Management Strategies for Hyperglycemia Associated with the α-Selective PI3K Inhibitor Alpelisib for the Treatment of Breast Cancer.

Alpelisib is an α-selective phosphatidylinositol 3-kinase inhibitor used for treating hormone receptor-positive (HR+), human epidermal growth receptor 2-negative (HER2-), PIK3CA-mutated locally advanced or metastatic breast cancer following disease progression on or after endocrine therapy. Hyperglycemia is an on-target effect of alpelisib affecting approximately 60% of treated patients, and sometimes necessitating dose reductions, treatment interruptions, or discontinuation of alpelisib. Early detection of hyperglycemia and timely intervention have a key role in achieving optimal glycemic control and maintaining alpelisib dose intensity to optimize the benefit of this drug. A glycemic support program implemented by an endocrinology-oncology collaborative team may be very useful in this regard. Lifestyle modifications, mainly comprising a reduced-carbohydrate diet, and a designated stepwise, personalized antihyperglycemic regimen, based on metformin, sodium-glucose co-transporter 2 inhibitors, and pioglitazone, are the main tools required to address the insulin-resistant hyperglycemia induced by alpelisib. In this report, based on the consensus of 14 oncologists and seven endocrinologists, we provide guidance for hyperglycemia management strategies before, during, and after alpelisib therapy for HR+, HER2-, PIK3CA-mutated breast cancer, with a focus on a proactive, multidisciplinary approach.

An observational longitudinal study of the impact of sleeve gastrectomy on glycemic control in type 2 diabetes mellitus.

BACKGROUND: Laparoscopic sleeve gastrectomy is increasingly being acknowledged as an effective independent bariatric procedure for obese persons with type 2 diabetes. Data on laparoscopic sleeve gastrectomy from India on this group of patients are limited. This study presents 12-month follow-up data of laparoscopic sleeve gastrectomy on obese Indian patients with type 2 diabetes. SUBJECTS AND METHODS: In total, 43 obese patients with type 2 diabetes who received sleeve gastrectomy surgery in the Department of Bariatric Surgery, Medanta the Medicity, Gurgaon, India, were evaluated prospectively for a period of 1 year. RESULTS: Seven patients missed follow-up visits, and one patient died, leaving 35 patients who were analyzed. The mean glycated hemoglobin (HbA1c) levels at baseline and 12 months after surgery were 7.94±1.9% and 5.80±0.7%, respectively (P<0.001). Of these, 77.14% reached the primary end point of HbA1c level ≤6% without medication. HbA1c level at target (i.e., <7%) occurred in 91.4%. The mean body weight decreased from 122.08±23.32 kg to 83.43±15.12 kg at 12 months (P<0.001). The percentage of weight loss and percentage of excess weight loss at 12 months were 31.14±7.8% and 61.52±15%, respectively. Antidiabetes medication use decreased from 88.57% to 11.4%. CONCLUSIONS: Laparoscopic sleeve surgery is a safe and effective treatment option among the obese Indian type 2 diabetes population with significant remission rates. Follow-up studies are necessary to assess the long-term durability of these results.

Widespread vitamin D deficiency among Indian health care professionals.

UNLABELLED: Information on vitamin D status of Indian health care professionals is limited. Among 2,119 subjects studied, just 6 % were found to be sufficient in vitamin D status. There is urgent need of an integrated approach to detect and treat vitamin D deficiency among health care professionals to improve on-the-job productivity. INTRODUCTION: Vitamin D deficiency is prevalent worldwide. India has been reported to be one of the worst affected countries. Several single-center studies from India have shown high prevalence of vitamin D deficiency. Little is known regarding the vitamin D status of Indian health care professionals. AIM: This study aimed to determine prevalence of vitamin D deficiency among health care professionals in different regions of India. METHOD: In this cross-sectional, multicenter study, we enrolled 2,119 medical and paramedical personnel from 18 Indian cities. Blood samples were collected from December 2010 to March 2011 and analyzed in a central laboratory by radioimmunoassay. Vitamin D deficiency was defined as 25-hydroxyvitamin D [25(OH)D] <20 ng/mL or <50 nmol/L, insufficiency as 25(OH)D = 20-30 ng/mL or 50-75 nmol/L, and sufficiency as 25(OH)D >30 ng/mL or >75 nmol/L. RESULTS: Mean (±SD) age of subjects was 42.71 ± 6.8 years. Mean (±SD) 25(OH)D level was 14.35 ± 10.62 ng/mL (median 11.93 ng/mL). Seventy-nine percent of subjects were deficient, 15 % were insufficient, and just 6 % were sufficient in vitamin D status. No significant difference was found between vitamin D status in southern (25(OH)D = 13.3 ± 6.4 ng/mL) and northern (25(OH)D = 14.4 ± 8.5 ng/mL) parts of India. CONCLUSION: Our study confirms the high prevalence of vitamin D deficiency all across India in apparently healthy, middle-aged health care professionals.