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Gudlavalleti AG, Babu GR, Kamalakannan S, Murthy GVS, Schaper NC, van Schayck OCP. Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e57313. [PMID: 39167436 PMCID: PMC11375384 DOI: 10.2196/57313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Diabetes is a growing concern worldwide, particularly in low- and middle-income countries (LMICs). Type 2 diabetes mellitus constitutes a significant proportion of cases and is associated with debilitating microvascular complications. Type 2 diabetes mellitus is steadily increasing among the LMICs where many barriers to health care exist. Thus, task shifting to community health workers (CHWs) has been proposed as a solution to improve diabetes management in these settings. However, CHWs often lack the necessary training to manage diabetes effectively. Thus, a systematic review is required to present evidence of the highest degree for this intervention. OBJECTIVE This study aims to establish the protocols for a systemic review. METHODS Using the Participants Intervention Comparator Outcome Time Study Design (PICOTS) framework, this study outlines a systematic review aiming to evaluate the impact of training programs for CHWs in diabetes management in LMICs. Quantitative studies focusing on CHWs, diabetes training, focusing on diabetes management outcomes like hemoglobin A1c levels and fasting blood glucose levels, between January 2000 and December 2023 and found on databases such as PubMed, Ovid MEDLINE, Evidence Based Medicine Reviews, BASE, Google Scholar, and Web of Science will be included. We will include randomized controlled trials but will also include observational studies if we find less than 5 randomized controlled trials. An author committee consisting of 3 reviewers will be formed, where 2 reviewers will conduct the review independently while the third will resolve all disputes. The Cochrane Methods Risk of Bias Tool 2 will be used for assessing the risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation approach for the meta-analysis and narrative synthesis analysis will be used. The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. RESULTS The review will begin in May 2024 and conclude in 3 months. CONCLUSIONS The review will synthesize existing evidence and provide insights into the effectiveness of such programs, informing future research and practice in diabetes care in LMICs. TRIAL REGISTRATION PROSPERO CRD42022341717; https://tinyurl.com/jva2hpdr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57313.
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Affiliation(s)
- Anirudh Gaurang Gudlavalleti
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sureshkumar Kamalakannan
- Department of social work, education and community wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - G V S Murthy
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
| | - Nicolaas C Schaper
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Kalra S, Anjana RM, Verma M, Pradeepa R, Sharma N, Deepa M, Singh O, Venkatesan U, Elangovan N, Aggarwal S, Kakkar R, Mohan V. Urban-Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18). Diabetes Ther 2024; 15:1597-1613. [PMID: 38771471 PMCID: PMC11211308 DOI: 10.1007/s13300-024-01602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Diabetes is a multifactorial disease with far-reaching consequences. Environmental factors, such as urban or rural residence, influence its prevalence and associated comorbidities. Haryana-a north Indian state-has undergone rapid urbanisation, and part of it is included in the National Capital Region (NCR). The primary aim of the study is to estimate the prevalence of diabetes in Haryana with urban-rural, NCR and non-NCR regional stratification and assess the factors affecting the likelihood of having diabetes among adults. METHODS This sub-group analysis of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study (a nationally representative cross-sectional population-based survey) was done for Haryana using data from 3722 participants. The dependent variable was diabetes, while residence in NCR/non-NCR and urban-rural areas were prime independent variables. Weighted prevalence was estimated using state-specific sampling weights and standardized using National Family Health Survey-5 (NFHS-5) study weights. Associations were depicted using bivariate analysis, and factors describing the likelihood of living with diabetes were explored using a multivariable binary logistic regression analysis approach. RESULTS Overall, the weighted prevalence of diabetes in Haryana was higher than the national average (12.4% vs. 11.4%). The prevalence was higher in urban (17.9%) than in rural areas (9.5%). The prevalence of diabetes in rural areas was higher in the NCR region, while that of prediabetes was higher in rural non-NCR region. Urban-rural participants' anthropometric measurements and biochemical profiles depicted non-significant differences. Urban-rural status, age and physical activity levels were the most significant factors that affected the likelihood of living with diabetes. CONCLUSIONS The current analysis provides robust prevalence estimates highlighting the urban-rural disparities. Urban areas continue to have a high prevalence of diabetes and prediabetes; rural areas depict a much higher prevalence of prediabetes than diabetes. With the economic transition rapidly bridging the gap between urban and rural populations, health policymakers should plan efficient strategies to tackle the diabetes epidemic.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India.
- University Centre for Research and Development, Chandigarh University, Mohali, India.
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, 151001, India
| | - Rajendra Pradeepa
- Department of Research Operations and Diabetes Complications, Madras Diabetes Research Foundation, Chennai, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bilaspur, Bilaspur, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Omna Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, 151001, India
| | | | - Nirmal Elangovan
- Department of Research Operations and Diabetes Complications, Madras Diabetes Research Foundation, Chennai, India
| | | | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, 151001, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Swain J, Jadhao P, Sravya SL, Teli B, Lavanya K, Singh J, Sahoo A, Das S. Mitochondrial Dysfunction and Imeglimin: A New Ray of Hope for the Treatment of Type-2 Diabetes Mellitus. Mini Rev Med Chem 2024; 24:1575-1589. [PMID: 37861052 DOI: 10.2174/0113895575260225230921062013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 10/21/2023]
Abstract
Diabetes is a rapidly growing health challenge and epidemic in many developing countries, including India. India, being the diabetes capital of the world, has the dubious dual distinction of being the leading nations for both undernutrition and overnutrition. Diabetes prevalence has increased in both rural and urban areas, affected the younger population and increased the risk of complications and economic burden. These alarming statistics ring an alarm bell to achieve glycemic targets in the affected population in order to decrease diabetes-related morbidity and mortality. In the recent years, diabetes pathophysiology has been extended from an ominous triad through octet and dirty dozen etc. There is a new scope to target multiple pathways at the molecular level to achieve a better glycemic target and further prevent micro- and macrovascular complications. Mitochondrial dysfunction has a pivotal role in both β-cell failure and insulin resistance. Hence, targeting this molecular pathway may help with both insulin secretion and peripheral tissue sensitization to insulin. Imeglimin is the latest addition to our anti-diabetic armamentarium. As imeglimin targets, this root cause of defective energy metabolism and insulin resistance makes it a new add-on therapy in different diabetic regimes to achieve the proper glycemic targets. Its good tolerability and efficacy profiles in recent studies shows a new ray of hope in the journey to curtail diabetes-related morbidity.
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Affiliation(s)
- Jayshree Swain
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Pooja Jadhao
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - S L Sravya
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Brij Teli
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Kasukurti Lavanya
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Jaspreet Singh
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Abhay Sahoo
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Sultanate of Oman
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Varshney A, Rawat R. Comparison of safety and efficacy of dapagliflozin and empagliflozin in type 2 diabetes mellitus patients in India. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230090. [PMID: 37585983 PMCID: PMC10427181 DOI: 10.1590/1806-9282.20230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/20/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Amit Varshney
- Kanti Devi Medical College Hospital and Research Center, Department of Emergency Medicine – Mathura (UP), India
| | - Ramakant Rawat
- Uttar Pradesh University of Medical Sciences, Department of Medicine – Etawah (UP), India
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Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, Joshi S, Bajaj S, Jabbar PK, Das HK, Kumar A, Dhandhania VK, Bhansali A, Rao PV, Desai A, Kalra S, Gupta A, Lakshmy R, Madhu SV, Elangovan N, Chowdhury S, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Mohan V. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023; 11:474-489. [PMID: 37301218 DOI: 10.1016/s2213-8587(23)00119-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. METHODS The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. FINDINGS A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. INTERPRETATION The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology & Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | | | | | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Centre, Patna, Bihar, India
| | | | - Anil Bhansali
- Department of Endocrinology, Gini Health, Mohali, Punjab, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Bambolim, Goa, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Arvind Gupta
- Department of Diabetology, Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Mohan V, Anjana RM, Tandon N. Lessons Learnt from the ICMR-INDIAB Study. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:137-139. [PMID: 38692603 DOI: 10.25259/nmji_655_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Viswanathan Mohan
- Department of Diabetology Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism All India Institute of Medical Sciences, New Delhi, India
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Deepa M, Elangovan N, Venkatesan U, Das HK, Jampa L, Adhikari P, Joshi PP, Budnah RO, Suokhrie V, John M, Tobgay KJ, Subashini R, Pradeepa R, Anjana RM, Mohan V, Kaur T, Dhaliwal RS. Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15). Indian J Med Res 2023; 157:239-249. [PMID: 37282387 PMCID: PMC10438401 DOI: 10.4103/ijmr.ijmr_2615_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 06/08/2023] Open
Abstract
Background & objectives Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods Data were acquired from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions. Interpretation & conclusions Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.
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Affiliation(s)
- Mohan Deepa
- Department of Epidemiology, Diabetes Complications, Chennai, Tamil Nadu, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | | | - Hiranya Kumar Das
- Regional Medical Research Centre, ICMR NE Region, Dibrugarh, Assam, India
| | - Lobsang Jampa
- Directorate of Health Services, Naharlagun, Arunachal Pradesh, India
| | - Prabha Adhikari
- Department of Epidemiology, Yenepoya Medical College, Yenepoya University Campus, Deralakatte, Karnataka, India
| | - Prashant P. Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Vizolie Suokhrie
- Directorate of Health & Family Welfare, Government of Nagaland, Kohima, Nagaland, India
| | - Mary John
- Deparment of Internal Medicine, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Karma Jigme Tobgay
- Department of Health Care, Human Services & Family Welfare, Government of Sikkim, Gangtok, Sikkim, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Mohan V, Uma Sankari G, Amutha A, Anjana RM, Jeba Rani S, Unnikrishnan R, Venkatesan U, Shanthi Rani CS. Clinical and biochemical profile of childhood-adolescent-onset type 1 diabetes and adult-onset type 1 diabetes among Asian Indians. Acta Diabetol 2023; 60:579-586. [PMID: 36700996 DOI: 10.1007/s00592-023-02034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
AIM To compare the clinical and biochemical profile and prevalence of complications among childhood/adolescent-onset (CAO; onset of diabetes< 20 years of age) and adult-onset (AO; onset of diabetes- ≥ 20 years of age) type 1 diabetes (T1D), seen at a tertiary care diabetes center in south India. METHOD Data of 5578 individuals with T1D, diagnosed based on a history of diabetic ketoacidosis or ketonuria, fasting C-peptide < 0.3 pmol/mL and stimulated C-peptide values < 0.6 pmol/mL, and requirement of insulin right from the time of diagnosis, presenting to our center between 1991 and 2021, were retrieved from our electronic medical records. Retinopathy was assessed by retinal photography, chronic kidney disease (CKD) by urinary albumin excretion ≥ 30 µg/mg of creatinine and/or eGFR < 60 mL/min, and neuropathy by vibration perception threshold >= 20v on biothesiometry. RESULTS Overall, 3559 (63.8%) of individuals with T1D, belonged to CAO group and 2019 (36.2%) to AO category. AO had higher prevalence of all microvascular complications compared to CAO at every diabetes duration interval, even after adjusting for A1c. Among the AO group, prevalence of retinopathy, CKD, and neuropathy was higher in the GAD negative group. Among CAO there were no differences between the GAD negative and GAD positive groups with respect to prevalence of complications of diabetes. CONCLUSION AO with T1D had higher prevalence of microvascular complications compared to CAO. Among AO, GAD negative individuals had higher percentage of retinopathy and CKD compared to GAD positive group.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| | - Ganesan Uma Sankari
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Saravanan Jeba Rani
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Coimbatore Subramanian Shanthi Rani
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research On Diabetes) & Dr. Mohan's Diabetes Specialities Centre (IDF Centre of Excellence in Diabetes Care), No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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Anjana RM, Deepa M, Pradeepa R. The ICMR-INDIAB Study: Results from the National Study on Diabetes in India. J Indian Inst Sci 2023. [DOI: 10.1007/s41745-023-00359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Kaur H, Bains V, Sharma T, Badaruddoza. Relationship between leptin gene variants (–2548G>A and 19A>G) and obesity among north Indian Punjabi population. J Genet 2022. [DOI: 10.1007/s12041-022-01401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Anjana RM, Srinivasan S, Sudha V, Joshi SR, Saboo B, Tandon N, Das AK, Jabbar PK, Madhu SV, Gupta A, Bajaj S, Chowdhury S, Kalra S, Gayathri R, Abirami K, Manasa VS, Padmapritha T, Lakshmipriya N, Geetha G, Deepa M, Pradeepa R, Unnikrishnan R, Kurpad AV, Krishnaswamy K, Kaur T, Dhaliwal RS, Mohan V. Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study. Diabetes Care 2022; 45:dc220627. [PMID: 36350789 DOI: 10.2337/dc22-0627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. RESEARCH DESIGN AND METHODS Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. RESULTS Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49-54%; protein, 19-20%; and fat, 21-26%; 2) PD remission to NGT: carbohydrate, 50-56%; protein,18-20%; fat, 21-27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54-57% and 56-60%; protein, 16-20% and 14-17%, respectively; and fat 20-24% for PD and NGT. CONCLUSIONS We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Seshadhri Srinivasan
- International Research Centre, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Dia Care-Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi - National Capital, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Pudcherry - Union Territory, India
| | | | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arvind Gupta
- Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Rajagopal Gayathri
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kuzhandaivelu Abirami
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Valangaiman Sriram Manasa
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Thamotharan Padmapritha
- Department of Instrumentation and Control Engineering, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Nagarajan Lakshmipriya
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Gunasekaran Geetha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Kamala Krishnaswamy
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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12
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Anjana RM, Unnikrishnan R, Deepa M, Venkatesan U, Pradeepa R, Joshi S, Saboo B, Das AK, Bajaj S, Bhansali A, Madhu SV, Dhandhania VK, Jabbar PK, Jain SM, Gupta A, Chowdhury S, Ali MK, Nirmal E, Subashini R, Kaur T, Dhaliwal RS, Tandon N, Mohan V. Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): a national cross-sectional study. Lancet Diabetes Endocrinol 2022; 10:430-441. [PMID: 35461575 DOI: 10.1016/s2213-8587(22)00072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes. METHODS The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets. FINDINGS Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7-56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7-37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2-50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9-43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (<10 years) were associated with better achievement of combined ABC targets. Only 951 (weighted proportion 16·7%) of the study population and 227 (weighted proportion 36·9%) of those on insulin reported using self-monitoring of blood glucose. INTERPRETATION Achievement of treatment targets and adoption of healthy behaviours remains suboptimal in India. Our results can help governments to adopt policies that prioritise improvement of diabetes care delivery and surveillance in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ulagamathesan Venkatesan
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Shashank Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Ashok Kumar Das
- Department of General Medicine and Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | | | | | - Sunil M Jain
- TOTALL, Diabetes Thyroid Hormone Research Institute, Indore, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Mohammed K Ali
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elangovan Nirmal
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
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13
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Siddiqui MK, Anjana RM, Dawed AY, Martoeau C, Srinivasan S, Saravanan J, Madanagopal SK, Taylor A, Bell S, Veluchamy A, Pradeepa R, Sattar N, Venkatesan R, Palmer CNA, Pearson ER, Mohan V. Young-onset diabetes in Asian Indians is associated with lower measured and genetically determined beta cell function. Diabetologia 2022; 65:973-983. [PMID: 35247066 PMCID: PMC9076730 DOI: 10.1007/s00125-022-05671-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS South Asians in general, and Asian Indians in particular, have higher risk of type 2 diabetes compared with white Europeans, and a younger age of onset. The reasons for the younger age of onset in relation to obesity, beta cell function and insulin sensitivity are under-explored. METHODS Two cohorts of Asian Indians, the ICMR-INDIAB cohort (Indian Council of Medical Research-India Diabetes Study) and the DMDSC cohort (Dr Mohan's Diabetes Specialties Centre), and one of white Europeans, the ESDC (East Scotland Diabetes Cohort), were used. Using a cross-sectional design, we examined the comparative prevalence of healthy, overweight and obese participants with young-onset diabetes, classified according to their BMI. We explored the role of clinically measured beta cell function in diabetes onset in Asian Indians. Finally, the comparative distribution of a partitioned polygenic score (pPS) for risk of diabetes due to poor beta cell function was examined. Replication of the genetic findings was sought using data from the UK Biobank. RESULTS The prevalence of young-onset diabetes with normal BMI was 9.3% amongst white Europeans and 24-39% amongst Asian Indians. In Asian Indians with young-onset diabetes, after adjustment for family history of type 2 diabetes, sex, insulin sensitivity and HDL-cholesterol, stimulated C-peptide was 492 pmol/ml (IQR 353-616, p<0.0001) lower in lean compared with obese individuals. Asian Indians in our study, and South Asians from the UK Biobank, had a higher number of risk alleles than white Europeans. After weighting the pPS for beta cell function, Asian Indians have lower genetically determined beta cell function than white Europeans (p<0.0001). The pPS was associated with age of diagnosis in Asian Indians but not in white Europeans. The pPS explained 2% of the variation in clinically measured beta cell function, and 1.2%, 0.97%, and 0.36% of variance in age of diabetes amongst Asian Indians with normal BMI, or classified as overweight and obese BMI, respectively. CONCLUSIONS/INTERPRETATION The prevalence of lean BMI in young-onset diabetes is over two times higher in Asian Indians compared with white Europeans. This phenotype of lean, young-onset diabetes appears driven in part by lower beta cell function. We demonstrate that Asian Indians with diabetes also have lower genetically determined beta cell function.
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Affiliation(s)
- Moneeza K. Siddiqui
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ranjit Mohan Anjana
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Adem Y. Dawed
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Cyrielle Martoeau
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Sundararajan Srinivasan
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jebarani Saravanan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sathish K. Madanagopal
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Alasdair Taylor
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Samira Bell
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Abirami Veluchamy
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Rajendra Pradeepa
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Naveed Sattar
- grid.8756.c0000 0001 2193 314XInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Radha Venkatesan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Colin N. A. Palmer
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Ewan R. Pearson
- grid.8241.f0000 0004 0397 2876National Institute for Health Research Global Health Unit for Diabetes Outcomes Research, Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Viswanathan Mohan
- grid.410867.c0000 0004 1805 2183Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
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14
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Chadha M, Das AK, Deb P, Gangopadhyay KK, Joshi S, Kesavadev J, Kovil R, Kumar S, Misra A, Mohan V. Expert Opinion: Optimum Clinical Approach to Combination-Use of SGLT2i + DPP4i in the Indian Diabetes Setting. Diabetes Ther 2022; 13:1097-1114. [PMID: 35334083 PMCID: PMC8948458 DOI: 10.1007/s13300-022-01219-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/01/2022] [Indexed: 12/20/2022] Open
Abstract
The Asian-Indian phenotype of type 2 diabetes mellitus is uniquely characterized for cardio-metabolic risk. In the context of implementing patient-centric holistic cardio-metabolic risk management as a priority, the choice of various combinations of antidiabetic agents should be individualized. Combined therapy with two classes of antidiabetic agents, namely, dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter-2 inhibitors, target several pathophysiological pathways. The wide-ranging clinical outcomes associated with this combination, including improvement of glycemia and adiposity, reduction of metabolic and vascular risk, safety, and simplicity for sustainable compliance, are extremely relevant to the Asian Indian patient population living with T2DM. In this review we describe the available evidence in detail and present a rational practical guidance for the optimum clinical use of this combination in this patient population.
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Affiliation(s)
- Manoj Chadha
- Endocrinology, P.D. Hinduja Hospital, Mumbai, India
| | - Ashok Kumar Das
- Endocrinology, Pondicherry Institute of Medical Science, Puducherry, India
| | - Prasun Deb
- Endocrinology, Krishna Institute of Medical Sciences, Hyderabad, India
| | | | - Shashank Joshi
- Endocrinology, Joshi Clinic and Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Rajiv Kovil
- Department of Diabetology, Dr Kovil’s Diabetes Care Centre, Mumbai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), New Delhi, India
| | - Viswanathan Mohan
- Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
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15
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Deepa M, Anjana RM, Unnikrishnan R, Pradeepa R, Das AK, Madhu SV, Rao PV, Joshi S, Saboo B, Kumar A, Bhansali A, Gupta A, Bajaj S, Elangovan N, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Tandon N, Mohan V. Variations in glycated haemoglobin with age among individuals with normal glucose tolerance: Implications for diagnosis and treatment-Results from the ICMR-INDIAB population-based study (INDIAB-12). Acta Diabetol 2022; 59:225-232. [PMID: 34596779 DOI: 10.1007/s00592-021-01798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
AIM To report on glycated haemoglobin (HbA1c) values among individuals with normal glucose tolerance (NGT) at different age groups, using data acquired from a large national survey in India. MATERIALS AND METHODS Data on glycaemic parameters at different age groups were obtained from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, in adults aged ≥ 20 years representing all parts of India. Age-wise distribution of HbA1c was assessed among individuals with NGT (n = 14,222) confirmed by an oral glucose tolerance test using the World Health Organization (WHO) criteria. Results were validated in another large epidemiological study (n = 1077) conducted in Chennai, India. RESULTS Among NGT individuals, HbA1c increased gradually with age from 5.16 ± 0.71% (33 mmol/mol) in the age group of 20-29 years to 5.49 ± 0.69% (37 mmol/mol) in those aged 70 + years. In the validation study, conducted in another study population, HbA1c was 5.35 ± 0.43% (35 mmol/mol) in age group of 20-29 years and 5.74 ± 0.50% (39 mmol/mol) in those aged 70 and above. In the INDIAB study, for every decadal increase in age, there is a 0.08% increase in HbA1c and this increase was more significant in females (females: 0.10% vs. males: 0.06%) and in urban (urban: 0.10% vs. rural: 0.08%) population. CONCLUSIONS HbA1c levels increase steadily with age. This suggests that age-specific cutoffs be used while utilizing HbA1c to diagnose diabetes and prediabetes, so as to minimize the risk of overdiagnosis and unnecessary initiation of treatment in elderly people who could have physiological increase in HbA1c levels.
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Affiliation(s)
- Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sri Venkata Madhu
- University College of Medical Sciences and GTB Hospital, Delhi, New Delhi, India
| | | | - Shashank Joshi
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Dia Care-Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, Bihar, India
| | - Anil Bhansali
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sarita Bajaj
- Moti Lal Nehru Medical College, Allahabad, India
| | - Nirmal Elangovan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Radhakrishnan Subashini
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Tanvir Kaur
- Indian Council of Medical Research, Delhi, New Delh, India
| | - R S Dhaliwal
- Indian Council of Medical Research, Delhi, New Delh, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India.
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16
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Pradeepa R, Subashini R, Venkatesan U, Ningombam S, Purty A, John M, Reang T, Luaia R, Tripathy SK, Modi S, Mokta JK, Desai A, Dash K, Deepa M, Nirmal E, Unnikrishnan R, Anjana RM, Kaur T, Dhaliwal RS, Mohan V. Effect of internal migration on diabetes and metabolic abnormalities in India - The ICMR-INDIAB study. J Diabetes Complications 2021; 35:108051. [PMID: 34607777 DOI: 10.1016/j.jdiacomp.2021.108051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
AIMS To assess the effect of migration (rural-to-urban and vice versa) on prevalence of diabetes and metabolic disorders in Asian Indians participating in the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. MATERIALS AND METHODS The ICMR-INDIAB study is a national study on diabetes and associated cardiometabolic disorders in individuals aged ≥20 years from 28 states and 2 union territories of India. Individuals who moved to a different place from their place of birth and had resided in the new location for at least one year were considered as migrants. Anthropometric measurements, blood pressure estimation and a capillary oral glucose tolerance test were performed. RESULTS Of the 113,043 participants, 66.4% were non-migrant rural dwellers, 19.4% non-migrant urban dwellers, 8.4% rural-urban migrants, 3.8% multiple migrants and 2.0% urban-rural migrants. Weighted prevalence of diabetes was highest in rural-urban migrants followed by urban dwellers, urban-rural migrants and rural dwellers [14.7%, 13.2%, 12.7% and 7.7% respectively (p < 0.001)]. Rural-urban migrants had highest prevalence of abdominal obesity (50.5%) compared to the other three groups. The risk for diabetes was 1.9 times higher in rural-urban migrants than among rural dwellers. Five risk factors [hypertension, abdominal and generalized obesity, physical inactivity and low fruit and vegetable intake] together explained 69.8% (partial population attributable risk) of diabetes among rural-urban migrants and 66.4% among non-migrant urban dwellers. CONCLUSIONS Rural-to-urban migration is associated with increased risk of developing diabetes and other cardiometabolic abnormalities. Adoption of healthier lifestyle patterns among migrants could help prevent/delay onset of these abnormalities in this population.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
| | - Radhakrishnan Subashini
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | | | - Anil Purty
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mary John
- Christian Medical College & Hospital, Ludhiana, India
| | | | | | | | - Sagar Modi
- Himalayan Institute of Medical Sciences, Dehradun, India
| | | | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Elangovan Nirmal
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
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Singh A, Puhan R, Pradhan A, Ali W, Sethi R. Small Dense Low-Density Lipoprotein for Risk Prediction of Acute Coronary Syndrome. Cardiol Res 2021; 12:251-257. [PMID: 34349867 PMCID: PMC8297045 DOI: 10.14740/cr1254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background Elevated Low density Lipoprotein (LDL) levels have been traditionally associated with development of atherosclerotic coronary artery disease (CAD). As LDL-cholesterol levels are not always raised in acute coronary syndrome (ACS) patients, sd-LDL is an emerging risk factor. The purpose of the present study was tri-fold. Firstly, it aimed to investigate the association of sd-LDL as a risk factor in ACS patients. Secondly, it aimed to correlate the presence of sd-LDL with severity of coronary artery disease as determined by coronary angiography. Lastly, it aimed to correlate the presence of sd-LDL with short-term outcomes. Methods This was a prospective, hospital-based, cross-sectional, case-control study conducted over a 1-year study duration. Patients above the age of 18 years diagnosed with ACS within 24 h of admission were studied. Blood samples were collected after all patients had undergone coronary angiography and sd-LDL levels were measured. Results ACS patients had significantly higher sd-LDL levels than non-ACS patients (16.10 ± 1.42 mg/dL vs. 12.67 ± 0.71 mg/dL, P = 0.036). Males had significantly higher sd-LDL levels than females (16.79 ± 1.55 mg/dl vs. 10.77 ± 2.62 mg/dl, P=0.047). Patients with non-left anterior descending coronary artery (LAD) involvement had significantly higher sd-LDL levels compared to patients with LAD involvement (21.92 ± 3.55 mg/dL vs. 14.03 ± 1.35 mg/dL, P = 0.007). Conclusion These results suggest that sd-LDL is a risk factor for the development of ACS in an Indian population.
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Affiliation(s)
- Abhishek Singh
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Rajendra Puhan
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Wahid Ali
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
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Khandekar R, Senthil T, Nainappan M, Edward DP. Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India. Telemed J E Health 2021; 28:176-188. [PMID: 33999730 DOI: 10.1089/tmj.2021.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.
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Affiliation(s)
- Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Deepak P Edward
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Chicago, Illinois, USA
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Purty A. Fostering collaborative research partnerships – Lessons learned. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2021. [DOI: 10.4103/jcrsm.jcrsm_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gauthaman J. A qualitative analysis of the Parliamentary questions on the issue of obesity raised over the past two decades in India. J Family Med Prim Care 2021; 10:4223-4228. [PMID: 35136793 PMCID: PMC8797104 DOI: 10.4103/jfmpc.jfmpc_1026_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Obesity is a major health issue that is drastically affecting the Indian population in the recent years. It is a major predisposing factor for non-communicable diseases. Introduction: The parliament is a powerful organization that holds sessions on regular basis and allows a question hour at the end of each session. Members ask varied questions on major issues and these documented questions are a valuable source of data for policy analysis. Material and Methods: Questions on obesity were collected from the official websites of Lok Sabha and Rajya Sabha and thematic analysis was done with inductive reasoning. Themes and subthemes were categorized and questions were coded into nodes using N Vivo software. Results: A total of 134 questions on obesity were asked in both the houses, out of which 101 questions were from Lok Sabha and 33 questions were from Rajya Sabha. Majority of the questions were asked to the ministry of health and family welfare. Only a total of 48 unique parliamentarians from 13 states have asked questions on obesity in the past two decades. Discussion: The questions were of competing interests with majority of questions on incidence of obesity. A number of questions on school and community based interventions were asked and new suggestions were given by members. Questions on BMI documentation of individuals and gender predisposition showed presence of awareness and knowledge among the members on obesity. Most of the existing policies are malnutrition based and obesity has not been adequately addressed. More questions with stronger representation from all states of the country can help in effective policy planning and implementation of programs to eliminate obesity.
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NDSP 05: Prevalence and pattern of dyslipidemia in urban and rural areas of Pakistan; a sub analysis from second National Diabetes Survey of Pakistan (NDSP) 2016-2017. J Diabetes Metab Disord 2020; 19:1215-1225. [PMID: 33520835 DOI: 10.1007/s40200-020-00631-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
Objectives Dyslipidemia is a major risk issue for the development of cardiovascular disease. The aim of our study was to observe the pattern and prevalence of dyslipidemia in Pakistani population. Methodology This is a sub analysis of a population based second National Diabetes Survey of Pakistan (NDSP) 2016-2017 in adults aged 20 years or above, carried out from February 2016 to August 2017 across Pakistan. Multi stage sampling technique was used for the stratification of population, based on rural and urban domains. District wise clusters and sub clusters were selected i.e. 27 and 46 in number. Subjects, consented to participate were requested to come after an overnight fast for anthropometric measurements, oral glucose tolerance test and fasting lipid profile (except for subjects with self-reported diabetes). Dyslipidemia was identified using Adult Treatment Panel III guidelines. Results A total of 10,834 subjects (43.8% male and 56.2% female) having mean age of 43.8 ± 14.0 years, participated in the survey. Of the subjects studied, 39.3% had hypercholesterolemia, 48.9% had hypertriglyceridemia, 39.7% had high LDL-C levels while 83.9% men and 90% women had low HDL levels. High cholesterol and triglyceride levels were highest in 50-59 years age group, while high LDL and low HDL was most common in 40-49 years age group. Diabetes, obesity and hypertension were found to be the significant determinants for dyslipidemia. Conclusion Prevalence of dyslipidemia seems to be very high in Pakistan, necessitating an urgent call for early screening and effective management through lifestyle intervention and appropriate lipid lowering drugs to prevent this important cardiovascular risk factor.
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Sarveswaran G, Kulothungan V, Mathur P. Clustering of noncommunicable disease risk factors among adults (18-69 years) in rural population, South-India. Diabetes Metab Syndr 2020; 14:1005-1014. [PMID: 32623362 DOI: 10.1016/j.dsx.2020.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Non-communicable diseases (NCDs) and its risk factors are increasing worldwide and in India. Controlling the rise in risk factors at present is crucial to prevent NCD surge in future. Current study was conducted to estimate the burden of clustering of NCD risk factors among adult population (18-69 years) residing in selected villages of rural Bengaluru, Karnataka METHODS: Population based screening for NCD risk factors were carried out among adults in rural Bengaluru during May to October 2019. NCD risk factors were screened using WHO STEPwise approach to chronic disease risk factor surveillance (STEPs) instrument and Integrated Disease Surveillance Project (IDSP) NCD risk factor tool. Presence of three or more risk factors in same individual was considered as presence of clustering of NCD risk factors. Additional analysis was done for clustering of NCD risk factors with different number of risk factors. RESULTS Prevalence of clustering of NCD risk factors in rural adult population was as follows; ≥2 risk factors 81.0%, ≥3 risk factors 56.3%, ≥4 risk factors 33.6%, ≥5 risk factors 14.5% and ≥6 risk factors 4.8%. The most common NCD risk factors were inadequate intake of fruits and vegetables (82.3%), physical inactivity (46.8%) and central obesity (46.4%). Clustering NCD risk factors were significantly associated with increased age, males and lower levels of education. CONCLUSIONS High burden of clustering of risk factor indicates the need for health policies with integrated NCD risk factors prevention strategies than targeted approach. Awareness regarding the effect of clustering needs to be increased among the primary care physicians practising in rural areas.
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Affiliation(s)
- Gokul Sarveswaran
- ICMR - National Centre for Disease Informatics and Research (NCDIR), Bengaluru, India.
| | | | - Prashant Mathur
- ICMR - National Centre for Disease Informatics and Research (NCDIR), Bengaluru, India.
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Anjana RM, Baskar V, Nair ATN, Jebarani S, Siddiqui MK, Pradeepa R, Unnikrishnan R, Palmer C, Pearson E, Mohan V. Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population: a data-driven cluster analysis: the INSPIRED study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001506. [PMID: 32816869 PMCID: PMC7437708 DOI: 10.1136/bmjdrc-2020-001506] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/04/2020] [Accepted: 07/02/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering. RESEARCH DESIGN AND METHODS From a network of 50 diabetes centers across nine states of India, we selected 19 084 individuals with type 2 diabetes (aged 10-97 years) with diabetes duration of less than 5 years at the time of first clinic visit and performed k-means clustering using the following variables: age at diagnosis, body mass index, waist circumference, glycated hemoglobin, serum triglycerides, serum high-density lipoprotein cholesterol and C peptide (fasting and stimulated). This was then validated in a national epidemiological data set of representative individuals from 15 states across India. RESULTS We identified four clusters of patients, differing in phenotypic characteristics as well as disease outcomes: cluster 1 (Severe Insulin Deficient Diabetes, SIDD), cluster 2 (Insulin Resistant Obese Diabetes, IROD), cluster 3 (Combined Insulin Resistant and Deficient Diabetes, CIRDD) and cluster 4 (Mild Age-Related Diabetes, MARD). While SIDD and MARD are similar to clusters reported in other populations, IROD and CIRDD are novel clusters. Cox proportional hazards showed that SIDD had the highest hazards for developing retinopathy, followed by CIRDD, while CIRDD had the highest hazards for kidney disease. CONCLUSIONS Compared with previously reported clustering, we show two novel subgroups of type 2 diabetes in the Asian Indian population with important implications for prognosis and management. The coexistence of insulin deficiency and insulin resistance seems to be peculiar to the Asian Indian population and is associated with an increased risk of microvascular complications.
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Affiliation(s)
- Ranjit Mohan Anjana
- Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
- Diabetology, Dr Mohan's Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, India
| | - Viswanathan Baskar
- Data Management, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Saravanan Jebarani
- Data Management, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Moneeza Kalhan Siddiqui
- Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, Dundee, UK
| | - Rajendra Pradeepa
- Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
- Diabetology, Dr Mohan's Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, India
| | - Colin Palmer
- Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, Dundee, UK
| | - Ewan Pearson
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, Dundee, UK
| | - Viswanathan Mohan
- Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
- Diabetology, Dr Mohan's Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, India
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Kaur P, Anjana RM, Tandon N, Singh MK, Mohan V, Mithal A. Increased prevalence of self-reported fractures in Asian Indians with diabetes: Results from the ICMR-INDIAB population based cross-sectional study. Bone 2020; 135:115323. [PMID: 32200024 DOI: 10.1016/j.bone.2020.115323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes mellitus (DM), has been associated with increased fracture risk. However, there are no data pertaining to the prevalence of fractures for patients with DM in India. The aim of this study was to determine the prevalence of fractures in Asian Indians with and without diabetes. METHODS The study used the data of Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a community- based cross sectional survey conceived with the aim of obtaining the prevalence rates of diabetes in India as a whole. A community-based sample of 57,117 individuals aged ≥20 years was obtained. Diabetes was diagnosed by oral glucose tolerance test using capillary blood (except in self-reported diabetes). Fractures were self-reported. RESULTS Fracture data were available in 54,093 subjects. Out of these, 1416 (2.6%) had fractures. Overall prevalence of diabetes and prediabetes was 7.1% and 10.5% respectively. Prevalence of fractures was significantly higher in diabetes group (4%) compared with non-diabetes group (2.5%). In multivariate logistic regression analysis, diabetes was associated with an increased risk (1) of any fracture (OR=1.28, 95% CI: 1.07-1.5) and (2) of low trauma fracture (hip and spine combined) (OR = 1.8, 95% CI:1.1-2.8). After gender stratification, diabetes was a risk factor for fracture only in women. Age (>40 years) in women, high waist circumference (>90 cm) in men, alcohol consumption and urban residence in both men and women were other significant contributors to fracture risk. CONCLUSION Increased prevalence of self-reported fractures was seen in individuals with diabetes in this population-based study from India.
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Affiliation(s)
- Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram, Haryana, India.
| | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Kumar Singh
- Department of Clinical Research and Studies, Medanta-The Medicity Hospital, Gurugram, Haryana, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram, Haryana, India
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Little M, Humphries S, Dodd W, Patel K, Dewey C. Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study. BMC Public Health 2020; 20:675. [PMID: 32404080 PMCID: PMC7218837 DOI: 10.1186/s12889-020-08679-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India. METHODS We undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes. RESULTS Prevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70). CONCLUSION This study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.
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Affiliation(s)
- Matthew Little
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada.
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
| | - Sally Humphries
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Warren Dodd
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kirit Patel
- Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB, Canada
| | - Cate Dewey
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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Adekanmbi VT, Uthman OA, Erqou S, Echouffo‐Tcheugui JB, Harhay MN, Harhay MO. Epidemiology of prediabetes and diabetes in Namibia, Africa: A multilevel analysis. J Diabetes 2019; 11:161-172. [PMID: 30058263 PMCID: PMC6318039 DOI: 10.1111/1753-0407.12829] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/20/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes is a leading cause of progressive morbidity and early mortality worldwide. Little is known about the burden of diabetes and prediabetes in Namibia, a Sub-Saharan African (SSA) country that is undergoing a demographic transition. METHODS We estimated the prevalence and correlates of diabetes (defined as fasting [capillary] blood glucose [FBG] ≥126 mg/dL) and prediabetes (defined by World Health Organization [WHO] and American Diabetes Association [ADA] criteria as FBG 110-125 and 100-125 mg/dL, respectively) in a random sample of 3278 participants aged 35-64 years from the 2013 Namibia Demographic and Health Survey. RESULTS The prevalence of diabetes was 5.1% (95% confidence interval [CI]: 4.2-6.2), with no evidence of gender differences (P = 0.45). The prevalence of prediabetes was 6.8% (95% CI 5.8-8.0) using WHO criteria and 20.1% (95% CI 18.4-21.9) using ADA criteria. Male sex, older age, higher body mass index (BMI), and occupation independently increased the odds of diabetes in Namibia, whereas higher BMI was associated with a higher odds of prediabetes, and residing in a household categorized as "middle wealth index" was associated with a lower odds of prediabetes (adjusted odds ratio 0.71; 95% credible interval 0.46-0.99). There was significant clustering of prediabetes and diabetes at the community level. CONCLUSIONS One in five adult Namibians has prediabetes based on ADA criteria. Resources should be invested at the community level to promote efforts to prevent the progression of this disease and its complications.
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Affiliation(s)
- Victor T. Adekanmbi
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Olalekan A. Uthman
- Warwick‐Centre for Applied Health Research and Delivery, Division of Health SciencesUniversity of Warwick Medical SchoolCoventryUK
- International Health Group, Liverpool School of Tropical MedicineLiverpoolUK
| | - Sebhat Erqou
- Department of MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Justin B. Echouffo‐Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Meera N. Harhay
- Department of Medicine, Division of Nephrology and HypertensionDrexel University College of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Abstract
This article describes a 40 year journey in diabetes research of an Indian diabetologist, starting as an undergraduate medical student. The article describes how collaborations with multiple stake-holders is necessary if one is to advance one's research from the simple studies that one starts with and take it to higher and higher levels. It is also essential that the seeds for doing research are planted early in a medico's life even during undergraduate days, as only then will more doctors take up medical research as a career. Finally, the article demonstrates how it is possible to do good quality research in India if one has the passion and sustained interest in the field even if one is not in a university or academic setup.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Excellence in Diabetes Care and Education & ICMR Centre for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
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Abstract
PURPOSE OF REVIEW South Asia is one of the epicenters of the global diabetes pandemic. Diabetes in south Asians has certain peculiar features with respect to its pathophysiology, clinical presentation, and management. This review aims to summarize some of the recent evidence pertaining to the distinct diabetes phenotype in south Asians. RECENT FINDINGS South Asia has high incidence and prevalence rates of diabetes. The progression from "pre-diabetes" to diabetes also occurs faster in this population. Pancreatic beta cell dysfunction seems to be as important as insulin resistance in the pathophysiology of diabetes in south Asians. Recent evidence suggests that the epidemic of diabetes in south Asia is spreading to rural areas and to less affluent sections of society. Diabetes in south Asians differs significantly from that in white Caucasians, with important implications for prevention, diagnosis, and management.
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Affiliation(s)
- Ranjit Unnikrishnan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, WHO Collaborating Centre, Non-Communicable Disease Prevention & Control & IDF Centre of Excellence in Diabetes Care, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Prasanna Kumar Gupta
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, WHO Collaborating Centre, Non-Communicable Disease Prevention & Control & IDF Centre of Excellence in Diabetes Care, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Viswanathan Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, WHO Collaborating Centre, Non-Communicable Disease Prevention & Control & IDF Centre of Excellence in Diabetes Care, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
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Muralidharan S, Mohan V, Anjana RM, Jena S, Tandon N, Allender S, Ranjani H. Mobile Health Technology (mDiab) for the Prevention of Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e242. [PMID: 29233806 PMCID: PMC5743924 DOI: 10.2196/resprot.8644] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 01/18/2023] Open
Abstract
Background The prevalence of type 2 diabetes is increasing in epidemic proportions in low- and middle-income countries. There is an urgent need for novel methods to tackle the increasing incidence of diabetes. The ubiquity of mobile phone use and access to Internet makes mobile health (mHealth) technology a viable tool to prevent and manage diabetes. Objective The objective of this randomized controlled trial is to implement and evaluate the feasibility, cost-effectiveness, and sustainability of a reality television–based lifestyle intervention program. This intervention program is delivered via a mobile phone app (mDiab) to approximately 1500 Android smartphone users who are adults at a high risk for type 2 diabetes from three cities in India, namely, Chennai, Bengaluru, and New Delhi. Methods The mDiab intervention would be delivered via a mobile phone app along with weekly coach calls for 12 weeks. Each participant will go through a maintenance phase of 6 to 8 months post intervention. Overall, there would be 3 testing time points in the study: baseline, post intervention, and the end of follow-up. The app will enable individuals to track their weight, physical activity, and diet alongside weekly video lessons on type 2 diabetes prevention. Results The study outcomes are weight loss (primary measure of effectiveness); improvement in cardiometabolic risk factors (ie, waist circumference, blood pressure, glucose, insulin, and lipids); and improvement in physical activity, quality of life, and dietary habits. Sustainability will be assessed through focus group discussions. Conclusions If successful, mDiab can be used as a model for translational and implementation research in the use of mHealth technology for diabetes prevention and may be further expanded for the prevention of other noncommunicable diseases such as hypertension and cardiovascular diseases. Trial Registration Clinical Trials Registry of India CTRI/2015/07/006011 http://ctri.nic.in/Clinicaltrials/pdf_generate.php? trialid=11841 (Archived by WebCite at http://www.webcitation.org/6urCS5kMB)
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Affiliation(s)
- Shruti Muralidharan
- Global Obesity Centre, World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Australia
| | - Viswanathan Mohan
- Translational Research Department, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Translational Research Department, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sidhant Jena
- Janacare Solutions Private Limited, Bengaluru, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Steven Allender
- Global Obesity Centre, World Health Organization Collaborating Centre for Obesity Prevention, Deakin University, Geelong, Australia
| | - Harish Ranjani
- Translational Research Department, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, Adhikari P, Rao PV, Saboo B, Kumar A, Bhansali A, John M, Luaia R, Reang T, Ningombam S, Jampa L, Budnah RO, Elangovan N, Subashini R, Venkatesan U, Unnikrishnan R, Das AK, Madhu SV, Ali MK, Pandey A, Dhaliwal RS, Kaur T, Swaminathan S, Mohan V. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol 2017; 5:585-596. [PMID: 28601585 DOI: 10.1016/s2213-8587(17)30174-2] [Citation(s) in RCA: 442] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. METHODS We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. FINDINGS The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0-7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7-5·0) to 10·0% (8·7-11·2) in Punjab and was higher in urban areas (11·2%, 10·6-11·8) than in rural areas (5·2%, 4·9-5·4; p<0·0001) and higher in mainland states (8·3%, 7·9-8·7) than in the northeast (5·9%, 5·5-6·2; p<0·0001). Overall, 1862 (47·3%) of 3938 individuals identified as having diabetes had not been diagnosed previously. States with higher per-capita GDP seemed to have a higher prevalence of diabetes (eg, Chandigarh, which had the highest GDP of US$ 3433, had the highest prevalence of 13·6%, 12.8-15·2). In rural areas of all states, diabetes was more prevalent in individuals of higher SES. However, in urban areas of some of the more affluent states (Chandigarh, Maharashtra, and Tamil Nadu), diabetes prevalence was higher in people with lower SES. The overall prevalence of prediabetes in all 15 states was 10·3% (10·0-10·6). The prevalence of prediabetes varied from 6·0% (5·1-6·8) in Mizoram to 14·7% (13·6-15·9) in Tripura, and the prevalence of impaired fasting glucose was generally higher than the prevalence of impaired glucose tolerance. Age, male sex, obesity, hypertension, and family history of diabetes were independent risk factors for diabetes in both urban and rural areas. INTERPRETATION There are large differences in diabetes prevalence between states in India. Our results show evidence of an epidemiological transition, with a higher prevalence of diabetes in low SES groups in the urban areas of the more economically developed states. The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Affiliation(s)
- Ranjit Mohan Anjana
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Mohan Deepa
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Rajendra Pradeepa
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | | | | | | | | | | | - Banshi Saboo
- Dia Care-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, India
| | - Anil Bhansali
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mary John
- Christian Medical College, Ludhiana, India
| | | | - Taranga Reang
- Agartala Government Medical College, Agartala, India
| | | | | | | | - Nirmal Elangovan
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Radhakrishnan Subashini
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ulagamathesan Venkatesan
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Unnikrishnan
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sri Venkata Madhu
- University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Mohammed K Ali
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Arvind Pandey
- National Institute of Medical Statistics, New Delhi, India
| | | | - Tanvir Kaur
- Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention and Control, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
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Oommen AM, Abraham VJ, George K, Jose VJ. Prevalence of risk factors for non-communicable diseases in rural & urban Tamil Nadu. Indian J Med Res 2017; 144:460-471. [PMID: 28139545 PMCID: PMC5320852 DOI: 10.4103/0971-5916.198668] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background & objectives: Surveillance of risk factors is important to plan suitable control measures for non-communicable diseases (NCDs). The objective of this study was to assess the behavioural, physical and biochemical risk factors for NCDs in Vellore Corporation and Kaniyambadi, a rural block in Vellore district, Tamil Nadu, India. Methods: This cross-sectional study was carried out among 6196 adults aged 30-64 yr, with 3799 participants from rural and 2397 from urban areas. The World Health Organization-STEPS method was used to record behavioural risk factors, anthropometry, blood pressure, fasting blood glucose and lipid profile. Multiple logistic regression was used to assess associations between risk factors. Results: The proportion of tobacco users (current smoking or daily use of smokeless tobacco) was 23 per cent in the rural sample and 18 per cent in the urban, with rates of smoking being similar. Ever consumption of alcohol was 62 per cent among rural men and 42 per cent among urban men. Low physical activity was seen among 63 per cent of the urban and 43 per cent of the rural sample. Consumption of fruits and vegetables was equally poor in both. In the urban sample, 54 per cent were overweight, 29 per cent had hypertension and 24 per cent diabetes as compared to 31, 17 and 11 per cent, respectively, in the rural sample. Physical inactivity was associated with hypertension, body mass index (BMI) ≥25 kg/m2, central obesity and dyslipidaemia after adjusting for other factors. Increasing age, male sex, BMI ≥25 kg/m2 and central obesity were independently associated with both hypertension and diabetes. Interpretation & conclusions: Diabetes, hypertension, dyslipidaemia, physical inactivity and overweight were higher in the urban area as compared to the rural area which had higher rates of smokeless tobacco use and alcohol consumption. Smoking and inadequate consumption of fruits and vegetables were equally prevalent in both the urban and rural samples. There is an urgent need to address behavioural risk factors such as smoking, alcohol consumption, physical inactivity and inadequate intake of fruits and vegetables through primary prevention.
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Affiliation(s)
- Anu Mary Oommen
- Department of Community Health, Christian Medical College, Vellore, India
| | | | - Kuryan George
- Department of Community Health, Christian Medical College, Vellore, India
| | - V Jacob Jose
- Department of Cardiology, Christian Medical College, Vellore, India
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Prevalence of type 2 diabetes and its complications in India and economic costs to the nation. Eur J Clin Nutr 2017; 71:816-824. [PMID: 28422124 DOI: 10.1038/ejcn.2017.40] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 01/04/2023]
Abstract
Diabetes, a major lifestyle disorder, has become a global burden, and the prevalence rates are rising steeply in developing economies. Rapid socioeconomic transition with urbanization and industrialization are the main causes for the global diabetes epidemic. Among developing economies, the highest increase in number of people with diabetes is in China followed by India. In India, the epidemic of diabetes continue to increase and is experiencing a shift in diabetes prevalence from urban to rural areas, the affluent to the less privileged and from older to younger people. Diabetes is a progressive disorder leading to complications, which are broadly divided into small vessel or microvascular disease and large vessel or macrovascular disease. Microvascular complications affect the inner part of the eye-the retina known as diabetic retinopathy, the kidney termed as diabetic nephropathy and the peripheral nerves termed as diabetic neuropathy. The macrovascular complications affect the heart, the brain and the peripheral arteries termed as cardiovascular disease, cerebrovascular disease and peripheral vascular disease, respectively. Given the lifelong expenditure associated with diabetes and its complications, individuals, families and the society are unable to cope with the economic, emotional and social disease burden due to diabetes. The economic burden of diabetes can be reduced by providing universal healthcare coverage, access to affordable medicines and early detection and treatment of the disorder. This emphasizes the need for a multi-prolonged strategy to minimize the burden of diabetes and its complications.
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Vimaleswaran KS. Gene-nutrient interactions on metabolic diseases: Findings from the GeNuIne Collaboration. NUTR BULL 2017. [DOI: 10.1111/nbu.12252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K. S. Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR); Department of Food and Nutritional Sciences; University of Reading; Reading UK
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Abstract
India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation &Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre of Education, No. 6 Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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Ahluwalia G. Obesity paradigm in India: Are the consequences an impending Tsunami? Indian J Med Res 2016; 142:106-8. [PMID: 26354206 PMCID: PMC4613430 DOI: 10.4103/0971-5916.164211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gautam Ahluwalia
- Department of Medicine, Dayanand Medical College & Hospital, Ludhiana 141 001, Punjab, India
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Sadeghian HA, Madhu SV, Agrawal K, Kannan AT, Agrawal K. Effects of a self-management educational program on metabolic control in type 2 diabetes. Turk J Med Sci 2016; 46:719-26. [PMID: 27513247 DOI: 10.3906/sag-1501-115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/27/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM India has 63 million diabetic people and the overall prevalence of diabetes in this country is 8.37%. Lifestyle modification by education is the most cost-effective strategy to have better metabolic control. The aim of this study was to investigate the effects of a self-management educational program on control of type 2 diabetes. MATERIALS AND METHODS It was a randomized controlled interventional study conducted among 306 patients with type 2 diabetes mellitus attending the Diabetic Clinic at G.T.B. Hospital, Delhi, from March 2010 to May 2013. The intervention was in the form of group education based on a self-management program, which was earlier developed in the pilot study. RESULTS The baseline characteristics were comparable in the two groups. After 6 months, there was a significant improvement in the HbA1c levels (P = 0.0001), physical activity level (P = 0.001), and BMI (P = 0.001) in the study group as compared to the control group and this difference persisted even when analysis was done using generalized estimation equations. CONCLUSION The findings of this study proved that a self-management educational program is an essential component in the management of diabetes and provided concrete evidence that this is an effective instrument in the control of body weight, blood pressure, and glycated Hb levels in type 2 diabetes.
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Affiliation(s)
| | | | - Kamal Agrawal
- Department of Community Medicine, UCMS & GTB Hospital, Delhi, India
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Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, Dhandania VK, Madhu SV, Rao PV, Geetha L, Subashini R, Unnikrishnan R, Shukla DK, Kaur T, Mohan V, Das AK. Prevalence of generalized & abdominal obesity in urban & rural India--the ICMR-INDIAB Study (Phase-I) [ICMR- NDIAB-3]. Indian J Med Res 2016; 142:139-50. [PMID: 26354211 PMCID: PMC4613435 DOI: 10.4103/0971-5916.164234] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND & OBJECTIVES Overweight and obesity are rapidly increasing in countries like India. This study was aimed at determining the prevalence of generalized, abdominal and combined obesity in urban and rural India. METHODS Phase I of the ICMR-INDIAB study was conducted in a representative population of three States [Tamil Nadu (TN), Maharashtra (MH) and Jharkhand (JH)] and one Union Territory (UT)[Chandigarh (CH)] of India. A stratified multi-stage sampling design was adopted and individuals ≥ 20 yr of age were included. WHO Asia Pacific guidelines were used to define overweight [body mass index (BMI) ≥ 23 kg/m [2] but < 25 kg/m [2]], generalized obesity (GO, BMI ≥ 25 kg/m [2], abdominal obesity (AO, waist circumference ≥ 90 cm for men and ≥ 80 cm for women) and combined obesity (CO, GO plus AO). Of the 14,277 participants, 13,800 subjects (response rate, 96.7%) were included for the analysis (urban: n = 4,063; rural: n = 9737). RESULTS The prevalence of GO was 24.6, 16.6, 11.8 and 31.3 per cent among residents of TN, MH, JH and CH, while the prevalence of AO was 26.6, 18.7, 16.9 and 36.1 per cent, respectively. CO was present in 19.3, 13.0, 9.8 and 26.6 per cent of the TN, MH, JH and CH population. The prevalence of GO, AO and CO were significantly higher among urban residents compared to rural residents in all the four regions studied. The prevalence of overweight was 15.2, 11.3, 7.8 and 15.9 per cent among residents of TN, MH, JH and CH, respectively. Multiple logistic regression analysis showed that female gender, hypertension, diabetes, higher socio-economic status, physical inactivity and urban residence were significantly associated with GO, AO and CO in all the four regions studied. Age was significantly associated with AO and CO, but not with GO. INTERPRETATION & CONCLUSIONS Prevalence of AO as well as of GO were high in India. Extrapolated to the whole country, 135, 153 and 107 million individuals will have GO, AO and CO, respectively. However, these figures have been estimated from three States and one UT of India and the results may be viewed in this light.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
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Little M, Humphries S, Patel K, Dodd W, Dewey C. Factors associated with glucose tolerance, pre-diabetes, and type 2 diabetes in a rural community of south India: a cross-sectional study. Diabetol Metab Syndr 2016; 8:21. [PMID: 26958082 PMCID: PMC4782344 DOI: 10.1186/s13098-016-0135-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/17/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND India's national rural prevalence of type 2 diabetes has quadrupled in the past 25 years. Despite the growing rural burden, few studies have examined putative risk factors and their relationship with glucose intolerance and diabetes in rural areas. We undertook a cross-sectional study to determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes in a rural area of south India. In addition, we determined which factors were associated with type 2 diabetes. METHODS We sampled 2 % of the adult population from 17 villages using a randomized household-level sampling technique. Each participant undertook a questionnaire that included basic descriptive information and an assessment of socioeconomic status, physical activity, and dietary intake. Height, weight, waist and hip circumference, and blood pressure measurements were taken. An oral glucose tolerance test was used to determine diabetes status. We used stepwise logistic model building techniques to determine associations between several putative factors and type 2 diabetes. RESULTS 753 participants were included in the study. The age- and sex-standardized prevalence of IFG was 3.9 %, IGT was 5.6 %, and type 2 diabetes was 10.8 %. Factors associated with type 2 diabetes after adjusting for confounders included physical activity [OR 0.81], rurality [OR 0.76], polyunsaturated fat intake [OR 0.94], body mass index [OR 1.85], waist to hip ratio [OR 1.62], and tobacco consumption [OR 2.82]. CONCLUSION Our study contributes to the growing body of research suggesting that diabetes is a significant concern in rural south India. Associated risk factors should be considered as potential targets for reducing health burdens in India.
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Affiliation(s)
- Matthew Little
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Sally Humphries
- />Department of Sociology and Anthropology, University of Guelph, Guelph, ON Canada
| | - Kirit Patel
- />Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB Canada
| | - Warren Dodd
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
| | - Cate Dewey
- />Department of Population Medicine, University of Guelph, Guelph, ON Canada
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Venkataraman V, Anjana RM, Pradeepa R, Deepa M, Jayashri R, Anbalagan VP, Akila B, Madhu SV, Lakshmy R, Mohan V. Stability and reliability of glycated haemoglobin measurements in blood samples stored at -20°C. J Diabetes Complications 2016; 30:121-5. [PMID: 26508472 DOI: 10.1016/j.jdiacomp.2015.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
AIM To validate the stability of glycated haemoglobin (HbA1c) measurements in blood samples stored at -20°C for up to one month. METHODS The study group comprised 142 type 2 diabetic subjects visiting a tertiary centre for diabetes at Chennai city in south India. The HbA1c assay was done on a fasting blood sample using the Bio-Rad Variant machine on Day 0 (day of blood sample collection). Several aliquots were stored at -20°C and the assay was repeated on the 3rd, 7th, 15th, and 30th day after the sample collection. Bland-Altman plots were constructed and variation in the HbA1c levels on the different days was compared with the day 0 level. RESULTS The median differences between HbA1c levels measured on Day 0 and the 3rd, 7th, 15th, and 30th day after blood collection were 0.0%, 0.2%, 0.3% and 0.5% respectively. Bland-Altman plot analysis showed that the differences between the day '0' and the different time points tend to get larger with time, but these were not clinically significant. CONCLUSIONS HbA1c levels are relatively stable up to 2weeks, if blood samples are stored at -20°C.
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Affiliation(s)
- Vijayachandrika Venkataraman
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Ramamoorthy Jayashri
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Viknesh Prabu Anbalagan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Bridgitte Akila
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Sri Venkata Madhu
- University College of Medical Sciences and GTB Hospital, Delhi, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India.
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Kaushal K, Kalra S. Community health orientation of Indian Journal of Endocrinology and Metabolism: A bibliometric analysis of Indian Journal of Endocrinology and Metabolism. Indian J Endocrinol Metab 2015; 19:399-404. [PMID: 25932398 PMCID: PMC4366781 DOI: 10.4103/2230-8210.152787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Endocrine and metabolic diseases especially diabetes have become focus areas for public health professionals. Indian Journal of Endocrinology and Metabolism (IJEM), a publication of Endocrine Society of India, is a peer-reviewed online journal, which covers technical and clinical studies related to health, ethical and social issues in field of diabetes, endocrinology and metabolism. This bibliometric analysis assesses the journal from a community health perspective. MATERIALS AND METHODS Every article published in IJEM over a period of 4 years (2011-2014) was accessed to review coverage of community health in the field of endocrinology. RESULTS Seven editorials, 30 review articles, 41 original articles, 12 brief communications, 20 letter to editors, 4 articles on guidelines and 2 in the section "endocrinology and gender" directly or indirectly dealt with community health aspects of endocrinology. Together these amounted to 17% of all articles published through these 4 years. There were 14 articles on general, 60 pertaining to pancreas and diabetes, 10 on thyroid, 7 on pituitary/adrenal/gonads, 21 on obesity and metabolism and 4 on parathyroid and bone; all community medicine related. CONCLUSION Community health is an integral part of the modern endocrinology diabetology and metabolism practice and it received adequate journal space during the last 4 years. The coverage is broad based involving all the major endocrine disorders.
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Affiliation(s)
- Kanica Kaushal
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
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Unnikrishnan R, Anjana RM, Deepa M, Pradeepa R, Joshi SR, Bhansali A, Dhandania VK, Joshi PP, Madhu SV, Rao PV, Lakshmy R, Jayashri R, Velmurugan K, Nirmal E, Subashini R, Vijayachandrika V, Kaur T, Shukla DK, Das AK, Mohan V. Glycemic control among individuals with self-reported diabetes in India--the ICMR-INDIAB Study. Diabetes Technol Ther 2014; 16:596-603. [PMID: 25101698 PMCID: PMC4135327 DOI: 10.1089/dia.2014.0018] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS This study estimated the levels of glycemic control among subjects with self-reported diabetes in urban and rural areas of four regions in India. RESEARCH DESIGN AND METHODS Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study was conducted in a representative population of three states of India (Tamil Nadu, Maharashtra, and Jharkhand) and one Union Territory (Chandigarh) and covering a population of 213 million people. Using a stratified multistage sampling design, individuals ≥20 years of age were recruited. Glycemic control among subjects with self-reported diabetes was assessed by measurement of glycated hemoglobin (HbA1c), estimated by the Variant™ II Turbo method (Bio-Rad, Hercules, CA). RESULTS Among the 14,277 participants in Phase I of INDIAB, there were 480 subjects with self-reported diabetes (254 urban and 226 rural). The mean HbA1c levels were highest in Chandigarh (9.1±2.3%), followed by Tamil Nadu (8.2±2.0%), Jharkhand (8.2±2.4%), and Maharashtra (8.0±2.1%). Good glycemic control (HbA1c <7%) was observed only in 31.1% of urban and 30.8% of rural subjects. Only 22.4% of urban and 15.4% of rural subjects had reported having checked their HbA1c in the past year. Multiple logistic regression analysis revealed younger age, duration of diabetes, insulin use, and high triglyceride levels to be significantly associated with poor glycemic control. CONCLUSIONS The level of glycemic control among subjects with self-reported diabetes in India is poor. Urgent action is needed to remedy the situation.
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Affiliation(s)
- Ranjit Unnikrishnan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prashant P. Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, India
| | - Sri Venkata Madhu
- Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology & Metabolism, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ramakrishnan Lakshmy
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Ramamurthy Jayashri
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Kaliaperumal Velmurugan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Elangovan Nirmal
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Venkataraman Vijayachandrika
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Tanvir Kaur
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Deepak Kumar Shukla
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Post-Graduate Medical Education & Research, Puducherry, India
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Prevalence of and risk factors for hypertension in urban and rural India: the ICMR–INDIAB study. J Hum Hypertens 2014; 29:204-9. [DOI: 10.1038/jhh.2014.57] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/07/2014] [Accepted: 05/29/2014] [Indexed: 11/08/2022]
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Bansal B, Mithal A, Carvalho P, Mehta Y, Trehan N. Medanta insulin protocols in patients undergoing cardiac surgery. Indian J Endocrinol Metab 2014; 18:455-467. [PMID: 25143899 PMCID: PMC4138898 DOI: 10.4103/2230-8210.137486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.
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Affiliation(s)
- Beena Bansal
- Senior Consultant, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Chairman, Division of Endocrinology and Diabetes, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Pravin Carvalho
- Scientist, Gida Technology Services, Bangalore, Karnataka, India
| | - Yatin Mehta
- Chairman, Institute of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Naresh Trehan
- Chairman, Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta, The Medicity, Gurgaon, Haryana, India
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Shriraam V, Mahadevan S, Anitharani M, Selvavinayagam, Sathiyasekaran B. National health programs in the field of endocrinology and metabolism - Miles to go. Indian J Endocrinol Metab 2014; 18:7-12. [PMID: 24701424 PMCID: PMC3968736 DOI: 10.4103/2230-8210.126521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The endocrine and metabolic diseases of childhood obesity, diabetes mellitus, hypertension, iodine deficiency disorders, vitamin D deficiency, and osteoporosis are major public health problems. Different programs including National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke address these problems although some are yet to be addressed. National surveys have shown high prevalence of these disorders and their risk factors. Most of the programs aim at awareness raising, lifestyle modification, (primary prevention) and screening (secondary prevention) for the disease conditions as these are proven to be cost-effective compared to late diagnosis and treatment of various complications. Urgent concerted full scale implementation of these programs with good coordination under the umbrella of National Rural Health Mission is the need of the moment. The referral system needs strengthening as are the secondary and tertiary levels of health care. Due attention is to be given for implementation of these programs in the urban areas, as the prevalence of these conditions is almost equal or even higher among urban poor people where primary and secondary prevention measures are scarcely available and treatment costs are sky-high.
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Affiliation(s)
- Vanishree Shriraam
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Porur, Tamil Nadu, India
| | - Shriraam Mahadevan
- Department of Endocrinology and Diabetes, Sri Ramachandra Medical College and Research Institute, Porur, Tamil Nadu, India
| | - M Anitharani
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Porur, Tamil Nadu, India
| | - Selvavinayagam
- Tamil Nadu Health Systems Project, Directorate of Public Health, Government of Tamil Nadu, Tamil Nadu, India
| | - Bwc Sathiyasekaran
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Porur, Tamil Nadu, India
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Prevalence of dyslipidemia in urban and rural India: the ICMR-INDIAB study. PLoS One 2014; 9:e96808. [PMID: 24817067 PMCID: PMC4016101 DOI: 10.1371/journal.pone.0096808] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/11/2014] [Indexed: 12/18/2022] Open
Abstract
Aim To study the pattern and prevalence of dyslipidemia in a large representative sample of four selected regions in India. Methods Phase I of the Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study was conducted in a representative population of three states of India [Tamil Nadu, Maharashtra and Jharkhand] and one Union Territory [Chandigarh], and covered a population of 213 million people using stratified multistage sampling design to recruit individuals ≥20 years of age. All the study subjects (n = 16,607) underwent anthropometric measurements and oral glucose tolerance tests were done using capillary blood (except in self-reported diabetes). In addition, in every 5th subject (n = 2042), a fasting venous sample was collected and assayed for lipids. Dyslipidemia was diagnosed using National Cholesterol Education Programme (NCEP) guidelines. Results Of the subjects studied, 13.9% had hypercholesterolemia, 29.5% had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and 79% had abnormalities in one of the lipid parameters. Regional disparity exists with the highest rates of hypercholesterolemia observed in Tamilnadu (18.3%), highest rates of hypertriglyceridemia in Chandigarh (38.6%), highest rates of low HDL-C in Jharkhand (76.8%) and highest rates of high LDL-C in Tamilnadu (15.8%). Except for low HDL-C and in the state of Maharashtra, in all other states, urban residents had the highest prevalence of lipid abnormalities compared to rural residents. Low HDL-C was the most common lipid abnormality (72.3%) in all the four regions studied; in 44.9% of subjects, it was present as an isolated abnormality. Common significant risk factors for dyslipidemia included obesity, diabetes, and dysglycemia. Conclusion The prevalence of dyslipidemia is very high in India, which calls for urgent lifestyle intervention strategies to prevent and manage this important cardiovascular risk factor.
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Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, Dhandhania VK, Rao PV, Subashini R, Unnikrishnan R, Shukla DK, Madhu SV, Das AK, Mohan V, Kaur T. Knowledge and awareness of diabetes in urban and rural India: The Indian Council of Medical Research India Diabetes Study (Phase I): Indian Council of Medical Research India Diabetes 4. Indian J Endocrinol Metab 2014; 18:379-385. [PMID: 24944935 PMCID: PMC4056139 DOI: 10.4103/2230-8210.131191] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Representative data on knowledge and awareness about diabetes is scarce in India and is extremely important to plan public health policies aimed at preventing and controlling diabetes. AIM The aim of the following study is to assess awareness and knowledge about diabetes in the general population, as well as in individuals with diabetes in four selected regions of India. MATERIALS AND METHODS The study subjects were drawn from a representative sample of four geographical regions of India, Chandigarh, Tamil Nadu, Jharkhand and Maharashtra representing North, South, East and West and covering a population of 213 million. A total of 16,607 individuals (5112 urban and 11,495 rural) aged ≥20 years were selected from 188 urban and 175 rural areas. Awareness of diabetes and knowledge of causative factors and complications of diabetes were assessed using an interviewer administered structured questionnaire in 14,274 individuals (response rate, 86.0%), which included 480 self-reported diabetic subjects. RESULTS Only 43.2% (6160/14,274) of the overall study population had heard about a condition called diabetes. Overall urban residents had higher awareness rates (58.4%) compared to rural residents (36.8%) (P < 0.001). About 46.7% of males and 39.6% of females reported that they knew about a condition called diabetes (P < 0.001). Of the general population, 41.5% (5726/13,794) knew about a condition called diabetes. Among them, 80.7% (4620/5726) knew that the prevalence of diabetes was increasing, whereas among diabetic subjects, it was 93.0% (448/480). Among the general and diabetic population, 56.3% and 63.4% respectively, were aware that diabetes could be prevented. Regarding complications, 51.5% of the general population and 72.7% diabetic population knew that diabetes could affect other organs. Based on a composite knowledge score to assess knowledge among the general population, Tamil Nadu had the highest (31.7) and Jharkhand the lowest score (16.3). However among self-reported diabetic subjects, Maharashtra had the highest (70.1) and Tamil Nadu, the lowest score (56.5). CONCLUSION Knowledge and awareness about diabetes in India, particularly in rural areas, is poor. This underscores the need for conducting large scale diabetes awareness and education programs.
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Affiliation(s)
- M. Deepa
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - A. Bhansali
- Department of Epidemiology and Diabetology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R. M. Anjana
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - R. Pradeepa
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - S. R. Joshi
- Department of Epidemiology and Diabetology, Lilavati Hospital, Mumbai, India
| | - P. P. Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, India
| | | | - P. V. Rao
- Department of Endocrinology and Metabolism, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - R. Subashini
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - R. Unnikrishnan
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - D. K. Shukla
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - S. V. Madhu
- Department of Medicine, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - A. K. Das
- Department of Endocrinology, Jawaharlal Institute of Post– Graduate Medical Education and Research, Puducherry, India
| | - V. Mohan
- Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation and Dr.Mohan's Diabetes Specialities Centre, Chennai, India
| | - T. Kaur
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Anjana RM, Pradeepa R, Das AK, Deepa M, Bhansali A, Joshi SR, Joshi PP, Dhandhania VK, Rao PV, Sudha V, Subashini R, Unnikrishnan R, Madhu SV, Kaur T, Mohan V, Shukla DK. Physical activity and inactivity patterns in India - results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act 2014; 11:26. [PMID: 24571915 PMCID: PMC3974063 DOI: 10.1186/1479-5868-11-26] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/21/2014] [Indexed: 12/01/2022] Open
Abstract
Background The rising prevalence of diabetes and obesity in India can be attributed, at least in part, to increasing levels of physical inactivity. However, there has been no nationwide survey in India on physical activity levels involving both the urban and rural areas in whole states of India. The aim of the present study was to assess physical activity patterns across India - as part of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Methods Phase 1 of the ICMR-INDIAB study was conducted in four regions of India (Tamilnadu, Maharashtra, Jharkhand and Chandigarh representing the south, west, east and north of India respectively) with a combined population of 213 million people. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) in 14227 individuals aged ≥ 20 years [urban- 4,173; rural- 10,054], selected from the above regions using a stratified multistage design. Results Of the 14227 individuals studied, 54.4% (n = 7737) were inactive (males: 41.7%), while 31.9% (n = 4537) (males: 58.3%) were active and 13.7% (n = 1953) (males: 61.3%) were highly active. Subjects were more inactive in urban, compared to rural, areas (65.0% vs. 50.0%; p < 0.001). Males were significantly more active than females (p < 0.001). Subjects in all four regions spent more active minutes at work than in the commuting and recreation domains. Absence of recreational activity was reported by 88.4%, 94.8%, 91.3% and 93.1% of the subjects in Chandigarh, Jharkhand, Maharashtra and Tamilnadu respectively. The percentage of individuals with no recreational activity increased with age (Trend χ2: 199.1, p < 0.001). Conclusions The study shows that a large percentage of people in India are inactive with fewer than 10% engaging in recreational physical activity. Therefore, urgent steps need to be initiated to promote physical activity to stem the twin epidemics of diabetes and obesity in India.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr,Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control & IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, India.
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Ladha K, Tiwari B. Type 2 diabetes and edentulism as chronic co-morbid factors affecting Indian elderly: an overview. J Indian Prosthodont Soc 2013; 13:406-12. [PMID: 24431769 PMCID: PMC3792296 DOI: 10.1007/s13191-013-0266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022] Open
Abstract
In past 50 years, type 2 diabetes has emerged as one of the major public health problem. India leads the world with the largest number of diabetic patients and has a huge elderly population. The present article discusses the effect of diabetes and edentulism on the overall general health of elderly. The prevalence of type 2 diabetes and edentulism in Indian elderly and their inter-relationship has been discussed. Dentists must provide optimum oral care with special attention towards comprehensive periodontal management and oral hygiene awareness among diabetics to prevent tooth loss. Dental and medical professionals can improve patient management of the oral and overall effects of diabetes by implementing various awareness programs; organizing camps; distributing informative pamphlets and dietary counseling. Dentists can detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation and management.
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Affiliation(s)
- Komal Ladha
- Department of Prosthodontics, ESIC Dental College & Hospital, New Delhi, India
| | - Bhawana Tiwari
- Department of Prosthodontics, ESIC Dental College & Hospital, New Delhi, India
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Khandelwal S, Reddy KS. Eliciting a policy response for the rising epidemic of overweight-obesity in India. Obes Rev 2013; 14 Suppl 2:114-25. [PMID: 24103051 DOI: 10.1111/obr.12097] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Abstract
India is experiencing multiple transitions with respect to nutrition patterns, epidemiology and demography. Along with staggering childhood undernutrition, a rapid rise in chronic diseases and their risk factors including overweight-obesity (O-O), among all sections of society, is compounding India's health challenges. We present an overview of the O-O scenario (prevalence, determinants) and profile existing initiatives to address this modifiable risk factor in India. Urgent attention from all sectors, committed resources, policy support and targeted actions are warranted to combat the dual burden of malnutrition. The health systems should be reoriented and strengthened, in addition to enabling actions in other sectors, to address prevention and control of non-communicable diseases and associated risk factors like O-O.
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Affiliation(s)
- S Khandelwal
- Public Health Foundation of India, New Delhi, India
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50
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Tentolouris N, Lathouris P, Lontou S, Tzemos K, Maynard J. Screening for HbA1c-defined prediabetes and diabetes in an at-risk greek population: performance comparison of random capillary glucose, the ADA diabetes risk test and skin fluorescence spectroscopy. Diabetes Res Clin Pract 2013; 100:39-45. [PMID: 23369230 DOI: 10.1016/j.diabres.2013.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/03/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND We examined the accuracy of random capillary glucose (RCG) and two noninvasive screening methods, the ADA diabetes risk test (DRT) and skin fluorescence spectroscopy (SFS) as measured by Scout DS for detecting HbA1c-defined dysglycemia or type 2 diabetes in an at-risk cohort. METHODS Subjects were recruited at two clinical sites for a single non-fasting visit. Each subject had measurements of height, weight and waist circumference. A diabetes score was calculated from skin fluorescence measured on the left forearm. A finger prick was done to measure RCG and HbA1c (A1C). Health questionnaires were completed for the DRT. Increasing dysglycemia was defined as A1C ≥ 5.7% (39 mmol/mol) or ≥ 6.0% (42 mmol/mol). Type 2 diabetes was defined as A1C ≥ 6.5% (47.5 mmol/mol). RESULTS 398 of 409 subjects had complete data for analysis with means for age, body mass index, and waist of 52 years, 27 kg/m(2) and 90 cm. 51% were male. Prevalence of A1C ≥ 5.7%, ≥ 6.0% and ≥ 6.5% were 54%, 34% and 12%, respectively. Areas under the curve (AUC) for detection of increasing levels dysglycemia or diabetes for RCG were 63%, 66% and 72%, for the ADA DRT the AUCs were 75%, 76% and 81% and for SFS the AUCs were 82%, 84% and 90%, respectively. For each level of dysglycemia or diabetes, the SFS AUC was significantly higher than RCG or the ADA DRT. CONCLUSIONS The noninvasive skin fluorescence spectroscopy measurement outperformed both RCG and the ADA DRT for detection of A1C-defined dysglycemia or diabetes in an at-risk cohort.
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Affiliation(s)
- Nicholas Tentolouris
- 1st Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
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