Page 1

Vol.4 Issue 4

JULY - SEPTEMBER 2018

THE DIAGNOSTICS NEWS JOURNAL

Published at Agappe Diagnostics Limited on July 01, 2018 | 62 Pages | ` 20

IN GLORY OF THE NATIONAL AWARD FROM THE HON’BLE PRESIDENT OF INDIA Mr. Thomas John

DIABETES MELLITUS LABORATORY INVESTIGATIONS Dr. D. M. Vasudevan

“NEVER NEGLECT DIABETES” AN INTERVIEW Dr. V. Mohan

“PREVENTION IS BETTER THAN CURE” AN AWARENESS SESSION Dr. Anand Gokani

TYPE 1 DIABETES: CURRENT SCENARIO Dr. K.M. Prasanna Kumar

“LEADING A SEDENTARY LIFE IGNITES DIABETES” AN INTERVIEW Dr. Arvind Lal

DIABETOLOGY Exploring Pathophysiology of Diabetes Mellitus - Type 1 and 2


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CONTENTS ○

7

Volume 4 | Issue 4 | July-September 2018 ○

Recapturing the sweetness of life

12-15 Laboratory investigations in Diabetes Mellitus 20-23 Never neglect diabetes! Dr. V. Mohan 24-25

Importance of Diabetic profile

26-29 “Prevention is better than cure”- An awareness session-Dr. Anand Gokani

08-11 IN GLORY OF THE NATIONAL

AWARD FROM THE HON’BLE PRESIDENT OF INDIA

16-19

SHE PAINTS HER LIFE WITH VIBRANT HUES

37-39 Beauty, Boldness and Compassion! She has it all!! 40-43 Type 1 Diabetes: Current scenario in India 44-46 Steer away from diabetes A social menace! 47-49 Glycated Hemoglobin (HbA1c) New trends in testing

52-53 Brand Reach - Customer Speaks 54

Engagements - Exhibitions & Conferences

55

Engagements - Special Days

58

Moments-Awards

59

AG Privilege Registration Form

60

Medical Quiz & Editorial Submissions

30-33

DECORATING THE BEAUTIFUL FABRIC OF LIFE

Views and opinions expressed in this magazine are not necessarily those of Agappe Diagnostics Limited, its publisher, or editors. We do our best to verify the information published but do not take any responsibility for the absolute accuracy of the information. We do not take responsibility for returning unsolicited material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the publisher. Techagappe publishers reserve the right to use the information published herein in any manner whatsoever. Caution: After going through the techniques, procedures, theories, and materials that are presented in Techagappe, you must make your own decisions about specific treatment for patients and exercise personal/professional judgment for further clinical testing or education and your own clinical expertise before trying to implement new procedures. Contact info: The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. www.agappe.com Contact: Ph: + 91 484 2867065, Mob: +91 9349011309. Published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. Contact: Ph: + 91 484 2867000, Fax: + 91 484 2867222; Printed at Five Star Offset Printers, Nettoor, Cochin-40, for Agappe Diagnostics Limited Printed and Published by Ms. Meena Thomas on behalf of Agappe Diagnostics Limited and Printed at Five Star Offset Printers, Nettoor, Cochin-40 and published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas.

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TECHAGAPPE

JULY-SEPTEMBER 2018


○ ○ ○ ○

From The Chief Editor’s Desk

THE DIAGNOSTICS NEWS JOURNAL

○ ○

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Exploring Diabetes Mellitus...

I am very pleased to place before you, this 16th issue of Techagappe, the

quarterly review of health and laboratory medicine. Since its beginning, all editions were based on various organs and health conditions. This magazine is now regular in publication at intervals of three months. I am also happy to report that the laboratory community has warmly welcomed the previous issues of the magazine. This issue focuses on the complications of Diabetes Mellitus. We have, as usual, included three scientific articles, three life stories, two interviews and one technical article. In the MD’s desk, we are highlighting the recent national award we have received from the honorable president of India for the innovation in Mispa I series. The first scientific article describes the laboratory methods for identifying the complications of diabetes. The second scientific article is from the pen of the great-grandson of Mahatma Gandhi, Dr. Anand Gokani from Mumbai on Type 2 Diabetes. His article emphasises awareness sessions and preventive measures. The third article is from Dr. K.M. Prasanna Kumar from Bangalore about Type 1 Diabetes and its relevance in the current Indian scenario. In the life story sessions, we have three young women who are from different parts of the country. We start with Ms. Pranjali Valsangkar who is an IT specialist from Pune, suffering from Type 1 Diabetes for a long time and has been successfully managing it by an artificial pancreatic system. Her experiences are tunefully elucidated in the poem session also. The second story is of a professional tailor from Malappuram district of Kerala, Ms. Shabnam, who had undergone pancreas and kidney transplants three years back due to complications arising from Type 1 Diabetes. Now she is free from insulin injections. The third story is from north India, about a young pathologist who suffers from Type 1 Diabetes, and is now a member of the International Diabetes Federation. In this capacity, she serves the juvenile diabetic patients. In this issue, there are two informative interviews with two eminent doctors, Dr. V. Mohan from Chennai and Dr. Aravind Lal from Delhi. Both of them have contributed their valuable time to discuss with TechAgappe team about the latest trends in the treatment and laboratory tests for diabetic patients. In the technical category, we are presenting a practical article on new trends in HbA1c testing, which will help the laboratory technologists to function more effectively.

○ ○ ○ ○ ○ ○

EXECUTIVE DIRECTORS Meena Thomas Mary Baby Meleth Sangeeta Joseph Dr.D.M.Vasudevan

MANAGING DIRECTOR Thomas John

CHAIRMAN Prof. M.Y. Yohannan

BOARD OF DIRECTORS

PHOTOGRAPHY Nelson Thomas

WEB MANAGER Sanjaymon K.R

DESIGN AND LAYOUT M.T. Gopalakrishnan Dezign Centre, Kochi. 9947144570

PUBLISHING COORDINATOR Jayesh Kumar

LEGAL ADVISORY BOARD Adv. Denu Joseph

EDITORIAL ADVISORY BOARD Rajesh M. Patel Dr. C.S. Satheesh Kumar Sudhir K. Nair Jofy Paul Sanjaymon K.R Vijith Kumar V. Mallya Bintu Lijo

CONSULTING EDITOR Rarima N.S

CHIEF EDITOR Dr. D.M.Vasudevan

EDITOR Meena Thomas

EDITORIAL BOARD

Volume 4 | Issue 4| July-September 2018 ○

With warm personal regards

Subscription-For subscription queries, write to techagappe@ agappe.in or call us at +91 484 2867065. Permissions-For permissions to copy or reuse material from Techagappe, write to techagappe @agappe.in Letters to the editor-Email: techagappe@agappe.in Postal address: The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district, Kerala-683 562, India. Advertisement QueriesEmail: techagappe@agappe.in

I am glad to state that we have received very good feedback and great appreciatory letters for the last issue along with quiz participation. I am sure that this issue of the TechAgappe will give useful insights to the Diabetes Mellitus, and different aspects of laboratory practices. I am proud to announce that the ensuing issues of TechAgappe will cover other important topics. Your constructive criticisms to improve the contents will be greatly appreciated.

Dr. D.M. Vasudevan

TECHAGAPPE

JULY-SEPTEMBER 2018

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LETTERS TO THE EDITOR

Pleasurable reading, Serene presentation

Dear TechAgappe team, kindly accept my heartiest congratulations on publishing such a marvelous magazine, which is full of the most valuable information in a systematic way. I have gone through your latest issue of TechAgappe (April - June, 2018) and was completely swayed by its contents. I am very much impressed with the presentation and selection criteria of articles. All are well placed. It is my desire to go through all the previous issues at the earliest. I trust that you will understand my feelings and arrange for the same as a special case.

Seasonal greetings, Team TechAgappe! Thank you for gifting me the latest issue of the journal. I would say, for a clear mind, reading should be a habit. To become it as a habit, quality materials should be available for us. Nowadays, a lot of magazines, from different sectors, are available. But reading will be a pleasure only when the magazine has that kind of serene presentation. Whatever shown in the journal is information. Even an advertisement is very useful for us. I could not read this magazine first issue onwards. But I will read its online versions where all the past editions are available. Wish your team good luck. Let your great vision and mission to help people through TechAgappe succeed in the future also.

N.K Bansal, Goyal Intercity, Ahmedabad

Mr. D. Datta, Dhanbad, Jharkhand

A cornucopia of information

Empowering lives Being a regular reader of TechAgappe’s health tips, I would like to share my understanding for a peaceful and healthy life. We should develop a good opinion of ourselves first of all. Eating good food at the right time is very important. Doing exercises regularly is one of the finest requirements for better health. Stress is not avoidable but we should learn to manage it. After all, live in the present, enjoy it and find your work-life balance, wherever you are. Finally, after daily responsibilities, sound sleep is a must to nourish you for the next day. I gained these tips from the health tips sessions of Tech Agappe. Good work, TechAgappe team! Vaskar Baidya, Girija Diagnostic Centre, Tripura.

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Power-packed with updated knowledge

An excellent clinical presentation makes this magazine worth reading from page to page. Article on advanced interventional cardiology, heart transplant, cardiac biomarkers, lipid profile and last but not the least, the best one is the article on hardware calibration in clinical laboratory practices, which will really help medical professionals in updating their knowledge. All the articles are nicely selected and updated. A message for organ donation is an inspiring one through your heart trans plant article. I salute Dr. Jose Chacko Periappuram for his ever shining services to the mankind. Dr. T. N. Budhe, Sushroosha Nursing Home, Kurkheda

Grateful for the great information source ‘TechAgappe’

Commendable health tips for better life

Chandresh Dagha, Anant Pathology Lab, Malad, Mumbai

Prof. S. Prabhavathi, Principal, Vellalar College of Nursing, Erode

TechAgappe is overall a well presented and edited magazine. The look and feel and the articles presented are marvelous. Coloured photographs are pleasing and clear. The magazine is remarkable with ample and apt material. Health tips are decently well placed, which touches the natural way of living and caters to our healthy life solutions. The technical article about preanalytics is highly appreciated as it is interestingly very important for lab diagnostics and the information is saved and kept with us as a reference point. Thanks Agappe for your whole-hearted efforts to helps us better with ‘Tech Agappe’.

I always admire and appreciate the poetry column, a literary-scientific mixture. Every issue is special and brings cover stories of good information in a simple manner. Further, I would say that the health tips are very useful and very relevant these days as it is written in such a way that even layman can understand. For maintainingquality in laboratory practices, GLP column is very excellent. I appreciate all the officials of TechAgappe in continuing this effort for the betterment of medical as well as social community and for their well-being.


Poem on Diabetes

Recapturing the Sweetness of Life

Cover Story

“You are so sweet!” someone complimented her.

She smiled. “Of course! Sugar is in my blood” She reminded herself…

She was asked a question “What do you want to be in near future? Her reply: SUGARFREE The therapist asked, “Have you forgotten anything since the last two years?” “Yes. To live” Her body wanted to give up, but her heart wanted just the opposite. She chose to be with her heart… At 23, life was full of sweet surprises! What she forgot was, too much sweetness can cause diabetes… Life was never the same for her.. But… Life was not this better She sailed in the ship of her own dreams… But she forgot, that ships may sink… but her dreams cannot… “How much it pain?” As vast as the ocean, as limitless as the sky… Only my will to be happy empowers it all…

Pranjali Valsangkar

Graphic Designer, Pune. (To read her story, refer page no.16)

TECHAGAPPE

JULY-SEPTEMBER 2018

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Agappe MD’s Desk

IN GLORY OF THE NATIONAL AWARD FROM

THE HON’BLE PRESIDENT OF INDIA Thomas John, Managing Director, AGAPPE.

In the recent past, the R&D initiatives have brought the most prestigious recognition to Agappe – a national award. Agappe’s Mispa-i3, the automated Cartridge based Specific protein Analyzer was selected as the winner of National Award 2018 for the ‘Indigenous Development of Technology and Commercialisation’. The award was organised by the Technology Development Board, Department of Science and Technology, Govt. of India, in connection with the 20th Technology Day at Vigyan Bhavan, New Delhi.

I

Secretary, Department of Science and Technology.

The National Award was presented by the Hon’ble President of India, Shri. Ram Nath Kovind to Mr. Thomas John, the Managing Director and Mrs. Meena Thomas, the Director of Agappe, in the presence of Dr. Harsh Vardhan, Honourable Union Minister for S&T and ES and Prof. Ashutosh Sharma,

May 11th is commemorated as the National Technology Day considering the outstanding technological feats like the successful carrying out of nuclear tests at Pokhran, the victorious test flight of first indigenous aircraft ‘Hansa-3’ at Bangalore and the

t was indeed a moment of overwhelming pleasure and pride for the Agappe family when Agappe was selected as the winner of the National Awards 2018. The prestigious recognition was given for the ‘Indigenous Development of Technology and Commercialisation’ of Mispa-i3, the Automated Cartridge Based Specific Protein Analyzer.

The Technology Development Board, which is governed by Department of Science and Technology, GOI, has distributed the National Award on the 20th National Technology Day to those industrial concerns that have displayed excellence in commercializing the indigenous technology. This award ceremony was held on 11th May 2018.

Mr. Thomas John, Managing Director and Mrs. Meena Thomas, Director, Agappe Diagnostics Ltd., receiving the prestigious memento from Hon’ble President of Ind ia, Shri. Ram Nath Kovind as the winner of National Awards 2018 for the “Indigenous Development of Technology and Commercialisation” of Mispa-i3, the Automated Cartridge Based Specific Protein Analyzer, in the presence of Dr. Harsh Vardhan, Union Minister for S&T and ES.

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Thomas John and Meena Thomas with other National Award winners shared the frame with Hon’ble President of Ind ia, Shri. Ram Nath Kovind. successful test firing of the Trishul missile – all on May 11th. Agappe participated with the peers in the realm with its revolutionary innovation, Mispa-i3 the Automated Cartridge Based Specific Protein Analyzer. Through this contribution, Agappe could to reduce the patient diagnostic cost to 1/10th in the specific protein testing. While felicitating the innovators with the awards, the president emphasized on the common attributes of the technologies awarded. “First, the solution should favour the Indian scenario; secondly, it should be cost-effective and finally, the technology should be of topmost quality”, he stated. The Union Minister for Science & Technology and Earth Sciences, Dr. Harsh Vardhan, while complimenting the winners, highlighted on a renewed pledge of empowering people with comprehensive technology.

The Innovation Generator – Agappe R&D Since the time of inception, Agappe has set its focus on providing top-notch products to its customers. In the initial stages, we associated with a number of European and Japanese companies to deliver the best quality products. Within a few years, Agappe realised the importance of establishing an in-house R&D wing to succeed in its motto of providing better quality products at a highly affordable pricing. As the years passed by, the demand from the IVD industry steadily increased and our product innovation was turning remarkable in each situation. Agappe started with indigenization of the chemistry reagents at first and followed with the introduction of system packs as well. Subsequently, the development of immunochemistry assays was also materialised by our R&D team. The successful introduction

of same was an indelible mark of achievement and the display of expertise of our team. In making the advanced technology reagents, Agappe’s R&D team proved their mettle by developing LEIT (Latex-Enhanced Immuno Turbidimetry) reagents. We are proud of being the only Indian company which has its own LEIT reagents. Today, Agappe is considered to be the topmost clinical chemistry reagent manufacturer in India and has a heads-up position in haematology reagents. Over the time, Agappe also focused on indigenizing the diagnostic equipment and thus in 2010, we started a wing for R&D equipment as well. In the year 2012, we were able to launch our first product of R&D equipment - the compact and affordable Specific Protein Analyzer viz. ‘Mispa-i2’. This system was developed on a platform where it can perform tests in nephelometry and photometry together through a technology called ‘Unique Channel Shifting (UCS)’. This analyser can perform about 25 specific protein parameters with high accuracy. The system has a specially designed calibration card which

Agappe participated with the peers in the realm with its revolutionary innovation, Mispa-i3, the Automated Car tridge Based Specific Protein Analyzer. Through this contribution, Agappe could reduce the patient diagnostic cost to 1/10 th in the specific protein testing.

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Agappe MD’s Desk helps in reducing the errors in the calibration process. On the other hand, for HbA1c estimation, Mispa-i2 is also certified by NGSP (National Glycohemoglobin Standardization Program), which is considered as the international standard for diabetes testing. The success of Mispa-i2 has changed the pace of R&D activities in Agappe and the thirst for new products in R&D was never-ending. This has eventually led our team to develop the semi-automated chemistry analyzer – ‘Mispa VIVA’; the coagulation analyzer – ‘Mispa Clog Plus’ etc. In 2016, we were able to launch a new version of the specific protein analyser, which works on cartridge-based system viz. ‘Mispa-i3’. Mispa-i3 offers benefits like high precision and quick turnaround results for all protein assays and supports the clinical management of a variety of diseases such as diabetes, cardiovascular disorders, inflammation, kidney disease and other specific protein assays. This automated analyser works with pre-filled, barcoded, ready-to-use reagent cartridges with 30 and 10 test pack sizes offering stability for more than 6 months. The goal of using a pre-filled cartridge with a barcode was to reduce the errors in the sampling process at the diagnostic centres. The system is also equipped with Smart card calibration which eliminates the errors and reagent wastage. The analyser has a voice support mode, which guides the user at every phase of the testing and gives error free work environment, making life easier for laboratories, clinicians and patients.

New projects in Agappe R&D: z Agappe join hands with Hitachi Chemical for manufacturing their most advanced fully automatic specific protein and clinical chemistry analysers in India. These instruments provide ease of operation, fast and highly specific results at a reduced cost - estimated at roughly one-third of the cost per test compared to the conventional method analyzers. The equipment enables early detection of kidney malfunctioning, cardiac problems and osteoporosis. This can also support detection of prostate cancer through PSA testing and TB detection through ADA testing. z Agappe is associated with Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, through technology transfer agreement for developing and marketing the Rapid Diagnostic Kit with antibiogram for Urinary Tract Infections (UTI). The new method developed by the Sree Chitra Tirunal Institute for Medical Sciences and Technology will be manufactured and marketed by Agappe Diagnostics Ltd. It will be a real blessing to the Indian diagnostic scenario. By this new technique, the infective agent could be identified within 6 hours. Above all, being affordable and very simple, the technique requires no costly equipment. z We could also establish an association with Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvanantha-

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puram, Kerala for another project through Technology transfer agreement for developing and marketing the Vein Detection systems. The technology and system will facilitate the pre-analytical aspects of drawing samples and also in terms of supporting the treatment at the clinician’s office for medicinal injection processes. The highest advantage accessible is for the paediatric consultation centres, where the identification of vein in infants is very difficult. z Pre-analytical automation is one of the best ways to prevent pre-analytical errors due to improper sampling. This has led Agappe to think of developing a prompt and apt solution and thus, the ‘Mispa Label’ is introduced as an intelligent tube labelling system. It is a unique product with 6 channels and can be connected to the LIS or HIS interface easily. This system helps in reducing about 70% of the errors, which are occurred in the pre-analytical (mainly sampling errors) phase in any IVD laboratory. Today, Agappe invests more than 6% of its total revenue towards R&D activities, which in turn helps us to be the No.1 innovative company in the Medical Diagnostic sector.


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Cover Story Diabetes Mellitus - An Overview

Dr. D. M. Vasudevan, MBBS, MD (Biochem), FRCPath, Technical Director, AGAPPE.

LABORATORY INVESTIGATIONS IN DIABETES MELLITUS

Diabetes is a disease known from very ancient times. Charaka, in his treatise (circa 400 BC), gives an elaborate clinical description of madhumeha (sweet urine). He described that urine of the patient will attract ants. This is the first in vitro test described in the medical literature. Thomas Willis, in 1670, rediscovered the sweet taste of diabetic urine. In 1838, Peligot proved that the sugar of diabetic urine is the same as the one present in grape sugar. Qualitative test for urine sugar was perfected by Hermann Fehling (1848) and semiquantitative test by Stanley Benedict (1908). Folin-Wu method In the 1930s and 1940s, this method was popular for the quantitative estimation of glucose in the blood. The method is based on the reducing property of glucose. An alkaline copper reagent is reduced by glucose at 100 degree Celsius. The cuprous oxide formed is reacted with phosphomolybdate to produce a coloured complex, which is measured colorimetrically. The method is non-specific and many other reducing substances present in serum may give the colour leading to false higher values. The normal fasting blood glucose value by Folin-Wu method was taken as 90-130 mg/ 100 ml.

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Nelson-Somogyi method In the 1950s, this method replaced the Folin-Wu method for quantitative determination of reducing sugars because of the simplicity of the reaction. In this method, copper oxidises the sugar, which forms a coloured complex with arsenomolybdate. The colour is read at 520 nm. Again, this was a nonspecific reaction and any reducing substance in the blood may contribute to the colour reaction. The normal fasting blood glucose value by Nelson-Somogyi method was taken as 80-120 mg/100ml.

Ortho-Toluidine method By 1960s, the ortho-toluidine method was described, which became very popular in 1970s. The amine reacts with the aldehyde group of glucose to give a coloured condensation product. The reaction is specific for the aldehyde residue and since glucose is the major aldehyde in the blood, the result is said to be nearer to the ‘true blood glucose value’. However, by 1980s, it was known that the ortho-toluidine is mildly carcinogenic and so the method was discontinued in 1990s.

Enzymatic Method, GOD-POD method By 1990s, the glucose oxidase-peroxidase (GODPOD) method came into use and by the end of the century, it was the standard procedure for blood glucose estimation. Glucose oxidase is very specific - it converts glucose to gluconic acid and hydrogen peroxide. Peroxidase converts the peroxide into water and nascent oxygen. This oxygen oxidises a colourless chromogenic substrate (e.g. ortho-dianisidine) to a coloured one and the colour intensity is directly proportional to the concentration of glucose. This is highly specific, giving ‘true glucose’ values. The reference value of fasting blood glucose by GOD-POD method is taken as 70–110 mg/dl.

Disadvantages of GOD-POD method

lysis is inhibited. If fluoride is not added, blood cells will utilise glucose and by the time the blood reaches the laboratory, some glucose is metabolised by the cells. So, false low values may be obtained. 3. The graph of the colour reaction will be a straight line only up to 300 mg. After that, the graph flattens. So, higher values are not recorded unless the serum sample is diluted and the test is redone.

Enzymatic Method, Hexokinase Method

From 2005 onwards, Hexokinase method came into promi1. Although it is stated that the method is very specific, this nence in the market. The hexokinase method is the most spestatement is true with regard to cific method for measuring gluthe GOD reaction only. The seccose in serum or plasma. The enond reaction, ie. POD part is very zyme hexokinase will convert gluThe hexokinase method has more non-specific. The dye will be cose to glucose-6-phosphate. oxidised by any reducing subspecificity, precision and accuracy. This is a very specific reaction and stance present in the blood. For only glucose will give this reaction. Therefore, newer automated laboratexample, if the patient has taken The glucose-6-phosphate is then vitamin C a few hours before the ories use hexokinase method. Both reacted with glucose-6-phostest, the value will be wrong. phate dehydrogenase to form 2. For estimation of blood glucose, the blood is collected using an anticoagulant (potassium oxalate) and an inhibitor of glycolysis (sodium fluoride). Fluoride inhibits the enzyme called enolase and hence glyco-

hexokinase and glucose-6-phosphate dehydrogenase enzymes are very specific and no other components of the blood will interfere with the reaction.

TECHAGAPPE

NADP, which is measured spectrophotometrically.

Advantages of Hexokinase method over GOD-POD method 1. The hexokinase method has

JULY-SEPTEMBER 2018

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Cover Story Diabetes Mellitus - An Overview

AGAPPE’S AGGLH is based on Gold Standard Hexokinase Method which is 100% specific and with an Excellent Linearity of 900 mg/dL that helps reduce rerun of the high sample, saves time & cost.

more specificity, precision and accuracy. Therefore, newer automated laboratories use hexokinase method. Both hexokinase and glucose-6-phosphate dehydrogenase enzymes are very specific and no other components of the blood will interfere with the reaction. (Whereas the POD part of the GOD-POD reaction is nonspecific). 2. Blood collection does not require special precaution of adding fluoride. In fact, fluoride will inhibit the hexokinase enzyme and so fluoride should NOT be used. Immediately after the blood collection, serum or plasma is separated and tested later on. 3. The graph of the colour reaction will be a straight line up to 900 to 1000 mg. So, higher values could be estimated correctly. The parameters for diagnosis of Diabetes Mellitus are the following:

1. Blood glucose level

Sample Collection: As per current WHO recommendations,

two samples are collected - one at fasting (‘0’ hour sample) and two-hour post-glucose load. This is sufficient to get a correct assessment of the patient.

Normal Values and Interpretations: Following the glucose

< 110 mg/dl

> 126 mg/dl

1 hr (peak) after glucose load

< 160 mg/dl

Not prescribed Not prescribed

2 hr after glucose load

< 140 mg/dl

> 200 mg/dl

Preparation of the Patient: The patient is instructed to have

JULY-SEPTEMBER 2018

is 75 g anhydrous glucose (82.5 g of glucose monohydrate) in 250300 ml of water. This dose is fixed for an adult, irrespective of body weight. (When the test is done in children, the glucose dose is adjusted as 1.75 g /kg body weight). In order to prevent vomiting, the patient is asked to drink it slowly (within about 5 minutes). The flavouring of the solution will also reduce the tendency to vomit.

Fasting

2. Glucose Tolerance Test

TECHAGAPPE

Glucose Load Dose: The dose

The plasma sugar levels in OGTT in normal persons and in diabetic patients Criteria for Criteria for Normal d iagnosing diagnosing persons I.G.T diabetes

As per WHO recommendation, in a normal person, the fasting plasma glucose level is 70–110 mg/dl. The present day tendency is to view values above 100 mg/ml as suspicious. According to the recommendations of the American Diabetic Association, the revised upper limit is 100mg/dl, above which a person has to be further tested periodically.

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good carbohydrate diet for 3 days prior to the test. The patient should avoid drugs likely to influence the blood glucose levels, for at least 2 days prior to the test. The patient should not take food after 8 PM the previous night and should not take breakfast. This is to ensure 12 hours fasting. At about 8 am, a sample of blood is collected in the fasting state. A urine sample is also obtained. This is denoted as the ‘0’ hour sample.

110 to126 mg/dl

140 to 199mg/dl

load, the level rises and reaches a peak within 1 hour and then comes down to normal fasting levels by 2 to 2½ hours. This is due to the secretion of insulin in response to the elevation in blood glucose. Criteria for diagnosis of diabetes are shown in Table 1. Impaired Glucose Tolerance (IGT): Here blood sugar values are above the normal level, but below the diabetic levels (see Table 1). The fasting plasma glucose level is between 110 and 126 mg/dl and two-hour post-glucose value is between 140 and 200 mg/dl.


Such persons need careful followup because IGT progresses to frank diabetes at the rate of 2% patients per year.

Gestational Diabetes Mellitus (GDM): This term is used

when carbohydrate intolerance is noticed, for the first time, during a pregnancy. A known diabetic patient, who becomes pregnant, is not included in this category. Women with GDM are at increased risk for subsequent development of frank diabetes. GDM is associated with an increased incidence of neonatal mortality. Maternal hyperglycemia causes the foetus to secrete more insulin, causing stimulation of foetal growth and increased birth weight. After the childbirth, the women should be re-assessed.

Glycated Hemoglobin or Glyco-hemoglobin or HbA1c It is the best index of long-term control of blood glucose level. Enzymatic addition of any sugar to a protein is called ‘glycosyla tion’, while the non-enzymatic process is termed ‘glycation’. Once attached, glucose is not removed from hemoglobin. Therefore, it remains inside the erythrocyte, throughout the lifespan of RBCs. (120 days). The value of HbA1c is expressed as the percentage of the total Hb.

Interpretation of Glyco-Hb Values: It is unaffected by recent food intake or recent changes in blood sugar levels. The estimation

As per WHO recommendation, in a normal person, the fasting plasma glucose level is 70–110 mg/dl. The present day tendency is to view values above 100 mg/ml as suspicious. According to the recommendations of the American Diabetic Association, the revised upper limit is 100mg/dl. may be done once in every month so as to analyze the effectiveness of the treatment. Normally, the level of HbA1c is less than 5.5%. The value 5.5% denotes very good control of diabetes by treatment measures; 7% means adequate control; 8% inadequate control and 9% means very poor control. Any value above 5.5% is to be closely watched. Values between 5.6 and 6.4 are to be considered as impaired glucose tolerance. The risk of retinopathy and renal complications are proportionately increased with elevated glycated hemoglobin value. Reduction in 1% of Glyco-Hb will decrease longterm complications to an extent of 30%. Any type of anemia, where RBC lifespan is reduced, will reflect in lowered HbA1c value because the time-averaged value is less. Advantages of HbA1c over fasting blood sugar estimation are (1) For HbA1c, fasting sample is not required; the test may be done at any time. (2) Low intraindividual variability. (3) HbA1c sample is stable while blood sugar level is lowered unless precautions are taken. (4) HbA1c value is not altered by acute factors while many factors will affect blood sugar values. (5) HbA1c reflects long-term glucose control, while blood sugar estimation will show the result of a particular time only. (6) HbA1c is a better index for predicting complications. Because of all these reasons, HbA1c has become the preferred test nowadays.

Diagnostic Criteria for Diabetes Mellitus 1. If the fasting plasma sugar is more than 126 mg /dl, on more than one occasion. 2. Or, if two-hour post-glucose load value of OGTT is more than 200 mg /dl (even on one occasion). 3. Or, if both fasting and two-hour values are above these levels, on the same occasion. 4. If the random plasma sugar level is more than 200 mg/ dl, on more than one occasion. Diagnosis should not be based on a single random test alone; it should be repeated. 5. Glycated Hemoglobin (Glyco-Hb) or HbA1c level more than 6.5 % at any occasion. As per the recommendations of American Association of Clinical Chemistry and American Diabetes Association, HbA1c level is the preferred method for initial diagnosis of diabetes mellitus.

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Life Story Pranjali Valsangkar (Graphic Designer)

SHE PAINTS HER LIFE WITH VIBRANT HUES

For Pranjali, the present health condition has now become a part of her life. She can’t just ignore the warning from her insulin pump. Late night is never an excuse for her. Tiredness or laziness will yield nothing better. If you ignore the warning signal, chances are that you might not be alive to do so tomorrow.

It’s a Normal Day for Her!

The last Friday was a busy day for Pranjali Sanjay Valsangkar (27) from Pune. After her work as a graphic designer at Kaleidoscope, a brand development expert agency which is a 25 year old organisation, she had gone for her daily German classes. Later that evening, she had dinner with her friends. It was while waiting for the food to be served, a small beep sound typically like a warning came from Pranjali’s insulin pump, which was attached to her body. The warning showed no delivery of insulin. She had changed her patch for the insulin pump in the morning and it was working properly for the entire day and now she understood that it was not working properly at this very moment. The patch had failed in a day, for reasons unknown. After reaching home around 10.30 pm, she tried another patch and that too failed. The third patch was however successful. Now, she could take a good night’s rest! For Pranjali, this has now become a part of her life. She can’t just ignore the warning from her insulin pump. Late night is never an excuse for her. Tiredness or laziness will yield nothing better. If you ignore the warning signal, chances are that you might not be alive to do so tomorrow. “Living with Type 1 Diabetes is not so hard if you accept the cond ition,” Pranjali points out.

Pranjali Sanjay Valsangkar

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Daughter of Sanjay Valsangkar, an employee at Bank of India and Mrunal Valsangkar, who works with LIC Premium Centre, Pranjali was born and brought up in Pune. She was a very active child. For the neighbours, Pranjali was a bubbly, perky child who used to enjoy skating. Apart from this, she was also part of many extracurricular activities. She was very social and lovable child. After completing her Diploma in Applied Arts from Pune, Pranjali became a commercial artist. Inspired by her, Pranjali’s younger sister also became a graphic designer later.

period. “Those days, just as I woke up, I felt like vomiting. Thirst was another problem. Even after drinking several litres of water, I felt thirsty again. My normal weight was around 48-50 kg and it reduced to 28-30 kg during that period,” she recalls the panic days. The disease was very new to the 24-year old Pranjali. The only disease she remembers having in her childhood was jaundice and she had no other health issues at all until that time. She was also part of NCC in school and college apart from many other activities. “I was very shocked and shattered with the news. The unawareness about Diabetes Type 1 or Type 2 also made situations worse,” she comments. She was admitted to the hospital for four days and the doctors started injecting insulin to her. “I was in the hope that in three or four days, I will get discharged from hospital and I will be back again to my routine life. But on the last day, the doctor came to me and told me that I will have to inject insulin all by myself in the following days on a regular basis. I was totally really shocked,” Pranjali recalled those moments with intense emotion.

An Unexpected Twist! The Unforgettable November 2, 2014! Pranjali remembers the day when the biggest revelation about her life came upon. The d ifficulties of disease engulfed Pranjali for a while now. She had really fallen very sick and getting infections along with fever, urinary infection and was experiencing weight loss. She had no idea what was happening to her. She felt it was because of her hectic schedule. By October, her condition turned really bad. She was gripped by a bad fever and a viral infection. The doctor suggested her to do several tests including thyroid, diabetes and so on. The sugar level recorded was 430 mg/dL and the doctor was really shocked. He wondered how she could even stand up with this high sugar level. To confirm the results, the doctor suggested another checkup at some other lab and the sugar level was pretty much the same. Tiredness, thirst and frequent urination were the problems she faced during the period. She also remembers of having morning sickness during that

After some reflection on the disease, Pranjali understood that there was no point in crying about the condition. To overcome the situation, she should think and act like she was being cured. She realized that only that would keep her ticking. Her famPranjali during her d iagnosis days (file pic) ily was also in deep shock. “My family would have been in much more depression if I hadn’t acted bravely,” Pranjali smiles confidently. At that time, she was not working as she had a job change in her mind.

After some reflection on the disease, Pranjali understood that there was no point in crying about the condition. To overcome the situation, she should think and act like she was being cured. She realized that only that would keep her ticking.

The treatment started with insulin injections. For Type 1 Diabetes, there was no other option available. Type 1 Diabetes happens when your own immunity system is attacked by your own beta cells in the body. Insulin is mainly produced in the beta cells located in the pancreas. In Type 1 Diabetes, these beta cells are degenerative. As a result, we become insulin insufficient. There is no solid reason why this condition happens. It can happen to anybody at any time. It is not hereditary. The complications are same as of the diabetic patients. It may affect the kidney, eyes, heart and so on. The three major symptoms are frequent urina-

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Life Story Pranjali Valsangkar (Graphic Designer) tion, major weight loss and thirst. “I had always made it a point to tell people that Type 1 Diabetes is not a disease but a disorder. If you are Vitamin D deficient, you will have to take injections to get rid of the deficiency. It is also same here. Only thing is that this is not curable,” she says.

A New Addition! Fifteen days after being diagnosed with Type 1 Diabetes, another news came as a shock to Pranjali. “It was another condition called Listhesis, a rare condition which happens only to 5% people. It is a gap between two joints in your spinal chord, a very small gap which causes intolerable pain”. It was just above the tailbone and happened because of the weight loss. She had become so weak that the muscle support around her spine was almost nil. The bone was already weak due to weight loss and added to it, the muscle support is also gone. “I couldn’t sit, sleep or do anything. The only good thing was that I had a good immunity power. The main factors that contributed in my recovery were my belief in God and myself and my family and friends. They were my biggest support. I was also very fortunate to be treated by very good and efficient doctors. It took me a long time to accept all this which came quite unexpectedly,” Pranjali emits a smile that defeated her disease to an extent. A surgery was suggested to Pranjali for Listhesis when she was diagnosed with the condition. However, her body weight, which was 30 kg that time, made doctors postpone the surgery as they feared it wouldn’t give the desired results. Instead of surgery, they injected a medicine into her spine and later, she

The insulin pump is now attached to her body and is like an artificial pancreas. It does the work of what beta cells do in our pancreas. It is attached 24x7 to her and only when she goes for a shower does she remove it. Much like an organ, it has been with Pranjali ever since 2015. was cured miraculously of Listhesis. “My orthopaedic surgeon, Dr. Mahesh Mone played a very significant role in this recovery. He gave me the confidence to go on” she adds. She now does physiotherapy daily and can now sit, sleep and travel quite comfortably. Injecting insulin was a painful process. She had to take around 10 units of insulin respectively before she had her breakfast, lunch or dinner. Sometimes, there would be oozing of blood and sometimes, bruises. Accepting it took a long time for her. It was then her doctor, Dr. Nandedkar suggested another doctor who was specialised in handling cases with Type 1 Diabetes. Dr. Abhay Mutha, a renowned Diabetologist (who unfortunately expired in January 2018), was also indulged in providing children (who can’t afford to buy) free insulin, injections and insulin pens. He monitored Pranjali’s sugar levels and suggested her to use an insulin pump. He said it

WHAT IS AN ARTIFICIAL PANCREAS DEVICE SYSTEM? The Artificial Pancreas Device System is a system of devices that closely mimics the glucose regulating function of a healthy pancreas. Most Artificial Pancreas Device Systems consists of three types of devices already familiar to many people with diabetes: a continuous glucose monitoring system (CGM) and an insulin infusion pump. A blood glucose device (such as a glucose meter) is used to calibrate the CGM. A computer-controlled algorithm connects the CGM and insulin infusion pump to al-

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low continuous communication between the two devices. Sometimes an artificial pancreas device system is referred to as a "closedloop" system, an "automated insulin delivery" system, or an "autonomous system for glycemic control." An Artificial Pancreas Device System will not only monitors glucose levels in the body but also automatically adjusts the delivery of insulin to reduce high blood glucose levels (hyperglycemia) and minimize the incidence of low blood glucose (hypoglycemia) with little or no input from the patient.


could be a life-changing experience for her. He also provided a free trial so that he could also monitor how it reacted to her body and also for her to experience it. By then, it had been more than a year since Pranjali started taking insulin injections.

Finally, a Solution! The insulin pump is now attached to her body and is like an artificial pancreas. It does the work of what beta cells do in our pancreas. It is attached 24x7 to her and only when she goes for a shower does she remove it. Much like an organ, it has been with Pranjali ever since February 2015. “Like the Pranjali Valsangkar with her insulin pump Pranjali Valsangkar with her father which is attached to her body and works like doctor said it was a lifeSanjay, mother Mrunal and sister Siddhi an artificial pancreas changing experience for me. I gained weight. I gained muscles. In the developed countries, us.” She takes our attention to the communities in Mumbai and people who have this condition use insulin pumps as it is more con- Delhi which conduct meetings and marathons for Type 1 Diabetes venient. The cartridge needs to be filled after every four days. I will people. She is now part of a worldwide community called ‘Beyond suggest this to each and everyone who faces a similar situation. The Type 1’. Pranjali hasn’t got any diet restrictions now. Only thing is only problem is that it is quite costly. I bought it for Rs.2.5 lakhs. There that she will have to take insulin according to her diet. If she wants are other models like insulin pumps in which you can have your to enjoy a jalebi, it is acceptable provided she takes insulin to sugar readings as well, provided you have a sensor, which is also, like compensate it. Though this does not mean she eats a lot of sweet. “Avoiding sweets as much as possible must be the aim of every the pump attached to your body” she states. diabetic person. Sugar really is a killer”. She points out. Meanwhile, she also tried hypnotherapy as a part of Pranic HealPrecaution is always helpful and hence once in a year, a coming which she certifies to have given her wonderful results. As she was mentally disturbed before, it provided great relief and relaxation plete health check-up is a necessity. Liver function, kidney, eye tests - all are checked thoroughly. There is also an HbA1c test to her. It helped her a lot in winning back a normal life. which needs to be done every 3 months. Regarding eyesight, it is From her childhood itself, Pranjali used to love languages and her recommended to check every 6 months. This is a standard prolearning German sprouted from that passion. In future, she also likes tocol in similar cases. to try a job abroad preferably in Germany. It will also be a step toThe biggest inspirations for Pranjali are all the fellow diabetwards living independently. “Now I have everyone to take care of me. ics she has met through her community ‘beyond type 1’, espeWhen I fall ill, I have my parents to take care of me and support me. cially all the small children who, like her fight diabetes everyday. But I would like to see how I can manage on my own. I believe going They make her face everyday courageously and with new hope. abroad will be a good decision to experiment it,” she comments with She finds herself fortunate and grateful everyday for being alive great confidence. and experiencing this beautiful world. As said, to lead a normal life after being diagnosed with Type What are the tactics followed by Pranjali in keeping Type 1 Diabetes in control? Acceptance of the condition is the prime thing to 1 Diabetes is not hard if you maintain your lifestyle and however tackle the situation as she points out. “As part of your organ is not much you do Type 1 always catches you unaware so be easy on working properly and you should take care of it. You should under- yourself and in any condition DON’T STRESS OUT. “Accept the stand and accept it. Taking an injection one day is ok. But taking situation. Face it with courage and never give-up. Even now I injection four times a day needs some mental preparation. From the dream of a cure. But you can only be hopeful about it.” Pranjali society, we don’t need sympathy but we need them to understand signs off leaving a happy note of unwavering hope.

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Interview

Dr. V. Mohan

"

NEVER NEGLECT " DIABETES Dr. V. Mohan T

echAgappe: Could you please tell us about your childhood? How did you get interested in diabetology?

Being the Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre, Chennai, Dr. V. Mohan is a pre-eminent Indian diabetologist who has a rich experience of more than 40 years in the field of diabetology. A recipient of the prestigious Padma Shri award, the fourth highest civilian award in India, Dr. V Mohan found some time to talk to TechAgappe team. Excerpts from the interview:

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Dr. V. Mohan: My father, Prof. M. Viswanathan was technically, the first diabetes specialist in India. He came from Kerala to study Medicine at Stanley Medical College & Hospital (SMC), Chennai, and when he finished his medical studies, he set up the first diabetic clinic in India in 1948 at Stanley. He can therefore be aptly called the ‘Father of Diabetology’ in India. He was an Honorary Professor of Medicine at SMC in the morning and a General Physician in private practice in the evening. Till 1971, he continued in the Govt. set up and later, he wanted to do something of his own. I had just finished High School then. It was he who suggested that I take up medicine as my profession. I got admission into Madras Medical College and straightaway joined my father in his work on diabetes. My father was an eminent teacher, a researcher and a great clinician. He kept all his medical records and managed to publish several research articles. Initially, I learned how to collect and interpret data and carry out some basic statistics. We also hired a Professor of Biochemistry to set up our Biochemistry lab. By my second year MBBS, I began doing serious diabetes research, while at the same time learning anatomy, physiology and biochemistry at the Medical College. This was a unique experience. By the time I finished my MD in 1981, I had already published 30 research papers. This is an achievement of sorts, as only very few of my teachers had this many papers. After


finishing, my post-graduate studies, I joined my father as a fulltime diabetes specialist. I continued till 1991 with him except for the two years I spent abroad - one year at London as a Wellcome Trust Fellow and another year at Ulm in Germany as an Alexander von Humboldt Fellow.

of the organisation. Anjana is also the Managing Director now. Both of them have FRCP (Fellowship of all the Royal College of Physicians of UK) in addition to MD and Diploma in Diabetes from abroad. They both have published more than 100 research papers each.

My wife Dr. Rema was one of the first diabetic retinopathy specialists of India. She was my classmate and I suggested her to pursue her career in ophthalmology, as it is directly related to diabetes. We went to England basically for her to get training in diabetic retinopathy. She got trained with Dr. Eva Kohner, the world-renowned diabetic retinopathy specialist in London. In 1991, my wife and I decided to start our own centre at South Madras as my father had made North Madras as his base. We started in a small rented clinic at Royapettah. Since we already had some 20 years of experience and had earned quite a good name, the centre was very successful. We introduced several new things like the first Diabetes Electronic Records full fledged diabetes check up facilities etc. Indeed we were so successful that within a few years we moved to our own building at Gopalapuram. We later started establishing branches. Our first branch was at Anna Nagar and the second, at Hyderabad. Over the last 27 years, we have established 42 branches of our centre and have over 430,000 registered diabetic patients, 1300 staff. I also probably hold the world record for a medical doctor who has published the most number of research papers, as I have crossed 1150 research papers. My daughter Dr. Anjana and son-in-law Dr.Ranjit Unnikrishnan are also now part

TechAgappe: Dr. Mohanâ&#x20AC;&#x2122;s Diabetes Specialities Centre is a World Health Organisation (WHO) Collaborating Centre for Non-Communicable Diseases Prevention and Control. Tell us more about it. Dr. V. Mohan: The WHO collaborating centre is a stamp of approval for our services. As a part of the research, I had been working with WHO, Indian Council of Medical Research, Wellcome Trust and many other foundations. The WHO Collaborating Centre is a great honour. When you become a WHO Collaborating Centre, you can use their logo along with yours, WHO in return would expect us to prepare documents, posters and educational materials and if they require my expert opinion in Geneva, Switzerland, I may be asked to represent Asia or India for this. Mostly, this is for advocacy, research and awareness creation etc. We are also an ICMR Centre for Advanced Research on Diabetes. We are one of the few private institutions in the country which has got this ICMR recognition. The third recognition we have, is from the International Diabetes Federation (IDF). The IDF is a conglomeration of all the diabetes societies of the world. IDF has recognised

Dr. V. Mohan sharing his experiences with Rajesh Patel, Business Head, AGAPPE.

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Interview

Dr. V. Mohan

us as IDF Centre of Education and IDF Centre of Excellence in Diabetes Care. TechAgappe: Dr. Mohan’s Diabetes Specialities Centre is a large organisation today. What are the different institutions under it? Dr. V. Mohan: Health Care: Within our organisation, we have several institutions. For Diabetes Health Care, we have Dr. Mohan’s Diabetes Specialities Centre. We currently have 42 centres, all over South India, Bhubaneswar, UP and Delhi. We will also be expanding to Kolkata shortly. This is already the largest chain of diabetes centres in the world. Research: Our research work comes under the Madras Diabetes Research Foundation. This is a 100% non-profit organisation. Registered under Societies Act, it has no income at all and is funded by research grants or donations. There are 20 full-time scientists here involved in research and around 25 Ph.D. students. We have a large campus at Siruseri, Kancheepuram apart from three other campuses. At our Siruseri campus, we have built one of the largest standalone diabetes research centres in the Dr. V. Mohan receiving Dr. B.C. Roy Award from world with over 30,000 sq. ft of built up facility Dr. A.P.J. Abdul Kalam, former President of India. on 6 acres of land. There, we have all the basic sciences like genomics, cell and molecular biology, tissue cul- run fellowship courses on diabetic retinopathy and also provide ture labs, advanced biochemistry labs with all the equipment training courses for dieticians, educators and lab technicians. and a huge storage area where more than half a million blood Charity: Our Charitable Trust ‘Diabetes International Research samples are stored for various research studies. Education and Charitable Trust (DIRECT)’ looks after economiEducation: We have an Education Academy – Dr. Mohan’s cally weak patients who get free treatment here including free Diabetes Education Academy. It is estimated that there are 73 medicines and checkups. We are supported by several foundamillion diabetes patients in India and to treat all of them, the tions in this activity. We have also some rural projects. We run free doctors available now will not be sufficient. We started a Fel- camps with the Sri Sathya Sai Organisations and Trust as Bhagawan lowship in Diabetes Program and a Post-Doctoral Fellowship in Sathya Sai Baba is my spiritual guru and master and the true reaDiabetes Program. In collaboration with the Public Health Foun- son for all my success. dation of India (PHFI), we run a Certificate Course in Evidence Health Care Products : Finally, we have a technology healthcare Based Diabetes Management. Through this, we have trained products unit. This is called Dr. Mohan’s Diabetes Healthcare around 15,000 doctors in diabetes from all over India. This is Products. We have brown rice, high fibre white rice etc. for diabethe largest training program in diabetes in the world. We also tes patients, which are sold through several departmental stores in South India.

Diabetes is a very good model of noncommunicable diseases. If one has diabetes, it affects the whole system like eye, kidney, heart, feet, nose, brain etc. Today, one of the leading causes of death in India is heart attacks. In many cases, it is caused by diabetes.

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TechAgappe: Why is diabetes considered as the mother of all diseases? Dr. V. Mohan: I think you have put it very correctly. An article published in The Lancet in which I am also a co-author titled ‘Nations within Nations’ compares the health of Indian people in the year 1991 and 2016. The best parameter to calculate the health of a nation is finding the cause of mortality. In 1991, communicable diseases were the main cause of mortality in all Indian states and union territories, except for Kerala. In 2016, however, all the states have improved and in all states communicable diseases declined and non communicable diseases are now the major cause of death.


Diabetes is a very good model of non-communicable diseases. If one has diabetes, it affects the whole system like eye, kidney, heart, feet, nose, brain etc. Today, one of the leading causes of death in India is heart attacks. In many cases, it is caused by diabetes. In all probability, in five years time, India will be the diabetes capital of the world. What HIV did to Africa, diabetes can do to India unless we take preventive steps. Earlier, the mean age group of diabetic patients was used to be around 40-45 years while now people are beginning to get it in the age group of 20-25 years. This is something to be to be taken seriously.. Three significant things happened in the epidemiology of diabetes. Firstly; it shifted from the older age group to the younger age groups. Secondly; it shifted from the rich to the middle class and now to the poor. Diabetes was called as a rich man’s disease earlier. Today, the rich are aware of the disease and eat healthy food, do exercises and take care of their health while the poor are unaware and eat cheap unhealthy food. This is a very unfortunate situation as most often the poor people can’t afford the treatment for diabetes. Thirdly, diabetes is now moving from urban to rural areas. In the urban areas, patients at least have the facilities for the treatment of diabetes while in most rural areas, specialized diabetes care facilities are not available. TechAgappe: You are now close to celebrating 50 years in the field of Diabetology. Have you achieved the purpose of your life? Dr. V. Mohan: Yes, I believe so. When I started on with my father, our lab was a small car shed. A technician used to come once in a while. We never thought that we will be building a diabetes re-

Diabetes is now moving from urban to rural areas. In the urban areas, patients at least have the facilities for the treatment of diabetes while most rural areas, specialized diabetes care facilities are not available. search centre later. When we started our own centres, it was in a single room. Our research has now grown into several campuses. We are not part of Government or any university and hence we are proud that we could achieve all this. Today, six universities collaborate with us for offering Ph.D. courses. We believe as long as we are able to deliver quality, we should continue to grow. However what we have achieved is only a drop in the ocean and so much more remains to be done!. TechAgappe: What about the future plans? Dr. V. Mohan: In Tamil Nadu, we want to have our centres in every district. We are also spreading out to Andhra Pradesh in the coming months. In Kerala, we have already two centres at Thiruvananthapuram and Kochi. Currently, our focus is on expanding to the Tier II and Tier III cities in India. Eastern India is also one of our future targets for growth. TechAgappe: Finally, as a diabetologist, what is your message to the society? Dr. V. Mohan: My messages are as follows: First, even if you have diabetes, don’t worry. You can still lead a long and healthy life. Never neglect diabetes. Diabetes is not a disease but a disorder. Second, if you don’t have diabetes but your parents have it, chances are high for you to develop it. Check it before it’s too late. If you identify the disorder in the pre-diabetes stage, you can prevent diabetes or even revert to normal.

Dr. V. Mohan receiving Padma Shri Award from Smt. Pratibha Patil, former President of India.

Unfortunately, if you don’t take care, then diabetes is progressive condition and complications may arise in the future. My advice to everyone is to exercise regularly, maintain ideal body weight, eat healthy, do Yoga or meditation, eat and sleep on time and above all - Smile. If you follow these simple rules, 50-80% of non-communicable lifestyle diseases like diabetes can be prevented!.

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Promotion Importance of Diabetic Profile

CONSTANT MANAGEMENT CAN CANTROL

DIABETIC MELLITUS Bintu Lijo, Manager - Customer Support, AGAPPE.

Diabetes mellitus (DM), simply means high blood sugar level, is

a silent killer and it kills you 10 years before your time as per the study conducted by Oxford university. There are now 382 million people worldwide living with diabetes, according to International Diabetes Federation (IDF) and India ranks among top 3 countries. Diabetes is a condition in which the body either does not produce enough insulin, or does not properly respond to insulin. Individuals with diabetes are at increased risk of heart and kidney disease, retinopathy, neuropathy, and nonalcoholic fatty liver disease. The two main types of diabetes are Type 1 and Type 2. If diagnosed with diabetes, regulate glucose tests can help manage or maintain conditions. Type 1, is commonly seen in children or teenagers whose bodies are not producing enough insulin. Type 2 diabetes, is typically seen in adults who are overweight. The insulin in their bodies are either not working normally, or there is not being enough produced. Along with blood sugar control, people with diabetes need to have an eye on their cholesterol levels because Diabetes is associated with high lipids, clinically known as diabetic dyslipidemia. Later this excess fat may build up in liver and leads to nonalcoholic fatty liver disease. Medical health experts assert that regular check-ups and timely detection plays a vital role in controlling and managing the diabetic problems. Proper Diabetic profile testing is very important for the timely detection and monitoring of Diabetes.

Who needs to undergo diabetes tests? Diabetes symptoms may not show up in its early stages. If any of the following signs of diabetes, are noticed, then the person needs to undergo diabetes tests immediately. z Urinating often z Feeling very thirsty or hungry (even if you are eating or have just eaten) z Extreme fatigue/lethargy z Blurred vision z Cuts or bruises that heal slowly

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z Weight loss (even though you are eating more (Type 1) z Tingling/numbness/pain in hands and/or feet (Type 2)

What should be the frequency of Diabetic profile check? The guidelines for frequency are based on diabetes risk. Screening when no risk factors present: Test in every three years Screening when risk factors present: Older than 45, a family history of diabetes / high blood pressure / high cholesterol should test once in a year. Monitoring z If your blood sugar control is good – four times a year z If your blood sugar control is poor – Every month

Complete Diabetic Profile can be divided to 3 and it includes Routine diabetic tests – Glucose, Microalbumin, Dipstick test Standard diabetic tests - HbA1c, C-peptide Comprehensive Metabolic Panel (CMP) – Creatinine, lipid profile, liver profile, Urea, Electrolytes


Diabetic Profile Test Parameters from Agappe z No Prozone effect up to 6000 mg/L & no false negative - Safe reporting

Glucose z Hexokinase Method – The reference method for Glucose estimation developed by AACC

Ultrastik z 11 parameters including Microalbumin – Wide test menu

z Hexokinase method is 100% specific Hexokinase convert glucose to glucose6-phosphate & only glucose will give this reaction

z 30 seconds to 2 minutes- Rapid test results z Designed specifically considering Indian conditions like Humidity & temperature – High accuracy

z Excellent Linearity of 900 mg/dL - Reduce rerun of the high sample, saves time & cost

z High shelf life of 2 years – Ensure complete usage of strips

AGA1c

z Fast Reaction - Only 5 minutes to complete reaction, fast reporting

z Latex-enhanced Immunoturbidimetry Method - Uses ultra micron latex particle, High Specificity, Sensitivity& Reproducibility

z High accuracy, CV <2% - Excellent CV shows the reliability of the method

z Direct Method-directly measures A1c in %Highly Precise & Accurate result

Microalbumin z Turbidimetric Immunoassay method Highly sensitive, Accuracy Guaranteed z Calibrator provided -Multipoint calibration-Takes out extra cost & matrix problems

zWide measuring range of 4-395 mg/L Safe reporting of lower & higher side values

z Two Reagent system with 4 level calibrators -No stability problems z NGSP Standardize DCCT Reference material & correlated with HPLC-Ensured Accuracy

Routine diabetic tests Glucose Fasting blood glucose test (8 or 12 or 14 hours after eating), glucose tolerance test, Postprandial glucose test (2 hours after eating) & Random blood sugar test help to diagnose diabetes, prediabetes and gestational diabetes. Microalbumin A urine microalbumin test is a test to detect very small levels of a blood protein (albumin) in urine. By this method, it can find out whether diabetes has damaged kidneys because Diabetes is the leading cause of kidney failure. Dipstick test Kidney damage can cause proteins to leak through the kidneys and exit the body via urine. This test is to evaluate severe hyperglycemia (severe high blood sugar) by looking for ketones & microalbumin in the urine.

Standard diabetic tests C-peptide This test is used to differentiate between type I (low level of insulin and C-peptide) and type II (normal or high level of C-peptide) diabetes. C-peptide levels are measured instead of insulin levels because C-peptide can assess a person’s own insulin secretion even if they receive insulin injections. HbA1c It is the ideal parameter which can be used to assess the diabetic

control. It shows how well your diabetes has been controlled in the past 2 to 3 months and whether your medicine needs to be changed. As per the recent studies, People with diabetes who reduced their HbA1c by less than 1% can cut their risk of dying within 5 years by 50%

Comprehensive Metabolic Panel (CMP) This panel evaluates liver and kidney function along with important cholesterol levels including HDL, LDL, VLDL and triglycerides. Diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which increases risk for heart disease and stroke. An increased level of electrolyte may indicate kidney disease, so Electrolytes also need be tested.

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Cover Story Type 2 Diabetes - An Overview

”PREVENTION IS BETTER THAN CURE”

AN AWARENESS SESSION BY DR. ANAND GOKANI Renowned diabetologist Dr. Anand Gokani (Bombay Hospital and Medical Research Centre) stands unique among his peers through his unorthodox approach towards diabetology as a whole. He confirms that prevention is better than cure in the case of diabetes and takes sincere efforts to save the youth from falling prey to diabetes. This includes awareness sessions, preventive measures including stress management sessions and workshops. Dr. Anand also carries a proud and prestigious lineage - he is the great-grandson of Mahatma Gandhi. Understanding Diabetes A true understanding of diabetes is quite significant. “You should know that whatever we eat, when it comes to our intestine, it digests and breaks up into its basic components. Carbohydrates break up into sugar and enter the blood. The protein breaks up into amino acids and enters the blood. Fats break up into fatty acids and glycerol and enter the blood. Whatever the nature of the food, when it gets into your blood, it is in it’s very basic form,” he elucidates. Dr. Anand explains that sugar in the blood is not a bad thing. “The sugar travels through your blood to every cell in your body and then burns up to produce energy. In a way, sugar is the fuel of our body. But to burn this sugar you need vitamins, minerals and insulin. Imagine sugar as wood, vitamin and minerals as matchsticks and insulin as a fan. You take the matchsticks and burn the wood. When the wood catches fire, you fan the fire so that it burns brightly producing light and energy. In a similar manner, sugar burns in every cell of the body. That’s how we survive,” he gives a vivid clarification.

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How good is cooked food? Nature has made provisions for supplying all these to our body. Insulin comes from the pancreas which is an organ in close proximity to the intestine. The specialised cells in the pancreas produce insulin at all times. Sugar, vitamin and minerals are found in fruits, vegetables and nuts. “So, if someone eats a fair amount of fruits, vegetables and nuts, which are a source of carbohydrates, vitamins and minerals, they can lead a normal life. But when you cook food, it destroys or inactivates the vitamins and minerals. We only preserve carbohydrates, protein and fat through cooking. The vitamins and minerals are very low in cooked food,” says Dr. Anand. Whenever a child is born, the child has a full complement of nutrition taken from the mother and stored in the liver. That stock is very difficult to estimate. It is assumed that if the mother has a very good stock of nutrition, she gives around 10% of it to her child. If it is less, then also she gives around 10% of what she has to the child. So, how much nutrition a child gets depends on its mother. That could be the concept of heredity. What happens when you eat cooked food? “When you eat the cooked food, the carbohydrate enters your body and converts as glucose. When it goes into the liver, it literally ‘steals’ the vitamins and minerals already stored there to produce energy. Even though you feel that this food is good and provides energy, it is a misconception. Unfortunately, our society espoused this notion. The stock in the liver reduces as you grow old. “As I said earlier, the wood is present but there is no matchstick to ignite the wood. Hence there is no fire and the wood piles up. By the same analogy the glucose does not burn and the energy drops,” he adds. The first symptom of diabetes comes in the form of tiredness. Fatigue or tiredness will be connected to every organ by the time the signs of diabetes appear.

sugar takes more time inside the body to burn up. This sugar, which piles up, is referred to as diabetes,” Dr. Anand throws light on the reason of diabetes. Dr. Anand also points out that the acidic food has, unfortunately, become our daily food. “There are four types of food that are actually addictive drugs - alcohol, tobacco, tea and coffee. While the first two are extremely vicious poisons, the latter are gentle poisons. But they are surely different versions of poison.

Choose your food Wisely! The first cause of diabetes is the deficiency of vitamins and minerals. In this regard, the initial treatment will be to step up the intake of fruits, vegetables, salads and nuts. “A lot of the modern food is acidic. When you eat or drink this kind of food, it falls on the organs like acid and the stomach becomes the first victim. This causes a low grade inflammation of the stomach which will harm the digestive cells. Acidity and gas problems are the resultant diseases. From there, the acid goes to the pancreas owing to this the cells die early. Continuous cell death reduces the mass of the active pancreas. Some cells might escape and produce insulin, which will be insufficient for the body. Thus,

The first cause of diabetes is the deficiency of vitamin and minerals. In this regard, the initial treatment will be to step up the intake of fruits, vegetables, salads and nuts. A lot of the modern food is acidic.

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Cover Story Type 2 Diabetes - An Overview Milk, maida, sugar, fried and spicy food are also in this list. To a certain extent, red meat is also there if you can’t digest it. Our body, being alkaline, is allergic to acidic food and therefore, all organs suffer including liver, brain, kidney and so on,” the doctor gives a warning signal here.

Say No to Stress! Another factor which fuels diabetes is stress. All the negative emotions like anger, hatred, and jealousy when locked up inside, keep on generating acids and destroy the cells. Earlier, families were the venues where you can talk to each other and relieve your stress. But now, in a modern family where both husband and wife work, there is no time for them to talk to each other. This should change drastically.

Exercise Regularly Lack of exercise is another vital cause of diabetes. Every joint in the body is connected by nerves to every gland in the body. The pancreas is also a gland. If you move your limbs, nerves will stimulate the pancreas to make insulin. The logic is very profound. To move a joint, you need to contract the muscle. To do so in a sustained manner, you need energy. For energy, you need food and insulin. So, one nerve will pass the message to another nerve and inform the brain about the need for food and ignites hunger whilst another nerve will push the pancreas to send insulin. Now, the situation has changed as we are looking for food as a habit rather than as a need. There is no stimulus to the pancreas to

Another factor which fuels diabetes is stress. All the negative emotions like anger, hatred, and jealousy when locked up inside, keep on generating acids and destroy the cells.

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generate insulin and hence, the sugar piles up leading to diabetes. Hereditary traits do not guarantee diabetes and non-hereditary traits don’t mean that you won’t get the disease. “It all lies in how you treat your body. Even if diabetes runs in your family, if you live conservatively, eating healthy food like more fruit and salads, working hard and having no negative emotions, you can escape the disease,” he points out.

Diabetes can affect Kidneys Talking about how diabetes affects the kidneys he said that long standing, uncontrolled diabetes, the chronic use of junk foods (acidic in nature) and the abuse of medications for every symptom experienced leads to gradual and systematic destruction of kidney cells first leading to protein in urine and later advancing to kidney failure.

Diagnosis of Diabetes Diagnosis of diabetes is done using three criteria. First is your random blood sugar test. Any level more than 200 mg can be treated as a strong indication of diabetes. The Glucose tolerance test is a foolproof test to find out diabetes. There are criteria for doing this test, especially for pregnant ladies. The HbA1c test is the third test for the diagnosis of diabetes. The number of diabetic patients is increasing multifold each year. “In 2000, India crossed the mark of 36 million diabetic patients. It was estimated that by 2025, the number will reach around


50 million. But by 2018 itself, India has more than 60 million diabetic patients. Diabetes is a major lifestyle disease now. Automation and lack of exercise play a pivotal role in this. It is alarming to note that many youngsters have diabetes now, which will make the nation handicapped as its main workforce suffers from this disease,” he hints at an alarming fact here.

Manage your Diabetes The management of diabetes is a three pronged programme viz. diet, exercise and medication. A good diet has no substitute in management and prevention of diabetes. Proper exercises and medication also help to lead a positive life with energy and to stay away from diabetes. He also advises the youth to stay away from sugared drinks like colas. The influence of advertisement is quite strong in making the youth choose colas. “While the prime time slot in TV and the prime spot in newspapers are used for their ads, little do people notice the health warnings against them by any advisory bodies, which will be usually deeply buried in by the media,” he points out. Speaking about the various drugs which are available in the market to control diabetes, Dr. Anand has got a clear-cut stand about them. “There are some drugs which help to produce more insulin from the pancreas by stimulating the cells directly or indirectly. There are some drugs which improve the efficiency of existing insulin by doing some chemical play. These two drug groups can be called legitimate as they help to normalise glucose metabolism

“It all lies in how you treat your body. Even if diabetes runs in your family but if you live very conservatively eating healthy food like more fruits and salads, working hard and having no negative emotions, you can escape the disease,” he points out. and produce energy. However, some newer drugs prevent the digestion of carbohydrates and thereby prevent the absorption of glucose from the intestine. They don’t allow glucose to enter the blood and thus blood sugar remains normal. I don’t feel it is a legitimate way of treating diabetes. I may be radical in my thinking but that’s how I feel,” he clarifies. In general, out of the 10 medicines available, only three might be safe to use. He also points out how several medicines were banned by regulatory bodies after they were found to be harmful to the user.

Lifestyle Management

To youngsters of the nation, his message is very simple and straightforward. “It is very important to change your lifestyle. You can never depend on a drug to cure you in the case of diabetes. In this case, prevention is better than cure. It is better to safeguard your organs than losing them. I may quote a Yogi who has given me the best advice to prevent diabetes. “Diabetes se door rehana HbA1c hein toh Uttar Pradesh ko Normal Leval thanda rakho, Madhya 4% -5.5% Pradesh ko mulayam or Dakshin Pradesh ko garam!” Uttar Pradesh is your mind. Keep it calm and cool. Don’t get stressed. Madhya Pradesh is your abdomen. You should keep it soft. Don’t eat food that causes constipation. Dakshin Pradesh are your legs. Keep them hot by engaging yourself in various forms of exercise. Dr. Anand gives an excellent advice to escape the disease through this lucid example.

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Life Story Shabnam (Professional Tailor)

DECORATING THE BEAUTIFUL FABRIC OF LIFE... Shabnam Mohammed (32) is busy doing the final touchup of a churidar with the new machine she had purchased to maintain the inflow of orders and for fast delivery of dress materials. She is the proprietor of Shabnam Ladies Tailors, Kumaranellur, 5 km away from Edappal, Malappuram district. Her three workers are also busy stitching and knitting clothes with the finesse that makes people choose her shop without much hesitation. “Despite the emerging number of readymade wares, we are never shor t of work. To finish the job on time, we sometimes work overtime,” says Shabnam beaming with energy and enthusiasm. Her demeanour matches exactly as any other proud, extremely healthy young entrepreneur. But Shabnam deserves a little more elaboration.

Many people know Shabnam as the high-

spirited girl who roams the streets of Kumaranellur on her Honda Activa. Only a few know the real story of Shabnam and the hardships she had undergone. In the medical records, Shabnam is credited as Kerala’s first woman to undergo a combined pancreas-kidney transplant. The fact that only a few such transplants had been conducted all over India makes Shabnam’s case quite significant.

Shabnam Mohammed

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Born to Mohammed Ali and Subaida, Shabnam is their third child. She has four siblings including a brother. Mohammed Ali was basically into bakery business and Shabnam indulged in the sweets her father brought home. Life was quite good indeed. Even when Shabnam had her share of dis-


eases during her childhood, nothing was much serious. Her mother remembers it was always Shabnam who had been affected by diseases. Neither her brother nor her sisters had any health problems during their childhood. It was in 2000 things took an unanticipated, sharp turn. Shabnam was appearing for her tenth-grade exam (SSLC) that year. The first symptom Shabnam noticed was her unusual weight loss. Despite the strange hunger she felt, she kept on losing weight. She also felt very thirsty throughout day and night. Shabnam’s mother Subaida recalls how she noticed her daughter using the toilet at night several times. Feeling this to be a little uncommon, they took her to a local medical practitioner. After examining her, he asked Mohammed to take her to the hospital immediately. At the hospital, they prescribed some tests and after examining the results, they asked him to get her admitted to another hospital. The doctor asked them to hurry to the hospital at once. It was here the doctors explained the seriousness of the situation to them. The doctors informed them that Shabnam’s sugar level has reached almost 500 mg/dL while the normal is around 80-120mg/dL. Insulin was given to her and the doctors engaged nurses to instruct her on how to take insulin herself. The doctors said that the condition was diabetes found in children, which has led to a situation like this. Thus, at the tender age of 15, she began to take insulin herself thrice a day. For a 15-year old, the disease changed her world topsy-turvy. She states that at first, what she felt was uncontrollable anger to the people around her. Sometimes she used to skip her insulin intake as a protest and anger towards her own condition. Neither she nor her family members had any knowledge about the disease. Her family had no history of diabetes. She had to get admitted to the hospital often when the situation turned worse. Even though she had reduced the intake of sweets she hadn’t completely quit it. Sometimes, without the knowledge of her parents, she used to enjoy it and finally end up in hospital. After a few days in the hospital, she would return to her normal life. With her disease condition, she couldn’t attend the SSLC exam. Since she wasn’t very bright in her studies, her parents also didn’t persuade her to go about it. When she was diagnosed with the disease, Dr. Ajith, who had been treating her, suggested teaching her something with which she could support herself in the future. Thus Shabnam turned to tailoring. Her family also had a few tailors and she mastered the skills easily. Today, she is one of the

Shabnam and her family busiest tailors in the locality. The job also worked as a stress reliever and maintained her mental health in perfect balance. For three years, she did all her work from home itself. But as the customers increased, she moved into a shop in the town. Since her father owned a few apartments in the area, finding a place for the shop wasn’t difficult. At first, Shabnam had just one employee and now the number has turned to three. In a hurry to find a solution to their daughter’s disease, her parents went to several local medical practitioners. “That was a foolish act. Every time the situation got worse and we had to seek medical attention at the hospital itself,” recalls her parents. Their advice is to stay away from fake medical practitio-

For a 15-year old, the disease changed her world topsy-turvy. She states that at first, what she felt was uncontrollable anger to the people around her.

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Life Story Shabnam (Professional Tailor)

Shabnam at her tailoring shop ners. “We wasted many years going behind their advice,” they added with much dismay. Meanwhile, during regular checkups, the doctors informed her parents that the function of her kidney was also getting affected. Shocked, they took Shabnam to a super speciality hospital in Thrissur for further treatment. However, some unhappy incidents forced them to move to Ernakulam. Her father remembers how that doctor wouldn’t even share the details of her disease to them – her close relatives. “The doctor behaved arrogantly and was always busy”, recalls them. “He didn’t even care to tell us about the possible ways ahead if kidney failure happens. We remember how casually he said that there is nothing to be done now as the kidney failure is in its final stage. By then, we had completed 13 dialyses for her. It was only then he said that there is an option of a kidney transplant and that too, only if happened in two days. You can’t buy a kidney from a shop! He should have informed us much earlier,” they recol-

Shabnam’s brother, who was abroad, came for a holiday and noticed a piece of news about the case of Syed Yunus Shahir who had gone through a similar situation. He had a pancreas-kidney transplant and was the first patient to undergo such a combined transplant in India at that time.

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lected the bad days. Shabnam’s mother points out that there were a few doctors in the same hospital who helped them in many ways. “We still keep in touch over the phone with those good doctors who gave us directions at that point of time,” she adds with gratitude. Shabnam was shifted to Amrita Institute of Medical Sciences (AIMS), Ernakulam, on the following day itself. It was from there they came to know that Shabnam’s pancreas was not functioning from her birth onwards. They wonder whether other doctors diagnosed this correctly as no one told them about this before. Only at AIMS, did they come to know about the complexity of her case. The child can store insulin from their mother during the time of gestation for months and years. Till 15 years, Shabnam had no frequent problems as the stored insulin was used. Now it is over and that insulin has to be pumped into her body. “For that one year (2014-2015), I mostly spend time in the bed. The dialysis continued for almost the whole year with three or four processes a week,” recalls Shabnam. Meanwhile, Shabnam’s brother, who was abroad, came for a holiday and noticed a piece of news about the case of Syed Yunus Shahir (39) from Palakkad, who had gone through a similar situation. He had a pancreas-kidney transplant and was the first patient to undergo such a combined transplant in India at that time. Shabnam’s family is really grateful to Dr. Ramachandran at AIMS who was very caring and considerate to his patients. He inquired about their opinion on combined organ transplant after explaining the risks associated with it. The doctor also pointed out that in Syed’s case, there had been no dialysis till he underwent the transplant. In Shabnam’s case, it was different. The huge expense related to the transplant was another issue to be addressed.


Her mother recalls how the relatives and people around the locality helped to pay off the expenses related to the transplant. Though it was estimated that Rs.25 lakhs will be required, the collective efforts gathered more than Rs.50 lakhs for the surgery. “God has helped us when we required the help,” she says. Shabnam had waited for one year after registering for an organ transplant. During that time, they had gone to the hospital four times for a possible transplant when they were informed that an organ was available. However, those were not perfect matches for her. The cadaver organ Shabnam received was from a 30-year old male from Ernakulam, who had a brain death. Recently, they had contacted the donor’s wife and child. Shabnam’s transplant surgery took place on July 31st, 2015 at AIMS. She was taken to the operation theatre by midnight and taken out the next day by 12 pm. The pancreas transplant took around 8 hours while kidney transplant took around the remaining 4 hours. Doctors informed her parents at regular intervals on how the transplant was progressing. She regained consciousness only after three days. Even though they tried shifting her to her room, most of the time, she used to catch a fever in not less than 2 or 3 hours after being taken to the room and would be again shifted to ICU. For three months after the transplant, she had been in the ICU itself. Post surgery, she faced a few complications. A tube which had been inserted to pass urine went wrong once removed and reinserted so that the urine started to flow through the wounds of the surgery. At first, the doctors failed to understand that it was urine which was coming out through the wounds of the surgery. Later, they put two tubes inside her body - one to remove the urine in her stomach and another to pass urine the regular way.

Another incident which they remember is about being asked to take her scan after the transplant surgery. The technicians there asked her to consume water prior to the scan. Her parents informed that she could consume only two glasses of water a day. However, the staff insisted on taking a glass of water and just minutes after consuming a glass of water, Shabnam had difficulty breathing. She lost her consciousness in the next moment and was rushed to the ICU facility. Shabnam underwent three major surgeries after the transplant and the excess amount they collected was used for this. It was only after six months, she was discharged home. Prior to that, she had also encountered ear balance problems, which resulted in vomiting and headache. As they were unaware of the cause of her vomiting and headache, they contacted Dr. Ramachandran and promptly informed him of her condition. Dr. Ramachandran identified the problem and took great care to ensure the safety of his patient. It’s almost four years now after the transplant and Shabnam leads a normal life now. The hospital days are long gone and there have been no further complications after it. Every three months, she has to go for a regular checkup. Shabnam says that her greatest desire was to live well for a day after the surgery enjoying all the food and sweets. Now, she has got no restrictions on food or sweets and enjoys whatever she feels like eating. She now jokes that she will one day enter into Guinness Book of Records as a person who had lived the longest after a combined transplant.

Today, Shabnam is an independent woman. She earns a decent income through her tailoring shop. Regarding her future plans, she says she dreams of expanding her shop. “A married life is still far away. Already, a few marriage proposals ended up nowhere as we informed them about my transplant. At present, I have made up my mind to concentrate on my shop and leave the rest to the hands of God. After all, the God has given me more than I could ask. I feel absolutely grateful!” she emits that radiant smile that Shabnam with Dr. Ramachandran N. Menon, Dr. George Kurian and Dr. Unnikrishnan G. at has defeated Amrita Institute of Medical Science, Kochi even fate.

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Interview

Dr. Arvind Lal (Dr. Lal PathLabs)

LEADING A SEDENTARY “ LIFE IGNITES DIABETES...

Dr. Arvind Lal, Chairman and Managing Director of Dr. Lal PathLabs

Dr. Arvind Lal, the Chairman and Managing Director of Dr. Lal PathLabs, one of the most respected pathology laboratories in India, is recognised as a pioneer in providing laboratory services in India, par excellence. The President of India has also conferred him an Honorary Brigadier’s rank in the Armed Forces Medical Services. Being the recipient of the prestigious Padma Shri award, Dr. Arvind finds some time to talk to the TechAgappe team at their head office located at New Delhi. Excerpts from the interview: TechAgappe: Could you please tell us about your childhood?

How did the idea of establishing a chain of diagnostic labs in India emerge in your mind? Dr. Arvind Lal: I never wanted to become a doctor. Even for my studies, I had not selected biology. I had made up my mind to become a fighter pilot in the Indian Navy. But when I discovered that I had a myopic condition on my left eye (which will never allow me to become a pilot), I thought of several other options as a profession. It was then that one of my uncles suggested me to become a doctor. So I had to give up my geometrical drawing, which was my other subject and studied biology in eight months’ time. Thus I made it into my pre-medical test and then to medical college. Even before that, my father Late Dr. Major S. K. Lal had established a pathological lab in 1949 and is considered as the oldest pathological lab in India. This lab is of my age as I was born in the same year. He passed away in 1971 and I had to take up the lab. I had been a lecturer of pathology and did my post graduation during that time. I introduced several Dharani new Dr. things to theSubrahmaniam lab like Thyroid Testing, which has

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been never done at a private lab in India before. We also got the first Auto-analyser which gave results within one minute, first Haematology Analyser, first lab information management system back in 1986 and so on. In 1996, we opened our second lab to do molecular diagnostics. We are proud to say that we introduced vacuum based evaluation tube in 1989, which was a game changer in India. Be it the case of machinery, we were the first in India to introduce the latest equipment. We also had a tie-up with a foreign company back in 1995, which was later renamed as ‘Quest Diagnostics’ and we were their first partners in India. In the Dr. Arvind Lal receiving Padma Shri Award from Smt. Pratibha Patil, same year, we grew as a private former President of India. limited company from a partnership company. We got our first private equity partner in 2005 - Dr. Arvind Lal: In India, anybody can open up a lab anywhere West Bridge Capital Partners. Today, we run around 280 labs, 2000 in the country. It is estimated that India has around 1 lakh collection centres and we pick up samples from 7000 additional laboratories in the private sector. Most of these labs are run pickup points. by people who have no relation to pathology or healthcare sector. There is even a Supreme Court Judgement stating that We were also the first to bring up franchisee concept to the only a doctor can run a lab. There are many labs which claim healthcare sector in India. But we don’t franchise our labs and do as testing centres even though they are actually ‘testing shops.’ that only with the collection of samples. No quality control measures, precautionary measures or ethiTechAgappe: What is your idea about preventive testing against cal practices are taken at such testing shops. If the Government of India can regulate the sale of Ultra Sound Machine disease testing? and restrict authority to run a blood bank, it should enforce Dr. Arvind Lal: As doctors, we are confronted with the burden of the law on who can run a laboratory also. The first and the non-communicable diseases or lifestyle diseases. I will say that foremost step is that the laboratories should become more there is no family in India that doesn’t have any member unafquality conscious. The second step is that you provide a time fected by any of these diseases like diabetes, high blood pressure, frame or a deadline for every laboratory to get accreditation of stroke, obesity, cardiac disease, cancer, liver problems, kidney or NABL or ISO. My opinion is that if you don’t observe good lung diseases. Almost 65% of our population dies due to these quality, the bad quality will cost you dearly. We should be qualdiseases. If we do not prevent these diseases on time, our country ity conscious and the government has also got a role in this will never become prosperous because two percent of the GDP is regard. gone treating these diseases. Any human being, who is rational and educated, will want to bring it down. And that cannot be done TechAgappe: What are the plans of Dr. Lal PathLabs to take unless we do preventive testing. So, it is good to do the test during quality disease diagnosis to the rural population of India? your wellness than during your illness. The sooner, the better! Through early diagnosis, we will be able to save millions of lives in "AGAPPE is associated with Dr. Lal PathLabs for India. Communicable diseases also have its share in India. The their protein analysis. They are using our number one communicable disease in India is Tuberculosis. Though the government is doing a good job in preventing these Innovative product Mispa-i2, specific protein diseases, it can do much better with the help of private sector. analyzer in many of their centres across the TechAgappe: As one of the leaders in providing world-class diagnostic services, maintaining the highest ethical standards and quality, what are your suggestions to change the present condition prevailing in the diagnostic sector in India?

Country. We are very proud to be associated with the pioneers like Dr. Lal PathLabs”. Sudhir Nair, Head - Marketing, Agappe Diagnostics Limited.

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Interview

Dr. Arvind Lal (Dr. Lal PathLabs)

Dr. Arvind Lal: We are only concentrating on metro cities and tier I cities as of now. But don’t forget that more than 70% of the population lives in the rural areas. The three problems we face while going down to rural parts are- accessibility, affordability and quality. Even then, Dr. Lal Path Labs have always tried to become more accessible. We have increased the number of our labs and collection centres to reach the patient more effectively. Considering the factor of affordability, it is true that we can’t serve people below the poverty line at this point. Last year alone, we tested around 1.5 crore patients and are able to provide them world-class quality reports.

fingers, tips of their toes and so on. They get injured often and ultimately will have to get amputated. Diabetes also leads to silent heart attacks. Diabetic retinopathy is another situation, which shows the gravity of the disease. Your foot will be another area, which will be affected by diabetes. Gestational diabetes needs to be monitored carefully as the child will be heavier than the normal child. TechAgappe: Agappe takes pride in claiming that we are ‘The Best Partner in Diagnostics’. We strive hard to retain it. What is your advice to Agappe in keeping the slot filled as ‘The Best Partner in Diagnostics’?

Dr. Arvind Lal: You have to come up with products that match world-class quality. We are not yet par with the westWe propose that the Govt. of India ern world in manufacturing analysers, should largely be interested in taktesting and IVD equipment. I wish our ing care of primary health care of companies must have their own model, the patients and leave the secondwhich must reflect that we can go one ary and tertiary care to the private step ahead than those companies groups, who are available on a payDr. Arvind Lal, with former Prime Minister of abroad. (For eg: we can have a lab on a ment basis. Those private groups India Dr. Manmohan Singh chip and we can take them right to pashould choose good nursing houses, doctors and can guarantee the quality. We are ready to tients’ homes or a collection centre or a pickup point. In this way, serve the poor if need arises even though that means cutting we would be able to diagnose the disease with it rather than senddown the cost of our top quality services. We are already pro- ing their blood sample to 50 or 100 km away to have them diagnosed.) Quality and innovation will help Agappe to stay ahead but viding it for CGHS patients. you should also take care of a third factor-Off the shelf products TechAgappe: As a doctor, what is your message to the diabetic and services. You should be able to execute your idea fast. patients? Dr. Arvind Lal: It is saddening to note that we do nothing to TechAgappe: As a doctor, you are now many years into this IVD stand away from diabetes. Leading a sedentary lifestyle with no Sector. What do you think? Have you achieved your vision? exercise, morning walk, eating unhealthy food especially fast and junk food etc ignites diabetes. On top of all, doing nothing to take care of oneself even when someone knows that he is diabetic is like adding fuel to the flame.

People with diabetes should take care of themselves at least10 times more than they are normal. Here I doubt whether all patients take the reports to the doctor. In the UK, under National Healthcare Service (NHS) Testing, if doctors can bring the HbA1c level of patients down, they get incentivised or rewarded. In India, leave aside the reward, but I would suggest patients keep your blood sugar under a tight control. HbA1c is less than seven for a diabetic and less than six for a non-diabetic. Get your urine checked every now and then, especially for microalbumin (to detect kidney damage). You should note that 70% of renal failure cases coming to Dr. Lal PathLabs are diabetic patients. Diabetic Neuropathy is another condition seen in many people in India. They lose their sensation in their limbs, the tips of their

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Dr. Arvind Lal: No, no, I have just started it. The thing which keeps bothering me is that there are still thousands of people in India dying without getting a proper diagnosis. To reach them, our accessibility has to be increased. We should be up-to-date with quality and should make it definitely affordable for all those people. TechAgappe: What are the current issues faced by the industry? Dr. Arvind Lal: GST is too high for the industry. At present, we are included in the 28% slab. We also don’t get the input credit for CGST. Though healthcare sector is exempted from GST, as there is no input credit, even people like us have been affected badly. I am pointing out the monetary aspect. So, some reforms have to be incorporated into the entire healthcare sector. TechAgappe: Do you have any plans for overseas? Dr. Arvind Lal: We are already there in Nepal and Bangladesh. We are looking at the opportunities in Africa. We will not lag behind in exploring opportunities abroad.


Life Story Dr. Apoorva Gomber (Doctor)

BEAUTY, BOLDNESS AND COMPASSION!

SHE HAS IT ALL!!

Apoorva Gomber (27) is a vibrant, enthusiastic PG student in Pathology at New Delhi. She has an ideal fighting spirit flaming in her that helps her win over her health disorder - Type 1 Diabetes. She fights not just to prove her courage and confidence but she is a strong voice for many, who face a similar situation. She doesn’t welcome sympathy. All she wants is societal acceptance for the people living with type one diabetes , particularly when Type 1 Diabetes is not a disease but an auto-immune disorder. This can happen to anyone at any age, irrespective of gender or class.

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orn to doctor parents in Delhi, Apoorva’s story is pretty much similar to anyone with Type 1 Diabetes. Apoorva was studying in her eleventh grade when the symptoms of Type I Diabetes surfaced. She suddenly began losing weight and from a 50kg body weight, she reduced to 40 kg. “I was actually feeling happy about this weight loss as I had been eating a lot that time. Ice cream and CocoCola were my favourite things. I was happy that I could munch on everything and can still wear a 26 waist size jeans,” she says. But the joy turned out to melancholic notes in a few days. There appeared infections on her face and lips. Along with this, breathing problems, especially when she climbs upstairs and dozing off, all started manifesting.

Apoorva Gomber

Her mother thought that Apoorva was anaemic which is commonly the first clinical diagnosis a doctor makes in a young female in India. They ran a blood test and found her haemoglobin levels to be normal. So other things were ignored. Later, she had a row of urinary infections. Her father became doubtful about this and randomly checked her sugar levels also. It was around 750 mg/dL while the normal was around 72-108 mg/dL. The HbA1c was 16.4%, which was more than twice the ADA (American Diabetes guidelines) of a normal level of 6.5% and the doctors were astonished how she was alive until then. “My father was shattered at this news. I was admitted to the hospital immediately and insulin

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Life Story Dr. Apoorva Gomber (Doctor) shots were given to me from the next day onwards,” Apoorva recollects. She was gaining weight during those hospital days and came to 65 kg. She felt alone and kept wondering what was wrong with her and no longer wanted to take her insulin shots. Like most diseases in India are kept under the cover because of lack societal acceptance her family too was not very open about the disease. So she had to confine her disease condition to herself. Only a few close family members knew that she had Type 1 Diabetes. Her parents were very supportive and encouraged her to go ahead with her life. She took about oneyear leave from her studies as she just couldn’t focus on her studies. Since she was from a family of doctors, she knew a little about the seriousness of her condition. She also wanted to learn more about her condition and to know about her peers who suffered from this disorder in Delhi. In 2009, she joined for her MBBS studies. It was a very hard time for Apoorva as the long study hours made her weak facing a hard time managing her blood sugars. She remembers some of her friends joking about her whether she was high on drugs being unaware of Apoorva’s condition. Since she had insulin injections, she used to go to the washroom and administer them. This must have made them mistaken it for drugs. Sometimes, she even missed taking injections as she didn’t want others to know about her disorder. But gradually, she opened up her Instagram page called ‘T1D Fighter’ and she thought that it was the only way to reveal her mind to others. “Despite following all the instructions on food and quantity and taking them on time, sometimes my sugar levels would go very low with symptoms of hypoglycaemia like shivering , feeling dizziness and at times loss of unconsciousness. I wrote openly about my feelings during that time on social media so I could get connected with more people living with diabetes with an aim to remove the taboo which this disease is linked with in our country. Connecting and

But what makes her unique is what she stands for currently. Meeting people behind the International Diabetes Federation (IDF) Project opened up new opportunities for her. The organisation is for all people who suffer from diabetes. sharing my experiences and going through stories from people all over living with type one diabetes was really empowering for me and I gained strength from it,” Apoorva recalls how she managed the disorder at that tender age. She unveiled the mask of “TID Fighter’ on social media and revealed her name only after a year. She never posted her pictures as she felt there was a taboo prevalent in India which prevents women with Type 1 Diabetes from getting married. Within a year, she got connected with several people living in Delhi itself with Type 1 Diabetes. Gradually, she got in touch with people abroad also, especially in UK and USA. She once got an opportunity to visit American Diabetes Association with her father and met several eminent personalities there. It was there, she got introduced to the movement ‘Beyond Type 1.’ Beyond Type 1 is a new brand of philanthropy leveraging the power of social media and technology, changing what it means to live with a chronic disease. By educating the global community about this autoimmune disease, as well as providing resources and support for those living with Type 1. Apoorva is a Global ambassador council member at Beyond Type 1 and has been taking various initiatives to organize “Live Beyond educational sessions” to spread awareness about the disease. But what makes her unique is what she stands for currently. Meeting people behind the International Diabetes Federation (IDF) opened up new opportunities for her. The organisation is for all people who suffer from diabetes. Headquartered in Belgium, they choose people who can do advocacy projects related to diabetes and change the present scenario in their own country.

Apoorva Gomber as the regional representative from SEAR-south East Asian region standing alongside other regional representatives at the YLD- Young leader in diabetes -IDF, Abu Dhabi 2018

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Apoorva’s current advocacy project is organising a camp exclu-


It’s DIYA- Diabetes Ind ia youth in action- an active advocacy group for people living with type one diabetes . sively for people living with Type 1 Diabetes. She got the idea from interacting with people from the US and the UK where they conduct camps for such people. They will gather up in a school or a convenient place for a day – having food and spending time together just like normal people. It is also an occasion for them to share information on the newer technologies like insulin pumps/ CGM’s. It is more of an awareness and social support project. In India, she feels that people won’t even admit that they have diabetes. Apoorva believes that by sharing their stories, people could come close to each other and get support. Her project from 20182019 is to organise one such camp in her area. At present, Apoorva is a part of an NGO called Diabetes India Youth in Action (DIYA), which is led by a collaborative effort of nine other people - who are also living with Type 1 Diabetes. It is a patient advocacy project where people living with the condition stand for their own rights. It works to remove the stigma associated with Type 1 Diabetes. “I have seen people break their relationship when they find out that their partner is a Type 1 Diabetic. It is shocking to know that even students face discrimination in schools or colleges for having this condition. A few days back, one of my friend said how she was rejected by others when she wanted to stand for Sports Captaincy in College,” she voices forth the societal stigma towards people like her. The NGO also aims to coordinate with government agencies to increase the availability of insulin. Even when it is available through government hospitals, the cost of insulin is still high. Apoorva has to spend Rs.5000/- per

Even in the Government of India’s Disability Act, which aims to provide essential medicines free of cost, insulin is not added in the list. Apoorva feels that it’s high time the government accepts the significance of insulin.

month for her basic insulin to survive. In other countries, unlike India, it is covered under insurance. They also aim to create awareness among people on how to inject insulin. “If you don’t know how to use it, the chances are high that you might end up in an overdose which is disastrous,” Apoorva adds. Through DIYA, they have organised two or three picnic camps. They have also organised Carbohydrates Counting sessions so that people can know how they can improve on their food and how to calculate their ‘Carbs’ with the right amount of insulin. Insulin is a life-saving drug for people like Apoorva. Even in the Government of India’s Disability Act, which aims to provide essential medicines free of cost, insulin is not added in the list. Apoorva feels that it’s high time the government accepts the importance of insulin and ensures accessibility & affordability for all. DIYA team is also working on an insurance policy aimed at patients like them. They have collaborated with ‘Medtronic India’ help provide insulin pumps to patients who need them most. She says ‘Mithai Project’ organised by Government of Kerala for children who suffer from Type 1 Diabetes is indeed a welcome move. Insulin pumps will be provided to 400 children who suffer from the disorder in the first phase. Children from families, who have an annual income below Rs.2 lakhs, can apply for the scheme currently. People ask Apoorva why she preferred pathology to diabetes. “I had made up my mind that I would become a doctor. But then, I didn’t do well in the medical exams to choose what I wanted. Besides, my father also didn’t want me to go for something which my health won’t allow. Even then, I want to pursue diabetology and in the future, may switch from pathology to something related with diabetes,” she adds with a winning smile. “Every disease goes through a phase of acceptance and denial. The phase of denial is long over for me now. I won’t allow diabetes to defeat me,” Apoorva is confidently moving towards the direction of her goals.

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Cover Story Type 1 Diabetes - An Overview

TYPE 1 DIABETES:

CURRENT SCENARIO IN INDIA Type 1 Diabetes Mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and healthcare providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. The challenges of T1DM include awareness of the disease that is very poor among the general public and also in parents of T1DM children along with the health care professionals. The challenge of lack of awareness of T1DM can be met by increasing public awareness programs, conducting workshops for diabetes educators regarding T1DM in children, newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. Diagnosis of T1DM was a challenge a few decades ago but the situation has improved today with diagnostic tests and facilities, made available even in villages.

Dr. K.M. Prasanna Kumar

Consultant Endocrinologist, Centre for Diabetes and Endocrine Care, Bangalore Diabetes Hospital, Bangalore, India. Courtesy to http://www.ijem.in/ ype 1 Diabetes Mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and health care providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. A study in USA showed that when a 10-year-old boy or girl develops diabetes, he/she loses almost 18.7–19 years of life compared to their nondiabetic counterparts. A researcher has also stated “focused studies show that outcomes can be improved by better management, but there is no evidence of this actually happening on a worldwide basis.” Newer treatment approaches have facilitated improved outcomes in terms of both glycemic control and reduced risks for development of complications. The major challenges remain in the development of approaches to the prevention and management of T1DM and its complications.

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Major Challenges The challenges of T1DM include awareness of the disease which is very poor amongst the general public and also in parents of T1DM children, and this

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WHAT IS TYPE 1 DIABETES AND HOW DOES IT AFFECT?

Type 1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin. We do not know what causes this autoimmune reaction. Type 1 diabetes is not linked to modifiable lifestyle factors. There is no cure and it cannot be prevented. Type 1 diabetes: · Occurs when the pancreas does not produce insulin · Represents around 10% of all cases of diabetes and is one of the most common chronic childhood conditions · Onset is usually abrupt and the symptoms obvious · Symptoms can include excessive thirst and urination, unexplained weight loss, weakness and fatigue and blurred vision

· Is managed with insulin injections several times a day or the use of an insulin pump. What happens to the pancreas? In type 1 diabetes, the pancreas, a large gland behind the stomach, stops making insulin because the cells that make the insulin have been destroyed by the body’s immune system. Without insulin, the body’s cells cannot turn glucose (sugar), into energy. People with type 1 diabetes depend on insulin every day of their lives to replace the insulin the body cannot produce. They must test their blood glucose levels several times throughout the day. The onset of type 1 diabetes occurs most frequently in people under 30 years, however new research suggests almost half of all people who develop the condition are diagnosed over the age of 30. About 10-15% of all cases of diabetes are type 1.

Reference: https://www.diabetesaustralia.com.au/type-1-diabetes

exact cause of type 1 diabetes is not yet known, but we do know it has a strong family link and cannot be prevented. We also know that it has nothing to do with lifestyle, although maintaining a healthy lifestyle is very important in helping to manage type 1 diabetes. At this stage nothing can be done to prevent or cure type 1 diabetes. Symptoms Being excessively thirsty, Passing more urine, Feeling tired and lethargic, Always feeling hungry, Having cuts that heal slowly, Itching, skin infections, Blurred vision, Unexplained weight loss, Mood swings, Headaches, Feeling dizzy and Leg cramps. These symptoms may occur suddenly. If they occur, see a doctor. Through a simple test, a doctor can find out if they’re the result of type 1 diabetes.

What happens if people with type 1 diabetes don’t receive insulin?

Management, care and treatment

Without insulin the body burns its own fats as a substitute which releases chemical substances in the blood. Without ongoing injections of insulin, the dangerous chemical substances will accumulate and can be life threatening if it is not treated. This is a condition call ketoacidosis.

Type 1 diabetes is managed with insulin injections several times a day or the use of an insulin pump. While your lifestyle choices didn’t cause type 1 diabetes, the choices you make now can reduce the impact of diabetesrelated complications including kidney disease, limb amputation and blindness.

When we speak about the causes, the needs to be improved to effectively counter the problem of T1DM. The general population is unaware of the existence of diabetes in children of 2–5 years of age and believe that it affects only the middle-aged group. Awareness among the public health care professionals is also very poor, and the syllabus curriculum of medicine students does not emphasize much on T1DM. The challenge of lack of awareness of T1DM can be met by increasing public

awareness programs, conducting workshops for diabetes educators regarding T1DM in children (giving details of symptoms, diagnosis, diet, monitoring and management), newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. The Changing Diabetes in Children (CDiC) program is working on all these methods to increase T1DM awareness for the past few years. Diabetes care professionals,

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Cover Story Type 1 Diabetes - An Overview

Agappe’s AGA1c reagent is the unique double reagent system which is reliable, convenient, accurate and ensures value for money. It has regular and system packs and can be per formed in most of the fully automated or semi-automated system. including nurses, dieticians and doctors, may not possess the specific skills required to optimally manage T1DM, and they may not have the time or energy to put these skills into practice. The need for a structured diabetes education program, for patients and parents/healthcare providers, which focuses on T1DM management, persists. The Ind ian Diabetes Educators Programme in 2010–2012 in association with project Health Opportunities for People Everywhere and International Diabetes Federation (IDF) have trained nearly 5000 diabetes educators in India. This program, however, specifically lacked education on T1DM but has planned for future T1DM specific training to such health educators. The psycho-social aspect of diabetes in children is another challenge in T1DM management. The patients/children sometimes fail to understand the severity of blood sugar levels and only focus on the incentives provided by the social workers/ health care workers of the CDiC program. This would need regular interaction between parents, nurses, doctors, teachers, and the school authorities, which must be assured for close monitoring. The child must be encouraged to participate in the school and family activities. Proper education of self-care must be given to the child so that the child can cope with his/her existing disease, maintain self-confidence, ensure self-management and adapt with life at large. The disease has many challenges, and these are not global but specific to developing countries. Diagnosis of T1DM was a challenge a few decades back, but the situation has improved today with diagnostic tests and facilities, made available even in villages. Investigation facilities and infrastructure, however, are very poor at the primary care level, especially in rural areas.

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Insulin availability, acceptability, and affordability are also major problems, compounded by the various types of insulin that are available in the market with a varied price range: From a few rupees to a few thousand rupees. However, effective use of insulin remains a matter of utmost importance, rather than the different types of insulin. Furthermore, the problem persists with insulin storage; up to 80% patients lack a good storage facility at home.

Another major problem is the lack of a T1DM registry in India and the data provided is an assumed number. A registry should be developed and include every child detected with T1DM. This would help the health care providers and the government for planning and delivery of diabetes management techniques and medicines. A statement from the American Diabetes Association says that every child newly diagnosed with T1DM should be evaluated by a diabetes team (consisting of a pediatric endocrinologist, a nurse educator, a dietician, and a mental health professional) qualified to provide up-to-date pediatric specific education and support. In India, however, this type of team may be difficult to set up for the general public health, but the CDiC team is working toward it. The CDiC team is improving the infrastructure for managing T1DM better and is reaching out pan-India through 21 CDiC centers and 20 satellite centers. CDiC has plans to extend this to over 100 centers across the country. The center network should be such that it has a terminal and supervising center at the village, district and state levels. The present condition forces a child to travel 150–300 km in 4–12 h time for reaching a CDiC center, which is at a much higher cost than the medications given to the child.

The psycho-social aspect of diabetes in children is another challenge in T1DM management. The patients/children sometimes fail to understand the severity of blood sugar levels and only focus on the incentives provided by the social / health care workers of the CDiC program.


There are approximately 70,000â&#x20AC;&#x201C;75,000 children with T1DM in the country and CDiC is only able to cater to about 4000 of these children. It, however, has been able to successfully produce a model for delivery of standard of care for children. There are approximately 70,000â&#x20AC;&#x201C;75,000 children with T1DM in the country and CDiC is only able to cater to about 4000 of these children. CDiC, however, has been able to successfully produce a model for delivery of standard of care for these children. Steps toward the further enhancement of the program would involve establishment of infrastructure, providing insulin (even small amounts of insulin would be able to prevent ketosis and subsequent death in children), tackling the barriers and challenges as d iscuss ed above (lack of awareness, monitoring, etc.) and making expensive insulin available to all T1DM patients, with government removing the tax levied on insulin. This could be possible if both the state and central governments are actively involved in this program. A public-private partnership initiative is needed involving the ministry of health in the central government, civil society, World Diabetes Foundation/IDF/Juvenile Diabetes Foundation, State Governments, City Corporations and the Local Nongovernmental Organization (NGOs). NGOs and public-private partnerships, without support from the government, would not be able to do much about the cause. CDiC looks forward for support from the government and would be able to give the data collected so far, share the roadmap of achievements till now, and the roadmap for the next 3 years. This would lead to increased participation from children. Changing Diabetes in Children is working with some agencies to supply diabetes strips at about 2 rupees/strip, which usually costs around 25 rupees. The CDiC aims to give 60 strips to each child along with the contact details of a social worker/diabetes educator who can be contacted telephonically in case of any variations in daily blood sugar levels, following which he/she can suggest remedies or increase insulin dose. The diagnostic tests available are fairly expensive in the country and the CDiC program has

made the same available to a very large number of children who could not afford the same; subsequently achieving in controlling and bringing down HbA1c levels. The key impact on deliverables by CDiC is reduction of the number of children developing diabetic ketoacidosis, decrease in mortality, reduction in the number and duration of admissions in hospitals, reduction in the number of school days lost, growth of child to their adequate growth potential, and a significant increase in body weight of children with T1DM. At the patient level, the disease poses challenges in terms of difficulties in education, marriage, and job opportunities. CDiC is also looking into the motivation of children for continuing their school education which is essential and would help them sustain themselves in the future. In this regard, CDiC is planning for introduction of scholarship to children enrolled in this program, for admission into schools. The program is also providing school books and other necessary materials to children for helping them continue their education.

Summary The wide disparities in socioeconomic levels, educational background, and availability of diabetes care pose major hurdles in the management of this disease in India. Parents and the family tend to view T1DM as a stigma. People need to take the lead to ensure comprehensive clinical and psychological care for all children with T1DM by preconceptional planning program. The final aim of all such programs should be that no child should die of diabetes.

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Health Tips

STEER AWAY FROM DIABETES

A SOCIAL MENACE Dr. C.S. Satheesh Kumar, Sr. Vice President-Supply Chain Management, AGAPPE., (Retd. Drugs Controller, Kerala)

The number of people with Type 2 Diabetes is increasing in every country but more than 80% of them live in low and middle-income countries such as India, Bangladesh, Bhutan, Pakistan, Sri Lanka, Philippines and Indonesia. India stands second with 69.2 million people with diabetes and another 36.5 million with prediabetes, which is a high-risk condition for diabetes and cardio-vascular disease.

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iabetes is a major global, social menace in the modern era which needs personal attention as a matter of fact. In diabetes, otherwise called Diabetes Mellitus, one canâ&#x20AC;&#x2122;t properly use or store glucose in the body. Over time, glucose builds up in the bloodstream, which can lead to serious health complications unless people take steps to manage their blood sugar. Almost 90% of the occurrence is Type 2 Diabetes compared to Type 1.The International Diabetes Federation has estimated that glo-

bally there are 415 million people with diabetes in 2015 and is predicted to increase in umber, around 642 million by 2040. It is quite alarming to note that more than 47% of the worldâ&#x20AC;&#x2122;s population is still undiagnosed for diabetes with the prevalence still bound to increase further. Furthermore, 318 million people are estimated to have impaired glucose tolerance and 20.9 million live births are affected by some form of hyperglycemia during pregnancy, of which 85.1% are due to gestational diabetes. The number of people with Type 2 Diabetes is increasing in every country but more than 80% of them live in low and middle-income countries such as India, Bangladesh, Bhutan, Pakistan, Sri Lanka, Philippines and Indonesia. India stands second with 69.2 million people with diabetes and another 36.5 million with prediabetes, which is a highrisk condition for diabetes and cardio-vascular disease. This increasing incidence is mainly attributed to lifestyle changes, eating unhealthy food and being physically inactive. Long-term diabetes can

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cause card iovascular disease, nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), foot damage, hearing impairment, Alzheimer’s disease etc.

“An ounce of prevention is worth a pound of cure.”

“An ounce of prevention is worth a pound of cure.”

Type 1 Diabetes is an autoimmune disease in which the body does not produce insulin and the immune system destroys insulin-producing beta cells in the pancreas. Type 1 Diabetes is usually diagnosed in children, teenagers and young adults, who need life-long insulin therapy. Globally, there are approximately 78000 new cases diagnosed in young people every year, with many additional cases diagnosed in adults. Beta cells in the pancreas are wrongfully targeted and killed off by specific antibodies created by the body’s immune system.

meat, broccoli, mushrooms, green beans, brewer’s yeast, beer, chicken, cereals, eggs, sea food, corn, potatoes, fresh vegetables etc. Food rich in Zinc are cashew, pumpkin seeds, mushrooms, spinach, pomegranate, avocado, banana etc. So, our food habits shall be so matched to accommodate the A1 beta-casein is identified as a major contributor in triggering essential micro-nutrients to prevent the onset of diabetes, as Type 1 Diabetes, as per some studies. Cows of European origin are per one school of thought. the only global source of A1 beta-casein may be as a result of Excessive urination, increased thirst, increased hunger, mutation caused some thousands of years ago. A1 beta-casein, on digestion, releases a peptide (protein fragment) which has opioid blurred vision, unexplained weight loss, excessive urination, faand inflammatory characteristics. The protein fragment is called tigue, frequent infections, slow-healing wounds, dry & itchy skin beta-casomorphin-7, causing multiple health issues including Type etc. are the common symptoms of diabetes. 1 Diabetes. Goats, sheep, Asian cattle, buffalo, camels and indeed According to a study done by the University College Dublin in humans produce milk only of the A2 casein, which is not harmful. Ireland, resistant starch, which occurs naturally in foods such as As per this theory, cow’s milk and dairy products, along with early bananas, potatoes, grains and legumes, may benefit your health cessation of breast feeding, turn to be one of the major reasons for by aiding blood sugar control, supporting gut health and enhanconset of juvenile diabetes. Exclusive breastfeeding is widely re- ing satiety. This is a form of starch that is not digested in the small garded as being protective against Type 1 Diabetes in early infancy intestine and is therefore considered a type of dietary fiber. but its benefits may be lost if the mother supplements breast milk with cows’ milk or if the duration of breastfeeding is too short. It is FOOD THAT CAN INDUCE DIABETES also conceivable that some dietary triggers might cross into breast Fatty Foods - Foods high in saturated or trans fats like fatty milk. These factors might contribute to the inconsistencies in the meats, such as organ meats, bacon, pepperoni and salami, greasy reported association between breastfeeding and Type 1 Diabetes. Type 2 Diabetes primarily occurs owing to many reasons in general. Hereditary influences, malnutrition due to Chromium, Magnesium and Zinc in diet, lack of exercise, sedentary life style, stressful life, excess consumption of maida, sugar etc. play pivotal role in the onset of diabetes. So, our life should be modified so as to prevent the disease condition as far as possible. Principal source for Magnesium are whole wheat grains, spinach, dark, leafy greens, almonds, cashews, black beans, whole peanuts etc. Chromium is available in whole grains, brown rice,

It is always advisable to stop usage of cow milk & dairy products, especially in infancy. In India too, 90-95% of cows are of European genesis.

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Health Tips foods such as French fries, cheeseburgers, full-fat milk, cheese, packaged and baked foods, fast food and frozen pizza are to be avoided. Refined Grains - Maida containing foods like bread, breakfast cereals or pasta made with refined white flour need to be eliminated from the diet. White rice should be avoided. Opt for whole-wheat bread and brown rice to reduce your risk of diabetes. Sugar - Prolonged use of foods that contain added sugar such as soda, cakes, cookies and candy contain a significant amount of added sugar and increase your triglyceride levels. Processed foods, such as condiments, jams and frozen snacks contain large amounts of sugar even if they don’t taste particularly sweet. Besides, if you are diabetic, better abstain from alcohol. In short, for the best outcome, best food choices are fruits, vegetables, whole grains, legumes, and lean cuts of meat. Healthy fats such as avocado, olive oil, fatty fish, nuts and seeds, may be consumed with careful portion control. Brown rice is rich in fiber and rich in manganese. Replacing white rice with brown rice can lower your risk for Type 2 Diabetes by 16 percent. This gluten-free grain is relatively high in calories, so sticking with a single serving size is recommended. It is also essential that you follow a diet high in antioxidants, in other words, have plenty of fruits like oranges, kiwi, mangoes, strawberries, which will help detoxify your pancreas. We should take vegetable juices containing cabbage, carrot, and lettuce on an empty stomach and you should not drink anything for half an hour. Most important is that never add sugar to any of these juices. Lifestyle modification is the major tool to combat this dreaded disease. An important theory propagated globally is,

Regular exercise like walking and swimming can help prevent heart disease, lower blood pressure and improve your cholesterol levels. Break up long periods of sitting and stand or walk while doing things like talking on the phone or watching TV.

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“Drink your food eat your water”. This is one of the famous schools of thought in terms of healthy eating habits, though it is difficult to follow. This indicates to chew your food in mouth till it becomes liquid so that we can incorporate as much of our saliva with our food to mix the amylase present in saliva for better digestion. Foods that are difficult to digest are particularly in need of extra chewing, if the food isn’t broken down sufficiently, the stomach acids have to work harder to break down large chunks of food. If the food hangs around in the hot climate of the gut, food can ferment because of the delay in digestion, which can then become toxic. We should hold water in our mouths for a few moments before swallowing. Green tea is proposed to be good drink, but without added sugar. Too little sleep or poor sleep can disrupt your hormones, leading to increased appetite, higher blood sugar and a thicker waistline. In fact, researchers from Netherlands found that a single night of sleep deprivation can decrease insulin sensitivity by almost 25 percent. According to a study done by the University of Sweden, ginger has potential power to control blood glucose by using muscle cells. The study found that ginger extracts could increase the uptake of glucose into muscle cells independently of insulin. Being overweight causes insulin resistance and makes it difficult for the body to maintain appropriate blood glucose levels. Stress and diabetes don’t mix. A minimum of 30 minutes of physical activity is a must for diabetics. Regular exercise is required for keeping your glucose levels under control. Muscle movement results in the utilization of insulin. Thirty minutes of walk every day will cut your risk of diabetes by onethird. Stress can elevate blood sugar. But you can find relief by sitting quietly for 15 minutes, meditating or practicing Yoga. Yoga is again a very effective tool for diabetes. Yoga postures like Ardha Matsyendrasana (half-twist pose) combined with Dhanurasana (bow pose), Vakrasana (twisted pose), Matsyendrasana (half-spinal twist), Halasana (plough pose), Mayoorasana and Vajrasana squeeze and compress the abdomen and help stimulate the pancreatic secretions or hormonal secretions. As a result, more insulin is pushed into the system. This rejuvenates the insulin producing beta cells in the pancreas of diabetics suffering from both type 1 and 2. Practicing the postures in a relaxed manner, without exertion, meditation and breathing techniques help most patients control the triggers or causes of diabetes. In short, believe and follow the dictum by Benjamin Franklin “An ounce of prevention is worth a pound of cure.”


Cover Story Good Laboratory Practices

GLYCATED HEMOGLOBIN(HbA1c)

NEW TRENDS IN TESTING

Glucose estimation still has the highest share in the IVD testing. One of the reasons for the high prevalence of uncontrolled diabetes is due to the improper monitoring of blood glucose levels. The recent years have shown a drastic change in the diabetes testing facilities with the introduction of highly affordable POCT systems, especially for the blood glucose. Sanjaymon K.R., General Manager, AGAPPE.

A study conducted estimates 285 million people worldwide (6.6%)

in the age group of 20â&#x20AC;&#x201C;79 with diabetes in 2013. India is on the top of the list with 50.8 million adults being prediabetic. Type 2 Diabetes is more prevalent than Type 1 Diabetes due to the lifestyle and dietary habits. The overall prevalence of diabetes was 12% of the population aged above 20 years. It is estimated that by the year 2030, approximately 80 million people in India will have diabetes.

according to time and is highly dependent on any recent food intake. To get a better diagnosis, HbA1c testing is introduced. Studies show that a reduction in 1% in the HbA1c will reduce the complications by 30 %. Since it is not affected by the recent food intake, it is the most preferred tests for diabetes

Glucose estimation still has the highest share in the IVD testing. One of the reasons for the high prevalence of uncontrolled diabetes is due to the improper monitoring of blood glucose levels. The recent years have shown a drastic change in the diabetes testing facilities with the introduction of highly affordable POCT systems, especially for the blood glucose. One of the limiting factors for such testing is the fact that the test is specific to the amount of glucose present in blood only at the time of drawing the blood and glucose levels in blood varies widely

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Cover Story Good Laboratory Practices AGAPPE's

AGA1c: The HbA1c with a difference

What is the principle used in AGA1c. Latex Enhanced Immunoturbidimetry method, which measures the ratio of hemoglobin A1c that occupy in a total hemoglobin in the whole blood. The sample is added to the unsensitized latex particles, and the surfaces of the latex adsorb total hemoglobin in the sample. Anti-human HbA1c mouse monoclonal antibody complex agglutinates by Anti-mouse IgG goat antibody, is measured as a turbidity.

What makes AGA1c different. z AGA1c comes with LEIT method For highly sensitive & specific assay

z AGA1c highly correlated with HPLC method Reliable and accurate result Guaranteed z AGA1c has NGSP Certified Standardization using DCCT Reference Ensured accuracy z AGA1c has less than 2% CV Accuracy Guaranteed

z AGA1c, is a double reagent system No stability problems

z AGA1c, 4 levels calibrators are provided along with the kit Assured result accuracy at no extra cost

z AGA1c is a Direct measurement of HbA1c in % Highly precise & accurate results

z AGA1c can be done on Semi Auto & Fully auto analyzers Can be adapted easily

monitoring. The major methods in Glycohaemoglobin are :

Column Chromatography This method is one of the earlier methods based on the chromatographic separation of the HbA1c fraction from the total Hb. The test is performed manually using chromatography columns and requires more than one hour for performing a test. This method requires constant monitoring of the column and has to adhere to multiple steps and also needs highly

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z AGA1c using monoclonal antibody which is highly specific to A1c Accuracy Guaranteed

TECHAGAPPE

JULY-SEPTEMBER 2018

skilled technical staff for performing the test. The HbA1c is calculated from the different elutes obtained after the chromatography by measuring the absorbance photometrically. Since multiple steps are involved, the chances of technical error were high.

Affinity chromatography based POCT systems These systems are cartridge-based analyzers based on the affinity chromatography. The total Hb and the glycated Hb fractions are measured individually and the HbA1c % is calculated


based on a factor. Since the tests are performed based on the cartridge, the cost of testing is very high as compared to the other methods. The control measurement is performed using a specific control cartridge and it is always recommended to run the control cartridge before testing. Some systems have a multistep procedure with the addition of buffer solutions at specific intervals and hence care should be taken to add the buffers exactly on time to have a better result.

HPLC systems More than 40% of the HbA1c testing is performed using HPLC platforms. The systems are known for the quality of results and commercial controls are available for quality assurance. There are multiple systems available in this segment - from single platforms to modular systems. These are bigger systems which require more space and also are costly. One of the advantages of these systems is primary tube sampling. These systems have bi-directional connectivity and can be connected to the LIS/HIS platforms. One of the limitations for these of platforms is that, due to its working principle, it requires huge workload to have better feasibility. Since the cost of the hardware and the recurring costs are quite high, it is not affordable for rural laboratories.

IT-based systems Introduction of the immunoturbidimetry reagents altogether changed the way HbA1c testing is performed in the laboratory. The test is based on the principle of latex-based agglutination. This can be performed in most of the fully-automated and new generation semiautomated systems, which gives it a wide popularity. In the beginning, the reagents are presented in three reagent

systems where the laboratory needs to prepare working reagents for testing and the reagent stability was a concern. To address this issue, two part ready-to-use reagents are introduced around ten years back. Since the reagents are coming up with calibrators and controls, it was very easy to program the tests in chemistry platforms. This segment was revolutionized when highly affordable nephelometry-based semiautomated HbA1c systems are introduced at the beginning of this decade. This made the testing popular in the rural segment. Today, cartridge-based nephelometry systems are available in the realm.

Except for HPLC platforms, all other HbA1c testing platforms required a manual step for making the haemolysate from the whole blood and this increased the TAT when the workload is high. With an increase in the prevalence of diabetes population and increased awareness, the HbA1c testing has increased exponentially. There is a high demand for platforms with primary tube sampling. This coined the idea of automatic haemolysing on board. Today, the new generation fully-automated clinical chemistry systems are available with an automated onboard lysing function where the systems automatically make the haemolysate from the primary whole blood samples. This helps in sample traceabilAGAPPEâ&#x20AC;&#x2122;s Reagent Strips ity, reduces the preanalytical error and also decreases For Urinalysis the TAT of testing. There are systems available with a special function to perform both HbA1c and Glucose z Easy To Use - Just dip from the same primary tube which gives better result and read correlation and also reduces multitube sampling. The systems come up with continuous sample loading z Rapid Results - 60 sec. function to take care of the high workload which the z High Quality - Color Chart laboratories take for the HbA1c testing. These sysz Designed specifically tems are having inbuilt Quality Control statistics to assure the quality of the tests. considering Indian It is always recommended that the laboratories conditions should upgrade the hardware periodically with new generation combination systems with better algorithms to z Shelf Life - 2 years assure uncompromising accuracy and TAT.

URINE DIPSTICK

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AGA1c -INDIA’S NO. 1 SELLING HbA1c REAGENT

For Accurate And Precise Blood Glucose Measurement

HEALTHY LIVING with AGA1c testing once in a month

First double reagent system | LEIT Methodology | Highly correlates with HPLC NGSP certified reagents | Accurate results | Easy procedure


The Gold Standard In Glucose Estimation With

HEXOKINASE METHOD 7 Excellent Linearity of 900 mg/dL 7 Fast Reaction, 5 Min incubation 7 One month on board stability 7 High accuracy, CV <2% 7 Provided 2mL Calibrator for along with kit The hexokinase method developed by the American Association of Clinical Chemistry has been accepted as the reference method for glucose determination. The Hexokinase method is a two-step reaction. This method has advantages over glucose oxidase method, primarily because fewer substances interference and it uses safer reagents. In the first step, hexokinase in the presence of ATP, adds a phosphate to glucose to form Glucose – 6 – Phosphate (G6P). In the second step, G6P in the presence of NAD and the enzyme Glucose-6- phosphate-dehydrogenase is converted to D-Gluconate-6-phosphate with the production of reduced nicotinamide adenine dinucleotide (NADH).

EXCELLENT SENSITIVITY & SPECIFICITY HIGH LINEARITY Packs Liquichek - 4 x 125 mL | Mispa Nano/ Mispa Ace - 4 x 35/2 x 18 mL Mispa Clinia - 4 x 50/2 x 30 mL | TBA-25FR - 4 x 35/2 x 19 mL For more details, contact our TBA-120FR/ 2000FR - 4 x 100/4 x 28 mL

*

Toll Free No: 1800 425 7151


Brand Reach Customer Speaks

1

100% Satisfaction with Agappe Pr oduct Product Ms. Rachana, Lab-in-Charge, Malabar Multispecialty Hospital, Calicut.

2

We are using Mispa i3 of Agappe for the past several years and we are 100% satisfied with the accurate and precise results in protein parameters. Agappe’s service, support and turnaround time is also quite appreciable.

Highly RRecommendable ecommendable Pr oducts Products I have been using Agappe AGA1c for the last one year. I run AGA1c in the semi-automated analyzer and I am 100% happy about the results. The after-sales support we are experiencing from them is also appreciable. I do recommend AGA1c brand to my friends and colleagues in the IVD industry. All the best to the Agappe team.

Dr. Semsing Signar MD, Hills Diagnostic Centre, Karbi Anglong, Assam

Accurate Results, Always Dr. Akbar Lirani MD, Medipath Pathology, Raipur

4

I have been using Agappe AGA1c for the last 3 years and run AGA1c in both the semi-automated & fully- automated analyzers. The results I get are always accurate. I’m also using C3, C4, Ceruloplasmin in the semi automatic. Agappe offers appreciable after-sales support also. I would delightfully recommend Agappe products to my peers in the IVD segment.

Excellent Quality Pr oduct & RReagents eagents Product We are using Agappe’s Mispa Nano – Fully automated Analyzer. We also use Agappe’s reagents, which give accurate & precise results. We are satisfied with the equipment as well as reagents, specially AGA1c. I would say quality is excellent.

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Dr. Anjali Mahindru, Sigma Diagnostic Lab, Jalandhar


Long-term and Cor dial RRelation elation with Agappe Cordial Sr. Jyothsana,

Lourdes Hospital, Ernakulam

6

We are proud to say that we are using Agappe reagents for the last 20 years. We are very much satisfied with the results. Agappeâ&#x20AC;&#x2122;s AGA1c is the best HbA1c available in the market. We are expecting more & more innovative products from Agappe.

Very TTrustwor rustwor thy Pr oduct rustworthy Product Few months back, I have purchased Agappe Mispa Count (Hematology Analyzer) and the equipment is very compact & user-friendly. The results were accurate and I have no complaints till date. I trust Agappe & Mispa Count.

Dr. Renjith Thomas, Thomas Clinic, Paravur, Ernakulam

7

Perfect and Pr ecise RResults esults Precise Dr. Nayyar Khan MD, Wellcare Diagnostic Clinic, Thane

8

5

We are using Mispa i3 of Agappe, a much needed analyzer for labs and hospitals focusing on result accuracy of proteins at all measuring ranges, especially the parameters like CRP & RF.

Commendable Pr oduct, PPerformance erformance Product, and Pr ompt Service Prompt I am using Mispa Ace, the fully automated biochemistry analyser from Agappe Diagnostics Ltd. since one year. The performance of the machine is excellent for all parameters and also the service is excellent.

TECHAGAPPE

Afsana Hakim, Lab-in-Charge, Glow Vision Diagnostic Center, Pune

JULY-SEPTEMBER 2018

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Engagements Exhibitions & Conferences

MORE PLACES TO KNOW ABOUT US 2018 70th Annual Scientific Meeting & Clinical Lab Expo

Team Agappe in attendance at MEDLAB ASIA PACIFIC 2018-THE LEADING HEALTHCARE EVENT IN ASIA on 2 - 4 April 2018, Stall No. M31, Singapore.

BETTER HEALTH THROUGH LABORATORY MEDICINE July 29 - August 2, 2018, Agappe’s Booth No: 653 Venue: McCormick Place, Chicago, Illinois.

Team Agappe in attendance at MEDICONEX 2018-THE LARGEST MEDICAL EXIBITION IN NORTH AFRICA on 14 - 16 April 2018, Stall No. J30A, Cairo, Egypt.

Team Agappe in attendance at EGYMEDICA 2018-THE BIGGEST EXIBITION IN EGYPT on 03 - 05 May 2018, Booth No. B4/5, Cairo, Egypt.

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AACC is a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare. Their leadership in education, advocacy and collaboration helps lab professionals adapt to change and do what they do best: provide vital insight and guidance so patients get the care they need. AACC’s strategic plan set goals for innovation, growth, and influence in five areas: value of membership; best practices; science and innovation; financial resources; and global influence. As the leading event for laboratory medicine worldwide, the 2018 AACC Annual Meeting & Clinical Lab Expo is the place where breakthrough innovations in clinical testing and patient care are introduced to the healthcare world.


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SPECIAL DAYS Jul 01 : Doctor's Day Jul 05 : World Environment Day Jul 06 : World Zoonoses Day Jul 11 : World Population Day Jul 15 : Plastic Surgery Day Jul 28 : World Hepatitis Day Jul 29 : International Tiger Day

SPECIAL DAYS Aug 03 : World Friendship Day Aug 06 : Hiroshima Day Aug 09 : Nagasaki Day Aug 10 : Organ Donation Day Aug 12 : World Youth Day Aug 13 : World Lefthanders Day Aug 19 : World Humanitarian Day

SPECIAL DAYS Sept 08 : World Literacy Day Sept 10 : Suicide Prevention Day Sept 12 : World First Aid Day Sept 16 : World Ozone Day Sept 18 : World Alzheimer's Day Sept 25 : World Maritime Day Sept 28 : World Rabies Day Sept 29 : World Heart Day


Promotion

New Product


RELIABLE RESULT GUARANTEED


Moments

Awards

NATIONAL AWARDS 2018 FOR MISPA-i3

I

t gives us immense pleasure and pride to inform you that AGAPPE has been selected as the winner of National Awards 2018 for the â&#x20AC;&#x153;Indigenous Development of Technology and Commercialisationâ&#x20AC;? of Mispa-i3, the Automated Cartridge Based Specific Protein Analyzer. The award was organised by the Technology Development Board, Department of Science and Technology, Govt. of India, in connection with the 20th Technology Day on 11th May 2018 at Vigyan Bhavan, New Delhi. The prestigious memento of National Award was presented by Honourable President of India, Shri. Ram Nath Kovind to Mr. Thomas John, Managing Director and Mrs. Meena Thomas, Di-

rector & COO of AGAPPE. The award was delivered in the presence of Dr. Harsh Vardhan, Honourable Union Minister for S&T and ES and Prof. Ashutosh Sharma, Secretary, Department of Science and Technology. The ceremony was attended by a number of well-known dignitaries from different industry and Higher Government officials. This is really the proudest moment for all AGAPPEANS that followed to the recognition which we received for Mispa-i2 at the Rashtrapati Bhavan in 2015. Our Mispa-i3 has created the Historic Landmark in the Indian IVD with its outstanding technology advantage of testing Specific Protein parameters. Eventually, bringing the brand AGAPPE to the heights of IVD Segment.

KERALA STATE POLLUTION CONTROL BOARD AWARDS 2018

Agappe has been awarded by Kerala State Control Board for substantial and sustaining efforts in pollution control and for initiatives in environment protection in 2018. On behalf of Agappe, Mr. Babu Daniel, Vice President-System Automation has received award from Sri A.C. Moideen, Co-operation and Tourism Minister, Government of Kerala.

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Reward Programme

CONSENT

By signing this form, I confirm that the information provided above is true and that I am fully familiar with and accept the General Business Terms for Privilege Account. I agree that the authorized personnel of Agappe Company may collect and process my personal information, the information about received privileges, collected points, information regarding the privileges used and other Information acquired during my visit to AG privilge website and ACEP mobile application. Also in absence of me I authorize my staff Mr / Mrs. / Miss / ………………………….........to avail benefits of AG Privilege and redeem Reward point's benefits using the registered mobile……………………………..... Number, through AG Privilege Website / AG Privilege mobile application. Also Agappe Diagnostics Ltd undertakes to handle the information in line with the requirements of the Personal Data Protection Act and that it will use them only for marketing reasons.

Proprietor Name:..................................................................................................................................................... Address..................................................................................................................................................................... .................................................................................................................................................................................... Date:

Disclaimer • AG Privilege points are subjected to offer made to Agappe Loyal customers who are either purchasing or using existing Agappe reagent as products.AG Privilege offers are not valid on instrument purchase. • Lab must claim points accrued through the program through the redemption process to exchange the points for reagents. • Lab must claim points or rewards only after reaching the redemption level. • Points can be claimed and used for rewards available in the then current program only and by authorized personnel of Laboratory. • Point requirements assigned to any reward are subject to change from time to time without notice, and rewards may be substituted at any time. • The loyalty points can be claimed by the Legal owner of the program and will be done only after

Sign & Seal of the owner / proprietor / director

Scan QR code to download AG Privilege app

submitting the signed copy of the disclaimer. • Agappe diagnostics/Agappe employee will not be in any manner responsible for any claim on account of claim/Point redeemed or point burnt by lab technicians/distributors, distributor staff or any other personnel who is not a part of lab or hold any organizational position. Any such act, if it comes to the notice, will be considered as malpractice and the concern laboratory owner/director or any other official will be informed. • Delivery of reagents will be done after conducting and possible due diligence. • Agappe require verification of lab identity and account prior to processing your order. • Government/Semi Government undertakings will not be covered under this program. • The Privilege program is not meant for any Agappe staff. • Jurisdiction: Any dispute arising out of this program shall be subject to the exclusive jurisdiction of the Courts at Ernakulam, Kerala, India.

Kindly fill the form carefully and hand over to Agappe’s staff or post to The Manager-Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562. For more details, contact +91 9349011309.

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Editorial Quiz & Feedback 1. Which is not a symptom of d iabetes? A. Itchy skin B. Thirst C. Frequent urination D. Muscle pain 2. Type 2 diabetes can cause long-term damage in the functions of....... A. Kidneys B. Eyes C. Nerves D. All of the above 3. .............is a condition in which the kidneys are unable to conserve water. A. Diabetes mellitus B. Diabetes insipidus C. Gestational diabetes D. Diabetic coma 4. Which of these make it more likely for you to get type 2 d iabetes? A. Obesity B. Race C. Gender D. Age

Quiz Answers of April-June 2018 Edition.

5. Diabetes can only be managed with medicine. A. True B. False

1-A, 2-A, 3-D, 4-A, 5-B

Scan QR code and participate in the lucky draw contest. Amazing prizes are waiting for the winners. Conditions apply*

Answers of this quiz contest will be published in the next edition along with details of the winner and the prize. Participants can either hand over the answers to Agappeâ&#x20AC;&#x2122;s staff or send in their responses directly to TechAgappe at techagappe@ agappe.in or post a mail to The Manager-Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562.

What do you think of this edition of Techagappe? Are you happy with the overall look and feel of the magazine? Do you recommend any change of style with regard to presentation of articles? You can share your views with us in the space given below. All you have to do is to post this sheet of paper to the address given below. The best letter shall be featured in the next editionâ&#x20AC;&#x2122;s letters to the editor section. ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ............................................................................................................................................................................... Name..................................................Address..................................................................................................... PIN....................................Mob.............................................Mail ID..................................................................

Postal address:

The Manager - Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562. Email: techagappe@agappe.in Mob: +91 9349011309

Kindly let us know which section of the magazine you like more... Poem Cover Stories

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Life Stories Good Laboratory Practices

JULY-SEPTEMBER 2018

Health Tips Interviews


Why Manual Tube Labeling when you have

MISPA LABEL

?

Simple Reliable

Label Intelligent Tube Labeling System

Fast Accurate

Simplied Pre-Analytics

CORPORATE OFFICE Agappe Hills, Pattimattom P.O, Dist. Ernakulam, Kerala - 683 562, India. Tel: +91 484 2867000. Fax: +91 484 2867222; agappe@agappe.in Branches: Delhi | Bangalore | Kolkatta

REGISTERED OFFICE Office No : 401 & 402, 4th Floor, Jaisingh Business Centre, 119, Sahar Road, Parsiwada, Andheri (East), Mumbai - 400099, India. Tel : 022-4300 8000, Fax no: 022 - 4300 8050 | mumbaioffice@agappe.in

Efficient

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Printed and Published by Ms. Meena Thomas on behalf of Agappe Diagnostics Limited and Printed at Five Star Offset Printers, Nettoor, Cochin-40 and published from Agappe Diagnostics Limited, â&#x20AC;&#x153;Agappe Hillsâ&#x20AC;?, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas.

Sharp for accuracy and smooth in procedure open to all and no closed loops bright as future and simple as present

Techagappe 16th Edition (July - September 2016) E Book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

Techagappe 16th Edition (July - September 2016) E Book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

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