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Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters. [ABSTRACT FROM AUTHOR]

Background: There exist several barriers to physical activity (PA) among adolescent girls. We therefore developed a culturally acceptable dance/fitness intervention called THANDAV (Taking High-Intensity Interval Training [HIIT] ANd Dance to Adolescents for Victory over noncommunicable diseases [NCDs]). The main aim of this study was to evaluate the THANDAV protocol among Asian Indian girls aged 10 to 17 years. Materials and Methods: THANDAV consisted of a 10-min routine with high- and low-intensity dance steps that was taught to 23 adolescent girls. Heart rate (HR), energy expenditure, body mass index (BMI), and blood pressure (BP) were recorded. Focused group discussions (FGDs) were conducted after the quantitative measurements were completed. Results: The average age of the girls was 13.9 ± 2.1 years, and the mean BMI and BP were 19.8 ± 3.3 kg/m2 and 107/68 (±8/7) mm/Hg, respectively. All participants achieved 80% of their maximum HR during the first dance and managed to sustain this HR throughout the 10-min routine. There was a significant increase in the HR (bpm) [88.7 ± 8.4 to 195.6 ± 11.8, P < 0.001] and VO2 (L/min) [0.025 ± 0.0 to 0.395 ± 0.1, P < 0.001] postintervention. The average energy cost of the activity (metabolic equivalent) was 6.3. The FGDs revealed that THANDAV was a socially acceptable, fun, and energetic form of PA. Conclusions: The THANDAV intervention meets HIIT norms and is a novel culturally appropriate form of PA that is enjoyable, takes little time, and can be done at home. It has the potential to be a sustainable intervention to improve cardiorespiratory fitness and prevent NCDs in Asian Indian adolescent girls. Clinical Trials Registry of India: CTRI/2020/02/023384. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes in youth is increasing worldwide in parallel with the obesity epidemic. This study aimed to determine the incidence rates of dysglycemia (diabetes or prediabetes) and evaluate the predictors of its progression or regression to normal glucose tolerance (NGT) in a cohort of children and adolescents studied in Chennai, South India. Methods: A longitudinal follow-up of the Obesity Reduction and Awareness of Noncommunicable Diseases through Group Education (ORANGE) cohort was performed after a median of 7.1 years (n = 845; 5928 person-years of follow-up). To determine their diabetes status at follow-up, participants underwent an oral glucose tolerance test (n = 811 with NGT and 34 with prediabetes at baseline), excluding those with diabetes at baseline. Incidence rates for dysglycemia were reported per 1000 person-years of follow-up. Cox proportional hazards model was used to estimate the predictors of progression and regression. Results: Out of 811 individuals with NGT at baseline, 115 developed dysglycemia giving an incidence rate of 20.2 per 1000 person-years (95% confidence interval: 16.8-24.2). Among those with prediabetes at baseline, 70.6% of the individuals converted to NGT and the remaining 29.4% either got converted to diabetes or remained as prediabetes. Higher age, body mass index, fasting plasma glucose, 2-hour plasma glucose (2-h PG), positive family history of diabetes, and systolic blood pressure (BP) were independent predictors of incident dysglycemia, whereas lower age, waist circumference, 2-h PG, systolic BP, and triglycerides predicted regression to normoglycemia. Conclusions: This study highlights the growing burden of dysglycemia in Asian Indian youth and emphasizes the need for targeted preventive actions. [ABSTRACT FROM AUTHOR]

Background: We have recently demonstrated a medium glycemic index for novel high fiber white rice (HFWR) variety compared to regular white rice (RWR). However, substituting HFWR for RWR during the whole day's diet may provide extended benefits. The current study aims to assess the 24 h glycemic responses of a HFWR diet compared to a RWR diet.Methods: Continuous glucose monitoring (CGM) was used to assess the glycemic profile in 18 overweight, non-diabetic Asian Indians aged 25 to 50 in a randomized cross-over design. The volunteers were provided with iso-caloric (≈2100 kcal/day) HFWR or RWR based diets for four continuous days and switched diets after appropriate washout. Fasting blood samples for insulin assessments were collected at baseline and at the end of 4 day feeding. The glucose response in terms of incremental area under the curve (IAUC) was recorded. General linear model was used to assess the adjusted mean change of fasting insulin level of HFWR compared to RWR. Age and sex were adjusted as confounders in the model.Results: The average 24 h glucose response for HFWR was significantly lower (IAUC 66.3 ± 3.1 mg-5 min/dL) than RWR (IAUC 79.8 ± 5.7 mg-5 min/dL). The adjusted mean change in fasting insulin levels from baseline was also lower for HFWR compared to RWR. HFWR elicited a 34% and 30% lower 24 h glycemic and insulin response respectively, compared to RWR.Conclusion: Replacing RWR with HFWR may be a healthier alternative for Asian Indians who are at a higher risk of developing type 2 diabetes. [ABSTRACT FROM AUTHOR]

Several algorithms and guidelines have been proposed by countries and international professional bodies; however, no recent updated management algorithm is available for Asian Indians. Specifically, algorithms developed and validated in developed nations may not be relevant or applicable to patients in India because of several factors: early age of onset of diabetes, occurrence of diabetes in nonobese and sometimes lean people, differences in the relative contributions of insulin resistance and β-cell dysfunction, marked postprandial glycemia, frequent infections including tuberculosis, low access to healthcare and medications in people of low socioeconomic stratum, ethnic dietary practices (e.g., ingestion of high-carbohydrate diets), and inadequate education regarding hypoglycemia. All these factors should be considered to choose appropriate therapeutic option in this population. The proposed algorithm is simple, suggests less expensive drugs, and tries to provide an effective and comprehensive framework for delivery of diabetes therapy in primary care in India. The proposed guidelines agree with international recommendations in favoring individualization of therapeutic targets as well as modalities of treatment in a flexible manner suitable to the Indian population. [ABSTRACT FROM AUTHOR]

Background: This study examined the association in a South Indian population with gestational diabetes mellitus (GDM) of type 2 diabetes risk variants that have previously conferred susceptibility to GDM in other populations. Subjects and Methods: The study groups comprised 518 women with GDM and 910 pregnant women with normal glucose tolerance (NGT). Women with GDM were recruited from a tertiary diabetes center in Chennai, in south India, and NGT women were selected from antenatal clinics also in Chennai. Genomic DNA was isolated from whole blood using the phenol chloroform method. Twelve previously reported GDM-associated single nucleotide polymorphisms (SNPs) in or near nine loci were genotyped using the MassARRAY™ system (Sequenom, San Diego, CA). Results: Among the 12 SNPs genotyped, 11 SNPs were in Hardy-Weinberg equilibrium and had a call rate of >95%. Of the 11 SNPs previously associated with GDM in other populations, significant association was observed only with the rs7754840 and rs7756992 SNPs of the CDK5 regulatory subunit associated protein 1-like 1 ( CDKAL1) gene in this population. The minor alleles of the SNPs rs7754840 and rs7756992 showed significant susceptibility to GDM with an odds ratio of 1.34 (95% confidence interval, 1.12-1.60; P=0.0013) and 1.45 (95% confidence interval, 1.21-1.72; P=0.00004), respectively. Conclusions: The rs7754840 and rs7756992 SNPs of the CDKAL1 gene were found to be associated with GDM in this south Indian population. This is the first study describing genetic susceptibility of GDM in Asian Indians. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the relationship between diabetic retinopathy (DR) and coronary artery diseases (CAD) in Asian Indians, who are known to be at high risk of CAD and diabetes but have lower prevalence of DR. Subjects and Methods: Type 2 diabetes subjects ( n=1,736) were selected from the urban component of the population-based Chennai Urban Rural Epidemiology Study Eye Study. Four-field stereo retinal color photography was done, and DR when present was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Among the 1,723 subjects with gradable fundus photographs, 12-lead electrocardiogram (ECG) was performed in 1,602 individuals, and analysis was restricted to this group. CAD was diagnosed based on documented medical history of CAD or Minnesota coding of ECGs. Results: The prevalence of CAD was significantly higher among subjects with DR compared with those without (11.3% vs. 6.7%; P=0.007). A significant association was observed between DR and CAD in subjects with glycated hemoglobin (HbA1c) levels >7% ( P=0.002). After controlling for age and gender, only hard exudates were associated with CAD ( P=0.032). Logistic regression analysis revealed that even after adjusting for age, gender, HbA1c, mean arterial blood pressure, smoking, serum cholesterol, triglyceride, and low-density lipoprotein cholesterol levels, DR was significantly associated with CAD among the study subjects (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.00-2.49; P=0.049) and those subjects with duration of diabetes >10 years (OR=4.06; 95% CI, 1.55-10.60; P=0.004). Conclusions: This cross-sectional study shows a significant association between DR and CAD in South Indian subjects with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aim: This study looked at the association of adipokines, inflammatory and oxidative stress markers in subjects with the following phenotypes: metabolically healthy, nonobese (MHNO), metabolically healthy, obese (MHO), metabolically obese, nonobese (MONO), and metabolically obese, obese (MOO). Materials and Methods: Subjects with MHNO ( n=462), MHO ( n=192), MONO ( n=315), and MOO ( n=335) were randomly selected from the Chennai Urban Rural Epidemiology Study. Adiponectin, visfatin, resistin, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), oxidized low-density lipoprotein (LDL), and monocyte chemoattractant protein-1 (MCP-1) were measured by enzyme-linked immunosorbent assay. Results: Levels of adiponectin were lowest in the MOO group, followed by the MONO, MHO, and the MHNO groups ( P=0.042), whereas the levels of visfatin ( P=0.042) and resistin ( P=0.043) were highest in the MOO group, followed by the MONO, MHO, and the MHNO groups. Levels of hs-CRP ( P=0.029), TNF-α ( P=0.036), IL-6 ( P=0.042), oxidized LDL (P=0.036), and MCP-1 ( P=0.039) increased from the MHNO to MHO to MONO to MOO phenotypes. Linear regression analysis of the parameters with body mass index (BMI) and metabolic syndrome components showed that adiponectin is negatively associated with abdominal obesity (β=−0.060; P=0.039) and BMI (β=−0.076; P=0.009) and that TNF-α is negatively associated with high-density lipoprotein levels (β=0.114, P=0.049) even after adjusting for age and gender. hs-CRP (β=0.112, P=0.020) and oxidized LDL (β=0.114, P=0.050) showed a positive association with systolic blood pressure even after adjusting for age and gender. Conclusions: The metabolically obese phenotype is characterized by altered adipokine and inflammatory profiles, which could make this phenotype at high risk for type 2 diabetes mellitus and cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Prevalence of diabetes continues to increase in urban areas, and escalation is discernible in semi-urban and rural areas. It is reported to affect Asian Indians a decade earlier compared with other populations, and complications (e.g., nephropathy) occur earlier and are severe and more prevalent than in other races. Because of these adverse features and suboptimal management practices, type 2 diabetes mellitus (T2DM) poses a huge health and economic burden to the country. Simple and culturally sensitive interventions for Asian Indians have been shown to be effective in prevention/amelioration of diabetes and other cardiovascular risk factors in multiple settings, among urban and rural residents, in migrants, and in those who are healthy or obese or have metabolic syndrome or T2DM. Furthermore, short-term intensive lifestyle intervention in children improves anthropometric and metabolic parameters. Finally, intervention with specific nutrient or oil substitution in Indian diets has been reported to produce benefit in multiple metabolic cardiovascular risk factors. There is, however, further need for conducting well-designed and planned intervention trials with robust outcome data at the primary and secondary levels. These trials must be culturally sensitive and should investigate cost-effective strategies. [ABSTRACT FROM AUTHOR]

The author comments on an article by India Diabetes Management Algorithm Proposal Group titled "A Proposed India-Specific Algorithm for Management of Type 2 Diabetes" as one of the keys toward formulating management guidelines that address a critical need in a population where authoritative guidelines are available. While metformin remains the first line of treatment in the management of type 2 diabetes for overweight patients, the authors propose using sulfonylrea as first-time treatment.