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Prevention and management of type 2 diabetes: dietary components and nutritional strategies
Get PDFIn the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities
Comparison of the world health organization and the International association of diabetes and pregnancy study groups criteria in diagnosing gestational diabetes mellitus in South Indians
Get PDFWe aimed to compare the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the World Health
Organization (WHO) criteria to diagnose gestational diabetes mellitus (GDM) in Chennai, India. Materials and Methods: We reviewed
the retrospective data of 1351 pregnant women who underwent screening for GDM at four selected diabetes centers at Chennai (three
private and one government). All women underwent an oral glucose tolerance test using 75g glucose load and fasting, 1-h, and 2-h
samples were collected. The IADPSG and WHO criteria were compared for diagnosis of GDM. Results: A total of 839 women had GDM
by either the IADPSG or the WHO criteria, of whom the IADPSG criteria identifi ed 699 and the WHO criteria also identifi ed 699 women
as having GDM. However, only 599/839 women (66.6%) were identifi ed by both criteria. Thus, 140/839 women (16.7%) were missed
by both the IADPSG and the WHO criteria. 687/699 (98.2%) of the women with GDM were identifi ed by the WHO criteria. In contrast,
each value of IADPSG criteria i.e., fasting, 1 h, and 2 h identifi ed only 12.5%, 14%, and 22%, respectively. Conclusions: A single
WHO cut-point of 2 h140 mg/dl appears to be suitable for large-scale screening for GDM in India and other developing countries
Challenges in Estimation of Glycated Hemoglobin in India
No full textGlycated hemoglobin (HbA1c) is the most widely accepted index of long-term glycemic control. However, there are some
clinical situations that make the accurate measurement of HbA1c difficult. Although some of these situations are general,
others are more specific to some parts of the world like India. These conditions include hemoglobinopathies such as thalassemias
and structural hemoglobin (Hb) variants such as HbS and HbD, as well as iron-deficiency anemia and the use of certain
drugs. Because of the relatively frequent occurrence of some of these conditions in some parts of India, it is important that they
are looked for when evaluating an inappropriately high or low HbA1c level. Alternative indices may have to be used for
assessing glycemic control in these cases
Serum lipids and diabetic retinopathy.
Get PDFSerum lipids and diabetic
retinopathy: A cross-sectional study” by Idiculla et al.,[1]
published in IJEM. The authors demonstrate in a
hospital-based study from Bangalore that elevated serum
lipids are associated with retinal hard exudates formation
in type 2 diabetic patients. I was surprised that the authors
have not done a literature search to see whether similar
studies have been done in Indi
Effect of Filarial Infection on Serum Inflammatory and Atherogenic Biomarkers in Coronary Artery Disease (CURES-121)
Get PDFHelminth infections can potentially confer protection against metabolic disorders, possibly through immunomodulation. In this study, the baseline prevalence of lymphatic filariasis (LF) among subjects without (N = 236) and with (N = 217) coronary artery disease (CAD) was examined as part of the Chennai Urban Rural Epidemiological Study (CURES). The prevalence of LF was not significantly different between CAD− and CAD+ subjects. The LF antigen load and antibody levels indicated comparable levels of infection and exposure between the groups. Within the CAD group, LF+ and LF− subjects had no significant difference in the intimal medial thickness and high-sensitivity C-reactive protein values. However, LF infection was associated with augmented levels of tumor necrosis factor-α and interleukin-6 among CAD+ subjects. The LF infection had no effect on serum adipocytokine profile. In conclusion, unlike type-2 diabetes, there is no association between the prevalence of LF and CAD and also no evidence of protective immunomodulation of LF infection on CAD in the Asian Indian population
Increased Levels of Serum Granulocyte-Macrophage Colony-Stimulating Factor Is Associated with Activated Peripheral Dendritic Cells in Type 2 Diabetes Subjects (CURES-99)
Get PDFBackground: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a pro-inflammatory cytokine with
growth factor–like properties for monocytes and dendritic cells (DCs). In the present study, serum GM-CSF
levels and the activation status of DCs were studied in type 2 diabetes mellitus (T2DM) subjects.
Methods: Study subjects were recruited from the Chennai Urban Rural Epidemiology Study. Healthy controls
(n = 45) and T2DM patients (n = 45) were included in the study. Serum levels of GM-CSF, interleukin-1b, interleukin-
6, and tumor necrosis factor-a were measured. Enumeration of circulating DCs (myeloid [m] and plasmocytoid
[p]) and its surface antigen expression were quantified by flow cytometry.
Results: The serum GM-CSF levels were significantly higher among diabetes subjects compared with subjects
without diabetes and showed a positive correlation with glycated hemoglobin (r = 0.208, P = 0.018). The serum
GM-CSF levels were lower in subjects on combined insulin and oral hypoglycemic agents (OHA) treatment
(1.09 pg/mL) compared with those taking OHA alone (1.9 pg/mL). The increased GM-CSF levels were associated
with the activated phenotype of mDCs and pDCs, as determined by up-regulation of the lineage markers.
Conclusion: The activated state of mDCs and pDCs seen among diabetes subjects might be due to the increased
levels of GM-CSF and other pro-inflammatory cytokines
Association of Leukocyte Count and hsCRP with Metabolic Abnormalities in Subjects with Normal Glucose Tolerance (CURES – 64)
Get PDFObjective : The aim of the present study was to assess the association of leukocyte count and high sensitivity
C-Reactive protein (hsCRP) with metabolic abnormalities in subjects with normal glucose tolerance.
Methods : Subjects with Normal Glucose Tolerance (NGT) (n = 865) were recruited from the Chennai Urban Rural
Epidemiology Study [CURES]. Standard methods were used for assessing hsCRP [Nephelometry, in a subset] and
leukocytes [Flowcytometry, Sysmex SF-3000]. Insulin resistance was calculated using the Homeostasis Assessment
model (HOMA-IR).
Results : Body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, HbA1c,
serum cholesterol, LDL cholesterol, HOMA IR and hsCRP increased significantly with increasing tertiles of leukocyte
count [p for trend < 0.001]. Both leukocyte count and hsCRP showed a positive correlation with cardiovascular risk
factors. Leukocyte count showed a positive correlation with hsCRP [p=0.008]. Both mean leukocyte count [p<0.001]
and hsCRP [p=0.04] were higher in subjects with Metabolic Syndrome (MS), which increased with increase in number
of metabolic abnormalities [p for trend <0.001]. Regression models showed leukocyte count [p<0.001] and hsCRP
[p=0.03] to be associated with MS, even after adjusting for age and gender.
Conclusion : A significant association exists between systemic inflammation [leukocyte count and hsCRP] and MS/
cardiovascular risk factors in Asian Indians even among non-diabetic subjects
Identification of novel variants in the hepatocyte nuclear factor-1alpha gene in South Indian patients with maturity onset diabetes of young.
No full textCONTEXT: Mutations in the HNF 1A gene are the most common cause of maturity-onset diabetes of the young (MODY) in most populations. India currently has the largest number of people with diabetes in the world, and onset of type 2 diabetes occurs at a younger age with possible overlap with MODY. There are very few data on MODY mutations from India. OBJECTIVE: The objective was to screen coding and promoter regions of HNF1A gene for mutations in unrelated South Indian subjects in whom a clinical diagnosis of MODY was made. DESIGN: This was an observational cross-sectional study. SETTING: The study was conducted at a diabetes specialties centre in Chennai in southern India. PATIENTS: Ninety-six unrelated south Indian subjects in whom clinical diagnosis of MODY was made were included in the study. The control population comprised of 57 unrelated nondiabetic subjects selected from the Chennai Urban Rural Epidemiology Study, a study conducted on a representative population (aged > or =20 yr) of Chennai. RESULTS: We identified nine novel variants comprising seven mutations (one novel mutation -538G>C at promoter region and six novel coding region mutations) and two polymorphisms in the HNF1A gene. Functional studies revealed reduced transcriptional activity of the HNF1A promoter for two promoter variants. We also observed cosegregation with diabetes of the Arg263His coding region mutation in eight members of one MODY family, whereas it was absent in nondiabetic subjects of this family. CONCLUSION: This study suggests that mutations in the HNF1A gene comprise about 9% of clinically diagnosed MODY subjects in southern India and a novel Arg263His mutation cosegregates with MODY in one family
Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial
No full textBackground The combination of three blood-pressure-lowering drugs at low doses, with a statin, aspirin, and folic
acid (the polypill), could reduce cardiovascular events by more than 80% in healthy individuals. We examined the
eff ect of the Polycap on blood pressure, lipids, heart rate, and urinary thromboxane B2, and assessed its tolerability.
Methods In a double-blind trial in 50 centres in India, 2053 individuals without cardiovascular disease, aged
45–80 years, and with one risk factor were randomly assigned, by a central secure website, to the Polycap (n=412)
consisting of low doses of thiazide (12·5 mg), atenolol (50 mg), ramipril (5 mg), simvastatin (20 mg), and aspirin
(100 mg) per day, or to eight other groups, each with about 200 individuals, of aspirin alone, simvastatin alone,
hydrochlorthiazide alone, three combinations of the two blood-pressure-lowering drugs, three blood-pressure-lowering
drugs alone, or three blood-pressure-lowering drugs plus aspirin. The primary outcomes were LDL for the eff ect of
lipids, blood pressure for antihypertensive drugs, heart rate for the eff ects of atenolol, urinary 11-dehydrothromboxane
B2 for the antiplatelet eff ects of aspirin, and rates of discontinuation of drugs for safety. Analysis was by intention to
treat. This study is registered with ClinicalTrials.gov, number NCT00443794.
Findings Compared with groups not receiving blood-pressure-lowering drugs, the Polycap reduced systolic blood
pressure by 7·4 mm Hg (95% CI 6·1–8·1) and diastolic blood pressure by 5·6 mm Hg (4·7–6·4), which was similar
when three blood-pressure-lowering drugs were used, with or without aspirin. Reductions in blood pressure
increased with the number of drugs used (2·2/1·3 mm Hg with one drug, 4·7/3·6 mm Hg with two drugs, and
6·3/4·5 mm Hg with three drugs). Polycap reduced LDL cholesterol by 0·70 mmol/L (95% CI 0·62–0·78), which
was less than that with simvastatin alone (0·83 mmol/L, 0·72–0·93; p=0·04); both reductions were greater than for
groups without simvastatin (p<0·0001). The reductions in heart rate with Polycap and other groups using atenolol
were similar (7·0 beats per min), and both were signifi cantly greater than that in groups without atenolol (p<0·0001).
The reductions in 11-dehydrothromboxane B2 were similar with the Polycap (283·1 ng/mmol creatinine, 95% CI
229·1–337·0) compared with the three blood-pressure-lowering drugs plus aspirin (350·0 ng/mmol creatinine,
294·6–404·0), and aspirin alone (348·8 ng/mmol creatinine, 277·6–419·9) compared with groups without aspirin.
Tolerability of the Polycap was similar to that of other treatments, with no evidence of increasing intolerability with
increasing number of active components in one pill.
Interpretation This Polycap formulation could be conveniently used to reduce multiple risk factors and cardiovascular
risk.
Funding Cadila Pharmaceuticals, Ahmedabad, India
Subclinical inflammation/oxidation as revealed by altered gene expression profiles in subjects with impaired glucose tolerance and Type 2 diabetes patients
No full textAlthough subclinical inflammation and oxidative stress are implicated in the aetiology of diabetes, there are hardly any studies in prediabetes. Therefore, we made an attempt to study the gene expression pattern of certain inflammatory/oxidative genes using lymphocytes from Type 2 diabetic patients, impaired glucose tolerance (IGT), and normal glucose tolerance (NGT) subjects. Compared to NGT group, interleukin-6, tumor necrosis factor-α (TNF-α), p22Phox NADPH oxidase, and thioredoxin interacting protein (TXNIP) mRNA levels were higher and suppressor of cytokine signaling (SOCS-3) mRNA was lower in subjects with IGT and diabetes. The mean (±SE) levels of thiobarbituric acid reactive substances and protein carbonyl content were also elevated in glucose intolerant subjects. In multiple linear regression analysis, TXNIP and TNF-α showed a significant association with HbA1c even after adjusting for TBARS and PCO (TXNIP: β = 1.70, P < 0.01; TNF-α: β = 1.86, P < 0.01). Increased subclinical inflammation/oxidation is seen in Asian Indians with not only Type 2 diabetes but also IGT