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   Table of Contents - Current issue
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May-August 2020
Volume 11 | Issue 2
Page Nos. 49-124

Online since Wednesday, June 24, 2020

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EDITORIAL  

Coronavirus disease-2019 (COVID-19) and its effect on diabetes p. 49
Viswanathan Mohan
DOI:10.4103/JOD.JOD_41_20  
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OBITUARY Top

Obituary: Prof. A. Samad Shera p. 50
Viswanathan Mohan
DOI:10.4103/JOD.JOD_17_20  
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REVIEW ARTICLES Top

Diabetes and coronavirus disease-2019 (COVID-19) Highly accessed article p. 52
Ranjit Unnikrishnan, Banshi Saboo, Jothydev Kesavadev, Neeta Deshpande, Sosale Ramachandra Aravind, Shashank Joshi, Ranjit Mohan Anjana, Akhtar Hussain, Viswanathan Mohan
DOI:10.4103/JOD.JOD_36_20  
Ever since the coronavirus disease (COVID) pandemic started hitting the world, the connection between diabetes and coronavirus disease-2019 (COVID-19) started becoming more clear. In this article, we asked the question whether people with diabetes are more prone to COVID-19 and whether they also are likely to get more severe form with the disease and have worse outcomes than people without diabetes. We also discussed the mechanisms by which diabetes worsens COVID-19 and also possible changes to the treatment of diabetes in the presence of COVID-19. Finally, we discuss preventive strategies that need to be taken in people with diabetes to prevent COVID-19.
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COVID-19, hypertension, and cardiovascular disease p. 57
HK Chopra, RR Kasliwal, A Muruganathan, Mohsin Wali, C Venkata S Ram
DOI:10.4103/JOD.JOD_30_20  
The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular (CV) health of patients, although the respiratory disease is the predominant clinical sign of COVID-19. The presence of comorbidities such as hypertension, diabetes, and CV disease (CVD) increases the risk of morbidity and mortality due to CVD. Numerous patients with COVID-19 have basic CV ailments or develop severe heart injury due to the disease. Severe CV injury characterized by a huge rise of heart troponins is the most commonly seen effect on the heart. This happens in approximately 8%–12% of all patients. Direct myocardial injury because of viral association of cardiomyocytes and the effect of systemic inflammation appear to be the most common mechanisms responsible for the cardiac injury. The presence of preexisting CV disease and/or development of acute cardiac injury is associated with significantly worse outcomes in patients with COVID-19. Most of the current reports on COVID-19 have only briefly described CV manifestations in these patients. Given the significant adverse prognostic impact of cardiac involvement, further studies are needed on the incidence, mechanisms, clinical presentation, and outcomes of various CV manifestations in patients with COVID-19.
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The role of hydroxychloroquine in COVID-19: Where do we stand? p. 65
Ranjit Mohan Anjana, Nadiminty Ganapathi Sastry, Muthu Ramuu, Prasanna Kumar Gupta, Jaggi Shalini, Brijendra Kumar Srivastava, Chaithanya Murthy Kocherlakota, Tata Sameer Nandan, Gangadhara Praveen, Jyotish Nair, Routray Philips, Viswanathan Mohan, Ranjit Unnikrishnan
DOI:10.4103/JOD.JOD_33_20  
Hydroxychloroquine (HCQ) is a drug, which has long been used in the treatment of malaria, rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome. Recently with the COVID-19 pandemic hitting the world, there have been studies suggesting that hydroxychloroquine may be useful both in the prevention and the treatment of COVID-19, although the evidence so far has been conflicting. This article reviews the available evidence for the use of hydroxychloroquine in COVID-19 and also mentions some of the ongoing trials in this field.
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Vitamin D and its role in coronavirus disease 2019 (COVID-19) p. 71
Viraj Ramesh Suvarna, Viswanathan Mohan
DOI:10.4103/JOD.JOD_18_20  
The unprecedented (in scale, scope) coronavirus disease 2019 (COVID-19) pandemic has taken the world by storm. Cases and case fatality rates are mounting and in this panic-stricken environment, where there are no specific antinovel corona viral drugs or vaccines, doctors are experimenting with drugs that have not been specifically approved for this virus. Against this backdrop, a review article has been written based on locating, selecting, extracting, and synthesizing relevant available in vitro and clinical data on the use of vitamin D as an innate immunity boosting agent, and its possible effects in certain viral (including corona viral) and other acute respiratory tract infections. Vitamin D is not only a micronutrient or vitamin, but also a hormone that has vitamin D receptors on cells all over the body. Vitamin D deficiency/insufficiency is a pandemic, though not infectious, and correcting vitamin D deficiency or insufficiency is required. Whether vitamin D has specific effects against this novel coronavirus in patients with COVID-19 is not known, as there is no randomized controlled clinical trial on its use in such patients. Perhaps there is need for research in this area and particularly when people cannot get adequately exposed to the sun due to the lockdown, taking vitamin D supplements may help them become vitamin D sufficient. Whether it will be sufficient in their fight against COVID-19 is a question that needs to be answered through appropriate research.
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Strategies adopted in conduct of clinical trials amidst coronavirus disease-2019 (COVID-19) p. 81
Subramani Poongothai, Ranjit Mohan Anjana, Ramasamy Aarthy, Selvam Kasthuri, Mohamed Althab Begum, Kulasegaran Karkuzhali, Kannikan Viswanathan, Balasundaram Bhavani Sundari, Ravi Pavitha, Boopathi Hemalatha, Abdul Ali Tameem Nisha, Mahalakshmi Ravisankar, Rajkumar Marappan, Jagannathan Ramesh
DOI:10.4103/JOD.JOD_32_20  
The conduct of clinical trials is crucial to all research stakeholders and very challenging to the investigators, study teams, and participants during (coronavirus disease-2019) COVID-19 pandemic. The main challenges include difficulties in maintaining complete adherence to approved protocol, regulatory provisions applicable guidelines, recruitment of subjects, protection of rights, safety and well-being of trial subjects (participants), is of paramount importance. The CDSCO (Central Drugs Standard Control Organization), EMA (European Medicines Agency), and FDA (Food and Drug Administration) have come out with the guidelines on the management of clinical trials during the COVID-19. This article describes the process of conducting clinical trials at Department of Clinical Trials at Madras Diabetes Research Foundation (MDRF), Chennai, during the COVID-19 pandemic. Effective strategies taken at our site include compliance with scheduled visits of subjects, laboratory testing (investigations), administration of investigational product(s), assessment of safety and efficacy parameters, reporting of SAEs (serious adverse event). These strategies could be a useful reference to investigators, doctors, and research staff across hospital sites in India and elsewhere.
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ORIGINAL ARTICLES Top

Use of continuous glucose monitoring in diagnosis and management of cystic fibrosis-related diabetes in children p. 86
Sze M Ng, Akinsola Ogundiya
DOI:10.4103/JOD.JOD_13_19  
Background: Cystic fibrosis related diabetes (CFRD) is the most common comorbidity in children with cystic fibrosis (CF). Routine screening for CFRD is the oral glucose tolerance test (OGTT) where blood glucose levels are measured at 0 and 120 min. Studies have found that patients with CFRD often have an initial postprandial raised blood glucose level at 60 min while still achieving a normal 120-min blood glucose level from an OGTT, resulting in delayed diagnosis and treatment of CFRD. The aim of this study was to assess whether the use of continuous glucose monitoring (CGM) could aid in early diagnosis and treatment in children with CFRD. Methods: We included five patients diagnosed with CFRD. All the patients had a raised 1-h OGTT blood glucose level (>11.0 mmol/L), and consented for CGM for two weeks. Treatment was commenced initially as bolus fast-acting insulin (Novorapid), which targeted the initial postprandial rise in blood glucose level. If the CGM showed continued overnight hyperglycemia, basal long-acting insulin (Lantus) was later added to the treatment regimen. Results: All the patients showed improvement in their forced expiratory volume at 1s and weights following insulin treatment. Conclusions: Abnormalities of glucose metabolism have an adverse impact on morbidity and mortality in patients with CF. Early detection of glucose abnormalities using CGM and early targeted intervention is an important factor to consider in improving lung function and nutritional status. Further studies are warranted on the use of CGM in the early detection and management of CFRD in children.
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Impact of noncommunicable disease text messages delivered via an app in preventing and managing lifestyle diseases: Results of the “myArogya” worksite-based effectiveness study from India p. 90
Harish Ranjani, Sharma Nitika, Ranjit Mohan Anjana, Sandhya Ramalingam, Viswanathan Mohan, Nalini Saligram
DOI:10.4103/JOD.JOD_6_19  
Background: Smartphones provide an opportunity for preventing lifestyle diseases through mobile applications. Purpose: The aim of this study was to investigate the effectiveness of a mobile phone application (app) in making lifestyle changes in the community in individuals across glycemic categories. Materials and Methods: Adult participants (n = 674) across eight worksites were randomized into an intervention group that downloaded the “myArogya” app and received noncommunicable disease prevention messages twice a week for 6 months in the form of modules and into a control group who did not receive the app. Both groups attended a talk on diabetes prevention and management at baseline. Clinical and biochemical parameters were screened at baseline and postintervention. Eating and behavior scores were computed based on a set of questions on lifestyle habits. The primary outcomes were compared across study arms and within glycemic categories. Results: Intervention group participants with prediabetes showed a greater percent change in HbA1c levels (−1.9%) and blood pressure levels (systolic −2.7% and diastolic −3.1%), and a significant increase in exercisers (8%) compared to controls. Both intervention and control group participants reported that they had quit smoking and showed similar increase in moderate-to-vigorous physical activity, mean eating score, and total behavior score. A similar percentage of intervention (47%) and control group (48%) participants achieved two or more prescribed goals. Conclusion: “myArogya” app helped to reduce blood pressure and smoking behaviors, adopt healthy eating, and improve physical activity level among the study participants. Prediabetes and diabetes participants were more inclined toward making positive lifestyle changes as compared to participants in normal glucose tolerance category. However, similar number of participants met the study goals across groups.
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prevalence of diabetes mellitus in newly detected patients with hepatitis C p. 101
Showkat A Kadla, Nisar A Shah, Rupakshi Pathania, Bilal A Khan, Shahnaz A Mir, Asif I Shah, Shabir A Sheikh
DOI:10.4103/JOD.JOD_14_19  
Introduction: Hepatitis C, in addition to liver disease, also causes extrahepatic manifestations in almost 35% of patients, resulting in a spectrum of autoimmune conditions. The prevalence of type 2 diabetes has been reported to be more in these patients. There is a compelling reason to believe this because studies have shown an increased prevalence of hepatitis C virus (HCV) in type 2 diabetes mellitus (DM). The study was conceived to find the prevalence of type 2 DM in HCV-positive patients and its relation to genotype. Materials and Methods: This was a hospital-based case-control study, conducted in the Department of Gastroenterology, Government Medical College Srinagar, Jammu and Kashmir, India. All patients with hepatitis C were enrolled and investigated as per the study design. According to the standard protocol already in vogue, the cases were thoroughly investigated which included all base line investigations, GTT, HbA1c and HOMA-IR. However, majority of the controls were subjected to GTT, HbA1c and homeostatic model assessment of insulin resistance (HOMA-IR) only. Results: Among the cases, the mean age was 45.97 ± 11.982 years; 67.14% had genotype 3 and 32.85% had genotype 1. Cases and controls were compared on the basis of fasting blood sugar levels in three different ranges (≤100 mg%, 101–125 mg%, and ≥126 mg%) and a 2-h GTT at three different levels (<140 mg%, 140–199 mg%, and ≥200 mg%). Other parameters of comparison included HbA1c, serum insulin levels, HOMA-IR, body mass index, liver function test, and lipids. Among all these, only the difference in the level of HOMA-IR (<2.5 in 45.71% of cases and 65.71% of controls) was statistically significant (P = 0.0063). On comparing the diabetogenic potential of two genotypes on the basis of fasting blood sugar and a 2-h GTT, genotype 3 was found to be more diabetogenic. Conclusion: Hepatitis C causes 2.1-fold increase in the prevalence of type 2 diabetes in patients without the evidence of chronicity or complications with increased predisposition to genotype 3 over genotype 1.
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A study on prevalence and risk factors of diabetic nephropathy in newly detected type 2 diabetic patients p. 109
Rahul Ravindran, S Kalaivalli, S Srinivasagalu, Lakshminarayanan Karthik
DOI:10.4103/JOD.JOD_17_19  
Aims and Objectives: This clinical study aimed to find out the prevalence of diabetic nephropathy in newly detected type 2 diabetic patients and also the risk factors associated with the development of the diabetic nephropathy. Settings and Design: The study group comprised 200 subjects diagnosed with type 2 diabetes mellitus. The patients were explained about the study and the study was conducted over a period of 18 months as a cross-sectional study. Materials and Methods: A progressive kidney disease diabetic nephropathy involves damaging the capillaries in the kidneys’ glomeruli. Patients were investigated for the presence of diabetic nephropathy with several risk factors such as hypertriglyceridemia, dyslipidemia, smoking, body mass index, hypertension, family history of diabetes, and kidney diseases. Statistical Analysis Used: Chi-squared test, two-sample t-test, and binary logistic regression model were used for data analysis using the Statistical Package for Social Sciences software version 11.5. Results: The prevalence found in this study was 13%. Of 200 patients, 26 were found to have diabetic nephropathy. Among these patients, 12% had microalbuminuria and 1% had macroalbuminuria. Incidence of nephropathy was higher in associated risk factors such as hypertension, obesity, and hypercholesterolemia. Conclusion: Effective measures to create awareness among the people and educate them for a healthy life style are to be taken. The effective control of the risk factors in type 2 diabetic patients will prevent the development of nephropathy and also retard its progression.
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Prospective associations between a food-based Indian Diet Quality Score and type 2 diabetes risk among South Indian adults (CURES-154) p. 115
Nagarajan Lakshmi Priya, Rajagopal Gayathri, Vasudevan Sudha, Gunasekaran Geetha, Nagamuthu Gayathri, Bhupathiraju Shilpa, Coimbatore Subramanian Shanthi Rani, Krishnaswamy Kamala, Ranjit Mohan Anjana, Unnikrishnan Ranjit, Selvaraj Pradeep, Viswanathan Mohan
DOI:10.4103/JOD.JOD_35_19  
Background: Asian Indians are culturally different and have diverse dietary and culinary habits. Further, there are potential biological differences in metabolism due to genetic or cultural factors. This warrants the development of a unique population-specific food-based diet score for prevention of noncommunicable disorders. Materials and Methods: Dietary intake was assessed using a validated food frequency questionnaire in 1033 adults who participated in the 10-year follow-up study of Chennai Urban Rural Epidemiological Study (CURES). The diet score was developed considering eight food groups and one major cooking oil that were either significantly associated with a higher or lower risk of incident type 2 diabetes (T2D). The foods that showed a protective effect was assigned higher scores and vice versa for foods that increased the risk of diabetes assigned the lower. We further assessed the effect of Indian Diet Quality score (IDQS) and three popular diet quality indices: the Healthy Eating Index-2015 (HEI), the Dietary Approach to Stop Hypertension (DASH), and Diabetes Diet Score (DDS) in relation to the risk of incidence of diabetes among Indian population. Results: Higher IDQS is associated with a significant lower risk of diabetes incidence; however, no such significant association was observed with diet quality indices (DASH, HEI-2015, and DDS) and diabetes incidence. This warrants the need for population-specific diet score for Indians. Conclusion: Higher IDQS was associated with a lower risk of T2D among South Indian adults. Thus, IDQS can be a suitable tool to identify the diet–disease relationship especially in a population with diverse dietary intakes.
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