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Ramachandran A.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Wan Ma R.C.,Chinese University of Hong Kong | Snehalatha C.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals
The Lancet | Year: 2010

Prevalence of type 2 diabetes has rapidly increased in native and migrant Asian populations. Diabetes develops at a younger age in Asian populations than in white populations, hence the morbidity and mortality associated with the disease and its complications are also common in young Asian people. The young age of these populations and the high rates of cardiovascular risk factors seen in Asian people substantially increase lifetime risk of cardiovascular disease. Several distinctive features are apparent in pathogenetic factors for diabetes and their thresholds in Asian populations. The economic burden due to diabetes at personal, societal, and national levels is huge. National strategies to raise public awareness about the disease and to improve standard of care and implementation of programmes for primary prevention are urgently needed. © 2010 Elsevier Ltd. All rights reserved.


Jagannathan R.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Nanditha A.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Sundaram S.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Simon M.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | And 4 more authors.
Journal of Association of Physicians of India | Year: 2014

Objective: To study the magnitude of undetected diabetes, impaired glucose tolerance (IGT) and clustering of cardiometabolic risk factors among male industrial workers. Methods: Measurements of 2h post glucose blood glucose (2h PG), blood pressure, body mass index (BMI) and waist circumference (WC) were done in 8741 non-diabetic men of 35-55 years. Presence of family history of diabetes (FH) was noted. Risk associations with diabetes and IGT were studied using multiple logistic regression analysis. Clustering of overweight/obesity, abdominal obesity, hypertension was noted. Results: Prevalence of undetected diabetes (14. 9%) and IGT (31. 4%) were high. FH, age, hypertension and BMI showed strong associations with diabetes and IGT. More than 40% had clustering of risk factors. Conclusion: High prevalence of undetected diabetes, IGT and clustering of cardiometabolic risk factors among young industrial workers mandates that regular screening for metabolic disorders should be undertaken to prevent development of severe morbidity in the productive years of life. © JAPI.


Ramachandran A.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Moses A.,Moses Diabetes Center | Shetty S.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Thirupurasundari C.J.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | And 4 more authors.
Diabetes Research and Clinical Practice | Year: 2010

Objective: Assess the ability of a new device based on electrochemical principles using iontophoresis (the EZSCAN ®) to detect impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). Methods: Eligible Asian Indian subjects, n=212, had anthropometric and blood pressure measurements, followed by an OGTT, HbA1c, serum lipids tests and EZSCAN ® measurement. Results: Biochemically, 24 subjects were diagnosed with DM, 30 with IGT, 57 subjects had normal glucose tolerance (NGT) with metabolic syndrome (MS) and 101 had NGT without MS. Fasting plasma glucose (FPG) and HbA1c levels were highest in the DM group (p<0.0001 for both). HDL-C levels were different (p=0.015). FPG at a cut-off level of 7.0mmol/L had a low sensitivity to detect DM (29%) EZSCAN ® had a 75% sensitivity to detect DM, 70% for IGT and 84% for NGT with MS at threshold >50%. Conclusions: FPG had low sensitivity to detect DM in the study group. EZSCAN ® demonstrated good sensitivity to detect IGT and DM and also identified NGT with MS. The concept of measuring ion fluxes through the skin appears to be a powerful method for early detection of MS, IGT and DM. © 2010 Elsevier Ireland Ltd.


Holman R.R.,University of Oxford | Bethel M.A.,University of Oxford | George J.,University of Oxford | Sourij H.,University of Oxford | And 18 more authors.
American Heart Journal | Year: 2016

Exenatide once-weekly is an extended release formulation of exenatide, a glucagon-like peptide–1 receptor agonist, which can improve glycemic control, body weight, blood pressure, and lipid levels in patients with type 2 diabetes mellitus (T2DM). The EXenatide Study of Cardiovascular Event Lowering (EXSCEL) will compare the impact of adding exenatide once-weekly to usual care with usual care alone on major cardiovascular outcomes. EXSCEL is an academically led, phase III/IV, double-blind, pragmatic placebo-controlled, global trial conducted in 35 countries aiming to enrol 14,000 patients with T2DM and a broad range of cardiovascular risk over approximately 5 years. Participants will be randomized (1:1) to receive exenatide once-weekly 2 mg or matching placebo by subcutaneous injections. The trial will continue until 1,360 confirmed primary composite cardiovascular end points, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, have occurred. The primary efficacy hypothesis is that exenatide once-weekly is superior to usual care with respect to the primary composite cardiovascular end point. EXSCEL is powered to detect a 15% relative risk reduction in the exenatide once-weekly group, with 85% power and a 2-sided 5% alpha. The primary safety hypothesis is that exenatide once-weekly is noninferior to usual care with respect to the primary cardiovascular composite end point. Noninferiority will be concluded if the upper limit of the CI is <1.30. EXSCEL will assess whether exenatide once-weekly can reduce cardiovascular events in patients with T2DM with a broad range of cardiovascular risk. It will also provide long-term safety information on exenatide once-weekly in people with T2DM. ClinicalTrials.gov Identifier: NCT01144338 © 2016 Mosby, Inc.


Nanditha A.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Jagannathan R.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Sundaram S.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | Susairaj P.,India Diabetes Research Foundation And Dr A Ramachandrans Diabetes Hospitals | And 5 more authors.
Journal of Association of Physicians of India | Year: 2014

Objective: To study the associations of baseline gamma-glutamyltransferase (GGT) and alanine transaminase (ALT) with incident diabetes among Asian Indian men with impaired glucose tolerance (IGT).Methods: In a 2 year prospective, randomised, controlled primary prevention study of diabetes, among 537 IGT men aged 35-55years, 123 incident diabetes (DM) cases occurred. Anthropometric {body mass index (BMI), waist circumference (WC)}, and laboratory measurements (fasting, 30 min and 2 hr plasma glucose (2 hr PG), HbA1c and plasma insulin, lipid profile, ALT, GGT) were estimated at baseline (Clinical Trial Identification No: NCT00819455). Predictive associations of baseline GGT and ALT values during the study were assessed using appropriate statistical methods.Results: Baseline GGT but not ALT was significantly higher in incident diabetes cases. Mean (95%CI) GGT decreased in subjects who reverted to normal glucose tolerance (NGT), whereas it increased in subjects who deteriorated to diabetes (NGT:-3.5 (-6.4 to -0.6); IGT:-0.3 (-3.0 to 2.4); DM:8.3 (3.6 to 13.0) UL-1; P < 0.0001). The risk of DM significantly increased with increasing baseline GGT after adjusting for confounders such as BMI, alcohol drinking, 2 hr PG and insulin resistance (2.02[1.35-3.02]; P = 0.001). Receiver operating characteristic curve showed that the model comprising of baseline fasting plasma glucose (FPG) and GGT (area-under-curve(AUC)[95% CI]: 0.668[0.613-0.722]; P < 0.0001) was equally sensitive in identifying subjects with risk of diabetes as compared to 2 hr PG (AUC [95% CI]: 0.670[0.614-0.725]; P < 0.0001) and HbA1c (AUC[95% CI]: 0.677[0.619-0.734]; P < 0.0001) alone.Conclusions: GGT was an independent predictor of incident diabetes. Combination of GGT and FPG offers a simple and sensitive tool to identify subjects at high risk of developing diabetes. © 2014, Journal of Association of Physicians of India. All rights reserved.

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