The Diabcare-Asia 1998 study--outcomes on control and complications in type 1 and type 2 diabetic patients

The aim of this study was to describe the glycaemic and metabolic control and diabetes-related complications in type 1 and type 2 Asian patients.

METHODS

Data of diabetes patients from 230 diabetes centres in 12 Asian regions were collected on a retrospective-prospective basis through review of medical records, interview and laboratory assessments. Analysis of glycated haemoglobin (HbA1c) was carried out in central laboratories appointed by Bio-Rad. The data collection case record forms were scanned electronically.

RESULTS

22177 patients with valid data made up the analysis population. Among patents with type 1 and type 2 diabetes, there was a higher proportion of women than men (53% vs. 47% for type 1 patients and 56% vs. 44% for type 2 diabetes). Hypertension (61%) and overweight (40% with BMI > or = 25 kg/m2 were common in type 2 patients. Dyslipidaemia was also present in at least half of both types of patients. Control of glycaemia (mean HbA,1c and fasting blood glucose [FBG]) was poor in type 1 (9.9 +/- 2.5%; 10.2 +/- 5.2 mmol/l) and type 2 patients (8.5 +/- 2.0%; 8.9 +/- 3.4 mmol/l). Glycaemia in the majority of both types of patients fell short of those stipulated by various guidelines. In type 2 patients, glycaemia deteriorated (HbA1c > 7.5%, FBG > or = 7.0 mmol/l) with duration of diabetes > 7 years. Both types of diabetes appear to share a similar high prevalence of complications of cataract, retinopathy and neuropathy, although the prevalence of cataract (27%) and neuropathy (35%) was higher in type 2 diabetes. Screening for microalbuminuria was not common.

CONCLUSIONS

The Inadequate metabolic and hypertension control, especially in type 2 patients, needs to be addressed.

DiabCare Asia--India Study: diabetes care in India--current status

AIM

To investigate the relationship between diabetes control, management and late complications in a subset of urban Indian diabetes population treated at tertiary diabetes care centres and measure the quality of management to set benchmarks for future improvement.

METHODOLOGY

The study population consisted of 100 consecutive review patients treated for more than one year at each of the 26 participating centres. HbA1c was estimated centrally by Bio-Rad Variant method. The methods used to diagnose diabetic complications varied among centres, depending on the doctor's standard clinical examination. A more detailed methodology was eschewed for reason of brevity of the data collection form, and lack of standardisation of methods. Similarly, the assessment of renal function was performed via a variety of methods, namely dipstick proteinuria, a 24 hour urinary excretion assay, presence of microalbuminuria and serum creatiine concentration; retinopathy was detected using fundoscopy. Data was collected in a standardized data collection form, entered into an SAS database, validated and descriptive analysis performed.

RESULTS

A total of 2,269 subjects with valid relevant data formed the study population. Subjects had a mean age of 53.3 +/- 13 years. The mean age at onset of diabetes was 43.6 +/- 12.2 years, with a mean diabetes duration of 10.0 +/- 6.9 years. Type 2 diabetics constituted 90.6% of the patients. Approximately half the patients had poor control (HbA1c > 2% points above upper limit of normal and FBG > 139 mg/dl). Mean HbA1c (central laboratory) was 8.9 +/- 2.1% and FBG 150 +/- 59 mg/dl. Over 54% patients had severe late complications, apart from a high frequency of associated hyperlipidemia. Mean HbA1c level and frequency of complications was higher in patients with longer diabetes duration. Frequency of self-monitoring was low. Only 4% of patients were on diet therapy, 53.9% were receiving oral hypoglycemic agents (OHAs), 22% were receiving insulin and 19.8% a combination of insulin and OHAs. Frequency of insulin usage was higher amongst patients with longer diabetes duration.

CONCLUSIONS

This large multi-centre collaborative observational study shows that type 2 diabetes begins at an early age amongst Indians. With increasing duration of diabetes, glycemic control deteriorates leading to late complications. Diabetes care in India leaves much to be desired. Concerted efforts to increase awareness amongst health professionals to improve diabetes care are urgently needed. The study by increasing awareness about the current status of diabetes care provides a useful benchmark to plan future improvements.

Diabetes and atherosclerosis as immune-inflammatory disorders: options for reversal of disease processes

Hypothesis is presented to suggest that the present epidemic of DM and ACVD in Asian indians and possibly in other communities is iatrogenic resulting from what may be called modern malnutrition due to increased intake of total and n-6 fats and decreased intake of n-3 fat and antioxidants. Such a diet induces oxidative stress and activates the immune system. Imbalance between n-6 and n-3 fats result in inappropriate immune response. It also leads to increased and unbalanced biosynthesis of metabolites of n-6 fats. These are immune suppressive, proinflammatory and thrombogenic. They also contribute to insulin resistance and dyslipidemias. This makes DM and atherosclerosis as malnutrition related oxidative immune inflammatory disorders. Various risk factors are also the result of the same inappropriate response. Our intervention studies give considerable support to this hypothesis. It is suggested that simple correction of diet defects can reverse the disease process and thereby offer a simple, practical therapeutic option not only for the primary prevention of each of these disorders or their complications but also for the so called risk factors for these diseases. It is suggested that the real remedy for DM, ACVD and all the risk factors lies not in drugs or surgery but in the kitchen. However more studies are needed to precisely define various molecular mechanisms involved or the exact requirements of various nutrients.

Significance of the N-6/N-3 ratio for insulin action in diabetes

This report supplies supportive data for the hypothesis that a high n-6/n-3 dietary fat ratio is a potent, negative variable in NIDDM. Further work is necessary to critically evaluate this hypothesis.