International Journal of Diabetes in Developing Countries (March 2018) 38 (Suppl 1):S1–S115 https://doi.org/10.1007/s13410-018-0604-7 GUIDELINES RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017 Sarita Bajaj1 Published online: 28 February 2018 # The Author(s) 2018. This article is an open access publication Steering committee Chairperson: Dr. Sarita Bajaj Members: Dr. Anuj Maheshwari, Dr. Banshi Saboo, Dr. B. M. Makkar, Dr. C. R. Anand Moses, Dr. Ch. Vasanth Kumar, Dr. J. Jayaprakashsai, Dr. Jayant Panda, Dr. K. R. Narasimha Setty, Dr. P. V.Rao, Dr. Rajeev Chawla, Dr. Rakesh Sahay, Dr. Samar Banerjee, Dr. Sanjay Agarwal, Dr. Sanjay Kalra, Dr. S. R. Aravind, Dr. Sujoy Ghosh, Dr. Sunil Gupta, Dr. S. V. Madhu, Dr. Vijay Panikar, Dr. Vijay Viswanathan Members of the expert panel group for each section Diagnosis Dr. S. R. Aravind (Coordinator), Dr. C. Munichoodappa, Dr. V.Mohan, Dr. K. M. Prasanna Kumar, Dr. G. R. Sridhar, Dr. Vageesh Ayyar, Dr. Ranjit Unnikrishnan, Dr. Sanjay Reddy, Dr. Bhavana Sosale, Dr. R. M. Anjana, Dr. Subhankar Chowdhury Screening and early detection Dr. S. V. Madhu (Coordinator), Dr. Nikhil Tandon, Dr. A. Ramachandran, Dr. D. Bachani, Dr. Subhankar Chowdhury, Dr. A. Aggarwal Obesity and diabetes Dr. B. M. Makkar (Coordinator), Dr. Anoop Misra, Dr. Naval Vikram, Dr. R. M. Anjana, Dr. Sujoy Ghosh, Dr. Neeta Deshpande, Dr. J. K. Sharma Diet therapy Dr. P. V. Rao (Coordinator), Dr. Ch. Vasanth Kumar, Dr. S. V. Madhu, Dr. K. M. Prasanna Kumar, Dr. A. K. Das, Dr. Sarita Bajaj, Dr. G. R. Sridhar Lifestyle management Dr. Rakesh Sahay (Coordinator), Dr. K. R. Narasimha Setty, Dr. B. K. Sahay, Dr. Anoop Misra, Dr. Ganapathi Bantwal, Dr. A. G. Unnikrishnan, Dr. Nihal Thomas Education Dr. Sunil Gupta (Coordinator), Dr. G. C. Reddy, Dr. J. Jayaprakashsai, Dr. B. K. Sahay, Dr. N. Sudhakar Rao, Dr. P. V. Rao Oral antidiabetic agents Dr. Vijay Panikar (Coordinator), Dr. Banshi Saboo, Dr. Jayant Panda, Dr. Shashank R. Joshi, Dr. Samar Banerjee,Dr. Vijay Viswanathan, Dr. Anil Bhoraskar, Dr. Vijay Negalur, Dr. V. Chopra, Dr. V. Mohan, Dr. G. R. Sridhar, Dr. Sujoy Ghosh, Dr. Alok Kanungo, Dr. Sambit Das, Dr. A. K. Das, Dr. Ajay Kumar, Dr. Arvind Gupta, Dr. Urman Dhruv, Dr. Sanjeev Phatak, Dr. Mangesh Tiwaskar Injectables Dr. Sujoy Ghosh (Coordinator), Dr. Banshi Saboo, Dr. Jayant Panda, Dr. Shashank R. Joshi, Dr. Samar Banerjee, Dr. Vijay Viswanathan, Dr. Anil Bhoraskar, Dr. Vijay Negalur, Dr. V. Chopra, Dr. V. Mohan, Dr. G. R. Sridhar, Dr. Alok Kanungo, Dr. Sambit Das, * Sarita Bajaj [email protected] 1 Department of Medicine, MLN Medical College, Allahabad, UP, India S2 Int J Diabetes Dev Ctries (March 2018) 38 (Suppl 1):S1–S115 (continued) Dr. A. K. Das, Dr. Ajay Kumar, Dr. Arvind Gupta, Dr. Urman Dhruv, Dr. Sanjeev Phatak, Dr. Mangesh Tiwaskar Alternate therapies Dr. K. R. Narasimha Setty, Dr. S. V. Madhu, Dr. K. M. Prasanna Kumar, Dr. A. K. Das, Dr. Sarita Bajaj, Dr. G. R. Sridhar Individualizing therapy Dr. Sanjay Agarwal (Coordinator), Dr. Rajeev Chawla, Dr. S. V. Madhu Postprandial hyperglycemia Dr. Anuj Maheshwari (Coordinator), Dr. Sarita Bajaj, Dr. B. K. Sahay, Dr. Banshi Saboo, Dr. Manash P. Baruah, Dr. Ameya Joshi, Dr. Sameer Aggarwal Clinical monitoring Dr. C. R. Anand Moses (Coordinator), Dr. C Munichoodappa, Dr. Krishna Seshadri, Dr. A. G. Unnikrishnan, Dr. Ganapathi Bantwal, Dr. Mala Dharmalingam, Dr. R. M. Anjana, Dr. Bhavana Sosale, Dr. Sanjay Reddy, Dr. Neeta Deshpande Self-monitoring Dr. Ch. Vasanth Kumar (Coordinator), Dr. Samar Banerjee, Dr. Debmalya Sanyal, Dr. Sunil Gupta Chronic complications Dr. Rajeev Chawla (Coordinator), Dr. Viay Viswanathan, Dr. Sudha Vidyasagar, Dr. S. K. Singh, Dr. Shalini Jaggi, Dr. Hitesh Punyani, Dr. Vinod Mittal, Dr. R. K. Lalwani Infection and vaccinations Dr. Jayant Panda (Coordinator), Dr. Sidhartha Das, Dr. A. K. Das, Dr. Vijay Viswanathan, Dr. Abhaya Kumar Sahu, Dr. Ramesh K. Goenka Fasting and diabetes Dr. Sarita Bajaj (Coordinator), Dr. Sanjay Kalra, Dr. Sandeep Julka, Dr. Yashdeep Gupta, Dr. Navneet Agarwal Diabetes and CV risk Dr. Sanjay Kalra (Coordinator), Dr. Gagan Priya, Dr. Jubbin Jacob, Dr. Sameer Aggarwal, Dr. Deepak Khandelwal Hypoglycemia Dr. Vijay Viswanathan (Coordinator), Dr. Mangesh Tiwaskar, Dr. Girish Mathur Technologies Dr. Banshi Saboo (Coordinator), Dr. S. R. Aravind, Dr. Jothydev Kesavadev, Dr. Manoj Chawla, Dr. Rajeev Kovi Table of contents Abbreviations (alphabetical order) Preface A1C Glycated hemoglobin IDRS Indian Diabetes Methodology Risk Score Diagnosis of diabetes ACE Angiotensin converting IFG Impaired fasting glucose Screening/early detection of diabetes/prediabetes enzyme Obesity and diabetes ACR Albumin-to-creatinine ratio IGT Impaired glucose Diet therapy tolerance Lifestyle management ACS Acute coronary syndrome IR Insulin resistance Education ADA American Diabetes LDL Low density Oral antidiabetic agents Association lipoprotein Injectables AGIs Alpha-glucosidase inhibitors MI Myocardial infarction Alternate therapies ARB Angiotensin receptor blocker MNT Medical Nutrition Therapy Individualizing therapy BMI Body mass index MS Metabolic syndrome Postprandial hyperglycemia CAD Coronary artery disease MUFA Monounsaturated Clinical monitoring fatty acids Targets of glucose control NDS Neuropathy Self-monitoring of blood glucose Disability Score Chronic complications CHF Congestive heart failure NSS Neuropathy Infections and vaccinations Symptom Score Fasting and diabetes CKD Chronic kidney disease OADs Oral antidiabetic agents Diabetes and CV risk CURES Chennai Urban Rural OGTT Oral glucose Hypoglycemia Epidemiological Study tolerance test Technologies CV Cardiovascular PAD Peripheral arterial Annexures disease CVD Cardiovascular disease PPG Postprandial glucose DBP Diastolic blood pressure PUFA Polyunsaturated fatty acids Int J Diabetes Dev Ctries (March 2018) 38 (Suppl 1):S1–S115 S3 (continued) international BMI cut-off points, Indians tend to have larger DM Diabetes mellitus PVD Peripheral vascular waist circumference (WC) and waist-to-hip ratios (WHR), indi- disease cating a greater degree of central body obesity [13]. Asian DN Diabetic neuropathy QoL Quality of life Indians also have increased metabolic risk compared to their DPP-4 Dipeptidyl peptidase-4 RCT Randomized controlled trial western counterparts due to high leptin levels [14], greater IR DR Diabetic retinopathy SBP Systolic blood [6, 15, 16], higher insulin sensitivity index and lower acute pressure insulin response to glucose [17], early loss of β-cell function DSME Diabetes self-management SGLT 2 Sodium-glucose [6], Bconcept of thin-fat Indian,^ or Bsarcopenic obesity^ [18]. education cotransporter 2 ESRD End stage renal disease SMBG Self-monitoring of Numerous international and national guidelines are in place blood glucose for the management of T2DM. Adopting country-specific guide- GFR Glomerular filtration rate SU Sulfonylurea lines improves treatment outcomes in diabetes. The Research GLP-1 Glucagon like peptide-1 T2DM Type 2 diabetes Society for the Study of Diabetes in India (RSSDI) therefore mellitus HDL High density lipoprotein UTI Urinary tract infection published the clinical practice recommendations for the manage- HYQ Hydroxychloroquine WC Waist circumference ment of T2DM in 2015, which was adapted from the 2014 IDA Iron deficiency anemia WHO World Health global guidelines for type 2 diabetes by IDF. The recommenda- Organization tions were specifically designed considering the diverse socio- IDF International Diabetes WHR Waist-to-hip ratio Federation economic and cultural background of Indians. The 2015 RSSDI guidelines were very well accepted by the healthcare practi- tioners across India and helped in decision-making. Preface However, diabetes research is continuously evolving. Every year, several publications are being added to the literature which Management of diabetes, a disease which is assuming epidemic can significantly impact holistic diabetes care. Addition of new proportions, remains a challenge despite the availability of nu- medicines to the diabetes management armamentarium, which is merous guidelines. According to International Diabetes beneficial in terms of reduction in morbidity and mortality risk, is Federation (IDF) 2015 estimates, globally 415 million people transforming the treatment of T2DM. Keeping this in mind, in are suffering from diabetes and this figure may reach up to 642 the 2017 update, all of the sections have been updated with million in 2040 [1]. Currently, 78.3 million people with diabe- recent evidence. Moreover, three new sections, Hypoglycemia, tes are in Southeast Asia (SEA) region and this may rise up to Diabetes and CV risk, and Technologies, have been incorporated 140.2 million in 2040 if proper measures are not taken [1]. and some of the annexures revised. The objective of this updated India has the second largest population (69.2 million) with RSSDI 2017 clinical practice recommendations is to provide diabetes in the world after China (109.7 million) [2]. In addi- evidence-based recommendations for the treatment of patients tion, approximately 52% adults with diabetes remain undiag- with T2DM. It is expected that these recommendations will help nosed in India. Large-scale surveys, such as District Level define practically implementable best practices not only for the Household and Facility Survey (DLHS) 2012–2013 and management of T2DM but also help in timely prevention of Annual Health Survey (AHS) 2014, have reported that around acute and chronic complications