Tag Archives: type 2 diabetes

Bold Action Needed on South Asian Heart Health: Pramila Jayapal

Congresswoman Pramila Jayapal (WA-07) and global health expert Gayathri Badrinath co-authored an op-ed in The Hill that urged bold action to address the lack of awareness about the unique and growing heart health risks of South Asian Americans. 

South Asian Americans are four times more at risk of developing heart disease than the general population, according to a report published in the Circulation of the American Heart Association. The lead author Annabelle Santos Volgman, reported that early onset diabetes and bad cholesterol were contributing factors that increased the risk of early “atherosclerosis,” a condition in which plaque deposits in arteries causes heart disease.

South Asians are more likely to have a heart attack before the age of 50 and are now the group with the highest risk of Type 2 diabetes.

Studies also show that the lack of exercise or physical activity puts South Asians  at greater risk for heart disease, in addition to other contributing factors like diet, obesity or insulin resistance. However, there remains a lack of awareness within the community about making key lifestyle changes that can reduce their risk for heart disease.

The op-ed in The Hill accentuated the lack of awareness among South Asian Americans about the “staggering epidemic of heart disease” in their communities and emphasized the immediate need for education and outreach to the medical establishment and South Asians (of Indian Pakistani, Bangladeshi, Sri Lankan, or Nepalese descent ) across the country. It also  referenced the bipartisan bill – the  South Asian Heart Health Awareness and Research Act of 2019  – introduced by Jayapal and U.S. Representative Joe Wilson (R-SC) in June last year, to develop and disseminate culturally appropriate informational material for the South Asian community.

Read the full op ed here.

U.S. Representative Pramila Jayapal represents Washington’s 7th District and is the first South Asian American woman elected to Congress. She is the co-chair of the Congressional Progressive Caucus and a member of the Judiciary, Education & Labor, and Budget Committees. 

Gayathri Badrinath is the Founder & CEO of Devyn, a company developing precision digital therapeutics for women and dedicated to advancing the health of women globally. Prior to founding Devyn, Gayathri spent more than 20 years in global health care organizations across the pharmaceutical, medical device and diagnostics industries. She is a Board member at WomenHeart: The National Coalition for Heart Disease.

Photo by Online Marketing on Unsplash


Sankara Taps AI in Blindness Campaign

Long lines in front of eye doctors’ clinics do not include children who have never complained that they can’t see.

They are blind, and they don’t know it. Their world has always been hazy. They have never seen it any other way. Thousands of others are silently turning blind with diabetes, and don’t even know it. The challenge to help these people increases manifold when they are in remote areas, where no specialized treatment can reach them.

It is in cases like these, when a mere selfie can alert the doctors of impending visual problems, that Dr. Kaushik Murali, an  ophthalmologist/ eye surgeon at Sankara Eye Hospital Bangalore, is hoping artificial intelligence can be the answer. The problem, if nipped in the bud, can save the vision of the child or a diabetic individual.

Murali and his team have annotated 8,000 retinal scan pictures, including a range of people with vision problems resulting from diabetes. This will help identify the beginnings of this specific cause of blindness, a disease called diabetic retinopathy. ROP is caused by type-two diabetes. They are training the algorithm to identify key markers of diabetic retinopathy, such as nerve tissue damage, swelling, and hemorrhaging. The disease creates lesions in the back of the retina that can lead to total blindness. “Today the algorithm has 98 percent capability of identifying any patient who has a ROP change,” said Murali.

Seventy million people have diabetes in India and 18 percent of diabetic Indians already have the ailment, according to the International Diabetes Federation. By 2045, India is projected to have 134 million cases, making India the country with the most number of diabetics,

Many diabetic patients assume that early signs of the disease are simply minor vision problems. Some don’t even know they are diabetic. In these cases, where blindness often is preventable if diabetic retinopathy is caught early, loss of vision is unnecessary. Medications, therapies, exercise, and a healthy diet are highly effective treatments for preventing further damage if the disease is diagnosed early enough,

The system is trained by deep learning. The program’s diagnosis for each image is compared with that of the ophthalmological panel and the parameters of the function are adjusted to reduce the error margin for each image. This process is repeated for each image until the program can make an accurate diagnosis based on the intensity of pixels in the retinal image. The results are extremely encouraging. The algorithm showed similar — in fact slightly better — levels of sensitivity and specificity as a panel of ophthalmologists.

A similar campaign is spearheading the cause of preventing blindness in children. A lazy eye will be quickly caught by the machine and preemptive action planned.

Ritu Marwah is an award winning author, chef, debate coach, and mother of two boys. She lives in the bay area and  has deep experience in Silicon Valley start-ups as well as large corporations as a senior executive.

Sankara Raises Over $500K

The gentleness of the Sankara family and their quiet demeanor reached out and enveloped attendees as they entered the India Community Center in Milpitas on December 8. Sankara Eye Foundation’s annual banquet was held to raise funds for surgeries and to support construction of hospitals in Rajasthan, Madhya Pradesh and Telangana.

Student volunteers guided patrons toward steaming delicious food served by Mantra. Amritsari fish and almond tikkis along with melt-in-the-mouth tandoori paneer welcomed the guests. The aroma of hot sweet chai tea flavored the air mixing with the sounds of music sung by Smriti Jayaraman. Two dancers in bright Indian attire gracefully twirled on stage to familiar Bollywood tunes.

Picture: Founder and Executive Chairman of SEF, Murali Krishnamurthy , Mr. and Mrs. Ram Reddy (President TIE SV), Mr. and Mrs Jay Vishwanathan (ED TIE SV), Dr. Ramani(Founder and Chairman Sankara India).

Sankara’s target that evening was to raise half a million dollars. Ram Reddy urged the gathering to participate in the cause that changed people’s lives for as little as $30.

Dr. R. V. Ramani, the chief guest and founder Sankara Eye Foundation-India, explained that donations in part go toward setting up hospitals and building new operation rooms within existing locations. These new facilities work to become self-sustaining units. They operate utilizing the principle of an 80-20 split, meaning that for every one operation done for a client that pays, four free operations are performed for those in need at one of the hospitals run by Sankara in India.

India has the largest population of the world’s blind with over 55 million visually impaired individuals with 8 million of them totally blind. The Sankara team reported that each location completes 50 surgeries every day.

For a $1,000 donation, the donor can get their name imprinted on a wall reserved for founders, while for a donation of just $30 a donor can fund a single surgery.

Timely retinal scans prevent blindness in children. Dr. Kaushik Murali, a pediatric ophthalmologist who works at Sankara Eye Hospital in Bangalore said, “The two large public health problems that we have looked at are diabetic retinal disease and childhood blindness, especially amblyopia, where a child does not use both eyes equally. One eye is more dominant and the brain suppresses the other eye because of which development gets impacted. We can capture an image of the retina and have a machine learning (ML) algorithm identify the areas that have been impacted and help grade it. This procedure democratizes screenings and makes it available to a  larger number of people. In theory, we can take a picture of your retina with your Android phone and with some modifications run it through an app, and that app will tell you whether you need to see a doctor.”

Any improvements in the ability to identify amblyopia in children is crucial, especially when such improvements can help to broaden access to screening procedures for the majority of children. This is because children often simply adapt to changes in vision or visual impairment. Rather than identify the presence of an issue, they will rely more on one eye, moving further away or closer to the object they are viewing. Amblyopia results in reduced visual acuity, binocularity, depth perception, and contrast sensitivity.

This not only impacts the weaker eye, which is deteriorating, but also increases the strain on the other eye which is stronger. Strain caused by amblyopia can affect the child’s energy levels, fine motor skills, ability to concentrate, and can eventually cause social problems. These problems can lead to children losing confidence, failing in school, and being mislabeled as inept or aggressive.

Sankara’s work to combat amblyopia is happening across their multiple hospitals as well as through their work at partner hospitals.

Manjula and Viggy Mokkarala, who had seen Viggy’s father perform surgeries that altered peoples’ lives, chose Sankara as their nonprofit of choice. At the Sankara Foundation gala at ICC, they gave $100,000 toward this cause.

Similarly, Ameeta and Dilmohan Chadha donated a large sum to the cause. Chadha said he felt the tenets of his religion, Sikhism, sarbad da galah (welfare of all) and Vandh Chako, (share what one has with others), taught him to share what he had. Sankara, Chadha said, is the conduit through which we can practice our religion’s teachings.

As the evening progressed, the happiness of this shared experience of making a difference in people’s lives lightened the mood. The founder and executive chairman of SEF, Murali Krishnamurthy, broke into a song, “Jot se jot jalate chalo,” light one candle with another.

Ritu Marwah is an award winning author, chef, debate coach, and mother of two boys. She lives in the bay area and  has deep experience in Silicon Valley start-ups as well as large corporations as a senior executive.

Heart Health Month: Diabetes and the Heart

As a child growing up in India, it was common to hear elders on both my mother’s and father’s sides talk about their diabetes and their high blood pressure. I used to overhear conversations about stents, angioplasty, and blockages during family get-togethers. My father took pride in helping his friends measure their blood pressure. At the time, I hardly knew what any of these terms meant; I never imagined that I would have to deal with some of these conditions myself. I had always thought of these problems as problems related to older people, and assumed that they were of no concern to a man in his 30s or 40s. However, fate necessitated that I learn and understand all these terms intimately.

I did not realize at the time, but the very first signs of my predisposition to diabetes surfaced in my mid-twenties during a free employee health checkup when lipid panel results revealed that I had elevated triglycerides, a possible sign of metabolic syndrome. A primary care doctor I consulted simply put me on cholesterol-lowering medication and advised me to take it for life. I remember thinking “It is just one small pill, which is nothing compared to the large number of pills my father takes on a daily basis. My affliction must be pretty minor.” Starting on a plan for “medication for life”should have given me pause, given that both my parents were diabetic, but it did not. My life at that time did not indicate illness in any discernible way. I was young, active, excited to be married and to be parenting a beautiful new baby. I had a great job and life was good.

Seven years later at my annual health checkup, I mentioned to my doctor that my eyes were having trouble focusing in the mornings. He asked me to get blood work done. Results showed elevated A1c which is a measure a of a person’s average blood glucose levels over the past few months. I was officially diagnosed with diabetes! My diagnosis should not have come as a shock. After all, diabetes was in my genes. Yet, I found myself pulling over to the side of the road to catch my breath when I heard the news from my doctor’s office. Images of my father struggling with his insulin injections and the mounds of pills that he had been taking for half of his life swirled through my head, and I was shattered. How could I have type 2 diabetes at the age of 33? I was put on prescription medication that soon caused episodes of hypoglycemia. My concerned wife convinced me to get help from an endocrinologist who helped with medication management and I was able to regain some control over my life.

That was ten years ago. Over the course of a decade, as work and stress  increased, I could not maintain a regular fitness regimen and exercised sporadically. I continued to gain weight and my A1c slowly began to rise. Long hours at a demanding high tech job, plus family responsibilities sent stress levels through the roof. There was no special diet except a superficial avoidance of sugar and sweet treats. I was on the typical Indian “rice and chapati-centric” meal plan. It was the perfect storm and my diabetes flourished.

I knew I needed to get control of my diabetes and invest in my health, not only for myself, but also for the sake of my wife and daughters. I made a commitment to see an endocrinologist every three months and a cardiologist once every year. Still I could not keep my A1c in check. Two years ago, my medication was increased to the maximum allowable dosage. I was exercising regularly and felt strong and energetic, but my blood test results still did not show any signs of improvement. In desperation, I turned to the Internet and the library for help. I read all there was to read on pre-diabetes, insulin resistance, and type 2 diabetes I learned more about the importance of diet and exercise for those with this metabolic disease. I read about insulin and how it works, about cortisol, ghrelin and glucagon. I even read a few books on diabetes management. I gained significantly in knowledge, but could not put all the disparate information together into a regimen that I could maintain. I tried techniques like intermittent fasting, a diet avoiding sweets completely and another diet with less than 100g of carbs per day. These had good short term results, but I just could not sustain these diets in the long term. . I was overwhelmed and frustrated.

It was at this time that my cardiologist recommended the South Asian Heart Center at El Camino Hospital. At first, I enrolled in the Center’s AIM to PreventTM program and learned about the specifics of my personal condition. I was happy to find experts who presented information about type 2 diabetes in a way that I could understand, accept and utilize. The program helped me understand my diet and choose my foods mindfully. Last year when the Center launched a new program called STOP-D to stop diabetes before it starts, I was among the first to register.  STOP-D, a structured, culturally adapted program based on proven national diabetes prevention curriculum was just what I needed. I learned the science through webinars and workshops led by experts, and benefited from personalized lifestyle coaching. My peers and I shared recipes and achievements, and motivated each other to stick to the program. I not only focused on the obvious – exercise and diet – but also meditation and sleep, which turned out to be just as important. In the one year on STOP-D, I have picked up actionable tips and tools on diet and exercise, stress reduction and more that have become part of my daily life.  

I grew to appreciate vegetables, even salad, and stopped eating a lot of  rice. My eating habits now are very different  from the diet that I grew up with  in Hyderabad, India. I have a sweet tooth and I soon devised ways to avoid temptations in the office lunch room. I discovered that not only the quantity, but the quality of food and my interaction with food matters a lot. My heart health coach constantly encouraged me by setting up little challenges to take me to the next level.  

The Center’s focus on sleep led me to investigate the reasons for my inadequate sleep patterns.  I now use a machine to treat my sleep apnea and am getting a full night’s sleep for the first time in years.  I used to think that meditation is quackery but my coach gently wore down my resistance.  I tried it and was amazed to find it clarified my thought process, helping me decompress and think through challenging choices.

Over the course of this program, and with the support of my family, I have learned to exercise sustainably, eat right, and reduce stress with proper sleep and regular meditation. I’ve lost weight and my A1c level has dropped from 6.8 to a pre-diabetic level of 5.7.  Now I understand that, for me, as for so many others, that medication alone is not enough.  I needed a structured lifestyle program too.  I am glad I made this investment in my health so I can take care of my family, now and in the future.  

Sajjad Lateef a 44 year old father of two, is a technical product manager at Illumio in Sunnyvale, California.