Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA)

Major depressive disorder in patients with type 2 diabetes mellitus: Prevalence and clinical characteristics

BACKGROUND

This study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM).

METHODS

We enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwan's National Health Insurance database.

RESULTS

We enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1-2 and > 2).

LIMITATIONS

One limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables.

CONCLUSIONS

The prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries.

Type 2 diabetes epidemic in East Asia: a 35-year systematic trend analysis

Facing the challenge of effective prevention type 2 diabetes (T2DM) in China (as part of global health) requires knowledge about both the temporal trend and risk factors variation in T2DM. We searched the PubMed, CNKI, WANFANG, and International Diabetes Federation (IDF) databases for data on the prevalence of T2DM/ IGT (impaired glucose tolerance) published from January 1, 1980 to December 31, 2014 in China, Japan and Korea. The prevalence of T2DM was estimated with 95% confidence intervals (CIs) using random-effects meta-analysis. T2DM prevalence trend in the next 10 years was estimated by using a time series regression model based on the 35 years of data. The 621 articles covered 11.8 million Chinese people, 1.64 million Japanese, and 37.69 million Koreans. The aggregate prevalence of T2DM in China has increased sharply from 1.3% in 1980-1989 to 4.5% in 1990-1999, 6.8% 2000-2009, and 8.7% in 2010-2014. We estimated that by 2025, T2DM prevalence will have grown to 12.5%. Central obesity is the largest preventable cause of T2DM. We also found that female having a very high BMI (body mass index, ≥28 kg/m2) and being an older (≥50 years old) female are next-highest risk factors for T2DM compared with male. Consistent with the patterns characterized for China, T2DM prevalence in Japan increased with aging, and men were more likely to develop T2DM. It was the same as Korea. In the Far East, especially in China, T2DM prevalence will continue to increase until 2025. Statistical analyses were conducted using Stata 12.0 and SPSS 19.0.

Abnormal glucose regulation in Chinese patients with coronary artery disease: A cross-sectional study

The purpose of this study was to investigate the prevalence of abnormal glucose regulation (AGR) in patients with established coronary artery disease (CAD), and the association of AGR and acute coronary events in Chinese patients.A total of 3441 hospitalized patients with established diagnosis of CAD were recruited from 41 centers in 25 cities of China. Oral glucose tolerance test (OGTT) was performed in 2112 patients without known diabetes. Acute coronary events were recorded for the patients.AGR was detected in 1880 (89%) patients in the OGTT cohort, with 1265 (59.9%) diagnosed with impaired glucose tolerance, 363 (17.2%) diagnosed with diabetes, and 30 (1.4%) diagnosed with isolated impaired fasting glucose. The overall proportion of patients diagnosed with diabetes increased from 30.7% (n = 930) at baseline to 42.6% (n = 1298) following the OGTT analysis. In total 85% (n = 3047) patients in the study was diagnosed with AGR. Multivariate analysis showed that AGR was independently associated with acute coronary events, after adjusting for the traditional risk factors including age, smoking, hypertension, and hyperlipidemia.The prevalence of AGR is increasing in Chinese patients with CAD, as compared with previous report. AGR was independently associated with acute coronary events. Prospective studies are warranted to evaluate the benefit of intervening prediabetes in adult patients with CAD.

Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study

OBJECTIVE

The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan.

METHODS

Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization.

RESULTS

The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization.

CONCLUSION

Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.

The association of triglycerides and total cholesterol concentrations with newly diagnosed diabetes in adults in China

Background

It has already been suggested that high abnormal blood lipid concentration is associated with hyperglycaemia. However, no data is available about the roles of triglycerides (TG) and total cholesterol (TC) levels in diabetes. Here, for the first time we investigated the roles of TG and TC levels, gender and abdominal fat in the development of newly diagnosed diabetes in China.

Materials and Methods

Two population-based cross-sectional surveys were conducted from 2006 to 2009 in Qingdao, China. Newly diagnosed diabetes was defined according to FPG and/or 2 h PG criteria. The associations between diabetes and TG, and TC levels were assessed by multi-variable logistic regression models.

Results

As compared with non-diabetes, the odds ratio[(95% confidence intervals), OR(95% CI)] for diabetes corresponding to hypertriglyceridemia (HTG) were 1.54 (1.01, 2.35) in men and 2.02 (1.49, 3.10) in women for TG and accompany with Hypercholesterolemia (HTC) 2.93 (1.97, 4.37) and 2.13 (1.49, 3.05) for TC, when both were fitted simultaneously in the model adjusting for age, geographic division, marital status, school years, family history of diabetes, monthly income, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), high density lipoprotein cholesterol (HDL-C), alanine amino transferase (ALT) and gamma-glutamyltransferase (GGT).

Conclusions

HTG in both gender, borderline high TC and HTC in men were an independent risk factor for diabetes in this Chinese population, however, HTC was mediated through abdominal fat for diabetes in women. Our findings may help to enhance the current knowledge of diabetes patho-physiology, and the associations between TG, TC level and diabetes is also clinically informative.

Diabetes Mellitus Among Adults in Herat, Afghanistan: A Cross-Sectional Study

INTRODUCTION

Diabetes is reaching epidemic levels in Afghanistan. This study identifies the risk factors associated with diabetes in Herat City, Afghanistan, and explores the prevalence of previously undiagnosed diabetes.

METHODS

A cross-sectional study was conducted using multistage cluster sampling by adopting the World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS). We enrolled 1129 participants aged 25-70 years between May and June of 2015 (47.4% males, 52.6% females). A structured questionnaire was used for data collection of demographic, socioeconomic, and behavioral factors. Investigators collected anthropometric measurements and blood samples from study participants. A multivariable logistic regression model was used to identify factors associated with diabetes prevalence.

RESULTS

We found that the prevalence of diabetes in Herat City was 9.9% (9.8% in males and 10.1% in females). Of the 1129 respondents, only 3.3% were previously diagnosed with diabetes or were under treatment, whereas 6.6% of respondents were previously undiagnosed. The multivariable analyses showed that age, frequency of rice consumption, type of cooking oil, and systolic blood pressure were associated with diabetes.

CONCLUSIONS

This is one of the first studies to discuss the high prevalence of undiagnosed diabetes in Herat, Afghanistan. This study found several modifiable factors that were associated with diabetes in Herat, Afghanistan. Future reduction of disease burden should focus on these factors in the development of the most optimal diabetes prevention programs.

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus and associated risk factors among adults living in a rural Koladiba town, northwest Ethiopia

Background

Diabetes mellitus is becoming a big public health challenge, particularly in developing countries like Ethiopia. It is a manageable disease if early screening and follow up is made. However, as studies in Ethiopia are limited and unorganized, determining the magnitude of prediabetes and diabetes and identifying associated risk factors is quite essential.

Methods

A community-based, cross-sectional study was conducted from February to April 2015 among adults (aged ≥20 years) in a rural Koladiba town. A multistage sampling technique was used to select a total of 392 study participants. Data were collected after a fully informed written consent was obtained from each participant. Demographic, behavioral, and clinical data were collected using a well-structured questionnaire. Multivariable logistic regression models were fitted to control the effect of confounders. Adjusted odds ratios (AOR) with their 95% confidence intervals (95% CI) were computed to measure associations. A p value of <0.05 was considered as statistically significant.

Results

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus were 12% (95% CI 9–16) and 2.3% (95% CI 1.1–4), respectively, in Koladiba. Overweight (AOR: 4.257, 95% CI 1.345–13.476), obesity (AOR: 5.26, 95% CI 1.138–24.316), hypertriglyceridemia (AOR: 2.83, 95% CI 1.451–5.521), and systolic hypertension (AOR: 3.858, 95% CI 1.62–9.189) were found to be independently associated with impaired fasting glucose. Positive family history of diabetes also showed a marginal association with impaired fasting glucose (p = 0.057). Male sex (p = 0.012) and hypertriglyceridemia (p = 0.030) were associated with undiagnosed diabetes mellitus.

Conclusions

The prevalence of impaired fasting glucose and undiagnosed diabetes mellitus are found to be significant. Obesity, hypertriglyceridemia, and systolic hypertension are independently associated with impaired fasting glucose among adults. We recommend that the community be aware of healthy life style, early screening, and maintain continuous follow up.

Vitamin D improves the content of TGF-β and IGF-1 in intervertebral disc of diabetic rats

OBJECTIVE

The contents of transforming growth factor-β and insulin-like growth factor-1 in disc of diabetic rats were measured at three different periods after injected with 1,25-Dihydroxyvitamin D3, and compared with that in normal rats. The significance of content changes was also discussed.

METHODS

Fourty-five Sprague-Dawley (SD) rats were divided into three groups, namely the experimental group (STZ+calcitriol), control group (STZ+citrate buffer), and normal group (citrate buffer). Complete lumbar discs in these groups were obtained at the second, fourth, sixth week, respectively. After paraffin-embedded sections and HE staining, the structure and morphology changes of disc were observed. The content of transforming growth factor-β and insulin-like growth factor-1 was measured by immunohistochemical method, and the expression of transforming growth factor-β and insulin-like growth factor-1 was detected by Western Blot.

RESULTS

In hematoxylin-eosin staining, degenerative changes were observed in disc of experimental and control group at three different periods, and there were no changes in disc in normal group. Immunohistochemical method indicated the content of transforming growth factor-β and insulin-like growth factor-1 in experimental and control group was significantly lower than normal group at three different periods ( P < 0.05). And there were significant differences between experimental and control group at three different periods ( P < 0.05).

CONCLUSION

Vitamin D can protect the degeneration of intervertebral disc and improve the content of transforming growth factor-β and insulin-like growth factor-1 in the intervertebral disc, which provides a new idea for the prevention and treatment of degenerative changes of the intervertebral disc in diabetic patients. Impact statement No researchers reported Vitamin D could protect degeneration of intervertebral disc. That is to say, we found a new method to prevent and treat degenerative changes of the intervertebral disc in diabetic patients. And Vitamin D prevented the discs by improving the content of TGF-β and IGF-1.

Growth arrest-specific protein 6 (Gas6) as a noninvasive biomarker for early detection of diabetic nephropathy

BACKGROUND

To investigate the diagnostic level of cystatin C and growth arrest-specific gene 6 (Gas6) levels in elderly type 2 diabetic patients with different degrees of diabetic nephropathy (DN).

METHODS

Four hundred and eighty-two old people, including 130 healthy controls, 130 normoalbuminuric diabetic patients, 122 with microalbuminuria, and 100 with macroalbuminuria, were recruited. Plasma Gas6 and serum cystatin C levels were measured.

RESULTS

Plasma Gas6 concentration was significantly lower in diabetic patients with microalbuminuria or macroalbuminuria, as compared with diabetic subjects with normoalbuminuria; while cystatin C was significantly higher. Gas6 was inversely correlated with BMI, WHR, and HbA1c, while cystatin C was inversely correlated with urea nitrogen and creatinine. Multivariate logistic regression analysis showed that, after adjusted for established diabetes risk factors, higher plasma Gas6 was significantly associated with a decreased risk of DN, while higher serum cystatin C was significantly associated with an increased risk. Receiver operating characteristic curve analysis showed that Gas6 was better than cystatin C as a biomarker for early diagnosis and detection of DN, with a cutoff value of 9.435 ng/mL (86.1% sensitivity and 84.6% specificity).

CONCLUSION

Compared to cystatin C, Gas6 may be potentially a better noninvasive diagnostic biomarker for early detection of DN.

Familial History of Diabetes is Associated with Poor Glycaemic Control in Type 2 Diabetics: A Cross-sectional Study

To investigate the association of familial history (FH) of diabetes with the glycaemic control status of patients with type 2 diabetes (T2D), a cross-sectional study using stratified cluster sampling was conducted with 20,340 diabetic patients in Jiangsu, China. In total, 21.3% of the subjects reported a FH of diabetes. Patients with a FH of diabetes showed a higher risk of poor glycaemic control (59.7%) than those without a diabetic FH (49.8%), with an odds ratio (OR) of 1.366 (P < 0.001). Glycaemic control status did not significantly differ between the T2D patients with parental FH and those with sibling FH. Compared with patients with paternal FH, patients with maternal FH had a higher risk of poor glycaemic control (OR = 1.611, P = 0.013). Stratified analyses showed that a FH of diabetes was significantly associated with poor glycaemic control among T2D patients with a low education level (P < 0.05). In the <60 years old, overweight, and low level of physical activity groups, patients with a maternal history of diabetes showed a higher risk of poor glycaemic control than those without a FH (P < 0.05). In conclusion, FH of diabetes, especially a maternal history, had an independently adverse effect on the glycaemic control of T2D patients.

Self-reported diabetes education among Chinese middle-aged and older adults with diabetes

Background

To compare self–reported diabetes education among Chinese middle–aged and older adults with diabetes in three population groups: urban residents, migrants in urban settings, and rural residents.

Methods

We used data from the 2011 China Health and Retirement Longitudinal Study. The sample included 993 participants age 45 and older who reported having diabetes diagnosed from a health professional. We performed multilevel regressions performed to examine the associations between characteristics and different aspects of diabetes education received.

Findings

Our study shows that 20.24% of the participants received no diabetes education at all. Among those who received information, 46.82% of respondents with diabetes received weight control advice from a health care provider, 90.97% received advice on exercise, 60.37% received diet advice, 35.12% were spoken to smoking control, and only 17.89% of persons were informed of foot care. After controlling socioeconomic factors, life style, number of comorbidities and community factors, we found that compared with migrant population and rural residents, urban residents were more likely to receive diabetes education on diet. Urban residents were also more likely to obtain diabetes education and more aspects of diabetes education comparison with migrants and rural residents.

Conclusions

Our study suggests diabetes education is a serious concern in China, and a significant proportion of the participants did not receive advice on smoking control and foot care. Rural residents and migrants from rural areas received much less diabetes education compared with urban residents. Efforts to improve diabetes educations are urgently needed in China.

Type 2 diabetes mellitus unawareness, prevalence, trends and risk factors: National Health and Nutrition Examination Survey (NHANES) 1999-2010

Objectives To determine whether the associations with key risk factors in patients with diagnosed and undiagnosed type 2 diabetes mellitus (T2DM) are different using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. Methods The study analysed the prevalence and association with risk factors of undiagnosed and diagnosed T2DM using a regression model and a multinomial logistic regression model. Data from the NHANES 1999-2010 were used for the analyses. Results The study analysed data from 10 570 individuals. The overall prevalence of diagnosed and undiagnosed T2DM increased significantly from 1999 to 2010. The prevalence of undiagnosed T2DM was significantly higher in non-Hispanic whites, in individuals <30 years old and in those with near optimal (130-159 mg/dl) or very high (≥220 mg/dl) non-high-density lipoprotein cholesterol levels compared with diagnosed T2DM. Body mass index, low economic status or low educational level had no effect on T2DM diagnosis rates. Though diagnosed T2DM was associated with favourable diet/carbohydrate intake behavioural changes, it had no effect on physical activity levels. Conclusion The overall T2DM prevalence increased between 1999 and 2010, particularly for undiagnosed T2DM in patients that were formerly classified as low risk.

Relevance of the dietary glycemic index, glycemic load and genetic predisposition for the glucose homeostasis of Chinese adults without diabetes

Type 2 diabetes (T2DM) and pre-diabetes have become a major public health problem in China. We examined whether a higher dietary glycemic index (GI) or glycemic load (GL) was associated with a less favorable glucose homeostasis among Chinese adults and whether these associations were modified by their genetic predisposition or whether combined effects exist with their cereal fiber intake. Multivariable regression analyses were performed in 3918 adults aged 23-69 years for whom three 24-hour dietary recalls and information on glucose homeostasis, genetic background and potential confounders was available. Adults in the highest GI (GL) tertile had an approximately 9% (5%) higher fasting plasma glucose, 11% (3%) higher glycated haemoglobin, 12% (7%) higher insulin level, and 28% (22%) higher hepatic insulin resistance compared to those in the lowest tertile (adjusted p_for-trend ≤ 0.04). Moreover, a higher dietary GI or GL was associated with higher odds of pre-diabetes (p_for-trend = 0.03). These associations were more pronounced among persons with a high T2DM genetic risk score (p_{for-interaction} ≤ 0.06) or a low cereal fiber intake (p_{for-interaction} ≤ 0.05). In conclusion, our study indicates that the dietary GI or GL is of relevance for glucose homeostasis among Chinese adults, particularly among individuals genetically predisposed to T2DM.

Prevalence of anxiety disorder in patients with type 2 diabetes: a nationwide population-based study in Taiwan 2000-2010

This study investigates the prevalence of anxiety disorder (AD) in Taiwanese patients with type 2 diabetes (T2D). Study participants were identified based on at least one service claim for ambulatory or inpatient care with a principal diagnosis of AD and at least 2 service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2D, as listed in the National Health Insurance database of Taiwan. The prevalence of AD decreased from 13.75 to 11.00 % in patients with T2D, whereas it increased from 4.17 to 6.09 % in the general population during the 2000-2010 period. A high prevalence of AD in patients with T2D was associated with age >30 years, the female sex, living in the northern region, comorbidities of congestive heart failure, peripheral vascular disease, cerebrovascular disease, and depression disorder, and a Charlson participant comorbidity index of ≥1. A low prevalence of AD in patients with T2D was associated with residency in urban areas, the comorbidity of hemiplegia or paraplegia, the usage of metformin and sulfonylureas, and rapid-acting insulin injection therapy. The prevalence of AD was higher in patients with T2D than in the general population. Therefore, more public health emphasis is required for preventing and treating AD in patients with T2D, specifically those with the mentioned risk factors.

Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China

IMPORTANCE

In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes.

OBJECTIVES

To assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China.

DESIGN, SETTING, AND PARTICIPANTS

A 7-year nationwide prospective study of 512 869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014.

EXPOSURES

Diabetes (previously diagnosed or detected by screening) recorded at baseline.

MAIN OUTCOMES AND MEASURES

All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline.

RESULTS

Among the 512 869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n = 302 618) were women, and 5.9% (n = 30 280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24 909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100 000; adjusted RR, 2.00 [95% CI, 1.93-2.08]), which was higher in rural areas than in urban areas (rural RR, 2.17 [95% CI, 2.07-2.29]; urban RR, 1.83 [95% CI, 1.73-1.94]). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 [95% CI, 2.19-2.63]), stroke (4444 deaths; RR, 1.98 [95% CI, 1.81-2.17]), chronic liver disease (481 deaths; RR, 2.32 [95% CI, 1.76-3.06]), infections (425 deaths; RR, 2.29 [95% CI, 1.76-2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95% CI, 1.28-1.86]), pancreas (357 deaths; RR, 1.84 [95% CI, 1.35-2.51]), female breast (217 deaths; RR, 1.84 [95% CI, 1.24-2.74]), and female reproductive system (210 deaths; RR, 1.81 [95% CI, 1.20-2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 [95% CI, 14.22-24.57]) than in urban areas (6.83 [95% CI, 4.73-9.88]). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths).

CONCLUSIONS AND RELEVANCE

Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.

Clinical characteristics of Chinese patients with duration of type 2 diabetes >40 years

BACKGROUND

Although type 2 diabetes mellitus (T2DM) shortens life expectancy by 10-12 years, some patients survive extremely long durations of diabetes. The clinical characteristics of Chinese patients with >40 years T2DM remain unknown. Thus, the aim of the present study was to document the clinical profile of patients with T2DM for ≥40 years.

METHODS

The present study evaluated 157 survivors with >40 years T2DM from a total of 582 773 patients with T2DM enrolled in a Chinese national survey of HbA1c. Two matched case-control studies were performed on long T2DM survivors (cases) separately matched according to: (1) survey day, sex, and survey hospital; and (2) age, sex, and survey hospital. Conditional logistic regression analysis was performed to obtain odds ratios (ORs) for long survival.

RESULTS

Patients with a long duration of T2DM had a mean (± SD) age of 75 ± 10 years. Their T2DM had been diagnosed at a mean age of 32 years and the median duration of diabetes was 41 years. In both case-control studies, long-duration T2DM was associated with an increased risk of hyperglycemia (OR 6.31; 95% confidence interval [CI] 1.89-21.09) and coronary heart disease (CHD; OR 2.18 95% CI 1.01-4.70). However, long-duration T2DM was not associated with a higher likelihood of abnormal lipids, diabetic nephropathy (DN), or stroke compared with patients with a shorter duration of T2DM.

CONCLUSIONS

The present study suggests that Chinese patients with long-term T2DM also had increased risks of hyperglycemia and non-fatal CHD. Further studies are needed to investigate whether survival of these patients was associated with non-increased risk of DN.

Reanalysis and External Validation of a Decision Tree Model for Detecting Unrecognized Diabetes in Rural Chinese Individuals

We reanalyzed previous data to develop a more simplified decision tree model as a screening tool for unrecognized diabetes, using basic information in Beijing community health records. Then, the model was validated in another rural town. Only three non-laboratory-based risk factors (age, BMI, and presence of hypertension) with fewer branches were used in the new model. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) for detecting diabetes were calculated. The AUC values in internal and external validation groups were 0.708 and 0.629, respectively. Subjects with high risk of diabetes had significantly higher HOMA-IR, but no significant difference in HOMA-B was observed. This simple tool will help general practitioners and residents assess the risk of diabetes quickly and easily. This study also validates the strong associations of insulin resistance and early stage of diabetes, suggesting that more attention should be paid to the current model in rural Chinese adult populations.

Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up

AIMS

We sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally.

METHODS AND RESULTS

Data on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million-a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health. WHO-standardized IHD mortality increased for rural males by 9.2% per year (95% CI: 6.7-11.7%; P < 0.0001), and the trend was statistically significantly higher (P = 0.0001) than in urban males by 6.4% per year (95% CI: 3-10%; P = 0.02). WHO-standardized IHD mortality rate increased for rural females by 7.0% per year (95% CI: 4.6-9.4%; P < 0.0001); this was statistically significantly higher than urban females by 4.3% per year (95% CI: 1-8%; P = 0.02). The age group over 80 years showed the greatest increase in IHD mortality.

CONCLUSIONS

Mortality from IHD is increasing in China, in contrast to decreasing in other countries. This is largely driven by increasing IHD mortality in rural areas and subjects over 80 years old. This needs urgent attention by public health workers and policymakers.

Impact of Anxiety Disorders on Mortality for Persons With Diabetes: A National Population-Based Cohort Study

BACKGROUND

Most studies of the relationship between psychiatric disorders and mortality in patients with diabetes mellitus (DM) have focused on the role of depression.

OBJECTIVE

The aim of this study was to investigate the impact of anxiety disorders (ADs) on mortality in persons with DM in Taiwan.

METHODS

We used Taiwan׳s National Health Insurance claims database interlinked externally with Taiwan׳s Death Registry to study mortality in diabetic patients with and without ADs during the study period 2000-2004. Five-year survival cures were calculated using the Kaplan-Meier method for DM with ADs and DM without ADs. Cox regression analysis was used to analyze the predictive factors for DM mortality.

RESULTS

We identified 5685 persons with DM, including 732 (12.88%) who also had ADs. The 5-year survival was longer for diabetic patients with ADs than those without it. A higher risk of mortality was found in diabetic patients who were male. It was also higher for those who were 45-64 years old and ≥65 years old, those who resided in rural areas, those who had incomes <US$ 666 (NT$ 20,000) or were living on dependent incomes. ADs were found to confer a lower risk of mortality regardless of diabetes type.

CONCLUSIONS

ADs confer some protection from mortality in patients with DM. Our findings add valuable epidemiological information from a different ethnic population.

Prevalence of Depressive Disorder in Persons With Type 2 Diabetes: A National Population-Based Cohort Study 2000-2010

BACKGROUND

Diabetes mellitus, a chronic and disabling disease, is epidemic worldwide. Depressive disorder affects the productivity of workers and leads to disability.

OBJECTIVE

This study investigated the prevalence of depressive disorder among persons with type 2 diabetes in Taiwan.

METHODS

We extracted service claims data for subjects who had at least 2 ambulatory care service claims or 1 inpatient service claim with a principal diagnosis of type 2 diabetes and at least 1 ambulatory or inpatient service claim with a principal diagnosis of depressive disorder from Taiwan's National Health Insurance Database.

RESULTS

From 2000-2010, the prevalence of depressive disorder increased from 3.50-4.07% in people with type 2 diabetes, and from 1.05-2.27% in the general population. The higher prevalence of depressive disorder in persons with type 2 diabetes was associated with being female; residence in central, southern, and eastern Taiwan; residence in urban areas; the comorbidities of hemiplegia or paraplegia, cerebrovascular disease, and anxiety disorder; Charlson Comorbidity Index scores ≥1; diabetes duration >9 years; and the use of rapid-acting insulin injection therapy.

CONCLUSIONS

The prevalence of depressive disorder is higher among persons with type 2 diabetes than the general population. Consequently, more public health attention should be devoted to the prevention and treatment of this debilitating disease in persons with type 2 diabetes, especially those with the earlier mentioned risk factors.

Association between obesity indices and type 2 diabetes mellitus among middle-aged and elderly people in Jinan, China: a cross-sectional study

BACKGROUND

The relationship between obesity and type 2 diabetes mellitus (T2DM) varies with geographical area and race.

OBJECTIVES

To investigate the prevalence of T2DM and the proportion of subjects with undiagnosed T2DM. In addition, to compare the associations between different obesity indices and T2DM for middle-aged and elderly people from six communities in Jinan, China.

SETTING

A cross-sectional study was designed and the study subjects were chosen from blocks which were randomly selected in the 6 communities of Jinan, China in 2011-2012.

PARTICIPANTS

A total of 3277 residents aged ≥50 years were eligible for this study, but 1563 people were excluded because they did not provide anthropometric data such as height, weight, waist circumference (WC), hip circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, triglyceride (TG), total cholesterol (TC) or information about their current medication use. Hence, 1714 participants were included in the final data analysis.

RESULTS

The prevalence of T2DM among people aged ≥50 years was 16.6% (19.3% for men and 15.3% for women) and the proportion of patients with undiagnosed T2DM was 32.7%. Compared with the lowest levels of body mass index (BMI), WC, waist-to-hip ratio or waist-to-stature ratio (WSR), the ORs and 95% CIs of the highest levels for men, after adjusting for age, smoking, alcohol drinking, regular exercise, hypertension, TG and TC, were 1.607 (0.804 to 3.210), 2.189 (1.118 to 4.285), 1.873 (0.968 to 3.623) and 2.572 (1.301 to 5.083), respectively, and for women, 2.764 (1.622 to 4.712), 2.407 (1.455 to 3.985), 2.500 (1.484 to 4.211) and 2.452 (1.447 to 4.155), respectively.

CONCLUSIONS

Among adults aged ≥50 years in Jinan, China, the best indicator of the relationship between obesity and T2DM is WSR for men and BMI for women, respectively.

Socioeconomic disparities in type 2 diabetes mellitus prevalence and self-management behaviors in rural southwest China

BACKGROUND

This study examines how socioeconomic factors are associated with prevalence and self-management of diabetes among ethnic minority groups in the rural Yunnan province, which has the most ethnic minority groups per province in southwest China.

METHODS

A cross-sectional survey was carried out in 2014 in a rural southwest population consisting of 5532 consenting individuals aged ⩾35years. Information about participants' demographic characteristics, as well as diabetes diagnosis, treatment, and self-management behaviors, were obtained using a standard questionnaire. Fasting blood sugar levels were recorded for each individual. A socioeconomic position (SEP) index was constructed using principal component analysis.

RESULTS

The age-standardized prevalence of diabetes in the study population was 4.8%. In persons with diabetes, 23.1% regularly self-monitored blood glucose, 43.2% adhered to taking prescribed anti-diabetic drugs or insulin injections, and 63.1% took at least one measure to control blood glucose. Individual educational level was found to be negatively associated with the prevalence of diabetes, whereas individuals with greater household assets and higher SEP were more likely to be suffered from diabetes. Persons with diabetes with greater household assets, higher level of education, and higher SEP had a greater probability of regularly self-monitoring blood glucose, compliance to prescribed medicines, and taking measures to control diabetes. Access to medical services was positively associated with regularly self-monitoring blood glucose and compliance to prescribed medicines.

CONCLUSIONS

Socioeconomic disparities in diabetes prevalence and self-management do exist. Future interventions to further control diabetes and improve diabetes management must be tailored to address socioeconomic factors.

Efficacy and safety of dapagliflozin in Asian patients with type 2 diabetes after metformin failure: A randomized controlled trial

BACKGROUND

Dapagliflozin, a highly selective sodium-glucose cotransporter 2 inhibitor, reduces hyperglycemia, body weight, and blood pressure in patients with type 2 diabetes (T2D).

METHODS

This randomized double-blind placebo-controlled parallel-group 24-week study assessed the efficacy, safety, and tolerability of dapagliflozin added to metformin in Asian patients with inadequately controlled T2D (HbA1c 7.5%-10.5%). Patients were randomized to receive placebo (n = 145) or dapagliflozin 5 (n = 147) or 10 mg (n = 152).

RESULTS

Most participants were Chinese (86.0%), with a mean age of 53.8 years and mean T2D duration of 4.9 years; 92.1% completed the study. Adjusted mean HbA1c changes from baseline at Week 24 (primary endpoint) were -0.23%, -0.82%, and -0.85% in the placebo, dapagliflozin 5 and 10 mg groups, respectively, resulting in dapagliflozin 5 and 10 mg versus placebo differences of -0.59% and -0.62%, respectively (both P < 0.0001). Dapagliflozin 5 and 10 mg differences versus placebo were, respectively: -1.2 and -1.5 mmol/L for fasting plasma glucose; -1.1 and -1.8 kg for weight; and -2.3 and -2.7 mmol/L for 2-h postprandial glucose (all P <0.0001). In the placebo, dapagliflozin 5 and 10 mg groups, respectively: adverse events (AEs) occurred in 52.4%, 52.4%, and 55.3% of patients; serious AEs occurred in 4.1%, 2.0%, and 2.0%; urinary tract infections occurred in 4.8%, 4.1%, and 6.6%; and genital infections occurred in 0%, 2.0%, and 1.3%. No AEs of pyelonephritis or renal failure occurred.

CONCLUSIONS

Dapagliflozin 5 or 10 mg as add-on to metformin was well tolerated in Asian patients with T2D and significantly improved glycemic control with the additional benefit of weight reduction.

Probit Models to Investigate Prevalence of Total Diagnosed and Undiagnosed Diabetes among Aged 45 Years or Older Adults in China

The aims of this study are to identify the most important predictors of total diagnosed and undiagnosed diabetes and estimate the mean change in the predicted probability among aged 45+ adults in China. We used baseline data collected from 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) (n = 9,513). First, we estimated the prevalence of diagnosed, measured, total diagnosed, and undiagnosed diabetes. Second, we used probit models to determine whether individual attributes, socioeconomic characteristics and behavioral health factors, including smoking, alcohol consumption, obesity, central obesity, are associated with total diagnosed and undiagnosed diabetes. We also consider other factors, including contact with medical system, hypertension and urban/rural settings. Third, we estimated average marginal effects of variables in probit models. Among Chinese people aged 45+, the prevalence of diagnosed, measured, total diagnosed and undiagnosed diabetes were 5.8% (95%CI, 5.3%-6.3%), 14.7% (95%CI, 14.0%-15.4%), 17.0% (95%CI, 16.3%-17.7%), 11.3% (95%CI, 10.6%-12.0%), respectively. The probability of total diagnosed diabetes is 3.3% (95% CI, 1.2%-5.3%) and 10.2% (95% CI, 7.0%-13.5%) higher for overweight and obesity than normal BMI, 5.0% (95% CI, 3.0%-7.1%) higher for central obesity than normal waist circumference, 5.4% (95% CI, 3.7%-7.0%) higher for hypertensive than normotensive and 1.8% (95% CI, 0.8%- 2.7%) higher in urban areas than in rural areas, respectively. The probability of undiagnosed diabetes is 2.7% (95% CI, 1.2%-4.2%) and 7.2% (95% CI, 4.7%-9.6%) higher for overweight and obesity than normal BMI, 2.6% (95% CI, 0.9%-4.4%) higher for central obesity than normal waist circumference and 2.6% (95% CI, 1.2%-4.0%) higher for hypertensive than normotensive, respectively, and -1.5% (95% CI, -2.5% to -0.5%) lower for individuals who were in contact with the medical system. Greater focus on prevention of diabetes is necessary for obesity, central obesity, hypertensive and in urban areas for middle-aged and older in China.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

THE DIABETES EPIDEMIC IN CHINA: AN INTEGRATED REVIEW OF NATIONAL SURVEYS

OBJECTIVE

To review trends in the prevalence and incidence of diabetes mellitus (DM) and related risk factors in China.

METHODS

We searched the literature using PubMed, China Knowledge Resource Integrated Database, and China Wanfang Digital Database for large epidemiologic studies and national surveys.

RESULTS

During the past 30 years (1980-2010), 7 national diabetes mellitus surveys were conducted in China mainland, indicating that the prevalence of DM has increased 17-fold, from 0.67 to 11.6% of the population. The prevalence of impaired glucose regulation (IGR, including impaired fasting glucose and impaired glucose tolerance) also increased, from 2.09 in 1994 to 27.2% in 2010. There was no national representative study of the incidence of diabetes to date; the reported incidence of type 2 diabetes during past 25 years in several cohort studies varied (2.7 to 15.8 per 1,000 person-years). Potential risk factors which could have contributed to the increasing prevalence and incidence of DM and IGR in the Chinese population include social and economic development, urbanization, dietary pattern, and Westernized lifestyle. Further, genetic studies have suggested that unique inheritable risk factors in the Chinese population may increase the risk for DM when compared to Caucasians.

CONCLUSION

DM and IGR have become epidemic in China. Public health strategies should focus on modifying lifestyle and dietary factors, particularly among those with a susceptible genetic background.

ABBREVIATIONS

BMI = body mass index DM = diabetes mellitus FBG = fasting blood glucose GWAS = genome-wide association study IGR = impaired glucose regulation IGT = impaired glucose tolerance OGTT = oral glucose tolerance test T2D = type 2 diabetes WC = waist circumference WHR = waist-hip ratio.

Telmisartan combined with probucol effectively reduces urinary protein in patients with type 2 diabetes: A randomized double-blind placebo-controlled multicenter clinical study

BACKGROUND

Persistent proteinuria is an important factor contributing to the progression of diabetic nephropathy. The present randomized double-blind placebo-controlled multicenter clinical study evaluated the efficacy and safety of telmisartan combined with the antioxidant probucol in reducing urinary protein levels in patients with type 2 diabetes (T2D).

METHODS

Patients with T2D and 24-h proteinuria 0.5-3 g were enrolled in the study and randomly assigned to one of two groups: a telmisartan or a probucol + telmisartan group. Both groups were given telmisartan 80 mg q.d. for 48 weeks. The probucol + telmisartan group was given probucol 500 mg b.i.d. for the first 24 weeks, with the dosage then reduced to 250 mg b.i.d. for the remaining 24 weeks. The telmisartan group was given probucol placebo.

RESULTS

In all, 160 patients were enrolled in the present study. The 24-h proteinuria levels were significantly reduced in the probucol + telmisartan compared with telmisartan group. For patients with baseline 24-h proteinuria levels <1.0 g, both treatments resulted in significant reductions in 24-h proteinuria levels after 48 weeks treatment. However, in patients with baseline 24-h proteinuria levels ≥1.0 g, 24-h proteinuria levels after 48 weeks treatment were only reduced in the probucol + telmisartan group. There was no significant difference between the two groups for either adverse cardiovascular or other events.

CONCLUSIONS

In patients with diabetic nephropathy, probucol combined with telmisartan more effectively reduces urinary protein levels than telmisartan alone.

Potential Impact of Time Trend of Life-Style Factors on Cardiovascular Disease Burden in China

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death in China. Evaluation of risk factors and their impacts on disease burden is important for future public health initiatives and policy making.

OBJECTIVES

The study used data from a cohort of the China Health and Nutrition Survey to estimate time trends in cardiovascular risk factors from 1991 to 2011.

METHODS

We applied the comparative risk assessment method to estimate the number of CVD events attributable to all nonoptimal levels (e.g., theoretical-minimum-risk exposure distribution [TMRED]) of each risk factor.

RESULTS

In 2011, high blood pressure, high low-density lipoprotein cholesterol, and high blood glucose were associated with 3.1, 1.4, and 0.9 million CVD events in China, respectively. Increase in body mass index was associated with an increase in attributable CVD events, from 0.5 to 1.1 million between 1991 and 2011, whereas decreased physical activity was associated with a 0.7-million increase in attributable CVD events. In 2011, 53.4% of men used tobacco, estimated to be responsible for 30.1% of CVD burden in men. Dietary quality improved, but remained suboptimal; mean intakes were 5.4 (TMRED: 2.0) g/day for sodium, 67.7 (TMRED: 300.0) g/day for fruits, 6.2 (TMRED: 114.0) g/day for nuts, and 25.0 (TMRED: 250.0) mg/day for marine omega-3 fatty acids in 2011.

CONCLUSIONS

High blood pressure remains the most important individual risk factor related to CVD burden in China. Increased body mass index and decreased physical activity were also associated with the increase in CVD burden from 1991 to 2011. High rates of tobacco use in men and unhealthy dietary factors continue to contribute to the burden of CVD in China.

Development and validation of a Diabetes Risk Score for screening undiagnosed diabetes in Sri Lanka (SLDRISK)

BACKGROUND

Screening for undiagnosed diabetes is not widely undertaken due to the high costs and invasiveness of blood sampling. Simple non-invasive tools to identify high risk individuals can facilitate screening. The main objectives of this study are to develop and validate a risk score for screening undiagnosed diabetes among Sri Lankan adults and to compare its performance with the Cambridge Risk Score (CRS), the Indian Diabetes Risk Score (IDRS) and three other Asian risk scores.

METHODS

Data were available from a representative sample of 4276 adults without diagnosed diabetes. In a jack-knife approach two thirds of the sample was used for the development of the risk score and the remainder for the validation. Age, waist circumference, BMI, hypertension, balanitis or vulvitis, family history of diabetes, gestational diabetes, physical activity and osmotic symptoms were significantly associated with undiagnosed diabetes (age most to osmotic symptoms least). Individual scores were generated for these factors using the beta coefficient values obtained in multiple logistic regression. A cut-off value of sum = 31 was determined by ROC curve analysis.

RESULTS

The area under the ROC curve of the risk score for prevalent diabetes was 0.78 (CI 0.73-0.82). In the sample 36.3 % were above the cut-off of 31. A risk score above 31 gave a sensitivity, specificity, positive predictive value and negative predictive value of 77.9, 65.6, 9.4 and 98.3 % respectively. For Sri Lankans the AUC for the CRS and IDRS were 0.72 and 0.66 repectively.

CONCLUSIONS

This simple non-invasive screening tool can identify 80 % of undiagnosed diabetes by selecting 40 % of Sri Lankan adults for confirmatory blood investigations.

Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China

With one-fifth of the world's total population, China's prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. Understanding China's current cardiovascular epidemic requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The latter have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the healthcare system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that 4 priorities should be taken: pursue multisectorial government and nongovernment strategies targeting the underlying causes of CVD (the whole-of-government and whole-of-society policy); give priority to prevention; reform the healthcare system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the 4 priorities, the pandemic of CVD and other major noncommunicable diseases in China will be reversed and the global sustainable development goal achieved.

Elevated plasma tumor necrosis factor-α receptor 2 and resistin are associated with increased incidence of kidney function decline in Chinese adults

Adipokines and inflammatory markers have been linked to kidney disease in animal models; however, evidence from prospective human studies is sparse. Recruited from Beijing and Shanghai in 2005, a total number of 2220 non-institutionalized Chinese individuals aged 50-70 years with baseline estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m(2) were prospectively followed for 6 years. Plasma levels of resistin, retinol-binding protein 4 (RBP4), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α receptor 2 (TNF-R2) were determined at baseline. Kidney function decrease was assessed by measurements of eGFR over 6 years. Incident-reduced eGFR was defined as the onset of eGFR <60 mL/min/1.73 m(2), according to the Modification of Diet in Renal Disease Study Equation for Chinese. During the 6 years of follow-up, 333 (15.0 %) participants had incident-reduced eGFR. Each 1 standard deviation elevated concentration of resistin [relative risk (RR) 1.10; 95 % CI 1.00-1.24] and TNFR-2 (RR 1.30; 95 % CI 1.13-1.49) at baseline were significantly associated with a higher risk of incident-reduced eGFR. Comparing the highest with the lowest quartiles, the RR of incident-reduced eGFR was 1.43 (95 % CI 1.01-2.03) for resistin and 2.03 (95 % CI 1.41-2.93) for TNF-R2 (both P trend < 0.05) after adjustment for baseline demographic characteristics, lifestyle behaviors, BMI, plasma lipid profile, hypertension, and diabetes. These associations remained significant when further controlling for levels of RBP4, IL-6, and CRP, none of which was significantly associated with the risk of incident-reduced eGFR. In this prospective cohort study, elevated levels of resistin and TNF-R2, but not other adipokines and inflammatory markers, were independently associated with a greater risk of kidney function decline in middle-aged and elderly Chinese.

Prevalence, Awareness, Treatment and Control of Diabetes Mellitus-A Population Based Study in Shanghai, China

In this study, we aimed to investigate the prevalence, awareness, treatment, and control of diabetes in Shanghai, China. A sample of 3600 residents aged from 18 to 80 years selected by a randomized stratified multiple-stage sampling method in Shanghai was investigated, with blood samples collected. Diabetes was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/L, or glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol), or previous diagnosis by a physician. Adequate control of diabetes was taken as a level of HbA1c < 7.0% (53 mmol/mol) among people with treated diabetes. Multivariable regression analysis was used to explore associated factors for diabetes and prediabetes. In the 3136 participants suitable for analysis, the prevalences of diabetes, prediabetes, and previously diagnosed diabetes were 15.91%, 37.37%, and 4.46%, respectively. Among those with diabetes, only 28.06% were aware of their condition, 25.85% were currently undergoing medication treatment, and 12.42% achieved glycaemic control. Logistic regression showed that old age, preobesity, obesity, elevated triglyceride (TG), elevated C-reactive protein (CRP), and lower education level were associated with an increased risk of diabetes; old age, obesity, elevated TG, and elevated low-density lipoprotein (LDL) were associated with an increased risk of prediabetes, while male sex and rural residence were associated with a decreased risk of prediabetes. In summary, the state of diabetes in China is alarming; the rates of awareness, treatment, and control were relatively low. More efforts should be made to promote the prevention and control of diabetes in china.

Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus: A Randomized Controlled Trial in China

To compare the remission of type 2 diabetes mellitus (T2DM) through treatment with laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB), and to analyze the cost-effectiveness of medical treatment, LSG, and LRYGB in T2DM patients (BMI ≥ 28).A 2-group randomized controlled trial was conducted at Diabetes Surgery Centre, Beijing Shijitan Hospital in Beijing, China. Subjects were 80 patients ages 16 to 65 years with a body mass index of 28 kg/m or more and duration of T2DM no more than 15 years. Subjects were randomly assigned (1:1) to undergo either LSG (n = 40) or LRYGB (n = 40) between February 3, 2011 and October 31, 2013. Of those patients, 72 (90%) were available at follow-up at 2 years. These patients included 34 (85%) who underwent LSG and 38 (95%) who underwent LRYGB. This study presents the follow-up data at 2 years, which compared LSG and LRYGB in T2DM patients. Partial remission and complete remission were determined, and weight loss, BMI, changes in abdominal circumference, cholesterol, and triglycerides were measured. The cost-effectiveness of each type of bariatric surgery was analyzed with a Markov simulation model that yielded quality-adjusted life-years (QALYs) and costs.From our analysis results, LSG and LRYGB are both have taken a great effect on the reduction of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and bodyweight in patients with T2DM. The cost-effectiveness ratios of medical treatment, LSG, and LRYGB respectively are 1589.02, 1028.97, and 1197.44 dollars per QALY.Our analysis indicates that LSG appear to provide a cost-effective method of T2DM treatment for the patients.

Prevalence of type 2 diabetes mellitus among inland residents in China (2000-2014): A meta-analysis

Aims/Introduction

Besides the aging population in China, the following have become serious public health problems: increasing urban population, lifestyle changes and diabetes. We assessed the epidemiology of type 2 diabetes mellitus in China between 2000 and 2014, and analyzed time trends to better determine the prevalence status of diabetes in China and to provide a basis for prevention and decision‐making.

Materials and Methods

In our systematic review, we searched China National Knowledge Infrastructure, Chinese VIP Information, Wanfang and PubMed databases for studies on type 2 diabetes mellitus between 2000 and 2014 in China. Two investigators extracted the data and assessed the quality of the included literature independently. We excluded studies that did not use 1999 World Health Organization criteria for diabetes. We also excluded reviews and viewpoints, studies with insufficient data, studies that were not carried out in mainland China and studies on troops, community, schools or physical examination people. We used stata 12.0 to combine the prevalence of all studies, calculated the pooled prevalence and its 95% confidence interval, and analyzed the differences among men/women, urban/rural areas and year of study. We calculated the prevalence of seven geographic areas of China, respectively, and mapped the distribution in the whole country to estimate the pooled prevalence of each area.

Results

Our search returned 4,572 studies, 77 of which satisfied the inclusion criteria. The included studies had a total of 1,287,251 participants, in which 680,574 cases of type 2 diabetes mellitus were recorded. The overall prevalence (9.1%) has been increasing since the 1970s, and it increased rapidly with age. The prevalence of the 65–74 years group was as high as 14.1%. Meanwhile, the prevalence among men/women and urban/rural areas was significantly different. The prevalence was 9.9% for men and 11.6% for women, which were significantly higher than the average at the end of the last century and the beginning of this century. The prevalence rate in urban areas (11.4%) was significantly higher than that in rural areas and in urban‐rural fringe areas, and the prevalence in rural areas (8.2%) was slightly higher than that in urban‐rural fringe areas (7.5%). In addition, the prevalence in each geographic area were estimated and mapped, which showed a large imbalance in the map.

Conclusions

Our analysis suggested that type 2 diabetes mellitus is highly prevalent in China. These results underscore the urgent need for the government to vigorously strengthen the management of diabetes prevention and control.

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China

Background:

In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services.

Methods:

This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination.

Results:

We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups.

Conclusions:

We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

Cardiovascular Risk Factors Among Low-Income Women: A Population-Based Study in China from 1991 to 2011

BACKGROUND

Data on long-term trends in the prevalence and clustering of cardiovascular disease (CVD) risk factors among women in China are rare, especially among low-income women. The aim of this study was to investigate the secular trends in the prevalence of CVD risk factors among low-income women in northern China.

MATERIALS AND METHODS

The prevalence and clustering of CVD risk factors, including hypertension, diabetes, obesity, current smoking status, and alcohol consumption, were assessed and compared in women aged 35-74 years in northern China in 1991 and 2011.

RESULTS

The age-adjusted prevalence of cardiovascular risk factors among women was significantly higher in 2011 than in 1991, with increases of 31% (53.6% vs. 41.1%) for hypertension, 148% (20.9% vs. 8.4%) for obesity, 256% (11.7% vs. 3.3%) for diabetes, and 1634% (4.5% vs. 0.3%) for alcohol consumption. Over the 21-year period, there were significant differences in the prevalence of clustering of ≥1, ≥2, and 3 risk factors in all age groups. The greatest increase was observed among women aged 35-44 years, with a 7.3-fold increase in the prevalence of clustering of three risk factors. Simultaneously, the prevalence of clustering of ≥1 risk factors among women aged 35-44 years was 1.7-fold higher in 2011 than in 1991; the prevalence of clustering of ≥2 risk factors was raised by 5.5-fold among elderly women.

CONCLUSIONS

Our findings suggest that it is crucial to emphasize the prevention and control of cardiovascular risk factors among young women in rural China to reduce the burden of CVDs.

Status of cardiovascular health in Chinese adults

BACKGROUND

Cardiovascular disease has become the leading cause of death in China.

OBJECTIVES

The goal of this study was to evaluate the current status of cardiovascular health in Chinese adults.

METHODS

Cardiovascular health data were collected from a nationally representative sample of 96,121 Chinese adults age ≥ 20 years in 2010. Ideal cardiovascular health was defined according to the American Heart Association's 2020 Strategic Impact Goals as follows: the simultaneous presence of 4 favorable health behaviors (ideal smoking status, ideal body mass index, physical activity at goal, and healthy dietary habits) and 4 favorable health factors (ideal smoking status, untreated total cholesterol <200 mg/dl, untreated blood pressure <120/<80 mm Hg, and untreated fasting plasma glucose <100 mg/dl) in the absence of a history of cardiovascular disease.

RESULTS

The estimated percentage of ideal cardiovascular health was 0.2% in the general adult population in China (0.1% in men and 0.4% in women). An estimated 0.7% (0.4% in men and 1.0% in women) of Chinese adults had all 4 ideal health behaviors, and 13.5% (5.0% in men and 22.3% in women) had all 4 ideal health factors. Men most frequently had 3 to 4 ideal components, and women most commonly had 4 to 5 ideal components of the 7 cardiovascular health metrics. Ideal diet (1.6%) was the least common among all cardiovascular health metrics. Female sex and younger age were the 2 most common protective factors for cardiovascular health in Chinese adults.

CONCLUSIONS

The percentage of ideal cardiovascular health in Chinese adults is extremely low. Both population-wide and high-risk strategies should be implemented with great effort to promote cardiovascular health in China.

Overweight, resting heart rate, and prediabetes/diabetes: A population-based prospective cohort study among Inner Mongolians in China

We aimed to investigate the cumulative effect of overweight and resting heart rate on prediabetes/diabetes incidence in an 10-year follow-up study in Inner Mongolians. Among 1729 participants who were free from prediabetes and diabetes at baseline, 503 and 155 subjects developed prediabetes and diabetes, respectively. We categorized the participants into 4 subgroups according to overweight and resting heart rate status. The multivariate-adjusted OR (95% CI) in normal weight with heart rate ≥80 bpm, overweight with heart rate <80 bpm, and overweight with heart rate ≥80 bpm were 1.24 (0.95-1.61), 1.83 (1.29-2.61), 2.20 (1.41-3.45) for prediabetes and 1.52 (0.97-2.40), 3.64 (2.21-6.01), 4.61 (2.47-8.61) for diabetes, respectively, compared with normal weight with heart rate <80 bpm. The area under ROC curve (AUC) for the prediction of diabetes incidence for a model containing overweight and resting heart rate, along with conventional factors (AUC = 0.751), was significantly (P = 0.003) larger than the one containing only conventional factors (AUC = 0.707). Our study indicated that overweight was an independent risk factor of prediabetes and diabetes, and overweight with faster resting heart rate might further increase the risk of prediabetes and diabetes.

Association between the Hypertriglyceridemic Waist Phenotype, Prediabetes, and Diabetes Mellitus in Rural Chinese Population: A Cross-Sectional Study

Background: The objective was to evaluate the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in rural Chinese population. Methods: In a cross-sectional study, 11,579 adults (5361 men and 6218 women) aged 35 years or older were recruited from rural areas of China. Anthropometric measurements, laboratory examinations and self-reported information were collected by trained personnel. The HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. We used logistic regression analysis to evaluate the associations of interest. Results: Adults with the HTGW phenotype had a significantly higher prevalence of prediabetes and diabetes than those without the HTGW phenotype. Compared with the normal waist-normal triglycerides (NWNT) group, those in the HTGW group had a higher adjusted odds ratio of diabetes (OR: 2.10; 95% CI: 1.62–2.73). The association for diabetes was stronger for men (OR: 2.27; 95% CI: 1.52–3.40) than for women (OR: 1.86; 95% CI: 1.32–2.63). However, multivariate analysis indicated that the HTGW phenotype was not associated with prediabetes. Conclusions: This study demonstrated that the HTGW phenotype was associated with diabetes in a large rural Chinese population, and suggested this phenotype as a simple screening tool to identify adults with cardiometabolic conditions.

Cancer prevention and control: alarming challenges in China

China is geographically the third largest country in the world and the most populated low-to-middle-income country. Cancer incidence and mortality rates for some cancers in the USA and European countries have steadily decreased over the last decades, whereas the incidence and mortality of certain cancers in China have been increasing at an alarming speed. Rapid industrialization and urbanization in China have been accompanied by incredible changes in lifestyle and environment combined with an aging population. Mortality caused by lung, colorectal and breast cancers has been steadily increasing, whereas cancer mortality from gastric, esophageal and cervical tumors has tended to decrease. Similar to what has occurred in the United States, unhealthy lifestyles in China, including heavy smoking and poor diet combined with pollution, have contributed to increased cancer risk. China is facing many challenges in cancer treatment and prevention for the general population. The major areas that need to be addressed in the control of cancer in China include cancers associated with environmental pollution, tobacco use, occupational carcinogens, infection, excessive alcohol consumption, dietary deficiencies and obesity. In this perspective, we review the problems in each area and suggest ideas for future directions in cancer research and strategies and actions to reduce the incidence of cancer in China.

Incidence of type 2 diabetes and number of events attributable to abdominal obesity in China: A cohort study

BACKGROUND

The aim of the present study was to estimate the incidence of type 2 diabetes (T2D) and the number of diabetes events attributable to abdominal obesity in China.

METHODS

A cohort study was conducted in a sample of 24,996 Chinese adults aged 35-74 years, with 19.9% of subjects lost to follow-up. Waist circumference (WC) was measured at baseline in 1998 and 2000-01, and abdominal obesity was defined as WC ≥ 90 cm in men and ≥80 cm in women. Information on incident diabetes was collected during follow-up in 2007-08. We estimated the number of T2D events attributed to abdominal obesity using confounder-adjusted population-attributable risk, incidence of diabetes, and the population size of China in 2010.

RESULTS

After a mean follow-up of 8.0 years, the age-standardized incidence of T2D was 9.6 and 9.2 per 1000 person-years in men and women, respectively. Abdominal obesity accounted for 28.1% (95% confidence interval [CI] 14.8%, 40.5%) of incident diabetes among men and 41.2% (95% CI 28.3%, 52.6%) among women using the diagnostic criteria of abdominal obesity recommended by the International Diabetes Federation. We estimated that, in 2010, 2.4 (95% CI 1.5, 3.2) million diabetes events were attributable to abdominal obesity: 1.0 (95% CI 0.5, 1.4) million in men and 1.4 (95% CI 1.0, 1.8) million in women.

CONCLUSIONS

Abdominal obesity is a major risk factor for T2D. Strengthening programs and initiatives for preventing and controlling obesity focusing on lifestyle changes should be a priority in the national strategy to reduce diabetes burden in China.

Nickel exposure is associated with the prevalence of type 2 diabetes in Chinese adults

BACKGROUND

Nickel exposure can induce hyperglycaemia in rodents, but little is known about its association with abnormal glucose metabolism in humans. We aimed to investigate the association of nickel exposure with the prevalence of type 2 diabetes in Chinese adults.

METHODS

A total of 2115 non-institutionalized men and women aged 55 to 76 years from Beijing and Shanghai were included, and urinary nickel concentration was assessed by inductively coupled plasma mass spectroscopy. The prevalence of type 2 diabetes was compared across urinary nickel quartiles. Fasting plasma glucose, insulin, lipids, C-reactive protein and glycated haemoglobin A1c, as well as urinary albumin and creatinine were measured.

RESULTS

The median concentration of urinary nickel was 3.63 mg/l (interquartile range: 2.29–5.89 mg/l), and the prevalence of diabetes was 35.3% (747 cases/2115 persons). Elevated levels of urinary nickel were associated with higher fasting glucose, glycated haemoglobin A1c, insulin and homeostatic model assessment of insulin resistance (all P<0.01). The odds ratios (95% confidence interval) for diabetes across the increasing urinary nickel quartiles were 1.27 (0.97–1.67), 1.78 (1.36–2.32) and 1.68 (1.29–2.20), respectively (referencing to 1.00), after multivariate adjustment including lifestyle factors, body mass index and family history of diabetes (P for trend <0.001). The association remained unchanged after further controlling for urinary creatinine and C-reactive protein (P for trend <0.001).

CONCLUSIONS

Increased urinary nickel concentration is associated with elevated prevalence of type 2 diabetes in humans.

Prevalence of Diabetes and Impaired Fasting Glucose in Hypertensive Adults in Rural China: Far from Leveling-Off

In recent years data from many investigations has shown a leveling–off trend in diabetes incidence. In order to explain the diabetes epidemic in rural China during the past ten years, we conducted a survey from July 2012 to August 2013. Data from comprehensive questionnaires, physical examinations, and blood tests were obtained from 5919 residents with hypertension, aged ≥ 35 years. Diabetes and impaired fasting glucose (IFG) were defined according to the American Diabetes Association (ADA) criteria. The overall prevalence of diabetes and IFG were 15.3% (13.6% in men, 16.8% in women) and 40.7% (44.1% in men, 34.7% in women) in the hypertensive rural Chinese population. The prevalence of previously diagnosed diabetes was 6.5% (4.6% in men, 8.4% in women). The prevalence of undiagnosed diabetes was 8.7% (9.0% in men, 8.5% in women). Multivariate logistic regression revealed that increasing age, drinking, overweight or obesity, systolic blood pressure, low HDL-C, high total cholesterol and triglycerides increased the risk of diabetes (p < 0.05). Diabetes is thus still prevalent in rural areas of China and is manifesting an accelerating trend. It remains an important public health problem in China, especially in rural areas and routine assessment for the early detection and treatment of diabetes should be emphasized.

Prevalence and temporal pattern of hospital readmissions for patients with type I and type II diabetes

OBJECTIVE

Repeated hospitalisation for patients is common and costly, yet partly preventable. However, we know little about readmissions for patients with diabetes in China. The current study aims to assess the frequency and temporal pattern of and risk factors for all-cause readmission among hospitalised patients with diabetes in Tianjin, China.

METHOD

This retrospective, cohort analysis used the Tianjin Basic Medical Insurance Register System data of 2011. The patterns of and the reasons for all-cause readmissions for patients with diabetes were described. The differences of readmission-free survival (RFS) between newly and previously diagnosed patients were compared. Time-dependent Cox models were established to identify the risk factors for readmission at different time intervals after discharge.

RESULTS

Readmission rates were approximately 30%, with the most common diagnoses of cerebral infarction (for type I) or diabetes (for type II) for patients with diabetes. The majority of patients were readmitted to the hospital after more than 90 days, followed by 8-30 days (all p=0.002). Approximately 37.2% and 42.8% of readmitted patients with type I and type II diabetes were diagnosed previously, and the RFS rates for previously diagnosed patients were significantly lower than for newly diagnosed patients at any time interval after discharge. Prior history of diabetes (all p<0.05), length of stay (all p<0.01) and reimbursement ratio (90% vs >92%, all p<0.0002) were consistently associated with the RFS for patients readmitted to the hospital at <7, 8-30, 31-60 and 61-90 days.

CONCLUSIONS

Hospital readmissions among patients with diabetes were affected by the diagnosis status. Patient characteristics and the quality of healthcare might regulate short-interval and long-interval hospital readmission, respectively, after discharge.

Physical activity level and incident type 2 diabetes among Chinese adults

PURPOSE

The objective is to examine the association between physical activity level (PAL) and incident type 2 diabetes among middle-age and older Chinese men and women in urban China.

METHODS

This prospective study included 6348 participants (age 35 to 74 yr) who were free of diabetes and cardiovascular disease at baseline. PAL was estimated on the basis of self-reported overall physical activity on a typical day. According to PAL, participants were classified into four groups: sedentary (PAL, 1.00-1.39), low active (PAL, 1.40-1.59), active (PAL, 1.60-1.89), and very active (PAL, >1.89). The association of PAL with incident diabetes was examined by Cox proportional hazards model.

RESULTS

During 7.9 yr of follow-up (50,293 person-years), 478 incident cases of type 2 diabetes were identified. After adjustment for age, sex, geographic region, educational level, smoking, alcohol use, and family history of diabetes, the HR (95% CI) values for type 2 diabetes across increasing categories of PAL were 1.00 (reference), 0.82 (0.62-1.09), 0.63 (0.47-0.83), and 0.47 (0.36-0.61), respectively (P for trend <0.0001). Additional adjustment for baseline body mass index or waist circumference attenuated the magnitude of risk reduction, but it remained significant. The inverse association between PAL and risk of incident diabetes was persistent in subgroup analyses according to age, sex, hypertension, smoking, body mass index, waist circumference, and fasting plasma glucose level.

CONCLUSIONS

Higher PAL is associated with substantial reduction in risk of type 2 diabetes. Our findings suggest the importance of a physically active lifestyle in the prevention of diabetes.

Observational Registry of Basal Insulin Treatment (ORBIT) in Patients with Type 2 Diabetes Uncontrolled by Oral Hypoglycemic Agents in China--Study Design and Baseline Characteristics

BACKGROUND

Efficacy of basal insulin (BI) has been well studied by randomized controlled trials, but the impact of BI on glycemic control in the real world has not been well documented. The Observational Registry for BI Treatment (ORBIT) study is designed to evaluate the real-life outcomes of BI in China.

MATERIALS AND METHODS

Participants with type 2 diabetes (n=19,894), from December 2011 to June 2013, inadequately controlled on oral hypoglycemic agents (OHAs) were initiated on BI treatment from 209 hospitals in all the eight regions in Mainland China. Data for each patient on use of OHAs and insulin (type and dose), glycemic control, hypoglycemic episodes, body weight, quality of life, and costs were collected at baseline and 3 and 6 months.

RESULTS

For the 18,995 participants who were eligible for baseline analysis, mean±SD age was 55.4±10.4 years, with 52.5% males. The mean duration of diabetes was 6.4±5.3 years and was positively associated with the economic level of eight regions. Before initiation of BI, patients had a mean hemoglobin A1c level of 9.6±2.0% with a fasting plasma glucose level of 11.7±4.0 mmol/L. Of the patients, 35.5% had some diabetes complications. Metformin, sulfonylureas, and α-glycosidase inhibitors were the most commonly used OHAs. The proportions of patients using one, two, or more than two OHAs before BI initiation were 48.4%, 42.7%, and 8.9%, respectively.

CONCLUSIONS

To the best of our knowledge, the ORBIT study is the largest registry study to evaluate glycemic outcomes and safety of BI in real-world China. Baseline data indicate delays in initiation of BI in the majority of patients with type 2 diabetes in China.

Mortality rates and the causes of death related to diabetes mellitus in Shanghai Songjiang District: an 11-year retrospective analysis of death certificates

BACKGROUND

China is one of the countries with the highest prevalence of diabetes in the world. We analysed all the death certificates mentioning diabetes from 2002 to 2012 in Songjiang District of Shanghai to estimate morality rates and examine cause of death patterns.

METHODS

Mortality data of 2654 diabetics were collected from the database of local CDC. The data set comprises all causes of death, contributing causes and the underlying cause, thereby the mortality rates of diabetes and its specified complications were analysed.

RESULTS

The leading underlying causes of death were various cardiovascular diseases (CVD), which collectively accounted for about 30% of the collected death certificates. Diabetes was determined as the underlying cause of death on 28.7%. The trends in mortality showed that the diabetes related death rate increased about 1.78 fold in the total population during the 11-year period, and the death rate of diabetes and CVD comorbidity increased 2.66 fold. In all the diabetes related deaths, the proportion of people dying of ischaemic heart disease or cerebrovascular disease increased from 18.0% in 2002 to 30.5% in 2012. But the proportions attributed directly to diabetes showed a downtrend, from 46.7-22.0%.

CONCLUSIONS

The increasing diabetes related mortality could be chiefly due to the expanding prevalence of CVD, but has nothing to do with diabetes as the underlying cause. Policy makers should pay more attention to primary prevention of diabetes and on the prevention of cardiovascular complications to reduce the burden of diabetes on survival.

Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes

OBJECTIVE

The relationship between glycemic control and adverse outcomes found in a population with diabetes has seldom been evaluated in patients with type 2 diabetes. We explored the association between hemoglobin A1c (HbA1c) and hospitalization risks within one-year and eight-year follow-up periods.

METHODS

We conducted a retrospective cohort study on 57,061 patients with type 2 diabetes from National Diabetes Case Management Program during 2002-2004 in Taiwan. HbA1c at baseline and in-hospital mortality, all-cause and cause-specific hospitalization over one year and eight years were analyzed.

RESULTS

After multivariate adjustment, one-year risk was higher for cases with HbA1c level <6%, 9-10%, ≥10% versus 6-7% for all-cause hospitalization (hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 1.03-1.20; 1.08, 1.01-1.16, and 1.19, 1.12-1.26, respectively) and for ≥10% for diabetes-related hospitalization (1.68, 1.46-1.92). Yet each 1-step increment in HbA1c category (<6.0, 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-9.9 and ≥10.0%) showed linkage with lower risk of hypoglycemia hospitalization (0.81, 95% CI: 0.74-0.88). For eight-year risk, subjects with HbA1c level <6%, and ≥10% were more likely to have in-hospitality mortality (1.16, 1.03-1.31, and 1.23, 1.11-1.35, respectively). Each 1-step increment in HbA1c category showed an association with higher risks of all-cause and diabetes-related hospitalization (1.04, 1.03-1.05, and 1.15, 1.14-1.17, respectively).

CONCLUSIONS

Higher HbA1c level correlated with lower one-year risk due to hypoglycemia hospitalization but increased one-year and eight-year risks due to all-cause and diabetes-specific hospitalization among Chinese people with type 2 diabetes in Taiwan. Future study must ascertain how to meet HbA1c targets and improve outcome without risk to this population.