Summary Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Background: Insurers in South Asia are challenged by lack of a culturally relevant and clinically effective lifestyle intervention that can be delivered at scale. This study reports results from participants of a real-world pilot using Wellthy Diabetes™ (WD), a digital therapeutic for people living with type 2 diabetes, in collaboration with an insurance provider with the aim to validate WD as a diabetes management and risk reduction tool. WD was developed in scientific collaboration with the Research Society for Study of Diabetes in India (RSSDI). Methods: A 16-week lifestyle modification program was delivered to persons with T2DM through an Artificial Intelligence (AI) powered smartphone app. The program included behavioral modification training based on structured DSME content, developed along AADE7™ guidelines. The WD app enables users to self-report data on blood glucose, weight, meals, and physical activity and encourages logging through personalized reminders and nudges using an AI-powered digital persuasion model. Participants received real-time feedback and coaching through an AI-powered chatbot and personalized coaching from an expert diabetes coach. A1c measures were conducted at the start and end of the program. This study presents results from 102 program completers who completed follow-up A1c. Results: The mean pre and post-intervention A1c for 102 program completers (mean age: 50.8 years and 68% males) were 8.51% (95% CI:8.23-8.79) and 8.02% (95% CI: 7.72-8.32), respectively, showing a mean post-intervention reduction of -0.49% A1c (95% CI:-0.73 - -0.25, p=0.01). Sixty percent (n=61) of participants reduced their A1c by the end of the program with a mean reduction of -1.17% A1c (95% CI: 0.75-1.60). Conclusion: This study demonstrates Wellthy Diabetes as a clinically effective intervention for Health and Life Insurers in South Asia to improve health outcomes and reduce risk for people with type 2 diabetes through improved glycemic control. Disclosure A.R. Sosale: None. M. Shaikh: Employee; Self; Wellthy Therapeutics Pvt Ltd. A. Shah: Stock/Shareholder; Self; Wellthy Therapeutics.R. Chawla: None.B.M. Makkar: None. J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca.S. Joshi: None.N. Deshpande: None.S. Agarwal: None.A. Maheshwari: None.S. Madhu: None.B.D. Saboo: None.

Time-in-Range (TIR) has been recently established as a treatment target in diabetes to complement the time-tested A1c. Studies in the Caucasian population have shown that every 10% increase in TIR corresponds to 0.8% reduction in A1c. To study the relationship between TIR with A1c in the Asian-Indian population, CGM data from EMR of patients with type 1 and type 2 diabetes (n=424) followed up by a telemedicine program (DTMS) at our comprehensive diabetes care center in Kerala was obtained. Mann Whitney U test, t-test, ANOVA, and Pearson correlation coefficient were used for univariate analysis. Baseline characteristics were age 54 + 14 years, Gender frequency: F/M 127/297, diabetes duration 10.83+8.24 years, A1c 7.44+1.17 (%), eA1c 6.74+1.24 (%), and Average Blood Glucose (ABG) 146.96 + 35.62 (mg/dL). All the patients were eligible for a reduction of A1C <7.5%. In this subset of Asian-Indian population, our statistical analysis revealed that a TIR of >70% corresponds to an A1c level of <7.5% in agreement with the previous studies. In our telemedicine-based chronic care model, an A1c of <7.5% was achieved in 67.5% of the subjects. However only 36% achieved a TIR >70% and 66% achieved a TIR >60%; a finding which underscores the significance of TIR independent of A1c levels. The study suggests that TIR should evolve as a powerful target and predictor of diabetes complications and should be a routine measure in diabetes care. Disclosure J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. A. Shankar: None. G. Krishnan: None. B.D. Saboo: None. G. Sanal: None. M. Krishna B: None. S. Ts: None. S. Jothydev: None.

Objective Antihyperglycemic activity of Thymoquinone (TQ) was evaluated in diabetic mouse model and patients. Methods TQ (50 mg/kg) was orally administered daily for 21 days in combination with metformin in diabetic mice and a reduction on blood glucose level was monitored. In human, a 90-day randomized study was carried out in 60 Type 2 Diabetes mellitus patients to evaluate safety and efficacy of TQ administration with metformin in a 3-arm study. Patients in arm 1 (T1) received 1 tablet of metformin SR 1000 mg and 1 tablet of TQ 50 mg once daily. The second arm (T2) patients received 1 tablet of metformin SR 1000 mg and 2 tablets of TQ 50 mg once daily. Patients in arm 3 (R) received 1 tablet of metformin SR 1000 mg only. Results The diabetic mice treated with combination of TQ and metformin showed significant decrease in blood sugar compared to those treated with only metformin. In patients who completed the study, the glycated hemoglobin (HbA1c) values in T1, T2 and R decreased after 3 months from 7.2, 7.2 and 7.3 to 6.7, 6.8, and 7.1, respectively. A greater reduction in Fasting Blood Glucose and Post Prandial Blood Glucose was also observed in T1 and T2 arms compared to R. Conclusion At dose levels of 50 and 100 mg of TQ combined with a daily dose of 1000 mg Metformin demonstrated a reduction in the levels of HbA1c and blood glucose compared to the standard treatment of diabetic patients with metformin alone.

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