1
|
Mohan V, Manasa VS, Abirami K, Unnikrishnan R, Gayathri R, Geetha G, RamyaBai M, Padmavathi S, Rajalakshmi M, Pradeepa R, Anjana RM, Krishnaswamy K, Sudha V. Effect of Replacing Sucrose in Beverages with Nonnutritive Sweetener Sucralose on Cardiometabolic Risk Factors Among Asian Indian Adults with Type 2 Diabetes: A 12-Week Randomized Controlled Trial. Diabetes Ther 2024:10.1007/s13300-024-01622-6. [PMID: 39046696 DOI: 10.1007/s13300-024-01622-6] [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] [Received: 05/15/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Country-specific evidence-based research is crucial for understanding the role of nonnutritive sweeteners (NNS) in managing type 2 diabetes (T2D). The main aim of this study was to explore the effect of replacing sucrose with sucralose in coffee/tea in Asian Indians with type 2 diabetes (T2D). METHODS This 12-week, parallel-arm randomized controlled trial included 210 participants with T2D, assigned to the intervention group, where sugar/sucrose in coffee or tea was substituted with sucralose, or the control group, where sugar/sucrose was continued. Lifestyle factors remained unchanged. The primary outcome was change in HbA1c. Secondary outcomes were changes in body weight (BW), body mass index (BMI), waist circumference (WC), lipid profiles, and inflammatory markers. RESULTS At the end of 12 weeks, no change was observed in HbA1c, fasting plasma glucose, lipid profile, and inflammatory markers between or within groups. There was a small but significant reduction in BW (- 0.5 kg [95% CI - 1.0, - 0.1]; p = 0.02), BMI (- 0.2 kg/m2 [- 0.4, 0.0]; p = 0.03), and WC (- 0.8 cm [- 1.4, - 0.3]; p = 0.002) in the intervention group. Improvements were also observed in lipid accumulation product (p = 0.01), visceral adiposity index (p = 0.04), triglyceride/glucose index (p = 0.04), total energy intake (p = 0.04), and carbohydrate intake (p < 0.0001). CONCLUSIONS In Asian Indians with T2D, replacing about 60 kcal of added sucrose with sucralose in coffee/ tea had no benefit on glycemia but resulted in a small reduction in body weight, body mass index, and waist circumference. TRIAL REGISTRATION Clinical Trials Registry of India (CTRI/2021/04/032686).
Collapse
Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research on Diabetes) and Dr Mohan's Specialities Centre (IDF Centre of Excellence in Diabetes Care), Chennai, 600086, India.
| | - Valangaiman Sriram Manasa
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
- Department of Biochemistry, University of Madras, Chennai, Tamil Nadu, India
| | - Kuzhandaivelu Abirami
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research on Diabetes) and Dr Mohan's Specialities Centre (IDF Centre of Excellence in Diabetes Care), Chennai, 600086, India
| | - Rajagopal Gayathri
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Gunasekaran Geetha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mookambika RamyaBai
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Soundararajan Padmavathi
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Marimuthu Rajalakshmi
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Biochemistry, University of Madras, Chennai, Tamil Nadu, India
- Department of Research Operations and Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation (ICMR Centre for Advanced Research on Diabetes) and Dr Mohan's Specialities Centre (IDF Centre of Excellence in Diabetes Care), Chennai, 600086, India
| | - Kamala Krishnaswamy
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vasudevan Sudha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
2
|
Islam MT, Khan MAAM, Rahman S, Kibria KMK. Genetic association of novel SNPs in HK-1 (rs201626997) and HK-3 (rs143604141) with type 2 diabetes mellitus in Bangladeshi population. Gene 2024; 914:148409. [PMID: 38527673 DOI: 10.1016/j.gene.2024.148409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Hexokinase, a key enzyme in glycolysis, has isoforms like HK-1, HK-2, HK-3, and Glucokinase. Unpublished exome sequencing data showed that two novel polymorphisms in HK-1 rs201626997 (G/T) and HK-3 rs143604141 (G/A) exist in the Bangladeshi population. We investigated the possible relationship of these SNPs with T2DM. MATERIALS AND METHODS Peripheral blood samples from the study participants were used to isolate their genomic DNA. An allele-specific PCR was standardized that can discriminate between the wild-type and mutant-type alleles of HK-1 (rs201626997) and HK-3 (rs143604141) polymorphisms. The data was analyzed by SPSS for statistics. RESULTS We performed allele-specific PCR for 249 diabetic patients and 195 control samples. For HK-1 (rs201626997), 24 (5.4%) have a mutant allele, and for HK-3 (rs143604141), 25 (5.6%) are mutant. There is no significant relationship between the individuals' disease condition and the HK-1 polymorphism (P value 0.537). But the GA genotype of the HK-3 rs143604141 pertains to an increased risk of diabetes (P value 0.039). HK-3 rs143604141 polymorphism has a moderate correlation (P value 0.078, OR, 3.11, 95% CI, 0.88-10.94) with a family diabetic history. Both polymorphisms showed no significant correlation with gender or BMI. However, hexokinase-1 polymorphism significantly related with diastolic blood pressure (P value 0.048). CONCLUSION This study will help us to easily detect the polymorphisms of HK-1 (rs201626997) and HK-3 (rs143604141) in different populations of the world. Further studies with a greater number of participants and more physiological information are required to better understand the underlying genetic causes of T2DM susceptibility in Bangladesh.
Collapse
Affiliation(s)
- Md Tarikul Islam
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Md Abdullah Al Mamun Khan
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Shahidur Rahman
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh; Department of Biochemistry and Biotechnology, Khwaja Yunus Ali University, Sirajganj-6751, Bangladesh
| | - K M Kaderi Kibria
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh.
| |
Collapse
|
3
|
Martemucci G, Khalil M, Di Luca A, Abdallah H, D’Alessandro AG. Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions. Metabolites 2024; 14:327. [PMID: 38921462 PMCID: PMC11206163 DOI: 10.3390/metabo14060327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.
Collapse
Affiliation(s)
| | - Mohamad Khalil
- Clinica Medica “A. Murri”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari Medical School, 70121 Bari, Italy;
| | - Alessio Di Luca
- Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (A.D.L.); (A.G.D.)
| | - Hala Abdallah
- Clinica Medica “A. Murri”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari Medical School, 70121 Bari, Italy;
| | | |
Collapse
|
4
|
Gami A, Bisht S, Satish P, Blaha MJ, Patel J. The utility of coronary artery calcium scoring to enhance cardiovascular risk assessment for South Asian adults. Prog Cardiovasc Dis 2024; 84:7-13. [PMID: 38723928 DOI: 10.1016/j.pcad.2024.05.001] [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: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
South Asian individuals represent a highly diverse population and are one of the fastest growing ethnic groups in the United States. This population has a high prevalence of traditional and non-traditional cardiovascular disease (CVD) risk factors and a disproportionately high prevalence of coronary heart disease. To reflect this, current national society guidelines have designated South Asian ancestry as a "risk enhancing factor" which may be used to guide initiation or intensification of statin therapy. However, current methods of assessing cardiovascular risk in South Asian adults may not adequately capture the true risk in this diverse population. Coronary artery calcium (CAC) scoring provides a reliable, reproducible, and highly personalized method to provide CVD risk assessment and inform subsequent pharmacotherapy recommendations, if indicated. This review describes the utility of CAC scoring for South Asian individuals.
Collapse
Affiliation(s)
- Abhishek Gami
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Baltimore, MD, USA
| | - Sushrit Bisht
- Anne Arundel Medical Center, Department of Internal Medicine, Annapolis, MD, USA
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, TX, USA
| | - Michael J Blaha
- South Asian Cardiovascular Health Initiative (SACHI), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Jaideep Patel
- South Asian Cardiovascular Health Initiative (SACHI), Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
| |
Collapse
|
5
|
Tang ASP, Tan C, Lim WH, Ng CH, Tan DJH, Zeng R, Xiao J, Ong EYH, Cho E, Chung C, Lim WS, Chee D, Nah B, Tseng M, Syn N, Bonney G, Liu K, Huang DQ, Muthiah M, Siddiqui MS, Tan EXX. Impact of Pretransplant Diabetes on Outcomes After Liver Transplantation: An Updated Meta-analysis With Systematic Review. Transplantation 2024; 108:1157-1165. [PMID: 37899382 DOI: 10.1097/tp.0000000000004840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes. METHODS A search was conducted in Medline and Embase databases for articles comparing the post-transplant outcomes between patients with and without pre-LT DM. Pairwise analysis using random effects with hazard ratios (HRs) was used to assess the longitudinal post-LT impacts of pre-LT DM. In the absence of HR, pooled odds ratios analysis was conducted for secondary outcomes. RESULTS Forty-two studies involving 77,615 LT recipients were included in this analysis. The pooled prevalence of pre-LT DM amongst LT recipients was 24.79%. Pre-LT DM was associated with significantly lower overall survival (HR, 0.65; 95% confidence interval, 0.52-0.81; P <0.01) and significantly increased cardiovascular disease-related mortality (HR, 1.78; 95% confidence interval, 1.11-2.85; P =0.03). Meta-regression of other patient characteristics identified Asian ethnicity and hypertension to be significant predictors of worse overall survival, whereas African-American ethnicity was associated with significantly improved overall survival in patients with pre-LT DM. Further analysis of secondary outcomes revealed pre-LT DM to be a significant predictor of post-LT cardiovascular events and end-stage renal disease. CONCLUSIONS The present study illustrates the impact of pre-LT DM on post-LT survival, and cardiovascular and renal outcomes and provides a sound basis for revision of preoperative management of pre-LT DM.
Collapse
Affiliation(s)
- Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rebecca Zeng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elden Yen Hng Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elina Cho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charlotte Chung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Shyann Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Douglas Chee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Michael Tseng
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Glenn Bonney
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Ken Liu
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Eunice X X Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| |
Collapse
|
6
|
Rivera FB, Bantayan NRB, Aparece JP, Cruz LLA, Magallong JV, Pine PL, Idian-Javier AMN, Lumbang GNO, Lerma EV, Lara-Breitinger KM, Gulati M, Vijayaraghavan K. Sex, racial, ethnic, and geographical disparities in major adverse cardiovascular outcome of glucagon-like peptide-1 receptor agonists among patients with and without diabetes mellitus: A meta-analysis of placebo-controlled randomized controlled trials. J Clin Lipidol 2024:S1933-2874(24)00047-3. [PMID: 38906751 DOI: 10.1016/j.jacl.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been pivotal in the management of type 2 diabetes mellitus (T2DM) and in the reduction of major adverse cardiovascular events (MACE). Notably, large cardiovascular outcomes trials (CVOTs) demonstrate significant disparities in inclusion, based on sex, race, ethnicity, and geographical regions. OBJECTIVES We examined the impact of GLP-1RA on MACE in patients with or without T2DM, based on sex, race, ethnicity, and geography. METHODS A literature search for placebo controlled RCTs on GLP-1RA treatment was conducted. Thorough data extraction and quality assessment were carried out, focusing on key outcome, and ensuring a robust statistical analysis using a random effects model to calculate log odds ratio with 95% confidence intervals (CIs). RESULTS A total of 8 CVOTs comprising 71,616 patients were included. Compared with placebo, GLP-1RAs significantly reduced MACE in both sexes (females: logOR -0.19, (95% CI, -0.28 to -0.10), p < 0.01] versus males: logOR -0.17, 95% CI, -0.23 to -0.10), p < 0.01], (p interaction NS)], and among Asians (logOR -34 (95% CI, -0.53 to -0.15, p < 0.01), and Whites (logOR -17 (95% CI, -0.25 to -0.09, p < 0.01), with no difference in MACE among Blacks and Hispanics. Odds of MACE were also reduced in Asia (logOR -31 (95% CI, -0.50 to -0.11, p < 0.01), and Europe (logOR -27 (95% CI, -0.40 to -0.13, p < 0.01), but there was no statistical difference in MACE in North America and Latin America. CONCLUSION Significant reductions in MACE with GLP-1RA treatment were demonstrated between both sexes and across certain ethnicities and certain geographical regions.
Collapse
Affiliation(s)
| | - Nathan Ross B Bantayan
- University of the Philippines College of Medicine, Manila, Philippines (Drs Bantayan and Cruz)
| | - John Paul Aparece
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA (Drs Aparece and Magallong)
| | - Linnaeus Louisse A Cruz
- University of the Philippines College of Medicine, Manila, Philippines (Drs Bantayan and Cruz)
| | - John Vincent Magallong
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA (Drs Aparece and Magallong)
| | - Polyn Luz Pine
- AteneoSchool of Medicine and Public Health, Pasig, Philippines (Drs Pine and Idian-Javier)
| | | | | | - Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA (Dr Lerma)
| | - Kyla M Lara-Breitinger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, (MN), USA (Dr Lara-Breitinger)
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA (Dr Gulati)
| | | |
Collapse
|
7
|
Venkatesan U, Amutha A, Jones AG, Shields BM, Anjana RM, Unnikrishnan R, Mappillairaju B, Mohan V. Performance of European prediction models for classification of type 1 and type 2 diabetes in Indians. Diabetes Metab Syndr 2024; 18:103007. [PMID: 38636306 DOI: 10.1016/j.dsx.2024.103007] [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: 08/25/2023] [Revised: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
AIM We aimed to determine the performance of European prediction models in an Indian population to classify type 1 diabetes(T1D) and type 2 diabetes(T2D). METHODS We assessed discrimination and calibration of published models of diabetes classification, using retrospective data from electronic medical records of 83309 participants aged 18-50 years living in India. Diabetes type was defined based on C-peptide measurement and early insulin requirement. Models assessed combinations of clinical measurements: age at diagnosis, body mass index(mean = 26.6 kg/m2), sex(male = 64.9 %), Glutamic acid decarboxylase(GAD) antibody, serum cholesterol, serum triglycerides, and high-density lipoprotein(HDL) cholesterol. RESULTS 67955 participants met inclusion criteria, of whom 0.8 % had T1D, which was markedly lower than model development cohorts. Model discrimination for clinical features was broadly similar in our Indian cohort compared to the European cohort: area under the receiver operating characteristic curve(AUC ROC) was 0.90 vs. 0.90 respectively, but was lower in the subset of young participants with measured GAD antibodies(n = 2404): and an AUC ROC of 0.87 when clinical features, sex, lipids and GAD antibodies were combined. All models substantially overestimated the likelihood of T1D, reflecting the lower prevalence of T1D in the Indian population. However, good model performance was achieved after recalibration by updating the model intercept and slope. CONCLUSION Models for diabetes classification maintain the discrimination of T1D and T2D in this Indian population, where T2D is far more common, but require recalibration to obtain appropriate model probabilities. External validation and recalibration are needed before these tools can be used in non-European populations.
Collapse
Affiliation(s)
- Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India.
| | | | - Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| | - Bagavandas Mappillairaju
- Centre for Statistics, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; Dr. Mohan's Diabetes Specialties Centre, Chennai, Tamil Nadu, India
| |
Collapse
|
8
|
Yuan L, Verhoeven A, Blomberg N, van Eyk HJ, Bizino MB, Rensen PCN, Jazet IM, Lamb HJ, Rabelink TJ, Giera M, van den Berg BM. Ethnic Disparities in Lipid Metabolism and Clinical Outcomes between Dutch South Asians and Dutch White Caucasians with Type 2 Diabetes Mellitus. Metabolites 2024; 14:33. [PMID: 38248836 PMCID: PMC10819672 DOI: 10.3390/metabo14010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) poses a higher risk for complications in South Asian individuals compared to other ethnic groups. To shed light on potential mediating factors, we investigated lipidomic changes in plasma of Dutch South Asians (DSA) and Dutch white Caucasians (DwC) with and without T2DM and explore their associations with clinical features. Using a targeted quantitative lipidomics platform, monitoring over 1000 lipids across 17 classes, along with 1H NMR based lipoprotein analysis, we studied 51 healthy participants (21 DSA, 30 DwC) and 92 T2DM patients (47 DSA, 45 DwC) from the MAGNetic resonance Assessment of VICTOza efficacy in the Regression of cardiovascular dysfunction in type 2 dIAbetes mellitus (MAGNA VICTORIA) study. This comprehensive mapping of the circulating lipidome allowed us to identify relevant lipid modules through unbiased weighted correlation network analysis, as well as disease and ethnicity related key mediatory lipids. Significant differences in lipidomic profiles, encompassing various lipid classes and species, were observed between T2DM patients and healthy controls in both the DSA and DwC populations. Our analyses revealed that healthy DSA, but not DwC, controls already exhibited a lipid profile prone to develop T2DM. Particularly, in DSA-T2DM patients, specific lipid changes correlated with clinical features, particularly diacylglycerols (DGs), showing significant associations with glycemic control and renal function. Our findings highlight an ethnic distinction in lipid modules influencing clinical outcomes in renal health. We discover distinctive ethnic disparities of the circulating lipidome and identify ethnicity-specific lipid markers. Jointly, our discoveries show great potential as personalized biomarkers for the assessment of glycemic control and renal function in DSA-T2DM individuals.
Collapse
Affiliation(s)
- Lushun Yuan
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Aswin Verhoeven
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Niek Blomberg
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Huub J. van Eyk
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Maurice B. Bizino
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.B.B.); (H.J.L.)
| | - Patrick C. N. Rensen
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Ingrid M. Jazet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (H.J.v.E.); (I.M.J.)
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.B.B.); (H.J.L.)
| | - Ton J. Rabelink
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.V.); (N.B.); (M.G.)
| | - Bernard M. van den Berg
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.Y.); (P.C.N.R.); (T.J.R.)
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
9
|
Kanaya AM. Diabetes in South Asians: Uncovering Novel Risk Factors With Longitudinal Epidemiologic Data: Kelly West Award Lecture 2023. Diabetes Care 2024; 47:7-16. [PMID: 38117990 PMCID: PMC10733655 DOI: 10.2337/dci23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/03/2023] [Indexed: 12/22/2023]
Abstract
South Asian populations have a higher prevalence and earlier age of onset of type 2 diabetes and atherosclerotic cardiovascular diseases than other race and ethnic groups. To better understand the pathophysiology and multilevel risk factors for diabetes and cardiovascular disease, we established the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study in 2010. The original MASALA study cohort (n = 1,164) included 83% Asian Indian immigrants, with an ongoing expansion of the study to include individuals of Bangladeshi and Pakistani origin. We have found that South Asian Americans in the MASALA study had higher type 2 diabetes prevalence, lower insulin secretion, more insulin resistance, and an adverse body composition with higher liver and intermuscular fat and lower lean muscle mass compared with four other U.S. race and ethnic groups. MASALA study participants with diabetes were more likely to have the severe hyperglycemia subtype, characterized by β-cell dysfunction and lower body weight, and this subtype was associated with a higher incidence of subclinical atherosclerosis. We have found several modifiable factors for cardiometabolic disease among South Asians including diet and physical activity that can be influenced using specific social network members and with cultural adaptations to the U.S. context. Longitudinal data with repeat cardiometabolic measures that are supplemented with qualitative and mixed-method approaches enable a deeper understanding of disease risk and resilience factors. Studying and contrasting Asian American subgroups can uncover the causes for cardiometabolic disease heterogeneity and reveal novel methods for prevention and treatment.
Collapse
Affiliation(s)
- Alka M. Kanaya
- Division of General Internal Medicine, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
10
|
Ahmed N, Islam NS. The Health Implications of Perceived Anti-Muslim Discrimination Among South Asian Muslim Americans. AJPM FOCUS 2023; 2:100139. [PMID: 37928060 PMCID: PMC10624581 DOI: 10.1016/j.focus.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Introduction Anti-Muslim discrimination in the U.S. has increased exponentially since 2001, but the impact of anti-Muslim discrimination has yet to be fully examined because of limited data available on this topic and population. The objectives of this study were to (1) examine the association between perceived anti-Muslim discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans and (2) examine the association between other forms of perceived discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans. Methods Data were collected using an online survey, which was disseminated on subscriber e-mail lists for organizations that serve South Asian or Muslim communities. Participants were asked about perceived discrimination, depressive symptoms, diet, physical activity, tobacco use, and alcohol consumption. Data were analyzed using structural equation modeling in Mplus 8. Results Societal anti-Muslim discrimination had a positive association with depressive symptoms (0.19, p<0.05), as did interpersonal anti-Muslim discrimination (0.20, p<0.05) and other forms of discrimination (0.22, p<0.05). None of the discrimination scales were associated with dietary patterns, tobacco use, or alcohol consumption. Conclusions Study results demonstrated a link between discrimination and depressive symptoms. Further research is needed to examine associations with other adverse health outcomes and potential buffers against discrimination.
Collapse
Affiliation(s)
- Naheed Ahmed
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
| | - Nadia S. Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York
| |
Collapse
|
11
|
Deshmukh V, Chaudhury T, Chadha M, Chawla M, Mukherjee S, Pitale S, Basu D, Gadekar A, Menon S, Trivedi C, Salvi V, Ramakrishnan S, Goyal G. LIVE INDIA: Effectiveness of Gla-100 in a Post hoc Pooled Analysis of FINE ASIA and GOAL Registries. Diabetes Ther 2023; 14:2075-2088. [PMID: 37789213 PMCID: PMC10597908 DOI: 10.1007/s13300-023-01469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Real-world evidence on insulin glargine 100 U/ml (Gla-100) initiation in Indian type 2 diabetes mellitus (T2DM) individuals is limited. The present study aimed to evaluate the effectiveness of Gla-100 in insulin-naïve T2DM participants from India. METHODS This post hoc analysis includes real-world data of insulin-naïve Indian participants with T2DM who started Gla-100 treatment in two Asian registries: FINE ASIA and GOAL. Changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, insulin dose, and incidence of hypoglycemia from baseline to 6 months were assessed. RESULTS A total of 955 participants with T2DM were identified and analyzed. The mean [standard deviation (SD)] age and duration of diabetes were 54.7 (9.8) years and 9.8 (6.3) years, respectively. Mean HbA1c and FPG were significantly reduced after 6 months of Gla-100 treatment [- 2.07 (1.4) %; - 94.4 (65.2) mg/dl, respectively]. HbA1c targets of < 7.0% and < 7.5% were achieved by 292 (30.6%) and 589 (61.7%) study participants, respectively. The overall incidence of hypoglycemia was low (n = 52; 5.4%); only two participants (0.2%) reported severe hypoglycemia. Insulin was titrated with a mean (SD) increment of 2.5 (5.6) U/day after 6 months, leading to a mean Gla-100 dose of 18.2 (8.9) U/day. Mean body weight remained unchanged from baseline to 6 months (- 0.1 kg). CONCLUSION In routine clinical practice, Gla-100 significantly improved glycemic parameters after 6 months of treatment with a low risk of hypoglycemia and no weight change in participants with T2DM.
Collapse
Affiliation(s)
- Vaishali Deshmukh
- Deshmukh Clinic and Research Centre, Second Floor, Pinnacle Prestige, Landmark: Next to Durvankur Hotel, Near Cosmos Bank, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune, Maharashtra, 411030, India.
| | | | - Manoj Chadha
- P.D. Hinduja Hospital and Research Centre, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Ghanshyam Goyal
- S K Diabetes Research and Education Centre, S V S Marwari Hospital Campus, Kolkata, India
| |
Collapse
|
12
|
Choy KYC, Louie JCY. The effects of the ketogenic diet for the management of type 2 diabetes mellitus: A systematic review and meta-analysis of recent studies. Diabetes Metab Syndr 2023; 17:102905. [PMID: 38006799 DOI: 10.1016/j.dsx.2023.102905] [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: 07/31/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To systematically review the effects of the ketogenic diet on glycaemic control, body weight, cardiovascular risk factors, and liver and kidney function in patients with type 2 diabetes. METHODS PubMed, MEDLINE, Embase, Cochrane Library and CINAHL were searched for randomised controlled trials published between 2001 and 2021 that compared the ketogenic diet to a control diet for effects on glycaemic control, body weight, cardiovascular risk factors, liver and renal function markers in adults with type 2 diabetes for >14 days. Meta-analyses using fixed or random effects models were conducted. RESULTS Nineteen reports from 11 randomised controlled trials were included. Compared to the control, the ketogenic diet showed no significant difference in changes in glycaemic control or body weight, but greater increases in HDL (standardised mean difference 0.19; 95%CI 0.02-0.37; I2 = 0 %; moderate-quality evidence) and greater reductions in triglycerides (standardised mean difference -0.41; 95%CI -0.64 to -0.18; I2 = 0 %; low-quality evidence). CONCLUSIONS The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.
Collapse
Affiliation(s)
- Kimberley Yu Ching Choy
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China
| | - Jimmy Chun Yu Louie
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong SAR, China; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.
| |
Collapse
|
13
|
Barbour W, Wolff E, Puar P, Hibino M, Bakbak E, Krishnaraj A, Verma R, Verma M, Quan A, Yan AT, Connelly KA, Teoh H, Mazer CD, Verma S. Effect of empagliflozin on cardiac remodelling in South Asian and non-South Asian individuals: insights from the EMPA-HEART CardioLink-6 randomised clinical trial. BMC Cardiovasc Disord 2023; 23:557. [PMID: 37964221 PMCID: PMC10648366 DOI: 10.1186/s12872-023-03549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND This exploratory sub-analysis of the EMPA-HEART CardioLink-6 trial examined whether the previously reported benefit of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) mass (LVM) regression differs between individuals of South Asian and non-South Asian ethnicity. METHODS EMPA-HEART CardioLink-6 was a double-blind, placebo-controlled clinical trial that randomised 97 individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to either empagliflozin 10 mg daily or placebo for 6 months. LV parameters and function were assessed using cardiac magnetic resonance imaging. The 6-month changes in LVM and LV volumes, all indexed to baseline body surface area, for South Asian participants were compared to those for non-South Asian individuals. RESULTS Compared to the non-South Asian group, the South Asian sub-cohort comprised more males, was younger and had a lower median body mass index. The adjusted difference for LVMi change over 6 months was -4.3 g/m2 (95% confidence interval [CI], -7.5, -1.0; P = 0.042) for the South Asian group and -2.3 g/m2 (95% CI, -6.4, 1.9; P = 0.28) for the non-South Asian group (Pinteraction = 0.45). There was no between-group difference for the adjusted differences in baseline body surface area-indexed LV volumes and LV ejection fraction. CONCLUSIONS There was no meaningful difference in empagliflozin-associated LVM regression between South Asian and non-South Asian individuals living with T2DM and CAD in the EMPA-HEART CardioLink-6 trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02998970 (First posted on 21/12/ 2016).
Collapse
Affiliation(s)
- William Barbour
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, N6A 5C1, Canada
| | - Erika Wolff
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- School of Medicine, University College Cork, Cork, T12 K8AF, Ireland
| | - Pankaj Puar
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ehab Bakbak
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Aishwarya Krishnaraj
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Raj Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, D02 YN77, Ireland
| | - Meena Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andrew T Yan
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - C David Mazer
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, M5B 1W8, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada.
| |
Collapse
|
14
|
Mondal S, Kopalle LN, Nagendra L, Jacob J, Shaikh S, Shrestha D, Selim S, Somasundaram NP, Raza SA, Naseri MW, Bhattacharya S, Kalra S. Monitoring Endocrine Nursing in South Asia (MENSA). Indian J Endocrinol Metab 2023; 27:559-566. [PMID: 38371180 PMCID: PMC10871020 DOI: 10.4103/ijem.ijem_236_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 02/20/2024] Open
Abstract
Background South Asian countries face the colossal challenge of tackling the massive burden of diabetes and other endocrine disorders. These patients grossly outnumber the specialists trained to deal with these conditions. A trained cadre of diabetes specialist nurses (DSN) and endocrine specialist nurses (ESN) might help bridge this gap. Exploring the perception of DSN/ESN among South Asian doctors will help to understand their role, responsibilities and future prospects. Methods One hundred and seventy-four endocrinologists from South Asia participated in an online survey on their perception of DSNs and ESNs. Results Out of the 174 respondents, 61 (35%) were currently working with DSN/ESN, 79 (45.4%) had worked in the past and 131 (75.2%) were willing to start recruiting or employ additional DSN/ESN in the future. The majority considered that the primary function of DSN and ESN is to educate on diabetes (n = 86, 96.6%) and endocrine disorders (n = 34, 57.6%), respectively, followed by anthropometry and initial work-up. Only a small minority felt they could write independent follow-up prescriptions (nurse-led clinics) [DSN - 16 (18%) and ESN - 3 (5.1%)]. Graduation with a certificate course in diabetes and basic endocrinology was considered a sufficient qualification by 68 (39.1%) respondents. Endocrinologists from countries other than India were more willing to recruit ESN/DSN in the future (89.7% vs 72.4%; P < 0.03) and approve a nurse-led clinic (62.1% vs 29.7%; P < 0.03). Upon multiple logistic regression, working in countries other than India was an independent predictor of future willingness to work with DSN/ESN (odds ratio (OR): 4.48, 95% confidence interval (CI) 1.09-18.43, P = 0.03). Conclusion DSN and ESN could facilitate the management of healthcare-seekers with diabetes and endocrine disorders. A certification course to train nurses on diabetes and basic endocrine disorders following graduation could be helpful. Major hindrances in creating a regular cadre of DSN/ESN were limited opportunities for career progression and lack of additional remuneration for services.
Collapse
Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Nil Ratan Sarkar Medical College, Kolkata, India
| | | | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Jubbin Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, India
| | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai, India
| | - Dina Shrestha
- Consultant Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Syed Abbas Raza
- Consultant Endocrinologist, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Wali Naseri
- Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Saptarshi Bhattacharya
- Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| |
Collapse
|
15
|
Bhattacharya S, Kalra S. ADA-EASD Consensus Report on the Management of Hyperglycaemia in Type 2 Diabetes in an Afro-Asian Context: Broadening the Perspective. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:4-6. [PMID: 38187081 PMCID: PMC10769473 DOI: 10.17925/ee.2023.19.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/16/2023] [Indexed: 01/09/2024]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes consensus statement 2022 effectively captures the changing paradigm of modern diabetes care. As emphasized in the guidelines, a person-centered decision cycle focusing on preventing complications and improving quality of life is the driving principle behind modern diabetes management. Other notable features of the document are its emphasis on self-management education, therapeutic behaviour, sleep hygiene, nonalcoholic fatty liver disease and weight loss. Focus on individualization of care, social determinants of health, and ethnic variations are pertinent from an Afro-Asian perspective. The "language matters" section is a welcome addition that will help to overcome several barriers in diabetes care.
Collapse
Affiliation(s)
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
- University Center for Research & Development, Chandigarh University, Mohali, Punjab, India
| |
Collapse
|
16
|
Nield L, Bhanbhro S, Steers H, Young A, Fowler Davis S. Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England. Healthcare (Basel) 2023; 11:2499. [PMID: 37761696 PMCID: PMC10530582 DOI: 10.3390/healthcare11182499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
The Voluntary, Community and Social Enterprise (VCSE) sector offers services and leadership within the health and care system in England and has a specialist role in working with underserved, deprived communities. This evaluation aims to identify best practices in self-management support for those living with type 2 diabetes mellitus (T2DM) and to develop a theory of change (TofC) through understanding the impact of VCSE organisations on diabetes management. An appreciative inquiry (AI) was carried out and co-delivered using qualitative interviews and an embedded analysis with VCSE partners. A voluntary service coordinated seven VCSE organisations who assisted with recruiting their service users and undertook interviews to identify the impact of existing activities and programmes. People living with T2DM were interviewed about services. Themes were as follows: (a) individual and group activities; (b) trusted services and relationships across the community; (c) long-term engagement; (d) sociocultural context of diet and nutritional choices; (e) experience of adaptation; and (f) culturally appropriate advice and independent VCSE organisations. The structured educational approach (DESMOND) for T2DM was accessed variably, despite these services being recommended by NICE guidelines as a standard intervention. The VCSE offered continuity and culturally appropriate services to more marginalised groups. This evaluation highlights the importance of targeted engagement with underserved communities, particularly where primary care services are more limited. The TofC is a unique insight into the impact of VCSE services, offering bespoke support to manage T2DM, suggesting areas for improvements in capacity and offering the capability to sustain the VCSE sector as an essential element of the T2DM care pathway in England.
Collapse
Affiliation(s)
- Lucie Nield
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Sadiq Bhanbhro
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Helen Steers
- Voluntary Action Sheffield, Sheffield S1 4FW, UK;
| | - Anna Young
- Sheffield Hallam University Health Centre, Sheffield S1 1WB, UK;
| | - Sally Fowler Davis
- School of Allied Health, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| |
Collapse
|
17
|
Wan CS, Rawat P, Gulyani P, Elmi Y, Ng AH. Dietary management of type 2 diabetes mellitus among South Asian immigrants: A mixed-methods study. Nutr Diet 2023; 80:413-424. [PMID: 37271927 DOI: 10.1111/1747-0080.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
AIMS There is a high prevalence of South Asian immigrants in Australia living with type 2 diabetes mellitus, with the dietary management of the condition presenting as a key challenge. However, their current dietary patterns and barriers to diabetes self-management are unclear. Therefore, this study aims to (i) investigate current dietary patterns and (ii) explore barriers and facilitators to dietary management in this population. METHODS A concurrent mixed-methods study comprising three 24-h dietary recalls and a semi-structured interview for each self-identified South Asian immigrant adult with diabetes recruited across Victorian primary care clinics and social media to address the aforementioned two aims. Dietary recall data were converted into food groups using Foodworks, and data analysed in SPSS. Qualitative data were thematically analysed using NVivo. RESULTS Among 18 participants recruited, 14, 16 and 17 participants had grain, fruit and dairy intake lower than daily Australian recommendations, respectively. These findings echoed qualitative data that participants viewed diabetes management as reducing carbohydrate intake. Participants reported difficulties incorporating diabetes-related dietary and lifestyle recommendations into their routine and a lack of knowledge about available organisational support. They mentioned challenges in receiving social support from families and friends and relied on support from health professionals. Facilitators included proficiency in nutrition information label reading and self-blood glucose monitoring skills. CONCLUSION Enhancing the accessibility to organisational support, facilitating the adaption of dietary recommendations into individuals' routines, and strengthening support from health professionals are essential components in intervention development to improve diabetes management for South Asians.
Collapse
Affiliation(s)
- Ching Shan Wan
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Victoria, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | | | - Purva Gulyani
- Diet Yumm, Craigieburn, Victoria, Australia
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Yusra Elmi
- Diet Yumm, Craigieburn, Victoria, Australia
| | - Ashley H Ng
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Zakharova N, Luo C, Aringazina R, Samusenkov V. The efficacy of L-carnitine in patients with nonalcoholic steatohepatitis and concomitant obesity. Lipids Health Dis 2023; 22:101. [PMID: 37438785 DOI: 10.1186/s12944-023-01867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND In light of the high prevalence of nonalcoholic fatty liver disease and obesity, treatment options for nonalcoholic steatohepatitis are of particular interest. The purpose of the study is to assess the efficacy of L-carnitine and its effects on the functional state of the liver, as well as on lipid and carbohydrate metabolism in patients with nonalcoholic steatohepatitis and concomitant obesity. METHODS People in the control group followed a hypocaloric diet and received 1 tablet of simvastatin 20 mg once a day and 2 capsules of essential phospholipids 600 mg three times a day for 90 days. People in the experimental group followed a hypocaloric diet and received 1 tablet of simvastatin 20 mg once a day and L-carnitine 10 mL orally two times a day for 90 days. RESULTS L-carnitine normalized the blood lipid profile of subjects, as demonstrated by a significant decrease in the blood levels of total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, and insulin resistance. The use of L-carnitine in patients with nonalcoholic steatohepatitis and concomitant obesity contributes to the steady reduction of the main clinical and biochemical symptoms of nonalcoholic steatohepatitis. CONCLUSIONS L-carnitine produces positive effects on the blood lipid profile and carbohydrate metabolism.
Collapse
Affiliation(s)
- Natalia Zakharova
- Department of Chemistry, I.M. Sechenov First Moscow State Medical University (Sechenov University, Trubetskaya str., 8-2, Moscow, 119991, Russian Federation
| | - Chenguang Luo
- Department of Hospital Therapy named after Academician G.I. Storozhakov of the Medical Faculty, Pirogov Russian National Research Medical University, Ostrovityanova str., 1 , Moscow, 117997, Russian Federation
| | - Raisa Aringazina
- Department of Internal Diseases № 1, Non-Commercial Joint-Stock Society "West Kazakhstan Marat Ospanov Medical University", Aleksey Maresyev str, Aktobe, 030019, Kazakhstan.
| | - Vadim Samusenkov
- Department of Prosthetic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya str., 8-2, Moscow, 119991, Russian Federation
| |
Collapse
|
19
|
Zhang J, Van Spall HG, Li L, Khan MS, Pandey A, Thabane L, Bai X, Wang Y, Lip GY, Li G. Effects of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on cardiovascular and kidney outcomes in Asian versus White patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2023; 17:102804. [PMID: 37315473 DOI: 10.1016/j.dsx.2023.102804] [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] [Received: 01/09/2023] [Revised: 05/08/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The study aimed to assess the treatment effects of the two medications on cardiovascular and kidney outcomes in Asian compared with White patients with type 2 diabetes mellitus (T2DM). METHODS MEDLINE, EMBASE, and CENTRAL were searched up to October 31, 2022. We included the trials that assessed the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus placebo in Asian and White patients with T2DM on major adverse cardiovascular events (MACE) and kidney outcomes. The Bucher method was used to perform an indirect comparison for estimating the differences in treatment effects of GLP-1 RA and SGLT2i between Asian versus White patients. Interaction tests were also performed for treatment-by-race to assess the potential effect modification by race. RESULTS We included 22 publications from 13 randomized trials. For MACE, there were no differences in treatment effects of GLP-1 RA (HR = 0.84, 95% CI: 0.68-1.04) or SGLT2i (HR = 0.90, 95% CI: 0.72-1.13) in Asian versus White patients. No differences in treatment effects of SGLT2i on kidney outcomes in Asian versus White patients were found (HR = 1.01, 95% CI: 0.75-1.36). There was no significant effect modification by race on cardiovascular and kidney outcomes. CONCLUSIONS There were no significant differences in treatment effects of GLP-1 RA or SGLT2i for MACE between Asian and White patients with T2DM. Likewise, no significant differences in treatment effects of SGLT2i on kidney outcomes were found between Asian and White patients.
Collapse
Affiliation(s)
- Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Harriette Gc Van Spall
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | | | - Ambarish Pandey
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Xuerui Bai
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Yaoyao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Sciences at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| |
Collapse
|
20
|
Gulati RK, Husaini M, Dash R, Patel J, Shah NS. Clinical programs for cardiometabolic health for South Asian patients in the United States: A review of key program components. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2023; 7:100093. [PMID: 37275679 PMCID: PMC10237508 DOI: 10.1016/j.hsr.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medical literature shows that South Asians have approximately a 2-fold higher risk of atherosclerotic cardiovascular disease (CVD) compared with other populations. Given this high prevalence, clinical programs to promote cardiovascular health have emerged in the United States that are dedicated to clinical care for South Asian individuals. In this review, we have summarized the key characteristics of clinical programs in the U.S. dedicated to preventing and managing CVD in South Asian American patients. These clinical centers have many unique components in common that are catered to South Asian patient populations including ethnicity concordance of clinical providers, intensive cardiovascular screening protocols with laboratory studies and potentially genetic testing, dieticians and nutritionists who are familiar with South Asian-style dietary patterns, health coaches to support behavior change, community outreach programs, and involvement in clinical research to learn further about risk factors, prevention, and treatment of cardiovascular disease in South Asian populations. There are still many evidence and programmatic gaps left to uncover in the prevention, diagnosis, and management of CVD in South Asian. This review provides guidance for important features, barriers, and facilitators for future cardiovascular centers to develop in the United States where they can serve South Asian populations.
Collapse
Affiliation(s)
- Reeti K. Gulati
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mustafa Husaini
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rajesh Dash
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jaideep Patel
- South Asian Cardiovascular Health Initiative (SACHI) for the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
21
|
Rai SK, Gortmaker SL, Hu FB, Kanaya AM, Kandula NR, Sun Q, Bhupathiraju SN. A South Asian Mediterranean-style diet is associated with favorable adiposity measures and lower diabetes risk: The MASALA cohort. Obesity (Silver Spring) 2023; 31:1697-1706. [PMID: 37203330 PMCID: PMC10204148 DOI: 10.1002/oby.23759] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The Mediterranean diet is associated with lower risks for type 2 diabetes (T2D) and cardiovascular disease in certain populations, although data among diverse groups are limited. This study evaluated cross-sectional and prospective associations between a novel South Asian Mediterranean-style (SAM) diet and cardiometabolic risk among US South Asian individuals. METHODS The study included 891 participants at baseline in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Culturally relevant foods were grouped into nine categories to construct the SAM score. The study examined associations of this score with cardiometabolic risk factors and incident T2D. RESULTS At baseline, higher adherence to the SAM diet was associated with lower glycated hemoglobin (-0.43% ± 0.15% per 1-unit increase in SAM score; p = 0.004) and lower pericardial fat volume (-1.22 ± 0.55 cm3 ; p = 0.03), as well as a lower likelihood of obesity (odds ratio [OR]: 0.88, 95% CI: 0.79-0.98) and fatty liver (OR: 0.82, 95% CI: 0.68-0.98). Over the follow-up (~5 years), 45 participants developed T2D; each 1-unit increase in SAM score was associated with a 25% lower odds of incident T2D (OR: 0.75, 95% CI: 0.59-0.95). CONCLUSIONS A greater intake of a SAM diet is associated with favorable adiposity measures and a lower likelihood of incident T2D.
Collapse
Affiliation(s)
- Sharan K. Rai
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Population Health Sciences, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Alka M. Kanaya
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Namratha R. Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shilpa N. Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
22
|
Vijayan M, Deshpande K, Anand S, Deshpande P. Risk Amplifiers for Vascular Disease and CKD in South Asians: When Intrinsic β-Cell Dysfunction Meets a High-Carbohydrate Diet. Clin J Am Soc Nephrol 2023; 18:681-688. [PMID: 36758530 PMCID: PMC10278793 DOI: 10.2215/cjn.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
South Asians, comprising almost one fourth of the world population, are at higher risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, and CKD compared with other ethnic groups. This has major public health implications in South Asia and in other parts of the world to where South Asians have immigrated. The interplay of various modifiable and nonmodifiable risk factors confers this risk. Traditional models of cardiometabolic disease progression and CKD evaluation may not be applicable in this population with a unique genetic predisposition and phenotype. A wider understanding of dietary and lifestyle influences, genetic and metabolic risk factors, and the pitfalls of conventional equations estimating kidney function in this population are required in providing care for kidney diseases. Targeted screening of this population for metabolic and vascular risk factors and individualized management plan for disease management may be necessary. Addressing unhealthy dietary patterns, promoting physical activity, and medication management that adheres to cultural factors are crucial steps to mitigate the risk of cardiovascular disease and CKD in this population. In South Asian countries, a large rural and urban community-based multipronged approach using polypills and community health workers to decrease the incidence of these diseases may be cost-effective.
Collapse
Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
- Institute for Critical Care Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| | - Kavita Deshpande
- Department of Family Medicine, La Maestra Community Health Centers, San Diego, California
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Priya Deshpande
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at the Mount Sinai Hospital, New York, New York
| |
Collapse
|
23
|
Farhat G. Culturally Tailored Dietary Interventions for Improving Glycaemic Control and Preventing Complications in South Asians with Type 2 Diabetes: Success and Future Implications. Healthcare (Basel) 2023; 11:healthcare11081123. [PMID: 37107956 PMCID: PMC10138081 DOI: 10.3390/healthcare11081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Glycaemic control is the basis of type 2 diabetes mellitus (T2DM) management and is crucial for preventing diabetes microvascular and macrovascular complications. The South Asian population is at higher risk of T2DM and resultant cardiovascular disease, peripheral vascular disease and death compared to Caucasians. Effective diabetes care has been deemed challenging in this population, but little is known about the usefulness of lifestyle interventions in improving glycaemic control and reducing complications. This narrative review aims to explore the efficacy of lifestyle interventions targeted to South Asians with T2DM in inducing clinically relevant improvements in HbA1c levels at such levels that reduce the risk of diabetes complications. A search of the literature using six databases (MEDLINE (EBSCOhost), PubMed, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Scopus) identified dietary-based, physical-activity-based and education-based interventions that aimed to manage T2DM in South Asians. Results showed that dietary and physical activity interventions (duration 3-12 months) have been effective in generating a clinically relevant decrease in HbA1c levels (≥0.5%) in South Asians with T2DM and could potentially assist in reducing diabetes complications. Education-based interventions produced small effects on glycaemic control. These outcomes support the development of comparable longer-term randomised clinical trials combining dietary and physical activity interventions with the aim to provide further evidence on specific interventions that can lower complications and ensure effective diabetes care in a high-risk population.
Collapse
Affiliation(s)
- Grace Farhat
- Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BG, UK
| |
Collapse
|
24
|
Al-Reshed F, Sindhu S, Al Madhoun A, Bahman F, AlSaeed H, Akhter N, Malik MZ, Alzaid F, Al-Mulla F, Ahmad R. Low carbohydrate intake correlates with trends of insulin resistance and metabolic acidosis in healthy lean individuals. Front Public Health 2023; 11:1115333. [PMID: 37006572 PMCID: PMC10061153 DOI: 10.3389/fpubh.2023.1115333] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Both obesity and a poor diet are considered major risk factors for triggering insulin resistance syndrome (IRS) and the development of type 2 diabetes mellitus (T2DM). Owing to the impact of low-carbohydrate diets, such as the keto diet and the Atkins diet, on weight loss in individuals with obesity, these diets have become an effective strategy for a healthy lifestyle. However, the impact of the ketogenic diet on IRS in healthy individuals of a normal weight has been less well researched. This study presents a cross-sectional observational study that aimed to investigate the effect of low carbohydrate intake in healthy individuals of a normal weight with regard to glucose homeostasis, inflammatory, and metabolic parameters. Methods The study included 120 participants who were healthy, had a normal weight (BMI 25 kg/m2), and had no history of a major medical condition. Self-reported dietary intake and objective physical activity measured by accelerometry were tracked for 7 days. The participants were divided into three groups according to their dietary intake of carbohydrates: the low-carbohydrate (LC) group (those consuming <45% of their daily energy intake from carbohydrates), the recommended range of carbohydrate (RC) group (those consuming 45-65% of their daily energy intake from carbohydrates), and the high-carbohydrate (HC) group (those consuming more than 65% of their daily energy intake from carbohydrates). Blood samples were collected for the analysis of metabolic markers. HOMA of insulin resistance (HOMA-IR) and HOMA of β-cell function (HOMA-β), as well as C-peptide levels, were used for the evaluation of glucose homeostasis. Results Low carbohydrate intake (<45% of total energy) was found to significantly correlate with dysregulated glucose homeostasis as measured by elevations in HOMA-IR, HOMA-β% assessment, and C-peptide levels. Low carbohydrate intake was also found to be coupled with lower serum bicarbonate and serum albumin levels, with an increased anion gap indicating metabolic acidosis. The elevation in C-peptide under low carbohydrate intake was found to be positively correlated with the secretion of IRS-related inflammatory markers, including FGF2, IP-10, IL-6, IL-17A, and MDC, but negatively correlated with IL-3. Discussion Overall, the findings of the study showed that, for the first time, low-carbohydrate intake in healthy individuals of a normal weight might lead to dysfunctional glucose homeostasis, increased metabolic acidosis, and the possibility of triggering inflammation by C-peptide elevation in plasma.
Collapse
Affiliation(s)
- Fatema Al-Reshed
- Immunology and Microbiology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Sardar Sindhu
- Animal and Imaging Core Facility, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ashraf Al Madhoun
- Animal and Imaging Core Facility, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Fatemah Bahman
- Immunology and Microbiology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Halemah AlSaeed
- Immunology and Microbiology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nadeem Akhter
- Immunology and Microbiology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Md Zubbair Malik
- Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman, Kuwait
| | - Fawaz Alzaid
- Institute Necker Enfants Malades (INEM), French Institute of Health and Medical Research (INSERM), Immunity and Metabolism of Diabetes (IMMEDIAB), Université de Paris Cité, Paris, France
| | - Fahd Al-Mulla
- Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman, Kuwait
| | - Rasheed Ahmad
- Immunology and Microbiology Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
25
|
Gardner MP, Wang J, Hazlehurst JM, Sainsbury C, Blissett J, Nirantharakumar K, Thomas N, Bellary S. Risk of progression from pre-diabetes to type 2 diabetes in a large UK adult cohort. Diabet Med 2023; 40:e14996. [PMID: 36308066 PMCID: PMC10099224 DOI: 10.1111/dme.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022]
Abstract
AIMS People with pre-diabetes are at high risk of progressing to type 2 diabetes. This progression is not well characterised by ethnicity, deprivation and age, which we describe in a large cohort of individuals with pre-diabetes. METHODS A retrospective cohort study with The Health Improvement Network (THIN) database was conducted. Patients aged 18 years and over and diagnosed with pre-diabetes [HbA1c 42 mmol/mol (6.0%) to 48 mmol/mol (6.5%) were included]. Cox proportional hazards regression was used to calculate adjusted hazard rate ratios (aHR) for the risk of progression from pre-diabetes to type 2 diabetes for each of the exposure categories [ethnicity, deprivation (Townsend), age and body mass index (BMI)] separately. RESULTS Of the baseline population with pre-diabetes (n = 397,853), South Asian (aHR 1.31; 95% CI 1.26-1.37) or Mixed-Race individuals (aHR 1.22; 95% CI 1.11-1.33) had an increased risk of progression to type 2 diabetes compared with those of white European ethnicity. Likewise, deprivation (aHR 1.17; 95% CI 1.14-1.20; most vs. least deprived) was associated with an increased risk of progression. Both younger (aHR 0.63; 95% CI 0.58-0.69; 18 to <30 years) and older individuals (aHR 0.85; 95% CI 0.84-0.87; ≥65 years) had a slower risk of progression from pre-diabetes to type 2 diabetes, than middle-aged (40 to <65 years) individuals. CONCLUSIONS South Asian or Mixed-Race individuals and people with social deprivation had an increased risk of progression from pre-diabetes to type 2 diabetes. Clinicians need to recognise the differing risk across their patient populations to implement appropriate prevention strategies.
Collapse
Affiliation(s)
- Michael P. Gardner
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jingya Wang
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | | - Chris Sainsbury
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | | | | - Neil Thomas
- Institute for Applied Health ResearchUniversity of BirminghamBirminghamUK
| | | |
Collapse
|
26
|
Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
Collapse
Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| |
Collapse
|
27
|
Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
Collapse
Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| |
Collapse
|
28
|
Mohan V, Sudha V, Shobana S, Gayathri R, Krishnaswamy K. Are Unhealthy Diets Contributing to the Rapid Rise of Type 2 Diabetes in India? J Nutr 2023; 153:940-948. [PMID: 36858259 DOI: 10.1016/j.tjnut.2023.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
The prevalence of diabetes is increasing at an alarming rate globally, particularly in India. In the urban areas, the prevalence of diabetes among adults aged ≥20 y, which was around 2% in the early 1970's, has increased by >20% in 50 y. The rapid nutrition transition due to high economic growth rates increased urbanization and globalization has resulted in higher intakes of processed refined grain staples, mainly white rice in Southern and Eastern India and refined wheat in Northern and Western India. This coupled with inadequate quantity and quality of protein; unhealthy fats; lower intake of vegetables, fruits, and fiber; and a sedentary lifestyle are the main drivers of the diabetes epidemic in India. This review attempts to discuss both the quality and quantity of Indian diets with specific reference to macronutrients. This review also outlines some of the strategies that can be employed to slow down the diabetes epidemic in this region. We believe that the lessons learned from India would be applicable to other developing nations as well, particularly to the South East Asian region. J Nutr 2023;xx:xxx.
Collapse
Affiliation(s)
- Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialties Centre, IDF Centre of Diabetes Education, Chennai, Tamil Nadu, India.
| | - Vasudevan Sudha
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Shanmugam Shobana
- Department of Diabetes Food Technology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajagopal Gayathri
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kamala Krishnaswamy
- Department of Foods, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
29
|
Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
Collapse
Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
30
|
Ji L, Liu J, Xu ZJ, Wei Z, Zhang R, Malkani S, Cater NB, Frederich R. Efficacy and Safety of Ertugliflozin Added to Metformin: A Pooled Population from Asia with Type 2 Diabetes and Overweight or Obesity. Diabetes Ther 2023; 14:319-334. [PMID: 36763328 PMCID: PMC9944172 DOI: 10.1007/s13300-022-01345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION The efficacy and safety of ertugliflozin have not been well characterized in Asian populations with type 2 diabetes (T2D) and overweight or obesity as defined by the Chinese Diabetes Society [body mass index (BMI) ≥ 24 kg/m2]. METHODS These post hoc analyses of pooled data from two randomized, double-blind, 26-week studies assessed the efficacy and safety of ertugliflozin (5 mg or 15 mg) compared with placebo in participants from Asia with T2D and baseline BMI ≥ 24 kg/m2, with inadequate glycemic control on metformin. Longitudinal analyses were used to calculate least squares (LS) mean [95% confidence interval (CI)] change from baseline in glycemic indices and body weight. The proportions of participants achieving efficacy targets and experiencing adverse events (AEs) were assessed. RESULTS The 445 participants had a mean age of 55.5 years, T2D duration 6.6 years, glycated hemoglobin (HbA1c) 8.1%, and BMI 27.6 kg/m2. At week 26, placebo-adjusted LS mean (95% CI) changes from baseline for ertugliflozin 5 mg and 15 mg, respectively, were - 0.78% (- 0.95% to - 0.61%) and - 0.80% (- 0.98% to - 0.63%) for HbA1c, and - 1.74 kg (- 2.29 kg to - 1.19 kg) and - 2.04 kg (- 2.60 kg to - 1.48 kg) for body weight. A greater proportion of participants receiving ertugliflozin 5 mg and 15 mg versus placebo, respectively, achieved HbA1c < 7.0% (42.1% and 46.3% vs. 13.9%), body weight reduction ≥ 5% (35.5% and 38.3% vs. 11.1%), and systolic blood pressure < 130 mmHg (42.4% and 34.5% vs. 21.7%). The proportion of participants with AEs was 52.6% (ertugliflozin 5 mg), 52.3% (ertugliflozin 15 mg), and 55.6% (placebo). CONCLUSIONS In participants from Asia with T2D inadequately controlled by metformin monotherapy, and BMI ≥24 kg/m2, ertugliflozin (5 mg or 15 mg) resulted in greater glycemic and body weight reductions compared with placebo and was generally well tolerated. TRIAL REGISTRATION Clinicaltrials.gov identifiers NCT02033889, NCT02630706.
Collapse
Affiliation(s)
- Linong Ji
- Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Jie Liu
- Global Clinical Development, MRL, Merck & Co., Inc., Rahway, NJ, USA
| | - Zhi Jin Xu
- Biostatistics, Merck & Co., Inc., Rahway, NJ, USA
| | - Zhiqi Wei
- Global Medical Affairs, MRL, MSD China, Shanghai, China
| | - Ruya Zhang
- Global Medical Affairs, MRL, MSD China, Shanghai, China
| | - Seema Malkani
- Global Medical and Scientific Affairs, MRL, Merck & Co., Inc., Rahway, NJ, USA
| | - Nilo B Cater
- Global Medical Affairs, Pfizer Inc., New York, NY, USA.
| | - Robert Frederich
- Clinical Development and Operations, Pfizer Inc., Groton, CT, USA
| |
Collapse
|
31
|
Katte JC, McDonald TJ, Sobngwi E, Jones AG. The phenotype of type 1 diabetes in sub-Saharan Africa. Front Public Health 2023; 11:1014626. [PMID: 36778553 PMCID: PMC9912986 DOI: 10.3389/fpubh.2023.1014626] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
The phenotype of type 1 diabetes in Africa, especially sub-Saharan Africa, is poorly understood. Most previously conducted studies have suggested that type 1 diabetes may have a different phenotype from the classical form of the disease described in western literature. Making an accurate diagnosis of type 1 diabetes in Africa is challenging, given the predominance of atypical diabetes forms and limited resources. The peak age of onset of type 1 diabetes in sub-Saharan Africa seems to occur after 18-20 years. Multiple studies have reported lower rates of islet autoantibodies ranging from 20 to 60% amongst people with type 1 diabetes in African populations, lower than that reported in other populations. Some studies have reported much higher levels of retained endogenous insulin secretion than in type 1 diabetes elsewhere, with lower rates of type 1 diabetes genetic susceptibility and HLA haplotypes. The HLA DR3 appears to be the most predominant HLA haplotype amongst people with type 1 diabetes in sub-Saharan Africa than the HLA DR4 haplotype. Some type 1 diabetes studies in sub-Saharan Africa have been limited by small sample sizes and diverse methods employed. Robust studies close to diabetes onset are sparse. Large prospective studies with well-standardized methodologies in people at or close to diabetes diagnosis in different population groups will be paramount to provide further insight into the phenotype of type 1 diabetes in sub-Saharan Africa.
Collapse
Affiliation(s)
- Jean Claude Katte
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,*Correspondence: Jean Claude Katte ✉
| | - Timothy J. McDonald
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Academic Department of Clinical Biochemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Eugene Sobngwi
- National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaounde Central Hospital, Yaoundé, Cameroon,Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Angus G. Jones
- Institute of Clinical and Biomedical Sciences, University of Exeter Medical School, Exeter, United Kingdom,Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| |
Collapse
|
32
|
Gayathri R, Abirami K, Kalpana N, Manasa VS, Sudha V, Shobana S, Jeevan RG, Kavitha V, Parkavi K, Anjana RM, Unnikrishnan R, Gokulakrishnan K, Beatrice DA, Krishnaswamy K, Pradeepa R, Mattes RD, Salas-Salvadó J, Willett W, Mohan V. Effect of almond consumption on insulin sensitivity and serum lipids among Asian Indian adults with overweight and obesity- A randomized controlled trial. Front Nutr 2023; 9:1055923. [PMID: 36704786 PMCID: PMC9873375 DOI: 10.3389/fnut.2022.1055923] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Background Asian Indians have an increased susceptibility to type 2 diabetes and premature coronary artery disease. Nuts, like almonds, are rich in unsaturated fat and micronutrients with known health benefits. Objectives This study aimed to assess the efficacy of almonds for reduction of insulin resistance and improving lipid profile in overweight Asian Indian adults. Methods This parallel-arm, randomized, controlled trial was conducted in Chennai, India on 400 participants aged 25-65 years with a body mass index ≥ 23 kg/m2. The intervention group received 43 g of almonds/day for 12 weeks, while the control group was advised to consume a customary diet but to avoid nuts. Anthropometric, clinical, and dietary data were assessed at periodic intervals. Glucose tolerance, serum insulin, glycated hemoglobin, C-peptide and lipid profile were assessed at baseline and end of the study. Insulin resistance (homeostasis assessment model-HOMA IR) and oral insulin disposition index (DIo) were calculated. Results A total of 352 participants completed the study. Significant improvement was seen in DIo [mean (95% CI) = + 0.7 mmol/L (0.1, 1.3); p = 0.03], HOMA IR (-0.4 (-0.7, -0.04; p = 0.03) and total cholesterol (-5.4 mg/dl (-10.2, -0.6); p = 0.03) in the intervention group compared to the control group. Incremental area under the curve (IAUC) and mean amplitude of glycemic excursion (MAGE) assessed using continuous glucose monitoring systems were also significantly lower in the intervention group. Dietary 24-h recalls showed a higher significant reduction in carbohydrate and increase in mono unsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake in the intervention group compared to the control group. Conclusion Daily consumption of almonds increased the intake of MUFA with decrease in carbohydrate calories and decreases insulin resistance, improves insulin sensitivity and lowers serum cholesterol in Asian Indians with overweight/obesity. These effects in the long run could aid in reducing the risk of diabetes and other cardiometabolic disease.
Collapse
Affiliation(s)
- Rajagopal Gayathri
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India,Department of Biochemistry, University of Madras, Chennai, Tamil Nadu, India
| | - Kuzhandhaivelu Abirami
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Natarajan Kalpana
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Valangaiman Sriram Manasa
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vasudevan Sudha
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Shanmugam Shobana
- Department of Diabetes Food Technology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Raman Ganesh Jeevan
- Department of Diabetes Food Technology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Vasudevan Kavitha
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Karthikeyan Parkavi
- Department of Diabetes Food Technology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - D. Annette Beatrice
- Department of Home Science, Women’s Christian College, Chennai, Tamil Nadu, India
| | - Kamala Krishnaswamy
- Department of Foods Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Richard D. Mattes
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain,Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Walter Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States,Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India,*Correspondence: Viswanathan Mohan, , www.drmohansdiabetes.com
| |
Collapse
|
33
|
Ottone M, Bartolini L, Bonvicini L, Giorgi Rossi P. The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations. Front Public Health 2023; 11:969143. [PMID: 36969620 PMCID: PMC10031649 DOI: 10.3389/fpubh.2023.969143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
The objective of this study was to compare the effect of diabetes and pathologies potentially related to diabetes on the risk of infection and death from COVID-19 among people from Highly-Developed-Country (HDC), including Italians, and immigrants from the High-Migratory-Pressure-Countries (HMPC). Among the population with diabetes, whose prevalence is known to be higher among immigrants, we compared the effect of body mass index among HDC and HMPC populations. A population-based cohort study was conducted, using population registries and routinely collected surveillance data. The population was stratified into HDC and HMPC, according to the place of birth; moreover, a focus was set on the South Asiatic population. Analyses restricted to the population with type-2 diabetes were performed. We reported incidence (IRR) and mortality rate ratios (MRR) and hazard ratios (HR) with 95% confidence interval (CI) to estimate the effect of diabetes on SARS-CoV-2 infection and COVID-19 mortality. Overall, IRR of infection and MRR from COVID-19 comparing HMPC with HDC group were 0.84 (95% CI 0.82-0.87) and 0.67 (95% CI 0.46-0.99), respectively. The effect of diabetes on the risk of infection and death from COVID-19 was slightly higher in the HMPC population than in the HDC population (HRs for infection: 1.37 95% CI 1.22-1.53 vs. 1.20 95% CI 1.14-1.25; HRs for mortality: 3.96 95% CI 1.82-8.60 vs. 1.71 95% CI 1.50-1.95, respectively). No substantial difference in the strength of the association was observed between obesity or other comorbidities and SARS-CoV-2 infection. Similarly for COVID-19 mortality, HRs for obesity (HRs: 18.92 95% CI 4.48-79.87 vs. 3.91 95% CI 2.69-5.69) were larger in HMPC than in the HDC population, but differences could be due to chance. Among the population with diabetes, the HMPC group showed similar incidence (IRR: 0.99 95% CI: 0.88-1.12) and mortality (MRR: 0.89 95% CI: 0.49-1.61) to that of HDC individuals. The effect of obesity on incidence was similar in both HDC and HMPC populations (HRs: 1.73 95% CI 1.41-2.11 among HDC vs. 1.41 95% CI 0.63-3.17 among HMPC), although the estimates were very imprecise. Despite a higher prevalence of diabetes and a stronger effect of diabetes on COVID-19 mortality in HMPC than in the HDC population, our cohort did not show an overall excess risk of COVID-19 mortality in immigrants.
Collapse
|
34
|
Pardhan S, Upadhyaya T, Smith L, Sharma T, Tuladhar S, Adhikari B, Kidd J, Sapkota R. Individual patient-centered target-driven intervention to improve clinical outcomes of diabetes, health literacy, and self-care practices in Nepal: A randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1076253. [PMID: 36742401 PMCID: PMC9893775 DOI: 10.3389/fendo.2023.1076253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To examine the effectiveness of a culturally and linguistically appropriate, patient-centered, target-driven lifestyle intervention with video education training in improving clinical outcomes, health literacy, and diabetic self-care practices in newly diagnosed patients in Nepal. METHODS A total of 110 participants with newly and consequently diagnosed Type 2 were randomly allocated into intervention (mean age = 45 ± 9.7 years) and control (mean age = 47 ± 12.5 years) groups. Intervention group participants were trained on a culturally and linguistically appropriate diabetic video education program and were given a customized dietary and physical activity plan with specific targets to practice at home. Participants' compliance was monitored weekly via telephone calls. Both groups received the usual treatment from their doctor and were followed up after three months. Outcome measures included changes in: i. diabetic health literacy, diet, and physical activity measured using self-reported questionnaires; and ii. blood glucose (glycated hemoglobin, HbA1c), cholesterol, blood pressure, body mass index, and visual acuity. Clinical outcome measures were blinded from randomization and intervention allocation. RESULTS After three months, HbA1c decreased to 6.1% from the baseline value of 7.2% in the intervention group compared to 6.6% in the control group from the baseline value of 7.1% (p <0.05). The intervention group had mean total cholesterol and low-density lipoprotein of 174 and 95.5 mg/dL, which were significantly lower than 186 and 107.5 mg/dL in the control group. Daily white rice consumption decreased by 36.5% in the intervention vs. 4% in the control group (p <0.05). After three months, the intervention group participants exercised more than the control group (p <0.05). All intervention group participants self-initiated retinal screening checks since the baseline visit among which 13% showed early diabetic retinopathy signs compared to 0% in the control group. Health literacy improvement in the intervention group was found to be sustained after three months too. CONCLUSIONS A culturally appropriate, target-driven lifestyle intervention with video education training is effective in improving clinical outcomes, health literacy, and self-care practice in newly diagnosed diabetic patients in Nepal, i.e., at a time period when effective diabetes control is vital to prevent further complications. The training intervention could be rolled out nationwide in order to reduce the risk of diabetic-related complications and improve people's quality of life and productivity.
Collapse
Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
- *Correspondence: Shahina Pardhan, ; Raju Sapkota,
| | - Tirthalal Upadhyaya
- Department of Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Tara Sharma
- Department of Medicine, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | - Sarita Tuladhar
- Department of Ophthalmology, Gandaki Medical College Teaching Hospital, Pokhara, Nepal
| | | | - John Kidd
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Raju Sapkota
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
- *Correspondence: Shahina Pardhan, ; Raju Sapkota,
| |
Collapse
|
35
|
Salvatore T, Galiero R, Caturano A, Rinaldi L, Criscuolo L, Di Martino A, Albanese G, Vetrano E, Catalini C, Sardu C, Docimo G, Marfella R, Sasso FC. Current Knowledge on the Pathophysiology of Lean/Normal-Weight Type 2 Diabetes. Int J Mol Sci 2022; 24:ijms24010658. [PMID: 36614099 PMCID: PMC9820420 DOI: 10.3390/ijms24010658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Since early times, being overweight and obesity have been associated with impaired glucose metabolism and type 2 diabetes (T2D). Similarly, a less frequent adult-onset diabetes in low body mass index (BMI) people has been known for many decades. This form is mainly found in developing countries, whereby the largest increase in diabetes incidence is expected in coming years. The number of non-obese patients with T2D is also on the rise among non-white ethnic minorities living in high-income Western countries due to growing migratory flows. A great deal of energy has been spent on understanding the mechanisms that bind obesity to T2D. Conversely, the pathophysiologic features and factors driving the risk of T2D development in non-obese people are still much debated. To reduce the global burden of diabetes, we need to understand why not all obese people develop T2D and not all those with T2D are obese. Moreover, through both an effective prevention and the implementation of an individualized clinical management in all people with diabetes, it is hoped that this will help to reduce this global burden. The purpose of this review is to take stock of current knowledge about the pathophysiology of diabetes not associated to obesity and to highlight which aspects are worthy of future studies.
Collapse
Affiliation(s)
- Teresa Salvatore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Livio Criscuolo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Anna Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Gaetana Albanese
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Christian Catalini
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
- Mediterrannea Cardiocentro, I–80122 Napoli, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, I–80138 Naples, Italy
- Correspondence:
| |
Collapse
|
36
|
Agarwala A, Patel J, Blaha M, Cainzos-Achirica M, Nasir K, Budoff M. Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians. Am J Prev Cardiol 2022; 13:100455. [PMID: 36636123 PMCID: PMC9830106 DOI: 10.1016/j.ajpc.2022.100455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
South Asian (SA) individuals, particularly those that reside in the United States and other Westernized countries, are at an elevated risk for ASCVD and mortality related to ASCVD. The 2018 ACC/AHA/Multi-society Cholesterol guideline listed SA as a high-risk ethnicity, underscoring the importance of treating modifiable risk factors to reduce ASCVD burden. Coronary artery calcium (CAC), a highly specific marker of subclinical atherosclerosis, may be a useful test to improve risk stratification among SA individuals. CAC testing is a cost-effective, highly reproducible, and specific marker of subclinical atherosclerosis, shown to improve ASCVD risk assessment across all racial/ethnic groups, thereby serving as a guide for initiating or deferring preventive therapies. In this White Paper we will discuss the use of CAC scoring to optimize risk stratification and delivery of preventive therapies to individuals of SA ethnicity.
Collapse
Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX, United States,Corresponding author at: Baylor Scott & White The Heart Hospital Baylor Plano, 1100 Allied Dr, Plano, TX 75093, United States.
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States,Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, United States
| | - Michael Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States,Johns Hopkins Heart and Vascular Institute at Greater Baltimore Medical Center, Baltimore, MD, United States
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, MD, United States,Institut Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain,Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Matthew Budoff
- UCLA, School of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, United States
| |
Collapse
|
37
|
Hasbullah FY, Mohd Yusof BN, Abdul Ghani R, Mat Daud Z‘A, Appannah G, Abas F, Shyam S. Maternal and Dietary Factors Are Associated with Metabolic Syndrome in Women with a Previous History of Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16797. [PMID: 36554678 PMCID: PMC9779785 DOI: 10.3390/ijerph192416797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
While it is known that women with a previous history of gestational diabetes mellitus (post-GDM) have a higher risk of metabolic syndrome (MetS), evidence of lifestyle practices from low- and middle-income countries (LMICs) is still scarce. This study aimed to determine the factors associated with MetS in women post-GDM. This cross-sectional study involved 157 women post-GDM (mean age 34.8 ± 5.6 years) sampled from Selangor, Malaysia. We collected data on sociodemographic characteristics and obstetric history. Food intake was assessed using a food frequency questionnaire, and dietary patterns were derived from principal component analysis. MetS was diagnosed according to the 2009 Harmonized criteria. The prevalence of MetS in this study was 22.3%. Western dietary pattern consumption was correlated with MetS, body mass index (BMI), waist circumference, and triglyceride levels. Independent factors associated with MetS were lower education level (odds ratio, OR 4.017, p = 0.007), pre-pregnancy BMI (OR 1.192, p = 0.002), and Caesarean delivery (OR 3.798, p = 0.009). The study identified the maternal and dietary factors associated with MetS in women post-GDM in Malaysia. Community-based interventions that include dietary modification are warranted to prevent MetS and its complications, thus helping to reduce the overall disease burden.
Collapse
Affiliation(s)
- Farah Yasmin Hasbullah
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Barakatun-Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Diabetes Research Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Institute for Social Science Studies, Putra Infoport, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Rohana Abdul Ghani
- Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia
| | - Zulfitri ‘Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Geeta Appannah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Faridah Abas
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Sangeetha Shyam
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Centre for Translational Research, IMU Institute for Research and Development (IRDI), International Medical University (IMU), Kuala Lumpur 57000, Malaysia
| |
Collapse
|
38
|
Fosam A, Bansal R, Ramanathan A, Sarcone C, Iyer I, Murthy M, Remaley AT, Muniyappa R. Lipoprotein Insulin Resistance Index: A Simple, Accurate Method for Assessing Insulin Resistance in South Asians. J Endocr Soc 2022; 7:bvac189. [PMID: 36636252 PMCID: PMC9830979 DOI: 10.1210/jendso/bvac189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Context Identification of insulin resistance (IR) in South Asians, who are at a higher risk for type 2 diabetes, is important. Lack of standardization of insulin assays limits the clinical use of insulin-based surrogate indices. The lipoprotein insulin resistance index (LP-IR), a metabolomic marker, reflects the lipoprotein abnormalities observed in IR. The reliability of the LP-IR index in South Asians is unknown. Objective We evaluated the predictive accuracy of LP-IR compared with other IR surrogate indices in South Asians. Methods In a cross-sectional study (n = 55), we used calibration model analysis to assess the ability of the LP-IR score and other simple surrogate indices (Homeostatic Model Assessment of Insulin Resistance, Quantitative insulin sensitivity check index, Adipose insulin resistance index, and Matsuda Index) to predict insulin sensitivity (SI) derived from the reference frequently sampled intravenous glucose tolerance test. LP-IR index was derived from lipoprotein particle concentrations and sizes measured by nuclear magnetic resonance spectroscopy. Predictive accuracy was determined by root mean squared error (RMSE) of prediction and leave-one-out cross-validation type RMSE of prediction (CVPE). The optimal cut-off of the LP-IR index was determined by the area under the receiver operating characteristic curve (AUROC) and the Youden index. Results The simple surrogate indices showed moderate correlations with SI (r = 0.53-0.69, P < .0001). CVPE and RMSE were not different in any of the surrogate indices when compared with LP-IR. The AUROC was 0.77 (95% CI 0.64-0.89). The optimal cut-off for IR in South Asians was LP-IR >48 (sensitivity: 75%, specificity: 70%). Conclusion The LP-IR index is a simple, accurate, and clinically useful test to assess IR in South Asians.
Collapse
Affiliation(s)
- Andin Fosam
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rashika Bansal
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amrita Ramanathan
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Camila Sarcone
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Indiresha Iyer
- Department of Cardiovascular Medicine, Cleveland Clinic, Akron, OH 44302, USA
| | - Meena Murthy
- Department of Endocrinology, Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Ranganath Muniyappa
- Correspondence: Ranganath Muniyappa, MD, PhD, Clinical Endocrine Section, Diabetes, Endocrinology and Obesity Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive MSC 1613, Building 10, CRC, Rm 6-3952, Bethesda, MD 20892-1613, USA.
| |
Collapse
|
39
|
Ramachandran U, Mahajan K, Shah A, Ghoshal B, Khurshid A, Desilva N, Shiriti M, Patel N, Gaur S, Karasz A. Challenges and Barriers to Providing Primary Care to Children of South Asian Origin: Pediatricians' Perspectives. Clin Pediatr (Phila) 2022:99228221143306. [PMID: 36482667 DOI: 10.1177/00099228221143306] [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] [Indexed: 12/14/2022]
Abstract
South Asian (SA) Americans have a high risk of metabolic and cardiovascular disease. Prevention efforts should start in childhood and should be culturally appropriate. We sought to understand the challenges and barriers that pediatricians face in providing care for SA children to inform professional education on culturally effective care. Qualitative interviews were conducted with a diverse sample (N = 17) of pediatricians. Challenges reported included feeding problems, inadequate physical activity, and mental health concerns. Communication barriers included parents' anxiety around feeding, influence of grandparents, stigma around mental health, and cultural communication gaps. Effective strategies included clear communication, a gradual approach, ensuring buy-in from grandparents, greater attention to family history, and improved cultural knowledge in pediatrician. Addressing feeding problems was the most mentioned challenge, which is especially concerning given the high chronic disease risk in SAs. Education on culturally appropriate strategies can equip pediatricians to effectively counsel SA families to address these risks.
Collapse
Affiliation(s)
- Usha Ramachandran
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kaavya Mahajan
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aashiki Shah
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Bishakha Ghoshal
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Afrida Khurshid
- Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nilifa Desilva
- Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Margia Shiriti
- Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nolan Patel
- Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alison Karasz
- Department of Family Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
40
|
Mohan V, Singh AK, Zargar AH, Almeida A, Bhalla AK, Mohan JC, Dalal J, Sahay M, Mohanan PP, Maitra S, Ghosh S, Jeloka T, Kaul U, Sakhuja V, Das MK. Cardiorenal disease management in type 2 diabetes: An expert consensus. Diabetes Metab Syndr 2022; 16:102661. [PMID: 36375366 DOI: 10.1016/j.dsx.2022.102661] [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: 02/16/2022] [Revised: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM The interplay between cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes (T2D) is well established. We aim at providing an evidence-based expert opinion regarding the prevention and treatment of both heart failure (HF) and renal complications in people with T2D. METHOD ology: The consensus recommendations were developed by subject experts in endocrinology, cardiology, and nephrology. The criteria for consensus were set to statements with ≥80% of agreement among clinicians specialized in endocrinology, cardiology, and nephrology. Key expert opinions were formulated based on scientific evidence and clinical judgment. RESULTS Assessing the risk factors of CVD or CKD in people with diabetes and taking measures to prevent HF or kidney disease are essential. Known CVD or CKD among people with diabetes confers a very high risk for recurrent CVD. Metformin plus lifestyle modification should be the first-line therapy (unless contraindicated) for the management of T2D. Glucagon-like peptide 1 (GLP-1) agonists can be preferred in people with atherosclerotic cardiovascular disease (ASCVD) or with high-risk indicators, along with sodium-glucose cotransporter-2 inhibitors (SGLT2i), whereas SGLT2i are the first choice in HF and CKD. The GLP-1 agonists can be used in people with CKD if SGLT2i are not tolerated. CONCLUSION Current evidence suggests SGLT2i as preferred agents among people with T2D and HF, and for those with T2D and ASCVD. SGLT2i and GLP-1RA also lower CV outcomes in those with diabetes and ASCVD, and the treatment choice should depend on the patient profile.
Collapse
Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr.Mohan's Diabetes Specialities Centre, Chennai, India. http://www.drmohans.com
| | - Awadhesh Kumar Singh
- Department of Endocrinology, G.D. Hospital and Diabetes Institute, Kolkata, India
| | | | - Alan Almeida
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Jamshed Dalal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital & Osmania Medical College, Hyderabad, India
| | | | - Sanjay Maitra
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata, India
| | | | | | - Vinay Sakhuja
- Department of Cardiology and Dean, Academics and Research, Batra Hospital and Medical Research Center, New Delhi, India
| | - Mrinal Kanti Das
- Department of Cardiology, C.K. Birla Hospitals (BMB/CMRI), Kolkata, India
| |
Collapse
|
41
|
Platelet-Neutrophil Association in NETs-Rich Areas in the Retrieved AIS Patient Thrombi. Int J Mol Sci 2022; 23:ijms232214477. [PMID: 36430952 PMCID: PMC9694992 DOI: 10.3390/ijms232214477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
Histological structure of thrombi is a strong determinant of the outcome of vascular recanalization therapy, the only treatment option for acute ischemic stroke (AIS) patients. A total of 21 AIS patients from this study after undergoing non-enhanced CT scan and multimodal MRI were treated with mechanical stent-based and manual aspiration thrombectomy, and thromboembolic retrieved from a cerebral artery. Complementary histopathological and imaging analyses were performed to understand their composition with a specific focus on fibrin, von Willebrand factor, and neutrophil extracellular traps (NETs). Though distinct RBC-rich and platelet-rich areas were found, AIS patient thrombi were overwhelmingly platelet-rich, with 90% of thrombi containing <40% total RBC-rich contents (1.5 to 37%). Structurally, RBC-rich areas were simple, consisting of tightly packed RBCs in thin fibrin meshwork with sparsely populated nucleated cells and lacked any substantial von Willebrand factor (VWF). Platelet-rich areas were structurally more complex with thick fibrin meshwork associated with VWF. Plenty of leukocytes populated the platelet-rich areas, particularly in the periphery and border areas between platelet-rich and RBC-rich areas. Platelet-rich areas showed abundant activated neutrophils (myeloperoxidase+ and neutrophil-elastase+) containing citrullinated histone-decorated DNA. Citrullinated histone-decorated DNA also accumulated extracellularly, pointing to NETosis by the activated neutrophils. Notably, NETs-containing areas showed strong reactivity to VWF, platelets, and high-mobility group box 1 (HMGB1), signifying a close interplay between these components.
Collapse
|
42
|
Tran NQ, Truong SD, Ma PT, Hoang CK, Le BH, Dinh TTN, Van Tran L, Tran TV, Le LHG, Le KT, Nguyen HT, Vu HA, Mai TP, Do MD. Association of KCNJ11 and ABCC8 single-nucleotide polymorphisms with type 2 diabetes mellitus in a Kinh Vietnamese population. Medicine (Baltimore) 2022; 101:e31653. [PMID: 36401380 PMCID: PMC9678638 DOI: 10.1097/md.0000000000031653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a genetically influenced disease, but few studies have been performed to investigate the genetic basis of T2DM in Vietnamese subjects. Thus, the potential associations of KCNJ11 and ABCC8 single nucleotide polymorphisms (SNPs) with T2DM were investigated in a Kinh Vietnamese population. A cross-sectional study consisting of 404 subjects including 202 T2DM cases and 202 non-T2DM controls was designed to examine the potential associations of 4 KCNJ11 and ABCC8 SNPs (rs5219, rs2285676, rs1799859, and rs757110) with T2DM. Genotypes were identified based on restriction fragment length polymorphism and tetra-primer amplification refractory mutation system polymerase chain reaction. After statistically adjusting for age, sex, and BMI, rs5219 was found to be associated with an increased risk of T2DM under 2 inheritance models: codominant (OR = 2.15, 95% confidence intervals [CI] = 1.09-4.22) and recessive (OR = 2.08, 95%CI = 1.09-3.94). On the other hand, rs2285676, rs1799859, and rs757110 were not associated with an increased risk of T2DM. Haplotype analysis elucidated a strong linkage disequilibrium between the 3 SNPs, rs5219, rs2285676, and rs757110. The haplotype rs5219(A)/rs2285676(T)/rs757110(G) was associated with an increased risk of T2DM (OR = 1.42, 95%CI = 1.01-1.99). The results show that rs5219 is a lead candidate SNP associated with an increased risk of developing T2DM in the Kinh Vietnamese population. Further functional characterization is needed to uncover the mechanism underlying the potential genotype-phenotype associations.
Collapse
Affiliation(s)
- Nam Quang Tran
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Steven D. Truong
- Department of Medicine, School of Medicine, Stanford University, USA
| | - Phat Tung Ma
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Chi Khanh Hoang
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Bao Hoang Le
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thang Tat Ngo Dinh
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Luong Van Tran
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thang Viet Tran
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Linh Hoang Gia Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Khuong Thai Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Hien Thanh Nguyen
- Department of Medical Laboratory Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Hoang Anh Vu
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thao Phuong Mai
- Department of Physiology-Pathophysiology-Immunology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- * Correspondence: Minh Duc Do, Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City 700000, Vietnam (e-mail: )
| |
Collapse
|
43
|
Gupta K, Al Rifai M, Hussain A, Minhas AMK, Patel J, Kalra D, Samad Z, Virani SS. South Asian ethnicity: What can we do to make this risk enhancer a risk equivalent? Prog Cardiovasc Dis 2022; 75:21-32. [PMID: 36279943 DOI: 10.1016/j.pcad.2022.10.001] [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] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
South Asians account for around 25% of the global population and are the fastest-growing ethnicity in the US. This population has an increasing burden of atherosclerotic cardiovascular disease (ASCVD) which is also seen in the diaspora. Current risk prediction equations underestimate this risk and consider the South Asian ethnicity as a risk-enhancer among those with borderline-intermediate risk. In this review, we discuss why the South Asian population is at a higher risk of ASCVD and strategies to mitigate this increased risk.
Collapse
Affiliation(s)
- Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Mahmoud Al Rifai
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aliza Hussain
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Dinesh Kalra
- Rudd Heart & Lung Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| |
Collapse
|
44
|
Susarla G, Rizza AN, Li A, Han S, Khan R, Chan W, Lains I, Apivatthakakul A, Brustoski K, Khetan V, Raman R, Igo RP, Iyengar SK, Mathavan S, Sobrin L. Younger Age and Albuminuria are Associated with Proliferative Diabetic Retinopathy and Diabetic Macular Edema in the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study. Curr Eye Res 2022; 47:1389-1396. [PMID: 35815717 PMCID: PMC9637383 DOI: 10.1080/02713683.2022.2091148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
Purpose: The purpose of the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study is to identify non-genetic and genetic risk factors associated with diabetic retinopathy (DR). This report examines the non-genetic risk factors for DR in South Indian patients.Methods: Participants with South Indian ancestry and type 2 diabetes (T2D) were included from two sources: the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS) and prospective recruitment at Sankara Nethralaya affiliates. Fundus photography and optical coherence tomography (OCT) were obtained on participants. Fundus images were graded for DR severity and OCTs were graded for center-involved diabetic macular edema (ciDME). Multivariate analyses were performed using stepwise logistic regression to assess effects of the demographic and clinical factors on proliferative DR (PDR) and DME.Results: Among the 2941 participants with DR grading, participants with PDR were more likely to be younger [odds ratio (OR)=0.95], men (OR = 1.83), have a longer duration of diabetes (OR = 1.10), have a higher hemoglobin A1c (OR = 1.12), have albuminuria (OR = 5.83), have hypertension (OR = 1.69), have a higher HDL (OR = 1.02) and a lower total cholesterol (OR = 0.99) (all p < 0.05). Among the 483 participants with gradable OCT scans, participants who had ciDME were more likely to be younger (OR = 0.97), men (OR = 2.80), have a longer duration of diabetes (OR = 1.06), have lower triglycerides (OR = 0.99), and have albuminuria (OR = 3.12) (all p < 0.05).Conclusions: Younger age, male sex, longer duration of diabetes, higher HbA1c, and presence of albuminuria were identified as risk factors for PDR and DME in a South Indian population with T2D.
Collapse
Affiliation(s)
- Gayatri Susarla
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A N Rizza
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Rehana Khan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Weilin Chan
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ines Lains
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Atitaya Apivatthakakul
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Kim Brustoski
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Khetan
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Robert P Igo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sudha K Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| |
Collapse
|
45
|
Teagle WL, Norris ET, Rishishwar L, Nagar SD, Jordan IK, Mariño-Ramírez L. Comorbidities and ethnic health disparities in the UK biobank. JAMIA Open 2022; 5:ooac057. [PMID: 36313969 PMCID: PMC9272510 DOI: 10.1093/jamiaopen/ooac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The goal of this study was to investigate the relationship between comorbidities and ethnic health disparities in a diverse, cosmopolitan population. Materials and Methods We used the UK Biobank (UKB), a large progressive cohort study of the UK population. Study participants self-identified with 1 of 5 ethnic groups and participant comorbidities were characterized using the 31 disease categories captured by the Elixhauser Comorbidity Index. Ethnic disparities in comorbidities were quantified as the extent to which disease prevalence within categories varies across ethnic groups and the extent to which pairs of comorbidities co-occur within ethnic groups. Disease-risk factor comorbidity pairs were identified where one comorbidity is known to be a risk factor for a co-occurring comorbidity. Results The Asian ethnic group shows the greatest average number of comorbidities, followed by the Black and then White groups. The Chinese group shows the lowest average number of comorbidities. Comorbidity prevalence varies significantly among the ethnic groups for almost all disease categories, with diabetes and hypertension showing the largest differences across groups. Diabetes and hypertension both show ethnic-specific comorbidities that may contribute to the observed disease prevalence disparities. Discussion These results underscore the extent to which comorbidities vary among ethnic groups and reveal group-specific disease comorbidities that may underlie ethnic health disparities. Conclusion The study of comorbidity distributions across ethnic groups can be used to inform targeted group-specific interventions to reduce ethnic health disparities.
Collapse
Affiliation(s)
- Whitney L Teagle
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily T Norris
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Lavanya Rishishwar
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Shashwat Deepali Nagar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - I King Jordan
- Applied Bioinformatics Laboratory, Atlanta, Georgia, USA.,School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.,PanAmerican Bioinformatics Institute, Valle del Cauca, Cali, Colombia
| |
Collapse
|
46
|
Ali MK, Kadir MM, Gujral UP, Fatima SS, Iqbal R, Sun YV, Narayan KMV, Ahmad S. Obesity-associated metabolites in relation to type 2 diabetes risk: A prospective nested case-control study of the CARRS cohort. Diabetes Obes Metab 2022; 24:2008-2016. [PMID: 35676808 PMCID: PMC9543742 DOI: 10.1111/dom.14788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
AIMS To determine whether obesity-associated metabolites are associated with type 2 diabetes (T2DM) risk among South Asians. MATERIALS AND METHODS Serum-based nuclear magnetic resonance imaging metabolomics data were generated from two South Asian population-based prospective cohorts from Karachi, Pakistan: CARRS1 (N = 4017) and CARRS2 (N = 4802). Participants in both cohorts were followed up for 5 years and incident T2DM was ascertained. A nested case-control study approach was developed to select participants from CARRS1 (Ncases = 197 and Ncontrols = 195) and CARRS2 (Ncases = 194 and Ncontrols = 200), respectively. First, we investigated the association of 224 metabolites with general obesity based on body mass index and with central obesity based on waist-hip ratio, and then the top obesity-associated metabolites were studied in relation to incident T2DM. RESULTS In a combined sample of the CARRS1 and CARRS2 cohorts, out of 224 metabolites, 12 were associated with general obesity and, of these, one was associated with incident T2DM. Fifteen out of 224 metabolites were associated with central obesity and, of these, 10 were associated with incident T2DM. The higher level of total cholesterol in high-density lipoprotein (HDL) was associated with reduced T2DM risk (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.53, 0.86; P = 1.2 × 10-3 ), while higher cholesterol esters in large very-low-density lipoprotein (VLDL) particles were associated with increased T2DM risk (OR 1.90, 95% CI 1.40, 2.58; P = 3.5 × 10-5 ). CONCLUSION Total cholesterol in HDL and cholesterol esters in large VLDL particles may be an important biomarker in the identification of early development of obesity-associated T2DM risk among South Asian adults.
Collapse
Affiliation(s)
- Mohammed K. Ali
- Hubert Department of Global HealthRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
- Department of Family and Preventive MedicineSchool of Medicine, Emory UniversityAtlantaGeorgiaUSA
| | - M. Masood Kadir
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Unjali P. Gujral
- Hubert Department of Global HealthRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical SciencesAga Khan UniversityKarachiPakistan
| | - Romaina Iqbal
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Yan V. Sun
- Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - K. M. Venkat Narayan
- Hubert Department of Global HealthRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
- Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Shafqat Ahmad
- Department of Medical SciencesMolecular Epidemiology and Science for Life Laboratory, Uppsala UniversityUppsalaSweden
- Preventive Medicine DivisionHarvard Medical School, Brigham and Women's HospitalBostonMassachusettsUSA
| |
Collapse
|
47
|
Muilwijk M, Loh M, Mahmood S, Palaniswamy S, Siddiqui S, Silva W, Frost GS, Gage HM, Jarvelin MR, Rannan-Eliya RP, Ahmad S, Jha S, Kasturiratne A, Katulanda P, Khawaja KI, Kooner JS, Wickremasinghe AR, van Valkengoed IGM, Chambers JC. The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes-a statistical analysis plan. Trials 2022; 23:755. [PMID: 36068618 PMCID: PMC9450360 DOI: 10.1186/s13063-022-06667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care. METHODS The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance. DISCUSSION The iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP. ETHICS AND DISSEMINATION The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations. TRIAL REGISTRATION EudraCT 2016-001,350-18 . Registered on 14 April 2016. CLINICALTRIALS gov NCT02949739 . Registered on 31 October 2016.
Collapse
Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Samreen Siddiqui
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Wnurinham Silva
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Gary S Frost
- Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Heather M Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics Centre, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, Surrey, GU2 7WG, UK
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | | | - Sajjad Ahmad
- Punjab Institute of Cardiology, Punjab Institute of Cardiology, Jail Road, Shadman, Lahore, Punjab, Pakistan
| | - Sujeet Jha
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Anuradhani Kasturiratne
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Jaspal S Kooner
- London Northwest University Healthcare NHS Trust, Uxbridge Road, Southall, UB1 3HW, Middlesex, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Ananda R Wickremasinghe
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| |
Collapse
|
48
|
Nguyen A, Khafagy R, Meerasa A, Roshandel D, Paterson AD, Dash S. Insulin Response to Oral Glucose and Cardiometabolic Disease: A Mendelian Randomization Study to Assess Potential Causality. Diabetes 2022; 71:1880-1890. [PMID: 35748295 DOI: 10.2337/db22-0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
Mendelian randomization (MR) suggests that postprandial hyperinsulinemia (unadjusted for plasma glucose) increases BMI, but its impact on cardiometabolic disease, a leading cause for mortality and morbidity in people with obesity, is not established. Fat distribution i.e., increased centripetal and/or reduced femoro-gluteal adiposity, is causally associated with and better predicts cardiometabolic disease than BMI. We therefore undertook bidirectional MR to assess the effect of corrected insulin response (CIR) (insulin 30 min after a glucose challenge adjusted for plasma glucose) on BMI, waist-to-hip ratio (WHR), leg fat, type 2 diabetes (T2D), triglyceride (TG), HDL, liver fat, hypertension (HTN), and coronary artery disease (CAD) in people of European descent. Inverse variance-weighted MR suggests a potential causal association between increased CIR and increased BMI (b = 0.048 ± 0.02, P = 0.03), increased leg fat (b = 0.029 ± 0.012, P = 0.01), reduced T2D (b = -0.73 ± 0.15, P = 6 × 10-7, odds ratio [OR] 0.48 [95% CI 0.36-0.64]), reduced TG (b = -0.07 ± 0.02, P = 0.003), and increased HDL (b = 0.04 ± 0.01, P = 0.006) with some evidence of horizontal pleiotropy. CIR had neutral effects on WHR (b = 0.009 ± 0.02, P = 0.69), liver fat (b = -0.08 ± 0.04, P = 0.06), HTN (b = -0.001 ± 0.004, P = 0.7, OR 1.00 [95% CI 0.99-1.01]), and CAD (b = -0.002 ± 0.002, P = 0.48, OR 0.99 [95% CI 0.81-1.21]). T2D decreased CIR (b -0.22 ± 0.04, P = 1.3 × 10-7), with no evidence that BMI, TG, HDL, liver fat, HTN, and CAD modulate CIR. In conclusion, we did not find evidence that increased CIR increases cardiometabolic disease. It might increase BMI with favorable fat distribution, reduce T2D, and improve lipids.
Collapse
Affiliation(s)
- Anthony Nguyen
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
| | - Rana Khafagy
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ameena Meerasa
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
| | - Delnaz Roshandel
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Satya Dash
- Department of Medicine, University Health Network, and University of Toronto, Toronto, Canada
| |
Collapse
|
49
|
Association of Polygenic Variants with Type 2 Diabetes Risk and Their Interaction with Lifestyles in Asians. Nutrients 2022; 14:nu14153222. [PMID: 35956399 PMCID: PMC9370736 DOI: 10.3390/nu14153222] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022] Open
Abstract
Over the last several decades, there has been a considerable growth in type 2 diabetes (T2DM) in Asians. A pathophysiological mechanism in Asian T2DM is closely linked to low insulin secretion, β-cell mass, and inability to compensate for insulin resistance. We hypothesized that genetic variants associated with lower β-cell mass and function and their combination with unhealthy lifestyle factors significantly raise T2DM risk among Asians. This hypothesis was explored with participants aged over 40. Participants were categorized into T2DM (case; n = 5383) and control (n = 53,318) groups. The genetic variants associated with a higher risk of T2DM were selected from a genome-wide association study in a city hospital-based cohort, and they were confirmed with a replicate study in Ansan/Ansung plus rural cohorts. The interacted genetic variants were identified with generalized multifactor dimensionality reduction analysis, and the polygenic risk score (PRS)-nutrient interactions were examined. The 8-SNP model was positively associated with T2DM risk by about 10 times, exhibiting a higher association than the 20-SNP model, including all T2DM-linked SNPs with p < 5 × 10−6. The SNPs in the models were primarily involved in pancreatic β-cell growth and survival. The PRS of the 8-SNP model interacted with three lifestyle factors: energy intake based on the estimated energy requirement (EER), Western-style diet (WSD), and smoking status. Fasting serum glucose concentrations were much higher in the participants with High-PRS in rather low EER intake and high-WSD compared to the High-EER and Low-WSD, respectively. They were shown to be higher in the participants with High-PRS in smokers than in non-smokers. In conclusion, the genetic impact of T2DM risk was mainly involved with regulating pancreatic β-cell mass and function, and the PRS interacted with lifestyles. These results highlight the interaction between genetic impacts and lifestyles in precision nutrition.
Collapse
|
50
|
Jamil A, Jonkman LJ, Miller M, Jennings L, Connor SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amna Jamil
- UPMC Presbyterian‐Shadyside Pittsburgh Pennsylvania USA
| | - Lauren J. Jonkman
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Michelle Miller
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Luke Jennings
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Sharon E. Connor
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| |
Collapse
|