Diabetes In South Asians Research Articles

Association of pro-inflammatory cytokines, adipokines and hepatokine with incident diabetes in India: a nested case-control study within CARRS cohort.

To study the association of pro-inflammatory markers with incident diabetes in India. We did a nested case-control study within the CARRS (Centre for ArdiometabolicRiskReduction inSouth Asia) cohort. Of the 5739 diabetes-free individuals at the baseline, 216 participants with incident diabetes and 432 age-, gender- and city-matched controls at 2-year follow-up were included. We measured high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 ( MCP-1), adiponectin, leptin and fetuin-A in the stored baseline blood samples. We did multivariate conditional logistic regression to estimate association of inflammatory markers (as quartiles) and incident diabetes. Covariates were baseline fasting plasma glucose (FPG) and lipids, body mass index (BMI), family history of diabetes, smoking and alcohol use. Baseline hsCRP and TNF-α were higher, and IL-6 and adiponectin were lower among cases vs. controls. In multivariate conditional logistic regression models, only quartile-3 (odds ratio [OR]: 2.96 [95% CI:1.39, 6.30]) and quartile-4 (OR: 2.58 [95% CI:1.15, 5.79]) of TNF-α and quartile-4 of MCP-1 (OR: 2.55 [95% CI:1.06, 6.16]) were positively associated with diabetes after adjusting for baseline FPG and BMI. These associations did not remain after adjusting for family history. High level (quartile-4) of IL-6 was negatively associated with diabetes after adjusting for all factors (OR: 0.18 [95% CI:0.06, 0.55]). Higher TNF-α and MCP-1 levels and lower IL-6 were associated with higher risk of developing diabetes. Better understanding and potential methods of addressing these biomarkers, especially in relation to family history, are needed to address diabetes in South Asians.

Adipose tissue-derived metabolite risk scores and risk for type 2 diabetes in South Asians

BackgroundSouth Asians are at higher risk for type 2 diabetes (T2D) than many other race/ethnic groups. Ectopic adiposity, specifically hepatic steatosis and visceral fat may partially explain this. Our objective was to derive metabolite risk scores for ectopic adiposity and assess associations with incident T2D in South Asians.MethodsWe examined 550 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort study aged 40–84 years without known cardiovascular disease or T2D and with metabolomic data. Computed tomography scans at baseline assessed hepatic attenuation and visceral fat area, and fasting serum specimens at baseline and after 5 years assessed T2D. LC-MS-based untargeted metabolomic analysis was performed followed by targeted integration and reporting of known signals. Elastic net regularized linear regression analyses was used to derive risk scores for hepatic steatosis and visceral fat using weighted coefficients. Logistic regression models associated metabolite risk score and incident T2D, adjusting for age, gender, study site, BMI, physical activity, diet quality, energy intake and use of cholesterol-lowering medication.ResultsAverage age of participants was 55 years, 36% women with an average body mass index (BMI) of 25 kg/m2 and 6% prevalence of hepatic steatosis, with 47 cases of incident T2D at 5 years. There were 445 metabolites of known identity. Of these, 313 metabolites were included in the MET-Visc score and 267 in the MET-Liver score. In most fully adjusted models, MET-Liver (OR 2.04 [95% CI 1.38, 3.03]) and MET-Visc (OR 2.80 [1.75, 4.46]) were associated with higher odds of T2D. These associations remained significant after adjustment for measured adiposity.ConclusionsMetabolite risk scores for intrahepatic fat and visceral fat were strongly related to incident T2D independent of measured adiposity. Use of these biomarkers to target risk stratification may help capture pre-clinical metabolic abnormalities.

Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US

Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.

Cost-effectiveness of a multicomponent quality improvement care model for diabetes in South Asia: The CARRS randomized clinical trial.

To assess the cost-effectiveness of a multicomponent strategy versus usual care in people with type 2 diabetes in South Asia. Economic evaluation from healthcare system and societal perspectives. Ten diverse urban clinics in India and Pakistan. 1146 people with type 2 diabetes (575 in the intervention group and 571 in the usual care group) with mean age of 54.2 years, median diabetes duration: 7 years and mean HbA1c: 9.9% (85 mmol/mol) at baseline. Multicomponent strategy comprising decision-supported electronic health records and non-physician care coordinator. Control group received usual care. Incremental cost-effectiveness ratios (ICERs) per unit achievement in multiple risk factor control (HbA1c <7% (53 mmol/mol) and SBP <130/80 mmHg or LDLc <2.58 mmol/L (100 mg/dL)), ICERs per unit reduction in HbA1c, 5-mmHg unit reductions in systolic BP, 10-unit reductions in LDLc (mg/dl) (considered as clinically relevant) and ICER per quality-adjusted life years (QALYs) gained. ICERs were reported in 2020 purchasing power parity-adjusted international dollars (INT$). The probability of ICERs being cost-effective was considered depending on the willingness to pay (WTP) values as a share of GDP per capita for India (Int$ 7041.4) and Pakistan (Int$ 4847.6). Compared to usual care, the annual incremental costs per person for intervention group were Int$ 1061.9 from a health system perspective and Int$ 1093.6 from a societal perspective. The ICER was Int$ 10,874.6 per increase in multiple risk factor control, $2588.1 per one percentage point reduction in the HbA1c, and $1744.6 per 5 unit reduction in SBP (mmHg), and $1271 per 10 unit reduction in LDLc (mg/dl). The ICER per QALY gained was $33,399.6 from a societal perspective. In a trial setting in South Asia, a multicomponent strategy for diabetes care resulted in better multiple risk factor control at higher costs and may be cost-effective depending on the willingness to pay threshold with substantial uncertainty around cost-effectiveness for QALYs gained in the short term (2.5 years). Future research needs to confirm the long-term cost-effectiveness of intensive multifactorial intervention for diabetes care in diverse healthcare settings in LMICs.

Dietary weight-management for type 2 diabetes remissions in South Asians: the South Asian diabetes remission randomised trial for proof-of-concept and feasibility (STANDby)

We aimed to assess whether a structured weight management programme incorporating a total diet replacement (TDR) (3-5 months ∼850kcal/day formula diet) weight loss phase is acceptable to people of South Asian ethnicity and can achieve type 2 diabetes (T2D) remissions similarly to other populations. Adults of South Asian ethnicity, aged 18-65 years, with T2D for ≤4 years, and BMI 25-45kg/m2 were recruited from primary care and social media, and randomised to commence TDR either immediately (iTDR), or delayed (dTDR) for 3-5 months as a usual care control arm during this period. Intervention effects were tested in randomised comparisons powered to detect significant weight loss, and in an expanded observational analysis to determine remission effect size, including both iTDR and dTDR groups. Acceptability in those recruited was explored by questionnaire and weight change. Current Controlled Trials, ISRCTN10720065. Date of Registration 27/09/2017. Twenty-five eligible individuals were recruited. Mean baseline (SD) age was 45.8 (11.1) years, weight 88.2 (13.7) kg, BMI 32.1 (3.8) kg/m2, HbA1c 60.4 (11.3) mmol/mol, liver fat by MRI 15.6 (9.4)%. In the RCT, mean(SD) weight change after TDR was-7.7 (7.2)% in the intervention group (n=13), and-1.2 (1.4)% in the usual-care control group (n=12) (p=0.005), with T2D remission achieved by 5/13, compared to 0/12 respectively (p=0.039). In the observational study, 23/25 started TDR and 19/23 participants completed the TDR phase. Median time spent in TDR was 105 days (IQR 77-134 days). T2D remission was achieved in 10/23 (43%), and weight changes were concordant with the RCT. Overall, 8/23 (35%) lost over 10% bodyweight. Absolute liver fat proportion near halved from 15.3% at the start of TDR to 8.6% (p<0.001). In UK-based South Asians, TDR-led weight loss and T2D remission rates are comparable to those observed in white cohorts, and the intervention was acceptable in most of those recruited. There is potential to further improve outcomes, but one-third lost >10% body weight, and the mechanism underpinning T2D remission appears similar, driven by weight change with loss of excess ectopic body-fat. We gratefully acknowledge funding for the MRI scans from the, Miss MJM Smith Trust (registered charity: SC040586). No other external funds were provided for this trial. NS is supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217).

Oral Health Knowledge, Attitudes and Practices of People Living with Diabetes in South Asia: A Scoping Review.

Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review's aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes.

Macronutrient Recommendations for Remission and Prevention of Diabetes in Asian Indians Based on a Data-Driven Optimization Model: The ICMR-INDIAB National Study.

To derive macronutrient recommendations for remission and prevention of type 2 diabetes (T2D) in Asian Indians using a data-driven optimization approach. Dietary, behavioral, and demographic assessments were performed on 18,090 adults participating in the nationally representative, population-based Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Fasting and 2-h postglucose challenge capillary blood glucose and glycosylated hemoglobin (HbA1c) were estimated. With HbA1c as the outcome, a linear regression model was first obtained for various glycemic categories: newly diagnosed diabetes (NDD), prediabetes (PD), and normal glucose tolerance (NGT). Macronutrient recommendations were formulated as a constrained quadratic programming problem (QPP) to compute optimal macronutrient compositions that would reduce the sum of the difference between the estimated HbA1c from the linear regression model and the targets for remission (6.4% for NDD and 5.6% for PD) and prevention of progression in T2D in PD and NGT groups. Four macronutrient recommendations (%E- Energy) emerged for 1) diabetes remission in NDD: carbohydrate, 49-54%; protein, 19-20%; and fat, 21-26%; 2) PD remission to NGT: carbohydrate, 50-56%; protein,18-20%; fat, 21-27%; 3 and 4) prevention of progression to T2D in PD and NGT: carbohydrate, 54-57% and 56-60%; protein, 16-20% and 14-17%, respectively; and fat 20-24% for PD and NGT. We recommend reduction in carbohydrates (%E) and an increase in protein (%E) for both T2D remission and for prevention of progression to T2D in PD and NGT groups. Our results underline the need for new dietary guidelines that recommend appropriate changes in macronutrient composition for reducing the burden due to diabetes in South Asia.

1193-P: Natural History of Type 2 Diabetes in South Asians: Arrow of Time

Background: People of South Asian ancestry are at high risk for type 2 diabetes, but the time to disease progression in this population is not fully understood. Methods: We analyzed data from 2714 adults aged ≥20 years, enrolled in the Chennai site of the prospective Cardiometabolic risk reduction in South Asia (CARRS) study. Participants had 75g OGTT and HbA1c measurements. We defined normal glucose tolerance (NGT) , isolated impaired fasting glucose (iIFG) , impaired glucose tolerance (IGT) , and diabetes based on ADA criteria. We constructed continuous chain Markov models to estimate the transition through multiple states (NGT -&amp;gt; iIFG -&amp;gt; diabetes; NGT -&amp;gt; IGT -&amp;gt; diabetes) . The annual and five-year transition probability among states was estimated based on transition intensity. Results: Participants were, on average, 38.4 (range 20-89) years old, and 40.1% were male. Prevalence of iIFG and IGT was 16.9% and 7.3%, respectively. Over 5 years of follow up, the progression rates were: NGT to iIFG, 36.3 (95% CI: 32.5, 40.5) per 1,000 person-years (PYR) , NGT to IGT, 27.4 (95% CI: 24.1, 31.1) per 1,000 PYR, iIFG to diabetes 47.3 (95% CI: 40.4, 55.4) per 1,000 PYR, and IGT to diabetes 77.1 (95% CI: 65.1, 91.3) per 1,000 PYR. The estimated annual probability of remaining as NGT, iIFG, and IGT were 95.2% (94.7%, 95.8%) , 87.3% (85.5%, 89.0%) ;%) , and 81.9% (79.6%, 84.3%) %) , respectively. Assuming unidirectional transition, the annual probability of conversion from NGT to iIFG, and iIFG to diabetes were 4.5% (3.9%, 4.9%) , and 12.7% (10.9%, 14.5%) , respectively; and NGT to IGT, and IGT to diabetes were 3.8% (3.3%, 4.2%) and 18.1% (15.7%, 20.3%) . The estimated mean sojourn time (years) in each state were: NGT 20.5 (18.2, 23.2) , iIFG 7.4 (6.4, 8.6) , and IGT 5.0 (4.4, 5.8) , respectively. Conclusion: The course to diabetes in South Asians is rapid once prediabetes sets in, allowing a window of only 5-7.4 years to implement proven prevention. Innovative prevention efforts in normoglycemic people may be needed to prevent prediabetes in the first place. Disclosure K.Narayan: n/a. H.H.Chang: None. N.Tandon: None. V.Mohan: None. D.Kondal: None. L.R.Staimez: None. R.Anjana: None. U.Gujral: None. M.Deepa: None. S.A.Patel: Research Support; Johnson &amp; Johnson. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck &amp; Co., Inc. D.Prabhakaran: None. Funding The National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health (HHSN268200900026C)

1194-P: Gender Differences in Incidence of Prediabetes and Diabetes in South Asians

Background: Among South Asians, women have higher prevalence of diabetes than men, but few studies have examined gender differences in incidence. Methods: We analyzed data from 2714 adults aged ≥20 years, enrolled in the Chennai site of prospective Cardiometabolic risk reduction in South Asia (CARRS) study. We defined normal glucose tolerance (NGT) , isolated impaired fasting glucose (iIFG) , impaired glucose tolerance (IGT) , and diabetes based on ADA criteria. We estimated incidence densities for: NGT (n=2205) to iIFG and iIFG (n=641) to diabetes; NGT (n=2205) to IGT; and IGT (n=341) to diabetes. Results: Prevalence of iIFG was higher in women (20.5% vs. 11.8%) , while prevalence of IGT was lower (6.6% vs. 8.5%) than in men. During median 2.6 y (IQR: 0.7, 5.8) of follow-up, 316 individuals progressed from NGT to iIFG, 239 from NGT to IGT, 155 from iIFG to diabetes, and 135 from IGT to diabetes. Overall, incidence (95% CI) of NGT to iIFG was higher than incidence of NGT to IGT (36.3 [32.5, 40.5] vs. 27.4 [24.1, 31.1] per 1,000 person-years [PYR], respectively) . However, the incidence of iIFG to diabetes was lower than incidence of IGT to diabetes (47.3 [40.4, 55.4] vs. 77.1 [65.1, 91.3] per 1,000 PYR, respectively) . Compared with men, women had higher conversion from NGT to iIFG (42.1 [36.9, 48] vs. 27.7 [22.7, 33.8]) , but lower incidence of NGT to IGT, 22.9 (19.2, 27.4) vs. 34.2 (28.5, 40.9) . Women had higher conversation both from iIFG to diabetes [49.0 (40.8,58.8) vs. 43.1 (31.6,58.7) ] and IGT to diabetes (87.7 [70.5,109.0] vs. 65.3 [50.0,85.2]) . In Cox models adjusting for age, BMI and family history of diabetes, women were 1.41 times (95% CI: 1.07,1.84) likely to convert from NGT to iIFG compared to men, but, men are 1.76 (1.33, 2.34) times at risk from NGT to IGT. There was no gender difference for conversion from iIFG or IGT to diabetes. Conclusion: Prevalence and incidence of iIFG is higher in South Asian women than men, while prevalence and incidence of IGT is higher in men. Conversion from iIFG or IGT to diabetes is similar among genders. Disclosure K.Narayan: n/a. H.H.Chang: None. N.Tandon: None. V.Mohan: None. D.Kondal: None. L.R.Staimez: None. R.Anjana: None. U.Gujral: None. M.Deepa: None. S.A.Patel: Research Support; Johnson &amp; Johnson. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck &amp; Co., Inc. D.Prabhakaran: None. Funding The National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health (HHSN268200900026C)

The role of cardiovascular risk assessment in addressing prevention of cardiovascular disease and cardiovascular complications of diabetes in South Asia

In the face of the rising incidence of cardiovascular diseases (CVD) and diabetes in low-income and middle-income countries in South Asia, the most cost-effective and equitable strategies for prevention of heart attacks, strokes and vascular complications of diabetes need to be incorporated into primary care services. Health system and resource limitations in these countries call for directing preventive services and pharmacological treatment to people with high cardiovascular risk, identified by risk stratification using hypertension and diabetes as entry points. Absolute cardiovascular risk prediction scores should be used routinely in primary care. Individual management guidelines for hypertension, dyslipidemia and diabetes need to be replaced by integrated and simplified cardiovascular risk management guidelines.

Type 2 diabetes in South Asians compared to Europeans: Higher risk and earlier development of major cardiovascular events irrespective of the presence and degree of retinopathy. Results from The HinDu The Hague Diabetes Study.

IntroductionSouth Asians with diabetes have more severe diabetic retinopathy (DR) and cardiovascular complications than white Caucasians. However, how big this gap is and the relation with the severity of DR has not been studied. Here, we quantify the difference in time from diabetes diagnosis until a first non‐fatal Major Adverse Cardiovascular Event (TUF MACE) in different DR groups in South Asians and Europeans.Methods3831 adults with type 2 diabetes, 1358 South Asians and 2473 Europeans, treated in our diabetes clinic between 2006 and 2017 were included. Data on risk factors, diabetes duration, age of diagnosis and diabetes complications were collected from the diabetes‐specific database and analysed using descriptive statistics and Cox regression. DR was graded in 3 categories, and non‐fatal MACE was pre‐specified.ResultsPrevalence of non‐fatal MACE was the same when DR was absent, increased with increasing severity of DR in both ethnic groups, but was more frequent in South Asians with DR (mild: 50 vs. 42% and severe 62 vs. 46%. Classic risk factors only differed in relation to smoking habits, which were significantly lower in South Asians.After correction for classic risk factors and age at diabetes diagnosis TUF MACE was significantly shorter in South Asians, an effect also seen in the no‐DR group (4.1 yrs. HR 1.5, 95% CI 1.3–1.8 and 7.4 yrs. earlier, HR 2.0, 95% CI 1.6–2.6 for no‐DR and severe DR, respectively).ConclusionsWhen adjusted for age at diabetes diagnosis, we show that time until first non‐fatal MACE in South Asians is significantly shorter compared to Europeans and increases from no‐ to severe DR.

Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites

IntroductionWe compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and...

Moderate-to-vigorous physical activity changes in a diabetes prevention intervention randomized trial among South Asians with prediabetes – The D-CLIP trial

AimsThe Diabetes Community Lifestyle Improvement Program (D-CLIP) was a lifestyle education program to prevent diabetes in South Asians with prediabetes. This paper examines the impact of the D-CLIP intervention on moderate-to-vigorous intensity physical activity (MVPA). MethodsThis randomized controlled trial to prevent diabetes included 573 individuals with prediabetes from Chennai, India. The intervention was designed to increase MVPA to ≥150 minutes per week. MVPA was measured by questionnaire at baseline, six, 12, 18, 24, 30 and 36 months of follow-up. Random effects models were used to examine the relationship between treatment group and odds of reporting ≥150 weekly minutes of MVPA and to examine the impact of the intervention on weekly MVPA. ResultsWith the exception of the proportion of respondents at baseline with a high waist circumference, selected sample characteristics did not differ at baseline between the intervention and control groups. The intervention significantly (p < 0.05) increased the proportion of respondents who reported ≥150 weekly minutes of MVPA by 28.5%, 13.6% and 14.0% at six, 12 and 18 months respectively. Mean minutes of weekly MVPA significantly (p < 0.05) increased by an additional 56.7, 34.3, 23.6 and 24.3 minutes/week at six, 12, 18, and 24 months, respectively. ConclusionThe D-CLIP intervention significantly increased MVPA at six, 12 and 18 months of follow-up. Interventions to prevent diabetes in South Asians with prediabetes can significantly increase MVPA in this population.

Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review.

Ethnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.

Culture and epidemiology of diabetes in South Asia.

Culture and epidemiology of diabetes in South Asia.

DDT linked to type 2 diabetes risk

People who have immigrated to the US from South Asia have a high risk of developing type 2 diabetes compared with the rest of the population, and public health researchers have been searching for an explanation. Initial results from a study of immigrants from India living in the San Francisco Bay Area suggest a provocative one: exposure to the pesticide DDT (Environ. Sci. Technol. 2019, DOI: 10.1021/acs.est.9b03373). Type 2 diabetes in South Asia and in the South Asian diaspora is a large and growing problem. An estimated 80 million people in India have the disease. South Asians are a rapidly growing immigrant group in the US, and 23% of them have type 2 diabetes. “This high risk of diabetes in South Asian immigrants is not explained by obesity,” a condition commonly associated with diabetes, says Michele La Merrill, an environmental toxicologist at the University of California, Davis. “People have been

Effect of a multicomponent intervention on achievement and improvements in quality-of-care indices among people with Type 2 diabetes in South Asia: the CARRS trial.

To evaluate whether and what combinations of diabetes quality metrics were achieved in a multicentre trial in South Asia evaluating a multicomponent quality improvement intervention that included non-physician care coordinators to promote adherence and clinical decision-support software to enhance physician practices, in comparision with usual care. Using data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) trial, we evaluated the proportions of trial participants achieving specific and combinations of five diabetes care targets (HbA1c <53 mmol/mol [7%], blood pressure <130/80 mmHg, LDL cholesterol <2.6 mmol/L, non-smoking status, and aspirin use). Additionally, we examined the proportions of participants achieving the following risk factor improvements from baseline: ≥11-mmol/mol (1%) reduction in HbA1c , ≥10-mmHg reduction in systolic blood pressure, and/or ≥0.26-mmol/l reduction in LDL cholesterol. Baseline characteristics were similar in the intervention and usual care arms. Overall, 12.3%, 29.4%, 36.5%, 19.5% and 2.2% of participants in the intervention group and 16.2%, 38.3%, 31.6%, 11.3% and 0.8% of participants in the usual care group achieved any one, two, three, four or five targets, respectively. We noted sizeable improvements in HbA1c , blood pressure and cholesterol, and found that participants in the intervention group were twice as likely to achieve improvements in all three indices at 12 months that were sustained over 28 months of the study [relative risk 2.1 (95% CI 1.5,2.8) and 1.8 (95% CI 1.5,2.3), respectively]. The intervention was associated with significantly higher achievement of and greater improvements in composite diabetes quality care goals. However, among these higher-risk participants, very small proportions achieved the complete group of targets, which suggests that achievement of multiple quality-of-care goals is challenging and that other methods may be needed in closing care gaps.

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials.

Individuals of South Asian origin have a high risk of type 2 diabetes and of dying from a diabetes-attributable cause. Lifestyle modification intervention trials to prevent type 2 diabetes in high-risk South Asian adults have suggested more modest effects than in European-origin populations. The strength of the evidence of individual studies is limited, however. We performed an individual participant data meta-analysis of available RCTs to assess the effectiveness of lifestyle modification in South Asian populations worldwide. We searched PubMed, EMBASE, Cochrane Library and Web of Science (to 24 September 2018) for RCTs on lifestyle modification interventions incorporating diet and/or physical activity in South Asian adults. Reviewers identified eligible studies and assessed the quality of the evidence. We obtained individual participant data on 1816 participants from all six eligible trials (four from Europe and two from India). We generated HR estimates for incident diabetes (primary outcome) and mean differences for fasting glucose, 2h glucose, weight and waist circumference (secondary outcomes) using mixed-effect meta-analysis overall and by pre-specified subgroups. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence of the estimates. The study is registered with the International Prospective Register of Systematic Reviews ([PROSPERO] CRD42017078003). Incident diabetes was observed in 12.6% of participants in the intervention groups and in 20.0% of participants in the control groups. The pooled HR for diabetes incidence was 0.65 (95% CI 0.51, 0.81; I2= 0%) in intervention compared with control groups. The absolute risk reduction was 7.4% (95% CI 4.0, 10.2), with no interactions for the pre-specified subgroups (sex, BMI, age, study duration and region where studies were performed). The quality of evidence was rated as moderate. Mean difference for lifestyle modification vs control groups for 2h glucose was -0.34mmol/l (95% CI -0.62, -0.07; I2= 50%); for weight -0.75kg (95% CI -1.34, -0.17; I2= 71%) and for waist -1.16cm (95% CI -2.16, -0.16; I2= 75%). No effect was found for fasting glucose. Findings were similar across subgroups, except for weight for European vs Indian studies (-1.10kg vs -0.08kg, p = 0.02 for interaction). Despite modest changes for adiposity, lifestyle modification interventions in high-risk South Asian populations resulted in a clinically important 35% relative reduction in diabetes incidence, consistent across subgroups. If implemented on a large scale, lifestyle modification interventions in high-risk South Asian populations in Europe would reduce the incidence of diabetes in these populations.

2274-PUB: Glycemic Index and Response of Plant-Based Nutritional Supplement and Its Subjective Satiety in Indian Adults

Background: The major nutritional challenges faced by individuals with diabetes in South Asia is adhering to dietary advocacy and providing optimal nutrition with adequate protein and dietary fibre as they usually consume very high carbohydrate diet. This is particularly a concern in vegetarians. Aim: The objective of the study was to assess the Glycemic Index (GI) and Glycemic Response (GR) of two different flavors of a plant based nutritional supplement specially designed with high protein and fibre. The subjective satiety was also assessed. Methods: In all, fifteen overweight/obese subjects aged 18-45 years were recruited. After overnight fasting, blood samples were drawn at -5 and 0 minutes. Test and reference food providing available carbohydrates of 25g each was consumed by the participants. The capillary blood samples were drawn at 15, 30, 45, 60, 90 and 120 minutes. Participants underwent 3 days of reference food testing and 1 day of test food test in random order with 2 days of wash out period. The GI was assessed using validated ISO, 2010 protocol. Satiety index was measured using Visual Analog Scale (VAS). The dietary intake of the subjects for previous day and the test day was measured by 24-hour dietary recall. The Incremental Area Under the Curve (IAUC) was calculated using the trapezoid rule. The study was registered in the clinical trial registry of India, CTRI/2018/04/012979. Results: The GI and GR of both flavors of the supplement was categorized as low GI. The GI and GR of Flavor 1 was 27.3±4.8 and 16.4 ±2.6 (Mean ± SEM) respectively. For Flavor 2 the GI and GR was 36.7±4.4 and 25.7 ± 2.3 (Mean ± SEM). For Flavor 1, 60% of participants reported feeling hungry only after 3 hours, showing good satiety. Conclusion: The plant based high fibre high protein supplement, along with regular meal could help in reducing the postprandial glycemic response and improve satiety. Disclosure V. Mohan: None. V. Parthasarthy: None. R. Jeevan: None. G. Viswanathan: None. K. Vasudevan: None. G. Nagamuthu: None. G. Rajagopal: None. P. Karthikeyan: None. S. Shanmugam: None. R. Anjana: None. R. Unnikrishnan: None. S. Vasudevan: None. A. Toppo: Employee; Self; Dr. Reddys Laboratories. S. Mehta: Employee; Self; Dr. Reddys Laboratories. S.A. Acharya: Employee; Self; Dr. Reddys Laboratories. R.M. Bhoite: Employee; Self; Dr. Reddys Laboratories.

Economic Impact of Diabetes in South Asia: the Magnitude of the Problem.

To critically assess and identify gaps in the current literature on the economic impact of diabetes in South Asia. The total annual (direct medical and non-medical and indirect) costs for diabetes care in South Asia range from $483-$2637 per patient, and on an average 5.8% of patients with diabetes suffer catastrophic spending i.e. when households reduce basic expenditure by 40% to cope with healthcare costs. The mean direct costs per patient are positively associated with a country's gross domestic product (GDP) per capita, although there is wide heterogeneity across South Asian countries. With an estimated 84 million people suffering from diabetes in South Asia, diabetes imposes a substantial economic burden on individuals, families, and society. Since the disease burden increasingly occurs in the most productive midlife period, it adversely affects workforce productivity and macroeconomic development. Diabetes-related complications lead to markedly higher treatment costs, causing catastrophic medical spending for many households, thus underscoring the importance of preventing diabetes-related complications.