Early diagnosis and prevention of diabetes in developing countries

Acute effects of a single bout structured resistance and combined exercise on blood glucose profile during exercise in patients with type 2 diabetes and healthy adults: A randomized crossover study

AIMS

The effects of postprandial resistance and combined exercise on blood glucose profiles, particularly in patients with type 2 diabetes, remain unclear. Comprehending these responses may aid in diabetes management.

METHODS

Three trials were conducted: trial A examined aerobic, resistance, and combined exercise; trials B and C focused on three intensities of resistance and combined exercise. Participants including patients with type 2 diabetes and healthy adults completed a randomized crossover experiment with two arrangements of three interventions and continuous glucose monitoring. Blood glucose iAUC and slope were analyzed via repeated measures two-way ANOVA.

RESULTS

A total of 21 patients with type 2 diabetes (47.81±11.88 years) and 26 healthy adults (31.77±6.66 years) were assigned. In trials A-C, the main effect of subject group on iAUC/min was significant (p＜0.001, p = 0.003, and p＜0.001). The exercise in trial A (p = 0.006) and subject group in trial C (p = 0.005) significantly impacted the blood glucose slope.

CONCLUSIONS

Resistance and combined exercise reduce postprandial hyperglycemia in type 2 diabetes patients. Monitoring glucose before exercise may help prevent extreme events.

Analyzing classification and feature selection strategies for diabetes prediction across diverse diabetes datasets

Introduction

In the evolving landscape of healthcare and medicine, the merging of extensive medical datasets with the powerful capabilities of machine learning (ML) models presents a significant opportunity for transforming diagnostics, treatments, and patient care.

Methods

This research paper delves into the realm of data-driven healthcare, placing a special focus on identifying the most effective ML models for diabetes prediction and uncovering the critical features that aid in this prediction. The prediction performance is analyzed using a variety of ML models, such as Random Forest (RF), XG Boost (XGB), Linear Regression (LR), Gradient Boosting (GB), and Support VectorMachine (SVM), across numerousmedical datasets. The study of feature importance is conducted using methods including Filter-based, Wrapper-based techniques, and Explainable Artificial Intelligence (Explainable AI). By utilizing Explainable AI techniques, specifically Local Interpretable Model-agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP), the decision-making process of the models is ensured to be transparent, thereby bolstering trust in AI-driven decisions.

Results

Features identified by RF in Wrapper-based techniques and the Chi-square in Filter-based techniques have been shown to enhance prediction performance. A notable precision and recall values, reaching up to 0.9 is achieved in predicting diabetes.

Discussion

Both approaches are found to assign considerable importance to features like age, family history of diabetes, polyuria, polydipsia, and high blood pressure, which are strongly associated with diabetes. In this age of data-driven healthcare, the research presented here aspires to substantially improve healthcare outcomes.

Improving the in vivo stability and sensor lifetime with new blend membranes on CGM sensors

PDMS/HT outer membrane-coated CGM sensors can extend the in vivo lifetime to 28 days.

Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program

Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program-providing comprehensive, continuous medical care-has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002-2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.

Prevalence and associated factors of prediabetes in adult East African population: A systematic review and meta-analysis

Introduction

Diabetes mellitus is a major public health problem with serious consequences, and more than three-fourths of diabetes live in low- and middle-income countries. According to a recent study, people with prediabetes have nearly six times the risk of developing diabetes than those with normal glucose levels. However, due to the inconsistency and absence of representative data, this study aimed to estimate the prevalence of prediabetes and its associated factors in the adult East African population.

Methods

Databases were systematically searched for articles published between January 1, 2013, and December 30, 2022. All observational community-based studies that reported prediabetes prevalence and/or associated factors in adult East African populations were included in the meta-analyses. Three authors independently extracted all required data using the Excel data extraction format and analyzed using Stata™ Version 11. An I2 test was conducted to determine significant heterogeneity. Finally, a random effects model was used to determine the overall prevalence of prediabetes and its associated factors. The study was registered with Prospero number CRD42023389745.

Results

The search strategy identified 267 articles. After screening for full-text review, twenty-one articles were included in the final analysis. The overall prevalence of prediabetes was 12.58 % (95 % CI:10.30, 14.86 %) in the adult East African population. Furthermore, the subgroup analysis revealed that prediabetes in the urban population 20 % (95 % CI: 1.60, 38.37) was twice as prevalent as in rural 10.0 % (95 % CI: 5.52, 14.48) populations. The prevalence of prediabetes by the ADA diagnostic criteria was 21.45 % (95 % CI: 15.54, 27.35) three times higher than the WHO 7.20 % (95 % CI: 5.70, 8.69). Moreover, prediabetes was significantly associated with old age (OR = 1.64, 95 %, CI: 1.07, 2.53), hypertension (OR = 2.43, 95 %, CI: 1.02-5.79), obesity and overweight (OR = 1.70, 95 %, CI: 1.09,2.65).

Conclusion

This study showed a high prevalence of prediabetes, which was significantly associated with old age, hypertension, and high BMI. This study suggests that health policymakers should pay attention to the prevention and control strategies that is targeted at those with obesity, hypertension, and old age.

Hypertension and diabetes patients' perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda - a qualitative study

Background: In sub-Saharan Africa, the burden of non-communicable diseases is steadily rising amidst a high prevalence of communicable diseases stretching the healthcare system. This study explored hypertension and diabetes patients' perspective of challenges and their coping mechanisms in Mukono and Buikwe districts in Uganda. Methods: This descriptive qualitative study involved four focus group discussions with 26 patients at four selected health facilities. All interviews were audio recorded, transcribed verbatim and data analysed following the thematic content analysis guided by the semantic approach with the aid of Atlas ti 6.0.15 software. Results: Five themes were identified regarding challenges and coping mechanisms of patients in managing their conditions. 1) Inadequate opportunities for diagnosis, with community screening supporting identification of patients. 2) Accessing care came amidst transport challenges, absence of health workers and the lack of essential supplies for monitoring conditions. Patients borrowed transport funds or trekked to health facilities and some formed groups to contribute resources to buy equipment and supplies. 3) Access to medications was affected by frequent drug stockouts at public health facilities which pushed patients to purchase own drugs or obtain these through friends and networks. However, other patients resorted to cheaper herbal remedies. 4) Monitoring and managing conditions was affected by insufficient knowledge and opportunities for self-monitoring. Information from health workers and experiences from peers bridged the knowledge gap while private facilities or community health workers supported self-monitoring. 5) Adopting changes in behaviour was challenging but patients fitted these within their usual routines and mobilised family members to also adopt lifestyle changes while ignoring those they deemed unrealistic. Conclusions: The coping mechanisms patients adopted to manage their chronic conditions reflects self-care initiatives at the individual and community levels which could be reinforced and supplemented to better support and empower patients as steps are taken to address existing challenges.

Prevalence of prediabetes and associated factors among community members in rural Isingiro district

BACKGROUND

In rural Uganda a significant number of persons afflicted with pre-diabetes are unaware of the condition. This is likely to lead to diabetic complications resulting in catastrophic health expendirure.The burden of prediabetes in rural Isingiro has not previously been determined. This study examined the prevalence of prediabetes and the associated factors among rural community members.

METHODS

We conducted a cross-sectional survey and enrolled 370 participants aged between 18 and 70 years in the Kabuyanda sub-county, rural Isingiro district in march 2021. Multistage sampling and systematic random sampling were conducted to select eligible households. Data was collected using a pretested WHO STEP-wise protocol questionnaire. The primary outcome was prediabetes (FBG = 6.1mmol/l to 6.9mmol/l), calculated as a proportion. Participants known to be diabetic or on medication were excluded. Chi-square tests and multivariate logistic regression model were performed for data analysis using STATA.

RESULTS

The prevalence of prediabetes was 9.19% (95% CI 6.23-12.14). Independent factors significantly associated with pre-diabetes were; advancing age [AOR = 5.7, 95% CI:1.03-32.30], moderate-intensity work [AOR = 2.6,95% CI:1.23-5.63], high level of consumption of a healthy diet [AOR = 5.7, 95% CI:1.67-19.05] and body mass index [AOR = 3.7, 95% CI:1.41-9.20].

CONCLUSION

Prediabetes is prevalent among adult community members in rural Isingiro, southwestern Uganda. Age and lifestyle factors predict prediabetes in this rural population, suggesting a need for targeted health promotion interventions.

RFFE - Random Forest Fuzzy Entropy for the classification of Diabetes Mellitus

Diabetes is a category of metabolic disease commonly known as a chronic illness. It causes the body to generate less insulin and raises blood sugar levels, leading to various issues and disrupting the functioning of organs, including the retinal, kidney and nerves. To prevent this, people with chronic illnesses require lifetime access to treatment. As a result, early diabetes detection is essential and might save many lives. Diagnosis of people at high risk of developing diabetes is utilized for preventing the disease in various aspects. This article presents a chronic illness prediction prototype based on a person's risk feature data to provide an early prediction for diabetes with Fuzzy Entropy random vectors that regulate the development of each tree in the Random Forest. The proposed prototype consists of data imputation, data sampling, feature selection, and various techniques to predict the disease, such as Fuzzy Entropy, Synthetic Minority Oversampling Technique (SMOTE), Convolutional Neural Network (CNN) with Stochastic Gradient Descent with Momentum (SGDM), Support Vector Machines (SVM), Classification and Regression Tree (CART), K-Nearest Neighbor (KNN), and Naïve Bayes (NB). This study uses the existing Pima Indian Diabetes (PID) dataset for diabetic disease prediction. The predictions' true/false positive/negative rate is investigated using the confusion matrix and the receiver operating characteristic area under the curve (ROCAUC). Findings on a PID dataset are compared with machine learning algorithms revealing that the proposed Random Forest Fuzzy Entropy (RFFE) is a valuable approach for diabetes prediction, with an accuracy of 98 percent.

The effects of Gymnema Sylvestre supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults: A systematic review and meta-analysis

There is a growing interest in the considerable health benefits of Gymnema Sylvestre (GS) supplementation, as some studies have reported that it may improve cardiometabolic risk factors. However, the widespread impact of GS supplementation on the parameters mentioned above is not fully resolved. Consequently, this study aimed to examine the effects of GS supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults. Eligible randomized controlled trials (RCT), published up to November 2021, were identified through PubMed, Scopus, and ISI Web of Science databases. Six studies were included and analyzed using a random-effects model to calculate weighted mean differences (WMDs) with 95% confidence intervals (CI). All studies were conducted in adults that used a GC supplement (>1 week) and assessed our selected cardiovascular risk factors. Outcomes revealed that GS supplementation significantly decreased triglyceride (p < .001), total cholesterol (p < .001), low-density lipoprotein (p < .001), fasting blood sugar (p < .001), and diastolic blood pressure (p = .003). Some limitations, including notable heterogeneity, low quality of studies, and lack of diversity among research participants, should be considered when interpreting our results. Our outcomes suggest that GS supplementation may improve cardiovascular risk factors. Future large-high-quality RCTs with longer duration and various populations are needed to firmly establish the clinical efficacy of the plant.

Dapagliflozin Improves Diabetic Cardiomyopathy by Modulating the Akt/mTOR Signaling Pathway

Background

Dapagliflozin can significantly improve heart failure, and Cx43 is one of the molecular mechanisms of heart failure. This study investigated the effect of dapagliflozin on Cx43 and Akt/mTOR signaling pathway in ventricular myocytes.

Methods

A rat model of type 2 diabetes mellitus was established by high-fat diet combined with streptozotocin, and the animals were treated randomly with dapagliflozin. The morphological changes of the myocardium were observed by hematoxylin eosin staining, and the expression and distribution of Cx43 in ventricular myocytes were detected by immunohistochemistry. And Western blot determined the expressions of Cx43, Akt, mTOR, p62, and LC3 proteins in rat myocardium.

Results

Compared with the normal control group, the heart rate of diabetic rats decreased significantly (p < 0.05), QRS wave of ECG widened, and QT interval prolonged (p < 0.05). Dapagliflozin treatment in diabetic rats resulted in improvements in these ECG indexes (p < 0.05) with early administration group obtaining greater efficacy than the late administration group (p < 0.05). In the normal control group, the cardiomyocytes were arranged orderly, and the expression of Cx43 was dense, uniform, and regular, which was higher than that in the intercalated disc. In the diabetic control model group, the cardiomyocytes were enlarged and presented disorderly with detection of Cx43 in the cytoplasm. Early use of dapagliflozin better improved these myocardial tissue lesions. Of note, as diabetic rats exhibited decreased expression of Cx43, Akt, and mTOR (p < 0.05), increased p62 expression (p < 0.05), and decreased LC3-II/I ratio (p < 0.05), administration of dapagliflozin partially reversed the expression of the above proteins (p < 0.05) with greater improvement in the early administration group compared with the late administration group (p < 0.05).

Conclusions

Dapagliflozin increases the expression of Cx43 in cardiomyocytes of diabetic rats and thereby alleviates heart failure partly through regulating the Akt/mTOR signaling pathway.

Extracellular vesicles-incorporated microRNA signature as biomarker and diagnosis of prediabetes state and its complications

Extracellular vesicles (EVs) are small anuclear vesicles, delimited by a lipid bilayer, released by almost all cell types, carrying functionally active biological molecules that can be transferred to the neighbouring or distant cells, inducing phenotypical and functional changes, relevant in various physio-pathological conditions. The microRNAs are the most significant active components transported by EVs, with crucial role in intercellular communication and significant effects on recipient cells. They may also server as novel valuable biomarkers for the diagnosis of metabolic disorders. Moreover, EVs are supposed to mediate type 2 diabetes mellitus (T2DM) risk and its progress. The T2DM development is preceded by prediabetes, a state that is associated with early forms of nephropathy and neuropathy, chronic kidney disease, diabetic retinopathy, and increased risk of macrovascular disease. Although the interest of scientists was focused not only on the pathogenesis of diabetes, but also on the early diagnosis, little is known about EVs-incorporated microRNA involvement in prediabetes state and its microvascular and macrovascular complications. Here, we survey the biogenesis, classification, content, biological functions and the most popular primary isolation methods of EVs, review the EVs-associated microRNA profiling connexion with early stages of diabetes and discuss the role of EVs containing specific microRNAs in prediabetes complications.

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico

OBJECTIVES

The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs.

DESIGN

Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control.

SETTING

Public primary health centres in 27/32 Mexican states.

PARTICIPANTS

Individuals aged ≥20 years lacking healthcare access.

RESULTS

From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61).

CONCLUSION

Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.

The effect of Gymnema sylvestre supplementation on glycemic control in type 2 diabetes patients: A systematic review and meta-analysis

This systematic review and meta-analysis aims to find the effect of Gymnema sylvestre (GS) supplementation on glycemic control in type-2 diabetes mellitus (T2DM). PubMed, Cochrane library, Google Scholar, and Science Direct were searched from inception to June 2020 to identify the studies that reported GS supplementation on glycemic parameters. Standardized mean difference (SMD) was calculated by comparing the post-intervention data with baseline data. SMDs with 95% confidence intervals (CIs) were pooled using a random-effects model. Our meta-analysis consisting of 10 studies with a total of 419 participants showed that GS supplementation significantly reduces fasting blood glucose (FBG) (SMD 1.57 mg/dl, 95% CI 2.22 to -0.93, p < .0001, I² 90%), postprandial blood glucose (PPBG) (SMD 1.04 mg/dl, 95% CI 1.53 to -0.54, p < .0001, I² 80%), and glycated haemoglobin (HbA1c) (SMD 3.91, 95% CI 7.35 to -0.16%, p < .0001, I² 99%) compared to baseline. Further, our study also found that GS significantly reduces triglycerides (SMD 1.81 mg/dl, 95% CI 2.95 to -0.66, p < .0001, I² : 96%), and total cholesterol (SMD 4.10 mg/dl, 95% CI 7.21 to -0.99, p < .0001, I² : 98%) compared to baseline. Our study shows that GS supplementation is effective in improving glycemic control and reducing lipid levels in T2DM patients and suggests that such supplementation might be used as an effective therapy for the management of T2DM and its associated complications to an extent.

Loss of the tRNALysCUU encoding gene, Chr-11 tRNA-Lys-CUU, is not associated with Type 2 diabetes mellitus

AIM

To investigate the presence/absence of the Chr-11 tRNA-Lys-CUU gene as a marker for genetic predisposition to Type 2 diabetes mellitus (T2DM).

METHODS

We enrolled 122 patients diagnosed with T2DM and 77 non-diabetic individuals. We evaluated clinical and biochemical parameters (body mass index, hypertension, cholesterol levels, glycosylated hemoglobin, triglycerides, etc.), and performed a genotypic profiling of Chr-11 tRNA-Lys-CUU by polymerase chain reaction analyses.

RESULTS

Approximately one third of the population lacked Chr-11 tRNA-Lys-CUU. We did not observe a statistically significant association between the presence/absence of Chr-11 tRNA-Lys-CUU and T2DM.

CONCLUSION

The genotypic distribution of Chr-11 tRNA-Lys-CUU in our population was consistent to that reported by others. This gene failed as a marker for T2DM predisposition.

Prevalence and factors associated with dysglycemia among girls in selected boarding secondary schools in Wakiso District, Uganda

BACKGROUND

There is limited information on dysglycemia in adolescents in low-income countries. The objective of this study was to determine the prevalence and factors associated with dysglycemia among boarding secondary school adolescent girls in a peri-urban district.

METHODS

The design was a cross-sectional survey. A total of 688 adolescents from four randomly selected girls-only boarding secondary schools in Wakiso District, Uganda, participated in this study. Fasting plasma glucose, body mass index (BMI), and blood pressure (BP) were measured. A questionnaire was used to assess demographic and lifestyle factors. Suspected dysglycemia was defined using the American Diabetes Association cutoff of fasting glucose ≥5.6 mmol/L. Overweight and hypertension were defined being above two SDs or the 95th percentile of the WHO BMI for age and BP for age reference charts, respectively. Logistic regression was used to determine the factors independently associated with dysglycemia.

RESULTS

The mean age of the participants was 15.4 years (SD=1.7 years). Probable dysglycemia was found in 44 of 688 (6.4%) participants, ranging from 3.5% in the least affluent school to 9.8% in the most affluent school. No case of type 2 diabetes was found. 11.6% of the participants were found to have probable hypertension. Dysglycemia was higher in adolescents who were overweight (adjusted OR [AOR] 2.3; 95% CI 1.22-4.48), those with hypertension (AOR 4.0; 95% CI 1.86-8.45), and those who frequently stocked biscuits (AOR 3.0; 95% CI 1.21-7.28). Dysglycemia was lower in older adolescents (AOR 0.3; 95% CI 0.10-0.86) and those who took water with meals (AOR 3.0; 95% CI 1.21-7.28).

CONCLUSION

In these predominantly peri-urban boarding secondary schools, 6.4% of the adolescent girls have probable dysglycemia. As Africa undergoes the epidemiological transition, there is a need for closer surveillance for diabetes and hypertension in peri-urban schools and school health measures against lifestyle diseases.

Prevalence and factors associated with pre-diabetes and diabetes mellitus in Kenya: results from a national survey

BACKGROUND

Diabetes Mellitus is one of the four major non-communicable diseases causing about 4 million deaths in 2017. By 2040, low income countries are projected to experience 92% increase in mortality due to diabetes. Undiagnosed diabetes poses a public health concern with costly public health implications especially in Africa. It is therefore crucial to examine the burden and risk factors for diabetes at national level to inform policy and national programs.

METHODS

Data from the 2015 Kenya national STEPs survey of adults aged 18-69 years were used. Pre-diabetes was defined as impaired fasting blood glucose level (6.1 mmol/l to < 7 mmol/l) while diabetes was defined as impaired fasting blood glucose level ≥ 7 mmol/l. Descriptive statistics were used to determine the prevalence of pre-diabetes and diabetes and logistic regression was used to identify associated factors.

RESULTS

Complete data for 4069 respondents (51% females), with 46% aged 18-29 and 61% in rural areas were analyzed. The age-standardized prevalence for pre-diabetes and diabetes were 3.1% (95% CI: 2.2, 4.0) and 2.4% (1.8, 3.0) respectively. Only 43.7% were aware of their glycemic condition, one in five of those who had diabetes had received treatment, and only 7% of those diagnosed with diabetes had their blood glucose under control. Primary education ((both incomplete (0.21, 95%CI 0.10-0.47) and complete (0.40, 95%CI 0.23-0.71)) were associated with lower odds of pre-diabetes. Older age (60-69 years, AOR; 5.6, 95%CI 2.1-15.1) and raised blood pressure (2.8, 95% CI 1.5-5.0) were associated diabetes while overweight/obesity among women was associated with diabetes.

CONCLUSION

The overall diabetes prevalence in Kenya is consistent with what has been reported in other sub-Saharan African countries. Of concern is the higher prevalence of pre-diabetes and undiagnosed diabetes that can progress to complications in the absence of interventions and the low diabetes awareness and control. This is the first nationally representative study to identify important groups at risk of pre-diabetes and diabetes that can be targeted for screening, health promotion and treatment.

Clinical presentation of newly diagnosed diabetes patients in a rural district hospital in Eastern Uganda

Background

Our objective was to describe the clinical presentation of new diabetes patients in a rural hospital, to enhance clinical detection in low resource settings.

Methods

A case series assessment of 103 new diabetes patients consecutively enrolled at Iganga Hospital in rural Eastern Uganda was conducted. All underwent a basic clinical assessment through the clinic's routine procedures. Following diagnosis, variables pertinent to the study (symptoms, blood pressure, anthropometry, and blood glucose) were secondarily abstracted from their clinical records.

Results

Fiftty two percent of new diabetes patients were female. The mean age was 49 years (SD=14.4). Two clinical symptoms were present in almost all new patients: Frequent urination (100%) and frequent thirst (79%). Moderately occurring symptoms (i.e. 25–50% of patients) included blurred vision, frequent eating and frequent sweating. The mean duration of symptoms was 1.4 years; 48% had high blood pressure while 46% were overweight. Random blood sugar was normal for 25% of patients. The majority (71%) were classified as having ‘moderate illness' at diagnosis. Severe illness was significantly lower among patients aged 40 or older compared to younger patients (OR 0.1; 95% CI 0.03–0.35).

Conclusion

Out-patients aged 40–65 years should be prioritised for early diabetes diagnosis and associated risk factors in this setting.

Value of EZSCAN parameters for diabetes screening in Chinese

OBJECTIVE

To study the parameters of EZSCAN as a screening tool for diabetes in Chinese.

METHODS

A total of 6,270 subjects participated in the study. All subjects underwent tests of EZSCAN, fasting plasma glucose (FPG), oral glucose tolerance test and HbA_1c.

RESULTS

1. All subjects were divided into 4 groups: the normal group, sugar metabolic abnormalities as low-risk group, middle-risk group and high-risk group. The difference of diabetes incidence among the 4 groups was statistically significant. With the increase of EZSCAN score, the prevalence of diabetes increased significantly. But there is no statistically difference between the low-risk group and the middle-risk group. 2. After adjustment for other variables, there is significantly positive relationship among EZSCAN risk score and the risk of diabetes. Meanwhile there is no statistically difference between the low-risk group and the middle-risk group. 3. The cut-off point of EZSCAN for diabetes was 44.5% with the sensitivity was 73.2% which was higher than of FPG and HbA_1c.

CONCLUSION

As EZSCAN-diabetes risk score increases, the risk of diabetes increases. EZSCAN can be used as a tool for screening for diabetes. At the best screening diabetes cut-off point value 44.5%, the sensitivity is higher than traditional method of FPG and HbA_1c.

Antioxidant, antiglycation and insulinotrophic properties of Coccinia grandis (L.) in vitro: Possible role in prevention of diabetic complications

In an attempt to develop Complementary and Alternative Medicine (CAM) for the treatment of diabetes and related complications, the antidiabetic potential of the mature unripe fruits of Coccinia grandis (CGF) was evaluated. Oxidative stress and glycation plays an important role in manifesting of diabetes and vascular complications. Agents with antioxidant and antiglycation properties may retard these pathological alterations. In this study, the edible plant Coccinia grandis was assessed for in vitro estimation of antioxidant and antiglycation potential and its insulinotrophic properties in RINm5F cells. Antioxidant activity was evaluated as DPPH (1,1-diphenyl-2-picrylhydrazyl), hydrogen peroxide and superoxide anion scavenging activities, whereas the protein glycation inhibitory potential was evaluated using in vitro albumin-fructose glycation model. Glycation inhibition was estimated by different biochemical parameters viz. fructosamine, protein carbonyl group and protein aggregation using thioflavin T fluorescence. C. grandis extract exerted a dose dependent radical scavenging activity and exhibited a significant antiglycation potential. The extract also showed a significant insulinotrophic property with 1.28 and 1.71-fold increase in insulin release when compared to control at 0.25 and 0.50 mg/mL, respectively. These data suggest the possible antidiabetic role of CGF extract, presumably by its antioxidant, antiglycation and insulin secretory effects. Present findings provide experimental evidence that the fruits of C. grandis have potential antidiabetic activity which might be used as a functional food and safe remedy for the treatment of diabetes and associated complications. This study also revealed that the plant can be a promising source for development of natural antiglycating agents and novel insulin secretagogues.

Adapting existing diabetes risk scores for an Asian population: a risk score for detecting undiagnosed diabetes in the Mongolian population

Background

Most of the commonly used diabetes mellitus screening tools and risk scores have been developed with American or European populations in mind. Their applicability, therefore, to low and middle-income countries remains unquantified. Simultaneously, low and middle-income countries including Mongolia are currently witnessing rising diabetes prevalence. This research aims to develop and validate a diabetes risk score for the screening of undiagnosed type 2 diabetes mellitus in the Mongolian adult population.

Methods

Blood glucose measurements from 1018 Mongolians, as well as information on demography and risk factors prevalence was drawn from 2009 STEPS data. Existing risk scores were applied, measuring sensitivity using area under ROC-curves. Logistic regression models were used to identify additional independent predictors for undiagnosed diabetes. Finally, a new risk score was developed and Hosmer-Lemeshow tests were used to evaluate the agreement between the observed and predicted prevalence.

Results

The performance of existing risk scores to identify undiagnosed diabetes was moderate; with the area under ROC curves between 61–64 %. In addition to well-established risk factors, three new independent predictors for undiagnosed diabetes were identified. Incorporating these into a new risk score, the area under ROC curves increased to 77 % (95 % CI 71 %–82 %).

Conclusions

Existing European or American diabetes risk tools cannot be adopted in Asian countries without prior validation in the specific population. With this in mind, a low-cost, reliable screening tool for undiagnosed diabetes was developed and internally validated for Mongolians. The potential for cost and morbidity savings could be significant.

Antiproliferative and Apoptotic Effects of Shemamruthaa, a Herbal Preparation, in 7,12-Dimethylbenz(a)Anthracene-Induced Breast Cancer Rats

A herbal preparation, Shemamruthaa (SM), was formulated to investigate the molecular mechanism by which it exhibits anticancer effects in mammary carcinoma bearing rats. Female Sprague-Dawley rats were used for the study, and mammary carcinoma was induced by administration of 7,12-dimethylbenz(a)anthracene, intragastrically. After 3 months of induction period, the rats were treated with SM (400 mg/kg body weight) for 14 days. Our study shows that SM-treated mammary carcinoma rats showed regression in tumor volume with concomitant increase in p(53), Bax, caspase-3, and caspase-9 mRNA and protein levels compared with mammary carcinoma-induced rats. Proliferating cell nuclear antigen and anti-apoptotic Bcl-2 were markedly increased in mammary carcinoma-induced rats, whereas the SM treatment significantly decreased the expression of these proteins. The expression pattern of apoptotic signaling molecules analyzed in the present study signifies the therapeutic efficacy of SM against breast cancer.

Evaluating the performance of the Framingham Diabetes Risk Scoring Model in Canadian electronic medical records

OBJECTIVE

The objective of this study was to evaluate the performance of the Framingham Diabetes Risk Scoring Model (FDRSM) in a Canadian population, using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database.

METHODS

We analyzed the records of 571 631 patients, between the ages of 45 and 64, between 2002 and 2005, by extracting the most recent laboratory and examination results, including age, sex, body mass index, fasting blood glucose, high-density lipoprotein, triglycerides and blood pressure. We calculated the risk scores of these patients based on the FDRSM. We tracked these patients for 8 years to find out whether or not they were diagnosed with diabetes. We used the area under the receiver operating characteristics curve (AROC) to estimate the discrimination capability of the FDRSM on our study sample and compared it with the AROC reported in the original Framingham diabetes study.

RESULTS

The AROC for our main research sample of 1970 patients for whom all risk factors and follow-up data were available was 78.6% compared to the AROC of 85% reported in the FDRSM. We found that 70.1% of our main sample had risks lower than 3%; 16.3% had risks between 3% and 10%; and 13.6% had risks greater than 10% for diabetes over the following 8-year period.

CONCLUSIONS

The discrimination capability of the FDRSM Canadian electronic medical records is fair. However, building a more accurate model for predicting diabetes based on the characteristics of Canadian patients is highly recommended.

Patients' perspectives of care for type 2 diabetes in Bangladesh -a qualitative study

BACKGROUND

Worldwide, type 2 diabetes affects approximately 220 million people and is the cause of 1.1 million deaths each year, 80% of which occur in low and middle income countries (LMICs). Over the next 20 years, prevalence is expected to double worldwide and increase by 150% in LMICs. There is now a move towards improving care for diabetes. However no information on patients' needs, perceptions and experiences is available, hindering effective and appropriate changes in policy and practice. We developed a study with the objective of understanding patients' experiences of treatment for type 2 diabetes.

METHODS

During January 2011, we conducted in-depth interviews in five sites across two administrative districts of Bangladesh, purposefully chosen to represent different geographic regions and local demographics In total, we conducted 23 (14 male, 9 female) individual interviews across the 5 sites, to gain insight into patients' understanding of their diabetes and its management.

RESULTS

Patients' levels of knowledge and understanding about diabetes and its management is depended on where they received their initial diagnosis and care. Away from specialist centres, patients had poor understanding of the essential of diabetes and its management. No appropriate written or verbal information was available for a significant number of patients, compounded limited knowledge and understanding of diabetes by healthcare professionals. Patients felt that with improved provision of appropriate information they would be able to better understand their diabetes and improve their role in its management. Access to appropriate diagnosis and subsequent treatment was restricted by availability and costs of services.

CONCLUSION

Effective, appropriate and essential healthcare services for diabetes in Bangladesh is extremely limited, a majority of patients receive suboptimal care. Site of diagnosis will impact significantly on the quality of information provided and the quality of subsequent treatments. Although appropriate services are available at some specialist centres, the inability of patients to pay for routine tests and check-ups prevents them from receiving timely diagnoses and appropriate continuity of care. The double burden of communicable diseases and diseases is now a well-recognised. Emphasis must be placed on developing appropriate and effective preventive strategies to address this burden.

How diabetes risk assessment tools are implemented in practice: a systematic review

This review aimed to explore the extent of the use of diabetes risk assessment tools and to determine influential variables associated with the implementation of these tools. CINAHL, Google Scholar, ISI Citation Indexes, PubMed, and Scopus were searched from inception to January 2013. Studies that reported the use of diabetes risk assessment tools to identify individuals at risk of diabetes were included. Of the 1719 articles identified, 24 were included. Follow-up of high risk individuals for diagnosis of diabetes was conducted in 5 studies. Barriers to the uptake of diabetes risk assessment tools by healthcare practitioners included (1) attitudes toward the tools; (2) impracticality of using the tools and (3) lack of reimbursement and regulatory support. Individuals were reluctant to undertake self-assessment of diabetes risk due to (1) lack of perceived severity of type 2 diabetes; (2) impracticality of the tools; and (3) concerns related to finding out the results. The current use of non-invasive diabetes risk assessment scores as screening tools appears to be limited. Practical follow up systems as well as strategies to address other barriers to the implementation of diabetes risk assessment tools are essential and need to be developed.

A systematic review of Gymnema sylvestre in obesity and diabetes management

The prevalence of obesity is associated with many health-related problems. Currently, more than 300 million people are considered to be obese. According to the World Health Organization (WHO), by 2030, 87 and 439 million people will be affected in India and the world, respectively. Today, herbal medicines are gaining interest in the treatment of obesity and diabetes, because of their minimal side effects. Gymnemic acid - an active component isolated from Gymnema sylvestre - has anti-obesity and antidiabetic properties, decreases body weight and also inhibits glucose absorption. Several components extracted from Gymnema prevent the accumulation of triglycerides in muscle and liver, and also decrease fatty acid accumulation in the circulation. In this paper, an attempt has been made to review the effects of various extracts from Gymnema sylvestre in the regulation of carbohydrate and lipid metabolism in both animal and clinical studies.

Diabetes and pre-diabetes among persons aged 35 to 60 years in eastern Uganda: prevalence and associated factors

Background

Our aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and pre-diabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa.

Methods

A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call® Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG ≥6.1mmol L^-1 (World Health Organization (WHO) criteria or ≥5.6mmol L^-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L^-1, or being on diabetes treatment.

Results

The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95%CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95%CI 7.3-10.2) using WHO criteria and 20.2% (95%CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95%CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95%CI 0.4-0.9; APRR 0.6, 95%CI 0.4-0.8; APRR 0.5, 95%CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs.

Conclusions

There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary.

Evaluation of EZSCAN as a screening tool for impaired glucose metabolism

AIMS

To evaluate the performance of EZSCAN as a screening tool for impaired glucose metabolism (IGM), including impaired glucose tolerance, impaired fasting glucose and undiagnosed diabetes in a Chinese population.

METHODS

876 subjects participated in the study. All subjects underwent tests of EZSCAN, glycated hemoglobin, fasting plasma glucose (FPG), and oral glucose tolerance test (OGTT). Correlation of electrical skin conductance (ESC) with glucose level was evaluated by Pearson correlation coefficient. EZSCAN performance was assessed by receiver operating characteristic curve.

RESULTS

Among the 876 subjects, 53% had normal glucose tolerance (NGT), and 47% had IGM. The ESC for the hands and feet was 72 ± 10 μS and 75 ± 7 μS, respectively, in NGT group; and 64 ± 13 μS and 67 ± 11 μS, respectively, in IGM group. The ESC at hands and feet was significantly correlated with both 2h-OGTT and FPG (p<0.001). NGT group demonstrated a EZSCAN score of 33 ± 11%, which is significantly lower than that of IGM group (44 ± 12%, p<0.001). The cut-off point of EZSCAN for IGM detection was 40% with a sensitivity of 80% and a specificity of 72%.

CONCLUSIONS

EZSCAN is a useful screening tool for identifying subjects at increased risk for impaired glucose metabolism in prediabetes and diabetes. Diagnostic laboratory test should be performed in subjects with EZSCAN scores greater than 40%.

Molecular Mechanism Underlying the Antidiabetic Effects of a Siddha Polyherbal Preparation in the Liver of Type 2 Diabetic Adult Male Rats

A siddha polyherbal preparation consisting of 5 medicinal plants, namely, Asparagus racemosus, Emblica officinalis, Salacia oblonga, Syzygium aromaticum, and Tinospora cordifolia, in equal ratio, was formulated to examine the molecular mechanism by which it exhibits antidiabetic effects in the liver of high-fat and fructose-induced type 2 diabetic rats. The polyherbal preparation treated type 2 diabetic rats showed an increase in insulin receptor, Akt, and glucose transporter2 mRNA levels compared with diabetic rats. Insulin receptor, insulin receptor substrate-2, Akt, phosphorylated Akt substrate of 160kDaThreonine642, α-Actinin-4, β-arrestin-2, and glucose transporter2 proteins were also markedly decreased in diabetic rats, whereas the polyherbal preparation treatment significantly improved the expression of these proteins more than that of metformin-treated diabetic rats. The expression pattern of insulin signaling molecules analyzed in the present study signifies the therapeutic efficacy of the siddha polyherbal preparation.