Incidence of diabetes in Asian-Indian subjects: a five year follow-up study from Bangladesh.

AIMS: To determine the incidence of Type 2 diabetes and its risk factors. Further, to examine the effect of relative changes in obesity (BMI and waist circumference). METHODS: A sample of 2011 non-diabetic adults aged 20 and above were randomly selected and followed from 1999 to 2004. Fasting blood glucose including biophysical and anthropometric measures was measured. RESULTS: The overall 5 year cumulative incidence of diabetes was 16.4 per 1000 person-years and 65.1 per 1000 person-years in those with impaired fasting glucose adjusted for age and sex. Among obesity measures, only waist >85in. increased the risk for diabetes in males (RR=3.0). Relative changes stratified by loss in BMI and WC ≥5% or gain of BMI >15% from the baseline values for men were significantly associated with the incidental cases of diabetes. Increased hip circumference for men was significantly associated with a protective effect while an opposite association was observed for women. CONCLUSION: Relative change in both loss and excessive gain of BMI were risks for increased diabetes. Targeted intervention in those with impaired fasting blood glucose will expectedly reduce the incidental cases. Further investigations are needed for non obese related diabetes in Asian Indian subjects.

In Bangladesh, overweight individuals have fewer symptoms of depression than nonoverweight individuals.

The aim of this study was to examine whether the association between overweight and depression usually found in western societies would also be found in locations where overweight is not stigmatized. A total of 1,271 individuals from rural Bangladesh were randomly selected; the response rate was 76%. Depressive symptoms were measured with the Montgomery-Asberg Depression Rating Scale (MADRS). The sum MADRS scores were 13.4 (s.d. = 5.8) and 18.5 (8.1) for overweight vs. nonoverweight (t = 6.6; P < 0.000) men, respectively, and 19.7 (7.8) and 23.2 (7.9) for overweight vs. nonoverweight women, respectively (t = 4.2; P < 0.000). Thus the MADRS score was lower in overweight individuals. After adjusting for sex and age, BMI significantly predicted the MADRS score (beta = -0.3; t = 10.2; P < 0.000). These findings suggest that overweight may be related to fewer depressive symptoms in non western cultures.

Depression and diabetes in a rural community in Pakistan.

AIMS: To determine the prevalence of depression amongst subjects with diabetes and associated risk factors in a rural area of Pakistan. METHODS: One thousand two hundred and ninety rural individuals aged 20 years and above were randomly included in the study. Fasting plasma glucose (FPG), BMI, WHR were recorded. Depression was assessed by Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: The prevalence of depression was 5.4% (95% CI: 4.2-6.6), slightly higher amongst women compared to men. Depression prevalence was 14.7% (6.6-22.8) amongst those with diabetes as opposed to 4.9 (3.7-6.1) amongst those without diabetes. Age, gender, and diabetes were independent risk factors for depression, while obesity had a protective effect. CONCLUSIONS: A relatively low prevalence of depression were recorded amongst the rural inhabitants, while a high prevalence was observed amongst diabetic subjects in Pakistan. This may suggest that psychiatric intervention may be required both for improved care and for primary prevention of diabetes.

A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.

BACKGROUND: Lamotrigine has been shown to be an effective treatment for bipolar depression and rapid cycling in placebo-controlled clinical trials. This double-blind, placebo-controlled study was conducted to assess the efficacy and tolerability of lamotrigine and lithium compared with placebo for the prevention of relapse or recurrence of mood episodes in recently manic or hypomanic patients with bipolar I disorder. METHODS: After an 8- to 16-week open-label phase during which treatment with lamotrigine was initiated and other psychotropic drug regimens were discontinued, patients were randomized to lamotrigine (100-400 mg daily), lithium (0.8-1.1 mEq/L), or placebo as double-blind maintenance treatment for as long as 18 months. RESULTS: Of 349 patients who met screening criteria and entered the open-label phase, 175 met stabilization criteria and were randomized to double-blind maintenance treatment (lamotrigine, 59 patients; lithium, 46 patients; and placebo, 70 patients). Both lamotrigine and lithium were superior to placebo at prolonging the time to intervention for any mood episode (lamotrigine vs placebo, P =.02; lithium vs placebo, P =.006). Lamotrigine was superior to placebo at prolonging the time to a depressive episode (P =.02). Lithium was superior to placebo at prolonging the time to a manic, hypomanic, or mixed episode (P =.006). The most common adverse event reported for lamotrigine was headache. CONCLUSIONS: Both lamotrigine and lithium were superior to placebo for the prevention of relapse or recurrence of mood episodes in patients with bipolar I disorder who had recently experienced a manic or hypomanic episode. The results indicate that lamotrigine is an effective, well-tolerated maintenance treatment for bipolar disorder, particularly for prophylaxis of depression.