An Expert Group Consensus Statement on “Approach and Management of Prediabetes in India”

The prevalence of prediabetes, a forerunner of diabetes is very high, and its conversion to diabetes is also more rapid among Asian Indians. Prediabetes also predisposes to the development of macrovascular and to a lesser extent of microvascular complications of diabetes. In a large community-based epidemiological study, the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB), data reported an overall prevalence of prediabetes of 10.3%, derived from 15 Indian states. This shows that the diabetes epidemic is far from over as many of them may soon convert to diabetes. Prediabetes, however, should not be considered a path to diabetes rather it should be a window of opportunity for the prevention of diabetes. This early screening, detection, and treatment of prediabetes should be made a national priority. Several countries have introduced lifestyle programs to prevent diabetes and, when indicated, pharmacological intervention with metformin as well. This consensus statement outlines the approaches to screening and lifestyle and pharmacological management of prediabetes in Asian Indians.

Targeted sequencing of the DMD locus: A comprehensive diagnostic tool for all mutations

Background & objectives: Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder and is caused mainly by deletion, duplication and point mutations in the DMD gene. Diagnosis of DMD has been a challenge as the mutations in the DMD gene are heterogeneous and require more than one diagnostic strategy for the validation of the mutation. This study was planned to evaluate the targeted next-generation sequencing (NGS) as a single platform to detect all types of mutations in the DMD gene, thereby reducing the time and costs compared to conventional sequential testing and also provide precise genetic information for emerging gene therapies. Methods: The study included 20 unrelated families and 22 patients from an Indian population who were screened for DMD based on phenotypes such as scoliosis, toe walking and loss of ambulation. Peripheral blood DNA was isolated and subjected to multiplex ligation-dependent probe amplification (MLPA) and targeted NGS of the DMD gene to identify the nature of the mutation. Results: In the study patients, 77 per cent of large deletion mutations and 23 per cent single-nucleotide variations (SNVs) were identified. Novel mutations were also identified along with reported deletions, point mutations and partial deletions within the exon of the DMD gene. Interpretation & conclusions: Our findings showed the importance of NGS in the routine diagnostic practice in the identification of DMD mutations over sequential testing. It may be used as a single-point diagnostic strategy irrespective of the mutation type, thereby reducing the turnaround time and cost for multiple diagnostic tests such as MLPA and Sanger sequencing. Though MLPA is a sensitive technique and is the first line of a diagnostic test, the targeted NGS of the DMD gene may have an advantage of having a single diagnostic test. A study on a larger number of patients is needed to highlight NGS as a single, comprehensive platform for the diagnosis of DMD.

Analysis Of Prevalence And Factors Influencing Adolescent Idiopathic Scoliosis Among School Students In Thiruvallur District

Background: The occurrence of AIS is on a high, which necessitates preventive measures at the earliest for which screening is essential at the school level. Prevalence of AIS around the world is 0.4- 5.2 %. Scoliosis leads to problems such as cosmetic deformity, quality of life, visible disability, backache, personal growth, autonomy, and reduced respiratory function. These problems can be prevented if scoliosis is diagnosed and treated earlier. To screen for AIS among selected schools and to analyze factors influencing adolescent idiopathic scoliosis. Methods: A total of 3250 Students between age 11 to 15 years were screened for AIS from Thiruvallur district. The screening was performed at two levels using Adam’s forward bend test and scoliometer, respectively. A detailed analysis was performed on symptomatic AIS subjects (n=58) for various influencing factors and determinants. Results: The prevalence of AIS from 11- 15 years was 0.27%, 0.30%, 0.49%, 0.36% and 0.33% respectively. AIS-affected thoracic region (50%) of females (58%) with a predominant right sided curvature (55%). Bag type and weight, sitting posture in a classroom, study posture was found to influence AIS. Conclusion: This study emphasizes early screening of AIS for school children at the age of 11- 15 years based upon the high prevalence rates compared to global standards. Parents and teachers should be aware of the bag type and weight, sitting and studying posture for early prevention of AIS.

Cord Blood Vitamin D Levels of Term Neonates.

We estimated cord blood 25-hydroxy vitamin D levels of 50 term healthy neonates born in a tertiary care center of Kozhikode, Kerala, India. Vitamin D levels were normally distributed with a mean (SD) value of 11.36 (4.75) ng/mL and median (range) values of 10.85 (3.9-24.9) ng/mL. Majority of babies had values between 5 to 15 ng/mL. This study shows that even in tropical climates most of our neonates are born with deficient vitamin D levels.

Analysis of heavy metals in dying wetland Pallikaranai, Tamil Nadu, India.

Pallikaranai wetland has high ecological significance as it has been a home for other associated biodiversities. This wetland is highly polluted due to the rapid industrialization, urbanization and dumping of solid waste. The water quality of the Pallikaranai wetland has been studied with reference to toxic metals. The metals analyzed include lead, chromium, iron, copper, nickel, zinc and cadmium. The heavy metal analysis in surface waters were in the following range ; Cd : BDL – 0.019 mg l-1, Fe : BDL – 1.52 mg l-1, Cu : BDL – 0.02 mg l-1, Ni : BDL- 0.60 mg l-1, Pb : 0.03 – 1.13 mg l-1, Zn : 0.002 – 0.14 mg l-1 and Cr : 0.10 – 1.52 mg l-1 respectively. The dominance of various heavy metals in the surface water of the Pallikaranai wetland followed the sequence: Pb> Cr > Fe > Ni > Zn > Cd > Cu. The quality of water has deterioted due to the various anthropogenic activities. Most of the metal ions were in higher concentration compared to the standards. It has been observed that the quality of the surface water is not safe for aquatic and domestic life, hence necessary management actions should be taken to control the quality of the surface water.

Assessment of air pollution tolerance levels of selected plants around cement industry, Coimbatore, India.

Being the second largest manufacturing industry in India, cement industry is one of the major contributors of suspended particulate matter (SPM). Since plants are sensitive to air pollution, introducing suitable plant species as part of the greenbelt around cement industry was the objective of the present study. Suitable plant species were selected based on the Air pollution tolerance index (APTI) calculated by analyzing ascorbic acid (AA), pH, relative water content (RWC) and total chlorophyll (TChl) of the plants occuring in the locality. Plants were selected within a 6 km radius from the industry and were graded as per their tolerance levels by analyzing the biochemical parameters. From the statistical analysis at 0.05 level of significance a difference in the APTI values among the 27 plant species was observed, but they showed homogenous results when analysed zone wise using one-way analyses of variance. Analyses of individual parameters showed variation in the different zones surrounding the cement industry, whereas the APTI value (which is a combination of the parameter viz. AA, RWC, TChl, pH) showed more or less same gradation. Significant variation in individual parameters and APTI was seen with in the species. All the plants surrounding the cement industry are indicative of high pollution exposure comparable to the results obtain for control plants. Based on the APTI value, it was observed that about 37% of the plant species were tolerant. Among them Mangifera indica, Bougainvillea species, Psidum quajava showed high APTI values. 33% of the species were highly susceptible to the adverse effects of SPM, among which Thevetia neriifolia, Saraca indica, Phyllanthus emblica and Cercocarpus ledifolius showed low APTI values.15% each of the species were at the intermediary and moderate tolerance levels.

Coriandrum sativum L. aqueous extract mitigates high fat diet induced insulin resistance by controlling visceral adiposity in C57BL/6J Mice / Coriandrum sativum L. extracto acuoso mitiga dieta rica en grasas de alta resistencia a la insulina inducida por el control de la adiposidad visceral en ratones C57BL/6J

This study investigates the effect of dietary supplementation with Coriandrum sativum L. seed aqueous extract (CS) to a high fat diet (HFD), for induced insulin resistance (IR) C57BL/6J mice. Changes in body weight, food intake, feed efficiency ratio, fasting blood glucose (FBG), plasma insulin, fasting insulin resistance index (FIRI), plasma and hepatic triglyceride (TG), total cholesterol (TC) and, plasma free fatty acid (FFA) levels were evaluated in control and treated groups. Also, the diameter, surface area and number of adipocytes and, intraperitoneal glucose tolerance test (IPGTT) and intraperitoneal insulin response test (IPRTT) were performed. CS supplementation (1 percent and 3 percent w/w) to HFD fed mice (for 12 weeks) significantly prevented HFD induced increment in body weight gain, food intake, feed efficiency, FBG, plasma insulin, FIRI, plasma and hepatic TG and TC and, plasma FFA, adipocyte diameter and surface area along with decrement in adipocyte number. Also, improved responses were recorded in the IPGTT and IPRTT in CS supplemented HFD fed mice. These set of changes were comparable to the rosiglitazone (0.05 percent) supplemented HFD fed mice. Our findings suggest that CS improves insulin sensitivity primarily by mitigating plasma and tissue lipids and, adipocyte hypertrophy.

En este estudio se investigó el efecto de un extracto acuoso de semillas de Coriandrum sativum L. (CS), adicionado a una dieta con alto contenido graso en ratones C57BL/6J, con resistencia a la insulina inducida. Los cambios en el aumento de peso corporal, consumo de alimento, eficiencia alimenticia, glicemia, insulina plasmática, índice de resistencia a la insulina, triglicéridos hepáticos y plasmáticos, colesterol total y concentración plasmática de ácidos grasos libres, fueron evaluados en grupos control y tratados. Adicionalmente se controló, el diámetro, superficie y número de adipocitos, prueba de tolerancia a la glucosa intraperitoneal y la prueba de respuesta de la insulina por vía intraperitoneal. La adición de CS (1 por ciento y 3 por ciento w / w) a la dieta con alto contenido graso a ratones (12 semanas) previno de manera significativa el incremento de peso, la ingesta de alimentos, la eficiencia alimenticia, FBG, la insulina plasmática, FIRI, los triglicéridos hepáticos y plasmáticos, el colesterol total, ácidos grasos libres plasmáticos, el diámetro de los adipocitos y la superficie junto con el decremento en el número de los adipocitos. Además, mejoras de la respuesta se registraron en el IPGTT y IPRTT. Este conjunto de cambios fue comparable al obtenido con rosiglitazona (0,05 por ciento), adicionada a la dieta con alto contenido graso. Estos hallazgos sugieren que el CS mejora la sensibilidad a la insulina principalmente por la mitigación de los lípidos del plasma, del tejido y la hipertrofia del adipocito.

Combined effects of chlorpyrifos and lead on biochemical parameters after repeated dose 90-day dietary exposure in wistar rats.

The presence of organophosphorus pesticides and heavy metals as food contaminants along the food production line is a common finding. To investigate the interactive/combination effects of chlorpyrifos (CPF) and lead acetate (LA) on biochemical parameters, Wistar rats were exposed to both via dietary mode for a period of 90 days. The study was designed using two different dose levels of CPF and LA, and grouped into seven groups: control - 0 (Group 1), CPF - 1 (Group 2), LA - 50 (Group 3), CPF - 1 + LA - 50 (Group 4), CPF - 10 (group 5), LA 1000 (Group 6) and CPF - 10 + LA - 500 (Group 7) ppm. The haematology and clinical chemistry parameters were evaluated at the end of weeks 4 and 13 of exposure period, and after 4 weeks of recovery period. There were no significant changes in haematological parameters, except for a slight anaemic effect in leadtreated animals. Serum biochemistry revealed reductions in serum and RBC cholinesterase enzymes at the end of weeks 4 and 13 in groups 5 and 7. The 90-day exposure followed by a post-treatment free period of 28-days revealed higher inhibition of RBC cholinesterase enzyme in the recovery group of Chlorpyrifos-plus-Lead treated group, when compared with CPF-alone treated group. A similar trend was observed in serum glucose level of animals treated with a combination of CPF and lead after the treatment-free period of 28 days. The cholinesterase activity and serum glucose concentration observed in group 7 animals were not comparable to group 5 animals after 28 days of recovery period. The findings suggest long lasting and/or persistence of effects of a combination of chlorpyrifos and lead on glucose homeostasis and cholinesterase activity.

Exenatide and acute pancreatitis.

For a female, type 2 diabetic patient, with 4 years duration of diabetes, Exenatide (Byetta) was prescribed as glycaemic control was not satisfactory along with Glimepiride and Metformin. She had gastrointestinal disturbances, since the first day of the injection. From the eighth day she developed signs of acute pancreatitis which was confirmed with CT-Scan and biochemical investigations. Byetta was withdrawn, the patient was treated for acute pancreatitis and the symptoms subsided.

Population based study of quality of diabetes care in southern India.

OBJECTIVES: To analyse and compare the clinical profile and glycaemic outcome in known diabetic cases in South Indian urban and periurban populations. MATERIAL AND METHODS: Details of known type 2 diabetic cases identified in a population survey of diabetes in Chennai city, Kanchipuram town and Periurban Villages (PUV) of Panruti in Tamil Nadu were analyzed (n=524, M:F, 256:268). Glycaemic outcome, prevalence of hypertension, dyslipidaemia and obesity, and treatment details were studied and compared between the areas. RESULTS: Mean age at diagnosis was 45.3 +/- 10.1 years, prevalence of hypertension was 57.4% (32% known), 48% were obese and a larger percentage (63.3%) had abdominal obesity Dyslipidaemia was present in nearly 50%. Abnormalities were more in urban areas than in PUV. Glycaemic target (post prandial glucose < or =160 mg/dl) was met by 28.8% only; better results were seen in PUV. In PUV 46% were not taking any diabetic treatment. As expected, majority of patients in all areas were treated with oral drugs. CONCLUSIONS: This population-based data indicated that the clinical outcome in known diabetic cases was far from satisfactory even in the city, where specialized diabetes care was available.

Single dose effects of chlorpyrifos and lead combination on neurobehavioural aspects in wistar rats.

Chlorpyrifos, a well known organophosphorus insecticide, and the heavy metal lead, were evaluated for their simultaneous interactive effects on neurobehavioural parameters in Wistar rats after single dose exposure via oral gavaging. The study comprised of functional observation battery and motor activity tests. The study was designed using two different dose levels of chlorpyrifos and lead acetate and grouped into seven groups; control (group 1), chlorpyrifos-5mg/kg (group 2), lead acetate- 100mg/kg (group 3), chlorpyrifos-5mg/kg + lead acetate- 100mg/kg (group 4), chlorpyrifos-50mg/kg (group 5), lead acetate-1000mg/kg (group 6) and chlorpyrifos-50mg/kg + lead acetate-1000mg/kg (group 7). Excitotoxicity and motor activity changes were evident in groups 5 and 7 animals. The animals treated with chlorpyrifos at 50mg/kg exhibited behavioural changes after 2–3 hours of oral gavaging and waned over 2 days. At 50mg/kg chlorpyrifos + 1000mg/kg lead acetate, severe cholinergic signs were noticed approximately 24 hours of exposure and symptoms regressed over 4 days. The incidence and severity of cholinergic behavioural changes were more pronounced in group 7 animals. Chlorpyrifos in the presence of lead delays the cholinergic effects which might be due to its chelating properties with metals and predominant behavioural changes suggest potentiating role of lead on excitotoxicity of chlopyrifos. The present study will be potentially relevant for physicians/scientists to decipher more about variability of action that could arise from accidental poisoning by these agents.

High prevalence of cardiometabolic risk factors among young physicians in India.

AIM: To assess the health status of young Indian doctors engaged in clinical practice compared with the general population. MATERIALS AND METHODS: During a continuing medical education programme on diabetes, data from 2499 doctors from urban and semiurban areas, (mean age 39.0 + 9.0 yrs), were collected and was compared with 3278 subjects from general population (mean age 37.0 +/- 8.0 yrs). Prevalence of diabetes, hypertension, obesity, dyslipidaemia, metabolic syndrome, smoking and alcohol consumption were analysed. RESULTS: Doctors had significantly higher (p<0.001) prevalence of all abnormalities except diabetes, compared with the general population (diabetes 13.3 Vs 14.8%, impaired glucose tolerance 10.7 Vs 7.4%, hypertension 35.6% Vs 27.0%, obesity 55.5% Vs 35.8%, metabolic syndrome 29.0% Vs 24.8%). Undetected cases of diabetes and hypertension were similar in both groups. Use of alcohol was more common among doctors. Other illness was less common among doctors (13.2% Vs 21.8%, p < 0.001). CONCLUSIONS: In India, doctors had high prevalence of metabolic disorders showing that they had not taken good care of their health. Doctors need to be motivated to practise good healthcare habits that they advocate to their clients.

Parental influence on the spectrum of type 2 diabetes in the offspring among Indians.

AIM: Familial aggregation of type 2 diabetes and its vascular complications is strong in Indians. In this study, we have analysed whether the age of the parent at birth of the offspring had any influence on the age at diagnosis of diabetes and age at onset of microvascular complications in the diabetic offspring. METHODS: Families with either a type 2 diabetic father or mother and a type 2 diabetic offspring, all of whom had been tested at our centre were included in this study (n = 300, father--122, mother--178, offspring male --201, female--99). Anthropometric details, age at diagnosis of diabetes, age at onset of complications and duration of diabetes were recorded. All relevant clinical and investigatory tests were done and appropriate statistical analyses were done. RESULTS: Age at onset of diabetes was lower in the offspring than in their parents at least by a decade. The age at diagnosis of diabetes in the offspring was determined inversely by the age of the parent at childbirth (p<0.001) and positively by the age of onset of diabetes and the presence of complications in the parents (both p<0.0001). Moreover, the age at diagnosis of complications in the offspring were determined inversely by the age of the parent at childbirth (p=0.0001) and positively by the age of onset of complications in the parents (p=0.0009). DISCUSSION: A younger parental age at childbirth was protective to the offspring in that the offspring developed diabetes and the complications at an older age.

Stress and undetected hyperglycemia in southern Indian coastal population affected by tsunami.

AIM: Natural calamities are known to result in higher stress conditions and also result in adverse health outcomes including development of non-communicable diseases. The impact of tsunami on mental stress and prevalence of hyperglycemic conditions was assessed in a population affected by the calamity in coastal populations of southern India. METHODS: Two populations similar in demography and physical characteristics, but, one affected by tsunami were selected for a comparative study. Subjects aged 20 years or above were randomly selected (control population n = 1176; tsunami population n = 1184). Details of stress were assessed using Harvard trauma questionnaire and scores were assigned. Glucose tolerance was assessed using 2h capillary blood glucose (75gms glucose load) and diagnosis was made using WHO criteria. RESULTS: Stress score was significantly higher in tsunami population. Although the total prevalence of diabetes was similar (control - 10.0 %; tsunami population - 10.5 %) prevalence of undetected diabetes (5.7 % vs. 3.8 %; Z = 9.54, P < 0.001) and impaired glucose tolerance (9.8 % vs. 8.3 %; Z = 12.83, P < 0.001) higher in the tsunami area. Stress score was higher in women and in the young in the tsunami area. CONCLUSION: Population affected by tsunami was under high stress and also showed a high prevalence of undetected diabetes and impaired glucose tolerance.

Profile of diabetic foot complications and its associated complications--a multicentric study from India.

AIM: The aims of this study were to determine. The prevalence of foot complications such as neuropathy, peripheral vascular disease (PVD), amputations and infections and the associated diabetic complications and practice of foot care among these subjects. METHODS: A total of 1319 type 2 diabetic patients, were selected from four different centres across India. The centres were Diabetes Research Centre (DRC), Chennai, Government Rajaji Hospital (GRH), Madurai, Christian Medical College (CMC), Vellore and All India Institute of Medical Science (AIIMS), Delhi. Details were collected regarding foot problems and associated complications. RESULTS: The prevalence of neuropathy was 15% (n=193) and PVD was 5% (n=64). Infections were present in 7.6% (n=100) of patients. The infection rate varied from 6-11% in the different centres. Nearly 3% of subjects had undergone a minor or major amputation. DISCUSSION: This study found that the prevalence of infection was 6-11% and prevalence of amputation was 3% in type 2 diabetic patients. Neuropathy (15%) was found to be an important risk factor for diabetic foot infections. Effective foot care advice should be propagated to reduce the burden imposed by diabetic foot complication particularly in developing countries like India.