Dr. Mohan's Diabetes Specialities Centre

Abstract Background: India carries a disproportionately high burden of type 2 diabetes mellitus (T2DM), characterized by early onset, suboptimal glycemic control, and delayed insulin initiation. High treatment costs and limited access further worsen outcomes, particularly among lower-income groups. Biosimilar insulins such as InsuQuick ® (insulin aspart 100 U/mL), approved for use in India, offer an accessible and affordable alternative. Objective: To evaluate the real-world safety, effectiveness, and tolerability of InsuQuick ® (insulin aspart 100 U/mL), a biosimilar rapid-acting insulin, in Indian adults with inadequately controlled T2DM. Materials and Methods: A retrospective, multicentric, observational study was conducted across 25 Indian clinical sites. Adults aged 18–65 years with T2DM and baseline glycated hemoglobin (HbA1c) between 7.1% and 12.0% were included. All received InsuQuick ® as part of ongoing diabetes management, newly initiated or continued at the physician’s discretion. Glycemic outcomes were evaluated over 16 weeks. Results: Of 477 patients, 69.2% achieved HbA1c < 7.1%. Mean reductions were observed in HbA1c (−1.95%), fasting plasma glucose (−57.1 mg/dL), and postprandial glucose (−102.2 mg/dL; P < 0.0001). Efficacy was consistent across subgroups with varying disease duration, comorbidities, or prior basal insulin use. Adverse events occurred in 6.1%, including 1.3% with mild hypoglycemia; none were serious. Conclusion: InsuQuick ® demonstrated consistent and clinically meaningful glycemic improvements across diverse patient subgroups in real-world Indian settings. Its favorable safety profile and effectiveness suggest its potential as an accessible, cost-effective alternative for insulin intensification in routine clinical care. These findings support broader adoption of biosimilar insulin therapies to address the diabetes burden in low-resource settings.

Abstract This chapter examines semaglutide as a multiorgan therapeutic strategy for cardiometabolic risk reduction, with particular focus on cardiovascular disease, chronic kidney disease, and metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis. It integrates contemporary guidance from the American Diabetes Association (ADA) 2025 Standards of Care, the ADA/European Association for the Study of Diabetes /EASD consensus, and Kidney Disease: Improving Global Outcomes recommendations with evidence from Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes-6, Semaglutide Effects on Cardiovascular Outcomes In People With Overweight or Obesity, effect of semaglutide versus placebo on the progression of renal impairment in subjects with type 2 diabetes and chronic kidney disease (FLOW), Semaglutide Cardiovascular Outcomes Trial, and effect of semaglutide in subjects with noncirrhotic nonalcoholic steatohepatitis, alongside mechanistic literature on glucagon-like peptide-1 receptor agonist-mediated cardioprotective and nephroprotective effects. In cardiovascular prevention, semaglutide is positioned early in high-risk type 2 diabetes on the basis of risk-factor clustering, visceral adiposity, inflammation, and residual cardiometabolic risk, independent of glycated hemoglobin alone. In chronic kidney disease, the review highlights FLOW as a practice-changing kidney outcomes trial demonstrating reduction in major kidney events, slower estimated glomerular filtration rate decline, and reduction in albuminuria. In metabolic dysfunction-associated steatotic liver disease/MASH, semaglutide is presented as a clinically meaningful option for steatohepatitis resolution and fibrosis-related benefit, particularly in obesity- and diabetes-associated liver disease. Overall, the chapter supports semaglutide as an organ-protective therapy whose benefits extend beyond glucose lowering toward integrated cardiovascular, renal, and hepatic risk reduction.

Rapid changes in urbanization in India have paralleled increased prevalence in noncommunicable diseases (NCDs), including type 2 diabetes (T2D), hypertension (HTN), and obesity. To examine sex-specific temporal trends in the prevalence of T2D, HTN, general obesity (GO), and abdominal obesity (AO) among urban populations in India since 2000, a systematic review and meta-analysis was conducted in accordance with a registered Prospective Register of Systematic Reviews protocol (CRD42024548962). PubMed, Global Health (via EBSCOhost), Embase, Scopus, and Web of Science were searched for studies from 2000-2025 (initial search: October 12, 2024; update: July 4, 2025). Eligible studies were cross-sectional and reported the prevalence of T2D or HTN or obesity in urban Indian populations. Screening, data extraction, and risk-of-bias assessment using the Hoy tool were performed independently by 2 reviewers, with a third resolving conflicts. Pooled prevalence was estimated via random-effects meta-analysis in R (version 4.5.3), with forest and funnel plots generated using ggplot2. Out of 3143 records screened, 57 studies were included. The pooled prevalence demonstrated upward trajectory. T2D rose from 13% in 2000-2005 to 21% in 2021-2025, and HTN from 29% to 31%. For obesity, GO increased from 24% in 2000-2005 to 36% in 2016-2020, while AO rose from 47% to 72% over the same period. Sex-stratified analyses showed greater increases among males for T2D and HTN, whereas AO increased more among females. These findings underscore increasing T2D, HTN, and obesity in urban India, highlighting the need for strengthened primary care and supportive environmental and policy measures address the urban NCD burden.

Type 2 diabetes (T2D) is a rapidly expanding global health challenge that heightens vulnerability to infections, including dengue, the most widespread mosquito-borne viral disease worldwide. Emerging evidence indicates that individuals with T2D are at increased risk of severe dengue manifestations, such as dengue hemorrhagic fever and dengue shock syndrome, a vulnerability likely driven by diabetes-associated immune dysregulation, endothelial dysfunction, metabolic derangements, and chronic low-grade inflammation, especially in the setting of poor glycemic control. This review summarizes current epidemiological evidence linking T2D to dengue severity and examines the key immunopathogenic mechanisms underlying this association. It also reviews the evolution of dengue vaccines, noting that previous candidate vaccines were limited by safety and implementation concerns, and provides an overview of contemporary vaccine platforms while highlighting the scarcity of data specific to people with diabetes. Importantly, we identify gaps in existing dengue guidelines regarding diabetes-focused prevention and management. Finally, we outline priorities for future research and discuss the potential role of dengue vaccination within diabetes care pathways, while emphasizing the need for diabetes-specific clinical trials, safety evaluations, and health-economic studies before vaccination prioritization can be recommended.

Abstract Despite the established efficacy of glucagon-like peptide-1 receptor agonists, treatment intensification in type 2 diabetes (T2D) remains limited by clinical inertia, nonadherence, and reluctance toward injectables. Oral semaglutide, enabled by permeation enhancer-based gastric absorption, offers a peptide-based oral option with robust glycemic efficacy, meaningful weight reduction, and low hypoglycemia risk. The review integrates evidence from the Peptide Innovation for Early Diabetes Treatment (PIONEER) program, cardiovascular outcomes data, pharmacokinetic studies, and contemporary American Diabetes Association/American Association of Clinical Endocrinology-aligned recommendations, and translates these into practical guidance for Indian physicians. It addresses patient profiles most suited for initiation, dose escalation, administration instructions, gastrointestinal tolerability, nonresponse, Ramadan use, elderly patients, concomitant oral contraceptives and levothyroxine, diabetic retinopathy, gallstone risk, and oral-versus-injectable semaglutide selection. The central message is that oral semaglutide can be positioned as a high-efficacy oral incretin option for Indian patients with T2D, provided that treatment is individualized, dosing instructions are reinforced, and counseling is optimized to improve adherence, tolerability, and long-term outcomes.