Dr Mohans Diabetes Specialties Center

Chennai, India

Dr Mohans Diabetes Specialties Center

Chennai, India
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Misra A.,Fortis Flt Lt Rajan Dhall Hospital | Misra A.,Diabetes Foundation India | Sharma R.,Medicity | Gulati S.,Diabetes Foundation India | And 31 more authors.
Diabetes Technology and Therapeutics | Year: 2011

India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising "epidemics" of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians. © 2011 Mary Ann Liebert, Inc.

Kooner J.S.,Imperial College London | Kooner J.S.,Ealing Hospital National Health Service NHS Trust | Saleheen D.,Center for Non Communicable Diseases Pakistan | Saleheen D.,University of Cambridge | And 82 more authors.
Nature Genetics | Year: 2011

We carried out a genome-wide association study of type-2 diabetes (T2D) in individuals of South Asian ancestry. Our discovery set included 5,561 individuals with T2D (cases) and 14,458 controls drawn from studies in London, Pakistan and Singapore. We identified 20 independent SNPs associated with T2D at P < 10 -4 for testing in a replication sample of 13,170 cases and 25,398 controls, also all of South Asian ancestry. In the combined analysis, we identified common genetic variants at six loci (GRB14, ST6GAL1, VPS26A, HMG20A, AP3S2 and HNF4A) newly associated with T2D (P = 4.1 × 10 -8 to P = 1.9 × 10 -11). SNPs at GRB14 were also associated with insulin sensitivity (P = 5.0 × 10 -4), and SNPs at ST6GAL1 and HNF4A were also associated with pancreatic beta-cell function (P = 0.02 and P = 0.001, respectively). Our findings provide additional insight into mechanisms underlying T2D and show the potential for new discovery from genetic association studies in South Asians, a population with increased susceptibility to T2D. © 2011 Nature America, Inc. All rights reserved.

Venkataraman K.,National University of Singapore | Kannan A.T.,University of Delhi | Kalra O.P.,University of Delhi | Gambhir J.K.,University of Delhi | And 3 more authors.
Journal of Community Health | Year: 2012

A cross-sectional survey of 507 in- and outpatients, with diagnosed Type 2 diabetes mellitus (T2DM) was undertaken to study the relationships between personal, disease and treatment-related factors and diabetes control in a tertiary care hospital. On multivariate logistic regression analysis, self-efficacy (odds ratio (OR) = 2.94; 95% confidence interval (CI) = 1.92-4.54); P < 0.001) was the single most important determinant of current diabetes control (HbA1c ≤t 7%), along with absence of hyperglycemic symptoms in the past year (OR = 1.83; 95% CI = 1.15-2.93, P < 0.01), current treatment with oral medication (OR = 1.77; 95% CI = 1.17-2.66; P < 0.007), and adherence to dietary restrictions (OR = 2.7; 95% CI = 1.28-5.88; P < 0.009). Self-efficacy was itself influenced by educational status, employment, availability of family support, and positive mental attitudes. Our findings suggest that health care delivery inputs, patients' personal characteristics including education and attitude, and family support for care are complexly processed to determine patients' ability to manage their disease, which ultimately influences disease outcomes. © Springer Science+Business Media, LLC 2012.

Vimaleswaran K.S.,University of Reading | Bodhini D.,Madras Diabetes Research Foundation | Lakshmipriya N.,Nutrition and Dietetics Research | Ramya K.,Madras Diabetes Research Foundation | And 10 more authors.
Nutrition and Metabolism | Year: 2016

Background: Lifestyle factors such as diet and physical activity have been shown to modify the association between fat mass and obesity-associated (FTO) gene variants and metabolic traits in several populations; however, there are no gene-lifestyle interaction studies, to date, among Asian Indians living in India. In this study, we examined whether dietary factors and physical activity modified the association between two FTO single nucleotide polymorphisms (rs8050136 and rs11076023) (SNPs) and obesity traits and type 2 diabetes (T2D). Methods: The study included 734 unrelated T2D and 884 normal glucose-tolerant (NGT) participants randomly selected from the urban component of the Chennai Urban Rural Epidemiology Study (CURES). Dietary intakes were assessed using a validated interviewer administered semi-quantitative food frequency questionnaire (FFQ). Physical activity was based upon the self-report. Interaction analyses were performed by including the interaction terms in the linear/logistic regression model. Results: There was a significant interaction between SNP rs8050136 and carbohydrate intake (% energy) (Pinteraction = 0.04), where the 'A' allele carriers had 2.46 times increased risk of obesity than those with 'CC' genotype (P = 3.0 × 10-5) among individuals in the highest tertile of carbohydrate intake (% energy, 71 %). A significant interaction was also observed between SNP rs11076023 and dietary fibre intake (Pinteraction = 0.0008), where individuals with AA genotype who are in the 3rd tertile of dietary fibre intake had 1.62 cm lower waist circumference than those with 'T' allele carriers (P = 0.02). Furthermore, among those who were physically inactive, the 'A' allele carriers of the SNP rs8050136 had 1.89 times increased risk of obesity than those with 'CC' genotype (P = 4.0 × 10-5). Conclusions: This is the first study to provide evidence for a gene-diet and gene-physical activity interaction on obesity and T2D in an Asian Indian population. Our findings suggest that the association between FTO SNPs and obesity might be influenced by carbohydrate and dietary fibre intake and physical inactivity. Further understanding of how FTO gene influences obesity and T2D through dietary and exercise interventions is warranted to advance the development of behavioral intervention and personalised lifestyle strategies, which could reduce the risk of metabolic diseases in this Asian Indian population. © 2016 Vimaleswaran et al.

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.

Surendar J.,Madras Diabetes Research Foundation | Aravindhan V.,Madras Diabetes Research Foundation | Rao M.M.,Madras Diabetes Research Foundation | Ganesan A.,Madras Diabetes Research Foundation | And 2 more authors.
Metabolism: Clinical and Experimental | Year: 2011

The term metabolic syndrome (MS) refers to a conglomeration of many metabolic disorders. Recent studies suggest that inflammation plays a vital role in MS. There are however no data available on the recently characterized novel T-cell-derived cytokine interleukin (IL)-17 in MS; studies on the anti-inflammatory cytokine transforming growth factor (TGF)-β are also limited. The aim of the study was to look at IL-17 and TGF-β levels in subjects with and without MS. The study subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES), a population-based study in Chennai (formerly Madras) in southern India. Group 1 consisted of subjects without MS (non-MS) (n = 98) and group 2 consisted of subjects with MS (n = 156). MS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria modified for waist, according to the World Health Organization Asia Pacific guidelines. Serum IL-17 and TGF-β levels were estimated by enzyme-linked immunosorbent assay. Interleukin-17 levels were decreased (P < .001) and TGF-β levels (P < .001) were increased in subjects with MS compared to those without. With an increase in the number of metabolic risk factors, the IL-17 levels showed a decline, whereas the TGF-β levels showed an increase (P < .001). With respect to individual components of MS, TGF-β and IL-17 showed a significant association with blood pressure and blood glucose even after adjusting for age and sex. We report that IL-17 levels are decreased, whereas TGF-β levels are increased, among Asian Indians with MS. © 2011 Elsevier Inc. All rights reserved.

Surendar J.,Madras Diabetes Research Foundation | Mohan V.,Madras Diabetes Research Foundation | Mohan V.,Dr Mohans Diabetes Specialties Center | Rao M.M.,Madras Diabetes Research Foundation | And 3 more authors.
Diabetes Technology and Therapeutics | Year: 2011

Objective: Metabolic syndrome (MS) is a cluster of metabolic abnormalities associated with obesity, insulin resistance (IR), dyslipidemia, and hypertension in which inflammation plays an important role. Few studies have addressed the role played by T cell-derived cytokines in MS. The aim of the study was to look at the T-helper (Th) 1 (interleukin [IL]-12, IL-2, and interferon-γ [IFN-γ]) and Th2 (IL-4, IL-5, and IL-13) cytokines in MS in the high-risk Asian Indian population. Research Design and Methods: Study subjects were recruited from the Chennai Urban Rural Epidemiology Study. MS was defined using National Cholesterol Education Program-Adult Treatment Panel III criteria modified for waist according to World Health Organization Asia Pacific guidelines. Serum cytokine profile was determined by multiplex cytokine assay in subjects with (n=21) and without (n=33) MS. Results: Both Th1 and Th2 cytokines showed up-regulation in MS. IL-12 (5.40 pg/mL in MS vs. 3.24 pg/mL in non-MS; P < 0.01), IFN-γ (6.8 pg/mL in MS vs. 4.7 pg/mL in non-MS; P < 0.05), IL-4 (0.61 pg/mL in MS vs. 0.34 pg/mL in non-MS; P < 0.001), IL-5 (4.39 pg/mL in MS vs. 2.36 pg/mL in non-MS; P < 0.001), and IL-13 (3.42 pg in MS vs. 2.72 pg/mL in non-MS; P < 0.01) were significantly increased in subjects with MS compared with those without. Both Th1 and Th2 cytokines showed a significant association with fasting plasma glucose level even after adjusting for age and gender. The Th1 and Th2 cytokines also showed a negative association with adiponectin and a positive association with the homeostasis model of assessment of IR and high-sensitivity C-reactive protein. Conclusions: Apart from pro-inflammatory cytokines, Th cytokines might play an important role in inflammation, IR, and MS. © Copyright 2011, Mary Ann Liebert, Inc.

Chidambaram M.,Madras Diabetes Research Foundation | Chidambaram M.,Dr Mohans Diabetes Specialties Center | Chidambaram M.,World Health Organization | Chidambaram M.,International Diabetes Federation | And 8 more authors.
Metabolism: Clinical and Experimental | Year: 2010

Recent genomewide association studies have identified several new gene variants associated with type 2 diabetes mellitus (T2D) mostly in European populations. These need to be replicated in other populations. We studied 926 unrelated T2D and 812 normal glucose-tolerant subjects randomly selected from the Chennai Urban Rural Epidemiology Study in Southern India. A total of 45 single nucleotide polymorphisms (SNPs) from 15 genes and 13 unannotated loci identified from recent genomewide association T2D studies were genotyped. Only 6 of 45 SNPs studied were replicated in this South Indian population. Three SNPs-rs7756992 (P = .007), rs7754840 (P = .015), and rs6931514 (P = .029)-of the CDKAL1, rs7020996 (P = .003) of the CDKN2A/B gene, rs7923837 (P = .038) of the HHEX gene, and rs12056034 (P = .033) of the BAZ1B gene were associated with T2D in our population. Large-scale studies are needed in our population to validate our findings. © 2010 Elsevier Inc. All rights reserved.

Mohan V.,Diabetes Research Foundation | Mohan V.,Dr Mohans Diabetes Specialties Center | Mohan V.,International Diabetes Federation | Rani C.S.S.,Diabetes Research Foundation | And 6 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-To compare clinical profile of long-term survivors and nonsurvivors with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS-After conducting a retrospective survey of >200,000 case records, we identified T2DM survivors (>40 years of duration) and age at diagnosis and sex-matched T2DMnonsurvivors. Prevalence of complications and causes of death were analyzed. Retinopathy was diagnosed by retinal photography. Microalbuminuria and macroalbuminuria, peripheral vascular disease based on ankle-brachial index >0.9, coronary artery disease based on history of myocardial infarction or coronary revascularization, and neuropathy based on vibration perception threshold >20 V were compared in both groups. RESULTS-The mean duration of diabetes of survivors (n = 238) was 43.7±3.9 years, and that of the nonsurvivors (n = 307), at time of death, was 22.4±11.0 years (P<0.001). Nonsurvivors had significantly higher systolic and diastolic blood pressures, plasma glucose, HbA1c, serum cholesterol, LDL cholesterol, and triglycerides and lower HDL cholesterol compared with long-term survivors (P<0.001 for all parameters except systolic blood pressure, which was P = 0.027). Myocardial infarction (46.4%) and renal failure (16.6%) were the most common causes of death. Prevalence of most complications was higher among survivors because of longer duration and older age, as follows, for survivors versus nonsurvivors: retinopathy, 76 vs. 62%; microalbuminuria, 39.1 vs. 27.3%; macroalbuminuria, 8.4 vs. 23.7%; neuropathy, 86.5 vs. 63.5%; peripheral vascular disease, 23.1 vs. 11.4%; and coronary artery disease, 44.5 vs. 40.7%. CONCLUSIONS-Long-term survivors with T2DM had better glycemic and blood pressure control and more favorable lipid profiles. © 2013 by the American Diabetes Association.

Aravindhan V.,Madras Diabetes Research Foundation | Mohan V.,Madras Diabetes Research Foundation | Mohan V.,Dr Mohans Diabetes Specialties Center | Surendar J.,Madras Diabetes Research Foundation | And 8 more authors.
PLoS Neglected Tropical Diseases | Year: 2010

Epidemiological studies have shown an inverse correlation between the incidence of lymphatic filariasis (LF) and the incidence of allergies and autoimmunity. However, the interrelationship between LF and type-2 diabetes is not known and hence, a cross sectional study to assess the baseline prevalence and the correlates of sero-positivity of LF among diabetic subjects was carried out (n = 1416) as part of the CURES study. There was a significant decrease in the prevalence of LF among diabetic subjects (both newly diagnosed [5.7%] and those under treatment [4.3%]) compared to pre-diabetic subjects [9.1%] (p = 0.0095) and non-diabetic subjects [10.4%] (p = 0.0463). A significant decrease in filarial antigen load (p = 0.04) was also seen among diabetic subjects. Serum cytokine levels of the pro-inflammatory cytokines-IL-6 and GM-CSF- were significantly lower in diabetic subjects who were LF positive, compared to those who were LF negative. There were, however, no significant differences in the levels of anti-inflammatory cytokines-IL-10, IL-13 and TGF-β-between the two groups. Although a direct causal link has yet to be shown, there appears to be a striking inverse relationship between the prevalence of LF and diabetes, which is reflected by a diminished pro-inflammatory cytokine response in Asian Indians with diabetes and concomitant LF.

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