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1.
J Diabetes Complications ; : 108022, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34593315

RESUMO

BACKGROUND AND AIM: Neonatal diabetes mellitus (NDM) is a rare monogenic disorder of pancreatic beta cell mass and/or function. In the present study we aimed to evaluate the INS gene mutations in a cohort of children with Permanent Neonatal Diabetes Mellitus (PNDM) and to explore the clinical and genetic characteristics of PNDM caused by INS mutations. METHODS: Direct sequencing of all exons of INS genes was carried out in 189 children with PNDM. Clinical and biochemical data were collected and correlated. The pathogenicity of mutations was determined based on the American College of Medical Genetics and Genomics and Association of Medical Pathology guidelines. RESULTS: Two novel mutations (His34Pro, Leu35Met) in a compound heterozygous state and seven known mutations (Gly32Ser, Phe48Cys, Arg89Cys, Cys96Tyr, Ser98Ile, Try108Asp and Cys109Phe) in the INS gene were identified in 8 patients out of the total of 189 PNDM children studied. Four mutations were involved in defects with disulphide bond formation and hence were in crucial regions of the gene. All the mutations were de novo in origin. CONCLUSIONS: This is the first comprehensive study from India to investigate the insulin gene mutations in PNDM and to show that INS gene mutations also contribute to the causation of PNDM.

2.
J Diabetes Complications ; : 108051, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34607777

RESUMO

AIMS: To assess the effect of migration (rural-to-urban and vice versa) on prevalence of diabetes and metabolic disorders in Asian Indians participating in the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. MATERIALS AND METHODS: The ICMR-INDIAB study is a national study on diabetes and associated cardiometabolic disorders in individuals aged ≥20 years from 28 states and 2 union territories of India. Individuals who moved to a different place from their place of birth and had resided in the new location for at least one year were considered as migrants. Anthropometric measurements, blood pressure estimation and a capillary oral glucose tolerance test were performed. RESULTS: Of the 113,043 participants, 66.4% were non-migrant rural dwellers, 19.4% non-migrant urban dwellers, 8.4% rural-urban migrants, 3.8% multiple migrants and 2.0% urban-rural migrants. Weighted prevalence of diabetes was highest in rural-urban migrants followed by urban dwellers, urban-rural migrants and rural dwellers [14.7%, 13.2%, 12.7% and 7.7% respectively (p < 0.001)]. Rural-urban migrants had highest prevalence of abdominal obesity (50.5%) compared to the other three groups. The risk for diabetes was 1.9 times higher in rural-urban migrants than among rural dwellers. Five risk factors [hypertension, abdominal and generalized obesity, physical inactivity and low fruit and vegetable intake] together explained 69.8% (partial population attributable risk) of diabetes among rural-urban migrants and 66.4% among non-migrant urban dwellers. CONCLUSIONS: Rural-to-urban migration is associated with increased risk of developing diabetes and other cardiometabolic abnormalities. Adoption of healthier lifestyle patterns among migrants could help prevent/delay onset of these abnormalities in this population.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34609928

RESUMO

AIM: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. MATERIALS AND METHODS: We attempted to replicate the earlier described clusters of T2D In 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilising six clinically relevant variables. Individuals who had followup HbA1c upto 2 years were included for the drug response analysis (n=13,247). RESULTS: Among the 32,867 participants included in the study, 20779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9 %. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the Mild Age-Related Diabetes [MARD] cluster, followed by Insulin Resistant Obese Diabetes [IROD] (27%), Severe Insulin Deficient Diabetes [SIDD] (21%) and Combined Insulin Resistant and Deficient Diabetes [CIRDD] (12%) clusters. The most frequently used antihyperglycemic agents were sulphonylureas, metformin and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pre-treatment) HbA1c. CONCLUSIONS: In this new cohort we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.

4.
Acta Diabetol ; 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596779

RESUMO

AIM: To report on glycated haemoglobin (HbA1c) values among individuals with normal glucose tolerance (NGT) at different age groups, using data acquired from a large national survey in India. MATERIALS AND METHODS: Data on glycaemic parameters at different age groups were obtained from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, in adults aged ≥ 20 years representing all parts of India. Age-wise distribution of HbA1c was assessed among individuals with NGT (n = 14,222) confirmed by an oral glucose tolerance test using the World Health Organization (WHO) criteria. Results were validated in another large epidemiological study (n = 1077) conducted in Chennai, India. RESULTS: Among NGT individuals, HbA1c increased gradually with age from 5.16 ± 0.71% (33 mmol/mol) in the age group of 20-29 years to 5.49 ± 0.69% (37 mmol/mol) in those aged 70 + years. In the validation study, conducted in another study population, HbA1c was 5.35 ± 0.43% (35 mmol/mol) in age group of 20-29 years and 5.74 ± 0.50% (39 mmol/mol) in those aged 70 and above. In the INDIAB study, for every decadal increase in age, there is a 0.08% increase in HbA1c and this increase was more significant in females (females: 0.10% vs. males: 0.06%) and in urban (urban: 0.10% vs. rural: 0.08%) population. CONCLUSIONS: HbA1c levels increase steadily with age. This suggests that age-specific cutoffs be used while utilizing HbA1c to diagnose diabetes and prediabetes, so as to minimize the risk of overdiagnosis and unnecessary initiation of treatment in elderly people who could have physiological increase in HbA1c levels.

5.
Front Immunol ; 12: 716515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34566972

RESUMO

Metainflammation, as seen in chronic diabetes subjects, impairs immunity and increases the susceptibility to infections. In the present study, the effect of diabetes on immune response against filariasis was studied. Both toll-like receptor (TLR)-mediated and crude antigen-induced immune responses were quantified, in whole blood cultures from filariasis-infected subjects (LF+), with and without diabetes. Blood cultures were stimulated with TLR ligands (TLR2 and TLR4) or filarial antigen or were left unstimulated (control) for 18 h. Cytokine, chemokine, and defensin secretion was quantified by ELISA. Expression of HLA-DR, B7-1, B7-2, activation marker (CD69), and Th (Th1, Th2, Th17, and Th9) phenotypes was quantified by flow cytometry. Expression of immunomodulatory effectors (Cox-2, HO-1, IDO-1, and p47Phox) and Th-polarizing transcription factors (T-bet, GATA3, and ROR-γt) was quantified by quantitative PCR. Secretion of IL-27, IL-1Ra, IL-12, IL-33, IL-9, and SDF-1 was increased under diabetes conditions with increased Th9 polarization and increased expression of Cox-2 and IDO. Overall, diabetes was found to augment both TLR-mediated and antigen-induced inflammation, which can promote chronic pathology in LF+ subjects.

6.
Nutrients ; 13(9)2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34578944

RESUMO

The increasing prevalence of type 2 diabetes among South Asians is caused by a complex interplay between environmental and genetic factors. We aimed to examine the impact of dietary and genetic factors on metabolic traits in 1062 Asian Indians. Dietary assessment was performed using a validated semi-quantitative food frequency questionnaire. Seven single nucleotide polymorphisms (SNPs) from the Transcription factor 7-like 2 and fat mass and obesity-associated genes were used to construct two metabolic genetic risk scores (GRS): 7-SNP and 3-SNP GRSs. Both 7-SNP GRS and 3-SNP GRS were associated with a higher risk of T2D (p = 0.0000134 and 0.008, respectively). The 3-SNP GRS was associated with higher waist circumference (p = 0.010), fasting plasma glucose (FPG) (p = 0.002) and glycated haemoglobin (HbA1c) (p = 0.000066). There were significant interactions between 3-SNP GRS and protein intake (% of total energy intake) on FPG (Pinteraction = 0.011) and HbA1c (Pinteraction = 0.007), where among individuals with lower plant protein intake (<39 g/day) and those with >1 risk allele had higher FPG (p = 0.001) and HbA1c (p = 0.00006) than individuals with ≤1 risk allele. Our findings suggest that lower plant protein intake may be a contributor to the increased ethnic susceptibility to diabetes described in Asian Indians. Randomised clinical trials with increased plant protein in the diets of this population are needed to see whether the reduction of diabetes risk occurs in individuals with prediabetes.

7.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34585887

RESUMO

INTRODUCTION: Although metabolic surgery has been shown to offer beneficial primary outcome results in obese individuals / obese Type 2 diabetes mellitus (T2DM) patients, there is paucity of information on the underlying mechanisms. In the recent years, estimations of non-invasive molecular parameters viz., telomere length and mtDNA copy number (mtDNAcn) assume significance as robust biomarkers. However, there is lack of evidence about this especially, in the Indian context. To assess the changes in the telomere length and mtDNAcn levels after metabolic surgery in obese Asian Indians with dysglycemia along with routine measurements of anthropometry, glycemic/lipidimic parameters and inflammatory markers. METHODS: This study is a prospective one-year follow-up study of 16 obese individuals with dysglycemia who underwent metabolic surgery at a tertiary diabetes centre in South India. Telomere length, mtDNAcn, serum adiponectin, glycated haemoglobin and high- sensitivity C-reactive protein (hs-CRP) levels were analysed before surgery and at 6 and 12 months after surgery. RESULTS: There was a significant reduction in weight (p<0.001), BMI (p<0.001), waist circumference (p<0.001), fasting and postprandial glucose (p<0.05), HbA1c (p<0.001), triglycerides (p<0.05), hs CRP (p<0.05) and increase in serum adiponectin (p<0.05) at 6 and 12 months post-surgery compared to the preoperative status. There was a significant reduction in mtDNAcn (p<0.001) and a significant increase in telomere length (p<0.001) at 6 and 12 months post metabolic surgery. CONCLUSION: We report an increase in telomere length and decrease in circulatory mtDNA copy number levels at 6 and 12 months post metabolic surgery in obese individuals with T2DM in India.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , DNA Mitocondrial/genética , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/genética , Seguimentos , Humanos , Obesidade/complicações , Obesidade/genética , Estudos Prospectivos , Telômero/genética
8.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472814

RESUMO

Around 300- 400 AD, ancient Indian physicians described a condition akin to diabetes mellitus which was called "Madhumeha". Sushrutha and Charaka, are also credited with describing two types of diabetes which would roughly correspond to type 1 diabetes and type 2 diabetes. However, little is known about the history of diabetes in India between the first and 19th century AD. A thorough search of literature revealed a large number of publications on diabetes from India in the 1800s and early 1900s, mostly from Calcutta and the Madras Presidency, suggesting that the prevalence of diabetes was high in these two places. Building on the observations made by a number of English physicians, Chunilal Bose in 1907 suggested the link between diabetes and lifestyle in India. Amazingly, India did not have to wait long after the discovery of insulin by Banting and Best at Toronto in 1921, to get its own supply. Around this time, Dr. J.P. Bose, eminent physician and diabetologist from Calcutta made remarkable contributions to the study of diabetes in India. He was also the first to describe the dramatic effects of insulin administration to children with type 1 diabetes in India. All these facts have remained largely forgotten which prompted the authors to delve deep into the history of diabetes in pre-independence India. This has led to the unearthing of several pearls of knowledge which are presented in this article as a fitting tribute to the 100th year of Insulin Discovery.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Médicos , Criança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , História do Século XX , Humanos , Índia/epidemiologia , Insulina , Masculino
9.
Artigo em Inglês | MEDLINE | ID: mdl-34569820

RESUMO

Objective To compare the clinical profile of long-term survivors and non-survivors with T1D(T1D) in India. Research design and methods This is a retrospective study of 76 individuals with T1D who had survived for at least 40 years ('survivors') and 51 individuals with T1D who had died with shorter duration of diabetes ('non-survivors'), from diabetes clinics in different cities of India. Prevalence of complications in both groups and causes of death of the non-survivors were analyzed. Retinopathy was diagnosed by retinal photography; chronic kidney disease (CKD) by urinary albumin excretion (micro- or macroalbuminuria) and estimated glomerular filtration rate; peripheral vascular disease (PVD) by Doppler measurement of ankle-brachial pressure index; coronary artery disease (CAD) based on history of myocardial infarction or coronary revascularization and neuropathy by biothesiometry. Results Mean glycated hemoglobin (8.4±1.5 vs 10.7±2.2%, p<0.001), serum low density lipoprotein-cholesterol (91±29 vs 107±22mg/dl, p=0.004) and systolic blood pressure (135±16 vs 153±37mmHg, p=0.003) were lower, and high density-lipoprotein cholesterol (51±11 vs 43±15mg/dl, p=0.002) higher, among survivors compared to non-survivors. Diabetic retinopathy, CKD, neuropathy, PVD and CAD were more frequent among non-survivors. CAD [25.5%] and renal failure [23.5%] were the most frequent causes of death. Conclusions In this first report of long-term survivors with T1DM from India, we report that survivors had better glycemic and blood pressure control, more favorable lipid profiles and lower prevalence of complications compared to non-survivors. However, there could be other protective factors as well, which merit further studies.

10.
Environ Dev Sustain ; : 1-27, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34393622

RESUMO

This study aims to explore the state-wise assessment of SARS-CoV-2 (COVID-19) pandemic spread in Malaysia with focus on influence of meteorological parameters and air quality. In this study, state-wise COVID-19 data, meteorological parameters and air quality index (AQI) were collected from March 13 to April 30, 2020, which encompass three movement control order (MCO) periods in the country. Overall, total infected cases were observed to be higher in MCO phase 1 and 2 and significantly reduced in MCO phase 3. Due to the variation in the spatial interval of population density and individual immunity, the relationship of these parameters to pandemic spread could not be achieved. The study infers that temperature (T) between 23 and 25 °C and relative humidity (RH) (70-80%) triggered the pandemic spread by increase in the infected cases in northern and central Peninsular Malaysia. Selangor, WP Kuala Lumpur and WP Putrajaya show significantly high infected cases and a definite trend was not observed with respect to a particular meteorological factor. It is identified that high precipitation (PPT), RH and good air quality have reduced the spread in East Malaysia. A negative correlation of T and AQI and positive correlation of RH with total infected cases were found during MCO phase 3. Principal component analysis (PCA) indicated that T, RH, PPT, dew point (DP) and AQI are the main controlling factors for the spread across the country apart from social distancing. Vulnerability zones were identified based on the spatial analysis of T, RH, PPT and AQI with reference to total infected cases. Based on time series analysis, it was determined that higher RH and T in Peninsular Malaysia and high amount of PPT, RH and good air quality in East Malaysia have controlled the spreading during MCO phase 3. The predominance of D614 mutant was observed prior to March and decreases at the end of March, coinciding with the fluctuation of meteorological factors and air quality. The outcome of this study gives a general awareness to the public on COVID-19 and the influence of meteorological factors. It will also help the policymakers to enhance the management plans against the pandemic spreading apart from social distancing in the next wave of COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1007/s10668-021-01719-z.

11.
Diabetes Metab Syndr ; 15(5): 102261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34464909

RESUMO

AIM: To identify the profiles and factors associated with progression/regression of ultrasound-derived hepatic steatosis with type 2 diabetes mellitus seen at a tertiary diabetes center in southern India. METHODS: Participants were individuals with type 2 diabetes mellitus with at least two consecutive ultrasound measurements available. Hepatic steatosis was assessed using high-resolution B-mode ultrasonography. Admittedly ultrasonography has lower sensitivity and specificity, however, it is the only modality available in a routine clinical setting to screen for hepatic steatosis. Progression or regression of hepatic steatosis was assessed after a mean follow-up of 3.0 ± 2.1 years and correlated with clinical and biochemical parameters. RESULTS: A total of 1835 participants with type 2 diabetes mellitus were studied, of whom 88.6% had some form of hepatic steatosis at baseline which included mild steatosis (grade 1) in 982 (53.5%), moderate steatosis (grade 2) in 628 (34.2%) and severe steatosis (grade 3) in 15 (0.8%). Hepatic steatosis progression, regression or no change in grade of hepatic steatosis were seen in 21.5%, 26.6% and 51.9% of participants. Increase in body weight, body mass index, glycated haemoglobin, serum triglycerides and gamma glutamyl transferase were the factors associated with progression of hepatic steatosis, whereas regression showed reduction in body weight, body mass index, fasting plasma glucose and glycated haemoglobin. CONCLUSION: Among South Indian type 2 diabetes patients with hepatic steatosis, severity of steatosis progressed in 1/3rd while it regressed in 1/4th. These retrospective data need proper ascertainment in controlled studies.

12.
Diabetes Res Clin Pract ; : 108972, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34343595

RESUMO

Executive Summary This document updates the 1999 World Health Organization (WHO) classification of diabetes. It prioritizes clinical care and guides health professionals in choosing appropriate treatments at the time of diabetes diagnosis, and provides practical guidance to clinicians in assigning a type of diabetes to individuals at the time of diagnosis. It is a compromise between clinical and aetiological classification because there remain gaps in knowledge of the aetiology and pathophysiology of diabetes. While acknowledging the progress that is being made towards a more precise categorization of diabetes subtypes, the aim of this document is to recommend a classification that is feasible to implement in different settings throughout the world. The revised classification is presented in Table 1. Unlike the previous classification, this classification does not recognize subtypes of type 1 diabetes and type 2 diabetes and includes new types of diabetes ("hybrid types of diabetes" and "unclassified diabetes").

13.
Environ Res ; 203: 111791, 2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34333012

RESUMO

Uranium (U) in groundwater is hazardous to human health, especially if it is present in drinking water. The semiarid regions of southern India chiefly depend on groundwater for drinking purposes. In this regard, a comprehensive sampling strategy was adopted to collect groundwater representing different lithologies of the region. The samples were collected in two different seasons and analysed for major and minor ions along with total U in the groundwater. Two samples during pre monsoon (PRM) and seven samples during post monsoon (POM) had U > 30 µgL-1, which is above the World Health Organization's provisional guideline value. The high concentration of U (188 µgL-1) was observed in the alluvial formation though a few samples showed the release of U near the pink granite (39 µgL-1) and the concentration was low in the lateritic formation (10 µgL-1). The uranyl carbonato complexes UO2(CO3)22- and UO2(CO3)34- were associated with high pH which facilitated the transport of U into groundwater especially during POM. U3O8 is the major form observed in groundwater compared to either UO2 or UO3 in the both seasons. The uranium oxides were observed to be more prevalent at the neutral pH. Though U concentration increases with pH, it is mainly governed by the redox conditions. The principal component analysis (PCA) analysis also suggested redox conditions in groundwater to be the major process facilitating the U release mechanism regardless of the season. The POM season has an additional source of U in groundwater due to the application of nitrogenous fertilizers in the alluvium region. Furthermore, redox mobilization factor was predominantly observed near the coastal region and in the agricultural regions. The process of infiltration of the fertilizer-induced U was enhanced by the agricultural runoff into the surface water bodies in the region. Health risk assessment was also carried out by determining annual effective dose rate, cancer mortality risk, lifetime average daily dose and hazard quotient to assess the portability of groundwater in the study area. Artificial recharge technique and reducing the usage of chemical based fertilizers for irrigation are suggested as sustainable plans to safeguard the vulnerable water resource in this region.

14.
JAMA Netw Open ; 4(6): 2113775, June. 2021. graf, tab
Artigo em Inglês | Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1283951

RESUMO

IMPORTANCE: Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized. OBJECTIVE: To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length. DESIGN, SETTING, AND PARTICIPANTS: This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021. EXPOSURES: Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping. MAIN OUTCOMES AND MEASURES: The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs. RESULTS: Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 AM (1:30 AM-3:00 AM). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 PM and 10 PM, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 AM and 6 AM (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8PM) nor wake-up time was associated with obesity. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.


Assuntos
Sono , Índice de Massa Corporal , Obesidade , Polissonografia
15.
J Assoc Physicians India ; 69(1): 71-73, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34227779

RESUMO

Tight glycemic control has been recognised as the cornerstone of modern diabetes management. Until recently, glycated hemoglobin (HbA1c) was the only reliable tool for measuring glycemic control, but it is not an ideal metric as it is retrospective, unable to pick up hypo- and hyperglycemic excursions and prone to interference by conditions such as anemia and hemoglobinopathies. The advent of continuous glucose monitoring systems is a giant leap in diabetes management as it enables visualisation of glucose trends over periods of time, helping in identification of hypo- and hypoglycemic events and enabling appropriate treatment decisions to be made. The recent launch of the real-time patient CGM in India is a further step in the right direction as it will empower patients to take control of their diabetes by providing them information on their glucose levels and trends in real time.


Assuntos
Automonitorização da Glicemia , Diabetes Mellitus Tipo 1 , Glicemia , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Índia , Insulina , Estudos Retrospectivos
16.
JAMA Netw Open ; 4(6): e2113775, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34190997

RESUMO

Importance: Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized. Objective: To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length. Design, Setting, and Participants: This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021. Exposures: Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping. Main Outcomes and Measures: The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs. Results: Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 am (1:30 am-3:00 am). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 pm and 10 pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 am and 6 am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm) nor wake-up time was associated with obesity. Conclusions and Relevance: This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.

17.
J Diabetes Complications ; 35(8): 107970, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34119405

RESUMO

AIM: The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus. METHODS: Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with anthropometric and biochemical measurements. A detailed neuropsychological assessment [Montreal cognitive assessment scale (MoCA), Trail making A and B, Digit span, Spatial span, Letter Number Sequencing] was done. Cognitive impairment was defined as MoCA score of <23. RESULTS: Participants (n=250, 50% women, 63.6% middle-age) had a mean (±SD) age of 53.6 (±9.1) years and HbA1c of 55.1±6.8mmol/mol (7.2±0.6%). Cognitive impairment was present in 57 (22.8%) participants. In the middle-age subgroup, cognitive impairment was higher (23.9%) than those in the fourth decade (6.3%), but comparable (24.0%) to the older age (60-70years) individuals. Diabetes-related vascular complications [Odds ratio (95% CI) 2.03 (1.05, 3.94)]; hypertension [2.00 (1.04, 3.84)], depression [2.37 (1.24, 4.55)] and lower education [2.73 (1.42, 5.23)] had a significant association with cognitive impairment on multivariate logistic regression analysis. CONCLUSION: The high burden of cognitive impairment calls for an urgent need to establish longitudinal cohorts in midlife to understand this population's cognitive trajectories and see the influence of various bio-psychosocial variables.

18.
Diabetes Care ; 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183429

RESUMO

OBJECTIVE: To directly compare the efficacy and safety of a fixed-ratio combination, of insulin glargine 100 units/mL and the glucagon-like peptide 1 receptor agonist lixisenatide (iGlarLixi), with those of a premix insulin analog, biphasic aspart insulin 30 (30% insulin aspart and 70% insulin aspart protamine) (BIAsp 30) as treatment advancement in type 2 diabetes suboptimally controlled on basal insulin plus oral antihyperglycemic drugs (OADs). RESEARCH DESIGN AND METHODS: In SoliMix, a 26-week, open-label, multicenter study, adults with suboptimally controlled basal insulin-treated type 2 diabetes (HbA1c ≥7.5% and ≤10%) were randomized to once-daily iGlarLixi or twice-daily BIAsp 30. Primary efficacy end points were noninferiority in HbA1c reduction (margin 0.3%) or superiority in body weight change for iGlarLixi versus BIAsp 30. RESULTS: Both primary efficacy end points were met: after 26 weeks, baseline HbA1c (8.6%) was reduced by 1.3% with iGlarLixi and 1.1% with BIAsp 30, meeting noninferiority (least squares [LS] mean difference -0.2% [97.5% CI -0.4, -0.1]; P < 0.001). iGlarLixi was also superior to BIAsp 30 for body weight change (LS mean difference -1.9 kg [95% CI -2.3, -1.4]) and percentage of participants achieving HbA1c <7% without weight gain and HbA1c <7% without weight gain and without hypoglycemia (all P < 0.001). iGlarLixi was also superior versus BIAsp 30 for HbA1c reduction (P < 0.001). Incidence and rates of American Diabetes Association level 1 and 2 hypoglycemia were lower with iGlarLixi versus BIAsp 30. CONCLUSIONS: Once-daily iGlarLixi provided better glycemic control with weight benefit and less hypoglycemia than twice-daily premix BIAsp 30. iGlarLixi is a more efficacious, simpler, and well-tolerated alternative to premix BIAsp 30 in suboptimally controlled type 2 diabetes requiring treatment beyond basal insulin plus OAD therapy. VIDEO 1: diacare;dc21-0393v4/F1F1f1Infographic available at https://care.diabetesjournals.org/content/dc21-0393-infographic.

19.
BMJ Open ; 11(6): e048926, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34145019

RESUMO

OBJECTIVE: People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. RESULTS: Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. CONCLUSION: People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.


Assuntos
COVID-19 , Pandemias , Doença Crônica , Controle de Doenças Transmissíveis , Humanos , Índia/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Percepção , Pesquisa Qualitativa , SARS-CoV-2
20.
J Public Health Policy ; 42(3): 501-509, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34012012

RESUMO

During the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India's first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.


Assuntos
COVID-19 , Política de Saúde , Pandemias , Telemedicina , COVID-19/epidemiologia , Humanos , Índia/epidemiologia
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