RSSDI 2008

 Research Presentations

 November 21, 2008

 Hall C
 11.00-11.30 am

Point of care testing for blood glucose: utility and reliability of blood glucose meters in out- patient (diabetes clinics and community health camps) and in- patient (nursing homes and hospitals) settings in semi urban and rural India. Ramachandra Reddy, Srinivasa Diabetes Centre, Mandya
Introduction. Portable hand held electronic meters for point of care and self home blood glucose monitoring have been basic tools in diabetes care in developed and developing countries over the last 4 decades. Despite continued improvements in technology and reliability, practical problems (cost, training, quality control, reproducibility, and ultimate clinical reliability) remain, in the utility and penetrance of this essential technology in the semi-urban and rural population of developing countries like India. Also, there is a widely prevalent belief among patients, especially the less literate, and general practitioners, that the blood glucose results  “provided by the meter” are inferior to the “laboratory reported” values, thereby inhibiting the use of meters in self home and spot clinical blood glucose testing.
Aims. To evaluate the real life reliability, convenience and clinical utility of blood glucose meters in an out patient diabetes clinic setting, in comparison with simultaneously determined laboratory venous plasma glucose values.
Methods. 400 T2DM subjects were studied in a Diabetes Clinic (serving urban, semi urban, and rural population)    Fasting and postprandial venous blood samples (400 + 400) were obtained, and glucose analyses were done in parallel by: (a) blood glucose meters (Contour - CON, and Ascentia - ASC) in the clinic, and (b) chemistry analyzers in the laboratory (GOD/POD method). Comparative analysis of the 2 strategies of glucose measurement was done, with laboratory venous plasma values as reference. 

*Variability range: laboratory venous plasma glucose as reference
**%: percent of samples tested

Results. In FBG analyses > 15% variation was 8% and 7.5% for CON and ASC meters respectively.    In PPBG analyses > 15% variation was 17.5% and 18% for CON and ASC meters respectively.  Variations were greater in samples with laboratory plasma glucose values > 400 mg/dl. 

Conclusions

1.  Portable hand held electronic meters for point of care (Diabetes Clinic) blood glucose monitoring and immediate management planning are very useful tools in diabetes care in developing countries, especially in the semi-urban and rural populations. 

2.  This strategy is reliable, practical, cost effective (savings on time, travel and other expenses) in socially relevant diabetes care. 

3.  The prevalent belief among patients and general practitioners, that the blood glucose results “provided by the meter” are inferior to the “laboratory reported” values, is incorrect.

4.  In reference to laboratory determinations, blood glucose values generated by the meter in relatively more variable for PPBG (15 to 20%), especially higher values, than FBG. Thus, diagnosis of IFG and IGT will not be significantly affected by the meter approach, thus emphasizing their reliability in screening community health camps etc.

5.  Of course, very meticulous methodology (at every minute step) in blood glucose testing my meter is crucial.

Prevention of progression of diabetic nephropathy.  Lakshminarayan V, Venkat Rao S. Sreehari Diabetes Foundation, Mysore.
Diabetic nephropathy is one of the fatal long term complication of T2 DM. The single most important step to interfere with its emergence and progression is to monitor the patients regularly for the presence of albuminuria and to focus on intensified treatment.
The earliest clinical evidence of nephropathy is the appearance of low but abnormal levels of albumin in urine referred to as microalbuminuria (MAU). Valsartan, a highly selective ARB, has been shown effective in reducing BP and albuminuria. The effect of this ARB in reducing BP and urinary albumin excretion rate (UAER) and its safety has been investigated in Indian patients of T2 DM with or without HTN.
Forty microalbuminuric T2 DM subjects (29 M, 11F) aged 39-69 years, visiting as outpatients of Shreehari Diabetes Foundation, participated in the study. At baseline 23 patients had HTN and 17 were without HTN. Baseline data were obtained on hematology, biochemistry, HbA1c, lipid profile, UAER,BP and ECG. Valsartan 80 mg/day was started with upward titration to 160 mg/day after 4 weeks, with further addition of diuretic HCTZ 12.5 mg/day at end of 8 weeks.
The percentage reduction in UAER was more after 8 weeks (30-39%), compared to 16 weeks (25-26%), indicating that treatment with valsartan shows an effect an MAU, as early as 8 weeks, in both normo and hypertensive diabetics. The proportion of patients returning to normoalbuminuria status after 8 weeks of valsartan treatment was 13-15% and 9% after 16 weeks. The lesser reduction in UAER after 16 weeks may probably be due to progression of disease state in some patients. The percentage of normotensive patients significantly increased from 38-44% to 50-69% after 8 weeks and 78% after 16 weeks, signifying that valsartan has good efficacy in treating HTN in T2 DM. No adverse events were reported in any patient treated with valsartan for 16 weeks. Laboratory investigations such as hematology, blood chemistry and lipid profile were within normal limits in patients treated with valsartan for 16 weeks, signifying that no adverse changes were observed with the drug.

Pharmacovigilance: The Importance of Reporting an Adverse Drug Reaction.  Akku Shyam Prasad  Dept. of Pharmacology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda.
Aim. The presentation aims at bringing about awareness amongst clinicians about the National Pharmacovigilance Programme and highlights the importance of reporting an adverse drug reaction.
Abstract. India being the global hub for clinical research is being targeted by a large number of multinational drug companies for conducting clinical trials for new drugs. The need hence arises to monitor these drugs so as to ensure a safer health care system. Once put onto the market, a medicine leaves the secure and protected scientific environment of clinical trials and is legally set free for consumption by the general population. It is essential that new and medically still evolving treatments are monitored for their effectiveness and safety under real-life conditions post release. Information about rare but serious adverse drug reactions, chronic toxicity, use in special groups (eg. pregnant women, children, elderly) and drug interactions is often incomplete or not available. Certain adverse drug reactions may not be detected until a very large number of people have received the medicine. National Pharmacovigilance Programme initiated by Central Drugs Standard Control Organization (CDSCO) is one of the important post-marketing tools to ensure the safety of pharmaceutical and related health products.
Pharmacovigilance is defined as the detection, assessment and prevention of adverse drug reactions in humans.
The purpose of the programme is to collect data, analyze it and use the inferences to recommend informed regulatory interventions, besides communicating risks to healthcare professionals and the public. The data so collected will generate broad based ADR data on the Indian population and share the information with global health-care community through WHO-Uppsala Monitoring Centre, Sweden. The clinicians of today bare more responsibility towards the society than ever before and play a key role in ensuring a safer health care system by reporting an adverse drug reaction to the National Pharmacovigilance Programme centre. The clinician is expected not only to report an adverse drug reaction but also any suspected drug reaction or interaction.
It throws light on various issues such as: What to report? Who can report? Where to report? What happens to the information submitted? An Adverse Drug Reaction Form has been set up so at to make data analysis simpler.
The importance of reporting an ADR- Example: Cerivastatin which was first approved as a lipid-regulating agent in 1997. By 2000 a total of 549 cases of rhabdomyolysis associated with cerivastatin use had been reported to the WHO Collaborating Centre for International Drug Monitoring, Uppsala, Sweden. In November 1999 in the United States, and in March 2000 in Canada, prescribing information was changed to include a contraindication for the combined use of cerivastatin andgemfibrozil, another lipid-regulating medicine. On 8 August 2001, the manufacturer voluntarily withdrew cerivastatin from the market on the grounds of an increased risk of rhabdomyolysis, particularly when used in combination with gemfibrozil.
The terminology pertaining to side effects, adverse drug reactions, adverse drug events, signal need some explanation and the programme expands these so as to have a clear picture.

11.30-12.30 am
 

IDMPS Study
Management of Hyperglycemia in Type 2 Diabetes Patients in India: Results from IDMPS Year 1. Ramachandran A, Snehalatha C. India Diabetes Research Foundation, Dr A Ramachandran’s Diabetes Hospitals, Egmore, Chennai, India.

Objective. International Diabetes Management Practices Study (IDMPS), a 5-year, multinational observational study, assesses the current therapeutic management of diabetes in different parts of the world and evaluates the compliance with international guidelines to improve the quality of care for patients.

Methods. One-year data were collected from Indian type 2 diabetes mellitus (T2DM) patients (>18 years) during a 2-week cross-sectional period.

Results. The first cross-sectional period of the study assessed 1639 T2DM patients (56.5% males; mean age of 54.1±11.8 years). Their mean BMI was 26.7±4.6 kg/m2 (n=1606) and mean diabetes duration was 8.0±6.5 years. At least one diabetes late complication was seen in 47.8% patients, of which 89.5% had microvascular complications and 42.1% had macrovascular complications. Only 1.3% patients were treated with diet+exercise, 5.9% with insulin alone (basal, basal+prandial, prandial, premix and others), 23.7% with insulin+oral antidiabetic drugs (OAD), and 69.1% with OAD alone (glinidines, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, sulphonylureas, and biguanides+sulphonylureas). The median frequency of laboratory monitoring for HbA1c was 2.0 in past 2 years (n=809), that for FBG was 6 per year (n=1619), and that of self-monitoring for FBG+PPG was 2.0 per week (n=310). Median HbA1c was 7 and only 256 (32.1%) patients reached the target value of HbA1c<7%. Also, median FBG was 121 mg/dL and only 353 (23.3%) patients reached the optimal FBG=100 mg/dL.

Conclusion. Target value of HbA1c was seen in 32.1% T2DM patients. This was in agreement with the results in other countries. Efforts must be taken to improve the outcome by better monitoring and treatment adherence.

Glycemic Control in Insulinized Type 2 Diabetes Patients in India: Results from IDMPS Year 1. Ramachandran A, Snehalatha C. India Diabetes Research Foundation, Dr A Ramachandran’s Diabetes Hospitals, Egmore, Chennai, India.

Objectives. International Diabetes Management Practices Study (IDMPS), a 5-year observational study, assesses the current therapeutic management of diabetes worldwide and evaluates compliance with international guidelines.

Methods. One-year data were collected from Indian type 2 diabetes mellitus (T2DM) patients.

Results. Of 1639 T2DM patients, 485 (29.6%) were insulinized, with 5.9% on insulin alone and 23.7 % on insulin+oral antidiabetic drugs (OAD). In insulinized patients (55.3% men), mean age was 55.0±12.4 years, mean BMI 26.4±4.6 kg/m2, mean disease duration 11.2±7.1 years and mean duration of insulin treatment 3.5±4.2 years. The most common insulin regimens were premix+OAD, premix alone, and basal+OAD. The mean insulin dose (IU/day) was 17.8±10.1, 32.3±15.5, 39.4±10.4 and 46.1±18.4 for patients receiving 1, 2, 3 and >4 doses, respectively. HbA1c was tested in 60.6% (median frequency: 2 in previous 2 years, mean HbA1c: 8.0±1.5% [n=287]) and 68 (14.3%) patients reached HbA1c<7%. Median frequency of laboratory testing of FBG was (median) per year, mean FBG was 147.5±62.9 mg/dL (n=435), and 98 (22.5%) patients reached FBG<100 mg/dL. Overall, 235 (48.7%) patients reached the glycemic target. BG was self-monitored by 151 (31.1%), while 110 (22.7%) patients self-adjusted insulin. Patients who self-monitored BG had better glycemic control than those without self-monitoring (HbA1c<7%: 29.4% vs 19.6%, c2 =2.27,p=0.023 FBG<100 mg/dL: 25.7% vs 21.1%, (NS)). Patients who did/did not reach glycemic target differed significantly in terms of owning a glucometer and self-monitoring of BG.

Conclusions. Nearly 50% of insulinized Indian T2DM patients have good glycaemic control. Self monitoring is rare and their daily insulin dose was low. Self-monitoring of BG was associated with better glycemic control.

1.30-2.30 PM

A comparative study of association of Psycho-Social Stress in Diabetics Vs Non-diabetics.  Vinod MR, Narahari MG, Basavana Gowdappa H, Prabhakar AK.  JSS Medical College, Mysore.

Background. The association of psycho-social stress in diabetic patients has been widely documented in the literature. However, there is little published data from the Indian subcontinent on the association of psycho-social stress in diabetes.

Aims & Objectives. The present study aims at studying the association of psychosocial stress in diabetes using a validated questionnaire developed by the Indian Council of Medical Research (ICMR).

Methods. The study included 100 diagnosed cases of diabetes and an equal umber of controls matched on age and sex attending the out patient department of JSS Medical College Hospital, Mysore. The administered questionnaire encompassed various components viz; interpersonal relationship, liability, financial constraints, marital issues and health related problems. Also, it included a separate questionnaire related to stressful life events. The four digit scale was utilized for measuring the stress level for each of the component included in the study. The cut off points for level of stress was derived and tested for its reliability and validity. The cut off levels recommended by ICMR was adopted for classification of stress level. The factor analysis was carried out to derive major factors related with stressful events. A total of six factors were derived. The relative risks of stress was estimated for both the sexes and also mean standard deviation for each of the factors were estimated for cases and controls and compared.

Results. A total of 28 subjects had stress with 26 in the diabetic cases and only 2 in the controls providing an overall relative risk of 17.21 with confidence band of 3.96-74.84. The results indicated that diabetic females had a higher stress levels (41.3%) as against males (13%). In females the relative risk was very high 15.48 (confidence band 3.39-71.76). The analysis of stress related to life events indicated that the total relative risk in diabetics was 9.71 (CI =4.41-21.38), for females it was 20.36 (5.49-75.43) and males 5.5 (CI=2.01-15.06) respectively. The detailed results of factor analysis will be presented in the poster.

Conclusion. This pilot study has shown a greater association of psycho-social stress in diabetics and the stress levels are comparatively higher in females.

Determinants of the quality of life among diabetic subjects in Kerala, India. Ron Thomas Varghese, Rekha Salini, Pradeep Abraham, Reeshma KK and Vijayakumar K.  Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala.
The number of Indian diabetic subjects is projected to be 57 million in 2025. Due to the large number of people involved and its associated complications, the disease warrants urgent attention. Studies have proved that the prevalence of diabetes is high in the state of Kerala. Of the few studies are carried out in India considering the magnitude of the disease here most pertains to the quantitative estimates of the disease. The virtual absence of literature on quality of life of Indians with diabetes has prompted us to assess quality of life and its determinants in our subjects.
Objectives. To estimate the level of quality of life (QOL) and its determinants among subjects having diabetes in Thiruvananthapuram, Kerala, India.
Research Designs and Methods. We conducted a cross sectional study on 200 subjects who attended the Diabetes clinic, Medical College & Institute for Diabetes, Thiruvananthapuram. Univariate & Multivariate analysis of data collected by interview method using a questionnaire (DQOL-DCCT) were done using odds ratio & chi square test for significance. Those who achieved score above 60% were presumed to have good QOL. Multiple Logistic Regression analysis was done following a forward step wise method of elimination.
Results. 62% subjects had good QOL. Following factors were found to be significantly associated with QOL by Univariate analysis: Satisfaction in social relationships & friendships, time for management of diabetes, feeling of physical illness, worry of diabetic complications, satisfaction with treatment, male gender, occupation involving moderate physical work, better education, mixed diet, diet & exercise as treatment modality, physical activity, family history of diabetes, regular consultation, having diabetic friends, better sex life, no urgency of micturition due to diabetes, less frequently complaining about diabetic condition.
Conclusion. Multivariate analysis established that satisfaction in social relationships & friendships, time set apart for management of diabetes, feeling of physical illness, worry of diabetic complications, contribute to major variation in QOL and accounted for 46.5% variation of QOL in men, these factors coupled with treatment satisfaction accounted for 65.4% variation in QOL in women.

Effects of Yoga on psychologial well-being and BMI. Madhu K and Sridhar GR on behalf of Yoga and Diabetes Research Group, Institute of Yoga and Consciousnes, Visakhapatnam.
We evaluated the effect of yoga practice on clinical and psychological outcomes in subjects with type 2 diabetes mellitus (n:38) in a 40 day yoga camp at the Institute of Yoga and Consciousness, Visakhapatnam. The 40 day yogic practices were overseen by trained yoga teachers. At the end of the study, there was a reduction of body mass index (26.514+/-3.355 to 25.771+/-3.40; p<0.001), anxiety (6.20+/-3.72 to 4.29+/-4.46; p<0.05) and improvement in total general well-being (48.6+/-11.13 to 52.66+/-52.66+/-12.87; p<0.05). In conclusion participation of subjects with T2DM in yoga practice for 40 days resulted in reduced BMI, improved well-being and reduced anxiety.

Psychological distress in south Indian women with polycystic ovary syndrome. Sundararaman PG, Shweta, Sridhar GR. Endocrine and Diabetes Center, Visakhapatnam.
Polycystic ovary syndrome (PCOS), is now recognized to be associated with insulin resistance and attendant metabolic complications. It leads to psychological distress. There are no Indian studies on psychological stress in women with PCOS. We studied ninenty nine women who presented with PCOS to the Endocrinology clinic of Govt Hospital for Women and Children, Chennai. They were administered Goldberg’s GHQ 28 (General Health Questionnaire) to assess psychological status, along with clinical, hormonal and ultrasound evaluation Fifty four percent had a GHQ28 score >8 Among them 38% had a family size<4, 72% had obesity, 70% had hirsutism, 72% had a waist circumference >88cm and 69% had a F/G score>4. All these variables were statistically significant; p<0.05 using Chi-square test. In summary women presenting with PCOS had increased psychological distress, which was related to smaller size of family, and more severe physical manifestations of the condition.

2.30-3.00 pm

Continuing Learning : Revisiting Glycaemic Pathway in patients admitted for CABG.  Menaka R, Manjunath A, Narendra BS, Bhattacharyya A.   Department of Diabetes and Endocrinology, Manipal Hospital, Bangalore.
Aims and Objectives. Good glycaemic control is an important determinant of outcome after CABG. We had shown that a structured plan (Glycaemic pathway) of managing Diabetes involving specialist in patients undergoing CABG is worthwhile. Based on the findings we have modified our pathway in order to improve glycaemic control in similar patients.
Materials and Methods. This cohort constitutes first 50 patients completing ‘Modified Glycaemic pathway’. In comparison to our earlier pathway, we had titrated the scale on IV/SC insulin in order to achieve better glycaemic control.
Results. Glycaemic control while on IV insulin was good in 60%, suboptimal in 37% and poor in 3% of patients in the modified glycaemic pathway in comparison to earlier study (61, 37 and 2% respectively). Similarly while on SC insulin control was good in 63% of patients, fair in 36% and poor in 1% as compared to 53, 45 and 2% before modification of the pathway. As anticipated, the frequency of hypoglycaemia was higher but they were all mild and managed easily. All were discharged on Insulin. There were no mortalities both before and after modification of pathway.
Conclusion. We are happy to show clearly the benefit of a structured intervention in glycaemic management of patients undergoing CABG. Also the current data documents the need to review one’s own protocols to find out the scope of improvement in line of continuing medical education that can provide better patient care.

Continuous subcutaneous insulin infusion for type 2 diabetes mellitus in pregnancy.  Muthukrishnan J, Harikumar KVS, Verma A, Ugale M¹, Modi KD.  Dept of Endocrinology, Medwin Hospital, Hyderabad.  ¹ Kirloskar Hospital, Hyderabad.
Objective. To present two pregnant women with poorly controlled Type 2 Diabetes mellitus on multiple dose insulin injections (MDII) managed successfully on Continuous subcutaneous insulin infusion (CSII).
Methods. Two women with pregnancy complicated by Type 2 Diabetes mellitus were initially managed on MDII. They were switched over to CSII in view of poor glycemic control and frequent hypoglycemia during the third trimester.
Result. In both cases, satisfactory improvement in glycemic control without hypoglycemia was achieved. Both delivered a healthy child without macrosomia or neonatal hypoglycemia. Details of clinical and glycemic profile are presented in table 1. Conclusion. Intensive regimen with MDII often fails to achieve glycemic targets and result in frequent hypoglycemia in women with high insulin requirements. Use of CSII is effective mode of therapy in such cases.

Table 1: Comparative data of glycemic control parameters in two pregnant women with Type 2 Diabetes Mellitus treated with CSII

                                                                Case 1                                             Case 2

Mode of Therapy                         MDII                   CSII                    MDII                       CSII 

Gestation period (duration)      6th to 25th      26th to 36th       4th to 25th        26th to 36th  
(weeks)                                            (20)                    (11)                  (22)                     (11)

Median FPG (mg/dl)                        104                     92                   140                      110

Median PPBG                                   162                   128                  265                      145     

HbA1c (%)                                          7.8                     6.2                   9.3                       8.2      

Maximum Insulin                             82                      90                   146                      220
requirement (Units/day)          

Weight gain in pregnancy (Kg)                    12                                              11

3-30-4.30 pm

A study on lipoprotein pattern in case of Diabetes Mellitus type 2 under treatment of various hypoglycemic drugs. Prabhakar PK¹, Mukesh Doble A¹, Uday Kumar B^{2 1}Department of Biotechnology, Indian Institute of Technology Madras, Chennai.  ²Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna. 
Background. Atherosclerosis and coronary heart disease (CHD) are the major vascular complications of diabetes and they have enormous impact on the health of those affected. The present study was carried out to determine the effect of different therapies (oral hypoglycemic drug (OHD) and insulin) on the lipid profile of diabetic patients. There are reports that in the case of diabetes mellitus the lipid profile becomes irregular and are associated with atherosclerosis and CHD.
Method. For the present study 60 diabetic patients were selected randomly in the age group of 35-55 years, 30 of them are oral drug users and 30 use insulin. 30 healthy persons of comparable age were selected as control. The fasting plasma sugar was estimated by O-toluidine method, serum cholesterol and HDL-c was estimated by cholesterol oxidase-peroxidase method and serum triglyceride was estimated by glycerol-3-phosphate oxidase method. LDL-c and VLDL were estimated by using Friedelwald’s formula.
Results. Fasting plasma glucose level was significantly higher in both the insulin and OHD users in comparison to the control group. But there was no significant difference between insulin and OHD users. The total cholesterol, triglyceride, LDL-c and VLDL-c of diabetic patients were significantly higher in both insulin user and OHD users when compared to the control. Whereas, the HDL–c was significantly lower in diabetic patients when compared to the control.
Conclusion. Type 2 diabetic patients who were on insulin therapy had slightly better lipid profile than those who were on oral hypoglycemic therapy. Lipid abnormality may be the result of the unbalanced metabolic effect of diabetes. Control of hyperglycemia does moderately improve the lipid profile in diabetic patients. Lipoproteins fractions (HDL-c, LDL-c, VLDL-c and Cholesterol) of the diabetic patients were found to be highly disturbed as compared to the control group and they showed a trend of developing atherogenic states in the future.

Comparison of effects of Glimepiride on blood sugar levels between male and female sexes. Pramod JM, Prasanna Kumar KM, Shivamurthy MC, Niveditha.  MS Ramaiah Medical College, Bangalore. 
Introduction. Glimepiride is a long acting sulfonylurea with additional extra-pancreatic effects. The incidence of hypoglycemia with Glimepiride is significantly lower than other Sulphonylureas.
Aim. To compare the effects of Glimepiride on blood sugar levels between male and female sexes.
Materials and Methods. The study group consisted of 35 patients with type 2 diabetes mellitus who were on treatment with Glimepiride for a minimum of one month. The study group consisted of 17 males and 18 females aged between 25 to 65 years. Study group was started on once daily Glimepiride with individualized dose (dose with which the FBS was controlled i.e. FBS <140mg%). The glycaemic control was assessed by fasting blood glucose levels measured at the end of each week of treatment for three weeks.
Results. The mean baseline FBS levels between male and female subjects did not differ much and was not statistically significant (p=0.144). The mean FBS level at the end of each week of treatment for three weeks between male and female subjects did not differ much and was not statistically significant (p value for first, second and third week being 0.235, 0.237 and 0.389 respectively).
Conclusion. The study has shown that there is no difference in the effects of Glimepiride on blood sugar levels between male and female sexes. This is consistent with the finding that there are no differences between males and females in the pharmacokinetics and pharmacodynamics of Glimepiride.

Evaluation of effect of dose and duration of treatment with metformin on serum vitamin B12 levels in type 2 diabetic patients.  Harsha KP, Prasanna Kumar KM, Sanjay Reddy, Shivamurthy MC, Niveditha .  MS Ramaiah Medical College and Teaching Hospital Bangalore.
Introduction.  Metformin induced impaired vitamin B12 absorption leading to fall in serum cobalamin levels has been described in literature as early as 1971. Approximately 10% of patients and in some studies 30% of patients on metformin therapy developed metformin related cobalamin deficiency. The risk of cobalamin deficiency is comparatively more among patients with vegetarian diet than in non-vegetarians
Objectives. To evaluate the effect of dose and duration of treatment with metformin on serum vitamin B12 levels in type 2 diabetic patients.
Materials and Methods. By using available database of patients with type 2 diabetes mellitus lists of all patients with type 2 diabetes mellitus on metformin monotherapy or insulin and metformin was made. These patients will be asked to visit the hospital by contacting them through telephone. A total of 40 patients were chosen. By using a pilot tested proforma details were collected on demographic data, dietary habits. Duration of treatment with metformin and dose of metformin was also noted. All patients will undergo routine investigations which include RBS, PPBS, and HbA1c. After taking their informed consent, 5 ml of blood will be collected and sent to the central laboratory for serum vitamin B12 estimation. Vitamin B12 estimation was done using a recently developed method called as active vitamin B12 assay.
Results. Our results showed that mean Vitamin B12 levels among patients on dose of less than 1gm/day was 57.8pcm/dl and was 40.4 pcm/l in patients on dose more than 1gm/day. The mean B12 levels were 39.7, 54.3 and 75.9pcm/l in duration of treatments <2 yrs, 3-5yrs and >5yrs respectively.
Conclusion. Our study shows that dose of metformin did not show any significant relationship with serum vitamin B12 levels while there was a progressive increase in serum B12 levels with increasing duration of therapy.

Sitagliptin added on to the ongoing anti-diabetic therapy:  An initial experience. Patel HS¹, Navneet Wadhwa²  Diabetes Education Management and Research Centre, Jabalpur. 
Introduction. Sitagliptin a highly specific and potent inhibitor of DPP-4 enzyme, is a novel approach for the management of type II diabetes. It enhances the incretin levels by 2-3 fold to improve both alpha and beta cell dysfunctions simultaneously resulting in the physiological control of plasma glucose levels. Sitagliptin, the only DDP-4 inhibitor approved by US FDA is available in India since April 2008.
Methods. Sitagliptin was added in 25 patients uncontrolled with ongoing anti-diabetics therapy. The clinical data record was retrospectively evaluated and analysed for the change in the fasting and post prandial plasma glucose levels at a follow up visits at three and six weeks. The improvement in the plasma glucose levels were statistically analysed for the absolute reductions in fasting and post prandial plasma glucose and across subgroups on the basis of the age, BMI and duration of diabetes.
Results. Six weeks of Sitagliptin as an add on therapy in 25 patients (19 male, 6 female) had significant improvements in the fasting and post prandial plasma glucose levels. The patients were on multi drug therapies including metformin, sulponylurea, insulin, pioglitazone and alpha glucosidase inhibitors. The mean age was 50.76 years (36-67 years), mean BMI 25.11 kg/m2 (19.8-29.17 kg/m2) and mean duration of diabetics 6 years (3-16 years). Mean HbA1c at the Sitagliptin initiation was 9.27% (7.8%-12.7%), with none of the patients within the glycemic target of HbA1c <7%. Majority of the patients had a family history of diabetes (64%), compliance to diet (72%), exercise (72%) and had associated comorbid conditions like hypertension, retinopathy and renal impairment (56%).
At week 3 and 6, sitagliptin led to highly significant (p<0.001) reductions in both fasting and post prandial plasma glucose. At week 6, as compared to the baseline, the plasma glucose levels consistently improved with mean decrease of 52 mg/dl (31% reduction) and 102mg/dl decrease (37% reduction), in both fasting and post prandial plasma glucose, respectively. The subgroup analysis for the reductions in both fasting and post prandial plasma glucose across age groups (= 50 and < 50 years, FPG p=0.363, PPG p=0.16 ), BMI (= 25 and < 25 kg/m2 , FPG p=0.664, PPG p=0.976) and duration of diabetes ( = 6 and < 6 years, FPG p=0.676, PPG p=0.81), demonstrated similar results across the subgroups.
Conclusions. Sitagliptin 100mg once daily when added to the ongoing anti-diabetic therapy resulted in effective and highly significant reductions in both fasting and post prandial plasma glucose at 3 weeks and 6 weeks. Sitagliptin was consistently effective across subgroups of patients defined by age, BMI and duration of diabetes. This initial experience is expected to be further strengthened for the glycemic control and treat to target (HbA1C < 7%) comparative analysis by repeat HbA1c estimation at the end of 12 weeks.
The observations of this study are similar and consistent with the existing trials results and the recently presented data at ADA 2008, San Francisco.

Thiazolidinedione induced thyroid associated orbitopathy.  Menaka R, Laksmi M, Bhattacharyya A  Departments of Diabetes-Endocrinology and Ophthalmology, Manipal Hospital, Bangalore.
Aims and Objectives. Thyroid associated orbitopathy (TAO) is seen less frequently in our country but can have sight threatening consequences. We report two cases of Rosiglitazone induced TAO. CASE 1 55-yr-male with T2DM on Glibenclamide and Metformin, started on Carbimazole for Graves’ disease 6mths back, referred with TAO. He was started on Rosiglitazone (TZD-Thiazolidinediones) for uncontrolled diabetes 3mths back. On examination he had B/L proptosis with eyelid retraction and exposure keratitis. Extraocular movements were restricted with visual compromise. He was euthyroid. CT scan confirmed TAO. He was started on IV methylprednisolone and without improvement and underwent orbital decompression. CASE 2 46yr-doctor presented with prominent eyes 2mths after diagnosis of T2DM. Graves’ disease 5yrs back was treated with Carbimazole for 6mths. He did not have ophthalmopathy or dermopathy and was happy with remission. CT scan of the orbit confirmed TAO, he was euthyroid. Penny dropped with medication history – given Rosiglitazone for Diabetes. He responded to stoppage of TZD along with a course of oral Prednisolone for 4wks. DISCUSSION TZD is known to increase SC fat. Expression of TSH-receptor and adipogenesis in orbit is well documented in Graves’ disease. PPAR-ã activation by TZD has been shown to stimulate functional TSH-receptor expression and to induce recruitment and differentiation of orbital fibroblasts into mature lipid-laden adipocytes.
Conclusion. TZD exacerbates TAO; this should be kept in mind when selecting treatment for diabetic patients with Graves’ disease.

4.30-5.00 pm

Glycated albumin at different stages of diabetic nephropathy in India.  Vijay Viswanathan, Satyavani K, Priyanka Tilak  MV Hospital for diabetes and diabetes research centre, Royapuram, Chennai.
Aims. Glycated Haemoglobin (HbA1c) which is an index of long term glycaemic control in diabetic patients is measured in majority of patients world wide. Glycated albumin (GA) is useful for the evaluation of short term glycaemic control (2 weeks) in patients with diabetes. The aims of this study were to assess the GA levels at different stages of diabetic nephropathy and to derive a normal cutoff value for glycated albumin in this population.
Methods. A total of 197 subjects (M:F; 109: 88) were selected for this study and were divided into three groups based on their renal function and compared with a non diabetic control group. The groups were as follows; group1 (control) n = 50, group2 (normoalbuminuria) n = 42, group 3 (Microalbuminuria) n = 55, group 4 (proteinuria) n = 50. GA was measured by enzymatic procedure using the Lucica GA – L kit (Asahi Kasei Pharma Corp, Japan).
Results. The normal cutoff value for GA was derived using control group and it was found to be 15% (range 7-17%). GA % was significantly higher in diabetic patients at different stages of diabetic nephropathy compared to non diabetic control group [cont 12.9±1.8, normo 20.8±5.8, micro26.1±8.6, macro23.5±83). Microalbuminuric patients had significantly higher GA levels than normoalbuminuric patients (p<0.05) Proteinuric subjects had slightly lower GA levels compared to micro group but it was not statistically significant.
Conclusion. GA was found to be a better marker for evaluating short term glycemic status among diabetic patients with different degree of renal impairment.

Insulin resistance at different stages of diabetic kidney disease in India.  Vijay V, Satyavani K, Priyanka T.  Diabetes Research Centre and MV Hospital for Diabetes, Royapuram, Chennai.
Objective. Insulin resistance (IR) is associated with diabetes and cardiovascular disease. Many studies showed that IR is present in chronic renal failure and evidences suggest that IR can also occur in early stages of renal disease. There is paucity of data from Indian population hence this study was planned with the aim of defining the degree of Insulin resistance among different stages of diabetic nephropathy.
Subjects and Methods. A total of 160 subjects (M:F;89:71), were selected for this study and divided into3 groups based on their renal function and compared with control group. The groups were:group1 (control) n=32, group2 (Normoalbuminuria) n=26, group3 (Microalbuminuria) n=59 and group4 (Macroalbuminuria) n=43. Subjects on insulin treatment were excluded. Insulin was estimated by chemiluminescence method. Biochemical investigations were done by enzymatic procedures. Insulin resistance was calculated HOMA method. The normal cut off value for IR (2.4) was derived using mean+2SD of controls.
Results. There was no significant difference between the study groups with respect to age, BMI and duration of diabetes. Mean IR increased significantly with decreasing renal function (NGT:1.30±0.53; Normo: 4.0±2.7; Micro: 5.81±4.1; Macro: 8.0±5.1,p<0.04). Larger percentage of subjects had insulin resistance (=2.4) at different stages of impaired renal function (Normoalb: 69.2%; Microalb: 76.2%, Macroalb: 90.6%) compared to normal (3.12%). Mean IR increased with the deteriorating renal function as assessed by eGFR, (eGFR>90:  5.8±4.2; eGFR60–89: 6.5±4.8; eGFR30–59ml/min:7.5±4.5).
Conclusion. This study showed that as DN progresses, IR is aggravated and it may be in addition to other associated factors, possibly accelerate the decline in renal function. The relationship between several potential modifiable mechanisms which are said to be contributing in worsening of IR among DN is yet to be defined in our population.

4.00-5.00 PM

First study of aryl hydrocarbon nuclear translocator gene in Indians: correlation with resistance to diabetes in Raika community.  Agrawal RP¹, Jhanjaria A¹, Mohta N¹, Suman Kapoor², Manav Kapoor², Urvashi Dube², Shashwat Sharad², Dogra R¹.  ¹Diabetes Care and Research Centre, S P Medical College, Bikaner.  ²Center for Biotechnology, Biological Sciences Group, Birla Institute of Technology and Science, Pilani, Rajasthan.
Objective. To study polymorphism of ARNT gene so as to ascertain its correlation with resistance to diabetes in Raika community.
Methods. Study was conducted in 57 individuals from the Raika community and 75 people of Non-Raika communities. DNA from blood samples was isolated by using the procedure of Hammond et al with minor modifications. DNA was visualized on 0.8% agarose gel for quality check and was further quantified and qualified by taking optical density at 260 and 280 nm on a UV spectrophotometer. Genomic DNA was genotyped using PCR amplification and restriction fragment length polymorphism.
Results and Discussion. The mean age of Raika individuals was 41.14±17.92 and that of non-Raika individuals was 46.93±12.37. The anthropometric and clinical parameters, which are markers for risk for type 2 diabetes, were seen better in the Raika community. The frequency of GG allele in Raika community was 0.92 and in Non Raika community was 0.94. Similarly, the distribution of AG allele in Raika community was 0.08 and in non Raika community 0.06.
Conclusion. Present study concluded that the polymorphism studied has same frequency distribution in both Raika and non-Raika people with or without diabetic conditions. As explained by other studies throughout the world it is once again established that diabetes is not totally environmental and genes play their role in its etiology. The negative results of the present study have excluded atleast one gene from this list and lead the way to explore several genes not with a targeted gene approach but with a targeted approach towards genes.

Association of Thr 256 Ser, coding polymorphism of AHSG gene, with South Indian type 2 diabetes. Thanigaivelan K, Ezhilarasi K, Shila S, Parthiban M, Satyavani K, Vijay Viswanathan.  Biochemistry Department, MV Hospital for Diabetes and Diabetes Research Centre, Chennai.
Background. Alpha-2-Heremans-Schmid Glycoprotein (AHSG), coded by AHSG gene, is a natural inhibitor of the insulin receptor tyrosine kinase, and plays a significant role in decreasing the insulin sensitivity.
Aim. To study the association of Thr256 Ser polymorphism in AHSG gene (exon 7-chr 3q27) with South Indian type 2 diabetes.
Material and Methods. A total of 50 type 2diabetic patients attending outpatient department of MV Hospital for diabetes, Chennai during May to July 2008 were included in this study. 50 hospital staff that were not having T2DM served as control population. Genomic DNA was isolated from the blood samples of these subjects and subjected to PCR amplification using the primer sequence
5’GTAAGGCAACACTCAGTGA3’-Forward primer
5’TCATCACTGCCATGTCTAG3’-Reverse primer
Amplified products were subjected to RFLP using restriction enzyme SacI , which cleaves at the site
5’GAGCT*C3’
3’C*TCGAG5’
The appearance of bands, corresponding to base pair of 731 in agarose gel electrophoresis was looked for. This represents the Single Nucleotide Polymorphism (SNP) of Thr 256 Ser in AHSG gene.
Results. 4% of normal individuals and 40% of T2DM patients of South India were having nonsynonymous coding polymorphism of AHSG gene (Thr 256 Ser). There is significant association of this polymorphism with T2DM.
Conclusion. This study suggests that AHSG gene (Thr 256 Ser) polymorphism is associated with type 2 diabetes of South Indian population.

Ileal switch with sleeve gastrectomy for control of type 2  diabetes.  Hari Kumar KVS¹, Surendra Ugale², Vishwas Naik², Neeraj Gupta², Bhaskar P², Modi KD¹.  ¹Department of Endocrinology, Medwin Hospitals, Nampally, Hyderabad.  ²Department of Laparoscopic Surgery, Kirloskar Hospital, Bashir Bagh, Hyderabad.
Objective. To determine the efficacy of a novel procedure consisting of ileal switch (transposition of a segment of ileum into proximal jejunum) and sleeve gastrectomy on glycemic control and other constituents of metabolic syndrome in type 2 diabetes patients.
Methods. In this ongoing study, five patients underwent laparoscopic procedure of sleeve gastrectomy coupled with transposition of a segment of ileum into proximal jejunum. All patients had diagnosis of diabetes for more than 3 yrs with poor control despite use of oral hypoglycemic agents (OHA) and insulin. The primary outcome is remission of diabetes (HbA1c<7% without requiring OHA) and secondary outcomes are change in weight, blood pressure, insulin resistance and in parameters of metabolic syndrome.
Results. Out of 5 patients who underwent surgery, we report the six month follow up data of two patients, and 2 month follow up of another 2 patients. The first two patients had remission in diabetes and other two showed significant decrease in requirement of OHA. HbA1c dropped from 9.9% to 7% in 1st patient and from 15.8% to 5.8% in 2nd patient. All 4 patients showed remission of hypertension (not requiring anti hypertensive drugs) coupled with significant weight loss ranging from 15 to 25%. There was significant improvement in secondary outcomes measured.
Conclusion. Our preliminary data demonstrated the feasibility, safety and efficacy of this novel surgical procedure in type 2 diabetes. Further long term data from more number of patients is necessary to confirm these findings.

November 22, 2008
Hall C  
1.30-2.30 PM

Clinical profile of Iatrogenic Neuroglycopenia.  Pasupuleti Ravi Kishore, Vidyasagar Sudha, Seth Pankaj, Varma Muralidhar, Prashanth.  Kasturba Medical College, Manipal.
Objective. To study clinical profile of neuroglycoponia in patients with type 2 diabetes mellitus.
Methods. The clinical profile of patients admitted in Kasturba Hospital, Manipal with neuroglycopenia between 2005 Jan to 2008 August were observed with respect to demographic details, duration of diabetes, precipitating factors, clinical manifestations, drug therapy, and complications.
Results. Of the 20 diabetic patients, the mean age was 61.68yrs, 45% being above 60yrs. 14 (70%)  of patients had altered sensorium, 5(25%) had coma, 3 patients had <30mg/dl,12 had 31-50, 5 had >50mg/dl of capillary glucose.
Reducing the food due to illnesses was the most important precipitating factor 80% (16).  13 were patients on insulin and OHAs, 7 were on sulfonylureas or combinations. 7 had diabetes >10 years, 3 had diabetes for 5-10 years. 10 were diabetic for <5years and in these 4 were on insulin, 2 self-adjusted the dose of drugs and 2 were newly started on drugs. Chronic renal failure was an important association(25%). Past history of hypoglycemic attack was present in 2 patients. 5 patients were alcoholics.
Conclusion. Neuroglycopenia is common in elderly. The most important precipitating factor being reduced food intake during illness. Most common clinical presentation is altered sensorium. Chronic renal failure has significant association, probably as these patients are on insulin. CNS manifestations are common in the initial phases of drug therapy as patients are unfamiliar with warning symptoms or in patients with >10yrs of diabetes.
We feel all patients should be educated about use of drugs in diabetes, especially in elderly age group and those on insulin.

Iatrogenic hypoglycaemia –A physician’s challenge.  Srivastava S, Ahmad S, Verma SK, Shirazi N.  Himalayan Institute of Medical Sciences, HIHT University, Swami Rama Nagar, Jolly Grant, Dehradun.
Introduction. Iatrogenic hypoglycaemia is the limiting factor in intensive glycemic control in subjects with diabetes mellitus. Over-enthusiastic prescription of anti-hyperglycaemics has increased the incidence of hypoglycaemic episodes over and above the incidental and accidental occurrences.
Material and Methods. All the diabetic and non-diabetic patients with low blood glucose levels (<40 mg/dL) at presentation to the Himalayan Institute of Medical Sciences, Dehradun, were included in the study; those with septicaemia, liver dysfunction, and malignancy-associated anorexia, were excluded.
Results. We encountered 62 patients with iatrogenic hypoglycaemia over a period of 8 months. The male to female ratio was 1:3 and the median duration of diabetes was >5 yrs. Thirty-eight patients [61.2%] were aware of the symptoms of hypoglycaemia; others presented with unconsciousness [n=12, 19.3%], seizures [n=2, 3.3%], unconsciousness with hemiparesis [n=2, 3.3%] and uncontrolled blood glucose levels [n=8, 12.9%]. Sulfonylurea- and insulin-associated hypoglycaemia was seen in 37 [59.6%] and 24 [38.7%] instances respectively. One non-diabetic was a rare case of fluoroquinolone (moxifloxacin) induced hypoglycaemia. The most prominent causes of iatrogenic hypoglycaemic episodes observed in our study were over-enthusiastic use of anti-hyperglycaemics; frequent escalation of doses; ignorance of associated co-morbidities predisposing to dysglycaemia; use of alcohol; renal insufficiency, vigorous exercises and missing a meal.
Conclusion. Increasing pressure advertising by the pharmaceuticals and lack of patient-doctor coordination are perhaps the core issues behind the increasing incidence of iatrogenic hypoglycaemia which may occasionally be crippling and fatal.

Iatrogenic Hypoglycemia: Sweating to glycemic control may cause Cognitive Impairment. Anuj Maheshwari, U.P.D.C. and Research Centre, Lucknow. Nisha Maheshwari, Sri Hari Kamal. Diabetes and Diabetic foot Clinic, Lucknow.
In last decade, with recommendations of targeting tight glycemic control, hypoglycemia has come up as a significant denominator in achieving perfection in wellbeing. Desiring precise post prandial glycemic control to avoid CV risks, convenience of premixed Insulin is being fatal not only posing risk of hypoglycemia especially when peaks of NPH and regular insulin coincide but also increasing weight most likely because of unscheduled snacking during Hypoglycemia then to Insulin pharmacodynamics. Analogues were introduced to avoid hypoglycemia using their shorter duration of action. Despite it, twice a day popularly used premixed analogues, cause significant diurnal glycemic variability. In spite of good HbA1c, controlled glucose level at fasting or post-prandial, a high pre dinner value forces clinician to increase dose of insulin. It may lead to hypoglycemia causing more frequent snacking and weight gain. Regular occurrence of this blunts endocrine defenses and counter-regulatory response to hypoglycemia. The failure of the symptomatic counter-regulatory response, leads to decreased perfusion and brain Glucose uptake in sub thalamic brain centers, including ventromedial and lateral hypothalamus, making him unaware of hypoglycemia. Many patients complain of short term memory loss, being intolerant and short tempered, lack of concentration, having disinterest in surroundings gradually amounting to depression, losing interest in work etc.
An observational clinical study of hypoglycemia was done among 212 diabetics taking insulin or analogue or their premixed combinations with or without oral drugs in 12 weeks which was later on extended to 24 weeks. They were advised to check blood glucose at least twice daily even if they did not have any problem and to check in addition when they feel themselves hypoglycemic or having unexplained symptom. Data on glucometers were downloaded and analysed. 188 patients completed study comprising of 53% males and 47% females. 24 patients did not use glucometers or lost to follow up. 32% shown classical symptoms of hypoglycemia confirmed with glucometers while 8% could not confirm their symptoms with Glucometers but relieved on correction. 63% of hypoglycemia noticed with premixed insulin with highest weight gain followed by premixed analogue but without significant difference in weight gain. Least hypoglycemia noticed in Basal Insulin supported by oral drugs without weight gain followed by Basal Bolus Therapy with least weight gain. Highest diurnal glycemic variability was observed with premixed analogues twice daily regime while it was least with basal bolus. Hypoglycemia unawareness found to be highest with premixed analogue which was intending to increase with duration followed by premixed insulin and least with Basal oral therapy. Cognitive impairment was noticed to be exponentially increasing with tight and consistent glycemic control, of course more with premixed analogue. Weight gain was more with post prandial tight control or hypoglycemia.
Although consistent tight glycemic control helps in avoiding microvascular complications, but exploring perfection through intensive lowering of blood glucose and setting new standards of lowering HbA1c, may compel our patient to sweat for irresistible desire to eat. On one hand it may increase weight and insulin resistance posing cardiovascular risks and on another hand regular occurrence develops unawareness to hypoglycemia passing through the cognitive impairment. Targeting new lows of blood glucose may induce hepatic glucose output causing undesirable glycemic variability that makes it difficult to keep round the clock optimum control and ultimately patient sweats off clinicians efforts.

Serious symptomatic hypoglycemia in a patient on insulin pump.  Jothydev Kesavadev, Arun Shankar, Dhanya K Gopi, Sunitha Jothydev.  Jothydev’s Diabetes and Research Center, Trivandrum.
In T1DM, high A1c and recurrent low sugars poses a treatment challenge. Use of Insulin pumps reduces hypos enabling patients maintain near normal sugars. This report of serious symptomatic hypoglycemia, requiring hospitalization, cautions us in taking into account multiple factors in determining basal profiles and bolus insulin dosages in patients with wide glycemic excursions, while on pump.
Here we document the case report of 26 y.o T1DM, 16 years duration, on MDI from our center. He used to experience frequent hypoglycemias which easily got corrected by oral ingestion of glucose. His A1c remained >10% and was switched over to CSII. Initial insulin in pump was <20% previous dose. He was on daily follow up by our diabetes team.(Diabetes Tele-Management System-DTMS). One month later, ½ an hour after lunch, waiting for bus, he recalls symptoms of hypoglycemia, suspended pump but immediately fell down unconscious. He completely recovered in hospital. Later he underwent a series of educational sessions with diabetes team on carb counting, insulin sensitivity factor, using bolus wizard, temporary basal at times of exercise and walking etc. He has now completed >2 years on pump with no further hypo but acceptable A1c.
Close follow up is mandatory during the initial 3-6 weeks so as to optimize insulin delivery. Smart pumps when combined with intellectual and mathematical skills of patients and care givers offers the best benefit of an advanced insulin delivery mechanism mimicking a normal pancreas only in motivated subjects.

2.30-3.30 pm

Plasma Adiponectin and central obesity in type 2 diabetes.  Nitin Kapoor, Neeta Deshpande, Kalagate SB, Kothiwale VA.  JN Medical College, Belgaum. 
Aim. To correlate plasma adiponectin with obesity in type-2 diabetes.
Methods. 90 age matched male subjects were divided into 4 groups based on BMI: Diabetic overweight –DO(n=35), Diabetic normal weight -DNW(n=35), Non Diabetic overweight-NDO(n=10) and Non Diabetic Normal weight -NDNW(n=10). Only well controlled (HbA1c <7.5%) diabetics with normal ECG and not on thiazolidinediones were included. All were studied with respect to anthropometry (BMI&WHR) and Plasma adiponectin(Measured by ELISA,both globular and full-length).
Results. Mean adiponectin is higher in non-diabetics compared to diabetics. Among the 4 groups adiponectin levels were lower in the two overweight groups (DO, NDO) Vs non-overweight groups (DNW, NDNW). (P<0.001).
There was a statistically significant (P<0.001) inverse relation between the range of BMI values and Plasma Adiponectin amongst diabetics.
Based on WHR,adiponectin levels were significantly lower(P<0.001) in the centrally obese subjects compared to normal-WHR subjects, whether diabetic or not.
The correlation coefficient of reduced adiponectin is higher with WHR (+0.9209 and +0.9690 for diabetics and non-diabetics respectively) than with BMI (+0.7494 and +0.6924 for diabetics and non-diabetics respectively).
Although all diabetic subjects had good glycemic control (HbA1c <7.5), there was a statistically significant inverse relation between the range of HbA1c values and Plasma Adiponectin, whether in overweight (p=0.0067) or normal weight (p=0.0046)Conclusion.
Both diabetes and obesity have an inverse correlation with Adiponectin.
Plasma adiponectin levels correlates better with WHR than BMI and probably predicts insulin resistance and development of atherosclerosis.
Even within a normal range of HbA1c, lower values were associated with higher adiponectin.

Prevalence of metabolic syndrome among South Indian subjects with elevated intermediate glucose response during OGTT.  Vijay V, Satyavani K, Clementina M, Priyanka T.  Diabetes Research Centre and MV Hospital for Diabetes, Royapuram, Chennai. 
Aims. Individuals with IGT or IFG are at high risk of developing type 2 diabetes and CVD. In earlier report, we found that a larger percentage of subjects having an elevated intermediate post glucose response (1 hour value of=160 mg/dl, Early Glucose Intolerance, EGI) during OGTT converted to diabetes compared to normoglycaemic subjects. The aim of this study was to see the prevalence of metabolic syndrome among EGI subjects.
Methods. A total of 1107 subjects (M:F; 745:362) enrolled for a ‘primary prevention program’ were selected. A standard OGTT was done and the subjects were divided into groups based on their glucose tolerance status, NGT(n=402), EGI(n=405), IGT(n=300). Anthropometric and blood pressure measurements were recorded. Biochemical investigations were done using enzymatic procedures. Diagnosis of metabolic syndrome was made using ATP III criteria with modified waist circumference appropriate for Indians.
Results. The prevalence of metabolic syndrome was significantly higher in EGI (36.1%) compared to NGT (27.9%) (c2=5.8, p=0.015). Presence of metabolic syndrome was higher in IGT (57%)when compared with NGT and EGI (p<0.0001). Presence of individual abnormalities such as increased FPG, BMI and BP were higher in EGI than NGT. Multiple logistic regression analysis with presence of metabolic syndrome as dependent variable showed a significant association with
EGI (OR 1.76; 95%CI 1.23 – 2.5) and IGT (OR 3.97; 95%CI 2.7 – 5.8) (p = 0.001)Conclusions. EGI which is a distinct entity showed a significantly higher prevalence of metabolic syndrome than normoglycaemic subjects. Diagnosis of metabolic syndrome among these individuals might help in prevention of diabetes and cardiovascular disease.

High prevalence of metabolic syndrome and cardiovascular risk among police personnel compared to general population in India.  Shabana Tharkar,  Satyavani Kumpatla, Parthiban Muthukumaran,  Vijay Viswanathan  MV Hospital for Diabetes and Diabetes Research Centre, Royapuram, Chennai. Aim. The aim of this study was to determine the prevalence of metabolic syndrome and associated cardiovascular risk factors among police personnel and compare with the general population (GP).
Methods. Two populations similar in demography were selected for this study. A total of 719 men aged = 30 years from Chennai, were randomly selected (police n = 318, GP, n = 401). Fasting blood samples were collected, glucose and lipid profile were estimated. Prevalence of metabolic syndrome was determined using IDF definition. Risk associations for metabolic syndrome and diabetes were analyzed using multiple logistic regression analyses.
Results. The prevalence of metabolic syndrome (57.3 vs 28.2 %; ÷2 = 64.5, p< 0.0001) was significantly higher among police compared to GP. Regression analyses showed that age, body mass index, alcohol consumption and smoking were associated with metabolic syndrome while age, family history of diabetes, abdominal adiposity and increased body mass index were associated with diabetes among the policemen. The police had higher prevalence of individual cardio metabolic abnormalities and diabetes in comparison with GP (p<0.05).
Conclusions. Prevalence of metabolic syndrome and other cardiometabolic abnormalities were significantly higher among the police. Further research is required to determine the causative factors and effective intervention strategies must be planned to keep the police force healthy and vigilant.

Insulin resistance and other metabolic abnormalities in ‘Normal Weight Obese’ type 2 diabetics.  Deshpande N R^1,2, Aman SD², Pilankar R², Dhareshwar R².  ¹KLE’s Dr Prabhakar Kore Hospital and MRC, Belgaum, ²Belgaum Diabetes Centre, Belgaum.
Background. It is postulated that body fat is more strongly associated with development of insulin resistance and other risk factors of atherosclerosis. Since Normal Weight Obesity (NWO) is a clinical entity with predominant visceral obesity, this study aimed at finding the degree of insulin resistance and other metabolic abnormalities among the NWO type 2 diabetics.
Aim. To study insulin resistance and other metabolic parameters in ‘Normal Weight Obese’ type 2 diabetics.
Methods. 97 type 2 diabetics attending a diabetic clinic were evaluated for clinical and laboratory metabolic parameters. Only male, freshly detected type 2 diabetics were included so as to form a uniform cohort of subjects. Insulin resistance (IR) was calculated by HOMA-IR index. NWO was defined as body fat>20% with normal body weight(BMI<25 kg/m2). The data was compared with overweight (BMI>25 kg/m2) and non obese individuals (BMI<25 kg/m2 and body fat<20%). Data was statistically analyzed.
Results. Of the 97 subjects studied, 46 subjects had normal BMI, of whom, 64% had NWO. Statistically, most metabolic parameters in the NWO group were similar to the frankly obese group, especially fasting insulin levels, IR, total cholesterol, LDL-C, triglycerides, uric acid, HDL-C. On the other hand, the same parameters were grossly deranged in the NWO group as compared to the non-obese group -p values: 0.009 (cholesterol), 0.03 (triglycerides), 0.03 (LDL-C), 0.05 (HDL-C), 0.03 (fasting insulin), 0.04 (uric acid). The mean IR in the NWO group (IR=64.9) was twice that in the non-obese group (IR=31), but almost equal to that in the obese group (IR=74). There was no significant difference in glycemic control, blood pressure, SGOT, SGPT, between various groups.
Conclusion. Most metabolic parameters in the NWO group veer more towards the frankly obese group and are far more deranged than in the non-obese group. Thus, measuring BMI alone would miss this distinct category of subjects that comprises a large proportion of apparently non-obese (by BMI) individuals. Larger studies would be needed to emphasize importance of routinely measuring fat percentage as a better indicator of metabolic abnormalities.

Is there need for assessing cardiometabolic risk factors in young healthy asymptomatic individuals?  Manohar KN, Agarwal A, Agarwal G, Bhattacharyya A.  Lotus Health Care Center, Indiranagar, Bangalore.
Aims & Objectives. The prevalence of T2DM, HBP, and CAD is on the rise more so in people in Indian subcontinent. Our aim is to justify the need for routine health screening for cardiometabolic risks in young asymptomatic healthy individuals.
Methods. Young asymptomatic healthy individuals were subjected to history, examination and biochemistry including blood sugar and Lipid profile.
Results. Four hundred and fifty four subjects constituted this cohort, 61.5% males; average age was 26 (21 – 30y), 34% had a family history of cardio-metabolic risk (including HTN, T2 DM, IHD, CVA), 28% of the males were smokers. As per ICMR, 22% were overweight while 40% were obese. Prevalence of hypertension was 9% (reconfirmed on subsequent visits) while 9 % had diabetes and 11% had IGT. Most alarming abnormality was in lipid profile at 46% (36% high total cholesterol, 43% high Triglyceride, 9% low HDL and 12% high LDL cholesterol and 32% combined dyslipidaemia). Of the 21% people with abnormal carbohydrate tolerance, 16% had a positive family history of diabetes, 14% had associated hypertension and 35% had dyslipidaemia. Amongst people with hypertension 16% had diabetes & 60% had abnormal lipid parameters. Of the cohort, only 44% had all lab parameters (blood sugars and cholesterol) in normal range. Resting ECG was normal in all cases. Conclusion. We recommend blood sugar and lipid analysis apart from physical examination at predefined intervals in young healthy asymptomatic individuals. We can take the advantage for pre-employment health check in young adults to unfold such abnormalities.

3.30-5.00 pm

Childhood Obesity Prevalence Study.  Sunil Gupta, Archana Bhojwani, Manisha Phadke.  Diabetes Care ‘n Research Centre, Nagpur. 
Aim. To study prevalence of childhood obesity amongst school going children and its corelation with dietary habits.
Method. 1010 children of age 10-12 years were selected from two schools of varying socio-economic background. A complete record of the food intake by using 24 hrs 3 days dietary recall method with dietary fat intake and physical activity profile was collected from parents. Birth Weight (BW) of the child was correlated with present body weight (wt). Food habits like veg, non-veg, fast food, eating in food joints, meals with watching T.V was also noted. Body fat monitoring alongwith anthropometric measurements such as height, weight, waist, hip were recorded using standard methods. A detailed questionnaire was applied to all subjects.
Result. As per CDC growth chart Childhood Obesity (CO) was seen in 7.1%, M-61 (10.3%),F-10 (2.4%). Risk of Overweight (ROO) was in 136 (13.5%), M-117 (19.8%), F-19 (4.5%). Underweight prevalence was 128 (12.7%) M-54 (9.2%) F-74 (17.6%). Mean Calorie and total fat intake amongst CO and ROO subjects was more compared to others [1669 Cal vs. others-1506 Cal\d and fat Intake 37.5 g\d vs. others 32.4 g\d respectively]. SFA intake was more in CO and ROO children than others (10.1 g\d vs. 6.2 g\d).
Conclusion. Obesity was found higher among males than females. Childhood obesity was more prevalent among higher income group. Low birth weight and macrocosmic children are more prone to become obese.

Association of non alcoholic fatty liver disease with diabetic micro- and macro-vascular complications in South Indian diabetic subjects. Vijay V, Srikanth M, Mahesh K, Satyavani K. Diabetes Research Centre and MV Hospital for Diabetes, Royapuram, Chennai.
Aims. Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder that is strongly associated with insulin resistance and type 2 diabetes. The main purpose of this study was to see whether there is an association between NAFLD and diabetic micro and macro vascular complications among diabetic subjects.
Methods. The subjects were selected from 2,161 (M: F, 1187: 974) type 2 diabetic subjects who regularly attended a tertiary diabetes care center and undergone ultrasound of abdomen for assessment of fatty liver. A total of 156 patients with evidence of NAFLD (group1) were compared with 142 (group-2) randomly selected from patients with normal liver ultrasound. Presence of micro and macro vascular complications of diabetes were recorded. Ultra sonography was done for all the subjects.
Results. HbA1c and liver enzymes levels were significantly higher in subjects with NAFLD compared to subjects without NAFLD. Prevalence of obesity, hypertension and dyslipidaemia were significantly higher in subjects with NAFLD. They had higher prevalence of retinopathy (29.4% vs 9.8%, p<0.001), neuropathy (27.5% vs 10.5%,p<0.001), nephropathy (32vs 25%,p=0.2). The prevalence of CAD among NAFLD patients (11.5%vs1.4%, p=0.01) was higher and POVD was similar in both the groups. The results of multiple logistic regression analysis showed that NAFLD was associated with BMI, retinopathy, neuropathy and CAD.
Conclusions. Our study concluded that NAFLD as diagnosed by ultra sound was associated with micro and macro vascular complications of diabetes. Prevalence of obesity, hypertension and dyslipidaemia were significantly higher in subjects with NAFLD.

Foot abnormalities in diabetics – Prevalence and predictors.  Deshpande N R^1,2, Aman SD², Pilankar R², Saroj², Dhareshwar R².  ¹KLE’s Dr Prabhakar Kore Hospital and MRC, Belgaum^{.  2}Belgaum Diabetes Centre, Belgaum.
Background. Diabetic Foot/amputation is a highly disabling complication and also the most frequent cause of hospitalization, reducing quality of life. It is preventable by proper education. India is the ‘diabetes capital’ of the world. Yet there is lack of awareness about the risk factors. This study was planned with the intention of evaluating risk factors that can be associated with development of diabetic foot while considering various ethnic and cultural practices such as bare foot walking (socioeconomic, occupational and religious reasons).
Aim. To estimate prevalence of foot abnormalities among type 2 diabetics and predictors of these abnormalities in a diabetic population.
Methods. 160 randomly selected Type 2 diabetic subjects attending a diabetic clinic were subjected to foot assessment. Evaluation for various risk factors of diabetic foot (neuropathy & vasculopathy) was performed by trained podiatrists. The subjects were categorized as cases (with foot abnormalities) and controls (without foot abnormalities). Data was analyzed to compare risk factors in both groups.
Results.
·    Total screened = 160
·    Subjects with foot abnormalities = 73 (45.62%)
Variables studied included poor socio-economic status (SES), high-risk occupations (farmers, mechanics), urban/rural setting, smoking, hypertension, diabetes duration, glycemic control. Variables that predicted foot abnormalities were poor SES (p=0.02), high-risk occupations (p=0.03), smoking (p=0.01) and hypertension (p=0.02). Glycemic control and diabetes duration were similar in both groups. However, subjects in study group were on multitherapy for diabetes (p=0.03) and had higher rate of retinopathy (p=0.08).
Conclusion. Factors other than glycemic control and diabetes duration are probably operative in causation of diabetic foot in specific ethnic/cultural groups.

Study of Rheumatological manifestations in type 2 diabetes mellitus. Agrawal NK, Amit Bhaskar, Amit Rastogi, Naik D, Valvani A. Department of Endocrinology and Metabolism, Institute of Medical Sciences, BHU, Varanasi.
Objective. To study the prevalence of rheumatological manifestations in patients with type 2 diabetes mellitus.
Material and Methods. This is a hospital based cross-sectional study involving 101 patients with type 2 diabetes with rheumatological manifestations. They were clinically evaluated and were assessed for glycemic status, glycosylated haemoglobin (A1c), serum total protein, albumin, calcium, phosphorus level were measured. They were also subjected to x-rays to rule out bone abnormalities.
Result. There were 51 males. The mean age was 53.8 years. The rheumatological manifestations were common in males of 46-55 years of age. Mean duration of diabetes was 8.4 years. Maximum numbers of cases (40%) were wthin 1-5 years of detection of diabetes. Adhesive capsulitis was seen in 53 patients while 30 patients had osteoarthritis, 12 patients had diabetic hand syndrome, 6 patients had shoulder hand syndrome, 3 patients had osteoporosis, 1 patient each had hammer toe and trigger finger. Out of 53 patients of frozen shoulder male were 30 (56.6%) and females were 23 (43.4%). In osteoarthritis majority of were female ie. 20 (66.67%). Eight out of 12 patients having diabetic hand syndrome were male (66.67%). Out of 6 cases of shoulder hand syndrome 4 were male. All 3 cases of osteoporosis were female. 1 case of hammer toe and trigger finger was seen in male and female respectively. Mean fasting plasma glucose, postprandial plasma glucose were 138.6 mg% and 194.6 mg% while the mean A1C level was 9.27%. The mean serum calcium and phosphorus level were 9.46 mg% and 3.9 mg% respectively. HbA1c > 9% was found in 49% patients with frozen shoulder, 47% of osteoarthritis cases, 75% cases of diabetic hand syndrome, 83% patients of shoulder hand syndrome and all patients with osteoporosis.
Conclusion. Rheumatological manifestations occur early in the course of diabetes in middle aged patients; adhesive capsulitis being commonest followed by osteoarthritis and diabetic hand syndrome. Poor glycemic control is associated with increased prevalence of rheumatological diseases.

Does UTI Pathogen differ in diabetics ?.  Sarita Ugemuge, Sunil Gupta.  Sunil’s Diabetes Care n’ Research Centre, Nagpur.
Aim. To study the etiological agents & resistance to various antimicrobial agents in diabetic population suffering from UTI.
Material and Methods. A total of 106 urine samples of diabetic subjects tested for aerobic bacterial culture. Isolates were identified by standard methods and antimicrobial susceptibility testing was carried out by Kirby Bauer’s method.
Results. Out of 106 samples , 54 (50.94%) samples were found to be positive for pathogens. 96.3% cultures were gm-ve bacilli, with Klebsiella being the commonest isolate (74.07%) followed by E. coli (22.22%). The antibiotic susceptibility of the isolated cultures was performed following NCCLS guidelines. For antibiotics, such as Norflox, Ciprofloxacin, Cefadrox, Cefuroxime and Cefixime, more than 50% of the Klebsiella cultures were resistant, while for other antibiotics the susceptibility pattern showed variation from 10 to 40% (susceptible samples). In case of the E. coli cultures, the maximum percentage of samples resistant to any antibiotic was 33%. The comparative assessment showed that the % of antibiotic resistant Klebsiella isolates were significantly (P<0.05) more than the E. coli isolates.
Conclusion. Amongst UTI of diabetics Gram negative bacilli were commonly isolated. Klebsiella was the most frequently encountered UTI pathogen (unlike in nondiabetic UTI, where E. coli is more commonly seen) The antibiotic resistance pattern of pathogens indicated significantly (P<0.05) high number of resistant Klebsiella than E. coli. Klebsiella was found to be resistant to more number of antibiotics than E. coli.

Prevalence of vascular complication and vascular risk in diabetes patients in Goa.  Gomes E, Wilson B, Vaz M.  Goa Medical College, Bambolim, Goa.  Aims and Objective. To estimate the prevalence of vascular complications and the prevalence of various risk factors on them
Materials and Methods. A cross sectional study of Type II Diabetic patients admitted to Goa Medical College, Medicine ward from July 2004-June 2005. n = 214. Demographics, family history, Medical Examination, H/o present illness, BP were recorded. Retinopathy, Nephropathy, Neuropathy, PVD and CAD were assessed.
Results:
·    72% of patients were aged >51 years
·    55% males
·    66.3% had DM for >5 years
·    Only 21% of patients had BMI >25
·    Only 31% patients had received Insulin earlier
·    60% of patients have had at least one complication and among them 5.1% had at least one complication at diagnosis
·    The complications in the decreasing prevalence was
     Retinopathy                            32.25%      
     Nephropathy                          30.84%      
     Neuropathy                            29.44%      
     CAD                                        24.77%    
     PVD                                        14.95%      
     Stroke                                      9.81%        
.    Higher the age greater the complications (<40years - 3/15 where as >70 years – 26/28 patients)
·    Less no of patients with Family history (56.5%) of diabetes had complications than who with out family history (61.2%) = NS
Conclusion.
·    The complications were in the following order of prevalence: Retinopathy> Nephropathy>Neuropathy
·    Age was a significant risk factor along with duration of DM
·    BMI and HTN significantly contributed to risk of developing complications
·    Again substantiated that the higher the HbA1C higher are the complications and it had significant association with occurrence of Nephropaty
·    Nephropathy was predictor of Retinopathy

Role of hs-CRP in diabetes and hypertension patients.  Rahul Misra, Prakash G, Premavathy RK, Kashyap VK, Reba Chabbra, Sathyamoorthy K. Government Mohan Kumaramangalam Medical College, Salem.
Background. C-reactive protein (CRP) is an acute-phase protein [2] produced by the liver and adipose tissue during episodes of inflammation. Recent findings have suggested that even slightly elevated concentrations of (CRP), have predicted coronary events in Diabetes and hypertension patients in several studies [4-8].
Aim. To assess the hs-crp levels in diabetes and hypertension patients
Methods and Materials. 70 patients with diabetes and 70 patients with hypertension were selected from diabetes clinic and hypertension clinic separately at GMKMC Hospital, Salem. Age, sex, history and general examination findings were recorded. The blood samples were centrifuged and the serum collected was stored in deep freezer at -20c in microbiology lab. These samples were then sent for testing hs-crp levels at National Institute Of Biologicals,Noida.
Statistical analysis used. chi square test, p value, annova test
Results. hs-crp levels were high in diabetic patients in comparison to hypertension patients (P 0.471). Diabetic males were having high hs-crp levels in comparison to diabetic females(P 0.005). Hypertensive males were having high hs-crp levels in comparison to hypertensive females (P 0.595). Patients with diabetes for >3 years were having high hs-crp levels in comparison to those <3 years(P 0.000).Patients with hypertension for >3 years were having high hs-crp levels in comparison to those <3 years. (P:0.000)
Conclusions. CRP is strongly correlated with both diabetes and hypertension. However, Diabetic patients have high HS-CRP levels than Hypertension patients. Hence, HS-CRP levels must be monitored in Diabetic patients.

A novel invitro method for screening of Anti-AGE molecules. Sachin S Pawar, Prachi S Lukatuke, Chaitrali C Kulkarni, Aneri p Manvar, Ghanshyam B Srivastava.
Abstract. Glycation is a reaction in which sugars react non- enzymatically with a wide range of proteins to form Advanced Glycation End Products (AGEs). The procedure to form and assay AGEs are far complex, therefore we have devised a simple high throughput screening method (HTS) for evaluating of anti-AGE molecules. Glucose (50mM) and Bovine Serum Albumin (50mg/ml) was autoclaved using set parameters for formation of AGEs. Flourimeter analysis at (Ex360nm/Em440nm) was the method used to determine extent of glycation. Metformin ( 1mM) and Diclofenac (1mM) were used as standards. There was marked increase in flourimeteric readings of the mixture of glucose and albumin, which was inhibited by Diclofenac and Metformin. Thus autoclaving followed by flourimeteric analysis may be HTS procedure for the evaluation of (new chemical entities) NCEs for the therapeutic intervention of AGEs.

November 23, 2008
Hall A

November 23, 2008  9.00-11.15 am
Nutrition Symposium : Functional Foods

9.00-11.15 PM

Nutritional researches at CFTRI on Foods for Diabetics.  Venkat Rao S, Lakshminarayan V.  Shreehari Diabetes Foundation, Mysore. 
In 1956, observations on a diabetic patient requiring 20 units of insulin showed that he ceased to have glycosuria for three months during which his food included 4-6 oz a day of tender field beans (Dolichos lablab), a popular seasonal vegetable of Karnataka. Unlike the tender seeds, the mature seeds had no effects. This observation was strongly indicative that the proteins in foods exerted a favorable effect on carbohydrate utilization.
Glucose tolerance tests carried out on a total of 54 T2DM patients given 30 g of casein along with 75g of glucose showed that blood sugar levels at the corresponding intervals in the tests with the protein & glucose together, were lower than in the controls, in two-thirds of the cases, confirming the favorable effect of protein on carbohydrate utilization.
Further experiments conducted on 20 adult cases of T2DM patients showed that proteins evoke a marked endogenous response to insulin secretion. This was adequate to explain the effect of protein on blood sugar levels. Supplements of daily diets of 20 T2DM patients with 30 g casein protein for a period of 6 to 8 weeks brought down the insulin requirements, as shown by a fall in fasting glucose levels in two-thirds of the subjects. Withdrawal of protein from the diet resulted in a prompt rise in fasting sugar levels calling for increased insulin dosage. In a second trial with 30 subjects glucose tolerance done in many cases when the patients were on protein supplementation, showed improved performance in tolerance tests
It was concluded from the experiments that a 30g supplement of protein per day is equivalent to about 20 units of insulin showing that food is an essential factor to control hyperglycemia through enhanced insulin activity by protein. In recent years, several studies conducted on T2DM subjects have reported that glucose concentration did not increase after protein ingestion but insulin levels increased markedly and this results in rapid storage of glucose in liver and skeletal muscles.

Oats – A Functional Food and an alternative medicine for diabetics in developing countries.  Lakshminarayan V¹, Venkat Rao S¹, Murali TSR². ¹Shreehari Diabetes Foundation, Kuvempunagar, Mysore. ² Pepsico Holdings Pvt Ltd, Gurgaon. 
Introduction. Oat grain is a wonderful reservoir of natural nutrients and biologically active substances. Russia, USA, Canada, Northern Europe are the main producers of oats and the world production is 50 million tons per year. Traditionally, the largest use of oats has been for animal feed. The beneficial nutritional and physiological effects of oat products has generated an increased demand for oats in human nutrition, eg. reduction of serum cholesterol and glucose levels by beta-glucans and other dietary fibre components.
Conclusions from our Study
1.  GI value of quick cooking oatmeal is in the moderate range (i.e., <70) at the end of  2hr. (high GI >70, moderate GI 56-69 and low GI <55).
2.  The optimum quantity of oats for breakfast is around 50g, in order that postprandial sugar levels are moderately increased.
3.  Around 50g of quick cooking oatmeal is advised for breakfast for diabetic patients.

Effect of sucralose on glycation.  Kulkarni CC¹, Luktuke PS, Manvar AP, Shrivastav GB.  Sinhagad Institute Of Pharmacy, Pune
Objective. Diabetes is the disease of complications. The complications of the diabetes are more agonizing and torturing than the disease itself. Glycation is called as the non- enzymatic glycosylation as a result of sugar bonding to the protein molecule. Itr is the haphazard process that impairs the functioning of biomolecules. It involves the evolution of the molecule through a complex series of the reactions Amadori product, Schiff base, Millard reactions and lastly the molecule form AGEs (Advanced Glycation End Product). AGE’s are implicated in the initiation of renal dysfunction, cardiovascular diseases, type-2 diabetes and other age related chronic diseases. Artificial sweetener helps the consumer to cut down on calories and control weight, help to manage the chronic condition such as diabetes.
Sucralose is the low-calorie sweetener made from table sugar (Sucrose). Sucralose in reality it is about 600 times sweeter than sugar and can be used in place of sugar to eliminate or reduce calories in a wide variety of products, including beverages, baked goods, desserts, dairy products, canned fruits, syrups and condiments. The toxicity studies done on sucralose have clearly indicated as non-toxic compared to other sweeteners but till date no study onits effect on glycation has been done.
Method. The studies are carried on the effect of glycation of sucralose on model protein such as insulin, in-vitro by measurement of Fluorescence at Ex 370nm/Em 400nm.
Result. The readings are taken under two conditions such as hot air oven (600 ) and the incubator (370). The Sucralose shows increa  sed fluorescence (66-hot air oven,87.33-incubator on average) as compared to, sucrose (4.5-hot air oven,10.16-incubator on average).
Conclusion. This clearly indicates sucralose shows more glycation than thsucrose, which needs to be addressed, and its mechanism needs to be further investigated.

Effect of Trigonella foenum on fasting blood glucose levels in Alloxan induced diabetes in rabbits. Subhani G, Mujtaba S. Kamineni Institute of Medical Sciences, Narketpally.
Introduction. Anti-diabetic plant medicines might provide an important source of new oral hypoglycemic compounds for development as pharmaceutical entities, or as simple dietary adjuncts to existing therapies.
Aims and Objectives. To study the hypoglycemic effect of seeds of Trigonella foenum (methi).
Material and Methods. Alcoholic extract of fenugreek seeds was prepared by cold percolation method over 24hrs using a Soxhlet apparatus. Diabetes was induced in rabbits by administration of Alloxan at 150mg/kg body wt IV. Rabbits with fasting blood sugar 220-500mg/dl were considered diabetic. Diabetic rabbits were divided into groups (n=6) receiving different treatments: vehicle (control), standard antidiabetic drug Metformin (62.5mg/kg b.w) Alcoholic extract (0.5g, 1g and 1.5 g/kg b.w), for 35 days. Blood samples were analyzed for fasting blood glucose daily for the fifteen days and the once weekly for 3weeks.
Results. The mean blood glucose levels in the treatment group with low, medium & high doses of extract were (179.16, 151.66, 127.5mg/dl at the end of 5 weeks. The mean blood glucose levels in the control and positive control group at the end of 5 weeks were (266.83 & 112.66). Observed data was found statistically significant (P<0.05) in reduction of fasting blood glucose.
Conclusion. Fenugreek extract has shown significant reduction in fasting blood glucose levels in diabetic rabbits. They may reduce the dosage of antidiabetic agents when given as a dietary adjunct. The broad dose range of the extract producing hypoglycemic effect in diabetic rabbit was an interesting observation, which requires further study.

Efficacy of aloevera juice consumption on glycemic response in the type-2 diabetic patients.  Agrawal RP, Motha N, Dogra R, Tiwari R, Arora D, Goyal S.  Diabetes Care and Research Centre, S P Medical College, Bikaner. Objectives. The present investigation was carried out to find out the hypoglycemic effect of Aloevera juice on type 2 diabetic patients.
Material and Methods. 24 type 2 diabetic patients were recruited from the out patients of Diabetes Care & Research Center, Bikaner with maximum possible homogeneity in age, sex, occupation and life style. The subjects were divided into two groups: Group 1 (control, n=12) were given conventional treatment i.e. diet, exercise, drugs while group 2 (experimental, n=12) were given 150ml freshly extracted alloevera juice daily during fasting stage in addition to the conventional treatment for 3 months. The biochemical and biophysical parameters were analyzed initially and after 3 months.
Results. Significant changes were noticed in group-2 for fasting blood sugar (196.75±39.59 to 124.17±33.12mg%) and HbA1c (8.66±1.004 to 6.2±0.98mg%). There was also significant improvement in the lipid profile of group-2 after aloevera juice supplementation i.e. total cholesterol (203.5±28.62 to 174.45±25.09mg%), triglycerides (186.21±18.75 to 113.92±19.99mg%), HDL (38.36±3.38 to 51.08±3.65mg%), LDL (124.93±25.84 to 100.76±21.21mg%) and VLDL (37.24±3.75 to 22.78±3.99mg%). There was a slight reduction in BMI (26.38±1.06 to 25.04±0.93) and WHR (0.96±0.03 to 0.94±0.03).
Conclusion. It can be very well concluded that aloevera juice consumption provides better glycemic control alongwith improvement in lipid profile as well as anthropometric measurements.

The efficacy of Cynara scolymus L leaves and Rheum ribes L stalks extract on hypercholersterolemic type II diabetic patients. Fallah Huseini H¹, Mohseni F², Larijani B², Heshmat R², Jamshidi AH¹. ¹Department of Pharmacology, Institute of Medicinal Plants, ACECR, Karaj, Iran. ²Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences Tehran, Iran.
Introduction. Hypercholesterolemia is a main corn stone of attention in patients suffering from diabetes. Rheum ribes (Rr) and Cynara scolymus (Cs) are used in traditional medicine for treatment of hypercholesterolemia.
Aim. To investigate the efficacy of Rr stalks and Cs leaves extract in treatment hypercholesterolemia in type II diabetic hypercholesterolemic patients.
Methods. A one-month randomized double blind clinical trial was conducted in 54 type II diabetic hypercholesterolemic patients in a 3 well-matched groups (n=18). Three groups received Rr, Cs and placebo tablets at the dosage of 400 mg, respectively 3 time a day plus standard therapy. The patients fasting blood sugar (FBS), cholesterol (Cho), LDL, HDL, triglyceride, SGOT and SGPT were determined at the beginning and at the end of the study after one month.
Results. In Rr treated group Cho, LDL, FBS level and in Cs treated group Cho level after one month were significantly decreased as compared to placebo group.
Conclusion. The Rr therapy have beneficial effect on reducing lipid and glucose profile as well as Cs has beneficial effect on reducing cholesterol level in hypercholesterolemia type II diabetic patients.

A Long term Double-Blind study on Tolerability & Efficacy of Psyllium based Premixes staple food on plasma glucose Concentrations and plasma lipid profile in Type II Diabetes Mellitus Subjects: A six month cross over design. Jaswanth Mal Khatod and Devarajan T V  ¹Dept of Diabetology &Internal Medicine, ²Dept of Dietetics (Apollo First Med Hospitals, Chennai) Vilas Shirhatti, Ankita Marwah and Joe Lewis Marico Ltd., Bombay College of Pharmacy, Mumbai.
Type II diabetes Mellitus is an increasing health problem with the prevalence of the disease doubling year by year. The occurrence of Diabetes in adults worldwide is estimated to be above 4.0% and found to rise up to 5.4% in 2025, even with the existence of the Anti Hyperglycemic therapies. This is higher in the developed countries than in developing countries. Functional foods incorporated as part of the daily diet provide the much needed alternative approaches other than the existing anti hyperglycemic therapies. Use the Plant fibers as supplement to anti diabetic therapies which include Psyllium and pectin-the water soluble fibers have proved to be effective in managing the blood sugar levels as well improving the lipid profile another key concern of the diabetics. Last year we had reported the results of a short term double blind cross over study of formulated premix staple with respect to its effect on reducing blood glucose levels. The objective of the long term clinical study presented here was to evaluate the blood glucose response as well as the effect on lipid profile to a meal containing a formulated premix staple during a long term usage in non-insulin dependent type II diabetics. A scientifically well formulated premix staple makes it convenient and acceptable for the patients to incorporate it as part of their daily meal. The premix is mixed with normal wheat flour before making the rotis. A long term Randomized, double blind cross over study to assess the Tolerability & Efficacy of Psyllium based premixes mixed with daily staple foods on levels of plasma glucose concentrations and lipid profile were studied in Type II Diabetes Mellitus Subjects. A 12 Point glucose profile, changes in lipid profile, Glycated hemoglobin, c Peptide, insulin and BMI and body weight were measured during the study period. The findings of this clinical study can be summarized as follows. The product had a significant effect on the glycemic control and reduction in blood glucose levels in Type II diabetes mellitus patients. The product had demonstrable effect on the lipid profile and has the ability to reduce total cholesterol, triglycerides, LDL cholesterol and cholesterol to HDL ratio and at the same time aids in increasing the HDL cholesterol. A measurable decrease was observed in the HbA1c values during the period the study product is consumed. No remarkable changes were seen in body weight and BMI. The study product is safe and does not have any impact on the insulin and c-peptide values, thus confirming that metabolism is not affected by long term consumption of the product. The study product did not have any noticeable side effects during the consumption period as compared to the commercial product. The taste of the product is as good as the commercial product and the rotis made were softer than the normal commercial wheat flour. Thus psyllium based premixes staple food is an excellent form of functional food supplement for Type II Diabetes Mellitus patients, when consumed along with prescribed anti-diabetic medicines under the observation and guidance of a medical practitioner.

Ajinomoto produces neurotoxic effect in Albino mice.  Syed Mujtaba Hussain, Mishra SS. Kamineni Institute of Medical Sciences, Narketpally.
Background. Ajinomoto, monosodium glutamate (MSG), a central excitatory neurotransmitter plays an important role in ischemic brain damage and neurodegenerative disorders; its role in depression is still inconclusive.
Aims and Objectives. To study the role of MSG on motor coordination &depression in albino mice.
Materials and Methods. Four groups of Albino mice (n = 6), weighing more than 25gms were selected and subjected to various tests for motor coordination (Rotarod test, catatonic response time and hang test) and depression (forced swimming test and tail suspension test). Group1,2,3 received monosodium glutamate in 0.5gm,1gm and 2gm/day orally. All the tests were repeated after 1 week of administration. The animals were weighed before & after the study.
Results. The mean of average time in Rotarod test increased for group1 (23.6-40.4sec) and group2 (10.4-45sec) & catatonic response time decreased for group1 (28.8-17.0sec) & group2 (16.6-11.25sec). Group3 showed decrease in Rotarod test (15.8-3sec) & increased catatonic response time (18.8-46.2). Hang test for neuromuscular strength remained unchanged. The immobility time for 5minutes in Tail suspension test increased for all groups, Group1 (176.2-180.8sec) group2 (160.2-273.8sec) group3 (95-300sec). The immobility time in forced swimming test for 5min increased, Group1 (50-75.2sec), Group2 (130-166sec), Group3 (97.5-186.2sec). Weight increased in all groups. The animal one from each group were sacrificed and sent for histopathological test.
The motor coordination has improved in group1&2 but shows severe deterioration in group3 . All the groups showed signs of depression. Results were analyzed by paired ‘t’ test and were significant.
Conclusion. MSG produced neurotoxicity & depression in albino mice.

Hall B
1.30-3.30 pm
Bio Informatics in Diabetes

Clustering of protein sequences using variant threshold valued nearest Neighbor clustering algorithm. Lavanya Devi G, Allam Apparao, Damodaram A , Kanchana Mala P, Satyanarayana KVV, Sridhar GR  Department of Computer Science and Systems Engineering Andhra University  Autonomous College of Engineering Andhra University, Andhra Pradesh, India.
Abstract. With the burgeoning bioinformatics and proteomics studies in metabolic disorders including insulin resistance and diabetes mellitus, innovative methods for clustering of data obtained have become imperative. Multiple protein sequence alignments in general rely on conventions regarding the score of a multiple alignment in pair wise fashion. With the increase in the number of sequences, the run time of sequencing expands exponentially. To address a possible solution to this problem, this paper presents multiple sequence alignment method using variant threshold valued nearest neighbor clustering algorithm. This algorithm clusters similar sequences at one time. BLAST has been used to annotate the clusters generated by variant threshold valued nearest neighbor clustering algorithm. The proposed method of clustering and annotating with BLAST consists of the following steps (1) Pair wise alignments of sequences through probabilistic assumptions (2) Generate the (optimal) distance matrix (3) Clustering the sequences with variant threshold valued nearest neighbor clustering algorithm (4) Annotating the protein clusters with BLAST. The performance of the proposed system was evaluated with 40 genesequences in a TCA  cycle (a citrate cycle) of bacteria. The system generated 11 clusters and found the longest subsequences of each cluster, which are biologically significant.

Computational methods to Mine Knowledge from Microarrays. Karteeka Pavan K, Allam Appa Rao, Sridhar GR.
Microarrays are made it possible to simultaneously monitor the expression profiles of thousands of genes under various experimental conditions. The study of gene expression profiling of cells and tissue has become a major tool for discovery in medicine. Microarray experiments allow description of genome-wide expression changes in health and disease. Such gene expression information can be used in medicine for comparing clinically relevant groups (eg. healthy vs diseased), uncovering new subclasses of diseases, and predicting clinically important outcomes, such as the response to therapy and survival. Analysis of gene expression data has proved to be a useful tool for identifying coexpressed genes, biologically relevant groupings of genes and samples. In this paper we present the computational methods in Microarray analysis to extract the biological information, clusters the gene expression data using Automatic Generation of Merge factor for ISODATA - AGMFI developed by us and compares the results with K-means.

Comparative Genomics and Clustering of Diabetes related Proteins. Bhramaramba R , Allam Appa Rao, Vijaya Kumar V, Sridhar GR.
The objective of the study is to find the organisms in which most of the Diabetes related proteins are present and to find the clustering among them using Histograms and bivariate plots. Protein Data has been taken and attributes calculated using C software and analysis done using Statistica package. In Diabetes related proteins it was found that humans have orthologs in House Mice and Norway Rat and hence there exist common Diabetes related proteins though the length varies slightly across the organisms (mammals). It can be inferred from the bivariate plots that House Mice and Norway Rat cluster and are similar in terms of the protein attributes and differ from that of Human Sample.

Neural network (MLP) Clinical Decision Support System to predict WellBeing in Diabetes.  Narasinga Rao MR, Sridhar GR, Madhu K, Allam Appa Rao.
We have developed a neural network system which is trained to predict the well being in diabetes, using data generated in real life. We developed a Multi Layer Perceptron Neural Network model, which had been trained by back propagation algorithm. Data was used from a cohort of 241 individuals with diabetes. We used age, gender, weight, fasting plasma glucose as a set of inputs and predicted measures of well-being (depression, anxiety, energy and positive well-being). With five inputs (age, sex, weight, fasting plasma glucose, bias), four outputs are four (depression, anxiety, energy and positive well-being) the momentum rate was 0.9, the learning rate 0.7, using a sample of 50. the maximum individual error is 0.001. When the number of iterations were 500, number of hidden layers 1 and the number of units in the hidden layer 6, the normalized system error was 470.57. With input samples of 100,150 and 200, keeping the other variables constant, the normalized system error was 419.61, 359.67 and 332.32 respectively. Similar values are found for the normalized system error when the number of units in the hidden layer have been increased to 7,8 and 9 respectively. With two hidden layers, and with each hidden layer containing 6,7,8,9,10,11 units for the samples 50, 100, 150 and 200 , the same values of normalized system error was found.
Conclusion. We have developed a prototype neural network model to predict the psychosocial well-being in diabetes, when biological or biographical variables are given as inputs. When greater data was fed real data to the system, the normalized system error can be reduced.

Comparison of secondary structure of Butyrylcholinesterase (BchE) using in silico methods. Sridhar GR, Kudipudi Srinivas, Allam Appa Rao, Boyidi Poorna Satyanarayana,  Nageswar Rao K, Srinubabu G.
Butyrylcholinesterase has a well established pharmacogenetic role in the hydrolysis of muscle relaxant succinylcholine. But its physiological roles are unclear. It was shown to modulate the expression of insulin resistance syndrome. In the current insilico work we delineated the secondary structure of the enzyme and compare it with other proteins of similar structures. Using the amino acid sequences of BchE, we obtained the secondary structure output using the SOPM tool. From the PDB database we compared the secondary structure of BchE with those having 65% or more similarity. The proteins are present in both the cytoplasm, extracellular compartment and cytoplasmic membranes. In summary we compared the predicted secondary structure of butyrylcholinesterase and obtained 13 proteins with at least 65% similarity that are found in the cytoplasm and extracellular regions, with catabolic, synthetic, electron transport and immune processing.

Plant insulin: an in silico approach.  Saradha Jyothi Koona¹, Kudipudi Srinivas², Sridhar GR³, Subba Rao B¹, Allam Apparao⁴.  ¹Department of Botany, Andhra University, VisakhapatnamIndia; ²Dept of Computer Science, Acharya Nagarjuna University, Nagajuna Nagar, India ³Endocrine and Diabetes Centre, Visakhapatnam ^.4Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam.
Insulin is a hormone traditionally believed to occur only in the animal kingdom, not in plants. We performed a bioinformatics study of plant genomes and observed that sequences similar to animal insulin exist in cow pea, jackbean and bauhinia purpurea. We constructed phylogenetic tree of the different insulins. In conclusion insulin like molecules exist in the plant kingdom and may be responsible for plant development and other as yet unknown metabolic functions. In addition they may be responsible for some of the actions of plant extracts for their antidiabetic properties.

Bioinformatic Analysis of Functional Proteins Involved in Obesity Associated with Diabetes. Manga Tayaru N¹, Hanuman Thota², Suresh Babu Changalasetty² , Lalitha Saroja Thota³, Allam Appa Rao¹, Srinubabu Gedela*^{1 1}International Center for Bioinformatics, Department of Computer Science and Systems    Engineering, Andhra University, Visakhapatnam  ²Department of Computer Sciences and Engineering, Acharya Nagarjuna University, Guntur ³ Annamalai University, Annamalai Nagar.
The twin epidemic of diabetes and obesity pose daunting challenges worldwide. The dramatic rise in obesity-associated diabetes resulted in an alarming increase in the incidence and prevalence of obesity, an important complication of diabetes. Differences among individuals in their susceptibility to both these conditions probably reflect their genetic constitutions. The dramatic improvements in genomic and bioinformatic resources are accelerating the pace of gene discovery. It is tempting to speculate the key susceptible genes/proteins that bridges diabetes mellitus and obesity. In this regard, we evaluated the role of several genes/proteins that are believed to be involved in the evolution of obesity associated diabetes by employing multiple sequence alignment using ClustalW tool and constructed a phylogram tree using functional protein sequences extracted from NCBI. Phylogram was constructed using Neighbor-Joining Algorithm, a bioinformatic tool. Our bioinformatic analysis reports resistin gene as ominous link with obesity associated diabetes. This bioinformatic study will be useful for future studies towards therapeutic inventions of obesity associated type 2 diabetes.

Computational analysis of microsatellites in colon cancer genes. Vamsidhar Enireddy, Kishore Gunna, Allam Appa Rao, Sridhar G R, Suresh B Mudunuri. Carcinoma of the colon, which has been recognized to co-exist with metabolic syndrome and type 2 diabetes, is also a major cause of death, appearing at a younger age in Asian Indians. It results from an interaction of genes and environmental changes. Mutations of MSH gene is a well known factor in the pathogenesis. Earlier we showed that microsatellite regions were associated with mutations in the MSH gene. Here we extended the study to include all known genes known to be associated with colon cancer and identified microsatellite regions in each. There were no known mutations in any of the other genes in the HGMD (Human genome mutation database) except for MSH gene. Therefore, in the presence of microsatellite regions, further studies in the association of mutations of genes and colon cancer must evaluate for mutations that might occur at the microsatellite regions.

Computational Analysis of Repeat Patterns in Diabetic Genes. Suresh B Mudunuri, Allam Appa Rao, Sridhar G R,  Department of Computer Science and Systems Engineering, Andhra University, Visakhapatnam.
Human genome sequence contains a large number of small repeat patterns that vary in number and size. Microsatellites are one such type of repeats of pattern size 1-6 that repeat tandemly. These repeats are known to be responsible for causing various diseases such as neuro-degenerative diseases and are also responsible for evolution of the organisms. These microsatellites are more prone for mutations (changes) in their sequence leading to formation of abnormal protein/no protein which in turn result in various diseases. Analysis of these repeats invivo is expensive and time consuming. So, we made a simple computational analysis of few genes responsible for causing diabetes and the results are satisfactory. We found that the human insulin promoter factor 1 (IPF-1) gene gets mutated due to the presence of microsatellites and thus causing diabetes in some cases. We have collected the mutations of these genes from Human Gene Mutation Database and the microsatellites extracted using the tool Imperfect Microsatellite Extractor (IMEx) were mapped and found interesting facts. Our analysis revealed that the InsCCG243 (Proline insertion) mutation that is known to inhibit the insulin production, is due to microsatellite polymorphism. We analyzed 9 known mutations in the IPF-1 gene (excluding the silence mutations) and found out except one (R197H), all the other mutations (C18R, Q59L, Pro63fsdel, D76N, G212R, E224, P239Q, InsCCG243) fall outside the domain region. The mutation falling in the domain region seems to be inducing a change in the secondary structure and resulting in change or absence of protein function. We report that 4 out of these 9 mutations fall inside the microsatellite tracts and thus indicating a positive role of microsatellites in mutagenesis. A complete analysis of all the human genes which directly or indirectly cause diabetes needs to be done to get much more interesting results.

Cluster Analysis in Biomarker Identification of microarray data of type 2 Diabetes and nephropathy. Satya vani Guttula¹,Allam Appa Rao², G.R.Sridhar³, M.S.Chakravarthy¹, Paturi V Rao^4, R.Rajendar², Subha⁵. ¹Dept of Marine Living Resources, ²College of Engineering, ⁵Department of microbiology , Andhra University, ³Endocrine and Diabetes Centre, Visakhapatnam, ⁴Department of Endocrinology, Nizams Institute of medical sciences, Hyderabad.
Abstract. Cluster analysis of DNA micro array data is described that uses statistical algorithms to arrange the genes according to similarity in patterns of gene expression and the output displayed graphically. Hierarchical Clustering is a multivariate tool often used in phylogenetics, comparative genomics to relate the evolution of species. The patterns seen in microarray expression data can be interpreted as indications of the status of the genes responsible in Type2 Diabetic nephropathy in Peripheral Blood Cells. Out of 415 genes totally expressed in the 3 DNA chips came to conclusion that only 116 genes expressed in T2DN and in that only 50 are functional genes. These 50 functional genes are responsible for diabetic nephropathy, out of these 50, some of the genes which are more expressed and responsible are AGXT: Alanine-glyoxylate aminotransferase, RHOD: Ras homolog gene family, CAPN6: Calpain 6, EFNB2: Ephrin-B2, ANXA7: Annexin A7, PEG10: Paternally expressed 10, DPP4: Dipeptidyl-peptidase 4 (CD26, adenosine deaminase complexing protein 2), ENSA: Endosulfine alpha, IGFBP2: Insulin-like growth factor binding protein 2, 36kDa, CENPB: Centromere protein B, 80kDa, MLL3: Myeloid/lymphoid or mixed-lineage leukemia 3, BDNF: Brain-derived neurotrophic factor, EIF4A2: Eukaryotic translation initiation factor 4A, isoform 2, PPP2R1A: Protein phosphatase 2 (formerly 2A), regulatory subunit A, alpha isoform.

50 genes and their nucleotide sequences are taken from NCBI and a
phylogenetic tree is constructed using CLUSTAL W and the distances are
closer to each other concluding that based on the sequence similarity
and evolution the genes are expressed similarly.

Data Mining of Diabetes Related Proteins Bhramaramba R¹, Allam Appa Rao², Vakula Vijay Kumar³, Sridhar GR⁴ 1 Department of Computer Science and Engineering, Anil Neerukonda Institute of Technology and Sciences, Visakhapatnam, India 2 Vice-Chancellor, JNTU, Kakinada, India 3 Dean, Godavari Institute of Engineering and Technology, Rajahmundry 4 Endocrine and Diabetes Centre, Visakhapatnam

Objective. To obtain meaning from the flood of genomic data by using data mining techniques namely, principal component analysis and Discriminant Analysis pertaining to a sample diabetes related proteins obtained from a database.

Methods. C software has been used to calculate the protein attributes.

Discriminant Analysis and Principal Component Analysis have been performed using SPSS 16.0 Software. Protein Sample has been taken from www.genecards.org.

Results. Comparative analysis of genome sequences was performed to unravel the complexities of biological processes by using data mining tools. Almost all human genes known to be associated with disease have rat orthologs. About 30% of rat genome aligns only with the mouse. Globally the mouse genome is about 14% smaller than the human genome.  Eighty percent of mouse proteins had strict 1:1 orthologs in human genome. The rat genome was smaller than human, but larger than the mouse. Both however encode a similar number of genes. The use of rat and mouse for comparison with human proteins is appropriate because sufficient evolutionary distance exists between rodents and humans.

Conclusion. principal component analysis could assist in assigning function to diabetes related proteins, which are being identified at an increasing pace. Discriminant Analysis technique proves that among the three species under study human beings distinctly differs from the other two species house mice and Norway Rat in respect of their protein attributes.

Analysis from all methods showed that there was a clustering of proteins from humans, which was different from that of mouse and rat; those from the latter two animals clustered together.

Ceramide Mediates Glucolipotoxicity of the Pancreatic Beta Cell. Anjan Kowluru. Department of Pharmaceutical Sciences, Wayne State University, Detroit.
The sphingolipid ceramide [CER] has been recognized as an important mediator of a variety of cellular responses including cell death via apoptosis. Intracellular generation of CER could result either from de novo synthesis from fatty acids or from hydrolysis of sphingomyelin. Available evidence suggests that chronic exposure of isolated beta cells  to high levels of glucose [i.e., glucotoxicity], lipids [i.e., lipotoxicity] or both [i.e., glucolipotoxicity] leads to their metabolic dysfunction and demise via apoptosis. However, the precise mechanisms underlying dysregulation of beta cells under glucolipotoxic conditions remain less understood.  Herein, we report a significant increase in the CER-activated protein phosphatase activity in isolated beta cells under glucolipotoxic conditions. This results in dephosphorylation and subsequent inactivation of key cellular proteins, including mitochondrial Bcl2 leading to mitochondrial dysfunction [e.g., loss in membrane potential and release of cytochrome C into the cytosol] and demise of the beta cell. These findings were confirmed in islets derived from the ZDF rat, a model for type 2 diabetes.  Further, we also observed a significant increase in CER-induced generation of reactive oxygen species and the associated oxidative stress in isolated beta cells under glucolipotoxic conditions thereby leading to mitochondrial dysfunction. Based on these data, we propose that intracellular generation of CER under glucolipotoxic conditions represents one of the signaling steps leading to mitochondrial dysfunction and demise of the beta cell culminating in the onset of diabetes.

Islet Cells Auto-Immunity in Youth Onset Diabetes Mellitus in India
Kochupillai N¹, R Goswami², N Gupta², Anil Kukreja³, Neol K Maclaren³, Michael Lan^{4 1}Director, Medical Research, M S Ramaiah Medical College, Bangalore,  ²All India Institute of Medical Sciences, New Delhi ³The Weill College of Medicine of Cornell University, New York, NY, USA,  ⁴The Research Institute for Children, New Orleans, LA, USA 

132 consecutive youth onset diabetics (age of onset <30 years) were studied for serological markers of islet cell auto-immunity, associated thyroid auto-immunity as well as co-existing malnutrition and calcific pancreatropathy. 37% had classical type I Diabetes Mellitus. 32% were Ketosis Resistant Diabetes of the Young (KRDY), 11% were having Fibro-Calcific Pancreatopathy (FCPD) and 7% had auto-immune polyglandular syndrome (coexisting islet cell and thyroid autoimmunity). 22% of type I and 30% of auto-immune polyglandular auto-immunity related diabetics showed both GAD65 and IA–2 antibody positivity, whereas only 4.7% of KRYD showed GAD65 + IA–2 Ab positivity (p<0.001). However, GAD65 Ab lone +vity was shown by 38% of KRYD, which was significantly more than the 14.2% & 10% positivity seen in type I and auto-immune polyglandular auto-immune types respectively. The FCPD group showed GAD65 & IA–2 Ab positivity in 14.2% and GAD Ab alone positivity in 7.1% 26 & 60% respectively of type I and auto immune polyglandular syndrome groups had thyroid microsomal Ab +vity. Type I group had significantly less C-peptide response to glucagon when compared to the ketosis resistant and auto-immune polyglandular groups. Type II youth onset group studied tested negative for islet cell auto immunity markers. Thus, 4 out of 5 of youth onset diabetic groups studied demonstrate serological markers of islet cell auto-immunity.

-------------------------------------------------------------------------------------------------------------------------- Submission of Abstracts

Diabetes researchers were invited to collect relevant data for presenting theme papers and for sending research abstracts of oral or poster presentations to Chairman, Scientific committee before: August 31, 2008.

Nutrition Section :  Functional Foods
Ahuja Symposium : Iatrogenic Hypoglycemia

All members were requested to send their suggestions regarding topics that they would like to be discussed during the CME programme of the 36th Annual Conference of RSSDI in Hyderabad to:
Professor Rao P.V., Chairman, Scientific Committee
(Head, Department of Endocrinology and Metabolism,
Nizam's Institute of Medical Sciences University)

Diabetes Center, Millennium Block,
NIMS Hospital, Hyderabad 500 082 India
www.rssdi2008.org   scientific(at)rssdi2008.org, rssdi2008(at)gmail.com
tel +91-40 23327111, +919394272693
__________________________________________________________________________________

Travel Grants:

A limited number of travel grants are available from RSSDI, to support the travel expenses of young delegates, whose scientific papers have been accepted for presentation at RSSDI-2008. Requests for travel grants may be sent to the Chairman, Scientific Committee.

Professor Rao P.V., Chairman, Scientific Committee
(Head, Department of Endocrinology and Metabolism,
Nizam's Institute of Medical Sciences University)
Diabetes Center, Millennium Block,
NIMS Hospital, Hyderabad 500 082 India
www.rssdi2008.org   rssdi2008(at)gmail.com
tel +91-40 23327111, +91 9394272693
__________________________________________________________________________________

Guidelines for abstract submission: