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3.
J Pak Med Assoc ; 70(1): 183-185, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31954050

RESUMO

This communication is an interesting and off-beat take on the concept of theranostics, as applied to diabetes care. It proposes the use of the term diabeto-theranostics, to define the combined use of diagnostic and therapeutic modalities, so as to create individualized or personalized treatment strategies in persons with diabetes. Historical examples such as the chlorpropamide challenge test and modern innovations such as genotyping are described. The rubrics of gluco-phenotype, endo-phenotype, metabolic phenotype, glucagon: insulin ratio, and adenosine monophosphate activated protein kinase (AMPK) status in planning glucose lowering therapy are explained. Novel concepts such as psycho-theranostics and electro-theranostics in diabetes are discussed.

4.
J Pak Med Assoc ; 70(1): 186-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31954051

RESUMO

Hearsay, including e-hearsay, is an unwanted, yet unavoidable, part of modern medical practice. Misinformation creates a barrier for the acceptance of, and adherence to, diabetes management. Modern technology has facilitated the spread of (mis) information. This communication describes the disadvantages of hearsay. It suggests ways for physicians to tackle diabetes hearsay in their patients and community.

5.
Diabetes Ther ; 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31981212

RESUMO

AIM: To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM). BACKGROUND: Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. REVIEW RESULTS: After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. CONCLUSIONS: In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals.

6.
Diabetes Ther ; 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31916214

RESUMO

AIM: The primary objective of this review is to develop a practice-based expert group opinion on the role of precision medicine with a specific focus on sulfonylureas (SUs) in diabetes management. BACKGROUND: The clinical etiology, presentation and complications of diabetes vary from one patient to another, making the management of the disease challenging. The pre-eminent feature of diabetes mellitus (DM) are chronically elevated blood glucose concentrations; however, in clinical practice, the exclusion of autoimmunity, pregnancy, pancreatic disease or injury and rare genetic forms of diabetes is crucial. Within this framework, precision medicine provides unique insights into the risk factors and natural history of DM. Precision medicine goes beyond genomics and encompasses patient-centered care, molecular technologies and data sharing. Precision medicine has evolved in the field of diabetology. It has helped improve the efficacy of SUs, a class of drugs, which have been effectively used in the management of diabetes mellitus for decades, and it has enabled the expansion of SUs use in diabetes patients with genetic mutations. REVIEW RESULTS: After due discussions, the expert group analyzed studies that focused on the use of SUs in diabetes patients with genomic variations and rare mutations. The expert group opined that SUs are important glucose-lowering drugs and that precision medicine helps in improving the efficacy of SUs by matching them to those patients who will benefit most. CONCLUSION: Precision medicine opens new vistas for the effective use of SUs in unexpected patient populations, such as those with genetic mutations.

8.
Comput Med Imaging Graph ; 79: 101659, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786374

RESUMO

Gradient-based texture analysis methods have become popular in computer vision and image processing and has many applications including medical image analysis. This motivates us to develop a texture feature extraction method to discriminate Amyotrophic Lateral Sclerosis (ALS) patients from controls. But, the lack of data in ALS research is a major constraint and can be mitigated by using data from multiple centers. However, multi-center data gives some other challenges such as differing scanner parameters and variation in intensity of the medical images, which motivate the development of the proposed method. To investigate these challenges, we propose a gradient-based texture feature extraction method called Modified Co-occurrence Histograms of Oriented Gradients (M-CoHOG) to extract texture features from 2D Magnetic Resonance Images (MRI). We also propose a new feature-normalization technique before feeding the normalized M-CoHOG features into an ensemble of classifiers, which can accommodate for variation of data from different centers. ALS datasets from four different centers are used in the experiments. We analyze the classification accuracy of single center data as well as that arising from multiple centers. It is observed that the extracted texture features from downsampled images are more significant in distinguishing between patients and controls. Moreover, using an ensemble of classifiers shows improvement in classification accuracy over a single classifier in multi-center data. The proposed method outperforms the state-of-the-art methods by a significant margin.

9.
Indian J Endocrinol Metab ; 23(5): 507-513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31803589

RESUMO

Background and Aims: In spite of large volume of data linking Vitamin D with cardiovascular morbidity, autoimmunity, cancer, and virtually every organ system, Vitamin D and thyroid is a lesser-known aspect of Vitamin D in clinical practice. This article intends to highlight the current literature on the impact of Vitamin D status and supplementation on thyroid autoimmunity and cancer. Methods: References for this review were identified through searches of PubMed for articles published to from 1950 to August 2019 using the terms "thyroid" [MeSH Terms] AND "Vitamin D" [MeSH Terms] OR "thyroid" [All Fields] AND "Vitamin D" [All Fields]. Results: Significant inverse correlation was documented between anti-thyroid peroxidase antibody (TPOAb) and serum 25-hydroxy-Vitamin D (25OHD). TPOAb positivity is more prevalent in Vitamin D deficient individuals. A large volume of medical literature is available from observational studies linking Vitamin D with thyroid autoimmunity. Data from interventional studies documenting beneficial effects of Vitamin D on thyroid autoimmunity is also available, but lesser than that from observational studies. Short-term high dose oral Vitamin D supplementation reduces TPOAb titers. Certain Vitamin D receptor (VDR) gene polymorphism have been linked to increased occurrence of autoimmune thyroid disorders (AITD). Vitamin D deficiency, decreased circulating calcitriol has been linked to increased thyroid cancer. Certain VDR gene polymorphisms have been linked with increased as well as decreased occurrence of thyroid cancer. Data is scant on use of Vitamin D and its analogues for treating thyroid cancer. Conclusion: In spite of large volume of medical literature from observational studies linking Vitamin D with thyroid autoimmunity and cancer, meaningful concrete clinical data on impact of Vitamin D supplementation on hard clinical end points in these disorders is lacking, and should be the primary area of research in the next decade.

10.
J Pak Med Assoc ; 69(12): 1919-1921, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31853130

RESUMO

This article presents simple 'activity day' rules for persons living with diabetes who wish to take part in exercise and sports. It describes basic precaution related to self-care, carbohydrate intake, insulin dosage, noninsulin drug medication, and multisystem health. The framework provides a template for individualized recommendations which will help ensure safe and enjoyable participation in exercise and sports.

11.
J Pak Med Assoc ; 69(12): 1922-1923, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31853131

RESUMO

This communication describes the concept, rationale, and potential of social prescription in diabetes care. It calls for use of strategy to harness the strengths of the South Asian socio-cultural milieu, and contain the diabetes epidemic.

12.
J Pak Med Assoc ; 69(12): 1765-11766, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31853099
13.
Neurol Clin Pract ; 9(5): 400-407, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31750025

RESUMO

Background: We investigated cerebral degeneration and neurochemistry in patients with amyotrophic lateral sclerosis (ALS) using magnetic resonance spectroscopy (MRS). Methods: We prospectively studied 65 patients and 43 age-matched healthy controls. Participants were recruited from 4 centers as part of a study in the Canadian ALS Neuroimaging Consortium. All participants underwent single-voxel proton MRS using a protocol standardized across all sites. Metabolites reflecting neuronal integrity (total N-acetyl aspartyl moieties [tNAA]) and gliosis (myo-inositol [Ino]), as well as creatine (Cr) and choline (Cho), were quantified in the midline motor cortex and midline prefrontal cortex. Comparisons were made between patients with ALS and healthy controls. Metabolites were correlated with clinical measures of upper motor neuron dysfunction, disease progression rate, and cognitive performance. Results: In the motor cortex, tNAA/Cr, tNAA/Cho, and tNAA/Ino ratios were reduced in the ALS group compared with controls. Group differences in tNAA/Cr and tNAA/Cho in the prefrontal cortex displayed reduced ratios in ALS patients; however, these were not statistically significant. Reduced motor cortex ratios were associated with slower foot tapping rate, whereas only motor tNAA/Ino was associated with finger tapping rate. Disease progression rate was associated with motor tNAA/Cho. Verbal fluency, semantic fluency, and digit span forwards and backwards were associated with prefrontal tNAA/Cr. Conclusions: This study demonstrates that cerebral degeneration in ALS is more pronounced in the motor than prefrontal cortex, that multicenter MRS studies are feasible, and that motor tNAA/Ino shows promise as a potential biomarker.

14.
J Pak Med Assoc ; 69(11): 1746-1749, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740893

RESUMO

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in cardiology practice. A diagnosis of AF implies a greater need for hospitalization, a higher risk of stroke and heart failure, and earlier mortality. These complications can be avoided if AF is diagnosed and treated in a timely manner. To achieve this, physicians need to maintain a high index of clinical suspicion, practice cardiovigilance, and screen for AF in appropriate clinical settings. This review describes the vast spectrum of endocrine and metabolic disease that are associated with AF. Through this perspective, it encourages physicians and endocrinologists to play an active role in AF detection, referral and long term management.

15.
J Pak Med Assoc ; 69(11): 1750-1751, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740894

RESUMO

More often than not, the root cause of unsatisfactory diabetes care can be traced to in appropriate communication. In this brief article, we share the four pillars of communication that a successful physician should be able to address: person, patient, public and peers. A good physician should be able to understand herself or himself, communicate with patients and the society at large, and handle professional relationships. This quadruple helps us identify our strengths and shortcomings and facilitates attempts at self-improvement, so as to improve the quality of our life.

16.
Indian J Endocrinol Metab ; 23(4): 460-467, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31741907

RESUMO

Background: This study evaluated the real-world weight loss and glycemic outcomes of multidrug therapy (MDT) according to various combinations of metformin, sodium-glucose cotransporter -2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor analogs (GLP1a), and orlistat in diabesity. Methods: Data retrospectively captured from medical records of 2 different centers in New Delhi for patients >35 years-age having prediabetes/diabetes and on at least any one of the 4 above medications with >6-months follow-up was analyzed. Results: In total, 5,336 patient records were screened; 2,442 with prediabetes/diabetes were considered; 1,509 patients who fulfilled all criteria were analyzed. Use of metformin, SGLT2i, sulfonylureas, DPP4i, pioglitazone, orlistat, and GLP1a was 85.35%, 74.95%, 68.32%, 60%, 39.16%, 9.08%, and 4.17%, respectively. However, 365, 970, and 104 patients were on one of 4 concerned medications (Group-1; 24.18%), dual MDT (Group-2; 64.28%), and triple/quadruple MDT (Group-3; 6.89%). Metformin with SGLT2i was most commonly used dual MDT (94.12%). Analysis according to weight-loss quartiles from 558 patients showed 6.9 kg weight-loss in the highest quartile. People losing maximum weight were significantly younger; had higher use of metformin, SGLT2i, GLP1, orlistat, and lower pioglitazone use; greatest HbA1c reduction (-1.3 vs. -0.3; quartile-1 vs. quartile -4; P < 0.001); and significantly higher occurrence of HbA1c<5.7% (16.8% vs. 6.29%; quartile-1 vs. 4; P < 0.001). Patients in Group-3 had the highest baseline BMI and maximum weight loss with highest number of patients with HbA1c<5.7% (19.44% vs. 10.34%; Group-3 vs. Group-1; P < 0.001). Conclusion: Greater weight loss with HbA1c reduction along with a greater number of patients attaining HbA1c <5.7% highlights that MDT is the way forward to tackle diabesity in India.

17.
Indian J Endocrinol Metab ; 23(4): 495-497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31741913

RESUMO

Artificial intelligence/Machine learning (AI/ML) is transforming all spheres of our life, including the healthcare system. Application of AI/ML has a potential to vastly enhance the reach of diabetes care thereby making it more efficient. The huge burden of diabetes cases in India represents a unique set of problems, and provides us with a unique opportunity in terms of potential availability of data. Harnessing this data using electronic medical records, by all physicians, can put India at the forefront of research in this area. Application of AI/ML would provide insights to our problems as well as may help us to devise tailor-made solutions for the same.

18.
J Family Med Prim Care ; 8(10): 3096-3107, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31742126

RESUMO

Type 2 diabetes is characterised by a progressive decline in insulin secretion, and sooner or later patients require insulin therapy. However, physicians are reluctant to initiate insulin therapy because of perceived inadequacy in managing insulin therapy, cost and lack of benefits. Experts from across the country met at a workshop during 12th National Insulin Summit which was held in September at Hyderabad and came up with key recommendations to build capacity and confidence in general practitioners for insulin usage. Barriers can be overcome through self-education and training; effective patient education; imparting coping skill training to patients; and bridging gaps to improve adherence. Moreover, optimum insulinization requires knowledge about the available options for initiation and intensification of insulin therapy; various insulin regimens; dosing and titration; and choosing effective and simple insulin therapy as per patient characteristics. Hence, the objective of this review article is to help build capacity and confidence among general practitioners on optimising insulin therapy.

19.
Eur Endocrinol ; 15(2): 67-69, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31616495

RESUMO

This communication shares insights into the definition of disease progression and drug durability in type 2 diabetes. Disease progression may be defined as gradual worsening of beta-cell function, clinically observed as an increase in drug dosage, drug frequency or number of glucose lowering drugs needed to maintain HbA1c control; and/or a ≥0.5% rise in HbA1c, unexplained by acute, modifiable factors, while using the same drug regimen; and/or as the occurrence or worsening of cardiovascular or microvascular complications, in spite of standard care, over a pre-specified time period. Durability of a drug or a drug combination may be defined as its ability to postpone or delay progression of disease, in a safe and well tolerated manner. Thus, all drugs that are able to prevent disease progression (i.e., postpone loss of glycaemic control, need for intensification of therapy or onset or worsening of complications) may be termed 'durable'.

20.
Eur Endocrinol ; 15(2): 77-82, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31616497

RESUMO

INTRODUCTION: The Palaeolithic diet is designed to resemble that of human hunter-gatherer ancestors thousands to millions of years ago. This review summarises the evidence and clinical application of this diet in various disorders. An empiric vegan variant of it has been provided, keeping in mind vegan food habits. REVIEW OF THE LITERATURE: different types of Palaeolithic diets in vogue include the 80/20, the autoimmune, the lacto, the Palaeolithic vegan and the Palaeolithic ketogenic. We have developed an Indian variant of the Palaeolithic vegan diet, which excludes all animal-based foods. The Palaeolithic diet typically has low carbohydrate and lean protein of 30-35% daily caloric intake in addition to a fibre diet from non-cereal, plant-based sources, up to 45-100 g daily. In different observational studies, beneficial effects on metabolic syndrome, blood pressure, glucose tolerance, insulin secretion, lipid profiles and cardiovascular risk factors have been documented with the Palaeolithic diet. Short-term randomised controlled trials have documented weight loss, and improved glycaemia and adipo-cytokine profiles. Few concerns of micronutrient deficiency (e.g. calcium) have been raised. CONCLUSION: Initial data are encouraging with regard to the use of the Palaeolithic diet in managing diabesity. There is an urgent need for large randomised controlled trials to evaluate the role of the Palaeolithic diet with different anti-diabetes medications for glycaemic control and the reversal of type 2 diabetes.

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