Risk assessment of diabetes using the Indian Diabetes Risk Score among older adults: Secondary analysis from the Longitudinal Ageing Study in India.

BACKGROUND: The Indian Diabetes Risk Score (IDRS) is a simple tool to assess the probability of an individual having type 2 diabetes (T2DM) but its applicability in community-dwelling older adults is lacking. This study aimed to estimate the risk of T2DM and its determinants among older adults without prior diabetes (DM) using the IDRS, while also assessing its sensitivity and specificity in individuals with a history of diabetes. METHODS: We analyzed cross-sectional data from the Longitudinal Ageing Study in India (LASI) wave-1 (2017-18). IDRS was calculated amongst individuals aged ≥45 years considering waist circumference, physical activity, age and family history of DM. Risk was categorized as high (≥60), moderate (30-50), and low (<30). RESULTS: Among 64541 individuals, 7.27 % (95 % CI: 6.78, 7.80) were at low risk, 61.80 % (95 % CI: 60.99, 62.61) at moderate risk, and 30.93 % (95 % CI: 30.19, 31.67) at high risk for T2DM. Adjusted analysis showed higher risk of T2DM among men, widowed/divorced, urban residents, minority religions, overweight, obese, and individuals with hypertension. ROC curve yielded an AUC of 0.67 (95 % CI: 0.66, 0.67, P < 0.001). The IDRS cutoff ≥50 had 73.69 % sensitivity and 51.40 % specificity for T2DM detection. CONCLUSION: More than 9 in 10 older adults in India without history of DM have high-moderate risk of T2DM when assessed with the IDRS risk-prediction tool. However, the low specificity and moderate sensitivity of IDRS in existing DM cases constraints its practical utility as a decision tool for screening.

Worldwide differences in childhood type 1 diabetes: The SWEET experience.

OBJECTIVE: To study worldwide differences in childhood diabetes, comparing relevant indicators among five regions within the SWEET initiative. SUBJECTS: We investigated 26 726 individuals with type 1 diabetes (T1D) from 54 centers in the European region; 7768 individuals from 30 centers in the Asia/Middle East/Africa region; 2642 people from five centers in Australia/New Zealand; 10 839 individuals from seven centers in North America, and 1114 patients from five centers in South America. METHODS: The SWEET database was analyzed based on the following inclusion criteria: T1D, time period 2015-2019, and age < 21 years, with analysis of the most recent documented year of therapy. For the statistical analysis, we used multivariable linear and logistic regression models to adjust for age (<6 years, 6- < 12 years, 12- < 18 years, 18- < 21 years), gender, and duration of diabetes (<2 years, 2- < 5 years, 5- < 10 years, ≥10 years). RESULTS: Adjusted HbA1c means ranged from 7.8% (95%-confidence interval: 7.6-8.1) in Europe to 9.5% (9.2-9.8) in Asia/Middle East/Africa. Mean daily insulin dose ranged from 0.8 units/kg in Europe (0.7-0.8) and Australia/New Zealand (0.6-0.9) to 1.0 unit/kg 0.9-1.1) in Asia/Middle East/Africa. Percentage of pump use was highest in North America (80.7% [79.8-81.6]) and lowest in South America (4.2% [3.2-5.6]). Significant differences between the five regions were also observed with regards to body mass index SD scores, frequency of blood glucose monitoring and presence of severe hypoglycaemia. CONCLUSIONS: We found significant heterogeneity in diabetes care and outcomes across the five regions. The aim of optimal care for each child remains a challenge.

Comparison of Analogue insulin with other insulins in patients with type 1 diabetes in Ahmedabad, Western India: A Rretrospective study.

BACKGROUND & AIM: Type of insulin is prescribed according to the glycaemic status of the patient, affordability, and preference of the patient. Analogues are considered to be the good therapeutic treatment for patients with type 1 diabetes, as they closely mimic physiological insulin kinetics and minimize the risk of hypoglycemia as compared to other insulin formulations. In this study, we aimed to assess the effectiveness of different insulin regimen (analogue insulins, regular insulins, and NPH insulins) in patients with type 1 diabetes in Ahmedabad, western India. METHOD: A retrospective study was carried out on patients with type 1 diabetes aged below 18 years. They were categorized into three groups as per their insulin regimen-on analogues, on regular insulin and on premix insulin. Their mean HbA1c was extracted from the database in order to know the effectiveness of their respective insulin regimen. Only those patients were studied who had undergone HbA1c from January 2018 to January 2020, who were regular in their visit to the clinic (>3 visits/year in past 2 years), were on stable insulin regimen and had absence of lipodystrophy.Outcome was analyzed based on glycosylated hemoglobin concentration. Because of retrospective nature of the analysis, accurate capture of hypoglycemia data was not possible. RESULTS: .450 patients were studied and out of that 180 were on analogue insulin, 210 were on regular insulin and, 60 patients were on premix insulin. Mean duration of diabetes 7.7 years, 8.2 years and 8.5 years, respectively. The mean Hba1c value in the corresponding insulin regimen was 9.37%, 9.3%, and 9.7% respectively. The difference in HbA1C values was statistically not significant. CONCLUSION: There is no difference in HbA1c levels with the use of any three insulin regimens in patients with type 1 diabetes. Further prospective studies are required in a controlled manner in Indian patients to corroborate these preliminary findings and also compute the risk of hypoglycaemia.