Diabetes In Asian Populations Research Articles

The relationship between the CUN-BAE body fatness index and incident diabetes: a longitudinal retrospective study

BackgroundThe Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index has been recommended as an ideal indicator of body fat and exhibited significant correlation with cardiometabolic risk factors. However, whether the CUN-BAE index correlates with incident diabetes in Asian populations is unknown. Therefore, this longitudinal study was designed to evaluate the association between baseline CUN-BAE index and type 2 diabetes mellitus (T2DM).MethodsThis retrospective longitudinal study involved 15,464 participants of 18–79 years of age in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study over the period of 2004–2015. Cox proportional hazards regression was performed to test the relationship between the baseline CUN-BAE index and diabetes incidence. Further stratification analysis was conducted to ensure that the results were robust. The diagnostic utility of the CUN-BAE index was tested by the receiver operating characteristic (ROC) curve.ResultsOver the course of an average follow-up of 5.4 years, 373 (2.41%) participants developed diabetes. A higher diabetes incidence was associated with higher CUN-BAE quartiles (P for trend< 0.001). Each 1 unit increase in CUN-BAE index was associated with a 1.08-fold and 1.14-fold increased risk of diabetes after adjustment for confounders in males and females, respectively (both P < 0.001). Stratification analysis demonstrated a consistent positive correlation between baseline CUN-BAE and diabetes incidence. Moreover, based on ROC analysis, CUN-BAE exhibited a better capacity for diabetes prediction than both body mass index (BMI) and waist circumference (WC) in both sexes.ConclusionsThe baseline CUN-BAE level was independently related to the incidence of diabetes. Increased adiposity determined by CUN-BAE could be used as a strong nonlaboratory predictor of incident diabetes in clinical practice.

Serum 25-hydroxyvitamin D3 Levels and Diabetes in a Japanese Population: The DOSANCO Health Study.

Both decreased insulin sensitivity and impaired insulin secretion are common in Asian populations with diabetes, in contrast to Western populations. There is limited evidence regarding the association between insulin response in diabetes in Asian populations and serum 25-hydroxyvitamin D3 (25[OH]D3) insufficiency. The present cross-sectional study compared the prevalence of diabetes, defined as a fasting plasma glucose level ≥126 mg/dL and/or a HbA1c level ≥6.5%, among 480 participants aged 35-79 years not taking anti-diabetes medications, based on serum 25(OH)D3 levels. A logistic regression model was used to calculate the odds ratios for diabetes in each serum 25(OH)D3 group. Furthermore, this study examined the association between serum 25(OH)D3 levels and the index of homeostasis model assessment of insulin resistance (HOMA-IR) using a linear regression model. The prevalence of diabetes was 7.29% in the study population, and was higher in lower serum 25(OH)D3 quartile groups. The odds ratios for diabetes in the first, second, and third serum 25(OH)D3 quartile groups (25[OH]D3: ≤18.10, 18.11-22.90, and 22.91-28.17 ng/mL) were 4.02 (95% confidence interval [CI], 1.25-12.92), 2.50 (95% CI, 0.77-8.10), and 1.91 (95% CI, 0.60-6.09), respectively, with the fourth quartile group (⩾28.18 ng/mL) serving as the reference group, after adjusting for sociodemographic, lifestyle, physical and environmental factors. Serum 25(OH)D3 levels showed an inverse association with log-transformed HOMA-IR after adjusting for similar factors (standardized β = -0.08; 95% CI, -0.14 to -0.02). Serum 25(OH)D3 levels were inversely associated with diabetes prevalence in a general Japanese population, with a slight inverse association between serum 25(OH)D3 levels and HOMA-IR.

In silico functional and pathway analysis of risk genes and SNPs for type 2 diabetes in Asian population.

Type 2 diabetes (T2D) has earned widespread recognition as a primary cause of death, disability, and increasing healthcare costs. There is compelling evidence that hereditary factors contribute to the development of T2D. Clinical trials in T2D have mostly focused on genes and single nucleotide polymorphisms (SNPs) in protein-coding areas. Recently, it was revealed that SNPs located in noncoding areas also play a significant impact on disease vulnerability. It is required for cell type-specific gene expression. However, the precise mechanism by which T2D risk genes and SNPs work remains unknown. We integrated risk genes and SNPs from genome-wide association studies (GWASs) and performed comprehensive bioinformatics analyses to further investigate the functional significance of these genes and SNPs. We identified four intriguing transcription factors (TFs) associated with T2D. The analysis revealed that the SNPs are engaged in chromatin interaction regulation and/or may have an effect on TF binding affinity. The Gene Ontology (GO) study revealed high enrichment in a number of well-characterized signaling pathways and regulatory processes, including the STAT3 and JAK signaling pathways, which are both involved in T2D metabolism. Additionally, a detailed KEGG pathway analysis identified two major T2D genes and their prospective therapeutic targets. Our findings underscored the potential functional significance of T2D risk genes and SNPs, which may provide unique insights into the disease’s pathophysiology.

Healthful Plant-Based Diet and Incidence of Type 2 Diabetes in Asian Population.

Plant-based diets have been suggested to be beneficial for type 2 diabetes (T2D). However, studies investigating the association between the healthiness of a plant-based diet and T2D risk are limited. This study explored the prospective association between scores from three different plant-based diet indices and risk of T2D and investigated whether associations differ by demographic and lifestyle factors in the Korean population. Data were derived from the Korean Genome and Epidemiology Study (KoGES), a prospective cohort study initiated between 2001 and 2002. Dietary intakes were assessed using a validated food frequency questionnaire. Scores for three plant-based diet indices (overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI)) were measured. A total of 7363 Korean adults aged 40–69 years without T2D and related chronic diseases at baseline were included. Incident T2D was defined as elevated plasma glucose (≥126 mg/dL), self-report of a doctor’s diagnosis of T2D, or use of oral hypoglycemic drug. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for T2D risk. During a follow-up period of 14 years, 977 participants developed T2D. A 10-point higher score in hPDI was associated with a 14% lower risk of T2D (HR: 0.86, 95% CI, 0.77–0.95), adjusting for potential confounders. In subgroup analysis, inverse associations between hPDI and T2D risk were stronger in participants with a family history of T2D (HR: 0.58, 95% CI, 0.44 0.76) or history of hypertension (HR: 0.73, 95% CI, 0.60 0.89) than those without a family history of T2D (p interaction = 0.01) or history of hypertension (p interaction = 0.04). Considering the quality of the plant foods may be important for the prevention of T2D in the Korean population, which habitually consumes diets rich in plant foods.

Do We Need a War on Amputations? A Call to Arms!

In their paper, Riandini et al. use the provocative catchphrase “war on diabetes”, which was introduced by the government of Singapore in 2016 to emphasise the efforts made to improve the increasing prevalence of diabetes in Asian populations.1 At first glance, this colloquial wording may appear rather martial and the academic voice of restraint in all of us would probably advocate an alternative. However, on closer consideration, there are many similarities. Wars have always been incredibly costly and caused thousands of limbs and lives.

Genetic Studies for Diabetes in Asia – The Key to Precision Medicine (Vol. 24, No. 11, Full Issue)

For the month of November 2020, APBN takes a dive into the genetic links behind the diabetes epidemic in Asia. Looking specifically at genetic markers for diabetes in Asian populations, researchers have discovered unique identifiers that could promote development precision medicine for diabetes in the Asia Pacific region. In the Spotlights, we explore innovative research from the 2020 Tokyo Tech Research Showcase and how they are helping to build a greener and sustainable future. Check out in our columns the future of commercial space flight and how space tourism is becoming a reality.

Serum acylcarnitines and amino acids and risk of type 2 diabetes in a multiethnic Asian population.

IntroductionWe evaluated whether concentrations of serum acylcarnitines and amino acids are associated with risk of type 2 diabetes and can improve predictive diabetes models in an Asian population.Research design and methodsWe used data from 3313 male and female participants from the Singapore Prospective Study Program cohort who were diabetes-free at baseline. The average age at baseline was 48.0 years (SD: 11.9 years), and participants were of Chinese, Malay, and Indian ethnicity. Diabetes cases were identified through self-reported physician diagnosis, fasting glucose and glycated hemoglobin concentrations, and linkage to national disease registries. We measured fasting serum concentrations of 45 acylcarnitines and 14 amino acids. The association between metabolites and incident diabetes was modeled using Cox proportional hazards regression with adjustment for age, sex, ethnicity, height, and parental history of diabetes, and correction for multiple testing. Metabolites were added to the Atherosclerosis Risk in Communities (ARIC) predictive diabetes risk model to assess whether they could increase the area under the receiver operating characteristic curve (AUC).ResultsParticipants were followed up for an average of 8.4 years (SD: 2.1 years), during which time 314 developed diabetes. Branched-chain amino acids (HR: 1.477 per SD; 95% CI 1.325 to 1.647) and the alanine to glycine ratio (HR: 1.572; 95% CI 1.426 to 1.733) were most strongly associated with diabetes risk. Additionally, the acylcarnitines C4 and C16-OH, and the amino acids alanine, combined glutamate/glutamine, ornithine, phenylalanine, proline, and tyrosine were significantly associated with higher diabetes risk, and the acylcarnitine C8-DC and amino acids glycine and serine with lower risk. Adding selected metabolites to the ARIC model resulted in a significant increase in AUC from 0.836 to 0.846.ConclusionsWe identified acylcarnitines and amino acids associated with risk of type 2 diabetes in an Asian population. A subset of these modestly improved the prediction of diabetes when added to an established diabetes risk model.

The Effects of Bariatric Surgery on Type 2 Diabetes in Asian Populations: a Meta-analysis of Randomized Controlled Trials.

To evaluate the effects of bariatric surgery on patients with type 2 diabetes through comparing Asian and non-Asian populations according to follow-up time. In this meta-analysis of randomized controlled trials (RCTs), we searched PubMed databases for relevant articles. A meta-analysis was undertaken of 37 eligible RCTs. Diabetes remission rates among Asian populations were similar to those of non-Asian populations at 1 year (95% confidence interval (CI) 0.519 [0.417, 0.619] vs 0.571 [0.316, 0.794], respectively) but were found to be higher in Asian populations at 2 years compared to non-Asian populations (95% CI 0.672 [0.469, 0.826] vs 0.563 [0.220, 0.855], respectively). Asian populations showed greater reductions in HbA1c (- 3.512 [- 2.726, - 4.299], - 3.001 [- 1.433, - 4.569], and - 3.345 [- 2.267, - 4.423]) than non-Asian populations (- 2.129 [- 1.821, - 2.438], - 2.301 [- 1.881, - 2.722], and - 2.107 [- 1.941, - 2.273]) at 1, 2, and 5 years, respectively. Asian populations also showed greater reductions of fasting plasma glucose than non-Asian populations, and these effects were prominent at 3- and 5-year follow-up (Asian populations, - 83.297 [- 73.264, - 93.331]; non-Asian populations, - 54.288 [- 37.409, - 71.166] at 3 years; Asian populations, - 99.014 [- 82.239, - 115.788]; non-Asian populations, - 45.756 [- 21.892, - 69.621] at 5 years). Bariatric surgery is more successful in diabetes remission and glucose outcome improvement in Asian populations with type 2 diabetes than in non-Asian populations, even over long-term follow-up periods. Bariatric surgery can be considered an effective treatment option and may present an appropriate opportunity to improve the prognosis for Asian patients with type 2 diabetes.

Association of erythrocyte n-3 polyunsaturated fatty acids with incident type 2 diabetes in a Chinese population

The association between circulating n-3 polyunsaturated fatty acid (PUFA) biomarkers and incident type 2 diabetes in Asian populations remains unclear. We aimed to examine the association of erythrocyte n-3 PUFA with incident type 2 diabetes in a Chinese population. A total of 2671 participants, aged 40-75y, free of type 2 diabetes at baseline, were included in the present analysis. Incident type 2 diabetes cases (n=213) were ascertained during median follow-up of 5.6 years. Baseline erythrocyte fatty acids were measured by gas chromatography. We used multivariable Cox regression models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of type 2 diabetes across quartiles of erythrocyte n-3 PUFA. After adjustment for potential confounders, HRs (95% CIs) of type 2 diabetes were 0.68 (0.47, 1.00), 0.77 (0.52, 1.15), and 0.63 (0.41, 0.95) in quartiles 2-4 of docosapentaenoic acid (C22:5n-3) (P-trend=0.07), compared with quartile 1; and 1.08 (0.74, 1.60), 1.03 (0.70, 1.51), and 0.57 (0.38, 0.86) for eicosapentaenoic acid (C20:5n-3) (P-trend=0.007). No association was found for docosahexaenoic acid (C22:6n-3) or alpha-linolenic acid (C18:3n-3). Erythrocyte n-3 PUFA from marine sources (C22:5n-3 and C20:5n-3), as biomarkers of dietary marine n-3 PUFA, were inversely associated with incident type 2 diabetes in this Chinese population. Future prospective investigations in other Asian populations are necessary to confirm our findings.

Association Between SLC30A8 Gene rs3802177 Polymorphism and T2DM in Asian Population-a Meta-Analysis

To further confirm the association between SLC30A8 gene rs3802177 polymorphism and T2DM in Asian population, we collect data from multiple relevant papers and performed Meta-analysis. We constructed allele model, dominant model and recessive model by fixed effects model or random effects models which were determined according to the Q value and I2 value calculated by heterogeneity test. OR with 95%CI was selected as evaluation index to discuss the influences of SLC30A8 gene rs3802177 polymorphisms on T2DM. The most reasonable genetic model was determined by comparisons between every two genotypes. According to the inclusion and exclusion criteria, a total of five qualified articles were used for data retrieval, which include 6234 cases and 6169 controls. Significant association were found in all the genetic models (C vs T: OR=1.110, 95%CI 1.053-1.169, P<0.001, CC+CT vs TT: OR=1.124, 95%CI 1.018-1.240, P=0.020, CC vs CT +TT: OR=1.153, 95%CI 1.071-1.241, P<0.001), suggesting that the polymorphism of rs3802177 in SLC30A8 gene is associated with the occurrence of T2DM, and the C allele is a risk gene. The results of genotype comparison showed that the most suitable genetic model was recessive model, in which individuals with CC genotypes were 1.153 times more likely to have T2DM than those with CT and TT genotypes. The results suggested SLC30A8 gene rs3802177 polymorphism is associated with type 2 diabetes in Asian population.

Lifestyle interventions in preventing new type 2 diabetes in Asian populations.

The aim of this study was to review current evidence on interventional studies aimed at the prevention of type 2 diabetes in Asian population with lifestyle interventions. Prevalence of type 2 diabetes sharply increased in most Asian countries during the last decades. This issue has now also relevant implication for Europe where different surveys are also consistently revealing an higher prevalence of type 2 diabetes and other and major CVD risk factors among subjects originating from Asian Countries than in the native population. Nutrition and lifestyle transition seem to play a role in disclosing the predisposition for the development of type 2 diabetes and great interest is now shown toward the possibility to intervene with lifestyle intervention on at risk populations. A meta-analysis of Randomized Controlled Trials showed that lifestyle interventions are highly effective also in the Asian population. All studies were, however, conducted with an individual approach based on the identification of high-risk individuals. When ethnic minority groups have to be addressed, an approach directed to the community rather than to the individual might, however, be more effective. This review reinforces the importance for policy-makers to consider the involvement of the whole community of minority immigrant groups with lifestyle intervention programs.

Effects of intake of fish or fish oils on the development of diabetes.

The association between fish and fish oils intake and diabetes remains largely unknown. Here we systematically reviewed published articles (clinical trials, prospective cohort studies, systematic reviews and meta-analyses) about the effects of intake of fish or fish oils on the development of diabetes. An intake of fish oils seems not to affect insulin sensitivity, insulin secretion, beta-cell function or glucose tolerance. There is a considerable statistical heterogeneity in the overall summary estimates of the association between fish or fish oils consumption and the development of type 2 diabetes, which is partly explained by geographical differences. Marine n-3 polyunsaturated fatty acids have beneficial effects on the prevention of type 2 diabetes in Asian populations.

Methylenetetrahydrofolate reductase A1298C polymorphism and diabetes risk: evidence from a meta-analysis

Aim: The relationship between the methylenetetrahydrofolate reductase (MTHFR) A1298C polymorphism and the susceptibility of diabetes remains inclusive or controversial. For better understanding of the influence of MTHFR A1298C polymorphism on diabetes risk, we performed this meta-analysis. Methods: All related articles were identified through a search of PubMed, Embase, Chinese Biomedical Literature Database (CBM, Chinese), China National Knowledge Infrastructure (CNKI), and Wangfang Database (Chinese). The relationship between the MTHFR A1298C polymorphism and diabetes susceptibility was conducted by odds ratios (ORs) and 95% confidence intervals. Results: Total of six studies with 897 cases and 852 controls were included in our meta-analysis. Overall, the significance associated was found between MTHFR A1298C polymorphism and the susceptibility of diabetes under recessive model (CC vs. AC/AA: OR = 1.70, 95% CI = 1.18–2.45, p = 0.004). On the subgroup analysis according to ethnicity, the results indicated that MTHFR A1298C polymorphism has a significant association with diabetes in Asian population under dominant model (CC/AC vs. AA: OR = 1.31, 95% CI = 1.003–1.72, p = 0.047). However, there was no association found between MTHFR A1298C polymorphism and diabetes susceptibility in Caucasians. Conclusions: The results indicated that the MTHFR A1298C polymorphism is a dangerous factor for diabetes, especially for Asians.

Changing characteristics of the type 2 diabetes epidemic of China and other Asian countries.

Changing characteristics of the type 2 diabetes epidemic of China and other Asian countries.

The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations

BackgroundIdentification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown.MethodsUsing data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model.ResultsThe San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males.ConclusionsWe conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable.

Antihyperglycemic Effects of Fermented and Nonfermented Mung Bean Extracts on Alloxan-Induced-Diabetic Mice

Mung bean was reported as a potential antidiabetic agent while fermented food has been proposed as one of the major contributors that can reduce the risk of diabetes in Asian populations. In this study, we have compared the normoglycemic effect, glucose-induced hyperglycemic effect, and alloxan-induced hyperglycemic effect of fermented and nonfermented mung bean extracts. Our results showed that fermented mung bean extracts did not induce hypoglycemic effect on normal mice but significantly reduced the blood sugar levels of glucose- and alloxan-induced hyperglycemic mice. The serum levels of cholesterol, triglyceride (TG), and low-density lipoprotein (LDL) were also lowered while insulin secretion and antioxidant level as measured by malonaldehyde (MDA) assays were significantly improved in the plasma of the fermented mung bean-treated group in alloxan-induced hyperglycemic mouse. These results indicated that fermentation using Mardi Rhizopus sp. strain 5351 inoculums could enhance the antihyperglycemic and the antioxidant effects of mung bean in alloxan-treated mice. The improvement in the antihyperglycemic effect may also be contributed by the increased content of GABA and the free amino acid that are present in the fermented mung bean extracts.

The experiences of and meaning for women living and coping with type 2 diabetes: a systematic review of qualitative evidence.

Effective management of diabetes not only relies on lifestyle modification and adherence to a treatment regime, but also the ability to cope with the impact of the disease on daily activities. Stress associated with the multi-caregiver role of women may affect the ability to manage the disease effectively. To explore the experience of women living and coping with type 2 diabetes. Adult women aged 18 years and above diagnosed with type 2 diabetes.The meaning of living and coping with type 2 diabetes.Qualitative studies, including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The search strategy used sought only to identify published English research papers from the year 1990 to 2010. A three-step search strategy was undertaken. The retrieved papers were assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data was extracted using the Joanna Briggs Institute Qualitative Assessment and Review data extraction tool. The data were synthesised using the Joanna Briggs Institute approach of meta-synthesis by meta-aggregation. Nine studies were included in the review. Forty-one findings were obtained and then grouped into 11 categories which were then aggregated into four synthesised findings: "Living with type 2 diabetes is emotionally and mentally challenging", "Support (of self, by others, spiritual) provides the ability to cope with diabetes", "Women see their personal responsibility in the management of diabetes and try to maintain their autonomy. Despite this, women place the needs of the family over their own needs thereby resulting in ineffective management" and "Effective management of diabetes is hindered by role duties of women as well as their attitudes and the attitudes of the healthcare providers". Women are challenged by their multi-caregiving roles and the complexities of managing their diabetes simultaneously. Holistic, individual psycho-education programs for female patients with diabetes and carer programs educating families and friends will facilitate more effective and successful management. As supported by the evidence obtained in this review, diabetic education programs should include strategies that facilitate emotional coping. Family members should be encouraged to attend diabetes management programs or workshops designed for caregivers or family members to enable them to support female family members with diabetes effectively. Education programs for doctors should focus on the therapeutic helping relationship and the role this relationship plays in facilitating improved health outcomes for patients. Implementation of action research with interventions that address the key issues identified in this systematic review would be useful. Additionally, further longitudinal studies that link the incidence and severity of complications and quality of life issues associated with diabetes management to such intervention programs will clarify the benefits, modifying factors and barriers. Despite a plethora of literature examining the coping styles and experiences of Caucasian people with diabetes there is a paucity of literature investigating similar issues among Asian populations. Thus further research studies that examine the experience of living and coping with type 2 diabetes in Asian populations are needed to enhance understanding for these patients.

Journal of Diabetes NEWS

Journal of Diabetes NEWS

Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the Asia cohort consortium.

BackgroundThe occurrence of diabetes has greatly increased in low- and middle-income countries, particularly in Asia, as has the prevalence of overweight and obesity; in European-derived populations, overweight and obesity are established causes of diabetes. The shape of the association of overweight and obesity with diabetes risk and its overall impact have not been adequately studied in Asia. Methods and FindingsA pooled cross-sectional analysis was conducted to evaluate the association between baseline body mass index (BMI, measured as weight in kg divided by the square of height in m) and self-reported diabetes status in over 900,000 individuals recruited in 18 cohorts from Bangladesh, China, India, Japan, Korea, Singapore and Taiwan. Logistic regression models were fitted to calculate cohort-specific odds ratios (OR) of diabetes for categories of increasing BMI, after adjustment for potential confounding factors. OR were pooled across cohorts using a random-effects meta-analysis. The sex- and age-adjusted prevalence of diabetes was 4.3% in the overall population, ranging from 0.5% to 8.2% across participating cohorts. Using the category 22.5–24.9 Kg/m2 as reference, the OR for diabetes spanned from 0.58 (95% confidence interval [CI] 0.31, 0.76) for BMI lower than 15.0 kg/m2 to 2.23 (95% CI 1.86, 2.67) for BMI higher than 34.9 kg/m2. The positive association between BMI and diabetes prevalence was present in all cohorts and in all subgroups of the study population, although the association was stronger in individuals below age 50 at baseline (p-value of interaction<0.001), in cohorts from India and Bangladesh (p<0.001), in individuals with low education (p-value 0.02), and in smokers (p-value 0.03); no differences were observed by gender, urban residence, or alcohol drinking.ConclusionsThis study estimated the shape and the strength of the association between BMI and prevalence of diabetes in Asian populations and identified patterns of the association by age, country, and other risk factors for diabetes.

Adrenergic India: Managing its diabetes

India is an adrenergic nation. No one can doubt this statement. While maintaining its ancient traditions, India is modernizing at a rapid rate. In every sector, ranging from agriculture to manufacturing to services, including health care, signs of progress are visible. Health care indicators for the country convey the story of progress. Life expectancy of an average Indian has increased from 32–33 years for both genders, in 1947, to 65.77 years and, in 2011, to 67.95 years, respectively.[1,2] The weight of the Reference Indian Man has been increased by the Indian Council for Medical Research, from 55 to 60 kg. Similarly, the Reference Indian Woman has grown heavier by 10 kg, and weighs 55 kg in 2010.[3] Yet, the progress and modernity of India have come at a cost. In parallel with the socioeconomic changes that we observe, changes in morbidity patterns have been noted. While acute illnesses, such as smallpox, leprosy, polio, and guineaworm have been controlled, chronic and metabolic diseases have become more frequent. The prevalence of diabetes has risen markedly in India. While data from earlier decades reveals a low prevalence of type 2 diabetes in India, recent workers have reported extremely high rates of diabetes, especially in urban centers.[4,5] The reasons for this rise in diabetes are not difficult to find. India has become a fast-paced society, moving toward modernization and urbanization. While achieving this laudable goal, changes in dietary intake and physical activity patterns have also occurred. In India the change is more obvious among urban residents, who consume 32% of energy from fat as compared with 17% in rural residents.[6] In the past decade, motor vehicle ownership has increased by 11% annually.[7] These factors, along with increased stress, have contributed to the increase in prevalence of diabetes. Psychosocial stress, depression, and short sleeping hours, which have become increasingly common in developing countries undergoing rapid economic developments, have been associated with higher risk of the metabolic syndrome and diabetes in Asian populations.[8] The effect of stress on the endocrine system, including glucose metabolism, is well known. While acute stress may be beneficial in some cases, chronic or sustained stress may cause insulin resistance and hyperglycemia.[9] Stress, therefore, should be a focus of attention while managing diabetes. Although the Ominous Octet theory of de Fronzo[10] includes various traditional and novel pathophysiologic mechanisms of diabetes, stress seems to have been forgotten. The role of dopamine as the forgotten felon of diabetes has been highlighted earlier.[11] Nowhere is this more appropriate than in a transitional society, such as that of modern India. Within the central nervous system, dopamine is the most prevalent catecholamine.[12] Tonic stimulation of dopamine is a physiological mechanism for animals to survive the stress of migration or wintering. Sustained or tonic stimulation of the dopaminergic system, on the other hand, is harmful, and may lead to insulin resistance and hyperglycemia. In modern India, we seem to be living in a highly charged, or sustained hyperdopaminergic state.[13] While this hyperadrenergic or hypercatecholaminergic state is helpful in achieving progress, it does have its demerits. One of them may be the Indian epidemic of diabetes mellitus. In such a situation, the availability of a dopamine modulating antidiabetic drug, with proven efficacy and cardiovascular safety is a welcome development. Timed release bromocriptine is a novel preparation of a time-tested drug, approved by the USFDA, in 2009, for the therapy of type 2 diabetes mellitus.[11] This is the first drug to be approved by the organization after it laid down stringent requirements for demonstration of cardiovascular safety of antidiabetic drugs. Bromocriptine is prescribed once daily, early morning, in an initial dose of 0.8 mg/day, as monotherapy, or in combination with other oral drugs. Clinical utility should be maximal in obese, depressed (anhedonic) patients with limited mobility and features of insulin resistance for the therapy of type 2 diabetes mellitus.[12,13] A detailed review by Shivaprasad et al., in this issue of IJEM,[14] describes the basic and clinical pharmacology of bromocriptine. An original article contributed by Ramteke et al., in this issue, provides evidence of the benefit of this molecule in a clinical trial setting in India.[15] A large multicentric postmarketing study is underway to assess the efficacy, safety, and tolerability of bromocriptine in Indian patients. Data from this study, and from clinical experience, will provide useful information about the utility of this promising molecule.