Dr Mohans Diabetes Specialities Center

Gopalapuram, India

Dr Mohans Diabetes Specialities Center

Gopalapuram, India
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Patel V.,London School of Hygiene and Tropical Medicine | Chatterji S.,Health Statistics and Informatics | Ebrahim S.,London School of Hygiene and Tropical Medicine | Ebrahim S.,Public Health Foundation of India | And 7 more authors.
The Lancet | Year: 2011

Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved. © 2011 Elsevier Ltd.

Rajalakshmi R.,Dr Mohans Diabetes Specialities Center | Prathiba V.,Dr Mohans Diabetes Specialities Center | Mohan V.,Dr Mohans Diabetes Specialties Center
Indian Journal of Ophthalmology | Year: 2016

Diabetic retinopathy (DR), one of the leading causes of preventable blindness, is associated with many systemic factors that contribute to the development and progression of this microvascular complication of diabetes. While the duration of diabetes is the major risk factor for the development of DR, the main modifiable systemic risk factors for development and progression of DR are hyperglycemia, hypertension, and dyslipidemia. This review article looks at the evidence that control of these systemic factors has significant benefits in delaying the onset and progression of DR. © 2016 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow.

Joshi S.R.,Sir J J Group of Hospitals | Mohan V.,Dr Mohans Diabetes Specialities Center | Joshi S.S.,Mumbai Diet and Health Center | Mechanick J.I.,Mount Sinai School of Medicine | Marchetti A.,Rutgers University
Current Diabetes Reports | Year: 2012

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India - coupled with a sedentary lifestyle and specific socioeconomic pressures - has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant Indiaspecific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs. © Springer Science+Business Media, LLC 2012.

Pradeepa R.,Dr Mohans Diabetes Specialities Center | Prabhakaran D.,Asia Risk Centre | Mohan V.,Dr Mohans Diabetes Specialities Center
Diabetes Technology and Therapeutics | Year: 2012

Diabetes and cardiovascular diseases (CVDs) are increasing in epidemic proportions globally, with the most marked increase in emerging economies. Among emerging economies, China and India have the highest numbers of people with diabetes and CVD. Over the last two decades, 80% of CVD and diabetes mortality occurred in low- and middle-income countries, suggesting that these disorders have become a leading threat to public health in most of the developing countries. The burden of CVD and diabetes in the developing countries affects the productive younger age group, and this has serious economic implications. Diabetes shares many characteristics and risk factors with CVD, and thus the risk for CVD also escalates with the increase in prevalence of diabetes. Both genetic and environmental factors play a major role in causation of diabetes and CVD. However, the major drivers of this dual epidemic are demographic changes with increased life expectancy, lifestyle changes due to rapid urbanization, and industrialization. To reduce the burden of diabetes and CVD in the coming decades, emerging economies need to set national goals for early diagnosis, effective management, and primary prevention of these disorders. In order to curb the epidemic of diabetes and CVD, population-based, multisectoral, multidisciplinary, and culturally relevant approaches including various departments of the government as well as non-governmental agencies are required. © 2012 Mary Ann Liebert, Inc.

Ley S.H.,Harvard University | Hamdy O.,Joslin Diabetes Center | Mohan V.,Dr Mohans Diabetes Specialities Center | Hu F.B.,Harvard University
The Lancet | Year: 2014

In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities.

Davies M.J.,University of Leicester | Gagliardino J.J.,National University of La Plata | Gray L.J.,University of Leicester | Khunti K.,University of Leicester | And 2 more authors.
Diabetic Medicine | Year: 2013

Aims: To identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus. Methods: A literature search was conducted in PubMed and EMBASE in November 2011 to identify studies reporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes. Results: Seventeen studies were identified; six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conducted exclusively in the USA. Four categories of factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, type of delivery device and cost of medication. For predictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence was improved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies). Conclusions: Adherence to insulin therapy is generally poor. Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, although findings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence and enable development of strategies to improve. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

Amutha A.,Dr Mohans Diabetes Specialities Center | Datta M.,Dr Mohans Diabetes Specialities Center | Unnikrishnan R.,Dr Mohans Diabetes Specialities Center | Anjana R.M.,Dr Mohans Diabetes Specialities Center | Mohan V.,Dr Mohans Diabetes Specialities Center
Diabetes Technology and Therapeutics | Year: 2012

Objective: This study describes the clinical characteristics of childhood- and adolescent-onset type 2 diabetes mellitus (CAT2DM) seen at a diabetes center in southern India. Research Design and Methods: Between January 1992 and December 2009, 368 CAT2DM patients were registered. Anthropometric measurements were done using standardized techniques. Biochemical investigations included C-peptide measurements and glutamic acid decarboxylase antibody assay wherever feasible. Retinopathy was diagnosed by retinal photography; microalbuminuria, if urinary albumin excretion was between 30 and 299 mg/μg of creatinine; nephropathy, if urinary albumin excretion was ≥300 mg/μg; and neuropathy, if vibration perception threshold on biothesiometry was ≥20 V. Results: The proportion of CAT2DM patients, expressed as percentage of total patients registered at our center, rose from 0.01% in 1992 to 0.35% in 2009 (P<0.001). Among the 368 cases of CAT2DM, 96 (26%) were diagnosed before the age of 15 years. The mean age at first visit and age at diagnosis of the CAT2DM subjects were 22.2±9.7 and 16.1±2.5 years, respectively. Using World Health Organization growth reference charts, 56% of boys and 50.4% of girls were >85 th percentile of body mass index for age. Prevalence rates of retinopathy, microalbuminuria, nephropathy, and neuropathy were 26.7%, 14.7%, 8.4%, and 14.2%, respectively. Regression analysis revealed female gender, body mass index >85 th percentile, parental history of diabetes, serum cholesterol, and blood pressure to be associated with earlier age at onset of CAT2DM. Conclusions: CAT2DM appears to be increasing in urban India, and the prevalence of microvascular complications is high. Female predominance is seen at younger ages. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Zhang H.,Capital Medical University | Zhang H.,Cangzhou Central Hospital | Mohan V.,Madras Diabetes Research Foundation | Mohan V.,Dr Mohans Diabetes Specialities Center | And 9 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Insulin resistance plays a part in diabetic nephropathy (DN). The association between the peroxisome proliferator-activated receptor γ Pro to Ala alteration at codon 12 (Pro12Ala) polymorphism and the risk of insulin resistance has been confirmed. The association between the polymorphismand DN risk has also been widely studied recently, but no consensus was available up to now. RESEARCH DESIGN AND METHODS - A systematic search of electronic databases (MEDLINE, Embase, and China National Knowledge Infrastructure) and reference lists of relevant articles was carried out, and then 18 case-control studies involving 3,361 DN cases and 5,825 control subjects were identified. RESULTS - In the overall analysis, the Ala12 variant was observed to be significantly associated with decreased DN risk (odds ratio 0.76 [95% CI 0.61-0.93]). Some evidence of heterogeneity among the included studies was detected, which could be explained by the difference of ethnicity and stage of DN. Subgroup analyses stratified by ethnicity and stage of DN were performed, and results indicated the Pro12Ala polymorphism was associated with the risk of DN in Caucasians but no similar association was observed in Asians. Additionally, we observed that Ala12 was associated with decreased risk of albuminuria. With only a few of subjects were available, we failed to detect statistically significant association between the polymorphism and end-stage renal disease (ESRD). CONCLUSIONS - Our results indicated that the Ala12 variant is a significantly protective factor for DN. Future research should focus on the effect of Pro12Ala polymorphism on ESRD and gathering data of Africans. © 2012 by the American Diabetes Association.

Unnikrishnan R.,Dr Mohans Diabetes Specialities Center | Mohan V.,Dr Mohans Diabetes Specialities Center
Acta Diabetologica | Year: 2015

Fibrocalculous pancreatic diabetes (FCPD) is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. The disease is restricted to tropical regions of the world, and southern India has the highest known prevalence of FCPD. The typical patient with FCPD is a lean adolescent or young adult of either sex, presenting with history of recurrent bouts of abdominal pain and steatorrhea. Demonstration of large, discrete pancreatic calculi by plain radiographs or ultrasonography of the abdomen is diagnostic. While the exact etiology of FCPD is unknown, genetic, nutritional and inflammatory factors have been hypothesized to play a role. Diabetes in FCPD is often brittle and difficult to control; most patients require multiple doses of insulin for control of glycemia. However, in spite of high blood glucose levels, patients rarely develop ketosis. Malabsorption responds to pancreatic enzyme supplementation. Surgical removal of stones is indicated for symptomatic relief of intractable pain. While patients with FCPD develop microvascular complications as frequently as those with type 2 diabetes, macrovascular disease is uncommon. Development of pancreatic malignancy is the most dreaded complication and should be suspected in any patient who complains of weight loss, back pain or jaundice. © 2014, Springer-Verlag Italia.

Pradeepa R.,Dr Mohans Diabetes Specialities Center | Anjana R.M.,Dr Mohans Diabetes Specialities Center | Unnikrishnan R.,Dr Mohans Diabetes Specialities Center | Ganesan A.,Dr Mohans Diabetes Specialities Center | And 2 more authors.
Diabetes Technology and Therapeutics | Year: 2010

Background: This study assessed the relationship between and risk factors for microvascular complications of diabetes in an urban South Indian type 2 diabetes population. Methods: Subjects with diabetes (n=1,736) were selected from the population-based Chennai Urban Rural Epidemiology Study (CURES) Eye Study conducted on a representative population of Chennai city in south India. Four-field stereo retinal color photography was done, and diabetic retinopathy (DR) was classified according to the Early Treatment DR Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the big toe using biothesiometry was ≥20V. Overt nephropathy was diagnosed if the subjects had persistent macroalbuminuria (urinary albumin excretion ≥300 μg/mg of creatinine) and microalbuminuria if it was between 30 and 299 μg/mg of creatinine. Among the 1,715 subjects with gradable fundus photographs, 1,608 individuals who had information on all test parameters were included. Results: Overall, DR was present in 282 (17.5%), neuropathy in 414 (25.7%), overt nephropathy in 82 (5.1%), and microalbuminuria in 426 (26.5%) subjects. Eighteen subjects had all three microvascular complications of diabetes. The risk of nephropathy (odds ratio [OR] =5.3, P<0.0001) and neuropathy (OR =2.9, P< 0.0001) was significantly higher among the subjects with sight-threatening DR compared to those without DR. Common risk factors identified for all the three microvascular complications of diabetes were age, glycated hemoglobin, duration of diabetes, and serum triglycerides. DR was associated with nephropathy after adjusting for age, gender, hemoglobin A1c, systolic blood pressure, serum triglycerides, and duration of diabetes (OR= 2.140, 95% confidence interval = 1.261-3.632, P=0.005). Conclusions: This is the first population-based study from India to report on all microvascular complications of diabetes and reveals that the association between DR and nephropathy is stronger than that with neuropathy. © 2010 Mary Ann Liebert, Inc.

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