PREVALENCE AND DISTRIBUTION OF ABNORMAL CARBOHYDRATE TOLERANCE IN THE FAMILY MEMBERS OF KNOWN DIABETICS

204 healthy family members of 91 known diabetics were screened for abnormal carbohydrate tolerance (ACT). The prevalence of asymptomatic diabetes and impaired glucose tolerance were found to be 3.44% and 8.33% respectively. There was positive correlation in the prevalence of ACT and age of the family members. Male children of diabetic parents were at higher risk of inheriting the disease. The risk increased when compounded with obesity and mumps infection. Suitable preventive strategies have been highlighted.KEY WORDS: Abnormal carbohydrate tolerance (ACT), Diabetes mellitus (DM), Impaired glucose tolerance (IGT)     

Estimation of the energy cost of physical activity in infancy

OBJECTIVE: To estimate physical activity energy expenditure (AEE) in groups of free living infants in the first year of life. DESIGN: Mixed longitudinal study of 124 healthy infants, using 232 estimations of AEE made between 1.5 and 12 months. Infants studied at more than one time point were treated as new cross sectional data points. Total energy expenditure and body composition were estimated using doubly labelled water. Sleeping metabolic rate was predicted from weight. RESULTS: AEE increased from 5% of energy intake at 1.5 months to 34% at 12 months. Growth costs declined by 90%, but metabolisable intake by only 20%, over the same period. CONCLUSIONS: Energy is increasingly diverted from growth to activity during infancy. Values for AEE may aid in estimating energy requirements of groups factorially. Further work is required, however, on individual variability in AEE, and on the effects of disease, hospitalisation, surgery, and malnutrition.     

Pulmonary vascular resistance in complete atrioventricular septal defect. A comparison between children with and without Down's syndrome

Invasive data obtained in children with complete atrioventricular septal defect over the last three years are presented to determine the age at which pulmonary vascular obstructive disease develops. Comparisons were made between children with (n = 21) and without Down's syndrome (n= 12). The investigation was restricted to patients less than one year of age at initial catheterization. Patients with complicated associated heart defects were excluded. Patients with Down's syndrome had a higher ratio of pulmonary to systemic vascular resistance than children without Down's syndrome in the basal situation. This difference almost disappeared after 100% oxygen had been given to patients with elevated pulmonary vascular resistance, indicating that hypoxia and/or hypoventilation is of importance, especially in children with Down's syndrome. Fixed elevated pulmonary vascular resistance was found in 11% of Down patients under one year, with the youngest patient being 5.5 months old. One child without Down's syndrome may have had fixed elevated pulmonary vascular resistance. It is concluded that all children with complete atrioventricular septal defect should be evaluated and operated on at a very young age.     

How much wrapping do babies need at night?

In a longitudinal, population based study, overnight temperature recordings were made in the bedrooms of 152 babies aged 3-18 weeks and the insulation provided by their bedclothing was assessed. Outdoor temperatures for the study nights were also available. Parents applied more insulation on colder nights with lower bedroom temperatures than on warmer nights (mean 8.5 tog at 15 degrees C minimum bedroom temperature falling to 4.0 tog at 25 degrees C). For a particular temperature they also applied 2 tog more insulation in winter than in summer. The amounts of bedclothing used in the home were compared with insulation levels predicted to achieve thermo-neutrality over a similar range of environmental temperature from heat balance studies in young infants. They corresponded closely. The average amount of bedclothing chosen for babies in Avon allows them to remain in thermoneutral conditions throughout the night. These values are proposed as broad guidelines for the thermal care of young babies at night.     

Anti‐inflammatory effects of exendin‐4, a glucagon‐like peptide‐1 analog,on human peripheral lymphocytes in patients with type 2 diabetes

Aims/Introduction

Type 2 diabetes is characterized by dysregulation of immunity, oxidative stress and reduced incretin effects. Experimental studies suggest that glucagon‐like peptide (GLP‐1) might have immunomodulating effects. We hypothesize that GLP‐1 receptor agonist, exendin‐4, might reduce inflammatory response in type 2 diabetes.

Materials and Methods

Using peripheral blood mononuclear cells (PBMC) sampled from 10 type 2 diabetes and 10 sex‐ and age‐matched control subjects and supernatants from PBMC culture, the expression of phospho‐mitogen activated protein kinase (MAPK) signaling pathways in CD4+ T helper lymphocytes and monocytes was analyzed using flow cytometry. Cytokines/chemokines and superoxide anion before and after treatment with exendin‐4 were measured by cytometric bead array and chemiluminesence assay, respectively.

Results

Compared with control subjects, PBMC from type 2 diabetes patients showed activated MAPK (P38, c‐Jun NH2‐terminal protein kinase and extracellular signal‐regulated kinase) signaling pathway, elevated superoxide anion, increased pro‐inflammatory cytokines (tumor necrosis factor‐α, interleukin‐1β, interleukin‐6) and chemokines (CCL5/regulated on activation normal T‐cell expressed and secreted and CXCL10/interferon‐γ‐induced protein 10). These changes were attenuated by exendin‐4, possibly through the suppression of p38 MAPK.

Conclusions

These results suggest that exendin‐4 might downregulate pro‐inflammatory responses and reduce oxidative stress by suppressing MAPK signaling pathways in type 2 diabetes.     

Awareness of eye complications and prevalence of retinopathy in the first visit to eye clinic among type 2 diabetic patients

AIM: To assess the awareness of eye complications and the prevalence of retinopathy, in the first visit to eye clinic, among type 2 diabetic patients attending a tertiary medical centre in Kuala Lumpur, Malaysia. METHODS: An investigator-administered questionnaire was given to 137 patients with diabetes undergoing first time eye screening in the eye clinic. This was followed by a detailed fundus examination by a senior ophthalmologist to assess for presence of retinopathy. RESULTS: Almost 86% of respondents were aware of diabetic eye complications, especially in patients who had achieved tertiary educational level (96.3%). The majority of the patients (78.8%) were referred by their physicians and only 20.4% came on their own initiative. Many of the patients (43.8%) did not know how frequent they should go for an eye check-up and 72.3% did not know what treatments were available. Lack of understanding on diabetic eye diseases (68.6%) was the main barrier for most patients for not coming for eye screening earlier. Despite a high level of awareness, only 21.9% had recorded HbA1c level of <6.5% while 31.4% were under the erroneous assumption of having a good blood sugar control. A total of 29.2% had diabetic retinopathy in their first visit eye testing. CONCLUSION: In the present study, 29.2% of type 2 diabetic patients had retinopathy in their first time eye testing. Although the awareness of diabetic eye complications was high among first time eye screening patients, the appropriate eye care-seeking behavior was comparatively less and should be rectified to prevent the rise of this sight threatening eye disease.