Showing papers in "International Journal of Diabetes in Developing Countries in 2015"

RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017

Abstract: Members: Dr. Anuj Maheshwari, Dr. Banshi Saboo, Dr. B. M. Makkar, Dr. C. R. Anand Moses, Dr. Ch. Vasanth Kumar, Dr. J. Jayaprakashsai, Dr. Jayant Panda, Dr. K. R. Narasimha Setty, Dr. P. V. Rao, Dr. Rajeev Chawla, Dr. Rakesh Sahay, Dr. Samar Banerjee, Dr. Sanjay Agarwal, Dr. Sanjay Kalra, Dr. S. R. Aravind, Dr. Sujoy Ghosh, Dr. Sunil Gupta, Dr. S. V. Madhu, Dr. Vijay Panikar, Dr. Vijay Viswanathan

In vivo and in vitro antidiabetic effects of citrus flavonoids; a study on the mechanism of action

Abstract: Type 2 diabetes mellitus is a result of hyperglycemia caused by overproduction of glucose at the hepatic level or because of abnormal β cell function or insulin resistance at target cells. The purpose of this study was to investigate the hypoglycemic effect of hesperidin and naringin and to suggest their probable mechanisms of action in high fat-fed/streptozotocin (STZ)-induced type 2 diabetic rats. Male albino rats were divided into four groups. Group 1 was normal control, and others were induced with diabetes by feeding a high-fat diet for 2 weeks followed by an intraperitoneal injection of streptozotocin (35 mg/kg b.wt.). Group 2 was kept as diabetic control, and groups 3 and 4 were further treated with an oral dose of 50 mg/kg hesperidin and naringin. In the diabetic control group, levels of glucose and glycosylated hemoglobin were significantly increased, while serum insulin level and hepatic and muscle glycogen were decreased. Both hesperidin and naringin supplementation significantly reversed these parameters. The activity of the hepatic key enzyme hexokinase was significantly increased whereas, glucose-6-phosphatase, glycogen phosphorylase, and fructose-1,6-bisphosphatase activities were significantly decreased as a result of treatment. Furthermore, both compounds were found to decrease intestinal glucose absorption in situ and to increase insulin release from isolated islets, peripheral glucose uptake in vitro, and adipose tissue glucose transporter type 4 (GLUT4) messenger RNA (mRNA) and protein expressions. These results showed that hesperidin and naringin have potent antihyperglycemic activity in high fat-fed/STZ-induced diabetic rats.

Determining diabetes using iris recognition system

Abstract: Iridology is a science which correlates the apparitions of iris to tissue weaknesses in the body. It merely reveals weaknesses, inflammation, or toxicity in organs or tissues. It also indicates weakness long before the symptoms appear. In this paper, support vector machine-based iris recognition system utilizing iridology has been used to determine diabetes. Features from eye image database of 40 people having healthy eye (normal) and having affected eye (diabetes) have been extracted by 2-D wavelet tree. The overall accuracy is obtained to be 87.50 % which reasonably demonstrates the effectiveness of the system.

Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center

Abstract: General diagnostic criteria used in our country for determination of gestational diabetes mellitus (GDM) involve Diabetes in Pregnancy Study Group India (DIPSI) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines. DIPSI states that when a pregnant woman walks into the antenatal clinic in fasting state, she has to be given 75 g oral glucose load, and if 2-h plasma glucose (PG) is ≥140 mg/dL, then it is considered to be a case of GDM. The IADPSG after Hyperglycemia and Adverse Pregnancy Outcome (HAPO) recommends any of the values of fasting plasma glucose (FPG) ≥92 mg/dL, 1-h PG ≥180 mg/dL, or 2-h PG ≥153 mg/dL to diagnose GDM. Our objective was to study the implications of implementing the IADPSG guidelines or DIPSI guidelines for screening and diagnosis of GDM in Indian population. Another objective was to evaluate the importance of isolated fasting glucose which is the main difference between the two guidelines. This retro-prospective study was performed at the Max Super Speciality Hospital, Saket, Delhi. Consecutive pregnant women (N = 152) in 24th–28th week of pregnancy underwent 75 g oral glucose tolerance test (OGTT). The proportions of GDM computed by both IADPSG and DIPSI criteria were analyzed, and the discordant pair of diagnosing GDM was examined by McNemar test. A total of 152 pregnant women went through 75 g OGTT. Among them, 113 (74.34 %) were diagnosed with gestational diabetes as per the DIPSI criteria of 2 h post plasma glucose (PPG) ≥140 mg/dL while taking into account the isolated fasting blood glucose alone as per the IADPSG criteria 34 (22.36 %), women were diagnosed with GDM. Furthermore, by including 2-h plasma glucose (PG) ≥153 mg/dL, 69 (45.39 %) were detected with GDM. Diagnosis of GDM by DIPSI criteria leaves 22.36 % undiagnosed which may easily be detected through IADPSG. Since the DIPSI criteria would miss a substantial number of patients, we suggest that the IADPSG criteria are better for screening of GDM in India.

Medical adherence and its predictors in Diabetes Mellitus patients attending government hospitals in the Indian Capital, Delhi, 2013: a cross sectional study

Abstract: India has the second highest Diabetes Mellitus burden globally which represents a major public health challenge. Poor adherence to medication and other treatment recommendations in diabetes patients is associated with poor glycemic control which may lead to early onset of complications with high cost of management. We assessed medical adherence and their predictors in type 2 diabetes patients attending Government Hospitals in Delhi. We conducted a cross sectional study among 385 Type 2 DM patients. We assessed medication adherence with the eight item Morisky Medication Adherence Scale. Dietary and exercise adherence were also assessed. Data was analyzed using SPSS Version 17. Prevalence of good medication adherence was 74.5 %, adherence to dietary recommendations was 70 % and adherence to exercise recommendations was 48 % in the study population. On adjusted analysis, lower socio-economic status, oral hypoglycemic agent treatment alone and reporting non-replenishment on exhaustion of drug stocks was associated with higher likelihood of poor medication adherence. Barriers against dietary adherence were differing familial dietary choices, inflation, beliefs that occasional transgression was benign and cultural factors like dining together at same time. Clinical pathology especially knee joint pain was reported as most frequent barrier to exercise adherence. The medication adherence rates found in this study were higher than most other studies conducted in India. Provision of free anti hyperglycemic medication at government hospitals by reducing patient out of pocket expenses facilitates maintenance of a high level of medication adherence. Furthermore, higher dietary and exercise adherence may reflect the improved self efficacy in patients.

Effect of multispecies probiotic supplements on serum minerals, liver enzymes and blood pressure in patients with type 2 diabetes

Abstract: Emerging evidence suggests that diabetes is associated with altering serum minerals, elevated liver enzymatic activity and blood pressures. This study was designed to determine the effects of multispecies probiotic supplements on serum minerals, liver enzymes and blood pressure in diabetic patients. This randomized double-blinded controlled clinical trial was performed among 58 diabetic patients aged 35–70 y. Subjects were randomly assigned to consume either multispecies probiotic supplements (N = 28) or the placebo group (N = 30) for 8 weeks. The multispecies probiotic supplement was consisted of seven viable and freeze-dried strains: Lactobacillus acidophilus (2 × 109 CFU), Lactobacillus casei (7 × 109 CFU), Lactobacillus rhamnosus (1.5 × 109 CFU), Lactobacillus bulgaricus (2 × 108 CFU), Bifidobacterium breve (2 × 1010 CFU), Bifidobacterium longum (7 × 109 CFU), Streptococcus thermophilus (1.5 × 109 CFU) and 100 mg fructo-oligosaccharide with lactose as carrier substances. Fasting blood samples were taken at baseline and after 8-week intervention to measure serum minerals, liver enzymes and total bilirubin. Consumption of the probiotic supplements, compared to the placebo, resulted in an increased serum calcium concentrations (0.21 vs. −0.83 mg/dL, P = 0.009) and a decreased serum alanine aminotransferase (ALT) levels (−2.46 vs. 4.62 mg/dL, P = 0.02). We did not find a significant difference in terms of effect on serum magnesium, zinc, iron, alkaline phosphatase (ALP), aspartate aminotransferase (AST) levels and blood pressures comparing the two groups. In conclusion, multispecies probiotic supplementation among diabetic patients had beneficial effects on serum calcium and ALT concentrations.

Efficacy of urinary N-acetyl-β-D-glucosaminidase to evaluate early renal tubular damage as a consequence of type 2 diabetes mellitus: a cross-sectional study

Abstract: We assessed the prognostic accuracy of urinary N-acetyl-β-D-glucosaminidase (NAG), an early proximal tubular damage marker for the onset of diabetic nephropathy. The study included 491 eligible participants with 76 healthy controls, 194 type 2 diabetes mellitus (T2DM) patients with 0–5, 5–10, 10–15, and 15–20 years of T2DM duration, 71 microalbuminuric patients, 100 diabetic nephropathy patients, and 50 non-diabetic nephropathy patients. Fasting glucose, serum fructosamine, HbA1C, urinary microalbumin, serum creatinine, estimated glomerular filtration rate (eGFR), serum NAG, and urinary NAG were estimated. We compared urinary NAG activity with other well-established markers of diabetic nephropathy like microalbuminuria, eGFR, and serum creatinine. Urinary NAG excretion was increased by 8 and 12 folds in T2DM patients of 10–15 and 15–20 years of diabetes duration (p < 0.0001), respectively, without the appearance of microalbuminuria. The urinary NAG activity increased 16 and 18 fold in moderately increased albuminuria and diabetic nephropathy patients, respectively (p < 0.0001), without any change in non-diabetic nephropathy patients. A cutoff value of 3 U/L of urinary NAG has demonstrated a sensitivity of 96.1 % and a specificity of 100 % discriminating healthy controls from patients with T2DM duration of 10–15 years (AUC 1.000) and 15–20 years (AUC 0.999); microalbuminuria (AUC 0.999), and diabetic nephropathy (AUC 1.000). Urinary NAG excretion gradually increases with the increase in duration of diabetes and appeared much before the microalbuminuria, decreased eGFR, and increased serum creatinine. Thus, the urinary NAG may be considered as a potential site-specific early tubular damage marker leading to diabetic nephropathy.

Kidney injury molecule-1 (Kim-1): an early biomarker for nephropathy in type II diabetic patients

Abstract: Renal damage is a serious major microvascular diabetic complication implicated in the death of diabetic patients, which would necessitate the need for new biomarkers to detect early stage of diabetic nephropathy (DN). Kidney injury molecule-1 (Kim-1), a type I transmembrane protein, is undetectable in normal kidneys but markedly induced in proximal tubules after ischemic and toxic injury. So, the present study was conducted to estimate and evaluate Kim-1 as a biomarker for DN. This cross-sectional study was carried out on 60 male and female type II diabetic patients (whose serum creatinine level was less than 2 mg/dL). Diabetic patients were classified as microalbuminuric with nephropathy (urinary albumin was 30–300 mg/dL) and normoalbuminuric without nephropathy (urinary albumin was <30 mg/dL). Twenty matched apparently healthy subjects were included as control group. Patients and controls were assessed for fasting blood glucose, glycosylated hemoglobin (HbA1c), serum creatinine, blood urea nitrogen (BUN), microalbuminuria, and urinary Kim-1. Urinary Kim-1 levels were elevated significantly tenfold in type II diabetic microalbuminuric patients as compared to the control group and normoalbuminuric diabetic patient. Urinary Kim-1 levels were positively correlated with microalbuminuria, serum creatinine, BUN, duration of diabetes, and BMI. Higher urinary Kim-1 level in T2D particularly in those with nephropathy and its correlation with urinary microalbumin, serum creatinine, blood urea, and BUN may reflect the role of Kim-1 as a biomarker for diagnosis and prognosis of diabetic nephropathy among T2D patients taking into account other risk factors.

Incidence of diabetic foot disorders in patients with diabetes in Jeddah, Saudi Arabia

Abstract: Epidemiology of diabetic foot disorders in Saudi Arabia has not been well documented. We therefore performed a 1-year follow-up study to characterize the incidence of diabetic foot disorders, including peripheral arterial disease (PAD), peripheral neuropathy (PN), foot ulcer, gangrene, and amputation, among 556 diabetic patients in Saudi Arabia. All the disorders were diagnosed by standard objective diagnostic tools or diagnosed clinically by a specialized surgeon. Complication of foot ulcer (CFU) was defined as at least one of the following complications: foot ulcer, gangrene, and amputation. Diabetic foot disorder (DFD) was defined as at least one of the following complications: PAD, PN, foot ulcer, gangrene, and amputation. The 1-year cumulative incidence of PAD, PN, CFU, and DFD was 6.3, 9.2, 3.6, and 16.7 %, respectively. The 1-year cumulative incidence was 1.8 % for foot ulcer, 1.5 % for gangrene, and 0.6 % for amputation. Only one participant was diagnosed as more than one disorder. The longer duration of diabetes was associated with an increased incidence of PN and DFD. Relatively high incidences, as well as the duration of diabetes as the major risk factors for diabetic foot disorders were found in this Saudi population.

Selenium, zinc, and copper levels and their relation with HbA1c status in children with type 1 diabetes mellitus

Abstract: In recent years, the oxidative stress-induced free radicals have been implicated in the pathogenesis of type 1 diabetes mellitus (DM). It has been also reported that elements like selenium (Se), zinc (Zn), and copper (Cu) involved in lipid peroxidation may play a role in the pathogenesis and exacerbation of this disease. The aim of the present study was to evaluate the antioxidant status and micronutrient levels in children with type 1 DM. The study included 35 children with type 1 DM (16 girls and 19 boys) with a mean age of 13.8 ± 4.5 years and a mean disease duration of 3.6 ± 2.8 years and 26 age-matched healthy children (11 girls and 15 boys) with a mean age of 12.8 ± 3.3 years. The Se and Zn levels of children with type 1 DM were significantly lower than those of controls. Glycosylated hemoglobin (HbA1c) levels were found to be inversely correlated with Se and Zn levels. There was no any statistically significant difference between serum Cu levels of patients with type 1 DM and controls. Glutathione peroxidase (GSH-Px) levels were lower in patients with type 1 DM when compared with those of controls, and there was a negative correlation between HbA1c and GSH-Px levels. We believe that the increased oxidative stress may be originated from low levels of glutathione peroxidase resulted from decreased levels of Se. The negative correlation between Se, Zn, GSH-Px, and HbA1c levels may show poor metabolic control of the disease and effect of oxidative injury. Those elements should be closely monitored during the course of type 1 DM, and supplementation of these elements may be beneficial both for controlling diabetes and preventing long-term oxidative injury related to diabetic complications.

Serum 8-hydroxy-2′-deoxyguanosine (8-oxo-dG) levels are elevated in diabetes patients

Abstract: The increased oxidative stress in diabetes is known to contribute to the development of diabetes. We investigate whether serum 8-hydro-2′-deoxyguanosine (8-oxo-dG) is associated with diabetes at the time of first diagnosis and evaluate whether it can be used as a reliable biomarker for the oxidative stress in diabetes. The study was designed as a case control study with two groups: patient with diabetes and control. The diabetes group consisted of a total of 28 patients consulting the hospital for the first time and definitely diagnosed for diabetes, and the control group was composed of 65 healthy subjects. Serum 8-oxo-dG was measured by a competitive enzyme-linked immunosorbent assay (ELISA) kit, specially developed to minimize cross-reaction of 8-oxo-dG antibody with serum guanosine. The average serum 8-oxo-dG levels in patients with diabetes and controls were 0.72 ± 0.41 and 0.24 ± 0.14 ng/mL, respectively, statistically significant (p < 0.001). The 8-oxo-dG value was significantly higher in women with diabetes, compared with men with diabetes (p = 0.028). The sensitivity and the specificity of the 8-oxo-dG ELISA assay were 0.80 and 0.96, respectively, and the ROC value was 0.93. This study suggests that increased oxidative stress has an important role in the pathogenesis of diabetes. Serum 8-oxo-dG may be a useful clinical biomarker for the early diagnosis of stress-related diseases, e.g. diabetes and its management.

Trends in diabetes epidemiology in Indian population in spite of regional disparities: a systemic review

Abstract: Diabetes mellitus has emerged as a serious health problem and India has the distinction of having the second largest number of diabetics in world after China We have performed a systemic review to evaluate the trends of prevalence, extent of diabetic problem in India based on available literatures over a period of 52 years (1960 to 2011) Pertinent literatures providing details of sample size, age group, along with prevalence of any of the three outcomes of interest, ie diabetes mellitus, impaired fasting glucose, impaired glucose tolerance were included In this report, we have analysed the changes in prevalence of diabetes mellitus and prediabetes in India from 103 potential literatures A secular trend regarding increase in diabetic prevalence was observed in India, though in rural areas it is slower than urban areas Prevalence of impaired glucose tolerance and impaired fasting glucose was found high in different parts of India, suggesting the presence of a large pool of people with potential to develop diabetes Change in lifestyle, food habit, physical inactivity and genetic variation may be responsible for such situation Extent of lack of awareness and carelessness to undergo screening for diabetes was clearly demonstrated in the recent study Though regional disparities, lack of well designed studies, differences in diagnostic protocol and lack of follow-up studies are the major limitations to understand the effect of diabetes mellitus throughout the equally A multidisciplinary approach and situation based policy are needed to combat the pandemic

A Study of Asymptomatic Bacteriuria in North Indian Type 2 Diabetic Patients

Abstract: The prevalence of asymptomatic bacteriuria (ASB) in diabetic patients varies from 9 to 27 % in various studies which is certainly higher as compared to healthy individuals. The risk factors which lead to increased prevalence of asymptomatic bacteriuria in diabetic patients are immune system dysregulation, development of bladder dysfunction and prostatism. Studies have reported that ASB has a higher prevalence in diabetic individuals as compared to nondiabetics. Patients having type 2 diabetes mellitus along with age- and sex-matched controls who were hemodynamically stable were enrolled. A prospective case-control study was done. A total of 200 patients were enrolled, and they were divided into two groups, i.e. those with diabetes and nondiabetic patients (age- and sex-matched controls) without symptoms of UTI. Urine examination and biochemical investigations of the patients were done. In our study, the prevalence of ASB among the diabetic patients was significantly higher 28.2 % as compared to 7.5 % in the controls (p = 0.001). The main risk factors for asymptomatic bacteriuria in our study were female sex (p = 0.003), increased age (p = 0.007), longer duration of diabetes mellitus (p = 0.003), poor glycemic control (p < 0.001) and recent urinary tract infection (p = 0.02). There were no significant differences in the serum creatinine levels in the patients with asymptomatic bacteriuria among diabetics as compared to the culture-negative patients. The presence of ASB may be considered a marker of poorly controlled and long-standing diabetes.

Angiotensin I-converting enzyme inhibitory activity and hypocholesterolemic effect of some fermented tropical legumes in streptozotocin-induced diabetic rats

Abstract: Cardiovascular disease (CVD) is the common cause of morbidity and mortality in diabetes. Any antidiabetic management strategy should therefore include the control of CVD risk factors. Thus, this study describes the effect of fermented legume condiment-supplemented diets on lung angiotensin I-converting enzyme (ACE) and lipid profile in streptozotocin (STZ)-induced diabetic rats. Adult male Wistar rats were used for the study and diabetes was induced in them by a single intraperitoneal injection of STZ (35 mg/kg b.w.). After the diabetic status had been confirmed, the animals were randomly divided into six groups consisting of six animals each and were fed with diets supplemented with fermented Bambara groundnut, locust bean, and soybean. The study lasted for 14 days after which the plasma was analyzed for the lipid profile and the rats’ lungs were assayed for ACE activity. Elevated ACE activity, plasma total cholesterol, triglyceride, and LDL-cholesterol showed significant (P < 0.05) reduction in the rats treated with fermented legume condiment-supplemented diets, with a concomitant increase in plasma HDL-cholesterol as compared with the diabetic control. This study therefore concludes that fermented legume condiment-supplemented diets could attenuate diabetes-induced dyslipidemia, a major coronary disease risk factor, in experimental rats. This health benefit of the condiment diets could be associated with their ACE inhibitory and antihypercholesterolemic properties. However, the diet supplemented with fermented locust bean condiment appeared to be the most potent.

Comparison of salivary nitric oxide and epidermal growth factor level between diabetic patients and healthy individuals

Abstract: The purpose of the current study was to compare salivary Nitric oxide and epidermal growth factor level in diabetic patients and healthy individuals. In this paired-control study 20 patients with type 1 diabetes mellitus, 20 patients with type 2 diabetes mellitus and 20 age and sex matched healthy subjects participated. The level of salivary Nitric oxide was increased in type 1 and 2 diabetic patients in comparison to control individuals (P = 0.037 and P = 0.058), respectively. Epidermal growth factor concentration was higher in type 1 and 2 diabetic patients compare to healthy ones, (P = 0.037 and P = 0.005) respectively. There was no significant difference between salivary Nitric oxide and Epidermal growth factor level regarding to the type of diabetes (P > 0.05). Significant statistical correlation was found between Nitric oxide and Epidermal growth factor levels and the fasting blood glucose and HbA1c (P < 0.001). Conclusions: Salivary Nitric oxide and Epidermal growth factor levels were higher in type 1 and type 2 diabetic patients and there was correlation with severity of disease.

Hospital based incidence, patterns of presentation and outcome of type 1 diabetes: 12 years’ data from a tertiary care center in North India

Abstract: Increase in the incidence of Type 1 diabetes (T1D) over last several decades has been reported worldwide. There is a dearth of data on incidence/prevalence of T1D in children from India. We studied the trends in incidence of T1D amongst children attending a tertiary care pediatric hospital of North India over last 12 years and the changes in incidence, patterns of presentation and disease outcomes during this period by retrospective analysis of patient records and hospital census data. The study population comprised of 647 children with onset of T1D below 16 years who attended the hospital from April, 2001 to March, 2013. There was a consistent increase in the total number of T1D patients every year. The increase in the proportion of younger ( 15 years) patients (mean yearly percentage 60.3 versus 25 %). The proportion of patients presenting during winter months was almost double than the average of any of the 3 seasons (39 versus 20.3 %). The overall mortality was 1.7 %. In conclusion, the number of patients with T1D has shown an increase although the severity of presentation has declined. Marked seasonality in presentation indicates some unidentified environmental factors triggering the onset of disease in our patient population.

Delayed diagnosis of diabetic ketoacidosis in children—a cause for concern

Abstract: Diabetic ketoacidosis (DKA) is the major cause for mortality in children with diabetes mellitus (DM). Delayed diagnosis or missed diagnosis is common among children with DKA. This study was undertaken to identify the impact of delayed diagnosis on clinical presentation, complications, and mortality of DKA in children from a tertiary care center at Chennai. Among the 118 episodes of DKA in 100 children less than 12 years of age, delayed diagnosis was more common in new onset diabetes mellitus (DM). Forty-four out of 68 children with new onset DM with DKA (64.7 %) had delayed diagnosis. Thirty-two children with established diabetes presented with 50 episodes of DKA. Among these, eight episodes (16 %) had a delay in diagnosis; 85.7 % of infants, 76.9 % of toddlers, and 58 % of the preschool and school children had delayed diagnosis. Urinary tract infections, respiratory illness, vomiting, febrile illness, acute abdomen, and encephalopathy were the common diagnosis in children where DKA was missed. The causes for delay in diagnosis and management of DKA were lack of parental and physician awareness, improper referral, and delayed transport. Presence of shock, altered sensorium, severe DKA, lower PaCO2 at admission, and complications like renal failure and cerebral edema were higher in children with delayed diagnosis of DKA. This was found to be statistically significant. Delayed diagnosis was a significant risk factor for mortality in children with DKA (p = 0.00) in this study population.

Risk indicators of diabetic retinopathy in patients with type 2 diabetes screened by fundus photographs: a study from Pakistan

Abstract: This study aims to evaluate the risk indicators of diabetic retinopathy in patients with type 2 diabetes screened by fundus photographs at a tertiary care diabetes centre in Karachi, Pakistan. A cross-sectional study was conducted at the outpatient department of Baqai Institute of Diabetology and Endocrinology from October 2009 to March 2010. Patients ≥30 years of age were recruited randomly. Demographic, anthropometric, clinical and biochemical data were collected, and ophthalmic screening was done by two field fundus photography. Fundus photographs of 366 patients were graded according to the modified Early Treatment Diabetic Retinopathy Disease Severity Scale (ETDRS) criteria. Retinopathy was present in 27.3 % patients. Fifteen percent of patients had non-sight-threatening retinopathy while 12 % had sight-threatening retinopathy. Patients with retinopathy had significantly increased mean duration of diabetes, systolic and diastolic blood pressure and HbA1c (p < 0.001). Patients with sight-threatening retinopathy also had increased serum cholesterol (p < 0.05) and serum creatinine (p < 0.001). Multivariate logistic regression revealed male gender (3.5 times, 95 % confidence interval (CI); 1.73–7.12), increased duration of diabetes (≥10 years, 5.46 times, 95 % CI; 2.15–13.85), hypertension (≥130/85, 1.96 times, 95 % CI; 0.95–4.03) and poor glycemic control (HbA1c ≥7 %, 1.39 times, CI; 1.23–1.56) as significant factors for developing retinopathy. Diabetic retinopathy was present in every fourth subject, while sight-threatening retinopathy was present in every eighth subject with type 2 diabetes. The results of the present study highlight the importance of screening for retinopathy. The identification of risk indicators associated with retinopathy in our population may lead to measures of prevention of sight-threatening complication of diabetes. Fundus photographs revealed increased frequency of retinopathy among patients with type II diabetes. Male gender, increased mean duration of diabetes, hypertension and poor glycemic control related with the presence of retinopathy, while increased serum cholesterol and creatinine related with severity of retinopathy. The present study highlights the importance of screening for retinopathy. The presence and severity of retinopathy in this population was attributed to the factors identified in earlier studies. The present study thus validated the findings of studies conducted on diverse populations across the world.

Infections and diabetes

Abstract: Infections and diabetes illustrate the health problems facing India, and more. The two often coexist, making each other the worse for it. Subjects with diabetes have a greater frequency and severity of many common infections (urinary, pulmonary, soft tissue) whereas some rare infections are seen almost exclusively in the diabetic population viz. rhino-cerebral mucormycosis, malignant otitis-externa and emphysematous cholecystitis, cystitis, and pyelonephritis. These infections should be sought in patients presenting with DKA and hyperglycemic hyperosmolar syndrome. Fournier’s gangrene and infections of the foot occur predominantly in diabetics. The increased susceptibility to infections and impaired wound healing is due to diminished vascularity, autonomic dysfunction, and abnormalities in cell-mediated immunity and phagocytic function. The common pathogens are Escherichia coli, Klebsiella, Campylobacter, and Salmonella enteritidis. Infections may worsen glycemic control. Periodontal infection is linked with dysglycemia and cardiorenal complications. Prevention from infection requires good glycemic control, good hygiene, and preventive vaccination. Beside the well-recognized association of infection and diabetes, a recent study from India reported that the prevalence of hepatitis C in these subjects is higher; it was positive in 11 out of 192 (5.7 %) with a higher prevalence in men and in those with poorer glycemic control [1]. Similarly in an earlier study also from India, hepatitis B virus was more common in subjects with acute viral hepatitis having diabetes (58.33 vs. 25.3 % in controls) [2]. In a multiple variable logistic regression analysis, acute hepatitis B and diabetes were shown to be related to severe hepatitis. Interestingly, Helicobacter pylori infection was higher in subjects with diabetes (n 62; 77.5 %) compared to controls (n 62; 77.5%). It was correlated with poorer glycemic control, suggesting that chronic inflammation with the infection may be associated with subsequent development of insulin resistance [3]. Urinary tract infection is commonly observed in diabetes. Among Indian subjects with culture-positive urinary infection, nearly 30 % were asymptomatic. Diabetes was associated with a higher prevalence of pyelonephritis and with poorer glycemic control. In descending order, cultured pathogenic bacteria were E. coli (64.6 %), Klebsiella (12.1 %), and Enterococcus (9.9 %). Extended-spectrum beta-lactamaseproducing E. coli was more common in diabetes [4]. With clinical introduction of antidiabetic agents acting through inducing glycosuria (SGLT2 inhibitors), counseling about genital hygiene must be integrated to reduce the risk of genital and urinary infections. The enormous physical and financial burden of diabetic foot infection has been highlighted in a recent journal editorial [5]. The current issue describes diabetic foot involvement from Saudi Arabia [6] and China [7] and an uncommon bacteriological infection [8]. In India, smoking and barefoot walking are common underlying factors in foot complications among persons from both urban and rural areas [9], which are preventable. Recurrent infections are also a major burden [10], which must be tackled by proper education about foot care [11]. In a recent prospective study from Varanasi, Singh et al. showed that in 62 consecutive subjects with foot involvement, * G. R. Sridhar sridharvizag@gmail.com

Inhibition of carbohydrate hydrolyzing enzymes associated with type 2 diabetes and antioxidative properties of some edible seeds in vitro

Abstract: This study sought to evaluate the antioxidant properties and effects of some edible wild seeds [Afzelia africana Sm. (AFZ), Cyperus esculentus L. (CYP), Eleusine coracana Gaertn. (ELE), Irvingia gabonensis (Aubry-Lecomte ex O’Rorke) Baill. (IRV), Monodora myristica Dunal. (MON) and Parinari curatellifolia Planch. ex Benth. (PAR)] on α-amylase and α-glucosidase activities. The phenolic content and antioxidant activities of aqueous extracts of the seeds as typified by 1,1-diphenyl-2 picrylhydrazyl (DPPH) and hydroxyl (OH) radicals scavenging abilities and inhibition of Fe2+-induced malondialdehyde (MDA) production in rat’s pancreas in vitro were also assessed. ELE had significantly (p < 0.05) higher total phenol content than the other seeds; however, AFZ had the highest flavonoid content. The extracts scavenged DPPH· and OH· in a dose-dependent manner with aqueous extracts of PAR having the highest DPPH· scavenging ability, while extracts from IRV had the highest OH· scavenging ability and inhibition of Fe2+-induced MDA production in rat’s pancreas. Furthermore, all the extracts inhibited α-amylase and α-glucosidase activities in a dose-dependent manner. The α-amylase inhibitory effect of MON (IC50 = 0.48 mg/mL) was comparable to that of acarbose (IC50 = 0.40 mg/mL), while the α-glucosidase inhibitory effect of AFZ (IC50 = 0.45 mg/mL) was comparable to that of acarbose (IC50 = 0.39 mg/mL). The results suggest the potential use of the seeds in the dietary management of blood glucose levels associated with type 2 diabetes.

Illness perceptions and perceived barriers to self-care in patients with type 2 diabetes mellitus: an exploratory study from India

Abstract: The aim of the present study was to examine the relationship between perceived barriers to self-care, illness perceptions, metabolic control and quality of life. Sixty patients with type 2 diabetes mellitus, aged 30–60 years, were recruited from the endocrinology department of a general hospital in Bangalore. They were assessed on the Barriers to Self-Care scale, Illness Perceptions Questionnaire (Revised), Summary of Diabetes-Specific Self-Care Activities. The outcomes were assessed by the brief Diabetes Quality of Life scale and the current glycosylated haemoglobin (HbA1c) level. Results were analysed using descriptive statistics, correlation coefficients and regression analysis. Perceived barriers to self-care were significantly associated with identity, consequence, timeline cyclical, and emotional representation, personal control, treatment control and illness coherence dimensions of illness perceptions. Self-care was associated with personal and treatment control and illness coherence dimensions of illness perceptions. Self-care was positively associated with metabolic control. Barriers to self-care were associated with self-care and were an important predictor of self-care and quality of life. The findings of this study emphasize the importance of social cognitive variables such as illness perceptions, self-efficacy beliefs and perceived barriers in impacting self-care and quality of life in patients with type 2 diabetes mellitus.

Knowledge and awareness of oral health among diabetic patients—a cross-sectional study from Mangalore City

Abstract: Despite the worldwide recognition of the dangers of diabetes mellitus (DM), diabetes patients’ awareness and attitude towards their heightened risks for oral disease has not been fully addressed. The study was conducted to explore the knowledge and awareness of oral health among diabetic patients. A total of 150 known diabetics were asked to fill the self-reported questionnaire which was specially designed for the study. Only completed questionnaires were included in the data analysis. The response rate for this particular study was 90.6 %. The gender distribution study subjects were 67 males (48.6 %) and 71 females (51.4 %). About 87 (63 %) of the respondents were not aware of which type of diabetes they had. Sixty-five (48.1 %) of the respondents were not aware of systemic complications associated with diabetes. Even though majority of the respondents had awareness about association between oral conditions and diabetes, only 11 (22.5 %) people knew about periodontal conditions associated with diabetes. Majority of the respondents (63.7 %) used toothbrush to clean their teeth. Fifty-two (37 %) of the respondents brushed once daily and 46 (33.3 %) brushed twice daily. Out of 138 respondents, 48 (35 %) knew about interdental cleansing. In order to promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health.

Effect of group cognitive behavioral therapy (CBT) on psychological well-being and glycemic control in adults with type 2 diabetes

Abstract: This study was designed to determine whether participation in group cognitive behavioral therapy (CBT) would result in better glycemic control, higher motivation in diabetes self-management, and improved psychological well-being. The experimental design involved a sample of 60 Malaysian adults having type 2 diabetes for more than a year, drawn from the health clinic at Universiti Sains Malaysia, Penang. Participant volunteers were males and females aged between 20 and 65 years of various ethnic backgrounds. Glycemic control was measured by HbA1c value for each participant with pre- and post-blood tests, while psychological well-being was measured by the Well-being Questionnaire (W-BQ 22) developed by Bradley (1990) to measure depression, mood, anxiety, and various aspects of positive well-being exclusively for diabetics. CBT intervention program and patient education supplements were administered to the experimental group over 3 months, whereas the control group received neither; both groups carried on their normal type 2 diabetes treatment and physicians’ consultations. The results indicated that group CBT improved the mean psychological well-being scores among participants in the experimental group from 37.56 in the pretest to 49.83 in the posttest. The findings of the current study suggested that the therapy could also help diabetics achieve more acceptable HbA1c levels and better adjust to diabetes.

Assessment of depression and death anxiety level in diabetic patients in Eskisehir, Turkey

Abstract: This study was carried out in order to determine the levels of depression and death anxiety in diabetic patients and to examine the relationship between depression and death anxiety. The current study is a descriptive study carried on diabetic patients having inpatient treatment in the Internal Diseases Service of Eskisehir Osmangazi University, Medical Faculty Hospital, between 2 January and 29 June 2012. The hospital anxiety and depression scale and Templer death anxiety scale are used, respectively, for the assessment of depression and anxiety and the assessment of death anxiety level in this study. Thirty-two patients (40.0 %) are male and 48 patients (60.0 %) are female. Of the patients, 51.2 % (n = 41) and 36.3 % (n = 29) are determined to have depression and anxiety, respectively. Death anxiety level is determined to be higher in women and the ones at primary school level and below (p < 0.05 for each). A positive relationship is found between disease level and death anxiety level (r s = 0.239; p = 0.033). A positive relationship is found between anxiety level and death anxiety level of the ones in the study group (r s = 0.256; p = 0.022). Death anxiety and depression are important medical problems in diabetic patients. It was seen that death anxiety increases as long as anxiety level and period of disease increase. It will be useful to perform psychiatric consultations of patients at certain intervals and to treat the ones at high depression and death anxiety levels.

Prevalence and risk factors associated with diabetes mellitus among Kabul citizens—Afghanistan, 2012

Abstract: Diabetes mellitus, a chronic metabolic disease that can lead to severe complications and even death in affected individuals, is on the rise worldwide. In 2011, an estimated 185 million people were living with diabetes, with a projected prevalence of 276 million by 2030. In Afghanistan, reliable published information about diabetes mellitus is unavailable. Therefore, a cross-sectional study was conducted during December 2011–March 2012 to estimate the prevalence and determine factors for diabetes mellitus among adults living in urban Kabul. A multistage random sampling technique was used to recruit adults of ≥40 years. Background data, blood pressure, body mass index, and blood sugar were obtained via a structured questionnaire, physical examinations, and blood specimen. Individuals previously diagnosed with diabetes mellitus or those having a fasting blood sugar >126 mg% were considered as diabetes mellitus. Univariate and multivariate analyses were performed using SPSS version 20. Out of total 1183 participants, 157 (13.2 %, confidence interval (CI 12.2–14.2) were identified as diabetes mellitus. Factors independently associated with diabetes mellitus were age with cutoff 45 years (OR=1.59, CI 1.04 - 2.44), educaiton level (OR=1.90, CI 1.21 - 3.01) family history of diabetes (odds ratios (OR) = 8.5, CI 5–14), sedentary lifestyle (OR = 3.6, CI 1.8–7.3), eating rice (OR = 2.0, CI 1.3–3.1), using a car for transportation (OR = 2.3, CI 1.2–4.8), hypertension (OR = 1.8, CI 1.2–2.8), and using liquid cooking oil (OR = 0.4, CI 0.3–0.6). Measures such as raising awareness and lifestyle modifications may help to reduce the burden of the disease among adults in Kabul.

The effect of rebound exercise and treadmill walking on the quality of life for patients with non-insulin-dependent type 2 diabetes

Abstract: Patients often require rehabilitation following complications or co-morbidities associated with diabetes. Exercise is recommended for glycemic control in diabetic patients but they do not engage in physical activities due to fatigue or fear of worsening their condition resulting in poor quality of life (QoL). Treadmill activities and rebound exercise on a mini-trampoline are used for cardio-respiratory and general fitness but their effect on the QoL in non-insulin dependent type 2 diabetes patients (T2D) has not been determined. This study was designed to compare the effect of moderate intensity rebound exercise and treadmill walking on the QoL of T2D patients. One hundred and fifty patients were randomized equally into control, rebound or treadmill group and received hypoglycemic medication and diabetic counseling. The control group did not engage in exercise, rebound group bounced or jumped on a mini-trampoline and treadmill group walked on a treadmill at 40-60 % of heart rate maximum (220-age) for 20-30 minutes, 3 times per week for 12 weeks. QoL using the SF-36 questionnaire was assessed pre-and post-interventions. Results showed a drop out of 6(12 %) control; 11(22 %) rebound and 13(26 %) treadmill groups respectively. There were significant improvements in all domains post-rebound exercise (P 0.05) and control a significant decline in vitality and mental health (P < 0.05). Rebound exercise and treadmill walking can be used to improve QoL for T2D patients and possibly reduce the side effects and co-morbidities associated with diabetic medication and diabetes.

The effectiveness of interactive multi-modality intervention on self-management support of type 2 diabetic patients in Thailand: a cluster-randomized controlled trial

Abstract: This cluster-randomized controlled trial study aimed to assess the effectiveness of the interactive multi-modality technology (IMM) as an intervention to increase self-management among type 2 diabetic patients in a 3-month period. The IMM intervention contained email, Short Message Service (SMS), and website with four main functions (i.e., self-regulation, self-monitoring and assessment, social support, and reminder system—linked to email and SMS). In this trial, four public offices in the Bangkok Metropolis were recruited and randomly assigned into either the intervention or the control group. One hundred and twenty-six Thai patients who had met inclusion criteria (hemoglobin A1c or A1c >7.0 %, no serious illness, and Internet and mobile phone accessibility) were subsequently assigned to the intervention (n = 78) and the control (n = 48) groups. Patients in the intervention group received the IMM intervention. Those in the control group received self-management knowledge via email only. Outcome measures, A1c, and behavioral questionnaires (Diabetes Quality of Life, Self-efficacy, and Self-care Management) were applied to all patients at baseline and at 3-month follow-up. T test and chi-square test were used to analyze the data. After 3 months, 55 (out of 78) and 30 (out of 48) patients remained in the study. Main findings revealed a significant difference in A1c level between the groups (p < 0.001). The self-care management score increased in both groups, but the increase was significantly higher in the intervention group (p < 0.001). For the first time, this demonstrates the effectiveness of the IMM intervention among type 2 diabetic Thai patients with computer literacy.

Investigation of sleep quality, quality of life, anxiety and depression in patients with diabetes mellitus

Abstract: This study was undertaken to determine sleep quality and quality of life, anxiety and depression in patients with type 2 diabetes in a Turkish university hospital in 2010. “The Pittsburgh Sleep Quality Index (PSQI)”, “the Short Form-36 Quality of Life Scale” (SF36), “Beck Depression Inventory” (BDI), “Beck Anxiety Inventory” (BAI) and self-designed questionnaires were used. Sleep quality was bad in 67.9 % of the patients. The total mean for patients’ PSQI score was calculated as 6.41 ± 2.79. Analyzing the sections of the SF36, the mean score for functional condition was 51.99 ± 25.09, 50.76 ± 1.29 for well-being, 47.98 ± 14.78 for sense of life and 50.24 ± 1.49 for global life quality. The mean incidence of depression in patients was 6.35 ± 4.08, and mean frequency of anxiety was 7.81 ± 3.98. There was a significant difference between PSQI, BDI and BAI when patients’ age, duration of disease, and chronic overlapping diseases were considered. To conclude, in the majority of type 2 diabetic patients (67.9 %) we determined poor quality of sleep and mild depression and anxiety. Understanding sleep disorders, anxiety and depression in type 2 diabetic patients will help in the management of the disease and the enhancement of quality of life. Most nurses are aware of diabetes inpatients’ poor sleep quality, high level of anxiety and depression.

Novel school-based health intervention program—a step toward early diabetes prevention

Abstract: The purpose of this study is to determine the existing knowledge, attitude, practices (KAP), and impact of intervention with diabetes awareness and prevention education among school students in New Delhi, India The Diabetes Awareness and Prevention Education is a 2-year, school-based intervention, conducted with two cohorts of students who were in the sixth and seventh grade when the study started from six schools of Delhi (n = 3 private and 3 government), India These schools were purposively selected to represent socioeconomic strata and different geographies within Delhi Students in these schools were surveyed before the intervention began and after 1-year intervention (n = 1520) The intervention used strategies which included the following: orientation workshops for teacher coordinators and peer leaders, interactive classroom sessions (curriculum) led by trained teachers, peer-led small group activities (peer-led health activism), fun learning games, students’ worksheets, and intraschool competitions, etc After intervention, significantly more students reported that diabetes is high level of glucose in blood than at baseline Consumption of junk food items significantly reduced among students post intervention A total of 65 and 138 % more students in private and government schools, respectively, reported outdoor activities during leisure time Teacher-led classroom discussions with active youth engagement and empowerment (peer-led health activism) can be an important strategy with potential long-term benefits for early diabetes prevention