Bharti Hospital

This opinion piece highlights the importance of person centred philosophy in primary care. The authors define, describe and detail the concepts of person centred and responsible person centred care. They call for equal emphasis on evidence-based treatment, empathic delivery, experiential learning, ethical guidelines and environmental constraints.

Type 2 diabetes (T2D) is the most common type of diabetes worldwide, accounting for over 90% of all cases. Micronutrient deficiencies (hidden hunger) are implicated in glycaemic control among T2D patients. This systematic review and meta-analysis aim to investigate the association between multiple micronutrient deficiencies and glycaemic control in patients with type 2 diabetes (T2D). The systematic review and meta-analysis followed the Cochrane Handbook and PRISMA 2020 standards. We searched various databases to identify relevant studies and used a pre-piloted data extraction sheet to gather information. Statistical analysis was conducted using R version 4.3.2 and specific packages. A weak but significant negative correlation was observed between overall micronutrient deficiencies and glycaemic control indices: Fasting Blood Glucose (FBG), Post Prandial Blood Glucose (PPBG), and Glycosylated haemoglobin (HbA1c). Vitamin D deficiency had a small but significant correlation with FBG [:r=-0.0920, p-value = 0.0285], PPBG [:r=:-0.2416, p-value = 0.0175), and HbA1c, ( [:r=:-0.1975, p-value < 0.01]. However, there was no significant correlation with HOMA IR. Magnesium deficiency was moderately correlated with HbA1c[:r=:-0.3526, p-value < 0.01]and HOMA IR [:r=:-0.3427, p-value = 0.0016). Zinc had a negligible correlation with Hb1Ac, while iron and vitamin B12 had a low positive correlation. Study reported as statistically significant but weak negative correlation amongst micronutrient deficiency and glycaemic control among T2D patients. Only a small percentage of the variation in HbA1c, FBG, PPBG, and HOMA IR was attributable to micronutrient deficiencies. This study presents the limited explanatory power of micronutrient deficiencies alone on glycaemic control.Systematic Review Registration: PROSPERO registration number- CRD42023439780. “https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=439780”.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-31681-z.

Stress is a part of life. Stress impacts persons living with chronic disease and those who care for them. Thus, coping with stress becomes an integral part of diabetes self-management education. This opinion piece describes useful ways of coping with stress. It uses a simple 4 × 3 model, designed in an alliterative manner. Four trigonal pillars, or the four As-approach/attitude, analysis, activity, and adjuvant methods-determine the efficacy of coping with stress. Each of these domains includes various attitudes, behaviors, and choices (ABC), which are described in a pleasing manner as 12 Ps. This list reinforces strategies, styles, and systems that can be used to ensure positive, productive coping.

Women living with diabetes may experience unplanned pregnancies. This poses challenges and risk to both maternal and foetal health in case glycaemia and other associated comorbidities are not optimized. This may lead to doubts regarding continuation of pregnancy, given there are no clear guidelines or position statement for decision regarding termination or continuation of pregnancy. Multiple biomedical, psychosocial and environmental factors determine the course and outcome of such pregnancies. In such situations, a comprehensive analysis of foeto maternal health helps inform the antenatal woman, so that the right decision can be made, in a person-centred manner. This review proposes various algorithms to assist in shared decision making, including a 2x2x2 rubric (Psychosocial: statutory (legal), system-specific; emotional, economic; Biomedical: obstetric, offspring health; medical, metabolic health). No single biochemical value should be taken as an indication for termination of pregnancy, unless the foetus is incompatible with life.

Pain in patients with diabetes can be unpleasant, but at times protective as well. We propose the term 'glucodynia' i.e., an unpleasant sensory and emotional experience, associated with or without any organ-system dysfunction, in people living with diabetes. Glucodynia may be due to microvascular, musculoskeletal, metabolic, mood-related, miasmatic, mitogenic, visceral myogenic, malnutritionrelated or medicine-related (iatrogenic) causes. In this manuscript we explain the different mechanisms of pain in patients living with diabetes. Furthermore, the therapeutic modalities that can be used to reduce pain sensation are described.

Abstract Acute appendicitis can rarely perforate extraperitoneally, tracking into the abdominal wall, gluteal region, or perinephric space, leading to delayed diagnosis. We report three such cases managed at our tertiary centre between January 2022 and December 2024, detailing clinical features, imaging findings, interventions (drainage and appendectomy), microbiology, and outcomes. All patients recovered fully with no recurrences at follow up. Awareness of these atypical presentations and prompt cross-sectional imaging with tailored drainage and appendectomy can minimize morbidity. Limitations include single-centre, retrospective design, and small sample size.

Obesity is a ‘heavyweight’ disease, with more than its fair share of controversies and challenges. Differing modes of diagnosis, a variety of diagnostic and interventional thresholds, and a rapidly evolving therapeutic landscape all contribute to confusion in obesity medicine. To bring clarity to this field, the term ‘clinical obesity’ has recently been proposed [Box 1]. The Lancet Commission on obesity as a condition characterized by excessive adiposity, along with at least one of 18 complications mentioned in adults, or one of 13 complications identified in adolescents.[1] While these lists are exhaustive, they are unable to encapsulate the entire spectrum of life with obesity.Box 1: Definition of clinical obesityWe therefore suggest a fresh look at this concept. We define clinical obesity as a disease state characterized by excessive adiposity, identified by ethnic age and gender specific anthropometric and/or imaging parameters, associated with any comorbid condition, complication or clinically significant laboratory abnormality/disease, dysfunction, disability, or deviation from normal, which has the potential to be corrected by weight loss and maintenance. This definition includes the Lancet rubric, and goes beyond it. It focuses on action (weight loss) to achieve better health (potential to be corrected). It is also more inclusive, as it makes the divide between comorbidity and complication irrelevant. By including ‘disease, dysfunction, disability and deviation from normal’, it covers every possible aspect of obesity medicine. The biopsychosocial challenges of living with obesity all find a place under this umbrella definition.[2] This person-friendly definition contrasts with contemporary thought, which has excluded psychological and social facets of obesity from the concept of clinical obesity.[3] This is unfortunate, and these issues are major impediments to quality of life with obesity.[4] While we commend the Commission for its attempt to standardize obesity, we highlight the need for a more inclusive, more person-centred definition, that addresses psychosocial and endocrine health as well. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Diabetes and obstructive sleep apnoea (OSA) are interconnected chronic conditions. The increasing prevalence of obesity drives the pathogenesis of these interrelated disorders. OSA, characterised by nocturnal hypoxia resulting from recurrent episodes of upper airway obstruction during sleep, is common in individuals with type 2 diabetes mellitus (T2DM). At the same time, T2DM increases the risk of OSA through mechanisms involving obesity, systemic inflammation, and autonomic dysfunction. OSA increases insulin resistance, impairs glucose tolerance, and worsens glycaemic control. Management strategies should involve early screening for OSA in individuals with T2DM and vice versa. Continuous positive airway pressure (CPAP) therapy improves insulin sensitivity and cardiovascular outcomes, though its impact on glycaemic control remains inconsistent. Emerging evidence suggests that newer anti-obesity medications may reduce OSA severity alongside improving metabolic parameters. Future research should focus on identifying the molecular pathways linking OSA and diabetes, evaluating long-term CPAP benefits, and optimising pharmacological approaches to improve outcomes in both conditions.