Diabetes Care & Hormone Clinic

Medication adherence refers to patients taking their prescribed treatments at the correct dose, timing, and frequency. In contrast, medication discontinuation involves sustained interruption of the entire regimen, with greater risks of metabolic decompensation and complications. Despite its clinical significance, anti-diabetes medication discontinuation remains poorly understood, with no standardized definitions or validated assessment tools. To develop and validate a culturally adapted, self-administered questionnaire to assess the prevalence, duration, and factors linked to discontinuation of anti-diabetes medication. This multicenter observational study was conducted across 11 diabetes care centers in Northern India. A structured questionnaire was developed through expert consensus and patient pre-testing, followed by psychometric validation. The validated instrument was then administered to a large cohort of adults with diabetes to assess discontinuation patterns and associated factors. Among 747 participants (mean age: 55.98 years; 54.2% male), 189 individuals (25.3%) reported at least one episode of medication discontinuation lasting more than seven consecutive days. Discontinuation was frequently prolonged: 36.3% of affected participants discontinued therapy for one to six months, and 29.4% for more than one year. Compared with those who remained on therapy, individuals who discontinued had higher average glycemic levels, including a mean HbA1c approximately 0.5% higher, along with higher fasting and post-prandial glucose values. The most commonly reported reasons for discontinuation were medication unavailability (34/197; 17.3%), fear of hypoglycemia (33/197; 16.8%), perceived good glycemic control (29/197; 14.7%), and belief that medication was unnecessary (27/197; 13.7%). Discontinuation was more common among individuals with behavioral risk factors and microvascular complications, while concurrent use of cardiovascular medications was associated with greater treatment persistence. Most participants considered discontinuation unjustified and expressed strong support for digital reminder systems. Medication discontinuation affects approximately one in four diabetes patients, often for extended periods. Unlike adherence, discontinuation is rarely measured. This validated questionnaire provides the first reliable tool to assess this behavior in India, highlighting knowledge gaps and access barriers as primary drivers, rather than socioeconomic factors. Interventions should focus on patient education and digital adherence support systems.

Aims: The epidemiology of diabetic patients is well studied in India. However, there is limited data on the epidemiology of diabetes among the rural and urban communities. This study has been designed to understand the geographical pattern and presentation of diabetes in North India. Methods and Materials: An observational, multicentre, cross-sectional study was conducted among diabetic patients visiting outpatient clinics of the primary care centres at various cities of Uttar Pradesh state from January 2019 to October 2020. The patients’ epidemiological, demographic and clinical characteristics were collected with the help of a predesigned questionnaire tool. The collected data were analysed using an appropriate statistical test. Results: A total of 3,951 patient records had been studied. The median age of diabetics was 50 years, and their median BMI was 26 kg/m 2 and indicating diabetic patients were obese as per Asian Indian criteria. Patients from rural settings had 59% higher odds of not having received any formal education, and 23% higher odds of any addiction-related history. Odds of heart disease and of stroke were significantly higher in the urban setting than rural setting. Positive history of any addiction was associated with 85% higher odds of heart disease or stroke ( P < .05) in the overall adult population. Multiple regression analysis showed age of patient and liquor consumption were associated with a statistically significant association with heart disease. Conclusion: There was a discrepancy in presentation of diabetic individuals within the rural and urban communities of India.

The Ayushman Bharat Digital Mission (ABDM) marks a pivotal step in India's journey toward a unified, citizen-centric health ecosystem. Its integration with primary healthcare (PHC)-the most accessible and foundational tier of service delivery-offers transformative potential. By enabling unique digital health IDs, interoperable health records, and consent-based data sharing, ABDM promises to improve continuity of care, empower frontline health workers, and support the long-term management of chronic diseases at the community level. However, ground-level implementation faces challenges such as poor infrastructure, limited digital literacy, workflow resistance, and concerns around data privacy. This viewpoint argues that while technology is central, its true value will emerge only through inclusive design, local ownership, and sustained investment in human capacity. ABDM, if thoughtfully implemented, can redefine the role of PHC-not merely as a first point of contact, but as a digitally enabled, person-centered platform for equitable care delivery.

GDM is an intermediate phase in a woman's life that certainly poses a high risk of type 2 diabetes. Maternal health affects the health of offspring, a precursor of the vicious cycle of diabetes that continues through generations. Knowing the causative factors of GDM is important to breaking this cycle. To study the risk factors of GDM in Indian women. The observational study database records from 2022 to 2023 from 11 different centres across India. We included pregnant women diagnosed with GDM with any OGTT criteria and excluded women with pre-existing diabetes. A total of 431 women with GDM were included in the study. 166 women were diagnosed with GDM in the 3rd trimester, followed by 235 women in the 2nd trimester, and 30 women in the 1st trimester of pregnancy. Those detected with GDM during the 1st trimester had a BMI of 27.9kg/m2, followed by 28.3 and 29.3kg/m2 in 3rd trimester. Multigravida showed a positive correlation with a family history of T2D (0.04), previous history of GDM (p-value < 0.001), history of stillbirth (p-value < 0.001) and hypertension (p-value 0.03). Pre-pregnancy BMI and women's age at family planning are two important risk factors for the prevention of gestational diabetes.

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction‐associated steatotic liver disease (MASLD), formerly known as non‐alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high‐risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high‐risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non‐invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well‐planned study design that could enhance the scientific value of these statements.

The morbidity of type 2 diabetes mellitus (T2DM) is rising dramatically both at the national and international levels. In recent years, many novel medications are developed or in development for better management of hyperglycemia in people with T2DM. Focusing on the new promising molecules, here we aim to present the opinion of experts and their consensus on the use of imeglimin for the treatment of T2DM in India. Multiple advisory board meetings were conducted with six leading key opinion leaders (KOLs) in endocrinology and diabetes specialty across India to share their experiences, understand and discuss the real-world imeglimin treatment strategies, its effectiveness and safety in patients with T2DM. A novel oral antidiabetic drug (ADD), imeglimin, a tetrahydrotriazine compound of the "glimin" family, is currently being used in the treatment of T2DM. Its mode of action is unique when compared to other types of ADDs as it has a dual mode of action, which includes (1) improving the action of insulin and (2) reversing pancreatic β-cell dysfunction. Additionally, imeglimin has been associated with reduced hepatic steatosis, protection from β-cell apoptosis and stimulation of skeletal muscle glucose absorption. Efficacy and safety of imeglimin as a monotherapy is well demonstrated in treatment-naive patients when metformin is contraindicated or in patients who are intolerant to metformin, metformin failure, or as an add-on/combination with other oral antidiabetic drugs (OADs), mainly DPP4i, SGLT2i or insulin. The clinical efficacy of imeglimin is dose dependent, and it is observed that the efficacy of imeglimin 1,000 mg BID is >500 mg BID. This consensus paper presents the experts' opinion of their real-world clinical experiences on imeglimin treatment, its clinical efficacy, safety and their recommendations for better management of T2DM.

Diabetes management requires continuous monitoring of glucose, medication, diet, and activity. With over 537 million cases globally, digital health solutions support self-care. This study assesses the Madhumeh Setu app, comparing its functionality, quality, and user experience with top diabetes apps using Mobile App Rating Scale (MARS). A four-phase evaluation was conducted: systematic app search from Google Play Store; assessment of essential app features based on AADE-7 guidelines; qualitative ratings by healthcare professionals using MARS, and user comparison of Madhumeh Setu with MySugr and BeatO through MARS. Out of 2116 screened apps, 11 met the inclusion criteria. MySugr received the highest MARS rating (4.40 ± 0.14), followed by BeatO (4.12 ± 0.04) and Madhumeh Setu (4.05 ± 0.05). While MySugr scored highest overall, Madhumeh Setu performed similarly to BeatO in functionality and engagement. A one-way ANOVA showed that Madhumeh Setu differed significantly from MySugr (p < 0.00001) but was like BeatO, indicating it matches existing diabetes management solutions. This study underscores the potential of digital health solutions in diabetes care. As mobile health advances, culturally specific apps such as Madhumeh Setu will become vital for diabetes management. Future studies should use long-term trials to evaluate their effects on blood sugar, medication use, and well-being, with ongoing improvements based on user input to aid wider adoption, especially in low-and-middle-income countries.