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Sathish T, Oldenburg B, Tapp RJ, Shaw JE, Wolfe R, Balachandran S, D’Esposito F, Absetz P, Mathews E, Zimmet PZ, Thankappan KR. Baseline characteristics of participants in the Kerala Diabetes Prevention Program: a cluster randomized controlled trial of lifestyle intervention in Asian Indians. Diabet Med 2017; 34:647-653. [PMID: 27279083 PMCID: PMC5148720 DOI: 10.1111/dme.13165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 01/03/2023]
Abstract
AIMS To describe the baseline characteristics of participants in the Kerala Diabetes Prevention Program. METHODS The Kerala Diabetes Prevention Program is a cluster randomized controlled trial of lifestyle intervention for prevention of Type 2 diabetes mellitus in India. Participants in the study were those aged 30-60 years who had an Indian Diabetes Risk Score ≥ 60 and who were without Type 2 diabetes on oral glucose tolerance test. Data on demographic, lifestyle, clinical and biochemical characteristics were collected using standardized tools. RESULTS A total of 2586 individuals were screened with the Indian Diabetes Risk Score, of these 1529 people (59.1%) had a score ≥ 60, of whom 1209 (79.1%) underwent an oral glucose tolerance test. A total of 202 individuals (16.7%) had undiagnosed Type 2 diabetes and were excluded, and the remaining 1007 individuals were enrolled in the trial (control arm, n = 507; intervention arm, n = 500). The mean participant age was 46.0 ± 7.5 years, and 47.2% were women. The mean Indian Diabetes Risk Score was 67.1 ± 8.4. More than two-thirds (69.0%) had prediabetes and 31.0% had normal glucose tolerance. The prevalence of cardiometabolic risk factors was high, including current tobacco use (34.4% in men), current alcohol use (39.3% in men), no leisure time exercise (98.0%), no daily intake of fruit and vegetables (78.7%), family history of diabetes (47.9%), overweight or obesity (68.5%), hypertension (22.3%) and dyslipidemia (85.4%). CONCLUSIONS The Kerala Diabetes Prevention Program recruited participants using a diabetes risk score. A large proportion of the participants had prediabetes and there were high rates of cardiometabolic risk factors. The trial will evaluate the effectiveness of lifestyle intervention in a population selected on the basis of a diabetes risk score.
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Affiliation(s)
- T. Sathish
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Correspondence to: Thirunavukkarasu Sathish
| | - B. Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - R. J. Tapp
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - J. E. Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - R. Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - S. Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - F. D’Esposito
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - P. Absetz
- School of Health Sciences, University of Tampere, Tampere, Finland
- Collaborative Care Systems Finland, Helsinki, Finland
| | - E. Mathews
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - P. Z. Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - K. R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Moran C, Tapp RJ, Hughes AD, Magnussen CG, Blizzard L, Phan TG, Beare R, Witt N, Venn A, Münch G, Amaratunge BC, Srikanth V. The Association of Type 2 Diabetes Mellitus with Cerebral Gray Matter Volume Is Independent of Retinal Vascular Architecture and Retinopathy. J Diabetes Res 2016; 2016:6328953. [PMID: 27314049 PMCID: PMC4897713 DOI: 10.1155/2016/6328953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/24/2016] [Accepted: 04/27/2016] [Indexed: 12/19/2022] Open
Abstract
It is uncertain whether small vessel disease underlies the relationship between Type 2 Diabetes Mellitus (T2DM) and brain atrophy. We aimed to study whether retinal vascular architecture, as a proxy for cerebral small vessel disease, may modify or mediate the associations of T2DM with brain volumes. In this cross-sectional study using Magnetic Resonance Imaging (MRI) scans and retinal photographs in 451 people with and without T2DM, we measured brain volumes, geometric measures of retinal vascular architecture, clinical retinopathy, and MRI cerebrovascular lesions. There were 270 people with (mean age 67.3 years) and 181 without T2DM (mean age 72.9 years). T2DM was associated with lower gray matter volume (p = 0.008). T2DM was associated with greater arteriolar diameter (p = 0.03) and optimality ratio (p = 0.04), but these associations were attenuated by adjustments for age and sex. Only optimality ratio was associated with lower gray matter volume (p = 0.03). The inclusion of retinal measures in regression models did not attenuate the association of T2DM with gray matter volume. The association of T2DM with lower gray matter volume was independent of retinal vascular architecture and clinical retinopathy. Retinal vascular measures or retinopathy may not be sufficiently sensitive to confirm a microvascular basis for T2DM-related brain atrophy.
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Affiliation(s)
- C. Moran
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Department of Neurosciences, Monash Health, Melbourne, VIC 3168, Australia
- Aged Care, Alfred Health, Melbourne, VIC 3162, Australia
| | - R. J. Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010, Australia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751
| | - A. D. Hughes
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary's Hospital and Imperial College, London SW7 2AZ, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - C. G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
- Research Centre of Applied and Preventative Cardiovascular Medicine, University of Turku, 20700 Turku, Finland
| | - L. Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - T. G. Phan
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Department of Neurosciences, Monash Health, Melbourne, VIC 3168, Australia
| | - R. Beare
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC 7000, Australia
| | - N. Witt
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary's Hospital and Imperial College, London SW7 2AZ, UK
| | - A. Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - G. Münch
- Department of Pharmacology and Molecular Medicine Research Group, School of Medicine, University of Western Sydney, Campbelltown, NSW 2753, Australia
| | - B. C. Amaratunge
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC 7000, Australia
| | - V. Srikanth
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Department of Neurosciences, Monash Health, Melbourne, VIC 3168, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
- *V. Srikanth:
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Hussain SM, Wang Y, Shaw JE, Magliano DJ, Wong TY, Wluka AE, Graves S, Tapp RJ, Cicuttini FM. Retinal arteriolar narrowing and incidence of knee replacement for osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2015; 23:589-93. [PMID: 25596324 DOI: 10.1016/j.joca.2015.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/17/2014] [Accepted: 01/08/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The role of the microcirculation in the pathogenesis of osteoarthritis (OA) remains unclear. This prospective cohort study examined the association between retinal vascular calibre and incidence of knee replacement for OA. DESIGN 1838 participants of the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study had retinal vascular calibre measured using a nonmydriatic digital fundus camera in 1999-2000 and were aged ≥ 40 years at joint replacement data collection commencement. The incidence of knee replacement for OA during 2002-2011 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). RESULTS 77 participants underwent knee replacement for OA. They had narrower retinal arteriolar calibre compared with those without knee replacement (166.1 ± 24.8 μm vs 174.3 ± 24.5 μm, P = 0.004). For every one standard deviation reduction in retinal arteriolar calibre, the incidence of knee replacement increased by 25% (HR 1.25, 95% confidence interval (CI) 1.00-1.56). Participants in the narrower two-thirds of arteriolar calibre had twice the risk of knee replacement compared with those in the widest one-third (HR 2.00, 95% CI 1.07-3.74, P = 0.03) after adjustment for sex, body mass index (BMI), physical activity and HbA1c. There was no association for retinal venular calibre. CONCLUSIONS Retinal arteriolar narrowing is associated with increased risk of knee replacement for OA suggesting that further work is warranted to determine the role of the microcirculation in the pathogenesis of knee OA.
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Affiliation(s)
- S M Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
| | - Y Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
| | - J E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - D J Magliano
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - T Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
| | - S Graves
- Department of Surgery, Flinders University Adelaide, SA, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, School of Population Health & Clinical Practice, University of Adelaide, SA 5005, Australia.
| | - R J Tapp
- Department of Optometry and Vision Sciences, The University of Melbourne, Australia; Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
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Tapp RJ, Anjou MD, Boudville AI, Taylor HR. The roadmap to close the gap for vision--diabetes-related eye care in the Indigenous Australian population. Diabet Med 2013; 30:1145-6. [PMID: 23586406 DOI: 10.1111/dme.12215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
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Williams ED, Tapp RJ, Magliano DJ, Shaw JE, Zimmet PZ, Oldenburg BF. Health behaviours, socioeconomic status and diabetes incidence: the Australian Diabetes Obesity and Lifestyle Study (AusDiab). Diabetologia 2010; 53:2538-45. [PMID: 20740271 DOI: 10.1007/s00125-010-1888-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [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: 06/10/2010] [Accepted: 08/05/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS To identify the impact of socioeconomic status on incident impaired glucose metabolism and type 2 diabetes and to investigate the mediating role of health behaviours on this relationship using national, population-based data. METHODS The Australian Diabetes Obesity and Lifestyle (AusDiab) Study is a national, population-based, longitudinal study of adults aged 25 years and above. A total sample of 4,405 people provided complete baseline (1999-2000) and 5 year follow-up (2004-2005) data relevant for these analyses. Fasting plasma glucose and 2 h plasma glucose were obtained from an OGTT, and demographic, socioeconomic and behavioural data were collected by interview and questionnaire. Multinomial logistic regression examined the role of socioeconomic position in the development of diabetes and mediation analyses tested the contribution of health behaviours in this relationship. RESULTS Highest level of education was a stronger predictor of incident impaired glucose tolerance and type 2 diabetes (p = 0.002), compared with household income (p = 0.103), and occupational grade (p = 0.202). Education remained a significant independent predictor of diabetes in fully adjusted models. However, the relationship was attenuated by the health behaviours (smoking and physical activity). Mediation analyses indicated that these behaviours were partial mediators (explaining 27%) of the socioeconomic status-diabetes relationship. CONCLUSION/INTERPRETATION Smoking and physical activity partly mediate the relationship between low education and type 2 diabetes. Identification of these modifiable behavioural mediators should facilitate the development of effective health promotion campaigns to target those at high risk of developing type 2 diabetes.
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Affiliation(s)
- E D Williams
- School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 89 Commercial Road, Melbourne, Victoria 3004, Australia.
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Sharp AS, Tapp RJ, Thom SAM, Francis DP, Hughes AD, Stanton AV, Zambanini A, O'Brien E, Chaturvedi N, Lyons S, Byrd S, Poulter NR, Sever PS, Mayet J. Tissue Doppler E/E' ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J 2009; 31:747-52. [DOI: 10.1093/eurheartj/ehp498] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Tapp RJ, Zimmet PZ, Harper CA, de Courten MP, McCarty DJ, Balkau B, Taylor HR, Welborn TA, Shaw JE. Diagnostic thresholds for diabetes: the association of retinopathy and albuminuria with glycaemia. Diabetes Res Clin Pract 2006; 73:315-21. [PMID: 16644057 DOI: 10.1016/j.diabres.2006.02.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [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: 11/01/2005] [Accepted: 02/20/2006] [Indexed: 12/21/2022]
Abstract
AIM We examined the association of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG) and HbA1c with retinopathy and microalbuminuria using both deciles of glycaemia and change point models, to validate current diagnostic criteria for diabetes and to identify therapeutic thresholds for glycaemic control. METHODS The Australian Diabetes Obesity and Lifestyle study (AusDiab), conducted in 1999-2000, included adults aged > or =25 years from 42 randomly selected areas of Australia. Retinopathy and albuminuria were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,182 participants with retinal photographs and 2,389 with urinary albumin/creatinine results. RESULTS The prevalence of retinopathy in the first 8 deciles of FPG and HbA1c and the first 9 deciles of 2hPG were 7.2, 6.6, and 6.3%, respectively and showed no variation with increasing glucose or HbA1c. Above these levels, the prevalence rose markedly to 18.6% in the top 2 deciles of FPG, 21.3% in the top 2 deciles of HbA1c and 10.9% in the top decile of 2hPG. The thresholds for increasing prevalence of retinopathy were 7.1 mmol/l for FPG, 6.1% for HbA1c and 13.1 mmol/l for 2hPG. The prevalence of microalbuminuria rose gradually across deciles of each glycaemic measure. Thresholds were less clear than for retinopathy, but were seen at a FPG of 7.2 mmol/l and HbA1c of 6.1%, with no evidence of a threshold effect for 2hPG. CONCLUSIONS The prevalence of retinopathy rose dramatically in the highest deciles of each glycaemic measure, while for microalbuminuria the increase of prevalence was more gradual. The FPG values corresponded well with the WHO diagnostic cut-point for diabetes, however the 2hPG value did not. HbA1c thresholds were similar for both retinopathy and microalbuminuria and compared well to values shown in other studies. These results support current targets for FPG and HbA1c in preventing microvascular complications.
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Affiliation(s)
- R J Tapp
- International Diabetes Institute, Melbourne, Australia.
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Abstract
AIMS To determine the prevalence and risk factors for neuropathy and peripheral vascular disease (PVD) in the Australian diabetic population and identify those at high risk of foot ulceration. METHODS The Australian Diabetes Obesity and Lifestyle study included 11 247 adults aged >or= 25 years in 42 randomly selected areas of Australia. Neuropathy and PVD were assessed in participants identified as having diabetes (based on self report and oral glucose tolerance test), impaired fasting glucose, impaired glucose tolerance and in a random sample with normal glucose tolerance (total n = 2436). RESULTS The prevalence of peripheral neuropathy was 13.1% in those with known diabetes (KDM) and 7.1% in those with newly diagnosed (NDM). The prevalence of PVD was 13.9% in KDM and 6.9% in NDM. Of those with diabetes, 19.6% were at risk of foot ulceration. Independent risk factors for peripheral neuropathy were diabetes duration (odds ratio (95% CI) 1.73 (1.33-2.28) per 10 years), height (1.42 (1.08-1.88) per 10 cm), age (2.57 (1.94-3.40) per 10 years) and uric acid (1.59 (1.21-2.09) per 0.1 mmol/l). Risk factors for PVD were diabetes duration (1.64 (1.25-2.16) per 10 years), age (2.45 (1.86-3.22) per 10 years), smoking (2.07 (1.00-4.28)), uric acid (1.03 (1.00-1.06) per 0.1 mmol/l) and urinary albumin/creatinine ratio (1.11 (1.01-1.21) per 1 mg/mmol). CONCLUSIONS The prevalence of neuropathy and PVD was lower in this population than has been reported in other populations. This may reflect differences in sampling methods between community and hospital-based populations. Nevertheless, a substantial proportion of the diabetic population had risk factors for foot ulceration.
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Affiliation(s)
- R J Tapp
- International Diabetes Institute, Melbourne, Australia.
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