Understanding the Link: Hypertension Awareness and Behaviour Among Type 2 Diabetes Mellitus Patients

S.S. Dariya

The study focused on the coexistence of Type 2 Diabetes Mellitus (T2DM) and hypertension (HTN) among 2367 patients in India, revealing that approximately two-thirds of T2DM patients also had HTN. Patients with HTN, on average, were older, more likely to be male, and demonstrated higher awareness of risk factors than those without HTN. Although 74.1% of patients with HTN exhibited high blood pressure, 33.2% reported using a BP monitoring device. Encouragingly, 91% of patients with HTN were aware of at least one risk factor associated with high BP. The study emphasizes the need for targeted interventions to improve awareness, monitoring, and management, particularly in patients facing the dual challenge of T2DM and HTN in India.


Impact of Vildagliptin 100mg SR OD on Glycemic control & Weight in Type 2 Diabetes Mellitus patients with Obesity–a Pan India Retrospective study

Dr. Sona Warrier

The study focused on the impact of Vildagliptin 100mg SR OD on glycemic control and weight in patients with Type 2 Diabetes Mellitus (T2DM) and obesity. Among 2180 T2DM patients, 33% had obesity. No significant age difference was noted, but the diabetes-obesity group had more females. After 3 months of Vildagliptin 100mg SR OD usage, the obese group exhibited a significantly higher drop in weight (2.7 kgs) compared to the non-obese group (1.5 kgs). The drop in HbA1c was 0.5% in the obese group and 0.7% in the non-obese group, with both differences being statistically significant. The study concludes that Vildagliptin 100mg SR OD resulted in significant weight loss and improved HbA1c levels in both obese and non-obese T2DM patients.


Effectiveness of Vildagliptin 100mg SR OD in Type 2 Diabetes Mellitus patients with Hypertension – a Pan India Retrospective study

Dr. Sona Warrier

This study evaluates the effectiveness of Vildagliptin 100mg SR OD on glycemic parameters and blood pressure control in patients with Type 2 Diabetes Mellitus (T2DM) and Hypertension (HTN). Involving 2180 subjects from 146 Indian sites, the study found that Vildagliptin 100mg SR OD, a once-daily formulation, resulted in significant improvements in HbA1c levels after 3 months. Among T2DM patients with HTN, the reduction in HbA1c was greater in the HTN group than the non-HTN group. Additionally, the study suggests that Vildagliptin 100mg SR OD maintains blood pressure levels over the 3-month period. Overall, the findings indicate positive outcomes for glycemic control and blood pressure maintenance with the use of Vildagliptin 100mg SR OD in this patient population.


Prevalence of Haemoglobin Variants in T2DM Through HbA1c Assessment

S. Gupta

The study aimed to assess the prevalence of hemoglobin variants in Type 2 Diabetes Mellitus (T2DM) through HbA1c measurement using High-Performance Liquid Chromatography (HPLC). Among 6613 T2DM subjects, 29.2% had HbA1c <7%, 36.1% at 7.1-9%, 26.9% at 9.1-12%, and 7.7% >12.1%. Sickle Hemoglobin (HbS) was the most common variant found in 1.1% of subjects, while HbD (Haemoglobin D-Punjab) was found in 0.1%. No other variants were identified. The study suggests that HbA1c measurement with HPLC can reveal hemoglobin variants, with Sickle Hemoglobin being prevalent in Type 2 DM in Central India. The findings emphasize the importance of considering hemoglobin variants in diabetes management.


DNA Methylation and the Development of Diabetic Kidney Disease

Professor Assam-El-Osta

The study presented at the IDF congress in 2023 discussed the relationship between DNA methylation and the development of diabetic kidney disease. The Finnish Diabetic Nephropathy study was founded to uncover the risk factors and the mechanisms of diabetic complications. The study demonstrated reduced DNA methylation in diabetic subjects with end-stage renal disease (ESRD). Differential Transcription Factor Binding Sites (TFBS) intersect Differentially methylated regions (DMRs) that distinguish diabetes. Differential gene methylation overlapping TFBS was associated with DKD progression in the FinnDiane discovery group. It was observed that reduced DNA methylation is a feature of progressive T1D renal disease in Scandinavian and Asian registries. The reduced methyl protection predicts the progression of albuminuria and improves renal function decline. Insulin pathways are regulated by reduced methylation and CTCF/Pol2B indices in human podocytes. The reduced methylation corresponds with DKD risk in T1D.


Evolution of Eye Screening Technology

Mr. David Kerr

The study presented at IDF 2023 discussed the evolution of eye screening technology. Digital imaging showed <0.03% face-to-face time with a professional. Less than 50% of PWDs adhere to the recommendation of annual screening. Traditional screening requires an in-person visit which is not achievable by working-aged individuals or those from remote areas. The majority of patients don’t show signs of disease and only a small portion will require intervention. Artificial Intelligence (AI) identifies the hidden features that are often not humanly detectable, bypasses manual feature extraction, and can discover novel features correlated with a certain outcome in the training dataset. AI and smartphones provide access, trust, numeracy, literacy, understanding, and relevance. AI screens for disease, offload mundane tasks/feeds the EHR, answers question guides clinicians, and monitors patients at home.


Harnessing The Power of AI To Help Eliminate Preventable Blindness

Jennifer I. Lim

The study presented at IDF 2023 discussed the role of artificial intelligence (AI) in diabetic retinopathy. A lower prevalence of DR was observed in Asians. The ideal screening tool is high sensitivity vs specificity. Digital Fundus photographs are better than ophthalmoscopy for detecting DR. AI can address the screening burden. FDA has approved ID x DR EyeArt screening tools for DR. IDxDR has improved AI system grades no DR, mtmDr, and vtDR, it has 85.7% sensitivity and 79.3% specificity. The EyeArt tool is used for ≥ 18-year-old patients with no prior DR diagnosis. It grades no DR, mtmDR, vtDR. AI performed better than ophthalmologists in grading DR levels. AI false positives were observed in 11% EyeArt vs 0.3% in ophthalmologists. AI false negatives showed no vision-threatening retinopathy and all were ETDRS level 35. AI prevents severe vision loss by 5 years. It is effective in care frictions and imperfections and is more cost-effective than conventional ophthalmologists screening. AI for DR screening and management addresses screening burden-efficient point-of-care, can address disparities of care in underserved rural areas and is less costly than telemedicine and physicians.


Harnessing The Power of AI To Help Eliminate Preventable Blindness

Steven Yeh

The study presented at the IDF 2023 discussed a recent implementation experience within a private and rural setting. Translational Evaluation of Healthcare AI (TEHAI)  is a framework that assesses real-world systems that include: 1) Capability, 2) Utility, 3) Adoption.  It emphasizes translational and ethical features of the model development and deployment. Questionnaires and checklists are provided to guide evaluation. The general principles of AI implementation considerations are Technology assessment/scoping, stakeholder engagement, robust business plan, information technology assessment, implementation, and roll-out. Communication and messaging are key for all team members. AI provides unique opportunities that bridge both private and public health systems of varying geographies to understand rural vs urban settings for patient-provider-health systems engagement. AI has the potential to address patient and global health needs related to the burden of diabetic retinopathy (DR).


Artificial Sweeteners

Dr. Awadhesh Kumar Singh

The study presented at IDF 2023 focused on the use artificial or non-sugar sweeteners (NSS). These sweeteners are often consumed by people with diabetes mellitus (DM) (type 1 or type 2) or without DM. People with DM consume NSS as a replacement for sugar whilst people without DM consume in anticipation of no weight gain. Available evidence from the recent Cochrane meta-analysis of randomized controlled trials (RCTs) suggests consumption of NSS is not associated with any benefit or harm on important outcomes (HbA1c, body weight, and adverse events) in the short-term compared with sugar, placebo, or nutritive low-calorie sweeteners, in people with DM. However, no data are currently available on long-term diabetes-related complications associated with NNS use including mortality in DM. The latest meta-analysis commissioned by the World Health Organization (WHO) showed consumption of NSS is associated with some weight loss in short-term RCTs in people without DM, however, there was a potential harm including increased mortality in the long-term prospective cohort studies.


Keto Diets and CV Risk

Prof. Shashank Joshi

The study was presented at the IDF 2023 and it assessed the role of the keto diet in diabetes and CV risks. The Keto diet initiated in the 1920s was initially used to treat epilepsy but lost its popularity with the discovery of anticonvulsants. The Keto diet works in 2 pathways in gluconeogenesis 1) Breakdown of proteins and 2) Breakdown of lipids. Keto diet in endocrine disorders provides favorable effects on caloric intake, body weight, lipid parameters, glycemic indices, and insulin sensitivity. The Keto diet provides better blood glucose control but is extremely restrictive, difficult to travel with, has temporary solutions, and potential side effects, and can cause medical complications and nutritional deficiencies. A ketogenic diet should be considered as a last resort.  Modification in drug dosage is recommended before initiating such a diet depending on glycemic control and class of antidiabetes medication therapy. Keto diet is linked to doubling the risk of heart disease. It was associated with increase in low density lipoprotein (LDL) levels and a two-fold increase in cardiovascular events. Keto diet showed dramatic improvements in short term but is rarely sustainable. Moderation is the key while following any long-term diet.