Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2007 | Month : August | Volume : 1 | Issue : 4 | Page : 209 - 216

Role of Atorvastatin in Anti-diabetes Management

MITRA A

School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, Pin code-721302, India.

Correspondence Address :
Analava Mitra, Assistant Professor, School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, Pin code-721302, India. Tel.: 91-322-282656/282657(R), fax: 91-322-282631, e-mail: amitra@adm.iitkgp.ernet.in

Abstract

The hyperinsulinaemic/insulin-resistant state is a metabolic condition linked to widespread and heterogeneous clinical syndromes like hypertension, obesity, type 2 diabetes, dyslipidaemia, atherosclerosis and coronary vascular disease. About 25% of the non-diabetic population shows abnormalities of insulin sensitivity and compensatory hyperinsulinaemia. Data from National Health and Nutrition Examination Survey (NHANES) show 50 million Americans or more had hypertension. In world scenario, it approximates 1 billion individuals and 7.1 million deaths per year. India has 4% of adult population at risk of hypertension. India is facing a diabetic explosion also. It has the world’s largest diabetic population – about 25 million, and the number is predicted to rise to 35 million by 2010 and to 57 million by 2025. The exact cause of the increase in prevalence of hyperinsulinaemic/insulin-resistant state is unknown, and both genetic and life style factors are being blamed. Beta-blockers (atenolol) and statins (atorvastatin) are widely used to combat hypertension and dyslipidaemia, particularly in obese patients who are also prone to diabetes and coronary artery disease. A 3-month study is done to compare the effects of atenolol with atenolol and atorvastatin in two groups of hypertensive volunteers. The study shows that statins improve the dyslipidaemic picture and also increases insulin sensitivity.

Keywords

Beta-blockers, Diabetes, Atorvastatin

The South Asian population is known to be at risk of atherosclerosis, even though the subject does not have the clinical evidence of coronary artery disease (CAD). Atorvastatin is known for its cholesterol lowering and cardioprotective effects. In India population is vast, and there is heterogenicity of origin or race, geography and habit, socioeconomic status, dietary habits, methods of cooking and preservation, use of pesticides, etc. These factors, along with known variables like age, sex, etc., influence lipid profile of individuals. In a study with 3000 patients, CAD occurred in 50% with cholesterol level of 152 mg% and in 5% even if cholesterol level was below 140 mg%. The significant finding was elevated triglycerides (>196 mg%) and low high-density lipoprotein cholesterol (HDLC) (<39 mg%). The lipid profile in Indians may appear benign, but the high triglycerides and low HDLC levels actually increase the rate of CAD. Persons with high low-density lipoprotein (LDL), high triglyceride and low high-density lipoprotein (HDL) have a three-fold higher rate of CAD (1). Diabetes mellitus is defined as a syndrome characterised by chronic hyperglycaemia and disturbances of carbohydrate, fat and protein metabolism associated with absolute or relative deficiencies in insulin secretion and/or insulin action (2). The hyperinsulinaemic /insulin-resistant state is a metabolic condition linked to such widespread and heterogeneous clinical syndromes as hypertension, obesity, type 2 diabetes, etc. About 25% of the non-diabetic population show abnormalities of insulin sensitivity and compensatory hyperinsulinaemia. Considering the magnitude and severity of hyperinsulinaemic/insulin-resistant state, pharmaceutical measures are initiated early in an Indian and common drug to be used in hypertension and dyslipidaemia are beta-blockers and statins.

As hypertension is mainly asymptomatic, it acts as a silent killer. Even in advanced countries like U.S.A., 30% of individuals are unaware of their hypertension, other 40% do not like to be treated and 67% do not bother about the blood pressure (BP) values, which remains above 140/90 mmHg (3). About 10–15% of Indian adult receive regular antihypertensive treatment (4). Risk of hypertension, particularly systolic blood pressure (SBP), increases with advancing age, and about 50% of 60–69 years old are affected. The value becomes 75% in 70 years and above age range (3),(5). Vasan et al. (6) reported that lifetime risk of hypertension is 90% for normotensive men and women at 55 or 65 years of age and who survives up to 80–85 years. Reduction of SBP, which continues throughout life, reduces total mortality, cardiovascular mortality, stroke and heart failure events. Diastolic blood pressure (DBP) is more potent cardiovascular risk factor than SBP before 50 years of age, and afterwards SBP is more important (7). In the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT) and controlled onset verapamil investigation of cardiovascular end points (CONVINCE) trial, it is found SBP control rate is less than DBP control rate (8),(9). Physician’s ignorance may be a factor in poor control of SBP.

While body mass index in Indians was not higher, they had a significantly higher waist–hip ratio indicating that although Indians have no more general obesity than the others, they tend to put it on centrally or abdominally. They also had more hyperinsulinaemia, glucose intolerance and increased plasma activator inhibitor 1 (PAI-1). Regarding the antioxidants, Indians had a lower level of plasma vitamin C and selenium (10). These factors could be due to food habits, especially prolonged cooking at hig

Material and Methods

Selection of volunteers
Sixty-four patients are screened for the study from a random population of 90 hypertensive patients receiving atenolol as anti-hypertensive measures from BC Roy Technology Hospital of IIT, Khargpur, by a random selection process, from which 44 patents are considered based on patient compliance, intelligence to understand dietary prescriptions and directions and whether free from any other disease on initial medical testing. Naturally, the volunteers are not receiving any drugs other than mentioned and not suffered from any diseases within the study period. Written consent for the study as per protocol and institute ethical clearance is obtained. The patients are divided into two groups, of 22 patients each, by a random selection process, the experimental group receiving atenolol and atorvastatin and the control group receiving atenolol only.

Duration of study
The study duration is for 3 months.

Anthropometrical, clinical and biochemical characters of volunteers
Anthropometrical, clinical and biochemical characters of volunteers are shown in (Table/Fig 1).
Clinically, both the groups show no abnormality, other than hypertension in both groups, along with dyslipidaemia in the experimental group. Different biochemical and clinical parameters like liver function tests (LFT), total leukocyte count (TLC), differential leukocyte count (DLC), Hb, urea, creatinine, total proteins, serum electrolytes, urine tests, electro-cardiograph (ECG), X-ray of chest, etc. are almost identical and within normal range in both the groups.

Collection of blood samples
Twelve hours fasting values are taken initially and at monthly intervals for 3 months. Measurement of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), very low-density lipoprotein cholesterol (VLDLC), triglycerides (TG) and fasting blood sugar (FBS) is done by standard methods, as depicted by Boehringer Mannheim (23) and by reagents supplied to meet the standard quality at monthly intervals by an indwelling catheter placed in the anti-cubital vein. Serum insulin level is measured by radioimmunoassay by Spandan Diagnostics.

Statistical methods
For calculation of t-statistic and p-values, standard SPSS package is used. The statistical analysis is done based on paired t-test, and p-value is calculated using paired t-statistic. The normality of the parent population (from which the data have been collected) is not tested, but since the sample size is 44, which could be considered to be large, t-statistic is used, the validity of which is justified through central limit theorem.

Results

(Table/Fig 2) shows values of blood parameters of 22 volunteers who are receiving atenolol and atorvastatin, in comparison with 22 volunteers who are receiving atenolol. It is found that in the group receiving atenolol and atorvastatin (experimental group) TC is reduced from initial values of 282 +/-18 mg/dl to 271 +/-16 mg/dl (p = 0.05). HDLC increased from 48 +/-5 mg/dl to 50 +/-7 mg/dl (p = 0.04). LDLC reduced from 195 +/-11 mg/dl to 182 +/-21 mg/dl (p = 0.05). VLDLC, TG values remain almost same, and changes are statistically insignificant. FBS values changed from initial 105 +/- 17 mg/dl to 100 +/-6 mg/dl (p = 0.04). (Table/Fig 2) also shows values of blood parameters of 22 volunteers who are receiving atenolol only (control group). It is observed that TC is from initial values of 202 +/-12 mg/dl to 200 +/-16 mg/dl. HDLC changes from 42 +/-5 mg/dl to 43 +/-7 mg/dl. LDLC changes from 139 +/-12 mg/dl to 140 +/-21 mg/dl. VLDLC, TG and FBS values remain almost same, and all the value changes are statistically insignificant. (Table/Fig 3) shows serum insulin and homeostasis model assessment of insulin resistance (HOMA 2-IR) values of different groups, in order to determine insulin sensitivity. It was observed that in the experimental group, serum insulin value initially is 32 +/-3 microU/ml and finally is 29 +/-3 microU/ml (p = 0.03), and in the control group, serum insulin value initially is 31 +/-2 microU/ml and finally is 31 +/-2 microU/ml. HOMA 2 values (insulin resistance or IR) of the two groups of patients show that in the experimental group it was 4.2 +/-0.5 initially to 3.7 +/-0.4 after 3 months, and in the control group it was 4.2 +/-0.3 initially and 4.2 +/-0.2 finally, showing increase in insulin sensitivity by atorvastatin.

Discussion

The exact cause of increase in insulin sensitivity by atorvastatin is unknown. The study shows that atorvastatin increases insulin sensitivity in normal subjects. It thus corroborates the findings of Parhofer et al. (24), who found that, though uncertain, short-term statin therapy can affect insulin sensitivity in patients with insulin resistance syndrome. Compared with placebo, treatment with atorvastatin (10 mg/day) resulted in significant reductions in the HOMA index (21%), fasting C-peptides (18%) and glucose, as well as a borderline reduction of insulin. In addition, significant reductions in total and LDL cholesterol concentrations were observed in the atorvastatin group. Some subjects with a better lipid profile and more normal baseline parameters respond less. Thus, the team concludes that patients with more pronounced metabolic syndrome would benefit more than those with less pronounced changes, and the present study thus is contrary to the studies of Parhofer et al. (24). Okajima et al. (25) suggest that statins could have some impact on insulin action, and, to estimate the direct effects of statins on insulin secretion from pancreatic beta cells, MIN6 cells were treated with pravastatin, simvastatin or atorvastatin. Basal insulin secretion at low glucose concentration was unexpectedly increased at very high doses of simvastatin or atorvastatin after 24 and 48 hours of incubation, though insulin secretion at high glucose was not significantly changed, and, thus, net glucose-stimulated insulin secretion was apparently decreased by these lipophilic statins. Atorvastatin is frequently administered for the treatment of hypercholesterolemia associated with type 2 diabetes mellitus. However, a marked deterioration of glycaemic control has been reported in some patients treated with atorvastatin. Takano et al. (26) suggest a predisposition to a deterioration of glycaemic control in type 2 diabetic patients treated with atorvastatin and thus are against the evidence gained by the present study. Prasad et al. (27) hypothesised that statins influence the development of new-onset diabetes mellitus in renal transplant recipients. Yoshitomi et al. (28) assessed the relationship between IR and the changes of lipid profile in patients with hyperlipidaemia treated by atorvastatin. The IR did not affect the degree of reduction in cholesterol by atorvastatin in non-diabetic subjects. The IR may influence hypertriglyceridaemia greater than the effect of atorvastatin in non-diabetic subjects. It has been suggested that HMG Co-A reductase inhibitors (‘statins’) may reduce the risk of developing type 2 diabetes mellitus. Yee et al. (29) designed to evaluate whether use of statins would also delay progression to insulin therapy. After multivariate adjustment, however, statin use was associated with a 10-month delay before newly treated diabetic subjects needed to start insulin treatment. Whether this relationship exists for patients at high risk of developing diabetes should be examined in a randomised trial. In order to evaluate a hypothesised protective effect of the use of HMG Co-A reductase inhibitors (statins) on the development of type 2 diabetes, Jick and Bradbury (30) conducted a nested case–control study, based on data from the UK-based General Practice Research Database (GPRD). There was little evidence for a duration effect for simvastatin in these data, though there is a slight suggestion of a long-term protective effect with pravastatin. The study results are most consistent with the conclusion that there is little, if any, protective effect of statins on the development of type 2 diabetes. Ohmura et al. (31) report a patient in whom the administration of HMG CoA

Conclusion

Statins reduce the magnitude of hyperinsulinaemic/insulin-resistant state. Statins are believed to have an anti-infective role. The exact cause of hyperinsulinaemic/insulin-resistant state is unknown. Hyperinsulinaemic/insulin-resistant state is very common and is of explosive occurrence in India. Infective aetiology may play a role in the causation of the state, and statins reduce the infective conditions by its anti-infective role. The claim is controversial and several studies also refute the findings. Further, studies are needed in Indian context to find out a conclusive result.

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Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3]

JCDR is now Monthly and more widely Indexed .