Background There is limited data on the prevalence and outcome of prediabetes (PDM) and the incidence of type 2 diabetes mellitus (T2DM) in South Asia. We investigated these in a prospective, community-based study involving a cohort of urban adults in Sri Lanka, with a seven-year follow-up. Methods Participants were selected by age-stratified random sampling, and were initially screened in 2007 and reevaluated in 2014. To assess the participants, structured interviews, anthropometric measurements, liver ultrasound, biochemical, and serological tests were performed on both occasions. Results 2985 individuals were recruited in 2007 [54.8% women, median age (IQR) 53 (47-59)]; 737 had T2DM [baseline prevalence 24.7% (95% CI: 23.1–26.2)] and 525 had PDM [baseline prevalence 17.9% (95% CI: 16.2-19.6)]. 2148 (71.6%) attended follow-up in 2014 [57.5% women; median (IQR) 60 (54–66) years], which included 1650 who did not have T2DM in 2007. By 2014, 436/1650 (27.6%) had developed new T2DM [annual incidence 3.9% (95% CI:3.0-4.9)]. On logistic regression, PDM, central obesity, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD) at baseline showed significant association with new-onset T2DM. Of 525 with PDM in 2007, 365 (69.5%) presented for follow-up in 2014; 147/365 (40.3%) remained in PDM, 201/365 (55.1%) had progressed to T2DM and 17/365 (4.6%) had reverted to normoglycemia. Annual conversion rate of PDM to T2DM was 7.9%. Increase in waist circumference and low HDL from baseline predicted progression to T2DM. Conclusions Presence of features of the metabolic syndrome at baseline predicted new-onset T2DM and conversion of PDM to T2DM. Targeted lifestyle interventions are essential for individuals with metabolic risk to prevent future T2DM.

Patients with thalassemia syndromes(TS) affected with COVID 19 attending a thalassemia center in Sri Lanka situated in the region most affected with COVID 19 were studied over a 16- month period. To assess the collateral effects on overall thalassemia care in the center, data on transfusion, chelation, clinic attendance was analyzed. Morbidity events and deaths recorded during the COVID 19 period and a similar period before the beginning of COVID 19 infection in Sri Lanka too were reordered in all clinic registrants. Seven patients (of 502) with TS had developed COVID 19 during the 16-month period and all were minimally symptomatic and had recovered without complications. Number of monthly clinic visits reduced from 338 in pre-COVID19 to 268 during COVID-19 (P = 0.004). Iron chelators usage too reduced during pandemic period (P < 0.001). Though admissions related to morbidity reduced during the pandemic (58 vs 16, P <0.001) there were more non COVID19 deaths (8 vs 4). Numbers affected with COVID 19 and the severity of infection seemed milder in this cohort of patients with TS but the collateral effects on the management of the unit and its effects on mortality in this vulnerable population appears to have been substantial.