Eating a healthy breakfast decreases the risk of developing type 2 diabetes

Eating a healthy breakfast decreases the risk of developing type 2 diabetes

New Delhi: World Diabetes Day is celebrated annually on November 14. Led by the International Diabetes Federation (IDF), World Diabetes Day was created in 1991 by IDF and the World Health Organization in response to growing concerns about the escalating health threat posed by diabetes.

Healthy Living and Diabetes is the World Diabetes Day theme for this year with focus on the importance of starting the day with a healthy breakfast to help prevent the onset of type 2 diabetes and effectively manage all types of diabetes to avoid complications.

"Eating a healthy breakfast decreases the risk of developing type 2 diabetes", said Padma Shri, National Science Communication and Dr B C Roy National Awardee, Dr KK Aggarwal president Heart Care Foundation of India and Senior National Vice President Indian Medical Association.

"A healthy diet is, more expensive than an unhealthy one. The wide availability of cheap energy dense low-nutrient food is contributing to the global epidemic of type 2 diabetes. Foods which reduce the risk of type 2 diabetes such as vegetables, fresh fruit, whole grains and unsaturated fats need to be more affordable and more widely available", added Dr Aggarwal.

A healthy diet containing leafy vegetables, fresh fruit, whole grains, lean meat, fish and nuts  can help reduce a person’s risk of type 2 diabetes  and avoid complications in people with diabetes.

Diabetes is a huge and growing burden: while 382 million people were living with diabetes  in 2013 that number is expected to balloon to  almost 600 million people by 2035. Diabetes is fast gaining the status of a potential epidemic in India with more than 62 million diabetic individuals currently diagnosed with the disease.

Up to 11% of total healthcare expenditure in every country across the globe could be saved by tackling the preventable risk factors for type 2  diabetes and over 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier 

lifestyles. 

Verapamil can reverse Diabetes

Verapamil can increase the beta cell mass: Verapamil, a drug used to control high blood pressure and arrhythmias has been shown by Dr Anath Shalev at University of Birmingham, Alabama to not only prevent type 1 diabetes in mice but reverse severe established diabetes. The drug down regulates a key promoter of type 1 diabetes (thioredoxin-interacting protein ) and bolster whatever dysfunctional beta cells remain in the pancreas. The treatment definitely creates an environment where beta cells are allowed to survive.

And now one year human trial, entitled, "The repurposing of verapamil as a beta-cell survival therapy in type 1 diabetes," is expected to begin early in 2015 by the same group.

Over a decade ago, the UAB team was able to identify a protein called thioredoxin-interacting protein (TXNIP), which is dramatically increased in human islet cells in response to high glucose levels. The researchers hypothesized that TXNIP might be involved in beta-cell death associated with diabetes. 

  Even short-term postprandial glucose excursions, as seen in pre-diabetes, may lead to a gradual, cumulative increase in TXNIP expression before any onset of overt diabetes. Furthermore, insulin resistance or any increased demand on the beta cell may also lead to elevated beta-cell TXNIP levels.

The team showed that TXNIP does indeed induce beta-cell death by apoptosis: in mice models in which TXNIP had been genetically deleted, for example, the animals were completely protected against diabetes.

Reduction of intracellular calcium inhibits the transcription and expression of TXNIP, so by using the calcium-channel blocker Verapamil to do this, they were able to mimic the effects of genetically deleted TXNIP in mice and preserve the insulin-producing beta cells.

Even after the animals had developed full-blown diabetes with high blood sugar levels, when treated with Verapamil, blood sugars normalized, and this was due to the reappearance and normalization of insulin-producing beta cells. [Mol Endocrinol. 2014:28:1211-1220]

Note: In India use of Verapamil in diabetes will be an off label use and hence will require consent. However those with high blood pressure or with hear blockages can be shifted to Verapamil.'

Non obstructive heart blockages not benign : Dr K K Aggarwal

In a retrospective study of patients undergoing elective coronary angiography, non-obstructive coronary artery disease (heart blockages), compared with no apparent coronary artery disease ( no blockages), was associated with a significantly greater 1-year risk of heart attack and all-cause mortality.


After risk adjustment, there was no significant association between 1- or 2-vessel non-obstructive coronary artery disease ( blockages in one or two arteries) and mortality, but there were significant associations with mortality for 3-vessel non-obstructive coronary artery disease (blockages in all three arteries).


Veterans with evidence of non-obstructive CAD on elective coronary angiography had a 2- to 4.5-fold greater risk for heart attack compared with those with no evidence of blockages and 1-year heart attack risk was found to increase progressively by the extent of blockages, rather than increasing abruptly when blockages became obstructive.
The results of this study are published in Nov. 5 JAMA.


Never tell your patients " that your coronaries are fine and they have nothing to worry about," but one should say " 'There is evidence of atherosclerosis and while there is no need to panic, we need to address it.'" Remember there is nothing like " mild coronary artery disease or mild blockages in the heart."

Up to 1 in 4 Angiograms Show Minimal Plaque or blockages.

Non-obstructive blockages mans presence of atherosclerotic plaque revealed during coronary angioplasty or angiography that does not appear to obstruct blood flow or result in angina symptoms.

These non-obstructive lesions occur in between 10% and 25% of patients undergoing elective angiography, and their presence has historically been characterized as "insignificant" or "no significant blockages  in the medical literature even though multiple studies have shown plaque ruptures leading to heart attack commonly come from non-obstructive plaques.

Recurrent Kidney Stones: IMA Guidelines

Recurrent Kidney Stones: IMA Guidelines


Lifetime prevalence of kidney stones is approximately 13% in men and 7% in women. Without treatment, approximately 35% to 50% of those with kidney stones will experience recurrence within 5 years from the first stone.


Here are some guidelines


1. Increasing fluid intake to achieve at least 2 L of urine per day. "Increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects. However, people who already drink the recommended amount of liquids, or when increased fluid intake is contraindicated, should not increase their fluid intake.

2. Available evidence shows no difference between intake of tap water or intake of a specific brand of mineral water in preventing kidney stones.

3. If drinking increased amounts of water is ineffective in preventing kidney stones, one may try pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol.  These three types of drugs effectively reduced recurrence of composite calcium stones in patients who had a history of two or more stones. Combination therapy is no more effective than monotherapy.  All these drugs were associated with adverse events. For thiazides, these were orthostasis, gastrointestinal upset, erectile dysfunction, fatigue, and muscle symptoms. Citrates are associated with gastrointestinal symptoms and allopurinol with rash, acute gout, and leukopenia.

4. Patients should reduce intake of colas and other soft drinks acidified with phosphoric acid, as lower consumption is linked to lower risk for stone recurrence.

5. Fruit-flavored soft drinks can be taken as they are often acidified with citric acid.

6. Patients should reduce consumption of dietary oxalate, typically found in chocolate, beets, nuts, rhubarb, spinach, strawberries, tea, and wheat bran.

7. Patients should eat less dietary animal protein and purines.

8. Patients should maintain normal dietary calcium.

[ Contributor: Padma Shri, Dr B C Roy National Awardee and National Science Communication Awardee Dr K K Aggarwal, Honorary Secretary General IMA]

[Reference: November 4 issue of the Annals of Internal Medicine]

No heart patient should take antibiuotics without supervision: Dr K K Aggarwal

Antibiotic Cotrimoxazole when Combined With ACE Inhibitor or ARB can end up with Sudden Death

Trimethoprim-Sulfamethoxazole May Increase Risk for Hyperkalemia in the Elderly


New Delhi: In a study published in BMJ, the risk of sudden death went up by more than a third in older patients taking ACE inhibitors or angiotensin-receptor blockers (ARBs) who were also put on the antibacterial agent cotrimoxazole (sulfamethoxazole and trimethoprim), compared with those who were instead given amoxicillin.

The elevated risk was likely caused by its capacity for raising serum potassium, which became fatal on top of other medications known for causing hyperkalemia.

Patients who are on ACE inhibitors or ARBs, are at risk for hyperkalemia, should not take any antibiotic without medical supervision.

If given


1. One should give it at the lowest dose and for a minimum period of time
2. And keep a watch on potassium.


Diabetics are vulnerable


Patients with type 2 diabetes have a tendency for hyperkalemia because od silent kidny involvement
Heart failure patients if on potassium-sparing spironolactone are also at risk
Patients with both reduced left ventricular function and diabetes have the greatest risk.

The risk, he said, depends on the antibiotic's dosage and duration of use. Ten days of cotrimoxazole may be risky while three days not.
In the study data from patients aged 66 or older who received ACE inhibitors or ARBs in Ontario from 1994 to 2012, identified outpatients who died of sudden death within 7 days of being prescribed cotrimoxazole, amoxicillin, ciprofloxacin, norfloxacin, or nitrofurantoin. Those 1027 cases were matched to 3733 controls alive within that time frame relative to the antibiotic prescriptions, based on, among other things, age, sex, chronic kidney disease, and diabetes.

The adjusted odds ratios (95% CI) for sudden death within 7 days of an antibiotic prescription on top of an ACE inhibitor or ARB, by antibiotic, relative to amoxicillin (which does not pose a hyperkalemia risk itself or prolong the QT interval) were: 1.38 for cotrimoxazole; 1.29 for ciprofloxacin; 0.74 for norfloxacin and 0.64 for nitrofurantoin.

Ciprofloxacin can predispose to sudden death by prolonging the QT interval.

Type 2 diabetes can be delayed or prevented

Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.

India is the diabetic capital of the world.

People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications. Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.

The National Diabetes Month, include World Diabetes Day on Nov. 14.

In type 1 diabetes, the body does not make insulin. In type 2 diabetes the body does not make or use insulin well. Gestational diabetes, occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.

Type 2 diabetes has begun to affect young people.

Losing a modest 15 pounds of weight through diet and exercise can actually cut your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.

In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.

Diabetes Tips

·         Choose healthy foods to share.

·         Take a brisk walk together every day.

·         Talk with your family about your health and your family’s risk of diabetes and heart disease.

·         If you smoke, seek help to quit.

·         Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

Affecting over 127 lakh Indians, Artrial Fibrillation is the new growing epidemic of the country

Experts conclude at the 7^th APHRS Scientific Session one of the largest International conferences on Heart Rhythm disorders in the World

Atrial Fibrillation, one of the most common Heart Rhythm disorders was concluded to be a growing epidemic in India affecting over 12.7 million Indians in 2013 as compared to 12.3 million in 2012. This was the main topic of discussion at the 7^th APHRS Scientific Session, one of the largest gatherings of Cardiac Electrophysiologists in the world. In it’s in its 7^th edition, the APHRS Scientific Session was jointly organized in India for the first time ever by the Asia Pacific Heart Rhythm Society (APHRS) and the Indian Heart Rhythm Society (IHRS). The topics of discussion included ECGs, Sudden Cardiac Death, Atrial Fibrillation, Heart Failure and Arrhythmia. The four-day conference was held between October 29 – Nov 1 simultaneously at Hotel Taj Palace and ITC Maurya in New Delhi.

A special focus was also given to technological development in the field of heart rhythm disorders through revolutionary technologies such as Leadless Pacemakers and Subcutaneous Implantable Cardioverter Defibrillator’s (ICD). According to the data presented in the APHRS 2014 white book, which was released on the closing ceremony of the conference, in 2013 over 23 lakh Indians suffered from heart failure and 6,27,000 died due to sudden cardiac death. The total number of pacemakers implanted in the year 2013 was 36,322 and ICD’s 1950. This showed the need for global platforms such as these to discuss the growing incidence of heart rhythm disorders and its treatment.

The highlight of the conference were the 200 scientific sessions conducted by 250 core leading National and International faculty including Dr Richard Fogel (President Heart Rhythm Society USA), Dr Young Hoon Kim (President APHRS), Dr Johnathan Kalman, Dr Kalyalam Shivkumar and Dr Mohan Nair (Organizing Committee Chairman APHRS Scientific Session 2014).

Speaking on the occasion Dr Mohan Nair, Chairman Organizing Committee, 7^th Asia APHRS Scientific Session and Chairman Cardiology, Saket City Hospital said, “It is indeed a proud moment to have an International conference of such stature and scale being organized in India. With the increasing incidence of heart rhythm disorders in the country, it is extremely important that we make full use of the advancements in technology in the fields of arrhythmia and electro cardiology and educate the community about new and innovative treatment options available globally. I am happy to say that India today is at par with global and more and more innovations are being done in India in the field in line with our Prime Minister’s Make in India initiative”. 

Speaking on the occasion, Dr Young-Hoon Kim, President APHRS said, “Started in 2008, APHRS takes place every year in different countries of the Asia Pacific Region. The goal behind scheduling these conferences in different countries is to provide an exchange of information related to not only arrhythmia and electro cardiology but also to put forward an apt platform for the exposure to the local culture which is rewardingly educational and deeply enriching. I had a great time in India and look forward to coming back in the future. I am happy to announce that the next APHRS Scientific Session will take place in Melbourne, Australia in 2015”.

Giving a global perspective, Dr Jonathan Kalman, Professor at The Royal Melbourne Hospital in Melbourne, said, “Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance and a major cause of stroke and death. Over recent decades, the incidence of AF has increased dramatically, positioning AF as one of the epidemics of the new millennium. Conferences like the APHRS Scientific Session like are extremely important platforms to discuss advancements in the field and provide adequate training to heart rhythm physicians to address this modern epidemic”.

Adding to this, Dr Richard Fogel, President, Heart Rhythm Society, USA said, “The treatment of arrhythmic disorders differs not just within different North American countries but also globally, making a platform such as this extremely beneficial and important. Technological advancement has now revolutionized treatment of heart rhythm disorders. For instance putting a three lead pacemaker is now an established non-drug therapy for end stage heart failure.”

      Key Highlights of the conference included

1.     Atrial fibrillation is the leading cause of stroke (paralysis) in the elderly

2.     Patient with atrial fibrillation need long-term blood thinners. Now safer blood thinners are available which do not require blood monitoring

3.     Sudden cardiac death is preventable. The general public should learn hands-only cardiopulmonary resuscitation (CPR)

4.     Patients who have low pumping action of the heart require a machine, implantable cardioverter-defibrillators (ICD), an internal electric shock device, which delivers an electric shock when the heart stops functioning due to the disturbed very high rhythm and thus restores normal rhythm

5.     Today it is possible to electrically burn (ablate) the electrical pathways of the heart that cause abnormal rhythm

6.     It is possible now to put a pacemaker without a lead

7.     It is now possible to put an internal electric shock device (ICD) subcutaneously below the skin bypassing the muscle

8.     All children going for competitive sports in school should be screened for chances of sudden cardiac death during sports

9.     All patients with low pumping action of the heart may require not only an internal electric shock device (ICD), but also a 3 lead pacemaker to improve pumping action of heart

10.  All patients with irregular rhythm, atrial tachycardia, should go for electric burning of accessory pathway of the heart (ablation), which is now practically a nonsurgical procedure

11.  All high risk patients should be screened for risk of sudden cardiac death so that necessary measures can be taken to prevent sudden cardiac death.

 12.   There is a need for a nationwide sudden cardiac death prevention program