Abstracts of The 47th Annual Conference of Research Society for the Study of Diabetes in India

Type 2 diabetes: epidemiological changes at Instituto Mexicano del Seguro Social—associated with complications in Mexico Abstract Background Mexico is a country with a high frequency of type 2 diabetes mellitus (DM2). DM-related complications can increase the number of medical appointments and hospitalizations, impact patient quality of life, and exacerbate hospital care costs. The goals of this study were to analyze epidemiological data of DM2 over the last 10 years and to compare its comorbidities and mortality in individuals listed at the Instituto Mexicano del Seguro Social (IMSS) in 2013 and 2015. The database was compiled for doctors, validated by engineers in computer systems, and analyzed by statisticians. E-10-E-14 registered patients with DM2 (based on International Classification of Diseases (ICD-10)) from 2005, 2013, and 2015 were analyzed through the Family Medicine Units and Non-Communicable Diseases Analysis System (SANENT)® databases. Incidence, comorbidity, and mortality were described. Results We included 29,525,905 individuals, including 3,395,389 DM2 patients, in 2013, and 31,389,711 individuals, including 3,547,006 DM2 patients, in 2015, in the IMSS. The incidences of DM2 in 2005 and 2015 were 124 and 120 per 100,000 IMSS members, respectively, without significant differences. The diabetes complications caused partial disability in 253 and 341 per 100,000 individuals in 2013 and 2015, respectively. Overall mortality decreased from 2005 to 2015 (rates of 594 vs. 350 per 100,000 persons; p < 0.001). Conclusion Though the overall mortality and incidence of DM2 decreased from 2005 to 2015, the complications maintained the same prevalence rates in 2013 and 2015; however, disability complications increased in 2013 and 2015, emphasizing the need for proper control methods acting over this dual axis.

Mild hyperamylasemia in type 1 diabetic children without diabetic ketoacidosis is associated with C-peptide Abstract Background The aim of this study is to investigate the relationship between plasma amylase concentration and C-peptide level in type 1 diabetic and healthy children. Methods The cross-sectional study involved 31 Chinese type 1 diabetic children without complications and 107 healthy control subjects. Clinical examination and laboratory examinations were assessed for all participants. Results Significantly higher amylase concentrations were measured in type 1 diabetic children than in controls (102.8 U/l vs. 70.2 U/l, respectively; p < 0.001), but plasma lipase was significantly lower in type 1 diabetic children. The mean concentrations of pancreatic amylase were also lower in type 1 diabetic children than controls, but this difference did not reach statistical significance. Plasma amylase was significantly negatively correlated with lipase and C-peptide concentrations and was significantly positively correlated with both blood glucose and glycemic control. There were also negative correlations among blood glucose, glycemic control, and plasma lipase and an interaction between plasma lipase and C-peptide concentrations. Pancreatic amylase concentration was significantly correlated with the dose of insulin administered to the type 1 diabetic children. A total of 22.1% of the type 1 diabetic children were temporarily positive for urine protein but did not have diabetic nephropathy. Conclusions It is recommended that clinicians perform amylase assays to assess the extreme low level of C-peptide which is difficult to detect in children with T1DM.

High-fat diet with alcohol elevate oxidative stress which cause hyperlipidemia by inducing mutation in the ANGPTL3 locus Abstract Background Angiopoietin-like 3 (ANGPTL3) is a secreted protein which predominantly expressed in the liver, and involves in upregulation of lipid metabolism. Mutation in ANGPTL3 leads to decrease in the concentration of triglycerides (TGs), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), which makes it a promising candidate for hyperlipidemia. Objectives The present study aims to identify the effect of alcohol and high-fat diet, on the ANGPTL3 locus, in the development of hyperlipidemia. Methods 24 male Wister rats divided into four groups viz. control group (regular diet), HFD group (high-fat diet), ALC group (alcohol consuming), and HFD + ALC group (high-fat diet + alcohol consuming). All the groups were followed up for 12 weeks. Malondialdehyde (MDA), total body weight, TG, LDL, and HDL level were measured at the endpoint of study, and gene mutation analysis was also done for ANGPTL3. Results MDA level found to be significantly increases in HFD + ALC group, HFD group, and ALC group compared to the control group. RFLP analysis revealed a mutation in the ANGPTL3 gene which occurred only in HFD + ALC group. Moreover, body weight, TG, LDL, and HDL found to increase significantly in HFD + ALC, HFD, and ALC group as compared to the control group. Conclusions The present finding indicates is that high-fat diet with alcohol increases the oxidative stress in the liver, which causes a gain of function mutation in ANGPTL3 gene, resulting in hyperlipidemia.

Association of Cornell product with metabolic syndrome in middle-aged people in China Abstract Background Metabolic syndrome (MS) has attracted much attention worldwide for its harmful effects. Although the Cornell product (CP) and Sokolow-Lyon (SL) voltage are independent and strong risk factors of cardiovascular disease, their associations with MS and the relative strength of these associations are unknown. Therefore, we studied these aspects in a community of middle-aged people. Methods A total of 1112 community residents aged 40–65 years, among which 169 had IDF (2005)–defined MS (MS group) and 943 did not have MS (NMS group), underwent electrocardiography (ECG) at baseline. A questionnaire survey, physical measurements, laboratory biochemical assessments, urine test, ECG, body fat analysis, and abdominal MRI examination were performed subsequently. Fifty-eight participants had developed MS (new-onset MS group) at the follow-up, while 472 residents had not developed MS over the next year (MS-free group). We compared the CP and SL voltage between these two groups. Results In the overall analysis, CP values were higher in the MS group than in the NMS group (p < 0.05), but SL voltage values were not significantly different (p > 0.05). In the gender-stratified multivariate analysis, CP was significantly different in the male and female populations (p < 0.05), but SL voltage was only different in the male population (p = 0.042). After removing hypertension from MS and NMS groups, there was still significant difference in CP value (< 0.05). Thus, CP showed a more pronounced influence. The new-onset MS group showed significantly higher CP values and the changes in CP values than did the MS-free group at baseline and follow-up (p < 0.05), but the changes in SL values were not significant (p > 0.05). Conclusions CP values differed significantly between the MS and NMS groups. The new-onset MS group showed higher baseline CP values. Thus, CP is more advantageous than SL voltage in presaging the incidence of MS-related cardiovascular risk.

Association of advanced glycation end products (AGEs) with endothelial dysfunction, oxidative stress in gestational diabetes mellitus (GDM) Abstract Background Advanced glycation end products (AGEs) are major risk factors for vascular complications in diabetes. Its role in gestational diabetes mellitus (GDM) and vascular complications in GDM is not known. Objective The present study was aimed to study the association of AGEs with GDM and vascular inflammation. Methods Plasma samples from normal pregnant and GDM women (n = 50 each) were obtained from two tertiary referral centers in Tamil Nadu, India. Quantification of AGEs, methylglyoxal (MGO), ICAM-1, and malondialdehyde (MDA) were performed by commercially available ELISA kits. Results and conclusions The third trimester fasting blood sugar (101.35 ± 26.15 vs. 81.63 ± 6.14, p < 0.002) and postprandial blood sugar (150.69 ± 23.07 vs 105.79 ± 11.99, p < 0.0001) were significantly high in GDM women compared to normal pregnant women. The concentrations of AGEs (13.18 ± 8.74, p < 0.001), MGO (15.7 ± 13.54, p < 0.02), and ICAM-1 (217.8 ± 86.92, p = 0.005) were significantly higher in GDM women compared to AGEs (2.68 ± 0.89), MGO (9.26 ± 5.38), and ICAM-1 (142.3 ± 38.21) in normal pregnant women. Further, elevated levels of MDA concentration (0.64 ± 0.08, p < 0.002) and low GSH levels (0.19 ± 0.1, p < 0.0001) in the GDM women were indicative of oxidative stress. AGE levels significantly correlated with MDA concentration which indicates AGEs may be responsible for oxidative stress in GDM women. Further, elevated level of ICAM-1 in GDM women suggests endothelial activation which may impact endothelial function. Thus, AGEs may be used as a biomarker during pregnancy to predict vascular complications due to GDM.

Analysis of variation in pre-meal exercise effect on fasting interstitial glucose level

Diabetic muscle infarction in type 1 and type 2 diabetes mellitus: lessons from two cases Abstract Diabetic muscle infarction (DMI) is an underreported complication of poorly controlled diabetes mellitus. We present clinical and laboratory data of two patients, a 27-year-old woman with Down syndrome and type 1 diabetes mellitus (T1DM) and a 47-year-old man with type 2 diabetes mellitus (T2DM) who presented with DMI. Poor control of T1DM and delayed diagnosis of T2DM were the major underlying factors in these cases. Although the condition responds well to conservative treatment, overall prognosis of patients is poor with respect to diabetes complications and mortality.

Long-term remission of type 2 diabetes—two roads to the elusive goal

Results of simultaneous application of hyperbaric oxygen and negative pressure wound therapy in diabetic foot ulcers treatment Abstract Background The aim of this paper is to determine which therapy gives best results regarding process of healing of diabetic foot ulcers among three proposed: only negative pressure wound therapy, only hyperbaric oxygen therapy, and both when used in conjunction. Methods This bicentric prospective study included 60 patients, and they were, consecutively, assigned to one of three groups. The first group consisted of 20 patients who were treated only by hyperbaric oxygen therapy, second group consisted of 20 patients treated with combined hyperbaric oxygen and negative pressure wound therapy, and third group consisted of 20 patients who were treated only by negative pressure wound therapy. In some cases, previous revascularization of lower limb was performed and patients with poor run-off, without possibility to perform revascularization, were excluded from the study. Results Patients were predominantly men (56.7%) and mean age was 60.57 years. Majority of patients had ulcers of ischemic origin (45%), in 30% of cases, the reason of foot ulceration was neuropathy, and in 25% of patients, the etiology was combined. During the study, in three patients (5%), minor amputations were observed. Regarding Wagner classification of foot ulcers, most dominant was stage II (χ = 12.618, df = 4, p < 0.05). Statistically significant reduction of wound area was achieved when hyperbaric oxygen and negative pressure wound therapy were used in conjunction comparing to isolated use either of these two modalities of treatment (χ = 116.000, df = 44, p < 0.01). Conclusion Our data suggests simultaneous use of hyperbaric oxygen therapy and negative pressure wound therapy in diabetic foot ulcer treatment in order to achieve best results. Of great importance is previous wound debridement and successful limb revascularization.