Harish Ranjani

Harish Ranjani
Madras Diabetes Research Foundation | MDRF · Department of Translational Research

CDE, PhD
Translational Research, Digital Health and Implementation Science projects with focus on sustainable lifestyle changes.

About

82
Publications
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Introduction
Ranjani works in the area of Public Health specifically with respect to prevention and control of NCDs. Priority research focus being epidemiology and prevention of childhood and adolescent obesity and type 2diabetes, prevention of diabetes in 'real life' community settings through lifestyle modification and behaviour change in adults and health promotion activities. She is a Nutritionist by training from University of Mumbai.

Publications

Publications (82)
Article
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Background This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex. Methods Cr...
Article
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As blood-derived miRNAs (c-miRNAs) are modulated by exercise and nutrition, we postulated that they might be used to monitor the effects of a lifestyle intervention (LI) to prevent diabetes development. To challenge this hypothesis, obese Asian Indian pre-diabetic patients were submitted to diet modifications and physical activity for 4 months (LI...
Article
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Background: There is little epidemiological data from India on the prevalence of polycystic ovarian syndrome (PCOS). The objectives of the present study were to estimate the prevalence of PCOS using different criteria among adolescents and young women and to evaluate risk factors associated with PCOS. Materials and Methods: A total of 518 participa...
Article
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Objective India is experiencing an increasing prevalence of type 2 diabetes and cardiovascular diseases. Mobile health technology may be a strategy to reduce the risk of cardiometabolic disorders. This paper reports on the effect of a mobile health intervention on cardiometabolic risk factors. Methods The mobile health and diabetes intervention wa...
Article
Aim The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus. Methods Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with a...
Article
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Background: There exist several barriers to physical activity (PA) among adolescent girls. We therefore developed a culturally acceptable dance/fitness intervention called THANDAV (Taking HIIT And Dance to Adolescents for Victory over NCDs). The main aim of this study was to evaluate the THANDAV protocol among Asian Indian girls aged 10 to 17 years...
Article
Aims: The Diabetes Community Lifestyle Intervention Program (D-CLIP) was a lifestyle education program to prevent diabetes in South Asians with prediabetes. This paper examines the impact of the D-CLIP intervention on moderate-to-vigorous intensity physical activity (MVPA). Methods: This randomized controlled trial to prevent diabetes included 5...
Article
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the youth. The aim of the study was to conduct a metabolic risk factor profiling of NAFLD in adolescents and young adults in Chennai city in south India. Materials and Methods: The study participants included adolescents (n = 188) and young adu...
Article
Objectives: We aimed to evaluate the quality of currently available health apps for prevention of type 2 diabetes among Asian Indians using validated rating scales. Materials and Methods: Using the keywords, “diabetes prevention,” “healthy lifestyle,” and “fitness,” a total of 1486 apps available in India via Google Play were assessed for eligibili...
Article
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Active School Travel (AST) is an important domain for physical activity among adolescents; however, few studies in India have explored barriers or correlates of AST. This was a cross-sectional study of 324 adolescents aged 12–17 years recruited via households and schools from diverse areas of Chennai, India. Adolescents reported their mode of trave...
Preprint
BACKGROUND Scientific evidence for digital health applications (apps) which claim to help in the prevention and management of Type 2 diabetes (T2D) is limited. OBJECTIVE We aimed to evaluate the quality of currently available health apps for prevention of T2D amongst Asian Indians. METHODS Using the keywords, ‘diabetes prevention’, ‘healthy lifes...
Article
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Importance A stepwise approach that includes screening and lifestyle modification followed by the addition of metformin for individuals with high risk of diabetes is recommended to delay progression to diabetes; however, there is scant evidence regarding whether this approach is cost-effective. Objective To estimate the cost-effectiveness of a step...
Article
Background and aims Angiopoietin-2 (ANG-2) mediates endothelial inflammation to initiate atherosclerosis and angiogenesis. Here we determined the serum levels of ANG-2 in hyperinsulinemic subjects and whether insulin increases its expression and release. Methods Healthy male subjects were recruited from the D-CLIP and CURES studies and, based on t...
Article
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Background: Smartphones provide an opportunity for preventing lifestyle diseases through mobile applications. Purpose: The aim of this study was to investigate the effectiveness of a mobile phone application (app) in making lifestyle changes in the community in individuals across glycemic categories. Materials and Methods: Adult participants (n = 6...
Article
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Background: In low- and middle-income countries, sedentary behavior is widely prevalent in the young. Reliable and valid instruments are essential for evaluating sedentary behavior and physical activity in children and adolescents. Objectives: To evaluate the reliability and validity of an easy to use physical activity questionnaire for children...
Article
Aim: To evaluate the effects of a prolonged lockdown due to Coronavirus (COVID-19) on adoption of newer technologies and changes in glycemic control on patients with type 2 diabetes (T2D) in India. Methods: The study population included a random list of 3000 individuals with T2D derived from 30,748 individuals who had visited a large tertiary di...
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Objectives We sought to understand the feasibility, acceptability, and sustainability of using peer educators to deliver a worksite-based lifestyle intervention program to reduce cardiometabolic risk in India. Methods INtegrating DIAbetes prevention in WORKplaceS (INDIA-WORKS, Clinicaltrial.gov #NCT02813668) is an implementation study to evaluate...
Article
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Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Ch...
Article
Introduction: Expert guidelines recommend a stepwise approach (lifestyle modification followed by addition of metformin in those not meeting goals) in high-risk people to delay progression to diabetes. However, there is scant evidence on the cost-effectiveness of implementing stepwise diabetes prevention. We estimated the 3-year within trial cost-e...
Article
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Aims: To examine the clinical utility of 30-min plasma glucose (30-min-PG) measurement during an oral glucose tolerance (OGTT) in predicting type 2 diabetes (T2DM). Research design and methods: Data from a 3-year, randomized, controlled, primary prevention trial among 548 Asian Indians with prediabetes were analyzed. Participants underwent OGTT...
Article
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Background India has the 2nd largest number of children and adolescents living with diabetes in the world. Hence, the present study aimed to evaluate the knowledge on diabetes and obesity among school going adolescents in Chennai, south India. Methods Study participants were 3505 adolescents belonging to sixth and seventh grades of select private...
Article
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Background: Prevalence of type 2 diabetes (T2D) is increasing worldwide. Identifying and targeting individuals at high risk, is essential for preventing T2D. Several studies point to mobile health initiatives delivered through personal smart devices being a promising approach to diabetes prevention, through weight loss. The aim of the mobile health...
Technical Report
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With India’s youth projected to be a major proportion of the world’s workforce, evaluating active living in India has implications for the world economy. The 2018 report card on physical activity for children and youth is a state of the evidence advocacy document that enumerates the barriers, challenges, facilitators, and opportunities for active l...
Article
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Aims Diabetes prevention interventions have been less successful in Asian Indians compared to other populations, which may be due in part to dietary differences. The objective of this study was to determine the impact of a diabetes prevention intervention on diet and risk of diabetes in Asian Indians at high risk. Methods Data were included from t...
Article
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Objective We evaluated the effects of a diabetes prevention itervention on self-efficacy (SE) and the associations between SE and diabetes-related outcomes among overweight Asian Indian adults with pre-diabetes in a randomized controlled translational trial (the Diabetes Community Lifestyle Improvement Program, D-CLIP). Research design and methods...
Article
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The explosive increase in the prevalence of diabetes mellitus in resource-strapped regions of the world demands innovative solutions in healthcare. Advances in information technology, diagnostics and food technology have the potential to make diagnosis and treatment of diabetes simpler, cost-effective and patient-friendly. Newer methods of glucose...
Article
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Background: The prevalence of type 2 diabetes is increasing in epidemic proportions in low- and middle-income countries. There is an urgent need for novel methods to tackle the increasing incidence of diabetes. The ubiquity of mobile phone use and access to Internet makes mobile health (mHealth) technology a viable tool to prevent and manage diabe...
Article
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The Obesity Reduction and Awareness of Non-communicable disease through Group Education (ORANGE) Phase II program, is a school-based intervention aimed at healthy lifestyle practices for sixth and seventh grade adolescents (n = 2345) attending private (n = 1811) and government (n = 534) schools in Chennai. The objectives of this paper are (a) to de...
Article
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Aims: While lifestyle modification is known to offer several metabolic benefits, there is paucity of comprehensive data on changes in biomarkers of adiposity, inflammation as well as gut hormones. We investigated these biomarkers in overweight/obese individuals with prediabetes randomized to either 4 months of a lifestyle improvement program or st...
Article
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Essential steps in diabetes prevention and management include translating research into the real world, improving access to health care, empowering the community, collaborative efforts involving physicians, diabetes educators, nurses, and public health scientists, and access to diabetes prevention and management efforts. Mobile phone technology has...
Article
Aims: To compare the clinical profile and complications between younger and older onset type 2 diabetes (T2DM) patients at a tertiary care diabetes center in south India. Methods: We compared individuals with T2DM detected at age ≤25years (n=267) and at age≥50years (n=267), matched for gender and duration of diabetes. We reviewed electronic pati...
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Aim: The aim of this study was to determine the optimal glycated hemoglobin (HbA1c) cut point for diagnosis of gestational diabetes mellitus (GDM) and to evaluate the usefulness of HbA1c as a prognostic indicator for adverse pregnancy outcomes. Methods: HbA1c estimations were carried out in 1459 pregnant women attending antenatal care centers in ur...
Article
Aim: To evaluate the impact of a structured model of care (MOC) prepared for resource-constrained settings, on the pregnancy outcomes of Asian Indian women with gestational diabetes mellitus (GDM). Methods: Pregnant women were screened under the Women in India with GDM Strategy (WINGS) MOC for GDM using the International Association of Diabetes...
Article
Background: There is little data on the incidence of diabetes complications in young onset type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in non European populations. Methods: From a tertiary diabetes centre, Chennai, India, we recruited 108 T1DM (defined by abrupt onset of symptoms or diabetic ketoacidosis, absent insulin reserve requiring i...
Article
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Objective: This study tests the effectiveness of expert guidelines for diabetes prevention: lifestyle intervention with addition of metformin, when required, among people with prediabetes. Research design and methods: The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a randomized, controlled, translation trial of 578 overweight/ob...
Article
Background In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors...
Article
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Studying biomarkers early could help to identify high-risk individuals who could be targeted for the prevention of type 2 diabetes (T2D). Secreted frizzled-related protein 4 (SFRP4) is highly expressed in the islets, and its levels are increased several years before diabetes diagnosis (1). We report here on the systemic levels of SFRP4 and its asso...
Article
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Aim To determine postpartum glucose tolerance status among women with gestational diabetes mellitus (GDM) recruited under the Women in India with GDM Strategy (WINGS) Model of Care (MOC). Methods Through the WINGS MOC programme, 212 women with GDM were followed till delivery between November 2013 and August 2015. All women were advised to return f...
Article
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Diabetes care involves a complex interaction between patients, physicians, the health care system, and society. In low- and middle-income countries (LMICs), where the majority of individuals with diabetes live, there is a shortage of resources and infrastructure for diabetes care. Translation of proven interventions for diabetes prevention and care...
Article
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There are few data on excess direct and indirect costs of diabetes in India and limited data on rural costs of diabetes. We aimed to further explore these aspects of diabetes burdens using a clinic-based, comparative cost-of-illness study. Methods Persons with diabetes ( n = 606) were recruited from government, private, and rural clinics and comp...
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Background To determine the prevalence of Gestational Diabetes Mellitus (GDM) in urban and rural Tamil Nadu in southern India, using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health Organization (WHO) 1999 criteria for GDM. Methods A total of 2121 pregnant women were screened for GDM from antenatal...
Article
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Objective: To compare physical activity (PA) patterns in pregnant woman with and without gestational diabetes (GDM) and to assess the effects of an exercise intervention on change in PA patterns, blood glucose levels and pregnancy outcomes in GDM women. Methods: For the first objective, PA patterns were studied in 795 pregnant women with and wit...
Article
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Background & objectives: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight...
Article
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The purpose of this study is to determine the existing knowledge, attitude, practices (KAP), and impact of intervention with diabetes awareness and prevention education among school students in New Delhi, India. The Diabetes Awareness and Prevention Education is a 2-year, school-based intervention, conducted with two cohorts of students who were in...
Article
Aim: This study was designed to assess β-cell function and insulin sensitivity indices among normal glucose tolerance (NGT) subjects stratified by 1-h plasma glucose (1hPG) values during an oral glucose tolerance test (OGTT). Materials and methods: One hundred sixty-six NGT subjects underwent a five-point OGTT, and glucose and insulin levels wer...
Article
Aim To describe recruitment challenges in a randomized controlled translational trial (RCTT) of diabetes prevention in India. Methods The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a RCTT, comparing standard of care to a step-wise model of diabetes prevention. Overweight adults with prediabetes were identified through a two-step...
Article
We compared smartphone fundus photography, nonmydriatic fundus photography, and 7-field mydriatic fundus photography for their abilities to detect and grade diabetic retinopathy (DR). This was a prospective, comparative study of 3 photography modalities. Diabetic patients (n = 300) were recruited at the ophthalmology clinic of a tertiary diabetes c...
Article
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It is well known that inflammation is associated with diabetes, but it is unclear whether obesity mediates this association in individuals with youth-onset type 2 diabetes (T2DM-Y). We recruited age-matched individuals with type 2 diabetes (age at onset <25 years) and normal glucose tolerance youth. Participants were further classified using Asia-P...
Article
Aim: To investigate insulin sensitivity and insulin secretion patterns among Asian Indian youth without and with type 2 diabetes (T2DM-y defined as onset of diabetes at or below 25 years) with normal and high visceral fat (VF) levels. Methods: We recruited 74 T2DM-y individuals, within 18 months of diagnosis and compared them to 77 age-matched c...
Article
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The aim of the study was to evaluate usefulness of capillary blood glucose (CBG) for diagnosis of gestational diabetes mellitus (GDM) in resource-constrained settings where venous plasma glucose (VPG) estimations may be impossible. Consecutive pregnant women (n = 1031) attending antenatal clinics in southern India underwent 75-g oral glucose tolera...
Article
Adiposity is an important diabetes risk factor, and Asian Indians have elevated diabetes risk. This analysis assessed the relationship between behavioral and psychosocial factors and adiposity among Asian Indians to better understand factors driving elevated weight/waist circumference in this population. This study used screening data (N=1285) from...
Article
To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9 years at a tertiary diabetes center in India. We compared glycemic burden [cumulative time spent above a HbA1c of 53 mmol/mol (7 %)] and incidence of diabetes complications (retinopathy, neuropathy, nephropa...
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The prevalence of obesity in adolescents and children has risen to alarming levels globally, and this has serious public health consequences. Sedentary lifestyle and consumption of calorie-dense foods of low nutritional value are speculated to be two of the most important etiological factors responsible for escalating rate of childhood overweight i...
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Aim: To compare the adhesion, migration and endothelial differentiation potential of peripheral blood-derived mononuclear cells (PBMCs) obtained from drug-naive normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) Asian Indian men. Methods: Based on the 75-g oral glucose tolerance test, 30 NGT and 31 IGT subjects were recruited in...
Article
Aims This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population. Methods Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed...
Article
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Objective: To determine the prevalence of overweight and obesity among children and adolescents in Chennai, India, using national and international age- and sex- specific body mass index (BMI) cut-off points. Methods: The Obesity Reduction and Awareness and Screening of Non communicable diseases through Group Education in Children and Adolescent...
Article
Aim To assess the prevalence and risk factors for diabetic retinopathy(DR) in people with young onset type 1 (T1DM-Y) and type 2 diabetes (T2DM-Y). Methods T1DM-Y(n = 150) and T2DM-Y(n = 150) participants, age between 10 and 25 years at diagnosis, had a complete clinical evaluation, biochemical assessment, and four field digital retinal colour pho...