Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients

Correlation analysis between foot deformity and diabetic foot with radiographic measurement

Background

Foot deformity is a risk factor for diabetic foot ulcer. This study was aimed to investigate the relationship between hallux valgus (HV) and diabetic foot through the radiographic measurement.

Methods

The patients with diabetic foot hospitalizing in the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from September 2016 to June 2020 were selected. Then the foot plain X-ray radiographs were completed, and the size of HV angle (HVA) was measured. Their clinical data were collected, and the ulcer recurrence rate, amputation rate and mortality rate of the patients were followed up.

Results

A total of 370 patients were included. According to HVA, patients were divided into non-HV group (HVA<15°), and mild (15°≤HVA ≤ 20°), moderate (20°40°) HV groups. The age, height, BMI, smoking history and glycosylated hemoglobin level among the non-HVA, mild, moderate, and severe HV group (P<0.05), while smoking history, HbA1c, eGFR and autonomic neuropathy were significantly lower in HV group than those in non-HV group (P<0.05). The ulcer area in patients with moderate HV was larger than that in non-HV patients, and the severity of infection in patients with severe HV was significantly higher than that the other three groups (P<0.05).

Conclusion

The occurrence of HV is not only related to age and BMI, but also to the creatinine and eGFR level, autonomic neuropathy, lower limb arteriosclerosis occlusion, coronary heart disease and hypertension. Therefore, more attention should be paid to renal function screening, neuropathy screening and evaluation of lower extremity vascular lesions in patients with diabetes, especially those with moderate or higher HV.

Clinico-Etiological Evaluation of Chronic Leg Ulcer in a Tertiary Care Center of Eastern India

Background:

A chronic leg ulcer (CLU) is a significant public health problem. It has various etiologies. Racial, familial, occupational, and social factors may also have an impact on the prevalence of different causes of leg ulcers. Though there are western data on the epidemiology of leg ulcer, similar data are largely unavailable from our part of the world.

Aims:

We undertook a study in a tertiary care center in eastern India to determine the clinical and etiological pattern of patients with CLU.

Materials and Methods:

Hundred consecutive patients presenting with CLU, fulfilling the criteria, were included after informed consent. Patients were subjected to proper history taking, clinical examination, routine blood test, and pus for culture and sensitivity test (where needed) along with Ankle Brachial Index (ABI).

Results:

Among the 100 patients, venous ulcer (34%) was predominant followed by arterial ulcer (14%), mixed arterial and venous ulcer (11%). History of smoking (56%) and obesity (BMI >25) (32%) were the common risk factors in leg ulcer patients. Fifty nine percent of the total CLU were infected and out of this, 86.4% showed growth of microorganisms. Staphylococcus aureus (39%) was the most commonly isolated organism, followed by Pseudomonas aeruginosa (15%). Eleven (24.44%) clinically diagnosed venous ulcer patients showed significantly lower ABI (<0.9) and were diagnosed as mixed ulcer (a venous ulcer with a peripheral arterial disease).

Conclusion:

Venous ulcer and mixed ulcer are the most common type of CLU.

Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study

OBJECTIVE

To assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.

PRIMARY AND SECONDARY OUTCOME MEASURES

Risk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.

RESULTS

Overall, 44.5% of the subjects were found 'at risk' of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.

CONCLUSION

A significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Regional Variation in Comorbid Prediabetes and Diabetes and Associated Factors among Hypertensive Individuals in Rural Bangladesh, Pakistan, and Sri Lanka

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.

Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken

Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.

Footwear Affects Biomechanical Work And Knee Adduction Moment During Stance Phase In Medial Knee Osteoarthritic Male Pakistani Adults

OBJECTIVE

The objective of this study was to explore the effects of commonly used footwear in urban Pakistan on knee adduction moment (KAM), knee adduction angular impulse (KAAI) and biomechanical work at lower limb joints (both individually and collectively).

METHODOLOGY

Cinematographic gait analysis of 20 medial knee osteoarthritis patients (Kellgren-Lawrence Grade I and II, age: 55.48 ± 5.78 years; weight: 68.92 ± 9.61 kg, height: 1.62 ± 0.15m) was done, walking barefoot, with casual shoes, party shoes and traditional Pakistani sandals, at a walking speed of 1.2m/sec.

RESULTS

Repeated measures ANOVA with Tukey corrections showed that all the shoes were found to be increasing first & second peaks external KAM and decreasing net joint work and total limb work significantly, at p < 0.05.

CONCLUSION

Effects of footwear were found to be majorly favouring knee osteoarthritis progression. This might be one of the risk factors of increased kOA rate in urban Pakistan.

Prevalence of Foot Complications in People With Type 2 Diabetes Mellitus: A Community-Based Survey in Rural Udupi

The objective of the study was to determine the prevalence of foot complications among people with type 2 diabetes mellitus in the rural part of Udupi district, Karnataka, India. A cross-sectional observational study design was conducted in the rural area of Udupi district. In the study, accredited social health activists were trained to screen people with type 2 diabetes mellitus for diabetic foot complications at a community level. Adults over 35 years of age were screened for the presence of type 2 diabetes mellitus by accredited social health activists who reside in the rural part of Udupi district. Participants with type 2 diabetes mellitus were included in the study. Blood glucose level was measured using a glucometer. Foot examination was done by visual inspection, monofilament, tuning fork, and pedal pulse. In the present study, 2110 among the total participants were found to have type 2 diabetes mellitus. The prevalence of musculoskeletal foot complications was 1218 (58%), vascular problem 466 (22.2%), sensory neuropathy 634 (30.2%), autonomic neuropathy 1729 (81.9%), ulcer 134 (6.38%), and infection 561 (26.7%) among people with type 2 diabetes mellitus. In the current study, we found 84.7% of people residing in rural Udupi had type 2 diabetes mellitus. Hence, there is a strong need to create awareness about diabetic foot care in these people.

Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus

BACKGROUND

Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus.

METHODS

A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system.

RESULTS

The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS.

CONCLUSION

The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Diabetic retinopathy in patients with diabetic foot syndrome in South India

Purpose

The purpose was to study the retinopathy status in diabetic patients with a risk of diabetic foot (DF) syndrome visiting a tertiary care hospital in South India.

Methods

In this cross sectional study all patients with diabetes mellitus (DM) with a risk of DF syndrome, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status.

Results

One hundred and eighty-two patients diagnosed to have a risk profile for DF syndrome were included in the study. Their mean age was 59.28 years and 75.27% were males. The mean duration of Type 1 and Type 2 variants of DM was 14.9 years and 10.9 years, respectively. Of the 182 patients, 67.58% had retinopathy changes. Proliferative diabetic retinopathy (DR) constituted 17.88% of the total patients with retinopathy. An increased presence of retinopathy in patients with an increased risk grade of DF was found significant by the Chi-square test (P < 0.001).

Conclusion

Our study found an increased presence of DR in a South Indian cohort with DF syndrome. The severity of retinopathy was greater in patients with higher grades of risk for DF. The establishment of an association between DR and DF syndrome will help in developing an integrated management strategy for these two debilitating consequences of diabetes.

The burden of diabetes-related foot disorders in community-dwellers living in rural Ecuador: Results of the Atahualpa Project

BACKGROUND/OBJECTIVES

Prevalence of diabetes-related foot disorders (DRFD) in rural areas of developing countries is unknown. The burden of these conditions in Atahualpa, a rural Ecuadorian village, were assessed.

METHODS

Using a population-based design, Atahualpa residents aged ≥40 years with diabetes mellitus were identified. Ankle brachial index determinations were used to assess presence of peripheral arterial disease, and the Michigan Neuropathy Screening Instrument was used to estimate peripheral neuropathy. Ulcers in the foot/ankle as well as history of amputations were considered as evidence of active diabetic foot disease. Using a linear model of risk, factors that independently correlated with DRFD, were assessed.

RESULTS

Mean age of 110 participants was 64±12years (59% women). Peripheral arterial disease was diagnosed in 24% of cases and peripheral neuropathy in 59% (15% had both conditions). In the adjusted model, increasing age and being men increased the risk for DRFD. Active diabetic foot disease was noted in 7% of participants, and another 60% were at moderate-to-high risk for developing this complication (according to NHS Borders Foot Classification System).

CONCLUSIONS

The prevalence of DRFD is high in rural Ecuador, and most of the affected individuals are at risk for developing active diabetic foot disease.

Impact of diabetic foot ulcer on health-related quality of life: A cross-sectional study

Studies have reported that health-related quality of life (HRQoL) is adversely affected by diabetic foot ulcer (DFU). There is a paucity of data on the effects of foot ulcers on HRQoL of diabetes patients in our population. Because South-Asians, especially Indians, have unique features related to diabetes and its complications, generalizing the data about their effect on HRQoL from any other part of the world is not a pragmatic approach. This study evaluated the impact of foot ulcers on HRQoL of diabetes patients. This cross-sectional study, conducted in Kasturba Hospital, Manipal (coastal South India), included 200 DFU patients in a study group (SG) and 200 diabetes patients in a control group (CG). The RAND-36 questionnaire was employed for evaluating HRQoL scores for the patients in both groups. DFU patients also completed the Diabetic Foot Ulcer Scale-Short Form questionnaire. Independent t-test was used to test the differences in mean scores. Results found that both CG and SG have "poor" HRQoL (mean score <50) on all the subscales except for two in CG. There is a statistically significant difference between groups (P < 0.05) on all eight of the subscales of HRQoL. For both CG and SG, the Physical Component Summary domain score (44.9 ± 6.3 v 28.4 ± 3.4) and Mental Component Summary domain score (42.5 ± 3.8 v 29.5 ± 7.1) were poor. There were significant differences between CG and SG for both mean Physical Component Summary score and Mental Component Summary score of HRQoL (p < 0.05). The Diabetic Foot Ulcer Scale-Short Form found that HRQoL is very poor for DFU patients on all six domains. The study concludes that DFU patients have very poor HRQoL compared with diabetic patients. Likewise, the diabetic foot is associated with severely impaired HRQoL in both physical and mental health aspects. This study will help to develop a patient education model for DFU patients by looking at the various HRQoL domains that are adversely affected by the presence of foot ulcer.

Intrinsic foot muscle and plantar tissue changes in type 2 diabetes mellitus

BACKGROUND

Diabetes mellitus is a metabolic disorder with involvement of the neurovascular and muscular system. Peripheral neuropathy (PN) is thought to be the principal cause of foot complications in type 2 diabetes mellitus (T2DM). However, foot evaluation using ultrasonography early in the course of diabetes has not gained due importance. The aim of the present study was to evaluate the thickness of intrinsic foot muscles, plantar skin, plantar fascia, and plantar fat pad in T2DM subjects with and without PN using musculoskeletal ultrasonography.

METHODS

This study was conducted in 30 T2DM subjects with and without PN and 30 age-matched non-diabetes mellitus (NDM) subjects. After detailed clinical evaluation, high-frequency musculoskeletal ultrasonography was used to measure the thickness of the intrinsic foot muscles and plantar tissue thickness under the metatarsals. Data were analyzed using independent t-tests to compare T2DM groups with NDM subjects, and one-way ANOVA followed by Tukey's honestly significant difference test for between- and within-group analyses.

RESULTS

There was a significant reduction in the thickness of the intrinsic foot muscles and plantar tissue in T2DM compared with NDM subjects (P < 0.05). However, there were differences in intrinsic foot muscle and plantar tissue thickness between T2DM subjects with and without PN.

CONCLUSION

There was a substantial decrease in intrinsic foot muscle and plantar tissue thickness in T2DM compared with NDM subjects, indicating that structural changes appear in the foot before PN develops. The techniques used in this study cannot exclude the possibility that neuropathic changes that are clinically undetectable may develop in parallel with changes in plantar tissues.

Diabetes knowledge and glycemic control among patients with type 2 diabetes in Bangladesh

Aims

To explore the association between knowledge on diabetes and glycemic control among patients with type 2 diabetes in Bangladesh.

Methods

A cross-sectional study was conducted among 515 patients with type 2 diabetes attending a tertiary hospital in Dhaka, Bangladesh. Trained interviewers were used to collect data on socioeconomic status, time since the onset of diabetes, co-morbidities, anthropometric measurements, blood tests, knowledge and perceptions about the causes, management, and complications of diabetes through face to face interviewers based on a structured questionnaire. Diabetes knowledge was reported using a composite score. Chi square tests and correlation analysis were performed to measure the association between knowledge on diabetes and glycemic control.

Results

Overall, 45.6% participants had good, 37.7% moderate and 16.7% poor knowledge on diabetes. The mean composite score was 0.75 ± 0.28 and the proportion of participants with a score of ≤50% was 16.7%. Only 24.3% participants identified physical inactivity as a risk factor for diabetes. Knowledge on diabetes was significantly associated with education, gender, monthly income, duration of diabetes, body mass index, family history of diabetes, and marital status but not with glycated hemoglobin (HbA1c). Correlation matrix showed weak negative association between diabetes knowledge score and glycemic control (p < 0.001).

Conclusion

Patients with type 2 diabetes in Bangladesh have limited knowledge on the causes, management and risk factors for diabetes, despite receiving professional health education and care in a tertiary diabetic hospital. Strategies to improve the quality of diabetes education and identifying other potential factors for glycemic control are important for ensuring optimum management of diabetes in Bangladesh.

Evaluation of DNA damage in Type 2 diabetes mellitus patients with and without peripheral neuropathy: A study in South Indian population

Background:

The increasing incidence of Type 2 diabetes mellitus globally has collaterally increased the incidence of diabetes-associated complications such as neuropathy. Oxidative stress induced DNA damage is one of the mechanisms implicated in the pathogenesis of diabetic complications. Here we aimed to evaluate the extent of DNA damage in diabetes patients with and without clinical neuropathy using the Cytokinesis Block Micronucleus Cytome assay, in a group of South Indian population.

Materials and Methods:

The Cytokinesis Block Micronucleus Cytome assay was performed in lymphocyte cultures of 42 type 2 diabetes patients (22 with neuropathy and 20 without neuropathy) and 42 age and sex matched controls. Nuclear aberrations like Nuclear Buds, Nucleoplasmic Bridges and Micronuclei were analyzed.

Results:

The frequency of nuclear aberrations in diabetes patients with neuropathy was higher than compared to diabetes patients without neuropathy. The mean frequencies of nuclear aberrations per cell in diabetes patients with neuropathy and without neuropathy were 0.02 ± 0.02 and 0.01 ± 0.01, respectively. This was significantly higher than in the controls (0.002 ± 0.002) (P < 0.0001). An increasing trend of nuclear aberrations in correlation with the duration of diabetes was observed.

Conclusion:

This study highlights the use of the Cytokinesis Block Micronucleus Cytome assay as a potent tool for the identification of DNA damage, which may prove to be useful biomarker to assess the severity diabetes-associated complications such as neuropathy. Implementation of this technique at the clinical level would potentially enhance the quality of management of patients with diabetes and its complications like neuropathy.

Diabetes in South Asians

Economic, dietary and other lifestyle transitions have been occurring rapidly in most South Asian countries, making their populations more vulnerable to developing Type 2 diabetes and cardiovascular diseases. Recent data show an increasing prevalence of Type 2 diabetes in urban areas as well as in semi-urban and rural areas, inclusive of people belonging to middle and low socio-economic strata. Prime determinants for Type 2 diabetes in South Asians include physical inactivity, imbalanced diets, abdominal obesity, excess hepatic fat and, possibly, adverse perinatal and early life nutrition and intra-country migration. It is reported that Type 2 diabetes affects South Asians a decade earlier and some complications, for example nephropathy, are more prevalent and progressive than in other races. Further, prevalence of pre-diabetes is high, and so is conversion to diabetes, while more than 50% of those who are affected remain undiagnosed. Attitudes, cultural differences and religious and social beliefs pose barriers in effective prevention and management of Type 2 diabetes in South Asians. Inadequate resources, insufficient healthcare budgets, lack of medical reimbursement and socio-economic factors contribute to the cost of diabetes management. The challenge is to develop new translational strategies, which are pragmatic, cost-effective and scalable and can be adopted by the South Asian countries with limited resources. The key areas that need focus are: generation of awareness, prioritizing health care for vulnerable subgroups (children, women, pregnant women and the underprivileged), screening of high-risk groups, maximum coverage of the population with essential medicines, and strengthening primary care. An effective national diabetes control programme in each South Asian country should be formulated, with these issues in mind.

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.

Managing diabetic foot infection in India

The burden of diabetic foot complications, in terms of both physical and socioeconomical constraints, poses a heavy challenge both to the patient and the physician, especially in developing countries, where the number of people living with diabetes is increasing at an alarming rate compared with the developed world. In developing countries like India, there are specific causes and risk factors that increase the burden of diabetic foot infections (DFIs), for example, sociocultural risk factors such as barefoot walking, using improper footwear, poor knowledge of foot care practices, lack of adequate and timely access to podiatry services, and poor health care resources. Management of DFI in light of these limitations is quite a challenge to health care professionals. Several techniques and strategies are required to address this problem and should be combined with a multidisciplinary team effort to reduce the burgeoning epidemic of diabetic foot disease. This review is intended to address some of the major aspects of management of DFI in India.

Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians

It is estimated that type 2 diabetes (T2D) currently affects about 246 million people worldwide, with South Asians, especially Indians, having both the largest number of cases and the fastest growing prevalence. South Asian ethnicity has been identified as a major risk factor for the development of T2D with central adiposity, insulin resistance and an unfavourable lipid profile being identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed and Science Direct, were consulted and manual searches were conducted for cited references in leading diabetes-related journals. In all, 152 articles were included for the final assessment reported in this review. Genetic predisposition, central adiposity and unfavourable lifestyle, including physical inactivity and an unhealthy diet, were associated with the prevalence of T2D in migrant South Asians. 'Westernization', acculturation, socio-economic factors and lack of knowledge about the disease have also been identified as contributors to the development of T2D in this population. Higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors need further investigation. Preventive measures and appropriate interventions are currently limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment. This article describes the prevalence rate, risk factors and complications associated with T2D in migrant South Asians living in different countries.

Role of industries in the care of diabetic foot

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

Thermography and thermometry in the assessment of diabetic neuropathic foot: a case for furthering the role of thermal techniques

There are currently 3 established techniques employed routinely to determine the risk of foot ulceration in the patient with diabetes mellitus. These are the assessment of circulation, neuropathy, and foot pressure. These assessments are widely used clinically as well as in the research domain with an aim to prevent the onset of foot ulceration. Routine neuropathic evaluation includes the assessment of sensory loss in the plantar skin of the foot using both the Semmes Weinstein monofilament and the biothesiometer. Thermological measurements of the foot to assess responses to thermal stimuli and cutaneous thermal discrimination threshold are relatively uncommon. Indeed, there remains uncertainty regarding the importance of thermal changes in the development of foot ulcers. Applications of thermography and thermometry in lower extremity wounds, vascular complications, and neuropathic complications have progressed as a result of improved imaging software and transducer technology. However, the uncertainty associated with the specific thermal modality, the costs, and processing times render its adaptation to the clinic. Therefore, wider adoption of thermological measurements has been limited. This article reviews thermal measurement techniques specific to diabetic foot such as electrical contact thermometry, cutaneous thermal discrimination thresholds, infrared thermography, and liquid crystal thermography.