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Saboo B, Chandalia H, Ghosh S, Kesavadev J, Kochar IPS, Prasannakumar KM, Sarda A, Bantwal G, Mehrotra RN, Rai M. Insulin Glargine in Type 1 Diabetes Mellitus: A Review of Clinical Trials and Real-world Evidence Across Two Decades. Curr Diabetes Rev 2024; 20:e100323214554. [PMID: 36896906 PMCID: PMC10909813 DOI: 10.2174/1573399819666230310150905] [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: 08/16/2022] [Revised: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Over the past two decades, insulin glargine 100 U/mL (Gla-100) has emerged as the "standard of care" basal insulin for the management of type 1 diabetes mellitus (T1DM). Both formulations, insulin glargine 100 U/mL (Gla-100) and glargine 300 U/mL (Gla- 300) have been extensively studied against various comparator basal insulins across various clinical and real-world studies. In this comprehensive article, we reviewed the evidence on both insulin glargine formulations in T1DM across clinical trials and real-world studies. METHODS Evidence in T1DM for Gla-100 and Gla-300 since their approvals in 2000 and 2015, respectively, were reviewed. RESULTS Gla-100 when compared to the second-generation basal insulins, Gla-300 and IDeg-100, demonstrated a comparable risk of overall hypoglycemia, but the risk of nocturnal hypoglycemia was higher with Gla-100. Additional benefits of Gla-300 over Gla-100 include a prolonged (>24- hours) duration of action, a more stable glucose-lowering profile, improved treatment satisfaction, and greater flexibility in the dose administration timing. CONCLUSION Both glargine formulations are largely comparable to other basal insulins in terms of glucose-lowering properties in T1DM. Further, risk of hypoglycemia is lower with Gla-100 than Neutral Protamine Hagedorn but comparable to insulin detemir.
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Affiliation(s)
- Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Hemraj Chandalia
- Diabetes Endocrine Nutrition Management and Research Centre (DENMARC), Mumbai, Maharashtra, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R, Kolkata, West Bengal, India
| | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes and Research Centre, Trivandrum, Kerala, India
| | - IPS Kochar
- Department of Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
| | - KM Prasannakumar
- Centre for Diabetes and Endocrine Care, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Archana Sarda
- Sarda Centre for Diabetes and Self-care, Aurangabad, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John’s Medical College & Hospital, Bangalore, Karnataka, India
| | - RN Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India
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Chobot A, Lanzinger S, Alkandari H, Todd Alonso G, Blauensteiner N, Coles N, De Sanctis L, Mul D, Saboo B, Smart C, Tsai MC, Zabeen B, Dovc K. Diabetes care practices and outcomes in 40.000 children and adolescents with type 1 diabetes from the SWEET registry during the COVID-19 pandemic. Diabetes Res Clin Pract 2023:110809. [PMID: 37385473 PMCID: PMC10293122 DOI: 10.1016/j.diabres.2023.110809] [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: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
AIMS This study aimed to provide a global insight into initiatives in type 1 diabetes care driven by the COVID-19 pandemic and associations with glycemic outcomes. METHODS An online questionnaire regarding diabetes care before and during the pandemic was sent to all centers (n=97, 66,985 youth with type 1 diabetes) active in the SWEET registry. Eighty-two responded, and 70 (42,798 youth with type 1 diabetes) had available data (from individuals with type 1 diabetes duration >3 months, aged ≤21 years) for all 4 years from 2018 to 2021. Statistical models were adjusted, among others, for technology use. RESULTS Sixty-five centers provided telemedicine during COVID-19. Among those centers naive to telemedicine before the pandemic (n=22), four continued only face-to-face visits. Centers that transitioned partially to telemedicine (n=32) showed a steady increase in HbA1c between 2018 and 2021 (p<0.001). Those that transitioned mainly to telemedicine (n=33%) improved HbA1c in 2021 compared to 2018 (p<0.001). CONCLUSIONS Changes to models of care delivery driven by the pandemic showed significant associations with HbA1c shortly after the pandemic outbreak and 2 years of follow-up. The association appeared independent of the concomitant increase in technology use among youth with type 1 diabetes.
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Affiliation(s)
- Agata Chobot
- Institute of Medical Sciences, University of Opole, Department of Pediatrics, Opole, Poland; University Clinical Hospital in Opole, Department of Pediatrics, Opole, Poland.
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Hessa Alkandari
- Dasman Diabetes Institute, Department of Populational Health, Kuwait
| | - G Todd Alonso
- University of Colorado, Anschutz Medical Campus, Barbara Davis Center, Aurora, CO, USA
| | - Nicole Blauensteiner
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Nicole Coles
- Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Luisa De Sanctis
- Regina Margherita Children Hospital, Torino - Department of Public Health and Pediatric Sciences, University of Torino, Italy
| | - Dick Mul
- Diabeter, centre for pediatric and adult diabetes care and research, Rotterdam, The Netherlands
| | - Banshi Saboo
- Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital and School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bedowra Zabeen
- BADAS Paediatric Diabetes Care and Research Center, BIRDEM Hospital, Dhaka, Bangladesh
| | - Klemen Dovc
- University Medical Center Ljubljana, University Children's Hospital, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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B J, Kesavadev J, Shrivastava A, Saboo B, Makkar BM. Evolving Scope of Clinical Empathy in the Current Era of Medical Practice. Cureus 2023; 15:e40041. [PMID: 37425530 PMCID: PMC10324523 DOI: 10.7759/cureus.40041] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Clinical empathy is one of the most essential tools of medical practice, and it is an act of correctly acknowledging the emotional state of another without experiencing that state oneself. Empathy comprises four components. Mounting evidence exists to support the use of clinical empathy as a tactic for effective health care. Resolving the multi-fold barriers of clinical empathy is important. Clinical empathy is very important in the current era, and a trust-based relationship in patient care is a way to optimal clinical outcomes that can be achieved through better communication and treatment-compliance plans between health care professionals and patients.
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Affiliation(s)
- Jayakrishnan B
- Department of Medicine, Educare Institute of Dental Sciences, Malappuram, IND
| | - Jothydev Kesavadev
- Department of Diabetes and Endocrinology, Jothydev's Diabetes and Research Center, Trivandrum, IND
| | | | - Banshi Saboo
- Department of Endocrinology, Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, IND
| | - Brij Mohan Makkar
- Department of Endocrinology, Dr. Makkar's Diabetes & Obesity Centre, New Delhi, IND
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Saboo B, Unnikrishnan R, Kesavadev J, Tiwaskar M, Czupryniak L, Chawla M, Choudhary P, Battelino T, Agarwal S, Danne T, Mohan V. Intermittent Use of Continuous Glucose Monitoring: A New Paradigm in Treatment of Type 2 Diabetes. J Assoc Physicians India 2023; 71:11-12. [PMID: 37355844 DOI: : 10.5005/japi-11001-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
OBJECTIVES To suggest how continuous glucose monitoring (CGM) may be used intermittently in individuals with type 2 diabetes (T2D). MATERIALS AND METHODS The use of CGM is largely in those with type 1 diabetes (T1D), in whom it makes sense to use CGM continuously as CGM provides a valuable tool to not only adjust their insulin doses but also to match it with their diet, physical activity, and other lifestyle modifications. In the case of T2D, however, especially for those not on insulin, the use of CGM may not be needed on a continuous basis. The use of CGM on an intermittent basis is rarely discussed in the literature. This article tries to provide clinical situations where CGM can be used intermittently. RESULTS Intermittent use of CGM defined as the "use of CGM once in 2 or 3 months or a fixed frequency," and may be useful in several situations in those with T2D. We suggest the following indications for the intermittent use of CGM in T2D-newly diagnosed patients where treatment is being started, uncontrolled diabetes where treatment is being altered, starting intensive lifestyle modification, during infections, during preoperative control, in children and adolescents with T2D, as a motivational tool to improve behavioral modification, after metabolic surgery, and in patients on steroids, apart from other indications. CONCLUSION Intermittent use of CGM in T2D can be useful in special situations and can also be cost saving particularly in resource-constrained regions of the world.
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Affiliation(s)
- Banshi Saboo
- Chief Diabetologist & Chairman, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat
| | - Ranjit Unnikrishnan
- Vice Chairman & Consultant Diabetologist; Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, Tamil Nadu
| | - Jothydev Kesavadev
- Chairman and Managing Director, Jothydev's Diabetes Research Center, Trivandrum, Kerala
| | - Mangesh Tiwaskar
- Consultant Physician & Diabetologist, Karuna Hospital, Mumbai, Maharashtra, India
| | - Leszek Czupryniak
- Head, Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Manoj Chawla
- Director and Consultant Diabetologist, Department of Diabetology, Lina Diabetes Centre, Mumbai, Maharashtra, India
| | - Pratik Choudhary
- Professor of Diabetes, Leicester Diabetes Centre, Leicester University, Leicester, East Midlands, England
| | - Tadej Battelino
- UCHDepartment of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center, Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Thomas Danne
- Director, Department of General Paediatrics, Endocrinology/Diabetology & Clinical Research, Diabetes Center Auf der Bult, Hannover Medical School, Hannover, Germany
| | - Viswanathan Mohan
- Chairman & Chief of Diabetology, Department of Diabetology, Dr Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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5
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Trivedi GY, Kathirvel S, Sharma K, Saboo B. Effect of Various Lengths of Respiration on Heart Rate Variability during Simple Bhramari (Humming). Int J Yoga 2023; 16:123-131. [PMID: 38204770 PMCID: PMC10775838 DOI: 10.4103/ijoy.ijoy_113_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 01/12/2024] Open
Abstract
Background Heart rate varies during breathing and the heart rate variability (HRV) facilitates the autonomic homeostatic capacity. The maximum HRV was observed at around 10 s of prolonged respiration as per HRV biofeedback literature. However, there is a gap in understanding the variations in HRV by different respiration lengths during simple Bhramari practice. Objective To assess the effect of various respiration lengths (8, 10, 12, and 14 s) on HRV during the simple Bhramari (humming) practice. Methodology A total of 118 individuals (67 males, 51 females) signed up for the study based on convenience sampling at a wellness center. A randomized (simple permutation) within-subject crossover design with repeated measures was used to measure their HRV during the simple Bhramari practice. The results were analyzed with one-way ANOVA and paired samples t-test. Results The results indicate that, unlike the 10 s of respiration during HRV biofeedback breathing, maximum HRV during humming happens between 12 and 14 s of long breathing. Conclusions The unique findings of the study demonstrate the maximization of HRV between the respiration lengths of 12 and 14 s. Future work should explore expanding the research to a broader group of participants, including individuals with chronic conditions and other demographic variables and mantra chanting.
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Affiliation(s)
- Gunjan Y. Trivedi
- Co-founder, Society for Energy and Emotions, Wellness Space, Ahmedabad, Gujarat, India
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Sharma
- Chief of Interventional Cardiology, SAL Hospital, Ahmedabad, Gujarat, India
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Das AK, Saboo B, Chawla R, Aravind SR, Rajput R, Singh AK, Mukherjee JJ, Jhingan A, Shah P, Deshmukh V, Kale S, Jaggi S, Sridhar GR, Dhediya R, Gaurav K. Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach. Int J Diabetes Dev Ctries 2023:1-19. [PMID: 37360324 PMCID: PMC10113130 DOI: 10.1007/s13410-023-01192-6] [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: 11/12/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023] Open
Abstract
Sulfonylureas (SU) continue to be a vital therapeutic category of oral hypoglycemic agents (OHAs) for the management of type 2 diabetes mellitus (T2DM). Physicians consider modern SU (gliclazide and glimepiride) as "safe and smart" choices for T2DM management. The presence of multiple international guidelines and scarcity of a national guideline may contribute to the challenges faced by few physicians in choosing the right therapeutic strategy. The role of SU in diabetes management is explicit, and the present consensus aims to emphasize the benefits and reposition SU in India. This pragmatic, practical approach aims to define expert recommendations for the physicians to improve caregivers' knowledge of the management of T2DM, leading to superior patient outcomes.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Banshi Saboo
- Department of Diabetology, DIA-CARE, Ahmedabad, India
| | | | - S. R. Aravind
- Department of Medicine, Diacon Hospital, Bengaluru, India
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana India
| | | | - J. J. Mukherjee
- Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, India
| | - Ashok Jhingan
- Department of Diabetology, Delhi Diabetes Education and Research Foundation, New Delhi, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Shailaja Kale
- Dr Shailaja Kale’s Diabetes & Speciality Clinic, Pune, India
| | | | | | - Rajnish Dhediya
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
| | - Kumar Gaurav
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
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7
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Trivedi G, Sharma K, Saboo B, Kathirvel S, Konat A, Zapadia V, Prajapati PJ, Benani U, Patel K, Shah S. Humming (Simple Bhramari Pranayama) as a Stress Buster: A Holter-Based Study to Analyze Heart Rate Variability (HRV) Parameters During Bhramari, Physical Activity, Emotional Stress, and Sleep. Cureus 2023; 15:e37527. [PMID: 37193427 PMCID: PMC10182780 DOI: 10.7759/cureus.37527] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Objective In this study, our goal was to understand the comparative impact of humming, physical activity, emotional stress, and sleep on several heart rate variability (HRV) parameters, including the stress index (SI), and to assess the effectiveness of humming (simple Bhramari) as a stress buster based on the HRV parameters. Methods This pilot study assessed the long-term HRV parameters of 23 participants in terms of four activities: humming (simple Bhramari), physical activity, emotional stress, and sleep. The single-channel Holter device measured the readings, and data was analyzed using Kubios HRV Premium software for time and frequency-domain HRV parameters, including the stress index. Regarding statistical analysis, single-factor ANOVA followed by paired t-test was used to compare the results of HRV parameters "during" the four activities to understand if humming generates the outcome to enhance the autonomic nervous system. Results Our findings revealed that humming generates the lowest stress index compared to all three other activities (physical activity, emotional stress, and sleep). Several additional HRV parameters also supported the positive impact on the autonomic nervous, equivalent to stress reduction. Conclusions Humming (simple Bhramari) can be an effective stress-buster based on the assessment of several HRV parameters during its practice and in comparison with other activities. A regular daily humming routine can help enhance the parasympathetic nervous system and slow down sympathetic activation.
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Affiliation(s)
- Gunjan Trivedi
- Society for Energy & Emotions, Wellness Space, Ahmedabad, IND
| | - Kamal Sharma
- Cardiology, Dr. Kamal Sharma Cardiology Clinic, Ahmedabad, IND
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, IND
| | - Soundappan Kathirvel
- Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, IND
| | | | | | - Urva Benani
- Smt. NHL Municipal Medical College, Internal Medicine, Ahmedabad, IND
| | - Kahan Patel
- Internal Medicine, B J Medical College, Ahmedabad, IND
| | - Suchi Shah
- Internal Medicine, AMC MET Medical College, Ahmedabad, IND
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8
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Kalra S, Unnikrishnan AG, Prasanna Kumar KM, Sahay R, Chandalia HB, Saboo B, Annamalai S, Kesavadev J, Shukla R, Wangnoo SK, Baruah MP, Jacob J, Arora S, Singla R, Sharma SK, Damodaran S, Bantwal G. Correction to: Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India. Diabetes Ther 2023; 14:787. [PMID: 36806989 PMCID: PMC10064363 DOI: 10.1007/s13300-023-01377-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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9
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Mohan V, Joshi S, Mithal A, Kesavadev J, Unnikrishnan AG, Saboo B, Kumar P, Chawla M, Bhograj A, Kovil R. Expert Consensus Recommendations on Time in Range for Monitoring Glucose Levels in People with Diabetes: An Indian Perspective. Diabetes Ther 2023; 14:237-249. [PMID: 36705888 PMCID: PMC9943834 DOI: 10.1007/s13300-022-01355-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/05/2022] [Indexed: 01/28/2023] Open
Abstract
Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR.
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Affiliation(s)
| | - Shashank Joshi
- Department of Endocrinology, Lilavati Hospital, Mumbai, India
| | | | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes Research Centres, Trivandrum, Kerala, India
| | - Ambika G Unnikrishnan
- Department of Endocrinology, Chellaram Hospital-Diabetes Care and Multispecialty, Bavdhan, Pune, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care Hormone Clinic, Ambawadi, Ahmedabad, India
| | - Prasanna Kumar
- Department of Endocrinology, Center for Diabetes and Endocrine Care, Kalyanangar, Bengaluru, India
| | - Manoj Chawla
- Department of Endocrinology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Abhijit Bhograj
- Department of Endocrinology, Manipal Hospital, Hebbal, Bengaluru, Karnataka, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care, Centre Andheri (West), Mumbai, India
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10
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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11
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Shrivastava A, Kesavadev J, Mohan V, Saboo B, Shrestha D, Maheshwari A, Makkar BM, Modi KD, Das AK. Clinical Evidence and Practice-Based Guidelines on the Utility of Basal Insulin Combined Oral Therapy (Metformin and Glimepiride) in the Current Era. Curr Diabetes Rev 2023; 19:e090123212444. [PMID: 36624650 PMCID: PMC10617787 DOI: 10.2174/1573399819666230109104300] [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: 04/10/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Basal insulin combined oral therapy consisting of insulin and oral anti-diabetic drugs (OADs) is recommended for type 2 diabetes uncontrolled on OADs. There is a lack of clear evidence and recommendations on the combined use of basal insulin analogues to more than one OADs (glimepiride plus metformin) in effective control of glycemic parameters and its safety in terms of reduced hypoglycemic events, weight gain and cardiovascular risk. In this context, a group of clinical experts discussed the utility of basal insulin combined oral therapy with metformin and glimepiride in the current era. METHODS The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists and diabetologists from India and Nepal. RESULTS The panel thoroughly reviewed existing literature on the subject and proposed clinical evidence and practice-based guidelines. CONCLUSION These current clinical practice guidelines highlight the efficacy and safety of basal insulin combination therapy with various available basal insulins including neutral protamine hagedorn, detemir, glargine and degludec in addition to metformin and glimepiride therapy.
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Affiliation(s)
| | - Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, India
| | - Viswanathan Mohan
- Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Dina Shrestha
- Norvic International Hospital and Medical College, and Hospital for Advanced Medicine and Surgery, Maharajganj, Kathmandu, Nepal
| | - Anuj Maheshwari
- Department of Medicine, American College of Physicians, BBD University, Lucknow, India
| | - Brij Mohan Makkar
- Dr. Makkar’s Diabetes & Obesity Centre, Paschim Vihar, New Delhi, India
| | | | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
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12
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Kesavadev J, Saboo B, Kovil R, Joshi S, Shankar A, Ashik A, Ashok AD, Basanth A, Krishnan G. Insulin degludec/insulin aspart safely improves HbA1c: A long-term real-world cohort study (IDEA). Diabetes Obes Metab 2023; 25:306-309. [PMID: 35986629 DOI: 10.1111/dom.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jothydev Kesavadev
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, India
| | - Banshi Saboo
- Department of Diabetology, Diacare- Diabetes & Hormone Clinic, Ahmedabad, India
| | - Rajiv Kovil
- Dr. Kovil's Diabetes Care Centre, Mumbai, India
| | | | - Arun Shankar
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, India
| | - Asha Ashik
- Department of Diabetes, Jothydev's Diabetes Research Centre, Kochi, India
| | - Ashwin David Ashok
- Departmentof Diabetes, Jothydev's Diabetes Research Centre, Attingal, India
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13
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Kalra S, Unnikrishnan AG, Prasanna Kumar KM, Sahay R, Chandalia HB, Saboo B, Annamalai S, Kesavadev J, Shukla R, Wangnoo SK, Baruah MP, Jacob J, Arora S, Singla R, Sharma SK, Damodaran S, Bantwal G. Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India. Diabetes Ther 2023; 14:29-45. [PMID: 36380217 PMCID: PMC9880128 DOI: 10.1007/s13300-022-01332-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.
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14
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Kalra S, Jacob J, Unnikrishnan AG, Bantwal G, Sahoo A, Sahay R, Jindal S, Agrawal MS, Kapoor N, Saboo B, Tiwaskar M, Kochhar K. Expert Opinion on the Diagnosis and Management of Male Hypogonadism in India. Int J Endocrinol 2023; 2023:4408697. [PMID: 36876281 PMCID: PMC9977550 DOI: 10.1155/2023/4408697] [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] [Received: 09/27/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/24/2023] Open
Abstract
Male hypogonadism (MH) is a clinical and biochemical syndrome caused by inadequate synthesis of testosterone. Untreated MH can result in long-term effects, including metabolic, musculoskeletal, mood-related, and reproductive dysfunction. Among Indian men above 40 years of age, the prevalence of MH is 20%-29%. Among men with type 2 diabetes mellitus, 20.7% are found to have hypogonadism. However, due to suboptimal patient-physician communication, MH remains heavily underdiagnosed. For patients with confirmed hypogonadism (either primary or secondary testicular failure), testosterone replacement therapy (TRT) is recommended. Although various formulations exist, optimal TRT remains a considerable challenge as patients often need individually tailored therapeutic strategies. Other challenges include the absence of standardized guidelines on MH for the Indian population, inadequate physician education on MH diagnosis and referral to endocrinologists, and a lack of patient awareness of the long-term effects of MH in relation to comorbidities. Five nationwide advisory board meetings were convened to garner expert opinions on diagnosis, investigations, and available treatment options for MH, as well as the need for a person-centered approach. Experts' opinions have been formulated into a consensus document with the aim of improving the screening, diagnosis, and therapy of men living with hypogonadism.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
| | - Jubbin Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana 141008, Punjab, India
| | | | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College, Bengaluru 560034, Karnataka, India
| | - Abhay Sahoo
- Department of Endocrinology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar 751003, Odisha, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad 500095, Telangana, India
| | - Sushil Jindal
- People's Medical College and Research Centre, Bhopal 462037, Madhya Pradesh, India
| | - Madhu Sudan Agrawal
- Department of Urology, Global Rainbow Hospita, l, Agra 282007, Uttar Pradesh, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Ida Scudder Road, Vellore 632004, Tamil Nadu, India
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Banshi Saboo
- Department of Medicine, Dia Care, Ahmedabad 380015, Gujarat, India
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Mumbai 400068, Maharashtra, India
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15
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Maheshwari A, Hasnani D, Bhattacharya M, Mukhyaprana Prabhu M, Saxena D, Khandelwal B, Nawal CL, Makkar BM, Ansari S, Chawla P, Agrawal P, Saxena A, Verma N, Saboo B, Chavda V, Singh UP, Arora V. Assessment of determining factors for severity of NeoCOVIDiabetes in India: A pan India multicentric retrospective study. Diabetes Metab Syndr 2023; 17:102692. [PMID: 36584552 PMCID: PMC9760612 DOI: 10.1016/j.dsx.2022.102692] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS There is a bidirectional relationship between COVID-19 and diabetes. The primary objective of this study was to estimate the prevalence of patients newly detected to have diabetes (NDD) who recovered from COVID-19 in India whilst comparing NDD with patients without diabetes (ND) and those who have known to have diabetes (KD) in terms of glycemic status pre- and post-COVID with disease severity. MATERIALS & METHODOLOGY There were 2212 participants enrolled from 15 sites, with 1630 active participants after the respective execution of selection criteria. Data collection was done using a specialized Case Record Form (CRF). Planned statistical analysis and descriptive statistics were concluded for significance between patient groups on various parameters. RESULT The differences in age between the study groups were statistically significant. The average blood glucose at COVID-19 onset was significantly higher in KD than in NDD. Significantly more proportion of NDD (83%) had been hospitalized for COVID management when compared to KD (45%) and ND (55%). The NDD group received higher doses of steroids than the other two groups. On average, patients in the NDD group who received at least one vaccination (one dose or two doses) had a higher High-Resolution Computed Tomography (HRCT) score. Patients who had not been vaccinated in ND and KD groups experienced a higher HRCT score. CONCLUSION Prospective metabolism studies in post-acute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.
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Affiliation(s)
- Anuj Maheshwari
- Hind Institute of Medical Sciences, Barabanki, Sri Hari Kamal Diabetes Heart Clinic, Lucknow, Uttar Pradesh, India.
| | - Dhruvi Hasnani
- Rudraksha Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | - M Mukhyaprana Prabhu
- Kasturba Medical College, Manipal, MAHE (Deemed to be University), Karnataka, India
| | - Divya Saxena
- Saxena Multispeciality Hospital, Sonipat, Haryana, India
| | | | - C L Nawal
- SMS Medical College, Jaipur, Rajasthan, India
| | | | - Sajid Ansari
- S.S Heart Care Centre, Lucknow, Uttar Pradesh, India
| | - Prahlad Chawla
- Nishkaam Diabetes Care and Research, Ghaziabad, Uttar Pradesh, India
| | | | - Ashish Saxena
- Dr Saxena Medicentre (A Unit of Diabetes & Heart Centre), Ludhiana, Haryana, India
| | - Narsingh Verma
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Banshi Saboo
- Diacare- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Vipul Chavda
- Rudraksha Institute of Medical Sciences, Ahmedabad, Gujarat, India
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Battelino T, Alexander CM, Amiel SA, Arreaza-Rubin G, Beck RW, Bergenstal RM, Buckingham BA, Carroll J, Ceriello A, Chow E, Choudhary P, Close K, Danne T, Dutta S, Gabbay R, Garg S, Heverly J, Hirsch IB, Kader T, Kenney J, Kovatchev B, Laffel L, Maahs D, Mathieu C, Mauricio D, Nimri R, Nishimura R, Scharf M, Del Prato S, Renard E, Rosenstock J, Saboo B, Ueki K, Umpierrez GE, Weinzimer SA, Phillip M. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol 2023; 11:42-57. [PMID: 36493795 DOI: 10.1016/s2213-8587(22)00319-9] [Citation(s) in RCA: 128] [Impact Index Per Article: 128.0] [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: 08/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
Randomised controlled trials and other prospective clinical studies for novel medical interventions in people with diabetes have traditionally reported HbA1c as the measure of average blood glucose levels for the 3 months preceding the HbA1c test date. The use of this measure highlights the long-established correlation between HbA1c and relative risk of diabetes complications; the change in the measure, before and after the therapeutic intervention, is used by regulators for the approval of medications for diabetes. However, with the increasing use of continuous glucose monitoring (CGM) in clinical practice, prospective clinical studies are also increasingly using CGM devices to collect data and evaluate glucose profiles among study participants, complementing HbA1c findings, and further assess the effects of therapeutic interventions on HbA1c. Data is collected by CGM devices at 1-5 min intervals, which obtains data on glycaemic excursions and periods of asymptomatic hypoglycaemia or hyperglycaemia (ie, details of glycaemic control that are not provided by HbA1c concentrations alone that are measured continuously and can be analysed in daily, weekly, or monthly timeframes). These CGM-derived metrics are the subject of standardised, internationally agreed reporting formats and should, therefore, be considered for use in all clinical studies in diabetes. The purpose of this consensus statement is to recommend the ways CGM data might be used in prospective clinical studies, either as a specified study endpoint or as supportive complementary glucose metrics, to provide clinical information that can be considered by investigators, regulators, companies, clinicians, and individuals with diabetes who are stakeholders in trial outcomes. In this consensus statement, we provide recommendations on how to optimise CGM-derived glucose data collection in clinical studies, including the specific glucose metrics and specific glucose metrics that should be evaluated. These recommendations have been endorsed by the American Association of Clinical Endocrinologists, the American Diabetes Association, the Association of Diabetes Care and Education Specialists, DiabetesIndia, the European Association for the Study of Diabetes, the International Society for Pediatric and Adolescent Diabetes, the Japanese Diabetes Society, and the Juvenile Diabetes Research Foundation. A standardised approach to CGM data collection and reporting in clinical trials will encourage the use of these metrics and enhance the interpretability of CGM data, which could provide useful information other than HbA1c for informing therapeutic and treatment decisions, particularly related to hypoglycaemia, postprandial hyperglycaemia, and glucose variability.
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Affiliation(s)
- Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | | | | | - Guillermo Arreaza-Rubin
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA, USA
| | | | | | - Elaine Chow
- Phase 1 Clinical Trial Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pratik Choudhary
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly Close
- diaTribe Foundation, San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Auf der Bult, Hanover, Germany
| | | | - Robert Gabbay
- American Diabetes Association, Arlington, VA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Satish Garg
- Barbara Davis Centre for Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Tina Kader
- Jewish General Hospital, Montreal, QC, Canada
| | | | - Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Lori Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - David Maahs
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, CA, USA
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBERDEM (Instituto de Salud Carlos III), Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Revital Nimri
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Rimei Nishimura
- The Jikei University School of Medicine, Jikei University, Tokyo, Japan
| | - Mauro Scharf
- Centro de Diabetes Curitiba and Division of Pediatric Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital, Montpellier, France; Institute of Functional Genomics, University of Montpellier, Montpellier, France; INSERM Clinical Investigation Centre, Montpellier, France
| | - Julio Rosenstock
- Velocity Clinical Research, Medical City, Dallas, TX; University of Texas Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Kohjiro Ueki
- Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Yale University, New Haven, CT, USA
| | - Moshe Phillip
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tauschmann M, Forlenza G, Hood K, Cardona-Hernandez R, Giani E, Hendrieckx C, DeSalvo DJ, Laffel LM, Saboo B, Wheeler BJ, Laptev DN, Yarhere I, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes 2022; 23:1390-1405. [PMID: 36537528 PMCID: PMC10107687 DOI: 10.1111/pedi.13451] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregory Forlenza
- Pediatric Diabetes Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korey Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Elisa Giani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daniel J DeSalvo
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics Department, Southern District Health Board, Dunedin, New Zealand
| | | | - Iroro Yarhere
- Endocrinology Unit, Paediatrics Department, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Shamanna P, Dharmalingam M, Vadavi A, Saboo B, Damodaran S, Mohamed M, Mohammed J, Poon T, Keshavamurthy A, Thajudeen M, Bhonsley S, Mohammed S, Joshi S. PSUN230 Concordance between HbA1c, eA1C and fasting plasma glucose criteria to define type 2 diabetes remission: Insights from the Six months of Digital Twin Intervention Trial. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Introduction
Twin Precision Treatment (TPT): a novel whole-body digital twin enabled precision nutrition that utilises 174 health markers and 3000 daily data points from blood tests and connected devices that measure weight, physical activity, sleep and sensor glucose values, for achieving remission.
Methods
Contemporary consensus statement defines remission as a return of hemoglobin A1c (HbA1c) to <6.5% and persists for at least three months in the absence of diabetes medication. Estimated HbA1c (eA1C) <6.5% or fasting plasma glucose (FPG) <126 mg/dl can be used as an alternative tool in determining remission when HbA1C<6.5% is not a reliable marker. The concordance in remission by the different criteria was obtained and Kappa agreement was calculated. We evaluated the data of the multicenter RCT that is based on the patented Whole-Body Digital Twin (WBDT) enabled precision treatment for reversing diabetes. The trial was approved by an independent ethics committee, the Medisys Ethics committee (MCERB/2020/07). Trial registration: Clinical Trials Registry India (CTRI) (CTRI/2020/08/027072). SPSS Version 28.0 was used for the statistical analysis.
Results
We analyzed the dataset of 199 patients. The mean age was 43.3 years (±8.7); diabetes duration was 3.7 years (±2.7). The mean baseline HbA1c (%) of 9 (±1.8) reduced to 5.7 (±0.5) (p<0.001). The mean baseline eA1C (%) of 8.1(±2.3) reduced to 4.9 (±0.6) (p<0.001). The mean baseline FPG of 170.2(±59.9) (mg/dl) reduced to 95.9 (±18.2) (mg/dl) (p<0.001). 167(83.9%) achieved remission by HbA1c criteria. 166 (83.4%) achieved eA1C<6.5%. 161 (80.9%) achieved remission for FPG <126 mg/dl. 167 (83.9%) achieved remission by for either FPG <126 mg/dl or eA1C<6.5%. For every person achieving remission based on HbA1c criteria there were equivalent number achieving remission by eA1C criteria (1: 1) and proportionally the same by FPG criteria (1: 0.96). Concordance of rate of remission by eA1c and HbA1c was 97.5% and their kappa agreement was 0.91 (95% CI 0.83 to 0.99, p<0.001) (almost perfect agreement). Concordance of rate of remission by FPG and HbA1c criteria was 94%, kappa 0.79 (95% CI 0.68-0.90, p<0.001) (moderate agreement). By either FPG or eA1C criteria, the concordance rate was 97%, kappa 0.89 (95% CI 0.80 to 0.98, p<0.001) (strong agreement). We benchmarked eA1C and FPG against HbA1c for achieving remission. Sensitivity (%), specificity (%), and kappa agreement for eA1C and FPG was 98.2, 93.8, 0.91 and 94.6, 90.6, 0.79, respectively.
Conclusion
There was high concordance irrespective of the criteria used to evaluate remission. This homogeneity in the criteria may positively affect, assessing remission by the independent yet flexible choice of markers of remission. Using patient-level data in RCT would be an important step in putting the remission guidelines to utility in the real world. It appears that HbA1c, eA1C and FPG are comparable and reliable markers for assessing remission of T2D
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Shashank J, Mohammed J, Mohamed M, Poon T, Dharmalingam M, Saboo B, Damodaran S, Vadavi A, Thajudeen M, Keshavamurthy A, Bhonsley S, Mohammed S, Shamanna P. LBSUN149 Effectiveness Of Digital Twin Technology For The Improvement In Depression Among Patients Undergoing Remission Of Diabetes. J Endocr Soc 2022. [PMCID: PMC9629280 DOI: 10.1210/jendso/bvac150.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Twin Precision Treatment (TPT): a novel whole-body digital twin enabled precision nutrition that utilises 174 health markers and 3000 daily data points from blood tests and connected devices that measure weight, physical activity, sleep and sensor glucose values, for achieving remission. The prevalence of depression is higher among those with diabetes than in the general population. The Patient Health Questionnaire (PHQ-9) is commonly used to assess depression in people with diabetes, but the impact of the diabetes reversal program on the depression has not yet been investigated. Methods We compared the change in the PHQ-9 scores at the baseline and at three months for the patients enrolled in the real-world study in TPT program. Contemporary consensus statement defines remission as a return of hemoglobin A1c (HbA1c) to <6.5% and persists for at least three months in the absence of diabetes medication. Results We evaluated 96 patients of which 54.1% (n=52) had any grade of depression. 28% (n=27), 18% (n=17), 5% (n=5), 3% (n=3) had mild, moderate, moderate to severe and severe depression. Within these categories 67% (n=18) improved from mild to normal, 94% (n=16) improved in the moderate category with 10 improved to normal category, none remained as moderately severe and severe depression, respectively. There was a significant association with the improvement in the PHQ-9 scores and the number of daily oral medication count change. Out of 15 on 1 medication/day changed to 7 (46.7%) off medication. Out of 27 with 2 medications/day, 10 (37%) were off medications. Out of 22 with 3 medications/day, 5 (22.7%) were off medications. Out of 12 with 4 medications/day, 2 (16.7.7%) were off medications; p<0. 005. The mean HbA1c % at baseline (8.9±2.4) changed to (6.8±9.2), p<0. 001. The mean body weight (kg) at baseline (76.2±13.5) changed to (71.9±12.9), p<0. 001. Discussion This is perhaps the first evaluation for the improvement of the PHQ-9 in patients undergoing remission by digital twin technology. Depression was highly prevalent. Higher the PHQ-9 score, greater was the degree of improvement in depression. TPT appears to be a useful tool to simultaneously address reversal of diabetes and improvement in the grade of depression. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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Unnikrishnan R, Anjana RM, Mukhopadhyay S, Kesavadev J, Mithal A, Joshi S, Saboo B, Tandon N, Mohan V. Comment on Lontchi-Yimagou et al. An Atypical Form of Diabetes Among Individuals With Low BMI. Diabetes Care 2022;45:1428-1437. Diabetes Care 2022; 45:e157-e158. [PMID: 36318673 DOI: 10.2337/dc22-1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centres, Trivandrum, Kerala, India
| | - Ambrish Mithal
- Department of Endocrinology and Diabetes, Max Healthcare, New Delhi, India
| | - Shashank Joshi
- Department of Endocrinology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Department of Diabetology, Dia Care-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
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Das AK, Saboo B, Maheshwari A, Nair V M, Banerjee S, C J, V BP, Prasobh P S, Mohan AR, Potty VS, Kesavadev J. Health care delivery model in India with relevance to diabetes care. Heliyon 2022; 8:e10904. [PMID: 36237970 PMCID: PMC9552106 DOI: 10.1016/j.heliyon.2022.e10904] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
The Indian healthcare scenario presents a spectrum of contrasting landscapes. Socioeconomic factors, problems with medical infrastructure, insufficiency in the supply of medical requisites, economic disparities due to major differences in diabetes care delivery in the government and private sectors and difficulty in accessing quality health care facilities challenges effective diabetes care in India. The article gives insights into the practical solutions and the proposed White paper model to resolve major challenges faced by the Indian diabetes care sector for effective diabetes care delivered at Jothydev's Diabetes Educational Forum Global Diabetes Convention 2019. The prevalence of diabetes in India is on its rise. Socioeconomic factors, lack of diagnosis etc challenges Indian diabetes care system. Health care models appropriate for Indian scenario should be developed. Public-Private partnership is required for effective health care delivery.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, Tamil Nadu, India
| | - Banshi Saboo
- Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | - Samar Banerjee
- Dept. of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Jayakumar C
- Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Benny P. V
- Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Sunil Prasobh P
- Department of Internal Medicine, Government Medical College, Kollam, Kerala, India
| | - Anjana Ranjit Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Trivandrum, Kerala, India,Corresponding author.
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22
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Kumar V, Agarwal S, Saboo B, Makkar B. RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus. Int J Diabetes Dev Ctries 2022; 42:576-605. [PMID: 36536953 PMCID: PMC9750845 DOI: 10.1007/s13410-022-01143-7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
Hypertension and diabetes mellitus (DM) are two of the leading lifestyle diseases in the Indian and South Asian populations that often co-exist due to overlapping pathophysiological factors. Obesity, insulin resistance, inflammation, and oxidative stress are thought to be some common pathways. Up to 50% of hypertensive cases in India are diagnosed with type 2 diabetes mellitus (T2DM), which defines the need for a comprehensive guideline for managing hypertension in diabetic patients. These RSSDI guidelines have been formulated based on consultation with expert endocrinologists in India and Southeast Asia, acknowledging the needs of the Indian population. Ambulatory blood pressure monitoring and office and home-based blood pressure (BP) monitoring are recommended for the early analysis of risks. Cardiovascular risks, end-organ damage, and renal disorders are the primary complications associated with diabetic hypertension that needs to be managed with the help of non-pharmacological and pharmacological interventions. The non-pharmacological interventions include the nutrition education of the patient to reduce the intake of salt, sodium, and trans fats and increase the consumption of nuts, fresh fruits, vegetables, and potassium-rich foods. It is also recommended to initiate 50 to 60 min of exercise three to four times a week since physical activity has shown to be more beneficial for hypertension control in Indian patients than dietary modulation. For the pharmacological management of hypertension in patients with T2DM, angiotensin II receptor blockers (ARBs) are recommended as the first line of therapy, demonstrating their superiority over other antihypertensive agents such as ACEi. However, most of the global hypertension guidelines recommend initiation with combination therapy to achieve better BP control in most patients and to reduce the risk of adverse events. For combination therapy, calcium channel blockers (CCBs) are recommended to be administered along with ARBs instead of beta-blockers or diuretics to avoid the risk of cardiovascular events and hyperglycaemia. Among the CCBs, novel molecules (e.g. cilnidipine) are recommended in combination with ARBs for better cardiovascular and reno-protection in diabetic hypertensive patients.
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Affiliation(s)
- Vasanth Kumar
- Apollo Hospitals, Hyderabad, India
- President. RSSDI, Prune, India
| | - Sanjay Agarwal
- Aegle Clinic-Diabetes Care, Pune, India
- Department of Medicine and Diabetes, Ruby Hall Clinic, Pune, India
- Secretary-General, RSSDI, Pune, India
| | - Banshi Saboo
- Immediate Past-President, RSSDI, Pune, India
- Dia-Care Hormone Clinic, Ahmedabad, India
| | - Brij Makkar
- President-Elect, RSSDI, Prune, India
- Dr Makkar’s Diabetes & Obesity Centre, A-5B/122, Paschim Vihar, New Delhi, 110063 India
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Chawla M, Chawla P, Saboo B, Chawla R, Gangopadhyay KK, Kalra S, Aravind S, Sinha B, Shah T, Kesavadev J, Rajput R. Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts. Diabetes Metab Syndr 2022; 16:102587. [PMID: 36055167 DOI: 10.1016/j.dsx.2022.102587] [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: 02/07/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH. METHOD The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH. RESULT & Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.
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Affiliation(s)
- M Chawla
- Lina Diabetes Care Centre, Mumbai, India.
| | - P Chawla
- Consultant Diabetologist and Director of Clinical Research, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - B Saboo
- Dept of Endocrinology, Dia Care, Ahmedabad, Gujrat, India
| | - R Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - K K Gangopadhyay
- Consultant in Endocrinology, CK Birla Hospitals, Peerless Hospital, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - B Sinha
- AMRI and Fortis Hospitals, Kolkata, India
| | - T Shah
- Director and Diabetologist Iva Diabetes Care Centre Mumbai, Sl Raheja Fortis Hospital, Mumbai, India
| | - J Kesavadev
- Jothydev's Diabetes and Research Center, Kerala, India
| | - R Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
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Anjana RM, Srinivasan S, Sudha V, Joshi SR, Saboo B, Tandon N, Das AK, Jabbar PK, Madhu SV, Gupta A, Bajaj S, Chowdhury S, Kalra S, Gayathri R, Abirami K, Manasa VS, Padmapritha T, Lakshmipriya N, Geetha G, Deepa M, Pradeepa R, Unnikrishnan R, Kurpad AV, Krishnaswamy K, Kaur T, Dhaliwal RS, Mohan V. Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study. Diabetes Care 2022; 45:dc220627. [PMID: 36350789 DOI: 10.2337/dc22-0627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. RESEARCH DESIGN AND METHODS Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. RESULTS Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49-54%; protein, 19-20%; and fat, 21-26%; 2) PD remission to NGT: carbohydrate, 50-56%; protein,18-20%; fat, 21-27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54-57% and 56-60%; protein, 16-20% and 14-17%, respectively; and fat 20-24% for PD and NGT. CONCLUSIONS We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Seshadhri Srinivasan
- International Research Centre, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Shashank R Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Dia Care-Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi - National Capital, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Pudcherry - Union Territory, India
| | | | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arvind Gupta
- Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Rajagopal Gayathri
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kuzhandaivelu Abirami
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Valangaiman Sriram Manasa
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Thamotharan Padmapritha
- Department of Instrumentation and Control Engineering, Kalasalingam Academy of Research and Education, Srivilliputhur, Tamil Nadu, India
| | - Nagarajan Lakshmipriya
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Gunasekaran Geetha
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Kamala Krishnaswamy
- Department of Foods, Nutrition & Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Hasnani D, Saboo B, Chaturvedi A, Sikdar M, Shankar A, Choudhury R, Saboo B, Singh NM, Jha S, Chavda V. Current insulinization trends in India. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01123-x] [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] [Indexed: 11/28/2022] Open
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Nimri R, Tirosh A, Muller I, Shtrit Y, Kraljevic I, Alonso MM, Milicic T, Saboo B, Deeb A, Christoforidis A, den Brinker M, Bozzetto L, Bolla AM, Krcma M, Rabini RA, Tabba S, Gerasimidi-Vazeou A, Maltoni G, Giani E, Dotan I, Liberty IF, Toledano Y, Kordonouri O, Bratina N, Dovc K, Biester T, Atlas E, Phillip M. Comparison of Insulin Dose Adjustments Made by Artificial Intelligence-Based Decision Support Systems and by Physicians in People with Type 1 Diabetes Using Multiple Daily Injections Therapy. Diabetes Technol Ther 2022; 24:564-572. [PMID: 35325567 DOI: 10.1089/dia.2021.0566] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 11/12/2022]
Abstract
Objective: Artificial intelligence-based decision support systems (DSS) need to provide decisions that are not inferior to those given by experts in the field. Recommended insulin dose adjustments on the same individual data set were compared among multinational physicians, and with recommendations made by automated Endo.Digital DSS (ED-DSS). Research Design and Methods: This was a noninterventional study surveying 20 physicians from multinational academic centers. The survey included 17 data cases of individuals with type 1 diabetes who are treated with multiple daily insulin injections. Participating physicians were asked to recommend insulin dose adjustments based on glucose and insulin data. Insulin dose adjustments recommendations were compared among physicians and with the automated ED-DSS. The primary endpoints were the percentage of comparison points for which there was agreement on the trend of insulin dose adjustments. Results: The proportion of agreement and disagreement in the direction of insulin dose adjustment among physicians was statistically noninferior to the proportion of agreement and disagreement observed between ED-DSS and physicians for basal rate, carbohydrate-to insulin ratio, and correction factor (P < 0.001 and P ≤ 0.004 for all three parameters for agreement and disagreement, respectively). The ED-DSS magnitude of insulin dose change was consistently lower than that proposed by the physicians. Conclusions: Recommendations for insulin dose adjustments made by automatization did not differ significantly from recommendations given by expert physicians regarding the direction of change. These results highlight the potential utilization of ED-DSS as a useful clinical tool to manage insulin titration and dose adjustments.
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Affiliation(s)
- Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
- Division of Endocrinology, Diabetes and Metabolism, Dalia and David Arabov Endocrinology and Diabetes Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Ido Muller
- DreaMed Diabetes Ltd., Petah Tikva, Israel
| | | | - Ivana Kraljevic
- Department of Endocrinology and Diabetes, UHC Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Montserrat Martín Alonso
- Department of Pediatrics, Children's Endocrinology Unit, University Hospital of Salamanca, Spain
| | - Tanja Milicic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Asma Deeb
- Pediatric Endocrine Division, Sheikh Shakhbout Medical City and Khalifa University, Abu Dhabi, United Arab Emirates
| | - Athanasios Christoforidis
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Marieke den Brinker
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgium
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | | | - Michal Krcma
- Diabetes and Endocrinology Unit, Department of Internal Medicine, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Rosa Anna Rabini
- Department of Diabetology, Hospital Mazzoni, Ascoli Piceno, Italy
| | - Shadi Tabba
- Department of Pediatric Endocrinology, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | | | - Giulio Maltoni
- Unit of Pediatrics, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisa Giani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Idit Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
- Rabin Medical Center, Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel
| | - Idit F Liberty
- Department of Medicine and Diabetes Unit, Soroka Medical Center, Faculty of Health Sciences, Beer Sheva, Israel
| | - Yoel Toledano
- Division of Maternal Fetal Medicine, Helen Schneider Women's Hospital, Rabin Medical Center, Endocrinology Clinic, Petah Tikva, Israel
| | - Olga Kordonouri
- Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Natasa Bratina
- Department of Endocrinology, Diabetes and Metabolic Diseases, UMC-University Children's Hospital Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Klemen Dovc
- Department of Endocrinology, Diabetes and Metabolic Diseases, UMC-University Children's Hospital Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Torben Biester
- Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Eran Atlas
- DreaMed Diabetes Ltd., Petah Tikva, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
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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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Zargar AH, Kalra S, K M PK, Murthy S, Negalur V, Rajput R, Rastogi A, Saboo B, Sharma SK, Sahay R, Aravind SR, Shaikh S, Tiwaskar M, Ingole S, Kamble S. Rising cost of insulin: A deterrent to compliance in patients with diabetes mellitus. Diabetes Metab Syndr 2022; 16:102528. [PMID: 35863268 DOI: 10.1016/j.dsx.2022.102528] [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: 11/27/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The rapid increase in burden of type 2 diabetes mellitus (T2DM), poses a huge medico-economic challenge, especially when the cost of care is funded by out-of-pocket expenses. The aim of this review is to highlight various issues associated with rising cost of insulin, prevalence of cost-related insulin underuse, insulin related cost-saving behaviors, and viable solutions for the benefit of patients with T2DM receiving insulin. METHODS Electronic databases (PubMed and Google Scholar) from 2000 to 2020 were searched using the key terms uncontrolled diabetes mellitus, insulin therapy, glycemic control, direct cost, indirect cost, out-of-pocket expenses, cost-related insulin underuse, cost-saving behaviors, and biosimilar insulin in developed countries and India. RESULTS In majority of the patients with T2DM on monotherapy, addition of another oral antidiabetic agent is required. Despite these measures, the target glycemic goals are not achieved in majority of the patients resulting in various complications. These complications can be prevented and target glycemic goals can be achieved with early initiation of insulin therapy. However, rising cost is a major deterrent to the lifelong use of insulin. This results in non-compliance and further deterioration of glycemic control. Recently, biosimilar insulins have revolutionized the management of T2DM and look promising from the economic point of view. CONCLUSIONS Biosimilar insulins are likely to further enhance the compliance of patients and should be used whenever feasible in patients with DM. However, the patient, along with prescriber should be allowed to make shared, informed decisions regarding the insulin they wish to use.
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Affiliation(s)
- Abdul Hamid Zargar
- Centre for Diabetes and Endocrine Care, Gulshan Nagar, Chanpora, Srinagar, 190015, Jammu and Kashmir, India.
| | - Sanjay Kalra
- Bharati Hospital, Karnal, 132001, Haryana, India.
| | - Prasanna Kumar K M
- Centre for Diabetes & Endocrine Care & Diabetacare, Kalyan Nagar Post, Bangalore, 560043, Karnataka, India.
| | - Sreenivasa Murthy
- Lifecare Hospital and Research Centre, Sahakaranagara, Bangalore, 560092, Karnataka, India.
| | - Vijay Negalur
- Dr Negalur's Diabetes & Thyroid Specialty Centre, Gloria Chambers, Thane, 400603, Maharashtra, India.
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS Rohtak, Rohtak, 124001, Haryana, India.
| | - Ashu Rastogi
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Banshi Saboo
- Dia Care (Diabetes Care & Hormone Clinic), Department of Diabetology, Near Nehru Nagar Circle, Ahmedabad, Gujrat, India.
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, 500095, Telangana, India.
| | - S R Aravind
- Diacon Hospital, Rajajinagar, Bangalore, 560019, Karnataka, India.
| | - Shehla Shaikh
- K.G.N. Clinic, Patel Arcade, Nagpada Junction, Mumbai, 400008, Maharashtra, India.
| | - Mangesh Tiwaskar
- Department of Medicine, Shilpa Medical Research Centre, Dahisar East, Mumbai, 400068, Maharashtra, India.
| | - Shahu Ingole
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
| | - Sanjay Kamble
- Department of Medical Affairs, Wockhardt Towers Bandra Kurla Complex, Bandra (East), Mumbai, 400051, Maharashtra, India.
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Kalra S, Dhar M, Afsana F, Aggarwal P, Aye TT, Bantwal G, Barua M, Bhattacharya S, Das AK, Das S, Dasgupta A, Dhakal G, Dhingra A, Esfahanian F, Gadve S, Jacob J, Kapoor N, Latheef A, Mahadeb Y, Maskey R, Naseri W, Ratnasingam J, Raza A, Saboo B, Sahay R, Shah M, Shaikh S, Sharma SK, Shrestha D, Somasundaram N, Tiwaskar M, Jawdekar A. Asian Best Practices for Care of Diabetes in Elderly (ABCDE). Rev Diabet Stud 2022; 18:100-134. [PMID: 35831938 PMCID: PMC10044048 DOI: 10.1900/rds.2022.18.100] [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: 12/15/2022] Open
Abstract
The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and
subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical
experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population
in the Asian region.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sambit Das
- Dr.Sambit's Centre of Diabetes and Endocrinology, India
| | | | | | | | | | | | | | | | - Ali Latheef
- National Diabetes Centre, Indira Gandhi Memorial, India
| | | | | | | | | | - Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Centre, Pakistan
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
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Vazeou A, Tittel SR, Birkebaek NH, Kordonouri O, Iotova V, Piccini B, Saboo B, Pundziute Lyckå A, Seget S, Maahs DM, Stergiou G. The Importance of Office Blood Pressure Measurement Frequency and Methodology in Evaluating the Prevalence of Hypertension in Children and Adolescents With Type 1 Diabetes: The SWEET International Database. Diabetes Care 2022; 45:1462-1471. [PMID: 35476140 DOI: 10.2337/dc21-2472] [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] [Received: 11/28/2021] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of hypertension is higher in children and adolescents with type 1 diabetes (T1D) compared with those without. This retrospective analysis of a large cohort of children and adolescents with T1D from the SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) international consortium of pediatric diabetes centers aimed to 1) estimate the prevalence of elevated office blood pressure (BP) and hypertension and 2) investigate the influence of BP measurement methodology on the prevalence of hypertension. RESEARCH DESIGN AND METHODS A total of 27,120 individuals with T1D, aged 5-18 years, were analyzed. Participants were grouped into those with BP measurements at three or more visits (n = 10,440) and fewer than 3 visits (n = 16,680) per year and stratified by age and sex. A subgroup analysis was performed on 15,742 individuals from centers providing a score indicating BP measurement accuracy. RESULTS Among participants with BP measurement at three or more visits, the prevalence of hypertension was lower compared with those with fewer than three visits (10.8% vs. 17.5% P < 0.001), whereas elevated BP and normotension were higher (17.5% and 71.7% vs. 15.3% and 67.1%, respectively; both P < 0.001). The prevalence of hypertension and elevated BP was higher in individuals aged ≥13 years than in younger ones (P < 0.001) and in male than female participants (P < 0.001). In linear regression models, systolic and diastolic BP was independently determined by the BP measurement methodology. CONCLUSIONS The estimated prevalence of elevated BP and hypertension in children and adolescents with T1D is ∼30% and depends on the BP measurement methodology. Less frequent BP evaluation may overestimate the prevalence of hypertension.
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Affiliation(s)
- Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Niels H Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Hannover Medical School, Hannover, Germany
| | - Violeta Iotova
- Department of Pediatrics, Medical University, Varna, Bulgaria
| | - Barbara Piccini
- Regional Center for Pediatric Diabetes, Meyer University Children's Hospital, Florence, Italy
| | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Auste Pundziute Lyckå
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, and Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - David M Maahs
- Department of Pediatrics and Stanford Diabetes Research Center, Stanford, CA
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Anjana RM, Unnikrishnan R, Deepa M, Venkatesan U, Pradeepa R, Joshi S, Saboo B, Das AK, Bajaj S, Bhansali A, Madhu SV, Dhandhania VK, Jabbar PK, Jain SM, Gupta A, Chowdhury S, Ali MK, Nirmal E, Subashini R, Kaur T, Dhaliwal RS, Tandon N, Mohan V. Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): a national cross-sectional study. Lancet Diabetes Endocrinol 2022; 10:430-441. [PMID: 35461575 DOI: 10.1016/s2213-8587(22)00072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [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: 07/01/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes. METHODS The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets. FINDINGS Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7-56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7-37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2-50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9-43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (<10 years) were associated with better achievement of combined ABC targets. Only 951 (weighted proportion 16·7%) of the study population and 227 (weighted proportion 36·9%) of those on insulin reported using self-monitoring of blood glucose. INTERPRETATION Achievement of treatment targets and adoption of healthy behaviours remains suboptimal in India. Our results can help governments to adopt policies that prioritise improvement of diabetes care delivery and surveillance in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ulagamathesan Venkatesan
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Shashank Joshi
- Department of Diabetology and Endocrinology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Ashok Kumar Das
- Department of General Medicine and Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | | | | | - Sunil M Jain
- TOTALL, Diabetes Thyroid Hormone Research Institute, Indore, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Mohammed K Ali
- Department of Epidemiology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elangovan Nirmal
- Department of Research Operations, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Indian Council of Medical Research Centre for Advanced Research on Diabetes and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
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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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Anjana RM, Siddiqui MK, Jebarani S, Vignesh MA, Kamal Raj N, Unnikrishnan R, Pradeepa R, Panikar VK, Kesavadev J, Saboo B, Gupta S, Sosale AR, Seshadri KG, Deshpande N, Chawla M, Chawla P, Das S, Behera M, Chawla R, Nigam A, Gupta A, Kovil R, Joshi SR, Agarwal S, Bajaj S, Pearson ER, Doney ASF, Palmer CNA, Mohan V. Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians. Diabetes Technol Ther 2022; 24:190-200. [PMID: 34609928 DOI: 10.1089/dia.2021.0277] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Moneeza Kalhan Siddiqui
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Saravanan Jebarani
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mani Arun Vignesh
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Nithyanantham Kamal Raj
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Vijay K Panikar
- Department of Diabetology, Dr. Panikars Speciality Care Centre, Mumbai, Maharashtra, India
| | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes and Research Centre, Kerala, India
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care & Hormone Clinic, Ahemedabad, Gujarat, India
| | - Sunil Gupta
- Department of Diabetology, Sunil's Diabetic Care & Research Center, Nagpur, Maharashtra, India
| | - Aravind R Sosale
- Department of Diabetology, Diacon Hospital, Bangalore, Karnataka, India
| | - Krishna G Seshadri
- Department of Endocrinology, Chennai Diabetes and Endocrine Clinic, Chennai, Tamilnadu, India
| | - Neeta Deshpande
- Department of Diabetology, Belgaum Diabetes Centre, Belgaum, Karnataka, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Purvi Chawla
- Department of Diabetology, Lina Diabetes Care, Mumbai, Maharashtra, India
| | - Sidhartha Das
- Department of Diabetology, Prof.S.Das Clinic, Cuttack, Odisha, India
| | - Manoranjan Behera
- Department of General Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre, Delhi, India
| | - Anant Nigam
- Department of Diabetology, Nigam Diabetes Centre, Jaipur, Rajasthan, India
| | - Arvind Gupta
- Department of Diabetology, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Rajiv Kovil
- Department of Diabetology, Dr. Kovil's Diabetes Care Centre, Mumbai, Maharashtra, India
| | - Shashank R Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sanjay Agarwal
- Department of Medicine Aegle Clinic-Diabetes Care, Pune, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Ewan R Pearson
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Alexander S F Doney
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Colin N A Palmer
- Division of Population Health & Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Mohan V, Saboo B, Khader J, Modi KD, Jindal S, Wangnoo SK, Amarnath S. Position of Sulfonylureas in the Current ERA: Review of National and International Guidelines. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221074663. [PMID: 35185350 PMCID: PMC8854230 DOI: 10.1177/11795514221074663] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/22/2021] [Indexed: 01/21/2023] Open
Abstract
Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to–benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.
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Affiliation(s)
- Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Jabbar Khader
- Department of Endocrinology, Government Medical College, Trivandrum, Kerala, India
| | | | - Sushil Jindal
- Department of Endocrinology, People's college of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Subhash Kumar Wangnoo
- Endocrinologist and Diabetologist, Apollo centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, New Delhi, India
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Mohan V, Shanthi Rani CS, Saboo B, Mukhopadhyay S, Chatterjee S, Dharmarajan P, Gupta S, Pendsey S, Chandrakanta J, Umasankari G, Amutha A, Salis S, Datta S, Gupta PK, Routray P, Jebarani S, Sastry NG, Venkatesan U, Anjana RM, Unnikrishnan R. Clinical Profile of Long-Term Survivors and Nonsurvivors with Type 1 Diabetes in India. Diabetes Technol Ther 2022; 24:120-129. [PMID: 34569820 DOI: 10.1089/dia.2021.0284] [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] [Indexed: 11/12/2022]
Abstract
Objective: To compare the clinical profile of long-term survivors and nonsurvivors with type 1 diabetes (T1D) in India. Research Design and Methods: This is a retrospective study of 76 individuals with T1D who had survived for at least 40 years ("survivors") and 51 individuals with T1D who had died with shorter duration of diabetes ("non-survivors"), from diabetes clinics in different cities of India. Prevalence of complications in both groups and causes of death of the nonsurvivors were analyzed. Retinopathy was diagnosed by retinal photography; chronic kidney disease (CKD) by urinary albumin excretion (micro-or macroalbuminuria) and estimated glomerular filtration rate; peripheral vascular disease (PVD) by doppler measurement of ankle-brachial pressure index; coronary artery disease (CAD) based on history of myocardial infarction or coronary revascularization, and neuropathy by biothesiometry. Results: Mean glycated hemoglobin (8.4% ± 1.5% vs. 10.7% ± 2.2%, P < 0.001), serum low-density lipoprotein cholesterol (91 ± 29 mg/dL vs. 107 ± 22 mg/dL, P = 0.004), and systolic blood pressure (135 ± 16 mmHg vs. 153 ± 37 mmHg, P = 0.003) were lower, and high-density lipoprotein cholesterol (51 ± 11 mg/dL vs. 43 ± 15 mg/dL, P = 0.002) higher, among survivors compared to nonsurvivors. Diabetic retinopathy, CKD, neuropathy, PVD, and CAD were more frequent among nonsurvivors. CAD [25.5%] and renal failure [23.5%] were the most frequent causes of death. Conclusions: In this first report of long-term survivors with T1D from India, we report that survivors had better glycemic and blood pressure control, more favorable lipid profiles and lower prevalence of complications compared to nonsurvivors. However, there could be other protective factors as well, which merit further studies.
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Affiliation(s)
- Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | | | - Banshi Saboo
- Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | | | - Sunil Gupta
- Sunil's Diabetes Care n' Research Pvt Ltd., Nagpur, India
| | | | - Jha Chandrakanta
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Ganesan Umasankari
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Anandakumar Amutha
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | | | - Supriya Datta
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Prasanna Kumar Gupta
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Philips Routray
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Saravanan Jebarani
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | | | | | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
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Saboo B, Erande S, Unnikrishnan AG. A prospective multicentre open label study to assess effect of Teneligliptin on glycemic control through parameters of time in range (TIR) Metric using continuous glucose monitoring (TOP-TIR study). Diabetes Metab Syndr 2022; 16:102394. [PMID: 35078097 DOI: 10.1016/j.dsx.2022.102394] [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: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Continuous glucose monitoring (CGM) has been effective in assessing glycemic variability in diabetic patients. This study aims at assessing the effect of Teneligliptin using ambulatory glucose profile (AGP) indicators. METHODS A prospective, multicentre, open label study enrolling 59 type 2 diabetes patients between 18 and 65 years age was done between November 2020-May 2021. Patients were administered Teneligliptin 20 mg once daily, in addition to Metformin. The study included pre-treatment and two post-treatment phases. The data on time in range (TIR) and other AGP indicators of glycemic variability were obtained on each patient in all the three study phases and analysed to understand the effect of Teneligliptin on glycemic variability. Safety evaluation was done based on vital and biochemical parameters. RESULTS The percent TIR in post-treatment phase I was significantly higher than the pre-treatment phase (p < 0.0001), and was maintained till the end of phase II (p = 0.037). There was significant lowering of time above range (≥180 mg/dL) in the phase I (p = 0.003), which was maintained in phase II (p = 0.043), suggesting better control over hyperglycemic state. The reduction in mean glucose level in phase I and II was also significant compared to baseline (p = 0.003 and p = 0.023 respectively). The glucose variability percent and glucose management indicator also showed significant lowering in both the phases. CONCLUSIONS Teneligliptin addition to patients uncontrolled on Metformin monotherapy significantly reduced glycemic variability, as well showed significant glycemic improvement. Since this study was a single arm study, a comparative study with other DPP-4 inhibitors is needed.
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Affiliation(s)
| | - Suhas Erande
- Akshay Hospital, Department of Medicine, Pune, India.
| | - A G Unnikrishnan
- Chellaram Diabetes Institute, Department of Endocrinology, Pune, India.
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Deepa M, Anjana RM, Unnikrishnan R, Pradeepa R, Das AK, Madhu SV, Rao PV, Joshi S, Saboo B, Kumar A, Bhansali A, Gupta A, Bajaj S, Elangovan N, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Tandon N, Mohan V. Variations in glycated haemoglobin with age among individuals with normal glucose tolerance: Implications for diagnosis and treatment-Results from the ICMR-INDIAB population-based study (INDIAB-12). Acta Diabetol 2022; 59:225-232. [PMID: 34596779 DOI: 10.1007/s00592-021-01798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 05/07/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
AIM To report on glycated haemoglobin (HbA1c) values among individuals with normal glucose tolerance (NGT) at different age groups, using data acquired from a large national survey in India. MATERIALS AND METHODS Data on glycaemic parameters at different age groups were obtained from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, in adults aged ≥ 20 years representing all parts of India. Age-wise distribution of HbA1c was assessed among individuals with NGT (n = 14,222) confirmed by an oral glucose tolerance test using the World Health Organization (WHO) criteria. Results were validated in another large epidemiological study (n = 1077) conducted in Chennai, India. RESULTS Among NGT individuals, HbA1c increased gradually with age from 5.16 ± 0.71% (33 mmol/mol) in the age group of 20-29 years to 5.49 ± 0.69% (37 mmol/mol) in those aged 70 + years. In the validation study, conducted in another study population, HbA1c was 5.35 ± 0.43% (35 mmol/mol) in age group of 20-29 years and 5.74 ± 0.50% (39 mmol/mol) in those aged 70 and above. In the INDIAB study, for every decadal increase in age, there is a 0.08% increase in HbA1c and this increase was more significant in females (females: 0.10% vs. males: 0.06%) and in urban (urban: 0.10% vs. rural: 0.08%) population. CONCLUSIONS HbA1c levels increase steadily with age. This suggests that age-specific cutoffs be used while utilizing HbA1c to diagnose diabetes and prediabetes, so as to minimize the risk of overdiagnosis and unnecessary initiation of treatment in elderly people who could have physiological increase in HbA1c levels.
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Affiliation(s)
- Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sri Venkata Madhu
- University College of Medical Sciences and GTB Hospital, Delhi, New Delhi, India
| | | | - Shashank Joshi
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Banshi Saboo
- Dia Care-Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Ajay Kumar
- Diabetes Care and Research Centre, Patna, Bihar, India
| | - Anil Bhansali
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sarita Bajaj
- Moti Lal Nehru Medical College, Allahabad, India
| | - Nirmal Elangovan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Radhakrishnan Subashini
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India
| | - Tanvir Kaur
- Indian Council of Medical Research, Delhi, New Delh, India
| | - R S Dhaliwal
- Indian Council of Medical Research, Delhi, New Delh, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research On Diabetes, No 4, Conran Smith Road, Gopalapuram, Chennai, India.
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Saiyed M, Saboo B, Pancholi M, Saraf V, Shah M. Prevalence of microvascular complications in adolescents and adults with type 1 diabetes: A descriptive study from India. J Diabetol 2022. [DOI: 10.4103/jod.jod_101_21] [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: 11/04/2022] Open
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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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Ghosh S, Saboo B. The reversal model for metabolic syndrome (RMMS) study: The rationale and design. J Diabetol 2022. [DOI: 10.4103/jod.jod_8_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] [Indexed: 11/04/2022] Open
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Prasad RB, Asplund O, Shukla SR, Wagh R, Kunte P, Bhat D, Parekh M, Shah M, Phatak S, Käräjämäki A, Datta A, Kakati S, Tuomi T, Saboo B, Ahlqvist E, Groop L, Yajnik CS. Subgroups of patients with young-onset type 2 diabetes in India reveal insulin deficiency as a major driver. Diabetologia 2022; 65:65-78. [PMID: 34689214 PMCID: PMC8660725 DOI: 10.1007/s00125-021-05543-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
AIM/HYPOTHESIS Five subgroups were described in European diabetes patients using a data driven machine learning approach on commonly measured variables. We aimed to test the applicability of this phenotyping in Indian individuals with young-onset type 2 diabetes. METHODS We applied the European-derived centroids to Indian individuals with type 2 diabetes diagnosed before 45 years of age from the WellGen cohort (n = 1612). We also applied de novo k-means clustering to the WellGen cohort to validate the subgroups. We then compared clinical and metabolic-endocrine characteristics and the complication rates between the subgroups. We also compared characteristics of the WellGen subgroups with those of two young European cohorts, ANDIS (n = 962) and DIREVA (n = 420). Subgroups were also assessed in two other Indian cohorts, Ahmedabad (n = 187) and PHENOEINDY-2 (n = 205). RESULTS Both Indian and European young-onset type 2 diabetes patients were predominantly classified into severe insulin-deficient (SIDD) and mild obesity-related (MOD) subgroups, while the severe insulin-resistant (SIRD) and mild age-related (MARD) subgroups were rare. In WellGen, SIDD (53%) was more common than MOD (38%), contrary to findings in Europeans (Swedish 26% vs 68%, Finnish 24% vs 71%, respectively). A higher proportion of SIDD compared with MOD was also seen in Ahmedabad (57% vs 33%) and in PHENOEINDY-2 (67% vs 23%). Both in Indians and Europeans, the SIDD subgroup was characterised by insulin deficiency and hyperglycaemia, MOD by obesity, SIRD by severe insulin resistance and MARD by mild metabolic-endocrine disturbances. In WellGen, nephropathy and retinopathy were more prevalent in SIDD compared with MOD while the latter had higher prevalence of neuropathy. CONCLUSIONS /INTERPRETATION Our data identified insulin deficiency as the major driver of type 2 diabetes in young Indians, unlike in young European individuals in whom obesity and insulin resistance predominate. Our results provide useful clues to pathophysiological mechanisms and susceptibility to complications in type 2 diabetes in the young Indian population and suggest a need to review management strategies.
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Affiliation(s)
- Rashmi B Prasad
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden.
| | - Olof Asplund
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
| | - Sharvari R Shukla
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
- Symbiosis Statistical Institute, Symbiosis International University, Pune, India
| | - Rucha Wagh
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Pooja Kunte
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Dattatrey Bhat
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Malay Parekh
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Meet Shah
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Sanat Phatak
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Annemari Käräjämäki
- Department of Primary Health Care, Vaasa Central Hospital, Vaasa, Finland
- Diabetes Center, Vaasa Health Care Center, Vaasa, Finland
| | - Anupam Datta
- Assam Medical College and Hospital, Dibrugarh, India
| | | | - Tiinamaija Tuomi
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
- Abdominal Center, Endocrinology, Helsinki University Central Hospital, Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, Helsinki University, 00290, Helsinki, Finland
| | - Banshi Saboo
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Emma Ahlqvist
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
- Institute for Molecular Medicine Finland FIMM, Helsinki University, 00290, Helsinki, Finland
| | - Chittaranjan S Yajnik
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India.
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Prasad RB, Asplund O, Shukla SR, Wagh R, Kunte P, Bhat D, Parekh M, Shah M, Phatak S, Käräjämäki A, Datta A, Kakati S, Tuomi T, Saboo B, Ahlqvist E, Groop L, Yajnik CS. Correction to: Subgroups of patients with young-onset type 2 diabetes in India reveal insulin deficiency as a major driver. Diabetologia 2022; 65:254. [PMID: 34807304 PMCID: PMC9172718 DOI: 10.1007/s00125-021-05620-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rashmi B Prasad
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden.
| | - Olof Asplund
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
| | - Sharvari R Shukla
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
- Symbiosis Statistical Institute, Symbiosis International University, Pune, India
| | - Rucha Wagh
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Pooja Kunte
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Dattatrey Bhat
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Malay Parekh
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Meet Shah
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Sanat Phatak
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India
| | - Annemari Käräjämäki
- Department of Primary Health Care, Vaasa Central Hospital, Vaasa, Finland
- Diabetes Center, Vaasa Health Care Center, Vaasa, Finland
| | - Anupam Datta
- Assam Medical College and Hospital, Dibrugarh, India
| | | | - Tiinamaija Tuomi
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
- Abdominal Center, Endocrinology, Helsinki University Central Hospital, Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, Helsinki University, 00290, Helsinki, Finland
| | - Banshi Saboo
- Dia Care - Diabetes Hormone Clinic, Ahmedabad, India
| | - Emma Ahlqvist
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, CRC, Lund University, Malmö, Sweden
- Institute for Molecular Medicine Finland FIMM, Helsinki University, 00290, Helsinki, Finland
| | - Chittaranjan S Yajnik
- Diabetes Unit, Kamalnayan Bajaj Diabetology Research Centre, King Edward Memorial Hospital and Research Centre, Pune, India.
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Saboo B, Parikh RM. RSSDI's Defeat Diabetes Campaign: India takes a major leap in the direction of diabetes care capital of the world. Int J Diabetes Dev Ctries 2021; 41:523-525. [PMID: 34924729 PMCID: PMC8668391 DOI: 10.1007/s13410-021-01036-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Banshi Saboo
- DiaCare-Diabetes Care and Hormonal Clinic, Ahmedabad, Gujarat India
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Shamanna P, Joshi S, Shah L, Dharmalingam M, Saboo B, Mohammed J, Mohamed M, Poon T, Kleinman N, Thajudeen M, Keshavamurthy A. Type 2 diabetes reversal with digital twin technology-enabled precision nutrition and staging of reversal: a retrospective cohort study. Clin Diabetes Endocrinol 2021; 7:21. [PMID: 34776010 PMCID: PMC8591797 DOI: 10.1186/s40842-021-00134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background Type 2 diabetes reversal has been viewed in the literature primarily as a dichotomous event (reversed or not reversed), even though this viewpoint may not be optimal for clinicians or patients. This cohort study’s objectives were to define stages of type 2 diabetes reversal and measure changes in reversal stages before and after 90 days of digital twin-enabled precision nutrition therapy. Methods This study defines seven stages of diabetes reversal. The study is a retrospective pre/post comparison of changes in reversal stage, hemoglobin A1c (HbA1c), weight, body mass index (BMI), and other metrics measured before and after precision nutrition therapy. Reversal stages were defined as Stage 0: HbA1c < 5.7% without medication for > 1 year, Stage 1: HbA1c < 5.7% without medication for < 1 year, Stage 2: HbA1c < 6.5% without medication, Stage 3: estimated HbA1c (eA1c) between 5.7 and 6.4% without medication, Stage 4: estimated HbA1c (eA1c) between 5.7 and 6.4% with metformin monotherapy, Stage 5: dual oral therapy, Stage 6: > = 3 medications. Results Reversal stage information was available for 463 patients at baseline and 90 days. At baseline, the proportions of patients in each reversal stage were Stages 1 and 2: 0%, Stage 3: 1%, Stage 4: 8%, Stage 5: 6%, and Stage 6: 85%. After 90 days, the proportions in each reversal stage were Stage 1: 2%, Stage 2: 9%, Stage 3: 32%, Stage 4: 39%, Stage 5: 7%, and Stage 6: 11%, indicating significant progress. Reversal stage progression rates varied by patient subgroup. Conclusions Type 2 diabetes patients reached differing reversal stages during 90 days of precision nutrition therapy. Use of reversal stages may benefit patients during therapy. Trial registration This was a retrospective study that was approved by the Medisys Clinisearch Ethical Review Board (without registration number) in 2019.
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Affiliation(s)
| | | | - Lisa Shah
- Twin Health, Mountain View, California, 94043, USA
| | - Mala Dharmalingam
- Bangalore Endocrinology & Diabetes Research Centre, Bangalore, Karnataka, 560003, India
| | - Banshi Saboo
- Diacare - Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, 380005, India
| | | | | | | | - Nathan Kleinman
- Kleinman Analytic Solutions, LLC, Missouri City, TX, 77459, USA.
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Saboo B, Agarwal S, Gupta S, Makkar B, Panneerselvam A, Sahoo AK, Ramchandani GD, Das S, Erande S, Kadam Y, Abhyankar MV, Revankar S. REAL-world evidence of risk factors and comorbidities in YOUNG Indian adults with type 2 diabetes mellitus: A REAL YOUNG (diabetes) study. J Family Med Prim Care 2021; 10:3444-3452. [PMID: 34760771 PMCID: PMC8565132 DOI: 10.4103/jfmpc.jfmpc_2010_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To assess the clinical characteristics, risk factors, and comorbidities associated with type 2 diabetes mellitus (T2DM) in young adult patients. Methods This is a retrospective, multicentric real-world study that included young adults (18-45 years) with T2DM. Primary information including demographics, medical and family history, biochemical measures (pre-and post-prandial blood glucose levels, glycosylated hemoglobin [HbA1c] and blood pressure, and lipid parameters) smoking and drinking habits were collected retrospectively from the medical records of the respective hospitals/clinics. Data were analyzed using descriptive and appropriate comparative statistics. Results A total of 22,921 patients from 623 sites were included. The median age was 37.0 years and the majority were men (61.6%). The proportion of patients from the age group >35-≤45 years was 62.7%. Among all patients, 46.9% had only T2DM; however, 53.1% of patients had T2DM with other comorbidities (T2DM with hypertension, dyslipidemia, and both). The majority of patients had elevated body mass index (BMI) (overweight, 46.6%; and obese, 22.9%). Family history of T2DM (68.1%) was most common in overall population. Sedentary lifestyle (63.1%), alcohol consumption (38.9%), and regular smoking (23.1%) were the most common associations in patients with T2DM with dyslipidemia and hypertension. Uncontrolled HbA1c level (≥7%) were observed in 79.2% of patients. The level of HbA1c was significantly increased with the duration of T2DM and sedentary lifestyle (p < 0.001). Conclusion Higher BMI, family history of T2DM, sedentary lifestyle, alcohol consumption, and smoking were the most common risk facors, while hypertension and dyslipidemia were the most prevalent comorbidities associated with T2DM in young Indian adults.
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Affiliation(s)
- Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Sanjay Agarwal
- Department of Internal Medicine, Dr. Sanjay Agarwal's Aegle Clinic, City, Pune, Maharashtra, India
| | - Sunil Gupta
- Department of Diabetology, Sunil's Diabetes Care Research Centre, Nagpur, Maharashtra, India
| | - Brij Makkar
- Department of Diabetology, Dr. Makkar's Diabetes and Obesity Centre, Delhi, India
| | - A Panneerselvam
- Department of Diabetology, Aruna Diabetes Centre, Chennai, Tamil Nadu, India
| | - Abhay Kumar Sahoo
- Department of Endocrinology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India
| | - G D Ramchandani
- Ramachandani Diabetes Care and Research Centre, Kota, Rajasthan, India
| | - Sambit Das
- Department of Endocrinology, Endeavour Clinics, Bhubaneswar, Odisha, India
| | - Suhas Erande
- Department of Diabetology, Akshay Hospital and Diabetic Speciality Centre and Insulin Pump Centre, Pune, Maharashtra, India
| | - Yogesh Kadam
- Department of Diabetology, Poona Diabetes Centre, Pune, Maharashtra, India
| | - Mahesh V Abhyankar
- Department of Scientific Services, Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
| | - Santosh Revankar
- Department of Scientific Services, Scientific Services, USV Private Limited, Mumbai, Maharashtra, India
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Abstract
BACKGROUND Current guidelines state that screening for diabetes should be done at 30 years of age in India. METHODS Investigators from multiple sites in India were involved in providing data regarding patients with type 2 diabetes (T2D) aged 30 years or less. Other relevant studies were also reviewed. RESULTS Overview of published and unpublished data show increasing prevalence of T2D in individuals 30 years and less. About 3/4th of them had overweight/obesity. CONCLUSION Screening for diabetes in India should start at 25 years in non-pregnant adults instead of 30 years as currently stipulated.
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Affiliation(s)
- Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), India; Diabetes Foundation (India) (DFI), India.
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr.A.Ramachandran's Diabetes Hospitals, Chennai, India
| | - Banshi Saboo
- Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | | | - Ashok Kumar Das
- Sri Aurobindo Heath System, New Medical Center, Pondicherry, India
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48
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Gupta R, Kesavadev J, Krishnan G, Agarwal S, Saboo B, Shah M, Mittal A, Durani S, Luthra A, Singhal A, Rasheed M, Rao GVS, Tripathi V, Jha A, Ghosh A, Mohan V, Singh AK, Phatak S, Panicker J, Bhadada SK, Joshi S, Pal R, Mithal A, Vikram N, Misra A. COVID-19 associated mucormycosis: A Descriptive Multisite Study from India. Diabetes Metab Syndr 2021; 15:102322. [PMID: 34717135 PMCID: PMC8635309 DOI: 10.1016/j.dsx.2021.102322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. METHODS Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. RESULTS There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. CONCLUSION Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.
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Affiliation(s)
| | | | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | | | | | - Atul Mittal
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Suhail Durani
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Atul Luthra
- Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Anuj Singhal
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - G V S Rao
- Dr Rao's ENT Centre, Hyderabad, Telangana, India
| | | | - Alka Jha
- Fortis Rajan Dhall Hospital, New Delhi, India
| | | | - V Mohan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamilnadu, India
| | | | | | | | | | | | - Rimesh Pal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Naval Vikram
- All India Institute of Medical Sciences, New Delhi, India
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49
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Nanditha A, Raghavan A, Misra A, Saboo B, Singh AK, Joshi SR, Agarwal S, Tandon N, Tiwaskar M, Aravind SR, Ramachandran A. Management of Hyperglycemia in COVID-19 and Post-COVID-19 Syndrome - Proposed Guidelines for India. J Assoc Physicians India 2021; 69:11-12. [PMID: 34585892 DOI: pmid/34585892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SARS-CoV-2 virus spread rapidly all over the globe in 2020 and the second wave has taken our nation, India by storm. The pandemic has posed unique challenges in people with metabolic disorders, including diabetes, hypertension, obesity, pulmonary, cardiovascular, kidney and non-alcoholic fatty liver disease. Uncontrolled diabetes, in conjunction with endocrine, inflammatory and metabolic effects of the infection itself has made management of hyperglycemia in COVID-19 infection particularly challenging. Furthermore, the post-COVID-19 syndrome has also emerged as a sequela in COVID-19 survivors, increasing the risk of death, complications and adding further burden on the health care system. With more than a year of experience, we have gained substantial insight; and now provide practical recommendations on the management of hyperglycemia in COVID-19 as well as post COVID-19 syndrome.
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Affiliation(s)
- Arun Nanditha
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Arun Raghavan
- Director, Consultant Diabetologist, India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - 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 (India) (DFI), New Delhi
| | - Banshi Saboo
- Chief Diabetologist Chairman, Diabetes Care Hormone Clinic, Ahmedabad, Gujarat
| | - Awadhesh Kumar Singh
- Senior Consultant Endocrinologist, G.D Hospital Diabetes Institute, Kolkata, West Bengal
| | - Shashank R Joshi
- Senior Consultant Endocrinologist, Lilavati Hospital and Medical Research Centre, Mumbai, Maharashtra
| | - Sanjay Agarwal
- Director - Aegle Clinic for Diabetes Care, Head of Dept. Medicine Diabetes, Ruby Hall Clinic. Senior Consultant Diabetes Medicine, Jehangir Hospital, Pune, Maharashtra
| | - Nikhil Tandon
- Professor Head, Department of Endocrinology Metabolism, All India Institute of Medical Sciences, New Delhi
| | - Mangesh Tiwaskar
- Consultant Physician Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Sosale R Aravind
- Director, Diacon Hospital, Bangalore, Karnataka; 10President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
| | - Ambady Ramachandran
- President, India Diabetes Research Foundation, Chairman, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, Tamil Nadu
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50
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Hasnani D, Chavda V, Agrawal D, Patni B, David A, Gathe S, Chawla R, Kesavadev J, Gupta S, Hasnani S, Saboo B. Validation of RSSDI therapeutic wheel with clinical experience of Indian physicians. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00998-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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