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Kumar V, Zahiruddin QS, Jena D, R R, Kaur M, Srivastava M, Barwal A, Siva Prasad GV, Rajput P, Jaiswal V, Kathuria R, Joshi A, Shabil M, Taneja M, Mishra A, Alabed AAA, Bushi G, Mehta R, Sah S, Gaidhane AM, Satapathy P. Trends and projections of type 2 diabetes mellitus in South Asia: a three-decade analysis and forecast through 2031 using global burden of disease study (1990 - 2021). Expert Rev Endocrinol Metab 2025; 20:99-106. [PMID: 39763434 DOI: 10.1080/17446651.2024.2448790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 12/20/2024] [Indexed: 02/18/2025]
Abstract
BACKGROUND The rapid rise of non-communicable diseases, particularly type 2 diabetes mellitus (T2DM), poses a significant global public health challenge, with South Asia experiencing an increasingly severe burden. This study aimed to analyse historical trends of T2DM across South Asia from 1990 to 2021 and forecast incidence through 2031. RESEARCH DESIGN AND METHODS We carried out analysis based on the data from the 2021 Global burden of disease study. Joinpoint regression was used to identify significant changes in trends over time, and ARIMA models were applied to forecast incidence rates. RESULTS Between 1990 and 2021, the average annual percentage change (AAPC) of age-standardized prevalence rates and incidence rates increased by 2.15 and 1.72 respectively. The age-standardized mortality rate rose more slowly, at 1.05 AAPC, with females experiencing a slightly higher AAPC than males. ARIMA forecasts suggest that by 2031, T2DM incidence rates will continue to rise significantly across all South Asian countries. CONCLUSIONS This study highlights the need for public health policies focused on preventing obesity, promoting physical activity, and improving healthcare access. It also calls for addressing regional disparities in T2DM prevalence and mortality to better allocate resources and prioritize policies to combat the diabetes epidemic inSouth Asia.
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Affiliation(s)
- Vijay Kumar
- Evidence for Policy and Learning, Global Center for Evidence Synthesis, Chandigarh, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Diptismita Jena
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Roopashree R
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, India
| | - Mandeep Kaur
- Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
| | | | - Amit Barwal
- Chandigarh Pharmacy College, Chandigarh Group of College, Mohali, India
| | - G V Siva Prasad
- Department of Chemistry, Raghu Engineering College, Visakhapatnam, India
| | - Pranchal Rajput
- School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India
| | | | - Rachna Kathuria
- New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India
| | - Arun Joshi
- Graphic Era Institute of Medical Sciences, Graphic Era (Deemed to be University), Dehradun, India
| | - Muhammed Shabil
- Department of Pharmacy, Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Iraq
| | - Madhur Taneja
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, India
| | - Abhinav Mishra
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, India
| | | | - Ganesh Bushi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Rachana Mehta
- Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, India
| | - Sanjit Sah
- Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Prakasini Satapathy
- Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
- University Center for Research and Development, Chandigarh University, Mohali, India
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Shanta AP, Fatema-Tuz-Zohora, Mahtarin R, MacKerell AD, Ahsan M. Isolation of phytoconstituents from an extract of Murraya paniculata with cytotoxicity and antioxidant activities and in silico evaluation of their potential to bind to aldose reductase (AKR1B1). J Biomol Struct Dyn 2024:1-15. [PMID: 39636240 DOI: 10.1080/07391102.2024.2435623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/30/2024] [Indexed: 12/07/2024]
Abstract
The study on Murraya paniculata (Orange Jasmine) stem bark extract found it to have antioxidant and cytotoxic proper-ties. The structures of the isolated phytoconstituents were determined using NMR spectroscopy. Compounds were evaluated for their potential to be aldose reductase inhibitors using molecular docking and dynamics (MD) simulations. Phytochemical screening of methanolic crude extract was performed from which different fractions of the extract were screened for antioxidant activity using the DPPH radical scavenging method and cytotoxicity using the brine shrimp lethality bioassay. The aqueous fraction showed strong antioxidant activity as compared to the standard butylated hy-droxytoluene, whereas pet ether, dichloromethane, chloroform and methanolic extract exhibited moderate antioxidant activity. Activities in the DPPH assay ranged from 17 to 63 µg/ml and all fractions showed cytotoxic activity. Five identified phytochemical compounds (1-5) include ergosterol endoperoxide (1), the coumarin derivatives 7-methoxy-8-(3-methylbut-2-enyl)-1-benzopyran-2-one (2) and 5,7-dimethoxy-8-(3-methylbut-2-enyl)-1-benzopyran-2-one (3) and a mixture of β-sitosterol (4), and stigmasterol (5). Among them ergosterol endoperoxide has been isolated from the stem bark of the M. paniculata for the first time. MD simulations of the identified compounds indicated their potential to bind to the aldose reductase (AKR1B1) protein. Predicted binding affinities of the compounds based on the site identification the ligand competitive saturation (SILCS) technology was -15.04, -8.85, -9.83, -11.95, and -11.75 kcal/mol for 1 through 5, respectively. The present results are anticipated to lead to further study of the activities of the five compounds including experimental evaluation of their inter-actions with AKR1B1.
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Affiliation(s)
- Afifa Parvin Shanta
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
- Department of Pharmacy, Southeast University, Banani, Bangladesh
| | - Fatema-Tuz-Zohora
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Rumana Mahtarin
- Division of Infectious Diseases and Division of Computer Aided Drug Design, The Red-Green Research Centre, BICCB, Tejgaon, Bangladesh
| | - Alexander D MacKerell
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Monira Ahsan
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
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Damayanthi H, Kokawalage RH, Govindapala D, de Silva NL. Perception of diet, dietary practices and sources of dietary information among people with type 2 diabetes followed up at a tertiary care outpatient clinic: a qualitative study. BMC Nutr 2024; 10:156. [PMID: 39639399 PMCID: PMC11619095 DOI: 10.1186/s40795-024-00968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 11/28/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Dietary practices and beliefs among people living with diabetes in low-middle-income South-Asian countries are unique. Understanding them is paramount in supporting them to improve their clinical outcomes. This study aimed to understand the perception of diet, dietary practices, and sources of dietary information among Sri Lankan adults with type 2 diabetes. METHODS Focus group discussions (FGD) were conducted with the participation of adults with type 2 diabetes attending a Medical Clinic at a tertiary care hospital in Sri Lanka. Eligible participants were recruited between June to October 2022 through convenience sampling. FGDs were facilitated by two researchers using a semi-structured discussion guide developed for this study. Abridged transcripts were formulated using the notes and audio recordings. Data were analysed using Braun and Clarke's six-step method for thematic analysis. RESULTS Among 38 participants included in five FGDs, the mean age was 59.9 (range: 39-76) years, 27 (71.1%) were females, and mean duration since the diagnosis of diabetes was 9.4 (range: 0-25) years. Five main themes were identified. (1) Diet in diabetes and composition of the meal; participants were aware of the importance of diet in diabetes and understood a healthy meal including the plate concept. (2) Individual components in the diet; many participants used 'sugar' to refer to 'starch' in the food. Participants considered rice superior to wheat flour-based products in diabetes. Finger millet products were believed to lower blood glucose. We observed beliefs on the glycaemic effects of specific varieties of yams, legumes and fruits. Some participants completely avoided sweets and starchy vegetables. (3) Utilisation of food labels; only a few participants referred to food labels. (4) Factors affecting the practice; external factors such as the recent economic crisis, family members' influence, and availability affected their food choices. (5) Sources of information; some felt that ready access to information was limited. CONCLUSIONS We identified several misconceptions and undue dietary restrictions, minimal utilisation of food labels and information sources, and the impact of several external factors including economic restrictions. Understanding these dynamic patient and social factors would enable culturally acceptable dietary interventions by health professionals to improve patient outcomes.
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Affiliation(s)
- Hasitha Damayanthi
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ravihansi Hasinthara Kokawalage
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate, Ratmalana, Sri Lanka
| | - Dumitha Govindapala
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate, Ratmalana, Sri Lanka
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepura, Nugegoda, Sri Lanka
| | - Nipun Lakshitha de Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Estate, Ratmalana, Sri Lanka.
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Hamza M, Edwards RC, Beaumont JD, De Pretto L, Torn A. Access to natural green spaces and their associations with psychological wellbeing for South Asian people in the UK: A systematic literature review. Soc Sci Med 2024; 359:117265. [PMID: 39217719 DOI: 10.1016/j.socscimed.2024.117265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
Use of natural green spaces (NGS) is associated with improved psychological well-being (PWB). Ethnic minorities, particularly South Asian (SA) communities in the UK, face unequal access to NGS and experience a greater prevalence of health challenges than the general population. Improving access to green space can contribute to addressing current health inequalities. Following PRISMA guidelines, this systematic literature review aimed to synthesise existing research on NGS access barriers experienced by SAs and associations between NGS use and PWB. A comprehensive search was conducted through SAGE, Science Direct, and SCOPUS in August 2022; we included qualitative, quantitative and mixed-methods studies with findings on NGS access and/or associations between NGS use and PWB for SAs in the UK. We employed deductive thematic analysis to explore inhibitors and enablers of access which were then conceptualised through a multidimensional framework. Associations between NGS and PWB were coded inductively and mapped separately. This review is registered on PROSPERO: CRD42022353711. Twenty-six studies were included in the review which varied substantially in their aims, methods, context, and participants. Included studies on NGS grouped SAs within broader demographic categories such as minority ethnic communities or Muslims. Our findings indicate that SAs are disadvantaged in their access to NGS due to numerous intersecting factors including unequal distribution, inadequate transport, racialisation of NGS, and safety concerns. Whilst these findings generally aligned with broader literature on NGS access, certain access barriers and enablers are particularly significant to SA communities. We also identified several dimensions of PWB that are enhanced for SAs through interacting with NGS including overall mental health outcomes, physical wellbeing, and social relatedness. This review highlights opportunities to improve access to NGS and thereby enhance PWB outcomes for SA people. It also identifies the lack of primary research exploring NGS access and PWB associations for SA communities, specifically in rural contexts.
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Affiliation(s)
- Mohammed Hamza
- Faculty of Social Science and Education, Leeds Trinity University, Leeds, LS18 5HD, UK.
| | - Rachael C Edwards
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, London, WC1E 6BT, UK
| | - Jordan D Beaumont
- Sheffield Business School, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | - Laura De Pretto
- Faculty of Social Science and Education, Leeds Trinity University, Leeds, LS18 5HD, UK
| | - Alison Torn
- Faculty of Social Science and Education, Leeds Trinity University, Leeds, LS18 5HD, UK
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Rahim E, Rahim FO, Anzaar HF, Lalwani P, Jain B, Desai A, Palakodeti S. Culturally Tailored Strategies to Enhance Type 2 Diabetes Care for South Asians in the United States. J Gen Intern Med 2024; 39:2560-2564. [PMID: 38943015 PMCID: PMC11436665 DOI: 10.1007/s11606-024-08902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024]
Abstract
South Asian immigrants in the United States face an elevated risk of developing type 2 diabetes (T2DM). This phenomenon has been linked to lifestyle factors and social determinants of health (SDOH) such as high-carbohydrate diet, limited physical activity, and stress from assimilation and other life challenges. Unfortunately, barriers stemming from language discordance, low health literacy, and certain cultural practices can hinder effective clinical management of T2DM among South Asian immigrants. In this perspective, we address these sociocultural barriers and propose culturally informed recommendations to improve healthcare delivery for South Asian groups and empower South Asian patients to self-manage T2DM. Our recommendations include (1) considerations and support for SDOH in South Asian communities, (2) culturally tailored healthcare delivery for South Asians, (3) mHealth technologies for T2DM education and self-management; and (4) enhanced epidemiological and South Asian-centric research.
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Affiliation(s)
| | | | | | | | - Bhav Jain
- Stanford University School of Medicine, Stanford, CA, USA
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Singh K, Kondal D, Jagannathan R, Ali MK, Prabhakaran D, Narayan KMV, Anand S, Tandon N. Rate and risk factors of kidney function decline among South Asians with type 2 diabetes: analysis of the CARRS Trial. BMJ Open Diabetes Res Care 2024; 12:e004218. [PMID: 39153754 PMCID: PMC11409274 DOI: 10.1136/bmjdrc-2024-004218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/27/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia. RESEARCH DESIGN AND METHODS We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site. RESULTS The mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was -1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: -2.11; 95% CI: -3.45 to -0.77), previous cardiovascular disease (-1.93; 95% CI: -3.45 to -0.40), and statins use (-0.87; 95% CI: -1.65 to -0.10) were associated with faster eGFR decline. CONCLUSIONS People with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications. TRIAL REGISTRATION NUMBER NCT01212328.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, New Delhi, Delhi, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Ram Jagannathan
- Emory University School of Medicine, Atlanta, Georgia
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
- Family and Preventive Medicine, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | | | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, USA
- Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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Nicodemus N, Ang-Golangco N, Aquitania G, Ardeña GJR, Dampil OA, Fernando RE, Flor NT, Kho S, Mirasol R, Panelo A, Pasaporte F, Puno-Rocamora M, Shoeb A, Tolentino M. Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults With Type 2 Diabetes in the Philippines: Results from a Prospective, Non-interventional, Real-World Study. J ASEAN Fed Endocr Soc 2024; 39:61-69. [PMID: 39620193 PMCID: PMC11604473 DOI: 10.15605/jafes.039.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/28/2023] [Indexed: 12/19/2024] Open
Abstract
Objective Blood glucose levels of the majority of Filipino patients with type 2 diabetes (T2D) remain uncontrolled. Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of the long-acting basal insulin degludec and the rapidacting prandial insulin aspart. The real-world ARISE (A Ryzodeg® Initiation and Switch Effectiveness) study investigated clinical outcomes across six countries in people with T2D who initiated IDegAsp. This publication presents the clinical outcomes of the Filipino cohort from a subgroup analysis of the ARISE study. Methodology This 26-week, open-label, non-interventional study examined outcomes in adults with T2D initiating or switching to IDegAsp (N=185) from other antidiabetic treatments per local clinical guidance. Results Compared with the baseline, there was a significant improvement in glycated hemoglobin at the end of the study (EOS) (estimated difference [ED] -1.4% [95% confidence interval -1.7, -1.1]; P <0.0001). Fasting plasma glucose (ED -46.1 mg/dL [-58.2, -34.0]; P <0.0001) and body weight (ED -1.0 kg [-2.0, -0.1]; P = 0.028) were significantly reduced at EOS compared with baseline. IDegAsp was associated with a decrease in the incidence of self-reported healthcare resource utilization. Adverse events were reported in eight (4.3%) participants. Conclusion Initiating or switching to IDegAsp was associated with improved glycemic control, lower body weight, and lower HRU for people with T2D in the Philippines. No new, unexpected AEs were reported.
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Affiliation(s)
| | | | | | | | | | | | | | - Sjoberg Kho
- University of Santo Tomas Hospital, Manila, Philippines
| | | | - Araceli Panelo
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Ahsan Shoeb
- Novo Nordisk Philippines, Taguig City, Philippines
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Lin L, Dekkers IA, Tao Q, Paiman EHM, Bizino MB, Jazet IM, Lamb HJ. MR Assessed Changes of Renal Sinus Fat in Response to Glucose Regulation in West European and South Asian Patients With Type 2 Diabetes. J Magn Reson Imaging 2024; 60:729-738. [PMID: 38085104 DOI: 10.1002/jmri.29174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Ethnic differences in the progression and outcome of diabetic kidney disease (DKD) remain to be elucidated. MRI-quantified renal sinus fat volume could be a potential biomarker to help investigate the changes of DKD risk in response to glucose regulation. PURPOSE To evaluate whether the effect of glucose-lowering treatment on renal sinus fat volume differed in West Europeans (WE) compared to South Asians (SA), and whether ethnic-related difference exists regarding the effect of liraglutide on renal sinus fat. STUDY TYPE Retrospective. POPULATION Ninety-three patients with type 2 diabetes mellitus, including 47 WE (27 males) aged 59.3 ± 6.5 years, and 46 SA (19 males) aged 54.4 ± 9.8 years. FIELD STRENGTH/SEQUENCE 3.0 T dual-echo fast gradient-echo pulse sequence using two-point Dixon technique with a phase-correction algorithm. ASSESSMENT Changes of renal sinus fat volume were measured by a radiologist (LL) with 4-years' experience, and were compared between the two ethnic groups, together with glycemic level, metabolic risk factors and renal function. The effects of liraglutide were assessed. STATISTICAL TESTS Normality of the data was visually evaluated by histograms and Q-Q plots. Within-group and between-group differences were analyzed using paired t-tests and analysis of covariance. Associations were analyzed by person's correlation and multiple linear regression models. RESULTS Renal sinus fat decreased in SA patients (Δ% = -7.6% ± 14.8%), but increased in WE patients (Δ% = 5.0% ± 13.1%), with a significant difference between the two ethnic groups. In the WE group, the increase of sinus fat volume was significant in the placebo subgroup (Δ% = 6.8% ± 12.5%), in contrast to the nonsignificant increase in the liraglutide subgroup (Δ% = 3.0% ± 13.8%, P = 0.444). DATA CONCLUSION Renal sinus fat accumulation responds differently to glucose regulation, showing a reduction in SA patients in contrast to a persistent accumulation in WE patients. A trend of less accumulation of sinus fat in WE patients receiving liraglutide has been observed. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Ling Lin
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M Jazet
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Da L, Tarasenko Y, Chen C. Asian American sub-ethnic disparities and trends in epithelial ovarian cancer diagnosis, treatment and survival. ETHNICITY & HEALTH 2024; 29:685-702. [PMID: 38967965 DOI: 10.1080/13557858.2024.2359387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Studies on ovarian cancer (OC) diagnosis, treatment and survival across disaggregated Asian sub-ethnic groups are sparse. Few studies have also conducted trend analyses of these outcomes within and across Asian groups. METHODS Using logistic, Cox, and Joinpoint regression analyses of the 2000-2018 Surveillance, Epidemiology, and End Results (SEER) data, we examined disparities and trends in OC advanced stage diagnosis, receipt of treatments and the 5-year cause-specific survival across seven Asian sub-ethnic groups. RESULTS There were 6491 OC patients across seven Asian sub-ethnic groups (mean [SD] age, 57.29 [13.90] years). There were 1583(24.39%) Filipino, 1183(18.23%) Chinese, and 761(11.72%) Asian Indian or Pakistani (AIP) patients. The majority (52.49%) were diagnosed with OC with at an advanced stage. AIP were more likely to have advanced stage diagnosis than other subgroups (ORs, 95%CIs: 0.77, 0.62-0.96 [Filipino]; 0.76, 0.60-0.95 [Chinese]; 0.71, 0.54-0.94 [Japanese]; 0.74, 0.56-0.98 [Vietnamese] and 0.66, 0.53-0.83 [Other Asians]). The Filipinos were least likely to receive surgery but most likely to undergo chemotherapy. Japanese patients had the worst 5-year OC cause-specific survival (50.29%, 95%CI: 46.20%-54.74%). Based on the aggregated analyses, there was a significantly decreased trend in advanced-stage diagnosis and an increased trend in receipt of chemotherapy. Trends in OC outcomes for several subethnicities differed from those observed in aggregated analyses. CONCLUSION In this cohort study of 6491 patients, OC diagnosis, treatment, survival, and trends differed across Asian American ethnic subgroups. Such differences must be considered in future research and interventions to ensure all Asian American subethnicities equally benefit from the advancements in OC care and control.
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Affiliation(s)
- Lijuan Da
- School of Public Health, Zhejiang University, Hangzhou, People's Republic of China
| | - Yelena Tarasenko
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University (GSU), Statesboro, USA
| | - Chen Chen
- Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, People's Republic of China
- Center for Biostatistics, Bioinformatics, and Big Data, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
- Department of Biostatistics, GoBroad Research Center, Shanghai, People's Republic of China
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 PMCID: PMC11389897 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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Low CG, Merchant M, Hung Y, Liu YH, Vu J, Pursnani S. Assessing Glycosylated Hemoglobin Thresholds for Development of Cardiovascular Disease by Racial and Ethnic Groups. J Am Heart Assoc 2024; 13:e033559. [PMID: 38761085 PMCID: PMC11179793 DOI: 10.1161/jaha.123.033559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic-specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups. METHODS AND RESULTS This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456-1.843]; P<0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022-1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal. CONCLUSIONS Findings suggest that the use of race and ethnic- and sex-specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.
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Affiliation(s)
| | | | - Yun‐Yi Hung
- Kaiser Permanente Division of ResearchOaklandCA
| | - Yu Hsin Liu
- Kaiser Permanente Medical CenterSanta ClaraCA
| | - Joseph Vu
- Kaiser Permanente Medical CenterSanta ClaraCA
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12
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Fields ND, Narayan KMV, Ranjani H, Staimez LR, Anjana RM, Patel SA, Mohan V, Ali MK, Weber MB. Perceived stress and progression of cardiometabolic risk factors among South Asians with prediabetes in a lifestyle intervention trial. Prim Care Diabetes 2024; 18:183-187. [PMID: 38177017 PMCID: PMC11009057 DOI: 10.1016/j.pcd.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
AIMS To examine associations between perceived stress and cardiometabolic risk factors in South Asians with prediabetes and assess whether a diabetes prevention program mitigates the impact of stress on cardiometabolic health. METHODS We conducted a secondary analysis of the Diabetes Community Lifestyle Improvement Program, a lifestyle modification trial for diabetes prevention in India (n = 564). Indicators for cardiometabolic health (weight, waist circumference, blood pressure, glucose, HbA1c, and lipids) were measured at each visit while perceived stress was assessed via questionnaire at baseline. Multivariable linear regression assessed associations between stress and cardiometabolic parameters at baseline and 3-year follow up. RESULTS At baseline, perceived stress was associated with higher weight (b=0.16; 95% CI: 0.04, 0.29) and waist circumference (b=0.11; 95% CI: 0.01, 0.21) but lower 30-minute postload glucose (b=-0.44; 95% CI: -0.76, -0.14) and LDL cholesterol (b=-0.40; 95% CI: -0.76, -0.03). Over the study period, perceived stress was associated with weight gain (b=0.20; 95% CI: 0.07, 0.33) and increased waist circumference (b=0.14; 95% CI: 0.04, 0.24). Additionally, higher perceived stress was associated with lower HDL cholesterol among the control arm (pinteraction = 0.02). CONCLUSIONS Baseline stress was associated with negative cardiometabolic risk factor outcomes over time in those with prediabetes.
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Affiliation(s)
- Nicole D Fields
- Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Harish Ranjani
- Madras Diabetes Research Foundation, Chennai 600086, India
| | - Lisa R Staimez
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, Chennai 600086, India; Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Chennai 600086, India
| | - Shivani A Patel
- Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai 600086, India; Dr. Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Chennai 600086, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Mary Beth Weber
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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13
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Yurkovich JT, Evans SJ, Rappaport N, Boore JL, Lovejoy JC, Price ND, Hood LE. The transition from genomics to phenomics in personalized population health. Nat Rev Genet 2024; 25:286-302. [PMID: 38093095 DOI: 10.1038/s41576-023-00674-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 03/21/2024]
Abstract
Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data-driven personalized approach that reflects their genetics, behaviour and environment, we can start to address these challenges. This assessment includes longitudinal phenome measures, such as the blood proteome and metabolome, gut microbiome composition and function, and lifestyle and behaviour through wearables and questionnaires. Here, we review ongoing large-scale genomics and longitudinal phenomics efforts and the powerful insights they provide into wellness. We describe our vision for the transformation of the current health care from disease-oriented to data-driven, wellness-oriented and personalized population health.
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Affiliation(s)
- James T Yurkovich
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, USA
| | - Simon J Evans
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
| | - Noa Rappaport
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Institute for Systems Biology, Seattle, WA, USA
| | - Jeffrey L Boore
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
| | - Jennifer C Lovejoy
- Phenome Health, Seattle, WA, USA
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA
- Institute for Systems Biology, Seattle, WA, USA
| | - Nathan D Price
- Institute for Systems Biology, Seattle, WA, USA
- Thorne HealthTech, New York, NY, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Leroy E Hood
- Phenome Health, Seattle, WA, USA.
- Center for Phenomic Health, The Buck Institute for Research on Aging, Novato, CA, USA.
- Institute for Systems Biology, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA.
- Department of Immunology, University of Washington, Seattle, WA, USA.
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14
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Shahid MB, Saeed M, Naeem H, Kumari U. Diabetes mellitus: Is Pakistan the epicenter of the next pandemic? Chronic Dis Transl Med 2024; 10:75-77. [PMID: 38450301 PMCID: PMC10914006 DOI: 10.1002/cdt3.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/09/2023] [Accepted: 09/12/2023] [Indexed: 03/08/2024] Open
Abstract
Estimated age-adjusted comparative diabetes prevalence in adults (20-79 years) in Pakistan from the year 2011 to 2021.
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Affiliation(s)
| | | | - Hamza Naeem
- King Edward Medical UniversityLahorePakistan
| | - Usha Kumari
- Dow University of Health SciencesKarachiPakistan
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15
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Abdelhameed F, Giuffrida A, Thorp B, Moorthy MK, Gevers EF. Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London Centre-A Decade-Long Analysis of Incidence, Outcomes, and Transition. CHILDREN (BASEL, SWITZERLAND) 2024; 11:173. [PMID: 38397285 PMCID: PMC10887333 DOI: 10.3390/children11020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. This study of a Barts Health NHS Trust cohort from 2008 to 2022 aims to elucidate the incidence, clinical outcomes, and complications associated with paediatric T2D. A retrospective analysis utilising electronic and paper records identified 40 patients with T2D. The incidence doubled from 2.6/year in 2008-2013 to 5.4/year in 2014-2018. Sixty-eight percent exhibited co-morbidities, notably learning disabilities. At diagnosis, the mean BMI was 32.4 ± 6.71 kg/m2, with no gender-based disparity and no significant change over a two-year follow-up. The initial HbA1c was 75.2 ± 21.0 mmol/mol, decreasing to 55.0 ± 17.4 mmol/mol after three months (p = 0.001) and then rising to 63.0 ± 25.5 mmol/mol at one year (p = 0.07). While 22/37 patients achieved HbA1c < 48 mmol/mol, only 9 maintained this for a year. Several metabolic and cardiovascular complications were observed at diagnosis and follow-up, with no significant change in frequency. In 2022, 15 patients transitioned to adult services. HbA1c at transition was 74.7 ± 27.6 mmol/mol, showing no change one year post-transition (71.9 ± 26.9 mmol/mol, p = 0.34). This study highlights substantial therapeutic failure, with current management falling short in achieving a sustained reduction in BMI or HbA1c. Novel treatment approaches are needed to improve clinical outcomes and address the high burden of co-morbidities and complications.
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Affiliation(s)
- Farah Abdelhameed
- Barts Health NHS Trust—Royal London Children’s Hospital, London E1 1BB, UK; (F.A.); (A.G.); (B.T.); (M.K.M.)
- William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London EC1M 6BQ, UK
| | - Anna Giuffrida
- Barts Health NHS Trust—Royal London Children’s Hospital, London E1 1BB, UK; (F.A.); (A.G.); (B.T.); (M.K.M.)
- School of Medicine, University of Catania, 95124 Catania, Italy
| | - Ben Thorp
- Barts Health NHS Trust—Royal London Children’s Hospital, London E1 1BB, UK; (F.A.); (A.G.); (B.T.); (M.K.M.)
| | - Myuri K. Moorthy
- Barts Health NHS Trust—Royal London Children’s Hospital, London E1 1BB, UK; (F.A.); (A.G.); (B.T.); (M.K.M.)
| | - Evelien F. Gevers
- Barts Health NHS Trust—Royal London Children’s Hospital, London E1 1BB, UK; (F.A.); (A.G.); (B.T.); (M.K.M.)
- William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London EC1M 6BQ, UK
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16
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Shantsila E, Shantsila A, Williams N, Lip GY, Gill PS. Left ventricular hypertrophy and mortality in ethnic minority groups in the UK: e-ECHOES study. J Hypertens 2024; 42:95-100. [PMID: 37706514 PMCID: PMC10712994 DOI: 10.1097/hjh.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/19/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, and its scale in South Asian and African-Caribbean communities is unknown. Left ventricular hypertrophy (LVH) is a measure of target organ damage in uncontrolled hypertension. The study assesses LVH prevalence in South Asian and African-Caribbean communities and its impact on mortality. METHOD This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Left ventricular mass index (LVMI) was calculated using echocardiography to establish LVH. The predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. RESULTS The study included 3200 South Asians (age 59 ± 10 years, 52% women, 45% had a history of hypertension, 5.8 ± 1.0-year follow-up). LVH was found in 1568 (49%), of whom 45% did not have hypertension diagnosis. On Cox regression, LVH was independently associated with all-cause mortality [hazard ratio 1.38, 95% confidence interval (95% CI) 1.01-1.88], cardiovascular mortality (hazard ratio 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%, undiagnosed hypertension prevalence 37%. The study included 1858 African-Caribbeans (age 62 ± 12, 45% women, 45% had history of hypertension, 5.1 ± 0.9-year follow-up). LVH was found in 1186 (64%), of whom 32% did not have hypertension diagnosis. LVH was borderline associated with all-cause mortality (hazard ratio 1.57, 95% CI 1.01-2.44), but not cardiovascular mortality (hazard ratio 1.82, 95% CI 0.80-4.16). The projected overall hypertension prevalence was 78.5%, and undiagnosed hypertension prevalence was 20.8%. CONCLUSION UK South Asians and African-Caribbeans have a high prevalence of hypertension, which is often underdiagnosed and poorly controlled.
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Affiliation(s)
- Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Alena Shantsila
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Paramjit S. Gill
- Academic Unit of Primary Care Warwick Medical School, University of Warwick Coventry, UK
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17
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Re F, Oguntade AS, Bohrmann B, Bragg F, Carter JL. Associations of general and central adiposity with hypertension and cardiovascular disease among South Asian populations: a systematic review and meta-analysis. BMJ Open 2023; 13:e074050. [PMID: 38110373 DOI: 10.1136/bmjopen-2023-074050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The relevance of measures of general and central adiposity for cardiovascular disease (CVD) risks in populations of European descent is well established. However, it is less well characterised in South Asian populations, who characteristically manifest larger waist circumferences (WC) for equivalent body mass index (BMI). This systematic review and meta-analysis provide an overview of the literature on the association of different anthropometric measures with CVD risk among South Asians. METHODOLOGY MEDLINE and Embase were searched from 1990 to the present for studies in South Asian populations investigating associations of two or more adiposity measures with CVD. Random-effects meta-analyses were conducted on the associations of BMI, WC and waist-to-hip ratio (WHR) with blood pressure, hypertension and CVD. Quality assessment was performed using the Newcastle-Ottawa scale. RESULTS Titles and abstracts were screened for 7327 studies, yielding 147 full-text reviews. The final sample (n=30) included 2 prospective, 5 case-control and 23 cross-sectional studies. Studies reported generally higher risks of hypertension and CVD at higher adiposity levels. The pooled mean difference in systolic blood pressure (SBP) per 5 kg/m2 higher BMI was 3 mmHg (2.90 (95% CI 1.30 to 4.50)) and 6 mmHg (6.31 (95% CI 4.81 to 7.81) per 13 cm larger WC. The odds ratio (OR) of hypertension per 5 kg/m2 higher BMI was 1.33 (95% CI 1.18 to 1.51), 1.45 (95% CI 1.05 to 1.98) per 13 cm larger WC and 1.22 (95% CI 1.04 to 1.41) per 0.1-unit larger WHR. Pooled risk of CVD for BMI-defined overweight versus healthy-weight was 1.65 (95% CI 1.55 to 1.75) and 1.48 (95% CI 1.21 to 1.80) and 2.51 (95% CI 0.94 to 6.69) for normal versus large WC and WHR, respectively. Study quality was average with significant heterogeneity. CONCLUSIONS Measures of both general and central adiposity had similar, strong positive associations with the risk of CVD in South Asians. Larger prospective studies are required to clarify which measures of body composition are more informative for targeted CVD primary prevention in this population.
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Affiliation(s)
- Federica Re
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ayodipupo S Oguntade
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bastian Bohrmann
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Carter
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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18
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Goon S, Chapman-Novakofski K. Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:905-913. [PMID: 37943229 DOI: 10.1016/j.jneb.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/31/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.
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Affiliation(s)
- Shatabdi Goon
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
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Jang HY, Kim IW, Oh JM. Comparative Safety Analysis of Empagliflozin in Type 2 Diabetes Mellitus Patients with Chronic Kidney Disease versus Normal Kidney Function: A Nationwide Cohort Study in Korea. Pharmaceutics 2023; 15:2394. [PMID: 37896154 PMCID: PMC10610004 DOI: 10.3390/pharmaceutics15102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Empagliflozin has been shown to reduce cardiovascular morbidity and mortality in patients with type 2 diabetes. Various research on its efficacy in patients with chronic kidney disease (CKD) have been actively conducted. So far, few studies have investigated the safety of these adverse effects specifically in Asians with CKD. We aim to address these safety concerns on a patient population of Asian CKD patients using real-world data. METHODS We conducted a retrospective cohort study using health insurance data from the Korean Health Insurance Review & Assessment Service and compared safety outcomes between empagliflozin and sitagliptin in 26,347 CKD patients diagnosed with diabetes. Adverse outcomes, including major adverse cardiac events (MACEs), all-cause mortality, myocardial infarction (MI), stroke, and hospitalization for heart failure (HHF), among others, were assessed. RESULTS Among a 1:1 matched cohort (6170 on empagliflozin, 6170 on sitagliptin), empagliflozin was associated with a significant reduction in MACEs, all-cause mortality, MI, hospitalization for unstable angina, coronary revascularization, HHF, hypoglycemic events, and urinary tract infections, but increased the risk of genital tract infections. No significant changes were observed for transient ischemic attack, acute kidney injury, volume depletion, diabetic ketoacidosis, thromboembolic events, and fractures. CONCLUSIONS The usage of empagliflozin in diabetic CKD patients shows a significant reduction in many adverse outcomes compared to sitagliptin, but with an increased risk of genital tract infections. These findings provide evidence for future clinical decision-making around the use of empagliflozin in Asian CKD patients.
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Affiliation(s)
- Ha Young Jang
- College of Pharmacy, Gachon University, Incheon 21936, Republic of Korea;
| | - In-Wha Kim
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea;
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Siddiq S, Ahmed S, Akram I. Clinical outcomes following COVID-19 infection in ethnic minority groups in the UK: a systematic review and meta-analysis. Public Health 2023; 222:205-214. [PMID: 35970621 PMCID: PMC9181265 DOI: 10.1016/j.puhe.2022.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK. STUDY DESIGN Systematic review and meta-analysis. METHODS This study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle-Ottawa Scale checklist. PROSPERO ID CRD42021248117. RESULTS Fourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21-2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85-1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04-1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73-3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89-2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64-3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80-2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20-2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35-3.22, k = 3). CONCLUSION This review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19-related disease severity and mortality compared with the White ethnic group majority.
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Affiliation(s)
- S Siddiq
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; UK Health Security Agency, UK.
| | - S Ahmed
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; National Institute of Health Research Applied Research Collaboration for Greater Manchester (NIHR ARC-GM), UK
| | - I Akram
- Southend Clinical Commissioning Group, UK; Valkyrie Surgery, Westcliff-On-Sea, UK; West Central Primary Care Network, UK; Royal College of General Practitioners, London, UK
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21
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Mazumder H, Islam KF, Rahman F, Gain EP, Saha N, Eva IS, Shimul MMH, Das J, Hossain MM. Prevalence of anemia in diabetes mellitus in South Asia: A systematic review and meta-analysis. PLoS One 2023; 18:e0285336. [PMID: 37163539 PMCID: PMC10171606 DOI: 10.1371/journal.pone.0285336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE Anemia and Diabetes Mellitus (DM) are amongst major clinical and public health challenges in South Asia that influence the progression of chronic health problems in this population. Despite a growing body of research on these problems, there is a lack synthesized evidence on the burden of anemia among people with DM in this region. This meta-analytic review was conducted to estimate the prevalence of anemia among people with DM in South Asia. METHODS A systematic search of the literature was conducted in five primary databases and additional sources up to July 29, 2022, that reported the prevalence of anemia among DM patients in any of the eight South Asian countries. Observational studies that met pre-determined eligibility criteria according to the protocol registered in PROSPERO (CRD42022348433) were included in this meta-analysis. Random effect models were used to estimate pooled prevalence. RESULTS Of the 40 eligible studies, 38 underwent meta-analysis representing 14,194 participants with DM. The pooled prevalence of anemia was 45% (95% CI: 37.0-54.0, I2 = 99.28%, p = 0.00) among diabetic people in South Asia. In sub-group analysis, the pooled prevalence of anemia was higher in females (48%, 95% CI: 37.0-60.0, I2 = 98.86%, p = 0.00) compared to males (39%, 95% CI: 29.0-48.0, I2 = 98.18%, p = 0.00). Diabetic patients with older age (≥ 50 years) reported higher pooled estimates of anemia (48%, 95% CI: 38.0-58.0, I2 = 99.07%) than younger age group (< 50 years) (34%, 95% CI: 21.0-47.0, I2 = 98.83%). In addition, we found variation in pooled prevalence estimates of anemia considering the type of DM, such as type 1 reported 2% (95% CI: 0.00-4.00), type-2 reported 48% (95% CI: 40.0-56.0, I2 = 98.94%), and Gestational diabetes mellitus (GDM) reported 6% (95% CI: 3.00-12.0). CONCLUSION High pooled estimates of anemia among diabetic patients in South Asia, including publication bias, warrants further clinical and public health research following standard research methods to understand the more context-specific epidemiological insights and evidence.
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Affiliation(s)
| | - Kazi Faria Islam
- Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Farzana Rahman
- Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | | | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | | | | | - Jyoti Das
- North South University, Dhaka, Bangladesh
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22
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Straat ME, Martinez-Tellez B, van Eyk HJ, Bizino MB, van Veen S, Vianello E, Stienstra R, Ottenhoff THM, Lamb HJ, Smit JWA, Jazet IM, Rensen PCN, Boon MR. Differences in Inflammatory Pathways Between Dutch South Asians vs Dutch Europids With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:931-940. [PMID: 36262060 PMCID: PMC9999357 DOI: 10.1210/clinem/dgac598] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/06/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT South Asian individuals are more prone to develop type 2 diabetes (T2D) coinciding with earlier complications than Europids. While inflammation plays a central role in the development and progression of T2D, this factor is still underexplored in South Asians. OBJECTIVE This work aimed to study whether circulating messenger RNA (mRNA) transcripts of immune genes are different between South Asian compared with Europid patients with T2D. METHODS A secondary analysis was conducted of 2 randomized controlled trials of Dutch South Asian (n = 45; age: 55 ± 10 years, body mass index [BMI]: 29 ± 4 kg/m2) and Dutch Europid (n = 44; age: 60 ± 7 years, BMI: 32 ± 4 kg/m2) patients with T2D. Main outcome measures included mRNA transcripts of 182 immune genes (microfluidic quantitative polymerase chain reaction; Fluidigm Inc) in fasted whole-blood, ingenuity pathway analyses (Qiagen). RESULTS South Asians, compared to Europids, had higher mRNA levels of B-cell markers (CD19, CD79A, CD79B, CR2, CXCR5, IGHD, MS4A1, PAX5; all fold change > 1.3, false discovery rate [FDR] < 0.008) and interferon (IFN)-signaling genes (CD274, GBP1, GBP2, GBP5, FCGR1A/B/CP, IFI16, IFIT3, IFITM1, IFITM3, TAP1; all FC > 1.2, FDR < 0.05). In South Asians, the IFN signaling pathway was the top canonical pathway (z score 2.6; P < .001) and this was accompanied by higher plasma IFN-γ levels (FC = 1.5, FDR = 0.01). Notably, the ethnic difference in gene expression was larger for women (20/182 [11%]) than men (2/182 [1%]). CONCLUSION South Asian patients with T2D show a more activated IFN-signaling pathway compared to Europid patients with T2D, which is more pronounced in women than men. We speculate that a more activated IFN-signaling pathway may contribute to the more rapid progression of T2D in South Asian compared with Europid individuals.
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Affiliation(s)
- Maaike E Straat
- Correspondence: Mariëtte R. Boon, MD PhD, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - Borja Martinez-Tellez
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Huub J van Eyk
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Maurice B Bizino
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Suzanne van Veen
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Eleonora Vianello
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Rinke Stienstra
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University, 6708 PB Wageningen, the Netherlands
- Department of Medicine, Radboud University Medical Center, 6525 XZ Nijmegen, the Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Johannes W A Smit
- Department of Medicine, Radboud University Medical Center, 6525 XZ Nijmegen, the Netherlands
| | - Ingrid M Jazet
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Patrick C N Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Mariëtte R Boon
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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23
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Chen DC, Lees JS, Lu K, Scherzer R, Rutherford E, Mark PB, Kanaya AM, Shlipak MG, Estrella MM. Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank. J Am Heart Assoc 2023; 12:e027079. [PMID: 36695320 PMCID: PMC9973614 DOI: 10.1161/jaha.122.027079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023]
Abstract
Background South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). Conclusions Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.
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Affiliation(s)
- Debbie C. Chen
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Genentech, Inc.South San FranciscoCA
| | - Jennifer S. Lees
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Kaiwei Lu
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Rebecca Scherzer
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
| | - Elaine Rutherford
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Renal Unit, Mountainhall Treatment Centre, NHS Dumfries and GallowayDumfriesUnited Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
- Glasgow Renal and Transplant UnitQueen Elizabeth University HospitalGlasgowUnited Kingdom
| | - Alka M. Kanaya
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
| | - Michael G. Shlipak
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Department Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCA
| | - Michelle M. Estrella
- Division of Nephrology, Department of MedicineUniversity of California, San FranciscoSan FranciscoCA
- Kidney Health Research CollaborativeSan Francisco VA Medical Center & University of California, San FranciscoSan FranciscoCA
- Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
- Division of Nephrology, Department of Medicine, San Francisco VA Health Care SystemSan FranciscoCA
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24
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Tran NQ, Truong SD, Ma PT, Hoang CK, Le BH, Dinh TTN, Van Tran L, Tran TV, Le LHG, Le KT, Nguyen HT, Vu HA, Mai TP, Do MD. Association of KCNJ11 and ABCC8 single-nucleotide polymorphisms with type 2 diabetes mellitus in a Kinh Vietnamese population. Medicine (Baltimore) 2022; 101:e31653. [PMID: 36401380 PMCID: PMC9678638 DOI: 10.1097/md.0000000000031653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a genetically influenced disease, but few studies have been performed to investigate the genetic basis of T2DM in Vietnamese subjects. Thus, the potential associations of KCNJ11 and ABCC8 single nucleotide polymorphisms (SNPs) with T2DM were investigated in a Kinh Vietnamese population. A cross-sectional study consisting of 404 subjects including 202 T2DM cases and 202 non-T2DM controls was designed to examine the potential associations of 4 KCNJ11 and ABCC8 SNPs (rs5219, rs2285676, rs1799859, and rs757110) with T2DM. Genotypes were identified based on restriction fragment length polymorphism and tetra-primer amplification refractory mutation system polymerase chain reaction. After statistically adjusting for age, sex, and BMI, rs5219 was found to be associated with an increased risk of T2DM under 2 inheritance models: codominant (OR = 2.15, 95% confidence intervals [CI] = 1.09-4.22) and recessive (OR = 2.08, 95%CI = 1.09-3.94). On the other hand, rs2285676, rs1799859, and rs757110 were not associated with an increased risk of T2DM. Haplotype analysis elucidated a strong linkage disequilibrium between the 3 SNPs, rs5219, rs2285676, and rs757110. The haplotype rs5219(A)/rs2285676(T)/rs757110(G) was associated with an increased risk of T2DM (OR = 1.42, 95%CI = 1.01-1.99). The results show that rs5219 is a lead candidate SNP associated with an increased risk of developing T2DM in the Kinh Vietnamese population. Further functional characterization is needed to uncover the mechanism underlying the potential genotype-phenotype associations.
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Affiliation(s)
- Nam Quang Tran
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Steven D. Truong
- Department of Medicine, School of Medicine, Stanford University, USA
| | - Phat Tung Ma
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Chi Khanh Hoang
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Bao Hoang Le
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thang Tat Ngo Dinh
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Luong Van Tran
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thang Viet Tran
- Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Endocrinology, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Linh Hoang Gia Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Khuong Thai Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Hien Thanh Nguyen
- Department of Medical Laboratory Technology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Hoang Anh Vu
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thao Phuong Mai
- Department of Physiology-Pathophysiology-Immunology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- * Correspondence: Minh Duc Do, Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City 700000, Vietnam (e-mail: )
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25
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Nair DR, Chauhan A, Vaidya D. Were US Asian Indian decedents with atherosclerosis more likely to have concurrent diabetes mellitus? Analysis of national multiple cause of mortality data (2012-2019). Diabetol Metab Syndr 2022; 14:159. [PMID: 36307890 PMCID: PMC9614193 DOI: 10.1186/s13098-022-00933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Asian Indians (AI) are at high risk for both atherosclerotic diseases (ATH) and diabetes mellitus (DM). We analyze the clustering of these two comorbidities as contributing causes of death in AI versus Non-AI populations in the US. METHODS Using Mortality Multiple Cause-of-Death Files (2012-2019) from the National Center for Health Statistics, we included deaths at age ≥ 45 years among US residents where AI versus Non-AI status could be ascertained (n = 55,461 AI; n = 20,090,038 Non-AI) and identsified ATH (ICD10: I20-I25, I63, I70) and DM (ICD10: E10-E14) as contributing causes of death. We calculated the tetrachoric correlation (Rho) between these contributing causes and the difference in the fraction of deaths involving DM in those with versus without ATH. RESULTS Among AI decedents, 29.9% of deaths included ATH as a contributing cause, 16.4% included DM as a contributing cause with 8.3% deaths being included in the overlap (Rho = 0.36, SE = 0.007) whereas, among Non-AI, 22.4% of deaths included ATH as a contributing cause, 10.0% included DM as a contributing cause with 4.1% deaths being included in the overlap (Rho = 0.31, SE = 0.001). Thus, DM and ATH as co-occurring causes correlated more strongly in AI versus Non-AI (p < 0.001). Further, this difference in clustering of DM with ATH was highest for younger AI women (age < 60 years) compared to comparable Non-AI women. CONCLUSIONS The more frequent co-occurrence of DM and ATH as causes of death among AI compared to Non-AI suggest that the increased burden of these diseases among AI during life has vicious synergistic consequences in terms of mortality. Public health strategies targeted to AI should focus on prevention and clinical treatment of both conditions jointly, in all adults, and especially in women < 60 years.
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Affiliation(s)
| | | | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street / Suite 8028, Baltimore, MD 21287-0003 USA
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26
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Sharma-Oates A, Zemedikun DT, Kumar K, Reynolds JA, Jain A, Raza K, Williams JA, Bravo L, Cardoso VR, Gkoutos G, Nirantharakumar K, Lord JM. Early onset of immune-mediated diseases in minority ethnic groups in the UK. BMC Med 2022; 20:346. [PMID: 36224602 PMCID: PMC9558944 DOI: 10.1186/s12916-022-02544-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of some immune-mediated diseases (IMDs) shows distinct differences between populations of different ethnicities. The aim of this study was to determine if the age at diagnosis of common IMDs also differed between different ethnic groups in the UK, suggestive of distinct influences of ethnicity on disease pathogenesis. METHODS This was a population-based retrospective primary care study. Linear regression provided unadjusted and adjusted estimates of age at diagnosis for common IMDs within the following ethnic groups: White, South Asian, African-Caribbean and Mixed-race/Other. Potential disease risk confounders in the association between ethnicity and diagnosis age including sex, smoking, body mass index and social deprivation (Townsend quintiles) were adjusted for. The analysis was replicated using data from UK Biobank (UKB). RESULTS After adjusting for risk confounders, we observed that individuals from South Asian, African-Caribbean and Mixed-race/Other ethnicities were diagnosed with IMDs at a significantly younger age than their White counterparts for almost all IMDs. The difference in the diagnosis age (ranging from 2 to 30 years earlier) varied for each disease and by ethnicity. For example, rheumatoid arthritis was diagnosed at age 49, 48 and 47 years in individuals of African-Caribbean, South Asian and Mixed-race/Other ethnicities respectively, compared to 56 years in White ethnicities. The earlier diagnosis of most IMDs observed was validated in UKB although with a smaller effect size. CONCLUSION Individuals from non-White ethnic groups in the UK had an earlier age at diagnosis for several IMDs than White adults.
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Affiliation(s)
- Archana Sharma-Oates
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK. .,School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | | | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - John A Williams
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Laura Bravo
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Victor Roth Cardoso
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Georgios Gkoutos
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
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27
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Patel M, Abatcha S, Uthman O. Ethnic differences between South Asians and White Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review. Syst Rev 2022; 11:207. [PMID: 36176009 PMCID: PMC9520891 DOI: 10.1186/s13643-022-02079-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death worldwide, with significantly worse mortality-related outcomes in ethnic minorities in developed countries. A systematic literature review and meta-analysis of observational studies was conducted to investigate cardiovascular disease-related mortality inequalities between South Asian and White Caucasian ethnic groups. METHODS Published studies on mortality between South Asians and Whites in developed countries were retrieved from MEDLINE, PubMed, Embase, Web of Science, and grey literature sources (inception-April 2021) and critically appraised using the Quality in Prognosis Studies tool. Bayesian random-effects meta-analyses were performed for both primary and secondary outcomes. Heterogeneity was determined using the I2 statistic. RESULTS Of the 9879 studies screened originally, 41 were deemed eligible. A further 3 studies were included via the later search. Of these, 15 reported cardiovascular disease-related mortality, 23 reported all-cause mortality, and 6 reported both. The meta-analysis results showed that South Asians had a significantly increased risk of cardiovascular disease mortality compared to Whites (risk ratio = 1.32; 95% credible interval = 1.14 to 1.54) and a decreased risk of all-cause mortality (risk ratio = 0.95; 95% credible interval = 0.83 to 1.12). DISCUSSION South Asians had statistically significantly higher odds of cardiovascular disease-related mortality compared to Whites, but not for all-cause mortality. Risk of bias was a serious concern mainly due to a lack of confounders being reported. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42021240865.
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Affiliation(s)
- Mubarak Patel
- Warwick Evidence, Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK.
| | - Salim Abatcha
- Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK
| | - Olalekan Uthman
- Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK
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Jamil A, Jonkman LJ, Miller M, Jennings L, Connor SE. Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amna Jamil
- UPMC Presbyterian‐Shadyside Pittsburgh Pennsylvania USA
| | - Lauren J. Jonkman
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Michelle Miller
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Luke Jennings
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Sharon E. Connor
- Department of Pharmacy & Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
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Brown AGM, Shi S, Adas S, Boyington JEA, Cotton PA, Jirles B, Rajapakse N, Reedy J, Regan K, Xi D, Zappalà G, Agurs-Collins T. A Decade of Nutrition and Health Disparities Research at NIH, 2010-2019. Am J Prev Med 2022; 63:e49-e57. [PMID: 35469699 PMCID: PMC9340660 DOI: 10.1016/j.amepre.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Nutrition health disparities include differences in incidence, prevalence, morbidity, and mortality of diet-related diseases and conditions. Often, race, ethnicity, and the social determinants of health are associated with dietary intake and related health disparities. This report describes the nutrition health disparities research supported by NIH over the past decade and offers future research opportunities relevant to NIH's mission as described in the Strategic Plan for NIH Nutrition Research. METHODS Data were extracted from an internal reporting system from FY2010 to FY2019 using the Research, Condition, and Disease Categorization spending categories for Nutrition and Health Disparities. RESULTS Over the past decade, NIH-supported nutrition and health disparities research increased, from 860 grants in 2010 to 937 grants in FY2019, whereas total nutrition and health disparities funding remained relatively stable. The top 5 Institutes/Centers that funded nutrition and health disparities research (on the basis of both grant numbers and dollars) were identified. Principal areas of focus included several chronic diseases (e.g., obesity, diabetes, cancer, heart disease) and research disciplines (e.g., clinical research and behavioral and social science). Focus areas related to special populations included pediatrics, minority health, aging, and women's health. CONCLUSIONS The gaps and trends identified in this analysis highlight the need for future nutrition and health disparities research, including a focus on American Indian and Asian populations and the growing topics of rural health, maternal health, and food insecurity. In alignment with the Strategic Plan for NIH Nutrition Research, health equity may be advanced through innovative research approaches to develop effective targeted interventions to address these disparities.
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Affiliation(s)
- Alison G M Brown
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
| | - Scarlet Shi
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Samantha Adas
- Office of Nutrition Research, NIH, Bethesda, Maryland
| | - Josephine E A Boyington
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Paul A Cotton
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Bill Jirles
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
| | - Nishadi Rajapakse
- National Institute on Minority Health and Health Disparities, NIH, Bethesda, Maryland
| | - Jill Reedy
- National Cancer Institute, NIH, Rockville, Maryland
| | - Karen Regan
- Office of Nutrition Research, NIH, Bethesda, Maryland
| | - Dan Xi
- National Cancer Institute, NIH, Rockville, Maryland
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Patel M, Abatcha S, Uthman OA. Ethnic differences between South Asians and white Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review protocol. BMJ Open 2022; 12:e052487. [PMID: 35840299 PMCID: PMC9295640 DOI: 10.1136/bmjopen-2021-052487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death worldwide, with significantly worse CVD outcomes in ethnic minorities in developed countries, especially South Asians, compared with the prevailing white ethnic group. This protocol outlines the process for conducting a systematic literature review to investigate the CVD outcome inequalities between South Asian and white Caucasian ethnic groups. METHODS Studies that compared the South Asian ethnic minority with the predominant white ethnicity in developed countries with CVD will be included from inception to 22 April 2021. We will search MEDLINE, Embase, Web of Science and grey literature to find all relevant peer-reviewed articles, reports and online theses. Articles will be screened using inclusion/exclusion criteria applied first at the title and abstract level, and then full texts, both by two independent reviewers. Articles kept in the review will undergo a risk of bias assessment using the Quality In Prognosis Studies tool and data will be extracted. Random-effects meta-analysis and heterogeneity tests will be undertaken, and tests for publication bias, outlying highly-influential observations. If insufficient data is founded or studies are highly heterogeneous, a narrative synthesis will be conducted. ETHICS Formal ethical approval is not required for this review. DISSEMINATION The results and findings of this systematic literature review will be disseminated through peer-reviewed publications and reports. PROSPERO REGISTRATION NUMBER CRD42021240865.
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Affiliation(s)
- Mubarak Patel
- Warwick Medical School, University of Warwick, Warwick, Coventry, UK
| | - Salim Abatcha
- Warwick Medical School, University of Warwick, Warwick, Coventry, UK
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Awad SF, A Toumi A, A Al-Mutawaa K, A Alyafei S, A Ijaz M, A H Khalifa S, B Kokku S, C M Mishra A, V Poovelil B, B Soussi M, G El-Nahas K, O Al-Hamaq A, A Critchley J, H Al-Thani M, Abu-Raddad LJ. Type 2 diabetes epidemic and key risk factors in Qatar: a mathematical modeling analysis. BMJ Open Diabetes Res Care 2022; 10:10/2/e002704. [PMID: 35443971 PMCID: PMC9021773 DOI: 10.1136/bmjdrc-2021-002704] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/27/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries. RESEARCH DESIGN AND METHODS An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources. RESULTS Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar-for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial. CONCLUSIONS T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Dawha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
| | - Amine A Toumi
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Kholood A Al-Mutawaa
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Salah A Alyafei
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Muhammad A Ijaz
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | | | - Suresh B Kokku
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Amit C M Mishra
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Benjamin V Poovelil
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Mounir B Soussi
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | | | | | - Julia A Critchley
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Mohammed H Al-Thani
- Public Health Department, Ministry of Public Health Qatar, Doha, Ad Dawhah, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine - Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Dawha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York City, New York, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Kusuma D, Atanasova P, Pineda E, Anjana RM, De Silva L, Hanif AAM, Hasan M, Hossain MM, Indrawansa S, Jayamanne D, Jha S, Kasturiratne A, Katulanda P, Khawaja KI, Kumarendran B, Mridha MK, Rajakaruna V, Chambers JC, Frost G, Sassi F, Miraldo M. Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data. PLoS Med 2022; 19:e1003970. [PMID: 35472059 PMCID: PMC9041866 DOI: 10.1371/journal.pmed.1003970] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. METHODS AND FINDINGS We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. CONCLUSIONS Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
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Affiliation(s)
- Dian Kusuma
- Centre for Health Economics Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Petya Atanasova
- Centre for Health Economics Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Elisa Pineda
- Centre for Health Economics Policy Innovation, Imperial College Business School, London, United Kingdom
- School of Public Health, Imperial College London, United Kingdom
| | | | | | - Abu AM Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md. Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | - Malay K Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - John C Chambers
- School of Public Health, Imperial College London, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gary Frost
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Franco Sassi
- Centre for Health Economics Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Marisa Miraldo
- Centre for Health Economics Policy Innovation, Imperial College Business School, London, United Kingdom
- Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
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Barker MM, Zaccardi F, Brady EM, Gulsin GS, Hall AP, Henson J, Htike ZZ, Khunti K, McCann GP, Redman EL, Webb DR, Wilmot EG, Yates T, Yeo J, Davies MJ, Sargeant JA. Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile: A pooled analysis. World J Diabetes 2022; 13:260-271. [PMID: 35432761 PMCID: PMC8984563 DOI: 10.4239/wjd.v13.i3.260] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of type 2 diabetes (T2D) in younger adults, an increasingly common public health issue, is associated with a higher risk of cardiovascular complications and mortality, which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.
AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.
METHODS A pooled dataset was used, comprised of data from five previous studies of adults with T2D, including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years. Anthropometric and blood biomarker measurements included body weight, body mass index (BMI), waist circumference, body fat percentage, glycaemic control (HbA1c), lipid profile and blood pressure. Univariable and multivariable linear regression models, adjusted for diabetes duration, sex, ethnicity and smoking status, were used to investigate the association between age at diagnosis and each cardiovascular risk factor.
RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female, current smokers and treated with glucose-lowering medications, compared to participants diagnosed later in life. Participants diagnosed with T2D under the age of 40 also had higher body weight, BMI, waist circumference and body fat percentage, in addition to a more adverse lipid profile, compared to participants diagnosed at an older age. Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight [95% confidence interval (CI): 0.52-0.82 kg], 0.18 kg/m2 higher BMI (95%CI: 0.10-0.25) and 0.32 cm higher waist circumference (95%CI: 0.14-0.49), after adjustment for duration of diabetes and other confounders. Younger age at diagnosis was also significantly associated with higher HbA1c, total cholesterol, low-density lipoprotein cholesterol and triglycerides.
CONCLUSION The diagnosis of T2D earlier in life is associated with a worse cardiovascular risk factor profile, compared to those diagnosed later in life.
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Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Emer M Brady
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Andrew P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Zin Zin Htike
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East Midlands, Leicester LE5 4PW, United Kingdom
| | - Gerald P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma L Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma G Wilmot
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Jian Yeo
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
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Chowdhury HA, Paromita P, Mayaboti CA, Rakhshanda S, Rahman FN, Abedin M, Rahman AKMF, Mashreky SR. Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey. PLoS One 2022; 17:e0263259. [PMID: 35171912 PMCID: PMC8849622 DOI: 10.1371/journal.pone.0263259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) standard tool.
Methods
This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as ‘ready’ to manage diabetes at each facility level.
Results
The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level.
Conclusions
The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.
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Affiliation(s)
- Hasina Akhter Chowdhury
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Progga Paromita
- Kirtipasha Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh
| | | | - Shagoofa Rakhshanda
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Farah Naz Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Minhazul Abedin
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
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Zhang Y, Wei X, Gu Q, Zhang J, Ding Y, Xue L, Chen M, Wang J, Wu S, Yang X, Zhang S, Lei T, Wu Q. Cascade amplification based on PEI-functionalized metal–organic framework supported gold nanoparticles/nitrogen–doped graphene quantum dots for amperometric biosensing applications. Electrochim Acta 2022. [DOI: 10.1016/j.electacta.2021.139803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Krishan P, Bhopal RS, Vlassopoulos A, Curry G, Kakde S. Could high heat cooking and food processing promoting neo-formed contaminants partially explain the high prevalence of chronic kidney disease in South Asian populations? A hypothesis. Diabetes Metab Syndr 2022; 16:102398. [PMID: 35182827 DOI: 10.1016/j.dsx.2022.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The occurrence of chronic heart and kidney diseases among the South Asian populations has been rising exponentially over the years. Research has been carried out in the past to explain the increased susceptibility with no resultant strong evidence. Various possible causes have been suggested with a previous hypothesis suggestive of high heat cooking techniques being responsible for increased production of neo-formed contaminants such as advanced glycation end products (AGEs) and trans-fatty acids (TFAs) leading to increased chronic heart diseases among the South Asian diaspora (India, Pakistan, Bangladesh, Sri Lanka in South Asia and overseas). The aim of this study proposes the high-heating cooking techniques and subsequent NFCs also to be responsible for the development of chronic kidney ailments among the South Asians. METHODS Review of the literature was conducted to ascertain the burden of accumulation and actions of AGEs and TFAs on kidney structure and functions. The varied high-heat cooking techniques including reheating of oils, food processing and kinds of food sources and their association with increased NFCs production and kidney damage were explored. RESULTS Higher NFCs content of AGEs/TFAs in reheated oils at elevated temperatures and TFAs among processed and fast foods of South Asians was associated with elevated diabetic complications and CKDs progression in few animal and human studies but the research on the actual burden of NFCs in the renal tissues of South Asians was lacking. CONCLUSION We hypothesize the high heat cooked foods generating increased levels of NFCs to be responsible for the preponderance of higher risk of CKDs among South Asians. Scientific exploration of the hypothesis to obtain quantifiable evidence of NFCs is suggested.
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Affiliation(s)
- Prerna Krishan
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Raj S Bhopal
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Antonis Vlassopoulos
- Department of Food Science & Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855, Athens, Greece
| | - Gwenetta Curry
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Smitha Kakde
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Khan M, Khan M, Ahmad M, Alam R, Khan S, Jaiswal G. Association of circulatory adiponectin with the parameters of Madras Diabetes Research Foundation-Indian Diabetes Risk Score. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Visaria A, Nagaraj B, Shah M, Kethidi N, Modak A, Shahani J, Chilakapati R, Raghuwanshi M. Low Amount and Intensity of Leisure-time Physical Activity in Asian Indian Adults. Am J Health Promot 2021; 36:440-449. [PMID: 34911346 DOI: 10.1177/08901171211059807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities. DESIGN, SETTING, AND SAMPLE We utilized the 2011-2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions. MEASURES PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial. ANALYSIS We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status. RESULTS While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: -164 [-314,-15]) without diabetes (-185 [-319,-52]), and low/normal BMI (-422 [-623,-222]). CONCLUSION Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.
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Affiliation(s)
- Aayush Visaria
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Bharath Nagaraj
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Megh Shah
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nikhit Kethidi
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anurag Modak
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Advanced Biotechnology and Medicine, 33244Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Jai Shahani
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachana Chilakapati
- Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Maya Raghuwanshi
- Division of Endocrinology, Department of Medicine, 33244Rutgers New Jersey Medical School, Newark, NJ, USA
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Mehta S, Nain P, Agrawal BK, Singh RP, Kaur J, Maity S, Bhattacharjee A, Peela J, Nauhria S, Nauhria S. Effectiveness of Empagliflozin With Vitamin D Supplementation in Peripheral Neuropathy in Type 2 Diabetic Patients. Cureus 2021; 13:e20208. [PMID: 35004028 PMCID: PMC8730350 DOI: 10.7759/cureus.20208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Neuropathy is the most prevalent broad-spectrum microvascular complication of diabetes. The present study aims to evaluate the effect of empagliflozin with vitamin D supplementation on diabetic peripheral neuropathy. Methods: A prospective, randomized, controlled study was conducted for six months including 150 type 2 diabetic patients, divided into three groups (n=50/group): Group 1, patients on oral hypoglycemic agents; Group 2, patients on empagliflozin and Group 3, patients on empagliflozin with vitamin D. Biochemical parameters were estimated for outcome measurements and patients’ neuropathic pain was analysed using Douleur Neuropathique 4 Questions, Neuropathic Pain Symptom Inventory and Ipswich Touch the toes test questionnaire. Data were analysed using a one-way analysis of variance. Results: Diabetic neuropathy in males was more prevalent (more than 50%) as compared to females in all three groups, with an average age of 50±6 years, along with a diabetic history of 15±4.5 years and a glycated hemoglobin A1C (HbA1C) level of >10%. The mean value of serum vitamin D level significantly increased by 64.7% (19±5 to 54±8 ng/mL; p<0.05). A remarkable decrease (by 17.4%) from baseline in the HbA1C level was observed after six months of treatment only in Group 3, whereas in other groups (1 and 2), there was a non-significant decrease in HbA1C levels when compared to baseline. Moreover, a significant improvement in neuropathic condition was seen only in Group 3. Conclusion: The results indicated that empagliflozin with vitamin D supplementation significantly controlled or reduced HbA1C and improved diabetic neuropathic symptoms in patients. It is suggested that this combination can be considered as the primary therapeutic approach for neuropathic complications in diabetic patients.
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Affiliation(s)
- Sanjana Mehta
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Parminder Nain
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Bimal K Agrawal
- Department of Internal Medicine, Maharishi Markandeshwar Institute of Medical Science and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | | | - Jaspreet Kaur
- Department of Pharmacy Practice, Maharishi Markandeshwar College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, IND
| | - Sabyasachi Maity
- Department of Physiology, St. George's University School of Medicine, St. George's, GRD
| | | | - Jagannadha Peela
- Department of Medical Genetics and Biochemistry, St. Matthew's University, George Town, CYM
| | - Shreya Nauhria
- Department of Psychology, University of Leicester, Leicester, GBR
| | - Samal Nauhria
- Department of Pathology, St. Matthew's University, George Town, CYM
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Hashemi H, Rezvan F, Pakzad R, Ansaripour A, Heydarian S, Yekta A, Ostadimoghaddam H, Pakbin M, Khabazkhoob M. Global and Regional Prevalence of Diabetic Retinopathy; A Comprehensive Systematic Review and Meta-analysis. Semin Ophthalmol 2021; 37:291-306. [PMID: 34402390 DOI: 10.1080/08820538.2021.1962920] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence. METHODS A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR. RESULTS Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I2 was 99% (p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity. CONCLUSION One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Farhad Rezvan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | | | | | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Rehabilitation Science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Pakbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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41
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Medina HN, Callahan KE, Morris CR, Thompson CA, Siweya A, Pinheiro PS. Cancer Mortality Disparities among Asian American and Native Hawaiian/Pacific Islander Populations in California. Cancer Epidemiol Biomarkers Prev 2021; 30:1387-1396. [PMID: 33879454 PMCID: PMC8254771 DOI: 10.1158/1055-9965.epi-20-1528] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/03/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk. METHODS Age-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW). RESULTS AANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25-1.58), including for breast (MRR = 1.33; 95% CI, 1.08-1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53-4.42). CONCLUSIONS AANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations. IMPACT Not all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
| | - Karen E Callahan
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, UC Davis Comprehensive Cancer Center/UC Davis Health, Davis, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, Sutter Health Palo Alto Medical Foundation Research Institute, University of California San Diego School of Medicine, San Diego, California
| | - Adugna Siweya
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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Jeffcoate W, Game F, Morbach S, Narres M, Van Acker K, Icks A. Assessing data on the incidence of lower limb amputation in diabetes. Diabetologia 2021; 64:1442-1446. [PMID: 33783587 DOI: 10.1007/s00125-021-05440-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/18/2021] [Indexed: 01/22/2023]
Affiliation(s)
- William Jeffcoate
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals Trust, Nottingham, UK.
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Kristien Van Acker
- Centre de Santé des Fagnes Clinique Chimay, Department of Diabetology, Endocrinology and Wound Care, Chimay, Belgium
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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do Vale Moreira NC, Ceriello A, Basit A, Balde N, Mohan V, Gupta R, Misra A, Bhowmik B, Lee MK, Zuo H, Shi Z, Wang Y, Montenegro RM, Fernandes VO, Colagiuri S, Boulton AJM, Hussain A. Race/ethnicity and challenges for optimal insulin therapy. Diabetes Res Clin Pract 2021; 175:108823. [PMID: 33887353 DOI: 10.1016/j.diabres.2021.108823] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
AIMS We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. METHODS We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: "ethnicity", "diabetes", "insulin", "history of insulin", "insulin therapy", "food/rice", "carbohydrate intake", "insulin resistance", "BMI", "insulin dosing", "insulin sensitivity", "insulin response", "glycaemic index", "glycaemic response", "efficacy and safety", with interposition of the Boolean operator "AND".In addition, we reviewed the reference lists of the articles found. RESULTS The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemicresponse to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. CONCLUSIONS Race/ethnicity affects glucose metabolism and insulin regulation.Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.
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Affiliation(s)
| | | | - Abdul Basit
- Baquai Medical University, Karachi, Pakistan
| | - Naby Balde
- Endocrinology and Diabetes Department, Donka Conakry University Hospital, Conakry, Guinea; Foundation Diabetes and NCD, Conakry, Guinea; International Diabetes Federation, IDF, Brussels, Belgium
| | - V Mohan
- Dr. Mohans Diabetes Specialties Centre, Chennai, India
| | | | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Delhi, India
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Moon K Lee
- International Diabetes Federation, IDF, Brussels, Belgium; Division of Endocrinology & Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Hui Zuo
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Renan M Montenegro
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil
| | | | - Stephen Colagiuri
- International Diabetes Federation, IDF, Brussels, Belgium; Boden Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Andrew J M Boulton
- International Diabetes Federation, IDF, Brussels, Belgium; University of Manchester, UK
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza-Ceará, Brazil; International Diabetes Federation, IDF, Brussels, Belgium; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh; Faculty of Health Sciences, Nord University, Bodø, Norway.
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Bizino MB, Jazet IM, van Eyk HJ, Rensen PCN, Geelhoed-Duijvestijn PH, Kharagjitsingh AV, Paiman EHM, Smit JW, Lamb HJ. Efficacy of liraglutide on glycemic endpoints in people of Western European and South Asian descent with T2DM using multiple daily insulin injections: results of the MAGNA VICTORIA studies. Acta Diabetol 2021; 58:485-493. [PMID: 33399989 DOI: 10.1007/s00592-020-01635-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/04/2020] [Indexed: 01/04/2023]
Abstract
AIMS Data on the effect of liraglutide on glycemic endpoints in people with T2DM using multiple daily insulin injections (MDI) are scarce, especially in the context of ethnicity. METHODS This is a secondary analysis of the placebo-controlled randomized clinical "MAGNA VICTORIA" trials in Western European (WE) and South Asian (SA) people with T2DM. Participants had inadequate glycemic control despite using metformin and/or sulfonylurea derivatives and/or insulin. Participants were assigned to liraglutide (1.8 mg) or placebo for 6 months, in addition to standard care. The primary endpoint number of participants reaching target HbA1c was compared for liraglutide versus placebo in the complete dataset and MDI-treated participants using Chi-square test. Liraglutide's efficacy in WE and SA was compared using a generalized linear model. RESULTS Forty-five subjects were randomized to liraglutide and 51 to placebo. In each group, one participant did not complete the study. Liraglutide-treated patients reached target HbA1c more frequently: 23/45 (51%) vs 11/51 (22%), relative probability 2.4 (1.3-4.3), p = 0.002. Subgroup analysis in 43 MDI participants showed that the proportion reaching target HbA1c using liraglutide was significantly higher than in placebo: 9/22 (41%) vs 1/21 (5%), p = 0.005. There was no difference between WE and SA in terms of liraglutide efficacy (p = 0.18). CONCLUSIONS Liraglutide treatment resulted in increased chance of reaching target HbA1c as compared to placebo. Liraglutide efficacy was sustained in participants using MDI regimens and those of SA descent. Liraglutide should be considered for T2DM people with inadequate glycemic control despite MDI.
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Affiliation(s)
- Maurice B Bizino
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ingrid M Jazet
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Huub J van Eyk
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick C N Rensen
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Aan V Kharagjitsingh
- Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Diabetology and Endocrinology and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Johannes W Smit
- Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hildebrandus J Lamb
- Department of Radiology, Leiden University Medical Center, LUMC Postzone C2S, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Quality of Life Assessment in Diabetic Patients Using a Validated Tool in a Patient Population Visiting a Tertiary Care Center in Bhubaneswar, Odisha, India. ScientificWorldJournal 2021; 2020:7571838. [PMID: 33456400 PMCID: PMC7785381 DOI: 10.1155/2020/7571838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
Odisha has 4.2 million diabetic patients against the country's 70 million with an urban prevalence of nearly 15.4%. Diabetes is affecting younger age groups, thus having a crucial impact on quality of life of the affected. A qualitative endeavour was attempted at the diabetic clinic of a tertiary care set up in the capital city of Bhubaneswar to create a diabetic surveillance data assembly, wherein subjects above 18 years of age and newly diagnosed or on follow-up, after obtaining informed consent, were made to respond to a quality of life (QOLID) validated tool. The pretested tool has 8-domain role limitation due to physical health, physical endurance, general health, treatment satisfaction, symptom botherness, financial worries, emotional/mental health, and diet advice tolerance. The validated tool had 34 items (questions) that were selected to represent these domains on the basis of extraction communality, factor loading, and interitem and item-total correlations. The final questionnaire had an overall Cronbach's alpha value of 0.894 (subscale: 0.55 to 0.85), showing high internal consistency in the current study population. A score for each domain was calculated by simple addition of items scores. Each individual domain score was then standardized by dividing by maximum possible domain score and multiplying by 100. All individual standardized domain scores were then added and divided by 8 (number of domain) to obtain an overall score. The data collection was done for 400 patients as an interim analysis. Univariate and subsequently multivariate analysis was performed to decide the predictors that affected quality of life. Age over 50 years (OR = 1.81, CI 1.12–2.93; p=0.014), female gender (OR = 2.05, CI 1.26–3.35; p=0.004), having foot complications (OR = 2.81, CI 1.73–4.55; p < 0.001), and having depression (OR = 1.88, CI 1.15–3.06, p=0.011) emerged as predictors of poor QOLID scores. The tool can be made a subtle part of chronic case management of diabetes to ensure patient's participation in the treatment of the disease and to create a database that can redefine diabetic care in India to suit the diverse regional settings in the country.
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Yeo JL, Brady EM, McCann GP, Gulsin GS. Sex and ethnic differences in the cardiovascular complications of type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211034297. [PMID: 34408835 PMCID: PMC8365016 DOI: 10.1177/20420188211034297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus represents a global health concern affecting 463 million adults and is projected to rapidly rise to 700 million people by 2045. Amongst those with type 2 diabetes (T2D), there are recognised differences in the impact of the disease on different sex and ethnic groups. The relative risk of cardiovascular complications between individuals with and without T2D is higher in females than males. People of South Asian heritage are two to four times more likely to develop T2D than white people, but conversely not more likely to experience cardiovascular complications. Differences in the pathophysiological responses in these groups may identify potential areas for intervention beyond glycaemic control. In this review, we highlight key differences of diabetes-associated cardiovascular complications by sex and ethnic background, with a particular emphasis on South Asians. Evidence assessing therapeutic efficacy of new glucose lowering drugs in minority groups is limited and many major cardiovascular outcomes trials do not report ethnic specific data. Conversely, lifestyle intervention and bariatric surgery appear to have similar benefits regardless of sex and ethnic groups. We encourage future studies with better representation of women and ethnic minorities that will provide valuable data to allow better risk stratification and tailored prevention and management strategies to improve cardiovascular outcomes in T2D.
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Affiliation(s)
- Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Mehta A, Singh S, Saeed A, Mahtta D, Bittner VA, Sperling LS, Virani SS. Pathophysiological Mechanisms Underlying Excess Risk for Diabetes and Cardiovascular Disease in South Asians: The Perfect Storm. Curr Diabetes Rev 2021; 17:e070320183447. [PMID: 32619174 DOI: 10.2174/1573399816666200703182458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND South Asians are at a significantly increased risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), are diagnosed at relatively younger ages, and exhibit more severe disease phenotypes as compared with other ethnic groups. The pathophysiological mechanisms underlying T2D and CVD risk in South Asians are multifactorial and intricately related. METHODS A narrative review of the pathophysiology of excess risk of T2D and CVD in South Asians. RESULTS T2D and CVD have shared risk factors that encompass biological factors (early life influences, impaired glucose metabolism, and adverse body composition) as well as behavioral and environmental risk factors (diet, sedentary behavior, tobacco use, and social determinants of health). Genetics and epigenetics also play a role in explaining the increased risk of T2D and CVD among South Asians. Additionally, South Asians harbor several lipid abnormalities including high concentration of small-dense low-density lipoprotein (LDL) particles, elevated triglycerides, low high-density lipoprotein (HDL)- cholesterol levels, dysfunctional HDL particles, and elevated lipoprotein(a) that predispose them to CVD. CONCLUSION In this comprehensive review, we have discussed risk factors that provide insights into the pathophysiology of excess risk of T2D and CVD in South Asians.
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Affiliation(s)
- Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Sumitabh Singh
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Anum Saeed
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, PA, United States
| | - Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, TX, United States
| | - Vera A Bittner
- Division of Cardiovascular Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Laurence S Sperling
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, TX, United States
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Chetan MR, Miksza JK, Lawrence I, Anjana RM, Unnikrishnan R, Amutha A, Shanthi Rani CS, Jebarani S, Mohan V, Khunti K, Narendran P. The increased risk of microvascular complications in South Asians with type 1 diabetes is influenced by migration. Diabet Med 2020; 37:2136-2142. [PMID: 31721280 DOI: 10.1111/dme.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
AIM We aimed to explore the association between South Asian ethnicity and complications of type 1 diabetes, and whether this is affected by migration. METHODS In this retrospective cohort study, data on diabetes control and complications were obtained for South Asians in India (South AsiansIndia , n = 2592) and the UK (South AsiansUK , n = 221) and white Europeans in the UK (n = 1431). Multivariable logistic regression was used to identify associations between ethnicity and diabetic kidney disease, retinopathy and neuropathy adjusting for age, sex, BMI, disease duration, HbA1c , blood pressure (BP) and cholesterol. RESULTS South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease [odds ratio (OR) 5.0, 95% confidence intervals (CI) 3.6-7.1] and retinopathy (OR 1.8, 95% CI 1.2-2.5), but lower odds of neuropathy (OR 0.5, 95% CI 0.4-0.6) than white Europeans. South AsiansIndia had significantly greater adjusted odds of diabetic kidney disease (OR 3.0, 95% 1.8-5.3) than South AsiansUK , but there was no significant difference in the odds of other complications. CONCLUSIONS In this hypothesis-generating study, we report that South Asian ethnicity is associated with greater risk of diabetic kidney disease and retinopathy, and lower risk of neuropathy than white European ethnicity. Part of the excess diabetic kidney disease risk is reduced in South AsiansUK . These associations cannot be accounted for by differences in vascular risk factors. Our findings in South Asians with type 1 diabetes mirror previous findings in type 2 diabetes and now need to be validated in a study of the effect of ethnicity on type 1 diabetes complications where healthcare is provided in the same setting.
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Affiliation(s)
- M R Chetan
- College of Medical and Dental Sciences, Birmingham, UK
| | - J K Miksza
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - I Lawrence
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - R M Anjana
- Madras Diabetes Research Foundation, Chennai, India
| | | | - A Amutha
- Madras Diabetes Research Foundation, Chennai, India
| | | | - S Jebarani
- Madras Diabetes Research Foundation, Chennai, India
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - P Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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49
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Gupta M. Addressing atherosclerotic cardiovascular disease risk in South Asians: A daunting task ahead. Atherosclerosis 2020; 315:76-78. [PMID: 33172687 DOI: 10.1016/j.atherosclerosis.2020.10.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Canada; Canadian Collaborative Research Network, 3 Conestoga Drive, Suite 300, Brampton, ON, L6Z 4N5, Canada.
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50
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Koipuram A, Carroll S, Punthakee Z, Sherifali D. Diabetes knowledge, risk perception, and quality of life among South Asian caregivers in young adulthood. BMJ Open Diabetes Res Care 2020; 8:8/2/e001268. [PMID: 33168524 PMCID: PMC7654120 DOI: 10.1136/bmjdrc-2020-001268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Persons of South Asian descent have a higher prevalence of type 2 diabetes mellitus (T2DM). The management of T2DM in the South Asian community has required the support of adult children, potentially impacting the quality of life, diabetes-related knowledge, and risk perception among these caregivers. RESEARCH DESIGN AND METHODS To investigate diabetes-related knowledge, quality of life, risk perception, and actual risk of developing diabetes among South Asian young adults whose parents are living with T2DM. A cross-sectional study was conducted (n=150). An online survey was administered. Data were analyzed with descriptive and inferential statistics. RESULTS There was a statistically significant difference in diabetes-related knowledge between males and females (p<0.001). Males (in comparison to females) had a lower risk perception of developing diabetes (p=0.06). Further, risk perception and diabetes-related knowledge were positively associated with caregiver's physical health (p=0.002). CONCLUSION Findings highlight the importance of providing gender-specific and culturally tailored diabetes educational interventions.
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Affiliation(s)
- Angela Koipuram
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Carroll
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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