Prasad Katulanda

University of Colombo · Department of Clinical Medicine

Background: Young-onset diabetes (YOD) is characterised by unique diagnostic and management challenges more pronounced in resource-limited settings like Sri Lanka. Aims: We aimed to ascertain the prevalence, patterns and characteristics of YOD in Sri Lanka and describe the state of care. Methods: Retrospective review of baseline data of all patient...

Obesity has reached pandemic proportions globally and, in the South Asian countries. However, the rate of increase in the South East Asian region is alarming. This rapid increase is not only associated with a sharp increase in the metabolic and psychosocial complications of obesity but also will be a huge burden on the health economics of these dev...

Background Escalation of ultra-processed foods (UPFs) sales has been recorded in low-to-middle-income countries, including in South Asia. However, individual consumption levels and sociodemographic characteristics influencing UPF consumption remain largely unknown in South Asia. We aimed to quantify UPF consumption and investigate its sociodemograp...

Objectives To perform a comparative analysis of the extended APPROPRIATE trial of measures of reactive nitrogen species and antioxidant capacity in patients having resistant hypertension with controlled hypertension and healthy controls. Results Mean serum NO2- and NOx levels were significantly lower and mean AOC was significantly higher in patien...

Aims Very low‐calorie diet (VLCD) can induce weight loss and diabetes remission (DR) amongst people with obesity and recent‐onset type 2 diabetes (T2D). We aimed to determine the effectiveness and acceptability of VLCD in achieving DR amongst Sri Lankan adults with T2D. Methods A retrospective analysis was conducted in a diabetes practice where VL...

Background The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments. Methods This study reviewed and assessed food environment po...

Background Evaluation of hypercalcaemia in a patient with chronic kidney disease (CKD) is challenging, especially in low-resource settings. Hormone assays should be interpreted with caution as CKD affects both parathyroid hormone (PTH) and vitamin D. Therapies such as bisphosphonates are contraindicated in CKD, while fluid resuscitation can lead to...

Introduction Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking qui...

Objective: We aimed to study the impact of the current economic crisis (EC) on healthcare services in a tertiary care hospital in Colombo. Methodology: A retrospective study was conducted at the National Hospital Sri Lanka (NHSL), Colombo. Attendance to out-patient department (OPD), new patients in medical clinics, admissions to medical wards, deat...

Introduction and objectives: Multimorbidity affects 37% of adults globally. It increases mortality and healthcare expenses. We aimed to determine its prevalence and associations among Sri Lankan adults. Methods: A descriptive cross-sectional survey was conducted in the Western province of Sri Lanka during 2018-2020. Adults (age > 20 years) were rec...

Diabetes distress is the emotional & psychological burden resulting from the demands of managing diabetes and the fear of potential complications which is likely to have a negative impact on self-care and glycaemic control, hence aggravating the disease outcomes. Many individuals experience distress with no clear sign or symptom that might prompt i...

Introduction: Economic crisis is a complex event that affect the behavioral patterns including alcohol consumption and smoking via opposing mechanisms. Objectives: This study aimed to evaluate the changes in risk behaviours during the economic crisis. Methods: This descriptive comparative study was conducted for the adults in Western and Uva prov...

Background Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: 1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and 2) assess the relationships between SLT and smoking intensity, smoking quit at...

Aims SGLT2 inhibitors provide cardiovascular and renal protection in people with type 2 diabetes (T2DM). Real-world data on their effect on improving glucose and cardiovascular risk factors, and adverse effects in South Asians are limited. Methods We retrospectively analyzed clinical, demographic, anthropometric and biochemical data among adults w...

Background: South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention...

Background There is little data to accurate interpretation of spirometry data in South Asia, a major global region with high reported burden for chronic respiratory disease. Method We measured lung function in 7,453 healthy men and women aged over 18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asi...

Background: Most chronic liver diseases are subclinical until advanced, delaying their detection and management. Population screening should be guided by prevalence, which determines cost-effectiveness. Autopsy studies are a valuable source to estimate population prevalence and associated factors, particularly for conditions that need invasive scre...

Background The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people’s diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the...

Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex. Methods: This cross-sectional study...

Abstract Background People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings. Hypothesis Compared to usual care, the risk of T2D can be reduced amongst South Asians with central ob...

Purpose Vitamin D deficiency/insufficiency may increase the susceptibility to COVID-19. We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality and role of vitamin D in its treatment. Methods We searched CINHAL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Sci...

Aims COVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes. Materials and methods A cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-Ju...

Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India...

Background: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods: We a...

Background and aims To examine the effects of aerobic training (AT) and resistance training (RT) compared to standard care on glycemic control in South Asian Sri Lankan adults with Type 2 Diabetes Mellitus (T2DM). Methods Randomized controlled trial (RCT) with parallel-group design recruited 86 sedentary Sri Lankans (aged 35–65 years) with T2DM in...

Objectives: The objective was to assess the effect of propranolol on oxidative stress and anti-oxidant potential in patients with resistant hypertension as a secondary analysis of the APPROPRIATE trial. This randomized double blinded clinical trial recruited patients with resistant hypertension and allocated forty patients to propranolol and place...

Background Suboptimal diet is the leading cause of global morbidity and mortality. Addressing this problem requires context-specific solutions informed by context-specific data collected by context-specific tools. This study aimed to assess the relative validity of a newly developed brief dietary survey to estimate food intake and adherence to the...

Background South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high-costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for prevention of T2...

Background People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings. Hypothesis Compared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised...

Background South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods We asses...

Introduction: Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis. Objective: To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults. Methods: A sample of 1200 participants...

Background and aims: This paper describes the data resource profile of South Asia Biobank (SAB), which was set up in South Asia from November 2018 to March 2020, to identify the risk factors and their complex interactions underlying the development of type-2 diabetes mellitus, cardiovascular disease and other chronic diseases in South Asians. Data...

The coronavirus disease 2019 (COVID-19) pandemic has emerged as one of the greatest challenges faced by humankind in the recent past. People with diabetes and related comorbidities are at increased risk of its complications and of COVID-19-related death. Older age, multi-morbidity, hyperglycaemia, cardiac injury and severe inflammatory response are...

SARS-CoV-2 virus has spread across the globe rapidly causing an unprecedented pandemic. Due to the novelty of the disease, the possible impact on endocrine system is not clear. In order to compile a mini-review describing possible endocrine consequences of SARS-CoV-2 infection we performed a literature survey using the key words Covid-19, Coronavir...

There is an increasing prevalence of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) in older people in many countries across the world. Older adults with type 2 DM have a significantly higher incidence of falls compared with their counterparts without DM. This review synthesize published findings on sensorimotor, cognitive, balance...

Background: The indigenous population in Sri Lanka called “Veddas” estimated to be around 0.05% of the total population in the island. This population is unique that they used to live mostly in jungles with primitive lifestyles. The objective was to study the cardiovascular risk factors in this indigenous (Vadda) community. Methods: A descriptive c...

Mobile phone-based health interventions (mHealth) are viewed as an attractive approach to foster behaviour change, and found to be effective in promoting physical activity and healthy diets. The present study aims to investigate whether mHealth with advice for dietary and lifestyle modifications would reduce 10-year cardio vascular disease (CVD) ri...

Background Older adults with type 2 diabetes mellitus (DM) have high incidence of falls. The aim of this study was to compare sensorimotor functions, balance, mobility, fear of falling, and fall history in older people with DM (with and without neuropathy) and non-diabetic healthy controls.Methods We enrolled 153 participants aged 50–70 years: 51 p...

Aims To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool. Methods Older adults with DM (n = 103; age = 61.6 + 6.0 years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction t...

Background: The Timed up and Go Test (TUG) is often used as a mobility measure in older people. However, it is unclear whether the TUG is useful for identifying fall risk in people with diabetes mellitus (DM) and which physical and cognitive/psychological factors influence the performance of this test. Objectives: To investigate whether slow TUG ti...

Introduction: Sri Lanka has a predominantly rural population. However, there is a dearth of research on health and socioeconomic issues in this group. Objective: To describe basic socioeconomic characteristics and health profile in a rural population. Methods: A descriptive cross-sectional household survey was conducted in 1950 households in t...

Mobile phone-based health interventions (mHealth) are viewed as an attractive approach to foster behaviour change, and found to be effective in promoting physical activity and healthy diets. The present study aims to investigate whether mHealth with advice for dietary and lifestyle modifications would reduce 10-year cardio vascular disease (CVD) ri...

The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numer...

Objective: The current paper describes methods of evaluating dietary habits of Sri Lankan adolescents based on the Diet Quality Index-International (DQI-I), which has been used in multiple international studies to describe dietary variety, moderation, adequacy and balance. The paper describes the method for calculating DQI-I scores and examines as...

Aims: Life threatening macrovascular and microvascular complications of diabetes can be minimized by effective glycaemic control. Self monitoring of blood glucose with glucometers is recognized as a cost effective strategy to improve glycaemic control. However accuracy and precision of glucometers will determine the effectiveness of this strategy....

Background: The determination of behaviours that lead to noncommunicable diseases (NCDs), such as high dietary salt intake, are multifactorial. The prevention of NCDs, including the promotion of healthy dietary choice, including low salt intake, therefore requires multisectoral working. Although the need of a multisectoral approach to risk factor...

Background Fasting plasma glucose (FPG) is the most commonly used screening tool for diabetes in Sri Lanka. Cut-off values from American Diabetes Association recommendations are adopted in the absence of local data. We aimed to establish FPG cut offs for Sri Lankans to screen for diabetes and pre-diabetes. Methods Data on FPG and diabetes/pre-diab...

Aims: Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes. Materials & methods: Blood samples were available from 690 patients with type...

Background. Adherence to long-term therapy for diabetes remains low. Accurately measuring adherence is the primary step in improving adherence. We translated and validated the Sinhalese version of the Brief Medication Questionnaire (BMQ) in patients with diabetes. Methods. The study was conducted at the National Hospital of Sri Lanka between April...

Annexure 1: Sinhalese translation of the Brief Medication Questionnaire used for validation.

Background: Explorations into quantifying the inequalities for diabetes mellitus (DM) and its risk factors are scarce in low and lower middle income countries (LICs/LMICs). The aims of this study were to assess the inequalities of DM and its risk factors in a suburban district of Sri Lanka. Methods: A sample of 1300 participants, (aged 35-64 yea...

Background: The prevalence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) is rising globally. T2DM is particularly problematic in South Asia with an estimated 10-15% of Sri Lankans diagnosed with the disease. Exercise is known to improve blood glucose, lipid profiles, blood pressure and adiposity, key goals in the management...