:: Affiliated to the Tamilnadu Dr. M.G.R. Medical University, University of Madras
  :: ‘ICMR Advanced Centre for Genomics of Type 2 Diabetes’ :: IDF Centre for Education
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  Diabetology

The department is headed by Dr. V. Mohan, MD, FRCP (London, Edinburgh, Glasgow & Ireland), Ph.D, DSc, D.Sc (Hon. Causa), FNASc, whose interests in diabetology span over three decades. The team has been involved in obtaining accurate prevalence data on diabetes and its various complications and in studying markers for atherosclerosis, insulin resistance, and prevention of diabetes.  The department of diabetology aims at the development of novel approaches to the early diagnosis, treatment, and prevention of diabetes. Our goal is to initiate systematic clinical studies based on the basic scientific observations made in the laboratory, which would in turn fuel innovative treatment options. The department emphasizes on providing clinicians with basic science and research expertise for the enhancement of medical research in India . The department also provides assistance for basic scientists for translating their novel findings into clinical practice. A brief description about the studies carried out by the department is provided below.

 
  Vision  
 

To provide evidence based knowledge on Diabetes and its complications and their determinants.

 
  Mission
 
 

To obtain accurate prevalence data on diabetes and its various complications, to study markers for atherosclerosis and insulin resistance and to explore avenues for prevention of diabetes.

 
 

CHENNAI URBAN POPULATION STUDY (CUPS)

 
 

CUPS is a population-based study carried out on 1262 individuals, 479 belonging to the middle income group [Asiad Colony] and 783 from a low income group [Bharathi Nagar colony] in Chennai. CUPS demonstrated that nearly 12% of the Chennai residents had diabetes and 5.9% had pre-diabetes. These figures are six times higher than that reported in 1970’s. Nearly 20 publications have come from CUPS.

 
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CHENNAI URBAN RURAL EPIDEMIOLOGY STUDY – (CURES)

 
 

 

CURES is a large ongoing epidemiologic study involving a representative population of Chennai (screening 26,001 individuals from 46 corporation wards), in southern India and was launched in August 2001 with the support of the Chennai Willingdon Corporate Foundation. The main objectives are to estimate the prevalence of diabetes and its complications in urban Indians and to identify the risk factors for non-communicable diseases (NCDs).  The 5 different phases of the CURES have been completed and has resulted in over 70 publications till date.

 
     
 

RISING PREVALENCE OF DIABETES IN CHENNAI CITY: 

 
 

CURES gave us a unique opportunity to compare the secular trends of diabetes in the Chennai over the last two decades. From 1989 to 2004 prevalence of diabetes increased by 72.3% in urban Chennai.

 
     
  INDIAN DIABETES RISK SCORE [IDRS]:  
 
CURES also looked at the development of a risk score for diabetes prediction and prevention. One simple way of screening a large population for type 2 diabetes is by development of a simple risk score based on data that can be routinely used at the primary care level. Indian Diabetes Risk Score [IDRS] was developed based on the phase 3 data from CURES. Using statistical analysis, we determined the risk factors, which best predicted diabetes. The IDRS is based on the answers to four simple questions and a simple measurement.
 
     
 

Particulars

Score

Age [years]

< 35 [reference]
35 - 49
> 50

0
20
30

Abdominal obesity 

Waist <80 cm [female] , <90 [male] [reference]
Waist 80 – 89 cm [female], 90 – 99 cm [male]
Waist > 90 cm [female], > 100 cm [male]

0
10
20

Physical activity

Vigorous exercise or Strenuous work
Moderate exercise work / home
Mild exercise work / home
No exercise & Sedentary work / home

0
10
20
30

Family history

No family history
Either parent
Both parents

0
10
20

Maximum score 100
 
 

Source : Dr. V. Mohan, et al, J Assoc Physicians India, 2003

 
 
An IDRS value > 60 had the optimum sensitivity (72.5%) and specificity (60.1%) and accuracy of 61.3%, for prediction of diabetes in an individual. This simplified Indian Diabetes Risk Score is useful for identifying undiagnosed diabetic subjects in India and could make screening programmes more cost effective as it can reduce the cost by 50% if replaced for screening programmes with blood sugar estimations.
 
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Prevalence and significance of generalized and central body obesity in Asian Indians

 
 

This study has determined prevalence of generalized and abdominal obesity in urban Asian Indians and compared the association of body mass index (BMI) and waist circumference (WC) with metabolic risk variables. In Asian Indians, prevalence of combined obesity is high among both sexes, while isolated generalized obesity is more common in men and isolated abdominal obesity, more common in women. However, these prevalence rates vary markedly depending on cut points used. Waist circumference (WC) is a better marker of obesity related metabolic risk than BMI in women compared to men in this population.

 
     
 

NAFLD, Type 2 diabetes and metabolic syndrome

 
 

This study estimated the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with type 2 diabetes (DM) and metabolic syndrome (MS) in an urban south Indian population. NAFLD is present in a third of urban Asian Indians and its prevalence increases with increasing severity of glucose intolerance and in MS. This is the first population-based prevalence of NAFLD from south Asia that faces the brunt of the diabetes epidemic.

 
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Surveillance for cardiovascular disease risk factors among the south Indian Industrial population

 
 

The objectives of this study is (1) to assess the cardiovascular disease (CVD) risk in industrial population in Chennai, south India and (2) to see whether the status of treatment and control of diabetes and hypertension would be different in an industrial population where free health care is provided compared to the general population of Chennai. Our findings emphasize the following: (1)The prevalence of CVD is high in industrial population of Chennai. (2) Although the overall treatment and control of diabetes and hypertension is better than general population, it is still inadequate and this emphasizes the need for greater awareness about non-communicable diseases.

 
     
 

Anthropometric cut points for identification of cardio metabolic risk factors in an urban Asian Indian population

 
 

The aim of this study was to determine the anthropometric cut points for risk of cardiometabolic risk factors in an urban Asian Indian population. From the findings, we suggest that the optimal BMI cut point for identifying any 2 cardiometabolic risk factors was 23 kg/m2 in both sexes, whereas that of waist circumference (WC) was 87 cm for men and 82 cm for women. The study validates the World Health Organization Asia Pacific guidelines of BMI of 23 kg/m2 for the designation of overweight; waist circumference (WC) of 87 cm for men and 82 cm for women appear to be appropriate cut points to identify cardiometabolic risk factors including prediabetes in urban Asian Indians.

 
     
 

Family Genetic Study

 
 

Large families with several diabetic subjects were selected from the pedigrees collected from CURES and all the adult family members (aged ≥ 20 years) were invited to participate in this study to determine the genetics basis of diabetes and its complications. 

 
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Early Detection of Atherosclerosis

 
 

The techniques that have been standardized at our centre to identify the atherosclerotic disease process include Endothelial Dysfunction analysis and Arterial Stiffness assessment to detect functional changes of atherosclerosis and Intima Medial thickness to detect structural changes. For the first time these investigations were performed in India and normal values obtained from the population. These early changes occur at mm range and to identify these changes accurately, a unique software has been developed which helps detecting the disease and also monitoring the changes in response to treatment.

 
     
 

Body fat distribution: Validation of its measurement and role in diabetes

 
 
Although obesity is a major contributing factor to diabetes, Asian Indians are known to have lower body mass index [BMI] than Europeans. However, for any given BMI, Asian Indians have greater waist-to-hip ratios and abdominal fat than Europeans. There are very few studies on fat distribution in Indians and virtually none comparing diabetic and nondiabetic subjects. Further there are few studies in Asian Indians validating the various methods available for body fat measurement. Thus, the first objective of this study was to measure body fat distribution in Asian Indians in relation to type 2 diabetes. The second objective was to correlate visceral and central abdominal fat with each other and with anthropometric parameters. The third aim was to test the validity of body fat measured by two commercial impedance analyzers (leg-to-leg and hand-held) as well as by skinfolds with Dual Energy X-ray Absorptiometry (DEXA) as the reference method in a population based study in southern India. This is a case-control study of 82 type 2 diabetic and 82 age- and sex-matched nondiabetic subjects from CURES.
The study showed that in urban south Indians, measurement of body fat by the leg-to-leg impedance and the skinfold method have better agreement (lower bias) with DEXA than the hand-held impedance while all three methods showed a fairly good correlation with DEXA.
 
     
  Study On ENPP1/ PC1 Gene K121Q Polymorphism And Ethnic Susceptibility To Type 2 Diabetes  
 
ENPP1 or PC1 gene which codes for the membrane glycoprotein Ectonucleotide Pyrophosphates 1 is one of the candidate genes for type 2 diabetes. A single nucleotide polymorphism in exon 4 of the ENPP1 gene also known as K121Q is found to be associated with insulin resistance in European population. The study done in MDRF in collaboration with the Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, was carried out in three different cohorts characterized by different susceptibility to diabetes and living in different environmental conditions: South Asians living in Chennai, South Asians who migrated to Dallas, Texas; and Caucasians living in Dallas, Texas. In all the three study cohorts, the prevalence of XQ+QQ genotype was significantly higher in diabetic than non-diabetic subjects. The ENPP1 121Q allele consistently predicted type 2 diabetes in all three cohorts supporting the hypothesis that the ENPP 121Q allele is associated with genetic susceptibility and may identify individuals at risk for type 2 diabetes. The findings are of great significance as the ENPP1 121Q polymorphism for the first time was shown to be associated with type 2 diabetes in Asian Indians, a high-risk group for type 2 diabetes and heart disease.
 
     
  Research Team  
 

Dr. V. Mohan
Dr. R.M. Anjana
Dr. I. Ranjit Unnikrishnan
Dr. R. Sanjai Srinivasan
Dr. M. Ramuu
Dr. Prasanna Kumar Gupta
Dr. Brijendra Kumar
Dr. J.P. Vignesh
Dr. Sundaramoorty Chandru
Dr. Mahuya Sikdar Roy
Dr. V. Subhashini Devi

President
Vice President, Consultant & Research Officer
Director, Consultant & Research Officer
Asst. Director, Consultant & Research Associate
Asst. Director, Consultant & Research Associate
Asst. Director, Consultant & Research Associate
Asst. Director, Consultant & Research Associate
Consultant & Research Associate
Consultant & Research Associate
Consultant & Research Associate
Consultant & Research Associate

 
     
 
 
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