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Can the management of depression in type 2 diabetes be democratized?

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World Journal of Diabetes 2022年第3期13卷 203-212页

作者： gumpeny r sridhar Department of Endocrinology Endocrine&Diabet CtrVisakhapatnam 530002India

Both type 2 diabetes and depression are common and are projected to increase.There is increasing evidence for a bidirectional relationship between the two.Diabetes is a risk factor for depression;contrariwise,individuals with depression are at greater risk of developing diabetes.They are a burden for both the individual and the society.Co-existent depression worsens diabetic control because of obesity,insulin resistance and the adverse metabolic effects of anti-diabetes medicines.In addition,compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet,taking proper medications on time,getting metabolic parameters assessed and maintaining a sleep cycle.Depression occurs in many grades;mild depression is more common in diabetes than frank or full-blown depression leading to suicide.Unfortunately,there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes.Therefore,alternate models for management of mild to moderate depression are required.There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors.INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus.The international study,carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient,the family and the consultant endocrinologist/diabetologist.The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began.It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator.It is possible to scale up

关键词： Insulin resistance Bidirectional Patient health questionnaire-9 Care-coordinator Antidepressants Integrating DEPrEssioN and Diabetes treatmENT study Non-professional

Emerging links between type 2 diabetes and Alzheimer's disease

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World Journal of Diabetes 2015年第5期6卷 744-751页

作者： gumpeny r sridhar gumpeny Lakshmi gumpeny Nagamani Endocrine and Diabetes Centre Department of Obstetrics and GynecologyAndhra Medical College

Type 2 diabetes mellitus and Alzheimer's disease are both associated with increasing age,and each increases the risk of development of the other.Epidemiological,clinical,biochemical and imaging studies have shown that elevated glucose levels and diabetes are associated with cognitive dysfunction,the most prevalent cause of which is Alzheimer's disease.Cross sectional studies have clearly shown such an association,whereas longitudinal studies are equivocal,reflecting the many complex ways in which the two interact.Despite the dichotomy,common risk and etiological factors(obesity,dyslipidemia,insulin resistance,and sedentary habits) are recognized;correction of these by lifestyle changes and pharmacological agents can be expected to prevent or retard the progression of both diseases.Common pathogenic factors in both conditions span a broad sweep including chronic hyperglycemia per se,hyperinsulinemia,insulin resistance,acute hypoglycemic episodes,especially in the elderly,microvascular disease,fibrillar deposits(in brain in Alzheimer's disease and in pancreas in type 2 diabetes),altered insulin processing,inflammation,obesity,dyslipidemia,altered levels of insulin like growth factor and occurrence of variant forms of the protein butyrylcholinesterase.Of interest not only do lifestyle measures have a protective effect against the development of cognitive impairment due to Alzheimer's disease,but so do some of the pharmacological agents used in the treatment of diabetes such as insulin(especially when delivered intranasally),metformin,peroxisome proliferator-activated receptors γ agonists,glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors.Diabetes must be recognized as a risk for development of Alzheimer's disease;clinicians must ensure preventive care be given to control and postpone both conditions,and to identify cognitive impairment early to manage it appropriately.

关键词： Cognition Insulin resistance Insulin Butyrylcholinesterase Dementia

Scope and caveats:Artificial intelligence in gastroenterology

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Artificial Intelligence in Gastroenterology 2024年第1期5卷 9-13页

作者： gumpeny ramachandra sridhar Atmakuri V Siva Prasad gumpeny Lakshmi Department of Endocrinology and Diabetes Endocrine and Diabetes CentreVisakhapatnam 530002India Department of Gastroenterology Institute of GastroenterologyVisakhapatnam 530003India Department of Internal Medicine Gayatri Vidya Parishad Institute of Healthcare&Medical TechnologyVisakhapatnam 530048India

The use of Artificial intelligence(AI)has evolved from its mid-20th century origins to playing a pivotal tool in modern medicine.It leverages digital data and computational hardware for diverse applications,including diagnosis,prognosis,and treatment responses in gastrointestinal and hepatic conditions.AI has had an impact in diagnostic techniques,particularly endoscopy,ultrasound,and histopathology.AI encompasses machine learning,natural language processing,and robotics,with machine learning being central.This involves sophisticated algorithms capable of managing complex datasets,far surpassing traditional statistical methods.These algorithms,both supervised and unsupervised,are integral for interpreting large datasets.In liver diseases,AI's non-invasive diagnostic applications,particularly in non-alcoholic fatty liver disease,and its role in characterizing hepatic lesions is promising.AI aids in distinguishing between normal and cirrhotic livers and improves the accuracy of lesion characterization and prognostication of hepatocellular carcinoma.AI enhances lesion identification during endoscopy,showing potential in the diagnosis and management of early-stage esophageal carcinoma.In peptic ulcer disease,AI technologies influence patient management strategies.AI is useful in colonoscopy,particularly in detecting smaller colonic polyps.However,its applicability in nonacademic settings requires further validation.Addressing these issues is vital for harnessing the potential of AI.In conclusion,while AI offers transformative possibilities in gastroenterology,careful integration and balancing of technical possibilities with ethical and practical application,is essential for optimal use.

关键词： Machine learning Neural networks Diagnosis Work-flow Ethics Image Polyps Hepatoma

Sleep, circadian dysrhythmia, obesity and diabetes

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World Journal of Diabetes 2016年第19期7卷 515-522页

作者： gumpeny ramachandra sridhar Narasimhadevara Santhi Nirmala Sanjana Endocrine and Diabetes Centre Visakhapatnam 530002 India MGM Medical College Navi Mumbai 410209 India

Synchrony of biological processes with environmental cues developed over millennia to match growth, reproduction and senescence. This entails a complex interplay of genetic, metabolic, chemical, light, hormonal andhedonistic factors across life forms. Sleep is one of the most prominent rhythms where such a match is established. Over the past 100 years or so, it has been possible to disturb the synchrony between sleep-wake cycle and environmental cues. Development of electric lights, shift work and continual accessibility of the internet has disrupted this match. As a result, many noncommunicable diseases such as obesity, insulin resistance, type 2 diabetes, coronary artery disease and malignancies have been attributed in part to such disruption. In this presentation a review is made of the origin and evolution of sleep studies, the pathogenic mediators for such asynchrony, clinical evidence and relevance and suggested management options to deal with the disturbances.

关键词： Insulin resistance Chronotype Obesity Evolution Clock Shift work

Human butyrylcholinesterase knock-out equivalent: Potential to assess role in Alzheimer’s disease

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Advances in Alzheimer's Disease 2012年第1期1卷 1-11页

作者： gumpeny ramachandra sridhar Talluri Sekhar Padmanabhuni Venkata Nageswara rao Allam Appa rao C. r. rao Advanced Institute for Mathematics Statistics & Computer Science (AIMSCS) Hyderabad India Department of Biotechnology GITAM University Visakhapatnam India Department of Computer Science GITAM University Visakhapatnam India Endocrine and Diabetes Center Visakhapatnam India

Butyrylcholinesterase (BChE) is an enzyme which has been shown to be involved in the patho-genesis, treatment and prognosis of Alzheimer’s disease. In its current form, however, evidence is equivocal with all of the associations. Variant forms of the protein exist, where the enzymatic function is lost to varying degrees. We performed in silico evaluation of these variants. Bioinformatics and molecular modeling, based on data from ESTHEr database and Protein Data Bank (rCSB), were used for in silico predictions of the structures of the silent variants that involve a single amino acid change. Variants with loss of enzyme activity were evaluated for structural changes near the active site and the thermody-namic stability of the variants was estimated. The results indicated that the loss of activity of the variants can, in most cases, be attributed to structural changes in the active site or to lower thermodynamic stability. Our results showed that the loss of enzyme activity may be due to changes in the active site, oligomerization or loss of structural stability. Individuals with loss of function mutation of BChE can be studied and followed up for their proneness or resistance to cognitive decline with aging.

关键词： Apnea Anesthesia Insulin resistance Mutants Thermal Stability