Oral glucocorticoids are efficacious for treating respiratory diseases but with a high risk to induce diabetes. We analysed a subset of patients from the Redi iron ore miners from a rural setting (n=25,500), who were newly diagnosed diabetics on extensive chronic methylprednisolone equivalent glucocorticoid dose of ≥4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard (n=1100, males= 660, females=4400). t test and Fisher's exact test were used for the statistical analysis. The mean HbA1c was 7.1% (SD ± 0.62, 95% CI 7-7.3), mean age 51 years (SD ± 14, 95% CI 48 - 54), mean BMI 26 kg/m2 (SD ± 3.6, 95% CI 25 - 27), mean Fasting Plasma Glucose 146 mg/dl (SD ± 49, 95% CI 136-155) mg/dl, mean Post Prandial Glucose 207mg/dl (SD±74, 95% CI 192 - 221). HbA1c at diagnosis in the relatively low risk group (young - normal weight group with age < 40 years, BMI <25 kg/m2) (n=231) was less than the high risk group (older - overweight with age > 40 years, BMI >25 kg/m2) (n=616); mean HbA1c 6.7% (SD±0.33, 95% CI 6.5 - 6.8) vs. mean HbA1c 7.3% (SD±0.65, 95% CI 7.1 - 7.5) (p<0.0001). There was a significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI < 26 kg/m2 (n=594) to develop GIDM (p=0.006). We observed that high incidence of GIDM (4.31%) is an alarmingly harmful problem which has pronounced comorbid implications, especially in the younger, economically productive population in the limited resource setting. The health care professionals need to be educated to limit the use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance in this population, makes the treatment of GIDM difficult, which calls for action to limit the mining activities and mitigate the risk of chronic complications due to diabetes. Disclosure V. Redkar: None. S. Redkar: None. M. Inamdar: None. A. Inamdar: None. S. Redkar: None. M. Jagtap: None. S. Rane: None. S.V. Kulkarni: None. J. Deshpande: None. U. Wadhwa: None.

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Introduction Oral glucocorticoids are efficacious agents for treating respiratory diseases, with high risk to induce metabolic diseases including diabetes and hypertension Purpose To analyse the hypertensive patient population from the rural setting on ongoing glucocorticoid treatment and diagnosed as diabetic due to the extensive chronic methylprednisolone equivalent glucocorticoid dose of more than 4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard Methods We diagnosed the identified and analysed a subset of patients from the Redi iron ore miners (n=25,500), who were newly diagnosed diabetics (n=1100) and with associated systemic hypertension (systolic BP >140 mmHg, diastolic BP > than 90 mmHg). Patients diagnosed as Oral Glucocorticoid Induced Diabetes Mellitus (GIDM) and hypertensives (n=847; 572 males and 275 females) were characterised on metabolic parameters. t-test was utilised for statistical analysis Results We observed a high incidence of GIDM (4.31%) with a high rate of hypertension (77%, 847/1100). Mean SBP was 150 mmHg (SD ± 9.9, 95% CI 147–152), mean DBP was 90 mmHg (SD ± 8.9, 95% CI 88–92). BMI in GIDM with hypertension (GIDM-H) group was similar to GIDM group (26 kg/m2) (Table), with relatively older age in GIDM–H (53 vs 51 years). The glycemic parameters were relatively more deranged in GIDM-H group. There was significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI <26 kg/m2 (n=594) to develop GIDM (p=0.006) Metabolic Parameters GIDM Vs GIDM-H Mean ±SD, min, max, 95% CI GIDM (n=1100) GIDM with Hypertension (n=847) Age (yrs) 51 (SD ±14, 95% CI 48–54) 53 (SD ±13, 95% CI 50–56) HbA1c (%) 7.1 (SD ±0.62, 95% CI 7–7.3), 7.2 (SD ±0.60, 95% CI 7.1–7.3) BMI (kg/m2) 26 (SD ±3.6, 95% CI 25–27) 26 (SD ±3.4, 95% CI 25–27) Fasting Plasma Glucose (mg/dl) 146 (SD ±49, 95% CI 136–155) 149 (SD ±48, 95% CI 138–160) Post Prandial Glucose (mg/dl) 207 (SD ±74, 95% CI 192 - 221) 212 (SD ±74, 95% CI 195–228) Conclusions The high rates of hypertension in patients with GIDM is an alarmingly problem which has pronounced harmful comorbid implications, especially in younger, economically productive population in limited resource setting. The health care professionals need to be educated to limit use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance, strategies to reduce cardiovascular risk and damage, makes treatment of hypertension and GIDM difficult, which calls for action to limit the mining activities and mitigate risk of chronic complications

We studied 1200 (Males=868, Females =332) hypertensive, T2DM hospitalised for 24 hours to analyse the association of hypertension and arrhythmias simultaneously for three years (January 2015-December 2017), as part of the PREDICT protocol, a mixed methods approach, developed as a standard care of management at three tertiary care hospitals. We used Trillium 3000 Holter recorder (Forest Medical) and DynaPulse 5000A Ambulatory Blood Pressure monitoring (ABPM) and the Trillium Gold software, respectively for the recording and the data analysis. ANOVA, Graphpad was used for statistical analysis. The mean age was 51.2 ± 7.9 years (range 41-82 years). The tertile in the triad of age &gt; 60 years, duration of diabetes &gt; 20 years and HbA1c &gt; 11% had the highest incidence of arrhythmias (p&lt;0.0001). The socioeconomic status was high in 401 patients (43%), middle income in 436 (36.3%) and low income in 363 cases (30%). The commonest risk factors were sedentary lifestyle (64%), obesity (56%), dyslipidemia (37%), smoking (23%), sleep apnea (21%). The mean 24-hour BP was 143 ± 12 mmHg for the SBP and 92.6 ± 12.2 mmHg for DBP. The awake and asleep BP mean were respectively 147 ± 11 mmHg and 137 ± 13.7 mmHg for SBP, 89.5 ± 10.2 and 83.1 ± 8.9 mmHg for DBP. Arterial pressure variability and bradyarrhythmia were significantly associated with sleep apnea (p&lt;0.0001). Patients with ST-T wave depression &gt; 1 mm (26%) and tachycardia (31%) as a sub-group were significantly associated with both the reverse dippers and non-dippers. (p&lt;0.0001). Chronotherapy in concurrence with the circadian rhythm to reduce the side effects, optimise the dosage, reduce the pill burden would be a suitable option to achieve a better BP control in T2DM. Nocturnal anti-hypertensive dosing to target the nocturnal hypertension would be an appropriate management approach. Disclosure V. Redkar: None. S. Redkar: None. S. Redkar: None. A. Inamdar: None. M. Inamdar: None. S. Rane: None. D. Khanolkar: None. M. Jagtap: None. D. Yeralkar: None. N. Wadhwa: None.

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