A gluco-mindful approach to diabetic gastroparesis.

Diabetes gastroparesis is a common manifestation of autonomic neuropathy in persons with long-standing, uncontrolled diabetes. Most discussion about its management revolves around the mitigation of symptoms. Here, we share tips on choosing the right glucose-lowering medication, based upon predominant symptomatology of gastroparesis. We highlight about insulin preparations, and their timing of administration, can be tailored according to need. We also emphasize the need to choose oral glucose lowering drugs with care.

Indigenous ways of encouraging physical activity.

While guidelines recommend 30 to 60 minutes of physical activity daily, in order to manage diabetes or lose weight, it is difficult to motivate patients to do so. A wide variety of factors, ranging from biomedical (metabolic and musculoskeletal) to psychological and social, contribute to this. This communication describes socially accepted indigenous forms of physical activity, exercise and sports, which are easy to initiate and sustain. This information empowers physicians and other health care professionals to encourage lifestyle modification in a person-centred, community-oriented manner.

SGLT2-inhibition and Vascular Euphoria a Reconciliation of Vascular Health and Disease Homeostasis.

The concept of SGLT2-inhibition, once regarded as a non-physiological approach to glycemia control, now finds a foundational relevance in risk-modification for cardiovascular, kidney, and metabolic outcomes, spanning beyond type-2 diabetes. Major studies have proven meaningful improvements in various clinical outcomes, with different SGLT2-i agents. Apart from glycosuria, SGLT2-inhibition is associated with several patho-physiological effects, which may contribute to the clinical benefits seen with these agents. This narrative review is an attempt to appraise the different patho-physiological effects mediated by SGLT2-inhibition, based on contemporary evidence. The review classifies these effects in the acronym of EUPHORIA, and grades the possible relevance of each effect, in improving clinical outcomes.

Insulin stewardship for inpatient hyperglycaemia.

Insulin usage is an essential component of glycaemic management. The frequent incidence of dysglycaemia in hospitalized patients means that insulin is frequently encountered in both critical and non-critical settings. To ensure that insulin is used effectively and safely, an insulin stewardship programme is needed in all health care settings. This article describes the rationale, components, and potential monitoring tools of insulin stewardship. It encourages readers to set up and audit insulin stewardship in their hospitals, for the betterment of patient care.

Approach to glucose control: The SECURE model.

This communication describes a framework to help plan and implement glucose lowering strategies in hospitalized patients. Termed the SECURE model, it utilizes six clinical characteristics to decide intensity of insulin therapy. The SECURE rubric is more comprehensive than the conventional gluco-centric approach promoted by routinely used algorithms. SECURE promotes good clinical sense and pragmatic care in the critical care setting.

Handling compassion fatigue in diabetes.

Diabetes care providers, including family members, friends and physicians face many professional hazards during the course of their work. Amongst these is compassion fatigue. This communication describes how one can identify compassion fatigue and its potential negative impact. It shares pragmatic ways to minimize and handle compassion fatigue, and prevent burnout in physicians.

Handling hearsay in diabetes care.

Hearsay, including e-hearsay, is an unwanted, yet unavoidable, part of modern medical practice. Misinformation creates a barrier for the acceptance of, and adherence to, diabetes management. Modern technology has facilitated the spread of (mis) information. This communication describes the disadvantages of hearsay. It suggests ways for physicians to tackle diabetes hearsay in their patients and community.

Social prescription in diabetes.

This communication describes the concept, rationale, and potential of social prescription in diabetes care. It calls for use of strategy to harness the strengths of the South Asian socio-cultural milieu, and contain the diabetes epidemic.

Creating happiness in the diabetes care clinic.

Happiness is an essential part of human health. The purpose of health care, including diabetes care, is to achieve happiness, or euthymia. Happiness, can also be viewed as a means to achieving good health, as well as a technique to overcome challenges, encourage team work and ensure better adherence to therapy. This opinion piece shares simple ways of achieving happiness in the diabetes care clinic. It lists best practices related to environment communication style, communication content, and inter-consultation contact. If integrated into daily practice, these will help create a happy health care ecosystem, which in turn will enhance patient satisfaction.

Screening for heart failure in diabetes.

Heart failure (HF) is an important, yet under recognized and under diagnosed complication of diabetes. This communication describes the clinical features of heart failure, and shares a validated tool which helps identify HF. This information will be of help to all health care professionals, especially those who work in primary care settings with minimal access to advanced imaging and biochemical investigations.

Pre-conception management.

This communication shares two frameworks which help conceptualize the vast spectrum of pre-conception care. A 3x3 rubric classifies pre-conception assessment and interventions into gynaeco-obstetric, biomedical and psychosocial. Yet another creative checklist uses the letters A through I to present 9 aspects of pre-conception management. The aim of this article is to simplify the vast field of pre-conception care for primary care physicians and other health care professionals.

Obstetric metabolic medicine: a window to health.

Metabolic health is an integral part of overall health. Thisis especially true during the preconception, antenataland postpartum periods. Metabolic health influencesfoeto-maternal outcomes, as well as the long term healthof the unborn child. This communication shares apragmatic 3x3 rubric, which acts as a checklist for thehealth care provider. It calls for teamwork betweenobstetricians, physicians and other stakeholders, to ensureoptimal health outcomes for all.

Social prescription in diabetes.

This communication describes the concept, rationale, and potential of social prescription in diabetes care. It calls for use of strategy to harness the strengths of the South Asian socio-cultural milieu, and contain the diabetes epidemic.

'Oxidative stress'-A new target in the management of diabetes mellitus.

Diabetes mellitus (DM) is a chronic condition that poses a mammoth challenge for the healthcare system in developing as well as developed nations. Diabetes mellitus is associated with damage to the vasculature which leads to microvascular and macrovascular complications. Oxidative stress is a consequence of glucotoxicity and lipotoxicity, which are associated with diabetes. Glucotoxicity and lipotoxicity play a part in the pathogenesis of ß-cell dysfunction. The hyperglycemic state in DM leads to oxidative stress which further hampers insulin secretion. In diabetes, the biological antioxidants also get depleted along with a reduction in glutathione (GSH), an increase in the oxidized glutathione (GSSG)/GSH ratio, and a depletion of non-enzymatic antioxidants. This results in the formation of a viscous circle of hyperglycemia leading to increased oxidative stress that further hampers insulin secretion which in turn results in hyperglycemia. Antioxidants are efficacious in reducing diabetic complications. The antioxidants produced biologically fall short, hence external supplements are required. In this review, the authors have discussed the relationship between oxidative stress in DM and the advantages of antioxidant supplements in controlling blood glucose levels and also in deaccelerating the complications related to DM.

An Expert Opinion on "Glycemic Happiness": Delineating the Concept and Determinant Factors for Persons with Type 2 Diabetes Mellitus.

The importance of the psychological impact of diabetes is globally well-documented. Evidence suggests that there is a high level of psychosocial burden of diabetes in India. Moreover, there is a lack of relevant knowledge among the patients and caregivers regarding the psychological impact of diabetes and how to cope with it, as compared to the majority of other countries. "Happiness of the patient" is an essential component of diabetes management, which potentially affects the treatment outcome, treatment adherence, self-care, and lifelong management of diabetes. Although several validated tools and scales exist for measuring psychological outcomes both in patients and physicians, tools to assess "happiness in diabetes care" are still lacking. With this background, an expert group meeting was held in India in September 2019, involving nine expert diabetologists and endocrinologists across the country to discuss the concept of "glycemic happiness". This article summarizes the expert opinion on the factors affecting psychological outcomes in diabetes, introduces the concept of glycemic happiness, describes available scales and tools to measure general happiness, and delineates the five sets of questionnaires developed with questions that may help correlate with "glycemic happiness". The questionnaires are based on a five-point Likert method. The experts also discussed and decided upon the study design for a proposed observational survey to assess glycemic happiness of persons with type 2 diabetes mellitus (T2DM) based on the developed five sets of questionnaires. Given the huge burden of diabetes in India, the introduction of the concept of glycemic happiness will help in the optimization of diabetes care in the country.

Barophenotypic Characterization - The key to Person Centric Management of Obesity.

Obesity is now recognized as a chronic disease by many international medical societies. However, its comprehensive assessment is still a challenge in most clinical settings. This paper describes a novel practical approach to assess the barophenotype of a given individual. The word barophenotype is a portmanteau of "baro," which means weight, and phenotype, which reflects an external expression of a trait. This can be easily assessed using an ABCDE framework, encompassing the Adipose topography, Barophenotypic Behavior, Comorbidity assessment, Dysfunctionality, and Expectations. Furthermore, the utility of this framework in determining an appropriate person-centric therapeutic plan has also been described.

Cardiometabolic vigilance in COVID-19 and resource husbandry in resource-challenged times: Clinical practice- based expert opinion.

BACKGROUND AND AIMS: The ongoing pandemic of coronavirus disease 2019 (COVID-19) is rapidly evolving, thereby posing a profound challenge to the global healthcare system. Cardiometabolic disorders are associated with poor clinical outcomes in persons with COVID-19. Healthcare challenges during the COVID-19 pandemic are linked to resource constraints including shortage of Personal Protective Equipment's (PPE), laboratory tests and medication. In this context, a group of clinical experts discussed the endocrine and cardiology vigilance required in times of COVID-19. Further, the group proposed certain resource husbandry recommendations to be followed during the pandemic to overcome the constraints. METHOD: The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists, Consultant Physicians and cardiologists from India. The panel thoroughly reviewed existing literature on the subject and proposed expert opinion. RESULTS: The expert panel put forward clinical practice-based opinion for the management of cardiometabolic conditions including diabetes mellitus and hypertension. As these conditions are associated with poor clinical outcomes, the expert panel recommends that these persons be extra-cautious and take necessary precautions during the ongoing pandemic. Further, experts also provided appropriate, affordable, available and accessible solution to the resource constraint situations in times of COVID-19 pandemic. CONCLUSION: The clinical expert opinion put forward in this article will serve as a reference for clinicians treating diabetes and cardiovascular disease during the COVID-19 pandemic.