Use of Sulfonylurea Based on Diet Recall
Sulfonylurea is the most potent diabetes agents and to avoid hypoglycaemia, sulfonylurea has to be selected based on diet composition and pattern of the patent. A study conducted by Panchal D revealed that the use of sulfonylurea drugs as per the diet pattern, particularly meal pattern and percent of carbohydrate achieve glycaemic control with minimum risk of hypoglycaemia in T2D patients.
Management of Primary Hyperparathyroidism
• Alendronate and Denosumab can be used to increase bone density • Cinacalcet can be used to reduce the serum calcium concentration into the normal range if there are no contraindications• Calcium intake/supplementation should follow the guidelines: 800 mg/day for women 70 years old.
Surgical Management of Primary Hyperparathyroidism (PHPT)
Surgery is recommended if Serum calcium is >1 mg/dL (0.25 mmol/L); Skeletal involvement: A fracture by VFA or vertebral X-ray or BMD by T-score < -2.5; Renal involvement: eGFR or creatinine clearance (>250 mg/day in women; >300 mg/day in men) or Nephrocalcinosis or nephrolithiasis by X-ray, or ultrasound, or Hypercalciuria (>250 mg/day in women; >300 mg/day in men).
Diagnosis of Hyperparathyroidism
PHPT can be evaluated with:Biochemical: Measure adjusted total serum calcium, phosphorus, intact PTH, 25OHD, creatinine.Skeletal: Three-site DXA; imaging for vertebral fractures; Trabecular Bone Score if available.Renal: eGFR, or creatinine clearance, 24-hour urinary calcium and biochemical risk factors for stones; imaging for nephrolithiasis/nephrocalcinosis.
Treatments for Non-alcoholic Fatty Liver Disease
Nonalcoholic steatohepatitis (NASH) treatment is recommended in intermediate and high risk patients. Current treatments for patients with NAFLD (not FDA approved but can be used for obese or diabetic patients) were lifestyle interventions, bariatric surgery, GLP-1RA and Pioglitazone. Studies have shown that Pioglitazone increases adiponectin, reduces fat, and lowers liver fibrosis risk in NASH.
Synchronization of the Circadian in Metabolic Disease - By Dr Narsingh Verma
Dr Narsingh Verma presented his talk at APICON 22 on circadian rhythms and metabolic diseases. Dysregulation among the central and peripheral circadian clock causes a disturbance in metabolism leading to various metabolic disorders, including T2D, hypertension, and obesity. But dysregulated circadian rhythm can be re-synchronized by lifestyle modification - healthy eating and physical activity.
Nutritional Interventions to Prevent Dementia & Alzheimer's - By Dr Anuj Maheshwari
Dr Anuj Maheshwari presented his talk at APICON 2022 on Nutritional interventions to stop dementia. Combining a dash diet which is usually recommended for hypertension with the Mediterranean diet has also given very good results in reducing dementia. Adding fruits and vegetables to diets which are more friendly towards increasing insulin sensitivity and less insulin reduce the chances of dementia.
Is Generic Dapagliflozin Safe and Effective for Patients With T2D? - By Dr S K Sharma
Dr S K Sharma presented his talk at APICON 2022 on dapagliflozin for T2D. Dapagliflozin has been shown to be effective in clinical trials. It also protects organs like pipes, pumps and filter. Pipes means vascular disease; pump means heart; filter means kidney. Now it is available in the affordable generic version. Doctors can prescribe the generic dapagliflozin in their daily practice for T2D.
Need For Hypertension Focused Clinics All Over India - By Dr A Muruganathan
Dr A Muruganathan presented his talk at APICON 2022 on hypertension. 1 in 3 people have HTN in India and the control rate is less than 12%. HTN is a hemodynamic malignancy that causes heart attacks, cerebral problem, paralysis, eye problem and kidney failure. So when you control HTN, you can prevent all complications. He highlights the need for hypertension focused clinics all over India.
Insights on the Management of Hypertensive Patients with Atrial Fibrillation- By Dr Soumitra Ray
Dr Soumitra Ray presented his talk at APICON 2022 on Hypertension Management in Atrial Fibrillation. A-fib and HTN often coexist and increase the risk of systemic thromboembolism. So, be careful when you find one condition to hunt for the other conditions and treat them at the appropriate time. He recommends using a manual blood pressure machine to check hypertension in A-fib patients.
All You Need to Know About Reversal of Diabetes - By Dr V Mohan
Dr V Mohan presented his talk at APICON 2022 on Reversal of diabetes. There are different clusters of type 2 diabetes: 1. Severe insulin-deficient variety occurs at a young age and is not reversible. 2. Insulin resistant obese diabetic is eminently reversible. Thus, identify the subgroups in which remission can be achieved and encourage them to lose weight and cut down their calorie intake.
Innovations in Basal Insulin for Long-Term Glycaemic Control - By Dr Manoj Chawla
Dr Manoj Chawla presented his talk at APICON 2022 on Insulin Innovation: Recognizing the role of Gen 2.0 Basal in diabetes management. Basal insulin, especially the 2nd-generation basal insulin: U-300 glargine, is made more protracted in its action by making it more concentrated. It works for a longer period and very effective with lesser nocturnal hypoglycemia and less weight gain.
Strategies for Primordial Prevention of Diabetes Mellitus - By Dr Banshi Saboo
Dr Banshi Saboo presented his talk at APICON 2022 on Diabetes Care in India. He said that primordial prevention of diabetes mellitus could be done in Indians. Many mothers have PCOD, premature delivery, C-section or malnutrition, resulting in a low birth weight baby. If we can improve the birth weight with continuous education, we can prevent these young adults from developing diabetes.
Could Oral Semaglutide Be a Magic Bullet for Type 2 Diabetes?
Oral semaglutide, which was approved in the US in Sep 2019, has emerged as a promising therapeutic option for patients with Type 2 Diabetes. In PIONEER trial, oral semaglutide 14 mg lowered HbA1c more than placebo, empagliflozin, sitagliptin, liraglutide, and dulaglutide. The oral semaglutide group lost considerably more weight than the placebo, sitagliptin, and liraglutide groups.
Dr Tejas Shah - Judicious Use of Oral Drugs in the Management of Diabetes
Dr Tejas Shah, MBBS, Diabetologist in Mumbai, member of MCI, advises judicial use of oral drugs for diabetes management. Each drug has its own role: metformin reduces insulin resistance; sulfonylurea increases insulin secretion; DPP-4 inhibitor increases incretin levels; acarbose and voglibose reduce postprandial glucose concentrations; SGLT2i reduces renal tubular glucose reabsorption.
Dr Swati Srivastav - New Drug Molecules for Preventing Secondary Diabetic Complications
Dr Swati Srivastav emphasizes on preventing diabetic complications using new drugs molecules such as combination of SGLT2 inhibitors and DPP4 inhibitors. In regard to the cardiovascular outcomes, SGLT2 inhibitors reduce hospitalization due to heart failure. DPP4 inhibitors lowers CVD risk and aid in weight loss. It can also be used safely in patients with chronic kidney disease.
Dr Swati Srivastav - Effective Medications for Patients With Chronic Kidney Disease
Dr Swati Srivastav, MD, Fellow in Diabetes, Trained in Endocrine Tech, and professor at SMS Medical College, Jaipur. She shares her view on medications that can be effectively used in patients with renal impairment. SGLT2 inhibitor is a good option for patients with GRF as low as 45 ml/min. There are also some DPP-4 inhibitors, such as linagliptin, that can also be used in such patients.
