The KgA1c Paradox: Widening the spectrum.

The term KgA1c paradox is used to describe the unwanted rise in weight that occurs when HbA1c is controlled using conventional therapy. We highlight facets of pathophysiology, prevention, pharmacology, person centred care, and epidemiology, which correspond to the concept of KgA1c paradox. We suggest a novel index, KgA1c product [(BMI) x (HbA1c)], which can be used to evaluate efficacy of drugs, and assess metabolic control in persons with diabetes.

Assessment of Hydration Status Using Conventional Method and Salivary Osmolarity as a Point-of-care Tool.

Dehydration is a well-known problem worldwide, and its assessment can be challenging due to confusing physical signs. The most effective way to assess hydration status is through the costly stable isotope methodology, but this approach has practical limitations. More commonly accepted and utilized indicators of hydration status are hematological and urinary parameters. However, hematological markers require invasive methods, and urinary markers have varying degrees of success in tracking hydration changes. While alterations in body weight can serve as a means of promptly evaluating hydration status, various factors such as food consumption, fluid intake, fecal losses, and urine production can impact these changes. Researchers have turned their attention to saliva as a potential marker and point-of-care (POC) testing to address the limitations of existing biomarkers. Saliva is appealing due to its easy collection process and similarities to extracellular fluid in terms of water and ion concentrations. Recent studies have shown that saliva flow rate, osmolarity/osmolality, and total protein concentration can effectively monitor changes in body mass during acute dehydration. Misdiagnosing dehydration can have severe clinical consequences, leading to morbidity and even mortality. This narrative review focuses on recognizing the significance of hydration assessment, monitoring, and the potential of salivary osmolarity (SOSM) as an assessment tool. Healthcare professionals can improve their practices and interventions to optimize hydration and promote overall wellness using such tools.

Diabetes Fever.

While diabetes manifests multiple clinical presentations, complications and comorbidities, most modern discourse focuses on the cardiovascular aspects of the syndrome. In this communication, we explore the vast spectrum of fever and diabetes. We highlight the bidirectional interactions between febrile illness and diabetes, as well as drug-drug interactions. These multifaceted connections must be understood by all health care professionals who manage diabetes and/or fever.

Functional Foods may be Dysfunctional: A South Asian Perspective.

This communication describes a few functional seeds and spices, commonly consumed in South Asia, which may impair the absorption of drugs that are used in diabetes and medical management. The aim of this article is to highlight the possibility of these foods having a 'dysfunctional', rather than functional effect on health. Physicians should include questions about the use of these spices in their history taking.

Emotional fluidity in chronic care.

In this exploratory opinion piece, we define emotional fluidity as a state of changing emotions which influence choice of, attitudes and behaviour towards, and response to, chronic health care and therapy. This manifests clinically as changing opinions regarding suitability of modern health care, and as or varying, responses to suggestions and interventions from the health care team. Diabetes distress is an extreme example of emotional fluidity. Emotional fluidity also encompasses the variability of the health care professional's response to emotional and medical needs of persons seeking care. This can be inter-individual or intra-individual, and can be influenced by compassion fatigue. Health care professionals should be aware of emotional fluidity, and should be able to address its negative impact, as well as amplify its positive influence.

Infectious Disease And Diabetes.

In this communication, we provide a bird's eye view of the various ways in which infectious diseases intersect with diabetes. We list the ways in which infectious diseases can influence glucose homoeostasis and diabetes management, and explores how diabetes care is associated with infections and infection management. This is especially important for health care providers in regions with a high burden of infectious disease.

Healer's High.

We explore the concept of healer's high, a phenomenon similar to runner's high. We define healer's high as a psycho-endocrine response of intense happiness and bliss, accompanied by a feeling of enhanced energy, experienced by health care professionals when they heal or help someone. We describe the endocrinology that underlies healer's high, and posit that this phenomenon may be used to enhance professional satisfaction, and mitigate compassion fatigue and burnout.

The Diabetic Platelets.

This communication describes the platelet morphology and physiology noted in persons with diabetes and its complications. It reviews the effects of glucose lowering drugs on platelet function, and summarizes the role of anti-platelet drugs in diabetes management.

Lemborexant: An adjuvant in difficult-to-control diabetes?

Diabetes is a multi-faceted syndrome on which the brain is an etiopathogenetic factor, as well as a target organ for damage. Drugs which act on the brain, such as bromocriptine and antipsychotic drugs, are known to influence glycaemic control. This article describes lemborexant, a dual oxexin receptor antagonist (DORA), and hypothesizes that it may be used as an adjuvant in difficult-to-control diabetes. Its utility should be explored in persons with insomnia and high fasting glucose, unregulated appetite, and diabetes distress.

Lupus nephritis: an update.

Lupus nephritis (LN) is an inflammatory condition of the kidneys that encompasses various patterns of renal disease including glomerular and tubulointerstitial pathology. It is a major predictor of poor prognosis in patients with systemic lupus erythematosus (SLE). Genetic factors, including several predisposing loci, and environmental factors, such as EBV and ultraviolet light, have been implicated in the pathogenesis. It carries a high morbidity and mortality if left untreated. Renal biopsy findings are utilized to guide treatment. Optimizing risk factors such as proteinuria and hypertension with renin-angiotensin receptor blockade is crucial. Immunosuppressive therapy is recommended for patients with focal or diffuse proliferative lupus nephritis (Class III or IV) disease, and certain patients with membranous LN (Class V) disease. Over the past decade, immunosuppressive therapies have significantly improved long-term outcomes, but the optimal therapy for LN remains to be elucidated. Cyclophosphamide-based regimens, given concomitantly with corticosteroids, have improved survival significantly. Even though many patients achieve remission, the risk of relapse remains considerably high. Other treatments include hydroxychloroquine, mycofenolate mofetil, and biologic therapies such as Belimumab, Rituximab, and Abatacept. In this paper, we provide a review of LN, including pathogenesis, classification, and clinical manifestations. We will focus, though, on discussion of the established as well as emerging therapies for patients with proliferative and membranous lupus nephritis.