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Open access

Saibal Chakravorty, Indranil Purkait, Anil Pareek and Avinash Talware

Abstract

Hydroxychloroquine, an antimalarial agent has also been found to possess antidiabetic action. Onset of type-2 diabetes (T2DM) and cardiovascular disease is now considered to be the outcome of systemic inflammation. Many clinical trials are targeting systemic inflammation to reduce cardiovascular risk. Anti-inflammatory drugs with cardiovascular effects may be valuable therapeutic intervention to reduce massive cardiovascular risk in T2DM. In this review, antidiabetic action and potential cardioprotective role of hydroxychloroquine has been discussed. By virtue of its antidiabetic, lipid lowering, anti-platelet, anticoagulant and anti-inflammatory properties, hydroxychloroquine can be a key therapeutic alternative to manage patients with T2DM.

Open access

Cătălina Iamandi-Cioinaru, Bogdan Corad, Monica Marin, Andreea Trocea, Anca Colda, Emilia Rusu and Gabriela Radulian

Abstract

Background and aims: This paper aims at understanding patient’s perspective in coping with diabetes in Romania. The study analyzes whether there are significant differences between health related quality of life (HRQL) of patients with diabetes, based on socio-demographic and disease-related characteristics.

Material and methods: The study included 128 patients aged ≥ 18 years, diagnosed with type 1 and 2 diabetes and was conducted in the period of November 2015 – July 2016. The project included two main research instruments – one questionnaire applied face-to-face to each patient and one questionnaire completed by the physicians including health data for each patient who agreed to participate in the study. The set of tested characteristics includes: (i) gender; (ii) place of residence; (iii) education level; (iv) marital status; (v) employment status; (vi) level of personal income; (vii) age; (viii) type of diabetes; (ix) duration of diabetes; (x) household composition (another person with diabetes); (xi) network support and (xii) patient’s access to information and communication technology (ICT).

Results: The mean age was 54.23±12.76 years, with three quarters of respondents above the age of 40 years and 68% married. More than half of participants have access to internet, either at home or at work.

Conclusions: The results indicate that gender, household’s composition, place of residence, access to ICT, employment status, type of diabetes, personal income level, the presence of a support network, age and diabetes duration differentiate between reported HRQL indicators. The study adds knowledge for understanding chronic disease patients’ self-assessment of HRQL in Romania.

Open access

Alka Pawalia, Sivachidambaram Kulandaivelan, Satya Savant and Vikram Singh Yadav

Abstract

Background and aims: The purpose of this study was to investigate the effect of physical activity and diet during prenatal period and its effect on gestational weight gain (GWG), BMI, waist circumference (WC), hip circumference (HC) and post-partum weight retention (PPWR).

Materials and Methods: This was an experimental study (pre-post comparison) with 45 pregnant women having singleton pregnancy of >16 weeks of gestation, BMI>18.5 Kg/m2 and having a mobile phone. They were randomly divided into 3 groups (n=12 each; compliance rate 80%) (i.e.) exercise (n=12), exercise with diet advise (n=12) and control (n=12) group. Exercise groups attended weekly antenatal exercise sessions at the hospital during pregnancy; diet group received regular diet counseling followed by mobile text-messages (reminder, motivational, guidelines and benefits) to maintain adequate diet. The data was analyzed using IBM-SPSS software.

Results: Exercise groups gained less weight then control. Similarly, had mean GWG less as compared to control group though not statistically significant. The mean WC changes were significant amongst the groups with the exercise groups having least gain in WC (p<0.05).

Conclusion: Adopting an active lifestyle along with proper diet care can prevent development of abdominal obesity and metabolic syndrome in Indian pregnant women which could prevent them from other associated lifestyle diseases in future.

Open access

Cristian Guja and Andrada Mihai

Open access

Meriem Bencharif, Chaima Boudaoud, Amal Fenaghra and Youcef Benabbas

Abstract

Background and aims: Fasting of Ramadan leads to changes in dietary habits, physical activity, sleep and time of drug intake for diabetics. The objective of this study was to evaluate the effect of pre-Ramadan education on dietary intake and anthropometry of two groups of patients.

Material and methods: The entire cohort was divided in a group (G1; n=86) which attended nutritional education sessions and group that did not attend these sessions (G2; n=72). The protocol included three visits before, during and after the month of Ramadan.

Results. Total energy intake of the G1 did not differ significantly between visits, unlike the G2. Patients in the G1 reduced their carbohydrate intake during Ramadan with 32.5g, compared to the G2 which decreased their consumption with17.2g. The intake of saturated fatty acids was significantly higher in the G2 (p=0.001) after Ramadan. The number of obese class 2 of the G1 decreased after Ramadan, however for the G2, the number increased. The waist-to-hip ratio and the body fat (%) were unchanged between the three periods.

Conclusion. The management of diabetes should be multidisciplinary to ensure better continuity of care. Specialized and individual educational actions must be concrete in diabetics wishing to fast.

Open access

Nidhi Takkar, Jai Prakash Takkar, R Padmakumar, Navin A Patil, Karthik N Rao and Dipanjan Bhattacharje

Abstract

Background and Aims: Autonomic dysfunction in type 2 diabetes mellitus (DM) patients may translate into an increased cardiovascular morbidity and mortality. Autonomic system regulates ‘heart rate recovery’ (HRR), an important predictor of cardiovascular mortality, which can be assessed using the exercise electrocardiogram (ECG). Hence, utilizing HRR, this study assessed the autonomic function of the cardiovascular system after one minute of exercise stress test in both, patients with and without type 2 DM.

Materials and Methods: A prospective case control study involving 50 patients with type 2 DM and 50 without type 2 DM, matched for age and sex, was carried out. Each subject underwent an exercise stress test by treadmill using the Bruce protocol. Cardiovascular parameters like heart rate was recorded using a 12 lead ECG along with blood pressure.

Results: Patients with T2DM had lesser HRR after exercise (p < 0.001). Exercise capacity was significantly reduced among patients with T2DM when compared to controls (p = 0.01). A multiple linear regression analysis (R2=0.26) revealed that duration of diabetes (β=−0.02, p=0.048) and resting systolic blood pressure (SBP) (β=−010, p=0.048) are independent predictors of HRR.

Conclusion: The study revealed HRR to be significantly reduced among patients with type 2 DM. HRR may hint at the presence of cardiac autonomic dysfunction and predict the cardiovascular mortality.

Open access

Juraj Gmitrov

Abstract

Insulin resistance is a root cause of Type 2 Diabetes Mellitus (T2DM) appearing long time before the outbreak of hyperglycemia. On molecular level, a complex impairment of various biochemical processes occurs, the most important being the failure of phosphatidylinositol 3-kinase enzymatic chain responsible for activation of glucose transporters and endothelial nitric oxide (NO) synthesis. Therefore, in insulin resistant states the defect of glucose utilization is coupled with NO deficit and vasodilatory impairment, generating a huge body of residual cardiovascular risk. However, majority of drugs administered to treat T2DM (sulfonylureas, high doses of insulin) even amplify this malignant relationship, reflected by aggravated obesity, dyslipidemia and arterial hypertension. Early and tight glycemic control strategy is helpful to prevent cardiovascular complications in younger diabetics and harmful for long lasting diabetes in older patients, dying mostly from macrovascular complications (80%) for which hyperglycemia, responsible primarily for microvascular impairment, is a weak risk factor compared with hypercholesterolemia or high blood pressure. Glucocentric paradigm of T2DM treatment should be therefore revised in favor of pathophysiologic approaches with drugs selected to address multifactorial risk, affecting different components of diabetes pathophysiology, to achieve hypoglycemic goals without worsening obesity, insulin resistance, sympathetic overactivity and NO deficit, for example with dual or triple combinations (with dosage adjusted to glycemia) such as: metformin + SGLT2 inhibitor + GLP-1 agonist or metformin + SGLT2 inhibitor + pyoglitazone. Patients should be strongly advised to enhance physical activity, reduce body weight this being the most effective method to decrease insulin resistance, the key factor of extensive cardiovascular damage.

Open access

David M. Garner, Naiara Maria de Souza and Luiz Carlos M. Vanderlei

Abstract

Background: The priniciple objective here is to analyze cardiovascular dynamics in diabetic subjects by actions related to heart rate variability (HRV). The correlation of chaotic globals is vital to evaluate the probability of dynamical diseases.

Methods: Forty-six adults were split equally. The autonomic evaluation consisted of recording HRV for 30 minutes in supine position without any additional stimuli. “Chaotic globals” are then able to statistically determine which series of interbeat intervals are diabetic and which are not. Two of these chaotic globals, spectral Entropy and spectral Detrended fluctuation analysis were derived from six alternative power spectra: Welch, Multi-Taper Method, Covariance, Burg, Yule-Walker and the Periodogram. We then compared results to observe which power spectra provided the greatest significance by three statistical tests: One-way analysis of variance (ANOVA1); Kruskal-Wallis technique and the multivariate technique, principal component analysis (PCA).

Results: The Chaotic Forward Parameter One (CFP1) applying all three parameters is proven the most robust algorithm with Welch and MTM spectra enforced. This was proven following two tests for normality where ANOVA1 (p=0.09) and Kruskal-Wallis (p=0.03). Multivariate analysis revealed that two principal components represented 99.8% of total variance, a steep scree plot, with CFP1 the most influential parameter.

Conclusion: Diabetes reduced the chaotic response.

Open access

Chee Huei Phing, Lee Syeh Hoa and Tan Xue Hua

Abstract

Background and aims: In light of the urbanization, industrialization and mechanized transportation, cardiovascular risk factors have been predominated. Hence, it is hypothesized that Malaysian students entering the university would not be oblivious to this reality. The study aims to investigate the cardiovascular disease risk factors stratified on genders and body weight status.

Material and Methods: This pilot study had a cross-sectional design. Subjects were assessed for several parameters such as smoking, alcohol consumption, dietary habits, weight, height, physical activity level, waist circumference, hip circumference, blood pressure, pulse rate, glucose, uric acid and cholesterol level. Subjects were students aged 18 years and above who agreed to participate.

Results: Males have higher mean height, weight, waist circumference, hip circumference, body mass index and waist-to-hip ratio compared to females (p<0.05). In addition, males have higher mean value for systolic blood pressure (p<0.05), diastolic blood pressure, glucose level, uric acid level and cholesterol level, but lower mean value for pulse rate. Systolic blood pressure and diastolic blood pressure correlated significantly with the three obesity indices, explicitly body mass index, waist circumference and waist-to-hip ratio(p<0.05).

Conclusions: It is crucial to implement intervention programs for those individuals with high risk in developing cardiovascular diseases.

Open access

Cornelia Bala, Paraschiva Andreia Preda and Kovacs Tünde