Effect of Sudarshan Kriya Yoga on anxiety, depression, and quality of life in people with type 2 diabetes : A pilot study in Kuwait

Aim: This pilot study in Kuwait was aimed to assess the effect of Sudarshan kriya yoga (SKY) on anxiety, depression and total quality of life in people with type 2 diabetes mellitus (T2DM). Methods: 26 T2DM patients aged greater than 30, male and female visiting the outpatient clinic of Dasman Diabetes Institute were enrolled for the study. Pre and post 5 day SKY intervention responses of participants on psychosocial problems were evaluated using four questionnaires (Hamilton anxiety, patient health questionnaire (PHQ-9), Hospital anxiety depression and WHO total quality of life (QOL). Biochemical parameters; such as lipid profile, glycated hemoglobin (HbA1c) were measured at baseline and after 15 weeks of SKY practice. Results: The mean age of the participants was 56.7 (+/- 11.4 SD) years, and mean duration of diabetes 15.0 (+/- 9.3 SD) years. Comparison of responses before and after intervention indicated a significant improvement in the QOL, depression, anxiety and insomnia. But no significant improvement in glycemic control. Conclusion: Results indicate that SKY can be potentially beneficial for treating anxiety, insomnia, and depression associated in people with T2DM and in improving the quality of life in people with T2DM. (C) 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan : A Systematic Review and Meta-Analysis

Background. Ramadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan. Methods. In this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3. Results. A total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio=0.38, 95% CI: 0.26 to 0.55, p < 0.00001). Conclusion. The results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.Peer reviewe

The Complex Etiology of Childhood Obesity in Arabs Is Highlighted by a Combination of Biological and Socio-Economic Factors

Objectives: To identify predictors of childhood and adolescent obesity in Kuwaitis with Arab ethnicity.Methods: A cross-sectional sample of 6–18 year-old schoolchildren was randomly selected from 244 public schools across all six governorates in the State of Kuwait. Anthropometric data were measured from 6,574 Arab Kuwaiti schoolchildren, and a structured questionnaire was used to collect information on possible risk factors associated with obesity. Overweight and obesity were defined in accordance with the Center for Disease Control and Prevention criteria.Results: The prevalence of overweight and obesity in children (aged 6–18 years) were 17.7% and 33.7%, respectively. The likelihood of childhood obesity increased with birth weights &gt;4.0 Kg [odds ratio (OR) = 2.3; p &lt; 0.0001], maternal employment (OR = 1.26, p = 0.0006), maternal age at pregnancy &gt;30 years (OR = 1.24; p = 0.0016) and family size of &lt;6 members (OR = 1.16, p = 0.0106).Conclusions: Public health professionals should be aware that advanced maternal age, maternal employment, smaller family size, and high birthweight may predict the risk of obesity in Kuwaiti Arab children and adolescents

Gender Differences in Ghrelin Association with Cardiometabolic Risk Factors in Arab Population

Ghrelin is a stomach produced hormone that has been shown to have protective role against development of CVD which is a leading cause of death in the Arab world. The objective of this study is to examine the gender difference in association between traditional CVD risk factors and plasma ghrelin among Arabs. 359 Arab residents in Kuwait participated in a cross-sectional survey (≥20 years old): 191 were females and 168 were males. Plasma level of ghrelin was assessed using Luminex-based assay. Ghrelin levels were significantly higher in females (935 ± 78 pg/mL) than males (763 ± 65 pg/mL) (P=0.0007). Females showed inverse association with WC (r=-0.23, P=0.001) and HbA1C (r=-0.19, P=0.0102) as well as SBP (r=-0.15, P=0.0383) and DBP (r=-0.16, P=0.0230), respectively. Higher levels of ghrelin were shown to associate with increased insulin resistance, as measured by HOMAIR, in male Arab subjects (P-trend = 0.0202) but not in females. In this study we show that higher ghrelin level was negatively associated with measures of obesity, HbA1C, and blood pressure in females and positively associated with increased insulin resistance in Arab males

Genome-wide association study identifies novel risk variants from RPS6KA1, CADPS, VARS, and DHX58 for fasting plasma glucose in Arab population

Consanguineous populations of the Arabian Peninsula, which has seen an uncontrolled rise in type 2 diabetes incidence, are underrepresented in global studies on diabetes genetics. We performed a genome-wide association study on the quantitative trait of fasting plasma glucose (FPG) in unrelated Arab individuals from Kuwait (discovery-cohort:n = 1,353; replication-cohort:n = 1,196). Genome-wide genotyping in discovery phase was performed for 632,375 markers from Illumina HumanOmniExpress Beadchip; and top-associating markers were replicated using candidate genotyping. Genetic models based on additive and recessive transmission modes were used in statistical tests for associations in discovery phase, replication phase, and meta-analysis that combines data from both the phases. A genome-wide significant association with high FPG was found at rs1002487 (RPS6KA1) (p-discovery = 1.64E-08, p-replication = 3.71E-04, p-combined = 5.72E-11; beta-discovery = 8.315; beta-replication = 3.442; beta-combined = 6.551). Further, three suggestive associations (p-values <8.2E-06) with high FPG were observed at rs487321 (CADPS), rs707927 (VARS and 2Kb upstream of VWA7), and rs12600570 (DHX58); the first two markers reached genome-wide significance in the combined analysis (p-combined = 1.83E-12 and 3.07E-09, respectively). Significant interactions of diabetes traits (serum triglycerides, FPG, and glycated hemoglobin) with homeostatic model assessment of insulin resistance were identified for genotypes heterozygous or homozygous for the risk allele. Literature reports support the involvement of these gene loci in type 2 diabetes etiology.Peer reviewe

Enhanced Adipose Expression of Interferon Regulatory Factor (IRF)-5 Associates with the Signatures of Metabolic Inflammation in Diabetic Obese Patients

Interferon regulatory factors (IRFs) are emerging as the metabolic transcriptional regulators in obesity/type-2 diabetes (T2D). IRF5 is implicated with macrophage polarization toward the inflammatory M1-phenotype, nonetheless, changes in the adipose expression of IRF5 in T2D and relationship of these changes with other markers of adipose inflammation remain unclear. Therefore, we determined the IRF5 gene expression in subcutaneous adipose tissue samples from 46 T2D patients including 35 obese (Body Mass Index/BMI 33.83 &plusmn; 0.42 kg/m2) and 11 lean/overweight individuals (BMI 27.55 &plusmn; 0.46 kg/m2) using real-time qRT-PCR. IRF5 protein expression was assessed using immunohistochemistry and confocal microscopy. Fasting plasma glucose, insulin, HbA1c, C-reactive protein, cholesterol, low- and high-density lipoproteins (LDL/HDL), and triglycerides were measured using commercial kits. IRF5 gene expression was compared with that of signature inflammatory markers and several clinico-metabolic indicators. The data (mean &plusmn; SEM) show the enhanced adipose IRF5 gene (p = 0.03) and protein (p = 0.05) expression in obese compared to lean/overweight diabetic patients. Adipose IRF5 transcripts in diabetic obese individuals associated positively with those of TNF-&alpha;, IL-18, IL-23A, CXCL8, CCL2, CCL7, CCR1/5, CD11c, CD68, CD86, TLR4/7/10, Dectin-1, FGL-2, MyD88, NF-&kappa;B, IRF3, and AML1 (p &lt; 0.05). In diabetic lean/overweight subjects, IRF5 expression associated with BMI, body fat %age, glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR, C-reactive protein (CRP), IL-5, and IL-1RL1 expression; while in all T2D patients, IRF5 expression correlated with that of IRF4, TLR2/8, and CD163. In conclusion, upregulated adipose tissue IRF5 expression in diabetic obese patients concurs with the inflammatory signatures and it may represent a potential marker for metabolic inflammation in obesity/T2D