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Background: Diabetic nephropathy is known to be a leading complication of diabetes mellitus, characterized by diverse aspects such as high urinary albumin level, elevated blood pressure, and genetic susceptibility leading to end-stage renal disease. The current study was carried out to investigate the association of eNOS and TGFβ1 gene polymorphisms in the progression of diabetic nephropathy among type 2 diabetic patients in the South Indian population. The eNOS and TGFβ1 genetic variants were genotyped in 280 T2DM patients, 140 with DN, 140 without DN, and 140 controls. Genotyping was performed using ARMS PCR and the genomic variants were confirmed by the Sanger sequencing method. Results: A significant (p < 0.05) association was observed in the genotypic frequencies of eNOS (G > T) polymorphism in the T2DM patients with diabetic nephropathy when compared to controls. The frequency of TT (heterozygous) genotype was observed to increase in patients with type 2 diabetes and DN when compared to the diabetic patients without DN and controls. This indicates that diabetic patients with TT genotype are at an increased risk to develop DN. However, TGFβ1 (G > C) polymorphism did not show any association in the allele and genotypic frequencies with DN when compared with T2DM and controls. Conclusion: The results of the study propose a strong influence of TT genotype of eNOS gene be significantly linked with diabetic nephropathy in T2DM patients. Whereas no association was examined concerning TGFβ1 gene polymorphism and DN. Nevertheless, large sample size studies are required to confirm the part of these genetic variants in the development of DN. [ABSTRACT FROM AUTHOR]

Background and aims: The purpose of the study is to assess the concentrations of spexin (SPX) and other specific biochemical parameters, subsequently spexin (SPX) gene polymorphisms among south Indian healthy controls and in T2DM and T2DM +HTN patient's blood samples, which were selected according to certain inclusion and exclusion criteria. Material and method: Named and kit methods are used for the evaluation of spexin, biochemical parameters, and for spexin (SPX) gene polymorphism. Results: In this prospective study, spexin concentration is a negatively associated biomarker, and elevated levels of glucose, insulin resistance, liver enzymes, and inflammation are independently associated with assessing the diabetic and arterial hypertension disease states. The SPX gene sequencing illustrates exon mutation in the 6th position and no polymorphism is detected in the 2nd, 3rd, 4th, and 5th exons. Whereas intronic mutations are observed in the 3rd and 5th positions. Furthermore, heterogeneous mutations are observed in the 8th and 13th samples. Samples 10 and 14 showed homozygous of -42G>A mutation in exon 6. Samples 11, 12, 18, 19, 21, and 22 showed a heterozygous mutation (-42G>R) in the intron that is present 5' to the exon 6. There is a deletion mutation in the acceptor site of the intron present 5' to the exon 4. Conclusion: This is the first study reporting an association between spexin gene polymorphisms and the levels of spexin peptides. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic myonecrosis or muscle infarction is an unusual complication of Type 2 Diabetes, usually associated with longstanding disease. It commonly presents as an acute non-traumatic palpable swelling of the affected muscle with predilection for the quadriceps and thigh muscles, often accompanied by retinopathy and nephropathy. Methodology: A retrospective review of the medical records of patients admitted with diabetic myonecrosis under the Department of Endocrinology, Christian Medical College Vellore over a period of ten years(2006-2015) was done. Data pertaining to clinical, biochemical and radiological characteristics were obtained and treatment modalities and outcomes were recorded. Results and Analysis: A total of n = 4 patients with diabetic myonecrosis and completed clinical data were included in the study. In our present series, the mean age at presentation was 45.5 years (±7.3 years), the mean duration of the diabetes was 9.0 years (±2.5 years)with an equal distribution of male and female subjects. The mean HbA1c (9.5 ± 0.6%) was suggestive of poor glycemic control at presentation with all (100%) the patients in our series having concomitant one or more microvascular complications. While laboratory parameters of elevated CPK or LDH were mostly normal, the findings of T1 hyperintense and T2 hypointense heterogenous lower limb lesions were present in all the subjects (n = 4). Conservative management with bed rest, analgesics and good glycemic control were effective in good clinical improvement over a period of 1-2 months. Conclusions: Our series of diabetic myonecrosis in Indian patients with Type 2 diabetes mellitus, elucidates the varied clinical presentations, with MRI findings rather than laboratory markers being the mainstay of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Previous studies in diverse ethnic groups have reported that progressive resistance training is effective for glycemic control. However, it is unknown whether this form of exercise therapy leads to clinically meaningful changes in metabolic, cardiovascular and anthropometric parameters in Asian Indians. Aim: The study was designed to investigate the efficacy of progressive resistance training on glycemic, musculoskeletal, anthropometric and cardiovascular variables in untrained middle-aged type 2 diabetic patients living in North India. Materials and Methods: Forty-eight untrained patients, 35 men and 13 women (mean ± SD age, 44.7 ± 4.2 years), with a diagnosis of type 2 diabetes were randomly divided into 2 groups: A group receiving progressive resistance training and a control group who provided participative involvement. The primary outcomes were glycemic control and muscle strength. Additionally, anthropometric and cardiovascular risk parameters were evaluated at baseline and after intervention or control program at 8 weeks. Results: Mixed ANOVA revealed a significant group-by-time interaction for the main outcomes of the study. Change in glycosylated hemoglobin was mean ± SD, 0.6 ± 0.5 in progressive resistance training group compared to no change in control group (P < .001). Progressive resistance training group showed a greater improvement in upper and lower body muscle strength (P < .001), waist circumference (P = .008), and high density lipoprotein cholesterol (P = .004). However, no significant group-by-time interaction was detected on body weight, total cholesterol, triglycerides, low density lipoprotein cholesterol, and systolic and diastolic blood pressure. Conclusions: A short-term progressive resistance training program leads to clinically meaningful improvements in glycemic control and muscle strength in untrained middle-aged type 2 diabetic patients of Asian Indian ethnicity. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Hypertension and dyslipidemia have been associated with cardiovascular disease (CVD). We investigated the association of candidate gene polymorphisms in angiotensin-converting enzyme (ACE) and cholesterol ester transfer protein (CETP) genes in a cohort of Asian Indian patients with and those without type 2 diabetes. Methods: PCR-based genotyping of insertion/deletion (I/D) polymorphism of ACE (rs4646994) and –629C>A of CETP (rs1800775) was carried out in 520 individuals, of whom 160 had CVD+type 2 diabetes mellitus (T2DM), 90 were CVD patients without T2DM, 150 had T2DM with no cardiovascular complications, and 120 were age- and sex-matched healthy controls. Results: With respect to the ACE gene I/D polymorphism, there was a higher percentage of D/D genotype in CVD+T2DM patients, but it was not statistically significant, while the CETP –629A allele was significantly associated with CVD+T2DM patients (P=.000007; odds ratio=0.46; 95% confidence interval=0.32–0.65) as compared with the normal controls and not with CVD alone. Additive interactions between the AA+I/I genotypes, AC+I/D genotypes, and AC+D/D were identified between the patients and the controls with P values of .0052, .0009, and .0078, respectively. Conclusions: Our study suggests that candidate gene polymorphism –629C>A of CETP may serve as a susceptibility biomarker for CVD in T2DM patients. Analyzing the combined effect of both ACE and CETP genotypes would enhance the sensitivity and specificity of CVD risk estimation in the T2DM patients in our population. [Copyright &y& Elsevier]

Exercise, along with medical nutrition therapy and pharmacological interventions, is an important component in the clinical management of type 2 diabetes mellitus (T2D). Current clinical guidelines on type 2 diabetes provide no detailed information on the modalities of effective exercise intervention in the treatment of type 2 diabetes. Both endurance and resistance types of exercise seem to be equally effective in improving metabolic control in patients with type 2 diabetes. Determining the best method of providing exercise is clinically relevant to this population. This paper reviews the epidemiology of diabetes and problems of physical function associated with type 2 diabetes and discuss the benefits of exercise therapy on the parameters of glycemic control and function in type 2 diabetes patients, with special reference to Asian Indians. Based on the currently available literature, it is concluded that type 2 diabetes patients should be encouraged to participate in specifically designed exercise intervention programs. Attention should be paid to the avoidance of cardiovascular and musculoskeletal deconditioning. More clinical research is warranted to establish the efficacy of different dosages of exercise intervention in a holistic approach for type 2 diabetes subpopulations within different stages of the disease and various levels of co-morbidity. [ABSTRACT FROM AUTHOR]

Aim: HbA1c test is considered to be the reliable measure for evaluating long-term glycemic control in type 2 diabetes. The purpose of this study was to evaluate whether knowledge about HbA1c test is associated with a better glycemic control. Materials and Methods: We conducted a cross-sectional survey of 480 (M:F; 287:193) adults with type 2 diabetes attending a tertiary care center during a period of four months. Baseline demographic and clinical data of all the subjects was obtained. Subject's knowledge about HbA1c test and their target goal was assessed using a questionnaire. Recent HbA1c results were obtained from medical records. Results: Seventy four per cent of the subjects had awareness about HbA1c test and about 43% of those who knew HbA1c test also knew their target goal. 33% remember their last HbA1c result. The mean A1C of Group A was significantly lower when compared with Group B (8.1 ± 1.7 vs 9.2 ± 1.9, P<0.0001). Group C had lower A1C levels compared to Group D (7.7 ± 1.4 vs 8.5 ± 1.9, P<0.0001). Patients who kept their HbA1c less than 7% were significantly higher in Group C than in Group D. (37.8 vs 12.7%, P<0.00001). Subjects had good glycemic control with increasing levels of awareness about HbA1c. Conclusion: Majority of the diabetic patients who attended the tertiary care center for diabetes care knew HbA1c test and half of them were aware about their target goal. Awareness about HbA1c had a positive impact on maintenance of better glycemic control. [ABSTRACT FROM AUTHOR]

Aims The aim of the study was to investigate the association of serum adiponectin levels with the Pro12Ala polymorphism of the peroxisome proliferator activated receptor-γ ( PPARG) gene in Asian Indians. Methods We selected 400 diabetic subjects, 200 with the Pro12Pro genotype (100 male and 100 female) and 200 with the Pro12Ala genotype (100 male and 100 female) and 400 age- and sex-matched normal glucose tolerance subjects with similar genotype profiles from the Chennai Urban Rural Epidemiology Study. Fasting serum adiponection levels were measured using radioimmunoassay. The Pro12Ala polymorphism was genotyped by PCR–restriction fragment length polymorphism using BstUI. Results All clinical and biochemical parameters were similar in the subjects with the Pro12Pro and Pro12Ala genotypes. There was no significant difference in serum adiponectin values between subjects with the Pro12Pro and Pro12Ala genotypes (males 5.4 vs. 5.8 µg/ml, P = 0.546; females 6.9 vs. 7.2 µg/ml, P = 0.748). Adiponectin values did not differ among these two genotypes even when categorized based on their diabetes status (normal glucose tolerance Pro12Pro 7.9 vs. Pro12Ala 7.7 µg/ml, P = 0.994; diabetes Pro12Pro 4.7 vs. Pro12Ala 5.4 µg/ml, P = 0.622). Conclusion The Pro12Ala polymorphism of the PPARG gene is not associated with serum adiponectin levels in Asian Indians. [ABSTRACT FROM AUTHOR]

Telomere shortening has been reported in several diseases including atherosclerosis and Type 1 diabetes. Asian Indians have an increased predilection for Type 2 diabetes and premature coronary artery disease. The aim of this study was to determine whether telomeric shortening occurs in Asian Indian Type 2 diabetic patients. Using Southern-blot analysis we determined mean terminal restriction fragment (TRF) length, a measure of average telomere size, in leucocyte DNA. Type 2 diabetic patients without any diabetes-related complications ( n = 40) and age- and sex-matched control non-diabetic subjects ( n = 40) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Plasma level of malondialdehyde (MDA), a marker of lipid peroxidation, was measured by TBARS (thiobarbituric acid reactive substances) using a fluorescence method. Mean (± SE) TRF lengths of the Type 2 diabetic patients (6.01 ± 0.2 kb) were significantly shorter than those of the control subjects (9.11 ± 0.6 kb) ( P = 0.0001). Among the biochemical parameters, only levels of TBARS showed a negative correlation with shortened telomeres in the diabetic subjects ( r = −0.36; P = 0.02). However, telomere lengths were negatively correlated with insulin resistance (HOMA-IR) ( r = −0.4; P = 0.01) and age ( r = −0.3; P = 0.058) and positively correlated with HDL levels ( r = 0.4; P = 0.01) in the control subjects. Multiple linear regression (MLR) analysis revealed diabetes to be significantly ( P < 0.0001) associated with shortening of TRF lengths. Telomere shortening occurs in Asian Indian Type 2 diabetic patients. Diabet. Med. (2005) [ABSTRACT FROM AUTHOR]

Asian Indians have high prevalence of diabetes and premature coronary artery disease (CAD). The aim of this study was to determine the association of CAD in Asian Indian type 2 diabetic subjects with normo, micro and macroalbuminuria. Type 2 diabetic subjects [n= 1736], inclusive of self reported diabetic subjects [1382/1529, response rate 90.4%] and randomly selected newly diagnosed diabetic subjects [n=354] were recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai in Southern India. Microalbuminuria, estimated by immunoturbidimetric assay, was diagnosed if albumin excretion was between 30 - 299 µg/mg of creatinine and macroalbuminuria, if ≥300 µg/mg of creatinine. Coronary artery disease [CAD] was diagnosed based on a past history of documented myocardial infarction and/or electrocardiographic [ECG] evidence of Q wave and/or ST segment changes. Analysis was restricted to 1596 individuals on whom data on albumin excretion and CAD were available [1596/1736, response rate 91.9%]. The overall prevalence of micoalbuminuria was 26.8% [427 / 1596], macroalbuminuria, 5.5% [87/1596] and CAD, 13.0% [208/1596]. Subjects with macroalbuminuria had the highest prevalence of CAD [34.5%], followed by microalbuminuric subjects [14.8%] and normoalbuminuria [10.6%, p for trend: <0.0001]. Univariate regression showed both microalbuminuria [Odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.05 - 2.02, p<0.001] and macroalbuminuria [OR: 4.46, 95% CI: 2.7 - 7.1, p<0.001] to be significantly associated with CAD. After adjusting for age, glycated hemoglobin, smoking, triglycerides and LDL cholesterol, the association remained significant only for macroalbuminuria [OR:3.73, 95% CI: 2.2 - 6.4, p< 0.001]. In conclusion, there is an association between albumin excretion and CAD in Asian Indian type 2 diabetic subjects and this is stronger in those with macroalbuminuria. [ABSTRACT FROM AUTHOR]

Asian Indians particularly those with type 2 diabetes have accelerated atherosclerosis at younger age. The aim of the present study was to assess the association of hsCRP, TNF-α with carotid IMT in individuals with different grades of glucose intolerance among Asian Indians. Three groups were randomly recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai in South India, Group 1: normal glucose tolerance (NGT) (n=150); Group 2: impaired glucose tolerance (IGT) (n=150) and Group 3: type 2 diabetes (DM) (n = 150). hs-CRP [Nephelometry, DadeBehring], TNF-α [enzyme linked immunosorbent assay] and carotid IMT [high resolution B-mode ultrasonography] were assessed. Subjects with diabetes had higher IMT values [0.85 ± 0.30 mm] compared to IGT [0.79 ± 0.16 mm; p<0.05] and NGT subjects [0.71 ± 0.12 mm; p<0.001]. HsCRP levels were higher in those with DM and IGT [DM: 2.8 mg/L, IGT: 2.1 mg/L] compared to NGT [1.2 mg/L, p for trend 0.003]. TNF-α levels were also higher in IGT and DM groups compared to NGT subjects [NGT: 3.5 ± 2.2, IGT: 4.6 ± 2.1, DM: 6.1 ± 2.4 pg / ml, p for trend <0.001]. HsCRP [r = 0.104, p=0.02] and TNF-α [r = 0.265, p<0.001] showed a positive correlation with IMT in the total study population and in subjects with NGT [hsCRP: r = 0.253, p = 0.002, TNF-α: r = 0.265, p = 0.001]. In multiple linear regression analysis, hsCRP [β =0.006, p<0.034] and TNF-α [β =0.015, p<0.001] showed an association with IMT among NGT subjects even after adjusting for age and gender. We conclude that among Asian Indians (1) levels of hsCRP and TNF-α increase with increasing degrees of glucose intolerance (2) among NGT subjects, both hsCRP and TNF-α are associated with increase in carotid IMT and this is independent of age and gender. [ABSTRACT FROM AUTHOR]