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Every health theory needs a colorful pyramid, so here is one to show the progression from chronic infections to type 2 diabetes.
Chiodini I, Torlontano M, Scillitani A, Arosio M, Bacci S, Di Lembo S, Epaminonda P, Augello G, Enrini R, Ambrosi B, Adda G, Trischitta V.
Diabetes poses a unique challenge to the scores of children born with type 1 diabetes or who develop it at a very young age. The IDF estimates that there are approximately 490,000 children younger than 15 years with type 1 diabetes and probably a similar number of young diabetics between 15-25. At Diabetes Management & Supplies, we value the part we play on your treatment plan team and realize that winning is promoting good health. As with many diseases, prevention strategies to tackle obesity – promoting healthy nutrition and exercise - are more cost-effective than the treatment routinely provided by health services.
Programmes to encourage patients to control their conditions – some have shown positive results.
Payment systems and diseases management programmes rewarding good outcomes and continuity of care. Placing community care at the centre of health systems to improve quality of diabetes care. Objectives: To determine the frequency of metabolic syndrome in type 2 diabetes according to three commonly used operational definitions {World Health Organization(WHO), National Cholesterol Education Program Adult Treatment Panel( NCEP ATP III) and International Diabetes Federation( IDF)}. Methods: Data was collected retrospectively of 210 patients with type 2 diabetes visiting outpatient clinics of one of the large tertiary care hospitals at Karachi, Pakistan between June 2008 to November 2008.
Conclusion: Our study results suggested that NCEP ATPIII and IDF are the most reliable criteria for diagnosing metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF definition. Five diagnostic criteria have been put forward since the inception of this syndrome MS which has created perplexity among practitioners. Thereafter in 2001, NCEP ATP III National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) proposed another definition for the diagnosis of metabolic syndrome MS with less focus on insulin resistance as compared to WHO criteria but not addressing separate cut off points of waist circumference for Asian population initially.10 In 2003, American Association of Clinical Endocrinologists (AACE) proposed another set of criteria for the diagnosis of MS metabolic syndrome. Considering that SA have a higher percentage of body fat mainly in the form of abdominal adiposity at a lower Body Mass Index (BMI) in comparison with other population,12 International Diabetes Federation (IDF) in 2005 suggested separate cutoff points of waist circumference for Asian population and defined central obesity as waist circumference of more than 80 cm for women and 90 cm in men based on local statistics from the corresponding area.13 The revised NCEP ATPIII modified for SA South Asian population incorporated the same cut off points for Asian population as given by IDF. Type 2 diabetes is also emerging as a global epidemic with increasing prevalence in developing countries.14 Pakistan is among top ten countries estimated to have the highest number of diabetics occupying sixth position on the diabetes prevalence listing currently15,16 and it is estimated that prevalence would be doubled by 2025. There are studies that have looked into the differences in most widely used definitions of metabolic syndrome MS in general,18-21 but only few studies have compared these definitions in the diabetic population.22-24 Therefore we decided to determine the frequency of MS metabolic syndrome in Type 2 diabetics according to NCEP ATPIII, IDF and WHO definitions and then to compare these traits within the Pakistani population. This cross-sectional study was conducted in the out-patient clinics at a tertiary care hospital of Karachi, Pakistan. The sample size was calculated on an assumption that minimum 208 participants would be required to study the frequency of (MS) metabolic syndrome in type 2 diabetics of around 46-74% (2, 25) to achieve 80% power, 0.068 percentage point of true value and 5% significance level. The laboratory tests which are routinely done for patients with type 2 diabetes including triglycerides and high density lipoprotein (HDL-C) were recorded. The data was analyzed separately according to NCEP ATP III, IDF and WHO definitions and the results were then compared. Description of baseline, anthropometric and laboratory parameters of type 2 diabetics comparing patients fulfilling any one of the three definitions of metabolic syndrome MS with those not having MS syndrome are provided in Table-2.
The frequency increased to 179 (85.2%) by WHO, using the new cut offs for defining overweight (BMI of 23 vs.
Central obesity was present in 162 (77%) patients by WHO criteria followed by 197 (90.5%) based on IDF and NCEP ATP III.
For prevalence of hypertriglyceridaemia, no statistically significant difference between both genders were found. Our study showed a considerably high frequency of MS in people with type 2 diabetes based on NECP (ATPIII) and IDF criteria. One of the hospital based studies in Iran, showed the prevalence of MS in type 2 diabetics according to the NCEP (ATPIII) criteria, to be 65%.30 In this study instead of BMI, waist circumference was used highlighting the importance of abdominal adiposity, a better marker of MS as compared to BMI. The higher frequency of MS in women according to all criteria is also consistent with other studies from South Asian countries.33,34 This could be attributed to less physical activity in women due to ethnic and cultural restrictions. Regarding the selection of criteria for diagnosing MS the slightly higher prevalence of MS by ATP III definition in comparison to IDF (91.9% vs. Except for this difference the ATP III and IDF definitions are essentially identical as seen by the degree of agreement (kappa statistic= -0.728).
On the basis of these findings NCEP (ATPIII) modified criteria should preferably be used in the Pakistani population. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams. Funding is constantly needed for new projects and to update and refurbish existing facilities. Diabetes mellitus (DM) also known as simply diabetes is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Latent Autoimmune good desserts for gestational diabetes ak anchorage Diabetes in Adults (LADA) Symptoms Diagnosis Treatment and Prognosis.
October 2010 Michigan Quality Improvement Consortium diet for gestational diabetes mellitus georgia athens Guideline Management of Diabetes Mellitus The following role of exercise in diabetes mellitus california visalia guideline applies to patients with type 1 and type 2 diabetes mellitus.


Half of all deaths from smoking occur among patients with mental or substance Consensus development conference on antipsychotic drugs and obesity and diabetes. The webinar will focus on the good, the bad and the ugly of biofilms that hold our waterlines hostage. Maria Perno Goldie, RDH, MS To read previous RDH eVillage FOCUS introductions by Maria Perno Goldie, go to introductions. Sponsored Content is made possible by our sponsor; it does not necessarily reflect the views of our editorial staff. Consequently, the later stages overlap the earlier stages--that's why people with type 2 diabetes have so many inflammatory disorders.
Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients.
Metabolic syndrome and type 2 diabetes mellitus: focus on peroxisome proliferator activated receptors (PPAR).
Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. Chlamydia pneumoniae infection and its association with coronary heart disease and cardiovascular risk factors in a sample South Asian population.
In some areas, the life expectancy of a child with diabetes is less than a year after developing the disease. In addition, diabetics are prone to depression, making it difficult to follow treatment guidelines. These have been introduced with some success in the Netherlands, France, Germany and the United Kingdom. Participants are agreeing to the Copenhagen Roadmap, an outcome document offering concrete suggestions for good practice in the management of chronic diseases. The alarmingly high frequency of metabolic syndrome in type 2 diabetes found in this study suggests that primary prevention strategies should be initiated earlier and early in this ethnic group and our health care system should be geared up to cope with this deadly quartet. This encompasses atherogenic dyslipidaemia, hypertension, dysglycaemia and visceral obesity and pro coagulant state.5 Apart from increasing prevalence, the age of onset is also declining among South Asian (SA) population6 due to genetic predisposition and consumption of easily available energy dense foods from an early age.
Apart from the cut off differences, NCEP ATP III gives equal weight to each component of metabolic syndrome MS as compared to IDF for which abdominal obesity remains a prerequisite for the diagnosis.13 Moreover, microalbuminuria which is a controversial variable of WHO criteria is not included in other definitions. Data of 210 type 2 diabetes patients was collected retrospectively who were visiting the clinics between June and November 2008, by using a questionnaire which included demographic characteristics and individual components of MS i.e.
Patients already on anti-hypertensive and anti-lipid medications specifically in the form of fibric acid derivatives and niacin were taken as cases of hypertension and hypertriglyceridaemia respectively, irrespective of their blood pressure and lipid levels. Hypertension was found in 116 (55.2%) patients according to WHO in comparison to 147 (70%) by NCEP & IDF cut off of blood pressure. However, by all other criteria MS was significantly more common among females as compared to males, 95.9% vs. However, for low HDL cholesterol, prevalence was higher in males, 44 (57.14%) than in females 33 (43%) by WHO criteria (pTo find out the independent predictors of MS, a multivariable logistic regression was performed. The frequency was quite high in comparison to 46-76% found in other hospital based studies from Pakistan.25-27 This is very interesting keeping in view that all of these studies were done in the same region. A multicenter hospital based study in Brazil and Finland showed a close frequency of central obesity and MS (85 & 91.5%) was observed in type 2 diabetics[31] although the study population comprised of people of European descent. This also highlights the importance of education of our women in terms of prevention of MS with life style changes which would indirectly influence the eating habits of the whole family. 86.7%) could be attributed to the relative flexibility of the ATP III in which abdominal obesity is not considered as a prerequisite for the diagnosis.
According to this, NCEP (ATPIII) and IDF are the most reliable criteria's for diagnosing MS in type 2 diabetic patients, with NECP capturing more patients in comparison to IDF. Using waist circumference an obligatory criterion still missed out 5.2% cases of MS in our study. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).
The kidneys kick into high gear to get rid of all that extra glucose in the blood hence the urge to relieve yourself sometimes Post-Core: A Closer Look at Type 2 Diabetes What are the Symptoms of Type 2 Diabetes? However I’ve followed dozens of trials aimed at curing type-1 diabetes during this time and every one of those other trials had more than three people. An evaluation of your diet and a discussion of prenatal vitamins Before considering pregnancy you should begin taking a daily vitamin that contains folic acid.
The WDD campaign is led by the International Diabetes Federation (IDF) and its member associations.
Life for a Child provides support and resources to children with diabetes in developing countries. Additionally, the number of children and adolescents developing type 2 diabetes is on the increase around the world.  The IDF estimates that 80-100,000 children and young people around the world are in urgent need of assistance.
Carefully following any medication orders and instructions is vital to your plan's success. This trend has got major health implications since South Asians constitute one fifth of world's population7 and the health care system in majority of these countries is not very primed to deal with these medical conditions.
Among these definitions, WHO, NCEP ATPIII & IDF have been the main ones which are used most widely. The data were presented as the mean ± SD and median [inter-quartile range (IQR)] for skewed variables, respectively.


Female gender, low HDL cholesterol and high systolic blood pressure were found to be the most important predictors for MS (Table-4).
The disparity could be attributed to lower frequency of obesity (30-74%) found in the above mentioned studies in comparison to our study (90.5%).
Our data was also consistent with an Indian study showing prevalence of 91.1% MS20 using the same NCEP (ATPIII) definition. In contrast WHO showed lower frequency of MS due to different cutoffs used for HDL levels and obesity. To further validate these recommendations, more studies are required to estimate the predictive power for micro and macro vascular complications and to establish the most appropriate definition of MS for South Asian population with type 2 diabetes.
Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action. The deadly quartet: upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications [Internet].
International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes. Prevalence of metabolic syndrome in urban Pakistan (Karachi): comparison of newly proposed International Diabetes Federation and modified Adult Treatment Panel III criteria.
Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-34). Diagnostic criteria for metabolic syndrome: a comparative analysis in an unselected sample of adult male population.
An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey.
Frequency of metabolic syndrome in type 2 diabetes and its relationship with insulin resistance. High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3. Frequency of the metabolic syndrome in adult type2 diabetics presenting to Pakistan Institute of Medical Sciences. Metabolic syndrome in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors. Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in Type 2 diabetes. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations.
Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. According to the Centers for Disease Control and Prevention (CDC) there are almost 26 million people in the United States diagnosed with diabetes (2011). His research into the health benefits of proper nutrition is the foundation for a best-selling line of dietary supplements from Natural Factors where he is Director of Product Development. To you information itchy fingers may also be formidable sign of diabetes wherein blood sugar level in not appropriate as required by the body. Dental hygiene and dental clinicians are their first line of defense to health, oral and physical. Categorical variables were presented as numbers and percentages; Continuous variables were compared using Student t test for normally distributed variables and Wilcoxon rank-sum test for non-normally distributed variables and categorical variables were compared by chi-square or Fisher exact test.
This difference remained significant even after adjusting it with BMI cutoffs for Asian population of 23 vs.30 endorsed by WHO expert consultation35 pointing towards the fact that waist circumference or central obesity is a more valuable tool for detection of MS in Asian population. The alarmingly high frequency of MS in type 2 diabetes found in our study, indicates that our health care system should to take emergent steps in implementing life style intervention programmes. Message 3 of 3 (2644 Views) You also can take steps to prevent or manage the symptoms of dry mouth. There are genetic tests that can be conducted to help predict your child’s odds of developing type 1. In univariate analysis, comparison between MS and without MS was done for each variable of interest.
Multivariable logistic regression analysis was conducted to identify the factors associated with MS. You will be taught how to integrate waterline maintenance with confidence, and discover when to shock your waterlines.
You will be able to formulate a plan for routine maintenance, and learn about product choices to maintain healthy waterlines.



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