Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. MASLD is strongly linked to obesity, sedentary lifestyles, and metabolic syndrome. In India, the prevalence of MASLD exhibits regional variations because of genetic, dietary, and socioeconomic factors. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) are standardized non-invasive tools for assessing fibrosis and steatosis in MASLD. This study aimed to determine the prevalence and severity of MASLD across different Indian regions and examine regional disparities in MASLD burden. This retrospective, multicenter, cross-sectional study analyzed the data of 13,750 adults from 105 diabetes and endocrine clinics across six geographic zones in India between May 2023 and February 2024. Participants underwent LSM and CAP assessment using FibroScan™. Based on LSM, liver fibrosis was categorized as F0-F1 (2–7 kPa), F2 (7–10 kPa), F3 (10–14 kPa), and F4 (≥ 14 kPa). Based on CAP, MASLD was classified as mild (238–260 dB/m), moderate (261–292 dB/m), and severe (≥ 293 dB/m). The prevalence of MASLD was 68.2
AIM:Rising prevalence of Type 2 Diabetes (T2D) among young Asians has emerged as a public health crisis that threatens the long-term health, economic stability, and productivity of nations across Asia (1). Early-onset T2D poses unique challenges, including higher rates of undiagnosed cases, more aggressive disease progression, an increased risk of chronic complications and higher mortality (2). Hyperglycemia during the reproductive age especially among the female population can potentially have transgenerational impact through epigenetic changes. METHODS:A comprehensive search was conducted on PubMed with a combination of relevant keywords. A preliminary draft prepared after review of literature was electronically circulated among a panel of 64 experts from various parts of the region and representatives of the participating organizations - Diabetes India (www.diabetesindia.org.in) and the Diabetes Asia Study Group (DASG, www.da-sg.org). RESULTS:This Ahmedabad Declaration outlines the scale of the problem, its root causes, and a comprehensive action plan for Asian populations. The objectives of this declaration include raising awareness, addressing systemic barriers, and advocating for evidence-based policies and interventions, limited to people with T2D. Through collaborative efforts, we aim to mitigate the growing burden of diabetes in young Asians and secure a healthier future.
The global rise in diabetes mellitus presents a major healthcare challenge due to its associated complications. Effective glycemic control, crucial for reducing diabetes-related morbidity and mortality, encompasses 3 key components: fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c). While FPG and HbA1c are commonly used for evaluating glycemic control, PPG also significantly influences overall glucose management. Postprandial hyperglycemia, the early deviation in type 2 diabetes mellitus (T2DM), plays a dominant role in individuals with near-target HbA1c levels. Advances in continuous glucose monitoring (CGM) provide a more comprehensive understanding of PPG fluctuations, offering real-time data and reducing the limitations of traditional monitoring methods. CGM technology revolutionizes glycemic monitoring, enhancing the management of PPG and supporting better diabetes care. This review emphasizes the importance of monitoring and managing PPG throughout the postprandial state in individuals with diabetes. It further consolidates evidence highlighting the importance of viewing PPG as a continuum and the potential of CGM in improving PPG management.
Primary prevention of diabetes still remains as an unmet challenge in a real world setting. While, translational programmes have been successful in the developed nations, the prevailing social and economic inequities in the low and middle income countries, fail to integrate diabetes prevention into their public health systems. The resulting exponential increase in the prevalence of diabetes and the cost of treatment has put primary prevention in the back seat. As a call to action, an expert group was formed to lay down practical guidelines for clinicians in the South East Asian regions to implement primary prevention programmes at an individual or at a community level. The guideline was developed based on the outcomes of the evidence based prevention programmes conducted in India. This decentralised self-guided approach for primary prevention of diabetes follows a three step implementation process of screening, diagnosis of intermediate hyperglycaemia and design and delivery of personalized interventions. Recommendations provided on dietary intake and physical activity can be tailored by the clinician to suit individual needs. Initiation of pharmacological treatment to achieve desired targets has also been addressed. A personalised approach by the clinician may be effective and offer a sustainable solution to curb the rising epidemic.
