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Wu J, Chen Q, Zou JZ, Chen YY, Chen HH, Lin YY, Huang XD. Association between hepatic steatosis index and glucose status conversion from impaired fasting glucose base on Chinese adults: a cohort study from real-world. Eur J Med Res 2025; 30:100. [PMID: 39953638 PMCID: PMC11827240 DOI: 10.1186/s40001-025-02354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/03/2025] [Indexed: 02/17/2025] Open
Abstract
OBJECTIVE Evidence regarding the relationship between the hepatic steatosis index (HSI) and glycemic conversion outcomes in individuals with impaired fasting glucose (IFG) is still limited. Our study aims to explore the role of HSI in the reversion to normoglycemia or the progression to diabetes among Chinese IFG individuals. METHODS We conducted a retrospective analysis using data from 11,327 IFG individuals who had undergone wellness examinations at Rich Healthcare Group. To analyze the association between the baseline HSI and glucose status conversion, a Cox regression model was used, and the hazard ratio (HR) and 95% confidence interval (CI) were computed. A generalized additive model was used to examine non-linear relationships. A two-piecewise binary logistic regression model was employed to further elucidate the non-linearity. Sensitivity and subgroup analyses were also conducted. RESULTS Over an observation period spanning 33,892 person-years, the rate of normoglycemia reversion was found to be 41.75%, whereas the rate of progression to diabetes was 11.63%. After accounting for potential confounding variables, our analysis demonstrated that among IFG individuals, there was an inverse relationship between HSI and the likelihood of returning to normoglycemia (HR = 0.93, 95% CI: 0.90-0.96, P < 0.001), and a positive association between the HSI and progression to diabetes (HR = 1.49, 95% CI: 1.40-1.58, P < 0.001). The smooth curve-fitting plot revealed a nonlinear association between the HSI and diabetes progression, with inflection points at 26.55 and 40.74. Sensitivity analysis and subgroup analysis confirmed the stability of the study's findings. CONCLUSION HSI was significantly linked to normoglycemia reversion and diabetes progression in IFG individuals, indicating its potential as a risk indicator for diabetes and a guide for prevention strategies. However, further research is needed to confirm this.
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Affiliation(s)
- Juan Wu
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Qi Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Jun-Zhong Zou
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Yi-Ying Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Hua-Hong Chen
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Yu-Ye Lin
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China
| | - Xu-Dong Huang
- Department of Laboratory Medicine, Jieyang People's Hospital, No. 107 Tianfu Road, Rongcheng District, Jieyang, Guangdong, China.
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Mittal M, Jethwani P, Naik D, Garg MK. Non-medicalization of medical science: Rationalization for future. World J Methodol 2022; 12:402-413. [PMID: 36186743 PMCID: PMC9516546 DOI: 10.5662/wjm.v12.i5.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
As we delve into the intricacies of human disease, millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease, but with debatable impact and consequences. Endocrinology is no different, with almost every organ system and associated diseases having subclinical entities. Although the expansion of these “grey” pre-conditions and their treatments come with a better understanding of pathophysiologic processes, they also entail financial costs and drug adverse-effects, and lack true prevention, thus refuting the very foundation of Medicine laid by Hippocrates “Primum non nocere” (Latin), i.e., do no harm. Subclinical hypothyroidism, prediabetes, osteopenia, and minimal autonomous cortisol excess are some of the endocrine pre-clinical conditions which do not require active pharmacological management in the vast majority. In fact, progression to clinical disease is seen in only a small minority with reversal to normality in most. Giving drugs also does not lead to true prevention by changing the course of future disease. The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.
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Affiliation(s)
- Madhukar Mittal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Parth Jethwani
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
| | - Dukhabandhu Naik
- Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - MK Garg
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
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Dutta D, Sharma M, Aggarwal S, Agarwal A, Dhall A. Treatment outcomes of graded dose of empagliflozin in type-2 diabetes: A real world study. Ann Afr Med 2022; 21:26-33. [PMID: 35313401 PMCID: PMC9020632 DOI: 10.4103/aam.aam_69_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Costs are important cause of therapeutic noncompliance in type-2 diabetes mellitus (T2DM). Half-tablet empagliflozin (EMPA)-25 mg has lowest monthly cost among all EMPA preparations; data is unavailable on efficacy of half EMPA-25. This study compared real world weight loss and glycaemic outcomes of 10 mg versus 12.5 mg versus 25 mg of EMPA. Methods: Data, retrospectively captured from records of 2 different centresfor patients > 35 years-age having T2DM on EMPA as part of standard pharmacotherapy for T2DM, having > 6 months follow-up data available was analysed. Patients were in 3-groups depending on EMPA dosage: Group 1 on EMPA 10 mg/day (1-tablet EMPA-10), Group-2 on EMPA 12.5 mg/day (half-tablet EMPA-25), and Group 3 on EMPA 25 mg/day (1-tablet EMPA-25). Primary endpoints were glycaemic efficacy and weight-loss. Results: Of 3601 records screened, data from 599 patients (184, 239 and 176 in Group-1, 2 and 3 respectively) was analysed. All 3 groups were comparable with regards to sex, blood pressure, haemoglobin, renal function, medications use. Group-3 were significantly older, had longest diabetes duration, highest HbA1c and lowest body mass index. Glycaemic efficacy was comparable among groups (ΔHbA1c Groups 1-3: −0.9 (−1.9 – 0.0), −1.0 (−1.8 – 0.5) and − 1.0 (−1.5 – 0.22], respectively; P = 0.363). Patients on EMPA 12.5 or 25 mg/d had significantly higher total (−1.4 [−3.0 –0.2] vs. −0.3 [−2.4 – 1.32] kg; P = 0.028) and percent weight-loss (−1.75% [−4.15 – 0.26] vs. −0.44% [−3.11 – 1.39]; P = 0.039), and significantly higherfraction achieving HbA1c < 5.7% (12% vs. 0; P = 0.021), compared to EMPA-10. Conclusion: Half EMPA-25 is the most cost effective way of using EMPA in clinical practice.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis and Rheumatism Super Speciality Clinics, New Delhi, India
| | - Meha Sharma
- Department of Rheumatology, Center for Endocrinology, Diabetes, Arthritis and Rheumatism Super Speciality Clinics, New Delhi, India
| | - Sameer Aggarwal
- Department of Endocrinology, Apex Hospital, Rohtak, Haryana, India
| | - Anshita Agarwal
- Department of Endocrinology, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anil Dhall
- Department of Cardiology, Janakpuri Super Speciality Hospital, New Delhi, India
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Atkin SL, Butler AE, Hunt SC, Kilpatrick ES. The retinopathy-derived HbA1c threshold of 6.5% for type 2 diabetes also captures the risk of diabetic nephropathy in NHANES. Diabetes Obes Metab 2021; 23:2109-2115. [PMID: 34033191 DOI: 10.1111/dom.14449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 01/06/2023]
Abstract
AIM To determine if an HbA1c diagnostic threshold of less than 6.5% (<48 mmol/mol) could be identified based on a urinary albumin-creatinine ratio (UACR) of 30 mg/g or higher in subjects not known to have diabetes. METHODS A UACR was measured for 20 158 participants in the 2011-2018 nationally representative cross-sectional National Health and Nutrition Examination Surveys (NHANES; cycles 7-10 inclusive). RESULTS There was a significant trend for an increasing risk with a UACR of 30 mg/g or higher across increasing HbA1c categories (P < .0001). This trend was mainly attributable to the high prevalence of raised UACR in the 7.0% or higher HbA1c subgroup of subjects not previously diagnosed with diabetes. None of the odds ratios in the lower HbA1c subgroups versus the HbA1c subgroup of less than 5.0% reached significance. There were racial/ethnic differences in UACR risk (P < .0001), with White and Black subjects exhibiting little increased risk (vs. HbA1c <5.0%) until they reached an HbA1c of 7.0%, while Asian and Hispanic subjects showed some increased, but non-significant, risks at lower HbA1c levels. Maximizing the area under receiver operating characteristic curves from logistic regressions predicted an ideal HbA1c threshold of 5.8%, but there was little variation in area from 5.5% to 7.0%. CONCLUSION A clinically useful diagnostic threshold below 6.5% for HbA1c for elevated UACR risk was not identified, with an increased risk only obvious at an HbA1c of 7.0% or higher. Thus, the retinopathy-derived HbA1c threshold of 6.5% also captures the risk of diabetic nephropathy in NHANES.
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Affiliation(s)
- Stephen L Atkin
- Royal College of Surgeons Ireland-Bahrain, Busaiteen, Bahrain
| | - Alexandra E Butler
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Steven C Hunt
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Doha, Qatar
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Abstract
Evidence increasingly demonstrates that prediabetes is a toxic state, as well as a risk factor for diabetes, and is associated with pathophysiological changes in several tissues and organs. Unfortunately, use of available evidence-based treatments for prediabetes is low. This review seeks to explain why prediabetes must be viewed and treated as a serious pathological entity in its own right. It offers an overview of the pathophysiology and complications of prediabetes and describes how this condition can be reversed if all treatment avenues are deployed early in its course.
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Affiliation(s)
| | - Fatima Bello
- Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria
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Xie Q, Xu C, Wan Q. Association between microalbuminuria and outcome of non-diabetic population aged 40 years and over: The reaction study. Prim Care Diabetes 2020; 14:376-380. [PMID: 31874822 DOI: 10.1016/j.pcd.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 01/06/2023]
Abstract
AIMS The goal of this study was to analyze the association between microalbuminuria (MAU) and the outcome of non-diabetic populations among Chinese people. METHODS A cohort of 2042 Chinese individuals without diabetes, aged 40 years or older were included. We identified people with impaired fasting glucose and/or impaired glucose tolerance by conducting an oral glucose tolerance test, and then followed them up after 3years. We defined MAU as a urinary albumin-to-creatinine ratio (ACR) exceeding the normal range of 2.5-25mg/mmol (males) or 3.5-35mg/mmol (females). RESULTS Among 2042 adults aged 40 years or older in an urban fringe area of Luzhou city (1984 cases were followed up), 262 (12.8%) developed diabetes over 3years. MAU was significantly associated with age, fasting plasma glucose, 2-h glucose, hemoglobin A1c, and triglycerides (P<0.05). Follow-up FBG, 2hPG, TG, and HbA1c levels in the IGR+MAU group were higher than those in other groups (P<0.05). If the relative risk of the isolated normal glucose tolerance (NGT) group progressing to diabetes was set to 1, the risk of progression to diabetes in the NGT+MAU, isolated impaired glucose regulation (IGR), and IGR+MAU groups increased 1.1, 3.9, and 7.5 times, respectively. CONCLUSIONS Our study found that MAU is associated with increased risk of diabetes in NGT and IGR populations, especially in the IGR populations, MAU may predict adulthood at very high risk for diabetes.
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Affiliation(s)
- Qian Xie
- Department of Gerontology, The People's Hospital of LeShan, 614000 LeShan, China.
| | - Chaoran Xu
- Department of Gerontology, The People's Hospital of LeShan, 614000 LeShan, China
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of XiNan Medical University, 641400 Luzhou, China
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Hayashi Y. Detection of Lower Albuminuria Levels and Early Development of Diabetic Kidney Disease Using an Artificial Intelligence-Based Rule Extraction Approach. Diagnostics (Basel) 2019; 9:133. [PMID: 31569548 PMCID: PMC6963949 DOI: 10.3390/diagnostics9040133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to determine the lowest cut-off value for albuminuria levels, which can be used to detect diabetic kidney disease (DKD) using the urinary albumin-to-creatinine ratio (UACR). National Health and Nutrition Examination Survey (NHANES) data for US adults were used, and participants were classified as having diabetes or prediabetes based on a self-report and physiological measures. The study dataset comprised 942 diabetes and 524 prediabetes samples. This study clarified the significance of the lower albuminuria (UACR) levels, which can detect DKD, using an artificial intelligence-based rule extraction approach. The diagnostic rules (15 concrete rules) for both samples were extracted using a recursive-rule eXtraction (Re-RX) algorithm with continuous attributes (continuous Re-RX) to discriminate between prediabetes and diabetes datasets. Continuous Re-RX showed high test accuracy (77.56%) and a large area under the receiver operating characteristics curve (75%), which derived the two cut-off values (6.1 mg/g Cr and 71.00 mg/g Cr) for the lower albuminuria level in the UACR to detect early development of DKD. The early cut-off values for normoalbuminuria (NA) and microalbuminuria (MA) will be determined to help detect CKD and DKD, and to detect diabetes before MA develop and to prevent diabetic complications.
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Affiliation(s)
- Yoichi Hayashi
- Department of Computer Science, Meiji University, 1-1-1 Higashimita, Tama-ku, Kawasaki 214-8571, Japan.
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Dutta D, Kalra S, Sharma M. Adenosine monophosphate-activated protein kinase-based classification of diabetes pharmacotherapy. J Postgrad Med 2019; 63:114-121. [PMID: 27652986 PMCID: PMC5414421 DOI: 10.4103/0022-3859.191007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The current classification of both diabetes and antidiabetes medication is complex, preventing a treating physician from choosing the most appropriate treatment for an individual patient, sometimes resulting in patient-drug mismatch. We propose a novel, simple systematic classification of drugs, based on their effect on adenosine monophosphate-activated protein kinase (AMPK). AMPK is the master regular of energy metabolism, an energy sensor, activated when cellular energy levels are low, resulting in activation of catabolic process, and inactivation of anabolic process, having a beneficial effect on glycemia in diabetes. This listing of drugs makes it easier for students and practitioners to analyze drug profiles and match them with patient requirements. It also facilitates choice of rational combinations, with complementary modes of action. Drugs are classified as stimulators, inhibitors, mixed action, possible action, and no action on AMPK activity. Metformin and glitazones are pure stimulators of AMPK. Incretin-based therapies have a mixed action on AMPK. Sulfonylureas either inhibit AMPK or have no effect on AMPK. Glycemic efficacy of alpha-glucosidase inhibitors, sodium glucose co-transporter-2 inhibitor, colesevelam, and bromocriptine may also involve AMPK activation, which warrants further evaluation. Berberine, salicylates, and resveratrol are newer promising agents in the management of diabetes, having well-documented evidence of AMPK stimulation medicated glycemic efficacy. Hence, AMPK-based classification of antidiabetes medications provides a holistic unifying understanding of pharmacotherapy in diabetes. This classification is flexible with a scope for inclusion of promising agents of future.
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Affiliation(s)
- D Dutta
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - M Sharma
- Department of Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Dutta D, Sharma M, Aggarwal S, Mohindra R, Bhattacharya S, Kalra S. Vitamin D, Thyroid Autoimmunity and Cancer: An Interplay of Different Factors. Indian J Endocrinol Metab 2019; 23:507-513. [PMID: 31803589 PMCID: PMC6873262 DOI: 10.4103/ijem.ijem_526_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS In spite of large volume of data linking Vitamin D with cardiovascular morbidity, autoimmunity, cancer, and virtually every organ system, Vitamin D and thyroid is a lesser-known aspect of Vitamin D in clinical practice. This article intends to highlight the current literature on the impact of Vitamin D status and supplementation on thyroid autoimmunity and cancer. METHODS References for this review were identified through searches of PubMed for articles published to from 1950 to August 2019 using the terms "thyroid" [MeSH Terms] AND "Vitamin D" [MeSH Terms] OR "thyroid" [All Fields] AND "Vitamin D" [All Fields]. RESULTS Significant inverse correlation was documented between anti-thyroid peroxidase antibody (TPOAb) and serum 25-hydroxy-Vitamin D (25OHD). TPOAb positivity is more prevalent in Vitamin D deficient individuals. A large volume of medical literature is available from observational studies linking Vitamin D with thyroid autoimmunity. Data from interventional studies documenting beneficial effects of Vitamin D on thyroid autoimmunity is also available, but lesser than that from observational studies. Short-term high dose oral Vitamin D supplementation reduces TPOAb titers. Certain Vitamin D receptor (VDR) gene polymorphism have been linked to increased occurrence of autoimmune thyroid disorders (AITD). Vitamin D deficiency, decreased circulating calcitriol has been linked to increased thyroid cancer. Certain VDR gene polymorphisms have been linked with increased as well as decreased occurrence of thyroid cancer. Data is scant on use of Vitamin D and its analogues for treating thyroid cancer. CONCLUSION In spite of large volume of medical literature from observational studies linking Vitamin D with thyroid autoimmunity and cancer, meaningful concrete clinical data on impact of Vitamin D supplementation on hard clinical end points in these disorders is lacking, and should be the primary area of research in the next decade.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, CEDAR Super-Specialty Clinics, Dwarka, Gujarat, India
| | - Meha Sharma
- Department of Rheumatology, CEDAR Super-Specialty Clinics, Dwarka, Gujarat, India
| | - Sameer Aggarwal
- Department of Endocrinology, Apex Super-Specialty Hospital, Rohtak, Haryana, India
| | | | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Gupta L, Khandelwal D, Lal PR, Kalra S, Dutta D. Palaeolithic Diet in Diabesity and Endocrinopathies - A Vegan's Perspective. EUROPEAN ENDOCRINOLOGY 2019; 15:77-82. [PMID: 31616497 PMCID: PMC6785956 DOI: 10.17925/ee.2019.15.2.77] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/15/2019] [Indexed: 12/17/2022]
Abstract
Introduction: The Palaeolithic diet is designed to resemble that of human hunter-gatherer ancestors thousands to millions of years ago. This review summarises the evidence and clinical application of this diet in various disorders. An empiric vegan variant of it has been provided, keeping in mind vegan food habits. Review of the literature: different types of Palaeolithic diets in vogue include the 80/20, the autoimmune, the lacto, the Palaeolithic vegan and the Palaeolithic ketogenic. We have developed an Indian variant of the Palaeolithic vegan diet, which excludes all animal-based foods. The Palaeolithic diet typically has low carbohydrate and lean protein of 30–35% daily caloric intake in addition to a fibre diet from non-cereal, plant-based sources, up to 45–100 g daily. In different observational studies, beneficial effects on metabolic syndrome, blood pressure, glucose tolerance, insulin secretion, lipid profiles and cardiovascular risk factors have been documented with the Palaeolithic diet. Short-term randomised controlled trials have documented weight loss, and improved glycaemia and adipo-cytokine profiles. Few concerns of micronutrient deficiency (e.g. calcium) have been raised. Conclusion: Initial data are encouraging with regard to the use of the Palaeolithic diet in managing diabesity. There is an urgent need for large randomised controlled trials to evaluate the role of the Palaeolithic diet with different anti-diabetes medications for glycaemic control and the reversal of type 2 diabetes.
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Affiliation(s)
- Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Deep Dutta
- Department of Endocrinology, CEDAR Super-specialty Clinics New Delhi, India
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Arora B, Gupta L, Khandelwal D, Bhattacharya S, Kalra S, Chittawar S, Paliwal A, Lal PR, Dutta D. Knowledge, attitude, and practices of fasts in patients with type 2 diabetes among different religions in North India. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Dutta D, Jaisani R, Khandelwal D, Ghosh S, Malhotra R, Kalra S. Role of Metformin, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Orlistat based Multidrug Therapy in Glycemic Control, Weight Loss, and Euglycemia in Diabesity: A Real-World Experience. Indian J Endocrinol Metab 2019; 23:460-467. [PMID: 31741907 PMCID: PMC6844169 DOI: 10.4103/ijem.ijem_185_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study evaluated the real-world weight loss and glycemic outcomes of multidrug therapy (MDT) according to various combinations of metformin, sodium-glucose cotransporter -2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor analogs (GLP1a), and orlistat in diabesity. METHODS Data retrospectively captured from medical records of 2 different centers in New Delhi for patients >35 years-age having prediabetes/diabetes and on at least any one of the 4 above medications with >6-months follow-up was analyzed. RESULTS In total, 5,336 patient records were screened; 2,442 with prediabetes/diabetes were considered; 1,509 patients who fulfilled all criteria were analyzed. Use of metformin, SGLT2i, sulfonylureas, DPP4i, pioglitazone, orlistat, and GLP1a was 85.35%, 74.95%, 68.32%, 60%, 39.16%, 9.08%, and 4.17%, respectively. However, 365, 970, and 104 patients were on one of 4 concerned medications (Group-1; 24.18%), dual MDT (Group-2; 64.28%), and triple/quadruple MDT (Group-3; 6.89%). Metformin with SGLT2i was most commonly used dual MDT (94.12%). Analysis according to weight-loss quartiles from 558 patients showed 6.9 kg weight-loss in the highest quartile. People losing maximum weight were significantly younger; had higher use of metformin, SGLT2i, GLP1, orlistat, and lower pioglitazone use; greatest HbA1c reduction (-1.3 vs. -0.3; quartile-1 vs. quartile -4; P < 0.001); and significantly higher occurrence of HbA1c<5.7% (16.8% vs. 6.29%; quartile-1 vs. 4; P < 0.001). Patients in Group-3 had the highest baseline BMI and maximum weight loss with highest number of patients with HbA1c<5.7% (19.44% vs. 10.34%; Group-3 vs. Group-1; P < 0.001). CONCLUSION Greater weight loss with HbA1c reduction along with a greater number of patients attaining HbA1c <5.7% highlights that MDT is the way forward to tackle diabesity in India.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology, Diabetes, Arthritis and Rheumatism Superspecialty Clinics, Dwarka, India
| | - Ritu Jaisani
- Department of Endocrinology, Venkateshwar Hospitals, Dwarka, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaj Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Soumitra Ghosh
- Department of Internal Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rajiv Malhotra
- Department of Endocrinology, Venkateshwar Hospitals, Dwarka, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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A 2018 clinical practice pattern in the management of diabetes in India and Nepal: a three-city study. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0701-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dutta D, Mukhopadhyay S. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy. Ann Intern Med 2018; 169:511-512. [PMID: 30285192 DOI: 10.7326/l18-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Deep Dutta
- Venkateshwar Hospitals, New Delhi, India (D.D.)
| | - Satinath Mukhopadhyay
- Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India (S.M.)
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Sharma N, Sharma LK, Anand A, Gadpayle AK, Gaurav K, Mukherjee S, Kulshreshtha B, Dutta D. Presence, patterns & predictors of hypocortisolism in patients with HIV infection in India. Indian J Med Res 2018; 147:142-150. [PMID: 29806602 PMCID: PMC5991125 DOI: 10.4103/ijmr.ijmr_43_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background & objectives: Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 μg/dl (<165 nmol/l; Group 1), 6-11 μg/dl (165-300 nmol/l; Group 2), 11-18 μg/dl (300-500 nmol/l; Group 3) and ≥18 μg/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P< 0.05), having longer disease duration (P< 0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P< 0.01), lower fasting glucose (P< 0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively). Interpretation & conclusions: AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 μg/dl (300 nmol/l).
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Affiliation(s)
- Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Lokesh Kumar Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Atul Anand
- Anti-Retroviral Therapy Clinic, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Adesh Kisanji Gadpayle
- Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kumar Gaurav
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Sabyasachi Mukherjee
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Bindu Kulshreshtha
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
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Abstract
India has the dubious distinction of being a hotspot for both diabetes and hypertension. Increased salt and sugar consumption is believed to fuel these two epidemics. This review is an in-depth analysis of current medical literature on salt and sugar being the two white troublemakers of modern society. The PubMed, Medline, and Embase search for articles published in January 2018, using the terms "salt" [MeSH Terms] OR "sodium chloride" [All Fields] OR "sugar" [All Fields]. India is world's highest consumer of sugar with one of the highest salt consumption per day. Increased salt intake is associated with increased risk of hypertension, left ventricular hypertrophy and fibrosis, cardiovascular events, renal stones, proteinuria, and renal failure. Increased sugar intake is directly linked to increased risk of obesity, fatty liver disease, and metabolic syndrome. Also, increased sugar intake may be indirectly related to the increased risk of type 2 diabetes. Both salt and sugar intake is directly linked to increased systemic and hypothalamic inflammation, endothelial dysfunction, microangiopathy, cardiovascular remodelling, cancers, and death. High fructose corn is especially damaging. There is no safe limit of sugar consumption, as the human body can produce its own glucose. Being nature's gift to mankind, there is no harm in moderate consumption of salt and sugar, however, modest reduction in the consumption of both can substantially reduce the burden of non-communicable diseases. Public health interventions to facilitate this behavioural change must be instituted and encouraged.
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Affiliation(s)
- Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Venkateshwar Hospitals, Dwarka, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Priti R. Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Dutta D, Sharma LK, Sharma N, Gadpayle AK, Anand A, Gaurav K, Gupta A, Poondla Y, Kulshreshtha B. Occurrence, patterns & predictors of hypogonadism in patients with HIV infection in India. Indian J Med Res 2018; 145:804-814. [PMID: 29067983 PMCID: PMC5674551 DOI: 10.4103/ijmr.ijmr_1926_15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background & objectives: Data on hypogonadism among human immunodeficiency virus (HIV)-infected Indians are not available. This study was aimed to evaluate the occurrence, pattern and predictors of hypogonadism in HIV-infected Indians. Methods: Consecutive stable HIV-infected patients, 18-70 yr age, without any severe comorbid state, having at least one year follow up data at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: From initially screened 527 patients, 359 patients (225 males; 134 females), having disease duration of 61.44±39.42 months, 88.58 per cent on highly active antiretroviral therapy (HAART), 40.67 per cent having tuberculosis history and 89.69 per cent with vitamin D insufficiency were analyzed. Testosterone <300 ng/dl was documented in 39.11 per cent males. Primary, hypogonadotropic hypogonadism (HypoH) and compensated hypogonadism were observed in 7.56, 31.56 and 12.44 per cent males, respectively. Males with hypogonadism were significantly older (P=0.009), and had higher opportunistic infections (P<0.001) with longer disease duration (P=0.05). Menstrual abnormalities were observed in 40.3 per cent females, who were significantly older (P<0.001), had lower CD4 count (P=0.038) and higher tuberculosis history (P=0.005). Nearly 46.3, 16.2 and 13 per cent women with menstrual abnormalities were in peri-/post-menopausal state, premature ovarian insufficiency (POI) and HypoH, respectively. Age, CD4 count at diagnosis and 25(OH)D were best predictors of male hypogonadism. Age and CD4 count increment in first 6-12 months following HAART were the best predictors of POI. Interpretation & conclusions: Hypogonadism was observed to be a significant problem in HIV-infected men and women in India, affecting 39 and 29 per cent patients, respectively. HypoH was the most common form in males whereas ovarian failure being the most common cause in females.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Lokesh Kumar Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Adesh K Gadpayle
- Department of Medicine, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Atul Anand
- Medicine Anti-Retroviral Therapy Clinic, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kumar Gaurav
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ankit Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Yashwanth Poondla
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Bindu Kulshreshtha
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Mondal SA, Dutta D, Kumar M, Singh P, Basu M, Selvan C, Mukhopadhyay S. Neck Circumference to Height Ratio is a Reliable Predictor of Liver Stiffness and Nonalcoholic Fatty Liver Disease in Prediabetes. Indian J Endocrinol Metab 2018; 22:347-354. [PMID: 30090726 PMCID: PMC6063186 DOI: 10.4103/ijem.ijem_31_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) and dysglycemia are public health challenges. There is urgent need for anthropometric surrogates for NAFLD screening. This study evaluated role of neck circumference (NC) and neck-height ratio (NHtR) as predictors of liver stiffness measure (LSM) in individuals with prediabetes (IPD). METHODS In a cross-sectional study, 188 IPD from 1130 screened individuals underwent anthropometry, ultrasonography, Fibroscan® for LSM, dyslipidemia, insulin resistance (IR), and fetuin-A assessment. RESULTS Hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), metabolic syndrome (MetS), NAFLD, and significant liver stiffness (SLS) (LSM >8.5kPa) were observed in 53.7%, 31.4%, 71.3%, 73.9%, 24.5%, and 11.2% prediabetes individuals, respectively. Prediabetes with NAFLD had significantly higher body mass index (BMI), NC, NHtR, glycated hemoglobin, triglycerides, fatty liver index (FLI), and LSM. Prediabetes in highest NHtR quartile had significantly higher BMI, hypertension, MetS, fasting glucose, glycated hemoglobin, homeostatic model assessment-IR, NAFLD, LSM, SLS, and lower HDL-C. Stepwise forward linear regression revealed that NHtR, FLI, and LDL-C were best predictors of LSM, at baseline (Model-1), after adjusting for age and sex (Model-2), and adjusting model-2 plus systolic and diastolic blood pressure (Model-3). NHtR and NC (in females) and NHtR and BMI (in males) had largest area under the curves for predicting LSM, NAFLD, and MetS. NHtR ≥21.54 cm/m (sensitivity: 90%; specificity: 52.5%; females) and ≥21.62 cm/m (sensitivity: 80%; specificity: 49.4%; males) was best predictor of SLS. INTERPRETATION AND CONCLUSION NHtR is a reliable tool for community screening of NAFLD and liver stiffness in prediabetes.
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Affiliation(s)
- Samim Ali Mondal
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, Venkateshwar Hospitals, New Delhi, India
| | - Manoj Kumar
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Pankaj Singh
- Department of Gastroenterology, School of Digestive and Liver Disease, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Madhurima Basu
- Department of Biochemistry, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Chitra Selvan
- Department of Endocrinology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Abstract
: The burden of chronic kidney disease (CKD) is rising both in this country and worldwide. An estimated 10% to 15% of U.S. adults are currently living with CKD. Reducing the CKD burden requires a systematic, interdisciplinary approach to care. The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease. Nurses are well positioned to facilitate the implementation of collaborative care. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1 offers an overview of the disease, describes identification and etiology, and discusses ways to slow disease progression. Part 2, which will appear next month, addresses disease complications and treatment of kidney failure.
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Microalbuminuria as a simple predictor of incident diabetes over 8 years in the Korean Genome and Epidemiology Study (KoGES). Sci Rep 2017; 7:15445. [PMID: 29133894 PMCID: PMC5684338 DOI: 10.1038/s41598-017-15827-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/26/2017] [Indexed: 01/06/2023] Open
Abstract
Microalbuminuria (MAU) is a common subclinical disease and related with cardiovascular outcome both in diabetic and non-diabetic patients. However, there is rare data about the effect of MAU on the development of diabetes. Thus, we aimed to investigate whether MAU is associated with the development of incident diabetes. A total of 3385 subjects without diabetes (1503 men and 1882 women; mean age, 53 years) who participated in the Ansung–Ansan cohort study from 2001–2002 (baseline) to 2011–2012 (fifth follow-up visit) were followed for a mean of 8 years. The prevalence of MAU at baseline was 10.8% (365 patients), and the incidence of newly developed diabetes during the follow-up period was 15.3% (56 patients) in subjects with MAU. The hazard ratio (HR) for development of diabetes was 1.43 (95% confidence interval (CI) 1.07–1.91, p-value 0.016), independent of traditional risk factors for diabetes including pre-diabetes, age, obesity, and family history. The impact of MAU on diabetes was also significant in the non-pre-diabetic population (HR 2.08, 95% CI 1.07–4.03, p-value 0.031). In conclusion, our results show that incident MAU is associated with future development of diabetes and could be an early marker for diabetes, even in the non-prediabetic population.
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Seong JM, Park CE, Gi MY, Sun KS, Kim YJ, Yoon H. The Relationship Between Pulse Pressure, the Estimated Glomerular Filtration Rate, and Urine Microalbumin/Creatinine Ratio in Korean Adults. Kidney Blood Press Res 2017; 42:816-826. [PMID: 29073612 DOI: 10.1159/000484381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Pulse pressure (PP) is a predictor of adverse outcomes in patients on haemodialysis. Thus, the present study was conducted to assess the relationship between PP, estimated glomerular filtration rate (eGFR), and urine microalbumin/creatinine ratio (uACR) in Korean adults. METHODS Data of 9,409 adults (4,206 men and 5,203 women) aged ≥ 20 years from the Sixth Korean National Health and Nutrition Examination Survey (2013-2014) were analyzed. RESULTS A multivariate analysis revealed that systolic blood pressure (SBP) (β = -0.170, 95% confidence interval [CI], -0.216 to -0.159), diastolic blood pressure (DBP) (β = 0.088, 95% CI 0.108-0.200; p < 0.001), and PP (β = -0.134, 95% CI -0.215 to -0.157) were significant factors determining eGFR. In contrast, SBP (β = 0.152, 95% CI, 0.985-1.456; p < 0.001), DBP (β = -0.062, 95% CI -1.141 to -0.442; p < 0.001), and PP (β = 0.118, 95% CI 0.965-1.436; p < 0.001) were the significant factors determining uACR. The odds ratios (ORs) of a high PP (PP ≥ 60 mmHg) with a normal group [eGFR ≥ 60 ml/min/1.73 m2 and uACR < 30 mg/g] as a reference were significant for decreased eGFR [eGFR < 60 ml/min/1.73 m2, 1.484 (95% CI, 1.003-2.196)], elevated uACR [uACR ≥ 30 mg/g, 2.592 (95% CI, 2.085-3.223)], and decreased eGFR plus elevated uACR [eGFR < 60 ml/min/1.73 m2 and uACR ≥ 30 mg/g, 3.889 (95% CI, 2.519-6.004)]. CONCLUSION Enhanced PP was associated with a decreased eGFR and an increase in uACR in Korean adults. In addition, the PP increased greatly when a decrease in eGFR and an increase in uACR appeared simultaneously.
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Affiliation(s)
- Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok, Republic of Korea
| | - Chang Eun Park
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan, Republic of Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, Gwangju, Republic of Korea
| | - Kwang Soon Sun
- Department of Nursing, Christian College of Nursing, Gwangju, Republic of Korea
| | - Yu Jeong Kim
- Department of Nursing, Chosun Nursing College, Gwangju, Republic of Korea
| | - Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Gwangyang, Republic of Korea
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Nada DW, El Morsy S, Abu-Zaid MH, Aboelhawa MA, Zakaria MA, El Sheikh EA, Gaber RA. The role of microalbuminuria as a predictor of subclinical cardiovascular events in rheumatoid arthritis patients and its relation to disease activity. Clin Rheumatol 2017; 37:623-630. [PMID: 29063462 DOI: 10.1007/s10067-017-3849-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects many body tissues and leads to major morbidity and mortality. Renal disease in RA is clinically important because it restricts the management of primary disease and increases mortality. The objectives of this study are to (1) investigate the difference between RA patients with and without microalbuminuria (MAU) and (2) find out the relation between MAU and disease activity as well as subclinical cardiovascular effects. Ninety RA patients were divided into two groups according to the presence of MAU, in addition to 30 healthy volunteers. ESR, hs-CRP, RF, lipid profile, urinary microalbumin, GFR, renal function tests, carotid intima media thickness (cIMT), flow-mediated dilatation of the brachial artery (FMD), ECG, and echocardiographic examination were performed for patients and controls. MAU positive RA patients revealed significantly higher lipid profile, ESR, hs-CRP, DAS 28, cIMT, and lower FMD as well as ECG and echocardiographic abnormalities compared to MAU negative RA patients. Moreover, there was significant positive correlation between MAU and DAS28, hs-CRP, LDL, cIMT as well as negative correlation with FMD%. In our study, all RA patients with MAU had a normal serum creatinine concentration and gave a negative result with Albustix. MAU is significantly correlated with ESR, hs-CRP, lipid profile, cIMT, and FMD% in RA patients; therefore, it can be used as an index to measure disease activity as well as subclinical cardiovascular affection in RA patients.
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Affiliation(s)
- D W Nada
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - S El Morsy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - M H Abu-Zaid
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - M A Aboelhawa
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammad A Zakaria
- Rheumatology, Physical Medicine and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - E A El Sheikh
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - R A Gaber
- Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Association Between Body Mass Index Combined with Albumin: creatinine Ratio and All-cause Mortality in Chinese Population. Sci Rep 2017; 7:10878. [PMID: 28883431 PMCID: PMC5589898 DOI: 10.1038/s41598-017-11084-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
The association between body mass index (BMI) combined with albumin: creatinine ratio (ACR) and all-cause mortality in the general population has not been established. To address this, we examined a representative sample from the general population of China. The study included 46,854 participants with a follow-up of 4.6 years. Compared to the normal weight with ACR <10 mg/g group (the reference group), the crude hazard ratios (HRs) for all-cause mortality for the underweight with ACR >10 mg/g, normal weight with ACR >10 mg/g, overweight with ACR >10 mg/g, and obese with ACR >10 mg/g groups, were 2.22 (95% CI, 1.41 to 3.49), 1.70 (95% CI, 1.42 to 2.04), 1.52 (95% CI, 1.22 to 1.89), and 2.05 (95% CI, 1.45 to 2.89), respectively. After multivariable adjustments for age, race, comorbidities, and baseline eGFR, the HRs for the underweight with ACR >10 mg/g and normal weight with ACR >10 mg/g groups were 1.85 (95% CI, 1.17 to 2.91) and 1.36 (95% CI, 1.13 to 1.63), respectively. The results indicate that BMI combined with ACR can better predict all-cause mortality than BMI alone in the general Chinese population. Underweight and normal weight people with elevated ACR are at a higher risk of all-cause mortality than those in the same BMI category with ACR <10 mg/g.
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Choi JW, Oh IH, Lee CH, Park JS. Effect of synergistic interaction between abnormal adiposity-related metabolism and prediabetes on microalbuminuria in the general population. PLoS One 2017; 12:e0180924. [PMID: 28715448 PMCID: PMC5513435 DOI: 10.1371/journal.pone.0180924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/23/2017] [Indexed: 12/27/2022] Open
Abstract
Central obesity and related metabolic components are important risks for microalbuminuria. To describe the effects of interactions between central obesity and related metabolic components on microalbuminuria, we conducted a nation-wide, population-based interaction analysis using cardio-metabolic index (CMI) as a candidate indicator of central obesity and related abnormal lipid metabolism. We recruited native Koreans aged 20 years or older with no medical illness. A total of 5398 participants were divided into quintiles according to CMI with sex as a covariate factor. Participants in the highest CMI quintile had elevated blood pressure (BP), increased glycemic exposure, poor lipid profile, and increased urine albumin-to-creatinine ratio compared to other lower quintiles. Multiple logistic regression models adjusted for age, sex, systolic BP, and diastolic BP showed that CMI had an independent association with increased glycemic exposure and increased urine albumin-to-creatinine ratio. Our interaction analysis revealed a significant interaction between the highest CMI quintile and prediabetes with an increased risk of microalbuminuria (adjusted RERI = 0.473, 95% CI = 0.464–0.482; adjusted AP = 0.276, 95% CI = 0.156–0.395; adjusted SI = 2.952, 95% CI = 1.234–4.670). Our findings suggest a significant association between central obesity-related abnormal lipid metabolism and prediabetes, and their interaction may exert a synergistic effect on renal vascular endothelial dysfunction even before the appearance of full-blown diabetes mellitus. To confirm these findings, large population-based prospective studies are needed.
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Affiliation(s)
- Jong Wook Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Il Hwan Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (JSP); (CHL)
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (JSP); (CHL)
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Bahety P, Agarwal G, Khandelwal D, Dutta D, Kalra S, Taparia P, Singhal V. Occurrence and Predictors of Depression and Poor Quality of Life among Patients with Type-2 Diabetes: A Northern India Perspective. Indian J Endocrinol Metab 2017; 21:564-569. [PMID: 28670541 PMCID: PMC5477445 DOI: 10.4103/ijem.ijem_123_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS Globally, depression has been linked to Type-2 diabetes mellitus (T2DM). However, similar data from India are scant. This study evaluated the occurrence and predictors of depression and health-related quality of life (QOL) in patients with T2DM as compared to healthy controls. MATERIALS AND METHODS One hundred adults with T2DM without prior diagnosis of depression and 100 matched controls were evaluated. Depression was assessed using Patient Health Questionnaire-9. World Health Organization QOL Brief (WHO-QOL-BREF) was used to assess QOL. Demography, anthropometry, biochemical parameters of diabetes control, and microvascular and macrovascular complications in patients were recorded. RESULTS Depression was significantly more common in T2DM (63%) as compared to controls (48%) (odds ratio [OR] - 1.84 [1.04, 3.24]; P = 0.03). In T2DM, depression was higher in patients with disease duration >5 years (OR = 2.66; P = 0.02), glycated hemoglobin >7% (OR = 3.45; P = 0.004), retinopathy (OR - 3.56; P = 0.03), and nephropathy (OR - 4.11; P = 0.07). Occurrence of depression was significantly higher among the patients with macrovascular complications, namely, coronary artery disease (17.4%; P = 0.000006), cerebrovascular disease (14.2%; P = 0.0006), and peripheral vascular disease (7.9%; P = 0.05). Insulin users had higher depression as compared to patients using only oral antihyperglycemic medications (P = 0.034). Patient with depression had significantly low QOL. The WHO-QOL for all the domains was significantly lower in T2DM with microvascular and macrovascular complications, as compared to those without. CONCLUSION Indian T2DM had higher prevalence of depression and lower QOL as compared to controls, which was associated with poor glycemic control and higher end-organ damage. Public health measures are required to create more awareness for managing depression in diabetes.
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Affiliation(s)
- Prerna Bahety
- Department of Family Medicine, Maharaja Agrasen Hospital, New Delhi, India
| | - Gunjan Agarwal
- Department of Medicine, Maharaja Agrasen Hospital, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Venkateshwar Hospital, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Pankaj Taparia
- Department of Neurology, Maharaja Agrasen Hospital, New Delhi, India
| | - Vikas Singhal
- Department of Psychiatry, Maharaja Agrasen Hospital, New Delhi, India
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Urinary Lipidomics: evidence for multiple sources and sexual dimorphism in healthy individuals. THE PHARMACOGENOMICS JOURNAL 2017; 18:331-339. [PMID: 28607507 DOI: 10.1038/tpj.2017.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/21/2017] [Accepted: 05/10/2017] [Indexed: 12/11/2022]
Abstract
Urinary lipidomics may add new valuable biomarkers to the diagnostic armamentarium for early detection of metabolic and kidney diseases. Sources and composition of urinary lipids in healthy individuals, however, have not been investigated in detail. Shotgun lipidomics was used to quantify lipidomic profiles in native urine samples from 16 individuals (eight men, eight women) collected in five fractions over 24 h. All probands were comprehensively characterized by urinary and clinical indices. The mean total urinary lipid concentration per sample was 0.84 μM in men and 1.03 μM in women. We observed significant intra- and interindividual variations of lipid concentrations over time, but failed to detect a clear circadian pattern. Based on quantity and subclass composition it seems very unlikely that plasma serves as major source for the urinary lipidome. Considering lipid metabolites occurring in at least 20% of all samples 38 lipid species from 7 lipid classes were identified. Four phosphatidylserine and one phosphatidylethanolamine ether species (PE-O 36:5) were detectable in almost all urine samples. Sexual dimorphism has been found mainly for phosphatidylcholines and phosphatidylethanolamines. In men and in women urinary lipid species were highly correlated with urinary creatinine and albumin excretion, reflecting glomerular filtration and tubular transport processes. In women, however, lipid species deriving from urinary cells and cellular constituents of the lower genitourinary tract considerably contributed to the urinary lipidome. In conclusion, our study revealed the potential of urinary lipidomics but also the complexity of methodological challenges which have to be overcome for its implementation as a routine diagnostic tool for renal, urological and metabolic diseases.
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Nah EH, Cho S, Kim S, Cho HI. Comparison of Urine Albumin-to-Creatinine Ratio (ACR) Between ACR Strip Test and Quantitative Test in Prediabetes and Diabetes. Ann Lab Med 2017; 37:28-33. [PMID: 27834062 PMCID: PMC5107614 DOI: 10.3343/alm.2017.37.1.28] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/19/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes. METHODS Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests. RESULTS The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method. CONCLUSIONS The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.
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Affiliation(s)
- Eun Hee Nah
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
| | - Seon Cho
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Suyoung Kim
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Han Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea
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Sharma LK, Dutta D, Sharma N, Gadpayle AK. The increasing problem of subclinical and overt hypervitaminosis D in India: An institutional experience and review. Nutrition 2017; 34:76-81. [DOI: 10.1016/j.nut.2016.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/28/2016] [Accepted: 09/24/2016] [Indexed: 01/06/2023]
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Mukhopadhyay S, Dutta D. Is It Justified to Have a Lower BMI Cutoff for Metabolic Surgery for Asians with Type 2 Diabetes? Obes Surg 2017; 27:1065-1066. [PMID: 28132127 DOI: 10.1007/s11695-017-2565-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, 244 AJC Bose Road, Kolkata, India
| | - Deep Dutta
- Department of Endocrinology, Venkateshwar Hospital, Dwarka, New Delhi, 110075, India.
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Dutta D, Dharmshaktu P, Aggarwal A, Gaurav K, Bansal R, Devru N, Garga UC, Kulshreshtha B. Severity and pattern of bone mineral loss in endocrine causes of osteoporosis as compared to age-related bone mineral loss. J Postgrad Med 2016; 62:162-9. [PMID: 27241810 PMCID: PMC4970342 DOI: 10.4103/0022-3859.183170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Data are scant on bone health in endocrinopathies from India. This study evaluated bone mineral density (BMD) loss in endocrinopathies [Graves’ disease (GD), type 1 diabetes mellitus (T1DM), hypogonadotrophic hypogonadism (HypoH), hypergonadotropic hypogonadism (HyperH), hypopituitarism, primary hyperparathyroidism (PHPT)] as compared to age-related BMD loss [postmenopausal osteoporosis (PMO), andropause]. Materials and Methods: Retrospective audit of records of patients >30 years age attending a bone clinic from August 2014 to January 2016 was done. Results: Five-hundred and seven records were screened, out of which 420 (females:male = 294:126) were analyzed. A significantly higher occurrence of vitamin D deficiency and insufficiency was noted in T1DM (89.09%), HyperH (85%), and HypoH (79.59%) compared to age-related BMD loss (60.02%; P < 0.001). The occurrence of osteoporosis among females and males was 55.41% and 53.97%, respectively, and of osteopenia among females and males was 28.91% and 32.54%, respectively. In females, osteoporosis was significantly higher in T1DM (92%), HyperH (85%), and HypoH (59.26%) compared to PMO (49.34%; P < 0.001). Z score at LS, TF, NOF, and greater trochanter (GT) was consistently lowest in T1DM women. Among men, osteoporosis was significantly higher in T1DM (76.67%) and HypoH (54.55%) compared to andropause (45.45%; P = 0.001). Z score at LS, TF, NOF, GT, and TR was consistently lowest in T1DM men. In GD, the burden of osteoporosis was similar to PMO and andropause. BMD difference among the study groups was not significantly different after adjusting for body mass index (BMI) and vitamin D. Conclusion: Low bone mass is extremely common in endocrinopathies, warranting routine screening and intervention. Concomitant vitamin D deficiency compounds the problem. Calcium and vitamin D supplementations may improve bone health in this setting.
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Affiliation(s)
- D Dutta
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - P Dharmshaktu
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - A Aggarwal
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - K Gaurav
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - R Bansal
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - N Devru
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - U C Garga
- Department of Radiology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
| | - B Kulshreshtha
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India
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Selvan C, Dutta D, Thukral A, Nargis T, Kumar M, Mukhopadhyay S, Chowdhury S. Neck height ratio is an important predictor of metabolic syndrome among Asian Indians. Indian J Endocrinol Metab 2016; 20:831-837. [PMID: 27867888 PMCID: PMC5105569 DOI: 10.4103/2230-8210.192927] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS The predictive potential of neck circumference (NC) based indices (a measure of upper body fat distribution) for predicting metabolic syndrome (MetS) and its components among Indians is not known. This study aimed to evaluate the role of NC and neck height ratio (NHtR) as independent predictors of MetS and its components as compared to traditional anthropometric indices. MATERIALS AND METHODS A total of 451 individuals from 867 screened individuals, 30-80 years age, without any co-morbid state who gave informed written consent underwent clinical, anthropometric, and biochemical assessment. RESULTS Patients with MetS in both the sexes had significantly higher NC, NHtR, glycated hemoglobin, fasting glucose, and dyslipidemia (higher triglycerides, total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, low-density lipoprotein cholesterol/HDL-C ratio, and lower HDL-C). In both sexes, individuals in the highest tertile of NC had significantly greater central and generalized obesity, lower HDL-C, and significantly higher MetS. Receiver operating characteristic analysis revealed waist circumference (WC) to have the largest area under the curve for predicting MetS in both sexes, followed by NHtR, NC, and body mass index. NC and NHtR of >34.9 cm (sensitivity 78.6%; specificity 59.3%) and >21.17 cm/m (sensitivity 80.7% and specificity 64.6%) respectively for men and >31.25 cm (sensitivity 72.3%; specificity 64.4%) and >20.48 cm/m (sensitivity 80.4% and specificity 60%) respectively for women were the best values for identifying MetS. Increased NC and NHtR had odds ratio of 1.52 (95% confidence interval [CI]: 1.37-1.68; P < 0.001) and 1.96 (95% CI: 1.67-2.29; P < 0.001) respectively in identifying MetS. CONCLUSION NC and NHtR are good predictors of MetS and cardiovascular risk factors in Asian Indians. NHtR is reliable and perhaps an even better index than NC with regards to cardiovascular risk prediction.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anubhav Thukral
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Titli Nargis
- PhD Scholar, Indian Institute of Chemical Biology, Kolkata, West Bengal, India
| | - Manoj Kumar
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Institute of Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Koh GY, Rowling MJ, Schalinske KL, Grapentine K, Loo YT. Consumption of Dietary Resistant Starch Partially Corrected the Growth Pattern Despite Hyperglycemia and Compromised Kidney Function in Streptozotocin-Induced Diabetic Rats. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:7540-7545. [PMID: 27665944 DOI: 10.1021/acs.jafc.6b03808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We previously demonstrated that feeding of dietary resistant starch (RS) prior to the induction of diabetes delayed the progression of diabetic nephropathy and maintained vitamin D balance in streptozotocin (STZ)-induced type 1 diabetic (T1D) rats. Here, we examined the impact of RS on kidney function and vitamin D homeostasis following STZ injection. Male Sprague-Dawley rats were administered STZ and fed a standard diet containing cornstarch or 20, 10, or 5% RS for 4 weeks. T1D rats fed 10 and 20% RS, but not 5% RS, gained more weight than cornstarch-fed rats. Yet, renal health and glucose metabolism were not improved by RS. Our data suggest that RS normalized growth patterns in T1D rats after diabetes induction in a dose-dependent manner despite having no effect on blood glucose and vitamin D balances. Future interventions should focus on the preventative strategies with RS in T1D.
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Affiliation(s)
- Gar Yee Koh
- The Interdepartmental Graduate Program in Nutritional Sciences and ‡Department of Food Science and Human Nutrition, Iowa State University , Ames, Iowa 50011, United States
| | - Matthew J Rowling
- The Interdepartmental Graduate Program in Nutritional Sciences and ‡Department of Food Science and Human Nutrition, Iowa State University , Ames, Iowa 50011, United States
| | - Kevin L Schalinske
- The Interdepartmental Graduate Program in Nutritional Sciences and ‡Department of Food Science and Human Nutrition, Iowa State University , Ames, Iowa 50011, United States
| | - Kelly Grapentine
- The Interdepartmental Graduate Program in Nutritional Sciences and ‡Department of Food Science and Human Nutrition, Iowa State University , Ames, Iowa 50011, United States
| | - Yi Ting Loo
- The Interdepartmental Graduate Program in Nutritional Sciences and ‡Department of Food Science and Human Nutrition, Iowa State University , Ames, Iowa 50011, United States
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Sagarad SV, Sukhani N, Machanur B, Patil S. Effect of Vitamin D on Anginal Episodes in Vitamin D Deficient Patients with Chronic Stable Angina on Medical Management. J Clin Diagn Res 2016; 10:OC24-6. [PMID: 27656481 DOI: 10.7860/jcdr/2016/20521.8345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/23/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Vitamin D deficiency has been found to contribute to various cardiac conditions, such as hypertension, coronary artery disease, stroke, and atherosclerosis. However, the clinical cardiovascular benefits after short term supplementation have not been reported. AIM To study the beneficial effect of Vitamin D supplementation on angina episodes in Vitamin D deficient patients with chronic stable angina on medical management. MATERIALS AND METHODS A total of 40 patients were studied with group 1 (20 patients) with low Vitamin D levels and group 2 with normal Vitamin D levels. 60000 IU of Vitamin D supplementation was given every week for 8 weeks in group 1. Frequency of anginal episodes and use of sub-lingual nitrates were compared at base-line and after 8 weeks post supplementation. RESULTS Significant 20% (p <0.05) reduction in anginal episodes and 17.24% (p <0.05) reduction in use of sub-lingual nitrates was noted in group1 after Vitamin D supplementation. The benefits were independent of BP, heart rate and medications, thus, attributing to supplementation. No significant change was noted in group 2. CONCLUSION Cardiovascular patients need to be evaluated for Vitamin D deficiency. Supplementation to correct Vitamin D levels may have additional cardiovascular benefits like reduction in angina episodes.
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Affiliation(s)
- Suresh V Sagarad
- Assistant Professor, Department of Cardiology, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Neha Sukhani
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Basavaraj Machanur
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
| | - Shashidhar Patil
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences , Raichur, Karnataka, India
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Vitamin D deficiency and the associated factors in children with type 1 diabetes mellitus in southern Iran. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0499-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Chaudhary S, Dutta D, Kumar M, Saha S, Mondal SA, Kumar A, Mukhopadhyay S. Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial. Indian J Endocrinol Metab 2016; 20:391-398. [PMID: 27186560 PMCID: PMC4855971 DOI: 10.4103/2230-8210.179997] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS Although Vitamin D deficiency has been linked to autoimmune thyroid disorders (AITD), the impact of Vitamin D supplementation on thyroid autoimmunity is not known. This study aimed to evaluate the impact of Vitamin D supplementation on thyroid autoimmunity (thyroid peroxidase antibody [TPO-Ab] titers) in patients with newly diagnosed AITD in a randomized controlled trial. MATERIALS AND METHODS One hundred two patients with newly diagnosed AITD (TPO-Ab > 34 kIU/L and/or sonographic evidence of thyroiditis) patients were randomized into Group-1 (intervention group) and Group-2 (control group). Group-1 received cholecalciferol 60,000 IU weekly and calcium 500 mg/day for 8 weeks; Group-2 received calcium 500 mg/day for 8 weeks. Responders were defined as ≥25% fall in TPO-Ab titers. Individuals with at least 3-month follow-up were analyzed. Trial is registered at ctri.nic.in (CTRI/2015/04/005713). RESULTS Data from 100 AITD patients (68 with thyroid stimulating hormone [TSH] ≤10 mIU/L, 32 with TSH > 10 mIU/L), 93% having Vitamin D insufficiency, were analyzed. TPO-Ab titers were highest among patients in the lowest 25-hydroxyvitamin D quartile (P = 0.084). At 3 months follow-up, there was significant fall in TPO-Ab in Group-1 (-46.73%) as compared to Group-2 (-16.6%) (P = 0.028). Sixty-eight percentage patients in Group-1 were responders compared to 44% in Group-2 (P = 0.015). Kaplan-Meier analysis revealed significantly higher response rate in Group-1 (P = 0.012). Significantly greater reduction in TPO-Ab titers was observed in AITD with TSH ≤ 10 mIU/L compared to TSH > 10 mIU/L. Cox regression revealed Group-1 followed by TPO-Ab and free tetraiodothyronine levels to be a good predictor of response to therapy (P = 0.042, 0.069, and 0.074, respectively). CONCLUSION Vitamin D supplementation in AITD may have a beneficial effect on autoimmunity as evidence by significant reductions in TPO-Ab titers.
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Affiliation(s)
- Sandeep Chaudhary
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manoj Kumar
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Sudipta Saha
- Department of Radiology, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Samim Ali Mondal
- Department of Biochemistry, Dr. B C Roy Post Graduate Institute of Basic Medical Education and Research, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Ashok Kumar
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Association of Microalbuminuria with Metabolic Syndrome among Aged Population. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9241278. [PMID: 27200378 PMCID: PMC4856886 DOI: 10.1155/2016/9241278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 01/06/2023]
Abstract
Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55–98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226–2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044–1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107–1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348–0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C.
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Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res 2016; 143:401-4. [PMID: 27377494 PMCID: PMC4928544 DOI: 10.4103/0971-5916.184281] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education & Research (PGIMER) & Dr Ram Manohar Lohia (RML) Hospital, 1 Baba Kharak Singh Marg, New Delhi 110 001, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology & Metabolism, Institute of Post-Graduate Medical Education & Research (IPGMER) & Seth Sukhlal Karnani Memorial (SSKM) Hospital, 244 AJC Bose Road, Kolkata 700 020, West Bengal, India
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Chen S, Hong K, Zou F, Peng Q, Hu W, Li J, Lai X, Cheng X, Su H. Impact of glucose load in an oral glucose tolerance test on urinary albumin excretion varies with 2-h glucose levels. J Diabetes 2016; 8:206-13. [PMID: 25676539 DOI: 10.1111/1753-0407.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate whether an oral glucose load can induce an increase in urinary albumin excretion (UAE). METHODS One hundred and thirty subjects without macroalbuminuria or increased fasting serum glucose (≥7.0 mmol/L) were included in the study. At 0600 hours, subjects were asked to empty their bladder and drink 300 mL water. At 0800 hours, venous blood and 2-h urine were collected for fasting examination. Subjects were then asked to drink 300 mL solution containing 75 g glucose and, at 1000 hours, samples were collected again for post-challenge examination. Concentrations of serum glucose, urinary glucose, albumin, N-acetyl-β-D-glucosaminidase and retinol-binding protein were measured. RESULTS Based on the results of the oral glucose tolerance test, subjects were divided into three groups: (i) normal glucose tolerance (NGT; n = 55); (ii) impaired glucose tolerance (IGT; n = 39); and (iii) newly diagnosed diabetes mellitus (NDM; n = 36). In the NDM group, post-challenge urinary excretion of glucose and albumin was 14- and 1.6-fold greater than fasting values, respectively. In the IGT and NGT groups, although post-challenge urinary glucose excretion was 2.6- and 1.6-fold greater than fasting values, UAE did not increase. There was a positive correlation between post-challenge serum glucose and the UAE rate (UAER; r = 0.24, P < 0.01) and the UAER increment (ΔUAER; r = 0.19, P < 0.05), as well as between the serum glucose increment and post-challenge UAER (r = 0.23, P < 0.01) and ΔUAER (r = 0.18, P < 0.05). Post-challenge serum glucose levels were independently correlated with logarithmically converted post-challenge UAER (β = 0.322, P = 0.008). CONCLUSIONS Oral glucose load can induce a significant increase in UAE in NDM subjects. The main mechanism may be glomerular hyperfiltration.
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Affiliation(s)
- Sisi Chen
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kui Hong
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fang Zou
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Peng
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weitong Hu
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Juxiang Li
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoshu Cheng
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hai Su
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, China
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Song X, Qiu M, Zhang X, Wang H, Tong W, Ju L, Gu L, Sun S, Zhang H, Wang W, Tian J. Gender-related affecting factors of prediabetes on its 10-year outcome. BMJ Open Diabetes Res Care 2016; 4:e000169. [PMID: 27239315 PMCID: PMC4873952 DOI: 10.1136/bmjdrc-2015-000169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/12/2016] [Accepted: 03/04/2016] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate the gender-related affecting factors of prediabetes on its 10-year outcome, in a longitudinal study. METHODS AND RESULTS This longitudinal population-based study was performed in the Ping Liang community, Yangpu district, Shanghai, between November 2002 and October 2014. There were 334 participants with prediabetes enrolled in the final analysis. While a certain proportion of the prediabetic population progress to diabetes, the majority remain at the same level or even revert to normal glucose regulation. No gender difference was observed in the change of glucose regulation. However, results from an adjusted logistic regression analysis in males showed that physical activity was significantly associated with both elevated odds of reverting to normal glucose regulation (active vs inactive, OR 3.00, 95% CI 1.09 to 8.30) and developing diabetes (OR 0.34, 95% CI 0.13 to 0.92). Age, baseline 2 h glucose, triglycerides and smoking status were also risk factors significantly associated with diabetes development; while for females, waist circumference played a key role in the outcome. Every unit elevation of waist circumference was associated with lower odds of reverting to normal glucose regulation (OR, 0.94; 95% CI 0.89 to 0.98) and higher odds of progressing to diabetes (OR, 1.05; 95% CI 1.01 to 1.10). Baseline hypertension and family history of diabetes carried higher risk for developing diabetes as well. CONCLUSIONS Physical activity in males and waist circumference in females are important factors predicting both progression to diabetes and regression to normal glucose regulation, indicating that more exercise for males and lower waist circumference for females are beneficial for prediabetes to achieve reversion.
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Affiliation(s)
- Xiaomin Song
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Endocrinology and Metabolism, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Miaoyan Qiu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan'e Zhang
- Department of Endocrinology and Metabolism, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haiyan Wang
- Ping Liang Community Health Service Center, Yang Pu District, Shanghai, China
| | - Wenxin Tong
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Ju
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Gu
- Department of Endocrinology and Metabolism, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siming Sun
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Hongli Zhang
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Weiqing Wang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyan Tian
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
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Ghosh SS, Righi S, Krieg R, Kang L, Carl D, Wang J, Massey HD, Sica DA, Gehr TWB, Ghosh S. High Fat High Cholesterol Diet (Western Diet) Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide. PLoS One 2015; 10:e0141109. [PMID: 26580567 PMCID: PMC4651339 DOI: 10.1371/journal.pone.0141109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/04/2015] [Indexed: 01/06/2023] Open
Abstract
A high fat meal, frequently known as western diet (WD), exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS) leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx) or WD (Nx+WD). The controls were sham operated animals on normal diet (control) and WD (WD). To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM), a known LPS antagonist, and curcumin (CU), a compound known to ameliorate chronic kidney disease (CKD), was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively). Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency.
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Affiliation(s)
- Siddhartha S. Ghosh
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Samuel Righi
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Richard Krieg
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Daniel Carl
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jing Wang
- Division of Pulmonary Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - H. Davis Massey
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Domenic A. Sica
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Todd W. B. Gehr
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Shobha Ghosh
- Division of Pulmonary Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
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The Role of Vitamin D in Diabetes and Cardiovascular Disease: An Updated Review of the Literature. DISEASE MARKERS 2015; 2015:580474. [PMID: 26576069 PMCID: PMC4630385 DOI: 10.1155/2015/580474] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
The dietary reference values for Vitamin D were set primarily considering its role in bone health, but with the discovery of Vitamin D receptors throughout body tissues, new links with other health conditions are now studied, such as for diabetes and cardiovascular diseases (CVD). This paper shall analyze and examine all new research studies carried out, especially in 2013–2015 regarding diabetes mellitus (DM) and cardiovascular diseases (CVD). Vast research has been carried out to establish strong relationship between Vitamin D serum levels, supplementation, diabetes, and CVD. However, the results from researches identified in this paper are disputable. Benefits of Vitamin D adequate levels were recognized from gestational period until later in disease development such as diabetes and/or CVD, but since not all studies are in agreement further investigation is suggested. Researches conducting large randomized controlled trials, exploring range of supplement doses, with variable baseline serum Vitamin D levels, and inclusion of array of associated parameters, are still required to conduct large-scale analysis and draw conclusion as a risk factor. Until then it is possible to conclude that maintenance of serum Vitamin D levels holds advantageous aspects in diabetic and cardiovascular conditions, and people should strive to attain them.
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Dutta D, Mukhopadhyay S. Comment on Anjana et al. Incidence of Diabetes and Prediabetes and Predictors of Progression Among Asian Indians: 10-Year Follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care 2015;38:1441-1448. Diabetes Care 2015; 38:e146. [PMID: 26294782 DOI: 10.2337/dc15-0908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
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Dutta D, Mondal SA, Kumar M, Hasanoor Reza AH, Biswas D, Singh P, Chakrabarti S, Mukhopadhyay S. Serum fetuin-A concentration predicts glycaemic outcomes in people with prediabetes: a prospective study from eastern India. Diabet Med 2014; 31:1594-9. [PMID: 24975463 DOI: 10.1111/dme.12539] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/04/2014] [Accepted: 06/25/2014] [Indexed: 01/06/2023]
Abstract
AIM To evaluate the role of fetuin-A levels in predicting glycaemic outcomes (progression to diabetes or reversion to normoglycaemia) in people with prediabetes. METHODS A total of 2119 people were screened, of whom 144 people with prediabetes, 50 people with normoglycaemia and 66 people with newly diagnosed diabetes underwent estimation of fasting insulin, fetuin-A, interleukin-6, interleukin-1β, tumour necrosis factor-α, lipid and 25-hydroxyvitamin-D levels and assessment of non-alcoholic fatty liver disease using ultrasonography and the fatty liver index. People with prediabetes were followed and analysed according to glycaemic outcome and quartile of fetuin-A level. RESULTS Fetuin-A, interleukin-1β, interleukin-6, tumour necrosis factor-α and triglyceride levels and presence of non-alcoholic fatty liver disease increased across the glycaemic spectrum and were highest in people with diabetes. A total of 32 people with prediabetes reverted to normoglycaemia, 23 progressed to diabetes and 65 remained with prediabetes over a mean ± sd follow-up of 32.12 ± 8.4 months. People progressing to diabetes had higher baseline glycaemia rates, fetuin-A levels, interleukin-1β levels, fatty liver index scores and prevalence of non-alcoholic fatty liver disease and lower 25-hydroxyvitamin-D levels. People with prediabetes in the highest fetuin-A quartile had the highest risk of progression to diabetes (relative risk 2.68, 95% CI 0.95-7.55; P = 0.06) and the lowest rate of reversion to normoglycaemia (relative risk 0.27, 95% CI 0.08-0.85; P = 0.03). Fetuin-A levels correlated with interleukin-1β levels (r = 0.420; P < 0.001), interleukin-6 levels (r = 0.231; P = 0.022) and fatty liver index scores (r = 0.319; P < 0.001). Cox regression showed that higher fetuin-A levels and higher BMI and lower 25-hydroxyvitamin-D levels were predictive of lower rates of reversion to normoglycaemia. Age, triglyceride levels, and interleukin-6 and interleukin-1β levels were predictive of progression to diabetes. CONCLUSIONS Increased fetuin-A level has an adverse impact on glycaemic outcomes in prediabetes. This study highlights the importance of fetuin-A as a predictor of glycaemic outcomes in prediabetes.
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Affiliation(s)
- D Dutta
- Department of Endocrinology and Metabolism, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Calcutta, India
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Kim CH, Kim KJ, Kim BY, Jung CH, Mok JO, Kang SK, Kim HK. Prediabetes is not independently associated with microalbuminuria in Korean general population: the Korea National Health and Nutrition Examination Survey 2011-2012 (KNHANES V-2,3). Diabetes Res Clin Pract 2014; 106:e18-21. [PMID: 25271114 DOI: 10.1016/j.diabres.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/12/2014] [Indexed: 12/22/2022]
Abstract
We investigated the association between microalbuminuria and prediabetes in Korean population using data from the KNHANES 2011-2012. Prevalence of microalbuminuria was significantly increased in prediabetes group. However, the odds ratio became insignificant after adjustment for blood pressure, and the prevalence of microalbuminuria was not increased in prediabetic subjects without hypertension.
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Affiliation(s)
- Chul-Hee Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea.
| | - Kyu-Jin Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Bo-Yeon Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Chan-Hee Jung
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Ji-Oh Mok
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Sung-Koo Kang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Hong-Kyu Kim
- Health Screening & Promotion Center, Asan Medical Center, Seoul, South Korea
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