Hypoglycaemic activity of Bixa orellana extract in the dog.

In West Indian folklore, a variety of plants are used for medicinal purposes. One such plant, Bixa orellana (annatto), is commonly used in the treatment of diabetes mellitus. Preliminary studies have shown that a crude annatto seed extract exhibited either glucose lowering or hyperglycaemia-inducing activity depending on how it was further manipulated. This present investigation sought to determine the effects of the glucose-lowering extract on C-peptide and streptozotocin-induced diabetic dogs. This annatto extract was found to decrease blood glucose levels in fasting normoglycaemic and streptozotocin-induced diabetic dogs. In addition, in normal dogs, it suppressed the postprandial rise in blood glucose after an oral glucose load. Interestingly, the extract also caused an increase in insulin-to-glucose ratio in normal dogs. Increased insulin levels were not due to increased insulin synthesis as after 1-h residence time and half-hour postprandial, decreased C-peptide levels was observed. It was concluded that Bixa orellana (annatto) lowered blood glucose by stimulating peripheral utilization of glucose, and it is possible that this glucose-lowering extract might be of pharmacological importance.

Some bio-medical mechanisms in athletic prowess.

Variations in somato-genetic patterns in muscle-fibre biology, biochemical metabolic pathways and pulmonary physiology are hypothesized to have been concentrated by natural selection over the centuries in the Afrocentric peoples displaced from West Africa to the New World. These phenotypic and genotypic characteristics are attributed to provide the athletic prowess so well documented in African-Americans. Not the least of coincidence seems to be the influence of the compensatory mechanisms on oxygen transport and its availability to the tissues, in response to the sickle cell gene. The reduced availability coupled with reduced myoglobin in the preponderant fast-twitch muscle fibres which are adapted for rapid energy (ATP) regeneration, all give a NET outcome of muscle anatomical and biochemical advantages which support outstanding performances in athleticism.

Food processing methods influence the glycaemic indices of some commonly eaten West Indian carbohydrate-rich foods.

Glycaemic index (GI) values for fourteen commonly eaten carbohydrate-rich foods processed by various methods were determined using ten healthy subjects. The foods studied were round leaf yellow yam (Dioscorea cayenensis), negro and lucea yams (Dioscorea rotundata), white and sweet yams (Dioscorea alata), sweet potato (Solanum tuberosum), Irish potato (Ipomoea batatas), coco yam (Xanthosoma spp.), dasheen (Colocasia esculenta), pumpkin (Cucurbita moschata), breadfruit (Artocarpus altilis), green banana (Musa sapientum), and green and ripe plantain (Musa paradisiaca). The foods were processed by boiling, frying, baking and roasting where applicable. Pure glucose was used as the standard with a GI value of 100. The results revealed marked differences in GI among the different foods studied ranging from 35 (se 3) to 94 (se 8). The area under the glucose response curve and GI value of some of the roasted and baked foods were significantly higher than foods boiled or fried (P<0.05). The results indicate that foods processed by roasting or baking may result in higher GI. Conversely, boiling of foods may contribute to a lower GI diet.

The Unitarian Hypothesis for the aetiology of diabetes mellitus.

Over the years, several clinical syndromes have been described in diabetes mellitus. Although world opinion has settled somewhat on the main two types, the debate continues as to how the 'formes frustes' syndromes fit in and what if any implications there are for the accepted aetiology of the disease. Type 1, insulin dependent diabetes mellitus, results from pancreatic inadequacy as a result of a variety of insults such as autoimmune attack, toxic damage, etc. Insulin administration is at the core of the therapeutic approach. Type 2, non insulin dependent diabetes mellitus, results from reduced responsiveness of the target tissues to insulin and as such, an insulin resistance syndrome is described. Lifestyle adjustment and oral hypoglycaemic agents are the mainstay of therapy. Over the years, however, insulin insufficiency will develop in most cases and insulin therapy required in order to achieve normoglycaemia. The aetiology of these main two types has been maintained to be distinct from each other and as such types 1 and 2 are described as two separate developmental conditions. Furthermore, the variant patterns, such as malnutrition related, drug induced, intermittent or phasic insulin requiring, gestational, temporary, stress related, etc., all present a challenge as to how they fit in aetiologically. The Unitarian Hypothesis, by presenting this overall cascade of biochemical and physiological interactions, brings a logic which embraces the points of entry of a variety of insults, all of which can lead to the clinical picture of hyperglycaemia and its attendant adverse outcomes. The hypothesis buttresses the belief that nature - the genetic predisposition which directs potential antibody development; and nurture - the environmental influences such as nutritional status (over- or under-), infective and toxic attack, can aggravate or initiate aspects of the cascade of reactions leading to hyperglycaemia. The causative agents functioning internally within the cascade are imputed to be free radicals, oxidizing molecular species and antibodies and the corollary to this overview concept would be that a situation that minimizes the genesis and accumulation of these three agents would minimize the development of diabetes mellitus. Currently the debate is rife about the use of free radical scavengers and antioxidants in the treatment and prevention of diabetes mellitus. The verdict is still out on this approach. Our research on rootcrops such as yams and cassava, staple foods in tropical countries, indicates the presence of cyanoglycosides such as linamarin, which on digestion yields cyanide radicals. These radicals are pancreatotoxic especially in the undernourished state. Dog models however, have shown that free radical scavengers such as riboflavin, Vitamin B(2), is protective against this toxic damage. Further, scientific investigations have clearly demonstrated the role of antibody attack and have been able to ward off the appearance of type 1 diabetes mellitus in susceptible individuals, by the early use of immunosuppressive therapy such as cyclosporin. Thus the Unitarian Hypothesis demonstrates how all types of clinical syndromes being described in diabetes mellitus are not necessarily variants of a specific illness but rather manifestations of a central process of membrane damage-->antibody response-->insulin inadequacy (quantitatively or qualitatively); and the future intervention in containing this disease may well lie in focusing on preservation of the integrity of the body's cell membranes.

Some bio-medical mechanisms in athletic prowess / Algunos de los mecanismos biomédicos de las proezas atléticas

Variations in somato-genetic patterns in muscle-fibre biology, biochemical metabolic pathways and pulmonary physiology are hypothesized to have been concentrated by natural selection over the centuries in the Afrocentric peoples displaced from West Africa to the New World. These phenotypic and genotypic characteristics are attributed to provide the athletic prowess so well documented in African-Americans. Not the least of coincidence seems to be the influence of the compensatory mechanisms on oxygen transport and its availability to the tissues, in response to the sickle cell gene. The reduced availability coupled with reduced myoglobin in the preponderant fast-twitch muscle fibres which are adapted for rapid energy (ATP) regeneration, all give a NET outcome of muscle anatomical and biochemical advantages which support outstanding performances in athleticism.

Existe la hipótesis de que los patrones somatogenéticos en la biología fibromuscular, las vías meta-bólicas bioquímicas, y la fisiología pulmonar, se han concentrado mediante selección natural a lo largo de siglos, en los pueblos afrocéntricos desplazados desde C1frica Occidental al Nuevo Mundo. A estas características fenotípicas y genotípicas se les atribuye las proezas atléticas, tan bien docu-mentadas en los afroamericanos. Tampoco parece ser coincidencia en lo más mínimo, la influencia de los me-canismos compensatorios de transporte de oxígeno, y su disponibilidad en los tejidos, en respuesta al gene de la célula falciforme. Esta disponibilidad reducida acoplada con la mioglobina reducida en las fibras musculares de contracción rápida preponderantes que están adaptadas para la rápida re-generación de energía (ATP), producen de conjunto un resultado neto en términos de ventajas musculares anatómicas y bioquímicas que constituyen la base de las actuaciones destacadas en el atletismo.

The effect of annatto on insulin binding properties in the dog.

Various plants are used in Caribbean folklore for the treatment of a variety of illnesses including diabetes mellitus. Preliminary investigations of several crude plant extracts have indicated that the annatto (Bixa orellana), among others, does in fact exhibit hypoglycaemic properties. This present investigation sought to isolate the hypoglycaemic principle(s) from the crude extract and to determine the mechanism of action. Purification experiments employing thin layer chromatography (TLC) and high performance liquid chromatography (HPLC) resulted in an oil-soluble, partially purified annatto extract. The latter caused a decrease in blood glucose level of 5.62+/-0.13 (n=34) mmol/dL versus 6.31+/-0.12 (n=34) for the control (p<0.01) 1 h after administration. This hypoglycaemia persisted for an additional hour when the oral glucose tolerance test (OGTT) was performed on dogs treated with annatto and compared with the control. Plasma insulin levels measured at 1.0 h showed that there was an increase in plasma insulin levels of 59.57+/-8.3 microIU/mL for the annatto treated dogs versus 40.95+/-5.46 microIU/mL for the control (p<0.05), this elevation persisted throughout the duration of the OGTT which followed. Insulin receptor studies, using a modification of the method of Gambhir et al. done on mononuclear leucocytes and erythrocytes obtained from blood taken 1 h after administration showed that there was an increase in the percentage receptor binding when compared with the control. Insulin affinity results showed that there was an increase of 1.8+/-0.2x10(8) m-1 (n=12) in mononuclear leucocytes for the annatto treated dogs versus 1.2+/-0.2x10(8) m-1 for the control (p<0.05). In the enythrocytes, there was also an increase in affinity from 1.2+/-0.2x10(8) m-1 to 2.3+/-0.2x10(8) m-1 for the control and treated animals, respectively. In conclusion, it can be stated that annatto is responsible for the hypoglycaemic episodes seen in the dogs which was mediated by an increase in plasma insulin concentration as well as an increase in insulin binding on the insulin receptor due to elevated affinity of the ligand for the receptor.

Changes in some liver enzymes in streptozotocin-induced diabetic rats fed sapogenin extract from bitter yam (Dioscorea polygonoides) or commercial diosgenin.

The effects of steroidal sapogenin extract from bitter yam or commercial diosgenin on liver enzyme changes were investigated Diabetic male Wistar rats were fed diets supplemented with 1% steroidal sapogenin extract or commercial diosgenin for three weeks. Plasma glucose levels and the activities of hepatic glucose-6-phosphatase, pyruvate kinase and glucose-6-phosphate dehydrogenase were assessed Liver total cholesterol, HDL-cholesterol and total phospholipid were also measured. Plasma glucose decreased significantly (p < 0.05) in diabetic rats fed the three test diets compared to the diabetic control. The three test diets significantly decreased glucose-6-phosphatase activity compared to the diabetic control The activities of ATP-citrate lyase, pyruvate kinase and glucose-6-phosphate dehydrogenase were significantly reduced in the liver of diabetic rats compared to normal control. Supplementation of the diet with bitter yam steroidal sapogenin extract or commercial diosgenin did not significantly alter ATP citrate lyase and pyruvate kinase activities but significantly increased glucose-6-phosphate dehydrogenase activity in the liver compared to diabetic rats. This study shows that the feeding of the two test diets to diabetic rats results in alterations in the metabolism of glucose with subsequent reduction in plasma glucose concentration.

The effect of phytic acid on the levels of blood glucose and some enzymes of carbohydrate and lipid metabolism.

In this study, six groups of rats were fed as follows: Groups 1 and 2 were fed formulated diets supplemented with zinc or without zinc respectively. Groups 3 and 4 were fed formulated diets supplemented with zinc plus phytic acid extracted from sweet potato (Ipomea batatas) or commercial phytic acid respectively. Groups 5 and 6 were fed formulated diets supplemented with phytic acid extract from sweet potato or commercial phytic acid respectively. The animals were fed for three weeks and then sacrificed The activities of key enzymes of carbohydrate and lipid metabolism as well as transaminases in the liver were determined. Blood glucose level was also assessed. Phytic acid extract consumption from sweet potato and commercial phytic acid plus zinc supplement lowered blood glucose levels. There was no significant change in the activity of 6-phosphogluconate dehydrogenase among the groups. Similarly, phytic acid supplementation showed no significant decrease in the activity of pyruvate kinase compared to the group fed formulated diets. There was a significant increase in the activity of glucose-6-phosphate dehydrogenase in the groups fed phytic extract from sweet potato compared to the other groups. The activities of malic enzyme and ATP-citrate lyase in this study were not significantly altered among the groups. There is a lowering of blood glucose levels which is desirable for diabetics who consume sweet potato diets. The changes in some of the hepatic metabolic enzymes are geared towards compensating for the decreased glycolytic responses.

Changes in some liver enzymes in streptozotocin-induced diabetic rats fed sapogenin extract from bitter yam (Dioscorea polygonoides) or commercial diosgenin / Cambios en Algunas Enzimas Hepáticas en ratas con Diabétes Inducida Mediante Estreptozotocina, Alimentadas con Extracto de Sapogenina de ñame Amargo (Dioscorea polygonoides) o Diosgenina Comercial

The effects of steroidal sapogenin extract from bitter yam or commercial diosgenin on liver enzyme changes were investigated Diabetic male Wistar rats were fed diets supplemented with 1 steroidal sapogenin extract or commercial diosgenin for three weeks. Plasma glucose levels and the activities of hepatic glucose-6-phosphatase, pyruvate kinase and glucose-6-phosphate dehydrogenase were assessed Liver total cholesterol, HDL-cholesterol and total phospholipid were also measured. Plasma glucose decreased significantly (p < 0.05) in diabetic rats fed the three test diets compared to the diabetic control. The three test diets significantly decreased glucose-6-phosphatase activity compared to the diabetic control The activities of ATP-citrate lyase, pyruvate kinase and glucose-6-phosphate dehydrogenase were significantly reduced in the liver of diabetic rats compared to normal control. Supplementation of the diet with bitter yam steroidal sapogenin extract or commercial diosgenin did not significantly alter ATP citrate lyase and pyruvate kinase activities but significantly increased glucose-6-phosphate dehydrogenase activity in the liver compared to diabetic rats. This study shows that the feeding of the two test diets to diabetic rats results in alterations in the metabolism of glucose with subsequent reduction in plasma glucose concentration

Se investigaron los efectos del extracto de sapogenina esteroidal del ñame amargo o la diosgenina comercial, sobre los cambios enzimáticos del hígado. A ratas Wistar machos con diabetes les fueron suministradas dietas con suplementos de 1% de extracto de sapogenina esteroidal o diosgenina comercial por espacio de tres semanas. Se evaluaron los niveles de glucosa plasmática y las actividades de la glucosa-6-fosfatasa hepática, el piruvato kinasa y la glucosa-6-fosfato deshidrogenasa. Asimismo fueron medidos el colesterol total del hígado, el colesterol HDL y el fosfolípido total. La glucosa plasmática disminuyó significativamente (p < 0.05) en las ratas diabéticas a las que se les alimentó con las tres dietas de la prueba, en comparación con el control diabético. Las tres dietas de la prueba disminuyeron significativamente la actividad de la glucosa-6-fosfatasa en comparación con el control diabético. Las actividades de la ATP-citrato liasa, la piruvato kinasa y la glucosa-6-fosfato deshidrogenasa disminuyeron significativamente en el hígado de las ratas diabéticas, en comparación con el control normal. El suplemento dietético con extracto de sapogenina esteroidal de ñame amargo o la diosgenina comercial no alteró de manera significativa las actividades de la ATP-citrato liasa y la piruvato kinasa, pero aumentó significativamente la actividad de la glucosa-8-fosfato deshidrogenasa en el hígado, en comparación con las ratas diabéticas. Este estudio demuestra que la alimentación con las dos dietas de prueba suministrada a las ratas diabéticas, produce alteraciones en el metabolismo de la glucosa, con la consiguiente reducción de la concentración de glucosa plasmática

The effect of phytic acid on the levels of blood glucose and some enzymes of carbohydrate and lipid metabolism / El Efecto del ácido fítico sobre los niveles de la glucosa en sangre y sobre algunas enzimas del metabolismo de carbohidratos y lípidos

In this study, six groups of rats were fed as follows: Groups 1 and 2 were fed formulated diets supplemented with zinc or without zinc respectively. Groups 3 and 4 were fed formulated diets supplemented with zinc plus phytic acid extracted from sweet potato (Ipomea batatas) or commercial phytic acid respectively. Groups 5 and 6 were fed formulated diets supplemented with phytic acid extract from sweet potato or commercial phytic acid respectively. The animals were fed for three weeks and then sacrificed The activities of key enzymes of carbohydrate and lipid metabolism as well as transaminases in the liver were determined. Blood glucose level was also assessed. Phytic acid extract consumption from sweet potato and commercial phytic acid plus zinc supplement lowered blood glucose levels. There was no significant change in the activity of 6-phosphogluconate dehydrogenase among the groups. Similarly, phytic acid supplementation showed no significant decrease in the activity of pyruvate kinase compared to the group fed formulated diets. There was a significant increase in the activity of glucose-6-phosphate dehydrogenase in the groups fed phytic extract from sweet potato compared to the other groups. The activities of malic enzyme and ATP-citrate lyase in this study were not significantly altered among the groups. There is a lowering of blood glucose levels which is desirable for diabetics who consume sweet potato diets. The changes in some of the hepatic metabolic enzymes are geared towards compensating for the decreased glycolytic responses

En este estudio, se alimentaron seis grupos de ratas de la forma que a continuación se describe. Los grupos 1 y 2 fueron alimentados con dietas formuladas con o sin suplemento de zinc respectivamente. Los grupos 3 y 4 fueron alimentados con dietas formuladas con suplemento de zinc más ácido fítico extraído del boniato (Ipomea batatas) o el ácido fítico comercial respectivamente. Los grupos 5 y 6 fueron alimentados con dietas formuladas con suplemento de extracto de ácido fítico del boniato o ácido fítico comercial respectivamente. Los animales fueron alimentados durante tres semanas y luego sacrificados. Se determinó la actividad de las enzimas claves del metabolismo de carbohidratos y lípidos, así como las transaminasas en el hígado. Asimismo se evaluó el nivel de glucosa en sangre. El consumo de extracto de ácido fítico del boniato y el ácido fítico comercial más el suplemento de zinc, diminuyeron los niveles de glucosa en sangre. No hubo cambios significativos en la actividad de la 6-fosfogluconato deshidrogenasa entre los grupos. De modo similar, la suplementación con ácido fítico no mostró una disminución significativa de la actividad de la piruvato kinasa en comparación con el grupo alimentado con dietas formuladas. Sin embargo, hubo un aumento significativo en la actividad de la glucosa-6-fosfato deshidrogenasa en los grupos alimentados con extracto fítico de boniato en comparación con los otros grupos. No hubo alteración significativa de las actividades de la enzima málica y la ATP-citrato liasa en este estudio. Hay una disminución de los niveles de glucosa en sangre, deseable para los diabéticos que consumen dietas de boniato. Los cambios en algunas de las enzimas metabólicas hepáticas están encaminados a compensar la disminución de las respuestas glicolíticas.

Hypoglycaemic effect of stigmast-4-en-3-one and its corresponding alcohol from the bark of Anacardium occidentale (cashew).

Intravenous administration of the hexane extract of the bark of Anacardium occidentale (cashew) in normal, healthy dogs produced a significant lowering of the blood glucose levels. Pursuit of the hypoglycaemic principle(s) in the hexane extract resulted in the isolation and characterization of two compounds, stigmast-4-en-3-ol (1) and stigmast-4-en-3-one (2). These compounds were purified by chromatographic methods and the structures were characterized by spectroscopic methods. Both compounds produced significant hypoglycaemic activity after intravenous administration at a dose of 1.3 mg/kg body weight. The bark of the cashew plant, A. occidentale, exhibited a hypoglycaemic effect probably due to the presence of these compounds.

Obesity in the Caribbean: the Jamaican experience.

AIM: This study was designed to investigate the point prevalence and pattern of obesity in the Jamaican adult population. METHODS: A two-stage-stratified random sampling design was used, and individuals aged 15 years and over were interviewed. In addition, anthropometric measurements were performed. The data were analysed using the SPSS statistical software version 8. Non-response was documented and factored into the final analysis of the survey data. RESULTS: A total of 2105 individuals responded to the all island survey, with 69% being females. Truncal obesity and gynoid obesity showed similar prevalence data. Both were affected by increasing age, being female, level of education attained and smoking status. CONCLUSIONS: Jamaica has a point prevalence of obesity, truncal 36.2% and gynoid 34.1%, in the 15 and over age group.

Lead pollution and amelioration measures in the community of Frazers Content, St Catherine, Jamaica.

Lead poisoning, especially in children, is a preventable disease. Many children are exposed to this hazard, especially in poor communities, because of a paucity of information on lead poisoning and increasing economic hardships. In 1994, the case of the poor suburban community of Frazers Content, St Catherine, Jamaica, came to the public attention because of the high frequency of hospital admissions, or outpatient treatment, of children for lead poisoning. This paper reviews a Blue Cross of Jamaica-led-initiative aimed at the clean up and education of the Frazers Content community. The following four-pronged approach was employed: environmental and biological sampling and sample analysis, health education, decontamination and community clean up and entrepreneurial activities. The project outputs included: training of 17 community wardens and 22 schoolteachers; the clean up of 64 residences which had lead levels in excess of 500 ppm; the establishment of an entombment site for the contaminated soil in accordance with the Jamaica Natural Resources Conservation Authority and training of residents in entrepreneurial skills, chicken and rabbit rearing and nursery establishment. The paper includes discussion of the lessons learnt and recommendations for future action.

Lead pollution and amelioration measures in the community of Frazers Content, St Catherine, Jamaica

Lead poisoning, especially in children, is a preventable disease. Many children are exposed to this hazard, especially in poor communities, because of a paucity of information on lead poisoning and increasing economic hardships. In 1994, the case of the poor suburban community of Frazers Content, St Catherine, Jamaica, came to the public attention because of the high frequency of hospital admissions, or outpatient treatment, of children for lead poisoning. This paper reviews a Blue Cross of Jamaica-led-initiative aimed at the clean up and education of the Frazers Content community. The following four-pronged approach was employed: environmental and biological sampling and sample analysis, health education, decontamination and community clean up and entrepreneurial activities. The project outputs included: training of 17 community wardens and 22 schoolteachers; the clean up of 64 residences which had lead levels in excess of 500 ppm; the establishment of an entombment site for the contaminated soil in accordance with the Jamaica Natural Resources Conservation Authority and training of residents in entrepreneurial skills, chicken and rabbit rearing and nursery establishment. The paper includes discussion of the lessons learnt and recommendations for future action.

The effect of capsaicin on blood glucose, plasma insulin levels and insulin binding in dog models.

Capsicum frutescens has been used to treat diabetes mellitus by traditional healers in Jamaica. This study was designed to identify any hypoglycaemic principle(s) and to determine the mechanism of action. Purification experiments employing thin layer chromatography (TLC) and high performance liquid chromatography (HPLC) led to the extraction of the active principle, capsaicin. Capsaicin caused a decrease in blood glucose levels of 4.91 +/- 0.52 (n = 6) mmol/dL versus 6.40 +/- 0.13 mmol/dL (n = 6) for the control (p < 0.05) at the 2.5 h time interval when the oral glucose tolerance test (OGTT) was performed on dogs treated with capsaicin and compared with the control. Plasma insulin levels measured at the 2.5 h time interval showed that there was an increase in plasma insulin levels of 5.78 +/- 0.76 microIU/mL (n = 6) for the capsaicin treated dogs versus 3.70 +/- 0.43 microIU/mL (n = 10) for the control (p < 0.05). Insulin receptor studies, using a modification of the method of Gambhir et al. done on monocytes obtained from blood at the 2.5 h time interval showed that there was a decrease in the percentage receptor binding for the capsaicin treated dogs when compared with the control. Insulin affinity results showed that there was a decrease of 2.4 x 10(-4) in monocytes for the capsaicin treated dogs versus 8.77 x 10(-4) for the control (p < 0.05). Also, insulin receptor calculations showed a decrease in number, 2.63 x 10(8) +/- 5.73 x 10(7), compared with 8.77 x 10(8) +/- 1.47 x 10(8) for the control. In conclusion it can be stated that capsaicin is responsible for the hypoglycaemic episodes seen in the dogs and that it also causes an increase in insulin secretion which leads to a reduction of insulin binding on the insulin receptors.

Effect of yam (Dioscorea cayenensis) and dasheen (Colocassia esculenta) extracts on the kidney of streptozotocin-induced diabetic rats.

Streptozotocin-induced diabetic wistar rats were maintained for 4 weeks on a supplement of extracts of yam (Dioscorea cayenensis) or dasheen (Colocassia esculenta). The activities of malic enzyme, NADP+ isocitrate dehydrogenase, Glucose 6-P-dehydrogenase and the transaminases were determined to assess any degree of metabolic alteration caused by diabetic nephropathy. Diabetic rats fed normal diet and those fed yam extract, dasheen extract and commercial linamarin respectively lost weight significantly compared to healthy controls. The diabetic rats fed dasheen extract, maintained near normoglycaemic values compared to diabetic rats on normal diet (P < 0.05). Malic enzyme activity was significantly reduced (P < 0.05) in diabetic rats on the normal diet compared to normal healthy controls. Feeding of yam or dasheen extract raised the activity of this enzyme towards normal. Feeding of dasheen extract or commercial linamarin significantly lowered (P < 0.05) the activity of NADP+ isocitrate dehydrogenase below that of healthy controls. Glucose 6-P-dehydrogenase activity was significantly increased (P < 0.05) in diabetic rats compared to healthy controls. Alanine transaminase in the kidney of diabetic rats fed yam extract was significantly higher than healthy controls (P < 0.05). These results demonstrate an overall aggravation of the diabetic nephropathy by yam and dasheen extracts in the diet. In the Caribbean region where these foods are dietary staples, there may be a correlation with the reported high prevalence of diabetes mellitus and the development of renal disease.

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8) did not complete the study and were excluded from further analysis. Six (13) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n = 15), [Gp B], oral hypoglycaemic agents, OHAs (n = 17), [Gp C], or insulin (n = 8), Gp D]. In addition, during the run-in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3-month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 +/- 1.1 to 8.4 +/- 0.9 (p < 0.027) and, from 11.0 +/- 1.0 to 8.7 +/- 0.7 (p < 0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 +/- 1.1 to 12.2 +/- 1.0 (p < 0.016) in Gp B, from 14.9 +/- 1.1 to 11.9 +/- 1.1 (p < 0.002) in Gp C, and from 14.1 +/- 1.4 to 11.8 +/- 1.4 (p < 0.02) in Gp D. Twenty-three per cent (23) of the patients experienced flatulence; 7.5, changes in bowel habits and 5, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.

The role of C-peptide in the classification of diabetes mellitus.

We investigated twenty-one insulin-using patients, who had all been labelled as having insulin dependent diabetes mellitus (IDDM) or type 1 diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at age 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.