Factor In Development Of Diabetes Research Articles

IDF21-0644 Hypertension during pregnancy is a risk factor for developing Hyperglycemia – Results of national screening in Bulgaria

Background: In our cross-sectional multicenter population-based study in the Bulgarian population (2012) - 2032 people, men / women (20-80 years) the comparison of the strength of the risk factors on diabetes (obesity, hypertension, dyslipidemia) showed that the most powerful risk factor for development of Diabetes is Hypertension – OR-4.585, 95 % CI: 3.002-7.003, p<0.001. Aim: The aim is to study in the Bulgarian population of pregnant women the relationship between Hyperglycemia during pregnancy and Hypertension (AH) before and during pregnancy. Method: In 547 pregnant women, with a mean age of 30.49±5.127 years, a cross-sectional multicenter population-based study was conducted in 84 settlements in Bulgaria. A questionnaire was completed, blood pressure was measured (Guideline of ESC/ESH, 2018); A two-hour, 75 g oral glucose tolerance test (oGTT) was performed. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: The incidence of Hyperglycemia for the whole group of pregnant women was 14.4% (79/547). Of all pregnant women screened, 2.4% (13/547) developed AH during the current pregnancy. Hyperglycemia was found in 38.5% (5/13) of women with AH versus 13.9% (74/534) of women without AH, p<0.028. There was a significant correlation between Hyperglycemia and AH during the current pregnancy (p<0.01). Discussion: AH during pregnancy is an additional risk factor for developing Hyperglycemia. The proven significant correlation between Hyperglycemia and AH during pregnancy requires oGTT to be recommended during the initial screening of pregnant women to demonstrate any pre-existing glucose tolerance disorders.

Knowledge, Attitude and Practice of Diabetes among School Teachers in Upper Siang District of Arunachal Pradesh: A Cross-sectional Study

Introduction: Diabetes is a global problem and expected to affect around 300 million adults all over the world and around 57 million in India by year 2025. Studies indicate that the awareness of diabetes among general population in Arunachal Pradesh is low. School teachers form the backbone of a society and are entrusted with the work of spreading knowledge and awareness among children and youths on many topics including health. School teachers also act as community leaders and shape the public perception. Aim: To assess the Knowledge, Attitude and Practice (KAP) of diabetes among school teachers in Upper Siang district of Arunachal Pradesh, India. Materials and Methods: The present cross-sectional study was carried out in all the five High and Higher Secondary schools in headquarter region of Upper Siang district of Arunachal Pradesh, India. Data was collected from February to May 2018. In each school, 22 randomly selected teachers from staff register were interviewed regarding KAP of diabetes using predesigned questionnaire.Data was descriptively analysed in form of frequencies and percentages and presented in form of tables. Results: A total of 110 school teachers were interviewed. Majority 108 (98.18%) had knowledge about condition called diabetes. About 96 (87.27%) thought more and more people are getting affected from diabetes. However, only 4 (3.63%) of the respondents had knowledge that diabetes can impact younger people also. According to the responses, renal 63 (57.27%) and ocular 46 (41.82%) involvement were the two most common organs involved in diabetes. Almost half of the respondents felt that family history of diabetes, 54 (49.09%) was the most important risk factor for development of diabetes. Almost onethird, 34 (30.91%) of the respondents did not feel eating healthy and regular blood sugar 103 (93.64%) checking is important in diabetes. About 44 (40%) responding negative to the practice of morning walk for diabetes control. Conclusion: Among school teachers in Arunachal Pradesh majority had a knowledge about diabetes as an entity but there was a significant lacuna in attitude and practices towards diabetes which needs to be inculcated as a means for better education for the teachers and transition of knowledge to students.

TCF7L2 gene polymorphism as a risk for type 2 diabetes mellitus and diabetic microvascular complications

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic condition with various genetics and environmental influences that affects the capacity of the body to produce or use insulin resulting in hyperglycemia, whichmayleadtovariablecomplications. It is one of the world'srisinghealth problems. Thereisemerging evidence that some genetic polymorphisms can impact the risk of evolving T2DM. Wetrytodeterminetherelationship of (rs7903146) variant of the Transcription factor 7-like 2 (TCF7L2) gene with T2DM and its microvascular complications. This case-control study included 180 subjects: 60 diabetic patients without complications, 60 diabetic patients with microvascular complications and 60 matched healthy controls. Genotypes of rs7903146 (C/T) SNP in the TCF7L2 gene were evaluated by real-time polymerase chain reaction via TaqMan allelic discrimination. Logistic regression was used to detect the most independent factor for development of diabetes and diabetic microvascular complications. Variant homozygous TT and heterozygous CT genotypes were significantly increased in diabetic without complications and diabetic with complications groups than controls (p = 0.003, 0.001) respectively. The T allele was more represented in both patient groups than controls with no significant difference between patient groups. TT genotype as well as T allele was significantly associated with increased T2DM risk. The T allele of rs7903146 polymorphism of TCF7L2 confers susceptibility to development of T2DM. However, no significant association was found for diabetic complications.

SAT-226 Lifestyle Modifications or Adrenalectomy? Pheochromocytoma Presenting with New Onset Diabetes Mellitus

IntroductionWhen clinicians think of pheochromocytomas, diabetes might not be the first thing that comes to mind. Pheochromocytomas elicit deterioration in glucose tolerance in 20% to 40% of affected individuals. Size of the pheochromocytoma could be an independent risk factor for developing diabetes, as larger pheochromocytomas often present with diabetes mellitus in 23% to 33% of patients with symptomatic pheochromocytomas. Evidence suggests that pheochromocytoma proposes a risk for development of diabetes. There is no consensus or recommendations on which patients with new onset diabetes should be screened for pheochromocytoma or how to manage hyperglycemia in these patients.Clinical Case42 YO F with PMH of HTN presented to primary care clinic c/o polyuria, fatigue, 25-pound weight loss, epigastric pain and worsening hypertension over 3 months. Initial work up showed a HbA1C of 9%. The patient was diagnosed with type 2 diabetes mellitus and started on Metformin 1g BID with no improvement of glucose levels or symptoms. As part of initial work up for suspicion of pancreatic malignancy patient had an abdominal CT scan showing a 5.6 x 4.8 cm well-circumscribed left adrenal mass. Patient was referred for endocrine evaluation. Initial workup showed negative GAD Ab, normal 1mg Dexamethasone suppression test, normal aldosterone/renin ratio, elevated Free Normetanephrine of 17,921 pg/mL and elevated chromogranin A of 3,427 ng/mL. Based on biochemical evidence of catecholamine excess and left adrenal mass on imaging, patient was diagnosed with Pheochromocytoma. MIBG showed no evidence of metastatic disease. She was started on insulin therapy, Doxazosin 1mg BID which was titrated to 2mg BID and Amlodipine 5mg was increased to 10mg daily. Pt was referred to surgery for adrenalectomy. On pre-op evaluation patient had significant improvement of glucose levels and symptoms. Propranolol 20mg BID was started for BP optimization. A laparoscopic left adrenalectomy was performed without complications. Patient did not require anti-hypertensive medications or insulin during hospitalization and was discharged on metformin 500mg daily with no anti-hypertensive medications. At one-month Post-adrenalectomy follow up patient had normal BP of 116/72 mmHg and A1C of 5.4% with normal glucose logs indicating resolution of diabetes and HTN post adrenalectomy.ConclusionDiabetes is a multifactorial disease that has direct impact on patient’s quality of life, morbidity and mortality. It is important to consider pheochromocytoma as a risk factor for development of diabetes, especially in young patients with atypical presentation, uncontrolled hypertension or without evidence of antibodies or insulin resistance. Screening and early diagnosis of pheochromocytoma could mean significant reduction on long term diabetes complications as diabetes seems to improve or even resolve after adrenalectomy.

Dysglycemia after distal pancreatectomy: Results of a 10-year series using prospective endocrine evaluation

Background: Distal pancreatectomy (DP) is a commonly utilized procedure by hepatopancreatobiliary surgeons for the management of pancreatic body and tail lesions. While associated with low mortality rates, the development of postoperative diabetes represents a challenge to both patient and physician. Limited literature is available regarding the development or reversibility of impaired glucose tolerance and/or type-II diabetes mellitus (IGT/DM) in this patient population. The primary aim was to define the post-surgical clinical evolution of IGT/DM and the association with the pre-operative glycemic profile of patients following DP. Methods: In this prospective study, pre and postoperative fasting and 2-hour postprandial oral glucose challenge testing (OGTT) laboratories including plasma glucose, glycated hemoglobin (A1c), insulin, and c-peptide were measured in consecutive non-diabetic patients undergoing DP by the senior author from 2007 to 2017. Benign, pre-malignant, and malignant indications were included. Differences in postprandial chemistries from fasting values are denoted with delta (Δ) prefix. American Diabetes Association definitions were used for glycemic classifications. Univariate and multivariate risk factor analysis was performed overall and for individual diabetic classes in determining the development of IGT/DM. Kaplan-Meier survival curves were constructed for onset to endocrine and exocrine dysfunctions, and patient survival. Results: Among 216 patients included (mean age 63 ± 13.7 years, 71.3% Caucasians, 56% female, mean BMI 28.5 m/kg2); 29.6% (n = 64), 31% (n = 67), 39.5% (n = 85) were pre-operatively diagnosed with no-diabetes (No-DM), with pre-diabetes (Pre-DM), or diabetes (DM), respectively. At 120-months of follow-up, 17 (13.5%), 86 (39.0%), and 115 (53.2%) patients were classified as No-DM, Pre-DM or DM, respectively. Based on preoperative laboratories, patients with Pre-DM had 85% increased risk of developing post-op dysglycemia (RR = 1.85, CI 1.126-3.041, p = 0.021), compared to those with no-DM, while 80% (68/85) patients with preoperative DM retained there IGT/DM status postoperatively. Patients developing post-operative IGT/DM demonstrated higher preoperative fasting glucose, OGTT-glucose, and A1c (all p ≤ 0.010), and a greater Δglucose compared to those classified as Pre-DM and No-DM, respectively (Δ64.5±38.0 vs Δ32.5±37.9 vs Δ4.33 ± 6.03; p 130, Δglucose >30, A1c >6.0, HOMA-IR ≥2, and surgical pathology of chronic pancreatitis as risk factors for developing IGT/DM. In patients with No-DM preoperatively, a HOMA-IR >1 was identified as a risk factor for development of postoperative IGT/DM after adjusting for multiple co-variates. For patients classified with DM preoperatively by fasting or OGTT chemistries but whom still retained an A1c ≤ 6.4, multivariate analysis identified an A1c ≤ 6.1 and the absence of a history of smoking as predictors of these diabetics returning to euglycemia postoperatively. There was no association between advancing age, BMI, race, or pancreatic ductal adenocarcinoma and post-operative IGT/DM development. Conclusion: Approximately 40% and 53% of patients undergoing distal pancreatectomy develop post-operative IGT and DM, respectively over 10-years. Higher pre-op fasting glucose, OGTT glucose, A1c, HOMA-IR, and chronic pancreatitis are significant risk factors for development of diabetes. Alternatively, diabetics diagnosed by fasting or OGTT glucose values but non-diabetic A1c values, a preoperative A1c ≤ 6.1 and absence of a history of smoking may indicate postoperative conversion to a euglycemic state. The development of new-onset IGT/DM or persistent diabetes diagnosis following distal pancreatectomy is multifactorial and assessment of pre-operative glycemic status is paramount when counseling patients on their risk of developing postoperative IGT/DM.

Angiotensin Converting Enzyme Gene Insertion/Deletion Polymorphism Is Not Responsible for Antihypertensive Therapy Induced New Onset of Type 2 Diabetes in Essential Hypertension.

Background:Antihypertensive drug therapies have been reported to be associated with new onset of type 2 diabetes mellitus in some hypertensive patients after prolonged use. Angiotensin converting enzyme (ACE) gene has been found to affect essential hypertension, response of antihypertensive therapies, and glycemic disturbances. Therefore, ACE gene I/D polymorphism may be associated with risk of new onset of type 2 diabetes via metabolic disturbances, glycemic dysregulation, and insulin resistance.Aim:To assess the correlation between ACE gene I/D polymorphism and glycemic disturbance under influence of diuretic and other antihypertensive drug therapies.Materials and methods:We recruited 270 normotensive patients as control (150 men and 120 women), 270 hypertensive patients (95 men and 175 women), and 240 hypertensive with new onset of diabetes patients (80 men and 160 women). All samples were genotyped for ACE gene polymorphic alleles and relationship between different genotypes and anthropometric and clinical parameters along with drug therapies was established and analyzed.Results:Baseline clinical (systolic blood pressure, diastolic blood pressure, and fasting blood glucose level) and anthropometric parameters (height, weight, waist circumference, hip circumference, waist-hip ratio, and body mass index) of study populations were found highly statistically significant (P < .05) when compared among study groups. Furthermore, genotype wise comparison of all these parameters in essential hypertensive (EH) and essential hypertensive with onset of diabetes (EHNOD) patients found most of them nonsignificant and no variation was found with respect to different genotypes of ACE gene. The genotype wise comparison of clinical parameters among different antihypertensive drug therapy was found statistically nonsignificant in both EH and EHNOD patients.Discussion:Anthropometric parameters can be taken as the risk indicator factors for hypertension and diabetes. However, ACE gene polymorphism may not be a risk factor for development of diabetes in hypertensive patients.Conclusion:The present study suggested that ACE gene polymorphism did not show any significant association with the risk of new onset of diabetes in EH patients and more detailed studies with large population size are needed.

Predicting Diabetes in the First Two Years Postpartum among Women with Recent Gestational Diabetes—The Linda-Brasil Study

Background: GDM is a strong risk factor for early development of diabetes. Yet, adherence to protocols for testing at postpartum is usually low. We investigated the main predictors of diabetes up to two years post-partum among women with recent GDM participating in the LINDA-Brasil cohort. Methods: We recruited potential participants with GDM for an ongoing clinical trial of postpartum diabetes prevention, LINDA-Brasil. We ascertained diabetes by OGTT. We estimated relative risks and 95% CIs, and area under the ROC curve (AUC) for diabetes postpartum through logistic regression. Results: We recruited 27women with GDM, of whom 1482 (55%) underwent OGTT testing postpartum. Among these, mean (SD) pre-pregnancy BMI was 30.2 (6.4) kg/m2 and mean age, 32.0 (6.3) years; 316 (21.3%) used insulin during pregnancy, an additional 314 (21.2%) oral hypoglycemic agents (OHAs). During follow-up, 163 (11%) developed diabetes. Use of insulin during pregnancy predicted a six-fold higher crude risk of developing diabetes postpartum (RR 6.7; 95% CI 4.7-9.4) and of OHAs, a two-fold risk (RR=2.0; 95% CI 1.4-2.9). The inclusion of just these two variables yielded an AUC of 0.754; adding fasting and 2h plasma glucose at the diagnosis of GDM increased it to 0.810; further addition of age and pre-pregnancy BMI increased it minimally (0.813), and age was not statistically significant. Most incident cases used insulin (59%) or OHAs alone (20%) during pregnancy, thus, 79% of all cases (sensitivity) could be identified as being at high risk just by this information. Stated as post-test probabilties, 20% of those using antidiabetic medication during pregnancy but only 4% of those not using medication developed diabetes. Conclusions: Simple clinical or administrative information can be effectively used to prioritize screening and counselling for diabetes prevention in the initial years following pregnancy complicated by GDM. Disclosure C.D. Castilhos: None. R. Ladwig: None. M. Drehmer: None. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. C. Facanha: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.

Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka.

Nonalcoholic fatty liver disease (NAFLD) is becoming one of the most important causes for chronic liver disease and also hepatocellular carcinoma (HCC) in Sri Lanka. This tendency is also recognized worldwide. More than half of the middle-aged and elderly adults in urban Sri Lanka have ultrasonic evidence of NAFLD. The NAFLD is also identified in population from rural areas of Sri Lanka and also in children. Nonalcoholic steatohepatitis (NASH) cirrhosis is the most common cause of referral for liver transplantation in Sri Lankans. The NASH is also the most common cause for rejecting potential donors for liver transplantation in Sri Lanka. Patients who underwent liver transplantation for cryptogenic cirrhosis developed evidence of NASH following liver transplantation. Recent evidence suggests that there is a genetic component to NAFLD. PNPLA3, a single gene polymorphism linked to the short arm of chromosome 22, is associated with the severity of NAFLD. The presence of this genetic polymorphism appears to carry higher risk of patients with NAFLD developing NASH with fibrosis cirrhosis and hepatocellular carcinoma. In a large population-based study from Sri Lanka, there was a tendency to develop NAFLD associated with this genetic polymorphism. In a population-based study, NAFLD was identified as an independent risk factor for development of diabetes. This association is recognized worldwide now. Most patients with HHC in Sri Lanka developed it on a back ground of cryptogenic cirrhosis. At the same time, the prevalence of the markers for hepatitis B and C was rare in Sri Lankan patients with HCC.How to cite this article: Dassanayake AS. Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka. Euroasian J Hepato-Gastroenterol 2018;8(1):69-72.

Knee and hip OA as risk factors for development of CVD and diabetes in a community based longitudinal study

Purpose: Osteoarthritis (OA) and comorbid conditions such as cardiovascular disease (CVD) and diabetes often occur together. However, the temporal relationship between them is unclear. Therefore, we sought to explore whether OA is associated with the development of CVD and diabetes in a longitudinal cohort. Methods: We carried out a longitudinal analysis using data from baseline assessment and up to two follow-up periods in the Johnston County OA Project. African American and Caucasian men and women aged 45 years or older at study entry who were free of CVD (n=3,560) or diabetes (n=3,740) at baseline were included in analyses. There were two dichotomous outcomes of interest: self-reported CVD or self-reported diabetes. Knee and hip rOA were defined as a Kellgren-Lawrence (KL) grade of ≥2 in either knee or hip at baseline clinical assessment. Severe rOA was defined as a KL grade of ≥3, and symptomatic rOA (sxOA) and severe sxOA were subsets of those with rOA and severe rOA, respectively, who also had symptoms in the same joint. Population-averaged models for non-normal (binomial) repeated measures using generalized estimating equations (GEE) were used to estimate odds ratios (OR) and 95% confidence intervals (CI) and determine associations between knee and hip OA measures and development of CVD and diabetes at a later follow up period. All models were adjusted for age, BMI, sex, race, and education (less than or at least High School [HS]); any self-reported knee or hip injury (depending on the OA outcome) during at least one time-point; enrollment cohort (original or enrichment); and years of follow-up from baseline. Results: At baseline, the mean age was 61.5 years, 64.6% were women, 32.1% African American, 31.9% did not complete high school, and had a mean BMI of 29.7. There were 27.4% of participants who had knee rOA and 17.2% had knee sxOA, while 29.4% had hip rOA and 10.4% had hip sxOA. Adjusted odds of CVD increased for those with knee and hip sxOA (aOR=1.18, 95% CI=1.02-1.37; aOR=1.29, 95% CI=1.09-1.53, respectively) and severe sxOA (aOR=1.24, 95% CI=1.04-1.48; aOR=1.64, 95% CI=1.05-2.56, respectively). Additionally, those with rOA in both hips were at increased odds of developing CVD (aOR=1.27, 95% CI=1.06-1.51). There were no associations observed for knee or hip OA as a factor in development of diabetes. Conclusions: In our large cohort of individuals free of CVD at baseline, we observed that knee and hip OA were independently associated with development of CVD at later time points. Results from this study may suggest that knee and hip OA may lead to development of CVD and therefore may be an important for clinicians to be aware of this increased risk and to provide targeted interventions.TableAdjusted1 ORs and 95% CI for the association between knee and hip rOA and incident CVD and DiabetesCVD2Diabetes2Knee rOA1.02 (0.90–1.17)0.95 (0.80–1.13)Single knee rOA0.90 (0.76–1.07)0.95 (0.76–1.17)Both knees rOA1.14(0.98–1.33)0.96 (0.79–1.17)Symptomatic Knee rOA1.18 (1.02–1.37)0.98 (0.82–1.18)Severe Knee rOA1.06 (0.91–1.23)0.93 (0.77–1.12)Severe Symptomatic Knee rOA1.24 (1.04–1.48)0.94 (0.76–1.18)Hip rOA1.07 (0.94–1.21)0.96 (0.82–1.13)Single Hip rOA0.97 (0.84–1.12)0.93 (0.77–1.12)Both Hips rOA1.27 (1.06–1.51)1.03 (0.82–1.30)Symptomatic Hip rOA1.29 (1.09–1.53)1.06 (0.85–1.32)Severe Hip rOA1.08 (0.80–1.44)0.79 (0.52–1.22)Severe Symptomatic Hip rOA1.64 (1.05–2.56)0.73 (0.34–1.54)1Adjusted for baseline cohort, age, gender, race, education, BMI, joint injury, high blood pressure and CVD/diabetes.2Includes both knee and hip measures as predictors in same model Open table in a new tab 1Adjusted for baseline cohort, age, gender, race, education, BMI, joint injury, high blood pressure and CVD/diabetes. 2Includes both knee and hip measures as predictors in same model

Prenatal Testosterone Programming of Insulin Resistance in theFemale Sheep.

Insulin resistance, a common feature of metabolic disorders such as obesity, nonalcoholic fatty liver disease, metabolic syndrome, and polycystic ovary syndrome, is a risk factor for development of diabetes. Because sex hormones orchestrate the establishment of sex-specific behavioral, reproductive, and metabolic differences, a role for them in the developmental origin of insulin resistance is also to be expected. Female sheep exposed to male levels of testosterone during fetal life serve as an excellent translational model for delineating programming of insulin resistance. This chapter summarizes the ontogeny of insulin resistance, the tissue-specific changes in insulin sensitivity, and the various factors that are involved in the programming and maintenance of the insulin resistance in adult female sheep that were developmentally exposed to fetal male levels of testosterone during the sexual-differentiation window.

Resection of Pheochromocytoma Improves Diabetes Mellitus in the Majority of Patients.

Catecholamine excess in patients with pheochromocytoma often results in impaired glucose tolerance, leading to diabetes mellitus. Little data are available on the long-term effect of surgery on diabetes. The primary aim of this study was to determine the likelihood of diabetes cure after surgery, while secondary objectives were to determine risk factors for development of diabetes preoperatively and persistence of diabetes postoperatively. All patients undergoing surgery for pheochromocytoma from 1996 to 2015 were retrospectively reviewed to identify those with a preoperative diagnosis of diabetes. Demographic and diabetes-specific data were collected. Median follow-up was 52.1months. Overall, 153 patients underwent surgery. Diabetes was seen in 36 (23.4%) patients. Eight patients met the exclusion criteria and were removed from the final analysis, while 22 (78.6%) patients had complete resolution of diabetes. Four patients remained on medication with improved control. Overall, 93.0% of patients had improvement of their diabetes; two patients did not improve. Patients with large, symptomatic tumors were more likely to develop preoperative diabetes, and diabetes was more likely to persist in patients who had an elevated body mass index (BMI). Diabetes was found concurrently with pheochromocytoma in 23% of patients, more often in those with large, symptomatic tumors. The majority of patients had long-term resolution of diabetes after successful resection; however, some patients may continue to require treatment of diabetes after operation, especially those with a higher BMI.

Retrospective cohort study on risk factors for development of gestational diabetes among mothers attending antenatal clinics in Nairobi County.

IntroductionWorld Health Organization estimates that deaths resulting from diabetes will rise above 50% by the year 2020; hence urgent action is needed to reverse the trend notably through nutrition and lifestyle intervention among populations at risks. Studies have established that nutritional environment and physiology of the mother affects neonate's health at infancy and later in life thus this study sought to investigate the risk factors for development of gestational diabetes focusing age, weight, family history and pre-existing medical condition which could be modified to improve population health.MethodsA retrospective cohort study design was used. Subjects were sampled from selected maternity facilities in Nairobi and were subjected to oral glucose test to ascertain Gestational Diabetes mellitus (GDM) status. A questionnaire was administered to a sample of 238 respondents. Quantitative data was then analyzed as descriptive statistic, univariate and multivariate regression.ResultsAverage age for mothers with GDM was high with a mean of 33.06 (95% C.I: 31.59-34.52) compared to a mean of 27.9 (95% C.I: 27.01-28.78) for non-GDM mothers. Weight before pregnancy was high with mean of 74.04 (95% C.I: 70.82-77.30) among mothers with GDM compared to mean of 60.27 (95% C.I:58.59-61.96) among non-GDM mothers. Mothers with diabetic history in the family had twice the risk of developing GDM (OR= 2.27; 95% C.I: 1.23-4.17) compared to those who did not observe diabetic history in the family.ConclusionGestational diabetes cases are relatively high. Age advancement; high weight and diabetic history in family are determining factors for development of diabetes among pregnant women.

Evaluation of prevalence and risk factors of gestational diabetes in a tertiary care hospital in Kerala

AimsThe prospective study was conducted with the aim to evaluate the prevalence and risk factors of gestational diabetes mellitus in a tertiary care referral hospital in Kerala. Materials and MethodsA prospective observational study was conducted with the aim to study the prevalence, risk factors, complications, treatment pattern and cost analysis of GDM. The study was carried out in the Obstetrics & Gynecology dDepartment of Al Shifa hHospital located in northern Kerala. ResultsOver an eight-month period, 201 patients who met the inclusion criteria were enrolled for study from which prevalence of GDM was estimated at 15.9%. The study revealed higher prevalence of risk factors and complications such as age >25 years, BMI >26kg/m2, family history of DM, past history GDM, history of big baby, gestational hypertension, vaginal candidiasis, premature rupture of membranes and hyperbilirubinemia in GDM group as compared to non-GDM group. The study also demonstrated that modern life-style was a major influencing factor for development of diabetes in the study population. ConclusionThe study reveals the necessity of proper screening diagnosis and management of GDM in pregnant women by the clinicians so as to prevent the future burden of type 2 diabetes.

P19 Awareness and knowledge of obesity (and its contributing factors) as a risk factor for development of diabetes

P19 Awareness and knowledge of obesity (and its contributing factors) as a risk factor for development of diabetes

Adiponectin to the Rescue: How the Embryo Maintains Glucose Uptake in a Diabetic Mother

Adiponectin to the Rescue: How the Embryo Maintains Glucose Uptake in a Diabetic Mother

The outcome of body mass index in patients undergoing percutaneous coronary angiography

Background Obesity is a well-known risk factor for development of diabetes, hypertension, and coronary artery disease. However, recently the “obesity paradox” showed that short-term outcome is superior after PCI in overweight and obese patients. Therefore, a prospective, single-center observational study was performed to evaluate the in-hospital outcome of obese patients who were candidates for elective PCI in Cairo University hospital. Methods Prospective analysis of clinical and catheter related data were obtained from 156 patients admitted to our center for elective PCI. Patients were stratified according to their BMI into two groups: group A: overweight/obese (>25 kg/m 2 ) and group B: non-obese ( 2 ), respectively. All patients were subjected to thorough clinical examination for assessment of risk factors for CAD as well as to laboratory work-up to rule out electrolyte abnormalities and to detect any change in cardiac markers following PCI. Pre- and post procedural ECG and echocardiographic data were obtained from all patients. Standard coronary angiography was done through trans-femoral approach using modified Seldinger technique with the intervention performed according to the operator discretion. Results The majority of patients who underwent PCI in our center were obese (81%). Group A patients were significantly younger ( P = 0.01) and had more risk factors for coronary artery disease (CAD) than group B patients. The prevalence of chronic stable angina was significantly higher among group A patients while prevalence of STEMI was much lower when compared to that of group B ( P = 0.006, P = 0.002, respectively). Coronary angiography revealed that atherosclerotic affection of more than one vessel was more prevalent among group A patients ( P = 0.2). Fourteen cases (9% of patients) developed post procedure complications. After adjustment of several covariates, vascular complications, heart failure and death were more prevalent in group B ( P = 0.1, P = 0.1, P = 0.3, respectively), while chest pain and instant stenosis were more prevalent in group A ( P = 0.8, P = 0.3, respectively) with insignificant difference in the prevalence of complications between both groups. A U-shaped relation has been exhibited between BMI and MACE with the lowest risk observed in the middle of the BMI spectrum. Conclusions Obesity is not associated with neither increased nor reduced risk of adverse post-procedural in-hospital outcomes following elective PCI. These findings, however, do not discount the need for sustained efforts in secondary prevention of obesity and its consequences.

Cardiovascular Benefits and Diabetes Risks of Statin Therapy in Primary Prevention: An Analysis From the JUPITER Trial

Conclusion: The cardiovascular mortality benefits of statin therapy exceed the potential diabetes hazard induced by statins. Summary: Recent trial data and meta-analysis have suggested that statins confer an increase risk for development of diabetes (Ridker PM, et al, N Engl J Med 2008;359:2195-207; and Sattar N, et al, Lancet 2010;375:735-42). Recognition of the increased risk of diabetes with statin therapy has lead to questions on the balance of benefit and risk of statin drugs for primary prevention. The authors, therefore, analyzed data from participants from the JUPITER trial to address the balance of vascular benefits and diabetes hazards with statin use. In the JUPITER trial, 17,603 men and women without previous cardiovascular disease were randomly assigned to rosuvastatin (20 mg/d) or placebo and were monitored for 5 years for the primary end point of myocardial infarction, stroke, admission to the hospital for unstable angina, arterial revascularization, or cardiovascular death. Prespecified secondary end points of the trial included venous thromboembolism, incident of physician-reported diabetes, and all-cause mortality. With respect to diabetes development, patients were stratified on the basis of having none or at least one of the major four risk factors for developing diabetes: metabolic syndrome, impaired fasting glucose, body mass index ≥30 kg/m2, or glycated hemoglobin A1c >6%. There were 11,508 trial participants with one or more major diabetes risk factors. In individuals with one or more diabetes risk factors, statin allocation was associated with a 39% reduction in the primary end point (hazard ratio [HR], 0.61, 95% confidence interval [CI], 0.47-0.79, P = .0001), a 36% reduction in venous thromboembolism (HR, 0.64; 95% CI, 0.39-1.06; P = .08), a 17% reduction in total mortality (HR, 0.83; 95% CI, 0.64-1.0; P = .15), and a 28% increase in diabetes (HR, 1.28; 95% CI, 1.07-1.54, P = .01). For those with diabetes risk factors, 134 vascular events or deaths were avoided for every 54 new cases of diabetes diagnosed. For trial participants with no major diabetes risk factors, statin allocation was associated with a 52% reduction in the primary end point (HR, 0.48; 95% CI, 0.33-0.68; P = .001), a 53% reduction in venous thromboembolism (HR, 0.47; 95% CI, 0.21-1.03; P = .05), a 22% reduction in total mortality (HR, 0.78l; 95% CI, 0.59-1.03; P = .08), and no increase in diabetes (HR, 0.99; 95% CI, 0.45-2.21; P = .99). In patients without diabetes risk factors, 86 vascular events were avoided, with no new cases of diabetes diagnosed. In the 486 participants in the trial who developed diabetes in the follow-up (270 on rosuvastatin vs 216 on placebo; HR, 1.25, 95% CI, 1.05-1.49; P = .01), the point estimate of cardiovascular risk reduction associated with statin therapy (HR, 0.63; 95% CI, 0.25-1.06) was consistent with that for the trial as a whole (HR, 0.56; 95% CI, 0.46-0.69). Compared with placebo, statin accelerated the average time to diagnosis of diabetes by 5.4 weeks (83.3 [standard deviation, 47.8] weeks on rosuvastatin vs 89.7 [50.4] weeks on placebo). Comment: Three meta-analyses were published between 2009 and 2011 indicating an increase risk of type 2 diabetes in patients taking a statin medication. In addition, intensive-dose statin therapy appeared to be associated with higher risk than lower-dose therapy (Preiss D, et al, JAMA 2011;305:2556-64). This prompted the Food and Drug Administration to recommend safety label changes to statin drugs (http://www.FDA.gov/drugs/drugsaftey/ucm293101.htm). This report, while confirming the increased risk of diabetes in patients on statin medications, suggests that in the setting of primary prevention, even in the face of risk factors for development of diabetes, the use of statin medications has a favorable overall effect on mortality and cardiovascular events, despite an increased risk of diabetes. The authors believe the data provide reassurance for patients and physicians with regard to lipid-lowering agents as adjuncts to smoking sensation, exercise, and diet in the prevention of major cardiovascular events.

World Congress on the Insulin Resistance Syndrome, 2009

This is the first of four articles summarizing presentations at the Seventh World Congress on the Insulin Resistance Syndrome, held in San Francisco, California, on 5–7 November 2009, pertaining to cellular mechanisms of insulin resistance. ### Circadian rhythms and insulin resistance Peter Grant (Leeds, U.K.) introduced the topic of circadian rhythms and their relationship to insulin resistance. The thrifty genotype hypothesis (1) suggests a survival advantage of insulin resistance, presumably during periods of famine. Insulin resistance should then be considered a physiologic process, with duration the critical issue, so that prolonged insulin resistance leads to disease—rather than what might be considered beneficial insulin resistance after increased nutrient ingestion in preparation for famine. Animals that prepare themselves for hypernation have adipocyte hypertrophy, hyperphagia, inflammatory changes, hyperinsulinemai, hyperglycemia, and reduced energy expenditure—all short- to medium-term processes. Seasonal animals have marked insulin resistance just prior to hibernation (2), with seasonal cycling related to the fat phenotype; a secondary period of fat accumulation occurs during springtime. There is an endogenous clock that sets up oscillating systems in virtually every tissue, synchronized by a central clock regulatory mechanism. “You disrupt the clock at your own peril,” Grant noted, with sleep duration a risk factor for development of diabetes. Cardiovascular physiology is under circadian variation, affecting blood pressure, endothelial function, vascular tone, lipid metabolism, platelet and leukocyte function, and thrombosis. Effects of shift working in man include gastrointestinal, reproductive, and metabolic disturbances; insulin resistance; fasting and postprandial hypertriglyceridema; and increased risk of cardiovascular disease (CVD), “so this is not a minor change.” One could hypothesize that seasonal insulin resistance benefits the hibernating animal, but “man seems,” Grant said, “to have completely lost contact with ‘the animal,’ … [putting] on weight year after year.” Joseph Bass (Chicago, IL) reviewed information about the molecular clock and its linkage to metabolic control. There are hypothalamic …

Prepregnancy Overweight and Gestational Diabetes as Determinants of Subsequent Diabetes and Hypertension After 20-Year Follow-Up

The prevalence of overweight or obesity and gestational diabetes mellitus (GDM) is increasing and is a major public health concern. Maternal risk factors for development of diabetes in later life include GDM and overweight during pregnancy. Overweight is a strong risk factor for GDM, and the occurrence of both increases the risk for subsequent metabolic syndrome. Little data are available on the risk of diabetes and metabolic diseases in women with normal glucose tolerance during pregnancy, who have risk factors for GDM. Moreover, few studies have investigated the individual contribution of overweight and GDM during pregnancy to the risk of diabetes and hypertension in later life. This prospective population-based study evaluated prepregnancy overweight and GDM as determinants of risk for diabetes and hypertension, separately and in combination, 20 years after pregnancy. Population-based cohort data from the Northern Finland Birth Cohort 1986 were linked with register-based data on diagnosis of diabetes and hypertension obtained from records on reimbursement of medical expenses and diagnoses at hospital discharge. The oral glucose tolerance test (OGTT) was used to diagnose GDM. Several categories of risk were evaluated for diabetes and hypertension (which were the primary study outcomes). These included: (1) normal weight women with GDM (n = 70); (2) overweight women with GDM (n = 54); (3) normal-weight (n = 768); (4) overweight (n = 250) women with risk factors for GDM but normal OGTT results; and (5) women with no risk factors for GDM (n = 5341). Calculation of the population-attributable fractions (PAFs) estimated the cumulative incidence of diabetes and hypertension associated with prepregnancy overweight. Analysis of time-to-event curves showed that the cumulative incidence of diabetes and hypertension diagnosed in the whole study population was 1.3% and 7.5%, respectively. Women with concomitant prepregnancy overweight and GDM were at extremely high risk of diabetes (hazard ratio [HR], 47.24; PAF, 15.8%) and hypertension (HR, 9.16; PAF, 4.4%). The occurrence of prepregnancy overweight in women with a normal OGTT during pregnancy was associated with increased risk of diabetes (HR, 12.63; PAF, 22.2%) and hypertension (HR, 2.86; PAF, 6.0%), whereas a finding of GDM only among women with prepregnancy normal weight was associated with increased risk of diabetes (HR, 10.61; PAF, 5.2%) but not hypertension. These findings show that prepregnancy overweight is a critical risk factor for development of diabetes and hypertension 20 years after delivery. Overweight combined with even mild GDM markedly increases the risks of these diseases.

Relationship Between Body Mass Index and Left Main Disease: The Obesity Paradox

Obesity is a well-known risk factor for development of diabetes, hypertension, and coronary artery disease. However, the obesity paradox shows that short-term outcome has been reported to be superior after revascularization in overweight patients. We conducted this study to examine this theory in patients who were candidates for coronary artery bypass graft and to determine if there is a relationship between obesity and the severity of coronary artery involvement and left main disease in Iranian patients. A total of 15,550 patients who had undergone isolated coronary artery bypass graft were studied retrospectively. All medical records of the aforementioned patients were derived from our hospital surgery data bank. Preoperative angiography was used for angiographic data. After adjusting for confounding variables, we still found a significant relationship with higher BMI and lower prevalence of left main disease. We found that despite a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia, overweight and obese patients who were candidates for coronary artery bypass graft surgery were significantly less likely to have left main disease according to preoperative angiography. This study suggests that obese patients are more likely to be referred for coronary artery bypass graft in earlier stages of coronary involvement.