Background: Patients with type 2 diabetes mellitus (T2DM) having elevated levels of blood glucose and glycated hemoglobin (HbA1c) are at higher risk of macro- and microvascular complications. Nonetheless, the goal of achieving glycemic control cannot be met with the use of pharmacotherapy alone. The recent emergence of digital therapeutic tools has shown the possibility of improving the modifiable risk factors and self-management of diabetes. Objective: The aim of this study was to examine the clinical utility of a digital therapeutic intervention as an add-on therapy to achieve glycemic control in patients with T2DM. Methods: This was a 12-week prospective, single-arm digital intervention study in patients with T2DM receiving regular antidiabetic treatment. The eligibility criteria included male and female patients with HbA1c≥6.5%, functional English literacy, and a mobile phone capable of running the intervention app. Outcome measures of the study were mean changes in HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PPBG), BMI, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index at the end of 12 weeks. Results: A total of 128 participants completed the study period of 12 weeks. There were 54.7% (70/128) men and 45.3% (58/128) women with a mean age of 48.48 years (SD 10.27). At the end of 12 weeks, the mean change in HbA1c, FBG, PPBG, and BMI for the overall study population was –0.84% (P<.001), –8.39 mg/dl (P=.02), –14.97 mg/dl (P<.001), and –0.24 kg/m2 (P=.06), respectively. Among the participants showing improvement in the HbA1c value at the end of 12 weeks (responders), the mean change in HbA1c, FBG, PPBG, and BMI was –1.24% (P<.001), –12.42 mg/dl (P=.003), –21.45 mg/dl (P<.001), and –0.34 kg/m2 (P=.007), respectively. There was an increase in HOMA-IR values for the overall study population (0.54, P=.29). HbA1c response showed a significant association with a baseline HbA1c level ≥7.5%, no prior history of smoking, and no prior COVID-19 infection, as well as with higher levels of program engagement. Conclusions: A digital therapeutic intervention when used alongside standard medications significantly reduces HbA1c, FBG, and PPBG levels in patients with T2DM.

Despite revolutionizing diabetes care globally, continuous glucose monitoring (CGM) adoption in India remains limited, as a result of several economic, infrastructural, clinical, and sociocultural concerns. This narrative review aims to map unmet needs and propose practical, context-specific solutions. Continuous use of CGM remains the preferred approach for optimal glucose management and achieving long-term metabolic advantages, providing insights for proactive, data-driven, and preventive diabetes care. However, main barriers to CGM uptake include limited awareness among people with diabetes and healthcare providers, high costs, lack of reimbursement, limited device availability beyond major cities, and economic, infrastructural, and sociocultural access inequities across urban and rural populations. The psychological burden from frequent alarms, data fatigue, and stigma with noticeable or intrusive devices add to these challenges. Addressing these barriers necessitates a multifaceted strategy involving affordable, climate-adapted devices, interoperable digital ecosystems, India-specific reimbursement models, and robust educational infrastructure. The emergence of cost-effective CGM devices with a range of advanced features, such as predictive glucose algorithms and personalized pattern identification, is pivotal to this effort. These innovations improve clinical outcomes and quality of life by simplifying the user experience, addressing challenges, such as alarm fatigue while translating complex data into actionable insights, facilitating widespread CGM adoption in India.

Introduction Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India. Research design and methods A cross-sectional national-level project ‘Save the Feet and Keep Walking’ campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023. Results Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet. Conclusions One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.

Type 2 diabetes (T2D) is closely linked to metabolic dysfunction–associated steatotic liver disease (MASLD). However, the burden of clinically significant and advanced liver fibrosis, including cirrhosis, from community-based Indian populations remains poorly defined, with most prior studies limited by small size, referral bias, or single-centre design. The DiaFib-Liver Study was a cross-sectional investigation conducted between January and July 2024 across multiple centres in India. Consecutive adults with T2D, asymptomatic for liver disease, who had undergone vibration-controlled transient elastography (VCTE) within the preceding six months were enrolled by diabetologists and endocrinologists across India. Patients with competing liver diseases or hepatology referrals were excluded. Liver stiffness measurement (LSM) thresholds defined clinically significant fibrosis (≥8.0 kPa), advanced fibrosis (≥10.0 kPa), and probable cirrhosis (≥15.0 kPa). Hepatic steatosis was assessed using the controlled attenuation parameter (CAP), with CAP ≥248 dB/m used to define steatosis. Predictors of clinically significant fibrosis were assessed with multivariable logistic regression. A total of 9202 adults with T2D were included (mean age 53.3 years [SD 11.8]; 61% [5617/9202] male). Overall, 26% (2433/9202) had clinically significant fibrosis, 14% (1289/9202) advanced fibrosis, and 5% (491/9202) had LSM values consistent with probable cirrhosis (≥15.0 kPa). Among participants with CAP data, 65% (5289/8136) had CAP-defined hepatic steatosis (CAP ≥248 dB/m). Importantly, 13% (370/2847) of patients without steatosis (CAP <248 dB/m) already had clinically significant fibrosis, including 4% (107/2847) with probable cirrhosis (LSM ≥15.0 kPa). Independent predictors of clinically significant fibrosis included obesity (OR 1.98, 95% CI 1.80–2.19), dyslipidaemia (OR 1.21, 95% CI 1.10–1.34), reduced eGFR (OR 1.23, 95% CI 1.02–1.49), and diabetes duration ≥10 years (OR 1.12, 95% CI 1.00–1.24). Regional variation was evident, with prevalence ranging from 21% (256/1241) in central to 30% (643/2126) in southern India. Among non-obese patients (BMI <25), 19% (752/3996) had clinically significant fibrosis, with age as the only independent predictor. One in four adults with T2D in India has clinically significant liver fibrosis and one in twenty already has probable cirrhosis based on elastography thresholds, establishing advanced liver disease as a “fourth major complication” of diabetes. Fibrosis—not steatosis—should be the focus of systematic assessment in diabetes care. These findings highlight the urgent need to integrate fibrosis screening into national diabetes programs. Prospective outcome studies and cost-effectiveness analyses are warranted to inform strategies for MASLD in T2D. This study did not receive any funding.

Introduction: The temporomandibular disorders (TMDs) include a heterogeneous group of clinical conditions affecting the stomatognathic system and its related structures. It is characterized by pain specific to the maxillofacial region, and these disorders are the main cause of chronic facial pain and disability. Management of TMDs is challenging due to the unknown etiology and complex anatomy of the temporomandibular joint region. Aim and Objectives: To evaluate the effect of botulinum toxin type-A (BTX-A) on pain and day to day functional and social activities of myofascial pain with or without TMDs, and to compare the effectiveness of BTX-A with a placebo group with the aid of EMG and a Behavioural Questionnaire. Materials and Methods: The study was done on 24 patients randomly divided into two groups and each group contains 12 participants. The study group showed a statistically significant decrease in the muscle activity after 14 days, and the patients responded that there was a significant reduction in the pain and improvement in their day-to-day functional as well as social activities after BTX-A treatment with 8 months follow-up. Conclusion: BTX-A has been proven to have positive desired effects on patients with TMDs.