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Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome
No full textAim: To estimate prevalence of non-alcoholic fatty liver disease (NAFLD) and its association
with glucose intolerance (type 2 diabetes (DM), prediabetes) and metabolic syndrome (MS) in
urban south Indians.
Methods: This study was carried out in 541 subjects (response rate 92%) of the original
sample of 26,001 subjects in the Chennai Urban Rural Epidemiology Study maintaining the
representativeness. Anthropometry and lipid estimations were done in all and oral glucose
tolerance test in all, except self-reported diabetic subjects. NAFLD was diagnosed by
ultrasonography and MS by modified Adult Treatment Panel III (ATP III) criteria. DM,
impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were defined using
WHO consulting group criteria.
Results: Overall prevalence of NAFLD was 32% (173/541 subjects) (men: 35.1%, women:
29.1%, p = 0.140). Prevalence of most cardio-metabolic risk factors was significantly higher
in NAFLD subjects. Prevalence of NAFLD (54.5%) was higher in subjects withDMcompared to
those with prediabetes (IGT or IFG) (33%), isolated IGT (32.4%), isolated IFG (27.3%) and
normal glucose tolerance (NGT) (22.5%) (DM vs. prediabetes: p < 0.05, DM vs. NGT: p < 0.001,
prediabetes vs. NGT: p < 0.05). Even after adjusting for age, gender and waist circumference,
NAFLD was associated with diabetes (OR: 2.9, 95% C.I.: 1.9–4.6, p < 0.001) and MS (OR: 2.0, 95%
C.I.: 1.3–3.1, p < 0.001).
Conclusion: NAFLD is present in a third of urban Asian Indians and its prevalence increases
with increasing severity of glucose intolerance and in MS. This is the first population-based
prevalence of NAFLD from south Asia which faces the brunt of the diabetes epidemic
Efficacy and safety of sitagliptin in the treatment of patients with type 2 diabetes in China, India, and Korea
No full textThe efficacy and safety of sitagliptin as monotherapy were evaluated in Chinese, Indian, and Korean patients with type 2 diabetes inadequately controlled by diet and exercise. In a randomized, placebo-controlled, double-blind, 18-week trial, 530 patients with HbA1c ≥7.5% and ≤11.0% (mean baseline 8.7%) received sitagliptin 100 mg once daily or placebo. Compared with placebo, sitagliptin significantly (p < 0.001) reduced mean HbA1c (−1.0%), fasting plasma glucose (−1.7 mmol/L), and 2-h postprandial glucose (−3.1 mmol/L), and a significantly (p < 0.001) greater proportion of sitagliptin-treated versus placebo-treated patients achieved HbA1c <7% (20.6% versus 5.3%, respectively) at study end. Efficacy of sitagliptin was demonstrated in each country. Sitagliptin was generally well-tolerated. Clinical adverse events (AEs) were reported in 23.3% and 15.2% of sitagliptin-treated and placebo-treated patients, respectively. The difference was primarily due to increased gastrointestinal AEs in the sitagliptin group, most of which were mild and resolved on study drug. Serious AEs, discontinuations due to AEs, and drug-related AEs occurred with a low incidence in both groups. No hypoglycemia was reported. In conclusion, in this study, sitagliptin monotherapy for 18 weeks significantly improved glycemic control and was well-tolerated in patients with type 2 diabetes from China, India, and Korea
Challenges in Diabetes Management with Particular Reference to India
Get PDFDiabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand years of life lost and for 2263 thousand disability adjusted life years (DALYs) in India during 2004. However, health systems have not matured to manage diabetes effectively. The limited studies available on diabetes care in India indicate that 50 to 60% of diabetic patients do not achieve the glycemic target of HbA1c below 7%. Awareness about and understanding of the disease is less than satisfactory among patients, leading to delayed recognition of complications. The cost of treatment, need for lifelong medication, coupled with limited availability of anti-diabetic medications in the public sector and cost in the private sector are important issues for treatment compliance. This article attempts to highlight the current constraints in the health system to effectively manage diabetes and the need for developing workable strategies for ensuring timely and appropriate management with extensive linkage and support for enhancing the availability of trained manpower, investigational facilities and drugs
Dietary carbohydrates, glycemic load and serum high-density lipoprotein cholesterol concentrations among South Indian adults
No full textTo examine the relationship between dietary carbohydrates, glycemic load and high-density lipoprotein cholesterol
(HDL-C) concentrations in Asian Indians, a high-risk group for diabetes and premature coronary artery disease.
Subjects/methods: The study population comprised of 2043 individuals aged X20 years randomly selected from Chennai
Urban Rural Epidemiological Study (CURES), an ongoing population-based study on a representative population of Chennai (formerly Madras) city in southern India. Participants with self-reported history of diabetes or heart disease or on drug therapy for dyslipidemia were excluded from the study. Dietary carbohydrates, glycemic index and glycemic load were assessed using a
validated interviewer administered semiquantitative Food Frequency Questionnaire (FFQ). Results: Both dietary glycemic load (Po0.0001) and total dietary carbohydrate intake (Po0.001) were significantly associated
with higher serum triglyceride levels and lower serum HDL-C levels. For the lowest to highest quintile of glycemic load, the multivariate-adjusted mean HDL-C values were 44.1mg per 100 ml and 41.2mg per 100 ml (6.6% difference, P for trendo0.001), while for total carbohydrate it was less (5% difference, P for trend¼0.016). The pattern of decrease in HDL-C for the lowest to highest quintile of glycemic load was more pronounced among men (1st vs 5th quintile: adjusted HDL-C: 4.3mg per 100 ml decrease (10.3%)) than women (1st vs 5th quintile: adjusted HDL-C: 3.2mg per 100 ml decrease (6.9%)). Our findings indicate that both total carbohydrates and dietary glycemic load intake are inversely associated with plasma HDL-C concentrations among Asian Indians, with dietary glycemic load having a stronger association
Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India.
Get PDFOBJECTIVE: To determine random capillary blood glucose (RCBG) cut points that discriminate diabetic and pre-diabetic subjects from normal individuals. RESEARCH DESIGN AND METHODS: RCBG was performed in 1,333 individuals randomly chosen from 63,305 individuals who had participated in an opportunistic screening program. An oral glucose tolerance test was also performed by venous plasma glucose on an autoanalyzer. RCBG cut points that discriminate diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were determined using receiver operating characteristic curves. RESULTS: Using 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) criterion, the RCBG cut point of 140 mg/dl (7.7 mmol/l) gave the highest sensitivity and specificity. For 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) and fasting plasma glucose (FPG) >or=126 mg/dl (7.0 mmol/l) criteria, either 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) or FPG >or=126 mg/dl (7.0 mmol/l) criterion, and the FPG >or=126 mg/dl (7.0 mmol/l) criterion, RCBG cut point was 143 mg/dl (7.9 mmol/l). RCBG cut points for IGT, IFG according to World Health Organization criterion, and IFG according to American Diabetes Association criterion were 119 mg/dl (6.6 mmol/l), 118 mg/dl (6.6 mmol/l), and 113 mg/dl (6.3 mmol/l), respectively. CONCLUSIONS: Asian Indians with RCBG >110 mg/dl at screening can be recommended to undergo definitive testing
Mortality in diabetes mellitus:revisiting the data from a developing region of the world
No full textEditoria
Hypertension & pre-hypertension in developing countries
Get PDFHypertension is reported to be the fourth contributor
to premature death in developed countries and the
seventh in developing countries1. Recent reports indicate
that nearly 1 billion adults (more than a quarter of the
world’s population) had hypertension in 2000, and this
is predicted to increase to 1.56 billion by 20252. Earlier
reports also suggest that the prevalence of hypertension
is rapidly increasing in developing countries3,4 and is
one of the leading causes of death and disability in
developing countries
A novel association of a polymorphism in the first intron of adiponectin gene with type 2 diabetes, obesity and hypoadiponectinemia in Asian Indians
No full textAdiponectin is an adipose tissue speciWc protein
that is decreased in subjects with obesity and type 2
diabetes. The objective of the present study was to examine
whether variants in the regulatory regions of the adiponectin
gene contribute to type 2 diabetes in Asian Indians.
The study comprised of 2,000 normal glucose tolerant (NGT)
and 2,000 type 2 diabetic, unrelated subjects randomly
selected from the Chennai Urban Rural Epidemiology
Study (CURES), in southern India. Fasting serum adiponectin
levels were measured by radioimmunoassay. We
identiWed two proximal promoter SNPs (¡11377C!G and
¡11282T!C), one intronic SNP (+10211T!G) and one
exonic SNP (+45T!G) by SSCP and direct sequencing in
a pilot study (n = 500). The +10211T!G SNP alone was
genotyped using PCR-RFLP in 4,000 study subjects. Logistic
regression analysis revealed that subjects with TG genotype
of +10211T!G had signiWcantly higher risk for
diabetes compared to TT genotype [Odds ratio 1.28; 95%
ConWdence Interval (CI) 1.07–1.54; P = 0.008]. However,
no association with diabetes was observed with GG genotype
(P = 0.22). StratiWcation of the study subjects based on
BMI showed that the odds ratio for obesity for the TG
genotype was 1.53 (95%CI 1.3–1.8; P < 10¡7) and that for
GG genotype, 2.10 (95% CI 1.3–3.3; P = 0.002). Among
NGT subjects, the mean serum adiponectin levels were
signiWcantly lower among the GG (P = 0.007) and TG
(P = 0.001) genotypes compared to TT genotype. Among
Asian Indians there is an association of +10211T!G polymorphism
in the Wrst intron of the adiponectin gene with
type 2 diabetes, obesity and hypoadiponectinemia
Islet autoimmunity status in Asians with young-onset diabetes (12–40 years): Association with clinical characteristics, beta cell function and cardio-metabolic risk factors
No full textIn this paper, the islet autoimmunity status and relation to clinical characteristics, beta cell
function and cardio-metabolic risk factors in young-onset Asian diabetic patients are
evaluated at baseline. The study population consisted of 912 patients (from China, India,
Malaysia and Singapore) with age 12–40 years and diabetes duration <12 months. Autoantibodies
to glutamic acid decarboxylase (GADA) and tyrosine phosphatase (IA-2A), beta
cell function and cardio-metabolic risk parameters were assessed. Among our young patient
cohort, 105 (11.5%) patients wereGADA and/or IA-2A positives (Ab +ve). Ab +ve patients were
younger, leaner, had more severe hyperglycaemia and lower beta cell function. The frequency
of metabolic syndrome was significantly lower in Ab +ve patients (27%) compared to
Ab ve patients (54%). However, a substantial proportion of patients in both groups of
patients had atherogenic dyslipidaemia, hypertension and albuminuria (micro or macro). In
our study cohort, only one in 10 Asian youth with new-onset diabetes had evidence of islet
autoimmunity. At least 60% of Ab +ve and 50% of Ab ve patients demonstrated classical
features of type 1 and type 2 diabetes respectively. Regardless of autoimmunity status, the
cardio-metabolic risk factors, in particular atherogenic dyslipidaemia, hypertension and
albuminuria were common in our patients with young-onset diabetes
Epidemiology and causation of coronary heart disease and stroke in India
No full textCardiovascular diseases are major causes of mortality and
disease in the Indian subcontinent, causing more than
25% of deaths. It has been predicted that these diseases
will increase rapidly in India and this country will be host
to more than half the cases of heart disease in the world
within the next 15 years. Coronary heart disease and
stroke have increased in both urban and rural areas.
Case–control studies indicate that tobacco use, obesity
with high waist:hip ratio, high blood pressure, high LDL
cholesterol, low HDL cholesterol, abnormal apolipoprotein
A-1:B ratio, diabetes, low consumption of fruits and
vegetables, sedentary lifestyles and psychosocial stress
are important determinants of cardiovascular diseases in
India. These risk factors have increased substantially over
the past 50 years and to control further escalation it is
important to prevent them. National interventions such as
increasing tobacco taxes, labelling unhealthy foods and
trans fats, reduction of salt in processed foods and better
urban design to promote physical activity may have a
wide short-term impact.
The World Health Organisation (WHO) re