Search

Your search keyword '"Menon, V. Usha"' showing total 20 results
Start Over Author "Menon, V. Usha"
20 results on '"Menon, V. Usha"'

1. Effect of a multicomponent quality improvement strategy on sustained achievement of diabetes care goals and macrovascular and microvascular complications in South Asia at 6.5 years follow-up: Post hoc analyses of the CARRS randomized clinical trial

Author

Ali, Mohammed K., Singh, Kavita, Kondal, Dimple, Devarajan, Raji, Patel, Shivani A., Menon, V. Usha, Varthakavi, Premlata K., Vishwanathan, Vijay, Dharmalingam, Mala, Bantwal, Ganapati, Sahay, Rakesh Kumar, Masood, Muhammad Qamar, Khadgawat, Rajesh, Desai, Ankush, Prabhakaran, Dorairaj, Narayan, K. M. Venkat, and Tandon, Nikhil

Subjects
South Asia -- Health aspects, Diabetes therapy -- Quality management -- Methods, Diabetic angiopathies -- Care and treatment, Diabetes -- Care and treatment -- Complications and side effects, Biological sciences
Abstract

Background Diabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial. Methods and findings This parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c [greater than or equal to]8% and systolic BP [greater than or equal to]140 mm Hg and/or LDL-cholesterol [greater than or equal to]130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c Conclusions In urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes. Trial registration ClinicalTrials.gov NCT01212328., Author(s): Mohammed K. Ali 1,2, Kavita Singh 3,4, Dimple Kondal 5, Raji Devarajan 4, Shivani A. Patel 1,2,6, V. Usha Menon 7, Premlata K. Varthakavi 8, Vijay Vishwanathan 9, Mala [...]

Published
2024
Full Text
View/download PDF

3. Cost‐effectiveness of a multicomponent quality improvement care model for diabetes in South Asia: The CARRS randomized clinical trial

Author

Singh, Kavita, primary, Kondal, Dimple, additional, Menon, V. Usha, additional, Varthakavi, Premlata K., additional, Viswanathan, Vijay, additional, Dharmalingam, Mala, additional, Bantwal, Ganapati, additional, Sahay, Rakesh Kumar, additional, Masood, Muhammad Qamar, additional, Khadgawat, Rajesh, additional, Desai, Ankush, additional, Prabhakaran, Dorairaj, additional, Venkat Narayan, K. M., additional, Phillips, Victoria L., additional, Tandon, Nikhil, additional, and Ali, Mohammed K., additional

Published
2023
Full Text
View/download PDF

4. Tackling NCD in LMIC: Achievements and Lessons Learned From the NHLBI–UnitedHealth Global Health Centers of Excellence Program

Author

Rubinstein, Adolfo, He, Jiang, Alam, Dewan S., Peters, David H., Wu, Yangfeng, Yan, Lijing L., Merson, Michael, Ramirez, Manuel, Caballero, Benjamin, Xavier, Denis, Yusuf, Salim, Prabhakaran, Dorairaj, Narayan, K.M. Venkat, Kimaiyo, Sylvester, Velazquez, Eric, Denman, Catalina A., Cornejo, Elsa, de Zapien, Jill, Rosales, Cecilia, Miranda, J. Jaime, Gilman, Robert H., Levitt, Naomi, Gaziano, Thomas A., Ghannem, Hassen, Laatikainen, Tiina, Rabadan-Diehl, Cristina, Engelgau, Michael M., Belis, Deshiree, Sampson, Uchechukwu, Smith, Richard, Dianis, Nancy L., Wolbach, Tracy L., Matta, Gabriela, Gutierrez, Laura, Elorriaga, Natalia, Poggio, Rosana, Irazola, Vilma, Bazzano, Lydia, Bhuiya, Abbas, Wazed, Abdul, Khan, Alfazal, Siddiquee, Ali T., Islam, Anwar, Khan, Jahangir A.M., Uddin, Jasim, Hasan, Khaled, Khanam, Masuma A., Yunus, Mohammad, Chowdhury, Muhammad A.H., Monalisa, Nazratun N., Alam, Nurul, Streatfield, Peter K., Ahmed, Shyfuddin, Parvin, Sonia, Ali, Taslim, Niessen, Louis W., Hossain, Mohammad D., Koehlmoos, Tracey L.P., Standing, Hilary, Lucas, Henry, Bleich, Sara N., Anderson, Gerard F., Trujillo, Antonio J., Mirelman, Andrew J., Hao, Jesse, Zhang, Jing, Tian, Maoyi, Huang, Polly, Luo, Rong, Fang, Weigang, Li, Xian, Feng, Xiangxian, Li, Zhifang, Deal, Kelly, Peterson, Eric, DeLong, Elizabeth, Zhou, Bo, Shi, Jingpu, Neal, Bruce, Jan, Stephen, Li, Nicole, McMahon, Stephen, Zhang, Jianxin, Sun, Jixin, Elliot, Paul, Zhao, Yi, Zhang, Yuhong, Yao, Chen, Sun, Ningling Huang, Han, Qide, Shen, Ruqun, Niu, Wenyi, Wang, Yanfang, Ke, Yang, Huang, Yining, Leeder, Stephen, Lopez, Alan, Zhang, Ruijuan, Yu, Yan, Roman, Ana V., Mendoza, Carlos, Roche, Dina, Mejicano, Gabriela, Cordova, Maria A., Kroker, Maria F., Fort, Meredith, Letona, Paola, Kanter, Rebecca, Garcia, Regina, Murillo, Sandra, Chacon, Violeta, Montero, Rafael, Lopez, Erika J., Peña, Liz, Castro, Maricruz, Dengo, Ana L., Ulate, Emilce, Alvarado, Nadia, Sibrian, Josefina, Alegria, Astarte, Gutierrez, Ana M., Fontes, Flavia, Sigamani, Alben, Kamath, Deepak, Xavier, Freeda, Deepthi, K.B., Anupama, M., Mathu, Nandini, George, Nisha, Rahul, Pranjali, Pais, Prem, Girish, Preeti, Thomas, Seena, Usha, T., Thomas, Tinku, Joshi, Rajnish, Chidambaram, N., Gupta, Rajeev, Chow, Clara, Pogue, Janice, O'Donnell, Martin, Devereaux, P.J., Misquith, Dominic, Agrawal, Twinkle, Fathima, Farah N., Reddy, Kolli Srinath, Shivashankar, Roopa, Ajay, Vamadevan S., Khan, Hassan M., Kadir, M. Masood, Masood, Muhammad Q., Fatmi, Zafar, Krishnan, Anand, Singh, Kavita, Tandon, Nikhil, Khadgawat, Rajesh, Menon, V. Usha, Sethi, Bipin Kumar, Unnikrishnan, A.G., Hutcheson, Mark L., Ali, Mohammed K., Cunningham, Solveig A., Patel, Shivani A., Gujral, Unjali, Desai, Ankush, Mohan, Deepa, Pradeepa, R. Guha, Mohan, V., Viswanathan, Vijay, Sahay, Rakesh, Shah, Seema, Bantwal, Ganapathi, Varthakavi, Premlata K., Nair, Manisha, Akwanalo, Constantine, Lagat, David, Barasa, Felix, Koech, Myra, Sugut, Wilson, Korir, Belinda, Mosol, Priscah, Ali, Shamim, Sherman, Charles B., Carter, Jane, Bloomfield, Gerald, Binanay, Cynthia, Vedanthan, Rajesh, Bernabé-Ortiz, A., León-Velarde, F., Smith, George D., Málaga, Germán, García, Héctor H., Casas, Juan P., Sacksteder, Katherine, Smeeth, Liam, Huicho, Luis, Rivera, María, Gamboa, Raúl, Ebrahim, Shah, Montori, Víctor M., Wise, Robert A., Checkley, William, Diette, Gregory B., Nojilana, Beatrice, Majikela-Dlangamandla, Buyelwa, Sylvester, Carmelita, Malan, Johanna, Murphy, Katherine, Steyn, Krisela, van Niekerk, Lindi, Mash, Robert, Puoane, Thandi, Kim, Grace, Pandya, Ankur, Abrahams-Gessel, Shafika, Rhode, Hilary, Pather, Michael, Andrade, Alvaro R., Garcia, Beatriz, Velasco, Carlos, Medina, David, Bravo, Delia, Munguia, Diana, Bateman, Eric, Castro, Francisco, Schneider, Helen, Ibarra, Ilse, Zulu, Jabulisiwe, Felix, Joel, Tribe, Karla, Bobrow, Kirsten, Fairall, Lara, Folb, Naomi, Murillo, Norma, Pacheco, Norma, Rodriguez, Paloma, Navarro, Paola, Flores, Reyna, Van Zyl Smit, Richard, Meddoza, Rosario, Surka, Sameer, Van Haght, Serena, Hernandez, Yanira, Tsolekile, Lungiswa, Jeridi, Gouider, Harrabi, Imed, Maatoug, Jihen, Boughammoura, Lamia, Chaieb, Larbi, Mrizek, Nejib, Gaha, Rafika, Limam, Khalifa, Amimi, Souad, Gaha, Karima, Gamra, Habib, Al'Absi, Mustafa, Vartiainen, Erkki, Moore, Cornelius, Spillan, Debi, Cooper, Kristiane, Mitchell, Megan, Kirby, Ruth, Gao, Yunling, Aluko, Emmanuel, Sampson, Uchechukwu K., Miranda, Jaime, and Bloomfield, Gerald S.

Published
2016
Full Text
View/download PDF

5. Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia

Author

Singh, Kavita, Ali, Mohammed K., Devarajan, Raji, Shivashankar, Roopa, Kondal, Dimple, Ajay, Vamadevan S., Menon, V. Usha, Varthakavi, Premlata K., Viswanathan, Vijay, Dharmalingam, Mala, Bantwal, Ganapati, Sahay, Rakesh Kumar, Masood, Muhammad Qamar, Khadgawat, Rajesh, Desai, Ankush, Prabhakaran, Dorairaj, Narayan, K. M. Venkat, Phillips, Victoria L., Tandon, Nikhil, and On behalf of the CARRS Trial Group

Published
2019
Full Text
View/download PDF

6. Delayed diagnosis of plasma cell disorder-related Fanconi syndrome in young adults presenting as osteomalacia: report of two cases with normokalemia and normal haematological parameters at the time of presentation.

Author

Franklin, Joel, primary, Pavithran, Praveen V., additional, Sidharthan, Neeraj, additional, NV, Seethalkshmy, additional, Abraham, Nithya, additional, Menon, V. Usha, additional, Nair, Vasantha, additional, and Kumar, Harish, additional

Published
2023
Full Text
View/download PDF

13. Oral Levothyroxine is an Effective Option for Myxedema Coma: A Single-Centre Experience

Author

Rajendran, Arjun, Bhavani, Nisha, Nair, Vasantha, Pavithran, Praveen V., Menon, V. Usha, and Kumar, Harish

Abstract

Introduction:Myxedema coma is an endocrine emergency with a very high mortality rate. As per the American Thyroid Association, initial thyroid hormone replacement for myxedema coma should be intravenous levothyroxine (LT4). However, in India, the availability of intravenous LT4 is limited. Often, crushed LT4 tablets are given through the enteral route when parenteral therapy is unavailable. No data or protocol is available for the administration of oral LT4 in myxedema coma. The aim of this study was to assess the effectiveness of oral LT4 in patients diagnosed with myxedema coma and to formulate a protocol for oral LT4 that can be used to guide the treatment of patients when intravenous LT4 is unavailable. Methods:This retrospective observational study included patients diagnosed with myxedema coma between January 2010 and December 2019. The diagnosis of myxedema coma was based on the diagnostic scoring system for myxedema coma proposed by Popoveniuc et al. [Endocr Pract. 2014 Aug;20(8):808–17]. Dosing of oral LT4 was decided as per our institutional protocol. Results:Fourteen patients (11 males and 3 females) with a median age of 67.5 years (range 11–82) with myxedema coma were included. All patients had central nervous system manifestations, and sepsis was the most common precipitating factor. The median myxedema score was 72.5 (normal ≤25), and the median length of hospital stay was 12 days (range 3–18). The oral LT4 regimen consisted of a loading dose of 300–500 μg, followed by taper over the next 3–5 days. With this regimen, 13 patients survived, and only 1 patient died. Conclusion:Oral LT4 is an effective treatment option for myxedema coma when intravenous LT4 is unavailable.

Published
2021
Full Text
View/download PDF

14. Tackling NCD in LMIC: Achievements and Lessons Learned From the NHLBI—UnitedHealth Global Health Centers of Excellence Program

Author

Engelgau, Michael M., primary, Sampson, Uchechukwu K., additional, Rabadan-Diehl, Cristina, additional, Smith, Richard, additional, Miranda, Jaime, additional, Bloomfield, Gerald S., additional, Belis, Deshiree, additional, Narayan, K.M. Venkat, additional, Rubinstein, Adolfo, additional, He, Jiang, additional, Alam, Dewan S., additional, Peters, David H., additional, Wu, Yangfeng, additional, Yan, Lijing L., additional, Merson, Michael, additional, Ramirez, Manuel, additional, Caballero, Benjamin, additional, Xavier, Denis, additional, Yusuf, Salim, additional, Prabhakaran, Dorairaj, additional, Kimaiyo, Sylvester, additional, Velazquez, Eric, additional, Denman, Catalina A., additional, Cornejo, Elsa, additional, De Zapien, Jill, additional, Rosales, Cecilia, additional, Miranda, J. Jaime, additional, Gilman, Robert H., additional, Levitt, Naomi, additional, Gaziano, Thomas A., additional, Ghannem, Hassen, additional, Laatikainen, Tiina, additional, Engelgau, Michael M., additional, Sampson, Uchechukwu, additional, Dianis, Nancy L., additional, Wolbach, Tracy L., additional, Matta, Gabriela, additional, Gutierrez, Laura, additional, Elorriaga, Natalia, additional, Poggio, Rosana, additional, Irazola, Vilma, additional, Bazzano, Lydia, additional, Bhuiya, Abbas, additional, Wazed, Abdul, additional, Khan, Alfazal, additional, Siddiquee, Ali T., additional, Islam, Anwar, additional, Khan, Jahangir A.M., additional, Uddin, Jasim, additional, Hasan, Khaled, additional, Khanam, Masuma A., additional, Yunus, Mohammad, additional, Chowdhury, Muhammad A.H., additional, Monalisa, Nazratun N., additional, Alam, Nurul, additional, Streatfield, Peter K., additional, Ahmed, Shyfuddin, additional, Parvin, Sonia, additional, Ali, Taslim, additional, Niessen, Louis W., additional, Hossain, Mohammad D., additional, Koehlmoos, Tracey L.P., additional, Standing, Hilary, additional, Lucas, Henry, additional, Bleich, Sara N., additional, Anderson, Gerard F., additional, Trujillo, Antonio J., additional, Mirelman, Andrew J., additional, Hao, Jesse, additional, Zhang, Jing, additional, Tian, Maoyi, additional, Huang, Polly, additional, Luo, Rong, additional, Fang, Weigang, additional, Li, Xian, additional, Feng, Xiangxian, additional, Li, Zhifang, additional, Deal, Kelly, additional, Peterson, Eric, additional, DeLong, Elizabeth, additional, Zhou, Bo, additional, Shi, Jingpu, additional, Neal, Bruce, additional, Jan, Stephen, additional, Li, Nicole, additional, McMahon, Stephen, additional, Zhang, Jianxin, additional, Sun, Jixin, additional, Elliot, Paul, additional, Zhao, Yi, additional, Zhang, Yuhong, additional, Yao, Chen, additional, Sun, Ningling Huang, additional, Han, Qide, additional, Shen, Ruqun, additional, Niu, Wenyi, additional, Wang, Yanfang, additional, Ke, Yang, additional, Huang, Yining, additional, Leeder, Stephen, additional, Lopez, Alan, additional, Zhang, Ruijuan, additional, Yu, Yan, additional, Roman, Ana V., additional, Mendoza, Carlos, additional, Roche, Dina, additional, Mejicano, Gabriela, additional, Cordova, Maria A., additional, Kroker, Maria F., additional, Fort, Meredith, additional, Letona, Paola, additional, Kanter, Rebecca, additional, Garcia, Regina, additional, Murillo, Sandra, additional, Chacon, Violeta, additional, Montero, Rafael, additional, Lopez, Erika J., additional, Peña, Liz, additional, Castro, Maricruz, additional, Dengo, Ana L., additional, Ulate, Emilce, additional, Alvarado, Nadia, additional, Sibrian, Josefina, additional, Alegria, Astarte, additional, Gutierrez, Ana M., additional, Fontes, Flavia, additional, Sigamani, Alben, additional, Kamath, Deepak, additional, Xavier, Freeda, additional, Deepthi, K.B., additional, Anupama, M., additional, Mathu, Nandini, additional, George, Nisha, additional, Rahul, Pranjali, additional, Pais, Prem, additional, Girish, Preeti, additional, Thomas, Seena, additional, Usha, T., additional, Thomas, Tinku, additional, Joshi, Rajnish, additional, Chidambaram, N., additional, Gupta, Rajeev, additional, Chow, Clara, additional, Pogue, Janice, additional, O'Donnell, Martin, additional, Devereaux, P.J., additional, Misquith, Dominic, additional, Agrawal, Twinkle, additional, Fathima, Farah N., additional, Reddy, Kolli Srinath, additional, Shivashankar, Roopa, additional, Ajay, Vamadevan S., additional, Khan, Hassan M., additional, Kadir, M. Masood, additional, Masood, Muhammad Q., additional, Fatmi, Zafar, additional, Krishnan, Anand, additional, Singh, Kavita, additional, Tandon, Nikhil, additional, Khadgawat, Rajesh, additional, Menon, V. Usha, additional, Sethi, Bipin Kumar, additional, Unnikrishnan, A.G., additional, Hutcheson, Mark L., additional, Ali, Mohammed K., additional, Cunningham, Solveig A., additional, Patel, Shivani A., additional, Gujral, Unjali, additional, Desai, Ankush, additional, Mohan, Deepa, additional, Pradeepa, R. Guha, additional, Mohan, V., additional, Viswanathan, Vijay, additional, Sahay, Rakesh, additional, Shah, Seema, additional, Bantwal, Ganapathi, additional, Varthakavi, Premlata K., additional, Nair, Manisha, additional, Akwanalo, Constantine, additional, Lagat, David, additional, Barasa, Felix, additional, Koech, Myra, additional, Sugut, Wilson, additional, Korir, Belinda, additional, Mosol, Priscah, additional, Ali, Shamim, additional, Sherman, Charles B., additional, Carter, Jane, additional, Bloomfield, Gerald, additional, Binanay, Cynthia, additional, Vedanthan, Rajesh, additional, Bernabé-Ortiz, A., additional, León-Velarde, F., additional, Smith, George D., additional, Málaga, Germán, additional, García, Héctor H., additional, Casas, Juan P., additional, Sacksteder, Katherine, additional, Smeeth, Liam, additional, Huicho, Luis, additional, Rivera, María, additional, Gamboa, Raúl, additional, Ebrahim, Shah, additional, Montori, Víctor M., additional, Wise, Robert A., additional, Checkley, William, additional, Diette, Gregory B., additional, Nojilana, Beatrice, additional, Majikela-Dlangamandla, Buyelwa, additional, Sylvester, Carmelita, additional, Malan, Johanna, additional, Murphy, Katherine, additional, Steyn, Krisela, additional, Van Niekerk, Lindi, additional, Mash, Robert, additional, Puoane, Thandi, additional, Kim, Grace, additional, Pandya, Ankur, additional, Abrahams-Gessel, Shafika, additional, Rhode, Hilary, additional, Pather, Michael, additional, Andrade, Alvaro R., additional, Garcia, Beatriz, additional, Velasco, Carlos, additional, Medina, David, additional, Bravo, Delia, additional, Munguia, Diana, additional, Bateman, Eric, additional, Castro, Francisco, additional, Schneider, Helen, additional, Ibarra, Ilse, additional, Zulu, Jabulisiwe, additional, Felix, Joel, additional, Tribe, Karla, additional, Bobrow, Kirsten, additional, Fairall, Lara, additional, Folb, Naomi, additional, Murillo, Norma, additional, Pacheco, Norma, additional, Rodriguez, Paloma, additional, Navarro, Paola, additional, Flores, Reyna, additional, Van Zyl Smit, Richard, additional, Meddoza, Rosario, additional, Surka, Sameer, additional, Van Haght, Serena, additional, Hernandez, Yanira, additional, Tsolekile, Lungiswa, additional, Jeridi, Gouider, additional, Harrabi, Imed, additional, Maatoug, Jihen, additional, Boughammoura, Lamia, additional, Chaieb, Larbi, additional, Mrizek, Nejib, additional, Gaha, Rafika, additional, Limam, Khalifa, additional, Amimi, Souad, additional, Gaha, Karima, additional, Gamra, Habib, additional, Al'Absi, Mustafa, additional, Vartiainen, Erkki, additional, Moore, Cornelius, additional, Spillan, Debi, additional, Cooper, Kristiane, additional, Mitchell, Megan, additional, Kirby, Ruth, additional, Gao, Yunling, additional, and Aluko, Emmanuel, additional

Published
2016
Full Text
View/download PDF

15. Subclinical Hypothyroidism and Cardiac Risk: Lessons from a South Indian Population Study.

Author

Nair, Sashi Niranjan, Kumar, Harish, Raveendran, Manoj, and Menon, V. Usha

Subjects
HYPOTHYROIDISM, HEART disease risk factors, DISEASES, INDIANS (Asians)
Abstract

Introduction: The benefits of treating subclinical hypothyroidism are currently under debate, prevention of adverse cardiac events purporting to be one of the main benefits. The effect of subclinical hypothyroidism on the cardiovascular health of the Indian sub-population is largely unknown. This study was designed to examine these effects and to help guide treatment of this disorder. Methods: A cross-sectional adult population survey was carried out in urban coastal area of central Kerala. 986 volunteers underwent complete biochemical and physical examinations, 110 were found to have subclinical hypothyroidism (8.9%). The ten-year risk of an adverse cardiac event, was calculated using the Framingham score algorithm. Eligible subclinical hypothyroid subjects (N = 110) and a randomly selected, age and gender matched control group (N = 220) were compared. Results: This population was found to have high baseline levels of diabetes 19.5%, hypercholesterolemia 57.2% and systolic hypertension 24.6%. No association was found between subclinical hypothyroid status or rising TSH and Framingham 10-year risk. While no difference between groups was noted with respect to lipid profile, a rising TSH was found to be significantly correlated with mild worsening of the lipid profile. A significant positive correlation was found between skinfold thickness and TSH. Conclusions: Subclinical hypothyroidism is not a contributing factor to elevated Framingham risk in this population, and while a mild effect was observed on the lipid profile, its effect is unlikely to be clinically relevant. We hypothesize that in this population a genetic component may be responsible for the uniquely high rates of metabolic syndrome and other endocrine diseases. [ABSTRACT FROM AUTHOR]

Published
2018
Full Text
View/download PDF

16. Determinants of urban–rural differences in cardiovascular risk factors in middle-aged women in India: A cross-sectional study

Author

Pandey, Ravindra M., primary, Gupta, Rajeev, additional, Misra, Anoop, additional, Misra, Puneet, additional, Singh, Vasundhara, additional, Agrawal, Aachu, additional, Dey, Sanjit, additional, Rao, Shobha, additional, Menon, V. Usha, additional, Kamalamma, N., additional, Devi, K.P. Vasantha, additional, Revathi, K., additional, and Sharma, Vinita, additional

Published
2013
Full Text
View/download PDF

17. Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial.

Author

Ali, Mohammed K., Singh, Kavita, Kondal, Dimple, Devarajan, Raji, Patel, Shivani A., Shivashankar, Roopa, Ajay, Vamadevan S., Unnikrishnan, A. G., Menon, V. Usha, Varthakavi, Premlata K., Viswanathan, Vijay, Dharmalingam, Mala, Bantwal, Ganapati, Sahay, Rakesh Kumar, Masood, Muhammad Qamar, Khadgawat, Rajesh, Desai, Ankush, Sethi, Bipin, Prabhakaran, Dorairaj, and Narayan, K. M. Venkat

Subjects
TREATMENT of diabetes, QUALITY of life, RANDOMIZED controlled trials, SYSTOLIC blood pressure, PATIENT satisfaction, MEDICAL decision making, ELECTRONIC health records, TYPE 2 diabetes treatment, BLOOD pressure, COMPARATIVE studies, DECISION support systems, GLYCOSYLATED hemoglobin, HEALTH care teams, INFORMATION storage & retrieval systems, MEDICAL databases, LONGITUDINAL method, LOW density lipoproteins, RESEARCH methodology, MEDICAL cooperation, TYPE 2 diabetes, QUALITY assurance, RESEARCH, EVALUATION research, TREATMENT effectiveness
Abstract

Background: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia.Objective: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes.Design: Parallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328).Setting: Diabetes clinics in India and Pakistan.Patients: 1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).Intervention: Multicomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records.Measurements: Proportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes).Results: Baseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction.Limitation: Findings were confined to urban specialist diabetes clinics.Conclusion: Multicomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics.Primary Funding Source: National Heart, Lung, and Blood Institute and UnitedHealth Group. [ABSTRACT FROM AUTHOR]

Published
2016
Full Text
View/download PDF

18. Migrating husbands and changing cardiovascular risk factors in the wife: a cross sectional study in Asian Indian women

Author

Gupta, Rajeev, primary, Gupta, Rajiv, additional, Agrawal, Aachu, additional, Misra, Anoop, additional, Guptha, Soneil, additional, Pandey, Ravindra M, additional, Misra, Puneet, additional, Vikram, Naval K, additional, Dey, Sanjit, additional, Rao, Shobha, additional, Menon, V Usha, additional, Kamalamma, N, additional, Revathi, K, additional, Mathur, Beena, additional, and Sharma, Vinita, additional

Published
2011
Full Text
View/download PDF

20. Glycaemic status and prevalence of comorbid conditions among people with diabetes in Kerala.

Author

Menon VU, Guruprasad U, Sundaram KR, Jayakumar RV, Nair V, and Kumar H

Subjects
Aged, Comorbidity, Cross-Sectional Studies, Diabetes Complications prevention & control, Diabetes Mellitus blood, Dyslipidemias epidemiology, Female, Humans, Hypertension epidemiology, India epidemiology, Male, Middle Aged, Obesity epidemiology, Prevalence, Young Adult, Blood Glucose, Diabetes Mellitus epidemiology, Glycated Hemoglobin
Abstract

Background: We aimed to assess the glycaemic status and prevalence of comorbid conditions such as obesity, hypertension and dyslipidaemia in people with diabetes in a southern Indian community., Methods: A cross-sectional community survey of adults > 18 years of age was done in central Kerala. Among the 3069 subjects surveyed, 276 were known to have diabetes. Of these, 169 who had type 2 diabetes underwent a detailed physical examination and anthropometric measurements, and determination of levels of fasting blood glucose, glycosylated haemoglobin, fasting lipid, serum creatinine and urine protein. Data of 164 subjects who had glycosylated haemoglobin levels were included for final analysis., Results: The mean (SD) duration of diabetes was 5.5 (5.04) years and the mean age was 56.9 (11.4) years. Among the patients, 28 (17.2%) were receiving no treatment for diabetes, 24 (14.7%) were on diet control and 111 (68%) on pharmacotherapy. Only 6 patients were on insulin. The mean fasting blood glucose was 153 (63) mg/dl and the mean glycosylated haemoglobin level was 8.1 (2.34)%. In 60% of patients, the glycosylated haemoglobin level was above the recommended target of 7%. Obesity (31%), hypertension (51%), low-density lipoprotein cholesterol > 100 mg/dl (90%) and serum triglyceride levels > 150 mg/ dl (38%) were present in the study population. Only 29% of patients were on antihypertensive treatment and 5% on lipid-lowering agents., Conclusion: In this population, only 40% of people with diabetes had adequate glycaemic control. The use of insulin was infrequent. Comorbid conditions were common and inadequately treated. This indicates a lack of proper diabetic care in this community, which could lead to an increase in the burden of cardiovascular disease in the future.

Published
2008

Catalog

Books, media, physical & digital resources
See catalog results