# Sanjay Kalra

Sanjay Kalra (born 18 April 1970) is an Indian endocrinologist working at Bharti Hospital, Karnal, Haryana. Kalra is a Past President of Endocrine Society of India, South Asian Federation of Endocrine Societies, and Indian Professional Association for Transgender Health. He has also served on the executive council of the Research Society for Study of Diabetes in India. He has over 1,000 PubMed. indexed articles to his name, and has fostered bilateral and multilateral links between various Afro Asian countries in the field of endocrinology. He has developed the terms Glucokathexis, Lipokathexis, Glucocrinology and Lipocrinology Glycemic hygiene, Endocrine hygiene, Ergonomic Endocrinology, and the GlucoCoper tool to assess coping mechanisms. Winner of the DAWN Award (2009). He has also published the concepts of diabetes fatigue syndrome, euthymia in diabetes, quaternary prevention in endocrinology, and quinary prevention.

## Education

Kalra is a graduate of Christian Medical College, Ludhiana. He completed his post-graduation (MD) in Medicine at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, and fellowship (DM) in Endocrinology and Metabolism at All India Institutes of Medical Sciences, New Delhi.

## Professional Contribution

Kalra has established Bharti Hospital, Karnal, which provides clinical care, research, training, and education in endocrinology. As executive editor (2011–15), he worked to establish the Indian Journal of Endocrinology and Metabolism (IJEM) as India's second-best scientific journal (Google Metrix). He also serves as an executive editor, Thyroid Research and Practice, and associate editor, Diabetic Medicine Editor, Diabetic Medicine (UK). He works as an international advisory member for various journals, including US Endocrinology, Sri Lankan Journal of Diabetes Endocrinology and Metabolism (SLJDEM), Journal of Pakistan Medical Association8, and Journal of Diabetes Endocrinology Association of Nepal (JDEAN).
As a founder member and past President, Kalra has contributed to setting up and strengthening the South Asian Federation of Endocrine Societies (SAFES). This contribution has been acknowledged by neighboring countries, and he has been awarded Fellowship and Life Membership of Sri Lanka College of Endocrinologists (SLCE), as well as life membership of Pakistan Endocrine Society (PES).

## Contribution to science and evidence base of Insulin therapy by Dr Sanjay Kalra

As of January 2024, Dr Sanjay Kalra has over 23,000 citations of his publications along with an H index of 68 and an i10-index of 439. His main focus has been Insulin therapy.
Basal
Dr Kalra has been abreast with the latest literature on insulin and has written several articles on their evolution and appropriate patient-centric use in different clinical settings. In addition to highlighting the key advantages of each type of basal insulins, specific articles have been written to help with their use in special populations including but not limited to pediatric populations and pregnancy. His work has not only focused on initiation but also on tips to intensify basal insulin therapy with specific emphasis on optimizing the insulin techniques for basal insulin. In addition to papers on type 2 diabetes, Dr Kalra has extensively written on the role of different insulins in type 1 diabetes as well.
Premixed
Appropriate patient selection is one of key components of successful use of premixed insulin regime. Dr Kalra has been the lead author for spearheading this concept in a comprehensive review in collaboration with authors from over 25 countries. He has also extensively published on the use of pre-mixed insulin during the fasting period of Ramadan and in another paper addressed the use of this formulation in special situations from initiation to intensification.
He has also periodically published updates about the premixed insulins over the last decade including real-world evidence of newer co-formulations.
Motivation, Technique, Counseling
Dr Kalra has spearheaded several original studies focusing on understanding the prevailing insulin usage practices in the South Asian region. Dr Kalra has been instrumental in leading several manuscripts that have focused on regional best practices and recommendations highlighting the advancements in Insulin delivery devices, injection technique teaching methods, monitoring, and complication management. He has been the lead author for the expert recommendations for using insulin in India published in 2017.
Novel Concepts Concepts such as insulin hesitancy, insulin stewardship, patient-friendly intensification, insulin related emotions, social marketing, insulin flexibility, insulin misperceptions, insulin taxonomy, insulin objectivity, insulin triage, smarter insulin therapy, spearheaded by Dr Kalra are novel, important and presented in an easy to remember method.29, These concepts are not only helpful in boosting the confidence of the patients in taking insulin but also for the general practitioners.
Person-centered Approach
Person-centered clinical management is now considered the most sustainable and effective model for chronic diseases. Dr Kalra has worked extensively on this concept especially in relation to insulin use.
He has also identified the key barriers of insulin usage and described the bridges to overcome these barriers in especially in low- and middle-income countries.34,69,
He has also been the lead author for many multinational panels and evidence based recommendations focusing on individualization of time in range goals,32, and on administration techniques including his paper published in Mayo Clinic Proceedings.

## Contribution to Obesity Science by Dr Sanjay Kalra

Epidemiology of Obesity
Dr Kalra has been the lead senior author for several epidemiological studies in the field of obesity. In addition to using national datasets he has been one of the regional lead investigators for his state in the ICMR (Indian Council of Medical Research) funded –INDIAB Study. Several papers from this cohort have been published including the national prevalence of obesity published in Lancet last year and several other papers from this cohort.
In addition, he has also been involved in studying the prevalence of obesity related comorbidities including but not limited to steatotic liver disease. In a recently published paper from the Comprehensive National Nutrition Survey, he is the senior author of this largest series on the prevalence of childhood obesity from India. From another large cohort of elderly people called the Longitudinal Aging Study of India, Dr Kalra has been the lead author to publish the first national statistics on the prevalence of sarcopenia and sarcopenic obesity in India.
Simplified Clinical Approach
Concepts like Bariatric Triage, Gut Guardianship, medical gastronomy, obesity-friendly language are easy to grasp and clinically very helpful to implement in day to day practice.
He has also addressed the pathogenesis, comorbidities and complications of obesity in several of his review papers including a recent review paper on MASLD published in Endocrine Clinics of North America.
Many other papers led by Dr Kalra are a ready reckoner for those who are naïve in the field of obesity management and require guidance on simple steps to set up obesity clinics and looking for easy to follow clinical protocols for evaluation and management of obesity.$^{78,101,}$
Lifestyle and Drug Management
Dr Kalra has time and again published and emphasized on the importance of lifestyle management in the treatment of obesity. He has emphasized on the use of traditional activities for improving physical function of patients with obesity.116,
Nutrition has been one of key areas of education and research for Dr Kalra. He has advocated the understanding of the concept of mega nutrients for usage of fiber and water as they are consumed in much larger quantities than macronutrients.
He has been the author on the national consensus of fiber intake in India. Person-centered obesity care has been another strong focus of Dr Kalra's teachings and lectures. The same is very relevant in the flied of obesity and several of his papers have time and again emphasized how one size does not fit all in obesity management and provided deep insights how to choose person centered care and anti-obesity management strategies.$^{76}$
He has been abreast with the developments of the GLP-1 receptor agonists and periodically published comprehensive updates on these molecules as more evidence was generated over the last one decade.
Sarcopenia and Sarcopenic Obesity
In a recently published scoping review led by Dr Kalra as a senior author, the current literature about the impact of sarcopenic obesity on the development and progression of cardiovascular disease has been summarized. Furthermore, evidence-based therapeutic and preventive strategies for the same have been proposed in this manuscript. He has also published extensively to facilitate diagnosis of sarcopenia and sarcopenic obesity in resource constrained settings and has spearheaded the write-up for a South Asian consensus on the same.
Advocacy and Guidelines
Dr Kalra has been the lead author and senior author for several guidelines in the field of Obesity and Nutrition Health.$^{103,104,140}$
He has been the lead author for several papers that have highlighted the need and action plan for advocacy needed for curbing the obesity pandemic in the country including the problem of gender disparity for this disease.$^{138}$
He has also extensively advocated on methods to curb and prevent the obesity pandemic. Not only confined to the Indian Subcontinent but several advocacy related papers representing the challenges, concerns and need for larger collaboration between different countries have been published.$^{143}$ He is also a coauthor on the medical management of patients before and after undergoing bariatric surgery.
Innovation and Novel Ideas Possibly as a Reality of the Future
Dr Kalra coined the term Barocrinology as a science dedicated to the field of obesity.$^{116}$ He has ever since published several concepts pertaining to Baro-health and also is a lead section editor of the Barocrinology section of one of the leading PubMed indexed South Asian journal. Concepts like Barocene Era, Barometric nervosa, Bariatric pyramid, Baromania, Baro-Bullying, Lipokathesis, Ominous Octet of obesity, Obesity as a communicable disease are not described in literature but help to understand complex obesity science related concepts in a simple and easy manner.$^{114}$
Furthermore, Dr Kalra has also drafted several easy to follow models to help implement intensive behavioral therapy in clinical management of obesity. He has drawn analogies of obesity management with quantum physics, traditional customs and religious diversity. All of these have been well appreciated and extensively cited.

## Research and Publications Highlighting the Concept of Person-centered Care in the Management of Chronic Metabolic Disorders

Dr Kalra has emphasized the importance of person-centered care for over a decade through his reviews, research, and communications in various national and international journals. One of his earlier citations on this topic goes back to a paper he had spearheaded in 2013, where he described the role of a person-centered approach during insulin initiation and intensification, which indeed is one of the most challenging aspects during the clinical management of diabetes.$^{79}$ Though a large body of his work has been focused on diabetes$^{77,79}$, he has applied concepts of this approach even in patients with other chronic metabolic disorders like obesity and other common endocrine disorders including hypogonadism and hypothyroidism.$^{78}$
Dr Kalra has written about both menopause distress and late-onset male hypogonadism, not only simplifying their complex definitions but also in detail describing the person-centric thresholds, targets, tools, and techniques (management).$^{167,168}$ He is also the lead author of a paper called Thyroid Tantrums in Teenagers, which reflects on many variations that can happen at this age, reflecting the underlying management, assessment, testing technique, associated biomedical illness, and training. Moreover, his work in this field encompasses across all age groups. In a recently published article, he published geriatric goalposts on independence and interdependence, clearly highlighting the importance of person-centric care in the elderly.
The key principles for person-centered care highlighted in Dr Kalra's papers include maintaining very good communication with the patient.$^{65,102}$ Other core principles for patient-centered care are ensuring that the cost of therapy fits the patient's pocket and that the management plan can be followed easily. A special emphasis on the happiness of not only the patient, but also the treating physician has been given. Strengthening family support, social acceptance, and caring for the patient's emotions are other important components highlighted by Dr Kalra that provide good patient-centered care.$^{69,}$ Furthermore, the utility of indigenous methods for lifestyle change and personal hygiene has also been mentioned as a successful method for improving patient-centered care.$^{123,166,}$
Dr Kalra has also proposed several frameworks that make it easy for the treating clinician to incorporate the above-mentioned principles in practicing person-centered patient care.$^{129,161,162,}$ These frameworks have attracted several citations in the literature. In collaboration with researchers in Morocco, he has published the SURE framework delineating the glycemic personality of a given patient and thereby assisting in a person-centered choice in diabetes care.181 In another paper on the Motivation-Opportunity-Capability (MOC) model for the management of obesity, he highlighted the importance of understanding the behavior of a patient with obesity and suggested therapeutic strategies that are more likely to be effective in a person-centric manner by focusing on the opportunities and capability of the given patient.
Contributing further through original research on this subject, Dr Kalra has been part of multicentric international collaborative research that has contributed to a deeper understanding of patient-centric management.
In a 3-year pan India real-world longitudinal study on diabetes outcomes (LANDMARC trial), data is being collected on the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control, and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually, develop person-centered care and facilitate public health agencies to invest appropriate resources in the management of diabetes.$^{182}$
Another large, multicentric international collaborative study called the DAWN (Diabetes Attitudes Wishes and Needs) project highlighted how cross-national benchmarking using psychometrically validated indicators can help identify areas for improvement and best practices to drive changes that improve outcomes for people with diabetes.$^{183,184}$