Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013

Association between calf circumference and cardiac metabolic risk factors in middle-aged and elderly women

Aims

To assess the correlation between calf circumference and cardiac metabolic risk factors such as hypertension, abnormal blood glucose and dyslipidaemia among middle-aged and elderly women.

Methods

The cross-sectional study population consisted of 476 female participants aged 40-80 years, including 304 perimenopausal and 172 postmenopausal women. Calf circumference, body mass index (BMI), blood pressure, blood glucose and blood lipids were measured. Logistic regression analysis was used to evaluate the study aims.

Results

Calf circumference was lower in postmenopausal than perimenopausal women, and postmenopausal women had the highest rates of hypertension, abnormal blood glucose and abnormal blood lipids. Pearson correlation coefficients showed that calf circumference was positively correlated with triglycerides (TGs), BMI, fasting plasma glucose (FPG),2-h plasma glucose, glycated haemoglobin (HbA1C), systolic blood pressure and diastolic blood pressure; and negatively correlated with high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC). The group with the lowest quantile of calf circumference had higher rates of hypertension (odds ratio (OR)2.14,95% confidence interval (CI)1.67-2.74),dysglycaemia (OR1.40,95%CI1.03-1.90) and dyslipidaemia (OR2.14,95%CI 1.86-2.46).

Conclusion

In perimenopausal women, measurements of calf circumference can be used to predict the presence of cardiac metabolic risk factors, which can be detected by observing blood pressure, blood glucose, and blood lipids.

Prevalence and risk factors of stroke in China: a national serial cross-sectional study from 2003 to 2018

Stroke imposes a substantial burden worldwide. With the rapid economic and lifestyle transition in China, trends of the prevalence of stroke across different geographic regions in China remain largely unknown. Capitalizing on the data in the National Health Services Surveys (NHSS), we assessed the prevalence and risk factors of stroke in China from 2003 to 2018. In this study, data from 2003, 2008, 2013, and 2018 NHSS were collected. Stroke cases were based on participants' self-report of a previous diagnosis by clinicians. We estimated the trends of stroke prevalence for the overall population and subgroups by age, sex, and socioeconomic factors, then compared across different geographic regions. We applied multivariable logistic regression to assess associations between stroke and risk factors. The number of participants aged 15 years or older were 154,077, 146,231, 230,067, and 212,318 in 2003, 2008, 2013, and 2018, respectively, among whom, 1435, 1996, 3781, and 6069 were stroke patients. The age and sex standardized prevalence per 100,000 individuals was 879 in 2003, 1100 in 2008, 1098 in 2013, and 1613 in 2018. Prevalence per 100,000 individuals in rural areas increased from 669 in 2003 to 1898 in 2018, while urban areas had a stable trend from 1261 in 2003 to 1365 in 2018. Across geographic regions, the central region consistently had the highest prevalence, but the western region has an alarmingly increasing trend from 623/100,000 in 2003 to 1898/100,000 in 2018 (P trend<0.001), surpassing the eastern region in 2013. Advanced age, male sex, rural area, central region, hypertension, diabetes, depression, low education and income level, retirement or unemployment, excessive physical activity, and unimproved sanitation facilities were significantly associated with stroke. In conclusion, the increasing prevalence of stroke in China was primarily driven by economically underdeveloped regions. It is important to develop targeted prevention programs in underdeveloped regions. Besides traditional risk factors, more attention should be paid to nontraditional risk factors to improve the prevention of stroke.

Interplay between Risk Factors and Coronary Artery Calcium in Middle-Aged and Elderly Symptomatic Patients

Background

The prognostic value of coronary artery calcium (CAC) combined with risk factor burdens in middle-aged and elderly patients with symptoms is unclear.

Methods

A cohort study comprising 7432 middle-aged and elderly symptomatic patients (aged above 55 years) was conducted between December 2013 and September 2020. All patients had undergone coronary computed tomography angiography, and the Agatston score were used to measure CAC scores. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), which was defined as a composite outcome of nonfatal myocardial infarction, revascularization (percutaneous coronary intervention or coronary artery bypass graft), stroke, and cardiovascular death. Congestive heart failure, cardiogenic shock, malignant arrhythmia, and all-cause mortality were defined as the secondary outcomes.

Results

There are 970 (13%) patients with CAC 0-10, 2331 (31%) patients with CAC 11-100, and 4131 (56%) patients with CAC ≥ 101. The proportion of patients aged 55-65 years, 65-75 years and ≥ 75 years was 40.7%, 38.1% and 21.2%, respectively. The total number of MACCEs over the 3.4 years follow-up period was 478. The percentage of CAC ≥ 101 was higher among the 75-year-old group than the 55-65-year-old group, increasing from 46.5% to 68.2%. With the increase in the CAC score, the proportion of patients aged ≥ 75 years increased from 12.9% to 25.8%, compared to those aged 55-65 years. The number of risk factors gradually increased as the CAC scores increased in the symptomatic patients aged over 55 years and the similar tendencies were observed among the different age subgroups. The proportion of non-obstructive coronary artery disease (CAD) was comparable between the three age groups (53.5% vs 51.9% vs 49.1%), but obstruction CAD increased with age. The incidence of MACCE in the group with CAC ≥ 101 and ≥ 4 risk factors was 1.71 times higher (95% confidence interval (CI) 1.01-2.92; p = 0.044) than the rate in the group with CAC ≥ 101 and 1 risk factor. In the CAC 0-10 group, the incidence of MACCE in patients aged ≥ 75 years was 12.65 times higher (95% CI: 6.74-23.75; p < 0.0001) than that in patients aged 55-65 years. By taking into account the combination of CAC score, age, and risk factor burden, the predictive power of MACCE can be increased (area under the curve (AUC) = 0.614).

Conclusions

In symptomatic patients aged 55 or above, a rise in age, CAC scores, and risk factor burden was linked to a considerable risk of future MACCE. In addition, combining CAC scores, age and risk factors can more accurately predict outcomes for middle-aged and elderly patients with symptoms.

Tanshinone IIA mediates protection from diabetes kidney disease by inhibiting oxidative stress induced pyroptosis

ETHNOPHARMACOLOGICAL RELEVANCE

Salvia miltiorrhiza is widely used traditional Chinese medicine in the treatment of diabetes kidney disease (DKD). Tanshinone IIA (Tan IIA) are one of the main components of the root of red-rooted Salvia miltiorrhiza Bunge. However, whether tanshinones delay the progression of DKD and the underlying mechanisms are unknown.

AIM OF THE STUDY

Clarify the mechanisms underlying the occurrence and progression of DKDs from a novel viewpoint and confirm the function and mechanism of Tan IIA.

MATERIALS AND METHODS

We experimented with models of DKD (db/db mice) and cultured human renal glomerular endothelial cells (HRGECs). We measured the biochemical indicators of mouse blood and urine to confirmed that Tan IIA exerted protective effects on the kidneys of db/db mice. Renal histopathology and immunohistochemical staining were used to determine the role of Tan IIA. High glucose-induced HRGECs pyroptosis based on the results of Western blot, CCK-8 cell viability test, calcein/PI staining, ROS/superoxide anion generation and transmission electron microscope. We also confirmed that Tan IIA alleviated HRGEC pyroptosis through the same methods. The relationships between oxidative induction and regulation of NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation were investigated using Western blot following the application of an NLRP3 inhibitor and oxidative stress inhibitor.

RESULTS

Tan IIA alleviated kidney injury and improved the levels of urine, blood indicators, the expression of NLRP3 and thioredoxin-interacting protein (Txnip) in db/db mice kidney. In vitro, high glucose inhibited HRGECs viability, increased ROS generation, enhanced the proportion of propidium iodide-stained cells. In addition, we discovered the expression of GSDMD-NT, NLRP3, cleaved IL-1β, cleaved caspase-1, and Txnip increased, but the expression of Trx1 decreased after treated by high glucose. These changes were partially ameliorated by Tan IIA.

CONCLUSION

Hyperglycemia could induce pyroptosis in renal glomerular endothelial cells. However, Tan IIA could delay the progression of DKD by inhibiting pyroptosis by regulating the Txnip/NLRP3 inflammasome.

Glycemic outcomes of people with diabetes mellitus in Brazilian primary health care

Background

The capillary blood glucose monitoring program at home a challenge in primary health care. Therefore, it is fundamental to identify the glycemic control of people with diabetes mellitus through HBA1c and to analyze its associated factors.

Objective

To identify the glycemic profile of people with Diabetes Mellitus (DM) through HbA1c and analyze factors associated.

Materials & methods

Cross-sectional study developed in Ribeirão Preto, São Paulo, Brazil. Secondary data from the electronic health record of people registered in the Primary Health Care system were used. A sample of 3181 participants was obtained. People with HbA1c < 7.0% (53 mmol/mol) were considered to have adequate glycemic control. For people aged ≥ 55 years, a less stringent target, < 8.0% (64 mmol/mol), was also considered. The odds ratio was the measure of effect analyzed with their respective 95% Confidence Intervals (95% CI).

Results

Adequate glycemic control with HbA1c < 7.0% (53 mmol/mol) was found in 44.8% of people and, when using the less rigid target, HbA1c < 8.0% (64 mmol/mol) for people aged ≥ 55 years-old, 70.6% had adequate glycemic control. Age and drug therapy were associated with adequate glycemic control (p < 0.001), which was more frequent among older people and those who used only metformin.

Conclusion

The study shows that the achievement of adequate glycemic control is still a challenge, especially with regard to younger people and those who use insulin.

Changes of equality of medical service utilization in China between 1993 and 2018: findings from six waves of nationwide household interview survey

BACKGROUND

Changes in China's health care system in the last three decades was remarkable. The current study aims on examine the change of equality of health care utilization in mainland China based on a nationwide household interview survey.

METHODS

We used household interview data extracted from six waves of National Health Service Survey between 1993 and 2018. Changes of health care utilization were descripted. Equality of the utilization were examined with univariate meta-regression across urban and rural areas, socioeconomic development regions and income groups.

RESULTS

The proportion of outpatient visits within last two weeks experienced a decrease from 17.0% in 1993 to 13.0% in 2013 and bounced back to 24.0% in 2018. The age-standardized trend remained unchanged. Hospitalization in the last 12 month increased from 2.6% in 1998 to 13.8% in 2018. The perceived unmet need of hospital admission fell from 35.9% in 1998 to 21.5% in 2018. The gaps in health care utilization between urban and rural areas, across regions and by income groups have been narrowed, implying improved equality of using medical services in the last two and a half decades.

CONCLUSION

China has experienced significant increases in health care utilization over the past 25 years. Meanwhile, the unmet needs for health care decreased remarkably and the equality of health care utilization improved significantly. These results imply significant achievements in health service accessibility in China.

Serum Uric Acid Levels Are Related to Diabetic Peripheral Neuropathy, Especially for Motor Conduction Velocity of Tibial Nerve in Type 2 Diabetes Mellitus Patients

Background

Oxidative stress is one of the most critical factors that contribute to the pathogenesis of neuronal damage, including diabetic peripheral neuropathy (DPN). Uric acid is a kind of natural antioxidant that plays a major role in the antioxidant capacity against oxidative stress. Here, we aim to determine the role of serum uric acid (SUA) in the DPN of patients with type 2 diabetes mellitus (T2DM). Patients and Methods. 106 patients with T2DM were recruited and divided into the DPN group and the control group. Clinical parameters, especially for motor nerve fiber conduction velocity and sensory nerve fiber conduction velocity, were collected. Differences between T2DM patients with and without DPN were compared. Correlation and regression analyses were performed to explore the association between SUA and DPN.

Results

Compare with 57 patients with DPN, 49 patients without DPN showed lower HbA1c and elevated SUA levels. Additionally, SUA levels are negatively associated with the motor conduction velocity of tibial nerve with or without adjusting for HbA1c. Besides, it is suggested that decreased SUA levels may influence the motor conduction speed of the tibial nerve by multiple linear regression analysis. Moreover, we demonstrated that decreased SUA level is a risk factor for DPN in patients with T2DM by binary logistic regression analysis.

Conclusion

Lower SUA is a risk factor for DPN in patients with T2DM. Additionally, decreased SUA may influence the damage of peripheral neuropathy, especially for motor conduction velocity of the tibial nerve.

Association between MetS-IR and prediabetes risk and sex differences: a cohort study based on the Chinese population

Objective

The metabolic score for insulin resistance (MetS-IR) is an emerging surrogate marker for insulin resistance (IR). This study aimed to investigate the association and sex differences between MetS-IR and prediabetes risk in a Chinese population.

Methods

This cohort study included 100,309 adults with normoglycemia at baseline and had followed longitudinally for 5 years, and with prediabetes, defined according to the 2018 American Diabetes Association (ADA) recommended diagnostic criteria, as the outcome of interest. Multivariate Cox proportional hazards regression and restricted cubic spline (RCS) regression models were used to assess the association between MetS-IR and prediabetes risk.

Results

During an observation period of 312,843 person-years, 7,735 (14.84%) men and 4,617 (9.57%) women with pre-diabetes onset were recorded. After fully adjusting for confounders, we found an independent and positive correlation between MetS-IR and the risk of prediabetes in the Chinese population, and the degree of correlation was stronger in women than in men (HR: 1.24 vs 1.16, P-interaction<0.05). Furthermore, using RCS nested in the Cox regression model, we found that there was a nonlinear correlation between MetS-IR and prediabetes risk in both sexes with an obvious saturation effect point, and when the MetS-IR was greater than the value of the saturation effect point, the risk of prediabetes was gradually leveling off. We further calculated the saturation effect points of MetS-IR used to evaluate the risk of prediabetes which in men was 42.82, and in women was 41.78.

Conclusion

In this large cohort study, our results supported that MetS-IR was independently and positively associated with the risk of prediabetes in the Chinese population, with the association being stronger in women than in men.

A new, alternative risk score for sarcopenia in Chinese patients with type 2 diabetes mellitus

OBJECTIVE

To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity.

RESEARCH DESIGN AND METHODS

The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations. The study was registered at Chinese Clinical Trial Registry (ChiCTR-EOC-15006901).

RESULTS

The new, alternative sarcopenia risk score included five variables: age, gender, BMI, total energy intake per day, and the proportion of calories supplied by protein. The score ranged from - 2 to 19. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.806 (95% CI 0.741-0.872) and 0.836 (95% CI 0.781-0.892) in the exploratory and validation populations, respectively. At the optimal cutoff value of 12, the sensitivity and specificity of the score for the prediction of sarcopenia were 70.9% and 81.0% in the exploratory population and 53.7% and 88.8% in the validation population, respectively. The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation (χ² = 4.459, P = 0.813).

CONCLUSIONS

The new, alternative sarcopenia risk score appears to be an effective screening tool for identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

Modifiable predictors of type 2 diabetes mellitus and roles of insulin resistance and β-cell function over a 6-year study and 30-year follow-up

PURPOSE

This study aimed to examine the modifiable predictors of T2DM and the roles of insulin resistance (IR) and β-cell function over a 6-year study and 30-year follow-up.

METHODS

A total of 462 non-diabetic participants, 282 with impaired glucose tolerance (IGT), and 180 with normal glucose tolerance (NGT) were enrolled in this analysis. The Matsuda IR index and area under the curve of insulin-to-glucose ratio (AUCI/G-R) were used as IR and β-cell function indices in the analysis.

RESULTS

In all participants, multivariable analysis showed that BMI, glucose status, Matsuda IR index and systolic blood pressure (SBP) at baseline were independently associated with an increased risk of T2DM over 30 years, whereas lifestyle intervention and AUCI/G-R were inversely associated with this risk. The predictive effect of the Matsuda IR index and AUCI/G-R in participants with IGT was consistent with the results of all participants, whereas in those with NGT, only the Matsuda IR index, not the AUCI/G-R, predicted the development of T2DM (HR = 1.42, 95% CI 1.07-1.89 vs HR = 1.09, 95% CI 0.76-1.56). The predictive effect of the Matsuda IR index on T2DM existed even in participants with BMI < 25 (p = 0.049).

CONCLUSION

The modifiable predictors of T2DM in Chinese adults were high BMI, hypertension, mild hyperglycaemia, IR, and β-cell dysfunction. Both IR and β-cell function contributed to the development of T2DM in the long term; however, IR remains the initial and long-standing key risk factor for T2DM.

Decreased DANCR contributes to high glucose-induced extracellular matrix accumulation in human renal mesangial cell via regulating the TGF-β/Smad signaling

Glomerulosclerosis is one of the major histopathologic changes in diabetic kidney diseases (DKD), which is characterized by excessive deposition of extracellular matrix (ECM) in the glomerulus mainly produced by mesangial cells in response to transforming growth factor-β (TGF-β) stimuli under diabetic conditions. Despite TGF-β has been implicated as a major pathogenic factor in the development of diabetic glomerulosclerosis, clinical trials of monoclonal antibodies against TGF-β failed to demonstrate therapeutic benefits. Thus, developing alternative therapeutic strategies to effectively block the TGF-β/Smad signaling could be of paramount importance for DKD treatment. Emerging evidence indicates that dysregulation of certain lncRNAs can lead to aberrant activation of TGF-β/Smad signaling. Herein, we identified a novel lncRNA, named DANCR, which could efficiently function as a negative regulator of TGF-β/Smad signaling in mesangial cells. Ectopic expression of DANCR could specifically block the activation of TGF-β/Smad signaling induced by high-glucose or TGF-β in human renal mesangial cells (HRMCs). Mechanistically, DANCR functions to stabilize nemo-like kinase (NLK) mRNA through interaction with insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2), resulting in enhanced phosphorylating on the linker region of activated Smad2/3 in the nucleus. Taken together, our data have uncovered an lncRNA-based regulatory modality of the TGF-β/Smad signaling and identified DANCR as an endogenous blocker of TGF-β/Smad signaling in HRMCs, which may represent a potential therapeutic target against the diabetic glomerulosclerosis.

Trends in metabolic indicators and microvascular complications in Chinese adults with newly diagnosed type 2 diabetes: A retrospective, single-centre study of twenty-years

BACKGROUND

The purpose of this study is to assess metabolic indicators and trends in microvascular complications among Chinese adults with newly diagnosed type 2 diabetes during 2000-2020.

METHODS

3,907 patients were included and divided into three groups according to a time period of 7 years. This study analyzed trends in proportions of patients reached therapeutic targets of blood glucose, pressure and lipids, and trends in albuminuria, retinopathy, and peripheral neuropathy.

RESULTS

In the past 20 years, the age of adults with newly diagnosed type 2 diabetes tended to be younger, and the proportion of female patients increased. There seemed no improvements in blood glucose and pressure. The rate of awareness and treatment on target of hypertension was less than 50%. There was a significant decrease in the prevalence of retinopathy, but no changes in nephropathy or peripheral neuropathy. Complications were more common for patients who were smoker, male, or with hypertension and obesity.

CONCLUSIONS

Over the past two decades, there have been encouraging reductions in retinopathy in Chinese adults with newly diagnosed diabetes, but no significant change in albuminuria and peripheral neuropathy. It may be related to the low awareness of diabetes and insufficient controlled blood glucose, pressure and lipids on target.

Evaluating the Clinical Accuracy of a Non-invasive Single-Fasting-Calibration Glucometer in Patients with Diabetes: A Multicentre Study

INTRODUCTION

The aim of this study was to evaluate the stability and accuracy of glucose measurements determined using the metabolic heat conformation (MHC)-based non-invasive glucometer in a multicentre, self-controlled clinical trial. This device is the first to obtain a medical device registration certificate awarded by the National Medical Products Administration of China (NMPA).

METHODS

The multicentre clinical study was conducted at three sites and enrolled 200 subjects whose glucose was measured with a non-invasive glucometer (the Contour Plus blood glucose monitoring system) and by venous plasma glucose (VPG) measurements, in a fasted state and at 2 and 4 h after meals.

RESULTS

Based on both the non-invasive and VPG measurements, 93.9% (95% confidence interval 91.7-95.6%) of the blood glucose (BG) values fell within consensus error grid (CEG) zones A + B. The measurements obtained in a fasted state and at 2 h after meals were more accurate, with 99.0% and 97.0% of the BG values, respectively, falling within zones A + B. Compared to those subjects who received insulin, the proportion of values in zones A + B and the correlation coefficients were 3.1% and 0.0596 higher, respectively. The accuracy of the non-invasive glucometer was influenced by the level of insulin resistance calculated by the homeostatic model assessment method, which had a correlation coefficient with the mean absolute relative difference of - 0.1588 (P = 0.0001).

CONCLUSION

The MHC-based non-invasive glucometer assessed in the present study demonstrates generally high stability and accuracy in the glucose monitoring of people with diabetes. The calculation model needs to be further explored and optimised for patients with different diabetes subtypes, levels of insulin resistance and insulin secretion capacity.

CLINICAL TRIAL REGISTRY NUMBER

ChiCTR1900020523.

Sanhuang xiexin decoction synergizes insulin/PI3K-Akt/FoxO signaling pathway to inhibit hepatic glucose production and alleviate T2DM

ETHNOPHARMACOLOGICAL RELEVANCE

Sanhuang Xiexin Decoction (SHXXD) is a classic prescription for the treatment of diabetes. Excessive hepatic glucose production (HGP) is a major determinant of the occurrence and development of diabetes. Inhibition of HGP can significantly improve type 2 diabetes mellitus (T2DM).

AIM OF THE STUDY

To investigate the mechanism by which SHXXD inhibits HGP.

MATERIALS AND METHODS

First, a mouse model of T2DM was established through high-fat diet (HFD) feeding combined with streptozotocin (STZ) injection to determine the pharmacodynamic effect of SHXXD in T2DM mice. Then, the possible pathways induced by SHXXD in the treatment of T2DM were predicted by network pharmacology combined with transcriptomics (including target prediction, network analysis and enrichment analysis). Finally, the specific mechanism of SHXXD was elucidated by in vitro experiments.

RESULTS

In vivo experiments showed that SHXXD reduced fasting blood glucose and alleviated weight loss in T2DM mice. Improved glucose clearance rates and insulin sensitivity improve dyslipidemia, liver tissue structural abnormalities and inflammatory cell infiltration as well as increase glycogen storage in T2DM mice. The results of network pharmacology and transcriptome analysis showed that SHXXD contained 378 compounds and 2625 targets. In total, 292 intersection targets were identified between the differentially expressed genes (DEGs) of the liver tissue insulin resistance (IR) related dataset GSE23343. KEGG enrichment analysis showed that the insulin/PI3K-Akt/FoxO signaling pathway may be related to SHXXD-mediated improvements in T2DM. In vitro experimental results showed that SHXXD increased glucose consumption by HepG2-IR cells and improved their insulin sensitivity. RT‒qPCR and Western blotting results showed that SHXXD inhibited hepatic gluconeogenesis through the insulin/PI3K-Akt/FoxO signaling pathway by promoting IGFIR, PIK3R1 and AKT2 expression and subsequently inhibiting PEPCK and FBP1 expression via phosphorylation of Foxo1. In addition, PI3K/Akt deactivated p-GSK3β through phosphorylation, thereby promoting GS expression and increasing glycogen synthesis.

CONCLUSIONS

SHXXD can target the liver to cooperate with the insulin/PI3K-Akt/FoxO signaling pathway to inhibit HGP to alleviate T2DM.

Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes

Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.

The hypertension and hyperlipidemia status among type 2 diabetic patients in the community and influencing factors analysis of glycemic control

OBJECTIVE

To understand the prevalence of hypertension and hyperlipidaemia as well as the current status of glycaemic control and its influencing factors among type 2 diabetes mellitus patients in the community in South China, and to provide recommendations for the prevention and control of diabetes.

METHODS

Questionnaires, physical examinations and laboratory tests were conducted on patients with type 2 diabetes mellitus who participated in the National Basic Public Health Service Programme in Guangzhou in 2020. The chi-square test, t-test and multi-factor unconditional logistic regression analysis were performed using R 4.1.2 software.

RESULT

Among 127,423 type 2 diabetic patients in Guangzhou, 57,695 achieved glycemic control standards, with a glycemic control rate of 45.28%.In this study, the proportion of T2DM patients with hypertension and hyperlipidaemia together was 27.79%, The percentage of T2DM patients with hypertension alone and hyperlipidaemia alone was 28.34% and 20.53% respectively, and the rate of no complications was 23.34%. There was a statistically significant difference in the rate of glycaemic control between the different disease combination states (P < 0.05). The glycaemic control rate was 47.67% in diabetic patients without hypertension and hyperlipidaemia, 52.54% and 37.24% in those with combined hypertension alone and hyperlipidaemia alone respectively, compared to 41.80% in diabetic patients with hypertension and hyperlipidaemia. After adjusting for all covariates, multivariate analysis showed that combined hypertension alone was associated with good glycaemic control (OR 0.817, 95% CI 0.791, 0.843, P < 0.001),when using comorbid T2DM as a control group, combined hyperlipidaemia alone, combined hypertension and hyperlipidaemia were associated with poor glycaemic control (OR 1.521, 95% CI 1.470,1.574, P < 0.001 and OR 1.250, 95% CI 1.211,1.291, P < 0.001), Subgroup analyses as well as multifactorial unconditional logistic regression analyses showed that patients with type 2 diabetes who were overweight and obese, smoked, drank alcohol, had a diagnosis of diabetes for ≥ 6 years, had fair or poor adherence and had a family history of diabetes had lower rates of glycaemic control.

CONCLUSION

The results of this study showed that the co-morbidity of hypertension and hyperlipidaemia was high and prevalent among diabetic patients in Guangzhou. Moreover, glycaemic control of T2DM patients with hyperlipidaemia was lower than other diabetic patients. Obesity and overweight, poor lifestyle and dietary habits are also major factors affecting the treatment and control of T2D patients in this region. Therefore, comprehensive measures should be actively taken to control blood glucose levels in type 2 diabetic patients by also incorporating lipid management into the community and strictly controlling lipid levels.

The Importance of Prediabetes Screening in the Prevention of Cardiovascular Disease

Background

Prediabetes is a disordered state of glucose metabolism defined by an elevated blood glucose level that is below the level required for the diagnosis of diabetes. Prediabetes is associated with an increased risk of cardiovascular disease. The onset and progression of macrovascular disease occur during the prediabetes phase. Early diagnosis and screening of prediabetes are essential steps to prevent diabetes and its associated complications.

Objective

To assess the prevalence of prediabetes and undiagnosed diabetes in patients with cardiovascular disease according to the ADA criteria.

Methods

This cross-sectional study included 2968 a high cardiovascular risk patients aged 40 to 75 years admitted to the Department of Internal Medicine. Sociodemographic variables and other relevant medical history information were collected by the researchers during the clinical interview. A fasting blood sample was obtained to determine HbA1c levels and other relevant laboratory findings.

Results

Of the total number of participants, 1496 participants were not diagnosed with diabetes, 485 (32.4%) of them had HbA1c values indicating prediabetes and 158 (10.6%) of them had HbA1c values indicating new diagnosed diabetes. Up to one-third of those with undiagnosed prediabetes had already been diagnosed with cardiovascular complications.

Conclusion

Routine screening of glycemic metabolism could be valuable in identifying high-risk individuals before a cardiovascular event occurs.

Patient preferences for anti-hyperglycaemic medication for type 2 diabetes mellitus in China: findings from a national survey

OBJECTIVE

This study aimed to investigate the preferences regarding risks, benefits and other treatment attributes of patients with type 2 diabetes mellitus (T2DM) in China when selecting a second-line anti-hyperglycaemic medicine.

METHODS

A discrete choice experiment with hypothetical anti-hyperglycaemic medication profiles was performed using a face-to-face survey administered to patients with T2DM. The medication profile was described using seven attributes: treatment efficacy, hypoglycaemia risk, cardiovascular benefits, gastrointestinal (GI) adverse events, weight change, mode of administration and out-of-pocket cost. Participants chose between medication profiles by comparing attributes. Data were analysed using a mixed logit model with marginal willingness to pay (mWTP) and maximum acceptable risk (MAR) calculated. The preference heterogeneity within the sample was explored using a latent class model (LCM).

RESULTS

A total of 3327 respondents from five major geographical regions completed the survey. Treatment efficacy, hypoglycaemia risk, cardiovascular benefits and GI adverse events were major concerns among the seven attributes measured. Weight change and mode of administration were of lesser concern. Regarding mWTP, respondents would pay ¥236.1 (US$36.6) for an anti-hyperglycaemic medication with an efficacy of 2.5% points reduction in HbA1c, while they were willing to accept a weight gain of 3 kg only if they received a compensation of ¥56.7 (US$8.8). Respondents were willing to accept a relatively large increase in hypoglycaemia risk (MAR=15.9%) to improve treatment efficacy from intermediate (1.0% points) to high (1.5% points). LCM identified the following four unobserved subgroups: trypanophobia, cardiovascular-benefits-focused, safety-focused and efficacy-focused and cost-sensitive.

CONCLUSION

Patients with T2DM prioritised free out-of-pocket costs, highest efficacy, no hypoglycaemia risk and cardiovascular benefits over weight change and mode of administration. There exists great preference heterogeneity among patients, which should be taken into account in healthcare decision-making processes.

Rural-urban differentials of prevalence and lifestyle determinants of pre-diabetes and diabetes among the elderly in southwest China

BACKGROUND

Diabetes has become a major public health problem in China. A better understanding of diabetes determinants and urban-rural differences is essential to crafting targeted diabetes prevention measures for the elderly living in both urban and rural areas. This study aimed to compare rural-urban differentials in prevalence and lifestyle determinants of pre-diabetes and diabetes among the elderly in southwest China.

METHODS

A cross-sectional health interview and examination survey was conducted among individuals aged ≥ 60 years in both a rural and urban area of China. Anthropometric measurements, including height, weight, and waist circumference, as well as blood pressure and fasting blood glucose measurements were taken. Associated risk factors for pre-diabetes and diabetes were evaluated using multivariate logistic regression analysis.

RESULTS

In total, 1,624 urban residents and 1,601 rural residents consented to participate in the study. The urban prevalence of pre-diabetes and diabetes (46.8% and 24.7%, respectively), was higher than the rural prevalence (23.4% and 11.0%, respectively, P<0.01). Urban elderly participants had markedly higher prevalence of obesity, central obesity, and physical inactivity than their rural counterparts (15.3%, 76.0%, and 9.2% vs. 4.6%, 45.6%, and 6.1%, P<0.01). In contrast, rural elderly adults had higher prevalence of smoking than urban ones (23.2% vs. 17.2%, P<0.01). Obese (OR 1.71, 95% CI 1.27-2.30 vs. OR 1.73, 95% CI 1.30-3.28) and centrally obese participants (OR 1.59, 95% CI 1.18-2.15 vs. OR 1.83, 95% CI 1.32-2.54) were more likely to suffer from diabetes in both urban and rural regions. Furthermore, urban current smokers had a higher probability of suffering from diabetes (OR 1.58, 95% CI 1.11-2.25), while hypertension was positively associated with the prevalence of diabetes in the rural area (OR 2.13, 95% CI 1.54-2.95). Obese participants in the rural area were more likely to suffer from pre-diabetes (OR 2.50, 95% CI 1.53-4.08), while physical inactivity was positively associated with prevalence of pre-diabetes in the urban area (OR 1.95, 95% CI 1.37-2.80).

CONCLUSION

Pre-diabetes and diabetes are more prevalent among urban older adults than their rural counterparts in southwest China. The identified rural-urban differentials of lifestyle factors have significant impacts on prevalence of pre-diabetes and diabetes. Thus, tailored lifestyle interventions are needed to improve diabetes prevention and management among the elderly in southwest China.

Development and validation of a nomogram to estimate future risk of type 2 diabetes mellitus in adults with metabolic syndrome: prospective cohort study

OBJECTIVES

To develop and validate the 4-year risk of type 2 diabetes mellitus among adults with metabolic syndrome.

DESIGN

Retrospective cohort study of a large multicenter cohort with broad validation.

SETTINGS

The derivation cohort was from 32 sites in China and the geographic validation cohort was from Henan population-based cohort study.

RESULTS

568 (17.63) and 53 (18.67%) participants diagnosed diabetes during 4-year follow-up in the developing and validation cohort, separately. Age, gender, body mass index, diastolic blood pressure, fasting plasma glucose and alanine aminotransferase were included in the final model. The area under curve for the training and external validation cohort was 0.824 (95% CI, 0.759-0.889) and 0.732 (95% CI, 0.594-0.871), respectively. Both the internal and external validation have good calibration plot. A nomogram was constructed to predict the probability of diabetes during 4-year follow-up, and on online calculator is also available for a more convenient usage ( https://lucky0708.shinyapps.io/dynnomapp/ ).

CONCLUSION

We developed a simple diagnostic model to predict 4-year risk of type 2 diabetes mellitus among adults with metabolic syndrome, which is also available as web-based tools ( https://lucky0708.shinyapps.io/dynnomapp/ ).

Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study

Background

The prevalence of allergic rhinitis (AR) has been increasing steadily worldwide, especially in countries with increasing industrialization such as China. However, available evidence regarding AR prevalence among Chinese adults is scarce and limited to regional data collected in earlier years. We therefore aimed to provide a more recent and robust estimate of AR prevalence using a nationwide representative cross-sectional study in China.

Methods

Data of 184 326 participants aged 18 years or older were obtained from the China Chronic Disease and Risk Factor Surveillance conducted in 2018-2019. AR was determined by self-reported sneezing, nasal itching, obstruction, or rhinorrhea symptoms for at least 1 h in the absence of a cold or flu within the last 12 months. Multivariable logistic model was used to examine the risk factors of AR, and a possible non-linear relationship was further tested by restricted cubic spline. Potential additive interactions of risk factors with sex, residence, and geographic region were assessed by relative excess risk due to interaction (RERI).

Results

The weighted prevalence of AR was 8.1% (95% confidence interval [CI], 7.4%-8.7%), of whom 23.7% (95% CI, 21.3%-26.0%) were aware of their diagnosis. Increased odds of AR were associated with younger age, men, living in urban area or north region, more education, smoking, underweight, and higher income. Despite the nonsignificant linear trend, the spline regression demonstrated a non-linear association between AR and sleep duration, with higher odds at both ends. Additionally, the observed associations were generally stronger among men and people living in urban area and north region, with significant RERI ranging from 0.07 (95% CI, 0.00-0.14) to 0.40 (95% CI, 0.12-0.67).

Conclusions

AR is prevalent in China and the associated factors and interactions are helpful to design targeted preventive strategies towards certain subpopulations. The low awareness of AR calls for a national effort on AR screening.

Nomogram model and risk score to predict 5-year risk of progression from prediabetes to diabetes in Chinese adults: Development and validation of a novel model

AIM

To develop a personalized nomogram and risk score to predict the 5-year risk of diabetes among Chinese adults with prediabetes.

METHODS

There were 26 018 participants with prediabetes at baseline in this retrospective cohort study. We randomly stratified participants into two cohorts for training (n = 12 947) and validation (n = 13 071). The least absolute shrinkage and selection operator (LASSO) model was applied to select the most significant variables among candidate variables. And we further established a stepwise Cox proportional hazards model to screen out the risk factors based on the predictors chosen by the LASSO model. We presented the model with a nomogram. The model's discrimination, clinical use and calibration were assessed using the area under the receiver operating characteristic (ROC) curve, decision curve and calibration analysis. The associated risk factors were also categorized according to clinical cut-points or tertials to create the diabetes risk score model. Based on the total score, we divided it into four risk categories: low, middle, high and extremely high. We also evaluated our diabetes risk score model's performance.

RESULTS

We developed a simple nomogram and risk score that predicts the risk of prediabetes by using the variables age, triglyceride, fasting blood glucose, body mass index, alanine aminotransferase, high-density lipoprotein cholesterol and family history of diabetes. The area under the ROC curve of the nomogram was 0.8146 (95% CI 0.8035-0.8258) and 0.8147 (95% CI 0.8035-0.8259) for the training and validation cohort, respectively. The calibration curve showed a perfect fit between predicted and observed diabetes risks at 5 years. Decision curve analysis presented the clinical use of the nomogram, and there was a wide range of alternative threshold probability spectrums. A total risk score of 0 to 2.5, 3 to 4.5, 5 to 7.5 and 8 to 13.5 is associated with low, middle, high and extremely high diabetes risk status, respectively.

CONCLUSIONS

We developed and validated a personalized prediction nomogram and risk score for 5-year diabetes risk among Chinese adults with prediabetes, identifying individuals at a high risk of developing diabetes. Doctors and other healthcare professionals can easily and quickly use our diabetes score model to assess the diabetes risk status in patients with prediabetes. In addition, the nomogram model and risk score we developed need to be validated in a prospective cohort study.

Diabetes in intraductal papillary mucinous neoplasm of the pancreas and its association with malignancy

BACKGROUND

Intraductal papillary mucinous neoplasms (IPMNs) have the potential to become malignant. Few studies have focused on the prevalence of the diabetes mellitus (DM) in IPMNs and its association with malignancy. We evaluated the association between DM and malignant IPMNs in this study.

METHODS

A total of 226 patients with pathologically confirmed IPMNs were included. Demographic data, serum biochemical data, and imaging findings were collected. The malignant IPMNs were defined as those with high-grade dysplasia and associated invasive carcinoma. The association between DM and malignant IPMNs was studied using logistic regression analysis.

RESULTS

The prevalence of DM was 17.7% for all type IPMNs and 31.7% for malignant IPMNs. Compared to patients without DM, those with DM had a 3.6-fold (odds ratio [OR]: 3.62; 95% confidence interval [CI]: 1.26-10.44) higher risk of invasive carcinoma and 2.5-fold (OR: 2.48; 95% CI: 1.06-5.77) higher risk of malignant IPMNs. Similar results were observed in main pancreatic duct (MPD) involved IPMNs. New-onset DM was associated with a 4.13-fold (OR: 4.13, 95% CI: 1.27-13.36) higher risk of invasive carcinoma.

CONCLUSION

DM is associated with a higher risk of malignant IPMNs and invasive carcinoma, especially in patients with MPD-involved IPMNs.

Islet function changes of post-glucose-challenge relate closely to 15 years mortality of elderly men with a history of hyperglycemia

Aims

We aimed to investigate the relationship between islet function changes during a glucose challenge and 15-year mortality in elderly men.

Methods

Elderly men who did the oral glucose tolerance test in 2005 owing to an abnormal glucose history without diabetes were included. Changes in insulin resistance and secretion were evaluated using the homeostasis model assessment (HOMA) of fast, post-load, and ratios. Comparisons between the dead and the survival groups were analyzed using the Student's t-test (continuous variables) or χ2 test (Categorical variables). Single-factor logistic regression was used to identify the possible affecting factors. Multifactorial logistic regression was used to identify the independent risk factors in total population and in the subgroups. ROC curve was used to assess the predictive ability of risk factor and to determine the cut-off value.

Results

Of the 220 elderly men, 67 died according to 15-year retrospection. Age (OR = 1.243, P = 0.000), diastolic pressure (OR = 0.958, P = 0.027), and HOMA-IR (2 h/0 h) (OR = 1.040, P = 0.010) were independent risk factors for 15-year mortality. Subgroup analysis showed that HOMA-IR (2 h/0 h) was an obvious risk factor, especially for normal glucose tolerance (OR = 1.060, P = 0.030), age 60-70 years (OR = 1.068, P = 0.005), and hypertension (OR = 1.048, P = 0.013); HOMA-β (2 h/0 h) showed some protective effects in the impaired glucose regulation subgroup (OR = 0.779, P = 0.057). HOMA-IR (2 h/0 h) cut-off value was 15.

Conclusions

HOMA-IR (2 h/0 h) higher than 15 was an independent risk factor for 15-year mortality in elderly men with hyperglycemia history.

Ethnic Variation in Diabetic Retinopathy Lesion Distribution on Ultra-widefield Imaging

PURPOSE

To evaluate whether the distribution of diabetic retinopathy (DR) lesions differs among various ethnicities.

DESIGN

Multi-center, retrospective cohort study.

METHODS

We accrued a cohort of 226 eyes with DR consisting of 51 East Asian eyes, 102 South Asian eyes, 30 Caucasian eyes, and 43 Latino eyes, all evaluated with ultrawide field pseudocolor images. Images were manually annotated for DR lesions and were classified as having predominantly peripheral lesions (PPL) or predominantly central lesions (PCL) using 4 quantitative methods. The percent distribution of PCL to PPL was compared among different ethnicities.

RESULTS

Using a single-field lesion frequency-based method, East Asian eyes more frequently demonstrated a PPL distribution (86.3%), whereas South Asian eyes more frequently demonstrated a PCL distribution (64.7%). These findings were also observed when considering only the subset of treatment-naïve eyes. Furthermore, in treatment-naïve eyes without proliferative DR, the percent distribution of PPL to PCL in East Asian eyes was significantly different when compared to other ethnicities (P < .0001 South Asian, P = .035 Caucasian, P = .0003 Latino). The majority of patients (60%-78%) in all ethnic groups had moderate nonproliferative diabetic retinopathy(NPDR), and the same difference between East Asian and South Asian eyes was observed in this subgroup.

CONCLUSIONS

The distribution of DR lesions appears to vary among different ethnicities. DR lesions tend to be distributed more peripherally in East Asian eyes compared to other ethnic groups, particularly South Asian eyes, which tend to have more central disease. The prognostic implications of these ethnic differences in DR lesion distribution require further investigation.

Comparison of Local Metabolic Changes in Diabetic Rodent Kidneys Using Mass Spectrometry Imaging

Understanding the renal region-specific metabolic alteration in different animal models of diabetic nephropathy (DN) is critical for uncovering the underlying mechanisms and for developing effective treatments. In the present study, spatially resolved metabolomics based on air flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) was used to compare the local metabolic changes in the kidneys of HFD/STZ-induced diabetic rats and db/db mice. As a result, a total of 67 and 59 discriminating metabolites were identified and visualized in the kidneys of the HFD/STZ-induced diabetic rats and db/db mice, respectively. The result showed that there were significant region-specific changes in the glycolysis, TCA cycle, lipid metabolism, carnitine metabolism, choline metabolism, and purine metabolism in both DN models. However, the regional levels of the ten metabolites, including glucose, AMP, eicosenoic acid, eicosapentaenoic acid, Phosphatidylserine (36:1), Phosphatidylserine (36:4), Phosphatidylethanolamine (34:1), Phosphatidylethanolamine (36:4), Phosphatidylcholine (34:2), Phosphatidylinositol (38:5) were changed in reversed directions, indicating significant differences in the local metabolic phenotypes of these two commonly used DN animal models. This study provides comprehensive and in-depth analysis of the differences in the tissue and molecular pathological features in diabetic kidney injury in HFD/STZ-induced diabetic rats and db/db mice.

Association of socioeconomic status with glycated haemoglobin level and risk factors for diabetic retinopathy: a cross-sectional study in Sichuan, western China

OBJECTIVE

Diabetes affects 1 in 10 adults in China. Diabetic retinopathy (DR) is a diabetes-related complication that, if untreated, impairs vision and causes blindness. Evidence on DR diagnosis and risk factors is limited. This study aimed to add evidence from socioeconomic factors.

DESIGN

A cross-sectional survey of people with diabetes conducted in 2019 was analysed by using logistic regression to evaluate the association of socioeconomic factors with the glycated haemoglobin (HbA1c) level and DR.

SETTING

Five counties/districts of western China (Sichuan) were included.

PARTICIPANTS

Registered participants with diabetes aged from 18 to 75 years were selected, and at last 2179 participants were included in the analysis.

RESULTS

In this cohort, 37.13% (adjusted value 36.52%), 19.78% (adjusted value 19.59%) and 17.37% of participants had HbA1c<7.0%, DR (24.96% of those in the high-HbA1c group) and non-proliferative DR, respectively. Participants with higher social health insurance coverage (urban employee insurance (UEI)), higher income and urban residents tended to have glycaemic control (HbA1c) compared with their counterparts (OR: 1.48, 1.08 and 1.39, respectively). Participants with UEI or higher income had a lower risk of DR (OR: 0.71 and 0.88, respectively); higher education was associated with a 53%-69% decreased risk of DR.

CONCLUSION

This study shows disparities in the effect of socioeconomic factors on glycaemic (HbA1c) management and DR diagnosis among people with diabetes in Sichuan. Lower socioeconomic (especially non-UEI) status conferred a higher risk of high HbA1c and DR. The insights from this study indicate the need for national programmes to implement community-level measures to facilitate access to better HbA1c management and early detection of DR in patients with lower socioeconomic status and diabetes.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry (ChiCTR1800014432).

Visceral adiposity index is positively associated with fasting plasma glucose: a cross-sectional study from National Health and Nutrition Examination Survey 2017-2020

BACKGROUND

Visceral adiposity index (VAI) has been recognized as a reliable indicator for visceral adiposity. However, it remains largely unexplored on its association with fasting plasma glucose (FPG). The current study aims to explore the association between VAI and FPG using a representative dataset.

METHODS

A cross-sectional study was carried out based on the dataset from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Univariate and Multiple linear regression analysis were performed to explore the relationship between VAI and FPG. Generalized additive model (GAM) and smooth curve fitting analysis were performed to explore the nonlinear relationship between VAI and FPG. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of VAI for FPG elevation.

RESULTS

A total of 4437 participants with complete data were finally included in the research. Individuals were divided into 4 quartiles according to the calculated VAI value: Q1 (VAI<0.69), Q2 (0.69 ≤ VAI < 1.18), Q3 (1.18 ≤ VAI < 2.02) and Q4 (VAI ≥ 2.02). FPG significantly increased with the increasing VAI quartile. Multiple linear regression analysis showed VAI was independently positively associated with FPG after adjusting confounding factors. As a continuous variable, an increase of one unit in VAI was correlated with 0.52 mmol/L (95% CI: 0.41-0.63, p < 0.0001) higher FPG level. As a categorical variable, 4th VAI quartile group was related to 0.71 mmol/L (95% CI: 0.47-0.95, p < 0.001) higher FPG level compared with 1st VAI group. GAM and smooth curve fitting analysis identified the non-linear relationship between VAI and FPG, and 4.02 was identified as the inflection point using two-piecewise linear regression. The positive association between VAI and FPG existed when VAI was lower (β = 0.73, p < 0.0001) and higher than 4.02 (β = 0.23, p = 0.0063). ROC analysis indicated VAI has a good predictive value for FPG elevation (AUC = 0.7169, 95% CI: 0.6948-0.7389), and the best threshold of VAI was 1.4315.

CONCLUSION

VAI was an independently risk indicator for FPG, and VAI was nonlinearly positively associated with FPG. VAI had a good predictive value for elevated FPG. VAI might become a useful indicator for risk assessment and treatment of hyperglycemia in clinical practice.

Triglyceride glucose-body mass index and the risk of progression to diabetes from prediabetes: A 5-year cohort study in Chinese adults

Objective

Evidence regarding the relationship between the triglyceride glucose-body mass index (TyG-BMI) and the risk of progression from prediabetes to diabetes remains limited. Our study aimed to investigate the relationship between them in patients with prediabetes.

Methods

In this retrospective cohort study, data were collected from 25,279 patients with prediabetes who received health checks between 2010 and 2016. We used a Cox proportional-hazards regression model to examine the relationship between TyG-BMI and diabetes risk. We used Cox proportional hazards regression with cubic spline functions and smooth curve fitting to identify the nonlinear relationship between them. In addition, A series of sensitivity and subgroup analyses were also conducted.

Results

The mean age of the included participants was 49.29 ± 13.82 years old, and 1,6734 (66.2%) were male. The mean TyG-BMI was 219.47. The median follow-up time was 2.89 years, and 2,687 (10.63%) individuals had a final diagnosis of diabetes. After adjusting for covariates, TyG-BMI was positively linked with incident diabetes in patients with prediabetes (HR = 1.011, 95%CI 1.010-1.012). TyG-BMI had a non-linear connection with diabetes risk, and its inflection point was 231.66. Right and left effects sizes (HR) at the inflection point were 1.017 (95%CI:1.014-1.019) and 1.007 (95%CI:1.005-1.009), respectively. The sensitivity analysis demonstrated the robustness of these results.

Conclusion

This study demonstrated a positive, non-linear relationship between the TyG-BMI and diabetes risk in Chinese patients with prediabetes. When the TyG-BMI was <231.66, there was a significant positive association between TyG-BMI and the risk of progression from prediabetes to diabetes. This study serves as a reference to promote clinical consultation and optimize diabetes prevention decisions for patients with prediabetes.

The relationship between islet β-cell function and metabolomics in overweight patients with Type 2 diabetes

A cross-sectional study was performed using metabolomics in overweight patients with Type 2 diabetes (T2D) at different stages of the disease. We aimed to identify potential metabolites for assessing islet β-cell function in order to investigate the correlation between islet β-cell dysfunction and metabolite changes in overweight patients with T2D. We selected 60 overweight adults (24 ≤ body mass index [BMI] < 28 kg/m2) with T2D who had been admitted to our hospital. The participants were equally divided into three groups according to disease duration: H1 (duration ≤ 5 years), H2 (5 years < duration ≤ 10 years), and H3 (duration > 10 years). Questionnaires, physical examinations, laboratory tests, and imaging studies were administered to all participants. The modified homeostasis model of assessment (HOMA) index was calculated using fasting C-peptide levels, and metabolite assays were performed using mass spectrometry. The results showed that HOMA-β and visceral fat area (VFA) were negatively correlated with diabetes duration. The VFA was positively correlated with arginine, cysteine, methionine, proline, and succinyl/methylmalonylcarnitine levels. The HOMA-β was negatively correlated with the serine and tetradecanoyldiacylcarnitine levels, and positively correlated with the aspartic acid, cysteine, homocysteine, piperamide, proline, and valine levels. The HOMA-IR was negatively correlated with hydroxypalmitoylcarnitine levels and positively correlated with the myristoylcarnitine levels. Thus, at different stages of T2D progression in overweight patients, serine, aspartic acid, cysteine, homocysteine, piperamide, proline, valine, and tetradecanoyldiacylcarnitine may be associated with HOMA-β and represent potential novel biomarkers for evaluating islet β-cell function.

Evaluating the role of time in range as a glycemic target during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes

BACKGROUND

Tight glycemic control during short-term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes.

METHODS

SIIT was given to 116 patients with newly diagnosed T2D, with daily eight-point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9-6.0 mmol/L; 2 h postprandial blood glucose, 3.9-7.8 mmol/L) were achieved and maintained for 2 weeks. TIR_PIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR_{3.9-7.8mmol/L} and TIR_{3.9-10.0mmol/L} . Acute insulin response (AIR), HOMA-IR, HOMA-B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes.

RESULTS

TIR_PIR , TIR_{3.9-7.8mmol/L} , and TIR_{3.9-10.0mmol/L} were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β-cell function and insulin sensitivity improved remarkably, and the 1-year remission rate was 55.2%. △AIR and △DI were positively correlated with all the TIR values, whereas only TIR_PIR was correlated with △HOMA-IR (r = -0.22, p = 0.03). Higher TIR_PIR but not TIR_{3.9-7.8mmol/L} or TIR_{3.9-10.0mmol/L} was robustly associated with diabetes remission; patients in the lower TIR_PIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6-7.2， p = .001). Only those with TIR_PIR  ≥ 65% had a one-year remission rate of over 60%.

CONCLUSIONS

These findings advocate TIR_PIR  ≥ 65% as a novel glycemic target during SIIT for clinical decision-making.

Chronic Disease in China: Geographic and Socioeconomic Determinants Among Persons Aged 60 and Older

OBJECTIVES

This study aimed to reveal the epidemic characteristics of chronic diseases among the Chinese older population and provide empirical strategies for the prevention and management of chronic diseases in the seniors in China.

DESIGN

A national cross-sectional study.

SETTING AND PARTICIPANTS

A total of 224,640 Chinese residents aged 60 and older were invited, and 222,179 (98.9%) participated in our survey.

METHODS

Standardized questionnaires were used to collect socioeconomic information and self-reported physician-diagnosed chronic diseases. The associations between individual socioeconomic status and chronic diseases were estimated using generalized linear mixed-effects models.

RESULTS

The national prevalence of any chronic diseases was 81.1% (95% CI 80.9-81.2), representing 179.9 million Chinese older adults. The prevalence increased with aging and peaked at 80 to 84 years old (87.2, 95% CI 86.7-87.7), this is consistent with studies in developing countries. Women (84.2, 84.0-84.4), rural residents (82.6, 82.4-82.8), and ethnic minorities (82.2, 81.5-82.8) had a higher prevalence than men (77.7, 77.4-77.9), urban residents (79.7, 79.5-79.9), and people of Han ethnicity (81.0, 80.8-81.2), respectively. For provincial prevalence, Tibet had the highest prevalence of chronic diseases (91.8, 91.5-92.0), and Fujian had the lowest (72.7, 72.5-72.9). The absolute differences between the highest and lowest provinces for the specific chronic condition ranged from 2.78% for cancer to 36.3% for cardiovascular diseases.

CONCLUSIONS AND IMPLICATIONS

Chronic diseases were highly prevalent among older adults in China and varied geographically. Advanced socioeconomic status appeared to have double-edged impacts on the prevalence of chronic diseases. Our findings support that reducing gender and geographic disparities should be prioritized in China's chronic disease prevention and management, and an affordable long-term care services system for older adults should be established urgently in China.

Identification of key genes, biological functions, and pathways of empagliflozin by network pharmacology and its significance in the treatment of type 2 diabetes mellitus

Background

To explore the key genes, biological functions, and pathways of empagliflozin in the treatment of type 2 diabetes mellitus (T2DM) through network pharmacology.

Methods

The TCMSP (a traditional Chinese medicine system pharmacology database and analysis platform) was used to screen empagliflozin's active components and targets. The target genes of T2DM were screened according to the GeneCards and OMIM databases, and a Venn diagram was constructed to obtain the target for T2DM treatment. Cytoscape 3.7.2 software was adopted to construct the drug-component-target-disease network. Functional annotation of Gene Ontology (GO) and enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were performed using R software.

Results

Target genes with a probability >0 were selected, among which Compound 012, Compound 060, Compound 093, Compound 111, and Compound 119 Swiss Target Prediction suggested that no similar active substances or predictable target genes were found. A "compound-target gene-disease" network was constructed, in which SLC5A2, SLC5A1, SLC5A4, SLC5A11, ADK, and ADORA2A were the core genes of T2DM. The key factors of the GO summary map included chemical reaction, membrane organelle, protein binding, and so on. The KEGG pathway summary map included the AMPK pathway, insulin resistance, the MAPK pathway, longevity-related pathway regulation, and so on. The top 10 pathways were endocrine resistance, the NF-κB signaling pathway, the HIF-1 signaling pathway, apoptosis, cell senescence, the Ras signaling pathway, the MAPK signaling pathway, the FoxO signaling pathway, the P13K-Akt signaling pathway, and the p53 signaling pathway. The binding of active compounds to key proteins was verified based on the Swiss Dock database, and the molecular docking of 193 bioactive compounds was finally verified. Among them, SLC5A2, SLC5A1, LDHA, KLK1, KLF5, and GSTP1 had better binding to the protein molecules.

Conclusions

Empagliflozin may regulate the targets of SLC5A2, SLC5A1, LDHA, KLK1, KLF5, and GSTP1. There are numerous ways of treating T2DM with empagliflozin, including by regulating apoptosis, cell aging, as well as the NF-κB, HIF-1HIF-1, Ras, MAPK, FoxO, P13K-Akt, and p53 pathways.

Development and validation of a nomogram model for individualized prediction of hypertension risk in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) with hypertension (DH) is the most common diabetic comorbidity. Patients with DH have significantly higher rates of cardiovascular disease morbidity and mortality. The objective of this study was to develop and validate a nomogram model for the prediction of an individual's risk of developing DH. A total of 706 T2DM patients who met the criteria were selected and divided into a training set (n = 521) and a validation set (n = 185) according to the discharge time of patients. By using multivariate logistic regression analysis and stepwise regression, the DH nomogram prediction model was created. Calibration curves were used to evaluate the model's accuracy, while decision curve analysis (DCA) and receiver operating characteristic (ROC) curves were used to evaluate the model's clinical applicability and discriminatory power. Age, body mass index (BMI), diabetic nephropathy (DN), and diabetic retinopathy (DR) were all independent risk factors for DH (P < 0.05). Based on independent risk factors identified by multivariate logistic regression, the nomogram model was created. The model produces accurate predictions. If the total nomogram score is greater than 120, there is a 90% or higher chance of developing DH. In the training and validation sets, the model's ROC curves are 0.762 (95% CI 0.720-0.803) and 0.700 (95% CI 0.623-0.777), respectively. The calibration curve demonstrates that there is good agreement between the model's predictions and the actual outcomes. The decision curve analysis findings demonstrated that the nomogram model was clinically helpful throughout a broad threshold probability range. The DH risk prediction nomogram model constructed in this study can help clinicians identify individuals at high risk for DH at an early stage, which is a guideline for personalized prevention and treatments.

Effectiveness and safety of hydrogen inhalation as an adjunct treatment in Chinese type 2 diabetes patients: A retrospective, observational, double-arm, real-life clinical study

Aim

To analyze the effectiveness and safety of hydrogen inhalation (HI) therapy as an adjunct treatment in Chinese type 2 diabetes mellitus (T2DM) patients in a real-life clinical setting.

Methods

This observational, non-interventional, retrospective, double-arm, 6-month clinical study included T2DM patients receiving conventional anti-diabetes medication with or without HI initiation from 2018 to 2021. Patients were assigned to the HI group or non-HI group (control group) after 1:1 propensity score matching (PSM). The mean change in glycated hemoglobin (HbA1c) after 6 months in different groups was evaluated primarily. The secondary outcome was composed of the mean change of fasting plasma glucose (FPG), weight, lipid profile, and homeostasis model assessment. Logistics regression was performed to evaluate the likelihood of reaching different HbA1c levels after 6-month treatment between the groups. Adverse event (AE) was also evaluated in patients of both groups.

Results

In total, 1088 patients were selected into the analysis. Compared to the control group, subjects in HI group maintained greater improvement in the level of HbA1c (-0.94% vs -0.46%), FPG (-22.7 mg/dL vs -11.7 mg/dL), total cholesterol (-12.9 mg/dL vs -4.4 mg/dL), HOMA-IR (-0.76 vs -0.17) and HOMA-β (8.2% vs 1.98%) with all p< 0.001 post the treatment. Logistics regression revealed that the likelihood of reaching HbA1c< 7%, ≥ 7% to< 8% and > 1% reduction at the follow-up period was higher in the HI group, while patients in the control group were more likely to attain HbA1c ≥ 9%. Patients in HI group was observed a lower incidence of several AEs including hypoglycemia (2.0% vs 6.8%), vomiting (2.6% vs 7.4%), constipation (1.7% vs 4.4%) and giddiness (3.3% vs 6.3%) with significance in comparison to the control group.

Conclusion

HI as an adjunct therapy ameliorates glycemic control, lipid metabolism, insulin resistance and AE incidence of T2DM patients after 6-month treatment, presenting a noteworthy inspiration to existing clinical diabetic treatment.

A Single-dose, Two-Period Crossover Bioequivalence Study Comparing Two Liraglutide Formulations in Healthy Chinese Subjects

Liraglutide, a glucagon-like peptide 1 receptor agonist, is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes. The original liraglutide products are costly, which limits patient access to this therapeutic treatment. Herein, a biosimilar was developed that is highly similar to the reference drug in molecular structure and bioactivity, and is expected to have similar pharmacokinetic (PK) and safety profiles in clinical studies. This study aimed to primarily evaluate the bioequivalence of 2 liraglutide formulations and secondarily assess their safety in healthy Chinese subjects following a single-dose subcutaneous injection. Thirty-two healthy volunteers were recruited in this randomized, open-label, single-dose, 2-period crossover bioequivalence study (ChiCTR2100043348). The geometric mean ratios (GMRs) of the test drug to the reference drug (T/R) and corresponding 90% confidence intervals (CIs) for maximum concentration (C_max ) and the area under the concentration-time curve from time 0 to the time of the last quantifiable concentration (AUC_0-t ) were estimated using a mixed-effects model, and bioequivalence was determined to have been achieved if the 2-sided 90%CI fell within the predefined range of 80%-125%. PK parameters were comparable between T and R, with GMRs of T/R for C_max and AUC_0-t being 105.7% and 107.7%, respectively, the 90%CI of which met the acceptance criteria for bioequivalence. We also observed a similar and favorable safety profile in the T and R arms, with adverse events being predominantly mild in severity and of gastrointestinal origin. Our findings indicate that the test drug is safe and well tolerated, bioequivalent to the reference drug, and warrants further testing in a phase III clinical trial.

Disparities of obesity and non-communicable disease burden between the Tibetan Plateau and developed megacities in China

Background

Non-communicable diseases (NCDs) including risk factors, e.g., obesity, are the major causes of preventable deaths in China, yet NCD disparities in China remain under-studied.

Objective

This study aimed to compare the determinants and burden of NCDs within four selected provinces in mainland China: the least developed Qinghai-Tibet Plateau group (PG, Tibetan Autonomous Region [TAR] and Qinghai Province) and most developed megacity group (MCG, Shanghai, and Beijing).

Methods

Studies, reports, and other official sources with comparable data for NCD burden and related determinants for the four provinces were searched. Geographic, demographic, socioeconomic, and dietary characteristics and selected health indicators (e.g., life expectancy) were extracted from the China Statistical Yearbook and China Health Statistics Yearbook. Data on NCD burdens were extracted from the National Chronic Disease and Risk Factor Surveillance Study and other nationally representative studies.

Results

The overall NCD mortality rates and prevalence of metabolic risk factors including obesity, hypertension, and diabetes in mainland China have increased in the past 20 years, and this trend is expected to continue. The PG had the highest level of standardized mortality rates (SMRs) on NCDs (711.6-896.1/100,000, 6th/6-level); the MCG had the lowest (290.6-389.6/100,000, 1st/6-level) in mainland China. The gaps in SMRs were particularly high with regard to chronic respiratory diseases (PG 6th^/6-level, MCG 1st/6-level) and cardiovascular diseases (6th/6 and 4th/6 in TAR and Qinghai; 1st/6-level and 2nd/6-level in Shanghai and Beijing). In contrast, the prevalence rates of obesity, hypertension, and diabetes were generally higher or comparable in MCG compared to PG. Diabetes prevalence was particularly high in MCG (5th/5-level, 13.36-14.35%) and low in PG (1st/5-level, 6.20-10.39%). However, awareness, treatment, and control of hypertension were poor in PG. Additionally, PG had much lower and severely inadequate intakes of vegetables, fruits, and dairy products, with additional indicators of lower socioeconomic status (education, income, etc.,) compared with MCG.

Conclusion

Evidence showed large disparities in NCD burden in China's provinces. Socioeconomic disparity and dietary determinants are probably the reasons. Integrated policies and actions are needed.

Factors Affecting Outcome in Diabetic Patients with COVID-19: A Cross-sectional Study

BACKGROUND: Type-2 diabetes mellitus (T2DM) is a chronic disease and often found as a comorbid in COVID-19. Poor glycemic control might play a role in worsening of clinical outcome in COVID-19 patients who lead to increase morbidity and mortality. AIM: We conducted a study to evaluate relationship between T2DM with or without macrovascular and microvascular complications and cigarette smoking habit with COVID-19 outcomes. METHODS: A cross-sectional study of hospitalized COVID-19 patients was conducted in Dr. Wahidin Sudirohusodo Hospital, Makassar from May 2020 to August 2020. COVID-19 status was obtained using real-time polymerase chain reaction for SARS-CoV-2, T2DM status was obtained using blood glucose or HbA1c, and other characteristic data were obtained. Mortality was the clinical outcome in our study. RESULTS: One hundred and six subjects data were enrolled. Most subjects were male (n = 55; 51.9%), and 55–65 year-old (n = 40; 37.7%). Eighty subjects were survived (75.5%) and 26 subjects did not survive (24.5%). Onset of T2DM ≥ 5 years had a higher mortality rate compared to onset < 5 years (34.9% vs. 17.5%; p = 0.041). Other factors such as gender, age, nutritional status, hypertension, heart disease, smoking habit, and HbA1c did not show significant difference in terms of mortality. CONCLUSION: COVID-19 patients with onset of T2DM for more than 5 years had a worse outcome compared to the onset of T2DM <5 years.

Type 2 diabetes mellitus as a possible risk factor for myasthenia gravis: a case-control study

Background

A certain number of myasthenia gravis (MG) patients clinically had type 2 diabetes mellitus (T2DM) prior to MG onset, which suggests that the onset of MG may correlate with the history of T2DM. This study aimed to examine the correlation between MG and T2DM.

Methods

In a single-center, retrospective, 1:5 matched case-control study, all 118 hospitalized patients with a diagnosis of MG from 8 August 2014 to 22 January 2019 were enrolled. In total, four datasets with different sources of the control group were retrieved from the electronic medical records (EMRs). Data were collected at the individual level. A conditional logistic regression analysis was used to test the risk of MG associated with T2DM.

Findings

The risk of MG was significantly associated with T2DM, and there were notable differences by sex and age. Whether compared to the general population, general hospitalized patients without autoimmune diseases (AIDs), or patients with other AIDs except MG, women aged over 50 years with T2DM had an increased risk of MG. The mean onset age of diabetic MG patients was more than that of the non-diabetic MG patients.

Interpretation

This study demonstrates that T2DM is strongly associated with the subsequent risk of MG and varies significantly by sex and age. It reveals that diabetic MG may be a unique subtype that is different from the conventional MG subgroup classification. More clinical and immunological features of diabetic MG patients need to be explored in further studies.

Saxagliptin combined with additional oral antihyperglycaemic agents in drug-naive diabetic patients with high glycosylated haemoglobin: A 24-week, multicentre, randomized, open-label, active parallel-controlled group clinical trial in China (SUCCESS)

AIM

To assess the efficacy and safety of a dipeptidyl peptidase-4 (DPP-4) inhibitor combined respectively with three oral antihyperglycaemic agents in Chinese patients with newly diagnosed type 2 diabetes mellitus (T2DM) with high levels of glycated haemoglobin (HbA1c).

MATERIALS AND METHODS

Between 30 December 2014 and 1 November 2017, a 24-week, multicentre, parallel-controlled study was performed on drug-naive T2DM patients. In total, 648 patients with 8.0% ≤ HbA1c ≤ 11.0%, aged 18-80 years and body mass index (BMI) 19-40 kg/m² were randomly assigned 1:1:1 to receive saxagliptin (Saxa) combined with metformin (Met), acarbose (Aca) or gliclazide (Gli) modified release (MR) tablets (Saxa + Met, Saxa + Aca and Saxa + Gli). The primary outcome was the absolute change in HbA1c from baseline; secondary outcome was the percentage of patients achieving HbA1c <7.0% and ≤6.5%.

RESULTS

Each treatment arm contained 216 patients; overall, 583 completed the 24-week trial. At 24 weeks, the mean (95% confidence interval) change in HbA1c from baseline in Saxa + Met, Saxa + Aca and Saxa + Gli were, respectively: -2.9% [-3.1, -2.8]; -2.6% [-2.8, -2.5]; and -2.8% [-2.9, -2.6] (overall p = .04, Saxa + Aca vs. Saxa + Met, p = .010, Saxa + Gli vs. Saxa + Met, p = 0.18). At 24 weeks, 84.9%, 74.7% and 80.3% of participants were at HbA1c <7.0% (overall p = .05); and 72.6%, 59.8% and 63.3% were HbA1c ≤6.5% (overall p = 0.10). The rates of minor or symptomatic hypoglycaemia were very low.

CONCLUSIONS

Initial treatment with a DPP-4 inhibitor combined with Metform, alpha-glycosidase inhibitor or sulphonylurea was safe and effective for patients with newly diagnosed T2DM and high HbA1c. DPP-4 inhibitor combined with Met showed the best efficacy for this population.

Diabetes with kidney injury may change the abundance and cargo of urinary extracellular vesicles

BACKGROUND

Urinary extracellular vesicles (uEVs) are derived from epithelia facing the renal tubule lumen in the kidney and urogenital tract; they may carry protein biomarkers of renal dysfunction and structural injury. However, there are scarce studies focusing on uEVs in diabetes with kidney injury.

MATERIALS AND METHODS

A community-based epidemiological survey was performed, and the participants were randomly selected for our study. uEVs were enriched by dehydrated dialysis method, quantified by Coomassie Bradford protein assay, and adjusted by urinary creatinine (UCr). Then, they identified by transmission electron microscopy (TEM), nanoparticle track analysis (NTA), and western blot of tumor susceptibility gene 101.

RESULTS

Decent uEVs with a homogeneous distribution were finally obtained, presenting a membrane-encapsulated structure like cup-shaped or roundish under TEM, having active Brownian motion, and presenting the main peak between 55 and 110 nm under NTA. The Bradford protein assay showed that the protein concentrations of uEVs were 0.02 ± 0.02, 0.04 ± 0.05, 0.05 ± 0.04, 0.07 ± 0.08, and 0.11 ± 0.15 μg/mg UCr, respectively, in normal controls and in prediabetes, diabetes with normal proteinuria, diabetes with microalbuminuria, and diabetes with macroproteinuria groups after adjusting the protein concentration with UCr by calculating the vesicles-to-creatinine ratio.

CONCLUSION

The protein concentration of uEVs in diabetes with kidney injury increased significantly than the normal controls before and after adjusting the UCr. Therefore, diabetes with kidney injury may change the abundance and cargo of uEVs, which may be involved in the physiological and pathological changes of diabetes.

Molecular Insights of Plant Phytochemicals Against Diabetic Neuropathy

Diabetes and its associated complications including diabetic neuropathy have become a menacing headache for health workers and scientists all over the world. The number of diabetic individuals has been growing exponentially every day while the entire medical fraternity feels crippled and unable to handle such an enormous and anarchical scenario. The disease also demonstrates itself in the patients in numerous ways ranging from a little discomfort to death. Diabetic neuropathy has a poor prognosis since it might go unnoticed for years after the onset of diabetes. The etiology of the disease has been linked to oxidative stress caused by increased free radical production. Hyperglycemia causes multiple metabolic pathways to be activated, as well as significant oxidative stress, which becomes the major cause of cell death, culminating in Diabetic Neuropathy. So, it is the need of the hour to find out permanent treatment for this life-threatening disease. The primary goal of this study is to emphasize the potential importance of numerous processes and pathways in the development of diabetic neuropathy as well as the possible role of plant metabolites to control the disease at a molecular level. A possible mechanism was also summarized in the study about scavenging the reactive oxygen species by a flavonoid component. The study also covered the in vivo data of various plants and some of the flavonoid compounds actively studied against Diabetic Neuropathy by inhibiting or reducing the contributing factors such as proinflammatory cytokines, ROS, RNS inhibition, and upregulating the various cellular antioxidants such as GSH, SOD, and CAT.

Distinct depressive symptom trajectories are associated with incident diabetes among Chinese middle-aged and older adults: The China Health and Retirement Longitudinal Study

OBJECTIVE

Previous studies have reported that depression and depressive symptom are associated with diabetes incident. However, the association between long-term depressive symptom patterns and risk of diabetes remains unknown. The aim of present study was to evaluate the association between depressive symptom trajectories and risk of diabetes.

METHODS

We used data of 8806 participants (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS). Trajectories of depressive symptom were identified by latent mixture modeling. Multivariable logistic regression model was used to examine the association of depressive symptom trajectories with diabetes.

RESULTS

Five depressive symptom trajectories were identified, characterizing by maintaining a low CES-D scores throughout the follow-up (low-stable; 3227 participants [36.65%]); maintaining a moderate CES-D scores throughout the follow-up (moderate-stable; 3402 participants [38.63%]); moderate starting CES-D scores then increasing scores (moderate-increasing; 681 participants [7.73%%]); high starting CES-D scores but then decreasing scores (high-decreasing; 1061 participants [12.05%]); and maintained high CES-D scores throughout the follow-up (high-stable; 435 participants [4.94%]). During 2015 to 2018 (Wave 3 to Wave 4), a total of 312 respondents experienced diabetes. Compared with participants in the low-stable depressive symptom trajectory, those following a high-decreasing (ORs = 2.04; 95%CIs 1.48-2.98) and high-stable depressive symptom trajectories (ORs = 3.26; 95%CIs 2.06-5.16) were at substantially higher risk of developing diabetes.

CONCLUSIONS

Individuals with high-decreasing and high-stable depressive symptom trajectories over time were associated with increased risk of incident diabetes. Long-term depressive symptom may be a strong predictor of having diabetes.

Frailty Index was Associated With Adverse Outcomes in Admitted Elderly Patients With Type 2 Diabetes Mellitus

We aimed to investigate the role of the laboratory frailty index (LFI) in diabetic complications and incident disability in admitted older patients with type 2 diabetes mellitus (T2DM). We retrospectively collected the clinical data of older patients with T2DM from December 2018 to May 2020. Frailty was quantified using the LFI, which considers the accumulation of 27 items of abnormal laboratory outcomes. Univariate and multivariate analyses were performed to evaluate the relationship between LFI and diabetes-related adverse outcomes. In total, 293 consecutive older patients with T2DM were recruited for this study. According to the predefined LFI criteria, 110 (37.5%) participants were non-frail, 131 (44.7%) were prefrail, and 52 (17.8%) were frail. Univariate and multivariate analysis revealed that LFI was associated with the diabetic microangiopathy complications (odds ratio for prefrail [ORprefrail] 1.760, 95% confidence interval for prefrail [CIprefrail] 1.019-3.041, P = .043; ORfrail 4.667, 95% CIfrail 2.012-10.826, P < .001) and activities of daily living (ADL) disability (ORprefrail 2.323, 95% CIprefrail 1.209-4.463, P = .011; ORfrail 9.367, 95% CIfrail 4.030-21.775, P < .001), but not with the diabetic macroangiopathy complications and diabetic peripheral neuropathy. Frailty, as determined by the LFI, was proven to be an effective tool for the prediction of diabetic microangiopathy complications and ADL disability.

Based on Propensity Matching Scores: Comparison of the Efficacy of Two Kinds of Bariatric Surgery for Obese Type 2 Diabetes

PURPOSE

To compare the efficacy of OADS and SG in treating obese T2D in China.

MATERIALS AND METHODS

We included 99 obese Chinese patients with T2D undergoing OADS or SG with a 1-year postoperative follow-up from January 2014 to October 2021. Using the propensity score matching (PSM) method, patients from both groups were matched 1:1. Outcomes for losing weight, controlling diabetes, and nutrition were then determined.

RESULTS

There were 32 patients in each group after using the PSM method, and there was no statistically significant difference between the two groups in terms of all the baseline indicators (P > 0.05). When comparing weight loss outcomes, the OADS group outperformed the SG group in terms of change in BMI and %TWL, with statistically significant differences [15.0 (8.1-26.6) kg/m², 10.0 (4.10-23.5) kg/m² P = 0.001; 38.5% ± 6.7%, 29.5% ± 9.4%, P = 0.000]. When comparing the efficacy of diabetes, the OADS group outperformed the SG group in terms of HbA1C and complete remission of diabetes, with statistically significant differences [5.1 (3.8-5.6)%, 5.4 (4.3-7.9)%, P = 0.001; 100%, 75%, P = 0.005]. Besides, the incidence of postoperative zinc deficiency in the OADS group was significantly higher than in the SG group (P = 0.019) and there was no significant difference in other postoperative nutritional outcomes between the two groups.

CONCLUSION

Although OADS and SG are both effective in the treatment of obese T2D, OADS performs better. Besides, the long-term efficacy of both needs to be recorded at subsequent follow-up.

Prevalence of Prediabetes and Related Modifiable Cardiovascular Risk Factors Among Employees of Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia

BACKGROUND

Prediabetes is considered an important risk factor for type 2 diabetes and related cardiovascular problems. However, evidence shows that both prediabetes and its associated cardiovascular risk factors could be mitigated through lifestyle modification. This study aims at determining the magnitude of prediabetes and related modifiable cardiovascular risk factors as an initial step towards undertaking such mitigation measures.

METHODS

A cross-sectional study was conducted on employees of a tertiary care hospital from March to June/2019. Socio-demographic data were collected using a self-administered questionnaire. Anthropometric and blood pressure measurements were performed following WHO guidelines. Biochemical parameters were assayed following standard operating procedures. Categorical variables are summarized using frequencies and percentages. Normality test was performed ahead of describing the numeric data and log transformations were carried out when appropriate. International Diabetes Federation (IDF) and American Diabetes Association (ADA) criteria were used to classify glycemic status. Likewise, IDF and revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were employed for the diagnosis of metabolic syndrome.

RESULTS

In this study, we engaged a total of 265 employees. About 35.1% were males and 64.9% were females. The median age was 29 (9) years. About 5.7% and 18.1% had prediabetes based on IDF and ADA criteria, respectively. Equally, 3.4% had FBS levels that meet the criteria for overt diabetes on IDF and ADA. Besides, 55.1% had a metabolic risk as implied by the elevated waist-to-height ratio (WhtR), 24.2% had hypertriglyceridemia, 27.9% had above optimal LDL and 57% had low HDL. Overall, 17.9% and 21.9% of the participants had metabolic syndrome according to IDF and revised NCEP ATP III criteria, respectively.

CONCLUSION

The prevalence of prediabetes and metabolic syndrome observed in hospital employees is comparable with the general population.

Association between body mass index and reversion to normoglycemia from impaired fasting glucose among Chinese adults: a 5-year cohort study

Objective

Evidence regarding the relationship between body mass index (BMI) and reversion to normoglycemia from prediabetes is still limited. The purpose of our study is to survey the link of BMI on reversion to normoglycemia among patients with impaired fasting glucose (IFG).

Methods

This study, a retrospective cohort, covered 32 regions and 11 cities in China and collected 258,74 IFG patients who underwent a health check from 2010 to 2016. We investigated the association between baseline BMI and reversion to normoglycemia in patients with IFG using the Cox proportional-hazards regression model. The nonlinear relationship between BMI and reversion to normoglycemia was determined using a Cox proportional hazards regression with cubic spline functions and smooth curve fitting. In addition, we also performed a series of sensitivity analyses and subgroup analyses. A competing risk multivariate Cox regression was performed using progression to diabetes as a competing risk for reversal of normoglycemic events.

Results

After adjusting covariates, the results showed that BMI was negatively related to the probability of reversion to normoglycemia (HR=0.977, 95%CI:0.971-0.984). Compared with participants with normal BMI(<24kg/m²), overweight (BMI:24-28kg/m²) participants with IFG had a 9.9% lower probability of returning to normoglycemia (HR=0.901,95%CI:0.863-0.939), while obese patients (BMI ≥ 28kg/m²) had a 16.9% decreased probability of reverting from IFG to normoglycemia (HR=0.831,95%CI:0.780-0.886). There was also a nonlinear relationship between them, and the inflection point of BMI was 21.7kg/m². The effect sizes (HR) on the left sides of the inflection point were 0.972(95%CI:0.964-0.980). The competing risks multivariate Cox's regression and sensitivity analysis demonstrated the robustness of our results.

Conclusion

This study demonstrates a negative and nonlinear relationship between BMI and reversion to normoglycemia in Chinese patients with IFG. Minimizing BMI to 21.7 kg/m² in patients with IFG through aggressive intervention may significantly increase the probability of returning to normoglycemia.

Investigation of risk factors associated with impaired glucose regulation: Using the momentum equation to assess the impact of risk factors on community residents

OBJECTIVE

To identify risk factors for impaired glucose regulation (IGR) and assess their impact on community residents, this study used a questionnaire to conduct cross-sectional surveys and analysis.

METHODS

Overall, 774 residents of an urban community in northern China (Jian city) participated in this study. Trained investigators conducted surveys using questionnaires. Based on their medical history, respondents were divided into three glucose status groups as follows: normal (NGT), IGR, and diabetes mellitus (DM). Statistical analysis of survey data was performed using SPSS v. 22.0.

RESULTS

Age, hypertension, family history of diabetes (FHD), dyslipidemia, obesity, and cardiovascular and cerebral disease (CVD) were positively correlated with IGR in men and women. IGR was negatively correlated with a sedentary lifestyle in men and positively correlated with being overweight in women. The number of type 2 diabetes mellitus (T2D) risk factors per subject was positively correlated with age in the NGT group. Glucose status deteriorated with increasing age and the number of risk factors. FHD was the strongest risk factor in both men and women.

CONCLUSIONS

Prevention of IGR includes weight control, physical activity, and prevention of hypertension and dyslipidemia, especially in subjects with FHD.

Worldwide trends in prediabetes from 1985 to 2022: A bibliometric analysis using bibliometrix R-tool

Background

Prediabetes is a widespread condition that represents the state between normal serum glucose and diabetes. Older individuals and individuals with obesity experience a higher rate of prediabetes. Prediabetes is not only a risk factor for type 2 diabetes mellitus (t2dm) but is also closely related to microvascular and macrovascular complications. Despite its importance, a bibliometric analysis of prediabetes is missing. The purpose of this study is to provide a comprehensive and visually appealing overview of prediabetes research.

Methods

First, the Web of Science (WOS) database was searched to collect all articles related to prediabetes that were published from 1985 to 2022. Second, R language was used to analyze the year of publication, author, country/region, institution, keywords, and citations. Finally, network analysis was conducted using the R package bibliometrix to evaluate the hotspots and development trends of prediabetes.

Results

A total of 9,714 research articles published from 1985 to 2022 were retrieved from WOS. The number of articles showed sustained growth. Rathmann W was the most prolific author with 71 articles. Diabetes Care was the journal that published the highest number of articles on prediabetes (234 articles), and Harvard University (290 articles) was the most active institution in this field. The United States contributed the most articles (2,962 articles), followed by China (893 articles). The top five clusters of the keyword co-appearance network were "prediabetes", "diabetes mellitus", "glucose", "insulin exercise", and "oxidative stress". The top three clusters of the reference co-citation network were "Knowler. WC 2002", "Tabak AG 2012", and "Matthews DR1985".

Conclusions

The combined use of WOS and the R package bibliometrix enabled a robust bibliometric analysis of prediabetes papers, including evaluation of emerging trends, hotspots, and collaboration. This study also allowed us to validate our methodology, which can be used to better understand the field of prediabetes and promote international collaboration.