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Viswanathan V.,Mv Hospital For Diabetes And Prof swanathan Diabetes Research Center | Kumpatla S.,Mv Hospital For Diabetes And Prof swanathan Diabetes Research Center | Aravindalochanan V.,Mv Hospital For Diabetes And Prof swanathan Diabetes Research Center | Rajan R.,Mv Hospital For Diabetes And Prof swanathan Diabetes Research Center | And 3 more authors.
PLoS ONE | Year: 2012

Background: Diabetes mellitus (DM) is recognised as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. There are inadequate data on prevalence of DM and pre-diabetes among TB cases in India. Aim was to determine diabetes prevalence among a cohort of TB cases registered under Revised National Tuberculosis Control Program in selected TB units in Tamil Nadu, India, and assess pattern of diabetes management amongst known cases. Methods: 827 among the eligible patients (n = 904) underwent HbA1c and anthropometric measurements. OGTT was done for patients without previous history of DM and diagnosis was based on WHO criteria. Details of current treatment regimen of TB and DM and DM complications, if any, were recorded. A pretested questionnaire was used to collect information on sociodemographics, habitual risk factors, and type of TB. Findings: DM prevalence was 25.3% (95% CI 22.6-28.5) and that of pre-diabetes 24.5% (95% CI 20.4-27.6). Risk factors associated with DM among TB patients were age (31-35, 36-40, 41-45, 46-50, >50 years vs <30 years) [OR (95% CI) 6.75 (2.36-19.3); 10.46 (3.95-27.7); 18.63 (6.58-52.7); 11.05 (4.31-28.4); 24.7 (9.73-62.7) (p<0.001)], positive family history of DM [3.08 (1.73-5.5) (p<0.001)], sedentary occupation [1.69 (1.10-2.59) (p = 0.016)], and BMI (18.5-22.9, 23-24.9 and ≥25 kg/m2 vs <18.5 kg/m2) [2.03 (1.32-3.12) (p = 0.001); 0.87 (0.31-2.43) (p = 0.78); 1.44 (0.54-3.8) (p = 0.47)]; for pre-diabetes, risk factors were age (36-40, 41-45, 46-50, >50 years vs <30 years) [2.24 (1.1-4.55) (p = 0.026); 6.96 (3.3-14.7); 3.44 (1.83-6.48); 4.3 (2.25-8.2) (p<0.001)], waist circumference [<90 vs. ≥90 cm (men), <80 vs. ≥80 cm (women)] [3.05 (1.35-6.9) (p = 0.007)], smoking [1.92 (1.12-3.28) (p = 0.017)] and monthly income (5000-10,000 INR vs <5000 INR) [0.59 (0.37-0.94) (p = 0.026)]. DM risk was higher among pulmonary TB [3.06 (1.69-5.52) (p<0.001)], especially sputum positive, than non-pulmonary TB. Interpretation: Nearly 50% of TB patients had either diabetes or pre-diabetes. © 2012 Viswanathan et al.


Kapur A.,World Diabetes Foundation | Harries A.D.,International Union Against Tuberculosis and Lung Diseases | Harries A.D.,London School of Hygiene and Tropical Medicine
Diabetes Research and Clinical Practice | Year: 2013

Diabetes mellitus (DM) and tuberculosis (TB) have existed for thousands of years and even now the global disease burden from DM and TB is huge. The incidence of TB is declining slowly but it still remains a big problem in many populous large low and middle income countries. On the other, hand the burden of diabetes is increasing very rapidly, particularly in the very same countries where TB is endemic. The intersecting double burden is therefore ominous particularly as several studies and systematic reviews have indicated that DM increases the risk of TB disease and results in poor treatment outcomes. To address the double burden, WHO and the International Union Against Tuberculosis and Lung Disease (The Union) in 2011 launched a collaborative framework for the care and control of diabetes and tuberculosis, to encourage collaborative research and implement bidirectional screening of the two diseases in routine settings. This review article (i) explores some of the new evidence for the association between TB and DM, (ii) discusses issues with regard to clinical presentation and outcomes, (iii) presents the evidence, challenges and strategies for bidirectional screening based on field studies to implement the framework and (iv) finally presents suggestions on how diabetes care delivery may benefit from the lessons of the TB DOTS approach and public health principles for structured care delivery. © 2012 Elsevier Ireland Ltd.


News Article | December 6, 2016
Site: www.newsmaker.com.au

Frederick B and John M in 1923 were Nobel Prize awardee in Physiology or Medicine for discovery of Insulin. This serves a milestone in history of diabetes management as the death rate due to diabetes significantly reduced after its discovery. Insulin is a natural and most essential preprohormone produced by INS gene by islets of langerhans in pancreas by allowing body to take up glucose as energy source. Insulin prevents hyperglycemia and maintain blood sugar levels in co-ordination with glucagon. Diabetes is a most common health problem causing high blood sugar level resulting into excessive thirst and large amount of urine production. It causes secondary health associated problems such as diabetic ketoacidosis, hyperosmolar hyperglycemic states, and other serious complications (heart attack, stroke, kidney failure, leg amputation) leading to premature death. Diabetes is divided into 3 types i.e Type I diabetes, Type II diabetes and gestational diabetes. According to NCD CCS, insulin treatment is essential treatment for diabetes. FDA approved genetically engineered recombinant human Insulin and Insulin analogues are used in insulin management system. It is being estimated by World Diabetes Foundation that there will be 438 million people with diabetes by year 2030 which interprets demand for insulin management system market or solutions to accompany escalating diabetes population. Insulin management system shows a promising market growth due high global prevalence and incidence, extensive research and advancement in technology for effective insulin delivery systems and support from government and health care centers in making insulin management systems available throughout globe. According to WHO since 1980, the global prevalence of diabetes in adult population has risen from 4.7% to 8.5%. While in past decade the prevalence of Diabetes in low and middle income countries is higher than in higher income countries. Also, according to research carried out in University of Florida the reason for the mortality of children with type I diabetes is lack of access to Insulin management systems due to its high price. Hence unavailability of cheaper or affordable insulin management system thus hinder its market growth while its availability would increase market size and demand in low and middle income countries. The market for global Insulin management system is classified on the basis of disease indication, product type, mode of action, route of administration, end user and geography. Based on product type, the market for global insulin management system is segmented into the following: Based on disease indication, the global insulin management system market is segmented into the following: Based on product mode of action, the global insulin management system market is segmented into the following: Based on product route of administration, the global insulin management system market is segmented into the following: Based on end user, the global insulin management system market is segmented into the following: Insulin treatment for Type II diabetes holds largest share due to its high prevalence and also availability of variety and advances in insulin management systems available to treat type II diabetes. Also in comparison to recombinant human Insulin there is greater share for insulin analogues due to its higher efficacy with fast and long lasting effects. Moreover in comparison to painful traditional methods of insulin administration by injections, use of inhaled insulins are expected to have larger share in insulin management system market. Inhaled insulins are easy to administer, fast acting and is eliminated from body in less time. Thus, Insulin that is affordable, easy to administer, readily available, fast acting with long lasting effect and quick elimination from body is expected to hold strong position in insulin management system market. Region wise, the global regions in Insulin Management System market is classified into, North America, Latin America, Western and Eastern Europe, Asia-Pacific (excluding Japan) and MEA (Brazil, Argentina, Nigeria, Saudi Arabia & Egypt). America dominates the global insulin management system market due to higher prevalence of diabetes, high income population and also due to significant patent protection for brands of biosimilar insulin. Europe holds second largest insulin management system market due to better disrtribution of network for key players in insulin management system market. While Asia Pacific and MEA is fastest growing due to adoption of various advancement in insulin management system. Initiatives taken by government in developing countries to provide better healthcare facilities and easy utilization of insulin management system plays a larger role in increasing market for insulin management systems. Eli Lilly and Company, GlaxoSmithKline, Biocon, Sanofi Aventis, Julphar, Novo Nordisk, SemBioSys, and WOCKHARDT, Abbott India Ltd., USV Limited, Torrent Pharmaceuticals Ltd and Piramal Enterprises Limited are key players.


BAGSVAERD, Denmark, Nov. 14, 2016 /PRNewswire/ -- Today, Novo Nordisk announced a four-year extension of its Changing Diabetes® in Children programme which provides access to diabetes care and free insulin to children with type 1 diabetes in developing countries. The expansion sees five new countries join the programme; Cambodia, Ivory Coast, Myanmar, Senegal and Sudan. By 2020, more than 20,000 children over the course of 11 years will have benefited from the programme. To view the Multimedia News Release, please click: Ten years ago, a child in Sub-Saharan Africa diagnosed with type 1 diabetes often had a life expectancy of less than a year[i]. In response, Novo Nordisk established the Changing Diabetes® in Children programme to support sustainable quality care and improved diagnosis of the condition. Since the start of the programme in 2009, 13,700 children in nine countries in Africa and South-East Asia have received free human insulin and access to diabetes care. "The Changing Diabetes® in Children programme has been iconic," says Professor Azad Khan, president of the Diabetic Association of Bangladesh. "It has changed the lives of children with type 1 diabetes in Bangladesh. Their survival depends on the supply of insulin as well as education on how to cope with diabetes, and the programme provides all of this." A large number of children enrolled in the program are experiencing good control and have a chance to lead healthier lives. To date, 108 clinics have been established and more than 7,000 healthcare professionals have been trained in diabetes care. In addition to providing access to insulin, the Changing Diabetes® in Children programme aims to support the development of sustainable healthcare systems. Lars Rebien Sørensen, president and CEO of Novo Nordisk, expressed: "The provision of free medicine alone doesn't solve complex healthcare challenges. From the outset of this programme, we have therefore worked closely with local partners to deliver sustainable solutions alongside insulin to improve the lives of children with type 1 diabetes both now and in the future." The global partners in the programme are Novo Nordisk, Roche, the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the World Diabetes Foundation (WDF). In each of the nine already established countries (Cameroon, Democratic Republic of Congo, Ethiopia, Guinea, Kenya, Tanzania, Uganda, Bangladesh and India), the programme is implemented as a public-private partnership with a group of local partners. The national ministries of health in these countries play a key role to ensure that Changing Diabetes® in Children is anchored within the existing healthcare system. Novo Nordisk is a global healthcare company with more than 90 years of innovation and leadership in diabetes care. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions: haemophilia, growth disorders and obesity. Headquartered in Denmark, Novo Nordisk employs approximately 42,600 people in 75 countries and markets its products in more than 180 countries. For more information, visit novonordisk.com, Facebook, Twitter, LinkedIn, YouTube Further information  Media: Charlotte Zarp-Andersson +45-4442-7603 czpa@novonordisk.com Ken Inchausti (US) +1-609-786-8316 kiau@novonordisk.com Investors: Peter Hugreffe Ankersen +45-3075-9085 phak@novonordisk.com Melanie Raouzeos +45-3075-3479 mrz@novonordisk.com Hanna Ogren +45-3075-8519 haoe@novonordisk.com Anders Mikkelsen +45-3079-4461 arm@novonordisk.com Kasper Veje (US) +1-609-235-8567 kpvj@novonordisk.com


Veeraswamy S.,Dr V Seshiah Diabetes Research Institute | Vijayam B.,Dr V Seshiah Diabetes Research Institute | Gupta V.K.,Kishori Ram Hospital and Diabetes Care Center | Kapur A.,World Diabetes Foundation
Diabetes Research and Clinical Practice | Year: 2012

The prevalence of diabetes is increasing globally and the causes attributed are the ageing population, urbanization, obesity epidemic, physical inactivity and stressful modern life. While all these factors contribute to the epidemic of DM, intra-uterine exposures and gestational programming are emerging as potential risk factors. Gestational programming is a process whereby stimuli or stresses that occur at critical or sensitive periods of foetal development, permanently change structure, physiology, and metabolism, which predispose individuals to disease in adult life. If the stimulus happens to be glucose intolerance in pregnancy, gestational diabetes mellitus (GDM) manifests. Diagnosis of GDM in a woman predisposes her and her offspring for increased risk of developing glucose intolerance and obesity in the future. GDM may play a crucial role in the increasing prevalence of diabetes and obesity and hence has become a public health priority issue. There has to be an excellent coordination and cooperation between all the stake holders of health delivery care system. A great understanding of the importance of GDM and its consequences by the Government and public will go a long way in containing the epidemic of diabetes. © 2012 Elsevier Ireland Ltd.


Murthy K.R.,Vittala International Institute of Ophthalmology | Murthy P.R.,Vittala International Institute of Ophthalmology | Kapur A.,World Diabetes Foundation | Owens D.R.,University of Cardiff
Diabetes Research and Clinical Practice | Year: 2012

The prevalence of diabetes in developing countries is on the increase and along with it the need to provide structured care to avoid the feared long term complications among them loss of vision and blindness due to diabetic retinopathy (DR). The biggest hurdle facing most developing countries is the lack of resources and trained manpower to both screen and treat the large number of people with DR. Countries also face the additional problem of unequal distribution of resources between the urban and rural areas. To overcome these challenges models of mobile diabetic retinopathy screening and treatment aided by the use of telemedicine have been introduced and demonstrated to be popular and effective. The aim of this review article is to describe different mobile diabetic retinopathy screening and treatment models developed in India, which can be readily replicated in developing countries presented with similar difficulties. © 2012 Elsevier Ireland Ltd.


Christensen D.L.,Copenhagen University | Kapur A.,World Diabetes Foundation | Bygbjerg I.C.,Copenhagen University | Bygbjerg I.C.,World Diabetes Foundation
International Journal of Gynecology and Obstetrics | Year: 2011

The concept of developmental origins of health and disease and the epidemic of noncommunicable diseases in low- and middle-income countries has increased the focus on low birth weight (LBW). Most studies linking LBW to future risk of metabolic diseases have focused on maternal nutrition and anemia. Several studies have shown that LBWis linked to skeletal muscle insulin resistance and future risk of type 2 diabetes, possibly caused by permanent modifications in skeletal muscle morphology and biochemistry leading to lowered functional capacity and physical activity in adult life. In some parts of the world, malaria infection during pregnancy is the most common cause of anemia and LBW. By causing disruption to nutrient supply, as well as hypoxia, placental malaria and anemia negatively impact intrauterine fetal development. Thus, in utero exposure to placental malaria and consequent LBW may impart a higher risk of developing type 2 diabetes in early adult life. This has not been investigated systematically. Worldwide, an estimated 125 million pregnancies occur annually in malarial areas with a vast potential for intrauterine growth restriction, LBW, and subsequent risk of metabolic dysfunction, including type 2 diabetes; this potential link also opens an opportunity for early prevention of future metabolic diseases by paying greater attention to malaria during pregnancy. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.


Nielsen K.K.,Copenhagen University | Nielsen K.K.,World Diabetes Foundation | Kapur A.,World Diabetes Foundation | Damm P.,Copenhagen University | And 3 more authors.
BMC Pregnancy and Childbirth | Year: 2014

Background: Gestational diabetes mellitus (GDM) - a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised.Methods: To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed.Results: Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants.Conclusions: The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context. © 2014 Nielsen et al.; licensee BioMed Central Ltd.


To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, need for repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level.


Kapur A.,World Diabetes Foundation
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2015

Non-communicable diseases (NCDs) and maternal health are closely linked. NCDs such as diabetes, obesity and hypertension have a significant adverse impact on maternal health and pregnancy outcomes, and through the mechanism of intrauterine programming maternal health impacts the burden of NCDs in future generations. The cycle of vulnerability to NCDs is repeated with increasing risk accumulation in subsequent generations. This article discusses the impact, interlinkages and advocates for integration of services for maternal and child health, NCD care and prevention and health promotion to sustainably improve maternal health as well address the rising burden of NCDs. © 2014 Elsevier Ltd. All rights reserved.

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