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Biomedical subjects

C Snehalatha

Publications and source records attributed to C Snehalatha.

At least 91 records · Page 5Linked to original sources
PubMed1996

Incidence of IDDM in children in urban population in southern India. Madras IDDM Registry Group Madras, South India.

This study was carried out to estimate the incidence of childhood insulin dependent diabetes mellitus (IDDM) in an urban southern Indian, population. A registry for IDDM has been set up in the city of Madras. South India. Details of newly diagnosed IDDM children, aged less than 15 years, were analysed retrospectively, for a period of 1991-1994. Primary sources were government and service hospitals, large diabetes clinics and secondary sources were diabetes camp, private diabetologists and endocrinologists. A capture-recapture method was used and the estimate of case in the population (1991 census) was calculated. Incidence (case/100,000) was calculated in the total group and then for boys and girls separately. The incidence for the 4 year period was 10.5/100,000/year (CI 5.0). The corresponding values for boys and girls were 12.6 +/- 11 and 9.6 +/- 4.7 respectively. The peak incidence was between 10 and 12 years. This is the first population based incidence data from India and showed that the incidence of childhood IDDM is not low in urban children.

Adolescent↗
PubMed1996

Acute phase serum proteins in diabetic retinopathy.

The serum concentration of various acute phase reactants were studied in patients with non-insulin dependent mellitus with and without retinopathy and in control subjects. The serum levels of haptoglobin was elevated in diabetics with retinopathy and the levels were highest in those with proliferative diabetic retinopathy. The levels of serum albumin, alpha-1 acid glycoprotein, alpha-1 antitrypsin and caeruloplasmin were not significantly different between the patients with retinopathy and controls. Haptoglobin increases serum viscosity and this could be the mechanism by which it plays a role in pathogenesis of diabetic retinopathy. These preliminary observations need to be confirmed by studies based on larger number of patients. Longitudinal studies on acute phase reactants in various stages of development of diabetic retinopathy would also provide valuable information.

Acute-Phase Proteins↗
PubMed1996

Hyper insulinism and decreased insulin sensitivity in nonobese healthy offspring of conjugal diabetic parents and individuals with IGT and NIDDM.

Insulin sensitivity was measured by insulin tolerance test using KITT as an index of insulin mediated glucose metabolism in 9 non-obese healthy offspring of conjugal diabetic parents (OCDP) and 9 non-obese NIDDM patients. The mean KITT value in the offspring of conjugal diabetic parents was 3.85 +/- 1.64 min-1 x 100 which was lower (P < 0.05) than the value of 5.49 +/- 1.9 min-1 x 100 in the control subjects. While, the mean KITT value in NIDDM patients was 1.85 +/- 0.9 min-1 x 100 which was significantly lower (P < 0.001) than that in the control subjects. Estimation of plasma immunoreactive insulin (IRI) and C-peptide in these subjects and in subjects with impaired glucose tolerance (IGT) showed significantly higher levels of insulin than that in the control subjects but there was no corresponding increase in the C-peptide levels. The mean area under the insulin curve (IRI) was 242 +/- 69 microU/ml in the control subjects versus 527 +/- 206 microU/ml in IGT (P < 0.001), 648 +/- 215 microU/ml in NIDDM (P < 0.001) and 466 +/- 130 microU/ml in OCDP (P < 0.001). These results suggest that 1) healthy offspring of two type II diabetic parents have decreased insulin sensitivity and insulin resistance is present in all the NIDDM patients, 2) peripheral hyperinsulinism is a common feature in healthy offspring of conjugal diabetic parents, and in subjects with IGT and mild NIDDM and this hyperinsulinism is not due to increased B-Cell secretion but due to some metabolic alterations of insulin occurring at the extra pancreatic levels.

Adult↗
PubMed1995

Insulin receptor substrate-1 gene mutations in NIDDM; implications for the study of polygenic disease.

Variations in the coding regions of the insulin receptor substrate-1 (IRS-1) gene have recently been suggested to contribute to the susceptibility of non-insulin-dependent diabetes mellitus (NIDDM). The purpose of this study was to examine the role of the IRS-1 missense mutations at codons 972 (glycine to arginine) and 513 (alanine to proline) in two diverse populations from South India and Finland at high risk for NIDDM. DNA was amplified and digested with restriction enzymes BstN1 to detect the codon 972 mutation and Dra III to detect the codon 513 mutation. The codon 513 mutation was not found in the study subjects. The codon 972 mutation was present in 10.3% of 126 middle-aged NIDDM subjects and 5.3% of 95 matched control subjects in the South Indians (p = 0.17). In elderly Finnish subjects the frequency of the mutation was 7.5% in 40 NIDDM subjects and 7% in 42 matched control subjects. The frequency of codon 972 mutation in the South Indian NIDDM subjects was very similar to the two previously published studies in Danish and French subjects although each study individually fails to reach conventional levels of significance. The data from all four ethnic groups were analysed together after ascertaining that significant heterogeneity did not exist between the studies. Overall, the frequency of the codon 972 mutation is found in 10.7% NIDDM subjects and 5.8% control subjects (p = 0.02). These studies suggest that the codon 972 mutation of the IRS-1 gene might act as a susceptibility gene predisposing to NIDDM in certain ethnic groups.

Adult↗
PubMed1995

Proteinuria in NIDDM in south India: analysis of predictive factors.

There are few data on the risk factors for diabetic nephropathy in the Asian Indian population, although several studies have shown a high prevalence of the disease in this ethnic group. This study also aimed to assess the role of hyperglycaemia and hypertension in the causation and course of nephropathy in this population, which has low rates of obesity. Retrospective analysis of two groups of non-insulin dependent diabetic (NIDDM) patients, one without proteinuria (< 100 mg/day, n = 25) and the other with proteinuria (> or = 500 mg/day, n = 25), matched for age, sex, duration of diabetes and body mass index (BMI) was done to study the factors predisposing to proteinuria and also its progression during a 2 year follow-up. Logistic regression analysis showed that the factors contributory to proteinuria were initial HbA1 and initial systolic blood pressure. The average proteinuria during the follow-up was dependent on the initial and average systolic and diastolic blood pressure values. No correlation was seen between cholesterol or triglyceride values and the change in proteinuria. Creatinine clearance deteriorated in the proteinuric group and this was related to the presence of proteinuria and initial diastolic blood pressure. This study emphasizes the importance of blood pressure in the progression of diabetic nephropathy, even in people who have low BMI. Therefore, good control of blood pressure has an important role to play in the management of this condition.

Blood Glucose↗
PubMed1994

Family studies of non-insulin-dependent diabetes mellitus in South Indians.

Though a genetic basis for non-insulin-dependent diabetes mellitus (NIDDM) is clear, the likely mode of inheritance is not known. The segregation of NIDDM was studied in 64 nuclear South Indian pedigrees (449 individuals) ascertained through an affected proband having both parents and more than 1 sibling alive and available for oral glucose tolerance testing. A high proportion of parents were found to be of abnormal glucose tolerance [89 of 128 (70%) diabetic and 11 of 128 (9%) impaired]. Complex segregation analysis was performed using (1) POINTER which implements the mixed model and distinguishes major gene, multifactorial and non-transmitted environmental contributions to affection and (2) COMDS which implements an oligogenic model with major gene, modifier gene and environmental contributions to a) affection and b) diathesis (an ordered polychotomy amongst non-affected family members, based on 2-h plasma glucose level). Using POINTER, there was no formal support for a major gene and the most parsimonious solutions were achieved with multifactorial models. Using COMDS, we found i) significant improvements in models when information on glucose levels in nondiabetic family members (diathesis) was included, ii) support for segregation of a diallelic gene as well as background familial resemblance, and iii) under the best-supported model, this diallelic locus featured incomplete dominance (d = 0.8) and a disease-predisposing allele frequency of 14%. In South Indians, segregation of NIDDM is inadequately described by simple major gene models: more complex models provide more satisfactory descriptions. This finding, if applicable in other populations, has important implications for the search for diabetes-susceptibility genes.

Blood Glucose↗
PubMed1994

Delayed onset of diabetes in children of low economic stratum--a study from southern India.

Influence of the socioeconomic status on the age at onset of insulin-dependent diabetes mellitus (IDDM) was analysed in 614 patients who developed diabetes < or = 20 years. The peak occurrence was seen at 11 years in girls (n = 293). The boys (n = 321) showed multiple peaks between 11 and 18 years. In the urban patients (n = 463), the peak was at 11 years in contrast to a delayed peak at 18 years in the rural group (n = 151). When analysed with respect to the family income, the higher income group (HIG) (Rs > 2000/month) showed a sharp peak at 11 years whereas the lower income group (LIG) showed a peak at 18 years (chi 2 = 7.2, P = 0.007). The median body weight of the LIG was lower compared to the HIG. Although the exact cause for the delayed age at onset of IDDM in the rural or LIG is not known, it is likely to be a consequence of the lower socioeconomic and nutritional status (indicated by low body weight) and probably indicates the influence of environmental factors in the pathogenesis of the disease.

Adolescent↗
PubMed1994

Height at onset of insulin-dependent diabetes in children in southern India.

A total of 250 children with insulin-dependent diabetes mellitus (IDDM), having age at onset of diabetes < or = 18 years were studied. Their height at onset of diabetes was compared with that of the normal age- and sex-matched control population. No differences were observed in the heights of the two groups of children. Therefore, our results were similar to that found in Japan and differed from the reports in European children with IDDM in whom an increased growth velocity was noted before the onset of IDDM.

Adolescent↗
PubMed1994

Prevalence of diabetes in pregnant women--a study from southern India.

This study was carried out to assess the prevalence of diabetes in southern Indian women during pregnancy. Nine hundred and fifty women having > or = 24 weeks of gestation, attending two general gynaecology centres for antenatal check-ups were screened. Initially, the screening test with 1-h plasma glucose sampling following 50 g glucose load was done and those with glucose values > or = 140 mg/dl were subjected to a 3-h oral glucose tolerance test (OGTT) with 100 g glucose load. Among the 950 women, 6 were known diabetic subjects. Of the other 944, 89 were positive on screening test and 67 of them reported for OGTT. Four were detected to have gestational diabetes mellitus (GDM) (O'Sullivan and Mahan's criteria). Therefore the prevalences of total diabetes and GDM were 1.19% and 0.56%, respectively.

Adult↗
PubMed1994

Differences in plasma insulin responses in urban and rural Indians: a study in southern-Indians.

Fasting and 2 h post glucose plasma immunoreactive insulin (fasting IRI and 2 h IRI) responses were measured in urban (n = 149) and rural (n = 40) individuals with normal glucose tolerance during an epidemiological survey. In this survey, 900 urban and 1038 rural subjects were screened for glucose intolerance by capillary blood sampling. The respective response rates were 91% and 88%. We had planned to collect venous blood for IRI estimation, i.e. from 180 urban and 200 rural subjects. The compliance for the same was poor from the rural subjects and therefore the number available for IRI estimation was small. The mean +/- SD ages of the urban and rural groups were similar (35.3 +/- 9.9 and 38.6 +/- 13.1 years, respectively). The rural population had lower body mass index (BMI) and subscapular:triceps ratio compared to the urban group (p < 0.001). The total calorie consumption was lower and physical activity was higher in rural population. Fasting and 2 h insulin values in urban population were 16.6 +/- 9.4 mU l-1 and 60.6 +/- 42.5 mU l-1 and in rural 6.7 +/- 5.1 mU l-1 and 32.4 +/- 27.8 mU l-1, respectively; the values being significantly lower in the rural population (p < 0.001). Multiple regression analysis showed that in urban population the fasting insulin was correlated to the BMI and the 2h IRI to 2 h glucose, BMI and the subscapular:triceps ratio. In the rural population, similar results were obtained, except in that the 2 h IRI was influenced by the gender also.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

High prevalence of NIDDM and IGT in an elderly south Indian population with low rates of obesity.

OBJECTIVE--To assess the prevalence of diabetes and impaired glucose tolerance (IGT) in the urban and rural elderly population in south India. RESEARCH DESIGN AND METHODS--Urban and rural populations > or = 60 years of age and representative of the areas (873 urban and 588 rural subjects) were screened for diabetes and IGT using fasting and 2-h postglucose capillary blood glucose measurements. RESULTS--In the urban area, 211 (23.7%) had diabetes, and 101 (12.4%) had IGT. In the rural area, 56 (9.9%) had diabetes, and 82 (14.9%) had IGT. The ratio of newly diagnosed to known diabetes was 1:3 in the urban and 1:1 in the rural areas. Positive family history of diabetes, body mass index (BMI), subscapular-to-triceps ratio, and waist-to-hip ratio were significantly associated with diabetes in the urban population. Only age and BMI showed significant association with diabetes in the elderly rural population. None of the tested parameters, except age in the urban subjects, showed association with IGT. CONCLUSIONS--This study highlights the high prevalence of glucose intolerance in elderly south Indians having low mean BMI (mean +/- SD; urban 21.7 +/- 4.6, rural 17.9 +/- 3.3 kg/m2). Although there was a twofold higher prevalence of diabetes in the urban area, the occurrence of IGT was similar in urban and rural populations.

Age Factors↗
PubMed1994

Pancreatic beta cell function in normoglycaemic offspring of diabetic parents.

The aim of the study was to look for any time-realted fluctuation in the pancreatic beta cell function in normal offspring of diabetic parents, over a period of three years. Serum insulin (IRI) and C-peptide (CP) responses to oral glucose were reevaluated three years after the initial study in 25 normoglycaemic offspring of conjugal Type 2 diabetic parents. The mean area under the curve of IRI (AUC IRI) response was higher than normal control value in the offspring at both time points (P < 0.01) and the two values did not differ much. The 2 hr IRI was also significantly higher (P < 0.05) than the control value. CP responses at both time points in the offspring did not differ from the mean control value. Wide fluctuations in the individual IRI were noted on follow-up despite similar plasma glucose response. Follow-up IRI was higher in 6, lower in 5 (+/- 25% of the initial) and remained unaltered in the other 4 offspring. The corresponding CP showed increased values in 3, decreased values in 5 and no change in 7 offspring. The fluctuations were nonuniform in nature among the individuals studied. Disparity between the IRI and CP responses were present in 5 offspring during the follow-up. This study thus shows that wide fluctuations in insulin responses occur even in the normoglycaemic offspring of diabetic parents.

Adult↗
PubMed1994

Prevalence of proteinuria in non-insulin dependent diabetes.

Proteinuria was estimated in 600 non-insulin dependent diabetes mellitus (NIDDM) patients in 24 hrs collection of urine. The test was repeated at least twice in a year to confirm the persistence of proteinuria. Mild proteinuria (200-500 mg/d) occurred in 94 (15.7%) and nephropathy (> 500 mg/d) in 112 (18.7%) patients. Nephropathy commonly occurred with long-standing diabetes (> 10 years). Development of proteinuria correlated directly with the duration of diabetes, diastolic and systolic blood pressure, age of the patients, serum creatinine and inversely with creatinine clearance. Retinopathy was seen in 75% of those with nephropathy. It is concluded that proteinuria occurs in one third of NIDDM patients and the risk of nephropathy increases with duration of disease.

Diabetes Mellitus, Type 2↗
PubMed1993

Positive association in the absence of linkage suggests a minor role for the glucokinase gene in the pathogenesis of type 2 (non-insulin-dependent) diabetes mellitus amongst south Indians.

Mutations of the glucokinase gene have been implicated in the development of glucose intolerance in pedigrees with maturity-onset diabetes of the young. However, the contribution of the glucokinase gene to the aetiology of common Type 2 (non-insulin-dependent) diabetes mellitus is uncertain. We have studied the role of the glucokinase gene in the pathogenesis of Type 2 diabetes in South Indians, using both population-association and linkage methodology. A pair of CA-repeat sequences (GCK(3') and GCK(5')) straddling the glucokinase gene were employed as markers, each subject being typed using the polymerase chain reaction and polyacrylamide gel electrophoresis. Comparisons of allele frequencies at these markers were made between 168 Type 2 diabetic subjects and 70 racially-matched control subjects. No differences in allele frequencies were apparent at the GCK(5') marker; however, there were significant differences in allele frequencies at the GCK(3') marker between the Type 2 diabetic subjects and control subjects (chi 2 = 11.6, df = 3, p = 0.009) with an increase of the z allele (78.0% vs 66.4%) and a decrease of the z + 2 allele (13.7% vs 25.0%) amongst the diabetic subjects. Linkage between glucose intolerance and the glucokinase gene was studied in 53 nuclear pedigrees under a variety of genetic models. Linkage was excluded (lod score < -2) at a recombination fraction of zero under five of the ten models used and highly unlikely (-2 < lod score < -1) under the others. The combination of positive association and negative linkage suggests that glucokinase acts as a minor gene influencing the development of Type 2 diabetes within this population.

Adult↗
PubMed1993

Fasting plasma glucose in the diagnosis of diabetes mellitus: a study from southern India.

The usefulness of fasting plasma glucose (FPG) in the diagnosis of diabetes mellitus was assessed in Asian Indians in South India. Oral GTT values in 570 newly screened adults were studied. Taking the WHO criteria of 2 h plasma glucose (PG) of > or = 11.1 mmol l-1 for diagnosis of diabetes, the validity of a FPG of > or = 7.8 mmol l-1 cut off value for diabetes was assessed. Using the regression analysis, the correlations of the FPG to 2 h PG were examined. Among the 268 with 2h PG value of > or = 11.1 mmol l-1, 205 (76.5%) had FPG > or = 7.8 mmol l-1. Sensitivity of FPG was 76.5% for diagnosis of diabetes and its specificity was 99%. An exponential regression model gave the best fit for FPG vs 2 h PG and using the regression equation, the predicted FPG for a 2 h PG of 11.1 mmol l-1 was 7.05 mmol l-1. Sensitivity increased to 90.3% with FPG of 7.05 mmol l-1 while the specificity remained at 92%. It is concluded that in the south Indian subjects, the sensitivity for diagnosis of diabetes with FPG of > or = 7.8 mmol l-1 was 76.5%; and it increased to 90.3% with FPG of > or = 7.05 mmol l-1.

Adult↗
PubMed1993

Maternal age and birth order of young IDDM patients. A study from southern India.

OBJECTIVE: To assess the effects of maternal age and birth order on the risk of IDDM in Asian Indians. RESEARCH DESIGN AND METHODS: Data from a diabetes registry in Madras, India, was used to find IDDM patients diagnosed before 20 yr of age. A questionnaire was used to elicit clinical details of subjects. RESULTS: Children with mothers < or = 24 yr of age had a higher percentage of IDDM. Children with lower birth orders had a higher prevalence of IDDM. CONCLUSIONS: The risk of IDDM in children is increased in children with lower birth orders, born of younger mothers.

Adolescent↗