International Journal of Diabetes and Technology

: 2022  |  Volume : 1  |  Issue : 5  |  Page : 3--11



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 1. Does Hemoglobin Level Determine the Type and Severity of Diabetic Retinopathy Among Adults With Type 2 Diabetes Mellitus?

Mehrin Samed1, Nashwa Adul Gafoor1, V. Babitha2, Padma B. Prabhu2

1Government Medical College, Kozhikode, Kerala, India

2Department of Ophthalmology, Government Medical College Kozhikode, Kerala, India

Background: Anemia has been identified as a risk factor for Diabetic Retinopathy, a leading cause of blindness worldwide. However, the “at-risk” values of hemoglobin in prognosticating diabetic retinopathy have not been defined.

Objective: This study intends to evaluate the relationship between the level of hemoglobin and the type and severity of diabetic retinopathy among patients with type 2 diabetes mellitus (T2DM).

Methodology: Design - descriptive cross-sectional study; duration-6 months, study setting- tertiary care hospital in North Kerala, study population- T2DM patients, age > 40 years with diabetic retinopathy, sample size-87 cases. Variables - gender, age, duration of disease, stages of retinopathy, Hemoglobin (Hb), HbA1c, Renal Function Test (RFT). p-value <0.05 is considered statistically significant. Data were analyzed using chi-square and one-way ANOVA with PASW statistics 18.0.0.

Results: Male-female ratio=1.2:1, mean age - 59.83 ± 6.201, mean duration of disease- 11.06± 5.564. Mean Hb was 11.65 ± 1.89. 81.6% of subjects were anemic. 50.6% of subjects had proliferative diabetic retinopathy (PDR) and others had non-proliferative diabetic retinopathy (NPDR). 69% of patients had maculopathy. Anemia was more prevalent in PDR patients and those with maculopathy. Among NPDR and PDR, anemic had severe disease. The mean Hb values showed a statistically significant relationship with the type and severity of retinopathy irrespective of gender and nephropathy. Mean Hb and type of retinopathy had a statistically significant relationship among subjects with poor glycemic control. The lower mean Hb is related to the male gender with normal HbA1c values among maculopathy cases.

Conclusion: Lower hemoglobin values correlated with the severity of diabetic retinopathy and the presence of maculopathy independent of gender and presence of nephropathy. Correcting anemia and maintaining a normal Hb value may delay the onset and progression of diabetic retinopathy and maculopathy in adults with T2DM.

 2. Efficacy and Safety Of Glp-1 Analogues in Diabetic Kidney Transplant Patients

Mita B. Shah, Neil Saldanha, Bharat Shah

Consultant Diabetologist, Department of Diabetes Global, Hospital, Mumbai, Maharashtra, India

Background: Glucagon like peptide (GLP-1) analogue works by increasing insulin release from the pancreas and decreasing excessive glucagon release. They have been shown to improve glucose control while reducing body weight. This property could be useful in diabetic kidney transplant patients with a tendency to gain weight.

Objective: To study the efficacy and safety of GLP-1 analogues in kidney transplant patients with diabetes and with a tendency to gain weight.

Methodology: This retrospective study included 17 kidney transplant patients with diabetes and gaining weight after transplantation. They were on triple immunosuppression consisting of Calcineurin inhibitors (CNI), Mycophenolate mofetil (MMF)/azathioprine, and prednisolone. Twelve were having diabetes before transplant and 5 had new-onset diabetes after transplant (NODAT). Fourteen patients received dulaglutide (dose 1.5 mg weekly) and 3 received liraglutide (dose 1.2 mg daily). Two patients discontinued within a short period of starting due to gastrointestinal side effects (nausea and abdominal fullness). The remaining 15 patients were followed for at least 6 months. This study is an analysis of these 15 patients. Weight, HbA1c, tacrolimus level, and creatinine before and after 6 months of GLP-1 analogue treatment were compared. Safety was analysed by the adverse event (AE) reports.

Results: Of the 15 patients who completed at least 6 months, 12 were males and 3 were females. The mean + 1SD age at the start of the GLP-1 analogue was 52.4 + 8.5 years. The median duration after transplant was 38.7 months (range 6 to 194 months) at the time of introducing the GLP-1 analogue. The mean + 1SD weight before starting GLP-1 analogue was 86.6 + 10.6 kg. Six months after therapy it was 84.6 + 11.3 (p<0.05). Hypoglycemic agents could be reduced in all. Tacrolimus level was 7.3 + 2.8 before and 7.5 + 1.7 after 6 months of therapy. Serum creatinine was 1.1 + 0.4 before and 1.1 + 0.3 after 6 months of therapy. There was no significant adverse event except abdominal discomfort and nausea.

Conclusion: In diabetic kidney transplant patients, GLP-1 analogue therapy was effective in decreasing weight and maintaining glucose control without affecting the CNI level or graft function. At the same time, there was no significant adverse event.

 3. Patient Satisfaction with Teleconsultation In Diabetes Care During the Pandemic: An Observational Survey

Vishal Madanlal Chaudhari1, Dnyanoba Kishanrao Bhaskar2, Medha Ajit Oak3,4

1Sai Jyot Multispeciality Hospital, Dombivali, Maharashtra, India

2Lifeline Hospital, Pune, Maharashtra, India

3OAK Hospital, Dombivali, Maharashtra, India

4ICON Multispecialty Hospital, Dombivali, Maharashtra, India

Background: With the advent of teleconsultation due to the ongoing coronavirus pandemic, doctors and patients alike have had to adjust to the virtual environment for routine consultations for chronic conditions like type 2 diabetes mellitus (T2DM).

Objective: To assess patient satisfaction with the practice of teleconsultation in diabetes during the pandemic.

Methodology: A cross-sectional, observational survey was conducted involving 163 persons with T2DM who availed teleconsultation services in 3 diabetes care centers in Maharashtra. This survey was based on a 14-item questionnaire developed by the authors. It was derived out of existing validated scales and administered online via a survey tool between April 1 and May 30, 2021. The analysis of the survey is presented here.

Results: About 60% of the patients were male, while 40% were female. The majority of the tele consults occurred in 41-60 year age group. Of the 163 responses obtained, 145 (88.9%) of patients were happy with the quality of conversations with their physicians. Further, 125 (76.6%) of patients were satisfied with the explanation provided by their physician about their condition, while 128 (78.5%) were satisfied with the duration of consultation and 118 (72.3%) said that they were satisfied with the thoroughness, carefulness, and skillfulness of the physician and his/her staff during the teleconsultation. Further, 158 (96.9%) would be happy to use teleconsultation again, while 155 (95%) would recommend teleconsultation to their friends and family. Around 150 patients, (92%) felt that, their confidentiality is maintained similar to in-clinic face-to-face consultation and 98 (60%) opined that they would continue to use teleconsultations even after face-to-face interactions resume post-pandemic.

Conclusion: The majority of patients were satisfied with the teleconsultations that became the norm during the pandemic. The quality of conversations, the explanation of their condition, and the time provided were rated as excellent by most of the patients, which is gratifying in these tough times for humankind.

 4. TIME Spent in Glycemic Control After Initiating Treatment with Oral Semaglutide Versus Empagliflozin: An Exploratory Analysis of the Pioneer 2 Trial

Rahul Mangalath Rajendraprasad1, Julio Rosenstoc2, Bertrand Cariou3, Erik Christiansen4, Christin L. Hertz4, Eduard Montanya5, Morten Abildlund Nielsen4, K. Filip6,7,8,9

1Novo Nordisk India, Bengaluru,

2Dallas Diabetes Research Center at Medical City, Dallas, Texas, United States of America;

3Department of Endocrinology, L'Institut du Thorax, CIC INSERM 1413, CHU Nantes, UNIV Nantes, Nantes, France;

4Novo Nordisk A/S, Søborg, Denmark;

5Hospital Universitary Bellvitge-IDIBELL, CIBERDEM, and University of Barcelona, Barcelona, Spain;

6Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark;

7Steno Diabetes Center Copenhagen, Gentofte, Denmark;

8Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;

9Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Background: A standard objective in the management of Type 2 diabetes mellitus (T2DM) is the achievement and maintenance of HbA1c targets, but the duration of time that patients spend within glycemic control targets has not been previously reported for oral semaglutide.

Objective: In this exploratory analysis, the duration of time that patients were in glycemic control (HbA1c < 7.0% and < 6.5%) during the 52-week PIONEER 2 trial (NCT02863328) was assessed.

Methodology: Patients with uncontrolled T2DM (N=822; HbA1c 7.0 - 10.5%) were randomized to oral semaglutide 14 mg once daily or empagliflozin 25 mg once daily. Both drugs underwent dose escalation, with oral semaglutide starting at 3 mg, increasing to 7 mg after 4 weeks, and 14 mg after 8 weeks. Empagliflozin was initiated at 10 mg and escalated to 25 mg after 8 weeks. For this analysis, outcomes were evaluated using the on-treatment without rescue medication observation period, in all randomized patients.

Results: Baseline characteristics were similar between treatment arms. The mean baseline HbA1c for both arms was 8.1%. A greater proportion of patients receiving oral semaglutide vs empagliflozin achieved HbA1c < 7.0% at some point during the study (78% vs 60%), and for the following lengths of time that HbA1c remained < 7% (65% vs 48%); ≥26 weeks (56% vs 38%); and ≥38 weeks (46% vs 28%). During treatment, the overall mean duration of time spent at HbA1c < 7% and < 6.5% was 27 weeks and 16 weeks, respectively, for oral semaglutide, and 19 weeks and 7 weeks for empagliflozin. Based on the trial product estimand, the odds of patients achieving HbA1c < 7% at both weeks 26 and 52 were significantly greater with oral semaglutide vs empagliflozin (estimated odds ratio 4.12 [95% CI 2.94, 5.76); p<0.0001).

Conclusion: Despite an 8-week dose-escalation schedule and a mean baseline HbA1c of 8.1%, nearly half of the patients receiving oral semaglutide achieved glycemic control (HbA1c < 7.0%) for more than 70% of the 52-week treatment duration. These data suggest that patients spend more time in glycemic control during treatment with oral semaglutide vs empagliflozin.

 5. Depression and Other Concerns in Pregnancy Among Women With and Without Gestational Diabetes Mellitus

S. Sindhu, S. Uma Mageshwari

Department of Food Service Management and Dietetics, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India

Background: Women with Gestational Diabetes Mellitus (GDM) are double impacted by the physiological transition in pregnancy and the growing concerns of fetal and maternal risks associated with GDM. This study was conducted to understand the main concerns in pregnancy among women with and without GDM.

Objectives: To obtain information on (a) depression and other concerns in pregnancy (b) difference in mean depression scores between women with and without GDM.

Methodology: The study was conducted among 114 pregnant women (75 women with GDM and 39 without GDM) from seven hospitals in Kochi, Kerala, using a purposive sampling criterion. Pregnant women in the age group 18 to 45 years willing to participate were included in the study while those with pre-existing diabetes mellitus, multiple pregnancies, and severe complications were excluded. Details regarding the demographic profile, medical history, week treatment, and main concerns in pregnancy among the respondents were obtained using an interview schedule. All participants also self-scored the Beck's Depression Inventory (BDI) which was used to assess their degree of depression. Statistical analysis was performed using SPSS version 21. Descriptive statistics were reported as the frequency of the total number of responses for each question and percentages calculated. A chi-square test on concerns in pregnancy among women with GDM and without GDM and a t-test of mean BDI scores among women with GDM and without GDM was done to identify the difference between groups.

Results: Chi-square analysis of main concerns in pregnancy among women with GDM and without GDM revealed significant differences between groups (χ2 =46.65; p =.0001). Forty-four Women with GDM (58.7%) and four women without GDM (10.3%) reported baby growth and outcome of pregnancy as their main concerns in pregnancy. The t-test of mean BDI scores of women with GDM (9.03±5.25) and women without GDM (6.31±3.74) was found to be significantly different at 5 percent level of significance. A greater mean BDI score in women with GDM suggested that they have a higher degree of depression than their counterparts.

Conclusion: There was a greater degree of depression and concerns in pregnancy among women with GDM than in women without GDM. The study recommends screening pregnant women for potential stress factors and providing appropriate psychosocial support systems to overcome such issues.

 6. Glycemic and Body Weight Responses to Oral Semaglutide in the Pioneer Trial Program

Vijaya Vasanthakumar1, Kathleen M. Dungan2, Erik Christiansen3, Christin L. Hertz4, Linda Mellbin5, Morten Abildlund Nielsen6, Vincent C. Woo7, Tina Vilsbøll8

1Senior Medical Advisor, Novo Nordisk, India Pvt Lt 2The Ohio State University, Columbus, United States of America

3,4Novo Nordisk, Soborg, Denmark

5Department of Cardiology, Karolinska Institute

6Department of Public Health, Aarhus University, Denmark

7Section of Endocrinology and Metabolism, McGill University Health Centre, McGill University, Canada

8Centre for Diabetes Research, Gentofte Hospital, University of Copenhagen, Denmark

Objective: The PIONEER phase 3 program investigated glycemic response and other efficacy endpoints in patients (pts) with type 2 diabetes randomized to the glucagon-like peptide-1 analog oral semaglutide (sema; 3, 7 or 14 mg once daily), placebo (pbo) or an active comparator (empagliflozin [empa] 25 mg, sitagliptin [sita] 100 mg or liraglutide [lira] 1.8 mg once daily).

Methodology: This post hoc analysis of the PIONEER 1-5 and 8 trials evaluated the response of any reduction in HbA1c (%) and/or body weight (%), and a clinically relevant composite endpoint of HbA1c reduction ≥1% and body weight loss ≥5%, with oral sema 14 mg vs. comparators at the end of treatment (26-78 weeks).

Results: Across trials, any reduction in HbA1c was observed in higher proportions of pts with oral sema (89-95%) than with pbo (51-64%) or active comparators (82-88%). A simultaneous reduction in both HbA1c and body weight was seen in 72-86% of pts treated with oral sema. The composite of HbA1c reduction of ≥1% and body weight loss of ≥ 5% was achieved by 27-41% of pts with oral sema, 1-8% of pts with pbo, 11% with sita 100 mg, 18% with lira 1.8 mg, and 20% with empa 25 mg. Within each trial, the odds of achieving HbA1c reduction of ≥1% and body weight loss of ≥5% with oral sema 14 mg were significantly greater vs. all comparators (p<0.0001).

Conclusion: These results demonstrate that oral sema 14 mg was more effective vs. comparators for providing any HbA1c reduction, or both an HbA1c reduction of ≥1% and body weight loss of ≥5%.

 7. Efficacy of Oral Semaglutide According to Background Medication: An Exploratory Subgroup Analysis of the Pioneer Trial Program

Kingshuk Bhattacharjee1, John B. Buse2, Matthew J. Crowley3, Jan W. Eriksson4, Mette Gilsum, Christin L. Hertz5, Marcel Kaiser6, Anne Mller Nielsen7, Martin Haluzík 8

1Medical Manager, Novo Nordisk, India Pvt. Ltd 2University of Texas, Southwestern Medical Centre, Dallas

3Division of Endocrinology, Department of Medicine, Duke University, Durham, North Carolina.

4Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Sweden

5Novo Nordisk, Soborg, Denmark

6Practise for Internal Medicine and Diabetology, Frankfurt, Germany

7Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Denmark

8Novo Nordisk, Soborg, Denmark

Background : Oral semaglutide is the first oral glucagon-like peptide 1 (GLP-1) receptor agonist product approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes (T2DM).

Objective : The global PIONEER program investigated the efficacy and safety of the first oral glucagon-like peptide-1 receptor agonist, oral semaglutide.

Methodology: Across PIONEER trials, patients with T2DM were randomized to once-daily oral semaglutide (3, 7, 14 mg or flexibly dosed) or comparator. The present exploratory subgroup analysis evaluated the effect of background medications on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of the trial (week 26, 52, or 78) in five PIONEER trials (3-5, 7-8). Data were analyzed from patients who received oral semaglutide or comparator (sitagliptin, liraglutide, or placebo) based on background medication received: metformin, sulfonylurea, sodium-glucose co-transporter 2 inhibitor, insulin, or combinations.

Results: Baseline characteristics were generally similar across subgroups. Reductions in HbA1c and BW were greater for oral semaglutide vs. comparators (except liraglutide, with similar HbA1c reductions), regardless of background medication. In general, there were no statistically significant interactions between treatment and subgroups. Estimated treatment differences were consistent within each trial and background medication subgroups.

Conclusion: These findings support the use of oral semaglutide across a broad population of patients with T2DM in combination with other commonly used glucose-lowering agents.

 8. Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus

Soumya Sathyan1, S. S. Sawarkar1

1Department of General Medicine, JJMMC, Davangere, Karnataka, India

Background: Type 2 diabetes mellitus (T2DM) is one of the major health problems all over the world. Autonomic dysfunction is common in patients with diabetes but symptomatic autonomic neuropathy is not that common. Recognizing asymptomatic cardiac dysautonomia early will be helpful to delay or arrest its progression.

Objective: This study aims at evaluating cardiac autonomic neuropathy based on postural hypotension, QTc interval, and heart rate variability.

Methodology: 100 T2DM patients, both male, and female attending OP and IP departments were taken in the study. They were grouped according to the duration of diabetes into two groups of <5 years (group A) and >5 years (group B) and bedside tests for autonomic dysfunction will be done.

Results: Out of 100, 33 patients had <5 years duration and 67 patients had >5 years duration of diabetes. It was observed that no. of patients with prolonged QTc (QTc>440 ms) were higher in group B (>5 yrs). 2 out of 33 in group A and 22 out of 67 in group B had postural hypotension. Lack of heart rate variability (<20 bpm) was observed in 31 out of the 33 subjects in Group-A (93.6%) and 67out of the 67 subjects in Group-B (100%).

Conclusion: The results of our study illustrate the fact that cardiac autonomic dysfunction is common in people with diabetes and its prevalence increases with the duration of diabetes. This study aims at proactive treatment of borderline and early autonomic dysfunction at the earliest to arrest and prevent progression of the disease and thus preventing catastrophic events.

 9. Correlation Between Hba1C and Hdl Cholesterol in Patients with Type Two Diabetes

Susmitha Suresh1, Sumesh Raj1

1Department of Internal Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India

Background: Glycosylated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control. By its function as an indicator for the mean blood glucose level, HbA1c predicts the risk for the development of diabetic complications in patients with diabetes. An early intervention to normalize circulating lipids has been shown to reduce cardiovascular complications and mortality.

Objective: To establish a relationship between HbA1c and HDL-cholesterol in patients with type 2 diabetes (T2DM) and to look for a correlation between HbA1c and High Density Lipoprotein (HDL) cholesterol in T2DM.

Methodology: This is an observational hospital-based case-control study carried out in a tertiary care hospital over 6 months. A total of 60 patients were divided into two groups one with diabetes and the other without diabetes comprising 30 individuals each.The study variables are Fasting Blood Sugar (FBS), Total cholestrol (TC), Triglycerides (TG), Very Low Density Lipoprotein (VLDL), HbA1c, HDL, Low Density Lipoprotein (LDL). The treatment group included patients who were newly diagnosed with T2DM and above 30 years of age while the control group included people without diabetes. Patients who received previous hypoglycemic medications and those with abnormal liver function, nephropathy, neuropathy, or retinopathy were excluded from the study. Statistical analysis was done by using Student's unpaired t-test and Pearson's correlation coefficient.

Results: In our study it was found that FBS, HbA1c, TC, TG, HDL and LDL levels were higher in the cases as compared to controls. Positive correlations were observed between serum levels of TC (r=0.08, p=0.66), TG (r=0.16, p=0.37), LDL (r=0.15, p=0.42), VLDL (r=0.10, p=0.59) with HbA1c. HbA1c shows significant negative correlation with HDL (r= -0.47, p=0.008).

Conclusion: An altered lipid profile is associated with an elevated level of blood glucose level. HbA1c can be used as an indicator of lipid profile status in T2DM. A low HDL level was found in T2DM compared to those without T2DM. The age group of 30 - 40 years is vulnerable to developing diabetes, as, at an early age, they are not aware of this situation. So, they should be screened for blood glucose, HbA1c, and lipid profile levels. Early detection of the abnormalities of serum lipid profile and HbA1c can minimize the risk for micro and macroangiopathies in patients with diabetes. Further studies involving a larger population should be conducted to evaluate the significance of HDL cholesterol in T2DM.

 10. The First 30 Egyptian Patients with Type 1 Diabetes on 14-Day Factory Calibrated Glucose Monitoring System: Clinical Usefulness

Hossam Arafa Ghazi1,2,3

1Faculty of Medicine, Mansoura University, Mansoura, Egypt

2Cardiff University, Cardiff, Wales, UK

3South Wales University, Wales, UK

Background: Management of patients with type 1 diabetes (T1D) in a developing country with limited resources like Egypt is challenging for health caregivers. FreeStyle Libre Pro (FSLP) is a novel technology in the continuous glucose monitoring system (CGM). It measures blood glucose every 15 minutes for 14 days creating 1344 captures which make the Ambulatory Glucose Profile (AGP). FSLP does not need finger stick calibration from the patient and easily inserted making is different from the conventional CGM.

Objective: This study recruits 60 Egyptian patients with T1D and was conducted to evaluate the clinical usefulness of FSLP in patients with T1D.

Methodology: Individual education about T1D for each subject was performed and daily self-monitoring blood glucose was advised. Symptoms of hypoglycemia and nocturnal hypoglycemia were illustrated to the patients, and they were asked to report the blood glucose level and time of hypoglycemia if occurs. 30 FSLP sensors were inserted in one group and 30 patients with T1D were taken as a matched control group. After revision of AGP from the case group, instructions for the patients were given to modify their lifestyle and insulin regimen.

Results: Three months later, patients with FSLP have shown statistically significant lower episodes of hypoglycemia and nocturnal hypoglycemia.

Conclusion: Although episodes of severe hypoglycemia and HbA1c were lower in the case group, it is not statistically significant.

 11. Utility Of Serum Uric Acid to High-Density Lipoprotein Ratio in Prediction of Glycemic Control

V. Ram Arvind, C. Manokaran

Department of General Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Background: India has witnessed diabetes as a growing problem and is on the verge of a diabetes mellitus epidemic. Glycemic control is the way to prevent the morbidity associated with diabetes.

Objective: This study aimed to find out the utility of uric acid to the high-density lipoprotein ratio as a marker of diabetes control.

Methodology: A hospital-based cross-sectional study was conducted among type 2 diabetes individuals who attended outpatient clinics and individuals who were admitted to the inpatient wards of our hospital were enrolled. High-density lipoprotein cholesterol, serum uric acid, and glycated hemoglobin were performed. HbA1c lower than 7% were classified as well-controlled type 2 diabetes mellitus (T2DM) group and those with HbA1c between 7-10% were classified as uncontrolled T2DM group and those with HbA1c greater than 10% were classified as poorly controlled T2DM group. HbA1c was correlated with HDL, serum uric acid, and Uric acid to high-density lipoprotein ratio (UHR).

Results: Our study demonstrates that uric acid is inversely related to HbA1c and uric acid decreases following elevated HbA1c and this relationship was statistically significant whereas there was a non-significant inverse relationship between HDL and HbA1c and UHR with HbA1c.

Conclusion: Established diabetes will have a lowering of uric acid as the diabetes control worsens and UHR could not be used as a confounding factor like ARBs.

 12. Lifestyle Changes Among Professional College Students During Covid-19 Pandemic

Anaswara Gopi1, Anto Clare Vinson1, Divija Ramachandran1

1Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Kerala, India

Background: COVID-19 pandemic has brought about long-lasting restrictions on mobility outside one's home. It has also caused a sudden shift to long hours of e-learning. All these have led to a distinct change in the way students spend their time, their dietary habits, and their lack of exercise. The increased food intake and lower physical activities may lead to weight gain pointing to obesity and related comorbidities like Hypertension, Dyslipidemia, Cardiovascular disorders.

Objectives: To assess the changes in dietary habits and physical activity in professional college students during the Covid-19 pandemic.


Study design: Cross-sectional study.Study population: Professional college students.Period of study: 1st part: 20th September 2020 to 14th October 2020.

2nd part: 5th May 2021 – on going.Study tool: Self-administered semi-structured online questionnaire.Data collection: Semi-structured online questionnaire was distributed among the target population.Data analysis: In frequency and proportion for categorical data, mean, the standard deviation for quantitative variables.Inclusion criteria: Professional college students who gave consent to participate in the survey.Exclusion criteria: Those with chronic illnesses like asthma, handicapped persons, metabolic disorders.Study variables: Change in dietary intake, change in physical activity levels.

Results: The questionnaire was distributed among professional college students and 286 responded.

Out of 286, 67.1% were females and 32.9% were males.The respondents included students from various professional colleges like medical colleges, engineering colleges, etc.Age of the participants: 18 to 28 years.Mean age: 21 years with standard deviation 1.73 years.Mean weight: 61 kg with a standard deviation of 11.39 kg.60.83% of the respondents had a perceived increase in rice consumption.60.53% of respondents had an increased consumption of oily food items like fried foods and snacks.56.99% of the respondents had an increased consumption of non-vegetarian items.Physical activity was reduced considerably during the period which was categorized as

155 (54%) of the respondents did light activities like slow walking, shopping, gardening, etc.70 (24.47%) of the respondents did moderate activities like jogging, cycling, yoga.51 (17.86%) of them did vigorous activities like running, playing cricket, etc.


A higher reduction of physical activity and habitual food consumption among the population during the pandemic were more pronounced.Around 60% had reported increased consumption of rice, oil, and non-vegetarian food.As a result, there was higher weight gain among the population which may lead to obesity that can give rise to lifestyle diseases like diabetes.Our findings reinforce the importance of promoting a healthy lifestyle during periods of social isolation.

 13. Prompt Use of Technology Can Save Lives: First Reported Case of Decompression Sickness (DCS) From Kerala

Athena Suresh, S. Ajith Kumar

Department of Hyperbaric Medicine and Diabetic Foot Care, SP Fort Hospital, Thiruvananthapuram, Kerala, India

Introduction: Decompression Sickness (DCS) is a complication that occurs usually in divers, due to the formation of bubbles by inert gases, mainly nitrogen, when exposed to low ambient pressure after a decompression. Based on the principle of Henry's gas law, during ascent to a surface reduction in pressure can cause the release of dissolved nitrogen into blood and tissues leading to bubble formation and causing symptoms. DCS most often presents with musculoskeletal and neurological manifestations.

Case Presentation: A 34-year-old male, fire and safety officer, an experienced diver following a scuba dive after a rapid ascent presented in a semi-comatose state with right-sided weakness, aphasia, inability to open his left eye. We received him 5 hours after the incident. We made a clinical suspicion of DCS with the background history of a deep dive and his clinical presentation.

Management and Outcome: He was immediately commenced on hyperbaric oxygen therapy (HBOT) according to the standard protocol. Magnetic Resonance Imaging (MRI) with Magnetic Resonance Angiography (MRA) of the brain was done which revealed features suggestive of DCS. Baseline investigations and coagulation profiles were within normal limits. High Resonance Computed Tomography (HRCT) of the chest ruled out pulmonary involvement and echocardiogram showed no evidence of patent foramen ovale. His Glasgow Coma Scale (GCS) improved after receiving the first session of HBOT. He was able to talk normally and walk with support from day 3. The patient recovered without any sequelae after receiving multiple intensive sessions of HBOT and supportive care. He was discharged on day 10 and was advised to avoid flying for a week and diving for a period of 8 to 12 weeks.

Discussion: HBOT is a technology-based treatment that involves the use of 100 % oxygen at a pressure higher than the sea level pressure inside a specially designed chamber. HBOT acts by recompressing the bubbles, replacing nitrogen bubbles with oxygen, and results in the collapse of bubbles. HBOT also counteracts platelet and leukocyte activation and their endothelial interaction. Professional divers should be aware of conditions such as DCS. Early recognition of DCS and its prompt management with HBOT and rehabilitation is the key to recovery.

 14. Covid Associated Rhino Orbito Cerebral Mucormycosis: Preying on the Weak

Vaishnavi Sangeeth1, S. Jayaprabha2, R. Aravind3

1Government Medical College, Thiruvananthapuram, Kerala, India

2Department of ENT, Government Medical College, Thiruvananthapuram, Kerala, India

3Department of Infectious Diseases, Government Medical College, Thiruvananthapuram, Kerala, India

Background: Mucormycosis (previously called zygomycosis) is a rare but serious angio-invasive infection caused by a group of fungi called mucormycetes.

Objectives: To study the clinicopathological profile and management outcome of COVID associated rhino orbito cerebral mucormycosis cases admitted at our tertiary care centre.

Methodology: We did a retrospective case study of 12 patients admitted at our tertiary care centre from the period of August 2020 to April 2021. All 10 cases were defined according to accepted guidelines mucormycosis[1) and had a history of COVID infection. They were treated with antifungals and surgical debridement and outcome was monitored.

Results: 7 out of 12 patients recovered and are currently on follow up. 5 patients expired out of which 4 had rhino orbito cerebral disease and 2 had severe concurrent COVID infection with DKA. 11 out of 12 patients were known case of diabetes on treatment and glycemic control proved an important prognostic factor as well as a predictor of the severity of disease and chances of recovery.

Conclusion: The association of COVID and Mucormycosis has certain obvious components like uncontrolled hyperglycemia and steroid-induced immunosuppression. Beyond all of this the basic pathogenetic effects of the virus i.e. thrombotic activity and immune dysregulation appears to play a significant role in the aetiology behind patients with mild COVID developing the invasive disease. Anti-fungals, glycemic control and surgical debridement in a timely manner remain the mainstay.

 15. Association Between Subclinical Hypothyroidism and Type 2 Diabetes Mellitus: A Cross-Sectional Study in a Tertiary Health Centre, Kerala

Mohammed Ramees, Sumesh Raj

Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India

Background: Commonly, Subclinical Hypothyroidism (SCH) is frequently seen in patients with type 2 diabetes mellitus (T2DM). However, the association between subclinical hypothyroidism and T2DM remains unknown. This study attempts to determine the association between SCH and T2DM.


Compare the prevalence of SCH in patients with T2DM and those without T2DM.Evaluate the association between SCH and glycemic control in patients with T2DM.

Methodology: We conducted a cross-sectional study among 95 participants who were admitted to Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram. The study period was 6 months (Jan-Jun 2021). Participants were divided into two groups, people with diabetes (n=50, 52.63%) and without diabetes (n=45, 47.36%). The study variables were age, Body Mass Index (BMI), blood pressure, HbA1c, Blood Urea Nitrogen (BUN), lipid profile, and thyroid profile. Subclinical hypothyroidism (SCH) was diagnosed when thyroid-stimulating hormone (TSH) was more than 4.0 mIU/L with a normal level of free thyroxine (T4: 0.7-1.4 ng/dL). HbA1c was used to sub-group the group of people with diabetes. (Group 01: <7 %, Group 02: 7-8.9%, Group 03: >9%). The association between T2DM and SCH was determined using Chi-square. A p-value of less than 0.05% was considered significant.

Results: Our study included 49 (51.57%) females and 46 (48.42%) males. The mean of the participants was 56±10 years. In the group with diabetes, 14 (28%) participants had SCH, compared with 12 (26.66%) participants in the control group. The prevalence of SCH was not statistically different between the two groups (p-value 0.442). In the group comprising patients with diabetes, participants were also divided according to the HbA1c values in which 3 (21.42%) participants had HbA1c less than 7%, 4 participants (21.42%) had HbA1c from 7- 8.9% and 7 participants (50%) had HbA1c more than 9 %.

Conclusion: The prevalence of SCH was found to be similar between between patients with and without diabetes. Our study also observed there was a two-fold increase in the prevalence of SCH among uncontrolled patients with diabetes (HbA1c more than 9%) compared with the well-controlled (HbA1c < 7%) group. These results suggest SCH as comorbidity may be considered in patients with poor glycemic control. Further prospective studies involving a larger cohort should be conducted to evaluate the significance of HbA1c and SCH.

 16. Gender-Based Difference in Glycemic Outcomes in Patients With Type 2 Diabetes

B. Meera Krishna, T. S. Sanal, Arun Shankar, Gopika Krishnan, Jothydev Kesavadev

Jothydev's Diabetes Research Centre, Thiruvananthapuram, Kerala, India

Background: Management of type 2 diabetes mellitus (T2DM) requires optimal glycemic control to avoid diabetes-related morbidities and mortality. Reports and observational studies have suggested gender-based differences in diabetes care. Such disproportionalities in the glycemic outcomes of T2DM patients have not been addressed in the Indian population.

Methodology: A cross-sectional study using data from Electronic Medical Records (EMR) of T2DM patients maintained through a Diabetes Tele Management System (DTMS®) endorsed by a comprehensive diabetes care center based in Kerala, India from 2013 to 2017. Both univariate and multivariate analyses were applied to compare the outcome measures, HbA1c, Fasting Blood Sugar (FBS), Low Density Lipoprotein (LDL), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) of the male and female patients.

Results: Data from 406 T2DM patients: 95 females and 311 males were evaluated. The two groups were comparable for all the parameters at baseline. Following four years of diabetes management, men showed a superior HbA1c reduction compared to women (8.15+1.98 vs 7.22+1.14, p <0.05). T2DM women could not produce an appreciable result in the secondary outcomes such as Low-Density Lipoprotein, Diastolic Blood Pressure, Fasting Blood Sugar, and Systolic Blood pressure levels compared to T2DM men.

Conclusion: Data of treatment outcomes in a 4-year follow-up of diabetes management provides less biased results. The difference can be attributed to sociocultural factors, in addition to biological characteristics. Physicians should identify the obstacles experienced by women in T2DM management.

 17. Chronic Inflammatory Demyelinating Polyradiculoneuropathy in Diabetes Mellitus: A Commonly Missed Unique Presentation

G. Vigneshwaran, Sankar Kalairajan, Vivek Paul Benjamin

Department of General Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India

Introduction: Diabetic Peripheral Neuropathy (DPN) is a common complication of diabetes mellitus. But inflammatory neuropathy is also not uncommon compared to diabetic neuropathy. Among inflammatory polyneuropathy, the commonest and treatable is Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). But in clinical practice, CIDP is often missed in a patient with diabetes and labelled as DPN.

Case Presentation: A 45-year-old male, known case of type 2 diabetes mellitus (T2DM) for 5 years on regular treatment, presented with complaints of weakness of both lower limbs for 10 weeks, proximal weakness more than distal. It was insidious in onset and progressive in nature. History of pricking type of sensation in both legs present. No history of trauma, fever, or diarrhoea. History of normal bowel and bladder habits. No significant drug and family history.

On examination: The tone and bulk of all four limbs were normal. Bilateral upper limb power was normal. Power in the bilateral hip was 3/5 and in the bilateral knee was 4/5. Deep tendon reflexes were absent in all 4 limbs. Plantar was bilateral flexor. Cranial nerves and cerebellum were normal.

Management and Outcome:

Routine blood investigations were normal.

FBS- 132 mg/dL, PPBS- 212 mg/dL, HbA1c- 7.2%Human immunodeficiency virus (HIV) and Anti-nuclear antibody (ANA) was negative.Normal thyroid profile.MRI spine was normal.CSF showed increased protein and albumino-cytological dissociation.Nerve conduction study of bilateral lower limb showed absent F waves suggesting axonal polyneuropathy.Diagnosed as CIDP, the patient improved with administration of oral corticosteroids for 6 months.

Discussion: Patients with diabetes have an increased risk up to 11 folds for the development of CIDP when compared to those without diabetes. Hypotheses postulated for DM-CIDP are: antigen presentation against myelin over nerve damage due to mild diabetic neuropathy, increased proinflammatory cytokines and metalloproteinase-9 in the peripheral nerves, and diabetic microangiopathy disrupting the blood-nerve barrier. Though the mean age group for DM-CIDP is 5th and 6th decade, cases have also been reported in young. Hence possibilities of CIDP should be considered in diabetic patients with diabetes with progressive symmetrical weakness in spite of good glycemic control, irrespective of age and duration of diabetes. DM-CIDP patients respond well to oral corticosteroids when identified early, avoiding costly modalities like IV immunoglobulins.

 18. Time-In-Range: The Paradigm Shift in Managing Diabetes with Pregnancy/Gestational Diabetes

Ritu Johari

Abbott Diabetes Care, Mumbai, Maharashtra, India


Diabetes in pregnancy or gestational diabetes is a situation that brings in negative emotions in a time of happiness - bringing an added concern about the impact of glucose levels on pregnancy outcomes.Gestational diabetes mellitus (GDM) is common in pregnancy and is associated with adverse pregnancy and foetal outcomes. The prevalence of GDM in India is approx. 1.3% which varies with various factors going as high as 2.4%.The increased risks to both mother and developing foetus imposed on pregnancies complicated by diabetes are well established. The risks increase proportionately with worsening glycemic control.


Explore the adoption of Time-in-range in managing diabetes during pregnancy/GDM.


Pregnancy is a hyperdynamic state which profoundly affects glycemic control and the management of diabetes with increased glycemic variability early in the pregnancy; with increasing insulin resistance, requiring intensification of insulin doses to maintain glucose levels; and thus, predisposing to hypoglycemia. Glucose control in this sub-set of patients may hence vary and need constant monitoring.These patients may be classified as those managed with lifestyle modifications alone versus those requiring insulin for control of diabetes.While Self-Monitoring of Blood Glucose (SMBG) has been identified as a fundamental tool for monitoring glucose in GDM patients, it is not sufficient as a tool for accurate management as various readings may be missed using SMBG in contrast to Continuous Glucose Monitoring (CGM) that charts glucose 24x7 uninterrupted day and night.


As demonstrated in one of the studies, the use of supplementary CGM combined with routine antenatal care can improve the glycemic control and pregnancy outcomes of patients with GDM. This was attributed to reduced exposure to maternal hyperglycemia.Evidence also suggests, CGM is a well-tolerated, safe, and user-friendly option for patients with GDM.

Conclusion: Effective glucose monitoring and therapy adjustments are recommended to protect against diabetes related pregnancy complications.

 19. Tracking Progression From Prediabetes to Diabetes: Role of Technology

Ritu Johari

Abbott Diabetes Care, Mumbai, Maharashtra, India


Prediabetes was formally established by the American Diabetes Association (ADA) in 1997 as impaired fasting glucose as the pre-cursor to diabetes.Prediabetes is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.India statistics: Prevalence of pre-diabetes in India is approx. 10.3% as per World Health Organisation (WHO) criteria and 24.7% as per the ADA criteria (ICMR INDIAB study) which is, either way, more than the prevalence of diabetes in the country – 7.3%. (2017).


To assess tools to track the progression of prediabetes to diabetes.


Without preventive measures, pre-diabetes progress to overt diabetes at the rate of approximately 5% per year. Both diabetes and prediabetes is associated with vascular complications. Asian Indians have been shown to progress faster through the prediabetes stage than do people of other ethnic groups.As per evidence, prediabetes is the stage where one can reverse the wheel and stop the patient from progressing to diabetes – reversible disease state.


One of the landmark trials shows a 58% reduction in progression from pre-diabetes to diabetes by implementing a lifestyle intervention. Recommendations by prestigious institutes have therefore focused on lifestyle modifications such as healthy diet, physical fitness and weight loss as preventive as well as treatment measures for prediabetes.Lifestyle modification in diabetes warrants patient participation to make changes in diet, physical exercise and monitor the impact of these interventions on glucose levels to ensure the aptness of the changes. This can be executed with ease using the continous glucose monitoring technology that provides various insights including the time-in-range.


Prediabetes poses an opportunity to act aggressively to enable lowering the diabetes burden of the country thus lowering the country's morbidity/mortality rates and potential threat to global medical health resources. Technology has been instrumental in arenas such as cancer therapy and surgical interventions; it is time we use technology in the space of diabetes too.

 20. Application of Time in Range (TIR) in Diabetes Care Algorithm

Ritu Johari

Abbott Diabetes Care, Mumbai, Maharashtra, India


India is one of the global epicenters of diabetes.Established evidence determines lack of diabetes control as the underlying reason for unfavorable outcomes of diabetes in India.Lack of diabetes control, in turn, is attributed to sub-optimal glucose monitoring by patients. This roots from multiple patient and doctor factors such as denial of disease severity, non-readiness for medical spends, on one hand versus fear of patient loss, lack of conviction or clinical inertia on the other.


How to leverage TIR in diabetes management.


Monitoring in diabetes is largely read as self-monitoring of blood glucose (SMBG). However, the limitations of this tool brought to the limelight the discovery of Glycosylated Hemoglobin (HbA1c)– which became the gold standard for diabetes management. Despite massive use, HbA1c has been found to fall short against the latest tool– 'Time-in-Range'(TIR). The TIR indicates the time spent in control by the patients with diabetes and provides the opportunity to learn about their diabetes and get empowered to make meaningful decisions.Continuous Glucose Monitoring (CGM) is the technology that helps obtain TIR which has also been proposed as a metric for clinical trials. TIR introduced formally in 2017 guidelines by Advanced Technologies & Treatments for Diabetes(ATTD) has been found associated with diabetes complications; lower the time in the range – higher the complications.


Growing evidence shows the use of CGM enables patient involvement in diabetes management which is now recognized as a cornerstone for effective diabetes control.CGM coupled with TIR can effectively be positioned in typical situations of patients with diabetes that may help bring optimal control of glucose.

Conclusion: In a scenario where we have exhausted all pharmaceutical options with multiple generics in the market, it is time to optimize strategies to ensure we reach glycemic targets for patients with diabetes using these available tools and technologies. Moreover, TIR effectively proves to be the centrepiece with its wide applicability across diabetes cases, ability to demonstrate evaluation of ongoing treatment options or dietary-cum-lifestyle interventions and educational potential by including patients in their diabetes management.

 21. Correlation Between Hba1c And Serum Crp in Adult Patients With Type 2 Diabetes

M. Parvathy, Prasanth Prasad, Sumesh Raj

Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India

Backgrounds: In patients with type 2 diabetes mellitus (T2DM), low-grade inflammation is reflected by increased plasma levels of several biomarkers of inflammation such as C-reactive protein (CRP). There is an inflammatory atherothrombotic condition in T2DM and associated with a high prevalence of cardiovascular disease. Recent studies suggest that poor glycemic control is significantly associated with macrovascular complications in diabetes. CRP is found to be elevated in patients with diabetes.

Objective: The objective of the study is to establish a relationship between serum CRP with T2DM and to look for the correlation between HbA1c and serum CRP levels in patients with diabetes.

Methodology: This retrospective observational study was carried out in a tertiary care hospital. Total 86 patients with T2DM above 30 years age (M: F- 57:29, mean age 54.3±9.2, mean BMI 24.28kg/m2) with HbA1c levels >6.5 were included in the study and compared with controls. Patients with renal impairments, coronary artery disease, autoimmune diseases, and infections were excluded from the study.

Results: Serum CRP levels were more in patients with diabetes compared to controls (p <0.01) and has a positive correlation with HbA1c and FBS in diabetic patients. Serum CRP is significantly related to FBS (r0.909, p <0.05). Serum ferritin is also significantly related to HbA1c (r-0.209, p <0.05). There was no correlation between S.CRP and age, sex, BMI, coexistent hypertension, total cholesterol, low density lipoprotein (LDL), and serum triglycerides.

Conclusion: Serum CRP was found to be significantly higher in patients with diabetes. There was a positive correlation between serum CRP and HbA1c. There was no correlation between serum CRP and the duration of diabetes. These results suggest that sub-clinical inflammation is more prominent in persons with T2DM which leads to microvascular and macrovascular complications in diabetes mellitus.

 22. Efficacy of Oral Semaglutide According to Race: An Exploratory Subgroup Analysis of the Pioneer Trial Program

Kunal Srivastava1, Cyrus Desouza2, Aslam Amod3, Klaus Kallenbach4, Peter J. Lin5, Morten Abildlund Nielsen6, Rasmus Sørrig7, Eduard Montanya7

1Medical Advisor, Novo Nordisk India, Pvt Ltd

2Professor, Internal Medicine, Division of Diabetes, Endocrine and Metabolism, Nebraska Medical Centre, Omaha, Nebraska, United States of America

3Life Chatmed Garden Hospital and Nelson Mandela, School of Medicine, Durban, South Africa

4Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark

5Canadian Heart Research Centre, North York, Ontario, Canada

6Department of Public Health, Aarhus University, Denmark

7Novo Nordisk, Soborg, Denmark

Background: The global PIONEER program investigated the efficacy and safety of oral semaglutide, a glucagon-like peptide-1 receptor agonist.

Objective: Study the effect of race on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of treatment.

Materials and Methods: Patients with type 2 were randomized to once-daily oral semaglutide (3, 7, or 14 mg, or flexibly dosed [flex]), placebo, or active comparator (empagliflozin 25 mg, sitagliptin 100 mg or liraglutide 1.8 mg). This exploratory subgroup analysis evaluated the effect of race on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of treatment (week 26, 52, or 78). Data were analyzed from PIONEER 1-5, 7, and 8 by race (White, Asian, Black/African American).

Results and Conclusion: Baseline characteristics were generally similar across subgroups except for BW, which was lower in Asian patients. Generally, greater HbA1c reductions were observed with oral semaglutide 14 mg/flex vs. comparators across subgroups. In PIONEER 1, 4, and 8, there was a significant interaction between treatment and race, with greater HbA1c reductions and estimated treatment differences in Asian patients than in other subgroups. Overall, BW reductions were greater for oral semaglutide vs. comparators, regardless of subgroup and without significant interactions between treatment and race. Our findings in this exploratory subgroup analysis suggest that, in some PIONEER trials, Asian patients achieve greater HbA1c reductions than other race groups when treated with oral semaglutide.

 23. A Prospective Study Characterizing Metabolic Features of New-Diabetic Ketoacidosis in Covid-19 Patients From India

Riddhi Dasgupta1, Avica Atri1, Sunetra Mondal1, Abhishek Bhattacharjee2, Ramprasad Gorai2, Arindam Hazra2, Brojen Chowdhury2, Dhriti Sundar Dutta2, Mousumi Lodh3, Arunangshu Ganguly4

1Department of Endocrinology, HealthWorld Hospitals, Durgapur, West Bengal, India

2Department of Internal Medicine, HealthWorld Hospitals, Durgapur, West Bengal, India

3Department of Clinical Biochemistry, HealthWorld Hospitals, Durgapur, West Bengal, India

4Department of Cardiology, HealthWorld Hospitals, Durgapur, West Bengal, India

Background: Recent evidence suggests a bidirectional relationship between COVID-19 infection and new-onset-diabetes (NOD).

Objective: To study the changes in metabolic parameters of COVID-19 patients presenting with new-DKA on serial follow-up.

Methodology: 20 subjects each of NOD with DKA (NOD-DKA), type 1A diabetes, type 2 diabetes (T2DM), and people without diabetes controls were studied with 75g- Oral Glucose Tolerance Test (OGTT) for measuring insulin secretion and hepatic, peripheral, and adipose insulin sensitivity. Liquid chromatography/Mass spectrometry (LC-MS) was used to test lipid and aminoacid metabolomics – with metabolic tests done at 0,4 and 8 months follow-up.

Results: Insulin secretion and pan-insulin sensitivity were severely impaired in NOD-DKA (n=20) group at baseline with n=16 (80%) of them showing significantly enhanced recovery at 4 and 8 months (all p<0.01) compared to the NOD-nonremission (n=4) group. The severity of COVID-19 infection and elevated inflammatory markers were associated with poor remission of insulin secretion and resistance on regression analysis. Metabolomics in the NOD-DKA group suggested a distinctive pathway of ketosis in NOD-DKA.

Conclusion: Ours is the first prospective study to provide a comprehensive metabolic outline of a unique form of new-onset DKA in previously normoglycemic COVID-19 positive Indians, with nearly 80% achieving near-complete recovery of beta-cell functions over eight months of follow-up despite acute presentation resembling type 1A diabetes.