management of glycemic control in associated disorders

Glycemic control is a very useful parameter for the prevention of the chronic metabolic diseases complications such as diabetes, metabolic syndrome, cardiovascular and kidney disease. Glycemic control management among chronic metabolic diseases has been an area of active research from the past decades. The glycemic index specifies that how fasting blood glucose level is elevated after consuming a high carbohydrate-containing diet. The metabolic studies among the human populations showed that glycemic index is directly related with different chronic metabolic diseases. The sturdiest associations are suggested that the low caloric diet consumption can prevents metabolic complications. Primary and tight glycemic control is compulsory to prevent and reduce the development of vascular complications in individuals with chronic disorders. The aim of this review was to provide a practical guideline on the bases of the survey of the related key studies which had reflected the clinical guidelines and current perspectives related to glycemic management. The objective of this review is also to investigate the interventions, related to glycemic control in patients with diabetes, metabolic syndrome and cardiovascular diseases. In conclusion, we can say that multidisciplinary management of glycemic control are powerful measure for the prevention of metabolic diseases complications, providing necessary support for reducing in economic burden of chronic metabolic diseases

Prevalence of metabolic syndrome among obese diabetic subjects

Background: Metabolic syndrome [MS] is a cluster of metabolic risk factors including obesity, glucose intolerance, insulin resistance, dyslipidemia and hypertension. MS in obese and type 2 diabetic [T2DM] subjects increases the risk of cardiovascular diseases [CVD]. The objective of the present study is to estimate the prevalence of MS in obese T2DM subjects by using International Diabetes Federation [IDF] and National Cholesterol Education Program-Adult Treatment Panel III [NCEP-ATP III] definitions

Methods: Obese T2DM [n=70] and normal healthy subjects [n=30] of both genders were selected from hospitals and diabetic centers of various localities of Karachi, Pakistan. The frequency of MS was estimated by utilizing criteria of the proposed definitions of IDF and NCEP-ATP III

Results: The prevalence of MS using IDF definition in obeseT2DM subjects was 85.7%. It is significantly higher [p

Conclusion It is concluded that, the overall prevalence of MS is increasing significantly in obese T2DM subjects by using IDF and NCEP - ATP III definitions. However, IDF is more stringent for defining MS. Therefore, it is needed to initiate the preventive measures of a healthy lifestyle and emphasis should be given to reduce weight, increase physical activity, and increase intake of healthy low-glycemic-index foods

Effect of simvastatin on insulin sensitivity in type 2 diabetic subjects

To study the effect of Simvastatin therapy on insulin sensitivity in type 2 Diabetes mellitus subjects. This is a randomized case control study, conducted at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. The study was conducted in 100 type 2 diabetes subjects of both sexes. Patients were randomized into two groups. Fifty patients were given Simvastatin 40mg/day for three months while 50 patients were used as controls. Both groups had similar anthropometric [age, duration of diabetes, BMI and Blood pressure] and biochemical [serum creatinine, fasting plasma glucose, fasting insulin level and lipid profile] characteristics. Insulin resistance was assessed by calculating homeostasis model assessment for insulin resistance [HOMA-IR] before and after 3 months of simvastatin treatment [40mg/day]. Simvastatin [40mg/day] markedly decreased cholesterol, triglycerides and LDL levels but did not significantly affect insulin sensitivity as determined by HOMA-IR. However it improved insulin sensitivity in subjects having insulin resistance.[HOMA IR reduction 1.92; p=0.001] Short term simvastatin therapy [3 months] had no effect on insulin sensitivity, but had a significant lipid lowering effect in all the subjects

Serum lipids and lipoproteins in chronic primary glomerular diseases

Chronic Primary Glomerular Diseases [CPGD] that are common in our country, are often neglected and not given due attention, leading rise in number of patients with renal failure. Hyperlipidemia and lipoprotein abnormalities may play role in development of glomerular atherosclerosis in renal disease. Study was designed to characterize the status of lipids and lipoproteins in patients with CPGD and to find their correlation with serum albumin and that correction of the hyperlipidemia would be favorable in solving the progress of the renal failure. Study was conducted at Biochemistry Department, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC] Karachi. Seventy uncomplicated nephrotic patients [44 males, 26 females; age range 18 - 51 rears] with biopsy-proven CPGD were collected from Nephrology Department, JPMC, Karachi and twenty age- matched control subjects were investigated for serum total protein, albumin, triacylglycerols, total cholesterol, high-density lipoprotein cholesterol [HDL- cholesterol] and low-density lipoprotein cholesterol [LDL- cholesterol]. A highly significant [P<0.001] increase levels of triacylglycerols, total cholesterol, LDL- cholesterol, and the ratio of LDL-cholesterol to HDL- cholesterol, whereas a highly significant [P<0.001] decrease levels of serum HDL-cholesterol, total protein and albumin were observed in all patients when compared to matched control subjects. The correlation coefficient between serum albumin vs. triacylglycerols and total cholesterol were negative but highly significant [r = -0.68 and r = -0.64] were observed in such patients. It was concluded that CPGD are accompanied invariably by alteration in lipids and lipoproteins, which have potential for accelerating the atherosclerosis and increasing the risk of renal failure

Assessment of insulin resistance in type 2 diabetic subjects at a tertiary care hospital of Karachi Pakistan

During the last few decades there has been a surge of interest in the assessment of insulin resistance. Our study aims to identify the insulin resistance in type 2 diabetic population so that we might be able to identify insulin resistance easily in daily routine clinical practice. All type 2 diabetic subjects having age 30 years or more are selected with exclusion criteria [hepatic, renal or cardiac impairment]. After taking informed consent from the patients fasting blood samples were taken. Assessment of insulin resistance was done by homeostasis model assessment HOMA. HOMA-R = Insulin [mu/ml] x glucose [mmol/1]/22.5 All statistical analyses were performed using the statistical program SPSS [version 11] A Total of 118 subjects were recruited in the study. Mean age of subjects was 49.1 +/- 10.2 years. Mean BMI was 27.8 +/- 4.9 kg/m2o Subjects comprising of 62.4% males and 37.6% females. Mean HOMA in our Type 2 diabetic subjects was 4.1 [male 4.41 and female 3.73]. In our study 73.7% subjects has HOMA value of 1. 77 or more, while 57% have HOMA value of 2.8 or more

Biological properties of some medically important snake species of Pakistan

Venoms from eight medically important snake species including three sea snake species, belonging to families Viperidae and Elapidae, were tested for lethal, hemolytic [direct and indirect] edema - inducing and hemorrhagic activities. The species includes five from family Elapidae; Hydrophis cyanocinctus, Enhydrina schistosa, Naja naja. Bungarus caeruleus and Microcephalophis gracilis gracilis whereas three from family Viperidae; Vipera russelli russelli, Eristochphis macmahoni and Echis carinatus. All venom tested moderate to high levels of lethal, hemolytic [both direct and indirect] and edema - inducing activities, except that venoms of snake species of family Elapidae, including the sea snake species, are characterized by low levels or absence of hemorrhagic activity. LD 50 values were found to be 0.39mg/kg 0.41 mg/kg 0.28 mg/kg. 0.30 mg/kg and 0.40 mg/kg for the species of family Elapidae respectively whereas 0.30 mg/kg, 0.26 mg/kg and 0.41 mg/kg for species of family Viperidae

Effect of drugs against cytotoxic compounds from marine animals I-nephrotoxic activity of sea-snake microcephalophis gracilis gracilis venom

Protective effectiveness of two Ca2+ - antagonist drugs, verapamil and diltiazem were tested against nephrotoxic activity of sea - snake Microcephalphis gracilis gracilis venom in guinea pigs and albino rats. Administration of both lethal and sublethal does of Microcephalphis gracilis gracilis crude venom induced glomerulonephritis and tubular degeneration in kidneys of envenomated animals accompanied by increased tissue Ca2 + concentration. Administration of both verapamil and diltiazem in envenomated animals not only cause significant decrease in ca2 + concentration but also reduced necrosis and cellular degeneration in kidneys. It is thus suggested that cytotoxic compounds present in this marine vomom cause tissue and cellular necrosis by increasing Ca2+ influx within the cells which in turn stimulates Ca2 + -dependent processes resulting in both organ dysfunction and some - time fatality in few cases