Correlation between non-alcoholic fatty liver disease and metabolic parameters in persons with newly diagnosed type 2 diabetes mellitus.

BACKGROUND: There are limited studies investigating the association between type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) in the region of Bihar, India. AIM: To estimate the prevalence of NAFLD in persons with newly diagnosed T2DM in the population of North Bihar, India. METHODS: This single centre cross-sectional study was undertaken in the Research Centre for Diabetes Hypertension and Obesity, Samastipur, Bihar, India. Data were collected from persons newly diagnosed with T2DM or those diagnosed within 6 months of when the study was conducted between December 2022 to May 2023. RESULTS: A total of 148 people with newly diagnosed T2DM were included (median age 47 years, 46.6% female) and 109 patients with liver disease on ultrasound evaluation. The persons with liver disease consumed more fats and oils (88.1% vs 74.4%, P = 0.042) and they had significantly greater body mass index (27.4 vs 23.0, P < 0.001), waist circumference (37 vs 33, P < 0.001), and waist-to-hip ratio (1.00 vs 0.70, P = 0.025). Females were associated with greater liver disease [odds ratio (OR): 3.09, 95% confidence interval (CI): 1.09-8.80, P = 0.32]. Waist circumference (OR: 1.42, 95%CI: 1.22-1.66, P < 0.001) and low-density lipoprotein cholesterol (OR: 1.01, 95%CI: 1.01-1.02, P = 0.048) were associated with any liver disease. The factors most associated with grade 2/3 liver disease was right upper quadrant pain or heaviness (OR: 5.22, 95%CI: 1.40-19.41, P = 0.14), greater income (OR: 3.58, 95%CI: 1.28-10.04, P = 0.015) and waist circumference (OR: 1.31, 95%CI: 1.02-1.69, P = 0.036). CONCLUSION: NAFLD is common in new/recently diagnosed T2DM and disease burden is high and common among patients who are either high consumers of fats and oils or have obesity-associated markers.

Missed Opportunities in Type 2 Diabetes Mellitus: A Narrative Review.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a significant health problem around the world. OBJECTIVE: This review aims to define missed opportunities and how they apply to patients with T2DM. METHOD: This narrative review describes the natural history of T2DM and also describes where missed opportunities may arise. RESULTS: Missed opportunities may relate to prevention, early detection, diagnosis, and treatment of diabetes. The cornerstone of T2DM prevention is the control of modifiable risk factors and lifestyle changes to potentially prevent diabetes. Early detection of T2DM is important as it is a chronic condition that can progress rapidly if untreated. Missed opportunities related to the diagnosis of T2DM draw attention to the heterogeneous presentation of diabetes. The condition can be incidentally identified in asymptomatic patients, so all healthcare professionals should be aware of the disease. Furthermore, it is not unexpected that patients with atypical symptoms may have a delay in diagnosis. The treatment-related missed opportunities in T2DM are broad and include self-care, education, remission of T2DM, risk factor management, prevention of complications, medication therapy and compliance, as well as individualized care. Considering patient pathways is a useful approach to evaluate missed opportunities in patient care. CONCLUSION: Missed opportunities are a concept that is not often considered in diabetes care, which calls upon reflection of real-world activities and consideration of whether patient outcomes could have been improved with changes in decision-making. Future studies that aim to improve patient care should consider this concept.

Phase 4 pharmacovigilance trial of paromomycin injection for the treatment of visceral leishmaniasis in India.

Background. A phase 3 study demonstrated the safety and efficacy of paromomycin (paromomycin IM injection) for treatment of VL in an inpatient setting. Methods. This phase 4 study was conducted to assess the safety and efficacy of paromomycin in children and adults in an outpatient setting in Bihar, India. Results. This study enrolled 506 adult and pediatric patients. Of the 494 patients in the intent-to-treat (ITT) population, 98% received a full course of treatment. The overall study completion rate was 94% (462/494) for the ITT population and 96% (461/479) for the efficacy-evaluable (EE) population. Initial clinical cure was 99.6%, and final clinical cure 6 months after treatment was 94.2%. Grade 3 or 4 adverse events occurred in 5% of patients; events with a frequency of ≥1% were increases in alanine aminotransferase and aspartate aminotransferase. Conclusions. This study confirms the safety and efficacy of paromomycin to treat VL in an outpatient setting.