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   2016| March-April  | Volume 20 | Issue 2  
    Online since February 15, 2016

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Glucagon-like peptide-1 receptor agonists in the treatment of type 2 diabetes: Past, present, and future
Sanjay Kalra, Manash P Baruah, Rakesh K Sahay, Ambika Gopalakrishnan Unnikrishnan, Shweta Uppal, Omolara Adetunji
March-April 2016, 20(2):254-267
DOI:10.4103/2230-8210.176351  PMID:27042424
Glucagon-like peptide-1 (GLP-1)–based therapy improves glycaemic control through multiple mechanisms, with a low risk of hypoglycaemia and the additional benefit of clinically relevant weight loss. Since Starling and Bayliss first proposed the existence of intestinal secretions that stimulate the pancreas, tremendous progress has been made in the area of incretins. As a number of GLP-1 receptor agonists (GLP-1 RAs) continue to become available, physicians will soon face the challenge of selecting the right option customized to their patient's needs. The following discussion, derived from an extensive literature search using the PubMed database, applying the terms incretin, GLP-1, exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and taspoglutide, provides a comprehensive review of existing and upcoming molecules in the GLP-1 RA class in terms of their structure, pharmacological profiles, efficacy, safety, and convenience. Search Methodology: A literature search was conducted using the PubMed database, applying the terms incretin, GLP-1, exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and taspoglutide. Relevant articles were those that discussed structural, pharmacokinetic and pharmacodynamic differences, classification, long-acting and short-acting GLP-1 RAs, phase 3 trials, and expert opinions. Additional targeted searches were conducted on diabetes treatment guidelines and reviews on safety, as well as the American Diabetes Association/European Society for Study of Diabetes (ADA/EASD) statement on pancreatic safety.
  30 8,070 1,994
DiabCare survey of diabetes management and complications in the Gulf countries
Muhamed Shahed Omar, Khaled Khudada, Saher Safarini, Sherif Mehanna, Jalal Nafach
March-April 2016, 20(2):219-227
DOI:10.4103/2230-8210.176347  PMID:27042419
Aim: To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors.Methods: Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients' medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed.Results: Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1cof 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). Conclusion: The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications.
  10 1,913 337
Effect of Vitamin D supplementation on glycemic control in Type 2 diabetes subjects in Lagos, Nigeria
Anthony Chinedu Anyanwu, Olufemi Adetola Fasanmade, Ifedayo Adetola Odeniyi, Sandra Iwuala, Herbert Babatunde Coker, Augustine Efedaye Ohwovoriole
March-April 2016, 20(2):189-194
DOI:10.4103/2230-8210.176345  PMID:27042414
Introduction: Improvement of glycemic control reduces the risk of diabetic complications. Reports suggest that Vitamin D supplementation improves glycemia. However, there are no data on the influence of Vitamin D on diabetes mellitus (DM) in Nigeria. Objective: To determine the effect of Vitamin D supplementation on glycemic control in Type 2 DM (T2DM) participants with Vitamin D deficiency.Design: This was a single-blind, prospective randomized placebo-controlled trial, involving T2DM participants attending the Diabetes Clinic of the Lagos University Teaching Hospital. Forty-two T2DM participants with poor glycemic control and Vitamin D deficiency were selected following a prior cross-sectional study on 114 T2DM participants for the determination of Vitamin D status and glycemia. These participants were randomized into two equal groups of treatment and placebo arms. Intervention: Three thousand IU of Vitamin D3were given to the participants in the treatment arm. Glycemic status was determined at baseline and after 12 weeks. Statistical analysis was performed using Statistical Package for Social Sciences version 20. P < 0.05 was considered statistically significant. Results: Vitamin D3 supplementation resulted in a significant improvement in serum Vitamin D level and fasting plasma glucose in the treatment arm compared to placebo. There was a nonsignificant reduction in the mean HbA1c level in the treatment group after 12 weeks of Vitamin D3 supplementation (Z = −1.139; P = 0.127) compared to the placebo group, which had a further increase in the mean HbA1c level (Z = −1.424; P = 0.08). The proportion of participants with poor glycemic control (HbA1c > 6.5%) who converted to good control after Vitamin D supplementation was significantly higher in the treatment arm compared to placebo (P < 0.05). Conclusion: Vitamin D3 supplementation in persons with T2DM and Vitamin D deficiency results in a significant improvement in glycemic control.
  7 1,848 533
High prevalence of preobesity and obesity among medical students of Lahore and its relation with dietary habits and physical activity
Zeeshan Nasir Khan, Muhammad Zaman Khan Assir, Mudassar Shafiq, Aghosh-e-Gul Chaudhary, Atika Jabeen
March-April 2016, 20(2):206-210
DOI:10.4103/2230-8210.176357  PMID:27042417
Objective: The objective of this study was to determine the prevalence of obesity among students of medical colleges of Lahore and to study its correlation with high-caloric diet intake and physical inactivity. Study Design: A cross-sectional survey was conducted at four medical colleges of Lahore, Pakistan between March and June 2012. Methods: A total of 244 medical students (85 males, 159 females) of the median age of 20 years (range: 18–25) were randomly included in the study. Anthropometric measures were obtained. High-caloric diet intake and physical profile were assessed through a self-reported questionnaire. The relationships between obesity indices (body mass index [BMI], waist-to-hip ratio) were investigated and correlated with the studied dietary and physical activity factors. Results: Approximately, 30.5% males and 16% females had BMI ≥25.0 kg/m2 overall affecting 21% of total medical students. Central obesity was found in 46% of male and 31.4% of female students. Central obesity was associated with a higher total daily caloric intake, studying at private medical college and male gender. Overall, 197 of 244 (80.7%) students played no sports in college. Median time to watch television or work on the computer was 120 min a day (range: 30–420). Only 70 (28.7%) students had regular walk or jogging. Conclusion: A substantial proportion of Pakistani medical students were overweight or obese. Higher total daily caloric intake was associated with central obesity but not a BMI >25. Physical activity parameters favored an overall sedentary aptitude for medical students.
  7 2,087 454
Sodium-glucose co-transporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors combination therapy in type 2 diabetes: A systematic review of current evidence
Awadhesh Kumar Singh, Ritu Singh
March-April 2016, 20(2):245-253
DOI:10.4103/2230-8210.176353  PMID:27042423
As type 2 diabetes mellitus (T2DM) is a chronic and progressive disease with multiple pathophysiologic defects, no single anti-diabetic agent can tackle all these multi-factorial pathways. Consequently, multiple agents working through the different mechanisms will be required for the optimal glycemic control. Moreover, the combination therapies of different anti-diabetic agents may complement their actions and possibly act synergistic. Furthermore, these combinations could possess the additional properties to counter their undesired physiological compensatory response. Sodium-glucose co-transporter-2 inhibitors (SGLT-2I) are newly emerging class of drugs, with a great potential to reduce glucose effectively with an additional quality of lowering cardiovascular events as demonstrated very recently by one of the agents of this class. However, increase in endogenous glucose production (EGP) from the liver, either due to the increase in glucagon or compensatory response to glucosuria can offset the glucose-lowering potential of SGLT-2I. Interestingly, another class of drugs such as dipeptidyl peptidase-4 inhibitors (DPP-4I) effectively decrease glucagon and reduce EGP. In light of these findings, combination therapies with SGLT-2I and DPP-4I are particularly appealing and are expected to produce a synergistic effect. Preclinical studies of combination therapies with DPP-4I and SGLT-2I have already demonstrated a significant lowering of hemoglobin A1c potential and human studies also find no drug-drug interaction between these agents. This article aims to systematically review the efficacy and safety of combination therapy of SGLT-2I and DPP-4I in T2DM.
  5 2,203 835
Empagliflozin: Not just a glorified diuretic
Mathew John
March-April 2016, 20(2):154-156
DOI:10.4103/2230-8210.176361  PMID:27042407
  4 1,450 509
Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects
Neha Singhal, VP Praveen, Nisha Bhavani, Arun S Menon, Usha Menon, Nithya Abraham, Harish Kumar, RV JayKumar, Vasantha Nair, Shanmugha Sundaram, Padma Sundaram
March-April 2016, 20(2):157-161
DOI:10.4103/2230-8210.176360  PMID:27042408
Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India. Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission. Subjects and Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups. Statistical Analysis Used: Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups. Results: Fifty-seven (32.7%) patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2%) patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02). Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively). Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01). The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009). Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.
  4 1,267 312
Gender differences in 7 years trends in cholesterol lipoproteins and lipids in India: Insights from a hospital database
Rajeev Gupta, Madhawi Sharma, Neeraj Krishna Goyal, Preeti Bansal, Sailesh Lodha, Krishna Kumar Sharma
March-April 2016, 20(2):211-218
DOI:10.4103/2230-8210.176362  PMID:27042418
Objective: To determine gender differences and secular trends in total, low-density lipoprotein (LDL) and high DL (HDL) cholesterol and triglycerides using a large hospital database in India. Methods: All blood lipid tests evaluated from July 2007 to December 2014 were analyzed. Details of gender and age were available. Statin therapy was obtained at two separate periods. Trends were calculated using linear regression and Mantel-Haenszel X2. Results: Data of 67395 subjects (men 49,904, women 17,491) aged 51 ± 12 years were analyzed. Mean levels (mg/dl) were total cholesterol 174.7 ± 45, LDL cholesterol 110.7 ± 38, non-HDL cholesterol 132.1 ± 44.8, HDL cholesterol 44.1 ± 10, triglycerides 140.8 ± 99, and total: HDL cholesterol 4.44 ± 1.5. Various dyslipidemias in men/women were total cholesterol ≥200 mg/dl 25.4/36.4%, LDL cholesterol ≥130 mg/dl 28.1/35.0% and ≥100 mg/dl 54.4/66.4%, non-HDL cholesterol ≥160 mg/dl 25.5/29.6%, HDL cholesterol <40/50 mg/dl 54.4/64.4%, and triglycerides ≥150 mg/dl 34.0/26.8%. Cholesterol lipoproteins declined over 7 years with greater decline in men versus women for cholesterol (Blinear regression = −0.82 vs. −0.33, LDL cholesterol (−1.01 vs. −0.65), non-HDL cholesterol (−0.88 vs. −0.52), and total: HDL cholesterol (−0.02 vs. −0.01). In men versus women there was greater decline in prevalence of hypercholesterolemia (X2trend 74.5 vs. 1.60), LDL cholesterol ≥130 mg/dl (X2 trend 415.5 vs. 25.0) and ≥100 mg/dl (X2 trend 501.5 vs. 237.4), non-HDL cholesterol (X2trend 77.4 vs. 6.85), total: HDL cholesterol (X2 trend 212.7 vs. 10.5) and high triglycerides (X2trend 10.8 vs. 6.15) (P < 0.01). Use of statins was in 2.6% (36/1405) in 2008 and 9.0% (228/2527) in 2014 (P < 0.01). Statin use was significantly lower in women (5.8%) than men (10.3%). Conclusions: In a large hospital - database we observed greater hypercholesterolemia and low HDL cholesterol in women. Mean levels and prevalence of high total, LDL, non-HDL and total: HDL cholesterol declined over 7 years. A lower decline was observed in women. This was associated with lower use of statins.
  4 2,350 313
Association between glycemic control and morning blood surge with vascular endothelial dysfunction in type 2 diabetes mellitus patients
Rama Kumari Nuthalapati, Bhaskara Raju Indukuri
March-April 2016, 20(2):182-188
DOI:10.4103/2230-8210.176349  PMID:27042413
Objective: Morning blood pressure surge (MBPS) is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and MBPS, and its effect on vascular injury in patients with type 2 diabetes mellitus (T2DM). The current study examined the association between glycemic control and MBPS and the involvement of MBPS in the development of vascular dysfunction in T2DM patients. Materials and Methods: One hundred and twenty-two consecutive T2DM outpatients from the Department of Cardiology and Endocrinology were enrolled in this study. We did MBPS in T2DM patients, 85 (male) (69.7%) patients and 37 (female) patients (30.3%); mean age 60.1 ± 9.39; (n = 122) using 24 h ambulatory blood pressure monitoring and assessed vascular function by brachial artery flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD). Results: The correlation between MBPS and various clinical variables were examined by single regression analysis in all subjects. MBPS showed significant and positive correlation with pulse rate (P = 0.01), fasting blood sugar (P = 0.002), and postprandial blood sugar (P = 0.05). To further confirm the association of insulin resistance (IR) with MBPS in T2DM patients, we examined the correlation between homeostasis model assessment-IR (HOMA-IR), an established marker of IR and MBPS in diabetic (DM) patients who were not taking insulin no significant association with MBPS in T2DM patients (P = 0.41), angiotensin-converting enzyme/angiotensin receptor blocker (P = 0.07). We examined the relationship between MBPS and vascular injury by measuring endothelium-dependent FMD and endothelium-independent NMD in T2DM patients. Among the various traditional risk factors for atherosclerosis such as DM duration (P = 0.04), platelet reactivity (P = 0.04) and morning surge (P = 0.002) emerged as significant factors. HOMA-IR was a negative correlation with FMD. Conclusions: The current study demonstrated that poor glycemic control and IR have predictive value for the occurrence of MBPS in T2DM patients, which might be significantly associated with endothelial dysfunction.
  4 2,735 721
Iodine nutritional status in Uttarakhand State, India
Neha Sareen, Umesh Kapil, Vanisha Nambiar, Ravindra Mohan Pandey, Preetika Khenduja
March-April 2016, 20(2):171-176
DOI:10.4103/2230-8210.176363  PMID:27042411
Introduction: Uttarakhand (UK) state is a known endemic region to iodine deficiency (ID). Objective: To assess the current status of iodine nutrition in a population of UK. Methodology: Three districts, namely Udham Singh Nagar (USN), Nainital (N), and Pauri Garhwal (PG) were selected. In each district, 30 clusters were identified by utilizing the population proportional to size cluster sampling methodology. Total of 6143 school age children (SAC) (USN; 1807, N; 2269, PG: 2067), 5430 adolescent girls (AGs) (USN; 1823, N; 1811, PG: 1796), 1727 pregnant mothers (PMs) (USN; 632, N; 614, PG: 481), and 2013 Neonates (USN; 649, N; 670, PG: 694), were included in the study. Clinical examination of thyroid of each child, AG and PM was conducted. Spot urine and salt samples were collected from children, AGs and PMs. Cord blood samples were collected from neonates for estimation of thyroid stimulating hormone (TSH). Results: In SAC, total goiter rate (TGR) was 13.2% (USN), 15.9% (N), and 16.8% (PG). Median urinary iodine concentration (UIC) level was 150 μg/l (USN), 125 μg/l (N), and 115 μg/l (PG). In AGs, TGR was 6.8% (USN), 8.2% (N) and 5.6% (PG). Median UIC level was 250 μg/l (USN), 200 μg/l (N), and 183 μg/l (PG). In PMs, TGR was 16.1% (USN), 20.2% (N), and 24.9% (PG). Median UIC level was 124 μg/l (USN), 117.5 μg/l (N) and 110 μg/l (PG), respectively. In Neonates, TSH levels of >5 mIU/L were found in 55.3 (USN), 76.4 (N) and 72.8 (PG) percent of neonates. Conclusion: UIC level in PMs and TSH levels among neonates indicate the prevalence of ID in three districts surveyed.
  3 1,366 261
Profile of leptin, adiponectin, and body fat in patients with hyperprolactinemia: Response to treatment with cabergoline
Nazir Ahmad Pala, Bashir Ahmad Laway, Raiz Ahmad Misgar, Zaffar Amin Shah, Tariq A Gojwari, Tariq A Dar
March-April 2016, 20(2):177-181
DOI:10.4103/2230-8210.176346  PMID:27042412
Introduction: Though hypoadiponectinemia and leptin resistance have been proposed as potential factors for weight gain in patients with hyperprolactinemia (HPL), the effects of HPL and cabergoline on these adipocyte-derived hormones are not clear. Aims of this study were (i) to assess the alterations of body fat, leptin, and adiponectin in patients with HPL (ii) effect of cabergoline treatment on these parameters. Methods: Nineteen consecutive patients with prolactinoma (median prolactin [PRL] 118.6 (interquartile range: 105.3) μg/L) and 20 controls were studied in a nonrandomized matched prospective design. The controls were age, gender, and body mass index (BMI) matched. Anthropometric data, metabolic variables, leptin, and adiponectin were studied at baseline and 3 and 6 months after cabergoline treatment. Results: Patients with prolactinoma had increased level of fasting plasma glucose (P < 0.001) as compared to age-, gender-, and BMI-matched healthy controls. Estradiol concentration of controls was higher than that of patients (P = 0.018). Patients with prolactinoma had higher levels of leptin (P = 0.027) as compared to healthy controls without a significant difference in adiponectin levels. There was a significant decrease of body weight at 3 months (P = 0.029), with a further decline at 6 months (P < 0.001) of cabergoline therapy. Furthermore, there was a significant decrement of BMI (P < 0.001), waist circumference (P = 0.003), waist-hip ratio (P = 0.03), total body fat (P = 0.003), plasma glucose (P < 0.001), leptin levels (P = 0.013), and an increase in estradiol concentration (P = 0.03) at 6 months of cabergoline treatment. Conclusion: Patients with prolactinoma have adverse metabolic profile compared to matched controls. Normalization of PRL with cabergoline corrects all the metabolic abnormalities.
  3 1,315 286
Management of anemia in patients with diabetic kidney disease: A consensus statement
Sarita Bajaj, Brij Mohan Makkar, Vinod K Abichandani, Pradeep G Talwalkar, Banshi Saboo, SS Srikanta, Ashok Das, Sruti Chandrasekaran, P Venkata Krishnan, Arun Shah, Georgi Abraham, Pankaj Tikku, Sushil Kumar
March-April 2016, 20(2):268-281
DOI:10.4103/2230-8210.176348  PMID:27042425
This consensus statement focuses on the window of opportunity, which exists while treating patients with diabetic kidney disease and anemia.
  3 3,631 821
Effects of gliclazide add on metformin on serum omentin-1 levels in patients with type 2 diabetes mellitus
Ali I Al-Gareeb, Haidar F Alrubai, Sammar M Suliaman
March-April 2016, 20(2):195-198
DOI:10.4103/2230-8210.176355  PMID:27042415
Background: Omentin is a newly identified adipokine that has beneficial influence against cardiovascular disorders. Hence, considering the impact of anti-diabetic drug on omentin levels may provide an adjuvant strategy to protect diabetic patients against valuable clinical hazards. Aim of the Study: To investigate the influence of metformin alone or in combination with gliclazide on the level of serum omentin among patients with type 2 diabetes mellitus (T2DM). Patients and Methods: A total of 70 newly diagnosed patients with T2DM were enrolled in this randomized, double-blind prospective study, and divided into two equal groups based on treatment regimen in which Group 1 treated with metformin (1000 mg) and Group 2 treated with metformin (1000 mg) plus gliclazide (80 mg). Blood glucose levels, HbA1C, insulin levels, and serum omentin-1 were measured at baseline and after 12 weeks of treatment. Result: Use of gliclazide as an add-on therapy to metformin in patients with T2DM result in better glycemic control evidenced by significant reductions in the levels of blood glucose levels and HbA1C and much more improvement in insulin sensitivity evidenced by significant decreased in insulin resistance index, whereas it has adverse impact on serum omentin-1 levels evidenced by significant decrement in omentin-1 level in comparison to their pretreatment levels among Group 2 patients. Conclusions: Adding of gliclazide to metformin in treatment of patients with T2DM might extend the therapeutic action of metformin in regarding much better controlling of glycemic indices, but, at the same time, it might attenuate the cardioprotective effects of metformin by its adverse influence on serum omentin-1 levels.
  2 1,972 448
Prevalence of underweight, overweight, and obesity among 2, 162 Brazilian school adolescents
Clarice Siqueira Silva, Cyro Teixeira da Silva Junior, Bruna Soares Ferreira, Francielle Dal Mora da Silva, Patricia Siqueira Silva, Analúcia Rampazzo Xavier
March-April 2016, 20(2):228-232
DOI:10.4103/2230-8210.176364  PMID:27042420
Introduction: The nutritional profile of the Brazilian population has changed in recent years. Therefore, this study aimed to assess the prevalence of nutritional status among Brazilian school adolescents during the period from January 2014 to December 2014.Methods: This study employed an observational design with a cohort of school adolescents. Anthropometric measurement was assessed by nutritionists in government schools. The cut-off points for body mass index according to Brazilian criteria for adolescents of both sexes between 10 years and 19 years old were underweight (≤17.5 kg/m2), overweigh (≥25.0 kg/m2), and obesity (≥30.0 kg/m2). Results: The number of students included in the analysis was 2162, of which 71.0% were males and 29% were females (P = 0.00001). The mean age (years) was 13.14 ± 2.17 for boys and 12.66 ± 1.85 for girls (P = 0.0001). The prevalence of underweight, overweight, and obesity observed in our population of school adolescents according to the Brazilian criteria was 2.8%, 8.1%, and 2.4% for males, respectively, and 23.0%, 10.7%, and 3.6% for females, respectively. For both sexes, there was no statistically significant difference between overweight (P = 0.5469) and obesity (P = 0.7863), but there was for underweight (P = 0.001). Conclusions: The occurrence of excess weight among Brazilian school adolescents is similar to the international prevalence, but the prevalence of underweight was very high among girls. The nutritional status of adolescents must be considered a public health problem in Brazil.
  2 1,334 330
The seroprevalence of immunoglobulin A transglutaminase in type 1 diabetic patients of South Indian origin
Annie A Pulikkal, Anish Kolly, KM Prasanna Kumar, C Shivaprasad
March-April 2016, 20(2):233-237
DOI:10.4103/2230-8210.176359  PMID:27042421
Context: Celiac disease (CD) is a commonly encountered autoimmune condition in patients with type 1 diabetes (T1D). There is sparse data on the seroprevalence of immunoglobulin A (IgA) transglutaminase (tTG) in T1D patients of South Indian origin. Aims: To detect the prevalence of IgA tTG in T1D patients of South Indian origin. To evaluate the relation between the presence of autoimmunity and metabolic control and complications of diabetes. Materials and Methods: We conducted a cross-sectional study on 258 T1D patients. All the patients were subjected to biochemical tests and evaluated for microvascular complications. IgA tTG was estimated by ELISA. IgA tTG levels >40 AU/ml was considered positive. Results: Of the 258 participants, 12 (4.65%) were found to be positive for IgA tTG antibodies. Distribution of IgA positivity was equal in both sexes. There was a significant negative correlation of IgA tTG positivity with hemoglobin and glycated hemoglobin (HbA1c). Conclusions: The seropositivity of CD in South Indian patients with T1D has been observed to be 4.68%. This is much lower compared to studies from North India. This can be explained by both the genetic and dietary factors. The seropositivity correlated negatively with hemoglobin and HbA1c.
  2 1,147 242
Postural variation of pulmonary diffusing capacity as a marker of lung microangiopathy in Indian patients with type 2 diabetes mellitus
Avinash Kumar, Geetanjali Bade, Anjali Trivedi, Viveka P Jyotsna, Anjana Talwar
March-April 2016, 20(2):238-244
DOI:10.4103/2230-8210.176343  PMID:27042422
Introduction: Diabetes mellitus (DM) is characterized by the presence of chronic hyperglycemia and formation of advanced glycation end products (AGEs). Interaction between AGE and its receptor leads to endothelial damage and microangiopathy. This study was undertaken to investigate the possibility of using a postural variation of diffusing capacity as an early marker of lung microangiopathy and its correlation with the level of adhesion molecules, HbA1c, duration of diabetes, and insulin resistance in type 2 DM (T2DM) patients with and without microangiopathy. Materials and Methods: Forty patients having T2DM without any microangiopathy (n = 20) as well as with microangiopathy (n = 20), and 22 age and sex matched healthy controls were enrolled in this cross-sectional study. Measurement of lung volumes and capacities were done. DLco was measured in sitting and supine position. Levels of vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fasting glucose, and insulin were estimated in plasma of the patients and compared with controls. Results: Restrictive type of ventilatory change was observed in DM patients. Diffusing capacity (% predicted) in the supine position (P < 0.0001), postural change in DLco (P < 0.0001), and coefficient of diffusion were significantly less in DM patients as compared to controls. Plasma levels of VCAM-1 were significantly higher in DM patients without microangiopathy and negatively correlated (r = −0.4054, P = 0.0094) with Δ DLco in all diabetic subjects. All patients had significantly higher insulin resistance. Conclusion: Lack of postural increase in diffusing capacity in type 2 diabetic patients along with increased VCAM-1 levels could reflect the presence of an early microangiopathy of the small pulmonary vessels.
  2 1,860 250
Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes
Mwanja Kakusa, Brown Kamanga, Owen Ngalamika, Soka Nyirenda
March-April 2016, 20(2):199-205
DOI:10.4103/2230-8210.176358  PMID:27042416
Background: Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies. Aim: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome. Materials and Methods: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. Results: The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. Conclusion: The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.
  1 1,607 336
The Endocrine Society of India - A way forward
Shashank R Joshi, Krishna G Seshadri
March-April 2016, 20(2):149-150
DOI:10.4103/2230-8210.176365  PMID:27042405
  - 11,457 301
Of statins and low-density lipoprotein cholesterol, “fats” and fiction
Ambika Gopalakrishnan Unnikrishnan, Sanjay Kalra, Ambrish Mithal
March-April 2016, 20(2):151-153
DOI:10.4103/2230-8210.176344  PMID:27042406
  - 1,539 358
Effect of steroid replacement on thyroid function and thyroid autoimmunity in Addison' s disease with primary hypothyroidism
Jaya Prakash Sahoo, Jayakumar Selviambigapathy, Sadishkumar Kamalanathan, K Nagarajan, Muthupillai Vivekanandan
March-April 2016, 20(2):162-166
DOI:10.4103/2230-8210.176356  PMID:27042409
Background: Steroid replacement without thyroxine supplementation normalizes thyroid function test (TFT) in some but not all Addison's disease patients with primary hypothyroidism. Both autoimmune and nonautoimmune mechanisms contribute to this improvement in TFT. However, the documentation of the change in thyroid autoimmunity after cortisol replacement is very limited in the literature. The aim of this study was to determine the effect of steroid replacement on TFT and anti-thyroid peroxidase antibody (anti-TPO-Ab) titer in Addison's disease with primary hypothyroidism. Materials and Methods: This observational study was conducted in a tertiary care center in South India. Six Addison's disease patients with primary hypothyroidism, who were only on steroid replacement, were included in the study. Low serum cortisol (<83 nmol/L) with high plasma adrenocorticotropic hormone (>22 pmol/L) and/or hyperpigmentation of skin/mucous membranes was considered as the diagnostic criteria for Addison's disease. Primary hypothyroidism (both overt and subclinical) was defined as high thyroid stimulating hormone (TSH) with/without low free thyroxine (fT4). TFT and anti-TPO-Ab were performed before and after steroid replacement in all of them. Results: Poststeroid replacement, there was a normalization of TSH in all but one subjects. In overt hypothyroidism patients, fT4 also normalized. The improvement in TFT was not associated with decreasing titer of the anti-TPO-Ab in all six patients. However, there was a significant difference in TSH after steroid replacement compared to the baseline status. Conclusions: The concept of normalization of primary hypothyroidism with cortisol replacement in patients with Addison's disease should be recognized to avoid iatrogenic thyrotoxicosis caused by thyroxine replacement. Both autoimmune and nonautoimmune mechanisms contribute to these alterations.
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Reference intervals in evaluation of maternal thyroid function of Manipuri women
Felix K Jebasingh, Ranabir Salam, Trinity Laishram Meetei, Premchand Thangjam Singh, Nabakishore Naorem Singh, Lallan Prasad
March-April 2016, 20(2):167-170
DOI:10.4103/2230-8210.176354  PMID:27042410
Context: The population of Manipur is of different ethnic background from the rest of the country. Several authors have suggested population/ethnic and laboratory specific reference range of maternal thyroid profile of different trimesters. Aims: To find the reference range of thyroid stimulating hormone (TSH), total thyroxine (TT4) and total tri-iodothyronine (TT3) levels for normal pregnant women of native Manipur descendants. Settings and Design: The cross-sectional study was conducted at a teaching Institute after ethical clearance was obtained. Subjects and Methods: A reference populations of 375 normal pregnant women were established after screening about 600 pregnant women. The study excluded patients with hyperemesis gravid arum, past history or family history of thyroid disorders as well as the connective tissue disorders, WHO grade 1 or 2 goiter, or any medications that alter thyroid functions. The serum levels of TSH, TT4, and TT3 were measured using chemiluminescence assay. Statistical Analysis Used: Data for TT3 and TT4 were expressed as mean ± standard deviation, median and 5–95th percentiles. Results: The mean TSH in the three trimesters was 1.06 + 0.45, 1.23 + 0.30, and 1.25 + 0.36, respectively. The normal reference range thus was different from that of the kit reference range. On comparing to the Indian normative reference for the pregnant women, our results were not similar. However, the values were near similar to that of the American Thyroid Association guidelines. Conclusions: We conclude our study results with a new reference range for the pregnant population in Manipur and also emphasis the use of trimester-specific reference range of thyroid hormone.
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