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  Citation statistics : Table of Contents
   2018| January-April  | Volume 9 | Issue 1  
    Online since April 2, 2018

 
 
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REVIEW ARTICLES
Technology in the management of diabetes mellitus
Ranjit Unnikrishnan, Nitika Sharma, Viswanathan Mohan, Harish Ranjani
January-April 2018, 9(1):3-11
DOI:10.4103/jod.jod_4_17  
The explosive increase in the prevalence of diabetes mellitus in resource-strapped regions of the world demands innovative solutions in healthcare. Advances in information technology, diagnostics and food technology have the potential to make diagnosis and treatment of diabetes simpler, cost-effective and patient-friendly. Newer methods of glucose testing such as the ambulatory glucose profile promise to make clinical decision-making easier and more robust. More advanced modes of insulin delivery are likely to help larger proportions of patients achieve their glycaemic goals with minimal risk of hypoglycaemia. Use of telemedicine and electronic medical records represents a significant advance in improving delivery of diabetes care and monitoring its outcomes. Efforts are also on to harness the wide penetrance of mobile phones in spreading awareness about diabetes and its prevention as well as in screening for retinopathy. Advances in technology also promise to favourably alter the food habits of the population, with the advent of the novel high-fibre white rice being a case in point. This narrative review aims to discuss some of the ways in which emerging technologies are making diabetes monitoring and treatment easier, more effective and pleasant for the patient.
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CASE REPORT
Hereditary chronic pancreatitis in a patient with type 1 diabetes mellitus
Varalakshmi Muthukrishnan, Alpa Sorathiya, Ranjit Unnikrishnan, Viswanathan Mohan, Prasanna Kumar Gupta
January-April 2018, 9(1):32-35
DOI:10.4103/jod.jod_34_17  
In this case report, we present a young patient with type 1 diabetes who had hereditary chronic pancreatitis. We evaluated him for the cause of pancreatitis, but it was inconclusive and finally the genetic testing was done for him, which revealed heterozygous missense mutation in exon 3 of the PRSS1 gene (protease serine 1 gene) on chromosome 7. Hence, we were able to make the diagnosis of hereditary chronic pancreatitis. Chronic pancreatitis secondary to any cause can lead to permanent diabetes, which is typically difficult to control. However, in this case, the episodes of recurrent pancreatitis were present after the onset of type 1 diabetes as compared to the usual presentation of diabetes after the advancement of chronic pancreatitis.
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EDITORIAL
Cardiovascular safety studies for diabetic medications: Do the benefits outweigh the costs?
Brian K Irons
January-April 2018, 9(1):1-2
DOI:10.4103/jod.jod_40_17  
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LETTER TO EDITOR
Giant bullosis diabeticorum over charcot knee
Ganesh Singh Dharmshaktu, Tanuja Pangtey
January-April 2018, 9(1):36-37
DOI:10.4103/jod.jod_38_17  
  - 1,210 171
ORIGINAL ARTICLE
Association of cardiovascular complications with circulating levels of tribbles 3 human homolog and matrix metalloproteinases in Indian type 2 diabetic patients, with or without hypertension
Prashant Shirish Ratnaparkhi, Namrata B Kulkarni, Meghana U Ganu, Sanjay G Godbole, Sudha Shrikant Deo
January-April 2018, 9(1):25-31
DOI:10.4103/jod.jod_29_17  
Aim and Objective: Matrix metalloproteinases (MMPs) and Tribbles 3 (Trb3) human homologue have been reported to induce atherosclerosis. We wanted to evaluate the association of circulating levels of Trb3 human homologue and MMPs (MMP2 and MMP9), with possible cardiovascular complications in Indian type 2 diabetic patients (type 2 diabetes mellitus [T2DM]), with or without hypertension (HT). Materials and Methods: Serum from 144 individuals, classified as follows: Group A1= (DM + HT); T2DM >5 years + HT (n = 55); Group A2 = DM; T2DM <2 years, (n = 28); Group B1 = HT; (n = 31) and Group B2 = HC; (n = 30) age- and sex-matched healthy controls. Anthropometric measurements, biochemical profiles of sugar and lipids were established using auto analyser. MMP2, MMP9, Trb3, oxidised low-density lipoprotein cholesterol, and proinsulin were measured in the serum using ELISA. Results: Using Bonferroni correction, we found that MMP2 levels were increased in (DM + HT), when compared to individuals with DM and HT (P = 0.006 and 0.000). HT group had reduced levels of MMP2, as compared to HC, (P = 0.000). The Mann–Whitney U-test for MMP9 revealed that DM group had elevated levels of MMP9 compared to (DM + HT), HT and HC group, (P = 0.011, 0.000, and 0.001). (DM + HT) had elevated levels of MMP9 when compared to HT group, (P = 0.012).). Levels of MMP9 in HT were lower than the HC group, although not significant. Levels of Trb3 were found to be elevated in (DM + HT) when compared to DM, (P = 0.032). The levels of Trb3 were higher in the HT, when compared to HC group, although not statistically significant. Multiple linear regression model for Framingham Risk Score, weighted with post prandial blood sugar yielded R2 = 0.338; F = 7.602 (df = 9), P = 0.000. Trb3 (β = −0.179, P = 0.019); MMP2 (β =0.021, P = 0.787) and MMP9 (β = −0.03, P = 0.684). Conclusion: Trb3 is a useful marker for evaluating the association of cardiovascular risk in diabetic patients.
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REVIEW ARTICLES
Hypertriglyceridemia: A new paradigm
Johny J Kannampilly
January-April 2018, 9(1):12-18
DOI:10.4103/jod.jod_22_17  
Low-density lipoprotein cholesterol (LDL-C) has been proven time and again to be independently associated with the risk of cardiovascular diseases (CVD). However, triglycerides (TG) are now also emerging as an important as well as independent risk factor for CVD. International lipid guidelines recommend statins as first-line drugs. However, there always remains a residual risk with statins, especially in the high-risk diabetes subset of patients. The most important reason cited for increased residual CV risk with statins is the non-high density lipoprotein cholesterol component, of which high TGs are an integral part. Several large epidemiological, Mendelian randomisation, population-based and genetic studies are emerging which are pointing towards the fact that high TG leads to CV morbidity and mortality. Pathophysiological basis of hypertriglyceridemia associated with increased CV risk has been attributed to increase circulating chylomicron and TG-rich lipoprotein remnants, increased small dense LDL, heightened risk of endothelial dysfunction and plaque formation. Recent international guidelines recommend TG lowering therapy at TG >200 mg/dl when not controlled by optimal statin therapy. TG levels more than 500 mg/dl, however, require non-statin lipid-lowering agents as primary agents to reduce the risk of acute pancreatitis. Fibrates, niacin and omega 3 fatty acids are recommended as TG-lowering drugs. However, they are not without their share of adverse events. Saroglitazar is a novel dual peroxisome proliferator-activated enzyme agent which has been found to be free of many such adverse events and also adequate in providing dual control over hypertriglyceridemia along with significant glycaemic control.
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Depressive symptoms among participants with type 2 diabetes in Southeast Asia: A systematic review
Rifat Rezia, Anwar Islam, Sheikh Mohammed Shariful Islam
January-April 2018, 9(1):19-24
DOI:10.4103/jod.jod_23_17  
Objective: Diabetes and depression are two major non-communicable diseases that have increased in epidemic proportion globally. Depression is common in participants with diabetes causing increased morbidity and mortality. This article aimed to review co-morbid depression in participants with type 2 diabetes (T2D) in Southeast Asia. Methods: We conducted a systematic review of published literature on the prevalence of depression among adult patients with T2D in Southeast Asia. A comprehensive search was performed using PubMed, Google Scholar and BanglaJOL for published studies between 1990 and 2014 with full text available in English. Study selection and data extraction were conducted independently by two researchers. A formal meta-analysis was not performed, and only summary findings of the relevant studies were presented. Results: A total of six studies including 3837 participants were included. The prevalence of depressive symptoms among participants with T2D ranged from 14% to 41%, with the highest prevalence of 60.8% among female T2D patients in Pakistan. The pooled prevalence of depressive symptoms in participants with T2D was 27.7% (95% confidence interval 21.4%–34.0%). Depressive symptoms were higher among females in four studies and associated with increasing age. Conclusion: Our review shows a high prevalence of depressive symptoms among participants with T2D in Southeast Asia. Further research is needed to clarify the association between depressive symptoms and diabetes in this population group, and efforts for prevention, early diagnosis and optimum management through innovative mechanisms of both conditions are warranted.
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