The Cardio-Renal-Metabolic (CRM) Grand Rounds, brings together leading experts in nephrology, endocrinology, and internal medicine to discuss the latest developments in the treatment of cardio-renal-metabolic disorders. The event offers an in-depth exploration of modern therapeutic approaches, including SGLT2 inhibitors, with a focus on holistic patient care. Participants will gain practical insights into early detection, management, and comprehensive care strategies for these complex conditions.

Cardio-Renal-Metabolic Grand Rounds

Steroid stewardship is the systematic attempt to rationally administer and monitor glucocorticoids in patients who require this therapy, while balancing benefit and potential harm. Steroid stewardship is gaining popularity in the treatment of acute exacerbations of chronic obstructive pulmonary disease and asthma. Steroids, on the other hand, are utilised for a wide range of indications by numerous medical professions. As a result, rather than focusing solely on respiratory medicine, it is critical to address disease-specific steroid management in a broader perspective. Dr. Ganapathi Bantwal, a renowned expert in the field of medicine, will define and characterise steroid stewardship, develop a pedagogical structure to promote comprehension, offer endocrine and infectious disease perspectives, and make recommendations to help make this a global, pan-specialty movement.

Steroid Stewardship - Prudent use of Glucocorticoids

The sodium-glucose cotransporter 2 inhibitors (SGLT2i) or gliflozins are considered as a major class in the therapeutic strategy of type 2 diabetes mellitus (T2DM) due to their proven efficacy in reducing blood sugar levels and, more importantly, in decreasing major cardiovascular events (MACE). SGLT2i have been compared to paradigm-shifting drugs for their major clinical benefits in heart failure (HF) patients and chronic kidney disease (CKD) patients, diabetic as well as non-diabetic , leading to the question often posed: “Could flozins be the statins for risk-based primary prevention of heart failure? However, even though SGLT2i treatment reduces cardiovascular events, its long-term effectiveness is still unknown, particularly in atherosclerosis. Let us understand their indications for use in T2DM patients from Prof. Dr. Ganapathi Bantwal, Head of Dept of Endocrinology at St. Johns College & Hospital, Bangalore. 

Are SGLT2 Inhibitors the New Statins? 

Over the years, accuracy and popularity of Blood Glucose Monitoring Devices have increased dramatically. With that improvement has come a new way to manage blood glucose - time in range (TIR). Time-in-range emerged as a valuable blood glucose metric, ‘beyond HbA1c’ for a deeper insight into glycemic control in people with diabetes. It denotes the proportion of time that a person's glucose level remains within the desired target range. Despite its proven value, TIR has not been used to its full potential in clinical settings for the management of T2DM. In this discussion with Prof. Dr. Ganapathi Bantwal, we understand the prospects of TIR as a valuable clinical metric that complements HbA1c in daily treatment decision making.

Time in Range: A Conceptual Shift in Diabetes Management

Diagnostic dilemmas in young onset diabetes mellitus pose unique challenges due to the increasing prevalence of diabetes in children and adolescents worldwide. Earlier onset of diabetes leads to longer lifetime exposure to hyperglycemia and consequently greater tendency for long-term complications. In this age group, a spectrum of hyperglycemic disorders needs to be considered in the differential diagnosis and arriving at a final diagnosis of T2DM isnt as straightforward. We have Prof. Dr. Ganapathi Bantwal, HOD of Endocrinology at St. Johns Hospital, address these dilemmas in diagnosis with some interesting case scenarios that will give us some unmistakable insights into the management of young onset diabetes mellitus. 

Diagnostic Dilemmas: Young Onset Diabetes Mellitus

The greater frequency of infections in diabetic patients is caused by the hyperglycemic environment that favors immune dysfunction (e.g., damage to the neutrophil function, depression of the antioxidant system, and humoral immunity), micro- and macro-angiopathies, neuropathy, decrease in the antibacterial activity of urine, gastrointestinal and urinary dysmotility, and greater number of medical interventions in these patients. In addition to the increased morbidity, infectious processes may be the first manifestation of diabetes mellitus or the precipitating factors for complications inherent to the disease, such as diabetic ketoacidosis and hypoglycemia. The major infections associated with diabetes mellitus are diabetic foot infections, repeated UTI'S, Tuberculosis, Hepatitis B & C infections, Candidiasis, invasive external otitis and Bacterial Pyelonephritis. Let's hear from Dr. Bantwal the infections typically seen in Indian Diabetes and how to manage them.

Infections Typically seen in Indian Diabetics

In order to reduce glucose concentrations in people with type 2 diabetes mellitus, metformin is frequently regarded as the best initial pharmacological option. Due to concerns about lactic acidosis, the medication is, however, contraindicated in a large number of people with impaired kidney function. Metformin should occasionally be administered cautiously or not at all. Learn more about these unique situations with Dr. Ganapathi Bantwal, live only on Medflix.

Metformin in special situations

High-intensity statin therapy is recommended for all patients with diabetes and ASCVD. Statins reduce cholesterol levels and offer other benefits, including plaque stabilization, reduction of inflammation, reversal of endothelial dysfunction, and decreasing thrombogenicity, thus reducing cardiovascular disease risk. Guidelines recommend statin therapy for all patients with T2DM who are >40 to 75 years old and have a low-density lipoprotein (LDL) cholesterol level of 70 mg/dL or greater for primary prevention of cardiovascular diseases. Dr. Ganapathi Bantwal, HOD- Endocrinology at St. Johns Medical College & Hospital, joins us LIVE to illustrate the indications for statin therapy in diabetic individuals 

Statins in Diabetes

It's that time of the week again! For the sixth episode of the case of the week series we have with us as mentor & guide, Dr. Ganapathi Bantwal, Prof & Head of Department of Endocrinology at St.Johns Hospital, Bangalore. In the spirit of World Diabetes Day month, our resident Dr. Abhishek Kulkarni brings to the table a rather gripping case of a 13/M, k/c/o Type 1 DM who has recurrent episodes of DKA. From the initial evaluation up until the preferred line of Mx, let's discuss it all. Say no to the fear of medical exams, Experience the #JoyOfLearning Medicine. Stay tuned on 25th November, Friday at 9 PM only on Medflix!

Case of the Week #6

Cushing's syndrome remains an extremely complex endocrine condition. It comprises a large group of signs and symptoms that reflect prolonged and inappropriately high exposure of tissue to glucocorticoids. More often patients have a number of features that are caused by cortisol excess but that are also common in the general population, such as obesity, depression, diabetes, hypertension, or menstrual irregularity. As a result, there is an overlap in the clinical presentation of individuals with and without the disorder. The choice of tests, the integrity of the specimens and the quality of endocrine assays are key factors for optimal patient care. On Medflix, Dr. Ganapathi Bantwal joins us LIVE to provide us with extensive guidance on how to overcome these diagnostic challenges.

Cushing's syndrome: Why is it difficult to diagnose?

The term “glucocorticoids” (GCs) represents both naturally secreted hormones by adrenal cortex and anti-inflammatory and immunosuppressive agents. Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. Cushing’s syndrome, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, osteoporosis, psychiatric disturbances, and immunosuppression are among the most important side effects which are significantly noticeable at high doses for prolonged periods. Dr. Ganapathi Bantwal, Professor & Head of Dept. of Endocrinology helps us understand these crucial parameters to effectively manage glucocorticoid side effects.

Managing and Minimizing the side effects of Glucocorticoids 

Dyslipidemia is common in diabetes and there is substantial evidence that decreasing cholesterol improves cardiovascular outcomes, even in patients with seemingly normal lipid profiles. There is an association between atherosclerotic cardiovascular disease and serum cholesterol and triglyceride levels in both type 1 and type 2 diabetes. High triglyceride levels and low high-density lipoprotein (HDL) cholesterol are hallmarks of type 2 diabetic dyslipidemia. Join us LIVE on Medflix as we further explore this topic with renowned endocrinologist and diabetologist, Dr. Ganapathi Bantwal.

Defying Dangers of Diabetic Dyslipidemia

Immediate Past President - Endocrine Society of India | Professor & Head, Dept. of Endocrinology | St. John's Medical College & Hospital, Bangalore.

Dr. Ganapathi Bantwal

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