Karnāl, India
Karnāl, India

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Kalra S.,Bharti Hospital
US Endocrinology | Year: 2016

The large multinational, randomised, double-blind LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results - A Long Term Evaluation) trial recently reported the cardiovascular (CV) benefits achieved with liraglutide therapy in type 2 diabetes mellitus (T2DM). This editorial analyses the primary and secondary CV outcomes (CVO) results of the LEADER trial, and discusses the impact these will have on clinical practice of diabetes in specific, and medicine in general. It delves into the evolution of clinical and biochemical outcomes used in diabetes, and discusses the role of liraglutide in shaping future outcomes. The editorial describes the potential role of liraglutide in primary, secondary and tertiary prevention of CV disease (CVD), and suggests exaptation of this molecule for use in cardiology, nephrology and neurology.


Kalra S.,Bharti Hospital | Agrawal N.,Obesity and Thyroid Center
Current Diabetes Reports | Year: 2013

Diabetes mellitus is a chronic disease with a higher risk of associated infections. HIV infection severely affects diabetic patients and acts as a significant health concern. Highly active antiretroviral therapy (HAART) has changed HIV from an acute infection to a chronic infection with associated significant metabolic abnormalities such as insulin resistance, impaired glucose tolerance, metabolic syndrome, diabetes, dyslipidemia, obesity, and lipodystrophy. These metabolic disturbances add complexity to the standards of care in HIV infection and further increase the risk for cardiovascular disease and renal complications. The co-association of diabetes and HIV needs to be managed appropriately to prevent mortality and morbidity and improve patient outcome. The current understanding of diabetes and other metabolic abnormalities along with management strategies in HIV infected patients are summarized in this article. The review also focuses on recent challenges in the diagnosis and management of co-existent diabetes and HIV infection. © 2013 Springer Science+Business Media New York.


Kalra S.,Bharti Hospital
Journal of Association of Physicians of India | Year: 2011

Diabetes mellitus (DM) is one of the most common chronic disorders, with increasing prevalence worldwide. Type 2 diabetes (T2DM), a multifaceted disease involving multiple pathophysiological defects, accounts for nearly 85-95% of total reported cases of DM. Chances of developing T2DM are increased by obesity and physical inactivity and are augmented further with age. Two most important unmet needs associated with the management of T2DM are the lack of lasting efficacy in reducing hyperglycemia and failure to target primary causes. Different classes of Oral Hypoglycemic Agents (OHA's) with nearly equipotent efficacy are now available targeting the different pathophysiologic factors contributing to T2DM; however, almost all of them are associated with one or the other kind of adverse effect. Several studies have found that certain diabetes drugs may carry increased cardiovascular (CV) risks compared to others. The new approach in management of T2DM based upon the effects of incretin hormones; Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). Vildagliptin is a drug from a new class of medications called dipeptidyl peptidase IV (DPP4) inhibitors. By inhibiting DPP-4, vildagliptin causes an increase in GLP-1, an intestinal hormone that aids in glucose homeostasis and insulin secretion. Vildagliptin has a half-life of about 90 minutes; however, ≥50% of DPP4 inhibition continues for more than 10 hours, allowing for once- or twice-daily dosing. Clinical trials have shown that vildagliptin is effective in significantly lowering glycosylated hemoglobin (HbA1c), fasting plasma glucose, and prandial glucose levels. β-cell function may also be improved. The drug has placebo like tolerability and rate of hypoglycemia events. Vildagliptin expands non-injectable treatment options available for management of T2DM patients, who are poorly controlled with monotherapy. © JAPI.


Kalra S.,Bharti Hospital
Journal of the Pakistan Medical Association | Year: 2013

Diabesity is a modern epidemic, which indicates the coexistence of both diabetes and obesity.Linked by various pathophysiological mechanisms, revolving around insulin resistance and hyperinsulinaemia, diabesity has important diagnostic and therapeutic implications. This review describes the important associations of diabesity, and highlights the various ono-pharmacological and pharmacological methods of management. It makes a strong call for utilising indigenous, low cost means of enhancing healthy dietary and physical activity habits.


Kalra S.,Bharti Hospital
Journal of the Pakistan Medical Association | Year: 2013

Advances in our understanding of the pathophysiology have spurred improvements in the way we approach and manage the disease. From being considered a disease of insulin deficiency, to one of insulin resistance (mediated by the liver, muscle and fat cell) and deficiency combined, to the multifaceted syndrome we now know it to be, diabetes has evolved significantly. This review describes the recently identified mechanisms linked with the causation and development of diabetes. It includes the newer players listed in the Ominous Octet (the alpha cell, the gastrointestinal tract, kidney and brain) and describes four hormones which complete the Dirty Dozen (dopamine, testosterone, renin-angiotensin system, Vitamin D). The article goes on to discuss fresh research incriminating iron and gut-derived serotonin in the etiopathogenesis of diabetes, and suggests therapeutic implications of pathophysiologic advances.


Khunti K.,University of Leicester | Davies M.J.,University of Leicester | Kalra S.,Bharti Hospital
Diabetes, Obesity and Metabolism | Year: 2013

Good glycaemic control in type 2 diabetes (T2DM) is associated with a reduced risk of diabetes complications; however, achieving and maintaining glycaemic control represents a major challenge to physicians, and despite the availability of a range of antidiabetic therapies, many patients with T2DM will eventually require insulin supplementation to reach target glycaemic levels. Insulin initiation, adjustment of the insulin dose and the need for frequent assessment of blood glucose levels are often complicated by patient and physician misconceptions and concerns regarding its use. For most patients requiring insulin therapy, dose titration is carried out by physicians; however, evidence suggests that this process may not provide optimal glycaemic management for patients. Self-monitoring of blood glucose and self-adjustment of insulin dose (insulin self-titration) is well established in type 1 diabetes, suggesting that similar therapeutic self-management may be beneficial when applied to patients with T2DM. This article reviews the rationale and clinical evidence for insulin self-titration in patients with T2DM with the aim of highlighting the importance of educating patients about insulin therapy and empowering them to manage their diabetes through self-titration of insulin. © 2012 Blackwell Publishing Ltd.


Baruah M.P.,Excel Hospitals | Kalra S.,Bharti Hospital
Recent Patents on Endocrine, Metabolic and Immune Drug Discovery | Year: 2012

Type 2 diabetes mellitus (T2DM) is a global public health problem. Due to the progressive nature of the disease, a combination(s) of two or more drugs acting on different pathophysiological process is often necessary to achieve early and sustained achievement of individualized glycemic targets. At the same time, choosing the safest option to avoid hypoglycemia is of paramount importance. GLP-1 analogues are a relatively recent class of anti-diabetic drugs, and are highly effective with an acceptable safety profile. Attempts have been made to combine GLP-1 analogues with basal insulin for management of T2DM. Presently GLP-1 analogues like exenatide/long acting exenatide and liraglutide have been co-administered with basal insulin like glargine and detemir respectively, and are approved by regulatory agencies. Currently a fixed dose combination (FDC) of insulin degludec and liraglutide is under development. GLP-1 analogue and insulin as FDC or by co-administration, is a rational method of controlling fasting and postprandial glucose effectively. The efficacy and safety of this combination has been studied in a wide population with promising outcomes. Innovative use of GLP-1 analogues beyond diabetes is also being attempted, and a variety of patents are filed or granted for the same. This review summarizes the current status of GLP-1 and insulin combination in the management of T2DM and highlights the new frontiers in research involving GLP-1. Patents on combination of GLP-1 and insulin which were granted earlier, and the ones which have been applied for, are also discussed. © 2012 Bentham Science Publishers.


Kalra S.,Bharti Hospital | Gupta Y.,Government Medical College and Hospital
Journal of Diabetes and Metabolic Disorders | Year: 2015

The choice of initial insulin is often dictated by subjective criteria: the " severity" of diabetes, the ability of the person with diabetes to self inject, at specific times of the day, and the physician's personal experience. No objective criteria have been evolved by any expert body so far to help guide clinicians make an appropriate, and accurate, choice of initiating insulin. Neither have large studies been able to shed light on the preferred type of insulin regime for a particular individual.This communication suggests various objective parameters which may be used to inform this decision. © 2015 Kalra and Gupta.


Kalra S.,Bharti Hospital
Journal of the Pakistan Medical Association | Year: 2013

The glucagon-like peptide-1 receptors agonists (GLP1RA) are a relatively new class of drugs, used for management of type 2 diabetes. This review studies the characteristics of these drugs, focusing upon their mechanism of action, intra-class differences, and utility in clinical practice. It compares them with other incretin based therapies, the dipeptidyl peptidase-IV inhibitors, and predicts future developments in the use of these molecules, while highlighting the robust indications for the use of these drugs.


Kalra S.,Bharti Hospital | Gupta Y.,Government Medical College and Hospital
North American Journal of Medical Sciences | Year: 2015

Insulin degludec (IDeg) is an ultralong acting basal insulin. IDeg has unique pharmacokinetic and pharmacodynamic properties which allow once a daily dosage, at any time of the day. Its use is associated with a significantly lower risk of hypoglycemia. This review discusses the pragmatic use of IDeg, based on available evidence. A complete search of all nine original research papers (BEGIN® clinical trial program) pertaining to IDeg, listed in PubMed, was made to prepare this article. © 2015 North American Journal of Medical Sciences. All rights reserved.

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