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Balasundaram BS, Mohan AR, Subramani P, Ulagamathesan V, Tandon N, Sridhar GR, Sosale AR, Shankar R, Sagar R, Rao D, Chwastiak L, Mohan V, Ali MK, Patel SA. The Impact of a Collaborative Care Model on Health Trajectories among Patients with Co-Morbid Depression and Diabetes: The INDEPENDENT Study. Indian J Endocrinol Metab 2023; 27:410-420. [PMID: 38107735 PMCID: PMC10723617 DOI: 10.4103/ijem.ijem_348_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 12/19/2023] Open
Abstract
Context Collaborative care models for depression have been successful in a variety of settings, but their success may differ by patient engagement. We conducted a post-hoc analysis of the INDEPENDENT trial to investigate the role of differential engagement of participants on health outcomes over 3 years. Settings and Design INDEPENDENT study was a parallel, single-blinded, randomised clinical trial conducted at four socio-economically diverse clinics in India. Participants were randomised to receive either active collaborative care or usual care for 12 months and followed up for 24 months. Method We grouped intervention participants by engagement, defined as moderate (≤7 visits) or high, (8 or more visits) and compared them with usual care participants. Improvements in composite measure (depressive symptoms and at least one of three cardio-metabolic) were the primary outcome. Statistical Analysis Mean levels of depression and cardio-metabolic measures were analysed over time using computer package IBM SPSS Statistics 25. Results The composite outcome was sustained the highest in the moderate engagers [27.5%, 95% confidence interval (CI): 19.5, 36.7] and the lowest in high engagers (15.8%, 95% CI: 8.1, 26.8). This pattern was observed for individual parameters - depressive symptoms and glycosylated haemoglobin. Progressive reductions in mean depressive symptom scores were observed for moderate engagers and usual care group from baseline to 36 months. However, in high engagers of collaborative care, mean depressive symptoms were higher at 36 months compared to 12 months. Conclusion Sustained benefits of collaborative care were larger in participants with moderate engagement compared with high engagement, although a majority of participants relapsed on one or more outcome measures by 36 months. High engagers of collaborative care for co-morbid depression and diabetes may need light touch interventions for longer periods to maintain health and reduce depressive symptoms.
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Affiliation(s)
| | - Anjana Ranjit Mohan
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Poongothai Subramani
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Radha Shankar
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Deepa Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Department of Global Health, University of Washington, Seattle, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Department of Global Health, University of Washington, Seattle, USA
| | - Viswanathan Mohan
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
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Leong WY, Gupta A, Hasan M, Mahmood S, Siddiqui S, Ahmed S, Goon IY, Loh M, Mina TH, Lam B, Yew YW, Ngeow J, Lee J, Lee ES, Riboli E, Elliott P, Tan GP, Chotirmall SH, Wickremasinghe AR, Kooner JS, Khawaja KI, Katulanda P, Mridha MK, Jha S, Ranjit Mohan A, Pradeepa G, Kasturiratne A, Chambers JC. Reference equations for evaluation of spirometry function tests in South Asia, and among South Asians living in other countries. Eur Respir J 2022; 60:2102962. [PMID: 35896203 PMCID: PMC9712850 DOI: 10.1183/13993003.02962-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are few data to support accurate interpretation of spirometry data in South Asia, a major global region with a high reported burden of chronic respiratory disease. METHOD We measured lung function in 7453 healthy men and women aged ≥18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. First, we assessed the accuracy of existing equations for predicting normal forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC ratio. Then, we used our data to derive (n=5589) and internally validate (n=1864) new prediction equations among South Asians, with further external validation among 339 healthy South Asians living in Singapore. RESULTS The Global Lung Initiative (GLI) and National Health and Nutrition Examination Survey consistently overestimated expiratory volumes (best fit GLI-African American, mean±sd z-score: FEV1 -0.94±1.05, FVC -0.91±1.10; n=7453). Age, height and weight were strong predictors of lung function in our participants (p<0.001), and sex-specific reference equations using these three variables were highly accurate in both internal validation (z-scores: FEV1 0.03±0.99, FVC 0.04±0.97, FEV1/FVC -0.03±0.99) and external validation (z-scores: FEV1 0.31±0.99, FVC 0.24±0.97, FEV1/FVC 0.16±0.91). Further adjustment for study regions improves the model fit, with highest accuracy for estimation of region-specific lung function in South Asia. CONCLUSION We present improved equations for predicting lung function in South Asians. These offer the opportunity to enhance diagnosis and management of acute and chronic lung diseases in this major global population.
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Affiliation(s)
- Wei Yee Leong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ananya Gupta
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital (Devki Devi Foundation), New Delhi, India
- Faculty of Medicine, Imperial College London, London, UK
| | - Mehedi Hasan
- Centre for Non-communicable Disease and Nutrition (CNCDN), BRAC James P Grant of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sara Mahmood
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan
| | - Samreen Siddiqui
- Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital (Devki Devi Foundation), New Delhi, India
| | - Sajjad Ahmed
- Punjab Institute of Cardiology, Punjab, Pakistan
| | - Ian Y Goon
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Tyree Foundation Institute of Health Engineering, The University of New South Wales, Sydney, Australia
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Skin Centre, Singapore
| | - Theresia H Mina
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Benjamin Lam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Family and Community Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yik Weng Yew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Skin Centre, Singapore
| | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Mental Health, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Geak Poh Tan
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Jaspal S Kooner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Khadija I Khawaja
- Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Malay K Mridha
- Centre for Non-communicable Disease and Nutrition (CNCDN), BRAC James P Grant of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sujeet Jha
- Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital (Devki Devi Foundation), New Delhi, India
| | | | | | | | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Das AK, Saboo B, Maheshwari A, Nair V M, Banerjee S, C J, V BP, Prasobh P S, Mohan AR, Potty VS, Kesavadev J. Health care delivery model in India with relevance to diabetes care. Heliyon 2022; 8:e10904. [PMID: 36237970 PMCID: PMC9552106 DOI: 10.1016/j.heliyon.2022.e10904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
The Indian healthcare scenario presents a spectrum of contrasting landscapes. Socioeconomic factors, problems with medical infrastructure, insufficiency in the supply of medical requisites, economic disparities due to major differences in diabetes care delivery in the government and private sectors and difficulty in accessing quality health care facilities challenges effective diabetes care in India. The article gives insights into the practical solutions and the proposed White paper model to resolve major challenges faced by the Indian diabetes care sector for effective diabetes care delivered at Jothydev's Diabetes Educational Forum Global Diabetes Convention 2019. The prevalence of diabetes in India is on its rise. Socioeconomic factors, lack of diagnosis etc challenges Indian diabetes care system. Health care models appropriate for Indian scenario should be developed. Public-Private partnership is required for effective health care delivery.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, Tamil Nadu, India
| | - Banshi Saboo
- Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | - Samar Banerjee
- Dept. of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Jayakumar C
- Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Benny P. V
- Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Sunil Prasobh P
- Department of Internal Medicine, Government Medical College, Kollam, Kerala, India
| | - Anjana Ranjit Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Trivandrum, Kerala, India,Corresponding author.
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Shaikh N, Rautela G, Galaviz K, Tandon N, Narayan KMV, Chwastiak L, Mohan V, Mohan AR, Poongothai S, Prabhakaran D, Kadir M, Ali MK. Diet Intake and Patterns in Adults With and Without Depression in South Asia. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab038_065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To compare dietary intake and patterns among adults with and without depression in South Asia.
Methods
Baseline survey data from the 2015–16 Centre for cArdiometabolic Risk Reduction in South-Asia study, representative of three urban South Asian cities (n = 13 588), were analyzed. Non-pregnant adults ≥ 20 years completed interviewer-administered surveys including a semi-quantitative Food Frequency Questionnaire (FFQ) and Patient Health Questionnaire-9 (PHQ-9) to assess depression. Participants were categorized as having moderate/severe depression (PHQ-9 = 10–27), mild depression (PHQ-9 = 5–9), and no depression (PHQ-9 = 0–4). FFQ data were transformed into daily food (g/d) and beverage (ml/d) intake. Among adults with and without depression, we compared differences in socio-demographic characteristics and daily food and nutrient intake (energy and macronutrients and their distributions) using Students t tests and chi-sq tests and determined diet patterns using exploratory factor analysis.
Results
Overall,16% (95% CI 14.7, 17.5) had mild depression and 6% (95% CI 5.1, 7.1) had moderate/severe depression. Compared with adults with no or mild depression, adults with moderate/severe depression had lower intake of energy (2196 ± 804 [no] vs. 2408 ± 852 [mild] vs. 2751 ± 902 [moderate/severe] kcal/d), carbohydrates (284 ± 102 vs. 318 ± 117 vs. 366 ± 125 g/d)), protein (77 ± 35 vs. 81 ± 36 vs. 87 ± 33g/d)), fat (81 ± 36 vs. 88 ± 37 vs. 101 ± 39 g/d), and all food groups except meat (41 ± 83 vs. 41 ± 97 vs. 28 ± 73 g/d) and poultry (132 ± 146 vs. 107 ± 143 vs. 76 ± 113 g/d). Across groups, diets comprised 51–53% carbohydrates, 12–14% protein, and 32–33% fat. Four distinct diet patterns were seen among adults without depression (traditional, modern, non-vegetarian, vegetarian), with mild depression (traditional, western, vegetarian, non-vegetarian), and with moderate/severe depression (traditional, energy-dense, western, non-vegetarian).
Conclusions
Diets of South Asian adults with depression were poorer in quality and quantity than those without depression. Efforts are needed to better study the direction of these associations and ways to improve diets of South Asians.
Funding Sources
NHLBHI, NIH, Oxford Health Alliance Vision 2020 of the UnitedHealth Group, Fogarty International Center and the Eunice Kennedy Shriver NIDDK, NIH and the Emory Global Health Institute.
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Islek D, Weber MB, Ranjit Mohan A, Mohan V, Staimez LR, Harish R, Narayan KMV, Laxy M, Ali MK. Cost-effectiveness of a Stepwise Approach vs Standard Care for Diabetes Prevention in India. JAMA Netw Open 2020; 3:e207539. [PMID: 32725244 DOI: 10.1001/jamanetworkopen.2020.7539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A stepwise approach that includes screening and lifestyle modification followed by the addition of metformin for individuals with high risk of diabetes is recommended to delay progression to diabetes; however, there is scant evidence regarding whether this approach is cost-effective. OBJECTIVE To estimate the cost-effectiveness of a stepwise approach in the Diabetes Community Lifestyle Improvement Program. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation study included 578 adults with impaired glucose tolerance, impaired fasting glucose, or both. Participants were enrolled in the Diabetes Community Lifestyle Improvement Program, a randomized clinical trial with 3-year follow-up conducted at a diabetes care and research center in Chennai, India. INTERVENTIONS The intervention group underwent a 6-month lifestyle modification curriculum plus stepwise addition of metformin; the control group received standard lifestyle advice. MAIN OUTCOMES AND MEASURES Cost, health benefits, and incremental cost-effectiveness ratios (ICERs) were estimated from multipayer (including direct medical costs) and societal (including direct medical and nonmedical costs) perspectives. Costs and ICERs were reported in 2019 Indian rupees (INR) and purchasing power parity-adjusted international dollars (INT $). RESULTS The mean (SD) age of the 578 participants was 44.4 (9.3) years, and 364 (63.2%) were men. Mean (SD) body mass index was 27.9 (3.7), and the mean (SD) glycated hemoglobin level was 6.0% (0.5). Implementing lifestyle modification and metformin was associated with INR 10 549 (95% CI, INR 10 134-10 964) (INT $803 [95% CI, INT $771-834]) higher direct costs; INR 5194 (95% CI, INR 3187-INR 7201) (INT $395; 95% CI, INT $65-147) higher direct nonmedical costs, an absolute diabetes risk reduction of 10.2% (95% CI, 1.9% to 18.5%), and an incremental gain of 0.099 (95% CI, 0.018 to 0.179) quality-adjusted life-years per participant. From a multipayer perspective (including screening costs), mean ICERs were INR 1912 (INT $145) per 1 percentage point diabetes risk reduction, INR 191 090 (INT $14 539) per diabetes case prevented and/or delayed, and INR 196 960 (INT $14 986) per quality-adjusted life-year gained. In the scenario of a 50% increase or decrease in screening and intervention costs, the mean ICERs varied from INR 855 (INT $65) to INR 2968 (INT $226) per 1 percentage point diabetes risk reduction, from INR 85 495 (INT $6505) to INR 296 681 (INT $22 574) per diabetes case prevented, and from INR 88 121 (INT $6705) to INR 305 798 (INT $23 267) per quality-adjusted life-year gained. CONCLUSIONS AND RELEVANCE The findings of this study suggest that a stepwise approach for diabetes prevention is likely to be cost-effective, even if screening costs for identifying high-risk individuals are added.
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Affiliation(s)
- Duygu Islek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Beth Weber
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Lisa R Staimez
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Ranjani Harish
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Michael Laxy
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
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Viswanathan M, Ranjit Mohan A, Ranjit U, Prasanna Kumar G, Philips R, Saravanan J, Ulagamathesan V, Ganesan US, Kumaradas GV, Rajendran AK, Thangarajan R, Rajendra P, Coimbatore Subramanian SR. Clinical Profile of Elderly Patients (Over 90 Years) with Type 2 Diabetes Seen at a Diabetes Center in South India. Diabetes Technol Ther 2020; 22:79-84. [PMID: 31638436 DOI: 10.1089/dia.2019.0219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: The current life expectancy in India is <70 years. Type 2 diabetes mellitus (T2DM) is known to reduce life expectancy by 6-8 years. Hence elderly people with T2DM in India would be rare. We report on the clinical profile of Asian Indian patients with T2DM who lived beyond 90 years of age and compared them with T2DM patients aged 50 to 60 years. Methods: From the diabetes electronic medical records of >470,000 diabetes patients, we identified T2DM patients who had lived ≥90 years and compared them with those in the 50-60 years age group, matched for gender and duration of diabetes. Clinical data included age at last visit, age at diagnosis, duration of diabetes, family history, smoking and alcohol, details of medications, body mass index (BMI), and blood pressure. Biochemical data included fasting and postprandial plasma glucose, glycated hemoglobin, fasting and stimulated C-peptide levels, lipid profile, and renal function studies. Assessment of retinopathy, nephropathy, neuropathy, coronary artery disease (CAD), and peripheral vascular disease (PVD) was also done. Results: A total of 325 T2DM patients aged ≥90 years and 278 T2DM patients aged between 50 and 60 years were selected for the study. Patients aged ≥90 years had higher systolic blood pressure (P < 0.001) and lower BMI (P < 0.001) than those between 50 and 60 years. Prevalence of retinopathy (29.7% vs. 53.5%) and macroalbuminuria (3.7% vs. 16.0%) was lower in the ≥90 years T2DM patients than in the 50-60 years age group. However, prevalence of neuropathy (89.8% vs. 50.8%), PVD (13.5% vs. 2.0%), and CAD (60.3% vs. 32.0%) was higher among the ≥90 years patients. Eighty-five percent of the T2DM aged ≥90 years were on oral hypoglycemic agents (OHAs), (of whom 64.9% were on sulfonylurea), 12% were on insulin, and 3% on diet alone. Among the 50-60 years old, 87.8% were on OHAs and 12.2% on insulin. Conclusions: This is the first report on the clinical profile of Asian Indians with T2DM aged ≥90 years, and significant differences are seen in their clinical profile compared with younger T2DM patients.
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Affiliation(s)
- Mohan Viswanathan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Unnikrishnan Ranjit
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Gupta Prasanna Kumar
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Routary Philips
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Jebarani Saravanan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Venkatesan Ulagamathesan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Uma Sankari Ganesan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Gini Venisha Kumaradas
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Ashok Kumar Rajendran
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | | | - Pradeepa Rajendra
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
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Balaji B, Ranjit Mohan A, Rajendra P, Mohan D, Ram U, Viswanathan M. Gestational Diabetes Mellitus Postpartum Follow-Up Testing: Challenges and Solutions. Can J Diabetes 2019; 43:641-646. [PMID: 31230979 DOI: 10.1016/j.jcjd.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022]
Abstract
One in every 4 pregnancies is affected by hyperglycemia, of which 90% is gestational diabetes mellitus (GDM). Women with GDM are at a high risk of developing both short- and long-term complications. Various studies have shown the heightened risk of type 2 diabetes among women with GDM. Despite clear evidence from published literature about the substantial risk that GDM imposes on women after delivery, rates of postpartum follow up have been low in most parts of the world. Several reasons, such as lack of awareness among health-care professionals and patient-related barriers, such as emotional stress and adjusting to motherhood, have been cited as reasons for poor follow-up rates. To address these issues and come up with solutions to improve postpartum follow-up rates, it is important to understand these barriers both from the patient and the health-care system points of view. In this review, we have summarized some of the key issues contributing to the low postpartum follow-up rates and have discussed possible strategies to tackle them. Use of proactive reminder systems, such as postal service, telephone call, short messaging service and e-mail, recall registries for GDM and utilization of mobile health technology are some of the key strategies that have been discussed in this review. A brief note on the Women in India with GDM Strategy project, which developed a model of care for GDM in resource-constrained settings and adopted several strategies that led to a 95.8% postpartum follow up, has also been presented.
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Affiliation(s)
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Pradeepa Rajendra
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Mohan Viswanathan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Cauldwell M, Steer PJ, Curtis S, Mohan AR, Dockree S, Mackillop L, Parry H, Oliver J, Sterrenburg M, Bolger A, Siddiqui F, Simpson M, Walker N, Bredaki F, Walker F, Johnson MR. Maternal and fetal outcomes in pregnancies complicated by the inherited aortopathy Loeys-Dietz syndrome. BJOG 2019; 126:1025-1031. [PMID: 30811810 DOI: 10.1111/1471-0528.15670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Pregnancies in women with Loeys-Dietz syndrome (LDS) are rare and are typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited. DESIGN A retrospective cohort study. SETTING Eight specialist UK centres. SAMPLE Pregnant women with LDS. METHODS Data was collated on cardiac, obstetric, and neonatal outcomes. MAIN OUTCOME MEASURES Maternal and perinatal outcomes in pregnancies complicated by LDS. RESULTS Twenty pregnancies in 13 women with LDS were identified. There was one miscarriage, one termination of pregnancy, and 18 livebirths. In eight women the diagnosis was known prior to pregnancy but only one woman had preconception counselling. In four women the diagnosis was made during pregnancy through positive genotyping, and the other was diagnosed following delivery. Five women had a family history of aortic dissection. There were no aortic dissections in our cohort during pregnancy or postpartum. Obstetric complications were common, including postpartum haemorrhage (33%) and preterm delivery (50%). In all, 14/18 (78%) of deliveries were by elective caesarean section, at a median gestational age at delivery of 37 weeks. Over half the infants (56%) were admitted to the neonatal unit following delivery. CONCLUSION Women with LDS require multidisciplinary specialist management throughout pregnancy. Women should be referred for preconception counselling to make informed decisions around pregnancy risk and outcomes. Early elective preterm delivery needs to be balanced against a high infant admission rate to the neonatal unit. TWEETABLE ABSTRACT Pregnancy outcomes in women with Loeys-Dietz syndrome.
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Affiliation(s)
- M Cauldwell
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - P J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - S Curtis
- Adult Congenital Heart Disease Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A R Mohan
- Department of Obstetrics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Dockree
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Mackillop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Parry
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Oliver
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Sterrenburg
- Department of Human Development and Health, Princess Anne Hospital, University of Southampton, Southampton, UK
| | - A Bolger
- Department of Adult Congenital Heart Disease, Glenfield Hospital, Leicester, UK
| | - F Siddiqui
- Department of Obstetrics, Royal Leicester Infirmary, Leicester, UK
| | - M Simpson
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK
| | - N Walker
- Department of Obstetrics, University College Hospital, London, UK
| | - F Bredaki
- Department of Adult Congenital Heart Disease, Bart's Heart Centre, London, UK
| | - F Walker
- Department of Adult Congenital Heart Disease, Bart's Heart Centre, London, UK
| | - M R Johnson
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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9
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Mohan AR, Raj P, Saravanan J, Vedantham S, Venkatesan R, Narayanan M, Rajendra P, Unnikrishnan R, Jayaram S, Gupta R, George P, Srivastava BK, Bose USC, Munawar L, Santhosh S, Viswanathan M. Leveraging big data using a novel clinical database and analytic platform based on 323,145 individuals with and without of Diabetes. Can J Biotech 2017. [DOI: 10.24870/cjb.2017-a211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Sooranna SR, Lee Y, Kim LU, Mohan AR, Bennett PR, Johnson MR. Mechanical stretch activates type 2 cyclooxygenase via activator protein-1 transcription factor in human myometrial cells. Mol Hum Reprod 2004; 10:109-13. [PMID: 14742695 DOI: 10.1093/molehr/gah021] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The uterus is subject to stretch throughout pregnancy, which, in the presence of progesterone, is a potent stimulus for uterine growth. However, in the absence of progesterone or when stretch is excessive, as in multiple pregnancy, it may provoke the onset of labour. We have investigated the effect of stretch on prostaglandin synthesis in primary human uterine myocytes [non-pregnant (NP), pregnant not in labour (NL) and pregnant in labour (L)]. The cells were grown on flexible bottom culture plates and subjected to 1 or 6 h static stretch. Expression of type 2 cyclooxygenase (COX-2) mRNA was similar in samples obtained from NP and L groups and both were significantly greater than those found in the NL group. Stretch of cells from all groups resulted in increased COX-2 mRNA expression. In further studies carried out on cells taken from the NL group, 6 h of stretch resulted in increased COX-2 protein levels and, in the media, increases in prostaglandin (PG) I(2) metabolite and PGE(2) concentrations and a reduction in the concentration of PGF(2)alpha metabolites. After stretch, EMSA studies showed increased activator protein-1 (AP-1) nuclear protein DNA binding activity but not of nuclear factor kappaB. These data demonstrate that stretch of human myocytes results in increased COX-2 activity and suggest that this may occur through activation of the AP-1 system.
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Affiliation(s)
- S R Sooranna
- Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH
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11
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Dutta A, Batra YK, Mohan AR, Chari P. An unusual solution to unsuspected difficult airway: the esophageal dilator guide. Can J Anaesth 2001; 48:1048-9. [PMID: 11698332 DOI: 10.1007/bf03016602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Mitra SK, Sundaram R, Mohan AR, Gopumadhavan S, Venkataranganna MV, Venkatesha U, Seshadri SJ, Anturlikar SD. Protective effect of Prostane in experimental prostatic hyperplasia in rats. Asian J Androl 1999; 1:175-9. [PMID: 11225890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
AIM Prostane, a polyherbal formulation, was evaluated for its efficacy on 5alpha-reductase inhibition, alpha-adrenergic antagonistic activity and testosterone-induced prostatic hyperplasia. METHODS 5alpha-reductase inhibition was evaluated using rat prostate homogenate as an enzyme source. Adrenergic antagonistic activity was evaluated using isolated rat vas deferens. Experimental prostatic hyperplasia was induced in rats by giving testosterone 3 mg/kg sc for 21 days. RESULTS Prostane dose-dependently inhibited 5alpha-reductase activity and exhibited alpha-adrenergic antagonistic activity. Treatment with Prostane at 250, 500 and 750 mg/kg body wt, po for 21 days significantly reduced the prostatic weight, the epithelial height and the stromal proliferation in experimental prostatic hypertrophy. CONCLUSION Prostane is effective in the treatment of experimental prostatic hypertrophy in rats and may be passed on to clinical trials on benign prostatic hypertrophy after necessary toxicological evaluations.
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Affiliation(s)
- S K Mitra
- R&D Centre, The Himalaya Drug Co, Makali, Bangalore, India.
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13
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Abstract
The aim of this work was to determine the antioxidant activities of a range of phytoestrogenic isoflavones. The antioxidant activity in the aqueous phase was determined by means of the ABTS.+ total antioxidant activity assay. The results show that the order of reactivity in scavenging the radical in the aqueous phase is genistein > daidzein = genistin approximately equal to biochanin A = daidzin > formononetin approximately equal to ononin, the latter displaying no antioxidant activity. The importance of the single 4'-hydroxyl group in the reactivity of the isoflavones, as scavengers of aqueous phase radicals, as well as the 5'7-dihydroxy structure is demonstrated. Examination of their abilities to enhance the resistance of low density lipoproteins to oxidation supports the observation that genistein is the most potent antioxidant among this family of compound studied, both in the aqueous and in the lipophilic phases.
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Affiliation(s)
- M B Ruiz-Larrea
- International Antioxidant Research Centre UMDS-Guy's Hospital, London
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