Ukwuani-Kwaja A. N.   Nwaogu J.   Abba A.   and Yahaya M.   

Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia due to abnormal insulin secretion, action or both. The synthetic available anti-diabetic drugs exhibited various adverse effects such as diarrhea, hypoglycemia. In recent years, scientists have turned their attention towards the medicinal plants which bear the rich source of metabolites which offer specific therapeutic function in the human body without any adverse effect. Sterculia setigera and Ficus platyphylla are medicinal plants that are used to treat various diseases and including diabetes traditionally. The present study is aimed at investigating the antidiabetic activity of the S. setigera and F. platyphylla methanol stem bark extracts. Phytochemical screening was determined using the standard method. In vitro studies were carried out using α-amylase and glycosylated hemoglobin inhibitory assay. The results of phytochemical constituents detected were flavonoids, Tannins, Steroids, Saponins, cardiac glycosides, Terpenoids, and Phenols. Inhibitory effects of both plant extracts were dose dependent against haemoglobin glycosylation and α-amylase. At highest concentration (25mg/ml), highest inhibitions were recorded in S. setigera (70.30%) and F. platyphylla (70.00%) which was comparable to Metformin (57. 2%). IC₅₀ of Sterculia setigera (3.18mg/ml) and Ficus platyphylla (5.97mg/ml) were lower than metformin (8.84 mg/ml) against hemoglobin glycosylation. At concentration of (1.0mg/ml) S. setigera (72.21%) and F. platyphylla the (70.41%) showed the highest inhibitory effect which was not significantly different (p<0.05) compared to Voglibose (83.47%). In the present study, the IC₅₀ of both extracts were higher (0.64 and 0.69mg/ml) and not significantly comparable to the Voglibose (0.26mg/ml). In conclusion, this study suggests that Sterculia setigera and Ficus platyphylla methanol stem bark extract possess hypoglycaemic potentials. This justifies their ethnomedicinal use for the treatment of diabetes.

Asharani N   and Anagha Sridhar B   

Background: Diabetes Mellitus is a multifactorial metabolic disorder characterized by hyperglycaemia which on long standing results in microvascular and macrovascular complications. Knowledge, attitude and practices concerning diabetes mellitus are imperative to minimize the prevalence and morbidity associated with diabetes mellitus. Materials & Methods: This cross-sectional study was conducted at a teaching rural hospital among 100 known diabetic patients visiting the hospital for regular check-up. The self-administered questionnaire collected the data to assess knowledge, attitude and practices towards diabetes and knowledge determinant factors. Participant's socio-demographic characteristics including gender, level of education and duration of diabetes was reported using descriptive statistics. Mean and SD was used to express the age, anthropometric measurements, glucose levels and knowledge score. The response of knowledge, attitude and practice questions was expressed as frequency and percentage. The logistic regression analysis was done to determine the association between gender, age group, educational status and duration of diabetes with knowledge score. The level of statistical significance was set at p< 0.05. Results: Of the total 100participants, 52% were males and 135 were illiterate. 77% had good knowledge of diabetes symptoms, risk factors, complications, life style modifications and glucose monitoring. 77%, 88% and 76% had good knowledge, positive attitude and good practices respectively. The regression analysis showed increased odds of good knowledge among females [(1.552 (0.559 - 4.311)] and in subjects with diabetes of more than 5years [1.090 (0.278 – 4.264)]. Further the analysis showed that the knowledge on diabetes was poor as participant's age advanced [OR: 0.281(0.065 - 1.217) & OR: 0.199 (0.046 – 0.864)]. Additionally, there were increased odds of good knowledge in participants with increase in educational level. Conclusion: Majority of the participants had good knowledge, positive attitude and good practices, however there is still scope for improvement in the areas such as inclusion of regular exercise, periodic lipid profile analysis and eye examination.

Raja Selvarajan   Satyan M Rajbhandari   and K Vijay Kumar   

Background: Type 2 diabetes mellitus (T2DM), a metabolic disorder with high levels of glucose due to absolute insulin deficiency or relative insulin deficiency (insulin resistance) affects about 20 percent of adults in South Asia (SA) in the United Kingdom (UK). This is similar to that of urban Indian population, where the incidence is about 15 percent. Despite this, there is a scarcity of data comparing SA with that of the Indian urban community in the UK. Objective: The aim of the present study was to study the prevalence and differences of undiagnosed diabetes and associated risk factors between the urban adult Indian populations living in Bangalore and in South Asians residing in the UK. Materials and Methods: The general publics above age of 30 (adult) were encouraged to come for general checkup including capillary blood glucose test during public health events held at various town halls in UK. In the UK, nearly 230 SA adults were screened at 3 separate events held in Preston, Bolton and London. While in Bangalore, at 4 events were held at mosques and the community centres and 412 adult subjects were tested. Subjects known to have diabetes (DM) were analyzed separately from those that were not known to have diabetes (non-DM. Clinical monitoring of anthropometric data and random levels of capillary blood glucose were analyzed. Results: We found that 14.6 % and 42.7% of subjects had previously documented diabetes in the UK and India, respectively (P<0.001). No characteristic differences in age and BMI were found between the subjects of SA in the UK and those in India. In Bangalore, more men (69%) attended screening programme compared to the UK (14.6 percent). Of people without history of diabetes 30.1% of Indians in urban Bangalore had elevated blood sugar in comparison to SA in the UK (10.8%). Conclusion: There is an urgent need to perform screening of adult population for diabetes in urban India, where almost 20% people have impaired glucose tolerance.

S. K. Sharma   A. K. Ajmani   P. Khosla   P. Mukhopadhyay   G. Bhatia   K. G. Prakash   G. Chhaya   P. D. Supe   V. Pavithran   H. Bora   S. Ingole   and R. Jain   

Objective: To compare the change in immunogenic response, safety and efficacy of insulin glargine in Glaritus® and Lantus® treatment arms from baseline to six months in patients with type 2 diabetes mellitus (T2DM) uncontrolled on oral antidiabetic drugs (OADs). Material and methods: In an ongoing prospective, open-label, randomized, parallel-group, comparative, multicenter, phase IV study, adult patients with uncontrolled T2DM are treated with either Glaritus® once daily or Lantus® once daily for six months, both given subcutaneously. Glaritus® treatment arm is to be continued for another six months. The primary endpoint for the study was the percentage change in anti-insulin antibodies (AIA) titer to glargine in both treatment arms from baseline to six months. Results: Ninety patients were randomized to each group. Baseline characteristics were comparable between the groups (p>0.05). There was no significant difference in percent change in the AIA titer between the two treatment arms at the end of six months in ITT (intent-to-treat) and mITT(modified intent to treat) population (LS mean diff [95% CI]: 2.2% (-15.1%, 19.6%), p=0.7987 and 3.4% (-15.1%, 21.9%), p=0.7181, respectively). No significant between-group difference was seen in change in the HbA1c level at the end of six months in ITT and mITT population [LS mean diff (95% CI): -0.2 (-0.4, 0.0), p=0.1072 for ITT population; and -0.1 (-0.3, 0.1), p=0.2283, for mITT population]. There was also no significant difference between two groups for the incidence of adverse events [Glaritus® 17 (18.9%) and Lantus® 20 (22.2%) p=0.5800]. Conclusion: Glaritus® was found to be non-inferior to Lantus® in glycaemic control and comparable in immunogenic response and safety at the end of six months in patients with T2DM uncontrolled on OADs.

Subhash Saxena   Priya Mathur   and Arvind Gupta   

With the changing life style in the recent decade risk of chronic non-communicable diseases (NCDs) like diabetes has increased globally. World Health Organization (WHO) projections show that NCDs will be responsible for a significantly increased number of deaths in the next decade, especially in urban sedentary population. We planned to assess GROUP A/B OFFICERS EMPLOYEES OF FINANCIAL AND PUBLIC SECTORS (nationalized banks, insurance sector, government and semi-government PCUS), as they belong to special workgroup who predominantly have sedentary life style [1]. The prevalence of sedentary lifestyle among bankers is high and as it kills some 5.3 million people every year, according to the WHO, and with the increase and aging of the population, these lifestyles will become increasingly more common in low- and middle-income countries like India. Lifestyles with little or no physical activity are the leading cause of obesity, and one of the main risk factors for diabetes and cardiovascular disease. According to the International labor organization (ILO), people who engage in little physical activity run a 20% or 30% greater risk of dying from above causes. [2] Sodium-glucose linked transporter (SGLT) type2 inhibitors, constituting the most recently available oral glucose-lowering drug category, exert their effect by increasing urinary glucose excretion. Optimal prescribing of agents within this category requires a full understanding of their risks in addition to their benefits. Besides improving glycaemia control, weight and blood pressure some members of this class provide beneficial cardiovascular and Reno protective Effects. [7, 13] So the present retrospective observational study was aimed to observe clinical effectiveness of add-on Canagliflozin 100 mg in high risk sedentary population i.e. uncontrolled Indian Type 2 Diabetes mellitus (Type2DM) Patients with body mass index (BMI) >25 kg/m², includes group A/B officer employees of financial and public sectors who were already on other hypoglycemic, anti-hypertensive and lipid lowering agents. These data were analyzed over a period of 12 months (1 stJune2017-30may 2018) among above-said employees of various sectors in Jaipur. After Ethical clearances from institutional ethical committee, a total of 113 Type2DM participants were included at baseline, 13 were excluded from study and their annual health data's subsequently analyzed after add-on Canagliflozin 100 mg pre breakfast, with earlier pharmacological management with no dose adjustment during the entire period of study. Significant reduction glycated hemoglobin (HbA1c) was noted in, as we observed the target HbA1c near normal (p-<0.0001). Significant weight reduction was found in two sub-groups in our study (p< 0.0001). Significant reduction of Triglyceride was noted in all study groups (p-<0.0001), but same trend was not observed in LDL, HDL and TC, although reduction was definitely noted.

Ruby Wyett   Blake Peck   and Daniel Terry   

Type 2 Diabetes Mellitus (T2DM) is a chronic, progressive metabolic disease that is an international epidemic. General Practitioners (GPs) are the cornerstones of T2DM management. The aim of this study was to determine the scope of care and management of patients with T2DM within General Practice, while highlighting domains of success and areas where improvement can be made. Demographic and laboratory cross sectional data were collected by examining electronic patient records at one rural General Practice to address the aims of the study. Data included key management parameters of Hemoglobin A1c (HbA1c), estimated Glomerular Filtration Rate (eGFR), microalbuminuria, blood pressure and cholesterol levels, in addition to age, sex, and residential postcode. Further, data regarding the use of insulin, antihypertensive medications and lipid-lowering medications were collected and analyzed. Descriptive and inferential statistics were used and significance was determined at p≤0.05. A total of 294 electronic patient records were examined. Glycaemic control was shown to have clinically improved over time, with only 10.8% of patients having poor control at their latest HbA1c test. Despite improvement in HbA1c, only 35.4% of patients had been referred for diabetes education to a diabetes clinic. eGFR showed an overall decline in patient kidney function above the level of decline consistent with aging. Males were significantly more likely to have microalbuminuria with increased severity than females. The study demonstrated an overall clinical improvement in the diabetic control of patients, while identifying key at risk sub-populations. The findings suggest the need for continuous patient orientated management, while highlighting areas for improvement that impact patient health outcomes and avenues for service sustainability greater.

Maha Abuelgasim Alamil Mohammed   and Nazik Ibrahim Abdel Rahman   

Diabetic foot complications are a major challenge for the healthcare system, with enormous economic consequences for the patients, their families, and the society and a leading cause of mortality and morbidity in developing countries. Diabetic foot ulcer (DFU) is the most costly and devastating complication, which affects 15% of diabetic patients during their lifetime. Good knowledge, attitude, and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputations. The aim of this study was to assess the knowledge, attitude, and practice of foot care among type 2 diabetic patients and to determine the relationship between proper foot care and diabetic foot lesions. This is an observational, descriptive, cross-sectional, hospital- based study. It was conducted in the diabetic out-patient clinic at Al-Ribat University Hospital, in Khartoum, Sudan 2016. A total number of 156 type 2 diabetic patients were enrolled in this study; with 75% of the participants were females and 25% males. Duration of DM, exercise, smoking adherent to diabetic diet, type of therapy, co-morbidity, foot lesions, and foot care knowledge, attitude, and practice were tested. Having diabetes longer than 10 years were 37.8%, mean age was 53.4 ± 7.68 years. There was high prevalence of peripheral neuropathy(PN) symptoms 56.4% while 42.3% of the patients had peripheral arterial disease symptoms .17 patients had loss of sensation while only 2 patients had loss of peripheral pulses (dorsalis pedis and posterior artery pulses). Regarding knowledge, attitude, and practice about diabetic foot care, 56.5% had good foot care knowledge, 70.5% had bad attitude, and 62.2% had moderate practice. Based on Chi square test of relationship between proper foot care and diabetic foot ulcer (DFU), there was association between bad knowledge, attitude, and practice about foot care and DFU, P. values: 0,03, 0,000, 0.036 respectively. Advising the diabetics about frequent foot care clinic visits, regular feet examination, proper footwear, exercise program, and smoking cessation would be beneficial in preventing diabetic foot complication. Policy and decision makers should initiate interventional foot care education programs throughout the country, with our ultimate goal is to save limbs.

Nazik Ibrahim Abdel Rahman   

The present work is Prospective cross sectional study. The main objective is to determine the presence of microalbuminuria in the patients urine in relation to the duration and the age and gender by using urine strip for microalbuminuria. The complications of diabetes mellitus especially end stage renal failure is a major health problem, This study is about the screening diabetic patients for microalbuminuria by simple urine strip for microalbuminuria. During period from Jan. to Aug. 2008, 100 diabetic patients were randomly selected from diabetic clinics of Omdurman Teaching Hospital and Altyser Health Center by using simple direct standardized questionnaire for 100 diabetic patients type I & II. And the urine samples were examined for microalbuminuria Results: out of 100 diabetic patients, 66% were females and 34% were males, type I constitutes about 5 % and type II about 95%, the ages range from (9-90) years. Microalbuminuria detected in about 41% of the patients and 59% had negative results, most of the patients with positive results were in age group (45 -54). The clinical practice in diabetic clinics in Sudan is not following the international guidelines regarding the screening of diabetic nephropathy, so a significant number of the diabetic patients with diabetic nephropathy are missed.

Trébissou Aïssé Florence Judith   Sanogo Mamadou   Sibailly Pascal   Ankotché Amos   Lokrou Adrian   Hatem Masmoudi   Yapo Adou Francis   and Djaman Allico Joseph   

Diabetes autoantibodies, which are important markers of classification and prevention of type 1 diabetes, are absent in the diabetes care in Côte d'Ivoire. The study aim was to determine the age at which these autoantibodies were at their highest levels in type 1A diabetic patients (T1D) and their siblings in Côte d’Ivoire. The study population is composed of 28 T1D patients and 59 siblings, aged from 5 to 21 years. T1D were followed up in the U.H.C Endocrinology departments of Yopougon and Treichville, in the District of Abidjan. Anti-GAD and anti-IA2 autoantibodies were researched by ELISA and anti-ICA autoantibodies by indirect immunofluorescence on monkey pancreas. The peaks of anti-GAD and anti-IA2 autoantibodies were observed respectively at 9 years old (604.30±521.70 IU/ml) and 10 years old (125.10±90.10 IU/ml) in T1D. In siblings, the peaks of anti-GAD and anti-IA2 autoantibodies were observed respectively at 13 years old (137 IU/ml) and 10 years old (53±40 IU/ml). The peak of diabetes autoantibodies in T1D and their siblings in Côte d'Ivoire is at a very young age noted. This could explain the high mortality rate among T1D youth in Côte d'Ivoire.

Lisa R Maness   Jasmine L Barber   and Jude Okoyeh   

Over 27 million people in the U.S. have type 2 diabetes mellitus, with a disproportionate number being African American. There is abundant evidence of environmental and genetic influence, with several single nucleotide polymorphisms reaching genome-wide significance. The work was a pilot study to begin to determine whether type 2 diabetes mellitus can be improved in society through personalized medicine, by approaching individual patients from the standpoint of their unique at-risk or protective genes in addition to lifestyle and family history. Twenty-seven patients volunteered to answer questions on family history of type 2 diabetes mellitus and had their body mass index, glucose, glycosylated hemoglobin, and insulin levels determined. They also had DNA extracted with single nucleotide polymorphisms determined by Affymetrix precision medicine research array. Fourteen single nucleotide polymorphisms relating to T2DM were found in the microarray used in this study. Number of at-risk single nucleotide polymorphisms varied for participants and 3 had the protective single nucleotide polymorphisms. While all participants had at-risk single nucleotide polymorphisms, some individuals with a body mass index in the obese range or with family history of the disease were found to have a greater number of single nucleotide polymorphisms that place them at risk for type 2 diabetes mellitus. This study shows how combined knowledge of patient single nucleotide polymorphisms, family history, and lab parameters may provide information for developing a personalized medicine plan.

Nihal Yücel   Aycan Bölük   Ã–zlem Madenci   Zeynep Yildiz   Mehmet Sargın   and Asuman Orçun   

Introduction: There is an ongoing debate over the involvement of irisin in the glucose metabolism. In this study, we aimed to see the association of irisin with the markers of glucose intolerance. Materials and Methods: We analyzed the relation of irisin with metabolic markers such as 51ÊÓƵostatic Model Assessment-Insulin Resistance (HOMA-IR), insulin, and glucose in 152 subjects, subdivided into normal, impaired glucose tolerance and diabetic subgroups. Results: We found that the irisin levels of individuals with different stages of glucose intolerance did not show any significant difference. There was not any correlation between irisin levels with HOMA-IR. However, we observed a positive and significant correlation between circulating irisin concentrations and 120-minute glucose, 120-minute insulin, and HbA1c levels. Conclusion: The conclusive results of this study are that irisin could be somehow associated with insulin resistance but do not show a significant difference with neither diabetes nor different stages of insulin resistance.

Aka F. B. Angelo   Kablan A. L.Claude   and Kati-Coulibaly Séraphin   

The drink from the roasted and ground coffee beans of Coffea, which has been blamed, with alcohol, tobacco and drugs have been recognized for over a decade as a drink with positive effects on health. Among its benefits is an inverse association between low coffee consumption and high prevalence of type 2 diabetes. This study aims at evaluating the antidiabetic effects of an aqueous extract of roasted and ground beans of Coffea canephora robusta associated with a sulphonylurea (Glibenclamide) on glycaemia and on the release and storage of hepatic glucose among rats made diabetic by alloxan. Simultaneous oral administration of 20 mg/kg bw of aqueous extract of roasted and ground coffee beans of coffea canephora robusta + 10 mg/kg bw of glibenclamide after 28 days of treatment results in a highly significant decrease in blood glucose in diabetics rats, potentiating the effect of glibenclamide. Compared to aqueous and residual aqueous extracts, the ethanolic extract of roasted and ground beans of Coffea canephora robusta has a better inhibition of the release of hepatic glucose in the normoglycemic rats. After 90 days of treatment, the combination of coffee + glibenclamide favour more the storage of hepatic glucose compared with to diabetic rats treated only with glibenclamide. It appears that the aqueous extract of roasted and ground beans of Coffea canephora robusta would have antidiabetic properties and would act by supporting on the one hand the inhibition of the glycogenolysis and on the other hand the storage of hepatic glucose (glycogenogenesis). These results are quite in favour of the preventive effects from beverage resulting from roasted and ground Coffea in the appearance of type 2 diabetes.

Ogoudjobi OM   Sossa Jérôme C   Lokossou MSHS   Tshabu-Aguemon C   Kérékou A   Tandjiékpon E   Denakpo JL   and Perrin R-X   

Gestational diabetes mellitus is the most commonly observed endocrine disorder during pregnancy. It results in severe fetal and maternal complications that can increase the fetal morbidity and mortality and the risk for overt diabetes in women. Identification of pregnant women at high risk for gestational diabetes mellitus is therefore needed for early detection in order to reduce its consequences for the mother, the fetus and the newborn. The objective of the study was to identify risk factors for gestational diabetes in a reference maternal health care centre in southern Benin. This was a case-control study carried out from 1st February 2015 to 31st July 2017 in reference maternal health care centre at the University Hospital of Porto-Novo. All pregnant women with a gestational age of 24 to 28 weeks of amenorrhea, who utilized antenatal care service of University Hospital of Porto-Novo, were screened for gestational diabetes mellitus. The chi-square test was used to identify risk factors for gestational diabetes mellitus. The statistical significance was fixed at p < 0.05. Of the 967 pregnant women participated in the study, 73 cases of gestational diabetes mellitus, were detected (7.5%). Risk factors of gestational diabetes identified were: maternal age ≥ 35 years [OR 7.82 CI 95% (4.75-12.89)], body mass index ≥ 25 kg/m² [OR 9.56 CI 95% (5.17-17.70)], family history of diabetes at 1st degree [OR 2.78 CI 95% (1.53-5.06)], a history of fetal macrosomia [OR 7.25 CI 95% (3.11-16.92)], a history of stillbirth [OR 2.98 CI 95% (1.78-5.00)], an antecedent of more than two spontaneous miscarriages [OR 1.93 CI 95% (1.19-3.12)] and the personal history of hypertension [OR 3.91 CI 95% (1.52-10.07)]. This study confirmed the influence of maternal age and some medical and obstetric histories as risk factors of gestational diabetes mellitus. These pregnant women at high risk of gestational diabetes mellitus should benefit from early detection.

Arif Faruqui   

The aim of this article is to evaluate the impact of postprandial hyperglycemia in patients with type 2 diabetes mellitus (T2DM). Postprandial hyperglycemia is a major determinant in overall glycemic control. Diabetic mellitus is an endocrine disorder steadily increasing worldwide, particularly in the developing countries like India. Diabetic patients are at high risk of cardiovascular events and mealtime plasma glucose fluctuations are important cardiovascular risk factors in type 2 diabetic patients. Diabetes is also one of the most important risk factors for chronic kidney disease. For diabetic patients with chronic kidney disease (CKD), the risk of cardiovascular disease is even higher. CKD can impair the ability of the kidneys to metabolize drugs and as a consequence a dose adjustment or an extended dose interval is usually needed in CKD patients in order to keep an optimal safety/efficacy profile. Oral hypoglycemic agents like glinides and alpha glucosidase inhibitors do not require dose adjustments and hence can be used safely in patients with CKD. Oral treatment with Repaglinide has proven beneficial effect on cardiovascular risk factors. It is therefore very important to use pharmacological tools allowing keeping post-meal glucose oscillations within narrow range. Regimens that target both fasting and post meal glycemia are needed to achieve optimal glucose control to prevent microvascular and macrovascular complications.

Rajneesh Prajapat   and Ijen Bhattacharya   

Background: Diabetes is a metabolic epidemic that causes vascular complications. The presence of oxidative stress in diabetes patients and the preventive role of vitamins therapy have been reported by many researchers. Vitamins supplementation improves antioxidant defense system in diabetes patients. Aim: To study the effect of vitamin E and C supplementation on oxidative stress in diabetes patients. Methods: Subjects enrolled in the study received 500 mg of both vitamin C and vitamin E daily twice for 4 months under medical supervision. Fasting blood glucose, MDA, catalase, SOD and nitric oxide were determined. Serum vitamin E and plasma vitamin C were also measured. Statistical analysis was performed using SPSS 12.0. Numerical normally distributed and categorical data were compared using independent t-test. Data were presented as means ± SD. Results: After supplementation with vitamin E and C in diabetic patients, a signify decrease in FBS, MDA levels and increase in serum nitrite, erythrocyte SOD, blood catalase, vitamin E and vitamin C levels were observed. A negative correlation between MDA and vitamins was observed. Conclusion: Vitamin E and C supplementation is useful for the treatment of oxidative stress related complications in diabetes patients. Prescribed medicines contain active ingredients that may cause effect on the patients in terms of side-effects. Controlled vitamin therapy for prolonged period may not cause any side-effects, as well as play effective role for the management of type 2 diabetic related oxidative stress.

Ylber Jani   Sotiraq Xhunga   Artur Serani   Bekim Pocesta   Fatmir Ferati   Dali Lala   Agim Zeqiri   Arben Mirto   Atila Rexhepi   and Ahmet Kamberi   

Background: Serum lipids are poorly controlled in most European countries and the control rate is even lower in diabetic patients. All international guidelines recommend aggressive management of lipids in this population. To date, evidence on whether diabetic dyslipidemia is adequately managed or not in western region of the Republic of Macedonia are scarce. Objective: To determine the degree of dyslipidemia control in diabetics patients, according to evidence and current guidelines, by primary healthcare physicians, in our region. Methods: This is a multicenter, non-interventional, observational study. Prospectively tested were 555 participants. The study was conducted at outpatient in Primary Health Care Clinics in 8 towns, on western region Republic of Macedonia. Study participants were selected among primary care patient, who were receiving ongoing care for diabetes mellitus type-2(T2DM) and dyslipidemia, during 1 calendar year. We recorded information from all healthcare encounters during 1 calendar year. Results: Our study showed that among diabetic patients with overt cardio-vascular disease(CVD), target LDL-C level of ( < 70 mg/dL),was achieved in 21.4% of patients, whereas 78.6% of patient did not achieved target LDL-C level, respectively.(p=.0000). Among diabetic patients without overt CVD, target LDL-C level of (< 100 mg/dL) was achieved in 44.2% of patients, whereas 55.7% of patients did not achieved target LDL-C level, respectively (p=.06). It was observed that, only 36.7% of the total study population, had achieved LDL-C goals according to evidence and current guidelines, whereas 63.3% of patients did not achieved target LDL-C level, despite an ongoing medical treatment, respectively.(p= .0000). Among the total study population (N=555), target LDL-C level was achieved in 14.0% of the female patients and in 47.3% of the male patients, respectively. (p=.002). Age, BMI and Duration of T2DM, were significantly associated with uncontrolled LDL-C level, according to evidence and current guidelines. (Age: OR=1.214; 95%CI 1.165-1.1263; p=.000; BMI: OR=1.270; 95% CI 1.203-1.341; p=.000; Duration of T2DM: OR=1.035; 95% CI 0.950-1.121;p=.036). Conclusions: Control rates of dyslipidemia among T2DM patients, in the western region of the Republic of Macedonia, continue to be alarmingly low, particularly in women. It is clear that aggressive dyslipidemia management is the need of the hour in patients with diabetes.

Radojica Djoković   Vladimir Kurćubić   Zoran Ilić   Marko Cincović   Miroslav Lalović   Boban JaÅ¡ović   and Jovan Bojkovski   

The objective of the present study was to investigate nutritional and metabolic status in Simmental cows during early and mid-lactation. Fifteen early lactation cows and 15 mid lactation cows were chosen for the analysis. Blood samples were collected to measure beta-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), triglycerides (TG), glucose and the activity of aspartate transaminase (AST). Blood metabolites, milk yield, dry matter intake (DMI) and energy balance (EB) were recorded. Correlation analysis showed that DMI was significantly negatively correlated with NEFA, BHB and AST, and positively with glucose and TG. EB was significantly negatively correlated with NEFA, BHB and AST, and positively with glucose. Early lactation as compared to mid lactation cows were found to have significantly higher blood serum concentrations of NEFA, BHB and AST activities and lower blood serum concentrations of glucose and TG, but not significant. These metabolic changes were in correlation with DMI and EB, but not with milk yield. Suggest that they can serve as useful indicators of the nutritional and metabolic status of dairy cows during lactation.

Rajneesh Prajapat   Ijen Bhattacharya   and Anupam Jakhalia   

Diabetes is a metabolic disorder that causes vascular complications. As vitamin C and E is known for its beneficial effects on blood sugar, serum lipids and glycated haemoglobin (HbA1c). In the present study, we assess the combined effect of vitamin C and E on blood sugar (FBS), serum creatinine (SC), total cholesterol (TC), low and high density lipoprotein (LDL, HDL), and glycated haemoglobin (HbAIc) in type 2 diabetes mellitus patients. A total of 50 patients with type 2 diabetes referred to Rama Hospital (NCR), India, were included in the study. They received 500 mg daily twice of both vitamin C and E for 4 months. Fasting blood sugar (FBS), serum creatinine (SC), total cholesterol (TC), low and high density lipoprotein (LDL, HDL), and HbAIc were measured before and after vitamin C and E consumption and the results were analyzed. A significant decrease in FBS, TC level and non-significant decrease in SC, LDL, and HbA1c level was seen in the patients supplemented with 500 mg of both vitamin C and E twice in a day for 4 months. Results indicate that daily consumption of 500 mg of vitamin C and E for 4 months may be beneficial for decreasing the FBS, TC, SC, LDL, and HbA1c and slight raise in HDL and calcium level in patients with type II diabetes and thus reducing the risk of complications.

Kouame Yao Yves   Okpekon Aboua Timothée   and Yapi Houphouët Félix   

This study aims to evaluate antidiabetic activity of aqueous and ethanolic extracts of Xylopia villosa stem bark. Induction of diabetes was made with Streptozocin on male rats. Treatments of diabetic rats with aqueous and ethanolic extracts of Xylopia villosa at doses of 100 and 200 mg / kg bw and Daonil (the reference molecule) at doses of 10 and 20 mg / kg bw revealed that ethanolic extract (200 mg / kg) bw behaved like Daonil (20 mg / kg bw). It is the therapeutic dose needed to correct hyperglycaemia. At this dose, the ethanolic extract allowed an important insulin secretion equivalent to the non-diabetic control rats and allowed the gradual reconstitution of the islets of Langerhans and the reappearance of the β cells responsible for the secretion of the insulin. This situation would be linked to the flavonoids and zinc contained in the extracts. Indeed, Zinc, in addition to being a powerful antioxidant, would have a protective insulin action and an important insulin-like effect by activating the kinases involved in insulin signaling and the phosphorylations necessary for insulin efficacy. Also, flavonoids improve the sensitivity of the body's cells to insulin, which reduces the incidence of type 2 diabetes.

Abhay Kumar Pandey   and Garima Pandey   

Understanding of basic mechanisms mediating epigenetic regulation is essential for knowing cellular differentiation and genomic programming for function. Epigenetics refers to chemical marks on genes and their products, impacting gene expression without any alteration in DNA base sequence. These marks are copied and carried over through cell division and yet, are reversible with appropriate molecular manipulations such as DNA methylation, chromatin rearrangement, microRNA mediated feedback checks etc. Such changes underlie fetal origins of adult chronic non communicable diseases, and project the primacy of nutrition in epigenetic aberrations. Regulation of over 25000 genes through epigenetic processes in health and disease opens vast sphere for physiologic understanding of nutrition and nutrients. Genomic science has systems approach to understanding. In present context that shapes as dynamic emergent nutrition physiology of health and disease. Present article presents a brief overview of the perspectives.

Abhay Kumar Pandey   Deepti Pandey   and Abha Pandit   

Background: Obesity is lead component of metabolic syndrome and dyslipidaemia is shown to play diverse roles in type-2 diabetes and its complications resulting in morbidity and mortality Aim: Obesity and lipid profile changes in diabetes are to be assessed and their possible bearing on observed hearing loss and delayed reaction time reasoned with reference to scientific understanding. Method: 51 type-2 diabetes patients and 51 age sex matched non-diabetic controls are examined for obesity parameters and lipid profile. Possible relevance of the findings to observed complications in the patients is contemplated by literature reference. Conclusion: Obesity and dyslipidemia appear to be important in initiation, progression and complications of type 2 diabetes. Consensus needs to develop on routine management of diabetes with due cognizance of need to treat obesity and dyslipidemia, beyond usual focus on glycaemic control.

Tania Haque   

Work is typically divided along gender lines with men being responsible for the outside work and as the main income- earner and women for housework and child care. Women's unpaid work is not recognized and therefore, women are considered as passive dependents. Non-recognition of women's activity not only leads to undervaluation of economic contribution but also contributes to their lower status in society relative to men in Bangladesh. Therefore unpaid work is not a gender-neutral bundle of chores that women perform out of comparative advantage or lower resources but instead it is an integral part to the reproduction of unequal power relations between men and women.

Rajneesh Prajapat   and Ijen Bhattacharya   

Recently recognized class of oral hypoglycemic, dipeptidyl peptidase (DPP4) inhibitors could block the dipeptidyl peptidase 4 (DPP4) enzymes. DPP4 is an intrinsic membrane glycoprotein and a serine exopeptidase that plays a major role in glucose metabolism and responsible for the degradation of incretins such as GLP-1, therefore providing a useful treatment to diabetes mellitus type 2. The present work focused on the study of the structural homology modeling of dipeptidyl peptidase 4 [Homo sapiens] (NP_001926). The Ramachandran plot of DPP4 (NP_001926.2) has 88.9% residues in the most favoured region while template 2QT9 has 96.1% residues in the most favoured region. The model was validated by using protein structure tools RAMPAGE and Prochek for reliability. Docking studies were further performed to analyze the interaction mode between selected DPP4 inhibitor anagliptin derivative SKK and receptor DPP4 by using Hex 8.0.0. The in-silico analysis was useful to identify the novel inhibitor that illustrates better activity than the other reported inhibitors.

Abha Pandit   and Abhay Kumar Pandey   

Background: Improved check on cardiovascular mortality due to diabetes has fast increased life span and prevalence of nephropathy in diabetics world over. Its variegated insidious sequel requiring useful markers for timely detection and address. Professional dictat is for periodic monitoring of estimated glomerular filtration rate (eGFR) in the diabetes patients. An indication of nephropathy from overall routine clinical and laboratory findings is worthwhile too. Objective: Study of clinico-demographic and biochemical indices associated with diabetic nephropathy defined by cutoff decline in eGFR, was undertaken to generate local evidence base for practice guidance. Method: 136 patients of type 2 diabetes mellitus under treatment at medicine outdoor for at least past one year were classified by eGFR cutoff of 60ml/min/1.73m² in to renal impaired (chronic kidney disease CKD group) and unimpaired groups. In a cross sectional study their clinico-demographic characteristics and biochemical investigation profiles were analysed and compared to elucidate local clinical evidence on relevant markers of CKD in type 2 diabetes. Result and Conclusion: Central obesity, long standing disease, inadequate glycaemic control, macroproteinuria, lower HDL-cholesterol and lower plasma antioxidant capacity profiles prominently associated diabetic patients with CKD. Hypertension was not prominently associated. Weight reduction, antioxidant nutrient supplements, better glycaemic control and improvement of HDL-cholesterol profiles were apparently demanding greater attention and care toward abetting/retarding occurrence of nephropathy in type 2 diabetes patients.

Safaa Abed ELRahman Hassan   Wigdan Abdel Rahman Elsheikh   Nazik Ibrahim Abdel Rahman   and Nabiela M. ElBagir   

The present work is a cross-sectional study aimed to evaluate the serum levels of calcium and Glycated Hemoglobin (HbA1c) of (40) patients with type 2 diabetes mellitus, attending Center clinic in Khartoum North- Sudan, and (40) apparently healthy (non-diabetic) volunteers as control group. Age and sex of the test group were matched with the control group. Serum levels of calcium were measured by auto analyzer Bs-200 (instruments and reagents from Mindray Company) and HbA1c amount was measured by CERA-STAT^TM 4000 Analyzer (reagents and instruments from Ceragem Medisys Company). Data was analyzed using SPSS. The results showed a significant reduction in the mean of serum calcium level of the diabetic group when compared with the control group (p value <0.05), whereas HbA1c was increased in diabetic patients (type 2) compared to the control group (p. value <0.05). However there was a good negative correlation between the serum calcium levels and HbA1c in diabetic patients. The results revealed that the increase in HbA1c, in diabetics of type 2 diabetes mellitus, is accompanied by a significant decrease in calcium serum levels, so uncontrolled diabetic patients are at risk of hypocalcaemia compared to controlled patients. This effect was not influenced by gender or duration of diabetes in the studied group.

Nazia Sharmin   Nasima Sultana   Hafizur Rahman   Taniza Rahman   Sanjella Nahreen Chowdhury   Md. Abdullah Yusuf   and Zakiur Rahman   

Background: Acute ischemic stroke more frequently occurs in diabetic patients. Objective: The purpose of the present study was to observe the risk of diabetes mellitus in the occurrence of acute ischemic stroke in Bangladesh. Methodology: This case control study was carried out in the Department of Biochemistry at Dhaka Medical College, Dhaka, Bangladesh from January 2014 to December 2014 for a period of one (01) year. The case group consisted of male and female patients (age range 18-65 years) presenting with ischemic stroke. Age and sex matched healthy individuals were selected as the control group. History of diabetes of both cases and controls were recorded and blood sample was collected from both case and control after overnight fasting for the estimation of blood sugar. Results: A total number of 100 study subjects were taken of which 50 subjects presented with acute ischemic stroke were considered as case and the remaining 50 healthy subjects were taken as control. Diabetes mellitus was more commonly reported in case group (46.0%) than control group (6.0%) and the difference was found statistically significant (p= 0.001).The risk estimation was calculated at 13.34 OR (95% C.I. 3.66 to 48.62). Conclusions: The findings of this study conclude that diabetes mellitus was found to be significantly associated with acute ischemic stroke.

Arif A. Faruqui   

Worldwide diabetes mellitus is highly prevalent and economically devastating illness. This study was a post marketing surveillance (PMS), non-randomized, open, non-comparative, mono-centric study. The drug administered was a fixed dose combination of voglibose 0.2 mg; glimepiride ½ mg and metformin 500 mg sustained release (SR). Fifty type 2 diabetic patients were given fixed dose combination twice daily with major meals for 3 months. Baseline value was recorded for glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and post prandial blood glucose/hyperglycemia (PPHG) level. There was significant decrease from baseline in HBA1c value 10.6 ± 1.3 vs. 6.6 ± 0.4 (P< 0.0001), FPG levels 208.33 mg/dl vs. 118.06 (P< 0.0001), and PPHG levels 360.14 mg/dl vs. 168.36, (P< 0.0001) after 3 months of treatment. The combination was found to be effective in controlling both fasting and post prandial glucose level and was well tolerated. Investigator commented that the use of triple drug combination is a good option in the management of type 2 diabetes which controls both fasting as well as post prandial blood glucose and ultimately HbA1c values.

L. R. Maness   

Understanding the dietary components that can prevent and treat diabetes mellitus types 2 (DMT2) is important to millions of people who are at risk for and currently suffer from the various aspects of this disease. Our diets can affect our health at the level of gene expression, thus, determining foods that can positively affect cellular activity can be advantageous to our daily lives. Butyric acid is a fatty acid that can be fermented from fiber by beneficial intestinal bacteria. This substance has been shown to improve insulin sensitivity and metabolic activity in mice and to affect genes involved in the insulin pathway both in cell culture and in mice. This study determined the effect of butyric acid on the expression of two genes important to insulin sensitivity, glucose transporter 4 (GLUT4) and insulin receptor substrate 1 (IRS1), in human preadipocytes in vitro. Butyric acid at concentrations 0.05 mg/ml, 0.1 mg/ml, and 1.0 mg/ml each increased the expression of both of these genes, indicating that cells are more sensitive to insulin in the presence of this component. This study indicates that butyric acid can be implemented into dietary plans to prevent and control DMT2 by increasing daily fiber intake.

Rajneesh Prajapat   and Ijen Bhattacharya   

Calpain-10 (CAPN10) is a cysteine protease that is known to hydrolyze specific substrates significant for calcium-regulated signaling pathways and it's activated by intracellular calcium (Ca²⁺). The calpain10 is known to be involved in the cellular degenerative processes that characterize several diseases such as cancer, stroke and heart attack. The role of calpain10 was recently identified and associated with diabetes mellitus type 2. In this paper, the homology modelling procedure was used to determine the 3D structure of human calpain10 (AAH07553). The μ-calpain (1QXP) of Rattus norvegicus was selected as a template for the construction of calpain10 model. Ramachandran plot of calpain10 (AAH07553) has only 55.9% residues in the most favored regions, while template μ-calpain (1QXP) has 69.3% residues in the most favored regions. The model was validated by using protein structure tools RAMPAGE and Prochek for reliability. 3D structure of calpain10 suggested its active site remains conserved among family members and the major interactions are similar to those observed for the template (1QXP).

Taras Y. Vitak   Solomon P. Wasser   Eviatar Nevo   and Natalia O. Sybirna   

Increase of nitric oxide production resulted in the development of oxidative-nitrosative stress that is considered to be an etiological cause of many diseases, including diabetes mellitus (DM). Recently, it was found that red blood cells (RBCs) are able to produce nitric oxide (NO), and due to the ability of hemoglobin to bind to nitric oxide, are the main depot of NO. Medicinal mushrooms are widely used in the correction and treatment of many diseases, including diabetes. Our previous results showed that Agaricus brasiliensis and Ganoderma lucidum have hypoglycemic effects and improve the functional state of RBCs. In this study, the influence of submerged cultivated mycelium powder (SCMP) of the abovementioned mushrooms on the red blood cells L-arginine/NO system of streptozotocin-induced DM rats was investigated. Wistar outbread white rats were used in the study. Streptozotocin was intraperitoneal injected one time at a dose of 50 mg/kg body weight. Mushroom preparations were orally administered at a dose of 1 g/kg/day for 14 days. We showed that administration of medicinal mushrooms SCMP to diabetic animals caused restoration of NO-synthase activity, normalized nitrite content (in case of A. brasiliensis), and led to nitrate growth. Therefore, treatment with mushroom mycelia normalizes the production of nitric oxide to physiological values.

Anjali Awasthi   Nikhat Parween   Vijay Kumar Singh   Arif Anwar   Birendra Prasad   and Jitendra Kumar   

Diabetes mellitus (DM) commonly referred as diabetes is a complex, heterogeneous disorder characterized by high blood glucose level. Insulin insufficiency or ineffective insulin termed as insulin resistance contributes to diabetes etiology. There are two major forms of DM termed as type-1 diabetes and type-2 diabetes. Type-1 diabetes is an autoimmune disease resulting in destruction of pancreatic cell leading to severe lack of insulin. Whereas, type-2 diabetes develop due to inefficient insulin utilization referred as insulin resistance or insufficient quantity of insulin production. Diabetes has become a global disease and in 2014 WHO has reported 9% of adults (18 years and above) had diabetes. The above trend is expected to increase in forthcoming years due to sedentary lifestyle, unhealthy diet and excessive body weight. Insulin signaling pathway is the key pathway involved in regulating blood glucose level. There are several factors reported to alter insulin secretion as well as insulin signaling pathway resulting in etiology and progression of diabetes. Diabetes treatment aims at controlling blood glucose level. There are various kinds of chemical drug and herbal/natural products being used to effectively control blood glucose level. Composition, dosage and mode of action of chemical drugs are well established. However, the mode of action of traditional and herbal medications, which are used widely by 90% of the population in developing countries for primary healthcare, is still poorly investigated. Around 800 plants have been reported worldwide which have anti-diabetic potential. This review explores and gives the insight on the insulin signaling pathway and other known factors which modulates diabetes. It also collates the potential of various anti-diabetic herbal/phytochemical medications which have been scientifically investigated for their anti-diabetic virtue and mode of action.

NeÅŸe Hayat Aksoy   and Pakize Dogan   

Fructose-1,6-bisphosphate aldolase plays an effective role in glucose metabolism and gluconeogenic pathway, and reversibly catalyzes the split of fructose 1,6-bisphosphate into the triose phosphates D-glyceraldehyde phosphate and dihydroxyacetone phosphate. Aldolase has 160 kDa molecular weight and three tissue specific isozymes. Gestational diabetes mellitus is defined as glucose intolerance that begins or is first detected during pregnancy. The placenta is a temporary established organ that operates exclusively for the time of pregnancy. It acts as a natural barrier between the maternal and fetal blood circulations and performs a wide range of endocrine and transport functions. In diabetes, the placenta undergoes a variety of structural and functional changes. Healthy and gestational diabetic human placental fructose-1, 6-bisphosphate aldolases were purified and investigated the substrate kinetic properties, in the previous studies. In this comparative study, we wanted to carry out characteristics of inhibition kinetics of aldolase in healthy and diabetic human placenta. The specific activity was defined as the number of activity units per mg of protein. Inhibition kinetics of fructose-bisphosphate aldolase was studied using dihydroxyacetone-phosphate, adenosine triphosphate, and magnesium ion as inhibitors. For healthy placental Aldolase it was detected that, adenosine triphosphate is partial competitive; dihydroxyacetone-phosphate is noncompetitive and magnesium metal is pure-competitive inhibitor. It was found that, dihydroxyacetone-phosphate is competitive; adenosine triphosphate is partial competitive and magnesium is partial competitive inhibitor of gestational diabetic human placental Aldolase.

NeÅŸe Hayat Aksoy   and Pakize Dogan   

Gestational diabetes mellitus is described as glucose intolerance at various degrees that is first detected during pregnancy. In diabetic complications, there are changes in placental function, particularly with respect to intake, transmit, and utilization of glucose, and also in glycolysis and glycolytic enzymes. The placenta possibly plays a critical role in protecting the fetus from adverse effects caused by the maternal diabetic conditions. Fructose 1,6-bisphosphate aldolase, a main glycolytic enzyme, catalyses the cleavage of fructose 1,6-bisphosphate, resulting in two three-carbon products in many cells. In this study, we principally have investigated the presence of aldolase in diabetic human placenta and then purified the enzyme. We also determined the optimum conditions of enzyme assay measurements. With this procedure, we determined the specific activity of placental aldolase as 590, 94 mU/mg protein, and aldolase was purified about 63,0 fold from gestational diabetic human placenta. The molecular weight of human placental aldolase was found as 160 kDa. In present study, substrate kinetics were also investigated, and two different K_m and V_max values at high and low concentrations of substrate Fructose 1,6-bisphosphate were observed. High substrate concentration range is determined as the linear substrate concentration zone. Therefore, advanced kinetic studies had been performed at this linear zone. Enzymatic assays were carried out, and substrate kinetic properties were determined. According to this determination, V_max value of gestational diabetic placental fructose 1,6-bisphosphate aldolase was found as 939,548±60,869 U/mg and Km as 24,304±2,948 mM.

Mariia Khokhla   Olexandra Horbulinska   Halina Hachkova   Lidiya Mishchenko   Olexandr Shulga   Rosa Vildanova   and Natalia Sybirna   

Yacon demonstrating prominent hypoglycemic action and having high content of biologically active compounds, is recognized for their ability to capture free radicals. This study is aimed to evaluate the influence of yacon leaves and root tubers water extracts and aqueous suspension of root tubers powder on rats' erythrocyte antioxidant defense system under the experimental diabetes mellitus type 1. Healthy animals and animals with diabetes mellitus were treated with water extracts of yacon leaves and root tubers at dose 70 or 500 mg / kg /day and with aqueous suspension of root tubers powder at dose 500 mg / kg /day or the same suspension which was stabilized by biocomplex PS. Thiobarbituric acid reactive substances (TBARS) and protein carbonyl content (PCC), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activity in erythrocytes lysates were measured. Water extracts of yacon leaves and root tubers and aqueous suspension of root tubers powder possess significant antioxidant effect, which was indicated by the decrease of TBARS and PCC and increase in SOD, CAT and GPx activity. Root tubers of yacon water extract at a dose of 500 mg/kg/day and aqueous suspension of root tubers powder stabilized by biocomplex PS possess he most pronounced antioxidant effect.

Daniel R Terry   Kristen Glenister   John Kilmartin   Gloria Kilmartin   Rob Sands   Jeremy Fowler   and Julian Wright   

Aim: The aim of this paper is to highlight the successes of and challenges faced by a publically funded diabetes center in a regional area. Methods: Demographic and laboratory cross sectional data were collected from electronic patient records. Data from a patient's very first test undertaken when attending the hospital and the latest test undertaken at the Diabetes center were noted and included age, sex, residential postcode and glycated haemoglobin (HbA1c) levels. Results: A third of patients reached the therapeutic guideline of 'very good control' for HbA1c levels. Females had lower Hb1Ac levels, while males and those that lived further away from the diabetes center had higher levels of HbA1c. However, a significant improvement in glycaemic control among men and those who lived 'out of town' was noted, while the corresponding pattern for women was not evident. Conclusion: The study demonstrated that there was an overall improvement in diabetes control among health consumers who attend the regional diabetes center, however, female patients residing in town showed a negligible change over time. At risk' patient groups may need further targeting for intensive intervention to achieve optimal diabetes control, even within the diabetes center.

L. R. Maness   

Diabetes mellitus type 2 (DMT2) affects hundreds of millions of people globally and costs billions of dollars each year. The importance of research toward prevention and treatment of this disease cannot be overestimated. Butyric acid is a short chain fatty acid that has been shown in mice and in intestinal cell culture studies to increase insulin sensitivity at the level of gene expression. However, little or no work has been reported on its effects on human liver cells. The present study determined the changes in gene expression of glucose transporter 2 (GLUT2) and insulin receptor substrate 1 (IRS1) on insulin shocked THLE-2 human liver cells exposed in vitro to the following concentrations of butyric acid in mg/ml: 0.05, 0.1, and 1.0. GLUT2 and IRS1 had increases in expression at doses of butyric acid previously found to be nontoxic in human serum. This work indicates that more studies involving the effects of butyric acid on gene expression of insulin resistant human hepatocytes are warranted.

K. N Subhakumari   Reshmy G S   and Sajitha Krishnan. P   

Cellular oxidative stress is the leading cause of the worst outcome of myocardial infarction (MI) in diabetes. Diabetes Mellitus is one of the important risk factors for heart pathology, because of increased production of Reactive oxygen Species(ROS).The present study was designed to find out the antioxidant status in diabetic and non-diabetic MI Patients.100 MI patients were grouped into 50 Diabetic MI(group 2) and 50 Non diabetic MI(group 3) and was compared with age matched 50 controls (group1). Malondialdehyde(MDA) or Thiobarbituric acid reactive substances (TBARs), antioxidant enzymes Superoxide Dismutase(SOD) &Catalase were measured in erythrocytes and Vitamin C in plasma was measured. The result showed that there is a significant decrease in the antioxidant status in diabetic and non-diabetic MI patients and a simultaneous significant increase in the lipid peroxidation .Thus there is an imbalance between oxidant and antioxidant molecules in MI patients, and magnitude of imbalance is greater in diabetic MI patients, possibly because of greater oxidative stress in diabetic patients. Potentially antioxidant therapy may play a critical role in reducing morbidity and mortality in MI.

GirumTefera   

Diabetic nephropathy is the leading cause of end stage kidney disease among type 2 diabetics worldwide. Proteinuria has been noted to be the cardinal symptom of progressive loss of renal function. This study examined the impact of duration of diabetes, demography (age, gender) and metabolic factors on the frequency of proteinuria among type 2 diabetics visiting Shakiso health center. In this Institution based retrospective study700 type 2 diabetics aged between25-65years result were analyzed from July 2013 to July 2014 and parameters estimated include fasting blood glucose (FBS), body mass index (BMI), urine protein and blood pressure. Proteinuria among the study cohorts was graded no proteinuria, mild proteinuria to heavy proteinuria. The frequency of proteinuria for the varied grades in type 2 diabetics enrolled in the study ranged from 73.3% (no proteinuria), 15.2% (mild proteinuria) and 15.6% (heavy proteinuria). 1(100%) patient with heavy proteinuria presented with grade 3 hypertension; and 4(33.3%) and 11(20.8%) patients presented with grade 1 and isolated systolic hypertension respectively. Multiple logistic regression analysis showed study participants with duration of diabetes ranging from 11-15 years (OR=2.8; 95% CI=1.1-7.2; p=0.028) and 16-20 years (OR=5.6; 95% CI=1.4-22.5; p=0.016) were at an increased risk of proteinuria. The frequency of nephropathy is promoted independently by advanced age, hypertension and duration of diabetes.

Sanjay Kumar   Satyendu Sagar   Anjali Awasthi   and Jitendra Kumar   

To determine the prevalence and etiology of Asymptomatic bacteriuria (ASB) and antimicrobial resistance of urinary isolates among diabetics mellitus and non-diabetics, a total of 200 patients comprising of 120 diabetes mellitus (DM) and 80 non- diabetes were studied. ASB was detected in 36% patients of which 40% are diabetic and 30% are non-diabetic. Coagulase Negative Staphylococcus (CoNS) were the predominant organism (36.36%) isolated from the urine of both diabetic and non-diabetic. We observed occurrence of ASB significantly increases with age in DM patients and is more prevalent in DM females compared to non-DM females. Whereas Klebsiella sp., Candida sp., and E. coli were also significantly more prominent in DM patients. Most isolates of Klebsiella sp. and E. coli showed resistances to multiple antibiotics tested. For the uropathogens found in the samples tested Levofloxacin proved to be the most sensitive antibiotic. The study revealed a high prevalence of ASB among DM than non-DM subjects. This study also demonstrates multiple drug resistance observed in both DM and non-DM subjects, therefore irrational and indiscriminate use of antibiotic should be avoided.

Samreen Riaz   and Sadia Rana   

Urinary tract infection (UTI) is one of the most common infections in the Pakistani local population that afflicts people and if not treated properly and timely could cause serious damages to the urinary tract. Nowadays increasing antibiotic resistance is one of the problems in managing UTI to check the metal resistance of this disease causing organisms. Urine specimens of in-patients and out-patients in Sheikh Zayed Hospital, Lahore were cultured on blood agar and eosin methylene blue agar (EMB). Isolated bacteria were identified according to standard microbiological tests and then subjected to sensitivity testing according to routine method of disk agar diffusion technique and metal resistance on media containing metal salts. Our findings suggest that there is a method to treat the UTI by antibiotics but nowadays antibiotic resistance is increasing day by day. Results of the present study underline the need for sensitivity tests prior to antibiotic therapy in UTI, which could help and guide in proper choosing of antibiotics and effective treatment and therefore prevention of antibiotic resistance.

Ashraf Soliman   Vincenzo De Sanctis   Mohamed Yassin   and Rania Elalaily   

Glucose meters provide quantitative information about blood glucose concentration that is discontinuous. Continuous glucose monitoring systems (CGMS) using sensors provide time sequences data, including "quantity," and adding direction, rate of change and rate of acceleration. Therefore CGMS appear more informative, efficacious and safe as meters when used for treatment choices. Recently some important improvements are achieved in consistency, ease of use and incorporation with other technologies. From the therapeutic point, ambulatory sensors are currently approved and used with success to treat diabetic patients on insulin therapy. CGMS can provide the data needed to prevent hypoglycemia. In addition, CGMS technology is expanding its benefits for diagnostic use and behavior modification in prediabetes especially in high risk adolescents like those with obesity with or without family history of diabetes, metabolic syndrome, cystic fibrosis and thalassemia. This mini-review clarifies both the therapeutic and diagnostic capabilities and potential use of CGMS to diagnose and manage glycemic abnormalities in adolescents. Moreover it summarizes the results of studies that compare CGMS to other diagnostic tools, namely intermittent capillary glucose monitoring using glucometers, fasting venous glucose measurement, oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin (HbA1C) in the management of these adolescents. The possible early diagnosis of glycemic abnormalities using CGMS in adolescents and their timely management to prevent progression to diabetes appears to be an attractive future therapeutic approach.

Terris R. Moss   

Health literacy is a measure of patient’s ability to read, comprehend, and act on medical instructions. Health care literacy entails being able to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Limited health literacy is associated with poor self-management of Type 2 Diabetes [1]. Limited health literacy is common among vulnerable populations including racial and ethnic minorities, the poor, elderly persons, and patients with chronic conditions. Health literacy is a stronger predictor of a person's health than age, income, employment status, education level, and race [18].The objectives of this research his to examine current studies for the impact of health literacy on clinical outcomes for Adults with Type 2 Diabetes. Self-monitoring of blood glucose is a clinical outcome determined to be a vital component of self-management therapy for Type 2 Diabetes Mellitus. From the literature search four homogeneous articles that have confirmed an association between health literacy and glycemic control were selected for a Meta-Analysis to determine the strength of this correlation. The research will highlight vulnerable populations of at risk for low healthcare literacy which may present barriers for effective Diabetes self-management and offer strategies for reducing those barriers. The purpose of this meta-analysis is to test the strength of previously publish correlations of homogenous studies using TOFLHA as the literacy measurement tool. As the focus on health literacy research does not neatly fall within a health literacy framework as several measures for health literacy measure a combination of print and numeracy skills. Some studies measure literacy as numeracy or oral literacy. The meta analysis is of studies using TOFHLA which is recognized as the tool for health literacy measurement

Radha R Chada   Bipin Kumar Sethi   Kavita Waghray   and Shanti K Naidu   

A cross-sectional population-based study was conducted on 1440 Indian children in Hyderabad to determine the prevalence of obesity, impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM), and to determine whether the increase in T2DM among adults is applicable to this population. Information was gathered through a questionnaire. All the children were screened for fasting capillary blood glucose (FCBG) and anthropometric measurements. None had impaired fasting glucose (IFG) or type 2 diabetes. The school age children and adolescents were categorized into various grades of nutritional status using WHO Reference values of BMI Z-scores. Among the total children, 15.9% of girls, 15.9% of boys were overweight, and 4.2% and 9.5% were obese respectively. Prevalence of overweight/obesity and diabetes among either of the parent or both parents of the children was found among 36.6% and 12.4% respectively. The study found surprisingly no prevalence of dysglycemia amongst children in a city with a high prevalence of diabetes in its adult population. More studies are needed to confirm and explain the paradox. This analysis represents the population based data upon which future studies will be based.

E. Dennis Murphy   

Subcutaneous insulin administration in the diabetic patient causes peripheral hyperinsulinemia, which contributes to vascular disease, hyperlipidemia and coagulation abnormalities. In the non diabetic patient, insulin is released from the pancreas into the portal system. The majority of this endogenous insulin is taken up by the liver in the first pass so that portal insulin exceeds peripheral insulin. Avoiding peripheral hyperinsulinemia requires that insulin be given orally or administered intra-portally; the latter we have done in diabetic dogs. We propose portal insulin placement in diabetes as physiologic and appropriate in an effort to avoid peripheral hyperinsulinemia and its sequellae.

Mokale Vinod   Naik Jitendra   Patil Komal   Chaudhari Rahul   and Khairnar Gokul   

A Liquisolid system is the one of the novel technique to enhance the dissolution rate of poorly water soluble drug such as Nateglinide. In this technique liquisolid system refers to formulation of formed by water insoluble drug mix with non-volatile solvent which is further converted into free flowing, non adherent powder form and which is directly compressed into tablets. In that the propylene glycol is used as non-volatile solvent in which drug having high solubility, microcrystalline cellulose and aerosil (silica) acts as carrier and coating material in the ratio of 10:1 and 20:1 respectively. Sodium starch glycolate acts as superdisintegrants and magnesium stearate as glidant in liquisolid system. The prepared liquisolid system were evaluated to their flowing properties such as bulk density, tap density, Hausner’s ratio, Carr’s index, and angle of repose. Fourier Transform Infrared spectroscopy (FTIR) and X Ray Diffraction (XRD) study show no interaction between the drug and excipients. Further tablets were evaluated hardness, diameter, thickness, weight variation, friability, disintegration test, uniformity of contents and in-vitro release study show liquisolid compact exhibited higher percentage of drug release than conventional and marketed tablets because of due to increase in wetting properties and surface availability for dissolution

Manoj Kumar Upadhyay   

The metabolic syndrome is a complex condition in which numerous aspects of normal metabolism are perturbed. The syndrome represents a cluster of the major risk factors for cardiovascular disease i.e. obesity, insulin resistance / hyperinsulinemia, impaired glucose tolerance / diabetes, dyslipidemia and hypertension. The syndrome is also described by a procoagulant state that is attributed, in part, to an elevation in circulating lipoprotein, fibrinogen and plasminogen activator inhibitor one levels. This in turn contributes to the metabolic abnormalities that lead to cardiovascular disease. Several hypothesis have been proposed for the etiology of the metabolic syndrome, and the potential role of insulin resistance, leptin resistance, and other disturbances as major contributing factors. Hyperinsulinemia and insulin resistance are predictors of type 2 diabetes and are key factors in the development of the metabolic syndrome. A survey was conducted to study the clinical correlation of metabolic syndrome in Indian type –2 diabetic patients with their socioeconomic status (high income group, middle income group & low income group) under different age group (upper age group, middle age group & low income group) in western Uttar Pradesh, India. Four hundred five type 2 diabetic patients aged 52 ±17 year including 215 (53.09%) males and 190 ( 46.91%) females were surveyed for this purpose. Of these hypertension & diabetics were simultaneously diagnosed in 196 (48.39%) & 152 (37.53%) patients. Family history of these patients showed the occurrence of diabetes , hypertension & concurrent hypertension with diabetes mellitus in about 59 (14.0%), 56 (13.8%) & 77 (19.1%) respectively. The frequencies of individual component of the metabolic syndrome were as follows: dyslipidemia - 68.4%, systemic hypertension – 54.3% , obesity – 42.5% microalbuminuria – 44.9% & hyperuracemia 58.3% . Ischemic heart disease (myocardial infarction) occurs in – 2.4%. Of these 405 diabetic studies, 278(68.2%) had metabolic syndrome victims occurs in the high income group & the low income group.

Kameel Mungrue   and Rene Marchan   

Objective: The purpose of this study is to compare four measurements used in the diagnosis of DN, (1) symptom scoring, (2) physical examination scoring, (3) Semmes Weinstein monofilament testing, and (4) vibration sensation among patients with T2DM attending primary care facilities in North Trinidad. In addition, the study will demonstrate discrepancies between these four methods as well as estimate the prevalence of DN. Subjects and Methods: A cross-sectional survey of 14 primary care facilities chosen randomly in North Trinidad was conducted. Of the 292 patients that were screened for entry into our study, 276 met the inclusion criteria. . Using four standard clinical methods ie Symptom Scoring, Physical Examination, Monofilament testing and Vibration Perception the proportion of patient with neuropathy was measured and compared. Results: The mean age of the sample population was 60.8 SD ± 11.1 with the average duration of T2DM being 10.2 SD ± 8.4 years. Additionally, there were more females than males with a female to male ratio of 2.3:1. The proportion of participants testing positive for neuropathy by Symptom Scoring, Physical Examination, Monofilament testing and Vibration Perception was 82.6%, 54%, 42.4% and 25.4% respectively. Conclusion: In conclusion the diagnosis of peripheral neuropathy can be made only after a careful clinical examination with more than 1 test, as recommended by the American Diabetes Association. However monofilament testing may in a primary care setting may not be accurate and relevant.

Muhammad Usman   Aqsa Nazir   Zertaisha Naheed   and Syed Tauseef Mohyud-Din   

In this paper, we are apply Adomian’s Decomposition Method to find appropriate solutions of to squeezing flow and heat transfer between two parallel disks with velocity slip, temperature jump which are of utmost importance in applied and engineering sciences. A concrete relation between the basic ideas of the proposed technique and the existing literature is also presented. Numerical results coupled with graphical representation explicitly reveal the complete reliability of the proposed algorithm

Serena Harris PharmD BCPS Sarah A. Nisly PharmD BCPS Laura Aykroyd PharmD BCPS Joni Carroll RN MSN CDE Brian Ulmer MD Michael Waddell MD Samuel Flanders MD and Rattan Juneja MBBS MD MRCP 

Background: Despite guidelines that recommend strongly against Sliding Scale Insulin (SSI) it continues to be the most commonly insulin regimen used in hospitals to treat hyperglycemia. In addition to being reactionary to a glucose that has already increased, SSI offers practical challenges in the randomness of the doses of insulin prescribed and often a disconnect with glucose testing that should be occurring in congruence to the insulin dosing. While many clinical trials have shown improved glycemic control in critical care patients receiving intravenous insulin; few studies have demonstrated the efficacy of subcutaneous (SQ) insulin in this setting. In this study, we have evaluated the safety and efficacy of SQ insulin administration utilizing a computerized program, the Clarian GlucoStabilizer™ Subcutaneous Program (CGS-SQ) in the intensive care unit (ICU). This program is designed to overcome some of the most common barriers of SQ insulin delivery, those of dose calculation and timing. Methods: A computerized SQ insulin delivery program -The Clarian GlucoStabilizer™ Subcutaneous Program (CGS-SQ)- was made available to ICU practitioners, facilitating standardized calculation of insulin doses and incorporating reminder alarms for blood glucose (BG) testing. This program used three defaults Insulin Sensitivity Factors (ISF) and Insulin to Carbohydrate Ratios (CR) to calculate insulin doses. Additionally, there is an option for practitioner determined ISF and ICR. Patients, aged ≥ 18 years, initiated on the CGS-SQ and admitted to the (ICU) were eligible for inclusion in this retrospective evaluation. Patients were divided into four groups based on initial insulin sensitivity factor (ISF) and carbohydrate ratio (CR). Three of the groups used a default ISF and CR; ISF 60, CR 15; ISF 30, CR 10 and ISF 15, CR 8. These groups were compared with those where the practitioner specified an individualized ISF and CR, referred to as PDS (practitioner defined setting). Primary endpoints included: mean glucose, time to target glucose, hyperglycemic and hypoglycemic events. Results: In the 1,384 patients identified, patients initiated with a predefined setting had lower mean glucose compared to patients with PDS (ISF 60, CR 15: 135 mg/dL vs. ISF 30, CR 10: 140 mg/dL vs. ISF 15, CR 8: 134 mg/dL vs. PDS: 143 mg/dL; p < 0.0001). Patients in the default settings had shorter time to target glucose and decreased incidence of hyperglycemia and hypoglycemia. Conclusions: Using a system of computerized prompts with standardization of insulin dose calculation, SQ insulin can be effectively used in the treatment of ICU patients to target BG of 100-150 mg/dL with minimal risk of hypoglycemia.

Heather Blume SeAnne Safaii Samantha Ramsay and Martha Raidl 

A four lesson diabetes curriculum and two discussion sessions, focusing on diabetes self-management (diet, medication, physical activity) were delivered via two educational modalities: 1) Traditional Face-to-Face (FTF) Classes and 2) Virtual Diabetes Education (VDE) Classes administered in the Second Life® virtual world. The purpose of the study was to 1) describe the psychosocial outcomes in young adults with type 1 and type 2 diabetes and 2) determine whether two types of educational modalities (FTF or VDE) impacted the psychosocial outcomes of young adults with diabetes. A convenience sample of young adults with diabetes (N=81), 18 to 28 years-old, completed pre and post psychosocial surveys that measured levels of depression, self-efficacy, and social support. Multivariate and univariate analyses of variance identified differences in psychosocial outcomes. Overall, 29.9% of young adult participants reported depressive symptoms at the beginning of the study, and those with type 2 diabetes had higher rates of depressive symptoms (44.4%) than participants with type 1 diabetes (26.6%). Individuals with type 1 diabetes had a higher level of self-efficacy (p=.000) and more social support (p=.03) than their peers with type 2 diabetes. No statistically significant differences were apparent among type 1 and type 2 diabetes groups at post study measures. Face-to-Face participants had significantly greater (p=.02) gains in levels of diabetes self-efficacy. Participants in the FTF condition improved mean diabetes self-efficacy scores and participants in the VDE condition decreased mean diabetes self-efficacy scores. Session attendance was higher in the FTF condition (x=3.72, SD=2.23) than among participants assigned to the VDE condition (x=1.79, SD=1.82). Education and support programs should address differences in psychosocial outcomes based on both diabetes type and educational modality.

Jeffery Evans and Dorothy Ann Shelton 

Mipomersen is a novel pharmacologic agent that utilizes anti-sense technology to reduce LDL in patients with very high LDL. The medication has been approved in the United States based on a series of small trials proving efficacy even with when added to traditional therapy. Safety concerns have been raised due to a potential for liver toxicity.

Abhijit Swami Giridhari Kar Bijush Difoesa and S G Shyam Lakshman 

Over the years, adolescents have been diagnosed to be diabetic, the type of which do not fit into the classical types of diabetes – type 1 and type 2. These cases have been reported round the globe. They share features of both types of diabetes like obesity, acanathosis nigricans along with insulin resistance and can even have complications like Diabetic ketoacidosis. The present case study is about a newly diagnosed obese adolescent diabetic patient with acanthosis nigricans presenting with diabetic ketoacidosis who responded to standard treatment of Diabetic ketoacidosis. Subsequently, he was found to have low levels of C-peptide without insulin autoantibodies. Such cases have been variously referred as Double diabetes or 1.5 diabetes in literature and may constitute a subvariant of Diabetes.

SeAnne Safaii Martha Raidl and Samantha Ramsay 

The purpose of this study was to identify perceived barriers young adults experience in diabetes self-management and possible strategies to overcome these barriers. Twenty two young adults, 18-28 years- old, with type 1 or type 2 diabetes attended three focus groups held in two north western states. Participants were asked to discuss barriers and strategies to help them manage their diabetes. The transcripts were coded and analyzed for themes. Four themes were identified: 1) lack of understanding of diet principles, medications and physical activity; 2) lack of support from family, friends and health care providers; 3) lack of resources to assist in managing blood sugar levels; and 4) participants reported the use of the internet and social networking as strategies for overcoming barriers. There are not a lot of materials developed for this age group. Most diabetes educational materials focus on children or adults. This qualitative study provides important insights from young adults regarding the development of educational materials and support systems to help them successfully manage their diabetes.

Tilal Abd El-Hameed Seedahmed and Samia Mahdi Ahmed 

This is a cross sectional study aimed to evaluate the plasma levels of magnesium and HbA_1C of (60) patients with type 2 diabetes mellitus and (40) apparently healthy (non – diabetic) volunteers as control group, the patients were chosen from different hospitals and specific centers. Age and sex of the test group were matched with the control group. The plasma levels of magnesium were measured using a spectrophotometer (Bio system Company reagents). HbA_1C levels were measured using reagents and instruments from NycoCard company. Data was analyzed using SPSS. The results showed a significant reduction in the mean of the plasma levels of magnesium of the diabetic group when compared with the control group (p. value <0.05), whereas HbA_1C were increased in diabetic patients (type 2) compared to the control group (p. value <0.05). However there was a strong negative correlation between the plasma levels of magnesium and HbA_1C levels in diabetic patients, also there was a weak negative correlation between the plasma levels of magnesium and duration of disease. Plasma levels of magnesium have a strong negative correlation with HbA_1C levels, so results revealed that uncontrolled diabetic patients are at higher risk of hypomagnesaemia compared to controlled patients.