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Mohan V.,Madras Diabetes Research Foundation | Shah S.,The Mutual | Saboo B.,Dia Care Clinic
Journal of Association of Physicians of India | Year: 2013

Background: According to the ICMR - INDIAB study, there are 62.4 million people living with diabetes in India. Type 2 diabetes (T2DM) is a progressive disease and hampers the quality of life of the patients due to micro and macrovascular complications. There are few studies on the status of glycemic control in the country. Such data would be useful to allocate health resources and plan measures for instituting better control of diabetes. Methods: The A1chieve study was an observational study of patients 66,726 with T2DM who were initiated, on or switched to, insulin analogues, alone or in combination with oral glucose lowering drugs at the discretion of their physician in accordance with local, routine clinical practice. This study reports on the participants in India from the A1chieve study. Results: Baseline data of A1chieve study in 20,554 Indian T2DM patients showed that the mean HbA1c was 9.2%. Diabetes control was worse in those with longer duration of diabetes (9.9 ± 5.5 years). Use of insulin was clearly suboptimal showing evidence of clinical inertia. The prevalence of both macrovascular and microvascular complications was high due to poor glycemic control. The prevalence of neuropathy was the most common complication followed by cardiovascular (23.6%), renal (21.1%) and eye (16.6%) complications. The prevalence of foot ulcer was 5.1%. Many patients had multiple complications. Conclusion: Glycemic control in India is poor and this has resulted in a high prevalence of complications. This emphasizes the fact that effective control of T2DM is urgently needed to prevent or reduce the risk of developing the complications of diabetes in Indian T2DM patients. © SUPPLEMENT TO JAPI. Source


Narayan K.M.V.,Emory University | Echouffo-Tcheugui J.B.,Emory University | Mohan V.,Emory University | Ali M.K.,Madras Diabetes Research Foundation
Health Affairs | Year: 2012

Continued increases in the prevalence of and disproportionate health spending associated with type 2 diabetes argue for policies focused on preventing that condition and treating it appropriately, even as we strive to improve coordination of care for coexisting chronic diseases. This article argues that four policy paradigm shifts will be necessary to achieve that specific emphasis on type 2 diabetes: conceptually integrating primary and secondary prevention along a clinical continuum; recognizing the central importance of early detection of prediabetes and undiagnosed diabetes in implementing cost-effective prevention and control; integrating community and clinical expertise, and resources, within organized and affordable service delivery systems; and sharing and adopting evidence-based policies at the global level. © 2012 Project HOPE-The People-to-People Health Foundation, Inc. Source


Anjana R.M.,Madras Diabetes Research Foundation
Journal of diabetes science and technology | Year: 2011

Currently available estimates of diabetes prevalence in India are based on published data derived from very few studies. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study is a community-based survey conceived with the aim of obtaining the prevalence rates of diabetes in India as a whole, covering all 28 states, the National Capital Territory of Delhi, and two of the union territories in the mainland of India, with a total sample size of 124,000 individuals. A stratified multistage sampling design has been used. In all study subjects, a structured questionnaire was administered and anthropometric parameters and blood pressure were measured. Fasting capillary blood glucose was first determined using a glucose meter. An oral glucose load was then administered to all subjects except those with self-reported diabetes, and the 2 h post-load capillary blood glucose was estimated. In every fifth subject, a fasting venous sample was collected for measurement of lipids and creatinine, a resting 12-lead electrocardiogram was performed, and dietary assessment questionnaire was administered. In all diabetic subjects, an additional diabetes questionnaire was used and a fasting venous sample drawn for glycated hemoglobin. All biological samples collected were analyzed in a central laboratory. All data collected were stored electronically. Quality control was achieved through multiple tiers of checks. The ICMR-INDIAB study is the first of its kind attempting to provide accurate and comprehensive state- and national-level data on diabetes prevalence in India. © 2011 Diabetes Technology Society. Source


Sandeep S.,Madras Diabetes Research Foundation
The Journal of the Association of Physicians of India | Year: 2011

The aim of the study was to assess the association of Insulin Resistance [IR] assessed by Homeostasis Assessment model (HOMA-IR) with cardiovascular risk factors in subjects with Normal Glucose Tolerance [NGT] in Asian Indians. This cross-sectional study recruited subjects from the Chennai Urban Rural Epidemiology Study [CURES] an epidemiological study in a representative population of Chennai [formerly Madras], in South India. We included 1550 subjects with normal glucose tolerance, ie, fasting plasma glucose < 100 mg/dl [5.6 mmol/L] and 2 hour post load plasma glucose < 140 mg/dl [7.8 mmol/L]. IR was calculated using the homeostasis assessment model (HOMA-IR) using the formula: fasting insulin (1IU/mL) fasting glucose (mmol/L)/22.5. Metabolic syndrome [MS] was defined based on modified Adult Treatment Panel III (ATP III) guidelines. HOMA-IR was found to be significantly associated with systolic blood pressure (beta = 0.100, p < 0.001), diastolic pressure (beta = 0.094, p < 0.001), total cholesterol (beta = 0.068, p = 0.005), serum triglycerides (beta = 0.105, p < 0.001), LDL cholesterol (beta = 0.118, p < 0.005), and HDL cholesterol (beta = -0.060, p < 0.001) even after adjusting age, gender and BMI. Subjects with family history of type 2 diabetes had significantly higher HOMA-IR [p = 0.011] compared to those without family history. In relation to physical activity, subjects with heavy grade activity had significantly lower HOMA-IR values compared to the light grade activity [p < 0.001] Subjects with generalized obesity [p < 0.001] and abdominal obesity [p < 0.001] had significantly higher HOMA-IR which remained statistically significant even after adjusting for age and gender. There was a linear increase in the mean values of HOMA IR with increase in number of components of MS [p for trend < 0.001] Among Asian Indians who are known to have high risk of premature coronary artery disease and diabetes, a significant association exists between insulin resistance with cardiovascular risk factors even among NGT subjects. Source


Unnikrishnan R.,Madras Diabetes Research Foundation | Mohan V.,Madras Diabetes Research Foundation
Diabetes Technology and Therapeutics | Year: 2013

Glycated hemoglobin (HbA1c) is the most widely accepted index of long-term glycemic control. However, there are some clinical situations that make the accurate measurement of HbA1c difficult. Although some of these situations are general, others are more specific to some parts of the world like India. These conditions include hemoglobinopathies such as thalassemias and structural hemoglobin (Hb) variants such as HbS and HbD, as well as iron-deficiency anemia and the use of certain drugs. Because of the relatively frequent occurrence of some of these conditions in some parts of India, it is important that they are looked for when evaluating an inappropriately high or low HbA1c level. Alternative indices may have to be used for assessing glycemic control in these cases. © 2013 Mary Ann Liebert, Inc. Source

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