Praveen Raj

Currently available data is limited in estimating the demography of Type 2 Diabetes Mellitus (T2DM) patients and hence this study helps in understanding the disease profile, associated complications, comorbidities, treatment paradigms and socio-economic impact in T2DM patients across India. A multicenter, observational, non-interventional, 6 month follow-up registry was conducted in 26 states across India involving 2944 T2DM patients between 18-75 years of age. Detailed medical history, profile of patients, diet patterns and lifestyle methods were captured. The laboratory parameters like FBG, PPBG and HbA1c were captured at enrolment, 3rd and 6th months. Out of total 2944 patients, data of 2849 (96.77%) patients were considered for analysis. The mean age of patients with diabetes was 52.9 years with mean diabetes duration of 5.8 years. About 1/4th of diabetics were hypertensive (24.05%) and majority was from the upper middle socio-economic strata (42.6%). About 15.8% patients were never advised lifestyle modifications and non-pharmacological interventions during the physician interaction. Metformin was the most commonly used oral hypoglycemic drug (58.53%) followed by glimepiride (35.87%); whereas a combination of metformin and glimepiride was used in 16.98% patients. Good glycemic control (HbA1c<7%) is observed only in 20.8% and 23.4% patients at 3rd and 6th months. Non-compliance to diabetic diet is found in 8% individuals. The most common cause of non-compliance is lack of motivation (5.54%), lack of information (2.28%), busy job schedules (1.94%) and financial reasons (1.56%). The one diabetes registry helps in understanding the T2DM patient flow, comorbid conditions and compliance to therapy from Indian perspective.

Diabetic neuropathy (DN), one of the most common complications affects nerves in T2DM patients. This study was aimed to understand the clinical presentation of DN; types of neuropathies; associated co-morbidities, risk factors, treatment patterns etc. A single-visit, cross-sectional, multi-centric, epidemiological study conducted at 363 centres. Data collection included demographics, lifestyle habits, medical history, concomitant medications, laboratory investigations and treatment regimens in DN. A total of 7172 patients enrolled with mean age of 52.8 years. The median duration of T2DM was 6 years and neuropathy was about 2 years. The prevalence rates of painful and painless DN were 49.1% and 50.9%. The most common types of neuropathies reported were acute (32.3%) and chronic (31.4%) sensory neuropathy and reported symptoms were numbness (30.7%), paresthesia (29.2%), and burning sensation (28.0%). Majority of the patients had uncontrolled glucose parameters i.e FBG: 90.1%, PPG: 90.5%, HBA1c: 69.8% and uncontrolled lipid profile i.e LDL: 65.5% and TG: 61%. Almost 2/3rd (61.3%) were treated with metformin as monotherapy or in combination. More than half (52.3%) received mecobalamin for DN treatment. Higher proportions of patients with painful neuropathy were prescribed pregabalin as compared to painless (32.18% vs 19.79%).Diabetic neuropathy is painless in almost half of the Indian patients. Acute sensory neuropathy occurs in most of the patients. Onset of diabetic neuropathy could be much earlier than expected and hence, routine screening is recommended. Metformin and Mecobalamin are commonly prescribed for the treatment of diabetes and DN. Pregabalin is a preferred treatment option for painful DN.

The global burden of diabetes as per the International Diabetes Federation 2013 amounts to 382 million and is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease1, 2Diabetes Mellitus is a chronic metabolic disorder which causes high mortality and morbidity due to its micro vascular and macro vascular complications.3Although there is an increase in the prevalence of type 1 diabetes, the major driver of the epidemic is the more common form of diabetes, i.e. type 2 diabetes mellitus (T2DM) which accounts for more than 90% of all diabetes cases.4Even though diabetes poses high economic burden in India, the real burden of the disease is mainly due to its associated complications.