Ambady Ramachandran

India Diabetes Research Foundation · Research

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) and long-term complications such as nephropathy have a strong genetic predisposition. Insulin resistance is thought to be a pathogenetic factor, predisposing genetically prone individuals to develop the microvascular complications of diabetes. To test these hypotheses, two groups of young ind...

Aims We studied the outcome of glycaemic management using Diahome, a smart-phone application compared to conventional treatment. Overall acceptability of the application among users was also assessed. Methods This is a retrospective, case-control study of patients on virtual diabetes care using the Diahome app (n = 441) and those visited the hospi...

Background and aims: Association of serum and salivary adiponectin, apelin, visfatin and vaspin were studied in type 2 diabetes (T2DM) among Asian Indians. Their concentrations in periodontitis were also studied. Methods: In this cross-sectional analysis, men and women aged ≥35 years, with no history of diabetes, were screened for ≥3 risk factor...

This ancillary analysis (STRIDE-I study) compares the prevalence ratio (PR) of type 2 diabetes (T2DM) in persons aged ≤40 and >40 years in 20 and 2016 in Southern India. In 2016, prevalence of T2DM, generalized and abdominal obesity increased in both groups (Table 1) . Hypertension and dyslipidaemia were higher among the older and younger populatio...

Introduction: IDMPS is an international, observational study to assess care practices and clinical profiles of people with diabetes in developing countries. Treatment non-adherence is a major barrier to treatment effectiveness. Open-ended self-reported reasons for omitting or adhering to glucose-lowering drugs in people with T2D were analyzed. Meth...

Introduction: Achieving optimal HbA1c in people with T1D requires good treatment acceptance and self-management. Methods: IDMPS is an international, observational study investigating care practices and clinical profiles of people with diabetes in developing countries. The present analysis of Wave 8 evaluated PROs in people with T1D and their associ...

Introduction: Treatment acceptance and self-management are essential for achieving better HbA1c in people with diabetes. Methods: IDMPS is an international, observational study investigating care practices and clinical profiles of people with diabetes in developing countries. This analysis of Wave 8 evaluated PROs in people with T2D and their assoc...

Digital healthcare is on the rise. Paucity of clinical data exists on the efficiency and effectiveness of the applications in diabetes management. We compared glycaemic outcomes at 4 months among type 2 diabetes (T2DM) patients opting virtual care using Diahome® app and in-person hospital visits. Data of 173 (91 app-users, 82 non app-users) were an...

Aims Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness. Methods Tissue h...

Aims: To study the concordance in the incidence of type 2 diabetes (T2DM) between cohorts with prediabetes, selected either by oral glucose tolerance test (OGTT) or glycosylated haemoglobin (HbA1c) at two years in a real world situation. Methods: Two cohorts with impaired glucose tolerance (IGT) were selected from the non-interventional arm of t...

To study the association and possible predictive role of visfatin, resistin, fetuin-A and chemerin with incident type 2 diabetes (T2DM) among Asian Indians with prediabetes. Their association with insulin resistance, β-cell function, glycaemia and anthropometry were also studied. This is a nested case–control study of a large 2-year prospective pre...

Background Current guidelines state that screening for diabetes should be done at 30 years of age in India. Methods Investigators from multiple sites in India were involved in providing data regarding patients with type 2 diabetes (T2D) aged 30 y or less. Other relevant studies were also reviewed. Results Overview of published and unpublished dat...

SARS-CoV-2 virus spread rapidly all over the globe in 2020 and the second wave has taken our nation, India by storm. The pandemic has posed unique challenges in people with metabolic disorders, including diabetes, hypertension, obesity, pulmonary, cardiovascular, kidney and non-alcoholic fatty liver disease. Uncontrolled diabetes, in conjunction wi...

Aims: To study changes in cardiovascular (CV) risk factors; hypertension (HTN), dysglycaemia (DG) and dyslipidaemia (DL) and their interrelationship, in urban and rural Southern India, in a decade METHODS: Epidemiological data of a city (Chennai, n=2192(2006), n=3850(2016)) and peri-urban villages (Panruti, n=2584 (2006), n=2468 (2016)) among pers...

Aims/hypothesis Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs). Methods The International Diabetes Management Practices Study is an ongoing, non-interventional study of clinical profiles...

IntroductionAlthough poor adherence to insulin is widely recognised, periodic discontinuation of insulin may cause more severe hyperglycaemia than poor adherence. We assessed persistence with insulin therapy in patients with type 1 (T1D) or type 2 diabetes (T2D) in developing countries and the reasons for insulin discontinuation.Methods The Interna...

Objective: Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS). Research design and methods: IDMPS is an ongoing multinational, cross...

Background and aims We studied the profile and outcome of patients hospitalized for coronavirus disease-19 (COVID-19) infection with and without type 2 diabetes (T2DM). Methods In this observational study, clinical details of patients with COVID-19, identified by Reverse Transcription – Polymerase Chain Reaction admitted to 4 hospitals in Chennai,...

2020 will go down in history as the year when the global community was awakened to the fragility of human health and the interdependence of the ecosystem, economy, and humanity. Amid the COVID-19 pandemic, the vulnerability of people with diabetes during a public health emergency became evident by their at least 2 times increased risk of severe dis...

Background and aim: Study the changing clinical and therapeutic profiles of type 2 diabetes (T2D) patients during a 10-year period in a diabetes care centre in Southern India. Methods: Retrospective, cross-sectional data of newly registered and review patients at four periods between 2009 and 2018 were analysed (n = 50,322). Clinical findings, a...

Background The paper-grip-test (PGT) involves pulling a small card from underneath the participant’s foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail...

Objective To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. Methods This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Ad...

Aim: To compare the effect of vildagliptin versus metformin on pancreatic beta-cell function among newly diagnosed, non-obese Asian Indians with type 2 diabetes (T2D) in 2 years. Methods: Randomized, multicentric, controlled, parallel-group study of 2 years treatment with vildagliptin or metformin in drug-naïve T2D persons (baseline HbA1c - 7.0 - 8...

The association of adiponectin, apelin, visfatin and vaspin with different glycaemic states (normal glucose tolerance (NGT), (impaired glucose tolerance (IGT) and type 2 diabetes (T2D)) and in the presence of periodontits were studied in saliva and blood (serum) samples. The utility of saliva and serum in measuring these adipokines was also compare...

Unfortunately, the standard deviations for ‘last HbA1c measurement’ in mmol/mol were miscalculated in Table 1 of this paper.

Aims/hypothesis: We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. Methods: The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional wave...

Aims/hypothesis This randomised controlled trial was performed in India and the UK in people with prediabetes to study whether mobile phone short message service (SMS) text messages can be used to motivate and educate people to follow lifestyle modifications, to prevent type 2 diabetes. Methods The study was performed in people with prediabetes (n...

Aim: The increased morbidity and mortality due to type 2 diabetes can be partly due to its delayed diagnosis. In developing countries, the cost and unavailability of conventional screening methods can be a setback. Use of random blood glucose (RBG) may be beneficial in testing large numbers at a low cost and in a short time in identifying persons...

The Research Society for the Study of Diabetes in India (RSSDI) has regularly updated its Clinical Practice Guidelines on various aspects of diabetes. The pharmacotherapeutic management of diabetes involves a plethora of agents targeting different aetiopathogenic mechanisms administered orally or via injections as well as insulin. While most people...

Aims: The aim of the study was to evaluate the effect of text messaging as a tool to improve glycaemic control among newly diagnosed T2D patients in a 2 year period. Methods: This is a multicentric, randomised controlled trial conducted in 5 states of India. The primary outcome was improvement in glycaemia measured by an HbA1c value of ≤7% (53mm...

Aim: To compare the efficacy and safety of initiating Glargine U100 + Glulisine to Premixed insulin in insulin naïve Asian Indian type 2 diabetes (T2D) patients. Method: We randomized 101 patients into Glargine U100 + Glulisine (Group 1) and 99 in premixed insulin (Group 2) from 7 different hospitals in Southern India and followed for 24 weeks. Ran...

Two cross-sectional epidemiological surveys were done in 2006 (Ramachandran A et al, Diabetes Care 2008) and 2016 (Nanditha A et al, Diabetes Care 2019, in press) in the same locations in men and women aged ≥ 20 years. We analyzed the increasing trend in dyslipidaemia among populations of varied levels of urbanization and socio-economic development...

Objective: The objective of the current study was to assess the secular trends in the prevalence of diabetes, prediabetes, and risk factors from two epidemiological surveys done 10 years apart in three adult populations of different geographic and socioeconomic backgrounds in Tamil Nadu, India. Research design and methods: This survey was conduc...

Background: Diabetes accelerates the decline in muscle strength in older people and substantially increases the risk for fall and injury. Weakening of lower extremity muscles, in particular, is a strong predictor for falls, but currently there is no established method for its assessment in clinics. The paper grip test (PGT) offers a qualitative ass...

Aims Optimal diabetes care requires clear understanding of the incidence of hypoglycaemia in real‐world clinical practice. Current data on hypoglycaemia are generally limited to those reported from randomised controlled clinical trials. The Hypoglycaemia Assessment Tool (HAT) study, a non‐interventional real‐world study of hypoglycaemia, assessed h...

Background In the EXSCEL (Exenatide Study of Cardiovascular Event Lowering), exenatide once‐weekly resulted in a nonsignificant reduction in major adverse cardiovascular events (MACEs) and a nominal 14% reduction in all‐cause mortality in 14 752 patients with type 2 diabetes mellitus (T2DM) with and without cardiovascular disease. Whether patients...

Objective: This was a 5 year comparative analysis of the incidence of type 2 diabetes in men who had persistent impaired glucose tolerance (P-IGT) versus transient impaired glucose tolerance (T-IGT). P-IGT (positive IGT on two oral glucose tolerance tests (OGTT), T-IGT (IGT in first OGTT and normal glucose tolerance (NGT) in the 2nd OGTT). Method...

Appendix S1. Trial Organization: EXSCEL Study Group Table S1. Baseline Characteristics by Experience of 3‐Point MACE Table S2. Number Censored and Follow‐up Time for Censored Subjects by Treatment Assignment for MACE and All‐Cause Death End Points Table S3. Number of Participants on Treatment at 1 Year and End of Follow‐up by Risk Quintile Group...

Background Type 2 diabetes is a serious clinical problem in both India and the UK. Adoption of a healthy lifestyle through dietary and physical activity modification can help prevent type 2 diabetes. However, implementing lifestyle modification programmes to high risk groups is expensive and alternative cheaper methods are needed. We are using a sh...

Aims: Self-management (self-monitoring of blood glucose, plus self-adjustment of insulin dose) is important in diabetes care, but its complexity presents a barrier to wider implementation, which hinders attainment and maintenance of glycemic targets. More evidence on self-management is needed to increase its implementation and improve metabolic ou...

Aim To validate the paper grip test for assessing plantar flexion strength of the hallux. Methods Plantar flexor strength for 69 people with diabetic neuropathy was assessed: (a) using the paper grip test while simultaneously a plantar pressure platform quantified the force under the hallux, and (b) using a hand-held dynamometer. Following testi...

Aims: This study aimed to evaluate the impact of diabetes education and access to health care coverage on disease management and outcomes in Latin America. Methods: Data were obtained from a sub-analysis of 2693 patients with type 1 diabetes mellitus recruited from 9 Latin American countries as part of the International Diabetes Mellitus Practic...

Background Data on the use of mobile technology in public health are sparse. Text messaging is cost-effective in disseminating information to large communities. The Ministry of Health and Family Welfare, Government of India, initiated and executed this mDiabetes programme. Objectives The main objective of this commissioned study was to test the fe...

This study investigated the validity of a clinically relevant test as a tool for assessing plantar flexion strength of the hallux in people with diabetic neuropathy.

Aims: We had shown that mobile phone based text messaging was an effective tool to deliver lifestyle changes among Asian Indian men with a 36% relative risk reduction in incident diabetes over two years. The present analysis investigated whether beneficial effects of intervention on diabetes prevention persisted for an additional three years after...

Appropriate disease management for people with diabetes requires control of not only blood glucose levels but also blood pressure and serum lipid profiles. The International Diabetes Management Practices Study (IDMPS) is a global observational survey on the management and patterns of care of people with type 1 (T1D) and type 2 (T2D) diabetes in the...

The IDMPS is an observational survey on the management of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. By 2045, Africa is predicted to experience a >150% increase in the proportion of people with diabetes; however, there is a lack of data to support clinical practice and healthcare planning. We report demographics and...

Diabetes treatment has evolved over the last decade. During this time, the IDMPS, a global observational survey on the management and patterns of care of people with type 1 and type 2 (T2D) diabetes in the developing world, has collected data in 7 individual waves. Each wave enrolled different participants. We report the glycemic condition and the...

Background: EXSCEL was a multinational, randomized, blinded, placebo-controlled, pragmatic CV outcome trial of once-weekly exenatide on the background of usual care. We report exenatide’s impact on estimated glomerular filtration rate (eGFR), new macroalbuminuria and 2 renal composites from a prespecified analysis plan. Methods: Opportunistic local...

Patient knowledge and self-management are important factors in attaining glycemic goals. The IDMPS is an observational survey on the management and patterns of care of people with type 1 (T1D) and type 2 (T2D) diabetes. People were enrolled from 24 countries in the Middle East including Pakistan, South Asia (India, Bangladesh), Eurasia (Russia, Ukr...

Adherence to insulin therapy is often suboptimal. Understanding patients’ perspectives on drug adherence is essential for identification of barriers to therapy. The IDMPS is a global observational survey on the management of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. In 2016-2017, participants were enrolled from 24...

Complications associated with diabetes have a considerable negative impact on patient wellbeing and economic contribution, and place a large burden on healthcare and welfare systems. Annual screening for diabetes-related complications is recommended in treatment guidelines. The IDMPS is a global observational survey on the management and patterns o...

Optimal diabetes care requires medical management, regular assessment, and self-care. We conducted a retrospective exploratory analysis using data from the IDMPS (a global observational survey on the management of diabetes in the developing world) using a subgroup discovery algorithm (Q-finder) to identify factors (patient profiles [PaPr]) associat...

The IDMPS is a global observational survey on the management and patterns of care of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. We report glycemic control in 2016-17 of people in 24 countries across Africa, the Middle East, South Asia, and Eurasia. In people with T1D, HbA1c levels targeted by physicians were <7% in...

The IDMPS is a global observational survey on the management and patterns of care of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. Due to regional heterogeneity, a logistic regression model per region was performed entering factors significant at the 10% level from the univariate analysis. Odds ratios with 95% CI were...

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hyp...

Identification and treatment of individuals with prediabetes is crucial. Effective interventional strategies are key to reducing the diabetes risk at the population level. Lifestyle intervention is found to be more effective but more expensive. Evidence of potential benefits from pharmacotherapy is accumulating. The choice of a pharmacologic interv...

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are effective glucose-lowering drugs. Findings from cardiovascular outcome trials showed cardiovascular safety of GLP-1 receptor agonists, but results for cardiovascular efficacy were varied. We aimed to examine overall cardiovascular efficacy for lixisenatide, liraglutide, semaglutide,...

Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare tr...

Aims: Variation in cardiometabolic risk in prediabetes and any impacts of ethnicity on such variation have been little studied. In an ethnically diverse dataset, selected according to a high-risk HbA1c-based definition of prediabetes, we have investigated relationships between glycaemia and cardiometabolic risk factors and the influence of ethnici...

BACKGROUND The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching p...

METHODSWe randomly assigned patients with type 2 diabetes, with or without previous car-diovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite out-come was the first occurrence of death from cardiovascular causes, nonfatal myo-cardial infarction,...

Aim: Changes in the mechanical properties of plantar soft tissue could affect the tissues’ ability to uniformly distribute plantar loads and therefore increase ulceration risk in people with diabetic foot disease. Despite evidence that plantar soft tissue mechanical properties change during the course of diabetes the exact implications of these cha...

Aims: Data on the impact of hypoglycaemia on patients’ daily lives and diabetes self-management, particularly in developing countries, are lacking. The aim of this study was to assess fear of, and responses to, hypoglycaemia experienced by patients globally. Materials and methods: This non-interventional, multicentre, 4-week prospective study using...

Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycemia and reduces weight gain while achieving individualized glycemic targets. This review focuses on the strength of evidence behind various options for intensifi...

We thank Dr. Garvey for his letter (1) in response to our 2015 Diabetes Care Editors’ Expert Forum on the prevention of type 2 diabetes (2). We appreciate his comments regarding the importance of the topic and the need for effective preventive strategies. Dr. Garvey also pointed out two shortcomings in our paper that we would like to address. Dr....

Aim: To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). Methods: 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at ba...

Background: EXSCEL is a randomized, double-blind, placebo-controlled trial examining the effect of exenatide once-weekly (EQW) versus placebo on time to the primary composite outcome (cardiovascular death, nonfatal myocardial infarction or nonfatal stroke) in patients with type 2 diabetes mellitus (DM) and a wide range of cardiovascular (CV) risk....