Aim: The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background: Modern SUs may be considered a panacea in DM care with their beneficial extrapancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results: The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8263688.

The expanding burden of Type 2 Diabetes Mellitus (T2DM) in today's world, with respect to incidence, prevalence, and cost incurred, is an existential risk to society. Various guidelines recommend individualization of treatment. This expert opinion aims to review the recent evidences and reach a consensus on the preferable combination therapy for use in newly diagnosed Indian T2DM patients with HbA 1C >7.5%. The core committee included seventeen diabetes specialists. Three statements were developed, discussed, and rated by specialists and recommendations were noted. Specialists were requested to rate the statements using a 9-point Likert's scale with score of 1 being “Strongly Disagree” and 9 being “Strongly Agree”. Statement-specific scores of all the specialists were added and mean score of ≥7.00 was considered to have achieved a consensus. Statements used to meet the consensus were: Statement 1. Majority of newly-diagnosed Indian diabetics have HbA 1C >7.5%; Statement 2. Patients with HbA 1C >7.5% may be initiated with dual therapy of dipeptidyl peptidase-4 inhibitors (DPP4Is) + Metformin; and Statement 3. In Indian patients with HbA 1C >7.5% at diagnosis, DPP4Is + Metformin may be considered as a first-line therapy. Literature review revealed that HbA 1C level at the time of diagnosis in majority of Indian T2DM patients is >7.5%. Consensus was reached that dual anti-diabetic therapy should be initiated in patients with HbA 1C >7.5%. DPP4Is + Metformin is the preferred cost-effective option and may be considered as a first-line therapy in Indian T2DM patients with HbA 1C >7.5% at diagnosis.

Type 2 diabetes mellitus (T2DM) is a global pandemic with increasing prevalence worldwide. Hearsay, or reported speech, is an important contributor to diabetes care related behavior and may influence the outcomes of diabetes treatment. An emerging concept in preventive medicine is Quinary prevention which aims at preventing health-related hearsay or misinformation. Methods: A group of international clinical experts comprising endocrinologists, diabetologists, cardiologists and community medicine specialists gathered in India and discussed ways to restrain the menace of de-hearsay in diabetes care.

Recently, focus on the development of controlled release drug delivery system has increased, as existing drugs exhibit certain pharmacokinetic limitations. The major goal of designing sustained release formulations is to improve the drug performance by prolonged duration of drug action, decreased frequency of dosing and reduced side effects by using smallest quantity of drug administered by the most suitable route. Osmotic-controlled release oral delivery system (OSMO technology) is the most promising strategy based system for sustained delivery of drug. Drug can be delivered in a controlled manner over a long period of time by the process of osmosis. Osmotic drug delivery system appears to be a promising solution for the limitations of conventional extended release formulations by virtue of their distinguished technological features. The present review describes briefly about various controlled drug delivery systems with special focus on advantages of osmotic-controlled release oral delivery system related to diabetes therapy and improved compliance.

Aim: To evaluate and monitor quality of diabetes care in a single risk score format BLUE INDEX (BI). Design and Method: We assessed overall health of patients with T2DM based on 10 parameters - 3 goals (A1c, BP, lipids), 4 self-care parameters (diet, exercise, follow-up, habits), and 3 health parameters (general health, infection, hypoglycemia). We categorized each parameter into six grades and formulated BI with minimum score 0 and maximum 50. BI > 45 = excellent and > 40 is considered as favorable. BI < 35 = undesirable. We calculated BI for 100 patients with T2DM > 1 year and repeated it at 2nd visit (3 months) and 3rd visit (6 months). Patients were educated for importance of each parameter and their overall health score was discussed. At the end of 3rd visit improvement in each parameter was studied. Result: 100 patients with T2DM > 1 year were studied and divided into 3 groups as per BI. Group A= BI < 35, Group B = BI 35-45 and Group C = BI > 45. At baseline there were 76, 17 and 7 patients in Group A, B and C respectively with mean BI =26 ±2. After 3 month - 33, 44 and 23 patients in Group A, B and C respectively with mean BI = 37±3 and after 6 months there were 21, 41 and 38 patients in Group A, B and C respectively with mean BI = 42±2. There was 61% improvement in BI over the 6 months. Conclusion: The BI provides comprehensive, pragmatic and patient centered mean of assessing care in persons with diabetes. The main role is in clinical triage, helping identify high risk persons who need intensive clinical intervention. Disclosure D. Panchal: None. S. Phatak: None. P. Zinzuwadia: None. B.D. Saboo: None. D. Hasnani: None. S. Kalra: None. A.K. Das: None. S. Dwivedi: None.