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Effects of Ramipril and Rosiglitazone on Cardiovascular and Renal Outcomes in People With Impaired Glucose Tolerance or Impaired Fasting Glucose
Get PDFOBJECTIVE— Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) are
risk factors for diabetes, cardiovascular disease (CVD), and kidney disease. We determined the
effects of ramipril and rosiglitazone on combined and individual CVD and renal outcomes in
people with IGT and/or IFG in the Diabetes REduction Assessment With ramipril and rosiglitazone
Medication (DREAM) trial.
RESEARCH DESIGNANDMETHODS— A total of 5,269 people aged30 years, with
IGT and/or IFG without known CVD or renal insufficiency, were randomized to 15 mg/day
ramipril versus placebo and 8 mg/day rosiglitazone versus placebo. A composite cardiorenal
outcome and its CVD and renal components were assessed during the 3-year follow-up.
RESULTS— Compared with placebo, neither ramipril (15.7% [412 of 2,623] vs. 16.0% [424
of 2,646]; hazard ratio [HR] 0.98 [95% CI 0.84 –1.13]; P0.75) nor rosiglitazone (15.0% [394
of 2,635] vs. 16.8% [442 of 2,634]; 0.87 [0.75–1.01]; P 0.07) reduced the risk of the
cardiorenal composite outcome. Ramipril had no impact on the CVD and renal components.
Rosiglitazone increased heart failure (0.53 vs. 0.08%; HR 7.04 [95% CI 1.60 –31.0]; P 0.01)
but reduced the risk of the renal component (0.80 [0.68–0.93]; P 0.005); prevention of
diabetes was independently associated with prevention of the renal component (P 0.001).
CONCLUSIONS— Ramipril did not alter the cardiorenal outcome or its components. Rosiglitazone,
which reduced diabetes, also reduced the development of renal disease but not the
cardiorenal outcome and increased the risk of heart failure
High Prevalence of Diabetes and Metabolic Syndrome Among Policemen
Get PDFThe prevalence of diabetes is rapidly rising all over
the globe at an alarming rate.1 Over the past 30 years,
the status of diabetes has changed from being considered
a mild disorder of the elderly, to one of the major causes
of morbidity and mortality affecting the youth and middle
aged. It is important to note that the rise in prevalence is
seen in all six inhabited continents of the globe.2 The major
driver of the epidemic is the more common form of diabetes
namely type 2 diabetes, which accounts more than 90% of
all diabetic cases
Burden of Neuropathic Pain in Indian Patients Attending Urban, Specialty Clinics: Results from a Cross Sectional Study
No full textBackground and Objective: Recent studies in Western
populations have reported high patient burden of neuropathic
pain. No data are currently available on the burden of
neuropathic pain in Indian patients. Our study evaluated the
burden of neuropathic pain in patients attending urban,
private-sector, specialty clinics.
Methods: This cross-sectional, observational study surveyed
467 patients with neuropathic pain to assess the burden of
pain (pain severity, patient-reported treatment effectiveness,
impact of hypothetical pain relief on overall health rating),
burden because of quality of life impairment (EuroQoL
health state, pain interference with daily living, sleep and
mood disturbances, medication-related adverse events), and
economic burden (treatment cost, impact on employment
and productivity). Physicians filled out a clinical case report
form to provide information on patient’s neuropathic pain
disorder and treatment provided. The data were analyzed to
assess the overall burden of neuropathic pain.
Results: Painful diabetic neuropathy was the most common
cause of neuropathic pain (72%). Majority (64%) of patients
reported moderate to severe pain, and about 50% reported
moderate to severe pain-related interference in activities of daily living. Substantial sleep impairment was reported as
compared with general population. About 50% of patients
reported co-morbid mood disorders, while 67% reported
medication-related adverse event in the preceding week.
Fifty-seven per cent of patients reported an adverse impact
on their employment status, including 13% who retired early
or were unemployed. Among those currently working, 72%
reported reduced productivity, including 22% who reported
reduced productivity “most” or “all” of the time.
Conclusions: In Indian patients with access to urban, privatesector,
specialty clinics neuropathic pain (particularly painful
diabetic neuropathy) remains a significant medical condition
with substantial negative impact on their quality of life
Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES-55)
No full textAims
This study was conducted to determine the prevalence of, and risk factors for, diabetic neuropathy (DN) in south
Indian Type 2 diabetic subjects.
Methods
Subjects were recruited from the Chennai Urban Rural Epidemiology Study, conducted on a representative
cohort from Chennai city. A total of 1629 diabetic subjects were included, of whom 1291 were known to have diabetes (KD)
subjects and 338 were randomly selected newly detected diabetic (NDD) subjects. Neuropathy was diagnosed if vibratory
perception threshold at the great toe, measured by biothesiometry, exceeded mean
+
2
SD
of a healthy non-diabetic study
population aged 20–45 years (cut point
≥
20 V).
Results
The overall prevalence of DN was 26.1% (age-adjusted 13.1%) with no significant difference in gender. The
prevalence of neuropathy was significantly higher in KD subjects compared with NDD subjects (27.8 vs. 19.5%,
P
=
0.002). The prevalence of diabetic retinopathy (24.1 vs. 15.3%,
P
<
0.0001) and hypertension (51.1 vs. 40.0%,
P
<
0.0001) were higher in those with neuropathy compared with those without. The odds ratio for neuropathy in
subjects with duration of diabetes
>
15 years compared with
≤
5 years was 5.7 (95% confidence interval: 3.52–9.08,
P
<
0.0001). Regression analysis showed age (
P
<
0.0001), glycated haemoglobin (
P
=
0.001) and duration of diabetes
(
P
=
0.045) to be significantly associated with neuropathy.
Conclusions
This cross-sectional population-based study shows that, among urban south Indian Type 2 diabetic subjects, the
prevalence of DN is 26.1% and that DN is significantly associated with age, glycated haemoglobin and duration of diabetes.
Diabet. Med. 25, 407–412 (2008)
Keywords
Asian Indians, diabetes, neuropathy, prevalence, risk factors
Abbreviations
BMI, body mass index; CI, confidence interval; CURES, Chennai Urban Rural Epidemiology Study; DN,
diabetic neuropathy; DR, diabetic retinopathy; FPG, fasting plasma glucose; HbA
1c
, glycated haemoglobin; KD, known
diabetic; NDD, newly detected diabetic; NPDR, non-proliferative diabetic retinopathy; OGTT, oral glucose tolerance test;
OR, odds ratio; PDR, proliferative diabetic retinopathy; SBP, systolic blood pressure; VPT, vibratory perception threshol
Is central obesity a better discriminator of the risk of hypertension than body mass index in ethnically diverse populations?
No full textOBJECTIVE: To compare the performance of body mass index (BMI) against waist circumference, waist: hip ratio (WHR) and waist: height ratio in the discrimination of hypertension in ethnically diverse populations. METHODS: Meta-analysis of 19 cross-sectional studies. MAIN OUTCOME MEASURES: Discrimination of hypertension (SBP/DBP > or = 140/90 mmHg) was adjudicated from Receiver Operating Characteristic curves; optimum thresholds were defined as those that maximized sensitivity plus specificity. RESULTS: Irrespective of which measure of overweight was used, the strength of the association with blood pressure was consistently greater among Asians compared with Caucasians or Pacific Islanders; however, in all regions, and for all anthropometric measures, the increment in blood pressure, and the additional risk of hypertension, were broadly similar for the same relative increment in each of the four measures. Optimum thresholds varied by region; WHR was the most consistent between the regions, with thresholds of 0.92-0.94 for men and 0.80-0.88 for women. No anthropometric variable was systematically better than others at the discrimination of hypertension. CONCLUSIONS: Blood pressure is similarly associated with each of the four measures of overweight chosen, but the associations were stronger among Asians. WHR has advantages in terms of consistency of thresholds for hypertension across ethnic groups in the Asia-Pacific
Advanced glycation index and its association with severity of diabetic retinopathy in type 2 diabetic subjects.
No full textBACKGROUND: This study investigates the association of advanced glycation index (AGI), a simple assay to detect advanced glycation endproducts (AGEs) in serum, with severity of diabetic retinopathy (DR) in type 2 diabetic subjects. METHODS: The study included 188 type 2 diabetic subjects without DR, 153 subjects with nonproliferative DR, 41 subjects with proliferative DR, and 188 control participants. Serum levels of AGEs were monitored with a spectrofluorimeter by recording Maillard-specific fluorescence. RESULTS: AGI values increased with severity of DR (analysis of variance, P<.0001). Among diabetic subjects, AGI (mean+/-S.E.) was higher among subjects with nonproliferative diabetic retinopathy (NPDR; 6.7+/-0.1 U) and proliferative diabetic retinopathy (PDR; 9.1+/-0.3 U) than among subjects without DR (P<.0001). By arranging the levels of serum AGI in quartiles, the proportion of PDR subjects increased with increasing AGI values, with maximum subjects in the last quartile (trend chi(2)=60.239, P<.0001). AGI was associated with NPDR even after adjusting for age, gender, duration of diabetes, and glycated hemoglobin [odds ratio (OR)=1.33; 95% confidence interval (95% CI)=1.12-1.57; P=.001]. Similarly, AGI showed a significant association with PDR even after adjusting for various risk factors (OR=2.47; 95% CI=1.75-3.47; P<.0001). Receiver-operating-characteristics curve analysis revealed that the threshold level of 8.07 U had a 78% sensitivity, an 83.6% specificity, and an 86.1% accuracy for detecting PDR. CONCLUSION: AGI showed a significant association with the severity of DR and, hence, could be used as a prognostic tool to predict the development and progression of DR
Barriers to Changing Dietary Behavior
Get PDFAbstract
Dietary change requires giving up long established patterns of eating behavior and acquiring new habits. ‘Noncompliance’
to diet advice may be a result of inability to provide diet self-management training and getting the
right messages across to change eating behavior. Using a pre-tested questionnaire based interview, we carried out a
study amongst 350 adults (> 20 years) with type 2 diabetes from two metro cities in South India, who had previously
received diet advice with the objective to understand perceptions, attitudes and practices, as well as study factors
that enhance or reduce compliance to diet advice. Ninety six patients (28%) followed diet for the full duration of
diabetes (Group1), 131 (38%) followed diet for a partial duration varying between more than a quarter to three
quarters of the total diabetes duration (Group 2) and 115 (34%) did not follow diet advice (Group 3) – followed for
a duration less than a quarter of their diabetes duration.
Study results show that many factors both patient and health care provider related influence outcomes of dietary
advice. Factors that have a positive impact on compliance are – older age, shorter duration, nuclear family, good
family support, less busy work life, higher health consciousness, advice given by dietician, more frequent visits to
dietician, advice that includes elements to promote overall health not merely control of blood sugar, diet counseling
that is easy to understand and use and includes healthy food options, cooking methods, practical guidance to
deal with lifestyle issues. We conclude that patient barriers related to life circumstance are mostly non-modifiable,
most modifiable barriers are related to behavioural aspect and the inability of the health care provider to provide
individualized diet advice and self management training. Efforts must be made to improve counseling skills
Ethnic difference in sex gap in high-density lipoprotein cholesterol between Asian Indians and Whites.
No full textOBJECTIVE: To study whether low plasma high-density lipoprotein cholesterol (HDL-C) reported in Asian Indians is common in both men and women when compared with whites and whether it is related to increased body mass index (BMI) and plasma triglyceride concentration. DESIGN: We evaluated the lipid profile and prevalence of low HDL-C (<40 mg/dL in men and <50 mg/dL in women) in the following cohorts of normoglycemic 1404 men and 1817 women: Asian Indians living in rural India; urban Chennai, India; and Dallas, TX; and whites living in Dallas, TX. RESULTS: After adjustment for age, BMI, and smoking, HDL-C was not significantly different in Asian Indian men compared with whites. However, Asian Indian women had lower HDL-C compared with white women, and rural Asian Indian women had the lowest HDL-C even in the absence of high triglycerides. Lean Asian Indian women with BMI of less than 23 kg/m had higher frequency of low HDL-C compared with lean white women with BMI of less than 25 kg/m (72%, 56%, 48%, and 25% in rural, urban, and Dallas Asian Indian and white women, respectively) and lean men (52%, 42%, 28%, and 35% in rural, urban, and Dallas Asian Indian and white men, respectively). Sex differences in HDL-C was estimated as 6.6+/-0.5 mg/dL for Asian Indians and 15.3+/-1.1 mg/dL for whites (P<0.0001 for sex difference in the 2 ethnic groups). CONCLUSIONS: Increased prevalence of low HDL-C independently of obesity or hypertriglyceridemia is observed in women but not in men of Asian Indian origin. The sex gap in HDL-C is significantly smaller in Asian Indians compared with whites independent of geographical location
Dietary Salt Intake and Hypertension in An Urban South Indian Population – [CURES - 53]
Get PDFObjective : The aim of the study was to determine the mean dietary salt intake in urban south India and to
look at its association with hypertension.
Methods : The Chennai Urban Rural Epidemiology Study (CURES) is an ongoing population based study on
a representative population of Chennai city in southern India. Phase 1 of CURES recruited 26,001 individuals
aged ≥ 20 years, of whom every tenth subject (n=2600) was invited to participate in Phase 3 for detailed
dietary studies and 2220 subjects participated in the present study (response rate : 84.5%). Participants with
self-reported history of hypertension, diabetes or heart disease were excluded from the study (n=318) and thus
the final study numbers were 1902 subjects. Dietary salt, energy, macronutrients and micronutrients intake
were measured using a validated semi-quantitative food frequency questionnaire. Diagnosis of hypertension
was based on the National Cholesterol Education Programme (NCEP) Adult Treatment Panel III criteria.
Logistic regression analysis was used to look at the association of dietary salt with hypertension.
Results : Mean dietary salt intake (8.5 g/d) in the population was higher than the recommended by the
World Health Organization (<5g/d). Higher salt intake was associated with older age and higher income
(p for trend<0.0001). Subjects in the highest quintile of salt intake had significantly higher prevalence of
hypertension than did those in the lowest quintile (48.4 vs 16.6%, p<0.0001). Both systolic and diastolic blood
pressure significantly increased with increase in quintiles of total dietary salt both among hypertensive
and normotensive subjects (p for trend p1 teaspoon/day at the dining table was
associated with a higher prevalence for hypertension compared to zero added salt (38.5% vs 23.3%, Chi-square
= 18.95; p<0.0001). Multiple logistic regression analysis revealed that even after adjusting for age, gender,
body mass index, total energy intake and dietary fat, total dietary salt intake was positively associated with
hypertension. [Odds ratio (OR): 1.161, 95% Confidence Interval (CI): 1.115-1.209, p<0.0001].
Conclusion: Intake of dietary salt in urban south India is higher than currently recommended. Increasing
salt intake is associated with increased risk for hypertension even after adjusting for potential confounders.
This calls for urgent steps to decrease salt consumption of the population at high ris