Association between Long Term Exposure to Air Pollution, Impaired Fasting Glucose, Impaired Glucose Tolerance and Prevalence of Diabetes.

Air pollution exposure have been shown to adversely impact health through a number of biological pathways, and is also associated with glucose metabolism. There are few studies that evaluated the associations between air pollution and fasting blood sugar and HbA1C levels. But no such study occurred in Indian population. Hence to address this knowledge gap, we investigated the associations between air borne fine particulate matter (PM10, PM2.5), nitrogen di-oxide and glucose metabolism in a tertiary care center in north western rajasthan. MATERIAL: We performed cross-sectional analysis in 3457 participants between 30 to 70 years of age group from five different urban and rural areas of Bikaner district. Air pollution concentration of multiple air pollutants (PM10, PM2.5andNitogen dioxide) were estimated by ambient air quality standard method by respiratory dust sampler. Diabetes was defined based on self reported diagnosis, medication prescription, oral glucose tolerance test and HbA1C. We adjusted for potential confounders including socio-economic status, smoking habits, alcohol consumtion, physical activity and Body Mass Index (BMI) by using logistic regression method. OBSERVATION: After adjustment for potential confounders, air pollutants PM10, NO2, except PM2.5 were associated with diabetes prevalence. The prevalence of diabetes was 8.93% and the mean HbA1C was 8.67±1.16, where as the concentration of PM10 was 156.12 mcg/m3, NO2 was 5.43 mcg/m3 and PM2.5 was 25.36 mcg/m3. The prevalence of IFG, IGT and diabetes increases with increased concentration of air pollutants. By applying Pearson's co-relation for air pollutants the 'r' value of PM10was 0.163, p value < 0.001, for PM2.5 'r' value was 0.001 and p value 0.965, for NO2 'r' value was 0.149 and p value was 0.001 respectively. By applying step wise logistic regression analysis, air pollutants PM10 (Odd Ratio 0.002, 95% CI 0.002;0.003) and by adding duration of exposure to air pollutants (Odd ratio 0.003,95%CI 0.001,0.005) by adding PM2.5 air pollutant (odd ratio 0.028,95%CI -0.042,-0.015) and by adding NO2 (odd ratio 0.140,95% CI 0.104,0.175). CONCLUSION: long term air pollution exposure was associated with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and prevalence of diabetes mellitus (DM). This study can be used as a good evidence that air pollution is an important and manageable risk factor for diabetes hence awareness about air pollution in the society and at government level is much needed.

Efficacy and safety of evogliptin versus sitagliptin as an add-on therapy in Indian patients with type 2 diabetes mellitus inadequately controlled with metformin: A 24-week randomized, double-blind, non-inferiority, EVOLUTION INDIA study.

AIM: This study aimed to assess efficacy and safety of evogliptin versus sitagliptin, when added to background metformin therapy in Indian patients with uncontrolled type 2 diabetes. METHOD: Overall, 184 patients with uncontrolled type 2 diabetes (7% ≤ HbA1c < 10%) receiving ≥8 weeks of stable metformin monotherapy (≥1 g/day), were randomized to receive add-on treatment (evogliptin 5 mg or sitagliptin 100 mg) for 24 weeks. Primary endpoint was change in HbA1c from baseline to 12 weeks (non-inferiority margin: <0.35). RESULTS: Mean reductions in HbA1c at 12 weeks in evogliptin- and sitagliptin-treated patients were -0.37 (1.06) and -0.32 (1.14), respectively. The adjusted mean difference between treatment groups was -0.022 (95% CI: -0.374, 0.330; P = 0.901), that demonstrated non-inferiority. Reductions in FPG and PPG were similar between evogliptin and sitagliptin at 12 and 24 weeks. Changes in body weight were comparable between the treatment groups. Patients achieving target HbA1c < 7.0% (evogliptin, 26.7% vs. sitagliptin, 20%) was almost equal in both groups. Treatment-emergent adverse events occured in 52 patients (evogliptin, 25% and sitagliptin, 31.5%) and were generally mild. CONCLUSIONS: Evogliptin was non-inferior to sitagliptin in HbA1c reduction. It effectively improved glycemic control and was well tolerated in type 2 diabetes patients inadequately controlled by metformin alone.

Clinical and Etiological Profile of Fever with Thrombocytopenia - A Tertiary Care Hospital Based Study.

Objectives: Febrile thrombocytopenia is a condition commonly caused by infections. The present study is intended to know the underlying etiology of fever with thrombocytopenia, the various presentations and complications in our community. Material and Methods: A cross-sectional epidemiological study was conducted including 1217 patients aged more than 14 years with fever and thrombocytopenia admitted in the medical wards from October 2013 to September 2014. Detailed clinical examination and routine investigations were done; specific investigations like blood culture, widal test, antigen test for malaria, IgM ELISA leptospira, IgM ELISA dengue, bone marrow aspiration/biopsy etc. were done as and when indicated. The data are presented as percentage and numbers. Rates and ratios are computed. Results: Infection was the commonest cause of thrombocytopenia and dengue was the commonest of the infections followed by malaria. Bleeding manifestations were seen in 42.7% of patients. 91.40% of patients with bleeding tendencies had petechiae/purpura as the commonest bleeding manifestation, followed by spontaneous bleeding in 57%. Spontaneous bleeding was noted when platelet counts were less than 20,000. Petechiae/Purpura were seen more commonly when platelet count was in the range of less than or equal to 50,000. Good recovery was noted in 95%, while 5% had mortality. Septicemia accounted for 85.24% of deaths followed by malaria (6.55%) and dengue (5%). Conclusion: Fever with thrombocytopenia is an important clinical condition commonly caused by infections, particularly dengue and malaria. In majority of patients thrombocytopenia was transient and asymptomatic, but in significant number of cases there were bleeding manifestations. On treating the specific cause drastic improvement in platelet count was noted. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia but with concomitant involvement of other organs leading to multiorgan dysfunction.

The Influence of Metformin on Serum Carbohydrate Antigen 19-9 (CA 19-9) Levels in Type 2 Diabetes Mellitus Patients.

Objective: Diabetes mellitus has been claimed to be a risk factor for the development of pancreatic carcinoma. CA 19-9 has a great sensitivity in detection of pancreatic adenocarcinoma. Metformin exhibits a strong and consistent antiproliferative action on several cancer cell lines including pancreatic cancer. We aim to determine the influence of metformin on CA 19-9 levels in type 2 diabetes mellitus patients. Methods: Total 193 patients with type 2 diabetes mellitus were registered for a single centre, cross-sectional study. On the basis of treatment modalities, patients were divided into metformin group (93 patients) and non-metformin group (100 patients). Detailed history, clinical examination, anthropometric measurements, serum CA 19-9 level, glucose and lipid metabolic profiles were determined. Results were presented as mean±SD. Association between CA 19-9 level and other variables were assessed with Pearson correlation and multiple stepwise regression analysis. Results: Mean CA 19-9 level was 18.99±4.30 U/ml in the metformin group as compared to 30.49±5.61 U/ml in non-metformin group (p<0.001). Mean value of CA 19-9 was found highest among all i.e. 37.05±4.94 U/ml in patients taking insulin. Patients having lifestyle modification for the management of diabetes had their mean CA 19-9 level of 21.39±5.62 U/ml. CA 19-9 level is positively correlated with age, duration of diabetes, BMI, 2-hour Plasma Glucose level, HbA1C, VLDL cholesterol, triglyceride, total cholesterol, LDL cholesterol (p<0.005) and negatively correlated with HDL cholesterol (p<0.001). Conclusion: Metformin is associated with lower level of CA 19-9 in type 2 diabetes mellitus patients. It may have a protective role in preventing pancreatic damage and pancreatic cancer in diabetic individuals. CA 19-9 level could be an effective indicator of glycemic control, disease progression and lipid metabolism in patients with type 2 diabetes mellitus.

SNP in KCNQ1 Gene is Associated with Susceptibility to Diabetic Nephropathy in Subjects with Type 2 Diabetes in India.

OBJECTIVE: Diabetic nephropathy (DN) remains the most common cause of end stage renal disease (ESRD) as the burden of diabetes increases worldwide. Only 25 to 40% of patients with type 2 diabetes mellitus (T2DM) develop diabetic nephropathy irrespective of glycemic control so there should be a specific genetic basis for the development of diabetic nephropathy. METHODS: We have collected venous blood samples from 50 cases (Diabetic nephropathy) and 20 controls (T2DM without nephropathy) diagnosed by spot urine albumin creatinine ratio (ACR). DNA was isolated from processed samples. PCR study and sequencing was done to detect polymorphism of rs2237897 in KCNQ1 gene. RESULTS: Statistically significant difference was found when the allelic frequencies between the two groups were compared (p=0.03), with the C allele having a 2.4 fold higher risk of having diabetic nephropathy (risk ratio, RR )= 1.16, 95%CI of RR = 1.01 to 1.3, Odds Ratio (OR) =2.4; 95% CI of OR =1.06 to 4.6). Chi-square analysis showed a significant difference in genotype frequency of rs2237897 (χ2 = 4.63, p=0.03) in Diabetic nephropathy subjects, compared with that of controls. CONCLUSIONS: This study suggested that, KCNQ1 being an established type 2 diabetes gene, genetic variation in this gene may contribute to susceptibility to diabetic nephropathy and the C allele is the risk allele for diabetic nephropathy, which is different from Japanese population where the T allele was the risk allele.

Association of Serum Prolactin Level with Impaired Glucose Regulation and Diabetes.

BACKGROUND: Increase in prolactin during pregnancy has been identified as a major stimulus for ß cells. These effects have been demonstrated in both in-vitro and in-vivo non-pregnant animal models. Recently, bromocriptine has also been approved for the therapy of type 2 diabetes, regardless of the baseline prolactin level, with its mechanism of action poorly understood. Hence, this study was planned to assess whether prolactin levels within normal range associates with prediabetes and diabetes. METHODS: A total of 300 participants, 180 males and 120 females, with equal number of subjects in the prediabetes, diabetes and normal group were analyzed. The participants were categorized into sex-specific quartiles of serum prolactin, with the first quartile representing subjects with the lowest prolactin levels and the fourth quartile having the highest levels. In addition, multinomial logit analyses were performed to evaluate the odds ratio and 95% confidence interval of having prediabetes & diabetes for each quartile. RESULTS: Prolactin levels in the normal group were 10.99 ± 3.65 ng/ml for the males and 12.25 ± 3.67 ng/ml for the post-menopausal females. The prolactin levels for the males in prediabetes group were 9.46 ± 3.43 ng/ml and for diabetes group were 8.98 ± 3.43 ng/ml (p value = 0.005). In females, the prolactin levels were 10.20 ± 3.99 ng/ml for the prediabetes group and 9.60 ± 3.85 ng/ml for the diabetes group (p value = 0.007). The mean fasting plasma glucose for the four male quartiles in their numerical order were 135 mg/dl, 128 mg/dl, 120 mg/dl and 110 mg/dl (p value = 0.04) and the mean HbA1c in the same order for the quartiles were 7%, 6.4%, 6.1% and 5.9% (p value = 0.01). Similarly, the mean fasting plasma glucose for the four female quartiles in their numerical order were 138 mg/dl, 131 mg/dl, 124 mg/dl and 107 mg/dl (p value = 0.03) and the mean HbA1c in the same order for the quartiles were 7.2%, 6.7%, 6.3% and 5.8% (p value = 0.01). The age adjusted odds ratio for 2nd, 3rd and 4th quartiles as compared to the 1st quartile for prediabetes in men were 0.82, 0.72 and 0.61 and for diabetes were 0.84, 0.65 and 0.55, respectively. Risk for diabetes in females ranged from 0.04 to 0.72 for the 3rd quartile and 0.03 to 0.56 for the 4th quartile as compared to 1st quartile. The risk for prediabetes in females ranged from 0.06 to 0.95 for 3rd quartile and 0.04 to 0.74 for the 4th quartile as compared to 1st quartile. CONCLUSIONS: Mean prolactin levels in both males and females were lower in prediabetics and lowest in diabetics. Prolactin, on quartile based analysis, associated with better HbA1c and fasting plasma glucose. Decreasing relative risk trends for both prediabetes and diabetes were found with increasing serum prolactin concentrations. No association was found with obesity and dyslipidemia.

Stronger relationship of serum apolipoprotein A-1 and B with diabetic retinopathy than traditional lipids.

AIM: Diabetic retinopathy (DR) is the most common preventable cause of blindness where early detection and treatment can be sight-saving. Search for biomarkers of the disease has been relentless. We aimed to determine whether lipoproteins apolipoproteins A1 and B1 (Apo-A1 and Apo-B1) have stronger associations with DR in contrast to conventionally measured low-density lipoprotein (LDL) and high-density lipoprotein cholesterol levels. MATERIALS AND METHODS: We performed a cross-sectional study and studied 117 patients. Serum lipid profile was assessed by autoanalyzer. Serum Apo-A1 and Apo-B were measured using immunoturbidimetric kit on an autoanalyzer. Apo-B/A1 ratio was calculated. Retinopathy was graded from the digital retinal photographs, taken with nonmydriatic auto fundus camera and classified according to International Clinical DR Disease Severity Scale. RESULTS: Mean Apo-A1 for mild, moderate, severe retinopathy, and proliferative DR (PDR) shows a significant negative correlation (P = 0.001) with severity of retinopathy. Mean Apo-B for mild, moderate, severe, PDR displayed a significant positive correlation with severity of retinopathy (P = 0.001). Mean Apo-B/A1 for mild, moderate, severe, PDR showed highly significant positive correlation with severity of retinopathy (P < 0.001). In contrast, mean LDL for mild, moderate, severe, PDR showed insignificant association with severity of DR (P = 0.081). CONCLUSION: Apo-A1 and Apo-B have a stronger association with the development of DR than traditional lipids and can thus facilitate early detection and treatment of the disease.

Vitamin D: A Critical Micronutrient for Vascular Health in Type 2 Diabetes Mellitus.

OBJECTIVE: Vitamin D deficiency may be responsible for endothelial dysfunction which in turn affects the onset and progression of vascular disease including coronary artery disease and its risk factor, directly or indirectly through various mechanisms. This study was undertaken to find out association between vitamin D and endothelial dilatation of brachial artery, which may help to suggest possible underlying mechanisms and may be of clinical importance in planning preventive and therapeutic strategies. MATERIAL AND METHODS: 50 cases of type 2 diabetes mellitus aged 40-60 years were taken. 50 cases without type 2 diabetes mellitus matched for confounding factors were taken as controls. Venous blood samples were collected for the investigations including vitamin D levels. Then Participants were subjected to ultrasound examination for measurement of flow mediated dilatation (FMD) and endothelial independent dilatation after ingestion of glyceryl tri-nitrate (GTN). Unpaired student T test and correlation coefficient analysis were used to find out association between different variables. RESULTS: The mean values of FMD were 18.85 ± 5.39% and 10.29 ± 4.91% in controls and cases respectively (p<0.001). The dilatation after GTN was observed to be 26.16 ± 4.25% and 18.74 ± 5.72% in controls and cases respectively (p<0.001). The mean levels of vitamin D among controls and cases were 25.41 ± 12.18 and 14.52 ± 8.28 ng/ml respectively. The correlation between endothelial dependent dilatation (FMD), endothelial independent dilatation (after GTN) and vitamin D was found to be more positive in cases (r=0.870, r=0.798) than controls (r=0.079, r=0.158). CONCLUSIONS: Vitamin D deficiency state is higher among cases of type 2 DM. Endothelial dependent dilatation (FMD) was found to be lower among the patients of type 2 DM. The study gives us an insight to identify the diabetics with vitamin D deficiency which may be at higher risk of vascular complications including coronary artery disease.

Ratio of Waist-To-Calf Circumference and Carotid Atherosclerosis in Patients of Type 2 Diabetes Mellitus.

AIM: Diabetes is a well known risk factor for carotid atherosclerosis. However, screening of all diabetics by carotid ultrasonography is cumbersome and cost-effective. Search for anthropometric measures related to severity of disease has been relentless. It's a proposal for waist-calf ratio as a better marker of carotid atherosclerosis than traditional measurements as it is cost-effective and non-invasive. METHODS: This was a cross-sectional observational study. 100 patients were included. Detailed history, clinical examination, biochemical indices and anthropometric measurements were recorded. Carotid atherosclerosis was measured using a high resolution USG system with 10 MHz linear transducer. The carotid intima-media thickness (CIMT) was measured at 3 points on far wall of mid and distal CCA and 1 cm proximal to dilation of carotid bulb. Mean value of six measurements from right and left CCA was used. CIMT → Distance between media-adventitia interface and lumen intima interface. Carotid Plaque → distinct area of hyperechogenicity and or protrusion into the lumen of vessel with at least 50% greater thickness than the surrounding area. Carotid atherosclerosis → Focal plaque or CIMT > 1.1 mm. RESULTS: Mean CIMT in quartiles of WCR in females and males are 1st (0.740, 0.674); 2nd (0.833, 0.726); 3rd (0.902, 0.814); 4th (1.005, 0.910) as well as mean WCR in quartiles of CIMT in males and females are 1st (2.292, 2.302); 2nd (2.473,2.443 ); 3rd (2.641, 2.671); 4th (3.177, 2.967). All the quartiles are statistically highly significant with p<0.001. Out of 100 patients 17 patients with carotid plaques, 12 had CIMT >1 and 14 had WCR >2.5. The difference was statistically significant with p<0.01. CONCLUSIONS: waist-calf ratio is a stronger anthropometric marker of carotid atherosclerosis and can be used in screening of high risk patients in diabetic population.

Effect of Carica papaya Leaf Extract Capsule on Platelet Count in Patients of Dengue Fever with Thrombocytopenia.

OBJECTIVE: Thrombocytopenia in dengue fever is a common and serious complication. However, no specific treatment is available for dengue fever induced thrombocytopenia. In few countries (Pakistan, Malaysia, Sri Lanka and other Asian countries) the leaf extract of Carica papaya has been effectively used for thrombocytopenia. So, the study is planned to access effect of Carica papaya leaf extract on platelet count in dengue fever patients. METHODS: All participants were randomised into two groups, study group and control group; the study group was given papaya leaf extract capsule of 500 mg once daily and routine supportive treatment for consecutive five days. The controls were given only routine supportive treatment. Daily complete blood counts, platelet counts and haematocrit level, liver function test, renal function test of both groups were observed. RESULTS: On the first day platelet count of study group and control group was (59.82±18.63, 61.06±20.03 thousands, p value 0.36). On the 2nd day platelet count of both study and control groups was not significantly different (61.67±19.46 and 59.93±19.52 thousands, p value 0.20) but on 3rd day platelet count of study group was significantly higher than control group (82.96±16.72, 66.45±17.36 thousands, p value < 0.01). On 4th and 5th day platelet count of study group (122.43±19.36 and 112.47±17.49 thousands respectively) was also significantly higher than the control group (88.75±21.65 and 102.59±19.35 thousands) (p value < 0.01). On 7th day platelet count of study group and control group were not significantly different (124.47±12.35 and 122.46±19.76 thousands respectively, p value 0.08). Average hospitalization period of study group v/s control group was 3.65±0.97 v/s 5.42±0.98 days (p value < 0.01). Average platelet transfusion requirement in study group was significantly less than control group (0.685 units per patient v/s 1.19 units per patient) (p value <0.01). CONCLUSIONS: It is concluded that Carica papaya leaf extract increases the platelet count in dengue fever without any side effect and prevents the complication of thrombocytopenia. So, it can be used in dengue fever with thrombocytopenia patients.

HIV Presenting as Cerebellar Ataxia.

Presenting features of HIV has always been a Pandora's box largely due to multisystem affection by the virus and a large array of opportunistic infections. We hereby report an extremely rare case of 40 yr old patient presenting as symmetric, progressive cerebellar ataxia later found to be HIV positive. Thorough knowledge of rare presentations of HIV and a high index of suspicion are necessary for early diagnosis and efficient treatment of HIV.

A Clinical Trial of Nitrosense patch for the treatment of patients with painful diabetic neuropathy.

AIMS: Impaired nitric oxide synthesis has been implicated as one of the underlying causes of diabetic painful neuropathy (DPN). Hence, effects of a cutaneous, nitric oxide releasing patch (NitroSense Derma Protect) were evaluated in subjects with DPN. METHODS: Fifty diabetics were randomised to active/placebo arms after a 2 wk wash-out period. Patients received 24 mg patches (each patch releases around 9 nmol/cm2/min of nitric oxide) for 3 hrs, every other day during a 3 wks period, or indistinguishable placebo patches. The extent of pain was recorded at start, at each visit and following completion of the study. Changes in pain from baseline were measured using the 11 point lickert scale (PLS), visual analogue scale (VAS), short form mcgill, pain questionnaire (SF-MPQ), present pain intensity (PPI) scale. RESULTS: Subjects treated with patch experienced a statistically significant reduction in pain from baseline when compared to placebo (PLS scale; p = 0.05). Defining responders as subjects with a > 50% reduction in PLS score from baseline, the number needed to treat (NNT) was calculated as 3.0. A significant post-treatment decrease (p = 0.009) in vibration perception threshold (VPT) for left foot after active treatment was observed. CONCLUSIONS: Present results highlight utility of NitroSense Derma Protect as controllable nitric oxide source for patients with DPN.

The Raikas - a unique combination of high prevalence of type 1 diabetes susceptibility genes and near zero incidence of the disease.

The Raikas, a camel rearing tribal group living in the Thar desert of Rajasthan has been reported with a very low incidence of diabetes. We analysed the frequency distribution of HLA alleles in this community and compared the same with the non-Raika group living in the same geographic location and also that of the healthy North Indian (NI) population. The data revealed an exceptionally high phenotype frequency of HLA-DRB1*03 in this community (53%) as compared to the non-Raika group (27.73%, p=7.9E-05) and the NI population (14.6%, p=7.65E06). Further analysis revealed the occurrence of four major DRB1*03 haplotypes in the Raikas: (i) A*26-B*08-DRB1*03 (AH8.2, 11.76%); (ii) A*24-B*08-DRB1*03 (AH8.3, 8.82%); (iii) A*02-B*08-DRB1*03 (3.78%); (iv) A*01-B*08-DRB1*03 (AH8.1v, 0.84%); all of which occurred with a several fold higher frequency in the Raikas than the other two groups. These haplotypes have been reported to be positively associated with T1D in the NI population. The apparent lack of T1D and/or other autoimmune diseases in the Raikas despite the higher occurrence of known disease associated HLA alleles/haplotypes is intriguing and highlights the quintessential role of the environmental factors, food habits and level of physical activity in the manifestation of T1D. Possible influence of other protection conferring genes located on, as yet undefined chromosomal locations cannot be ruled out.

Prevalence of Rheumatological Manifestations in Diabetic Population from North-West India.

INTRODUCTION: An increased prevalence of rheumatological manifestations is recognised in diabetes and is a common source of disability. The relationship with other risk factors and glycaemic control is uncertain. We designed this study to find out the prevalence of rheumatological manifestations, association with various risk factors and to assess differences between type 1 and type 2 diabetes. MATERIAL AND METHODS: The study was conducted from Jan 2010 to Dec 2011 at tertiary care hospital. We recorded type of diabetes, various risk factors viz age, duration of diabetes, glycaemic control (HbA1C) and BMI and noted prevalence of various rheumatological manifestations by clinical examination, X-ray and if needed CT scan/MRI. We explored correlation between rheumatological manifestations and these variables using logistic regression. RESULTS: The prevalence of rheumatological manifestations was estimated at 570 per 1000 population. The manifestations were more common in type 1 diabetes (62.7%). The various complications observed in the present study were DISH (13%), Frozen Shoulder (20%), Dupuytren's Contracture (7.2%), Osteoarthritis (36.1%), Neuroarthropathy (2.9%), Chieroarthropathy (22.6%) and Flexor Tenosynovitis (8.1%). Among various risk factors, duration of diabetes (odd ratio: 5.127), BMI (odd ratio: 7.429) and age (odd ratio: 4.731) were common risk factors. Poor glycaemic control was also associated with increased prevalence of rheumatological manifestations. CONCLUSION: Rheumatologic manifestations are very common in diabetics and are associated with poor glycaemic control, BMI, duration of diabetes and age of the patients.

Prevalence of micro and macrovascular complications and their risk factors in type-2 diabetes mellitus.

OBJECTIVES: To determine the prevalence of micro and macrovascular complications in type-2 diabetes in Northwest India and its correlation with various risk factors. METHODS: In this study, total 11,157 subjects (M:F 6661:4496), attending the diabetic clinic, were analysed. The study sample resembles the population sample in anthropometric, age and socioeconomic factors. All patients had undergone the test for retinopathy by fundus examination, nephropathy by microalbuminuria, serum creatinine and blood urea, neuropathy by monofilament and biothesiometer, peripheral vascular disease (PVD) by colour doppler and cardiovascular disease by ECG. RESULTS: Among 11,157 subjects, retinopathy was diagnosed in 32.5%, nephropathy was present in 30.2%, peripheral neuropathy was present in 26.8%, coronary heart disease (CHD) was present in 25.8% and peripheral vascular disease (PVD) was present in 28% of the subjects. Multiple logistic regression analyses showed that age had a significant association with retinopathy, neuropathy, coronary heart disease (CHD) and peripheral vascular diseases (PVD). Duration of diabetes had significant association with the neuropathy, nephropathy and PVD. Higher HbA1C increases the risk of retinopathy, neuropathy and nephropathy. Hypertension was associated with nephropathy and coronary heart disease. CONCLUSION: The study highlights the high prevalence of vascular complications in type-2 diabetes in Northwest India. Retinopathy and nephropathy were the commonest complications of diabetes in our study.

Camel milk: a possible boon for type 1 diabetic patients.

Poor nutrition in utero and in early life combined with over nutrition in later life may also play a role in epidemic of diabetes. The efficacy of camel milk consumption as an adjunct to routine diabetic management in type 1 diabetes is a approach showing new rays of hope to cope with this disorder by adding a food supplement with medicinal values. Research on the beneficial aspects of camel milk has been taking place in different corners of globe since last three decades. Continuous efforts to disclose the role of camel milk in diabetes has rendered it title of 'white gold'. Biochemical studies has revealed the components e.g. insulin like protein, lactoferrin, immunoglobulins are responsible for imparting camel milk the scientific weightage. In parallel, epidemiological surveys stating low prevalence of diabetes in communities consuming camel milk clearly indicate towards its hopeful role in maintaining hyperglycemia. This article shades light on camel milk production, composition, characteristics as well as it expresses positive effect of camel milk on blood glucose level, insulin dose, beta cell function. This review also compiles various epidemiological studies carried out to bring forth utility of camel milk suggesting it as a useful food supplement or alternative therapy for type 1 diabetic patients.

Hepatocyte growth factor, adiponectin and hepatic histopathology in non-alcoholic steatohepatitis.

OBJECTIVES: Hepatocyte growth factor (HGF) and Adiponectin are adipokines. Serum HGF and adiponectin levels are strongly associated with liver disease, obesity, insulin resistance and metabolic syndrome (MS). Non alcoholic steatohepatitis (NASH) is the hepatic component of metabolic syndrome. Our aim was to elucidate the status of HGF, adiponectin levels and histopathology of liver in NASH. METHODS: This study was conducted among 50 subjects (25 patients and 25 controls) age and sex matched attending OPD. Patients were randomly selected for the study and after explaining in detail design of the study, written consent was taken. Institutional ethical approval was also taken.The only diagnostic method for NASH is liver biopsy (after exclusion of other causes based upon clinical examination and laboratory investigations) and pathological grading and staging was done according to Brunt classification. Diagnosis of patients was done on the basis of liver biopsy and fasting HGF and adiponectin were performed with commercially available ELISA kits (quantikine HGF and adiponectin ELISA kits). RESULTS: Mean serum HGF in patient and control groups were 2.33 +/- 0.66 pg/ml and 0.56 +/- 0.21 pg/ml respectively (p < 0.001). Mean serum adiponectin in patient and control groups were 6.93 +/- 1.50 ng/ml and 14.54 +/- 3.58 ng/ml respectively (p < 0.001). Multiple regression analysis revealed that statistically significant difference was found (p < .001) when comparing mean brunt grade and brunt stage (hepatic histopathology) with fasting serum adiponectin and HGF CONCLUSION: Fasting serum HGF was significantly high and fasting serum adiponectin was significantly low in patients of various grades of hepatic histopathology in NASH.Various parameters of MS were significantly correlated with various stages of hepatic histopathology, as well as decreased serum adiponectin and increased fasting serum HGF.

Effect of camel milk on glycemic control and insulin requirement in patients with type 1 diabetes: 2-years randomized controlled trial.

BACKGROUND/OBJECTIVES: Hypoglycemic effect of camel milk supplementation in experimental rat model and significant reduction in doses of insulin in type 1 diabetic patients have been observed in our previous studies. This long-term study was undertaken to assess the efficacy, safety and acceptability of camel milk as an adjunct to insulin therapy in type 1 diabetics. SUBJECTS/METHODS: In this 2-year randomized clinical, parallel design study, 24 type 1 diabetics were enrolled and divided into two groups. Group I (n=12) received usual care, that is, diet, exercise and insulin and Group II (n=12) received 500 ml camel milk in addition to the usual care. Insulin requirement was titrated weekly by blood glucose estimation. Results were analyzed by using the regression technique. RESULTS: In camel milk group, there was decrease in mean blood glucose (118.58±19-93.16±17.06 mg/dl), hemoglobin A1c levels (7.81±1.39-5.44±0.81%) and insulin doses (32.50±9.99-17.50±12.09 U/day, P<0.05). Out of 12 subjects receiving camel milk, insulin requirement in 3 subjects reduced to zero. There was nonsignificant change in plasma insulin and anti-insulin antibodies in both the groups. CONCLUSION: It may be stated that camel milk is safe and efficacious in improving long-term glycemic control, with a significant reduction in the doses of insulin in type 1 diabetic patients.