International Journal of Diabetes in Developing Countries

Previous studies demonstrated that changes in lifestyle slow the progression of impaired glucose tolerance to overt diabetes but few trials examined the effect of diet alone without weight loss on the prevention of diabetes. We investigated the efficacy of two types of diet with different macronutrients, on preventing or delaying the onset of type 2 diabetes in subjects with either impaired fasting glucose or impaired glucose tolerance. Three hundred and twenty-two subjects with prediabetes were randomly assigned to a high monounsaturated fat diet, normal fat diet, or control groups and followed for 2 years. For calculating the daily energy requirement in subjects with BMI ≥ 25 kg/m2, the weight was adjusted with the use of 110% of the ideal body weight with no attempt for losing body weight. There was no difference in body weight decrease among the three groups after 2 years. The cumulative incidence of diabetes was 9.3% (95% CI, 3.6–14%) in the high monounsaturated fat diet (HMD) group, 13.2% (95% CI, 6.4–19%) in the normal fat diet (NFD) group, and 18.3% (95% CI, 10–25%) in the control group. The cumulative incidence of diabetes was 57% lower in the HMD group than that in the control group (95% CI, 0.1–0.9%; P = 0.03). This value was not significant in the NFD group (RR, 0.60; 95% CI, 0.2–1.2%; P = 0.1). Type 2 diabetes can be prevented by a high-monounsaturated fat, low-carbohydrate diet and receiving energy based on the adjusted ideal body weight without a weight loss program. Trial registration number: NCT02250066

Diabetes mellitus, a complex metabolic disorder, is a syndrome characterised by abnormalities in carbohydrate, lipid, and protein metabolism. Type 2 diabetes mellitus accounts for approximately 95 % of all cases of diabetes, and it usually affects people aged over 45 years. Without a proper diagnosis, these individuals are at significant risk for life-threatening and oral complications like xerostomia, increased incidence of caries, infection, poor healing and periodontal disease owing to structural modifications of salivary glands. Salivary diagnosis is an increasingly important field in dentistry, endocrinology, immunology and forensic medicine as a number of drugs, hormones and antibodies can be reliably monitored in saliva, which is an easily obtainable, noninvasive diagnostic medium and salivary composition may correspond to the systemic state of the patient rather than the oral health. Thus, this study was undertaken to determine the quantitative and qualitative changes of saliva in type 2 diabetes mellitus patients and to correlate the oral manifestations with the salivary disturbances. The study consisted of two groups, one control and one study group, each with 50 subjects. Sialometry and sialochemistry of all salivary samples were carried out and oral manifestations recorded. The observations of the study were subjected to statistical analysis using SPSS software version 12. Sialometry showed a significantly lower salivary flow rate and higher occurrence of oral manifestations in the diabetics. From the clinical standpoint, it may be reasonable to conclude that sialometry and sialochemistry can be a useful indicator of progression of diabetes mellitus.

Several studies have demonstrated the benefits of vegetable oil on cardiovascular risk factors in diabetes. The goal of the present study was to compare the effects of olive, almond and walnut oil on serum glucose, lipids and blood pressure in type 2 diabetic patients. In this cross over clinical study 24 hypercholesterolemic type 2 diabetic patients were recruited. Subjects consecutively assigned to consume 40 cc olive, almond and walnut oil daily over a 4-week period with a two-week washout period, accompanied by the Step I diet. Anthropometric measurements, HbA1c, lipid profile and serum glucose and blood pressure were measured initially and at the end of the study. Serum levels of total cholesterol (TC) and LDL-cholesterol at baseline and at the end of trial differed significantly after olive oil (P = 0.007, P = 0.02) and triglyceride (TG) after almond oil (P = 0.02). When the differences of these laboratory levels between olive, almond and walnut were tested, no significant differences were found. Our findings showed olive oil could reduce significantly serum levels of TC and LDL. Almond consumption could decrease TG significantly. Our research could not show significant reduction in blood pressure.

Heart rate-corrected QT (QTc) interval is associated with increased risk for cardiovascular events and mortality among individuals with diabetes mellitus (DM). Little is known about the epidemiology of prolonged QTc among people with DM in resource-limited settings. We conducted a cross-sectional study among adults with diabetes in ambulatory care at the Mbarara Regional Referral Hospital, from November 2018 to April 2019. Twelve-lead ECG recordings were performed on all participants. We collected clinical and laboratory data related to diabetes disease status and treatment control. We estimated QTc using Bazett’s formula and categorized it according to standardized sex-adjusted thresholds. Linear regression analysis was performed to identify correlates of QTc. We recruited 299 participants with a mean age of 50.1 years (SD±9.8) and mean HbA1c of 9.7 % (SD±2.6), and 69.6% were female. We detected prolonged and borderline QTc in 6.4% (19/299, 95% CI: 3.9–9.7%) and 23.4% (70/299, 95% CI: 18.7–28.6%) of participants, respectively. In multivariate models, factors associated with increasing QTc interval were mean arterial pressure (β=0.34; 95% CI: 0.07–0.63, p=0.019) and female sex (β=15.26; 95% CI: 7.58–22.94, p<0.001). The prevalence of abnormal QTc among individuals in routine diabetes care in southwestern Uganda was high. Female sex and mean arterial pressure were correlated with QTc interval. Given these findings, future studies should explore the clinical impact of abnormal QTc in this patient population.

The present study tested the hypothesis that simple variables, such as waist circumference, hypertriglyceridemia (eTG), and hypertriglyceridemic waist (eTGWC) phenotype could be used as screening tools for the identification of those at high risk in hypertension (HT) and type 2 diabetes mellitus (T2DM). Based on data from our health survey, check of 4206 participants (997 men and 3209 women) were 420 (42.1 %) and 2394 (74.6 %) AO men and women, 370 (37.1 %) and 1340 (41.8 %) eTG men and women, and 236 (23.7 %) and 1131 (35.2 %) eTGWC men and women. We demonstrated that AO, eTG, and eTGWC phenotype associated with increased risk of HT and T2DM. In men, the largest area under curve (AUC) of the receiver operating characteristic (ROC) curves demonstrated that AO was the best marker for HT and eTG was the best marker for T2DM in men, while eTGWC was the best marker for both HT and T2DM in women. In conclusion, it is suggested AO may serve as the early phenotype-associated sequel to eTG reach to eTGWC. Waist circumference measurements and fasting triglycerides can serve as inexpensive screening tools for HT and T2DM to identify those at high risk of HT and T2DM.

This paper aims to investigate whether there is a relationship between left atrial diameter (LAD) and target organ damage (TOD) in patients with type 2 diabetes mellitus (DM). Two-hundred-and-eleven patients with type 2 DM were recruited. Data on left ventricular mass index (LVMI), diabetic retinopathy, carotid intima–media thickness/carotid plaque, micro-albuminuria, and serum creatinine levels were collected to determine whether TOD occurred in patients with type 2 DM. Age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were used to assess cardiovascular disease risk. Patients were divided into four groups: zero TOD (group I, n = 50), one TOD marker (group II, n = 76), two TOD markers (group III, n = 51), and at least three TOD markers (group IV, n = 34). Using multivariate regression analyses, age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were significantly associated with LAD. LAD was associated with an increased number of markers for TOD. Univariate analyses demonstrated significant relationships between LAD and TOD in the context of serum creatinine and urinary albumin creatinine ratio (r = 0.292, p < 0.001), creatinine (r = 0.346, p < 0.001), carotid intima–media thickness (r = 0.128, p = 0.032), and LVMI (r = 0.399, p < 0.001). Multivariate regression analyses also determined that LVMI and creatinine were independent predictors of LAD enlargement. LAD may be associated with cardiovascular disease risk. LAD enlargement could be an effective indicator of TOD, particularly renal impairment and left ventricular hypertrophy. Screening for LAD may offer a new and rapid approach for evaluating the severity of DM.

As a clinical and non-invasive tool, the AGE Reader measures skin autofluorescence (SAF) to estimate the accumulation of advanced glycation end products (AGEs) in the skin. Accumulation of AGEs has been implicated in several inflammation-associated diseases, including diabetes and cardio-metabolic diseases. This study aimed to assess SAF in subjects with and without cardiovascular risk (CVR) factors and examine the association between SAF and various bio-clinical parameters. In a cross-sectional study, we included 250 participants between 19 and 86 years of age divided into two groups: a healthy group (n = 88) and subjects with CVR factors (n = 162 in total, diabetes n = 48, hypertension n = 62, and both n = 52). We assessed skin AGE measures and biological and clinical data. SAF was significantly higher in subjects with CVR factors than in healthy participants (2.42 ± 0.38 vs 1.90 ± 0.29 respectively; p < 0.001). SAF was associated with age, gender, BMI, duration of diabetes, HbA1c, triglyceride, and obesity. Multivariate analysis showed that age and duration of diabetes were the independent determinants of SAF. The ROC analysis indicated that a SAF > 2.25 AU was the optimal cut-off point to predict the presence of diabetes and/or hypertension and dyslipidemia (p < 0.001). This Tunisian population-based study shows an increased SAF level in subjects with diabetes and/or hypertension and dyslipidemia compared to healthy subjects. The AGE Reader device is a rapid and non-invasive tool in clinical practice to evaluate and screen CVR factors in Tunisia with a North African phototype.

Metformin is considered as a backbone therapy for type 2 diabetes (T2DM) management. Many patients need treatment with combination therapy. In India, multiple fixed-dose combinations with metformin are available. The study was done to compare the efficacy and safety of sitagliptin plus metformin combination versus metformin and sitagliptin monotherapy in newly diagnosed T2DM subjects. This was an open-label, randomized, parallel group, prospective and single centre study, in 60 subjects with T2DM. The subjects received either metformin 500 mg, sitagliptin 50 mg or fixed-dose combination of metformin 500 mg plus sitagliptin 50 mg. All study medicines were given twice daily for 12 weeks. Glycaemic control (HbA1c, fasting and postprandial blood glucose) and body mass index (BMI) were evaluated as efficacy parameters while safety was evaluated by reporting adverse events. Significant reduction in HbA1C level was seen in all three groups (P = 0.0001). HbA1C reduction was significantly higher in the combination group compared to metformin monotherapy (P = 0.0072). Fasting blood glucose (FBG) level reduced significantly in all three groups (P = 0.0001). The reduction in fasting blood glucose was significantly higher with combination compared to sitagliptin monotherapy (P = 0.0060). Postprandial blood glucose (PPG) also reduced significantly in all three groups (P = 0.0001). The reduction with sitagliptin was statistically higher compared to metformin (P = 0.0155). The combination treatment resulted in significantly higher reduction of PPG compared to sitagliptin monotherapy (P = 0.0160). Body mass index reduced significantly in all three groups (P = 0.0001). Reduction in BMI was significant with combination treatment compared to sitagliptin monotherapy (P < 0.05). Overall, study medications were well tolerated. The incidence of adverse event was 11.7 %. No serious adverse event was reported in the study. In newly diagnosed, drug naïve, type 2 diabetes mellitus management, fixed-dose combination of sitagliptin plus metformin is effective and well tolerated. Due to its multiple benefits, it can be used as a suitable option for selected subjects requiring combination therapy in type 2 diabetes mellitus.