SGLT2i as a First-line Antihyperglycemic in the Management of Type 2 Diabetes in the Context of Indians: A Systematic Review and Consensus.

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been used for almost a decade and have proven to be effective not only in managing Type 2 diabetes (T2D), but their cardio and renal protective features make them very useful in managing patients with risk of multiple comorbidities. This systematic review was undertaken by the authors because there is no evidence currently available in India that has studied the suitability of SGLT2i as a first-line agent in patients newly diagnosed with T2D in India. MATERIALS AND METHODS: First, literature was searched to identify features that are considered important when deciding on a first-line agent for managing T2D. A total of 5 broad topics were identified-glycemic control, extra glycemic effects, antihyperglycemic combination therapy, safety, and cost-effectiveness. These domains had further subheadings, and a total of 16 domains were identified. Metformin is the drug of choice as a first-line agent in such situations and has been considered the gold standard for evaluating the effects of SGLT2i across these domains. A systematic literature review on each domain was conducted to compare SGLT2i with the gold standard in Indian patients newly diagnosed with T2D. Evidence was graded (levels of evidence (LoE)-A, B, and C), and recommendations (class of recommendation (CoR)-I, II, and III) were classified by the expert group as defined in the methodology. RESULTS: According to the systematic reviews conducted, 11 domains had Level A evidence, 2 domains (impact on lipids and gut microbiome) had Level B, and 3 domains had Level C (ß-cell function, renal protection, and glycemic variability) evidence. Based on evidence and expert opinion, the authors recommend SGLT2i as a first-line agent for managing newly diagnosed patients with T2D with a Class I recommendation for 13 domains and Class II for the remaining 3 (impact on lipids, gut microbiome, and ß-cell function). Although a poorer level of evidence (Level C) was available for the glycemic variability domain, the authors still reported this as Class I recommendations according to their expert opinion and consensus. CONCLUSION: This article advocates adopting SGLT2 inhibitors as the primary treatment choice for treating patients with newly diagnosed T2D in India.

Comparison of venous plasma glucose and capillary whole blood glucose in the diagnosis of gestational diabetes mellitus: a community-based study.

BACKGROUND: Universal screening for gestational diabetes mellitus (GDM) is advocated in Indian women as they have the highest frequency of GDM among the South Asian population. For this the diagnostic procedure has to be simple, economical, and evidence based. Hence, this study was undertaken to compare point-of-care measured capillary whole blood glucose (CBG) with a glucometer and laboratory-estimated venous plasma glucose (VPG) and to suggest which is feasible as a diagnostic tool. METHODS: Consecutive pregnant women in the third trimester were included in this study with the approval of the institutional ethical committee. They were given 75 g of oral glucose in the fasting state. After 2 h, CBG was measured by finger prick using an Accu-Chek(®) glucometer (Roche Diagnostics India Pvt. Ltd., Mumbai, India), and venous blood was drawn to estimate VPG in the laboratory by the glucose oxidase-peroxidase method. The diagnosis of GDM was based on a 2-h plasma glucose level of ≥7.8 mmol/L (World Health Organization criteria). RESULTS: Among 819 pregnant women, 86 (10.5%) were diagnosed as having GDM. The CBG value at a 2-h plasma glucose level of ≥7.8 mmol/L had a sensitivity of 80.2% and specificity of 98.5% with false-positive and false-negative rates of 1.5% and 19.8%, respectively. The area under the receiver operator characteristic curve of CBG was 0.991. CONCLUSION: The CBG value at a 2-h plasma glucose level of ≥7.8 mmol/L may be recommended for the diagnosis of GDM in healthcare centers where laboratory technology is not available.

Point of care for gestational diabetes mellitus--a community-based study.

Universal screening for gestational diabetes mellitus (GDM) is advocated in Indian women as they have the highest frequency of GDM, among South Asian population. For this the diagnostic procedure has to be simple, economical and evidence based. Hence, this study was undertaken to compare the point-of-care measuring capillary blood glucose (CBG) by glucometer and venous plasma glucose (VPG) estimated in the laboratory and to suggest the feasible diagnostic tool. Consecutive pregnant women in the third trimester were included in this study with the approval of the institutional ethical committee. They were given 75 g oral glucose in the fasting state. After 2 hours, CBG was measured by finger-prick using one touch select simple glucometer and venous blood was drawn to estimate VPG in the laboratory by GOD- POD method. The diagnosis of GDM was based on 2 hours plasma glucose > or = 7.8 mmol/l. Among a cohort of 500 pregnant women, 32 (6.4%) were diagnosed as GDM in their first visit. The CBG value at 2 hours plasma glucose > or = 7.8 mmol/l had a sensitivity of 93.8% and specificity of 97.4% with a false positive and false negative of 2.6% and 6.2%, respectively. The area under the receiver operating characteristic curve of CBG was 0.993. CBG value at 2 hours plasma glucose > or = 7.8 mmol/l may be recommended for the diagnosis of GDM in healthcare centres where laboratory technology is not available.

Pregnancy and diabetes scenario around the world: India.

Women with gestational diabetes mellitus (GDM) are at an increased risk of developing diabetes in the future, as are their offspring. GDM is not only of clinical relevance, but is also an important public health issue. A community-based prospective study showed that the prevalence of GDM was 13.9%. We also observed that the frequency of GDM varied across urban, semi-urban, and rural areas. Based on multiple logistic regression analysis and taking the 3 areas into consideration, family history of diabetes, age greater than or equal to 25 years, and body mass index greater than or equal to 25 were found to have a significant independent association with GDM (P<0.001).