Burden of undiagnosed and suboptimally controlled diabetes in selected regions of India: Results from the SMART India population-level diabetes screening study

Risk assessment of diabetes using the Indian Diabetes Risk Score among older adults: Secondary analysis from the Longitudinal Ageing Study in India

BACKGROUND

The Indian Diabetes Risk Score (IDRS) is a simple tool to assess the probability of an individual having type 2 diabetes (T2DM) but its applicability in community-dwelling older adults is lacking. This study aimed to estimate the risk of T2DM and its determinants among older adults without prior diabetes (DM) using the IDRS, while also assessing its sensitivity and specificity in individuals with a history of diabetes.

METHODS

We analyzed cross-sectional data from the Longitudinal Ageing Study in India (LASI) wave-1 (2017-18). IDRS was calculated amongst individuals aged ≥45 years considering waist circumference, physical activity, age and family history of DM. Risk was categorized as high (≥60), moderate (30-50), and low (<30).

RESULTS

Among 64541 individuals, 7.27 % (95 % CI: 6.78, 7.80) were at low risk, 61.80 % (95 % CI: 60.99, 62.61) at moderate risk, and 30.93 % (95 % CI: 30.19, 31.67) at high risk for T2DM. Adjusted analysis showed higher risk of T2DM among men, widowed/divorced, urban residents, minority religions, overweight, obese, and individuals with hypertension. ROC curve yielded an AUC of 0.67 (95 % CI: 0.66, 0.67, P < 0.001). The IDRS cutoff ≥50 had 73.69 % sensitivity and 51.40 % specificity for T2DM detection.

CONCLUSION

More than 9 in 10 older adults in India without history of DM have high-moderate risk of T2DM when assessed with the IDRS risk-prediction tool. However, the low specificity and moderate sensitivity of IDRS in existing DM cases constraints its practical utility as a decision tool for screening.

Rural-urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians

INTRODUCTION

Hypertension and diabetes are modifiable risk factors for dementia. We aimed to assess rural-urban disparities in the diagnosis and treatment of these conditions among aging Indians.

METHODS

Participants (n = 6316) were from two parallel, prospective aging cohorts in rural and urban India. Using self-report and clinical/biochemical assessments, we subdivided participants with diabetes and hypertension into undiagnosed and untreated groups. Logistic regression and Fairlie decomposition analysis were the statistical methods utilized.

RESULTS

There was a significant rural-urban disparity in undiagnosed hypertension (25.14%), untreated hypertension (11.75%), undiagnosed diabetes (16.94%), and untreated diabetes (11.62%). Further, sociodemographic and lifestyle factors, such as age and tobacco use were the common contributors to the disparities in both undiagnosed hypertension and undiagnosed diabetes, whereas education and body mass index (BMI) were significant contributors to the disparity in untreated hypertension.

DISCUSSION

Rural Indians face significant healthcare disadvantages as compared to their urban counterparts, which prompts the urgent need for strategies for equitable healthcare.

Evaluating Tumor Necrosis Factor (TNF)-Alpha Pro-inflammatory Cytokines in Healthy and Oral Squamous Cell Carcinoma Patients With and Without Diabetes

Background Tumor necrosis factor-alpha (TNF-α) has a pivotal role in the pathogenesis and prognosis of cancer as well as diabetes mellitus (DM). Many oral squamous cell carcinoma (OSCC) patients are reported to have associated comorbidities such as type 2 diabetes mellitus (T2DM). Furthermore, T2DM exaggerates inflammation due to a lack of insulin action. Therefore, OSCC patients with T2DM may progress to the advanced stage more rapidly resulting in reduced survival even after glycemic control creating a challenge to oncologists in managing these patients. Unfortunately, it is difficult to predict the course of disease in these patients just based on clinical and radiological parameters. Considering the impact of TNF alpha in both disease progression, it is an interesting biological marker to explore. Further, saliva being a noninvasive biological fluid can help measure the TNF-α levels, thereby predicating the prognosis of OSCC. Unfortunately, there is limited information about the salivary TNF-αnf levels in OSCC patients with DM. Aim The aim of this study was to compare the salivary TNF-α in OSCC patients with and without DM. Methods Saliva samples were obtained from healthy individuals, OSCC patients with DM, and OSCC patients without DM. The quantification of TNF-α levels was performed using the EliKine™ Human TNF-α ELISA Kit, an enzyme-linked immunosorbent assay. The data were reported as means and standard deviations. To assess variations in salivary TNF-α levels among these groups, the Kruskal- Wallis test was employed. Results The study included a total of 30 participants with 10 in each group. There were 18 males and 12 females with a mean age of 37.2± 4.7 years. The TNF-α levels between the control group (51+42±1.4 pg/ml), OSCC patients without DM (67.43 ±1.7 pg/ml), and OSCC patients with DM (268±8.5 pg/ml) were noted. The mean salivary TNF-α level was statistically higher in OSCC with DM compared to the control and OSCC without DM group.  Conclusion The investigation compared the salivary TNF-α in OSCC patients with and without DM and has uncovered substantial differences in TNF-α concentrations within the examined cohorts, providing insights into the potential involvement of TNF-α in the context of OSCC, especially in patients with DM. Nevertheless, additional research is imperative to establish associations between TNF-α levels, the prognosis of OSCC, and the impact of DM.