of these, 22 (81.5%) received FT with urokinase. The TTD failed in 4 children (14.8%) who required salvage VATD. Primary VATD was performed in another 4 children (12.9%). The mean length of stay was 14.6 days (TTD, 14.1 days; salvage VATD, 20.0 days; primary VATD, 11.5 days), ranging from 8.0 to 30.0 days. Complications included readmission for fever (2 patients [6.5%]) and gastrointestinal bleeding (1 patient [3.2%]). There were no anaphylactic reactions or bleeding episodes due to urokinase. Two patients (7.4%) treated with TTD and FT developed an air leak that resolved spontaneously. The mean hospital charges were $78,832 (TTD with or without FT, $75,450; salvage VATD, $107,476; primary VATD, $69,634). The procedural charges were highest for salvage VATD. Conclusions Most cases of pediatric empyema can be treated by TTD with or without FT. This therapy is safe and effective for children with nascent disease. Primary VATD is preferred in children with advanced disease. Cost-effectiveness could be further improved through better prediction of those patients likely to fail TTD and require salvage VATD. An algorithmic approach based on findings from computed tomography or (better) ultrasonography of the chest may be the best way to make this distinction and rationalize care.