Special Issue on Diabetes - Issue 03, Vol 01, Oct 10. 2010

Issue 03 Vol 01

10th Oct, 2010

Send your queries to [email protected]

Chief Editor Dr. Shiva Murthy N Scientific Contributors Mrs. Manjula Devanur Dr. Shiva Murthy N Ms. Renuka Gahlawat Review Board Mr. Soumitra Chowdhury Mr. Benjamin Jackson Dr. Vladimir Mats Mr. John Packianathan Mr. Prakash Velappan Mr. Prasanna Sondur Mrs. Ramya Krishna Dr. Rhuta Khaparde

QUARTESIANQUARTESIANQUARTESIANQUARTESIAN NEWS LETTER NEWS LETTER NEWS LETTER NEWS LETTER Aims to provide interesting articles and news on current areas of research to scientific fellow members of the industry

EDITORIAL EDITORIAL EDITORIAL EDITORIAL

Issues surrounding Diabetes…

Quartesian Conveys Greetings for this Festival Season!!!

We received more than 50 feedbacks for our second issue (first issue received around

15 feedbacks). This shows more than 300% increase in the participation of the readers

in comparison to first issue.

We are happy to make a mention of Ms. Renuka from Fortis Clinical research, who

volunteered and contributed to this news letter. In this way one more new step has

been taken to entertain external contributors. We are very much encouraged with the

readers’ response and we thank for their best wishes, suggestions and contribution…

We are very glad to present third issue of QNL. In this issue the main focus is on

Diabetes research and five important study findings in this area have been briefed.

We have tried to explore the relationship of Type 2 Diabetes with breastfeeding, short

sleep, hyper-triglyceridemic waist, and childhood obesity.

Breastfeeding again proved to be protective to women’s health against diabetes.

Chromosomal link can act as the biomarker for diagnosing expected diabetes in

childhood itself. After reading the articles presented in this issue you will agree with

my next three comments:

A) Being lean is always better to keep diabetes away.

B) Sleep well and be happy without diabetes.

C) Nature can be the best source of medicines. Guava leaves tea can slow down

glucose uptake in GIT…

Playing with words is always interesting and writing meaningful sentences aimed at

protecting ones health, gives us immense pleasure…

We look forward to bring many more issues… thanks again for your continued

support…. QNL editorial boardQNL editorial boardQNL editorial boardQNL editorial board

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Please send your feedback and support to our initiative by emailing to [email protected]

Breastfeeding and TypeBreastfeeding and TypeBreastfeeding and TypeBreastfeeding and Type 2 Diabetes 2 Diabetes 2 Diabetes 2 Diabetes

Breastfeeding and its relation with various diseases is constantly on debate.

“Breastfeeding protects women from getting breast cancer” - is a well established fact.

New issue raised by RRISK study on relationship between breastfeeding and type 2 diabetes is presented below1

.

o RRISK (Reproductive Risk factors for Incontinence Study at Kaiser) recently reported that mothers who did not breastfeed their

children had significantly higher rates of type 2 diabetes later in life than moms who breastfed.

o Study involved a well-characterized, population-representative cohort of 2233 women, aged 40-78 years in California between 2003

and 2008.

o Fifty six percent had breastfed an infant for ≥1 month. In fully adjusted models, the risk of type 2 diabetes among women who

consistently breastfed all of their children for ≥1 month remained similar to that of women who had never given birth (Odds Ratio

1.01; 95% CI, 0.56-1.81).

o In contrast, mothers who had never breastfed an infant were more likely to have developed type 2 diabetes than nulliparous women

(Odds Ratio 1.92; 95% CI, 1.14-3.27).

o Mothers who never exclusively breastfed were more likely to have developed type 2 diabetes than mothers who exclusively

breastfed for 1-3 months (OR 1.52; 95% CI, 1.11-2.10).

o Results showed that risk of type 2 diabetes increases when term pregnancy is followed by <1 month of lactation, independent of

physical activity and BMI in later life.

Based on these findings, researchers opined that mothers should be encouraged to exclusively breastfeed all of their infants for at least 1 month.

SUPPORT AND FEEDBACK ON SECOND

ISSUE OF QNL

We are glad to share that we received lot of support and positive feedback from the prominent personnel in the industry and the list below is a sample one. We thank each and everyone and request for continued support….

Amin (Ana Design) Aleksandra Pesic (PSR Group) Rashi Gandhi (Triest Life Sciences) Ashok Shenoy K (Kasturba Medical College) Ajay (Clintec) Ashok Srivastava (Pharmalynx) Karnvir (Atharva Life Sciences) Rajiv Mahajan (Company Not known) M E Clark (Duanemorris) Raminder S. Sachdeva (DBMS) Sahil Verma (DBMS) Shilpi Jain (Panacea Biotec) Kamal Shahani (Cliniminds) Vyjayanthi.G (Apotex) Dhanpat Ram Agarwal (ITAG) Chintamani Joshi (FRLHT) Mithun Garai (Lamda Therapeutics) Rajiv Ramanathan (Quintiles) Jebasingh B (Company Not known) Rehaman (Aroma Consulting)

Karthik Anantharaman (Integrated Disease Management) Suman R Menon (Director, IICRM) Wasif Khan (Company Not Known) Aayam Gupta (Yoga Teacher, Suva Republic Of Fiji Islands) VSK (Journalist) Geetanjali Rao (Company Not known) Kushal Sarda (Bharati Vidyapeeth Pune) Prason Kumar (Lailapharma) Sheetal (Dr. Reddys) Sharon Bingert (Creative Technical Writer and Trainer in both Telecommunications and Pharma Industries) Shyam (PeopleSearch Consultants) Richee Moon (Super Religare Laboratories) Rajesh Agarwal (IFGL Bio Ceramics) Ramanjot Kaur (Company Not Known) Jadhav Rahul (Company Not Known) Bharat Reddy (Deloitte)

Renuka Gahlawat (Fortis Clinical Research) Ofelia R. Nievas (Clinipace) Joy Ganguly (Fortis Health Care) Rashmi Jain (e-Chikitsa Informatics Pvt.Ltd) P. Kamalakannan, (Priyadarshini Dental College) Pierre T. Soumenkoff (US Biomedical Systems) S.Manivannan (Parama Health Care) K. Venkateshwarlu., M.D (Ayu) (Natural Remedies) Swaroop.Sarangan (RIL) Praveen (BIOCON) Param Hans Mishra (Indian Spinal Injury Center) Jaison Jose (Novartis) James Fan (ICON) Chandrashekar (ICON)

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Guava LeafGuava LeafGuava LeafGuava Leaf Extract Extract Extract Extract –––– a folk remedy for Diabetes a folk remedy for Diabetes a folk remedy for Diabetes a folk remedy for Diabetes2222

� World Health Organization has estimated approximately 366 million people (4.4 %) with Diabetes Mellitus (DM) in the global population by 2030.

� Type II DM is expected to become more serious both in the developing as well as developed nations because of lifestyle changes, a shift to “Western-Style” diet.

� The common guava fruit (Psidium guajava) is used as a folk medicine for diabetes in Japan, Africa and East Asia. � Some alpha- glucosidase enzymes such as maltase, sucrase, and alpha-amylase digest carbohydrates to glucose in

the digestive tract. Inhibiting their activity would prevent digestion of carbohydrates and provide glycemic control.

� Research (Deguchi et al) demonstrated that aqueous guava leaf extract (GvEx) inhibits the in-vitro activities of these alpha-glucosidase enzymes in a dose dependent manner with 50% inhibitory concentration as 0.6 mg/mL, 2.1 mg/mL and 3.6 mg/mL for alpha amylase, maltase and sucrase, respectively.

� Research also elucidates the active component of the GvEx as some phenols, such as peduncladgin, casuarinin and isostrictinin.

� Further research revealed that the single ingestion of GvEx reduces postprandial glucose elevation via the inhibition of alpha-glucosidase.

� Consecutive ingestion of guava leaf tea with every meal also improves diabetic symptoms, such as hyperglycemia, hyperinsulinemia, insulin resistance as well as hyperlipidemia in pre-diabetic and mild- diabetic patients.

� With its alimentotherapy, guava leaf tea and GvEx induce neither toxicity, mutagenicity, nor abnormal interaction with anti-diabetic and anti-hyperlipidemia drugs. Thus, a safe food material.

� Please get your doctor’s advice before you start to use the same. Research in this area is in progress and your doctor is the best judge. (Authors are not responsible for any AEs or complications if you decide to use on your own)

Clinical Data Management and SAS programming Industry Training Courses An innovative Industry-Academia collaboration has been established between Quartesian and CliniMinds to

offer 6 months diploma courses. For course details please contact/write to [email protected]

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A

B

Short sleep Short sleep Short sleep Short sleep ––––

Increases risk for ImpaiIncreases risk for ImpaiIncreases risk for ImpaiIncreases risk for Impaired Fasting Glucosered Fasting Glucosered Fasting Glucosered Fasting Glucose3333 The Western New York Health Study reported that short sleep duration is associated with an elevated risk of a pre-diabetic state,

known as incident-impaired fasting glycaemia (IFG). IFG means where our body is not able to regulate glucose as efficiently as it

should be doing it and people with IFG have a greater risk of developing type 2 diabetes and is at an increased risk of heart

disease and stroke.

The researchers followed 1455 participants who were free of type 2 diabetes and known cardiovascular disease at baseline (1996–

2001) and were reexamined in the period 2003–2004 in a nested case-control study.

The Fasting Plasma Glucose (FPG) was <100 mg/dL at baseline and 100 to 125 mg/dL at follow-up for the cases and controls (n =

272) had FPG <100 mg/dL at both exams. Cases (n = 91) were individually matched to three controls (n = 272) on sex, race, and

year of study enrollment.

Average sleep duration was categorized as short (<6 hours), mid-range (6 to 8 hours), and long (>8 hours).

In multivariate conditional logistic regression after adjustment for several diabetes risk factors, the odds ratio of IFG among short

sleepers was 3.0 (95% CL: 1.05, 8.59) compared to mid-range sleepers.

On the contrary, there was no association between long sleep and IFG: Odds Ratio 1.6 (95% CL: 0.45, 5.42).

Adjustment for insulin resistance attenuated the association only among short sleepers: Odds Ratio 2.5 (95% CL: 0.83, 7.46).

Based on these findings, researchers concluded that short sleep duration was associated with an elevated risk of IFG and opined

that insulin resistance appears to mediate this association. As per this study, people who sleep less than six hours a night may be

three times more likely to IFG.

Academic Participation

CTA 2010 – Organized by Virtue Insight

Dr. Shiva Murthy, Director, Clinical Research and Business Development of Quartesian, participated in CTA 2010, Bangalore. He participated in panel discussion on “Overcoming regulatory challenges in Asian clinical trials”. Picture A: (Right to Left) Dr. Radhika Bobba, Dr. Shiva Murthy N, Mr. Lakshmanan Sathappan, Prof. Thuppil Venkatesh, and Dr. Milind Antani. Picture B: Active participation from Quartesian’s representative. Dr. Murthy commented and raised queries on “Setting up a medical writing unit in India” and “Patient Safety and Pharmacovigilance” topics.

Thanks for supplying the photos and giving this opportunity.

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Hypertriglyceridemic Waist Hypertriglyceridemic Waist Hypertriglyceridemic Waist Hypertriglyceridemic Waist ––––

Prone for Gestational DiabetesProne for Gestational DiabetesProne for Gestational DiabetesProne for Gestational Diabetes4444

Diane Brisson and group worked on this concept.

The aim of the study was to study the association between the hypertriglyceridemic-waist phenotype

(i.e., abdominal obesity in combination with hypertriglyceridemia) in early pregnancy and glucose

intolerance in later pregnancy.

They included 144 white pregnant women in whom the plasma triglycerides and waist girth were

measured at 11–14 weeks of gestation and glycemia was measured following a 75 g oral glucose

tolerance test performed at 24–28 weeks of gestation.

They reported that waist girth >85 cm in combination with a triglyceride level 1.7 mmol/L in the first

trimester was associated with an increased risk of two-hour glucose 7.8 mmol/L following the 75 g oral

glucose tolerance test (Odds Ratio 6.1, p = 0.002).

This risk remained significant even after researchers controlled for maternal age, fasting glucose at first

trimester and previous history of gestational diabetes (Odds Ratio 4.7, p = 0.02).

Based on these data, researchers concluded that measurement of waist girth in combination with

measurement of triglyceride concentrations in the first trimester of pregnancy could improve early

screening for gestational glucose intolerance.

Eligibility: MBBS with at least 2 years of experience in implementing public health programmes with hands on experience in supervision and training.

Remuneration: Rs. 60,000/- pm plus travel allowance and benefits. Work in Brief: Work as 3

rd party service provider

and will interact with WHO as consultants. Provide technical assistance to the RNTCP. Work closely with Govt. staff, partner states, district and sub-district level.

Application procedure: Apply before 20

th October,

2010, visit www.sams.co.in for more information. You can also email your details to [email protected]. This information is obtained from Times of India, Bangalore, October 06, 2010, Ascent, Page 2.

This information is presented with the intention of supporting this important national programme.

Medical Consultants Required For RNTCP* - Technical Assistance Project

*Revised National Tuberculosis Control Programme

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Disclaimer: The contents of the news letter are for internal circulation only and not for sale. To the

best of our knowledge the information was collected from the open sources and the article is re-

synthesized at Quartesian. We do not claim any copyrights and original authors of the research

retains all the claims and copyrights. We have done best to convey messages and conclusions to

reflect original article. We will not be responsible for any misunderstanding and disputes arising

out of this article. If you believe that any work included violates any copyrights you hold or

represent, we will immediately remove it upon notification. Basically this article is prepared and

distributed with the intention to spread the knowledge and enhance the research in the area

described. All queries are welcome to [email protected]

References 1. Eleanor Bimla Schwarz, Jeanette S. Brown, Jennifer M. Creasman,

Alison Stuebe, et al. Lactation and Maternal Risk of Type 2 Diabetes: A Population-based Study. The American Journal of Medicine, 2010; 123 (9): 863.

2. Yoriko Deguchi, Kouji Miyazaki. Anti-hyperglycemic and anti-hyperlipidemic effects of guava leaf extract. Deguchi and Miyazaki

Nutrition & Metabolism 2010, 7:9 3. Lisa Rafalson, Richard P. Donahue, Saverio Stranges, Michael J.

Lamonte, Jacek Dmochowski, Joan Dorn, Maurizio Trevisan. Short Sleep Duration Is Associated with the Development of Impaired Fasting Glucose: The Western New York Health Study. Annals of

Epidemiology, 2010. 4. Diane Brisson, Patrice Perron, Simon-Pierre Guay, Daniel Gaudet,

and Luigi Bouchard. The "hypertriglyceridemic waist" phenotype and glucose intolerance in pregnancy. CMAJ, September 2010.

5. G. Cai, S. A. Cole, N. F. Butte, V. S. Voruganti, A. G. Comuzzie. A Quantitative Trait Locus on Chromosome 13q Affects Fasting Glucose Levels in Hispanic Children. Journal of Clinical

Endocrinology & Metabolism, 2007; 92 (12): 4893.

Chromosomal Link Chromosomal Link Chromosomal Link Chromosomal Link ––––

Type 2 Type 2 Type 2 Type 2 Diabetes in Children and AdolescentsDiabetes in Children and AdolescentsDiabetes in Children and AdolescentsDiabetes in Children and Adolescents5555

G. Cai, and Group reported biomarker for early presentation of type 2 diabetes in Children and Adolescents.

Researchers aimed to localize quantitative trait loci influencing fasting serum glucose levels in 1030 Hispanic

children participating in the Viva La Familia Study.

They measured fasting serum glucose levels enzymatically, and genetic linkage analyses

using SOLAR

software.

They identified that fasting glucose was heritable, with a heritability of 0.62 ± 0.08 (P < 0.01). Genome-wide

scan mapped fasting serum glucose to markers D13S158–D13S173 on chromosome

13q (LOD score of 4.6).

They reported that insulin receptor substrate 2 gene is the regulator of glucose homeostasis and is the

candidate gene for obesity. This region was also reported previously to be linked to obesity and diabetes-

related phenotypes.

Researchers concluded that a quantitative trait locus on chromosome 13q contributes

to the variation in

fasting serum glucose levels in Hispanic children at high risk for obesity.

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