In the Spotlight: Role of Gla-100 in the Glycemic Management of Hospitalized people with diabetes.

Both hyperglycemia and hypoglycemia in hospitalized patients represent a major concern as they are associated with adverse outcomes-including increased rates of infection, longer hospital stay, and even death. Insulin therapy is the mainstay in the management of inpatient hyperglycemia. The traditional approach of sliding scale insulin (SSI) therapy for the temporary management of blood glucose levels in hospitalized patients, has now given way to basal-bolus insulin (BBI) therapy. This is owing to the BBI affording a better glycemic control in non-critical hospital settings as observed in multiple clinical studies using insulin glargine 100 U/mL (Gla-100) as the basal component. Furthermore, a string of clinical studies has also attested to Gla-100 being used effectively even in patients on corticosteroids, enteral or parenteral nutrition, and in perioperative settings. Hence, overall, the existing evidence would point to the growing role of BBI regimens centering around basal insulin like Gla-100 as an effective option with low safety concerns for insulin therapy in both hospitalized and out-patient settings in the treatment of patients with type 2 diabetes mellitus (T2DM).

Single all-optical platform for measurement of twist and transverse stress using polarization modulation in distinct dual-mode fiber placed in a Sagnac loop.

We report here the experimental demonstration of measurement of both twist and transverse stress using polarization modulation in a single all-fiber circuit consisting of a single-mode fiber (SMF)/dual-mode fiber (DMF) in a Sagnac interferometer (SI) loop. The SMF-SI prototype setup is seen to be suitable for precise measurement of twist over a broad range of ±50° and transverse stress up to 5 N with a sensitivity as high as 2.85×10(6) pW/° and 2.08×10(7) pW/N, respectively. It is envisaged that nearly ideal operation for twist measurement can be achieved by appropriately selecting the operating domain (pretwisted Sagnac loop for practical realization of the device) and required magnitude of applied transverse stress (weight yielding maximum sensitivity). Unlike SMF-SI, a DMF assisted SI exhibits asymmetric transmittance yielding a peak shift (∼45°) in addition to falling/rising peak amplitude of effective power(∼20 µW). This key characteristic is further utilized for tunable measurement of torsion (unidirectional from -70° to 40°) while keeping the sensitivity fixed. This research problem is then analyzed on the avenue of theoretical consideration and using classical polarization optics; we have derived the Jones birefringence matrix that accurately describes the transmission behavior of the configured fiber circuit (SMF-SI and DMF-SI) for each of the three cases, namely, transverse stress, twist, and both twist and transverse stress. Series of experimental measurements for various conditions of induced birefringence (linear/circular) were performed at length, and the results were compared with those determined theoretically towards configuring a twist and stress measuring device. The study provides an understanding of the underlying physics of dual-mode interference in a Sagnac configuration experiencing linear and circular birefringence.

Control of evanescent field using a dynamic waveguide composed of gelatin-coated few-layer fiber.

We report here the results of our studies on dynamic refractive-index (RI) profile few-layer fibers in view of controlling the mode-field profile, in particular the evanescent tails under varying structural configuration. We experimentally fabricate dynamic RI profile few-layer fibers using thin gelatin coating on selectively etched fibers and illustrate how the excitation of various modes and the evanescent field at the interface can be controlled with changing humidity parameter. As a technology outcome of this research, we demonstrate through an optimized structural configuration a well performing fiber-optic high (70%-98%) relative humidity (RH) sensor with sensitivity as high as -1.07 dBm/%RH.

Polarization and propagation characteristics of switchable first-order azimuthally asymmetric beam generated in dual-mode fiber.

We report here the controlled generation of a linearly polarized first-order azimuthally asymmetric beam (F-AAB) in a dual-mode fiber (DMF) by appropriate superposition of selectively excited zeroth-order vector modes that are doughnut-shaped azimuthally symmetric beams (D-ASBs). We first demonstrate continually switching polarization mode structures having an identical two-lobe intensity profile (i.e., intra-F-AAB conversion). Then, under a distinct launching state, we generate mode structures progressively toggling between the doughnut-shaped profile and two-lobe pattern having dissimilar polarization orientations (i.e., F-AAB to D-ASB conversion). Interestingly, a decentralized elliptical Gaussian beam possessing homogenous spatial polarization is obtained by enhancing the contribution of the fundamental mode (HE11/LP01) in selectively excited F-AAB. A smoothly varying azimuth of the input beam in this situation resulted in redistribution of transverse energy procuring a unique and exciting unconventional two-grain T-polarized beam having mutually orthogonal state of polarization (SOP). All of the above three were achieved under a given set of launching conditions (tilt/offset) of a Gaussian mode (TEM00) devised with changing SOP of the input beam. A strong modulation in the output beam characteristics was also observed with the variation in propagation distance (for a fixed input SOP) owing to the large difference in propagation constants of the participating modes (LP01 and one of the F-AABs). Finally, this particular study led to a design for a low-cost highly sensitive strain measuring device based on tracking the centroid movement of the output intensity pattern. Each of our experimentally observed intensity/polarization distributions is theoretically mapped on a one-to-one basis considering a linear superposition of appropriately excited LP basis modes of the waveguide toward a complete understanding of the polarization and mode propagation in the dual-mode structure.

Hexacoordinate nickel(II)/(III) complexes that mimic the catalytic cycle of nickel superoxide dismutase.

A functional model complex of nickel superoxide dismutase (NiSOD) with a non-peptide ligand which mimics the full catalytic cycle of NiSOD is unknown. Similarly, it has not been fully elucidated whether NiSOD activity is a result of an outer- or inner-sphere electron-transfer mechanism. With this in mind, two octahedral nickel(II)/(III) complexes of a bis-tridentate N2 S donor carboxamide ligand, N-2-phenylthiophenyl-2'-pyridinecarboxamide (HL(Ph)), have been synthesized, structurally characterized, and their SOD activities examined. These complexes mimic the full catalytic cycle of NiSOD. Electrochemical experiments support an outer-sphere electron-transfer mechanism for their SOD activity.

Practise Updates: Diagnosis and Management of Idiopathic Hirsutism.

Idiopathic hirsutism (IH) is a common clinical condition with multiple diagnostic and therapeutic uncertainties. There are no clear recommendations for the diagnosis and management of the condition. This practice update was developed to guide the primary care physicians and the specialists in better and more systematic management of IH particularly in the Indian context. Twelve experienced members consisting of eminent endocrinologists, physicians, a dermatologist, a gynaecologist and a psychiatrist were invited by the Integrated Diabetes and Endocrine Academy (IDEA). A literature search was performed using online databases from PubMed, Cochrane Library and Google Scholar. Published articles from peer-reviewed indexed journals, with a preference for meta-analyses and randomized controlled trials, were selected. A meeting took place with all the 12 members individually giving their opinions on predetermined questions of interest. After the initial meeting during IDEACON 2023, two more meetings were held and the practice update was formulated after voting. Practice updates were made on important areas such as the cut-off for modified Ferriman-Gallwey Score for the Indian population, conditions to be excluded before diagnosing IH, when to refer to specialists, investigations in a suspected case of IH and choice of therapies for its management.

Copper complexes relevant to the catalytic cycle of copper nitrite reductase: electrochemical detection of NO(g) evolution and flipping of NO2 binding mode upon Cu(II) → Cu(I) reduction.

Copper complexes of the deprotonated tridentate ligand, N-2-methylthiophenyl-2'-pyridinecarboxamide (HL1), were synthesized and characterized as part of our investigation into the reduction of copper(II) o-nitrito complexes into the related copper nitric oxide complexes and subsequent evolution of NO(g) such as occurs in the enzyme copper nitrite reductase. Our studies afforded the complexes [(L1)Cu(II)Cl]n (1), [(L1)Cu(II)(ONO)] (2), [(L1)Cu(II)(H2O)](ClO4)·H2O (3·H2O), [(L1)Cu(II)(CH3OH)](ClO4) (4), [(L1)Cu(II)(CH3CO2)]·H2O (5·H2O), and [Co(Cp)2][(L1)Cu(I)(NO2)(CH3CN)] (6). X-ray crystal structure determinations revealed distorted square-pyramidal coordination geometry around Cu(II) ion in 1-5. Substitution of the H2O of 3 by nitrite quantitatively forms 2, featuring the κ(2)-O,O binding mode of NO2(-) to Cu(II). Reduction of 2 generates two Cu(I) species, one with κ(1)-O and other with the κ(1)-N bonded NO2(-) group. The Cu(I) analogue of 2, compound 6, was synthesized. The FTIR spectrum of 6 reveals the presence of κ(1)-N bonded NO2(-). Constant potential electrolysis corresponding to Cu(II) → Cu(I) reduction of a CH3CN solution of 2 followed by reaction with acids, CH3CO2H or HClO4 generates 5 or 3, and NO(g), identified electrochemically. The isolated Cu(I) complex 6 independently evolves one equivalent of NO(g) upon reaction with acids. Production of NO(g) was confirmed by forming [Co(TPP)NO] in CH2Cl2 (λ(max) in CH2Cl2: 414 and 536 nm, ν(NO) = 1693 cm(-1)).

Characteristics of transverse-stress-induced phase change through a distinct dual-mode fiber in a Sagnac loop.

We report here the experimental realization of a fiber-optic transverse-stress sensor devised by a dual-mode optical-fiber segment in a standard Sagnac interferometer loop. The intermodal interference of the LP01 and LP02 modes of the dual-mode fiber (DMF) configuration is analyzed theoretically in the platform of polarization transmittance of the Sagnac loop in implementing the theoretical model. Several experimental measurements for various conditions of applied birefringence are studied at length and the results are compared with those estimated theoretically toward configuring a stress-measuring device. The study provides an understanding of the underlying physics of the working of DMF interference in a Sagnac configuration.

Hypophysitis - A Review of Fourteen Cases.

Background: Primary hypophysitis is a rare condition, usually diagnosed retrospectively after surgery for a suspected pituitary adenoma. Improved awareness of the condition and better imaging have resulted in more patients being diagnosed without surgery. Objective: A retrospective chart analysis study of hypophysitis from a single secondary endocrine and neurosurgical referral center in eastern India was conducted between 1999 and 2021 to assess the diagnostic and therapeutic challenges posed by these patients. Methods and Material: Fourteen patients presented to the center between 1999 and 2021. All patients had an MRI of the head with contrast and a full clinical workup. Twelve patients had headache, of whom one had progressive visual impairment. One patient had severe weakness, attributed later to hypoadrenalism and one had sixth nerve palsy. Results: Six patients had glucocorticoids as their primary treatment, four refused treatment, and one was on glucocorticoid replacement. One patient had decompressive surgery because of progressive visual loss, and two had surgery because of a presumptive diagnosis of pituitary adenoma. There was no difference between the patients who had glucocorticoids and those who did not. Conclusions: Our data suggest that it is possible to identify most patients with hypophysitis on clinical and radiological grounds. In the largest published series on this subject and in ours, glucocorticoid treatment did not alter the outcome.

IDEA Group Consensus Statement on Medical Management of Adult Gender Incongruent Individuals Seeking Gender Affirmation as Male.

Gender-affirming hormone therapy (GAHT) is the most frequent treatment offered to gender-incongruent individuals, which reduces dysphoria. The goal of therapy among gender-incongruent individuals seeking gender affirmation as male is to change their secondary sex characteristics to affect masculine physical appearances. GAHT greatly improves mental health and quality of life among gender incongruent individuals. India-specific guideline for appropriate care for gender-incongruent individuals is almost absent. This document is intended to assist endocrinologists and other healthcare professionals interested in gender incongruity for individuals seeking gender affirmation as male. A safe and effective GAHT regimen aims to effect masculinising physical features without adverse effects. In this document, we offer suggestions based on an in-depth review of national and international guidelines, recently available evidence and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement provides protocols for the hormone prescribing physicians relating to diagnosis, baseline evaluation and counselling, prescription planning for masculinising hormone therapy, choice of therapy, targets for monitoring masculinising hormone therapy, clinical and biochemical monitoring, recommending sex affirmation surgery and peri-operative hormone therapy. The recommendations made in this document are not rigid guidelines, and the hormone-prescribing physicians are encouraged to modify the suggested protocol to address emerging issues.

Shuttling of nickel oxidation states in N4S2 coordination geometry versus donor strength of tridentate N2S donor ligands.

Seven bis-Ni(II) complexes of a N(2)S donor set ligand have been synthesized and examined for their ability to stabilize Ni(0), Ni(I), Ni(II) and Ni(III) oxidation states. Compounds 1-5 consist of modifications of the pyridine ring of the tridentate Schiff base ligand, 2-pyridyl-N-(2'-methylthiophenyl)methyleneimine ((X)L1), where X = 6-H, 6-Me, 6-p-ClPh, 6-Br, 5-Br; compound 6 is the reduced amine form (L2); compound 7 is the amide analog (L3). The compounds are perchlorate salts except for 7, which is neutral. Complexes 1 and 3-7 have been structurally characterized. Their coordination geometry is distorted octahedral. In the case of 6, the tridentate ligand coordinates in a facial manner, whereas the remaining complexes display meridional coordination. Due to substitution of the pyridine ring of (X)L1, the Ni-N(py) distances for 1~5 < 3 < 4 increase and UV-vis λ(max) values corresponding to the (3)A(2g)(F)→(3)T(2g)(F) transition show an increasing trend 1~5 < 2 < 3 < 4. Cyclic voltammetry of 1-5 reveals two quasi-reversible reduction waves that correspond to Ni(II)→Ni(I) and Ni(I)→Ni(0) reduction. The E(1/2) for the Ni(II)/Ni(I) couple decreases as 1 > 2 > 3 > 4. Replacement of the central imine N donor in 1 by amine 6 or amide 7 N donors reveals that complex 6 in CH(3)CN exhibits an irreversible reductive response at E(pc) = -1.28 V, E(pa) = +0.25 V vs saturated calomel electrode (SCE). In contrast, complex 7 shows a reversible oxidation wave at E(1/2) = +0.84 V (ΔE(p) = 60 mV) that corresponds to Ni(II)→Ni(III). The electrochemically generated Ni(III) species, [(L3)(2)Ni(III)](+) is stable, showing a new UV-vis band at 470 nm. EPR measurements have also been carried out.

Non-conventional Genetic Basis of Congenital Adrenal Hypoplasia in South Asia.

Congenital adrenal hypoplasia or adrenal hypoplasia congenita (AHC) is a rare disorder ascribed to mutations in three genes, namely, the dosage-sensitive sex reversal-adrenal hypoplasia congenita critical region on the X chromosome, gene 1 (DAX-1/NROB1 gene), steroidogenic factor-1 gene (SF-1/NR5A1 gene), and Achalasia-Addisonianism-Alacrima syndrome gene (AAAS gene). Five cases of AHC of local South Asian origin are described here. Golden Helix VarSeq 2.2.0 (Golden Helix Inc., Bozeman, MT, United States), the clinical genomics interpretation and reporting platform, was used for genetic study. No subject had congenital adrenal hyperplasia (CAH). Four male neonates presented with hypoglycemia, and one older female child presented with hyperpigmentation. This girl had a recognized mutation in the AAAS gene, while none of the four male neonates had any of the recognized mutations associated with AHC. Further, none were salt-losing, which is the conventional Western phenotype. Thus, additional, yet unknown, gene(s) must be operative in AHC among South Asian subsets.

Clinical Profile of Long-Term Survivors and Nonsurvivors with Type 1 Diabetes in India.

Objective: To compare the clinical profile of long-term survivors and nonsurvivors with type 1 diabetes (T1D) in India. Research Design and Methods: This is a retrospective study of 76 individuals with T1D who had survived for at least 40 years ("survivors") and 51 individuals with T1D who had died with shorter duration of diabetes ("non-survivors"), from diabetes clinics in different cities of India. Prevalence of complications in both groups and causes of death of the nonsurvivors were analyzed. Retinopathy was diagnosed by retinal photography; chronic kidney disease (CKD) by urinary albumin excretion (micro-or macroalbuminuria) and estimated glomerular filtration rate; peripheral vascular disease (PVD) by doppler measurement of ankle-brachial pressure index; coronary artery disease (CAD) based on history of myocardial infarction or coronary revascularization, and neuropathy by biothesiometry. Results: Mean glycated hemoglobin (8.4% ± 1.5% vs. 10.7% ± 2.2%, P < 0.001), serum low-density lipoprotein cholesterol (91 ± 29 mg/dL vs. 107 ± 22 mg/dL, P = 0.004), and systolic blood pressure (135 ± 16 mmHg vs. 153 ± 37 mmHg, P = 0.003) were lower, and high-density lipoprotein cholesterol (51 ± 11 mg/dL vs. 43 ± 15 mg/dL, P = 0.002) higher, among survivors compared to nonsurvivors. Diabetic retinopathy, CKD, neuropathy, PVD, and CAD were more frequent among nonsurvivors. CAD [25.5%] and renal failure [23.5%] were the most frequent causes of death. Conclusions: In this first report of long-term survivors with T1D from India, we report that survivors had better glycemic and blood pressure control, more favorable lipid profiles and lower prevalence of complications compared to nonsurvivors. However, there could be other protective factors as well, which merit further studies.

Drug arrests and injection drug deterrence.

OBJECTIVES: We tested the hypothesis that higher rates of previous hard drug-related arrests predict lower rates of injection drug use. METHODS: We analyzed drug-related arrest data from the Federal Bureau of Investigation's Uniform Crime Reporting Program for 93 large US metropolitan statistical areas in 1992 to 2002 to predict previously published annual estimates of the number of injection drug users (IDUs) per 10,000 population. RESULTS: In linear mixed-effects regression, hard drug-related arrest rates were positively associated (parameter = +1.59; SE = 0.57) with the population rate of IDUs in 1992 and were not associated with change in the IDU rate over time (parameter = -0.15; SE = 0.39). CONCLUSIONS: Deterrence-based approaches to reducing drug use seem not to reduce IDU prevalence. Alternative approaches such as harm reduction, which prevents HIV transmission and increases referrals to treatment, may be a better foundation for policy.

Changes in the prevalence of injection drug use among adolescents and young adults in large U.S. metropolitan areas.

Young injection drug users (IDUs) are at risk for acquiring blood-borne diseases like HIV and Hepatitis C. Little is known about the population prevalence of young IDUs. We (1) estimate annual population prevalence rates of young IDUs (aged 15-29) per 10,000 in 95 large U.S. metropolitan statistical areas (MSAs) from 1992 to 2002; (2) assess the validity of these estimates; and (3) explore whether injection drug use among youth in these MSAs began to rise after HAART was discovered. A linear mixed model (LMM) estimated the annual population prevalence of young IDUs in each MSA and described trends therein. The population prevalence of IDUs among youths across 95 MSAs increased from 1996 (mean = 95.64) to 2002 (mean = 115.59). Additional analyses of the proportion of young IDUs using health services suggest this increase may have continued after 2002. Harm reduction and prevention research and programs for young IDUs are needed.

Congenital adrenal hyperplasia: an Indian experience.

AIMS: Data regarding the presentation and course of patients with congenital adrenal hyperplasia (CAH) is scarce in South Asia. We aimed to fill that gap by collating our experience with CAH and comparing it with findings from few other centres around the world for pertinent differences. METHODS: We retrospectively analysed the records of 86 CAH patients seen at our tertiary care centre in Eastern-India from 1996 to 2010. RESULTS: Forty-five patients (52.3%) had classic disease and 41 (47.7%) had non-classic disease (NC CAH). In the classic CAH group, 18 (20.9%) had salt wasting CAH (SW CAH) while 27 (31.4%) had simple virilising disease (SV CAH). Ten (11.6%) had a 46,XY karyotype. Patients with SW CAH were diagnosed earlier in infancy at a median age of 0.5 year, than those with SV type, who were diagnosed at 9 years (P < 0.05). The NC CAH patients were diagnosed still later, at 20.4 years. In patients with SW CAH, boys were diagnosed at an earlier median age of 0.1 year than girls who were diagnosed at 6.4 years (P < 0.05). Sixteen girls (21% of the girls) underwent vaginoplasty of whom four required additional clitoroplasty. One girl needed bilateral laparoscopic adrenalectomy. One NC CAH patient had a successful assisted pregnancy. Hypothyroidism, found in seven (8.1%) was the commonest coexisting abnormality. CONCLUSION: The skewed male : female ratio suggested that a substantial proportion of males were being missed and consequently may die. Majority of the diagnosed patients (n= 55, 64%) have been lost to follow-up. Remaining patients could be reasonably controlled with standard therapy.

Impact of oral anticholinergic on insulin response to oral glucose load in patients with impaired glucose tolerance.

BACKGROUND: Preliminary data indicates there is a cholinergic basis to insulin secretion. AIMS & OBJECTIVE: To investigate the impact of oral anticholinergics on insulin secretion in subjects with impaired glucose tolerance (IGT), in comparison with volunteers having normal glucose tolerance (NGT). Material & Methods: This prospective observational study recruited 10 IGT and 10 NGT subjects. An oral glucose tolerance test (OGTT) was conducted twice in the absence and presence of hyoscine butyl-bromide (HBB). The plasma glucose (PG) and insulin levels were serially estimated at 30-min increments for 2 h after the OGTT. Early (ΔI30/ΔPG30) & late (insulin/PGAUC 60-120) phase insulin activity were assessed subsequently. RESULTS: The study constituted of 10 IGT (4M/6F, BMI: 28.80 ± 2.30) and 10 NGT (5M/5F, BMI: 23.00 ± 0.80) subjects. In the NGT group, the pre-HBB mean glucose levels (0-120 min) were comparable with those recorded after HBB intake. However, after HBBB, the mean insulin levels decreased significantly at t = 90 and 120min, confirmed by attenuated late phase insulin activity in IGT (P = 0.023) & NGT (P = 0.006) group. On the other hand, in the IGT group, however, HBB did not impact on the mean PG and insulin levels (0-120 min). CONCLUSIONS: Our study findings indicate that insulin secretion is influenced by cholinergic system and that oral anticholinergics may attenuate the late phase insulin activity in varying degrees of glycemic status.

Exploring Cross-Sectional Predictors of Suicide Ideation, Attempt, and Risk in Gender Incongruent Adults in India.

INTRODUCTION: Suicide rates and suicidal tendencies among gender incongruent persons are higher compared to the general population. Yet little is known about the factors that are relevant for suicide-related outcomes among Indian gender incongruent individuals. MATERIALS AND METHODS: Within a large sample of gender incongruent adults (n=120), we examined the contribution of demographic (age, assigned sex, gender identity, relationship, and addiction status) and socio-economic variables (education, profession, income, social support) in the prediction of three suicide-related outcomes: past-year suicidal thought, history of suicidal attempt and a composite measure of the two. RESULTS: Of the entire sample, 25.8% (n=31) reported a past suicide attempt, with 18.3% (n = 22) reporting one attempt, 2.5% (n = 3) reporting two attempts, 1.7% (n = 2) reporting three attempts and 2.5% (n=3) reporting four to six attempts. The age at which the first suicide attempt occurs is mostly between 16 to 18 years. 19.26% (n = 21) reported that although they had not attempted suicide, they had given serious thought to killing themselves in the last year. A Chi-square test was conducted to ascertain each demographic variable and socio-economic marker. However, none of these proposed predictors correlated with suicide-related outcomes in our cohort. CONCLUSIONS: The gender incongruent community is highly susceptible to suicidal behavior. Gender identity may be the risk factor for that behavior. Further study with larger population needs to identify other relevant risk factors, including gender-related victimization and mental health conditions as risk factors.

Excellent Outcome of Protocol-Based Treatment of Motivated Type 2 Diabetes Mellitus (T2DM) Patients: A Real World Follow-Up for 11 Years.

Introduction and aim To evaluate the real-world clinical outcome of guideline-based treatment among adherent and committed type 2 diabetes mellitus (T2DM) patients. Methods The study reports the outcomes of an 11-year clinic-based standard care regime, based on the American Diabetes Association (ADA) guidelines and implemented in the authors' practices. Records of 145 T2DM patients, who were regularly followed up, were reviewed. Descriptive and inferential statistical analysis was carried out with the Statistical Analysis System (SAS) (SAS Institute Inc., Cary, NC, USA) and with Statistical Package for Social Sciences (SPSS) (IBM Corp., Armonk, NY, USA), with Microsoft Word and Excel to generate graphs and tables. Results Apart from a significant increase of body weight (but not of body mass index, BMI) and a significant decrease of diastolic blood pressure (DBP), there were insignificant changes in all major biochemical parameters, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), creatinine, estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR), over the 11 years of follow-up. Conclusion ADA guideline-based management effectively maintained treatment goals among treatment adherent and committed T2DM patients over 11 years. Glycemic parameters (FPG, PPG, and HbA1c) and renal parameters (serum creatinine, eGFR, and ACR levels) remained stable. Our outcomes data were better than those recorded in the landmark United Kingdom Prospective Diabetes Study (UKPDS) and Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE).

Lives of Gender Incongruent Community: An Indian Subset Chants "All is Well".

CONTEXT: Gender incongruent individuals are exposed to unique stressors as a result of their minority social position. Poor social support has a further adverse impact on the lives and wellbeing of gender incongruent individuals. There is a paucity of scientific data from India on the socioeconomic status (SES) of gender incongruent community. AIMS: Aim of the study is to understand and estimate the social support, wellbeing, and SES of gender incongruent individuals in Eastern India. SUBJECTS AND METHODS: Data of 120 gender incongruent patients from the endocrinology outpatient department of a tertiary care hospital in eastern India were collected. We looked at demographic characteristics, social support, underlying psychiatric comorbidities, and SES. SES was calculated by the Kuppuswamy's socioeconomic status (KSS) scale based on occupation, education, and income. STATISTICAL ANALYSIS USED: Microsoft Word and Excel were used to generate tables. RESULTS: Most of the gender incongruent individuals were transfeminine. Almost half of them had no history of addiction. Most of them had good support from family and friends and very few (only 3%) had mental health problems. Calculation by KSS scale showed most of the study population lay in the upper middle or lower middle socioeconomic class. CONCLUSIONS: Strong support from friends and family appears a key factor for protection against psychiatric comorbidities and an all-round impact on the lives and wellbeing of the study population.