Diabetes Research and Clinical Practice

2012-02-01

Managing diabetes in Asia: Overcoming obstacles and the role of DPP-IV inhibitors

2011-10-24

Abstract: Asia bears the world's greatest burden of type 2 diabetes (T2DM) and prevalence is increasing rapidly. Compared to other races, Asians develop T2DM younger, at a lower degree of obesity, suffer longer from its complications and die earlier. Curbing this epidemic requires an integrated, risk-based, and multidisciplinary approach. Inadequately managed T2DM has macrovascular and microvascular sequelae, Asians with T2DM being particularly susceptible to diabetic nephropathy. Earlier and more intensive monitoring and management of risk factors are required, especially for patients with, or at risk of, renal impairment. Particular challenges of T2DM management in Asia include: lack of access to specialist healthcare, insufficient clinical evaluation and delayed diagnosis. As in Caucasians, conventional treatment modalities are limited by deteriorating glycaemic control with disease progression and there is an unmet need for efficacious, safe, cost-effective and convenient pharmacotherapies for treating different stages of T2DM and preventing its complications, particularly in high-risk patients. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups. Such agents may play a significant future role in the management of T2DM.

Diabetologist's perspective on practice of evidence based diabetes management in India

Habib Hasan, Sanjay Zodpey, Abhay Saraf — 2011-10-17

Abstract: Diabetes demands early diagnosis, prompt treatment, continuous monitoring and follow up. Physicians play a pivotal role in diabetes management. However, evidence suggests that sub-optimal knowledge of guidelines and other issues may lead to ineffective management and poor patient outcomes. The aim of this research was to identify clinical diabetologist's perspectives on evidence based diabetes management, benefits of and barriers to the practice of evidence based guidelines in management of type 2 diabetes. Clinical diabetologists were administered a semi-structured questionnaire. Qualitative responses were analysed to identify key words, phrases and concepts from respondents. Majority of diabetologist (78.2%) preferred ADA guidelines alone or in combination with others guidelines where as 12.7% diabetologist follow all the guidelines on case by case basis. 27% and 25% diabetologists opined that guidelines ensure uniform standard of care across patient and achievement of diabetes management goals respectively. Poor awareness among physicians (22.7%), western guidelines being not applicable to Indian patients (22.7%), cost to patient (18.2%) were some of the barrier to practice of evidence based diabetes management. Some of the mechanism suggested to improve the practice of evidence based diabetes management included education of physicians in EBM (28.9%), making practice of evidence based guidelines legally binding (10.5%) and wider dissemination of existing guidelines (7.8%).

Life prolonging of disease management programs in patients with type 2 diabetes is cost-effective

A. Drabik, G. Büscher, P.T. Sawicki, K. Thomas, C. Graf, D. Müller, S. Stock — 2011-10-17

Abstract: Aim: Our objective was to examine the cost-effectiveness of disease management programs (DMPs) for type 2 diabetes mellitus (T2DM) taking into account their life prolonging effect.Methods: We compared real life costs in 19,888 propensity score matched pairs of T2DM DMP participants and T2DM patients in routine care (RC) according to sickness funds data. We estimated mean annual costs for survivors, last year of life costs for decedents, the influence of ageing on costs, incremental cost-effectiveness ratio and effects on hospitalization.Results: Annual costs for survivors were 3,318€ (DMP) and 3,570€ (RC). The mean costs in the last year of life were 16,911€ (DMP) and 15,763€ (RC). Ageing had a cost triggering effect for survivors (30€/36€ per year in DMP-/RC-group; p<0.001) and a cost decreasing effect in the last year of life (546€/483€ per year in DMP-/RC-group; p<0.001). The incremental cost-effectiveness ratio of the DMP vs. RC was −1396€ per life-year gained. Hospitalizations increased with age in case of survival and decreased with age in case of death but were always lower in the DMP-group.Conclusion: Despite increase in costs due to longer life DMPs are cost-effective.

The growth arrest-specific 6 (Gas6) gene polymorphism c.834+7G>A is associated with type 2 diabetes

Chien-Hsing Lee, Nain-Feng Chu, Yi-Shing Shieh, Yi-Jen Hung — 2011-09-28

Abstract: Aims: The plasma protein growth arrest-specific 6 (Gas6) is important to the inflammatory process and involved in the development of diabetic renal and vascular complications. Recently, Gas6 protein also represents a novel independent risk factor of type 2 diabetes. We further investigated the association of c.843+7G>A Gas6 polymorphism and type 2 diabetes.Methods: A total of 278 adults, including 96 with normal glucose tolerance (NGT), 82 with impaired glucose tolerance (IGT), and 100 with type 2 diabetes were recruited. All subjects were genotyped for c.843+7G>A Gas6 polymorphism.Results: Plasma Gas6 concentrations were significantly lower among patients with type 2 diabetes compared to subjects with IGT and NGT. Subjects with Gas6 c.843+7AA genotype had higher Gas6 levels and lower glucose values than GG genotype. The AA genotype and A allele were less frequent in patients with type 2 diabetes compared with NGT subjects. In univariate analysis, the AA genotype was found to be associated with a decreased risk for type 2 diabetes. Moreover, the association was even stronger after adjustment for established diabetes risk factors.Conclusions: The Gas6 c.843+7AA genotype and A allele are less prevalent in type 2 diabetes, which may have a protective role for type 2 diabetes.

Changes in dietary habits and their association with metabolic markers after a non-intensive, community-based lifestyle intervention to prevent type 2 diabetes, in Greece. The DEPLAN study

2011-09-28

Abstract: Aims: The aim of the present study was to evaluate the impact on dietary and activity habits of a non-intensive, community based lifestyle intervention for type 2 diabetes prevention, in high-risk Greek individuals.Methods: A total of 191 high-risk persons were invited to participate in a one-year lifestyle intervention program, consisting of six bi-monthly sessions with a dietician. The dietary aims of the intervention were: reduction of saturated fat, sugars and refined cereals intake and at least five servings of fruits and vegetables, daily. Demographic, dietary, anthropometric, medical and biochemical indices were recorded at baseline and at the end of the intervention.Results: The intervention was completed by 126 participants. At study end, participants reported decreased whole fat dairies and processed meats consumption (p=0.018 and 0.016, respectively), sugars (p=0.006) and refined cereals (p=0.045). Participants who improved their diet, decreased body weight (p=0.040), plasma triglycerides (p=0.020) and 2-h post-load plasma glucose (p=0.05) compared to those who had worsened their dietary habits. Total time spent daily on physical activity, remained unchanged throughout the intervention.Conclusions: The implementation of a group-based, non-intensive dietary counseling proved to be practical and feasible in “real-world” community settings and was accompanied by favorable dietary changes and health benefits.

Using a combined motivational and volitional intervention to promote exercise and healthy dietary behaviour among undergraduates

Ying Zhang, Richard Cooke — 2011-11-04

Abstract: Aims: This study tested the impact of combining a motivational intervention based on protection motivation theory (PMT, Rogers, 1983 ) plus a volitional intervention based on action planning and coping planning, as a way to promote the prevention of type 2 diabetes among UK undergraduates.Methods: Eighty-four participants were randomly assigned to either a control group or one of three experimental conditions: motivational intervention (PMT), volitional intervention (APCP), or combined motivational and volitional intervention (PMT&APCP). PMT variables, dietary and exercise behaviours were measured at three time-points over a four-week period.Results: The motivational intervention significantly changed PMT variables. The combined motivational and volitional intervention significantly decreased fat intake and increased the frequency of exercise relative to all other groups, and significantly increased the amount of fruit and vegetables consumed relative to control and volitional intervention groups.Conclusions: These results suggest that motivational intervention is effective at changing cognitions but changing behaviour requires an intervention based on both motivation and volition.

Health care professionals’ understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

K. Asimakopoulou, P. Newton, A.J. Sinclair, S. Scambler — 2011-10-31

Abstract: This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term ‘empowerment’, their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices – from leading them to the ‘right’ choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.

Association of pyruvate dehydrogenase kinase 4 gene polymorphisms with type 2 diabetes and metabolic syndrome

2011-10-24

Abstract: Aims: Pyruvate dehydrogenase kinase 4 (PDK4) plays a crucial role in glucose utilization and lipid metabolism by regulating the pyruvate dehydrogenase complex (PDC) and is an emerging therapeutic target for type 2 diabetes. To date, no study has specifically examined the relationship between PDK4 gene polymorphisms and type 2 diabetes or metabolic syndrome.Methods: The association of common single nucleotide polymorphisms (SNPs) was examined in PDK4 [−208A/G (rs10085637), IVS3+192C/T (rs3779478), IVS6+31A/G (rs2301630), IVS7+514A/G (rs12668651), IVS10+75C/T (rs10247649)] with type 2 diabetes and metabolic syndrome in 651 Korean subjects with type 2 diabetes and 350 nondiabetic Korean subjects. The association of these SNPs with clinical parameters related to metabolic syndromes including obesity, hyperglycemia, hypertension, and dyslipidemia was also examined.Results: No significant association was found between the studied SNPs and type 2 diabetes, metabolic syndrome, or clinical parameters. The PDK4 gene haplotype ACAGC showed a modest association with type 2 diabetes. However, the significance of this association was lost after considering for multiple comparisons.Conclusions: PDK4 polymorphisms may not be associated with type 2 diabetes or metabolic syndrome. Further studies utilizing a larger study population are required to confirm these results.

High-intensity aerobic training improves endothelium-dependent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus

2011-10-31

Abstract: Background: The aim of this study is to compare the effect of physical exercise program on the endothelial function of patients with metabolic syndrome and type 2 diabetes mellitus.Methods: Patients were randomized for high intensity aerobic training (HI: 80% maximum heart rate, n=10), low intensity aerobic training (LI: 55% of maximum heart rate, n=10) and control (n=11). Before and after 6 weeks of training, subjects performed the maximal exercise test and a study of the endothelial function, through a high resolution ultrasound of the brachial artery, which was assessed after reactive hyperemia (endothelium dependent vasodilation) and nitrate administration (endothelium independent vasodilation).Results: A total of 31 patients with metabolic syndrome and type 2 diabetes mellitus were studied, with mean age of 58±6 years, The percentage diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (HI before 2.52±2.85% and after 31.81±12.21%; LI before 3.23±3.52% and after 20.61±7.76%; controls before 3.56±2.33% and after 2.43±2.14%; p<0.05).Conclusions: High intensity aerobic training improved the functional capability and endothelium dependent vasodilator response, but it does not improve the endothelium independent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus.

Elevated micronuclei frequency in type 2 diabetes with high glycosylated hemoglobin

Suresh K.G. Shettigar, C. Shailaja, Ratnakar K. Kulkarni — 2011-11-11

Abstract: Aim: The role of oxidative damage to DNA due to hyperglycemia is well known. In the current study we have evaluated the induction of micronuclei due to increased glycosylation in type 2 diabetes.Methods: Forty-nine subjects divided into two groups of normoglycemic controls and type 2 diabetic cases were recruited in the study. Whole blood was cultured and micronuclei were scored in all the cases. This was correlated with age, sex, blood glucose levels and glycosylated hemoglobin.Results: Age and sex matched diabetic patients had an increased micronuclei frequency in response to elevated glycosylation of hemoglobin (R2=0.229, p=0.037) compared to normoglycemic subjects.Conclusion: The increased glycosylation seems to induce oxidative damage in the DNA of the diabetic patients, which manifests as an increased micronuclei frequency. This has a potential to be used as a biomarker for subsequent diabetic complications.

High free fatty acids level related with cardiac dysfunction in obese rats

Xiaodong Sun, Hua Pan, Huiwen Tan, Yerong Yu — 2011-11-16

Abstract: Aim: To determine whether reducing free fatty acids (FFAs) concentration has a protective effect on cardiac structure and function in high-fat-diet-induced obese rat.Methods: Sprague–Dawley rats were randomly divided into normal control, obesity and fenofibrate group. After 8 or 16 weeks, the maximum velocity of myocardial contraction (+dP/dt) and diastole (−dP/dt) were measured. The concentrations of triglyceride, FFAs and angiotensin II were measured. Mitochondrial cytochrome C release and protein levels of NF-kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) in myocardium were analyzed.Results: The triglyceride, FFAs and angiotensin II levels were significantly higher in circulating and myocardium in obese rats, associated with lipid deposition, increased mitochondrial cytochrome C release and protein levels of NF-κB and iNOS in myocardium. These alterations were reversed by fenofibrate, in parallel with improvement in +dP/dt, −dP/dt and ultrastructures of myocardial mitochondrion. The cardiac dysfunctions had negative correlation with intramyocardial lipid deposition, FFAs, angiotensin II, and protein levels of NF-κB and iNOS.Conclusion: Cardiac dysfunction of obese rats could be improved by reducing FFAs level. Intramyocardial lipid accumulation may increase the risk of heart failure in obese rats by increasing renin–angiotensin systems activity and protein levels of NF-κB and iNOS in myocardium.

HLA-DQB1 genotypes and islet cell autoantibodies against GAD65 and IA-2 in relation to development of diabetes post partum in women with gestational diabetes mellitus

2011-11-21

Abstract: Aims: To study HLA-DQB1 genes and islet cell autoantibodies against glutamic acid decarboxylase 65 (GADA) and insulinoma antigen-2 (IA-2A) in relation to diabetes post partum in mothers with diagnosed gestational diabetes mellitus (GDM).Methods: During 2003–2004, women undergoing a 75g oral glucose tolerance test (OGTT) during pregnancy were invited to participate in the Mamma Study. Cut-off level defining GDM was a 2-h capillary blood glucose of 7.8mmol/L. 1–2 years after delivery a 75g OGTT was performed, GADA and IA-2A were measured and HLA-DQB1 genes analysed. Data were available for 452 mothers with previous GDM and 168 randomly selected control subjects.Results: HLA-DQB1*0602 was negatively associated with GDM (p=0.033) and with development of diabetes post partum (p=0.017), whereas high risk HLA were not associated with GDM or with diabetes. The presence of GADA post partum was positively associated with diabetes post partum (p=0.0009), but not with impaired glucose tolerance.Conclusions: Mothers with GDM and HLA-DQB1*0602 were less likely to develop diabetes after pregnancy, and type 1 diabetes associated high risk HLA genes did not predict type 1 diabetes post partum. Additionally, GADA were positively associated with diabetes development.

Retinal microvascular calibre and risk of incident diabetes: The multi-ethnic study of atherosclerosis

2011-11-16

Abstract: Aim: To prospectively examine the association of retinal microvascular signs with incident diabetes and impaired fasting glucose (IFG) in a multi-ethnic population-based cohort.Methods: The multi-ethnic study of atherosclerosis comprised Caucasians, African-Americans, Hispanics and Chinese aged 45–84years. Retinal vascular calibre and retinopathy were quantified from baseline retinal photographs. Incident diabetes and IFG were ascertained prospectively.Results: After a median follow-up of 3years, 243 (4.9%) people developed diabetes and 565 (15.0%) developed IFG. After adjusting for known risk factors, participants with wider retinal arteriolar calibre had a higher risk of developing diabetes [HR: 1.60; 95% CI: 1.12–2.29, p=0.011 comparing highest with lowest arteriolar calibre tertile]. In ethnic subgroup analysis, the association between wider retinal arteriolar calibre and incident diabetes was stronger and statistically significant only in Caucasians [HR: 2.78; 95% CI: 1.37–5.62, p=0.005]. Retinal venular calibre and retinopathy signs were not related to risk of diabetes or IFG.Conclusion: Wider retinal arteriolar calibre is independently associated with an increased risk of diabetes, supporting a possible role for early arteriolar changes in diabetes development. This effect was largely seen in Caucasians, and not in other ethnic groups, and may reflect ethnic differences in susceptibility to diabetes from microvascular pathways.

Metabolic syndrome in adult cancer survivors: A meta-analysis

Hyun-Suk Jung, Seung-Kwon Myung, Byung-Su Kim, Hong Gwan Seo — 2011-11-11

Abstract: Background: Cross-sectional studies have reported inconsistent findings on whether the risk of metabolic syndrome is high among cancer survivors. We conducted a meta-analysis of cross-sectional studies.Methods: We searched MEDLINE (PubMed) and EMBASE in April 2010. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria.Results: Out of 257 articles meeting our initial criteria, 9 cross-sectional studies, which involved 6763 participants (1762 cases and 5001 controls) were included in the final analysis. Compared with the healthy control groups, the cancer survivors were at an increased risk of metabolic syndrome, in the random-effects meta-analysis of all 9 cross-sectional studies (OR=1.84; 95% CI=1.14–2.97; I2=80.5). In the subgroup meta-analysis by cancer type, a significant positive association was observed for hematologic malignancies, including ALL (acute lymphoblastic leukemia), AML (acute myelogenous leukemia), NHL (non-Hodgkin's lymphoma), and CML (chronic myelogenous leukemia) (OR=1.94; 95% CI=1.06–3.55; I2=68.1%), whereas no significant association was found for non-hematologic malignancies, including testicular tumor, prostate cancer, sarcoma, and epithelial ovarian cancer.Conclusions: Our meta-analyses of cross-sectional studies found that adult cancer survivors with hematologic malignancies were at an increased risk of metabolic syndrome.

Impact of introducing HbA1c into the diagnostic criteria on prevalence and cardiovascular risk profiles of individuals with newly diagnosed diabetes in Japan: The Toranomon Hospital Health Management Center Study 2 (TOPICS 2)

2011-11-21

Abstract: Objective: To evaluate the impact of HbA1c for diagnosis of diabetes and investigate whether cardiovascular risks profiles differ among individuals with diabetes diagnosed by HbA1c or fasting plasma glucose (FPG).Methods: This cross-sectional study involved 26,884 participants (30.6% women; aged 20–91 years) without known diabetes. Subjects were categorized into 4 groups according to the presence or absence of FPG ≥7.0mmol/L and/or HbA1c ≥6.5%, which were American Diabetes Association criteria. Oral glucose tolerance test data were not available.Results: Prevalence of undiagnosed diabetes was 3.6%. Of those individuals, 47.5% fulfilled both two criteria and 26.0% fulfilled only HbA1c criterion. Individuals with diabetes according to FPG ≥7.0mmol/L alone were characterized as having poorly controlled hypertension while those with HbA1c ≥6.5% alone were characterized as older, female, and having lower blood pressure and γ-glutamyltransferase values. Persons with newly diagnosed diabetes by HbA1c had low HDL cholesterol and high LDL or non-HDL cholesterol levels.Conclusions: Introducing HbA1c into the diagnosis allowed detection of many previously undiagnosed cases of diabetes in Japanese individuals. Those diagnosed by FPG were characterized by hypertension and those diagnosed by HbA1c had unfavorable lipid profiles, reflecting an atherosclerotic trait.

Validity evaluation of recently published diabetes risk scoring models in a general Chinese population

2011-11-30

Abstract: The study aimed to assess the validity of some recently published diabetes risk scoring models in a general Chinese population. In 2007, there was a re-examination of 711 individuals who were originally examined in 1992. Since 24 individuals had diabetes in 1992, 687 individuals were available for analysis. Validity was assessed with area under the receiver operating characteristic curve (AROC), and we assessed seven prospective and four cross-sectional models. When applied to our population, AROCs tended to be higher in Asian models than in non-Asian models (average AROCs 0.694±0.034 vs. 0.667±0.040, p=0.258), and those tended to be higher in prospective models than in cross-sectional models (average AROCs 0.695±0.028 vs. 0.652±0.042, p=0.072). A prospective model from Taiwan performed best (AROC 0.749; 95% CI 0.691–0.807). In conclusion, diabetes risk scoring models could not always be generalized from one population to another before validation. Asian models might be more suitable for Asian populations than non-Asian models, and prospective models might be more suitable for predicting future diabetes than cross-sectional models. When applied to our population, a prospective model from Taiwan performed best, and widespread application might be considered in the population.

Using Shiffman's political priority model for future diabetes advocacy

Ann Keeling — 2012-01-16

Securing political priority for diabetes has long been an issue for the global diabetes community. We have seen a ‘diabetes paradox’ on the international agenda; while the disease is epidemic in scale, constitutes a vast economic burden and leads to more deaths than AIDs and malaria combined, it has not commanded political attention or sufficient resources on the global stage. However, the recent focus on Non-Communicable Diseases (NCDs) has meant global health priorities are finally realigning with the reality of the burden of disease. IDF has led the campaign to address the chronic neglect of diabetes; after gaining political recognition that diabetes is a “chronic, debilitating and costly disease” with the 2006 UN Resolution on diabetes , IDF secured international political action with the UN Summit on NCDs in 2011. Despite taking diabetes to the highest global forum, however, political prioritisation of diabetes has yet to be fully realised – the disease remains underfunded and there is no widespread outrage about the extent of diabetes and the suffering caused. The complexity and idiosyncrasy of the global health agenda has attracted academic attention. To better assess the diabetes position and frame IDF's post-Summit advocacy priorities, this editorial looks at Shiffman's analysis of the features of a health issue that attract political priority on the global health agenda .

Contributing factors related to efficacy of the dipeptidyl peptidase-4 inhibitor sitagliptin in Japanese patients with type 2 diabetes

2011-09-07

Patients’ characteristics related to efficacy of sitagliptin were examined in 345 Japanese individuals with inadequately controlled type 2 diabetes whose baseline characteristics are shown in . Patients received sitagliptin 50mg/day for 24 weeks in addition to their existing diet therapy and other medications. We treated patients with sitagliptin at a dose of 50mg, the standard dose in Japan, because a previous study reported that HbA1c reduction by sitagliptin was not different when the drug was given at this dose versus at doses ≥50mg in Japanese patients with type 2 diabetes . The primary endpoint was HbA1c. This study is part of the Chikushi Anti-diabetes Trials (CHAT) program and was approved by Ethics Commission of Fukuoka University Hospital and Fukuoka University Chikushi Hospital. After 24-week sitagliptin therapy, HbA1c was significantly reduced versus baseline from 7.9±0.1% to 7.3±0.1% (p<0.0001). Stepwise multiple regression analysis of 301 patients in whom we had all information on sex, age, duration of diabetes, BMI, and baseline HbA1c revealed that higher baseline HbA1c (p<0.0001), lower body mass index (BMI) (p=0.0096), and shorter duration of diabetes (p=0.033) were significantly correlated to greater HbA1c reduction (). In addition, we found significant reductions of systolic blood pressure (from 133.0±0.9 to 130±0.7mmHg; p=0.001), diastolic blood pressure (from 75.2±0.7 to 73.4±0.7mmHg; p=0.0037), and LDL cholesterol (from 113.5±2.6 to 106.8±1.9mg/dl; p=0.0016). Treatment with sitagliptin 50mg/day for 24 weeks significantly lowered HbA1c in Japanese type 2 diabetic patients, especially in those with higher baseline HbA1c, lower BMI, and shorter duration of diabetes.

Comment on: Clinical application of best practice guidelines for genetic diagnosis of MODY2

2011-11-28

Clinical guidelines for molecular diagnosis of monogenic forms of diabetes have been recently published . Maturity-onset diabetes of the young (MODY) prevalence in Caucasian population is estimated to be less than 5% in patients with type 2 diabetes diagnosis .

Cervical necrotizing fasciitis and a descending mediastinal abscess caused by acute epiglottitis with diabetes mellitus: A life-threatening complication

Rongming Ge, Yong Mao, Xiao-lin Zhang, Shao-qiang Zheng — 2011-11-16

Abstract: Cervical necrotizing fasciitis and a descending mediastinal abscess of the neck following acute epiglottitis, life-threatening complications, is reported in a 43-year-old man with DM. The bacterial culture showed Peptostreptococcus anaerobius. The patient recovered after surgical debridement and broad-spectrum antibiotics therapy.

Management of gestational diabetes mellitus in a public hospital setting in India: Lessons from a minimalist approach

Abhishek Maiti, Koushik Nandi, Sudip Chatterjee — 2011-11-30

Abstract: We designed a safe minimalistic model of GDM management which could be conveniently implemented in resource-constrained settings in developing countries. Pregnancy outcomes in the normal controls and the treated GDM patients were similar. We showed that, with minimal care delivered in a consistent fashion it was possible to obtain excellent pregnancy outcomes.

Replication study of common variants in CDKAL1 and CDKN2A/2B genes associated with type 2 diabetes in Lebanese Arab population

2011-11-28

Abstract: We investigated the association of CDKAL1 (rs7754840 and rs7756992) and CDKN2A/2B (rs10811661) variants with T2DM. Higher MAF of rs7754840 and rs7756992 were seen in patients, and both were associated with T2DM under additive, dominant, and recessive models. CDKAL1 rs7754840 and rs7756992, but not CDKN2A/2B rs10811661, are associated with T2DM in Lebanese.

Effectiveness of a colour coded HbA1c graphical record in improving diabetes control in people with type 2 diabetes: A randomized control trial

S.S.L. Wong, C.J. Ng, S.M. Liew, N. Hussein — 2011-11-28

Abstract: We conducted a six-month randomized-controlled-trial to evaluate the effectiveness of a colour-coded HbA1c-graphical record in improving HbA1c level among type 2 diabetes patients. There was an improvement in the mean HbA1c knowledge score but the usage of the colour-coded HbA1c-graphical record did not produce reduction in the HbA1c level.

Diabetes Research and Clinical Practice

Contents

Managing diabetes in Asia: Overcoming obstacles and the role of DPP-IV inhibitors

Diabetologist's perspective on practice of evidence based diabetes management in India

Life prolonging of disease management programs in patients with type 2 diabetes is cost-effective

The growth arrest-specific 6 (Gas6) gene polymorphism c.834+7G>A is associated with type 2 diabetes

Changes in dietary habits and their association with metabolic markers after a non-intensive, community-based lifestyle intervention to prevent type 2 diabetes, in Greece. The DEPLAN study

Using a combined motivational and volitional intervention to promote exercise and healthy dietary behaviour among undergraduates

Health care professionals’ understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

Association of pyruvate dehydrogenase kinase 4 gene polymorphisms with type 2 diabetes and metabolic syndrome

High-intensity aerobic training improves endothelium-dependent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus

Elevated micronuclei frequency in type 2 diabetes with high glycosylated hemoglobin

High free fatty acids level related with cardiac dysfunction in obese rats

HLA-DQB1 genotypes and islet cell autoantibodies against GAD65 and IA-2 in relation to development of diabetes post partum in women with gestational diabetes mellitus

Retinal microvascular calibre and risk of incident diabetes: The multi-ethnic study of atherosclerosis

Metabolic syndrome in adult cancer survivors: A meta-analysis

Impact of introducing HbA1c into the diagnostic criteria on prevalence and cardiovascular risk profiles of individuals with newly diagnosed diabetes in Japan: The Toranomon Hospital Health Management Center Study 2 (TOPICS 2)

Validity evaluation of recently published diabetes risk scoring models in a general Chinese population

Using Shiffman's political priority model for future diabetes advocacy

Contributing factors related to efficacy of the dipeptidyl peptidase-4 inhibitor sitagliptin in Japanese patients with type 2 diabetes

Comment on: Clinical application of best practice guidelines for genetic diagnosis of MODY2

Cervical necrotizing fasciitis and a descending mediastinal abscess caused by acute epiglottitis with diabetes mellitus: A life-threatening complication

Management of gestational diabetes mellitus in a public hospital setting in India: Lessons from a minimalist approach

Replication study of common variants in CDKAL1 and CDKN2A/2B genes associated with type 2 diabetes in Lebanese Arab population

Effectiveness of a colour coded HbA1c graphical record in improving diabetes control in people with type 2 diabetes: A randomized control trial