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Vs Shivaram - One of the best experts on this subject based on the ideXlab platform.

  • Adherence to Insulin Therapy Assistance Program (iTAP) among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: Patients adhering to insulin therapy is a challenge especially in developing countries(India) due to factors challenged by patients and physicians. Objective: iTAP is a patient support program (PSP) designed by Biocon for T2DM patients receiving insulin therapy. PSP aimed to improve the adherence by educating patients on diabetes. Methods: The data collected in iTAP depicts real world setting with minimal intervention. Almost 10426 T2DM patients were registered with a run-in period of 4 years. Each visit is structured into, demonstration and initiation of insulin usage (Visit-0 or baseline) recap of visit-0 (Visit-1) diabetes overview (Visit-2) importance of exercise (Visit-3), healthy diet and lifestyle (Visit-4), education on foot care (Visit-5) and reinforcement of earlier training (Visit-6). Results: A total of 7234 patients were analysed. Patients adhere to therapy were longer when they complete 6 educational visits (p Conclusion: PSP plays a critical role for patient’s adherence and brings down the complication especially in chronic segment like diabetes. It’s important for HCPs to consider PSPs, this outcomes research emphasizes the effective patient—provider communication in overcoming some of the barriers to adherence especially in countries like India. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • A Real-World Evidence in Understanding the Barriers and Behaviours of Insulin Therapy among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: American Diabetes Association categorizes barriers to adherence as either patient barriers, medication factors, or system factors. The aim of the study is to understand the barriers and behaviors of insulin therapy among T2DM patients in India from a real world setting. Methods: The data is collected from an ongoing patient support program called as iTAP (Insulin Therapy Assistance Program) designed by Biocon in patients with T2DM receiving insulin. It’s an open label, multicentric, real world data depicting 10426 T2DM patients, of which 3192 (30.61%) patients have moved on to various therapies observed over 9 months. Data of these 3192 patients were analyzed to understand the reasons for shift in therapy. Results: The prime behavioral change is from insulin to oral hypoglycaemic drugs (64.35%) and others are, short term insulin therapy (12.81%), and change/shift from an ampoule to vial dosage (6.11%). The primary barriers in insulin therapies were hypoglycaemic episodes (25.9%), stress (17.1%), fear of injection (10.3%) and cost (7.4%). Conclusion: There is an underwhelming amount of data on interventions to addressing those barriers or even aimed at improving insulin adherence in general. Education and empowerment (stress, fear of injection and cost) through shared decision-making allow patients’ preferences to be presented and considered and subsequently generate the best individualized treatment plan for each patients. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

Praveen Raj - One of the best experts on this subject based on the ideXlab platform.

  • Adherence to Insulin Therapy Assistance Program (iTAP) among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: Patients adhering to insulin therapy is a challenge especially in developing countries(India) due to factors challenged by patients and physicians. Objective: iTAP is a patient support program (PSP) designed by Biocon for T2DM patients receiving insulin therapy. PSP aimed to improve the adherence by educating patients on diabetes. Methods: The data collected in iTAP depicts real world setting with minimal intervention. Almost 10426 T2DM patients were registered with a run-in period of 4 years. Each visit is structured into, demonstration and initiation of insulin usage (Visit-0 or baseline) recap of visit-0 (Visit-1) diabetes overview (Visit-2) importance of exercise (Visit-3), healthy diet and lifestyle (Visit-4), education on foot care (Visit-5) and reinforcement of earlier training (Visit-6). Results: A total of 7234 patients were analysed. Patients adhere to therapy were longer when they complete 6 educational visits (p Conclusion: PSP plays a critical role for patient’s adherence and brings down the complication especially in chronic segment like diabetes. It’s important for HCPs to consider PSPs, this outcomes research emphasizes the effective patient—provider communication in overcoming some of the barriers to adherence especially in countries like India. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • A Real-World Evidence in Understanding the Barriers and Behaviours of Insulin Therapy among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: American Diabetes Association categorizes barriers to adherence as either patient barriers, medication factors, or system factors. The aim of the study is to understand the barriers and behaviors of insulin therapy among T2DM patients in India from a real world setting. Methods: The data is collected from an ongoing patient support program called as iTAP (Insulin Therapy Assistance Program) designed by Biocon in patients with T2DM receiving insulin. It’s an open label, multicentric, real world data depicting 10426 T2DM patients, of which 3192 (30.61%) patients have moved on to various therapies observed over 9 months. Data of these 3192 patients were analyzed to understand the reasons for shift in therapy. Results: The prime behavioral change is from insulin to oral hypoglycaemic drugs (64.35%) and others are, short term insulin therapy (12.81%), and change/shift from an ampoule to vial dosage (6.11%). The primary barriers in insulin therapies were hypoglycaemic episodes (25.9%), stress (17.1%), fear of injection (10.3%) and cost (7.4%). Conclusion: There is an underwhelming amount of data on interventions to addressing those barriers or even aimed at improving insulin adherence in general. Education and empowerment (stress, fear of injection and cost) through shared decision-making allow patients’ preferences to be presented and considered and subsequently generate the best individualized treatment plan for each patients. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

Sarah Jabeen - One of the best experts on this subject based on the ideXlab platform.

  • Adherence to Insulin Therapy Assistance Program (iTAP) among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: Patients adhering to insulin therapy is a challenge especially in developing countries(India) due to factors challenged by patients and physicians. Objective: iTAP is a patient support program (PSP) designed by Biocon for T2DM patients receiving insulin therapy. PSP aimed to improve the adherence by educating patients on diabetes. Methods: The data collected in iTAP depicts real world setting with minimal intervention. Almost 10426 T2DM patients were registered with a run-in period of 4 years. Each visit is structured into, demonstration and initiation of insulin usage (Visit-0 or baseline) recap of visit-0 (Visit-1) diabetes overview (Visit-2) importance of exercise (Visit-3), healthy diet and lifestyle (Visit-4), education on foot care (Visit-5) and reinforcement of earlier training (Visit-6). Results: A total of 7234 patients were analysed. Patients adhere to therapy were longer when they complete 6 educational visits (p Conclusion: PSP plays a critical role for patient’s adherence and brings down the complication especially in chronic segment like diabetes. It’s important for HCPs to consider PSPs, this outcomes research emphasizes the effective patient—provider communication in overcoming some of the barriers to adherence especially in countries like India. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • A Real-World Evidence in Understanding the Barriers and Behaviours of Insulin Therapy among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: American Diabetes Association categorizes barriers to adherence as either patient barriers, medication factors, or system factors. The aim of the study is to understand the barriers and behaviors of insulin therapy among T2DM patients in India from a real world setting. Methods: The data is collected from an ongoing patient support program called as iTAP (Insulin Therapy Assistance Program) designed by Biocon in patients with T2DM receiving insulin. It’s an open label, multicentric, real world data depicting 10426 T2DM patients, of which 3192 (30.61%) patients have moved on to various therapies observed over 9 months. Data of these 3192 patients were analyzed to understand the reasons for shift in therapy. Results: The prime behavioral change is from insulin to oral hypoglycaemic drugs (64.35%) and others are, short term insulin therapy (12.81%), and change/shift from an ampoule to vial dosage (6.11%). The primary barriers in insulin therapies were hypoglycaemic episodes (25.9%), stress (17.1%), fear of injection (10.3%) and cost (7.4%). Conclusion: There is an underwhelming amount of data on interventions to addressing those barriers or even aimed at improving insulin adherence in general. Education and empowerment (stress, fear of injection and cost) through shared decision-making allow patients’ preferences to be presented and considered and subsequently generate the best individualized treatment plan for each patients. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • Insulin Initiation and Concomitant OHA (Oral Hypoglycaemic Agents) in Treatment of Diabetes Mellitus—Results of the Indian Human Insulin Registry (INHIRIT)
    Diabetes, 2018
    Co-Authors: Veeranna Karadi, Dilip Pawar, Sarah Jabeen, S. Sandeep, Saptarshi Bose, Sagar P. Wagh, Kingshuk Bhattacharjee, Santosh Anand
    Abstract:

    INHIRIT is a multi-centric, prospective, open-label, single-arm, observational, naturalistic registry of diabetes mellitus patients in India with the aim of understanding the criteria for insulins initiation in day to day practice. Patients initiated on human insulin were included in the registry during which their glycaemic parameters and body weight was monitored. The commonly used oral antidiabetic drugs (OADs) used along with insulin therapy and the relevance of BMI as a criterion for insulin selection also was evaluated. Results: Of the total 668 patients with insulin initiation data, 62 were treatment-naive. The mean total daily dose of insulin was 36.8 units/d. The daily insulin dose was higher for HbA1C between 7%-8% (42.03 units/d). The most commonly used OADs with insulin were the DPP-4 inhibitors (59.3%), sulfonylureas (50.6%) and metformin (42.7%). Other OADs used are alpha-glucosidase inhibitors (8.5%), thiazolidinedione’s (7.9%), SGLT inhibitors (1.3%) and other OADs (0.4%). Sulfonylureas used in the decreasing order glimepiride, gliclazide, glimepiride, glibenclamide and glipizide. Voglibose was the widely used alpha-glucosidase inhibitor and dapagliflozin was the commonly used SGLT inhibitor. There was found to be no preference of insulin type in underweight patients. However, more overweight and obese patients received human premix 30/70 compared to other insulin preparations. Conclusion: Our study illustrated the roles that different antidiabetic drugs play in the management of diabetes; chief among them was DPP-4 inhibitors, which represents almost 60% of prescriptions overlapping with insulin and the percentage use of sulfonylurea has decreased. Disclosure V. Karadi: None. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. S.: Employee; Self; Biocon. S. Bose: Employee; Self; Biocon. S.P. Wagh: None. K. Bhattacharjee: Employee; Self; Biocon. S. Anand: None.

Dilip Pawar - One of the best experts on this subject based on the ideXlab platform.

  • Adherence to Insulin Therapy Assistance Program (iTAP) among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: Patients adhering to insulin therapy is a challenge especially in developing countries(India) due to factors challenged by patients and physicians. Objective: iTAP is a patient support program (PSP) designed by Biocon for T2DM patients receiving insulin therapy. PSP aimed to improve the adherence by educating patients on diabetes. Methods: The data collected in iTAP depicts real world setting with minimal intervention. Almost 10426 T2DM patients were registered with a run-in period of 4 years. Each visit is structured into, demonstration and initiation of insulin usage (Visit-0 or baseline) recap of visit-0 (Visit-1) diabetes overview (Visit-2) importance of exercise (Visit-3), healthy diet and lifestyle (Visit-4), education on foot care (Visit-5) and reinforcement of earlier training (Visit-6). Results: A total of 7234 patients were analysed. Patients adhere to therapy were longer when they complete 6 educational visits (p Conclusion: PSP plays a critical role for patient’s adherence and brings down the complication especially in chronic segment like diabetes. It’s important for HCPs to consider PSPs, this outcomes research emphasizes the effective patient—provider communication in overcoming some of the barriers to adherence especially in countries like India. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • A Real-World Evidence in Understanding the Barriers and Behaviours of Insulin Therapy among Indian Type 2 Diabetes Mellitus (T2DM) Patients
    Diabetes, 2018
    Co-Authors: Praveen Raj, Dilip Pawar, Sarah Jabeen, Vs Shivaram
    Abstract:

    Introduction: American Diabetes Association categorizes barriers to adherence as either patient barriers, medication factors, or system factors. The aim of the study is to understand the barriers and behaviors of insulin therapy among T2DM patients in India from a real world setting. Methods: The data is collected from an ongoing patient support program called as iTAP (Insulin Therapy Assistance Program) designed by Biocon in patients with T2DM receiving insulin. It’s an open label, multicentric, real world data depicting 10426 T2DM patients, of which 3192 (30.61%) patients have moved on to various therapies observed over 9 months. Data of these 3192 patients were analyzed to understand the reasons for shift in therapy. Results: The prime behavioral change is from insulin to oral hypoglycaemic drugs (64.35%) and others are, short term insulin therapy (12.81%), and change/shift from an ampoule to vial dosage (6.11%). The primary barriers in insulin therapies were hypoglycaemic episodes (25.9%), stress (17.1%), fear of injection (10.3%) and cost (7.4%). Conclusion: There is an underwhelming amount of data on interventions to addressing those barriers or even aimed at improving insulin adherence in general. Education and empowerment (stress, fear of injection and cost) through shared decision-making allow patients’ preferences to be presented and considered and subsequently generate the best individualized treatment plan for each patients. Disclosure P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.

  • Insulin Initiation and Concomitant OHA (Oral Hypoglycaemic Agents) in Treatment of Diabetes Mellitus—Results of the Indian Human Insulin Registry (INHIRIT)
    Diabetes, 2018
    Co-Authors: Veeranna Karadi, Dilip Pawar, Sarah Jabeen, S. Sandeep, Saptarshi Bose, Sagar P. Wagh, Kingshuk Bhattacharjee, Santosh Anand
    Abstract:

    INHIRIT is a multi-centric, prospective, open-label, single-arm, observational, naturalistic registry of diabetes mellitus patients in India with the aim of understanding the criteria for insulins initiation in day to day practice. Patients initiated on human insulin were included in the registry during which their glycaemic parameters and body weight was monitored. The commonly used oral antidiabetic drugs (OADs) used along with insulin therapy and the relevance of BMI as a criterion for insulin selection also was evaluated. Results: Of the total 668 patients with insulin initiation data, 62 were treatment-naive. The mean total daily dose of insulin was 36.8 units/d. The daily insulin dose was higher for HbA1C between 7%-8% (42.03 units/d). The most commonly used OADs with insulin were the DPP-4 inhibitors (59.3%), sulfonylureas (50.6%) and metformin (42.7%). Other OADs used are alpha-glucosidase inhibitors (8.5%), thiazolidinedione’s (7.9%), SGLT inhibitors (1.3%) and other OADs (0.4%). Sulfonylureas used in the decreasing order glimepiride, gliclazide, glimepiride, glibenclamide and glipizide. Voglibose was the widely used alpha-glucosidase inhibitor and dapagliflozin was the commonly used SGLT inhibitor. There was found to be no preference of insulin type in underweight patients. However, more overweight and obese patients received human premix 30/70 compared to other insulin preparations. Conclusion: Our study illustrated the roles that different antidiabetic drugs play in the management of diabetes; chief among them was DPP-4 inhibitors, which represents almost 60% of prescriptions overlapping with insulin and the percentage use of sulfonylurea has decreased. Disclosure V. Karadi: None. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. S.: Employee; Self; Biocon. S. Bose: Employee; Self; Biocon. S.P. Wagh: None. K. Bhattacharjee: Employee; Self; Biocon. S. Anand: None.

Valentí Rull - One of the best experts on this subject based on the ideXlab platform.

  • New insights on palaeofires and savannisation in northern South America
    Quaternary Science Reviews, 2015
    Co-Authors: Valentí Rull, Encarni Montoya, Teresa Vegas-vilarrúbia, Tania Ballesteros
    Abstract:

    © 2015 Elsevier Ltd. Understanding the origin and ecological dynamics of tropical savannas in terms of natural and human drivers of change is a hot topic that may be crucial for conservation. The case of the Gran Sabana (GS), a huge savanna island within the Amazon-Orinoco rainforests, is presented as a pilot study for the Neotropics. A vivid debate exists on whether or not forests formerly covered the GS and on the potential role of anthropogenic fires in the establishment of present-day savannas. This debate has generated a conflict between conservation ecologists defending the ancient forests hypothesis and indigenous inhabitants (Pemones), for whom the use of fire is an inalienable cultural trait. Here we discuss the latest palaeoecological findings documenting past vegetation dynamics and the shaping of present GS landscapes. At the beginning of the Younger Dryas (YD), the GS was more forested than it is today but an abrupt, hitherto irreversible, shift toward savannisation, likely caused by coupled climate-fire synergies, was recorded between the mid-YD and the Early Holocene. It is suggested that fires could have been ignited by the first South American settlers in their eastward migration from the Panama Isthmus through the so called Atlantic Route. The Pemones would have established in the GS during the Late Holocene when savannas already covered the region. A simplistic debate between either forest or savanna as the >original> GS vegetation is unrealistic and should be replaced by a more dynamic approach. The term >original> vegetation itself is misleading and should not be used.This work was supported by projects BIOSABANA (Ministry of Education and Science; CGL2006-00974/BOS), ECOPAST (Ministry of Science and Innovation; CGL2009-07069/BOS), PANTEPUI and PANTEUPI-II (BBVA Foundation; Biocon 2004-90/05 and Biocon 2008-031, respectively).Peer Reviewe

  • Time, evolution and physical reductionism
    EMBO reports, 2012
    Co-Authors: Valentí Rull
    Abstract:

    Understanding and explaining the nature of time remains a major challenge for science. The task is made harder by the living world, which seems to run on a different concept of time than the realm of physics.This paper was written during the development of projects Biocon-08-031, funded by the BBVA Foundation, and CGL2009-07069/BOS, funded by the Spanish Ministry of Science and Innovation.Peer Reviewe

  • Sustainability, capitalism and evolution
    EMBO reports, 2011
    Co-Authors: Valentí Rull
    Abstract:

    Humans are exploiting the Earth in an unsustainable manner, which is accelerating both environmental degradation and loss of biodiversity. Moreover, owing to global climate change, the rates of deterioration and extinction will probably increase in the near future. The scientific community has been highly sensitive to this alarming development and increased the number of baseline and ecological studies on the impact of humans on the biosphere and proposed various strategies to alleviate the environmental and biotic crisis. This has triggered vivid discussions about the potential risks and benefits of measures such as adaptation and/or mitigation actions, ecosystem restoration, the assisted migration of species or triage conservation.This paper has been written with the support of projects Biocon-08-031, funded by the Banco de Bilbao Vizcaya Argentaria Foundation, and CGL07069/BOS, funded by the Spanish Ministry of Science and Innovation.Peer Reviewe