Assessment of air pollution tolerance levels of selected plants around cement industry, Coimbatore, India

Being the second largest manufacturing industry in India, cement industry is one of the major contributors of suspended particulate matter (SPM). Since plants are sensitive to air pollution, introducing suitable plant species as part of the greenbelt around cement industry was the objective of the present study. Suitable plant species were selected based on the Air pollution tolerance index (APTI) calculated by analyzing ascorbic acid (AA), pH, relative water content (RWC) and total chlorophyll (TChl) of the plants occuring in the locality. Plants were selected within a 6 km radius from the industry and were graded as per their tolerance levels by analyzing the biochemical parameters. From the statistical analysis at 0.05 level of significance a difference in the APTI values among the 27 plant species was observed, but they showed homogenous results when analysed zone wise using one-way analyses of variance. Analyses of individual parameters showed variation in the different zones surrounding the cement industry, whereas the APTI value (which is a combination of the parameter viz. AA, RWC, TChl, pH) showed more or less same gradation. Significant variation in individual parameters and APTI was seen with in the species. All the plants surrounding the cement industry are indicative of high pollution exposure comparable to the results obtain for control plants. Based on the APTI value, it was observed that about 37% of the plant species were tolerant. Among them Mangifera indica, Bougainvillea species, Psidum quajava showed high APTI values. 33% of the species were highly susceptible to the adverse effects of SPM, among which Thevetia neriifolia, Saraca indica, Phyllanthus emblica and Cercocarpus ledifolius showed low APTI values. 15% each of the species were at the intermediary and moderate tolerance levels.

Predictive value of HbA1c for incident diabetes among subjects with impaired glucose tolerance--analysis of the Indian Diabetes Prevention Programmes

AIMS

The objectives of the study were to assess the predictive value of baseline HbA(1c) for incident diabetes among the participants with impaired glucose tolerance in the Indian Diabetes Prevention Programmes 1 and 2.

METHODS

Data at baseline and at 3-year follow-up were analysed in combined cohorts of the Indian Diabetes Prevention Programmes 1 and 2. Within the 3 years, 324 of the 845 participants developed diabetes (World Health Organization criteria). The predictive value of baseline HbA(1c) for incident diabetes was determined by logistic regression analysis.

RESULTS

Baseline HbA(1c) values had heterogenous distribution. The distribution was similar in isolated impaired glucose tolerance or in impaired glucose tolerance in combination with impaired fasting glucose. A progressive increase in diabetes occurred with increasing HbA(1c). HbA(1c) showed the strongest association with incident diabetes in the multiple logistic regression analysis (odds ratio 3.548, P < 0.0001). The cut-off HbA(1c) of 43 mmol/mol (6.05%) had 67% sensitivity and 60% specificity to predict future diabetes. The diagnostic sensitivity of HbA(1c) of ≥ 48 mmol/mol (≥ 6.5%) was only 51%, with a specificity of 87%, when compared with the oral glucose tolerance glucose values.

CONCLUSIONS

Baseline HbA(1c) was highly predictive of future diabetes in Asian Indian subjects with impaired glucose tolerance and nearly 60% of the incidence occurred with values ≥ 42 mmol/mol (≥ 6.0). Diagnostic sensitivity of HbA(1c) ≥ 48 mmol/mol (≥ 6.5%) for new diabetes was only 51% using the oral glucose tolerance test as the standard for comparison.

Design, history and results of the Thiazolidinedione Intervention with vitamin D Evaluation (TIDE) randomised controlled trial

AIMS/OBJECTIVE

Conflicting data regarding cardiovascular effects of thiazolidinediones (TZDs) and extra-skeletal effects of vitamin D supported the need for a definitive trial. The Thiazolidinedione Intervention with vitamin D Evaluation (TIDE) trial aimed to assess the effects of TZDs (rosiglitazone and pioglitazone) on cardiovascular outcomes and the effects of vitamin D (cholecalciferol) on cancers and mortality.

METHODS

A large multicentre 3 × 2 factorial double-blind placebo-controlled randomised trial recruited from outpatient primary care and specialty clinics in 33 countries. From June 2009 to July 2010, 1,332 people with type 2 diabetes and other cardiovascular risk factors aged ≥ 50 years whose HbA(1c) was 6.5-9.5% (48-80 mmol/mol) when using two or fewer glucose-lowering drugs were randomised by a central computer system to placebo (n = 541), rosiglitazone 4-8 mg/day (n = 399) or pioglitazone 30-45 mg/day (n = 392); 1,221 participants were randomised to placebo (n = 614) or vitamin D 1,000 IU/day (n = 607). Participants and all study personnel were blind to treatment allocation. The primary outcome for the TZD arm was the composite of myocardial infarction, stroke or cardiovascular death, and for the vitamin D arm it was cancer or all-cause death. All randomised participants were included in the primary analysis.

RESULTS

From the study design, 16,000 people were to be followed for approximately 5.5 years. However, the trial was stopped prematurely because of regulatory concerns after a mean of 162 days without consideration of the accrued data. In the TZD arm, the cardiovascular outcome occurred in five participants (0.9%) in the placebo groups and three participants (0.4%) in the TZD groups (two allocated to pioglitazone, one to rosiglitazone). In the vitamin D arm, the primary outcome occurred in three participants (0.5%) in the placebo group and in two participants (0.3%) receiving vitamin D. Adverse events were comparable in all groups.

CONCLUSIONS/INTERPRETATION

Uncertainty persists regarding the clinically relevant risks and benefits of TZDs and vitamin D because of the early cancellation of this comprehensive trial.

Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS)

AIM

To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus (T2DM) in non-controlled studies ("real-world conditions") on quality of care, resource consumption and conditions of employment.

METHODS

This cross-sectional study and longitudinal follow-up describe the data (demographic and socioeconomic profiles, clinical characteristics, treatment of hyperglycaemia and associated cardiovascular risk factors, resource consumption) collected during the second phase (2006) of the International Diabetes Management Practices Study (IDMPS). Patients received diabetes education directly from the practice nurse, dietitian or educator, or were referred to ad hoc group-education programmes; all programmes emphasized healthy lifestyle changes, self-care and active participation in disease control and treatment. Educated vs non-educated T2DM patients (n=5692 in each group), paired by age, gender and diabetes duration, were randomly recruited for the IDMPS by participating primary-care physicians from 27 countries in Eastern Europe, Asia, Latin America and Africa. Outcome measures included clinical (body weight, height, waist circumference, blood pressure, foot evaluation), metabolic (HbA(1c) levels, blood lipid profile) and biochemical control measures. Treatment goals were defined according to American Diabetes Association guidelines.

RESULTS

T2DM patients' education significantly improved the percentage of patients achieving target values set by international guidelines. Educated patients increased their insulin use and self-care performance, had a lower rate of chronic complications and a modest increase in cost of care, and probably higher salaries and slightly better productivity.

CONCLUSION

Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs.

Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study

AIMS/HYPOTHESIS

Studying gene-lifestyle interaction may help to identify lifestyle factors that modify genetic susceptibility and uncover genetic loci exerting important subgroup effects. Adequately powered studies with prospective, unbiased, standardised assessment of key behavioural factors for gene-lifestyle studies are lacking. This case-cohort study aims to investigate how genetic and potentially modifiable lifestyle and behavioural factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes.

METHODS

Incident cases of type 2 diabetes occurring in European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts between 1991 and 2007 from eight of the ten EPIC countries were ascertained and verified. Prentice-weighted Cox regression and random-effects meta-analyses were used to investigate differences in diabetes incidence by age and sex.

RESULTS

A total of 12,403 verified incident cases of type 2 diabetes occurred during 3.99 million person-years of follow-up of 340,234 EPIC participants eligible for InterAct. We defined a centre-stratified subcohort of 16,154 individuals for comparative analyses. Individuals with incident diabetes who were randomly selected into the subcohort (n = 778) were included as cases in the analyses. All prevalent diabetes cases were excluded from the study. InterAct cases were followed-up for an average of 6.9 years; 49.7% were men. Mean baseline age and age at diagnosis were 55.6 and 62.5 years, mean BMI and waist circumference values were 29.4 kg/m(2) and 102.7 cm in men, and 30.1 kg/m(2) and 92.8 cm in women, respectively. Risk of type 2 diabetes increased linearly with age, with an overall HR of 1.56 (95% CI 1.48-1.64) for a 10 year age difference, adjusted for sex. A male excess in the risk of incident diabetes was consistently observed across all countries, with a pooled HR of 1.51 (95% CI 1.39-1.64), adjusted for age.

CONCLUSIONS/INTERPRETATION

InterAct is a large, well-powered, prospective study that will inform our understanding of the interplay between genes and lifestyle factors on the risk of type 2 diabetes development.

A quantitative assessment of patient barriers to insulin

AIM

To assess diabetes treatment preferences with a focus on patient barriers to insulin treatment.

MATERIALS AND METHODS

A questionnaire using indirect and direct methods was administered as part of the International Diabetes Management Practices Study (IDMPS). Discrete choice modelling was used to assess how product attributes influence patients' preferences for diabetes treatment. A multinomial logit model was used to find the odds ratio for each parameter, representing the probability of selecting a chosen alternative given a choice set. This allowed for the derivation of relative attribute importance, an indication of how influential product attributes are in the respondents' choices.

RESULTS

The IDMPS questionnaire was administered to 14,033 individuals with diabetes in 18 countries. The majority of respondents were women (53%) and had Type 2 diabetes mellitus (T2DM; 85%). Across subgroups, administration (i.e. oral vs. injection) was a driver of preference. Patient preferences varied according to diabetes type; individuals with T2DM assigned much higher relative importance to administration than those with Type 1 diabetes mellitus (T1DM; 30.86% vs. 4.99%; p<0.0001). Individuals with T2DM treated with insulin placed less importance on administration than insulin-naïve T2DM patients (3.09% vs. 47.48%; p<0.0001). Diabetes education also had a significant effect on the priority given to administration between T2DM patients who received diabetes training and those who did not (28.21% vs. 33.68%, respectively; p<0.0001).

CONCLUSION

The insulin barriers perceived by patients with diabetes evolved with their disease experience. While administration was the primary preference driver for insulin-naïve patients, patients were increasingly concerned with more clinically relevant barriers as they gained experience with insulin. This finding suggests that patients using insulin understand the importance of achieving an optimal balance between safety and efficacy.

Diabetes prevention programs

Primary prevention of type 2 diabetes is effective for curbing its epidemic. Lifestyle intervention has been found to be a highly effective, safe, and cost-effective method for the prevention of diabetes in high-risk persons, the benefit of which can extend for many years. Among the pharmacologic agents studied for prevention of diabetes, metformin has been found to be the safest. Interventions using drugs are less preferred because the drugs' effects tend to dissipate after their use is stopped and adverse effects may also result. The major challenge is to translate current knowledge into prevention programs at the national level.

Role of industries in the care of diabetic foot

Diabetic foot disease is a dreaded complication causing severe economic and social burden, mental and physical agony, and severe morbidity and mortality. This complication is largely preventable if the risk factors such as peripheral neuropathy and peripheral arterial disease are detected early and appropriate measures are taken to control glycemia, foot pressure, and chances of foot injury. In the case of ulceration, proper microbial control, pressure offloading by debridement, and use of appropriate footwear are mandatory to save the foot. This article focuses on the need for preventive care for diabetic complications demonstrating potentially helpful roles for industry in India.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND

Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study.

METHODS

This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study.

RESULTS

In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT.

CONCLUSIONS

The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation

This article presents the conclusions of a WHO Expert Consultation that evaluated the utility of the 'metabolic syndrome' concept in relation to four key areas: pathophysiology, epidemiology, clinical work and public health. The metabolic syndrome is a concept that focuses attention on complex multifactorial health problems. While it may be considered useful as an educational concept, it has limited practical utility as a diagnostic or management tool. Further efforts to redefine it are inappropriate in the light of current knowledge and understanding, and there is limited utility in epidemiological studies in which different definitions of the metabolic syndrome are compared. Metabolic syndrome is a pre-morbid condition rather than a clinical diagnosis, and should thus exclude individuals with established diabetes or known cardiovascular disease (CVD). Future research should focus on: (1) further elucidation of common metabolic pathways underlying the development of diabetes and CVD, including those clustering within the metabolic syndrome; (2) early-life determinants of metabolic risk; (3) developing and evaluating context-specific strategies for identifying and reducing CVD and diabetes risk, based on available resources; and (4) developing and evaluating population-based prevention strategies.

Mitochondrial ATP synthase inhibition and nitric oxide are involved in muscle weakness that occurs in acute exposure of rats to monocrotophos

Organophosphate poisoning in the context of self-harm is a common medical emergency in Asia. Prolonged muscle weakness is an important but poorly understood cause of morbidity and mortality of the poisoning. This study examined mitochondrial function and its modulation by nitric oxide in muscle weakness of rats exposed to an acute, oral (0.8LD(50)) dose of monocrotophos. Muscle mitochondrial ATP synthase activity was inhibited in the rat in acute exposure to monocrotophos while respiration per se was not affected. This was accompanied by decreased mitochondrial uptake of calcium and increased levels of nitric oxide. Reactive cysteine groups of ATP synthase subunits were reduced in number, which may contribute to decreased enzyme activity. The decrease in ATP synthase activity and reactive cysteine groups of ATP synthase subunits was prevented by treatment of animals with the nitric oxide synthase inhibitor, L-N(G) Nitroarginine methyl ester, at 12 mg/kg body weight for 9 days in drinking water, prior to monocrotophos exposure. This indicated a role for nitric oxide in the process. The alterations in mitochondrial calcium uptake may influence cytosolic calcium levels and contribute to muscle weakness of acute organophosphate exposure.

Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study

BACKGROUND

Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes.

METHODS

Cross-sectional data of 10,374 men and 12,552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (beta) were performed to estimate relationships between lipids and plasma glucose.

RESULTS

Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups.

CONCLUSIONS

Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered.

Resource use associated with type 2 diabetes in Asia, Latin America, the Middle East and Africa: results from the International Diabetes Management Practices Study (IDMPS)

AIMS

To estimate diabetes-related resource use and investigate its predictors among individuals with type 2 diabetes in 24 countries in Asia, Latin America, the Middle East and Africa.

METHODS

Cross-sectional observational data on diabetes-related resource use were collected from 15,016 individuals with type 2 diabetes within the second wave of International Diabetes Management Practices Study. Mean (SD) annual quantities were determined and predictors of diabetes-related hospitalisations, inpatient days, emergency room visits and absenteeism were investigated using negative binomial regression.

RESULTS

Patients in Asia (n = 4678), Latin America (n = 6090) and the Middle East and Africa (n = 4248) made a mean (SD) of 3.4 (6.9), 5.4 (6.7) and 2.5 (4.4) General Practitioner visits per year. The mean (SD) number of inpatient days amounted to 3.8 (18.1), 2.2 (13.9) and 2.6 (13.5) per year. Results of the regression analysis showed the major influence of diabetes-related complications and inadequate glycaemic control on resource use. The expected annual rate of hospitalisation of patients with macrovascular complications compared with those without was 4.7 times greater in Asia [incidence rate ratio (IRR) = 4.7, 95% CI: 2.8-7.8, n = 2551], 5.4 times greater in Latin America (IRR = 5.4, 95% CI: 3.0-9.8, n = 3228) and 4.4 times greater in the Middle East and Africa (IRR = 4.4, 95% CI: 2.8-6.9, n = 2630).

CONCLUSIONS

Micro- and macrovascular complications and inadequate glycaemic control are significant predictors of resource use in people with type 2 diabetes of developing countries. This knowledge confirms the health economic importance of early diagnosis of diabetes, education of patients and glycaemic control.

Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2)

AIMS/HYPOTHESIS

The objective of this prevention programme was to study whether combining pioglitazone with lifestyle modification would enhance the efficacy of lifestyle modification in preventing type 2 diabetes in Asian Indians with impaired glucose tolerance.

METHODS

In a community-based, placebo-controlled 3 year prospective study, 407 participants with impaired glucose tolerance (mean age 45.3 +/- 6.2 years, mean BMI 25.9 +/- 3.3 kg/m(2)) were sequentially grouped to receive either: lifestyle modification plus pioglitazone, 30 mg (n = 204) or lifestyle modification plus placebo (n = 203). The participants and investigators were blinded to the assignment. The primary outcome was development of diabetes.

RESULTS

At baseline, both groups had similar demographic, anthropometric and biochemical characteristics. At year 3, the response rate was 90.2%. The cumulative incidence of diabetes was 29.8% with pioglitazone and 31.6% with placebo (unadjusted HR 1.084 [95% CI 0.753-1.560], p = 0.665). Normoglycaemia was achieved in 40.9% and 32.3% of participants receiving pioglitazone and placebo, respectively (p = 0.109). In pioglitazone group, two deaths and two non-fatal hospitalisations occurred due to cardiac problems; in the placebo group there were two occurrences of cardiac disease.

CONCLUSIONS/INTERPRETATION

Despite good adherence to lifestyle modification and drug therapy, no additional effect of pioglitazone was seen above that achieved with placebo. The effectiveness of the intervention in both groups was comparable with that of lifestyle modification alone, as reported from the Indian Diabetes Prevention Programme-1. The results are at variance with studies that showed significant relative risk reduction in conversion to diabetes with pioglitazone in Americans with IGT. An ethnicity-related difference in the action of pioglitazone in non-diabetic participants may be one explanation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00276497 FUNDING: This study was funded by the India Diabetes Research Foundation.

Cardiovascular risk factors in the normoglycaemic Asian-Indian population--influence of urbanisation

AIMS/HYPOTHESIS

The aim of this study was to investigate the prevalence of cardiovascular risk factors in normoglycaemic Asian-Indians and its association with urbanisation and plasma glucose.

METHODS

Data on 5,517 normoglycaemic individuals aged >/=20 years (1,521, 1,851 and 2,145 inhabitants of a city, a town and villages, respectively), from a 2006 diabetes survey, were used. The presence of single and multiple abnormalities, including obesity, abdominal obesity, hypertension and dyslipidaemia, was analysed. Risk associations for hypertension and dyslipidaemia were analysed using multivariate analysis after adjusting for confounding variables.

RESULTS

Both the prevalence and clustering of cardiovascular risk variables were higher in urban areas than in villages, and were higher in the city than in the town. Nearly half (47%) of the normoglycaemic individuals from villages had at least one risk factor. Age, male sex, BMI, waist circumference, lack of physical activity and living in an urban environment were associated with hypertension and dyslipidaemia; postprandial glucose level showed no association with hypertension or dyslipidaemia after adjusting for these risk factors. Fasting plasma glucose level showed an independent association with dyslipidaemia.

CONCLUSIONS/INTERPRETATION

There is a high prevalence of cardiovascular risk factors even among normoglycaemic individuals, and this is highest in urban areas. Fasting plasma glucose level showed an association with dyslipidaemia but not hypertension.

Forest dynamics in the Eastern Ghats of Tamil Nadu, India

The primary deciduous forests in the Eastern Ghats (EG) of Tamil Nadu (TN) India have undergone many changes owing to various need-based forest managements, such as timber extraction for industry, railway sleepers, charcoal, and forest clearance for hydroelectric projects and agriculture, during preindependence and postindependence periods (i.e., from 1800 to 1980). The enactment of a forest conservation act during the 1980s changed the perception of forest managers from utilization to conservation. This study was taken up to assess the forests dynamics in the EG of TN spatially between 1990 and 2003 and nonspatially between 1900 and the 1980s. Landsat Thematic Mapper (TM) and Indian Remote Sensing satellite (IRS) 1D Linear Imaging and Self Scanning (LISS III) data were used to assess forests during 1990 and 2003, respectively. Field floristic survey and secondary data (such as published literature, floras, books, and forest working plans) were used to assess the forest dynamics in terms of forest type and species composition among the preindependence period, the postindependence period, and the present (i.e., before and after 1980). The satellite data analysis revealed a considerable amount of changes in all forest types during the 13 years. The comparison of species composition and forest types between the past and present revealed that need-based forest management along with anthropogenic activity have altered the primary deciduous forest in to secondary and postextraction secondary forests such as southern thorn and southern thorn scrub forests in the middle [400-900 m above mean sea level (MSL)] and lower slopes (<400 m MSL). However, the evergreen forests present at the upper slope (>900 m MSL) and plateau seemed not to be much affected by the forest management. The changes estimated by the satellite data processing in the major forest types such as evergreen, deciduous, southern thorn, and southern thorn scrub are really alarming because these changes have occurred after the implementation of a forest conservation act. The dependence of local people on forests for various purposes in this region is also considerably high, which might be a key factor for the changes in the forests. The results of this study not only provide an outlook on the present status of the forests and the change trends but also provide the basis for further studies on forests in the EG of TN.