Ethnic minorities living in developed countries have a high prevalence of Type 2 Diabetes (T2D). Applying a crossover design, blood glucose was determined every 15 min after intake of various types and amounts of food; cornflakes with milk, chickpeas with tomato and onion or bread, in twenty female Pakistani immigrants living in Norway. Sustained elevated postprandial glycaemia (PPG) was found after intake of cornflakes providing 75g available carbohydrates (CHO). Intake of cornflakes giving 25g CHO reduced the blood glucose peak value (PV) by 11% (p=0.008) and Incremental Area Under the 2-h blood glucose vs. time Curve (IAUC) by 51% (p=0.003). IAUC was reduced by 40% (p=0.001) when bread intake was lowered by 50%. PPG was also lowered after intake of 50g CHO as chickpeas spiced with tomato and onion, compared with the intake of same amount of available CHO, as corn flakes with milk. Change to chick pea type of CHO resulted in a reduction in PV (15.7%, p=0.0001), and IAUC (50.9%, p=0.0001) and increased the time to reach PV, on average by 20 min (p=0.006), and the glycaemic profile by 73.5% p=0.002. The order of post meal blood PV to one CHO type or amount corresponded well with the response order to another CHO type or amount (r>0.9, p<0.001). In diabetes prone subjects, the PPG can be appreciably blunted both by reducing the quantity and changing the quality of the ingested carbohydrates. Below the diabetes threshold, there seems to be high and low responders to a carbohydrate load.

At the crossroads of obesity, insulin resistance, and cardiovascular disease, is the nuclear receptor PPAR-γ. The modulation of PPAR-gamma activity is an interesting therapeutic approach to address multi-component metabolic syndrome. Any therapy that targets all the components of the metabolic syndrome is either non-existent or ineffective. Pioglitazone, a glitazone and Telmisartan, an angiotensin receptor blocker, share the unique property of activating PPAR-γ. Both have the potential to treat the hemodynamic, biochemical and inflammatory components of metabolic syndrome. To evaluate the efficacy of two PPAR-γ agonists; Pioglitazone and Telmisartan in treating multiple components of metabolic syndrome. This parallel group, interventional, randomized, open-labeled, active controlled comparative study, in patients having 3/5 NCEP-ATP III criteria was conducted at a University hospital. Changes in various hemodynamic and biochemical parameters along with hs-CRP, TNF-a, IL-6, at baseline and at 24 weeks, in the control group (n=20), Pioglitazone group (n=30) 30mg/day & Telmisartan group (n=30) 40mg/day, were studied. Analysis was done with Graph Pad Prism 5.0, two tailed p of <0.05 was considered significant (95% C.I). No statistically significant differences between the groups in various parameters were observed at baseline. Elevated waist circumference (WC), hypertension and diabetes mellitus were the most prevalent combination. Both Pioglitazone and Telmisartan were equally effective in reducing the WC, diastolic blood pressure and triglyceride. Pioglitazone was more effective in correcting hyperglycaemia, and Systolic Blood Pressure was more significantly reduced by Telmisartan. CRP and IL-6 were significantly and TNF-α was insignificantly reduced by telmisartan, vis-a-vis Pioglitazone. The present study provides the evidence of an anti-inflammatory and anti-atherogenic effect of PPAR-γ agonists: Pioglitazone and Telmisartan. The targeted treatment by PPAR-γ agonists is an effective monotherapy option in metabolic syndrome.

The objective of the study was to determine the association of chronic complications of type 2 diabetes with the biochemical and physical estimations in subjects attending single visit screening for complications. A retrospective analytical study was conducted by reviewing the clinical records of the patients with type 2 diabetes who attended the National Diabetes Centre of Sri Lanka from January 2005 to December 2010. Odds ratio (OR) with 95% confidence interval (CI) was calculated to examine the association of chronic complications with the biochemical and physical estimations. A total of 12517 type 2 diabetic patients aged 20 years or above were included in the study. Microvascular complications were present in 7102 (56.7%) subjects. Retinopathy was present in 2654(21.2%), neuropathy in 3509(28%), nephropathy in 4173(33.3%) subjects, whereas, 2626(21.0%) had more than one complication. Retinopathy was significantly associated with poor glycemic control [high HbA1c (OR:2.42;CI:2.09-2.79) and high fasting blood glucose (OR:1.48;CI:1.30-1.68)] and high systolic (OR:2.00;CI:1.83-2.18) and diastolic blood pressure (OR:1.66;CI:1.52-1.82). Neuropathy was also significantly associated with poor glycemic control [high HbA1c (OR: 1.30; CI: 1.17-1.45)] and high systolic (OR:2.01;CI:1.86-2.18) and diastolic blood pressure (OR:1.45;CI:1.33-1.57). Nephropathy was significantly associated with poor glycemic control [high HbA1c (OR:1.96;CI:1.75-2.19) and high fasting blood glucose (OR:1.88;CI:1.68-2.11)], high systolic blood pressure (OR:1.53;CI:1.41-1.65) and diastolic blood pressure (OR:1.52;CI:1.40-1.65), and high body mass index (OR:1.20;CI:1.11-1.29). Macrovascular complications were present in 785 (6.3%) subjects; ischemic heart disease in 676 (5.4%), cerebrovascular accidents in 99 (0.8%) and peripheral vascular disease in 14 (0.1%) subjects. Ischemic heart disease was significantly associated with high systolic (OR:1.79;CI:1.53-2.09) and diastolic blood pressure (OR:1.20;CI:1.02-1.41), and low HDL (OR:1.17;CI:1.01-1.37). Cerebrovascular accidents were significantly associated with high systolic (OR:2.77;CI:1.84-4.17) and diastolic blood pressure (OR:1.56;CI:1.04-2.33). This study shows that chronic complications of type 2 diabetes in Sri Lanka are related to multiple risk factors; microvascular complications are associated with poor glycemic control, high blood pressure and abnormal lipids, macrovascular complications with high blood pressure and abnormal lipids. It is important to diagnose and manage hypertension and dyslipidemia concomitantly with achieving the glycemic control in order to prevent diabetic complications.

Visual deficit is normally an end-stage sign of both vascular and metabolic abnormalities in Diabetes Mellitus which can affect the retina and the visual pathways. The aim of this study was to find whether the VEP latencies are altered in diabetics and if altered, whether it shows any correlation with the glycemic control and duration of diabetes. A case control study included 40 type 2 diabetic patients with age and sex matched 20 controls. All subjects were investigated for Fasting blood glucose (FBG), Post prandial blood sugar (PPBS), Glycosylated haemoglobin (HbA1C) and also underwent neurological and ophthalmological examination. Visual evoked potentials were recorded through using pattern reversal stimulation, using a checkerboard by placing 3 scalp electrodes i.e. Frontal (FPZ), Occipital (OZ) and grounding (CZ). The P100 and N75 latencies and amplitudes were studied. There was a prolongation of P100 and N75 latencies and a decrease in amplitude of VEP in diabetes mellitus group, when compared with the control group. The subjects with poor metabolic control showed an increase in latencies, when compared with the subjects having good metabolic control. It was observed that there was a prolongation in VEP latencies and reduction in amplitude in diabetic group as the duration increased. The anterior visual pathway seemed to have functional disturbance before the development of retinopathy in diabetic patients. VEP is a very sensitive method for evaluating the central visual pathway impairment in DM and is also recommended for a proper management of this metabolic illness, which can lead to blindness.

High ghrelin level is associated with increased appetite. Type 2 diabetes mellitus also has an association with increased appetite. However, many researchers have found low ghrelin levels in diabetic patients. To look into this controversy, the present study aimed to assess the ghrelin hormone levels in obese diabetic patients and correlate its level with different parameters including lipid profile, glycated hemoglobin (HbA1c), insulin resistance (IR) parameters calculated from Homeostasis Model Assessment Insulin Resistance (HOMA-IR), HOMA insulin sensitivity (HOMA2-%S), and HOMA beta cells function (HOMA2-%B). It was a cross sectional study in which sixty obese type 2 diabetic patients and 30 control subjects participated. Biochemical parameters were measured spectrophotometrically except ghrelin and insulin levels which were measured by using ELISA technique. HbA1c concentration was measured by ion-exchange chromatography. Insulin resistance parameters were calculated using HOMA 2 calculator software. Mean ghrelin levels were low in obese diabetic patients and non-IR patients had moderately higher ghrelin levels than IR patients. Ghrelin levels were negatively correlated with BMI, cholesterol, HbA1c, atherogenic ratios, and HOMA 2 - % S. Ghrelin levels were positively correlated with HDL-C and HOMA 2 IR. Regression analysis produced the equation which correlated the ghrelin level with the parameters of obesity, the risk of atherosclerosis, and insulin resistance parameters. It can be concluded that low ghrelin level is associated with poor diabetes control and bad prognosis parameters in obese diabetic patients.