Non-diabetic People Research Articles

Common carotid intima-media thickness in cardiovascular risk stratification of older people: the Rotterdam Study

Non-invasive measures of atherosclerosis, such as carotid intima-media thickness (cIMT), may improve global cardiovascular risk prediction. The aim of this study was to determine whether common carotid IMT in addition to traditional risk factors improves risk classification in a general population of older people. A group of 3580 non-diabetic people aged 55-75 years and free of cardiovascular disease at baseline were followed for a median time of 12.2 years. Compared to models based on Framingham risk factors, we studied the ability of common cIMT measurement to better classify people into categories of low (<10%), intermediate (10-20%) and high (>20%) 10-year risk of hard coronary heart disease (CHD) and stroke. In older men, addition of cIMT to Framingham risk factors did not improve prediction of hard CHD or stroke. In older women, addition of cIMT to Framingham risk factors significantly improved risk classification. cIMT improved the C-statistic of the model for hard CHD from 0.711 to 0.719 and for stroke from 0.712 to 0.721, at good calibration. Reclassification was least in the majority of women classified as low risk (4% (n = 76) for hard CHD and 3% (n = 62) for stroke) and most substantial in women at intermediate risk (43% (n = 70) for hard CHD and 28% (n = 76) for stroke). The net reclassification improvement in women was 8.2% (p = 0.03) for hard CHD and 8.0% (p = 0.06) for stroke. cIMT had some additional value beyond traditional risk factors in the cardiovascular risk stratification of older women, but not of older men.

Nine Days of Intensive Exercise Training Improves Mitochondrial Function But Not Insulin Action in Adult Offspring of Mothers with Type 2 Diabetes

A close association between insulin resistance and reduced skeletal muscle oxidative capacity has been reported in adult offspring of people with type 2 diabetes (T2D), prompting a hypothesis that insulin resistance may result from mitochondrial dysfunction or vice versa. We determined whether 9 d of intensive exercise training ameliorates the mitochondrial dysfunction and insulin resistance in offspring of T2D. We compared the response to 9 d of intensive exercise training in eight (seven females, one male) healthy adult offspring of mothers with T2D with eight (six females, two males) nondiabetic controls. Skeletal muscle mitochondrial ATP production was assessed using a luciferase-based assay, and insulin sensitivity was measured using hyperinsulinemic-euglycemic clamps. Short-term intensive training increased skeletal muscle mitochondrial ATP production and citrate synthase activity similarly in both groups (P < 0.01). In contrast, whereas short-term intensive training reduced the fasting glucose (~5%, P = 0.035) and insulin levels (~40%, P = 0.011) as well as increased the glucose infusion rate during the hyperinsulinemic-euglycemic clamp (~50%, P = 0.028) among controls, no changes in these parameters were observed among offspring except for an increase in fasting glucose (~7%, P = 0.004). A short-term intensive exercise training program was equally effective at increasing skeletal muscle oxidative capacity in nondiabetic people and in the offspring of mothers with diabetes. In contrast, the exercise improved insulin sensitivity only in nondiabetic people but not in the offspring of T2D mothers, revealing dissociation between improvements in skeletal muscle mitochondrial function and insulin sensitivity. The exercise effect on mitochondrial function and insulin sensitivity seems to be mediated by different regulatory pathways.

Small-dense LDL and LDL glycation in metabolic syndrome and in statin-treated and non-statin-treated type 2 diabetes

Small-dense LDL (SD-LDL) has been particularly implicated in atherosclerosis. It has previously been reported that in non-diabetic people SD-LDL is preferentially glycated. The distribution of glycated apolipoprotein B (glyc-apoB) in lipoproteins in metabolic syndrome (MS) and in type 2 diabetes has not previously been studied. Plasma apoB and glyc-apoB were determined in different apoB-containing lipoproteins including buoyant and SD-LDL in MS (n=18) and type 2 diabetes (DM) [n=48; 12 statin-untreated (DM-S) and 36 statin-treated (DM+S)]. Plasma glyc-apoB was 5.6 ± 0.9, 3.5 ± 0.5 and 4.0 ± 0.2 mg/dl in DM-S, DM+S and MS, respectively. The glycated proportion of SD-LDL-apoB was greater than buoyant LDL in all groups. SD-LDL contributed most to plasma glyc-apoB in DM-S, because SD-LDL-apoB was higher in DM-S than in MS and DM+S (p < 0.001). Plasma glyc-apoB correlated with SD-LDL-apoB (r=0.74, p < 0.0001 in diabetes and r=0.53, p < 0.001 in MS), but not with HbA(1c). SD-LDL is preferentially glycated in type 2 diabetes and MS. Its concentration is a stronger determinant of plasma glycapoB than glycaemia. Statin-induced changes in its level may be important in decreasing apoB glycation in diabetes. These findings may explain the small effect of improving glycaemia relative to statin treatment in reducing atherosclerosis risk in type 2 diabetes and the increased risk in MS even before the onset of type 2 diabetes.

Mitiglinide: A Novel Agent for the Treatment of Type 2 Diabetes Mellitus

To review the pharmacology, pharmacokinetics, efficacy, and safety of mitiglinide, a rapid-acting insulin secretion-stimulating agent to determine its potential role in therapy for the treatment of type 2 diabetes mellitus. A MEDLINE search (1966-May 2010) was conducted for English-language, human studies using the terms mitiglinide, KAD 1229, S 21403, and meglitinide analogs. Abstracts presented at the American Association and European Association for the Study of Diabetes annual meetings from 2005 to 2009 were also evaluated for relevant data. Articles pertinent to the pharmacology, pharmacokinetics, efficacy, and safety of mitiglinide were reviewed. Mitiglinide has been shown through small clinical studies (N <400) to modestly decrease hemoglobin A(1c), postprandial hyperglycemia, and oxidative stress and inflammatory markers associated with postprandial hyperglycemia. Mitiglinide exerts its hypoglycemic activity by closing adenosine triphosphate (ATP)-sensitive potassium channels in the β-islet cells of the pancreas. This agent has a rapid onset and short duration of action, mimicking a physiologic pattern of insulin release in nondiabetic people. Studies suggest a starting dose of 5 mg 3 times daily with meals and a maximum dose of 20 mg 3 times daily. Overall, mitiglinide is well tolerated, with the most common adverse effect being hypoglycemia. Mitiglinide is the third agent in the class of meglitinides that targets postprandial hyperglycemia. Because of a more intensive dosing regimen, potential cost, and lack of studies assessing the clinical impact of mitiglinide therapy on oxidative stress and inflammatory markers secondary to postprandial hyperglycemia, we cannot recommend this therapy over currently approved therapies.

Correlation of diabetic corneal neuropathy and retinopathy

Abstract Purpose Corneal confocal microscopy is a rapid, non‐invasive and reiterative technique, suitable for the accurate detection and quantification of corneal subbasal nerve plexus. The aim of this study is to correlate corneal nerve fibre alterations with the abnormalities in the retina of diabetic patients and compare them with those of nondiabetic people Methods 278 diabetic corneas and 94 corneas of age‐matched control subjects were included in the study. Diabetic patients were further classified with respect to the stage of retinopathy, according to indirect fundoscopy, fundus photography and fluorescein angiography. The central corneas were scanned with HRT II and we estimated nerve fibre density (NFB) nerve branch density (NBD), nerve fibre length (NFL) and nerve fibre tortuosity (NFT). Finally, we made out the glycemic and lipidemic profile of patients. Results NFD values for control, NDR, NPDR and PDR groups were 31.27 ± 0.99, 27.35 ± 0.77, 23.67 ± 0.83 and 18.77 ± 0.77 respectively and NBD values were 45.12± 2.85, 39.86 ± 3, 30.56 ± 2.71 and 24.98 ± 2.08 respectively. NFL values for control, NDR, NPDR and PDR were 16.58 ± 0.55, 14.82 ± 0.56, 12.27 ± 0.49 and 10.41± 0.45 respectively and NFT values were 5.78 ± 0.28, 6.6 ± 0.52, 6.57 ± 0.22 and 7.02 ± 0.39 respectively. NFD, NBD, NFL were significantly reduced and NFT appeared to be higher in diabetic patients, according to the stage of diabetic retinopathy. The glycemic profile was analogue to the retina status, but the lipidemic one appeared to vary. Conclusion Alterations in corneal nerve plexus are apparent in diabetic patients and more pronounced in PDR.Corneal confocal microscopy could be a promising technique for the early diagnosis and treatment of diabetic neuropathy.

The Levels of Soluble CD40 Ligand and C-Reactive Protein in Normal Weight, Overweight and Obese People

Obesity has been suggested as an independent risk factor for cardiovascular disease. Increasing evidence shows that engagement of soluble CD40 ligand (sCD40L) with its receptor plays a crucial role in the pathogenesis of atherosclerosis. The aim of the present study was to test whether obesity is associated with low-grade systemic inflammation as measured by serum high-sensitive C-reactive protein (hsCRP) and sCD40L concentration. Serum hsCRP and sCD40L concentrations were measured in 148 nondiabetic people. The participants were divided into three groups depending upon their body mass index (BMI) levels: Group 1 (normal weight), BMI<25 kg/m(2); Group 2 (overweight), BMI 25 kg/m(2) to 29.9 kg/m(2); and Group 3 (obese), BMI>or=30 kg/m(2). Obese people had more elevated hsCRP levels than both their normal weight and overweight counterparts (P=0.000 and P=0.000, respectively). Similarly, serum concentrations of sCD40L were significantly higher, statistically, in obese subjects compared with normal weight subjects (P=0.003). In addition, obese subjects had higher values of sCD40L than overweight subjects, but the difference did not reach statistical significance (P=0.063). The levels of high-density lipoprotein cholesterol were significantly lower in obese subjects compared to normal weight subjects (P=0.048). The analysis of platelet count disclosed a statistically significant difference between obese subjects and normal weight subjects (P=0.028). The levels of BMI were positively correlated with the serum levels of hsCRP and sCD40L in all subjects (r=0.514, P=0.000 and r=0.283, P=0.000, respectively). Levels of hsCRP were positively correlated with waist circumference, fasting glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, leukocytes, platelets, systolic and diastolic blood pressure. Similarly, soluble CD40L levels were positively correlated with waist circumference, fasting glucose and leukocytes. Obese patients showed a significant increase of hsCRP and sCD40L levels compared with normal weight subjects, which might contribute to the known proinflammatory milieu found in these patients.

Association between glycemic index, glycemic load, and fructose with insulin resistance: the CDC of the Canary Islands study

The involvement of carbohydrates in triggering insulin resistance (IR) remains a source of controversy. To study the relation between glycemic index (GI), glycemic load (GL), and fructose with insulin resistance in a predominantly rural population in the Canary Islands. Cross-sectional study carried out in 668 nondiabetic people aged 18-75. IR was estimated with serum glucose and C-peptide (HOMA2-IR). Nutrient intakes were obtained from a validated food frequency questionnaire. ANOVA was used to analyze nutrient distribution across quartiles of HOMA2-IR. Four multivariate nutrient density models (dependent variable: log-transformed HOMA2-IR) which differed only in the kinds of carbohydrates included were tested (Model 1: carbohydrates; Model 2: GI and then GL; Model 3: free fructose, other simple sugars and starch; Model 4: total fructose, remaining sugars and starch). There was no association between GI and IR. There was a direct association between GL (P<0.001), fructose (free [P=0.001], total [P=0.013]), energy intake (P<0.001), fruit fiber (<0.001), and glucose (P=0.003) with IR. There was an inverse association between cereal (P=0.008) and vegetable fiber (P<0.001) and IR. Multivariate models corroborated the association of carbohydrates, GL, fructose, vegetable fiber, and energy intake with IR. The association between GL and IR disappeared when Model 2 was adjusted by total fructose intake. There was a direct association between fructose intake and IR. There was no relationship between GI and IR. Although a direct association of GL with IR was detected, it was attributable to the consumption of fructose.

Aspirin as antiplatelet agent in diabetes: Cons

Diabetes, and particularly type 2 diabetes, is becoming a global epidemic. Approximately 180 million people are affected worldwide and as many as 300 millions are expected to be affected in 2025 [1]. Dietary errors, little physical activity, obesity and the metabolic syndrome are the main causes of this epidemic. In men with type 2 diabetes the risk of cardiovascular disease is increased 2 to 3 times [2]. Diabetes has a disproportionate impact on woman health, with a risk of cardiovascular events that is much higher than that of men (a 5to 7-fold absolute increase) [3]. Even though macrovascular disease is due to the early occurrence of atherosclerosis with great severity and diffuse distribution, the ultimate mechanism in the development of cardiovascular events (myocardial infarction, ischemic stroke and peripheral arterial disease) is the formation of occlusive thrombi on vulnerable atherosclerotic plaques. Accordingly, antithrombotic drugs have been widely employed for primary prevention in at-risk people with type 2 diabetes. Among these drugs, antiplatelet agents are those most frequently used, whereas there is a paucity of data on other drugs such as vitamin-K antagonists and heparins. In 1998 the American Diabetes Association (ADA) recommended, in people with diabetes older than 40who had one ormore cardiovascular risk factor, primary prophylaxis with aspirin, i.e., the oldest, cheapest and most widely used antiplatelet agent [4]. This recommendation was jointly reiterated in 2007 by ADA and the American Heart Association (AHA), that identified as additional risk factors prompting primary prevention with aspirin a family history of cardiovascular events, hypertension, smoking, dyslipidemia and microalbuminuria [5]. Pertaining to aspirin dosages, ADA and AHA recommended 75 to 162 mg/day [5]. Unfortunately, there is more and more evidence that, in spite of the forementioned recommendations of ADA and AHA, the efficacy of aspirin in the primary prevention of cardiovascular events in type 2 diabetes is much smaller than that exerted in non-diabetic people. The guidelines recommending aspirin for primary prevention in diabetes were primarily extrapolated from the results obtained in the frame of trials carried out in people enrolled for being at high risk of cardiovascular disease, with very few studies exclusively and purposely carried out in diabetics. The first evidence of the limited efficacy of antiplatelet therapy with aspirin in the frame of primary prevention stems for the 2002 meta-analysis of the Antithrombotic Trialists' Collaboration (287 trials, 135.000 participants) [6]. The relative reduction of major cardiovascular events in the subgroup of diabetics (5126 participants) was only 7%, much less than that observed in other asymptomatic people at risk of cardiovascular events (22%). Another caveat on the limited efficacy of aspirin in diabetes was subsequently provided by the Primary Prevention Project, carried out in 4500 people aged 50 or more who had no overt cardiovascular disease but at least one risk factor [7]. According

Prevalence of Mitochondrial tRNA Gene Mutations and Their Association with Specific Clinical Phenotypes in Patients with Type 2 Diabetes Mellitus of Coimbatore

The association of mitochondrial DNA mutation with type 2 diabetes mellitus (T2DM) is well established. In this study we aimed to assess the frequency of A3243G, A8296G, and other mitochondrial mutations with reference to clinical features in the diabetic population of Coimbatore, India. The study group included 150 patients (89 women and 61 men) with T2DM, whereas the control group included 100 nondiabetic people (59 women and 41 men). Genotyping was done by polymerase chain reaction followed by single-strand confirmation polymorphism method. A3243G and A8296G mutations were found to be prevalent in patients with T2DM when compared with the control group. The A3243G mutation was found in two patients, and both these patients showed similar clinical characteristics, thus representing a putative clinical subtype. A8296G mutation was detected in one patient. The same mutation was shared with his mother who was diagnosed to have diabetes mellitus (DM) with neuromuscular disorder. The siblings of the patient did not show any symptoms of DM. Lipid profile and urea and creatinine levels were found to be significantly high (10% and 0.064%) in patients with T2DM compared with control subjects. We concluded that the identification of these mitochondrial point mutations indicates a new genetic predisposition of DM in Coimbatore population.

Visceral Fat Is a Strong Predictor of Insulin Resistance Regardless of Cardiorespiratory Fitness in Non-Diabetic People

Abdominal adiposity and low cardiorespiratory fitness are associated with insulin resistance in people with impaired glucose tolerance and type 2 diabetes. However, little is known about which factor precedes insulin resistance in people with impaired glucose tolerance and type 2 diabetes, and which is the stronger predictor of insulin resistance in non-diabetic people. The purpose of this study was to examine the relationship between insulin resistance and cardiorespiratory fitness, visceral fat, and subcutaneous fat in non-diabetic people. Subjects included 87 men and 77 women aged 30-72 y (mean+/-SD, 51.3+/-12.3 y). Cardiorespiratory fitness was assessed by measuring the maximal oxygen uptake (VO2max) in a progressive continuous test to exhaustion on a cycle ergometer. The visceral and subcutaneous fat areas were measured by magnetic resonance imaging. The homeostasis model assessment of insulin resistance (HOMA-R) was calculated from the fasting concentrations of glucose and insulin. Stepwise multiple linear regression analysis revealed that visceral and subcutaneous fat were significant correlates of HOMA-R, explaining 24% and 6% of the variance, respectively, whereas sex, age, and VO2max were not significant independent determinants. Abdominal fat deposition rather than cardiorespiratory fitness is a significant predictor of insulin resistance in non-diabetic people; visceral fat is the most important factor.

Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study

Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study

Circadian blood pressure variability in type 1 diabetes subjects and their nondiabetic siblings - influence of erythrocyte electron transfer

BackgroundNormotensive non-diabetic relatives of type 1 diabetes (T1D) patients have an abnormal blood pressure response to exercise testing that is associated with indices of metabolic syndrome and increased oxidative stress. The primary aim of this study was to investigate the circadian variability of blood pressure and the ambulatory arterial stiffness index (AASI) in healthy siblings of T1D patients vs healthy control subjects who had no first-degree relative with T1D. Secondary aims of the study were to explore the influence of both cardiovascular autonomic function and erythrocyte electron transfer activity as oxidative marker on the ambulatory blood pressure profile.MethodsTwenty-four hour ambulatory blood pressure monitoring (ABPM) was undertaken in 25 controls, 20 T1D patients and 20 siblings. In addition to laboratory examination (including homeostasis model assessment of insulin sensitivity) and clinical testing of autonomic function, we measured the rate of oxidant-induced erythrocyte electron transfer to extracellular ferricyanide (RBC vfcy).ResultsSystolic blood pressure (SBP) midline-estimating statistic of rhythm and pulse pressure were higher in T1D patients and correlated positively with diabetes duration and RBC vfcy; autonomic dysfunction was associated with diastolic BP ecphasia and increased AASI. Siblings had higher BMI, lower insulin sensitivity, larger SBP amplitude, and higher AASI than controls. Daytime SBP was positively, independently associated with BMI and RBC vfcy. Among non-diabetic people, there was a significant correlation between AASI and fasting plasma glucose.ConclusionsSiblings of T1D patients exhibited a cluster of sub-clinical metabolic abnormalities associated with consensual perturbations in BP variability. Moreover, our findings support, in a clinical setting, the proposed role of transplasma membrane electron transport systems in vascular pathobiology.

What is the clinical usefulness of the metabolic syndrome? The Casale Monferrato study

Data on the clinical usefulness of the metabolic syndrome with respect to cardiovascular risk are not conclusive. We have assessed this issue in a large population-based cohort of diabetic and nondiabetic people in Southern Europe. An Italian population-based cohort of 3729 individuals (2211 without diabetes and 1518 with diabetes) was examined, with centralized measurements, including the Homeostasis Model Assessment (HOMA) index in nondiabetic people. The usefulness of the metabolic syndrome (ATP III criteria) as an indicator of cardiovascular disease (CVD), independently of classical and novel risk factor [C-reactive protein (CRP) and albumin excretion rate (AER)] was assessed by using unconditional logistic regression. One thousand, seven hundred and fifty-three individuals (47.0%) had neither diabetes nor the metabolic syndrome, 458 (12.3%) had the metabolic syndrome only, 442 (11.8%) had type 2 diabetes only and 1076 (28.9%) had both diabetes and the metabolic syndrome. The highest likelihood of having CVD was conferred by both diabetes and the metabolic syndrome [odds ratio (OR) = 4.37, 95% confidence interval (CI) 3.25-5.87], independently of age, sex, low-density lipoprotein-cholesterol, smoke, AER, and CRP values. After further adjustment for its individual components, the association between CVD and the metabolic syndrome was no more evident. Among people with CRP 3 mg/l or less, ORs were similar in nondiabetic people with the metabolic syndrome and in diabetic people without it, whereas among those with CRP greater than 3 mg/l OR was two-fold higher in the latter. Values in upper quartiles of the HOMA-IR conferred a significant two-fold increased OR of CVD, even after adjustment for individual components of the metabolic syndrome, CRP and AER. The additional information provided by the metabolic syndrome is limited, in both diabetic and nondiabetic people, whereas the HOMA index is a useful indicator of CVD, independently of individual components of the metabolic syndrome, classical and novel risk factors.

Higher Vitamin D Guideline Expected Soon

Higher Vitamin D Guideline Expected Soon

Differences in trends in estimated incidence of myocardial infarction in non-diabetic and diabetic people: Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) registry

One major objective of the St Vincent Declaration was to reduce the excess risk of myocardial infarction in patients with diabetes mellitus. We estimated the trend of the incidence and relative risk of myocardial infarction in the diabetic and non-diabetic populations in southern Germany from 1985 to 2006. Using data from the Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) Project in southern Germany, we ascertained all fatal and non-fatal first myocardial infarctions between 1985 and 2006 (n = 14,891, age 25-74 years). We estimated the diabetic and the non-diabetic populations using data on diabetes prevalence from surveys, and evaluated incidence of myocardial infarction in the two estimated populations. To test for time trends, we fitted Poisson regression models. Of individuals with first myocardial infarction, 71% were male and 28% known to have diabetes. In the non-diabetic population, myocardial infarction incidence decreased by about 1.5% to 2.0% per year. A comparable decrease was seen in the population of diabetic women. However, in the population of diabetic men, incidence of myocardial infarction increased by about 1% per year. Over the whole study period, myocardial infarction incidence decreased by 34% and 27% in non-diabetic men and women respectively (RR 0.66, 95% CI 0.59-0.74 and 0.73, 0.62-0.87 respectively). In diabetic women, it decreased by 27% (RR 0.73, 0.61-0.88), whereas in diabetic men, it increased by 25% (RR 1.25, 1.07-1.45). Our results suggest that the St Vincent goal of reducing excess cardiovascular morbidity in diabetic individuals has not been achieved and that the situation in men has actually got worse.

Effects of oral magnesium supplementation on insulin sensitivity and blood pressure in normo-magnesemic nondiabetic overweight Korean adults

Background and aim Little is known about the effect of magnesium on insulin sensitivity and BP in healthy individuals. Therefore, we investigated whether magnesium could improve insulin sensitivity and blood pressure (BP) in normo-magnesemic nondiabetic overweight adults. Methods and results In a double-blinded, placebo-controlled, randomized trial, a total of 155 participants (BMI ≥ 23 kg/m 2) received either 12.3 mmol (300 mg) of elemental magnesium in the form of magnesium oxide ( n = 75) or placebo ( n = 80) each day for 12 weeks, constituting the intent-to-treat population. A repeated-measures ANOVA was used to evaluate the between-group changes in variables during the study. The baseline characteristics between the intervention and control groups were similar. There were no significant differences between the groups in the pattern of change of the homeostasis model assessment insulin resistance index, BP over time during the 12-week study. In subgroup analysis, magnesium supplementation ( n = 8, 27, and 24, respectively) lowered BP much more than placebo ( n = 16, 29, and 25, respectively) in those subjects whose systolic BP ≥ 140 mmHg, diastolic BP 80–90 mmHg, and diastolic BP ≥ 90 mmHg at the start of the study ( P = 0.016, 0.043, and 0.023, respectively); in comparison, those subjects whose initial BP reading was low at baseline did not show a change in BP. No significant adverse events related to magnesium supplementation were recorded. Conclusions These results suggested that magnesium supplementation does not reduce BP and enhance insulin sensitivity in normo-magnesemic nondiabetic overweight people. However, it appears that magnesium supplementation may lower BP in healthy adults with higher BP.

Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study

Since insulin resistance is thought to be the underlying mechanism for metabolic syndrome, affected individuals might be sensitive to a dietary sodium intervention. We aimed to examine the association between metabolic syndrome and salt sensitivity of blood pressure. 1906 Chinese participants without diabetes, aged 16 years or more, were selected to receive a low-sodium diet (51.3 mmol per day) for 7 days followed by a high-sodium diet (307.8 mmol per day) for an additional 7 days. Participants were excluded from the analysis if metabolic risk factor information was missing or if they did not complete their dietary interventions. Blood pressure was measured at baseline and on days 2, 5, 6, and 7 of each intervention. Metabolic syndrome was defined as the presence of three or more of: abdominal obesity, raised blood pressure, high triglyceride concentration, low HDL cholesterol, or high glucose. High salt sensitivity was defined as a decrease in mean arterial blood pressure of more than 5 mm Hg during low-sodium or an increase of more than 5 mm Hg during high-sodium intervention. This study is registered with ClinicalTrials.gov, number NCT00721721. Of the 1881 participants with information regarding metabolic syndrome, 283 had metabolic syndrome. 1853 participants completed the low-sodium diet and 1845 completed the high-sodium diet. Multivariable-adjusted mean changes in blood pressure were significantly greater in participants with metabolic syndrome than in those without on both low-sodium and high-sodium diets (p<0.0001 for all comparisons). Additionally, risk of salt sensitivity rose with increasing numbers of risk factors for metabolic syndrome. Compared with those with no risk factors, participants with four or five had a 3.54-fold increased odds (95% CI 2.05-6.11) of high salt-sensitivity during the low-sodium and a 3.13-fold increased odds (1.80-5.43) of high salt-sensitivity during the high-sodium intervention. These results suggest that metabolic syndrome enhances blood pressure response to sodium intake. Reduction in sodium intake could be an especially important component in reducing blood pressure in patients with multiple risk factors for metabolic syndrome.

Predictive value of ankle-brachial Index to peripheral vascular disease in elderly type 2 diabetic patients

Objective To evaluate the function of peripheral vessels, the change of ankle-brachial Index (ABI) and toe-brachial Index (TBI), and its related risk factors in elderly type 2 diabetic patients were observed. Methods Doppler frequency spectrum was used on lower limb of 128 type 2 diabetic patients and 103 non-diabetic people. ABI and TBI were calculated, other indexes including body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hypersensitivity C-reactive protein(hs-CRP), triglyceride (TG), total cholesterol (TC), high density lipopretein (HDL), low density lipoprotein (LDL), fasting blood glucose(FBG), postprandial blood glucose (PPBG) and glycosylated hemoglobin (HbAlC) were measured. Results ABI and TBI were decreased in T2DM group as compared with control group (P<0.05), and hs-CRP was increased in T2DM group. With multiple stepwise regression, it showed that ABI and TBI was negatively related with age, SBP and T2DM duration, while ABI was positively correlated with HDL. In multiple logistic regression, cigarette, age, high blood pressure(HBP) and T2DM duration were independent risk factors with respective odds ratios of 1.94 (P<0.05), 2.12(P<0.01), 2.74(P<0.05) and 1.59(P<0.05), respectively. Conclusion Older age, T2DM duration, ciga-rette, hyperglycosema, HBP, low HDL and high bs-CRP play important roles in the occurrence and development of peripheral vascular dis-ease (PVD) in elderly type 2 diabetic patients. PVD of type 2 diabetic patients can be found earlier with Doppler diagnostic instrument. Key words: Diabetic anglopathies/DI; Ankle; Humerus; Blood pressure determination

Myths about diabetes and its treatment in North Indian population

BACKGROUND:Myths prevailing about diabetes in the society have become a major hurdle for its proper treatment and control.AIM:To find out about various myths related to diabetes and its treatment in the population.MATERIALS AND METHODS:A cross sectional study was carried out in a teaching hospital of Delhi in 2008. 124 diabetic patients attending the regular diabetic clinic, 78 people who accompanied these patients and 214 non-diabetic people were included in the study. A pre-tested interview schedule with 48 questions was used to get information about sociodemographic characteristics and myths about diabetes. Data was analyzed by Epi info software version 3.2.RESULTS:The most common myth in the population (22%) was that eating more sugar causes diabetes. Others were: diabetes can only occur in old age, soaking feet in water can help control blood sugar, diabetes is a result of past sins and is cured by spiritual treatment. Myths were significantly more common in females, non-diabetics, less educated group. There was a slightly higher prevalence of myths in Muslim population. 12.1% of diabetics were taking herbal medicines. 15.9% of the diabetics and 26% of non diabetics were unaware that complications could occur if diabetes was uncontrolled. 18.5% of diabetics and 30.1% of non-diabetics were unaware about role of diet and lifestyle measures in control of diabetes.CONCLUSIONS:The prevalence of myths about diabetes is high in North Indian population which could be associated with poor early health seeking behavior and poor compliance with treatment.

On the origin of sensory impairment and altered pain perception in Prader–Willi syndrome: A neurophysiological study

Introduction High pain threshold is a supportive diagnosis criterion for Prader–Willi syndrome (PWS), but its pathogenesis is poorly understood. In this study we investigate sensory pathways in PWS, in order to evaluate peripheral or central involvement in altered sensory perception. Methods 14 adult PWS patients, 10 obese non-diabetic people and 10 age-matched controls underwent: (a) motor/sensory nerve conduction velocities at the upper and lower limbs; (b) palmar/plantar sympathetic skin response; (c) somatosensory evoked potentials from upper/lower limbs; (d) quantitative sensory testing to measure sensory threshold for vibration, warm and cold sensation, heat and cold-induced pain and (e) blood sample analysis to evaluate glucose and insulin levels and to calculate the quantitative insulin-sensitivity check index (QUICKI). Results Electroneurographic examination, sympathetic skin response and somatosensory evoked potentials were all within normal ranges. In the PWS group, thermal and pain thresholds but not vibratory were significantly higher than in healthy and obese people ( p < 0.05). Sensory threshold did not correlate with BMI nor with QUICKI. Conclusions Our data suggest that altered perception in PWS does not seem attributable to a peripheral nerve derangement due to metabolic factors or obesity. Impairment of the small nociceptive neurons of dorsal root ganglia or involvement of hypothalamic region may not be excluded.