Showing papers in "International Journal of Diabetes in Developing Countries in 2020"
TL;DR: There is an overall improvement of glycemic control during COVID-19 lockdown independent of increase in physical activity in people with long duration of diabetes.
Abstract: COVID-19 is likely to affect the lives of individuals with type 2 diabetes. However, the effect of COVID-19 lockdown on physical activity and glycemic control in such individuals is not known. We studied the physical activity and glycemic control during lockdown in comparison to pre-lockdown parameters in individuals with long-standing type 2 diabetes. This prospective, observational study includes 2240 people with T2DM regularly attending diabetes clinic prior to lockdown. Glycemic record, HbA1c, and physical activity assessed with Global Physical Activity Questionnaire (GPAQ) as metabolic equivalents (MetS min/week) were obtained during lockdown (minimum duration of 3 months). A total of 422 out of 750 participants (nest) responded. The median (IQR) for age was 58 (52 to 64) years, duration of diabetes 11 (6 to 16) years, prevalent foot complications in 59.7%, and atherosclerotic cardiovascular disease in 21.3% of participants. There was a decrease in HbA1c from 7.8% (6.9 to 9.4) prior lockdown to 7.4% (6.6 to8.7) during lockdown [ΔHbA1c − 0.41 ± 0.27% (p = 0.005)] and postprandial blood glucose 200.0 mg/dl (152.0 to 252.0) to 158.0 (140.0 to 200.0) mg/dl (p < 0.001). The physical activity increased during lockdown from a GPAQ score 140 (0.0 to 1260) MetS to 840 (0.0 to 1680) MetS (p = 0.014). The improvement of glycemic control was observed in either gender and independent of the presence of foot complications or increase in physical activity. There is an overall improvement of glycemic control during COVID-19 lockdown independent of increase in physical activity in people with long duration of diabetes.
45 citations
TL;DR: In the RSSDI-ESI Consensus Group, Dr Sanjay Bhadada’s name was inadvertently missed out as one of the members under the category “Diabetes and CVD”.
Abstract: In the RSSDI-ESI Consensus Group, Dr Sanjay Bhadada’s name was inadvertently missed out as one of the members under the category “Diabetes and CVD”.
34 citations
TL;DR: The present study highlighted that diabetes poses a high economic burden on individuals/households and the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes.
Abstract: Diabetes mellitus is recognised as a major chronic pandemic disease that does not consider any ethnic and monetary background There is a dearth of literature on the cost of diabetes in the Indian context Therefore, the present study aims to capture the evidence from the literature on the cost of diabetes mellitus in India An extensive literature was reviewed from ACADEMIA, NCBI, PubMed, ProQuest, EBSCO, Springer, JSTOR, Scopus and Google Scholar The eligibility criterion is based on ‘PICOS’ procedure, and only those studies which are available in the English language, published between 1999 and February 2019, indexed in ABDC, EBSCO, ProQuest, Scopus and peer-reviewed journals are included A total of thirty-two studies were included in the present study The result indicates that the median direct cost of diabetes was estimated to be ₹18,890/- pa for the north zone, ₹10,585/- pa for the south zone, ₹45,792/- pa for the north-east zone and ₹8822/- pa for the west zone Similarly, the median indirect cost of diabetes was ₹18,146/- pa for the north zone, ₹1198/- pa for the south zone, ₹18,707/- pa for the north-east and ₹3949/- pa for the west zone The present study highlighted that diabetes poses a high economic burden on individuals/households The study directed the need to arrange awareness campaign regarding diabetes and associated risk factors in order to minimise the burden of diabetes
34 citations
TL;DR: Current literature, relevant websites, and related guidelines are reviewed to form this narrative review to help address key questions in type 1 diabetes and COVID-19.
Abstract: Coronavirus disease 2019 (COVID-19) has aroused global health concerns, particularly in relation to diabetes where it has been associated with poorer outcomes. The bulk of the evolving evidence in diabetes and COVID-19 relates to type 2 diabetes (T2D). Since there are a significant number of patients with type 1 diabetes (T1D) with unique concerns and challenges during the ongoing COVID-19 pandemic, we reviewed existing literature, relevant websites, and related guidelines to form this narrative review to help address key questions in this area. We systematically searched the PubMed database up to May 31, 2020, and retrieved all the articles published on T1D and COVID-19. We found 18 relevant articles, each of which carried a part of the evidence regarding the risk of contracting COVID-19 in patients with T1D, effect of COVID-19 on development of T1D, outcomes in T1D with COVID-19, and special management issues in T1D in the light of COVID-19. These have been documented in the present review. COVID-19 with T1D presents special challenges. While the available evidence does shed some light, we need more evidence to deal with this difficult duo.
25 citations
TL;DR: From the current study, it can be concluded that uncontrolled diabetic condition might be a risk factor for severity and morbidity of COVID-19 patients.
Abstract: Diabetes mellitus may be associated with increased severity and enhanced mortality in COVID-19 infections. The present study was undertaken to evaluate the clinical presentation, laboratory parameters, radiological imaging, management, and outcome of COVID-19 infection in patients of diabetes mellitus and its association with glycemic control. The present study was designed to evaluate the difference between uncontrolled and controlled diabetes for COVID-19 manifestations by enrolling 80 admitted COVID-19 patients. Patients were categorized into two groups, where group 1 had patients with uncontrolled diabetes as indicated by HbA1c > 8 g% and group 2 had patients with controlled diabetes as indicated by HbA1c < 8 g%. Information concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome was extracted from medical records for evaluation, interpretation, and association among both the groups. COVID-19 patients with uncontrolled diabetes exhibited a severe symptomatic presentation, excessive uncontrolled inflammatory responses, and hypercoagulable state. Total leukocyte count, neutrophil-lymphocyte ratio, serum levels of IL-6, FDP, and D-dimer were significantly raised (p < 0.05) in case of uncontrolled diabetes as compared with controlled diabetes. Radiological findings detected by chest radiograph and computed tomography chest suggested severe lung involvement in uncontrolled diabetes. COVID-19 patients with uncontrolled diabetes required intensive treatment as compared with controlled diabetes group in terms of insulin therapy (p = 0.0226) and non-invasive ventilation (p = 0.0292). Patients with uncontrolled diabetes had higher mortality (p = 0.0375) and required prolonged hospitalization (p = 0.0479) as compared with controlled diabetes group. From the current study, it can be concluded that uncontrolled diabetic condition might be a risk factor for severity and morbidity of COVID-19 patients. Uncontrolled diabetes mellitus might be responsible for an overall higher susceptibility for COVID-19 infection and severity in terms of symptomatic presentation, inflammatory storm, rapid pulmonary invasion, requirement of more intensive treatment, and a poor outcome.
22 citations
TL;DR: The present paper presents a meta-analysis of 148 cases of type 2 diabetes patients treated at the UCMS-GTB Hospital in Ahmedabad over a 12-month period from May 2013 to March 2014 that showed clear trends in disease progression and in particular in cases of high blood pressure and insulin resistance.
Abstract: Rajeev Chawla1, S. V. Madhu2, B. M. Makkar3, Sujoy Ghosh4, Banshi Saboo5, Sanjay Kalra6, On behalf of the RSSDI-ESI Consensus Group* 1North Delhi Diabetes Centre, Rohini, New Delhi, 2Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, 3Dr. Makkar’s Diabetes and Obesity Centre, Paschim Vihar, New Delhi, 4Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, 5DiaCare A Complete Diabetes Care Centre, Ahmedabad, Gujarat, 6Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
21 citations
TL;DR: In this sample of patients with T2DM in Vietnam, the majority had poor glycemic and metabolic control and Concerted efforts are needed to optimize control and prevent complications in these patients.
Abstract: To assess diabetes care delivery and prevention of short- and long-term diabetes-related complications in patients with type 2 diabetes mellitus (T2DM) in Vietnam. DiabCare Asia is an observational, non-interventional, cross-sectional study of hospital-based outpatient care for patients diagnosed with T2DM. A total of 1631 patients (mean age 62.7 years; 58.9% female) participated in the study. The percentage of patients with HbA1c < 7.0% (< 53 mmol/mol) was 36.1% and mean (standard deviation) HbA1c was 7.9 ± 1.8% (63 ± 19 mmol/mol). The proportion of patients using insulin was 40%, at a mean total daily dose of 35.4 U. Apart from dyslipidemia (81.2%) and hypertension (78.4%), the most common diabetes-related complications were peripheral neuropathy (37.9%) and eye complications (39.5%). Current insulin therapy was associated with peripheral vascular disease (odds ratio [OR] = 2.28 [95% confidence interval (CI) 1.68; 3.09]) and eye complications (OR = 1.70 [95% CI 1.37; 2.11]). In this sample of patients with T2DM in Vietnam, the majority had poor glycemic and metabolic control. Concerted efforts are needed to optimize control and prevent complications in these patients. Trial registration: NCT02066766
15 citations
TL;DR: The economical and evidence based “single test procedure” of DIPSI is most appropriate for screening during the COVID pandemic.
Abstract: Limited medical facilities are available due to Covid-19 pandemic. Nevertheless, all efforts should be made in planning judicial and possible methods of delivering health care, particularly to pregnant woman with GDM. GDM may play a crucial role in the increasing prevalence of diabetes and obesity and also may be the origin of cardiometabolic diseases. It is mandatary to diagnose and care pregnant woman with GDM. The test suggested to diagnose GDM has to be evidence based and in this regard “a single test procedure” evaluated meets this requirement. This doable test has been accepted by the Diabetes in Pregnancy Study Group India (DIPSI) and approved by MHFW-GOI, WHO, International Diabetes Federation, and International Federation of Obstetricians and Gynecologists. MHFW-GOI also recommends testing at first antenatal visit and then at 24–28 weeks of gestation. This opportunity can also be utilized for performing ultrasonography for assessing fetal development. The first-line management is MNT and life style modifications. Non-responders may require insulin or OHA. The target glycemic control is FPG ~ 5.0 mmol/dl (90 mg/dl) and 2 h PPPG ~ 6.7 mmol/dl (120 mg/dl). The goal is to obtain newborns birth weight appropriate for gestational age between 2.5 and 3.5 kg, a step to prevent offspring developing diabetes. The essential precaution required during COVID pandemic is to wear face mask, avoid crowded places, and maintain social distancing. Finally, the economical and evidence based “single test procedure” of DIPSI is most appropriate for screening during the COVID pandemic.
14 citations
TL;DR: An increased prevalence of stress was seen among Indian adolescents and young adults living with T1D and female gender, salaried individuals, and pre-existing poorly controlled diabetes contributed to an increased risk of stress.
Abstract: Strict isolation measures and interrupted health care services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as type 1 diabetes (T1D). A cross-sectional, observational study was done to assess determinants of stress and its impact on glycemic control in adolescents and young adults (aged 12–24 years) living with T1D in India. An online, semi-structured survey including Perceived Stress Scale (PSS-10) was distributed and results were analyzed. A total of 89 participants (46 males, mean age 19.61 ± 3.8 years) with T1D completed the survey. Age (r = 0.325, p = 0.005) and HBA1C level within the preceding 3 months (r = 0.274, p = 0.036) correlated positively with PSS-10 scores. There was a statistically significant difference in PSS-10 score based on gender (t(70) = − 2.147; p = 0.035), education (F (4,67) = 4.34, p = 0.003), and occupation (F(3,68) = 4.50, p = .006). On multiple linear regression, gender, occupation, and HbA1C were the significant determinants of PSS-10 (F(3,55) = 12.01, p < 0.001, R2 = 0.363). One-way ANOVA showed a significant impact of mean PSS-10 score on the glycemic control (F(2,69) = 3.813, p = 0.027). An increased prevalence of stress was seen among Indian adolescents and young adults living with T1D. Female gender, salaried individuals, and pre-existing poorly controlled diabetes contributed to an increased risk of stress. Increased stress resulted in worsened glycemic control.
13 citations
TL;DR: In the light of the current country–wide statistics for diabetes both in terms of prevalence and overall existing healthcare focus on diabetes, it is highly emphasized that a multifaceted approach should be designed to curb diabetes and its complications.
Abstract: Diabetes mellitus has reached epidemic proportions worldwide and it has emerged as a great socioeconomic burden for the developing world [1, 2]. It is predicted that between 2010 and 2030, there will be 67% surge in the prevalence of diabetes in developing countries [1]. Globally, in 2017, there were 451million people with diabetes. These numbers were estimated to reach 693 million by 2045 [3].It was also predicted that 49.7% of adult diabetics are undiagnosed; with a biblical proportion belongs to low income countries. Moreover, there was an estimated 374 million people with impaired glucose tolerance and it was projected that almost 21.3 million live births were affected by some form of hyperglycemia in pregnancy [3]. In Pakistan, the first survey [National Diabetes Survey of Pakistan (NDSP) 1994–98] revealed 8.7% prevalence [1].Since then, small-scale studies including survey of Pakistan Health Research Council (PHRC) reported prevalence between 13.1 and 26.9%. A latest survey [2nd NDSP 2016–17] estimated that approximately 26.3% of local population above 19 years age, is diabetic [Known diabetics; 19.2%, newly diagnosed diabetics; 7.1%]. The results show an increased prevalence compared to the 1st NDSP (Urban; 22.04% and rural; 17.15%). Overall, glycemic dysregulation (diabetes plus pre-diabetes) has doubled both in urban 43% and in rural dwellers 39% [1, 4]. The provincial pattern of prevalence is as follows: Punjab; 30.2%, Khyber PakhtunKhwa; 13.2%, Balochistan; 29.5% and Sindh; 32.3%. These figures equate to approximately 27.4 million people aged 20 and above, based on the 207.77 million total population [1, 6]. If the present situation continues, Pakistan is expected to achieve the highest prevalence of diabetes globally [2].The current status of diabetes presents a huge challenge for health care system, health professionals, and national health care policy makers. The economic burden, both in terms of morbidity and mortality associated with diabetes, will soon engulf a big portion of health budget in an already compromised health care setting with limited resources and funds. Poverty as a cause of complications of diabetes is posing an obstacle to the social and economic development. There is no operational policy or action plan yet for diabetes in the country [5].Similarly, the leading risk factors for diabetes, including unhealthy dietary habits, obesity, smoking, and sedentary lifestyle, are yet to be prioritized by the health policy makers. The country lacks consensus guidelines for diabetes management. Some support is available through the Advisory Board for the Ca r e o f D i a b e t e s (ABCD) whe r e gu i d e l i n e s , Recommendations for Optimal Management of Diabetes from Primary to Tertiary care level (PROMPT), are formed based on national data which should be implemented on priority basis [6]. However, there is no proper system organized for referral of diabetic patients with complications from primary to tertiary care level. At primary level, facilities for diagnoses and treatment are lacking. Similarly, diabetic registry does not exist so far [5]. In the light of the current country–wide statistics for diabetes both in terms of prevalence and overall existing healthcare focus on diabetes, it is highly emphasized that a multifaceted approach should be designed to curb diabetes and its complications. Operational policies and action plans to focus on primary prevention, delivering preventive services that target early detection of the disease and address the risk factors. Risk assessment of Pakistani individuals for diabetes * Iftikhar Ali iftikharalijan@gmail.com
11 citations
TL;DR: Changes in practice to a telehealth-driven approach, with emphasis on homecare and community clinics, need to be adopted, to ensure best possible care to patients with DFUs, in order to reduce their risk of DFU-related complications and need for hospitalization.
Abstract: The COVID-19 pandemic has had an unparalleled impact on the socio-economic and healthcare structure of India. Due to our large populations of diabetic patients, who have an increased risk of worse outcomes with COVID-19 infection, it is of utmost public health importance to analyse the relationship between the two. The aim of our review was to analyse the possible relationship between COVID-19 infection and DFUs, which are a fairly common, yet serious complication in diabetic patients, as well as their management, under the given changing circumstances. An extensive review of related educational articles was analysed from various databases. The two main pathogenic mechanisms described in COVID-19 infection are a cytokine storm (causing ARDS) as well as an acquired coagulopathy, with widespread thrombosis. DFUs are associated with an underlying peripheral neuropathy, a chronic low-grade inflammatory state and peripheral arterial disease, which lead to chronic non-healing ulcers. Similarities seen in the pathogenic mechanisms of these two conditions make a bidirectional relationship highly plausible. Due to the disruptions in the healthcare system brought on by the COVID-19 pandemic, changes in practice to a telehealth-driven approach, with emphasis on homecare and community clinics, need to be adopted, to ensure best possible care to patients with DFUs, in order to reduce their risk of DFU-related complications and need for hospitalization.
TL;DR: AGE levels significantly correlated with MDA concentration indicates AGEs may be responsible for oxidative stress in GDM women and may be used as a biomarker during pregnancy to predict vascular complications due to GDM.
Abstract: Advanced glycation end products (AGEs) are major risk factors for vascular complications in diabetes. Its role in gestational diabetes mellitus (GDM) and vascular complications in GDM is not known. The present study was aimed to study the association of AGEs with GDM and vascular inflammation. Plasma samples from normal pregnant and GDM women (n = 50 each) were obtained from two tertiary referral centers in Tamil Nadu, India. Quantification of AGEs, methylglyoxal (MGO), ICAM-1, and malondialdehyde (MDA) were performed by commercially available ELISA kits. The third trimester fasting blood sugar (101.35 ± 26.15 vs. 81.63 ± 6.14, p < 0.002) and postprandial blood sugar (150.69 ± 23.07 vs 105.79 ± 11.99, p < 0.0001) were significantly high in GDM women compared to normal pregnant women. The concentrations of AGEs (13.18 ± 8.74, p < 0.001), MGO (15.7 ± 13.54, p < 0.02), and ICAM-1 (217.8 ± 86.92, p = 0.005) were significantly higher in GDM women compared to AGEs (2.68 ± 0.89), MGO (9.26 ± 5.38), and ICAM-1 (142.3 ± 38.21) in normal pregnant women. Further, elevated levels of MDA concentration (0.64 ± 0.08, p < 0.002) and low GSH levels (0.19 ± 0.1, p < 0.0001) in the GDM women were indicative of oxidative stress. AGE levels significantly correlated with MDA concentration which indicates AGEs may be responsible for oxidative stress in GDM women. Further, elevated level of ICAM-1 in GDM women suggests endothelial activation which may impact endothelial function. Thus, AGEs may be used as a biomarker during pregnancy to predict vascular complications due to GDM.
TL;DR: It is suggested that experimental studies due to decreasing care burden and increasing the quality of life of mothers who have children with T1DM in terms of gaining better care for children with type 1 diabetes mellitus are applied.
Abstract: This was a descriptive study to determine the care burden and quality of life of mothers of children with type 1 diabetes mellitus (T1DM) and the correlation between these two variables. The sample consisted of 106 mothers of children with T1DM. Data were collected using a descriptive questionnaire, the Zarit Caregiver Burden Interview and WHOQOL-BREF quality of life scale, and were evaluated with the Mann-Whitney U test, Student’s t test, ANOVA, Kruskal-Wallis test and Spearman’s correlations. Mothers had a moderate burden level (34.95 ± 12.48) with a statistically significant difference between income state and care burden (p < 0.05). Environment-related quality of life was related to income and physical quality of life was related to the time of diagnosis (p < 0.05). Care burden was negatively correlated with some aspects of quality of life. These results imply that mothers of children with T1DM have a moderate care burden and that their care burden has a negative impact on their quality of life. It may be provided to support the systems and suggested applying experimental studies due to decreasing care burden and increasing the quality of life of mothers who have children with T1DM in terms of gaining better care for children with T1DM.
TL;DR: Practical experiences of problems faced by children and adolescents having T1DM during the past 2 months of lockdown are shared and proposed solutions may help them overcome these problems and help them in better diabetes management during such emergency situations.
Abstract: Type 1 diabetes (T1D) requires a holistic approach and continuous care. The current COVID-19 pandemic has made the health care professionals realise its challenges even more ardently than in the normal times. In a country like India with its huge population burden and a significant number of people having T1D, the risk of COVID-19 in people having T1DM is considerably high. In this article, we are sharing our practical experiences of problems faced by children and adolescents having T1DM during the past 2 months of lockdown. We have classified the challenges into 3 broad categories based on diabetes self-management, healthcare system and psychosocial aspects. We have tried to provide precise, comprehensive and region specific solutions to these challenges. Solutions briefly include maintaining the supply chain of essentials like insulin, syringes and glucose meter strips to psychological support, financial aid and support for hospitalization in case of COVID-19 itself or diabetes complications including diabetic ketoacidosis. Children and adolescents having T1DM require special care and attention during this period of COVID-19 pandemic because of various challenges as discussed. Our proposed solutions may help them overcome these problems and help them in better diabetes management during such emergency situations.
TL;DR: An early screening program reduces the risk of incidence of diabetic retinopathy and should be done once in a year, according to a prospective observational study conducted at the outpatient department of Baqai Institute of Diabetology and Endocrinology andBaqai Medical University.
Abstract: To evaluate frequency and risk factors of diabetic retinopathy in patients with type 2 diabetes. This prospective observational study was conducted from January 2017 to June 2017 at the outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE) and Baqai Medical University a tertiary care diabetes hospital of Karachi, Pakistan. Convenience sampling was done. Demographic, anthropometric, clinical, and biochemical data were collected, and ophthalmic screening was performed by funduscopy at a slit lamp biomicroscopy with the help 90 D fundus lens. Grading of diabetic retinopathy was done according to the modified Early Treatment Diabetic Retinopathy Disease Severity Scale (ETDRS) criteria. Retinopathy was present in 17.5% of patients. Non-sight-threatening retinopathy was found in 15.2% and sight-threatening retinopathy was found in 17.6%. In table 4, logistic regression analysis determined the relationship between retinopathy and its possible risk factors. In univariate logistic regression model, Age, poor glycemic control and longer duration of diabetes were found to be significant risk factors for developing retinopathy. In multivariate logistic regression model, duration of diabetes remained significantly associated with the development of retinopathy. Additionally, gender was not significantly associated in univariate analysis but it became significant after adjustment in multivariate model. An early screening program reduces the risk of incidence of diabetic retinopathy. Hence, screening of retinopathy should be done once in a year.
TL;DR: Yoga intervention targets elevated lipid levels and aids in correcting dyslipidemia in person with diabetes, and the result suggests that 6 months of yoga intervention resulted in a significant decline in AIP in persons with type 2 diabetes.
Abstract: Atherogenic index of plasma (AIP) is a strong marker to predict the risk of atherosclerosis and cardiovascular disease (CVD). Diabetes alters the utilization of lipids and lipoproteins which cause diabetes-induced atherogenic dyslipidemia leading to CVD. The study aims to determine whether yoga intervention influences lipid indices in type 2 diabetes mellitus subjects. A total of 104 persons with type 2 diabetes were included in this hospital-based prospective randomized trial. These were further randomized into non-yoga (n = 52) and yoga (n = 52) groups. Intervention of approximately 40 min yoga practice, minimum 5 times in a week over a period of 6 months, was done in the yoga group. Anthropometric parameters (body mass index (BMI) and waist-to-hip ratio (WHR)) were noted, and serum glucose (fasting and post-prandial) and lipid profile [total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL)] were estimated in all the subjects on fully automated analyzer. AIP and the logarithm of molar ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL cholesterol) were calculated. A statistical analysis was done using paired and unpaired student “t” test. A highly significant improvement in AIP was observed in the yoga group when compared before and after yoga intervention. Body mass index also showed a similar trend. A statistically significant decrease in TC, TG, LDL, VLDL, and AIP was observed in persons with diabetes in the yoga group when compared with persons with diabetes in the non-yoga group. The result of the study suggests that 6 months of yoga intervention resulted in a significant decline in AIP in persons with type 2 diabetes (p < 0.001). Our study concluded that yoga intervention targets elevated lipid levels and aids in correcting dyslipidemia in person with diabetes.
TL;DR: Investigation of the clinical features of critically ill SARS-CoV-2 patients with and without diabetes found that critically ill COVID patients with T2DM had more severe damages of the lymphocytes, islet cells, and heart function, and gastrointestinal symptoms, lymphopenia, and increased FBG may be early predictors for poor prognosis.
Abstract: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rapidly develop to critical condition. Here, we investigated the clinical features of critically ill SARS-CoV-2 patients with and without diabetes and identified risk factors for death of these patients. The medical records including epidemiological, demographic, clinical, and laboratory data from 49 critically ill SARS-CoV-2 patients were collected and analyzed in Huanggang City and Xiaogan City, Hubei Province, outside Wuhan. Sixty-seven percent (33) of patients survived and 33% (16) of patients died in 49 critically ill patients (32 men, 17 women), with a median age of 63 years (IQR 53–73). Univariate analyses indicated that the deceased patients were more often associated with two or more comorbidities, one or more gastrointestinal symptoms, high neutrophil percentage, low lymphocytes and lymphocyte percentage, high C-reactive protein, high procalcitonin, high fasting blood glucose (FBG), and high lactate dehydrogenase (LDH) compared with the survivors; moreover, the patients with T2DM had the higher neutrophil percentage, the lower lymphocyte percentage, and the higher levels of FBG and LDH compared with the patients without T2DM. Multivariable logistic regression analyses indicated that gastrointestinal symptoms (≥ 1 symptoms), decreased lymphocytes (< 1.1 × 109/L), and increased FBG (≥ 7.0 mmol/L) were the independent risk factors for death of critically ill patients. Critically ill COVID patients with T2DM had more severe damages of the lymphocytes, islet cells, and heart function, and gastrointestinal symptoms, lymphopenia, and increased FBG may be early predictors for poor prognosis.
TL;DR: The findings suggest that a genetically lowered vitamin B12 concentration may have an impact on central obesity in the presence of a dietary influence; however, the study failed to provide evidence for an impact of metabolic-GRS on lowering B12 concentrations.
Abstract: Observational studies in South Asian populations have suggested an association between vitamin B12 status and metabolic traits; however, the findings have been inconclusive. Hence, the aim of the present study was to use a genetic approach to explore the relationship between metabolic traits and vitamin B12 status in a Sri Lankan population and to investigate whether these relationships were modified by dietary intake. A total of 109 Sinhalese adults (61 men and 48 women aged 25–50 years) from Colombo City underwent anthropometric and biochemical measurements, dietary intake analysis, and genetic tests. Genetic risk scores (GRS) based on 10 metabolic single nucleotide polymorphisms (SNPs) (metabolic-GRS) and 10 vitamin B12 SNPs (B12-GRS) were constructed. The B12-GRS was significantly associated with serum vitamin B12 (p = 0.008) but not with metabolic traits (p > 0.05), whereas the metabolic-GRS had no effect on metabolic traits (p > 0.05) and vitamin B12 concentrations (p > 0.05). An interaction was observed between B12-GRS and protein energy intake (%) on waist circumference (p = 0.002). Interactions were also seen between the metabolic-GRS and carbohydrate energy intake (%) on waist-to-hip ratio (p = 0.015). Our findings suggest that a genetically lowered vitamin B12 concentration may have an impact on central obesity in the presence of a dietary influence; however, our study failed to provide evidence for an impact of metabolic-GRS on lowering B12 concentrations. Given that our study has a small sample size, further large studies are required to confirm our findings.
TL;DR: In adults in China, HCT level was associated with elevated central arterial stiffness, independent of conventional cardiovascular risk factors, and combined with other traditional cardiovascular risk Factors can better assess vascular heart disease.
Abstract: We aimed to investigate the association of haematocrit (HCT) level with central and peripheral arterial stiffness in adults in China. We particularly focussed on the association between HCT and other cardiometabolic risk factors. Adults aged ≥ 20 years were included in the study. Carotid radial pulse wave velocity (crPWV), carotid femoral pulse wave velocity (cfPWV), carotid dorsalis pedis pulse wave velocity (cdPWV), and HCT were measured. Overall, 3225 individuals were included in the study. After adjustment for age, sex, and body mass index, HCT level was found to increase significantly with increases in cfPWV, crPWV, and cdPWV (p = 0.001). Following adjustment for heart rate, blood pressure, and blood lipids, the association of HCT level with crPWV and cdPWV was not significant (p = 0.090 and 0.053, respectively); however, the association between HCT level and cfPWV remained significant (p = 0.007). We found significant interactions of HCT level with hypertension and metabolic syndrome in the effect on cfPWV (p = 0.0419 and 0.026, respectively). In adults in China, HCT level was associated with elevated central arterial stiffness, independent of conventional cardiovascular risk factors. As a serological marker, HCT can predict the degree of central arterial stiffness. HCT combined with other traditional cardiovascular risk factors can better assess vascular heart disease.
TL;DR: The model adjusted for body mass index, systolic blood pressure, diastolicBlood pressure, and fasting blood glucose showed that increasing irisin levels were associated with a reduced risk of hypertension, diabetes mellitus type 2, and overweight and obesity.
Abstract: This study aimed to investigate the irisin levels in elderly patients with hypertension, diabetes mellitus type 2, and overweight and obesity, to investigate the possible association between irisin levels and anthropometric and biochemical parameters, and also to assess the irisin levels associated with a risk of hypertension, diabetes mellitus type 2, and overweight and obesity. A nested case-control study was conducted, with hypertension, diabetes mellitus type 2, and overweight and obesity being set as the case group; 71 elderly patients from the cohort were enrolled in each case group, and 71 healthy elderly from the cohort were included in the control group. The anthropometric and biochemical parameters were measured in all elderly, and irisin levels were measured using enzyme-linked immunosorbent assay. The irisin levels were significantly lower in patients with hypertension, diabetes mellitus type 2, and overweight and obesity than in controls (p < 0.001). Irisin levels were negatively correlated with body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, cholesterol, triglyceride, and alanine aminotransferase. Moreover, the model adjusted for body mass index, systolic blood pressure, diastolic blood pressure, and fasting blood glucose showed that increasing irisin levels were associated with a reduced risk of hypertension, diabetes mellitus type 2, and overweight and obesity. Receiver operating characteristic curve analysis showed that the area under the curve was 0.779 for hypertension, 0.976 for diabetes mellitus type 2, and 0.957 for overweight and obesity. Irisin may thus play a role in blood pressure and blood glucose regulation.
TL;DR: Liraglutide could reduce liver fat accumulation in patients with T2DM and NAFLD and improve obesity and adjust blood lipids, however, the improvement of islet function might not be significant after 3 months of treatment.
Abstract: The objective is to investigate the effects of liraglutide on nonalcoholic fatty liver disease in type 2 diabetes mellitus. Thirty-two patients with T2DM and NAFLD admitted to the Third Affiliated Hospital of Dalian Medical University from December 2014 to December 2016 were selected, including 11 females and 21 males, aged 39.34 ± 8.54 years old. The patients were given liraglutide on the basis of their original hypoglycemic regimen. After 3 months treatment of liraglutide, FPG was reduced from 8.54 ± 2.21 mmol/L to 6.90 ± 1.73 mmol/L. HbA1c was reduced from 9.72 ± 1.95 to 7.78 ± 1.99. WC was reduced from 103.27 ± 9.92 kg to 93.97 ± 8.35 kg. BMI was reduced from 30.56 ± 4.06 kg/m2 to 28.01 ± 3.12 kg/m2. FLI was reduced from 79.23 ± 16.56 to 58.83 ± 19.75. The differences were statistically significant (p 0.05). In addition to effectively lowering glucose and improving islet resistance, liraglutide could also improve obesity and adjust blood lipids. However, the improvement of islet function might not be significant after 3 months of treatment. Liraglutide could reduce liver fat accumulation in patients with T2DM and NAFLD.
TL;DR: Evidence for a possible role of vitamin B12 deficiency in enhancing diabetes risk comes mainly from studies on pregnant women and their offspring and from studies using nutrigenetic approaches, which reinforce the hypothesis that there is a strong association between vitamin B 12 and GDM risk.
Abstract: The role of nutritional factors in contributing to diabetes risk has been the subject of research for several years. However, the focus on micronutrients particularly vitamins has been a more recent phenomenon. While most of the research has focused on vitamin D, the interest in vitamin B12 as a modulator of diabetes risk has been growing and the link reportedly getting stronger. The question of whether vitamin B12 deficiency is associated with risk of future diabetes is an important question to ask in our country as a large section of our population is pure vegetarian and is thus prone to deficiency of this vitamin. In fact, vitamin B12 deficiency is widely prevalent in our country affecting 47% of our population [1]. A recent study from South India in urban individuals reported that the prevalence of absolute and borderline vitamin B12 deficiency was over 50% [2]. Vitamin B12 levels decreased as the level of glucose intolerance increased and the proportion of those with vitamin deficiency increased with increasing severity of glucose intolerance, more so among males and vegetarians [2]. The association of vitamin B12 deficiency with hyperhomocysteinemia [3] and other metabolic abnormalities such as insulin resistance and dyslipidemia [4] has been known for a while. Also, hyperhomocysteinemia has been well recognized as a cardiovascular (CV) risk factor [4]. A recent study from North India in rural subjects [5] found positive correlation of vitamin B12 levels and low HDL levels although the possible mediation by homocysteine could not be confirmed. Also, no significant relationship between vitamin B12 levels and any of the other lipid parameters and between hyperhomocysteinemia and any of the obesity or lipid parameters was found. Whether vitamin B12 could also mediate diabetes risk is not known and is currently being investigated. Evidence for a possible role of vitamin B12 deficiency in enhancing diabetes risk comes mainly from studies on pregnant women and their offspring and from studies using nutrigenetic approaches. Studies fromwestern India [6] suggest that low vitamin B12 levels in pregnancy are associated with obesity. These have focused our attention on the potential role of maternal undernutrition on maternal and fetal obesity and insulin resistance. The effects of low vitamin B12 levels on obesity and insulin resistance in pregnant women have been confirmed in a study from the UK [7]. Another study from the UK [8] has also shown that maternal vitamin B12 levels are associated with maternal obesity and risk of gestational diabetes mellitus (GDM). Amore recent systematic review in 2019 [3] concluded that vitamin B12 deficiency could be associated with increased risk of GDM. The study included over 1810 pregnant women without GDM and 309 with GDM and showed that GDM patients had lower vitamin B12 levels than non-GDM subjects and that vitamin B12 level predicted GDM (OR 1.81). The results of these studies reinforce the hypothesis that there is a strong association between vitamin B12 and GDM risk. However, more studies would be required to clearly establish any causative link between the two. Emerging evidence also indicates that vitamin B12 deficiency in the mother has a profound influence on fetal growth and development, and this fetal programming can result in increased obesity, adiposity, and insulin resistance later in life [6]. Studies in the Pune cohort suggest that maternal undernutrition is closely linked to fetal obesity and insulin resistance. These studies also describe the thin-fat Indian babies where the babies were thin but with higher levels of adiposity compared with babies of European origin. Over two-thirds of the mothers of these babies displayed vitamin B12 deficiency. Low B12 levels were also associated with a greater likelihood of adiposity and insulin resistance during childhood [9].Vitamin B12 is known to critically influence several cellular pathways particularly nucleic acid synthesis and gene methylation that is involved in the expression of genes. Some of these * S. V. Madhu drsvmadhu@gmail.com
TL;DR: The prevalence of osteoporosis and osteopenia in patients with T2DM is high and female gender, increasing age, normal BMI, low serum 25-hydroxyvitamin D, and pioglitazone use further increase the risk of osteiporosis.
Abstract: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of hip and vertebral fractures. The increased fracture risk has largely been attributed to poor bone quality and microarchitecture. The contribution of bone quantity, measured as areal bone mineral density (BMD), to the risk of fracture is variable with most studies showing an increase in BMD in T2DM. The present study was undertaken to find out the prevalence of osteoporosis and osteopenia (based on BMD) in a cohort of patients with T2DM and delineate the possible modifiable and non-modifiable risk factors. In this cross-sectional observational study, 252 otherwise ostensibly healthy patients with T2DM underwent dual energy X-ray absorptiometry (DEXA) scan. Osteoporosis and osteopenia were defined based on T-scores. The effect of modifiable and non-modifiable risk factors on BMD and osteoporosis were assessed. The mean age of the cohort was 59.9 years with a M:F ratio 2.9:3.4. The mean BMD at the lumbar spine and hip were 0.892 g/cm2 and 0.715 g/cm2, respectively. Males had significantly higher BMD at both the sites compared to females. The prevalence of osteoporosis and osteopenia was 33% and 40%, respectively. Female gender, increasing age, normal body mass index (BMI), low serum 25-hydroxyvitamin D, and use of pioglitazone were significantly associated with the risk of osteoporosis. The prevalence of osteoporosis and osteopenia in patients with T2DM is high. Female gender, increasing age, normal BMI, low serum 25-hydroxyvitamin D, and pioglitazone use further increase the risk of osteoporosis.
TL;DR: How common fear of hypoglycemia was in Zambian out-patients with diabetes and how positively associated with diabetes specific emotional distress and diabetes self-care was determined.
Abstract: Severe hypoglycemia is a burdensome complication of diabetes mellitus that can induce fear of hypoglycemia and contribute to suboptimal glycemic control The challenge is to achieve and maintain adequate glycemic control while avoiding episodes of severe hypoglycemia The purpose of the study was to determine how common fear of hypoglycemia was in Zambian out-patients with diabetes and also to explore correlates of fear of hypoglycemia One hundred fifty-seven individuals with types 1 and 2 diabetes participated in the study Fear of Hypoglycemia Scale, Diabetes Self-Care Inventory, Problem Areas in Diabetes, and the Major Depression Inventory were completed Multiple linear regression models were computed to assess the association between fear of hypoglycemia and psychological factors About 19% [163% type 1 and 126% type 2] of individuals with diabetes based on item endorsement expressed fear of hypoglycemia especially among individuals with type 1 diabetes After controlling for demographic variables, diabetes self-care (s = 024, p < 005), and diabetes specific distress (s = 041, p < 0001) were associated with fear of hypoglycemia Fear of hypoglycemia was common and was positively associated with diabetes specific emotional distress and diabetes self-care Interventions to avert fear of hypoglycemia are needed while optimizing glycemic control through managing diabetes care and emotion distress in individuals with diabetes
TL;DR: The study reveals the need for effective diabetes-specific health awareness campaigns to address the rise of diabetes pandemic in resource-limited country like India.
Abstract: Type 2 diabetes is a pandemic in India, yet studies regarding knowledge, attitude, and practices in diabetes in various Indian communities are limited. It is essential to understand the current gaps in knowledge and problems with attitude and perceptions of the general population regarding diabetes to effectively plan public health policies. In this study, 2163 subjects (1079 urban, 1084 rural) from West Bengal, India, with no exposure to any formal diabetes awareness including through familial experience or by virtue of their profession, participated in a structured response cross-sectional knowledge-attitude practice (KAP) survey focusing on perception about diabetes, its diagnosis, and management during FY 2013–2014. Both rural and urban communities lacked complete knowledge of diabetes. Forty-nine percent of rural responders were not aware of the term “diabetes” itself. Also, among the rural responders who were familiar with the term lacked knowledge related to blood glucose monitoring and role of insulin in diabetes management. Though 74% of urban respondents were aware of insulin’s use in diabetes management, 39% had misconception regarding its extended use. Responders from both urban and rural communities showed higher awareness towards general health practices like, benefits of exercise or demerits of junk food, in comparison with diabetes-specific questions. The study reveals the need for effective diabetes-specific health awareness campaigns to address the rise of diabetes pandemic in resource-limited country like India. There is an urgent need to address unfounded fear of adverse reaction of insulin over extended use.
TL;DR: In a small sample of asymptomatic cardiovascular type 2 DM patients, myocardial ischemia, glycemic control, and microalbuminuria have influence on survival, requiring a more intensive global therapeutic approach.
Abstract: Complications from diabetes mellitus (DM) include cardiovascular system, peripheral neuropathy (PN), and autonomic dysfunction (AD). Goal: Assess the association of silent myocardial ischemia, AD, and PN in cardiovascular asymptomatic type 2 diabetics. As part of a multicenter project, 40 patients with type 2 DM were studied, with > 5 years of known disease and a baseline electrocardiogram non suggestive of coronary artery disease. Myocardial SPECT was performed with exercise stress test measuring corrected QT interval (QTc) and heart rate recovery (HRR) post-exercise (abnormal QTc ≥ 450 ms at rest and HRR < 14 beats at the first minute in maximum exercise). After 3 years, it was possible to re-study 32 cases. PN was evaluated with Michigan Neuropathy Screening Instrument (MNSI). Logistic regression analysis was performed to determine associated factors for AD, PN, SI, and survival analysis. Thirty-four percent of the group had ischemia in SPECT; QTc was prolonged in 23.3%; 31% fulfilled criteria of PN; and 25% of AD due to HRR alteration. With bivariate and multivariate analyses, associations were observed between lipid, glycemic parameters, ischemia, PN, and AD. The follow-up (mean 119 months) consigned 4 cardiac-related deaths; ischemia, glycemic control parameters, and microalbuminuria had significant value in bivariate analysis. In our small sample of asymptomatic cardiovascular type 2 DM patients, myocardial ischemia, glycemic control, and microalbuminuria have influence on survival, requiring a more intensive global therapeutic approach.
TL;DR: It is concluded that the PON1 and SRB1 gene polymorphisms may probably surrogate biomarkers for T2DM susceptibility.
Abstract: Single-nucleotide polymorphism (SNP) in Paraoxonase 1 (PON1) and scavenger receptor class b member 1 (SRB1) gene has been associated with impairing high-density lipoprotein (HDL) functionality as an antioxidant and shown to diminish ability of PON1 in cholesterol homeostasis. Several studies found that SRB1 and PON1 polymorphism increases T2DM risk. Our study aimed to investigate the association and susceptibility of polymorphic variants in SRB1 rs9919713 and PON1 rs662 with type 2 diabetes mellitus. In the present case-control study, 250 type 2 diabetes mellitus patients (T2DM) and 250 healthy volunteer were recruited. The genotypes of PON1 and SRB1 were determined by using polymerase chain reaction-restriction fragment length polymorphism (RFLP-PCR) technique, and biochemical analysis was done using standard protocol. C and R alleles showed significant association with T2DM susceptibility with an odds ratio of 1.42 (p < 0.005) and 1.40 (p < 0.007), respectively. The frequency of CC and RR genotype was significantly higher in T2DM patients compared with healthy controls. Furthermore, CC and RR genotypes were significantly associated with higher LDL and low HDL levels. Additionally, no other significant association was observed. We conclude that the PON1 and SRB1 gene polymorphisms may probably surrogate biomarkers for T2DM susceptibility.
TL;DR: In this article, a cross-sectional retrospective data analysis of T2DM patients' records who were screened for diabetic retinopathy across Apollo Sugar Clinics from June 2016 to December 2016 was performed.
Abstract: To determine the prevalence of diabetic retinopathy (DR) in patients with T2DM having low estimated glomerular filtration rate (eGFR). A cross-sectional retrospective data analysis of T2DM patients’ records who were screened for DR across Apollo Sugar Clinics from June 2016 to December 2016. DR was diagnosed through fundus examination; patients having eGFR values were grouped into eGFR < 60 and eGFR ≥ 60 mg/ml/1.73 m2. Appropriate statistical tests were applied to identify the association of eGFR and DR, and significance was set at 2-tailed p ≤ 0.05. A total of 1547 T2DM patients were screened; mean (SD) age was 56.7 (10.0) years. Among them, data of 443 patients with eGFR were included in the analysis. Mean eGFR was 91.2 mg/ml/1.73 m2; 12.5% patients had eGFR ≤ 60 mg/ml/1.73 m2 and 87.5% had ≥ 60 mg/ml/1.73 m2. DR was observed in 79 (17.8%) patients; it was higher in males (62%) than in females (38%). Further, the proportion of patients with DR was significantly higher in patients with eGFR ≤ 60 mg/ml/1.73 m2 compared with that in patients with eGFR ≥ 60 mg/ml/1.73 m2 (38% vs. 15%; p < 0.001). Association of DR with low eGFR in patients with T2DM may suggest presence of diabetes kidney disease in a community, thus reaffirming the significance of DR screening in community diabetes practices.
TL;DR: It is equally important to detect fresh cases of diabetes early and pick up hyperglycemic spikes in those known to be diabetic without delay—something which is very difficult at a time when the medical fraternity is struggling to manage the COVID-19 pandemic.
Abstract: The outbreak of COVID-19 all over the world this year has posed several new challenges to diabetes care and has also provided an opportunity for new lessons to be learnt in what seems to be transforming the way we treat diabetic patients. Some of the issues and challenges that have emerged include the reported high incidence [1, 2] of COVID-19 infections among patients with diabetes mellitus (DM), the greater severity, and higher rates of progression resulting in a higher number of ICU admissions [3] and higher mortality reported in them [1, 2]. The increased predisposition of patients with diabetes to COVID-19 infections particularly severe infections with acute respiratory distress is believed to be related to a compromised innate immunity that accompanies uncontrolled DM and an exaggerated proinflammatory cytokine response involving IL-6 and TNF-alpha [4]. The situation would be worse if there are other comorbidities such as hypertension, chronic kidney disease, or coronary artery disease which often coexist with diabetes and are also associated with more aggressive COVID-19 infections. This calls for early and aggressive management of COVID-19 in diabetic patients to prevent adverse outcomes. It is equally important to detect fresh cases of diabetes early and pick up hyperglycemic spikes in those known to be diabetic without delay—something which is very difficult at a time when the medical fraternity is struggling to manage the COVID-19 pandemic. A high degree of alertness with frequent self-monitoring of blood glucose levels is certainly advisable in known diabetic patients particularly insulin users to reduce the risk of being affected with COVID-19 infection and avoid any undesirable consequence should they get infected. As physicians involved in diabetes care, we need to advise our patients accordingly besides telling them to follow with greater intensity all the general measures to prevent exposure to COVID-19 infection. Just as it is important that we target and make every effort to achieve good glycemic control during these COVID times, it is equally important that we identify diabetes comorbidities and complications early and effectively manage them. It is well-known that several of these including hypertension, heart disease including heart failure, and chronic kidney disease are all associated with higher mortality in COVID-19 infections. Challenges in diabetes management begin with difficulties in effective implementation of lifestyle measures particularly with respect to physical activity and exercise. These are surmountable and can be largely met by advising indoor exercise routines, yoga, and other innovative ways of enhancing physical activity. Fortunately, limited access to fast foods and other unhealthy dietary choices in restaurants should help, but one should still be advised to judiciously choose from available homemade and packaged dietary choices. Poor access to alcohol and limited opportunities for smoking during lockdown can also become a unique opportunity to seriously consider giving up these habits which can help prevent long-term complications of diabetes. Stress and the higher levels of anxiety and depression that can occur during periods of lockdown not only affect the mental health and sleep of the diabetic patient but also adversely affect glycemic control. Appropriate measures to relieve stress are also important to maintain glucose control. Another important challenge in the management of diabetes mellitus has been regarding the appropriate use of various antidiabetic agents. This has been an area of concern as well as an area of intense speculation and debate. Advisories, not always supported by well-designed studies, are often confusing the treating physician. Overall, insulin appears to be a good option for glycemic control and is safe. It is advised that anti-hyperglycemic drugs that cause volume depletion or hypoglycemia are best avoided or used in small dosages. Metformin may show a higher propensity to lactic acidosis especially in those with volume depletion. SGLT2 inhibitors are contraindicated not only because they are associated with fluid loss but these groups of agents have also been found to be associated with a higher incidence of diabetic ketoacidosis * S. V. Madhu drsvmadhu@gmail.com
TL;DR: Significant association was observed between RETn gene polymorphism at SNP rs3745367 and T2D and no significant association was found between RETN gene polymorphisms at SNPrs3745368 and T1D.
Abstract: Resistin (RETN) protein plays an important role in the regulation of energy, glucose, and lipid homeostasis and maintenance of fasting blood glucose level by modulating hepatic insulin action. Though RETN gene polymorphism at single nucleotide polymorphism (SNP) rs3745367 (+299 G>A) and SNP rs3745368 (+62G>A) has been indicated to be relevant to type 2 diabetes mellitus (T2D), results are contradictory due to incomplete and inconsistent studies. Meta-analysis was conducted to evaluate the relationship between RETN gene polymorphism at SNP rs3745367 and rs3745368 with risk of T2D. A present study included 5276 subjects for polymorphism for SNP rs3745367 and 3617 subjects for SNP rs3745368 reported in 16 different studies available at Pubmed, EMBASE, and Google Scholar from January 2001 to May 2018. Inclusion and exclusion criteria were followed as per international norms. Publication bias was assessed using a funnel plot. The Review Manager 5.3 software was used for statistical analysis. Polymorphism was evaluated using the odds ratio (OR) corresponding to 95% confidence interval (CI). Heterogeneity among the studies was calculated using Q test. I2 was calculated to assess the variation caused by heterogeneity. Association of RETN polymorphism and T2D was analyzed using three genetic models viz. allelic, recessive, and dominant. Significant association was observed between RETN gene polymorphism at SNP rs3745367 and T2D. The pooled odds ratio (OR) was 1.45 (95% CI 1.10–1.92) with a p value of 0.009 under an allelic genetic model, whereas no significant association was found between RETN gene polymorphism at SNP rs3745368 and T2D. The pooled OR was 1.10 (95% CI, 0.66–1.83) with a p value of 0.71 under an allelic genetic model.