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Abstract: Abstract Indian people are at high risk for type 2 diabetes (T2DM) even at younger ages and lower body weights. Already 74 million people in India have the disease, and the proportion of those with T2DM is increasing across all strata of society. Unique aspects, related to lower insulin secretion or function, and higher hepatic fat deposition, accompanied by the rise in overweight (related to lifestyle changes) may all be responsible for this unrelenting epidemic of T2DM. Yet, research to understand the causes, pathophysiology, phenotypes, prevention, treatment, and healthcare delivery of T2DM in India seriously lags behind. There are major opportunities for scientific discovery and technological innovation, which if tapped can generate solutions for T2DM relevant to the country’s context and make leading contributions to global science. We analyze the situation of T2DM in India, and present a four-pillar (etiology, precision medicine, implementation research, and health policy) strategic research framework to tackle the challenge. We offer key research questions for each pillar, and identify infrastructure needs. India offers a fertile environment for shifting the paradigm from imprecise late-stage diabetes treatment toward early-stage precision prevention and care. Investing in and leveraging academic and technological infrastructures, across the disciplines of science, engineering, and medicine, can accelerate progress toward a diabetes-free nation. PubDate: 2023-03-21
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Abstract: Abstract Diabetic foot ulcers are one of the common secondary complications associated with diabetes and are characterized by delayed or absence of healing. Of the several factors contributing to poor healing, chronic low-grade inflammation significantly worsens wound healing resulting in adverse outcomes. As the innate immune system plays a vital role in wound healing, a closer look at their alterations may provide insights into developing novel treatment strategies to promote healing. In this review, we discuss the role of the innate immune system in driving chronic inflammation both at the wound site and at the systemic level, resulting in poor healing outcomes. Specifically, we highlight the findings from preclinical and clinical studies that describe the dysregulations of the innate system at the cellular and molecular level and how they contribute to low-grade chronic inflammation in wounds. Our review of the literature shows that preexisting low-grade inflammation, which is associated with altered myeloid cell phenotype and function, is key to impaired wound healing responses in individuals with diabetes. Hence, we suggest that modulating circulating myeloid cell function and low-grade chronic inflammation could be a helpful strategy in promoting diabetic foot ulcer healing. PubDate: 2023-03-15
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Abstract: Abstract Diabetes and related metabolic non-communicable diseases (NCDs), such as hypertension and obesity, are no longer only a problem in affluent industrialized countries; prevalence rates are rapidly rising in developing nations like India as well. Given that diabetes is becoming increasingly prevalent in India on account of rapid urbanization and economic development, reliable epidemiological data are essential for estimating the effects and determinants of diabetes and facilitating the development of prevention and control methods. Though several regional studies exist, the marked heterogeneity between states and regions of India limits the generalizability of their results. The national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was designed and conducted to provide accurate and comprehensive state- and national-level data on the prevalence of diabetes and other metabolic NCDs in India. The ICMR-INDIAB study was conducted in all 30 states/union territories of India between 2008 and 2020. The study reports on the prevalence of various cardiometabolic disease risk factors such as diabetes, prediabetes, obesity, hypertension and dyslipidemia, assessment of knowledge of diabetes in the general population and those with known diabetes, achievement of diabetes treatment targets and the role of migration, diet and physical inactivity on diabetes. This study, the largest nationally representative population-based study conducted in India, thereby helps to estimate the burden of diabetes and other metabolic NCDs in a representative sample of adults living in both urban and rural India. PubDate: 2023-03-15
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Abstract: Abstract Type 1 diabetes is a complex, chronic disease in which the insulin-producing beta cells in the pancreas are sufficiently altered or impaired to result in requirement of exogenous insulin for survival. The development of type 1 diabetes is thought to be an autoimmune process, in which an environmental (unknown) trigger initiates a T cell-mediated immune response in genetically susceptible individuals. The presence of islet autoantibodies in the blood are signs of type 1 diabetes development, and risk of progressing to clinical type 1 diabetes is correlated with the presence of multiple islet autoantibodies. Currently, a “staging” model of type 1 diabetes proposes discrete components consisting of normal blood glucose but at least two islet autoantibodies (Stage 1), abnormal blood glucose with at least two islet autoantibodies (Stage 2), and clinical diagnosis (Stage 3). While these stages may, in fact, not be discrete and vary by individual, the format suggests important applications of precision medicine to diagnosis, prevention, prognosis, treatment and monitoring. In this paper, applications of precision medicine in type 1 diabetes are discussed, with both opportunities and barriers to global implementation highlighted. Several groups have implemented components of precision medicine, yet the integration of the necessary steps to achieve both short- and long-term solutions will need to involve researchers, patients, families, and healthcare providers to fully impact and reduce the burden of type 1 diabetes. PubDate: 2023-03-07
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Abstract: Abstract The overlapping crises of type 2 diabetes (T2D) and climate change are two of the greatest challenges facing our global population. Dietary shifts have been identified as a critical leverage point to enact large-scale transformations to safeguard the health of humans and the planet. Dietary approaches for T2D and for mitigating environmental impact have been extensively studied as demonstrated by large separate bodies of evidence. A small number of emerging studies have jointly assessed the impacts of diets on T2D-related outcomes and the environment. In this review, we take an integrated approach to explore dietary strategies for the co-benefits for type 2 diabetes and the natural environment. Current evidence supports shifts towards diverse, healthful plant-based diets high in wholegrains, fruits, vegetables, nuts and vegetable oils and low in animal-based foods particularly red and processed meats, refined grains, and sugar-sweetened beverages as a leading strategy for prevention and treatment of T2D and mitigation of environmental impact. Dietary shifts towards healthful plant-based diets should align with regional dietary recommendations with consideration for local contexts and available resources. While the inextricable links between human and planetary health are increasingly appreciated, it is now evident that these challenges should be considered simultaneously for effective solutions. Breaking down the siloes and taking integrated approaches may also maximize potential for implementation by attracting collaboration and shared resources, funding, and effort. PubDate: 2023-03-01
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Abstract: Abstract Diabetes is an ancient disease and for centuries extreme diets and herbal remedies were used to treat diabetes symptoms. The discovery of insulin in 1921 transformed the landscape of diabetes treatment and was followed by the discovery of several new therapies which improved glycemia and increased patient life span. However, as patients with diabetes lived longer, they developed classic microvascular and macrovascular diabetes complications. In the 1990s, the DCCT and the UKPDS trials demonstrated that tight glucose control reduced the microvascular complications of diabetes, but had marginal effects on cardiovascular disease, the leading cause of death in patients with diabetes. In 2008, the FDA directed that all new diabetes medications demonstrate cardiovascular safety. From this recommendation emerged novel therapeutic classes, the GLP-1 receptor agonists and SGLT2-Inhibitors, which not only improve glycemia, but also provide robust cardio-renal protection. In parallel, developments in diabetes technology like continuous glucose monitoring systems, insulin pumps, telemedicine and precision medicine have advanced diabetes management. Remarkably, a century later, insulin remains a cornerstone of diabetes treatment. Also, diet and physical activity remain important components of any diabetes treatment. Today type 2 diabetes is preventable and long-term remission of diabetes is possible. Finally, progress continues in the field of islet transplantation, perhaps the ultimate frontier in diabetes management. PubDate: 2023-02-21
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Abstract: Abstract Quantum processors based on NMR architectures, which use nuclear spins as qubits and radio frequency pulses to implement unitary quantum gates, came into existence nearly two decades ago. Since their first proof-of-principle demonstrations as a testbed quantum processors, NMR quantum processors have contributed significantly to advances in various subareas of quantum information processing. Indian researchers have been working in this field since its inception and have continued to contribute to novel developments. This article begins by delineating the basic building blocks of an NMR quantum processor and evaluating the advantages and disadvantages of this quantum technology. Contributions of NMR quantum information processing techniques in the areas of the state initialization and quantum control, experimental implementation of quantum algorithms, entanglement detection and characterization, foundational tests of quantum mechanics, quantum state and process tomography, noise characterization and decoherence mitigation protocols, quantum simulation, and quantum thermodynamics are described. The article traces the historical development of this area, with an emphasis on Indian contributions and perspectives. PubDate: 2023-02-16
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Abstract: Abstract Deprescribing is the process by which medications are reduced without compromising safety to the patient (Jude et al. in 2022 Diabetes Ther 13: 619–634, 2022). The purpose of this narrative review is to discuss deprescribing as a topic, firstly discussing the benefits and pitfalls to such pharmacological interventions along with the current barriers and enablers to such a controversial topic, and then discussing deprescribing with respect to preventive medications, namely those that reduce the long term impacts of a condition or disease. Research that has previously focused on reducing polypharmacy has highlighted the benefits of such interventions, including reduction of adverse reactions or complications, improved patient satisfaction and quality of life, and improved cost effectiveness and drug compliance. Some potential harms that have been highlighted include an increased number of complications, increased symptoms of previously dampened conditions, and negligible changes in patient satisfaction that have stressed the importance of this intervention being patient centred and individualized to each patient. The implementation of deprescribing processes could drastically change the way people think about deprescribing and could be extremely beneficial to older patients living with type 2 diabetes worldwide. Developments in preventive medication deprescribing could pave the way for this intervention to become more common place improving the quality of life in patient’s final years. PubDate: 2023-02-09
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Abstract: Abstract The role of gut microbiota in type 2 diabetes (T2D) has been investigated through many recent studies conducted in different parts of the globe. However, intrinsic differences in the gut microbiota related to geography, ethnicity, dietary preferences, etc. tend to confound the disease-associated differences and make the search for any universal T2D-specific signature a challenging task. The present work makes an attempt to identify population or sub-population specific consensus gut microbiota signatures of T2D with a particular focus on Asian-Indians, who are reported to exhibit a distinct T2D phenotype. In this process, the article reviews and summarizes different microbial genera that have been reported to be associated with T2D in earlier studies conducted in different geographies. The results indicate that while the taxonomic signatures of T2D-associated gut microbiota (i.e. the presence and abundance of particular genera) may vary between populations, their functional roles in context of T2D pathophysiology have more coherence. Furthermore, it appears that while the gut microbiota of T2D subjects from different geographies are characterized by a combination of depletion of beneficial/ commensal taxa as well as an enrichment of harmful, pro-inflammatory and infectious taxonomic groups, the latter phenomenon may be more prevalent in Asian-Indian T2D subjects. PubDate: 2023-01-31
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Abstract: Abstract Type 2 diabetes (T2D) is one of the major global public health concerns. The incidence of T2D is expected to increase dramatically in the coming years globally as well as in India. Development of T2D is a result of desensitization of peripheral tissue to stimulation of insulin. Skeletal muscle is responsible for the majority of postprandial glucose uptake and is of the utmost importance to maintain glucose homeostasis. T2D is manifested by structural, functional, and metabolic impairment of skeletal muscle and is characterized as the primary site of insulin resistance in T2D patients. T2D patients exhibit impaired insulin-stimulated muscle glucose uptake, fat metabolic abnormality, increased accumulated muscle fat, and a dysbalance in muscle protein synthesis and breakdown. Skeletal muscle mitochondrial dysfunction also plays an essential role in the pathogenesis of insulin resistance. Skeletal muscle fiber shift and diabetes-associated loss of muscle mass and strength further worsen insulin sensitivity. This review provides a comprehensive overview of skeletal muscle pathophysiological changes in diabetes and discusses the potential therapies targeting skeletal muscle pathophysiology to ameliorate diabetes. PubDate: 2023-01-31
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Abstract: Abstract Diabetes is a chronic disease associated with a variety of metabolic abnormalities. Principal cause of disability and deaths in diabetes are coronary, peripheral, and cerebral vascular diseases mainly due to lipid abnormalities. Diabetic dyslipidemia is characterized by elevated small-dense low-density lipoprotein (LDL) cholesterol and triglycerides (TG) and low high-density lipoprotein (HDL) cholesterol. Elevated LDL cholesterol has been proven as causative for cardiovascular disease. Treatment thresholds for this variable have been advocated in multiple clinical practice recommendations and intensity of LDL lowering is dependent on associated risk factors. Statins are mainstay for treatment although combination therapies with ezetimibe and PCSK9 inhibitors are needed in very high-risk individuals. Recent research has confirmed role of raised TG as a cardiovascular risk factor. However, limited options are currently available as drug therapy. Low HDL cholesterol appears to be less of a contributor to cardiovascular risk than previously considered a risk marker. Primary cardiovascular disease prevention strategies in diabetes should focus on risk assessment, aggressive lifestyle interventions and treatment with statins, etc. In the present review we have focused on role of lipids in pathophysiology of diabetes associated cardiovascular disease and focus on evidence guided management. PubDate: 2022-12-13 DOI: 10.1007/s41745-022-00346-5
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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Abstract: Abstract The design of realistic quantum technologies relies intricately on the understanding of open quantum systems. Such open systems are often studied as an input–output theory, where time is often not explicitly parameterized. Such maps have a rich structure that has been elucidated by several authors over the years. In contrast to this, the master equation approach is a dynamical description where the infinitesimal evolution of the quantum system is studied. These two descriptions are related to each other when the underlying maps are parametrized in time or equivalently when the system dynamics is integrated for finite time. In this overview, we will briefly discuss some established results in this field alongside commenting on some recent results relating to deriving the transient and steady state dynamics of open quantum systems. We discuss structure of CP maps, review canonical forms of \(\mathcal {A}\) and \(\mathcal {B}\) maps and highlight their relationship to Lindblad equations. We review properties of Liouville superoperators and highlight some stable numerical methods to find steady states. We conclude the overview with a summary of results relating Zeno dynamics and the open systems approach to driven system engineering. PubDate: 2022-10-28 DOI: 10.1007/s41745-022-00338-5
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Abstract: Abstract Superconducting qubits are currently the leading platform for quantum computing and quantum information processing in general. Over the last decade, there have been rapid developments in the performance of small-scale quantum processors based on superconducting qubits, showing promise for a practical quantum processor in the coming years. These developments have taken place in terms of control and measurement techniques, connectivity, qubit architecture, and coherence performance. It has been led by novel design strategies, improvements in materials and fabrication processes, as well as advances in peripheral control electronics. In this article, we present a review of the various superconducting qubit devices, their coupling schemes, performance, and developments on the materials front. PubDate: 2022-10-17 DOI: 10.1007/s41745-022-00330-z
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Abstract: Abstract Ultracold atoms and ions provide novel test-beds for quantum sensing and metrology. Technological advancement towards the construction of ultrastable and narrow linewidth lasers, optical frequency combs, and microwave electronics made it possible to realize atom interferometers with state of the art sensitivity and the most accurate clocks in the world based on long-lived quantum states of atoms and ions. Such systems have been utilized in applications starting from geodesy and navigation to the measurement and redefinition of fundamental constants. The field awaits a more enriched future in addition to the proposed applications of such systems in improving the Global Positioning System, secured communications, and exploring mineral and underground water resources. Here, we briefly report on the initiatives and current status of India in this research field in view of the global progress. PubDate: 2022-10-11 DOI: 10.1007/s41745-022-00335-8
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Abstract: Abstract The incorporation of Bayesian inference into practical statistics has seen many changes over the past century, including hierarchical and nonparametric models, general computing tools that have allowed the routine use of nonconjugate distributions, and the incorporation of model checking and validation in an iterative process of data analysis. We discuss these and other technical advances along with parallel developments in philosophy, moving beyond traditional subjectivist and objectivist frameworks to ideas based on prediction and falsification. Bayesian statistics is a flexible and powerful approach to applied statistics and an imperfect but valuable way of understanding statistics more generally. PubDate: 2022-10-01 DOI: 10.1007/s41745-022-00307-y
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Abstract: Abstract We review the empirical Bayes approach to large-scale inference. In the context of the problem of inference for a high-dimensional normal mean, empirical Bayes methods are advocated as they exhibit risk-reducing shrinkage, while establishing appropriate control of frequentist properties of the inference. We elucidate these frequentist properties and evaluate the protection that empirical Bayes provides against selection bias. PubDate: 2022-10-01 DOI: 10.1007/s41745-022-00286-0
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Abstract: Abstract This paper provides background to articles in the special issue. It is aimed at readers who are not experts in statistics and may not be familiar with sequence of developments in topics covered. Reader will find very non-technical material about the role of statistics in genetics, health, evolution, survival analysis, etc. PubDate: 2022-09-13 DOI: 10.1007/s41745-022-00328-7
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