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Khalil AB, Beshyah SA, Abdella N, Afandi B, Al-Arouj MM, Al-Awadi F, Benbarka M, Ben Nakhi A, Fiad TM, Al Futaisi A, Hassoun AA, Hussein W, Kaddaha G, Ksseiry I, Al Lamki M, Madani AA, Saber FA, Abdel Aal Z, Morcos B, Saadi H. Diabesity in the Arabian Gulf: Challenges and Opportunities. Oman Med J 2018; 33:273-282. [PMID: 30038726 DOI: 10.5001/omj.2018.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Aly Bernard Khalil
- Department of Endocrinology, Imperial College London Diabetes Center, Abu Dhabi, UAE
| | - Salem A Beshyah
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Nabila Abdella
- Department of Medicine, Faculty of Medicine, University of Kuwait City, Kuwait City, Kuwait
| | - Bachar Afandi
- Department of Endocrinology, Tawam Hospital, Al-Ain, UAE
| | | | | | | | | | - Tarek M Fiad
- Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Abdullah Al Futaisi
- Department of Endocrinology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Wiam Hussein
- Department of Endocrinology, Dr. Wiam Clinic for Diabetes and Endocrine Disorders, Riffa, Bahrain
| | - Ghaida Kaddaha
- Department of Diabetes and Endocrinology, Suliman Al Habib Hospital, Dubai Medical City, Dubai, UAE
| | - Iyad Ksseiry
- Department of Diabetes and Endocrinology, Mediclinic Hospital, Dubai, UAE
| | - Mohamed Al Lamki
- Department of Diabetes and Endocrinology, Royal Hospital, Muscat, Oman
| | | | - Feryal A Saber
- Department of Diabetes and Endocrinology, Bahrain Defense Force Hospital, Riffa, Bahrain
| | | | - Bassem Morcos
- Medical Affairs, Merck Sharp and Dohme Corp., Dubai, UAE
| | - Hussein Saadi
- Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Al-Jarallah K, Shehab D, Abdella N, Al Mohamedy H, Abraham M. Knee Osteoarthritis in Type 2 Diabetes Mellitus: Does Insulin Therapy Retard Osteophyte Formation? Med Princ Pract 2016; 25:12-7. [PMID: 26517230 PMCID: PMC5588311 DOI: 10.1159/000441418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis (OA) in type 2 diabetes mellitus (T2DM) patients on insulin therapy differed from those not on insulin. MATERIAL AND METHODS A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes (controls) in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin (G1, n = 99), T2DM patients on insulin (G2, n = 112) and a nondiabetic control group (G3, n = 100). Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale (0-4) and the Osteoarthritis Research Society International Atlas grading scale (0-3). A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis. RESULTS A highly significant association (p < 0.0001) was observed for joint space narrowing (JSN) as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association (p < 0.0001) was retained for JSN [201 (89.7%) vs. 199 (99.5%)] and for osteophyte formation [26 (11.7%) vs. 72 (36.0%)]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 (11.7%) vs. 39 (19.7%), p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group (OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively). CONCLUSION Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin.
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Affiliation(s)
- Khaled Al-Jarallah
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- *Prof. Khaled Al-Jarallah, Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110 (Kuwait), E-Mail
| | - Diaa Shehab
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Nabila Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | - Mini Abraham
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Al Khaldi R, Mojiminiyi O, AlMulla F, Abdella N. Associations of TERC Single Nucleotide Polymorphisms with Human Leukocyte Telomere Length and the Risk of Type 2 Diabetes Mellitus. PLoS One 2015; 10:e0145721. [PMID: 26720590 PMCID: PMC4705103 DOI: 10.1371/journal.pone.0145721] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022] Open
Abstract
Previous Studies have mapped putative loci that may probably regulate leukocyte telomere length (LTL). The strongest associations with LTL were reported for SNP rs12696304 and rs16847897 near the non-coding Ribose Nucleic Acid (RNA) molecule component (TERC) of telomerase enzyme on 3q26. It is unclear whether these identified loci coding functional components of telomerase, exert a similar effect on LTL in other populations or influence risk factors of Type 2 Diabetes Mellitus (T2DM). The present study was performed to: study the influence of TERC polymorphisms on LTL, human telomerase reverse transcriptase (hTERT), indices of obesity and explore the potential associations with T2DM. 225 T2DM patients and 245 age and sex matched controls were studied. Allelic Discrimination (AD) genotyping was utilized to determine TERC SNPs [rs12696304 and rs16847897]. hTERT, adiponectin, Insulin, Homeostasis Model Assessment (HOMA-IR), and LTL were measured. Body Mass Index (BMI) and waist circumference (WC) were recorded. [CC] genotype of rs16847897 was significantly associated with shorter LTL [OR = 1.6, p = 0.004], lower hTERT levels [OR = 0.4, p = 0.006], higher BMI [OR = 2.2, p = 0.006], larger WC [OR = 23.4, p = 0.007] and hypo-adiponectemia [OR = 0.6, p = 0.006]. [GG] genotype of rs12696304 was also significantly associated with shorter LTL [OR = 1.5, p = 0.004], lower hTERT [OR = 0.7, p = 0.006] but with larger WC[OR = 5.3, p = 0.004]. [CC] genotype of rs16847897 and [GG] genotype of rs12696304 together increased the risk of T2DM significantly [OR = 1.7, p = 0.004]. We provide insights connecting a structure that is critically involved in maintaining genomic stability with obesity and T2DM. Given the central role of telomere length in determining telomere function our findings may expand our understanding of the pathological mechanisms underlying age associated conditions such as T2DM.
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Affiliation(s)
- Rasha Al Khaldi
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Olusegun Mojiminiyi
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- * E-mail:
| | - Fahd AlMulla
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Nabila Abdella
- Deartment of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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Hassoun AAK, Abdella N, Arouj MA, Awadi FA, Futaisi AA, Lamki MA, Madani AA, Saber FA, Nakhi AB, Beshyah SA, El-Ali S, Fiad TM, Hussein WI, Kaddaha G, Ksseiry I, Morcos B, Saadi H. Driving and diabetes mellitus in the Gulf Cooperation Council countries: Call for action. Diabetes Res Clin Pract 2015; 110:91-94. [PMID: 26345248 DOI: 10.1016/j.diabres.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
The aim of the present article is to increase awareness concerning safe driving for patients with diabetes in the Gulf Cooperation Council (GCC) countries and to provide recommendations concerning the management of these patients. The cognitive, motor, and sensory skills required for driving can be adversely affected by diabetes as well as the side effects of anti-diabetic medications, particularly hypoglycemia. The prevalence of diabetes in the GCC countries is among the highest in the world. As the number of diabetic drivers in these countries continues to increase, the number at risk of having a motor vehicle accident is also expected to increase. We reviewed the available literature concerning driving and diabetes, particularly in relation to the current situation in the GGC countries. Unfortunately, very little published information is available addressing this issue in the GCC countries. Most of the GCC countries lack legislation on driving and diabetes. We have proposed recommendations to help diabetic drivers in the GCC countries as well as to provide guidance to health care professionals managing these patients.
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Affiliation(s)
| | - Nabila Abdella
- Mubarak Al Kabeer Teaching Hospital, Kuwait City, Kuwait
| | | | | | | | | | | | | | | | - Salem A Beshyah
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Samer El-Ali
- Merck Sharp & Dohme Corp., Dubai, United Arab Emirates
| | - Tarek M Fiad
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Wiam I Hussein
- Dr Wiam Clinic for Diabetes and Endocrine Disorders, Riffa, Bahrain
| | | | - Iyad Ksseiry
- Mediclinic Hospital, Dubai, United Arab Emirates
| | - Bassem Morcos
- Merck Sharp & Dohme Corp., Dubai, United Arab Emirates
| | - Hussein Saadi
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Shehab D, Al Jarallah K, Abdella N. Poster 302 Does Insulin Therapy Retard Osteophyte Formation in Knee Osteoarthritis in Type 2 Diabetes Mellitus? PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shehab D, Al-Jarallah K, Abdella N, Mojiminiyi OA, Al Mohamedy H. Prospective evaluation of the effect of short-term oral vitamin d supplementation on peripheral neuropathy in type 2 diabetes mellitus. Med Princ Pract 2015; 24:250-6. [PMID: 25720672 PMCID: PMC5588231 DOI: 10.1159/000375304] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/18/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to assess the efficacy of short-term oral vitamin D supplementation on peripheral neuropathy in patients with type 2 diabetes. MATERIALS AND METHODS This prospective, placebo-controlled trial included 112 type 2 diabetic patients with diabetic peripheral neuropathy (DPN) and vitamin D [25(OH)D] deficiency. Patients were sequentially assigned to a treatment group (n = 57) and a placebo group (n = 55). DPN was assessed using a neuropathy symptom score (NSS), a neuropathy disability score (NDS) and a nerve conduction study (NCS). Vitamin D status was determined by measuring the serum total 25(OH)D concentration. Patients received either oral vitamin D3 capsules or starch capsules once weekly for 8 weeks. The primary outcome was changes in NSS and NDS from baseline. The secondary outcome was changes in the NCS result. RESULTS Serum 25(OH)D concentrations significantly improved after oral vitamin D supplementation in the treatment group when compared to the placebo group (32.8 ± 23.7 vs. 1.1 ± 3.6, p < 0.0001). Similarly, the improvement in NSS values was significantly greater in the treatment group than in the placebo group (-1.49 ± 1.37 vs. -0.20 ± 0.59, p < 0.001). No improvement was observed for NDS and NCS between the 2 groups after treatment. CONCLUSION Short-term oral vitamin D3 supplementation improved vitamin D status and the symptoms of neuropathy in patients with type 2 diabetes.
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Affiliation(s)
- D. Shehab
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- *Prof. D. Shehab, Faculty of Medicine, Kuwait University, PO Box 24923, Jabriya, Safat 13110 (Kuwait), E-Mail
| | - Khaled Al-Jarallah
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Nabila Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | - Hisham Al Mohamedy
- Department of Department of Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Chehadeh W, Kurien SS, Abdella N, Ben-Nakhi A, Al-Arouj M, Almuaili T, Al-Mutairi O, Al-Nakib W. Hepatitis C virus infection in a population with high incidence of type 2 diabetes: impact on diabetes complications. J Infect Public Health 2011; 4:200-6. [PMID: 22000848 DOI: 10.1016/j.jiph.2011.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 02/08/2023] Open
Abstract
A growing number of reports suggest a connection between hepatitis C virus (HCV) infection and type 2 diabetes (T2D). However, the association of HCV infection with diabetes-related complications has not yet been clarified. The aim of this study was to determine the prevalence of HCV infection in T2D-patients in Kuwait which has a high incidence of type 2 diabetes, and to investigate the association between HCV viremia and diabetes-related complications. A total of 438 patients with T2D (325 Kuwaitis and 113 Egyptians), and 440 control subjects, were enrolled for this study. HCV infection was assessed by testing for serum HCV-specific antibodies, and by detection of HCV RNA. HCV viral load and hemoglobin A1c (HbA1c) levels were assessed in patients with and without diabetes complications. Thirty one (7%) out of 438 T2D-patients had evidence of HCV infection compared to 4 (1%) out of 440 control adults (p<0.0001). The prevalence of HCV infection in Kuwaiti and Egyptian T2D-patients was 3% and 18%, respectively. Most of the HCV sequences detected in T2D patients and control subjects were of genotype 4. The HbA1c levels in T2D-patients with HCV viremia were significantly higher than those in HCV-negative patients. HCV viremia, female sex, age, family history of diabetes were found to be independent risk factors for diabetes complications. The results suggest that T2D-patients in Kuwait have higher prevalence of HCV infection than controls, and that HCV viremia is associated with diabetes-related complications.
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Affiliation(s)
- Wassim Chehadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
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Youssef MYZ, Alqallaf A, Abdella N. Anabolic androgenic steroid-induced cardiomyopathy, stroke and peripheral vascular disease. BMJ Case Rep 2011; 2011:bcr.12.2010.3650. [PMID: 22693308 DOI: 10.1136/bcr.12.2010.3650] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute stroke could be the presentation of unrecognised cardiomyopathy postanabolic androgenic steroid (AAS) abuse. A 39-year-old male patient displayed signs of acute stroke, which were associated with AAS abuse over the last 3 years. Despite the absence of symptoms and signs of congestive heart failure at presentation, AAS-induced cardiomyopathy with a thrombus in the left ventricle was discovered to be the aetiology of his stroke and peripheral vascular disease. Awareness of the complications of AAS led to the prompt treatment of the initially unrecognised dilated cardiomyopathy, and stroke.
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Affiliation(s)
- Maged Y Z Youssef
- Department of General Internal Medicine, Mubarak Al Kabeer Teaching Hospital, Kuwait University, Kuwait.
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Al Mutairi SS, Mojiminiyi OA, Shihab-Eldeen A, Al Rammah T, Abdella N. Putative roles of circulating resistin in patients with asthma, COPD and cigarette smokers. Dis Markers 2011; 31:1-7. [PMID: 21846943 PMCID: PMC3826866 DOI: 10.3233/dma-2011-0793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the hypothesis that circulating resistin reflects the degree of pulmonary inflammation, this study explores putative roles of resistin in patients with acute and stable inflammatory obstructive airway diseases and cigarette smokers. METHODS We determined complements C3, C4, fasting resistin, insulin, glucose and lipid profile; calculated insulin resistance (homeostasis model assessment (HOMA-IR) in patients with acute asthma exacerbation (n=34); stable asthma (n=26) and stable chronic obstructive pulmonary disease (COPD; n=26), cigarette smokers (n=81), and healthy control subjects (n=42). We determined the associations between these variables and pulmonary function tests. RESULTS Patients with COPD, acute and stable asthma had significantly higher resistin and insulin than control subjects. Resistin, insulin, HOMA-IR, FEV1% and FEV1/FVC were significantly (p< 0.05) different between patients with acute asthma compared with stable asthma and COPD; smokers had similar levels of resistin, C3 and C4 as patients with asthma and COPD. In smokers, patients with asthma or COPD, resistin showed significant inverse correlations with FEV1%; FEV1/FVC% and positive significant correlations with BMI and HOMA-IR. Logistic regression showed that resistin is associated (p< 0.05) with inflammatory obstructive airways disease - odds ratio (OR)=1.22 and smoking OR=1.18. CONCLUSION Resistin may be a disease activity marker and may contribute to insulin resistance in smokers, asthma and COPD.
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Chehadeh W, Abdella N, Ben-Nakhi A, Al-Arouj M, Al-Nakib W. Risk factors for the development of diabetes mellitus in chronic hepatitis C virus genotype 4 infection. J Gastroenterol Hepatol 2009; 24:42-8. [PMID: 18717762 DOI: 10.1111/j.1440-1746.2008.05503.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM A high occurrence of type 2 diabetes (T2D) in patients with chronic hepatitis C virus (HCV) infection has been reported in Kuwait and other countries. However, HCV genotype 4 has been underrepresented in all previous studies. Our aim was to investigate the viral and host risk factors associated with the development of T2D in patients with chronic hepatitis C genotype 4 infection in the absence of liver fibrosis and steatosis. METHODS The study population consisted of 181 HCV-positive patients and 170 control HCV-negative patients with T2D. RESULTS The prevalence of HCV-patients with T2D was 39.8%. There was no significant association of T2D with gender, nationality, obesity, HCV viral load, or antiviral therapy. Older age (>or= 50 years) and family history of diabetes were the only independent risk factor for T2D in HCV patients. However, the median age and the prevalence of obesity in HCV-positive patients with T2D were significantly lower than those in diabetic HCV-negative patients. By following-up HCV-patients receiving antiviral drugs, a significant decrease of fasting plasma glucose and glycosylated hemoglobin levels was observed in diabetic patients who achieved a sustained viral response (SVR). CONCLUSIONS The risk factors associated with the development of T2D in the general population cannot alone account for the high prevalence of T2D obtained in chronic HCV genotype 4 infection. In the absence of liver fibrosis and steatosis, the improvement in glycemic control obtained in SVR patients may imply direct involvement of HCV in the development of T2D.
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Affiliation(s)
- Wassim Chehadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat.
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Al Mutairi SS, Mojiminiyi OA, Shihab-Eldeen AA, Al Sharafi A, Abdella N. Effect of smoking habit on circulating adipokines in diabetic and non-diabetic subjects. Ann Nutr Metab 2008; 52:329-34. [PMID: 18714151 DOI: 10.1159/000151487] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 05/29/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the well-known inverse association between smoking and body weight, there have been conflicting reports on the association between smoking and adipokines such as leptin and adiponectin. AIM To determine and compare whether tobacco smoking (cigarettes or sheesha) affects circulating levels of adiponectin and/or influences leptin and leptin receptor (sOb-R) concentrations and free leptin in diabetic and non-diabetic subjects. METHODS AND SUBJECTS Fasting plasma adiponectin, leptin, sOb-R, glucose, insulin, and lipid profile were determined in 236 subjects grouped as control subjects (n = 53); non-diabetic cigarette smokers (n = 34), non-diabetic sheesha smokers (n = 38), diabetic nonsmokers (n = 75) and diabetic smokers (n = 36). Uni- and multivariate regression analyses were used to determine the associations of these variables with body mass index (BMI) and smoking. RESULTS When compared to control subjects, smoking cigarettes or sheesha was associated with significantly higher glucose, insulin resistance, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and lower serum leptin, sOb-R and free leptin. The effects of smoking on BMI, leptin and sOb-R were dose-dependent. Binary logistic regression analysis showed that smoking is a significant determinant of BMI; leptin, sOb-R, free leptin index, adiponectin and LDL-C. CONCLUSIONS We conclude that smoking sheesha does not reduce the metabolic effects of smoking. Smoking may modify leptin receptors and modulate leptin synthesis but the weight-lowering effect may not be related to leptin-induced anorectic signals.
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Moussa MAA, Alsaeid M, Abdella N, Refai TMK, Al-Sheikh N, Gomez JE. Prevalence of type 2 diabetes mellitus among Kuwaiti children and adolescents. Med Princ Pract 2008; 17:270-5. [PMID: 18523392 DOI: 10.1159/000129604] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 06/06/2007] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To determine the prevalence of type 2 diabetes among 6- to 18-year-old Kuwaiti children. SUBJECTS AND METHODS Children with type 2 diabetes were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) randomly selected using the 2000/2001 educational districts' registers as a sampling frame. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 2 diabetes was based on the World Health Organization and the American Diabetes Association criteria. RESULTS Type 2 diabetes was identified in 45 of the 128,918 children surveyed, thereby giving an overall prevalence of 34.9 per 100,000 [95% confidence interval (CI) 24.7-45.1]. There was a significant difference in prevalence between males (47.3, 95% CI 28.7-65.8) and females (26.3, 95% CI 14.8-37.8) at p = 0.05 and a significant trend for an increase in prevalence of type 2 diabetes with age (p = 0.026). The overall age-adjusted prevalence rate in the 2002 Kuwaiti population was 33.2 (95% CI 26.6-39.9), 41.6 (95% CI 31.2-52.0) in male and 24.6 (95% CI 16.4-32.7) in female children; the difference was significant at p = 0.013. There was no significant difference in prevalence between regions. Children with type 2 diabetes had a significantly higher frequency (51.1%) of a positive family history of diabetes than children of a similar age without type 2 diabetes (22.2%) (p = 0.004). CONCLUSION The prevalence of type 2 diabetes in adult Kuwaitis is spreading to children and adolescents, making it an emergency public health problem. Efforts need to be initiated to address prevention strategies of type 2 diabetes in youth.
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Affiliation(s)
- Mohamed A A Moussa
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait.
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Alkhalaf M, Al-Bustan S, Hamoda H, Abdella N. Polymorphism of p53 gene codon 72 in Kuwaiti with coronary artery disease and diabetes. Int J Cardiol 2007; 115:1-6. [PMID: 16797751 DOI: 10.1016/j.ijcard.2006.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 01/05/2006] [Accepted: 01/09/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM Polymorphism in the p53 gene at codon 72 has been linked to the development of certain diseases including cancer. A possible association between such polymorphism and the development of coronary artery disease (CAD) and diabetes is being investigated, but no conclusive evidence has been reached yet. Our study is the first pilot study to be conducted on Kuwaitis suffering from CAD and diabetes, aiming at investigating the possible existence of the above association. MATERIALS AND METHODS We analyzed the genotype distribution and allele frequency of p53 gene at codon 72 in 158 CAD samples and 110 controls, and in 142 diabetic and 130 controls. RESULTS Analysis of CAD patients revealed an alarming significant association between the disease and the existence of diabetes (P=0.0007). Also, the CAD patients had significantly higher level of triglyceride (P<0.0001) and cholesterol (P<0.0001) as compared to control. As for the polymorphism in p53 gene codon 72, we could not detect any association with the genotype Pro/Pro, Pro/Arg or Arg/Arg distribution (P=0.28) or allele (Pro or Arg) frequency (P=0.25) in the CAD patients. Similarly, no association was found with the genotype Pro/Pro, Pro/Arg or Arg/Arg distribution (P=0.44) or allele (Pro or Arg) frequency (P=0.26) in the diabetic patients. CONCLUSION CAD seems to be strongly linked to diabetes in Kuwait. Polymorphism in the p53 gene at codon 72 revealed no significant association with the development of CAD or diabetes in Kuwait, which confirms other similar results obtained in the US and Asia.
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Affiliation(s)
- Moussa Alkhalaf
- Department of Biochemistry, Faculty of Medicine, Kuwait University, P.O. Box: 24923 Safat 13110, Kuwait.
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Marouf R, Mojiminiyi O, Qurtom M, Abdella N, Al Wazzan H, Al Humood S, Al Mazeedy M. Plasma homocysteine and hematological factors in patients with venous thromboembolic diseases in Kuwait. Acta Haematol 2006; 117:98-105. [PMID: 17135722 DOI: 10.1159/000097384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 07/23/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Venous thromboembolic disease (VTE) is a common cause of morbidity in Kuwait, but the risk factors have not been studied. Hyperhomocysteinemia has been suggested as one of the risk factors. We postulate that hyperhomocysteinemia acts synergistically with hematological variables to increase VTE risk. This study evaluates the roles of hyperhomocysteinemia and hematological variables in patients with VTE. METHODS We measured fasting plasma total homocysteine (tHcy), activated protein C resistance, protein C (PC), protein S (PS) and antithrombin (AT) in 201 patients with VTE and 166 healthy controls. We also measured factor VIII, factor II, lupus anticoagulant, anticardiolipin, serum vitamin B12, folate, creatinine, lipid profile, glucose, full blood count and red cell folate. The glomerular filtration rate (GFR) was calculated from creatinine. RESULTS When patients on warfarin were excluded, 13.1% of patients (18 out of 137) had a deficiency in PC, 16.8% (23 out of 137) had a deficiency in PS, and when patients on heparin were excluded, 8.3% of patients (14 out of 168) had low AT. Spearman's rank correlation analysis showed that tHcy had significant correlations with age, creatinine and PS, and significant inverse correlations with GFR, high-density lipoprotein cholesterol and serum folate. Partial correlation analysis after correcting for age and sex showed that tHcy retained a significant correlation with creatinine, GFR and serum folate. Binary logistic regression analyses of the determinants of hyperhomocysteinemia included age, creatinine, GFR and serum folate. Multivariate logistic regression analysis showed significant association of tHcy with VTE (OR = 5.6; p < 0.0001) in the presence of known risk factors for VTE. CONCLUSION We conclude that elevated tHcy is a significant risk factor for the development of VTE, and therefore, it should be included in the workup for patients at risk of VTE, but the determinants of tHcy should be kept in mind.
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Affiliation(s)
- Rajaa Marouf
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait.
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15
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Abstract
BACKGROUND Proteinuria is a common manifestation of renal disease which is a significant cause of morbidity in patients with sickle cell disease (SCD). OBJECTIVE To evaluate and compare cystatin C, beta(2)-microglobulin, and creatinine as markers of renal disease in relation to the degree of proteinuria and other complications of SCD. METHODS 24 h urine collections were used for estimation of urine protein and creatinine clearance in 59 patients with SCD. Results were correlated with plasma cystatin C, beta(2)-microglobulin, creatinine, glomerular filtration rate (GFR; derived from plasma creatinine by Cockcroft-Gault, MDRD formulae, and calculated cystatin C clearance), and clinical and haematological variables. RESULTS Comparing the different methods of GFR, the proportion of patients with hyperfiltration (GFR >140 ml/min) were 30.5% (MDRD), 44.1% (Cockcroft-Gault), and 10.2 % (calculated cystatin C clearance). Cystatin C was the most consistent marker of hyperfiltration. The endogenous markers of GFR showed an increasing trend with increasing proteinuria, but haematological variables were not correlated with cystatin C, beta(2)-microglobulin, or plasma creatinine. Urine protein excretion was correlated with age (r = 0.33) and significant proteinuria was present in 13.6% of patients. Patients with proteinuria had lower haemoglobin concentration (p = 0.027) than those without proteinuria but HbF was not related to the degree of proteinuria or to markers of GFR. CONCLUSIONS Markers of GFR show variable ability to identify hyperfiltration in patients with SCD, but cystatin C is the best endogenous marker. Proteinuria is associated with age, haemoglobin, and abnormalities of GFR. Routine screening is recommended to allow for early detection and intervention.
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Affiliation(s)
- R Marouf
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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16
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Abstract
OBJECTIVE To report 3 patients who presented with effort-induced thrombosis of the upper limbs. CASE PRESENTATIONS AND INTERVENTION The 1st patient presented with a 2-week history of fever, shortness of breath, and increasing swelling of the neck after strenuous manual work. The 2nd patient presented with a 2-day history of pain, swelling, and discolouration of the right upper limb following a session of intense weight lifting. The 3rd patient presented with a 2-day history of swelling, pain, and discolouration of the left upper limb due to repeated rotatory movements of the arm at work. In all 3 cases, the diagnosis of effort-induced thrombosis of subclavian and axillary veins was made. In the 1st case, the lesion was bilateral and complicated by superior vena cava obstruction. In the 2nd and in the 3rd case, right and left subclavian veins were thrombosed, respectively. After consulting the vascular team, anticoagulation therapy was initiated in all 3 cases. The patients described showed gradual recovery with eventual recanalization of the thrombosed veins on follow-up. CONCLUSIONS These cases indicate the need to consider thrombosis of the subclavian vein as a part of the differential diagnosis in a patient with a history of strenuous manual work. Therapeutic options include immediate anticoagulation or thrombolysis, while vascular surgery should remain an option for cases with underlying anatomical anomalies.
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Affiliation(s)
- M Y Z Youssef
- Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait
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17
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Moussa MAA, Alsaeid M, Refai TMK, Abdella N, Al-Sheikh N, Gomez JE. Factors associated with type 1 diabetes in Kuwaiti children. Acta Diabetol 2005; 42:129-37. [PMID: 16258736 DOI: 10.1007/s00592-005-0192-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 04/15/2005] [Indexed: 12/13/2022]
Abstract
Type 1 diabetes is a common chronic disease in childhood, and the outcome of environmental, genetic and immunologic interactions. The aim was to study the social and metabolic characteristics (lipids, lipoproteins, apolipoproteins, lipoprotein a (Lpa) and total sialic acid) and predisposing factors in 6-18-year-old Kuwaiti children with type 1 diabetes. This pair-matched case-control study included 348 type 1 diabetic children (131 males, 217 females) matched by age and gender to 348 non-diabetic controls. Diabetic children were identified, according to the WHO and the American Diabetes Association criteria, at 182 randomly selected schools. Social and metabolic characteristics were adversely affected in diabetic children compared to their controls. The logistic regression analysis showed that the predisposing factors: family history of type 1 and type 2 diabetes and thyroid disease, were significant associated factors with type 1 diabetes after adjusting for demographic and social variables. The significant correlations of Lpa and total sialic acid with glycated haemoglobin, lipoproteins and apolipoproteins partially explain reporting them as possible markers for coronary heart disease. There are adverse metabolic changes in children with type 1 diabetes. As these changes are associated with early onset atherogenesis, metabolic markers need to be measured and possibly corrected at an early stage in children with diabetes.
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Affiliation(s)
- M A A Moussa
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, 24923, Safat 13110, Kuwait.
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18
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Moussa MAA, Alsaeid M, Abdella N, Refai TMK, Al-Sheikh N, Gomez JE. Social and psychological characteristics of Kuwaiti children and adolescents with type 1 diabetes. Soc Sci Med 2005; 60:1835-44. [PMID: 15686813 DOI: 10.1016/j.socscimed.2004.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Type 1 diabetes mellitus is a chronic disease that may have an impact on children's psychosocial adjustment. This study aimed to investigate the psychosocial characteristics of Kuwaiti children with type 1 diabetes as compared to healthy children without diabetes, and assess the impact of glycaemic control on psychosocial variables. A total of 349 school children aged 6-18 years with type 1 diabetes, and 409 children without diabetes having comparable age, gender, and social class were included in the study. Data were obtained by interviewing children and parents using a questionnaire. Psychological distress was measured by the Hopkins symptoms checklist-25 scale including anxiety and depression. Glycaemic control was assessed by glycosylated haemoglobin, HbA(IC) level. Glycaemic control was considered 'good to excellent' at HbA(IC)<8.0%, 'fair' at HbA(IC) 8.1 to 10.0%, and 'poor' at HbA(IC)>10.0%. Median scores of anxiety, depression, and total distress were significantly higher in children with diabetes indicating worse psychological adjustment. There was also significant difference between children with diabetes and those without diabetes in social aspects and school absence days. There was significant positive correlation between HbA(IC) concentration and scores of the psychological functioning indices. Children with poor glycaemic control had worse psychological adjustment. After controlling the variance accounted by gender and age, stepwise multiple regression analysis showed that girls, older children, children in need of emotional support, and those with higher HbA(IC) were at higher risk for psychological maladjustment. These variables explained 47.9% of the variation in total distress. In conclusion, the study supported our hypotheses. Children with diabetes had worse psychological adjustment, and distress was related to glycaemic control. Since psychological distress increases the risk for future complications due to its relation with glycaemic control, longitudinal studies are recommended to identify children with diabetes having distress at an early stage when preventive interventions are effective.
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Affiliation(s)
- M A A Moussa
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait.
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19
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Abstract
Currently in-training evaluation in Kuwait depends on the use of the global rating scale at the end of clinical rotation clerkships. Such a scale is inconsistent, subjective, and suffers from deficiencies such as positive skewness of the distribution of ratings and poor reliability. The aim of the study was to assess the inter-rater variation and the reliability of the recently introduced Interaction Card (IC) method for evaluating clinical performance and to measure the agreement between trainees' overall performance evaluation by the currently used global rating scale and the IC summative evaluation. In the study, 370 evaluators encountered 50 trainees during their basic clinical training rotations (internal medicine, surgery, obstetrics and gynecology, and pediatrics) at six hospitals. A total of 9146 encounters were conducted focusing on six clinical performance domains: clinical skills (taking history, case sheet, and physical examination), professional behaviour, case presentation, diagnosis, therapy and handling of emergencies. The method demonstrated significant inter-rater variation in the overall IC ratings according to specialty, rank of evaluator and hospital (p < 0.001). The Interaction Card was found to be reliable, as shown by the internal consistency between the six domains (Cronbach's alpha = 0.914). There was low correlation (Spearman rank correlation coefficient, rs = 0.337), and low agreement (Kappa = 0.131) between the global rating scale and Interaction Cards summative evaluations. The IC method provided instantaneous formative feedback and summative evaluation for clinical performance to trainees. The method can be generalized to encompass training and examinations programmes for all categories of trainees in most clinical specialties.
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Moussa MAA, Alsaeid M, Abdella N, Refai TMK, Al-Sheikh N, Gomez JE. Prevalence of type 1 diabetes among 6- to 18-year-old Kuwaiti children. Med Princ Pract 2005; 14:87-91. [PMID: 15785099 DOI: 10.1159/000083917] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Accepted: 03/22/2004] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To determine the prevalence of type 1 diabetes among 6- to 18-year-old Kuwaiti children according to gender, age, and region. SUBJECTS AND METHODS Children with type 1 diabetes aged 6-18 years were identified at 182 schools (50 primary, 63 intermediate, and 69 secondary) in Kuwait during the study period October 2000 to September 2002. Schools were randomly selected using the 2000/01 educational districts' registers as sampling frame proportional to the number of schools in each district. Prevalence rates were adjusted to the 2002 Kuwaiti population. Diagnosis of type 1 diabetes was based on the World Health Organization, and the American Diabetes Association criteria. RESULTS Prevalence of type 1 diabetes was 269.9 per 100,000 (95% confidence interval, CI 241.6-298.3). There was no significant difference in prevalence between male (247.6, 95% CI 205.2-290.0) and female (285.5, 95% CI 247.5-323.5). Type 1 diabetes was more prevalent in the age group 10-13 years (347.3), and lowest in the age group 6-9 years (182.6) per 100,000; the difference was significant at p < 0.001. The overall age-adjusted prevalence rate was 252.9 (95% CI 234.6-271.2), 229.1 (95% CI 204.6-253.6) in male and 277.4 (95% CI 250.0-304.7) in female children in the 2002 Kuwaiti population. The mean age at onset was 9.2, and 8.1 years in male and female children, respectively (p = 0.018). There was no significant difference in prevalence between regions. CONCLUSION Type 1 diabetes is a common chronic disease in Kuwaiti children.
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Affiliation(s)
- Mohamed A A Moussa
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait.
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21
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Onadeko BO, Khadadah M, Abdella N, Mukhtar M, Mourou M, Qurtom M, Samad M, Al-Shayeb A. Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait. Med Princ Pract 2005; 14:35-40. [PMID: 15608479 DOI: 10.1159/000081921] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 10/30/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. RESULTS Seventy-four of 104 (71%) hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 +/- 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients (78%) had a baseline FEV1 <50% before hospitalization and 45 (64%) had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen (19%) died on admission. Risk factors identified included severity of disease (p < 0.05); presence of comorbid disease (p < 0.01); acidemia (p < 0.0001); hypercapnia (p < 0.0001); previous hospitalization (p < 0.01), and assisted ventilation (p < 0.001). CONCLUSION This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.
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Affiliation(s)
- B O Onadeko
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
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22
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Moussa MAA, Alsaeid M, Abdella N, Refai TMK, Al-Sheikh N, Gomez JE. Lipoprotein(a) and Other Cardiovascular Metabolic Risk Factors in Kuwaiti Children with Type-1 Diabetes. Ann Nutr Metab 2004; 48:329-34. [PMID: 15467283 DOI: 10.1159/000081200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 04/20/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Lipoprotein(a) synthesis and catabolism could be influenced by insulin or by diabetes metabolic complications in patients with type-1 diabetes. The aim of the study was to investigate the relation of plasma lipoprotein(a) concentrations with metabolic cardiovascular risk factors in Kuwaiti children with uncomplicated type-1 diabetes. METHODS This case-control study included 115 (44 males and 71 females) diabetic children aged 6-18 years matched by age and sex to 115 non-diabetic children as controls. RESULTS There was no significant difference between the mean lipoprotein(a) concentrations in type-1 diabetic children (27.34 mg/dl) and their controls (22.80 mg/dl). Total cholesterol, apolipoprotein A1 and B levels were significantly higher in diabetic children than controls. In diabetic children, significant correlations were found between lipoprotein(a) levels and glycated hemoglobin (r = 0.249, p = 0.011), total cholesterol (r = 0.208, p = 0.025), and apolipoprotein B (r = 0.349, p < 0.001). The proportion of diabetic children with lipoprotein(a) >30 mg/dl was significantly higher in those having poor glycemic control (glycated hemoglobin >9.0%, p = 0.013), raised total cholesterol (p = 0.033), or with a family history of cardiovascular disease (p = 0.006). CONCLUSION Plasma lipoprotein(a) levels were not elevated in young type-1 diabetic children compared to non-diabetic controls; however, lipoprotein(a) levels were significantly higher in diabetic children with poor glycemic control. Moreover, there were significant correlations between lipoprotein(a) and the metabolic cardiovascular risk factors total cholesterol, atherogenic index, apolipoprotein B and apolipoprotein B/A1 ratio.
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Affiliation(s)
- M A A Moussa
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait.
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23
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Alsaeid M, Moussa MAA, Haider MZ, Refai TMK, Abdella N, Al-Sheikh N, Gomez JE. Angiotensin-converting enzyme gene polymorphism and lipid profiles in Kuwaiti children with type 1 diabetes. Pediatr Diabetes 2004; 5:87-94. [PMID: 15189494 DOI: 10.1111/j.1399-543x.2004.00040.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
METHODS We studied angiotensin-converting enzyme (ACE) gene polymorphism and lipid profiles in Kuwaiti children with uncomplicated type 1 diabetes. A total of 125 children with type 1 diabetes were matched in a case-control study on age and gender to 125 non-diabetic children as controls. Serum lipids (total cholesterol, TC; high-density lipoprotein cholesterol, HDL; low-density lipoprotein cholesterol, LDL-c; triglycerides, TG; apolipoprotein A1 and B, apo A1 and B; lipoprotein(a), Lp(a)); and glycated hemoglobin, HbA1c were evaluated according to ACE genotypes. RESULTS Genotype distributions were found to be similar in cases [ACE insertion/insertion (II) 9.6%, ACE insertion/deletion (ID) 38.4%, ACE deletion/deletion (DD) 52.0%], and controls (II 8.8%, ID 43.2%, DD 48.0%), and were characterized by higher frequencies of DD, ID, and lower frequencies of II. Diabetic children with DD genotype showed significantly higher levels of TC (p < 0.01), HDL (p < 0.001), and apo A1 (p < 0.001) than controls. There was a higher proportion of diabetic children with family history of cardiovascular disease (CVD) in the DD genotype group (51.9%) than those with II genotype group (11.1%) (p < 0.001). Also, there was a significant increase in the frequency of diabetic children with Lp(a) > 30 mg/dL in children with a family history of CVD (p = 0.008). Lp(a) levels were correlated with HbA1c in the diabetic group (r = 0.239, p = 0.019), but when patients with poor glycemic control (HbA1c > 9%) were excluded, the significant correlation disappeared (r = 0.127, p = 0.381). After adjusting confounding between variables, the logistic regression analysis showed that the two significantly related variables with the rise in Lp(a) were increasing TC level and poor glycemic control. CONCLUSIONS In children with type 1 diabetes, the role of ACE polymorphism as a probable contributor to CVD seems to be partially mediated through other factors such as poor glycemic control, TC, and Lp(a) level. A longitudinal study is recommended with a larger number of patients in each ACE genotype group in order to assess such associations.
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Affiliation(s)
- M Alsaeid
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Moussa MAA, Alsaeid M, Refai TMK, Abdella N, Al-Sheikh N, Gomez JE. Association of serum sialic acid with cardiovascular metabolic risk factors in Kuwaiti children and adolescents with type 1 diabetes. Metabolism 2004; 53:638-43. [PMID: 15131770 DOI: 10.1016/j.metabol.2003.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to investigate the relation of serum total sialic acid (TSA) concentrations with cardiovascular metabolic risk factors in Kuwaiti children and adolescents with uncomplicated type 1 diabetes. This case-control study included 150 (57 males and 93 females) type 1 diabetic children aged 6 to 18 years matched by age and sex to 150 nondiabetic children as controls. Measured variables included weight, height, systolic, diastolic blood pressure, and biochemical variables: blood glucose, glycated hemoglobin (HbA(1C)), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), apolipoproteins (apo) A1 and B, and urine microalbumin. There was no significant difference between mean serum TSA of the type 1 diabetic children (671.0 mg/L) and their controls (663.7 mg/L). In diabetic children, mean serum TSA was significantly higher in females (699.1 mg/L) than in males (625.2 mg/L) (P =.003). Significant correlations were found between serum TSA and the cardiovascular risk factors TC (P =.002), TG (P <.001), and apo B (P =.008). TSA mean level was significantly higher in diabetic children with poor glycemic control (HbA(1C) > 9.0%; P =.015), raised TC (P =.013), raised TG (P =.014), and in children with family history of cardiovascular disease (CVD; P =.02). In conclusion, the study suggests that serum TSA levels were not elevated in young type 1 diabetic children as compared with controls. The study also confirmed significant correlation of TSA concentrations with CVD risk factors TC, TG, and apo B, and as such serum TSA may be considered as a marker for CVD risk, especially in diabetic patients. A long-term prospective study is recommended to ascertain the longitudinal relationship of serum TSA with the adverse metabolic changes in type 1 diabetic children as complications prevail.
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Affiliation(s)
- Mohamed A A Moussa
- Department of Community Medicine and Behavioual Sciences, Kuwait University, Safat, Kuwait
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25
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Abstract
BACKGROUND Despite recent studies showing that serum cystatin C (CC) is a better marker for GFR than the ubiquitously used serum creatinine, its clinical utility remains under evaluation. METHODS To evaluate their usefulness in patients with type 2 diabetes mellitus (DM), serum concentrations of CC, beta-2 microglobulin (B2M) and creatinine were measured in 105 (38 males, 67 females) Kuwaiti patients with type 2 DM. The results were compared with creatinine clearance (Ccr), which was measured (mCcr) and estimated (eCcr) with the Cockroft-Gault formula, and correlated with 24-h urine protein and early morning urine albumin/creatinine excretion ratio. RESULTS In patients with eCcr and mCcr results (n=51), eCcr and mCcr showed significant correlation with each other (r's=.86, P<.0001) with no significant difference between the two. In all patients (n=105), CC and B2M showed significant correlation with each other (r's=.82, P<.0001) and with serum creatinine concentration (r's=.77 and.84, respectively, P<.0001). Serum CC, B2M and creatinine showed significant (P<.001) inverse correlation with eCcr (r's=-.63, -.61 and -.76, respectively). Partial correlations after correcting for age and sex improved the correlation of serum creatinine with eCcr (r=-.81, P<.0001), but there was no significant change in the correlations of CC and B2M with eCcr (r=-.65, P<.0001 and r=-.62, P<.0001, respectively). Receiver operating characteristic (ROC) plots for serum CC, B2M and creatinine for detection of changes in the eCcr showed that the area under the ROC curve+/-S.E. is 0.897+/-0.119 for CC, 0.871+/-0.091 for B2M and 0.785+/-0.087 for serum creatinine. There was no statistically significant difference between the areas under the curve (AUC) for serum creatinine and CC (P=.07) and B2M (P=.12). CC had the highest sensitivity for detection of eCcr (<60 ml/min/1.73 m(2)) at routinely used cutoff values. CC was also the best discriminator when patients with normoalbuminuria were compared with patients with microalbuminuria. CONCLUSION Although there is no significant difference in the overall diagnostic accuracies of CC, B2M and creatinine for the detection of changes in the GFR, CC is the most sensitive marker at routinely used cutoff values and would be more clinically useful than B2M or serum creatinine in diabetic patients.
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Affiliation(s)
- Olusegun A Mojiminiyi
- Department of Pathology, Faculty of Medicine, Kuwait University, PO Box 24923, Safat code 13110, Kuwait.
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Mojiminiyi OA, Abdella N, Moussa MA, Akanji AO, Al Mohammedi H, Zaki M. Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2002; 58:37-44. [PMID: 12161055 DOI: 10.1016/s0168-8227(02)00101-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12-3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70-17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.
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Affiliation(s)
- O A Mojiminiyi
- Department of Pathology, Faculty of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait.
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Shaltout AA, Moussa MAA, Qabazard M, Abdella N, Karvonen M, Al-Khawari M, Al-Arouj M, Al-Nakhi A, Tuomilehto J, El-Gammal A. Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait. Diabet Med 2002; 19:522-5. [PMID: 12109439 DOI: 10.1046/j.1464-5491.2002.00703.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS To provide age-gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged < or = 14 years. METHODS Data were prospectively collected over a period of 6 years (1992-1997) according to the DiaMond Project protocol using the capture-recapture method of ascertainment. RESULTS Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100,000 children 0-14 years (95% confidence interval (CI) 18.0-22.1); age-standardized incidence rate 20.9 (95% CI 18.8-23.0). The incidence rate among boys, 21.1 per 100,000 (95% CI 18.1-24.1) was slightly higher than that among girls, 19.0 per 100,000 (95% CI 16.1-21.8). The age-standardized incidence rate was 21.9 (95% CI 18.9-24.8) in boys, and 19.9 (95 CI 17.1-22.8) in girls. Incidence rates increased with age in both sexes (boys chi(2) for linear trend = 13.5, P < 0.001; and for girls chi(2) = 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6-year period (chi(2) = 6.210, P = 0.013), and in age group 5-9 (chi(2) = 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001). CONCLUSION The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.
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Affiliation(s)
- A A Shaltout
- Department of Paediatrics, Kuwait University, Kuwait
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Mojiminiyi OA, Marouf R, Abdella N, Kortom M, Abdul-Razzak R. Serum concentration of cystatin C is not affected by cellular proliferation in patients with proliferative haematological disorders. Ann Clin Biochem 2002; 39:308-10. [PMID: 12038606 DOI: 10.1258/0004563021902017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent reports have shown elevated concentrations of serum cystatin C (CC) in patients with solid tumours. The aim of our study was to investigate whether patients with proliferative haematological disorders have increased serum concentrations of CC compared with normal subjects. METHODS Full blood count, serum CC, beta2-microglobulin (beta2M) and serum creatinine were determined in 27 apparently healthy subjects and 35 patients with proliferative haematological disorders. Creatinine clearance was calculated using the Cockroft-Gault formula. RESULTS CC and beta2M showed a significant correlation with each other (r=0.96, P<0.0001). Serum beta2M (P=0.001) and the serum beta2M:CC ratio (P=0.001) were significantly higher in the patients with normal renal function than in controls, but serum CC was not significantly different (P=0.08). CC did not show a significant correlation with blood count parameters. DISCUSSION Compared with beta2M and the beta2M:CC ratio, serum CC is not influenced by cell proliferation in haematological disorders.
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Affiliation(s)
- O A Mojiminiyi
- Department of Pathology, Faculty of Medicine, Kuwait University, Sufat.
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Abstract
BACKGROUND Glycation and oxidative modification of lipoproteins enhance the uptake of these lipids by macrophages in the early stages of atherogenesis. Measurement of blood levels of modified LDL particles could thus constitute another useful modality in identifying subjects at high risk of coronary atherosclerosis (CHD). OBJECTIVE To measure the glycated LDL level and assess its associations with other metabolic parameters in diabetic and nondiabetic hyperlipidaemic subjects attending a Lipid Clinic in Kuwait. SUBJECTS AND METHODS One hundred thirty-three hyperlipidaemic (HL) (72 nondiabetic (ND); 61 diabetic (D)) patients and 42 healthy control (HC) subjects had their fasting serum samples analyzed for glucose, total cholesterol (TC), triglycerides (TG), urate, HDL, LDL (by routine autoanalyzer methods), apolipoproteins A1 and B (by nephelometry), fructosamine (by spectrophotometry) and glycated LDL (gLDL) by ELISA. RESULTS The serum gLDL level was significantly higher in HL [D+ND] than in HC (p<0.001). Within the HL group, the DHL patients had higher levels than the NDHL [p<0.001]. These differences were maintained when the gLDL level was also expressed as a percentage of the apo B concentration. The gLDL level correlated positively (p<0.01) with those of glucose, TC, TG and LDL and negatively with HDL (p<0.05) in all the subjects as a whole, healthy and hyperlipidaemia [HC+HL]. In the HL (D+ND) group as a whole, gLDL correlated significantly only with glucose [p<0.01]. In group DHL, however, gLDL correlated significantly with glucose, fructosamine and LDL [all p<0.05]. As expected, fructosamine levels were highest in the DHL group. The significant correlations established between fructosamine and the different analytes measured in the different subject groups were essentially similar to those observed for gLDL, except for the finding of persistent significant negative correlations of fructosamine with LDL in all the subject groups. CONCLUSIONS (i) Serum gLDL levels are increased in hyperlipidaemic patients and are further increased with diabetes, suggesting that the significant glycation of LDL occurs in all hyperlipidaemic patients irrespective of their glycaemic status. (ii) The significant correlation of gLDL with glucose and fructosamine in diabetic patients would suggest its potential utility as another index of medium term glycaemic control. (iii) gLDL is easily measurable and its values could provide additional information in ascertaining an individual's aggregate CHD risk.
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Affiliation(s)
- Abayomi O Akanji
- Clinical Chemistry Unit, Department of Pathology, Faculty of Medicine, Kuwait University, P.O. Box 24923 Safat, 13110, Kuwait.
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30
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Abstract
The aim of this study was to assess parameters of renal function and other determinants of plasma homocysteine in type 2 diabetic patients without coronary heart disease (CHD). Fasting plasma homocysteine, serum cystatin C and serum creatinine were determined in 183 (75 men, 108 women) Type 2 diabetic patients without clinical evidence of CHD. Creatinine clearance was calculated and parameters such as blood pressure, body mass index (BMI), and glycated haemoglobin (HbA(1c)) were assessed. The urine albumin:creatinine ratio was used to classify patients as normo-, micro- or macroalbuminuric. One hundred and ten patients were normoalbuminuric, 67 patients were microalbuminuric and six patients were macroalbuminuric. There was no statistically significant difference in plasma homocysteine concentration between patients with normoalbuminuria and microalbuminuria. There was a trend towards increasing plasma homocysteine with decreasing glomerular filtration rate (GFR) (r=-0.46; P<0.0001). There was statistically significant correlation between plasma homocysteine and age (r=0.37), serum cystatin C (r=0.47), and serum creatinine (r=0.56). Plasma homocysteine concentration was significantly higher in patients with BMI<30 kg/m(2) and showed significant inverse correlation with weight (r=-0.16; P=0.03) and body mass index (r=-0.24; P=0.001). Homocysteine and serum creatinine were significantly higher in males than females and higher in smokers than non smokers but was not associated with glycemic control and duration of diabetes. In conclusion, elevated homocysteine concentration in patients with type 2 DM without CHD is related to age, gender, smoking, BMI and GFR. Follow up studies will provide further information on the association between hyperhomocysteinemia and the development of cardiovascular disease.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat, Kuwait
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Mojiminiyi OA, Abdella N, George S. Evaluation of serum cystatin C and chromogranin A as markers of nephropathy in patients with type 2 diabetes mellitus. Scand J Clin Lab Invest 2000; 60:483-9. [PMID: 11129064 DOI: 10.1080/003655100448464] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Nephropathy is a significant cause of morbidity and mortality in patients with diabetes mellitus (DM). The condition is characterized by persistent albuminuria and years of progressive renal structural changes associated with decline in the glomerular filtration rate (GFR). This study evaluates whether serum concentrations of the endogenous markers of GFR, cystatin C and chromogranin A could be used as indicators of nephropathy in 77 patients with Type 2 DM. On the basis of early morning urine microalbumin:creatinine ratio, patients were divided into patients without diabetic nephropathy (DN) who were normoalbuminuric (n = 27) and patients with DN who were microalbuminuric (n = 8) or macroalbuminuric (n = 42). Patients with reduced GFR or elevated serum cystatin C did not show the expected increase in serum chromogranin A. Twenty-six percent of the patients with normoalbuminuria and 6% of those with DN had serum chromogranin A below the detection limit of the assay (< 2 U/L). In patients with DN, serum chromogranin A showed significant correlation with serum cystatin C, but not with serum creatinine and creatinine clearance. Serum cystatin C and creatinine showed poor correlation with duration of DM and HbA1c. Serum cystatin C and creatinine were significantly higher in patients with DN than in normoalbuminuric patients. Serum cystatin C showed significant correlation with serum creatinine (rs = 0.45, p = 0.002), but not with creatinine clearance (rs = 0.23, p = 0.17) in patients with DN. Four of nine patients with creatinine clearance between 50 and 80 mL/min had increased (> or = 1.4 mg/L) serum cystatin C compared with only two patients with increased serum creatinine concentration. Twenty of 50 (40%) patients with DN had elevated serum cystatin C compared with 6 of 50 (12%) with elevated serum creatinine. If microalbuminuria is regarded as the "gold-standard" test, serum cystatin C has a sensitivity of 40% and specificity of 100% for the detection of DN. However, further studies are required to confirm the usefulness of serum cystatin C estimation as a screening test and as an early indicator and predictor of the development of DN.
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Affiliation(s)
- O A Mojiminiyi
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat.
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32
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Abdella N, Akanji AO, Mojiminiyi OA, Al Assoussi A, Moussa M. Relation of serum total sialic acid concentrations with diabetic complications and cardiovascular risk factors in Kuwaiti Type 2 diabetic patients. Diabetes Res Clin Pract 2000; 50:65-72. [PMID: 10936670 DOI: 10.1016/s0168-8227(00)00144-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Serum total sialic acid is a marker of the acute phase response. Elevated levels have also been associated with cardiovascular disease in the general Caucasian population and especially in Type 2 diabetic subjects. The purpose of this study was to estimate serum total sialic acid concentrations among Kuwaiti Type 2 diabetic subjects and to investigate its association with macro and microvascular diabetes-related complications in that population. Serum total sialic acid levels were estimated by an enzymatic spectro-photometric assay in two groups of subjects: (i) 358 Kuwaiti Type 2 diabetics (156 men and 202 women) referred for their annual evaluation to the specialised diabetic clinic at the main university teaching hospital in Kuwait, and (ii) 47 healthy age and sex matched non-diabetic Kuwaiti control population (13 men and 34 women). Serum sialic acid levels were significantly higher (P<0.001) among the diabetic patients (mean+/-S.D.) (81.2+/-13.2 mg/dl) compared to the non-diabetic controls (66.9+/-11.0 mg/dl). Kuwaiti diabetic women had significantly higher concentrations compared to diabetic men (85.2+/-12.1 vs. 75.9+/-13.0 mg/dl, P<0.001). Among the controls there was no significant gender difference in sialic acid levels of women, (68.3+/-11.6 mg/dl) versus men (63.2+/-8.2 mg/dl). The gender difference in the diabetic patients was unrelated to the degree of obesity. Significant correlations were found between serum total sialic acid concentrations and such cardiovascular risk factors as plasma levels of apolipoprotein B, low density lipoprotein cholesterol, triglycerides and uric acid in the diabetic subjects. Furthermore, there was a significant elevation in serum total sialic acid concentrations with increasing urinary albumin excretion, P<0.001, but not with retinopathy or neuropathy.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110 Kuwait
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33
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Akanji AO, Mojiminiyi OA, Abdella N. Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyperlipidaemic subjects after Ramadan fasting in Kuwait. Eur J Clin Nutr 2000; 54:508-13. [PMID: 10878654 DOI: 10.1038/sj.ejcn.1601047] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In patients with metabolic and nutritional disorders such as diabetes and hyperlipidaemia, where strict compliance to advice on timing and composition of food intake is important, the prolonged daylight fasting during the month of Ramadan could produce undesirable biochemical consequences. AIM The study aimed to compare pre- and post-Ramadan lipid and lipoprotein profiles in stable Kuwaiti hyperlipidaemic subjects attending a Lipid Clinic. SUBJECTS AND METHODS The study population comprised 64 adult Kuwaitis (33 M, 31 F) who had been attending a Lipid Clinic for at least 12 months and were considered stable, without any acute systemic illness. At each clinic visit, the following parameters were measured: weight, total cholesterol (TC), triglycerides (TG), HDL, LDL, apo A-1, apo B, glucose and uric acid. These biochemical parameters were measured by routine automated analyzer techniques. The pre-Ramadan values comprised the means of two measurements taken at about 3 month and 1 month before commencement of Ramadan. Post-Ramadan values were obtained within 1 month of the end of the Ramadan fast. The parameters so obtained were compared in the whole group, and then according to gender, glycaemic status and modality of treatment (diet alone or with a fibrate or statin). RESULTS AND DISCUSSION In the nondiabetic subjects, apo A-1 and apo A-1/apo B and apo A-1/HDL ratios were increased post-Ramadan (P<0.001). Weight did not change and the other lipid parameters-TC, TG, LDL, apo B-did not worsen. These observations, more consistent in the men than in the women, and in subjects treated with a fibrate or a statin rather than on diet alone, indicate a favorable coronary heart disease (CHD) risk profile. In the diabetic patients, these changes in the apo A-1 level and its ratio to HDL and apo B were also present, but TC and apo B levels increased, the latter significantly (P<0.05). These divergent effects in diabetic patients could variably influence CHD risk liability. Serum uric acid levels were also simultaneously reduced post-Ramadan in the non-diabetic subjects and those on statin treatment. CONCLUSION When pre- and post-Ramadan lipid and lipoprotein profiles were compared in stable hyperlipidaemic subjects attending a Lipid Clinic in Kuwait, the most consistent changes post-Ramadan were increased levels of apo A-1 and apo A-1/apo B and apo A-1/HDL ratios and reduced uric acid levels. Body weight remained essentially unchanged and the other lipoprotein and lipid parameters were not worsened. These results suggest that Ramadan fasting in hyperlipidaemic subjects might favorably influence CHD risk.
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Affiliation(s)
- A O Akanji
- Department of Pathology, Kuwait University Faculty of Medicine, Safat.
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Abdella N, Al Nakhi A, Al Arouj M, Assoussi A, Moussa M. Impact of the 1997 American Diabetes Association criteria on classification of glucose intolerance among Kuwaitis below 50 years of age. Acta Diabetol 1999; 36:133-40. [PMID: 10664317 DOI: 10.1007/s005920050156] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Type 2 (non-insulin-dependent) diabetes is emerging as a leading chronic non-communicable disease among the adult Kuwaiti population. Based on the World Health Organization and similar reports the projected estimates for subjects suffering from type 2 diabetes by the years 2000 and 2010 show a striking tendency to high rates of the disease in our area. We report the prevalence rates of glucose intolerance among a relatively young adult Kuwaiti population below 50 years of age and the effect of implementing the recent 1997 American Diabetes Association diagnostic criteria on the frequency of type 2 diabetes, impaired glucose tolerance and impaired fasting glucose among this group. The overall prevalence rate for the three categories of glucose intolerance reached as high as 15.8% (95% CI, 14.2 to 17.4). Age, though all subjects were below 50 years, parental history of type 2 diabetes, diastolic blood pressure and serum triglycerides were found to be significant associated risk factors for the development of type 2 diabetes. Obesity was an apparent significant factor associated with the three forms of glucose intolerance (p < 0.001). Obesity and physical inactivity were documented in both non-diabetic and more so in diabetic Kuwaiti adults, which should form the basis of any immediate intervention programme. An integrated approach to the prevention of the described critical risk factors associated with type 2 diabetes is highly recommended in Kuwait. Research, focused on genetics of type 2 diabetes in the highly susceptible Kuwaiti population, should be planned.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait
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35
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Abstract
Non-insulin-dependent diabetes mellitus (NIDDM) is a major clinical and public health problem in Kuwait. The objective of the study was to determine prevalence rates of NIDDM among a representative sample of the Kuwaiti adult population aged 20 and older in two out of five governorates and identify the associated risk factors for the disease. A total of 3003 subjects (1105 men and 1898 women) were interviewed and examined by the research team during the period September 1995 to June 1996. A specially designed questionnaire was completed and the physical examination included height, weight and blood pressure measurements. Fasting blood samples were withdrawn, centrifuged immediately and refrigerated. Interpretation of oral glucose tolerance tests were based on the World Health Organisation diagnostic criteria for diabetes mellitus (1985). The denominator used for computing the prevalence was obtained from the 1995 Kuwait census. The overall prevalence of NIDDM in this study was found to be 14.8% (14.7% in men, 14.8% in women). Diabetic subjects presented at a relatively young age, prevalence rate in the age group 20-39 was 5.7% (95% confidence interval, 4.4-7.0) and in the age group 40-59 was 18.3% (95% confidence interval, 16.1-20.6). Obesity was found to be a significant risk factor, P < 0.001. The strong association of family history of NIDDM (adjusted odds ratio = 1.80, P < 0.001) suggests a genetic component. Hypertension was markedly associated with NIDDM and IGT (P < 0.001). With the demographic transition which already started among the Kuwaiti population and if the prevalence of NIDDM remains the same, aging of the population will contribute to even more upward trends in prevalence of abnormal glucose tolerance with its serious impact on morbidity and mortality among the Kuwaiti population. The strong association between hypertension and NIDDM may suggest a common approach to the prevention and control of these two conditions.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat
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36
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al Khawari M, Shaltout A, Qabazard M, Abdella N, al Moemen J, al-Mazidi Z, Mandani F, Moussa MA. Incidence and severity of ketoacidosis in childhood-onset diabetes in Kuwait. Kuwait Diabetes Study Group. Diabetes Res Clin Pract 1997; 35:123-8. [PMID: 9179467 DOI: 10.1016/s0168-8227(96)01365-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In 1992, the diabetes registry was started in Kuwait, as part of DiaMond, a WHO multinational collaborative project on the incidence of childhood-onset diabetes. Children (243) aged below 15 years, were identified between 1 January 1992 and 31 December 1995. Children (203) were Kuwaiti and 40 were non-Kuwaiti children but resident of Kuwait. For the years 1992, 1993, the annual incidence of childhood onset diabetes for Kuwaiti children was 15.4 per 100,000 (95% confidence interval 12.9-19), and the degree of ascertainment was 92%. Polyuria, polydypsia, weight loss and nocturia were the most frequently reported symptoms; four children were in coma and one in shock at presentation. Nearly half of the children (49%) presented ketoacidosis (venous pH < 7.3 and/or plasma bicarbonate level < 18 mmol/l). and in 53 children (23.5%) it was severe (venous pH < 7.1 and/or plasma bicarbonate level < 10 mmol/l). In 62 children (25.5%) it was mild to moderate (venous pH 7.1-7.3 and/or plasma bicarbonate level 10.1-18 mmol/l). The incidence of severe ketoacidosis was similar in all age groups and sexes. All children recovered completely without major complications and no deaths were recorded. We conclude that diabetic ketoacidosis is a common presentation at the onset of diabetes in childhood in Kuwait and attests to the lack of awareness of general practitioners and parents to the symptoms and signs of diabetes in childhood.
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Affiliation(s)
- M al Khawari
- Department of Paediatrics, Al Amiri Hospital, Faculty of Medicine, Kuwait University, Safai, Kuwait
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37
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Abstract
The reported prevalence of type 2 diabetes among the Kuwaiti population varied from one source to another. This study was undertaken to define the magnitude of the problem and to suggest plans for future diabetic care. All type 2 Kuwaiti diabetic subjects registered and continuing to attend regularly in two health areas Mubarak Health Area (MHA) and Farwania Health Area (FHA)] were selected for the study. There were 3222 in MHA and 5114 in FHA among the Kuwaiti population aged 20 years and above, accounting for a total crude prevalence of 7.6% in both health areas and for a prevalence rate of 5.6% in MHA and 10.0% in FHA. The age-specific prevalence of type 2 diabetes in both areas combined rose from 2.639 per 100 population in the age group 20-39 years to 15.350% and 26.252% in the age groups 40-59 and 60 and above, respectively. The female to male ratio was 1.7, 1.6, 1.1, respectively, in MHA and 1.7, 2.0, 0.9 in FHA for the age groups 20-39, 40-59, and 60 and above. This study shows that type 2 diabetes is a major public health problem in Kuwait, with a female preponderance. Obesity is a characteristic feature of the population studied, with a mean body mass index of 31.8 +/- 6.3 and 28.5 +/- 5.1 in women and men, respectively. A positive family history of diabetes mellitus was reported in 63% of the diabetic subjects. There is a need to standardize methods of reporting and to plan a national screening survey.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Lanham RJ, Armstrong D, Abdella N. Vascular complications of patients in Kuwait with type 2 diabetes mellitus (NIDDM) and elevated serum lipid peroxides. Adv Exp Med Biol 1994; 366:433-5. [PMID: 7771283 DOI: 10.1007/978-1-4615-1833-4_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R J Lanham
- Department of Medicine, School of Medicine, State University of New York, Buffalo 14225, USA
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Armstrong D, Abdella N, Salman A, Miller N, Rahman EA, Bojancyzk M. Relationship of lipid peroxides to diabetic complications. Comparison with conventional laboratory tests. J Diabetes Complications 1992; 6:116-22. [PMID: 1611135 DOI: 10.1016/1056-8727(92)90022-d] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
One hundred and seventy-three Arab patients with non-insulin-dependent diabetes mellitus (NIDDM) and 51 controls were examined. The routine laboratory tests of fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), fructosamine (FRA), and triglycerides (TG) were compared with lipid hydroperoxides (LHP) as detected by the thiobarbituric acid (TBA) method, which measures total TBA reacting substances (TBARS). All routine laboratory measures were elevated in the patient population. In the case of LHP, values in NIDDM were 491 +/- 183 mumol/L for men and 507 +/- 183 mumol/L for women, as compared with pooled normal values of 275 +/- 85 mumol/L. Seven patients with NIDDM undergoing hemodialysis were also elevated above normal (441 +/- 97 mumol/L). Comparisons between LHP and the other biochemical parameters indicated a positive statistical correlation with triglycerides (p less than 0.001); FBS, HbA1c, and FRA (p greater than 0.01). Patients with NIDDM on dietary control had somewhat lower LHP levels (441 +/- 135 mumol/L) than those receiving insulin (519 +/- 206 mumol/L), or oral hypoglycemic agents (518 +/- 177 mumol/L). Dietary maintenance also resulted in reduced FBS and HbA1c levels. Subdivision of patients according to duration of disease and by nationality showed that Kuwaiti nationals had slightly higher LHP values than did patients of other Arabic origin. Women patients (Kuwaiti and non-Kuwaiti) with NIDDM disease duration of greater than 10 years, had LHP levels above those of males (551 +/- 245 versus 478 +/- 126 mumol/L) and, as a group, showed significant enhancement of retinal complications (85.5% versus 55%). A statistically significant trend (p less than 0.08) could be demonstrated between the prevalence of retinopathy and increasing serum LHP levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Armstrong
- Department of Medical Technology, State University of New York (SUNY), Buffalo 14215
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40
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Abdella N, al Awadi F, Salman A, Armstrong D. Thiobarbituric acid test as a measure of lipid peroxidation in Arab patients with NIDDM. Diabetes Res 1990; 15:173-7. [PMID: 2132405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Increased levels of lipid peroxides have been implicated in the pathogenesis of diabetic complications. A convenient and sensitive method for estimation of lipid peroxide concentration is the quantitative estimation of their metabolic end-product malonyldialdehyde (MDA) expressed in mumol/L using the thiobarbituric acid test. The mean fasting MDA value in the plasma of 26 Arab subjects with NIDDM was significantly higher than in healthy controls (14.3 +/- 8.3 vs 2.3 +/- 3.4, p less than 0.001). Within a group of nine diabetic patients with markedly elevated MDA values (greater than 20 mumol/L), eight subjects had retinal changes, four had evidence of coronary artery disease and three had manifest cerebrovascular disease. Macroproteinuria was documented in only three patients in this same group. The mean body mass index was 28.7 +/- 5.4 and the glycaemic control was unsatisfactory with a mean glycosylated hemoglobin of 10.1 +/- 1.5%. The MDA results in an Arabic population were similar to reports in Japanese and British patients and should prove useful as a laboratory test in assessing the severity of the diabetic state, as well as a complementary test in diagnosis and management.
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Affiliation(s)
- N Abdella
- Department of Medicine, Kuwait University Health Science Centre
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41
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Abstract
A 47-year-old Arab male presented with a nephrotic syndrome and renal failure. Proliferative retinopathy was documented on fundoscopy. There was no history of symptomatic hyperglycemia, and biochemically, there was impaired glucose tolerance. This patient had classical microangiopathic complications that are closely related to the severity and duration of diabetes mellitus in the absence of overt hyperglycemia.
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University
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42
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Abstract
The effects of insulin on the lipid values of nonobese non-insulin-dependent diabetic (NIDDM) Arab women requiring insulin was investigated to find whether these patients have the same coronary artery risk factor related to lipid levels. In this study, 55 NIDDM women on insulin therapy (mean age 28 +/- 8.1 yr and duration of disease 5 +/- 1.2 yr) and 70 control subjects (matched for sex, age, and body mass index) were studied for their plasma levels of lipids, lipoproteins, and apolipoproteins. Concentrations of total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride (TG), LDL TG, high-density lipoprotein triglyceride (HDL TG), phospholipid, glucose, glycosylated hemoglobin (HbAtc), apolipoprotein B (apoB), LDL-apoB, and apoB/apoAl were significantly elevated in diabetic women compared with control subjects. There was no significant change in the levels of apoAll in plasma and lipoprotein fractions. Concentrations of HDL cholesterol (chol), HDL2-chol, HDL3-chol, plasma apoAl, HDL2-apoAl, HDL3-apoAl, and HDL-apoAl were significantly lower in diabetic women than in control subjects. There was no significant correlation between glucose or HbAtc and most of the lipids, lipoprotein lipids, and apolipoproteins measured. Despite normal body weight and insulin therapy, abnormalities in lipids, lipoprotein lipids, and apoB persisted in NIDDM patients compared with control subjects. Our data may favor an enhanced affinity toward atherosclerosis in these patients.
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Affiliation(s)
- N Al-Muhtaseb
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat
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Richens ER, Shaltout A, Bahr GM, Abdella N, Jayyab AK, Al-Saffar M, Behbehani K. Insulin binding substances, autoimmunity and type I diabetes in Kuwaiti patients and their kindred. Acta Diabetol Lat 1989; 26:115-22. [PMID: 2789462 DOI: 10.1007/bf02581363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Insulin autoantibodies (IAAs) are associated with type I diabetes mellitus (DM) and have been suggested as predictive markers of the disease. Using an ELISA assay, we have studied the prevalence of binding to human insulin in sera from an Arab type I DM population and compared it with the prevalence in the family members (FMs) of the probands, in type II DM patients from the same population, and in Arab control subjects. Significant levels of binding occurred in 11/16 (69%) of type I DM patients and in 21/34 (62%) of their FMs, but in only 5/31 (16%) of type II DM patients and in 1/25 (4%) of control subjects. Within families, there was homogeneity with regard to the level of insulin binding and the mean family levels correlated with those of the proband (r = 0.68, df = 7, p = 0.05). HLA-DR3 or -DR4 antigens occurred in 55/63 (87%) of type I DM patients and in 95/118 (81%) of their FMs. This was significantly higher (p less than 0.001) than in either type II DM patients (39/75, 52%) or in control subjects (34/93, 37%). ICAs were present in significantly more (25/43, 58%) of type I DM patients than their FMs (3/82, 3%) (p less than 0.001). They did not occur in either type II DM patients or in the control group. In conclusion, insulin binding occurred in sera from both type I diabetic patients and their kindred, and hence did not appear to be specifically associated with the development of clinical diabetes.
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Affiliation(s)
- E R Richens
- Department of Microbiology, Faculty of Medicine, University of Kuwait
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Abdella N, Luqman W, Hassan M, Salman A. Heterogeneity of serum basal C peptide levels amongst Arab patients with diabetes mellitus. Diabetes Res 1988; 9:47-50. [PMID: 3149222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Thirty-four Arab patients with history of diabetes mellitus but without history of ketoacidosis (Group 2), and 16 Arab patients with history of diabetes mellitus and ketoacidosis (Group 1) were studied. They were compared with 15 healthy control subjects and were further broken down according to sex and type of therapy. Fasting serum C-peptide, glucose and glycosylated haemoglobin levels were measured in all subjects. C-peptide levels in Group 2 were higher (t = 2.95) and exhibited greater heterogeneity (Variance ratio 3.60, p less than 0.005) than those in Group 1. Female subjects in Group 2 were more obese than male subjects in the same group, and exhibited greater heterogeneity of their C-peptide levels (Variance ratio 9.47, p less than 0.001). Although male patients in Group 2 on insulin therapy were older than male subjects on diet or oral hypoglycemic agents (t = 3.52, p less than 0.01), female subjects on insulin therapy were younger than those on diet or oral hypoglycemic agents (t = 2.05, p less than 0.05). Furthermore female patients on insulin therapy had lower serum glycosylated haemoglobin levels than female subjects on oral hypoglycemic agents (t = 2.05, p less than 0.05) but male patients on insulin therapy had higher serum glycosylated haemoglobin than those on oral hypoglycemic agents. These data suggest the earlier tendency of physicians to prescribe insulin in women of child bearing age but suggest that earlier prescribing habits of insulin may improve diabetic control.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Abdella
- Department of Medicine, Faculty of Medicine, Kuwait University
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45
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Abstract
The relationship of body fat distribution to glucose intolerance and non-insulin-dependent diabetes mellitus in Arab women was studied in 102 obese non-diabetic and 40 obese women with diabetes. The obese women underwent a glucose tolerance test. Linear regression analysis revealed a significant correlation between the waist/hip ratio and the plasma glucose concentration at 120 min. When divided into two groups according to the median of their waist/hip ratio (0.815), obese women without history of diabetes but with high waist/hip ratio (0.86 +/- 0.07, mean +/- SD) had significantly higher prevalence of glucose intolerance and of diabetes mellitus than those with the low ratio (0.78 +/- 0.03, chi 2 = 9.32, p less than 0.001). The highest ratio (0.89 +/- 0.06) was observed in the obese women with known diabetes mellitus.
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Affiliation(s)
- M Emara
- Department of Medicine and Community Medicine, Faculty of Medicine, Kuwait University, Safat
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Abstract
We describe the characteristics of 75 Arab Type 2 diabetic patients in Kuwait. Their age (+/- SD) at onset was 41 +/- 10 years, and fasting serum C-peptide concentration was 0.32 +/- 0.23 nmol/l (n = 51). Fifty-three percent (37/70) possessed HLA-DR3 or -DR4 epitopes, and 64% (47/73) had a family history of diabetes. Data review suggested that they could be segregated into two groups, those under 40 years old at onset (32 +/- 6 years, n = 37), and the remainder (48 +/- 6 years, n = 38) (p less than 0.001). Those in the former group had a significantly higher frequency of a family history of diabetes than those in the latter group (92% vs 38%, p less than 0.001) suggestive of a greater genetic influence on the development of Type 2 diabetes in those with early onset disease.
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Affiliation(s)
- E R Richens
- Department of Microbiology, Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait
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Behbehani K, Richens ER, Abdella N, Jayyab AK, Shaltout A, Al-Saffar M, Siboo R. HLA associations in an Arab type 1 diabetic population. Dis Markers 1987; 5:165-9. [PMID: 3502987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We have studied HLA-A, -B, -C, -DR, and -DQ antigen frequencies in 63 Type 1 diabetic Arab patients resident in Kuwait. Both HLA-DR3 (relative risk (RR) = 5.80) and -DR4 (RR = 2.87) showed positive associations with Type I diabetes mellitus in these patients whilst -DR2 (RR 0.16) and -DR5 (RR = 0.15) were negatively associated. The strong positive association with both HLA-DR3 and -DR4 was confirmed in Non-Gulf Arabs (RR = 12.55 and 4.29, respectively) whereas the Gulf Arabs had a significant positive association with HLA-DR3 (RR = 4.41) only. The disease was negatively associated with HLA-DR2 (RR = 0.05) in Gulf Arab patients only and with HLA-DR5 (RR = 0.10) in Non-Gulf Arabs only. HLA-DRw52 and -DRw53 were increased in Non-Gulf Arabs only (RR = 3.14 and 4.63, respectively). In both groups there was strong association with HLA-DQ3 (Gulf, RR = 28.11; Non-Gulf, RR = 6.25). Amongst HLA-A, -B, and -C loci, there was a positive association with HLA-B8 (RR = 19.06).
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Affiliation(s)
- K Behbehani
- Department of Microbiology, Faculty of Medicine, Kuwait
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Abdella N, Luqman W, Adamson U, Rashed A, Fenech FF. Some demographic and therapeutic features of diabetes mellitus in Kuwait. Diabetes Res 1987; 5:43-6. [PMID: 3621805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A survey of all consecutive visits to all diabetic clinics in Kuwait over a period of 4 months yielded 1,266 male and 1,838 female Kuwaiti patients. Their age structure analysis revealed percent frequencies of 1.25, 15.5, 57.8 and 25.3 for the age groups under 19, 20-39, 40-59 and over 60 years respectively. The overall female:male ratio was 1.42. The body mass index peaked in the age groups 30-39 (mean +/- SD = 31.3 +/- 7.1 for women and 29.4 +/- 6.4 for men) and was consistently higher in women than in men for all age groups. Diabetic women over 30 years of age received insulin therapy more often than men. Home urine testing was practised by only 25% of those under 30 years of age and 12% of those 30 years and over. The study showed that the majority of Kuwaiti patients were relatively young and that the women were affected more often and probably more severely than men as suggested by the higher frequencies of insulin administration.
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Luqman W, Abdella N, Moro M. Serum fructosamine concentration as measure of blood glucose control in insulin dependent diabetes. Br Med J (Clin Res Ed) 1985; 290:1075-6. [PMID: 3921112 PMCID: PMC1418361 DOI: 10.1136/bmj.290.6474.1075-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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