Vitamin D deficiency, vitamin D receptor gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes.

AIM: The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). METHODS: In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. RESULTS: The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (<20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA(1c), although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P<0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P=0.02) and the aa genotype of ApaI (OR: 0.46; P=0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. CONCLUSION: The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.

Left ventricular hypertrophy in hypertensive type 2 diabetic patients according to renal function.

AIM: Cardiovascular disease is the main cause of death in diabetic patients undergoing haemodialysis. Dialysis and hypertension increase left ventricular hypertrophy (LVH), a strong predictor of cardiovascular events. This study evaluated left ventricular structure and function in three groups of hypertensive type 2 diabetic patients with different renal function, and assessed the factors associated with LVH, in an Afro-Caribbean population. METHODS: Left ventricular structure and function were measured by ultrasonography. Group 1 consisted of 150 patients with normal renal function, group 2 included 183 patients with renal dysfunction and the third group comprised 75 dialysis patients. RESULTS: Left ventricular mass/height(2.7) increased from group 1 to groups 2 and 3 (49.00g/m(2.7), 57.12g/m(2.7) and 59.75g/m(2.7), respectively; P<0.0001). The prevalences of LVH were 48.3% in group 1, 64.8% in group 2 and 70.3% in the dialysis patients (P=0.001). LVH was more concentric than eccentric in groups 2 and 3. The factors significantly associated with LVH were obesity in groups 1 and 2, and an increase of 10mmHg in pulse pressure in groups 2 and 3, according to multivariate logistic-regression analysis. CONCLUSION: Our study confirmed that, in a population of Afro-Caribbean hypertensive type 2 diabetic patients, renal failure was associated to an increased left ventricular mass/height(2.7). The data show that the variables associated with LVH differ according to renal profile. This finding will be of value in the treatment and follow-up of these patients.

Asian Indians of Guadeloupe are less physically active than their island counterparts.

The status of ethnic minority has been reported to be associated with a tendency toward sedentary behavior. The Guadeloupean population is composed of Afro-Caribbeans and an Asian Indian minority. This study examined the association of ethnicity and physical activity on the island. Energy expenditures (EE), energy intakes (EI), and macronutrient intakes of 122 Guadeloupean workers (60 Indians and 62 controls) were assessed by three consecutive 24-h recalls. Two-way analyses of variance were conducted to test the hypothesis of an effect of ethnicity, taking the potential effect of sex into account, on these variables. Asian Indians reported lower EE (P=0.011), lower EE/EI ratios (P=0.001), and lower physical activity (P=0.003) than their Afro-Carribean counterparts. Their food intakes were not different in terms of EI or macronutrient intake. No sex x ethnicity interactions were significant. The present study reports a tendency toward physical inactivity in Asian Indians of Guadeloupe associated with EI similar to those of controls. Sedentary lifestyles and energetic imbalances are well-documented risk factors for several diseases, including type 2 diabetes and cardiovascular disease, both major public health concerns in Guadeloupe. Strategies to prevent sedentary lifestyles should be considered for Asian Indian Guadeloupeans.

Metabolic syndrome and Framingham risk score for prediction of cardiovascular events in Caribbean Indian patients with blood glucose abnormalities.

OBJECTIVE: To evaluate the metabolic syndrome (MS) and Framingham risk score (FRS) as predictors of cardiovascular (CV) events in Caribbean Indian patients who have type 2 diabetes (T2D) or impaired glucose tolerance (IGT). METHOD: A longitudinal and retrospective study was conducted involving patients classified as T2D or IGT in a first study in 1997 who responded for a second examination in 2006. Nonparametric tests and Cox's proportional hazards model were used. Hazard ratios (HRs) and their confidence intervals (95% CI) for risk of a first CV event, according to the presence of MS or a high FRS, were estimated. For MS, the models were adjusted for age, gender and smoking status. RESULTS: A total of 148 patients were included in the present study. The mean time without a CV event was 7.5 years (range 0.38-8.45 years). We noted 31 (25 nonfatal) first hospitalizations, for stroke (n=15), angina pectoris (n=8), acute coronary heart disease (n=7) and acute peripheral vascular disease (n=1). Ten (6.8%) patients died and six deaths were related to CV events. The HRs of CV events associated with metabolic syndrome, defined by the National Cholesterol Education Program's Adult Treatment Program III, were not significant. Conversely, HRs of CV events associated with the FRS were 4.78 (95% CI 1.65-13.5) and 2.94 (95% CI 1.42-6.06) for a risk score superior or equal to 10% and superior or equal to 20%, respectively. For coronary heart disease alone, the HRs associated with the FRS were 9.92 (95% CI 1.31-75.2) and 2.88 (95% CI 1.05-7.93), respectively. In these Caribbean Indian patients with blood glucose abnormalities, unlike the FRS, MS failed to identify subgroups at high cardiovascular risk in the short term (8.5 years). Nevertheless, the long-term risk-predictive value of these tools needs to be evaluated.

Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

Cardiovascular risk factors associated with diabetes in an Indian community of Guadeloupe. A case control study.

Indians of Guadeloupe have an especially high prevalence type 2 diabetes mellitus and a particular susceptibility to coronary heart disease. This case-control study conducted from September 15 to 24, 1997, analysed cardiovascular risk factors associated with diabetes and particularly dyslipidaemia in the Indian community of Guadeloupe. The 172 subjects included 86 diabetic patients of Indian origin and 86 age- and sex-matched non-diabetic controls. All subjects underwent a physical examination by the same observer. Obesity and hypertension were assessed, and fasting lipid concentrations were measured. The body mass index and waist-to-hip ratio were higher among patients than controls: 27.8 vs 25.1 Kg/m2 (p < 0.001) and 0.94 vs 0.90 (p < 0.001). Mean arterial systolic and diastolic pressures were higher for patients than controls (p < 0.001). Median HDL-cholesterol was 1.23 mmol/L for patients vs 1.4 mmol/L for controls (p < 0.001), and median triglycerides were 2.0 vs 1.3 mmol/L (p < 0.001). Mean apolipoprotein B was 1.40 +/- 0.36 g/L for patients vs 1.23 +/- 0.35 g/L for controls (p < 0.001). Our results show slight hypertension, central obesity, a lower plasma HDL-cholesterol concentration, a higher triglyceride concentration, and a higher apolipoprotein B concentration for diabetics. These data would appear to have important implications for the prevention of cardiovascular disease in this population.

Type 2 diabetes mellitus: association study of five candidate genes in an Indian population of Guadeloupe, genetic contribution of FABP2 polymorphism.

We studied by PCR-RFLP 6 polymorphisms in these 5 candidate genes: Ala54Thr in the fatty acid binding protein 2 gene (FABP2), A to G substitution in the uncoupling protein type 1 gene (UCP1), Asp905Tyr in the protein phosphatase type 1 gene (PP1G), Trp64Arg in the human beta 3 adrenergic receptor gene (beta 3AR) and 2 RFLP sites of the vitamin D receptor (VDR) gene (VDRTaq1 and VDRApa1). This study was conducted among 89 cases and 100 controls matched according to age, gender and absence of first degree family link (11 triplets with 2 controls for 1 case and 78 pairs with 1 control for 1 case). Cases and controls were taken among a sample of 429 individuals selected for the study of the prevalence of diabetes in this ethnic group from Guadeloupe. By conditional logistic regression analysis, there was a significant relation (p = 0.02) between the Ala54Thr FABP2 polymorphism and Type 2 DM. Multivariate analysis discriminate the FABP2 polymorphism (p = 0.10), a triglyceridemia over 2 g/l (p < 10(-3)) and high blood pressure (p = 10(-2)) as variables associated with Type 2 DM in this population. These findings suggest that FABP2 does not represent a major gene for Type 2 DM in this migrant Indian population living in Guadeloupe, but seems to be related to the metabolic insulin resistance syndrome.

Arterial hypertension in the adult population of Guadeloupe, and associated factors in subjects of African origin.

This study was designed to estimate the prevalence of hypertension in Guadeloupe, the French West Indies, and to evaluate the risk factors associated with hypertension in the largest ethnic group, that of African origin. Households were randomly selected using a two-stage systematic sample of districts and then of houses; all adults aged 18 years in the household were included. In total, 1043 men and women were studied. Blood pressure, plasma glucose concentrations and gamma-glutamyl transferase activity were measured, hypertensive treatment and lifestyle factors recorded. The prevalence of hypertension, age-standardized to the Guadeloupe population was 21% and 26% in men and women of African origin, 28% and 22% in those of Indian-origin and 18% and 16% for other origins. The vast majority of subjects were unaware of their hypertension (90% of men, 74% of women). After adjustment for age, factors associated with high blood pressure in the 826 adults of African origin were: obesity, hyperglycemia, low educational level and family history of hypertension and of stroke. Additional factors in women were alcohol consumption, gamma-glutamyl transferase activity, physical inactivity, occupational category and a retired status, even after adjustment for age. Measures must be taken to diagnose hypertension early, particularly in individuals of African and Indian origin. An effective education program is needed, with an emphasis on life-style factors associated with obesity: diet and physical activity.

The prevalence of diabetes mellitus in the adult population of Guadeloupe as estimated by history or fasting hyperglycemia.

A study was conducted between January 1984 and March 1985 to determine the prevalence of diabetes in the adult population of Guadeloupe (18 years of age and over). A two-step sampling frame, using a sampling fraction of 0.46%, where the primary units were composed of districts and where sub-units were households, was used. The household refusal rate was 22%. Subjects were classified as 'diabetic' when they were either already known or when their fasting plasma glucose was above 8.0 mmol/l. The total age and sex standardized prevalence of diabetes among the adult population of Guadeloupe can be estimated at 6.6%. The high prevalence rate appears to be related to obesity (strongly in women), a genetic susceptibility (22.5% of age standardized prevalence among subjects of Asian Indian origin for both sexes), and, possibly, in men of African origin only, to a maternal history of diabetes.

Diabetes mellitus and public health in Guadeloupe.

Diabetes mellitus is now among the ten leading causes of death in the Caribbean. Studies of the prevalence of dysglycaemic disorders and risk factors for diabetes are necessary in order to design and implement tailored prevention programmes. The present study is of a representative sample of the adult population in Guadeloupe. The estimated prevalence of diabetes is 5.8% in adults, and that of impaired glucose tolerance is 7.4%. The percentage of insulin-treated patients is low, 14% of diabetics. The principal risk factors of diabetes, as classically recognised, are shown to operate. At the individual level, the presence of a diabetic parent is a greater relative risk factor than obesity. However, considering the large percentage of persons who are obese, obesity seems to be the principal factor at which a primary prevention programme at the community level should be aimed, in order to limit the incidence of hyperglycaemic states.

Diabetes mellitus and public health in Guadeloupe

Diabetes mellitus is now among the ten leading causes of death in the Caribbean. Studies of the prevalence of dysglycaemic disorder and risk factors for diabetes are necessary in order to design and implement tailored prevention programmes. The present study is of a representative sample of the adult population in Guadeloupe. The estimated prevalence of diabetes is 5.8 percent in adults, and that of impaired glucose tolerance is 7.4 percent. The percentage of insulin-treated patients is low, 14 percent of diabetics. The principal risk factors of diabetes,as classically recognised, are shown to operate. At the individual level, the presence of a diabetic parent is greater relative risk factor than obesity. However, considering the large percentage of persons who are obese, obesity seems to be the principal factor at which a primary prevention programme at the community level should be aimed, in order to limit the incidence of hyperglycaemic states (AU)

Diabetes mellitus and public health in Guadeloupe

Diabetes mellitus is now among the ten leading causes of death in the Caribbean. Studies of the prevalence of dysglycaemic disorder and risk factors for diabetes are necessary in order to design and implement tailored prevention programmes. The present study is of a representative sample of the adult population in Guadeloupe. The estimated prevalence of diabetes is 5.8% in adults, and that of impaired glucose tolerance is 7.4%. The percentage of insulin-treated patients is low, 14% of diabetics. The principal risk factors of diabetes,as classically recognised, are shown to operate. At the individual level, the presence of a diabetic parent is greater relative risk factor than obesity. However, considering the large percentage of persons who are obese, obesity seems to be the principal factor at which a primary prevention programme at the community level should be aimed, in order to limit the incidence of hyperglycaemic states

Diabetes mellitus and risk factors in a French West Indian island - abstract

Diabetes mellitus is an important cause of morbidity and mortality in the Caribbean. In order to design and implement specific prevention programmes, it is necessary to estimate the prevalence of glycaemic disorders and study the risk factors involved. This paper presents the results of such a study from a representative sample of the adult population in Guadeloupe. The estimated total prevalence of glycaemic disorders was 13.2 per cent of the adult population over 18 years of age. Impaired glucose tolerance (IGT) appeared in 7.4 per cent of subjects. The prevalence of diabetes mellitus was 5.8 per cent (95 per cent confidence interval: 4.4-7.2). Insulin-dependent patients represent 14 per cent of all diabetics. The associated factors studied were sex, age, obesity, parental diabetes status and ethnicity. The relative risk (RR) for age in non-obese non-diabetic parent patients was 5.1. In older subjects, RR for diabetic parent without obesity was 3.2 and for obesity alone 1.8. For obesity and diabetic parent, RR was 5.0. In this case, there was additivity of these two factors. Except age, the individual predominant factor of Diabetes mellitus was the presence of a diabetic parent; this was more evident in the small and closed Indian group. In the Public Health approach, i.e. taking into account the prevalence of each risk factor in the population, obesity was the most important. It is also the one and only factor which could be reached directly by a prevention programme (AU)

The assays of glycosylated proteins in haemoglobinopathies and their use in screening for diabetes mellitus

We compare the relative validity of HbA1c and fructosamine as indices of long-term blood glucose levels in populations with a common occurence of haemoglobinopathies. In these patients, HbA1c levels are lower than HbA1c levels in non-haemoglobinopathy patients and do not reflect the gludicic status of the patient, unlike the fructosamine assay. This last test has a good potential to be used a a mass screening for diabetes mellitus in these populations (Africa, Caribbean, USA) in either homozygous or heterozygous haemoglobinopathy patients. Moreover, fructosamine presents numerous technical advantages which facilitates the screening (AU)

The assays of glycosylated proteins in haemoglobinopathies and theis use in screening for diabetes Mellitus

We compare the relative validity of HbA1c and fructosamine as indices of lon-term vlood glucose levels in populations with a common occurrence of haemoglobinopathies. In these patients, HbA1c levels are lower than AbA1c levels in non-haemoglobinopathy patients and do not reflect the glucidic status of the patients, unlike the fructosamine assay. This last test has a good potential to be used as a mass screening test for diabetes mellitus in the populations (Africa, Caribbean, USA) in either homozygous or heterozygous haemoglobinopathy patients. Moreover, fructosamine presents numerous technical advantages which facilitate the screening

The assessment of fructosamine determination as a screening test and for the therapeutic control of diabetes mellitus - abstract

The determination of fructosamine is a new colorimetric method to measure non-enzymatically glycated proteins in serum (Johnson et al, 1982). It has been proposed that fructosamine measurement in sera is an index of glucose control (1 to 3 weeks) during the period corresponding to plasma protein turnover (Baker, 1983). The purpose of the study was to adapt the test to centrifugal analysis, to establish normal ranges of fructosamine in blood for non-diabetic subjects and to correlate fructosamine levels with fasting blood glucose concentrations and glycated haemoglobins in normal and diabetic patients (WHO criteria). The results show a significant correlation between these tests. The fructosamine test seems to be useful as a screening test for diabetes mellitus and is suitable for assessing the control of blood glucose. Fructosamine determination represents an alternative measurement to glycated haemoglobin in blood. It is technically simple, accurate and easier in regard to automated adaptation (AU)