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Copy: The injectable adipocytolytic drug deoxycholic acid (DCA) is the first pharmacological intervention approved for the reduction of submental fat (SMF) and offers an alternative to invasive measures to improve the submental profile and the cervico-mental angle. DCA injection (ATX-101, Kybella [United States], Belkyra [Canada]; Kythera Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.), are proprietary formulations of synthetically derived DCA that is FDA approved for improvement in the appearance of moderate to severe convexity or fullness associated with SMF. Aim: As none of the aforementioned are available in India, we undertook this study to study the efficacy of generic DCA for SMF reduction in Indian patients. Methods: 50 patients with confirmed Indian ethnicity and unwanted SMF were injected 3 mg/cm2 of generic DCA into their SMF, with a 12-week follow-up period. In each session, 5 ml of 30 mg /ml DCA was injected. The sessions were spaced approximately 2 months apart. All these patients with reductions in SMF were reported using Clinician Reported SMF Rating Scale (CR-SMFRS) and Patient Reported SMF Rating Scale (PR-SMFRS) using the Validated Rating Scale for improvement in the appearance of their chin, the neck, and the cervico-mental profile. Also, for objective assessment of improvement in SMF, caliper measurements were used. Results: One session was required in 2 patients, 12 patients needed 2 sessions, 32 patients needed 3 sessions, and 4 patients needed 4 sessions. Altogether, 90% patients showed at least a decrease of 1 point in (CR-SMFRS). Reduction in SMF as confirmed by caliper measurements was statistically significant. Conclusion: The findings show generic deoxycholic acid to be equally effective in the treatment for SMF in Indian patients. J Drugs Dermatol. 2019;18(3):266-272.

Epinephrine (10 micrograms/kg body weight) s.c., glucagon (1 microgram/kg body weight) i.v. and glucose (0.5 g/kg body weight) i.v. were injected in groups of ketosis-prone young diabetics, ketosis-resistant young diabetics, maturity-onset diabetics, young and mature controls, each group comprising 8 subjects. Samples were drawn at timed intervals and analyzed for glucose, FFA, acetone, citrate and plasma free insulin. FFA and glycerol release by the adipose tissue in vitro was studied in 6 of each of the following groups: young diabetics and young controls in the presence of norepinephrine, anti-insulin serum or both. Failure of the adipose tissue of ketosis-resistant young diabetics to respond to lipolytic and ketogenic hormones has been suggested by others as the basis for the clinically observed resistance to ketoacidosis. The present data do not confirm any failure of the liver or adipose tissue to respond to glucagon, epinephrine or norepinephrine in these diabetics. The ketosis-resistant young diabetics have some endogenous insulin secretory capacity still preserved as evident from their basal and post-glucose free insulin levels and effects of anti-insulin serum on in vitro lipolysis by their adipose tissues. The available endogenous insulin though adequate in preventing excessive lipolysis and ketogenesis, appears insufficient to check hyperglycemia.