Health Bulletin 14/ August/ 2024

Here are the top health news for the day:

The NMC issues advisory after Kolkata incident, here is what it said
Amidst the widespread outrage within the medical fraternity in the country prompting doctors and medical students to strike in protest against the unfortunate event in Kolkata where an on-duty PG medico was reportedly brutally raped and murdered, the National Medical Commission (NMC) has issued a statement and an advisory.
In its advisory issued under the authority of Dr B Srinivas, NMC Secretary, the apex medical commission noted that incidents of violence against doctors in medical colleges have been reported in the recent past. Hence, the NMC has directed medical colleges to ensure the safety of doctors by developing a policy towards a safe work environment on the campus for all staff members including doctors and medical students.

For more information, click on the link below:

How many doctors are registered with medical councils? Health ministry provides state and UT wise breakdown in parliament
As per the data available from the National Medical Commission (NMC), there are altogether 13,86,136 allopathic doctors practising in India with the highest number of doctors registered with the Maharashtra Medical Council (MMC).
Maharashtra Medical Council has altogether 209540 registered allopathic doctors, followed by 149399 doctors registered with the Tamil Nadu Medical Council (TNMC) and 141154 doctors registered with the Karnataka Medical Council (KMC).
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NIRF 2024 rankings for top medical colleges released; AIIMS retains top spot
The National Institutional Ranking Framework (NIRF) 2024 has been released for Medical Colleges across India. The medical college ranking has been disclosed in a press conference by Union Education Minister Dharmendra Pradhan. NIRF Rankings 2024 highlights the education standard, infrastructure, faculty, and research facilities at these institutions.
All India Institute of Medical Sciences Delhi has been ranked number 1 across India with a score of 94.46. All India Institute of Medical Sciences (AIIMS), New Delhi occupies the top slot in medicine for the seventh consecutive year, i.e. from 2018 to 2024. Moreover, AIIMS is ranked in 7th position in the Overall category. It was ranked in 6th position in the Overall category in 2023.
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Kolkata doctor rape case: IMA Chief Meets JP Nadda, urges central legislation for doctor safety
In response to the recent brutal rape and murder of PG respiratory medicine medico at R G Kar Medical College and Hospital, a delegation from the Indian Medical Association (IMA) met with the Union Health Minister JP Nadda to address concerns related to doctor’s safety across the country.
During the meeting, a memorandum was submitted demanding the declaration of hospitals across the country as safe zones, a central law against violence and NMC to bring in security stipulations for recognition of medical colleges.
For more information, click on the link below:
Private hospitals in Kolkata are set to join protest today over the RG Kar rape and murder case
The protest over the rape and murder case at RG Kar Medical College is extending to private hospitals across the city. Doctors at both government and private hospitals have been urged to boycott OPD services and non-emergency duties from 8 AM to 4 PM on Wednesday. The call was made by the Joint Platform of Doctors (JPD), which includes various doctors’ associations like the Indian Medical Association’s Bengal chapter and the West Bengal Doctors’ Forum.
“We saw how the RG Kar hospital administration started demolishing structures in the chest medicine department in the name of renovation. The high court took away the investigation from Kolkata Police and handed it to the CBI hours after the demolition started,” said Kaushik Chaki, a member of the JPD.

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Medical Bulletin 14/ August/ 2024

Here are the top medical news for the day:

Study Finds Key Enzyme Linked to Memory Problems in Old Age, Based on Research in Mice
A study published in the journal Frontiers in molecular neuroscience states that Everyone has moments of forgetfulness from time to time, especially as we get older. But older adults don’t just have difficulty remembering new information. They also have a harder time modifying those memories when new details emerge. Yet, little is known about the mechanisms behind memory updating and how those mechanisms go awry with age.
A team of researchers from Penn State has identified an enzyme that contributes to age-related impairments in memory updating. When blocked, older mice were better able to incorporate new information and performed similarly to their younger counterparts. The researchers said that the findings may lead to the development of potential therapeutic targets for improving cognitive flexibility in old age.
When a memory forms, the brain rewires itself to keep that memory in place through a process called consolidation. Cells express proteins at the synapse, the gap between neurons that allows communication between nerve cells, linking together the cells activated when the memory formed. When the memory is recalled, those cells then fire together at the same time
In this study, the research team wanted to understand why it’s harder to update memories with normal ageing. To test this, they blocked histone deacetylase 3 (HDAC3), an enzyme that regulates gene transcription, the process of copying information from a DNA segment into RNA that will ultimately make a functional protein. HDAC3 has been shown to negatively affect memory formation and gene expression during consolidation but the researchers said its role in memory reconsolidation wasn’t previously studied.
HDAC3 typically tightens up the chromatin, a complex of DNA and proteins, and makes it hard for transcription to happen. If this enzymatic activity is blocked from happening, it may help maintain a more open chromatin state and improve gene expression. When HDAC3 was blocked during the memory reconsolidation phase, it prevented the typical age-related deficits in memory updating. Older mice performed as well as their younger counterparts during a memory update task.
The team used a methodology called the objects in updated locations paradigm, which Kwapis developed specifically to test memory updating. It includes three phases: a training session where mice learn two locations of identical objects; an update session where one of the objects is moved to a new location; and a test session where the objects are placed in four separate locations — the original two training locations, the updated location and a completely novel location.
The study found that alterations in this enzyme’s activity could contribute to cognitive decline in older age. The research highlights the potential of targeting this enzyme as a therapeutic strategy to mitigate memory loss and other cognitive impairments associated with ageing. However, further studies in humans are needed to confirm these findings and develop effective treatments.
References: Alaghband, Y., Kwapis, J. L., López, A. J., White, A. O., Aimiuwu, O. V., Al-Kachak, A., et al. (2017). Distinct roles for the deacetylase domain of HDAC3 in the hippocampus and medial prefrontal cortex in the formation and extinction of memory. Neurobiol. Learn. Mem. 145, 94–104. doi: 10.1016/j.nlm.2017.09.001
Vegan diet outperforms Mediterranean diet for weight loss and inflammation: Study
Eating a low-fat vegan diet reduces harmful inflammatory dietary compounds called advanced glycation end-products (AGEs) by 73%, compared to no reduction on a Mediterranean diet, according to new research by the Physicians Committee for Responsible Medicine published in the journal Frontiers in Nutrition. The decrease in AGEs on the vegan diet was associated with an average weight loss of 13 pounds, compared with no change on the Mediterranean diet.
The reduction of dietary AGEs on the low-fat vegan diet came mainly from excluding the consumption of meat (41%), minimising the consumption of added fats (27%), and avoiding dairy products (14%).
AGEs may be ingested through the diet, and animal products are generally higher in AGEs than plant foods. Cooking with high heat under dry conditions, such as grilling, leads to significant formation of AGEs, especially in animal-derived foods, which are also rich in fats. High amounts of AGEs circulating in the body can contribute to insulin resistance, which can lead to weight gain. AGEs are also linked to inflammation and oxidative stress, which contribute to chronic diseases like heart disease and type 2 diabetes.
The new research is a secondary analysis of a previous Physicians Committee study comparing a low-fat vegan diet to a Mediterranean diet. The study randomly assigned participants to either a low-fat vegan diet, which consisted of fruits, vegetables, grains, and beans, or a Mediterranean diet, which focused on fruits, vegetables, legumes, fish, low-fat dairy, and extra virgin olive oil, for 16 weeks. Neither group had a calorie limit. Participants then went back to their baseline diets for a four-week washout period before switching to the opposite group for an additional 16 weeks. Dietary AGEs were calculated based on self-reported dietary intake records. AGE scores were assigned to each food item, using a published database of AGE content.
This study indicated that a vegan diet may be more effective than a Mediterranean diet for weight loss and reduced harmful inflammatory dietary compounds. The findings suggested that a vegan diet’s emphasis on plant-based foods and exclusion of animal products might lead to greater reductions in body weight and markers of inflammation. This could be attributed to the higher intake of fibre, lower caloric density, and avoidance of certain inflammatory compounds found in animal products. This study highlights the potential benefits of a vegan diet in promoting overall health and reducing inflammation.
References: National Institute of Diabetes and Digestive, and Kidney Diseases.Overweight & obesity statistics. Bethesda, MD: National Institute of Diabetes and Digestive, and Kidney Diseases (2018).
Study uncovers how physical health influences mental health through brain pathways.
Multiple biological pathways involving organs and the brain play a key part in physical and mental health, according to a new study published in the journal Nature Mental Health.
It is analysed that out of 18,000 individuals, 7,749 people had no major clinically-diagnosed medical or mental health conditions, while 10,334 had reported a diagnosis of either schizophrenia, bipolar disorder, depression or anxiety.Using advanced statistical models, the researchers found a significant association between poorer organ health and higher depressive symptoms, and that the brain plays an important role in linking body health and depression.
The organ systems studied included the lungs, muscles and bones, kidneys, liver, heart, and the metabolic and immune systems.
By integrating clinical data, brain imaging and a wide array of organ-specific biomarkers in a large population-based cohort, for the first time it established multiple pathways involving the brain as a mediating factor and through which poor physical health of body organ systems may lead to poor mental health.
Physical health was also taken into account, as well as lifestyle factors such as sleep quality, diet, exercise, smoking, and alcohol consumption.
Professor Andrew Zalesky, an author of the study from the Departments of Psychiatry and Biomedical Engineering at the University of Melbourne, said. “This is a significant body of work because we have shown the link between physical health and depression and anxiety, and how that is partially influenced by individual changes in brain structure.
It is concluded that maintaining good physical health can positively influence brain function, leading to better mental well-being. Conversely, poor physical health may disrupt these brain pathways, contributing to mental health issues such as anxiety, depression, or cognitive decline. The findings underscored the importance of a holistic approach to health, where physical and mental well-being are closely intertwined, and suggest that interventions aimed at improving physical health could also have beneficial effects on mental health.
References: Tian, Y. E., et al. (2024). Brain, lifestyle and environmental pathways linking physical and mental health. Nature Mental Health. doi.org/10.1038/s44220-024-00303-4.
Study reveals the intestinal epithelium’s crucial role in the gluten response of celiac disease
In a new paper published today in the journal Gastroenterology, People with celiac disease must navigate everyday life by avoiding gluten, a protein in wheat, rye and barley which can trigger painful symptoms in the gut, impede the absorption of nutrients and raise the risk of other serious long-term issues.
Celiac disease, an autoimmune disorder affecting around 1% of the population, has roughly doubled in prevalence over the past 25 years, yet no treatment is available.
An interdisciplinary team from McMaster University in Canada, along with researchers from the US, Australia, and Argentina, has spent six years uncovering a crucial piece of the puzzle, the initiation and location of the gluten response.
They found that the inner lining of the upper intestine, called the “epithelium” composed of a variety of cells that are not classically part of the immune system – also plays an active role in directing the inflammatory response to gluten.
Using microscopic biomaterials in the laboratory, the team created a biologically functioning model of the intestinal epithelium which allowed the researchers to isolate the effects of specific molecules in the epithelial cells of people with celiac disease. The model allowed the researchers to generate and observe the reactions under controlled conditions, an option that is simply not available in extremely complex gut environments of living beings.
In conclusion, the breakthrough study elucidated the critical role of the intestinal epithelium in the pathophysiology of celiac disease. By demonstrating how epithelial cells contribute to the immune response against gluten, the research provided new insights into the mechanisms underlying the disease. These findings underscore the importance of targeting the intestinal epithelium in developing novel therapeutic strategies for celiac disease. The study’s results mark a significant advancement in our understanding of gluten sensitivity and open avenues for more effective treatments.
References: Rahmani, S., et al. (2024) Gluten-Dependent Activation of CD4+ T Cells by MHC Class II–Expressing Epithelium. Gastroenterology. doi.org/10.1053/j.gastro.2024.07.008.

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Kolkata doctor death case: West Bengal Medical Council appeals to doctors to end strike

Kolkata: Amid nationwide protests following the rape and murder of a postgraduate medico at Kolkata’s RG Kar Medical College and Hospital, the West Bengal Medical Council urged all agitating doctors under its jurisdiction to end their ongoing strike and return to work.

The Council on Tuesday requested all the doctors to call off their current strike and join the workplace as soon as possible keeping in mind the health of the common people.

Doctors across the country, are protesting over the sexual assault and murder of a woman post-graduate trainee (PGT) doctor at Kolkata’s RG Kar Medical College and Hospital on August 9.

According to an ANI report, in the letter signed by Sudipto Roy, President of the Council, it said, “We are deeply shocked and saddened by the recent sudden death of a young female doctor at the R.G Kar Medical College and Hospital. The West Bengal Medical Council strongly condemns this incident and demands justice against this heinous incident through immediate arrest and speedy trial of the guilty person.”

Also Read:Kolkata Doctor rape-murder: Doctors stage nationwide protest, healthcare services hit

“We are happy that the Chief Minister, Government of West Bengal, Mamata Banerjee intervened in this matter very swiftly, accepted the demands of all the agitating doctors, and directed the administration to take swift action against the guilty person/persons. The Council has full confidence in the Chief Minister as well as the State Government and believes that the family of our colleague, the deceased young doctor, will get speedy justice,” it added.

The West Bengal Medical Council further mentioned that the indefinite strike called by a section of the medical community across the state is disrupting the medical services of the poor people who are facing the services of government hospitals in the entire state, news agency ANI reported.

“In this situation, the West Bengal Medical Council requests all the doctors under it, keeping in mind the health of the common people, to call off their current strike movement and join the workplace as soon as possible and help restore normalcy in the health sector of the state,” the letter said.

The post-graduate trainee doctor was found dead in the seminar hall of RG Kar Medical College and Hospital in Kolkata on August 9. An investigation has confirmed rape and murder, with the victim’s body showing signs of a struggle. The family has alleged that the victim was raped and murdered.

The Calcutta High Court on Tuesday transferred the investigation into the case to the CBI.

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‘Symptom triggered’ testing can pick up early-stage aggressive ovarian cancer in 1 in 4 of those affected

A study published in the International Journal of Gynecological Cancer found that the UK’s protocol for picking up early-stage disease in women with high grade serous ovarian cancer—the most common, aggressive, and lethal form of the disease—is an effective way to diagnose even early-stage ovarian cancer.

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Australia offers lessons for increasing American life expectancy

Despite being home to some of the world’s most dangerous animals, Australia has led the English-speaking world in life expectancy for the last three decades. As for other high-income Anglophone countries, the Irish saw the largest gains in life expectancy, while Americans have finished dead last since the early 1990s, according to a team of social scientists led by a Penn State researcher.

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Childhood maltreatment is associated with greater cognitive difficulties than previously thought

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London and City University of New York suggests that the cognitive difficulties associated with childhood maltreatment, and particularly neglect, have been grossly underestimated in previous studies.

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Lack of purpose and personal growth in older age may precede mild cognitive impairment

Feeling that your life lacks purpose and that there are few opportunities for personal growth in older age may precede the development of mild cognitive impairment (MCI), a frequent precursor of dementia, suggests research published online in the Journal of Neurology, Neurosurgery & Psychiatry.

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Less sleep and later bedtime in childhood linked to future substance use

A good night’s sleep is essential for children’s health and development, but childhood sleep patterns may also be linked to future substance use. A new study, led by a team of Penn State researchers, has found that adolescents were more likely to have consumed alcohol or tried marijuana by age 15 if they went to bed later and slept fewer hours during childhood and adolescence.

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Why No Action Against Singhania University Despite NMC’s Complaint? HC Seeks response from Raj Govt

Jaipur: The Rajasthan High Court single judge bench recently took cognisance of the State Government’s failure to take action against Jhunjhunu’s Singhania University, which is offering MBBS admission despite not having the required approval from the National Medical Commission (NMC), the Apex Medical Education Regulatory Body in India.

Further, the single-judge bench of HC comprising Justice Sameer Jain on Monday asked the Additional Chief Secretary of the State Higher Education Department to appear before it on Tuesday and explain why action was taken against the institute i.e. Singhania University even after a complaint was filed in this regard by the NMC.

The HC bench issued this order while considering the pleas of the students who obtained MBBS degrees from Singhania University.

Medical Dialogues had earlier reported that taking note of the unpermitted MBBS and other medical courses being offered by Singhania University last year, NMC had issued an alert warning medical aspirants about the varsity’s mischievous claim.

The Commission issued the warning after an advertisement published by Singhania University, Pacheri Bari, Distt. Jhunjhunu, Rajasthan, inviting applications for MBBS and other medical courses.

Also Read: NMC warns against illegal MBBS and other medical courses at Singhania University

As per the latest media report by the Times of India, during the hearing of the plea by the MBBS students at Singhania University, NMC submitted before the HC that they had informed the State Government in time that Singhania University was not allowed to run an MBBS course and that enrolments to the course should have been closed.

UGC submitted that they allowed the University to run other courses, including B.Ed, but not an MBBS course. After taking note of the submissions by NMC and UGC, the HC bench directed the ACS Higher Education to appear before the Court and explain the situation.

Commenting on the matter, Sunil Kumar Singodia, associated with the case, informed TOI that the petitioners appeared in NEET 2016-2017 exam and were declared eligible. He added, “At this time, Singhania University issued an advertisement and sought applications for admission to the MBBS course.”

Back in 2022 also, Singhania University published an advertisement in various newspapers claiming that the High Court in the case of IGNOU had held that there was no provision in the Indian Medical Council Act which authorises and empowers BoG-MCI to grant permission or recognition to IGNOU to enable it to take admission and impart education in MBBS and other medical courses.

Referring to this, NMC had clarified that the varsity mischievously claimed that it was covered by a judgment of the High Court without referring to the cause title and Hon’ble Court that has pronounced it. Such a claim was frivolous, and baseless and was made in complete violation of the law made by the Parliament, the Commission had earlier clarified.

“It may be noted that the claim so made by the Singhania University is in violation of the provisions of the India Medical Council Act, 1956 and also NMC Act, 2019 and the Regulations framed there under. Accordingly, any admissions that are made by the Singhania University, Pacheri Bari, Distt. Jhunjhunu, Rajasthan in the courses of medicine (MBBS) is illegal and void ab initio,” NMC had mentioned.

Similar warnings have been issued since the academic year 2019 for the general public and medical aspirants seeking admission at the varsity.

In 2019, the erstwhile Medical Council of India (MCI) noted that all courses including MBBS, diploma and Doctor of Medicine courses were being run without permission and then it debunked the university claim referring to certain HC judgement that the state medical council have to recognise such degrees.

At that time, it had come to the notice of the Board of Governors of MCI that Singhania University was running courses, such as MBBS; Doctor of Medicine courses in Pharmacology, Anatomy, Biochemistry, Physiology, General Medicine, Obstetrics and Gynecology, Ophthalmology, Pathology, Community Medicine and Dermatology; and Diploma courses in Anesthesia, Obstetrics and Gynecology, Immuno- Hematology and Blood Transfusion, Oto-Rhino-Laryngology, and Radio-Diagnosis. The said institution had claimed that as per Punjab & Haryana High Court Judgment (following Supreme Court Judgment) in the Neelam Devi case, State Medical Council/any other concerned Council shall have to recognize the degree/ diploma/certificate awarded by the University ad shall have to enrol the degree holder to enable him/leer to do the practice.

Also Read: UGC warns against illegal MBBS and other medical courses at Singhania University

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Prediabetes in India: Navigating the Sugary Crisis with DCGI-Approved Metformin

The first World Prediabetes Day was organized by the Endocrine Society of India and the South Federation of Endocrine Societies on 14th August 2021. This date falls 90 days before the World Diabetes Day on November 14. It was selected because it takes 90 days to obtain a significant reduction in the raised glycosylated hemoglobin (HbA1c) levels.1 The logo of prediabetes (shown below), launched in 2022, signifies the “window of opportunity” that prediabetes provides to prevent or delay the onset of type 2 diabetes and the related complications. It underscores the importance of early detection and timely intervention in managing prediabetes.

Every August 14, World Prediabetes Day is commemorated. Increased awareness and a call for early action are necessary for the management of prediabetes; the symbolic logo of the Prediabetes ring, shown below (Fig. 1), illustrates how “Acting Early at Prediabetes” is crucial for prediabetes. Metformin’s approval by the Drug Controller General of India (DCGI) in 2022 transformed the management of prediabetes and made it feasible to lower risk and delay the onset of type 2 diabetes mellitus (T2DM); currently, the DCGI indicates metformin in adults prediabetes with overweight patients with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG), and/or increased HbA1C and still progressing towards T2DM despite the implementation of intensive lifestyle changes for 3 to 6 months (1).

Figure 1: Prediabetes Ring, Beat Prediabetes Initiative for India by International Diabetes Federation South East Asia

Prediabetes is an alarming condition, affecting 373.9 million people globally (2). India has 136 million people with prediabetes(3). Studies indicated that nearly 40% to 50% of Indian prediabetics may develop type 2 diabetes over three to five years (2). The prevalence of prediabetes is higher in rural areas as compared to diabetes (15.2% prediabetes in rural vs 8.9% diabetes in rural), as per the ICMR-INDIAB 17 study (2).

Prediabetes in Adolescents: Prediabetes in adolescents has increased recently around the world; with incidence ranging up to 23%, which is concerningly high and necessitates systemic action (4). The DERVAN (aDolescent and prEconception health peRspectiVe of Adult Non-communicable diseases) cohort further revealed that prediabetes in Indian adolescents is mainly caused by obesity driven by hyperinsulinemia, overworking of the pancreas, impaired β-cell function, and inadequate insulin production in undernourished individuals (5). Early intervention and risk assessment are essential to prevent future complications of diabetes, as prediabetes is merely the tip of the sugary iceberg when it comes to the disease. Prediabetes is significantly associated with cardiovascular, cerebrovascular, renal, and several other co-morbid conditions (2).

Diabetes Prevention & Delaying Progression of Prediabetes: Need & Scope of Metformin: Even delaying the onset of diabetes offers several possible benefits, even though prevention is the best outcome. People with diabetes are more likely to experience complications related to their diabetes, face stigmas or discrimination, and need more tests, procedures, and close monitoring (such as retinal and foot examinations and more stringent blood pressure control monitoring) than people with prediabetes (6).

Long-term adherence is often challenging in patients maintaining lifestyle modification of diet and physical activities (7,8). A cross-sectional study conducted in India among 4470 patients showed that only 23.3% and 31.7% adhere to diet and moderate exercise regularly (9).

Metformin is the only drug indicated for delaying or preventing T2D and can be considered for prediabetes in adults at higher risk of incident diabetes, in whom the benefits are strongest (6,10).

Benefit of Adding Metformin to Lifestyle Interventions: A randomized controlled experiment called the Diabetes Community Lifestyle Improvement Program (D-CLIP) was conducted among overweight/obese Asian Indian people who had either IGT, IFG, or IFG plus IGT designed to prevent diabetes. Through community-based recruitment, eligible individuals were identified, and they were randomized to receive either standard lifestyle advice (control) or a 6-month culturally-tailored lifestyle curriculum based on the U.S. Diabetes Prevention Program, plus step-wise addition of metformin (500 mg, twice daily) for participants who were at highest risk of developing diabetes at ≥4 months of follow-up. During the 3-year follow-up period, about 25.7% of intervention participants and 34.9% of control individuals developed diabetes; the relative risk reduction was 32%. Metformin decreased the relative risk by 31% in IGT, 12% in IFG, and 36% in IFG + IGT. Adding metformin in a stepwise manner to lifestyle education effectively prevents or delays diabetes in adults with prediabetes (11).

Effect of Metformin on Diabetes Incidence: Metformin has been demonstrated to significantly decrease diabetes incident risk in overweight and obese patients with prediabetes, according to several randomized controlled trials, including the Diabetes Prevention Program (DPP) research. Over three years, metformin demonstrated a 31% relative risk decrease in diabetes incidents compared to placebo, with a number needed to treat = 14 (12).

Effect of Metformin in Coronary Atherosclerosis in Prediabetes: An analysis conducted by Goldberg, Ronald B et.al., comparing metformin treatment or an individual behavioral lifestyle intervention program with placebo on coronary artery calcium (CAC) severity and presence in the long-term DPP/DPPOS. The Diabetes Prevention Program Outcome Study (DPPOS) consists of 3,234 people who had prediabetes, following an average of 14 years of follow-up, 2,029 patients had their coronary artery calcium (CAC) assessed. According to the study, men who took metformin experienced a remarkable 41% reduction in CAC severity when compared to placebo, but not a lifestyle change. This suggested that among men with prediabetes, metformin protects against coronary atherosclerosis (13).

The follow-up of UKPDS (United Kingdom Prospective Diabetes Study) participants for more than 4 decades with 80000 years accrued, one of the longest diabetes studies, revealed that early treatment with metformin led to 31% myocardial infarction and 20% overall risk reduction for death from any cause (14). Metformin, while producing a similar improvement in glycemic control as insulin or sulfonylureas, also markedly reduced ASCVD (atherosclerotic cardiovascular disease) by approximately 40%(15).

Metformin: Approved Pharmacological Agent in Prediabetes: The DCGI (Drug Controller General of India) approved metformin in prediabetes reduction in the risk or delay of the onset of T2DM in adults(8). In high-risk patients, the Endocrine Society and the American Diabetes Association’s Paediatric Obesity Clinical Guidelines suggest using metformin in prediabetes in addition to lifestyle changes (4).

Key Takeaways:

  • The prevalence of prediabetes is very high with a rapid conversion rate among Asian Indians. There is an increasing prevalence of prediabetes among adolescents.
  • Prevention of childhood obesity, early identification of high-risk patients, prompt screening and active intervention are crucial for the effective management of prediabetes.
  • Metformin is effective in preventing diabetes in India and is the only drug indicated for prediabetes management.
  • In India, the DCGI has approved metformin use in prediabetes, when indicated.

References:

1. ​​Recommendations of the SEC (Endocrinology & Metabolism) made in its 86th meeting held on 26.04.2022 & 29.04.2022 at CDSCO (HQ), New Delhi. Retrieved on 1st August 2024 from https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadCommitteeFiles/Recommendations%20Endocrinology%20%2026.4.22%20&%2029.4.22.pdf

2. Achuth KS, Subramanian M, Pradeep C. Prevalence of pre-diabetes and its associated risk factors among people in rural field practice area of Vydehi Institute of Medical Sciences and Research Centre Bangalore. Int J Community Med Public Health 2024;11:1675-80

3. Anjana, Ranjit Mohan et al. “Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17).” The lancet. Diabetes & endocrinology vol. 11,7 (2023): 474-489. doi:10.1016/S2213-8587(23)00119-5

4. Gupta, Anju et al. “Prediabetes in children and adolescents: A ticking bomb!.” World journal of clinical pediatrics vol. 13,2 92127. 9 Jun. 2024, doi:10.5409/wjcp.v13.i2.92127

5. Patil, Suvarna et al. “Prediabetes in rural adolescent girls from DERVAN cohort: data from the KONKAN region of the state of Maharashtra, India (DERVAN-4).” Frontiers in public health vol. 11 1181401. 3 Aug. 2023, doi:10.3389/fpubh.2023.1181401

6. American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. “The prevention or delay of type 2 diabetes.” Diabetes care vol. 25,4 (2002): 742-9. doi:10.2337/diacare.25.4.742

7. Jose, Jacob, and Nihal Thomas. “How should one tackle prediabetes in India?.” The Indian journal of medical research vol. 148,6 (2018): 675-676. doi:10.4103/ijmr.IJMR_1785_18

8. Kalra, Sanjay et al. “Prediabetes: A pragmatic triage for preventive pharmacotherapy.” JPMA. The Journal of the Pakistan Medical Association vol. 72,2 (2022): 369-372. doi:10.47391/JPMA.22-36

9. Taruna Sharma, Juhi Kalra, DC Dhasmana, Harish Basera. Poor adherence to treatment: A major challenge in diabetes. JIACM 2014; 15(1): 26-9

10. Das AK, Mohan V, Ramachandran A, et al. An Expert Group Consensus Statement on “Approach and Management of Prediabetes in India”. J Assoc Physicians India 2022;70(12):69–78.

11. Weber, Mary Beth et al. “The Stepwise Approach to Diabetes Prevention: Results From the D-CLIP Randomized Controlled Trial.” Diabetes care vol. 39,10 (2016): 1760-7. doi:10.2337/dc16-1241

12. Moin, Tannaz et al. “Review of Metformin Use for Type 2 Diabetes Prevention.” American journal of preventive medicine vol. 55,4 (2018): 565-574. doi:10.1016/j.amepre.2018.04.038

13. Goldberg, Ronald B et al. “Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.” Circulation vol. 136,1 (2017): 52-64. doi:10.1161/CIRCULATIONAHA.116.025483

14. Adler, Amanda I., et al. ‘Post-Trial Monitoring of a Randomised Controlled Trial of Intensive Glycaemic Control in Type 2 Diabetes Extended from 10 Years to 24 Years (UKPDS 91).’ Lancet, vol. 404, no. 10448, 2024, https://doi.org/10.1016/S0140-6736(24)00537-3.

15. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:854-865

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