Background and Aim: Coexistence of hypertension (HTN) and type 2 diabetes (T2DM) multiplies the risk of cardiovascular events. Early identification and prompt management of elevated blood pressure in T2DM has shown to improve the quality of life and to reduce the economic burden to the patients. We studied blood pressure (BP) lowering effect of Azilsartan (AZST) monotherapy in newly diagnosed stage 2 hypertensives with a history of T2DM. We also analysed its effects on blood glucose and renal indices. Methods: T2DM Subjects attending a specialized diabetes clinic, who were diagnosed with HTN for the first time, were invited to participate. Mean of 3 BP readings was considered for analysis after due consent. Subjects with stage 2 hypertension were administered AZST 40mg once daily. After 3 months they had a repeat BP recording. Subjects underwent serum creatinine, Na+, K+, fasting (FPG) and postprandrial (PPG) plasma glucose measurements at baseline and after 3moths’ of enrolment. We compared BP lowering efficacy and changes in plasma glucose and renal parameters at baseline and after 3months of AZST therapy. Diabetic, dyslipidemic and other chronic medicines were continued unchanged during the study period. Results: Inclusion criteria were met by 474 subjects (117, 25% females). Mean age and duration of diabetes were 53.3 (95% CI 52.3-54.3) and 7.03 (CI 6.6-7.5) years respectively. With AZST therapy mean SBP dropped from 152.7 (CI 151.1-154.3) mm Hg to 136.4 (CI 134.9-138.0) mm Hg (p <0.05) and the post treatment DBP declined to 79.6 (CI 78.8-80.4) mm Hg from its baseline value of 90.5 (CI 89.6-91.4) mm Hg (p <0.05). The mean baseline FPG and PPG were 158.8 (CI 154.0-163.4) mg/dL and 237.3 (CI 231.9-242.7) mg/dL in order. There was a non-significant decline in plasma glucose, but no changes were seen in eGFR or electrolytes. No adverse event was reported. Conclusion: Azilsartan monotherapy was found to be safe and effective in managing newly diagnosed stage 2 hypertension in type 2 diabetes without hampering renal function. Disclosure H. Mahapatra: None. M. Khuntia: None. S. Mishra: None. S.K. Mishra: None. R.K. Padhi: None. B. Jena: None. S. Das: None. R.K. Khatua: None. A.R. Jena: None. R. Mahapatra: None. L. Mahapatra: None. A.K. Sahoo: None. Funding Jyoti Diabetes Research Foundation

Objective: People with diabetes gradually require increasing dose of medications to achieve good control. We studied the glycemic response of adding Teneligliptin (Teneli) in T2DM subjects with high HbA1c despite being on stable doses of Met and Glim dose. Methods: In this retrospective study T2DM subjects, who were on fixed doses of Met 1000 to 2000mg and Glim 1 to 6mg daily for 3 months were considered. Subjects with an HbA1c between 8-11% and who were prescribed Teneli 20mg OD for at least 6 months, were shortlisted. Those taking insulin or antidiabetic drugs other than Glim+Met or those whose dose was up-titrated during the study period were excluded. We compared HbA1c, fasting (FPG), postprandrial (PPG) plasma glucose, total cholesterol (TC), triglyceride (TG), HDL, LDL, systolic (SBP) and diastolic (DBP) blood pressure at baseline and after 6months of Teneli initiation. Results: Data of 562 subjects (229, 41% females), who met the inclusion criteria were extracted for analysis from the hospital records. Mean age of the sample was 52.6 (95% CI: 51.7-53.4) years and duration of diabetes was 7.8 (6.6-8.3) years. Addition of Teneli resulted in a drop in HbA1c from 9.6% (8.2-10.6) to 8.8% (7.1-9.4) (p<0.05). FPG decreased from 158.8 (154.3-163.2) to 127.8 (124.5-131.1) and PPG from 236.4 (230.7-242.0) to 191.0 (186.0-196.0) respectively (p <0.05). Teneli also improved lipid parameters significantly, particularly TC and TG. With Tenali, SBP declined from 136.8 (134.8-137.9) to 129.5 (128.1-130.9) and DBP from 83.1 (82.2-83.9) to 81.0 (80.2-81.9). There was no incidence of severe hypoglycemia, though 18 (3.2%) cases of suspected hypoglycemia were managed at home. Conclusion: Adding Teneli to Met and Glim combination showed promising role in improving glycemic parameters, lipid components and blood pressure. Low hypoglycemia risk makes the drug a suitable add-on option for those with high HbA1c values. Disclosure H. Mahapatra: None. S. Mishra: None. M. Khuntia: None. B. Jena: None. S. Das: None. A.R. Jena: None. R.K. Padhi: None. A.K. Sahoo: None. R. Mahapatra: None. L. Mahapatra: None.

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Introduction: SGLT2 inhibitors are a new class of drugs approved for type 2 diabetes (T2DM) and have been placed high in treatment algorithm following the robust data supporting their use. Aim: We studied the long term efficacy and safety of Canagliglozin (CANA) versus placebo in Indian adults with type 2 diabetes who were inadequately controlled with metformin (MET) monotherapy. Methods: The study was undertaken at Sevayan Diabetes Centre, India with due consent from participants. Patients (HbA1c 8-12%) on MET were invited to participate. Those on other antidiabetic drugs or insulin were excluded. The CANA arm was administered CANA 100mg OD in addition to MET. The other group received placebo (PBO) and MET. Doses of MET were kept unchanged throughout the study. Antihypertensive, statin and antiplatelets were continued unchanged. Participants were compared after 52 weeks of enrollment. Result: Data of 96 (M/F 62/34) subjects were available for analysis (n=46 on CANA, n=50 on PBO). Groups were similar at baseline. Pre-enrollment HbA1c (%), FPG (mg%) and PPG (mg%) in CANA and PBO arm were 9.94±1.04 and 9.89±1.1, 193.2±26.1 and 193.6±33.0 and 261.3±28.1 and 260.5±30.3 in order (p=NS for all). After 52 weeks of treatment, CANA arm showed clinically meaningful 1.61±1.05% reduction in HbA1c from baseline (p= 0.0048), whereas the PBO arm witnessed a non-significant elevation in HbA1c. Use of CANA significantly decreased FPG by 60.05±17.75mg% and PPG by 62.35±21.92 mg%, whereas the PBO group noticed no appreciable changes in those glycemic parameters. Mycotic infections were common in CANA users (n=6 vs. n=3 in PBO), but improved with personal hygiene. Incidences of documented hypoglycemia were similar in both groups (12 in each). Conclusion: In Indian diabetics uncontrolled with metformin monotherapy, addition of canagliflozin resulted in statistically significant and durable reductions in HbA1c, FPG and PPG over 52 weeks period. Participants tolerated CANA well without any additional risk of hypoglycemia. Disclosure H. Mahapatra: None. M. Khuntia: None. L. Mahapatra: None. S. Das: None. B. Jena: None. S. Mishra: None. R.K. Padhi: None. A.R. Jena: None. R.K. Khatua: None. A. Patwari: None. S.K. Pradhan: None. S. Biswal: None. S. Nayak: None. U.S. Mishra: None. A.K. Sahoo: None. Funding Jyoti Foundation

Background and aims: Achieving glycemic goals is crucial in the overall management of diabetes. Selecting the right medication for the individual patient is of paramount importance in the present day’s patient centric glucose control. Metformin is the first line and gold standard antihyperglycemic agent that can be offered to type 2 diabetics. Addition of a second or third agent or insulin should be considered in those whose HbA1c remains high despite the up-regulated metformin dose or those who do not tolerate metformin. We aimed to find the pattern of metformin use in type 2 diabetic subjects in a diabetes specialty centre in coastal Odisha. Materials and methods: This observational study was conducted in a diabetes setup in coastal Odisha in June 2018. After obtaining consent from patients, authors looked into the prescriptions of all type 2 diabetic adults. Subjects who were prescribed metformin (in any dose) were enrolled in the study. Those with established nephropathy, coronary artery disease, stroke or cancers were excluded. Results:There were 802 footfalls noted during the study period, of which 723 metformin taking participants (298 females, 41.2%) were considered for analysis (79 persons were excluded: not meeting inclusion criteria/ not willing to participate/ history of nephropathy/ CAD/ stroke). Mean age, diabetes duration, FPG, HbA1c, serum creatinine, eGFR of the study population were 51.6±10.6 years, 11.9±11.2 years, 138.7±51.7 mg/dl, 7.8±2.1%, 0.93±0.29 mg/dl and 96.5±11.1ml/min respectively. Patients were prescribed metformin in various doses, i.e., 500mg (42 patients, 5.8%), 850mg (47 patients, 6.5%), 1000mg (396 patients, 54.8%), 1500mg (13 patients, 1.8%), 1700mg (86 patients, 11.9%) and 2000mg (130 patients, 18.0%), and 2500mg (9 patients, 1.2%). Metformin was prescribed as monotherapy (n=34, 4.7%) or along with other OADs (n=589, 81.5%) or in combination with insulin (n=178, 24.6%). Retrospective analysis of the medical records and further questioning revealed that gastric intolerance was the commonest reason for withdrawal of metformin in otherwise eligible subjects. Conclusion: Metformin was the most commonly prescribed antidiabetic drug and the daily dose of more than 85% of the metformin administered individuals was 1000mg or above.