Dr. Kovil's Diabetes Care Centre

Traditional Indian cereal-based breakfast items have high glycemic index (GI) contributing to postprandial (PP) glucose spikes. Use of diabetes-specific protein supplement (DSPS) may reduce glycemic excursions. The study aimed to evaluate the effect of partially replacing breakfast with DSPS (Protinex Diabetes Care) on PP glycemic response. Forty-two persons with type2 diabetes mellitus (T2DM) participated in this randomized, controlled, open-label, crossover study. Participants consumed a test breakfast (DSPS in 200ml milk + reduced portion of popular Indian savory breakfast (upma/poha)) or isocaloric control breakfast (upma/poha) for 5days, with 3-day washout. PP glucose and insulin were assessed on the first day of intervention at baseline, 30, 60, 90, 120, 150, and 180min after breakfast to calculate incremental area under the curve (iAUC0-3h) and delta peak (ΔCmax). During in-home use, macronutrient intake was assessed using dietary recalls, and glycemic variability (GV) was assessed using continuous glucose monitoring (CGM). Glucose iAUC0-3h and ΔCmax were 59% and 46% lower in test vs control, respectively. Insulin iAUC0-3h and ΔCmax did not differ significantly. During the test period, protein intake was significantly higher by 8.8g; mean amplitude of glycemic excursions (MAGE)-a GV metric-was significantly lower. There were no gastrointestinal or adverse events. DSPS was well accepted by participants. DSPS as a partial breakfast replacement improves blood glucose control without significantly impacting insulin response. In a real-world setting, DSPS enhances protein intake and reduces GV. These findings support DSPS as a practical, well-tolerated strategy for improving glycemic control and macronutrient intake balance in people with T2DM. The trial was registered with Clinical Trials Registry India (CTRI) CTRI/2024/08/072006 and has been registered in the International Clinical Trials Registry Platform (ICTRP).

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.

Background: Saroglitazar is dual peroxisome proliferator-activated receptor (PPAR) α/γ agonist and approved for elevated triglyceride (TG) reduction in type 2 diabetes mellitus (T2DM) and Non-alcoholic fatty liver disease in India. This study was conducted to evaluate the effect of Saroglitazar in T2DM patients with moderate to severe hypertriglyceridemia to contribute to nationwide existing data of real time clinical practice. Methods: It is a retrospective, observational study conducted from April 2023-2024, among T2DM participants with either moderate hypertriglyceridemia (200-499 mg/dl) or severe hypertriglyceridemia (&gt;500 mg/dl) who were prescribed Saroglitazar 4 mg once daily and followed up for 6 months with laboratory parameters (blood sugar and lipid profile). Results: A total of 53 patients’ data on demographic and clinical profile was collected and analysed. Saroglitazar, in addition with oral antidiabetic and lipid lowering medication showed statically significant improvement in total cholesterol, triglyceride and HbA1c at 6 months follow-up without any serious adverse events. Conclusion: In T2DM with moderate to severe hypertriglyceridemia, saroglitazar as an add on to statins is an effective and safe therapeutic option to reduce elevated TG and other lipid and glycemic parameters.

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are linked to the global diabetes epidemic, leading to increased disease progression and adverse health outcomes. The renaming of NAFLD to metabolic dysfunction-associated steatotic liver disease (MASLD) at the 2023 European Association for the Study of the Liver Congress highlights the complex relationship between metabolic disorders and liver health. Taking this into consideration, we aimed this study to identify prevalence and risk factors associated with the stages of NAFLD in individuals with T2DM in the Indian population. This observational, cross-sectional study was conducted on 1,521 T2DM patients at Dr Panikar's Speciality Care Centre, Mumbai, between September 1, 2022 and October 31, 2022. Demographic parameters such as age, gender, height, weight, and anthropometric parameters such as body mass index (BMI) and waist circumference were measured. Liver fibrosis and steatosis stages were identified by vibration-controlled transient elastography (VCTE) using FibroScan®. The prevalence of liver steatosis was 75.1% among the 1,521 diabetes cases [S0 (24.9%), S1 (15.1%), S2 (24%), and S3 (36%)], whereas the prevalence of liver fibrosis was 28.0% [F0 (72%), F1 (19%), F2 (5%), F3 (1.5%), and F4 (3.4%)]. The S1 (p = 0.012), S3 (p = 0.001), F1 (p = 0.001), and F2 (p = 0.001) grades showed significant gender-related changes, demonstrating a positive connection. Furthermore, waist circumference was associated with disease severity in both liver steatosis and fibrosis stages (p = 0.001), but BMI was solely associated with the degree of steatosis (p = 0.001). The mean age differences between these categories, however, did not reach statistical significance (p-values of 0.149 and 0.078, respectively, for the steatosis and fibrosis grades). The study reveals a high prevalence of NAFLD (steatosis and fibrosis) in T2DM patients, increasing the risk of advanced fibrosis. In T2DM patients with risk factors including waist circumference and BMI, appropriate screening and intervention are required.

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk.pThis article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists' recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient's glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient's postprandial glycemic expression and whether their food intake meets the Child-Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux.

Introduction: Necrotising ulcerative gingivitis (NUG) is a microbial disease characterized by the death and sloughing of gingival tissue. This article presents a classic case with characteristic symptoms of gingival necrosis, punched out ulcerated papillae, pseudomembrane formation and pain. Case Report: The patient was treated with the conventional treatment modalities of antimicrobial treatment, swabbing of the pseudomembrane with H2O2 followed by irrigation at home mouth rinses. A soft toothbrush was advised without any adjunctive toothpaste. Additionally, ozone therapy was done on the 3rd day since the lesion persisted. Each arch was ozonated for five minutes using custom made silicon stents with nozzle in the front to allow the ozone generator to pass through. With adjunctive ozone therapy lesions had started to resolve by the 5th day and the patient was also relieved of all associated symptoms. Conclusion: Elimination of the bacteria is a very important part of treatment of NUG. Treponema, bacteroides intermedius and fusobacterium species are the principle bacteria involved in the disease. These bacteria are essentially anaerobic. Ozone therapy creates an aerobic environment for these bacteria inhibiting their growth and disrupting the integrity of the bacterial cell wall by oxidation and inactivating the existing bacteria. Ozone therapy does not damage the other surrounding healthy cells. These healthy cells have a coating of enzymes like catalase, glutathione perioxidase, reductase and superoxide dimutase which prevents the oxygen radical from penetrating them. Hence using ozone as an adjunctive therapy helps accelerate healing and treat the basic etiology in a very targeted manner.