Source: http://indiadiabetesfoundation.org/Research.aspx
Timestamp: 2019-04-21 14:49:54+00:00

Document:
List of publications by our scientists.
1. Viswanathan M, McCarthy MI, Snehalatha C, Hitman GA, Ramachandran A: Familial aggregation of Type 2 (non‑insulin‑ dependent) diabetes mellitus in south India: absence of excess maternal transmission. Diabetic Medicine 13: 232‑237,1996.
2. Ramachandran A, Snehalatha C, Vijay V, Viswanathan M. Diabetic retinopathy at the time of diagnosis of NIDDM in South Indian subjects. Diab Res Clin Pract 32: 111-114, 1996.
3. Ramachandran A, Snehalatha C, Vijay V, Viswanathan M. Absence of seasonal variation in the occurrence of IDDM. A study from Southern India. Diabetes 19: 1035-1036, 1996.
4. Ramachandran A, Snehalatha C, Krishnaswamy CV. Incidence of IDDM in children in urban population in Southern India. Diab Res Clin Pract 34: 79-82, 1996.
5. Ramachandran A, Snehalatha C, Vijay V, Viswanathan M, Haffner SM. Risk of NIDDM conferred by obesity and central adiposity in different ethnic groups--A comparative analysis between Asian Indians, Mexicans Americans and Whites. Diab Res Clin Pract 36: 21 - 25,1997.
6. Ramachandran A, Snehalatha C, Latha E, Vijay V, Viswanathan M. Rising prevalence of NIDDM in urban population in India. Diabetologia 40: 232-237, 1997.
7. McDermott MF, Ramachandran A, Ogunkolade W, Aganna E, Curtis D, Boucher BJ, Snehalatha C, Hitman GA. Allelic variation in the Vitamin D receptor influences susceptibility to insulin-dependent diabetes mellitus in Indian Asians. Diabetologia 40: 971 - 75, 1997.
8. Ramachandran A, Snehalatha C, Vijay V, Satyavani K, Latha E, Haffner SM. Plasma leptin in non-diabetic Asian Indians & association with abdominal adiposity. Diabetic Medicine 14: 937- 941,1997.
9. Snehalatha C, Ramachandran A, Satyavani K, Yezhisai Vallabi M, Vijay V. Computed axial tomographic scan measurement of abdominal fat distribution and its correlation to anthropometric and insulin secretion in healthy Asian Indians. Metabolism 46: 1220 - 1224, 1997.
10. Ramachandran A, Gruber W, Lander T, Leese B, Songer T, Williams RS. The economics of Diabetes & diabetes care. A report of the diabetes health economic study groups. IDF & WHO p75, 1997.
11. Ramachandran A, Snehalatha C, Vijay V. Insulin-dependent diabetes mellitus the - Indian Scenario. Pract Diab Int 14: 93, 1997.
12. Shobana R, Rama Rao P, Vijay V, Snehalatha C, Ramachandran A. Diabetes education session for young IDDM probands and their family members in a developing country: an evaluation. Prac Diab Inter 14: 123 - 5, 1997.
13. Ramachandran A, Snehalatha C, Latha E, Vijay V. Evaluation of the use of fasting plasma glucose as a new diagnostic criterion for diabetes in Asian Indian population. Diabetes Care 21: 666 - 7, 1998.
14. Snehalatha C, Ramachandran A, Satyavani K, Latha E, Vijay V. Study of genetic prediabetic south Indian subjects: importance of hyperinsulinemia and b-cell dysfunction. Diabetes Care 21: 76 - 9, 1998.
15. Ramachandran A, Snehalatha C, Latha E, Satyavani K, Vijay V. Clustering of cardiovascular risk factors in urban Asian Indians. Diabetes Care 21: 967 - 71, 1998.
16. Snehalatha C, Ramachandran A, Satyavani K, Vijay V, Haffner SM. Specific insulin and proinsulin concentration in non‑diabetic south Indians. Metabolism 47 : 230 - 3, 1998.
17. Ramachandran A, Snehalatha C, Satyavani K, Vijay V. Effect of genetic predisposition on proinsulin responses in Asian Indians. Diab Res Clin Pract. 41: 71 - 77, 1998.
18. Snehalatha C, Ramachandran A, Satyavani K, Vijay V, Haffner SM. Plasma leptin is not associated with insulin resistance and proinsulin in non-diabetic South Asian Indians. Diabetic Medicine 15: 480 - 484,1998.
19. Ramachandran A, Snehalatha C, Clementina M, Sasikala R, Vijay V. Foetal outcome in gestational diabetes in south Indians. Diab Res Clin Pract 41: 185 - 89, 1998.
20. Shobana R, Snehalatha C, Latha E, Vijay V, Ramachandran A. Dietary profile of urban south Indians and its relation with glycaemic status. Diab Res Clin Pract 42 : 181 - 86, 1998.
21. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Gad65 antibodies in classification of Asian Indian diabetic subjects with onset between 20 - 40 years. Diabetes Care 22 (Letter) : 175 - 76, 1999.
22. Cassell P, Neverova M, Janmohamed S, Uwakwe N, Qureshi A, McCarthy MI, Saker PJ, Albon, Kopelman P, Noonan K, Easlick J, Ramachandran A, Snehalatha C, Pecqueur C, Ricquier D, Warden C, Hitman GA. An uncoupling protein 2 gene variant is associated with raised body mass index but not type II diabetes. Diabetologia 42 : 688-692, 1999.
23. Snehalatha C, Ramachandran A. Insulin resistance in Asian Indians. Prac Diab Inter : Review article 16: 19 - 22, 1999.
24. Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V. Impacts of urbanisation on the life style and on the prevalence of diabetes in native Asian Indian population. Diab Res Clin Pract 44: 207 - 213, 1999.
25. Snehalatha C, Satyavani K, Sivasankari S, Vijay V, Ramachandran A. Insulin secretion and action in different stages of glucose tolerance in Asian Indians. Diabetic Medicine 16: 408 - 414, 1999.
26. Ramachandran A, Snehalatha C, Shobana R, Vidyavathi P, Vijay V. Influence of life style factors in development of diabetes in Indians - scope for primary prevention. J. Assoc. Phy. India 47: 764 -66, 1999.
27. Snehalatha C, Ramachandran A, Satyavani K, Sivasankari S, Vijay V. Difference in body fat percentage does not explain the gender dimorphism in leptin in Asian Indians. J. Assoc. Phy. India 47: 1164 - 1167, 1999.
28. Shobana R, Begum R, Snehalatha C, Vijay V, Ramachandran A. Patients' adherence to diabetes treatment. J. Assoc. Phy. India 47: 1173 -1175, 1999.
29. Ramachandran A, Snehalatha C, Satyavani K, Latha E, Sasikala R, Vijay V. Prevalence of vascular complications and their risk factors in type 2 diabetes. J. Assoc. Phy. India 47 : 1152 - 1156, 1999.
30. Ramachandran A, Snehalatha C, Tuomilehto-Wolf E, Vidgren G, Ogunkolade BW, Vijay V, Hitman GA. Type 1 diabetes in the offspring does not increase the risk of parental type 2 diabetes in south Indians. Diabetes/Metabolism Research and Reviews 15: 328 - 331, 1999.
31. Snehalatha C, Ramachandran A, Satyavani K, Vijay V. Limitations of glycosylated haemoglobin as an index of glucose intolerance. Diab Res Clin Pract 47: 129 - 133, 2000.
32. Ramachandran A, Snehalatha C, Sasikala R, Satyavani K, Vijay V. Vascular complications in young Asian Indian patients with Type 1 diabetes mellitus. Diab Res Clin Pract 48: 51-56, 2000.
34. Shobhana R, Rama Roa P, Lavanya A, Williams R, Vijay V. Ramachandran A. Expenditure on health care incurred by diabetic subjects in a developing country - a study from southern India. Diab Res Clin Pract 48: 37-42, 2000.
35. Snehalatha C, Sivasankari S, Satyavani K, Vijay V, Ramachandran A. Insulin resistance alone does not explain the clustering of cardiovascular risk factors in southern India. Diabetic Medicine 17: 152-157, 2000.
36. Ramachandran A. Hope for diabetic patients. APICON 2000: Medicine Update Eds. BB. Thakur, Chairman Scientific Committee. J. Assoc. Phy. India 10: 491 - 95, 2000.
37. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Cosegregation of obesity with familial aggregation of type 2 diabetes. Diabetes, Obesity and Metabolism 2 : 149 - 154, 2000.
38. Ogunkolade WB, Ramachandran A, McDermott MF, Kumarajeewa TR, Curtis D, Snehalatha C, Mohan V, Cassell PG, Eskdale J, Gallagher G, Hitman GA. Family association studies of markers on chromosome 2q and type 1 diabetes in subjects from South India. Diabetes/Metabolism Research and Reviews16: 276 - 80, 2000.
39. Davey G, Ramachandran A, Snehalatha C, Hitman GA, Mckeigue PM. Familial Aggregation of central adiposity among southern Indians. Int. J of Obesity 24: 1523 - 27, 2000.
40. Shobhana R, Rama Rao P, Lavanya A, Vijay V, Ramachandran A. Cost burden to diabetic patients with foot complications- A study from Southern India. J. Assoc. Phy. India 48: 1147 – 50, 2000.
41. Ramachandran A, Sathyamurthy I, Snehalatha C, Satyavani K, Sivasankari S, Jaya Misra, Girinath MR, Vijay V. Risk variables for coronary artery disease in Asian Indians. Am J Cardiol 87: 267 - 71, 2001.
42. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna KS, Nair JD. For the Diabetes Epidemiology Study Group in India (DESI). High Prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 44: 1094 – 1101, 2001.
43. Snehalatha C, Ramachandran A, Sathyamurthy I, Satyavani K, Sivasankari S, Misra J, Vijay V. Association of proinsulin and insulin resistance with coronary artery disease in non-diabetic south Indian men. Diabetic Medicine 18: 706 - 708, 2001.
44. Snehalatha C, Vijay V, Suresh Mohan R, Satyavani K, Sivasankari S, Megha T, Radhika S, Ramachandran A. Lack of association of insulin resistance and carotid intimal medial thickness in non-diabetic Asian Indian subjects. Diabetes Met. Res. & Reviews 17: 444 – 447, 2001.
45. Ramachandran A, Snehalatha C, Vijay V, King H. Impact of poverty on the prevalence of diabetes and its complications in urban southern India. Diabetic Medicine 19: 130 -135, 2002.
46. Cassell PG, Jackson AE, North BV, Evans JC, Syndercombe-Court D, Phillips C, Ramachandran A, Snehalatha C, Gelding SV, Vijayaravaghan S, Curtis D, Hitman GA. Haplotype combinations of calpain 10 gene polymorphisms associate with increased risk of impaired glucose tolerance and type 2 diabetes in South Indians. Diabetes 51 (5): 1622 - 1628, 2002.
47. Ramachandran A, Vinitha R, Megha Thayyil, Sathish kumar CK, Sheeba L, Joseph S, Vijay V. Prevalence of overweight in urban Indian adolescent school children. Diab Res Clin Prac 57:185 – 190, 2002.
48. Snehalatha C, Ramachandran A, Satyavani K, Vijay V, Jaya Misra, Girinath MR, Sathya murthy I. Is Increased Apo lipoproteins B A Major Factor Enhancing The Risk Of Coronary Artery Disease In Type 2 Diabetes ? JAPI 50, 1036-1038: 2002.
49. Ramachandran A, Snehalatha C, Vijay V. Temporal Changes in Prevalence of Type 2 Diabetes and Impaired Glucose Tolerance in Urban Southern India Diab Res Clin Prac: 58, 55-60: 2002.
50. Ramachandran A. Urban India A Breeding ground for Diabetes. Diabetes voice: 47: 18- 20, 2002.
51. Shobhana, R, P. Rama Rao, A. Lavanya, R. Williams, C. Padma, V. Vijay, A. Ramachandran. Costs incurred by families having Type 1 diabetes in a developing country- a study from Southern India: Diab Res and Clin Practice 55: 45 – 48, 2002.
52. Snehalatha C, Ramachandran A, Satyavani K, Sivasankari S, Sathyamurthy I, Viswanathan V. Plasma Homocysteine concentrations and CAD in Asian Indians. J. Assoc. Phy. India 50: 1229 – 1231, 2002.
53. Ramachandran A, Snehalatha C, Vijay V. Burden of type 2 diabetes and its complications – The Indian scenario. Current science 83: 1471- 1476, 2002.
54. Ramachandran A, Snehalatha C, Satyavani K, Vijay V. Impaired fasting glucose and impaired glucose tolerance in urban population in India. Diab Med 20: 220 – 224, 2003.
55. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Type 2 Diabetes in Asian – Indian Urban Children. Diabetes Care 26: 1022-1025, 2003.
56. Snehalatha C, Vijay V, Ramachandran A. Cut Off values for Normal Anthropometric Variables in Asian Indian Adults. Diabetes Care 26: 1380 – 1384, 2003.
57. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic Syndrome In Urban Asian Indian Adults - A Population Study Using Modified ATP III Criteria. Diab Res Clin Prac. 60: 199-204, 2003.
58. Snehalatha C, Ramachandran A, Satyavani K, Sivasankari S, Vijay V. Clustering of Cardiovascular risk factors in impaired fasting glucose and impaired glucose tolerance. Int J Diab Dev Coun 23: 58-60, 2003.
59. Snehalatha C, Ramachandran A, Satyavani K, S. Sivasankari S, Vijay V. Insulin secretion and action show differences in impaired fasting glucose and in impaired glucose tolerance in Asian Indians. Diabetes Metab Res Rev 19: 329 – 332, 2003.
60. Shobhana R, Rama Rao, Lavanya A, Padma C, Vijay V, Ramachandran A. Quality of life and diabetes integration among subjects with type 2 diabetes. JAPI 51: 363 – 365, 2003.
61. Snehalatha C, Ramachandran A, Kapur A, Vijay V. Age-specific prevalence and risk associations for impaired glucose tolerance in Urban southern Indian Population. JAPI 51: 766 –769, 2003.
62. Snehalatha C, Ramachandran A, Satyavani K, S. Sivasankari S, Nanditha R, Vijay V, Hitman GA. Evaluation of the b cell response by C-peptide measurement in parents of children with type 1 diabetes. [Letter] JAPI 51: 927-928, 2003.
63. Snehalatha C, Ramachandran A, Mukesh B, Mary Simon, Vijay V, Steven .M. Haffner. Plasma Adiponectin Is An Independent Predictor Of Type 2 Diabetes In Asian Indians. Diabetes Care 26: 3226-3229, 2003.
64. Ramachandran A , Snehalatha C , Baskar ADS , Mary S , Sathish Kumar C.S, Selvam S , Catherine S , Vijay V , Temporal Changes in Prevalence of Diabetes and Impaired Glucose Tolerance Associated With Life Style Transition Occuring in Rural Population in India. Diabetologia 47: 860 - 865,2004.
65. Ramachandran A, Snehalatha C, Salini J, Vijay V. Use of Glimepiride and Insulin Sensitizers in the Treatment of Type 2 Diabetes – A study in Indians. JAPI 52: 459 – 463, 2004.
66. Ramachandran A. Specific Problems of the diabetic foot in developing countries. Diabetes Metab Res Rev 19: 329–332, 2004.
67. Ramachandran A, Snehalatha C, Vijay V, Colagiuri S. Detecting Undiagnosed Diabetes in Urban Asian Indians – Role of Opportunistic Screening. JAPI 52: 545 – 546, 2004.
68. Jackson AE, Cassell PG, North BV, Vijayaraghavan S, Gelding SV, Ramachandran A, Snehalatha C, Hitman GA. Polymorphic Variations in the Neurogenic Differentiation-1, Neurogenin-3, and Hepatocyte Nuclear Factor - 1a Genes contribute to Glucose Intolerance in a South Indian Population. Diabetes 53: 2122 – 2125, 2004.
69. Borch-Johnson K, Colagiuri S, Balku B, Glumer C, Ramachandran A, Dong Y, Gao W. Creating a pandemic of prediabetes : the proposed new diagnostic criteria for impaired fasting glycaemia. Diabetologia 47: 1396 – 1402, 2004.
71. Kapur A, Bjork S, Nair J, Kelkar S, Ramachandran A. Socio-economic determinants of the cost of diabetes. Diabetes Voice 49:18-21,2004.
72. Ramachandran A, Snehalatha C. Increasing trend in prevalence of diabetes in rural south Asian countries undergoing social transition. International Journal of Metabolism by Fax 35,2004.
73. Allotey RA, Mohan V, McDermott MF, Deepa R, Premalatha G, Hassan Z, Cassell PG, North BV, Vaxillaire M, Mein CA, Swan DC, Grady EO, Ramachandran A, Snehalatha C, Sinnot PJ, Hemmatpour SK, Froguel P, Hitman GA. The EIF2AK3 gene region and type 1 diabetes in subjects from South India. Genes and Immunity 5: 648 – 652,2004.
74. Ramachandran A. Diabetes & Obesity – The Indian Angle, International Journal of Medical Research 120: 437-439,2004.
75. Ramachandran A. Type 2 diabetes – Consequences of Urbanization. Type 2 Diabetes urban – rural (Textbook)1:15-18,2004.
76. Ramachandran A, Snehalatha C. Diabetes Mellitus. Public Health Nutrition (Text Book): 330-340,2004.
77. Ramachandran A. Contemporary Diabetes Care: an Integrated approach. International Journal of Metabolism by Fax: 41, 2004.
78. Michael M Engelgau, Colagiuri S, Ramachandran A, Borch-Johnson K, Venkat Narayan KM. Prevention of Type 2 Diabetes : Issues and Strategies for Identifying Persons for Interventions. Diabetes Technology & Therapeutics 6: 874-882, 2004.
79. Ramachandran A. Epidemiology of Diabetes in India – Three Decades of Research. JAPI 53:157-157,2004.
80. Ramachandran A, Snehalatha C, Vijayalakshmi S, Vijay V. Use of Metformin in Pregnancies with Diabetes: A Case Series from India. JAPI 53:157-158,2004.
81. Ramachandran A. Elderly diabetes is a Major Health Problem of the 21st Century. Type 2 Diabetes in Urban (Text Book) 12-16,2005.
82. Ramachandran A, Clustering of Cardiovascular Risk Factors in Asian Indians. Coronary Artery Disease: Risk promoters, pathophysiology and prevention (Text Book) 12-20, 2005.
84. Ramachandran A, Snehalatha C. Multiple risk factors and low risk threshold for Diabetes in Indians. Diabetes Mellitus Epidemic Combat the Challenge (ANRAP -Text Book):17-24, 2005.
85. Ramachandran A. Experiences of the WHO Collaborating Centre for Diabetes in India in managing tsunami victims with diabetes. Practical Diabetes International 22: 98-99, 2005.
86. Ramachandran A. Early diabetes control is vital to prevent fatality from MI and stroke. (Commentary). International Diabetes Monitor 17: 22-23,2005.
87. Snehalatha C, Satyavani K, Sivasankari S, Vijay V, Ramachandran A. Serum triglycerides as a marker of insulin resistance in non-diabetic urban Indians. Diab Res Clin Prac 69: 205-206,2005.
88. Ramachandran A, Snehalatha C, Vijay V, Wareham NJ, Colagiuri, S Derivation and validation of diabetes risk score for urban Asian Indians. Diab Res Clin Pract 70: 63-70, 2005.
89. Ramachandran A, Snehalatha C, Sathyamurthy I, Ravi MS, Nalini V, Vijay V, Tuomilehto J. High Incidence of glucose intolerance in Asian Indian Subjects with Acute Coronary Syndrome. Diabetes Care 28: 2492- 6,2005.
90. Brorly IB, Colagiuri R, Geelhoed-Duijvestijn P, Hitoshi I, Line K, Rudiger L, Torsten L, David M, Ramachandran A, Richard R, Frank S. The Diabetes Attitudes, Wishes, and Need (DAWN) Program: A new approach to improving outcomes of diabetes care. Diabetes Spectrum [Asian Edition] Volume 5, 2006.
91. Viswanathan V, N Thomas, N Tandon, A Asirvathan, Seena Rajasekar, A Ramachandran, K Senthilvasan, VS Murugesan, Muthulakshmi. Profile of Diabetic Foot Complications and its Associated Complications – A Multicentric Study from India. JAPI 53: 933-6,2005.
92. Viswanathan V, Sheethal S, Mamtha BM, Snehalatha C, Ramachandran A. Microalbuminuria : A Risk abnormal pulse wave velocity. Indian Journal of Cardiology 8: 9-12,2005.
93. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49: 289-297, 2006.
94. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V. Persistent impaired glucose tolerance has similar rate of risk factors as for Diabetes Result of Indian Diabetes Prevention Programme (IDPP). Diab Res Clin Pract 73:100-103, 2006.
95. Ramachandran A, Snehalatha C, Yamnuna A, Bhaskar AD, Simon Mary, Vijay V, Shobhana R, Murugesan N. Stress and undetected hyperglycemia in Southern Indian Coastal population affected by Tsunami. JAPI 54: 109 – 112, 2006.
97. K.M. Venkat Narayan, Ping Zhang, Alka M.Kanaya, Desmond E. Williams, Michael M. Engelgau, Giuseppina Imperatore, Ramachandran A. Diabetes: The Pandemic and Potential Solutions. Diabetes Control Priorities in Developing Countries, 591-603,2006. [Textbook – Chapter].
98. Ramachandran A, Shobhana R, Snehalatha C, Christina A, Murugesan N, Vijay V, Anil K. Increasing expenditure on health care incurred by diabetic subjects in a developing country – Study from India. Diabetes Care 30; 2: 252- 256,2007.
99. Ramachandran A, Cancer and All-Cause Mortality: Meta-Analysis of Randomized Clinical Trails of Metformin. American Diabetes Association 22-June-2011.
Insulin resistance and clustering of cardiometabolic risk factors in urban teenagers in southern India.
Ramachandran A, Snehalatha C, Yamuna A, Murugesan N, Narayan KM.
OBJECTIVE: We sought to study the occurrence of cardiometabolic risk variables, their clustering, and their association with insulin resistance among healthy adolescents in urban south India. RESEARCH DESIGN AND METHODS: School children aged 12-19 years (n = 2,640; 1,323 boys and 1,317 girls) from diverse socioeconomic backgrounds were studied. Demographic, social, and medical details were obtained; anthropometry and blood pressure were measured. Fasting plasma glucose, insulin, and lipid profiles were measured. Clusters of risk variables were identified by factor analysis. Association of insulin resistance (homeostasis model assessment) with individual risk variables and their clusters were assessed. RESULTS: One or more cardiometabolic abnormalities (i.e., low HDL cholesterol, elevated triglycerides, fasting plasma glucose, or blood pressure) was present in 67.7% of children (in 64.8% of normal weight and 85% of overweight children). Insulin resistance was associated with the above abnormalities except HDL cholesterol. It also showed significant positive association with BMI, waist circumference, body fat percentage, and total cholesterol (P < 0.0001). Factor analysis identified three distinct clusters, with minor differences in the sexes: 1) waist circumference and blood pressure; 2) dyslipidemia, waist circumference, and insulin; and 3) waist circumference, glucose, and plasma insulin, with minor differences in the sexes. Insulin was a component of the lipid and glucometabolic cluster. In girls, it was a component of all three clusters. CONCLUSIONS: Cardiometabolic abnormalities are present in nearly 68% of young, healthy, Asian-Indian adolescents and even among those with normal weight. Insulin resistance is associated with individual cardiometabolic factors, and plasma insulin showed association with clustering of some variables.
Cost Effectiveness of the Interventions in the Primary Prevention of Diabetes among Asian Indians: Within trial results of the Indian DiabetesPrevention Programme (IDPP).
Ramachandran A, Snehalatha C, Yamuna A, Mary S, Ping Z.
Objective: In Indian Diabetes Prevention Program (IDPP), a 3 year randomized control trial, life style modification (LSM) and metformin (Met) helped to prevent type 2 diabetes in subjects with impaired glucose tolerance (IGT). The direct medical cost and cost effectiveness of the interventions relative to the control group are reported here. Research design and methods: Relative effectiveness and costs of interventions (LSM, Met and LSM +Met) in IDPP were estimated, from the health care system perspective. Costs of intervention considered were only the direct medical costs. . Direct non medical, indirect and research costs were excluded. Cost effectiveness of interventions were measured as the amount spent on preventing one case of diabetes within the 3year trial period. Results: Direct medical cost to identify one subject with IGT was INR 5,278 ($117). Direct medical costs of interventions over the 3 year trial period were INR 2739 ($61) per subject in the control, INR 10,136 ($225) with LSM, INR 9,881 ($220) with Met and INR 12,144 ($270) with LSM + Met. Number needed to treat to prevent a case of diabetes was 6.4 with LSM, 6.9 with Met and 6.5 with LSM + Met. Cost-effectiveness of preventing one case of diabetes in LSM, Met and LSM + Met were INR 47,341 ($1052), INR 49,280 ($1095), and INR 61,133 ($1359), respectively. Conclusion: Both LSM and Met were cost-effective interventions for preventing diabetes among high risk individuals in India; perhaps in other developing countries as well. The long-term cost-effectiveness of the interventions needs to be assessed.
Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India.
Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V, Kapur A, Williams R.
OBJECTIVE: This study aimed to assess the direct cost incurred by diabetic subjects who were in different income groups in urban and rural India, as well as to examine the changing trends of costs in the urban setting from 1998 to 2005. RESEARCH DESIGN AND METHODS: A total of 556 diabetic subjects from various urban and rural regions of seven Indian states were enrolled. A brief uniform coded questionnaire (24 items) on direct cost was used. RESULTS: Annual family income was higher in urban subjects (rupees [Rs] 100,000 or $2,273) than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P < 0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Lower-income groups spent a higher proportion of their income on diabetes care (urban poor 34% and rural poor 27%). After accounting for inflation, a secular increase of 113% was observed in the total expenses between 1998 and 2005 in the urban population. The highest increase in percentage of household income devoted to diabetes care was in the lowest economic group (34% of income in 1998 vs. 24.5% in 2005) (P < 0.01). There was a significant improvement in urban subjects in medical reimbursement from 2% (1998) to 21.3% (2005). CONCLUSIONS: Urban and rural diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families in developing countries is rising, and the total direct cost has doubled from 1998 to 2005.
Awareness about diabetes and its complications in the general and diabetic population in a city in southern India.
Murugesan N, Snehalatha C, Shobhana R, Roglic G, Ramachandran A.
Diabetes Research Centre and M.V. Hospital for Diabetes, WHO Collaborating Centre for Research, Education and Training in Diabetes, No. 4, Main Road, Royapuram, Chennai 600 013, India.
OBJECTIVE: The study was done to find out the levels of awareness on diabetes in urban adult Indian population and to identify factors that influenced the awareness, including presence of diabetes. RESEARCH DESIGN AND METHODS: In population aged >/=20 years (n=3681, M=1769, F=1912), details regarding awareness about diabetes in relation with physical activity, healthy and unhealthy diet, causes, symptoms, prevention, complications and measures to improve health were collected using a questionnaire. A high total score indicated good knowledge. Influence of age, gender, educational status, occupation and presence of diabetic history was analysed. RESULTS: Fifty percent of subjects scored less than15. Maximum scored was 51/65. The median total score was 16. Total score was significantly lower in women than in men (15.0 versus17.0, p<0.0001). Educational status was low in women. Higher education (16.0 versus12.0, p<0.0001) and professional or executive jobs (17.0 versus 15.0, p<0.0001) were significantly associated with better awareness. Age had no influence. Knowledge regarding causes of diabetes, its prevention and the methods to improve health was significantly low among the general population. Diabetic subjects had better knowledge about symptoms of diabetes and the preventive aspects. CONCLUSIONS: The low median score indicated that the awareness was generally poor. The score was low especially in women and subjects with low education. The study highlights the urgent need for strategies to spread awareness about diabetes in the general population. Diabetic subjects also required better education on many aspects.
A role of glitazones, in the prevention of diabetes has been shown in the Troglitazone in Prevention of Diabetes (TRIPOD) study involving 235 Hispanic women with previous gestational diabetes. The subjects who remained free of diabetes during the drug treatment had stable glucose concentrations and stable b cell function over a period of 4.5 years. A role for pioglitazone in prevention of diabetes has been shown in a Chinese study. There are no studies from India showing beneficial effect of pioglitazone in prevention of diabetes. Efficiency of metformin as a preventive agent was shown in the Indian population with IGT in the Indian Diabetes Prevention Programme (IDPP-1). In this study another insulin sensitizer namely pioglitazone is being tested for its usefulness as a drug for prevention of diabetes.
To find out whether pioglitazone is more effective than the standard care with life style modification in preventing conversion of IGT to diabetes.
To assess the effect of the drug on anthropometry and biochemical parameters including b cell function and insulin resistance.
407 IGT subjects selected from the population were randomized. The study is now in the 3rd year of follow up. The outcome will be analysed when the international advisory committee decides to terminate the study after preliminary evaluation of the results.
Inter action of genetic and lifestyle factors on the incidence of type 2 diabetes.
The Integrated project InterAct is an Europeon Commission funded, large scale collaboration between nine European countries and India.
To discover how genetic and lifestyle behavioural factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes.
To investigate how these discoveries may help to prevent the development of diabetes.
To construct a consortium of life style intervention diabetes prevention trials in order to study the association of the genetic variation with differential response to the life style intervention and to consider the implications of these findings for preventive action.

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