Diabetes in India's North East Study: Prevailing Insulin Usage and Insulin Injection Practices amongst Type 2 Diabetes Mellitus Patients.

OBJECTIVE: Insulin therapy is mostly advised in patients with poorly controlled type 2 diabetes mellitus (T2DM). However, wide variation exists in insulin practice and usage across the Indian geography. MATERIALS AND METHODS: In this cross-sectional study, a retrospective audit of the medical records of T2DM patients who were receiving insulin and attending an urban referral clinic in Northeast India during the period from 2006 to 2017 was conducted to analyze the insulin utilization pattern and injection technique variation. A total of 1,454 patients were included, 60% were male and 40% were female. RESULTS: At presentation, the mean duration of T2DM was 12.13 (7.45) years. Insulin with or without oral anti-diabetic (OADs) was received by 52.27% and 47.73% of patients, respectively. The majority (62.93%) used a pen device for insulin administration. The patient-reported reasons for insulin therapy initiation were OAD failure (33.15%), glucotoxicity (30.26%) and diabetesassociated complications (20.36%). The mean ± standard deviation (SD) total daily dose (TDD) of insulin was 33.05 ± 17.09 (0.53 ± 0.30 units/kg/day). The breakup for the number of injection(s) per day was one (234,16.09%), two (970,66.71%), three (166,11.42%), four (78, 5.36%), and five (6, 0.41%). The majority (67.88%) used premixed insulin, while 10.90% used basal insulin alone. Compared to those without lipohypertrophy (LH), patients with LH were less likely to rotate the site of injection (0.85 vs 17.90%; p = 0.000), space the injections (10.71 vs 23.91%; p = 0.000), injected less often in correct site (7.81 vs 29.0%; p = 0.000), more likely to use wrong angles (10.08 vs 22.73%; p = 0.000) and reuse the needles (5.63 vs 14.86%; p = 0.000). Also, 34.87% of patients were not storing their insulin device at the right temperature and 8.87% experienced at least one episode of a hypoglycemic event. CONCLUSION: This audit depicts important attributes of current injection practices amongst T2DM patients on insulin and suggests the possible benefits of adopting correct practices for avoiding complications such as LH and hypoglycemia.

Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid.

Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.

COVID 19: Diabetes and Obesity API-ICP Recommendations.

Diabetes and Obesity are major risk factors which confer vulnerability to Covid 19 . Diabetes has immune defects which makes the individual susceptible to infections and covid 19 is no exception . Also covid 19 can cause pancreatic damage as well as stress hyperglycaemia in hospitals which may need Insulin . Among diabetes male gender,elderly,hypertension ,heart disease and chronic renal disease are more vulbwdvale to covid 19 and need strict supervision . Diabetes management in hospitalised situation merits early diabetes specific nutrition with Insulin. Adherence to lifestyle with self monitoring of blood glucose and adequate supply of Insulin and Oral antidiabetic agents is encouraged.