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About Shanghai
The 1st Asia Pacific Congress on
Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)
Shanghai, China, June 2-5, 2011
 
  Diabetes Print

BODY MASS INDEX ASSOCIATED WITH THE NUMBER OF PREGNANCIES IN WOMEN REFERRED TO HEALTH CENTERS OF SANANDAJ

N. Aliramaei (1), K. Zobeiry (2)

1 Kurdistan University of Medical Science, Sanandaj, Iran

2 Tehran University of Medical Science, Tehran, Iran

 

Introduction:  Obesity is created for any reason, Should be treated as a chronic disease. Based on results of research conducted, the most appropriate body mass index is below 25. Pregnant women are considered among the most vulnerable groups of any population and are required to receive health services appropriate and timely. Pregnant women are suffering from a variety of problems during the ninth month of pregnancy. Most discomfort is caused by physical and physiological changes of pregnancy.

Methods: This is a descriptive – analytical method and Researcher chose the research environment by cluster sampling method. Information was gathered through a questionnaire, Regular interview and measuring the weight and height of 300 women referred to health centers in sanandaj.

Results: Results based on the body mass index showed 47 percent overweight and 24 percent obesity and Severe obesity and only 7/1% low-weight.  There was also significant correlation between BMI with age and parity. The majority of women age with 26/7 % was between 25-20 years and the majority were married (%90/3). Their job, housewife (80%). Majority with 39/7% had primary education up to sixth grade. 66/3% did not mention a specific disease. Results also showed with 69/7% number of pregnancies was 1-2 times.

Discussion: Today, with the emphasis on population control and birth limitation, gradually the role of women have been less important in the family collection of children, increasing family size. According to these results, 47 % of women were overweight, and 24 % were obese and severely obese. Increasing weight and obesity greatly increases the economic costs of health care. Due to poor awareness of pregnant women seems necessary development and execution of educational programs and prenatal care. Education and increasing women's education level has significant role in the health state of mothers and children. 

 

VALIDITY OF DIETARY GLYCEMIC LOAD AS A PREDICTOR OF POSTPRANDIAL GLYCEMIA AND INSULINEMIA IN LEAN, YOUNG HEALTHY ADULTS

J. Bao (1), F. Atkinson (1), P. Petocz (2), W. Willett (3), J. Brand-Miller (1)

1 Boden Institute of Obesity, Nutrition & Exercise, the University of Sydney, Sydney, Australia

2 Department of Statistics, Macquarie University, Sydney, Australia

3 Harvard School of Public Health, Harvard University, USA

 

Background: The concept of dietary glycemic load (GL, defined as the mathematical product of the glycemic index (GI) and carbohydrate content of a serving of food) is increasingly used in nutritional epidemiology. Its ability to predict postprandial glycemia and insulinemia for a wide range of foods or mixed meals is unclear.

Objective: To determine the degree of association between calculated GL and glucose and insulin responses in healthy subjects consuming iso-energetic portions of single foods and meals.

Design: In study one, groups of healthy subjects consumed 1000 kJ portions of 121 single foods in 10 food categories. In study two, healthy volunteers consumed 2000 kJ of 13 mixed meals. Foods and meals varied widely in macronutrient content, fibre and GL. Glycemia and insulinemia were quantified as incremental area under the curve relative to a reference food (=100).

Outcomes: GL was the strongest predictor of the observed glucose and insulin responses induced by single foods (r = 0.92 and 0.77 respectively, both P< 0.001), accounting for 84% and 59% of the variation in glucose and insulin responses respectively. For mixed meals, responses varied over a five-fold range and were strongly correlated with GL (r = 0.76, P= 0.002 for glucose and r = 0.68, P= 0.01 for insulin). In contrast, macronutrients and fibre were not significant predictors of either response.

Conclusion: The findings provide robust support for the physiological validity of GL in predicting both postprandial glycemia and insulin demand to a wide variety of foods and meals.

 

NORMAL INSULIN DEMAND FOR DOSE ADJUSTMENT: THE NIDDA STUDY

J. Bao (1), H. Gilbertson (3), R. Gray (2), D. Munns (2), G. Howard (2), S. Colagiuri (1), J. Brand-Miller (1)

1 Boden Institute of Obesity, Nutrition & Exercise, the University of Sydney, Sydney, Australia

2 Sydney Insulin Pump Clinic, Sydney, Australia

3 Centre for Adolescent Health, Royal Children’s Hospital, Melbourne, Australia

 

Objective: Carbohydrate counting assumes only the quantity of carbohydrate influences insulin dose required in type 1 diabetes. A food insulin index (FII) has been developed and validated for predicting normal insulin demand generated by mixed meals in healthy adults. We sought to compare a novel algorithm based on the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes.

Research Design and Methods: Twenty eight participants consumed two different breakfast meals of equal energy, glycemic index, fibre and predicted insulin demand (FII=~60 for both meals) but ~2-fold difference in carbohydrate content, in random order on 3 consecutive mornings. Meal A was consumed using carbohydrate counting only. Meal B was consumed on two occasions, once using carbohydrate counting as the basis for the insulin dose (ie half dose as Meal A) and once using the novel algorithm (same dose as Meal A). Real-time continuous glucose monitor was used to assess postprandial glycemia.

Results: Compared with carbohydrate counting, the novel algorithm significantly decreased glucose incremental area under the curve over 3h(-52%, P<0.01), peak glucose excursion (- 41%, P=0.001) and improved the percentage of time within the normal BGL range (4–10 mmol/l) (+31%, P<0.001). There was no significant difference in the occurrence of hypoglycemia.

Conclusions: The findings support the use of a novel algorithm based on insulin demand in healthy subjects to optimize glycemic control without increasing the risk of hypoglycemia in type 1 diabetes patients using insulin pump therapy.

 

A PREVALENCE STUDY OF DEPRESSION AND ANXIETY AMONG ADULTS WITH TYPE 2 DIABETES MELLITUS

S.N. Basak (1,3), S. Rai (2,3)

1 MGM Medical College, Navi Mumbai, India

2 Department of Medicine, MGM Medical College, Navi Mumbai, India

3 Indian Council of Medical Research, Ansarinagar, New Delhi, India

 

Background: The WHO has projected that 300 million people will suffer from diabetes by 2025. ‘India’ is the number one contributor to this. A history of major depression was found in 33% of the patients; despite that, it is frequently unrecognized and untreated. Depression is associated with hyperglycemia and may affect the glycemic control and increase the risk of diabetic complications. This research was done to get an accurate idea of severity in depression and anxiety in adults with DM which will help us cope with the consequences. Methods: A sample size of 100 adults with Type 2 diabetes was considered after a certain inclusion and exclusion criteria. An OPD based cross-sectional study was done during 2010. Data regarding demographics, anthropometrics, biochemistry, micro and macrovascular complications of diabetes were considered. Following which they were given to fill the Beck Depression Inventory -2 and Clinical Anxiety Scale which was used to assess depression and anxiety respectively.

Results: More prevalent in men in a mean age group of ≥56yrs (OR=1.09,95%CI=0.6-1.9), with obesity(OR=1.6, 95%CI=0.9-2.8),mean duration of 5-10 years.69 % of the patients had a family history of diabetes,15% were hypertensive. Based on BDI- II,38%,44% were severely, moderately depressed respectively.Also,65% of the diabetic population is suffering from moderate anxiety, both of which are associated with agitation, irritability, tiredness and changes in appetite. Conclusion: Depression and Anxiety in adults with type 2 diabetes is largely prevalent esp, in males and in older age group with a long span of diabetes. Diabetes and depression can thus pretty much lead to development of the other. Hence, it is very essential to monitor our lifestyles NOW than regret later.

 

JEWISH NEW YEAR ASSOCIATED WITH DECREASED POINT OF CARE GLUCOSE IN HOSPITALIZED PATIENT POPULATION

M. Boaz (1,2), Z. Landau (3), Z. Matas (4), T. Chaimy (4), J. Wainstein (3)

1 Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel

2 Nutrition Department, School of Health Sciences, Ariel University Center, Ariel, Israel

3 Diabetes Unit, E. Wolfson Medical Center, Holon, Israel

4 Biochemistry Laboratory, E. Wolfson Medical Center, Holon, Israel

 

Background: In individuals with diabetes, glycemic control has been shown to be disrupted during the winter holiday period.

Methods: Blood glucose values from individuals hospitalized in internal medicine units were collected and analyzed during the period surrounding Rosh Hashanah, the Jewish New Year, 2010. Values obtained between 4-7 September 2010, were categorized as pre-holiday values; values from 8-11 September 2010 were classed as holiday values; and values from 12-15 September 2010 were labeled post-holiday values.  All values were collected at point of care (POC) using an automated, institutional glucometer located in each department, the data from which is downloaded to a central hospital-wide database. 

Results: A total of 3403 POC glucose values were recorded during the observation period.  POC glucose values were significantly lower during the Rosh Hashanah holiday than the pre- or post-holiday periods: 176.8±81.3 vs. 181.4±78.8 or 184.9±83.02, p=0.03.  During the Rosh Hashanah holiday, mean patient age was significantly older than the pre- or post-holiday period: 77.4±10.9 vs. 74.9±12.0 or 75.3±11.8, p<0.0001; however, age predicted less than 1% of the variability in POC glucose: r=0.02, p=0.23.  In a linear regression model, holiday period remained a significant independent predictor of POC glucose even after controlling for age and sex.

Conclusions: POC glucose was significantly lower during the Rosh Hashanah period relative to pre- and post-holiday values. This may reflect a shift in the composition of the hospitalized patient population during the holidays towards older individuals with more restricted dietary intake.

 

CUT-OFF VALUE OF 50-GRAM GLUCOSE CHALLENGE TEST FOR THE DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS

D. Boriboonhirunsarn (1), T. Lertbunnaphong (1), P. Khanmali (1)

1 Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

 

Objective: To determine the cut-off value of 50-g glucose challenge test (GCT) for the diagnosis of gestational diabetes mellitus (GDM) among Thai pregnant women.

Materials and Methods: A total of 816 pregnant women who were at risk for GDM and had abnormal result of 50-g GCT (≥140 mg/dL) before 20 weeks’ gestation were enrolled. All received 100-g oral glucose tolerance test (OGTT) for the diagnosis of GDM. This 2-step approach was repeated during 24-28 weeks’ gestation among those with normal 100-g OGTT results. Different cut-off values of 50-g GCT for the diagnosis of GDM were evaluated.

Results: Mean age was 32.4±5.1 years, and mean gestational age when 50-g GCT was performed was10.1±5.9 weeks. GDM was diagnosed in 290 cases (35.5%) and mean gestational age at diagnosis was 19.1±10.3 weeks. The risk of GDM increased with 50-g GCT values. Of 19 and 13 women whose 50-g GCT values were ≥230 mg/dL and ≥240 mg/dL, 90.5% and 100% were diagnosed with GDM respectively. Cut-off levels for GDM diagnosis among common risks were ≥230 mg/dL for family history of DM, ≥240 mg/dL for age ≥30 years, and ≥220 mg/dL for obesity (BMI ≥27 kg/m2). Results of 50-g GCT were not clearly related to GDM classification. However, among GDM cases whose 50-g GCT <200 mg/dL, 99.1% were in class A1.

Conclusion: 50-g GCT before 20 weeks’ gestation could be applied and used for diagnosis of GDM using appropriate cut-off value.

 

DIABETES MELLITUS FOLLOWING LIVER TRANSPLANTATION: INCIDENCE, GLUCOSE MONITORING AND TREATMENT OPTIONS IN SINGLE CENTRE

I. Daskalova (1), I. Takarov (2), E. Odisseeva (3), T. Lukanova (3), R. Velichkova (2), N. Vladov (2)

1 Clinic of Endocrinology, Military Medical Academy, Sofia, Bulgaria

2 HPB and Transplant Surgery, Military Medical Academy, Sofia, Bulgaria

3 Anestesia and Intensive Care Department, Military Medical Academy, Sofia, Bulgaria

 

New-onset diabetes mellitus (NODM) is a common metabolic complication following liver transplantation, developed in approximately 15-20% of patients. It is associated with poor outcomes in regard to a graft function and a patient survival. The aim of this study was to evaluate the incidence and risk factors for diabetes after liver transplantation in Bulgarian population. All 24 patients, who underwent liver transplantation at MMA, Sofia from April 2007 to November 2010 were retrospectively reviewed and enrolled in the study. 20 of them were male and 4 female with median age 43 years. HCV, HBV and CMV status, recipient gender, age and body mass index, pre-transplant arterial hypertension, serum glucose level, total insulin dose used and immunosuppressive therapy were collected for each patient. Tight glycemic control using continuous glucose monitoring and insulin pump application was made perioperatively. We have registered a new onset of DM in six of our patients.  Everyone of the examined group developed transient glucose intolerance within the first two post transplant weeks. Patients, who developed PTDM are males with alcoholic etiology of liver insufficiency, with overweight or obesity. We did not find a significant correlation of PTDM with presence of HCV-, CMV-infection and pre-operative hypertension. No increased percentage of graft rejection in this group was observed. On the sixth month after transplantation five of the presented recipients required insulin treatment, but one who developed reversible DM. The clinical impact of NODM has been underestimated in the past. Prevention of NODM after liver transplantation requires a planned and concerted effort, with thorough screening and risk assessment of candidates and adherence to a regular schedule of glycemic monitoring for all allograft recipients. The greatest attention must be paid on the modifiable factors – the obesity in the pre-operative period and individualization of the immunosuppressive therapy.

 

DIABETES CLINICAL MODEL IN REMOTE AREA

M.S. Kamel (1)

1 Internal Medicine Department, Minia University, Egypt

 

Control of diabetes mellitus is a high priority for primary health care systems. One innovative method of diabetes care delivery is the use of structured diabetes care in primary care. This includes the use of chronic care diabetes clinics or mini-clinics operated by general practitioners in primary care. There is limited experience with this model in non-Western settings. This study sought to evaluate a multi-component structured approach to diabetes care in primary care including chronic care diabetes clinics in a rermote area. A multifaceted intervention was initiated in the diabetes clinic composed of a diabetic flow chart, and educational programs for clinic nurses, doctors and patients. The study intervention took place over a period of 24 months with the diabetic outcomes (fasting blood glucose, HBA1C, BMI, blood pressure, renal functions, fundus examination, lipid profile and CVS morbidity and mortality) and adherence to follow-up appointments. Knowledge and satisfaction questionnaires were also administered to patients. A new diabetes clinic was established in One-day surgery hospital, Samalout, Minia Governorate, 250 km south to Cairo. It was designed as a structured diabetes care with a complex intervention comprising diabetes registry, patient education, educated diabetes nurse, local clinical protocol and structured communication across the primary-secondary care interface.

 

INTRA- ISLET PROTEIN- TYROSINE PHOSPHATASE 1BFa REGULATOR OF GLUCOSE- STIMULATED INSULIN SECRETION?

B. Lu (1), H. Wu (2), P. Gu (1), H. Du (1), J. Shao (1), D. Zao (2)

1 Department of Endocrinology, Nanjing General Hospital of Nanjing Military Command, Nanjing, China

2 Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China

 

Aim: The aim of present study was to investigate the effects of intra-islet inhibition of protein-tyrosine phosphatase 1B expression on glucose-stimulated insulin secretion (GSIS).

Methods: Twenty ten-week-old SD rats were randomly assigned to a regular diet (RD) or a high-fat diet (HFD) for 8 weeks. At the end of study, fasting glucose, fasting insulin concentration and lipid profile were measured and IPGTT was done after 12h fast. Recombinant adenoviruses containing siPTP1B (Ad-siPTP1B), or siControl (Ad-siControl) sequences were constructed. Islets were isolated and transfected and then assigned to Ad-siPTP1B group, Ad-siControl group, and mock control group. RT-PCR and Western blot were used to evaluate the expression level of PTP1B, GLUT-2 and glucokinsase. Batch incubation and islet perifusion were performed to evaluate kinetics of insulin release.

Results: Intra-islet PTP1B expression in HFD group was higher than that of RD group. GSIS was impaired in islets of HFD ratsiPƒ0.05). Ad-siPTP1B treatment resulted in 73% decrease in PTP1B mRNA levels and 61% decrease in PTP1B protein (pƒ0.05). Simultaneously, PTP1B inhibition resulted in 4.7} 0.8-fold increase of GSIS from basalipƒ0.05). Perifusion showed notable improvement of first-phase insulin secretion by Ad-siPTP1B treatment. And significant decrease of both GLUT-2 and GCK were found in HFD group C while up-regulation of both were achieved after PTP1B inhibiton.

Conclusions: Intra-islet PTP1B is an important physiological regulator of glucose-induced insulin release.

 

ASSOCIATION OF MATERNAL BMI WITH ADVERSE PREGNANCY OUTCOMES- DIFFERENCE BETWEEN SOUTH ASIAN, SOUTH EAST ASIAN AND AUSTRALIAN WOMEN

N. Moin (1), S. Hendon (1), J. Bradford (1), P. Henriksson (1), M. McLean (1)

1 University of Western Sydney and Blacktown Hospital, Sydney, Australia

 

Maternal obesity is strongly associated with adverse pregnancy outcome, but these data have mostly been derived from American or European populations. Different ethnic groups have differences in body size and composition and we should not assume similar degrees of risk at the same level of BMI. There is a need for ethnic specific classification of the association of BMI with obstetric risk. Our hospital network in Western Sydney serves an ethnically diverse population. 50% of women attending the Obstetric Service are born outside Australia. The most prevalent immigrant groups are from South Asia (Indian sub-continent) or South East Asia. We used a computerized database of women giving birth in Western Sydney to examine the association between maternal BMI and pregnancy outcome. We compared women born in South Asia (SA, n=4783), South-East Asia (SEA, n=4026) or Australia (n=18061) for composite measures of: (1) adverse foetal outcomes (stillbirth, foetal anomaly, macrosomia, admission to NICU); (2) adverse maternal outcomes (hypertension, diabetes, need for assisted conception) and (3) Assisted delivery (Caesarean or Instrumental). There was a graded increase of all three types of adverse events with increasing maternal BMI, in all three populations. At any given BMI range >20 women from SA and SEA had more adverse events than Australian-born women, and their obstetric risk started to rise at a relatively lower BMI. Australian-born, but not SA or SEA-born women had more adverse foetal events at a BMI.

 

EVALUATION OF SUDOMOTOR FUNCTION AS A SCREENING TOOL FOR DIABETES

B. Ongphiphadhanakul (1), C. Ngakumos (1),

P. Tengprattanakom (1), P. Brunswick (2), J.H. Calvet (2)

1 Ramathibodi Hospital, Bangkok, Thailand

2 Impeto Medical, Paris, France

 

Objective: Early detection may reduce the burden of diabetes and its complications. The aim of this study was to evaluate the utility in the screening of diabetes of EZSCAN®, a new non-invasive device developed for a quick and quantitative evaluation of sudomotor function whose disturbance begins in prediabetes.

Methods: One hundred and twenty five Thai subjects at high risk of diabetes were involved in the study. Each subject underwent an oral glucose tolerance test. A repeated test was performed if the initial test showed either impaired glucose tolerance or diabetes. EZSCAN® was performed in all subjects on the day of the initial oral glucose tolerance test. According to EZSCAN®, subjects were classified as green = no disturbance, yellow = intermediate disturbance and orange–red =high disturbance). Cut-off point for diabetes was 2-h plasma glucose ≥ 200 mg/dL.

Results: Based on two positive tests 5 subjects were classified as diabetes. When using EZSCAN’s orange-red group as the category for positive test, EZSCAN® had a sensitivity of 100% and a specificity of 43.3% to detect diabetes while they were 60% and 100% respectively for FPG. Of all the subjects whose EZSCAN® results were negative (green, n = 52), none had diabetes based on 2 positive oral glucose tolerance tests.

Conclusion: Assessment of sudomotor function by EZSCAN® appears to be a sensitive method to rule out diabetes or impaired glucose tolerance in asymptomatic subjects before performing more specific but less sensitive tests.

 

DUAL ENERGY X-RAY ABSORPTIOMETRY ASSESSMENT OF BONE MASS, FAT MASS DISTRIBUTION IN TYPE 2 DIABETES MELLITUS MEN

A. Shepelkevich (1), E. Pletneva (1), V. Vadzianava (2), N. Vasilieva (2)

1 Belarusian State Medical University, Minsk, Belarus

2 Republic Medical Rehabilitation and Balneotreatment Center, Minsk, Belarus

 

Background and aims: The central distribution of body fat has been identified as a significant risk factor for the development of cardiovascular disease. Determined parameters of metabolic syndrome and fat distribution are important for the prevention of macrovascular complications in type 2 diabetes mellitus (DM). Also several studies indicated that DM is a risk factor for certain types of osteoporotic fractures among adult people. The aim of the study: to assess BMD and features of fat mass distribution in men with type 2 DM in comparison with nondiabetic men.

Materials and methods: 47 men with type 2 DM and 17 controls were examined. The research involved DEXA with Body composition program.

Results: BMD (g/sm2) was statistically lower in diabetic patients at femoral neck (0,873±0,151 vs 0,972±0,161, p<0,02) in comparison with controls. Fat mass distribution parameters in type 2 DM men were: Total Body 31,35±8,43% vs 27,45±4,13%, p<0,05; Android: 40,5 ±8,09% vs 37,10±4,04%, p<0,05; AG Ratio: 1,28±0,21 vs 1,13±0,14, p<0,05; Trunk/Total: 0,63±0,09 vs 0,57±0,04, p<0,05 in comparison with controls.  (Arms+Legs)/Total parameter was higher in nondiabetic patients than in type 2 DM men (0,72±0,18 vs 0,54±0,21 , p<0,05).

Conclusion: The results of study revealed the prevalence of central (android) distribution of body fat among men with type 2 DM in comparison with nondiabetic patients. The data confirmed bone loss manifestation in type 2 DM men (predominantly at femoral neck).

 

COMPARISON OF ELDERLY DIABETIC LIFESTYLE IN SANANDAJ WITH STANDARDS

M. Zarei (1), F. Bidapoor (1), F. Gharibi (1)

1 Kurdistan University of Medical Science, Sanandaj, Iran

 

Background: This study compared lifestyle of   diabetic elderly patients with standard lifestyles.

Methods: This cross-sectional study of 250 elderly diabetic that was chosen performed BY cluster sampling method. Information based on questionnaires.

Results: Results showed that the average age in the diabetic elderly patients was 66 years. in the study population, 138 patients (55 / 2%) were female and 62 patients (44 / 8%) were men, none of them has standard precision food consumption(75/5 percent lower than standards  AND  24 / 5 percent more than standards )  And 31 / 2 percent of them had a good exercise (78 / 2 percent was walking exercise and 1.28 percent were cycling.) 87 patients (34 / 8%) was Glucose control  according  to their program. only 20 patients (8%) of regular blood glucose control had done.

Conclusion: This study showed that the quality of life for elderly people with diabetes who living in the Sanandaj City in comparison with appropriate standards is inconsistent and we have been plan to diabetes control, especially in countries where aging populations will increase in future.


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