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Background: Ramadan is a holy month in the Islamic calendar during which Muslims all over the world observe a fast between dawn and sunset. The management of people with diabetes who fast during Ramadan had previously been based on expert opinion rather than medical evidence gained from scientific data. Risk stratification is an essential aspect of all diabetes and Ramadan recommendations. The International Diabetes Federation has recently in 2021 formulated an excellent tool based on recent evidences that will help people with diabetes and their health care professionals to make better decisions regarding fasting during Ramadan. Through this study we aimed to apply this risk stratification tool in our patients with diabetes who opted to fast during Ramadan as well as compare their glycemic control and change in clinical and biochemical parameters pre and post Ramadan. Aims: To study the effect of Ramadan fasting on the glycemic control, occurrence of hypoglycemia as well as clinical and biochemical parameters of patients with diabetes and to categorize them based on risk stratification. We also aimed to assess the impact of adjustment of antidiabetic medications and their dosages with specific emphasis on hypoglycemia. Methods: We conducted an observational, single centre, prospective study in the outpatient clinic of department of Endocrinology at Osmania Medical College, Hyderabad. 150 patients who satisfied inclusion criteria were recruited at least 1 week prior to the month of Ramadan after taking informed written consent. A structured questionnaire was undertaken which included demographic details, type of diabetes, antidiabetic medications used (oral antidiabetic agents/insulin), any other chronic drug intake and comorbidities. Risk stratification tool as proposed by IDF in 2021 was used to categorise patients into low risk, moderate risk and high risk and appropriate health education and counselling were given. The patients were divided into 5 drug groups based on the drug modifications done for Ramadan. Modifications to treatment regimens were done as per standard protocols in order to achieve glycemic control and avoid the risk for hypoglycemia. The patients were followed up 1 week after Ramadan to assess the number of individuals who developed hypoglycemia during fasting and parameters like BMI, lipid profile, FBS, PPBS, HbA1c were measured. Results: The mean age of the study population was 47.63+/- 10.5 years.140 patients had type 2 diabetes and 10 patients had type 1 diabetes. 44% of study population belonged to low risk, 33% into moderate risk and 23% into high-risk category as per IDF 2021 risk stratification tool. Out of the total 150 study participants, 137 of them had fasted in the previous year's Ramadan (2020).46 of 137 (33.57%) patients gave history of experiencing hypoglycemia during the previous year's fasting (2020) as compared to only 27/148 (18.24%) in 2021. Among these, 62.9% were from the high-risk group. Comparison of the patient characteristics between Ramadan 2020 and Ramadan 2021 revealed that pre-Ramadan education resulted in lower number of patients with hypoglycemic episodes (16.05% vs 33.57%), motivated more number of patients to do SMBG during fasting (12.4% to 21.8%) and lower number of patients with hyperglycemia (10.94% to 5.83%). The percentage of individuals who fasted for at least 15 days increased from 90.5% to 97.08%. BMI showed an improving trend post Ramadan (25.97 ± 2.63 kg/m2 vs 25 kg/m2 ± 1.98) which was also statistically significant (P < .0001). Other parameters like Blood pressure, HbA1c, FBS, PPBS and LDL cholesterol showed improving trends post Ramadan although statistical significance could not be achieved. It was also noted that those who were prescribed Acarbose did not experience any hypoglycemic episodes as compared to other drug regimens like gliptins, metformin glimepiride combination, repaglinide and insulin and this difference was also statistically significant (P < .001). Maximum number of hypoglycemic episodes were reported in the insulin group (63.1%; 12/19), majority of them being type 1 diabetics (42.1%; 8/19), which highlights the importance of focusing on this group with regard to counselling and advice as well as risk stratification. Conclusion: The development and utilization of Ramadan-focused diabetes education programs is essential to provide better care and ensure the safety of people with diabetes who fast during Ramadan. The findings of this study clearly emphasize the continuous need to prioritize risk stratification and to institute pre-Ramadan assessment and interventions in advance. It is essential to promote and strengthen a structured approach to Ramadan focused diabetes education and self-monitoring to ensure safe fasting, thereby preventing and reducing complications. It also highlights potential role of Acarbose for use among diabetics during Ramadan.

Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and autoimmunity as well as diabetes complicating pregnancy when compared to the Western population. Despite the potential serious implications of this problem, not enough attention has been paid in our country to understand this, and there is an urgent need to explore the same. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: We conducted a cross sectional study in which pregnant women with gestational as well as pregestational diabetes were enrolled and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using anti TPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with gestational and pregestational diabetes was evaluated. Those with thyroid autoimmunity was compared with those without autoimmunity and the association of each group with the presence of diabetes mellitus was evaluated. The same tests were done on pregnant women without diabetes or thyroid disease who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. Among the gestational diabetics, the mean gestational age at diagnosis was 28.39 ± 4.69 weeks. The average duration of diabetes among those with pregestational diabetes was 3.10 ± 1.32 years. 40.67% participants had a family history of diabetes and 14% had family history of hypothyroidism. 56% were diagnosed with GDM and the rest had preGDM. Acanthosis nigricans was noted in 63.34% participants and 37.3% had goitre. 26.6% of the study population were diagnosed with hypothyroidism, none had hyperthyroidism. Of these, 45% were newly diagnosed during the current pregnancy.30.95% of those with GDM were noted to have hypothyroidism whereas it was 21.2% in preGDM. The prevalence of anti TPO antibody positivity was assessed in 140 patients which was found to be 9.29% whereas that of anti-thyroglobulin antibody was 3.57%.4.67% participants were noted to have oligohydramnios and 10% had polyhydramnios. 46.6% of those with polyhydramnios were found to have associated hypothyroidism which was statistically significant (P=.01). Maternal complications like gestational hypertension, pre term delivery, post-partum hemorrhage and caesarean section as well as neonatal complications like neonatal jaundice were higher in women with combined endocrinopathy. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes mellitus is higher than the prevalence in normal pregnancy. About one third of those with gestational diabetes and more than one fifth of those with pregestational diabetes were found to have hypothyroidism in our study. Almost half of patients with polyhydramnios were found to have associated hypothyroidism. Maternal complications and neonatal jaundice were found to be higher among those with combined endocrinopathy. However, the prevalence of thyroid autoimmunity in our study was lower as compared to previously published data which could be because of regional differences in iodine sufficiency or other unrecognised endocrine disruptors which could be at play. Nevertheless, our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy.

Background: In refractory primary hypothyroidism, even after ruling out important organic causes the resistance may persist and is called pseudo-malabsorption. If non-adherence is suspected, but not volunteered, the options to confirm the possibility are limited. We conducted this study to assess the use of Levothyroxine absorption test to diagnose pseudo-malabsorption and once weekly Levothyroxine to treat such patients Methods: This was an open labelled Randomized Control Trial with a Parallel design. All patients with age 18 or above attending Endocrinology OPD who was diagnosed with Primary Hypothyroidism but had TSH levels more than 10 mIU/L despite treatment with daily Levothyroxine at a dose of 2.5 mcg/kg/day for a period of 6 months or more were included after applying exclusion criteria after getting informed consent. Levothyroxine absorption test was done according to previously validated protocol and Absorption percentage was calculated using previously validated formula. If more than 60% it was suggestive of pseudo-malabsorption. They were randomised by simple randomization to receive oral Levothyroxine of a same standard brand either weekly once under direct supervision with a dose equal to the cumulative dose with a maximum of 14 mcg/kg (weekly dose group) or to continue to receive the same daily dose prior to randomization (daily dose group). Both groups received healthcare advice on adherence, adequate spacing and storage. Thyroid function tests were repeated at 8 weeks and at 12 weeks if not controlled at 8 weeks. Results: After randomization of 70 subjects selected after levothyroxine absorption, 40 were in the weekly once group and 30 were in the daily once group. 38 subjects in the weekly once group (95%) had controlled TFT levels by 12 weeks with 32 (80%) among them under control by 8 weeks whereas 18 subjects in the daily once group (60%) had controlled TFT levels by 12 weeks and had a statistically significant difference between the two groups (p value = 0.0005). There were no significant differences in the adverse events. 4 subjects in the weekly once group (10%) and 2 subjects in the daily once group had headache. 2 subjects in the weekly once group withdrew from the study due to headache. Conclusion: The weekly once dosage can be considered as a safe and effective option for every subject with refractory primary hypothyroidism when pseudo-malabsorption is suspected.

Background: Lipodystrophy constitutes a spectrum of diseases characterized by generalized or partial absence of adipose tissue. Underscoring the role of healthy fat in maintenance of metabolic homeostasis, fat deficiency in lipodystrophy typically leads to metabolic disturbances including insulin resistance, hypertriglyceridemia and ectopic fat accumulation. While rare recent genetic studies indicate that lipodystrophy is more prevalent than has been previously thought, suggesting underdiagnosis in clinical practice. Aims and Objectives: The present case series highlights the spectrum of lipodystrophy syndromes, clinical profile and complications. Case Details C1 & C2 who wer 28 yr & 26 yr female siblings presented with neck swelling, double chin appearance, loss of fat in extremities and not gaining weight, inspite of increased appetite. History of father having CAD mortality at 30 yr age.C3: 22 y/o female came with c/o oligomenorrhea, polyuria, polydipsia. On examination generalized loss of body fat was present.C4: 20 y/o female presented with c/o generalized fat loss, hirsutism, muscular appearance, polyuria and polydipsia. On evaluation of C1 & C2 a clinical diagnosis of Familial Partial lipodystrophy was made. Investigations revealed Prediabetes and Hypertriglyceridemia. C3 & C4 were clinically diagnosed as Congenital Generalized Lipodystrophy. Investigations revealed T2DM, PCOS, Hypertriglyceridemia which were appropriately managed. Conclusion: The aetiology and clinical features of lipodystrophy are variable. Awareness and early recognition in these cases is necessary for optimal management of the patient.

Disclosure: R.K. Sahay: Speaker; Self; Novo Nordisk, Roche Diagnostics. S.A. Kalam: None. N. Kudugunti: Speaker; Self; Novo Nordisk. S. Togarla: None. Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and diabetes complicating pregnancy when compared to the Western population. The association between both has been studied in multiple small studies which have however shown discordant results. Hence the need for exploring this further. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: 150 pregnant women with gestational/pregestational diabetes were enrolled in this cross sectional study and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using antiTPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with diabetes in pregnancy was evaluated along with maternal and perinatal outcomes. The same tests were done on 26 pregnant women without diabetes who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. 56% were diagnosed with GDM and the rest had pre-GDM. 26.6% of the study population were diagnosed with hypothyroidism. Of these,45% were newly diagnosed during the current pregnancy. The prevalence of antiTPO antibody positivity was found to be 9.33% whereas that of anti-thyroglobulin antibody was 3.33%. Maternal and perinatal complications were higher in the group with combined endocrinopathy with gestational hypertension and preterm delivery showing statistically significant increase among the latter group. Among those women with combined endocrinopathy who developed gestational hypertension,76.9% had GDM. All of them were found to have subclinical hypothyroidism which was newly diagnosed in third trimester. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes is higher than the prevalence in normal pregnancy. Undiagnosed subclinical hypothyroidism was found to be strongly associated with development of gestational hypertension. Our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy. Presentation: Thursday, June 15, 2023