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EDITORIALS |
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Adrenergic India: Managing its diabetes |
p. 1 |
Sanjay Kalra, Vageesh Ayyar, Ambika Gopalakrishnan Unnikrishnan DOI:10.4103/2230-8210.83046 PMID:21847447 |
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Every rose has it's thorn! |
p. 3 |
Ambika Gopalakrishnan Unnikrishnan, Sanjay Kalra, Ganapathi Bantwal DOI:10.4103/2230-8210.83048 PMID:21847451 |
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REVIEW ARTICLES |
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Noninsulin pharmacological management of type 1 diabetes mellitus |
p. 5 |
Vishvas Garg DOI:10.4103/2230-8210.83053 PMID:21847455The injectable nature and other shortcomings of insulin have stimulated interest in studying the noninsulin pharmacological therapies to manage type 1 diabetes mellitus (T1DM). The purpose of this study is to conduct a systematic literature review of noninsulin pharmacological therapies for the management of T1DM. For this, the following PubMed search was conducted: Diabetes Mellitus, Type 1/therapy"[Mesh] Limits: Review Sort by: Publication Date. After applying various inclusion and exclusion criteria, a total of 63 studies were reviewed. Based on this review, noninsulin pharmacological therapies can be divided into following classes: (1) Insulin-sensitizing agents (biguanides and thiazolidinediones), (2) gastrointestinal nutrient absorption modulators (α-Glucosidase inhibitors and amylin), (3) immunotherapeutic agents, (4) incretin-based therapies, (5) recombinant human insulin-like growth factors, and (6) other promising therapeutics. Some of these are already used either as monotherapy or adjuvant to insulin, whereas, to manage T1DM, the benefits and risks of the others are still under evaluation. Nonetheless, insulin still remains the cornerstone to manage the T1DM. |
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Degludec insulin: A novel basal insulin |
p. 12 |
Sanjay Kalra, Ambika Gopalakrishnan Unnikrishnan, Manash Baruah, Bharti Kalra DOI:10.4103/2230-8210.83056 PMID:21847448This paper reviews a novel insulin analogue, degludec, which has the potential to emerge as an ideal basal insulin. It reviews the limitations of existing basal insulin and analogues, and highlights the need for a newer molecule. The paper discusses the potential advantages of degludec, while reviewing its pharmacologic and clinical studies done so far. The paper assesses the potential role of insulin degludec and degludec plus in clinical diabetes practice. |
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Bromocriptine in type 2 diabetes mellitus |
p. 17 |
C Shivaprasad, Sanjay Kalra DOI:10.4103/2230-8210.83058 PMID:21847449Bromocriptine mesylate quick-release was approved by the Food and Drug Administration (FDA) in May 2009, for the treatment of type 2 diabetes. Bromocriptine is thought to act on the circadian neuronal activities in the hypothalamus, to reset an abnormally elevated hypothalamic drive for increased plasma glucose, free fatty acids, and triglycerides in insulin-resistant patients. Randomized controlled trials have shown that bromocriptine-QR lowers glycated hemoglobin by 0.4 - 0.8% either as monotherapy or in combination with other anti-diabetes medications. The doses used to treat diabetes (up to 4.8 mg daily) are much lower than those used to treat Parkinson's disease, and apart from nausea, the drug is well-tolerated. The novel mechanism of action, good side effect profile, and its effects to reduce cardiovascular event rates make it an attractive option for the treatment of type 2 diabetes. |
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Imaging of the pancreas: Recent advances  |
p. 25 |
Vikas Chaudhary, Shahina Bano DOI:10.4103/2230-8210.83060 PMID:21847450A wide spectrum of anomalies of pancreas and the pancreatic duct system are commonly encountered at radiological evaluation. Diagnosing pancreatic lesions generally requires a multimodality approach. This review highlights the new advances in pancreatic imaging and their applications in the diagnosis and management of pancreatic pathologies. The mainstay techniques include computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), radionuclide imaging (RNI) and optical coherence tomography (OCT). |
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ORIGINAL ARTICLES |
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Evaluation of the efficacy and safety of bromocriptine QR in type 2 diabetes |
p. 33 |
Karuna Balwant Ramteke, Sunita Jaiprakash Ramanand, Jaiprakash B Ramanand, Suyog Subhash Jain, Girish Tulsidas Raparti, Milind Hari Patwardhan, Mangala Murthy, Ravi G Ghanghas DOI:10.4103/2230-8210.83062 PMID:21847452Context: Diabetes mellitus is a chronic metabolic disorder of endocrinal origin with multiorgan involement. Today's physician has a lot many options to choose for treating type 2 diabetes, but does not always manages to achieve optimal glycemic control. The newer drug bromocriptine acts by novel hypothalamic circadian rhythm resetting mechanism. Objective: To evaluate the efficacy and safety of bromocriptine QR in type 2 diabetes. Materials and Methods: 105 patients according to inclusion and exclusion criteria were randomized into three groups by simple randomization. Group 1 received bromocriprine 2.4 mg once daily, group 2 received metformin 500 mg twice daily while group 3 received bromocriprine 1.6 mg daily and metformin 500 mg twice daily. Baseline measurement of fasting and postprandial blood sugar, HbA1 C and BMI were followed up at 6 th and 12 th weeks. Safety evaluation was done by questioning the patient and also through routine hematological and biochemical parameters. Z test was used for analysis. Results: Group 1 showed significant reduction in fasting and postprandial sugar and HbA 1c at 12 weeks. While groups 2 and 3 showed even higher reduction in these parameters albeit with slightly more adverse drug events like nausea, vomiting compared to group 1. Conclusion: Bromocriptine QR is an effective and safe antidiabetic drug which can be employed as monotherapy or in conjuction with metformin to achieve and maintain optimal glycemic control. |
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Clinical and biochemical profile of lean type 2 diabetes mellitus |
p. 40 |
Punyakrit Deb Barma, Salam Ranabir, Lallan Prasad, Thangjam Premchand Singh DOI:10.4103/2230-8210.83061 PMID:21847453Background: Type 2 diabetes mellitus is the most prevalent form of diabetes worldwide. In western countries majority of the cases are obese. The scenario may be different in certain parts of India. Various studies have reported a high prevalence of lean type 2 diabetes mellitus with a body mass index < 19 kg/m 2 . Materials and Methods: We evaluated 100 cases of lean type 2 diabetes mellitus (62 males and 38 females). Results and Conclusion: The mean duration of diabetes was 51.7 months (range 5-180 months). The glycemic control was poor according to standard guidelines. The majority of them showed response to oral hypoglycemic agents. Secondary failure to oral hypoglycemic agents was seen in 27 patients. The prevalence of microvascular complications was much higher than macrovascular complications. Neuropathy was the commonest complication seen in 70%, followed by retinopathy in 25%. Only 12 patients had hypertension, one had coronary artery disease and two had cerebrovascular accident. Lipid profile was not significantly deranged in our patients. |
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Study of beta-cell function (by HOMA model) in metabolic syndrome |
p. 44 |
MK Garg, MK Dutta, Namita Mahalle DOI:10.4103/2230-8210.83059 PMID:21847454Introduction: The clustering of cardiovascular risk factors is termed the metabolic syndrome (MS), which strongly predict risk of diabetes and cardiovascular disease. Many studies implicate insulin resistance (IR) in the development of diabetes, but ignore the contribution of beta-cell dysfunction. Hence, we studied beta-cell function, as assessed by HOMA model, in subjects with MS. Materials and Methods: We studied 50 subjects with MS diagnosed by IDF criteria and 24 healthy age- and sex-matched controls. Clinical evaluation included anthropometry, body fat analysis by bioimpedance, biochemical, and insulin measurement. IR and secretion were calculated by HOMA model. Results: Subjects with MS had more IR (HOMA-IR) than controls (3.35 ± 3.14 vs. 1.76 ± 0.53, P = 0.029) and secreted less insulin (HOMA-S) than controls (66.80 ± 69.66 vs. 144.27 ± 101.61, P = 0.0003), although plasma insulin levels were comparable in both groups (10.7 ± 10.2 vs. 8.2 ± 2.38, P = 0.44). HOMA-IR and HOMA-S were related with number of metabolic abnormalities. HOMA-IR was positively associated with body mass index, waist hip ratio, body fat mass, and percent body fat. HOMA-S was negatively associated with waist hip ratio, fasting plasma glucose and total cholesterol and positively with basal metabolic rate. Percent body fat was an independent predictor of HOMA-IR and waist hip ratio of HOMA-S in multiple regression analysis. Conclusions: Subjects with MS have increased IR and decreased insulin secretion compared with healthy controls. Lifestyle measures have been shown to improve IR, insulin secretion, and various components and effects of MS. Hence, there is an urgent need for public health measures to prevent ongoing epidemic of diabetes and cardiovascular disease. |
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Correlates of anxiety and depression among patients with type 2 diabetes mellitus |
p. 50 |
Yatan Pal Singh Balhara, Rajesh Sagar DOI:10.4103/2230-8210.83057 PMID:21847456Context: Research has established the relation between diabetes and depression. Both diabetes and anxiety/depression are independently associated with increased morbidity and mortality. Aims: The present study aims at assessing the prevalence of anxiety/depression among outpatients receiving treatment for type 2 diabetes. Settings and Design: The study was conducted in the endocrinology outpatient department of an urban tertiary care center. Materials and Methods: The instruments used included a semi-structured questionnaire, HbA1c levels, fasting blood glucose and postprandial blood glucose, Brief Patient Health Questionnaire, and Hospital Anxiety and Depression Scale (HADS). Statistical Analysis Used: Analysis was carried out using the SPSS version 16.0. Pearson's correlation coefficient was calculated to find out the correlations. ANOVA was carried out for the in between group comparisons. Results: There was a significant correlation between the HADS-Anxiety scale and Body Mass Index (BMI) with a correlation coefficient of 0.34 (P = 0.008). Also, a significant correlation existed between HADS-Depression scale and BMI (correlation coefficient, 0.36; P = 0.004). Significant correlation were observed between the duration of daily physical exercise and HADS-Anxiety (coefficient of correlation, -0.25; P = 0.04) scores. HADS-Anxiety scores were found to be related to HbA1c levels (correlation-coefficient, 0.41; P = 0.03) and postprandial blood glucose levels (correlation-coefficient, 0.51; P = 0.02). Conclusions: Monitoring of biochemical parameters like HbA1c and postprandial blood glucose levels and BMI could be a guide to development of anxiety in these patients. Also, physical exercise seems to have a protective effect on anxiety in those with type 2 diabetes mellitus. |
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CASE REPORTS |
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Emphysematous cystitis in a patient with type-2 diabetes mellitus |
p. 55 |
Prathosh Gangadhar, Yashpal Vikas Gogate, Rama Walia, Anil Bhansali DOI:10.4103/2230-8210.83051 PMID:21847457Emphysematous cystitis is a relatively rare clinical entity caused by gas-fermenting bacteria or fungus. Presentation is often nonspecific and imaging is the best diagnostic modality. We report a case of a 45-year-old male who presented with fever, dysuria, and pneumaturia, and was found to have emphysematous cystitis. |
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Diabetic myonecrosis: An underreported complication of diabetes mellitus |
p. 58 |
Bipul Kumar Choudhury, Uma Kaimal Saikia, Dipti Sarma, Mihir Saikia, Sarojini Dutta Choudhury, Dipu Bhuyan DOI:10.4103/2230-8210.83052 PMID:21847458Diabetic myonecrosis is an underreported complication of long-standing, poorly controlled diabetes mellitus which is usually self-limiting and responds well to conservative management. Patients frequently have microvascular complications, and although short-term prognosis is good, the long-term prognosis is poor. We report four cases of diabetic myonecrosis admitted in a tertiary care hospital. |
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Berardinelli Seip syndrome with insulin-resistant diabetes mellitus and stroke in an infant |
p. 62 |
CK Indumathi, S Lewin, Vageesh Ayyar DOI:10.4103/2230-8210.83054 PMID:21847459Berardinelli Seip congenital lipodystrophy (BSCL) is a rare metabolic disorder characterized by severe generalized lipodystrophy, insulin resistance, and dyslipedemia since infancy, and onset of overt diabetes mellitus in adolescence. Here we report a 5-month-old infant with clinical and metabolic manifestations of Berardinelli Seip syndrome including overt diabetes mellitus and stroke, which are very rare at this age. |
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Rhino-orbital-mucormycosis as a presenting manifestation of gestational diabetes mellitus |
p. 65 |
Mohd Hayat, Syed Mushtaq, Sameena Saba, Riyaz Saif DOI:10.4103/2230-8210.83055 PMID:21847460Rhino-orbital mucormycosis is an uncommon and aggressive, angioinvasive fungal infection that occurs in immunocompromised states like diabetes mellitus, chronic renal failure, hematological malignancies and deferroxamine therapy. We report a patient who presented with rhino-orbital mucormycosis at six months of gestation and was incidentally detected to have diabetes. She was successfully treated with amphotericin B and appropriate surgery. To the best of our knowledge, there is no such report in the literature. |
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LETTERS TO THE EDITOR |
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Diabetic cardiac autonomic neuropathy in well-controlled diabetics within 1 year of diagnosis |
p. 67 |
Ali Jawa, Rizwan Bokhari, Ali Jawad, Javed Akram DOI:10.4103/2230-8210.83045 PMID:21847461 |
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Asymptomatic peripheral artery disease in South Indian women with type 2 diabetis |
p. 68 |
MG Binu, P Shanija, J Bino John Sahayo DOI:10.4103/2230-8210.83047 PMID:21847462 |
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Health economic evaluation of dipeptidyl peptidase-4 inhibitors |
p. 69 |
Vishvas Garg DOI:10.4103/2230-8210.83049 PMID:21847463 |
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Outbreak of Escherichia coli and diabetes mellitus |
p. 70 |
Viroj Wiwanitkit DOI:10.4103/2230-8210.83050 PMID:21847464 |
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