Positive parental history of diabetes is associated with early diagnosis, better dietary compliance, and glycemic control among type 2 diabetes patients in southern Sri Lanka.

BACKGROUND: Parental history of diabetes is an established risk factor for type 2 diabetes mellitus (T2DM). There is limited data on the association of parental history with the prevalence of T2DM in Sri Lanka. The study aims to examine the prevalence and correlation of parental history and factors such as the onset age, glycaemic control, and self-reported dietary compliance among T2DM patients. With a rising incidence of T2DM in Sri Lanka, understanding the impact of parental history on age at diagnosis and glycemic control can aid in targeted screening and interventions. METHODS: A cross-sectional study was carried out on 500 T2DM patients attending a diabetes clinic in Galle, the capital of Southern Sri Lanka with a multiethnic population. Convenient sampling strategy was followed in the recruitment process and a questionnaire-based method was used to collect the data. All the collected data was analysed using SPSS V 25.0. RESULTS: 51.2% had a parental history of T2DM, and those with a positive parental history were diagnosed six years earlier than those with a negative parental history (p < 0.001). A significant correlation between parental history and gestational diabetes mellitus (GDM) was observed (p < 0.001). Patients with a parental history reported better dietary adherence (p < 0.001). Binary logistic regression analysis revealed patients with positive parental history had significantly lower HbA1C (p = 0.003, OR = 0.748). CONCLUSION: T2DM patients with a parental history showed significant association with early diabetes onset, GDM, better glycemic control, and dietary adherence.

Association of hypertriglyceridemic waist phenotype with metabolic syndrome traits and its diagnostic potential to predict metabolic syndrome in adults with excess body weight: A community-based cross-sectional study.

BACKGROUND: The hypertriglyceridemic waist (HTGW) phenotype is a simple measure to identify individuals at increased risk of metabolic syndrome (MetS) traits. The present study aimed to describe the HTGW prevalence, and its associations with MetS traits, and also determine the diagnostic potential of the mirror indices of HTGW phenotype to predict MetS and its components in community-dwelling adults with overweight or obesity in Southern, Sri Lanka. METHODS: In a cross-sectional study, 300 adults with excess body weight (body mass index >23 kg/m2) were enrolled and examined for the HTGW phenotype (fasting plasma triglyceride concentration ≥1.695 mmol/L and waist circumference >90 and >85 cm in males and females, respectively). RESULTS: One in five adults with excess body weight had the HTGW phenotype. Phenotype-positive adults had significantly higher fasting plasma glucose (FPG) (p = 0.010), low-density lipoprotein cholesterol (HDL-C) (p < 0.001), total cholesterol (p < 0.001), atherogenic index (p < 0.001), coronary risk index (p = 0.001), triglyceride glucose index (p = 0.040), bioimpedance visceral fat (p = 0.041) and significantly lower HDL-C (p = 0.001) and cardioprotective index (p = 0.009) than those without the HTGW phenotype. Adults with excess body weight and the HTGW phenotype had an increased risk of FPG (odds ratio [OR] = 1.294; 95% confidence interval [CI] 1.051-1.594), atherogenic index (OR = 3.138; 95% CI = 1.559-6.317) and triglyceride glucose index (OR = 3.027; 95% CI = 1.111-8.249). The HTGW phenotype was strongly associated with MetS traits (OR = 16.584; 95% CI = 6.230-44.147). The cut-off values for the product of waist circumference × triglyceride, to identify the risk of having MetS and dyslipidemia among adults with excess body weight were 158.66 and 160.15 cm × mmol/L, respectively. CONCLUSIONS: The readily available and inexpensive measures of the HTGW phenotype could serve as a clinically useful marker to identify MetS traits in adults with excess body weight.

Association of dietary intake with body mass index and glycemic profile among newly diagnosed patients with type 2 diabetes mellitus.

INTRODUCTION: Dietary intake plays an important role in determining body mass index (BMI) and glycemic profile in patients with type 2 diabetes mellitus (T2DM). Our aim was to describe habitual dietary intake and its associations with BMI and glycemic profile in a cohort of patients with newly diagnosed T2DM in Sri Lanka. METHODS: A cross-sectional study was carried out among 158 patients with newly diagnosed T2DM in Galle, Sri Lanka. Data on demographic, lifestyle, and family history of diabetes mellitus, and clinical measures were collected. The dietary information was collected using a 24-h dietary recall. RESULTS: Among the total number of study subjects, only 12.0%, 5.7% and 1.3% met the recommended daily consumption value of protein, fat, and fiber, respectively, whereas 99.4% of subjects had taken carbohydrates that exceeded the recommended consumption. There was a positive association between carbohydrate intake and BMI (0.004, [0.002], p = .048) and carbohydrate intake and glycated hemoglobin (HbA1C ) (0.001, [0.000], p = .049). Fat intake showed positive associations with BMI (0.029, [0.011], p = .006) and HbA1C (0.005, [0.002], p = .050). Protein intake showed a positive association with HbA1C (0.006, [0.003], p = .023). The aforementioned associations were observed after adjusting for demographic, lifestyle, and history of diabetes among the first-degree family members. The carbohydrate intake was positively associated with BMI (0.010, [0.003], p = .003) and HbA1C (0.001, [0.000], p = .050) with further adjustment in nutrient intake (except when used as an independent variable). Furthermore, the fat intake was associated with BMI (0.031, [0.011], p = .004) and HbA1C (0.005 [0.002], p = .050) with additional adjustments. CONCLUSIONS: The diet of the majority of newly diagnosed T2DM patients in this cohort consisted of a higher carbohydrate intake than the recommended level. However, they did not meet the recommended daily intake of protein, fat, and fiber. Both carbohydrate and fat intake were significantly and positively associated with BMI and HbA1C in patients with newly diagnosed T2DM.

Value of simple clinical parameters to predict insulin resistance among newly diagnosed patients with type 2 diabetes in limited resource settings.

BACKGROUND: Insulin resistance (IR) has been considered as a therapeutic target in the management of type 2 diabetes mellitus (T2DM). Readily available, simple and low cost measures to identify individuals with IR is of utmost importance for clinicians to plan optimal management strategies. Research on the associations between surrogate markers of IR and routine clinical and lipid parameters have not been carried out in Sri Lanka, a developing country with rising burden of T2DM with inadequate resources. Therefore, we aimed to study the utility of readily available clinical parameters such as age, body mass index (BMI), waist circumference (WC) and triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-C) in the fasting lipid profile in predicting IR in a cohort of patients with newly diagnosed T2DM in Sri Lanka. METHODS AND FINDINGS: We conducted a community based cross sectional study involving of 147 patients (age 30-60 years) with newly diagnosed T2DM in a suburban locality in Galle district, Sri Lanka. Data on age, BMI, WC, fasting plasma glucose (FPG) concentration, fasting insulin concentration and serum lipid profile were collected from each subject. The indirect IR indices namely homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI) and McAuley index (MCA) were estimated. Both clinical and biochemical parameters across the lowest and the highest fasting insulin quartiles were compared using independent sample t-test. Linear correlation analysis was performed to assess the correlation between selected clinical parameters and indirect IR indices. The area under the receiver operating characteristic (ROC) curve was obtained to calculate optimal cut-off values for the clinical markers to differentiate IR. BMI (p<0.001) and WC (p = 0.01) were significantly increased whereas age (p = 0.06) was decreased and TG/HDL-C (p = 0.28) was increased across the insulin quartiles. BMI and WC were significantly correlated (p<0.05) with HOMA, QUICKI and MCA. Out of the clinical parameters, age showed a borderline significant correlation with QUICKI and TG/HDL-C showed a significant correlation only with MCA. The area under ROC of BMI was 0.728 (95% CI 0.648-0.809; p<0.001) and for WC, it was 0.646 (95% CI 0.559-0.734; p = 0.003). The optimized cut-off value for BMI and WC were 24.91 kg/m2 and 81.5 cm respectively to differentiate the patients with IR or ID. Study limitations include small sample size due to recruitment of patients only from a limited geographical locality of the country and not totally excluding of the possibility of inclusion of some patients with slowly progressive type 1 DM or Latent onset diabetes of adulthood from the study population. CONCLUSIONS: The results revealed that there was a significant positive correlation between BMI, WC and HOMA while a significant negative correlation with QUICKI and MCA among the cohort of patients with newly diagnosed T2DM. The cut-off values of BMI and WC as 24.91 kg/m2 and 81.5 cm respectively could be used as simple clinical parameters to identify IR in newly diagnosed patients with T2DM. Our results could be beneficial in rational decision making in the management of newly diagnosed patients with T2DM in limited resource settings.

Antidiabetic Activity of Widely Used Medicinal Plants in the Sri Lankan Traditional Healthcare System: New Insight to Medicinal Flora in Sri Lanka.

The use of medicinal plant extracts and their isolated bioactive compounds for the management of diabetes mellitus has been tremendously increased in recent decades. The present study aimed at providing in-depth information on medicinal flora that has been widely used in the Sri Lankan traditional healthcare system for the management of diabetes mellitus. The data of this review article were obtained from published articles from January 2000 to September 2020 in scientific databases of PubMed, Web of Science, and Google Scholar. In this review, a total number of 18 medicinal plants with the antidiabetic activity were expressed, and their isolated antidiabetic active compounds were highlighted as new drug leads. Results of the reported studies revealed that medicinal plants exert a potent antidiabetic activity via both in vitro and in vivo study settings. However, bioactive compounds and antidiabetic mechanism (s) of action of many of the reported medicinal plants have not been isolated/elucidated the structure in detail, to date. Reported antidiabetic medicinal plants with other properties such as antioxidant and antihyperlipidemic activities deliver new entities for the development of antidiabetic agents with multiple therapeutic targets. This is a comprehensive review on potential antidiabetic activities of the Sri Lankan medicinal plants that have been widely used in the traditional healthcare system. The information presented here would fill the gap between the use of them by traditional healers in the traditional medicine healthcare system in Sri Lanka and their potency for development of new drug entities in future.

Efficacy and safety of a herbal drug of Coccinia grandis (Linn.) Voigt in patients with type 2 diabetes mellitus: A double blind randomized placebo controlled clinical trial.

BACKGROUND: Several lines of preclinical studies have shown promising antidiabetic effects of the aqueous leaves extract of Coccinia grandis (Linn.) Voigt (Cucurbitaceae) in vivo and in vitro. PURPOSE: The present study was conducted to evaluate the efficacy and safety of a newly developed herbal formulation of C. grandis in newly diagnosed patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN: A three months long, randomized, double blind, placebo controlled clinical trial in patients with newly diagnosed T2DM. METHOD: Based on fasting plasma glucose (FPG) concentration, a total number of 158 newly diagnosed patients with T2DM (45 ± 15 years age) were recruited for the present trial from the University Medical Clinic, Teaching Hospital, Karapitiya, Galle, Sri Lanka. They were randomly assigned to the test or placebo group to receive 500 mg of herbal drug (n = 79) or placebo drug (n = 79) once daily for three months. Patients and investigators were blinded for the treatment. Percentage of glycated hemoglobin (HbA1C %), insulin and lipid profile parameters were estimated at the base line and at the end of the intervention. Serum concentration of fructosamine was assessed at every other visit of the trial. The homeostatic model assessment for insulin resistance (HOMA-IR), atherogenic index (AI), cardio-protective index (CPI) and coronary risk index (CRI) were calculated. Furthermore, fasting plasma glucose concentration, renal and liver toxicity parameters, hematological parameters, blood pressure (BP) were assessed throughout the study in two weekly intervals till the end of three months. RESULTS: Out of 158, a total number of 145 patients completed the entire clinical trial period successfully. Mean (SD) changes of variables from the baseline to the end of the intervention in test and placebo groups were 0.65 (0.54) and 0.08 (0.66) for HbA1C % (p < 0.001), 1.91 (3.07) and -1.28 (9.77) for insulin (p < 0.001), 0.02 (0.03) and -0.01 (0.04) for frucosamine (p < 0.001), 1.51 (0.49) and 0.05 (0.50) for FPG (p < 0.001), 1.73 (1.36) and -0.37 (3.38) for HOMA-IR (p < 0.001), 0.16 (0.18) and -0.04 (0.42) for TG (p < 0.001), 0.07 (0.08) and -0.02 (0.19) for VLDL-C (p < 0.001), respectively. However, the herbal drug of C. grandis was unable to change other outcome variables significantly when compared to the placebo (p > 0.05). All the renal, liver and toxicity parameters, hematological parameters and BP were within the normal physiological reference ranges at each visit. CONCLUSION: Treatment with herbal drug of C. grandis (500 mg per day) for three months for patients with newly diagnosed T2DM significantly improved their glycemic and selected lipid profile parameters with well tolerated safety.

Demographic Associations of Diabetes Status by Both Fasting Plasma Glucose Concentration and Glycated Hemoglobin in a Community Survey in Galle District, Sri Lanka.

Diagnostic tools used in detecting individuals with diabetes mellitus (DM) include fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and oral glucose tolerance test (OGTT). The present study was aimed to determine the demographic associations of diabetes status by both tests (FPG and HbA1C) in Galle district, Sri Lanka. 147 adults (30-60 years) who are having FPG ≥ 126 mg/dL underwent demographic evaluations and testing for HbA1C. Group 01 (diabetes status diagnosed by both tests) and group 2 (diabetes status diagnosed only by FPG) were compared using independant sample t-test and chi-square test. Logistic regression was used to study the association between the demographic factors and the diabetes status by both tests. Of the 147 study subjects, 38.1% were males, 61.9% were females, and 63.3% had a family history of diabetes among first-degree relatives (FDR). Mean age, body mass index (BMI), waist circumference (WC), FPG, and HbA1C of the participants were 48.4 ± 7.2 years, 25.1 ± 4.0 kg/m2, 88.8 ± 9.0 cm, 139.4 ± 30.1 mg/dL, and 6.4 ± 0.7%, respectively. The prevalence of diabetes based on both tests was 55.1%. There is a significant difference in mean BMI and WC while no significant differences in mean age between groups 01 and 02. No association was seen between gender and diabetes status (X 2(1) = 0.086, p=0.770), while a significant difference was observed between DM among FDR and diabetes status (X 2(1) = 33.215, p < 0.001). Significance of odds of having diabetes by both tests with rising BMI (OR = 1.97, CI 1.15-3.36, p=0.013) and DM among FDR (OR = 7.95, CI 3.54-17.88, p=0.000) was seen. We conclude rising BMI and having DM among FDR are strongly associated with diabetes status diagnosed by both tests of FPG and HbA1C in community screening.

Prevalence and associations of non-alcoholic fatty liver disease (NAFLD) in Sri Lankan patients with type 2 diabetes: A single center study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes for chronic liver disease in Asians. It occurs more commonly in patients with type 2 diabetes mellitus (T2DM). However, data on prevalence and associations of NAFLD among Sri Lankans with diabetes are lacking. The main aim of this study is to investigate the prevalence and factors associated with NAFLD in a cohort of diabetic patients. METHODS: Total of 233 patients with type 2 diabetes mellitus, followed up at a diabetes center in Southern Sri Lanka, were recruited by convenience sampling method. Each of them underwent a detailed medical history, physical examination, laboratory investigations and abdominal ultrasonography(USS). The diagnosis of NAFLD was made according to the established criteria using USS. RESULTS: The overall prevalence of NAFLD based on USS was 62.6% with no significant gender difference. Compared to USS, elevation in AST and ALT levels, based on NHANES III criteria, occurred only in 42% (98/234). The patients with NAFLD (56.7 ±â€¯8.9) were significantly younger and had higher BMI and waist circumference, and raised AST and ALT than those without NAFLD. Binary logistic regression showed that the use of pioglitazone, higher BMI, and waist circumference were independently and significantly associated with NAFLD. CONCLUSIONS: NAFLD is common in Sri Lankan patients with T2DM and central and global obesity are significant associations. Use of pioglitazone seemed to be protective against the development of NAFLD. These findings underscore the need for weight management as a preventive measure of NAFLD in T2DM patients.

Attainment of recommended therapeutic targets of modifiable cardiovascular risk factors among individuals with type 2 diabetes mellitus screened at a diabetes clinic in Sri Lanka.

INTRODUCTION: Implementation of effective measures to control rising burden of cardiovascular diseases among patients with type 2 diabetes mellitus (T2DM) requires information on the adequacy of control and identification of specific groups with suboptimal control of blood glucose, lipids and blood pressure. METHODS: A cross-sectional study of patients with T2DM referred from primary care to a diabetes center was carried out to estimate the proportion of patients achieving the recommended therapeutic targets of four major modifiable cardiovascular risk factors: glycosylated hemoglobin (HbA1c <7%), low-density lipoprotein cholesterol <100 mg/dL, systolic blood pressure (SBP) <130 mmHg and diastolic blood pressure (DBP) <80 mmHg and their associations with age, gender, duration of diabetes and body mass index were studied. RESULTS: Mean (SD) age and the duration of the sample of 2422 (65% males) were 52 (11) and 9 (3), respectively. Percentages with optimal HbA1c, low-density lipoprotein cholesterol, SBP and DBP were 25.2%, 24.3%, 32% and 56.7%, respectively. Only 2% had achieved optimal control of all four risk factors. Significantly higher percentages of males were having optimal HbA1C, SBP and DBP, and regression analysis revealed that male gender was significantly associated with optimal control of SBP. CONCLUSION: Control of cardiovascular risk diseases factors among patients with T2DM managed in the primary care settings needs further improvements in target achievement in all four modifiable risk factors.

Prevalence of normoalbuminuric renal insufficiency and associated clinical factors in adult onset diabetes.

BACKGROUND: Microalbuminuria signifies the onset of diabetic nephropathy, but normoalbuminuric patients with diabetes who have a low Glomerular Filtration Rate (GFR) are not uncommon. The purpose of the study was to estimate the prevalence of such patients and to assess the clinical correlates. METHODS: Cross-sectional study included patients with diabetes attending medical clinics at Teaching Hospital Galle. Diagnosis of albuminuria was made if urinary albumin excretion was > 30 mg/g of creatinine in two out of three samples. Patients were stratified into chronic kidney disease stages according to the estimated GFR (eGFR) calculated by Modification of Diet in Renal Disease (MDRD). RESULTS: Mean (SD) age and duration of the disease of 456 (348 females) patients with diabetes were 60 (12) years and 10 (4) years. Sixty (13.2%) patients had low eGFR and 26.7% of them had normoalbuminuria. In the total sample, the proportion of patients with low eGFR and normoalbuminuria was 16 (3.5%). Among the patients with normoalbuminuria and low eGFR, 12.5% had retinopathy and none had any form neuropathy. When age, duration of disease, systolic and diastolic blood pressures, smoking, glycaemic control, presence of hypertension and ischaemic heart disease were included in binary logistic regression model, only age was found to be significant different (OR = 1.1, P = 0.03). CONCLUSION: A considerable proportion of adult diabetics are normoalbuminuric despite low eGFR. This limits the role of microalbuminuria as a screening tool to detect the onset of diabetic nephropathy. These patients do not exhibit distinct clinical features that facilitate identification of them using clinical information.

Association of Self-Reported Dietary and Drug Compliance with Optimal Metabolic Control in Patients with Type 2 Diabetes: Clinic-Based Single-Center Study in a Developing Country.

INTRODUCTION: Influence of dietary and drug compliance of patients with diabetes on attainment of optimal metabolic (glucose and lipid) control remains underexplored in developing countries. MATERIALS AND METHODS: Self-reported dietary and drug compliance score of 0-10, glycosylated hemoglobin (HbA1c), and low-density lipoprotein (LDL) levels were obtained from patients with diabetes. HbA1c <7% and LDL <100 mg/dL were used to define optimal glucose and lipid control, respectively. Proportions achieving each and both optimal parameters were estimated. Regression analysis was used to study the association of age, gender, age of onset and the duration of diabetes, self-reported dietary, and drug compliance scores with achievement of both parameters. RESULTS: Mean (SD) age and duration of diabetes of 207 patients were 55 (10) and 10 (03) years. Optimal glucose and LDL control were achieved by 30% and 62%, and 23% had achieved both. Regression analysis revealed significant association of self-reported high dietary compliance with achievement of both targets. CONCLUSIONS: Findings highlight the suboptimal glucose and lipid control among patients with diabetes. Significant association of better dietary compliance with control of both parameters emphasizes the value of proper dietary adherence in achieving the optimal metabolic control among patients with diabetes.

Prevalence of low HDL cholesterol and its associations among Sri Lankan patients with diabetes mellitus on statin therapy.

AIMS: We aimed to study the prevalence and associations of suboptimal high density lipoproteins level, a characteristic feature in diabetic dyslipidemia among patients under statin therapy. MATERIALS AND METHODS: From a database of 2416 patients, data on age, gender, duration of diabetes, body mass index (BMI) and waist circumference (WC), low density lipoproteins (LDL), triglyceride, high density lipoproteins (HDL) were obtained. Prevalence of suboptimal HDL (<40mg/dL in males and <50mg/dL in females) and its association with gender, age, duration of diabetes, BMI and WC were studied. RESULTS: The mean (SD) age of the sample (n=2416) was 53 (10) years and 64.2% of them (n=1550) were males. Prevalence of suboptimal HDL was 17.6%. Regression analysis revealed female gender, (OR 7.73, 95% CI 5.99-9.97) younger age (OR 0.98, 95% CI 0.97-0.99), higher BMI (OR1.05. 95% CI 1.00-1.2) and LDL level over 100mg/dL (OR 1.004, 95% CI 1.00-1.007) had significant associations with suboptimal HDL. CONCLUSIONS: Every sixth diabetic patient on statins has suboptimal HDL level. Females, younger and obese diabetic individuals should be more focused on achieving optimal HDL cholesterol levels.

Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes.

INTRODUCTION: Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. AIM: To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. MATERIALS AND METHODS: We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. RESULTS: Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). CONCLUSION: Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries.

Is Risk Factor-based Screening Good Enough to Detect Gestational Diabetes Mellitus in High-Risk Pregnant Women? A Sri Lankan Experience.

BACKGROUND: There is a long lasting dilemma over the ideal screening and diagnostic method in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced, selective screening based on risk factors is also practiced in some center. The aim of this study is to evaluate the most appropriate method to screen GDM in high-risk pregnant women in Sri Lanka. METHODS: This study was a clinic-based, cross-sectional study conducted in a tertiary referral center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24-28 weeks of gestation. Diagnosis of GDM was made according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) criteria. RESULTS: With universal screening using IADPSG criteria, 23.2% (105/452) were found to have GDM and with risk factor-based screening 20.1% (91/452) were detected to have GDM. The prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with universal screening approach. It was further dropped to 15.7% when the WHO criteria were used along with risk factors-based screening approach. CONCLUSIONS: The IADPSG criteria labeled considerably higher number of women as having GDM compared to the WHO criteria. With regards to the screening methods, the risk-based screening had a lower detection rate of GDM; however, it reduced the necessity of screening of women by around 20%.

Cardiovascular risk assessment in type 2 diabetes mellitus: comparison of the World Health Organization/International Society of Hypertension risk prediction charts versus UK Prospective Diabetes Study risk engine.

INTRODUCTION: Patients with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular diseases, and assessment of their cardiac risk is important for preventive strategies. PURPOSE: The Ministry of Health of Sri Lanka has recommended World Health Organization/International Society of Hypertension (WHO/ISH) charts for cardiac risk assessment in individuals with T2DM. However, the most suitable cardiac risk assessment tool for Sri Lankans with T2DM has not been studied. This study was designed to evaluate the performance of two cardiac risk assessments tools; WHO/ISH charts and UK Prospective Diabetes Study (UKPDS) risk engine. METHODS: Cardiac risk assessments were done in 2,432 patients with T2DM attending a diabetes clinic in Southern Sri Lanka using the two risk assessment tools. Validity of two assessment tools was further assessed by their ability to recognize individuals with raised low-density lipoprotein (LDL) and raised diastolic blood pressure in a cohort of newly diagnosed T2DM patients (n=332). RESULTS: WHO/ISH charts identified 78.4% of subjects as low cardiac risk whereas the UKPDS risk engine categorized 52.3% as low cardiac risk (P<0.001). In the risk categories of 10%-<20%, the UKPDS risk engine identified higher proportions of patients (28%) compared to WHO/ISH charts (7%). Approximately 6% of subjects were classified as low cardiac risk (<10%) by WHO/ISH when UKPDS recognized them as cardiac risk of >20%. Agreement between the two tools was poor (κ value =0.144, P<0.01). Approximately 82% of individuals categorized as low cardiac risk by WHO/ISH had higher LDL cholesterol than the therapeutic target of 100 mg/dL. CONCLUSION: There is a significant discrepancy between the two assessment tools with WHO/ISH risk chart recognizing higher proportions of patients having low cardiac risk than the UKPDS risk engine. Risk assessment by both assessment tools demonstrated poor sensitivity in identifying those with treatable levels of LDL cholesterol and diastolic blood pressure.