Diabetology

HIV and antiretroviral therapy-induced metabolic syndrome in people living with HIV and its implications for care: A critical review Sakhile Khetsiwe Salome Masuku, Joyce Tsoka-Gwegweni, Ben Sartorius Journal of Diabetology 2019 10(2):41-47 HIV has remained a major global public health concern for more than three decades. While global efforts are coalesced in the fight against HIV, the number of people living with HIV (PLHIV) is continuously increasing due to the rollout of antiretroviral therapy (ART). This relates, in part, to the intensified efforts in HIV prevention and control strategies through extensive HIV testing. Consequently, more and new people have learnt their HIV-positive status, implying that more are at risk of suffering the negative effects of HIV and ART. HIV has been implicated in the development of many non-communicable diseases such as cardiovascular diseases and type 2 diabetes mellitus (T2DM). This study conducted a critical review of the literature on the mechanisms through which HIV and ART cause metabolic syndrome, and the implications such understanding has to the care provided to PLHIV. The findings of this review suggest that HIV induces metabolic syndrome through stimulation of immune cells which, in turn, trigger an inflammatory response. ART also triggers the inflammatory response. The inflammatory response suppresses adiponectin and causes impaired insulin action on skeletal muscles. Since the presence of metabolic syndrome greatly increases the risk of non-communicable diseases, particularly T2DM, there is a need for metabolic syndrome screening and prevention among PLHIV. Conducting routine body mass index and waist circumference measurement with periodical triglycerides measurement is necessary for the early detection of metabolic syndrome and the prevention of T2DM and cardiovascular conditions. There is also a need for a model of care for PLHIV that will provide guidance on the prevention of metabolic syndrome hence prevent the development of T2DM with its dire effects on the quality of life.

Can decreased heart rate variability be a marker of autonomic dysfunction, metabolic syndrome and diabetes? Gunjan Y Trivedi, Banshi Saboo, Ram B Singh, Anuj Maheshwari, Kamal Sharma, Narsingh Verma Journal of Diabetology 2019 10(2):48-56 Epidemiological studies show an emergence of diet- and lifestyle-related diseases; Cardio-metabolic diseases (CMD) and neuropsychiatric diseases (classified as non-communicable diseases or chronic diseases). Diet and lifestyle factors can cause adverse effects on autonomic function resulting in decreased heart rate variability (HRV). Low HRV is a risk factor for CMDs. There is a need to find out new methods of early diagnosis for prevention and treatment of these problems because the neurohormonal dysfunction could be the earliest manifestation. It is possible that HRV could be a marker for the early diagnosis of these problems, because it is characterised with increased sympathetic and reduced parasympathetic activity. Several studies indicate that increased unhealthy diet, mental stress, sedentary lifestyle, tobacco, insomnia and alcoholism may be associated with neurohormonal dysfunction, which may cause decline in HRV. Majority of the chronic diseases (e.g., diabetes, hypertension, heart attack, neuropsychiatric disease and cancer) are associated with decreased HRV. The studies also indicate that solar and geomagnetic activities may influence circadian clock and hypothalamus resulting in the oxidative stress and inflammation with alteration in HRV. It is possible that reduced HRV will correlate with various stages of autonomic dysfunction, associated with chronic diseases. Simple methods need to be developed to measure HRV for early diagnosis of neurohormonal dysfunction, which may be important for early management. This review aims to find out available evidence on the role of HRV in the early diagnosis of chronic disease (with specific focus on Type 2 diabetes) and the factors affecting HRV.

Implications of CVD-REAL 2 study for Indian diabetic population Rajeev Chawla, Shalini Jaggi Journal of Diabetology 2019 10(2):57-61 South Asians are reported to have a higher risk of developing macrovascular complications of Diabetes, i.e., coronary artery and cerebrovascular diseases as compared to Caucasians. Literature evidence has shown that among the currently available agents, the sodium/glucose cotransporter 2 inhibitors (SGLT2i) offer a rational approach for management of T2DM over other glucose lowering therapies because of their insulinindependent action, modest weight loss, mild reduction in BP and low risk of hypoglycaemia. Recently, CVDREAL 2 study was conducted across six countries (Israel, Canada, South Korea, Japan, Singapore and Australia) to determine the CV benefits of various SGLT2i in >400,000 T2DM patients in a realworld scenario. Around 75% of the patients in this study were from the AsiaPacific region. Among all the available SGLT2i, most of the study population was exposed to dapagliflozin, contributing to 75% of the total exposure time. The CVDREAL 2 study favoured SGLT2i over other glucose lowering drugs for lower risk of death, HHF, MI and stroke. All these points suggest that the results of CVDREAL 2 study can be incorporated in the high CVD risk Indian population who need much more aggressive treatment for diabetes than other patient populations.

Quality evaluation of speciality rice varieties available in South Indian (Chennai) market Ramalingam Anjana, Haripriya Ashok Kumar, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Shanmugam Shobana, Vishwanathan Mohan, Vasudevan Sudha Journal of Diabetology 2019 10(2):62-68 Background: Several speciality rice with health claims are emerging in the south Indian market. The study aims to examine the nature of speciality rice with health claims available in the Chennai market. Methodology: A market survey was conducted in randomly selected outlets from 4 zones of the Chennai city urban market (100 stores including supermarkets/hypermarkets/departmental stores/pharmacies were visited and rice samples were collected). The product label information, claims declared on the pack and morphological features of the rice samples were examined and recorded using stereo-zoom microscope. Results: Fifteen rice samples of different categories including whole-grain rice (8), semi-polished rice (2) and polished white rice (5) were evaluated. Three samples had low-glycaemic index claims among whole-grain rice and 2 among polished white rice. The health claims were not supported with scientific evidence and were sometimes misleading as revealed by stereo-zoom microscopic examination. Conclusions: The authenticity of many of the health claims declared on the rice packs is questionable due to the lack of scientific evidence. The awareness about the quality of rice would be helpful for the consumer to make a wise choice about which cereal staple to purchase.

Oxidant/antioxidant status of Sudanese Type II diabetic patients with multiple complications Selma Mohammed Osman Mahmoud Yousif, Mohammed S M. Abdalla, Elmahdi M A. Elmahdi Journal of Diabetology 2019 10(2):69-75 Background: Diabetes-associated oxidative stress is induced by both increase in production of plasma-free radical concentrations and a significant reduction in antioxidant defence mechanisms, and it is associated with the pathophysiology of diabetes mellitus and its complications. Objectives: To evaluate the oxidant and antioxidant status in Type II diabetic patients with complications and diabetic patients without complications (DWC) compared to normal subjects and their association with diabetic complications. Materials and Methods: Plasma levels of malondialdehyde (MDA), antioxidant Vitamin C and antioxidant enzyme, superoxide dismutase (Cu-Zn SOD) activity were estimated in patients with diabetic nephropathy (DN), patients with diabetic neuropathy (DNe), diabetic patients with coronary artery disease (CAD), DWC, and controls matched for age, sex, body mass index and study region. Spectrophotometry and enzyme-linked immunosorbent assay techniques have been applied for the determination of MDA, Vitamin C and superoxide dismutase (SOD). Results: Comparing the level of Vitamin C and activity of SOD in all groups, it was observed that the lowest concentrations were found in CAD, DN and DNe groups, higher in DWC, and the highest in the control group. On the contrary, MDA levels (as an indicator of oxidative stress) were found to be increased in CAD, DN and DNe groups as compared to DWC and control groups. SOD and Vitamin C were found inversely correlated with glycosylated haemoglobin and MDA levels in all diabetic groups regardless of their complications. Multivariate model showed that all the variables independently associated with the diabetic complications. Conclusions: There is an imbalance between the oxidants and antioxidants in diabetic patients with complications and patients of DWC as compared to healthy groups.

Comparison of efficacy of add-on therapy of teneligliptin versus pioglitazone among type 2 diabetes mellitus patients ineptly controlled on dual therapy of metformin plus sulfonylurea Vanjari Nikhil Kumar, Sandeep Reddy Konyala, Siva Subrahmanyam Bandaru, Goverdhan Puchchakayala Journal of Diabetology 2019 10(2):76-82 Aim: The main aim of the study is to compare the efficacy of add-on therapy of teneligliptin (20 once daily) versus pioglitazone (15 mg once daily) among type 2 diabetes mellitus (T2DM) patients inadequately controlled on dual therapy of metformin (MF) plus sulfonylurea (SU). Materials and Methods: It is a prospective, observational, comparative study conducted in patients from the outpatient department of Sri Bhadrakali Hospital located at Warangal, Telangana state, India. The efficacy of pioglitazone and teneligliptin was assessed by measuring the change in the glycated haemoglobin (HbA1c), Fasting Plasma Glucose (FPG), Post Prandial Blood Glucose (PPBH) levels after 12 weeks of treatment. FPG, PPBG and HbA1c levels at baseline and 12 weeks. The primary endpoint was changed in HbA1c levels at 12 weeks as compared to the baseline levels in both groups. The secondary endpoints were changes in FPG, PPBG levels at 12 weeks as compared to baseline levels. Along with, serum cholesterol, triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured both at baseline and after 12 weeks. Results: At study end, HbA1c levels were reduced from baseline by 0.7% (P = 0.0049) in the pioglitazone group and 1% (P = 0.0002) in the teneligliptin group. The mean changes in FPG levels from baseline to week 12 were −39.8 mg/dl (P ≤ 0.0001) in teneligliptin and −11.48 mg/dl (P = 0.00380) in pioglitazone group. The mean PPG levels from −47.8 mg/dl (P = 0.0003) in teneligliptin and −25.5 mg/dl (P = 0015) in pioglitazone group. After 12 weeks of study, the levels of TG, total cholesterol (TC), LDL −71.5 (P = 0.0973), −15 (P = 0.0501), 18.8 (P ≤ 0.0008) mg/dl and −31.38 (P ≤ 0.0001), −21 (P ≤ 0.0001), −11.68 (P = 0.0028) mg/dl in teneligliptin group and pioglitazone group, respectively. There was significant increase in HDL levels 5.3 (P ≤ 0.0001) mg/dl in teneligliptin group and 5.2 (P = 0.0001) mg/dl in pioglitazone group. Conclusion: Both teneligliptin 20 mg and Pioglitazone 15 mg provided additional HbA1c lowering to that achieved with MF and SU. Teneligliptin showed more effective reductions in HbA1c, FPG, PPBG, HDL and LDL levels. Pioglitazone showed significant changes in HbA1c, HDL, TC, triglyceride levels and significant changes in FPG, PPBG and LDL levels. Reduction in HbA1c and plasma lipids slows down the diabetes progression and decreases the risk of microvascular and macrovascular complications.

Study on glycaemic control by canagliflozin and its effect on insulin resistance and plasma ketone in type 2 diabetes mellitus patients JS Kumar, K Karthickeyan, Bansi R Patel, KI Haroon Meeran, G Karishma, Vishnu T Raveendran Journal of Diabetology 2019 10(2):83-86 Aims: The aim is to study the effect of glycaemic control by canagliflozin and its effect on insulin resistance (IR) and plasma ketone in type 2 diabetes mellitus (DM). Settings and Designs: The study was done at the Diabetes Clinic, General Medicine Department of the hospital. The study designed to be a prospective observational open-label study. Subjects and Methods: The study was conducted in 60 patients for 3 months. The patients were divided into two groups test and standard. Canagliflozin is given to test over- and above-standard treatment, and standard group is given to the standard treatment. Blood samples are collected at the beginning and at the end of the study. Parameters such as body weight, waist circumference, fasting blood glucose, haemoglobin A1c (HbA1c), plasma ketone and homeostatic model assessment-IR (HOMA-IR) were analysed. Statistical Analysis Used: Data obtained from the present studies were collected and analysed statistically using software IBM SPSS version 21. Results: Various parameters such as HbA1c and weight loss showed a significant difference before and after the study in both standard and test group, respectively. Whereas, other parameters such as HOMA-IR, waist circumference and fasting blood sugar levels showed significant difference only in the test group. Conclusions: Canagliflozin provided better glycaemic control in type 2 DM patients along with decreased IR and marked weight loss. Increased plasma ketone levels were noted during the course of the therapy to an extent which can be used up by the body as a fuel and not cause ketoacidosis.

Effect of sudden ban of pioglitazone on glycaemic control of type 2 diabetes mellitus patients in a tertiary care hospital in South India Sheetal Vasundara Mathai, Prabha M Adhikari, Sashidhar M Kotian Journal of Diabetology 2019 10(2):87-88