Abstract Sarcopenia is a long-term, progressive condition affecting skeletal muscle, characterized by reduced muscle mass, diminished strength, and decreased muscle quality, and poses a significant health challenges in the aging population. It is now recognized as a distinct clinical condition of multifactorial origins. Among its numerous contributors, type 2 diabetes mellitus (T2DM) has emerged as a prominent player. Increasing evidence supports a reciprocal relationship between sarcopenia and T2DM, where hyperglycemia, insulin resistance, chronic inflammation, and mitochondrial dysfunction can accelerate muscle deterioration, while sarcopenia may further impair glucose metabolism. This narrative review explores the complex interrelationship between sarcopenia and T2DM, highlighting risk factors, shared pathophysiological mechanisms, and the importance of integrated strategies for early diagnosis and management in older adults.
Abstract Background: Diabetes mellitus (DM) is a chronic metabolic disorder and a major cause of morbidity and mortality. Its rising prevalence, along with modifiable risk factors like obesity and insufficient physical activity (PA), is a growing concern. This narrative review provides the evidence on the exponential trend in diabetes, obesity, and insufficient PA in Sri Lanka during the last three decades. Materials and Methods: A search on epidemiological surveys on diabetes, obesity, and insufficient PA among adults in Sri Lanka between 1990 and 2025 was conducted. Results: Earliest evidence on diabetes prevalence was from a rural community, 2.5% (1993). National level prevalence steadily increased from 10.3% (95% CI: 9.4–11.2) in 2005–2006 to 21.8% (95% CI: 20.1–23.5) in 2023, largely due to obesity and insufficient PA. This far exceeds the 2021 International Diabetes Federation (IDF) estimate of 11.3% (95% CI: 9.1–14.5). Obesity more than tripled from 3.7% (95% CI: 3.4–4.0) to 11% (95% CI: 10.0–12.0) between 2005–2006 and 2021, while the prevalence of overweight increased from 16.8% (95% CI: 16.2–17.4) to 39.4% (95% CI: 37.9–40.9). In 2005–2006, 60% of individuals in Sri Lanka were classified as highly physically active, while 11% were considered insufficiently active. By 2021, however, 34.8% (95% CI: 33.1–36.4) of Sri Lankan adults aged 18–70 years reported insufficient PA. Conclusion: Diabetes has markedly increased in Sri Lanka over the past three decades. From 2005 to 2021, adult obesity and insufficient PA have both tripled. The trends in epidemiological links between obesity, insufficient PA, and diabetes underscore the urgent need for effective preventive strategies.
Abstract Diabetic kidney disease (DKD) and diabetic retinopathy (DR) are important co-existing microvascular complications of type 2 diabetes (T2D) that share common pathogenic mechanisms related to chronic hyperglycemia and microvascular damage. Globally, 20%–40% of all people with T2D have DKD, and about one third have DR. The severity of one diabetic complication often reflects the severity of the other, and both these complications often progress in parallel. Recent studies highlight a significant correlation between the presence and severity of DR and subsequent risk of chronic kidney disease (CKD), suggesting potential utility of ocular biomarkers in CKD detection. The retina provides a noninvasive window to visualize the microvasculature. Recent research has demonstrated that analysis of retinal fundus photographs, routinely collected during DR screening along with some simple noninvasive systemic parameters, and use of artificial intelligence (AI), particularly in deep-learning algorithms (DLA), can accurately detect both prevalent and future risk of CKD in people with T2D. We reviewed articles published up to August 2025 on the correlation of DR and DKD. We also reviewed original research articles on the use of AI for CKD prediction by searching PubMed, Medline, Embase, Scopus, and Google Scholar using keywords like “diabetic retinopathy,” “retinal imaging,” “diabetic kidney disease,” “chronic kidney disease,” “artificial intelligence,” and “deep learning.” This narrative analyses the correlation between DR and DKD and the role of AI systems and noninvasive retinal imaging in the prediction of CKD in T2D.
Abstract Adipose tissue dysfunction is more related to obesity, insulin resistance (IR), and type-2 diabetes mellitus (T2DM). Visceral adipose tissue (VAT) plays a significant role in development of obesity and its associated metabolic disorders. The present study was aimed to evaluate the structural and molecular modifications in VAT in obese and T2DM subjects using histomorphometric and molecular analyses. Data extraction was done with publicly accessible English databases, such as PubMed and Google Scholar, which were searched from the years 2009 and 2024. A total of 103 studies were mined, and seven articles were chosen for the review. The review examined the hypertrophy of VAT, its fibrosis, gene expression levels, and the correlations with inflammation, IR, and T2DM. There is strong evidence that VAT contributes to resistance to insulin and metabolic diseases. Nonetheless, the variability in sample types, experimental methods, analytical tools, and the genes examined across the studies leads to an inconclusive comparison regarding the identification of significant biomarkers that warrant further investigation for diagnostic purposes and the development of targeted therapies [Supplementary Figure].
Abstract Background: Vitamin D has been implicated in glucose metabolism and insulin sensitivity, but evidence regarding its association with gestational diabetes mellitus (GDM) remains inconsistent. This study aimed to evaluate the association between maternal vitamin D deficiency and the risk of GDM. Materials and Methods: A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Studies assessing vitamin D status at or beyond 24 weeks of gestation were included in this study. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL (<50 nmol/L). Pooled odds ratios (ORs) and mean differences (MDs) were calculated using fixed- or random-effects models. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Seventeen observational studies were included in the qualitative synthesis, of which 12 were eligible for meta-analysis. Vitamin D deficiency was significantly associated with an increased risk of GDM (pooled OR = 1.42; 95% confidence interval [CI]: 1.24–1.64; P <0.00001; I 2 = 12%). Serum vitamin D concentrations demonstrated significantly lower vitamin D levels in women with GDM (pooled MD = −1.33 ng/mL; 95% CI: −2.36 to −0.31; P = 0.01; I 2 = 68%). Conclusions: Maternal vitamin D deficiency assessed at or after 24 weeks of gestation is significantly associated with an increased risk of GDM. These findings support vitamin D deficiency as a potential risk modifier for GDM, although causality cannot be inferred due to the observational nature of the evidence. Well-designed randomized controlled trials are needed to determine whether vitamin D supplementation during pregnancy can reduce the incidence of GDM.
Abstract Metabolic dysfunction-associated steatotic liver disease (MASLD) is very common in type 2 diabetes individuals and can progress to fibrosis and hepatocellular carcinoma if not detected and treated early. The term MASLD includes a spectrum of steatotic liver diseases along with the presence of two or more components of the metabolic syndrome in individuals where the liver pathology cannot be explained by alcohol intake. In this review article, we look at the various conventional treatment modalities like diabetic agents and non-diabetic agents as well as new treatment modalities like resmetirom, glucagon like peptide-1 (GLP-1) agonists, and dual GLP-1/GIP agonists for hepatic steatosis and fibrosis and summarize their mechanism of action and their effect on hepatic steatosis, progression, and regression of fibrosis in Table 1 and Table 2 respectively.
The metabolic syndrome (MetS) is one of the most subsequent factors of major noncommunicable diseases (NCDs). India has been contributing a sizable prevalence rate for this syndrome. Due to modernization and urbanization, a drastic lifestyle change of Indians, especially young adult population, can be seen in the country. The aims of this narrative review is to identify the prevalence of MetS and its associating factors among the young adult Indian population. A narrative review of research on MetS in young Indian adults from 2013 using PubMed, Scopus, Web of Science, and Google Scholar was carried out. The results were combined to give a concise summary of the prevalence and contributing factors. The prevalence of MetS among young adult population ranges from 2.13% to 34%. The associating factors include age, low physical activity and unhealthy dietary pattern, low socioeconomic status, low fruit and vegetable intake, academic stress, lack of sleep hygiene, and habit of watching screen while having food. By considering the ongoing rise in the prevalence of MetS and associating factors among the young adult population, researchers and healthcare providers need to give more emphasis on controlling and preventing the syndrome in order to reduce the burden of NCDs in future at the earliest stage.
Context:Sleep disturbances impair glucose metabolism and insulin sensitivity, influencing type 2 diabetes mellitus (T2DM). Despite its increasing prevalence, sleep health remains under recognized in diabetes care.Aims:To assess sleep quality among people with T2DM attending non-communicable disease (NCD) clinics at the rural and urban health training centers of a tertiary medical college hospital using the Epworth Sleepiness Scale (ESS).Settings and Design:A cross-sectional analytical study was conducted among diabetic adults attending NCD clinics between April and June 2024.Materials and Methods:Data were collected from 204 participants using a structured questionnaire including socio-demographic details, diabetes-related factors, and the validated ESS to assess sleep quality.Statistical Analysis Used:Descriptive statistics, the chi-square test, and logistic regression were applied to determine associations between ESS scores and related factors.Results:Among 204 participants, 60.3% were female, and 79.9% were below 65 years. Overall, 50.5% had poor sleep (ESS > 10): 22.1% mild, 8.8% moderate, and 19.6% severe. Employment status showed a significant association (chi & sup2; = 7.96, P = 0.04). Severe sleepiness was higher among urban participants (25.5% vs. 13.7%; chi & sup2; = 51.39, P < 0.001). Age and gender were not significant.Conclusion:Half of the diabetic participants experienced poor sleep, mainly unemployed and urban individuals. Routine sleep assessment and hygiene education in NCD clinics can enhance glycemic control and support Sustainable Development Goal 3-Good Health and Well-Being.
Introduction:Diabetes mellitus poses a major public health challenge in India, with Jharkhand reflecting both rising prevalence and unique challenges due to its rural and tribal population. Early detection and sustained management are critical, yet gaps in follow-up and control persist. This study analyzes state-level program data from 2021-2025 to assess the diabetes care cascade.Materials and Methods:A retrospective descriptive analysis was conducted using aggregated data from the Jharkhand State Health Department, covering the duration from 2021 to 2025. Indicators included enrollment, screening, diagnosis, initiation of treatment, follow-up adherence, and glycemic control. Percentages were calculated to reflect progression through the care cascade, and linear regression was applied to assess trends and forecast future coverage.Results:Enrollment expanded from 353,955 in 2021-2022 to 5.58 million in 2024-2025, with the screening coverage improving from 73.7% to 91.3%. Newly diagnosed diabetes cases increased from 3862 to 84,860. Treatment initiation improved markedly, with 90% of diagnosed patients started on therapy in 2024-2025 compared to negligible numbers in 2021-2022. However, follow-up adherence remained low, increasing only from 0.0008% to 20.2%. Among those retained in care, nearly half achieved glycemic control, but overall control rates were limited to less than 10% of all diagnosed cases. Forecasting suggests that full program coverage of the estimated diabetic population may take decades without strategic improvements.Discussion:Jharkhand has achieved large-scale screening and improved treatment initiation, but suboptimal follow-up and control rates highlight the areas of improvement in chronic disease management. Strengthening patient retention, culturally sensitive counseling, and community-based follow-up are essential to improve long-term outcomes.
Fibrocalculous pancreatic diabetes (FCPD) is a rare form of secondary diabetes in which there is insulin deficiency. The mainstay of treatment for FCPD is insulin. When insulin is delivered through basal bolus regime, there is a risk of hypo and hyperglycemic episodes if the dose is not adjusted properly. In this case, we report the journey of a patient with FCPD who was earlier on basal bolus insulin regime and later switched to the automated hybrid closed-loop 780G insulin pump, which significantly improved her quality of life.
Background:Cardiovascular complications are a major cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Fixed-dose combinations (FDCs) of antidiabetic agents may improve glycemic control, cardiovascular outcomes, and treatment adherence. However, real-world evidence in high cardiovascular risk settings is limited.Objective:The GRACE-CVD study evaluated the effectiveness, tolerability, and physician-reported outcomes of dual FDC (Metformin + Glimepiride) and triple FDC (Metformin + Dapagliflozin + Sitagliptin) in T2DM patients with established or high cardiovascular disease (CVD) risk.Materials and Methods:This retrospective, multicenter study analyzed 1772 adult T2DM patients from 150 Indian centers. Patients had either established CVD or high CVD risk. Key parameters, including HbA1c, fasting and postprandial blood glucose, blood pressure, lipid profile, renal function, weight, and adverse events, were assessed over an average follow-up of 4.1 +/- 3.1 months. Adherence, satisfaction, and reasons for prescribing FDCs were also captured.Results:Both FDC regimens significantly improved glycemic outcomes, with HbA1c of <7% achieved in 32% of patients at follow-up vs. 8% at baseline (P < 0.0001). Blood pressure, weight, and renal parameters also improved. Adverse events occurred in 13.2% of patients, with no increase in hypoglycemia. Over 75% showed good adherence, and similar to 85% of patients and physicians reported satisfaction. Notably, 30% of FDC prescriptions were aimed at improving cardiovascular outcomes.Conclusion:Dual and triple FDCs demonstrated effectiveness and tolerability in improving glycemic and cardiometabolic parameters in T2DM patients with or at high risk of CVD. These findings warrant further prospective studies for long-term cardiovascular impact.
Granuloma annulare (GA) is a benign granulomatous skin disorder presenting as dermal papules arranged in annular or grouped patterns. We highlight a case of a 40-year female patient who presented with multiple skin-colored raised lesions over the upper back, dorsum of both hands and forearms. During the routine investigations, the patient was diagnosed with diabetes mellitus. Dermoscopy and histopathological examination confirmed GA. The coexistence of GA and diabetes mellitus in this case raises clinical awareness of possible systemic associations in chronic skin conditions.
Introduction:Diabetes mellitus and anemia are among the most significant public health problems worldwide. The significant incidence of both diseases increases the probability of their coexistence in the same patient. This study investigated whether anemia types (microcytic, normocytic, and macrocytic) have any effect on glycated hemoglobin (HbA1c).Materials and Methods:The study included 40 patients with iron deficiency anemia (IDA; microcytic anemia), 40 patients with vitamin B12 deficiency (megaloblastic anemia), 18 patients with autoimmune hemolytic anemia (AHA; normocytic anemia), and 40 patients in the control group. The baseline hemoglobin (Hgb), mean corpuscular volume, fasting plasma glucose, and HbA1c values of patients meeting the inclusion criteria were measured, and the data for each study group were compared with those of the control group.Results:The Hgb value was significantly lower in the IDA, vitamin B12 deficiency, and AHA groups when compared separately with the control group (P < 0.00, P < 0.001, and P < 0.001, respectively). HbA1c levels were significantly higher in the group with IDA and megaloblastic anemia compared to the control group, while they were significantly lower in the group with AHA compared to the control group (P < 0.00, P < 0.001, and P < 0.001, respectively).Conclusion:Irrespective of the type of anemia (microcytic, normocytic, or macrocytic), HbA1c in anemic patients can lead to misinterpretation, misdiagnosis, or underdiagnosis, resulting in adverse outcomes. In anemic patients, using plasma glucose, glycosylated albumin, or fructosamine instead of HbA1c may be a more appropriate approach.
Type 2 diabetes mellitus (T2DM) and obesity are increasingly prevalent among women of reproductive age and are associated with adverse maternal and neonatal outcomes. Tirzepatide, a dual glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptor agonist, has demonstrated significant benefits in glycemic control and weight reduction; however, its safety profile in pregnancy remains uncertain, with animal studies suggesting potential risks. We report the case of a 36-year-old woman with T2DM, morbid obesity, chronic kidney disease, and polycystic ovarian syndrome who conceived inadvertently while on tirzepatide, dapagliflozin, and metformin, continuing therapy until the 31st week of gestation. Despite multiple comorbidities and prolonged exposure to tirzepatide, the patient remained clinically stable and underwent an emergency Cesarean section at 37 weeks, delivering a live female infant. The neonate exhibited no congenital anomalies or major complications, apart from mild tongue tie and a slightly reduced abdominal circumference and birth weight. This case highlights the necessity of preconception counseling and education for the use of tirzepatide in patients of childbearing age due to its easy and wide availability. Moreover, it provides preliminary reassurance regarding the safety of tirzepatide during pregnancy, but larger studies are needed to establish maternal and neonatal outcomes with certainty.
Background: Fasting during Ramadan is a challenge for those with type 2 diabetes mellitus (T2DM). Imeglimin is a new oral antidiabetic medicine that works in two ways and has a minimal risk of causing hypoglycemia and/or hemodynamic changes. These advantages make imeglimin a possible choice for use during Ramadan. Objective: The goal was to examine the safety and effectiveness of imeglimin versus vildagliptin in individuals with T2DM who were fasting during Ramadan. Materials and Methods: A total of 126 adults with T2DM were randomly assigned (1:1) to receive either imeglimin [1000 mg twice daily (BID)] or vildagliptin (50 mg BID), along with metformin. Changes in glycated hemoglobin (HbA1c) and the frequency of hypoglycemic and/or hyperglycemic episodes were the main outcomes. Patients were checked 4-6 weeks before and after Ramadan. Results: After Ramadan, both groups had significant decreases in HbA1c. The imeglimin group had a bigger drop (14.2% vs. 7.5%; P < 0.001 between groups, P = 0.227 within groups). The imeglimin group had fewer hypoglycemic (P = 0.02) and hyperglycemic episodes (P = 0.001) during fasting. The body mass index decreased more in the imeglimin group (P = 0.02) but not in the vildagliptin group (P = 0.084). There were no clinically significant changes in liver enzymes or kidney function in either group. Conclusion: Imeglimin and metformin together are a safe and effictive treatment for people with T2DM who are willing to fast during Ramadan.
Background:Sarcopenia, the progressive loss of muscle mass and strength, is a growing complication of type 2 diabetes mellitus (T2DM). However, its link with glycemic control, particularly in younger patients, remains unclear. This study aimed to determine the prevalence of sarcopenia in T2DM and examine its association with glycated hemoglobin (HbA1c).Materials and Methods:This cross-sectional study included 157 T2DM patients aged >40 years. Sarcopenia was assessed using the Asian Working Group for Sarcopenia criteria. The appendicular skeletal muscle mass, handgrip strength, Five-Time Sit-to-Stand Test, anthropometric, and laboratory parameters were analyzed. The statistical analyses included t-tests, chi-square tests, and receiver operating characteristic analysis.Results:Sarcopenic patients had lower body mass index (P < 0.001), waist circumference (P < 0.001), and low handgrip strength (P = 0.012) and reduced calf circumference (P < 0.001). HbA1c showed no association (P = 0.209, area under the curve = 0.453) with sarcopenia. The serum creatinine and blood urea levels were positively correlated with appendicular skeletal muscle mass (r = 0.204, P < 0.05) and skeletal muscle index (r = 0.182, P < 0.05), whereas hand grip strength was correlated positively with blood urea (r = 0.161, P < 0.05). Estimated glomerular filtration rate (eGFR) was significantly lower in females with longer diabetes duration (>= 5 years) compared with those with duration <5 years, and a trend (P = 0.06) of lower eGFR was noted in females with higher HbA1c (>= 8).Conclusion:The study revealed that neither glycemic control nor renal function markers are linked to sarcopenia in the relatively younger diabetic cohort (40-60 years). However, the handgrip strength and calf circumference served as good indicators of sarcopenia, suggesting the clinical utility of simple bed-site measures.
Background:Continuous glucose monitoring (CGM) provides detailed insight into glycemic patterns beyond traditional markers like HbA1c. However, despite growing interest in CGM worldwide, adoption in India remains limited due to cost and lack of local calibration studies.Materials and Methods:This retrospective study included 499 Indian adults with type 2 (n = 487) and type 1 (n = 12) diabetes who used a CGM device (FreeStyle Libre Pro or Gluconova) for 5-14 days. Clinical data included age, sex, body mass index, diabetes duration, HbA1c, and postprandial blood sugar (PPBS). CGM metrics analyzed were time in range (TIR), time above range (TAR), and time below range (TBR). Multivariable linear regression was used to identify independent predictors of CGM outcomes. A separate subgroup analysis assessed the relationship between PPBS and TIR.Results:Mean TIR was 47.0% +/- 26.7%, TAR was 41.2% +/- 30.9%, and TBR was 11.8% +/- 16.6%. HbA1c was independently associated with all CGM metrics. In the PPBS subgroup (n = 259), each 1 mg/dL increase in PPBS was associated with a 0.06% reduction in TIR (P < 0.001). According to international consensus guidelines (TIR > 70%, TBR < 4%), 78% of patients had suboptimal TIR, and 51% had excessive TBR. Overall, 88% (n = 437) of patients failed to meet one or both targets.Conclusion:In this real-world Indian cohort, CGM revealed poor glycemic control in the majority of patients. HbA1c and PPBS were independently associated with CGM-derived outcomes, particularly TIR. These findings support the integration of CGM with standard glycemic markers to improve individualized diabetes care.
