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ORIGINAL ARTICLES
Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu
Balaji Bhavadharini, Mohan Deepa, Sivagnanam Nallaperumal, Ranjit Mohan Anjana, Viswanathan Mohan
January-April 2017, 8(1):22-26
DOI:10.4103/jod.jod_2_17  
Aim: The aim of this study is to evaluate the knowledge of gestational diabetes mellitus (GDM), including risk factors, importance of screening and post-partum follow-up, amongst pregnant women attending antenatal care in maternity clinics in South India. Methodology: The study participants were recruited from two antenatal clinics in Chennai and a few primary healthcare centres in South India. A detailed questionnaire was used to obtain basic data regarding general awareness and knowledge about GDM and other issues related to screening, risk factors, monitoring, long-term consequences and post-partum follow-up. Education status was graded as illiterate, primary education, secondary education and graduates. A composite score for knowledge of GDM was calculated. Results: A total of 100 pregnant women attending antenatal clinics were interviewed, of whom 59 were from urban Chennai and the rest from Kanchipuram district. Regarding risk factors of GDM, 48.8% of rural women were unaware of any risk factor while 55.9% of urban women reported a family history of diabetes as a risk factor. 49.2% of urban women and 75.6% of rural women did not know the long-term consequences of GDM to babies born to GDM women. 50.8% (urban women) said GDM could lead to type 2 diabetes mellitus in future while only 45% of rural women were aware of this. Mean composite score increased with higher education with graduates in both urban and rural areas, scoring the highest. Conclusion: Knowledge about GDM is poor amongst pregnant women, especially in rural areas. This highlights the need for training physicians, paramedical people and the public regarding GDM.
  5 8,698 1,008
REVIEW ARTICLES
Can decreased heart rate variability be a marker of autonomic dysfunction, metabolic syndrome and diabetes?
Gunjan Y Trivedi, Banshi Saboo, Ram B Singh, Anuj Maheshwari, Kamal Sharma, Narsingh Verma
May-August 2019, 10(2):48-56
DOI:10.4103/jod.jod_17_18  
Epidemiological studies show an emergence of diet- and lifestyle-related diseases; Cardio-metabolic diseases (CMD) and neuropsychiatric diseases (classified as non-communicable diseases or chronic diseases). Diet and lifestyle factors can cause adverse effects on autonomic function resulting in decreased heart rate variability (HRV). Low HRV is a risk factor for CMDs. There is a need to find out new methods of early diagnosis for prevention and treatment of these problems because the neurohormonal dysfunction could be the earliest manifestation. It is possible that HRV could be a marker for the early diagnosis of these problems, because it is characterised with increased sympathetic and reduced parasympathetic activity. Several studies indicate that increased unhealthy diet, mental stress, sedentary lifestyle, tobacco, insomnia and alcoholism may be associated with neurohormonal dysfunction, which may cause decline in HRV. Majority of the chronic diseases (e.g., diabetes, hypertension, heart attack, neuropsychiatric disease and cancer) are associated with decreased HRV. The studies also indicate that solar and geomagnetic activities may influence circadian clock and hypothalamus resulting in the oxidative stress and inflammation with alteration in HRV. It is possible that reduced HRV will correlate with various stages of autonomic dysfunction, associated with chronic diseases. Simple methods need to be developed to measure HRV for early diagnosis of neurohormonal dysfunction, which may be important for early management. This review aims to find out available evidence on the role of HRV in the early diagnosis of chronic disease (with specific focus on Type 2 diabetes) and the factors affecting HRV.
  4 3,505 412
REVIEW ARTICLE
Glucose monitoring technologies - complementary or competitive? Role of continuous glucose monitoring versus flash glucose monitoring versus self-monitoring of blood glucose
Jothydev Kesavadev, Lakshmy Ramachandran, Gopika Krishnan
September-December 2017, 8(3):61-67
DOI:10.4103/jod.jod_14_17  
We have numerous technologies that can help keep a close watch on an individual's glycaemic status and thereby assist in developing successful diabetes management strategies. For more than five decades, self-monitoring of blood glucose (SMBG) has remained as the gold standard tool to manage glycaemic status and has gained huge acceptance. Rigorous research further led to the development of more and more advanced technologies such as continuous glucose monitoring and flash glucose monitoring. These novel technologies are more promising in terms of revealing the complete glycaemic picture and even more user-friendly than the already established blood glucosemetres. However, they are yet to achieve remarkable accuracy and performance. There will also be a subgroup of patients who will be using these technologies only occasionally and thus will definitely require SMBG at other times. Again, with regard to the retrospective ones, glucose data can be obtained only once they are downloaded to the system and hence, real-time values will still have to be procured with the help of an SMBG. In future when the accuracy and performance of these newer technologies become equal to that of glucometres, the glucometres might vanish. Until then, all these technologies will definitely go hand-in-hand and supplement each other than competing each other. All the related literature were retrieved from various databases including 'PubMed' and 'Cochrane Database of Systematic Reviews' using specific search terms that were relevant to the topics discussed this manuscript.
  3 5,406 800
ORIGINAL ARTICLES
Validation of the antidiabetic effects of Vernonia amygdalina delile leaf fractions in fortified diet-fed streptozotocin-treated rat model of type-2 diabetes
Stanley Irobekhian Reuben Okoduwa, Ismaila Alhaji Umar, Dorcas Bolanle James, Hajiya Mairo Inuwa
September-December 2017, 8(3):74-85
DOI:10.4103/jod.jod_19_17  
Background: Vernonia amygdalina (VA) is used in the traditional management of diabetes in Nigeria. Previous scientific verification of VA is on Type-1 diabetes model, in spite of the continuous increase in Type-2 diabetes (T2D) among adults. This study aimed to validate the antidiabetic effects of VA leaf fraction (VALF) in a unique T2D rat model. Materials and Methods: Methanol crude extract of VA leaf was fractionated with solvents of increasing order of polarity (n-hexane, chloroform, ethyl-acetate, n- butanol and water). The antidiabetic activities of the fractions were evaluated in vivo in T2D model rats. Albino Wistar rats were induced with T2D and treated with the VALF. Several T2D-related parameters were measured. Results: T2D rats showed significant increase in serum levels of fasting blood glucose (FBG), liver and kidney biomarkers. At 28-day post-oral treatment with the VALF, FBG levels were significantly (P < 0.05) reduced (n- hexane [29.3%], chloroform [66.7%], ethyl acetate [36.2%], n- butanol [45.59%] and aqueous [39.3%]). The glucose tolerance ability was significantly improved in the chloroform fraction (Vernonia amygdalina chloroform fraction [VAc])-treated groups compared to the other fractions-treated group and diabetic control group. Furthermore, the VAc was found to be most effective as it ameliorates most of the alterations caused in the studied parameters in diabetic rats when compared with n- hexane, ethyl acetate, n- butanol and aqueous fractions. Conclusion: The study validates the anti-diabetic effects of VALF in fortified diet-fed streptozotocin-treated rat model of T2D, and suggests that the VAc is a potential candidate for development of a more effective drug for the management of T2D.
  2 5,672 540
Regional prevalence of gestational diabetes mellitus in North India
Samreen Siddiqui, Swati Waghdhare, Manju Panda, Sangeeta Sinha, Prachi Singh, Shweta Dubey, Sujeet Jha
January-April 2019, 10(1):25-28
DOI:10.4103/jod.jod_32_18  
Background and Objective: Incidence of gestational diabetes mellitus (GDM) varies globally from 2% to 14%. These cases in India are also increasing and emerging as a major public health problem. The prevalence of GDM among urban population of India has been reported as 16% and 17.8%, respectively. We conducted this study at three different regions of North India to estimate the prevalence of GDM. Materials and Methods: This pilot prospective cross-sectional study was conducted at three centres of North India with a base at Max Super Speciality Hospital, Saket, New Delhi, over a period of 10 months (December 2015–October 2016). Pregnant females attending gynaecology clinic at these centres were screened and enrolled as per the study inclusion criteria, after taking informed consent. Medical records were reviewed for recent haemoglobin levels, fasting blood sugar levels and other clinical parameters. Results: A total of 230 participants were enrolled in this study with 65 from Muzaffarpur, 65 from Bhilai and remaining 100 from Delhi, which include a mixed population. The overall prevalence of GDM was observed as 10%, with a regional prevalence of 10.77% at Bhilai, lower prevalence at Muzaffarpur (3.07%) and 14% in Delhi with a mixed population. A significant difference (P < 0.01) was observed in the mean age and body mass index of participants at Bhilai, Muzaffarpur and Delhi. Conclusion: Although there was a variable sample size at these three centres, we could conclude from this pilot study that there is a high prevalence of GDM at Bhilai district while very low prevalence at Muzaffarpur and Bihar. Large-scale studies are required to be done to estimate the prevalence in these regions, which would ultimately create awareness among clinicians to screen all females for GDM.
  2 4,864 848
Incidence and factors associated with diabetic retinopathy among diabetic patients at arbaminch general hospital, gamo gofa Zone (longitudinal follow up data analysis)
Yilma Chisha, Wondwossen Terefe, Huruy Assefa
January-April 2017, 8(1):1-6
DOI:10.4103/jod.jod_6_17  
Background: Currently, 93 million people are estimated as living with diabetic retinopathy (DR) worldwide. The incidence, retinopathy-free survival time and associated factors of DR in developed countries have been well documented; but in Ethiopia, national data on incidence and associated factors of DR are lacking. Objective: The objective of this study is to determine incidence and factors associated with the development of DR among diabetic patients at Arbaminch General Hospital, Ethiopia. Materials and Methods: Longitudinal follow-up data analysis with record review of 400 diabetic patients was conducted at Arbaminch General Hospital. Among 400 diabetic patients, 270 diabetic patients with baseline information and without a history of hypertension at baseline were included in this study. Whereas, pregnancy induced diabetes and patients with retinopathy at baseline were excluded from this study. Consecutive sampling technique was applied to select study participants. Data of cohorts were extracted from medical record using pre-tested structured extraction checklist. Data cleaning, coding, categorising, merging and analysis carried out by STATA version 12. Descriptive statistics was done and summarised accordingly. Bivariate Cox proportional hazard regression analysis was done to select potential candidates for the full model atP ≤ 0.25 and multivariable Cox proportional hazard regression analysis was made to estimate the independent effect of predictors on the incidence of DR. Model diagnostic tests were performed and final model fitness was checked by Cox and Snell residuals; finally, statistical significance was tested atP < 0.05. Results: Overall incidence of DR at Arbaminch General Hospital among diabetic patients ever enrolled since 1990 E.C. was ~36 cases per 1000 patients per year and an estimated median time to develop was approximately 10 years. The incidence of diabetic retinopathy was high among patients whose disease duration was >12 years. Adjusted analysis showed that the hazard of developing DR was statistically and positively associated with baseline age, baseline systolic blood pressure (SBP) level and fasting blood glucose (FBG) level. Conclusion: In the current study, the incidence of DR was high. Since baseline age, baseline SBP level and high FBG level were statistically and positively related with the development of DR; special care should be given in addition to routine care.
  2 3,329 554
CONSENSUS GUIDELINES
Consensus and recommendations on continuous glucose monitoring
Manoj Chawla, Banshi Saboo, Sujeet Jha, Sudhir Bhandari, Prasanna Kumar, Jothydev Kesavadev, Yash Pal Munjal, Viswanathan Mohan, Ranjit Unnikrishnan, Vishal Katswar, Nanditha Arun, Bhavana Sosale, Ranjit Mohan Anjana, Dhruvi Hasnani
January-April 2019, 10(1):4-14
DOI:10.4103/jod.jod_45_18  
  1 5,138 1,044
EDITORIAL
Expanding the concept of ‘Clinical Inertia’ in diabetes
Viswanathan Mohan
January-April 2019, 10(1):1-3
DOI:10.4103/jod.jod_44_18  
  1 2,843 546
Diabetes in Asia: Special challenges and solutions
Akhtar Hussain
September-December 2018, 9(3):69-72
DOI:10.4103/jod.jod_22_18  
  1 3,865 1,186
ORIGINAL ARTICLES
Characteristics of insulin registry patients with Type 1 diabetes in Sri Lanka
Mahendra Arunashanthi Wijesuriya, Jessica Lynn Sandy, Chamari Lalani Warnapura, Angela C Middlehurst, Graham D Ogle
January-April 2019, 10(1):37-40
DOI:10.4103/jod.jod_26_18  
Background: There is a paucity of literature on epidemiology of type 1 diabetes (T1D) in Sri Lanka. This study reviews the characteristics of patients registered in an insulin bank programme in Sri Lanka. Materials and Methods: Data were collected and analysed from records of all 672 patients diagnosed with T1D registered in the insulin bank with dates of the diagnosis ranging from 1971 to 2016. Results: Of the 672 patients, age at the diagnosis ranged from the day of birth to 44 years. The majority of patients, 526 (78.3%) were diagnosed before 15 years of age, with 7 (1.0%) cases diagnosed before 6 months. Females accounted for 56.8% of cases. The ethnic distribution of T1D in the study population was consistent with the overall population. Conclusion: This study gives some insight into the epidemiological features of T1D in young people in Sri Lanka. The peak age at the diagnosis is similar to studies in the western countries. This study also demonstrated a slight female predominance and a small but significant number of cases diagnosed in infancy. Further epidemiological and clinical research would help guide organisation of care and distribution of resources in the management of T1D in Sri Lanka.
  1 1,711 217
Peripheral neuropathy and its clinical correlates in Type 2 diabetic subjects without neuropathic symptoms in Nnewi, South-Eastern Nigeria
Ogonna Celestine Oguejiofor, Chikezie Hart Onwukwe, Chidiebele Malachy Ezeude, Ejike Kenneth Okonkwo, Justin Chibueze Nwalozie, Charles Uzoma Odenigbo, Charlotte Blanch Oguejiofor
January-April 2019, 10(1):21-24
DOI:10.4103/jod.jod_2_18  
Background: Peripheral neuropathy (PN) is a risk factor for foot disease in type 2 diabetes mellitus (T2DM). There are scanty data on prevalence of PN and its clinical correlates in Nigerian T2DM subjects without neuropathic symptoms. Objectives: To evaluate the prevalence and clinical correlates of PN diagnosed using objective methods in T2DM subjects without symptoms of PN. Materials and Methods: This is a cross-sectional study involving T2DM subjects at the Diabetes Clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. History was obtained and physical examination done on subjects. Fasting plasma glucose (FPG) done on the day of assessment and values of glycated haemoglobin (HbA1c), and fasting lipid profile done within the preceding three months- were obtained from subjects' clinic folders. Diabetic Neuropathy Symptom Score (DNSS) was used to identify subjects without neuropathic symptoms. PN was diagnosed using tuning fork, and two biothesiometers. Data collection was done using researcher-administered study proforma. Data were analyzed using SPSS version 20. Results: 524 subjects [244 (46.6%) males and 280 (53.4%) females] were recruited for the study. 223 (42.6%) of these subjects did not have neuropathic symptoms and PN tested further with 3 objective methods. PN prevalence with tuning fork, analog and digital biothesiometers were 71.5%, 14.8% and 14.8% respectively. All clinical variables evaluated were poor predictors of PN (P > 0.05). Conclusion: PN diagnosed by objective methods is present in South-Eastern Nigerian T2DM subjects who do not have symptoms of PN. Tuning fork diagnosed PN much more than the other methods reflecting its subjectivity.
  1 2,147 294
Diabetic retinopathy awareness and practices in a low-income suburban population in Karachi, Pakistan
Rubina Hakeem, Zahid Awan, Saleh Memon, Munazza Gillani, Sikandar Ali Shaikh, Muhammad Adil Sheikh, Sidra Ilyas
May-August 2017, 8(2):49-55
DOI:10.4103/jod.jod_31_17  
Purpose: This study presents observations about knowledge, attitude and practices of people with diabetes living in Chanesar Goth, which is a suburban area of Karachi. Methodology: Data were collected by trained lady health workers during their home visits of the families. The responses in most cases were open ended and later categorised according to themes and purpose for asking specific questions. Results: The sample consisted of 59 (31.6%) males and 128 (68.4%) females. The mean age of males and females was 56 years and 49 years, respectively. The mean duration of diabetes for females and males was 6.8 years and 8.34 years, respectively. Frequency of correct answers to question about treatment of diabetes-related eye disease was relatively low (24% male, 20% female). Proportion of patients having good awareness was significantly higher among those who had diabetes for 10 or more years (60%) as compared to those who had diabetes for shorter duration (42%, P < 0.026). Only half of the patients had a firm belief that diabetes is preventable and about one-third had belief that diabetes is treatable. Patients'' eye testing practices were associated strongly with their attitude towards eye testing and their knowledge about the relation of eye problems to diabetes. Proportion of patients who had got their eyes checked more than twice since the diagnosis of diabetes was highest among patients with both knowledge and belief about eye testing (35.3%), followed by those who only had a firm belief (19.7%) and was lowest than among those who neither had belief nor knowledge (9.1%) (P = 0.008). The level of awareness was higher among females and those who had diabetes for a longer duration. Conclusion: Educational interventions should focus on inculcating positive attitudes and firm belief in the importance of self-care.
  1 3,193 389
Management of Type 1 diabetes in a limited resource context: A study of the diabetes research education and management trust model in Nagpur, Central India
Caroline Sarah Zuijdwijk, Sharad Pendsey, James Ron, Kathryn A Williams, Salwa Akiki, Seema Chalkhore, Graham D Ogle, Alexandra Ahmet
May-August 2017, 8(2):37-44
DOI:10.4103/jod.jod_3_17  
Background/Objective: Diabetes Research Education and Management (DREAM) Trust (DT) is a charitable organisation that offers free insulin and healthcare to children and youth with type 1 diabetes (T1D) in central India. We systematically describe DT's model of care and evaluate medical and sociodemographic factors influencing glycaemic control in this resource-poor setting. Methods: Study of DT patients diagnosed with T1D <16 years old and followed at DT ≥1 year. Participants completed an interview, retrospective chart review and prospective haemoglobin A1c (HbA1c) measurements. Uni- and multi-variate linear regressions determined factors associated with HbA1c. Percentage of underweight patients (as proxy for glycaemic control) was compared at presentation to DT versus time of interview. Results: A total of 102 DT patients (51% female) completed the interview and chart review. 74 had HbA1c measured. Median HbA1c was 10.4% (90.2 mmol/mol). In multivariate regression, higher HbA1c was independently associated with higher insulin dose/kg (P < 0.001) and holding a below the poverty line certificate (P = 0.004). There was no association between HbA1c and age, sex, caste, religion or experience of stigma. However, the psychosocial burden of T1D (expressed as concern about others learning about the diagnosis, and worry about the future), and experience of stigma were substantial. Percentage of patients with underweight body mass index was significantly lower at the time of study vs. presentation to DT (P = 0.005). Conclusions: The DT charitable programme overcomes social status, gender inequalities and experience of social stigma to provide life-saving treatment to children with T1D in central India. Glycaemic control remains inadequate however, with children living in extreme poverty most at risk.
  1 2,565 330
Evaluation of pharmacists' educational and counselling impact on patients' clinical outcomes in a diabetic setting
Winifred Aitalegbe Ojieabu, Shakirat Iyabo Bello, John E Arute
January-April 2017, 8(1):7-11
DOI:10.4103/jod.jod_5_17  
Background: Nigeria had the highest number of people living with diabetes mellitus in the African region in year 2013. Previous researchers have found that patients with knowledge of their diseases including their treatment methods have a high likelihood to succeed in managing the disease conditions. Many pharmaceutical care programmes which have been successfully applied in various countries to enhance clinical outcomes and health-related quality of life are not very common in Nigeria. Objective: This study was to evaluate pharmacist's educational and counselling impact on diabetic patients' outcomes in a diabetic setting. Materials and Methods: The 4-month randomised controlled study involved 150 elderly Type 2 diabetic patients. Sociodemographic and clinical parameters were measured. We educated and counselled the 75 patients in our intervention group at least four times during the study period, but the control group was deprived of the pharmacist's intervention. Results: Female to male participants was in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority (>40%) of the patients in both groups had primary education. Baseline and 4-month mean fasting blood sugar in the control group was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825), whereas the intervention group had 156.7 ± 30.5 and 131.8 ± 40.4, respectively (P < 0.001). Mean systolic blood pressure in both groups was 146.4 ± 13.9 and 133.8 ± 18.5 (P < 0.001), respectively. Adherence levels to medication taking in both groups were 42.7%:94.7%, respectively (P = 0.001). Conclusion: This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.
  1 4,801 634
Short-term insulin therapy at the time of diagnosis of Type 2 diabetes leads to better glycemic control and improved beta cell function
Siddharth Madnani, Ranjit Mohan Anjana, Sanjay Baliram Warade, Muthukrishnan Varalakshmi, Brijendra Kumar Srivastava, Prasanna Kumar Gupta, Philips Routray, Chandru Sundaramoorthy, Ranjit Unnikrishnan, Viswanathan Mohan
September-December 2019, 10(3):97-101
DOI:10.4103/jod.jod_39_18  
Background: Impaired insulin secretion and insulin resistance are the underlying pathophysiological defects in Type 2 diabetes (T2DM) that lead to hyperglycaemia. The β-cell defect in T2DM is usually progressive, leading to eventual β-cell exhaustion and dependence on insulin. It is known that glucotoxicity and lipotoxicity contribute to the initial decreased insulin secretion at the time of diagnosis of T2DM. Therefore, an aggressive approach early in the course of the disease to correct these defects could possibly alter the natural history of T2DM. Objectives: Our aim was to study the effect of administration of a short course of insulin therapy at the onset of T2DM on glycaemic parameters and pancreatic β-cell function as assessed by C-peptide estimation. Materials and Methods: Treatment-naïve T2DM patients (n = 426) with known duration of diabetes of <3 months were recruited from Dr. Mohan’s Diabetes Specialities Centre at Chennai. All patients were treated initially with short-term insulin therapy (4–6 weeks) along with oral hypoglycaemic agents (OHAs), usually metformin alone or sometimes in combination with sulphonylurea. Subsequently, they were continued on diet, exercise and OHA, wherever required. The baseline characteristics, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) and glycated haemoglobin (HbA1c), were compared after (an initial) a mean follow-up period of 2.6 months. Patients were then followed up for another 2 years to evaluate their long-term glycaemic control. Fasting and stimulated C-peptide levels were measured in a subset of patients at baseline and at follow-up at 2–3 months, 1 year and 2 years. Results: There was a significant reduction in both FPG and PPG levels. The mean FPG decreased from 214 ± 82 to 111 ± 29mg/dl (P < 0.001), whereas the PPG decreased from 332 ± 120 to 158 ± 54mg/dl (P < 0.001). The HbA1c decreased from 11.8% ± 1.9% to 6.8% ± 1.1% (P < 0.001). There was a significant improvement in the serum C-peptide levels, indicating an improvement in β-cell function. The fasting C-peptide levels improved from a mean of 0.85 ± 0.3 to 1.09 ± 0.4 pmol/ml, whereas the stimulated C-peptide value increased from a mean of 1.63 ± 0.8 to 2.09 ± 1.0 pmol/ml even at the end of 2 years after the insulin was discontinued. There was also a favourable change in lipid profile of the patients. Conclusion: Our study demonstrates that, in newly diagnosed T2DM, a short course of insulin therapy given for 4–6 weeks can lead to long-term good glycaemic control and beneficial effects on pancreatic β-cell function, which is sustained up to 2 years.
  1 1,955 694
The influence of one-carbon metabolism gene polymorphisms and gene-environment interactions on homocysteine, Vitamin B12, folate and lipids in a Brazilian adolescent population
Shelini Surendran, Carla C Morais, Dulcinéia S P Abdalla, Israa A Shatwan, Julie A Lovegrove, Cristiane Cominetti, Vimaleswaran Karani Santhanakrishnan, Maria A Horst
September-December 2019, 10(3):110-122
DOI:10.4103/jod.jod_37_18  
Background: Several single-nucleotide polymorphisms (SNPs) have been associated with the metabolism of Vitamin B12, folic acid, homocysteine and lipids. However, the interaction between SNPs involved in the one-carbon metabolism pathway and macronutrient intake on cardiovascular risk factors in the Brazilian population has not yet been investigated. Hence, the present study examined whether the association of ten SNPs involved in the one-carbon metabolism pathway with Vitamin B12, folic acid, homocysteine and lipid levels is modified by dietary factors and physical activity in adolescents with cardiovascular risk. Materials and Methods: A total of 113 adolescents (10–19 years old), from a public school in the city of Goiânia, Goiás, Brazil, underwent anthropometric, biochemical and food consumption evaluations and genetic tests. Results: After adjusting for potential confounders, SNPs rs4633 (catechol-O-methyltransferase, COMT), rs602662 (fucosyltransferase 2, FUT2) and rs1801394 (5-methyltetrahydrofolate-homocysteine methyltransferase reductase) showed significant associations with folic acid (P = 0.042), Vitamin B12 (P = 0.009) and oxidised low-density lipoprotein (ox-LDL) (P = 0.041) concentrations, respectively. The COMT SNP rs4680 showed a significant interaction with carbohydrate intake on ox-LDL concentrations (Pinteraction = 0.005). In addition, the FUT2 SNP rs602662 showed a significant interaction with protein intake on homocysteine concentrations (Pinteraction = 0.007). However, after correction for multiple testing, none of these associations and interactions were statistically significant. Conclusions: For the first time, we provide evidence for the interactions between COMT SNP rs4680 and carbohydrate intake on ox-LDL levels and the FUT2 SNP rs602662 and protein intake on homocysteine concentrations. However, replication of our results in a larger sample size is required to confirm our findings.
  1 1,946 206
REVIEW ARTICLES
HIV and antiretroviral therapy-induced metabolic syndrome in people living with HIV and its implications for care: A critical review
Sakhile Khetsiwe Salome Masuku, Joyce Tsoka-Gwegweni, Ben Sartorius
May-August 2019, 10(2):41-47
DOI:10.4103/jod.jod_21_18  
HIV has remained a major global public health concern for more than three decades. While global efforts are coalesced in the fight against HIV, the number of people living with HIV (PLHIV) is continuously increasing due to the rollout of antiretroviral therapy (ART). This relates, in part, to the intensified efforts in HIV prevention and control strategies through extensive HIV testing. Consequently, more and new people have learnt their HIV-positive status, implying that more are at risk of suffering the negative effects of HIV and ART. HIV has been implicated in the development of many non-communicable diseases such as cardiovascular diseases and type 2 diabetes mellitus (T2DM). This study conducted a critical review of the literature on the mechanisms through which HIV and ART cause metabolic syndrome, and the implications such understanding has to the care provided to PLHIV. The findings of this review suggest that HIV induces metabolic syndrome through stimulation of immune cells which, in turn, trigger an inflammatory response. ART also triggers the inflammatory response. The inflammatory response suppresses adiponectin and causes impaired insulin action on skeletal muscles. Since the presence of metabolic syndrome greatly increases the risk of non-communicable diseases, particularly T2DM, there is a need for metabolic syndrome screening and prevention among PLHIV. Conducting routine body mass index and waist circumference measurement with periodical triglycerides measurement is necessary for the early detection of metabolic syndrome and the prevention of T2DM and cardiovascular conditions. There is also a need for a model of care for PLHIV that will provide guidance on the prevention of metabolic syndrome hence prevent the development of T2DM with its dire effects on the quality of life.
  1 2,591 387
Technology in the management of diabetes mellitus
Ranjit Unnikrishnan, Nitika Sharma, Viswanathan Mohan, Harish Ranjani
January-April 2018, 9(1):3-11
DOI:10.4103/jod.jod_4_17  
The explosive increase in the prevalence of diabetes mellitus in resource-strapped regions of the world demands innovative solutions in healthcare. Advances in information technology, diagnostics and food technology have the potential to make diagnosis and treatment of diabetes simpler, cost-effective and patient-friendly. Newer methods of glucose testing such as the ambulatory glucose profile promise to make clinical decision-making easier and more robust. More advanced modes of insulin delivery are likely to help larger proportions of patients achieve their glycaemic goals with minimal risk of hypoglycaemia. Use of telemedicine and electronic medical records represents a significant advance in improving delivery of diabetes care and monitoring its outcomes. Efforts are also on to harness the wide penetrance of mobile phones in spreading awareness about diabetes and its prevention as well as in screening for retinopathy. Advances in technology also promise to favourably alter the food habits of the population, with the advent of the novel high-fibre white rice being a case in point. This narrative review aims to discuss some of the ways in which emerging technologies are making diabetes monitoring and treatment easier, more effective and pleasant for the patient.
  1 3,614 462
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