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Taki H, Tuomilehto J, Zimmet P, Tamosiunas A, Kowlessur S, Magliano DJ, Shaw JE, Söderberg S, Nilsson U. Left ventricular hypertrophy: an ECG-based study of prevalence and risk factors in a multiethnic population. Open Heart 2023; 10:e002495. [PMID: 37935562 PMCID: PMC10632900 DOI: 10.1136/openhrt-2023-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is frequently seen in association with arterial hypertension and indicates poor prognosis. This study aimed to determine the prevalence of LVH and associated factors in a multiethnic population from Mauritius. METHODS Population-based health surveys were performed in 2009 and 2015 and included in total 8961 individuals aged 35-75 years with recorded 12-lead ECG. LVH was defined according to three criteria: Sokolow-Lyon, Cornell voltage and Cornell product. Data were collected about health and lifestyle behaviour. Anthropometry and blood pressure were measured. Fasting levels of blood lipids and glucose were determined, oral glucose tolerance test was performed in people without glucose-lowering medications. RESULTS The age-standardised prevalence of LVH was 9% (n=875) according to any of the three ECG criteria. Individuals with LVH were older, more likely to have hypertension, diabetes, known cardiovascular disease (CVD) and elevated levels of cholesterol and creatinine. Further, they were more likely to be of African descent (Creole) and have lower educational level. In a multivariable model, Creole (OR (95% CI)) (1.56 (1.33 to 1.83)), low educational level (1.49 (1.28 to 1.75)), hypertension (3.01 (2.55 to 3.56)), known CVD (1.42 (1.11 to 1.83)) and elevated creatinine (1.08 (1.03 to 1.14)) remained associated with LVH. Individuals with non-treated or uncontrolled hypertension had a higher risk for LVH (3.09 (95% CI 2.57 to 3.71) and 4.07 (95% CI 3.29 to 5.05), respectively), than individuals with well controlled hypertension or normotension. CONCLUSION LVH occurs more frequently in individuals with hypertension, as well as in individuals with African ancestry and/or low education level.
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Affiliation(s)
- Hina Taki
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jaakko Tuomilehto
- Public Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Dianna J Magliano
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Sugiyama T, Yamada Y, Ito Y, Mineo R, Iwamoto R, Tamba S, Fujimoto T, Yamamoto K, Matsuzawa Y. Increase in glycemic set point, alongside a decrease in waist circumference, in the non-diabetic population during the Japanese National Intervention Program for metabolic syndrome: A single-center, large-scale, matched-pair analysis. PLoS One 2022; 17:e0268450. [PMID: 35947600 PMCID: PMC9365144 DOI: 10.1371/journal.pone.0268450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2008, the Japanese government implemented a National Intervention Program for metabolic syndrome. Low-risk individuals were not direct targets of this intervention. Nevertheless, they were indirectly enlightened by this massive campaign. Documentation of the metabolic shifts in low-risk individuals following the program launch may inform public health policy regarding approaches to metabolic risks in the general population. Methods We conducted a cross-sectional analysis of data from non-diabetic participants who underwent general health check-ups at the Physical Check-up Center of Sumitomo Hospital. Participants during 2007–2008 were pair-matched with those during 2015–2016 with respect to sex, age, smoking status, hemoglobin level, and red blood cell (RBC) count. Each participant was included only once in the study. Results Totals of 3,140 men and 2,048 women were pair-matched. The non-diabetic participants showed lower waist circumference, blood pressure, heart rate, and serum lipid concentrations during the second study period. In contrast, the entire distributions of fasting plasma glucose (FPG) concentration in both sexes and glycated hemoglobin (HbA1c) in women were shifted upwards. In men, Δ FPG was +1.6 mg/dL (P < 0.001) and Δ HbA1c was ±0% (P = 0.6). In women, Δ FPG was +3.0 mg/dL (P < 0.001), and Δ HbA1c was +0.1% (P < 0.001). Δ Homeostasis model assessment of β-cell function was −6.6 in men (P < 0.001) and −10.3 in women (P < 0.001). The homeostasis model assessment of insulin resistance did not change significantly. Conclusions The “glycemic set point” has increased in non-diabetic people in Japan during recent years. Lifestyle or environmental changes may have caused this metabolic shift through obesity-independent pathways, possibly through effects on pancreatic β-cell function. The underlying mechanism awaits further investigation.
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Affiliation(s)
- Takuya Sugiyama
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
- * E-mail:
| | - Yuya Yamada
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yoshito Ito
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryohei Mineo
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryuya Iwamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Sachiko Tamba
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | | | - Koji Yamamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yuji Matsuzawa
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
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Verma AK, Goyal Y, Bhatt D, Dev K, Alsahli MA, Rahmani AH, Almatroudi A. A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era. Diabetes Metab Syndr Obes 2021; 14:2775-2787. [PMID: 34168477 PMCID: PMC8216699 DOI: 10.2147/dmso.s304751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.
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Affiliation(s)
- Amit K Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Yamini Goyal
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Deepti Bhatt
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Kapil Dev
- Department of Biotechnology, Jamia Millia Islamia, New Delhi, India
| | - Mohammed A Alsahli
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraidah, 52571, Saudi Arabia
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4
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Morrell S, Taylor R, Nand D, Rao C. Changes in proportional mortality from diabetes and circulatory disease in Mauritius and Fiji: possible effects of coding and certification. BMC Public Health 2019; 19:481. [PMID: 31046741 PMCID: PMC6498492 DOI: 10.1186/s12889-019-6748-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/18/2023] Open
Abstract
Background Many developing countries are experiencing the epidemiological transition, with the majority of deaths attributed to cardiovascular disease, cancer, Type 2 diabetes (T2DM) and others. In some countries, large proportional mortality attributed to diabetes is evident in official mortality statistics, with Mauritius and Fiji rated as the highest in the world. Methods This study investigates trends in recorded diabetes and cardiovascular disease mortality in Mauritius and Fiji under coding from the International Classification of Diseases (ICD) versions 9 and 10, using mortality data reported from these countries to the World Health Organization (WHO). Results In Mauritius over 1981–2004, T2DM proportional mortality varied between 4% and 7% in males (M) and 5% and 9% in females (F). In 2005 there was a sudden increase to M 20% and F 25%, which continued to M 25% and F 30% by 2012. Over 1981–2004 the proportion of circulatory disease mortality rose from 44% to 49% in males, and from 46% to 57% in females. In 2005, circulatory disease mortality proportions fell precipitously to 34% in males and 37% in females, and declined to 31% and 34% by 2013. ICD–10 coding was introduced in 2005. In Fiji, sharp rises in proportional T2DM mortality from 3% in both sexes in 2001 to M 15% and F 20% in 2002 were followed by more gradual trend increases to M 20% and F 26% by 2012–13. Circulatory disease proportions fell steeply from M 57% and F 53% in 2001 to M 44% and M 38% by 2004, with subsequent less steep declines to M 39% and F 30% by 2012. ICD–10 coding was introduced in 2001. Conclusions Large, abrupt changes in diabetes and circulatory disease proportional mortality in Fiji and Mauritius coincided with the local introduction of ICD–10 coding in different years. There is also evidence for diabetes-related misclassification of underlying cause of death in Australia and the USA. These artefacts can undermine accurate monitoring of cause of death for evaluation of effectiveness of prevention and control, especially of circulatory disease mortality which is demonstrably reversible in populations.
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Affiliation(s)
- Stephen Morrell
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine University of New South Wales (UNSW), Sydney, Australia.
| | - Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine University of New South Wales (UNSW), Sydney, Australia
| | | | - Chalapati Rao
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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5
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Kurup R, Ansari AA, Singh J. A review on diabetic foot challenges in Guyanese perspective. Diabetes Metab Syndr 2019; 13:905-912. [PMID: 31336544 DOI: 10.1016/j.dsx.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.
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Affiliation(s)
- Rajini Kurup
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Abdullah Adil Ansari
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Jaipaul Singh
- School of Pharmacy and Forensic and Investigative Sciences, University of South Lancashire, Preston, Lancashire, United Kingdom.
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6
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Aziz Z, Mathews E, Absetz P, Sathish T, Oldroyd J, Balachandran S, Shetty SS, Thankappan KR, Oldenburg B. A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program. Implement Sci 2018; 13:97. [PMID: 30021592 PMCID: PMC6052531 DOI: 10.1186/s13012-018-0791-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs. METHODS The 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks. RESULTS Provider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be 'very useful' by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as 'very interested', and 55% found the group sessions 'very useful' in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program. CONCLUSION A comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs. TRIAL REGISTRATION Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909 . Registered 10 March 2011.
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Affiliation(s)
- Zahra Aziz
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia.
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
| | - Pilvikki Absetz
- School of Health Sciences, University of Tampere, Tampere, Finland.,Collaborative Care Systems Finland, Helsinki, Finland
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia
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L'Omelette AD, Dawonauth L, Rademacher L, Robillard PY, Scioscia M, Jankee S, Lee Kwai Yan MY, Razgia JB, Rademacher TW. New insights into early and late onset subgroups of preeclampsia from longitudinal versus cross-sectional analysis of urinary inositol-phosphoglycan P-Type. J Reprod Immunol 2017; 125:64-71. [PMID: 29253795 DOI: 10.1016/j.jri.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/14/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
Most pre-eclampsia (PE) studies have used cross-sectional data to derive conclusions regarding the pathophysiology of the condition. This has led to the concept that there exists early (<34 weeks) and late-onset (>34 weeks) disease according to gestational age at diagnosis. Survival time models have predicted that if the pregnancy was to continue indefinitely, all women would develop PE. In this study we have performed a longitudinal analysis of the urinary biomarker, inositol phosphoglycan (IPG), in a cohort of women giving birth in Mauritius (n-920). We have analysed the PE data in the traditional cross-sectional manner for n = 77 women who developed PE and also then looked at the longitudinal data for 71/77 of the same women. The data allows us to use longitudinal values to calculate a date of onset (first presence of biomarker in urine) and compare that to date of clinical diagnosis (cross sectional). We find two populations for both analysis consistent with an early and late stage subgroup. The calculated date of onset had subgroups (early and late) at 28.4 ± 0.41 weeks and 35.37 ± 0.26 weeks and for clinical date of diagnosis, 32.3 ± 0.59 weeks and 37.04 ± 0.62 weeks, respectively. The presence of the same biomarker in both subgroups and its ability to predict clinical onset 2-4 weeks prior to clinical diagnosis suggest that both groups may have similar aetiology.
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Affiliation(s)
| | - Lalita Dawonauth
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | | | - Pierre-Yves Robillard
- Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, La Réunion, Saint Pierre, France
| | - Marco Scioscia
- Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Sarojini Jankee
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Man Yoon Lee Kwai Yan
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Jeeawoody B Razgia
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Thomas W Rademacher
- Division of Infection and Immunity, University College London Medical School, London, United Kingdom; Middlesex University, London, United Kingdom
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Tabesh M, Shaw JE, Zimmet PZ, Soderberg S, Kowlessur S, Timol M, Joonas N, Alberti GMM, Tuomilehto J, Shaw BJ, Magliano DJ. Meeting American Diabetes Association diabetes management targets: trends in Mauritius. Diabet Med 2017; 34:1719-1727. [PMID: 28792634 DOI: 10.1111/dme.13447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/19/2022]
Abstract
AIMS To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. METHODS Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c , blood pressure and LDL cholesterol. RESULTS In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. CONCLUSIONS In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.
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Affiliation(s)
- M Tabesh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P Z Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - S Soderberg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Public Health and Clinical Medicine, Umeå University and Heart Center, Umeå, Sweden
| | - S Kowlessur
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - M Timol
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - N Joonas
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - G M M Alberti
- Department of Endocrinology and Metabolism, St Mary's Hospital and Imperial College, London, UK
| | - J Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Neurosciences and Preventive Medicine, Danube-University Krems, Austria
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - B J Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - D J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Tan KHX, Barr ELM, Koshkina V, Ma S, Kowlessur S, Magliano DJ, Söderberg S, Chia KS, Zimmet P, Lim WY. Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius. J Diabetes 2017; 9:855-864. [PMID: 27778460 DOI: 10.1111/1753-0407.12497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/11/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Asia is experiencing a type 2 diabetes epidemic, but prevalence differs by ethnicity and level of socioeconomic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes. METHODS Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardized diabetes and obesity prevalence. Modified Breslow-Cox proportional hazard models were used to obtain rate ratios for diabetes risk factors. RESULTS In Singapore, the age-standardized prevalence of diabetes remained stable for Chinese (men: 14% in 1992, 13% in 2010; women: 12% in 1992, 10% in 2010), but increases were observed for South Asians (men: 20% in 1992, 26% in 2010; women: 18% in 1992, 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians regardless of country. CONCLUSIONS Despite different socioeconomic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries.
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Affiliation(s)
- Kristin H X Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Elizabeth L M Barr
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Wellbeing and Preventable Chronic Disease Division Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Vira Koshkina
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health Singapore, Singapore, Singapore
| | - Sudhir Kowlessur
- Non-Communicable Diseases and Health Promotion Division, Ministry of Health and Quality of Life, Port Louis, Mauritius
| | - Dianna J Magliano
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Paul Zimmet
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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10
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Zimmet PZ. Diabetes and its drivers: the largest epidemic in human history? Clin Diabetes Endocrinol 2017; 3:1. [PMID: 28702255 PMCID: PMC5471716 DOI: 10.1186/s40842-016-0039-3] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/30/2016] [Indexed: 02/09/2023] Open
Abstract
The "Diabesity" epidemic (obesity and type 2 diabetes) is likely to be the biggest epidemic in human history. Diabetes has been seriously underrated as a global public health issue and the world can no longer ignore "the rise and rise" of type 2 diabetes. Currently, most of the national and global diabetes estimates come from the IDF Atlas. These estimates have significant limitations from a public health perspective. It is apparent that the IDF have consistently underestimated the global burden. More reliable estimates of the future burden of diabetes are urgently needed. To prevent type 2 diabetes, a better understanding of the drivers of the epidemic is needed. While for years, there has been comprehensive attention to the "traditional" risk factors for type 2 diabetes i.e., genes, lifestyle and behavioral change, the spotlight is turning to the impact of the intra-uterine environment and epigenetics on future risk in adult life. It highlights the urgency for discovering novel approaches to prevention focusing on maternal and child health. Diabetes risk through epigenetic changes can be transmitted inter-generationally thus creating a vicious cycle that will continue to feed the diabetes epidemic. History provides important lessons and there are lessons to learn from major catastrophic events such as the Dutch Winter Hunger and Chinese famines. The Chinese famine may have been the trigger for what may be viewed as a diabetes "avalanche" many decades later. The drivers of the epidemic are indeed genes and environment but they are now joined by deleterious early life events. Looking to the future there is the potential scenario of future new "hot spots" for type 2 diabetes in regions e.g., the Horn of Africa, now experiencing droughts and famine. This is likely to occur should improved economic and living conditions occur over the next few decades. Type 2 diabetes will remain one of the greatest challenges to human health for many years to come.
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Affiliation(s)
- Paul Z Zimmet
- Monash University & Baker IDI Heart and Diabetes Institute, Melbourne, VIC Australia
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Lin S, Tukana I, Linhart C, Morrell S, Taylor R, Vatucawaqa P, Magliano DJ, Zimmet P. Diabetes and obesity trends in Fiji over 30 years. J Diabetes 2016. [PMID: 26201444 DOI: 10.1111/1753-0407.12326] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND No systematic comparison has been conducted in Fiji using all suitable surveys of type 2 diabetes mellitus (T2DM) and obesity prevalence after standardizing methodology and definitions. METHODS Unit records from six surveys of Fiji adults were variously adjusted for age, ethnicity (Fiji Melanesians, i-Taukei, and Fijians of Asian Indian descent [Indians]) and urban-rural by sex to previous censuses. Trends were assessed using meta-regression (random effect models) and estimates projected to 2020. Poisson regression of strata was used to assess the effect of body mass index (BMI) increases on T2DM period trends. RESULTS Over 1980-2011, T2DM prevalence increased in i-Taukei men (3.2% to 11.1%; 1.32%/5 years) and women (5.3% to 13.6%; 1.40%/5 years) and Indian men (11.1% to 17.9%; 1.24%/5 years) and women (11.2% to 19.9%; 1.71%/5 years). Projected T2DM prevalence in 2020 is 13.3% and 16.7% in i-Taukei men and women, and 23.4% and 24.1% in Indian men and women, respectively. Obesity prevalence increased in i-Taukei men (12.6% to 28.9%; 2.99%/5 years) and women (30.1% to 52.9%; 3.84%/5 years) and in Indian men (2.8% to 9.4%; 1.21%/5 years) and women (13.2% to 26.6%; 2.61%/5 years). Projected obesity prevalence in 2020 is 34.0% and 60.0% in i-Taukei and women, and 11.4% and 31.0% in Indian men and women, respectively. After age-adjustment, an estimated 27%, 25%, 16% and 18% of the T2DM period trend is attributable to BMI in i-Taukei men and women and Indian men and women, respectively. CONCLUSIONS Prevalence of T2DM in Fiji is projected to continue increasing, driven by rising obesity, with consequences for premature mortality and life expectancy.
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Affiliation(s)
- Sophia Lin
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | | | - Christine Linhart
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | | | - Dianna J Magliano
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Paul Zimmet
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
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12
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Zimmet PZ, Alberti KGMM. Epidemiology of Diabetes-Status of a Pandemic and Issues Around Metabolic Surgery. Diabetes Care 2016; 39:878-83. [PMID: 27222545 DOI: 10.2337/dc16-0273] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/13/2016] [Indexed: 02/03/2023]
Abstract
The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes, such as genetic, lifestyle, and behavioral risk factors, has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes and must recognize its heterogeneity. Future research needs to be directed at improved understanding of the potential role of determinants, such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programs. Equally important is a better understanding of the role of metabolic surgery in helping to address the management both of persons with type 2 diabetes and of those persons in the community who are at higher risk for type 2 diabetes, particularly in emerging nations where the diabetes epidemic is in full flight.
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Affiliation(s)
- Paul Z Zimmet
- Baker IDI Heart & Diabetes Institute and Monash University, Melbourne, Australia
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13
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Cournot M, Lenclume V, Le Moullec N, Debussche X, Doussiet E, Fagot-Campagna A, Favier F. Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study. Blood Press 2016; 26:39-47. [PMID: 27195533 DOI: 10.1080/08037051.2016.1182854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5-39.0]) and in men (40.3% [37.6-43.0]) and in the under 30s (17.1% [14.0-20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12-1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33-2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05-1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries.
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Affiliation(s)
- Maxime Cournot
- a CHU de La Réunion, Centre d'Investigations Cliniques , Saint Denis , France.,b INSERM, CIC 1410 , Saint Pierre , France.,c INSERM, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI) , Sainte-Clotilde , France.,d Centre Hospitalier Gabriel Martin, Service de cardiologie , Saint-Paul , France
| | | | - Nathalie Le Moullec
- e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
| | - Xavier Debussche
- f CHU de La Réunion, Service d'endocrinologie et diabétologie , Saint-Denis , France
| | | | - Anne Fagot-Campagna
- g Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés , Paris , France
| | - François Favier
- b INSERM, CIC 1410 , Saint Pierre , France.,e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
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Caleyachetty R, Kengne AP, Muennig P, Rutter H, Echouffo-Tcheugui JB. Misperception of body weight among overweight or obese adults in Mauritius. Obes Res Clin Pract 2016; 10:216-9. [DOI: 10.1016/j.orcp.2016.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/20/2016] [Indexed: 11/25/2022]
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15
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Nanditha A, Ma RCW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, Shaw JE, Zimmet PZ. Diabetes in Asia and the Pacific: Implications for the Global Epidemic. Diabetes Care 2016; 39:472-85. [PMID: 26908931 DOI: 10.2337/dc15-1536] [Citation(s) in RCA: 285] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world's most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health "tsunami." Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.
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Affiliation(s)
| | - Ronald C W Ma
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | - Juliana C N Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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16
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Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nat Rev Nephrol 2015; 12:73-81. [DOI: 10.1038/nrneph.2015.173] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Esparza-Romero J, Valencia ME, Urquidez-Romero R, Chaudhari LS, Hanson RL, Knowler WC, Ravussin E, Bennett PH, Schulz LO. Environmentally Driven Increases in Type 2 Diabetes and Obesity in Pima Indians and Non-Pimas in Mexico Over a 15-Year Period: The Maycoba Project. Diabetes Care 2015; 38:2075-82. [PMID: 26246457 PMCID: PMC4613913 DOI: 10.2337/dc15-0089] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The global epidemics of type 2 diabetes and obesity have been attributed to the interaction between lifestyle changes and genetic predisposition to these diseases. We compared the prevalences of type 2 diabetes and obesity in Mexican Pima Indians, presumed to have a high genetic predisposition to these diseases, to those in their non-Pima neighbors, both of whom over a 15-year period experienced a transition from a traditional to a more modern lifestyle. RESEARCH DESIGN AND METHODS Prevalence of diabetes, impaired fasting glucose, impaired glucose tolerance, and obesity in Mexican Pimas (n = 359) and non-Pima Mexicans (n = 251) were determined in 2010 using methods identical to those used in 1995. RESULTS During this 15-year period, age-adjusted diabetes prevalence was unchanged in Pima men (5.8% in 1995 vs. 6.1% in 2010) yet increased in non-Pima men from 0.0 to 8.6% (P < 0.05). Diabetes prevalence tended to increase in both Pima women (9.4 vs. 13.4%) and non-Pima women (4.8 vs. 9.5%). Age-adjusted prevalence of obesity increased significantly in all groups (6.6 vs. 15.7% in Pima men; 8.5 vs. 20.5% in non-Pima men; 18.9. vs 36.3% in Pima women; 29.5 vs. 42.9% in non-Pima women). CONCLUSIONS Type 2 diabetes prevalence increased between 1995 and 2010 in non-Pima men, and to a lesser degree in women of both groups, but it did not increase in Pima men. Prevalence of obesity increased among Pimas and non-Pimas of both sexes. These changes occurred concomitantly with an environmental transition from a traditional to a more modernized lifestyle.
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Affiliation(s)
- Julian Esparza-Romero
- Departamento de Nutrición Pública y Salud, Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo A.C., Hermosillo, Sonora, México
| | - Mauro E Valencia
- Departamento de Nutrición Pública y Salud, Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo A.C., Hermosillo, Sonora, México
| | - Rene Urquidez-Romero
- Departamento de Nutrición Pública y Salud, Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo A.C., Hermosillo, Sonora, México
| | - Lisa S Chaudhari
- College of Health and Human Services, Northern Arizona University, Flagstaff, AZ
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Leslie O Schulz
- College of Health and Human Services, Northern Arizona University, Flagstaff, AZ
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Linhart C, Tivollier JM, Taylor R, Barguil Y, Magliano DJ, Bourguignon C, Zimmet P. Changes in cardiovascular disease risk factors over 30 years in Polynesians in the French Pacific Territory of Wallis Island. Eur J Prev Cardiol 2015; 23:856-64. [DOI: 10.1177/2047487315604833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/18/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Christine Linhart
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - Jean-Michel Tivollier
- Centre Hospitalier Territorial, Noumea, New Caledonia
- Reseau de l’Insuffisance Renale, Noumea, New Caledonia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of NSW, Sydney, Australia
| | - Yann Barguil
- Centre Hospitalier Territorial, Noumea, New Caledonia
| | | | | | - Paul Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Australia
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19
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Wennberg M, Söderberg S, Uusitalo U, Tuomilehto J, Shaw JE, Zimmet PZ, Kowlessur S, Pauvaday V, Magliano DJ. High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius. Diabet Med 2015; 32:513-20. [PMID: 25346062 PMCID: PMC4361378 DOI: 10.1111/dme.12618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 01/04/2023]
Abstract
AIMS To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius. METHODS Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed. RESULTS Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI. CONCLUSIONS High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.
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Affiliation(s)
- M Wennberg
- The Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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20
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Misra A, Ramchandran A, Jayawardena R, Shrivastava U, Snehalatha C. Diabetes in South Asians. Diabet Med 2014; 31:1153-62. [PMID: 24975549 DOI: 10.1111/dme.12540] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/24/2014] [Accepted: 06/25/2014] [Indexed: 12/23/2022]
Abstract
Economic, dietary and other lifestyle transitions have been occurring rapidly in most South Asian countries, making their populations more vulnerable to developing Type 2 diabetes and cardiovascular diseases. Recent data show an increasing prevalence of Type 2 diabetes in urban areas as well as in semi-urban and rural areas, inclusive of people belonging to middle and low socio-economic strata. Prime determinants for Type 2 diabetes in South Asians include physical inactivity, imbalanced diets, abdominal obesity, excess hepatic fat and, possibly, adverse perinatal and early life nutrition and intra-country migration. It is reported that Type 2 diabetes affects South Asians a decade earlier and some complications, for example nephropathy, are more prevalent and progressive than in other races. Further, prevalence of pre-diabetes is high, and so is conversion to diabetes, while more than 50% of those who are affected remain undiagnosed. Attitudes, cultural differences and religious and social beliefs pose barriers in effective prevention and management of Type 2 diabetes in South Asians. Inadequate resources, insufficient healthcare budgets, lack of medical reimbursement and socio-economic factors contribute to the cost of diabetes management. The challenge is to develop new translational strategies, which are pragmatic, cost-effective and scalable and can be adopted by the South Asian countries with limited resources. The key areas that need focus are: generation of awareness, prioritizing health care for vulnerable subgroups (children, women, pregnant women and the underprivileged), screening of high-risk groups, maximum coverage of the population with essential medicines, and strengthening primary care. An effective national diabetes control programme in each South Asian country should be formulated, with these issues in mind.
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Affiliation(s)
- A Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
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21
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NASLI-ESFAHANI E, PEIMANI M, RAMBOD C, OMIDVAR M, LARIJANI B. Developing a Clinical Diabetes Guideline in Diabetes Research Network in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:713-21. [PMID: 26110142 PMCID: PMC4475590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/12/2014] [Indexed: 11/09/2022]
Abstract
Development of evidence-based clinical guidelines to raising standards of medical care in diabetes is a core element of coping with the global diabetes epidemic. The purpose of this study was to develop a systematic clinical diabetes guideline from the latest scientific evidences and also to localize its recommendations according to regional and cultural needs of our society. Searches were conducted using NICE, SIGN, WDPCP, IDF, JDC, ADA, AACE, ICSI, CDA, AMDA, IDC, NyDoH guidelines which were examined and criticized and scored using Agree method. Guidelines which got higher score in some important areas of Agree scale including: rigor of development, clarity and comprehensiveness of the recommendations and applicability, especially in the climatic conditions of our country were selected. The existing recommendations were extracted by committee members and supporting evidences of each recommendation were determined based on the sources listed in the clinical guideline. Recommendations grading were classified from grade A to D based on the quality of their supporting evidences (BEL1-5). This guideline covered all areas related to diabetes including screening and diagnosis, lifestyle modification and patient education, management, complications and hypoglycemia. Regarding capacities of this guideline and lack of comprehensive and updated guidelines in our country and region, it is suggested that designing a pilot study to implement this Learner-centered guideline and finding its weaknesses can lead to patient care improvement and also propel us towards our goal to design a comprehensive guideline in compliance with regional and national needs in Middle East.
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Affiliation(s)
- Ensieh NASLI-ESFAHANI
- 1. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam PEIMANI
- 1. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia RAMBOD
- 1. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam OMIDVAR
- 1. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher LARIJANI
- 2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran,* Corresponding Author: Tel:
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Cooper ME, Rebuck AS. Type 2 diabetes in Asia: like chronic obstructive pulmonary disease, a threat to human health and wellbeing. J Diabetes 2014; 6:120-2. [PMID: 24134129 DOI: 10.1111/1753-0407.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mark E Cooper
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Abstract
According to the recent estimates by the International Diabetes Federation (IDF), South East-Asia (SEA) Region consisting of India, Sri Lanka, Bangladesh, Bhutan, Mauritius and Maldives, is home to more than 72 million adults with diabetes in 2013 and is expected to exceed 123 million in 2035. Nearly 95% of people with diabetes have type 2 diabetes (T2DM). Although type 1 diabetes (T1DM) is relatively rare in these countries, its prevalence is also rising. Furthermore, a large number (24.3 million) of people also have impaired glucose tolerance (IGT). Several characteristic differences are seen in the clinical and immunological presentation of these people when compared with their European counterparts. A sharp increase in the prevalence of T2DM has been observed in the SEA Region, both in urban and rural areas, which is mostly associated with the lifestyle transitions towards urbanisation and industrialisation. Evidence suggests that a large portion of T2DM may be preventable by lifestyle modification. However, morbidity and early mortality occur as a result of inadequate healthcare facilities for early detection and initiation of therapy, as well as suboptimal management of diabetes and associated morbidities. This is largely preventable by primary prevention of diabetes and enhancing awareness about the disease among the public and the healthcare providers. There is an urgent need for concerted efforts by government and non-governmental sectors to implement national programmes aimed at prevention, management and surveillance of the disease.
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Affiliation(s)
- Ambady Ramachandran
- India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ronald Ching Wan Ma
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, China
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Abstract
The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes (eg, genetic, lifestyle, and behavioural risk factors) has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes, taking into account its many origins and heterogeneity. Thus, research needs to be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programmes.
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Affiliation(s)
- Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | | | - William H Herman
- Michigan Center for Diabetes Translational Research, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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25
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Hocking S, Samocha-Bonet D, Milner KL, Greenfield JR, Chisholm DJ. Adiposity and insulin resistance in humans: the role of the different tissue and cellular lipid depots. Endocr Rev 2013; 34:463-500. [PMID: 23550081 DOI: 10.1210/er.2012-1041] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human adiposity has long been associated with insulin resistance and increased cardiovascular risk, and abdominal adiposity is considered particularly adverse. Intra-abdominal fat is associated with insulin resistance, possibly mediated by greater lipolytic activity, lower adiponectin levels, resistance to leptin, and increased inflammatory cytokines, although the latter contribution is less clear. Liver lipid is also closely associated with, and likely to be an important contributor to, insulin resistance, but it may also be in part the consequence of the lipogenic pathway of insulin action being up-regulated by hyperinsulinemia and unimpaired signaling. Again, intramyocellular triglyceride is associated with muscle insulin resistance, but anomalies include higher intramyocellular triglyceride in insulin-sensitive athletes and women (vs men). Such issues could be explained if the "culprits" were active lipid moieties such as diacylglycerol and ceramide species, dependent more on lipid metabolism and partitioning than triglyceride amount. Subcutaneous fat, especially gluteofemoral, appears metabolically protective, illustrated by insulin resistance and dyslipidemia in patients with lipodystrophy. However, some studies suggest that deep sc abdominal fat may have adverse properties. Pericardial and perivascular fat relate to atheromatous disease, but not clearly to insulin resistance. There has been recent interest in recognizable brown adipose tissue in adult humans and its possible augmentation by a hormone, irisin, from exercising muscle. Brown adipose tissue is metabolically active, oxidizes fatty acids, and generates heat but, because of its small and variable quantities, its metabolic importance in humans under usual living conditions is still unclear. Further understanding of specific roles of different lipid depots may help new approaches to control obesity and its metabolic sequelae.
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Affiliation(s)
- Samantha Hocking
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst NSW 2010, Sydney, Australia.
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Doobaree R, Yee K, Lam P, Constans J, Morlat P. Prévalence et facteurs de risque de l’artériopathie oblitérante des membres inférieurs asymptomatique chez des patients hospitalisés en médecine interne par la mesure de l’index de pression systolique : étude auprès de 892 patients à l’Île Maurice. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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