Diabetes Care and Research Foundation

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.

A BSTRACT Context: Accurate blood pressure (BP) measurement is fundamental for hypertension diagnosis and management, yet guideline-recommended practices are inconsistently implemented. Aims: This study aimed to assess the practices, availability, and barriers related to appropriate BP cuff selection among physicians in India. Settings and Design: A cross-sectional e-survey was conducted among 7251 physicians practicing across India from June 2025 to September 2025. Subjects and Methods: Data were collected on cuff availability, measurement techniques, and procedural barriers using an electronic questionnaire. Statistical Analysis Used: This study was designed as a descriptive analysis. Data were summarized using descriptive statistics and presented as frequencies and percentages for categorical variables. No inferential statistical tests were performed. Results: While 65% of physicians reported routinely measuring arm circumference, only 48% had access to multiple cuff sizes. A strong association was observed between cuff availability and measurement practices: 93% of physicians with multiple cuffs measured arm circumference versus 39% without adequate cuff availability. Medium cuffs were predominantly used (63%), with availability significantly influencing cuff selection. Critical gaps were identified: 64% used incorrect cuff sizes when proper sizes were unavailable, 36% reported inability to procure needed cuffs, and only 33% consistently ensured direct skin contact during measurement. Conclusions: This study reveals a significant equipment-practice gap in BP measurement, characterized by inadequate cuff availability leading to compromised measurement techniques and failures in accurate BP measurements. These findings highlight the urgent need for systemic interventions to ensure adequate resource allocation and reinforce standardized practices to improve hypertension management accuracy.

Type 2 diabetes (T2D), along with other co-morbidities (hypertension, hyperlipidemia, etc.), causes vascular complications and atherosclerosis, leading to heart or kidney damage. The timely detection of cardiovascular disease (CVD) and chronic kidney disease (CKD) risk helps in targeted treatment, thereby reducing hospitalization/death in people with T2D. The vascular complications of T2D, including the onset of CVD or CKD, have been widely studied. However, a clear understanding of the concurrent inter-relatability of diabetes-kidney-heart or diabetes-heart-kidney continuum would further assist the clinicians in preventing morbidity and mortality. The narrative review sought to outline the stages (“prevent,” “regress,” and “retard”), pathophysiological mechanism, and management of the continuum with defined patient profiles and associated risk factors. Pharmacotherapies with a focus on managing both cardiac and renal vascular changes (e.g., sodium-glucose transporter-2 inhibitors {SGLT-2is}, glucagon-like peptide-1 receptor agonists {GLP-1RA}, dipeptidyl peptidase-4 inhibitors {DPP-4is}, lipid-lowering therapy, and renin-angiotensin-aldosterone system {RAAS} blockers) have been discussed. In addition, new diagnostic approaches such as levels of B‐type natriuretic peptide (BNP), N‐terminal prohormone, cardiac troponin, cystatin C, and single-cell transcriptome sequencing, with proven accuracy for detecting vascular complications in the heart and kidney, have been summarized. The review underscores the importance of the early detection of the vascular complications in T2D with individual risk stratification for the initiation/continuation/switching of therapies, to enhance treatment adherence and outcomes.

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.