Search PubMed⌕ Search

Biomedical subjects

A Ramachandran

Publications and source records attributed to A Ramachandran.

At least 109 records · Page 6Linked to original sources
PubMed1998

Cardio vascular morbidity in proteinuric south Indian NIDDM patients.

Proteinuria is a well known risk factor for cardiovascular morbidity. There has been no report on cardiovascular morbidity in Indian NIDDM patients with proteinuria. Hence this study has been undertaken to estimate the prevalence of cardiovascular diseases (CVD) in South Indian NIDDM with proteinuria. We studied two groups of NIDDM patients with diabetes for > or = 5 years: group PR with persistent proteinuria of > 500 mg/day (n = 297) and group NPR with normoalbuminuria (albuminuria < or = 30 micrograms/mg creatinine)(n = 296), who reported for review during the study period. They were matched for age, duration of diabetes and BMI. The prevalence of cardiovascular diseases, namely myocardial infarction, the presence of ischaemic heart disease and the history of coronary bypass surgery were compared in the two groups. The prevalence of hypertension was higher among the PR than the NPR patients (56.5 vs 24.7%, chi 2 = 61.3, P < 0.01). CVD were detected in 39.2% (n = 116) of the PR and 13.2% (n = 39) of the NPR groups. (chi 2 = 54.85, P < 0.001). The risk was thus three-fold higher in the PR group. Univariate analysis showed that in the proteinuric group, the prevalence of complications was higher in association with hypertension (45.8% vs 30.2%, chi 2 = 6.82, P = 0.009). Multiple logistic regression analysis showed that the factors associated with CVD were proteinuria (odds ratio 5.03), age (OR 1.08) and BMI (OR 1.07) while sex, age at onset of diabetes, duration of diabetes, hypertension, smoking, HbA1, serum creatinine, cholesterol and triglycerides did not show independent contribution. The study, highlights the high risk conferred by macroproteinuria in Indian NIDDM patients. This risk is found to be independent of the presence of associated hypertension.

Aged↗
PubMed1998

Effects of genetic predisposition on proinsulin responses in Asian Indians.

This study was done in adult offspring of two diabetic (NIDDM) parents (ODP) to look for changes in specific insulin (insulin) and proinsulin responses due to strong familial background and also in different states of glucose intolerance. Equal numbers (20 in each group) of ODP with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes (DM) were chosen. Twenty, age and BMI matched healthy controls, without family history of diabetes, were also studied for comparison. Plasma specific insulin and proinsulin were measured by radioimmunoassays in fasting and 120' plasma samples collected during the GTT. Proinsulin to insulin ratio were calculated. Insulin resistance (IR-HOMA) was calculated. In NGT, fasting proinsulin-insulin ratio was significantly higher than the control value (P = 0.023). Insulin values at 120' was higher than control values, though it did not reach statistical significance. Proinsulin at 120' was higher than controls (P = 0.016). In IGT, the fasting proinsulin to insulin ratio, the 120' proinsulin and insulin values were higher than controls (P = 0.048, 0.0013 and 0.0001, respectively). Fasting proinsulin-insulin ratio in IGT was similar to the value in NGT. In diabetic subjects proinsulin concentrations were significantly higher than controls at fasting (P = 0.0004), and 120' (P = 0.0007). The fasting values were higher compared to NGT also (P = 0.037). Proinsulin-insulin ratios were higher than the values in controls (P = 0.0008), IGT (P = 0.047) and NGT (P = 0.05). Diabetic subjects had higher fasting insulin values compared to the control values although between the groups no statistical significance was found (P = 0.22 by Kruscall Wallis test). At 120' both insulin and proinsulin values increased from NGT to IGT, but with development of diabetes a reduction was seen in the responses. Insulin resistance (IR-HOMA) increased steadily from NGT to diabetes. The difference between NGT and controls in IR was not statistically significant. This study of Asian Indian offspring of diabetic parents has shown that genetic predisposition to diabetes resulted in increased proinsulin to insulin ratio at the fasting state. Absolute hyperproinsulinaemia occurred only with development of diabetes.

Adult↗
PubMed1998

Foetal outcome in gestational diabetes in south Indians.

The study was performed to reassess the prevalence of gestational diabetes mellitus (GDM) in south Indians and to study the foetal outcome in women with GDM in comparison with normal pregnancies. In 1036 pregnant women, glucose tolerance was tested with 75-g oral glucose load, in the second or third trimester. Those with 2-h plasma glucose of > or = 200 mg/dl were considered as diabetic (WHO Criteria). Those with 2-h values of 140-199 underwent a 3-h glucose tolerance test (GTT) with 100-g glucose load (O'Sullivan and Mahan criteria). GDM was diagnosed in nine women (0.87%) by this criteria. Foetal outcome in 211 GDM referred to the diabetes centre was compared with the outcome in 853 normal pregnancies. There were no cases of aborted pregnancy among the GDM, while six cases were reported among the normal glucose tolerance (NGT). Still birth and the number of premature babies were higher in GDM. Babies with birth weight > or = 3.5 kg were more among the GDM (P < 0.001). There was no difference in the occurrence of congenital anomalies in the two groups. It was noted that congenital abnormalities in the foetus were more common among those born of mothers with higher plasma glucose (9 versus 1.1%). Multiple linear regression analyses in NGT and GDM showed that the birth weight of the baby was dependent on the plasma glucose and the body mass index of the mothers. The results of the present study show that the prevalence of GDM in urban south India was low, when the NDDG criteria was used. It also indicated that the WHO criteria may be more appropriate as the foetal outcome was determined by even a small rise in maternal plasma glucose. With good metabolic control in GDM, the foetal risks are very much reduced.

Adolescent↗
PubMed1998

Dietary profile of urban south Indians and its relations with glycaemic status.

This study was done to analyse the dietary profile of urban south Indian adults. It was also aimed to study, if the dietary profile influenced the glycaemic and anthropometric data. Dietary details were collected in a representative urban sample of 900 study subjects in the epidemiological survey for diabetes conducted in 1995 in the city of Madras. The details were collected by a 24-h recall method. All the dietary factors were similar in the non-diabetic (NGT) and newly diagnosed diabetic cases, but the values were lower in known diabetic cases due to dietary modifications (P < 0.001 for all compared to NGT and new diabetic cases). For further analysis, known diabetic cases were deleted and the rest were combined as one group. Men consumed higher calories (2066+/-437, range 1028-3662 kcal) than women (1745+/-343, range 870-3260 kcal) (P < 0.01). Older persons consumed lower calories and percentages of the proximate principles in diet were proportionately lower. Higher calorie consumption was due to consumption of higher quantities of food and not any specific dietary factor. BMI, WHR, plasma glucose, serum cholesterol and triglycerides were not significantly influenced by the total calorie consumption. Calorie consumption was higher in persons engaged in strenuous physical activity. Total calories and proportionately the proximate principles of diet were less in the high income group. The similarity in diet in the non-diabetic and the newly diagnosed diabetic persons showed that the development of diabetes was probably not related to changes in dietary habits. Lower consumption of calories and carbohydrates by the known cases of diabetes was due to the dietary modifications introduced in the management of the disease. Lower calorie consumption in women and older people could be related to lower physical activity. This study shows a uniform dietary pattern among the different strata of society with minor variations based on age, gender and physical activity. No difference has been noted in dietary habits of the newly diagnosed diabetic subjects and the non-diabetic adults.

Adult↗
PubMed1998

Study of genetic prediabetic south Indian subjects. Importance of hyperinsulinemia and beta-cell dysfunction.

OBJECTIVE: To study 1) whether abdominal adiposity was present in adult offspring of two NIDDM parents, 2) whether abdominal adiposity was associated with the development of glucose intolerance, and 3) the association of pancreatic beta-cell function with impaired glucose tolerance (IGT) and NIDDM in these groups. RESEARCH DESIGN AND METHODS: One hundred offspring whose parents both had NIDDM were studied (60 men, 40 women, mean age 34 +/- 6.9 years, BMI 27.4 +/- 4.1 kg/m2). None had a history of glucose intolerance. Nondiabetic control subjects with no family history of diabetes were also studied for comparison (21 men, 19 women, age 36 +/- 10.3 years, BMI 26 +/- 3.7 kg/m2). A standard oral glucose tolerance test was done for all, and plasma glucose, C-peptide, and insulin responses were measured. Abdominal fat measurements at L4-L5 were made using a computed axial tomography scan. Subcutaneous fat (SF), visceral fat (VF), and total fat (TF) areas were measured and VF/SF ratio was calculated. An index of insulin secretion (delta I/G) was derived as the ratio of incremental insulin at 30 min divided by 30-min plasma glucose. RESULTS: IGT was detected in 32 offspring and diabetes in 21 offspring. Diabetic men had a higher TF area than the other groups. SF, VF, and VF/SF ratios were similar in control men and in offspring with normal glucose tolerance (NGT), IGT, or diabetes. Among control subjects, women had significantly lower VF than men. Female offspring had higher VF than the control subjects, but intragroup variations were absent. Fasting insulin and all C-peptide responses were higher in NGT compared with control subjects (P < 0.02). The 2-h insulin and C-peptide responses were higher in IGT subjects (P < 0.005). In diabetic subjects, the insulin-to-glucose ratio, C-peptide-to-glucose ratio, and delta I/G were significantly low compared with all other groups (P < 0.005). Multiple logistic regression analysis showed that the area of insulin response had a positive association and delta I/G had a negative association with diabetes, while age, sex, BMI, waist-to-hip ratio, abdominal fat areas, fasting and 2-h insulin, area of insulin, and the C-peptide measurements did not show independent associations. Two-hour insulin showed a positive association with IGT, while increasing area of insulin showed a negative association. CONCLUSIONS: Visceral adiposity seemed to precede glucose intolerance only in women, but it had no independent association with IGT or NIDDM. Insulin resistance, indicated by higher plasma insulin response, and insulin secretory defect, indicated by low delta I/G at 30 min, were associated with diabetes. beta-cell defect was not independently associated with IGT. Increased abdominal visceral adiposity does not appear to be a prerequisite for development of IGT or diabetes in Asian Indians with a strong genetic predisposition for diabetes.

Abdomen↗
PubMed1998

Clustering of cardiovascular risk factors in urban Asian Indians.

OBJECTIVE: To study the prevalence of cardiovascular risk factors in native urban Asian Indians and to look for the occurrence of clustering of these factors. RESEARCH DESIGN AND METHODS: The study included 953 subjects (532 men and 421 women), aged > or = 40 years, selected from a population survey for diabetes, which was conducted in 1994 in Madras, Tamil Nadu, India. Measurements of anthropometry, blood pressure, plasma lipid profile, glucose tolerance, plasma insulin response, and electrocardiogram were made. Based on the normal ranges derived from the population study, abnormalities in anthropometric values, plasma lipids, and insulin values were determined. Age-adjusted prevalences of the abnormalities were calculated using data from a 1991 urban census in Madras. The expected prevalences of the abnormalities in isolation and in combinations were calculated and compared with the corresponding observed figures. RESULTS: The prevalences of risk factors were in the order of central adiposity > dyslipidemia > hyperinsulinemia (2-h) > glucose intolerance > obesity > hypertension. The age-adjusted prevalence of coronary heart disease (CHD) was 3.9% (3.5% in men and 4.5% in women, NS), and T wave inversion was seen in an additional 10.3%. Isolated prevalences of all factors, except hypertension, were in lower frequency than expected. Combinations of each risk factor with one or two more risk factors occurred more frequently (1.3-4 times) than expected by chance. Impaired glucose tolerance and dyslipidemia showed association with hyperinsulinemia, whereas hypertension did not show such an association. CONCLUSIONS: Clustering of the cardiovascular risk factors or the components of insulin resistance syndrome occurs in the native Asian Indian population. This finding under-scores the need for preventive aspects of metabolic disorders and CHD.

Adult↗
PubMed1997

Involvement of host factors in transcription from baculovirus very late promoters -- a review.

The baculovirus expression vector system has emerged as the system of choice for the expression of a number of heterologous genes of both prokaryotic and eukaryotic origin. This system utilizes the baculovirus very late, hyperactive polyhedrin and p10 promoters to drive the transcription of foreign genes. Regulation of transcription from these promoters is presently not well understood even though a number of viral gene products that may be important for transcription have been identified. Fresh insight into host-virus interactions during baculovirus pathogenesis is now offered by the identification of insect host factors that interact with transcriptionally essential motifs of these promoters as well as cis-acting enhancer-like elements upstream from the promoter.

Base Sequence↗
PubMed1997

Does the presence of diabetic nephropathy in parents influence the metabolic response in the offspring?

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) and long-term complications such as nephropathy have a strong genetic predisposition. Insulin resistance is thought to be a pathogenetic factor, predisposing genetically prone individuals to develop the microvascular complications of diabetes. To test these hypotheses, two groups of young individuals were studied: 28 offspring of parents having NIDDM and diabetic nephropathy (group 1) aged 29.5 +/- 6.1 years, BMI 25.2 +/- 4.7 kg m(-2) and 31 offspring of diabetic parents with no history of nephropathy, aged 31.6 +/- 4.1 years and BMI 26.3 +/- 4.9 kg m(-2) (group 2). All underwent a standard oral glucose tolerance test with measurement of serum insulin levels and serum lipid profile. Urine albumin:creatinine ratio (A/C ratio) and blood pressure were also recorded. Diabetes was detected in 2/28 (7.1%) and 3/31 (9.7%) and IGT was detected in 5/28 (25%) and 8/31 (25%) of groups 1 and 2, respectively. These differences were not statistically significant, but were higher than in a group of non-diabetic controls with healthy parents. Comparison of the normoglycaemic subjects (19 and 20 in group 1 and 2, respectively) showed no significant differences between blood pressure readings, fasting and 2 h plasma glucose, and lipid profiles. Plasma insulin values, fasting and 2 h, and the area under the graph were also similar in both groups, indicating an absence of higher insulin response in group 1 in comparison with group 2. These values were also not different from those in the non-diabetic controls. A delay in insulin response to glucose was noted in many of the offspring as indicated by a low deltaI/deltaG at 30'. We conclude that offspring of diabetic parents with nephropathy do not show higher risk of glucose intolerance or insulin resistance compared to those with diabetic parents without nephropathy. The relatively high plasma glucose values in the presence of normal insulin secretion in both groups of offspring of diabetic parents suggest the presence of insulin resistance.

Adult↗
PubMed1997

Plasma leptin in non-diabetic Asian Indians: association with abdominal adiposity.

Plasma leptin concentrations were measured in 144 non-diabetic men and women (age 21-73 years, BMI 14.8-37.7 kg m(-2)), in fasting samples collected during a population survey for diabetes mellitus. Leptin, fasting and 2-h post-glucose load plasma concentrations of glucose and immunoreactive insulin were measured. In a subset of 50 normoglycaemic individuals, subcutaneous fat (SF) and visceral fat (VF) areas at L4-L5 level were also measured by CT. As in other populations, women had significantly higher plasma leptin concentrations than men (p < 0.001) but the values were similar in normal (NGT) and impaired glucose tolerance (IGT). Geometric mean concentrations of leptin in men and women with NGT were 4.8 and 17.7 ng ml(-1), respectively, and the corresponding values in IGT were 6.2 and 19.0 ng ml(-1). Multiple regression analysis in the total group showed that the leptin concentration (log-transformed) was strongly dependent on sex (R2 = 53.4%), BMI (R2 = 17.4%), and to a lesser degree on the 2-h plasma insulin (R2 = 2.4%) and the WHR (R2 = 0.8%). In men, the total abdominal fat showed a strong association with leptin (R2 = 49.3%) and in women the subcutaneous fat area showed a similar effect (R2 = 39.5%). It is likely that subcutaneous and not visceral fat may be a determinant of plasma leptin in Asian Indians, and the correlation between leptin and insulin resistance may be less strong than in other ethnic groups.

Abdomen↗
PubMed1997

Rising prevalence of NIDDM in an urban population in India.

A survey conducted in 1988-1989, in the city of Madras, South India, showed that the prevalence of diabetes mellitus in adults was 8.2% and prevalence of impaired glucose tolerance (IGT) was 8.7%. The present survey was another cross-sectional study conducted 5 years later in the same urban area to study the temporal changes in the prevalence of diabetes and IGT. The two sample populations surveyed were similar in age structure and socioeconomic factors. In the second survey in 1994-1995, a total of 2,183 subjects, 1,081 men and 1,102 women, with a mean age of 40 +/- 12 years were tested by an oral glucose tolerance test; fasting and 2-h post-glucose plasma glucose were measured. Anthropometric measurements, details of physical activity and clinical history of diabetes were recorded. Age-standardised prevalence of diabetes had increased to 11.6% from 8.2% in 1989 and IGT was 9.1%, similar to 8.7% in 1989. Multiple regression analysis showed age, waist:hip ratio, body mass index (BMI) and female sex were correlated to diabetes. Family history of diabetes showed interaction with age and BMI. Prevalence of IGT correlated to age, BMI and waist:hip ratio. This study highlights the rising trend in the prevalence of non-insulin-dependent diabetes (NIDDM) in urban Indians. The persistent high prevalence of IGT may also be a predictor of a further increase in NIDDM in the future. No significant differences in the anthropometric data were noted in this compared to the previous study.

Adult↗
PubMed1997

Allelic variation in the vitamin D receptor influences susceptibility to IDDM in Indian Asians.

Vitamin D has important immunomodulatory properties and prevents development of diabetes mellitus in an animal model of insulin-dependent diabetes (IDDM). We have studied the vitamin D receptor locus as a candidate for genetic susceptibility to IDDM in Southern Indian families. We found evidence for an association of one particular vitamin D receptor allele with IDDM susceptibility in this community. Ninety-three South Indian families consisting of available parents and an affected offspring were genotyped for three vitamin D receptor polymorphisms using the restriction enzymes TaqI, ApaI and BsmI as well as an adjacent microsatellite located to 12q14 (D12S85). Transmission disequilibrium testing analysis was used to assess preferential transmission of polymorphic markers and haplotypes with IDDM. There was significant excess transmission of vitamin D receptor alleles containing the BsmI restriction site to affected offspring in these families (p = 0.016). No association was found between D12S85 and IDDM. This study suggests that a polymorphism within or close to the vitamin D receptor gene may modify susceptibility to IDDM in this ethnic group.

Adolescent↗
PubMed1997

Computed axial tomographic scan measurement of abdominal fat distribution and its correlation with anthropometry and insulin secretion in healthy Asian Indians.

Asian Indians have high insulin resistance, hyperinsulinemia, a high prevalence of diabetes, and a high waist to hip ratio (WHR), although the rate of obesity is low. WHR and visceral fat (VF) are highly correlated, and both are associated with insulin resistance. This study was performed to determine the normal ranges of abdominal fat distribution (subcutaneous [SF] and VF) in nondiabetic South Indians and also to study its correlations with WHR, plasma insulin, and metabolic profiles. Fat areas were measured by computed axial tomographic scan at the L4 to L5 level. Mean areas of SF and VF in men and women in this study were similar to the values in white populations. Women had significantly less VF than men. Gender differences were observed in the contribution of fat areas to anthropometric, hormonal, and metabolic variables. In general, in men, total fat (TF) area showed significant independent correlation with body mass index (BMI), WHR, and total cholesterol, and VF correlated with insulin secretion. In women, TF and BMI were correlated and SF showed a correlation with total cholesterol. Insulin secretion in women did not show a correlation with fat areas.

Abdomen↗
PubMed1997

Risk of noninsulin dependent diabetes mellitus conferred by obesity and central adiposity in different ethnic groups: a comparative analysis between Asian Indians, Mexican Americans and Whites.

Epidemiological data from Asian Indians from Madras (AI) and Mexican Americans (MA) and non-Hispanic Whites (NHW) from San Antonio heart study were compared to determine the possible contributions by the anthropometric measurements to the varied prevalence of noninsulin dependent diabetes mellitus (NIDDM) in these ethnic groups. MA had the highest rate of obesity (mean body mass index (BMI) 28.9 +/- 5.9 kg/m2) and the highest prevalence of diabetes (men 19.6%; women 11.8%, P < 0.001 vs other groups). NHW although had high rates of obesity (mean BMI 26.2 +/- 5.2 kg/m2) had low prevalence of diabetes (men 4.4%; women 5.7%) than the AI (men 9.9%; women 5.7%) (Mean BMI 22.3 +/- 4.4 kg/m2, P < 0.001). Although AI had lower BMI than MA, the risk conferred by BMI was similarly high in AI and MA and both the ethnic groups had higher risks than NHW. Impaired glucose tolerance (IGT) was also more prevalent in MA than in AI (men, MA vs AI, 11.8 vs 7.5%, P < 0.003; women 16.1 vs 5.5%, P < 0.001). NHW had lower prevalence of IGT in men (5.7%) and women (6.3%) which were significantly lower (P < 0.001) compared to MA only. Age and BMI were predictive factors of NIDDM in all, while waist to hip ratio (WHR) was significant only in AI and MA, although NHW had high WHR. This may be an indicator of differences in genetic susceptibility. This study also highlights the similarity in risk factors between AI and MA living in urban environment and the significance of distribution of adiposity in the comparatively lean AI.

Adult↗
PubMed1997

Reduction in body weight helps to delay the onset of diabetes even in non-obese with strong family history of the disease.

Of the 1200 non-diabetic offspring of non-insulin-dependent diabetic patients registered under the prevention programme, 262 (M:F 189:73) were available for analysis with greater than or equal to 4 years of follow-up. All of them had been prescribed a calorie restricted diet to suit their body weight, occupation and age, and were advised to restrict the use of refined carbohydrates and fats. Regular exercise was also advised. Compliance with these prescriptions was assessed at each follow up. At the time of analysis, it was noted that only 14.5% had developed diabetes in a period of 8 +/- 4.2 years even though many of them had impaired glucose tolerance at entry in the programme. Multiple regression analysis showed that initial 2 h plasma glucose, initial glucose tolerance and gain in body weight were strong predictors of diabetes. Weight loss occurred in persons who adhered to diet and exercise programmes and conversion to diabetes was lower in them compared to those who gained weight (P < 0.002). Although the rate and degree of obesity is less among Indians, it has been observed in several earlier studies that even a minor increase in body mass index increased the risk of diabetes. This study highlights the fact that measures to control weight helps to delay the onset of diabetes even in the non-obese despite a strong family history of the disorder.

Adult↗
PubMed1996

Familial aggregation of type 2 (non-insulin-dependent) diabetes mellitus in south India; absence of excess maternal transmission.

The family histories of 976 South Indian Type 2 diabetic patients were recorded in a questionnaire-based survey to establish whether the excess maternal transmission of Type 2 diabetes reported in low prevalence Europid populations was also evident in this medium prevalence population. In 450 families (46.1%), no parental history of diabetes was reported. In 423 families with one parent diabetic, 222 fathers (52.5%) and 201 (47.5%) mothers were diabetic. In the remaining 103 (10.6%) families, both parents were diabetic. In contrast to previous studies, we found no evidence for substantial maternal excess in the transmission of diabetes (325 diabetic fathers vs 304 mothers; p = 0.4; p = 0.07 when compared using life table methods). The age of diagnosis of diabetes in probands was lower than that of their diabetic parents (p < 0.001): furthermore increasing parental history of diabetes was associated with an earlier diagnosis of diabetes in probands (p < 0.001). These results emphasize the extensive familial aggregation of Type 2 diabetes in this population but fail to replicate the evidence for excess maternal transmission evident in lower prevalence Europid populations, suggesting ethnic differences in the extent of this phenomenon.

Adult↗
PubMed1996

Evaluation of the importance of maternal history of diabetes and of mitochondrial variation in the development of NIDDM.

In 79 South Indian nuclear pedigrees ascertained via probands with NIDDM and both parents living, parental diabetic status was established through previously diagnosed NIDDM (n = 97) or oral glucose tolerance testing (n = 61). There was no significant difference between diabetes prevalence in mothers and fathers (60 vs 53 (76% vs 67%), respectively, p = 0.22). 'Age at diabetes diagnosis' survival curves did differ according to parental gender (p = 0.02) but this may reflect gender differences in health provision rather than pathophysiology. No maternal excess effects of the magnitude evident in previous studies were detected, suggesting either ethnic differences or overestimation of the maternal effect when reported histories of parental diabetes have been used. The tRNA(Leu(UUR) gene region was studied for diabetes-associated variation given the role of mutations in this gene in some pedigrees displaying maternal transmission of NIDDM. None of 142 unrelated South Indian NIDDM subjects displayed the MELAS mutation at nt3243. However, sequencing identified two variants of potential importance: (a) at nt3290 in the tRNA(Leu(UUR) gene, seen in 7/142 diabetic and 1/85 control subjects (p = 0.11), (b) at nt3316 in the ND1 gene (4/142 vs 1/85 subjects, respectively (p = 0.51)). Further studies are needed to determine the relevance of these variants to the development of NIDDM.

Adult↗