Gla-100 Development: a Story of 'Serendipitous' Disruptive Innovation.

Ever since the discovery of insulin a century ago, relentless attempts have been made to develop insulins that closely mimic the timeaction- profile of human physiologic insulin. The early basal insulins like neutral protamine Hagedorn (NPH), were intermediate-acting, with high risk of hypoglycemia. These primary limitations led to attempts at developing improved basal insulins with a longer duration of action. After several attempts at prolonging insulin action using phenol and structural modifications of the insulin hexamer, insulin glargine was developed in 1988. The superior and unique pharmacological properties, longer duration of action, and significantly lowered risk of hypoglycemia enabled insulin glargine to be distinguished from NPH as a better basal insulin, providing holistic glycemic control. The present review highlights the circumstances that led to the search of truly basal insulins, focusing on the journey of insulin glargine 100 U/mL (Gla-100).

Evaluation of adjustment methods used to determine prevalence of low birth-weight babies at a rural hospital in Andhra Pradesh, India.

Accurate reporting of prevalence of low birth weight (LBW) is important for monitoring health of a population. LBW is often underestimated in developing countries due to heaping of the data at 2.5 kg. UNICEF uses an average adjustment factor of 25% to re-classify babies listed as exactly 2.5 kg into the LBW category. From October 2009 to February 2010, we weighed 859 consecutive live births at a rural hospital in Andhra Pradesh, India, using analog and digital scales to evaluate the relative validity of the adjustment factor. Significantly more babies weighed exactly 2.5 kg on analog (13.4%) versus digital (2.2%) scales, showing heaping. Percentage of LBW by digital method (29.5%) was significantly higher compared to the analog method (23%) and with adjustment factors (26.4%). Conventional methods of adjusting birth-weight data underestimate the prevalence of LBW. Sensitive digital weighing machines or better adjustment methods are needed to monitor LBW in developing countries.

Rural-urban epidemiologic transition of risk factors for coronary artery disease in college students of Hyderabad and nearby rural area--a pilot study.

OBJECTIVES: Massive urbanization in developing nations like India is predicted to cause epidemiologic transition to increased Coronary Artery Disease (CAD). To evaluate the rural-urban epidemiologic transition, risk factors for CAD were measured in two groups of subjects; Rural and Urban college students. METHODS: Subjects included 232 college students (58 men and 58 women in each group) aged between 18-22 years (mean 19.2 +/- 1.0). Since the age of urban youth was significantly higher (19.9 vs 18.4 years), age-adjusted analysis was performed. RESULTS: Age-adjusted BMI was significantly higher in urban (21.8 vs 17.8); 69.8% of rural and 13.8% of urban were underweight whereas 3.5% of rural and 31.9% of urban were either overweight or obese. Waist circumference (73.2 vs 61.9 cm), waist: hip circumference ratio (0.80 vs 0.75), diastolic BP (72.7 vs 67.9 mmHg), fasting blood glucose (82.4 vs 79.0 mg/dl), total cholesterol (147.9 vs 129.2 mg/dl), and LDL (89.3 vs 71.9 mg/dl) were significantly higher in the urban group. Triglycerides (79.1 vs 76.5 mg/dl), VLDL (15.9 vs 15.2 mg/dl) and systolic BP (114 vs 115 mmHg) were not significantly different. HDL (43.3 vs 40.7 mg/dl) and Cholesterol/HDL ratio (3.5 vs 3.3) were higher in urban group but with borderline significance (p = 0.057 and 0.056 respectively). CONCLUSION: Epidemiologic transition to higher risk for CAD is found in urban youth of Hyderabad compared to nearby villages, with increases in values of most parameters which are associated with increased risk for CAD. These findings need to be confirmed in extended studies to plan public health interventions to counteract the adverse effects of urbanization in early life.

Reasons for seeking HIV-test: evidence from a private hospital in rural Andhra Pradesh, India.

This study sought to describe the development of HIV counselling and testing services in a rural private hospital and to explore the factors associated with reasons for seeking HIV testing and sexual behaviours among adults seeking testing in the rural hospital. Data for this study were drawn from a voluntary counselling and testing clinic in a private hospital in rural Andhra Pradesh state in southern India. In total, 5,601 rural residents sought HIV counselling and testing and took part in a behavioural risk-assessment survey during October 2003-June 2005. The prevalence of HIV was 1.1%. Among the two reported reasons for test-seeking--based on past sexual behaviour and based on being sick at the time of testing--men, individuals reporting risk behaviours, such as those having multiple pre- and postmarital sexual partners, individuals whose recent partner was a sex worker, and those who reported using alcohol before sex, were more likely to seek testing based on their past sexual behaviour. Men also were more likely to seek testing because they were sick. The findings from this large sample in rural India suggest that providing HIV-prevention and care services as part of an ongoing system of healthcare-delivery may benefit rural residents who otherwise may not have access to these services. The implications of involving the private sector in HIV-related service-delivery and in conducting research in rural areas are discussed. It is argued that services that are gaining prominence in urban areas, such as addressing male heterosexual behaviours and assessing the role of alcohol-use, are equally relevant areas of intervention in rural India.

Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study.

AIM: Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women. METHODS: Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression. RESULTS: 71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P = 0.003. Sex and age showed significant interaction (P = 0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4-33.1), depression (OR:9.6; 3.1-30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1-5.1). Among women, poor physical performance (OR: 3.33; 1.13-9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01-5.80) were independently associated with falls. IMPLICATIONS: Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling.