Baqai Institute of Diabetology and Endocrinology

Karachi, Pakistan

Baqai Institute of Diabetology and Endocrinology

Karachi, Pakistan
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Haleem D.J.,University of Karachi | Sheikh S.,Liaquat National Hospital & Medical College | Fawad A.,Baqai Institute of Diabetology and Endocrinology | Haleem M.A.,Sir Syed University of Engineering and Technology
Metabolic Brain Disease | Year: 2017

A large number of diabetes patients suffer from major depression and are at high risk of mortality. In view of a role of leptin in diabetes, depression and energy homeostasis, the present study concerns circulating levels of leptin in different BMI groups of un-depressed and depressed diabetes patients. Six hundred thirty male and female patients with a primary diagnosis of diabetes were grouped according to BMI and with or without clinical symptoms of depression. Age matched healthy, normal weight male and female volunteers without clinical symptoms of depression or diabetes were taken as controls. Blood samples were obtained after an overnight fast of 12 h. Serum was stored for the determination of leptin and glucose. We found that there were more female than male diabetes patients with comorbid depression. Fasting leptin was higher in normal weight non-diabetes women than men; but comparable in normal weight men and women diabetes patients. Fasting glucose levels were higher in diabetes than non diabetes groups; values were comparable in men and women. Depression was associated with a decrease and increase in leptin respectively in normal-overweight and obese men and women diabetes patients. Glucose levels were also higher in obese depressed than un-depressed diabetes patients. The results suggested that the female gender is at greater risk to comorbid diabetes with depression. Adipo-insular axis plays an important role in diabetes, associated depression and in the greater risk of the female gender to comorbid diabetes with depression. © 2017 Springer Science+Business Media New York

Fawwad A.,Baqai Medical University | Fawwad A.,Baqai Institute of Diabetology and Endocrinology | Rashid K.,Baqai Institute of Diabetology and Endocrinology | Basit A.,Baqai Institute of Diabetology and Endocrinology
Turkish Journal of Endocrinology and Metabolism | Year: 2017

Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has come up as a major cause of mortality and continues to cause enormous socio-economic loss across the globe. In the purview of this, a thorough understanding of the pathophysiology, etiology, and pathogenesis of the condition is the need-of-the-hour so as to develop potent therapeutics to have a better control of T2DM. In the developing countries, especially the South Asian region, the condition has become a major health issue owing to the low income and distinct socio-economic patterns. In the European population, a variety of genes have been found to be associated with T2DM; however, their contribution to the other ethnic groups is still unclear. In recent years, various research groups analyzed the prevalence of such genes in Asian populations. The Genome Wide Association Scan (GWAS) successfully identified more than 70 genetic variants that are associated with the T2DM. The present article intends to provide a comprehensive account of the major studies on the genetics of T2DM, with special reference to the Asian population. The various risk factors and the complications associated with the T2DM will be discussed. The review also highlights the major differences and similarities between the susceptibility loci that have been investigated in different ethnicities to provide a novel insight into the disease pathogenesis and its heritability patterns. The information presented, herein, on the genetics of type 2 Diabetes Mellitus holds signi?cance as it paves the way for the development of potential biomarkers and strengthens the fact that speci?c genetic alterations have important functional roles in the progression or development of T2DM. © 2017 by Turkish Journal of Endocrinology and Metabolism Association Turkish Journal of Endocrinology and Metabolism published by Türkiye Klinikleri.

Akram J.,Akram Medical Complex | Aamir A.,Postgraduate Medical Institute | Basit A.,Baqai Institute of Diabetology and Endocrinology | Qureshi M.S.,KRL Hospital | And 5 more authors.
Journal of the Pakistan Medical Association | Year: 2011

Objectives: To observe the prevalence of peripheral arterial disease (PAD) and associated factors among people with type 2 diabetes in Pakistan. Methods: A multicenter cross-sectional study was carried out at eight centers in all the provinces of Pakistan on people with type 2 diabetes. History of symptoms related to Peripheral arterial disease were noted and anthropometric measurements were recorded. Ankle brachial index (ABI) was measured using Doppler ultrasound; patients with ABI < 0.9 were classified as having low ABI. Results: There were 830 patients in the study, (49% males and 51% females). Females were younger and had a higher body mass index (BMI) (p<0.001). The prevalence of peripheral arterial disease was 31.6% with a 95% CI of 28.4% to 34.8%. There was no significant difference in the proportion of low ABI between males (30%) and females (33%) (p=0.29). Patients with low ABI were found to have significantly higherBMI (p=0.02) and waist circumference (p=0.001). The most common symptom in the patients with low ABI was pain on walking (84%), followed by numbness of the feet (64%). There was a significant difference in the reporting of all the symptoms (p<0.05) except for numbness of the feet (p=0.57) as compared to patients with normal ABI. No association was found between low ABI and duration of diabetes mellitus or cigarette smoking. There was no significant association between cardiovascular conditions and low ABI. Conclusion: Peripheral arterial disease is common among people with type 2 diabetes in Pakistan and needs to be properly evaluated by the medical professionals as early diagnosis can help prevent future complications.

Riaz M.,Baqai Medical University | Basit A.,Baqai Medical University | Hydrie M.Z.I.,University of Oslo | Hydrie M.Z.I.,Baqai Institute of Diabetology and Endocrinology | And 5 more authors.
Primary Care Diabetes | Year: 2012

Objective: To develop and evaluate a risk score to predict people at high risk of developing type 2 diabetes in Pakistan. Methodology: Cross sectional data regarding primary prevention of diabetes in Pakistan. Diabetes risk score was developed by using simple parameters namely age, waist circumference, and family history of diabetes. Odds ratios of the model were used to assign a score value for each variable and the diabetes risk score was calculated as the sum of those scores. Results: We externally validated the score using two data from 1264 subjects and 856 subjects aged 25 years and above from two separate studies respectively. Validating this score using the first data from the second screening study gave an area under the receive operator characteristics curve [AROC] of 0.758. A cut point of 4 had a sensitivity of 47.0% and specificity of 88% and in the second data AROC is 0.7 with 44% sensitivity and 89% specificity. Conclusions: A simple diabetes risk score, based on a set of variables can be used for the identification of high risk individuals for early intervention to delay or prevent type 2 diabetes in Pakistani population. © 2012 Primary Care Diabetes Europe. All rights reserved.

Kooner J.S.,Imperial College London | Kooner J.S.,Ealing Hospital National Health Service NHS Trust | Saleheen D.,Center for Non Communicable Diseases Pakistan | Saleheen D.,University of Cambridge | And 82 more authors.
Nature Genetics | Year: 2011

We carried out a genome-wide association study of type-2 diabetes (T2D) in individuals of South Asian ancestry. Our discovery set included 5,561 individuals with T2D (cases) and 14,458 controls drawn from studies in London, Pakistan and Singapore. We identified 20 independent SNPs associated with T2D at P < 10 -4 for testing in a replication sample of 13,170 cases and 25,398 controls, also all of South Asian ancestry. In the combined analysis, we identified common genetic variants at six loci (GRB14, ST6GAL1, VPS26A, HMG20A, AP3S2 and HNF4A) newly associated with T2D (P = 4.1 × 10 -8 to P = 1.9 × 10 -11). SNPs at GRB14 were also associated with insulin sensitivity (P = 5.0 × 10 -4), and SNPs at ST6GAL1 and HNF4A were also associated with pancreatic beta-cell function (P = 0.02 and P = 0.001, respectively). Our findings provide additional insight into mechanisms underlying T2D and show the potential for new discovery from genetic association studies in South Asians, a population with increased susceptibility to T2D. © 2011 Nature America, Inc. All rights reserved.

PubMed | University of Karachi, Baqai Institute of Diabetology and Endocrinology and Al Ibrahim Eye Hospital
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2015

To determine the acceptance of retinal screening, Laser uptake and subsequent follow-up in diabetic patients attending the Diabetes Centre of Diabetic Association of Pakistan (DAP), Karachi.Observational case series.Diabetic Centre of Diabetic Association of Pakistan (DAP), Karachi, from January 2011 to December 2012.All the diabetic patients were screened for Diabetic Retinopathy (DR) with non-Mydriatic Fundus Camera (NMFC). Patients with DR were examined by the ophthalmologist using fundus lens and slit lamp. DR was graded for severity on the basis of modified Airlie House Classification. Patients with Sight Threatening Diabetic Retinopathy (STDR) were advised Laser treatment. Each patient was followed-up for at least 6 months. The records of patients recommended Laser were retrieved, and called for re-examination.Retinal screening was accepted by all of the 8368 registered diabetics attending DAP Centre. On fundus photography, 21.2% (1777) individuals were found to have DR. Seven hundred and five (39.5%) patients were found to have STDR. Laser was advised to 96.4% (680) of STDR patients; amongst whom 70.5% (480) accepted Laser treatment. Out of 480 patients who had Laser treatment, 21.2% (107) turned out for follow-up after 6 months.Acceptance of retinal screening and Laser application was good; but follow-up was suboptional.

Saxena R.,Harvard University | Saleheen D.,Center for Non Communicable Diseases | Saleheen D.,University of Cambridge | Saleheen D.,University of Pennsylvania | And 54 more authors.
Diabetes | Year: 2013

We performed a genome-wide association study (GWAS) and a multistage meta-analysis of type 2 diabetes (T2D) in Punjabi Sikhs from India. Our discovery GWAS in 1,616 individuals (842 case subjects) was followed by in silico replication of the top 513 independent single nucleotide polymorphisms (SNPs) (P < 10-3) in Punjabi Sikhs (n = 2,819; 801 case subjects). We further replicated 66 SNPs (P < 10-4) through genotyping in a Punjabi Sikh sample (n = 2,894; 1,711 case subjects). On combined meta-analysis in Sikh populations (n = 7,329; 3,354 case subjects), we identified a novel locus in association with T2D at 13q12 represented by a directly genotyped intronic SNP (rs9552911, P = 1.82 × 10-8) in the SGCG gene. Next, we undertook in silico replication (stage 2b) of the top 513 signals (P < 10-3) in 29,157 non-Sikh South Asians (10,971 case subjects) and de novo genotyping of up to 31 top signals (P < 10-4) in 10,817 South Asians (5,157 case subjects) (stage 3b). In combined South Asian meta-analysis, we observed six suggestive associations (P < 10-5 to < 10-7), including SNPs at HMG1L1/CTCFL, PLXNA4, SCAP, and chr5p11. Further evaluation of 31 top SNPs in 33,707 East Asians (16,746 case subjects) (stage 3c) and 47,117 Europeans (8,130 case subjects) (stage 3d), and joint meta-analysis of 128,127 individuals (44,358 case subjects) from 27 multiethnic studies, did not reveal any additional loci nor was there any evidence of replication for the new variant. Our findings provide new evidence on the presence of a population-specific signal in relation to T2D, which may provide additional insights into T2D pathogenesis. © 2013 by the American Diabetes Association.

Rees S.D.,University of Birmingham | Rees S.D.,NHS England | Hydrie M.Z.I.,Baqai Institute of Diabetology and Endocrinology | O'Hare J.P.,University of Warwick | And 7 more authors.
PLoS ONE | Year: 2011

Background: The Meta-Analysis of Glucose and Insulin related traits Consortium (MAGIC) recently identified 16 loci robustly associated with fasting glucose, some of which were also associated with type 2 diabetes. The purpose of our study was to explore the role of these variants in South Asian populations of Punjabi ancestry, originating predominantly from the District of Mirpur, Pakistan. Methodology/Principal Findings: Sixteen single nucleotide polymorphisms (SNPs) were genotyped in 1678 subjects with type 2 diabetes and 1584 normoglycaemic controls from two Punjabi populations; one resident in the UK and one indigenous to the District of Mirpur. In the normoglycaemic controls investigated for fasting glucose associations, 12 of 16 SNPs displayed β values with the same direction of effect as that seen in European studies, although only the SLC30A8 rs11558471 SNP was nominally associated with fasting glucose (β = 0.063 [95% CI: 0.013, 0.113] p = 0.015). Of interest, the MTNR1B rs10830963 SNP displayed a negative β value for fasting glucose in our study; this effect size was significantly lower than that seen in Europeans (p = 1.29×10 -4). In addition to previously reported type 2 diabetes risk variants in TCF7L2 and SLC30A8, SNPs in ADCY5 (rs11708067) and GLIS3 (rs7034200) displayed evidence for association with type 2 diabetes, with odds ratios of 1.23 (95% CI: 1.09, 1.39; p = 9.1×10 -4) and 1.16 (95% CI: 1.05, 1.29; p = 3.49×10 -3) respectively. Conclusions/Significance: Although only the SLC30A8 rs11558471 SNP was nominally associated with fasting glucose in our study, the finding that 12 out of 16 SNPs displayed a direction of effect consistent with European studies suggests that a number of these variants may contribute to fasting glucose variation in individuals of South Asian ancestry. We also provide evidence for the first time in South Asians that alleles of SNPs in GLIS3 and ADCY5 may confer risk of type 2 diabetes. © 2011 Rees et al.

Rees S.D.,University of Birmingham | Hydrie M.Z.I.,Baqai Institute of Diabetology and Endocrinology | Shera A.S.,Diabetic Association of Pakistan | Kumar S.,University of Warwick | And 5 more authors.
Diabetologia | Year: 2011

Aims/hypothesis: Recent genome-wide association (GWA) studies and subsequent replication studies have greatly increased the number of validated type 2 diabetes susceptibility variants, but most of these have been conducted in European populations. Despite the high prevalence of the disease in South Asians, studies investigating GWA-validated type 2 diabetes risk variants in this ethnic group are limited. We investigated 30 single nucleotide polymorphisms (SNPs), predominantly derived from recent GWA studies, to determine if and to what extent these variants affect type 2 diabetes risk in two Punjabi populations, originating predominantly from the District of Mirpur, Pakistan. Methods: Thirty SNPs were genotyped in 1,678 participants with type 2 diabetes and 1,584 normoglycaemic control participants from two populations; one resident in the UK and one indigenous to the District of Mirpur. Results: SNPs in or near PPARG, TCF7L2, FTO, CDKN2A/2B, HHEX/IDE, IGF2BP2, SLC30A8, KCNQ1, JAZF1, IRS1, KLF14, CHCHD9 and DUSP9 displayed significant (p<0.05) associations with type 2 diabetes, with similar effect sizes to those seen in European populations. A constructed genetic risk score was associated with type 2 diabetes (p=5.46×10 -12), BMI (p=2.25×10 -4) and age at onset of diabetes (p=0.002). Conclusions/interpretation: We have demonstrated that 13 variants confer an increased risk of type 2 diabetes in our Pakistani populations; to our knowledge this is the first time that SNPs in or near KCNQ1, JAZF1, IRS1, KLF14, CHCHD9 and DUSP9 have been significantly associated with the disease in South Asians. Large-scale studies and meta-analyses of South Asian populations are needed to further confirm the effect of these variants in this ethnic group. © Springer-Verlag 2011.

Basit A.,Baqai Medical University | Danish Alvi S.F.,Baqai Institute of Diabetology and Endocrinology | Fawwad A.,Baqai Institute of Diabetology and Endocrinology | Ahmed K.,Primary Health Unit | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2011

Aims: To observe temporal changes in the prevalence of diabetes, impaired fasting glucose and its associated risk factors in the rural area of Baluchistan province of Pakistan according to American Diabetes Association criteria by comparing the two surveys done in 2002 and 2009. Methodology: This community based survey of 1264 subjects aged 25 years and above was conducted from February 2009 to February 2010 in sixteen villages of southern Baluchistan. The temporal changes were assessed in comparison with a similar survey conducted seven years previously. Data from 2002 survey was also re-analyzed according to the latest ADA criteria. Results: A two-fold increase in the prevalence of diabetes (from 7.2% to 14.2%) was seen in 2009 survey and the prevalence of impaired fasting glucose also increased significantly (6.5-11.0%). An important finding was the number of hypertensives and subjects with positive family history of diabetes also increased significantly (p< 0.000) from the previous survey. Conclusion: Coordinated National Programs for primary prevention to counteract the increasing prevalence of diabetes are the need of time. Further large scale studies with proper risk factor assessment are needed to ascertain the reasons of rising prevalence of glucose intolerance. © 2011 Elsevier Ireland Ltd.

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