Indian Journal of Diabetes and Endocrinology

Obesity constitutes a serious health concern as its  increasing rapidly worldwide. What is more alarming  is that obesity is increasingly now being observed  among all age groups in India. Obesity is gateway  to many health issues including impairing fertility  of both males and females. It has been observed in  obese male and female individuals have altered  adipokine and other hormonal profile, with poor  quality of sperm and oocyte and varied epigenetic  modifications of the germ cells. The review focuses  on various aspects of how obesity reduces fertility in  both the genders. The review also discusses some of  the obesity management procedures which thereby  also might help in controlling infertility among  obese individuals, particularly, how brown adipose  tissue (BAT) might be a focus for new therapeutics  for obesity by increasing energy expenditure in  obese individuals.

Background: A number of rat models have  been proposed to investigate the heterogeneity  of polycystic ovary syndrome (PCOS), hyperandrogenized routine being the most popular one.  Although, effects of androgen excess have been  widely investigated, the ameliorating potential of  the ovulogens on different aspects of the treatment  on a single model is yet to be explored. Aims: This  particular experimental study ends to investigate the  effects of metformin and letrozole on experimentally  induced rodent model of PCOS. Methods and materials: After neonatal androgenisation (1.5 mg/animal), rats  were given metformin (200 mg/kg body weight for  4 weeks) or letrozole (0.5 mg /kg/day for 15 days)  from ~53 day of age. Ovarian histology, response to  exogenous gonadotropins, hormonal profile, glucose  tolerance, and dyslipidaemic features with RTPCR of specific steroidogenic and hyperinsulinemic  genes were carried out to compare and evaluate  the therapeutic response of the drugs. Results  and conclusion: Androgenized rats had polycystic  ovaries characterized by increased theca interna  and fewer or no functional corpora lutea. Metformin  improved ovarian responses and was superior in  attenuating testosterone status, hyperinsulinemia, dyslipidaemia along with a significant improvement  in expression of the genes assessed. In conclusion,  metformin reverted the hyperinsulinemia-associated  hyperandrogenemia to reinstate ovulatory function  with parallel improvements in the metabolic corners  of the syndrome; however, letrozole appears to have  no beneficial effect with reference to restoration  of ovulation or amelioration of polycystic state of  the ovary.

Background: The objective of this clinicoepidemiological, Pan-India study was to evaluate  the prevalence of vitamin D (vitD) deficiency  in Indian patients with type-2 diabetes mellitus  (T2DM), hypertension (HT) and both T2DM and  HT and to understand their management practices.  Methods: Adults with a diagnosis of T2DM, HT or  both were enrolled across 29 sites in India. All the  patient-related data were extracted from medical  records. VitD insufficiency and deficiency was  defined as serum 25(OH)D levels 21-29 ng/ml and  ≤20 ng/ml, respectively.

Results: A total of 1501  (99.5%) patients completed the study (T2DM:99.2%;  HT:99.6%; T2DM+HT: 99.8%). Mean age at diagnosis  of vitD deficiency was 52.5±10.77 years. Prevalence  of patients with low vitD levels (vitD deficiency  [60.9%] and insufficiency [22.9%]) was 1257 (83.7%);  1231 (82%) were newly diagnosed cases. Prevalence  of low vitD levels amongst patients with T2DM,  HT and T2DM+HT was 84.2%, 82.6% and 84.5%,  respectively. Out of 1257 patients, 84.8% received  vitD supplementation. Preferred dose and route of  administration was 60,000 IU (70.2%) and oral (79.6%).  Preferred frequency of dose was once in a week  (76.7%). VitD deficiency (26.9%), vitD insufficiency  (34.5%), symptoms of vitD deficiency (10.4%) and comorbid condition (1.8%) were the factors considered  while prescribing vitD supplements.

Conclusion: Prevalence of vitD deficiency was higher in newly  diagnosed cases compared to already diagnosed  cases in all three cohorts. This study indicates the  magnitude of overlap between vitD deficiency and  T2DM or HT, and the need for routine screening for  early diagnosis and effective management.

Background: It is general trend amongst patients  with diabetes that usually they are at risk for  developing foot ulcers irrespective of age, gender,  symptoms, or adequacy of glycemic control. HBO  therapy is currently approved for a variety of tissue  healing and other applications. Transcutaneous  Oximetry [TCOM] is a simple, reliable noninvasive  technique for the objective assessment of wound  perfusion and oxygenation. Its definitive role in  predicting the wound healing has not yet been  proven.

Objective: We undertook a prospective study  to evaluate the role of Hyper Baric Oxygen Therapy in  healing of diabetic wounds and to determine whether  Transcutaneous Oximetry can predicts healing. Study

Design: A prospective study was performed to realize  the aim and objectives of this study. Place of Study: The study was carried out at the Prana HBO Centre,  which is owned by the Investigator and located in  the Northern parts of Mumbai, in India. Methods: The center has one Sechrist Monoplace hyperbaric  chamber and a TCOM machine with 3 electrodes.  The oxygen gas supply is from oxygen cylinders of  7000 liters’ capacity each. The data was collected from  all the patient files, which are stored at the center.  Transcutaneous Oximetry monitoring system was  utilized for measuring tissue oxygenation (TcPO2 )  in all the patients of both groups.

Observation and Discussion: There was 68% reduction in wound area  (mean baseline area of 22 cm 2 decreased to 7 cm 2 at  30 day of therapy, as per there mean value in group  HT by using paired t test, there is highly significantly  improvement in wound with p value 0.00001.  Hyperbaric oxygen therapy increases the chances of  healing of ulcers by decreasing exudates and very  well promotes granulation tissue, as well the wound  size decreases and wound tissue type and healing is  improvised.

Conclusion: Hyperbaric Oxygen Therapy  definitely has an adjunctive play in management of  non healing ulcers usually in diabetic patients.