Krishna Seshadri | Sri Ramachandra Medical University (original) (raw)

Papers by Krishna Seshadri

Research paper thumbnail of Doctor–Patient Communication

Research paper thumbnail of Inflammation and Type 2 Diabetes Mellitus

Research paper thumbnail of HbA1c reduction in Long Term Programs - experience from the Apollo Sugar Group

Research paper thumbnail of From Individualized to Personalized Medicine in Diabetes: An Expert Overview

The Journal of the Association of Physicians of India, 2019

Personalized medicine is an individualized and stratified approach to the management of a disease... more Personalized medicine is an individualized and stratified approach to the management of a disease. Personalized medicine can reform the prevention, prediction, and management of diabetes. Use of genetic information in polygenic and monogenic forms of diabetes can help to identify genetic variants and reclassify patients into pathophysiological subgroups. Targeted diagnostic, preventive, and therapeutic interventions can be defined for these groups for effective management of diabetes. Pharmacogenetics combines genotypic and phenotypic factors to develop personalized care in various pathophysiological subgroups of persons with diabetes. Personalized medicine finds wider utility in monogenic (especially Maturity Onset Diabetes of the Young (MODY) and Neonatal Diabetes Mellitus [NDM]) than in polygenic, diabetes. The most frequently mutated genes in MODY include HNF1A and HNF3A. the common genes responsible for NDM include KCNJ11 and ABCC8 (SUR) genes. These genes influence various asp...

Research paper thumbnail of Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians

Diabetes Technology & Therapeutics, 2021

AIM: To assess the prescribing patterns and response to different classes of antihyperglycemic ag... more AIM: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. MATERIALS AND METHODS: We attempted to replicate the earlier described clusters of T2D In 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilising six clinically relevant variables. Individuals who had followup HbA1c upto 2 years were included for the drug response analysis (n=13,247). RESULTS: Among the 32,867 participants included in the study, 20779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9 %. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the Mild Age-Related Diabetes [MARD] cluster, followed by Insulin Resistant Obese Diabetes [IROD] (27%), Severe Insulin Deficient Diabetes [SIDD] (21%) and Combined Insulin Resistant and Deficient Diabetes [CIRDD] (12%) clusters. The most frequently used antihyperglycemic agents were sulphonylureas, metformin and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pre-treatment) HbA1c. CONCLUSIONS: In this new cohort we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.

Research paper thumbnail of Real-World Observational Study of Glimepiride and Metformin Fixed-Dose Combination Along With Insulin in the Management of Type 2 Diabetes Mellitus: Indian Experience

Cureus, 2021

Background Type 2 diabetes mellitus (T2DM) is associated with a significant burden on both patien... more Background Type 2 diabetes mellitus (T2DM) is associated with a significant burden on both patients and the healthcare system. This study aimed to evaluate the demographics of patients with T2DM receiving different strengths of glimepiride and metformin combination along with insulin. This study also examined the concomitant conditions and therapies, duration of therapies, dosage titration, glycated hemoglobin (HbA1c) levels, hypoglycemic events, and weight changes during the course of therapy. Methods This retrospective, multicenter (347), observational study included adult patients with T2DM who received glimepiride and metformin combination along with insulin. Data related to demographic characteristics, duration of disease, co-morbidities, concomitant medications, and dosage pattern was collected from medical records authenticated by physicians during routine care. Results A total of 7058 patients were included in the study. The median age of included patients was 55 years and around 29% were aged >60 years and 60% were men. The majority of patients (83.3%) had insulin treatment initiation after glimepiride and metformin combination while other patients (16.7%) received glimepiride and metformin combination after insulin initiation. The mean HbA1c levels significantly decreased with a mean change of 1.33%. In one-third of the patients, down-titration of the insulin dose was done, indicating the insulin-sparing effect with the addition of the glimepiride and metformin combination. The most common comorbid condition was hypertension (64.7%). Of 3705 patients, 33.2% patients had weight loss and 66.8% had weight gain. A total of 432 patients reported hypoglycemic events. Physician global evaluation of efficacy and tolerability showed a good to excellent on the scale (97.3% and 96.6%). Conclusion This study presented good HbA1c lowering with glimepiride and metformin combination with insulin, ensuring a positive clinical outcome. Good to excellent efficacy and tolerability were observed in patients with T2DM across the age groups, in early as well as long-standing disease.

Research paper thumbnail of 2174-PUB: Profiling of Young Diabetes in India: A Cross-Sectional Analysis Report

Diabetes, 2020

Aim: The purpose of this study was to profile young-onset (defined as up to age 40 years) diabete... more Aim: The purpose of this study was to profile young-onset (defined as up to age 40 years) diabetes patients in India. Methods: The current analysis is a retrospective data analysis of young-onset diabetes patients. Young age diabetes is defined as patients diagnosed with diabetes between 18 to 40 years of age. T1DM and other secondary diabetes were excluded while profiling these patients. Patient’s data was extracted from EMRs of Apollo Sugar Outpatient clinics (n=35) from January 2018 to October 2019. Descriptive statistics were applied to analyze the data and report the results. Results: Of the total 85568 diabetes patient’s records, 4152 (5%) young diabetes patients were identified as fulfilling the criteria of T2DM of early-onset. Males were 2495 (60%) and females were 1657(40%). Mean blood pressure was 122/78 mmHg, average BMI was 28.4 kg/m2, 15% had hypertension, 39% had dyslipidemia and 1% had CAD. Positive family history was recorded in 5% of patients, and 1% were recorded t...

Research paper thumbnail of Best Practices and Tools for Titrating Basal Insulins: Expert Opinion from an Indian Panel via the Modified Delphi Consensus Method

Diabetes Therapy, 2020

Aim: To develop an evidence-based expert group consensus document on the best practices and simpl... more Aim: To develop an evidence-based expert group consensus document on the best practices and simple tools for titrating basal insulins in persons with type 2 diabetes mellitus (T2DM). Background: Glycemic control is suboptimal in a large proportion of persons with T2DM, despite insulin therapy, thereby increasing the risk of potentially severe complications. Early initiation of insulin therapy and appropriate dose titration are crucial to achieving glycemic targets. Attitudes and practices among healthcare professionals (HCPs) and perceptions about insulin therapy among persons with diabetes contribute largely to suboptimal glycemic control. Improving HCP-patient communication, encouraging the use of additional educational tools, and providing support for the titration process to increase confidence, both at the initiation visit and at home, facilitate the optimization of dose titration. In Indian settings, specific guidelines and a consensus statement are lacking on the optimal insulin initiation dose, frequency of dose titration, and basal insulin profile needed to achieve optimal

Research paper thumbnail of Impact of Vitamin D Fortified Food on Quality of Life and Emotional Difficulties Among Adolescents – a Randomized Controlled Trial

Indian Journal of Child Health, 2019

A dolescence is marked by a period of transition in the emotional, mental and behavioural spheres... more A dolescence is marked by a period of transition in the emotional, mental and behavioural spheres [1-4] thus, making it essential to study the health related quality of life (HRQoL) and emotional difficulties experienced in this phase [2,3]. The prevalence of behavioural and emotional problems among adolescents ranges from 16.5% to 40.8% in different parts of the world and in India it is in the range of 13.7% to 50% [1]. Vitamin D has been widely identified as a neurosteroid with multiple actions in the brain during the past 20 years [5]. It has long been recognized that out of the many areas in the body, the brain can also produce 1,25 dihydroxy vitamin D, the active form of vitamin D [6]. Sunlight is considered to be the most abundant source of vitamin D as it is naturally synthesized in the skin on exposure to ultraviolet B rays [7]. Surprisingly although India is located between 8.4° and 37.6° north latitude and majority of the occupants reside in regions with good and sufficient sunshine throughout the year, vitamin D deficiency is widespread among 70-100% Indians [8-12]. In north India, vitamin D deficiency was reported among 93.7% children and adolescents [13]. Thirty four percent of children in South Chennai were also shown to have hypovitaminosis [14]. Scientists have suggested vitamin D supplementation to have biological plausibility in promoting increased well-being and physical activity of individuals [15]. Epidemiological evidences indicate its role in emotional difficulties such as depression, anxiety and stress and HRQoL among individuals [16-18] .The link between vitamin D deficiency and headache [19] , muscular pain, psychotic features among mentally ill [17] , reduced physical activity [20] , lower back pain [21] , increased emotional and peer relationship problems among adolescents have been explored in several studies [22]. Vitamin D supplementation has resulted in lower rates of psychosis and depression among adolescents [17,23]. However, conflicting results have been observed in this area. In a study conducted among children in North India, vitamin D did not seem to have any link with neurodevelopment when compared with Vitamin B 12 [24]. Trials focusing the action of vitamin D supplementation on HRQoL and emotional difficulties of adolescents is lacking in India. To bridge this gap, the present study was designed to evaluate whether vitamin D fortified food will help in improving the HRQoL and emotional difficulties among adolescents. MATERIAL AND METHODS A randomized controlled trial was employed to study the effect of the vitamin D fortified food ('ladduu' (a homemade

Research paper thumbnail of Sleep and diabetes and the kidney

International Journal of Diabetes in Developing Countries, 2018

Research paper thumbnail of Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study

Indian Journal of Endocrinology and Metabolism, 2017

IntroductIon Strict control of diabetes is increasingly emphasized after the benefits demonstrate... more IntroductIon Strict control of diabetes is increasingly emphasized after the benefits demonstrated in the UK Prospective Diabetes Study and DCCT studies. [1,2] Hypoglycemia tops the list of hurdles in preventing tight glycemic control and is often

Research paper thumbnail of Lipid association of India expert consensus statement on management of dyslipidemia in Indians 2016 - part 1

Journal of the Practice of Cardiovascular Sciences, 2016

increasing in Indians, particularly at a younger age, the pattern of dyslipidemia is also distinc... more increasing in Indians, particularly at a younger age, the pattern of dyslipidemia is also distinct a s c o m p a r e d t o t h e w e s t e r n p o p u l a t i o n s. T h e d i s t r i b u t i o n a n d i n t e r p l a y o f c o n c o m i t a n t

Research paper thumbnail of Effect of metformin-sustained release therapy on low-density lipoprotein size and adiponectin in the South Indian women with polycystic ovary syndrome

Indian Journal of Endocrinology and Metabolism, 2017

IntRoductIon Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder, affect... more IntRoductIon Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder, affecting 5%-10% of women in the reproductive age. It is characterized by chronic anovulation, infertility, signs and symptoms of hyperandrogenism, acanthosis nigricans, insulin resistance (IR), type 2 diabetes mellitus (T2DM), dyslipidemia, and atherosclerosis. [1] Approximately 50%-70% of women with PCOS have central obesity and dyslipidemia, represented by increased triglycerides (TGLs) and low-density lipoprotein cholesterol (LDL-C) and decreased levels of high-density lipoprotein cholesterol (HDL-C) which may increase cardiovascular risk. [2] The prevalence of dyslipidemia is not the same in all populations with PCOS; ethnicity appears to play a major role. LDL is an atherogenic type of lipoprotein; its density varies from 1.006 to 1.063 g/ml. When the LDL particle size is <25.5 nm, it is known as small dense-LDL (sd-LDL). sd-LDL appears to confer a threefold increase in the risk of cardiovascular disease (CVD). [3,4] Adiponectin (APN) is an adipokine that is expressed exclusively in white adipose tissue and demonstrates insulin-sensitizing properties. It is hypothesized to play a protective role in the development and progression of obesity, T2DM, and CVD. APN has demonstrated anti-inflammatory, anti-thrombotic, anti-atherogenic, and cardioprotective properties both in vitro and in vivo models. Low levels of APN may be associated with obesity, IR, metabolic syndrome, T2DM, and CVD. [5] Objectives: The aim of the study is to compare surrogate markers of cardiovascular disease (CVD) risk, such as adiponectin (APN) levels and low-density lipoprotein (LDL) size, before and after sustained release metformin (Met-SR) therapy in women with polycystic ovarian syndrome (PCOS). Methods: Sixty women with PCOS and sixty age-matched controls in the age group 18-45 years were recruited after obtaining informed consent. Women with PCOS were initiated on Met-SR 1 g orally, which was increased to 1.5 g after 2 weeks and continued up to 24 weeks. Demographic data along with family history of type 2 diabetes mellitus, PCOS, and CVD were collected. Lipid profile plasma APN levels and LDL size were measured before and after therapy in the PCOS group. Data analysis was performed using the GraphPad Prism-5 software. Results: Women with PCOS had greater dyslipidemia, lower APN level and LDL size, and increased lipid accumulating product index as compared to controls. After 6 months of Met-SR therapy, women with PCOS demonstrated significant increase in plasma APN levels and LDL size and significant decrease in weight, waist-hip ratio (WHR), waist circumference (WC), and blood pressure (BP). A significant decrease was observed in body mass index (BMI) in the overweight and obese PCOS subgroups. Conclusion: Met-SR increases LDL size, APN concentration and decreases weight, WC, WHR, and BP in patients with PCOS. Met-SR may have salutary effects on LDL particle size through effects on APN levels in women with PCOS.

Research paper thumbnail of A pragmatic approach to the indeterminate thyroid nodule

Indian Journal of Endocrinology and Metabolism, 2017

Review Article IntRoductIon A thyroid nodule may be defined as a discrete lesion within the thyro... more Review Article IntRoductIon A thyroid nodule may be defined as a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding gland. [1] Palpable thyroid nodules are present in approximately 5% of women and 1% of men in iodine sufficient areas. If high-resolution ultrasound (USG) was used, up to 68% of randomly selected individuals may have nodules-more in women and increasing with age in both sexes. [2] There is a linear increase in the prevalence from almost none at age 15%-50% by the age of 65 years. [3]

Research paper thumbnail of Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes

Diabetes & metabolic syndrome, Jan 5, 2017

Over the time due to progressive nature of diabetes, proactive intensification of the existing in... more Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.

Research paper thumbnail of Fasting practices in Tamil Nadu and their importance for patients with diabetes

Indian journal of endocrinology and metabolism

Religious practices and cultural customs related to eating habits have a significant impact on li... more Religious practices and cultural customs related to eating habits have a significant impact on lifestyle and health of the community. The Ramadan fasting in Muslims and its influence on various metabolic parameters such as diabetes have been reasonably studied. However, literature related to Hindu religious customs related to fasting and food patterns during various festivals and its effect on diabetes are scarce. This article is an attempt to describe the Hindu religious customs related to fasting and food practices from the State of Tamil Nadu (South India) and to raise the awareness among physicians about its relationship with diabetes which may help in managing their diabetic patients in a better way.

Research paper thumbnail of System and method providing configuration services for communications devices

Research paper thumbnail of Effect of sustained released metformin therapy on phenotypic and biochemical markers of insulin resistance in polycystic ovary syndrome in South Indian women

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women... more Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial. Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of βcell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy. Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA-β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels. Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS.

Research paper thumbnail of Chapter-80 Surgery and Diabetes

RSSDI Textbook of Diabetes Mellitus, 2014

Research paper thumbnail of The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

Endocrine Connections, 2016

Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodi... more Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodine ablation, RIA) therapy in Graves' disease. We undertook a study to look at the impact of iodine uptakes on the outcome of 131I therapy. To determine the effect of prior ATD use on the duration of time to achieve cure in patients with high vs intermediate uptake Graves' disease who received a fixed dose (15 mCi) of 131I radioiodine. In a retrospective study of patients with Graves' disease, 475 patients who underwent RIA were followed-up on a two-monthly basis with thyroid function tests. Of the 123 patients with a documented preablation RAIU and consistent follow-up it was observed that 40 patients had an intermediate RAIU (10–30%) and 83 subjects had a distinctly increased uptake (>30%). Successful cure was defined as the elimination of thyrotoxicosis in the form of low free thyroxin and rising TSH levels. When a standard dose of 15 mCi 131I was administered, a cure ra...

Research paper thumbnail of Doctor–Patient Communication

Research paper thumbnail of Inflammation and Type 2 Diabetes Mellitus

Research paper thumbnail of HbA1c reduction in Long Term Programs - experience from the Apollo Sugar Group

Research paper thumbnail of From Individualized to Personalized Medicine in Diabetes: An Expert Overview

The Journal of the Association of Physicians of India, 2019

Personalized medicine is an individualized and stratified approach to the management of a disease... more Personalized medicine is an individualized and stratified approach to the management of a disease. Personalized medicine can reform the prevention, prediction, and management of diabetes. Use of genetic information in polygenic and monogenic forms of diabetes can help to identify genetic variants and reclassify patients into pathophysiological subgroups. Targeted diagnostic, preventive, and therapeutic interventions can be defined for these groups for effective management of diabetes. Pharmacogenetics combines genotypic and phenotypic factors to develop personalized care in various pathophysiological subgroups of persons with diabetes. Personalized medicine finds wider utility in monogenic (especially Maturity Onset Diabetes of the Young (MODY) and Neonatal Diabetes Mellitus [NDM]) than in polygenic, diabetes. The most frequently mutated genes in MODY include HNF1A and HNF3A. the common genes responsible for NDM include KCNJ11 and ABCC8 (SUR) genes. These genes influence various asp...

Research paper thumbnail of Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians

Diabetes Technology & Therapeutics, 2021

AIM: To assess the prescribing patterns and response to different classes of antihyperglycemic ag... more AIM: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. MATERIALS AND METHODS: We attempted to replicate the earlier described clusters of T2D In 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilising six clinically relevant variables. Individuals who had followup HbA1c upto 2 years were included for the drug response analysis (n=13,247). RESULTS: Among the 32,867 participants included in the study, 20779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9 %. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the Mild Age-Related Diabetes [MARD] cluster, followed by Insulin Resistant Obese Diabetes [IROD] (27%), Severe Insulin Deficient Diabetes [SIDD] (21%) and Combined Insulin Resistant and Deficient Diabetes [CIRDD] (12%) clusters. The most frequently used antihyperglycemic agents were sulphonylureas, metformin and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pre-treatment) HbA1c. CONCLUSIONS: In this new cohort we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.

Research paper thumbnail of Real-World Observational Study of Glimepiride and Metformin Fixed-Dose Combination Along With Insulin in the Management of Type 2 Diabetes Mellitus: Indian Experience

Cureus, 2021

Background Type 2 diabetes mellitus (T2DM) is associated with a significant burden on both patien... more Background Type 2 diabetes mellitus (T2DM) is associated with a significant burden on both patients and the healthcare system. This study aimed to evaluate the demographics of patients with T2DM receiving different strengths of glimepiride and metformin combination along with insulin. This study also examined the concomitant conditions and therapies, duration of therapies, dosage titration, glycated hemoglobin (HbA1c) levels, hypoglycemic events, and weight changes during the course of therapy. Methods This retrospective, multicenter (347), observational study included adult patients with T2DM who received glimepiride and metformin combination along with insulin. Data related to demographic characteristics, duration of disease, co-morbidities, concomitant medications, and dosage pattern was collected from medical records authenticated by physicians during routine care. Results A total of 7058 patients were included in the study. The median age of included patients was 55 years and around 29% were aged >60 years and 60% were men. The majority of patients (83.3%) had insulin treatment initiation after glimepiride and metformin combination while other patients (16.7%) received glimepiride and metformin combination after insulin initiation. The mean HbA1c levels significantly decreased with a mean change of 1.33%. In one-third of the patients, down-titration of the insulin dose was done, indicating the insulin-sparing effect with the addition of the glimepiride and metformin combination. The most common comorbid condition was hypertension (64.7%). Of 3705 patients, 33.2% patients had weight loss and 66.8% had weight gain. A total of 432 patients reported hypoglycemic events. Physician global evaluation of efficacy and tolerability showed a good to excellent on the scale (97.3% and 96.6%). Conclusion This study presented good HbA1c lowering with glimepiride and metformin combination with insulin, ensuring a positive clinical outcome. Good to excellent efficacy and tolerability were observed in patients with T2DM across the age groups, in early as well as long-standing disease.

Research paper thumbnail of 2174-PUB: Profiling of Young Diabetes in India: A Cross-Sectional Analysis Report

Diabetes, 2020

Aim: The purpose of this study was to profile young-onset (defined as up to age 40 years) diabete... more Aim: The purpose of this study was to profile young-onset (defined as up to age 40 years) diabetes patients in India. Methods: The current analysis is a retrospective data analysis of young-onset diabetes patients. Young age diabetes is defined as patients diagnosed with diabetes between 18 to 40 years of age. T1DM and other secondary diabetes were excluded while profiling these patients. Patient’s data was extracted from EMRs of Apollo Sugar Outpatient clinics (n=35) from January 2018 to October 2019. Descriptive statistics were applied to analyze the data and report the results. Results: Of the total 85568 diabetes patient’s records, 4152 (5%) young diabetes patients were identified as fulfilling the criteria of T2DM of early-onset. Males were 2495 (60%) and females were 1657(40%). Mean blood pressure was 122/78 mmHg, average BMI was 28.4 kg/m2, 15% had hypertension, 39% had dyslipidemia and 1% had CAD. Positive family history was recorded in 5% of patients, and 1% were recorded t...

Research paper thumbnail of Best Practices and Tools for Titrating Basal Insulins: Expert Opinion from an Indian Panel via the Modified Delphi Consensus Method

Diabetes Therapy, 2020

Aim: To develop an evidence-based expert group consensus document on the best practices and simpl... more Aim: To develop an evidence-based expert group consensus document on the best practices and simple tools for titrating basal insulins in persons with type 2 diabetes mellitus (T2DM). Background: Glycemic control is suboptimal in a large proportion of persons with T2DM, despite insulin therapy, thereby increasing the risk of potentially severe complications. Early initiation of insulin therapy and appropriate dose titration are crucial to achieving glycemic targets. Attitudes and practices among healthcare professionals (HCPs) and perceptions about insulin therapy among persons with diabetes contribute largely to suboptimal glycemic control. Improving HCP-patient communication, encouraging the use of additional educational tools, and providing support for the titration process to increase confidence, both at the initiation visit and at home, facilitate the optimization of dose titration. In Indian settings, specific guidelines and a consensus statement are lacking on the optimal insulin initiation dose, frequency of dose titration, and basal insulin profile needed to achieve optimal

Research paper thumbnail of Impact of Vitamin D Fortified Food on Quality of Life and Emotional Difficulties Among Adolescents – a Randomized Controlled Trial

Indian Journal of Child Health, 2019

A dolescence is marked by a period of transition in the emotional, mental and behavioural spheres... more A dolescence is marked by a period of transition in the emotional, mental and behavioural spheres [1-4] thus, making it essential to study the health related quality of life (HRQoL) and emotional difficulties experienced in this phase [2,3]. The prevalence of behavioural and emotional problems among adolescents ranges from 16.5% to 40.8% in different parts of the world and in India it is in the range of 13.7% to 50% [1]. Vitamin D has been widely identified as a neurosteroid with multiple actions in the brain during the past 20 years [5]. It has long been recognized that out of the many areas in the body, the brain can also produce 1,25 dihydroxy vitamin D, the active form of vitamin D [6]. Sunlight is considered to be the most abundant source of vitamin D as it is naturally synthesized in the skin on exposure to ultraviolet B rays [7]. Surprisingly although India is located between 8.4° and 37.6° north latitude and majority of the occupants reside in regions with good and sufficient sunshine throughout the year, vitamin D deficiency is widespread among 70-100% Indians [8-12]. In north India, vitamin D deficiency was reported among 93.7% children and adolescents [13]. Thirty four percent of children in South Chennai were also shown to have hypovitaminosis [14]. Scientists have suggested vitamin D supplementation to have biological plausibility in promoting increased well-being and physical activity of individuals [15]. Epidemiological evidences indicate its role in emotional difficulties such as depression, anxiety and stress and HRQoL among individuals [16-18] .The link between vitamin D deficiency and headache [19] , muscular pain, psychotic features among mentally ill [17] , reduced physical activity [20] , lower back pain [21] , increased emotional and peer relationship problems among adolescents have been explored in several studies [22]. Vitamin D supplementation has resulted in lower rates of psychosis and depression among adolescents [17,23]. However, conflicting results have been observed in this area. In a study conducted among children in North India, vitamin D did not seem to have any link with neurodevelopment when compared with Vitamin B 12 [24]. Trials focusing the action of vitamin D supplementation on HRQoL and emotional difficulties of adolescents is lacking in India. To bridge this gap, the present study was designed to evaluate whether vitamin D fortified food will help in improving the HRQoL and emotional difficulties among adolescents. MATERIAL AND METHODS A randomized controlled trial was employed to study the effect of the vitamin D fortified food ('ladduu' (a homemade

Research paper thumbnail of Sleep and diabetes and the kidney

International Journal of Diabetes in Developing Countries, 2018

Research paper thumbnail of Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study

Indian Journal of Endocrinology and Metabolism, 2017

IntroductIon Strict control of diabetes is increasingly emphasized after the benefits demonstrate... more IntroductIon Strict control of diabetes is increasingly emphasized after the benefits demonstrated in the UK Prospective Diabetes Study and DCCT studies. [1,2] Hypoglycemia tops the list of hurdles in preventing tight glycemic control and is often

Research paper thumbnail of Lipid association of India expert consensus statement on management of dyslipidemia in Indians 2016 - part 1

Journal of the Practice of Cardiovascular Sciences, 2016

increasing in Indians, particularly at a younger age, the pattern of dyslipidemia is also distinc... more increasing in Indians, particularly at a younger age, the pattern of dyslipidemia is also distinct a s c o m p a r e d t o t h e w e s t e r n p o p u l a t i o n s. T h e d i s t r i b u t i o n a n d i n t e r p l a y o f c o n c o m i t a n t

Research paper thumbnail of Effect of metformin-sustained release therapy on low-density lipoprotein size and adiponectin in the South Indian women with polycystic ovary syndrome

Indian Journal of Endocrinology and Metabolism, 2017

IntRoductIon Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder, affect... more IntRoductIon Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder, affecting 5%-10% of women in the reproductive age. It is characterized by chronic anovulation, infertility, signs and symptoms of hyperandrogenism, acanthosis nigricans, insulin resistance (IR), type 2 diabetes mellitus (T2DM), dyslipidemia, and atherosclerosis. [1] Approximately 50%-70% of women with PCOS have central obesity and dyslipidemia, represented by increased triglycerides (TGLs) and low-density lipoprotein cholesterol (LDL-C) and decreased levels of high-density lipoprotein cholesterol (HDL-C) which may increase cardiovascular risk. [2] The prevalence of dyslipidemia is not the same in all populations with PCOS; ethnicity appears to play a major role. LDL is an atherogenic type of lipoprotein; its density varies from 1.006 to 1.063 g/ml. When the LDL particle size is <25.5 nm, it is known as small dense-LDL (sd-LDL). sd-LDL appears to confer a threefold increase in the risk of cardiovascular disease (CVD). [3,4] Adiponectin (APN) is an adipokine that is expressed exclusively in white adipose tissue and demonstrates insulin-sensitizing properties. It is hypothesized to play a protective role in the development and progression of obesity, T2DM, and CVD. APN has demonstrated anti-inflammatory, anti-thrombotic, anti-atherogenic, and cardioprotective properties both in vitro and in vivo models. Low levels of APN may be associated with obesity, IR, metabolic syndrome, T2DM, and CVD. [5] Objectives: The aim of the study is to compare surrogate markers of cardiovascular disease (CVD) risk, such as adiponectin (APN) levels and low-density lipoprotein (LDL) size, before and after sustained release metformin (Met-SR) therapy in women with polycystic ovarian syndrome (PCOS). Methods: Sixty women with PCOS and sixty age-matched controls in the age group 18-45 years were recruited after obtaining informed consent. Women with PCOS were initiated on Met-SR 1 g orally, which was increased to 1.5 g after 2 weeks and continued up to 24 weeks. Demographic data along with family history of type 2 diabetes mellitus, PCOS, and CVD were collected. Lipid profile plasma APN levels and LDL size were measured before and after therapy in the PCOS group. Data analysis was performed using the GraphPad Prism-5 software. Results: Women with PCOS had greater dyslipidemia, lower APN level and LDL size, and increased lipid accumulating product index as compared to controls. After 6 months of Met-SR therapy, women with PCOS demonstrated significant increase in plasma APN levels and LDL size and significant decrease in weight, waist-hip ratio (WHR), waist circumference (WC), and blood pressure (BP). A significant decrease was observed in body mass index (BMI) in the overweight and obese PCOS subgroups. Conclusion: Met-SR increases LDL size, APN concentration and decreases weight, WC, WHR, and BP in patients with PCOS. Met-SR may have salutary effects on LDL particle size through effects on APN levels in women with PCOS.

Research paper thumbnail of A pragmatic approach to the indeterminate thyroid nodule

Indian Journal of Endocrinology and Metabolism, 2017

Review Article IntRoductIon A thyroid nodule may be defined as a discrete lesion within the thyro... more Review Article IntRoductIon A thyroid nodule may be defined as a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding gland. [1] Palpable thyroid nodules are present in approximately 5% of women and 1% of men in iodine sufficient areas. If high-resolution ultrasound (USG) was used, up to 68% of randomly selected individuals may have nodules-more in women and increasing with age in both sexes. [2] There is a linear increase in the prevalence from almost none at age 15%-50% by the age of 65 years. [3]

Research paper thumbnail of Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes

Diabetes & metabolic syndrome, Jan 5, 2017

Over the time due to progressive nature of diabetes, proactive intensification of the existing in... more Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.

Research paper thumbnail of Fasting practices in Tamil Nadu and their importance for patients with diabetes

Indian journal of endocrinology and metabolism

Religious practices and cultural customs related to eating habits have a significant impact on li... more Religious practices and cultural customs related to eating habits have a significant impact on lifestyle and health of the community. The Ramadan fasting in Muslims and its influence on various metabolic parameters such as diabetes have been reasonably studied. However, literature related to Hindu religious customs related to fasting and food patterns during various festivals and its effect on diabetes are scarce. This article is an attempt to describe the Hindu religious customs related to fasting and food practices from the State of Tamil Nadu (South India) and to raise the awareness among physicians about its relationship with diabetes which may help in managing their diabetic patients in a better way.

Research paper thumbnail of System and method providing configuration services for communications devices

Research paper thumbnail of Effect of sustained released metformin therapy on phenotypic and biochemical markers of insulin resistance in polycystic ovary syndrome in South Indian women

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women... more Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial. Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of βcell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy. Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA-β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels. Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS.

Research paper thumbnail of Chapter-80 Surgery and Diabetes

RSSDI Textbook of Diabetes Mellitus, 2014

Research paper thumbnail of The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

Endocrine Connections, 2016

Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodi... more Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodine ablation, RIA) therapy in Graves' disease. We undertook a study to look at the impact of iodine uptakes on the outcome of 131I therapy. To determine the effect of prior ATD use on the duration of time to achieve cure in patients with high vs intermediate uptake Graves' disease who received a fixed dose (15 mCi) of 131I radioiodine. In a retrospective study of patients with Graves' disease, 475 patients who underwent RIA were followed-up on a two-monthly basis with thyroid function tests. Of the 123 patients with a documented preablation RAIU and consistent follow-up it was observed that 40 patients had an intermediate RAIU (10–30%) and 83 subjects had a distinctly increased uptake (>30%). Successful cure was defined as the elimination of thyrotoxicosis in the form of low free thyroxin and rising TSH levels. When a standard dose of 15 mCi 131I was administered, a cure ra...