Sodium-Glucose Cotransporter-2 Inhibitor Suppresses Endoplasmic Reticulum Stress and Oxidative Stress in Diabetic Nephropathy Through Nrf2 Signaling: A Clinical and Experimental Study.

Diabetic nephropathy (DN), a severe complication of type 2 diabetes mellitus (T2DM), is marked by heightened endoplasmic reticulum stress (ERS) and oxidative stress (OS) due to protein misfolding and free radical generation. We investigated the sodium-glucose co-transporter-2 inhibitor (SGLT2i), canagliflozin (Cana), in alleviating ERS and OS in DN patients and THP-1 cells under hyperglycemic condition. A total of 120 subjects were divided into four groups, with 30 subjects in each group: healthy controls, T2DM individuals, DN patients receiving standard treatment, and those treated with Cana. The control group had no history of diabetes, cardiovascular or renal diseases, or other comorbidities. Cana was administered at doses of either 100 or 300 mg per day based on the estimated glomerular filtration rate (eGFR) value of DN individuals, with a mean follow-up of 6 months. Additionally, THP-1 monocytes were exposed to HGM (33.3 mM glucose with a cytokine cocktail of TNF-α and IFN-γ at 50 ng/mL each) to evaluate the relative levels of ERS, OS markers, and nuclear factor erythroid 2-related factor 2 (Nrf2), the transcription factor regulating cellular redox, which is downregulated in diabetes. Our results revealed that ERS markers GRP78 and PERK, as well as OS markers TXNIP and p22phox, were elevated in both DN patients and HGM-treated THP-1 monocytes and were reduced by Cana intervention. Furthermore, Cana regulated the phosphorylation of Nrf2, Akt, and EIF2α in HGM-treated monocytes. In conclusion, our findings highlight the role of Cana in activating Nrf2, thereby attenuating ERS and OS to mitigate DN progression.

Prevention of diabetes from prediabetes in real world setting in South India.

AIM: The aim was to explore the effect of lifestyle modification in a real world situation to prevent the progression to diabetes in India. METHODS: Participants who underwent OGTT from August 2017-2022 and were diagnosed as having Prediabetes (n = 200) were assigned into control (group1, n = 100) received standard care and intervention (group2, n = 100) received intensive counseling on physical activity (PA) and diet. PA included walking for 150 min/week and personalized advice based on the profession. OGTTs were repeated once every 6 months for 5 years and primary outcome was development of DM. RESULTS: The conversion rate was significantly higher in the control group than the intervention group (44.6 vs.7.9 %, p < 0.0001). Individuals who reverted back to normal was significantly higher in Group2 compared to Group1 (34.9 vs.6.2 %; p < 0.001). A significant increase in weight, BMI and waist circumference in group1 and significant reduction in glucose and HbA1c was noted in group2. Mean (95%CI) survival time for Group1 was 25.4 (20.8-29.9) and Group2 was 36.4months (32.6-40.1; p < 0.001). The factors which influenced the conversion of prediabetes to DM were averaged BMI, fasting and 2hr glucose levels of all follow up visit measurements. CONCLUSION: We can prevent diabetes in individuals with prediabetes using real world strategies in India.

Effect of prediabetes on tuberculosis treatment outcomes: A study from South India.

BACKGROUND AND AIMS: The aim was to assess the effect of prediabetes on tuberculosis(TB) treatment outcomes. METHODS: This is a prospective observational cohort study of 569 eligible new smear positive cases screened for DM between 2014 and 2018 in TB units in North Chennai, South India. Based on study criteria, a total of 187 subjects were included and categorised into two groups: TB with normoglycaemia (groupI) (HbA1c<5.7%) and TB with prediabetes (group II) (HbA1c = 5.7-6.4%) and followed them at 3rd and 6th month and treatment outcomes were assessed at the end of the TB treatment. RESULTS: Total cure rate was 72.7% with no significant difference between the groups. Higher proportion of deaths occurred in group II (6.3%) compared to group I (1.3%) (p = 0.09). At the end of intensive phase of directly observed therapy (DOTS) treatment, about 23.8% were observed to have positive sputum smear in group II compared to 8.6% in group I(p = 0.019). The estimated relative risk to remain as sputum smear positive among people with prediabetes at the end of intensive phase was 3.0(95% CI: 1.2-7.6). There was a significant association found with HbA1c at enrollment and unfavourable TB treatment outcomes (ß = 1.38, [odds ratio (95% CI) 3.98(1.65-9.64); p = 0.007]. CONCLUSION: Death rate was high and there was a delay in sputum conversion among TB patients with prediabetes at the end of the intensive phase of TB treatment. HbA1c at the time of diagnosis of prediabetes was significantly associated with unfavourable TB treatment outcomes.

Precision of Michigan Neuropathy Screening Instrument (MNSI) Tool for the Diagnosis of Diabetic Peripheral Neuropathy Among People with Type 2 Diabetes-A Study from South India.

Diabetic peripheral neuropathy (DPN) is one of the risk factors for foot-related complications among people with type 2 diabetes mellitus (T2DM). Hence, we aimed to validate the Michigan Neuropathy Screening Instrument (MNSI) tool against biothesiometer with a cut-off value of ≥25 V and also to determine the cut-off point of MNSI score for the diagnosis of diabetic neuropathy among people with T2DM in India. A cross-sectional study was conducted among 357 people with T2DM in a tertiary care centre for diabetes in Chennai, South India. The eligible study participants underwent testing with a biothesiometer and the MNSI tool was administered. The patient version tool of MNSI was translated to the local language, Tamil. The MNSI scores (1, 1.5, 2, and 2.5) were compared with biothesiometer value. For the MNSI scores of less than 1, 1.5, 2, and 2.5, sensitivities were 97.6%, 97.6%, 96.8%, and 77.8% and specificities were 76.6%, 77.9%, 85.7%, and 88.3% respectively. The cut-off value of MNSI score was derived as two with AUC of 0.934. The sensitivity was 96.8% and the specificity was 85.7% with 89.6% accuracy. The high sensitivity indicates the positive cases are diagnosed correctly. There is no validated tool available for detection of DPN in Indian population. The Indian version of MNSI tool was found to be effective for screening diabetic neuropathy among people with T2DM. The MNSI tool was found to be reliable, convenient, and non-invasive for diagnosis of DPN and can be used in routine clinical settings.

Longitudinal trends in glycated hemoglobin during and after tuberculosis treatment.

AIMS: To investigate the impact of pulmonary TB on glycemic status during and after TB treatment, and associations of glycemic trends with antidiabetic therapy and TB outcomes. METHODS: Data from two prospective cohort studies of adults in Chennai, India, with pulmonary TB were combined for this analysis. Participants were classified by baseline hemoglobin A1c (A1C) as having normoglycemia (NG; n = 74), prediabetes (pre-DM; n = 110), or diabetes (DM; n = 244). Repeat A1C measurements were performed at TB treatment months 3 and 6, and then 6 and 12 months after TB treatment completion. RESULTS: Median A1C at baseline declined after TB treatment initiation in all groups. No baseline NG or pre-DM participants progressed to DM by end of study, while 16.7% of baseline DM participants shifted to pre-DM or NG levels of A1C. In the baseline DM group, rising A1C after the intensive phase of TB treatment was significantly associated with adverse TB outcomes. CONCLUSIONS: Incident TB promotes transient glucose elevation but was not conclusively shown to promote chronic dysglycemia. Rising A1C during and after TB treatment may predict unfavorable treatment response in persons presenting with A1C ≥ 6.5 % at the time of TB diagnosis.

Unique Reciprocal Association Seen Between Latent Tuberculosis Infection and Diabetes Is Due to Immunoendocrine Modulation (DM-LTB-1).

Aim: The prevalence of latent tuberculosis infection (LTBI) among diabetes patients is poorly studied. In the present study, the prevalence of LTBI among pre-diabetes and diabetes patients was studied, along with immunoendocrine biomarkers (n = 804). Methods: LTBI was screened by Quantiferon TB gold in Normal glucose tolerance [(NGT); n = 170, [Pre-diabetes (PDM; n = 209), Newly diagnosed diabetes (NDM; n = 165) and Known diabetes (KDM; n = 260) subjects. CRP, TNF-α, IL-6, IL-1ß, IFN-ß, IL-12, IFN-γ, IL-2, insulin, leptin, and adiponectin levels in serum and IFN-γ levels in quantiferon supernatants were quantified by ELISA. The expression of T-bet was quantified using qRT-PCR. Serum TBARS and nitrite levels were quantified by colorimetry. Results: The LTBI prevalence was 32% in NGT, 23% in PDM, 24% in NDM, and 32% in KDM groups, with an adjusted OR of 0.61 (p < 0.05). Downregulation of CRP, TNF-α, and nitrites and upregulation of adiponectin could be responsible for LTBI mediated protection against insulin resistance (IR), while the high levels of IL-1ß, IL-12, and leptin could be responsible for IR mediated anti-TB immunity. The defective antigen-specific IFN-γ response, as seen in the KDM group, could be responsible for the low detection rate of LTBI and high probability of endogenous reactivation. Conclusion: There appears to be a biphasic relationship between diabetes-latent tuberculosis: At the early stages of diabetes it is reciprocal, while at a late stage it is synergistic, this important phenomenon obviously needs further research.

Prevalence and risk factors for diabetic retinopathy in prediabetes in Asian Indians.

AIM: To assess the prevalence of diabetic retinopathy (DR) and associated risk factors in Asian Indians with prediabetes. METHODS: In a cross-sectional study conducted at two tertiary care diabetes centres in Chennai, India, clinical and biochemical assessment and nonmydriatic ultra-wide field fundus photography was performed in individuals with prediabetes (impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]) based on oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c) between 5.7% and 6.4% in 2019. The retinal photographs were graded by certified ophthalmologists. Systemic risk factors associated with DR in prediabetes were assessed. RESULTS: The mean age of the 192 individuals with prediabetes was 48 ± 13 years (55.2% were males). DR was present in 12 (6.3%) individuals of which nine (4.7%) had mild non-proliferative DR (NPDR) and three (1.6%) had moderate NPDR. None had severe sight-threatening DR. The Poisson multiple regression analysis showed that after adjusting for other systemic covariates, HbA1c values ≥ 6% (6-6.4%) was associated with 2 times higher relative risk of DR (Risk ratio 1.95 (95% CI 1.07-3.545, p = 0.028) in comparison to HbA1c < 6%). CONCLUSION: DR was present in about 6% of the Asian Indians with prediabetes. Higher HbA1c values among individuals with prediabetes was associated with twice the relative risk for DR. Robust control of HbA1c should be encouraged even before the diagnosis of diabetes is established.

Hyperglucagonemia and impaired insulin sensitivity are associated with development of prediabetes and type 2 diabetes - A study from South India.

BACKGROUND AND AIMS: Glucagon levels and glucagon suppression in response to oral glucose load has not been elucidated at different stages of glucose intolerance in India. METHODS: A total of 81 subjects underwent OGTT and were classified into three groups as having normal glucose tolerance (NGT) (n = 23), prediabetes (PreDM) (n = 33), newly diagnosed diabetes (NDM) (n = 25). Insulin and glucagon at fasting, 30 and 120 min was measured by ELISA. HOMA-IR, measures of insulin sensitivity, early, late and overall glucagon suppression during OGTT was calculated. RESULTS: Plasma glucagon levels were higher at all-time points in the PreDM and NDM groups. Fasting glucagon levels were higher than post glucose load glucagon in all groups. There was a significant difference in the fasting(p = 0.001), 30 min(p = 0.004) and 120 min(p = 0.032) glucagon between the groups. HOMA-IR increased and insulin sensitivity decreased with worsening of glucose intolerance(p < 0.0001). The groups did not differ in terms of early glucagon suppression(p = 0.094). NDM group suppressed glucagon more than NGT from 30 to 120 min after glucose intake. CONCLUSION: This study demonstrated higher fasting glucagon levels. Prediabetes and newly diagnosed diabetes individuals had higher glucagon levels, high insulin resistance and lower insulin sensitivity. Hyperglucagonemia may contribute to type 2 diabetes.

Effect of yoga intervention on biochemical, oxidative stress markers, inflammatory markers and sleep quality among subjects with type 2 diabetes in South India: Results from the SATYAM project.

AIMS: The aim of this study was to investigate the effect of yoga intervention on the biochemical, oxidative stress markers and inflammatory markers and sleep quality among subjects with type 2 diabetes. METHODS: Subjects with type 2 diabetes attending a tertiary care centre for diabetes during Feb 2017 to Oct 2019 in Chennai, India were randomly assigned to two different groups. Group1(non-Yoga) (n = 150) was advised on simple physical exercises whereas group2(Yoga) (n = 150) was trained and advised to do yogasanas with static loosening exercises for 50 min for 5 days in a week. Both the groups were followed up for a period of 3 months. Anthropometric, biochemical, oxidative stress markers, inflammatory markers and sleep quality were assessed at baseline and after follow up. RESULTS: There was a significant reduction in BMI, blood glucose levels, HbA1c, lipid levels, IL6, TNFα and TBARS in Yoga group as compared to non-Yoga group. There was marked improvement in the levels of Adiponectin, PTGIS and sleep quality among subjects practising yogasanas. CONCLUSION: Regular practice of yogasanas improved glycaemic control, oxidative stress, inflammatory response and sleep quality among subjects with type 2 diabetes. Hence, Yogasanas can be used as an adjuvant therapy for managing type 2 diabetes.

TCF7L2 polymorphism a prominent marker among subjects with Type-2-Diabetes with a positive family history of diabetes.

The greatest risk of developing type2 diabetes (T2DM) was conferred by rs7903146 SNP of Transcription factor7-like2 (TCF7L2) gene in many ethnic populations. The aim was to investigate the association of TCF7L2 (rs7903146) gene polymorphism among newly diagnosed diabetes subjects with different parental diabetes registry. A total of 171 subjects were categorized into 3 groups based on parental diabetes registry i.e. Conjugal Diabetes Registry (CDR) (n = 50), One Parental Diabetes Registry (OPDR) (n = 56) and Non Parental Diabetes Registry (NPDR) (n = 62) (control group). Kompetitive allele specific PCR (KASP) genotyping assay was used in real time PCR for identifying the genotypes. None of the biochemical parameters showed any significant difference between groups except age at onset of diabetes (p = 0.001). The T allele of TCF7L2 (rs7903146) was associated with significant risk of diabetes. TT genotype which doubles the diabetes risk showed significant association among OPDR whereas in CDR both CT and TT genotypes showed significant association than CC wild type. The 'T' allele of TCF7L2 SNP was associated with significant risk when compared between OPDRvsNPDR (OR 2.45, p = 0.003) and CDRvsNPDR (OR 2.82, p = 0.0007). In conclusion, TCF7L2 gene polymorphism and positive family history of diabetes are strongly associated irrespective of the presence of other risk factors among diabetes subjects.

Higher dietary salt and inappropriate proportion of macronutrients consumption among people with diabetes and other co morbid conditions in South India: Estimation of salt intake with a formula.

AIM: The present study analysed the regular salt and macronutrients consumption of South Indian population with diabetes, hypertension and renal dysfunction. METHODS: The cross sectional study was performed among 200 subjects, divided into four different groups consisted of control, subjects with type 2 diabetes (T2DM) without any other complications, T2DM subjects with chronic kidney disease (CKD) and T2DM subjects with hypertension (HTN). The dietary salt intake was estimated from 24-h urinary sodium excretion and the amount of macronutrients was calculated using 24-h dietary recall method. RESULTS: Out of 200 study subjects, only 28 (14%) were consuming salt as per the recommended levels by WHO (i.e., 5-6 g/day). Thirty-eight (19%) subjects were consuming more than 18 g of salt per day, 67 (33.5%) were consuming 12-18 g of salt per day and another 67 (33.5%) were found to be consuming salt in a range of 6-12 g/day. Calorie contribution from the carbohydrates was significantly high compared to the calories from the proteins. Fat consumption and its corresponding energy contribution were also high among HTN group subjects. CONCLUSION: Observations of the study point out to the requirement of nationwide intensive and persistent efforts to enhance the public awareness on salt reduction.

Elevated one hour with normal fasting and 2 h plasma glucose helps to identify those at risk for development of Type2 Diabetes-11 years observational study from south India.

AIMS: To compare conversion rates of diabetes in subjects with elevated 1 h plasma glucose (1hrPG) during an OGTT with normal glucose tolerance(NGT) subjects over a period of 11 years. METHODS: 4023 subjects were selected from electronic data base of medical records.233 subjects who were followed up for a period of 11 years were included.160 with isolated prediabetes and their combinations were excluded.The remaining 73 were categorized into group1 NGT (n = 37) and group-2 (n = 36) with elevated 1hrPG.Kaplan Meier curves for incident diabetes and Cox proportional hazard model were compared between groups. RESULTS: During follow up, 10.8% and 44.4% converted to DM in group1 and group2 (p = 0.003). Elevated 1hrPG was associated with incident diabetes(HR 7.9[95%CI 2.2-28.1](p = 0.001)provided better risk assessment.The adjusted risk of event in subjects with elevated 1hrPG is likely to be 7 times more when compared to NGT.Subjects with elevated1hrPG remained free of diabetes for a median period of 7.6 years (95% CI 5.8-7.8) whereas NGT subjects remained free for 10 years (95% CI 8.5-10.0) (p < 0.001). CONCLUSION: In conclusion, conversion to DM was higher and risk was 7 times more in subjects with elevated 1hrPG. Elevated 1hrPG during OGTT has to be considered as a distinct entity.

RANKL Gene Polymorphism as a Potential Biomarker to Identify Acute Charcot Foot Among Indian Population With Type 2 Diabetes: A Preliminary Report.

Studies addressing the link between gene polymorphism and Charcot neuropathic osteoarthopathy (CN) have been limited to analyse osteoprotegerin gene. Aim is to understand the association of RANKL gene variants on the susceptibility of diabetic neuropathy and CN and to measure the serum levels of sRANKL among Indian population with type 2 diabetes. 77 subjects (48 males: 29 females) were recruited and divided into 3 groups. Group 1 Control: normal glucose tolerance (NGT). Group 2: Type 2 diabetes mellitus and neuropathy (DPN). Group 3: Established type 2 diabetes mellitus, DPN, and CN. Subjects were genotyped for RANKL SNP 693 C/G and 643 C/T using polymerase chain reaction-restriction fragment length polymorphism. sRANKL levels were measured using ELISA (enzyme-linked immunosorbent assay). The serum levels of sRANKL were significantly different between the 3 groups. In RANKL -643 C/T the frequency of "CT" genotype and the minor allele "T" was greater among the DPN and CN group compared with the NGT. Further statistical analysis found a significant difference in genotypic frequencies between DPN and NGT subjects with CT genotype. In RANK L -693 C/G the frequency of homozygote mutant "GG" and the minor allele "G" was greater among the DPN and CN group compared with the NGT. Significant differences in genomic frequencies were observed among "GG" genotype. RANKL -643 C/T was significantly associated with DPN alone while -693 C/G was significantly associated with both DPN and CN. Thus, the study suggests RANKL polymorphism might be considered as an independent risk factor for the development of CN.

Prevalence of Diabetes Mellitus and Exposure to Suspended Particulate Matter.

BACKGROUND: Evidence from various epidemiological studies has shown an association between particulate matter 2.5 (PM2.5) and diabetes mellitus. A prospective study from the United States reported that exposure to PM2.5 alters endothelial function, and leads to insulin resistance and reduction in peripheral glucose uptake. There is a paucity of data on the relation between air pollution and diabetes in low- and middle-income countries. OBJECTIVES: To estimate the prevalence of type 2 diabetes among people living in areas with higher exposures of suspended PM2.5 compared to people living in areas with lower exposures in Chennai, Tamil Nadu, India. METHODS: A cross-sectional study was carried out in two areas of Chennai city. The PM2.5 affecting vulnerable areas were stratified from a list of air quality monitoring stations in Tamil Nadu Pollution Control Board and Central Pollution Control Board. The highest and lowest areas of exposure were selected from the list. Households were randomly selected for the study. A total of 201 (67 male, 134 female) individuals from a high exposure area (HEA) and 209 (76 male 133 female) individuals from a low exposure area (LEA) were recruited for the study. Adults over 18 years of age were screened for random capillary blood glucose (RCBG) by glucometer (OneTouch Ultra). RESULTS: The prevalence of diabetes (34.8% vs 19.6% p =0.001) was 77.5% higher among people living in areas of high particulate matter exposure compared to people living in less exposed areas. Multivariable logistic regression analysis showed that age, gender, residential area, and family history of diabetes were significantly associated with the prevalence of diabetes (p<0.05). CONCLUSIONS: The present study indicates a link between high levels of exposure to PM2.5 and diabetes mellitus. Further prospective studies on populations exposed to elevated pollution are needed to establish whether this association has a causative link. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the Ethics Committee of the Prof. M Viswanathan Diabetes Research Centre, Chennai, India. COMPETING INTERESTS: The authors declare no competing financial interests.

Seroprevalence and risk factors associated with HBV and HCV infection among subjects with type 2 diabetes from South India.

This is a brief summary of the prevalence on Hepatitis C (HCV) and Hepatitis B (HBV) viral infections and associated risk factors in Type 2 diabetes subjects. Prevalence of HBV (9%) was higher compared to HCV (2%) infection in the screened 388 subjects. Results showed that these infections are independent of the liver damage. Risk factors prominently observed among positive HCV and HBV cases were longer duration of diabetes, hospital admission, history of jaundice and history of surgeries which enlightened the importance of hepatitis vaccination once the subject is diagnosed with diabetes.

Comparison of Two Creatinine Based Equations for Routine Estimation of GFR in a Speciality Clinic for Diabetes.

OBJECTIVE: To compare the bias, absolute bias, precision and accuracies between the equations, viz., CKD-EPI (Scr), CKD-EPI (Scys) and MDRD in Indian patients with type 2 diabetes. METHODS: 198 patients who underwent 24 h urinary collection for assessing kidney function between November 2014-January 2015 were included. Cohen's κ coefficient, Bland-Altman plot were calculated between estimated kidney function equations, and bias, precision, accuracies was calculated between the formulae. RESULTS: The mean eGFR based on MDRD, CKD-EPI (Scr) and CKD-EPI (Scys) equations were 64.5±21.9, 70.2±25.1 and 74.7±31.0 ml/min/ 1.73m2 respectively. The overall mean absolute bias was smallest for MDRD vs CKD EPI (Scr). The precision was also least for MDRD vs CKD EPI (Scr) indicating that the agreement between these equations is consistent for the range of values. MDRD vs CKD EPI (Scr) had the highest accuracy in comparison to other compared formula. The performance between MDRD versus CKD EPI (Scys) was different. There was a good agreement between MDRD and CKD EPI (Scr).in both stage 3 and stage 4 CKD. The MDRD vs CKD EPI (Scr) classified 72.2% of the patients correctly. CONCLUSIONS: In conclusion, there was a good agreement between CKD-EPI (Scr) and MDRD equations. CKD-EPI equation based on creatinine estimation is widely accepted method and clinicians may use this equation in routine clinical practice to assess kidney function among patients with type 2 diabetes.

Effect of a polyherbal formulation cream on diabetic neuropathic pain among patients with type 2 diabetes - A pilot study.

BACKGROUND & OBJECTIVES: Painful diabetic neuropathy is a common complication of diabetes and can severely limit patients' daily functions. The aim of this pilot study was to evaluate the safety and effect of using a polyherbal formulation in reducing the symptoms of diabetic neuropathic pain in comparison with placebo among patients with type 2 diabetes. METHODS: A total of 50 (M:F = 33:17) consecutive type 2 diabetes patients with painful diabetic neuropathy were enrolled in this study. All these patients had either two or more symptoms of diabetic neuropathy such as pain, burning and pricking sensations and numbness in their feet. They were randomly assigned to two groups: group 1 (n = 26) patients were treated with polyherbal formulation cream and group 2 (n = 24) patients were administered placebo. The patients were followed up for six months. Changes in the symptoms of painful diabetic neuropathy of each patient were recorded at baseline, third and sixth month using the Diabetic Neuropathic Score. RESULTS: The mean age of the patients, duration of diabetes and glycated haemoglobin (HbA 1c ) were similar in both groups at baseline. During follow up visits, there was a decrease in the HbA 1c levels in the study and control groups. The symptoms of painful diabetic neuropathy were also similar in both groups at baseline. A significant decrease in symptoms of neuropathic pain was observed among the group of patients treated with polyherbal formulation cream (76.9 per cent) compared to the placebo-treated group (12.5 per cent) (P<0.001), at the end of the final follow up. INTERPRETATION & CONCLUSIONS: In this pilot study polyherbal formulation cream was found to be effective as well as safe to treat painful diabetic neuropathy. However, its long term use needs to be evaluated for any further effectiveness and side effects.

Presence of elevated non-HDL among patients with T2DM with CV events despite of optimal LDL-C - A report from South India.

Elevated non-high density lipoprotein cholesterol (non-HDL-C) was the commonest lipid abnormality among T2DM patients with cardiovascular events (CV) events. Prevalence of elevated non-HDL-C was 21.6% among patients who were on statin therapy and with optimal low density lipoprotein-cholesterol (LDL-C) levels. Despite an optimal LDL-C level, 47% of the T2DM patients with CV events had elevated non-HDL-C.

High Prevalence and Heterogeneity of Diabetes in Patients With TB in South India: A Report from the Effects of Diabetes on Tuberculosis Severity (EDOTS) Study.

BACKGROUND: Previous studies reported an association of diabetes mellitus (DM) with TB susceptibility. Many studies were retrospective, had weak diagnostic criteria for DM, and did not assess other comorbidities. The Effects of Diabetes on Tuberculosis Severity (EDOTS) study is addressing these limitations with a longitudinal comparison of patients with TB who are classified as diabetic or normoglycemic according to World Health Organization criteria. We report interim findings after enrolling 159 of a planned 300 subjects. METHODS: A cohort study of patients with TB in South India with DM or normoglycemia defined by oral glucose tolerance test (OGTT) and fasting glucose. Glycohemoglobin (HbA1c), serum creatinine, lipids, and 25-hydroxyvitamin D were measured at enrollment. Patients were monitored monthly during TB treatment, and HbA1c measurement was repeated after 3 months. RESULTS: Of 209 eligible patients, 113 (54.1%) were classified as diabetic, 44 (21.0%) with impaired glucose tolerance, and 52 (24.9%) as normoglycemic. More patients with diabetes were detected by OGTT than by HbA1c. Diabetes was a newly received diagnosis for 37 (32.7%) in the DM group, and their median HbA1c (6.8%) was significantly lower than in those with previously diagnosed DM (HbA1c, 10.4%). Among 129 patients monitored for 3 months, HbA1c declined in all groups, with the greatest difference in patients with a newly received diagnosis of DM. CONCLUSIONS: Early EDOTS study results reveal a strikingly high prevalence of glycemic disorders in South Indian patients with pulmonary TB and unexpected heterogeneity within the patient population with diabetes and TB. This glycemic control heterogeneity has implications for the TB-DM interaction and the interpretation of TB studies relying exclusively on HbA1c to define diabetic status.

Comparison of plasma adiponectin & certain inflammatory markers in angiographically proven coronary artery disease patients with & without diabetes--a study from India.

BACKGROUND & OBJECTIVES: The association between adiponectin and risk of cardiovascular disease is well known. The aim of the present study was to evaluate adiponectin and certain inflammatory markers and to determine the correlations between them in angiographically proven coronary artery disease (CAD) in subjects with and without diabetes. METHODS: A total of 180 subjects who underwent coronary angiography for symptoms suggestive of CAD were categorised into groups based on their diabetes and/or CAD status: group1 (non-diabetic non-CAD); group2 (non-diabetic CAD); group3 (diabetic non-CAD) and group4 (diabetic CAD). Adiponectin, tumour necrosis factor α (TNF-α) and soluble form of E-selectin (sE-selectin) were estimated using quantitative sandwich enzyme immunoassay and high sensitive C-reactive protein (hsCRP) by particle enhanced immunoturbidimetric method. RESULTS: Adiponectin levels were significantly lower in subjects with either diabetes or CAD and were much lower in subjects who had both. hsCRP was elevated in CAD and diabetes but did not differ significantly between groups. sE-selectin and TNF-α levels were elevated in CAD. Adiponectin negatively correlated with age, glucose, sE-selectin, total and LDL cholesterol. hsCRP correlated with BMI, sE-selectin and urea. sE-selectin correlated with BMI, triglycerides and VLDL cholesterol, whereas TNF-α correlated with fasting plasma glucose. In the logistic regression analysis, adiponectin had a significant inverse association with CAD. sE-selectin and TNF-α also showed significant independent association with CAD. INTERPRETATION & CONCLUSIONS: Adiponectin and other inflammatory markers such as sE-selectin and TNF-α showed a significant association with CAD. Hence, early assessment of such markers can help to identify high risk patients, and to reduce the inflammatory component of diabetes and CAD.