Browsing by Author "Kalra, S."
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Item African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus(Adis, 2021) Mbanya, J.C.; Lamptey, R.; Uloko, A.E.; Ankotche, A.; Moleele, G.; Mohamed, G.A.; Ramracheya, I.; Ramaiya, K.; Ndiweni, M.; Mbaye, M.N.; Bahendeka, S.; Kalra, S.The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increas ing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treat ment with the appropriate type of insulin based on the meal patterns and lifestyle of the indi vidual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient’s habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.Item BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion(Diabetes Therapy, 2019-03-19) Lamptey, R.; Bajaj, S.; Das, A.K.; Kalra, S.; Sahay, R.; Saboo, B.; Das, S.; Shunmugavelu, M.; Jacob, J.; Priya, G.; Khandelwal, D.; Dutta, D.; Chawla, M.; Surana, V.; Tiwaskar, M.; Joshi, A.; Shrestha, P.K.; Bhattarai, J.; Bhowmik, B.; Latt, T.S.; Aye, T.T.; Vijayakumar, G.; Baruah, M.; Jawad, F.; Unnikrishnan, A.G.; Chowdhury, S.; Pathan, M.F.; Somasundaram, N.; Sumanathilaka, M.; Raza, A.; Bahendeka, S.K.; Coetzee, A.; Ruder, S.; Ramaiya, K.; Bavuma, C.; Shaikh, K.; Uloko, A.; Chaudhary, S.; Abdela, A.A.; Akanov, Z.; Rodrı`guez-Saldan˜a, J.; Faradji, R.; Tiago, A.; Reja, A.; Czupryniak, L.The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoringItem Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group(Diabetes Therapy, 2019-04) Kalra, S.; Das, A.K.; Baruah, M.P.; Unnikrishnan, A.G.; Dasgupta, A.; Shah, P.; Sahay, R.; Shukla, R.; Tiwaskar, M.; Das, S.et.alTo develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient–provider communication to aid enhancement of coping skills. After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and well-being of affected individuals. Sanofi India.Item Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care(Diabetes Therapy, 2019-12) Kalra, S.; Czupryniak, L.; Kilov, G.; Lamptey, R.; Kumar, A.; Unnikrishnan, A.G.; Boudiba, A.; Abid, M.; Akanov, Z.A.; Latheef, A.; Araz, M.; Audehm, R.; Bahendeka, S.Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.Item Plantains: Gluco-friendly usage(Journal Of Pakistan Medical Association, 2019-10) Lamptey, R.; Velayoudom, F.L.; Kake, A.; Uloko, E.A.; Rhedoor, A.J.; Kibirige, D.; Ndour, M.N.M.; Sobgnwi, E.; Kalra, S.Plantains are a staple food for a large proportion of the world's population. Rich sources of carbohydrates, they are considered taboo by most diabetes care providers. For persons living with diabetes, however, they are a preferred food item. This multi country authored article discusses the nutritional and culinary qualities of plantains. It discusses how to consume the fruit in a glucose-safe manner, by reducing the glycaemic load and total caloric load due to a low glycaemic index. Simple ways of modifying plantain preparation and serving are suggested, to help patients take this foodstuff without impacting glucose control.