Showing papers in "Diabetes and Metabolic Syndrome: Clinical Research and Reviews in 2011"

Shaddock peels (Citrus maxima) phenolic extracts inhibit α-amylase, α-glucosidase and angiotensin I-converting enzyme activities: a nutraceutical approach to diabetes management.

Abstract: In this study, the interactions of free and bound phenolic-rich extracts from shaddock peels (popular in folklore for the management of diabetes and hypertension) with α-amylase and α-glucosidase (key enzymes linked to type-2 diabetes) and angiotensin I-converting enzyme (ACE) (key enzyme linked to hypertension) were assessed. The free phenolics of shaddock ( Citrus maxima ) peels were extracted with 80% acetone, while the bound phenolics were extracted from the alkaline and acid hydrolyzed residue with ethyl acetate; and their interaction with the enzymes were assessed. The phenolic extracts inhibited α-amylase, α-glucosidase and ACE enzyme activities in a dose-dependent manner; however, bound phenolics had significantly higher ( P P P > 0.05) in their α-glucosidase inhibitory activities. The stronger inhibition of α-glucosidase when compared to α-amylase is of great pharmaceutical importance. The phenolic inhibited sodium nitroprusside induced lipid peroxidation in pancreas in a dose dependent manner. Therefore, free and bound phenolic extracts from shaddock peels could be used as nutraceutical for the management of hypertension and type-2 diabetes.

Overview of trans fatty acids: biochemistry and health effects.

Abstract: Trans fatty acids (TFA) are unsaturated fatty acids that contain at least one non-conjugated double bond in the trans configuration, resulting in a straighter shape. TFA present in our diet can either be industrially produced and ruminant or natural. The major process contributing to formation of industrial TFA is hydrogenation of vegetable oils. Thermal processes such as edible oil refining and frying also lead to the formation of TFA while, ruminant/natural TFA is formed in the rumen of ruminant animals through bio-hydrogenation. Industrial TFA poses severe effects on our health like cardiovascular problems, insulin resistance, infertility in women, compromised fetal development and cognitive decline. There are strict regulations for limiting/removing the TFA content from food supply across the world. However in India, there is scarcity of data on TFA content in foods and their consumption levels. Given the alarmingly rising trend of diabetes and cardiovascular disease in India, removal of TFA from the food supply along with generating awareness among the masses in this regard is of immense importance.

Diabetic retinopathy: Pathogenic mechanisms and current treatments

Abstract: Since diabetes is now a global epidemic, the incidence of retinopathy, a leading cause of blindness in patients aged 20-74 years, is also expected to rise to alarming levels. The risk of development and progression of diabetic retinopathy is closely associated with the type and duration of diabetes, blood glucose, blood pressure and possibly lipids. It is an unmet medical need that can lead to severe and irreversible loss of vision in people of working age worldwide. The aim of this review is to give an overview of the clinical and anatomical changes during the progression of retinopathy, the underlying pathogenic mechanisms that link hyperglycemia with retinal tissue damage, current treatments, and the emerging pharmacological therapies for this sight-threatening complication of diabetes.

Diabetes and chronic oxidative stress. A perspective based on the possible usefulness of ozone therapy.

Abstract: It is now well established that hyperglycemia, present in both type 1 and type 2 diabetes, causes a variety of biochemical derangements leading to a diffused vascular damage responsible for several pathologic manifestations. Although preclinical and clinical studies have been performed by an unreliable administration route, the correct approach of oxygen-ozonetherapy may break a vicious circle. Messengers, released by a precise interaction ex vivo of the patient's blood with an equivalent calculated dose of ozone (0.42-0.84 mM), react with a variety of cells after blood infusion and restore a number of functions went astray. This paper aims to open a debate on this new therapy for improving the prognosis of diabetes.

Effect of vitamin D supplementation in type 2 diabetes patients with pulmonary tuberculosis

Abstract: Aim Diabetes and vitamin D deficiency are widely prevalent in India. Studies have proven correlation between low vitamin D levels and pulmonary tuberculosis (PTB) and low vitamin D levels and insulin resistance. We evaluated the effects of vitamin D supplementation on type 2 diabetes mellitus patients with pulmonary tuberculosis (PTB). Methods Forty-five subjects (M:F = 34:11) were screened. Inclusion criteria were age >15 years, newly diagnosed PTB cases with uncontrolled diabetes, serum vitamin D Results Fifteen patients having vitamin D > 20 ng/ml were excluded. Age of the patients was 42.9 ± 13.2 years and serum vitamin D levels were 18.4 ± 15.3 ng/ml. Sputum smear conversion was 6 weeks in group 1 versus 8 weeks in group 2 ( p = 0.067). Glycated hemoglobin levels reduced from 11.1 ± 1.3 to 7.7 ± 0.9 in group1 versus 10.3 ± 1.2 to 7.8 ± 1.1 ( p > 0.1). Conclusion Vitamin D can serve as adjuvant treatment of tuberculosis in diabetics with vitamin D deficiency. Further studies are required to validate this observation and define a cut off for vitamin D level to prevent immunological alterations.

Effects of pregnancy on the onset and progression of diabetic nephropathy and of diabetic nephropathy on pregnancy outcomes.

Abstract: Controversy exists regarding the effect of pregnancy on the development and course of diabetic nephropathy. This study followed 43 pregnant women with previous diabetes mellitus, 32 without nephropathy (Group I) and 11 with nephropathy (Group II). Urinary albumin excretion (UAE), serum creatinine (Cr) and creatinine clearance (CCr) in the pre-pregnancy (Pre-P), first trimester (1T), third trimester (3T) and 1 year postpartum (PP) were evaluated. In both groups there were an increase in 3T compared to Pre-P of CCr (137 vs. 98 ml/min and 110 vs. 81 ml/min, p=0.0001, respectively) and UAE (7.78 vs. 3.15 mg/24 h and 592 vs. 119 mg/24 h, p=0.0001, respectively). Increase of Cr in the PP compared to 1T in Group II (0.88 vs. 0.70 mg/dL, p=0.031) was observed. There were no difference in UAE, CCr and Cr in the PP when compared to pre-P as well variance over time between groups. Group II showed higher prevalence of chronic hypertension (72.7 vs. 21.9%, p=0.004), preeclampsia (63.6 vs. 6.3%, p=0.0003) and lower gestational age at birth (36 vs. 38 weeks, p=0.003). We conclude that pregnancy was not associated with development and progression of diabetic nephropathy in women with or without mild renal dysfunction. The presence of diabetic nephropathy was associated with increased risk of perinatal complications.

Association of macrovascular complications of type 2 diabetes mellitus with serum magnesium levels.

Abstract: Background Diabetes mellitus and its complications are a significant cause of morbidity and mortality worldwide. Micronutrients have been evaluated as potential preventive and therapeutic measures in diabetes. The present study evaluated serum magnesium levels in diabetic patients—uncomplicated and those with macrovascular complications. Method This study was done on 150 subjects (60 normal, healthy controls and 90 diabetics). The 90 diabetic patients were selected in the following categories—30 patients without complications (Study Group I), 30 diabetic patients with coronary artery disease (Study Group II) and 30 diabetic patients with peripheral vascular disease (Study Group III). Plasma glucose, glycated hemoglobin and serum magnesium levels were estimated in all the patients. Results Fasting plasma glucose and glycated hemoglobin levels were significantly higher in all the 3 study groups as compared to the controls, however, serum magnesium levels were significantly lower (p Conclusion Dietary supplementation with magnesium in addition to classical therapies for diabetes may help in prevention of diabetic complications.

Sepsis in diabetes: A bad duo.

Abstract: Increasing incidence of morbidity and mortality of diabetic subjects due to infection necessitates the understanding of its patho-biology and further remedial measures for its prevention and treatment. The increased incidence of infection is because of systemic illness that has compromising effects on multiple organs including the nervous, vascular, musculoskeletal, and immunologic systems of the diabetic patients. Many factors contribute to this condition including hyperglycemia, insulin deficiency, ischemia and impaired immunity. Sepsis, as a separate entity, lead to destruction of cytokine network that can be fatal. Compromised defense mechanisms due to sepsis and cytokine dysregulation in diabetic patients make the situation worse. Early identification of local infection by applying advanced molecular tools, appropriate selection of antibiotics, intensive wound management, control of glycemic status and supportive treatment can reduce the rate of morbidity and mortality due to sepsis in patients with diabetes.

Prevalence of metabolic syndrome and associated socioeconomic and demographic factors among Palestinian adults (20–65 years) at the Gaza Strip

Abstract: Objectives Metabolic syndrome (MetS) is a multifaceted syndrome and has been described as a clustering of several risk factors for cardiovascular disease. This study was conducted to estimate the prevalence of MetS and its individual components among Palestinian adults, 20–65 years old in Gaza Strip. In addition to find any possible associations with socioeconomic and demographic factors. Material and methods The study sample included 230 adults aged 20–65 years. Data were collected by questionnaire interviews, anthropometrics, and biochemical analysis that included: serum glucose, total cholesterol, triglyceride, HDL, and LDL. MetS was defined according to the NCEP/ATP III diagnostic criteria. Results Overall prevalence of MetS was 23.0% among the study subjects, with no significant differences between males (18.1%) and females (28.1%). The prevalence of MetS increased significantly with age and was associated significantly with physical activity and martial status, while no significant associations were found with household income; geographical locality; smoking; watching TV; or family history. Conclusions Age, sex, physical activity and marital status are risk factors independently associated with MetS in the Palestinian population at the Gaza Strip. National health awareness and preventive programs should be established aiming at decreasing of MetS trends in the Palestinian population at Gaza Strip.

DPP IV inhibitors: Successes, failures and future prospects

Abstract: The dipeptidyl peptidase IV (DPP IV) enzyme is a novel target for the treatment of type 2 diabetes. Several DPP IV inhibitors are in the clinical development, since they are safe and tolerable with no increased risk of adverse events compared to placebo and have a low risk of hypoglycemia. They are flourishing as monotherapy and also in combination with commonly prescribed antidiabetic agents and are appropriate for once-daily oral dosing. However, further studies are needed to validate both long-term β-cell preservation and the role of these agents in the management of diabetes. The present review gives an inside out of the DPP IV inhibitors for its success, failure and future prospects in the treatment of diabetes and associated complication.

Insulin resistance and alanine amino transaminase (ALT) levels in first degree relatives of type 2 diabetes mellitus.

Abstract: Introduction Insulin resistance is established as an independent predictor of a range of disorders such as obesity, hypertension, dyslipidemia, type 2 diabetes mellitus and atherosclerotic cardiovascular diseases. There is an association of hyperinsulinemia with hypertriglycerdemia, low level of HDL and high level of LDL. In nonalcoholic fatty liver disease, there is an elevation of ALT, raising the possibility that the prospective relationship between ALT and type 2 diabetes may reflect cross-sectional associations with insulin resistance or obesity. Aim and objective To find the significance of insulin resistance and alanine aminotransferase level in first degree relatives of type 2 diabetes mellitus. Materials and methods The study included 50 first degree relatives of type 2 diabetes (25 men and 25 women) aged 20–60 years and 30 control of similar age. All cases were taken from SRM Medical College Hospital and Research Centre, Chennai. All the cases were analyzed for HOMA IR , QUICKI, IR ratio, fasting glucose, insulin (ELISA), lipid profile and alanine aminotransferase. Student's ‘ t ’ test was applied for statistical analysis. Result The data show the significance of insulin resistance (HOMA IR ) (2.76 ± 1.46, 1.35 ± 0.8, p p Conclusion Results of the study conclude that there is a high prevalence of insulin resistance in the first degree relatives of type 2 diabetes mellitus. ALT levels in the first degree relatives of type 2 diabetes mellitus had increased levels of insulin resistance, the pathogenesis suggesting increase in ALT levels as seen in insulin resistance condition. In our study, ALT was not statistically significant.

Association of metabolic syndrome with carotid atherosclerosis in the young North Indian population

Abstract: Background Metabolic syndrome (MetS) and its components are associated with increased risk of stroke and cardiovascular disease. Relationship of MetS to carotid atherosclerosis has not been documented well in North Indian population. Aims (1) To determine the incidence of metabolic syndrome in asymptomatic healthy young North Indian population; (2) to evaluate individuals with MetS patients for carotid atherosclerosis by carotid duplex ultrasound examination; (3) to determine the significance of each component of MetS in relation to carotid atherosclerosis in these patients. Methods 440 individuals in the age group of 25–50 years, asymptomatic for cardiac or cerebrovascular disease were screened for metabolic syndrome. 162 patients from a hospital-based population fulfilled the criteria for MetS (as per NCEP ATP III criteria). Duplex ultrasound (DU) examination of extracranial carotid vessels was performed on all the subjects. 112 age- and sex-matched controls were screened, and they underwent DU examination for comparison. Results Hypertriglyceridemia was the commonest component seen in 79.6% of the MetS subjects, followed by central obesity seen in 74.6% subjects. Carotid atherosclerotic disease was observed in 21.6% of patients with MetS. Mild atherosclerosis (intima media thickness (IMT) >0.09 cm) was observed in 82.8% and 17.3% had plaques with mild stenosis ( 0.09 cm) on DU. MetS was significantly associated with carotid DU abnormalities (increased IMT >0.09 cm) compared to controls (Fischer's exact test p p = 0.03). On multivariate regression analysis none of the individual components of MetS contributed significantly to the presence of carotid atherosclerosis. Conclusions MetS is common in asymptomatic healthy North Indian population, with hypertriglyceridemia being the commonest component of MetS in this population, which may be predictive of carotid atherosclerotic disease. Serum triglyceride estimation can serve as a screen for asymptomatic healthy subjects to select the target population for cerebrovascular disease prevention.

The metabolic syndrome in a Congolese population and its implications for metabolic syndrome definitions.

Abstract: Aim Metabolic syndrome defined by International cut-off values are limited to detect people at high cardiometabolic risk in Central Africans in comparison with metabolic syndrome defined by ethnic-specific definition. We examined the relationship between metabolic syndromes, diabetes control, abdominal obesity, HDL-cholesterol groups and atherosclerotic complications. Materials and methods A representative sample of type-2 diabetic central Africans from Kinshasa were studied. Outcome measures included control of diabetes, atherosclerosis, abdominal obesity, insulin resistance, total cholesterol, triglycerides, HDL-cholesterol, metabolic syndromes and atherosclerosis. Results Of 1266 type-2 diabetic patients (48.8%), (61.8%), (27.1%) and (81%) had uncontrolled diabetes, atherosclerotics, metabolic syndrome (IDF/Europe), and metabolic syndrome (IDF/local) respectively. There was a significant U-shaped relationship between atherosclerotics complications, insulin resistance, delta postprandial glycaemia and HDL-cholesterol stratification. There was also a significant U-shaped relationship between cardiometabolic risk ( P Conclusion Type-2 diabetic Central Africans exhibit very high rates of uncontrolled diabetes, atherosclerotic complications and metabolic syndrome. Both, abdominal obesity, insulin resistance, low and very high HDL-cholesterol levels are cardiometabolic risk factors.

Cardiovascular risk assessment in patients with type 2 diabetes mellitus and metabolic syndrome: role of biomarkers.

Abstract: Objectives Metabolic syndrome (MetS) and type 2 diabetes mellitus (DM) are associated with a high incidence of cardiovascular diseases. The aim of this study was to determine paraoxonase (PON), total sialic acid (TSA), and nitric oxide (NO) levels in addition to conventional risk markers in patients with DM, MetS and DM plus MetS. Material and methods The study has been carried out over 78 subjects which divided into four groups; control ( n = 18), DM ( n = 20), newly diagnosed MetS ( n = 20) and DM plus MetS patient groups ( n = 20). Results Both insulin and triglyceride concentrations were significantly higher in DM + MetS group than in control and DM groups and serum HDL-C concentrations were significantly lower in DM + MetS group than other groups. Patients with MetS had higher LDL-C, total cholesterol and hsCRP concentrations than in the other groups. Interestingly, in addition to body mass index and waist circumference values, LDL-C, total cholesterol and hsCRP concentrations were decreased in patients who have both DM and MetS. Serum NO and TSA levels were higher in MetS and DM + MetS groups compared to control subjects. Unexpectedly, PON activity has been found lower in control group when compared to other groups. Conclusions Although there is no doubt that association of DM and MetS elevates the risk of cardiovascular disease, occurrence of DM in patients with undiagnosed MetS might be encouraging patients to change their life styles and dietary habits.

Evaluation of the burden of type 2 diabetes mellitus in population of Puducherry, South India.

Abstract: Aims To find out the prevalence of undiagnosed diabetes mellitus and the correlates among the adult population of Puducherry, South India. Methods In this population based cross-sectional study in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry, by simple random sampling 1013 adults of 30 years and above, not on anti-diabetics drugs were included. Main outcome measures were the prevalence and correlates of undiagnosed diabetes mellitus among the adult population. Pre-designed and pre-tested questionnaire was used to elicit the information on family and individual socio-demographic variables. Height, weight, waist and hip circumference, blood pressure were measured and venous blood was collected to measure fasting blood glucose and blood cholesterol. Results Overall, 10.3% study subjects were diagnosed as diabetic. In univariate analysis age, dilatory habit, tobacco addiction, body mass index, waist hip ratio, hypertension, and total blood cholesterol were found statistically significant. In multivariate logistic regression (LR method) analysis age, residence, education, dietary habit, tobacco addiction, body mass index, waist hip ratio and total blood cholesterol were statistically significant. Conclusions In our study adults having increased age, urban residence, illiterate, non-vegetarian diet, tobacco addiction, obese and high total blood cholesterol were important correlates.

The deleterious effects of physical inactivity on elements of insulin resistance and metabolic syndrome in Central Africans at high cardiovascular risk

Abstract: Aim We aimed to describe the physical activity and to investigate the association between classical hypertension, obesity, diabetes, and new inflammation, IDF-defined metabolic syndrome, insulin resistance CV risk factors. Design This was a cross-sectional study based on interviews and physical and biochemistry measurements among Central African patients. Measurements Waist circumference (WC), blood pressure, weight and height to calculate body mass index (BMI), fasting glucose, CRP, ERS, uric acid, cholesterol (C), LDL-C, HDL-C, triglycerides, elements of homeostatic model assessment (HOMA) including insulin, HOMA index, QUICKI, insulin sensitivity (%S), beta-cell function (%β) and insulin resistance (IR). Findings Of the 60 patients included, 30 (50%) were physically inactive versus 30 (50%) active. In pooled analyses, in men and in women, there was significant and positive correlation between WC and seating/laying down position (WC = 92.41 + 1.49 seating time in hours, R2 = 0.11; P 2.42 was the optimal cut-off value to detect physically inactive patients: sensitivity = 93.3%, specificity = 100%, area under ROC = 0.991 ± 0.01 95% = 0.975–1.0; P Conclusion The association between low-grade inflammation markers, insulin resistance and physical inactivity favours the hypothesis that a low-grade inflammatory status and enhanced insulin, sensitivity may constitute a part of the CV benefits from physical activity.

The metabolic syndrome in type 2 diabetic patients in Gorgan: According to NCEP ATPIII and IDF definitions

Abstract: Aims People with metabolic syndrome are at increased risk for developing diabetes mellitus and cardiovascular disease. The present study aimed to assess the metabolic syndrome in type 2 diabetes and compare them with two used methods of diagnostic criteria in Gorgan. Methods The study group included 293 type 2 diabetic patients whom referred to the Department of Diabetes Center in Golestan University of Medical Sciences (2011). The metabolic syndrome was determined according to ATPIII and IDF definitions. Results According to ATPIII and IDF criteria, the frequency of metabolic syndrome was 75.42% and 76.79%, respectively. According to ATPIII, the mean triglycerides, body mass index, systolic blood pressure and diastolic blood pressure were higher in subjects with metabolic syndrome than subjects without metabolic syndrome. According to IDF, the mean triglycerides, body mass index and males’ waist circumferences were higher in subjects with metabolic syndrome. Conclusions This study showed that females were more affected than males. This may be due to the specific characteristics in the lifestyle changes between females and males diabetic patients among Gorgan inhabitants. Females are less educated in comparison with males diabetic. The majority of females with metabolic syndrome were householder. It seems that they do less physical activity at home. In conclusion, it appears that the female need to change their life style in this area to halt the burden of cardiovascular complications in diabetic patients.

Energy metabolism and the metabolic syndrome: Does a lower basal metabolic rate signal recovery following weight loss?

Abstract: Summary Aim To determine whether basal metabolic rate (BMR) was causally related to MetS, and to study the role of gender in this relationship. Methods Seventy-two Caucasian subjects (43 women, 29 men) had changes in basal metabolic rate (BMR), carbohydrate oxidation rate (COR), fat oxidation rate (FOR) and prevalence of the metabolic syndrome (MetS) assessed in response to weight loss. Results There was a significant gender × MetS interaction in BMR at the start. Women with MetS had higher adjusted BMR, whilst men with MetS had lower adjusted BMR than their respective counterparts. Weight loss resulted in a significant decrease in fat mass (−5.2 ± 0.31 kg, p = 0.001), fat free mass (−2.3 ± 0.27 kg, p = 0.001), BMR (−549 ± 58 kJ/d, p = 0.001) and a decreased proportion of MetS (22/72, χ 2 = 0.005). Subjects who recovered from MetS after weight loss (RMS) had ∼250 kJ/d significantly lower adjusted BMR compared to those who were never MetS (NMS, p = 0.046) and those who still had MetS (MetS+, p = 0.047). Regression analysis showed that change (Δ) in BMR was best determined by Δglucose × gender interaction ( r 2 = 23%), ΔFOR ( r 2 = 20.3%), ΔCOR ( r 2 = 19.4%) and Δtriglycerides ( r 2 = 7.8%). Conclusions There is a sexual dimorphism of BMR in MetS. Overall, the data support the notion that alterations in BMR may be central to the etiopathogenesis of MetS.

Compare the effects of different visfatin concentration on cardiovascular risk factors, adiponectin and insulin resistance in patients with T2DM.

Abstract: Aim The discovery of new adipokine, visfatin can significantly enhance our knowledge of insulin resistance and diabetes mellitus. We explored the relation of visfatin concentrations to cardiovascular risk factors, adiponectin and insulin resistance criteria in patients with type 2 diabetes mellitus (T2DM). Materials and Methods Fifty-eight patients with T2DM were recruited from the out patients clinic of Shariati Hospital. Laboratory and anthropometric measurements include FBG, OGTT, HbA1c, fasting serum visfatin, insulin and adiponectin, HOMA-IR and hsCRP, weight, height, BMI and WHR were performed in all participants. All of the statistical data were analyzed using the SPSS15 software. Results The log 10 -transformed (log) plasma visfatin concentration was in significant positive correlation with age ( r = 0.286, p = 0.033). Patients were divided in two groups by median log visfatin (0.85 ng/mL): group I had low values and group II had high values. In group I the log visfatin was in significant positive correlation with age ( r = 0.436, p = 0.018) and in group II log visfatin was in significant negative correlation with FPG and HbA1c ( r > 0.4, p Conclusion In conclusion high circulating levels of visfatin could be in healthy relations with cardiovascular risk factors, insulin resistance status and adiponectin in diabetic patients.

The impact of creatinine clearance on the outcome of diabetic foot ulcers in north Indian tertiary care hospital.

Abstract: Aim Wound healing has been reported to be poor in diabetic patients with impaired kidney functions that usually accompanies retinopathy and neuropathy. The insensitive foot is vulnerable to repeated trauma and development of ulcer precedes 70–80% of non-traumatic lower extremity amputation. The present study was aimed to study the impact of creatinine clearance (CCre) on the outcome of diabetic foot ulcers (DFU). Materials and methods Data from 162 DFU patients admitted to Rajiv Gandhi Centre for Diabetes and Endocrinology of J.N. Medical College, Aligarh Muslim University, Aligarh, India, between December 2009 and March 2011 were analyzed. Detailed history and patient's profile, grade of DFU, co-morbidities and complications, laboratory data, microbiological profile and final outcome were collected. CCre was calculated according to MDRD formula. Results The study revealed that, DFU healing was worst in patients with decreased CCre than in those who had normal CCre. Other factors associated with poor outcome were, higher grade of ulcer, infection type (subcutaneous and osteomyelitis) and biofilm infection. Amputation rates were also found to be higher in those with poor renal functions. Conclusions The results suggest that CCre is an important factor affecting wound healing in patients with DFUs. The automatic reporting of eGFR each time a serum creatinine concentration is requested will increase the awareness of significant kidney dysfunction in clinical practice especially in DFU patients and appropriate measures will improve the outcome.

PONI and its association with oxidative stress in type I and type II diabetes mellitus

Abstract: Objective Paraoxonase (PON) is an antioxidant enzyme linked with cardiovascular disease (CVD), diabetes as it prevents LDL oxidation. The relation of PON with the other established risk factor of diabetic complications has not been looked into. Research design and methods 370 subjects were included in the study. Dividing into four group, i.e. group I included type II DM ( n = 220), group II was age matched control ( n = 100), group III were type I DM ( n = 25) and group IV ( n = 25) were age matched control group. The protocol of the study was approved by the ethical committee of the institute. SOD, GSH, PON (paraoxonase and arylesterase activity), GHb, and MDA were estimated. Results A highly significant decrease in paraoxonase and arylesterase activity was seen in the type II DM ( p p > 0.05). Paraoxonase and arylesterase activity of PONI showed a negative significant correlated with MDA ( r = −0.51, p r = −0.23, p p Conclusion PONI is definitely associated with development of the complications of diabetes. This may be due to the role of it as an antioxidant. As it also show a negative correlation with MDA like the other antioxidants studied.

Prevalence of hypertension, control of blood pressure and treatment in hypertensive with type 2 diabetes in Hospital University Sains Malaysia

Abstract: Aims To determine the prevalence of hypertension, control of hypertension and patterns of antihypertensive medications in Malaysian type 2 diabetic patients who attended diabetes clinics in Hospital University Sains Malaysia (Tertiary Hospital). Materials and methods The study design was observational prospective longitudinal follow-up study; the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited whom attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The study period was from January till December 2008. Blood pressure was defined as >130/80 or use of antihypertension medications. Demographic characteristics of patients, level of blood pressure control, use of antihypertensive medications and patterns of antihypertensive therapy. Results The prevalence of hypertension in Malaysian type 2 diabetic patients was 998 (92.7%),antihypertensive drugs were prescribed in 940 (94.2%) of hypertensive patients with type 2 diabetic mellitus. The achievement of blood pressure control (≤130/80 mmHg) was 471 (47.2%) %. The percentage of patients receiving one, two, three, and four drugs were 253 (25.3%), 311 (31.3%), 179 (17.9%), and 197 (19.7%) respectively. Calcium channel blockers were the most commonly prescribed antihypertensive agents 757 (75.7%) followed by Angiotensin-converting enzyme inhibitors 446 (44.6%), and Angiotensin receptor blockers 42.4 (42.4%). Conclusion The prevalence of hypertension is high in Malaysian type 2 diabetic patients, hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Calcium channel blockers were the most commonly prescribed antihypertensive agents. There is an urgent need to educate both patients and health care providers of importance of achieving target of treatment in order to reduce morbidity and mortality due to diabetes with hypertension.

Biliopancreatic diversion induces villi elongation and cholecystokinin and ghrelin increase.

Abstract: Introduction Factors leading to weight loss and weight stabilization after bariatric surgery are not fully understood. Our aim was to evaluate, in Sprague–Dawley rats, the histological and gut hormonal changes after Larrad-biliopancreatic diversion (Larrad-BPD). Materials and methods Rats randomly underwent the following protocols: Larrad-BPD ( n = 4) versus pair fed (PF) ( n = 4). Weight and food intake were measured every day. By immunohistochemistry ghrelin was examined in the stomach, while cholecystokinin (CCK), glucagon-like-peptide-1 (GLP-1), peptide YY (PYY) and serotonin (5-HT) expression were analyzed in alimentary limb and ileum following or not the Larrad-BPD. Results Larrad-BPD rats exhibited significant ( P Discussion Larrad-BPD is followed by histological changes and a pleiotropic gut endocrine response aimed to compensate the reduction of intestinal area exposed to food. Until now, the hormones responsible for the intestinal hypertrophy have not been defined.

Risk factors of diabetic retinopathy in Bangladeshi type 2 diabetic patients.

Abstract: Aims To determine the risk factors associated with diabetic retinopathy (DR) in Bangladeshi type 2 diabetic subjects. Methods A cohort of 977 type-2 diabetic patients was recruited retrospectively based on hospital records in 2008, who were naive type-2 diabetes during 1993. Data on diabetes and lipid profile with serum creatinine and biophysical measures were obtained at baseline, 5, 10 and 15 years. DR was diagnosed by retinal color photography. Generalized linear models were used to assess the associations of clinical, biochemical and anthropometric variables with retinopathy at three follow-up. Cumulative exposures were determined based on average exposure to individual attribute. IRR and 95% CI were generated through Poisson regression model, adjusting for age-at-diagnosis of diabetes, baseline BMI, end-line waist-to-hip ratio and present physical activity status. Results DR patients had significantly poorer glycemic control at all three follow-ups. Age, residence, physical activity, serum creatinine and hypertension appeared as independent risk factors for DR in all three follow-up points. Poisson regression model identified glucose deregulation (IRR 1.8; CI 1.5–2.1), hypertension (IRR 1.5; CI 1.2–1.8) and raised serum creatinine (IRR 1.9; CI 1.5–2.3) as significant predictors for DR adjusted for possible confounders. Work related moderate-to-heavy physical activity (IRR 0.2; CI 0.1–0.3) appeared as protective. Conclusions Along with poor glycemic control, hypertension, nephropathy are independent risk factor retinopathy.

Prevalence of metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from diabetic foot ulcer patients

Abstract: Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa strains have been reported to be an important cause of nosocomial infections. There is not enough information from India regarding their prevalence in diabetic foot ulcer (DFU) patients. The present study was undertaken over a period of two year from December 2008 to March 2011 to study the incidence of MBL producing P. aeruginosa isolated from 162 DFU patients with various grades of ulcer (Texas classification). Forty isolates of P. aeruginosa were obtained from patients. These isolates were subjected to susceptibility testing to anti-pseudomonal drugs as per Clinical Laboratory and Standards Institute (CLSI) guidelines, and were further screened for the production of MBL by disc potentiation testing using ethylenediaminetetraacetic acid (EDTA)-impregnated imipenem and meropenem discs. Of the 40 isolates of P. aeruginosa, 22 (55%) isolates were found resistant to carbapenems (imipenem) and 18 (81.1%) were found to be MBL producers using imipenem+(EDTA) and 15(68.1%) by meropenem+EDTA. This rapid dissemination of MBL producers is worrisome and necessitates the implementation of not just surveillance studies but also proper and judicious selection of antibiotics, especially carbapenems.

Influence of maternal diabetes on serum leptinemic and insulinemic status of the offspring: A case study of selected patients in a tertiary care hospital in Bangladesh

Abstract: Introduction Leptin is now known to be an important hormone affecting intrauterine fetal growth. Since growth of fetus is also affected by the glycemic status of the mother. Serum leptin of infant is influenced by the maternal diabetic state. Investigation of cord blood leptin in babies of DM (Diabetes Mellitus) and GDM (Gestational Diabetes Mellitus) mothers (controlled blood glucose levels) may provide some indication about involvement of genetic factor in the development of leptin abnormalities in fetus. Aim The study was taken to investigate whether cord blood insulin, c-peptide and leptin levels correlate with birth weight in offspring of DM mother. Methods Blood was drawn from umbilical cord of 30 babies from GDM mothers (GDM-babies), 45 babies from Type 2 DM Mothers (DM-babies), and 30 babies from ND (Nondiabetic) mothers (ND-babies) of term pregnancy. Weight, blood glucose, placenta, serum leptin and c-peptide of the babies were measured. Results Birth weight of GDM and DM babies were significantly higher compared to ND-babies. Glucose level in GDM babies was significantly higher than ND and DM babies. Leptin levels in GDM babies were significantly higher than that of ND and DM babies. Serum c-peptide in GDM babies was significantly higher than DM and ND babies. However, there was no significant difference in leptin–glucose ratio among the three groups. Irrespective of degree of hyperglycemia leptin is a major determinant of fetal growth. Conclusions DM mother produces different insulinemic and leptinemic responses in the fetus indicating a possible genetic involvement.

Taq 1B polymorphism of cholesteryl ester transfer protein (CETP) in Egyptian patients with metabolic syndrome

Abstract: Aim We aimed at evaluation of the possible association of cholesteryl ester transfer protein (CETP) Taq1B polymorphism with the components of metabolic syndrome in a cohort of Egyptian patients compared to their healthy counterparts. Patients and methods Blood samples were collected for lipid profile, fasting glucose, insulin and routine biochemical tests. The Taq1B genotypes of CETP were determined using RFLP-PCR technique. Results The patients group showed a significantly higher B1B1 genotype and lower B2B2 genotype compared to the controls group. Serum HDL-C level was significantly higher in all subjects with the B2B2 genotype compared to those with B1B1 genotype. In the patients group, age positively correlated with cholesterol level, triglycerides, BMI and waist circumference. Conclusion Egyptian patients affected with metabolic syndrome have a higher prevalence of B1B1 genotype that is associated with lower serum HDL-C levels.

Thai ethnopharmacological herbs for diabetes treatment: data collection and informatics tracing for therapeutic property.

Abstract: Background In the present day, the standard treatments for this medical disorder include diet modification, antidiabetic drug and insulin treatment. However, in additional to standard treatment, the role of complementary and alternative medicine (CAM) should be mentioned. Objective Here, the author reports on the important Thai herbs that are used as compositions for CAM regimen for diabetes mellitus. Further informatics approach is done to fulfill the existed usefulness of identified herbs. Methods The data from famous classical Thai CAM centers then details of detected herbal contents in the regimens were registered. The derived ethnopharmacological registered data on Thai herbs were further assessed for its clinical feasibility for usage in diabetes treatment by matching the reported literature in the public standard medical database. Results There are 7 identified herbs with 1 herb that has supportive evidence in the published literature for feasibility in using in diabetes treatment. Conclusion There are many local Thai herbs that should be studied for its ethnopharmacological property for diabetes treatment. This is a preliminary for further research on diabetes treatment.

Optimal cut-off levels of body mass index and waist circumference in relation to each component of metabolic syndrome (MetS) and the number of MetS component

Abstract: Aims There is an ethnic difference of obesity index to diagnose metabolic syndrome. The authors explored the optimal cut-off levels for body mass index (BMI) and waist circumference (WC) in relation to each component of metabolic syndrome. Materials and methods Receiver operating characteristics (ROC) analysis was used to determine the optimal cut-off levels for each component of metabolic syndrome. This study included 4572 workers aged 42.5 ± 9.9 years. Results The optimal BMI cut-off values for diabetes mellitus, hypertension or dyslipidemia varied from 23.0 to 24.3 kg/m 2 . As for WC, the optimal cut-off values varied from 83.0 to 83.7 cm. The optimal BMI cut-off values relating with one to three components of metabolic syndrome varied from 23.2 to 25.3 kg/m 2 . As for WC, the optimal cut-off values varied from 83.0 to 85.0 cm. Pair-wise comparison of ROC curves showed that WC has an advantage in relation to metabolic syndrome and its components compared with BMI. By logistic regression analysis, odds ratios of obesity indices for hypertension, dyslipidemia or the number of metabolic component were all significantly increased. As for diabetes mellitus, odds ratios of BMI ≥25 and WC ≥85 significantly increased, respectively. Conclusions Japanese criteria of obesity in metabolic syndrome in man may be appropriate for diabetes mellitus. Ethnic difference in criteria of obesity in Asian metabolic syndrome exists, and mutual comparisons in the prevalence of metabolic syndrome have a difficulty to conduct.

Prevalence of metabolic syndrome in patients with angiographically proven coronary artery disease presenting to a tertiary care hospital in Delhi, India.

Abstract: Background Coronary artery disease is fast emerging as the major concern for afflicting people across the globe. The Indian subcontinent is highly predisposed to this condition due to distinctive risk factor profile of this population. This fact has led to a condition where the current preventative and management protocols that have worked well in the non-Asian Indian Caucasian populations, have failed to bring about the anticipated control over the incidence and progression of CAD in Asian Indians. Metabolic syndrome has been identified as a major determinant of CAD in this population. Materials and methods The prevalence of metabolic syndrome was determined in 431 patients undergoing coronary angiography through various diagnostic algorithms. The Asian modified diagnostic criteria were also implemented to estimate the metabolic syndrome prevalence in patients with different levels of stenosis. Results We observed a high incidence of metabolic syndrome in the patients with coronary artery disease. The prevalence of MS increased with increase in severity of coronary artery involvement. The IDF guideline with Asian modification was the most successful diagnostic algorithm. Conclusions It is now imperative to acknowledge the unique pattern of CAD and risk factor profile prevalent among South Asians. This will facilitate more focused and individualized management protocols directed to this population. Metabolic syndrome is a major syndrome prevalent in this population. Hence, effective control of MS may help in reducing the morbidity and mortality due to CAD in a great way.