Stability and reliability of glycated haemoglobin measurements in blood samples stored at -20°C.

AIM: To validate the stability of glycated haemoglobin (HbA1c) measurements in blood samples stored at -20°C for up to one month. METHODS: The study group comprised 142 type 2 diabetic subjects visiting a tertiary centre for diabetes at Chennai city in south India. The HbA1c assay was done on a fasting blood sample using the Bio-Rad Variant machine on Day 0 (day of blood sample collection). Several aliquots were stored at -20°C and the assay was repeated on the 3rd, 7th, 15th, and 30th day after the sample collection. Bland-Altman plots were constructed and variation in the HbA1c levels on the different days was compared with the day 0 level. RESULTS: The median differences between HbA1c levels measured on Day 0 and the 3rd, 7th, 15th, and 30th day after blood collection were 0.0%, 0.2%, 0.3% and 0.5% respectively. Bland-Altman plot analysis showed that the differences between the day '0' and the different time points tend to get larger with time, but these were not clinically significant. CONCLUSIONS: HbA1c levels are relatively stable up to 2weeks, if blood samples are stored at -20°C.

The prevalence of presarcopenia in Asian Indian individuals with and without type 2 diabetes.

OBJECTIVE: This study compared the skeletal muscle mass and prevalence of presarcopenia between Asian Indian individuals with and without type 2 diabetes. SUBJECTS AND METHODS: Participants with type 2 diabetes (n=76) and age- and sex-matched controls without diabetes (n=76) were drawn from the Chennai Urban Rural Epidemiological Study (CURES), which was carried out on a representative sample of Chennai City in South India. Skeletal muscle mass was estimated by dual-energy X-ray absorptiometry, and skeletal muscle mass index (SMI) was calculated by dividing the appendicular skeletal muscle mass by the square of the individual's height in meters and expressed as kg/m(2). Presarcopenia was defined as an SMI of ≤7.26 kg/m(2) for males and ≤5.5 kg/m(2) for females. Biochemical and anthropometric measurements were done using standardized procedures. RESULTS: The 152 participants included 68 women (44.7%). Mean age was 44±9 years (range, 28-67 years), and the mean body mass index (BMI) was 25.7±3.8 kg/m(2). The prevalence rates of presarcopenia among individuals with and without diabetes were 39.5% and 15.8%, respectively (P=0.001). The mean SMI values were significantly lower in those with diabetes (6.84±1.02 kg/m(2)) compared with participants without diabetes (7.28±1.01 kg/m(2)) (P=0.009). SMI showed a positive correlation with BMI and waist circumference but a negative correlation with age, fasting plasma glucose, glycated hemoglobin, and low-density lipoprotien cholesterol in the total study population. Logistic regression analysis showed that diabetes was independently associated with presarcopenia (P=0.001). CONCLUSIONS: Prevalence of presarcopenia is higher among Asian Indian subjects with type 2 diabetes compared with age- and sex-matched participants without diabetes.

Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice.

The Indian Diabetes Risk Score was initially developed by the Madras Diabetes Research Foundation (MDRF-IDRS) to help detect undiagnosed Type 2 diabetes (T2DM) in the community. Soon it was found that the MDRF-IDRS could also help to predict incident diabetes, metabolic syndrome, coronary artery disease (CAD), non-alcoholic fatty liver disease as well as sleep disorders in the community. It helps to differentiate T2DM from non-T2DM. Finally, it also helps to identify those with CAD, peripheral vascular disease and neuropathy among those with T2DM. Thus, the MDRF-IDRS is a simple, virtually 'no cost' tool which is useful in several clinical and epidemiological settings.

Prevalence of diabetes in Asian Indians based on glycated hemoglobin and fasting and 2-H post-load (75-g) plasma glucose (CURES-120).

OBJECTIVE: With the introduction of glycated hemoglobin (A1c) as a method of screening for diabetes, it is essential to study how use of A1c would affect the prevalence of diabetes in different ethnic groups. We compared the prevalence of diabetes by fasting (FPG) and 2-h post-load (75-g) plasma glucose (2-h PG) and A1c criteria in an Asian Indian population. RESEARCH DESIGN AND METHODS: Subjects (n=2,188) without known diabetes were drawn from the Chennai Urban Rural Epidemiological Study, a population-based study in Chennai, South India. FPG, 2-h PG, and A1c estimations were carried out. Prevalence rates of diabetes were compared using as cut points FPG ≥7 mmol/L (126 mg/dL), 2-hr PG ≥11.1 mmol/L (200 mg/dL), or A1c ≥6.5% criteria. RESULTS: Prevalence of diabetes was 6.1% (n=134) using the FPG criterion, 10.1% (n=221) by the 2-h PG criterion, and 12.8% (n=281) by the A1c criterion. Thus the prevalence of diabetes by the A1c criterion was 110% and 27% higher than the FPG and 2-hr PG criteria, respectively. Only 121 of these subjects were identified by all three criteria. Subjects diagnosed by the A1c criteria had the lowest FPG, 2-h PG, A1c, and serum triglyceride levels. CONCLUSIONS: In Asian Indians, use of A1c criteria would result in markedly higher prevalence rates of diabetes. It also identifies a different set of individuals with milder glucose intolerance and lower serum triglyceride levels.

Association of glycated hemoglobin with carotid intimal medial thickness in Asian Indians with normal glucose tolerance.

AIM: To assess the association of glycated hemoglobin (HbA1c) levels with carotid intimal medial thickness (CIMT) in Asian Indians with normal glucose tolerance (NGT). METHODS: Subjects with NGT were recruited from the Chennai Urban Rural Epidemiology Study carried out on a representative population of Chennai, South India. All subjects had fasting plasma glucose <100 mg/dl (5.6 mmol/l) and 2-h post load plasma glucose <140 mg/dl (7.8 mmol/l). HbA1c was measured using the Biorad Variant machine. CIMT was measured on the right common carotid artery using high-resolution B-mode ultrasonography. RESULTS: The study group included 1383 NGT subjects, of whom 760 (54.9%) were women. The mean CIMT value in the 1st quartile of HbA1c (<5.2%) was 0.65 and it increased significantly to 0.73 in the last quartile of HbA1c (>5.8) (p<0.001). Regression analysis showed that HbA1c had a strong association with CIMT after adjusting for age, gender, waist circumference, systolic and diastolic blood pressure, LDL cholesterol, serum triglycerides, HOMA-IR and smoking (ß - 0.046, p=0.047). CONCLUSION: Even among subjects with NGT, there is a significant increase in CIMT with increasing levels of HbA1c, showing the value of using HbA1c for diagnosis of glucose intolerance.

Secular trends of fibrocalculous pancreatic diabetes and diabetes secondary to alcoholic chronic pancreatitis at a tertiary care diabetes centre in South India.

CONTEXT: Data on prevalence and trends in diabetes secondary to chronic pancreatitis in developing countries is scarce. OBJECTIVE: To compare the secular trends in the prevalence of fibrocalculous pancreatic diabetes (FCPD) and diabetes secondary to alcoholic chronic pancreatitis (ACP) at a diabetes centre in south India. DESIGN: A retrospective analysis was done of all patients registered at Dr. Mohan's Diabetes Specialties Centre, Chennai, India between January 1991 and December 2010. PATIENTS: A total of 1,079 subjects with diabetes secondary to chronic pancreatitis were identified, of whom 47 were excluded because of difficulty in classification. MAIN OUTCOME MEASURE: The number of patients with FCPD and diabetes secondary to ACP were calculated as a percentage of the total number of diabetes patients seen at the centre during five year blocks. RESULTS: Of the total of 1,032 cases of diabetes secondary to chronic pancreatitis, FCPD comprised 898 (87%) and ACP 134 (13%). The prevalence of FCPD decreased from 1.6% during 1991-1995 to 0.2% during 2006-2010 (P<0.001). The prevalence of ACP remained constant at 0.1%. The age at diagnosis of FCPD increased (P=0.002) while that of ACP decreased (P=0.025) during the study period. There was a significant increase in BMI of FCPD P<0.001), but not of ACP (P=0.248) patients. CONCLUSIONS: At this centre, FCPD continues to be more common than ACP, but there is a decline in its frequency. The age at diagnosis of FCPD has increased, while that of ACP has decreased. The decline in FCPD probably reflects improved nutrition.

A simple Indian diabetes risk score could help identify nondiabetic individuals at high risk of non-alcoholic fatty liver disease (CURES-117).

OBJECTIVE: We aim to determine whether a simple Indian diabetes risk score (IDRS) is associated with individuals with non-alcoholic fatty liver disease (NAFLD) among nondiabetic Asian Indians. METHODS: Nondiabetic participants (n = 409) were selected from the Chennai Urban Rural Epidemiology Study. Mean age was 40 ± 11.9 years, mean body mass index was 23.2 ± 3.9 kg/m(2), and 224 (54.8%) were women. The IDRS was classified as high (≥60), medium (30-50), and low (<30) risk. Non-alcoholic fatty liver disease was assessed by high-resolution ß mode ultrasonography. To determine the factors associated with NAFLD, a univariate analysis was first done and a stepwise logistic regression analysis was done based on the factors associated with NAFLD. Biochemical and anthropometric measurements were obtained using standardized procedures. RESULTS: The overall prevalence of NAFLD was 24.7% (101/409 participants), and it was significantly higher among those with a high (30.4%) and medium IDRS (21%) compared with the low IDRS group (15.8%; trend chi square; p = .022). In stepwise logistic regression, IDRS was associated with NAFLD with an adjusted odds ratio of 1.78 (95% confidence interval 1.04-3.06), even after adjusting for potential confounders. CONCLUSIONS: The IDRS can be used as the initial step to screen individuals at high risk of NAFLD in the community.