Aziz Al-Safi Ismail

Early manifestation of macrovasculopathy in newly diagnosed never treated type II diabetic patients with no traditional CVD risk factors

Type II diabetes patients have increased risk of macrovascular complications compared with the general population. Arterial stiffness is considered as an independent predictor of macrovascular events. This study investigated arterial stiffness in newly diagnosed never treated diabetes and impaired glucose tolerance (IGT) patients without any traditional cardiovascular diseases (CVD) risk factors. After preliminary screening of 1620 individuals, 30 diabetic and 30 IGT patients were recruited and compared with age- and sex-matched 30 normoglycaemic subjects. The subjects were newly diagnosed, never treated, normotensive, non-obese, non-hyperlipidaemic and non-smoker. Haemodynamic variables, pulse wave velocity (PWV) and augmentation index (AI) were measured. The PWV was significantly higher in diabetic patients (10.37+/-2.64m/s vs. 8.70+/-1.29m/s; p=0.035) and was of borderline significant in IGT subjects (9.54+/-1.56m/s vs.8.70+/-1.29m/s, p=0.078) compared to normoglycaemic individuals. Augmentation index was higher of borderline significant in diabetic (134.53+/-17.32% vs. 129.17+/-11.18%, p=0.055) and IGT patients (132.02+/-16.11% vs. 129.17+/-11.18%, p=0.059) compared to normoglycaemic individuals. The study demonstrated that newly diagnosed never treated diabetic patients without any CV complications had early manifestation of macrovascular diseases as evident by increased arterial stiffness. The findings also revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases at an early age in diabetic patients.

Trigonella foenum-graecum seeds lowers postprandial blood glucose in overweight and obese individuals.

This study determined the effects of fenugreek on postprandial plasma glucose (PPG) and satiety among overweight and obese individuals. Fourteen subjects were studied in the morning after overnight fasts on four separate occasions. Glycaemic responses elicited by 50 g carbohydrate portions of white bread and jam with or without 5.5 g of fenugreek and fried rice with or without 5.5 g fenugreek were determined over 2 h. The primary endpoint was the incremental area under the plasma glucose response curve (IAUC). Adding fenugreek to both foods significantly reduced the IAUC compared to the food alone: white bread and jam, 180 ± 22 versus 271 ± 23 mmol × min/L (P = 0.001); fried rice, 176 ± 20 versus 249 ± 25 mmol × min/L (P = 0.001). Fenugreek also significantly reduced the area under the satiety curve for white bread with jam (134 ± 27 versus 232 ± 33 mm × hr, P = 0.01) and fried rice (280 ± 37 versus 379 ± 36 mm × hr, P = 0.01). It is concluded that fenugreek significantly decreased the PPG response and increased satiety among overweight and obese individuals.

Glycemic Responses of Patients with Type 2 Diabetes to Individual Carbohydrate-Rich Foods and Mixed Meals

Aims: Our purpose was to determine whether the glycemic index (GI) of individual foods applies to mixed meals. Methods: The glycemic responses elicited by portions of 4 individual foods with 25 g of available carbohydrate when served alone (rice, lacy pancake, flatbread and noodles) and when made into typical Malaysian mixed meals (coconut milk rice, lacy pancake with chicken curry, flatbread with dhal curry and fried noodles) were measured in 10 subjects with type 2 diabetes. To allow calculation of the GI of the foods and the relative glycemic responses of the mixed meals, each subject also tested 25 g of glucose 3 times. Capillary blood glucose was measured at 30-min intervals for 180 min after consuming each test meal. Results: The mean ± SEM incremental area under the curve (AUC) after flatbread (345 ± 26 mmol × min/l) was significantly greater than after rice (238 ± 35) and lacy pancake (235 ± 31, p < 0.05), with noodles being intermediate (294 ± 35). The AUC after the flatbread with dhal curry (341 ± 49), coconut milk rice (238 ± 39) and fried noodle (272 ± 42) mixed meals were similar to those after the individual foods, but the AUC after the lacy pancake with chicken curry mixed meal (388 ± 52) was significantly greater than after the individual food item (p < 0.01). Conclusions: The results support the utility of the GI of individual foods such as rice, flatbread and noodles when applied to mixed meals. The reason for the higher response after the lacy pancake mixed meal compared to the individual food is not clear and may warrant further research.

Gene expression profiling in ethnic Malays with type 2 diabetes mellitus, with and without diabetic nephropathy.

BACKGROUND Diabetic nephropathy (DN) is the most common cause of end-stage renal disease (ESRD) among type 2 diabetes mellitus patients (DM) in Malaysia. This study used microarray analysis to determine the gene expression profiling in ethnic Malay patients with type 2 DM. METHODS A total of 312 patients were recruited; 25 were on dialysis due to ESRD, 128 were classified as normoalbuminuric, 93 as microalbuminuric and 66 as macroalbuminuric, based on urine albumin to creatinine ratio of <3.5, between 3.5 and 35 and =35 mg/mmol, respectively. RESULTS Microalbuminuria was associated with up- and down-regulation of 2,694 and 2,538 genes, respectively, while macroalbuminuria was associated with up-regulation of 2,520 genes and down-regulation of 2,920 genes. There was significant up-regulation of 1,135 genes and down-regulation of 908 genes in the ESRD samples. Thirty-seven significantly up-regulated genes and 40 down-regulated genes were commonly expressed in all 3 groups of patients with worsening of renal functions. Up-regulated genes included major histocompatibility complex (HLA-C), complement component 3a receptor 1 (C3AR1), solute carrier family 16, member 3 (SLC16A3) and solute carrier family 9 (sodium/hydrogen exchanger) (SLC9A8). Consistently down-regulated genes included were bone morphogenetic phosphatase kinase (BMP2K), solute carrier family 12, member 1 (SLC12A1), solute carrier family 7 (SLC7A2), paternally expressed 10 (PEG10) and protein phosphatase 1 regulatory (inhibitor unit) (PPP1R1C). CONCLUSION This study has identified several genes of interest, such as HLA-C, SLC16A3, SLC9A8, SLC12A1 and SLC7A2, that require verification of their roles as susceptibility genes for diabetic nephropathy in ethnic Malays with type 2 DM.

Increased arterial stiffness in normoglycaemic offspring of newly diagnosed, never treated type 2 diabetic and impaired glucose tolerance parents

Arterial stiffness has been used to demonstrate vasculopathy in adults with diabetes but studies on arterial stiffness in offspring of diabetic patients are scarce, and no study has been reported in the offspring of parents with impaired glucose tolerance (IGT). In this study arterial stiffness in normoglycaemic offspring (n=30) of parents with type 2 diabetes, normoglycaemic offspring (n=30) of IGT parents and 30 age and sex-matched normoglycaemic offspring of normoglycaemic parents was investigated. Arterial stiffness was assessed by pulse wave velocity (PWV) and augmentation index (AI) using SphygmoCor. Significantly higher PWV was noted in offspring of type 2 diabetes than in offspring of normoglycaemic parents (6.94±0.9 vs. 6.33±0.7 m/s, p=0.010). Offspring of type 2 diabetes parents also demonstrated significantly higher PWV than IGT offspring (6.94±0.9 vs. 6.43±1.1, p=0.021). Significantly higher AI was observed in offspring of type 2 diabetes and IGT parents than progeny of normoglycaemic parents (105.62±14.2 vs. 96.42±7.7, p=0.001; 104.98±11.1 vs. 96.42±7.7%, p=0.004, espectively). The study demonstrated that normoglycaemic offspring of newly diagnosed, never treated type 2 diabetes and IGT parents had increased arterial stiffness. Such increases in arterial stiffness revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases in the normoglycaemic offspring. Br J Diabetes Vasc Dis 2009;9: 65–68.

Predictors of ischaemic heart disease in a Malaysian population with the metabolic syndrome.

Aims  Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population‐based study to examine these.