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The Global Burden of Diabetes: An Overview

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Abstract

Diabetes is an enormous and growing clinical and public health problem. In 2015, the International Diabetes Federation (IDF) estimated that 415 million adults had diabetes and that, by 2040, the number will increase to 642 million. The financial burden of diabetes is also huge. In 2015, the IDF estimated that most countries devote 5–20 % of total healthcare expenditures to diabetes. Global spending to treat diabetes and its complications was estimated to be $673 billion in 2015 and is projected to increase to $802 billion by 2040. Population-level interventions are needed to address the obesogenic and diabetogenic environment and targeted lifestyle, and possibly medication interventions are needed for diabetes prevention. The relative benefits and costs of interventions to prevent type 2 diabetes, to treat people with diabetes, and to address long-term complications and comorbidities must be assessed at international, national, and local levels. Research must focus on how best to implement diabetes prevention and treatment with limited resources in diverse populations and settings.

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... Alors que l'on estime son taux dans les régions de l'Ouest du Pacifique ainsi que de l'Amérique du Nord et des Antilles à plus de 10 % de la population, on l'estime par contre à près de 6% en Europe (Saeedi et al. 2019). Outre ces disparités régionales, l'on observe de surcroît des distinctions marquées chez les Peuples autochtones qui font parties des populations les plus à risque (WHO and IDF 2004;Yu and Zinman 2007;Herman 2017;Crowshoe et al. 2018a;Creatore et al. 2020). ...
... In Canada, the prevalence of chronic diseases, such as type 2 diabetes (T2D) and obesity are on the rise (Rosella et al. 2015;Statistique Canada 2020). Although recent evidence suggests that the global incidence of diabetes is slowing down (Sinclair et al. 2020;Fuentes et al. 2020), there are, nonetheless, large health inequities between Indigenous Peoples and the general population (Young et al. 2000;WHO and IDF 2004;Yu and Zinman 2007;Oster et al. 2014;Herman 2017;Crowshoe et al. 2018b;Creatore et al. 2020 Historical factors associated with colonization have been linked to social determinants that contribute to a disproportionately higher burden of chronic health problems like T2D among First Nations (Roy 1999;Adelson 2005;King et al. 2009;Jacklin et al. 2017;Voaklander et al. 2020). ...
... In addition to these regional disparities, there are also marked distinctions among Indigenous Peoples who are among the populations most at risk (WHO and IDF 2004;Yu and Zinman 2007;Herman 2017;Crowshoe et al. 2018b;Creatore et al. 2020). This is particularly true (Arnason et al. 1981; 2004; Moerman 2009;Uprety et al. 2012 healthcare users and that such differences decrease with a higher presence of Indigenous workers in the healthcare system. ...
Thesis
Les Peuples autochtones à travers le monde sont disproportionnellement touchés par le diabète. Parmi ces peuples, les Cris d’Eeyou Istchee et les Pekuakamilnuatsh, au Québec (Canada), ainsi que les Parikwene, en Guyane française (France), recourent à leur médecine locale pour soigner cette maladie. En 173 entrevues semi-dirigées, 208 participants venant de ces communautés et/ou travaillant dans leurs services de santé ont décrit ces médecines. Une méthode de recherche mixte, combinant des analyses thématiques à des statistiques multivariées, est développée pour analyser ces descriptions.Ces analyses ont montré que les participants cris, ilnu et parikwene décrivent leurs médecines en lien avec le diabète tant par les différents éléments du monde naturel, que les pratiques et coutumes locales qui en découlent, que les concepts les liant au territoire. Les pharmacopées à base animales et végétales font parties des thèmes les plus discutés. Plus de 381 espèces (109 animaux, 267 plantes, cinq lichens et champignons) lient les systèmes médicinales et alimentaires ensemble via des notions associées au bien-être ou aux propriétés organoleptiques. Au Québec, là où la population autochtone est plus impliquée dans les services de santé, il existe un rapprochement de la description des médecines locales entre le secteur de la santé et ses usagers.De façon générale, la place de l’alimentation dans les médecines locales ne peut être négligée dans le contexte du diabète. De plus, ces médecines sont indissociables du territoire qui offre un espace de guérison, de subsistance, et de continuité culturelle. Cela renvoie, in fine, à des questions importantes sur la reconnaissance des droits autochtones et des droits fonciers.
... Diabetes mellitus is a major health problem all over the world. 1 International Diabetes Federation estimated that about 415 million people were diagnosed as having diabetes mellitus in 2015. 1 It is estimated that the incidence will increase to about 642 million by the end of 2040. 1 This will lead to massive increase in morbidity and mortality due to complications related to diabetes mellitus. 2 ...
... Diabetes mellitus is a major health problem all over the world. 1 International Diabetes Federation estimated that about 415 million people were diagnosed as having diabetes mellitus in 2015. 1 It is estimated that the incidence will increase to about 642 million by the end of 2040. 1 This will lead to massive increase in morbidity and mortality due to complications related to diabetes mellitus. 2 ...
... Diabetes mellitus is a major health problem all over the world. 1 International Diabetes Federation estimated that about 415 million people were diagnosed as having diabetes mellitus in 2015. 1 It is estimated that the incidence will increase to about 642 million by the end of 2040. 1 This will lead to massive increase in morbidity and mortality due to complications related to diabetes mellitus. 2 ...
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Objectives: To determine association of iron deficiency anemia on hba1c level in diabetic patients. Study Design: Cross Sectional Analytical study. Setting: Department of Pathology PIMS Hospital. Period: From June 2018 to December 2018 (6 months duration). Material & Methods: A total of 117 diagnosed cases of diabetes mellitus were included in the study. Pregnant women, patients with end-stage renal disease, hypothyroidism, +hemoglobinopathies, hemolytic anemia, chronic liver disease and malignancy, participants with poorly controlled diabetes, and patient from the northern areas were excluded from the study. Patients were divided according to their fasting plasma glucose (FPG) level. FPG of 126mg/dl was used as a cut-off point for dividing the study population into two groups, i.e controlled sugar level (FPG between 100 and 126 mg/d L) and well controlled sugar level (FPG less than 100 mg/d L). Variables such as Hemoglobin, serum ferritin, serum Hba1c level etc. Results: Mean age of study population in the present study was 56.97±7.29 years. Out of 117 cases, about 45(38.5%) cases were female and 72 (38.5%) were male. Male to female ratio was 1: 1.6.Mean FPG level was 103.3±7.6 in our study population. The mean hba1c levels in the sample was 6.42±0.70 %. Mean Hb levels were recorded as 11.5±2.7 and 10.9±3.03 g/dl, respectively in female and male. From a total of 117 cases, only 66 were identified as having iron deficiency anemia. Only 54 patients had plasma glucose greater than 100 mg/dl. Odds ratio for hba1c>6.5% in iron deficient was 3.90(p=0.001). Conclusion: Iron deficiency can cause elevated serum hba1c level. Health care providers, including physicians, must consider the iron status before prescribing diabetics treatment on the basis of serum hba1c level.
... Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 108 million cases in 1980 7 to 415 million in 2017 .Based on current trends, the IDF projects that 642 million individuals will have diabetes by the year 7 2040 . NAFLD is strongly correlated with insulin-resistant states such as obesity, metabolic syndrome, and type 2 diabetes mellitus(T2DM). ...
... Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 108 million cases in 1980 7 to 415 million in 2017 .Based on current trends, the IDF projects that 642 million individuals will have diabetes by the year 7 2040 . NAFLD is strongly correlated with insulin-resistant states such as obesity, metabolic syndrome, and type 2 diabetes mellitus(T2DM). ...
Article
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries and now becoming in developing countries also. Central Obesity and sedentary life style is usually associated with NAFLD.There are a lot of study has been done regarding prevalence of NAFLD in diabetes but lesser study available for prediabetes. In different studies reviewed by us, prevalence of NAFLD in diabetic subjects has been reported to range from 26.5% to 86.7%1,2,3. In prediabetic patients this prevalence has been seen to range from 48.24% to 68%4,5,6. OBJECTIVE: To assess the prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in prediabetes and diabetes patients. RESEARCH DESIGN AND METHODS: A cross sectional study was conducted at SRN Hospital, Prayagraj. A total of 100 prediabetic and 100 diabetic patients were enrolled in the study. Patients on the basis of HbA1c(glycated hemoglobin) are divided in to two groups, prediabetic and diabetic group. Patients with known case of liver disease, taking steroid and regular alcohol intake were excluded from study. Ultrasonography B mode used for detection of fatty liver inltration and their grading. RESULT: Prevalence of NAFLD was 48% in prediabetic and 54% in diabetic group. In prediabetic group, 32% had grade 1, 13% had grade 2 and 3% had grade 3 NAFLD whereas in diabetic group 34% had grade 1, 18% had grade 2 and 2% had grade 3 NAFLD. In the present study, we found that diabetic patients as compared to pre-diabetic patients were signicantly older, had a higher proportion of males and higher BMI(Body mass index). Conclusion: There was no signicant difference between two groups for association of NAFLD and its severity. Higher BMI is associated with higher chances to get NAFLD and diabetes mellitus in future.
... Specifically, the phytochemical composition of myrtle berries is characterized by the dominant presence of anthocyanins, which confer the purple-dark color to the fruits and contribute to the health effects of myrtle, thanks to their antioxidant, anti-inflammatory, antitumoral, and lipid-lowering effects, among others (Afrin et al., 2020;Battino et al., 2019;Forbes-Hernandez et al., 2020). In myrtle berry, these bioactive compounds are mainly represented by delphinidin 3-O-glucoside, F I G U R E 2 Most common monoterpenes and sesquiterpenoids found in myrtle-derived essential oils petunidin 3-O-glucoside, malvidin 3-O-glucoside, and peonidin 3-Oglucoside, followed by cyanidin 3-O-glucoside, delphinidin-pentose, and petunidin-pentose Montoro et al., 2006;Pereira, Cebola, Oliveira, & Gil, 2016, 2017Sarais et al., 2016;Scorrano et al., 2017;Siracusa et al., 2019) (Figure 3; Snoussi et al., 2012;Tuberoso et al., 2010). ...
... Diabetes mellitus is a metabolic disorder, caused by serious defects in carbohydrate and lipid metabolism and characterized by chronic insulin resistance and hyperglycemia. In the last years, its incidence has grown vertiginously: 415 million adults had diabetes in 2015 and it is expected to reach 642 million within 2040 (Herman, 2017 (Olfert & Wattick, 2018). In the case of myrtle, some few reports have evaluated the antidiabetic effects of its berries, leaves, and essential oils in different experimental animal models (Table 5). ...
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Myrtle (Myrtus communis L.) is a typical plant of the coasts of Mediterranean area, which grows spontaneously as a shrub or a small tree. Myrtle berries, leaves, seeds, and essential oils are natural sources of several nutrients and bioactive compounds with marked health effects. In the ancient medicine, it has been indeed used for treating several common diseases, including gastrointestinal, urinary, and skin disorders, whereas currently it is widely employed in food, cosmetic, and pharmaceutical industries. This review aims to describe the nutritional and the phytochemical compositions of different parts of myrtle plant, as well as their antioxidant activities. In addition, several in vitro, in vivo, and ex vivo studies are also presented to give a general overview of the potential effects of myrtle on human health. Finally, a critical analysis of the limitations related to the current research on myrtle is given.
... Criteria for clinical identification of the metabohc syndrom e are shown in Table 1. There are currently 151 million people worldwide with clinically diagnosed diabetes (Amos et al., 1997;King et al., 1998;Trevisan et al., 1998;Zimmet et al., 1991Zimmet et al., & 2001. Of these, 4.9 million people are estimated to be suffering from type 1 diabetes (Amos et a l, 1997). ...
... Type 2 diabetes affects 5-7% of the population and is most common in middle and old age, occurring only very occasionally in young adults (Harris, 1995;King et al, 1998). The greatest prevalence of type 2 diabetes is found among Pima Indians and Micronesians living on Nauru Island in the Central Pacific (LiUioja, 1996;Trevisan et a l, 1998). ...
Thesis
Aims/Hypothesis: Oxidative stress has been implicated in the development of diabetic neuropathy. The objective of this study was to establish if type 1 or type 2 diabetes in the presence of polyneuropathy (PNP) and/or cardiovascular autonomic neuropathy (CAN) is associated with alterations in plasma and urinary measures of oxidative stress. Studied population: Diabetic patients (n=185; type1: n=61 and type 2: n=124) were recruited. Of these, 60 patients were without PNP and CAN, 103 patients with PNP but without CAN and 22 patients with PNP and CAN. Non-diabetic subjects (n=70) were employed as controls. Methods: Plasma and urinary 8-epi-PGF2α and its metabolites were measured by gas- chromatography/mass-spectrometry. Plasma total antioxidant capacity (TAC) was assessed by quenching of peroxiynitrite Pholasin® chemiluminescence (peroxynitrite-QPC), quenching of superoxide anion Pholasin® chemiluminescence (superoxide anion-QPC) and quenching of hypochlorous acid Pholasin® chemiluminescence (hypochlorous acid-QPC). Plasma vitamin C was assayed spectrofluorometrically. Plasma vitamin E was determined by HPLC with fluorometric detection. Results: Type 1 diabetic patients (PNP-/CAN-) had lower TAC (peroxynitrite-QPC, superoxide anion-QPC), vitamin C levels, vitamin E cholesterol/ratios, and 8-epi-PGF2α concentrations than in control subjects. Lower TAC (superoxide anion-QPC) and increased 8-epi-PGF2α concentrations were seen in the presence PNP. The additional presence of CAN was associated with further reductions in TAC (peroxynitrite-QPC and superoxide anion-QPC) and vitamin E/cholesterol ratios. Type 2 diabetic patients (PNP-/CAN-) exhibited lower TAC (peroxynitrite-QPC, superoxide anion-QPC), and vitamin E cholesterol/ratios compared to control subjects. Lower TAC (peroxynitrite-QPC and superoxide anion-QPC), vitamin C levels and vitamin E/cholesterol ratios, and increased 8-epi-PGP2α concentrations were observed the presence of PNP. Lower TAC (superoxide anion-QPC) was seen in the presence of additional CAN. Correlations occurred between neurological impairment score of the lower limb (NIS-LL) and peroxynitrite-QPC, superoxide anion-QPC as well as vitamin C levels. Multiple regression analysis revealed that peroxynitrite-QPC was independently associated with the neurological impairment score of the lower limb. Urinary 8-epi-PGF2α and its metabolites levels were lower in diabetic patients than in control subjects. However, no firm conclusion could be drawn concerning urinary 8-epi-PGF2α and its metabolites because the results exhibited substantial variability. Conclusions: This study has revealed that oxidative stress is enhanced in diabetic patients (PNP-/CAN-). Oxidative stress was more pronounced in patients with PNP and that the additional presence of CAN was without influence. Measurement of TAC, as assessed by peroxynitrite-QPC or superoxide anion-QPC, was superior in the terms of simplicity, cost and diagnostic value to nutrient antioxidants and lipid-oxidation products in assessing oxidative stress. These results indicate improved strategies for patient selection for clinical trials involving antioxidants aimed at the prevention or treatment of diabetic neuropathy.
... Non-communicable diseases, including Diabetes Mellitus, are on the rise globally. 1 A drift of lifestyle from rural to urban, with decreased physical activity and increase in consumption of fatty diets has contributed to an increase in Type 2 diabetes. 2 Simultaneously, the rapid surge of obesity worldwide has made it a pandemic, with several people being overweight or obese. ...
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Objective: To find prevalence of obesity, diabetes and pre-diabetes and its association with non-communicable diseases in a local community of Mughalpura, Lahore. Methodology: A cross-sectional study was conducted at Mughalpura Division, Lahore, Pakistan from January to June, 2021. The demographic details and data on blood sugar levels were collected from 380 participants using cluster sampling. Blood sugar ratio level was obtained as a key factor for observing diabetes and pre-diabetes. A test of association was used to observe the significant relation between diabetes with Basal Metabolic Index. Results: The average age of the participants was 46.0 + 12.6 SD (in years). Almost two-third of the participants were female and majority of participants were Punjabi. Among the total participants , 293 (77.1%) had normal blood sugar level, whereas 25 (6.6%) were pre-diabetic and 62 (16.3%) were diabetic. The underweight participants were 10 (2.6%), 86 (22.6%) were normal, 143 (37.6%) were overweight and 141 (37.1%) were obese. Conclusion: High prevalence of diabetes among obese individuals was found in a poor community of Mughalpura. Most of them were obese females. Significant association was found between systolic hypertension, diabetes and obesity .
... The global epidemic of diabetes imposes significant burdens on health care systems [1]. The International Diabetes Federation estimated that in the year 2021, 537 million people were living with diabetes worldwide, and estimated that this number would increase to 643 million by the year 2030 and 783 million by the year 2045 [2]. ...
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People with diabetic foot frequently exhibit poor gait and balance. However, there is no review to inform digital biomarkers of poor gait and balance related to diabetic foot, measurable by wearables outside traditional gait laboratories. Such information could assist in designing remote patient monitoring platform to track changes in gait and balance dysfunction among people with diabetic foot for timely referral and intervention. Accordingly, we conducted a web-based review using PubMed. Our search was limited to human subjects and English-written papers published in peer-reviewed journals. We identified 20 papers in this review. We found preliminary evidence of digital biomarkers of gait and balance dysfunction in people with diabetic foot, measured by wearables, such as slow gait speed, large gait variability, unstable gait initiation, and large body sway. However, due to heterogeneities in included papers in terms of study design, movement tasks, and small sample size, more studies are recommended to confirm this preliminary evidence. Additionally, based on our review, we recommend establishing appropriate strategies to successfully implement wearable-based assessment into clinical practice for diabetic foot care.
... Out of this number, between 14.2% and 20.8% of persons with type 2 DM are on insulin therapy either alone or in combination with oral or non-insulin anti-diabetic agents [12][13][14]. In Nigeria and other SSA countries, type 2 DM accounts for 85-99% of all the diabetic populations [15,16]. Therefore, T2DM patients constitute a considerable proportion of diabetic patients in our diabetes clinics. ...
Article
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Background: Insulin use in type 2 diabetes mellitus (T2DM) outpatients remains largely not well accepted in Nigeria. Both the physicians and the patients thread with caution whenever insulin is suggested as an outpatient treatment option. This study, therefore, is on the type 2 diabetes mellitus outpatients on insulin therapy despite the misgivings against insulin. Methodology: This was a cross sectional study in which consenting T2DM outpatients who meet the inclusion criteria for the study in five tertiary health facilities were recruited and relevant data obtained via investigator-administered questionnaire between January 1, 2020 and December 31, 2021. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. Results: A total of 268 T2DM outpatients were recruited into the study, made up of 116 (43.3%) men and 152 (56.7%) women. Out of this, 212 (79.1%) patients did not start insulin from onset of the illness. Insulin initiation was done for 203 (75.7%) of the patients by endocrinologists in teaching and specialist hospitals. A total of 161 (69.1%) patients used insulin pen. Insulin was self-administered by 189 (70.5%) of the patients while intermediate acting insulin was the predominant insulin used by 127 (47.4%) of the patients. No insulin side effect was reported by 191 (71.3%) of the patients and 252 (94.0%) patients reported that insulin injection pain was not enough reason not to be on insulin. Of the total number of patients, 110 (41.0%) patients reported hypoglycaemia which was treated at home by 90 (81.8%) of the patients. A total of 225 (84%) patients had personal glucometers of which 182 (80.9%) patients had glucose strips at the time of being recruited into the study. Conclusion / Recommendation: This study has shown that insulin is initiated for majority of patients several years after the onset of the illness and that insulin is initiated mainly at teaching and specialist hospitals. Insulin pens were predominantly used and most of the patients self administered insulin which had no side effects in majority of them. Self glucose monitoring of blood glucose was done by a majority of the patient. It is recommended that continuous diabetes education and improvement in insulin technology be done to increase insulin acceptance and usage.
... The optimum control of sugar levels is must to avoid micro and macro vascular complication of diabetes. 22 Good diabetic control can increase the quality of life and also decease the financial burden of this disease 23 . High mortality rate is associated with diabetic dyslipidemia 24,25 . ...
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Aim: To investigate evaluation of diabetic nephropathy and associated risk factors in type I and type II diabetic patients. Study design: Cross sectional prospective study Place and duration of study: Diabetic Clinic, Badin, 06 Months from August 2020 to January 2021 Methodology: Five hundred patients were conducted at Diabetic Clinic, Badin of Type I diabetes mellitus and Type II diabetes mellitus. Results: Twenty-five patients of Type I and 475 patients of Type II. The mean comparison of age, weight, height, body mass index, blood sugar, systolic BP, diastolic BP, HbA1c, serum creatinine, urine albumin and serum urea showed their significant value. Conclusion: Type II diabetes mellitus represent the large majority of macroalbuminuric, diabetics at risk of ESRD and diabetic nephropathy as compared to type I diabetic patient. Keywords: Diabetes mellitus, Diabetic nephropathy, Risk factors
... The optimum control of sugar levels is must to avoid micro and macro vascular complication of diabetes. 22 Good diabetic control can increase the quality of life and also decease the financial burden of this disease 23 . High mortality rate is associated with diabetic dyslipidemia 24,25 . ...
Article
Aim: To probe the existence of dyslipidemia in Type II diabetic patients at Mirpurkhas and to assess different pattern of dyslipidemia in Type II diabetic patients. Study design: Cross sectional prospective study. Place and duration of study: Two GP Clinics @ Mirpurkhas, 06 Months from 1st September 2020 to 28th February 2021. Methodology: Four hundred type II diabetic patients were registered. Complete history and physical examination done for all registered patients. The age, sex, occupation, address, family history of diabetes, addiction was recorded. Results: There were 241 (60.25%) females and 159 (39.75%) males. The prevalence of dyslipidemia in diabetic males was 58.49% and for females were 58.09%. High triglycerides and low high-density lipoprotein (HDL) were most prevalent pattern of dyslipidemia found in females and high low-density lipoprotein (LDL) followed by low high-density lipoprotein (HDL) was found in males. Overall, low HDL and high TG was most prevalent pattern found. Conclusion: Dyslipidemia is very prevalent in diabetic patients, and common patterns are hypertriglyceridemia and reduced levels of high-density lipoprotein cholesterol whereas, dyslipidemia may lead to cardiovascular abnormalities in diabetic patients. Optimal control of sugars and cholesterol can play major role in prevention of such sinister complications. Keywords: Dyslipidemia, Diabetes, Cardiovascular disorders. Prevalence
... Type 2 diabetes has emerged as an important health problem within the 21st century [87]. Ever increasing infiltration trends of diabetes is one of the major health-threatening issues in both developed and developing societies and individuals [88]. Hitherto, one human, five animal, and three in vitro studies have been conducted to investigate the antidiabetic potential of G. asiatica from 2011 to 2016 and no other Grewia species have been explored under the mentioned category so far. ...
Article
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Globally grown and organoleptically appreciated Grewia species are known as sources of bioactive compounds that avert the risk of communicable and non-communicable diseases. Therefore, in recent years, the genus Grewia has attracted increasing scientific attention. This is the first systematic review which focusses primarily on the nutritional composition, phytochemical profile, pharmacological properties, and disease preventative role of Grewia species. The literature published from 1975 to 2021 was searched to retrieve relevant articles from databases such as Google Scholar, Scopus, PubMed, and Web of Science. Two independent reviewers carried out the screening, selection of articles, and data extraction. Of 815 references, 56 met our inclusion criteria. G. asiatica and G. optiva were the most frequently studied species. We found 167 chemical compounds from 12 Grewia species, allocated to 21 categories. Flavonoids represented 41.31% of the reported bioactive compounds, followed by protein and amino acids (10.7%), fats and fatty acids (9.58%), ash and minerals (6.58%), and non-flavonoid polyphenols (5.96%). Crude extracts, enriched with bioactive compounds, and isolated compounds from the Grewia species show antioxidant, anticancer, anti-inflammatory, antidiabetic, hepatoprotective/radioprotective, immunomodulatory, and sedative hypnotic potential. Moreover, antimicrobial properties, improvement in learning and memory deficits, and effectiveness against neurodegenerative ailments are also described within the reviewed article. Nowadays, the side effects of some synthetic drugs and therapies, and bottlenecks in the drug development pathway have directed the attention of researchers and pharmaceutical industries towards the development of new products that are safe, cost-effective, and readily available. However, the application of the Grewia species in pharmaceutical industries is still limited.
... By 2040, more than 6.42 million people are expected to develop this disease (Herman, 2017). T2DM, which accounts for more than 90% of all cases of diabetes (Shaw et al., 2010), has become a global pandemic, especially in Western countries. ...
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L-arabinose is a good and healthy food additive. This study was conducted to investigate the effect of L-arabinose in a mouse model of type 2 diabetes mellitus (T2DM) induced by exposure to a high-fat diet (HFD) and streptozotocin (STZ). The model mice received L-arabinose at 20 and 60 mg (kg body weight [bw])⁻¹d⁻¹, metformin at 300 mg (kg bw)⁻¹d⁻¹ (positive control) or sterile water (control) via oral gavage. Compared with the model group, mice treated with L-arabinose exhibited attenuated symptoms of diabetes mellitus, including a slower rate of body weight loss, increased homeostasis model assessment of β-cell function index levels, decreased blood glucose, alleviation of steatosis, and repair of pancreatic islet cells. L-arabinose also exerted an anti-inflammatory effect and partially mitigated dyslipidemia. A 16S-rRNA sequence analysis of the gut microbiota revealed that at the phylum level, treatment with L-arabinose significantly reduced the ratio of Firmicutes to Bacteroidetes due to a decreased relative abundance of Firmicutes; at the genus level, it reversed the increase in the relative abundance of Allobaculum and the decrease abundance of Oscillospira caused by exposure to an HFD and STZ. And the model mice received L-arabinose at 20 mg (kg bw)⁻¹d⁻¹ had a better effect on improving T2DM than the high-dose group supplemented L-arabinose at 60 mg (kg bw)⁻¹d⁻¹. These results strongly suggest L-arabinose as an excellent candidate supplement to prevent or treat T2DM. Practical applications L-arabinose, xylitol and sucralose are well-known substitutes for sucrose. L-arabinose has been reported to have beneficial effects on hyperglycemia, glycemic index, and fat accumulation. In this study, we found that low-dose (20 mg (kg bw)⁻¹d⁻¹) supplementation of L-arabinose significantly improved glucose intolerance and gut microbiota incoordination in T2DM caused by HFD and STZ.
... Non-insulin dependent type II DM (T2DM) takes up 90% of total DM (diabetes mellitus) cases in current world (Chen, Xu, Wu, Li, & Guo, 2020;Herman, 2017). As we know, carbohydrate digestive enzymes can hydrolyze oligo-or di-saccharides into glucose (Cuccioloni et al., 2016;Yue et al., 2015). ...
Article
Cerasus humilis (Bge.) Sok. leaf-tea (CLT) has a potential anti-α-glucosidase effect. However, its anti-α-glucosidase functional compositions remain unclear. Results showed that 70% methanol extract of CLT (IC50 = 36.57 μg/mL) with the highest total phenolic/flavonoid contents exhibited significantly higher α-glucosidase inhibitory activity (α-GIA) than acarbose (IC50 = 189.57 μg/mL). Additionally, phenolic constituents of the CLT extract were analyzed for the first time in this work. Ten major potential α-glucosidase inhibitors (α-GIs) with high bio-affinity degree in the CLT extract were recognized using a bio-affinity ultra-filtration and HPLC-ESI-qTOF-MS/MS method. In vitro α-GIA assay confirmed that myricetin (IC50 = 36.17 μg/mL), avicularin (IC50 = 69.84 μg/mL), quercitrin, isoquercitrin, prunin and guajavarin were responsible for the α-GIA of the CLT extract. More importantly, the interaction mechanism between α-GIs and α-glucosidase was investigated via in silico analysis. This study provides a high-throughput screening platform for identification of the potential α-GIs from natural products.
... Prevalence of DM globally in 1995 was estimated to be 4.00% which can rise to 5.40% by 2025. It is found to be greater in developed rather in developing n [29]. In Asian states, more than 99.0% population is suffering from type-II diabetes. ...
Article
Diabetes mellitus has high global prevalence and occurrence and is considered to bean endocrinological and/or metabolic disorder. Conventional drug treatment is costly and has toxic side effects, although it is successful in treating diabetes mellitus. If effective and less toxic, herbal medicine will thus include alternative therapy. This research has been designed to investigate the role of Grewia asiatica extract in the control of diabetes in male albino rats with Streptozotocin mediated type 2 diabetes. Grewia asiatica fruit extract at a dose of 200mg/kg was given to Streptozotocin mediated type II DM Rats. A known anti-diabetic drug, Glibenclamide has been used as a standard drug. The method of the research was to monitor the effect of Grewia asiatica on the blood glucose level of Rats. In this study, Rats were split into four categories i.e. Control, Streptozotocin treated, Streptozotocin + Glibenclamide treated and Streptozotocin +Grewia asiatica extract-treated group. Grewia asiatica fruit extract significantly improve the blood glucose levels as compared to the standard drug Glibenclamide in Streptozotocin mediated diabetic group. Conclusion: It was concluded that Grewia asiatica may be used in the treatment of diabetes or decreasing the elevated level of blood sugar.
... Now a day, DM is recognized as an important cause of premature death and lifelong disability [8,9]. People with diabetes have an increased risk of developing serious life-threatening health problems, increasing medical care costs, and compromise the quality of life [4,6,7,10]. ...
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Background Self-care practice among people with diabetes is not well-implemented in Ethiopia. So far, in Ethiopia, several observational studies have been done on self-care practice and its determinants in people with diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap. Methods A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization’s Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles’ quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion of non-adherence to self-care practice in people with diabetes and the odds ratios of risk factors hindering to self-care practice after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD 42020149478. Results We included 21 primary studies (with 7,134 participants) in this meta-analysis. The pooled proportion of non-adherence to self-care in the diabetes population was 49.91 (95% CI: 44.73–55.08, I ² = 89.8%). Male (Pooled Odds Ratio (POR): 1.84 95%CI; 1.04–2.64, I ² = 15.0%), having private glucometer (POR: 2.71; 95%CI: 1.46–3.95, I ² = 0.0%), short-term Diabetes Mellitus (DM) duration (POR: 3.69; 95%CI: 1.86–5.52, I ² = 0.0%), DM complication (POR: 2.22; 95%CI: 1.48–2.95, I ² = 0.0%), treatment satisfaction (POR: 1.8; 95% CI: 1.15–2.44, I ² = 0.0%), received diabetes self-management education (POR: 2.71; 95% CI: 1.46–3.95, I ² = 0.0%) and poor self-efficacy (POR: 3.09; 95% CI: 1.70–4.48, I ² = 0.0%) were statistically significant factors of non-adherence to self-care practice. Conclusions The overall pooled proportion of non-adherence to self-care among adult diabetes in Ethiopia was high. Further works would be needed to improve self-care practice in the diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and each domain of self-care practice according to diabetes self-management guideline.
... In Morocco, diabetes equally affects 6.6% of men and women nation-wide, but is higher in urban areas [7]. Some studies showed figures being situated around 608 000 persons in 1995 [10]. This figure will achieve 2,5 million the horizon 2030 [11]. ...
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In Morocco, diabetes affects 6.6% of men and women nationwide and is higher in urban areas. Medicinal plants are used commonly by local people of Morocco for treating diabetes. The aim of this study was to identify plants species used for curing diabetes in the Agadir Ida Outanane region, Southwest Morocco. Data were collected by semi-structured and structured interviews. 400 interviews were conducted with knowledgeable villagers. The obtained data were analyzed through fidelity level (FL: 0-100%), use value (UV) and relative frequency of citation (RFC: 0-1). This ethnobotanical survey has identified 22 species belonging to 14 families distributed. The most represented families are Lamiaceae and Asteraceae. Three plants species, Cladanthus mixtus (L.) Chevall, Pulicaria mauritanica Batt., and Salvia aegyptiaca L., are mentioned for the first time for traditional treatment of diabetes. The most frequently cited plant species are Argania spinosa (L.) Skeels, Cistus creticus L., Globularia alypum L., Olea europaea L. This survey shows that traditional medicine is still used and constituted a very rich heritage in Agadir Ida Outanane region. The collected data may help for archiving and conservation of traditional knowledge on the use of medicinal plants in the study area. In addition, it forms a basis for preliminary information required for future phytochemical investigation on the most used plants.
... Further, the International Diabetes Federation (IDF) estimated that most countries devote 5-20% of total health-care expenditures on diabetes treatment and management. Estimated global spending to treat diabetes and its complications was $673 billion in 2015 and is projected to increase to $802 billion by 2040 (Herman 2017). Health-care expenditure for diabetes is projected to increase from $1.3 trillion in 2015 to more than 2.0 trillion by 2030 (Bommer et al. 2018). ...
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Diabetes mellitus is a chronic noncommunicable disease contributing to a major share of premature morbidity and mortality in age 30–70. Globally, the estimated number of people living with diabetes has risen from 108 million in 1980 to 476 million in 2017 with the prevalence of diabetes among adults over 18 years of age rising from 4.7% in 1980 to 8.5% in 2014. Worldwide, 1.4 million deaths and 2.5% of total deaths are attributed to diabetes in 2017. The rapid rise in the prevalence of diabetes in low- and middle-income countries suggests the changing course of the diabetes epidemiology that it is a more widespread problem across the rich and poor nations as well as among the rich and poor of the nations. Among WHO regions, the Eastern Mediterranean, part of Asia, and Africa have higher prevalence of diabetes as compared to other countries, while Southeast Asia and Western Pacific regions have the largest numbers of people with diabetes. Contributed by the complex interaction between genetic, behavioral, and environmental factors, globally, the prevalence of diabetes accentuates at the age of 45–49 with one in ten older adults diagnosed with diabetes with the peak prevalence rate of 24% in the oldest old age of 85–89. As a hormonal and metabolic chronic condition, diabetes is a main driver of several other comorbid health outcomes such as cardiovascular diseases, mental health disorders, kidney diseases, eye-related disorders, neuropathy, rheumatoid arthritis, bone-related diseases, etc. The global burden of diabetes not only poses serious challenges to public health but tend to have an overwhelming effect on the global development through substantial social and economic loss. Therefore, preventing and controlling diabetes with multisectoral efforts and effective interventions are very important. Early screening and adequate awareness and health-care intervention are essential to reduce the global burden of diabetes.
... The current management guidelines for T2DM focus on blood glucose stabilization combining education, lifestyle adjustments and pharmacotherapy, whilst monitoring for the aforementioned complications [8]. Despite these approaches, disease burden remains high with many patients still developing severe complications, not only placing a substantial load on individuals with the disease, but also the healthcare system as a whole [9]. As a result, the focus of current scientific research involves understanding the complex molecular mechanisms underlying the complications of T2DM. ...
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Oxidative stress and inflammation are considered major drivers in the pathogenesis of diabetic complications, including renal and cardiovascular disease. A symbiotic relationship also appears to exist between oxidative stress and inflammation. Several emerging therapies target these crucial pathways, to alleviate the burden of the aforementioned diseases. Oxidative stress refers to an imbalance between reactive oxygen species (ROS) and antioxidant defenses, a pathological state which not only leads to direct cellular damage but also an inflammatory cascade that further perpetuates tissue injury. Emerging therapeutic strategies tackle these pathways in a variety of ways, from increasing antioxidant defenses (antioxidants and Nrf2 activators) to reducing ROS production (NADPH oxidase inhibitors and XO inhibitors) or inhibiting the associated inflammatory pathways (NLRP3 inflammasome inhibitors, lipoxins, GLP-1 receptor agonists, and AT-1 receptor antagonists). This review summarizes the mechanisms by which oxidative stress and inflammation contribute to and perpetuate diabetes associated renal and cardiovascular disease along with the therapeutic strategies which target these pathways to provide reno and cardiovascular protection in the setting of diabetes.
... Diabetes mellitus (DM) is a metabolic disease characterized by persistent hyperglycemia resulting from insulin deficiency or insulin resistance or both. It is estimated that in year 2000 there were approximately 150 million individuals with the disease and that this number is likely to double by year 2025 [1]. Type 2 diabetes is the fourth or fifth leading cause of death in most developed countries and there is growing evidence that it has reached epidemic proportions in many developing and newly industrialised countries [2]. ...
Research
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Aims: This study investigates the hypoglycemic potential of Archachatina marginata haemolymph and its mechanism in streptozotocin-induced diabetic rats. Study Design: One factor experimental design. Place and Duration of Study: Methodology: The rats were set into four groups (n=5). Group 1-Non-diabetic control (NDC), Group 2-Diabetic Control (DC), Group 3-Diabetic rats with 1 mL administration of snail Original Research Article Adeboye et al.; JPRI, 18(1): 1-8, 2017; Article no.JPRI.33786 2 haemolymph (DSS1), Group 4-Diabetic rats with 2 mL snail haemolymph administration (DSS2). The blood glucose concentration of each rat was taken and thereafter, they were weighed and then administered with 55 mg/kg STZ in citrate buffer (pH 4.5) peritoneally non-diabetic control group (NDC). Rats with blood glucose level of 200 mg/dL and above were considered diabetic. Haemolymph of 1 mL and 2 mL were administered to rats in DSS1 and DSS2 respectively while DC received 2 mL distilled water for 14 consecutive days. Physiological orangs and blood samples were harvested for various analysis. Results: The A. marginata haemolymph significantly improved the plasma concentration of insulin and reduced plasma glucose level in a dose dependent manner P=.05. Conclusion: The A. marginata haemolymph has potential to exact hypoglycemic effect and improve the insulin concentration in streptozotocin induced diabetic rat.
... It results from either insulin deficiency, low insulin secretion, or reduced tissue sensitivity to insulin [2]. Recent statistics show that over 425 million individuals worldwide have diabetes; which is estimated to increase to 642 million by 2045 [3,4]. Hypertension, dyslipidemia, obesity, and cardiovascular diseases are often associated with diabetes [5,6]. ...
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This study evaluated the anti-diabetic and hepatic protective effect of the aqueous extract of the Aloe perryi (AP) in streptozotocin-induced diabetic rats. Rat were divided into control, diabetic, diabetic + glimepiride, diabetic + AP (150 or 300 mg/Kg) groups. AP (300 mg/Kg) alone lowered fasting serum glucose levels but increased insulin levels and HOMA-β. At both doses, AP significantly decreased hepatic levels of CHOL and LDL-C and reduced serum levels of TGs, CHOL, and LDL-C, without altering levels of HDL-C in the diabetic rats. Also, they improved liver architectures and reduced serum levels of ALT and AST. Concomitantly, they suppressed hepatic levels of MDA, and increase hepatic levels of SOD, GSH, CAT, and GPx. Except for lipids, the effect of the extract on all other parameters was more profound with the higher dose of the extract. In conclusion, AP extract exerts hypoglycaemic, insulin-releasing, and hepatic antioxidant potentials in diabetic rats.
... 11 Nowadays, the incidence of diabetes mellitus is dramatically increasing worldwide with the spread of Western-style dietary habits and rise of obesity. 12 The number of patients with diabetes is predicted to exceed 642 million by 2040, 13 and more than 90% of these numbers are type 2 diabetes mellitus (T2DM). 14 Accumulated evidence indicates that disordered gut microbiota is closely related to T2DM. ...
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In the present study, the hypoglycemic effects of glucomannan (AGM) and its enzyme-degraded products from Amorphophallus albus were investigated. Four degraded products were prepared through ultrafiltration of β-glucanase-degraded products of AGM. The hypoglycemic activities were evaluated in HFD-STZ-induced type 2 diabetes mellitus (T2DM) mice, and the diversity of gut bacteria was analyzed by 16S rRNA gene sequencing; the fecal short chain fatty acids (SCFAs) and endogenous metabolites were determined by UPLC-QTOF-MS/MS. It was found that AGM and its enzyme-degraded products, though with different molecular weights, had similar β-glycosidic bonds and monosaccharide compositions, exerted similar strength of hypoglycemic effects, and reinstated with a similar extent the disordered gut microbiota and the contents of SCFAs and endogenous metabolites. It was speculated that the hypoglycemic activity of AGM is decided by not the molecular weight but the glycosidic bonds/monosaccharide composition of AGM, which might be structurally specific to the gut bacteria, and thus certain SCFAs and endogenous metabolites that are related to the occurrence and therapy of T2DM. This study provides a scientific basis for using AGM as potential prebiotics beneficial for prevention or therapeutic treatment of T2DM.
... Diabetes Mellitus (DM) is recognized as one of the leading causes of morbidity and mortality in the world. And India will be one of the countries with the largest number of diabetic individuals by year 2025 [1]. DM is initially associated with hyperglycemia but then there is derangement of all other metabolic processes and increased susceptibility to lipid peroxidation [2]. ...
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Diabetes is a multifaceted disease occurring due to defective synthesis or action of insulin and as it progresses, complications develops which are associated with oxidative stress and decreased level of antioxidants. Hence this study was carried out to evaluate the levels of MDA and antioxidants like GSH, GPx, Gred, SOD during early phase of the dis-ease(recently diagnosed) in diabetic individuals and compare with normal subjects. A very significant increase (p<0.0001) was observed in the antioxidants levels, MDA ,HbA 1C and fructosamine in the study group as compared to the ones in the control. Increased expression of antioxidant enzymes was found to be positively associated with the free radical levels indicating that the body was trying to respond to the oxidative stress developed due to hy-perglycemia during early phase. Hence we conclude that the body tries to take care of the oxidative stress in the initial phase of the disease but this fails over a period of time leading to complications associated with diabetes.
... It results from an absolute or relative deficiency or resistance to insulin [79], remaining a prominent chronic disease with the number of diabetics quadrupling in the last three decades in the world [106,107]. The International Diabetes Federation estimated that 415 million adults had diabetes in 2015, and it is projected to reach 642 million within 2040 [108]. Oxidative stress is responsible for promoting diabetes and preclinical studies showed that garlic active organosulfur compounds reduced hyperglycemia via improving the antioxidant status in circulation of diabetic rats [106]. ...
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Garlic is a polyphenolic and organosulfur enriched nutraceutical spice consumed since ancient times. Garlic and its secondary metabolites have shown excellent health-promoting and disease-preventing effects on many human common diseases, such as cancer, cardiovascular and metabolic disorders, blood pressure, and diabetes, through its antioxidant, anti-inflammatory, and lipid-lowering properties, as demonstrated in several in vitro, in vivo, and clinical studies. The present review aims to provide a comprehensive overview on the consumption of garlic, garlic preparation, garlic extract, and garlic extract-derived bioactive constituents on oxidative stress, inflammation, cancer, cardiovascular and metabolic disorders, skin, bone, and other common diseases. Among the 83 human interventional trials considered, the consumption of garlic has been reported to modulate multiple biomarkers of different diseases; in addition, its combination with drugs or other food matrices has been shown to be safe and to prolong their therapeutic effects. The rapid metabolism and poor bioavailability that have limited the therapeutic use of garlic in the last years are also discussed.
... In several clinics and hospitals, the glucose management and diagnosis of blood glucose level in the body is still determined using the finger-prick technique. This should be done multiple times a day for a Type 1 patient especially in ICU (Intensive Care Unit), to keep track and avoid complications [3], [4]. Though CGM devices are available, the patient is not educated enough for self-monitoring; to avoid complications and risks, prediction models can be developed to predict the future glucose level which helps the diabetes patient to control and take action. ...
Article
Patients with diabetes requires continuous monitoring of blood glucose level. Over the past few decades, Continuous glucose monitoring (CGM) has become a very helpful tool to manage and record glucose levels in the blood. With the help of CGM, the control and regulation of blood glucose can be achieved. Collecting the data from CGM, the paper attempts to predict future glucose levels by applying Auto Regressive Moving Average (ARMA) model. This predicted glucose level can be used for forecasting, and immediate appropriate action can be employed to avoid the risks related to diabetes. A good efficient model and a controller can be developed to improve the control using the Model Predictive Control technique with the predicted data set. The major risks that can be avoided are hyperglycemia and hypoglycemia. This paper elaborates on the estimation and prediction of blood glucose levels using the ARMA model in MATLAB platform. The CGM data is collected from a type 1 diabetic patient, and five-day data is recorded using the CGM device. The time series of the collected raw data is analyzed, and the parameter estimation is obtained. The model order is selected, and forecasting models are determined. This type of method for prediction gives good prediction with a lesser error when compared with original raw data and estimated values.
... Diabetes mellitus (DM) is a major chronic public health concern due to its rapidly growing and enormous burden with serious though preventable consequences worldwide [1][2][3]. Globally, in 2015, the International Diabetes Federation [4] and World Health Organization [5] estimated that one out of eleven adults had diabetes while more than 40,800 deaths occurred from the disease. The IDF [6] also submitted that 451 million people ranging from age 18 to 99 years had DM in 2017 and approximately 5 million deaths were caused by the disease within the same age bracket in the year. ...
... Diabetes mellitus is a major and growing public health problem throughout the world. Recent studies indicate that there are 150 million people in the world with diabetes and this number is likely to increase to 300 million or more by the year 2025 (King et al., 1998). This disease is a multifactorial disorder associated with chronic hyperglycemia and with carbohydrate, fat, and protein metabolism imbalance resulting from deficiencies or disruptions in insulin secretion (Ugochukwu et al., 2003) and defects in reactive oxygen species scavenging enzymes (Kesavulu et al., 2000). ...
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The purpose of this study was to prevent or to delay the onset of diabetes-related complications, by using a natural marine resource, Sardina pilchardus oil, administrated to alloxan-induced diabetic rats showing hyperglycemia and hyperlipidemia. Gas chromatography mass spectrometry analysis of the sardine oil detected 18 constituents. The major ones were n-3 highly unsaturated fatty acids among which are docosahexaenoic acid (25.09%) and eicosapentaenoic acid (19.61%). Sardine oil inhibited the a-amylase activity in rats' sera (26.82%) and thus improved glycemia (54%). The supplement of this oil protected the b-cells from death and damage, significantly decreased total triglycerides, total cholesterol and LDL-cholesterol concentrations in diabetic rats' sera and increased the HDL-cholesterol level. Gavage administration of this oil to rats protected the liver and kidney functions by reducing the aspartate transaminase, alanine transaminase and phosphatase alkaline activities, and by decreasing creatinine, urea and uric acid levels.
... Currently, diabetes mellitus and dyslipidaemia constitute the most significant comorbid risk factors for CVD globally, and these deseases are postulated to increase in the near future (Herman & Zimmet, 2012;Yusuf, Reddy, Ôunpuu, & Anand, 2001). The International Diabetes Federation (IDF) estimates 415 million adults had diabetes mellitus during 2015 and this number is anticipated to increase to 642 million by 2040 (Herman, 2017). ...
Article
Tomato (Solanum lycopersicum) phytochemicals, which include phytoene, phytofluene, beta‐carotene, flavonoids, lycopene, and polyphenols, have been shown to improve the effects of fasting on plasma triglyceride (TG), low‐density lipoprotein cholesterol (LDL), high‐density lipoprotein cholesterol (HDL), total cholesterol (TC), and fasting blood sugar (FBS). The aim of this study was to systematically evaluate the effects of Tomato TC, TG, HDL, LDL, and FBS in humans. A systematic literature search was conducted in PubMed/MEDLINE, Web of sciences, and SCOPUS databases by two researchers for studies published until August of 2019 without language and time limitations. Results were combined with random effect models. Six studies were included in this meta‐analysis. Combined results reveal a significant reduction in cholesterol (weighted mean difference [WMD]: −4.39 mg/dl, 95% CI: −7.09, −1.68, I2 = % 48, p heterogeneity: .05), TG (WMD: −3.94 mg/dl, 95% CI: −7.67, −0.21, I2 = % 90, p heterogeneity: .001), LDL levels (WMD: −2.09 mg/dl, 95% CI: −3.73, −0.81, I2 = % 78, p heterogeneity: .001), and increasing in HDL levels (WMD: 2.25 mg/dl, 95% CI: 0.41, 4.10, I2 = % 97, p heterogeneity: .001). Tomato was found to have a higher reduction effect on TG and LDL in younger participants. While pooled results indicate no significant effect on FBS levels (WMD: 0.59 mg/dl, 95% CI: −0.28, 1.46, I2 = % 95, p heterogeneity: .001). In conclusion, the results indicate a significant reduction in total cholesterol, TG, and LDL and increase in HDL levels that is caused by tomato consumption.
... Moreover, it is estimated that the disease burden will increase by approximately 70% in low income countries by 2030 [3,4]. Sub-Saharan Africa, in particular, is believed to have the highest proportion of undiagnosed diabetes with more than two-thirds of people with diabetes unaware of their status [5,6]. ...
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Background: Cardiovascular autonomic neuropathy (CAN) is a common complication in individuals with diabetes mellitus (DM) but often overlooked in clinical practice. The burden and correlates of CAN have not been extensively studied in low-income countries, particularly in sub-Saharan Africa. Objectives: To determine the prevalence and correlates of CAN among adults in ambulatory diabetes care in southwestern Uganda. Method: We conducted a cross-sectional study among adults with diabetes from November 2018 to April 2019. CAN was assessed using the five autonomic function tests: deep breathing, Valsalva maneuver, postural index on standing, change in blood pressure during standing and diastolic blood pressure response to isometric exercise. We estimated the prevalence of CAN and fit regression models to identify its demographic and clinical correlates. Results: We enrolled 299 individuals. The mean age was 50.1 years (SD ± 9.8), mean HbA1c was 9.7 (SD ± 2.6) and 69.6% were female. CAN was detected in 156/299 (52.2%) of the participants on the basis of one or more abnormal cardiovascular autonomic reflex tests. Out of 299 participants, 88 (29.4%) were classified as early CAN while 61/299 (20.4%) and 7/299 (2.3%) were classified as definite and severe (advanced) CAN respectively. In multivariable regression models, age over 50 years (aOR 3.48, 95%CI 1.35 -8.99, p = 0.010), duration of diabetes over 10 years (aOR 4.09, 95%CI 1.78 -9.38, p = 0.001), and presence of diabetic retinopathy (aOR 2.25, 95%CI 1.16 -4.34, p = 0.016) were correlated with CAN. Conclusions: Our findings reveal a high prevalence of CAN among individuals in routine outpatient care for diabetes mellitus in Uganda. Older age, longer duration of diabetes and coexistence of retinopathy are associated with CAN. Future work should explore the clinical significance and long term outcomes associated with CAN in this region.
... The global prevalence of DM is known to be rapidly increasing as a result of aging populations and lifestyle changes. The International Diabetes Federation estimated that 415 million adults had diabetes in 2015 and the number would increase to 642 million by 2040 [1]. ...
Article
Objective This study investigated the biochemical, histopathological and physiological effects of Citrullus colocynthis on peripheral neuropathy in rats with streptozotocin (STZ)-induced diabetes. Methods Seventy adult male Sprague-Dawley rats were included in the present study. Diabetes was induced in 60 rats, with a single intraperitoneal injection of STZ (65 mg/kg). After 4 weeks, the diabetic rats were assessed for neuropathy. Then, the diabetic rats with neuropathy were randomly divided into 6 groups for a 4-week treatment with gabapentin, oral administration of C. colocynthis fruit pulp powder (100 and 300 mg/kg per day), topical preparations as oil-based solution and ointment, or placebo. Changes in metabolic, physiological, biochemical and histological parameters were considered as treatment outcomes. Results Metabolic outcomes (body weight and blood glucose level) were improved in the C. colocynthis-treated groups as compared to placebo. Tail-flick and hot-plate tests also had lower latency in the C. colocynthis-treated groups. Measurement of oxidative stress markers (malondialdehyde, superoxide dismutase and catalase) showed the antioxidant effect of C. colocynthis. Histological evaluation of the sciatic nerve showed that C. colocynthis decreased the number of demyelinated and degenerated nerve fibers. Among the C. colocynthis-treated groups, the one receiving 100 mg/kg per day oral powder had the best treatment outcomes. Conclusion The present study showed that C. colocynthis fruit, through its antioxidant and hypoglycemic activities, has a positive effect in the treatment of diabetic neuropathy.
... Diabetes mellitus (DM) is a major global threat and its prevalence is increasing at an alarming rate worldwide, especially in Asian countries (Cummings and Englyst, 1991;Chan et al., 2009). About 415 million adults suffered with type 2 diabetes mellitus (T2DM) globally during 2015, which is predicted to increase to 642 million by 2040 (Herman, 2017). Apart from obesity and physical inactivity, another major cause of high T2DM prevalence is the consumption of rapidly digestible carbohydrate-rich foods capable of increasing the blood sugar concentration. ...
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Resistant Starch (RS), plays a crucial role in human health and nutrition by controlling glucose metabolism. RS or dietary fibre content in rice is low because it goes through a variety of process before it is ready for cooking and consumption. Hence, this study was carried out to develop a rice mutant with increased RS. The rice mutant (γ278) with increased RS was developed by utilizing gamma (γ) rays as a mutagen. Mutant γ278 was characterized for mutations in the starch biosynthetic genes viz., GBSSI, SSI, SSIIa, SSIIIa, SBEIa, and SBEIIb to reveal the functional mutations/variations led to high RS content in rice. A total of 31 sequence variants/mutations in six genes were identified. We report the discovery of three deleterious mutation/variants each in GBSSI, SSIIa, and SSIIIa with the potential to increase RS content in rice. Further, wild × mutant crosses were made to develop an F2 population to study the effect of combination of deleterious mutations. The SNP (GBSSI:ssIIa:ssIIIa) combination responsible for high RS content in F2 population was identified and recorded highest amylose content (AC) (26.18%) and RS (8.68%) content. In conclusion, this marker combination will be highly useful to develop a rice variety with increased RS.
... Dysfunction in the regulation and utilization of glucose leads to a wide assortment of metabolic syndromes, including Diabetes Mellitus, a vast and growing clinical and public health problem. In 2015, the International Diabetes Federation estimated that 415 million adults had diabetes and that this number will increase to 642 million by 2040 (Herman 2017). Furthermore, there have been many studies published documenting the association of diabetes and increased frequency of fractures in such patients (Ivers et al. 2001;de Liefde et al. 2005;Vestergaard 2007). ...
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The bones form the framework of our body. We know that bones protect our vital organs, regulate calcium and phosphorous homeostasis, and function as a site of erythropoiesis. More recently, however, the identification of bone hormones has allowed us to envision bones as endocrine organs too. Within the last few years, the bone hormones osteocalcin and lipocalin 2 have been implicated with glucose and energy metabolism. We systematically reviewed articles surrounding this subject and found a clear relationship between the osteocalcin levels and glucose tolerance and insulin sensitivity. We also found that many journals have shown the detrimental effects of an absences of lipocalin 2 from adipocytes. As osteocalcin administration to mice showed decreased blood glucose levels and promoted glucose tolerance and insulin sensitivity. Future studies could perhaps explore the use of osteocalcin as a supplement for type 2 diabetes.
Article
Diabetes is a disease that plagues over 463 million people globally. About 40 million of these patients have Type 1 diabetes (T1DM), and the global incidence is increasing by up to 5% per year. T1DM is where the body's immune system attacks the pancreas, specifically the pancreatic beta cells, with antibodies to prevent insulin production. While current treatments such as exogenous insulin injections have been successful, exorbitant insulin costs and meticulous administration present the need for alternative long-term solutions to glucose dysregulation caused by diabetes. Encapsulated islet transplantation (EIT) is a tissue-engineered solution to diabetes. Donor islets are encapsulated in a semi-permeable hydrogel, allowing the diffusion of oxygen, glucose, and insulin but preventing leukocyte infiltration and antibody access to the transplanted cells. While successful in small animal models, EIT is still far from commercial use due to necessary long-term systemic immunosuppressants and consistent immune rejection. Most published research has focused on tailoring the characteristics of the capsule material to promote clinical viability. However, most studies have been limited in scope to biochemical changes. Current mechanobiology studies on the effect of substrate stiffness on the function of leukocytes, especially macrophages - primary foreign body response orchestrators, show promise in tailoring a favorable response to tissue-engineered therapies such as EIT. In this review, we explore strategies to improve the clinical viability of EIT. A brief overview of the immune system, the foreign body response, and current biochemical approaches will be elucidated throughout this exploration. Furthermore, an argument for using substrate stiffness as a capsule design parameter to increase EIT efficacy and clinical viability will be posed.
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Introduction: Measurement of glucose levels is the mainstay method of ensuring good glycemic control and preventing complications associated with uncontrolled diabetes. Continuous glucose monitoring enables easy and effective monitoring of interstitial glucose around the clock and hence improves glycemic control. Objectives: This study aimed to measure the effect of continuous glucose monitoring on glycated hemoglobin (HbA1c) at 3, 6, and 9 months following sensor insertion. Methods: A retrospective cohort study of pediatric and adolescent type 1 diabetes mellitus patients randomly sampled from 32 Ministry of Health diabetes centers across Saudi Arabia was performed. Patients were subjected to flash glucose monitoring using the FreeStyle® Libre flash glucose monitoring system (Abbott Diabetes Care, Witney, UK), an intermittently scanned continuous glucose monitoring device approved by the Conformité Européenne in 2014. These patients were first-time users of any kind of continuous glucose monitoring system, aged 4-18 years, and received insulin via multiple dose injection or continuous subcutaneous insulin infusion for at least 6 months prior to study start. Patients were excluded if they had used flash glucose monitoring or other interstitial glucose monitoring systems in the past 3 months, were pregnant, or had existing hemoglobinopathies. The flash glucose monitoring sensor was attached to the back of the upper arm at the baseline visit. HbA1c (%) was measured at baseline and 3, 6, and 9 months. Patient demographics were collected from electronic health records. Results: 1,307 patients were included, with a mean age of 11.1 years (standard deviation 3.6 years). Where specified, 51.4% were female. Mean HbA1c significantly reduced from baseline (10.8%) to 3 months (9.8%, p < 0.001), 6 months (9.2%, p < 0.001), and 9 months (9.1%, p < 0.001). For individuals with baseline HbA1c > 9%, mean HbA1c was significantly reduced from baseline (11.7%) to 3 months (10.3%, p < 0.001), 6 months (9.6%, p < 0.001), and 9 months (9.5%, p < 0.001). Conclusions: Flash glucose monitoring significantly reduced HbA1c levels at 3, 6, and 9 months following sensor insertion. This reduction was greatest in those patients with higher HbA1c at baseline (> 9%).
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Purpose of Review In this narrative review, we have summarized the literature on fracture risk in T1DM and T2DM with a special focus on fracture site, time patterns, glucose-lowering drugs, and micro- and macrovascular complications. Recent Findings T1DM and T2DM were associated with an overall increased fracture risk, with preferent locations at the hip, vertebrae, humerus, and ankle in T1DM and at the hip, vertebrae, and likely humerus, distal forearm, and foot in T2DM. Fracture risk was higher with longer diabetes duration and the presence of micro- and macrovascular complications. In T2DM, fracture risk was higher with use of insulin, sulfonylurea, and thiazolidinediones and lower with metformin use. Summary The increased fracture risk in T1DM and T2DM concerns specific fracture sites, and is higher in subjects with longer diabetes duration, vascular complications, and in T2DM with the use of specific glucose-lowering medication.
Article
Objective To investigate the effect of anthropometric measurements on serum adiponectin and inflammatory markers in Type 2 diabetes mellitus (T2DM).Methods This study was conducted with 46 subjects newly diagnosed with T2DM and 30 healthy volunteers free from pre-existing inflammatory disease, cancer, Type 1 diabetes and using any medications. Demographic, clinical and anthropometric data were collected. The anthropometric measurements and insulin resistance components (fasting plasma glucose (FPG), HbA1c, fasting insulin, HOMA-IR) were analyzed. HOMA-β values were calculated to measure pancreatic beta cell functions. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured to determine the presence of inflammation and serum adiponectin levels were assessed.ResultsIndividuals with T2DM showed higher body mass index (BMI), body fat percentage, waist circumference (WC), waist-to-hip ratio and waist-to-height ratio values. Serum cytokine levels were higher but adiponectin levels were lower in diabetic patients. Serum concentrations of CRP were found to be significantly correlated with WC and body fat mass (kg and %); TNF-α was significantly associated with WC and waist-to-hip ratio in individuals with T2DM. Adiponectin was negatively correlated with WC and waist-to-hip ratio in healthy subjects.Conclusions Prevention of obesity and central adiposity is an important factor to prevent elevations in inflammatory cytokine levels in diabetic patients.
Article
Background Nutrition is considered as a primary approach for diabetes management. It needs a comprehensive assessment of evidence to identify nutritional dimensions that should be explored in the future. We aimed to provide a roadmap on diabetes and nutrition and clarify research gaps in this field.Methods In the present review, we searched Scopus and PubMed electronic databases to collect eligible publications with English and Farsi languages from 2015 to December 2019 in the field of nutrition and diabetes. Relevant papers were classified into six subgroups including biochemistry/ animal studies, clinical nutrition, food industry, genetic, public health, and dietary supplements. Based on evidence-based pyramid, publications were categorized as well. Publications trend from 2015 to 2019 and frequency of publications in each category were provided.ResultsFinally, we reached 438 eligible papers. Most studies (40.86%) were clinical trials and in most human studies (n = 224) patients with type 2 diabetes were considered. Probiotic/prebiotic/ symbiotic, vitamin D, and omega-3/fish oil were the most frequent studied dietary supplements. Low portions of studies were dedicated to diabetic children (n = 3), type 1 diabetes (n = 6), diabetes complications (n = 23) and GDM (n = 25).Conclusion An increasing trend in nutrition publications in the field of diabetes was observed. Publications were mostly dedicated to clinical trials with a focus on dietary supplements. Low portion of studies have been dedicated to children with diabetes, diabetes complications, and GDM. More attention to high quality basic research, product-based projects, and interdisciplinary studies in the field of nutrition and diabetes are needed.
Article
PurposeThe role of indoleamine 2,3-dioxygenase (IDO) has been shown in insulin resistance and metabolic syndrome. The present study aimed to measure serum IDO activity in patients with type 2 diabetes (T2DM) and to determine its association with glycemic control, oxidative stress, and insulin resistance.Methods Seventy-four patients with T2DM and 74 healthy subjects were selected to participate in this study. Fasting serum biochemical parameters including fasting blood sugar (FBS), HbA1c, insulin, uric acid, albumin, tryptophan, kynurenine, and total antioxidant capacity (TAC) were measured. HOMA-IR, QUICKI, and HOMA-B were calculated using serum FBS and insulin values. IDO activity was estimated using kynurenine/tryptophan ratio (KTR). Data were analyzed using SPSS software (Version 15) and p < 0.05 was considered as a significant difference.ResultsThe findings showed higher levels of FBS, HbA1c, HOMA-IR, and KTR in the patients compared to the controls. TAC and HOMA-B were significantly lowered in the T2DM patients compared to controls. KTR was significantly correlated with the level of HbA1c, and T2DM patients with poor glycemic control (HbA1c ≤ 8) had significantly higher level of KTR. HOMA-B was significantly correlated with serum tryptophan and inversely correlated with HbA1c.Conclusion Serum KTR is increased in T2DM patients with poor glycemic control. Potential clinical implications and possible pathogenic roles of IDO in T2DM development should be further elucidated.
Article
In this study, the inhibitory effects of oat polyphenols constituent on advanced glycation end products (AGEs) formation in the bovine serum albumin (BSA)-glucose and BSA-fructose models were explored. Spectroscopic techniques, SDS-PAGE and molecular docking were used to characterize the antiglycation capacity of oat polyphenols constituent. The results unveiled that apigenin and luteolin had the strongest inhibitory effect on AGEs. Spectroscopy results indicated that apigenin and luteolin inhibited the BSA glycation in a dose-dependent manner by attenuating the changes of conformational structure and microenvironment induced by glycation. Apigenin and luteolin also suppressed the cross-linking or aggregation of glycated BSA, which was reflected in the changed molecular weight and determined by SDS-PAGE. The prediction of molecular docking demonstrated that binding affinity of BSA-luteolin was greater than that of apigenin, which might be due to the additional hydroxyl group in the position of A ring of luteolin. In conclusion, luteolin had a stronger AGEs inhibitory activity than apigenin (P < 0.05). Oat polyphenols may be a good food source for inhibiting the formation of AGEs in vitro.
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Background: Diabetes is an enormous, growing clinical and public health problem, which together with hypertension contributes significantly to the high risk of cardiovascular diseases (CVDs) globally. Aim: To examine the indirect and direct effects of risk factors simultaneously as a network of multiple pathways leading to diabetes in the rurally based adult population (aged 15+) using a household survey. Methods: This investigation was based on a predictive model using a cross-sectional community-based study to identify the direct and indirect effects of diabetes risk factors in the Dikgale Health and Demographic Surveillance System (HDSS) consisting of 15 villages, with 7200 households and a total population of approximately 36 000. Fasting blood glucose and total cholesterol were measured using ILAB 300 with the following cut-off values: high fasting blood glucose 7 mmol/L and triglycerides 1.70 mmol/L. Results: A total of 1407 individuals were interviewed, of whom 1281 had their blood pressure (BP) measured. The conceptual model was validated by the goodness-of-fit indexes (comparative fit index [CFI] = 1.00, Tucker Lewis index [TLI] = 1.041, root mean square error of approximation [RMSEA] = 0.001). Hypertension had the strongest direct effect of 0.0918 on diabetes, followed by age (0.0039) and high waist circumference (−0.0023). Hypertension also mediates the effects that high waist circumference (0.0005) and triglycerides (0.0060) have on diabetes status. Conclusion: The results in this study confirm the conceptual model considered in the risk factors for diabetes and suggest that hypertension, age and high waist circumference are the key variables directly affecting the diabetes status in the South African rural black population. The direct effect of triglycerides on diabetes suggests mediation by some measured factor(s).
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The detection of glucose is crucial in the management of diabetes and other medical conditions but also crucial in a wide range of industries such as food and beverages. The development of glucose sensors in the past century has allowed diabetic patients to effectively manage their disease and has saved lives. First-generation glucose sensors have considerable limitations in sensitivity and selectivity which has spurred the development of more advanced approaches for both the medical and industrial sectors. The wide range of application areas has resulted in a range of materials and fabrication techniques to produce novel glucose sensors that have higher sensitivity and selectivity, lower cost, and are simpler to use. A major focus has been on the development of enzymatic electrochemical sensors, typically using glucose oxidase. However, non-enzymatic approaches using direct electrochemistry of glucose on noble metals are now a viable approach in glucose biosensor design. This review discusses the mechanisms of electrochemical glucose sensing with a focus on the different generations of enzymatic-based sensors, their recent advances, and provides an overview of the next generation of non-enzymatic sensors. Advancements in manufacturing techniques and materials are key in propelling the field of glucose sensing, however, significant limitations remain which are highlighted in this review and requires addressing to obtain a more stable, sensitive, selective, cost efficient, and real-time glucose sensor.
Article
Diabetic neuropathy is an incapacitating chronic pathological condition that encompasses a large group of diseases and manifestations of nerve damage. It affects approximately 50% of patients with diabetes mellitus. Autonomic, sensory, and motor neurons are affected. Disabilities are severe, along with poor recovery and diverse pathophysiology. Physical exercise and herbal-based therapies have the potential to decrease the disabilities associated with diabetic neuropathy. Aerobic exercises like walking, weight lifting, the use of nutraceuticals and herbal extracts are found to be effective. Literature from the public domain was studied emphasizing various beneficial effects of different exercises, use of herbal and nutraceuticals for their therapeutic action in diabetic neuropathy. Routine exercises and administration of herbal and nutraceuticals, either the extract of plant material containing the active phytoconstituent or isolated phytoconstituent at safe concentration, have been shown to have promising positive action in the treatment of diabetic neuropathy. Exercise has shown promising effects on vascular and neuronal health and has proven to be well effective in the treatment as well as prevention of diabetic neuropathy by various novel mechanisms, including herbal and nutraceuticals therapy is also beneficial for the condition. They primarily show the anti-oxidant effect, secretagogue, anti-inflammatory, analgesic, and neuroprotective action. Severe adverse events are rare with these therapies. The current review investigates the benefits of exercise and nutraceutical therapies in the treatment of diabetic neuropathy.
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Background Diabetes Mellitus (DM) has become the third chronic non-communicable disease that hits patients after tumors, cardiovascular and cerebrovascular diseases, and has become one of the major public health problems in the world. Therefore, it is of great importance to identify individuals at high risk for DM in order to establish prevention strategies for DM. Methods Aiming at the problem of high-dimensional feature space and high feature redundancy of medical data, as well as the problem of data imbalance often faced. This study explored different supervised classifiers, combined with SVM-SMOTE and two feature dimensionality reduction methods (Logistic stepwise regression and LAASO) to classify the diabetes survey sample data with unbalanced categories and complex related factors. Analysis and discussion of the classification results of 4 supervised classifiers based on 4 data processing methods. Five indicators including Accuracy, Precision, Recall, F1-Score and AUC are selected as the key indicators to evaluate the performance of the classification model. Results According to the result, Random Forest Classifier combining SVM-SMOTE resampling technology and LASSO feature screening method (Accuracy = 0.890, Precision = 0.869, Recall = 0.919, F1-Score = 0.893, AUC = 0.948) proved the best way to tell those at high risk of DM. Besides, the combined algorithm helps enhance the classification performance for prediction of high-risk people of DM. Also, age, region, heart rate, hypertension, hyperlipidemia and BMI are the top six most critical characteristic variables affecting diabetes. Conclusions The Random Forest Classifier combining with SVM-SMOTE and LASSO feature reduction method perform best in identifying high-risk people of DM from individuals. And the combined method proposed in the study would be a good tool for early screening of DM.
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The objective behind the Euro Heart Survey on diabetes and the heart was to study the prevalence of abnormal glucose regulation in adult patients with coronary artery disease (CAD). The survey engaged 110 centres in 25 countries recruiting 4196 patients referred to a cardiologist due to CAD out of whom 2107 were admitted on an acute basis and 2854 had an elective consultation. Patient data were collected via a web-based case record form. An oral glucose tolerance test (OGTT) was used for the characterisation of the glucose metabolism. Thirty-one per cent of the patients had diabetes. An OGTT was performed on the 1920 patients without known diabetes, of whom 923 had acute and 997 had a stable manifestation of CAD, respectively. In patients with acute CAD, 36% had impaired glucose regulation and 22% newly detected diabetes. In the stable group these proportions were 37% and 14%. This survey demonstrates that normal glucose regulation is less common than abnormal glucose regulation in patients with CAD. OGTT easily discloses the glucometabolic state and should be a routine procedure. The knowledge of glucometabolic state among these patients should influence their future management because it has great potential to improve the outcome.
Conference Paper
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Prevalence of diabetes mellitus is a growing area of concern worldwide. An accurate and timely detection can lead to a normal life of a patient. The existing enzyme-based method for blood glucose detection suffers from poor sensitivity and interference with other blood constituents. Hence, the nano-material synthesis for sensitive and stable non-enzyme based sensors for blood glucose measurement is a worldwide frontline emerging area of research. In this study, the significance of transition metal nano-particle decorated graphene film as a non-enzymatic sensor is discussed. A scheme for synthesizing this sensor materials with detection mechanism is also proposed. The Biomedical and Bioprocess Engineering will be immensely benefitted by the outcome of such research on non-enzymatic glucose sensor material.
Article
PurposeThe purpose of this study was to investigate the effects of interval training on cardio metabolic risk factors and nitric oxide in type 2 diabetes patients.Method This single blinded randomized controlled trial was conducted at cardiology clinic of Rajaee hospital in Karaj. Thirty female patients with type 2 diabetes randomly assigned to interval training exercise (n = 15) and control (n = 15). In interval training exercise patients received interval training exercise with 18 sessions (three sessions per week). Each training session took 25 min and consists a single set of exercise with 10 time repetitions. Training was performed on a cycle ergometer set in constant watt mode at a pedal cadence of 80–100 revolutions/min. Each repetition of the training takes 60 s and there will be a 60 s recovery pried between each repetition. Each training session include a 3-min warm-up and 2-min cool-down at 50 W for a total of 25 min. Blood samples and of all the subjects were taken at baseline, 3 weeks after intervention and at the end of the study (6 weeks).ResultsIn intervention group, comparing with controls participants, a significant decrease were observed in levels of total cholesterol, triglyceride and HA1c after training program (p < 0.05). Moreover,exercise significantly increased the level of NOx (p < 0.05). Other cardiometabolic risk factors including SBP, DBP, FPG, LDL, HDL, insulin level, insulin resistance, HR, VO2 max, did not show significant differences between the two groups (p > 0.05).Conclusion Results of current study showed that interval training as a type of planned physical activity can be effective in lowering cardiovascular risk factors, especially lowering cholesterol and triglycerides, and can also have a beneficial effect on improving NO.
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Introduction: Diabetes mellitus has become a worldwide pandemic and is causing huge costs and burdens upon patients as well as health care providers. There is increasing evidence that lifestyle alterations are extremely effective in delaying the onset of pre diabetes or development from pre diabetes to Type-2 diabetes mellitus.
Article
Selenium nanoparticles (SeNPs) have been applied in fields of nano-biosensors, environment, and nano-medicine etc. due to its excellent characteristics. Early studies had shown that SeNPs have certain inhibition ability against glycation, but inhibition mechanism, especially for the influence of SeNPs on reaction activity of glycation sites remain unclear. The aim of presented research was to reveal the effects of SeNPs on β-Lactoglobulin (β-Lg)/D-ribose glycation system at molecular level and to explore the possible inhibitory mechanism of SeNPs on the formation of advanced glycation end products (AGEs) by analyzing the glycation sites via HPLC-Orbitrap-MS/MS. Changes in contents of AGEs formation and free amino contents had indicated that SeNPs could significantly slow down the glycation process, thus attenuating the formation of AGEs. HPLC-Orbitrap-MS/MS analysis revealed that at 6 h, 12 h, and 24 h, the number of glycation sites of glycated β-Lg decreased from 7, 7, 9 to 5, 5, 6 after the intervention of SeNPs, respectively. And the glycation extent of each glycation sites were controlled and dual-glycation ability of K8, K14, K47, K91 and K101 were changed. All these results confirmed that SeNPs could indeed slow down the process of protein glycation at molecular level. This may the main reason for SeNPs reducing the formation of AGEs during glycation. Therefore, this study shed a light to the insight of how SeNPs reduce the formation of AGEs.
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Background There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low-and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. Objective We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. Methods We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. Results We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs—in stark contrast to HICs—a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. Conclusions The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contex-tualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs. The evidence documenting the large—and at least partly avoidable—economic burden of type 2 diabetes has grown rapidly in the past 13 years. Many studies documenting the economic costs of type 2 diabetes in low-and middle-income countries (LMICs) have emerged, providing a first picture of the economic impact of diabetes in poorer countries, whereas the evidence on the labour market effects in LMICs remains scarce. Costs of diabetes, as well as its adverse labour market effects, increase over time and with disease severity, indicating that early investments into prevention and disease management may be particularly worthwhile. COI studies in particular did not rigorously account for potential biases in their estimation, suggesting that cost-effectiveness studies that make use of these estimates might under-or overestimate the value for money of the respective intervention or drug.
Article
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There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs.
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To describe the prevalence of diagnosed and undiagnosed diabetes and prediabetes for New Zealand adults. The 2008/09 New Zealand Adult Nutrition Survey was a nationally representative, cross-sectional survey of 4,721 New Zealanders aged 15 years and above. Self-reported diabetes and the 2010 American Diabetes Association cutoffs for HbA1c were used to define diagnosed diabetes, undiagnosed diabetes and prediabetes. Prevalence rates were calculated and age-specific diagnosed diabetes rates were compared with those from the Virtual Diabetes Register. Overall, prevalence of diabetes was 7.0%, and prevalence of prediabetes 18.6%. Prevalence of diabetes was higher in men (8.3%, 95% CI: 6.4, 10.1) than in women (5.8%, 95% CI: 4.7, 7.0), and was higher among the obese (14.2%, 95% CI: 11.6, 16.9) compared with the normal weight group (2.4%, 95% CI: 1.4, 3.6). Prevalence of undiagnosed diabetes was highest among Pacific people (6.4%, 95% CI: 3.8, 9.1) compared with Maori (2.2%, 95% CI: 1.2, 3.1) and New Zealand European and Others (1.5%, 95% CI: 0.9, 2.1). The high prevalence of prediabetes indicates the prevalence of diabetes will continue to increase in New Zealand. Implementation of effective evidence-based prevention strategies is required to reduce the increasing costs of the diabetes epidemic.
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Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications. In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment. The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8-75.2) in the control group compared with 43.8% (95% CI, 35.5-52.3) in the diet group, 41.1% (95% CI, 33.4-49.4) in the exercise group, and 46.0% (95% CI, 37.3-54.7) in the diet-plus-exercise group (P < 0.05). When analyzed by clinic, each of the active intervention groups differed significantly from the control clinics (P < 0.05). The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or > or = 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively. Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.
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To estimate the prevalence of diabetes and the number of people with diabetes who are > or =20 years of age in all countries of the world for three points in time, i.e., the years 1995, 2000, and 2025, and to calculate additional parameters, such as sex ratio, urban-rural ratio, and the age structure of the diabetic population. Age-specific diabetes prevalence estimates were applied to United Nations population estimates and projections for the number of adults aged > or =20 years in all countries of the world. For developing countries, urban and rural populations were considered separately Prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and to rise to 5.4% by the year 2025. It is higher in developed than in developing countries. The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 2025. The major part of this numerical increase will occur in developing countries. There will be a 42% increase, from 51 to 72 million, in the developed countries and a 170% increase, from 84 to 228 million, in the developing countries. Thus, by the year 2025, >75% of people with diabetes will reside in developing countries, as compared with 62% in 1995. The countries with the largest number of people with diabetes are, and will be in the year 2025, India, China, and the U.S. In developing countries, the majority of people with diabetes are in the age range of 45-64 years. In the developed countries, the majority of people with diabetes are aged > or =65 years. This pattern will be accentuated by the year 2025. There are more women than men with diabetes, especially in developed countries. In the future, diabetes will be increasingly concentrated in urban areas. This report supports earlier predictions of the epidemic nature of diabetes in the world during the first quarter of the 21st century. It also provides a provisional picture of the characteristics of the epidemic. Worldwide surveillance of diabetes is a necessary first step toward its prevention and control, which is now recognized as an urgent priority.
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Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known. We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years. The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle. Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.
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Type 2 diabetes frequently results from progressive failure of pancreatic beta-cell function in the presence of chronic insulin resistance. We tested whether chronic amelioration of insulin resistance would preserve pancreatic beta-cell function and delay or prevent the onset of type 2 diabetes in high-risk Hispanic women. Women with previous gestational diabetes were randomized to placebo (n = 133) or the insulin-sensitizing drug troglitazone (400 mg/day; n = 133) administered in double-blind fashion. Fasting plasma glucose was measured every 3 months, and oral glucose tolerance tests (OGTTs) were performed annually to detect diabetes. Intravenous glucose tolerance tests (IVGTTs) were performed at baseline and 3 months later to identify early metabolic changes associated with any protection from diabetes. Women who did not develop diabetes during the trial returned for OGTTs and IVGTTs 8 months after study medications were stopped. During a median follow-up of 30 months on blinded medication, average annual diabetes incidence rates in the 236 women who returned for at least one follow-up visit were 12.1 and 5.4% in women assigned to placebo and troglitazone, respectively (P < 0.01). Protection from diabetes in the troglitazone group 1) was closely related to the degree of reduction in endogenous insulin requirements 3 months after randomization, 2) persisted 8 months after study medications were stopped, and 3) was associated with preservation of beta-cell compensation for insulin resistance. Treatment with troglitazone delayed or prevented the onset of type 2 diabetes in high-risk Hispanic women. The protective effect was associated with the preservation of pancreatic beta-cell function and appeared to be mediated by a reduction in the secretory demands placed on beta-cells by chronic insulin resistance.
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The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
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Lifestyle modification helps in the primary prevention of diabetes in multiethnic American, Finnish and Chinese populations. In a prospective community-based study, we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than the above populations. We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9+/-5.7 years, BMI 25.8+/-3.5 kg/m(2)) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria. The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1-4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5-37.3, p=0.018), 26.4% with MET (95% CI 19.1-35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3-37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET. Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them.
Article
Background: Rosiglitazone is a thiazolidinedione that reduces insulin resistance and might preserve insulin secretion. The aim of this study was to assess prospectively the drug's ability to prevent type 2 diabetes in individuals at high risk of developing the condition. Methods: 5269 adults aged 30 years or more with impaired fasting glucose or impaired glucose tolerance, or both, and no previous cardiovascular disease were recruited from 191 sites in 21 countries and randomly assigned to receive rosiglitazone (8 mg daily; n=2365) or placebo (2634) and followed for a median of 3 years. The primary outcome was a composite of incident diabetes or death. Analyses were done by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00095654. Findings: At the end of study, 59 individuals had dropped out from the rosiglitazone group and 46 from the placebo group. 306 (11.6%) individuals given rosiglitazone and 686 (26.0%) given placebo developed the composite primary outcome (hazard ratio 0.40, 95% CI 0.35-0.46; p<0.0001); 1330 (50.5%) individuals in the rosiglitazone group and 798 (30.3%) in the placebo group became normoglycaemic (1.71, 1.57-1.87; p<0.0001). Cardiovascular event rates were much the same in both groups, although 14 (0.5%) participants in the rosiglitazone group and two (0.1%) in the placebo group developed heart failure (p=0.01). Interpretation: Rosiglitazone at 8 mg daily for 3 years substantially reduces incident type 2 diabetes and increases the likelihood of regression to normoglycaemia in adults with impaired fasting glucose or impaired glucose tolerance, or both.
Article
Impaired glucose tolerance is associated with increased rates of cardiovascular disease and conversion to type 2 diabetes mellitus. Interventions that may prevent or delay such occurrences are of great clinical importance. We conducted a randomized, double-blind, placebo-controlled study to examine whether pioglitazone can reduce the risk of type 2 diabetes mellitus in adults with impaired glucose tolerance. A total of 602 patients were randomly assigned to receive pioglitazone or placebo. The median follow-up period was 2.4 years. Fasting glucose was measured quarterly, and oral glucose tolerance tests were performed annually. Conversion to diabetes was confirmed on the basis of the results of repeat testing. Annual incidence rates for type 2 diabetes mellitus were 2.1% in the pioglitazone group and 7.6% in the placebo group, and the hazard ratio for conversion to diabetes in the pioglitazone group was 0.28 (95% confidence interval, 0.16 to 0.49; P<0.001). Conversion to normal glucose tolerance occurred in 48% of the patients in the pioglitazone group and 28% of those in the placebo group (P<0.001). Treatment with pioglitazone as compared with placebo was associated with significantly reduced levels of fasting glucose (a decrease of 11.7 mg per deciliter vs. 8.1 mg per deciliter [0.7 mmol per liter vs. 0.5 mmol per liter], P<0.001), 2-hour glucose (a decrease of 30.5 mg per deciliter vs. 15.6 mg per deciliter [1.6 mmol per liter vs. 0.9 mmol per liter], P<0.001), and HbA(1c) (a decrease of 0.04 percentage points vs. an increase of 0.20 percentage points, P<0.001). Pioglitazone therapy was also associated with a decrease in diastolic blood pressure (by 2.0 mm Hg vs. 0.0 mm Hg, P=0.03), a reduced rate of carotid intima-media thickening (31.5%, P=0.047), and a greater increase in the level of high-density lipoprotein cholesterol (by 7.35 mg per deciliter vs. 4.5 mg per deciliter [0.4 mmol per liter vs. 0.3 mmol per liter], P=0.008). Weight gain was greater with pioglitazone than with placebo (3.9 kg vs. 0.77 kg, P<0.001), and edema was more frequent (12.9% vs. 6.4%, P=0.007). As compared with placebo, pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes mellitus by 72% but was associated with significant weight gain and edema. (Funded by Takeda Pharmaceuticals and others; ClinicalTrials.gov number, NCT00220961.).
Article
Recently, a change of the diagnostic tool for diabetes from an oral glucose tolerance test (OGTT) to hemoglobin A1c (HbA1c) has been suggested. The aim of the study was to assess whether ethnicity modified the association between glucose levels and HbA1c and to compare diabetes prevalence according to diagnostic method among Greenland Inuit, Inuit migrants in Denmark, and a general Danish population. Data from two population-based surveys conducted from 1999-2002 were compared with a total of 7957 individuals, 1173 Inuit participants from the Greenland Population Study, including 256 Inuit migrants in Denmark, and 6784 Danish participants in the Inter99 study. The participants received a standard 75-g OGTT. HbA1c was analyzed by an ion-exchange HPLC Bio-Rad variant (Hercules, California). All analyses were performed in the laboratory at Steno Diabetes Centre. The Inuit had significantly higher levels of HbA1c than the Danish participants at any given level of fasting and 2-h glucose and for each category of glucose tolerance: normal glucose tolerance, impaired fasting glycemia, and impaired glucose tolerance. The prevalence of diabetes diagnosed by OGTT was 11.2% among Inuit residents in Greenland, 9.8% among Inuit migrants, and 4.2% among Danes vs. 31.7% among Inuit residents in Greenland, 21.3% among Inuit migrants, and 6.7% among Danes diagnosed by HbA1c. OGTT-defined diabetes was associated with increased cardiovascular risk factors compared to HbA1c-defined diabetes. The association between glucose and HbA1c is not the same in the two populations. The mechanism behind this difference is unknown, and studies on long-term consequences associated with HbA1c are needed.
Article
To estimate the global health expenditure on diabetes among people aged 20-79 years for the years 2010 and 2030. Country-by-country expenditures for 193 countries, expressed in United States Dollars (USD) and in International Dollars (ID), were estimated based on the country's age-sex specific diabetes prevalence and population estimates, per capita health expenditures, and health expenditure ratios per person with and without diabetes. Diabetes prevalence was estimated from studies in 91 countries. Population estimates and health expenditures were from the United Nations and the World Health Organization. The health expenditure ratios were estimated based on utilization and cost data of a large health plan in the U.S. Diabetes expenditures for the year 2030 were projected by considering future changes in demographics and urbanization. The global health expenditure on diabetes is expected to total at least USD 376 billion or ID 418 billion in 2010 and USD 490 billion or ID 561 billion in 2030. Globally, 12% of the health expenditures and USD 1330 (ID 1478) per person are anticipated to be spent on diabetes in 2010. The expenditure varies by region, age group, gender, and country's income level. Diabetes imposes an increasing economic burden on national health care systems worldwide. More prevention efforts are needed to reduce this burden. Meanwhile, the very low expenditures per capita in poor countries indicate that more resources are required to provide basic diabetes care in such settings.
Article
We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.
Article
The increased prevalence of type 2 diabetes mellitus is a major concern for health providers. We therefore assessed whether voglibose, an alpha-glucosidase inhibitor, could prevent the development of type 2 diabetes in high-risk Japanese individuals with impaired glucose tolerance. 1780 eligible patients on a standard diet and taking regular exercise with impaired glucose tolerance were randomly assigned to oral voglibose 0.2 mg three times a day (n=897) or placebo (n=883) in a multicentre, double-blind, parallel group trial. Treatment was continued until participants developed type 2 diabetes (primary endpoint) or normoglycaemia (secondary endpoint), or for a minimum of 3 years, subject to the findings of an interim analysis. Analysis was by full analysis set. This trial is registered with the University Hospital Medical Information Network (UMIN) clinical trials registry, number UMIN 000001109. In the interim analysis, voglibose was better than placebo (p=0.0026) in individuals treated for an average of 48.1 weeks (SD 36.3). Patients treated with voglibose had a lower risk of progression to type 2 diabetes than did those on placebo (50 of 897 vs 106 of 881; hazard ratio 0.595, 95% CI 0.433-0.818; p=0.0014). More people in the voglibose group achieved normoglycaemia than did those in the placebo group (599 of 897 vs 454 of 881; 1.539, 1.357-1.746; p<0.0001). 810 (90%) of 897 patients in the voglibose group had adverse events versus 750 (85%) of 881 in the placebo group. Serious adverse events (all one each) in the voglibose group were cholecystitis, colonic polyp, rectal neoplasm, inguinal hernia, liver dysfunction, and subarachnoid haemorrhage, and in the placebo group were cerebral infarction and cholecystitis. Voglibose, in addition to lifestyle modification, can reduce the development of type 2 diabetes in high-risk Japanese individuals with impaired glucose tolerance. Takeda.
Article
To estimate prevalence rates of diabetes and impaired glucose tolerance (IGT) in three American Indian populations, using standardized diagnostic criteria, and to assess the association of diabetes with the following selected possible risk factors: age, obesity, family history of diabetes, and amount of Indian ancestry. This cross-sectional study involved enrolled members, men and women aged 45-74 years, of 13 American Indian tribes or communities in Arizona, Oklahoma, and South and North Dakota. Eligible participants were invited to the clinic for a personal interview and a physical examination. Diabetes and IGT status were defined by the World Health Organization criteria and were based on fasting plasma glucose and oral glucose tolerance test results. Data on age, family history of diabetes, and amount of Indian ancestry were obtained from the personal interview, and measures of obesity included body mass index, percentage body fat, and waist-to-hip ratio. A total of 4,549 eligible participants were examined, and diabetes status was determined for 4,304 (1,446 in Arizona, 1,449 in Oklahoma, and 1,409 in the Dakotas). In all three centers, diabetes was more prevalent in women than in men. Arizona had the highest age-adjusted rates of diabetes: 65% in men and 72% in women. Diabetes rates in Oklahoma (38% in men and 42% in women) and South and North Dakota (33% in men and 40% in women), although considerably lower than in Arizona, were several times higher than those reported for the U.S. population. Rates of IGT among the three populations (14-17%) were similar to those in the U.S. population. Diabetes rates were positively associated with age, level of obesity, amount of Indian ancestry, and parental diabetes status. Diabetes is found in epidemic proportions in Native American populations. Prevention programs and periodic screening should be implemented among American Indians. Standards of care and intervention have been developed by the Indian Health Service for individuals in whom diabetes is diagnosed. These programs should be expanded to include those with IGT to improve glycemic control or to reduce the risk of development of diabetes as well as to reduce the risk of diabetic complications.
Article
Prevention and control programmes are needed to stem the rising epidemic of diabetes and its complications. However, these will not occur unless governments and public health planners are aware of the potential problem. Using published prevalence rates for NIDDM in different populations, and the current and projected age distributions, worldwide prevalence of NIDDM was estimated for 1995 and 1997, and well as projections for 2000 and 2010. Prevalence rates used for projections were chosen to reflect changes in lifestyle with economic development. The global prevalence of IDDM was estimated using published incidence rates and population figures, incorporating the likely survival time from development of IDDM. Data on diabetes complications are also summarised but no attempt has been made to extrapolate to a global estimated. In 1997, an estimated 124 million people worldwide have diabetes, 97% of these having NIDDM. By the year 2010 the total number of people with diabetes is projected to reach 221 million. The regions with the greatest potential increases are Asia and Africa, where diabetes rates could rise to 2 or 3 times those experienced today. With improvements in the treatment of IDDM, the prevalence of this form of diabetes is likely to increase as more people survive for longer after diagnosis. Increases in complications will undoubtedly follow increasing prevalence of diabetes, but population-based studies using standardised methods of diagnosis are required before reliable estimates of the extent of the problem can be made. It is hoped that the information provided in this report, and others like it, will act as an incentive to initiate or improve local diabetes monitoring and prevention strategies.
Article
Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
Article
The worldwide increase in type 2 diabetes mellitus is becoming a major health concern. We aimed to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance to type 2 diabetes. In a multicentre, placebo-controlled randomised trial, we randomly allocated patients with impaired glucose tolerance to 100 mg acarbose or placebo three times daily. The primary endpoint was development of diabetes on the basis of a yearly oral glucose tolerance test (OGTT). Analyses were by intention to treat. We randomly allocated 714 patients with impaired glucose tolerance to acarbose and 715 to placebo. We excluded 61 (4%) patients because they did not have impaired glucose tolerance or had no postrandomisation data. 211 (31%) of 682 patients in the acarbose group and 130 (19%) of 686 on placebo discontinued treatment early. 221 (32%) patients randomised to acarbose and 285 (42%) randomised to placebo developed diabetes (relative hazard 0.75 [95% CI 0.63-0.90]; p=0.0015). Furthermore, acarbose significantly increased reversion of impaired glucose tolerance to normal glucose tolerance (p<0.0001). At the end of the study, treatment with placebo for 3 months was associated with an increase in conversion of impaired glucose tolerance to diabetes. The most frequent side-effects to acarbose treatment were flatulence and diarrhoea. Acarbose could be used, either as an alternative or in addition to changes in lifestyle, to delay development of type 2 diabetes in patients with impaired glucose tolerance.
Prevalence of diagnosed and undiagnosed diabetes and prediabetes in New Zealand: findings from the
  • Kj Coppell
  • Ji Mann
  • Sm Williams
  • Jo E Drury
  • Pl Miller