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Pervez A, Ahmer A, Mahmud O, Martins RS, Hussain H, Nasir S, Pirzada S, Mustafa MA, Siddiqi U, Zakaria M, Rizvi NA, Arshad A, Haider AH, Nadeem S. Clinical Practice Guidelines for the Management of Type 2 Diabetes in South Asia: A Systematic Review. Diabetes Metab Syndr 2024; 18:103094. [PMID: 39111199 DOI: 10.1016/j.dsx.2024.103094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are a helpful tool for the evidence-based management of Type 2 Diabetes Mellitus (T2D). The aim of this systematic review was to synthesize and appraise the scope and quality of South Asian T2D CPGs. METHODS This PROPSERO registered (CRD42023425150) systematic review adhered to the 2020 PRISMA guidelines. We searched the PubMed, Embase, Cochrane, and Google Scholar databases for relevant guidelines. Data synthesis was performed using a qualitative approach and methodological quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified eleven unique CPGs (three each from Pakistan and Sri Lanka, two from India, and one each from Bangladesh, Nepal, and Bhutan) which were published or updated between 2017 and 2023. The CPGs included recommendations regarding screening, diagnosis, prevention, and management of T2D and its acute and chronic complications, comorbidities, and fasting with T2D. The AGREE II mean domain scores ranged from 37 % to 80 %; three CPGs were 'recommended for clinical use,' seven were 'recommended for use with modifications' and one was deemed unfit for implementation. CONCLUSION The present review summarized and appraised broadly CPGs from South Asia for T2D and can help direct improvements to future iterations.
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Affiliation(s)
- Alina Pervez
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Areesha Ahmer
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Omar Mahmud
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Hawra Hussain
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Sameen Nasir
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Mohsin Ali Mustafa
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Uswah Siddiqi
- Vanderbilt University Medical Center, Nashville, TN, 37232, United States
| | - Maheen Zakaria
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Nashia Ali Rizvi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Ainan Arshad
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan; Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Sarah Nadeem
- Department of Endocrinology, Kelsey Seybold Clinic, 1211 Nexus Ave, Stafford, TX, 77477, United States.
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Obokata M, Sorimachi H, Harada T, Kagami K, Saito Y, Ishii H. Epidemiology, Pathophysiology, Diagnosis, and Therapy of Heart Failure With Preserved Ejection Fraction in Japan. J Card Fail 2023; 29:375-388. [PMID: 37162126 DOI: 10.1016/j.cardfail.2022.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 03/17/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a global health care problem, with diagnostic difficulty, limited treatment options and high morbidity and mortality rates. The prevalence of HFpEF is increasing because of the aging population and the increasing burden of cardiac and metabolic comorbidities, such as systemic hypertension, diabetes, chronic kidney disease, and obesity. The knowledge base is derived primarily from the United States and Europe, and data from Asian countries, including Japan, remain limited. Given that phenotypic differences may exist between Japanese and Western patients with HFpEF, careful characterization may hold promise to deliver new therapy specific to the Japanese population. In this review, we summarize the current knowledge regarding the epidemiology, pathophysiology and diagnosis of and the potential therapies for HFpEF in Japan.
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Affiliation(s)
- Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yuki Saito
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Fatty liver index predicts the development of hypertension in a Japanese general population with and without dysglycemia. Hypertens Res 2023; 46:879-886. [PMID: 36631554 DOI: 10.1038/s41440-022-01161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023]
Abstract
Fatty liver has been suggested to be associated with the development of hypertension. However, whether this association is related to glycemia has not been elucidated. Therefore, we investigated whether the fatty liver index (FLI) predicts the development of hypertension among individuals with and without dysglycemia in a general Japanese population. A total of 3114 participants (1036 males and 2078 females) without hypertension who underwent a Specific Health Checkup in the fiscal year 2013 were followed up until 2018. The participants were divided into six groups based on FLI tertiles (low, moderate, or high) and whether they had dysglycemia. We estimated the hazard ratios (HRs) of each group by sex using the Cox proportional hazard model. Models were adjusted for age, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, smoking, and alcohol consumption and further adjusted for systolic blood pressure (SBP). During the mean follow-up period of 2.8 years, 160 of the 3114 participants developed hypertension. Using the low FLI group with normoglycemia as a reference, the HR for incident hypertension was increased in the high FLI group with and without dysglycemia in both sexes after adjusting for confounders, except SBP (HR [95% confidence interval]: male: 1.52 (1.06-2.17) in normoglycemia and 2.05 (1.43-2.92) in dysglycemia, and female: 1.86 (1.43-2.42) in normoglycemia and 2.98 (2.19-4.07) in dysglycemia). Furthermore, in females, this association was observed after adjusting for SBP. We concluded that FLI was independently associated with an increased risk of incident hypertension in individuals with and without dysglycemia.
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Rucker D, Joseph J. Defining the Phenotypes for Heart Failure With Preserved Ejection Fraction. Curr Heart Fail Rep 2022; 19:445-457. [PMID: 36178663 DOI: 10.1007/s11897-022-00582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) imposes a significant burden on society and healthcare. The lack in efficacious therapies is likely due to the significant heterogeneity of HFpEF. In this review, we define various phenotypes based on underlying comorbidities or etiologies, discuss phenotypes arrived at by novel methods, and explore therapeutic targets. RECENT FINDINGS A few studies have used machine learning methods to uncover sub-phenotypes within HFpEF in an unbiased manner based on clinical features, echocardiographic findings, and biomarker levels. We synthesized the literature and propose three broad phenotypes: (1) young, with few comorbidities, usually obese and with low natriuretic peptide levels, (2) obese with substantive cardiometabolic burden and comorbidities and impaired ventricular relaxation, (3) old, multimorbid, with high rates of atrial fibrillation, renal and coronary artery disease, chronic obstructive pulmonary disease, and left ventricular hypertrophy. We also propose potential therapeutic strategies for these phenotypes.
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Affiliation(s)
- Dane Rucker
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research & Information Center, Veterans Affairs Boston Healthcare System, Cardiology Section (111), 1400 VFW Parkway, West Roxbury, Boston, MA, 02132, USA. .,Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
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Olsthoorn L, Vreeken D, Kiliaan AJ. Gut Microbiome, Inflammation, and Cerebrovascular Function: Link Between Obesity and Cognition. Front Neurosci 2021; 15:761456. [PMID: 34938153 PMCID: PMC8685335 DOI: 10.3389/fnins.2021.761456] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity affects 13% of the adult population worldwide and this number is only expected to increase. Obesity is known to have a negative impact on cardiovascular and metabolic health, but it also impacts brain structure and function; it is associated with both gray and white matter integrity loss, as well as decreased cognitive function, including the domains of executive function, memory, inhibition, and language. Especially midlife obesity is associated with both cognitive impairment and an increased risk of developing dementia at later age. However, underlying mechanisms are not yet fully revealed. Here, we review recent literature (published between 2010 and March 2021) and discuss the effects of obesity on brain structure and cognition, with a main focus on the contributions of the gut microbiome, white adipose tissue (WAT), inflammation, and cerebrovascular function. Obesity-associated changes in gut microbiota composition may cause increased gut permeability and inflammation, therewith affecting cognitive function. Moreover, excess of WAT in obesity produces pro-inflammatory adipokines, leading to a low grade systemic peripheral inflammation, which is associated with decreased cognition. The blood-brain barrier also shows increased permeability, allowing among others, peripheral pro-inflammatory markers to access the brain, leading to neuroinflammation, especially in the hypothalamus, hippocampus and amygdala. Altogether, the interaction between the gut microbiota, WAT inflammation, and cerebrovascular integrity plays a significant role in the link between obesity and cognition. Future research should focus more on the interplay between gut microbiota, WAT, inflammation and cerebrovascular function to obtain a better understanding about the complex link between obesity and cognitive function in order to develop preventatives and personalized treatments.
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Affiliation(s)
- Lisette Olsthoorn
- Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Netherlands
| | - Debby Vreeken
- Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Netherlands.,Department of Bariatric Surgery, Vitalys, Rijnstate Hospital, Arnhem, Netherlands
| | - Amanda J Kiliaan
- Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Netherlands
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Abstract
BACKGROUND While obesity is linked with brain atrophy and dementia incidence, associations with regional adiposity are uncertain. Our goal was to determine whether cerebral gray matter volume is related to neck circumference (NC), a measure of regional adiposity having unique relationships with metabolic disorders and cardiovascular disease. METHODS Magnetic resonance imaging and NC were cross-sectionally assessed from 2011 to 2014 in a population-based sample of 2916 men and women in the Korean Genome and Epidemiology Study. RESULTS For men, NC was inversely associated with total and regional gray matter in the frontal, temporal, and occipital lobes after adjusting for age and intracranial brain volume. Associations were especially strong in the presence of diabetes. With further adjustment for indices of body composition and other characteristics, total and frontal gray matter in diabetic men were lowered by 6.1 mL (95% confidence interval: 2.5-9.7, P=0.004) and 2.9 mL (95% confidence interval: 1.0-4.9, P=0.017), respectively, per SD increase in NC (2.3 cm). For men without diabetes, and in all women, associations were less apparent. CONCLUSIONS In men with diabetes, NC was inversely associated with cerebral gray matter volume. The link between neck anthropometry and brain aging in diabetic men warrants further consideration.
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Williams R, Periasamy M. Genetic and Environmental Factors Contributing to Visceral Adiposity in Asian Populations. Endocrinol Metab (Seoul) 2020; 35:681-695. [PMID: 33397033 PMCID: PMC7803598 DOI: 10.3803/enm.2020.772] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/12/2020] [Indexed: 12/20/2022] Open
Abstract
Obesity-associated metabolic illnesses are increasing at an alarming rate in Asian countries. A common feature observed in the Asian population is a higher incidence of abdominal obesity-the "skinny-fat" Asian syndrome. In this review, we critically evaluate the relative roles of genetics and environmental factors on fat distribution in Asian populations. While there is an upward trend in obesity among most Asian countries, it appears particularly conspicuous in Malaysia. We propose a novel theory, the Malaysian gene-environment multiplier hypothesis, which explains how ancestral variations in feast-and-famine cycles contribute to inherited genetic predispositions that, when acted on by modern-day stressors-most notably, urbanization, westernization, lifestyle changes, dietary transitions, cultural pressures, and stress-contribute to increased visceral adiposity in Asian populations. At present, the major determinants contributing to visceral adiposity in Asians are far from conclusive, but we seek to highlight critical areas for further research.
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Affiliation(s)
- Rachel Williams
- Department of Internal Medicine, University of Central Florida (UCF) College of Medicine, Burnett School of Biomedical Sciences, Orlando, FL, USA
| | - Muthu Periasamy
- Department of Internal Medicine, University of Central Florida (UCF) College of Medicine, Burnett School of Biomedical Sciences, Orlando, FL, USA
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Fuse K, Kadota A, Kondo K, Morino K, Fujiyoshi A, Hisamatsu T, Kadowaki S, Miyazawa I, Ugi S, Maegawa H, Miura K, Ueshima H. Liver fat accumulation assessed by computed tomography is an independent risk factor for diabetes mellitus in a population-based study: SESSA (Shiga Epidemiological Study of Subclinical Atherosclerosis). Diabetes Res Clin Pract 2020; 160:108002. [PMID: 31904446 DOI: 10.1016/j.diabres.2020.108002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 12/31/2022]
Abstract
AIMS Ectopic fat accumulation is related to insulin resistance and diabetes mellitus (DM). However, the effect of fatty liver on DM in non-obese individuals has not been clarified. We investigated whether liver fat accumulation assessed by computed tomography (CT) is associated with the incidence of DM. METHODS In a prospective population-based study, 640 Japanese men were followed up for 5 years. The liver to spleen (L/S) ratio of the CT attenuation value was used as the liver fat accumulation index. We calculated the odds ratio (OR) and 95% confidence interval (CI) for the DM incidence of per 1 standard deviation (SD) lower L/S and those of L/S < 1.0 compared with L/S ≥ 1.0, using logistic regression models. RESULTS Both per 1 SD lower L/S and L/S < 1.0 were significantly associated with a risk for DM incidence (1 SD lower L/S: OR = 1.57, 95%CI = 1.14-2.16; L/S < 1.0: OR = 2.27, 95%CI = 1.00-5.14). The relationship between L/S and incidence of DM was consistent in the obese and non-obese groups, with thresholds of BMI 25 kg/m2, waist circumference 85 cm, or visceral adipose tissue 100 cm2. CONCLUSIONS Liver fat accumulation assessed by CT was associated with the incidence of DM.
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Affiliation(s)
- Keiko Fuse
- Department of Medicine, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan; Department of Public Health, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Akira Fujiyoshi
- Department of Hygiene, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan; Department of Public Health, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan; Department of Public Health, Shiga University of Medical Science, Seta, Tsukinowa, Otsu, Shiga 520-2192, Japan.
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