First-degree Family History Of Diabetes Research Articles

Contribution of a first-degree family history of diabetes to increased serum adipocyte fatty acid binding protein levels independent of body fat content and distribution.

Background/Objectives:First-degree relatives of patients with diabetes bear an increased risk of diabetes, overweight/obesity and cardiovascular disease. Accumulating evidence indicates that circulating concentrations of adipokines are altered in individuals with a first-degree family history of diabetes (FHD), but the adipokine adipocyte fatty acid binding protein (A-FABP) has been rarely studied in this population. The present study explored the association between a first-degree FHD and serum A-FABP levels.Subjects/Methods:A total of 1962 normoglycemic participants were divided into subgroups of men, premenopausal women and postmenopausal women. Serum A-FABP levels were measured using a sandwich enzyme-linked immunoabsorbent assay. Abdominal fat distribution, including visceral fat area and subcutaneous fat area, was assessed by magnetic resonance imaging.Results:Totals of 792 men, 544 premenopausal women and 626 postmenopausal women were enrolled. Serum A-FABP levels were much higher in subjects with a first-degree FHD than in those without an FHD in all subgroups (all P<0.05). Logistic regression analysis revealed an independent and positive relationship between a first-degree FHD and serum A-FABP levels in men (P=0.029), premenopausal women (P=0.036) and postmenopausal women (P=0.008). Multiple stepwise regression analysis showed that a first-degree FHD was an independent factor positively associated with serum A-FABP levels in men (standardized β=0.068, P=0.029), premenopausal women (standardized β=0.090, P=0.018) and postmenopausal women (standardized β=0.102, P=0.004).Conclusions:Serum A-FABP levels were increased significantly in normoglycemic individuals with a first-degree FHD. The contribution of the first-degree FHD to the elevated serum A-FABP levels was independent of total body fat content and abdominal fat distribution. Thus, use of serum A-FABP as a biomarker in the first-degree relatives of patients with diabetes may result in overestimation of the risk of obesity-induced metabolic disease and cardiovascular disease.

Lack of knowledge about diabetes in Pune—the city of knowledge!

India is experiencing an escalating epidemic of diabetes for which the most cost-effective solution is prevention. Awareness is the first step towards prevention. We undertook a questionnaire-based study to evaluate gaps in awareness of different implications of diabetes among various sections of the urban population of Pune. Individuals aged ≥13 years (378 diabetic, 1122 non-diabetic) from different socio-economic backgrounds were interviewed using a structured questionnaire. Awareness regarding causes, symptoms, complications, treatment and preventive measures, curability of diabetes and long-term implications of diabetes in pregnancy was evaluated. An awareness score was calculated based on the percent of total questions correctly answered. Of those surveyed, 78 % scored less than 50 %, 44 % did not know the meaning of diabetes, 30 % could not name any of the risk factors, symptoms, complications and preventive measures for diabetes, and 70 % were unaware of the long-term risks of diabetes in pregnancy. As a group, diabetic participants scored marginally better than non-diabetic participants (mean score 39 vs. 31 %; P < 0.001). Participants at high risk of diabetes (sedentary workers, non-diabetic participants with first-degree family history of diabetes and non-diabetic hypertensive participants) had poor knowledge about the condition (mean scores <40 %). Lower age, lower education and male gender were independently associated with poor awareness; education was the strongest predictor. Awareness regarding different implications of diabetes is poor in the population of Pune. There is a need for widespread and extensive public education campaigns to raise awareness and contribute to the national diabetes prevention initiatives.

Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: A cross sectional study comparing immigrants from the Middle East and native Swedes

AimsThis study sought to compare type 2 diabetes (T2D) risk indicators in Iraqi immigrants with those in ethnic Swedes living in southern Sweden. MethodsPopulation-based, cross-sectional cohort study of men and women, aged 30–75 years, born in Iraq or Sweden conducted in 2010–2012 in Malmö, Sweden. A 75g oral glucose tolerance test was performed and sociodemographic and lifestyle data were collected. T2D risk was assessed by the Finnish Diabetes Risk Score (FINDRISC). ResultsIn Iraqi versus Swedish participants, T2D was twice as prevalent (11.6 vs. 5.8%, p<0.001). A large proportion of the excess T2D risk was attributable to larger waist circumference and first-degree family history of diabetes. However, Iraqi ethnicity was a risk factor for T2D independently of other FINDRISC factors (odds ratio (OR) 2.5, 95% CI 1.6–3.9).The FINDRISC algorithm predicted that more Iraqis than Swedes (16.2 vs. 12.3%, p<0.001) will develop T2D within the next decade. The total annual costs for excess T2D risk in Iraqis are estimated to exceed 2.3 million euros in 2005, not accounting for worse quality of life. ConclusionsOur study suggests that Middle Eastern ethnicity should be considered an independent risk indicator for diabetes. Accordingly, the implementation of culturally tailored prevention programs may be warranted.

Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan

There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P < 0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists.

A family history of diabetes is not associated with arterial stiffness in non-diabetic Japanese population

Prevalent diabetes is at high risk for cardiovascular diseases and has a high familial inheritance. However, little is known whether a non-diabetic subject with a family history of diabetes is at high risk for vascular damage or not. The purpose of this study was to evaluate the association between a family history of diabetes and arterial stiffness in adult non-diabetic Japanese population. We analyzed eligible 787 non-diabetic subjects (502 men and 285 women) aged 35-69 years who enrolled in the baseline survey of a cohort study in Tokushima Prefecture, Japan and who underwent a brachial-ankle pulse wave velocity (ba-PWV) measurement. Information on individual life-style characteristics including medical history and treatment for diseases and a first-degree family history of diabetes was obtained through a structured self-administered questionnaire. Analysis of covariance and logistic regression analyses were used to evaluate the association between a family history of diabetes and ba-PWV. We found no differences in age-and-systolic blood pressure-adjusted and multivariate-adjusted means of ba-PWVs between subjects of both sexes with and without a family history of diabetes. Logistic regression analyses including both sexes also revealed that subjects with a family history of diabetes showed no differences in age-and-systolic blood pressure-adjusted and multivariate-adjusted odds ratios for high ba-PWV compared to those without that trait. Our results suggest that a family history of diabetes itself is not associated with arterial stiffness in adult non-diabetic Japanese population.

Diabetes Family History: A Metabolic Storm You Should Not Sit Out

First-degree relatives of people with type 2 diabetes are themselves at risk of developing the disease. While the transmission of genetic information from parents to offspring contributes to diabetes risk, there are other nongenetic risk factors that are shared by family members that can be amenable to intervention. These factors are likely to include sedentary behaviors such as television viewing and computer use. The extent to which family history influences the effects of sedentary behaviors on cellular energy metabolism and other markers of diabetes risk is poorly understood. An article by Hojbjerre et al. (1) in this issue of Diabetes examines the impact of 10-days' bed rest on young, nondiseased adults with or without a first-degree family history of diabetes. This commentary summarizes the findings from that study, places them in context with the findings of earlier studies, describes mechanisms of action, and identifies key areas where future research is required. Ecological comparisons (2), cohort studies (3), clinical trials (4), and government guidelines (5) tell us that a healthy lifestyle should include regular, moderately intense physical activity. Physically active people are at lower risk of type 2 diabetes (6), heart disease (7), specific cancers (8), and early death (9). Conversely, sedentary behaviors during leisure time and at work have been associated with cardiovascular morbidity (6,10) and mortality (11). While these epidemiological studies have received considerable media attention, many are prone to confounding and reverse causality. Intervention studies where participants are confined to bed (12,13) or in other ways discouraged from exercising (14) provide some of the strongest mechanistic evidence that sedentary behaviors are harmful to health. A study by Hojbjerre et al. (1) in this issue of Diabetes is one such example. Hojbjerre et al. (1) examined the effects of 10 days' bed rest on energy …

Emerging Trends in Diabetic Foot Ulcer Management in India

India is home to some 50 million diabetics (not a statistic to shout loud about), and 15% of this population suffer or are likely to suffer from the dreadful complications of diabetes, including the diabetic foot. There are well-understood pathological reasons and social factors that contribute adversely to this problem. For example, walking barefoot for social or religious reasons, being unable to afford any footwear, or wearing ill-fitting or inappropriate footwear on account of ignorance of good care all lead to foot damage that may not be treatable with medicines alone. Some form of amputation is often needed to treat the infected foot in order to spare a patient’s life. Worldwide, more than 1 million amputations are performed each year as a consequence of diabetes, which means that a lower limb is lost to diabetes somewhere in the world every every 30 seconds. Up to 85% of all amputations in people with diabetes are preceded by foot ulcers. In 90% of foot ulcer cases with diabetes, sensory neuropathy is part of the problem. Significant reductions in amputations may be achieved by well-organized diabetic foot ulcer care teams, good diabetes control, and wellinformed self care. Similar statements frequently appear not only in academic journals dedicated to diabetes management but also on Web sites of professional societies. Why does IJLEW wish to devote a special issue to this problem? The answer is to tease out the emerging trends in diabetic foot disease in India. As presented in the pages to follow, epidemiological data gathered around India indicate a rising prevalence of diabetes in urban areas. It also appears that there are differences in the prevalence of diabetes between urban and rural areas. This suggests that urbanization and all the ills that follow may have a role in the increase of this disease. It is also possible that equally reliable knowledge of the disease in rural areas is yet to be reported. It has been well advertised that urban, that is, modern ways of living are associated with lack of fitness in the young as well as in adults. This has also been associated with an increase in obesity in several societies on most continents. In India, however, central obesity is common despite low overall rates of obesity. The adverse effect of central obesity is manifested as an increasing basal metabolic index both in men and women. That some 75% of the type 2 diabetes patients have a first-degree family history of diabetes indicates a strong familial aggregation in Indian diabetic patients in the Indian subcontinent. On another note, Yagnik, after studies on birth weights, has argued in this issue of IJLEW that we should recognize the “thin-fat Indian baby” on account of high visceral fat content and lower-than-should-be-the-case maternal nutrition during pregnancy. This may be an excellent opportunity to practice prevention. The overall prevalence of neuroischemia in the subcontinental Indian is low as compared with Western patients, though it increases with age and, probably, smoking in males. Could health care education be usefully targeted in this direction? Prevention requires a sound understanding of a problem as well as resources with which it is practiced. In India, health care facilities are less well distributed than in other developing nations such as Brazil. This is especially so in regard to the diabetic population. The delivery of health care is shared by state-run institutions as well as a flourishing private sector. In state-run institutions, health care is delivered free of charge. In the private sector, hospitals and clinics charge fees for services provided. In the wellconnected bigger cities (or metros), high-tech treatment for diabetes may be found. The converse would appear to be the case in rural communities. It is well known and accepted that standard care for diabetic foot disease is best provided by a multidisciplinary team that should include trained foot care assistants. In India, there is a crying need for trained foot care assistants who can offer first-level support at the rural village and city levels. The foot care assistant is less trained than a medical doctor and is, therefore, less expensive and more accessible. This professional should work closely with the multidisciplinary team. Is there a case for putting telemedicine to best use here? Given telemedicine support, a medical/surgical consultation can become easier and swifter. The foot care assistant will be better empowered by the knowledge that a clinician is at hand. Indian software houses enjoy the privilege of leading the world; surely, these leaders would find it relatively easy to bend their skills to enable broadband communication and swift

Familial predisposition to cardiovascular risk and disease contributes to cardiovascular risk and disease interacting with other cardiovascular risk factors in diabetes—Implication for common soil (JDDM 14)

In diabetic population cardiovascular morbidity is high and the effects of genetic predisposition remain elucidated. In a large-scale multicenter-based diabetic population, clinical parameters including conventional cardiovascular risk factors and first-degree family history (FH) of diabetes, hypertension, coronary heart disease (CHD) and stroke were investigated in association with presence of CHD and stroke. Among 3611 diabetic patients, 181 (5.0%) had CHD and 118 (3.3%) had stroke. After adjustment for conventional risk factors, FH of CHD (OR 2.32, p < 0.0001) and of diabetes (OR 1.44, p < 0.05) were associated with CHD, and FH of stroke (OR 1.86, p < 0.01) was associated with stroke. FH of hypertension was significantly associated with presence of hypertension and obesity. Synergistic effect of FH of CHD in combination with hypertension or aging on increasing CHD, and that of FH of stroke in combination with microalbuminuria on increasing stroke were found. FH of diabetes, of hypertension, of CHD and of stroke were significantly associated with FH of each disease, indicating clustering of FH. In diabetic population, FH of CHD and FH of stroke doubled the risk of CHD and stroke, respectively, and had synergistic effect in combination with other risk factors. Clustering of FH may indicate interrelation of genetic predisposition.

Immigrants from the Middle‐East have a different form of Type 2 diabetes compared with Swedish patients

To compare the clinical characteristics of Type 2 diabetes (T2DM) between immigrants from the Middle-East and Swedish patients. The study group included 450 consecutive patients with T2DM, 379 Swedish-born aged 61 +/- 12 years and 71 patients originally from the Middle-East aged 50 +/- 11 years from the diabetes clinic of Malmo University Hospital. Onset of diabetes had occurred 12 years earlier in the Middle-East immigrants compared with the Swedish-born patients (43 +/- 10 vs. 55 +/- 12 years, P < 0.001). Immigrants had lower fasting serum C-peptide [0.7 (0.1-2.6) vs. 0.9 (0.1-4.0) nmol/l, P = 0.013], lower homeostasis model assessment (HOMA)-beta[1.7 (0.1-9.1) vs. 2.7 (0.1-59.0), P = 0.010], lower HOMA-IR [0.4 (0.02-1.19) vs. 0.4 (0.01-2.8), P = 0.005] than the Swedish group. A first-degree family history of diabetes was reported in 61% of immigrants, compared with 47% of Swedish-born (P = 0.022). Immigrants from the Middle-East have an earlier onset, stronger family history and more rapid decline of pancreatic B-cell function than Swedish patients, suggesting that they have a different form of T2DM compared with Swedish patients.

Screening for Type 2 diabetes in the accident and emergency department

To assess the proportion of patients, aged 40 years and over, attending an inner city accident and emergency department that have Type 2 diabetes, and the proportion previously undiagnosed, and to assess whether the identification of undiagnosed Type 2 diabetes is feasible in this setting. Five hundred unselected people participated. All completed a demographic questionnaire regarding risk factors for diabetes. In those without known diabetes, random capillary blood glucose (CBG) was measured. If this was greater than 7.0 mmol/l, patients were asked to return for two fasting blood glucose tests. Diagnosis of diabetes was based on World Health Organization criteria. Of the 500 participating subjects, 73 were already known to have Type 2 diabetes. Of the remaining 427 subjects, 36 had CBG>7.0 mmol/l. All 36 returned for fasting blood tests: 13 fulfilled the diagnostic criteria for Type 2 diabetes, eight for impaired fasting glucose (IFG), and 15 had normal fasting glucose values. The prevalence of Type 2 diabetes was therefore 17.2%, including 2.6% with a new diagnosis, and 14.6% with pre-existing disease; 1.6% were found to have IFG. Body mass index was greater in those with Type 2 diabetes (previously and newly diagnosed) [27.1 (5.15) (mean+/-standard deviation)] vs. 25.8 (4.70) kg/m2; unpaired t-test P=0.0213), and those with Type 2 diabetes were more likely to be of black and minority ethnic origin (57 vs. 28%; chi2 P<0.001) and to have a first-degree family history of diabetes (45 vs. 23%; chi2 P<0.001). It can be estimated from this survey that, annually, this case-finding methodology could identify 539 (95% CI 249-828) people aged 40 years and over attending our accident and emergency department with previously undiagnosed Type 2 diabetes.

Self-Reported Diabetes in Northland, New Zealand

There is little published community prevalence diabetes data in Northland, an area at the northernmost part of New Zealand containing 3.8% (140,088) of the total population (1). Māori, the indigenous people, are known to be at increased risk of diabetes (2), and Northland has a Māori population (29%) (1) higher than the national average (14.7%) (3). Hospitalization rates for diabetes are high in Northland, with a standardized relative ratio against the national rate of 1.77 (95% CI 1.55–1.92) (4). The purpose of this study was to assess the prevalence of self-reported diabetes in Northland and to calculate a two-factor (obesity and first-degree family history of diabetes) …