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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. Source


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. Source


Kalra S.,Bharti Hospital
Diabetes Therapy | Year: 2015

This article discusses the recently published EMPA-REG OUTCOME trial, which assessed cardiovascular outcomes with empagliflozin therapy in persons with type 2 diabetes mellitus and coexisting cardiovascular disease. The article describes the background and challenges of modern cardiovascular outcome trials, points out the strengths of the EMPA-REG OUTCOME study, and places the results in perspective. It highlights the significant impact that these results will have on cardiovascular preventive pharmacotherapy, and on future drug development in diabetes. At the same time, it reminds readers of the limitations of the results, and lists the questions raised by, or left unanswered by, the trial. © 2015, The Author(s). Source


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. Source


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. Source

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