Problems and solutions for Assessing Hyperglycaemia in Pregnancy in Non-metro Areas

Bhavatharini N, Changanidi ARA, Sanjeev VK, and Aruyerchelvan R

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Unique presentation: New Onset of Type 1 Diabetes in a Pre-exiting cases of type 2 Diabetes

Dr. Meet Shah, Dr. Banshi Saboo

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Palmar Eruptive Xanthomas as Presenting Manifestation of Diabetes Mellitus and Hypothyroidism

Dr. Veerendra B Sutar 

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C-Peptide: From Physiology to Clinical Use

Dr. Vinod K Abichandani, MD 

 

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Cure of Diabetes: Dream or Reality

Dr. Anshuman Kumar MD (PeD), Dr. Rana Bhattacharjee MD (Med)
DM (Endo) MRCP FICP

Diabetes is a complex, chronic illness requiring continuous medical care with multiple risk reductionstrategies beyond glycaemic control. Type 2 diabetes mellitus (T2DM) is now emerging as one of the main threats to human health in the 21st century. By 2025 AD, there will be 300 million people suffering from T2DM globally and India will have the highest number of cases (57.2 million) of all the countries.

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Targeting the Ominous Octet Pathophysiology of Type 2
Diabetes using Combination Therapy—Treat Early,
Treat Right!

RishadAhmed, Mansij Biswas

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder. The core physiologic defects, often termed as triumvirate since its conception in 1988, are insulin resistance in muscle and the liver, along with progressive loss of B-cell function.1 Decreased B-cell function results in reduced insulin secretion, while insulin resistance in muscle and the liver reduces glucose uptake from blood and its optimum utilization. Together, these defects elevate the blood glucose level (hyperglycaemia) in patients with T2DM. It has been postulated that patients who are in the upper range of impaired glucose tolerance (IGT) are near-maximally insulin resistant and have already lost over 80—85% of their B-cell function. It is the progressive B—cell dysfunction that determines
the rate of disease progression.

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Glycaemic Variability: Its Clinical Implications And
Management

Saptarshi Mukhapadhyay

Glycaemic control and its benefits in preventing microvascular diabetic complications are proved by various studies. Diabetes control and complications trial (DCCT) had reported variable glycated
haemoglobin (HbAlc) as a cause of increased microvascular complications in conventional glycaemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved beyond doubt. Glycaemic variability (GV) is one more tool to explain relation between hyperglycaemia and increased cardiovascular risk in these populations. Studies on the cellular level and in humans have shown a correlation between increased GV and oxidative stress and endothelial dysfimction. GV is significantly associated with morbidity and mortality of critically ill people.

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Impact of Previously Undetected type 2 Diabetes in Critically ill Patients Admitted in an Intensive Care Unit of a Suburban Hospital in South Bengal. 
Dr. Sanjay Sud, Dr. Purushottam Chatterjee.

Analysis of the glycaemic status of critially ill patients without any prior history of diabetes mellitus admitted in an ICU of a suburban hospital of South Bengal was done to find out the prevalence of the undetected disease. Many previous studies have shown that patients with diabetes have a poor ouotcome in comparison to non-diabetics. In present study- a retrospective and non-diabetics. In our present study- a retrospective an non-randomised study, data was collected from patients who were admitted in the above-mentioned setting, and diagnosed with type 2 diabetes for the first time to evaluate its effect on hospital stay and mortality compared to non-diabetic patients.

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The Human Placenta in Dysglycaemic Pregnancy
Dr. Vinod K Abichandani, MD: Dr. Chitralekha Joshi Vora, MD

The placenta is an important metabolic bridge between a mother and the growing foetus in her womb. It separates the maternal and foetal circulation, with which it is in contact through different surfaces, i.e., the syncytiotrophoblast exposes the placenta to the maternal circulation and the endothelium is in contact with foetal blood .

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Clinical Importance of Screening for Sleep Disorders for Chronic Disease
Dr. Gunjan Y Trivedi, Dr. Banshi Saboo and Dr. Dhruvi Hasnani.

There are five stages of sleep. Scientists categoriesed the stages of sleep based on the characteristics of t he brain and body during sleep. Stage 1, 2, 3 and 4 are categorised as non-REM sleep, and the 5th stage, is REM sleep. Genrally, brainwave frequencies and amplitudes from an electroncephalogram (EEG) are used to differentiate between the stages of sleep, along with other biological rhythms including eye movements (EOG or electromyography). Each sleep stage serves a unique role in brain and body restoration.

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The Blue Index – A Comprehensive Diabetes Assessment Score
Sanjeev R Phatak, Banshi D Saboo, Dharmendra Panchal, Shivangi Dwivedi, Padmanabh Zinzuwadia and Dhruvi Hasnani

 Targets are necessary in order to achieve targets. One of the most challenging aspects of target-based medicine, however, is defining easily measuralbe goals. This is especially true in diabetology, where multiple metabolic end points must be met in order to achieve comprehensive medical care.

The vast number of pathophysiologic mechanisms, monitoring investigations, pharmaceutical tools, and non-pharmacological interventions create a challengefor the overburdened diabetologist. Faced with the multiplicity of clinical activites, it is all to easy to inadvertently omit important aspects of diabetes management. It is even tougher to explain the various thought process of diabetes care to persons with diabetes, in a manner which is easy to understand.

 

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Problems of Diabetes Therapy in Women: From Menstruation, Infertility, and Menopause
Sugata Narayan Biswas and Partha Pratim Chakraborty

The challlenges of managing diabetes during adolescence are manifold. During adolescence and emerging adulthood, females undergo significant cognitive, emotional, and developmental changes. With the beginning of puberty, changes in insulin sensitivity related to grownth and sexual maturation require close monitoring of blood glucose levels and necessary adjustments to insulin therapy in type I diabetes mellitus patients. Though majority of TIDM adolescents are treated with intensive insulin regimens to achieve an ADA recommended glycated haemoglobin.

 

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What is New in the Management of Diabetic Peripheral Neuropathy?
Saptarshi Mukhopadhyaya

Diabetic paripheral neuropathy has been recognized as a major complication of diabetes since the mid 18800s. Dycket al described the disorder as a symmetrical sensorimotor polyneuropathy attributable to chronic hyperglycemia, associated metabolic derangements, cardiovascular risk covariates, and microvessel alterations. DPN is the most common long-term complication. Affecting 50% of the diabetic population. Prevalence increases with duration of diabetes and poor glycemic control.

 

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Clarity and Finality of Guidelines to Diagnose Hyperglycemia in Pregnancy- An Appraisal
Seshiah V

Hyperglycemia in pregnancy includes both pregestational diabetes mellitus and gestational diabetes mellitus (GDM) and this article deals with the latter. GDM is defined as carbohydrate intolearance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 diabetes mellitus (DM) as are their children. Thus, GDM offers an important opportunity for the development, testing, and implementation of clinical strategies for diabetes prevention.

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Prevalence of Gestational Diabetes in Women Attending
Ante-natal Clinic in West Bengal: A Hospital-based Cross-sectional Study from Eastern India
Dr. Asmita Chatterjee, Dr. S.M. Bhattacharya, Dr. Nirmalya Roy, and Kingshuk Bhattacharjee

Diabetes is one of the most prevalent diseases in the world and in recent years these prevalence rates are increasing. This is extremely relevant in the Indian scenario as the 6th edition of The World Diabetes Atlas estimated that over 65 million Indians are affected with diabetes mellitus in 2013; a 103% rise compared to their 2001 estimate of 32 million. Among these, there is a population of special importance, that is, women of child-bearing age, as hyperglycemia during pregnancy either due overt (pre-pregnancy) diabetes or gestational diabetes not only has a significant effect on maternal and fetal outcome but also has a far-reaching and long-term effect on the lives of both mother and child.

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Insulin and OADs: When and How to Combine?
Dr. Sowrabha Bhat and Dr. Rana Bhattacharjee

Diabetes is a progressive disease. After about 10–15 years of diabetes there is generally an exhaustion of the pancreatic insulin reserve. It is well known that adequate glycemic control reduces both
microvascular and macrovascular complications of diabetes. In most diabetics who fail to achieve their glycemic targets with oral antidiabetic medications, shifting completely to insulin may be the only option. But in some patients there may be a role of combining insulin with oral antidiabetic agents as they may work synergistically thus reducing the dose of insulin needed and therefore its metabolic side effects and the cost of medication.

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News in Pictures

3rd National Congress on Clinical Diabetes – 14th and 15th April, 2018, Kolkata

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The Human Pancreatic Alpha Cell in Health and Disease: A Clinician’s Perspective

by - Dr Vinod K. Abichandani

When Banting and Best injected extracts from pancreatic tissue intravenously or subcutaneously into diabetic dogs and humans, a marked reduction in blood sugar was noticed (reflecting the hypoglycaemic action of insulin). However, this was often preceded by a small transient elevation of blood sugar, which was initially thought to be caused by epinephrine. A few years later, this phenomenon was ascribed to a glucose-mobilizing substance, later named ‘glucagon. It took almost three further decades before the pancreatic α-cells were identified as being the source of glucagon, and hypoglycaemia documented as a trigger for the release of this hormone. 

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Use of Antidiabetic / Hypoglycaemic Agents in Cardiovascular Disease

by -Dr. Anand Shankar and Dr. Pankaj Hans

Cardiovascular (CV) complications are the most important cause of morbidity and mortality in diabetes. Diabetics are three times more prone to CV events, four times for heart failure and two times higher risk for death as compared to non-diabetics. The effect of improved glycaemic control on CV complication has been well established through clinical trials and meta-analyses. However, several studies have suggested that some antidiabetic drugs increase CV risk, despite being effective at lowering blood glucose in type 2 diabetes. When choosing the appropriate treatment strategy for patients with type 2 diabetes with CV risk, not only the glucose in type 2 diabetes. When choosing the appropriate treatment strategy for patients with type 2 diabetes with CV risk not only for glucose lowering effects but also overall benefits and risks for CV disease should be taken into consideration.

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Study of Thyrodiabetes in a Tertiary Care Hospital

Dr. Biswajit Roy, Prof Samar Banerjee

Diabetes mellitus is a common endocrine as well as a multisystem disorder, characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action or both. Diabetes is a health problem affecting the population worldwide in general and India in particular. Uncontrolled diabetes with its many adverse effects like cardiovascular and kidney diseases along with dyslipidemia increase morbidity and mortality. 

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The Comparative Effect of Metformin, Voglibose Alone and in Combination on Body Mass Index in Non-diabetic Obese Subjects

Dr. Jyoti Bobde, Dr Rajesh Kadam, Dr Deepak Bhosle

Throughout most of the human history, obesity has been viewed as a sign of health and prosperity. But now it has been termed as an epidemic and asocial burden, with increasing prevalence worldwide.Obesity is also defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyper plastic obesity) or a combination of both; or defined as a condition of abnormal excessive fat accumulation in adipose tissue, to the extent that health may be impaired to produce adverse health consequences and is associated with increased morbidity and mortality

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History of the Development of Oral Antidiabetic Agents

Prof Samar Banerjee

The history of antidiabetic medications maintain a great importance due to the so-called ‘epidemic disease of the century’, i.e. diabetes mellitus.1 The so-called Coca-Colanization or industrialization of the civilization has a negative impact on diet and lifestyle, and as a result, the incidence of type 2 diabetes mellitus has become a serious public health issue. The classic symptoms of diabetes were described long back in the ancient Egypt. At the time of the first attempts to treat the symptoms involved the mixtures of many natural products of animal or veterinary origin. 

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 Mind Your Step

Saptarshi Mukhopadhyay, Sarmistha Mukherjee

A 58-year-old male from Chinsurah presented to a primary care physician with history of low-grade fever for last 3 weeks. Fever was associated with occasional productive cough. By occupation,he was a farmer. He was a diabetic but non-hypertensive and was on treatment with Glipizide and Metformin combination. No previous history of operation or major medical illness were noted. He had stopped smoking cigars 5 years before this. 

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Vitamins and Type 2 Diabetes Mellitus

Dr. ABM Kamrul Hasan, Dr. AKM Aminul Islam, Dr. Moinul Islam, Dr. Shahjada Selim

Diabetes mellitus (DM) is a metabolic disorder of multiple aetiologies characterised by chronic hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects of insulin secretion, insulin action or both. Worldwide most prevalent type of diabetes is type 2 diabetes. Diabetes is associated with the development of the specific micro- and macrovascular complications. 

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The Problem of Rising Cost of treatment of Diabetes

Prof Samar Banerjee 

Diabetes is a one of the greatest killer disease and remains mostly undetected till the complications set in. Diabetes if not properly tackled, leads to complications such as cardiovascular diseases, eye diseases, kidney diseases, and neurovascular diseases. As per International Diabetes Federation (IDF) 2015 statistics, approximately 415 million people are affected with diabetes globally and it may rise to 642 million by 2040 and the greatest increase is predicted to occur in low income countries. In addition, around 318 million adults are also reported to be affected with impaired glucose tolerance. 

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