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Research Article Treatment of Early Gestational Glucose Intolerance V Seshiah 1, Pikee Saxena 2, Anjalakshi C 3, N. Bhavatharani 4, Geetha Lakshmi 5, B Madhuri 6, Rajesh Jain 7* 1Hony Distinguished professor, Department of Medicine Tamilnadu Dr. MGR. Medical University Chennai, India; 2Obstetrics and Gynaecology, LHMC New Delhi, India; 3Obstetrics and Gynaecology, Madha Medical College and Research Institute Chennai, IND; 4Research Society for Study of Diabetes in India, Erode, India; 5Obstetrics and Gynaecology, Madras Medical College, Chennai, IND;  6Member, Research Society for Study of Diabetes in India, Erode, India; 7*Department of Medicine, Jain Hospital & Research Centre, Kanpur, India Corresponding Author: Rajesh Jain MD, Consultant, Jain Hospital & Research Centre, Kanpur, India; Email: [email protected] Abstract Aim: This study aims to determine the risk of gestational diabetes mellitus (GDM) in the first trimester at 8 weeks based on the 2-hour postprandial blood glucose (2-hour PPBG) levels and assess the risk of GDM with intervention Interventionmin. Methodology: This study was conducted in two centers, with 182 pregnant women in Group A, 100 in Group B, and 69 in Group C. The participants were screened at 8-10 weeks, and DIPSI tests were performed to check for GDM development. Results: In Group A, when the 2-hour PPBG was less than 110 mg/dl, only 4% and 1.2% of participants developed GDM in Study 1 and Study 2, respectively. For Group B, 95.9% of the participants developed GDM with a 2-hour postprandial blood sugar of ≥110 mg/dl and no intervention. However, in Group C with Metformin intervention, only 1.4% of the women developed GDM. Key Words: EGGI; GDM; PPBG; DIPSI Diabetes mellitus is a rapidly evolving pandemic and a significant public health problem in recent decades [1]. It affects millions of people worldwide, significantly impacting the quality of their lives. Efforts are underway globally to detect diabetes in its early stages and prevent its complications [2].  Detection of diabetes does not mean prevention of diabetes. We need primary diabetes prevention [3]—the disease should not develop. To achieve a diabetes-free generation, Lise Kingo suggested focusing on “Female Gende” as the Key to Diabetes Prevention,” based on de”elopmental origin. At fertilization, only the spermatozoa’sspermatozoa’srs the ovum, and all the cytoplasm, mitochondria, and mitochondrial DNA are maternally inherited. Embryology of Beta Cell Development Each islet cell in the developing fetus functions as an endocrine organ. Pancreatic islets differentiate at the 10th & 11th weeks of gestation and recognize and respond to maternal glycemia at 11 weeks [4]. If the prandial glycaemic level is abnormal at this crucial time, it will stimulate increased beta cell secretion of insulin. Intrauterine Programming Gestational programming is a process whereby stimuli, maternal fuels, or stresses that occur at critical or sensitive periods of fetal development permanently change the structure, physiology, and metabolism, predisposing individuals to disease in adult life. A good example is gestational diabetes mellitus (GDM). “Fetal Origin” of Adult Disease,” as opined by” David Barker [5,6], suggests that major developmental events in the natural history of non-communicable diseases (NCDs) begin in utero. Hence, there is a need to “Focus on the”Fetus for the Future” to achieve ” diabetes-free generation, as suggested by author Seshiah. Also, his opinion is that “GDM is the m”ther of Non-Communicable Diseases.” In addition,” exposure to a hyperglycaemic environment in utero is associated with an increased occurrence of impaired glucose intolerance and dysfunctional insulin response in young offspring, independent of genetic predisposition to type 2 DM [7]. Even though one might have a genetic predisposition for diabetes, that person should be exposed to epigenetic factors, such as intrauterine or extrauterine [8]. The intrauterine factor (environment) is dominant [9]. This manifestation is simply explained as “Genetics loa”s the gun, and environment triggers it off,” without”genetic factors, the intrauterine environment can cause disease. Detection and Prediction of GDM Detection of GDM is possible with 2hr PG ≥ 140 mg/dl. The most important concern is predicting GDM to prevent its development and consequences [10]. A National Institute of Health (NIH) study in 2018 suggested that HBA1c 5.3 (2hr Postprandial Blood Glucose (PPBG) >110 mg/dl) in the 10th week predicts GDM [11]. Still, no explanation has been given for predicting or preventing GDM. Conceptualization Maternal 2hr PPBG should not cross >110 mg/dl at the 10th week as fetal beta cells start secreting insulin around the 11th week of Pregnancy. 2hPregnancyandial Blood Glucose (PPBG) at the 10th week > 110 mg/dl predicts GDM; hence, blood glucose must be brought to <110 mg/dl before 11 weeks as Fetal Beta starts secreting insulin around 10-11 weeks, with Fetal insulin secretion, changes in maternal metabolism start. Guidelines to Screen glucose intolerance at appropriate Gestational weeks: Prediction of GDM can be done if 2hr PPBG≥110 mg/dl at 10th week. At the 8th week itself, PPBG needs to be estimated because, in case PPBG is > 110 mg/dl at this week, a grace period of 2 weeks is available to bring it down to PPBG <110 mg/dl at the 10th week with metformin 250 mg twice a day, in addition to MNT and exercise. Instead, when PPBG is estimated at the 10th week and if it is>110 mg/dl, insufficient time will be available to achieve PPBG<110 mg/dl in the 11th week, so fetal beta cell insulin secretion starts to increase. If PPBG is < 110 mg/dl at the 10th week, no increase in fetal beta cell insulin secretion occurs at the 11th week of gestation. Metformin is safe for use throughout Pregnancy. MePregnancyas is approved as the first oral anti-diabetic medication to be used safely from conception to confinement to lower the risk of pregnancy-induced hypertension and pre-eclampsia [12]. The Lancet Diabetes & Endocrinology also showed no difference in weight, height, head, and waist circumference in children born to mothers treated with Metformin and placebo. Metformin exposure in utero is not linked to higher BMI for children of women with diabetes [13] and is safe. The ethics committee of Lady Hardinge Medical College and Madras Medical College has approved the administration of Metformin for the study. Objective.

Review open access Article. Veeraswamy Seshiah: Father of Gestational Diabetes in India N Bhavatharini 1, Aruyer Chelvan 2, ARA Changanidi 3, Rajesh Jain 4 1. Diabetology, SRC Diabetes Care Center, Erode, IND 2. Department of Diabetes, SRC Diabetes Centre, Erode, IND 3. Department of Nephrology, Gleneagles Health City, Chennai, IND 4. Public Health, Jain Hospital and Research Center., Kanpur, IND Corresponding author: Rajesh Jain, [email protected] Submitted: October 10, 2024; Accepted: October 27, 2024; Published: October 29, 2024 Abstract Professor Dr. V. Seshiah, MD, FRCP, DSc, (Hony), is a distinguishprofessNadu’sTamilmNadu’su’s Dr. MGR Medical University and established the First Department of Diabetology in India at Madras Medical College in 1978. He was the patron of the Research Society for the Study of Diabetes in India and the founder patron of the Diabetes in Pregnancy Study Group, India (DIPSI). Additionally, he served as the Vice-Chair of the Executive Board of the International Association of Diabetes and Pregnancy Study Group. Dr. V Balaji and Dr. V Seshiah Diabetes Care Center & Research Institute, which he founded, received the Ar”y “ecoratio”s “AM”R “EV” S”AR” a”d “SA”NY” SEVA ME”AL” in 1965 with clasp HIMALAYAS. Dr. Seshiah was also the recipient of the DR. B.C.ROY National Award was given in 1988 for developing diabetology as the Indian College of Physicians provided a specialty in the country and the Master Teacher Award. Moreover, he was honored with the Lifetime Achievement Award by the International Diabetes Federation in 2017, being the first Indian to receive this award. In 2022, the President of India, Mr. Kovind, presented the Padma Shri to Dr. Veeraswamy Seshiah for Medicine. Categories: Endocrinology/Diabetes/Metabolism, Public Health, Health Policy Keywords: dips, Diabetes in a pregnancy study group of India (dips) criteria, gestational diabetes mellitus (dm), diabetes ” g” station,” “history” ic”l vignette”e.” Introduction and Background Prof V Seshiah is an honorary distinguished professor of life at Tamilnadu’s Dr. MGR Medical University, Chennai. He entered his 86th year on 10 March 104 (now 86 years). Prof Seshiah is a visionary, an astute clinician, and a teacher of par excellence, and he is revered as the Father of Diabetes in India (Figure 1) [1]. One must know the length and depth of his work as an author and authority in diabetes, especially gestational diabetes. His work on diabetes has continuously enlightened clinicians day by day, year by year, and decade by decade. Path-breaking evidence has become a source of guidance and reference in practice and policy decisions. His topics span all diabetes, especially hyperglycemia in pregnancy, epidemiology, and therapeutics.     Prof Veeraswamy Seshiah was born in Perambur, North Chennai, Tamilnadu, on March 1038 to Mr. V V. Veeraswamy and Mrs. Bavanamma (a person with an aura of goappearSeshiah’sofsSeshiah’sh’s father worked in the Railways, and his mother was a homemaker. Other family members were his elder brother, Prof Dr. V Perumal, and a younger sister, Ms. Gajalaxshmi. His brother served as director of drug control in Tamil Nadu, and his sister was a housewife. The family lived at (Madras) Chennai throughout. Prof Seshiah, in his childhood, had been a frank and obedient child. Remembering an unforgettable incident, he said he met with an accident when he was five years old. They were asked to vacate and move out of Madras during the Second World Wartime to a village near Tindivanam. Once, he fell when he had a joy ride on a bullock cart with his playmates. His hecamcart’sr’sr artist’s wheel was a massive tearing of skin and scalp. It took months to recover from that injury, and that big scar is still present on the right lateral side of his scalp. Humorously, he said that he became very brilliant after that accident! PrSeshiah’sh’s family played a significant role in shaping his career. His father initially wanted him to pursue engineering, but his elder brother encouraged him to try Medicine and Engineering after he failed to get through. When he succeeded in the medical entrance, his brother supported his decision to pursue Medicine. Medicine support and determination led him to join the Madras Medical College in 1957, marking the beginning of his illustrious career. In 1962, during the Chinese war, there was a shortage of volunteers joining the army; Prof. Seshiah volunteered to join the Indian Army as a Lieutenant in the Army Medical Corps. In 1963, he became captain and was posted as a medical officer for the 1/3 Gurka battalion and then for the 7th Bihar infantry battalion in Jammu and Kashmir. In 1965, he participated (Figure 2) [1].   He participated in the war at “Uri Poonch” Bulge, J&K. In recognition of his service in the war theatre, he was awarded two prestigious awards: the “Samar Seva Star 1965″ and the ” Sainya Seva Medal” with a clasp Himalayas [2]. After completing his Army service, Prof Seshiah joined the Tamil Nadu Medical Service. While serving as an Assistant Professor of Medicine at Madras Medical College, he predicted that diabetes would become a widespread epidemic. In 1978, he established the first “Specialty Department of Diabetes” at Madras Medical College [3], the first of its kind in the country. At 40, Prof Seshiah became one of the youngest Professors. Recognizing the need to train physicians in this specialty, he initiated the “Postgraduate Course in Diabetology,” which was later recognized by the Medical Council of India. In 1980, he established the first “Feto-Placental-Maternal Unit” at the Institute of Obstetrics & Gynaecology, Government Maternity Hospital in Chennai. In 1988, in acknowledgment of his influential work in developing the field of Diabetology, he was honored with the prestigious “Dr. B.C. Roy National Award.” This award is the highest recognition for medical professionals by the Medical Council of India and is presented to the President of India. Prof Seshiah received this esteemed award from President Shri. R. Venkataraman [3]. Review Prof. Seshiah was honored with several awards for his academic, clinical, and research contributions, including the following: “Distinguished Member Award” from the Association of Physicians of India; “Master Teacher Award” from The

Research Article Incidence of Diabetes and Ischemic Heart Disease in COVID-19 Post-Pandemic Raj Kamal Choudhry1* Submitted: October 20, 2024; Accepted: October 27, 2024; Published: October 28, 2024 Corresponding Author1*: Dr Raj Kamal Choudhry, Professor, MD Medicine, Department, Jawaharlal Medical College, Bhagalpur, Bihar, India; email: [email protected] Abstract Background: The long-term effects of the COVID-19 Pandemic are currently getting more attention. The majority of individuals with COVID-19 report having symptoms for a duration greater than four weeks following their initial appearance. After COVID-19 infection, there is worry that cardiovascular and metabolic conditions may be harmed. The severity of the sickness and COVID-19 vulnerability, meanwhile, are known to be linked to cardiometabolic risk. Aim: To study the incidence of ischemic heart disease and diabetes mellitus post-COVID-19 pandemic Methods and Materials: Information for all individuals diagnosed with COVID-19 was taken at the beginning of the investigation from the department’s release of electronic medical records in February 2021. The main outcomes analyzed were first-ever documented CVD as well as DM diagnoses. The data were then collected at different periods. They were as follows: Before the date of indexing. Acute: Follow up till four weeks from the index. Post-acute: Five to twelve weeks from the date of indexing. Long: Thirteen weeks to fifty-two weeks from the date of indexing. Poisson confidence intervals (CIs) were computed. Results: CVD events were 1362 in the COVID-19 study group, while 131 in the control study group at a phase corresponding to four weeks after the indexed date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 781 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to five to twelve weeks since the indexing date. CVD events were 2,134 in the COVID-19 study group, while 298 in the control study group were at a phase corresponding to 13 to 52 weeks since the indexing date.   Conclusion: Early on, after COVID-19 infection, the risk of CVD is elevated, and this risk is elevated for up to three months. However, there is a long-term rise in the prevalence of CVD or DM in COVID-19 patients who do not already have these illnesses. Keywords: Prevalence, Cardiovascular disorders, diabetes mellitus, post COVID-19 Introduction The multiple organ systems illness known as Coronavirus Disease of 2019 (COVID-19) more universally acknowledged [1]. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus infects the respiratory system and causes host immune reactions that could have systemic implications by activating inflammatory mediators [2,3]. With the downregulated response of the immune system, irregular platelet aggregation, coagulopathy, endothelial cell malfunction, and thrombosis affecting different methods with a risk of end-organ harm, COVID-19 may cause an i”flammatory “cy”okine storm” [4]. While fresh cardiovascular disorders (CVD) and fresh cases of diabetes mellitus (DM) have been linked to initial COVID-19 contamination [5], longer-term consequences after the contamination have not been extensively described. Cardiac arrest, cardiac damage with raised troponin levels, and an increased morbidity and mortality probability among COVID-19-positive individuals who get hospitalized are some of the cardiac symptoms of COVID-19 [6,7]. In the first four weeks, COVID-19 can be additionally linked to sudden myocardial infarction and ischemic stroke [8-10]. Patients with COVID-19 have witnessed new-onset hyperglycemia, frequently referred to as “stress hy” euglycemia,” which has been linked with a poorer outcome [5,11]. Both existent and newly developed DM might have sequelae, such as hyperosmolarity condition and diabetic ketoacidosis condition [12–14]. Elevated concentrations of cytokine interleukin-6 (IL-6) and cytokine tumor necrosis factor-alpha (TNF) are indicative of direct pancreatic injury by SARS-CoV-2 and accompanying general inflammatory conditions seen in chronic post-COVID-19, which results in decreased pancreatic insulin production and insulin resistance [15,16]. The long-term effects of COVID-19 are currently getting more attention. The majority of individuals with COVID-19 report having symptoms for longer than 4 weeks following their initial appearance [17-19]. After COVID-19 infection, there is worry that cardiovascular conditions and metabolic conditions may be harmed. The severity of the sickness and COVID-19 vulnerability, meanwhile, are known to be linked to cardiometabolic risk. The recovery period following COVID-19 is still inadequately understood, though. With longitudinal data from digital medical records, it is possible to analyze COVID-19 results over a longer period. We conducted the study to compare a group of patients with COVID-19 exposure to a matched cohort of patients without a COVID-19 diagnosis. We sought to determine the overall impact of COVID-19 contamination on cardiovascular and metabolic consequences over four weeks, three months, and twelve months to identify areas for future research that may be most important and to guide clinical care and public health initiatives. Methods and Materials Data source and participant selection Information for all individuals diagnosed with COVID-19 was taken at the beginning of the investigation from the department’s release of electronic medical records in February 2021. The index deadline for COVID-19 contamination was the day of the first coding. We considered individuals with medical as”easement o” “co” firmed” or” “suspected” COVID-19 since conclusive testing was not generally accessible during the epidemic’s early stages. However, we performed a risk assessment using patients with a polymerase chain reaction (PCR) test validated COVID-19 medical coding documented. A subset of normal control patients without a history of COVID-19 contamination reported till the indexing date was contrasted to the COVID-19 group. Control participants were randomly selected from the March 2021 version registered populace, which offered the most recent data available in the database at the time of sampling. The records of controls were evaluated eighteen months before the beginning of the research, and they had to be compared for age, gender, and family practice. Patients who had widespread CVD or DM reported more than a year or within a year of the commencement of their record were not eligible to serve as controls. Outcome measures The main outcomes analyzed were the first-ever documented CVD and DM diagnoses. Stroke, venous thrombosis, pulmonary embolism, cardiomyopathy and myocarditis, heart failure, condition ischemic heart disease, condition of myocardial infarction, supraventricular tachycardia, atrial arrhythmias, atrial fibrillation