Current scenario of diabetes in India

The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India

Evidence suggests that diabetes is on the rise in India, affecting many people's life satisfaction. Comprehensive estimation of life satisfaction among diabetes patients does not exist in the country. This study examined the effects of socioeconomic status, depression, and diabetes symptoms severity on the life satisfaction of diabetes patients by controlling various demographic variables. It was a cross-sectional study comprising 583 diabetes patients from Punjab, India. Patients were interviewed using a multi-stage purposeful random sampling method. Descriptive analysis and partial least squares structural equation modelling were used in the study to test the hypotheses. Results revealed that socioeconomic status, depression and diabetes symptoms severity significantly influence the life satisfaction of diabetes patients. A 1% drop in diabetes symptoms severity corresponds to a 0.849% increase in life satisfaction, whereas a 1% decrease in depression results in a 0.898% increase in life satisfaction. Patients with higher diabetes symptoms severity were coping with common mental disorders. Women reported higher diabetes symptoms severity and depression than men, resulting in lower life satisfaction. An experimental evaluation of the effects of socioeconomic status, depression and diabetes symptoms severity, and numerous demographic factors on life satisfaction was reported. The findings will help policymakers understand the problem associated with life satisfaction among diabetes patients in the country.

Cost of diabetes and its complications: results from a STEPS survey in Punjab, India

BACKGROUND

Diabetes mellitus is an obtrusive universal health emergency in developed and developing countries, including India. With the exponential rise of epidemiological conditions, the costs of treating and managing diabetes are on an upsurge. This study aimed to estimate the cost of diabetes and determine the determinants of the total cost among diabetic patients.

METHODS

This cross-sectional study was executed in the northern state of Punjab, India. It involves the multi-stage area sampling technique and data was collected through a self-structured questionnaire adapted following the "WHO STEPS Surveillance" manual. Mann-Whitney U and Kruskal-Wallis tests were performed to compare the cost differences in socio-demographic variables. Lastly, multiple linear regression was conducted to determine and evaluate the association of the dependent variable with numerous influential determinants.

RESULTS

The urban respondents' average direct and indirect costs are higher than rural respondents. Age manifests very eccentric results; the highest mean direct outpatient care expenditure of ₹52,104 was incurred by the respondents below 20 years of age. Gender, complications, income, history of diabetes and work status were statistically significant determinants of the total cost. Study reports a rapid increase in the median annual direct and indirect cost from ₹15,460 and ₹3572 in 1999 to ₹34,100 and ₹4200 in 2021.

CONCLUSIONS

The present study highlights that the economic jeopardy of diabetes can be managed by educating people about diabetes and its associated risk factors. The economic burden of diabetes could be restrained by formulating new health policies and promoting the use of generic medicines. The result of the study directs that expenditure on outpatient care is to be reimbursed under the 'Ayushman Bharat-Sarbat Sehat Bima Yojana'.

Younger Age and Albuminuria are Associated with Proliferative Diabetic Retinopathy and Diabetic Macular Edema in the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study

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.

A Clinical Significance of Fungal Infections in Diabetic Foot Ulcers

Background: Diabetic foot ulcers (DFUs) are the most common and serious complications in uncontrolled diabetes. Infections are predominantly polymicrobial, with aerobic Gram-positive, anerobic, and fungal infections. Early detection of fungal infection and initiation of appropriate treatment in DFUs may lead to better healing and avoid amputations. The primary objective was to find out the prevalence of DFUs getting infected with fungus and the secondary objective was to identify the appropriate methodology for the detection of the fungus in DFUs.

Materials and methods: This was a cross-sectional observational study carried out in a tertiary care hospital with a sample size of 60 DFUs. Microbiological analysis was done by swab culture and deep tissue culture. Observational data were collected and the significance level was statistically analyzed.

Results: In the present study, the prevalence of fungal infections in DFUs was 31.7%. Only fungal tissue was positive in 15%, the fungal swab was positive in 8.33%, and both tissue and swab were positive in 8.33%. All these patients were treated with antifungal treatment as per the culture report in addition to appropriate antimicrobial therapy.

Conclusion: A fungal culture should be done in all patients with non-healing DFUs. Both fungal swab and tissue culture testing should be advocated in patients with DFUs for better mycological evaluation. The addition of antifungal medications may provide better outcomes in selected cases.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.

Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.

Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. 

Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

A methodical survey of mathematical model-based control techniques based on open and closed loop control approach for diabetes management

Disturbance of blood sugar level is controlled through well-known biomechanical feedback loops: high levels of glucose in blood facilitate to release insulin from the pancreas which accelerates the absorption rate of cellular glucose. Low glucose levels encourage to release pancreatic glucagon which induces glycogen breakdown to glucose in the liver. These bio-control systems do not function properly in diabetic patients. Though the control of disease seems intuitively easy, in real life, due to many differences in structure by diet and fasting, exercise, medications, patient’s profile and other stressors, it is not that easy. The mathematical models of the glucose-insulin regulatory system follow the patient’s physiological conditions which make it difficult to identify and estimate all the model parameters. In this paper, we have given a systematic literature review on mathematical models of the diabetic patients, and various kinds of disease control techniques through the development of open and closed loop insulin deliver command system and optimization of exogenous insulin rate. It demonstrates the open and closed loop type model-based control strategies underlying the assumptions of the concerned models. The combination of mathematical model with control strategies such as genetic algorithm (GA), neural network (NN), sliding mode controller (SMC), model predictive controller (MPC), and fuzzy logic control (FLC) has been considered, which provides an overview of this area, highlighting the control profile over the diabetic model with promising clinical results, outlining key challenges, and identifying needs for the future research. Also, the significance of these control algorithms has been discussed in the presence of the noises, the controller’s robustness and various other disturbances. It provides substantial information on diabetes management through various control techniques.

Maternal low protein diet and fetal programming of lean type 2 diabetes

Maternal nutrition is found to be the key factor that determines fetal health in utero and metabolic health during adulthood. Metabolic diseases have been primarily attributed to impaired maternal nutrition during pregnancy, and impaired nutrition has been an immense issue across the globe. In recent years, type 2 diabetes (T2D) has reached epidemic proportion and is a severe public health problem in many countries. Although plenty of research has already been conducted to tackle T2D which is associated with obesity, little is known regarding the etiology and pathophysiology of lean T2D, a variant of T2D. Recent studies have focused on the effects of epigenetic variation on the contribution of in utero origins of lean T2D, although other mechanisms might also contribute to the pathology. Observational studies in humans and experiments in animals strongly suggest an association between maternal low protein diet and lean T2D phenotype. In addition, clear sex-specific disease prevalence was observed in different studies. Consequently, more research is essential for the understanding of the etiology and pathophysiology of lean T2D, which might help to develop better disease prevention and treatment strategies. This review examines the role of protein insufficiency in the maternal diet as the central driver of the developmental programming of lean T2D.

Medication Adherence to Oral Hypoglycemic Drugs among Individuals with Type 2 Diabetes Mellitus - A Community Study

Context

Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence.

Aims

We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala.

Methods

A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis.

Results

The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence.

Conclusion

The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence.

Activation of Insulin-Like Growth Factor-2 Ameliorates Retinal Cell Damage and Exerts Protection in in vitro Model of Diabetic Retinopathy

BACKGROUND

The major event in the development of diabetes-related blindness and vision impairment is the onset of retinal cell damage. Overall awareness of insulin-like growth factor-2 (IGF2) mechanisms emphasizes its protective behavior in retinal cells that help to provide new information about the development of treatment for retinal complications.

OBJECTIVES

This study analyzes the effect of in vitro changes associated with the cell survival and rescue mechanism in IGF2 inhibition and activation using chromeceptin and IGF2 peptides in ARPE-19 cells cultured in high glucose conditions.

METHOD

Cell death was induced using high glucose (15 mmol/L), IGF2 inhibition was done using chromeceptin (1 µM) (Sigma Aldrich, Saint Louis, MO, USA), and IGF2 activation was done using IGF2 peptide (10 ng/mL). The cells were analyzed for changes in cell proliferation, apoptosis markers, antioxidant molecules, and alteration of cytokines.

RESULTS

The study demonstrated that cells lacking IGF2 exhibited a significant increase in reactive oxygen levels with apoptosis patterns. Also, gene expression analysis by qRT-PCR demonstrated a significant increase in Yes-associated protein 1, CDK2, TNF-α, and BIRC5 genes in cells under high glucose stress and IGF inhibition compared to control. Further, the cytokine analysis also revealed that cells devoid of IGF2 activated an increase in cytokines such as IL-8, CX43, ICAM-1, IL-17, CCL3, and MCP-1 and decreased paraoxonase compared to normal control cells. On the other hand, ARPE-19 cells grown in high glucose shows that IGF2 increases the survival genes with reduced levels of inflammatory cytokines.

CONCLUSION

The finding of the investigation, therefore, shows that the use of IGF2 activators may prevent the progression of ocular dysfunction in the control of diabetes-related complications.

A Systematic Review and Meta-analysis on Efficacy of Exercise on Posture and Balance in Patients Suffering from Diabetic Neuropathy

BACKGROUND

Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% patients suffering from diabetes. There is the involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability.

OBJECTIVE

The aim of this study is to assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus.

METHODS

Mean changes in Timed Up and Go test (TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on the PEDro Rating scale. The risk of bias was assessed by the Cochrane collaboration tool of risk of bias. Included studies had a low risk of bias. Sixteen RCT's were included for the meta-analysis.

RESULTS

Results of meta-analysis showed that there was a statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I2 = 84%, p < 0.00001) in the experimental group as compared to control group. There was a statistically significant difference in Berg Balance Scale scores and heterogeneity of I2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I2 = 100%, p =0.01 and eyes closed, heteogeneity I2 = 0%, p =0.01). Sensitivity analysis causes a change in heterogeneity.

CONCLUSION

It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training, etc. have a significant effect on improving balance and posture in diabetic neuropathy.

Economic menace of diabetes in India: a systematic review

AIM

Diabetes mellitus is recognised as a major chronic pandemic disease that does not consider any ethnic and monetary background. There is a dearth of literature on the cost of diabetes in the Indian context. Therefore, the present study aims to capture the evidence from the literature on the cost of diabetes mellitus in India.

METHODS

An extensive literature was reviewed from ACADEMIA, NCBI, PubMed, ProQuest, EBSCO, Springer, JSTOR, Scopus and Google Scholar. The eligibility criterion is based on 'PICOS' procedure, and only those studies which are available in the English language, published between 1999 and February 2019, indexed in ABDC, EBSCO, ProQuest, Scopus and peer-reviewed journals are included.

RESULTS

A total of thirty-two studies were included in the present study. The result indicates that the median direct cost of diabetes was estimated to be ₹18,890/- p.a. for the north zone, ₹10,585/- p.a. for the south zone, ₹45,792/- p.a. for the north-east zone and ₹8822/- p.a. for the west zone. Similarly, the median indirect cost of diabetes was ₹18,146/- p.a. for the north zone, ₹1198/- p.a. for the south zone, ₹18,707/- p.a. for the north-east and ₹3949/- p.a. for the west zone.

CONCLUSION

The present study highlighted that diabetes poses a high economic burden on individuals/households. The study directed the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes.

Glycemic index of millet based food mix and its effect on pre diabetic subjects

Diet plays an important role in management of diabetes and foods having low glycemic index are gaining more importance as they delay the release of glucose in the blood. It is essential to develop low glycemic food mix from regionally available ingredients for use in daily dietaries. Hence, the present study was undertaken to assess the glycemic index of the traditional recipes prepared from developed millet based food mix and their effect on pre diabetic subjects. The developed millet based food mix had appreciable amount of protein (19.41 g/100 g) and dietary fibre (21.11 g/100 g). The traditional recipes viz., roti, dosa and dumpling (mudde) prepared from developed mix exhibited higher acceptance with good sensory parameters and are comparable to regional preparations. The glycemic index was found to be 37, 48 and 53 for dosa, mudde and roti respectively with a glycemic load of 11.05, 18.43 and 18.09. However, all the three developed products showed the relatively lower glycemic index (< 55) and moderate glycemic load of < 20. Further, dietary intervention on pre diabetic subjects revealed that there was a significant reduction in FBS (120.50 ± 18.73 to 97.81 ± 20.00) and HbA1c (6.14 ± 0.30 to 5.67 ± 0.40) indicating their preferable option in the management of diabetes mellitus.

Senescence-associated miR-34a and miR-126 in middle-aged Indians with type 2 diabetes

Rapid urbanization and unhealthy dietary patterns critically increase the risk of type 2 diabetes (T2D) in middle-aged Indians. However, despite recent evidence of senescence-associated microRNAs (SA-miRNAs) in regulating complex pathways of ageing, their expressions in middle-aged Indians with T2D remain unexplored. Hence we aimed to investigate the changes in expressions of SA-miRNAs miR-34a and miR-126 in middle-aged T2D patients. A total of 30 T2D patients and 30 controls were recruited of age 31-50 years. The expressions of plasma miR-34a and miR-126 were determined by quantitative PCR. Oxidized LDL (OxLDL) and malondialdehyde (MDA) levels were quantified using enzyme-linked immunosorbent assay (ELISA). The effect of different glucose concentrations on miR-34a, miR-126, senescence-associated, and oxidative stress-responsive genes were also studied in an in vitro model of mice pancreatic β-cells. MiR-34a was significantly upregulated, whereas miR-126 was nonsignificantly reduced in T2D patients as compared to controls. T2D patients showed elevated levels of oxidative stress markers than controls. Analysis of cultured mice pancreatic β-cells exposed to high glucose showed significant upregulation of miR-34a, miR-126, p53, and superoxide dismutase 2 (SOD2). We found that circulating miR-34a levels and oxidative stress markers levels were elevated in the middle-aged Indians with T2D as compared to controls. The presence of diabetes may aggravate the normal ageing process in the middle-aged Indians. These SA-miRNAs can also be used to check the cellular dysfunctions and ageing of pancreatic β-cells.

A Cross-sectional Retrospective Analysis of Glycemic Burden and Nephropathy in an Indian Population and Formulation of a New Plan Using eGFR/HbA1c Grid Formation

Background Diabetes is a metabolic, non-communicable disease (NCD) that represents one of the major causes of morbidity and mortality worldwide. India has a huge burden of chronic kidney disease (CKD) that is associated with diabetes. Materials and methods Cross-sectional data were collected for a total of 241 patients from the authors' clinic record. A new approach for the management of patients with diabetes was proposed using a grid system, where we need to consider the Hemoglobin A1C (HbA1c) and estimated glomerular filtration rate (eGFR) values of the patient and assign a zone (green, blue, orange or red) and subsequently decide an appropriate treatment according to the assigned zone. Results We found that 20.73% of patients had decreased eGFR and only 31.12% of patients achieved target HbA1c level. A high prevalence of diabetic nephropathy (20.73%) was observed in this study population. A statistically significant difference among the four groups (zones) with respect to age (p <0.001), duration of diabetes (p = 0.024), HbA1c (p <0.001), and eGFR (p <0.001) was found. Conclusion The burden of diabetes and nephropathy is high in low-income countries and can be easily assessed by applying simple tools such as the newly proposed HbA1c/eGFR grid system to identify high-risk and medium-risk patients and adopting treatment according to the assigned zone.

Effect of Insulin-Like Growth Factor-1 on Diabetic Retinopathy in Pubertal Age Patients With Type 1 Diabetes

PURPOSE

The aims of this study were to correlate diabetic retinopathy (DR) changes with insulin-like growth factor 1 (IGF-1) levels in patients with type 1 diabetes of pubertal age group and to correlate the level of retinopathy with IGF-1 levels.

METHODS

This cross-sectional study was done over 2 years and involved patients with type 1 diabetes of age 8 to 25 years. Patients presenting to Ophthalmology OPD and inpatient department along with active recruitment from old pediatrics and endocrinology records were taken for the study. Fasting serum IGF-1 was calculated using enzyme-linked immunosorbent assay technique. Fasting blood sugar levels were taken. Detailed ophthalmic examination was done and DR was noted in all the patients and correlated with IGF-1 levels.

RESULTS

A total of 46 patients with type 1 diabetes were recruited into the study. The mean age of the patients was 14.33 ± 4.36 years, with a female-to-male ratio of 3:2. No relationship of IGF-1 with age of onset of diabetes (P = 0.7) or fasting capillary blood glucose (CBG) (P = 0.6) was found, but a significant relationship was found with duration of diabetes (P = 0.001) and low IGF-1 levels (P < 0.0001).

CONCLUSIONS

Severity of DR in patients with type 1 diabetes is inversely related to serum IGF-1 levels. Low IGF levels are an indicator for closer follow-up and strict management of diabetes and retinopathy.

A Special Report on Changing Trends in Preventive Stroke/Cardiovascular Risk Assessment Via B-Mode Ultrasonography

PURPOSE OF REVIEW

Cardiovascular disease (CVD) and stroke risk assessment have been largely based on the success of traditional statistically derived risk calculators such as Pooled Cohort Risk Score or Framingham Risk Score. However, over the last decade, automated computational paradigms such as machine learning (ML) and deep learning (DL) techniques have penetrated into a variety of medical domains including CVD/stroke risk assessment. This review is mainly focused on the changing trends in CVD/stroke risk assessment and its stratification from statistical-based models to ML-based paradigms using non-invasive carotid ultrasonography.

RECENT FINDINGS

In this review, ML-based strategies are categorized into two types: non-image (or conventional ML-based) and image-based (or integrated ML-based). The success of conventional (non-image-based) ML-based algorithms lies in the different data-driven patterns or features which are used to train the ML systems. Typically these features are the patients' demographics, serum biomarkers, and multiple clinical parameters. The integrated (image-based) ML-based algorithms integrate the features derived from the ultrasound scans of the arterial walls (such as morphological measurements) with conventional risk factors in ML frameworks. Even though the review covers ML-based system designs for carotid and coronary ultrasonography, the main focus of the review is on CVD/stroke risk scores based on carotid ultrasound. There are two key conclusions from this review: (i) fusion of image-based features with conventional cardiovascular risk factors can lead to more accurate CVD/stroke risk stratification; (ii) the ability to handle multiple sources of information in big data framework using artificial intelligence-based paradigms (such as ML and DL) is likely to be the future in preventive CVD/stroke risk assessment.

Secular TRends in DiabEtes in India (STRiDE-I): Change in Prevalence in 10 Years Among Urban and Rural Populations in Tamil Nadu

OBJECTIVE

The objective of the current study was to assess the secular trends in the prevalence of diabetes, prediabetes, and risk factors from two epidemiological surveys done 10 years apart in three adult populations of different geographic and socioeconomic backgrounds in Tamil Nadu, India.

RESEARCH DESIGN AND METHODS

This survey was conducted in 2016 using methodology similar to that used in 2006. Persons aged ≥20 years (n = 9,848) were screened for diabetes, prediabetes, and the risk variables. Fasting and 2-h plasma glucose, lipid profile, blood pressure, anthropometry, and socioeconomic and behavioral details were recorded. Comparative analyses of age-standardized prevalence were done. Prevalence ratios (PRs) between 2016 and 2006 of diabetes and also prediabetes were assessed using Poisson regression analyses.

RESULTS

Prevalence of diabetes increased from 18.6% (95% CI 16.6-20.5) to 21.9 (20.5-23.3) in the city, 16.4 (14.1-18.6) to 20.3 (18.9-21.6) in the town, and 9.2 (8.0-10.5) to 13.4 (11.9-14.8) in the periurban villages (PUVs) (P < 0.0001 in all). The PR showed a nonsignificant 8% rise in diabetes in the city, while significant increases had occurred in the town (39%) and PUVs (34%). Prevalence of prediabetes also increased. Age, family history of diabetes, and waist circumference were common risk determinants among the populations. Though general obesity and abdominal obesity increased, the latter was associated with the increased prevalence.

CONCLUSIONS

Prevalence of diabetes and prediabetes increased in all locations; the rise was significant only in the town and PUVs. Abdominal obesity is significantly associated with increased trend even among the villagers. Rural populations may be targeted for future public health measures to combat diabetes.

Prevalence of hypertension, diabetes, and associated risk factors among geriatric population living in a high-altitude region of rural Uttarakhand, India

Background:

Hypertension (HTN) and diabetes mellitus (DM) both are rapidly emerging as public health problems among geriatric population in developing countries. HTN can lead to stroke, myocardial infarction, congestive heart failure, and chronic kidney diseases among geriatric population. DM increases the risk of coronary heart disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy, and neuropathy among geriatric population.

Methodology:

A community-based, cross-sectional study was conducted during 2015–2016 in District Nainital, Uttarakhand. A list of all villages with their population in the district was developed. From this list, 30 villages were identified using population proportionate to size sampling method. From each village, 30 geriatric subjects were selected. A total of 1003 geriatric subjects age 60 years and above were included in the study. Data were collected on sociodemographic profile, blood pressure, fasting blood glucose, anthropometry, and lipid profile from all the enrolled subjects. The prevalence of HTN and DM was assessed. Univariate and multivariate analyses were done to identify risk factors associated with HTN and DM.

Results:

The prevalence of HTN and DM was found to be 54.5% and 14.6%, respectively. For HTN, advancing age, high educational level and body mass index (BMI) (≥25 kg/m²) and for DM higher education level and BMI (≥25 kg/m²) were found to be significant risk factors.

Conclusion:

A high prevalence of HTN and DM was found in geriatric population residing in rural area of Uttarakhand.

Population trends and public awareness of healthy and pathological ageing in India: A brief overview

India is poised to experience dramatic shifts in the age and makeup of its population. Specifically, projections havehighlighted an increase in both the percentage of the elderly and those suffering from dementia-related disorders.Previous studies have examined the demographics of aging, its impact on the healthcare infrastructure and recommended policies to better cater to the elderly. This article focuses on a summary of these findings in relation to key stakeholders in the care of the elderly including mental health professionals, family caregivers, and public health officials. We broadly conclude that there exists a general shallow level of understanding of what constitutes pathological aging (i.e. dementia) across all stakeholders, and this creates a cascade of effects including delays in treatment seeking and barriers in conducting and having accurate demographic studies. Moreover, addressing this knowledge gap can help enhance communication between these three stakeholders in the hopes of the following: (a) increased education and awareness, (b) faster seeking of care, and (c) earlier diagnoses leading to better opportunities to collect accurate demographics of those suffering from dementia-related disorders.

A Study of the Patients Suffering from Tuberculosis and Tuberculosis-diabetes Comorbidity in Revised National Tuberculosis Control Program Centers of Northern Madhya Pradesh, India

BACKGROUND

Diabetes mellitus (DM) is recognized as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence.

AIM

This study was conducted to document the coexistence of DM and TB in persons with established TB under the Revised National Tuberculosis Control Program.

TYPE OF STUDY

This was a cross-sectional, descriptive observational study conducted at selected Directly Observed Therapy center in Gwalior North Central India.

MATERIALS AND METHODS

A total of 550 patients with confirmed diagnosis of TB and on treatment were recruited. The study participants were screened for DM and diagnoses were made on the basis of the World Health Organization criteria. Clinical parameters were compared between persons with DM and those without DM.

RESULTS

DM/TB co-morbidity was noted in 85 individuals and these made up 15.4% of the study population. The mean age was higher in DM patients with TB (43.4 ± 15.4 vs. 33.1 ± 16.2 years, P = 0.000); the mean duration of symptoms of TB with DM was more (124 ± 16.4 vs. 107.49 ± 10.3 days). Multinomial logistic regression analysis showed that increasing age, positive family history of diabetes, sedentary occupation, and presence of pulmonary TB were significantly associated with diabetes among TB patients.

CONCLUSIONS

Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB.

Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus at High Risk for Foot Ulcers

AIM

To study the prevalence of cardiac autonomic neuropathy (CAN) in patients with Type 2 diabetes mellitus at high risk for foot ulcers.

MATERIALS AND METHODS

We screened patients attending diabetic clinic for identifying patients at high risk for foot ulcers. Those with foot risk category 1, 2 and 3 as per criteria of Foot Care Interest Group were subjected to battery of cardiovascular autonomic reflex tests. Those with one abnormal test were termed as probable CAN and those with two abnormal tests as definite CAN. Those with postural fall in blood pressure with one other abnormal test were termed to have advanced CAN.

RESULTS

A total of 74 patients were recruited in the study. The prevalence of abnormal cardiovascular autonomic reflex test was sustained hand grip 81%, E/I ratio 66.2%, 30:15 ratio 28.3% and orthostatic hypotension 13.5%. The prevalence of possible CAN was 31.0% (23/74) and definite CAN was 66.2% (49/74). Ten patients had advanced CAN. There was no observable difference in presence of probable or definite CAN in three risk category for foot ulcers.

CONCLUSION

We found a high prevalence of CAN in subgroup of diabetic patients at increased risk for foot ulcer.

Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States

This study used an experimental, pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes (T2DM) among Gujarati Asian Indians (AIs) in an urban community in the US. Participants included 70 adult AIs in the greater Houston metropolitan area. The primary outcomes were reduction in weight and hemoglobin A1c (HbA1c) and improvement in physical activity. Participants were screened for risk factors and randomly assigned to a 12-week group-based lifestyle intervention program (n = 34) or a control group (n = 36) that received standard print material on diabetes prevention. Participants also completed clinical measures and self-reported questionnaires about physical activity, social, and lifestyle habits at 0, 3, and 6 months. No significant baseline differences were noted between groups. While a significant decline in weight and increase in physical activity was observed in all participants, the intervention group lowered their HbA1c (p < 0.0005) and waist circumference (p = 0.04) significantly as compared to the control group. Findings demonstrated that participation in a culturally tailored, lifestyle intervention program in a community setting can effectively reduce weight, waist circumference, and HbA1c among Gujarati AIs living in the US.

Diabetic care initiatives to prevent blindness from diabetic retinopathy in India

It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20-50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.

Naringenin ameliorates streptozotocin-induced diabetic rat renal impairment by downregulation of TGF-β1 and IL-1 via modulation of oxidative stress correlates with decreased apoptotic events

CONTEXT

Naringenin, a flavonone and a nutritive antioxidant which is mostly obtained from grapefruit, orange or tomato skin, has been extensively studied due to its radical scavenging activity.

OBJECTIVE

The present study investigates the protective effect of naringenin on rat kidney after streptozotocin-induced diabetes.

MATERIALS AND METHODS

Sixty male Wistar rats were divided into six groups. Diabetes was induced by a single intraperitoneal injection of streptozotocin (50 mg/kg) in groups II, III and IV. Naringenin 5 mg/kg body weight was given to groups III and V, but 10 mg/kg was given to groups IV and VI, orally once a day for 10 weeks. After which all animals were sacrificed, and the biochemical, histopathological, immunohistochemical and apoptotic assays were conducted.

RESULTS

Naringenin treatment with 5 and 10 mg/kg significantly decreased (p < 0.05) the serum biochemical parameters, elevated tissue malondialdehyde levels and increased (p < 0.01) the reduced superoxide dismutase, catalase and reduced glutathione enzyme activities in the diabetic kidney. Diabetes-induced naringenin-treated groups showed an improved histology and revealed a significant reduction in apoptosis activity (7.2 ± 0.01 and 1.8 ± 0.05) and in expression of TGF-β1 (18.9 ± 3.4 and 10.2 ± 2.1) at a dose of 5 and 10 mg/kg, respectively. Similarly, in contrast to the diabetic group, a significant difference was observed in the IL-1 expression (15.68 ± 4.3) in 5 mg/kg and (9.85 ± 2.1) in 10 mg/kg naringenin-treated groups.

CONCLUSION

Naringenin acts as a protective agent in diabetic renal impairment by altering oxidative stress, modulation of cytokines expression and apoptotic events.

Effects of a self-management educational program on metabolic control in type 2 diabetes

BACKGROUND/AIM

India has 63 million diabetic people and the overall prevalence of diabetes in this country is 8.37%. Lifestyle modification by education is the most cost-effective strategy to have better metabolic control. The aim of this study was to investigate the effects of a self-management educational program on control of type 2 diabetes.

MATERIALS AND METHODS

It was a randomized controlled interventional study conducted among 306 patients with type 2 diabetes mellitus attending the Diabetic Clinic at G.T.B. Hospital, Delhi, from March 2010 to May 2013. The intervention was in the form of group education based on a self-management program, which was earlier developed in the pilot study.

RESULTS

The baseline characteristics were comparable in the two groups. After 6 months, there was a significant improvement in the HbA1c levels (P = 0.0001), physical activity level (P = 0.001), and BMI (P = 0.001) in the study group as compared to the control group and this difference persisted even when analysis was done using generalized estimation equations.

CONCLUSION

The findings of this study proved that a self-management educational program is an essential component in the management of diabetes and provided concrete evidence that this is an effective instrument in the control of body weight, blood pressure, and glycated Hb levels in type 2 diabetes.

Perceptions and practices related to diabetes reported by persons with diabetes attending diabetic care clinics: The India 11-city 9-state study

BACKGROUND

India has the second largest population of persons with diabetes and a significant proportion has poor glycemic control and inadequate awareness of management of diabetes.

OBJECTIVES

Determine the level of awareness regarding management of diabetes and its complications and diabetic care practices in India.

METHODS

The cross-sectional, hospital-based survey was conducted in 11 cities where public and private providers of diabetic care were identified. At each diabetic care facility, 4-6 persons with diabetes were administered a structured questionnaire in the local language.

RESULTS

Two hundred and eighty-five persons with diabetes were interviewed. The mean duration since diagnosis of diabetes was 8.1 years (standard deviation ± 7.3). Half of the participants reported a family history of diabetes and 41.7% were hypertensive. Almost 62.1% stated that they received information on diabetes and its management through interpersonal channels. Family history (36.1%), increasing age (25.3%), and stress (22.8%) were the commonest causes of diabetes reported. Only 29.1% stated that they monitored their blood sugar levels at home using a glucometer. The commonest challenges reported in managing diabetes were dietary modifications (67.4%), compliance with medicines (20.5%), and cost of medicines (17.9%). Around 76.5% were aware of complications of diabetes. Kidney failure (79.8%), blindness/vision loss (79.3%), and heart attack (56.4%) were the commonest complications mentioned. Almost 67.7% of the respondents stated that they had had an eye examination earlier.

CONCLUSIONS

The findings have significant implications for the organization of diabetes services in India for early detection and management of complications, including eye complications.

Perception of care and barriers to treatment in individuals with diabetic retinopathy in India: 11-city 9-state study

BACKGROUND

Diabetic retinopathy is a leading cause of visual impairment. Low awareness about the disease and inequitable distribution of care are major challenges in India.

OBJECTIVES

Assess perception of care and challenges faced in availing care among diabetics.

MATERIALS AND METHODS

The cross-sectional, hospital based survey was conducted in eleven cities. In each city, public and private providers of eye-care were identified. Both multispecialty and standalone facilities were included. Specially designed semi-open ended questionnaires were administered to the clients.

RESULTS

376 diabetics were interviewed in the eye clinics, of whom 62.8% (236) were selected from facilities in cities with a population of 7 million or more. The mean duration of known diabetes was 11.1 (±7.7) years. Half the respondents understood the meaning of adequate glycemic control and 45% reported that they had visual loss when they first presented to an eye facility. Facilities in smaller cities and those with higher educational status were found to be statistically significant predictors of self-reported good/adequate control of diabetes. The correct awareness of glycemic control was significantly high among attending privately-funded facilities and higher educational status. Self-monitoring of glycemic status at home was significantly associated with respondents from larger cities, privately-funded facilities, those who were better educated and reported longer duration of diabetes. Duration of diabetes (41%), poor glycemic control (39.4%) and age (20.7%) were identified as the leading causes of DR. The commonest challenges faced were lifestyle/behavior related.

CONCLUSIONS

The findings have significant implications for the organization of diabetes services in India.

Medication adherence and direct treatment cost among diabetes patients attending a tertiary healthcare facility in Ogbomosho, Nigeria

BACKGROUND

Diabetes mellitus (DM) is now prevalent in many countries in sub-Saharan Africa, with associated health and socioeconomic consequences. Adherence to antidiabetic medications has been shown to improve glycaemic control, which subsequently improves both the short- and long-term prognosis of the disease. The main objective of this study was to assess the level of adherence to antidiabetic drugs among outpatients in a teaching hospital in southwestern Nigeria.

METHODS

A cross-sectional study was carried out using the eight-item Morisky Medication Adherence Scale (MMAS-8) among diabetic patients attending the medical outpatients' diabetes clinic of Ladoke Akintola University Teaching Hospital, in Ogbomosho, Oyo State in southwestern Nigeria, during a three-month period (October to December 2013).

RESULTS

A total of 129 patients participated in the study with a male-to-female ratio of 1:1.5. Seventy-eight (60.5%) patients had systemic hypertension as a comorbid condition while the remaining were being managed for diabetes mellitus alone. Only 6 (4.7%) of the patients had type 1 DM while the remaining 123 (95.3%) were diagnosed with type 2 DM. Metformin was the most prescribed oral hypoglycaemic agent (n = 111, 58.7%) followed by glibenclamide (n = 49, 25.9%). Medication adherence was classified as good, medium, and poor for 52 (40.6%), 42 (32.8%), and 34 (26.6%) patients, respectively. Medication costs accounted for 72.3% of the total direct cost of DM in this study, followed by the cost of laboratory investigations (17.6%).

CONCLUSION

Adherence of diabetes patients in the study sample to their medications was satisfactory. There is a need for the integration of generic medicines into routine care as a way of further reducing the burden of healthcare expenditure on the patients.

Assessment of cost of illness for diabetic patients in South Indian tertiary care hospital

Background:

The impact of diabetes on health-care expenditures has been increasingly recognized. To formulate an effective health planning and resource allocation, it is important to determine economic burden.

Objective:

The objective of this study is to assess the cost of illness (COI) for diabetic inpatients with or without complications.

Methodology:

The study was conducted in the medicine wards of tertiary care hospital after ethical approval by the Institutional Ethical Committee. A total of 116 each diabetic with or without complications were selected and relevant data were collected using COI questionnaire and data were analyzed using SPSS version 20. Mann–Whitney U test is used to assess the statistical significant difference in the cost of treatment of diabetes alone and with complications’. P ≤ 0.05 was considered statistically significant.

Results:

Total COI includes the cost of treatment, investigation, consultation fee, intervention cost, transportation, days lost due to work, and hospitalization. The median of total COI for diabetic care without any complication was Rs. 22,456.97/- per patient per annum and with complication was Rs. 30,634.45/-. Patients on dialysis had to spend 7.3 times higher, and patients with cardiac intervention had to spend 7.4 times higher than diabetic patients without any complication.

Conclusion:

Treatment costs were many times higher in patients with complications and with cardiac and renal interventions. Complications in diabetic patients will increase the economic burden to family and also to the society.

Gestational diabetes mellitus in rural population of Western India - Results of a community survey

CONTEXT

Gestational diabetes mellitus (GDM) should be diagnosed early, as untreated maternal hyperglycemia leads to adverse materno-fetal outcome.

SUBJECTS AND METHODS

We studied prevalence of gestational diabetes by a house to house survey of a rural population in western India. A cluster of remote villages with little access to health care were chosen.

RESULTS

A total of 989 women participated in the study out of which 9.5% (n = 94) were diagnosed as GDM. In a stepwise multivariate regression analysis a higher body mass index during pregnancy was a predictor of gestational diabetes. The prevalence of diabetes was similar in women with gestational age of >24 weeks and <24 weeks, suggesting the need for early screening.

CONCLUSIONS

Our results suggest the need for implementing health programs to diagnose and treat gestational diabetes in this population.

Ayurveda in changing scenario of diabetes management for developing safe and effective treatment choices for the future

Ayurveda described diabetes mellitus (DM) as Madhumeha. This ancient evidence-based system of medicine enumerated various herbs and formulations for its management, which needs scientific validation. Whereas translational "bedside to bench" approach in biomedical research is an upcoming concept, its application in traditional and complementary medicine can be interesting. The intersecting concepts in the field Ayurveda and translational research needs "omics" approach. The Ayurvedic biology concepts about DM have its close relations with present systems biology approach. Metabolic changes causing tissue damage connected with genetic and immunological irregularities leading to insulin resistance coincide with ancient knowledge. Combinatorial therapy according to Prakriti type as elucidated by Ayurgenomics should be carried on for further research. "Bedside to bench" approaches in research utilizing metabolomics and pharmacogenomics approach can be a major step towards changing the therapeutic strategy towards diabetes. Prameha which is described as the pre-diabetic state is a novel concept in Ayurvedic etiopathogenesis, while metabolomic parameters like lipid level in urine can be a thrust area of research to have a pre-diabetic screening method in high-risk populations. This tradition-guided research paradigm can open up novel opportunities in traditional knowledge-inspired systems biology and drug discovery against diabetes.

Frequency of Food Consumption and Self-reported Diabetes among Adult Men and Women in India: A Large Scale Nationally Representative Cross-sectional Study

BACKGROUND

Recent studies have shown that the choice of foods and frequency of intake plays a role in diabetes prevention. We examined the association between frequency of consumption of specific food items and the occurrence of diabetes in adult Indian population.

METHODS

Cross sectional data of 99,574 women and 61,361 men aged 20-49 years who participated in India's third National Family Health Survey conducted during 2005-06 was used for this study. Association between frequency of food intake such as daily, weekly, occasionally and never, and prevalence of diabetes were estimated using multivariable logistic regression models after adjusting for body mass index, tobacco smoking, alcohol drinking, television watching and socio-economic and demographic characteristics, stratified by sex.

RESULTS

In men, weekly (OR:0.64; 95%CI:0.47-0.88) and occasional (OR:0.60; 95%CI:0.44-0.81) consumption of milk/curd, weekly (OR:0.48; 95%CI:0.27-0.87) and occasional (OR:0.52; 95%CI:0.28-0.99) consumption of pulses/beans and consumption of fruits (OR ranges from 0.33 to 0.39) was associated with a significantly lower likelihood of diabetes whereas daily (OR:0.55; 95%CI:0.34-0.88) or weekly (OR:0.56; 95%CI:0.35-0.90) pulses/beans consumption and fruits intake (OR ranges from 0.36 to 0.46) was associated with a lower likelihood of diabetes in women.

CONCLUSION

This study has confirmed findings from high income countries that diabetes among adult Indians, which is large and increasing, might be contained by regular consumption of vegetarian foods including pulses, beans, fruits and dairy products. However, this is an observational finding and uncontrolled confounding cannot be excluded as an explanation for the association. More epidemiological research with better measures of food intake and clinical measures of diabetes is needed in a developing country setting to validate the findings.

Comparison of salivary and serum glucose levels in diabetic patients

Diabetes mellitus is a noncommunicable disease with a rising prevalence worldwide and in developing countries. The most commonly used diagnostic biofluid for detection of glucose levels is blood, but sample collection is an invasive and painful procedure. Thus, there arises a need for a noninvasive and painless technique to detect glucose levels. The objectives of the present study were to estimate the glucose levels of saliva, to assess if any significant correlation existed between the serum and salivary glucose levels, and to correlate salivary glucose levels with regard to duration of diabetes, age, and gender. In the present study, serum and salivary glucose levels of 200 subjects (100 diabetic subjects and 100 nondiabetic subjects) were estimated by glucose oxidase method. Glycosylated hemoglobin levels were also measured in randomly selected 40 diabetic subjects. The findings of present study revealed a significant correlation between salivary and serum glucose levels in both diabetic and nondiabetic subjects. No significant relationship was observed between salivary glucose levels and gender or age in both diabetics and nondiabetics and between salivary glucose levels and duration of diabetes in diabetics. On the basis of the findings, it was concluded that salivary glucose levels could serve as a potentially noninvasive adjunct to monitor glycemic control in diabetic patients.

Economic burden of diabetes in urban indians

Purpose :

To find out the average economic burden of medical care on a patient with diabetes in Pune, India

Methods :

A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification.

Results :

219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV.

Conclusion :

The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).

Prevalence and risk factors for retinopathy in persons without diabetes: the Singapore Indian Eye Study

PURPOSE

To describe prevalence and risk factors for retinopathy in an Asian Indian population without diabetes.

METHODS

A population-based cross-sectional study of 3400 Indians aged 40-80 years residing in Singapore was conducted. Retinopathy was assessed from retinal photographs by trained graders using modified Airlie House Classification System. Risk factors were assessed from standardized interviews, clinical examinations and laboratory investigations. Diabetes mellitus was defined as glycosylated haemoglobin ≥6.5%, use of diabetic medication or physician diagnosis of diabetes.

RESULTS

Among the 1900 individuals without diabetes, mean HbA1c was 5.7% and mean systolic blood pressure was 132.4 mmHg. Age-standardized prevalence of retinopathy was 5.05% (n = 98; 95% confidence interval [CI], 4.07-6.21), with no significant difference in retinopathy prevalence between males (6.15%) and females (4.13%). Among non-diabetic persons with retinopathy, 96.9% (n = 95) had signs of minimal-to-mild retinopathy while 3.06% (n = 3) had moderate-to-severe retinopathy. After adjusting for multiple covariables, retinopathy signs were associated with higher levels of HbA1c (odds ratio [OR], 2.4; 95% CI, 1.3-4.5; per% increase), systolic blood pressure (OR, 1.02; 95% CI, 1.01-1.03; per mmHg increase) and serum creatinine (OR, 1.005; 95% CI, 1.002-1.009; per mm increase), but not C-reactive protein, cigarette smoking or lipid levels.

CONCLUSION

One in 20 Asian Indian persons without diabetes had retinopathy signs. Risk factors for these signs include higher glycosylated haemoglobin, systolic blood pressure and serum creatinine.

Prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients

CONTEXT

Despite the availability of efficacious anti-diabetic drugs, which act by different mechanisms to reduce the blood-glucose, the majority of people with diabetes on anti-diabetic drug therapy, have poor glycemic control and diabetic vascular complications.

AIM AND OBJECTIVES

The aim was to study the prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients attending tertiary care teaching hospital in Navi Mumbai.

MATERIALS AND METHODS

A prospective, cross-sectional, observational survey was carried out in 100 patients of diabetes mellitus attending diabetes outpatient/medicine outpatient departments, to assess their prescribing pattern of anti-diabetic drugs, and their blood-glucose level was measured by Accu-Chek Active glucometer to determine their glycemic control.

RESULTS

Average number of anti-diabetic drugs per prescription was 1.4. Sulfonylureas were the most commonly prescribed class, but metformin (biguanide) was the commonest prescribed individual drug among oral hypoglycemic agents (OHA). Fixed dose combination of biguanide and sulfonylurea was prescribed commonly. Monotherapy dominated over polytherapy and there was a higher percentage of use of insulin in Type 2 diabetics. Only 41% of patients on anti-diabetic therapy had optimal glycemic control. The association between anti-diabetic therapy along with lifestyle modification and glycemic control was statistically significant (P = 0.0011).

CONCLUSIONS

OHAs still dominate the prescribing pattern, but there was a shifting trend toward the use of insulin preparations in the management of Type 2 diabetes mellitus. In achieving optimal glycemic control, the efficacy of the anti-diabetic drugs was only 41%; therefore intensification of current drug treatment as well as planning multiple drug interventions with lifestyle modification is necessary.

Type of vegetarian diet, obesity and diabetes in adult Indian population

BACKGROUND

To investigate the prevalence of obesity and diabetes among adult men and women in India consuming different types of vegetarian diets compared with those consuming non-vegetarian diets.

METHODS

We used cross-sectional data of 156,317 adults aged 20-49 years who participated in India's third National Family Health Survey (2005-06). Association between types of vegetarian diet (vegan, lacto-vegetarian, lacto-ovo vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian) and self-reported diabetes status and measured body mass index (BMI) were estimated using multivariable logistic regression adjusting for age, gender, education, household wealth, rural/urban residence, religion, caste, smoking, alcohol use, and television watching.

RESULTS

Mean BMI was lowest in pesco-vegetarians (20.3 kg/m2) and vegans (20.5 kg/m2) and highest in lacto-ovo vegetarian (21.0 kg/m2) and lacto-vegetarian (21.2 kg/m2) diets. Prevalence of diabetes varied from 0.9% (95% CI: 0.8-1.1) in person consuming lacto-vegetarian, lacto-ovo vegetarian (95% CI:0.6-1.3) and semi-vegetarian (95% CI:0.7-1.1) diets and was highest in those persons consuming a pesco-vegetarian diet (1.4%; 95% CI:1.0-2.0). Consumption of a lacto- (OR:0.67;95% CI:0.58-0.76;p < 0.01), lacto-ovo (OR:0.70; 95% CI:0.51-0.96;p = 0.03) and semi-vegetarian (OR:0.77; 95% CI:0.60-0.98; p = 0.03) diet was associated with a lower likelihood of diabetes than a non-vegetarian diet in the adjusted analyses.

CONCLUSIONS

In this large, nationally representative sample of Indian adults, lacto-, lacto-ovo and semi-vegetarian diets were associated with a lower likelihood of diabetes. These findings may assist in the development of interventions to address the growing burden of overweight/obesity and diabetes in Indian population. However, prospective studies with better measures of dietary intake and clinical measures of diabetes are needed to clarify this relationship.

Prevalence of Diabetes Mellitus and Its Risk Factors among Permanently Settled Tribal Individuals in Tribal and Urban Areas in Northern State of Sub-Himalayan Region of India

Background. Effect of urban environment on the development of DM and its risk factors is studied with an ecological fallacy due to their study designs that formulate the background for the present study. Objective. To study the prevalence of DM and associated lifestyle related risk factors in traditional tribal individuals residing in tribal area and migrating persons of the same tribe to urban area of sub-Himalayan northern state of India. Methodology. Population based cross-sectional study. Results. A total of 8000 individuals (tribal: 4000; urban: 4000) were recruited. Overall, among urban tribes the prevalence of central obesity (59.0%), overweight (29.3%), stage 1 (22.8%) and stage 2 (5.3%) hypertension, and DM (fasting: 7.8%; OGTT: 8.5%) (P = 0.00) was significantly higher than the tribes of tribal area. Based on OGTT, the prevalence of DM was found to be 9.2% among central obese tribes of urban area and 6.7% of tribal area (P = 0.00). DM showed a significant high prevalence among urban tribes with prehypertension (urban: 8.3%; tribal: 2.9%; P = 0.00), and stage 1 (urban: 14.1%; tribal: 8.7%; P = 0.00) and stage 2 (urban: 17.5%; tribal: 13.9%; P = 0.59) hypertension. Conclusion. Urban environment showed a changing lifestyle and high prevalence of DM among tribal migrating urban tribes as compared to traditional tribes.

A revisit to prevailing care and challenges of managing diabetes in India: Focus on regional disparities

An unprecedented rise in diabetes mellitus (DM) prevalence in India is the outcome of lifestyle changes in the background of genetic predisposition. Moreover, there are substantial regional variations in diabetes prevalence and management. The highest prevalence of DM was observed in southern region (Ernakulum, Kerala) and lowest prevalence was observed in North Eastern region (Manipur). Similarly large variations have been evident in overall awareness and diabetes care across the geographies within India. The regional challenges are largely affected by poor disease awareness, socioeconomic disparity and underutilization of the public health-care services. Though government has taken initiatives to address this issue, overall situation demands a collaborative effort from patients, health care professionals and the state. An exhaustive literature search was performed for articles and studies published on electronic databases. Present article assesses the regional disparity of diabetes epidemiology, current management practices and government policies for T2DM in India, identifies policy and research gaps, and suggests corrective measures to address the lacunae in diabetes care.

High diabetes prevalence among tuberculosis cases in Kerala, India

BACKGROUND

While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM.

METHODOLOGY/PRINCIPAL FINDINGS

A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control.

CONCLUSIONS/SIGNIFICANCE

Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research.

Population-based versus high-risk strategies for the prevention of cardiovascular diseases in low- and middle-income countries

Cardiovascular diseases (CVD) are now the number one cause of death in low- and middle-income countries (LMIC), such as those in South East Asia (SEA). It is projected that SEA countries will have the greatest total number of deaths due to non-communicable diseases (NCDs) by 2020. In low resource countries, the rising burden of CVDs imposes severe economic consequences that range from impoverishment of families to high health system costs and the weakening of country economies. There are two possible options to be considered for addressing this issue: a "population-based strategy" and/or a "high risk" strategy. The question is, what is the optimal way to reduce the excessive burden of these diseases in the LMICs. We believe that by applying systematic policy and smoking cessation programs with proven effectiveness, there is a chance that the high smoking prevalence, particularly among SEA.

IFSO-APC consensus statements 2011

Associations of BMI with body composition and health outcomes may differ between Asian and European populations. Asian populations have also been shown to have an elevated risk of type 2 diabetes, hypertension, and hyperlipidemia at a relatively low level of BMI. New surgical indication for Asian patients should be discussed by the expert of this field. Forty-four bariatric experts in Asia-Pacific and other regions were chosen to have a voting privilege for IFSO-APC Consensus at the 2nd IFSO-APC Congress. A computerized audience-response voting system was used to analyze the agreement with the sentence of the consensus. Of all delegates, 95% agreed with the necessity of the establishment of IFSO-APC consensus statements, and 98% agreed with the necessity of a new indication for Asian patients. IFSO-APC Consensus statements 2011. Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities. Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30. The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5. Other eight sentences are agreed with by majority of the voting delegates to form IFSO-APC consensus statements. This will help to make safe and wholesome the progress of bariatric and metabolic surgery in Asia.

Vitamin d deficiency and insulin resistance in normal and type 2 diabetes subjects

Vitamin D is recognized to serve a wide range of biological functions. The presence of vitamin D receptors on different tissues explains it's diversity of actions. Reduced levels of vitamin D is associated with insulin resistance and increased diabetes risk. The study included 50 normal healthy individuals and 49 type 2 diabetes subjects. Fasting blood glucose, total cholesterol, triglycerides, HDLc, fasting insulin, parathyroid hormone, calcium, albumin and Homeostasis model for assessment of insulin resistance (HOMAIR) were measured in all the study participants. Type 2 diabetes subjects were divided into group 1 with 25 hydroxy vitamin D (25(OH)D) ≤20 ng/ml and group 2 with 25(OH)D >20 ng/ml. By the results of this study, the mean 25(OH)D level was low (20.09 ng/ml) in type 2 diabetes compared to controls (23.89 ng/ml) and the p value was 0.02. The estimated insulin resistance by HOMAIR was more in group 1 than in group 2 of diabetes with p value of 0.037. The Pearson's correlation-coefficient was negative for 25(OH)D and insulin in type 2 diabetes (r = -0.294), 25(OH)D was negatively correlated with HOMAIR in total subjects. Type 2 diabetes subjects had reduced levels of vitamin D than normal individuals. The insulin resistance was more in vitamin D deficiency state. Hence vitamin D has a role in glucose metabolism, deficiency can result in insulin resistance and diabetes.

Prevalence and risk factors for self-reported diabetes among adult men and women in India: findings from a national cross-sectional survey

OBJECTIVE

We examined the distribution of diabetes and modifiable risk factors to provide data to aid diabetes prevention programmes in India.

DESIGN

Population-based cross-sectional survey of men and women included in India's third National Family Health Survey (NFHS-3, 2005-2006).

SETTING

The sample is a multistage cluster sample with an overall response rate of 98 %. All states of India are represented in the sample (except the small Union Territories), covering more than 99 % of the country's population.

SUBJECTS

Women (n 99 574) and men (n 56 742) aged 20-49 years residing in the sample households.

RESULTS

Prevalence of diabetes was 1598/100 000 (95 % CI 1462, 1735) among men and 1054/100 000 (95 % CI 974, 1134) among women in India. Rural-urban and marked geographic variation were found with higher rates in south and north-eastern India. Weekly and daily fish intake contributed to a significantly higher risk of diabetes among both women and men. Risks of diabetes increased with increased BMI, age and wealth status of both women and men, but no effects of the consumption of milk/curd, vegetables, eggs, television watching, alcohol consumption or smoking were found. Daily consumption of pulse/beans or fruits was associated with a significantly reduced risk of diabetes among women, whereas non-significant inverse associations were observed in the case of men.

CONCLUSIONS

Prevalence was underestimated using self-reports. The wide variation in self-reported diabetes is unlikely to be due entirely to reporting biases or access to health care, and indicates that modifiable risk factors exist. Prevention of diabetes should focus on obesity and target specific socio-economic groups in India.

Prevalence and risk factors for diabetes and impaired glucose tolerance in Asian Indians: a community survey from urban eastern India

OBJECTIVES

To determine the prevalence of diabetes and impaired glucose tolerance (IGT) and to identify risk factors for the same specific to an underdeveloped urban locale of Eastern India.

METHODS

Study design. Population based cross-sectional study, with multistage random sampling technique. Setting. Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. Participants. 1178 adults of 20-80 years age randomly selected from 37 electoral wards of urban populace. Definition and diagnosis of diabetes mellitus and IGT. These were based on a Report of a World Health Organization/International Diabetes Federation Consultation of 2006. Main outcome measure. Prevalence and significant risk factors for Diabetes and IGT. Statistical analysis. Both descriptive and multivariable logistic regression analyses.

RESULTS

The crude rates of diabetes and IGT in the study population were 15.7% and 8.8%, respectively. Similarly age-standardized rates of diabetes and IGT were 11.1% and 6.7%, respectively. Both diabetes and IGT had shown a male preponderance.

CONCLUSION

Diabetes and IGT were very highly prevalent in this urban populace. Cardiometabolic risk factors like older age, central obesity, inadequate fruit intake, hypertension, hypertriglyceridemia and socio economic status were found to be significant predictors of diabetes in this study.