Management of diabetic dyslipidemia in Indians: Expert consensus statement from the Lipid Association of India.

In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians.

Primary hypothyroidism presenting as pseudoacromegaly.

Pseudoacromegaly is a condition characterized by cutaneous manifestations of growth hormone excess but with normal growth hormone levels. This is described in patients with severe insulin resistance, pachydermoperiostitis, burnt out acromegaly and with intake of drugs like Minoxidil. Severe thyroid hormone deficiency rarely present with similar picture and the issue is further complicated in presence of pituitary hyperplasia. We report an unusual presentation of primary hypothyroidism with pseudoacromegaly and thyrotroph hyperplasia mimicking a pituitary macroadenoma. The thyrotroph hyperplasia resolved completely with levothyroxine therapy.

Palmoplantar keratoderma with growth hormone deficiency.

Palmoplantar keratoderma (PPK) is a diverse group of disorders, characterized by thickening of the palms and soles, which are subdivided into focal or diffuse; it can be acquired or hereditary. Syndromic association of PPK is described in literature with all patterns of inheritance. Skin and nail changes, predisposition to malignancy, skeletal deformities, dwarfism and enamel abnormalities are rarely associated with PPK. In this case report, we present monozygotic twin sisters with palmoplantar keratoderma and growth hormone deficiency. We speculate a common mutation leading to these two apparently unrelated entities.

Diabetes in young--unusual case presentation.

Diabetes in young is increasing in prevalence with each decade. Phenotypic features like obesity and acanthosis nigricans characterize type 2 diabetes, whereas autoimmune diseases like vitiligo and hypothyroidism suggest type 1 diabetes. We recently encountered a young boy with vitiligo who presented with hyperglycemia, but not associated with ketonuria and has underlying chronic pancreatitis with secondary diabetes. We report the case for its unusual presentation and etiology of the diabetes.

SADDAN syndrome.

Achondroplasia is the most common type of short-limbed dwarfism in children resulting from fibroblast growth factor receptor (FGFR) mutations. Activating mutations of FGFR3 also result in other forms of skeletal dysplasia and craniosynostosis. Acanthosis nigricans is associated with these skeletal dysplasias and we recently encountered a skeletal dysplasia along with acanthosis nigricans in a young boy. We report the case due its unusual nature affecting one of twin brothers.

COVID-19: From bench to bed side.

BACKGROUND AND AIMS: The last two decades have experienced the outbreaks of three different coronaviruses in the different parts of the world namely; Severe acute respiratory syndrome cornonavirus-1 (SARS-CoV-1), Middle East respiratory syndrome (MERS-CoV) and Severe acute respiratory syndrome cornonavirus-2 (SARS-CoV-2). We aimed to delineate the differences in viral dynamics and clinical features between them and tried to focus on every basic details of SARS-COV-2 (COVID-19) that every health care provider must know. METHODS: We systematically searched the PubMed database up till April 2, 2020 and retrieved all the articles published on SARS-CoV-2, SARS-CoV-1, MERS-CoV that dealt with viral dynamics. RESULTS: Ample data is available to suggest the differences in etiology, transmission cycle, diagnosis, genetics, hosts, reproductive rates, clinical features, laboratory diagnosis and radiological features between SARS-CoV-1, MERS-CoV and SARS-CoV-2. CONCLUSION: Although SARS-CoV-2 (COVID-19) is more infectious than SARS-CoV-1 and MERS-CoV, most infections are generally mild and self-limiting. However, case-fatality rates are very high in patients with COVID-19 with comorbidities, compared to SARS-CoV-1 and MERS-CoV.

Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries.

BACKGROUND AND AIMS: No drugs are currently approved for Coronavirus Disease-2019 (COVID-19), although some have been tried. In view of recent studies and discussion on chloroquine and hydroxychloroquine (HCQ), we aimed to review existing literature and relevant websites regarding these drugs and COVID-19, adverse effects related to drugs, and related guidelines. AIMS AND METHODS: We systematically searched the PubMed database up till March 21, 2020 and retrieved all the articles published on chloroquine and HCQ and COVID-19. RESULTS: Two small human studies have been conducted with both these drugs in COVID-19, and have shown significant improvement in some parameters in patients with COVID-19. CONCLUSION: Considering minimal risk upon use, a long experience of use in other diseases, cost-effectiveness and easy availability across India, we propose that both these drugs are worthy of fast track clinical trial for treatment, and may be carefully considered for clinical use as experimental drugs. Since HCQ has been approved for treatment of diabetes in India, it should be further researched in diabetes and COVID-19, a subgroup where significant mortality has been shown.

A Practical Approach to Hypertension Management in Diabetes.

Hypertension is one of the most important comorbidities of diabetes, contributing significantly to death and disability and leads to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. Practical approaches to hypertension in diabetes, including individualized targets are discussed, as per stage and complication of diabetes, according to current studies and guidelines. Angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARBs) are the most effective drugs for treating hypertension in diabetes, in the absence of contraindications. Calcium antagonists or diuretics are acceptable as second-line agents. Once the target is achieved, antihypertensive drugs should be continued. Newer antidiabetes medications such as sodium glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), and dipeptidyl peptidase-4 inhibitors (DPP4i) have antihypertensive properties and may assist in treatment decision-making.

Adjuvant gonadotropin releasing hormone analog in gonadotoxic chemotherapy for preservation of fertility.

Chemotherapy induced infertility is a problem which is growing and often neglected. Fertility preservation strategy is an important component of the management in young patients with cancer. Gonadotropin releasing hormone analog therapy helps in ovarian suppression and the evidence is inconclusive for its benefit in fertility preservation. Other medical benefits with these drugs include reduction of vaginal bleeding in patients with thrombocytopenia.

Addition of exenatide or sitagliptin to insulin in new onset type 1 diabetes: a randomized, open label study.

Incretin based therapies are known to have pleotropic benefits in type 2 diabetes but have not been studied in new onset type 1 diabetes. In this randomized, open label study, we investigated the effect of the addition of exenatide or sitagliptin to insulin in patients with new onset type 1 diabetes. Our data suggest that the addition of exenatide and sitagliptin decreases insulin requirements without increasing endogenous insulin production and hypoglycemic events.