Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

[Arterial blood pressure in homozygote patients with drepanocytosis]. / Pression artérielle chez les patients drépanocytaires homozygotes.

BACKGROUND: Relative hypotension has been reported in sickle cell patients. The aim of this study was to compare blood pressure in patients with SS disease and subjects with normal hemoglobin genotype AA and to assess whether the same clinical, biological and socio-demographic variables are associated to the mean arterial pressure in patients with sickle cell disease and normal subjects. METHOD: Blood pressure was measured with a standardized automated oscillometric method in 88 SS patients et 88 AA control subjects seen in the University Hospital of Pointe-à-Pitre (Guadeloupe). A multiple linear regression analysis for mean arterial pressure was done including type of hemoglobin (forced variable), age, sex, body mass index, pulse rate, hemoglobin concentration and interaction terms between type of hemoglobin and other variables. A regression was also fitted separately for each population. A downward stepwise strategy was used to simplify the models. RESULTS: The two groups were similar for age, height and gender ratio and pulse rate. Mean arterial pressure was significantly lower in sickle cell patients (81.6 mmHg in SS patients vs 89.9 mmHg in AA subjects, p < 10(-4)). The final model included type of hemoglobin, age, sex, body mass index, pulse rate and an interaction between type of hemoglobin and age (global F = 22.04, adjusted R2 = 42%). The separate models indicated that sex was associated with mean arterial pressure only in patients with sickle cell disease and that age and hemoglobin concentration was associated with mean arterial pressure only in normal subjects. CONCLUSION: Blood pressure determinants are not similar in the two populations. The effect of age, especially, is not the same in patients with sickle cell disease and in normal subjects. These results confirm that specific patho-physiological models should be defined in sickle cell disease.

[Arterial pressure and urinary excretion of albumin in adults with sickle cell disease]. / Pression artérielle et excrétion urinaire d'albumine chez les patients drépanocytaires adultes.

OBJECTIVE: The increase of urinary albumin excretion could be associated with morbidity in patients with sickle cell disease. The objective of this study was to evaluate the relation between blood pressure and urinary albumin excretion, and to estimate the prevalence of hypertension according to the level of urinary albumin excretion. METHODS: A cross-sectional study was carried in 77 patients with sickle cell disease (48 patients with haemoglobin SS, 29 with haemoglobin SC) et 30 controls with haemoglobin AA. The patients with sickle cell disease were divided into 3 groups according to urinary albumin excretion: less than 30 mg daily (group I: normoalbuminuria); from 30 to 300 mg daily (group II: microalbuminuria); above 300 mg daily (group III: macroalbuminuria). All AA selected controls had normoalbuminuria (group IV). RESULTS: In normoalbuminuric patients, the average of blood pressure was significantly lower in patients with sickle cell disease than in controls (respectively 115.0 +/- 8.1 vs 132.1 +/- 15.1, p = 4.10(-6) for systolic pressure and 67.2 +/- 8.0 vs 78.8 +/- 9.8 mmHg, p = 10(-4) for diastolic pressure). There was a positive relation between urinary albumin excretion, even moderate (values < or = 300 mg daily) and blood pressure in SS patients (r = 0.40, p < 0.02 for systolic and r = 0.54, p < 0.01 for diastolic pressure) and in SC patients (r = 0.74, p < 0.001 and r = 0.58, p < 0.01). The prevalence of hypertension was 0% in group I, 25% in group II and 66% in group III. CONCLUSION: The positive association between blood pressure and urinary albumin excretion suggests that the latter should be taken into account in sickle cell disease's follow up.