Background: There is increasing interest in the impact of diabetes mellitus on cognitive functioning. Several studies found evidence of decreased cognitive performance in type 2 diabetics (T2DM). Since the P300 component of event-related potentials (ERPs) provides valuable information concerning cognition, we studied this component of ERPs in T2DM. Methods: Auditory P300 event-related potentials (P300) were elicited in 43 T2DM patients and 29 age and sex-matched healthy volunteers by use of the auditory oddball paradigm, taking into account the age of the subjects, disease duration and the metabolic control. Results: Compared with controls, diabetics had significantly longer P300 latencies (F= 5.05, p= 0.026) and lower P300 amplitudes both in Cz and Pz electrode positions (F= 8.01, p= 0.005 and F= 13.67, p= 0.000 respectively). In addition, a significant inverse correlation between P300 latency and amplitude was observed in diabetics both in Cz and Pz electrode positions (r= -0.43, p= 0.003 and r= -0.39, p= 0.01 respectively), whereas essentially no relationship between amplitude and latency was observed for the control group. N200 and P300 latencies and the reduction in their amplitudes in Cz and Pz leads were not related to either disease duration or metabolic control. Conclusions: The observed electrophysiological abnormalities may reflect impairment of information processing and working memory, possibly associated with an accelerated ageing process. Our findings suggest that surface-recorded ERPs may be useful for detecting and monitoring the changes in brain function associated with diabetes mellitus.

SGLT 2 inhibitors are a recent addition to the armamentarium of agents approved for treatment of hyperglycemia in management of type 2 diabetes. Unfortunately, the agents are fairly expensive with a modest efficacy rendering them to be probably the least cost effective drugs in management of hyperglycemia in subjects with type 2 diabetics. The cost efficacy falls even more because of additional expenses required for management of several short term and long term adverse outcomes causing a decline in quality of life. Ketosis and ketoacidosis are two of the several cautions issued by regulatory agencies and have gained prominence because of their serious nature with an occasional fatality. In this review, epidemiology and pathophysiology of onset of ketoacidosis in subjects administered SGLT2 inhibitors is discussed in order to improve recognition in early stage of the disorder and implement a prompt management strategy to prevent further morbidity, mortality as well as recurrent events.

Indian patients with type 2 diabetes (T2DM) usually suffer from multiple metabolic abnormalities, such as overweight, obesity, high triglycerides (TG), low HDL-C, increased blood pressure, along with insulin resistance. In India, Saroglitazar is being used in the management of diabetic dyslipidemia since 2013. Randomized controlled clinical trials of Saroglitazar (PRESS V & PRESS VI studies) 1, 2 have established safety and efficacy of Saroglitazar in T2DM patients with dyslipidemia. But the question is “What is the real time clinical safety and effectiveness of Saroglitazar in Diabetic dyslipidemia, if it is used for more than a year?

Fasting Ramadan is a pillar of Islam. Healthy adult Muslim must refrain from drinking and eating from dawn to sunset of everyday of this month. However there are no restriction on food or fluid intake between sunset and dawn. Sick persons, travelers and pregnant women are exempted from this duty. In fact, Muslims with diabetes and other chronic diseases are exempted from fasting, where fasting may lead to harmful consequences. Nevertheless, many patients insist on participating in Ramadan fasting. It is estimated that around 40 to 50 million of individuals with diabetes worldwide fast during Ramadan. The population based-epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study conducted in13 Islamic countries revealed that 43% of patients with type 1diabetes and 79% of patients with type 2 diabetes fast during Ramadan.

Background: For people with type 2 diabetes mellitus (T2DM), the frequency and/or composition of the morning meal may be especially important as the disease associated hormonal and metabolic perturbations contribute significantly to poor glucose control and weight gain. Few well-controlled studies have evaluated the effects of skipping breakfast and nutrient composition on metabolic outcomes in T2DM. This study evaluated the impact of consuming one of two convenient and healthful breakfast options versus skipping breakfast on postprandial blood glucose, insulin, glucagon-like peptide-1 (GLP-1), total energy intake and appetite. Materials and methods: This was a randomized, controlled, non-blinded, three- treatment, crossover study conducted at two sites. All subjects (n=32) had T2DM. On study day mornings, fasted subjects consumed each test meal in random order: the two nutritional interventions administered were (1) a typical whole food breakfast meal consisting of oatmeal (OAT; 200 kcals, 8g protein, 36g carbohydrate (CHO), 6g fiber, 4g fat) and (2) a calorically-matched glycemia-targeted specialized-nutrition (GTSN; 216 kcals, 10g protein, 29g CHO, 2g fiber and 8g fat) compared to (3) skipping breakfast (SBF). Blood samples for measurement of plasma glucose, insulin and GLP-1 and appetitive responses were collected at baseline (pre-meal) and after consumption of the test meal over 180 minutes. Results: Postprandial plasma glucose positive area under the curve (pAUC) mean was significantly reduced by 38% (based on individual percent changes) after GTSN compared to OAT. The SBF had the smallest glucose pAUC mean of all interventions. GLP-1 postprandial pAUC median of individual percent changes was significantly elevated after the consumption of GTSN by 280% compared to OAT and 995% compared to SBF. Subjective hunger pAUC mean was significantly elevated and fullness significantly lower after SBF compared to both the OAT and GTSN. No differences in hunger or fullness were observed between the GTSN and OAT interventions. Conclusion: This study demonstrated that utilization of GTSN improved glycemic control and elevated GLP-1 levels compared to a healthful breakfast food and breakfast skipping without negatively impacting appetitive response or energy intake. These results suggest that GTSN containing slowly digesting carbohydrates and monounsaturated fatty acids (MUFA) may provide additional metabolic benefits when used as a meal replacement compared to oatmeal and breakfast skipping for people with T2DM.