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A diabetes risk score helps identify metabolic syndrome and cardiovascular risk in Indians ? the Chennai Urban Rural Epidemiology Study (CURES-38)
No full textAims: The aims of the study were to compare the recently evolved Indian Diabetes Risk Score (IDRS), in subjects
with different grades of glucose intolerance and to evaluate its usefulness as an indicator of cardiovascular risk in
Asian Indians, a high risk group for diabetes and coronary artery disease (CAD).
Methods: The data for the present studywere obtained fromthe Phase 3 (n ¼ 2350, response rate: 90.4%) of the Chennai
Urban Rural Epidemiology Study, a population-based study done in Chennai, the largest city in southern India. IDRS was
developed based on multiple logistic regression analysis using four simple parameters namely age, abdominal obesity,
family history of type 2 diabetes and physical activity. In all subjects, family history of diabeteswas obtained, and details
on physical activity were assessed using a validated questionnaire. Subjects with an IDRS of <30 was categorized as low
risk, 30–50 as medium risk and those with 60 as high risk for diabetes. Biochemical and anthropometric measurements
were done using standardized procedures. Minnesota coding was used to grade 12-lead electrocardiogram.
Results: The mean IDRS increased significantly with worsening glucose intolerance [normal glucose tolerance (NGT)
subjects: 48 17, impaired glucose tolerance (IGT): 57 16, newly diagnosed diabetics (NDD): 61 15 and known
diabetics (KD): 68 12; p for trend <0.001]. Among NGT group, the prevalence of cardiovascular risk factors
increased progressively in low-, medium- to high-risk score groups; hypertension: 9.4, 22.1 and 38.2% (p for trend:
<0.001), hypertriglyceridemia: 8.8, 19.9 and 25.3% (p for trend: < 0.001), hypercholesterolemia: 7.2, 20.3 and 34.9%
(p for trend: < 0.001) and metabolic syndrome: 1.8, 14.6 and 30.3% (p for trend: < 0.001), respectively. The
prevalence of CAD was also significantly higher in individuals with high risk compared with those with low risk
(p ¼ 0.030) and the medium risk (p ¼ 0.050) in the NGT group.
Conclusions: The results suggest that in Asian Indians, (i) the diabetes risk score increases with increasing glucose
intolerance, and (ii) it can serve as an effective indicator of metabolic syndrome and cardiovascular risk even among
subjects with NGT
Serum visfatin in relation to visceral fat, obesity, and type 2 diabetes mellitus in Asian Indians.
No full textTo investigate the role of the novel adipokine visfatin in type 2 diabetes mellitus and obesity and to examine its association with visceral and subcutaneous fat in Asian Indians, who have increased susceptibility to type 2 diabetes mellitus and coronary artery disease, 150 subjects with type 2 diabetes mellitus (75 men, 75 women) and 150 age- and sex-matched subjects with normal glucose tolerance were recruited from the Chennai Urban Rural Epidemiology Study, a population-based study done in Chennai, southern India. Anthropometric and biochemical measurements were done by using standardized techniques. Fasting serum visfatin levels were measured by enzyme-linked immunosorbent assay. Visceral and subcutaneous fat were measured by computerized tomography in a subset of 130 individuals. Serum visfatin levels were significantly higher in diabetic subjects compared with nondiabetic subjects (11.4+/-5.9 vs 9.8+/-4.3 ng/mL, P=.008). However, this association was lost when adjusted for body mass index (odds ratio [OR], 1.048; 95% confidence interval [CI], 0.997-1.101; P=.067) or waist circumference (OR, 1.050; 95% CI, 0.999-1.104; P=.057). Serum visfatin showed a significant association with obesity even after adjusting for age, sex, and type 2 diabetes mellitus (OR, 1.060; 95% CI, 1.005-1.119; P=.033). Visceral fat, but not subcutaneous fat, was significantly associated with serum visfatin levels even after adjusting for age, sex, type 2 diabetes mellitus, and body mass index (P=.002). In Asian Indians, serum visfatin levels are associated with obesity and visceral fat but not with subcutaneous fat. Although visfatin levels are increased in type 2 diabetes mellitus, the association seems to be primarily through obesity
The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease.
No full textSouth Asians have high rates of diabetes and the highest rates of premature coronary artery disease in the world, both occurring about 10 years earlier than in other populations. The metabolic syndrome (MS), which appears to be the antecedent or "common soil" for both of these conditions, is also common among South Asians. Because South Asians develop metabolic abnormalities at a lower body mass index and waist circumference than other groups, conventional criteria underestimate the prevalence of MS by 25% to 50%. The proposed South Asian Modified National Cholesterol Education Program criteria that use abdominal obesity as an optional component and the South Asian-specific waist circumference recommended by the International Diabetes Federation appear to be more appropriate in this population. Furthermore, Asian Indians have at least double the risk of coronary artery disease than that of whites, even when adjusted for the presence of diabetes and MS. This increased risk appears to be due to South Asian dyslipidemia, which is characterized by high serum levels of apolipoprotein B, lipoprotein (a), and triglycerides and low levels of apolipoprotein A1 and high-density lipoprotein (HDL) cholesterol. In addition, the HDL particles are small, dense, and dysfunctional. MS needs to be recognized as a looming danger to South Asians and treated with aggressive lifestyle modifications beginning in childhood and at a lower threshold than in other populations
Association of lipoprotein lipase gene polymorphisms with obesity and type 2 diabetes in an Asian Indian population
No full textAims: Lipoprotein lipase (LPL), a pivotal enzyme in lipoprotein metabolism, catalyzes the hydrolysis of triglycerides of very lowdensity
lipoproteins and chylomicrons. Assuming that the variants in the promoter of the LPL gene may be associated with
changes in lipid metabolism leading to obesity and type 2 diabetes, we examined the role of promoter variants (–T93G and –
G53C) in the LPL gene in an urban South Indian population.
Methods: The study subjects (619 type 2 diabetic and 731 normal glucose-tolerant (NGT) subjects) were chosen from the
Chennai Urban Rural Epidemiology Study, an ongoing population-based study in southern India. The polymorphisms were
genotyped using polymerase chain reaction-restriction-fragment length polymorphism (PCR-RFLP). Linkage disequilibrium (LD)
was estimated from the estimates of haplotypic frequencies.
Results: The two polymorphisms studied were not in LD. The –T93G was not associated with type 2 diabetes but was associated
with obesity. 11.5% of the obese subjects (62/541) had the XG(TGþGG) genotype compared with 6.4% of the nonobese
subjects (52/809; P¼0.001). The odds ratio for obesity for the XG genotype was 1.766 (95% CI: 1.19–2.63, P¼0.005).
Subjects with XG genotype also had higher body mass index and waist circumference compared with those with TT genotype.
With respect to G53C, subjects with the XC(GCþCC) genotype had 0.527 and 0.531 times lower risk for developing type 2
diabetes and obesity, respectively.
Conclusions: Among Asian Indians, the –T93G SNP of the LPL gene is associated with obesity but not type 2 diabetes, whereas
the –G53C SNP appears to be protective against both obesity and type 2 diabetes
Type 2 diabetes in Asian Indian youth.
No full textThe prevalence of youth-onset type 2 diabetes is increasing worldwide in parallel with the obesity epidemic. In India, the age at onset of type 2 diabetes had traditionally been a decade or two earlier compared with the western population. Hence, it is not surprising that the prevalence of youth-onset type 2 diabetes is rapidly escalating in India not only among the more affluent sections of society but also in the middle and lower socioeconomic groups as well. In India, type 2 diabetes in youth overlaps with monogenic forms of diabetes such as maturity-onset diabetes of the young, fibrocalculous pancreatic diabetes, and malnutrition-modulated diabetes, all of which are ketosis-resistant forms of youth-onset diabetes. Screening of high-risk groups may help in the early detection of youth-onset type 2 diabetes and prevention of its complications. Primary prevention would require a multisectoral approach involving the government and non-governmental agencies with a focus on healthier lifestyles among children
Treatment of diabetes mellitus: Beyond glycaemic control
Get PDFType 2 diabetes mellitus has emerged as the leading metabolic
disorder worldwide, affecting more than 350 million individuals
as of 2007. India is the ‘diabetic capital’ of the world, with 41
million people afflicted with the disease. The clinical importance
of diabetes lies mainly in its propensity to produce macrovascular
and microvascular complications, leading to cardiovascular
disease, cerebrovascular disease, retinopathy, nephropathy,
neuropathy and foot problems, which account for considerable
morbidity and mortality throughout the world
Waist Circumference Thresholds Provide an Accurate and Widely Applicable Method for the Discrimination of Diabetes
Get PDFExcess weight, particularly central
obesity, is recognized to be a major
determinant of diabetes risk in all
populations, with the magnitude of the
association reported as being stronger in
Asians than whites (1–3). Consequently,
indicators of overweight have been incorporated
into several guidelines for the
early identification of individuals with
type 2 diabetes (4). However, the anthropometric
cut points for different ethnic
groups have been determined in various
ways, leading to uncertainty about their
applicability to diabetes screening. Here,
we clarify current uncertainty regarding
ethnic differences in the relationship between
overweight and diabetes and
whether there is a single measure of overweight
that can be determined routinely
and applied universally in clinical practice
to facilitate earlier detection of diabetes
in the general population
The rs12255372(G/T) and rs7903146(C/T) polymorphisms of the TCF7L2 gene are associated with type 2 diabetes mellitus in Asian Indians
Get PDFOne thousand thirty-eight normal glucose-tolerant and 1031 type 2 diabetic subjects selected from the Chennai Urban Rural
Epidemiology Study were genotyped using polymerase chain reaction-restriction fragment length polymorphism assay to investigate the
association of rs12255372(G/T) and rs7903146(C/T) polymorphisms of the transcription factor 7–like 2 (TCF7L2) gene with type 2 diabetes
mellitus in Asian Indians. The frequency of the “T” allele of both rs12255372(G/T) and rs7903146(C/T) polymorphisms was significantly
higher in diabetic subjects (23% and 33%) compared to that in normal glucose-tolerant subjects (19% and 28%; P = .001 and P = .0001,
respectively). Logistic regression analysis of the rs12255372(G/T) polymorphism showed that the odds ratio (adjusted for age, sex, and body
mass index) was 1.56 (95% confidence interval [CI], 1.03-2.37; P = .034) for the TT genotype and 1.29 (95% CI, 1.06-1.58; P = .011) for the
TG genotype when compared with the GG genotype. Adjusted odds ratios for the TT and TC genotypes of the rs7903146(C/T)
polymorphism were found to be 1.50 (95% CI, 1.08-2.08; P = .013) and 1.44 (95% CI, 1.18-1.76; P = .0003), respectively, compared with
the CC genotype. Normal glucose-tolerant subjects with the TT genotype of rs12255372(G/T) had significantly higher 2-hour plasma glucose
levels (mean ± SD, 6.1 ± 1.4 mmol/L) than those with the GG genotype (5.6 ± 1.0 mmol/L, P = .011). Normal glucose-tolerant subjects with
the TT genotype of rs7903146(C/T) polymorphism had significantly higher 2-hour plasma glucose levels (mean ± SD, 6.0 ± 1.3 mmol/L)
than those with the CC genotype (5.6 ± 1.0 mmol/L, P = .004). In conclusion, the T allele of the rs12255372(G/T) and rs7903146(C/T)
polymorphisms of TCF7L2 gene confer susceptibility to type 2 diabetes mellitus in Asian Indians.
© 2007 Elsevier Inc. All rights reserved
Epidemiology of type 2 diabetes: Indian scenario.
Get PDFIndia leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The so called "Asian Indian Phenotype" refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. At least a part of this is due to genetic factors. However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population. Even though the prevalence of microvascular complications of diabetes like retinopathy and nephropathy are comparatively lower in Indians, the prevalence of premature coronary artery disease is much higher in Indians compared to other ethnic groups. The most disturbing trend is the shift in age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on nation's health and economy. Early identification of at-risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole
Polycystic ovary syndrome: A component of metabolic syndrome?
Get PDFIn 1935, Stein and Leventhal first described the polycystic ovary (PCO) as a frequent cause of irregular ovulation in women seeking treatment for subfertility. Although the initial management was surgical with wedge resection of ovary, the availability of radioimmunoassay and increased clinical use of ultrasound made it clear that many women had the ultrasound characteristics of PCO with or without the biochemical or clinical features of PCOS and therefore that PCO were not associated with a single syndrome. The association between increased insulin resistance and PCOS is a consistent finding in all ethnic groups. Obesity is a common factor in the majority of women with PCOS. It is postulated that a woman may be genetically predisposed to developing PCOS but it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances. Weight loss, altered diet and exercise have been shown to be effective in the management of PCOS. Importance of early recognition, proper intervention, long-term monitoring and health implications needs more concern