Managing diabetes in India: paradigms in care--outcomes and analysis in a comprehensive, clinical practice survey of Indian physicians.
ABSTRACT Diabetes continues to be a pandemic despite huge strides in the awareness and management of the condition. The incidence of diabetes has been projected to rise by almost 170% in most of the developing countries including India. Currently, about 50 million people suffer from diabetes in India with the figures expected to reach 87 million by the year 2030. To assess the management trends in India, a cross-section of doctors across all the major zones of the country were requested to answer a set of questions based on a case profile. Approximately 1000 doctors from all corners of India provided their feedback on various issues of diabetes management. The patient profile was that of an overweight 46-year-old Indian female with hypertension, diabetes and dyslipidaemia with a history of recurrent urinary tract infection (UTI). Almost 84.5% of doctors concurred with the diagnosis of metabolic syndrome for this patient. The awareness about diabetes being a comorbidity as well as a cause for recurrent UTI was high with 86% of doctors choosing diabetes as a cause for recurrent UTI. Around 94% of doctors chose metformin as the drug of choice for the management of this patient. A total of 74% of doctors chose the combination of metformin and sulfonylurea for the management of postprandial hyperglycaemia. Opinions were divided on the choice of drugs for the management of diabetes in a non-obese patient with 31% of doctors still choosing metformin as the drug of choice as per the American Diabetes Association 2009 guidelines and 66% of doctors choosing glimeperide as the first choice in a non-obese patient in concordance with the Association of Physicians of India/Indian College of Physicians (API/ICP) guidelines on diabetes. However, 95% of doctors unanimously chose metformin as the drug of choice in patients with abdominal obesity and diabetes. Almost 83% of doctors were aware that Indians have a genetic predisposition to diabetes due to an inherently smaller beta cell mass associated with insulin resistance. Majority of the physicians were also aware of the adverse effects of most of the antidiabetic drugs with 86% of the physicians identifying hydrochlorothiazide as the cause of worsening uric acid levels in diabetics, when used for the management of hypertension. Practice patterns in India generally conform to guidelines. The survey also demonstrated that majority of the physicians are aware of the different complexities associated with the management of diabetes.
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ABSTRACT: Background Data on cutaneous manifestation of type 1 diabetes mellitus (DM) is scarce.Objectives To study the spectrum of dermatoses in patients with type 1 DM and effect of disease duration and long term glucose control on these cutaneous manifestations.Methods After prior consent, clinical examination and relevant investigations were done in 500 subjects with type 1 DM enrolled during July 2011-June 2012. Statistical tests were performed using SPSS 16. Presence of various dermatoses was correlated with duration of diabetes.ResultsOf five hundred subjects, 339 (67.8%) had one or more dermatoses. Mean age of the patients was 16.9 ± 6.9 years (range 1- 25 years) and mean total duration of diabetes was 4.43 ± 4.4 years. Cutaneous adverse effects related to insulin injections (CAII), comprising lipohypertrophy (41%), post-inflammatory hyperpigmentation (3%), lipoatrophy (0.6%) and acanthosis nigricans (0.4%), were the most common finding, followed by limited joint mobility (LJM) (16.8%), xerosis (15.8%) and scleroderma like skin changes (10%). Patients having long duration of DM (>4.4 years) were significantly more likely to have lipohypertrophy (P=0.000), LJM (P=0.000), scleroderma like skin changes (0.000), diabetic dermopathy (0.000), acanthosis nigricans (P=0.005) and skin tags (P=0.002). Lipohypertrophy, LJM and scleroderma like skin changes also showed significant correlation with blood glucose level.Conclusion Our study suggests cutaneous changes are common in young Asian patients with type 1 DM. Information, education and counselling of patients, care-givers and awareness among physicians is essential for prevention and early management of these dermatoses.This article is protected by copyright. All rights reserved.British Journal of Dermatology 04/2014; 171(6). DOI:10.1111/bjd.13077 · 4.10 Impact Factor