 Hi, I am Dr. Harika Upalpati, Consultant Physician, Manipal Hospital, Vijayawada. Today, 14th November is celebrated as World Diabetes Day and this is to raise awareness among the people and the theme for 2023 is Access to Diabetes Care. So, coming to diabetes, what exactly is the incidence of diabetes in India? Around 11 crores of the population is already diabetic. 35% of the Indian population is pre-diabetic. Coming to the risk factors of diabetes, what are the modifiable risk factors and the non-modifiable risk factors? Coming to the modifiable risk factors, those are overweight, smoking, alcohol, high blood pressure, dyslipidemia, stress management and inadequate sleep, physical inactivity. Coming to the non-modifiable risk factors are family history, gestational diabetes and giving birth to a baby more than 9 pounds, pre-diabetes age more than 45 years. Coming to the American Diabetes Association guidelines, how do we diagnose diabetes? So fasting plasma glucose levels more than 126 milligrams per deciliter, post-prandial glucose levels more than 200 milligrams per deciliter and HBVNC levels more than 6.5%. Coming to the symptoms of diabetes, fatigue, weight loss, blurring of vision, increased thirst, increased frequency of urination, increased appetite, parasthesias of hands and feet and the other symptoms are poor wound healing and increased exposure to fungal infections. Now coming to the complications of diabetes, the microvascular, macrovascular and autonomic complications. So microvascular complications are diabetic retinopathy, neuropathy and nephropathy. Coming to macrovascular complications are cerebrovascular diseases, coronary artery diseases and peripheral vascular diseases. So coming to the autonomic complications are erectile dysfunction, neurogenic bladder like urinary incontinence, diabetic gastroparesis, gastratory hyperhidrosis, dizziness and tachycardia. Now coming to the types of diabetes, type 1 diabetes is a juvenile diabetes or insulin dependent diabetes, type 2 diabetes is insulin resistant diabetes, pre-diabetes, gestational diabetes. So gestational diabetes after the mother delivers the child, the blood sugars revert to the normal but that person is at increased risk of type 2 diabetes later in the life. Lada latent autoimmune diabetes in adults, Modi maturity onset diabetes in the young, brittle diabetes, brittle diabetes is marked by frequent and severe episodes of high and low blood sugar fluctuations, neonatal diabetes which occurs in the first six months of life. Then brittle diabetes which is characterized by fluctuations in the high and low levels of blood sugars, this leads to frequent hospitalizations. So how do we prevent diabetes? One is frequent periodical health checkups, second is regular physical activity, eating a healthy and balanced diet, eat food that is rich in fruits, vegetables, lean proteins and healthy fats, avoid carbonated beverages, processed foods, sugars and fruit juices. So we have to limit the portion control to reduce the calorie intake and stabilize the blood sugar levels. So coming to the regular physical activity at least 150 minute moderate intensity, aerobic activity per week is required that can be in the form of brisk walk, swimming, cycling and running. Then coming to the weight management, even a modest weight loss can lead to insulin sensitivity and keep the blood sugar levels in check. Then regular inspection of the feet and eye examination to rule out diabetic retinopathy. You have to regularly examine your feet for any wounds, ulcers or any other infections. Then medication adherence, having proper quality sleep of at least 7 to 8 hours with smoking and alcohol and stress management. So these few tips can help you to prevent diabetes. So what is glycemic headset? It includes parameters that measure the patient's quality of life. It includes fasting blood glucose levels, post-prandial blood glucose levels, HBMNC, avoidance of hypoglycemia, avoid nocturnal hypoglycemia and minimize the glycemic variability. What actually is glycemic variability? Glycemic variability refers to the fluctuation and oscillations in the blood glucose levels. So this glycemic variability, this increased risk of hypoglycemia leads to microvascular or macrovascular complications and mortality in patients with diabetes mellitus. So coming to the non-invasive methods of blood glucose monitoring is the continuous glucose monitoring. We have a freestyle libra system where a sensor is placed on your skin to monitor the blood glucose levels continuously for around 14 days. So this helps us to see the fluctuations in the blood glucose levels and it is easy for the doctor to optimize the treatment. So coming to the treatment, so patients with 3 diabetes, they do not have to start on oral hypoglycemic or insulin. They need to modify their lifestyle, have a balanced diet rich in fiber, fruits and vegetables, reduce the body weight and avoid the other risk factors. Then coming to the diabetes, once the patient is diagnosed with HBMNC levels more than 6.5, they have to initiate medication. Here we have so many new oral hypoglycemic agents to treat diabetes. We have to initiate the patient on insulin only if the HBMNC levels are more than 9.5. So the patient do not have to panic if they have to take regarding the insulin treatment. So we can initiate the patients on a single double or triple oral hypoglycemic agents and frequent monitoring every monthly once till the HBMNC levels are less than 7 and if the HBMNC levels are less than 7, then once in 3 months monitoring for diabetes is enough and patients with 3 diabetes require screening every 6 months. So let us all join our hands together to combat the diabetes. So the only way to prevent diabetes is regular health screenings that can be conducted in the hospital or in the mass campaigns or a free checkups. So please do your health checks at least once in 6 months to combat diabetes. So please get biannual screenings if you have a family history of diabetes or any other risk factors which I already discussed. Thank you.