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Approximately 4.8 million Asian Indians were documented by the US Census Bureau in 2023. Members of this population follow different religious practices, speak a multitude of languages, and belong to different socioeconomic classes. Asian Indians immigrated to this country in different waves, leading to transgenerational diversity. Immigration, financial, religious, and cultural factors uniquely impact how Asian Indians interact with their healthcare providers. Asian Indians have settled throughout the country, and it is important that clinicians familiarize themselves with the specific health concerns that affect this rapidly growing population. [ABSTRACT FROM AUTHOR]

Introduction: Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). Methodology: This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. Results: Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤.05). Discussion: These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs. [ABSTRACT FROM AUTHOR]

Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions. Interpretation & conclusions: Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus (DM) is a major public health challenge around the world. It is crucial to understand the geographic distribution of the disease in order to pinpoint high-priority locations and focus intervention on the target populations. Hence, this study was carried out to determine the spatial pattern and determinants of type-2 DM in an Indian population using National Family Health Survey-4 (NFHS-4) and Longitudinal Aging Survey in India (LASI). Methods: We have adopted an ecological approach, wherein geospatial analysis was performed using aggregated district-level data from NFHS-4 (613 districts) and LASI survey datasets (632 districts). Moran's I statistic was determined and Local Indicators of Spatial Association (LISA) maps were created to understand the spatial clustering pattern of DM. Spatial regression models were run to determine the spatial factors associated with DM. Results: Prevalence of self-reported DM among males (15–50 years) and females (15–49 years) was 2.1% [95% confidence interval (CI) 2.0–2.3%] and 1.7% (95% CI 1.6–1.8%), respectively. Prevalence of self-reported DM among males and females aged 45 years and above was 12.5% (95% CI 11.5–13.5%) and 10.9% (95% CI 9.8–12%). Positive spatial autocorrelation with significant Moran's I was found for both males and females in both NFHS-4 and LASI data. High-prevalence clustering (hotspots) was maximum among the districts belonging to southern states such as Kerala, Tamil Nadu, Karnataka, and Andhra Pradesh. Northern and central states like Madhya Pradesh, Chhattisgarh, and Haryana mostly had clustering of cold spots (i.e., lower prevalence clustered in the neighboring regions). Conclusion: DM burden in India is spatially clustered. Southern states had the highest level of spatial clustering. Targeted interventions with intersectoral coordination are necessary across the geographically clustered hotspots of DM. [ABSTRACT FROM AUTHOR]

Background: Non-communicable Diseases (NCDs) are increasing rapidly all over the world, on the other hand, curcumin has various medicinal properties against NCDs and it is a major ingredient in the Indian household/recipes. Another important factor for the selection of this study was the outbreak of COVID-19 and people had increased awareness about turmeric/ curcumin use during this pandemic situation. So this study aims to find out the prevalence of non-communicable diseases across various centers and correlate them with the usage of curcumin in these centers. Materials and Methods: A descriptive cross-sectional study was performed at 4 centers in the state of Tamil Nadu, India. A self-structured questionnaire has been given to collect the details like demographic and disease status with turmeric use and their awareness status. Results: A total of 1276 households were included with 4495 family members. Among the population, the prevalence of non-communicable diseases is cardiovascular diseases (7.7%) followed by diabetes (7.6%), arthritis (3.6%), asthma (0.9%), cancer (0.1%), Alzheimer's disease (0.2%), psoriasis (0.5%) and others (1.5%). The average years of turmeric use (42.8 years) among the households and the average amount (1.8 grams) of curcumin in their daily recipes were found along with the average daily curcumin use of 0.54 grams. By applying the Mann-Whitney U test, there was a significant association between diabetes and arthritis with curcumin use was verified. Conclusion: This study highlights that the prevalence of diabetes and arthritis was significantly associated with curcumin use. On the other side, people in India were more aware of curcumin as a medicinal herb and consumed higher amounts, particularly during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Asian Indians (AI) are at high risk for both atherosclerotic diseases (ATH) and diabetes mellitus (DM). We analyze the clustering of these two comorbidities as contributing causes of death in AI versus Non-AI populations in the US. Methods: Using Mortality Multiple Cause-of-Death Files (2012–2019) from the National Center for Health Statistics, we included deaths at age ≥ 45 years among US residents where AI versus Non-AI status could be ascertained (n = 55,461 AI; n = 20,090,038 Non-AI) and identsified ATH (ICD10: I20-I25, I63, I70) and DM (ICD10: E10-E14) as contributing causes of death. We calculated the tetrachoric correlation (Rho) between these contributing causes and the difference in the fraction of deaths involving DM in those with versus without ATH. Results: Among AI decedents, 29.9% of deaths included ATH as a contributing cause, 16.4% included DM as a contributing cause with 8.3% deaths being included in the overlap (Rho = 0.36, SE = 0.007) whereas, among Non-AI, 22.4% of deaths included ATH as a contributing cause, 10.0% included DM as a contributing cause with 4.1% deaths being included in the overlap (Rho = 0.31, SE = 0.001). Thus, DM and ATH as co-occurring causes correlated more strongly in AI versus Non-AI (p < 0.001). Further, this difference in clustering of DM with ATH was highest for younger AI women (age < 60 years) compared to comparable Non-AI women. Conclusions: The more frequent co-occurrence of DM and ATH as causes of death among AI compared to Non-AI suggest that the increased burden of these diseases among AI during life has vicious synergistic consequences in terms of mortality. Public health strategies targeted to AI should focus on prevention and clinical treatment of both conditions jointly, in all adults, and especially in women < 60 years. [ABSTRACT FROM AUTHOR]

Objective: Diabetes increases the risk of premature mortality and considerably impacts on work productivity. We sought to examine the impact of diabetes in India, in terms of excess premature mortality, years of life lost (YLL), productivity-adjusted life years (PALYs) lost, and its associated economic impact.Research Design and Methods: A life table model was constructed to examine the productivity of the Indian working-age population currently aged 20-59 years with diabetes, followed until death or retirement age (60 years). The same cohort was resimulated, hypothetically assuming that they did not have diabetes. The total difference between the two cohorts, in terms of excess deaths, YLL and PALYs lost reflected the impact of diabetes. Data regarding the prevalence of diabetes, mortality, labor force dropouts, and productivity loss attributable to diabetes were derived from published sources.Results: In 2017, an estimated 54.4 million (7.6%) people of working-age in India had diabetes. With simulated follow-up until death or retirement age, diabetes was predicted to cause 8.5 million excess deaths (62.7% of all deaths), 42.7 million YLL (7.4% of total estimated years of life lived), and 89.0 million PALYs lost (23.3% of total estimated PALYs), equating to an estimated Indian rupee 176.6 trillion (U.S. dollars 2.6 trillion; purchasing power parity 9.8 trillion) in lost gross domestic product.Conclusions: Our study demonstrates the impact of diabetes on productivity loss and highlights the importance of health strategies aimed at the prevention of diabetes. [ABSTRACT FROM AUTHOR]

To study the association and possible predictive role of visfatin, resistin, fetuin-A and chemerin with incident type 2 diabetes (T2DM) among Asian Indians with prediabetes. Their association with insulin resistance, β-cell function, glycaemia and anthropometry were also studied. This is a nested case–control study of a large 2-year prospective prevention trial in persons at high risk of developing T2DM. Baseline HbA1c values between 6.0% (42 mmol/mol) and 6.2% (44 mmol/mol) were chosen for this analysis (n = 144). At follow-up, persons with incident T2DM (HbA1c ≥ 6.5%, 48 mmol/mol) were grouped as cases (n = 72) and those reverted to normoglycaemia, (HbA1c < 5.7% (39 mmol/mol) as controls (n = 72). Insulin resistance showed the strongest association with incident T2DM ((Odds Ratio (OR): 23.22 [95%CI 6.36–84.77]; p < 0.0001). Baseline visfatin (OR: 6.56 [95%CI 2.21–19.5]; p < 0.001) and fetuin-A (OR: 1.01 [95%CI (1.01–1.04)]; p < 0.0001) independently contributed to the conversion of prediabetes to T2DM. The contribution was significantly higher when their elevated levels coexisted (OR: 12.63 [95%CI 3.57–44.63]; p < 0.0001). The area under the curve was 0.77 ± SE 0.4 (95%CI 0.69–0.85) and 0.80 ± SE 0.04 (95%CI 0.73–0.88) for visfatin (median 17.7 ng/ml, sensitivity and specificity: 75%, p < 0.0001) and fetuin-A (mean 236.2 µg/ml, sensitivity: 71%, specificity: 75%, p < 0.0001) respectively. Higher baseline visfatin and fetuin-A concentrations are strongly associated with incident T2DM and are predictive of future diabetes. [ABSTRACT FROM AUTHOR]

In recent years, numerous studies have explored the quality of life (QoL) in those with diabetes mellitus. The aim of this scoping review was to explore the current state of knowledge on QoL and its various associated factors among people with diabetes in India. Three databases were searched (PubMed, Scopus, and Medline) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 41 articles were included in the review. The included studies were largely conducted in the Southern states and mainly investigated individuals with type 2 diabetes. The World Health Organization Quality of Life (WHOQOL-BREF) and Short Form Health Survey (SF-36) were the instruments used most often. In general, the studies showed that people with diabetes had poorer QoL than those without diabetes, and women with diabetes reported poorer QoL than men, consistent with findings across the world. However, the studies had significant methodological flaws which limit the validity and generalizability of the findings. Therefore, there is an urgent need to conduct high-quality QoL studies which are representative of all states of India as well as different types of diabetes in India in order to address this gap in the evidence. [ABSTRACT FROM AUTHOR]

Background: Sleep restores physiology and neurochemical components of our body and is essential for physical and mental health. Sleep disorders (SDs) are associated with insulin resistance and metabolic disorders. The association between SDs and diabetes needs to be understood in the Indian population. Purpose: The purpose was to investigate the association between SD and diabetes in the Indian population. Methods: As a part of nationwide Niyantrita Madhumeha Bharata Abhiyaan-2017 (NMB-2017), a cross-sectional study was conducted and data was collected from seven zones of India, after screening through the Indian Diabetes Risk Score (IDRS). The sleep quality was assessed on a scale of 1 to 4 (very good = 1, very bad = 4). The time taken to fall asleep (sleep latency) was assessed on a scale of 0 to 5 ("0" = nil and "5" = >1.5 h). Stress was assessed by the perceived stress scale. Results: Bad sleep quality was positively (odds ratio 1.055, CI [1.001, 1.113], and P <.01) associated with self-reported known diabetes. Increased time taken to fall in sleep (sleep latency) was associated significantly with IDRS high risk (odds ratio 1.085, CI [1.008, 1.168], and P =.01), with an average sleep latency /time takes to fall in sleep (maximum range 5 [>1.5 h], mode 2 [10 to 30 min]) minutes. Moderate stress was significantly associated with bad sleep quality (odds ratio 1.659). Conclusion: A positive association of bad sleep quality and stress with diabetes, and an increased sleep latency in the IDRS high-risk population point to the role of modifiable risk factors. Behavioral modification and stress reduction by using yoga may be beneficial in the better management of diabetes. [ABSTRACT FROM AUTHOR]

Introduction  Diabetes risk-screening tools are validated and implemented across various countries. There is a need for improvement in these risk scores with suitable modifications so as to make them more sensitive, specific, and suitable to the local population. Objectives  The aim of this study was to evaluate and compare the diagnostic accuracy and clinical utility of the Indian diabetes risk score (IDRS), the American diabetic association (ADA) risk score, and the Finnish Diabetes Risk Score in healthy subjects of South Indian origin in predicting the risk of diabetes and to correlate these risk scores with the blood glucose and hemoglobin A1c (HbA1c) levels in the study population. Materials and Methods  A total of 160 subjects attending the master health checkup/outpatient department of a tertiary care hospital were included in the study. Each subject was asked to fill a questionnaire. Details obtained using the questionnaire were assessed as per the three diabetic risk scores. Fasting blood sugar/random blood sugar and HbA1c were estimated. Statistical Analysis Used  Data analysis was done using SPSS 22/23. Pearson correlation was used to compare continuous variables, with p < 0.05 considered statistically significant. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Mitchell's clinical utility indices were calculated for each risk tool. Results  We found the prevalence of diabetes to be 11.9%. ADA risk score was the only risk score that showed a statistically significant difference (p -value = 0.05) between the low- and high-risk subjects. Conclusions  ADA or IDRS risk scores can be used for screening diabetes in the South Indian population. We suggest that inclusion of the history of gestational diabetes and hypertension in the IDRS risk score might improve its sensitivity as a screening tool in our local population. [ABSTRACT FROM AUTHOR]

Background: Sleep restores physiology and neurochemical components of our body and is essential for physical and mental health. Sleep disorders (SDs) are associated with insulin resistance and metabolic disorders. The association between SDs and diabetes needs to be understood in the Indian population. Purpose: The purpose was to investigate the association between SD and diabetes in the Indian population. Methods: As a part of nationwide Niyantrita Madhumeha Bharata Abhiyaan-2017 (NMB-2017), a cross-sectional study was conducted and data was collected from seven zones of India, after screening through the Indian Diabetes Risk Score (IDRS). The sleep quality was assessed on a scale of 1 to 4 (very good = 1, very bad = 4). The time taken to fall asleep (sleep latency) was assessed on a scale of 0 to 5 ("0" = nil and "5" = >1.5 h). Stress was assessed by the perceived stress scale. Results: Bad sleep quality was positively (odds ratio 1.055, CI [1.001, 1.113], and P < .01) associated with self-reported known diabetes. Increased sleep time (sleep latency) was associated significantly with IDRS high risk (odds ratio 1.085, CI [1.008, 1.168], and P = .01), with an average sleep latency (maximum range 5 [>1.5 h], mode 2 [10 to 30 min]) minutes. Moderate stress was significantly associated with bad sleep quality (odds ratio 1.659). Conclusion: A positive association of bad sleep quality and stress with diabetes, and an increased sleep latency in the IDRS high-risk population point to the role of modifiable risk factors. Behavioral modification and stress reduction by using yoga may be beneficial in the better management of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: We present a new diabetes risk score developed and validated in a multi-ethnic population in Guyana, South America. Measurement of in-country diabetes prevalence is a vital epidemiologic tool to combat the pandemic. It is believed that for every person diagnosed with type 2 diabetes there is another undiagnosed. The International Diabetes Federation (IDF) recommends a two-step detection programme using a risk score questionnaire to identify high-risk individuals followed by glycaemic measure. Methods: Data on 798 persons from the 2016 STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS) were used to correlate responses to 36 questions with glycated haemoglobin (HbA1C) and fasting plasma glucose (FPG) results. Bootstrapping was used to internally validate the derived seven-variable model. This model with the addition of family history questions was tested in a convenience sample of 659 Guyanese adults and externally validated in a cohort of another 528. Results: An 8-item Guyana Diabetes Risk Score (GDRS) was derived. The final model performed with an area under the curve (AUC) of 0.812 Conclusions: The validated eight-item Guyana Diabetes Risk Score will be extremely useful in identifying individuals at high risk of having diabetes in Caribbean, Black or East Indian populations. [ABSTRACT FROM AUTHOR]

Objective: Identify health perspectives among Asian Indians in greater Houston area, to guide a tailored community wide survey. Design: Four focus groups of different ages, gender, and nativity were conducted at which participants were asked for their opinions about specific health topics. Key informant interviews were conducted with ten community leaders to validate focus group responses. Recordings from focus groups and key informant interviews were transcribed and analyzed. Results: Diabetes, cancer, and hypertension were primary health concerns. Common themes were sedentary lifestyle and poor health literacy. Older participants were more accepting of having familial hypertension and high cholesterol. Women were more concerned about health of family members and dietary habits. Perspectives differed on eating habits, physical activity, use of Western medicine, and smoking based on nativity. Responses from key informant interviews validated focus group findings. Conclusion: Perspectives on health may differ among Asian Indians depending on gender, age, and nativity. [ABSTRACT FROM AUTHOR]

Aims: We had shown that mobile phone based text messaging was an effective tool to deliver lifestyle changes among Asian Indian men with a 36% relative risk reduction in incident diabetes over two years. The present analysis investigated whether beneficial effects of intervention on diabetes prevention persisted for an additional three years after withdrawal of active intervention.Methods: The primary two year randomized controlled trial (2010-2012) compared lifestyle changes with use of automated text messaging reminders in the intervention (n = 271) versus standard care advice (n = 266) at baseline. At the end of the study, both groups received additional advice on lifestyle changes by a trained dietician. Participants free of diabetes (n = 394) were invited three years later to ascertain the sustained effect of intervention. The primary outcome was incidence of type 2 diabetes. This trial is registered with ClinicalTrials.gov,number NCT02848547.Results: During the mean follow-up of 5 years, 346 out of 394 (87.8%) men were reviewed. Incidence of diabetes was reduced by 30% in the intervention group, with declining gap between-group differences over time (Kaplan-Meier analysis). Significant improvement in dietary adherence occurred in the intervention group at 2nd and 5th year follow up (trend χ2 = 21.35, p < 0.0001). Cox regression analysis showed that the 5th year incidence of diabetes was significantly reduced in the intervention group. Higher body mass index and 2 h plasma glucose at 24 months increased the incidence of diabetes.Conclusions: Sustained reduction in incident diabetes was apparent after cessation of active lifestyle intervention. This was possibly associated with continuing practice of improved lifestyle. [ABSTRACT FROM AUTHOR]

India has the dubious distinction of being a hotspot for both diabetes and hypertension. Increased salt and sugar consumption is believed to fuel these two epidemics. This review is an in-depth analysis of current medical literature on salt and sugar being the two white troublemakers of modern society. The PubMed, Medline, and Embase search for articles published in January 2018, using the terms "salt" [MeSH Terms] OR "sodium chloride" [All Fields] OR "sugar" [All Fields]. India is world's highest consumer of sugar with one of the highest salt consumption per day. Increased salt intake is associated with increased risk of hypertension, left ventricular hypertrophy and fibrosis, cardiovascular events, renal stones, proteinuria, and renal failure. Increased sugar intake is directly linked to increased risk of obesity, fatty liver disease, and metabolic syndrome. Also, increased sugar intake may be indirectly related to the increased risk of type 2 diabetes. Both salt and sugar intake is directly linked to increased systemic and hypothalamic inflammation, endothelial dysfunction, microangiopathy, cardiovascular remodelling, cancers, and death. High fructose corn is especially damaging. There is no safe limit of sugar consumption, as the human body can produce its own glucose. Being nature's gift to mankind, there is no harm in moderate consumption of salt and sugar, however, modest reduction in the consumption of both can substantially reduce the burden of non-communicable diseases. Public health interventions to facilitate this behavioural change must be instituted and encouraged. [ABSTRACT FROM AUTHOR]

Background We investigated the effect of iron deficiency anemia (IDA) on levels of glycated hemoglobin (HbA1c) and to compare its levels before and after iron supplementations. Methods Age and sex matched subjects were enrolled and clustered in 2 groups: IDA ( n = 62) and healthy controls (HC; n = 60). HbA1c levels were estimated by HPLC. Hemogram were estimated by hematology analyser. Serum ferritin (ELISA) and other parameters of iron profile were measured by standard guidelines of ICSH. HbA1c values and iron studies were repeated after 3 months of iron supplementation to determine the effect of iron therapy on HbA1c levels. Results Significantly higher HbA1c levels were observed in IDA subjects compared to HC (5.51 ± 0.696 v/s 4.85 ± 0.461%, p < 0.001). A significant negative correlation was observed between HbA1c and hemoglobin, hematocrit, RBC count, MCH, MCHC and serum ferritin in IDA subjects ( r = − 0.632, − 0.652, − 0.384, − 0.236, − 0.192 and − 0.441). Significant decline was noticed in HbA1c levels in IDA subjects after iron supplementation (5.51 ± 0.696 before treatment v/s 5.044 ± 0.603 post-treatment; p < 0.001). Post treatment, 70% subjects (14/20) with HbA1c in pre-diabetes range normalised to normal glucose tolerance (NGT) range and out of 6 patients with pre-treatment HbA1c in diabetes range, 5 reverted to pre-diabetes range while 1 of them reverted to the NGT range. Conclusions Caution must be exercised in interpreting the results of HbA1c in patients of IDA and iron deficiency must be corrected before diagnosing diabetes and pre-diabetes solely on the basis of HbA1c criteria. [ABSTRACT FROM AUTHOR]

Purpose/aim of the study: Though attenuated baroreflex sensitivity (BRS) is known to promote cardiovascular disease (CVD) risk in diabetics, its status in prediabetes has not been reported. Also, the link of BRS to CVD risk in normotensive diabetics has not been reported. This study aimed to evaluate the association of BRS to CVD risk in normotensive prediabetics and diabetics.Materials and methods: Participants (n= 154) of 18–45 years were divided into normoglycemics (n= 52), prediabetics (n= 64) and diabetics (n= 38) based on American Diabetes Association criteria. Body mass index, waist–hip ratio, waist–height ratio, body fat mass index, basal heart rate, systolic blood pressure, diastolic blood pressure, rate pressure product, BRS, heart rate variability (HRV), fasting plasma glucose, fasting insulin, lipid profile and atherogenic index of plasma (AIP) were measured. Indian Diabetes Risk Score (IDRS) and homeostatic model assessment of insulin resistance were calculated.Results: There was significant increase in all the parameters except BRS, HRV and high-density lipoprotein in prediabetics and diabetics compared to normoglycemics. All these parameters were significantly altered in prediabetics compared to diabetics. Significant negative correlation was found between BRS and other parameters in prediabetics and diabetics.Conclusions: BRS was attenuated in normotensive prediabetics and diabetics with high IDRS, insulin resistance, AIP, dyslipidemia and reduced HRV that predisposes them to CVD risk. The study demonstrates CVD risk quite early in the prediabetics with reduced HRV, high body fat, hyperinsulinemia, insulin resistance, AIP and rate pressure product. [ABSTRACT FROM PUBLISHER]

Angiotensin-converting enzyme (ACE) is the key enzyme of the renin angiotensin system (RAS) which maintains the blood pressure homeostasis in our body. The association of the ACE insertion/deletion (I/D) polymorphism with essential hypertension has been demonstrated by many studies. The purpose of the present study is to investigate the association of the insertion/deletion polymorphism of the ACE gene with hypertension and additive diseases in North Indian population. In total, 222 hypertensive and 218 normotensive adults participated in this hospital-based study. Anthropometric measures, lipids profiles, blood glucose, and blood pressure (BP) measures were collected from participants. ACE I/D polymorphism was determined by using insertion-specific amplification. The mean ages of study groups were 50.35 ± 12.40 and 47.32 ± 11.94 for cases and controls, respectively. Significant differences were observed in the frequencies of DD, ID, and II genotypes among the hypertensive and normotensive groups which were found to be 29.7%, 38.7%, and 31.5% vs. 53.7%, 23.4%, and 22.9%, respectively. It has been observed that the ACE ID genotype was significantly (p< 0.05) higher in hypertensive subjects, whereas, the DD genotype was significantly (p< 0.05) higher in control subjects. A strong association was found between cardiovascular diseases (CVDs) and ID genotype [p= 0.017, odds ratio (OR) = 3.091, 95% confidence interval (CI) = 1.224–7.807]. ID [p= 0.002, OR = 2.020, 95% CI = 1.281–3.185] and II [p= 0.032, OR = 1.677, 95% CI = 1.044–2.694] genotypes are more prone to diabetes with hypertension. This finding suggests that ACE insertion/deletion polymorphism is associated with hypertension and additive diseases in North Indians. [ABSTRACT FROM AUTHOR]

The article discusses the study on the glycemic and insulinemic responses of healthy East Indians after consumption of maltitol. It offers information on maltitol which is a bulk sweetener that exhibit a low glycemic response. The results reportedly revealed that maltitol glycemic response in healthy people is low.

OBJECTIVE There are few data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. This article presents the incidence of diabetes and prediabetes and the predictors of progression in a population-based Asian Indian cohort. RESEARCH DESIGN AND METHODS Data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort (phase 3) with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years), are presented. During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model. RESULTS The incidence rates of diabetes, prediabetes, and "any dysglycemia" were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity. CONCLUSIONS Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population. [ABSTRACT FROM AUTHOR]

Aims This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population. Methods Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed using a questionnaire, while a Likert type scale was used to assess perceived benefits of and barriers to exercise. Quality of life was measured using the EQ-5D. Results Out of 1281 participants (63.7% males), 24.1% reported doing ≥150 min of exercise/week (“exercisers”) compared to 75.9% “non-exercisers”. Exercisers were significantly older (47 vs. 43 years), better educated (68.8% vs. 60%), had a higher monthly income (41% vs. 29.2%), consumed more fruits (38.2% vs. 25.6%) and vegetables (84.1% vs. 77.7%) and had better perceived state of health (81.1% vs. 76.8%), compared to non-exercisers. Exercisers had significantly lower HOMA-IR, higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers. However, there were no significant differences in cardio-metabolic risk factors like diabetes, hypertension and obesity between the two groups. Walking was the most common type of exercise. Both exercisers and non-exercisers perceived the benefits of exercising, but barriers weighed more heavily on exercise behaviour. Conclusions Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health. [ABSTRACT FROM AUTHOR]

Background Indians may be particularly vulnerable to cardiometabolic disease, potentially due to higher body fat for a given BMI, or a tendency towards depositing abdominal adiposity. The aim of the study is to assess whether different measures of the distribution of adiposity (abdominal versus whole body) or amount of adiposity (DXA versus traditional anthropometric) are better at predicting prevalent cardiometabolic risk markers in an Indian population. Methods Participants were recruited from the Indian Migration Study (IMS) and the Andhra Pradesh Children and Parent Study (APCAPS). Participants attended a clinic in Hyderabad, India, January 2009-December 2010. Adiposity was measured by conventional anthropometry (including weight, height, waist) and DXA scanning (whole body and abdominal). Blood samples were taken and assessed for fasting plasma glucose, insulin, cholesterol, and triglycerides and blood pressure was measured. Lifestyle data were collected by questionnaire. Results We invited 4 617 participants to the clinic (1 995 IMS; 2 622 APCAPS) and examined 918 from IMS (46%) and 1 451 from APCAPS (55%). There were strong and consistent relationships between adiposity and cardiometabolic risk factors. Cardiometabolic risk factors did not appear to be more strongly associated with DXA measures as opposed to BMI, or skinfold measures of body fat. There was some evidence that WHR was more closely related to diabetes than total body adiposity, but this was not apparent for the other measures of abdominal adiposity (DXA measures, waist circumference) or other cardiometablic risk factors. Conclusions No strong evidence supports that DXA measures or abdominal measures of adiposity are better at predicting the prevalence of cardiometabolic risk factors in comparison to BMI. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence, incidence, etiology and factors related to progression of peripheral arterial disease [PAD] in Asian Indian type 2 diabetic patients. Methods: Patients with type 2 diabetes (T2DM), with multiple Doppler studies done between 2001 and 2011 at a tertiary diabetes center in south India, were included. Baseline clinical and biochemical characteristics and ankle brachial index [ABI] measurements were abstracted from the electronic medical records. Results: 2512 T2DM patients were followed for an average of 7 years. 7.6% of the study population had PAD in 2001 [women, 11.8%; men, 5.1%] with an adjusted odds ratio (OR) of 3.09 [confidence interval (CI): 1.9-4.9] for women. Prevalent PAD was associated with increased mortality [hazards ratio (HR) 3.3, CI: 1.4-7.7]. 280 new patients of PAD were identified -- crude incidence, 17/1000 patient years with higher rates in females [HR 1.94, CI: 1.4-2.7]. Age and duration of diabetes were the other predictors of incident PAD. Progression of PAD was seen in 16.5% of patients, with age (p = 0.002) and HbA1c (p = 0.022) being the predictors. Conclusions: Women had a higher prevalence of PAD. Older age, female gender and duration of diabetes were related to an increased incidence of PAD. An elevated HbA1c being associated with progression of PAD stresses the need for strict control of diabetes. [ABSTRACT FROM AUTHOR]

• Telomere length changes in metabolic and vascular disorders. • Peripheral blood lymphocytic telomere shortening in diabetic mellitus and idiopathic dilated cardiomyopathy (IDCM). • No correlation between echocardiography parameters & telomere length in IDCM. • Neuropathic complication does not influence telomere shortening phenotype. Telomere shortening has been associated with ageing and with many age-related diseases including cancer, coronary artery disease, heart failure and diabetes. We sought to investigate the link between telomere shortening and age-related diseases like type 2 diabetes mellitus (DM) (without any complications: DM; with neuropathic complication: DN) and idiopathic dilated cardiomyopathy (IDCM) in south Indian population. We compared telomere lengths of blood lymphocytes taken from patients with associated age-related diseases, namely DM (n = 47), DN (n = 52) and IDCM (n = 34) and controls (n = 46). In addition, we evaluated the relationship between echocardiographic left ventricular ejection fraction (LVEF), left ventricular end diastolic and systolic diameters (LVEDd and LVESd) and telomere length in IDCM patients. Telomere length negatively correlated with age in the cohorts with diabetes and IDCM, and in controls. Average telomere length in diabetes and IDCM patients was significantly shorter than that of controls either before or after adjustments for age and sex. Duration of diabetes in patients with type 2 diabetes did not correlate with telomere length. No correlation was found between the length of telomeres and echocardiography parameters like LVEF, LVEDd and LVESd in IDCM patients. Though echocardiographic characteristics of IDCM did not correlate with telomere length, telomere shortening was found to be accelerated in diabetes (both DM and DN) and IDCM in a south Indian population. Neuropathic complication in diabetes had no effect on telomere shortening. While telomere shortening is a cause or a consequence of diabetic and cardiac pathology remains further investigation, the current study substantiates the usefulness of telomere length measurements as a marker in conjunction with other biochemical markers of age-related diseases. [ABSTRACT FROM AUTHOR]

Background & objectives: Studies conducted to assess the prevalence of cardiovascular (CV) risk factors among different regions of the country show variation in risk factors in different age groups and urban and rural population. We undertook this study to determine the prevalence of cardiovascular risk factors among urban adults in a north Indian city. Methods: In a cross-sectional survey, 2227 subjects aged = 20 yr were studied from April 2008 to June 2009 in Urban Chandigarh, a north Indian city. Demographic history, anthropometry and blood pressure were assessed. Fasting, and 2 h capillary plasma glucose after 75 g glucose load, HDL-C and triglycerides were estimated. Results: The most prevalent cardiovascular risk factors in the age group of 20-29 yr was sedentary lifestyle (63%), while from fourth decade and onwards, it was overweight/obesity (59-85%). The second most common prevalent cardiovascular risk factor in the age group of 20-29 yr was overweight/obesity, in 30-49 yr sedentary lifestyle, in 50-69 yr hypertension and in subjects =70 yr, it was hypertriglyceridaemia. The prevalence of overweight/obesity, hypertension, dysglycaemia and smoking was almost double in subjects in the fourth decade of life, as compared to those in the third decade of life. The prevalence of CV risk factors significantly increased with age irrespective of gender and prevalence of low HDL-C was significantly more common in women as compared to men. Interpretation & conclusions: Sedentary lifestyle, obesity and low HDL-C are the most prevalent CV risk factors in subjects in the third and fourth decade of life in this north Indian population and clustering of these cardiovascular risk factors increases with advancing age. Strategies need to be formulated to target this population to prevent the epidemic of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the number one cause of death globally and are the leading cause of death in India also. Several surveys conducted across the country over the past few decades have shown a rising prevalence of major risk factors for CVD in Asian Indian population. The problem of increasing risk factors for CVD in India is because of lack of surveillance system and lack of proper diagnosis. This study will help to point out the need of research so that some advanced diagnosis system may be developed for proper diagnosis of CVDs and to reduce the growing burden of CVDs in the country. Methods: We did a literature search for the period from 1968 to 2012 using PUBMED search to identify all relevant studies of cardiovascular diseases. Besides PUBMED searching, manual searching has also been done. This article provides a review of current understanding of the epidemiology of cardiovascular disease, particularly, coronary heart disease (CHD), stroke and related risk factors in Asian Indian population. Results: Hypertension and diabetes are highly prevalent among Asian Indian population, which may explain their high rate of stroke and heart attack in India. The increasing rate of CVD may be explained by the high rates of other risk factors including adverse lipid profile. The etiology of cardiovascular diseases (CVD) is multifactorial and no single factor is an absolute cause. Conclusion: The cardiovascular diseases and its risk factors are increasing with a rapid pace in Asian Indian population. Though the prevalence of CVD risk factors is found higher in urban population, yet it is increasing at an alarming rate in rural population also, which is a serious threatening to the nation. Since majority of the Indians live in rural area, CVD may lead to epidemic proportions. We need health promotion programs and reorientation of primary health care to improve CVD detection in earlier stage and its management. [ABSTRACT FROM AUTHOR]

Background: Almost 15% of India's urban adult populace now lives with type 2 diabetes. This study aimed to characterize the eating patterns, knowledge, beliefs, and determinants of food choice, and assess associations with the metabolic health among urban Asian Indians with type 2 diabetes. Materials and Methods: A cross-sectional study of 258 individuals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m2 ; diabetes duration 10.1 ± 6.5 years) attending two out-patient clinics in New Delhi, India. Food-related information was collected during a semi-structured interview. Clinical, anthropometric, and biochemical data were recorded. Results: Beliefs related to health and diabetes played a role determining food choice and dietary patterns; erroneous views were associated with the poor food choices and greater metabolic perturbations. Average consumption of fruits/vegetables was low. Intakes were positively associated with intentions to manage diabetes; inversely associated with the waist circumference and negatively correlated with one's degree of personal responsibility for food choice. Household saturated fat usage was common. High fat intakes were positively associated with the taste preference, ratings of perceived "health-value;" waist circumference, glycosylated haemoglobin percentage (HbA1c%) and lipids. Conclusions: Strategies to enhance diabetes control among Asian Indians are required and should encourage fruit/vegetable intake, personal accountability, and consider individual beliefs and preferences. Greater emphasis and resources directed to regular dietary and behavioral counseling may assist.' [ABSTRACT FROM AUTHOR]

Several reviews and meta-analyses have demonstrated the incontrovertible benefits of statin therapy in patients with cardiovascular disease (CVD). But the role for statins in primary prevention remained unclear. The updated 2013 Cochrane review has put to rest all lingering doubts about the overwhelming benefits of long-term statin therapy in primary prevention by conclusively demonstrating highly significant reductions in all-cause mortality, major adverse cardiovascular events (MACE) and the need for coronary artery revascularization procedures (CARPs). More importantly, these benefits of statin therapy are similar at all levels of CVD risk, including subjects at low (<1% per year) risk of a MACE. In addition to preventing myocardial infarction (MI), stroke, and death, primary prevention with statins is also highly effective in delaying and avoiding expensive CARPs such as angioplasties, stents, and bypass surgeries. There is no evidence of any serious harm or threat to life caused by statin therapy, though several adverse effects that affect the quality of life, especially diabetes mellitus (DM) have been reported. Asian Indians have the highest risk of premature coronary artery disease (CAD) and diabetes. When compared with Whites, Asian Indians have double the risk of CAD and triple the risk of DM, when adjusted for traditional risk factors for these diseases. Available evidence supports the use of statin therapy for primary prevention in Asian Indians at a younger age and with lower targets for low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein (non-HDL-C), than those currently recommended for Americans and Europeans. Early and aggressive statin therapy offers the greatest potential for reducing the continuing epidemic of CAD among Indians. [ABSTRACT FROM AUTHOR]

Asian Indians are at increased risk of developing cardiometabolic diseases. We sought to determine differences between Asian Indians and other races/ethnicities in hypertension and diabetes prevalence and associated annual blood pressure (BP) and fasting blood glucose (FBG) testing. A total of 257,652 adults ≥18 years from the 2011–2018 U.S. National Health Interview Surveys (NHIS) were included. BP and FBG testing in the past 12 months was defined dichotomously (yes/not yes). Racial/ethnic groups included non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian, Other Asians, and Hispanic/Multiracial. We used logistic regression, adjusting for covariates and the survey design. Analyses were completed from 08/2020–06/2021. Asian Indians (N = 3049) had 21% and 99% higher odds of hypertension and diabetes, respectively, than NHWs (aOR [95% CI]; hypertension: 1.21[1.04,1.40], diabetes: 1.99[1.64,2.41]). Accordingly, Asian Indians without diabetes had significantly higher odds of FBG screening than NHWs (Asian Indian: 1.41[1.25,1.59], NHB: 0.99 [0.95,1.04], Other Asian: 1.07[0.98, 1.18], Hispanic: 1.13[1.07,1.20]). Asian Indians without hypertension had a 14% insignificant increase in BP testing compared to NHWs (1.14[0.97,1.33]). Predictors of testing in Asian Indians included older age, doctor's visit, graduate-level education, insurance coverage, and history of hypertension or diabetes. NHBs with diabetes and Hispanics with hypertension had lower odds of FBG testing (0.75[0.66,0.84]) and BP testing (0.85[0.79,0.92]), respectively, than NHWs. Asian Indians have higher odds of diabetes and hypertension than NHWs and higher, but relatively lower, odds of FBG and BP testing. Increasing routine BP and FBG testing in Asian Indians in younger adults may allow for earlier detection of high-risk individuals. • Asian Indians had a higher prevalence of diabetes and hypertension than non-Hispanic White participants. • Asian Indians had higher, but relatively lower, annual blood glucose and BP testing compared to non-Hispanic Whites. • Diabetic Blacks and Hypertensive Hispanics had lower odds of glucose testing and BP testing, respectively, than Whites. • Predictors of annual testing in Asian Indians included older age, doctor's visit, higher education, and insurance coverage. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to assess the efficacy and safety of pioglitazone in combination with other oral antidiabetics (OADs) in Indian patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This was an openlabel, prospective, no-randomized, single-center observational study conducted at a single center in India. A total of 958 adult patients with T2DM on OADs, with uncontrolled fasting (FBG) or postprandial blood glucose (PPG), were enrolled. Pioglitazone (7.5/15/30 mg) was added to existing therapy as a combination treatment with other OAD. Body weight (BW), body mass index (BMI), FBG and postprandial plasma glucose (PPPG) and glycosylated hemoglobin (HbA1c) were measured at the beginning (week 0) and at every follow-up treatment visit, i.e., 6 months (week 24), 1 year (week 48) and 2 years (week 96). Changes from baseline to each visit were analyzed using the Wilcoxon test. All patients also went through a urinalysis at baseline, and after 6 months, 1 year and 2 years of treatment, to assess for any abnormalities in the urine (pH, pus or protein), suggestive of bladder abnormalities. Results: The combined analysis was carried out on 958 completed patients in this study who were treated with pioglitazone 7.5 mg, 15 mg and 30 mg tablet and other OADs. The difference in mean value of FBG showed a highly significant decrease (P<0.0001) from baseline to end of treatment, i.e., from 167.0, (59.16) 172.6 (58.51) and 171.0 (39.47) to 140.2, (26.46) 143.8 (22.04) and 138.5 (27.82) mg/dL. Similarly, PPG showed a significant (P<0.0001, 0.002 and 0.008) decrease from baseline to end of the treatment, i.e., from 256.0, (61.79) 222.9 (67.88) and 223.6 (69.11) to 195.9, (46.92) 204.0 (48.03) and 187.6 (53.36) mg/dL, and there was a highly significant (P<0.0001) decrease in HbA1c levels, i.e., from 8.46, 8.34 and 8.42% to 7.781, 7.78 and 7.73%, respectively. However, gain in mean BW was also observed from baseline to end of the treatment, i.e., from 69.90, (9.44) 68.29 (8.62) and 67.64 (7.75) kg to 71.69, (8.35) 70.08 (7.96) and 69.70 (7.99) kg, respectively, and BMI increased from 26.74 (14.18-53.04) kg/m² at baseline to 27.45 (12.87-53.73) kg/m² at the end of the treatment, respectively (P<0.0001). No significant changes were found in urine in patients even after 2 years of treatment with pioglitazone. There was little variation in pH or presence of pus and proteins in the urine, indicating no increased risk of bladder-related abnormalities across all treated age groups even after 2 years of treatment with pioglitazone. Conclusion: Pioglitazone in combination with other OADs in Indian patients was an effective treatment protocol in glycemic control, reduction in FBG, PPPG and HbA1c and also helps in controlling weight gain in patients with T2DM. In this patient population, there was no increased risk of bladder-related abnormalities. Pioglitazone was therefore found to be a safe and efficacious addition to treatment in patients with poorly controlled diabetes. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of overweight and obesity and their effects on cardiometabolic risk factors in a representative sample of urban population in Eastern India. Materials and methods: A population-based survey was conducted among a randomly selected study population aged 20-80 years in an urban population of Berhampur city of Eastern India. Both anthropometric and biochemical information were collected, in addition to detailed information on classical cardiometabolic risk factors. Both descriptive and inferential statistical analyses were performed. Obesity and overweight were defined based on the revised Asian-Pacific population criteria (Body mass index [BMI] ≥25 kg/m[sup 2] and ≥23 kg/m[sup 2], respectively). Results: The age-standardized rates of obesity and overweight are 36.8% (Males: 33.2%; Females: 40.8%) and 17.6%, (Males: 20.4%; Females: 15.1%) respectively, i.e., over half are either obese or overweight in this study population. Compared to the World Health Organization (WHO) standard cutoff criteria of overweight [BMI ≥25 kg/m[sup 2]] and obesity [BMI >30 kg/m[sup 2]], the cardiometabolic risk factors studied showed a significant incremental rise even with the lower cutoffs of the revised Asia-Pacific criteria. Older age, female gender, family history of diabetes, being hypertensive, hypertriglyceridemia, hypercholesterolemia, physical inactivity and middle to higher socioeconomic status significantly contributed to increased obesity risk among this urban population. Conclusion: One-third of the urban populations are obese in Eastern India - an underestimate compared to the standard BMI cutoff criteria. Nevertheless, significant associations of the classical cardiometabolic risk factors with obesity were observed using the revised Asia-Pacific criteria clearly indicating a more aggressive cardiovascular prevention strategy for Asian Indians. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of metabolic syndrome and to identify predictors for the same, specific to an underdeveloped urban locale of Eastern India. Materials and Methods: Study design: Population-based cross-sectional study, with multistage random sampling technique. Setting: Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. Participants: 1178 adults of age 20-80 years randomly selected from 37 electoral wards of the urban city. Definition of Metabolic Syndrome: We followed a unified definition of the metabolic syndrome by joint interim statement of five major scientific organizations - the International Diabetes Federation, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association of the Study of Obesity. Individuals who meet at least three of five clinical criteria of abdominal obesity, hypertriglyceredimia, low HDL, hypertension, and hyperglycemia are diagnosed as having the condition; presence of none of these criteria is mandatory. Explicit cut points are defined for all criteria, except elevated waist circumference, which must rely on population and country-specific definitions. Main Outcome Measure: Prevalence and significant predictors of metabolic syndrome. Statistical Analysis: Both descriptive and multivariable logistic regression analyses. Results: Age-standardized prevalence rates of metabolic syndrome were 33.5% overall, 24.9 % in males and 42.3% in females. Older age, female gender, general obesity, inadequate fruit intake, hypercholesterolemia, and middle-to-high socioeconomic status significantly contributed to increased risk of metabolic syndrome. Conclusion: Metabolic syndrome is a significant public health problem even in one of the poorest states of India that needs to be tackled with proven strategies. [ABSTRACT FROM AUTHOR]

A close relationship exists between iron metabolism, diabetes and oxidative stress. Both diabetes and redox active iron are individually known to enhance oxidative stress. However, the role of iron deficiency and oxidative stress in diabetes is not clear; hence, the levels of oxidative stress in type 2 diabetes with and without iron deficiency have been compared. Two groups of 30 patients each with diabetes were selected (one group with iron deficiency and the other group with normal iron levels) and compared with 30 normal healthy controls. The anthropometric parameters, fasting blood sugar, iron profile and oxidative stress parameters (malondialdehyde levels (index of lipid peroxidation) and serum uric acid levels (antioxidant)) were measured. While the diabetes group had significantly increased serum levels of ferritin (an acute phase reactant and antioxidant) in comparison with normal controls (P=0.040), the diabetic group with iron deficiency had decreased serum levels of iron (P =0.000), ferritin (P = 0.000) and uric acid (P =0.006) and increased levels of malondialdehyde (P = 0.000) in comparison with diabetics without iron deficiency. This study shows an increase in oxidative stress in the diabetic group with iron deficiency together with reduction in antioxidant levels could further promote prooxidant levels and inflammation and in turn result in the development of complications in this high-risk Asian Indian population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: People of Indian Asian descent have an increased risk of cardiovascular disease (CVD) that cannot be explained by diabetes and other established CVD risk factors. We investigated if microcirculatory function was impaired in a population-based sample of people of Indian Asian descent compared with Europeans in the UK and whether any differences could be accounted for by diabetes or other CVD risk factors. Research design and methods: Cutaneous microvascular function was assessed using laser Doppler fluximetry in response to heating to 42°C (maximum hyperaemia) and 3min arterial occlusion (post occlusive reactive hyperaemia: PORH) in 148 Indian Asians and 147 Europeans. Blood pressure, anthropometry and fasting bloods were also measured. Results: Maximum hyperaemia and minimum resistance did not differ significantly by ethnicity. Resting flux and PORH were lower in Indian Asians and time to peak of PORH was prolonged. Diabetes was associated with reduced maximum hyperaemia and PORH. Adjustment for diabetes accounted for differences in resting flux and time to peak but not differences in PORH (Europeans=45.0 (40.3, 50.1)au, Indian Asians=35.6 (31.9, 39.7)au, mean (95% confidence interval); p =0.008 after adjustment). Differences in conventional CVD risk factors did not account for interethnic differences in microvascular responses. Conclusions: People of Indian Asian descent have impaired post-occlusive reactive hyperaemia unexplained by diabetes, dysglycaemia or other CVD risk factors. Abnormal microvascular function in response to ischaemia could represent a novel mechanism contributing to the elevated risk of CVD in Indian Asians. [Copyright &y& Elsevier]

Abstract: Aims: To describe the relationship of retinal arteriolar and venular caliber with diabetes, retinopathy and hyperglycemia, in an Asian Indian population. Methods: This was a population-based cross-sectional study of 3400 (75.6% response rate) Singapore ethnic Indians aged 40–80 years. Central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were obtained using a validated computer-assisted program. Diabetes mellitus was identified using standardized criteria. Diabetic retinopathy was graded based on the modified Airlie House Classification System. Results: There were 980 (32.2%) participants with diabetes. Of these, 327 (33.4%) had diabetic retinopathy. After multivariate adjustment, diabetic persons had a wider CRAE (145.23μm vs 142.38μm, P <0.001). This relationship was stronger in persons without hyperlipidemia (P-interaction<0.1). Among diabetic participants, wider CRVE was related to increasing severity of retinopathy (P for trend<0.05) and this association may be altered by hypertensive status. Retinal arteriolar caliber widened with increasing glucose (P <0.001) and HbA1C (P <0.001) levels. Conclusions: In Indian adults, wider retinal arteriolar caliber is associated with diabetes and hyperglycemia, while wider retinal venular caliber is associated with diabetic retinopathy. This is consistent with white populations and confirms the differential systemic association of retinal vascular caliber in Asian Indians. [Copyright &y& Elsevier]

Background & objectives: With increasing number of people with diabetes worldwide, particularly in India, it is necessary to search for low cost screening methods. We compared the effectiveness and costs of screening for undiagnosed type 2 diabetes mellitus (T2DM), using oral glucose tolerance testing (OGTT) alone, or following a positive result from the Indian Diabetes Risk Score (IDRS) or following a positive result from genotyping of the TCF7L2 polymorphisms in Asian Indians. Methods: In subjects without known diabetes (n=961) recruited from the Chennai Urban Rural Epidemiology Study (CURES), OGTT, IDRS, and genotyping of rs12255372 (G/T) and rs7903146(C/T) of TCF7L2 polymorphisms were done. IDRS includes four parameters: age, abdominal obesity, family history of T2DM and physical activity. Results: OGTT identified 72 subjects with newly diagnosed diabetes (NDD), according to the World Health Organization criteria of fasting plasma glucose ≥ 126 mg/dl or a plasma glucose ≥ 200 mg/dl, 2 h after 75 g oral glucose load. IDRS screening (cut-off ≥ 60) yielded 413 positive subjects, which included 54 (75%) of the 72 NDD subjects identified by OGTT. Genotyping yielded 493 positive subjects which only included 36 (50%) of the 72 NDD subjects showing less discriminatory power. Screening with both SNPs missed 27 (37.5%) NDD subjects identified by IDRS. In contrast, IDRS missed only 9 (12.5%) of the NDD subjects identified by genotyping. Total screening cost for OGTT alone, or with IDRS were 384,400 and 182,810 respectively. Comparing OGTT alone to IDRS followed by OGTT, the incremental cost per additional NDD subject detected by doing OGTT on everyone was 11,199 (201,590 for detecting additional 18 NDD subjects). Interpretation & conclusions: For screening a population of subjects without diagnosed diabetes in India, a simple diabetes risk score is more effective and less expensive than genotyping or doing OGTT on the whole population. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: : The aim of the study was to assess the association between visceral and subcutaneous fat with glucose intolerance, adipocytokines, inflammatory markers and carotid IMT in Asian Indians. Design and methods: : Subjects with NGT (n =85), IGT (n =49) and T2DM (n =93) were randomly selected from CURES. Total abdominal, visceral and subcutaneous fat were measured using Helical CT scan. Adiponectin, hs-CRP, TNF-alpha, oxidized LDL, visfatin and leptin and IMT and insulin resistance were assessed. Results: : Total abdominal fat (p =0.041) and the visceral fat (p =0.039) but not subcutaneous fat progressively increased from NGT, IGT and T2DM subjects. With increasing quartiles of visceral fat, there was a significant increase in insulin resistance (p =0.040); significant decrease in adiponectin (p =0.043) and increase in TNF-alpha (p =0.028), hs-CRP (p =0.043), OX-LDL (p =0.034) and visfatin (p =0.040), and carotid IMT (p =0.047) was observed. Conclusion: : Visceral fat levels increased with increasing glucose intolerance and are associated with decreased levels of adiponectin and increased levels of hs-CRP, TNF-alpha, oxidized LDL, visfatin, HOMA-IR and IMT. [Copyright &y& Elsevier]

Background & objective: Association between adiponectin and non-alcoholic fatty liver disease (NAFLD) has been reported in west. Studies in Indian population are lacking. This study was undertaken to assess the association of hypoadiponectinemia with NAFLD in Asian Indians. Method: In this cross-sectional study, subjects were randomly selected from Phase 5 of the Chennai Urban Rural Epidemiology Study (CURES), an epidemiological study based on a representative population of Chennai in south India. One hundred twenty one subjects without NAFLD and 72 subjects with NAFLD were selected. NAFLD was diagnosed by ultrasonography. Serum adiponectin levels were measured using radioimmunoassay. Insulin resistance was calculated using Homeostasis Assessment model (HOMA-IR). Results: Serum adiponectin values were significantly lower in subjects with NAFLD compared to those without 15.6 lag/ml (95% Confidence Interval (CI) 5.0 - 6.3 µg/ml] vs 7.4 µg/ml (95% CI: 6.7 - 8.1 µg/ml, P<0.01). Adiponectin levels decreased with increasing severity of NAFLD. Subjects with moderate to severe steatosis had significantly lower adiponectin levels (5.11 µg/ml, 95% CI: 4.1- 6.4 µg/ml) compared to subjects with mild steatosis (5.9 µg/ml, 95% CI: 5.0 - 6.9 µg/ml; P<0.001) and subjects without NAFLD (7.3 µg/ml, 95% CI: 6.6 - 8.0 µg/ml; P<0.01). Multiple logistic regression analysis revealed adiponectin to be negatively associated with NAFLD [Odds Ratio (OR): 0.865, 95% Confidence Interval (CI): 0.792-0.944, P=-0.001]. This remained statistically significant even after adjusting for confounding factors age, gender, body mass index, insulin resistance, waist circumference, total cholesterol, triglycerides and glucose intolerance (OR: 0.873, 95% CI: 0.793 - 0.961; P=0.005). Interpretation & conclusion: NAFLD is associated with lower serum adiponectin levels independent of conventional cardiovascular risk factors in Asian Indians known to have high prevalence of diabetes and coronary artery disease. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To determine the prevalence of and risk factors for metabolic syndrome (MS) among urban Asian Indian adults. Methods: 2225 subjects aged ≥20 years were studied in a population based cross-sectional survey in Chandigarh, a city in north India. Anthropometric measurements, estimation of capillary plasma glucose, HDL cholesterol and triglycerides were done. Metabolic syndrome prevalence was estimated using National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), modified NCEP ATP III and International Diabetes Federation (IDF) criteria. Multiple logistic regression analysis was done to find out risk factors for metabolic syndrome. Results: The prevalence rates of metabolic syndrome were 35.8% (NCEP ATP III), 45.3% (modified NCEP ATP III) and 39.5% (IDF criteria). As per modified NCEP ATP III criteria, central obesity was the commonest abnormality among females and elevated blood pressure among males. Risk factors for MS were increasing age, female gender, sedentary lifestyle and diabetes in parents. Conclusions: Our study showed a high prevalence of metabolic syndrome and its individual components. Independent risk factors for metabolic syndrome included increasing age, female gender, sedentary lifestyle and diabetes mellitus in parents. [Copyright &y& Elsevier]

The article discusses several studies related to diabetes, including fasting glucose criteria to diagnose diabetes in U.S. adults, the definition of glucose intolerance among Asian Indians and the effect of coffee consumption on the development of type 2 diabetes. On fasting glucose criteria, the percentages of population diagnosed by using glycated hemoglobin (HbA) were provided. The HbA levels which can determine diabetes in Asian population are explained. It was reported that coffee and tea consumption provided protection against diabetes development.

Abstract: Background: Although studies of immigrant Asian Indians in other countries show high rates of diabetes (DM), metabolic syndrome (MetS), and cardiovascular disease (CVD), no randomized, population-based studies of this rapidly growing ethnic group exist in the US. Methods: The sample comprised 1038 randomly selected Asian Indian immigrants, aged 18 years and older at seven US sites. Prevalence of diabetes and MetS (age-adjusted and sex-adjusted means) was estimated and ANOVA was used to calculate gender and group differences (normoglycemia/impaired fasting glucose/diabetes) for CVD risk factors. Results: The mean age was 48.2 years. The majority of respondents were male, married, educated, and with some form of health insurance. Prevalence of diabetes was 17.4%, and 33% of the respondents had prediabetes. Cardiovascular risk factors, especially high levels of triglycerides, total cholesterol, LDL cholesterol, homocysteine, and C-reactive protein, and low levels of HDL cholesterol, were also prevalent; elevated lipoprotein(a) was not observed. The age-adjusted prevalence of MetS was 26.9% by the original NCEP/ATP III criteria, 32.7% by the modified NCEP/ATP III criteria, and 38.2% by the IDF criteria. The MetS rates for women, but not for men, increased with age using all three criteria. There was a progressive worsening of all metabolic parameters as individuals progressed from normal to IFG to diabetes. Conclusion: The prevalence rates of diabetes and MetS among US Asian Indians are higher than reported in earlier, nonrandomized, smaller surveys. These data provide a firm basis for future mechanistic and interventional studies. [Copyright &y& Elsevier]

Background & objectives: The objective of the study was to determine whether visceral or subcutaneous component of abdominal fat was associated with insulin resistance and metabolic syndrome in non-diabetic Asian Indians. Method: This cross-sectional study had on 120 individuals with normal glucose tolerance (49 males and 71 females). A single slice CT scan at L4- L5 was done for measurement of visceral and subcutaneous abdominal fat. Metabolic syndrome was defined according to the South Asian Modified National Cholesterol Education Program Adult Treatment Panel III criteria (SAM-NCEP) criteria. Insulin Sensitivity Index (ISI-Matsuda) was used to assess insulin sensitivity/resistance. Results: Linear regression analysis revealed that visceral, but not subcutaneous fat was associated with serum triglycerides (R²=0.457, β= 0.34; P=0.006), HDL cholesterol (R²=0.430, β= -0.051; P=0.018) and ISI-Mutsuda (R²=0.437, β= -0.05; P=0.039) after adjusting for age, gender and BMI. Visceral fat showed significant association with metabolic syndrome (OR: 1.013, 95% CI: 1.001- 1.025; P=0.041) even after adjusting for age, gender, body mass index and glycated haemoglobin whereas subcutaneous fat did not show such an association. Interpretation & conclusions: These results indicate that in non-diabetic Asian Indians, visceral, but not subcutaneous component of abdominal fat is associated with insulin resistance, cardiovascular risk factors and metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes mellitus (DM) and periodontal disease / periodontitis (PD) is high, and the association of these two as risk factors influencing each other has been recognized and is extensively documented. However, a majority of these association studies have been done in developed countries and / or in developing countries other than India. Objective: To review, quantify and qualify the status of the published indexed scientific literature regarding the bidirectional association of DM and PD in India. Method: An internet search of the literature was conducted to examine relevant association studies of DM and PD in India. As a matter of interest, the related articles were searched manually from one non-indexed national (India) publication of periodontology until October 2008. Specific focus was on indexed literature and only these were considered for the review. Result: Eleven pertinent indexed publications addressing the concern with regard to population in India were identified. Most of them were in agreement with the accepted mechanisms involving these two diseases, but more supported a unidirectional view of interaction, that is, advocating the role of DM in a worsened periodontal condition. One study with an opposite view was recognised. Conclusion: The paucity of such research in India, which will be a hub of diabetics in the near future, reflects the need to make available a strong body of evidence in the indexed literature relating not only to DM and its 'sixth complication', PD, but also the strong influence of PD on DM. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To determine A1C cut points for glucose intolerance in Asian Indians. RESEARCH DESIGN AND METHODS -- A total of 2,188 participants without known diabetes were randomly selected from the Chennai Urban Rural Epidemiology Study. All had fasting plasma glucose (FPG) and 2-h postload plasma glucose measurements after a 75-g load and were classified as having impaired fasting glucose (IFG) (American Diabetes Association [ADA] criteria, FPG ≥ 5.5 and <7 mmol/l, and World Health Organization [WHO] criteria, FPG ge;6.1 and <7 mmol/l), impaired glucose tolerance (IGT) (2-h postload plasma glucose ≥7.8 and < 11.1 mmol/l), or diabetes (FPG ≥7 mmol/l and/or 2-h postload plasma glucose ≥11.1 mmol/ l). A1C was measured using the Bio-Rad Variant machine. Based on receiver operating characteristic curves, optimum sensitivity and specificity were derived for defining A1C cut points for diabetes, IGT, and IFG. RESULTS-- Mean ± SD values of A1C among subjects with normal glucose tolerance, IGT, and diabetes were 5.5 ± 0.4, 5.9 ± 0.6, and 8.3 ± 2.0%, respectively (P[sub trend] < 0.001) with considerable overlap. To identify diabetes based on 2-h postload plasma glucose, the A1C cut point of 6.1% had an area under the curve (AUC) of 0.941 with 88.0% sensitivity and 87.9% specificity. When diabetes was defined as FPG ≥7.0 mmol/l, the A1C cut point was 6.4% (AUC = 0.966, sensitivity 93.3%, and specificity 92.3%). For IGT, AUC = 0.708; for IFG, AUC = 0.632 (WHO criteria) and 0.708 (ADA criteria), and the AIC cut point was 5.6%. CONCLUSIONS -- In Asian Indians, A1C cut points of 6.1 and 6.4% defined diabetes by 2-h postload plasma glucose or FPG criteria, respectively. A value of 5.6% optimally identified IGT or IFG but was <70% accurate. [ABSTRACT FROM AUTHOR]

The article discusses the cross-sectional study on the use of the Madras Diabetes Research Foundation-Indian Diabetes Risk Score (MDRF-IDRS) to assess the risk of developing diabetes. The study reportedly involved adults from a rural area in Jammu and Kashmir, India who were evaluated for their health status and surveyed using a protocol with MDRF-IDRS. The results revealed that MDRF-IDRS can effectively identify people who are at high risk of developing diabetes mellitus.

KIRs (killer Ig-like receptors) expressed on natural killer (NK) cells are an important component of innate (and adaptive) immunity. They are either activatory or inhibitory, and certain KIRs are known to interact with specific motifs of HLA Class I molecules, which is very crucial in determining whether a cell is targeted to lysis or otherwise. Latent autoimmune diabetes in adults (LADA) is a slowly progressive form of autoimmune diabetes, with an adult onset (>30 years). Because autoantibodies and autoimmunity involved are involved in the etiology of LADA, KIRs might play an important role in conferring susceptibility to or protection against the disease. The purpose of this study was to identify killer immunoglobulin-like receptor (KIR) genes, which are associated with susceptibility to and protection against type 1 diabetes in Latvian and Asian Indian patients with LADA. KIR and HLA-C ligand genotyping was performed using PCR-SSP in LADA patients from Latvia ( n= 45) with age- and sex-matched controls ( n= 92) and from India ( n= 86) with controls ( n= 98). Results showed that in Latvian patients with LADA, KIRs 2DL1, 2DS2, and 2DS4 were associated with susceptibility and KIR 2DS5 with protection. In Asian Indian LADA patients, KIRs 2DL5 and 3DL1 were associated with susceptibility and KIRs 2DS1 and 2DS3 with protection. Stratification analyses for KIRs that bind to HLA-C1 and C2 were performed. We concluded that KIRs are important in conferring susceptibility (or protection) to adult patients with LADA in both our study populations. However the KIR genes (and their HLA-C ligands) conferring susceptibility or protection in these two populations differ, showing a role of ethnicity in disease susceptibility. [ABSTRACT FROM AUTHOR]

Adiponectin is an adipose tissue specific protein that is decreased in subjects with obesity and type 2 diabetes. The objective of the present study was to examine whether variants in the regulatory regions of the adiponectin gene contribute to type 2 diabetes in Asian Indians. The study comprised of 2,000 normal glucose tolerant (NGT) and 2,000 type 2 diabetic, unrelated subjects randomly selected from the Chennai Urban Rural Epidemiology Study (CURES), in southern India. Fasting serum adiponectin levels were measured by radioimmunoassay. We identified two proximal promoter SNPs (−11377C→G and −11282T→C), one intronic SNP (+10211T→G) and one exonic SNP (+45T→G) by SSCP and direct sequencing in a pilot study ( n = 500). The +10211T→G SNP alone was genotyped using PCR-RFLP in 4,000 study subjects. Logistic regression analysis revealed that subjects with TG genotype of +10211T→G had significantly higher risk for diabetes compared to TT genotype [Odds ratio 1.28; 95% Confidence Interval (CI) 1.07–1.54; P = 0.008]. However, no association with diabetes was observed with GG genotype ( P = 0.22). Stratification of the study subjects based on BMI showed that the odds ratio for obesity for the TG genotype was 1.53 (95%CI 1.3–1.8; P < 10−7) and that for GG genotype, 2.10 (95% CI 1.3–3.3; P = 0.002). Among NGT subjects, the mean serum adiponectin levels were significantly lower among the GG ( P = 0.007) and TG ( P = 0.001) genotypes compared to TT genotype. Among Asian Indians there is an association of +10211T→G polymorphism in the first intron of the adiponectin gene with type 2 diabetes, obesity and hypoadiponectinemia. [ABSTRACT FROM AUTHOR]

Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall prevalence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing factors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syndrome and obesity track into adulthood, these clinical entities need to be recognized early for effective prevention of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost-effective population intervention programs are urgently needed. In this context, we have launched one of the largest program ("MARG", The Path) to curb childhood obesity in India. [ABSTRACT FROM AUTHOR]