Supported and unsupported claims in medicinal drug advertisements in Indian medical journals.

The study assessed 292 supported and unsupported claims in 102 medicinal drug advertisements across 15 Indian medical journals published in 2009. WHO ethical criteria for medicinal drug promotion were applied. None of the advertisements satisfied all the WHO criteria. Safe prescribing information on major adverse drug reactions, contraindications and warnings was provided in only 19 advertisements.

Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre.

Background & objectives: Depression is common among people with diabetes and it is associated with poor outcomes. This study was carried out to investigate the prevalence and determinants of depression in patients with established type 2 diabetes (T2DM) attending a tertiary care hospital in north India. Methods: Patients with established T2DM were evaluated for depression by administering the nine-item PHQ-9 (Hindi version). Binary logistic regression model was used to examine association between predictor variables and risk of depression. Results were expressed as odds ratio and 95 per cent confidence interval. Cronbach alpha was calculated to assess internal consistency of PHQ-9. Results: Patients with T2DM (n=300) were evaluated [147(49%) male and 153(51%) female]. The median duration of diabetes (IQ) was 8(4-13) yrs. Of the study patients, 68 (23%) met the criteria for major depression, 54 (18%) for moderate depression and the remaining 178 (59%) had no clinically significant depression. Depression was strongly associated with age >54 yr (OR 1.26, 95% CI 1.02-1.67; P<0.05), central obesity (OR 1.34, 95% CI 1.04-1.64; P<0.001), neuropathy (OR 1.94, 95% CI 1.03-3.66; P=0.002), nephropathy (OR 1.81, 95% CI 1.02-3.21; P=0.041), peripheral vascular disease (OR 6.08, 95% CI 1.07-34.6; P=0.042), diabetic foot disease (OR 2.32, 95% CI 1.06-5.86; P<0.001) and pill burden (>4) (OR 1.27, 95%CI 1.01-1.44; P=0.035 ). However, the likelihood of depression was not significant with duration of diabetes and insulin use. Interpretation & conclusion: This study showed high prevalence of depression in patients with T2DM. The risk factors for depression were age, central obesity, diabetic complications particularly neuropathy and diabetic foot disease and increased pill burden.

Predictors of metabolic syndrome in Asian north Indians with newly detected type 2 diabetes.

Background & objectives: The identifi cation of metabolic syndrome (MS) among patients with type 2 diabetes (T2DM) is of great importance, since those with MS carry a cluster of cardiovascular risk factors. This study evaluates suitable criteria with high effi ciency in diagnosing MS and to identify the strongest predictors of MS in newly detected type 2 diabetes individuals. Methods: Newly detected type 2 diabetes (<6 months) patients were assessed. The MS was assessed by WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), modifi ed NCEP-ATP-III and International Diabetes Federation (IDF) criteria. Receiver operating characteristics (ROC) curves of serum triglycerides, HDL, and waist circumference were created for the prediction of MS and the area under the corresponding curves (AUC) were used to evaluate the predictive effi ciency of each MS parameter. Different cut points in the selected variables and the corresponding sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were estimated. Results: Among the 563 newly detected T2DM individuals, the presence of MS ranged from 57 to 68 per cent according to the different criteria. The higher percentage of MS was observed in modifi ed NCEPATP III criteria. In comparison to men, presence of MS was higher in women in all the four criteria [198 (67%) vs. 165 (62%); 209 (70%) vs. 111 (42%); 231 (78%) vs. 151 (57%); 222 (75%) vs. 129 (49%)] by modifi ed WHO, NCEP-ATP III, modifi ed NCEP-ATP III, and IDF, respectively. The predictive ability to diagnose MS was highest with modifi ed NCEP-ATP III and lowest with IDF criteria. The optimal cut-off of waist circumference in men and women were 90 and 88 cm respectively. Serum triglyceride in men effectively indicated the presence of MS in newly detected T2DM individuals, whereas, in women the HDL-C was the stronger predictor of MS. Interpretation & conclusions: The study results show that modifi ed NCEP-ATP III criteria predict highest occurrence of MS in newly detected T2DM patients. Elevated serum triglyceride for men and decreased serum HDL-C in women were the strongest single predictors, effectively indicating presence of MS in newly detected T2DM.

Prevalence and predictors of metabolic syndrome in non-obese Asian Indians with newly detected type 2 diabetes mellitus.

We measured the prevalence and have evaluated the sensitivity, specificity, positive and negative predictive value of different predictors according to different standard criteria for metabolic syndrome in non-obese newly detected type 2 diabetes. Two hundred and fifteen patients of BMI <25 kg/m2 were studied. Metabolic syndrome prevalence was high in non-obese newly detected type 2 diabetes mellitus individuals. Greater prevalence of metabolic syndrome was observed in modified WHO (50.23%) and lesser in IDF (30.69%) classification. Non-obese metabolic syndrome individuals display significantly higher BMI, per cent body fat, waist circumference, hip circumference, waist hip ratio, blood pressure, triglyceride and a lower high density lipopratein than non-obese individuals without metabolic syndrome. The cut-off point for waist circumference in men was 86 cm and 79.7 cm for women (modified ATP III). Elevated serum triglyceride for men and low serum high density lipoprotein in women were the strongest predictors that effectively indicated the presence of metabolic syndrome in non-obese individuals.