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Biomedical subjects

A Ramachandran

Publications and source records attributed to A Ramachandran.

At least 91 records · Page 5Linked to original sources
PubMed2000

Insulin resistance alone does not explain the clustering of cardiovascular risk factors in southern India.

AIMS: To determine whether insulin resistance (IR calculated using the HOMA model) has a dominant role in the clustering of cardiovascular risk factors in the Asian Indian population. METHODS: A total of 654 non-diabetic subjects aged > or =40 years (male 396: female 258) were selected from a population survey. They had estimates of fasting and 2 h plasma glucose, insulin levels, body mass index (BMI), waist-to-hip ratio (WHR) and blood pressure. Factor analysis was carried out using the principle components analysis (PCA) with varimax orthogonal rotation of continuously distributed variables, considered to represent the components of insulin resistance syndrome including the calculated IR. RESULTS: There were three major clusters of cardiovascular disease (CVD) risk variables in men and four clusters in women. Insulin resistance, 2 h plasma glucose, insulin and obesity aggregated as the major domain. Insulin resistance was not linked with hypertension. BMI was a common link for all the three factors in men, and for three of the four in women. CONCLUSIONS: Insulin resistance is not the only underlying factor for the clustering of CVD risk factors in south Indians. These findings are consistent with the presence of several distinct physiological domains, as shown in other ethnic groups.

Adult↗
PubMed2000

Clinical profile of diabetic foot infections in south India--a retrospective study.

AIMS: The aim of the study was to determine the profile of diabetes foot infections in south Indian diabetic subjects. The causative factors for delayed wound healing and the recurrence of infection were also studied. METHODS: During a period of 6 months, 374 patients who had undergone some surgical procedure for foot infection were available for follow-up (M:F 227:147, mean age 54.9 +/- 9.4 years, diabetes duration 10.9 +/- 7.7 years). All of them had records of clinical and treatment details, laboratory data including biothesiometry, Doppler tests and electrocardiogram (ECG) records. Foot ulcers were classified according to Wagner's classification. RESULTS: Majority of the patients had grade II and III ulcers (50% and 26.5%, respectively), grade IV was seen in another 21.9%. The median healing time was 44 days. Recurrence of infection which occurred in 53% was more common in patients with neuropathy and peripheral vascular disease (PVD). CONCLUSIONS: Recurrence of foot infection was common among south Indian Type 2 diabetic subjects and was related to the presence of PVD and neuropathy. There is also a need for improvement in footwear and foot care education.

Adult↗
PubMed2000

Scintigraphic evaluation of colonic transit in two patients with idiopathic chronic constipation.

Bowel transit in two women with protracted constipation was evaluated after oral administration of In-111 DTPA in water. Serial abdominal images were obtained for as long as 96 hours to assess transit through the stomach, small bowel, and colon. In both patients, large bowel transit was delayed. A pattern of colonic inertia was observed in one patient, whereas retention in the distal colon was seen in the other patient. Both patients underwent total colectomy with marked symptomatic relief. Colonic transit studies of these patients are presented, and the literature is reviewed.

Adult↗
PubMed2000

Cost burden to diabetic patients with foot complications--a study from southern India.

AIM: To study the economic burden of management of diabetes in patients with foot complications, as a large number of them suffer from foot complications of varying severity. This study relates to direct cost to diabetic patients with foot complications. MATERIAL AND METHODS: An illustrative sample of 270 Type 2 diabetic subjects, 164 without foot complications (Control group, Group 1) and 106 with foot complications (Group 2) were studied. They were available for the study during a six month period from January to June 1998. Group 2 had two sub-groups, i.e., those who needed out-patient (OP) treatment only (n = 23) and those who needed treatment in the hospital (HP) (n = 83). The study subjects were interviewed personally by the educator to collect demographic data and treatment expenditure. RESULTS: Total median expenditure incurred by the diabetic subjects without foot complications (Group 1) was Rs. 4373/- and by those with foot complications (Group 2) was Rs. 15,450/-. Patients who required hospitalised treatment incurred higher expenses than the OP patients, towards doctor's fees and hospitalisation (P < 0.0001). The percent of total income spent by the HP patients was higher than by the OP patients (P < 0.02). CONCLUSIONS: Diabetic subjects with foot problems incur very heavy expenditure in the treatment process. Most of the direct costs of diabetes treatment results from its complications. The hospitalisation costs for the complications of diabetes are particularly heavy. This underscores the need to reduce complications and also their economic burden.

Cost of Illness↗
PubMed1999

Nitric oxide prevents anoxia-induced apoptosis in colonic HT29 cells.

Apoptosis is a critical determinant of tissue mass homeostasis and may play a role in carcinogenesis. The aim of the present study was to investigate anoxia-induced cell death in colon-derived HT29 cells and the effect of nitric oxide on this phenomenon. It was found that HT29 cells subjected to anoxia undergo apoptosis in a time dependent manner, as determined by DNA fragmentation and Hoechst-33258 dye staining. Cytochrome c release from mitochondria to cytosol is a key step in this process and this release precedes DNA fragmentation. NO inhibits anoxia induced apoptosis in these cells by inhibiting the release of cytochrome c and thus may play a role in modulating the apoptotic cell death of colon-derived epithelial cells.

Arginine↗
PubMed1999

An uncoupling protein 2 gene variant is associated with a raised body mass index but not Type II diabetes.

AIMS/HYPOTHESIS: Linkage between markers close to the uncoupling protein 2 and 3 genes (11q13) and resting metabolic rate and a pre-diabetic phenotype have been found. The syntenic region in mouse has been found to be linked to quantitative traits associated with obesity and diabetes. UCP2 and UCP3 could therefore have an important role in body weight regulation and susceptibility to diabetes. We investigated a recently identified variant of the UCP2 gene in exon 8 as a marker for glucose and weight homeostasis. METHODS: Length variation of the UCP2 exon 8 variant was studied by the polymerase chain reaction and agarose gel electrophoresis. Sequence variants of the UCP3 gene were sought by semi-automated DNA sequencing. RESULTS: In 453 South Indian subjects, we found an association in women between the UCP2 exon variant and body mass index (p = 0.018). These findings were replicated in a separate group of South Indian subjects (n = 143, p < 0.001) irrespective of sex. Although no association was found between the UCP2 exon 8 variant and overt obesity in British subjects, the UCP2 genotype of obese women (n = 83) correlated with fasting serum leptin concentration (p = 0.006) in the presence of extreme obesity. These observations could not be explained by tight linkage disequilibrium with a coding region variant in the region of the UCP3 gene of biological significance. Lastly, no association was found between UCP2 and Type II (non-insulin-dependent) diabetes using either a family based design (85 families) or case control study (normal glucose tolerance n = 335, impaired glucose tolerance n = 42, Type II diabetes n = 76). CONCLUSION/INTERPRETATION: We have described a UCP2 gene exon 8 variant that may affect susceptibility to weight gain by influencing regulation of leptin.

Adult↗
PubMed1999

Familial aggregation of diabetic kidney disease in Type 2 diabetes in south India.

The study was done to assess whether there was a familial aggregation of diabetic kidney disease (DKD) in Type 2 diabetic subjects. The profile of associated complications was also studied. Two groups of diabetic siblings of Type 2 diabetic patients, matched for age, body mass index (BMI) and duration of diabetes mellitus were studied. The siblings also had Type 2 diabetes. Group A comprised of siblings of probands with diabetic nephropathy and retinopathy (n = 30, M:F = 20:10) and Group B were siblings of probands without diabetic nephropathy or microalbuminuria (MAU) (n = 30, M:F = 14:16). Anthropometry, measurement of blood pressure and tests for proteinuria, MAU and retinopathy and ECG and biothesiometry were carried out for all study subjects. Persistent proteinuria was present in 15 (50%) siblings in group A and none in group B. MAU was detected in 26.7% (n = 7) in Group A and 3.3% (n = 1) in Group B (P = 0.057). Thus a total of 22 out of 30 cases in Group A had albuminuria. In Group A, seven (23.3%) had proteinuria and hypertension. Hypertension was present in nine (30.0%) in group A, and in five (16.7%) in group B (NS). Occurrence of retinopathy was found to be significantly higher in group A than in group B (33.3 vs 6.7%, chi2 = 5.1, P = 0.023). Abnormal ECG changes were present in 10% and 6.7% in Group A and Group B, respectively. In Group A, one patient had peripheral vascular disease (PVD) while in Group B none had PVD. A comparison of sib pairs, matched for age, duration of diabetes and the level of metabolic control showed that there was strong familial clustering of diabetic kidney disease in south Indians with Type 2 diabetes. This was independent of the familial clustering of diabetes. Prevalence of other vascular complications were also higher in Group A.

Albuminuria↗
PubMed1999

Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population.

Recent studies from the Asian subcontinent show an increasing prevalence of diabetes. This increase has been attributed to factors related to lifestyle changes related to modernisation. A periurban rural population resembling the rural in their occupation, but with access to certain urban facilities was chosen for this study. The aim of the study was to assess the impact of modernisation on the rising prevalence of diabetes in the native Indians. A total of 1637 adults aged 20 years and above (749 men and 888 women) were tested for diabetes and impaired glucose tolerance (IGT) by 2 h post-glucose challenge. Demographic, anthropometric, dietary and occupational details, were recorded. Dietary habits were similar in all categories of socio-economic strata. In the present study group, the age standardised prevalence of Type 2 diabetes was 5.9%, which was intermediate to that in the urban (11.6%) and rural (2.4%) populations. The prevalence data of the latter two population were available from previous surveys. Prevalence of impaired glucose tolerance (IGT) was high (6.9%) and similar in all three population samples. In the periurban population, a large percentage of subjects were doing only routine household work and had a sedentary life-style. After correcting for the age and BMI, sedentary work and occupation had a significant association with diabetes, suggesting that sedentary lifestyle may be an important determinant for the higher prevalence of diabetes in an urbanising population.

Adult↗
PubMed1999

Insulin secretion and action in different stages of glucose tolerance in Asian Indians.

AIMS: To evaluate the sequence of changes in insulin secretion and action in different stages of glucose tolerance and the effect of obesity on insulin profile in South Indian adults. Blood samples from 260 consecutive cases with no known history of diabetes were collected. Plasma insulin levels were measured during a 75-g oral glucose tolerance test. Insulin resistance (IR) was calculated, using the homeostasis model assessment (HOMA). An index of insulin secretion was derived as the ratio of incremental insulin at 30 min divided by 30 minute plasma glucose (delta I/G). RESULTS: Normoglycaemia was present in 164, impaired glucose tolerance (IGT) in 60 and diabetes in 36 subjects. Fasting and 2 h insulin secretion showed bell shaped curves with increasing plasma glucose. The peak values corresponded to the cut-off values used for the diagnosis of clinical diabetes. IR was higher in obese than in nonobese, nondiabetic subjects but the effect of obesity on IR was not found in subjects with diabetes. IGT was associated with higher IR, but not with evidence of a beta-cell defect. CONCLUSIONS: Evaluation of insulin resistance and beta-cell function in different stages of glucose tolerance indicate that insulin resistance is manifested in the early stage of glucose intolerance in South Indians, i.e. IGT. A beta-cell defect was mostly found in people with diabetes. The beta-cell defect is more common in diabetes among the nonobese.

Adult↗
PubMed1999

Influence of life style factors in development of diabetes in Indians--scope for primary prevention.

OBJECTIVE: The objective of the study was to evaluate the influence of physical activity and stress factors on the development of diabetes mellitus (DM). METHODS: One hundred and eighty-seven adult subjects (M:F 112:75), registered in the primary prevention of diabetes programme for 2 or more years were studied prospectively. The study was done only in those who had either normal glucose tolerance (NGT) or diabetes at the time of review (tR). At entry (tE), 121 (64.7%) had normal glucose tolerance (NGT) and 66 (34.3%) had impaired glucose tolerance (IGT) by the WHO criteria. Dietary modifications and regular exercise programme were advised. Dietary modifications and regular exercise programme were advised. Study subjects were reviewed during August 1997 to October 1998. At review (TR) none had known history of diabetes. At TR, the status of glucose tolerance was assessed by oral GTT and influence of intervention measures and evaluation of the role of physical and psychological stress on glucose tolerance were assessed by a questionnaire method. RESULTS: At tR, 100 (53.5%) had NGT, and 87 (46.5%) had developed diabetes (DM). Adherence to exercise and other preventive measures was poor in the DM compared to nondiabetic group (NGT) (P < 0.0012). They showed lower dietary adherence (P = 0.042) and scores on mental stress was higher than in NGT group (P < 0.001). After controlling for age, gender and the initial 2 h plasma glucose, non-adherence to exercise and high scores of psychological stress showed strong association with diabetes. CONCLUSION: In this study, significant and independent roles of physical inactivity and psychological stress factors are demonstrated in the development of diabetes.

Adult↗
PubMed1999

Need for education on footcare in diabetic patients in India.

OBJECTIVES: The patient himself plays the crucial role in the prevention of diabetic foot disease and therefore education on foot care is important. In this study, we have evaluated the knowledge of the diabetic subjects regarding the foot problems and the care of feet in order to identify areas that require stress in the education programme. PATIENTS AND METHODS: Two hundred and fifty, consecutive cases of Type 2 diabetes (M:F, 176:74, age 57.2 +/- 9.7 yrs, duration 12.9 +/- 7.9 yrs) were selected for this study from the out-patient department of our hospital. A questionnaire was filled up for each patient by personal interview. The total score was 100 and a score of < 50 was considered as a low score for foot care knowledge. RESULTS: A score of < 50 was obtained in 67.2%. Low score was more common in women (78.5%) than in men (62.5%) (chi 2 = 5.26, P = 0.022). Low scores (< 50) were more common among those with lower level of formal education (chi 2 = 70.0, P < 0.0001), there were more women with low educational status. Significant foot problems like gangrene, foot ulcers were present in 27.2% and low scores were more common among those with these complications (82% vs 62%) (chi 2 = 8.3, P = 0.004). In general the scores on awareness of general foot care principles and basic facts about the foot complications were poor. Most of them (72%) had good knowledge about the right usage of foot wear. There was a trend to have lower scores with poor formal education (chi 2 = 51.1, P < 0.0001) and also with increasing age. There was no correlation between the scores and the number of hospital visits. Multiple linear regression analyses showed that 31.2% of the variations in the scores were explained by the level of education. CONCLUSIONS: This study underscores the importance of patient education on foot care principles, especially so, considering the magnitude of the problem of diabetes and the lower levels of literacy and poor socio economic status of many patients in this country.

Adult↗
PubMed1999

Prevalence of vascular complications and their risk factors in type 2 diabetes.

OBJECTIVE: a) To determine the prevalence of microvascular and macrovascular complications in Type 2 diabetes in India and b) to identify the major factors for the complications. METHODS: A study was done in 3010 subjects (M:F 1892:1118, Mean age 52 +/- 9.7 years) attending a diabetic clinic. The study sample resembled the population sample in anthropometry, age and socioeconomic factors. All patients had undergone the tests for retinopathy, nephropathy, neuropathy, peripheral vascular disease (PVD) and cardiovascular disease by ECG. RESULTS: Retinopathy was diagnosed in 23.7% (background retinopathy in 20.0% and proliferative in 3.7%), proteinuria was present in 19.7% and persistant proteinuria of > or = 500 mg/dl was seen in 5.5% of them, CHD was present in 11.4% and PVD was present in 4.0%. Of the total 119 cases with PVD, 18 had gangrene and 21 had undergone amputations. Peripheral neuropathy was present in 27.5%. Cerebrovascular accidents were reported in 26 cases (0.9%). Hypertension was present in 38% of the cases. Multiple logistic regression analyses showed that age had a significant association with retinopathy, neuropathy, CHD and PVD. Duration of diabetes had significant association with the complications other than CHD. Higher HbA1 increased the risk of retinopathy, neuropathy and nephropathy. Hypertension was associated with the complications except PVD and neuropathy. The strongest association was between hypertension and nephropathy. CONCLUSION: The study highlights the high prevalence of vascular complications in Type 2 diabetes in India. Retinopathy and neuropathy were the commonest complications of diabetes.

Diabetes Mellitus, Type 2↗
PubMed1999

Difference in body fat percentage does not explain the gender dimorphism in leptin in Asian Indians.

OBJECTIVE: Leptin is a hormone probably having regulatory function on energy intake and metabolic activities in humans. The study was done: (a) To determine the relation of leptin with the body fat% in Indians, (b) To see whether the differences in body fat accounted for the gender differences in the concentration of leptin and (c) to look for the effect of diabetes on the levels of leptin. METHODS: Glucose tolerance was determined by oral glucose tolerance test (GTT) in 87 subjects with no known history of diabetes. Leptin was estimated by radio immuno assay. Age, height, weight, waist and hip circumferences were noted. Body mass index (BMI, weight kg/height m2) and waist:hip ratio (WHR) were calculated. The body fat % was estimated by bioelectrical impedance analysis. RESULTS: Leptin correlated with log fat % and BMI, body weight and waist circumference in different categories of glucose tolerance (Pearson's correlation test). Leptin values were higher in women than in men even after correcting for the body fat % indicating that the gender dimorphism was not explained by the higher fat % in women. The geometric mean of leptin concentration in men was 3.6 ng/ml and in women 10.9 ng/ml (P < 0.0001). Leptin level were not influenced by the status of glucose tolerance. Gender showed a significant effect on leptin concentration (F = 11.0, df = 1.39, P = 0.002) after adjusting for the effect of covariates i.e. percentage of fat (log), BMI, age, WHR and 2 h plasma glucose by ANCOVA. None of the covariates except BMI (P < 0.0001) showed significant correlation with leptin. The total variance explained was 68.4%. CONCLUSION: We conclude that (1) Plasma leptin is strongly correlated to the body fat content (2) the gender dimorphism of leptin is not explained by the differences in fat percentage and (3) hyperglycemia does not influence plasma leptin levels.

Adipose Tissue↗
PubMed1999

Patients' adherence to diabetes treatment.

OBJECTIVES: a) To evaluate the patients' adherence to the treatment prescriptions and b) to analyse the reasons for non adherence. METHODS: A random sample of 386--type 2 diabetic subjects (M:F 223:163) were studied. Each subject was personally interviewed using a computerised proforma. The mean age of the study group was 52 +/- 10 years and 53% were treated with oral hypolycenic agent (OHA) and the rest with a combination of insulin and OHA. The mean duration of diabetes was 11.0 +/- 6.9 yrs. The overall adherence to the treatment regimen, diet and drug prescriptions and also regularity of home glucose monitoring by blood or urine tests were assessed. RESULTS: It was noted that only 25% of the study group were adhering to the treatment regularly. Dietary prescriptions were followed regularly only by thirty seven percent. Home glucose monitoring was being done only by twenty three percent. Non adherence was not related either to the age or duration of diabetes. Non adherence was more in the lower socio-economic group and was inversely related to the educational status. It was noted that approximately 20% of the subjects had an indifferent attitude to the advice given. CONCLUSIONS: The results showed that the rate of non adherence of treatment prescriptions was high. It stresses the need for constant motivation and one to one level education at frequent intervals to ensure better compliance to the treatment.

Adult↗
PubMed1998

Plasma leptin is not associated with insulin resistance and proinsulin in non-diabetic South Asian Indians.

In an earlier study, we observed only a weak association between plasma insulin (non-specific assay) and leptin in South Asian Indians. This was in contrast to the observations in many other ethnic groups. With the availability of measurements of specific insulin (SI) and proinsulin (PI) in the same study group, we have reanalysed the data to look for possible correlation of leptin with proinsulin and with insulin resistance calculated from the fasting values of specific insulin and glucose using the HOMA model. Subjects with normoglycaemia (n = 117) and impaired glucose tolerance (n = 27, WHO criteria) were included in the analysis. Leptin values were higher in women. Multiple linear regression analysis showed that the variations in leptin concentrations in men were associated with BMI, WHR, and 2 h SI values (R2 = 56.2%) while fasting SI and proinsulin concentrations had no significant association. In women BMI and age showed a significant association with serum leptin values (R2 = 40.1%). Univariate and multivariate analyses using insulin resistance as the dependent variable showed that it had no association with leptin in both genders. Leptin had no correlation with proinsulin also. This study confirmed that in Asian Indians the association between plasma leptin and insulin concentrations is weak and that leptin has no influence on insulin resistance. Proinsulin and leptin are also not correlated in this population. Insulin resistance shows correlation with the beta-cell function both in men and women.

Adult↗
PubMed1998

Specific insulin and proinsulin concentrations in nondiabetic South Indians.

The study was performed to determine plasma levels of proinsulin (PI) and specific insulin (SI) in normoglycemic (NGT) Asian Indians and to assess the effect of obesity and impaired glucose tolerance (IGT) on these concentrations. Blood samples from 151 adult nondiabetic South Indian subjects were collected during an epidemiological survey of diabetes. Plasma SI and PI levels were measured in fasting and 30-minute and 120-minute samples of a glucose tolerance test (World Health Organization criteria) using monospecific antibodies. The total insulin (TI) level was also measured by the nonspecific assay. The molar ratio of PI to SI (PI/SI) was calculated. Correlations of the peptides with anthropometry, serum lipids, and blood pressure (BP) were studied by univariate and multivariate analyses. Comparisons were also made in NGT versus IGT groups. As expected, TI values were higher than SI values, but the patterns of response were similar for both. SI and PI responses in NGT were similar to the values found in Mexican-Americans who had a higher body mass index (BMI). Asian Indians were thus found to have a high SI response despite a low BMI. Obesity and IGT produced an increased response of both PI and SI, with normal PI/SI ratios thus showing an absence of hyperproinsulinemia in either condition. Fasting PI showed a strong association with serum triglycerides, and proinsulin at 120 minutes was associated with cholesterol. None of the peptides showed a correlation with BP. Using specific assays for insulin and PI, it is shown that Asian Indians with NGT have a hyperinsulinemic response despite a low BMI. Obesity and mild hyperglycemia in IGT produce a simultaneous increase in PI and SI with no alteration in the PI/SI ratio.

Adult↗