Barriers to the Use of Insulin Therapy and Potential Solutions: A Narrative Review of Perspectives from the Asia-Pacific Region.

The rising prevalence of type 2 diabetes (T2D) is posing major challenges for the healthcare systems of many countries, particularly in the Asia-Pacific Region, in which T2D can present at younger ages and lower body mass index when compared with Western nations. There is an important role for insulin therapy in the management of T2D in these nations, but available evidence suggests that insulin is under-utilized and often delayed, to the detriment of patient prognosis. The authors of this article gathered as an advisory panel (representative of some of the larger Asia-Pacific nations) to identify their local barriers to insulin use in T2D, and to discuss ways in which to address these barriers, with their outputs summarized herein.

Longitudinal associations between ambient PM exposure and lipid levels in two Indian cities.

Background: Exposure to ambient PM is known to affect lipid metabolism through systemic inflammation and oxidative stress. Evidence from developing countries, such as India with high levels of ambient PM and distinct lipid profiles, is sparse.

Methods: Longitudinal nonlinear mixed-effects analysis was conducted on >10,000 participants of Centre for cArdiometabolic Risk Reduction in South Asia (CARRS) cohort in Chennai and Delhi, India.

Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: results from the D-CLIP trial.

Purpose: This study aimed to validate the factor structure of the 12-item Short-Form (SF-12) health-related quality of life (HRQOL) survey for Indian adults and assess the impact of lifestyle modification on the SF-12 of Indian adults with prediabetes.

Methods: To validate the context-specific construct of the SF-12, two-factor confirmatory factor analysis (CFA) was performed using data from 1285 adults residing in Chennai, India, who screened for the Diabetes Community Lifestyle Improvement Program (D-CLIP). D-CLIP was a randomized controlled trial of 578 participants with prediabetes (283 treatment, 293 control), focusing on the effect of lifestyle modifications on the prevention of diabetes.

Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study.

Background: The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets.

Methods: The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries.

Regression From Early GDM to Normal Glucose Tolerance and Adverse Pregnancy Outcomes in the Treatment of Booking Gestational Diabetes Mellitus Study.

Objective: To compare pregnancy outcomes among women with a normal oral glucose tolerance test (OGTT) before 20 weeks' gestation (early) and at 24-28 weeks' gestation (late) (no gestational diabetes mellitus, or No-GDM), those with early GDM randomized to observation with a subsequent normal OGTT (GDM-Regression), and those with GDM on both occasions (GDM-Maintained).

Research Design And Methods: Women at <20 weeks' gestation with GDM risk factors who were recruited for a randomized controlled early GDM treatment trial were included. Women with treated early GDM and late GDM (according to the World Health Organization's 2013 criteria) were excluded from this analysis.

Assessment of the risk of developing type 2 diabetes using the Indian diabetes risk score in an urban community in Chandigarh, India: A cross-sectional study.

Background: The urban poor is a group that is known to be vulnerable to the adoption of a more urbanized lifestyle that places them at a higher risk for diabetes. Identification of at-risk individuals using simple screening tools like the Indian diabetes risk score developed by Madras Diabetes Research Foundation (MDRF-IDRS) and appropriate lifestyle interventions could greatly help in preventing or postponing the onset of diabetes and thus reducing the burden of the disease on the community and the nation as a whole.

Materials And Methods: A cross-sectional study was conducted on individuals ≥30 years (n = 1533) of both genders in an urban colony of Chandigarh during a period of 1 year.

International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes.

Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death.

Natural History of Type 2 Diabetes in Indians: Time to Progression.

Objective: To describe the natural history of diabetes in Indians.

Research Design And Methods: Data are from participants older than 20 years in the Centre for Cardiometabolic Risk Reduction in South Asia longitudinal study. Glycemic states were defined per American Diabetes Association criteria.

Perinatal Outcomes in Early and Late Gestational Diabetes Mellitus After Treatment From 24-28 Weeks' Gestation: A TOBOGM Secondary Analysis.

Objective: In most gestational diabetes mellitus (GDM) studies, cohorts have included women combined into study populations without regard to whether hyperglycemia was present earlier in pregnancy. In this study we sought to compare perinatal outcomes between groups: women with early GDM (EGDM group: diagnosis before 20 weeks' gestation but no treatment until 24-28 weeks' gestation if GDM still present), with late GDM (LGDM group: present only at 24-28 weeks' gestation), and with normoglycemia at 24-28 weeks' gestation (control participants).

Research Design And Methods: This is a secondary analysis of a randomized controlled treatment trial where we studied, among women with risk factors, early (<20 weeks' gestation) GDM defined according to World Health Organization 2013 criteria.

Recent studies on hypertension prevalence and control in India 2023.

Hypertension is the most important chronic disease risk factor in India. Recent epidemiological studies have reported that hypertension is increasing in India with a more rapid increase in rural and young populations. Fifth National Family Health Survey (NFHS-5) and Indian Council of Medical Research-INDIAB surveys have reported that there are substantial geographic variations in hypertension prevalence with greater prevalence in more developed states and districts of the country.

Association of collaborative care intervention features with depression and metabolic outcomes in the INDEPENDENT study: A mixed methods study.

Aims: The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) trial tested a collaborative care model including electronic clinical decision support (CDS) for treating diabetes and depression in India. We aimed to assess which features of this clinically and cost-effective intervention were associated with improvements in diabetes and depression measures.

Methods: Post-hoc analysis of the INDEPENDENT trial data (189 intervention participants) was conducted to determine each intervention feature's effect: 1.

Association of pro-inflammatory cytokines, adipokines and hepatokine with incident diabetes in India: a nested case-control study within CARRS cohort.

Aims: To study the association of pro-inflammatory markers with incident diabetes in India.

Methods: We did a nested case-control study within the CARRS (Centre for Ardiometabolic Risk Reduction in South Asia) cohort. Of the 5739 diabetes-free individuals at the baseline, 216 participants with incident diabetes and 432 age-, gender- and city-matched controls at 2-year follow-up were included.

Wide-field imaging with smartphone based fundus camera: grading of severity of diabetic retinopathy and locating peripheral lesions in diabetic retinopathy.

Aim: To assess the performance of smartphone based wide-field retinal imaging (WFI) versus ultra-wide-field imaging (UWFI) for assessment of sight-threatening diabetic retinopathy (STDR) as well as locating predominantly peripheral lesions (PPL) of DR.

Methods: Individuals with type 2 diabetes with varying grades of DR underwent nonmydriatic UWFI with Daytona Plus camera followed by mydriatic WFI with smartphone-based Vistaro camera at a tertiary care diabetes centre in South India in 2021-22. Grading of DR as well as identification of PPL (DR lesions beyond the posterior pole) in the retinal images of both cameras was performed by senior retina specialists.

Evaluating bias with loss to follow-up in a community-based cohort: empirical investigation from the CARRS Study.

Background: Retention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias.

Methods: Data are from an ongoing cohort study, Center for cArdiometabolic Risk Reduction in South Asia (CARRS) in India (Delhi and Chennai).

Perceived stress and progression of cardiometabolic risk factors among South Asians with prediabetes in a lifestyle intervention trial.

Aims: To examine associations between perceived stress and cardiometabolic risk factors in South Asians with prediabetes and assess whether a diabetes prevention program mitigates the impact of stress on cardiometabolic health.

Methods: We conducted a secondary analysis of the Diabetes Community Lifestyle Improvement Program, a lifestyle modification trial for diabetes prevention in India (n = 564). Indicators for cardiometabolic health (weight, waist circumference, blood pressure, glucose, HbA1c, and lipids) were measured at each visit while perceived stress was assessed via questionnaire at baseline.

The Utility of ChatGPT in Diabetic Retinopathy Risk Assessment: A Comparative Study with Clinical Diagnosis.

Purpose: To evaluate the ability of an artificial intelligence (AI) model, ChatGPT, in predicting the diabetic retinopathy (DR) risk.

Methods: This retrospective observational study utilized an anonymized dataset of 111 patients with diabetes who underwent a comprehensive eye examination along with clinical and biochemical assessments. Clinical and biochemical data along with and without central subfield thickness (CST) values of the macula from OCT were uploaded to ChatGPT-4, and the response from the ChatGPT was compared to the clinical DR diagnosis made by an ophthalmologist.

The Impact of a Collaborative Care Model on Health Trajectories among Patients with Co-Morbid Depression and Diabetes: The INDEPENDENT Study.

Context: Collaborative care models for depression have been successful in a variety of settings, but their success may differ by patient engagement. We conducted a post-hoc analysis of the INDEPENDENT trial to investigate the role of differential engagement of participants on health outcomes over 3 years.

Settings And Design: INDEPENDENT study was a parallel, single-blinded, randomised clinical trial conducted at four socio-economically diverse clinics in India.

A Cohort Study on the Outcome of Diabetic Foot Ulcers.

Background: Diabetic foot ulcers (DFUs) represent a significant and challenging complication of diabetes mellitus, often leading to serious morbidity and a substantial burden on healthcare systems. The study was conducted with the objectives of evaluating the outcomes of DFUs.

Materials And Methods: A cohort study was conducted to evaluate the outcomes of DFUs from May 2019 to May 2020 at a tertiary care hospital located in Chennai.