Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

Misra, Anoop; Tandon, Nikhil; Ebrahim, Shah; Sattar, Naveed; Alam, Dewan S.; Shrivastava, Usha; Narayan, K M Venkat; Jafar, Tazeen H.

doi:10.1136/bmj.j1420

Cited by 116 publications

(116 citation statements)

References 26 publications

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“…Finally, it is notable that such findings appear in stark contrast to the current patterns of CVD risk in low and middle-income South Asian countries, as recently reported [21]. Thus, whilst the battle to lower CVD risks is being won in migrant south Asian communities, it is only just beginning in many developing regions and there is much progress still to be made in this area worldwide.…”

Section: Resultsmentioning

confidence: 70%

Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Johns

Sattar

2017

Curr Diab Rep

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Purpose of ReviewWe seek to describe the relationship between diabetes mellitus and cardiovascular risk in migrant South Asians compared to native white Europeans, and to determine the temporal change in this relationship over recent years.Recent FindingsRecent evidence suggests that the excess mortality risk associated with diabetes is lower in the migrant South Asian population compared with white Europeans. By contrast, South Asians continue to demonstrate elevated cardiovascular morbidity compared to white Europeans, although to a lesser extent than was observed in previous decades.SummaryThe excess mortality previously observed in South Asian migrants has attenuated with a lower mortality risk compared to white Europeans observed in several recent studies. We speculate that these findings may relate in part to earlier diabetes diagnosis and more prolonged exposure to cardiovascular risk factor management in the South Asian population. Further study is required to confirm these hypotheses.

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Section: Resultsmentioning

confidence: 70%

Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Johns

Sattar

2017

Curr Diab Rep

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“…Patients with type 2 diabetes mellitus (T2DM) have rapidly increased (72.9 million patients in 2017) in India . Diabetes in Asian Indians occurs one decade earlier and with more complications (eg, nephropathy, cardiovascular disease) than seen in other populations . Furthermore, Asian Indians with diabetes have more body fat, abdominal adiposity and liver fat than white Caucasians even when “nonobese” as categorised by body mass index (BMI) .…”

Section: Introductionmentioning

confidence: 99%

Sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes in North India: A 12-month prospective study in real-world setting

et al. 2018

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Summary Objective Sodium‐glucose cotransporter‐2 (SGLT2) inhibitors are increasingly being used in India. However, there is paucity of real‐world clinical data of SGLT2 inhibitors. We aim to provide real‐world experience regarding efficacy and safety of these drugs in Asian Indian patients with type 2 diabetes mellitus. Methodology We enrolled patients with type 2 diabetes mellitus who were given SGLT2 inhibitors on top of other antidiabetes medication. After initial work up, patients were followed up to 12 months. Measurements included weight, body mass index, blood pressure, HbA1C, fasting and postprandial blood glucose, lipids, urinary microalbumin, etc. Results Out of 1297 patients; 310 patients completed 12‐month follow‐up. Mean difference followed by percentage reduction of various parameters at 12 months was as follows; weight reduction (kg), −3.45 (95% CI, −2.9‐−4.0), 4.5; body mass index, (kg/m2), −1.26 (95% CI, −1.0‐−1.5), 4.4; HbA1c (%), −1.8 (95% CI, −0.2‐−3.40), 19; fasting blood glucose (mg/dL), −35.7 (95% CI, −27.2‐−44.1), 25.3; postprandial blood glucose (mg/dL), −54.7 (95% CI, −39.8‐−69.7), 25.3; systolic blood pressure (mm Hg), −8.25 (95% CI, −5.8‐−10.7), 5.2; diastolic blood pressure (mm Hg), −2.33 (95% CI, −1.0‐−3.6), 1.1; and serum triglycerides (mg/dL), −25.77 (95% CI, −9.1‐−42.5), 10.5. Of note, 41.9% and 10.6% of patients showed more than 5 and 10% decrease in body weight, respectively. Adverse drug reactions were seen in 22.8% patients and 41 (3.2%) patients stopped SGLT2 inhibitors because of various reasons. Importantly, five patients had severe urinary tract infection, one patient developed acute kidney injury because of rapid rise in creatinine, three developed slow rise in creatinine and one patient developed acute pyelonephritis. Ketosis was seen in 10 patients of whom one developed severe ketoacidosis. We did not record severe hypoglycaemia, lower extremity amputation, stroke, or bone fractures in this cohort.

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“…South Asia has seen a rapid rise in NCDs in recent years, and combined with communicable diseases, it poses a heavy double burden 54. CHWs could potentially undertake a range of activities, including:…”

Section: Recent Innovations and Opportunities For Community Outreachmentioning

confidence: 99%

Rethinking community based strategies to tackle health inequities in South Asia

Bhutta

Bang²,

Afsana

et al. 2018

BMJ

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Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

Cited by 116 publications

References 26 publications

Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes in North India: A 12-month prospective study in real-world setting

Rethinking community based strategies to tackle health inequities in South Asia

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