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Nassar M, Misra A, Bloomgarden Z. Impact of treatment with GLP-1RAs on suicide attempts in adults persons with type 2 diabetes: A retrospective comparative effectiveness study based on a global TriNetX health research database. J Diabetes 2024; 16:e13547. [PMID: 38501220 PMCID: PMC10949079 DOI: 10.1111/1753-0407.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To assess the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment and the risk of suicide attempts in people with type 2 diabetes (T2D), with a focus on subgroups with and without a history of depression or suicide attempts. METHODS This retrospective cohort study utilized TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 113 health care organizations with 135 million patient records with 8 million with T2D, 83% from the United States. The four cohorts were identified based on age, medication, diagnosis, and presence of depression or suicide attempts. Analytic methods included measures of association and number of Instances, with propensity score matching employed to mitigate potential confounders. The primary outcome was the incidence of suicide attempts among people with T2D with GLP-1RA treatment in comparison with dipeptidyl peptidase-4 inhibitor (DPP-4i) treatment. RESULTS People with T2D treated with GLP-1RA consistently exhibited a lower risk of suicide attempts compared to those treated with DPP-4i. This was particularly significant in people with a history of depression or suicide attempts. The risk and odds ratios were significantly lower in the GLP-1RA-treated cohorts than in DPP-4i across all analyses. CONCLUSION As compared with DPP-4i, our analysis shows a protective effect associated with GLP-1RA treatment on the risk of suicide attempts among people with T2D. However, further research, particularly prospective and randomized studies, is necessary to confirm these observations and understand the underlying mechanisms.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | - Anoop Misra
- Fortis‐C‐DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Diabetes Foundation (India), and National Diabetes Obesity and Cholesterol Foundation (NDOC)New DelhiIndia
| | - Zachary Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Dutta K, Bhatt SP, Madan S, Ansari IA, Tyagi K, Pandey S, Misra A. Acanthosis nigricans independently predicts hepatic fibrosis in people with type 2 diabetes in North India. Prim Care Diabetes 2024:S1751-9918(24)00003-2. [PMID: 38245384 DOI: 10.1016/j.pcd.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Acanthosis nigricans (AN) is a skin condition characterized by hyperpigmentation and thickening, often found in individuals with insulin resistance. Despite this well-established association, the potential link between AN and hepatic fibrosis in people with type 2 diabetes (T2D) has yet to be thoroughly explored. METHODOLOGY We recruited a total of 300 people with T2D, half of whom had AN (n, 150), and the other half without AN (n, 150). We evaluated body composition, biochemistry, and hepatic fat analysis (using the controlled attenuation parameter, CAP), as well as assessments of hepatic stiffness (using the kilopascal, kPa) using Fibroscan. We used multivariable regression analysis to find independent predictors of AN and their relationship to hepatic fibrosis. Furthermore, we developed a prediction equation and AUC for hepatic fibrosis. RESULTS Upon comparison between AN vs. NAN group, following were significatly higher; weight, BMI, hepatic transaminases, liver span, CAP, and kPa. After adjusting for age, weight, body mass index, diabetes duration, and specific anti-hyperglycaemic drugs (gliclazide, DPP-4 inhibitors, pioglitazone, and Glucagon-like peptide-1 receptor agonists), adjusted OR for AN were, liver span, 1.78 (95% CI: 0.91-3.49, p = 0.09), CAP, 7.55 (95% CI: 0.93-61.1, p = 0.05), and kPa, 2.47 (95% CI: 1.50-4.06, p = 0.001). A ROC analysis of predictive score for hepatic fibrosis showed optimal sensitivity and specificity at a score cut-off of 25.2 (sensitivity 62%, specificity 63%), with an AUC of 0.6452 (95% CI: 0.61235-0.76420). CONCLUSION Acanthosis nigricans has the potential to be used as an easy-to-identify clinical marker for risk of hepatic fat and fibrosis in Asian Indians with T2D, allowing for early detection and management strategies.
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Affiliation(s)
- Koel Dutta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Surya Prakash Bhatt
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Madan
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Kanika Tyagi
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India.
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Vaishya R, Misra A, Vaish A, Ursino N, D'Ambrosi R. Hand grip strength as a proposed new vital sign of health: a narrative review of evidences. J Health Popul Nutr 2024; 43:7. [PMID: 38195493 PMCID: PMC10777545 DOI: 10.1186/s41043-024-00500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 10076, India
| | - Anoop Misra
- Department of Endocrinology, C-DOC Fortis Hospital, Nehru Place, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 10076, India
| | - Nicola Ursino
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy.
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Vaishya R, Gupta BM, Misra A, Mamdapur GMN, Walke R, Vaish A. Top 100 highly cited papers from India on COVID-19 research: A bibliometric analysis of the core literature. Diabetes Metab Syndr 2023; 17:102898. [PMID: 37952296 DOI: 10.1016/j.dsx.2023.102898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND AIMS This study aimed to assess the current status of India's COVID-19 research from the top 100 most cited papers, using bibliometrics methods and indicators and suggest strengths and weaknesses. METHODOLOGY Publications on COVID-19 research from India between December 2019 and 22 August 2023 were retrieved from the Scopus database. From 37101 studies retrieved, the first top 100 Highly Cited Papers (HCPs) having received 270 to 2931 citations, were identified. RESULTS The top 100 most cited Indian papers were published from 2020 to 2023, with the majority (75) in the year 2021, followed by 24 in 2022. They were cited a total of 56661 times (average - 566.61 times). The 242 authors of these HCPs were from 159 Indian organizations, and the articles were published in 60 journals. 29 % and 59 % of these HCPs received external funding support and were involved in international collaborations, respectively. There was poor collaboration among Indian research institutions and a dearth of funding from India. None of the Indian HCPs figured in the global 100 HCPs. CONCLUSIONS Although citations of research papers published from India increased during COVID-19, limited collaboration, inadequate funding, and subpar publications hindered Indian scientists. To enhance India's research landscape, we propose dismantling barriers, nurturing collaboration, and encouraging knowledge exchange among domestic institutions.
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Affiliation(s)
- Raju Vaishya
- Indraprastha Apollo Hospitals, New Delhi, India.
| | | | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), India.
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Tyagi K, Madan S, Prakash Bhatt S, Ansari IA, Dutta K, Misra A. Sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes mellitus and moderate to severe hepatic fibrosis: A retrospective study. Clin Nutr ESPEN 2023; 57:305-310. [PMID: 37739673 DOI: 10.1016/j.clnesp.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to decrease hepatic transaminases, steatosis, and in some studies, hepatic fibrosis. However, the safety and efficacy of SGLT2i has not been tested in patients who have moderate to severe hepatic fibrosis. METHODS In a retrospective study of sixty patients with moderate to severe hepatic fibrosis (kPa estimated by Fibroscan > 10), SGLT2i were prescribed on top of other oral anti-hyperglycemic medications. The safety and efficacy of SGLT2i were evaluated. Using the Fibroscan, CAP scores (decibel/meter), and liver stiffness measurement (LSM) (kPa, kilopascals) were examined before and after treatment. RESULTS The mean age of the T2DM patients was 54.7 ± 10.3 years, and the mean duration of T2DM was 8.3 ± 7.1 years. SGLT2i were given from 3 to 36 months. After treatment, a decrease in glycated hemoglobin (HbA1c), and hepatic transaminases (SGOT and SGPT) was recorded. Upon follow up, CAP and kPa scores decreased significantly. Importantly, no adverse drug reaction, such as balanoposthitis, vulvovaginitis, urosepsis, and postural drop in blood pressure, were reported in any patient. CONCLUSION In this retrospective cohort study, patient with T2DM and moderate to severe hepatic fibrosis, use of SGLT2i is safe with respect to common adverse effects & may have contributed to improved hepatic profile.
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Affiliation(s)
- Kanika Tyagi
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Swati Madan
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Surya Prakash Bhatt
- National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Diabetes Foundation of India (DFI), New Delhi, India; Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Koel Dutta
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Diabetes Foundation of India (DFI), New Delhi, India.
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Dutta D, Nagendra L, Bhat S, Mohindra R, Surana V, Misra A. Optimal use of once weekly icodec insulin in type-2 diabetes: An updated meta-analysis of phase-2 and phase-3 randomized controlled trials. Diabetes Metab Syndr 2023; 17:102877. [PMID: 37832481 DOI: 10.1016/j.dsx.2023.102877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Previously published meta-analysis have analysed data from 3 small phase-2 randomized controlled trials (RCTs). Since then, 5 big phase-3 RCTs have been published on use of icodec in type-2 diabetes (T2D). This updated systematic review aimed to establish the best practices and safety of icodec in T2D. METHODS Databases were searched for RCTs involving T2D patients receiving icodec. Primary outcome was change in HbA1c. Secondary outcomes were alterations in glycaemic parameters and adverse events. RESULTS Data from 8 studies (4317 patients) was analysed. Compared to other basal insulins, icodec had comparable HbA1c lowering at 16-weeks [MD-0.19 %(95%CI: 0.58-0.20); P = 0.35; I2 = 92 %], better HbA1c lowering at 26-weeks [MD-0.19 %(95%CI: 0.35-0.013); P = 0.02; I2 = 94 %] and 52-weeks [MD -0.28 %(95%CI: 0.45-0.12); P = 0.0008; I2 = 100 %]. Percentage of participants achieving HbA1c<7 % with icodec was higher at 16-weeks [OR2.37(95%CI:1.05-5.35); P = 0.04], comparable at 26-weeks [OR1.38(95%CI:0.91-2.11); P = 0.13; I2 = 80 %], and higher at 52-weeks [OR1.55(95%CI:1.30-1.85); P < 0.00001; I2 = 0 %]. Percentage of participants achieving HbA1c<7 % without level 2/3 hypoglycaemia was higher with icodec at 26-weeks [OR1.37(95%CI:1.10-1.71); P = 0.004; I2 = 28 %] and 52-weeks [OR1.48(95%CI:1.24-1.77); P < 0.001; I2 = 0 %]. At 26-weeks, injection-site reactions was higher with icodec [OR1.95(95%CI:1.06-3.56); P = 0.03; I2 = 0 %]. At 26-weeks level-1 hypoglycemia [OR1.40(95%CI:1.02-1.94); P = 0.04; I2 = 58 %], but not level-2/3 hypoglycaemia was higher with icodec. Subset analysis revealed increased occurrence of level-1 [OR 4.19 (95 % CI: 3.20-5.50); P < 0.00001] and level-2 [OR 3.97 (95 % CI: 3.04-5.18); P < 0.00001] hypoglycaemia in participants who received one-time additional 50 % icodec loading dose as compared to those who did not. At 26-weeks, weight-gain was significantly higher with icodec [MD0.61 kg(95%CI:0.38-0.84); P < 0.00001; I2 = 98 %]. CONCLUSION Icodec insulin is well tolerated with glycaemic efficacy similar to all other available basal insulins.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.
| | - Sowrabha Bhat
- Department of Endocrinology, Yenepoya Medical College, Mangalore, India.
| | - Ritin Mohindra
- Department of Medicine, Post-Graduate Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vineet Surana
- Department of Endocrinology, Manipal Hospitals, New Delhi, India.
| | - Anoop Misra
- Department of Endocrinology, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India.
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Zhou XD, Targher G, Byrne CD, Somers V, Kim SU, Chahal CAA, Wong VWS, Cai J, Shapiro MD, Eslam M, Steg PG, Sung KC, Misra A, Li JJ, Brotons C, Huang Y, Papatheodoridis GV, Sun A, Yilmaz Y, Chan WK, Huang H, Méndez-Sánchez N, Alqahtani SA, Cortez-Pinto H, Lip GYH, de Knegt RJ, Ocama P, Romero-Gomez M, Fudim M, Sebastiani G, Son JW, Ryan JD, Ikonomidis I, Treeprasertsuk S, Pastori D, Lupsor-Platon M, Tilg H, Ghazinyan H, Boursier J, Hamaguchi M, Nguyen MH, Fan JG, Goh GBB, Al Mahtab M, Hamid S, Perera N, George J, Zheng MH. An international multidisciplinary consensus statement on MAFLD and the risk of CVD. Hepatol Int 2023; 17:773-791. [PMID: 37204656 PMCID: PMC10198034 DOI: 10.1007/s12072-023-10543-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. METHODS AND RESULTS A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. CONCULSIONS The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.
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Affiliation(s)
- Xiao-Dong Zhou
- Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Christopher D Byrne
- Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK
| | - Virend Somers
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - C Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, West Smithfield, UK
| | - Vincent Wai-Sun Wong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia
| | - Philippe Gabriel Steg
- Université Paris -Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France
| | - Ki-Chul Sung
- Department of Internal Medicine, Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, National Diabetes Obesity and Cholesterol Foundation and Diabetes Foundation (India), New Delhi, India
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao Town, Shunde District, Foshan, China
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Aijun Sun
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yusuf Yilmaz
- Institute of Gastroenterology, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Huang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, China
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Saleh A Alqahtani
- Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA
| | - Helena Cortez-Pinto
- Laboratório de Nutrição e Metabolismo, Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisbon, Portugal
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 206, Rotterdam, The Netherlands
| | - Ponsiano Ocama
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Manuel Romero-Gomez
- Department of Digestive and Liver Diseases, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Marat Fudim
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, 1001 Blvd. Décarie, Montreal, Canada
| | - Jang Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - John D Ryan
- Department of Hepatology, RCSI School of Medicine and Medical Sciences, Dublin/Beaumont Hospital, Dublin, Ireland
| | - Ignatios Ikonomidis
- Preventive Cardiology Laboratory and Cardiometabolic Clinic, Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Lupsor-Platon
- Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jerome Boursier
- Hepato-Gastroenterology Department, University Hospital, 4 Larrey Street, 49933, Angers Cedex 09, France
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Japan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - George Boon-Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Nilanka Perera
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia.
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China.
- Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.
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Vaishya R, Misra A. The journal 'Diabetes and Metabolic Syndrome: Clinical Research and Reviews̕ achieves a double-digit impact factor, marking its ascent. Diabetes Metab Syndr 2023; 17:102830. [PMID: 37531742 DOI: 10.1016/j.dsx.2023.102830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India.
| | - Anoop Misra
- Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Disease, and Endocrinology, New Delhi, India.
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Singh AK, Singh A, Singh R, Joshi SR, Misra A. Non-sugar sweeteners and health outcomes in adults without diabetes: deciphering the WHO recommendations in the Indian context. Diabetes Metab Syndr 2023; 17:102829. [PMID: 37451112 DOI: 10.1016/j.dsx.2023.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS A systematic review and meta-analysis conducted by the World Health Organization (WHO) assessed the health outcomes of non-sugar sweeteners (NSS) in randomized controlled trials (RCTs) and prospective cohort studies (PCSs) and reported conflicting findings. We aim to decipher these conflicting findings in RCTs and PCSs by critically reviewing their results, comparing them with previous meta-analyses, and providing a simplified interpretation including the Indian perspective. METHODS We critically reviewed the 210-page dossier of WHO including the full text of most of the key studies of NSS included in this meta-analysis and subsequently compared it with previous meta-analyses to identify similarities and differences to address a few key questions pertaining to health outcomes associated with NSS use in adults. RESULTS Poor health outcomes are often associated with excess sugar intake. While NSS are typically consumed as a sugar replacement, benefits are conflicting. While RCTs found some benefits in the short term, PCSs found harm associated with NSS use in the long term. CONCLUSION The 2022 WHO meta-analysis that assessed the health outcomes of NSS is the most robust and critically analyzed document available to date. Despite the absence of any strong conclusion that suggests NSS consumption increases the risk of cardio-metabolic disorders, no firm evidence also rejects this statement. NSS could be an attractive replacement for sugar in overweight/obese people in the short term, but long-term harm cannot be fully ruled out. We suggest avoiding consuming sugar and restricting NSS intake wherever possible until long-term studies confirm or refute these findings.
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Affiliation(s)
- Awadhesh Kumar Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Sun Valley Hospital & Diabetes Research Centre, Guwahati, Assam, India; Horizon Lifeline Multi-specialty Hospital, Kolkata, West Bengal, India.
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Horizon Lifeline Multi-specialty Hospital, Kolkata, West Bengal, India
| | | | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Vaishya R, Misra A, Nassar M, Vaish A. Global trend of research and publications in endocrinology, diabetes, and metabolism: 1996–2021. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/29/2023] [Indexed: 10/20/2023] Open
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Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges. J Diabetes 2023. [PMID: 37292055 DOI: 10.1111/1753-0407.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB-DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB-DM syndemic with the COVID-19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB-DM operationally difficult and of low effectiveness. Research regarding TB-DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB-DM comorbidity needs more efforts, including training and supervision of frontline workers.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Diabetes Foundation (India) (DFI), New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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Kumari A, Ranjan P, Vikram NK, Kaur D, Balsarkar G, Malhotra A, Puri M, Batra A, Madan J, Tyagi S, Guleria K, Dabral A, Sarkar S, Nigam A, Anwar W, Kamath S, Bhatla N, Kumari SS, Kumar R, Choranur A, Venkataraman S, Kaur T, Rathore AM, Kaloiya GS, Prakash A, Tiwaskar M, Verma A, Singh R, Sharma KA, Baitha U, Tewary K, Misra A, Guleria R. Evidence and consensus-based clinical practice guideline for the management of obesity and overweight in postpartum women: An AIIMS-DST initiative. J Family Med Prim Care 2023; 12:812-855. [PMID: 37448937 PMCID: PMC10336934 DOI: 10.4103/jfmpc.jfmpc_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 07/18/2023] Open
Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Divjyot Kaur
- Department of Home Science, University of Delhi, Delhi, India
| | - Geetha Balsarkar
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Anita Malhotra
- Department of Home Science, University of Delhi, Delhi, India
| | - Manju Puri
- Director Professor and Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), New Delhi, India
- Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Jagmeet Madan
- National President, Indian Dietetic Association, New Delhi, India
| | - Shakun Tyagi
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Anjali Dabral
- Professor and Head, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Wareesha Anwar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Kamath
- Former Dean, LT Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
- Former Dean, Seth G. S. Medical College, and KEM Hospital, Mumbai, Maharashtra, India
| | - Neerja Bhatla
- Professor and Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
- President, World Organization of Family Doctors (WONCA), New Delhi, India
| | | | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Psychology, University of Delhi, Delhi, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Clinical Psychology and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Archana Verma
- Vice President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Rakhi Singh
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
- Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- President, Diabetes Foundation (India) (DFI), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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Gulati S, Misra A, Tiwari R, Sharma M, Pandey RM, Upadhyay AD, Chandra Sati H. Premeal almond load decreases postprandial glycaemia, adiposity and reversed prediabetes to normoglycemia: A randomized controlled trial. Clin Nutr ESPEN 2023; 54:12-22. [PMID: 36963852 DOI: 10.1016/j.clnesp.2022.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Asian Indians show rapid conversion from prediabetes to type 2 diabetes (T2D). Novel dietary strategies are needed to arrest this progression, by targeting postprandial hyperglycaemia (PPHG). DESIGN We conducted a free-living randomized controlled open-label parallel arm study to evaluate the effect of a premeal load of almonds (20 g) 30 min before major meals on anthropometric, glycaemic, and metabolic parameters over 3 months. Sixty-six participants with prediabetes in the age range of 18-60 yrs were recruited. The study was registered at clinicaltrials.gov (registration no. NCT04769726). RESULTS Thirty participants in each arm completed the study. As per 'intention-to-treat' analysis, overall additional mean reductions were statistically significant for body weight, BMI, waist circumference (WC), subscapular and suprailiac skinfolds, and improved handgrip strength (Kg) (p < 0·001 for all) in the treatment arm vs. the control arm (after multiple adjustments). In the blood parameters, the additional mean reduction in the treatment arm vs. control arm was statistically significant for fasting and post-75 g oral glucose-load blood glucose, postprandial insulin, HOMA-IR, HbA1c, proinsulin, total cholesterol, and very low-density lipoprotein cholesterol (p < 0·001 for all). Most importantly, we observed a reversal to normoglycemic state (fasting blood glucose and 2 h post-OGTT glucose levels) in 23.3% (7 out of 30) of participants in the treatment arm which is comparable to that seen with Acarbose treatment (25%). CONCLUSION Incorporation of 20 g of almonds, 30 min before each major meal leads to significant improvement in body weight, WC, glycemia (particularly PPHG), and insulin resistance and shows potential for reversal of prediabetes to normal glucose regulation over 3 months.
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Affiliation(s)
- Seema Gulati
- Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Center of Nutrition & Metabolic Research (C-NET), New Delhi, India
| | - Anoop Misra
- Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Center of Nutrition & Metabolic Research (C-NET), New Delhi, India; Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Disease, and Endocrinology, New Delhi, India.
| | - Rajneesh Tiwari
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Meenu Sharma
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
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Abstract
BACKGROUND AND AIMS There have been advancements in artificial intelligence (AI) and deep learning in the past decade. Recently, OpenAI Inc. has launched a new chatbot, called ChatGPT that interacts in a conversational way and its dialogue format makes is user friendly and fast. In this paper we aimed to explore the current position and the accuracy of currently available version of ChatGPT in relation to healthcare and medical research. METHODS We searched the PubMed, Scopus, and Google databases from 15th to 25th February 2023, using the keywords: 'ChatGPT' AND 'medical research, healthcare, and scientific writing'. We found 29 results in PubMed and 9 results in Scopus database., in English language. In addition, we (RV, AM) interacted with ChatGPT multiple times to review accuracy of responses of various medical questions. RESULTS Using literature search and interactions with ChatGPT with medical questions, we infer that this version generates answers rapidly but narrates data from existing internet literature in a general manner. However, as emphasised by the company in the landing page of ChatGPT, we found errors in responses to medical questions, Further, narrated data were limited up to September 2021. Positive features include admission of its limitations in medical field, and as it has been designed, learning from previous answers. CONCLUSION Current version of ChatGPT may be useful in a limited manner as a narrative AI chatbot for medical personnel, however, researchers are advised to fact check all statements provided, keeping in mind its limitations.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, 110076, New Delhi, India.
| | - Anoop Misra
- Department of Endocrinology, Fortis C Doc Hospital, Nehru Place, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, 110076, New Delhi, India
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Meena K, Misra A, Vikram N, Ali S, Upadhyay AD, Luthra K. Genetic polymorphism of fatty acid binding protein-2 in hyperlipidemic Asian Indians in North India. Am J Hum Biol 2023; 35:e23834. [PMID: 36382874 DOI: 10.1002/ajhb.23834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fatty acid binding protein-2 (FABP-2) is involved in the metabolism of lipids in the intestine. FABP-2 Ala54Thr polymorphism involves a transition of G to A at codon 54 of FABP-2, resulting in an amino acid substitution Ala54 to Thr54 and is associated with elevated fasting triglycerides in some hyperlipidemic populations. In current genome builds and gene databases the variant of the Ala54Thr FABP-2 (rs 1 799 883) is annotated as c.163A>G (p. Thr55Ala). AIM AND OBJECTIVE The status of this polymorphism in hyperlipidemic Asian Indians from North India has not been investigated. This study was aimed to evaluate the distribution of the polymorphic variants of the Ala54Thr FABP-2 and their association with lipids in hyperlipidemic subjects. METHODS Ala54Thr FABP-2 polymorphism in both hyperlipidemic (n = 210) and normolipidemic (n = 342) subjects was assessed by PCR-RFLP. RESULTS Ala54Thr genotypes and alleles distribution did not differ between the hyperlipidemic and normolipidemic groups. The heterozygous genotype FABP-2 Ala/Thr was significantly associated with higher levels of triglycerides and very low-density lipoproteins as compared to the homozygous variant (Thr/Thr) genotype and the wild type homozygous (Ala/Ala) genotype. CONCLUSIONS The heterozygous genotype FABP-2 Ala54Thr is a risk factor for the development of hypertriglyceridemia and increased levels of VLDL-c in Asian Indians from North India.
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Affiliation(s)
- Kiran Meena
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India
| | - Naval Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shakir Ali
- Department of Biochemistry, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Luthra
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Nishi SK, Viguiliouk E, Kendall CWC, Jenkins DJA, Hu FB, Sievenpiper JL, Atzeni A, Misra A, Salas-Salvadó J. Nuts in the Prevention and Management of Type 2 Diabetes. Nutrients 2023; 15:nu15040878. [PMID: 36839236 PMCID: PMC9965730 DOI: 10.3390/nu15040878] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Diabetes is a continuously growing global concern affecting >10% of adults, which may be mitigated by modifiable lifestyle factors. Consumption of nuts and their inclusion in dietary patterns has been associated with a range of beneficial health outcomes. Diabetes guidelines recommend dietary patterns that incorporate nuts; however, specific recommendations related to nuts have been limited. This review considers the epidemiological and clinical evidence to date for the role of nut consumption as a dietary strategy for the prevention and management of type 2 diabetes (T2D) and related complications. Findings suggest nut consumption may have a potential role in the prevention and management of T2D, with mechanistic studies assessing nuts and individual nut-related nutritional constituents supporting this possibility. However, limited definitive evidence is available to date, and future studies are needed to elucidate better the impact of nuts on the prevention and management of T2D.
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Affiliation(s)
- Stephanie K. Nishi
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5C 2T2, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Correspondence: (S.K.N.); (J.S.-S.)
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5C 2T2, Canada
| | - Cyril W. C. Kendall
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5C 2T2, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - David J. A. Jenkins
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5C 2T2, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - John L. Sievenpiper
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON M5C 2T2, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5C 2T2, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - Alessandro Atzeni
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi 110048, India
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi 110016, India
- Diabetes Foundation (India), New Delhi 110070, India
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: (S.K.N.); (J.S.-S.)
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Gulati S, Misra A, Tiwari R, Sharma M, Pandey RM, Upadhyay AD, Sati HC. Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes. Eur J Clin Nutr 2023; 77:586-595. [PMID: 36732571 PMCID: PMC10169634 DOI: 10.1038/s41430-023-01263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rapid conversion from prediabetes to diabetes and frequent postprandial hyperglycemia (PPHG) is seen in Asian Indians. These should be the target of dietary strategies. OBJECTIVES We hypothesized that dietary intervention of preloading major meals with almonds in participants with prediabetes will decrease overall glycemia and PPHG. DESIGN The study included two phases: (1) an oral glucose tolerance test (OGTT)-based crossover randomized control study, the effect of a single premeal almond load (20 g) given before OGTT was evaluated (n = 60, 30 each period). (2) The continuous glucose monitoring system (CGMS)-based study for 3 days including premeal almond load before three major meals was a free-living, open-labeled, crossover randomized control trial, where control and premeal almond load diets were compared for glycaemic control (n = 60, 30 in each period). The study was registered at clinicaltrials.gov (registration no. NCT04769726). RESULTS In the OGTT-based study phase, the overall AUC for blood glucose, serum insulin, C-peptide, and plasma glucagon post-75 g oral glucose load was significantly lower for treatment vs. control diet (p < 0.001). Specifically, with the former diet, PPHG was significantly lower (18.05% in AUC on OGTT, 24.8% at 1-h, 28.9% at 2-h post OGTT, and 10.07% during CGMS). The CGMS data showed that premeal almond load significantly improved 24-glucose variability; SD of mean glucose concentration and mean of daily differences. Daily glycaemic control improved significantly as per the following: mean 24-h blood glucose concentration (M), time spent above 7.8 mmol/L of blood glucose, together with the corresponding AUC values. Premeal almond load significantly decreased following: overall hyperglycemia (glucose AUC), PPHG, peak 24-h glycaemia, and minimum glucose level during night. CONCLUSION Incorporation of 20 g of almonds, 30 min before each major meal led to a significant decrease in PPHG (as revealed in OGTT-based study phase) and also improved insulin, C-peptide, glucagon levels, and improved glucose variability and glycemic parameters on CGMS in participants with prediabetes. CLINICAL TRIAL REGISTRY The study was registered at clinicaltrials.gov (registration no. NCT04769726).
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Affiliation(s)
- Seema Gulati
- Diabetes Foundation (India), New Delhi, India.,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India.,Center of Nutrition & Metabolic Research (C-NET), New Delhi, India
| | - Anoop Misra
- Diabetes Foundation (India), New Delhi, India. .,National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India. .,Center of Nutrition & Metabolic Research (C-NET), New Delhi, India. .,Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Disease, and Endocrinology, New Delhi, India.
| | - Rajneesh Tiwari
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Meenu Sharma
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
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Dutta D, Mohindra R, Misra A. Comment on: "Efficacy and Safety of Saroglitazar in Patients with Cardiometabolic Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Clin Drug Investig 2023; 43:147-148. [PMID: 36637687 DOI: 10.1007/s40261-022-01245-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis and Rheumatism Superspeciality Healthcare, Plot 107 and 108, Sector 12A, Dwarka, New Delhi, 110075, India.
| | - Ritin Mohindra
- Department of Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, New Delhi, India
| | - Anoop Misra
- Department of Endocrinology, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
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Singh AK, Singh A, Singh R, Misra A. Efficacy and safety of imeglimin in type 2 diabetes: A systematic review and meta-analysis of randomized placebo-controlled trials. Diabetes Metab Syndr 2023; 17:102710. [PMID: 36702046 DOI: 10.1016/j.dsx.2023.102710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Imeglimin is a novel new oral compound recently approved for treating type 2 diabetes (T2D) in India. We conducted a systematic review and meta-analysis to evaluate the efficacy of imeglimin in people with T2D in the approved dose of 1000 mg twice daily (BID). METHODS We systematically searched the database of PubMed until December 20, 2022, and retrieved all published double-blind, randomized, placebo-controlled trials (RCTs) conducted with imeglimin 1000 mg BID, using appropriate keywords and MeSH terms. A meta-analysis was conducted to study the HbA1c lowering effect of imeglimin 1000 mg BID in people with T2D using the Comprehensive meta-analysis (CMA) software Version 3, Biostat Inc. Englewood, NJ, USA. RESULTS Of the seven Phase 2 studies and three Phase 3 studies conducted so far, only three published double-blind RCTs have reported the efficacy and safety of imeglimin 1000 mg BID against the placebo. Our meta-analysis using the random-effects model from two monotherapy studies (n = 360) showed imeglimin 1000 mg BID reduce HbA1c significantly (Δ -0.9%, 95% Confidence Interval [CI], -1.1 to -0.74%; P < 0.0001) against the placebo, without any heterogeneity (I2 = 0%). The pooled meta-analysis from all three RCTs (n = 574) found a significant reduction in HbA1c with imeglimin 1000 mg BID (Δ -0.79%; 95% CI, -1.00 to -0.59%; P < 0.0001) compared to placebo with high heterogeneity. CONCLUSIONS This meta-analysis found a significant HbA1c lowering effect of imeglimin in people with T2D with an acceptable tolerability profile. Still, larger and longer studies are needed.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Nassar M, Abosheaishaa H, Singh AK, Misra A, Bloomgarden Z. Noninsulin-based antihyperglycemic medications in patients with diabetes and COVID-19: A systematic review and meta-analysis. J Diabetes 2023; 15:86-96. [PMID: 36690377 PMCID: PMC9934962 DOI: 10.1111/1753-0407.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients with diabetes are more likely to suffer COVID-19 complications. Using noninsulin antihyperglycemic medications (AGMs) during COVID-19 infection has proved challenging. In this study, we evaluate different noninsulin AGMs in patients with COVID-19. METHODS We searched Medline, Embase, Web of Science, and Cochrane on 24 January 2022. We used the following keywords (COVID-19) AND (diabetes mellitus) AND (antihyperglycemic agent). The inclusion criteria were studies reporting one or more of the outcomes. We excluded non-English articles, case reports, and literature reviews. Study outcomes were mortality, hospitalization, and intensive care unit (ICU) admission. RESULTS The use of metformin rather than other glucose-lowering medications was associated with statistically significant lower mortality (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.47, 0.77, p < .001). Dipeptidyl peptidase-4 inhibitor (DPP-4i) use was associated with statistically significantly higher hospitalization risk (RR: 1.44, 95% CI: 1.23, 1.68, p < .001) and higher risk of ICU admissions and/or mechanical ventilation vs nonusers (RR: 1.24, 95% CI: 1.04, 1.48, p < .02). There was a statistically significant decrease in hospitalization for SGLT-2i users vs nonusers (RR: 0.89, 95% CI: 0.84-0.95, p < .001). Glucagon-like peptide-1 receptor agonist (GLP-1RA) use was associated with a statistically significant decrease in mortality (RR: 0.56, 95% CI: 0.42, 073, p < 0.001), ICU admission, and/or mechanical ventilation (RR: 0.79, 95% CI: 0.69-0.89, p < .001), and hospitalization (RR: 0.73, 95% CI: 0.54, 0.98, p = .04). CONCLUSIONS AGM use was not associated with increased mortality. However, metformin and GLP-1RA use reduced mortality risk statistically significantly. DPP-4i use was associated with a statistically significant increase in the risk of hospitalization and admission to the ICU.
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Affiliation(s)
- Mahmoud Nassar
- Department of MedicineIcahn School of Medicine at Mount Sinai/NYC Health+Hospitals/QueensNew York CityNew YorkUSA
| | - Hazem Abosheaishaa
- Department of MedicineIcahn School of Medicine at Mount Sinai/NYC Health+Hospitals/QueensNew York CityNew YorkUSA
| | - Awadhesh Kumar Singh
- Department of Diabetes & EndocrinologyGD Hospital & Diabetes InstituteKolkataIndia
| | - Anoop Misra
- Chairman, Fortis‐C‐DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Diabetes Foundation (India), and National Diabetes Obesity and Cholesterol Foundation (NDOC)New DelhiIndia
| | - Zachary Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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21
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Sureka S, Misra A, Raj H, Singh U. Evaluation of different pneumoperitoneal pressures with respect to technical feasibility and physiological parameters in laparoscopic renal surgery: A prospective and randomized study to determine the safe pressure. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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22
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Meenakshi S, Misra A. Effect of dates on blood glucose and other metabolic variables: A narrative review. Diabetes Metab Syndr 2023; 17:102705. [PMID: 36702045 DOI: 10.1016/j.dsx.2023.102705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is a common belief that individuals with type 2 diabetes mellitus (T2DM) must avoid consumption of dates. This article aims to review and discuss the available studies on dates on different variables, specifically blood glucose. METHODS A survey of studies related to the influence of consumption of dates on blood glucose, glycosylated hemoglobin, lipid profile, and body weight was conducted between January 2009 and Nov 2022, using various data bases (PubMed, Medline, Google Scholar and Scopus). RESULTS The glycemic index (GI) of date varieties ranges from 42.8 to 74.6, and glycemic load (GL) 8.5-24. The glycemic indices of various stages of dates are; Rutab (semi-ripe), 47.2; Tamer (fully ripe, traditionally sun-dried), 45.3, and Tamer (commercial), 35.5. Glucose tolerance-based studies and cross-sectional studies show no significant changes in glycemic indices or association with glycemic worsening with intake of dates. Few randomized controlled trials (RCT) also showed no change in glycemia and weight in the intervention groups consuming dates. Some data (including one RCT) show that the consumption of dates improve total cholesterol and LDL-C. CONCLUSIONS Available studies show that consumption of dates may not lead to impairment of glycemia in patients with T2DM, however, studies have several limitations like small sample size and short duration. More RCTs pertaining to the GI of different date varieties in different amounts are needed.
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Affiliation(s)
- Sachdev Meenakshi
- Tamil Nadu Government Multi Super Specialty Hospital, Chennai, India
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, 110016, India; National Diabetes Obesity and Cholesterol Foundation (N-DOC), Safdarjung Development Area, New Delhi, 110016, India; Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India.
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23
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Sachdev M, Misra A. Heterogeneity of Dietary practices in India: current status and implications for the prevention and control of type 2 diabetes. Eur J Clin Nutr 2023; 77:145-155. [PMID: 35039630 DOI: 10.1038/s41430-021-01067-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
Diet is one of the important modifiable factors in prevention of type 2 diabetes (T2D), making it important to understand geographical variations of food consumption pattern, their similarities and differences across various regions. Asian Indian diet patterns are mostly carbohydrate-based and with vast regional diversity. Staple food, food groups consumed, meat consumption pattern, type of fermented foods, food preparations, type of cooking oil used and food ingredients vary with different regions of India. There has been a slow transition from consumption of coarse grains to refined grains owing to socio-economic, cultural and other factors. Consumption of fruits and vegetables, fats, ready-to-eat foods and sugar is higher in urban population whereas consumption of carbohydrates in the form of cereals and millets is higher among the rural population. Cereal grains followed by pulses and legumes are main sources of protein, given that the frequency of meat consumption is low even among non-vegetarians in India compared to other countries. Overall, there is a tendency towards consumption of calorie-dense foods at the cost of food diversity, which may also result in micronutrient deficiencies as well as development of T2D and related metabolic diseases. Public health strategies and policy level decisions involving stakeholders with diet and lifestyle modification as focal points are absolute priorities to prevent and manage the burden of obesity and T2D in India.
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Affiliation(s)
- Meenakshi Sachdev
- Tamil Nadu Government Multi Super Specialty Hospital, Chennai, India
| | - Anoop Misra
- Diabetes Foundation (India), Safdarjung Development Area, New Delhi, 110016, India. .,National Diabetes Obesity and Cholesterol Foundation (N-DOC), Safdarjung Development Area, New Delhi, 110016, India. .,Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, B-16, Chirag Enclave, New Delhi, India.
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24
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Nassar M, Misra A, Bloomgarden Z. COVID-19 Vaccination in Persons with Diabetes: How they Work. Contemporary Endocrinology 2023:195-206. [DOI: 10.1007/978-3-031-28536-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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25
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Singh AK, Singh R, Shah VN, Misra A. Finerenone in SGLT-2 Inhibitors Era: Current Positioning in Diabetic Kidney Disease. CD 2022. [DOI: 10.5603/dk.a2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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26
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Vaishya R, Gupta BM, Misra A, Mamdapurj GM, Vaish A. Global research in sarcopenia: High-cited papers, research institutions, funding agencies and collaborations, 1993-2022. Diabetes Metab Syndr 2022; 16:102654. [PMID: 36323180 DOI: 10.1016/j.dsx.2022.102654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS This bibliometric analysis aims to analyze the high-cited papers (HCPs), those which have received >100 citations) on Sarcopenia to provide insight into publication performances and research characteristics of the literature. METHODS Global HCPs on Sarcopenia research were identified from the Scopus database from January 1993 to August 2022. VOSviewer, and Biblioshiny software were used to visualize the collaborative interaction among most productive countries, organizations, authors, and keywords. Select bibliometric measures were applied to evaluate the publication productivity and their influence in this area. RESULTS Out of 6219 publications on Sarcopenia only 398 were HCPs. These HCPs received an average of 271.7 citations per publication (CPP). The most productive organizations were the Università Cattolica del Sacro Cuore, Italy, and Jean Mayer USDA Human Nutrition Center on Aging, USA. The most impactful organizations in terms of CPP and relative citation index were CHU de Toulouse, France, and Università Cattolica del Sacro Cuore, Italy. The most productive authors were Landi F and Morley JE, and Anker SD from Italy and Germany respectively. The most impactful authors were: Cederholm T (Sweden), Cruz JAJ (Spain) and Rolland Y (France). There were few/no HCPs from South America, Africa, South Asia, and USSR. CONCLUSION Sarcopenia research has been predominantly done in USA, Europe, and China, and rarely from low and middle-income countries. Further focus of research should be on its etiopathogenesis (especially at the molecular level), prevalence in different communities, methods to diagnose it in early stages, and its cost-effective management.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery Indraprastha Apollo Hospitals Sarita Vihar, New Delhi, 110 076, India.
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), India; Diabetes Foundation (India) (DFI), India.
| | - Ghouse Modin Mamdapurj
- Synthite Industries Pvt. Ltd. NPD & Amp, R Department, Kolenchery, Ernakulam, PIN, 682 311, Kerala, India.
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery Indraprastha Apollo Hospitals Sarita Vihar, New Delhi, 110 076, India.
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Henneberg J, Grohmann-Izay B, Huang C, Schulze C, Llinas N, Giorgi D, Misra A, Pominchuk D, Prokhorof A, Rapoport B, Semiglazov V, Tseng L, Yanez Ruiz E, Loibl S. A Phase III, Randomized, Multicenter, Double-blind Study to Compare Efficacy and Safety of EG12014 (EirGenix Trastuzumab) with Herceptin® as Neoadjuvant Treatment in Combination with Anthracycline/Paclitaxel-based Systemic Therapy in Patients with HER2-positive Early Breast Cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pasqualin G, Misra A, Gauvreau K, Desai AS, Prakash A, Sanders S, Givertz MM, Valente AM. Ventricular-arterial coupling predicts outcomes in adults with a systemic right ventricle. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with a systemic right ventricle (SRV) and biventricular circulation experience high incidence of cardiovascular morbidities and decreased survival [1]. Non-invasive measures of subclinical ventricular dysfunction are needed to appropriately identify patients at increased risk for adverse outcomes. Ventricular-arterial coupling (VAC), the ratio between the effective arterial elastance (Ea) and ventricular end-systolic elastance (Ees), may predict clinical outcomes in patients with SRV [2].
Objectives
To assess VAC in adults with SRV and evaluate its correlation with clinical outcomes.
Methods
Consecutive cardiovascular magnetic resonance (CMR) examinations of adults with D-loop transposition of great arteries (TGA) after atrial switch operation and L-loop TGA performed at Boston Children's Hospital between 2005 and 2019 were analyzed. VAC was calculated as Ea/Ees (Ea = mean arterial blood pressure (MBP)/ventricular stroke volume; Ees = MBP/end-systolic volume). Global myocardial strain was measured by feature tracking analysis on cine steady-state free precession sequences. Cox proportional hazards regression analysis was performed to assess the association of SRV functional parameters with clinical outcomes. The analysis was adjusted for age, sex, and body mass index. The primary outcome was defined as a composite of death, cardiovascular arrest, hospitalizations for heart failure (HF); the secondary outcome as atrial arrhythmias; the tertiary outcome included other causes of cardiovascular hospitalizations (percutaneous or surgical interventions, device implantation, other cardiovascular disease). Cumulative incidence of the study outcomes was estimated using Kaplan-Meier method.
Results
One hundred sixty-seven adults (mean age 32±10 years, 59% men) with SRV were analyzed. Patients with HF (n=48, 29%) had higher VAC values as compared to those without HF (1.4±0.8 vs. 1.1±0.5, p=0.01). Over a mean follow-up of 6.5±4.2 years, 15 over 139 patients (11%) experienced the primary outcome with an incidence rate of 1.7 per 100 patient-years (95% confidence interval (CI), 1.04–2.85). Higher VAC values were significantly associated with an increased risk of the primary outcome (p for trend = 0.01, Figure 1). VAC was the only functional parameter associated with the primary outcome (hazard ratio (HR) 1.99, 95% CI: 1.06–3.73, p=0.031), secondary outcome (HR 2.33, 95% CI: 1.12–4.82, p=0.023) and tertiary outcome (HR 1.63, 95% CI: 1.09–2.44, p=0.018) in the adjusted analysis (Table 1). Ejection fraction (EF) was not associated with the study outcomes in the adjusted analysis (p>0.05, Table 1) whereas global circumferential and radial strain showed an association limited to the tertiary endpoint (p=0.004, Table 1).
Conclusions
CMR-derived VAC is associated with adverse outcomes in SRV patients and may improve risk stratification of this unique population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pasqualin
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A Misra
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - K Gauvreau
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - A S Desai
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A Prakash
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - S Sanders
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
| | - M M Givertz
- Brigham and Women'S Hospital, Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine , Boston , United States of America
| | - A M Valente
- Boston Children's Hospital, Department of Cardiology , Boston , United States of America
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Misra P, Jha S, Misra A, Kant S. Reporting of randomized controlled trials as per CONSORT guidelines. J Family Med Prim Care 2022; 11:6598. [PMID: 36618162 PMCID: PMC9810895 DOI: 10.4103/jfmpc.jfmpc_799_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Puneet Misra
- Centre for Community Medicine, AIIMS, New Delhi, India,Address for correspondence: Dr. Puneet Misra, Room No. 28, Centre for Community Medicine, Old OT Block, AIIMS, New Delhi - 110 029, India. E-mail:
| | - Shreya Jha
- Centre for Community Medicine, AIIMS, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, AIIMS, New Delhi, India
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Singh AK, Singh A, Singh R, Misra A. Finerenone in diabetic kidney disease: A systematic review and critical appraisal. Diabetes Metab Syndr 2022; 16:102638. [PMID: 36223666 DOI: 10.1016/j.dsx.2022.102638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Finerenone is a novel non-steroidal mineralocorticoid antagonist (MRA) recently approved for the treatment of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). We aim to conduct a systematic review of finerenone to know the efficacy and safety of finerenone in CKD with or without T2D. METHODS A systematic search in the electronic database of PubMed and Google Scholar was made from inception until September 09, 2022, using several MeSH keywords related to finerenone. Ongoing trials were additionally searched from ClinicalTrials.Gov. RESULTS Five phase 2 and three phase 3, randomized, double-blind, placebo- or active-controlled studies of finerenone have been published to date and several other randomized and real-world studies of finerenone are currently undergoing. CONCLUSIONS In short-term studies in patients with CKD and reduced ejection heart failure, with or without T2D, finerenone 20 mg appears to have a better renal outcome compared with spironolactone and a better mortality outcome compared with eplerenone, with significantly lesser hyperkalemia compared to both spironolactone and finerenone. In long-term studies in patients with CKD and T2D, finerenone 10/20 mg significantly reduces the progression of renal disease and reduced CV endpoints (especially heart failure hospitalization) compared to placebo. Finerenone has no effect on HbA1c, body weight, and sexual side effects including gynecomastia, and has only a modest effect on blood pressure. However, hyperkalemia leading to drug withdrawal was significantly higher with finerenone compared to placebo. Safety data in real-world settings is a pressing priority.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Singh AK, Singh A, Singh R, Misra A. Once-weekly basal insulin icodec: Looking ONWARDS from pharmacology to clinical trials. Diabetes Metab Syndr 2022; 16:102615. [PMID: 36108418 DOI: 10.1016/j.dsx.2022.102615] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Insulin icodec is currently the most advanced candidate insulin suitable for once-weekly administration. We aim to conduct a systematic review of the literature to find out the efficacy and safety of insulin icodec in patients with diabetes mellitus. METHODS We systematically searched the electronic database of PubMed, and Google Scholar from inception until August 20, 2022, using MeSH keywords. Ongoing trials of insulin icodec were additionally searched from the ClinicalTrials.Gov. We retrieved all the available granular details of phase 1 to phase 3 studies of insulin icodec in both type 1 and type 2 diabetes. RESULTS Phase 1 study showed insulin icodec having a half-life of 196 h (>1 week) while a steady state is achieved after 3 to 4 weekly injections. Phase 2 studies compared once-weekly icodec to insulin glargine (U-100) and found a similar glucose control with no significantly greater hypoglycemia risks. Top-line results from the five phase 3 studies reported better glucose control with once-weekly icodec compared to both once-daily insulin glargine (ONWARDS 1) and once-daily degludec (in both ONWARDS 2 and 4) with similar rates of hypoglycemia in type 2 diabetes, although there was a higher hypoglycemic event with insulin icodec in type 1 diabetes (ONWARDS 6) compared to once-daily degludec despite a similar glycemic control. CONCLUSION A brighter prospect of once-weekly insulin icodec is on the card in particular in type 2 diabetes in terms of reducing injection pricks by >85% vs. once-daily basal insulin analogs, although few unknowns still exist.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Gargari P, Mukhopadhyay P, Saboo B, Misra A, Ghosh S. Fabkin and glucose homeostasis. Diabetes Metab Syndr 2022; 16:102565. [PMID: 35850074 DOI: 10.1016/j.dsx.2022.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS The pathophysiology of different types of diabetes is incompletely understood. Fatty acid binding protein 4 (FABP4), an intracellular lipid chaperone, is secreted from adipocytes (during lipolysis) and macrophage. FABP4 is known to be associated with insulin resistance. However its precise role in the pathogenesis of T2DM is unclear. Fabkin, the hormonal complex of FABP4 with ADK (Adenosine Kinase) and NDPK (Nucleoside Diphosphate Kinase) is suggested to fill this gap in understanding pathogenesis. Herein, we summarize the role Fabkin in glucose homeostasis. METHODS Published relevant manuscripts that discussed the effect of FABP4 and Fabkin on glucose homeostasis were reviewed. RESULTS The formation of Fabkin complex is driven by the strong affinities of FABP4 to ADK and to inherent high-affinity interaction of ADK with NDPK. It does not have any definite receptors. The complex acts through the following pathways: i) by modulation of Glucose-Stimulated Insulin Signalling (GSIS) through extracellular ADP/ATP interaction via G-protein-coupled purinergic P2Y1 receptors in pancreatic β-cells which are potently agonized by ADP and antagonized by ATP. Fabkin drives ADK to produce ATP, coupled with reduced generation of ADP. This results in low extracellular ADP/ATP ratio which leads to impairment of insulin secretion, ii) by regulating intracellular calcium dynamics iii) by producing Endoplasmic Reticulum (ER) stress. CONCLUSIONS Fabkin may integrate energy balance with functions of metabolic organs and thus play a major role in glucose homeostasis.
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Affiliation(s)
- Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
| | - Banshi Saboo
- Chief Diabetologist & Chairman of Diabetes Care & Hormone Clinic at Ahmedabad, India.
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India.
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
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Kuchay MS, Misra A. Sodium-glucose cotransporter-2 inhibitors as first-line pharmacological therapy for type 2 diabetes? Diabetes Metab Syndr 2022; 16:102580. [PMID: 35921765 DOI: 10.1016/j.dsx.2022.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta the Medicity Hospital, Gurugram, 122001, Haryana, India.
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (NDOC), and Diabetes Foundation, India
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Vaishya R, Misra A. International rankings of Diabetes and Metabolic diseases related journals in comparison to other medical journals from India. Diabetes Metab Syndr 2022; 16:102559. [PMID: 35820260 DOI: 10.1016/j.dsx.2022.102559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Scientific publications from India and Asiatic countries are on rising in the last decade. We have attempted to analyze the growth (over the last 3 years) of various important journals being published from India in various medical fields, especially in the specialty of Endocrinology, Diabetes, and Metabolism. METHODS We used the database of SCOPUS, SCIMAGO, and Academic Accelerator to derive the required statistical information from various Indian journals, till 9th June 2022. RESULTS There are only a very few medical journals from India in Quartile 1(first 25% of all journals), namely Diabetes and Metabolic Syndrome: Clinical Research and Reviews (DMSCRR), Hepatology International, and the Indian Journal of Medical Research (IJMR). DMSCRR stands at #1 in Diabetes and Metabolic disease-related journals among all the medical journals from India. All metrics of DMSCRR have majorly increased over the last three years; its CiteScore has almost quadrupled, the h-index is doubled, and the number of citations received has quadrupled. The DMSCRR is now ranked globally at #23/227 (90th percentile) amongst all Endocrinology, Diabetes, and Metabolic journals. In the recently announced metrics by SCOPUS in June 2022, the DMSCRR has ranked as the #1 journal in Asiatic countries. CONCLUSION Some Indian journals have increased their rankings in 2021 and among them, the Diabetes Metabolic Syndrome: Clinical Research & Reviews has now become the highest-ranked medical journal in India, not only in the field of Endocrinology, Diabetes, and Metabolism but also in all the medical specialties.
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Affiliation(s)
- Raju Vaishya
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India.
| | - Anoop Misra
- Fortis C-Doc Hospital, Nehru Place, New Delhi1Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Diabetes Foundation (India), New Delhi, India.
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Bhatt SP, Misra A, Pandey RM, Upadhyay AD. Shortening of leucocyte telomere length is independently correlated with high body mass index and subcutaneous obesity (predominantly truncal), in Asian Indian women with abnormal fasting glycemia. BMJ Open Diabetes Res Care 2022; 10:10/4/e002706. [PMID: 35835478 PMCID: PMC9289012 DOI: 10.1136/bmjdrc-2021-002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Leucocyte telomere length (LTL) is linked to accelerate aging and premature mortality. In this research, we aimed to explore the relations between biochemical and anthropometry markers and LTL in Asian Indian women with abnormal fasting glycemia (impaired fasting glucose). RESEARCH DESIGN AND METHODS In this study, 797 pre-diabetic women (obese, 492; non-obese, 305) were recruited. Demographic and clinical profiles, anthropometry, and fasting blood glucose were evaluated. LTL was quantified by a quantitative PCR. LTL was expressed as the relative telomere length or telomere repeat:single copy gene (T:S) ratio. The subjects were separated into quartiles according to the LTL. RESULTS The average LTL was significantly decreased with increasing age. The average LTL was significantly shorter in obese women with abnormal fasting glycemia (p<0.05). R-squared (R2) statistic for multivariable linear model after adjusted for age, family income, education and hypertension showed that LTL was inversely correlated with body mass index (BMI), waist and hip circumference, waist-hip and waist-to-height ratio, truncal skinfolds (subscapular, and subscapular/triceps ratio, central and total skinfolds), fat mass (kg) and % body fat. The relationship between obesity measures and LTL (using the LTL quartile 1 as reference) identified central skinfolds (R2=0.92, p<0.0001), Σ4SF (R2=0.90, p<0.0001), BMI (R2=0.93, p<0.0001) and % body fat (R2=0.91, p<0.0001) as independent predictors of LTL. CONCLUSIONS Besides age, obesity and subcutaneous adiposity (predominantly truncal) are major contributors to telomere shortening in Asian Indian women with abnormal fasting glycemia (impaired fasting glucose).
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Affiliation(s)
- Surya Prakash Bhatt
- Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, Delhi, India
- Metabolic Research Unit, Diabetes Foundation (India), Safdarjung Development Area (SDA), New Delhi, Delhi, India
- Metabolic Research Unit, National Diabetes Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, Delhi, India
| | - Anoop Misra
- Metabolic Research Unit, Diabetes Foundation (India), Safdarjung Development Area (SDA), New Delhi, Delhi, India
- Metabolic Research Unit, National Diabetes Obesity and Cholesterol Foundation (N-DOC), SDA, New Delhi, Delhi, India
- Diabetes and Metabolic Unit, Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Nassar M, Nso N, Emmanuel K, Alshamam M, Munira MS, Misra A. Coronary Artery Calcium Score directed risk stratification of patients with Type-2 diabetes mellitus. Diabetes Metab Syndr 2022; 16:102503. [PMID: 35653928 DOI: 10.1016/j.dsx.2022.102503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS This study aimed to review the available data on the role of coronary artery calcium (CAC) scoring as the preferred adjunct modality to improve risk prediction and reduce the incidence of major adverse cardiac events and mortality in T2DM patients. METHODS We reviewed the findings of 21 studies. RESULTS This study revealed that the CAC scoring system could enhance cardiovascular disease (CVD) risk stratification and positively affect the medical management of patients with T2DM. CONCLUSION A CAC scoring approach is necessary to reduce the incidence and prevalence of preventable CVD events in patients with type 2 diabetes.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Kelechi Emmanuel
- Department of Medicine, University of Pittsburgh Medical Center Pinnacle, PA, USA.
| | - Mohsen Alshamam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Most Sirajum Munira
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), India.
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Ghosh A, Dutta K, Bhatt SP, Gupta R, Tyagi K, Ansari IA, Venugopal VK, Mahajan H, Pandey RM, Pandey S, Misra A. Dapagliflozin Improves Body Fat Patterning, and Hepatic and Pancreatic Fat in Patients With Type 2 Diabetes in North India. J Clin Endocrinol Metab 2022; 107:e2267-e2275. [PMID: 35263436 DOI: 10.1210/clinem/dgac138] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT Excess hepatic and pancreatic fat may contribute to hyperglycemia. OBJECTIVE The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). METHODS This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. RESULTS After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-β, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P < .0001) and mean pancreatic FF (from 7.5% to 5.99%, P < .0083). Reduction in liver fat was statistically significant after adjustment for change in body weight. CONCLUSION Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.
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Affiliation(s)
- Amerta Ghosh
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
| | - Koel Dutta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Surya Prakash Bhatt
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
| | - Ritesh Gupta
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Kanika Tyagi
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Irshad Ahmad Ansari
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | | | | | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Diabetes Foundation (India), New Delhi, India
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Chadha M, Das AK, Deb P, Gangopadhyay KK, Joshi S, Kesavadev J, Kovil R, Kumar S, Misra A, Mohan V. Expert Opinion: Optimum Clinical Approach to Combination-Use of SGLT2i + DPP4i in the Indian Diabetes Setting. Diabetes Ther 2022; 13:1097-1114. [PMID: 35334083 PMCID: PMC8948458 DOI: 10.1007/s13300-022-01219-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/01/2022] [Indexed: 12/20/2022] Open
Abstract
The Asian-Indian phenotype of type 2 diabetes mellitus is uniquely characterized for cardio-metabolic risk. In the context of implementing patient-centric holistic cardio-metabolic risk management as a priority, the choice of various combinations of antidiabetic agents should be individualized. Combined therapy with two classes of antidiabetic agents, namely, dipeptidyl peptidase 4 inhibitors and sodium-glucose co-transporter-2 inhibitors, target several pathophysiological pathways. The wide-ranging clinical outcomes associated with this combination, including improvement of glycemia and adiposity, reduction of metabolic and vascular risk, safety, and simplicity for sustainable compliance, are extremely relevant to the Asian Indian patient population living with T2DM. In this review we describe the available evidence in detail and present a rational practical guidance for the optimum clinical use of this combination in this patient population.
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Affiliation(s)
- Manoj Chadha
- Endocrinology, P.D. Hinduja Hospital, Mumbai, India
| | - Ashok Kumar Das
- Endocrinology, Pondicherry Institute of Medical Science, Puducherry, India
| | - Prasun Deb
- Endocrinology, Krishna Institute of Medical Sciences, Hyderabad, India
| | | | - Shashank Joshi
- Endocrinology, Joshi Clinic and Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Rajiv Kovil
- Department of Diabetology, Dr Kovil’s Diabetes Care Centre, Mumbai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), New Delhi, India
| | - Viswanathan Mohan
- Dr Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
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Saboo B, Misra A, Kalra S, Mohan V, Aravind SR, Joshi S, Chowdhury S, Sahay R, Kesavadev J, John M, Kapoor N, Das S, Krishnan D, Salis S. Role and importance of high fiber in diabetes management in India. Diabetes Metab Syndr 2022; 16:102480. [PMID: 35594690 DOI: 10.1016/j.dsx.2022.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS India is facing a triple burden of pre-diabetes, diabetes, and obesity. Unhealthy eating habits and physical inactivity have been linked to the onset and progression of type 2 diabetes mellitus (T2DM). Despite dietary recommendations, individuals consume inadequate amounts or unsuitable type of dietary fiber (DF) which needs correction. An Expert group attempted to review and report on the role and importance of high DF in the management of T2DM and offer practical guidance on high fiber use in daily diet. METHODOLOGY Twelve diabetologists and two expert dietitians from India were chosen to ensure diversity of the members both in professional interest and cultural background. The authors convened virtually for one group meeting and actively participated in a detailed discussion. Multiple reviews of the draft document followed by focused teleconference calls & email helped to reach consensus on final recommendations between Aug 2021 and Dec 2021. RESULTS Evidence has shown that medical nutrition therapy (MNT) is a valuable approach and an essential component of T2DM prevention and management. Studies have shown that fiber rich diabetes nutrition (FDN) has multi-systemic health benefits, including, improvement in glycemic control, reduction in glucose spikes, decrease in hyperinsulinemia, improvement in plasma lipid concentrations and weight management in T2DM patients. CONCLUSION A high fiber diet is vital for people with diabetes and associated conditions. Increasing fiber intake, preferably through food or through dietary supplement, may help. Fiber rich diabetes nutrition (FDN) is recommended in order to prevent and manage T2DM.
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Affiliation(s)
- Banshi Saboo
- DiaCare - A Complete Diabetes Care Centre, Ahmedabad, Gujarat, India.
| | - Anoop Misra
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, And Endocrinology, New Delhi, India
| | | | - V Mohan
- Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - S R Aravind
- Diacon Hospital, Bengaluru, Karnataka, India
| | - Shashank Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital & Research Centre, Maharashtra, Mumbai, India
| | - Subhankar Chowdhury
- Dept. of Endocrinology, IPGME & R and SSKM Hospital, Kolkata, West Bengal, India
| | - Rakesh Sahay
- Department of Endocrinology, Aster Prime Hospital, Hyderabad, Telangana, India
| | | | - Mathew John
- Providence Endocrine and Diabetes Specialty Centre, Trivandrum, Kerala, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes & Metabolism, CMC, Vellore, Tamil Nādu, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Orissa, India
| | - Dharini Krishnan
- DV Living Science Enterprise Pvt Ltd, Mylapore, Chennai, Tamil Nadu, India
| | - Sheryl Salis
- Nurture Health Solutions, Mumbai, Maharashtra, India
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Gupta R, Misra A. Hyperlipidemia management in diabetes: First line or supportive therapy? Diabetes Metab Syndr 2022; 16:102470. [PMID: 35378385 DOI: 10.1016/j.dsx.2022.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Coronary heart disease (CHD) is the most important cause of morbidity and mortality in type 2 diabetes. Current therapeutic approach has changed from glucocentric to vasculoprotective. This brief review highlights importance of management of hyperlipidemia (raised LDL cholesterol and triglycerides) on CHD outcomes in diabetes. METHODS Literature seach was done till March 2022 (Pubmed, Google scholar) using following search words; lipids, cholesterol, statins, triglycerides, fibrates, omega-3 polyunsaturated fatty (Omega-3 PUFAs) acids, LDL, diabetes, coronary heart disease. RESULTS Meta-analyses of randomized controlled trials have reported that LDL cholesterol lowering using moderate to high intensity statins significantly reduces adverse CHD outcomes in diabetes. Evidence of triglyceride reduction using fenofibrate or omega-3 PUFAs is not very robust although a trial of a purified omega-3 PUFAs has shown significant benefit. CONCLUSION Lipid lowering with statins along with comprehensive lifestyle changes in addition to glucose control is recommended as first-line therapy to reduce CHD mortality and morbidity in diabetes.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India; Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India.
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), India; Diabetes Foundation of India (DFI), India
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Kumari A, Ranjan P, Vikram NK, Kaur D, Balsalkar G, Malhotra A, Puri M, Batra A, Madan J, Tyagi S, Guleria K, Dabral A, Sarkar S, Nigam A, Anwar W, Kamath S, Bhatla N, Kumari SS, Kumar R, Choranur A, Venkataraman S, Kaur T, Rathore AM, Kaloiya G, Prakash A, Tiwaskar M, Verma A, Singh R, Sharma KA, Baitha U, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative. Diabetes Metab Syndr 2022; 16:102425. [PMID: 35248972 DOI: 10.1016/j.dsx.2022.102425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings. METHODS The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations. RESULTS The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations. CONCLUSION The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.
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Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Divjyot Kaur
- Department of Home Science, University of Delhi, New Delhi, India
| | - Geetha Balsalkar
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Mumbai, India
| | - Anita Malhotra
- Food and Nutrition, Department of Home Science, Vice-principal, Lakshmibai College, University of Delhi, New Delhi, India
| | - Manju Puri
- Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | | | - Shakun Tyagi
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Anjali Dabral
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Wareesha Anwar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Kamath
- Seth G S Medical College and KEM Hospital, Mumbai, LT Municipal Medical College and General Hospital, Mumbai, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Shantha Kumari
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - Raman Kumar
- Academy of Family Physicians of India, India
| | - Ambuja Choranur
- President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Psychology, University of Delhi, New Delhi, India
| | - Asmita Muthal Rathore
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Gaurishankar Kaloiya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Archana Verma
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - Rakhi Singh
- Endocrinology Committee, The Federation of Obstetric and Gynaecological Societies of India, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tewary
- All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India
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Miller V, Reedy J, Cudhea F, Zhang J, Shi P, Erndt-Marino J, Coates J, Micha R, Webb P, Mozaffarian D, Abbott P, Abdollahi M, Abedi P, Abumweis S, Adair L, Al Nsour M, Al-Daghri N, Al-Hamad N, Al-Hooti S, Al-Zenki S, Alam I, Ali JH, Alissa E, Anderson S, Anzid K, Arambepola C, Arici M, Arsenault J, Asciak R, Barbieri HE, Barengo N, Barquera S, Bas M, Becker W, Beer-Borst S, Bergman P, Biró L, Boindala S, Bovet P, Bradshaw D, Bukhary NBI, Bundhamcharoen K, Caballero M, Calleja N, Cao X, Capanzana M, Carmikle J, Castetbon K, Castro M, Cerdena C, Chang HY, Charlton K, Chen Y, Chen MF, Chiplonkar S, Cho Y, Chuah KA, Costanzo S, Cowan M, Damasceno A, Dastgiri S, De Henauw S, DeRidder K, Ding E, Dommarco R, Don R, Duante C, Duleva V, Duran Aguero S, Ekbote V, El Ati J, El Hamdouchi A, El-kour T, Eldridge A, Elmadfa I, Esteghamati A, Etemad Z, Fadzil F, Farzadfar F, Fernandez A, Fernando D, Fisberg R, Forsyth S, Gamboa-Delgado E, Garriguet D, Gaspoz JM, Gauci D, Geleijnse M, Ginnela B, Grosso G, Guessous I, Gulliford M, Gunnarsdottir I, Hadden W, Hadziomeragic A, Haerpfer C, Hakeem R, Haque A, Hashemian M, Hemalatha R, Henjum S, Hinkov H, Hjdaud Z, Hoffman D, Hopping B, Houshiar-rad A, Hsieh YT, Hung SY, Huybrechts I, Hwalla NC, Ibrahim HM, Ikeda N, Illescas-Zarate D, Inoue M, Janakiram C, Jayawardena R, Jeewon R, Jitnarin N, Johansson L, Jonsdottir O, Jundishapur A, Kally O, Kandiah M, Karupaiah T, Keinan-Boker L, Kelishadi R, Khadilkar A, Kim CI, Koksal E, Konig J, Korkalo L, Koster J, Kovalskys I, Krishnan A, Kruger H, Kuriyan-Raj R, Kweon S, Lachat C, Lai Y, Lanerolle P, Laxmaiah A, Leclercq C, Lee MS, Lee HJ, Lemming EW, Li Y, Lindström J, Ling A, Liputo NIL, Lopez-Jaramillo P, Luke A, Lukito W, Lupotto E, Ma Y, Mahdy ZA, Malekzadeh R, Manan W, Marchioni D, Marques LL, Marques-Vidal P, Martin-Prevel, Y, Mathee A, Matsumura Y, Mazumdar P, Memon A, Mensink G, Meyer A, Mirmiran P, Mirzaei M, Misra P, Misra A, Mitchell C, Mohamed HJBJ, Mohammadi-Nasrabadi F, Mohammadifard N, Moy FM, Musaiger A, Mwaniki E, Myhre J, Nagalla B, Naska A, Ng SA, Ng SW, Ngoan LTN, Noshad S, Ochoa A, Ocke M, Odenkirk J, Oh K, Oleas M, Olivares S, Orfanos P, Ortiz-Ulloa J, Otero J, Ovaskainen ML, Pakseresht M, Palacios C, Palmer P, Pan WH, Panagiotakos D, Parajuli R, Park M, Pekcan G, Petrova S, Piaseu N, Pitsavos C, Polasa K, Posada L, Pourfarzi F, Preston AM, Rached I, Rahbar AR, Rehm C, Richter A, Riley L, Salanave B, Sánchez-Romero LM, Sarrafzadegan N, Sawada N, Sekiyama M, Selamat R, Shamsuddin K, Shariff ZM, Sharma S, Sibai AM, Sinkko H, Sioen I, Sisa I, Skeaff S, Steingrimsdottir L, Strand T, Suarez-Ortegon MF, Swaminathan S, Swan G, Sygnowska E, Szabo M, Szponar L, Tan-Khouw I, Tapanainen H, Tayyem R, Tedla B, Tedstone A, Templeton R, Termote C, Thanopoulou A, Thorgeirsdottir H, Thorsdottir I, Trichopoulos D, Trichopoulou A, Tsugane S, Turrini A, van Oosterhout C, Vartiainen E, Veerman JL, Virtanen S, Vollenweider P, Vossenaar M, Waidyatilaka I, Waskiewicz A, Waterham E, Wieler L, Wondwossen T, Wu S, Yaakub R, Yap M, Yusof S, Zaghloul S, Zajkás G, Zapata M, Zarina K, Zohoori FV. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database. The Lancet Planetary Health 2022; 6:e243-e256. [PMID: 35278390 PMCID: PMC8926870 DOI: 10.1016/s2542-5196(21)00352-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
Abstract
Background Methods Findings Interpretation Funding
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Ranjan P, Vikram NK, Choranur A, Pradeep Y, Ahuja M, Puri M, Malhotra A, Kumari A, Chopra S, Batra A, Balsalkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore AM, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative. Diabetes Metab Syndr 2022; 16:102426. [PMID: 35248973 DOI: 10.1016/j.dsx.2022.102426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. METHODS The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach. RESULTS -The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight. CONCLUSION These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.
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Affiliation(s)
- Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Ambuja Choranur
- President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India
| | - Yashodhara Pradeep
- Era Medical College and University, Ex Prof. and Head Department of Obstetrics and Gynaecology, RML Institute of Medical Sciences, KGMU, Lucknow, Vice President Elect, FOGSI, Ex Vice President, IMS, India
| | - Maninder Ahuja
- President, Society of Meaningful Life Management, Associate Editor, Journal of Midlife Health, India
| | - Manju Puri
- Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Anita Malhotra
- Food and Nutrition, Department of Home Science, Vice-principal, Lakshmibai College, University of Delhi, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians & Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Geetha Balsalkar
- Department of Obstetrics and Gynaecology Seth G. S. Medical College, Mumbai, India
| | - Deepti Goswami
- Director Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Verma
- Department of Home Science, University of Delhi, New Delhi, India
| | | | - Jagmeet Madan
- National President, Indian Dietetic Association, India
| | - Anjali Dabral
- Head, Department of Obstetrics and Gynaecology, VMMC and safdarjung Hospital, New Delhi, India
| | - Sandhya Kamath
- Ex-Professor of Medicine and Dean, Seth G S Medical College and KEM Hospital, Mumbai, and LT Municipal Medical College and General Hospital, Mumbai, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurishankar Kaloiya
- Clinical Psychology, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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Singh AK, Singh R, Misra A. Oral semaglutide in type 2 diabetes mellitus: Comprehensive review, critical appraisal and clinical consideration of its use in India. Diabetes Metab Syndr 2022; 16:102436. [PMID: 35245858 DOI: 10.1016/j.dsx.2022.102436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Oral semaglutide is the first glucagon-like petide-1 receptor agonist (GLP-1RA) approved for oral use in the treatment of type 2 diabetes mellitus (T2DM). We aim to conduct a comprehensive review of literature to find out the efficacy and safety of oral semaglutide in T2DM, to lay out a clinical consideration for its use in India. METHODS We searched the electronic database of PubMed and Google Scholar from inception until January 31, 2022, using several MeSH keywords and retrieved all available granular details of phase 1, 2 and 3 randomized controlled trials (RCTs) of oral semaglutide. Subsequently, we reviewed the results critically to lay down the clinical recommendation of its use. RESULTS Ten phase 3 randomized, placebo- and or active-controlled studies of oral semaglutide (PIONEER programs) are currently published. Seven global trials of oral semaglutide (PIONEER 1-5, 7 and 8) that exclusively studied the efficacy (lowering of HbA1c and body weight, achieving target of HbA1c <7% and other composites of HbA1c and weight) outcomes, found 14 mg oral semaglutide to be superior to placebo or active comparators (empagliflozin, sitagliptin and liraglutide). Efficacy was similar in Asians, although no separate data exists for Indians due to the low number of participants. Expectedly, gastrointestinal intolerance were the most commonly observed side effects with oral semaglutide and the main reason for drug discontinuation. CONCLUSION Oral semaglutide 14 mg is an effective agent in the treatment of T2DM. Real-world studies of semaglutide are clearly needed in India in absence of meaningful data from RCTs in Indians.
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Affiliation(s)
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Kuchay MS, Misra A. Role of diabetologists in the management of nonalcoholic fatty liver disease: Primary prevention and screening/management of fibrosis and cirrhosis. Diabetes Metab Syndr 2022; 16:102446. [PMID: 35259705 DOI: 10.1016/j.dsx.2022.102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Nonalcoholic fatty liver disease (NAFLD) is a common condition, especially among individuals with type 2 diabetes (T2D). Presence of T2D increases the risk of progression of simple steatosis to more severe liver conditions, such as nonalcoholic steatohepatitis (NASH) and fibrosis (NASH-fibrosis). Since majority of patients with T2D are managed by diabetologists (including physicians and endocrinologists), their roles in the management of coexisting NAFLD are not well defined, partly due to lack of unambiguous guidelines. METHODS A literature search was performed with Medline (PubMed), Scopus and Google Scholar electronic databases till January 2022, using relevant keywords (nonalcoholic fatty liver disease and diabetologist; screening of NASH; management of NASH) to extract relevant studies describing prevention and screening of NAFLD/NASH, especially in people with T2D. RESULTS Diabetologists have two main roles for the management of patients with T2D and coexisting NAFLD. The most important role is to prevent the development of NASH-fibrosis in patients with simple steatosis (primary prevention). This can be achieved by reinforcing the importance of lifestyle measures, and by early use of glucose-lowering agents with beneficial effects on the liver. The second important role of diabetologists is to screen all patients with T2D for liver fibrosis and compensated cirrhosis, and provide appropriate referral for timely management of complications (secondary prevention). CONCLUSION Diabetologists can play a central role in mitigating the epidemic of NAFLD in individuals with T2D. However, diabetologists need to be aware about their roles in NASH-fibrosis prevention and screening. Furthermore, longitudinal studies should explore the role of newer glucose-lowering drugs in the primary prevention of NASH-fibrosis in individuals with coexisting T2D and simple steatosis.
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Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram, 122001, Haryana, India.
| | - Anoop Misra
- Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (NDOC) and Diabetes Foundation, India.
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Singh AK, Singh A, Singh R, Misra A. An updated practical guideline on use of molnupiravir and comparison with agents having emergency use authorization for treatment of COVID-19. Diabetes Metab Syndr 2022; 16:102396. [PMID: 35051686 PMCID: PMC8755553 DOI: 10.1016/j.dsx.2022.102396] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Molnupiravir is a newer oral antiviral drug that has recently received emergency use authorization (EUA) in USA, UK and India. We aim to conduct an update on our previous systematic review to provide practical clinical guideline for using molnupiravir in patients with COVID-19. METHODS We systematically searched the electronic database of PubMed, MedRxiv and Google Scholar until January 5, 2022, using key MeSH keywords. RESULTS Final result of phase 3 study in 1433 non-hospitalized COVID-19 patients showed a significant reduction in composite risk of hospital admission or death (absolute risk difference, -3.0% [95% confidence interval {CI}, -5.9 to -0.1%]; 1-sided P = 0.02) although with a non-significant 31% relative risk reduction (RRR). RRR for death alone was 89% (95% CI, 14 to 99; P-value not reported). Number needed to treat to prevent 1 death or 1 hospitalization or death composite appears to be closely competitive to other agents having EUA in people with COVID-19. However, cost-wise molnupiravir is comparatively cheaper compared to all other agents. CONCLUSION Molnupiravir could be a useful agent in non-pregnant unvaccinated adults with COVID-19 who are at increased risk of severity including hospitalization. However, it is effective only when used within 5-days of onset of symptoms. A 5-days course seems to be safe without any obvious short-term side effects.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Sabharwal M, Misra A, Ghosh A, Chopra G. Efficacy of Digitally Supported and Real-Time Self-Monitoring of Blood Glucose-Driven Counseling in Patients with Type 2 Diabetes Mellitus: A Real-World, Retrospective Study in North India. Diabetes Metab Syndr Obes 2022; 15:23-33. [PMID: 35023937 PMCID: PMC8743499 DOI: 10.2147/dmso.s345785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Poor glycemic control is prevalent in patients with type 2 diabetes mellitus (T2DM) in India. This study aims to understand the effectiveness of a smartphone-connected glucometer, real-time feedback, and contextualized counseling on glycemic control and hypoglycemic episodes in T2DM patients. METHODS This retrospective, multicenter study reviewed the medical records of T2DM patients belonging to several cities of north India, who were digitally engaged with a smartphone-connected glucometer and who had received at least one counseling session between September 2019 and July 2020. Intervention included self-monitoring of blood glucose (SMBG) using a smartphone-connected glucometer enabled with real-time transmission of information to certified diabetes educators (CDE) and their corresponding counseling based on SMBG findings. RESULTS Of 7111 adult T2DM patients included in this study, majority (75%) of the patients received a single session of counseling, and the remaining patients received 2 (16.7%), 3 (5%), 4 (2%), or ≥5 (1.3%) sessions. The mean age of the patients was 51.6 years, and the majority (77.9%) were males. Digital monitoring of BG and counseling with CDE significantly reduced the mean fasting (by 9.6%), pre-prandial (by 9.9%), and post-prandial (by 9.2%) BG values in 53%, 52%, and 54% of patients, respectively. The majority (81.4%) of patients showed no hypoglycemic episode (≤70 mg/dL) post-counseling. The hypoglycemia episodes observed with FBG, pre-prandial, and post-prandial BG values were reduced significantly by 58.5%, 48.1%, and 61.8%, respectively, post-counseling. CONCLUSION Digitally supported and real-time SMBG-driven counselling was effective in glycemic control and reduction of hypoglycemic episodes in T2DM patients in India. Moreover, reduction in hypoglycemia may be due to back end real-time support of CDE intervention.
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Affiliation(s)
- Mudit Sabharwal
- BeatO, Health Arx Technologies Pvt. Ltd., New Delhi, India
- Correspondence: Mudit Sabharwal Email
| | - Anoop Misra
- Fortis C-DOC Hospital, Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Amerta Ghosh
- Fortis C-DOC Hospital, Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Gautam Chopra
- BeatO, Health Arx Technologies Pvt. Ltd., New Delhi, India
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Kesavadev J, Misra A, Saboo B, Agarwal S, Sosale A, Joshi SR, Hussain A, Somasundaram N, Basit A, Choudhary P, Soegondo S. Time-in-range and frequency of continuous glucose monitoring: Recommendations for South Asia. Diabetes Metab Syndr 2022; 16:102345. [PMID: 34920199 DOI: 10.1016/j.dsx.2021.102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM The prevalence of diabetes is on its rise and South Asia bears a huge burden. Several factors such as heterogeneity in genetics, socio-economic factors, diet, and sedentary behavior contribute to the heightened risk of developing diabetes, its rapid progression, and the development of complications in this region. Even though there have been considerable advances in glucose monitoring technologies, diabetes treatments and therapeutics, glycemic control in South Asia remains suboptimal. The successful implementation of treatment interventions and metrics for the attainment of glycemic goals depends on appropriate guidelines that accord with the characteristics of the diabetes population. METHOD The data were collected from studies published for more than the last ten years in the electronic databases PubMed and Google Scholar on the various challenges in the assessment and achievement of recommended TIR targets in the SA population using the keywords: Blood glucose, TIR, TAR, TBR, HbA1c, hypoglycemia, CGM, Gestational diabetes mellitus (GDM), and diabetes. RESULTS The objective of this recommendation is to discuss the limitations in considering the IC-TIR Expert panel recommendations targets and to propose some modifications in the lower limit of TIR in older/high-risk population, upper limit of TAR, and flexibility in the percentage of time spent in TAR for pregnant women (GDM, T2DM) for the South Asian population. CONCLUSION The review sheds insights into some of the major concerns in implementing the IC-TIR recommendations in South Asian population where the prevalence of diabetes and its complications are significantly higher and modifications to the existing guidelines for use in routine clinical practice.
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Affiliation(s)
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) President, Diabetes Foundation, (DFI), India.
| | - Banshi Saboo
- Chairman and Chief Diabetologist, Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India.
| | - Sanjay Agarwal
- Diabetologist, Dr. Sanjay Agarwal's Aegle Clinic in Dhole Patil Road, Pune, India.
| | | | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital & Research Centre, Bandra (W), Mumbai, India.
| | - Akhtar Hussain
- Faculty of Health Sciences, Chronic Disease-Diabetes, NORD University, Stjørdal, Norway; Faculty of Medicine, Federal University of Ceara, Brazil.
| | - Noel Somasundaram
- Consultant Endocrinologist, National Hospital of Sri Lanka: Colombo, Western, LK, Sri Lanka.
| | - Abdul Basit
- Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Pakistan.
| | - Pratik Choudhary
- Senior Lecturer and Consultant in Diabetes, Department of Diabetes, King's College Hospital, London, UK.
| | - Sidartawan Soegondo
- Internist, Consultant Endocrinologist, Department of Internal Medicine, University of Indonesia, Indonesia.
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Vikram N, Ranjan P, Kumari A, Chopra S, Choranur A, Pradeep Y, Puri M, Malhotra A, Ahuja M, Meeta, Batra A, Balsarkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore A, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative. J Family Med Prim Care 2022; 11:7549-7601. [PMID: 36994026 PMCID: PMC10041015 DOI: 10.4103/jfmpc.jfmpc_51_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 01/31/2023] Open
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Vikram N, Ranjan P, Choranur A, Pradeep Y, Ahuja M, Meeta M, Puri M, Malhotra A, Kumari A, Chopra S, Batra A, Balsalkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore A, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based clinical practice guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative. J Midlife Health 2022; 13:34-49. [PMID: 35707299 PMCID: PMC9190956 DOI: 10.4103/jmh.jmh_7_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.
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