Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition with a profound impact on health-related quality of life (HRQoL). Poor adherence to medication, exercise prescriptions and self-care activities remains a significant barrier to glycaemic control and optimal patient outcomes. However, the multidimensional associations between adherence behaviours and quality of life (QoL) domains remain underexplored in Indian urban populations. Objectives: This study aimed to assess adherence to medication, exercise and diabetes-related self-care activities, and to examine their associations with health-related QoL across four domains—physical health, psychological health, social relationships and environment—in T2DM patients. Methods: A cross-sectional observational study was conducted among 193 T2DM patients recruited from diabetic clinics in Surat, Gujarat, India. Adherence to medication was measured using the Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS), exercise adherence using the Exercise Adherence Rating Scale (EARS) and self-care activities using the Diabetes Self-Management Questionnaire (DSMQ). QoL was assessed using the Gujarati version of the World Health Organization Quality of Life instrument, brief version (WHOQOL-BREF). Glycaemic control was evaluated through glycated haemoglobin (HbA1c). Spearman’s correlation coefficient was used for statistical analysis. Results: The mean age of participants was 49.78 ± 13.21 years; 59.07% were female. The mean medication adherence score was 7.11 ± 1.77; exercise adherence was 15.75 ± 5.50. Physical health QoL was low in 45.6% of participants. At the nominal level, medication adherence showed significant positive correlations with physical health QoL ( r = 0.22, P = .009) and social relationship QoL ( r = 0.304, P = .019); exercise adherence was significantly associated with physical health ( r = 0.25, P = .029), psychological health ( r = 0.49, P = .010) and general health satisfaction ( r = 0.554, P = .001); and multiple DSMQ subscales—including glucose management (GM), dietary control (DC) and physical activity (PA)—demonstrated significant correlations across QoL domains. After Benjamini-Hochberg false discovery rate (BH-FDR) correction for the 54 correlations tested, only the associations between DSMQ-GM and environmental QoL ( r = 0.581, P < .001) and between exercise adherence and general health satisfaction ( r = 0.554, P = .001) remained significant. Conclusion: Adherence to medication, exercise and diabetes-related self-care activities showed nominally significant associations with HRQoL in T2DM patients, of which the associations of diabetes self-management (GM) with environmental QoL and of exercise adherence with general health satisfaction remained robust after correction for multiple testing. Targeted interventions to improve adherence across these domains may benefit patient outcomes and well-being, though confirmatory studies are warranted.
Introduction: This review examines the significance and scientific foundation of drug expiration dates. It emphasises the risks linked to expired medications and their implications for health and safety. Methods: In September 2025, a comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar. Studies regarding drug degradation mechanisms, the impact of environmental factors on medication stability, and the consequences of using expired pharmaceuticals were identified and discussed. Results: The study highlights the importance of medication expiration dates as crucial indicators of drug safety and effectiveness, ensuring the potency and purity of medications. It identifies chemical degradation and environmental factors as vital elements that can compromise drug integrity post-expiration, potentially resulting in inefficacy or harm. Nevertheless, many medications remain effective beyond their expiration dates, challenging the absolute view of expired drugs as ineffective or hazardous. The risks associated with expired medications vary based on the type of medication and storage conditions, with particular concern for individuals with pre-existing conditions or those taking multiple medications. Conclusion: Comply with expiration dates and appropriately dispose of expired medications to uphold efficacy and safety, prevent environmental pollution, and reduce health risks. Despite the challenges, including disposal costs and the necessity for regular medication audits, as well as medication hoarding, this highlights the need for increased awareness and education regarding the importance of adhering to medication expiration dates and safe disposal practices.
Background and Aims: Point-of-care testing (POCT) for blood glucose provides rapid results and is widely used in clinical practice; however, concerns remain regarding its accuracy and agreement with laboratory auto-analyser methods. The purpose of this study was to compare glucose measurements obtained using POCT and a laboratory auto-analyser in a secondary healthcare centre within a low-resource setting. Methods: A comparison study was conducted using 120 paired blood glucose measurements obtained simultaneously by a POCT glucometer and a laboratory auto-analyser. Descriptive statistics were used to summarise glucose values. Pearson correlation and linear regression analyses assessed the relationship between methods, while agreement was evaluated using Bland-Altman analysis. Statistical significance was set at P < .05. Results: The mean glucose concentration measured by POCT was 6.59 ± 2.27 mmol/L, while that measured by the auto-analyser was 6.33 ± 2.93 mmol/L. A strong positive correlation was observed between the two methods ( r = 0.971, P < .001). Linear regression analysis yielded the equation auto-analyser = 1.249 × POCT − 1.905 ( R ² = 0.943), indicating proportional bias. Bland-Altman analysis demonstrated a mean bias of −0.26 mmol/L, with 95% limits of agreement ranging from −2.03 to +1.50 mmol/L. Greater variability in differences was observed at higher glucose concentrations. Conclusion: POCT glucose measurements show excellent correlation with laboratory auto-analyser results but exhibit systematic and proportional bias, particularly at higher glucose levels. While POCT is suitable for rapid glucose assessment and monitoring, laboratory auto-analyser methods remain the preferred reference for diagnostic and critical clinical decision-making.
Introduction: Left atrial (LA) strain and left ventricular (LV) global longitudinal strain (GLS) on two-dimensional echocardiography in asymptomatic Type 2 diabetes mellitus (T2DM) patients might help recognise subclinical myocardial dysfunction in these patients. Since T2DM is associated with underlying insulin resistance (IR), we explored the association of IR estimated by homeostatic model assessment of IR (HOMA-IR) with LA and LV strain. Materials and Methods: This cross-sectional study was undertaken in patients with T2DM with Stage A heart failure (HF). Detailed echocardiographic assessment of the LA and LV functions using 2D speckle-tracking echocardiography was carried out. Participants were categorised into two groups for analysis, using the lower limit of the highest HOMA-IR quartile as the cut-off point. Results: A total of 93 patients (51 males and 42 females; median age 57 years) were included in the analysis. Group A (IR <75th percentile) had significantly higher LA volume (34.52 vs. 29.71 mL) and aortic valve (AV) velocity (1.30 vs. 1.24 m/s) than Group B (IR >75th percentile). LV strain in Group A was −16.82 ± 2.90 and in Group B was −16.55 ± 2.19, with no significant difference. Similarly, the LA strain in both groups was statistically insignificant. Conclusion: In T2DM patients with Stage A HF, IR does not correlate with LA strain or LVGLS, yet it significantly associates with an increased LA volume and AV velocity.
Background: Exercise is the cornerstone of chronic low back pain (CLBP) management, yet long-term adherence remains poor. Up to 70% of individuals with CLBP fail to adhere to prescribed home exercise programmes, and the multilingual, socioculturally diverse Indian population faces unique contextual barriers and enablers not captured by existing Western-derived instruments. No validated tool exists to systematically assess these factors in Indian CLBP populations. Objective: To develop and psychometrically validate a Theoretical Domains Framework-based Barriers and Enablers to Exercise Adherence Checklist (BEEA-C) for individuals with CLBP. Methods: Item generation was performed through systematic review synthesis (Gilanyi et al., 2024), expert panel review ( n = 12) and patient focus groups ( n = 20). The draft checklist underwent forward-backwards translation into Hindi, Gujarati and Marathi. Content validity was assessed by a 10-member expert panel, yielding an item-level content validity index (I-CVI) and scale-level CVI (S-CVI/Ave). Cognitive debriefing ( n = 30) preceded the main validation study. A cross-sectional survey was conducted among 320 adults with CLBP attending the physiotherapy outpatient department (OPD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency (Cronbach’s alpha, McDonald’s omega), test–retest reliability intraclass correlation coefficient [ICC (2,1)]) and construct validity (convergent, divergent) were assessed. Results: The final BEEA-C comprised 48 items across four domains: (a) Exercise, Pain and Body (12 items), (b) Psychological Factors (14 items), (c) Social Factors (10 items) and (d) External Factors (12 items). S-CVI/Ave was 0.94. EFA revealed a four-factor solution explaining 62.3% of the variance. CFA confirmed adequate fit (CFI = 0.96, RMSEA = 0.057, SRMR = 0.061). Cronbach’s alpha ranged from 0.81 to 0.91 across subscales; ICC(2,1) = 0.89 (95% CI: 0.85–0.92). Convergent validity with the Brief Pain Inventory and Fear-avoidance Beliefs Questionnaire was satisfactory. Conclusion: The BEEA-C is a reliable, valid and culturally appropriate tool for identifying barriers and enablers to exercise adherence in multilingual Indian CLBP populations. It has direct clinical utility for individualised exercise prescription and adherence intervention planning.
