Prevalence of diabetes and hypertension and association with various risk factors among different Muslim populations of Manipur, India

The effect of curcumin and high-content eicosapentaenoic acid supplementations in type 2 diabetes mellitus patients: a double-blinded randomized clinical trial

BACKGROUND/OBJECTIVES

The present study investigated the effect of curcumin and eicosapentaenoic acid, as one the main components of omega-3 polyunsaturated fatty acids, on anthropometric, glucose homeostasis, and gene expression markers of cardio-metabolic risk in patients with type 2 diabetes mellitus.

SUBJECTS/METHODS

This clinical trial was conducted at the Endocrinology Clinic of Imam Reza Hospital in Tabriz. It aimed to determine the impact of Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), and curcumin supplements on various health indicators in patients with Type 2 Diabetes Mellitus (DM2) from 2021.02.01 to 2022.02.01. The study was a randomized double-blinded clinical trial and conducted over 12 weeks with 100 participants randomly divided into four groups. Stratified randomization was used to assign participants to two months of supplementation based on sex and Body Mass Index (BMI). The study comprised four groups: Group 1 received 2 capsules of 500 mg EPA and 200 mg DHA, along with 1 nano-curcumin placebo; Group 2 received 1 capsule of 80 mg nano-curcumin and 2 omega 3 Fatty Acids placebos; Group 3 received 2 capsules of 500 mg EPA and 200 mg DHA, and 1 capsule of 80 mg nano-curcumin; Group 4, the control, received 2 omega 3 Fatty Acids placebos and 1 nano-curcumin placebo.

RESULTS

After twelve weeks of taking EPA + Nano-curcumin supplements, the patients experienced a statistically significant reduction in insulin levels in their blood [MD: -1.44 (-2.70, -0.17)]. This decrease was significantly greater than the changes observed in the placebo group [MD: -0.63 (-1.97, 0.69)]. The EPA + Nano-curcumin group also showed a significant decrease in High-Sensitivity C-Reactive Protein (hs-CRP) levels compared to the placebo group (p < 0.05). Additionally, the EPA + Nano-curcumin group had a significant increase in Total Antioxidant Capacity (TAC) levels compared to the placebo group (p < 0.01). However, there were no significant differences in Fasting Blood Sugar (FBS), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index, Quantitative Insulin Sensitivity Check Index (QUICKI), or Hemoglobin A1c (HbA1C) levels between the four groups (all p > 0.05). There were significant differences between the Nano-curcumin and EPA groups [MD: -17.02 (-32.99, -1.05)], and between the Nano-curcumin and control groups [MD: -20.76 (-36.73, -4.79)] in terms of lowering the serum cholesterol level. The difference in Triglycerides (TG) serum levels between the EPA + Nano-curcumin and placebo groups were not statistically significant (p = 0.093). The Nano-curcumin group showed significant decreases in Low-Density Lipoprotein (LDL) levels compared to the EPA group [MD: -20.12 (-36.90, -3.34)] and the control group [MD: -20.79 (-37.57, -4.01)]. There was a near-to-significant difference in High-Density Lipoprotein (HDL) serum levels between the EPA + Nano-curcumin and EPA groups (p = 0.056). Finally, there were significant differences in the decrease of serum Vascular Endothelial Growth Factor (VEGF) levels between the EPA and Nano-curcumin groups [MD: -127.50 (-247.91, -7.09)], the EPA and placebo groups [MD: 126.25 (5.83, 246.66)], the EPA + Nano-curcumin and Nano-curcumin groups [MD: -122.76 (-243.17, -2.35)], and the EPA + Nano- curcumin and placebo groups [MD: 121.50 (1.09, 241.92)].

CONCLUSIONS

The findings of the present study suggest that 12-week supplementation with EPA and Nano-curcumin may positively impact inflammation, oxidative stress, and metabolic parameters in patients with diabetes. The supplementation of EPA and Nano-curcumin may be a potential intervention to manage diabetes and reduce the risk of complications associated with diabetes. However, further research is needed to validate the study's findings and establish the long-term effects of EPA and Nano-curcumin supplementation in patients with diabetes.

Prevalence of diabetes mellitus in Indian tribal population: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM), a significant public health problem across the nations, is among the top ten leading causes of death. More than 370 million indigenous people (referred to as tribal people in India) are spread across 90 countries. India has the largest tribal people of 104 million. Tribal populations are not exceptional to the threat of type 2 DM (T2DM) and other non-communicable diseases, and hence, public health programmes are addressing this problem. This paper reports the systematic review and meta-analysis of the literature on the prevalence of T2DM.

METHODS

We conducted a systematic review and meta-analysis of the literature to understand the prevalence of T2DM among the tribal populations of India, following the guidelines of the PRISMA Statement for Reporting Systematic Reviews and Meta-Analysis. The gender-wise prevalence was recalculated by extracting the data wherever possible. Forest plots were depicted based on the prevalence, and other analyses were performed.

RESULTS

On initial searches from three databases, 5422 citations were identified, and ultimately 27 studies were included in the review. These studies were undertaken amongst different tribes in different parts of India. The pooled prevalence of T2DM among men, women and combined were 6.04% (95% confidence interval (CI): 5.55% to 6.57%), 6.48% (95% CI: 6.01% to 6.99%) and 4.94% (95% CI: 4.72% to 5.17%), respectively. Considerable heterogeneity was found among these studies.

CONCLUSION

This systematic review provides an overview of the prevalence of T2DM among the Indian tribal population. The pooled overall prevalence is slightly lower than the general population. This situation is worrisome as the epidemic of T2DM will affect the poor tribal communities, who can least afford to bear the health care costs. Hence, the public health care services must be strengthened in all tribal areas. This review further warrants establishing surveillance of T2DM in tribal areas.

Factors associated with non-adoption of healthy behavior among individuals with diabetes: a population-based study in Brazil

BACKGROUND

The non-adoption of behavioral changes to control diabetes mellitus contributes to a low adherence to self-care. This study aimed to investigate the factors associated with non-adoption of healthy behaviors among diabetic individuals.

METHODS

Cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde) carried out in 2013 in Brazil, with adults (≥18 years) (n = 3098). The outcome variable was the non-adoption-two or fewer-of healthy behaviors. Logistic regression model was used to identify the factors associated with non-adoption of healthy behaviors.

RESULTS

Approximately, 50% of the participants adopted two or fewer healthy habits and the most frequently mentioned were not drinking excessively (94.1%) and not smoking (89.1%). Not using diabetic medication (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.02-1.85), not making regular doctor visits (OR = 1.42, 95% CI = 1.08-1.87), no limitation of usual activities (OR = 1.39, 95% CI = 1.01-1.94) and good self-rated health (OR = 1.47, 95% CI = 1.09-1.98) increased the chance of individuals non-adoption of healthy behaviors independently of gender, age, schooling and economic status.

CONCLUSIONS

Health professionals need to be aware of issues, such as diabetic medication use, frequency of doctor visits, limitation of usual activities and good self-rated health, which are factors that can interfere with the adoption of healthy behaviors of diabetic patients.

The Protective Effects of L-Carnitine and Zinc Oxide Nanoparticles Against Diabetic Injury on Sex Steroid Hormones Levels, Oxidative Stress, and Ovarian Histopathological Changes in Rat

Diabetes mellitus is a common chronic metabolic disorder. This study aimed to investigate the effects of co-treatment with L-carnitine (LC) and zinc oxide nanoparticles (ZnONPs) on serum levels of sex hormones, oxidative stress, and ovarian histopathology in streptozotocin (STZ)-induced diabetic rats. Female Wistar rats (n = 56, 180-220 g) received a single intraperitoneal (IP) injection of STZ (65 mg/kg). They were randomly assigned into the following groups: diabetic group (Dia), Dia+Met group (100 mg metformin/kg/day), Dia+LC group (200 mg/kg/day), Dia+ZnONPs group (10 mg/kg/day), and Dia+LC+ZnONPs group (200 mg LC/kg/day and 10 mg ZnONPs/kg/day). Control group (Ctl) received the same volume of STZ solvent. After 21 days of treatment, blood serum was centrifuged for sex hormone assays. The right ovary was used for biochemical analysis, and the left ovary was fixed in 10% neutral buffered formalin for histological assessment. The levels of estradiol, progesterone, FSH, and LH significantly increased in the Dia+ZnONPs+LC group (P < 0.001) compared with the Dia group. Co-treatment with LC and ZnONPs reduced malondialdehyde and carbonyl protein and increased glutathione, catalase, and superoxide dismutase activities in ovarian tissue compared with the Dia group (P < 0.05). Moreover, the number of all ovarian follicles significantly increased in this group compared with the Dia group (P < 0.05). The results of this study indicated that co-treatment with LC and ZnONPs could preserve ovarian function by increasing sex hormones levels and antioxidant activity and decreasing lipid peroxidation in diabetic rats. Therefore, this compound supplementation may improve ovulation and fertility in people with diabetes mellitus.

Hypertension prevalence and associated factors among patients with diabetes: A retrospective cross-sectional study from Jordan

Background

Hypertension (HTN) is a common comorbidity among diabetic patients. Studies reported that HTN prevalence in patients with diabetes mellitus (DM) depends on many risk factors related to the disease (the type and duration of DM), patients (age, sex, race/ethnicity, BMI), and medical history (glycemic control, renal problems). Best to our knowledge, limited evidence is available in this regard among Jordanian population.

Objectives

This retrospective cross-sectional study aimed to determine the prevalence of HTN among patients with DM in Jordan and factors that might be associated with the concurrence of both diseases.

Materials and methods

A cross-sectional study was conducted to determine HTN prevalence and risk factors among diabetic outpatients in Jordan. Patients were asked about their sociodemographic information and medical history. A descriptive analysis was used to determine HTN prevalence and a fit bivariate logistic regression model was used to identify the significant risk factors of HTN in patients with type 2 DM (T2DM).

Results

HTN was found to be concurrently occurring in approximately 80% of T2DM patients. This was found to increase with age. In addition, dyslipidemia, gout disease, ischemic heart disease, renal impairment, or a family history of HTN were found to be associated with the concurrence of HTN among T2DM patients.

Conclusion

Findings from this study highlight the need for proper monitoring of DM patients to reduce the co-occurrence of HTN. Specific attention should be directed to control the patients' glycemic and lipid profiles as well as the cardiac and renal health using non-pharmacological and pharmacological measures. This is of particular importance in T2DM patients at old age and with family history of HTN, to reduce patients’ deterioration. Results from this study will also be informative for the development of public health strategies to increase the awareness of the general population regarding T2DM and HTN since both diseases are very common among Jordanian population.

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Hypertension is concurrently occurring in around 80 % of Jordanian diabetics.

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The risk of having hypertension in diabetics increases with patient age, family history of hypertension, and dyslipidemia.

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Gout disease, ischemic heart disease, and renal impairment increase the risk of hypertension in diabetics.

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Public health strategies are needed to increase the awareness of general population regarding diabetes and hypertension.

Comparative Analysis of Some Structural Equation Model Estimation Methods with Application to Coronary Heart Disease Risk

This study compared a ridge maximum likelihood estimator to Yuan and Chan (2008) ridge maximum likelihood, maximum likelihood, unweighted least squares, generalized least squares, and asymptotic distribution-free estimators in fitting six models that show relationships in some noncommunicable diseases. Uncontrolled hypertension has been shown to be a leading cause of coronary heart disease, kidney dysfunction, and other negative health outcomes. It poses equal danger when asymptomatic and undetected. Research has also shown that it tends to coexist with diabetes mellitus (DM), with the presence of DM doubling the risk of hypertension. The study assessed the effect of obesity, type II diabetes, and hypertension on coronary risk and also the existence of converse relationship with structural equation modelling (SEM). The results showed that the two ridge estimators did better than other estimators. Nonconvergence occurred for most of the models for asymptotic distribution-free estimator and unweighted least squares estimator whilst generalized least squares estimator had one nonconvergence of results. Other estimators provided competing outputs, but unweighted least squares estimator reported unreliable parameter estimates such as large chi-square test statistic and root mean square error of approximation for Model 3. The maximum likelihood family of estimators did better than others like asymptotic distribution-free estimator in terms of overall model fit and parameter estimation. Also, the study found that increase in obesity could result in a significant increase in both hypertension and coronary risk. Diastolic blood pressure and diabetes have significant converse effects on each other. This implies those who are hypertensive can develop diabetes and vice versa.

The relationship between serum 25-hydroxy vitamin D and blood pressure and quality of life in overweight and obese patients with type 2 diabetes mellitus compared with healthy subjects

Background:

Vitamin D is one of the known lipoprotein hormones with metabolic properties. We aimed to determine the serum 25-hydroxy vitamin D concentration in overweight/obese subjects with diabetes mellitus type Ⅱ (DM Ⅱ) in association with systolic and diastolic blood pressure and quality of life compared with healthy participants.

Methods:

The current case-control study was carried out among 80 overweight/obese subjects with DM Ⅱ, and 77 healthy subjects matched by sex, age and body mass index (BMI). Serum 25-hydroxyvitamin D concentration was measured by ELISA method. In order to examine the quality of life, the Persian version of SF36 questionnaire was used.

Results:

There was significant difference between diabetic and healthy subjects considering serum 25-hydroxyvitamin D concentration (p=0.012). Serum 25-hydroxyvitamin D concentration was inversely correlated with diastolic blood pressure (p=0.02) and positively associated with physical function (p<0.001), social function (p<0.001) and general health (p<0.001) components of quality of life in diabetic subjects and physical health sub-scale (p=0.004) in all participants.

Conclusion:

Serum 25-hydroxyvitamin D concentration was significantly lower in diabetic subjects in comparison with healthy controls. There was a significant reverse relationship between serum concentrations of 25-hydroxyvitamin D with diastolic blood pressure and on the other hand, a significant positive relationship with physical function, social function and general health components and physical health subscale of quality of life in participants with DM Ⅱ.

Prevalence of type 2 diabetes mellitus (T2DM) in India: A systematic review (1994-2018)

AIM

To conduct a systematic and critical review of published studies on prevalence of Type 2 diabetes mellitus (T2DM) in urban and rural areas of India.

METHODS

We conducted a literature search in PubMed, EMBASE and Web of Science using the terms 'prevalence', 'Type 2 diabetes, 'India', 'urban' and 'rural' for English language articles published during January 1994-December 2018. We selected articles that reported the results of original studies that randomly sampled adults aged 15-80 years, and which reported T2DM prevalence based on the actual examination of blood samples.

RESULTS

Of 1751 articles screened by titles and abstracts, 37 fulfilled our inclusion criteria. Majority (28 of 37; 76%) of studies were from South India, especially from the states of Tamil Nadu, Andhra Pradesh, Kerala and Karnataka. The prevalence of T2DM showed a wide range from 1.9% to 25.2%. Only 11 studies covering 24 regions separately reported the data by urban or rural location. Albeit inconsistent, 17 studies reported prevalence of T2DM by age group.

CONCLUSION

In this systematic review, we show that there remains an ambiguity about the actual prevalence of T2DM from India due to several factors. The findings underscore a strong need for having periodic regional surveillance involving appropriate epidemiological methods.

Screening strategies for hypertension

BACKGROUND

Hypertension is a major public health challenge affecting more than one billion people worldwide; it disproportionately affects populations in low- and middle-income countries (LMICs), where health systems are generally weak. The increasing prevalence of hypertension is associated with population growth, ageing, genetic factors, and behavioural risk factors, such as excessive salt and fat consumption, physical inactivity, being overweight and obese, harmful alcohol consumption, and poor management of stress. Over the long term, hypertension leads to risk for cardiovascular events, such as heart disease, stroke, kidney failure, disability, and premature mortality. Cardiovascular events can be preventable when high-risk populations are targeted, for example, through population-wide screening strategies. When available resources are limited, taking a total risk approach whereby several risk factors of hypertension are taken into consideration (e.g. age, gender, lifestyle factors, diabetes, blood cholesterol) can enable more accurate targeting of high-risk groups. Targeting of high-risk groups can help reduce costs in that resources are not spent on the entire population. Early detection in the form of screening for hypertension (and associated risk factors) can help identify high-risk groups, which can result in timely treatment and management of risk factors. Ultimately, early detection can help reduce morbidity and mortality linked to it and can help contain health-related costs, for example, those associated with hospitalisation due to severe illness and poorly managed risk factors and comorbidities.

OBJECTIVES

To assess the effectiveness of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce morbidity and mortality associated with hypertension.

SEARCH METHODS

An Information Specialist searched the Cochrane Register of Studies (CRS-Web), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS) Bireme, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) without language, publication year, or publication status restrictions. The searches were conducted from inception until 9 April 2020.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and non-RCTs (NRCTs), that is, controlled before and after (CBA), interrupted time series (ITS), and prospective analytic cohort studies of healthy adolescents, adults, and elderly people participating in mass, targeted, or opportunistic screening of hypertension.

DATA COLLECTION AND ANALYSIS

Screening of all retrieved studies was done in Covidence. A team of reviewers, in pairs, independently assessed titles and abstracts of identified studies and acquired full texts for studies that were potentially eligible. Studies were deemed to be eligible for full-text screening if two review authors agreed, or if consensus was reached through discussion with a third review author. It was planned that at least two review authors would independently extract data from included studies, assess risk of bias using pre-specified Cochrane criteria, and conduct a meta-analysis of sufficiently similar studies or present a narrative synthesis of the results.

MAIN RESULTS

We screened 9335 titles and abstracts. We identified 54 potentially eligible studies for full-text screening. However, no studies met the eligibility criteria.

AUTHORS' CONCLUSIONS

There is an implicit assumption that early detection of hypertension through screening can reduce the burden of morbidity and mortality, but this assumption has not been tested in rigorous research studies. High-quality evidence from RCTs or programmatic evidence from NRCTs on the effectiveness and costs or harms of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce hypertension-related morbidity and mortality is lacking.

Chronic Kidney Disease among Middle-Aged and Elderly Population: A cross-sectional screening in a Hospital Camp in Varanasi, India

Chronic kidney disease (CKD) is no longer considered just a health burden, but a major health priority owing to its high treatment costs and poor outcome. The lack of community-based screening programs has led to the detection of CKD patients at advanced stages. This study aims to estimate the prevalence of CKD and patterns of known risk factors among the general population (middle-aged and elderly) attending a screening camp in a community-based setting. The study participants constituted a part of the general population of Varanasi (aged ≥45 years) who volunteered in a screening camp that was organized as part of the World Kidney Day Initiative at Opal Hospital. Information on age, sex, height, weight, smoking and drug history, history of diabetes, hypertension, and family history of kidney disease was extensively interrogated, while laboratory investigations such as urinalysis and serum creatinine levels were recorded. More than three-fifths of the participants were middle-aged adults (i.e., 45-64 years) and the remaining 34.8% were elderly population, i.e., ≥65 years. The overall prevalence of CKD in the 198 studied participants was 29.3%. Higher number of participants (40.6%) of elderly population had CKD (P = 0.011). The serum creatinine, albuminuria, and estimated glomerular filtration rate levels were strongly associated with CKD (P <0.05). Our study suggests that elderly individuals are at risk with higher serum creatinine levels and would benefit from early detection of CKD to prevent disease progression and associated morbidity and mortality.

Time-to-onset of treatment for hypertension and hyperlipidaemia in South African diabetes mellitus patients: A survival analysis using medicine claims data

WHAT IS KNOWN AND OBJECTIVE

Hypertension and hyperlipidaemia have high prevalence among diabetics and increase patients' risk of cardiovascular diseases, ultimately affecting prognosis negatively. Medicine claims data have gained prominence in the study of drug-related events and outcomes. There is paucity of publications on the time-to-onset of treatment for these conditions among South African diabetics using secondary data. This study aims to determine the time-to-onset of treatment for hypertension and hyperlipidaemia among diabetics using a South African medicine claims data.

METHODS

Survival analysis was conducted using retrospective data of patients enrolled continuously with a Pharmaceutical Benefit Management (PBM) company in South Africa from 1 January 2008 to 31 December 2016. We identified patients based on International Classification of Diseases, Tenth Revision (ICD-10) diagnoses codes for type 2 diabetes mellitus (E11) who were receiving antidiabetic medication according to the National Pharmaceutical Product Index (NAPPI) codes provided by the Monthly Index of Medical Specialities (MIMS) classification code 19.1 (N = 2996). Among these patients, we then selected those who had ICD-10 codes for hypertension (I10, I11, I12, I13, I15, O10 and O11) who were receiving antihypertensive medications, and those who had hyperlipidaemia (E78.5), who received antihyperlipidaemics during the study period. Data were extracted using SAS^® system version 9.4 classification codes. The Kaplan-Meier approach, used to compare the survival experience of patients who commenced treatment for hypertension and hyperlipidaemia, was conducted using IBM^® SPSS^® version 25. The time to the commencement of treatment of hypertension and hyperlipidaemia among the diabetics were measured in days. With 2008 serving as the index year, we followed up on patients until 31 December 2016.

RESULTS AND DISCUSSION

A total of 494 patients with an average age of 53.5 (SD 11.1) years were included in the study, 34.8% of whom were females. Prevalence of hyperlipidaemia and hypertension among patients were 35.0% and 45.6%, respectively. Average time-to-onset of treatment for hyperlipidaemia was 2684.4 (SD 42.2) days compared to 2434.2 (SD 47.6) days for hypertension. There was no statistically significant difference in age and sex among patients who started treatment for either of these conditions during the study (P = 0.404; Cohen's d = 0.132 for hyperlipidaemia and P = 0.644, Cohen's d = 0.059 for hypertension).

WHAT IS NEW AND CONCLUSION

Within an average of 6 years after an index period of 1 year free of disease, diabetics may commence treatment for hyperlipidaemia, hypertension or both. With all significant data appropriately captured, medicine claims data can be effectively used in survival analysis to determine time-to-onset of treatment for hyperlipidaemia and hypertension among diabetics.

Diabetes Mellitus and Its Association with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Diabetes mellitus (DM) is a growing public health concern globally, including Ethiopia. Although numerous studies have been published from different parts of Ethiopia, no attempt is made so far to estimate the burden of DM at the national level. This study aims to estimate the pooled prevalence of DM and its association with hypertension in Ethiopia.

METHODS

A systematic search was conducted in major databases. Two authors extracted the necessary data and analysis was conducted using STATA version 14. Heterogeneity across the studies was evaluated by Cochran's Q test and I² statistics.

RESULTS

Eighteen studies with a total of 45,284 participants were included in this review. The pooled prevalence of DM was 4.99% (95% CI: 3.86%, 6.11%). Hypertension was significantly associated with DM (OR: 8.32; 95% CI: 3.05, 22.71).

CONCLUSION

The burden of DM in Ethiopia is considerable, and the association between diabetes and hypertension is significant. Based on the evidence, this review recommends establishing the coordinated national programs that counteract the increasing burden of DM in the country is very essential. In addition, Early hypertension screening should be done in diabetic patients to control co-morbidity and further complications.

Usefulness of ambulatory blood pressure monitoring in chronic kidney disease: The moroccan experience

Among patients with chronic kidney disease (CKD), hypertension (HTN) is very common and widely recognized to accelerate the progression of CKD and increase the risk for cardiovascular events. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting HTN than office blood pressure (BP) measurement. The goal of this study is to describe the ABPM characteristics in a group of CKD and hypertensive patients. A transversal study was conducted over a period of six months, to evaluate the ABPM patterns among a group of hypertensive patients with CKD (Group 1) and compared the data with a control group (Group 2). ABPM was performed with measurement rate every 15 min during daytime and 30 min at night. Nondipping BP patterns were defined as the absence of fall in nocturnal systolic and diastolic BP >10% of daytime values. Masked HTN was defined as controlled office BP (<140/90 mm Hg) with an elevated overall average BP by 24-h ABPM (>125/75 mm Hg), and white-coat HTN was defined as association of elevated BP readings (>140/90 mm Hg) in a clinical setting and normal 24-h average BP levels (<130/80 mm Hg). Fifty patients were included in each group. HTN was much longer in duration among hypertensive patients with CKD and frequently associated with obesity, dyslipidemia, and diabetes (64% vs. 39.60%). Positive proteinuria was present in 82% of CKD patients with HTN. CKD patients with HTN received more antihypertensive drugs than Group 2 patients. HTN was much more uncontrolled among CKD patients (60% vs. 24%), more serious with higher daytime and nighttime SBP, and loss of physiologic dipping during nighttime BP measurement (80%). Out-of-office BP monitoring by ABPM may improve the assessment and the successful management of HTN in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat HTN would facilitate research.

Association between social determinants and the presence of essential hypertension in type 2 diabetes mellitus patients

The purpose of this study was to analyse the association between social determinants and the presence of essential hypertension in type 2 diabetes mellitus patients in one rural county (Jintan) of China. A health survey of Jintan residents was conducted in 2013, applying a cluster sampling method. Three hundred and fifty-seven type 2 diabetes mellitus patients were selected as research subjects. Among the patients selected, essential hypertension prevalence was 45.4% (n=162). After univariate analyses and logistic regression analyses, an association was observed between the presence of essential hypertension in type 2 diabetes mellitus patients and marital status, described as 'others (unmarried, divorce, widower, etc.)', and participating in active physical activity. Both of these two significant variables were positively associated with the higher prevalence of essential hypertension in type 2 diabetes mellitus patients. In conclusion, the patients suffering from type 2 diabetes mellitus combined with essential hypertension often reported an association with more negative social determinants (with the exception of participation in physical activity). Further strengthening the comprehensive multi-disease management to control and reduce the prevalence of essential hypertension in type 2 diabetes mellitus patients is required.

Epidemiology of Self-Reported Diabetes Mellitus in the State of Maranhão, Northeastern Brazil: Results of the National Health Survey, 2013

Objective: To estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in adults from the State of Maranhão, Northeastern Brazil. Methods: A cross-sectional study was carried out with 1774 individuals aged ≥18 years participating in the National Health Survey of 2013 in Maranhão. The adults were selected by probabilistic sampling and interviewed face-to-face by in-home visits. The Poisson regression model was used to verify the factors associated with DM. Results: The prevalence of DM was 5.39% (95% confidence interval [95% CI]: 3.73–7.73). After adjustment of the regression model for age, gender, smoking, education, hypertension, and hypercholesterolemia, DM was statistically associated with age ≥60 years, female sex, low educational level, and self-report hypertension. Conclusion: The present study found the prevalence of self-reported DM similar to that estimated in the general population of Brazil. Public policies for prevention and control should intensify control, especially in the subgroups most vulnerable to DM.

Diagnostic Usefulness of Serum Albumin as a Predictor of Diabetic Ketoacidosis

Context:

Diabetes mellitus is one of the most prevalent diseases worldwide. One of the acute complications of diabetes mellitus is diabetic ketoacidosis. It becomes essential for the healthcare physicians to identify the individuals who are likely to be prone to the development of ketosis. Serum albumin levels may be a cost-effective and simple parameter to prognosticate the risk of ketosis.

Aims:

This study was done to find a relationship between serum albumin levels and ketonuria.

Settings and Design:

After ethical approval, this prospective case–control study was carried out in patients diagnosed as type-2 diabetes mellitus.

Subjects and Methods:

Serum albumin levels were measured by bromo cresol green method. Measurement of urine ketones was done manually using dipsticks, a semi-quantitative manual method.

Statistical Analysis Used:

Student's t-test was used to compare continuous variables and Chi-square test for categorical variables. Pearson's correlation was done to establish correlation.

Results:

In the normoalbuminemic group, 72% were ketones negative and only 28% had positive ketones in urine, while in the hypoalbuminemic group, 50.7% had negative urine ketones and 49.3% had positive ketonuria. The mean value for ketones in urine was 9.7 mg/dL in the hypoalbuminemic group, but it was only 4.3 mg/dL in the normoalbuminemic group. Pearson's correlation between serum albumin and urine ketone levels was performed and the r-value was found to be −0.305.

Conclusions:

Serum albumin levels may predict the occurrence of ketosis in diabetic patients.

Modulatory influence of Parkia biglobosa protein isolate on testosterone and biomarkers of oxidative stress in brain and testes of streptozotocin-induced diabetic male rats

Parkia biglobosa seed an important household spice commonly consumed in Nigeria is believed to possess antioxidant activity that may exert modulatory effects in diabetes and diabetic complications. This study investigated the modulatory potential of Parkia biglobosa protein isolate (PBPi) on serum testosterone (sTT) level as well as its influence on biomarkers of oxidative stress in brain and testes of streptozotocin-induced diabetic male rats. Animals were made diabetic by single intraperitoneal administration of streptozotocin (STZ; 60 mg/kg body weight). PBPi (200 or 400 mg/kg body weight) was given orally by gavage or insulin (5 U/kg, i.p.) was administered daily to STZ-induced diabetic rats for 28 days. The results revealed a significant elevation in thiobarbituric acid reactive substances (TBARS) levels in the brain and testes of diabetic rats. This was closely associated with a concomitant reduction in levels of sTT and reduced testes weight, a noticeable decline in the glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT) as well as total glutathione (Total GSH) level in the brain and testes of diabetic rats. Interestingly, treatment with PBPi efficiently prevented the alterations witnessed in the serum sTT and also ameliorated various alterations in the biomarkers of oxidative stress (TBARS, Total GSH, GST, SOD and CAT) in brain and testes of diabetic rats. These results provide evidence that PBPi could protect the brain and testicular tissues against oxidative stress induced by STZ, via modulation of serum testosterone concentration and also by enhancing antioxidant defence system in STZ-diabetic rats.

Diabetes mellitus and its complications in India

India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.