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Shah K, Tiwaskar M, Chawla P, Kale M, Deshmane R, Sowani A. Hypoglycemia at the time of Covid-19 pandemic. Diabetes Metab Syndr 2020; 14:1143-1146. [PMID: 32668399 PMCID: PMC7347476 DOI: 10.1016/j.dsx.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypoglycemia is the limiting factor in the glycemic management of diabetes, which need to be addressed critically to avoid complications. Lockdown because of new coronavirus strain (COVID-19) pandemic has further complicated the issue of hypoglycemia due to limitations in access to food, outpatient clinics, pathological services and medicines. AIM To assess the factors associated with the risk of hypoglycemia during April-May 2020 lockdown in people with type 2 diabetes mellitus. METHODOLOGY We analyzed the data retrospectively from 146 patients of type 2 diabetes mellitus (T2DM) reporting to the emergency department (ED) during lockdown period with symptoms suggestive of hypoglycemia. RESULTS The majority of patients were male (90/146) with a mean age of 59.88 ± 10.09 years and a mean random blood glucose level of 57.67 ± 9.00 mg/dL. Two-third of patients (70.83%) had level 1 hypoglycemia, while level 2 hypoglycemia was reported in 29.16% of patients. A combination of Metformin and Sulfonylureas (SU) was most commonly associated with the risk of hypoglycemia (65.75%) followed by insulin (33.56%). Subjects who received insulin reported a lower blood glucose value (50.75 ± 8.20 mg/dL) as compared to those receiving a combination of metformin and SU (60.95 ± 7.10 mg/dl). 330.56% of patients who had received prophylaxis hydroxychloroquine (HCQ) 400 mg twice a day along with the routine anti-hyperglycemic agents without their dose adjustment reported hypoglycemia. Patients with hypertension, micro-vascular, macro-vascular complications, and coexistent with each other had a higher propensity to the risk of hypoglycemia (46.58%, 33.56%, 23.29%, and 32.88%) respectively. CONCLUSION The COVID-19 lockdown has shown to influence the risk of hypoglycemia in patients with T2DM, especially those receiving SU, insulin, HCQ especially in patients with associated co-morbidities. Patient education, support, and telemedicine plays a pivotal role to prevent hypoglycemia.
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Affiliation(s)
| | | | - Purvi Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, India.
| | - Mayura Kale
- Dr Kale's Diabetes and Psychiatry Clinic, India.
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Vora A, Tiwaskar M. Favipiravir. J Assoc Physicians India 2020; 68:91-92. [PMID: 32738849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Agam Vora
- Chest Physician, Vora Clinic, Mumbai, Maharashtra
| | - Mangesh Tiwaskar
- Physician and Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
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Tiwaskar M, Vora A. COVID 19 in India: What we have Accomplished so Far. J Assoc Physicians India 2020; 68:11-12. [PMID: 32738833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mangesh Tiwaskar
- Physician and Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Agam Vora
- Chest Physician, Vora Clinic Mumbai, Maharashtra
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Kalra S, Sahay R, Tiwaskar M, Priya G, Das S, Bantwal G. A Prospective Validation Survey to Assess Usage of Premix Insulins in Management of Diabetes with Respect to the Recommendations Enlisted in Indian Guidelines. J Assoc Physicians India 2020; 68:20-25. [PMID: 32610874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Widely used in the management of diabetes, the premix insulin therapy is influenced by several patient preferences and physician choices. The present survey aims to provide specific recommendations based on published data for appropriate management of T2DM with premix insulins. METHODS We administered an online questionnaire where the respondent physicians were requested to go-through the published India specific and international guidelines before the survey. The respondents were requested to answer the electronic survey based on their clinical experiences with patients having diabetes. RESULTS Overall, 1408 doctors participated in the survey. Majority of physicians preferred a premix insulin regimen for initiation. Short-term therapy with premix insulins in insulin-naive T2DM patients with symptomatic hyperglycemia and/ or glucotoxicity was strongly recommended by 40.7% physicians. Initiation of insulin early in the course of T2DM was recommended by 58.7% of physicians in cases where glycemic goals were not achieved by non-insulin drugs. Premix insulin analogues were preferred over human premix insulins by more than half of participating physicians (52.2%). Premix insulin analogues were preferred over basal insulins by 49.8% of physicians. Nearly half (44.5%) of the physicians recommended initiation of twice daily premix analogues over once daily basal insulins to achieve recommended glycemic targets. Around forty two percent (41.9%) physicians strongly believed that twice daily/thrice daily premix insulin analogues provide comparable glycemic control and safety to basal plus regimen with additional benefit of simplicity. During Ramadan premix insulin analogues were recommended over human premix by 46.5% physicians in view of improved safety and flexibility of dosing. SUMMARY Majority of Indian physicians concur with the recommendations of INCG 2017 guidelines. Premix insulins were preferred for insulin initiation. IDegAsp was preferred over other premix insulins by majority of physicians. Twice daily premix insulins were recommended for intensification.
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Affiliation(s)
- Sanjay Kalra
- Department of Diabetes and Endocrinology, Bharti Hospital, Karnal, Haryana
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, Telangana
| | | | | | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Orissa
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College Hospital, Bengaluru, Karnataka
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Arulrhaj S, Joshi SR, Shah SN, Tiwaskar M, Nadkar M, Vora A. API Guidelines on Immunizations during COVID 19 Pandemic. J Assoc Physicians India 2020; 68:58-60. [PMID: 32610881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Arulrhaj
- President, The Association of Physicians of India
| | | | | | - Mangesh Tiwaskar
- Honorary General Secretary, The Association of Physicians of India
| | - Milind Nadkar
- Honorary Editor Journal of The Association of Physicians of India
| | - Agam Vora
- Member of Governing Body, The Association of Physicians of India
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Alexander T, Thomson VS, Malviya A, Mohan B, Wander GS, S H, Seth S, Reddy S, Arulrhaj S, Shah S, Joshi S, Tiwaskar M, Nadkar M, Tewary K. Guidance for Health Care Providers on Management of Cardiovascular Complications in Patients Suspected or Confirmed with COVID 19 Virus Infection. J Assoc Physicians India 2020; 68:46-49. [PMID: 32610866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - S Arulrhaj
- Sundaram Arulrhaj Hospitals, Tuticorin, Tamil Nadu
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Tiwaskar M. Perception, Approach and Management of Loss of Appetite: A Cross-sectional, Questionnaire based Physician Survey. J Assoc Physicians India 2020; 68:55-60. [PMID: 32009364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Patients with acute and chronic illness experience loss of appetite (LOA). Timely diagnosis and accurate clinical management are crucial to prevent nutritional deficiencies and malnutrition. There is a paucity of information on physician's perception, approach, and practices in treating LOA during illnesses in India. The aim of this study was to assess the need gap by evaluating physicians' perception and approach towards LOA. METHODS This cross-sectional, non-interventional, observational, multicentric, questionnaire-based survey was conducted by telephonically interviewing 300 physicians (general physicians [GP]: 150; consultant physicians [CP]: 75; and pediatricians [PP]: 75) across India. All the parameters were summarized using descriptive statistics. RESULTS Mean years of experience for GPs were 16 years and that for CPs and PPs were 15 years. About 27% of GPs and 47% of CPs highlighted the importance of patient counseling and 39% of PPs proposed information leaflets, awareness campaigns to improve awareness. Overall, 98% and 93% of the physicians responded that patients with acute illnesses and chronic illnesses, respectively also have LOA. The most common age of patients presenting with LOA was below 12 years. Common symptoms presenting with LOA were weakness and fatigue. Patients are mostly concerned for LOA because of weakness as per 44% of CPs and GPs. Improving nutritional deficiency was considered as the reason to treat LOA by 59% physicians and 40% PPs. Multivitamin and multimineral containing appetite-stimulating preparations were preferred for LOA by 54% physicians. Overall, 58% of the physicians recommended appetite-stimulating tonics for one month, while 34% recommended them for 2 weeks. CONCLUSION Nearly all the patients with acute or chronic illnesses have LOA with weakness and fatigue as the most common presenting symptoms. There is a need to increase awareness among physicians to implement clear guidelines for the diagnosis and management of LOA. Majority of the physicians considered appetite-stimulating tonics as appropriate for the management of LOA.
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Tiwaskar M. Perception, Approach and Management of Loss of Appetite: A Questionnaire based Physician Survey. J Assoc Physicians India 2020; 68:106. [PMID: 31979974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Das AK, Kalra S, Tiwaskar M, Bajaj S, Seshadri K, Chowdhury S, Sahay R, Indurkar S, Unnikrishnan AG, Phadke U, Pareek A, Purkait I. Expert Group Consensus Opinion: Role of Anti-inflammatory Agents in the Management of Type-2 Diabetes (T2D). J Assoc Physicians India 2019; 67:65-74. [PMID: 31801334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diabetes is a major public health emergency of the 21st century. Results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study have found prevalence of diabetes and prediabetes in India to be as high as 7.3% and 10.3%, respectively with nation-wide projection of 77.2 million people with prediabetes and 69.2 million with diabetes. It is well established that insulin resistance (IR) and islet β-cell failure are the two major features of T2D Multiple mechanisms including glucotoxicity, lipotoxicity, oxidative stress, endoplasmic reticulum stress, formation of amyloid deposits in the islets, etc. have been hypothesized to participate in the pathology of the disease. In the concluding decade of the last century, numerous studies - prospective and cross-sectional, have confirmed the role of chronic low-grade inflammation as a pathogenetic factor of T2D. It has been shown that increased levels of various inflammatory markers and mediators including fundamental markers like white blood cell count, C-reactive protein (CRP) to the more specific circulating cytokines like, interleukin-6 (IL-6), IL-1β, plasminogen activator inhibitor-1 (PAI-1), etc. correlate with incident T2D. Based on the robust evidence implying the role of inflammation in T2D pathogenesis, several studies have proven that the proinflammatory cytokines play a central role in the development of microvascular diabetic complications such as nephropathy, retinopathy, and neuropathy. Inflammation in T2D causes accelerated atherosclerosis which predisposes to CVD, the leading cause of mortality in these patients. Recently there is a considerable increase in the interest among the researchers about anti-inflammatory therapies in the setting of chronic disorders such as T2D and CV diseases. In a multi-country study conducted in Asia, approximately 50% of Indian respondents had poor diabetes control. Most patients initially respond to sulfonylurea and/or metformin, and later these agents lose their effectiveness with time. Therapeutic option in patients uncontrolled on two-drug combination therapy is either to add third oral drug or insulin. However, use of insulin is limited due to its high cost and poor compliance. Majority of new treatment options like GLP1 agonists, insulin analogs and SGLT2 inhibitors are costly considering they are still under patent. The thiazolidinedione class of drugs is associated with adverse effects like fluid retention and weight gain that may result in or exacerbate edema and congestive heart failure. Thus there is a need for a safe and inexpensive treatment option for the management of uncontrolled T2D. Considering the role of inflammation in T2D pathogenesis, the drug should not only have antihyperglycemic effects but also reduce inflammatory burden thus reducing the progression and complications of T2D. The current interest is apparently directed towards drugs targeting inflammation acting at different stages of the inflammatory cascade. In the recently published CANTOS study, canakinumab, a selective, high-affinity, fully human monoclonal antibody which inhibits IL-1β, has no consistent long-term benefits on HbA1c. Other selective inhibitors like anakinra (IL-1 receptor antagonist) and etanercept (TNF inhibitor) too have yielded modest effects on glycemic parameters and insulin sensitivity. However, hydroxychloroquine (HCQ), a broad anti-inflammatory agent has been shown to reduce HbA1c by 0.87%. Hydroxychloroquine (HCQ) is considered as one of the safest disease modifying anti-rheumatic drug, used widely for the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The effect of HCQ in preventing development of diabetes in patients with chronic inflammatory diseases was highlighted in a prospective observational study of 4905 adults with rheumatoid arthritis and no diabetes with 21.5 years of follow-up. Patients who took HCQ for more than 4 years had a significant 77% lower risk of diabetes compared with non users of HCQ (RR, 0.23; 95% CI, 0.11-0.50). Taking cue from this study highlighting the anti-diabetic effect of HCQ, pioneering research studies evaluating these effects of HCQ were conducted in India. In 2014, hydroxychloroquine 400 mg got DCGI approval as an adjunct to diet and exercise to improve glycemic control of patients on metformin, sulfonylurea combination in Type 2 diabetes.
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Affiliation(s)
- A K Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry , Corresponding Author
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
| | - M Tiwaskar
- Department of Medicine, Shilpa Medical Research Center, Mumbai, Maharashtra
| | - S Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - K Seshadri
- Visiting Professor, Sri Balaji Vidhyapeeth, Pondicherry
| | - S Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal
| | - R Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana
| | - S Indurkar
- Consulting Diabetologist, Aurangabad, Maharashtra
| | | | - U Phadke
- Ruby Hall Clinic, Pune, Maharashtra
| | - A Pareek
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
| | - I Purkait
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
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Unnikrishnan AG, Saboo B, Joshi S, Kesavadev J, Makkar BM, Agarwal S, Aravind SR, Seshadri K, Chawla M, Deshpande N, Chawla R, Tiwaskar M. Consensus Statement on Use of Ambulatory Glucose Profile in Patients with Type 2 Diabetes Mellitus Receiving Oral Antidiabetic Drugs. J Assoc Physicians India 2019; 67:76-83. [PMID: 31793278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Glucose monitoring is an important aspect of diabetes care. The traditional methodologies of blood glucose monitoring such as fasting plasma glucose, post prandial glucose, glycosylated hemoglobin and self-monitoring of blood glucose do not adequately address hypoglycemia and glycemic variability, which are two important risk factors for diabetes-related complications. Ambulatory glucose profile (AGP) developed from a continuous glucose monitoring system is a simplified report, with standardized statistics and targets and visual representation of time in standardized glycemic ranges, glucose variability, and glycemic exposure over a single 24-h day. The role of AGP in T2DM patients who are on oral anti-diabetic drugs (OADs) is still not clearly defined. An expert group of endocrinologists and diabetologists met in Pune, India to discuss the role of AGP in T2DM patients on OADs. This article aims to discuss the consensus of the expert group on the role of AGP in T2DM patients on OADs and also reviews the various aspects of AGP and its interpretation; and the available evidences for disease management including treatment options based on AGP report.
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Affiliation(s)
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat
| | - Shashank Joshi
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | | | - B M Makkar
- Dr.Makkar's Diabetes and Obesity Centre, New Delhi
| | | | | | | | | | | | | | - Mangesh Tiwaskar
- Riddhi Vinayak Critical Care and Cardiac Centre, Mumbai, Maharashtra
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Kalra S, Das AK, Sahay RK, Baruah MP, Tiwaskar M, Das S, Chatterjee S, Saboo B, Bantwal G, Bhattacharya S, Priya G, Chawla M, Brar K, Raza SA, Aamir AH, Shrestha D, Somasundaram N, Katulanda P, Afsana F, Selim S, Naseri MW, Latheef A, Sumanatilleke M. Consensus Recommendations on GLP-1 RA Use in the Management of Type 2 Diabetes Mellitus: South Asian Task Force. Diabetes Ther 2019; 10:1645-1717. [PMID: 31359367 PMCID: PMC6778554 DOI: 10.1007/s13300-019-0669-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 12/17/2022] Open
Abstract
The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numerous benefits, several national and international guidelines are working towards addressing clinical questions pertaining to the optimal use of GLP-1 RAs for the management of diabetes. Although the newer class of drugs are associated with significant benefits such as patient-centric approach, these drugs demand the providers to be vigilant and knowledgeable about the medication. The South Asian population is at higher risk of type 2 diabetes mellitus (T2DM) because of their genetic predisposition and lifestyle changes. Hence, prevention and management of T2DM and its associated complications in this population are of paramount importance. The current report aims to present an overview of current knowledge on GLP-1 RAs based on pragmatic review of the available clinical evidence. In addition, this report is a consensus of expert endocrinologists representing South Asian countries including India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan and the Maldives on essential recommendations related to the use of GLP-1 RAs in a real-world scenario.
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Affiliation(s)
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | | | | | | | - Sambit Das
- Hi Tech Medical College and Hospital, Bhubaneshwar, India
| | | | | | | | | | | | | | | | - Syed Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Centre and National Defence Hospital, Lahore, Pakistan
| | | | | | | | | | | | - Shahjada Selim
- Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | | | - Ali Latheef
- Department of Medicine, Indra Gandhi Hospital, Male, Maldives
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Tiwaskar M. INSIGHTS (INSITES) on DPP 4 Inhibitors (Gliptins) for Diabetes Management in India. J Assoc Physicians India 2019; 67:11-12. [PMID: 31571444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Karuna Hospital, Mumbai, Maharashtra
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Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, Sahay R, Shukla R, Das S, Tiwaskar M, Vijayakumar G, Chawla M, Eliana F, Suastika K, Orabi A, Rahim AAA, Uloko A, Bahendeka S, Abdela AA, Mohammed F, Pathan F, Rahman MH, Afsana F, Selim S, Moosa M, Murad M, Shreshtha PK, Shreshtha D, Giri M, Hussain W, Al-Ani A, Ramaiya K, Singh S, Raza SA, Aye TT, Garusinghe C, Muthukuda D, Weerakkody M, Kahandawa S, Bavuma C, Ruder S, Vanny K, Khanolkar M, Czupryniak L. Glucocrinology of Modern Sulfonylureas: Clinical Evidence and Practice-Based Opinion from an International Expert Group. Diabetes Ther 2019; 10:1577-1593. [PMID: 31267358 PMCID: PMC6778594 DOI: 10.1007/s13300-019-0651-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 12/16/2022] Open
Abstract
AIM The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). BACKGROUND Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. RESULTS The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs. CONCLUSIONS Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes. FUNDING Sanofi India.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - M P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspecialty Care, Siliguri, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital Ltd., Kanpur, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, India
| | - G Vijayakumar
- Department of Diabetology, Apollo Hospitals, Chennai, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Ketut Suastika
- Indonesian Association of Endocrinology, Jakarta, Indonesia
| | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Andrew Uloko
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Silver Bahendeka
- Department of Internal Medicine, Diabetes and Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Fariduddin Mohammed
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Shajada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muaz Moosa
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Dina Shreshtha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - Mimi Giri
- Department of Endocrinology, Nepal Mediciti Hospital, Kathmandu, Nepal
| | - Wiam Hussain
- Department of Endocrinology and Diabetes, Dr Wiam Clinic, Royal Hospital, Awali Hospital, Awali, Bahrain
| | - Ahmed Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - Kaushik Ramaiya
- Department of Diabetology, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Surender Singh
- Department of Internal Medicine, Aster Al Raffah Hospital, Muscat, Oman
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Hospital and Research Center, Lahore, Pakistan
| | - Than Than Aye
- Myanmar Society of Endocrinology and Metabolism, Yangon, Myanmar
| | - Chaminda Garusinghe
- Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Dimuthu Muthukuda
- Department of Endocrinology, Sri Jayawardenepura General Hospital, Sri Jayawardenepura Kotte, Sri Lanka
| | - Muditha Weerakkody
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | | | - Charlotte Bavuma
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Rwanda
| | - Sundeep Ruder
- Department of Endocrinology and Metabolism, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Koy Vanny
- Department of Diabetes and Endocrinology, Dr Koy Vanny Diabetes and Endocrine Clinic, Phnom Penh, Cambodia
| | - Manish Khanolkar
- Department of Endocrinology and Diabetes, Waikato Hospital, Hamilton, New Zealand
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Saboo B, Joshi S, Shah SN, Tiwaskar M, Vishwanathan V, Bhandari S, Jha S, Chaudhary T, Arvind SR, Chawla R, Kalra S, Hasnani D. Management of Diabetes during Fasting and Feasting in India. J Assoc Physicians India 2019; 67:70-77. [PMID: 31561693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fasting and feasting are integral part of many religions and cultures. As the amount of food and fluid intake are markedly altered during these phases, patients with diabetes are prone to higher risk of complications. Even though several guidelines for fasting and feasting are available; Indian specific recommendations are the need of the hour, because of the distinct dietary habits and the diet content (high carbohydrate) of Indians. To fill this void, the current guidelines have been developed by experts from India who extensively reviewed the literature, shared their practical knowledge and ultimately arrived at a consensus.
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Affiliation(s)
- Banshi Saboo
- Chairman, Consultant Diabetologist, Diacare Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat
| | - Shashank Joshi
- Consultant Endocrinologist, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | | | - Mangesh Tiwaskar
- Consultant Diabetologist and Physician, Shilpa Medical Centre, Mumbai, Maharashtra
| | | | - Sudhir Bhandari
- Dean and Prof of Medicine, SMS Medical College and Hospital, Jaipur, Rajasthan
| | - Sujit Jha
- Consultant Diabetologist and Physician, Max Super Speciality Hospital, Mumbai, Maharashtra
| | | | - S R Arvind
- Director and Consultant Diabetologist, Diacon Hospital, Banglore, Karnataka
| | - Rajeev Chawla
- Director and Consultant Diabetologist, Life Line Medical Centre, Delhi
| | - Sanjay Kalra
- Consultant Endocrinologist, Bharati Hospital, Karnal, Haryana
| | - Dhruvi Hasnani
- Consultant Diabetologist, DiacareDiabetes Care and Hormone Clinic, Ahmedabad, Gujarat
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Panikar V, Joshi S, Tiwaskar M, Vadgama J, Nasikkar N, Kamat T, Deogaonkar N, Walawalkar S, Sachdev I, Jain C, Modh K, Panikar K, Kulkarni P, Medidar R. Efficacy of DPP4i as the Fourth Drug in the Management of Type2 Diabetes Mellitus in Asian Indians Poorly Controlled by Use of at least 3 Oral Antidiabetic Drugs. J Assoc Physicians India 2019; 67:60-62. [PMID: 31562719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To evaluate the efficacy of DPP-4 inhibitors (DPP-4i) as the fourth drug in Asian Indian type2 DM patients uncontrolled inspite of using at least 3 oral anti diabetic drugs. METHODS A retrospective analysis of 7858 T2DM patients, who received a DPP-4i (Sitagliptin, Vildagliptin, Teneligliptin, Linagliptin and Saxagliptin) as the fourth drug to achieve glycemic control was undertaken. Patients with inadequate glycaemic control despite receiving optimum doses of at least any other three OADs were included in this analysis. RESULTS Patients were subdivided into 5 groups, based on the DPP-4i used for treatment: Sitagliptin (n=4787), Vildagliptin (n=2205), Teneligliptin (n=775), Linagliptin (n=64) and Saxagliptin (n=27). The mean fasting blood glucose (FPG) was 160.9 ± 20.4 mg/dl and mean post prandial glucose (PPG) was 227.8 ± 26.3 mg/dl. The mean baseline HbA1c was 8.2 ± 1.5 %. The mean duration required to control diabetes with all DPP-4i was 8.2 weeks with significantly lesser time with Sitagliptin (6.8 weeks, p<0.001). 81.5% of the total cases responded to treatment with a DPP-4i (P <0.05). At the end of the monitoring period, there was significant reduction in mean FPG by-28.1 ± 16.1 mg/dL(P=0.001), mean PPG by -55.3 ± 17.0 mg/dL(P=0.001), and mean HbA1c by -1.2 ± 0.7 (P= 0.001). There was no significant difference between the groups with respect to reduction in PPG and HbA1c. CONCLUSION DPP-4 inhibitors are effective in achieving desired glycaemic goals even when used as a fourth drug in patients with inadequate glycaemic control despite receiving an optimum dose of at least 3 OADs.
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Affiliation(s)
- Vijay Panikar
- Consultant, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Shashank Joshi
- Consultant, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | | | - Jimit Vadgama
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra , Corresponding Author
| | - Nikhil Nasikkar
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Tejas Kamat
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | | | | | - Ishita Sachdev
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Chandani Jain
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Khushbu Modh
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Krish Panikar
- Consultant, Dr. Panikar s Speciality Care Centre, Mumbai, Maharashtra
| | - Pallavi Kulkarni
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
| | - Rahul Medidar
- Resident, Department of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra
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Bajaj S, Das AK, Kalra S, Sahay R, Saboo B, Das S, Shunmugavelu M, Jacob J, Priya G, Khandelwal D, Dutta D, Chawla M, Surana V, Tiwaskar M, Joshi A, Shrestha PK, Bhattarai J, Bhowmik B, Latt TS, Aye TT, Vijayakumar G, Baruah M, Jawad F, Unnikrishnan AG, Chowdhury S, Pathan MF, Somasundaram N, Sumanathilaka M, Raza A, Bahendeka SK, Coetzee A, Ruder S, Ramaiya K, Lamptey R, Bavuma C, Shaikh K, Uloko A, Chaudhary S, Abdela AA, Akanov Z, Rodrìguez-Saldaña J, Faradji R, Tiago A, Reja A, Czupryniak L. BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion. Diabetes Ther 2019; 10:1189-1204. [PMID: 31102253 PMCID: PMC6612329 DOI: 10.1007/s13300-019-0629-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.
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Affiliation(s)
- Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, India
| | - A K Das
- Department of Medicine, JIPMER, Puducherry, India
| | - Sanjay Kalra
- Department of Diabetes and Endocrinology, Bharti Hospital, Karnal, India.
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, India
| | - Banshi Saboo
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - M Shunmugavelu
- Trichy Diabetes Speciality Centre (P) Ltd., Trichy, India
| | - Jubbin Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College and Hospital, Ludhiana, India
| | | | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | | | | | - Ameya Joshi
- Bhaktivedanta Hospital and Research Institute, Thane, India
| | | | | | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Than Than Aye
- University of Medicine 2, Myanmar Society of Endocrinology and Metabolism (MSEM), Yangon, Myanmar
| | - G Vijayakumar
- Apollo Specialty Hospital and Diabetes Medicare Centre, Chennai, India
| | | | - Fatema Jawad
- Journal of Pakistan Medical Association, Karachi, Pakistan
| | | | | | - Md Faruqe Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Manilka Sumanathilaka
- National Hospital of Sri Lanka, Sri Lanka College of Endocrinologists, Colombo, Sri Lanka
| | - Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Silver K Bahendeka
- Mother Kevin Postgraduate Medical School, Martyrs University, St. Francis Hospital, Kampala, Uganda
| | - Ankia Coetzee
- Division of Endocrinology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Society for Endocrinology, Diabetes and Metabolism, Cape Town, South Africa
| | - Sundeep Ruder
- Life Fourways Hospital, University of the Witwatersrand, Cape Town, South Africa
| | | | - Roberta Lamptey
- Korle Bu Teaching Hospital, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Charlotte Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Khalid Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Andrew Uloko
- College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Abdurezak Ahmed Abdela
- Department of Internal Medicine, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zhanay Akanov
- Kazakh Society for Study of Diabetes, Almaty, Kazakhstan
| | | | - Raquel Faradji
- Clinica EnDi, RENACED Diabetes Tipo 1, Escuela de Medicina, TEC-ABC, Centro Médico ABC, Sociedad Mexicana de Nutrición y Endocrinología, Mexico City, Mexico
| | - Armindo Tiago
- Mozambican Diabetic Association, Maputo Central Hospital, Maputo, Mozambique
| | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Central University Hospital, Warsaw Medical University, Warsaw, Poland
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67
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Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, Sahay R, Shukla R, Das S, Tiwaskar M, Vijayakumar G, Chawla M, Eliana F, Suastika K, Orabi A, Rahim AAA, Uloko A, Lamptey R, Ngugi N, Bahendeka S, Abdela AA, Mohammed F, Pathan MF, Rahman MH, Afsana F, Selim S, Moosa M, Murad M, Shreshtha PK, Shreshtha D, Giri M, Hussain W, Al-Ani A, Ramaiya K, Singh S, Raza SA, Aye TT, Garusinghe C, Muthukuda D, Weerakkody M, Kahandawa S, Bavuma C, Ruder S, Vanny K, Khanolkar M, Czupryniak L. Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group. Diabetes Ther 2019; 10:791-804. [PMID: 31012081 PMCID: PMC6531538 DOI: 10.1007/s13300-019-0614-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 01/12/2023] Open
Abstract
AIM To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. BACKGROUND Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient-provider communication to aid enhancement of coping skills. RESULTS After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. CONCLUSIONS Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and well-being of affected individuals. FUNDING Sanofi India.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - M P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspecialty Care, Siliguri, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital Ltd., Kanpur, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, India
| | - G Vijayakumar
- Department of Diabetology, Apollo Hospitals, Chennai, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Ketut Suastika
- Indonesian Association of Endocrinology, Jakarta, Indonesia
| | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Andrew Uloko
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, University of Ghana, School of Public Health Ghana, Accra, Ghana
| | - Nancy Ngugi
- Department of Internal Medicine and Diabetes, Kenyatta National Hospital, Nairobi, Kenya
| | - Silver Bahendeka
- Department of Internal Medicine, Diabetes and Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Fariduddin Mohammed
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - Mohammed Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Shajada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muaz Moosa
- Department of internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Moosa Murad
- Department of internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Dina Shreshtha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Kathmandu, Nepal
| | - Mimi Giri
- Department of Endocrinology, Nepal Mediciti Hospital, Kathmandu, Nepal
| | - Wiam Hussain
- Department of Endocrinology & Diabetes, Dr Wiam Clinic, Royal Hospital, Awali Hospital, Awali, Bahrain
| | - Ahmed Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - Kaushik Ramaiya
- Department of Diabetology, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Surender Singh
- Department of Internal Medicine, Aster Al Raffah Hospital, Muscat, Oman
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Hospital and Research Center, Lahore, Pakistan
| | - Than Than Aye
- Myanmar Society of Endocrinology and Metabolism, Yangon, Myanmar
| | - Chaminda Garusinghe
- Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Dimuthu Muthukuda
- Department of Endocrinology, Sri Jayawardenapura General Hospital, Sri Jayawardenapure Kotte, Sri Lanka
| | - Muditha Weerakkody
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | | | - Charlotte Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Sundeep Ruder
- Department of Endocrinology and metabolism, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Koy Vanny
- Department of Diabetes and endocrinology, Dr KoyVanny Diabetes & Endocrine Clinic, Phnom Penh, Cambodia
| | - Manish Khanolkar
- Department of Endocrinology and Diabetes, Waikato Hospital, Hamilton, New Zealand
| | - Leszek Czupryniak
- Department of Diabetology & Internal Medicine, Medical university of Warsaw, Warsaw, Poland
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68
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Tiwaskar M. Cefixime-ofloxacin Combination in the Management of Uncomplicated Typhoid Fever in the Indian Community Setting. J Assoc Physicians India 2019; 67:75-80. [PMID: 31304712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Antimicrobial resistance is a global problem and is definitely a cause of concern in India too, in the context of typhoid fever. It is becoming clearer that monotherapy is not effective for typhoid fever and the option to be considered is combination therapy. There are very few antibiotic combinations that are approved and backed by clinical evidence, available in India for the treatment of typhoid fever. Cefixime-ofloxacin combination is approved by Indian Regulatory Authority and has a good body of clinical evidence in the current Indian context. In-silico studies have demonstrated positive rationale of combining these two drugs, while in-vitro studies have substantiated the same by showing a strain specific synergistic and or additive activity between the two drugs against S. typhi. Clinical studies in Indian patients have shown multiple benefits of using this combination in typhoid fever such as a quick time to defervescence (~3 days), complete clinical cure in ~7 days, effective symptomatic relief, efficacy in relapse cases and a reduced need for hospitalization. The drug combination also demonstrates a very good tolerability profile. Recommendations of the Association of physicians of India also back this combination in typhoid fever. Thus, in the current era of emerging antibiotic resistance, cefixime-ofloxacin is a safe, effective and reliable treatment option for clinicians to treat uncomplicated typhoid in the Indian community setting.
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Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Asian Heart Institute, Mumbai, Maharashtra
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69
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Viswanathan V, Krishnan D, Kalra S, Chawla R, Tiwaskar M, Saboo B, Baruah M, Chowdhury S, Makkar BM, Jaggi S. Insights on Medical Nutrition Therapy for Type 2 Diabetes Mellitus: An Indian Perspective. Adv Ther 2019; 36:520-547. [PMID: 30729455 PMCID: PMC6824451 DOI: 10.1007/s12325-019-0872-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Indexed: 02/07/2023]
Abstract
It is critical to integrate medical nutrition therapy (MNT) provided by a registered dietician (RD) into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DM in India, based on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60-70%), proteins (~ 20%) and fats (10%) that will be acceptable and beneficial in an Indian T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care. It outlines a step-wise approach to MNT involving a careful interplay of nutrition assessment, diagnosis, individualization and patient counseling. Overall, the success of MNT relies on providing accurate, acceptable and appropriate dietary choices for continued patient adherence. Collaborative efforts from diabetologists, endocrinologists, internists and RDs are required to prioritize and implement MNT in diabetes practice in India.Funding: Signutra Inc.
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Affiliation(s)
- Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), Chennai, Tamil Nadu, India
| | | | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India.
| | | | | | - Banshi Saboo
- Dia Care-Diabetes and Hormone Centre, Ahmedabad, Gujarat, India
| | | | - Subhankar Chowdhury
- Institute of Postgraduate Medical Education and Research/SSKM Hospital, Kolkata, India
| | - B M Makkar
- Diabetes and Obesity Center, New Delhi, India
| | - Shalini Jaggi
- Dr. Mohan's Diabetes Specialties Centre, New Delhi, India
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Kalra S, Sahay R, Tiwaskar M. Need for Insulin Stewardship Programmes. J Assoc Physicians India 2018; 66:83-84. [PMID: 31325271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sanjay Kalra
- Consultant Endocrinologist, Bharti Hospital, B.R.I.D.E., Karnal, Haryana
| | - Rakesh Sahay
- Consultant Endocrinologist, Osmania Medical College, Hyderabad, Telangana
| | - Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Shilpa Medical Research Centre, Dahisar East, Mumbai, Maharashtra
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71
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Tiwaskar M, Langote A, Kashyap R, Toppo A. Amlodipine in the Era of New Generation Calcium Channel Blockers. J Assoc Physicians India 2018; 66:64-69. [PMID: 30341872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Amlodipine is a classical drug with varied properties extending from control of blood pressure to as an antianginal and anti atherosclerotic agent. Amlodipine is a longer acting dihydropyridine calcium channel blocker, effective for 24 hours BP control and cause no BP variability. It is a powerful, well-tolerated, and safe antihypertensive agents that is widely used either alone or as a key component of combination therapy for hypertension. Its effective BP reduction has shown proven benefits in cardiovascular event reduction that is supported with strong evidences from large randomised controlled trials. Combination therapies of amlodipine with other agents eliciting renin-angiotensin-aldosterone system blockade (angiotensin II receptor blockers or renin inhibitors) have shown effective blood pressure-lowering strategies in CV risk reduction and progression of renal disease. Novel type of calcium channel blockers have been developed which have additional properties of blocking T and N subtypes of calcium channels and apart from their class effects they exerts specific action on heart rate and renin aldosterone system. They are considered to be more renoprotective due to this additional properties. Amlodipine is most potent and longer acting agent compared to the newer CCBs, its effectiveness in BP lowering still makes it the agent of choice among all the CCBs.
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Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Asian Heart Institute, Mumbai, Maharashtra
| | - Amit Langote
- Consultant Nephrologist and Transplant Physician, Apollo Hospital, Nerul, Navi Mumbai, Maharashtra
| | | | - Archana Toppo
- Associate Director, Dr. Reddys Lab Ltd., Ameerpet, Hyderabad, Telangana
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72
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Tiwaskar M. Hypertension and Hyperuricemia: A Compelling Correlation. J Assoc Physicians India 2018; 66:11-12. [PMID: 30341838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The long-term effects of hypertension are well-known and India is especially vulnerable to its impact. Since SUA levels are strongly correlated with hypertension, evaluation of SUA levels in patients at risk for hypertension and in those suffering from hypertension should be done as early as possible in the course of the disease. Treatment of hyperuricemia in hypertension with appropriate therapy may thus be a valuable addition to its management.
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Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Asian Heart Institute and Research Centre, Mumbai, Maharashtra
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Nadkar MY, Tiwaskar M, Kalra S, Shah SN, Bansode BR, Dutta A, Bajaj S, Aggarwal S, Balhara YPS, Das AK, Dhamija P, Gupta YK, Jacob J, Mishra S, Narasingan SN, Ponde CK, Prabhoo R, S B, Sahay M, Sahay RK, Sathyamurthy I, Tiwaskar S, Vora A. Association of Physicians of India: Position Statement on Role of Chirally Pure Molecules in Clinical Practice. J Assoc Physicians India 2017; 65:49-60. [PMID: 29327523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chirally pure molecules or enantiomers are non-superimposable mirror images of each other with a chiral center (such as carbon, sulphur, nitrogen or phosphorous atom). An equimolar mixture of enantiomers forms a racemate. Chirally pure molecules (single enantiomers) are important in the field of drug discovery as the drug targets such as enzymes and receptors are enantioselective in nature. Clinical studies have demonstrated that chirally pure drugs exhibit different pharmacokinetic and metabolic profiles, reduced adverse events, improved safety profiles and similar therapeutic activity at lowered drug dosage as compared with the racemate in many therapeutic areas. However, since there is a low level of awareness on the advantages of chirally pure molecules among clinicians, pharmacists and patients in India, the Association of Physicians of India (API) developed this position statement to increase awareness on the concept of chirality and the associated advantages of using chirally pure drugs in certain therapeutic areas to maximize patient outcomes. This includes the clinical evidence associated with single enantiomers such as S-metoprolol, S-amlodipine, esomeprazole, escitalopram, levobupivacaine, cisatracurium, S-etodolac, dexketoprofen, levofloxacin in terms of efficacy and safety as compared with their racemates. In addition, the API also provides some tactical recommendations for clinicians, pharmacists, patients, regulatory body and pharmaceutical companies to increase awareness on chirally pure drugs and puts forth the need for expedited availability of chirally pure drugs in the Indian market.
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Affiliation(s)
- Milind Y Nadkar
- Department of Medicine and Rheumatology, Seth GS Medical College, Mumbai, Maharashtra
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Center, Mumbai, Maharashtra
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana
| | - Siddharth N Shah
- Department of Diabetology, Bhatia Hospital, Saifee Hospital, S.L. Raheja Hospital and Reliance H.N. Hospital, Mumbai, Maharashtra
| | - B R Bansode
- Department of Medicine & Cardiology, Bharat Ratna Dr. Babasaheb Ambedkar Memorial Hospital, Mumbai, Maharashtra
| | - Anjanlal Dutta
- Department of Cardiology, Peerless Hospital, Kolkata, West Bengal
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - Sameer Aggarwal
- Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Haryana
| | | | - A K Das
- Department of Medicine and Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry
| | - Puneet Dhamija
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Y K Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi
| | - Jubbin Jacob
- Endocrine and Diabetes Unit, Christian Medical College and Hospital, Ludhiana, Punjab
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
| | - S N Narasingan
- Prof. M Vishwanathan Diabetes Research Center and SNN Specialties Clinic and Diagnostic Center, Chennai, Tamil Nadu
| | - C K Ponde
- Department of Cardiology, P.D. Hinduja National Hospital, Mumbai, Maharashtra
| | - Ram Prabhoo
- Department of Orthopedics, Mukund Hospital, Mumbai, Maharashtra
| | - Balakrishnan S
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and Hospital, Hyderabad, Telangana
| | - R K Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, Telangana
| | - I Sathyamurthy
- Department of Interventional Cardiology, Apollo Hospitals, Chennai, Tamil Nadu
| | - Shilpa Tiwaskar
- Department of Anesthesiology, Bhaktivedant Hospital, Mumbai, Maharashtra
| | - Agam Vora
- Department of Chest and Tuberculosis, Vora Clinic, Mumbai, Maharashtra
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Sahay M, Kalra S, Badani R, Bantwal G, Bhoraskar A, Das AK, Dhorepatil B, Ghosh S, Jeloka T, Khandelwal D, Latif ZA, Nadkar M, Pathan MF, Saboo B, Sahay R, Shimjee S, Shrestha D, Siyan A, Talukdar SH, Tiwaskar M, Unnikrishnan AG. Diabetes and Anemia: International Diabetes Federation (IDF) - Southeast Asian Region (SEAR) position statement. Diabetes Metab Syndr 2017; 11 Suppl 2:S685-S695. [PMID: 28483426 DOI: 10.1016/j.dsx.2017.04.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
Anemia is often associated with diabetes mellitus and is known to intensify the risk of developing diabetes-related microvascular and macrovascular complications. There is paucity in understanding of co-existence of these conditions, especially in Southeast Asian countries. Iron and/or erythropoietin deficiencies are the major causes of anemia in diabetes, and diabetic kidney disease plays a key role. Patients with diabetes need to be screened for anemia along with other risk factors and anemia should be corrected appropriately to improve overall clinical outcomes. This position statement aims to provide a comprehensive overview and an algorithm for appropriate management of anemia in patients with diabetes.
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Affiliation(s)
| | | | | | | | | | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | | | | | | | | | - Milind Nadkar
- Seth G.S. Medical College & KEM Hospital, Mumbai, India
| | | | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, India
| | | | | | | | - Ali Siyan
- Maldivian Diabetes Society, Male, Maldives
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75
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Balhara YPS, Kalra S, Kuppili PP, Kalaiselvan V, Unnikrishnan AG, Tiwaskar M, Sharma PK, Sahay M, Sahay R, Saboo B, Nadkar MY, Muruganathan A, Khandelwal D, Jeloka T, Ghosh S, Dhorepatil B, Dhamija P, Das AK, Bantwal G, Badani R. Indian College of Physicians Position Statement: Addictive Disorders Among Persons with Diabetes Mellitus. J Assoc Physicians India 2017; 65:11-12. [PMID: 31556275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Migraine, a common primary headache disorder which can be severely disabling, associated with poor health-related quality of life (HRQoL) amongst affected patients. The present study was performed to provide adequate clinical data on migraine and the management practices in India. MATERIAL AND METHODS A cross-sectional study was designed to assess disease burden, HRQoL, symptom profile, management trends and comorbidities associated with migraine patients across ten centres in India. This study assessed HRQoL using Migraine Specific Quality of life (MSQ) and Migraine Disability Assessment Scores (MIDAS) questionnaire. Categorical variables were summarized as frequency, and percentage and continuous variables as mean and standard deviation respectively. RESULTS A total of 705 patients were enrolled with a mean age of 35.2 years. Hypertension (7.0%) was the highest co-morbid illness associated with migraine. A higher MSQ score was observed in females as compared to males (39.3±12.4 and 37.4±11.6) while MIDAS showed a comparable score (27.7±47.6 and 27.2±35.4). Majority of migraine patients were unemployed (61.6%) and in profession, females had poor HRQoL than males by MIDAS and MSQ. Majority of patients had pulsating, bilateral attacks for the duration of 4h to 72 h. Paracetamol (47.1%) and propranolol (50.9%) was most commonly prescribed drugs for acute attack and prophylaxis, respectively. CONCLUSION The quality of life was superior in males as compared to females amongst migraine patients in India. Hypertension was the commonest comorbidity associated with migraine. KEY MESSAGES Migraine is associated with substantial disability with higher prevalence in females and older people (age >40 years). NSAIDs and propanol was widely prescribed drug in acute attacks and prophylaxis of migraine respectively. Cardiovascular diseases, diabetes mellitus and anxiety were common comorbidities associated with migraine.
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Affiliation(s)
| | | | | | - V Kalaiselvan
- Indian Pharmacopeia Commission, Ghaziabad, Uttar Pradesh
| | | | | | | | | | | | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat
| | - Milind Y Nadkar
- Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
| | | | | | - Tarun Jeloka
- Aditya Birla Memorial Hospital, Pune, Maharashtra
| | | | | | - Puneet Dhamija
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry
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76
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Anjana RM, Kesavadev J, Neeta D, Tiwaskar M, Pradeepa R, Jebarani S, Thangamani S, Sastry NG, Brijendra Kumar S, Ramu M, Gupta PPK, Vignesh J, Chandru S, Kayalvizhi S, Jagdish PS, Uthra SCB, Lovelena M, Jyoti S, Suguna Priya S, Kannan A, Mohan V, Unnikrishnan R. A Multicenter Real-Life Study on the Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 and Type 2 Diabetes. Diabetes Technol Ther 2017; 19:533-540. [PMID: 28930495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
AIM To assess the efficacy of ambulatory glucose profiling (AGP) generated by FreeStyle LibrePro™ flash glucose monitoring (FCGM) on glycemic control in patients with uncontrolled type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS Clinical and biochemical data were obtained from 5072 patients with diabetes who had an A1c ≥7% (2536 who had been initiated on FCGM-based AGP between March 2015 and October 2016 [cases] and 2536 age-, gender-, A1c-, site- and time-matched controls who were not initiated on AGP) across seven diabetes clinics in India. Anthropometric and clinical measurements were obtained through standardized techniques. Fasting and postprandial plasma glucose and glycated hemoglobin(A1c) were estimated before and after initiation of AGP. RESULTS Overall, there was a significant decrease in A1c both in cases and controls; however, the magnitude of reduction was higher among cases (1% vs.0.7%; P < 0.001).The overall reduction in A1c among cases was higher in T2D (9.2% to 8.3%) compared with T1D (9.6% to 9.4%); however, the absolute difference in A1c reduction between cases and controls was higher among T1D (0.5% vs. 0.2%) patients. The reduction in glycemic parameters was irrespective of age or gender (P for trend <0.001) across all study sites. The greatest reductions in A1c were noted within 6 months of AGP initiation. Multiple logistic regression showed that those who did not use AGP had a 1.42 higher risk (95% CI: 1.24-1.64) of not achieving even 0.1% reduction in A1c compared with those who were initiated on AGP even after adjusting for age, gender, body-mass index, systolic blood pressure, time to follow-up A1c, and medication use. CONCLUSIONS This study shows that FCGM-based AGP with FreeStyle LibrePro is associated with significant reductions in A1c levels in both T1D and T2D. In addition, improvement in A1c levels was maintained across all age groups and in patients enrolled at different diabetes clinics in India.
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Affiliation(s)
- Ranjit Mohan Anjana
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | | | | | | | - Rajendra Pradeepa
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
- 2 Jothydev's Diabetes and Research Center , Trivandrum, Kerala, India
| | - Saravanan Jebarani
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Suresh Thangamani
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Nadiminty Ganapathi Sastry
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Srivastava Brijendra Kumar
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Muthu Ramu
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Pokal Prasanna Kumar Gupta
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Jayaprakash Vignesh
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Sundramoorthy Chandru
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Sengottuvel Kayalvizhi
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Padoor Sethuraman Jagdish
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Subash Chandra Bose Uthra
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Munawar Lovelena
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Sah Jyoti
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Sengodan Suguna Priya
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Alagarsamy Kannan
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Viswanathan Mohan
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
| | - Ranjit Unnikrishnan
- 1 Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control and ICMR Centre for Advanced Research on Diabetes , Chennai, India
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77
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Kalra S, Unnikrishnan AG, Tiwaskar M, Sahay R, Saboo B, Negalur V, Khandelwal D, Gupta P, Ghosh S, Das AK, Bantwal G, Bajaj S, Agarwal S, Aggarwal R, Agarwal N. Medication Counseling for Thyroxine. Indian J Endocrinol Metab 2017; 21:630-631. [PMID: 28670549 PMCID: PMC5477453 DOI: 10.4103/ijem.ijem_91_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This communication from the National Indian Patient-centered Thyroid Management group provides a useful tool to help in medication counseling during hypothyroidism management. The authors classify and list aspects of thyroxine use which must be discussed with patients on thyroxine supplementation or replacement. Issues related to concomitant food and medications intake, preconception and pregnancy management, as well as sick day care, are also discussed.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | | | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Mumbai, Maharashtra, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Banshi Saboo
- Department of Medicine, Dia Care Diabetes Care, Ahmedabad, Gujarat, India
| | - Vijay Negalur
- Department of Medicine, Diabetes and Thyroid Specialities Center, Thane, Maharashtra, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Pritam Gupta
- Department of Medicine, Dr. Pritam Gupta's Clinic, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology, IGPGMR, Kolkata, West Bengal, India
| | - A. K. Das
- Department of Endocrinology, JIPMER, Puducherry, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Sameer Agarwal
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
| | | | - Navneet Agarwal
- Department of Medicine, Diabetes, Obesity and Thyroid Center, Gwalior, Madhya Pradesh, India
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78
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Sahay M, Kalra S, Tiwaskar M, Ghosh S, Badani R, Bantwal G, Das AK, Dhorepatil B, Jeloka T, Khandelwal D, Nadkar MY, Saboo B, Sahay R, Unnikrishnan AG, Aggarwal S, Agrawal N, Bajaj S, Baruah MP, Chadha M, Das S, Dhamija P, Julka S, Mehta P, Shah SN, Sharma B, Muruganathan A. Indian College of Physicians Position Statement on Anemia in Metabolic Syndrome. J Assoc Physicians India 2017; 65:60-73. [PMID: 28782315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | | | | | | | | | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry
| | | | - Tarun Jeloka
- Aditya Birla Memorial Hospital, Pune, Maharashtra
| | | | - Milind Y Nadkar
- Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra
| | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat
| | | | | | - Sameer Aggarwal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana
| | - Navneet Agrawal
- Diabetes Obesity and Thyroid Centre, Gwalior, Madhya Pradesh
| | | | | | | | | | | | - Sandeep Julka
- Radiance - The Hormone Health Clinic, Indore, Madhya Pradesh
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79
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Tiwaskar M. The Double Trouble: PVD and Peripheral Neuropathy in Diabetes. J Assoc Physicians India 2017; 65:11-13. [PMID: 28598041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Karuna Hospital, Mumbai, Maharashtra
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80
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Kalra S, Agarwal N, Aggarwal R, Agarwal S, Bajaj S, Bantwal G, Das AK, Ghosh S, Gupta P, Khandelwal D, Negalur V, Saboo B, Sahay R, Tiwaskar M, Unnikrishnan AG. Patient-centered Management of Hypothyroidism. Indian J Endocrinol Metab 2017; 21:475-477. [PMID: 28553608 PMCID: PMC5434736 DOI: 10.4103/ijem.ijem_93_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This communication from the National Indian Patient-centered Thyroid management group (InPACT) deals with a novel, yet essential, aspect of hypothyroidism management. The authors describe the role and scope of patient-centered care in this condition. They focus on the relevance of a patient-centered clinical approach, which will help decide appropriate targets, as well as techniques to achieve those targets. Means of helping persons with hypothyroidism live a healthy life, such as education about precaution in concomitant food and medications intake, as well as sick day management, are discussed.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Navneet Agarwal
- Department of Medicine, Diabetes, Obesity and Thyroid Center, Gwalior, Madhya Pradesh, India
| | | | - Sameer Agarwal
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. Johns Medical College, Bengaluru, Karnataka, India
| | - A. K. Das
- Department of Endocrinology, JIPMER, Puducherry, India
| | - Sujoy Ghosh
- Department of Endocrinology, IGPGMR, Kolkata, West Bengal, India
| | - Pritam Gupta
- Department of Medicine, Dr. Pritam Gupta's Clinic, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Vijay Negalur
- Department of Medicine, Diabetes and Thyroid Specialities Center, Thane, Maharashtra, India
| | - Banshi Saboo
- Department of Medicine, Dia Care, Ahmedabad, Gujarat, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Mumbai, Maharashtra, India
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Dhamija P, Kalra S, Sharma PK, Kalaiselvan V, Muruganathan A, Balhara YPS, Badani R, Bantwal G, Das AK, Dhorepatil B, Ghosh S, Jeloka T, Khandelwal D, Nadkar MY, Patnaik KP, Saboo B, Sahay M, Sahay R, Tiwaskar M, Unnikrishnan AG. Indian College of Physicians (ICP) Position Statement on Pharmacovigilance. J Assoc Physicians India 2017; 65:63-66. [PMID: 28462545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pharmacovigilance is the art and science of detection, understanding and prevention of adverse drug reactions and not merely a critical analysis of prescriptions and errors. This field starts with reporting by clinicians of a suspected adverse drug reaction (ADR) to the pharmacologist followed by joint causality analysis and ends at the application of new information by a clinician for benefit of patients. There are a number of ways, which can be utilised for reporting adverse effects using pen and paper format to software applications for smart phones. Varied types of activities spreading from systematic reviews to the mechanistic evaluation of ADR can be performed under the umbrella of pharmacovigilance. It is of utmost importance for clinicians to understand how to identify, communicate and understand adverse effects of drugs with an aim to prevent harm to patients.
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Affiliation(s)
- Puneet Dhamija
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | | | | | - V Kalaiselvan
- Indian Pharmacopeia Commission, Ghaziabad, Uttar Pradesh
| | | | | | | | | | - A K Das
- Pondicherry Institute of Medical Sciences, Puducherry
| | | | | | - Tarun Jeloka
- Aditya Birla Memorial Hospital, Pune, Maharashtra
| | | | - Milind Y Nadkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
| | | | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat
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82
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Muruganathan A, Tiwaskar M. Significance of BP Control in Reducing Stroke Events: Role of Amlodipine in an Indian Perspective. J Assoc Physicians India 2016; 64:49-52. [PMID: 27762516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While the incidence and prevalence of stroke is gradually decreasing in the western world, a parallel increase is seen in the developing world. It is a matter of special concern to us as approximately 20-30% of stroke occur in people younger than 45 years in India. Indians are prone to higher stroke risk because of urbanization, diabetes, cigarette smoking and high incidence of hypertension. Unfortunately, there is an inadequate awareness about the risk of stroke with hypertension among general public. Hypertension is considered to be the most important risk factor for stroke, and all forms of hypertension are associated with an increased risk of both ischemic and haemorrhagic stroke. The presence of hypertension also worsens mortality in stroke. Recently, it has been increasingly observed that controlling blood pressure variability (BPV) is equally important as achieving BP reduction, and an increased BPV has been shown to increase stroke risk. Thus, effective treatment option for stroke prevention should include drugs which can reduce BPV as well. The landmark ASCOT-BPLA trial reported that the calcium channel blocker amlodipine decreases stroke risk in hypertensive patients, and attributed this beneficial effect to its effective lowering of BPV. Such beneficial effects of amlodipine were replicated in other trials as well and thus it becomes an important drug from an Indian perspective. In this review, we analyse published literature and present a picture on the effect of amlodipine in the stroke prevention in hypertensive patients.
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Affiliation(s)
- A Muruganathan
- Adjunct Professor, Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu
| | - Mangesh Tiwaskar
- Consultant Physician and Diabetologist, Asian Heart Institute, Mumbai, Maharashtra
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83
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Tiwaskar M. Hypertension Control in India: Are we there Yet? OR Uncontrolled and Resistant Hypertension: The Indian Perspective. J Assoc Physicians India 2016; 64:11-12. [PMID: 27759336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mangesh Tiwaskar
- Consultant Physician, Asian Heart Institute & Research Centre, Karuna Hospital, Mumbai, Maharashtra
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84
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Muruganathan A, Guha S, Munjal YP, Agarwal SS, Parikh KK, Jha V, Jha AK, Abeywicreme I, Tiwaskar M, Nadkar MY, Pal J, Arafat SM, Prakash A, Panda J, Ramasubramanian V, Kumari S, Saha B, Chakraborty S, Ghosh MK, Koul PA. Recommendations for Vaccination Against Seasonal Influenza in Adult High Risk Groups: South Asian Recommendations. J Assoc Physicians India 2016; 64:3-11. [PMID: 28805048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented importance of vaccination, the uptake of influenza vaccine is very poor. This document provide recommendations for influenza vaccination in high-risk individuals and help implement best practices in the South Asian region and improve coverage of influenza vaccination to achieve better outcomes in this population.
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Affiliation(s)
| | | | - Y P Munjal
- Director, Physicians Research Foundation
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bibhuti Saha
- Prof. and Head, Dept. of Tropical Medicine, School of Tropical Medicine, Kolkata
| | | | - M K Ghosh
- Asst. Professor, School of Tropical Medicine, Kolkata
| | - Parvaiz A Koul
- Prof. and Head, Dept.of Medicine and Pulmonary Medicine, Sher-i-Kashmir, Institute of Medical Sciences, Srinagar. Abstract
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Trailokya A, Hiremath JS, Sawhney J, Mishra YK, Kanhere V, Srinivasa R, Tiwaskar M. Acenocoumarol: A Review of Anticoagulant Efficacy and Safety. J Assoc Physicians India 2016; 64:88-93. [PMID: 27730796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anticoagulant treatment is required for the treatment and prevention of thromboembolic disorders. Vitamin K antagonists are commonly used oral anticoagulants worldwide. Acenocoumarol is mono-coumarin derivative with racemic mixture of R (+) and S (-) enantiomers. Efficacy and safety of acenocoumarol has been evaluated in atrial fibrillation, cardiac valve replacement, after myocardial infarction, treatment of deep vein thrombosis, after major surgeries and after critical illness requiring prolonged hospitalization. Acenocoumarol is effective and safe in all age groups. It offers an advantage over warfarin in terms of better stability of anti-coagulant effect. Due to its economic advantage acenocoumarol may be suitable oral anticoagulant for long term use in countries like India.
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Affiliation(s)
- Abhijit Trailokya
- Medical Services Division, Abbott Healthcare Private Limited, Mumbai, Maharashtra
| | - J S Hiremath
- Director, Cath Lab, Ruby Hall Clinic, Pune, Maharashtra
| | | | - Y K Mishra
- Director, Department of Cardiovascular Surgery, Fortis Escorts Heart Institute & Research Centre, Delhi
| | - Vivek Kanhere
- Consultant Cardiac Surgeon, Chirayu Cardiac Centre, Bhopal
| | - R Srinivasa
- Senior Professor of Neurology and Head, Dept. of Neurology, MS Ramaiah Medical college and Hospitals, Bangalore, Karnataka
| | - Mangesh Tiwaskar
- Consultant Physician, Asian Heart Institute & Research Centre, Karuna Hospital, Mumbai, Maharashtra
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86
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Upadhyay R, Nadka MY, Muruganathan A, Tiwaskar M, Amarapurkar D, Banka NH, Mehta KK, Sathyaprakash BS. API Recommendations for the Management of Typhoid Fever. J Assoc Physicians India 2015; 63:77-96. [PMID: 29900721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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