Telomere shortening occurs in Asian Indian Type 2 diabetic patients

Aim: Telomere shortening has been reported in several diseases including atherosclerosis and Type 1 diabetes. Asian Indians have an increased predilection for Type 2 diabetes and premature coronary artery disease. The aim of this study was to determine whether telomeric shortening occurs in Asian Indian Type 2 diabetic patients. Methods: Using Southern‐blot analysis we determined mean terminal restriction fragment (TRF) length, a measure of average telomere size, in leucocyte DNA. Type 2 diabetic patients without any diabetes‐related complications (n = 40) and age‐ and sex‐matched control non‐diabetic subjects (n = 40) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Plasma level of malondialdehyde (MDA), a marker of lipid peroxidation, was measured by TBARS (thiobarbituric acid reactive substances) using a fluorescence method. Results: Mean (± SE) TRF lengths of the Type 2 diabetic patients (6.01 ± 0.2 kb) were significantly shorter than those of the control subjects (9.11 ± 0.6 kb) (P = 0.0001). Among the biochemical parameters, only levels of TBARS showed a negative correlation with shortened telomeres in the diabetic subjects (r = −0.36; P = 0.02). However, telomere lengths were negatively correlated with insulin resistance (HOMA‐IR) (r = −0.4; P = 0.01) and age (r = −0.3; P = 0.058) and positively correlated with HDL levels (r = 0.4; P = 0.01) in the control subjects. Multiple linear regression (MLR) analysis revealed diabetes to be significantly (P < 0.0001) associated with shortening of TRF lengths. Conclusions: Telomere shortening occurs in Asian Indian Type 2 diabetic patients

Adipocytokines and the expanding 'Asian Indian Phenotype'

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Differential gene expression of NADPH oxidase (p22phox) and hemoxygenase-1 in patients with Type 2 diabetes and microangiopathy

Aims: While the downstream effects of increased reactive oxygen species (ROS) in the pathogenesis of diabetes were well studied, only a few studies have explored the cellular sources of ROS. We examined whether protection against oxidative stress is altered in patients with diabetes and microangiopathy by examining changes in NADPH oxidase (p22phox) and hemoxygenase‐1 (HO‐1) levels. Methods: NADPH oxidase (p22phox) and HO‐1 gene expression were probed by RT‐PCR using leucocytes from patients with Type 2 diabetes without (n = 19) and with microangiopathy (n = 20) and non‐diabetic subjects (n = 17). Levels of lipid peroxidation as measured by thiobarbituric reactive substances (TBARS) and protein carbonyl content (PCO) were determined by fluorimetric and spectrophotometric methods, respectively. Results: p22phox gene expression (mean ± se) was significantly (P < 0.05) higher in diabetic patients with (0.99 ± 0.04) and without microangiopathy (0.86 ± 0.05) compared with control subjects (0.66 ± 0.05). Consistent with the mRNA data, the p22phox protein expression and NADPH oxidase activity was also increased in cells from diabetic patients compared with control subjects. However, HO‐1 gene expression was significantly (P < 0.05) lower in patients with (0.73 ± 0.03) and without microangiopathy (0.85 ± 0.02) compared with control subjects (1.06 ± 0.03). The mean (± se) levels of TBARS were significantly (P < 0.05) higher in diabetic patients with (14.36 ± 1.3 nm/ml) and without microangiopathy (12.20 ± 1.3 nm/ml) compared with control subjects (8.58 ± 0.7 nm/ml). The protein carbonyl content was also significantly (P < 0.05) higher in diabetic patients with (1.02 ± 0.04 nmol/mg protein) and without microangiopathy (0.84 ± 0.06 nmol/mg protein) compared with control subjects (0.48 ± 0.02 nmol/mg protein). In diabetic subjects, increased p22phox gene expression was negatively correlated with HO‐1 and positively correlated with TBARS, PCO, HbA1c and diabetes duration. In contrast, HO‐1 gene expression was correlated negatively with p22phox, TBARS, PCO, HbA1c and diabetes duration. Conclusion: Our results indicate that increased oxidative damage is seen in Asian Indians with Type 2 diabetes and microangiopathy and is associated with increased NADPH oxidase (p22phox) and decreased HO‐1 gene expression

Macrovascular component of diabetes atherosclerosis and insulin (CUPS-18)

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Epidemiology of coronary heart disease in Asians in Britain

In countries where people of South Asian origin have settled, unexpectedly high coronary heart disease rates have been recorded in South Asian men and women compared with other ethnic groups. In England high CHD mortality is shared by Gujarati Hindus, Punjabi Sikhs and Muslims from Pakistan and Bangladesh. The high CHD rates in these populations are unexplained by levels of smoking, blood pressure, plasma cholesterol or dietary fat intake. To test whether disturbances of haemostatic activity, lipoprotein metabolism or carbohydrate metabolism might underlie the high CHD mortality in South Asians, a population study in east London was undertaken. The results confirmed that the high CHD rates in South Asians compared with the native British population cannot be explained by differences in the distributions of blood pressure or plasma cholesterol. The hypothesis of a disturbance of haemostatic activity was not supported. A pattern of low plasma HDL cholesterol and high triglyceride levels, high serum insulin levels after a glucose load and high prevalence of non-insulin-dependent diabetes was identified in CD Bangladeshis. On the basis of these findings and a review of other recent work it is suggested that: (i) insulin resistance underlies these disturbances of lipoprotein and carbohydrate metabolism in Bangladeshis; (ii) this tendency to insulin resistance is a general pattern in South Asian populations overseas; and (iii) it is a possible underlying mechanism for the high rates of both CHD and diabetes in these populations. The planning of a large study to test this is described. Preliminary results confirm that a syndrome of metabolic disturbances related to insulin resistance, first identified in Bangladeshis, is present also in Gujaratis and Punjabis. This is associated with a striking tendency to central obesity in South Asians. These findings point to the aetiological role of insulin resistance in CHD and suggest possible strategies for prevention in South Asian communities

Diabetes in 2007 - What are the promises & challenges?

No Abstrac

Left ventricular diastolic dysfunction in asymptomatic type 2 diabetes mellitus patients

Background: Diastolic dysfunction has been described as an early sign of diabetic heart muscle disease preceding the systolic damage. The pathogenesis of ventricular dysfunction remains unknown and has been somewhat controversial. So far, very few population-based studies have been carried out in India, to demonstrate the prevalence of diastolic dysfunction in diabetic subjects. Hence the present study was done at our tertiary care centre to detect left diastolic dysfunction in asymptomatic type 2 diabetes individuals and to use echo-cardiologic assessment as an early detector of left diastolic dysfunction. The aim of this study was to detect left diastolic dysfunction in asymptomatic type 2 diabetes individuals and to use echocardiologic assessment as an early detector of left diastolic dysfunction.Methods: A hospital based cross-sectional observational study was conducted with 50 patients for echocardiographic evaluation of diastolic dysfunction in asymptomatic Type 2 Diabetes Mellitus. E/A <1 and increase in LA size was considered as the evidence of left ventricular Diastolic Dysfunction.Results: 15 (30%) patients were detected with Left Ventricular Diastolic Dysfunction (LVDD) among the 50 patients under study.Conclusions: Diastolic dysfunction in patients with diabetes is present in 30% of patients even when diabetes is present at a younger age, and is of a shorter duration. This dysfunction is suggestive of pre-clinical diabetic cardiomyopathy. E/A, DT and peak A velocity are sensitive indices of diastolic LV dysfunction. Thus, diastolic dysfunction can be used as an early indicator, as it is a precursor to increased LV hypertrophy and clinical left ventricular dysfunction

Prevalence of different components of the metabolic syndrome in type 2 diabetics attending tertiary care hospital in Himalayan region

Background: There are enormous studies on various aspect of Diabetes and Metabolic syndrome, majority of studies are on urban population, few in rural area but very few for the population living in far flung hilly region of Himalaya. The aim was to find the prevalence of different components of metabolic syndrome in Type 2 diabetics living in the hills of Himalaya and to find correlation with obesity.Methods: All the Type 2 Diabetic patients age 35 years and above attending the inpatients and out patient’s department of V. C. S. G. G. M. C and RI Srinagar, Uttarakhand from October 2012 to March 2013 were enrolled and were evaluated for metabolic syndrome by IDF (International Diabetes Federation) criteria.Results: 128 diabetics were enrolled (76 males and 52 females), the prevalence of obesity in patients of type 2 diabetics was 45.3%. There was poor correlation between obesity and type 2 diabetes (correlation coefficient 0.08) The prevalence of metabolic syndrome was 40.6 % and high percentage (62%) had all five components of the syndrome.Conclusions: The prevalence of obesity and Metabolic syndrome is relatively lower in Type 2 Diabetics of Shivalik range of Himalaya (Uttarakhand)

Epidemiology of type 2 diabetes: Indian scenario.

India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The so called "Asian Indian Phenotype" refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. At least a part of this is due to genetic factors. However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population. Even though the prevalence of microvascular complications of diabetes like retinopathy and nephropathy are comparatively lower in Indians, the prevalence of premature coronary artery disease is much higher in Indians compared to other ethnic groups. The most disturbing trend is the shift in age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on nation's health and economy. Early identification of at-risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole