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Davalagi S, Amuje R, H S. Cardiovascular Risk Assessment Among People With Type 2 Diabetes Mellitus in Urban Slums of Central Karnataka, India. Cureus 2023; 15:e46687. [PMID: 37942395 PMCID: PMC10629598 DOI: 10.7759/cureus.46687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The intricate interplay between type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) necessitates a comprehensive investigation into the cardiovascular risk landscape among individuals with T2DM. The burgeoning global burden of both conditions underscores the urgency of targeted research in this area, with the potential to inform preventive strategies and mitigate adverse cardiovascular outcomes. By unravelling the risk of CVD among T2DM patients and identifying key risk factors, the current research could pave the way for tailored interventions that could have the potential to substantially alleviate the cardiovascular burden associated with T2DM. AIMS AND OBJECTIVES To assess the cardiovascular risk and its determinants among T2DM patients. METHODS A cross sectional study was conducted among known diabetes patients accessing urban outreach clinic serving approximately 20,000 population across 18 urban slums in central Karnataka from September 2022 to June 2023. A pre-tested semi-structured questionnaire was used to collect information on socio-demographic details and CVD risk was assessed using QRISK3 score. Data were entered in Excel 2019 (Microsoft, Redmond, WA, USA) and analysed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA) and are presented in the tables and figures. RESULTS A total of 483 adults above 30 years participated in the study. Among them, the majority were men (67.9%). Cardiovascular risk factors were found more among males and the 10-year cardiovascular risk assessment prediction through QRISK3 score was higher among males compared to females and it was found to be statistically significant (13.5±8.6% vs. 19.5±10.1%, p<0.001). CONCLUSION According to a comparison of cardiovascular risk variables by gender among diabetic patients using the QRISK3's 10-year risk assessment, males, smokers/tobacco users, obese, and known hypertensives had significantly greater risk.
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Affiliation(s)
- Shubha Davalagi
- Community Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Rohit Amuje
- Community Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
| | - Shalini H
- Community Medicine, Jagadguru Jayadeva Murugarajendra (JJM) Medical College, Davangere, IND
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Das U, Kar N. Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave. BMC Endocr Disord 2023; 23:170. [PMID: 37568234 PMCID: PMC10416355 DOI: 10.1186/s12902-023-01421-3] [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: 12/13/2022] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal. METHODS The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults. RESULTS The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively. CONCLUSION The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.
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Affiliation(s)
- Ujjwal Das
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
- Dept. of Geography, Fakir Mohan University, Balasore, Odisha India
| | - Nishamani Kar
- Dept. of Geography in, Rajiv Gandhi University, Doimukh, Arunachal Pradesh India
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Kaul U, Arambam P, Sinha SK, Abhaichand R, Parida AK, Banker D, Mody R, Khan A, Sharma R, Moorthy N, Chandra S, Koduganti SC, Garg R, Sarma PR, Agrawal DK, Reddy KMK, Bangalore S. Rationale and design of the TUXEDO-2 India study: Ultra-Thin strUt Supraflex Cruz versus XiencE in a Diabetic pOpulation with multi-vessel disease-2. Am Heart J 2023; 256:128-138. [PMID: 36780372 DOI: 10.1016/j.ahj.2022.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The role of percutaneous coronary interventions (PCI) in patients with diabetes mellitus and multi-vessel disease has been questioned by the results of the FREEDOM trial, which showed superiority of coronary artery bypass graft(CABG) over first generation drug-eluting stents (DES) including a reduction in mortality. In the light of safer and more efficacious stents and significantly better medical management, those results that date back to 2012 need to be revisited. TUXEDO-2 is a study designed to compare two contemporary stents in Indian diabetic patients with multi-vessel disease. AIMS The primary objective of the TUXEDO-2 study is to compare the clinical outcomes of PCI with ultra-thin Supraflex Cruz vs Xience when combined with contemporary optimal medical therapy (OMT) in diabetic patients with multi-vessel disease. The secondary objective is to compare clinical outcomes between a pooled cohort from both arms of the study (Supraflex Cruz + Xience; PCI arm) vs CABG based on a performance goal derived from the CABG arm of the FREEDOM trial (historical cohort). The tertiary objective is a randomized comparison of ticagrelor vs prasugrel in addition to aspirin for the composite of ischemic and bleeding events. METHODS In this prospective, open-label, multi-centre, 2 × 2 factorial, randomized, controlled study, 1,800 patients with diabetes mellitus and multi-vessel disease (inclusion criteria similar to FREEDOM trial) with indication for coronary revascularization will be randomly assigned to Supraflex Cruz or Xience stents and also to ticagrelor- or prasugrel- based antiplatelet strategies. All patients will receive guideline directed OMT and optimal PCI including image- and physiology-guided complete revascularization where feasible. The patients will be followed through five years to assess their clinical status and major clinical events. The primary endpoint is a non-inferiority comparison of target lesion failure at one-year for Supraflex Cruz vs Xience (primary objective) with an expected event rate of 11% and a non-inferiority margin of 4.5%. For PCI vs CABG (secondary objective), the primary endpoint is major adverse cardiac events (MACE), defined as a composite of all cause death, nonfatal myocardial infarction, or stroke at one-year and yearly up to five years, with a performance goal of 21.6%. For ticagrelor vs prasugrel (tertiary objective), the primary endpoint is composite of death, myocardial infarction, stroke, and major bleeding as per the Bleeding Academic Research Consortium (BARC) at one-year with expected event rate of 15% and a non-inferiority margin of 5%. CONCLUSIONS The TUXEDO-2 study is a contemporary study involving state-of-the-art PCI combined with guideline directed OMT in a complex subset of patients with diabetes mellitus and multi-vessel disease. The trial will answer the question as to whether a biodegradable polymer coated ultra-thin Supraflex Cruz stent is an attractive option for PCI in diabetic patients with multi-vessel disease. It will also help address the question whether the results of FREEDOM trial would have been different in the current era of safer and more efficacious stents and modern medical therapy. In addition, the comparative efficacy and safety of ticagrelor vs prasugrel in addition to aspirin will be evaluated. (CTRI/2019/11/022088).
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Affiliation(s)
- Upendra Kaul
- Batra Hospital & Medical Research Centre, Delhi, New Delhi, India.
| | | | - Santosh Kumar Sinha
- LPS Institute of cardiology and Cardiac surgery, Kanpur, Uttar Pradesh, India
| | | | | | | | - Rohit Mody
- Max Super Specialty Hospital, Bhatinda, Punjab, India
| | - Aziz Khan
- Crescent Hospital and Heart Centre, Nagpur, Maharashtra, India
| | - Rajesh Sharma
- Indira Gandhi Medical College & Hospital, Shimla, Himachal Pradesh, India
| | - Nagaraja Moorthy
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Sharad Chandra
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Rajeev Garg
- Aware Gleneagles Global Hospital, Hyderabad, Telangana, India
| | | | - Deepesh Kumar Agrawal
- Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India
| | - K M K Reddy
- Osmania General Hospital, Hyderabad, Telangana, India
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Chenchula S, Gupta R, Gupta SK, Padmavathi R, Pathan S. Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India. Bioinformation 2022; 18:888-893. [PMID: 37654843 PMCID: PMC10465770 DOI: 10.6026/97320630018888] [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: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 09/02/2023] Open
Abstract
Rational prescribing of medicines is an important aspect of drug prescribing which helps in safe and efficacious and cost-effective drug treatment for patients. WHO Prescription indicators are intended to evaluate the services provided to the population concerning the rational use of medicines. The study aims to study prescription practices and rational use of medicines in the department of Internal medicine, using WHO prescribing indicators in a tertiary care teaching institute of national importance. A total of 50 prescriptions were digitally photographed and analysed for prescription practices and rational drug use, using standard WHO core prescribing indicators. A total of 301 drugs with multiple and diverse diagnoses were used. Statistical analysis was done using SPSS 22 version. The average number of drugs per prescription was 3.48%. It was found that only 13.79% of prescriptions have generic names, whereas 27.58% of patient encounters had at least one drug from the National List of Essential Medicine, 6.8% of prescriptions have antibiotics and 0.7% of prescriptions were injections. The number of prescriptions with fixed drug combinations was 27.55%. Indicators such as percentage of the National List of Essential Medicine, fixed drug combinations and prescribing with a generic name are used. Hence, we will suggest regular prescription audit practices and conducting CMEs and training workshops for clinicians for the rational use of medicines in all healthcare settings to succeed in the rational use of medicine.
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Affiliation(s)
| | - Rupesh Gupta
- Department of Internal Medicine, Government Medical College, Shahdol, India
| | | | - R Padmavathi
- SVS Medical College, Mahaboobnagar, Telangana, India
| | - Saman Pathan
- Department of Pharmacology, AIIMS, Bhopal, India
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Kumar S, Kant R, Yadav P, Kumar B. Effect of non-pharmacological interventions on adults with cardiovascular risk in a rural community. J Family Med Prim Care 2022; 11:5521-5526. [PMID: 36505636 PMCID: PMC9730992 DOI: 10.4103/jfmpc.jfmpc_2472_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, with three-fourth of deaths occurring in low- and middle-income countries (LMICs) like India. Currently, three out of the top five causes of morbidity and mortality in the country are NCDs. Objective This study evaluated the impact of non-pharmacological interventions as a comprehensive approach toward adults with cardiovascular risk in Indian rural communities. Material and Methods It was a quasi-experimental study conducted in Rishikesh, a holy city of Uttarakhand known as the world's yoga capital at the foothills of Himalaya. Out of 87 villages, four villages were randomly selected. Eighty-eight participants were enrolled (22 from each village and household). It was a multi-stage random sampling. All the participants with cardiovascular risk and age >30 years were recruited. Pregnant, severely ill, and unwilling to consent were excluded. Non-pharmacological intervention as a comprehensive approach, including yoga, meditation, mental health counseling, dietary counseling, tobacco, and alcohol cessation counseling has been provided to cardiovascular risk participants. Results Data of 76 participants were analyzed as the per-protocol analysis method. The drop-out rate was 13.63%. Male and female participants were 52 (68.4%) and 24 (31.6%) in number. Mean age of the participants was 55.28 ± 13.64 years. Diastolic blood pressure or DBP (P = 0.017*), systolic blood pressure or SBP (P = 0.008**), waist circumference (WC) (P = 0.000**), waist-to-hip ratio (P = 0.000**) and waist-to-height ratio (P = 0.000**) significantly improved in the post intervention group. Conclusion Non-pharmacological interventions as a comprehensive approach can significantly reduce modifiable risk factors for cardio-metabolic disease.
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Affiliation(s)
- Santosh Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Yadav
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence: Mrs. Poonam Yadav, Ph. D. Scholar, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India. E-mail:
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Barure R, Shanthaiah DM, Atluri S, Channabasappa S, Kolla G, Reddy SLS, Sarathi V. High Prevalence of Additional Cardiovascular Risk Factors in Eastern-Indian Young Adults with Type 2 Diabetes Mellitus. Indian J Endocrinol Metab 2022; 26:372-375. [PMID: 36185959 PMCID: PMC9519843 DOI: 10.4103/ijem.ijem_155_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS The American Diabetes Association recommends statin therapy for young type 2 diabetes mellitus (T2DM) adults only if one additional cardiovascular (CV) risk factor coexists. The data regarding CV risk factors in young Indian T2DM adults is limited. Hence, we assessed the prevalence of CV risk factors in young adults with T2DM from eastern India. METHODS In this cross-sectional study, diabetic medical health check records of eastern-Indian T2DM patients performed between March 2018 and March 2019 were retrospectively reviewed and the relevant data of T2DM patients (n = 3564) including CV risk factors [serum LDL-cholesterol of ≥100 mg/dL, hypertension (>140/90 mmHg), smoking, chronic kidney disease (eGFR of <60 ml/min), microalbumin to creatinine ratio of ≥30 mg/mg, and obesity/overweight (body mass index ≥23 kg/m2)] were analysed. RESULTS There were 3280 T2DM patients from eastern India and 679 (20.7%) were ≤40 years of age. Overweight/obesity (74.3%) and serum LDL-cholesterol of ≥100 mg/dL (69.2%) were the two most common additional CV risk factors. At least one additional CV risk factor was present in 576 (95.36%) patients, whereas at least two additional CV risk factors were present in 409 (67.7%) patients. At least one non-obesity/overweight CV risk factor was present in 472 (78.1%) patients. CONCLUSIONS The study demonstrates a high prevalence of additional CV risk factors in young eastern-Indian adults with T2DM. Hence, there is a need for an intensive approach to managing the CV risk factors in young Indian adults with T2DM.
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Affiliation(s)
- Ramdas Barure
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | | | - Sridevi Atluri
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Shivaprasad Channabasappa
- Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gautam Kolla
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - S. L. Sagar Reddy
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
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Unnikrishnan AG, Sahay RK, Phadke U, Sharma SK, Shah P, Shukla R, Viswanathan V, Wangnoo SK, Singhal S, John M, Kumar A, Dharmalingam M, Jain S, Shaikh S, Verberk WJ. Cardiovascular risk in newly diagnosed type 2 diabetes patients in India. PLoS One 2022; 17:e0263619. [PMID: 35358208 PMCID: PMC8970505 DOI: 10.1371/journal.pone.0263619] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) worldwide continues to increase, in particular in India. Early T2DM diagnosis followed by appropriate management will result in more cardiovascular event free life years. However, knowledge of the cardiovascular profile of newly diagnosed T2DM patients is still limited. The aim of this study was to understand the extent of cardiovascular disease (CVD) risk of newly diagnosed T2DM patients in India. Methods A cross sectional observational study was conducted to evaluate clinical laboratory and socio-demographic parameters of 5,080 newly diagnosed T2DM patients (48.3 ± 12.8 years of age; 36.7% female). In addition, we determined their cardiovascular risk according to the guidelines of the Lipid Association of India (LAI) and the criteria of the QRISK3 score. Results Of the newly T2DM diagnosed patients in India 2,007(39.5%) were classified as “High risk” and 3,073 (60.5%) were classified as “Very high risk” based on LAI criteria. On average, patients had 1.7 ± 0.9 major atherosclerotic cardiovascular disease (ASCVD) risk factors. Low HDL-C value was the most frequent major risk (2,823; 55.6%) followed by high age (2,502; 49.3%), hypertension (2,141; 42.1%), smoking/tobacco use (1,078; 21.2%) and chronic kidney disease stage 3b or higher (568; 11.2%). In addition, 4,192 (82.5%) patients appeared to have at least one cholesterol abnormality and, if the latest LAI recommendations are applied, 96.5% (4,902) presented with lipid values above recommended targets. Based on the QRISK3 calculation Indian diabetes patients had an average CVD risk of 15.3 ± 12.3%, (12.2 ± 10.1 vs. 17.1 ± 13.5 [p<0.001] for females and males, respectively). Conclusions Newly diagnosed Indian T2DM patients are at high ASCVD risk. Our data therefore support the notion that further extension of nationwide ASCVD risk identification programs and prevention strategies to reduce the occurrence of cardiovascular diseases are warranted.
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Affiliation(s)
| | - R. K. Sahay
- Department of Endocrinology, Osmania Medical College, Osmania General Hospital, Hyderabad, India
| | - Uday Phadke
- Sahyadri Hospital, Erandwane, Pune, Maharashtra, India
| | - S. K. Sharma
- Galaxy Speciality Centre, Jaipur, Rajasthan, India
| | - Parag Shah
- Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - Rishi Shukla
- Dr Rishi Shukla Centre for Diabetes & Endocrine Diseases, Kanpur, Uttar Pradesh, India
| | | | | | - Santosh Singhal
- Director, Sparsh Health Care & CHS Apple Hospital, Gwalior, Madhya Pradesh, India
| | - Mathew John
- Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | - Ajay Kumar
- Diabetes Care & Research Centre, Patna, Bihar, India
| | | | - Subodh Jain
- Diabetes Care Centre, Prayagraj, Uttar Pradesh, India
| | - Shehla Shaikh
- KGN Diabetes & Endocrinology Centre, Nagpada, Mumbai, Maharashtra, India
| | - Willem J. Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- * E-mail:
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Fatima Z, Atal S, Joshi R, Sadasivam B. Implications and Economic Impact of Applying International Guidelines and Recommendations to the Management of High-Risk Group of Type 2 Diabetes Mellitus Patients in India. Cureus 2022; 14:e22141. [PMID: 35308676 PMCID: PMC8920807 DOI: 10.7759/cureus.22141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
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Das S, Gupta AK, Bandyopadhyaya B, Darla BH, Arya V, Abhyankar M, Revankar S. Data on vildagliptin and vildagliptin plus metformin combination in type-2 diabetes mellitus management. Bioinformation 2021; 17:413-423. [PMID: 34092962 PMCID: PMC8131578 DOI: 10.6026/97320630017413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
It is of interest to evaluate the clinical effectiveness and safety of vildagliptin as monotherapy and combination therapy of vildagliptin and metformin for the management of type 2 diabetes mellitus (T2DM) patients in Indian settings. The study included patients with T2DM (aged >18 years) receiving vildagliptin monotherapy and vildagliptin in combination with metformin therapy of various strengths. Data related to demographics, risk factors, medical history, glycated hemoglobin (HbA1c) levels, and medical therapies were retrieved from medical records. Out of 9678 patients (median age, 52.0 years), 59.1% were men. A combination of vildagliptin and metformin (50/500 mg) was the most commonly used therapy (54.8%), and the median duration of therapy was 24.0 months. The predominant reason for selecting vildagliptin therapy was to improve HbA1c levels (87.8%). A total of 87.5% of patients required dosage up-titration. Vildagliptin therapy was used in patients with T2DM and associated complications (peripheral neuropathy, CAD, nephropathy, retinopathy, autonomous neuropathy, stroke/TIA, and peripheral artery disease). Among 5175 patients who experienced body weight changes, a majority of patients showed a loss of weight (68.6%). The target glycemic control was achieved in 95.3% of patients. The mean HbA1c levels were significantly decreased post-treatment (mean change: 1.34%; p<0.001). Adverse events were reported in 0.4% of patients. Physicians rated the majority of patients as good to excellent on the global evaluation of efficacy and tolerability scale (98.9%, each). Vildagliptin as monotherapy and combination therapy of vildagliptin and metformin was an effective therapy in reducing HbA1c helps in achieving target glycemic control, and was well tolerated in Indian patients with T2DM continuum.
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Affiliation(s)
| | - AK Gupta
- Rahas Medical Store Hospital, Lucknow, India
| | | | | | - Vivek Arya
- Center for Endocrine and Diabetes, Ahmedabad, India
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Association between genetic variants at chromosome 9p21 and risk of coronary artery disease in Emirati Type 2 Diabetes patients. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Govindarajan Venguidesvarane A, Jasmine A, Varadarajan S, Shriraam V, Muthuthandavan AR, Durai V, Thiruvengadam G, Mahadevan S. Prevalence of Vascular Complications Among Type 2 Diabetic Patients in a Rural Health Center in South India. J Prim Care Community Health 2020; 11:2150132720959962. [PMID: 33111620 PMCID: PMC7786422 DOI: 10.1177/2150132720959962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Vascular complications are the major cause of morbidity in patients with diabetes mellitus. Screening for these complications is crucial in early detection and tertiary prevention. Hence, this study aimed at finding the prevalence of micro and macrovascular complications and their associated factors in type 2 diabetes mellitus patients in a rural health center by using simple and easily available tools. Methodology: This hospital based cross sectional study was conducted in Rural Health and Training Centre (RHTC) of Sri Ramachandra medical college from Jan 2017 to Aug 2017. All type 2 diabetes patients registered at RHTC were included in the study. By the use of questionnaire, clinical examination and laboratory investigations, the prevalence of macro and microvascular complications and associated factors were ascertained. Multiple logistic regression was used to identify factors associated with vascular complications of diabetes. Results: The study included 390 type 2 diabetes patients. The overall prevalence of macrovascular and microvascular complications in our study population was 29.7% and 52.1%, respectively. Among the macrovascular complications, both coronary artery disease (CAD) and peripheral vascular disease (PVD) had a prevalence rate of 15.1%. Among the microvascular complications, peripheral neuropathy (44.9%) had the highest prevalence followed by nephropathy (12.1%) and diabetic foot (7.2%). Multiple logistic regression analyses showed high HbA1c level, lower education, high postprandial blood sugar, hypertension, abdominal obesity were significantly associated with increased risk of vascular complications of diabetes. Conclusion: This study demonstrated the increased prevalence of vascular complications in Type 2 diabetes patients in rural India. Regular screening to identify those patients at risk could prevent further progression of complications.
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Affiliation(s)
| | - Aliya Jasmine
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Samya Varadarajan
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vanishree Shriraam
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Vanitha Durai
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Shriraam Mahadevan
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Association of Pentraxin 3 rs2305619 (A/G) gene polymorphism and its serum level with the risk of nephropathy in type II diabetic patients. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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13
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Ramachandran A, Jain SM, Mukherjee S, Phatak S, Pitale S, Singh SK, Agrawal N, Majumdar A, Deshpande N, Jhulka S, Minakshisundaram S, Chawla M, Lodha S, Maheshwari A, Makkar BM, Rao S, Shah P, Ghosh R, Mohanasundaram S, Menon S, Chodankar D, Kanade V, Trivedi C. Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS). Ther Adv Endocrinol Metab 2020; 11:2042018820937217. [PMID: 32647562 PMCID: PMC7325532 DOI: 10.1177/2042018820937217] [Citation(s) in RCA: 8] [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: 10/24/2019] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. METHODS This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. RESULTS A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c) <7%: T1DM = 7.3% (3/44), T2DM = 25.2% (106/495); as targeted by the treating physician: T1DM = 31.8% (14/44), T2DM = 32.1% (59/185); global target: T1DM = 4.8% (2/42) and T2DM = 1.7% (8/482)]. In subjects with T2DM, HbA1c <7% was noted in 11/22 subjects receiving insulin only and 76/260 receiving only OGLDs. Lack of experience in self-managing insulin dosing, poor diabetes education and failure to titrate insulin dosages were the main reasons for non-achievement of glycemic targets. CONCLUSION Timely insulinization, education and empowerment of people with diabetes may help improve glycemic control in India.
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Affiliation(s)
- Ambady Ramachandran
- Department of Diabetology, Dr. Ramachandran’s Diabetes Hospital, No. 28, Marshall’s Road, Egmore, Chennai 600 008, India
| | - Sunil M. Jain
- Department of Endocrinology, TOTALL Diabetes Hormone Institute, Indore, India
| | - Sagarika Mukherjee
- Department of Diabetology, Dr. Sagarika Mukherjee’s Endocrinology Clinic, Kolkata, India
| | - Sanjeev Phatak
- Department of Diabetology, Vijayratna Diabetes Diagnosis and Treatment Centre, Ahmedabad, India
| | - Shailesh Pitale
- Department of Diabetology, Pitale Diabetes and Hormone Centre, Nagpur, India
| | - Shailendra K. Singh
- Department of Diabetology, Dr. Shailendra Kumar Singh’s Clinic, Varanasi, India
| | - Navneet Agrawal
- Department of Diabetology and Obesity, Diabetes, Obesity and Thyroid Centre, Gwalior, India
| | - Anirban Majumdar
- Department of Endocrinology, Anirban’s Diabetes- Obesity-Thyroid & Hormone Clinic, Kolkata, India
| | | | - Sandeep Jhulka
- Department of Diabetology, Radiance the Hormone Health Clinic, Indore, India
| | | | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care Centre and Mumbai Diabetes Research Centre, Mumbai, India
| | - Sailesh Lodha
- Department of Endocrinology, Dr. Sailesh Lodha Clinic, Rajasthan, India
| | - Anuj Maheshwari
- Department of Diabetology, Shri Hari Kamal Diabetes and Research Clinic, Lucknow, India
| | - Brij Mohan Makkar
- Department of Diabetology and Obesity, Diabetes and Obesity Centre, New Delhi, India
| | - Sadashiva Rao
- Department of Diabetology, Diabetic Care Centre, Vijayawada, India
| | - Parag Shah
- Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, India
| | - Romik Ghosh
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | | | - Shalini Menon
- Medical Affairs, Sanofi India Limited, Mumbai, Maharashtra, India
| | - Deepa Chodankar
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Vaishali Kanade
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
| | - Chirag Trivedi
- Clinical Study Unit, Sanofi Synthelabo India Limited, Mumbai, Maharashtra, India
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Prasad DS, Kabir Z, Revathi Devi K, Peter PS, Das BC. Prevalence and RIsk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes. Indian Heart J 2020; 71:400-405. [PMID: 32035523 PMCID: PMC7013173 DOI: 10.1016/j.ihj.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/18/2019] [Accepted: 12/09/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives To estimate the prevalence and to identify potential risk factors of silent myocardial ischemia in a cohort of patients with asymptomatic type 2 Diabetes (diabetes) for early detection of coronary risk by employing objective noninvasive clinical screening tools for Subclinical Atherosclerosis. Methods The study is a clinic-based observational study on 338 consecutive diabetes patients attending an urban health center from Eastern India. The response rate was 96.57% out of 350 eligible subjects, comprising 176 (52.1%) males and 162 (47.9%) females. Clinical, anthropometric, biochemical parameters were collected in all participants. Both tools, i.e., treadmill test (TMT) to identify subjects with silent myocardial ischemia, and carotid imaging to detect subclinical atherosclerosis by evaluating carotid intima-media thickness (CIMT), were assessed. Significant determinants were predicted by multivariable logistic regression. Results The study group was divided into a TMT negative (n = 260), and a TMT positive group (n = 78). These 78 TMT positive subjects (23.1%) were identified to have silent myocardial ischemia. The prevalence of silent myocardial ischemia was more common in males (28.4%) than in females (17.3%). The mean CIMT in our study group was 0.6741 ± 0.034 mm (males – 0.684 ± 0.034 mm and females – 0.663 ± 0.032 mm). Age ≥50 years, CIMT ≥0.70 mm, hypercholesterolemia, and hypertriglyceridemia were significant determinants for identifying asymptomatic diabetics at risk for silent myocardial ischemia. Conclusion Silent myocardial ischemia is highly prevalent at about one in four asymptomatic diabetic patients. An increased CIMT can be a surrogate marker of higher coronary risk amongst these asymptomatic diabetics.
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Affiliation(s)
- D S Prasad
- Sudhir Heart Centre, Berhampur, 760002, Odisha State, India.
| | - Zubair Kabir
- School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland.
| | - K Revathi Devi
- Diabetes Clinic, Sudhir Heart Centre, Berhampur, 760002, Odisha State, India.
| | - Pearline Suganthy Peter
- Australian Medical Research Foundation, Fresh Start Recovery Program, Perth, WA, 6008, Australia.
| | - B C Das
- Kalinga Institute of Medical Sciences, KIIIT University, Bhubaneswar, 751024, India.
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15
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In vitro and in vivo anti-diabetic activity of Citrullus colocynthis pulpy flesh with seeds hydro-ethanolic extract. ACTA ACUST UNITED AC 2020; 17:/j/jcim.ahead-of-print/jcim-2018-0228/jcim-2018-0228.xml. [DOI: 10.1515/jcim-2018-0228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/04/2019] [Indexed: 11/15/2022]
Abstract
AbstractBackgroundDiabetes is the one of the leading cause of morbidity and mortality. Traditionally phytotherapy is widely being used for diabetes treatment and highly valued. Citrus colocynthis has known anti-diabetic potential. However, anti-diabetic potential of hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds is not reported yet.MethodsThe extract of C. colocynthis pulpy flesh with seeds was done by maceration method using 70% ethanol. To evaluate anti-diabetic and antioxidant potential of the seeded fruit in vitro, α-glucosidase and DPPH inhibition assays was done, respectively. In vivo study used streptozotocin (STZ) induced diabetes model of rats. Rats were randomized in five groups i. e. normal control, negative control, standard control, C. colocynthis 150 and 300 mg/kg. STZ was administered to all groups except normal control. After wards, plant extract and glibenclamide is continued for 14 days. Blood samples were collected from rat tail vein daily and from Cardiac puncture at the end of study. The blood glucose levels were monitored daily by using one-touch blood glucose monitoring system. The blood glucose level was monitored on 0, 1st, 5th, 8th, 11th, and 14th day of induction.ResultsHydro-ethanolic extract of C. colocynthis pulpy flesh with seeds was able to decolorize DPPH and therefore possess antioxidant potential, continuous administration for 14 days showed a marked decrease in serum glucose levels (p 0.01) it is found to be somewhat less effective as glibenclamide (standard control) (p 0.001). A time-dependent decrease in blood glucose levels was observed (351.3 ± 4 to 258 m/kg).ConclusionHydro-ethanolic extract of C. colocynthis pulpy flesh with seeds lowered the serum triglyceride and cholesterol levels in diabetic rats significantly as compared to negative control. The hypoglycemic effect of hydro-ethanolic extract of C. colocynthis pulpy flesh with seeds is may be due to α-glucosidase inhibition potential.
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Rahimi E, Ahmadi A, Boroumand MA, Mohammad Soltani B, Behmanesh M. Nutrient sensing pathway genes expression dysregulated in patients with T2DM and coronary artery disease. Diabetes Res Clin Pract 2019; 151:39-45. [PMID: 30935928 DOI: 10.1016/j.diabres.2019.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 03/27/2019] [Indexed: 12/25/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder and its prevalence is rapidly increasing worldwide. Patients with T2DM suffer from an increased risk of vascular complications. Of these, the development of coronary artery disease (CAD) causes the most mortality in patients with T2DM, however, its underlying molecular mechanisms are not fully understood. Nutrient sensing pathways which play a key role in sensing cellular energy and nutrients levels are reported to dysregulated in metabolic disease like T2DM. The aim of this study was to investigate the expression levels of nutrient sensing genes including SIRT1, PRKAB1, PRKAB2 and mTOR in CAD+ versus CAD-T2DM patients. METHODS Sixty-five people with T2DM who referred to Tehran heart center were participated in this study. Based on coronary angiography data these individuals were classified into two groups: CAD+ T2DM (n = 34) and CAD-T2DM (n = 31). Peripheral blood mononuclear cells were isolated from these patients and the expression levels of genes were evaluated by RT-qPCR. RESULTS Significant down-regulations of the SIRT1 (3.1-fold, p = 0.0013) and PRKAB1 (3.5-fold, p = 0.0001) mRNA expression were observed in CAD+ T2DM group in comparison with CAD-T2DM patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.8529 (p = 0.0001) and 0.7078 (p = 0.004) for PRKAB1 and SIRT1 respectively. CONCLUSION Our results suggest that the dysregulation of genes involved in nutrient sensing pathway may be associated with the pathogenesis of CAD in patients with T2DM. Furthermore, the expression levels of these genes could be consider as potential biomarkers.
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Affiliation(s)
- Esmaeil Rahimi
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, P.O. Box 14115-154, Tehran, Iran
| | - Amirhossein Ahmadi
- Department of Biology, Faculty of Sciences, Persian Gulf University, Bushehr, Iran
| | - Mohammad Ali Boroumand
- Tehran Heart Center, Tehran University of Medical Sciences, P.O. Box 1411713138, Tehran, Iran
| | - Bahram Mohammad Soltani
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, P.O. Box 14115-154, Tehran, Iran
| | - Mehrdad Behmanesh
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, P.O. Box 14115-154, Tehran, Iran.
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Padhy M, Padiri RA, Hariharan M, Rana S. Diabetes Mellitus Knowledge Test: development, psychometric evaluation, and establishing norms for Indian population. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-018-0644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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18
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Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients. IJC HEART & VASCULATURE 2018; 21:74-77. [PMID: 30364662 PMCID: PMC6197767 DOI: 10.1016/j.ijcha.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022]
Abstract
Aims Atherosclerosis and ischemic heart disease are more common in diabetic patients. Atherosclerosis process can disturb the normal functioning of the vascular endothelium and increase vessel wall thickness. The aim of this study was the comparison of Carotid intima-media thickness (CIMT) with Exercise tolerance test as an alternative way to evaluate cardiac ischemia in diabetic patients. Methods In a cross-sectional study, 30 diabetic patients with positive exercise test and 30 diabetic patients with negative exercise test were enrolled. CIMT of the carotid artery in both groups of patients was measured. Result CIMT in the patients with positive and negative exercise test were 1.04 ± 0.21 mm and 0.61 ± 0.11 mm, respectively (P < 0.001). CIMT in positive exercise test group was positively associated with age and negatively associated with gender, FBS, HDL and LDL cholesterol and in negative exercise group was negatively associated with gender, age, FBS, HDL and LDL cholesterol. Conclusion Considering observed significant positive association between CIMT with result of exercise tolerance test (ETT) in type 2 diabetic patients, it may possible to use CIMT as an inexpensive and non-invasive method for evaluation of ischemic heart disease in diabetic patients.
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Clinical and angiographic profile of early-onset type 2 diabetes mellitus in acute coronary syndrome. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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20
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Shanmugapriya S, Saravanan T, Rajee SS, Venkatrajan R, Thomas PM. Drug prescription pattern of outpatients in a tertiary care teaching hospital in Tamil Nadu. Perspect Clin Res 2018; 9:133-138. [PMID: 30090712 PMCID: PMC6058512 DOI: 10.4103/picr.picr_86_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: Drug use prescribing indicators advocated by the World Health Organization (WHO) are important tools for assessing the degree of polypharmacy, use of generic medicines, and to evaluate if there is inappropriate use of antibiotics or parenteral medications besides estimating the adherence to the essential drugs list. This study aimed to assess the WHO prescribing indicators in prescriptions given at the medical outpatient department (OPD) in a private medical college hospital in South India. Materials and Methods: The study was done prospectively from patients when they presented for consultation at the medical OPD at our tertiary care center. Prescriptions were randomly chosen to be analyzed for the WHO prescribing indicators from September 2016 to April 2017. Results: A total of 700 prescriptions were analyzed and the average number of drugs per prescription was 2.955 ± 1.32. 32.57% of prescriptions had fixed drug combinations and a similar value of 36% was obtained for prescriptions containing more than one drug for the same indication. Amongst the prescribing indicators, generic prescribing was appallingly low (6.42%). In contrast, antibiotic prescribing and prescription of injections showed an appreciably rational trend with 15.42% and 8.14%, respectively. Furthermore, the prescription of the drugs enlisted in the essential drugs list was determined to be 90.67%. Discussion: The need for increase in generic prescribing and augmenting the adherence of prescriptions to the essential drugs list has been identified. This can be accomplished by multimodal approach that includes regulatory changes, conducting educational programs directed at attitudinal change among current doctors and imparting modifications in medical curriculum so as to inculcate the culture of abiding by the best prescription practices among budding doctors. Conclusion: This study has delineated the requisite for pertinent changes in current prescribing trends in a tertiary care teaching private colleges.
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Affiliation(s)
- S Shanmugapriya
- Department of Pharmacology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - T Saravanan
- Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - S Saranya Rajee
- Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - R Venkatrajan
- Department of Pharmacy Practice, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Pinky Mariam Thomas
- Department of Pharmacy Practice, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Davidson J, Kalra S, Singh V, Fegade M, Singh G, Mane A. Resolving the KgA1c paradox in the management of type 2 diabetes mellitus. Diabetes Metab Syndr 2017; 11 Suppl 1:S159-S168. [PMID: 28063802 DOI: 10.1016/j.dsx.2016.12.026] [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: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 11/27/2022]
Abstract
Excess body weight is a leading cause of metabolic complications such as hypertension and dyslipidemia in T2DM patients. Available antihyperglycemic agents have minimal or no impact on these complications and a majority are known to trigger weight gain, thereby exerting a paradoxical effect on overall metabolic status. This review introduces the concept of 'KgA1c paradox' and underscores the significance of resolving this paradox for comprehensive T2DM management. It provides a therapeutic rationale for inclusion of sodium glucose cotransporter 2 inhibitors in the T2DM treatment algorithm as these agents have demonstrated favorable glycemic effects along with reduction in body weight.
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Affiliation(s)
- Jaime Davidson
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India.
| | - Vikram Singh
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Mayuresh Fegade
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Gursimran Singh
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
| | - Amey Mane
- Janssen, Pharmaceutical Companies of Johnson & Johnson, Mumbai, Maharashtra, India
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Sumi S, Ramachandran S, RamanKutty V, Patel MM, Anand TN, Mullasari AS, Kartha CC. ENPP1 121Q functional variant enhances susceptibility to coronary artery disease in South Indian patients with type 2 diabetes mellitus. Mol Cell Biochem 2017; 435:67-72. [PMID: 28497367 DOI: 10.1007/s11010-017-3057-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 12/31/2022]
Abstract
Insulin resistance is associated with endothelial dysfunction and ensuing cardiovascular diseases in type 2 diabetes mellitus (T2DM) patients. ENPP1 is a key modulator of insulin signaling and its polymorphism, K121Q, increases the potency to competitively inhibit insulin receptor binding. We investigated the association of ENPP1 121Q variant with coronary artery disease (CAD) in patients with and without T2DM in South Indian population. Our study was conducted in 913 subjects: 198 patients with CAD, 284 patients in whom T2DM and CAD co-exists, 160 patients with T2DM and no CAD history, and 271 healthy volunteers. Genotyping was performed using PCR-RFLP and PCR-DNA sequencing. Genotype frequency of ENPP1 121Q was higher in disease groups compared to healthy subjects (p < 0.05). T2DM patients who carried polymorphic AC/CC genotypes were at 12.8-fold enhanced risk to CAD (95% CI 4.97-37.18, p < 0.01). Moreover we observed that 121Q, both in heterozygous and homozygous polymorphic states, was a risk factor for CAD without diabetes (OR 4.15, p < 0.01). 121Q variant was associated with T2DM patients with no CAD history too, but the risk was statistically insignificant after multivariate logistic regression analysis (OR 2.32, p > 0.05). We conclude that ENPP1 121Q variant is associated with increased risk for CAD in patients with T2DM in South Indian population. We also report that 121Q variant of ENPP1 was an independent risk factor for CAD irrespective of diabetic milieu. Factors which enhance insulin resistance increase the risk for onset and progression of coronary atherosclerosis irrespective of a diabetic background.
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Affiliation(s)
- S Sumi
- Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - Surya Ramachandran
- Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - V RamanKutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Maulin M Patel
- Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India
| | - T N Anand
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - C C Kartha
- Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, 695014, India.
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Sathyaseelan AJ, Adole PS, Wyawahare M, Saya RP. Assessment of Serum VASPIN Levels among Type 2 Diabetes Mellitus Patients with or without Acute Coronary Syndrome. J Clin Diagn Res 2016; 10:BC07-BC10. [PMID: 28208842 DOI: 10.7860/jcdr/2016/22417.8952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/07/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Type 2 Diabetes Mellitus (DM) is on the verge of becoming a pandemic in India. Type 2 DM patient have two to four times increased risk of carotid artery disease. Adipokines have been regarded recently as direct link between diabetes and atherosclerosis. Visceral Adipose Tissue Derived Serine Protease Inhibitor (VASPIN); one of the most recently discovered adipokine, inhibits the proteases responsible for insulin resistance, carotid plaque development and rupture. In literature, few studies have addressed the role of VASPIN in pathogenesis of Acute Coronary Syndrome (ACS) in patients with type 2 DM. AIM To find association between serum VASPIN with lipid profile, creatine kinase-total, creatine kinase-MB, troponin-I, age, height, weight, blood pressure, smoking, family history of ACS and to prove the hypothesis of low serum VASPIN level as predictor of ACS in patients with type 2 DM. MATERIALS AND METHODS Forty-one type 2 DM patients (controls) and 41 type 2 DM patients with ACS (cases) were enrolled in the study. Anthropometric measurements were performed and fasting serum biochemical parameters and VASPIN were measured. The results of cases and controls were compared by student t-test or Mann-Whitney test. All the parameters were correlated with serum VASPIN by Pearson's or Spearman's correlation. RESULTS Fasting serum VASPIN concentration was significantly (p< 0.0001) lower in the cases (0.43±0.22 pg/ml) than in the controls (0.83±0.29 pg/ml). Correlation analysis undertaken on all type 2 DM showed that serum VASPIN concentration was negatively correlated with age, waist circumference, hip circumference, systolic and diastolic blood pressure, duration of diabetes, serum Creative Kinase-Total, CK-MB and urea (p< 0.05). Utilizing Receiver Operating Characteristic (ROC) curve, the serum VASPIN level of less than 0.594pg/ml showed greatest risk of ACS among type 2 DM patients (p< 0.0001). CONCLUSION Type 2 DM patients with low serum vaspin concentration were at risk of ACS independent of other cardiovascular risk factors.
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Affiliation(s)
- Aswathy Jaya Sathyaseelan
- Student, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Prashant Shankarrao Adole
- Assistant Professor, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Mukta Wyawahare
- Associate Professor, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
| | - Rama Prakasha Saya
- Associate Professor, Department of Medicine, Kanachur Institute of Medical Sciences & Research Center , Mangalore, Andhra Pradesh, India
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Sathishkumar C, Prabu P, Balakumar M, Lenin R, Prabhu D, Anjana RM, Mohan V, Balasubramanyam M. Augmentation of histone deacetylase 3 ( HDAC3) epigenetic signature at the interface of proinflammation and insulin resistance in patients with type 2 diabetes. Clin Epigenetics 2016; 8:125. [PMID: 27904654 PMCID: PMC5122206 DOI: 10.1186/s13148-016-0293-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/15/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A role of proinflammation has been implicated in the pathogenesis of diabetes, but the up-stream regulatory signals and molecular signatures are poorly understood. While histone modifications such as changes in histone deacetylase (HDAC) are emerging as novel epigenetic biomarkers, there is lack of studies to demonstrate their clinical relevance in diabetes. Therefore, we investigated the extent of HDAC machinery and inflammatory signals in peripheral blood mononuclear cells (PBMCs) from patients with type 2 diabetes mellitus (T2DM) compared to control subjects. RESULTS HDAC3 activity was significantly (p < 0.05) increased in patients with T2DM compared to control subjects. While subtypes of HDACs were differentially expressed at their transcriptional levels in patients with type 2 diabetes, the most prominent observation is the significantly (p < 0.05) elevated messenger RNA (mRNA) levels of HDAC3. Expression levels of Sirt1 which represents the class III HDAC were decreased significantly in T2DM (p < 0.05). Plasma levels of both TNF-α and IL-6 were significantly higher (p < 0.05) in patients with type 2 diabetes compared to control subjects. Among the proinflammatory mediators, the mRNA expression of MCP-1, IL1-β, NFκB, TLR2, and TLR4 were also significantly (p < 0.05) increased in T2DM. Transcriptional levels of DBC1 (deleted in breast cancer 1, which is a negative regulator of HDAC3) were seen significantly reduced in PBMCs from T2DM. Interestingly, HDAC3 activity/HDAC3 mRNA levels positively correlated to proinflammation, poor glycemic control, and insulin resistance. CONCLUSIONS Striking message from this study is that while looking for anti-inflammatory strategies and drugs with novel mode of action for T2DM, discovering and designing specific inhibitors targeted to HDAC3 appears promising.
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Affiliation(s)
- Chandrakumar Sathishkumar
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Paramasivam Prabu
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Mahalingam Balakumar
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Raji Lenin
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Durai Prabhu
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Ranjith Mohan Anjana
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Viswanathan Mohan
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
| | - Muthuswamy Balasubramanyam
- Department of Cell and Molecular Biology and Dr. Rema Mohan High-Throughput Screening (HTS) Lab, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Gopalapuram, Chennai, 600086 India
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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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Bhatti GK, Bhadada SK, Vijayvergiya R, Mastana SS, Bhatti JS. Metabolic syndrome and risk of major coronary events among the urban diabetic patients: North Indian Diabetes and Cardiovascular Disease Study-NIDCVD-2. J Diabetes Complications 2016; 30:72-8. [PMID: 26271411 DOI: 10.1016/j.jdiacomp.2015.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The present study aimed at estimating the prevalence of metabolic syndrome (MetS) and prospectively, evaluating cardiovascular events among Asian Indians type 2 diabetic subjects. METHODS The sample comprised 1522 type 2 diabetic mellitus (T2DM) subjects aged 25-91years, who participated in the North Indian Diabetes and Cardiovascular Disease Study (NIDCVD). The participants were screened for hypertension, dyslipidemia, obesity and cardiovascular events. Anthropometric, clinical and biochemical measurements were done in all subjects. The prevalence of MetS was estimated in all the subjects according to the harmonized criteria of 2009. RESULTS The prevalence of MetS among urban Indian diabetic subjects was 71.9% and was significantly higher in females (86%) as compared to males (57.9%). To determine the independent predictors of the MetS in diabetic sample, binary logistic regression analyses were performed using demographic and biochemical parameters. Significant differences in the indices of generalized and abdominal obesity and lipids (total cholesterol, high density lipoprotein) were observed (p<0.01) in male:female and MetS and non-MetS comparisons. Regression analysis for prediction of CAD showed that family history, age, body mass index (BMI), SBP, physical inactivity and hypertension independently and significantly predicted the disease outcome. Binary logistic regression analysis revealed that MetS may be an independent risk/predictor of CAD (odd ratio (OR)=3.44, CI 1.31-9.01, p=0.012) along with higher age groups, BMI and hypertension in Indian population. CONCLUSION The study demonstrated that the high prevalence of MetS and its different components were positively associated with a higher risk of CAD in north Indian diabetic subjects. Nevertheless, MetS is a major health problem in India, comprehensive population studies are warranted for estimation of incidence and prevalence, and education should be provided on its prevention and control to reduce the diabetes-related morbidity and mortality.
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Affiliation(s)
- Gurjit Kaur Bhatti
- UGC Centre of Excellence in Applications of Nanomaterials, Nanoparticles and Nanocomposites, Panjab University, Sector 14, Chandigarh 160014, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Sarabjit Singh Mastana
- School of Sport, Exercise and Health Sciences, Centre for Global Health and Human Development, Human Genetics Lab, Loughborough University, Leicestershire LE113TU, UK
| | - Jasvinder Singh Bhatti
- Department of Biotechnology and Bioinformatics, Sri Guru Gobind Singh College, Sector 26, Chandigarh 160019, India; Department of Biochemistry, Panjab University, Sector 14, Chandigarh 160014, India.
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Chakrabarty S, Kabekkodu SP, Brand A, Satyamoorthy K. Perspectives on Translational Genomics and Public Health in India. Public Health Genomics 2015; 19:61-8. [PMID: 26683060 DOI: 10.1159/000442518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/19/2022] Open
Abstract
It is now recognized worldwide that anticipation and prevention of diseases have significant advantages for the health and healthy ageing of the population. Early recognition of the disease in a vulnerable population such as in children aged <5 years and adults aged >60 years enhances our preparedness for any eventualities and future burden of the diseases to society. It is also recognized that current public health practices alone cannot bring about the desired outcome. When tackling public health-related issues, such problems must be recognized and state-of-the-art principles and innovations from genomic sciences, information technologies, and medical specialties must be encompassed and embraced. These will enhance strategies for preparedness and provide us with a better understanding of how to identify, manage, and control disease burdens. The ever expanding landscape of genomics research also includes experimental and computational approaches for effectively utilizing DNA sequence information. From these perspectives, the intricacies of Mendelian single gene disorders are the least challenging compared to intricacies of multi-dimensional host factors for infectious diseases or complex disorders such as cancer. The concepts of public health in India are on firm footing; however, integration of contemporary advances to implement public health principles into practice has neither been attempted nor impacted on disease burden or our preparedness to prevent eventualities. At the same time, translational genomics is gradually paving the way for personalized medicine. Principles of personalized medicine remain to be fully understood and practiced despite the pharmacogenomics-based future of drug development, and treatment has not been as exciting as the advances in genomics we are witnessing today. The relevance, importance, and translational impediments of these advances will be discussed.
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Bansal B, Mithal A, Carvalho P, Mehta Y, Trehan N. Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India. Indian J Endocrinol Metab 2015; 19:47-51. [PMID: 25593825 PMCID: PMC4287778 DOI: 10.4103/2230-8210.146864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. MATERIALS AND METHODS Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation). RESULTS The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. CONCLUSION A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.
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Affiliation(s)
- Beena Bansal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | | | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Naresh Trehan
- Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
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Sandhiya S, Dkhar SA, Pillai AA, George M, Jayaraman B, Chandrasekaran A. Comparison of ranolazine and trimetazidine on glycemic status in diabetic patients with coronary artery disease - a randomized controlled trial. J Clin Diagn Res 2015; 9:OC01-5. [PMID: 25738014 DOI: 10.7860/jcdr/2015/10594.5448] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/31/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cardiovascular diseases have become the leading cause of death around the globe and diabetes mellitus (DM) is considered to be a coronary artery disease (CAD) risk equivalent. Ranolazine, an anti anginal drug has been found to reduce Glycated haemoglobin (HbA1c) in diabetes patients with chronic angina. However the effect of another antianginal drug trimetazidine, on glycemic status is not clear. AIM To compare the effect of ranolazine and trimetazidine on glycemic status in diabetic patients with CAD. SETTINGS AND DESIGN Patients diagnosed with CAD and diabetes mellitus attending Cardiology Out Patient Department (OPD), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India were recruited for this randomized open label parallel arm trial. MATERIALS AND METHODS The study conducted from January-2012 to April-2013 had 47 eligible patients diagnosed with CAD and diabetes mellitus. They were randomized to receive either ranolazine 500 mg BD or trimetazidine 35 mg BD for 12 weeks. HbA1c levels, fasting blood glucose (FBG), lipid profile, QT and QTc intervals were measured at baseline and after 12 weeks. STATISTICAL ANALYSIS Unpaired t-test was used to compare the baseline characteristics of between the groups while comparison within the groups were done using Paired t-test. Wilcoxon and Mann Whitney U-tests were used for non parametric data. Graph pad instat version-3 was used for statistical analysis. Values were expressed as mean ± SD. A p < 0.05 was considered statistically significant. RESULTS The study could not find any change in HbA1c levels in both ranolazine and trimetazidine groups. The adverse effects reported from patients on ranolazine include angina, constipation, postural hypotension, headache, dizziness, nausea and weakness while patients on trimetazidine complained of constipation, weakness, palpitations, angina, dizziness, nausea, dyspepsia, headache, gastric discomfort, joint pain, etc. CONCLUSION In patients with chronic angina and diabetes mellitus Ranolazine 500mg BD and Trimetazidine 35mg BD did not show any effect on HbA1c and fasting blood glucose lebel.
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Affiliation(s)
- Selvarajan Sandhiya
- Assistant Professor, Department of Clinical Pharmacology, JIPMER , Puducherry, India
| | | | | | - Melvin George
- Assistant Professor, Cardiac Clinical Trials, Department of Cardiology, SRM Medical College Hospital & Research Centre , Kattankulathur, Chennai, India
| | | | - Adithan Chandrasekaran
- Senior Professor & Head, Department of Clinical Pharmacology, JIPMER , Puducherry, India
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Kumar A. Changing trends of cardiovascular risk factors among Indians: a review of emerging risks. Asian Pac J Trop Biomed 2014. [DOI: 10.12980/apjtb.4.201414b401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Johnson C, Mohan S, Praveen D, Woodward M, Maulik PK, Shivashankar R, Amarchand R, Webster J, Dunford E, Thout SR, MacGregor G, He F, Reddy KS, Krishnan A, Prabhakaran D, Neal B. Protocol for developing the evidence base for a national salt reduction programme for India. BMJ Open 2014; 4:e006629. [PMID: 25344488 PMCID: PMC4212187 DOI: 10.1136/bmjopen-2014-006629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/01/2014] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The scientific evidence base in support of salt reduction is strong but the data required to translate these insights into reduced population salt intake are mostly absent. The aim of this research project is to develop the evidence base required to formulate and implement a national salt reduction programme for India. METHODS AND ANALYSIS The research will comprise three components: a stakeholder analysis involving government, industry, consumers and civil society organisations; a population survey using an age-stratified and sex-stratified random samples drawn from urban (slum and non-slum) and rural areas of North and South India; and a systematic quantitative evaluation of the nutritional components of processed and restaurant foods. The stakeholder interviews will be analysed using qualitative methods to summarise the main themes and define the broad range of factors influencing the food environment in India. The population survey will estimate the mean daily salt consumption through the collection of 24 h urine samples with concurrent dietary surveys identifying the main sources of dietary sodium/salt. The survey of foods will record the nutritional composition of the chief elements of food supply. The findings from this research will be synthesised and proposals for a national salt reduction strategy for India will be developed in collaboration with key stakeholders. ETHICS AND DISSEMINATION This study has been approved by the Human Research Ethics Committees of the University of Sydney and the Centre for Chronic Disease Control in New Delhi, and also by the Indian Health Ministry's Screening Committee. The project began fieldwork in February 2014 and will report the main results in 2016. The findings will be targeted primarily at public health policymakers and advocates, but will be disseminated widely through other mechanisms including conference presentations and peer-reviewed publications, as well as to the participating communities.
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Affiliation(s)
- Claire Johnson
- George Institute for Global Health, Oxford University, Oxford, UK
- University of Sydney, Sydney, Australia
| | | | - Deversetty Praveen
- George Institute for Global Health, Oxford University, Oxford, UK
- University of Sydney, Sydney, Australia
| | - Mark Woodward
- George Institute for Global Health, Oxford University, Oxford, UK
- University of Sydney, Sydney, Australia
| | - Pallab K Maulik
- George Institute for Global Health, Oxford University, Oxford, UK
| | - Roopa Shivashankar
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | | | - Jacqui Webster
- George Institute for Global Health, Oxford University, Oxford, UK
| | | | - Sudhir Raj Thout
- George Institute for Global Health, Oxford University, Oxford, UK
| | | | - Feng He
- Wolfson Institute of Preventative Medicine, London, UK
| | | | - Anand Krishnan
- All India Institute of Medical Science, New Delhi, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, Gurgaon, India
| | - Bruce Neal
- George Institute for Global Health, Oxford University, Oxford, UK
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Imperial College London, London, UK
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Augustine LF, Nair KM, Rao SF, Rao MV, Ravinder P, Balakrishna N, Laxmaiah A, Vazir S. Adolescent life-event stress in boys is associated with elevated IL-6 and hepcidin but not hypoferremia. J Am Coll Nutr 2014; 33:354-62. [PMID: 25302670 DOI: 10.1080/07315724.2013.875417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The link between stress-related increases in inflammatory markers, hepcidin, and iron status are poorly understood, especially in developing countries like India. The aim of the study was to examine the relationship between adolescent life-event stress (ALES), inflammatory markers, and its association with hepcidin and biomarkers of iron status among adolescent boys. METHODS Data pertaining to a subsample of 145 participants from a cross-sectional, school-based study recruiting 370 adolescent boys aged 15-19 years, from 5 schools in Hyderabad, India, were analyzed. Stress was assessed using the ALES scale, psychological distress by the General Health Questionnaire-2 (GHQ-12), and approach and avoidance coping using the Coping Strategies Scale. Biomarkers of iron and concentrations of other micronutrients, hepcidin, IL-6 and C-reactive protein (CRP) in plasma were analyzed. Data were subjected to regression, path analyses, and analysis of covariance (ANCOVA). RESULTS ALES was a significant predictor of interleukin (IL)-6 (β = 0.196, p = 0.012), CRP (β = 0.217, p = 0.010), and log hepcidin (β = 0.228, p = 0.006). Hepcidin correlated significantly (p < 0.001) with IL-6 (r = 0.344) and CRP (r = 0.370) but not with the biomarkers of iron status. Path analysis showed that the model had an acceptable fit, with a root mean square error of approximation of 0.019, 90% confidence interval (CI) of 0.00-0.074, comparative fit index of 0.988, chi-square p = 0.393, and chi-square/df of 1.053. CONCLUSIONS Adolescent life-event stress is associated with elevated IL-6 and hepcidin concentration but not hypoferremia. These findings may help in iron supplementation programs for tackling anemia.
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Affiliation(s)
- Little Flower Augustine
- a Division of Micronutrient Research , National Institute of Nutrition, Indian Council of Medical Research , Jamai-Osmania Hyderabad , Andhra Pradesh , INDIA
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miR-146a polymorphism influences levels of miR-146a, IRAK-1, and TRAF-6 in young patients with coronary artery disease. Cell Biochem Biophys 2014; 68:259-66. [PMID: 23794009 DOI: 10.1007/s12013-013-9704-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Modulation of nuclear factor KappaB (NF-κB) activation may play a role in regulating inflammatory conditions associated with coronary artery disease (CAD). MicroRNA-146a (miR-146a) primarily targets interleukin-1 receptor-associated kinase 1 (IRAK-1) and tumour necrosis factor receptor associated factor 6 (TRAF-6), which results in inhibition of NF-κB via the TLR pathway. This study investigated the influence of the miR-146a GC rs2910164 on miR-146a expression in young South African Indians with CAD. CAD patients and controls were genotyped by PCR-RFLP and miRNA-146a levels were measured by qPCR. IRAK-1, TRAF-6 and NF-κB expression was determined by Western blot. No differences in genotypic frequency was found (GG: 45 vs. 47%, GC: 46 vs. 41%, CC: 9 vs. 12%) in controls and patients respectively (odds ratio = 1.025; 95% confidence interval 0.6782-1.550; p = 0.9164). Significantly higher levels of miR-146a was associated with CAD patients with the CC genotype (6.25-fold increase relative to controls and patients with the wildtype variant, p < 0.0001). Significantly lower levels of IRAK-1 (0.38 ± 0.02; p = 0.0072) and TRAF-6 (0.44 ± 0.02; p = 0.0146) was found in CAD patients with the CC genotype. The lowest levels of NF-κB and C-reactive protein were found in patients with the homozygous C allele compared to the heterozygous GC and wildtype variants. We propose a role for miR-146a in TLR signalling through a negative feedback mechanism involving the attenuation of NF-κB by down-regulation of IRAK-1 and TRAF-6. Our observations implicate miR-146a as a target for lowering inflammation in CAD patients.
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Baldi I, Gulati A, Lorenzoni G, Natarajan K, Ballali S, Kameswaran M, Rajeswaran R, Gregori D, Sethi G. Public health implications of obstructive sleep apnea burden. Indian J Pediatr 2014; 81 Suppl 1:55-62. [PMID: 25139389 DOI: 10.1007/s12098-014-1539-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the implications of obstructive sleep apnea (OSA) burden among Indian children. METHODS MonteCarlo simulations were performed in order to estimate the number of OSA related obesity cases among Indian children (1-14 y of age) and the number of cases of stroke, coronary heart disease (CHD) and type 2 diabetes, considered as main adverse outcomes of OSA related childhood obesity, according to untreated and treated [adenotonsillectomy (AT) alone and AT associated to continuous positive airway pressure (CPAP)] pediatric OSA. Data used to perform MonteCarlo simulations were derived from a review about current literature exploring OSA related obesity. RESULTS The analysis on the number of adverse outcomes according to treated and untreated obesity related to OSA showed that treatments reduce the number of obesity cases, resulting in a great reduction of the amount of stroke, CHD and type 2 diabetes cases. However, the cost for treating adverse outcome was higher in patients treated for obesity related to OSA compared to those not receiving any treatment. CONCLUSIONS The reduction in the number of adverse outcomes due to treatment of obesity related OSA implicates the urgent need for public health policies in providing screening for OSA among children population: an early detection and a consequently prompt reaction to pediatric OSA could improve the burden of OSA related obesity.
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Affiliation(s)
- Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan, 18, 35121, Padova, Italy,
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Singh PN, Arthur KN, Orlich MJ, James W, Purty A, Job JS, Rajaram S, Sabaté J. Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. Am J Clin Nutr 2014; 100 Suppl 1:359S-64S. [PMID: 24847857 PMCID: PMC4144108 DOI: 10.3945/ajcn.113.071571] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
An increase in noncommunicable disease (NCD) in India has been attributed to an epidemiologic transition whereby, due to urbanization, there is an increase in traditional cardiovascular disease risk factors such as obesity. Accumulated biomarker data on the "Asian Indian phenotype" identify central obesity, which occurs at a lower body mass index (BMI), as a particularly potent risk factor in Asian Indians. A revised WHO case definition for obesity in India [BMI (in kg/m(2)) >25] has identified an obesity epidemic that exceeds 30% in some cities and rivals that in Western nations. This review summarizes 2 key lines of evidence: 1) the emergence of an obesity epidemic in urban and rural India and its contribution to the NCD burden and 2) the role of a "nutrition transition" in decreasing the whole plant food content of diets in India and increasing risk of obesity and NCDs. We then present new epidemiologic evidence from Asian Indians enrolled in the Adventist Health Study 2 that raises the possibility of how specific whole plant foods (eg, nuts) in a vegetarian dietary pattern could potentially prevent obesity and NCDs in a target population of >1 billion persons.
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Affiliation(s)
- Pramil N Singh
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Kristen N Arthur
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Michael J Orlich
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Wesley James
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Anil Purty
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Jayakaran S Job
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Sujatha Rajaram
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Joan Sabaté
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
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Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, Wangnoo SK, Kumar A, Kalra S, Unnikrishnan AG, Sharma SK, Rao PV, Akhtar S, Shetty RV, Das AK. Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study. Indian J Endocrinol Metab 2014; 18:370-378. [PMID: 24944934 PMCID: PMC4056138 DOI: 10.4103/2230-8210.129715] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES DiabCare India 2011 was a cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of urban Indian diabetes patients treated at referral diabetes care centres in India. MATERIALS AND METHODS This was a cross-sectional, multicentre (330 centres) survey in 6168 diabetes patients treated at general hospitals, diabetes clinics and referral clinics across India. Patient data, including medical and clinical examination reports during the past year were collected during their routine visit. The patients' and physicians' perceptions about diabetes management were recorded using a questionnaire. RESULTS A total of 6168 subjects with diabetes (95.8% type 2), mean age 51.9 ± 12.4 years and mean duration of diabetes, 6.9 ± 6.4 years were included. Mean HbA1c was 8.9 ± 2.1% and the mean fasting (FPG), post prandial (PPG) and random (RBG) plasma glucose levels were 148 ± 50 mg/dl 205 ± 66 mg/dl and 193 ± 68mg/dl respectively. Neuropathy was the most common complication (41.4%); other complications were: Foot (32.7%), eye (19.7%), cardiovascular (6.8%) and nephropathy (6.2%). The number of diabetic complications increased with mean duration of diabetes. Most (93.2%) of the patients were on oral anti-diabetic drugs (OADs) and 35.2% were on insulin (±OADs). More than 15% physicians felt that the greatest barrier to insulin therapy from patient's perspective were pain and fear of using injectable modality; 5.2% felt that the greatest barrier to insulin therapy from physician's perspective was the treatment cost; 4.8% felt that the major barriers to achieve optimum diabetic care in practice was loss to follow-up followed by lack of counselling (3.9%) and treatment compliance (3.6%). CONCLUSION DiabCare India 2011 has shown that type 2 diabetes sets in early in Indians and glycaemic control is often sub-optimal in these patients. These results indicate a need for more structured intervention at an early stage of the disease and need for increased awareness on benefits of good glycaemic control. It cannot be overemphasized that the status of diabetes care in India needs to be further improved. (ClinTrials.gov identifier: NCT01351922).
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | | | - Shashank R. Joshi
- Department of Endocrinology, Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India
| | - V. Seshiah
- Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, Chennai, India
| | | | - Samar Banerjee
- Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | - Ajay Kumar
- Diabetes Care and Research Centre, GCIB, Patna, India
| | | | | | | | - P. V. Rao
- Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shahid Akhtar
- Clinical, Medical and Regulatory Affairs Department, Novo Nordisk India Pvt. Ltd, Bangalore, India
| | - Raman V. Shetty
- Clinical, Medical and Regulatory Affairs Department, Novo Nordisk India Pvt. Ltd, Bangalore, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Seth A, Patel TM, Stuteville M, Kumar R, Mullasari AS, Kaul U, Mathew R, Sreenivas Kumar A, Ying SW, Sudhir K. Three-year data from the XIENCE V INDIA study: safety and efficacy of XIENCE V in 1000 real world Indian patients. Indian Heart J 2014; 66:302-8. [PMID: 24973835 DOI: 10.1016/j.ihj.2014.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/11/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cardiovascular disease in Asia has reached epidemic proportions in recent years. Use of drug eluting stents in Asians has rapidly expanded with varying penetration rates across different countries. The XIENCE V INDIA Study included 'real world' patients who underwent XIENCE V stent implantation to assess short and intermediate term outcomes in Indian patients with diverse risk factors. OBJECTIVE To evaluate 3-year clinical outcomes in a cohort of 'real world' Indian patients with CAD being treated with XIENCE V Everolimus Eluting Coronary Stent System. METHODS 1000 patients were enrolled from 18 sites in India between June 2008 and March 2009. Patients were included if their index procedures were completed using only XIENCE V. There were no clinical or angiographic exclusions. An independent Clinical Events Committee adjudicated all endpoint-related events. The primary endpoint was stent thrombosis rate annually through to 3 years as defined by the Academic Research Consortium criteria. The co-primary endpoint was the composite rate of cardiac death and myocardial infarction at 1 year. RESULTS At 1-year the primary endpoint of definite/probable stent thrombosis rate was 0.51%. No additional very late stent thrombosis was reported through a 3-year follow up. The composite endpoint of cardiac death and any myocardial infarction was 1.9%, 2.7% and 3.1% at 1, 2 and 3 years respectively. CONCLUSION Despite the high risk population of coronary artery disease, the use of XIENCE V in 'real world' Indian patients was associated with very low clinical event rates upto three years of follow up.
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Affiliation(s)
- Ashok Seth
- Chairman - Cardiovascular Sciences & Chief Cardiologist, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
| | | | | | | | - Ajit S Mullasari
- Institute of Cardiovascular Disease, Madras Medical Mission, Chennai, India
| | - Upendra Kaul
- Fortis Escorts Heart Institute, New Delhi, India
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Gupta A, Gupta R, Sharma KK, Lodha S, Achari V, Asirvatham AJ, Bhansali A, Gupta B, Gupta S, Jali MV, Mahanta TG, Maheshwari A, Saboo B, Singh J, Deedwania PC. Prevalence of diabetes and cardiovascular risk factors in middle-class urban participants in India. BMJ Open Diabetes Res Care 2014; 2:e000048. [PMID: 25489485 PMCID: PMC4256307 DOI: 10.1136/bmjdrc-2014-000048] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/07/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To determine the prevalence of diabetes and awareness, treatment and control of cardiovascular risk factors in population-based participants in India. METHODS A study was conducted in 11 cities in different regions of India using cluster sampling. Participants were evaluated for demographic, biophysical, and biochemical risk factors. 6198 participants were recruited, and in 5359 participants (86.4%, men 55%), details of diabetes (known or fasting glucose >126 mg/dL), hypertension (known or blood pressure >140/>90 mm Hg), hypercholesterolemia (cholesterol >200 mg/dL), low high-density lipoprotein (HDL) cholesterol (men <40, women <50 mg/dL), hypertriglyceridemia (>150 mg/dL), and smoking/tobacco use were available. Details of awareness, treatment, and control of hypertension and hypercholesterolemia were also obtained. RESULTS The age-adjusted prevalence (%) of diabetes was 15.7 (95% CI 14.8 to 16.6; men 16.7, women 14.4) and that of impaired fasting glucose was 17.8 (16.8 to 18.7; men 17.7, women 18.0). In participants with diabetes, 27.6% were undiagnosed, drug treatment was in 54.1% and control (fasting glucose ≤130 mg/dL) in 39.6%. Among participants with diabetes versus those without, prevalence of hypertension was 73.1 (67.2 to 75.0) vs 26.5 (25.2 to 27.8), hypercholesterolemia 41.4 (38.3 to 44.5) vs 14.7 (13.7 to 15.7), hypertriglyceridemia 71.0 (68.1 to 73.8) vs 30.2 (28.8 to 31.5), low HDL cholesterol 78.5 (75.9 to 80.1) vs 37.1 (35.7 to 38.5), and smoking/smokeless tobacco use in 26.6 (23.8 to 29.4) vs 14.4 (13.4 to 15.4; p<0.001). Awareness, treatment, and control, respectively, of hypertension were 79.9%, 48.7%, and 40.7% and those of hypercholesterolemia were 61.0%, 19.1%, and 45.9%, respectively. CONCLUSIONS In the urban Indian middle class, more than a quarter of patients with diabetes are undiagnosed and the status of control is low. Cardiovascular risk factors-hypertension, hypercholesterolemia, low HDL cholesterol, hypertriglyceridemia, and smoking/smokeless tobacco use-are highly prevalent. There is low awareness, treatment, and control of hypertension and hypercholesterolemia in patients with diabetes.
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Affiliation(s)
- Arvind Gupta
- Department of Diabetes, Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
| | - Rajeev Gupta
- Departments of Medicine and Endocrinology, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Krishna Kumar Sharma
- Department of Pharmacy, SMS Medical College, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Sailesh Lodha
- Departments of Medicine and Endocrinology, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Vijay Achari
- Department of Medicine, Patna Medical College, Patna, Bihar, India
| | - Arthur J Asirvatham
- Department of Medicine, Government Medical College, Madurai, Tamil Nadu, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Balkishan Gupta
- Department of Medicine, SP Medical College, Bikaner, Rajasthan, India
| | - Sunil Gupta
- Department of Diabetes, Diabetes Care and Research Centre, Nagpur, Maharashtra, India
| | | | - Tulika G Mahanta
- Department of Community Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Anuj Maheshwari
- Department of Medicine, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - Banshi Saboo
- Department of Diabetes, DiaCare and Research, Ahmadabad, Gujarat, India
| | - Jitendra Singh
- Department of Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Prakash C Deedwania
- Department of Cardiology, University of California San Francisco VA Medical Center, Fresno, California, USA
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Bochenek M, Zalewski J, Sadowski J, Undas A. Type 2 diabetes as a modifier of fibrin clot properties in patients with coronary artery disease. J Thromb Thrombolysis 2013; 35:264-70. [PMID: 23086579 PMCID: PMC3549239 DOI: 10.1007/s11239-012-0821-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Altered fibrin clot structure has been reported both in patients with coronary artery disease (CAD) and those with type 2 diabetes mellitus (DM2). The aim of the present study was to evaluate plasma fibrin clot permeability and susceptibility to lysis in patients with DM2 and CAD. We studied 132 consecutive CAD patients, including 67 subjects with DM2, scheduled for elective coronary artery bypass grafting surgery. Ex vivo plasma fibrin clot permeability (K(s)) and lysis time (t(50%)) induced by 1 μg/mL recombinant tissue plasminogen activator (tPA), along with plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), tPA, von Willebrand factor (vWF), P-selectin, soluble CD40 ligand (sCD40L), were measured. Diabetic and non-diabetic patients did not differ in regard to demographics and remaining cardiovascular risk factors. Concomitant DM2 was associated with higher glucose (+24.3%, p < 0.001), fibrinogen (+9.0%, p = 0.037), PAI-1 (+58.7%, p < 0.001), tPA (+24.0%, p < 0.001) and P-selectin (+12.2%, p < 0.001). Compared with the non-diabetic group, the CAD patients with DM2 had lower K(s) (-6.1%, p = 0.02) and prolonged t(50%) (+5.1%, p = 0.04). Multiple regression analysis of the whole study group showed that vWF, PAI-1, fibrinogen and DM2 were the independent predictors of t(50%) (R(2) = 0.58, p < 0.001), while only vWF was an independent predictor of K(s) (R(2) = 0.22, p < 0.001). This study indicates that DM2 is potent enough to unfavorably affect plasma fibrin clot characteristics despite abnormal clot phenotype typically observed in CAD. Of note, platelet and endothelial markers appear to contribute to fibrin clot properties in CAD concomitant with DM2.
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Kalra S, Sahay RK, Schnell O, Sheu WHH, Grzeszczak W, Watada H, Soegondo S, Yamamoto N, Weng J, Rathod R. Alpha-glucosidase inhibitor, acarbose, improves glycamic control and reduces body weight in type 2 diabetes: Findings on indian patients from the pooled data analysis. Indian J Endocrinol Metab 2013; 17:S307-S309. [PMID: 24251196 PMCID: PMC3830342 DOI: 10.4103/2230-8210.119634] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Alpha-glucosidase inhibitors are widely used especially in Asian countries as a treatment option for type 2 diabetes patients with high postprandial glycemia (PPG). The higher carbohydrate in the Indian diets lead to greater prandial glycemic excursion, increased glucosidase, and incretin activity in the gut and may need special therapeutic strategies to tackle these glucose peaks. This is the subgroup analysis of Indian subjects who participated in the GlucoVIP study that investigated the effectiveness and tolerability of acarbose as add-on or monotherapy in a range of patients with type 2 diabetes mellitus. A total of 1996 Indian patients were included in the effectiveness analysis. After 12.5 weeks (mean), the mean change in 2-hour PPG from baseline was -74.4 mg/dl, mean HbA1c decreased by -1.0%, and mean fasting blood glucose decreased by -37.9 mg/dl. The efficacy of acarbose was rated "very good" or "good" in 91.1% of patients, and tolerability as "very good" or "good" in 88.0% of patients. The results of this observational study suggest that acarbose was effective and well tolerated in the Indian patients with T2DM.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Research Institute of Diabetes and Endocrinology Bharti Hospital, Karnal, India
| | - R. K. Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - O. Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Munich, Germany
| | - W. H. H. Sheu
- Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - H. Watada
- Endocrinology and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - N. Yamamoto
- Bayer Healthcare, Global Medical Affairs, Beijing, China
| | - J. Weng
- The Third Affiliated Hospital of Sun Yat Sen University, Guangzhou, China
| | - R. Rathod
- Bayer Healthcare, Bayer Zydus Pharma Private Limited, Thane, India
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Ayyappa KA, Ghosh S, Mohan V, Radha V. Association of hepatic lipase gene polymorphisms with hypertriglyceridemia and low high-density lipoprotein-cholesterol levels among South Indian subjects without diabetes. Diabetes Technol Ther 2013; 15:503-12. [PMID: 23550552 DOI: 10.1089/dia.2012.0302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to investigate the association of four variants of the hepatic lipase (HL [or LIPC]) gene with various lipid parameters among South Indian subjects with normal glucose tolerance (NGT). SUBJECTS AND METHODS In total, 747 NGT subjects were randomly selected from the Chennai Urban Rural Epidemiological Study (CURES). Serum triglycerides, serum cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured using a Hitachi-912 autoanalyzer (Roche Diagnostics GmbH, Mannheim, Germany). Genotyping of HL gene variants was done by the polymerase chain reaction-restriction fragment length polymorphism method, and 20% of samples were sequenced to validate the genotypes obtained. Haplotype analysis was also carried out. RESULTS The TT genotype of the rs1800588 C/T (C-480T) polymorphism was significantly associated with hypertriglyceridemia, with an adjusted odds ratio of 2.58 (95% confidence interval 1.38-4.85, P=0.003), whereas those with the CC genotype of the rs6074 A/C (Thr479Thr) had significantly lower HDL-C levels (41.3±9.8 mg/dL) compared with the AA genotype (43.6±10.2 mg/dL, P=0.02). Haplotype analysis showed the TGC haplotype was significantly associated with low HDL-C levels. CONCLUSIONS Among South Indian subjects without diabetes, the rs1800588 C/T (C-480T) and rs6074 C/A (Thr479Thr) variants of the HL gene are associated with hypertriglyceridemia and low HDL-C, respectively. The TGC haplotype was significantly associated with low HDL-C.
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Affiliation(s)
- Kuppuswamy Ashok Ayyappa
- Madras Diabetes Research Foundation-ICMR Advanced Centre for Genomics of Type 2 Diabetes and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, IDF Centre for Education, Gopalapuram, Chennai, India
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Sympathovagal Imbalance in Young Prehypertensives: Importance of Male-Female Difference. Am J Med Sci 2013; 345:10-7. [DOI: 10.1097/maj.0b013e31824ba080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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A.R. S, Parameaswari P, Shanthi B, Revathy C, Parijatham B. The reference intervals for the haematological parameters in healthy adult population of chennai, southern India. J Clin Diagn Res 2012; 6:1675-80. [PMID: 23373026 PMCID: PMC3552202 DOI: 10.7860/jcdr/2012/4882.2630] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/12/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The haematological parameters are influenced by various factors like age, ethnicity, diet, genetic and gender differences and hence it is important to define the specific reference values with regards to the age, gender and the region. The indices like the Red Cell Distribution Width (RDW), the Mean Platelet Volume (MPV) and the Platelet Distribution Width (PDW) are newer haematological parameters which are calculated by automated haematology analyzers. There is an increasing evidence that these are clinically valuable bio markers. But not many studies have estimated the reference intervals for these parameters in our population. AIM AND OBJECTIVE Our primary objective was to identify the gender specific reference intervals for RDW, MPV, PDW and other haematological parameters for the healthy adult population of our region. We also aimed at comparing the study reference intervals with the existing reference ranges. MATERIALS AND METHODS A retrospective review of 2443 medical case sheets of the individuals who attended the preventive health check up program in a tertiary care hospital in the year 2011, was done. With 500 subjects who satisfied our study criteria, the haematological reference intervals were established. RESULTS Gender specific reference intervals were established for the newer indices as well as for the other haematological parameters. We derived the reference intervals for the newer parameters in our population as: RDW: 12.23%-15.36% in males and 12.3%-15.85% in females. MPV: 7.9 fL-13.7 fL in males and 8 fL -13.28 fL in females PDW: 9 fL -16.56 fL in males and 8 fL -13.28 fL in females. CONCLUSION Our values differed from the existing haematological reference values, thus showing the importance of developing region-specific reference intervals. Our data also showed the importance of establishing gender specific reference intervals.
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Affiliation(s)
- Subhashree A.R.
- Associate Professor, Department of Pathology, Chrompet, Chennai, Tamil nadu, India
| | - P.J Parameaswari
- Assistant Professor, Department of Biostatistics, Chrompet, Chennai, Tamil nadu, India
| | - B. Shanthi
- Associate Professor, Department of Biochemistry, Chrompet, Chennai, Tamil nadu, India
| | - C. Revathy
- Post Graduate, Department of Biochemistry, Chrompet, Chennai, Tamil nadu, India
| | - B.O. Parijatham
- Professor, Department of Pathology Sree Balaji Medical College & Hospital, Bharath University, Chrompet, Chennai, Tamil nadu, India
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Lakshmipriya N, Gayathri R, Praseena K, Vijayalakshmi P, Geetha G, Sudha V, Krishnaswamy K, Anjana RM, Henry J, Mohan V. Type of vegetable oils used in cooking and risk of metabolic syndrome among Asian Indians. Int J Food Sci Nutr 2012; 64:131-9. [PMID: 23025245 DOI: 10.3109/09637486.2012.728197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is little data on the type of vegetable oil used and the prevalence of metabolic syndrome (MS) in Asian Indians. Food frequency questionnaire was used to document the type of cooking oil in 1875 adults in Chennai city. MS was assessed by new harmonizing criteria. The prevalence of MS was higher among sunflower oil users (30.7%) than palmolein (23.2%) and traditional oil (17.1%, p < 0.001) users. The higher prevalence of MS in sunflower oil group persisted even when stratified according to body mass index, except in obese groups. The risk of MS was further compounded by quantity of refined cereals consumed. Higher LA%E and linoleic acid/alpha-linolenic acid ratio in sunflower oil probably contributes to increased risk of MS.
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Affiliation(s)
- Nagarajan Lakshmipriya
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases, International Diabetes Federation (IDF) Centre of Education, Gopalapuram, Chennai, India
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Prasad DS, Kabir Z, Dash AK, Das BC. Prevalence and risk factors for diabetes and impaired glucose tolerance in Asian Indians: a community survey from urban eastern India. Diabetes Metab Syndr 2012; 6:96-101. [PMID: 23153977 DOI: 10.1016/j.dsx.2012.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and to identify risk factors for the same specific to an underdeveloped urban locale of Eastern India. METHODS Study design. Population based cross-sectional study, with multistage random sampling technique. Setting. Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. Participants. 1178 adults of 20-80 years age randomly selected from 37 electoral wards of urban populace. Definition and diagnosis of diabetes mellitus and IGT. These were based on a Report of a World Health Organization/International Diabetes Federation Consultation of 2006. Main outcome measure. Prevalence and significant risk factors for Diabetes and IGT. Statistical analysis. Both descriptive and multivariable logistic regression analyses. RESULTS The crude rates of diabetes and IGT in the study population were 15.7% and 8.8%, respectively. Similarly age-standardized rates of diabetes and IGT were 11.1% and 6.7%, respectively. Both diabetes and IGT had shown a male preponderance. CONCLUSION Diabetes and IGT were very highly prevalent in this urban populace. Cardiometabolic risk factors like older age, central obesity, inadequate fruit intake, hypertension, hypertriglyceridemia and socio economic status were found to be significant predictors of diabetes in this study.
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Affiliation(s)
- D S Prasad
- Sudhir Heart Centre, Berhampur, Orissa, India.
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Ruxton CHS, Mason P. Is black tea consumption associated with a lower risk of cardiovascular disease and type 2 diabetes? NUTR BULL 2011. [DOI: 10.1111/j.1467-3010.2011.01937.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Sudhakaran C, Kishore U, Anjana RM, Unnikrishnan R, Mohan V. Effectiveness of sitagliptin in asian Indian patients with type 2 diabetes-an Indian tertiary diabetes care center experience. Diabetes Technol Ther 2011; 13:27-32. [PMID: 21175268 DOI: 10.1089/dia.2010.0120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND this study reports on the effectiveness of sitagliptin in Asian Indian type 2 diabetes patients seen at a tertiary diabetes care center who had inadequate glycemic control with oral hypoglycemic agents either alone or in combination, compared to a group of patients who received insulin glargine. PATIENTS AND METHODS patients with type 2 diabetes mellitus (n = 2,817) whose glycemia was not controlled adequately (glycated hemoglobin >6.5%) with oral hypoglycemic agents (either alone or in combination) received oral sitagliptin 100 mg once daily in addition to existing therapy for a period of 24 weeks. Patients who received insulin glargine as add-on therapy (n = 2,743) served as the reference group. Data analysis included glycated hemoglobin, fasting plasma glucose, lipid profile, body weight, and the occurrence of hypoglycemia. RESULTS significant reductions in glycated hemoglobin and fasting plasma glucose values were noted after 24 weeks of additional sitagliptin therapy that were comparable to those with insulin glargine. While sitagliptin addition resulted in a small weight loss (0.3 kg), insulin glargine addition resulted in a weight gain (0.7 kg). The overall incidence of adverse experiences was low and generally mild in both groups. CONCLUSIONS in a large group of Asian Indian type 2 diabetes patients seen at a tertiary diabetes center in whom glycemia was not controlled adequately by oral hypoglycemic agents (either alone or in combination), addition of sitagliptin helped to achieve glycemic control to a similar extent as insulin glargine but with a marginal weight advantage.
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Affiliation(s)
- Chidambarann Sudhakaran
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-communicable Diseases and International Diabetes Federation Centre of Education, Gopalapuram, Chennai, India
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