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Publications (7)0 Total impact

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    ABSTRACT: The present study was a prospective, parallel group, open-labeled, comparative, multicentric, active controlled study to evaluate the safety, tolerability and benefits of fixed dose combination of acarbose and metformin versus metformin alone in type 2 diabetic patients. A total of 229 patients with type 2 diabetes were enrolled at 5 medical centers across India. They received either acarbose (50 mg) + metformin (500 mg) bid/tid (n=115) or metformin monotherapy (500 mg) bid/ tid (n=114) for 12 weeks. Primary objective was to evaluate safety and tolerability based on the adverse events reported. Secondary objective was efficacy assessment based on changes in fasting, post prandial blood glucose and HbA1c values. In the acarbose + metformin group 10 patients reported 14 adverse events while in metformin group 9 patients reported 10 adverse events. No patient reported any serious adverse event or was withdraw from study because of adverse events. In the acarbose plus metformin group fasting blood glucose (FBG) decreased from a baseline of 158.85 +/- 18.14 mg/dl to 113.55 +/- 19.38 mg/dl (p < 0.0001) (decrease of 45.30 +/- 15.30 mg/dl) at 12 weeks, while in the metformin group fasting blood glucose decreased from a baseline of 158.31 +/- 26.53 mg/dl to 130.55 +/- 28.31 mg/dl (p < 0.0001) (decrease of 27.76 +/- 22.91 mg/dl) at 12 weeks. In the acarbose plus metformin group postprandial blood glucose (PPBG) decreased from a baseline of 264.65 +/- 34.03 mg/dl to 173.22 +/- 31.40 mg/dl (p < 0.0001) (decrease of 91.43 +/- 28.65 mg/dl) at 12 weeks, while in the metformin group PPBG decreased from a baseline of 253.56 +/- 36.28 mg/dl to 205.36 +/- 39.49 mg/dl (p < 0.0001) (decrease of 48.20 +/- 32.72 mg/dl) at 12 weeks. In the acarbose plus metformin group glycosylated haemoglobin (HbA1c) decreased from a baseline of 9.47 +/- 0.69% to 7.71 +/- 0.85% (p < 0.0001) (% decrease of 1.76 +/- 1.11) at 12 weeks, while in the metformin group HbAlc decreased from a baseline of 9.32 +/- 0.65% to 8.26 +/- 0.68% (p < 0.0001) (% decrease of 1.06 +/- 0.66) at 12 weeks. The combination of acarbose and metformin was found to be significantly superior in lowering the FBC (p < 0.0001), PPBG (p < 0.0001) and HbA1c (p < 0.0001) at 12 weeks as compared to metformin monotherapy. Fixed dose combination of acarbose and metformin was well tolerated and it was superior to metformin monotherapy in controlling FBG, PPBG and HbA(1C) levels in Type 2 Diabetes Mellitus patients.
    The Journal of the Association of Physicians of India 11/2010; 58:679-82, 687.
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    ABSTRACT: The effect of a single dose of intermediate acting (Lente) insulin given subcutaneously at 9.00 P.M. in 22 NIDDM subjects refractory to a combination of Sulphonylureas and Biguanides was analysed. Euglycemia was achieved and maintained during the study period of three months with a mean insulin requirement of 14.22 +/- 5.98 units/day. Plasma FFA, Total cholesterol, triglyceride and VLDL-cholesterol also showed significant reduction. The level of FFA modulates hepatic glucose production, which in turn correlates positively with the fasting blood glucose. The therapeutic modality of bed time Lente Insulin based on physiological principles is an effective way of achieving glycemic control in NIDDM subjects who have become non-responsive to oral hypoglycemic agents.
    The Journal of the Association of Physicians of India 11/1992; 40(10):666-8.
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    ABSTRACT: Subcutaneous Insulin Pulse Therapy (SIPT) consists of administration of small doses of regular insulin hourly or two hourly in the subcutaneous tissue of anterior abdominal wall through a scalp vein needle. Fifteen Non-Insulin Dependent Diabetes Mellitus (NIDDM) subjects, 8 males and 7 females with mean ages 58 +/- 8.7 years and mean duration of diabetes 11.7 +/- 9.1 years and mean BMI 25.2 +/- 5.64 were admitted for elective surgery. Glycemic control was attempted preoperatively with multiple pre-meal doses of Actrapid MC with a single injection of Monotard MC at bed time. The mean fasting plasma glucose in the 15 subjects with this insulin regimen was 321.28 +/- 69.32 mgm% and the insulin requirement per day was 106.87 +/- 35.77 units. The subjects were put on SIPT for 48 to 72 hours. During SIPT the mean fasting plasma glucose dropped to 123.2 +/- 74.11 mgm% and this marked decline in fasting plasma glucose value was statistically significant (P < .05). The insulin requirement during SIPT was 96.42 +/- 31.36 units, similar to the previous regimen (NS). The subjects were switched back to conventional insulin therapy after SIPT during which period the mean fasting plasma glucose was 125.82 +/- 34.50 mgm% and this value was again significantly lower than the pre SIPT fasting plasma glucose value (P < .05). Insulin requirement during conventional insulin therapy after SIPT was reduced to 71 +/- 21.89 units/day. This dose was significantly lower than the insulin dose administered during SIPT (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
    The Journal of the Association of Physicians of India 07/1992; 40(7):436-8.
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    ABSTRACT: We investigated the impact of minor f orms of abnormal glucose intolerance (AGT) on pregnancy outcome. We studied 1178 pregnant subjects with bad ob stetric history (BOH). Based on an oral glucose tolerance test (100 g m glucose load), minor forms identified were: 1. Impaired Gestational glucose Tolerance (IGGT) and 2. Isolated Abnormality of Blood Glucose (IABG). It was found that t he so-called minor forms of AGT are a ssociated with a very high percentage of foetal loss in the previous pregnancies. 126 subjects of AGT that were available for follow-up were treated with insulin to achieve a mean p regnancy plasma glucose of 105 mg%. Good foetal outcome was observed in 98.4%. The foetal l oss of 1.6% is comparable to that of the general antenatal population.
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    ABSTRACT: Diagnosis of Gestational Diabetes Mellitus (GDM) is made following a 100 gm glucose load based on criteria laid d own b y O'Sullivan and Mahan. While laying down these criteria, more importance was attached to the subsequent emergence of diabetes mellitus in the mother rather than the outcome of the index pregnancy. However, we find that subject who do not come under the classical definition of GDM, nevertheless exhibit a similar f oetal loss. Hence, we recommended that the existing cut-off values be lowered in order to enable the OGTT to be more sensitive in Predicting foetal outcome.
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    ABSTRACT: Autonomic Neuropathy in diabetics, contrary to the general belief that it is a late complication, can occur not only early in the natural course of the disease but even precede the diagnosis of diabetes, the best example being impotence. The assessment of autonomic neural involvement is usually done by evaluating cardiac autonomic reflex functions. The current evidence suggests that these tests reflect autonomic nervous damage not only in the heart but also elsewhere in the body. In the present study ninety six diabetic patients were screened for cardiovascular autonomic dysfunction using the four standard tests of cardiac autonomic functions namely (1) The heart rate response to Valsalva manoeuvre, (2) Heart rate variation during deep breathing (3) Blood pressure response to sustained hand grip and (4) immediate blood pressure response to standing from lying. The results of the study were correlated with the clinical symptoms of autonomic neuropathy and peripheral neuropathy in the patients tested. Materials and Methods Ninety six diabetic patients attending the Diabetic Clinic of the Govt. General Hospital, Madras formed the subjects of this study. Out of these ninety six subjects ten were insulin dependent diabetics and the rest were non-insulin dependent diabetics. The age group of the study subjects ranged from 20-60 years and the duration of diabetes from one year to 23 years. All were subjected to a careful clinical assessment, particular attention being given to the presence of clinical evidence of peripheral and autonomic neuropathy. A routine resting twelve lead ECG was done and detailed fundus examination was carried out. Patients with ECG evidence of IHD and those who had proliferative diabetic retinopathy were excluded from this study. Twenty age matched healthy controls were also assessed for the presence of cardiac autonomic neural dysfunction.
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