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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.

Hydrie M.Z.I.,University of Oslo | Hydrie M.Z.I.,Baqai Institute of Diabetology and Endocrinology | Basit A.,University of Oslo | Fawwad A.,University of Oslo | And 3 more authors.
Open Diabetes Journal | Year: 2012

Background: Insulin Resistance has been identified as an independent risk factor for a number of chronic diseases such as diabetes and cardiovascular diseases. Thus identifying insulin resistant cases would help to better prevent the progression of these diseases in such individuals. Objective: To identify a simple indirect method for detecting insulin resistance in our population by using fasting blood samples. Methods: Geographical Imaging Systems was used for randomly selecting the subjects during an epidemiological survey done. For visiting the 532 households selected by geographical imaging systems, nine field teams were developed. A total of 871 subjects older than 25 years were approached by these teams out of which 867 agreed to participate in the survey. Insulin resistance was assessed in 227 normal subjects by fasting insulin, Homeostasis model assessment for insulin resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI) and McAuley Index. Results: Insulin Resistance was defined at 75 th percentile cut off of insulin levels (9.25 U/mL) and at 75 th percentile of HOMA-IR (1.82). The 25 th percentile cut off was used for defining insulin resistance in QUICKI (0.347) and McAuley Index (6.77). Conclusion: A common approach towards managing subjects with metabolic risk factors will help identify insulin resistance earlier by this fasting method and using insulin resistance reference values identified from simple indirect methods would be of value in such cases. However larger population based studies are needed to further define and validate these cutoff values for insulin resistance to be used for the general population. © Hydrie et al.

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.

Kooner J.S.,Imperial College London | Saleheen D.,Center for Non Communicable Diseases Pakistan | Saleheen D.,University of Cambridge | Sim X.,National University of Singapore | And 80 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.

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