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.

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.

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.