Association of Cystatin-C with metabolic syndrome in normal glucose-tolerant subjects (CURES-97)

Background: This study looked at the association of cystatin-C (cys-C) with severity of metabolic syndrome in Asian Indians. Methods: Five sets of normal glucose tolerance subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES), a population-based study in southern India: 43 subjects with no metabolic risk factors, 44 subjects with one metabolic risk factor, 37 subjects with two risk factors, 40 subjects with three risk factors, and 40 subjects with four or five metabolic risk factors. Metabolic syndrome was defined using National Cholesterol Education Program criteria for adults modified for waist measured using the World Health Organization Asia Pacific guidelines. Serum cys-C was estimated by a high-sensitivity particle-enhancing nephelometry assay. Results: Subjects with four or five metabolic abnormalities had the highest cys-C levels, and with decreasing number of metabolic abnormalities, the cys-C levels decreased linearly (P for trend <0.001). Regression analysis showed a linear increase in cys-C levels with increasing number of metabolic abnormalities. Conclusion: Cys-C levels are highly correlated with the number of metabolic abnormalities in Asian Indians

Prevalence of depression in relation to glucose intolerance in urban South Indians- The Chennai Urban Rural Epidemiology Study (CURES-76)

Background: This study investigated the association between depression and glucose intolerance in urban residents of southern India. Methods: Subjects were recruited from the Chennai Urban Rural Epidemiology Study, carried out on a representative sample of 26,001 subjects recruited from Chennai city in southern India. Subjects with known diabetes were excluded (n=1,498). Of the remaining 24,503 subjects, fasting capillary blood glucose (FBG) estimation were available for 23,787 subjects (response rate, 97.1%) in whom depression was assessed using a validated instrument, the Patient Health Questionnaire-12. Subjects with FBG values ≥126mg/dL were termed as subjects with newly diagnosed diabetes (NDD), those with values between 100 and 125mg/dL as having impaired fasting glucose (IFG), and those with >100mg/dL as having normal fasting glucose (NFG). Results: The overall prevalence of depression was 14.3% (3391 of 23,787 subjects), and an increasing prevalence of depression was seen with increasing grades of glucose intolerance: NFG (13.1%), IFG (15.7%), and NDD (19.7%) (trend χ2=57.1, P<0.001). The prevalence of depression was higher in females at all grades of glucose intolerance. Risk for depression was higher among NDD subjects compared to NFG subjects (odds ratio=1.12, 95% confidence interval 1.03-1.22, P=0.01) and IFG subjects (odds ratio 1.21, 95% confidence interval 1.02-1.44, P=0.03) and also for IFG compared to NFG subjects (odds ratio=1.12, 95% confidence interval 1.02-1.21, P=0.01) after adjusting for age, gender, body mass index, hypertension, and socioeconomic status. Conclusion: The prevalence of depression increases with increasing grades of glucose intolerance and is highest among those with diabetes

Risk factors for microvascular complications of diabetes among South Indian subjects with type 2 diabetes - The Chennai Urban Rural Epidemiology Study (CURES) Eye study-5

Background: This study assessed the relationship between and risk factors for microvascular complications of diabetes in an urban South Indian type 2 diabetes population. Methods: Subjects with diabetes (n=1,736) were selected from the population-based Chennai Urban Rural Epidemiology Study (CURES) Eye Study conducted on a representative population of Chennai city in south India. Four-field stereo retinal color photography was done, and diabetic retinopathy (DR) was classified according to the Early Treatment DR Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the big toe using biothesiometry was≥20V. Overt nephropathy was diagnosed if the subjects had persistent macroalbuminuria (urinary albumin excretion≥300μg/mg of creatinine) and microalbuminuria if it was between 30 and 299μg/mg of creatinine. Among the 1,715 subjects with gradable fundus photographs, 1,608 individuals who had information on all test parameters were included. Results: Overall, DR was present in 282 (17.5%), neuropathy in 414 (25.7%), overt nephropathy in 82 (5.1%), and microalbuminuria in 426 (26.5%) subjects. Eighteen subjects had all three microvascular complications of diabetes. The risk of nephropathy (odds ratio [OR]=5.3, P<0.0001) and neuropathy (OR=2.9, P<0.0001) was significantly higher among the subjects with sight-threatening DR compared to those without DR. Common risk factors identified for all the three microvascular complications of diabetes were age, glycated hemoglobin, duration of diabetes, and serum triglycerides. DR was associated with nephropathy after adjusting for age, gender, hemoglobin A1c, systolic blood pressure, serum triglycerides, and duration of diabetes (OR=2.140, 95% confidence interval=1.261-3.632, P=0.005). Conclusions: This is the first population-based study from India to report on all microvascular complications of diabetes and reveals that the association between DR and nephropathy is stronger than that with neuropathy