Similar to many other countries around the world, Bangladesh is also suffering from a pandemic of diabetes. It makes the most significant contribution to morbidity and mortality in this country. Despite the high burden of diabetes, health care is still geared toward episodic care. The government has not yet invested substantial efforts into developing a national policy to detect, prevent, and control diabetes. Still, diabetes care is restricted to capital and other big cities. More than 60% of people with diabetes usually sought treatment and advice from private facilities, including the Diabetic Association of Bangladesh. For the past six decades, the Association has been trying to develop a proper organizational framework, health care, educational institutions, rehabilitation facilities for poor people with diabetes, appropriate diabetes prevention, and education programs. To address the pandemic, the country should focus on nationwide diabetes prevention and control programs, such as creating community awareness and changing lifestyle practices through well-designed public health programs. The country also needs public–private partnerships and multi-sectoral approaches to overcome the diabetes burden.

Objective: Vitamin D deficiency is claimed to be associated with many diseases in the world population. Many studies reported that vitamin D deficiency is quite prevalent in Pakistan. The aim of this review is to describe the current status of vitamin D deficiency in healthy individuals and in different disease conditions in this country. Materials and Methods: Search engines such as “Google Scholar,” “Medline,” and “PubMed” were used by applying key words such as vitamin D deficiency and different disease conditions in the Pakistani population. In this study, people with vitamin D levels less than 30 ng/mL were reported as being vitamin D deficient. Results: A total of 82 studies were included: Among these, 12 studies showed vitamin levels less than 30 ng/mL in healthy individuals (male and female) and 70 studies in different disease conditions. It was found that about 64.6% of healthy subjects had vitamin D levels less than 30 ng/ml. Moreover, 70 studies showed vitamin D deficiency in some diseases, such as musculoskeletal, bone, and periodontal problems, nursing mothers and children, tuberculosis (TB), diabetes, cardiovascular problems, and some type of cancers. Conclusion: The current status of vitamin D deficiency in the healthy population and in several diseases and conditions is thoroughly discussed in this review. This review could be helpful in understanding the status of vitamin D and the different aspects of vitamin D research in this population.

Diabetes-related eye problems are a growing eye health concern globally, and diabetic retinopathy (DR) is one of the leading causes of preventable blindness. Ideally, people with diabetes should have an initial comprehensive eye examination, including fundus examination through dilated pupils, and then followed up with recommended intervals. However, in reality, this cannot be achieved because of the limitations in the human resources and health facilities, among others. On the other hand, fundus screening for DR justifies the suggested principles for screening for combating a disease. DR screening programs at the local/regional/national level can serve as an effective way for the diagnosis and treatment of vision-threatening DR in people with diabetes. These programs need to be tailored according to the human resources and the infrastructure of the community; they will serve, and they should have a monitoring system in place, as well. The availability, accessibility, and affordability of the treatment should also be ensured for people with vision-threatening DR.

Medical nutrition therapy interventions among type 2 diabetes patients administered by registered dieticians are said to be beneficial to the extent of reducing glycated hemoglobin by 1%–2%. Despite patient-centered dietary interventions, adherence continues to remain a challenge in the Indian setting due to the carbohydrate-rich dietary pattern, dietary myths coupled with lack of nutritional awareness, poor literacy, financial burden, and lack of motivation. On the contrary, the evolution of “FAD” diets through drastic dietary changes present individuals with type 2 diabetes with a possibility of reversal of the disease further increasing the nutritional dilemma. These FAD diets extend beyond being mere trends and show improvements in several biochemical processes by reducing the intake of calories either through restriction (very low-calorie diet) or fasting (intermittent fasting) or low carbohydrate diets up to one year. This article by evaluating the suitability of these promising diets to Indian adults with type 2 diabetes aimed to provide evidence that could improve diabetes-related dietary knowledge. Through this narrative review, we conclude that a single drastic dietary modification as seen in very low-calorie diets (≤ 800 kcal/day) or the low-carbohydrate diet (≤ 75 g/d) is not suitable for Indians and such dietary measures will further hamper the sustainability of prescribed diets. The future directions in diet and disease would be to develop clinical trials that will show the effectiveness of dietary regimens constituting optimal energy deficit and macronutrient balances that will contribute to the remission of disease while preventing macronutrient deficiencies and relapse in the dietary regimen.

Introduction: Diabetes is one of the major disease burdens in the world. Globally around 463 million people (at a prevalence of 9.3%) suffered from diabetes recently. Apart from morbidity and mortality, diabetes poses high economic burden on healthcare systems, especially on national economies in developing countries like India. Estimation of the cost burden of diabetes can help decision-makers to understand the magnitude of the problem, prioritize research efforts and interventions, and plan resource allocation, especially in resource-poor settings. The focus of our review was to summarize cost burden of diabetes and its determinants from existing literature in the last 10 years in India. Materials and Methods: All literatures published in the period 2010–2020 were accessed through two databases: PubMed and Google Scholar. Reference lists of the article were again searched for further literatures. Cost calculated in different times was converted to current price in 2020 for ease of comparison. Results: Studies reported a wide range of expenditures in different settings of care. Inequity of expenses across income quintiles among patients was found. Complication of diabetes, insulin therapy, treatment in private facility, and events of hospitalization were the factors associated to high expenditure burden. Conclusion: Financial risk protection for vulnerable people and control over medicine market price will reduce out-of-pocket expenditure for diabetes. Comprehensive strategy to delay onset of complication as well as its early detection can be an opportunity to cut down diabetes-related economic burden.

Type 2 diabetes mellitus (T2DM) is an emerging epidemic among children and adolescents. There is a lack of comprehensive guidance to clinicians for the management of T2DM in this patient population. An expert panel of diabetes specialists from India reviewed the available literature, discussed, and proposed six recommendations on the identification of risk factors leading to the development of T2DM, diagnosis of T2DM, and non-pharmacological and pharmacological management of T2DM in children and adolescents. According to these recommendations, the most common risk factors leading to T2DM in children are obesity, metabolic syndrome, insulin resistance, family history, puberty, and genetic abnormalities. Diagnosis of T2DM in children and adolescents should be based on plasma glucose levels, with recommendation to test glycated hemoglobin levels quarterly. Lifestyle modifications may help in improving outcomes. Among pharmacological treatments, insulin and metformin are currently the approved first-line therapies and liraglutide is recommended if glycemic targets are no longer met with metformin or insulins. Early identification of risk factors, along with early diagnosis and initiation of insulin therapy with lifestyle modifications, may help in delaying the chronic complications associated with T2DM in children and adolescents.

Aim: Metabolic syndrome (MeS) refers to metabolic risk factors with different phenotype combinations. The study aim was to determine the clusters of MeS components by age and gender as predictors for the presence of fatty liver (FL). Materials and Methods: The cohort consisted of 990 subjects, undergoing executive health check between January 2019 and February 2020. Baseline data, anthropometric parameters, and ultrasound findings were noted. Patients with normal ultrasound were categorized as group 1 and those with FL as group 2. MeS is defined and clustered and risk of predicting FL was analyzed in age and gender. Results: Of the 990 subjects, 689 (69.6%) had FL (group 2); 554 patients (56%) were >45 years. Females had significant grade 1 (P < 0.05) and grade 2 (P < 0.01) FL, ≥45 years, and MeS of three or more components in FL, both above (P < 0.01) and below (P < 0.03) 45 years of age. Waist circumference (WC), diabetes mellitus (DM) with hypertension, triglyceride, and high-density lipoprotein (cluster 3) were statistically significant in males, both <45 and >45 years of age (P < 0.001); in females, the same cluster was statistically significant only for >45 years (P <0.001). Conclusion: Females ≥45 years had significant FL. MeS of three or more components was seen in both above and below 45 years in females with FL when compared with males. The highest risk clusters were the ones that included WC and WC + DM, indicating that the clusters associated with WC alone or in combination with DM had the highest risk for FL when compared with the other MeS combinations.

Introduction: Insulin resistance (IR) is a core component of the pathophysiology of type 2 diabetes mellitus (DM). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is the most commonly used marker of IR. Plasma magnesium is a relatively cheap analyte and has been linked with the pathophysiology of IR. This study primarily was aimed at evaluating the possible use of plasma magnesium as a surrogate marker of IR in type 2 diabetes. Materials and Methods: The study was a hospital-based cross-sectional study carried out at a tertiary hospital in South-western Nigeria between March and September 2018. The study was conducted on 70 persons with diabetes, and age- and sex-matched 70 controls who met the eligibility criteria were recruited into the study. Ethical approval was obtained and informed consent was obtained from the participants. Fasting plasma glucose, fasting plasma insulin, and plasma magnesium were measured using standard protocols. HOMA-IR was determined using the appropriate formula. Data analysis was carried out using the Statistical Package for Social Sciences software, (SPSS) version 22. Results: The mean age of the participants was 53.34 ± 9.57 years and that of the gender-matched controls was similar. Frequency of hypomagnesemia was significantly higher in the participants compared with controls (25.7% vs. 5.7%; P < 0.001). Similarly, a significantly greater proportion of the study participants (62.9%) had IR as expected compared with just 8.7% of the controls. The mean plasma magnesium (mg/dL) among the participants was significantly lower than that of the controls (1.73 ± 0.16 vs. 1.87 ± 0.14; P < 0.001). As expected, the mean HOMA-IR in the participants was significantly higher than that of the controls (2.64 ± 0.91 vs. 1.71 ± 0.32; P<0.001). There was a statistically significant negative correlation between plasma magnesium and IR among the participants (r=−0.443; P<0.001). However, among the controls, there was no statistically significant correlation between plasma magnesium and HOMA-IR (r=−0.034; P = 0.778). Conclusion: Plasma magnesium was found to correlate significantly with IR and may be used as a surrogate marker of IR in persons with type 2 DM but not in the general population.

Background: Poor medication adherence in type 2 diabetes mellitus (T2DM) leads to poor glycemic control. Materials and Methods: This randomized, open-labeled, controlled study recruited consenting adult patients with uncomplicated T2DM who were on daily oral antidiabetics with documented poor medication adherence (missing ≥20% of their prescribed doses in the past 15 days). Patients in the “incentive group” installed a digital therapeutics mobile app (KYT-Adhere) and received multiple daily medication reminders. Patients were asked to show the pill/(s) to the app before consuming the medication, after which the patients received “KYT-Points”; these would be converted into financial incentives after 3 months, provided that they maintained ≥80% medication adherence. These patients received incentives for 3 months and medication reminders for 6 months. “Control group” patients received standard care. Results: A total of 118/120 recruited patients completed the study; 59 each with similar baseline parameters were randomized to incentive and control groups. At baseline, medication adherence and HbA1c were comparable (adherence: 65.7±4.7% and 65.3±4.0%; HbA1c: 9.0±0.3% and 9.0±0.3% for incentive and control groups, respectively). Over the study duration, the incentive group showed a significant improvement in medication adherence (P < 0.001) and significant HbA1c reduction (P < 0.001). At study closure, the average medication adherence and HbA1c were significantly different between the two groups (adherence: 86.8±3.2% vs. 67.7±4.6%, P < 0.001; HbA1c: 7.3±0.2% vs. 8.2±0.3%, P < 0.001). Conclusion: Gamification through combining repeated medication reminders and rewards through a smartphone application brought about a behavioral change, which improved medication adherence and glycemic control among T2DM patients within 3 months and was sustained for 3 more months without rewards.

Purpose: The aim of the study was to evaluate the effect of whole-body vibration (WBV) with balance training on strength and functional ability in patients with diabetic peripheral neuropathy (DPN). Materials and Methods: Forty (19 males and 21 females) patients with DPN participated in the study. The patients were randomly allocated to experimental group (age = 57.3 ± 7.3) and control group (age = 57.1 ± 6.5). The experimental group performed WBV with balance training, whereas the control group performed only balance exercises for three weeks (five days/week). Outcome measures included neuropathy disability score (NDS), numeric pain rating scale (NPRS), timed up and go test (TUGT), Tinetti performance-oriented mobility assessment (Tinetti POMA) scale, strength of quadriceps, and tibialis anterior and reaction time. Results: Demographic characteristics and outcome measures at baseline were found to be nonsignificant between the groups. NDS, Tinetti POMA, quadriceps, and tibialis anterior strength showed significant time effect (P ≤ 0.016) and time × group interaction (P ≤ 0.008) whereas group effect was found to be nonsignificant. TUGT only showed significant time effect (P < 0.001). NPRS and reaction time showed significant time × group interaction (P ≤ 0.002). Conclusion: The WBV with balance exercise showed improvement in the NDS, functional balance, functional mobility, and strength of the lower limb muscles when compared with balance exercises only.

Context: Given the large disease burden of diabetes in Singapore, we felt a need to study the reasons for the low uptake of continuous glucose monitoring (CGM) in Singapore, despite its recognized benefits and international recommendation. Aims: The aim of this article is to identify perceptions of diabetes care providers (DCPs) and extent of barriers to promoting CGM uptake in Singapore. Settings and Design: This is a cross-sectional study in Singapore. Materials and Methods: A cross-sectional online survey of DCPs over 21 years of age, who provided direct outpatient care to diabetes patients in Singapore and spent minimally 50% of their total patient care time on diabetes care services, was conducted. Statistical Analysis Used: K-means cluster analyses grouped respondents by their diabetes technology and CGM attitudes, barriers to employing CGM clinically, and perceived barriers by patients for CGM uptake and adherence. Fisher’s exact tests and Kruskal–Wallis tests assessed for inter-group demographic differences. Results: From a total sample of 47 respondents, analyses formed three clusters, describing DCPs’ willingness to recommend CGM uptake. All respondents agreed cost is the top barrier. Willing (48.9% of sample) and Unwilling (23.4%) DCPs reported minimal and many barriers to employing CGM clinically, respectively, whereas Eager DCPs (27.7%) reported none. Eager and Willing DCPs, who perceived cost as the only barrier by patients, had more positive diabetes technology and CGM attitudes versus the Unwilling DCPs that perceived many barriers by patients. Conclusion: Local DCPs agreed on the role of CGM in optimizing glycemic control, and that cost is the top barrier against CGM uptake.

Background: India has an enormous burden of type 2 diabetes mellitus (T2DM), and this plays an important role in global T2DM research. However, the quantity and quality of Indian T2DM research remain largely unexplored. Objective: To provide a detailed analysis of Indian T2DM research output during 1982–2019 using select bibliometric indicators. Materials and Methods: Data on T2DM publications were retrieved from the Scopus database. The analysis focused on the quantitative output of Indian authors and organizations. The qualitative performance was assessed in terms of relative citation index, citations per paper, and highly cited papers. Results: Globally, 157 countries participated in T2DM research, producing 208902 publications during 1982–2019. India ranks in the ninth place in global output, with 7844 publications (3.75% share). Only 19.06% of papers had international collaboration, whereas 12% received funding. The leading productive organizations were the Madras Diabetes Research Foundation, Chennai, All India Institute of Medical Sciences (AIIMS), New Delhi, and Post Graduate Institute of Medical Education & Research, Chandigarh; whereas King Edward Memorial Hospital, Pune, AIIMS, New Delhi, and Fortis Healthcare, Gurgaon were the most impactful. The most productive authors were V. Mohan, S. Kalra, and A. Ramachandran. Journal of the Association of Physicians of India, Diabetes and Metabolic Syndrome Clinical Research and Reviews, and Journal of Clinical and Diagnostic Research were the leading productive journals. Only 2.23% of publications were highly cited. Conclusions: Considering the burden of T2DM, India’s research is lagging behind. Increasing national and international collaborations, active involvement of national and international funding agencies, and prioritizing research on youth with T2DM is the need of the hour.

Purpose: Comorbid depression and type 2 diabetes are associated with poor glycemic control, increased complications, and poor self-management, compared to either condition alone. The Integrating Depression and Diabetes Treatment (INDEPENDENT) clinical trial demonstrated the effectiveness of an integrated care model in improving diabetes and depression outcomes, in diabetes-specialty clinics in India. The INDEPENDENT model used task sharing to address the shortage of mental health professionals in India. Care coordinators (CCs) who were dietitians or counsellors were a key component of this care model. This article details the training and support provided to the CCs during the INDEPENDENT trial. Materials and Methods: CCs were nonphysician and nonpsychiatrist health specialists who supported patients in self-management of diabetes and depression, helping them set achievable goals and monitored progress. During the clinical trial, the CCs underwent both offsite and on-site trainings. The trainings equipped them with various lifestyle management tools for self-care, including one-on-one education sessions and motivational interviewing for self-monitoring, adherence to medication, diet, exercise regimes, and cessation of smoking, among others. Results: Nine CCs from the four sites were trained effectively during the course of the INDEPENDENT study from 2014 to 2018. Conclusions: Given the paucity of mental health professionals in India, the use of collaborative care and a team of well-trained CCs may be an effective strategy for the management of comorbid depression and diabetes. This model of care could help fill deficiencies in the delivery of care for comorbidity of depression and diabetes care in India.

Background: The first national-level multicentric clinic-based registry of youth-onset diabetes from India was started in the year 2006 by the Indian Council of Medical Research (ICMR). Objective: In this study, we present the data collected from one of the Regional Collaborating Centre, Chennai (RCC03) of the ICMR Young Diabetes Registry (YDR). Materials and Methods: YDR recruited young diabetes participants reporting on/after January 1, 2000, with age onset ≤25 years at the time of diagnosis of diabetes, and residing within the Chennai Metropolitan Area. The reporting centers (RCs) that were willing to participate in the registry were included, and their staff was trained to fill-in the baseline and follow-up proforma. Results: Overall, 29 RCs participated, which includes six government hospitals, and remaining are private speciality hospitals or single-physician clinics. So far, RCC03 had contributed 4194 young diabetes participants to ICMR-YDR from the Chennai region. Among the registered 48.1% (n = 2020) were type 1 diabetes mellitus (T1DM), 43.4% (n = 1821) were type 2 diabetes mellitus (T2DM), 6.4% (n = 269) were gestational diabetes mellitus, and remaining 2.0% (n = 84) had secondary diabetes. Among T1DM, 58% of them had age onset of <15 years, whereas in T2DM, 95% of them had age onset <15 years. Differences in their clinical profiles were seen among these participants. All T1DMs were on insulin treatment at the time of registration or they had been prescribed insulin at their first visit to the RCs, and 12% of the T2DMs were on insulin. Conclusions: The observations from RCC03 of the registry reveal that 48.1% were T1DM and 43.4% were T2DM. These results suggest that there is equal contribution of T1DM and T2DM cases in the Chennai region, which needs to be studied in detail.

Aim: The aim of this article is to determine knowledge level and perception about coronavirus disease 2019 (COVID-19) among people with diabetes. Materials and Methods: A cross-sectional study was conducted among 268 diabetic subjects from April 2020 to October 2020 at the outpatient department of Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. A series of questions regarding knowledge and perception about COVID-19 were asked, and participants’ demographic characteristics and source of information regarding COVID-19 were recorded and analyzed. Results: Among 268 participants, 59.7% had diabetes for more than 5 years. More than half of the subjects had heard about COVID-19 on television (63.8%). The majority of subjects had information about symptoms of COVID-19, including fever (92.2%), dry cough (79.9%), flu (78%), and shortness of breath (52.6%). Most of the participants had knowledge about preventive measures for COVID-19 such as wearing a face mask (77.6%), washing hands frequently with soap (72.8%), using hand sanitizer (72%), social distancing (47.4%), isolation and hygiene (38.8%), and quarantining (32.1%). However, less than half of the participants knew the correct meanings of social distancing (40.3%), isolation (29.1%), and quarantine (22.4%). Conclusion: Overall, most of the participants had information about common symptoms of COVID-19 including fever, dry cough, flu, and shortness of breath as they had heard about COVID-19 on television, at office, radio, and their living area. The government has taken effective measures in the prevention of COVID-19. Still, there remains a need for public awareness campaigns to combat the spread of disease.

Background: Fatty acids play an important role in health and well-being; almonds have the highest amount of monounsaturated fatty acids (MUFAs) among the nuts. Western studies have shown positive health effects of almonds. However, well-designed studies are sparse on Asian Indians who have a unique phenotype with higher predisposition to diabetes and cardiovascular disease (CVD). Hence, the present study describes the design and methods of a clinical trial to assess the effect of almond supplementation on insulin resistance, glycemic markers, and inflammation in overweight Asian Indians. Methods and Outcome Assessments: Parallel-arm open-labeled, randomized controlled trial was conducted in Chennai, India. The study included 400 overweight and obese volunteers of age 25–65 years with a body mass index ≥23 kg/m² and with some having cardiometabolic risks. The participants in the intervention group received 43 g of almonds per day as recommended by the American Heart Association for 12 weeks, whereas the participants in the control arm followed their habitual dietary patterns and were advised not to consume any nuts. All other lifestyle habits were similar. The anthropometric, clinical, biochemical, and diet data of the participants were assessed periodically. Dietary 24-hour recalls and plasma percent fatty acid of the participants were assessed at the baseline and end of the study as a measure of participant compliance to protocol. This study also assessed gut hormone levels as a marker for satiety. The effects of almonds supplementation on anti-inflammatory and inflammatory markers such as adiponectin, monocyte chemoattractant protein-1, and tumor necrosis factor-α were also assessed. Discussion: The study findings, if benefits are found, would help to improve the MUFAs intake by a single supplementation of almonds daily to meet the dietary guidelines of 15% of total calories of MUFAs. In addition, it might aid in the prevention of obesity-related chronic diseases such as diabetes and CVDs by reducing the cardiometabolic risk factors. Trial Registration: The trial was registered in the clinical trial registry of India CTRI201710010251.

Objective: The aim of this study was to discuss the components of yoga intervention and experimental design used to assess its effectiveness in diabetes care centers in Chennai. Materials and Methods: An interventional, randomized prospective study design was adopted. The study was conducted over a 6-month period. Based on inclusion and exclusion criteria, participants were selected from Dr Mohan’s Diabetes Specialities Centre. Informed consent was obtained, and participants were randomly assigned to either the intervention or the control group in a 1:1 ratio. Participants in the intervention group underwent yoga training every 2 weeks for up to 3 months. Each yoga session lasted 35 min and included a variety of asanas and pranayama techniques. Participants were also given an audio recording (CD) of the yoga instructions, and they were encouraged to practice yoga at home and advised to keep track of their progress in a dairy provided. Diabetes care was provided to the control group on a routine basis. In addition to biochemical parameters, mental health parameters were also assessed. Independent t-test was performed using SPSS 24.0. Results: A total of 152 participants were screened and randomized with 76 in the intervention arm and 76 in the control arm. There were no challenges in participants recruitment and retention. Data were collected during enrollment, 13 and 26 weeks. At baseline, the intervention arm’s mean HbA1c (%) was 8.4 ± 1.1%, whereas in the control arm, it was 8.3 ± 1.1% (P = 0.290), and fasting blood glucose levels were 142± 27 mg/dL in the intervention arm and 141 ± 29 mg/dL in the control arm (P = 0.811). There was no significant difference between groups in terms of lipid profile or mental health parameters at baseline. Conclusion: There is a major lacuna for controlled trials with methodological rigor in yoga intervention; this study may contribute to fill this requirement by systematically elucidating the role of yoga in the management of diabetes and to prevent complications. This study will provide a cost-effective care for people with diabetes. TRIAL REGISTRATION: CTRI/2018/04/013169

Many injection site cutaneous complications such as lipohypertrophy and atrophy are known to occur in type 1 diabetic individuals. Acanthosis nigricans (AN) with insulin injection is a rare complication described in few case reports. It is also described as a paraneoplastic manifestation of malignancies such as hepatocellular carcinoma (HCC). Here we describe a case of injection site acanthosis in a type 1 diabetic with underlying HCC. This case report highlights the importance of knowledge on proper injection technique to prevent such unfortunate complications. High degree of suspicion of underlying malignancies is warranted in atypical presentation of AN.

Rationale: DPP4 inhibitors are very important armamentarium for the management of type 2 diabetes mellitus. Usually, dipeptidyl peptidase-4 (DDP-4) inhibitors are free from side effects. Patient Concern: We report a case of teneligliptin-induced polyarthritis. Diagnosis: The diagnosis is teneligliptin-induced seronegative, non-erosive, polyarthritis. Intervention: We stopped teneligliptin. Outcome: On stopping teneligliptin, arthralgia was relieved. Lesson: Acute joint pain (arthralgia)/arthritis can be an adverse effect of teneligliptin or DPP-4 inhibitors. Arthritis, as an adverse effect of teneligliptin, is first such case report to the best of our knowledge.

Background and Aims: Metformin is universally accepted as first-line oral hypoglycemic agent for type 2 diabetics, with a low side effect profile and very few serious complications reported till date. Materials and Methods: A 30-year-old male, newly diagnosed diabetic was started sitagliptin + metformin (50/500) combination two times daily and presented with the complaint of nightmare and abnormal dreams. Results: On stopping metformin, the patient does not experience nightmares and abnormal dreams. Conclusion: We found an unusual side effect of metformin causing nightmare and abnormal dreams.

Diabetes mellitus is a chronic metabolic disease that results in micro-vascular and macro-vascular complications. Further, uncontrolled hyperglycemia can damage blood vessels and alters the anagen and telogen phases of hair growth leading to alopecia. We report a case of a 54-year-old woman diagnosed with type 2 diabetes mellitus (DM) and hypertension suffering from hair loss on the right side of scalp without any signs and symptoms of scalp inflammation. All the possible causes such as lipid profile, side effects of hypoglycemic agents and anti-hypertensive therapy, trichotillomania, and dermatological diseases were ruled out. Here, we emphasize that damaged blood vessels that hinder oxygen supply and nutrients to hair follicles could be the reason behind alopecia in DM patients. Furthermore, insulin plays an important role in cell proliferation and regrowth of hair follicles. It was also noted that patients’ response to glycemic control was remarkable, and timely initiation of insulin in patients with DM and alopecia restores normal hair growth. Still, more extensive research is required in this field, which will ultimately be helpful in the prevention of alopecia in DM patients.

Objective: The aim of this article is to assess the risk of diabetes among medical students in one medical college using IDRS (Indian Diabetes Risk Score) and to study the association between risk of diabetes and various factors. Materials and Methods: An institution-based cross-sectional study was carried out among 246 medical students at Mall Reddy Institute of Medical Sciences, Hyderabad, Telangana, India from June to July 2019. Questions pertaining to modified IDRS and measurements such as waist circumference were recorded. Results: The mean IDRS (34.15±11.57) indicated that this population was at moderate risk of diabetes. Majority (78%) were at moderate risk. IDRS was not found to be associated with blood pressure (mean systolic blood pressure for IDRS <30=117.51±6.25; for 30–50=115.72±6.65; and for >60=117.78±6.06; mean diastolic blood pressure for IDRS <30=75.55±6.15; for 30–50=75.39±6.26; for >60=73.33±6.14). Being female (mean IDRS =35.55±11.48 vs. 30.93±11.62 for males) and being overweight or obese (mean IDRS =36.84±11.56 vs. 33.07±11.54 for normal weight) were significantly associated with IDRS (P < 0.05). Conclusion: This population was at moderate risk of developing diabetes. Overweight or obese patients and females had higher IDRS and thus they were at more risk of developing diabetes in future.