Hemraj B. Chandalia

Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics

We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection. In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 ± 6.53 and 9.83 ± 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 ± 11.26 and 15.20 ± 10.21V (P < 0.02), ankle brachial ratio was 1.05 ± 0.19 and 1.14 ± 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively. In the diabetic and the control group, VPT was 15.62 ± 10.39 and 8.36 ± 3.61 V (P < 0.01), ankle brachial ratio was 1.14 ± 0.18 and 1.15 ± 0.12, and the questionnaire scores were 57% and 40.3%, respectively. In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes.

Forum for Injection Technique (FIT), India: the Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015

As injectable therapies such as human insulin, insulin analogs, and glucagon-like peptide-1 receptor agonists are used to manage diabetes, correct injection technique is vital for the achievement of glycemic control. The forum for injection technique India acknowledged this need for the first time in India and worked to develop evidence-based recommendations on insulin injection technique, to assist healthcare practitioners in their clinical practice.

Forum for injection techniques, India: the first Indian recommendations for best practice in insulin injection technique.

Advances in the treatment of diabetes have led to an increase in the number of injectable therapies, such as human insulin, insulin analogues, and glucagon-like peptide-1 analogues. The efficacy of injection therapy in diabetes depends on correct injection technique, among many other factors. Good injection technique is vital in achieving glycemic control and thus preventing complications of diabetes. From the patients’ and health-care providers’ perspective, it is essential to have guidelines to understand injections and injection techniques. The abridged version of the First Indian Insulin Injection technique guidelines developed by the Forum for Injection Technique (FIT) India presented here acknowledge good insulin injection techniques and provide evidence-based recommendations to assist diabetes care providers in improving their clinical practice.

Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.

Weight gain in type 2 diabetics with different treatment modalities.

BACKGROUND The aim of this study was to study (1) weight gain in type 2 diabetics with different treatment modalities and (2) relationship of weight gain with stable adult weight. METHODS A study of 469 type 2 diabetics on regular follow-up was undertaken to determine the effect of modality of therapy on patients weight. Stable weight maintained by the patient in good health was ascertained. Weight at visit 1 and subsequently at every follow-up was noted. Patients were grouped as per treatment modality. Weight gain was correlated with pretreatment weight loss, stable weight, and degree of metabolic control. RESULTS All treatment subgroups showed a steady upward trend of weight gain at 1-year follow-up. Maximum weight gain was seen in the sulphonylurea and insulin (SU + I) group (mean +/- SD, kg; 2.9 +/- 3.8, p < 0.05) followed by the insulin group (1.8 +/- 4.9), SU group (1.2 +/- 2.9), and SU + metformin (MF) + I group (0.6 +/- 2.8), and was the least in the SU + MF group (0.6 +/- 2.9). Weight gain was not significant, except in SU + I group. Addition of metformin prevented weight gain until 9 months follow-up, but the trend reversed on prolonged follow-up. Most patients tended to move towards their stable body weight. Patients with weight loss in the pre-treatment period (n = 253; weight loss 4.1 +/- 1.6 kg) gained significant weight (4.5 +/- 1.9 kg), while those without significant weight loss in the pre-treatment period (n = 216) did not. Weight gain was significant in the good and fair glycemic control groups, but not so in the poor glycemic control group. CONCLUSIONS Only the SU + I group gained significant weight. The weight gain on treatment was significantly related to pre-treatment weight loss. Most patients moved towards their stable body weight with improved metabolic control.

Addendum 2: Forum for Injection Technique, India

The second addendum to the Forum for Injection Techniques (FIT), India recommendations, first published in 2012 and followed by an addendum in 2013, covers various important issues. It describes how the impact of the so-called non-modifiable factors, which influence the injection technique, can be modulated; provides fresh information on timing of glucagon-like peptide 1 receptor agonist injections, methods of minimizing pain during injections, amyloidosis, and factors that impact adherence to insulin therapy. The addendum also lists semantic changes made to keep the FIT recommendations updated.

Addendum: First injection technique recommendations for patients with diabetes, Forum for Injection Techniques India

The forum for injection techniques, India recommendation, the first ever in the country on insulin injcetion techniques, have covered the science and the art of insulin injection technique in an exhaustive manner. However, a few gaps were identified in the document, which are addressed in the current addendum. This article focuses on insulin injection technique in special clinical situations, including geriatric people, women in pregnancy and those with dermatological or surgical disease who live with diabetes. The addendum also covers salient features of administration of insulin using the insulin pump.

Forum for Injection Technique 2.0 Addendum 1: Insulin use in indoor settings

Insulin is a frequently used drug in the indoor setting. Comprehensive recommendations for best practice in insulin injection technique have been published by the forum for injection technique (FIT), India. This addendum focuses on insulin use in indoor settings, and complements the FIT 2.0 recommendations. It discusses insulin use and disposal in critical care and noncritical care settings. It also highlights the need to ensure continuing nursing and medical education, and frame insulin policies for such use.