Publications by authors named "Sujeet Jha"

22 Publications

  • Page 1 of 1

HCQ prophylaxis in COVID-19 did not show any QTc prolongation in Healthcare workers.

Indian Heart J 2021 Jan-Feb;73(1):74-76. Epub 2020 Nov 10.

Institute of Endocrinology, Diabetes, and Metabolism, Max Healthcare, New Delhi, India.

Background: HCQ is a commonly recommended drug for the prophylaxis of COVID-19. One of its rare side-effect includes QTc prolongation.

Methods: This was a prospective, cross sectional and observational study conducted on Hydroxychloroquine (HCQ) among Healthcare Workers (HCWs) at Max Super Speciality Hospital, Saket, New Delhi, India. A 3-lead ECG (only limb leads, it does not require chest leads) was performed. The QTc cut offs were pre decided, QTC < 470 ms for males and <480 ms for females was considered within the normal limits and anything above this was regarded as QTc prolongation.

Results: There were 274 HCWs enrolled into the study, including 175 males and 99 females. Majority of the HCWs were young and had a mean age of 32.19 ± 9.29 years. Out of these, 218 were taking HCQ as per the Indian Council of Medical Research (ICMR) guidelines. The median cumulative dose being taken was 1600 mg and the median QTc of these participants was 390 ms in males and 391.5 ms in females. Subsequently, 33 participants were followed-up and found to have a median QTc of 389 ms and a cumulative dose of HCQ as 2000 mg.

Conclusion: In conclusion, ours is a first study in the middle of the pandemic which showed that HCQ prophylaxis in young HCWs without comorbidities did not show any QTc prolongation.
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http://dx.doi.org/10.1016/j.ihj.2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654303PMC
March 2021

Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme.

SSM Popul Health 2021 Mar 13;13:100751. Epub 2021 Feb 13.

Madras Diabetes Research Foundation, Chennai, India.

Background: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region.

Methods: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative.

Results: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown.

Conclusions: Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.
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http://dx.doi.org/10.1016/j.ssmph.2021.100751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902538PMC
March 2021

Adoption of Gla-100 in India and its Impact on Insulin Usage Patterns.

J Assoc Physicians India 2020 Dec;68(12[Special]):25-30

Chairman and Chief Diabetologist, Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu.

Fueled by perceptions regarding Indian dietary patterns and premixed insulin's claim to fame of providing dual fasting and post-prandial control, there was a greater inclination towards using premixed insulins in clinical practice until the last decade. However, the advent of insulin glargine 100 U/mL (Gla-100) opened up a new dimension in insulin therapy landscape in India. The data from the last 5 years reveal that Gla-100 has gained more traction among Indian clinical practitioners. Basis evidences that have emerged from various clinical studies, this present review elaborates on certain key issues which have helped Gla-100 carve its own niche and effected a progressive shift in insulin prescription pattern in India.
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December 2020

Prevalence of Flu-like Symptoms and COVID-19 in Healthcare Workers from India.

J Assoc Physicians India 2020 Jul;68(7):27-29

Hematology and Bone Marrow Transplant, Max Healthcare, New Delhi.

Background: The current COVID-19 pandemic is unprecedented. As the numbers expand exponentially, a paucity of data regarding health care workers (HCWs), who are at the forefront of this disaster, exists. Hence we decided to conduct a study amongst the HCWs to determine the prevalence and risk factor stratification.

Methods: This was an online questionnaire-based survey of healthcare workers conducted at Max Super Speciality Hospital, Saket, New Delhi, India from 23rd March to 30th April 2020. Data on flu-like symptoms, travel history, posting in high-risk or low risk zones, and prophylactic drugs was collected.

Results: Out of the 18000 HCWs who were approached 4403 responded and adequate data of 3667 was available for analysis. 14.7% had flu-like symptoms. 1.8% (20/1113) of the participants tested were positive for the virus. HCWs posted in the high-risk zones had more symptoms than those working in low-risk zones (169/539, 31.4% vs 679/3128, 21.7%), p<0.001; but no difference in COVID-19 positivity rates (p=0.849). Symptomatic HCWs had higher positivity (10/193, 5.2%) than the asymptomatic ones (10/920, 1.1%), p=0.001. HCQ was taken by 755/1113 (67.8%) people and 14 (1.9%) of these reported positive for the virus.

Conclusion: This is the first study on healthcare workers from India to the best of our knowledge. Our findings suggest that posting in a high-risk zone with adequate PPE does not pose higher risk to the HCWs. Moreover, HCQ as a prophylactic has no use.

Clinicaltrials.gov Identifier: NCT04339608.
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July 2020

Effectiveness of Pregabalin Compared to Duloxetine in Diabetic Peripheral Neuropathic Pain: An Observational Study.

J Assoc Physicians India 2019 Nov;67(11):32-36

Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Institute Ltd, New Delhi.

Introduction: Neuropathy is a comorbid complication of diabetes and Pregabalin and Duloxetine are the two most common drugs used for the treatment of neuropathic pain.

Aim: To determine the effectiveness and side effects of Pregabalin and Duloxetine in patients with diabetic peripheral neuropathic pain.

Materials And Methods: This prospective observational study was conducted at Max Super Speciality Hospital. Patients attending the endocrinology department, above 18 years of age who were prescribed with Pregabalin or Duloxetine were screened and included in this study. The data was collected for all study participants using a specially designed case record form by conducting personal interviews. SF-MPQ, Mc-Gill, NRS and DN-4 questionnaires were used to assess the extent of pain and the side-effects associated with the drugs.

Results: Based on the responses from the Numerical Rating Scale and McGill Pain Questionnaire, Pregabalin was seen to be less effective compared to Duloxetine. The only side effect observed with Pregabalin was drowsiness, which was observed in 4% cases at 50 mg dose whereas those reported with Duloxetine were drowsiness (22.2% at 20 mg and 33.3% at 30 mg), vomiting (11.1% at 20mg and 30mg), headache (11.1% at 20 mg and 30 mg), and dizziness (0% at 20mg and 11.1% at 30 mg).

Conclusion: Pregabalin has a better safety profile and tolerability compared to Duloxetine but the latter is more effective in treating Diabetic Peripheral Neuropathic Pain. However, further studies with a larger sample size and longer duration are required to be conducted for finding the effectiveness of these drugs, specifically in the Indian population.
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November 2019

From Individualized to Personalized Medicine in Diabetes: An Expert Overview.

J Assoc Physicians India 2019 Sep;67(9):78-82

Consultant and Head, Bharti Research Institute of Diabetes, Karnal, Haryana.

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 aspects of glucose metabolism such as β-cell K-ATP channel modulation, production of insulin and development of pancreas. The Madras Diabetes Research Foundation has fostered research in personalized medicine for diabetes based upon genetic information and has developed a national registry for neonatal diabetes and other monogenic form of diabetes.
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September 2019

Augmentation of IL-6 production contributes to development of gestational diabetes mellitus: An Indian study.

Diabetes Metab Syndr 2019 Mar - Apr;13(2):895-899. Epub 2018 Dec 27.

Amity Institute of Virology & Immunology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, 201313, India. Electronic address:

Aim: Inflammatory mediators like interleukin-6 (IL-6) and acute phase protein like C-reactive protein (CRP) are supposed to contribute to development of GDM, however clinical data supporting this hypothesis is limited. This study was designed to analyze the association of IL-6 and CRP with development of GDM in Indian females.

Methods: This case control study included pregnant women diagnosed as GDM (n = 53) and those having normal glucose tolerance (n = 50). Serum levels of IL-6 and CRP were analysed and correlated with various clinical parameters.

Results: Serum IL-6 levels were significantly high (p < 0.05) in GDM females as compared to control females. IL-6 levels correlated with pre-pregnancy body mass index (BMI), fasting blood sugar (FBS) and postprandial sugar (PPBS). Unlike IL-6, CRP levels did not show significant differences between GDM and control females. However, positive correlation of CRP levels with BMI, FBS and PPBS was observed.

Conclusion: High IL-6 levels in gestational diabetes may indicate a possible role for inflammation in pathophysiology of GDM.
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http://dx.doi.org/10.1016/j.dsx.2018.12.023DOI Listing
December 2019

Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population - a cross-sectional retrospective study.

Osteoporos Sarcopenia 2018 Jun 5;4(2):53-60. Epub 2018 May 5.

Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd., New Delhi, India.

Objectives: An understanding of bone mineral density (BMD) pattern in a population is crucial for prevention and diagnosis of osteoporosis and management of its complications in later life. This study aimed to screen the bone health status and factors associated with osteoporosis in an apparently healthy Indian population.

Methods: A retrospective review of medical records was done in a tertiary-care hospital for the subjects who had undergone preventive health-check-ups that included BMD measurements at femur-neck, total-femur, and lumbar-spine.

Results: We evaluated 524 subjects (age, 50.0 ± 12.4 years) including 41.2% female and 58.8% male subjects. Osteoporosis was present in 6.9% subjects (female, 11.1%; male, 4.2%) and osteopenia in 34% subjects (female, 40.3%; male, 29.9%). Absolute BMD was higher in male subjects (P < 0.001) compared to female subjects at all bone sites. Prevalence of osteoporosis increased with age in female subjects, but not in male subjects. Osteoporosis rates in the age-groups of 30-39, 40-49, 50-59, 60-69, and ≥70 years were 3%, 3.4%, 14.3%, 18.6%, and 36.4%, respectively in female subjects while prevalence in male subjects was 0%, 4%, 6.5%, 4.3%, and 5.6%, respectively, at lumbar spine. Height (r = 0.234-0.358), weight (r = 0.305-0.388), body mass index (r = 0.143-0.285) and physical activity (r = 0.136-0.153) were positively; and alkaline phosphatase (r = -0.133 to -0.203) was negatively correlated with BMD (all P < 0.01) at all sites. These parameters retained significant correlation after controlling for age and sex. No correlation of serum 25-hydroxy-vitamin-D and calcium was noted with BMD (P > 0.05) at any site.

Conclusions: Further data on absolute BMD, T scores, and prevalence rates of osteoporosis/osteopenia on multiple bone sites have been presented in this article.
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http://dx.doi.org/10.1016/j.afos.2018.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362954PMC
June 2018

Review of the Literature Examining the Association of Serum Uric Acid with Osteoporosis and Mechanistic Insights into Its Effect on Bone Metabolism.

Endocr Metab Immune Disord Drug Targets 2019 ;19(3):259-273

Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd, India.

Background And Objective: Osteoporosis is a common bone disorder that increases susceptibility to fragility bone fractures. The clinical and public health repercussions of osteoporosis are huge due to the morbidity, mortality, and cost of medical care linked with fragility fractures. Clinical assessment of osteoporotic risk factors can help to identify candidates at an early stage that will benefit from medical intervention and potentially lowering the morbidity and mortality seen with fractures and complications. Given this, research is ongoing to evaluate the association of osteoporosis with some novel or less well-studied risk factors/bio-markers such as uric acid (UA).

Discussion: Uric acid's antioxidant activity has been proposed to be one of the factors responsible for increasing longevity and lowering rates of age-related cancers during primate evolution, the level of which increased markedly due to loss of uricase enzyme activity (mutational silencing). Accumulated evidence shows that oxidative stress is the fundamental mechanism of age-related bone loss and acts via enhancing osteoclastic activity and increasing bone resorption. Antioxidant substances such as ascorbic acid scavenge free radicals are positively related to bone health. Thus, it is hypothesized that uric acid holds bone-protective potential owing to its potent antioxidative property. Several correlation studies have been conducted globally to investigate the relationship between serum uric acid with bone mineral density and osteoporosis. Few pre-clinical studies have tried to investigate the interaction between uric acid and bone mineral density and reported important role played via Runt-related transcription factor 2 (RUNX2)/core-binding factor subunit alpha-1 (CBF-alpha-1), Wingless-related integration site (Wnt)-3a/β-catenin signaling pathway and 11β Hydroxysteroid Dehydrogenase type 1.

Conclusion: In this review, the authors provided a comprehensive summary of the literature related to association studies reported in humans as well work done until date to understand the potential cellular and molecular mechanisms that interplay between uric acid and bone metabolism.
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http://dx.doi.org/10.2174/1871530318666181102115106DOI Listing
August 2019

Gene Screening and Association of Variants With Gestational Diabetes in North Indian Population.

Clin Med Insights Endocrinol Diabetes 2018 26;11:1179551418806896. Epub 2018 Oct 26.

Institute of Endocrinology, Diabetes & Metabolism, Max Healthcare Institute Ltd., New Delhi, India.

Background: gene variants have been reported to be associated with gestational diabetes mellitus (GDM) in the Caucasian population. There are no reports exploring this association in the Indian population.

Methods: This cross-sectional study included subjects from Max Super Speciality Hospital, New Delhi, India, over a span of 6 months. Females diagnosed with GDM as per the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria were enrolled. Direct gene sequencing was performed to screen all 10 exons and promoter region of gene.

Results: Out of the total 1000 females screened, 154 subjects had any degree of hyperglycemia. gene screening was done and we observed 11 variants in 80.4% (41/51) of the GDM subset and 89.6% (43/48) of the controls. Allele frequencies of observed variants were not different between the control subjects (12.5%) and those diagnosed with GDM (8.4%).

Conclusion: To the best of our knowledge, this is the first report from north India exploring association of variants with GDM and we do not observe any association of variants with GDM in our study population.: CTRI/2017/07/008964.
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http://dx.doi.org/10.1177/1179551418806896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204622PMC
October 2018

Role of immunological markers in gestational diabetes mellitus-a brief review.

Diabetes Metab Syndr 2019 Sep - Oct;13(5):2983-2985. Epub 2018 Jul 30.

Amity Institute of Virology & Immunology, Amity University, Sector-125, Noida, Uttar Pradesh, 201313, India.

Gestational Diabetes Mellitus (GDM) is a condition which develops due to insulin resistance. There are a number of immunological markers (IL-6, TNF-α, IL-10, etc), which play significant role during normal pregnancy and their irregular levels could likely cause some level of insulin resistance. There are studies which have compared the levels of different immunological mediators in GDM affected females and their healthy controls, but their findings are little controversial. Some of the studies have reported increased levels of IL-6, TNF-α, adiponectin, leptin, in females affected with GDM, while others do not confirm this. We have tried to summarize, in this short review, the findings of research studies being conducted globally, which have reported the association of insulin resistance, GDM and immunological markers. Our review suggests that there is a need for high quality data on the immunological parameters associated with GDM, especially from India.
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http://dx.doi.org/10.1016/j.dsx.2018.07.018DOI Listing
February 2020

Cross-sectional survey of biosimilar insulin utilization in Asia: The Joint Asia Diabetes Evaluation Program.

J Diabetes Investig 2018 Nov 24;9(6):1312-1322. Epub 2018 Apr 24.

Asia Diabetes Foundation, Prince of Wales Hospital, Sha Tin, Hong Kong.

Aims/introduction: Biosimilar insulin can reduce treatment costs, although the extent of its use is largely unknown. We examined biosimilar insulin use and its associations with the quality of glycemic control using the Joint Asia Diabetes Evaluation register.

Materials And Methods: We carried out a cross-sectional analysis in 81,531 patients with type 1 and type 2 diabetes enrolled into the Joint Asia Diabetes Evaluation Program from 2007 to 2014. All insulin related terms are extracted from the Joint Asia Diabetes Evaluation portal, and compared clinical profiles between biosimilar and originator insulin users. Multivariate analysis was performed to assess the association of biosimilar insulin compared with originator insulin with dosage, glycated hemoglobin and hypoglycemia events.

Results: Amongst 81,531 patients, 20.5% (n = 16,738) were insulin-treated. In four countries with high use of biosimilar insulin, 4.7% (n = 719) of insulin users (n = 10,197) were treated with biosimilar insulin (India n = 507, 70.3%; the Philippines n = 90, 12.5%; China n = 62, 8.6%; Vietnam n = 60, 8.3%). Biosimilar insulin users were younger and had higher body mass index, glycated hemoglobin, insulin dosage and more frequent hypoglycemia than originator insulin users. These associations were non-significant after adjustment for confounders. Only age, college education, diabetes education, lipid control, physical activity and history of cardiovascular complications were independently associated with these quality measures.

Conclusions: Biosimilar insulin use is not uncommon in Asia. Data exclusion due to incomplete capturing of brand names suggests possibly higher use. The multiple determinants of the quality of glycemic control call for establishment of prospective cohorts and diabetes registers to monitor the safety and efficacy of different brands of biosimilar insulin and their impacts on clinical outcomes.
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http://dx.doi.org/10.1111/jdi.12843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215931PMC
November 2018

Raised serum uric acid is associated with higher bone mineral density in a cross-sectional study of a healthy Indian population.

Ther Clin Risk Manag 2018 5;14:75-82. Epub 2018 Jan 5.

Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd, New Delhi, India.

Purpose: Oxidative stress has been implicated as a fundamental mechanism in the decline of bone mass. Reactive oxygen species are reported to suppress osteoblast generation and differentiation and enhance osteoclast development and activity. Increasing evidence suggests favorable effect of serum uric acid (UA) on bone metabolism due to its antioxidant properties. Therefore, we investigated the association between serum UA levels and bone mineral density (BMD) in healthy adult Indian subjects.

Materials And Methods: We reviewed the medical records of 524 subjects who had undergone preventive health check-ups in a tertiary care hospital that included UA and BMD measurements at femur neck, total femur, and lumbar spine. Subjects concomitantly taking drugs or having a medical condition that would affect the bone metabolism or UA levels were excluded.

Results: The final analysis included 310 subjects (mean age: 47.2±12.2 years; females: 43.5%; males: 56.5%). Study population was categorized into two groups based on the group median value for UA (ie, 5.4 mg/dL). BMD was significantly higher at all skeletal sites in subjects with UA >5.4 mg/dL compared to subjects with UA ≤5.4 mg/dL (<0.001). On correlation analysis, UA was positively associated with BMD at all skeletal sites (=0.211-0.277; <0.05). The correlation remained significant after controlling for age (<0.05) and lifestyle factors (smoking, alcohol use, physical activity, and diet; <0.05) independently. UA significantly (<0.001) accounted for 4.5%-7.7% of the variance in BMD (=0.045-0.077) in unadjusted model and 1.6%-3.2% of the variance (<0.05) when adjusted for age and body mass index combined at lumbar spine and right femur neck, respectively.

Conclusion: We conclude that raised UA levels are associated with higher BMD at all skeletal sites and UA may have a protective role in bone metabolism owing to its antioxidant effect.
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http://dx.doi.org/10.2147/TCRM.S147696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759848PMC
January 2018

Epigenome-wide association study of body mass index, and the adverse outcomes of adiposity.

Nature 2017 01 21;541(7635):81-86. Epub 2016 Dec 21.

German Center for Diabetes Research (DZD), München-Neuherberg, Germany.

Approximately 1.5 billion people worldwide are overweight or affected by obesity, and are at risk of developing type 2 diabetes, cardiovascular disease and related metabolic and inflammatory disturbances. Although the mechanisms linking adiposity to associated clinical conditions are poorly understood, recent studies suggest that adiposity may influence DNA methylation, a key regulator of gene expression and molecular phenotype. Here we use epigenome-wide association to show that body mass index (BMI; a key measure of adiposity) is associated with widespread changes in DNA methylation (187 genetic loci with P < 1 × 10, range P = 9.2 × 10 to 6.0 × 10; n = 10,261 samples). Genetic association analyses demonstrate that the alterations in DNA methylation are predominantly the consequence of adiposity, rather than the cause. We find that methylation loci are enriched for functional genomic features in multiple tissues (P < 0.05), and show that sentinel methylation markers identify gene expression signatures at 38 loci (P < 9.0 × 10, range P = 5.5 × 10 to 6.1 × 10, n = 1,785 samples). The methylation loci identify genes involved in lipid and lipoprotein metabolism, substrate transport and inflammatory pathways. Finally, we show that the disturbances in DNA methylation predict future development of type 2 diabetes (relative risk per 1 standard deviation increase in methylation risk score: 2.3 (2.07-2.56); P = 1.1 × 10). Our results provide new insights into the biologic pathways influenced by adiposity, and may enable development of new strategies for prediction and prevention of type 2 diabetes and other adverse clinical consequences of obesity.
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http://dx.doi.org/10.1038/nature20784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570525PMC
January 2017

Identification of a novel glucokinase mutation in an Indian woman with GCK-MODY.

Lancet Diabetes Endocrinol 2016 Apr;4(4):302

Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Institute Ltd, Saket, New Delhi, India.

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http://dx.doi.org/10.1016/S2213-8587(16)00040-1DOI Listing
April 2016

Psychological Insulin Resistance in Patients with Type 2 Diabetes.

J Assoc Physicians India 2015 Jul;63(7):33-9

Aims/hypothesis: To identify risk factors associated with psychological insulin resistance (PIR) in Indian type 2 diabetes (T2DM) population.

Methods: Patients with T2DM, aged 18 years, undergoing treatment with oral hypoglycaemic agents and providing written informed consent were considered eligible for the study. Patient's data was collected by face-to-face interaction using 5 validated diabetes questionnaires--Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-Efficacy Scale, Interpersonal Processes of Care Survey-29, and Barriers to Insulin Treatment scale. Demographic variables, categories of patients based on their annual family income, education, glycosylated haemoglobin (HbA1c), occupation and type of healthcare setup were correlated with overall scores of validated questionnaires. Statistical analyses were performed using Pearson correlation coefficients, analysis of variance, two-group t-test and hierarchical multiple regression.

Results: One hundred ninty-eight patients with T2DM were enrolled where 63% were males, 52% had HbA1c <7% (<53 mmol/mol), 32% were in service, 35% had the annual family income between Rs 100,000-500,000, 50% were graduates and 81% were enrolled from private healthcare set ups. Significant high opposition to use insulin was observed in females, patients based at home, patients with insufficient education, and patients visiting government set-ups compared to males, service-class patients, graduates, and patients approaching private set-ups, respectively.

Conclusions: In India, major factors contributing to PIR were fear of injection or fear of pain during injection, fear of hypoglycemia, social stigma and lack of education. Effective interpersonal interactions with healthcare providers could help to counteract PIR, especially in patients who are not sufficiently literate highlighting the need of skilled healthcare staffs in Indian public hospitals.
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July 2015

First identification of Flatbush diabetes in patients of Indian origin.

Diabetes Care 2015 Oct 18;38(10):e164-5. Epub 2015 Aug 18.

Division of Endocrinology, Max Super Speciality Hospital, New Delhi, India

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http://dx.doi.org/10.2337/dc15-1209DOI Listing
October 2015

Primary hyperparathyroidism presenting as a brown cell tumour of the hallux.

Lancet Diabetes Endocrinol 2015 Nov 6;3(11):914. Epub 2015 Aug 6.

Endocrinology Department, Max Super Speciality Hospital, Saket, New Delhi, India.

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http://dx.doi.org/10.1016/S2213-8587(15)00202-8DOI Listing
November 2015

Epigenome-wide association of DNA methylation markers in peripheral blood from Indian Asians and Europeans with incident type 2 diabetes: a nested case-control study.

Lancet Diabetes Endocrinol 2015 Jul 18;3(7):526-534. Epub 2015 Jun 18.

​ (J C Chambers PhD, M Loh PhD, B Lehne PhD, W R Scott MRCP, W Zhang PhD, G Campanella MSc, M Chadeau-Hyam PhD, U Afzal MRCP, Prof P Froguel PhD, Prof P Vineis MD, Prof M-R Jarvelin PhD, Prof P Elliott PhD) (J C Chambers, Prof M-R Jarvelin, Prof P Elliott, Prof J S Kooner FRCP) (W R Scott, S-T Tan MRCP, Prof J Scott PhD, Prof J S Kooner) (J Abbott PhD) (J C Chambers, W Zhang, S-T Tan, U Afzal, Prof J S Kooner) (J C Chambers, P Punjabi FRCS, Prof J S Kooner) (M Loh) (C Blancher PhD) (A Drong PhD, Prof M I McCarthy MD) (Prof M I McCarthy) (J Kriebel PhD, S Wahl MSc, C Gieger PhD, H Grallert PhD) (C Gieger) (J Kriebel, S Wahl, C Gieger, B Thorand PhD, H Grallert) (H Prokisch PhD) (J Kriebel, S Wahl, B Thorand, H Grallert) (V Motta PhD, F Rota PhD, L Tarantini PhD, B Albetti PhD, Prof P A Bertazzi MD, V Bollati PhD) (Prof M Ala-Korpela PhD) (H R Elliott Dip Biol, R C Richmond BA, R Caiazzo PhD, T R Gaunt FRCP, Prof C L Relton PhD) (L Yengo PhD, Prof F Pattou PhD, R Caiazzo, S Cauchi PhD, Prof P Froguel) (L Yengo, S Cauchi, Prof P Froguel) (L Yengo, Prof F Pattou, S Cauchi, Prof P Froguel) (M Adamowicz-Brice PhD, Prof T J Aitman PhD) (K Bozaoglu PhD, R Caiazzo, J Jowett PhD) (Z Y Mok BSc, H K Ng BSc, M A Rozario BSc, R Soong PhD) (E-S Tai PhD) (E-S Tai) (Prof F Pattou) (H Prokisch) (Prof M Ala-Korpela, A J Kangas MSc, P Soininen PhD) (M Loh, Prof M-R Jarvelin) (Prof M-R Jarvelin) (Prof M Ala-Korpela, P Soininen) (Prof M-R Jarvelin) (Prof M Ala-Korpela) (Prof O Ammerpohl PhD) (Prof C Schafmayer MD) (Prof J Danesh FRCP) (Prof S de Lusignan PhD, Prof S Jones PhD) (Prof T Illig PhD) (S Jha MRCP) (A Kasturiratne MD, Prof A R Wickremasinghe PhD) (N Kato PhD) (N Kotea PhD) (S Kowlessur Dip Pub Health Admin) (J Pitkäniemi PhD) (Prof J Tuomilehto PhD) (J Pitkäniemi) (D Saleheen PhD) (D Saleheen) (D Saleheen) (E-S Tai) (Prof S A Kyrtopoulos PhD) (C Herder PhD) (C Herder) (Prof J Hampe MD) (R Soong) (Prof P Vineis) (Prof M I McCarthy).

Background: Indian Asians, who make up a quarter of the world's population, are at high risk of developing type 2 diabetes. We investigated whether DNA methylation is associated with future type 2 diabetes incidence in Indian Asians and whether differences in methylation patterns between Indian Asians and Europeans are associated with, and could be used to predict, differences in the magnitude of risk of developing type 2 diabetes.

Methods: We did a nested case-control study of DNA methylation in Indian Asians and Europeans with incident type 2 diabetes who were identified from the 8-year follow-up of 25 372 participants in the London Life Sciences Prospective Population (LOLIPOP) study. Patients were recruited between May 1, 2002, and Sept 12, 2008. We did epigenome-wide association analysis using samples from Indian Asians with incident type 2 diabetes and age-matched and sex-matched Indian Asian controls, followed by replication testing of top-ranking signals in Europeans. For both discovery and replication, DNA methylation was measured in the baseline blood sample, which was collected before the onset of type 2 diabetes. Epigenome-wide significance was set at p<1 × 10(-7). We compared methylation levels between Indian Asian and European controls without type 2 diabetes at baseline to estimate the potential contribution of DNA methylation to increased risk of future type 2 diabetes incidence among Indian Asians.

Findings: 1608 (11·9%) of 13 535 Indian Asians and 306 (4·3%) of 7066 Europeans developed type 2 diabetes over a mean of 8·5 years (SD 1·8) of follow-up. The age-adjusted and sex-adjusted incidence of type 2 diabetes was 3·1 times (95% CI 2·8-3·6; p<0·0001) higher among Indian Asians than among Europeans, and remained 2·5 times (2·1-2·9; p<0·0001) higher after adjustment for adiposity, physical activity, family history of type 2 diabetes, and baseline glycaemic measures. The mean absolute difference in methylation level between type 2 diabetes cases and controls ranged from 0·5% (SD 0·1) to 1·1% (0·2). Methylation markers at five loci were associated with future type 2 diabetes incidence; the relative risk per 1% increase in methylation was 1·09 (95% CI 1·07-1·11; p=1·3 × 10(-17)) for ABCG1, 0·94 (0·92-0·95; p=4·2 × 10(-11)) for PHOSPHO1, 0·94 (0·92-0·96; p=1·4 × 10(-9)) for SOCS3, 1·07 (1·04-1·09; p=2·1 × 10(-10)) for SREBF1, and 0·92 (0·90-0·94; p=1·2 × 10(-17)) for TXNIP. A methylation score combining results for the five loci was associated with future type 2 diabetes incidence (relative risk quartile 4 vs quartile 1 3·51, 95% CI 2·79-4·42; p=1·3 × 10(-26)), and was independent of established risk factors. Methylation score was higher among Indian Asians than Europeans (p=1 × 10(-34)).

Interpretation: DNA methylation might provide new insights into the pathways underlying type 2 diabetes and offer new opportunities for risk stratification and prevention of type 2 diabetes among Indian Asians.

Funding: The European Union, the UK National Institute for Health Research, the Wellcome Trust, the UK Medical Research Council, Action on Hearing Loss, the UK Biotechnology and Biological Sciences Research Council, the Oak Foundation, the Economic and Social Research Council, Helmholtz Zentrum Munchen, the German Research Center for Environmental Health, the German Federal Ministry of Education and Research, the German Center for Diabetes Research, the Munich Center for Health Sciences, the Ministry of Science and Research of the State of North Rhine-Westphalia, and the German Federal Ministry of Health.
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http://dx.doi.org/10.1016/S2213-8587(15)00127-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724884PMC
July 2015

Prevalence of depression in patients with type 2 diabetes attending an outpatient clinic in India.

Postgrad Med J 2014 Oct 4;90(1068):552-6. Epub 2014 Aug 4.

Office of Research, Max Super Speciality Hospital, Saket, New Delhi, India.

Background: Clinical studies have suggested that depression is common among patients with type 2 diabetes (T2D). Depression is an important factor which affects the management and complications of diabetes. However, the available data regarding its prevalence in India are limited.

Objectives: To estimate the prevalence of depression in patients in India with T2D and to compare it with a non-diabetic group; and to determine the association of depression with glycaemic control and complications of diabetes in patients with T2D.

Methods: This case-control study was carried out over 5 months from May to September 2012 at a tertiary care hospital in India. Cases were patients with T2D and controls were individuals without diabetes. Depression was assessed using the Patient Health Questionnaire (PHQ)-9. The sociodemographic profile, duration of diabetes, presence of complications and other medical variables were also analysed.

Results: 260 subjects of Indian origin (162 men and 98 women; 130 with known T2D and 130 controls without T2D) were evaluated. The prevalence of depression in subjects with T2D was almost twice that in control subjects (46/130 (35.38%) vs 26/130 (20%); p=0.006). A statistically significant difference was found in the fasting blood glucose levels of subjects with depression and those without depression among the patients with T2D (145.70±53.92 vs 130.61±42.39; p=0.022), but depression was not found to be associated with any of the diabetic complications and glycaemic control.

Conclusions: Our findings demonstrate that there is a higher prevalence of depression in Indian patients with T2D, which is almost twice that in those without T2D. Since patients with T2D are at higher risk of developing depression, assessment of depression should be performed as part of the routine practice in India.

Trial Registration Number: CTRI/2012/06/002747.
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http://dx.doi.org/10.1136/postgradmedj-2014-132593DOI Listing
October 2014

Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis.

Thyroid 2012 Dec 15;22(12):1283-6. Epub 2012 Oct 15.

Department of Endocrinology, Max Health Care, Max Healthcare Institute Ltd., New Delhi, India.

Background: Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS.

Patient Findings: A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL).

Summary: Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state.

Conclusions: The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably a life-saving treatment in patients who are exposed to amounts of thyroid hormone far in excess of that usually produced by the thyroid gland.
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http://dx.doi.org/10.1089/thy.2011.0353DOI Listing
December 2012