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Metabolic Treatment For Diabetes In India

Diabetes And Endocrinology Medical Procedures

Diabetes And Endocrinology Medical Procedures

The Department of Diabetes and Metabolic Disorders provides comprehensive inpatient and outpatient services and is run by a highly qualified and experienced team of medical professionals. The department is equipped to undertake management of diabetes mellitus and thyroid disorders. We have earned a reputation for our abilities in dealing with complex lipid disorders, obesity and nutritional problems. The department is also equipped to deal with disorders related to the pituitary, adrenal, para-medical thyroid and reproductive endocrinology, especially complex secondary & tertiary care, adult and adolescent diabetes management, insulin pump therapy, gestational diabetes management and lipid and metabolic disorders. Diabetic foot ulcer is an open wound that occurs on the bottom of the foot in patients with diabetes. Foot ulcers due to diabetes often results in non-traumatic lower extremity amputations. However, the development of a foot ulcer is preventable with proper management and care. At Fortis Healthcare, our skilled team of doctors assures best treatment and care for the patients suffering from diabetes and prevent amputation by facilitating proper care and guidance. The hospital provides special centre for the latest in diabetes technology. The centre helps with insulin pump and continuous glucose monitor (CGM) for monitoring glucose levels, and managing the daily lifestyle of diabetic patients. The Fortis National Mental Health Program has been developed with the aim of extending mental health services to the broadest segment of society possible. The Department of Mental Health and Behavioural Sciences under the leadership and guidance of Dr. Samir Parikh, Chairperson Fortis National Mental Health Council, with its vision for uniform services across all Fortis f Continue reading >>

Barriers And Solutions To Diabetes Management: An Indian Perspective

Barriers And Solutions To Diabetes Management: An Indian Perspective

Barriers and solutions to diabetes management: An Indian perspective Find articles by Ambika Gopalakrishnan Unnikrishnan 8Senior Consultant Diabetologist, Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Center, Chennai, India Department of Endocrinology, Indraprastha Apollo Hospital, New Delhi, India 1Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, India 2Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India 3Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, India 4Director, Institute of Diabetology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India 5Department of Endocrinology, Care Hospital, Hyderabad, India 6Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, India 7Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, India 8Senior Consultant Diabetologist, Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Center, Chennai, India 9Department of Endocrinology, St. John's Medical College Hospital, Bangalore, India 10CEO and Director, Jothydev's Diabetes Research Center, Trivandrum, India 11Managing Director, TOTALL Diabetes Hormone Institute, Indore, India 12Department of Endocrinology, MS Ramaiah Medical College, Bangalore, India Corresponding Author: Dr. Subhash K. Wangnoo, Senior Consultant Endocrinologist, Endocrinology, Indraprastha Apollo Hospital, Delhi Mathura Road, New Delhi - 110 076, India. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attrib Continue reading >>

Indian Journal Of Endocrinology And Metabolism

Indian Journal Of Endocrinology And Metabolism

Effect of a low-calorie diet on restoration of normoglycemia in obese subjects with type 2 diabetes Anjali Amit Bhatt, Priya K Choudhari, Rutuja R Mahajan, Mehmood G Sayyad, Devi D Pratyush, Imtiaz Hasan, Rajesh S Javherani, Manish M Bothale, Vedavati B Purandare, Ambika Gopalakrishnan Unnikrishnan DOI:10.4103/ijem.IJEM_206_17PMID:28989891 Introduction: Type 2 diabetes mellitus (T2DM) is considered to be an inevitably progressive disease. Complex therapies add to the financial and psychological burden. Very low-calorie diets (LCDs) are emerging as an option in the management of type 2 diabetes. Methods: We performed a clinical audit of patients with T2DM who received 12 weeks of LCD. Results: This case series documents that 6 out of 12 participants (median baseline HbA1c 9%) achieved HbA1c level in nondiabetes range with LCD despite stopping all antidiabetes medications. There was an improvement in serum triglycerides, HDL cholesterol, total cholesterol, C-Reactive protein, urine microalbumin, liver transaminases, liver fat and the indices of insulin resistance, beta cell secretory capacity, and insulin sensitivity. Conclusion: If long-term follow-up proves sustained benefits, such dietary restriction may be an alternative to more drastic options for reversal of type 2 diabetes. This may also help in changing the treatment perspective of a newly detected T2DM from an incurable and inevitably progressive disease to a potentially reversible disease. Comparative evaluation of safety and efficacy of glimepiride and sitagliptin in combination with metformin in patients with type 2 diabetes mellitus: Indian multicentric randomized trial - START Study TV Devarajan, S Venkataraman, Narayanan Kandasamy, Abraham Oomman, Hari Kishan Boorugu, S. K. P. Karuppiah, Dushyant Balat DOI Continue reading >>

Cure Of Type 2 Diabetes By Metabolic Surgery? A Critical Analysis Of The Evidence In 2010

Cure Of Type 2 Diabetes By Metabolic Surgery? A Critical Analysis Of The Evidence In 2010

Cure of Type 2 Diabetes by Metabolic Surgery? A Critical Analysis of the Evidence in 2010 Find articles by Gerit Holger Schernthaner Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria Department of Medicine II, Medical University of Vienna, Vienna, Austria Corresponding author: Guntram Schernthaner, [email protected] . Author information Copyright and License information Disclaimer Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. The prevalence of type 2 diabetes has markedly increased in the last decade worldwide, but in particular in Asian countries such as China and India ( 1 3 ), in strong correlation with a comparably steep increase in the prevalence of obesity ( 4 ). The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese. The relative risk of diabetes increases about 42-fold in men as the BMI increases from <23 kg/m2 to >35 kg/m2 ( 5 ) and approximately 93-fold in women as BMI increases from <22 kg/m2 to >35 kg/m2 ( 6 ). Type 2 diabetes is a complex major endocrine disorder in which insulin resistance in the muscle and liver as well as -cell failure represent the core pathophysiological defects. In addition to the muscle, liver, and -cell, the fat cell (accelerated lipolysis), gastrointestinal tract (incretin deficiency/resistance), -cell (hyperglucagonemia), kidney (increased glucose reabsorption), and brain (insulin resistance) all play important roles in the development of type 2 diabetes ( 7 ). The development of type 2 diabetes is strongly ass Continue reading >>

Prevalence Of The Metabolic Syndrome Among North Indian Adolescents Using Adult Treatment Panel Iii And Pediatric International Diabetic Federation Definitions

Prevalence Of The Metabolic Syndrome Among North Indian Adolescents Using Adult Treatment Panel Iii And Pediatric International Diabetic Federation Definitions

Received date: November 07, 2013; Accepted date: March 06, 2014; Published date: March 10, 2014 Citation: Bhat RA, Parray I, Ahmald Z (2014) Prevalence of the Metabolic Syndrome among North Indian Adolescents Using Adult Treatment Panel III and Pediatric International Diabetic Federation Definitions. J Diabetes Metab 5:352. doi: 10.4172/2155-6156.1000352 Copyright: 2014 Bhat RA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Childhood obesity is an important risk factor for the development of metabolic syndrome in children and adolescent. Because of high prevalence of Insulin resistance and metabolic syndrome in Indian Adult population, studies are needed to identify the prevalence of these metabolic abnormalities in adolescent population. Aim: The aim of this study was to estimate the prevalence of metabolic syndrome using Pediatric International Diabetic Federation definition and compare it with estimates of Adult Treatment Panel III definition among adolescents in Northern India. Material and methods: At total of 899 adolescents attending school (aged 10-18 years) participated in this population-based prospective study. All the clinical and biochemical assessment was done after proper consent. The metabolic syndrome was determined by the National Cholesterol Education Program Adult Treatment Panel III definition modified for age and Pediatric international diabetic federation definition. Results: The prevalence of metabolic syndrome was 3.5% according to Adult Treatment Panel III criteria and 1.5% based on International Diabetic Federation criteria. No significa Continue reading >>

Centre For Endocrinology & Metabolic Disorders

Centre For Endocrinology & Metabolic Disorders

Some of the conditions treated at Continental Hospitals are: Diabetes Mellitus is a metabolic condition characterized by high levels of blood sugar due to reduced or non-functioning of the pancreas. The pancreas is responsible for secreting a hormone called Insulin that is regulates blood sugar to optimum levels. In order to convert glucose into energy, cells require insulin. Prolonged inability of the pancreas to produce the necessary amount of insulin leads to increased glucose in the body and develops into Diabetes. Type 1 diabetes: Type 1 Diabetes is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood. Type 1 diabetes is an autoimmune condition. It's caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn't make insulin. This type of diabetes may be caused by a genetic predisposition. It could also be the result of faulty beta cells in the pancreas that normally produce insulin. A periodic test called the A1C blood test estimates glucose levels in the blood over the previous three months. It's used to help identify overall glucose level control and the risk of complications from diabetes, including organ damage. Type 2 diabetes: Type 2 diabetes also known as insulin-dependent diabetes or adult-onset diabetes is a metabolic disorder that accounts for 9095% of all diabetic cases worldwide. With Type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body's needs, or the body's cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells. People who are obese -- more than 20% over their ideal body weight fo Continue reading >>

What Is Metabolic Surgery? Diabetes & Weight Loss Treatment

What Is Metabolic Surgery? Diabetes & Weight Loss Treatment

Metabolic syndrome is the name for a group of risk factors that increases the chance of developing heart disease , diabetes and stroke. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome. A large waistline indicating abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips. A high triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood. A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease. High blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup. High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes. The treatment of Metabolic Syndrome by surgical methods is called Metabolic Surgery. Experiments were done in the last half of the 20th century to see if diseases like high lipids and cholesterol could be treated with surgical procedures such as intestinal bypass. In 1995, Dr. Walter Pories and his research team published an article titled "Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus". Since that landmark paper, much evidence has been accumulated showing that surgery can cure/imp Continue reading >>

Role Of Metabolic Control To Prevent And Treat Sight Threatening Diabetic Retinopathy In Diabetic Cases Dhawan B, Vig V - J Obes Metab Res

Role Of Metabolic Control To Prevent And Treat Sight Threatening Diabetic Retinopathy In Diabetic Cases Dhawan B, Vig V - J Obes Metab Res

Metabolic control is the first step in managing microvascular complications of diabetes including diabetic retinopathy. Important parameters proved to be of the key role in managing diabetic retinopathy and preventing sight-threatening complications thereof include blood sugar levels, serum lipid profile, hemoglobin levels and renal function tests. The severity of hyperglycemia and hypertension are main modifiable factors which may prevent the development of diabetic retinopathy. Thus, all the diabetics have to be compliant in having a good metabolic control which not only prevents or slows down risk of visual loss, but also is associated with a better cardiovascular activity ultimately contributing to a better quality-of-life in these subjects. Keywords:Diabetic retinopathy, metabolic control, lipid profile Dhawan B, Vig V. Role of metabolic control to prevent and treat sight threatening diabetic retinopathy in diabetic cases. J Obes Metab Res 2014;1:245-6 Dhawan B, Vig V. Role of metabolic control to prevent and treat sight threatening diabetic retinopathy in diabetic cases. J Obes Metab Res [serial online] 2014 [cited2018 Oct 25];1:245-6. Available from: The prevalence diabetes mellitus (DM) in developing countries especially India has been increasing over years now. India harbors more than 62 million diabetic individuals currently diagnosed with the disease that is largest in the world. This makes us the diabetic capital of the world. [1] It is predicted that by 2030 DM may afflict up to 79.4 million individuals in India, while China (42.3 million) and the United States (30.3 million) will also see significant increases in those affected by the disease. [2] , [3] Diabetic retinopathy is the commonest microvascular complication of DM, and it has serious implications Continue reading >>

Permanent Cure For Diabetes

Permanent Cure For Diabetes

Diabetes is now curable. Is it Stunning news for you? Yes – It can be cured permanently by Metabolic and Bariatric surgery. Till about a few years ago, there was no permanent cure for diabetes. However, new research finds that Diabetes is a Curable Disease. Diabetes is a serious disease, known as ‘Mother of all diseases’. If it is not controlled, can leads to a host of serious health problems, including eye disorders and blindness, heart disease, stroke, kidney failure, nerve damage, pregnancy affects, amputation etc. To save life of number of people living with diabetes, a joint statement endorsed by 45 medical and scientific groups including Australian experts recommend surgery as standard treatment. This recommendation is also approved by International diabetes organizations. There are different kinds of surgeries that can dramatically end diabetes. Which type of surgery is suitable actually depends on your weight, any health issues that you may have, the experience of your surgeon, etc. Ileal Interposition: It is a Metabolic Surgery procedure, use to treat overweight diabetic patients. This technique is applied by placing ileum (distal part of the small intestine) either between stomach and the proximal part of the small intestine or by placing the ileum to the proximal part of the small intestine without touching the natural connections of the stomach. Benefit: Surgery Increases the secretion of the GLP-1 hormone which stimulates the Beta cells of the pancreas and increase secretion of insulin. Surgery helps control the level of blood sugar within six months. The success rate ranges between 80% – 100% depending upon the post-surgical care. Gastric Bypass (Roux-en-Y gastric bypass) Surgery: It is a kind of weight-loss surgery that reduces the size of your st Continue reading >>

Prevalence Of Dyslipidemia And Hypertension In Indian Type 2 Diabetic Patients With Metabolic Syndrome And Its Clinical Significance - Sciencedirect

Prevalence Of Dyslipidemia And Hypertension In Indian Type 2 Diabetic Patients With Metabolic Syndrome And Its Clinical Significance - Sciencedirect

Volume 5, Issue 3 , June 2014, Pages 169-175 Prevalence of Dyslipidemia and Hypertension in Indian Type 2 Diabetic Patients with Metabolic Syndrome and its Clinical Significance Author links open overlay panel DhananjayYadavab Open Access funded by Korea Centers for Disease Control and Prevention The present study was designed to estimate the prevalence of dyslipidemia and hypertension based on the National Cholesterol Educational Programme Adult Treatment Panel III definition of metabolic syndrome (MetS). The study also focuses on prevalence for MetS with respect to the duration of disease in GwaliorChambal region of Madhya Pradesh, India. Type 2 diabetic patients (n=700) were selected from a cross-sectional study that is regularly being conducted in the School of Studies in Biochemistry, Jiwaji University Gwalior, India. The period of our study was from January 2007 to October 2009. Dyslipidemia and hypertension were determined in type 2 diabetic patients with MetS as per National Cholesterol Educational Programme Adult Treatment Panel III criteria. The mean age of the study population was 549.3years with 504 (72%) males and 196 (28%) females. The prevalence of MetS increased with increased duration of diabetes in females; however, almost constant prevalence was seen in the males. Notable increase in the dyslipidemia (64.1%) and hypertension (49%) in type 2 diabetic patients were seen. The steep increase in dyslipidemia and hypertension could be the reason for the growing prevalence of diabetes worldwide. The study also noted a close association between age and occurrence of MetS. Individual variable of MetS appears to be highly rampant in diabetic population. Despite treatment, almost half of patients still met the criteria for MetS. Effective treatment of MetS comp Continue reading >>

Metabolic Surgery For The Treatment Of Type 2 Diabetes In Obese Individuals

Metabolic Surgery For The Treatment Of Type 2 Diabetes In Obese Individuals

, Volume 61, Issue2 , pp 257264 | Cite as Metabolic surgery for the treatment of type 2 diabetes in obese individuals Several bariatric operations originally designed to promote weight loss have been found to powerfully treat type 2 diabetes, causing remission in most cases, through diverse mechanisms additional to the secondary consequences of weight loss. These observations have prompted consideration of such operations as metabolic surgery, used expressly to treat diabetes, including among patients who are only mildly obese or merely overweight. Large, long-term observational studies consistently demonstrate that bariatric/metabolic surgery is associated with reductions in all cardiovascular risk factors, actual cardiovascular events, microvascular diabetes complications, cancer and death. Numerous recent randomised clinical trials, directly comparing various surgical vs non-surgical interventions for diabetes, uniformly demonstrate the former to be superior for improvements in all glycaemic variables, as well as other metabolic endpoints. These benefits are similar among individuals with type 2 diabetes and a preoperative BMI of 3035kg/m2 compared with traditional bariatric surgery patients with a BMI >35kg/m2. The safety profiles of modern laparoscopic bariatric/metabolic operations are similar to those of elective laparoscopic hysterectomy and knee arthroplasty. However, more evidence regarding the risks, benefits and costs of surgery is needed from very long-term (>5year) randomised clinical trials powered to observe hard clinical endpoints following the operations most commonly used today. Given the efficacy, safety and cost-effectiveness of metabolic surgery, the second Diabetes Surgery Summit (DSS-II) consensus conference recently placed surgery squarely with Continue reading >>

Metabolic Risk Factors And Type 2 Diabetes Incidence In American Indian Children

Metabolic Risk Factors And Type 2 Diabetes Incidence In American Indian Children

A total of 5532 nondiabetic Pima Indian children 519 years old. A total of 1281 children developed diabetes (median follow-up, 12.4 years). Diabetes incidence was higher in overweight children (BMI 85th percentile) than in nonoverweight children. Nonoverweight children had the lowest risk of diabetes (20-year cumulative incidence, 9.5%), whereas overweight children with impaired glucose tolerance (2-hour glucose 140 mg/dL) had the highest (79.0%). The relative risk for children with metabolic abnormalities compared with their healthy counterparts was higher in younger children than in older children early in follow-up. BMI and 2-hour glucose were related to incident diabetes in multivariable models (predicted 15-year cumulative incidence for the highest vs lowest quartile was 3.9 and 1.8 times as high for BMI and 2-hour glucose, respectively; P < .001), whereas blood pressure and cholesterol were not. BMI and impaired glucose tolerance in children are strong predictors of type 2 diabetes. Other components of the metabolic syndrome are not. Copyright 2016 by the Endocrine Society Continue reading >>

Diabetes Type Ii Treatment In India, Stem Cell Therapy For Diabetes Type 2

Diabetes Type Ii Treatment In India, Stem Cell Therapy For Diabetes Type 2

Prognosis associated with Type 2 Diabetes Diabetes can be diagnosed generally with the blood tests for examining blood sugar level at fasting and after meal. Apart from that many other examinations can help diagnose the problem at the early stage such as Skin and bones of the feet and legs are brittle or get numb. As against type 1 diabetes, patients with type 2 diabetes can produce insulin; however the insulin cannot be utilized by the body for the metabolism of glucose may be because the insulin is either not sufficient or the body is unable to recognize insulin for its function. Thus, due to bodys inability to transfer glucose to different cells, its accumulation in the blood stream increases. This cause the condition known as hyperglycaemia. Also since cells are not able to use glucose for the energy generation, their function is severely halted. Stem cells are the mother cells that are responsible for developing an entire human body from a tiny two-celled embryo; due to their unlimited divisions and strong power to differentiate into all the cells of different lineage. This power of stem cells has been harnessed by the technology to isolate them outside the human body, concentrate in the clean environment and implant back. Thus, stem cells treatment involves administration of concentrated cells in the targeted area, wherein they can colonize in the damaged area, adapt the properties of resident stem cells and initiate some of the lost functions that have been compromised by the disease or injury. Various data is available suggesting in vitro differentiation of stem cells into insulin producing beta cells. These cells can as well help in creating a microenvironment due to initiate secretion of different immune cells to counteract autoimmunity of the individual. We Continue reading >>

Diabetes Surgery In India, Metabolic Surgery For Diabetes

Diabetes Surgery In India, Metabolic Surgery For Diabetes

Diabetes mellitus is a chronic disease affecting almost every organ of the body. It might happen either due to decreased production of insulin or increased resistance to insulin in the body. It has emerged in epidemic proportions all over the world. It has become a major health hazard and is the main cause of premature illness, kidney and heart diseases and even blindness, ulcers and amputations, worldwide. The treatment of diabetes involves, lifestyle changes, diet control and certain drugs and insulin therapy. Inspite of best of the treatments, patients do not achieve good glycemic control which results in ongoing and slow damage to blood vessels, kidneys, heart, brain and eyes. These days metabolic surgery for diabetes has emerged as a proven tool for resolution or control of type 2 diabetes. As many as 80% of people suffering from type 2 diabetes have experienced complete resolution of disease after undergoing metabolic surgery. The remaining 20% have experienced benefits in terms of reduction of the amount, quantity and frequency of drugs. There have been reduction in the need for insulin injections as well. There are certain defined criteria which has been identified by international diabetes federation, the largest governing body in the world for Diabetes and related diseases to choose patients who are eligible for this surgery. Other organisations that endorse this surgery are American Heart Association and The American Diabetes Association. This surgery is done laparoscopically (through key holes). There are no drains and bandages in most of the cases. A person is fit to go back home in a day or two post-surgery. There are some special procedures for patients suffering from diabetes which are independent of BMI.Ileal interposition and duodenojejunal bypass are Continue reading >>

Stem Cell Treatment For Diabetes

Stem Cell Treatment For Diabetes

Diabetes is an Autoimmune medical condition subtly affecting our health. Since symptoms of frequent urination and greater thirst do not seem to be dangerous; diabetes is highly ignored in the initial stage. And the gravity of the situation is realized only in advanced stages. Diabetes is mainly classified into type I and type 2. Type 1 develops when the body's immune system sees its own cells as foreign and destroys them. As a result, insulin producing islets cells of the pancreas are lost and thus insulin production is stopped. In the absence of insulin, glucose intake by cells is impaired and it gets accumulated in the blood stream. In type 2 diabetes, insulin resistance is developed due to which cells are unable to utilize insulin for glucose metabolism. Diabetes when uncontrolled can lead to blindness, kidney failure, heart diseases and stroke. Therefore it is very necessary to keep excessive high level of glucose in the blood stream under check. Conventionally, there is no permanent diabetes cure except for medications and insulin injections. However,Stem cells technology has practically fulfilled the promise of dead cell replacements with the new one. With this unique transdifferentiation ability of stem cells, it is possible to develop insulin producing beta cells that are lost from the body. Symptoms Major Manifestations of Diabetes in patients include the following: Always tired, thirsty, hungry Vaginal infections Sexual problems Numb or tingling hands or feet Sudden weight loss Frequent urination Wounds that won't heal Blurry vision So,it is important to take charge of your condition in Diabetes. Diabetes can affect almost every organ of the body for example: Diabetic Retinopathy, Heart Disease, Diabetic kidney and Diabetic foot are all fall outs of Diabetes w Continue reading >>

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