Diabetes in India

Shah, Viral N.; Mohan, Viswanathan

doi:10.1097/med.0000000000000166

Cited by 31 publications

(13 citation statements)

References 76 publications

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“…These abnormalities include higher insulin resistance, elevated abdominal adiposity (i.e., higher visceral fat in spite of lower body mass index [BMI]), lower level of adiponectin and higher level of high sensitive C-reactive protein [ 100 – 103 ]. Moreover, Asian Indians have an increased metabolic risk compared to their counterparts; because of the existence of high leptin levels [ 104 ]; leptin concentration is a significant indicator of body fat ( P < 0.0001), hip circumference, and fasting insulin [ 105 ]; greater insulin resistance [ 102 , 106 , 107 ]; higher insulin sensitivity index and lower acute insulin response to glucose [ 108 ]; early loss of β-cell function [ 102 ]; ‘thin-fat Indian concept’ or ‘sarcopenic obesity’ (Asian Indians have thinner limbs [smaller muscle mass] with central obesity, with a higher waist-to-hip ratio and higher subscapular-to-triceps skin fold ratio than their British counterparts, which leads to higher insulin resistance) [ 109 ]; more people suffer from diabetes at a relatively lower BMI compared with those of European descent [ 110 ]; elevated mean A1C level (9.0%), which is 2.0% higher than the target suggested by international bodies [ 109 ]. …”

Section: The Indian Phenotypementioning

confidence: 99%

Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians

Singh

Unnikrishnan²,

Zargar³

et al. 2019

Diabetes Ther

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The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications. Some of the unique characteristics associated with SGLT2i, such as reduction in body weight (more visceral fat mass loss than subcutaneous fat loss), reduction in insulin resistance and improvement in β-cell function, as measured by homeostatic model assessment-β (HOMA-β) could be potentially beneficial and help in overcoming some of the challenges faced by Indian patients with diabetes. In addition, a patient-centric approach with individualised treatment during SGLT2i therapy is inevitable in order to reduce diabetic complications and improve quality of life. Despite their broad benefits profile, the risk of genital tract infections, volume depletion, amputations and diabetic ketoacidosis associated with SGLT2i should be carefully monitored. In this compendium, we systematically reviewed the literature from Medline, Cochrane Library, and other relevant databases and attempted to provide evidence-based recommendations for the positioning of SGLT2i in the management of diabetes in the Indian population. Funding : AstraZeneca Pharma India Limited.

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Section: The Indian Phenotypementioning

confidence: 99%

Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians

Singh

Unnikrishnan²,

Zargar³

et al. 2019

Diabetes Ther

Self Cite

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“…[1] Type 2 diabetes (T2D) among Indians has a younger age onset and is associated with greater abdominal obesity despite a relatively low body mass index (BMI), greater insulin resistance (IR), and early decline in beta cell function. [2] Obesity is one of the major risk factors for the development of DM and IR. Acanthosis nigricans (AN), initially coined by Unna in 1890, is characterized by thickened, hyperpigmented velvety plaques on the neck and intertriginous surfaces.…”

Section: Introductionmentioning

confidence: 99%

Association of acanthosis Nigricans and insulin resistance in indian children and youth – A HOMA2-IR based cross-sectional study

Nithun

Ranugha

Betkerur

et al. 2019

Indian Dermatol Online J

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Introduction: The American Diabetes Association includes acanthosis nigricans (AN) as an indicator of diabetes mellitus risk in overweight youth entering puberty. Some argue that AN is not an independent predictor of insulin resistance (IR), when body mass index (BMI) is controlled for. There is a paucity of studies on the association of AN and IR among children and young adults from India. Homeostatic model assessment-IR (HOMA2-IR), a computerized updated model, which is supposed to be superior to HOMA1-IR, has rarely been used for quantification of IR. Methods: Sixty cases (irrespective of BMI), aged 2–24 years with AN, and 30 age- and sex-matched normal weight controls were included. A thorough clinical examination and grading of AN was done. BMI, fasting glucose levels, and fasting insulin levels were measured for all. HOMA-IR calculator V.2.2.3 was used to calculate IR. Those with HOMA 2-IR >1.8 were considered insulin-resistant. Lifestyle modifications were advised for patients with IR. Results: The mean HOMA2-IR value in cases and controls was 2.422 and 1.322, respectively, which was statistically significant. Overweight and obese cases had 2.5 and 11.25 times higher risk of having IR, respectively, by logistic regression. The association of AN with IR was found to be statistically significant in normal weight cases when compared with controls ( P = 0.045). Grade 4 of neck severity ( P = 0.007), Grade 3 of neck texture ( P = 0.001), and Grade 4 of axillary severity ( P = 0.001) of AN were found to be significantly associated with IR. Limitations: The relatively small sample size may not reflect the accuracy of AN as a marker of IR. Conclusion: Acanthosis nigricans is associated with IR in both normal and obese. We propose that all children, adolescents, and youth with AN be screened for IR irrespective of BMI. Early identification and prompt lifestyle interventions may prevent or delay the onset of diabetes later.

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“…Notably, many of these individuals with IGT and prediabetes are unaware of their condition and therefore are at high risk of developing diabetes complications [ 5 ]. The high burden of T2DM puts an enormous burden on affected individuals, their families, and healthcare systems in LMICs [ 9 ]. This demands urgent action from program planners and policymakers to prevent and control T2DM.…”

Section: Introductionmentioning

confidence: 99%

A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program

et al. 2018

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BackgroundWhile several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs.MethodsThe 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks.ResultsProvider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be ‘very useful’ by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as ‘very interested’, and 55% found the group sessions ‘very useful’ in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program.ConclusionA comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs.Trial registrationTrial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909. Registered 10 March 2011.

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Diabetes in India

Cited by 31 publications

References 76 publications

Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians

Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians

Association of acanthosis Nigricans and insulin resistance in indian children and youth – A HOMA2-IR based cross-sectional study

A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program

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