The Indian type 2 diabetes risk score also helps identify those at risk of macrovasvular disease and neuropathy (CURES-77)

AIMS

To see whether the diabetic individuals identified by the Indian Diabetes Risk Score (IDRS) also have a higher prevalence of diabetes related complications.

METHODS

Type 2 diabetic subjects were selected from the Chennai Urban Rural Epidemiology Study in south India. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to Early Treatment Diabetic Retinopathy Study grading system. Coronary artery disease was diagnosed using Minnesota coding of 12-lead electrocardiograms. Diabetic peripheral neuropathy (DPN) was diagnosed if vibratory perception threshold [VPT] of the right great toe measured by biothesiometry was > or =20. The criterion for diagnosis of peripheral vascular disease (PVD) was an ankle-brachial index < 0.9. Macroalbuminuria was diagnosed if urinary albumin excretion was > or =300 microg/mg creatinine. A total of 1476 individuals who had information on all test parameters were included for analysis.

RESULTS

Subjects with IDRS score > or =60 had significantly higher prevalence of coronary artery disease (CAD) [9.2% vs. 5.4%, p = 0.043], DPN [29.2% vs. 8.8%, p < 0.001] and PVD [4.8% vs. 1.9%, p = 0.038] compared to subjects with IDRS score <60. However, the prevalence of DR and macroalbuminuria did not differ between the two IDRS subgroups. Age explained much of the observed differences in prevalence of CAD, PVD and DPN between the two IDRS subgroups.

CONCLUSIONS

This study further extends the clinical usefulness of IDRS to predicting diabetic complications like CAD, PVD and DPN as well.

Comparison of metal accumulation in the selected fishes from two sites of Vembanad backwaters, Kerala, India

The edible fishes Etroplus suratensis and Arius arius were collected from two different sites of Vembanad backwaters. Accumulation of heavy metals such as zinc, cadmium, lead and copper in different tissues of these fishes were analysed. Kidneys showed maximum accumulation of all the metals in both the fishes. Lead and copper were high in Kumarakom (Site-I) and zinc and cadmium in Cochin (Site-2) of the Vembanad backwaters. The study revealed that both the fishes were highly contaminated with metals.

Visceral & subcutaneous abdominal fat in relation to insulin resistance & metabolic syndrome in non-diabetic south Indians

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.

METHODS

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 (R(2);=0.457,beta= 0.34; P=0.006), HDL cholesterol (R(2);=0.430, beta= -0.051; P=0.018) and ISI-Matsuda (R(2);=0.437, beta= -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 & CONCLUSION

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.

Fate of fipronil and its metabolites in/on grape leaves, berries and soil under semi arid tropical climatic conditions

Fate of fipronil and its major metabolites fipronil sulfide (MB 45950), fipronil-desulfinyl (MB 46513) and fipronil sulfone (MB 46136) were studied in/on grape leaves, berries and soil. As initial residue deposits on the leaves the major component was that of fipronil, while all the 3 metabolites were also present. Among metabolites residues of MB 46513 was highest followed by MB 46136 and MB 45950. In leaves fipronil degraded faster than its metabolites. The residues of fipronil in leaves degraded at the half-life of 9.6 and 18.3 days and that of total fipronil (sum of fipronil and its metabolites) at 13.6 and 20 days, from treatment at recommended and double the recommended dose, respectively. At the time of harvest in leaves, grape berries and soil residues of fipronil and all its metabolites were below the quantifiable limit of 0.01 mg kg(-1).

Novel nanostructures and optical properties of silver doped sodium phosphate thin films

(50-x)Na2O-50P2O5-xAgCl (x = 0 to 15 mol%) glasses in bulk form were synthesized using melt-quenching technique. Thin films of these silver doped sodium phosphate glasses were deposited by thermal evaporation process. The influence of deposition of these glasses in thin film form and subsequent annealing at 600 degrees C on the structure and optical properties such as transmittance, reflectance, refractive index and band gap have been investigated in detail. X-ray diffraction studies of the as-deposited films show the films to be amorphous whereas annealed films show existence of orthorhombic and monoclinic phase of NaPO3 along with crystalline cubic phase of AgCl in doped glasses. Structural investigations of these annealed films show unique morphologies (needle-like and granular) at nano-scale. Both as-fabricated and annealed films are poor reflectors but show high transmittance in the entire spectral region under consideration, which is a direct consequence of particle size effects. Indirect band gap narrowing and variation in refractive index upon annealing is consistent with nanostructural transformations in these samples.

Electrochromic contrast enhancement of nanostructured poly(3,4-ethylenedioxythiophene)-polystyrene sulfonate films by composition/morphology control

Poly(3,4-ethylenedioxythiophene) (PEDOT) films have been electropolymerized from an aqueous micellar polyethylene glycol (PEG) based solution containing sodium poly(styrenesulfonate) (NaPSS) and lithium trifluoromethanesulfonate. On varying the NaPSS content in the electrodeposition bath, two strikingly different nanostructured morphologies were obtained for ensuing PEDOT:PSS films and these have been correlated to the electrochemical and optical performance of the films. The films grown from the formulation with EDOT:NaPSS in a 1:3 weight ratio comprise of a nanoparticulate structure with a to date scarcely reported hexagonal structure. The film surface is also characterized by some unusual floral shapes encompassing elongated grains. TEM studies reveal that in the 1:3 film two dimensional (planar) PEDOT chains are stacked on top of each other with a vertical separation of 4.63 A. On the other hand the film generated from a 1:1 solution shows a texture wherein a random segregation of PSS particles is seen and this adversely affects the electrochromic response of the film. The larger charge storage capacity (4.9 mC cm(-2)), better charge reversibility during coloration and bleaching, good electrochemical cycling stability up to 2500 cycles, higher electronic conductivity and a superior coloration efficiency of 233 cm2 C(-1) at a photopic wavelength of 550 nm under ion intercalation levels of 0.058 to 1.2 mC cm(-2) shown by 1:3 film as compared to the performance of the 1:1 film are ramifications of fast ion movement promoted by the novel microstructure and the hexagonal modification which has rarely been achieved in PEDOT:PSS films.

Prevalence of non-alcoholic fatty liver disease in urban south Indians in relation to different grades of glucose intolerance and metabolic syndrome

AIM

To estimate prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with glucose intolerance (type 2 diabetes (DM), prediabetes) and metabolic syndrome (MS) in urban south Indians.

METHODS

This study was carried out in 541 subjects (response rate 92%) of the original sample of 26,001 subjects in the Chennai Urban Rural Epidemiology Study maintaining the representativeness. Anthropometry and lipid estimations were done in all and oral glucose tolerance test in all, except self-reported diabetic subjects. NAFLD was diagnosed by ultrasonography and MS by modified Adult Treatment Panel III (ATP III) criteria. DM, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) were defined using WHO consulting group criteria.

RESULTS

Overall prevalence of NAFLD was 32% (173/541 subjects) (men: 35.1%, women: 29.1%, p=0.140). Prevalence of most cardio-metabolic risk factors was significantly higher in NAFLD subjects. Prevalence of NAFLD (54.5%) was higher in subjects with DM compared to those with prediabetes (IGT or IFG) (33%), isolated IGT (32.4%), isolated IFG (27.3%) and normal glucose tolerance (NGT) (22.5%) (DM vs. prediabetes: p<0.05, DM vs. NGT: p<0.001, prediabetes vs. NGT: p<0.05). Even after adjusting for age, gender and waist circumference, NAFLD was associated with diabetes (OR: 2.9, 95% C.I.: 1.9-4.6, p<0.001) and MS (OR: 2.0, 95% C.I.: 1.3-3.1, p<0.001).

CONCLUSION

NAFLD is present in a third of urban Asian Indians and its prevalence increases with increasing severity of glucose intolerance and in MS. This is the first population-based prevalence of NAFLD from south Asia which faces the brunt of the diabetes epidemic.

Tunable Nanostructures and Crystal Structures in Titanium Oxide Films

Controllable nanostructures in spin coated titanium oxide (TiO(2)) films have been achieved by a very simple means, through change of post deposition annealing temperature. Electron beam imaging and reciprocal space analysis revealed as-deposited TiO(2) films to be characterized by a dominant anatase phase which converts to the rutile form at 600 degrees C and reverts to the anatase modification at 1,200 degrees C. The phase changes are also accompanied by changes in the film microstructure: from regular nanoparticles (as-deposited) to nanowires (600 degrees C) and finally to dendrite like shapes at 1,200 degrees C. Photoluminescence studies, Raman spectral results, and X-ray diffraction data also furnish evidence in support of the observed solid state phase transformations in TiO(2).

Increased awareness about diabetes and its complications in a whole city: effectiveness of the "prevention, awareness, counselling and evaluation" [PACE] Diabetes Project [PACE-6]

AIMS AND OBJECTIVES

To determine the effectiveness of a large scale multipronged diabetes awareness program provided through community involvement in Chennai.

MATERIAL AND METHODS

Mass awareness and free screening camps were conducted between 2004-2007 at various locations of Chennai as part of the Prevention, Awareness, Counselling and Evaluation [PACE] Diabetes Project. During a 3-year period, 774 diabetes awareness camps were conducted to reach the public directly. After the PACE project was completed, 3000 individuals, representative of Chennai, were surveyed in 2007 using a systematic stratified random sampling technique. The results were compared to a similar survey carried out, as part of the Chennai Urban Rural Epidemiology Study [CURES] in 2001-2002, which served as a measure of baseline diabetes awareness.

RESULTS

Awareness of a condition called "diabetes" increased significantly from 75.5% in 2001-2002 (CURES) to 81% (p < 0.001) in 2007 (PACE). 74.1% of the citizens of Chennai are now aware that the prevalence of diabetes is increasing as compared to 60.2% earlier [p < 0.001]. Significantly more people felt that diabetes could be prevented (p < 0.001), and that a combination of diet and exercise were needed to do so (p < 0.001). Respondents reporting obesity, family history of diabetes, hypertension and mental stress as risk factors increased significantly after PACE (p < 0.001). More people were able to correctly identify the eyes (PACE 38.1% compared to CURES--16.1%, p < 0.001), kidney (PACE 42.3% compared to CURES 16.10%, p < 0.001), heart (PACE 4.6% compared to CURES 5.8%, p < 0.001) and feet (PACE 35.0% vs. CURES 21.9%, p < 0.001) as the main organs affected by diabetes.

CONCLUSION

Through direct public education and mass media campaigns, awareness about diabetes and its complications can be improved even in a whole city. If similar efforts are implemented state-wise and nationally, prevention and control of non-communicable diseases, specifically diabetes and cardiovascular disease, is an achievable goal in India.

Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES-55)

AIMS

This study was conducted to determine the prevalence of, and risk factors for, diabetic neuropathy (DN) in south Indian Type 2 diabetic subjects.

METHODS

Subjects were recruited from the Chennai Urban Rural Epidemiology Study, conducted on a representative cohort from Chennai city. A total of 1629 diabetic subjects were included, of whom 1291 were known to have diabetes (KD) subjects and 338 were randomly selected newly detected diabetic (NDD) subjects. Neuropathy was diagnosed if vibratory perception threshold at the great toe, measured by biothesiometry, exceeded mean + 2 sd of a healthy non-diabetic study population aged 20-45 years (cut point > or = 20 V).

RESULTS

The overall prevalence of DN was 26.1% (age-adjusted 13.1%) with no significant difference in gender. The prevalence of neuropathy was significantly higher in KD subjects compared with NDD subjects (27.8 vs. 19.5%, P = 0.002). The prevalence of diabetic retinopathy (24.1 vs. 15.3%, P < 0.0001) and hypertension (51.1 vs. 40.0%, P < 0.0001) were higher in those with neuropathy compared with those without. The odds ratio for neuropathy in subjects with duration of diabetes > 15 years compared with < or = 5 years was 5.7 (95% confidence interval: 3.52-9.08, P < 0.0001). Regression analysis showed age (P < 0.0001), glycated haemoglobin (P = 0.001) and duration of diabetes (P = 0.045) to be significantly associated with neuropathy.

CONCLUSIONS

This cross-sectional population-based study shows that, among urban south Indian Type 2 diabetic subjects, the prevalence of DN is 26.1% and that DN is significantly associated with age, glycated haemoglobin and duration of diabetes.

Incidence of diabetes and pre-diabetes in a selected urban south Indian population (CUPS-19)

OBJECTIVES

Several cross-sectional studies have reported on the prevalence of diabetes in India. However, there are virtually no longitudinal population-based studies on the incidence of diabetes from India. The aim of the study was to determine the incidence of diabetes and prediabetes in an urban south Indian population.

METHODS

The Chennai Urban Population Study [CUPS], an ongoing epidemiological study in two residential colonies in Chennai [the largest city in southern India, formerly called Madras] was launched in 1996; the baseline study was completed in 1997. Follow-up examination was performed after a mean period of 8 years. At follow-up, 501 [47.0%] subjects had moved out of this colonies and were lost to follow-up. Of the remaining 564 individuals, 513 [90.9%] provided blood samples for biochemical analysis. Regression analysis was done using incident diabetes as dependant variable to identify factors associated with development of diabetes or pre-diabetes.

RESULTS

Among subjects with normal glucose tolerance (NGT) at baseline [n=476], 64 (13.4%) developed diabetes and 48 (10.1%) developed pre-diabetes (IGT or IFG). The incidence rate of diabetes was 20.2 per 1000 person years and that of pre-diabetes was 13.1 per 1000 person years among subjects with NGT. Of the 37 individuals who were pre-diabetic at baseline, 15 (40.5%) developed diabetes [incidence rate: 64.8 per 1000 person years], 16 (43.2%) remained as pre-diabetic and 6 (16.2%) reverted to normal during the follow-up period. Regression analysis revealed obesity [Odds Ratio (OR): 2.1, p=0.001], abdominal obesity [OR: 2.23, p<0.001] and hypertension [OR: 2.57, p<0.001] to be significantly associated with incident diabetes. The Indian Diabetes Risk Score (IDRS) showed the strongest association with incident diabetes [OR: 5.14, p<0.001].

CONCLUSION

The study shows that the incidence of diabetes is very high among urban south Indians. While obesity, abdominal obesity and hypertension were associated with incident diabetes, IDRS was the strongest predictor of incident of diabetes in this population.

Surveillance for risk factors of cardiovascular disease among an industrial population in southern India

BACKGROUND

We assessed (i) the risk of cardiovascular disease in an industrial population in Chennai, southern India and (ii) whether the status of treatment and control of diabetes and hypertension would be different in an industrial population, which is provided free healthcare, compared with the general population of Chennai.

METHODS

Subjects residing in the residential areas of 2 industries (Indian Airlines and Integral Coach Factory) in Chennai in southern India were recruited. The subjects were employees (n = 440) selected by an age- and sex-stratified random sampling method, and their family members (n = 727) in the age group of 20-69 years; a total of 1167 subjects. Fasting plasma glucose, lipid estimations and anthropometric measurements were done in all the subjects. Information on demographic and lifestyle determinants was obtained using a questionnaire. Diabetes was diagnosed using the American Diabetes Association criteria and metabolic syndrome was defined by the Adult Treatment Panel III criteria with modified waist definition for Asian Indians.

RESULTS

Age-adjusted prevalence of major risk factors for cardiovascular disease using the 2001 Census of India were as follows: diabetes 11.9%; hypertension 25.4%; dyslipidaemia 40.2%; hypertriglyceridaemia 28.3%; overweight (body mass index > or = 23 kg/m2) 60.2%; and metabolic syndrome 34.1%. Use of tobacco in any form was present in 22.9% of men and 0.5% of women; 79% of the subjects followed a sedentary lifestyle. Among subjects receiving medication, 42.1% of subjects with diabetes and 55.3% of subjects with hypertension had their disease under adequate control. A comparison of these results with the general population of Chennai showed that the industrial population had a higher prevalence of cardiovascular risk factors in spite of having better access to healthcare facilities.

CONCLUSIONS

The prevalence of cardiovascular disease was high in this industrial population of Chennai. Although the overall treatment and control of diabetes and hypertension was better than that in the general population, it was still inadequate and this emphasizes the need for greater awareness about non-communicable diseases.

Electrochemical synthesis and surface characterization of poly(3,4-ethylenedioxythiophene) films grown in an ionic liquid

We report a facile method to synthesize poly(3,4-ethylenedioxythiophene) (PEDOT) films at room temperature in a waterproof ionic liquid, 1-ethyl-3-methylimidazolium bis(perfluoroethylsulfonyl)imide (EMIPFSI), by electropolymerization. The ionic liquid leads to the formation of randomly oriented nanofibers and particles confined to submicrometer-sized domains in the film microstructure. X-ray photoelectron spectroscopy (XPS) and energy-dispersive X-ray (EDX) studies provide information about the intercalation of the cation apart from the reported anion in the polymer film, and on how the imidazolium ion controls the growth of PEDOT nanostructures.

Prevalence and significance of generalized and central body obesity in an urban Asian Indian population in Chennai, India (CURES: 47)

OBJECTIVES

To determine the prevalence of generalized and abdominal obesity in urban Asian Indians and compare the association of body mass index (BMI) and waist circumference (WC) with metabolic risk variables.

METHODS

Subjects were recruited from the Chennai Urban Rural Epidemiology Study (CURES) carried out between 2001 and 2004 and involved 2350/2600 eligible subjects (response rate 90.4%). Anthropometric measurements, lipids and oral glucose tolerance tests were carried out. Generalized obesity (BMI>or=23 kg m(-2)) and abdominal obesity (WC>or=90 cm in men and >or=80 cm in women) were defined using WHO Asia Pacific guidelines.

RESULTS

The age standardized prevalence of generalized obesity was 45.9% (95% CI: 43.9-47.9%), (women: 47.4%; men: 43.2%, P=0.210), while that of abdominal obesity was 46.6% (95% CI: 44.6-48.6%), (women: 56.2%> men: 35.1%, P<0.001). Area under the curve for identifying subjects with any three metabolic risk factors using BMI was 0.66, 95% CI: 0.63-0.69, P<0.001, while, for WC, it was 0.70, 95% CI: 0.66-0.74, P<0.001 for men, and 0.69, 95% CI: 0.65-0.74, P<0.001 for women. Isolated generalized obesity (normal WC, increased BMI) was present in 12.7% of men and 6.1% of women. Isolated abdominal obesity (increased WC, normal BMI) was present in 4.7% of men and 14% of women. Combined obesity was present in 32.6% of men and 43.3% of women.

CONCLUSIONS

In Asian Indians, the prevalence of combined obesity is high among both sexes, while isolated generalized obesity is more common in men and isolated abdominal obesity more common in women. However, these prevalence rates vary markedly depending on cut points used. WC is a better marker of obesity-related metabolic risk than BMI in women compared to men in this population.

Prevalence, awareness and control of hypertension in Chennai--The Chennai Urban Rural Epidemiology Study (CURES-52)

OBJECTIVE

To study the prevalence, awareness and control of hypertension in Chennai representing Urban South India.

METHODS

The Chennai Urban Rural Epidemiology Study (CURES) is one of the largest epidemiological studies on diabetes carried out in India, where 26,001 individuals aged > or = 20 years were screened using systematic random sampling method. Every tenth subject recruited in Phase 1 of CURES was requested to participate in Phase 3 of CURES and the response rate was 2,350/26,001 or 90.4%. An oral glucose tolerance test was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements and lipid estimations were done in all subjects. Hypertension was diagnosed in all subjects who were on drug treatment for hypertension or if the blood pressure > or = 140/90 mmHg.

RESULTS

Hypertension was present in 20% [men:23.2% vs. women:17.1%, p<0.001] of the study population. Isolated systolic hypertension (Systolic BP > or = 140 and Diastolic BP<90 mmHg) was present in 6.6% while isolated diastolic hypertension (DBP > or = 90 and SBP<140 mmHg) was present in 4.2% of the population. Among the elderly population (aged > or = 60 years), 25.2% had isolated systolic hypertension. Age, body mass index, smoking, serum cholesterol and triglycerides were found to be strongly associated with hypertension. Among the total hypertensive subjects, only 32.8% were aware of their blood pressure, of these, 70.8% were under treatment and 45.9% had their blood pressure under control.

CONCLUSION

Hypertension was present in one-fifth of this urban south Indian population and isolated systolic hypertension was more common among elderly population. Majority of hypertensive subjects still remain undetected and the control of hypertension is also inadequate. This calls for urgent prevention and control measures for hypertension.

A diabetes risk score helps identify metabolic syndrome and cardiovascular risk in Indians - the Chennai Urban Rural Epidemiology Study (CURES-38)

AIMS

The aims of the study were to compare the recently evolved Indian Diabetes Risk Score (IDRS), in subjects with different grades of glucose intolerance and to evaluate its usefulness as an indicator of cardiovascular risk in Asian Indians, a high risk group for diabetes and coronary artery disease (CAD).

METHODS

The data for the present study were obtained from the Phase 3 (n = 2350, response rate: 90.4%) of the Chennai Urban Rural Epidemiology Study, a population-based study done in Chennai, the largest city in southern India. IDRS was developed based on multiple logistic regression analysis using four simple parameters namely age, abdominal obesity, family history of type 2 diabetes and physical activity. In all subjects, family history of diabetes was obtained, and details on physical activity were assessed using a validated questionnaire. Subjects with an IDRS of <30 was categorized as low risk, 30-50 as medium risk and those with > or =60 as high risk for diabetes. Biochemical and anthropometric measurements were done using standardized procedures. Minnesota coding was used to grade 12-lead electrocardiogram.

RESULTS

The mean IDRS increased significantly with worsening glucose intolerance [normal glucose tolerance (NGT) subjects: 48 +/- 17, impaired glucose tolerance (IGT): 57 +/- 16, newly diagnosed diabetics (NDD): 61 +/- 15 and known diabetics (KD): 68 +/- 12; p for trend <0.001]. Among NGT group, the prevalence of cardiovascular risk factors increased progressively in low-, medium- to high-risk score groups; hypertension: 9.4, 22.1 and 38.2% (p for trend: < 0.001), hypertriglyceridemia: 8.8, 19.9 and 25.3% (p for trend: < 0.001), hypercholesterolemia: 7.2, 20.3 and 34.9% (p for trend: < 0.001) and metabolic syndrome: 1.8, 14.6 and 30.3% (p for trend: < 0.001), respectively. The prevalence of CAD was also significantly higher in individuals with high risk compared with those with low risk (p = 0.030) and the medium risk (p = 0.050) in the NGT group.

CONCLUSIONS

The results suggest that in Asian Indians, (i) the diabetes risk score increases with increasing glucose intolerance, and (ii) it can serve as an effective indicator of metabolic syndrome and cardiovascular risk even among subjects with NGT.

Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34)

AIM

To compare the prevalence of metabolic syndrome (MS) using the World Health Organisation (WHO), Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria of MS in an urban south Indian population, and their ability to identify coronary artery disease (CAD) in males and females.

METHODS

Chennai Urban Rural Epidemiology Study (CURES) is one of the largest epidemiological studies on diabetes carried out in India, in which 26 001 individuals aged >or=20 years were screened using systematic random sampling method. Every tenth subject recruited in Phase 1 of CURES was requested to participate in Phase 3, and the response rate was 90.4%. An oral glucose tolerance test (OGTT) was performed in all individuals except self-reported diabetic subjects. Anthropometric measurements and lipid estimations were done in all subjects and the prevalence of MS estimated using the three criteria. Diagnosis of CAD, made by resting 12 lead ECG, was compared by the three criteria of MS.

RESULTS

MS was identified in 546 subjects (23.2%) by WHO criteria, 430 subjects (18.3%) by ATPIII criteria and 607 subjects (25.8%) by IDF criteria. Only 224 of these subjects were identified by all the three criteria. There was an increased risk of probable CAD in MS subjects diagnosed by WHO criteria (odds ratio (OR) 3.86, 95% Confidence Interval (CI), 2.37-6.29, p < 0.001), compared to ATPIII criteria (OR 2.19, 95% CI 1.30-3.67, p < 0.05) and IDF criteria (OR 1.90, 95% CI 1.16-3.12, p < 0.05). The WHO criteria marked out a much higher population for CAD risk compared to ATPIII and IDF criteria in males, but not in females.

CONCLUSION

In Asian Indians, the WHO, ATPIII and IDF criteria of MS identify different individuals. The WHO criteria identify a greater number of CAD subjects in males, but not in females.

Community empowerment--a successful model for prevention of non-communicable diseases in India--the Chennai Urban Population Study (CUPS-17)

BACKGROUND AND OBJECTIVE

Randomized clinical trials have documented that lifestyle changes through physical activity can prevent diabetes. However there is no data whether such strategies are applicable at community level, that is, in a real life setting. This study demonstrates the first attempt in India, to our knowledge, of increasing physical activity through community empowerment in an attempt at primary prevention of non communicable diseases.

METHODS

The Chennai Urban Population Study [CUPS] was conducted in the year 1996 in two residential areas: a middle income group the Asiad colony at Tirumangalam, and a low income group at Bharathi Nagar in T. Nagar. The Asiad colony was selected for this study. Of the 524 eligible individuals available at baseline in 1998 [age > or =20 years], 479 individuals consented for the study (response rate: 91.4%). After seven years, in 2004, the number of eligible individuals increased to 712 of whom 705 consented for the study (response rate:99%). Education regarding the benefits of physical activity was provided by mass awareness programmes like public lectures and video clippings. Both at baseline and during follow-up, details about the physical activity were collected using a validated questionnaire, which included job related and leisure time activities, and specific questions on exercise. Study individuals were then graded as having light, moderate and heavy physical activity using a scoring system.

RESULTS

In response to the awareness programmes given by our research team, the colony residents constructed a unique public park with their own funds. Though the occupation grades did not change, there was a significant change in the pattern of physical activity. At baseline, only 14.2% of the residents did some form of exercise. more than three times a week, which presently increased to 58.7% [p < 0.001]. The number of subjects who walked more than three times a week increased from 13.8% at baseline to 52.1% during follow-up [p < 0.001].

CONCLUSION

This study is a demonstration of how community empowerment with increased physical activity could possibly lead to prevention of diabetes and other non communicable diseases at the community level. This study also highlights the importance of sharing the results of research studies with the community.

Secular trends in the prevalence of diabetes and impaired glucose tolerance in urban South India--the Chennai Urban Rural Epidemiology Study (CURES-17)

AIMS/HYPOTHESIS

The aim of this study was to determine the secular trends in prevalence of diabetes and IGT in urban India.

MATERIALS AND METHODS

The Chennai Urban Rural Epidemiology Study (CURES) screened 26,001 individuals aged > or =20 years using the American Diabetes Association fasting capillary glucose criteria. The study population, which was representative of Chennai, was recruited by systematic random sampling. Every tenth subject from Phase 1 of CURES was invited to participate in Phase 3 for screening by World Health Organization (WHO) plasma glucose criteria. The response rate was 90.4% (2,350 responders from 2,600 potential subjects). The prevalences of diabetes and IGT in CURES were compared with three earlier studies: two conducted on a representative population of Chennai in 1989 and 1995, and the other the National Urban Diabetes Survey (NUDS) completed in 2000.

RESULTS

The overall crude prevalence of diabetes using WHO criteria in CURES was 15.5% (age-standardised 14.3%), while that of IGT was 10.6% (age-standardised 10.2%). Prevalence of diabetes increased by 39.8% (8.3-11.6%) from 1989 to 1995; by 16.3% (11.6-13.5%) between 1995 and 2000; and by 6.0% (13.5-14.3%) between 2000 and 2004. Thus within a span of 14 years, the prevalence of diabetes increased by 72.3% (chi (2) trend 22.23, p < 0.0001). The prevalence of IGT increased by 9.6% from 1989 to 1995 and by 84.6% between 1995 and 2000 (chi 2 trend 52.9, p < 0.0001). However, it decreased by 39.3% between 2000 and 2004 (p < 0.0001). There was a shift in the age at diagnosis of diabetes to a younger age in CURES compared with NUDS.

CONCLUSIONS/INTERPRETATION

Compared with earlier studies, the prevalence of diabetes in Chennai, representing urban India, has increased while that of IGT has decreased.

Nanostructured mesoporous tungsten oxide films with fast kinetics for electrochromic smart windows

A potential driven self-assembly of sodium dodecyl sulfate/tungsten oxide aggregates at the electrolyte-electrode interface followed by template extraction and annealing yielded mesoporous thin films of electrochromic tungsten oxide (WO(3)). Electron microscopy images revealed that the films are characterized by a hitherto unreported hybrid structure comprising nanoparticles and nanorods with a tetragonal crystalline phase of WO(3) with the measured lattice parameters: a = 0.53 nm and c = 0.37 nm. In addition to pentagonal voids characteristic of the tetragonal WO(3) phase at the lattice scale, open channels and pores of 5-10 nm in diameter lie between the nanoparticles, which cumulatively promote rapid charge transport through the film. This resulted in colouration efficiency (η(max)∼90 cm(2) C(-1) at λ = 900 nm) and switching kinetics (colouration time =  3 s and bleaching time =  2 s for a 50% change in transmittance) higher and faster than previously reported values for mesoporous WO(3) films. Repetitive cycling between the clear and blue states has no deleterious effect on the electrochromic performance of the film, which is suggestive of its potential as a cathode in practical electrochromic windows.

Mortality rates due to diabetes in a selected urban south Indian population--the Chennai Urban Population Study [CUPS--16]

OBJECTIVE

The aim of this study was to determine the mortality rate in diabetic and non-diabetic subjects in urban south India.

METHODS

The Chennai Urban Population Study is an ongoing epidemiological study in Chennai [formerly Madras, in south India]. All individuals > or = 20 years of age living in two residential colonies in Chennai were invited to participate in the study. Of the total 1399 eligible subjects, 1262 individuals responded [90.2%] at baseline, and of these, 1140 individuals [90.3%] could be followed annually from 1997 to 2003-04. Mortality rates and causes of death were the main outcome measures.

RESULTS

The median follow up period was six years. The overall mortality rate was higher in diabetic compared to non-diabetic subjects [18.9 vs.5.3 per 1000 person-years, p=0.004]. Mortality due to cardiovascular [diabetic subjects, 52.9%; non-diabetic subjects, 24.2%,p=0.042] and renal causes[diabetic subjects, 23.5%; non-diabetic subjects, 6.1%,p=0.072] was higher among diabetic subjects whereas mortality due to gastrointestinal 112.1%], respiratory [9.1%], lifestyle related [6.1%] and unnatural causes [18.2%] were observed only among non-diabetic subjects. Hazards ratio [HR] for all cause mortality for diabetes was 3.6, [95% Confidence Interval [CI]: 2.02-6.53, p<0.001] and this remained significant even after adjusting for age [HR:1.9, 95% CI:1.04-3.45, p=0.038]. Light grade physical activity was associated with higher mortality rate [p=0.008], but the significance disappeared when adjusted for age. Smoking was also associated with increased mortality.

CONCLUSIONS

In urban India, mortality rates are two fold higher in people with diabetes compared to nondiabetic subjects. Cardiovascular and renal diseases are the commonest causes of death among diabetic subjects.

A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects

AIM

The aim of this study was to develop and validate a simplified Indian Diabetes Risk Score for detecting undiagnosed diabetes in India.

METHODS

The risk score was derived from the Chennai Urban Rural Epidemiology Study (CURES), an ongoing epidemiological study on a representative population of Chennai. Phase 1 of CURES recruited 26,001 individuals, of whom every tenth subject was requested to participate in Phase 3 for screening for diabetes using World Health Organization (WHO) 2 hour venous plasma glucose criteria [i.e. > or = 200 mg/dl]. The response rate was 90.4% (2350/2600). The Indian Diabetes Risk Score [IDRS] was developed based on results of multiple logistic regression analysis. Internal validation was performed on the same data.

RESULTS

IDRS used four risk factors: age, abdominal obesity, family history of diabetes and physical activity. Beta co-efficients were derived based on a multiple logistic regression analysis using undiagnosed diabetes as the dependent variable. The beta co-efficients were modified so as to obtain a maximum possible score of 100. Receiver Operating Characteristic [ROC] curves were constructed to identify the optimum value of IDRS for detecting diabetes by WHO consulting group criteria. Area under the curve for ROC was 0.698 (95% confidence interval (CI): 0.663-0.733). An IDRS value > or = 60 had the optimum sensitivity (72.5%) and specificity (60.1%) for determining undiagnosed diabetes with a positive predictive value of 17.0%, negative predictive value of 95.1%, and accuracy of 61.3%.

CONCLUSION

This simplified Indian Diabetes Risk Score is useful for identifying undiagnosed diabetic subjects in India and could make screening programmes more cost effective.

The Chennai Urban Rural Epidemiology Study (CURES)--study design and methodology (urban component) (CURES-I)

The report of World Health Organization (WHO) shows that India tops the world with the largest number of diabetic subjects. This increase is attributed to the rapid epidemiological transition accompanied by urbanization, which is occurring in India. There is very little data regarding the influence of affluence on the prevalence of diabetes and its complications particularly retinopathy in the Indian population. Furthermore, there are very few studies comparing the urban/rural prevalence of diabetes and its complications. The Chennai Urban Rural Epidemiology Study (CURES) is designed to answer the above questions. CURES is initially planned as a cross-sectional study to evolve later into a longitudinal study. Subjects for the urban component of the CURES have been recruited from within the corporation limits of Chennai City. Chennai (formerly Madras), the largest city in Southern India and the fourth largest in India has been divided into 10 zones and 155 wards. 46 wards were selected by a systematic random sampling method to represent the whole of Chennai. Twenty thousand and one individuals were recruited for the study, this number being derived based on a sample size calculation. The study has three phases. Phase one is a door to door survey which includes a questionnaire, anthropometric, fasting capillary blood glucose and blood pressure measurements. Phase two focussed on the prevalence of diabetic complications particularly retinopathy using standardized techniques like retinal photography etc. Diabetic subjects identified in phase one and age and sex matched non-diabetic subjects will participate in these studies. Phase three will include more detailed studies like clinical, biochemical and vascular studies on a sub-sample of the study subjects selected on a stratified basis from phase one. CURES is perhaps one of the largest systematic population based studies to be done in India in the field of diabetes and its complications like retinopathy, nephropathy and neuropathy.

Purification and characterization of a glycoprotein inhibitor of toxic phospholipase from Withania somnifera

A phospholipase inhibitor (WSG) has been purified from Withania somnifera using gel-filtration and ion-exchange chromatographies. The WSG is an acidic glycoprotein. Its molecular mass as determined by SDS-PAGE was 27kDa. It neutralized the enzyme activity and pharmacological properties such as cytotoxicity, edema, and myotoxicity of a multi-toxic Indian cobra venom phospholipase (NNXIa-PLA) but failed to neutralize the neurotoxicity. The glycan part of the molecule does not appear to be involved in any of the pharmacological properties studied. The results suggest that the neutralization of the pharmacological effects of the toxic phospholipase is brought about by inhibition of the enzyme activity by formation of a complex between the WSG and the toxic phospholipase. We report the purification and characterization of a glycoprotein phospholipase A inhibitor from Withania somnifera, medicinal plant.