Objective: Gestational diabetes is glucose intolerance of varying severity with onset in the index pregnancy. This study aimed to compare fasting plasma glucose (FPG) with random plasma glucose (RPG) among pregnant females as methods of screening for gestational diabetes. Methods: A cross-sectional study of 100 pregnant females selected to have screening for gestational diabetes between gestational ages of 24 and 28 weeks using RPG and FPG. All the subjects had 75 g oral glucose tolerance test as the gold standard. Venous plasma glucose assay was performed using glucose oxidase method. Results: The prevalence of gestational diabetes was 29% using FPG cut-off ≥5.1 mmol/L and 6% using RPG cut-off ≥7.8 mmol/L. The RPG cut-off ≥11.1 mmol/L gave the lowest prevalence rate of 2%, while 75 g oral glucose tolerance test (gold standard test) gave the highest prevalence rate of 30%. RPG cut-off ≥7.8 mmol/L revealed a positive-predictive value of 66.7%, negative-predictive value of 72.3%, and area under the curve of 0.845 compared with FPG level at threshold of 5.1 mmol/L, which gave positive-predictive value of 93.1%, negative-predictive value of 95.8%, and area under the curve 0.920. Conclusion: This study revealed that FPG threshold of 5.1 mmol/L alone performed excellently as a screening test.

As the COVID-19 outbreak continues to endanger global health and hamper the world economy, there are concerns and reconsiderations for medication taken by patients with cardiometabolic disorders as they are more vulnerable to COVID-19. While several articles and perspectives have dealt with the concern and safe continuation of antihypertensive drugs, there is paucity of information on calcium channel blockers (CCB). Despite the biology of calcium channel involvement in virus entry and replication, the beneficial effect of CCB is somewhat speculative and only preclinically evident. This commentary focusses on the clinical research on CCB in the context of COVID-19.

Diabetic foot syndrome is common in uncontrolled diabetes and is a constellation of symptoms and signs that include neuropathy, infection, and ischaemia. It has become a global concern and a frequent cause of hospitalisation among diabetics. In this study, the authors’ objective was to assess the knowledge, practices, and risk of diabetic foot syndrome among diabetic patients seeking outpatient care at a tertiary hospital in Bengaluru, India. A cross-sectional study involving 198 patients with diabetes aged ≥18 years was conducted using a structured questionnaire, followed by examination using Inlow’s 60-second diabetic foot screen tool. The results were based on the International Working Group on the Diabetic Foot (IWGDF) risk classification system. The knowledge regarding diabetic foot syndrome was inadequate for fungal infections (23.5%), shoe bites (26.5%), and changes in foot colour and temperature. Footcare practices were satisfactory, with the exception of wearing footwear indoors (25.0%) and applying moisturiser to feet (19.0%). Lack of education, diabetic neuropathy, peripheral vascular disease, history of foot ulcer, and a lack of knowledge regarding dry skin, special footwear, and inappropriate footwear were important risk factors. The researchers concluded that the knowledge level of the subjects was relatively poor. Foot practices, such as inspecting and washing feet every day, were followed by the majority of subjects. Lack of education, complications such as neuropathy, peripheral vascular disease, dry skin, and lack of information obtained on foot care practices were significantly associated with diabetic foot syndrome.

This commentary outlines the effectiveness of family-centred models of diabetes self-management education (Family-DSME) interventions and identifies five considerable gaps in the available literature that are keeping Family-DSME interventions from being translated into clinical practice. These include: (a) confounding effects of including cultural tailoring in many Family-DSME studies; (b) variations in duration and dosage of Family-DSME interventions; (c) most studies failing to assess the effects of Family-DSME on the included family members; (d) lack of cost-effectiveness data; and (e) lack of implementation research on Family-DSME interventions. It is crucial that clinical researchers focus efforts on filling the gaps in knowledge that constrain Family-DSME from being translated into clinical practice.

Diabetes has become an emerging public health problem because of its serious complications, and high mortality and morbidity rates. Among the most common microvascular complications of diabetes is diabetic nephropathy (DN), which is a major cause of development of end-stage renal disease worldwide. The aetiopathogenesis of DN is not completely elucidated; however, studies have shown that the components of the MAPK signalling pathway play an essential role in the development and progression of the disease. The MAPK family is mainly composed of three subgroups: extracellular signal-regulated kinases 1 and 2, c-Jun N-terminal kinases (JNK) 1–3, and p38 MAPK, all of which are related to several cellular functions, such as cell death, differentiation, proliferation, motility, survival, stress response, and cell growth. In diabetic kidney disease, the MAPK pathway can be activated by processes resulting from hyperglycaemia (polyol pathway products, oxidative stress, and accumulation of advanced glycosylation end-products) and by angiotensin II, and it is related to several renal pathological processes. This review aims to summarise the role of the MAPK signalling pathway in diabetic nephropathy, as well as to link the biological aspects that contribute to clarify the pathological process behind the disease.

The commensal bacteria that are present in our body since infancy are known to play a role in metabolism, in health as well as disease. Diabetes is a growing epidemic, and a long-term solution that targets the disease at the molecular level is yet to be developed. In this article, we have reviewed the link between the body’s microbiota and disturbed glucose metabolism, as well as the reasons for bacterial dysbiosis and the mechanisms by which it causes inflammation. The link between dysbiosis and diabetes is convincing, particularly since probiotics have been shown to be of some benefit in normalising disturbed metabolism in diabetes patients. Probiotics have recently been found to have a wide application in diseases such as autoimmune, inflammatory, and allergic conditions. The efficacy of probiotics in diabetes has been proven by their ability to lower fasting glucose and insulin levels in a preclinical setting as well as in human trials. However, there is heterogeneity in these studies, including the species used, probiotic dosage, and the magnitude of efficacy. Based on the robust understanding of the benefits of probiotics in diabetes at the cellular level, in both animal studies and clinical trials, combined with their excellent tolerability, probiotics should be explored for their application in clinics.

Chorioretinal vascular diseases are among the leading causes of blindness in industrialised countries. The recent development and widespread adoption of intravitreal pharmacotherapy enables surgeons to not only stabilise disease in most cases, but also improve visual acuity (VA). Inhibitors of vascular endothelial growth factor (VEGF) have become first-line therapy for patients with neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO), and oedema due to retinal vein occlusions (RVO). The pivotal Phase III registration studies evaluated the efficacy and safety of monthly or bimonthly injections of anti-VEGF drugs, and remain the standard against which other treatments and injection regimens are compared. Adhering to a regimen of monthly drug injections requires considerable patient compliance and allocation of substantial healthcare resources, therefore most physicians use individualised treatment strategies. As-needed (PRN) and treat and extend (T&E) regimens reduce the number of clinic visits, intravitreal injections, or both, and are less expensive than monthly therapy. Both regimens reduce unwanted macular oedema and improve VA, but compared to monthly therapy over the course of 1 year, may be 1–3 letters less effective. Trials of 5-year duration suggest that PRN treatment modulates the severity of diabetic retinopathy (DR) and stabilises vision in patients with DR. Long-term data comparing these strategies in patients with nAMD and RVO are lacking, but VA frequently declines when observation periods and treatment intervals are extended beyond 4 weeks. Current observations suggest that aggressive long-term therapy with frequent injections may produce the best VA results in patients with nAMD and RVO.

The aim of this paper is to highlight the evidence on the interrelationships between exercise and Type 2 diabetes mellitus (T2DM) in the ageing population. The evidence addressed in the specific literature is presented in three domains: aerobic exercise, resistance exercise, and combined aerobic and resistance exercise. The effects of aerobic exercise are well established, but in the ageing population resistance training could be considered a superior intervention to help glycaemic control; the effects of resistance training on insulin sensitivity are attributable to an increase in muscle mass. Thus, although with resistance training body weight does not change much, the main effect of resistance training on body composition of the elderly should be a shift from fat to muscle mass, and the maintenance of a large muscle mass may reduce obesity related risk factors. Fewer studies have investigated the effects of combined resistance and aerobic training, but from the available evidences it would appear that combined exercise training seems to offer additional benefits if compared with aerobic training alone and resistance training alone.

Since the advent of insulin pens in 1985, there have been ongoing improvements providing several advantages over the traditional vial and syringe method of insulin delivery. In recent years, pens have become increasingly user-friendly, and some models are highly intuitive to use, requiring little or no instruction. Despite this progress, there remains to be disparity in access to insulin pens to people with diabetes in various countries. There is a need for improved awareness of the benefits of insulin pens among healthcare professionals. Continual advances have been made to address patient needs such as improved technology to make them easier to use; less painful; more discreet and convenient; and more accuracy for small doses of insulin, as well as the incorporation of a memory function, all contribute to an insulin delivery device that allows the patient to better manage their diabetes anytime and anyplace, without the bulk and challenge of carrying a vial and syringe. These advances have resulted in increased patient satisfaction with insulin pens and most importantly, all of these benefits improve adherence and result in improved clinical outcomes. This review highlights these benefits of insulin pen use and presents the issues to be considered when helping patients decide on the insulin pen that will best suit their needs.

Systolic and diastolic blood pressures display a circadian rhythmicity that can be assessed by 24-hour ambulatory blood pressure monitoring and analysed using the cosinor procedure. Altered characteristics to the circadian rhythm of blood pressure, which may result in adverse health outcomes, have been observed in both prediabetes and diabetes. We have investigated the circadian variability of blood pressure in patients with type 1 and type 2 diabetes. Chronobiologically interpreted ambulatory blood pressure monitoring uncovered not only midline estimating statistic of rhythm (MESOR)-hypertension and circadian hyper-amplitude-tension, but also circadian ecphasia (an odd timing of the daily blood pressure swing). Diastolic blood pressure acrophases were found to be phase shifted to earlier along the time axis only in patients with diabetes, but not in those with essential hypertension. Several mechanisms, from changes in nutrient-dependent signalling pathways to diabetic autonomic neuropathy, can contribute to alterations of circadian time structures in diabetic people. The chronology of blood pressure changes in animal models of diabetes and hypertension suggests that a chronobiological approach to the diagnosis of blood pressure disorders could offer advantages, but longitudinal studies in humans are needed to determine its potential relevance in hypertension associated with diabetes.