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This study unravels the intricate interplay between photoperiod, melatonin, and kisspeptin to orchestrate the pubertal onset of Common carp. Female fingerlings exposed to long days (LD) exhibited a hormonal crescendo, with upregulated hypothalamic-pituitary-ovarian (HPO) axis genes (kiss1, kiss1r, kiss2, gnrh2, gnrh3) and their downstream targets (lhr, fshr, ar1, esr1). However, the expression of the melatonin receptor (mtnr1a) diminished in LD, suggesting a potential inhibitory role. This hormonal symphony was further amplified by increased activity of key transcriptional regulators (gata1, gata2, cdx1, sp1, n-myc, hoxc8, plc, tac3, tacr3) and decreased expression of delayed puberty genes (mkrn1, dlk1). In contrast, short days (SD) muted this hormonal chorus, with decreased gnrh gene and regulator expression, elevated mtnr1a, and suppressed gonadal development. In in-vitro, estradiol mimicked the LD effect, boosting gnrh and regulator genes while dampening mtnr1a and melatonin-responsive genes. Conversely, melatonin acted as a conductor, downregulating gnrh and regulator genes and amplifying mtnr1a. Our findings illuminate the crucial roles of melatonin and kisspeptin as opposing forces in regulating pubertal timing. LD-induced melatonin suppression allows the kisspeptin symphony to flourish, triggering GnRH release and, ultimately, gonadal maturation. This delicate dance between photoperiod, melatonin, and kisspeptin orchestrates common carp's transition from juvenile to reproductive life.
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Carpas , Kisspeptinas , Melatonina , Fotoperíodo , Maturidade Sexual , Animais , Melatonina/metabolismo , Kisspeptinas/metabolismo , Kisspeptinas/genética , Feminino , Carpas/metabolismo , Carpas/genética , Carpas/crescimento & desenvolvimento , Carpas/fisiologia , Maturidade Sexual/fisiologia , Proteínas de Peixes/metabolismo , Proteínas de Peixes/genéticaRESUMO
INTRODUCTION: Several risk factors found to be associated with postoperative complications and cancer surgery, which carry a significant morbidity risk to cancer patients. Therefore, prehabilitation is necessary to improve the functional capability and nutritional status of a patient prior to surgery, so that the patient can withstand any postoperative activity and associated deterioration. Thus, this study aims to assess the effectiveness of prehabilitation interventions on the functional status of patients with gastric and oesophageal cancer who underwent esophagectomy and gastrectomy. MATERIAL AND METHODS: An interventional study was carried out among oesophageal and gastric cancer patients who had undergone surgery at the National Cancer Institute of Malaysia. The prehabilitation process took a maximum of two weeks, depending on the patient's optimisation before surgery. The prehabilitation is based on functional capacity (ECOG performance status), muscle function (handgrip strength), cardio-respiratory function (peak flow meter) and nutritional status (calorie and protein). Postoperative outcomes are measured based on the length of hospital stay, complications, and Clavien-Dindo Classification. RESULTS: Thirty-one patients were recruited to undergo a prehabilitation intervention prior to gastrectomy (n=21) and esophagectomy (n=10). Demographically, most of the cancer patients were males (67.7%) with an ideal mean of BMI (23.5±6.0). Physically, the majority of them had physical class (ASA grade) Grade 2 (67.7%), ECOG performance status of 1 (61.3%) and SGA grade B (51.6%). The functional capacity and nutritional status showed a significant improvement after one week of prehabilitation interventions: peak expiratory flow meter (p<0.001), handgrip (p<0.001), ECOG performance (p<0.001), walking distance (p<0.001), incentive spirometry (p<0.001), total body calorie (p<0.001) and total body protein (p=0.004). However, those patients who required two weeks of prehabilitation for optimization showed only significant improvement in peak expiratory flow meter (p<0.001), handgrip (p<0.001), and incentive spirometry (p<0.001). Prehabilitation is significantly associated postoperatively with the length of hospital stay (p=0.028), complications (p=0.011) and Clavien-Dindo Classification (p=0.029). CONCLUSION: Prehabilitation interventions significantly increase the functional capacity and nutritional status of cancer patients preoperatively; concurrently reducing hospital stays and complications postoperatively. However, certain cancer patients might require over two weeks of prehabilitation to improve the patient's functional capacity and reduce complications postoperatively.
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Asma , Cuidados Pré-Operatórios , Masculino , Humanos , Idoso , Feminino , Apendicectomia , Força da Mão , Malásia , Complicações Pós-Operatórias/prevenção & controleRESUMO
Four adult horses with histories of moderate abdominal pain and inappetence were diagnosed with delayed gastric emptying and gastric impaction attributed to pyloroduodenal obstruction (three cases) or duodenitis (one case). A stapled side-to-side gastrojejunostomy was performed on all horses. Two horses returned to work and survived ≥3 years. One horse was euthanased 6 months post-surgery due to recurrent abdominal pain, and one was found dead 5 months postsurgery after an unattended foaling.
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Derivação Gástrica , Doenças dos Cavalos , Cavalos , Animais , Derivação Gástrica/veterinária , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Dor Abdominal/veterinária , Doenças dos Cavalos/cirurgiaRESUMO
We study the microbiome of sea water collected from two locations of the Barbadian coral reefs. The two sites differ in several environmental and ecological variables including their endogenous benthic community and their proximity to urban development and runoffs from inland watersheds. The composition of the microbial communities was estimated using whole genome DNA shotgun sequencing with adjuvant measurements of chemical and environmental qualities. Although both sites exhibit a similar degree of richness, the less urbanized site (Maycocks reef at Hangman's Bay) has a strong concentration of phototrophs whereas the more urbanized location (Bellairs reef at Folkstone) is enriched for copiotrophs, macroalgal symbionts and marine-related disease-bearing organisms from taxa scattered across the tree of life. Our results are concordant with previous profiles of warm ocean surface waters, suggesting our approach captures the state of each coral reef site, setting the stage for longitudinal studies of marine microbiome dynamics in Barbados. Supplementary Information: The online version contains supplementary material available at 10.1007/s00338-022-02330-y.
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Type 2 diabetes (T2D) is associated with obesity and declining ß-cells. L-glutamine has been implicated in the amelioration of T2D by virtue of its incretin secretagogue property while, there are mixed reports on pitavastatin's adiponectin potentiating ability. We aimed to investigate the effect of pitavastatin (P), L-glutamine (LG), and combination (P + LG) on glycemic control and ß-cell regeneration in a high-fat diet (HFD) + streptozotocin (STZ)-induced T2D mouse model. C57BL6/J mice treated with HFD + STZ were divided into four groups: diabetes control (HFD + STZ), P, LG, and P + LG, while the control group (NCD) was fed with the normal-chow diet. Significant amelioration was observed in the combination therapy as compared to monotherapies in respect of (i) insulin resistance, glucose intolerance, lipid profile, adiponectin levels, and mitochondrial complexes I, II, and III activities, (ii) reduced phosphoenolpyruvate carboxykinase, glucose 6-phophatase, glycogen phosphorylase, and GLUT2 transcript levels with increased glycogen content in the liver, (iii) restoration of insulin receptor 1ß, pAkt/Akt, and AdipoR1 protein levels in skeletal muscle, and (iv) significant increase in islet number due to ß-cell regeneration and reduced ß-cell death. L-glutamine and pitavastatin in combination can ameliorate T2D by inducing ß-cell regeneration and regulating glucose homeostasis.
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AIMS: Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness. METHODS: Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy. RESULTS: Spearman correlation analysis revealed that increased pressure time integral at the 1st metatarsal-head region (r = -0.354, n = 39, P = 0.027) or at the heel (r = -0.378, n = 39, P = 0.018) was associated with reduced hardness in the same regions. After accounting for confounding parameters, generalised estimating equations analysis also showed that 10% increase in pressure time integral at the heel was associated with ≈ 1 unit reduction in hardness in the same region. CONCLUSIONS: For the first time, this study reveals that people with diabetes and neuropathy who tend to load their feet more heavily also tend to have plantar soft tissues with lower hardness. The observed difference in tissue hardness is likely to affect the tissue's vulnerability to overload injury. More research will be needed to explore the implications of the observed association for the risk of ulceration.
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Diabetes Mellitus , Pé Diabético , Doenças do Sistema Nervoso Periférico , Pé , Dureza , Calcanhar , HumanosRESUMO
Dysfunctional adipocytes/ß-cells advance type 2 diabetes (T2D). Calorie restriction (CR) improves insulin sensitivity and fasting blood glucose (FBG) levels, while γ-aminobutyric acid (GABA) exerts regenerative effects. The impact of therapies was assessed by a high-fat diet (HFD) + streptozotocin (STZ) induced T2D mouse model. The mice were fed a CR diet (30% reduction of HFD) and treated with GABA (2.5 mg/kg i.p) for 5 weeks. Standard protocols were used to assess metabolic parameters. The mRNA expression was monitored by SYBR Green-qPCR in the targeted tissues. Oxygen consumption rate in the mitochondrial complexes was evaluated by oxytherm clark-type oxygen electrode. Pancreatic ß-cell regeneration and apoptosis were analysed by immunohistochemistry. CR + GABA combination therapy showed improved metabolic parameters compared to the monotherapies. We have observed improved transcript levels of G6Pase, PEPCK, Glycogen Phosphorylase, GLUT2 and GCK in liver; ACC and ATGL in adipose tissue. Also increased SIRT-1, PGC-1α and TFAM expression; up-regulated mitochondrial complexes I-III activities were observed. We have seen increased BrdU/Insulin and PDX1/Ngn3/Insulin co-positive cells in CR + GABA treated group with a reduction in apoptotic marker (TUNEL/Insulin co-positive cells). Our results indicate that CR in combination with GABA ameliorates T2D in HFD + STZ treated mice by GABA induced ß-cell regeneration, and CR mediated insulin sensitivity.
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Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/metabolismo , Ácido gama-Aminobutírico/farmacologia , Animais , Glicemia/metabolismo , Restrição Calórica , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Dieta Hiperlipídica , Modelos Animais de Doenças , Insulina/metabolismo , Resistência à Insulina/fisiologia , Células Secretoras de Insulina/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Estreptozocina/farmacologia , Ácido gama-Aminobutírico/metabolismoRESUMO
At the pandemic of COVID-19, the movement of business and other non-essential activities were majorly restricted at the end of March 2020 in India and continued in different lockdown phases until June 2020. By categorically, studying sensitivity towards anthropogenic factors with other environmental implications in urban Indian cities during phase-wise lockdown scenarios will pave the way for a refined Clean Air Programme (CAP). In this study, the aerosol particulate matter variations between the lockdown phases in both spatial and temporal scales have been explored along with cities exceeding national ambient air quality (NAAQ) standards covering different geographical regions of India for their air quality level. The results of the spatial pattern of Copernicus Atmosphere Monitoring System (CAMS) near-real-time data showed a negative change both in Aerosol Optical Depth (AOD) (-0.2 to 0.1) and black carbon AOD (bcAOD) (-0.9 to -0.75). The changes were evident in successive phases of lockdown with an overall AOD reduction of about 70-90%. Southern urban cities showed a significant impact of mobile sources from temporal analysis than other cities. Principal Component Analysis (PCA) for effects of pollutants by anthropogenic factors (mobile and point source) and meteorological factors (wind speed, wind direction, solar radiation, relative humidity) revealed the two significant driving factors. PM reduction was about 50-70%, predominantly due to anthropogenic factors. The factor analysis revealed the influence of meteorological factors between the major urban cities (Delhi, Kolkata, Mumbai, Chennai, Bengaluru, and Hyderabad). Cities that exceed NAAQ standard performed well during phase-wise lockdowns, exceptional to cities in Gangetic plain. This study helps to frame region-specific strategic action plans for the CAP.
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Diabetes mellitus (DM) and diabetes-related complications are amongst the leading causes of mortality worldwide. The international diabetes federation (IDF) has estimated 592 million people to suffer from DM by 2035. Hence, finding a novel biomolecule that can effectively aid diabetes management is vital, as other existing drugs have numerous side effects. Melatonin, a pineal hormone having antioxidative and anti-inflammatory properties, has been implicated in circadian dysrhythmia-linked DM. Reduced levels of melatonin and a functional link between melatonin and insulin are implicated in the pathogenesis of type 2 diabetes (T2D). Additionally, genomic studies revealed that rare variants in melatonin receptor 1b (MTNR1B) are also associated with impaired glucose tolerance and increased risk of T2D. Moreover, exogenous melatonin treatment in cell lines, rodent models, and diabetic patients has shown a potent effect in alleviating diabetes and other related complications. This highlights the role of melatonin in glucose homeostasis. However, there are also contradictory reports on the effects of melatonin supplementation. Thus, it is essential to explore if melatonin can be taken from bench to bedside for diabetes management. This review summarizes the therapeutic potential of melatonin in various diabetic models and whether it can be considered a safe drug for managing diabetic complications and diabetic manifestations like oxidative stress, inflammation, ER stress, mitochondrial dysfunction, metabolic dysregulation, etc.
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Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Melatonina , Humanos , Melatonina/uso terapêutico , Melatonina/metabolismo , Melatonina/farmacologia , Diabetes Mellitus Tipo 2/metabolismo , Insulina/metabolismo , Complicações do Diabetes/metabolismo , Estresse OxidativoRESUMO
Green vegetables, fruits, cereals, and pulses are all rich sources of antioxidants. Retinoic acid, ascorbate, proanthocyanidins, tannins, saponins, melatonin, curcumin, allicin, and alpha-lipoic acid stand documented in plants as bioactive compounds. The international dietary committee advocates a specific quantum of these natural antioxidants through diet. Interestingly, environmental pollution has indeed affected most of these farm products. The use of chemical fertilizers, pesticides and heavy metals in soil has a cumulative effect on human health. Enough evidence is available for the presence of phytoestrogen, xenoestrogen, and a host of other endocrine disruptors in the food. These plant-based nutrients can mimic or enhance the natural hormone's health effects. While endocrine disruptors are found in many everyday products, this review aims to address endocrine disruptors from food in the Asian subcontinent. 'Food for thought' justifies the paradigm shift towards good endocrine health by swaying away from the conventional daily dietary recommendations.
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Anticorpos Antivirais/sangue , COVID-19/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , SARS-CoV-2/imunologia , Adulto , Idoso , COVID-19/transmissão , Teste Sorológico para COVID-19/métodos , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Índia , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
We demonstrate suppression of dephasing tied to deformation potential coupling of confined electrons to longitudinal acoustic (LA) phonons in optical control experiments on large semiconductor quantum dots (QDs) with emission compatible with the low-dispersion telecommunications band at 1.3 µm. By exploiting the sensitivity of the electron-phonon spectral density to the size and shape of the QD, we demonstrate a fourfold reduction in the threshold pulse area required to enter the decoupled regime for exciton inversion using adiabatic rapid passage (ARP). Our calculations of the quantum state dynamics indicate that the symmetry of the QD wave function provides an additional means to engineer the electron-phonon interaction. Our findings will support the development of solid-state quantum emitters in future distributed quantum networks using semiconductor QDs.
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AIMS: Diabetes mellitus (DM) is a disorder of heterogeneous etiology marked by persistent hyperglycemia. Exogenous insulin is the only treatment for type 1 diabetes (T1D). Islet transplantation is a potential long cure for T1D but is disapproved due to the possibility of immune rejection in the later stage. The approaches used for treating type 2 diabetes (T2D) include diet restrictions, weight management and pharmacological interventions. These procedures have not been able to boost the quality of life for diabetic patients owing to the complexity of the disorder. DATA SYNTHESIS: Hence, research has embarked on permanent ways of managing, or even curing the disease. One of the possible approaches to restore the pancreas with new glucose-responsive ß-cells is by their regeneration. Regeneration of ß-cells include islet neogenesis, dedifferentiation, and trans-differentiation of the already differentiated cells. CONCLUSIONS: This review briefly describes the islet development, functions of ß-cells, mechanism and factors involved in ß-cell death. It further elaborates on the potential of the existing and possible therapeutic modalities involved in the in-vivo replenishment of ß-cells with a focus on exercise, diet, hormones, small molecules, and phytochemicals.
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Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Hipoglicemiantes/uso terapêutico , Células Secretoras de Insulina/efeitos dos fármacos , Regeneração/efeitos dos fármacos , Comportamento de Redução do Risco , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Dieta Saudável , Exercício Físico , Humanos , Insulina/sangue , Células Secretoras de Insulina/metabolismo , Células Secretoras de Insulina/patologia , Recuperação de Função FisiológicaRESUMO
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Adiponectin is a prime determinant of the status of insulin resistance. Association studies between adiponectin (ADIPOQ) gene single nucleotide polymorphisms (SNPs) and metabolic diseases have been reported earlier. However, results are ambiguous due to apparent contradictions. Hence, we investigated (1) the association between ADIPOQ SNPs: -11377C/G, +10211T/G, +45T/G and +276G/T for the risk towards type 2 diabetes (T2D) and, (2) genotype-phenotype association of these SNPs with various biochemical parameters in two cohorts. Genomic DNA of diabetic patients and controls from Gujarat and, Jammu and Kashmir (J&K) were genotyped using PCR-RFLP, TaqMan assay and MassArray. Transcript levels of ADIPOQ were assessed in visceral adipose tissue samples, and plasma adiponectin levels were estimated by qPCR and ELISA respectively. Results suggest: (i) reduced HMW adiponectin/total adiponectin ratio in Gujarat patients and its association with +10211T/G and +276G/T, and reduced ADIPOQ transcript levels in T2D, (ii) association of the above SNPs with increased FBG, BMI, TG, TC in Gujarat patients and (iii) increased GGTG haplotype in obese patients of Gujarat population and, (iv) association of -11377C/G with T2D in J&K population. Reduced HMW adiponectin, in the backdrop of obesity and ADIPOQ genetic variants might alter metabolic profile posing risk towards T2D.
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Adiponectina/genética , Diabetes Mellitus Tipo 2/genética , Estudos de Associação Genética , Loci Gênicos , Predisposição Genética para Doença , Haplótipos/genética , Obesidade/genética , Adiponectina/sangue , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/sangue , Feminino , Frequência do Gene/genética , Humanos , Índia , Desequilíbrio de Ligação/genética , Masculino , Pessoa de Meia-Idade , Peso Molecular , Obesidade/sangue , Polimorfismo de Nucleotídeo Único/genética , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
This work focuses on the environment protected, ecological procedure by the combination of ZnO nanoparticles utilizing the extraction of Ocimum sanctum. The prepared nanoparticles are examined by different methods like Fourier-transform infrared spectroscopy (FTIR), X-ray Diffraction (XRD), Field emission scanning electron microscopy (FE-SEM), Energy Dispersive X-ray Analysis (EDAX). A systematic study has been made on the result of ZnO nano-coating for the corrosion behavior of mild steel. The ZnO nanoparticles of average diameter in the range 18-22 nm were coated on mild steel in nickel bath solution. The anticorrosion properties on the coated mild steel was carefully tested in 3.5% NaCl solution by performing potentio-dynamic polarization measurement and electrochemical impedance spectroscopy. Surface morphology of the coated mild steel immersed in corrosive solution was judged by using SEM with EDAX. The ZnO nano coating has shown a perfect protection against corrosion and the shielding capability is in the range between 86-95%. The incorporation of ZnO nanoparticles has upgraded the process of mild steel in all corrosion media are subjected to investigation.
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Vaspin, an insulin-sensitizing adipokine, has been associated with type 2 diabetes (T2D). The present study aimed to investigate the distribution of genotypes and high-risk alleles of vaspin genetic variants (rs77060950 G/T and rs2236242 A/T), in Gujarat subpopulation (India). Genomic DNA isolated from PBMCs was used to genotype vaspin polymorphisms by PCR-RFLP and ARMS-PCR from 502 controls and 478 patients. RNA isolated from visceral adipose tissue (VAT) of 22 controls and 20 patients was used to assess vaspin transcript levels by qPCR while the vaspin titre of the subjects was assayed using ELISA. Phenotypic characteristics of Fasting Blood Glucose (FBG), BMI and plasma lipid profile were estimated and analyzed for the genotype-phenotype correlation. We identified a significant association of rs2236242 A/T with T2D as the TT genotype conferred a 3.087-fold increased risk. The TT genotype showed association with increased FBG, BMI and Triglycerides levels. Increased GA, GT and TA haplotype frequencies, decreased VAT transcript and vaspin protein levels in T2D patients was observed, which were further negatively correlated with FBG and BMI. In conclusion, rs2274907 A/T polymorphism is strongly associated with reduced vaspin transcript and protein levels, and related metabolic alterations that may play a role in the advancement of T2D.
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Diabetes Mellitus Tipo 2/fisiopatologia , Íntrons , Polimorfismo de Nucleotídeo Único , Serpinas/genética , Diabetes Mellitus Tipo 2/genética , Genótipo , Humanos , RNA Mensageiro/genética , Serpinas/sangue , Serpinas/metabolismoRESUMO
OBJECTIVE: Omentin-1, an anti-inflammatory protein, is secreted by the visceral adipose tissue. Altered levels of Omentin-1 are associated with obesity and Type 2 Diabetes (T2D). Although Omentin-1 is implicated in the insulin signaling pathway, the relationship between the genetic variants of Omentin-1 and T2D is not yet explored. The current study evaluates the association of Omentin-1 polymorphisms (rs2274907 A/T and rs1333062 G/T), its transcript and protein levels, and genotype-phenotype correlation with metabolic parameters and T2D susceptibility. METHODS: Plasma and Peripheral Blood Mononuclear Cells (PBMCs) were separated from venous blood taken from 250 controls and 250 T2D patients recruited from Gujarat, India. Genomic DNA was isolated from PBMCs and genotyping of Omentin-1 variants was performed by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RNA was isolated from Visceral Adipose Tissue (VAT) samples of 12 controls and 10 patients, and transcript levels of Omentin-1 were assessed by qPCR. Plasma Omentin-1 levels were estimated by ELISA. Fasting Blood Glucose, Body Mass Index (BMI) and plasma lipid profile were considered for the genotype-phenotype correlation analysis. RESULTS: Our study revealed no association of Omentin-1 genetic variants with T2D risk (pâ¯>â¯0.05). However, the AT genotype of Omentin-1 rs2274907 A/T polymorphism was associated with increased BMI (pâ¯=â¯0.0247). Plasma Omentin-1 levels were significantly decreased (pâ¯<â¯0.0001) however, increased VAT Omentin-1 transcript levels (pâ¯=â¯0.0127) were observed in T2D patients. CONCLUSION: Our findings suggest that decreased circulatory Omentin-1 levels could pose a risk towards T2D susceptibility.
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Citocinas/sangue , Citocinas/genética , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/genética , Lectinas/sangue , Lectinas/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Glicemia/genética , Índice de Massa Corporal , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/patologia , Feminino , Proteínas Ligadas por GPI/sangue , Proteínas Ligadas por GPI/genética , Frequência do Gene/genética , Estudos de Associação Genética/métodos , Genótipo , Humanos , Índia , Insulina/genética , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/genética , Obesidade/patologia , Polimorfismo de Fragmento de Restrição/genéticaRESUMO
AIM: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. METHODS: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. RESULTS: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: -0.5 to -0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. CONCLUSIONS: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.