Illicit opioids have emerged as a major public health problem over the past century. It continues to remain so in the current times. From the studies conducted among the animals, it has been clear that there are acute as well as chronic effects of opioids on the endocrine system. Diabetes has been recognized as a major public health concern and is expected to be a major problem in the coming decades. In this article, we shall discuss the effects of opioids in the glucose homeostasis in both the animal population and human population and its relation to diabetes.

Fasting is one of the five pillars of Islam, and consequently, even the Muslims with diabetes prefer to fast fast during Ramadan, irrespective of the healthcare implications. However, this fast can be very difficult to manage in patients of Type 1 diabetes (T1DM), who are on insulin therapy. Risks of diabetic ketoacidosis, severe hypoglycaemia, hyperglycemia, dehydration and thrombotic episodes are increased. Lack of proper pre-fast assessment, management and diabetes education have been stumbling blocks in facilitating Ramadan fasting in type 1 diabetes patients. Recent developments like the use of insulin pumps and analogs and recognition of the importance of structured diabetes education and assessment to select the patients best suited for the rigors of fasting, have wrought a sea change in the usually negative approach of doctors towards Ramadan fasting in patients with T1DM. Sophisticated therapeutic options like smart insulins, can provide safer and more convenient options for management of Type 1 diabetes during Ramadan, a few years down the line. More studies are also needed to explore other options like GLP-1 agonists, alpha glycosides inhibitors and DDP-4 agonists, as adjuncts to insulin therapy.

The prevalence of diabetes is increasing, as is the cost of managing its comorbidities. Diabetic foot ulcers (DFUs) and their complications place a considerable cost burden on the health system, and lead to a significant level of disability. The relationship between depression and diabetes is well-established. The relationship between depression and foot ulcers in diabetic patients is less well-established. The purpose of this article is to provide a current concept review of the literature from 1988 to 2013, linking DFUs and depressive symptoms, with an emphasis on the impact depressive symptoms have on healing rates of DFUs. Articles specifically focusing on the biological relationship, depression's impact on self-care, screening for depressive symptoms, causes and cost of treating DFUs, and measuring depression were reviewed. A deeper understanding of this relationship is needed to identify causal relationships, improve treatment outcomes, and reduce healing times of DFUs.

Background: In management of diabetes, self-care plays an important role in prevention of complications. This study aims to find the proportion of diabetic patients following the recommended self-care practices in an urban area of Puducherry. Materials and Methods: Consecutive eligible patients registered in chronic disease clinic were interviewed using Summary of Diabetes Self Care Activities Score (SDSCA) questionnaire. Self-care practices were evaluated in domains of diet, physical activity, foot-care, adherence to medications and blood glucose monitoring. All domains were scored from the range of 0 to 7. Results: Totally 162 diabetic patients were interviewed. The mean (SD) age of participants was 57 (11.1) yrs. Among all domains, adherence to medication was the highest (95.6 %) followed by avoidance of selected food items (99.4%). Almost 78% of patients had their blood sugar checked at least once in the last three months. Only half of them (50.6%) had followed at least 20 minutes of leisure time physical activity. Except washing of foot (83.3%) all other foot care practices were less commonly (35-57%) followed. Conclusion: The study shows that higher level of compliance to self-care practices in terms of taking drugs and diet but self-care in other domains such as foot care is alarmingly low.

Aim: Hypertension and diabetes mellitus are important problems in the elderly. They can largely be avoided through appropriate lifestyle modification. We implemented an ongoing education program for the elderly in the villages near Bangalore, Southern Karnataka, India. This study aimed to assess the knowledge and practice regarding hypertension and diabetes among elderly residents in the study area with and without exposure to the education program. Materials and Methods: Elderly residents of three villages who attended the educational sessions ("exposed") and two similar villages without educational exposure ("unexposed") were identified, matched with regard to age and gender, and interviewed to assess the knowledge and practice regarding hypertension and diabetes. The responses were scored, and mean scores were calculated in the two groups. Results and Discussion: A total of 130 elderly persons, 65 "exposed" and 65 "unexposed" to the education program were interviewed. Overall, the "exposed" group scored significantly higher than the "unexposed" group with respect to knowledge (11.17 vs 4.97, P < 0.05) and practice (1.35 vs 0.40, P < 0.05) regarding hypertension. Knowledge (14.85 vs 6.57, P < 0.05) and practice (1.49 vs 0.34, P < 0.05) scores regarding diabetes were also higher in the "exposed" group. However, the scores were less than 50% of the maximum attainable score even in the "exposed" group showing the need for further educational input. Conclusion: Regular health education sessions by physicians, nurses, and community health workers for the elderly are a useful strategy in improving the knowledge and practice for preventing and managing chronic disease. This is a model of health promotion in the elderly.

Background: Vitamin D deficiency (VDD) is an important public health problem and is implicated as a risk factor for glucose intolerance during pregnancy. We studied the prevalence of VDD in patients with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM). Materials and Methods: All GDM and T2DM patients evaluated between October and December 2014 were included in this cross-sectional, observational study. Patients with the use of vitamin D, glucocorticoids, and secondary diabetes were excluded. We diagnosed VDD as a serum 25-hydroxyvitamin D (25OHD) less than 30 ng/ml and GDM based on the World Health Organization (WHO) criteria. The data were compared with 10 gestational, age-matched controls with normal glucose tolerance (NGT). Appropriate statistical methods were used for comparison between the three groups. Results: The study participants (37 GDM, 13 T2DM, and 10 NGT) had a median (25 ^th -75 ^th interquartile) age of 26 (24.3, 30) years, gestational age of 24.5 (21, 27) weeks, and 25OHD of 10.5 (8.1, 14.8) ng/ml. VDD was seen in 35 GDM, 12 T2DM, and eight patients with NGT (P = 0. 9637). The median 25OHD levels were comparable between the three groups (10, 10.6, and 13.95; P = 0. 1192). Univariate analysis did not show higher odds of GDM or T2DM in patients with VDD (P = 0. 1903). Conclusion: Our data showed that the prevalence of VDD is high during pregnancy, irrespective of the glucose intolerance. Large scale population studies are required to determine the association between the VDD and GDM.

Diabetes mellitus (DM), commonly regarded as a lifestyle disease, used to be a disease of affluent societies in the days of yore. However, now it has encroached into the rural and tribal communities as well. This narrative review provides us with an understanding of the epidemiology of diabetes burden in tribes of India. Around 15% of the country's area is covered by tribals and it constitutes ~8.6% (i. e., ~104 million) of India's total population. Prevalence of diabetes in tribal areas ranges from around 1% to 10%. Hence, intensive efforts directed towards filling the gaps in awareness levels and the operational research or other data gaps would help prevent and control the problem of diabetes and fill these gaps in tribal areas.