Experience with insulin pump treatment in Indian diabetics. A preliminary report.
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Biomedical subjects
Publications and source records attributed to C Snehalatha.
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A detailed study of four cases of MND-Madras has shown a significantly low plasma citrate level in these subjects. Comparison with other related groups of neurological disorders indicates the citrate/pyruvate ratio to be of diagnostic value in MND-Madras. This seems to suggest that the pathophysiology of MND-Madras may centre round altered citrate metabolism.
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OBJECTIVES: (a) To study whether there was an increased prevalence of glucose intolerance in the parents of probands with Type 1 diabetes and (b) to look for any possible link between the glucose intolerance in the parents with HLA-DQB1 alleles transmitted in excess to the Type 1 diabetes offspring. Study Design and Methods From 215 families of South Indian Type 1 diabetes probands, 336 parents (170 fathers, age 30-70 years; 166 mothers, age 23-72 years) were studied by oral glucose tolerance test (GTT). Glucose intolerance in the parents was compared with the population data available. HLA-DQB1 alleles in 170 of the families were studied by the Olerup method (based on sequence specific primers) and the transmission disequilibrium test (TDT) was used to determine the Type 1 diabetes-associated DQB1 alleles. RESULTS: Among the parents 11.2% had Type 2 diabetes which was similar to the population data of 11.6%. However there was a male predominence among the diabetic parents (chi(2)=7.0, p=0.008), while in the population there was a female predominence. Prevalence of IGT was significantly more among the parents (13.6%) compared with the population data (9.1%) (chi(2)=6.43, p=0.011). Both HLA-DQB1*0201 (p<0.0001) and DQB1*0302 (p=0.0001) were positively associated with Type 1 diabetes in the probands although 21% of the probands possessed neither DQB1*0201 or DQB1*0302. The distribution of glucose tolerance categories in the parents of the probands differed according to the presence of DQB1*0302 (p= 0.035) whilst no such differences existed for DQB1*0201. CONCLUSIONS: In summary, the presence of Type 1 diabetes in the South Indian offspring does not predict a higher occurrence of Type 2 diabetes in the parents. However, there is an increased occurrence of impaired glucose tolerance (IGT) among the parents. Family based studies demonstrate increased transmission of HLA-DQB1*0201 and HLA-DQB1*0302 with Type 1 diabetes similar to North American and European Caucasian subjects. Furthermore, HLA-DQB1*0302 may be a minor determinant of glucose tolerance in parents of offspring with Type 1 diabetes.
BACKGROUND: Several Type 1 diabetes susceptibility loci have been located to chromosome 2q12-21. However, results have not always been consistent and this may reflect study design and the population analysed. We have used a family-based design to look for an association between Type 1 diabetes and markers located to 2q12-21. METHODS: Ninety-one South Indian families consisting of subjects with Type 1 diabetes and their parents were genotyped for eight polymorphic markers localised to 2q12-21, which includes the interleukin-1 gene cluster. Radiation hybrid mapping was used to localise the map position of D2S308 and D2S363 on 2q12-21. The extended transmission disequilibrium test was used for statistical analysis. RESULTS: No associations were found between Type 1 diabetes and markers located in and around the interleukin-1 gene cluster or the interleukin-1 Type 1 receptor. In contrast, a suggestive association was found between Type 1 diabetes and two closely-linked markers telomeric of the interleukin-1 gene cluster (D2S308 and D2S363, separated by 3.3 cR) (p=0.004 and p=0.002, respectively). CONCLUSION: This preliminary study suggests that a locus close to D2S308 and D2S363 is involved in the aetiology of Type 1 diabetes in the South Indian population.
OBJECTIVE: Atherosclerosis is associated with insulin resistance (IR) and dyslipidaemia. Impaired glucose tolerance (IGT) is characterised by IR and is associated with a higher risk of atherosclerosis. The objective of the present study was to test whether early atherosclerosis indicated by intimal medial thickness (IMT) of common carotid artery (CCA) and internal carotid artery (ICA) is higher in IGT than in normoglycaemic subjects (NGT) and to look for an association of IMT with IR and dyslipidaemia. STUDY DESIGN AND METHODS: Ninety-nine randomly selected non-diabetic subjects aged >or=35 years (48 NGT and 51 IGT) were studied. Measurements of body mass index (BMI), waist/hip ratio (WHR), blood pressure, cholesterol-total, HDL, LDL, VLDL, triglycerides (TG), lipoprotein (a), apolipoprotein-A1 (Apo A1) and apolipoprotein-B (Apo B) and ratio of Apo A1/Apo B were estimated. Insulin resistance (HOMA-IR) was calculated using the fasting plasma insulin and glucose values. IMT of CCA and ICA were measured using high-resolution beta-mode ultrasonography. RESULTS: Subjects with IGT and NGT were matched for BMI and WHR; HOMA-IR was higher in IGT vs NGT (7.92+/-4.2 vs 6.07+/-3.76, p = 0.028). Age-adjusted IMT values were similar in NGT and IGT (CCA 0.59+/-0.17 and 0.63+/-0.22 mm and ICA 0.44+/-0.10 and 0.45+/-0.10 mm, respectively). Further analyses were done in the total group. Multiple linear regression analyses showed that CCA-IMT was significantly associated with age and negatively associated with Apo A1/Apo B ratio. ICA-IMT was associated with age only. IMT was significantly correlated with cholesterol-total and LDL-cholesterol and apolipoproteins. It was not associated with IR. CONCLUSION: In southern Indians, IGT did not influence the IMT. Although insulin resistance was higher in IGT, it was not associated with higher IMT. Conventional risk factors such as cholesterol, LDL-cholesterol and apolipoproteins showed association with IMT in the insulin-resistant population.
BACKGROUND: The aim of the study was to compare the abnormalities in insulin secretion and insulin sensitivity in impaired fasting glucose (IFG) and in impaired glucose tolerance (IGT). METHODS: Glucose tolerance was determined by oral glucose tolerance test in 289 non-diabetic subjects selected for this study (M : F, 160 : 129, mean age 42.2 +/- 11.0 (SD) years, mean body mass index (BMI) 24.9 +/- 4.2 kg/m(2)). Diabetic subjects were excluded from the study. The association of insulin resistance and beta-cell function (calculated by HOMA model) with IFG and IGT was studied using linear and multiple logistic regression analyses. Subjects with normoglycaemia (NGT) were used as controls. RESULTS: Insulin resistance was significantly more in IFG and in IGT than in NGT. beta-cell dysfunction was significantly higher in IFG than in IGT. IFG was associated with both insulin resistance (OR = 9.11, p < 0.001) and beta-cell dysfunction (inverse correlation, OR = 0.103, p < 0.001), while only insulin resistance was significantly associated with IGT (OR = 1.24, p = 0.005). CONCLUSIONS: In urban South Asian Indians, IFG differed from IGT in having combined insulin resistance and beta-cell dysfunction, while IGT was associated only with insulin resistance.