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(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]

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]

Objective: Several studies have reported the rising prevalence of diabetes in young adults globally. ADA currently recommends routine screening for diabetes starting at the age of 35 years. Indians are known to develop diabetes at a younger age, although there is a scarcity of large studies looking at the prevalence of diabetes in Young Indians. Objective of the study was to assess prevalence of diabetes in young Indians below the age of 35 years.The data of 225,955 individuals from a nationwide screening campaign was analyzed for the prevalence of diabetes among individuals younger than 35 years.The overall prevalence of diabetes among those below 35 years, 30 years, and 25 years of age was found to be 17.9%, 13.3%, and 9.8% respectively. Among those with a family history of diabetes, the prevalence was as high as 40.1%, 31.8%, and 26.4% respectively.The current study highlights a very high prevalence of diabetes in young Indians. It might be worth considering screening for diabetes as early as 18 years of age among Indians, especially in those with a family history of diabetes.Methods: Several studies have reported the rising prevalence of diabetes in young adults globally. ADA currently recommends routine screening for diabetes starting at the age of 35 years. Indians are known to develop diabetes at a younger age, although there is a scarcity of large studies looking at the prevalence of diabetes in Young Indians. Objective of the study was to assess prevalence of diabetes in young Indians below the age of 35 years.The data of 225,955 individuals from a nationwide screening campaign was analyzed for the prevalence of diabetes among individuals younger than 35 years.The overall prevalence of diabetes among those below 35 years, 30 years, and 25 years of age was found to be 17.9%, 13.3%, and 9.8% respectively. Among those with a family history of diabetes, the prevalence was as high as 40.1%, 31.8%, and 26.4% respectively.The current study highlights a very high prevalence of diabetes in young Indians. It might be worth considering screening for diabetes as early as 18 years of age among Indians, especially in those with a family history of diabetes.Results: Several studies have reported the rising prevalence of diabetes in young adults globally. ADA currently recommends routine screening for diabetes starting at the age of 35 years. Indians are known to develop diabetes at a younger age, although there is a scarcity of large studies looking at the prevalence of diabetes in Young Indians. Objective of the study was to assess prevalence of diabetes in young Indians below the age of 35 years.The data of 225,955 individuals from a nationwide screening campaign was analyzed for the prevalence of diabetes among individuals younger than 35 years.The overall prevalence of diabetes among those below 35 years, 30 years, and 25 years of age was found to be 17.9%, 13.3%, and 9.8% respectively. Among those with a family history of diabetes, the prevalence was as high as 40.1%, 31.8%, and 26.4% respectively.The current study highlights a very high prevalence of diabetes in young Indians. It might be worth considering screening for diabetes as early as 18 years of age among Indians, especially in those with a family history of diabetes.Conclusions: Several studies have reported the rising prevalence of diabetes in young adults globally. ADA currently recommends routine screening for diabetes starting at the age of 35 years. Indians are known to develop diabetes at a younger age, although there is a scarcity of large studies looking at the prevalence of diabetes in Young Indians. Objective of the study was to assess prevalence of diabetes in young Indians below the age of 35 years.The data of 225,955 individuals from a nationwide screening campaign was analyzed for the prevalence of diabetes among individuals younger than 35 years.The overall prevalence of diabetes among those below 35 years, 30 years, and 25 years of age was found to be 17.9%, 13.3%, and 9.8% respectively. Among those with a family history of diabetes, the prevalence was as high as 40.1%, 31.8%, and 26.4% respectively.The current study highlights a very high prevalence of diabetes in young Indians. It might be worth considering screening for diabetes as early as 18 years of age among Indians, especially in those with a family history of diabetes. [ABSTRACT FROM AUTHOR]

Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters. [ABSTRACT FROM AUTHOR]