Epidemiology and knowledge of selfcare of diabetes mellitus, obesity and hypertension in Guyana and beneficial use of Momordica charantia, in combination with daily exercise and diet modification, to treat these non-communicable diseases

In 2018, The World Health Organization (WHO) identified chronic non-communicable diseases (NCDs) or chronic diseases (CDs) as cardiovascular diseases (CVDs), diabetes mellitus (DM) obesity, cancer, stroke, chronic respiratory diseases (CRD), cerebrovascular disease (CVD), kidney failure (KF) and dental diseases. CVDs are further classified into heart failure or cardiomyopathy, hypertension, atherosclerosis, coronary artery diseases (CAD), sudden cardiac death (SCD), arrhythmias and others. DM, obesity and hypertension are three major global health NCDs affecting people in both developed and low-and middle- income developing countries such as Guyana. These diseases are interrelated where obesity is a risk factor for DM and both obesity and DM are risk factors for hypertension. The prevalence of all three NCDs are very high, and they are also very costly to treat in Guyana. Diabetes is classified mainly into type 1 DM (T1DM) and type 2 DM (T2DM) and 85-90% of diabetics suffer from T2DM. Obesity is when someone has a basal metabolic index (BMI) of 30 and over. Likewise, hypertension (HTN) or high blood pressure (HBP) is when someone has elevated BP over20/90 mm Hg and over. Modern life- style habits including overeating but not the right food, sedentary living, stress, genetic pre-disposition and others risk factors can lead obesity, diabetes and hypertension. Guyana is cursed with the ‘obese-diabetic-hypertensive time bomb’. This study investigated the epidemiology and cost-effective ways to treat these NCDs in Guyana and how knowledge of obesity and diabetic self-care management can prevent long–term complications associated with obesity and DM. In tackling the scientific problem, this study investigated the roles of regular exercise, diet modification and use of bitter melon or corilla (Momordica charantia), a local anti-diabetic vegetable in Guyana to treat obesity, diabetes and hypertension in newly diagnosed patients. The main epidemiological findings in this study reveal that the three NCDs increased in prevalence gradually over the years especially among both adult males and females but significantly more so among females, especially when they reach the ages between 46 to 69 years. In addition, almost twenty five percent of adult Guyanese failed to diagnose their medical conditions and many of those who are diagnosed prefer to seek advice from a traditional healer and take herbal remedies to treat their diseases rather than taking prescribed drugs. Data also show that such NCDs as diabetes, hypertension and CVDs are responsible for more deaths in Guyana and rank high globally. Initial time-course treatment and glucose tolerance tests (GTTs) reveal that M charantia consumption (5-20 grams twice daily as either a juice (weight/volume) can reduce blood sugar, blood pressure and other blood biomarkers such as total lipids (cholesterol) and triglycerides significantly (p<0.05) in diabetes-treated patients after 6 weeks compared to week 1 of the study (These effects were dose-dependent. The results also show that the hypoglycaemic effects were more pronounced when M charantia was combined with diet modification, exercise and the orthodox medicine, diamicron MR. M charantia had no synergistic effect on blood glucose when it was combined with dimicron MR. Measurement of blood cation levels using inductively -coupled plasma mass spectrometry (ICPMS) in plasma from diabetic and age-matched healthy control subjects reveal no significant change in the levels of the cations. Chemical analysis of M charantia revealed that it is rich in vitamin C, some cations, phenolic contents and antioxidant compounds Similarly, daily intake of M charantia either alone or in combination with physical activity and diet modification can reduce body weight and significantly (p<0.05) decrease blood pressure (BP), total lipids and triglycerides in obese subjects after 6 weeks of treatment compared to the start of the study (In newly diagnosed hypertensive patients, M charantia either alone or combined with regular exercise and diet modification can reduce significantly (p<0.05) high blood pressure after 6 weeks of treatment compared to week 1 at the start of the study. M charantia had no significant effect on BP when it was combined with orthodox medicine, amlodipine, a calcium channel blocker). The results also show that knowledge of the respondents using a questionnaire about T2DM self-care management was overall poor. Thus, the study concluded that the higher the level of knowledge about T2DM self-care, the less likely the diabetic patients will develop diabetes-related complications, as noted by the higher scoring of the control group. Therefore, effective health promotion and education programmes are recommended to target T2DM patients, as well as pre-diabetic and non-diabetic persons (chapter 6). However, obese patients have a good knowledge of obesity, but they were still obese. In conclusion, the results of this study have shown that M charantia, diet modification and daily exercise, either alone or in combination have potential cost-effective effects in treating diabetes, obesity and hypertension and knowledge of self-care management about diabetes can delay end-organ complications

Diabetic Foot Infections and Problems in Guyana

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting more than 465 million people. If diagnosed late or left untreated, DM can induce a number of long-term complications which are due to DM-induced hyperglycaemia leading to nephropathy, cardiomyopathy, neuropathy, retinopathy, impotence, foot ulcers and amputations. Diabetic foot problems (DFB) are major concerns for the patients as they affect their quality of life and exert great financial burden on them, especially for people from a low income developing country as Guyana. In 2019, it was estimated that the expenditure for diagnosis, treatment and care for diabetic foot patients was USAD$75 million in Guyana. Both obesity and diabetes are on the increase in Guyana with almost 11 - 12% of the adult population have DM, due to obesity (diabesity) and more women compared to men. Moreover, there is an unacceptable high rate of amputations due to lack of organised foot-care programme and the absence of national guidelines in its management. There are various aspects of good diabetic foot care and this article now reviews what has been achieved and what needs prioritisation to improve the management of diabetic foot problems in Guyana among patients with diabetes mellitus. ’The Guyana Diabetes and Foot Care Project” has made significant improvement in this area but the lack of specialist vascular surgical service is obvious

Diabetic Cardiomyopathy and the Role of Regular Exercise in Preventing the Disease: A Review

Diabetes mellitus (DM) is a major global metabolic disorder currently affecting over 450 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose level beyond physiological range or hyperglycaemia (HG), which in turn leads to a number of long-term complications, including diabetic cardiomyopathy (DC) over time. Around 80% of all diabetics will eventually die from DC. If left untreated, DC has been shown to be a critical factor in HF, independent of atherosclerosis, hypertension and valvular malfunction. The inability to maintain glucose homeostasis in the myocardium compromises cardiac structure and function in human diabetic subjects and also in animals with experimental diabetes. Daily exercise is known to protect the heart from sudden cardiac death. Exercise training (ET) is a beneficial non-pharmacological intervention for the treatment of cardiovascular diseases (CVDs). ET can induce cardio-protection in normal hearts and also in a partially diseased heart through a range of molecular mechanisms. The cardio-protective effect of ET is associated with the improvement of antioxidant capacity, mitochondrial viability and it can activate physiological cardiac growth, which are all mediated via distinct cellular and molecular mechanisms compared to those in pathological hypertrophy. Beneficial cardiac protection following regular ET in diabetes has been reported in both clinical and experimental animal studies. ET is a cost-effective strategy for prevention and treatment DC. However, the cellular and molecular mechanisms underlying DC and HF in diabetes and how regular exercise can reverse the pathology are not fully clear and further research should be carried out

Mechanisms of Diabetes Mellitus-Induced Sudden Cardiac Death

More than 450 million people worldwide have diabetes mellitus (DM), a metabolic disorder characterized by an increase in blood glucose level (hyperglycemia) that arises from insufficient insulin secretion or resistance to insulin’s action. More than 70% of individuals with chronic DM will develop cardiovascular diseases (CVDs) including atherosclerosis and coronary artery diseases (CADs), hypertension, cardiac arrhythmias, cardiomyopathy (heart failure), stroke, and chronic kidney disease. A significant number of these individuals will also succumb to sudden cardiac death (SCD). SCD usually occurs in early morning from abnormal heart rhythms or arrhythmias and ventricular fibrillation. When the pumping action of the heart becomes erratic, a reduction in oxygenated blood to the brain leads to unconsciousness and brain damage. SCD is independent of age and sex and positively correlates with impairment in cardiac metabolism, muscle damage, fibrosis, apoptosis, hypertrophy, ischemia, and deranged cation signaling. This review centers on mechanisms by which intracellular cations (Na+, K+, and Ca2+) handling, inflammation, and oxidative and carbonyl stresses due to diabetes-induced hyperglycemia can lead to the deterioration of excitation/contraction coupling (ECC), impaired contractility, arrhythmias, and SCD in DM patients. It also discusses the beneficial effects of exercise training to attenuate the risk of SCD

Medicinal and anti-oxidant effects of Bitter Melon (Momordica charantia) in the treatment of diabetic cardiomyopathy

Obesity is a major risk factor for diabetes mellitus (DM), which is a major global metabolic health disorder currently affecting over 460 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose or hyperglycemia (HG) beyond physiological level, which in turn leads to a number of long-term or end-organ complications over time and over 80% of all diabetics will eventually die from either HF or cardiomyopathy if left untreated. Treatment of DM is very costly and as such, patients turn to non-pharmacological or alternative forms of treatment, including weight loss, diet modifications and plant-based medicines, which are more cost-effective. There are several medicinal plants, which are currently used to treat for DM and they are known to exhibit anti-diabetic properties. One such plant is Momordica charantia, or bitter melon, which is used in many tropical countries as a traditional functional food and medicine, especially for the treatment of obesity, DM, hypertension and cancer. This review is related to the anti-oxidant beneficial effect of Momordica charantia in the treatment of diabetic cardiomyopathy (DCM). The beneficial effects of Momordica charantia in the treatment of obesity, diabetes and cardiovascular diseases (CVDs) have been reported in clinical and experimental animal studies and this review addresses some of these useful effects. However, the cellular and molecular mechanisms underlying its therapeutic antidiabetic effects of M charantia via its anti-oxidant activities are not fully known and further research studies need to be done

Bitter Melon in Combination with Diet Modification and Regular Exercise Can Prevent and Treat Obesity and Hypertension Cost-Effectively

hronic diseases (CDs), including hypertension, obesity and diabetes, are responsible for a large number of global deaths annually. This is due to current life style habits, including sedentary life style, smoking, excess alcohol intake, sugar and fast-food consumption, genetic factors, stress and others. This study investigated the effect of daily consumption of bitter gourd/melon (Momordica charantia) combined with life style changes to reduce body weight, systolic and diastolic blood pressure (SDBP), blood glucose and lipid levels in the body. The study recruited 32 obese male (16) and female (16) subjects with an average age of 42 years (±4.5 years) and the majority of them had secondary education. They were divided into four groups (4 men and 4 women per group). Group 1 (diet only) was asked to reduce daily food intake and avoided snaking or binging for 6 weeks. Group 2 (diet and bitter melon) did the same as group 1 but combined with the consumption of 20 g of bitter melon juice (vol/weight) daily for 6 weeks. Group 3 (diet, exercise and bitter melon) did the same as group 1 but combined with daily exercise involving walking, stretching or bicycle riding or a combination for 30 min plus the consumption of 20 g of bitter melon daily for 6 weeks. Group 4 (diet and exercise) did the same as group 1 plus daily exercise involving walking, stretching or bicycle riding or a combination for 30 min Initially, at week 1 the subjects were weighed and their height and SDBP taken. Blood samples were taken for the measurements of fasting blood glucose (FBG), HBA1c, total cholesterol and triglyceride. Their BMI and blood pressure were measured weekly over 6 weeks and another blood sample for each subject was taken at the end of week 6 for analysis as in week one for comparison. The results showed that all four interventions were associated with marked decreases in BMI but with little or no change in HBA1c and FBG compared week 1 with week 6. However, significant (p <0.05) decreases were observed in SDBP, total cholesterol and triglyceride comparing week 1 with week 6. It is concluded that life style changes including dieting, regular exercise and daily intake of bitter melon can help to reduce blood pressure and lipids and the weight of obese subjects leading to a better quality of life

Diabetes-induced chronic heart failure is due to defects in calcium transporting and regulatory contractile proteins: cellular and molecular evidence

Heart failure (HF) is a major deteriorating disease of the myocardium due to weak myocardial muscles. As such, the heart is unable to pump blood efficiently around the body to meet its constant demand. HF is a major global health problem with more than 7 million deaths annually worldwide, with some patients dying suddenly due to sudden cardiac death (SCD). There are several risk factors which are associated with HF and SCD which can negatively affect the heart synergistically. One major risk factor is diabetes mellitus (DM) which can cause an elevation in blood glucose level or hyperglycaemia (HG) which, in turn, has an insulting effect on the myocardium. This review attempted to explain the subcellular, cellular and molecular mechanisms and to a lesser extent, the genetic factors associated with the development of diabetes- induced cardiomyopathy due to the HG which can subsequently lead to chronic heart failure (CHF) and SCD. The study first explained the structure and function of the myocardium and then focussed mainly on the excitation-contraction coupling (ECC) processes highlighting the defects of calcium transporting (SERCA, NCX, RyR and connexin) and contractile regulatory (myosin, actin, titin and troponin) proteins. The study also highlighted new therapies and those under development, as well as preventative strategies to either treat or prevent diabetic cardiomyopathy (DCM). It is postulated that prevention is better than cure

Cellular and Biochemical Mechanisms Driving the Susceptibility of Obese Subjects to Covid-19 Infection

Overweight is a major global health problem currently affecting almost 2 billion people worldwide. An additional 800 million are obese. These figures showed that 40% of the global adult population aged 18 years, and over are overweight while 14% are obese. What is now worrying is that more than 40 million children worldwide, as young as 5 years of age are either overweight or obese. Individuals with a body mass index (BMI) of 25–29 kg/m2 are considered to be overweight while obesity is the term used when the BMI is 30 kg/m2 and over. Obesity is an imbalance between calorie intake and calorie expenditure. In general, obesity can be caused by excessive eating and reduced physical activity. Obesity is a major risk factor for non-communicable diseases such as diabetes mellitus, respiratory and liver dysfunctions, sleep apnea, chronic inflammation, compromised immune system, renal failure, cancer, musculoskeletal disorders, cardiovascular diseases and others. Obesity is also a major risk factor for coronavirus disease 19 (Covid-19), which can induce severe cases of pneumonia and sepsis or acute respiratory distress syndrome. In many cases, Covid-19 causes severe and long-lasting damage to the lungs and other vital organs of the body resulting in death. This review describes the cellular and biochemical mechanism(s) whereby obese patients become susceptible to Covid-19 infection. It also outlines how obesity on its own can affect the lungs, which in turn become more compromised in cases of Covid-19 disease resulting in the imminent death of the patient