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   Table of Contents - Current issue
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January-June 2018
Volume 6 | Issue 1
Page Nos. -

Online since Thursday, June 28, 2018

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EDITORIALS  

Theories of ethics and perception of symptoms: A diabetes perspective p. 1
Sanjay Kalra, Yatan Pal Singh Balhara, Manash P Baruah
DOI:10.4103/JSHD.JSHD_21_17  
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Diabetes distress p. 4
Sanjay Kalra, Komal Verma, Yatan Pal Singh Balhara
DOI:10.4103/JSHD.JSHD_22_17  
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REVIEW ARTICLES Top

Natural sweeteners p. 8
Karthik Balachandran
DOI:10.4103/JSHD.JSHD_20_17  
The artificial sweeteners,though marketed as zero calorie food additives, have been found to have several health hazards.Ironically they seem to worsen the metabolic syndrome - the very same disease they are supposed to treat.Natural sweeteners are an alternative to the artificial sweeteners and can be particularly helpful in patients who are newly diagnosed with diabetes. They help in transitioning the patient to a healthier life style. This narrative review, discusses the evidence for and against the use of natural sweeteners in the context of diabetes.
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Diabetes and poverty: A primer for resource poor countries p. 11
Altamash Shaikh, K V S Hari Kumar
DOI:10.4103/JSHD.JSHD_23_17  
Diabetes mellitus is assuming pandemic proportions and is affecting both the developed and developing countries. India and China are the two most populous countries in the world that account for one-sixth of the world population. The prevalence of diabetes is also very common in these two countries next to that of the United States of America. The unique characteristics of diabetes in Southeast Asians include low body weight, high visceral fat, and also the increased insulin resistance. The developing nations have to grapple with the dual burden of the nutrient deficiency and excess states. The resources allocated for the health are often scarce and have to be utilized optimally in these places. The course and complications of diabetes also differ between the developed and developing nations. In this review, we describe the unique characteristics of diabetes in poor countries and also suggest certain remedial measures to improve the same.
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Stress and its effect on noncommunicable disease: An insight p. 15
Sankhadeep Ghosh, Komal Verma
DOI:10.4103/JSHD.JSHD_32_17  
Stressors are an evident part of any individuals life and affects a lot of aspects of any individual. While the young generation or healthy individuals cope with it easily and favorably, however, the older people or unhealthy individuals are affected more adversely in case the stressors are persistent for a long time. This paper deals with providing an insight of the effect of stress on noncommunicable diseases.
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The sweet ‘truth’ of Gujarat – Gujarati diet & lifestyle and diabetogenesis Highly accessed article p. 22
Om J Lakhani, Altamash Shaikh
DOI:10.4103/JSHD.JSHD_38_17  
Gujarat is a state in Western part of India. It is well known for its cuisine which is predominantly lacto-vegetarian and has characteristic ‘sweet tinge’ in all the food items. The occupation and lifestyle of Gujarati people is mainly sedentary and participation in sports and other physical activities is limited. In this article we have explored the components and characteristics of Gujarati diet and lifestyle in relation to the risk of diabetes. Though prima facie the Gujarati diet and lifestyle may seem more diabetogenic compared to the cuisine of other states of India, there is very little objective evidence to suggest the same. Infact, the prevalence of diabetes in the state of Gujarat is lower compared to other states with equivalent GDP. In this is article we have also tried to find possible explanations of this paradoxical observation.
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ORIGINAL ARTICLES Top

Glycemic impact of intensified self monitoring of blood glucose in insulin treated subjects with type 2 diabetes mellitus p. 27
Ejiofor T Ugwu, Ibrahim D Gezawa, Olufunmilayo O Adeleye
DOI:10.4103/JSHD.JSHD_7_17  
Objective: The aim of this study was to evaluate if intensified self-monitoring of blood glucose (SMBG) improves glycemic control in insulin-treated subjects with type 2 diabetes mellitus (T2DM). Methods: Ninety-six adults with stable but poorly controlled [glycated hemoglobin (HbA1c) level >7.5%] T2DM receiving twice-daily biphasic insulin were randomly assigned to either of the two groups: intensive monitors (IM) that performed SMBG at least twice daily or conventional monitors (CM) that performed SMBG at their discretionary frequency for 12 weeks. Demographic, clinical, and glycemic indices, including fasting blood glucose (FBG), postprandial glucose (PPG), and HbA1c, were compared at baseline and week 12. Results: A total of 71 subjects (25 IM and 46 CM) completed the study. Both groups had similar HbA1c at baseline. From baseline to week 12, the IM group had higher mean daily test strip usage (P <0.001), engaged in more frequent insulin dose adjustments (P <0.001), and attained greater daily insulin dosage (P = 0.002). All glycemic indices including FBG, PPG, and HbA1c improved significantly from baseline to week 12 in the IM but not in the CM group. HbA1c level declined by −1.2±0.4% in the IM group (P = 0.002). There was no difference in the frequency of hypoglycemia in both groups. The monthly cost of intensified SMBG was nearly four times that of conventional monitoring (P <0.001). Conclusion: Both short- and long-term glycemic control significantly improved by intensified SMBG in stable but poorly controlled insulin-treated adults with T2DM. Intensified SMBG enabled better self-titration of insulin and probably other self-care practices. This benefit, however, occurred at the expense of costs that may be difficult to sustain in resource-poor countries.
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Achievement of 3B goals among T2DM patients: An experience from Central Nepal p. 34
Hari Kumar Shrestha, Ashish Shrestha, Rajendra Tamrakar, Sanu Raja Amatya
DOI:10.4103/JSHD.JSHD_29_17  
Background: Management of type 2 diabetes mellitus (T2DM) requires comprehensive control of three metabolic parameters: blood glucose, blood pressure (BP), and blood lipid commonly known as 3B. We studied the prevalence of patients reaching the 3B goals in Nepalese context. Materials and Methods: Patients aged 30 years or above who presented in Dhulikhel Hospital outpatient clinic of internal medicine department of Dhulikhel Hospital with a diagnosis of T2DM diagnosed at least for 6 months were enrolled in this cross-sectional, observational study. Patients with any major illness, surgery, or diabetic ketoacidosis in last 6 months, use of glucocorticoids, post-transplant diabetes, and gestational diabetes were excluded. The study was conducted during the period between January 2015 and June 2015. Chi-square test was used to compare qualitative variables. The nonparametric test (2 independent sample tests) was used for quantitative variables. Results: One hundred and fifty study participants had a mean age of 56±11.88 years, body mass index of 23.97 4.72kg/m2, and an HbA1c of 8.02±1.78%. The proportion of patients with good glycemic control (HbA1c <7%) was 30%. Only 26% patients had achieved targets for both systolic and diastolic BP (<130/80) and 35% patients had achieved the target of LDL less than 100. In this study, 32 (21.33%) patients had control of blood glucose and blood lipid, whereas 26 (17.33%) patients had control of blood glucose and BP. Likewise, only 19 (12.67%) patients met the target of blood glucose, BP, and blood lipid control. Conclusion: Our data showed that only 13% of patients achieved the 3B goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our center which may be a representative of the country.
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Study on bacteriological profile and antibiotic susceptibility pattern in patients with diabetic foot ulcers in a tertiary care teaching hospital p. 40
Javedh Shareef, Sandra Sunny, K R Bhagavan
DOI:10.4103/JSHD.JSHD_30_17  
Introduction: Diabetic foot ulcer and infections are one of the major complications in diabetic patients leading to frequent hospitalization and increased mortality. Knowledge about the microbes that cause infections will be helpful for providing appropriate antimicrobial therapy. Aim: To evaluate the bacteriological profile of patients with diabetic foot ulcers and their antibiotic susceptibility pattern. Methodology: A cross-sectional study was carried out for a period of eight months in the Department of surgery in patients with diabetic foot ulcer at a tertiary care teaching hospital. Patient data relevant to the study were collected using a standard data collection form designed as per the need of the study. Details of the organisms isolated and susceptibility pattern were collected from microbiology department. Results: A total of 122 pathogens were identified from 71 patients with male (63.38%) predominance over females (36.61%). Out of the 71 patients, 38 (53.52%) patients had monomicrobial infections and 33 (46.47%) patients had polymicrobial infections. Of the total 122 organisms, 79(64.75%) organisms were found to be gram negative organisms and 43(35.24%) were gram positive. Pseudomonas aeruginosa found in 22 (18.03%) patients was the predominant pathogen isolated followed by Klebsiella pneumonia found in 18 (14.75%) patients. The gram-positive organisms isolated showed maximum susceptibility towards antibiotics Teicoplanin and Linezolid while the gram-negative organisms showed susceptibility to Imipenem, Meropenem, and Piperacillin/Tazobactum combination. Conclusion: The study showed a preponderance of gram-negative bacilli among the isolates from the diabetic foot ulcers. It is recommended that antimicrobial sensitivity testing is necessary for initiating appropriate antibiotic regimen which will help to reduce the drug resistance and minimize the healthcare costs.
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Diabetes-free life in India: Application of survival function analysis p. 48
Shri Kant Singh, Sarang Pedgaonkar, Parul Puri, Jitendra Gupta
DOI:10.4103/JSHD.JSHD_36_17  
Background: India being a diverse country has an assortment of various socio-economic and demographic structures. These socio-economic and demographic factors often intervene with the diabetes-free survival in any geographical region. The present study explores diabetes-free survival patterns of adult respondents with respect to various socio-economic and demographic factors in eighteen states of India with better demographic indicators. Material and Methods: The study utilizes data from the fourth round of the District Level Household and Facility Survey (DLHS) undertaken during 2012–2013. The study computes the survival functions by five year age groups followed by Peto and Pike’s test for assessing the significant differences in the survival pattern between the various sub-groups in 18 states of India. Results: The study points out that the diabetes-free survival of a respondent is affected by factors such as the place of residence, sex, social group, the standard of living (wealth) index, and region of residence. Conclusions: Timely detection, screening, and treatment of non-communicable diseases, as well as palliative care, are recommended to the community for diabetes prevention. A healthy lifestyle including healthy diet, physical activity on regular basis, and avoiding tobacco needs to be promoted.
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BRIEF COMMUNICATION Top

Mango and diabetes p. 56
Bharti Kalra, Lovely Gupta, Deepak Khandelwal, Nishant Choubey
DOI:10.4103/JSHD.JSHD_26_17  
The mango is considered as the king of fruits. It is one of the most consumed seasonal fruits in South Asia. Most persons with diabetes and health-care providers assume that mango should be strictly avoided by persons with diabetes. However, mango is a fruit with good nutritive value, low glycemic load as well as with acceptable glycemic index. In this short review, we summarize the nutritive values of mango, as well as the ways in which mangoes can be enjoyed, in moderation, by persons with diabetes.
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BOOK REVIEW Top

CDiC textbook of pediatric diabetes: Book review p. 59
Nishant Raizada
DOI:10.4103/JSHD.JSHD_28_17  
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