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BACKGROUND: Dietary vitamin B12 (B12) deficiency is common in Indians. Long-term compliance to tablet supplementation is poor in asymptomatic individuals. OBJECTIVE: To study efficacy of B12 fortified nutrient bar and yogurt in improving plasma B12 concentrations in children and adults. METHODS: Two double-blind, placebo-controlled directly observed therapy randomized controlled trials were conducted for 120 days: (1) Healthy children (10-13 years) were fed nutrient bar fortified with B12 (2 µg), multiple micronutrients B12 (1.8 µg) or placebo. (2) Healthy adults (18-50 years) were fed yogurt fortified with B12 (2 µg) or Propionibacterium (1 × 108 cfu/g) or placebo. B12, folate, homocysteine, and hemoglobin concentrations were measured before and post intervention. RESULTS: We randomized 164 children and 118 adults; adherence was 96% and 82%, respectively. In children, B12 fortified bars increased B12 concentrations significantly above baseline (B12 alone +91 pmol/L, B12+ multiple micronutrients +82 pmol/L) compared to placebo. In adults, B12 fortified yogurt increased B12 significantly (+38 pmol/L) but Propionibacterium and placebo did not. In both trials, homocysteine fell significantly with B12 supplementation. Rise of B12 and fall of homocysteine were influenced by dose of B12 and folic acid. There was no significant difference in change of anthropometry and hemoglobin between groups. CONCLUSIONS: B12 fortified foods are effective in improving B12 status in Indian children and adults. They could be used to improve B12 status in the national programs for children, adolescents, and women of reproductive age. They could also be used as over-the-counter products.

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Insulin is an integral part of Type 1 diabetes management. Patient education is of utmost importance to ensure proper injection technique for getting appropriate glycaemic control as well as to avoid injection site adverse effects. Commonest injection site adverse effect is lipodystrophy, attributable to localized manifestation of the pharmacological action of insulin. However, we present a case where incorrect injection technique led to an unusual presentation of injection site adverse effect. Apart from the abnormal skin changes, the incorrect technique also adversely affected the glycaemic control. Though less prominent, some marks are still evident one and a half years after correction of the injection technique. However, the glycaemic control has substantially improved. This emphasizes the need of proper patient education regarding insulin injection technique.

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Insulin is an integral part of Type 1 diabetes management. Patient education is of utmost importance to ensure proper injection technique for getting appropriate glycaemic control and to avoid injection site adverse effects. Commonest injection site adverse effect is lipodystrophy.1 We present a case where incorrect injection technique led to an unusual presentation of injection site adverse effect, which is resolving after correction of the injection technique.

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Type I diabetes patients depend on insulin injections. Proper injection technique is essential for good glycaemic control. Incorrect technique can also lead to local injection site adverse effects, commonest being lipohypertrophy. Hypoglycaemia, by far the most dreaded adverse effect of insulin, receives utmost focus in management of patients on insulin. Lipohypertrophy, on the other hand, is a relatively neglected adverse effect. It is necessary for health care providers to realize that it can also have serious clinical implications. We present a case of persistent unexplained hyperglycaemia in a Type I Diabetes Mellitus (TIDM) patient with severe injection site lipohypertropy. After switching to normal unused sites, her blood sugar levels improved, along with reduction in insulin requirement. The case highlights the importance of continuous patient education and alert monitoring by health care providers.

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BACKGROUND: We assessed the burden of cardiometabolic risk factors in Information Technology (IT) employees as they are exposed to adverse lifestyle. MATERIALS AND METHODS: In this cross-sectional study, health records were obtained from two IT industries in Pune. Prevalence of cardiometabolic risk factors [hyperglycemia, high blood pressure (BP), hypertriglyceridemia, high low-density lipoprotein (LDL)-cholesterol, low high-density lipoprotein (HDL)-cholesterol, and overweight/obesity] was determined using standard cutoffs. We also examined clustering of risk factors (≥two risk factors). RESULTS: Data were available on 1,350 of 5,800 employees (mean age: 33 ± 6 years, 78% men). Prevalence of diabetes and hypertension was 2.5% and 13.5%, respectively. Prevalence of prediabetes, borderline high BP, hypertriglyceridemia, high LDL-cholesterol, low HDL-cholesterol, and overweight/obesity was 6.5%, 20.3%, 21%, 22.1%, 70.1%, and 51.4%, respectively. Risk factor clustering was observed in 63.5% that increased with age (P < 0.001). CONCLUSION: Given the high burden of risk factors at relatively young age, spreading awareness and promoting healthy lifestyle through workplace interventions are warranted.