Ambika Gopalakrishnan Unnikrishnan

Despite revolutionizing diabetes care globally, continuous glucose monitoring (CGM) adoption in India remains limited, as a result of several economic, infrastructural, clinical, and sociocultural concerns. This narrative review aims to map unmet needs and propose practical, context-specific solutions. Continuous use of CGM remains the preferred approach for optimal glucose management and achieving long-term metabolic advantages, providing insights for proactive, data-driven, and preventive diabetes care. However, main barriers to CGM uptake include limited awareness among people with diabetes and healthcare providers, high costs, lack of reimbursement, limited device availability beyond major cities, and economic, infrastructural, and sociocultural access inequities across urban and rural populations. The psychological burden from frequent alarms, data fatigue, and stigma with noticeable or intrusive devices add to these challenges. Addressing these barriers necessitates a multifaceted strategy involving affordable, climate-adapted devices, interoperable digital ecosystems, India-specific reimbursement models, and robust educational infrastructure. The emergence of cost-effective CGM devices with a range of advanced features, such as predictive glucose algorithms and personalized pattern identification, is pivotal to this effort. These innovations improve clinical outcomes and quality of life by simplifying the user experience, addressing challenges, such as alarm fatigue while translating complex data into actionable insights, facilitating widespread CGM adoption in India.

To assess the efficacy and safety of a fixed-dose combination (FDC) of dapagliflozin and pioglitazone versus a loose combination (LC) as an add-on therapy

Introduction: People with diabetes are prone to urinary tract infections (UTIs). The inappropriate use of antibiotics can lead to the development of multidrug-resistant infections, prolonging patient recovery and significantly increasing healthcare costs. In a hospital focused on diabetes care, it becomes important to ascertain the clinical and microbiological profiles to develop appropriate institutional infection control protocols for managing such patients more effectively on an empirical basis; for this purpose, a pilot study was conducted through a representative sample. Methods: The study included randomly selected 60 patients with UTI: 25 patients were from the wards of the hospital and 20 patients were from the intensive care unit, of whom 10 had complicated UTI with multi-organ dysfunction. The remaining (n = 15) were from the outpatient clinic. Microbiological, and where possible, clinical parameters were studied. Results: The mean age of the subjects was 67.12 ± 9.84 years and the female-to-male ratio was 38: 22; 37 of the 38 women were postmenopausal. The mean duration of diabetes was 15.20 ± 7.93 years. Fifty subjects (83%) had an HbA₁C >7%. Thirty-eight (63%) had recurrent UTI episodes. Four (6.7%) were on sodium glucose 2 transport inhibitors and estimated glomerular filtration rate (eGFR) was below 60 mL/min/1.73 m2 in 39 cases (65%). Escherichia coli was the most commonly isolated (59.7%), followed by Klebsiella pneumoniae (25.8%). Amikacin was the most effective antibiotic (86.7%), followed by imipenem, piperacillin–tazobactam, and meropenem. Eleven (18%) required ureteric stenting. Conclusion: In our study, people with diabetes have unique nature of UTI, characterized by predisposition to postmenopausal women, high need for urological procedures and a strong link to low eGFR, older age, long duration diabetes, and high HbA₁C. Amikacin could be the choice of antibiotic on empirical basis for inpatient setting, whereas nitrofurantoin could be the preferred oral antibiotic. Taking cognizance of these results, the study emphasizes the need for specialized infection control programs and guidelines for diabetes care settings.

Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery which is characterized by low glucose levels in patients following bariatric procedures. The development of postbariatric hypoglycaemia can be dangerous and also significantly impact patients’ quality of life and mental health. Timely diagnosis of PBH and prompt treatment in patients suffering from it is crucial. This case report describes the management of postbariatric hypoglycaemia in a 56-year-old female who had undergone sleeve gastrectomy 16 years ago. She presented to our outpatient department with postprandial hypoglycaemic episodes. She was advised medical nutrition therapy (MNT) and pharmacological agents such as voglibose and diazoxide were added due to the recurrence of hypoglycemic episodes. Eventually, with education and medical management, she gained a better understanding of her condition and started adhering to the MNT prescribed and she chose to transition away from the continuous glucose monitoring. Instead, she opted for self-monitoring of glucose levels using a home glucometer, allowing for greater autonomy.

Introduction: Hypogonadism is a common comorbidity associated with several metabolic disorders including type 2 diabetes (T2D) that can remain undetected without proper screening. Here, we evaluated the prevalence of hypogonadism in Indian male patients with T2D with or without obesity. Methods: In this prospective, observational study, male patients with T2D and hypogonadism were evaluated symptomatically using the androgen deficiency in ageing male (ADAM) questionnaire at baseline and confirmed on the basis of total testosterone (TT) levels (2 (obese) was 11.1%. At screening, 81.4% (487 of 598) patients had positive ADAM questionnaire results. Conclusions: Prevalence of hypogonadism in Indian patients with T2D was found to be 8.6% upon repeat evaluation of testosterone. Symptomatic (ADAM questionnaire) as well as biochemical (total testosterone levels with repeat evaluation) confirmation is vital in the definite diagnosis of male hypogonadism.