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Ting MK, Liao PJ, Wu IW, Chen SW, Yang NI, Lin TY, Hsu KH. Predicting Type 2 Diabetes Mellitus Occurrence Using Three-Dimensional Anthropometric Body Surface Scanning Measurements: A Prospective Cohort Study. J Diabetes Res 2018; 2018:6742384. [PMID: 30116743 PMCID: PMC6079414 DOI: 10.1155/2018/6742384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/07/2018] [Accepted: 02/27/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An accurate and comprehensive anthropometric measure for predicting type 2 diabetes mellitus (T2DM) has not yet been depicted. METHODS A total of 8450 nondiabetic participants were recruited during 2000-2010 in Taiwan. The cohort was followed up to the end of 2013, over an average of 8.87 years. At recruitment, participants completed a questionnaire related to basic demographics, lifestyle variables, personal disease history, and family disease history. 3D body surface scanning was used to obtain 35 anatomical measurements. A Cox proportional hazard model was used to conduct multivariable analyses. RESULTS A total of 2068 T2DM cases at an incidence rate of 27.59 × 10-3 (year-1) were identified during the follow-up period. Multivariable-adjusted hazard ratios (HRs) demonstrated that neck circumference (NC) (HR = 1.048; 95% CI = 1.033-1.064), waist width (WW) (HR = 1.061; 95% CI = 1.040-1.081), and left thigh circumference (TC) (HR = 0.984; 95% CI = 0.972-0.995) were significant predictors of the occurrence of T2DM. While dividing body measurement into median high/low groups, an increased risk of T2DM was observed among participants with a larger NC and smaller TC (HR = 1.375; 95% CI = 1.180-1.601) and a larger WW and smaller TC (HR = 1.278; 95% CI = 1.085-1.505) relative to other participants. CONCLUSIONS This study suggests that as well as using traditional waist and TC measurements, NC can be used as an indicator to provide an early prediction of developing T2DM, while providing clues for future mechanistic investigations of T2DM.
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Affiliation(s)
- Ming-Kuo Ting
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pei-Ju Liao
- Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan
| | - I-Wen Wu
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shuo-Wei Chen
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ning-I Yang
- Division of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzu-Yu Lin
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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202
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Guo W, Nie L, Wang XR, Xu ML, Yang WJ, Gao XY, Cai XL, Ji LN. Comparison of Placebo Effect between Asian and Caucasian Type 2 Diabetic Patients: A Meta-Analysis. Chin Med J (Engl) 2018; 131:1605-1612. [PMID: 29941715 PMCID: PMC6032690 DOI: 10.4103/0366-6999.235107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Placebo was defined as any therapy that is used for its nonspecific psychological and physiologic effect but has no specific pharmacologic impact on the condition being treated. Besides medication therapies, studies have found that the optimal dietary approach as well as physical activity and education are useful to control hyperglycemia in patients with type 2 diabetes (T2DM). The aim of this study was to evaluate the placebo effects of antidiabetic therapies in Asian and Caucasian T2DM patients and make a comparison between the two ethnicities. Methods: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed, from when recording began until December 2016. The main concepts searched in English were sulfonylurea (SU); alpha glucosidase inhibitors (AGI); metformin (MET); thiazolidinediones (TZD); dipeptidyl peptidase-4 inhibitors (DPP-4i); sodium-glucose cotransporter 2 inhibitors (SGLT2i); glucagon-like peptide-1 receptor agonist (GLP-1RA); type 2 diabetes (T2DM); placebo controlled; and randomized controlled trials. Using the Cochrane instrument, we evaluated the adequacy of randomization, allocation concealment procedures, and blinding. Results: This study included 63 studies with a total of 7096 Asian patients involved and 262 studies with a total of 27,477 Caucasian patients involved. In Caucasian population, the use of placebo led to significant reductions of glycosylated hemoglobin (HbA1c), −0.683% (P = 0.008) in SU monotherapy treatment, −0.193% (P = 0.001) in DPP-4i treatment, and −0.230% (P < 0.001) in SGLT2i treatment, respectively. In Asian population, the use of placebo resulted in significant decreases of HbA1c, −0.162% (P = 0.012) in DPP-4i treatment and −0.269% (P = 0.028) in GLP-1RA add-on therapy, respectively. The placebo also significantly reduced body weight. In Caucasian population, placebo use resulted in 0.833 kg (P = 0.006) weight loss by SU treatment and 0.953 kg (P = 0.006) weight loss by GLP-1RA treatment. In Asian population, the placebo led to a weight change of 0.612 kg (P < 0.001) by GLP-1RA analog treatment. The changes of HbA1c and weight due to the placebo effect in other treatments were not significant in both Asian and Caucasian population. Comparisons of the placebo effect on HbA1c change and weight change in each treatment group indicated that no significant difference was found between Asian and Caucasian population. Conclusions: The overall differences of the placebo effect on HbA1c changes as well as on body weight changes were not significant between Asian and Caucasian T2DM patients. The placebo effect on HbA1c changes and weight changes was not associated with baseline age, gender, baseline body mass index, baseline HbA1c, duration of diabetes, or study duration.
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Affiliation(s)
- Wei Guo
- Department of Emergency, Peking University People's Hospital, Beijing 100044, China
| | - Lin Nie
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing 101318, China
| | - Xi-Rui Wang
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing 101318, China
| | - Mei-Ling Xu
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing 101318, China
| | - Wen-Jia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
| | - Xue-Ying Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Ling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
| | - Li-Nong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
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203
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Cai X, Gao X, Yang W, Chen Y, Zhang S, Zhou L, Han X, Ji L. No disparity of the efficacy and all-cause mortality between Asian and non-Asian type 2 diabetes patients with sodium-glucose cotransporter 2 inhibitors treatment: A meta-analysis. J Diabetes Investig 2018; 9:850-861. [PMID: 29029369 PMCID: PMC6031489 DOI: 10.1111/jdi.12760] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/23/2017] [Accepted: 10/04/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS/INTRODUCTION To evaluate whether there is disparity of the efficacy and all-cause mortality and other adverse effects between Asian and non-Asian patients with sodium-glucose cotransporter 2 (SGLT2) inhibitors treatment. MATERIALS AND METHODS Randomized clinical trials publicly available before January 2017, comparing SGLT2 inhibitors treatment with a placebo in type 2 diabetes patients were identified. The association between treatment and outcomes was estimated by computing the weighted mean difference for glycated hemoglobin level, blood pressure level, lipid profile levels and bodyweight, and the odds ratios for adverse events. RESULTS A total of 17 trials with Asian patients were included and 39 trials with non-Asian patients were included. Comparison of the glycated hemoglobin decreases corrected by a placebo between Asian and non-Asian patients showed that there was a non-significant difference of 0.05% between groups (P > 0.05). Comparisons of the bodyweight changes and blood pressure changes corrected by a placebo between Asian and non-Asian patients did not show a significant difference between groups (P > 0.05). The risk of all-cause mortality was not increased when compared with a placebo both in Asian and non-Asian populations, and the risk of genital infection in Asian and non-Asian populations were both significant increased. CONCLUSIONS Overall, according to the present meta-analysis, comparison of the efficacy in SGLT2 inhibitors treatment between Asian and non-Asian type 2 diabetes patients showed no significant difference in glycated hemoglobin reduction and bodyweight reduction. Furthermore, no disparity was found in the risk of all-cause mortality or hypoglycemia in SGLT2 inhibitors treatment between Asian and non-Asian patients.
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Affiliation(s)
- Xiaoling Cai
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Xueying Gao
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Wenjia Yang
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Yifei Chen
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Simin Zhang
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Lingli Zhou
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Xueyao Han
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
| | - Linong Ji
- Endocrine & Metabolism DepartmentPeking University People's HospitalBeijingChina
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204
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Cooper LB, Yap J, Tay WT, Teng THK, MacDonald M, Anand IS, Sharma A, O'Connor CM, Kraus WE, Mentz RJ, Lam CS. Multi-ethnic comparisons of diabetes in heart failure with reduced ejection fraction: insights from the HF-ACTION trial and the ASIAN-HF registry. Eur J Heart Fail 2018; 20:1281-1289. [PMID: 29943890 DOI: 10.1002/ejhf.1223] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022] Open
Abstract
AIM To describe differences in patient characteristics and outcomes by ethnicity in patients with diabetes mellitus (DM) and heart failure (HF) with reduced ejection fraction (HFrEF, ejection fraction ≤35%) in a multi-ethnic cohort. METHODS AND RESULTS Patient level data from two cohorts (HF-ACTION and ASIAN-HF) were combined, and patients grouped by self-reported ethnicity. DM was defined as the presence of a clinical diagnosis and/or receiving anti-diabetic therapy. A total of 6214 (1324 whites, 674 blacks, 1297 Chinese, 1510 Indians, 717 Malays, 692 Japanese/Koreans) patients were included. The overall prevalence of DM was 39.5% (n = 2454). The prevalence of DM was lowest in whites (29.3%), followed by Japanese/Koreans (34.1%), blacks (35.9%), Chinese (42.3%), Indians (44.2%), and highest in Malays (51.9%). The correlation between age, sex, body mass index, coronary artery disease, hypertension, atrial fibrillation, peripheral vascular disease and chronic kidney disease with DM differed significantly by ethnicity (P for interaction <0.05). The strongest correlations were seen in Malay women, whites with obesity, Indians with coronary artery disease and hypertension, and blacks with chronic kidney disease. On multivariable analyses, DM was significantly associated with the composite of 1-year overall mortality/HF hospitalization (hazard ratio 1.37, 95% confidence interval 1.19-1.57; P < 0.001), with no interaction by ethnicity (P for interaction =0.31). CONCLUSIONS There is marked heterogeneity in the prevalence and correlates of DM among different ethnic groups with HF worldwide. Subgroups particularly predisposed to DM warrant special attention, since DM increases the combined risk of morbidity and mortality in all ethnicities with HF.
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Affiliation(s)
- Lauren B Cooper
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | - Abhinav Sharma
- Stanford University, Palo Alto, CA, USA.,University of Alberta, Edmonton, Alberta, Canada
| | - Christopher M O'Connor
- Inova Heart and Vascular Institute, Falls Church, VA, USA.,Duke University Medical Center, Durham, NC, USA
| | | | | | - Carolyn S Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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205
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Yang J, Park KW, Cho S. Inhibition of the CD36 receptor reduces visceral fat accumulation and improves insulin resistance in obese mice carrying the BDNF- Val66Met variant. J Biol Chem 2018; 293:13338-13348. [PMID: 29914985 DOI: 10.1074/jbc.ra118.002405] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/12/2018] [Indexed: 01/09/2023] Open
Abstract
Obesity-induced metabolic dysfunctions increase the risk for vascular diseases, including type II diabetes and stroke. Managing obesity is of interest to address the worldwide health problem; however, the role of genetic variability in human obesity development and specific targets for obesity-related metabolic disease have not been thoroughly studied. A SNP in the brain-derived neurotropic factor (BDNF) gene that results in the substitution of a valine with a methionine at codon 66 (Val66Met) occurs with a high frequency in humans. This study addressed the effect of genetic variability in developing obesity and the efficacy of the inhibition of cluster of differentiation 36 (CD36), a multifunctional receptor implicated in obesity and insulin resistance, in WT mice and mice with the BDNF Val66Met variant. CD36 inhibition by salvionolic acid B (SAB) in diet-induced obese WT mice reduced visceral fat accumulation and improved insulin resistance. The benefit of SAB was abrogated in CD36 knockout mice, showing the specificity of SAB. In addition, mice with the Val66Met variant in both alleles (BDNFM/M) fed a high-fat diet exhibited extreme obesity with increased CD36 gene and protein levels in macrophages. Chronic SAB treatment in BDNFM/M mice significantly decreased visceral fat accumulation and improved insulin resistance. Notably, the effect of SAB was greater in the extremely obese BDNFM/M mice compared with the WT mice. The study demonstrated a link between BDNF Val66Met and elevated CD36 expression and suggested that CD36 inhibition may be a potential strategy to improve metabolic dysfunctions and to normalize risk factors for vascular diseases in the obese population.
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Affiliation(s)
- Jiwon Yang
- From the Burke Medical Research Institute, White Plains, New York 10605 and
| | - Keun Woo Park
- From the Burke Medical Research Institute, White Plains, New York 10605 and
| | - Sunghee Cho
- From the Burke Medical Research Institute, White Plains, New York 10605 and .,the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York 10065
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206
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Davis TME, Mulder H, Lokhnygina Y, Aschner P, Chuang LM, Raffo Grado CA, Standl E, Peterson ED, Holman RR. Effect of race on the glycaemic response to sitagliptin: Insights from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab 2018; 20:1427-1434. [PMID: 29405540 DOI: 10.1111/dom.13242] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 01/04/2023]
Abstract
AIM Pooled efficacy studies suggest that glycaemic responses to dipeptidyl-peptidase 4 inhibitors in type 2 diabetes are greatest in Asians, who may also respond better to alpha-glucosidase inhibitors. We assessed the glycaemic impact of sitagliptin by race in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), and whether this was enhanced in Asians with concomitant acarbose therapy. MATERIALS AND METHODS TECOS enrolled 14 671 patients with type 2 diabetes, cardiovascular disease and HbA1c of 48-64 mmol/mol (6.5%-8.0%), and randomized them, double-blind, to sitagliptin or placebo. There were 3265 patients (22.3%) from Asian countries. Background glucose-lowering therapies were unaltered for the first 4 months post randomization unless clinically essential, facilitating comparison of sitagliptin-associated effects in self-identified East Asian, Other (South) Asian, White Caucasian, Hispanic, Black and Indigenous groups. RESULTS Median baseline HbA1c by race was 54 to 57 mmol/mol (7.1%-7.4%). Mean 4-month reduction in placebo-adjusted HbA1c was greatest in East Asians (-6.6 mmol/mol [-0.60%] vs ≤6.0 mmol/mol [≤0.55%] in other groups), with significantly greater reduction vs the 2 largest groups (White Caucasians, Other Asians; P < .0001) after adjustment for covariates. After the first 4 months, East and Other Asians were more likely to initiate additional oral therapy (metformin and/or sulfonylureas) than insulin vs White Caucasians (P < .0001). Acarbose use increased in the Asian patients, but no glycaemic interaction with allocated study medication was observed (adjusted P = .12). CONCLUSIONS The greatest initial reduction in HbA1c with sitagliptin in the TECOS population was in East Asians. No enhanced glycaemic effect was seen when sitagliptin was given with acarbose.
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Affiliation(s)
- Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Pablo Aschner
- School of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Rury R Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
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207
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Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol 2018; 6:e6-e15. [PMID: 29803268 PMCID: PMC5982644 DOI: 10.1016/s2213-8587(18)30150-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex. METHODS We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting. FINDINGS We estimated that 5·7% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 804 100 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (629 000 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for almost twice as many cancer cases as diabetes (293 300 cases). 25·8% of diabetes-related cancers (equating to 75 600 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002. INTERPRETATION A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients. FUNDING NIHR and Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Bin Zhou
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James Bentham
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; School of Mathematics, Statistics and Actuarial Science (SMSAS), University of Kent, Canterbury, UK
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
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208
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Abstract
The People's Republic of China (herein referred to as China) has witnessed one of the most dramatic rises in diabetes prevalence anywhere in the world. The latest epidemiological study suggests that approximately 11% of the population has diabetes, with a significant proportion remaining undiagnosed. Risk factors for diabetes in the Chinese population are similar to those in other populations, though gestational diabetes and young-onset diabetes is becoming increasingly common. Data on the prevalence of diabetic complications remain limited, though cardio-renal complications account for significant morbidity and mortality. Other diabetes-related comorbidities are becoming increasingly common, with cancer emerging as a major cause of mortality among individuals with diabetes. There are many challenges and obstacles that impede effective diabetes prevention and the delivery of care, though much progress has occurred over recent years. Lessons learnt from how China has responded to the challenges posed by the diabetes epidemic will be invaluable for other countries facing the many threats of diabetes and its complications.
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Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Chinese University of Hong Kong and Shanghai Jiao Tong University (CUHK-SJTU) Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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209
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Arambewela MH, Somasundaram NP, Jayasekara HBPR, Kumbukage MP, Jayasena PMS, Chandrasekara CMPH, Fernando KRAS, Kusumsiri DP. Prevalence of Chronic Complications, Their Risk Factors, and the Cardiovascular Risk Factors among Patients with Type 2 Diabetes Attending the Diabetic Clinic at a Tertiary Care Hospital in Sri Lanka. J Diabetes Res 2018; 2018:4504287. [PMID: 29951551 PMCID: PMC5989171 DOI: 10.1155/2018/4504287] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/23/2018] [Accepted: 04/15/2018] [Indexed: 12/17/2022] Open
Abstract
Diabetes incurs heavy burden to patients and the healthcare system. Assessment of disease burden is important in taking necessary precautions and management decisions. We aimed to determine the prevalence of macro- and microvascular complications, their risk factors, and coronary artery disease (CAD) risk factors among patients with type 2 diabetes mellitus (T2DM). A descriptive cross-sectional single-centre study was carried out among 3000 patients with T2DM attending the diabetic clinic at the National Hospital of Sri Lanka from January to July 2016. The study population had 72.7% females and 27.3% males. Mean age and disease duration were 58.3 ± 10.3 and 10.8 ± 7 years, respectively. Prevalence of CAD, stroke, and peripheral vascular disease were 10.6%, 1.1%, and 4.7% while diabetic retinopathy, neuropathy, nephropathy, diabetic foot, and lower extremity amputation (LEA) were 26.1%, 62.6%, 50.8%, 2.6%, and 1.3%, respectively. Prevalence of overweight/obesity, hypertension, dyslipidemia, and smoking were 80%, 77.6%, 76.7%, and 11%, respectively. Increased age, disease duration, and HBA1c were risk factors for microvascular disease and diabetic foot while age was the only risk factor for macrovascular complications. Occurrence of CAD, peripheral neuropathy, diabetic foot, and LEA was significantly higher among males than when compared to females. This study highlights the major burden of chronic complications and high prevalence of CAD risk factors in this population.
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Affiliation(s)
- Maulee Hiromi Arambewela
- Department of Diabetes and Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Noel P. Somasundaram
- Department of Diabetes and Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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210
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Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies. Int J Clin Pract 2018; 72:e13201. [PMID: 29790628 DOI: 10.1111/ijcp.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Observational studies examining the relationship between metabolic syndrome and the risk of chronic kidney disease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies. METHODS The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016 to identify all relevant studies. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of MetS and its components with CKD risk were extracted and pooled using a random-effects model. RESULTS A total of 66 studies, including 18 prospective cohorts and 48 cross-sectional studies, with 699 065 CKD patients and 11 109 003 participants were included in the meta-analysis. When all definitions were pooled, the presence of MetS was associated with a significant 50% increase of CKD risk (OR = 1.50, 95% CI = 1.43-1.56), with evidence of moderate heterogeneity (I2 = 72.3%, P < .001). The risk of CKD associated with MetS was higher in studies using the American Heart Association/National Heart, Lung, and Blood Institute criteria (OR = 1.68, 95% CI = 1.25-2.10) compared with those using the Adult Treatment Panel III (OR = 1.49, 95% CI = 1.42-1.56) and the International Diabetes Federation (OR = 1.32, 95% CI = 1.22-1.41) definitions. This relationship was independent of diabetes status. Moreover, all individual components of the MetS were significantly associated with CKD, and their coexistence resulted in an escalating dose-response relationship. The sensitivity and subgroup analyses established the stability of the findings. CONCLUSIONS This meta-analysis strongly suggests that the metabolic syndrome and its components are independently associated with the increased risk of CKD.
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Affiliation(s)
- Shahab Alizadeh
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahsa Ahmadi
- Department of Microbiology, Faculty of Basic Sciences, Karaj Branch, Islamic Azad University, Alborz, Iran
| | - Behnam Ghorbani Nejad
- Department of pharmacology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abolghassem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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211
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Abstract
PURPOSE OF THE REVIEW Causality has been demonstrated for few of the many putative risk factors for type 2 diabetes (T2D) emerging from observational epidemiology. Genetic approaches are increasingly being used to infer causality, and in this review, we discuss how genetic discoveries have shaped our understanding of the causal role of factors associated with T2D. RECENT FINDINGS Genetic discoveries have led to the identification of novel potential aetiological factors of T2D, including the protective role of peripheral fat storage capacity and specific metabolic pathways, such as the branched-chain amino acid breakdown. Consideration of specific genetic mechanisms contributing to overall lipid levels has suggested that distinct physiological processes influencing lipid levels may influence diabetes risk differentially. Genetic approaches have also been used to investigate the role of T2D and related metabolic traits as causal risk factors for other disease outcomes, such as cancer, but comprehensive studies are lacking. Genome-wide association studies of T2D and metabolic traits coupled with high-throughput molecular phenotyping and in-depth characterisation and follow-up of individual loci have provided better understanding of aetiological factors contributing to T2D.
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Affiliation(s)
- Laura B. L. Wittemans
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Luca A. Lotta
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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212
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De Silva AP, De Silva SHP, Haniffa R, Liyanage IK, Jayasinghe S, Katulanda P, Wijeratne CN, Wijeratne S, Rajapaksa LC. Inequalities in the prevalence of diabetes mellitus and its risk factors in Sri Lanka: a lower middle income country. Int J Equity Health 2018; 17:45. [PMID: 29665834 PMCID: PMC5905173 DOI: 10.1186/s12939-018-0759-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 04/10/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Explorations into quantifying the inequalities for diabetes mellitus (DM) and its risk factors are scarce in low and lower middle income countries (LICs/LMICs). The aims of this study were to assess the inequalities of DM and its risk factors in a suburban district of Sri Lanka. METHODS A sample of 1300 participants, (aged 35-64 years) randomly selected using a stratified multi-stage cluster sampling method, were studied employing a cross sectional descriptive design. The socioeconomic indicators (SEIs) of the individual were education level and occupational category, and at the household level, the household income, social status level and area deprivation level. DM was diagnosed if the fasting plasma glucose was ≥126 and a body mass index (BMI) of > 27.5 kg/m2 was considered high. Asian cut-off values were used for high waist circumference (WC). Validated tools were used to assess the diet and level of physical activity. The slope index of inequality (SII), relative index of inequality (RII) and concentration index (CI) were used to assess inequalities. RESULTS The prevalence of DM and its risk factors (at individual or household level) showed no consistent relationship with the three measures of inequality (SII, RII and CI) of the different indices of socio economic status (education, occupation, household income, social status index or area unsatisfactory basic needs index). The prevalence of diabetes showed a more consistent pro-rich distribution in females compared to males. Of the risk factors in males and females, the most consistent and significant pro-rich relationship was for high BMI and WC. In males, the significant positive relationship with high BMI for SII ranged from 0.18 to 0.35, and RII from 1.56 to 2.25. For high WC, the values were: SII from 0.13 to 0.27 and RII from 1.9 to 3.97. In females the significant positive relationship with high BMI in SII ranged from 0.13 to 0.29, and RII from 2.3 to 4.98. For high WC the values were: SII from 028 to 0.4 and RII 1.99 to 2.39. Of the other risk factors, inadequate fruit intake showed a consistent significant pro-poor distribution only in males using SII (- 0.25 to - 0.36) and in both sexes using CI. Smoking also showed a pro-poor distribution in males especially using individual measures of socio-economic status (i.e. education and occupation). CONCLUSIONS The results show a variable relationship between socioeconomic status and prevalence of diabetes and its risk factors. The inequalities in the prevalence of diabetes and risk factors vary depending on gender and the measures used. The study suggests that measures to prevent diabetes should focus on targeting specific factors based on sex and socioeconomic status. The priority target areas for interventions should include prevention of obesity (BMI and central obesity) specifically in more affluent females. Males who have a low level of education and in non-skilled occupations should be especially targeted to reduce smoking and increase fruit intake.
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Affiliation(s)
| | | | - Rashan Haniffa
- Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Isurujith Kongala Liyanage
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala University, Colombo, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Sumedha Wijeratne
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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213
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Qian X, Wang H, Yang G, Gao Z, Luo Y, Dong A, Zhang F, Xu M, Liu S, Yang X, Chen Y, Li G. Pioglitazone Improved Insulin Sensitivity and First Phase Insulin Secretion Among Obese and Lean People with Diabetes: A Multicenter Clamp Study. Diabetes Ther 2018; 9. [PMID: 29536426 PMCID: PMC6104278 DOI: 10.1007/s13300-018-0401-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION To investigate the effects of pioglitazone (PIO) on insulin resistance and first phase insulin secretion among obese and lean Chinese people with type 2 diabetes mellitus (T2DM). METHODS Sixty-eight drug-naïve patients with T2DM were treated with PIO for 16 weeks. Before and after the treatment, insulin sensitivity was evaluated by the euglycemic hyperinsulinemic clamp test. Plasma insulin levels at 0, 3, 5, 7, and 10 min during intravenous glucose tolerance test were determined to calculate the first phase insulin secretion and pancreatic β-cell function. Circulating adiponectin levels were quantified. RESULTS In both the lean and the obese patients with T2DM, the reduction of HbA1c following the PIO treatment was more than 1% (P < 0.001) and glucose infusion rate, acute insulin response, glucose disposal index, and β-cell glucose sensitivity increased significantly (P < 0.001). A multiple linear regression analysis showed that the improvements of first phase insulin secretion and insulin sensitivity were independently associated with the changes of HbA1c, but the change of first phase insulin secretion exhibited a higher correlation coefficient (R2 = 0.20, P = 0.001) than the change of insulin sensitivity did (R2 = 0.07, P = 0.040). The PIO treatment led to a significant increase in adiponectin levels only in the obese group (P < 0.05). CONCLUSION A 16-week treatment of PIO significantly increased insulin sensitivity and β-cell function in the lean group as well as in the obese group among Chinese T2DM patients, demonstrating that both lean and obese diabetic adults would profit from PIO. TRIAL REGISTRATION The ChiCTR registry number is ChiCTR-OPC-17011571. FUNDING Takeda Pharmaceutical Co. Ltd. and Pfizer Pharmaceutical Co. Ltd.
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Affiliation(s)
- Xin Qian
- Endocrinology and Cardiovascular Diseases Center, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Hui Wang
- Endocrinology and Cardiovascular Diseases Center, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Chongqing, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, No. 42 Xuegong Street, Shahekou District, Dalian, China
| | - Yong Luo
- Department of Endocrinology, Chongqing Three Gorges Central Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing, China
| | - Aimei Dong
- Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Road, Xicheng District, Beijing, China
| | - Fang Zhang
- Department of Endocrinology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Futian District, Shenzhen, China
| | - Mingtong Xu
- Department of Endocrinology, Second Affiliated Hospital of Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, China
| | - Shiping Liu
- Department of Endocrinology, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha, Hunan, China
| | - Xin Yang
- Department of Information Systems, Statistics, and Management Science, Culverhouse College of Commerce and Business Administration, The University of Alabama, Tuscaloosa, AL, USA
| | - Yanyan Chen
- Endocrinology and Cardiovascular Diseases Center, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, China
| | - Guangwei Li
- Endocrinology and Cardiovascular Diseases Center, Fuwai Hospital, Chinese Academy of Medical Sciences, No. 167 North Lishi Road, Xicheng District, Beijing, China.
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214
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Chiu THT, Pan WH, Lin MN, Lin CL. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes 2018; 8:12. [PMID: 29549240 PMCID: PMC5856738 DOI: 10.1038/s41387-018-0022-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/03/2018] [Accepted: 01/29/2018] [Indexed: 01/29/2023] Open
Abstract
Background/objectives Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians—whose pathophysiology differ from Westerners—is unknown. We aim to investigate the association between a vegetarian diet, change in dietary patterns and diabetes risk in a Taiwanese Buddhist population. Methods We prospectively followed 2918 non-smoking, non-alcohol drinking Buddhists free of diabetes, cancer, and cardiovascular diseases at baseline, for a median of 5 years, with 183 incident diabetes cases confirmed. Diet was assessed through a validated food frequency questionnaire at baseline and a simple questionnaire during follow-ups. Incident cases of diabetes were ascertained through follow-up questionnaires, fasting glucose and HbA1C. Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes. Results Consistent vegetarian diet was associated with 35% lower hazards (HR: 0.65, 95% CI: 0.46, 0.92), while converting from a nonvegetarian to a vegetarian pattern was associated with 53% lower hazards (HR: 0.47, 95% CI: 0.30, 0.71) for diabetes, comparing with nonvegetarians while adjusting for age, gender, education, physical activity, family history of diabetes, follow-up methods, use of lipid-lowering medications, and baseline BMI. Conclusion Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese.
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Affiliation(s)
- Tina H T Chiu
- Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. No. 2, Min-Sheng Road, Dalin Town, Chiayi County, 622, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.,Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan
| | - Wen-Harn Pan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Address: 128 Sec. 2, Academia Road, Nankang, Taipei, 115, Taiwan
| | - Ming-Nan Lin
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. No. 2, Min-Sheng Road, Dalin Town, Chiayi County, 622, Taiwan. .,Department of Family Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan.
| | - Chin-Lon Lin
- Department of Internal Medicine, Hualien Tzu Chi Medical Center, Hualien, Taiwan. No. 707, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan.,Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan
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215
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Cai Y, Zeng T, Wen Z, Chen L. Ethnic Differences in Efficacy and Safety of Alogliptin: A Systematic Review and Meta-Analysis. Diabetes Ther 2018; 9:177-191. [PMID: 29264712 PMCID: PMC5801238 DOI: 10.1007/s13300-017-0352-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Alogliptin is a highly selective, potent, and orally available dipeptidyl peptidase-4 (DPP-4) inhibitor. This study compared the glucose-lowering efficacy and safety of alogliptin between Asian and non-Asian patients with type 2 diabetes. METHODS We systematically searched MEDLINE, EMBASE, Cochrane Library, and ISI Web of Science databases for articles published June 2017 and earlier in English. We identified randomized controlled trials (RCTs) of adults with type 2 diabetes that compared alogliptin with placebo as either monotherapy or add-on therapy. We divided subgroups by ethnicity, and compared the results of alogliptin use in Asian and non-Asian-dominant studies. RESULTS A total of 15 RCTs with 4456 patients with type 2 diabetes were included in this study. Alogliptin lowered glycated hemoglobin (HbA1c) to a much greater extent in Asian-dominant studies [- 0.75% (95% CI - 0.84 to - 0.65)] than in non-Asian-dominant studies [- 0.61% (95% CI - 0.68 to - 0.54)] (P = 0.02). The risk ratio of achieving HbA1c goal was larger in Asian-dominant studies [2.88 (95% CI 2.15-3.87)] than in non-Asian-dominant studies [1.93 (95% CI 1.55-2.41)] (P = 0.03). The postprandial blood glucose-lowering efficacy was higher in Asian-dominant studies [- 2.42 mmol/l (95% CI - 2.99 to - 1.85)] than in non-Asian-dominant studies [- 0.60 mmol/l (95% CI - 1.60 to 0.40)] (P = 0.002), while the fasting blood glucose and body weight changes were similar between the two subgroups. The incidence of adverse events, including hypoglycemia, nasopharyngitis, upper respiratory tract infection, headache, and diarrhea, were comparable between the two groups. CONCLUSIONS Alogliptin is more effective in improving glycemic levels in Asians than in other ethnic populations. Future studies are required to explore the potential mechanisms.
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Affiliation(s)
- Yuli Cai
- Department of Endocrinology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China
| | - Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Zhongyuan Wen
- Department of Endocrinology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China.
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China.
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216
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Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol 2018; 6:95-104. [PMID: 29195904 PMCID: PMC5805864 DOI: 10.1016/s2213-8587(17)30366-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex. METHODS We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting. FINDINGS We estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002. INTERPRETATION A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients. FUNDING NIHR and Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Bin Zhou
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James Bentham
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Mathematics, Statistics and Actuarial Science (SMSAS), University of Kent, Canterbury, UK
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
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217
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Chua J, Lim CXY, Wong TY, Sabanayagam C. Diabetic Retinopathy in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 2018; 7:3-16. [PMID: 29376231 DOI: 10.22608/apo.2017511] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR), the most common complication of diabetes mellitus, is the leading cause of new cases of blindness in middle-aged and elderly in the Asia-Pacific. It has been estimated that 51% of all those with blindness due to DR globally (n = 424,400) and 56% of those with visual impairment due to DR (2.1 million) come from the Asia-Pacific. Prevalence of DR among those with diabetes ranged from 10% in India to 43% in Indonesia within the Asia-Pacific. Awareness of DR among persons with diabetes ranged from 28% to 84%. Most common modifiable risk factors for DR in the Asia-Pacific were hyperglycemia, blood pressure, dyslipidemia, and obesity. Implementation of systematic screening programs for DR and advancement in telemedicine screening methods have increased patient coverage and cost-effectiveness, though there are still numerous factors impeding screening uptake in the low-middle income regions of the Asia-Pacific. Management and treatment of DR in the Asia-Pacific is mainly limited to traditional laser retinopexy, but it is suboptimal despite new clinical approaches such as use of intravitreal anti.vascular endothelial growth factor and steroids due to limited resources. Further research and data are required to structure a more cost-effective public healthcare program and more awareness-building initiatives to increase the effectiveness of DR screening programs.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Claire Xin Ying Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- University College Dublin, Dublin, Ireland
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore
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218
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Liu Y, Jin PP, Sun XC, Hu TT. Thiazolidinediones and risk of colorectal cancer in patients with diabetes mellitus: A meta-analysis. Saudi J Gastroenterol 2018; 24:75-81. [PMID: 29637913 PMCID: PMC5900477 DOI: 10.4103/sjg.sjg_295_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS A growing body of evidence has suggested that thiazolidinediones (TZDs) potentially reduce the risk of colorectal cancer (CRC). This study aimed to evaluate the effect of TZDs on CRC risk in patients with diabetes mellitus (DM). PATIENTS AND METHODS A systematic search of electronic databases was performed for studies evaluating the exposure to TZDs and reporting CRC risk in diabetic patients. Pooled estimates with 95% confidence intervals (CIs) were estimated using fixed or random effects models. RESULTS A total of 10 observational studies reporting more than 18,972 CRC cases in 2,470,768 DM patients were included. Meta-analysis showed a 9% reduction in CRC risk associated with TZDs use in all studies [relative risk (RR) =0.91, 95% CI = 0.84-0.99, P = 0.03] and cohort studies (RR = 0.89, 95% CI = 0.80-0.99, P = 0.04), respectively. However, such effect was not shown in case-control studies. In subgroup analyses, lower CRC risk was found in Asian population (RR = 0.40, 95% CI = 0.29-0.53, P = 0.00), and a trend toward lower CRC risk was observed in US population (RR = 0.94, 95% CI = 0.88-1.01, P = 0.08). CRC risk was significantly modified with non-pioglitazone TZD use (RR = 0.88, 95% CI = 0.82-0.95, P = 0.00), but not with pioglitazone use (RR = 0.95, 95% CI = 0.89-1.01, P = 0.11). No significant difference was observed with cancer site (colon or rectum). There was considerable inherent heterogeneity across studies, partly explained by study location. CONCLUSIONS This meta-analysis supports a protective association between TZDs use and CRC risk in patients with DM. Future well-designed prospective studies with larger cohorts would be needed to understand this association better.
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Affiliation(s)
- Yang Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Piao-Piao Jin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Xue-Cheng Sun
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Ting-Ting Hu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China,Address for correspondence: Dr. Ting-Ting Hu, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China. E-mail:
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Hypoglycaemia among Insulin-Treated Patients with Diabetes: Southeast Asia Cohort of IO HAT Study. J ASEAN Fed Endocr Soc 2018; 33:28-36. [PMID: 33442108 PMCID: PMC7784114 DOI: 10.15605/jafes.033.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To provide real-world data on hypoglycaemia incidence in patients with type 1 (T1D) or type 2 diabetes (T2D) from the Southeast Asian cohort of the International Operations Hypoglycaemia Assessment Tool (IO HAT) study. Methodology IO HAT was a non-interventional, multicentre, 6-month retrospective and 4-week prospective study of hypoglycaemic events among insulin-treated adults with T1D or T2D, including four countries in Southeast Asia (Singapore, Philippines, Indonesia, and Bangladesh). Data were collected using a two-part self-assessment questionnaire (SAQ1 for retrospective and SAQ2 for prospective). The primary endpoint was the percentage of patients experiencing at least one hypoglycaemic event during the 4-week prospective observational period (ClinicalTrials.gov Identifier: NCT02306681). Results A total of 2594 patients completed SAQ1. Nearly all patients reported experiencing any hypoglycaemic event in the 4-week prospective period (T1D, 100%; T2D, 97.3%), with all patients reporting higher rates in the prospective versus retrospective period. Severe hypoglycaemia was also reported higher prospectively (57.2% and 76.9%) than retrospectively (33.9% and 12.2%) in both T1D and T2D, respectively. Nocturnal hypoglycaemia was reported higher retrospectively than prospectively. Conclusion Incidence of any and severe hypoglycaemia in the Southeast Asian cohort of IO HAT was higher prospectively versus retrospectively, suggesting hypoglycaemia has previously been under-reported in this region.
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220
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National Differences in Remission of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery-Subgroup Analysis of 2-Year Results of the Diabetes Surgery Study Comparing Taiwanese with Americans with Mild Obesity (BMI 30-35 kg/m 2). Obes Surg 2017; 27:1189-1195. [PMID: 27783367 PMCID: PMC5403871 DOI: 10.1007/s11695-016-2433-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The purpose of this study is to compare effects of different nations on Roux-en-Y gastric bypass (RYGB) vs. intensive medical management (IMM) in achieving remission of type 2 diabetes mellitus (T2DM). Materials and Methods Between April 2008 and December 2011, this randomized, controlled clinical trial was conducted at four teaching hospitals in the United States and Taiwan involving 71 participants with mild obesity (BMI 30–35 kg/m2). Thirty-six of 71 participants were randomly assigned to the RYGB group, and the others were in IMM group. Partial or complete remission of T2DM was defined as blood HbA1c < 6.5 % (48 mmol/mol) or <6 % (42 mmol/mol) without any antihyperglycemic medication for at least 1-year duration, respectively. Results At baseline, Taiwanese participants had a lower BMI, younger age, and shorter duration of T2DM than American participants. At 24 months, weight loss was greater in the RYGB group in both populations than in the IMM group. No IMM participant of either population had partial or complete remission of T2DM. In the RYGB group, a substantial proportion of the subjects achieved complete or partial remission (57 % in Taiwanese and 27 % in American participants, P = 0.08). Logistic regression revealed stimulated C-peptide (Odds ratio 2.22, P = 0.02) but not nationality as a significant predictor of diabetes remission. Conclusion Adding RYGB to lifestyle and medical management was associated with a greater likelihood of remission of T2DM in both Taiwanese and American subjects with mild obesity with type 2 diabetes. Residual beta-cell function at baseline appears to be the major factor predicting remission of T2DM. Trial registry number: clinicaltrials.gov Identifier: NCT00641251
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α-Mangostin protects against high-glucose induced apoptosis of human umbilical vein endothelial cells. Biosci Rep 2017; 37:BSR20170779. [PMID: 29054969 PMCID: PMC5725610 DOI: 10.1042/bsr20170779] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022] Open
Abstract
Diabetic vascular complications result from high-glucose induced vascular endothelial cell dysfunction. There is an emerging need for novel drugs with vascular endothelial cell protective effects for the treatment of diabetic vascular complications. The present study aimed to investigate the protective effect of α-mangostin against high-glucose induced apoptosis of cultured human umbilical vein endothelial cells (HUVECs). HUVECs were treated with glucose to induce apoptosis. The expression of the apoptosis-related proteins, Bcl-2, Bax, and cleaved caspase-3, were detected by Western blotting. Ceramide concentration and acid sphingomyelinase (ASM) activity were assayed by HPLC. The cell apoptosis rate was detected by flow cytometry after staining with annexin V/propidium iodide (PI). Compared with HUVECs cultured in 5 mM glucose, cells cultured in 30 mM glucose exhibited a higher apoptosis rate, up-regulation of cleaved caspase-3 and Bax (proapoptotic proteins), down-regulation of Bcl-2 (anti-apoptotic protein), increased ceramide concentration, and enhanced ASM activity (all P<0.05). α-Mangostin (15 µM) significantly attenuated the high-glucose induced increase in apoptosis rate (8.64 ± 2.16 compared with 19.6 ± 3.54%), up-regulation of cleaved caspase-3 and Bax, down-regulation of Bcl-2, elevation of ceramide level, and enhancement of ASM activity (all P<0.05). The effects of desipramine were similar to those of α-mangostin. The protective effect of α-mangostin on high-glucose induced apoptotic damage may be mediated by an inhibition of ASM and thus a decreased level of ceramide.
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Zhang F, Tang L, Zhang Y, Lü Q, Tong N. Glucagon-like peptide-1 mimetics, optimal for Asian type 2 diabetes patients with and without overweight/obesity: meta-analysis of randomized controlled trials. Sci Rep 2017; 7:15997. [PMID: 29167470 PMCID: PMC5700049 DOI: 10.1038/s41598-017-16018-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/07/2017] [Indexed: 02/05/2023] Open
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are desirable for diabetes, especially in patients with overweight/obesity. We aimed to determine whether GLP-1RAs exhibit different glucose-lowering efficacies between Asian type 2 diabetes (T2D) patients with and without overweight/obesity. Randomized controlled trials were searched in EMBASE, MEDLINE, CENTRAL, and ClinicalTrials.gov. Studies published in English with treatment duration ≥12 weeks and information on HbA1c changes were included. The studies were divided into normal body mass index (BMI) and overweight/obese groups according to baseline BMI. Among 3190 searched studies, 20 trials were included in the meta-analysis. The standardized mean differences in HbA1c change, fasting glucose change, and postprandial glucose change were equivalent between normal BMI and overweight/obese studies (p > 0.05). The relative risk of HbA1c < 6.5% target achievement in normal BMI trials (7.93; 95% confidence interval: 3.27, 19.20) was superior to that in overweight/obesity trials (2.23; 1.67, 2.97), with a significant difference (p = 0.020). Body weight loss (p = 0.572) and hypoglycemic risk(p = 0.920) were similar in the two groups. The glucose-lowering effects of GLP-1RAs were equivalent among Asian T2D patients. With their advantages for weight-loss or weight-maintenance, GLP-1RAs are optimal medicines for Asian T2D patients with and without overweight/obesity.
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Affiliation(s)
- Fang Zhang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lizhi Tang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuwei Zhang
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qingguo Lü
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Yap J, Singh GD, Kim JS, Soni K, Chua K, Neo A, Koh CH, Armstrong EJ, Waldo SW, Shunk KA, Low RI, Hong MK, Jang Y, Yeo KK. Outcomes of primary percutaneous coronary intervention in acute myocardial infarction due to unprotected left main thrombosis: The Asia-Pacific Left Main ST-Elevation Registry (ASTER). J Interv Cardiol 2017; 31:129-135. [DOI: 10.1111/joic.12466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Jonathan Yap
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Gagan D. Singh
- University of California Davis Medical Center; Sacramento CA
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Krishan Soni
- University of California; San Francisco and VA Medical Center; San Francisco CA
| | - Kelvin Chua
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Alvin Neo
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | - Choong Hou Koh
- Department of Cardiology; National Heart Centre Singapore; Singapore
| | | | | | - Kendrick A. Shunk
- University of California; San Francisco and VA Medical Center; San Francisco CA
| | - Reginald I. Low
- University of California Davis Medical Center; Sacramento CA
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Khung Keong Yeo
- Department of Cardiology; National Heart Centre Singapore; Singapore
- University of California Davis Medical Center; Sacramento CA
- Duke-NUS Medical School; Singapore
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Cai W, Qiu C, Zhang H, Chen X, Zhang X, Meng Q, Wei J. Detection of circulating natural antibodies to inflammatory cytokines in type-2 diabetes and clinical significance. JOURNAL OF INFLAMMATION-LONDON 2017; 14:24. [PMID: 29142506 PMCID: PMC5674864 DOI: 10.1186/s12950-017-0171-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/28/2017] [Indexed: 12/14/2022]
Abstract
Background Inflammatory cytokines have been demonstrated to be involved in developing insulin resistance and type-2 diabetes (T2D). Natural antibodies in the circulation have protective effects on common diseases in humans. The present study was thus designed to test the hypothesis that natural antibodies against inflammatory cytokines could be associated with T2D. Methods An enzyme-linked immunosorbent assay (ELISA) was developed in-house to detect plasma IgG against peptide antigens derived from interleukin 1α (IL1α), IL1β, IL6, IL8 and tumor necrosis factor-α (TNF-α) in 200 patients with T2D and 220 control subjects. Results Binary regression showed that compared with control subjects, T2D patients had a decreased level of plasma anti-IL6 IgG (adjusted r2=0.034, p=0.0001), anti-IL8 IgG (adjusted r2=0.021, p=0.002) and anti-TNF-α IgG (adjusted r2=0.017, p=0.003). Female patients mainly contributed to decreased levels of anti-IL6 IgG (adjusted r2=0.065, p=0.0008) and anti-IL8 IgG (adjusted r2=0.056, p=0.003), while male patients mainly contributed to decreased anti-TNF-α IgG levels (adjusted r2=0.024, p=0.005). ROC curve analysis revealed a sensitivity of 16.5% against specificity of 95.5% for anti-IL6 IgG assay and a sensitivity of 19.5% against specificity of 95.9% for anti-IL8 IgG assay. Glycated hemoglobin levels measured after 6-month glucose-lowering treatment appeared to be inversely correlated with plasma anti-IL1α IgG (r=-0.477, df=17, p=0.039) and anti-IL6 IgG (r=-0.519, df=17, p=0.023) although such correlation failed to survive the Bonferroni correction. Conclusions Deficiency of natural IgG against inflammatory cytokines is likely to be a risk factor for T2D development and detection of such antibodies may be useful for personalized treatment of the disease. Electronic supplementary material The online version of this article (10.1186/s12950-017-0171-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weiyi Cai
- Laboratory for Nursing Science & Institute of Laboratory Medicine, Guangdong Medical University, No.1 Xincheng Road, Dongguan, 523808 China
| | - Cailing Qiu
- Dalang Hospital of Dongguan, Dongguan, 523000 China
| | - Hongyu Zhang
- The Second Hospital, Jilin University, Changchun, 130041 China
| | | | - Xuan Zhang
- The Second Hospital, Jilin University, Changchun, 130041 China
| | - Qingyong Meng
- Laboratory for Nursing Science & Institute of Laboratory Medicine, Guangdong Medical University, No.1 Xincheng Road, Dongguan, 523808 China
| | - Jun Wei
- Division of Health Research, University of the Highlands & Islands, Centre for Health Science, Perth Road, Inverness, IV2 3JH UK
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225
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Sharma R, Matharoo K, Kapoor R, Bhanwer AJS. Association of PGC-1α gene with type 2 diabetes in three unrelated endogamous groups of North-West India (Punjab): a case-control and meta-analysis study. Mol Genet Genomics 2017; 293:317-329. [PMID: 29063962 DOI: 10.1007/s00438-017-1385-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
PGC-1α (Peroxisome proliferator-activated receptor gamma, coactivator 1 alpha) plays a key role in glucose homeostasis inside liver and muscle. The impact of six polymorphisms of PGC-1α with Type 2 Diabetes (T2D) susceptibility was evaluated on 1125 samples comprising of 554 T2D cases and 571 controls among three endogamous groups (Bania, Brahmin and Jat Sikh) of North-West India (Punjab). Single-locus analysis showed a significant differential pattern of genetic association of PGC-1α among studied groups emphasizing the role of ethnicity towards disease susceptibility. Haplotypes G-A-G-G-C-C in Bania group; G-G-G-G-C-A in Brahmin; G-A-A-G-T-C, G-G-G-G-T-C in Jat Sikh groups conferred ~ two to fivefold increased T2D risk. Intriguingly, the haplotype combination G-A-G-G-C-C provided T2D risk in Banias whereas it played a protective role in Brahmins reflecting the role of ethnic heterogeneity. In the secondary structure prediction of mRNA, slight free energy change along with structural changes was observed between the wild and variant allele of rs3736265, rs8192678 and rs2970847 loci. Meta-analyses conducted on rs8192678 and rs2970847 variants illustrated the overall effect of minor alleles providing a higher risk for the T2D development. Divergence in genetic variants and haplotype combinations associated with T2D risk among studied groups is inferred from the present dataset, which strongly highlights the combinatorial effect of diverse ethnic background of the population under study with genetics towards susceptibility to complex diseases like T2D.
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Affiliation(s)
- Rubina Sharma
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Kawaljit Matharoo
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India.
| | - Rohit Kapoor
- Heart Station and Diabetes Clinic, Amritsar, India
| | - A J S Bhanwer
- Department of Human Genetics, Guru Nanak Dev University, Amritsar, Punjab, India
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Ariyanti AD, Sisjayawan J, Zhang J, Zhang JQ, Wang GX, Miyagishi M, Wu SR, Kasim V. Elevating VEGF-A and PDGF-BB secretion by salidroside enhances neoangiogenesis in diabetic hind-limb ischemia. Oncotarget 2017; 8:97187-97205. [PMID: 29228603 PMCID: PMC5722555 DOI: 10.18632/oncotarget.21907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/23/2017] [Indexed: 12/30/2022] Open
Abstract
Hind-limb ischemia (HLI) is one of the major complication of diabetic patients. Angiogenesis potential in diabetic patients is severely disrupted, and the mechanism underlying it has not been fully elucidated, making it an obstacle for developing an efficient therapeutic angiogenesis strategy. Skeletal muscle cells, through their paracrine function, had been known to be critical for neoangiogenesis. Here we found that hyperglycemia upregulates the expression of skeletal muscle cells prolyl hydroxylase domain 3 (PHD3), which resulted in the decrease of the secretion of angiogenic factors, especially VEGF-A and PDGF-BB. We showed that treatment with salidroside, a small molecule drug, significantly suppresses PHD3 expression and increases VEGF-A and PDGF-BB secretion from skeletal muscle cells, which in turn enhances the proliferation and migration potentials of endothelial and smooth muscle cells. Finally, we demonstrated that intramuscular injection of salidroside into the ischemic hind limbs of diabetic HLI model mice could efficiently induce neoangiogenesis and blood perfusion recovery. Thus, our novel findings not only reveal the effects of hyperglycemia on the angiogenesis potential of skeletal muscle cells and the mechanism underlying it, but also provides a novel finding suggesting that salidroside might be a potential small molecule drug for diabetic HLI.
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Affiliation(s)
- Agnes Dwi Ariyanti
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Julita Sisjayawan
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Jing Zhang
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Jian-Qi Zhang
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Gui-Xue Wang
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Makoto Miyagishi
- Molecular Composite Medicine Research Group, Biomedical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba 305-8566, Japan
| | - Shou-Rong Wu
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Vivi Kasim
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
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227
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Tan KHX, Barr ELM, Koshkina V, Ma S, Kowlessur S, Magliano DJ, Söderberg S, Chia KS, Zimmet P, Lim WY. Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius. J Diabetes 2017; 9:855-864. [PMID: 27778460 DOI: 10.1111/1753-0407.12497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/11/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Asia is experiencing a type 2 diabetes epidemic, but prevalence differs by ethnicity and level of socioeconomic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes. METHODS Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardized diabetes and obesity prevalence. Modified Breslow-Cox proportional hazard models were used to obtain rate ratios for diabetes risk factors. RESULTS In Singapore, the age-standardized prevalence of diabetes remained stable for Chinese (men: 14% in 1992, 13% in 2010; women: 12% in 1992, 10% in 2010), but increases were observed for South Asians (men: 20% in 1992, 26% in 2010; women: 18% in 1992, 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians regardless of country. CONCLUSIONS Despite different socioeconomic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries.
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Affiliation(s)
- Kristin H X Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Elizabeth L M Barr
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Wellbeing and Preventable Chronic Disease Division Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Vira Koshkina
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health Singapore, Singapore, Singapore
| | - Sudhir Kowlessur
- Non-Communicable Diseases and Health Promotion Division, Ministry of Health and Quality of Life, Port Louis, Mauritius
| | - Dianna J Magliano
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Paul Zimmet
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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228
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Ning G, Bandgar T, Hehnke U, Lee J, Chan JCN. Efficacy and Safety of Linagliptin in 2681 Asian Patients Stratified by Age, Obesity, and Renal Function: A Pooled Analysis of Randomized Clinical Trials. Adv Ther 2017; 34:2150-2162. [PMID: 28819835 PMCID: PMC5599450 DOI: 10.1007/s12325-017-0595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 12/21/2022]
Abstract
Introduction Asian patients with type 2 diabetes (T2D) are younger, leaner, and more likely to develop renal dysfunction than White populations. In this multiethnic analysis of data from phase 3 trials, we investigated the efficacy and safety of the dipeptidyl peptidase-4 inhibitor linagliptin in Asians stratified by these subphenotypes. Methods Data from randomized, double-blind, placebo-controlled trials evaluating linagliptin (as monotherapy, add-on therapy to metformin ± sulfonylurea, combined with pioglitazone or added to insulin) were pooled with efficacy data from 11 randomized trials of at least 24 weeks and safety data from 15 trials of various durations. Results In the efficacy set, 1404 Asian patients received linagliptin [mean (standard deviation) age 54.5 (10.1) years; body mass index (BMI) 26.0 (3.9) kg/m2] and 661 received placebo [age 55.0 (9.7) years; BMI 26.1 (3.9) kg/m2] with the same glycated hemoglobin (HbA1c): 8.2 (0.9)% in both groups. At 24 weeks, the placebo-corrected adjusted mean ± standard error change from baseline in HbA1c with linagliptin was −0.73 ± 0.04% (95% confidence interval −0.81, −0.65; P < 0.0001). Reductions in HbA1c were similar upon stratification by age [<65 years, −0.71 ± 0.05% (−0.80, −0.62; P < 0.0001); ≥65 years, −0.81 ± 0.10% (−1.01, −0.60; P < 0.0001)], BMI (<25 kg/m2, −0.82 ± 0.06% [−0.94, −0.70; P < 0.0001]; ≥25 kg/m2, −0.65 ± 0.06% [−0.76, −0.54; P < 0.0001]) and estimated glomerular filtration rate [<90 mL/min/1.73 m2, −0.71 ± 0.06% (−0.82, −0.60; P < 0.0001); ≥90 mL/min/1.73 m2, −0.75 ± 0.06% (−0.87, −0.64; P < 0.0001)]. In the safety set (linagliptin, n = 1842; placebo, n = 839), 52.2% and 54.6% of patients, respectively, experienced adverse events. The rates of drug-related adverse events were 10.9% in the linagliptin group and 10.4% in the placebo group. The respective rates of hypoglycemia were 8.3% and 9.5%, mainly among patients treated with sulfonylurea or insulin. Severe hypoglycemia was rare (<1.0% in either group). Conclusion Linagliptin effectively reduced hyperglycemia in Asian patients with uncontrolled T2D, irrespective of age, BMI, renal function, or ethnic subgroups, and was well tolerated. Funding Boehringer Ingelheim, Eli Lilly and Company, and the Diabetes Alliance. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0595-7) contains supplementary material, which is available to authorized users.
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Thomson N, Worsley A, Wang W, Sarmugam R, Pham Q, Februhartanty J. Country context, personal values and nutrition trust: Associations with perceptions of beverage healthiness in five countries in the Asia Pacific region. Food Qual Prefer 2017. [DOI: 10.1016/j.foodqual.2017.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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230
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Wijesuriya M, Fountoulakis N, Guess N, Banneheka S, Vasantharajah L, Gulliford M, Viberti G, Gnudi L, Karalliedde J. A pragmatic lifestyle modification programme reduces the incidence of predictors of cardio-metabolic disease and dysglycaemia in a young healthy urban South Asian population: a randomised controlled trial. BMC Med 2017; 15:146. [PMID: 28851373 PMCID: PMC5576225 DOI: 10.1186/s12916-017-0905-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/29/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5-40 years with risk factors for T2DM. METHODS This was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. We individually randomised 4672 participants at risk of T2DM, of whom 3539 (mean age 22.5 (range 6-40 years, 48% males) received either trimonthly (P-LSM n = 1726) or 12-monthly (C-LSM n = 1813) peer educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. RESULTS During a median follow-up of 3 years, the cumulative incidence of the primary endpoint was n = 479 in P-LSM (74 per 1000 person years) vs. 561 in C-LSM (96 per 1000 person years), with an incident rate ratio (IRR) of 0.89 (95% CI 0.83-0.96, P = 0.02). In post hoc analyses, new onset dysglycaemia (T2DM, IFG and IGT), was the major contributor to the composite and was significantly reduced by P-LSM (IRR 0.9, 95% CI 0.83-0.97, P = 0.01). A significant impact of P-LSM on the incidence of the composite endpoint was noted in 1725 participants (P-LSM n = 850, C-LSM n = 875) aged below 18; P-LSM n = 140 (48 per 1000 person years) versus C-LSM n = 174 (55.4 per 1000 person years), with an IRR of 0.83 (95% CI 0.73-0.94, P = 0.004). CONCLUSIONS In a young at-risk South-Asian population, a pragmatic LSM programme significantly reduces the incidence of predictors of cardio-metabolic disease. Our results highlight the importance of early intervention in young at-risk subjects. TRIAL REGISTRATION World Health Organization international clinical trial registry platform ( SLCTR/2008/003 ). Registration Date: March 28, 2008. Retrospectively registered.
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Affiliation(s)
| | - Nikolaos Fountoulakis
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Nicola Guess
- Diabetes and Nutritional Sciences Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | | | | | - Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College, London, UK
| | - Giancarlo Viberti
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Luigi Gnudi
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK
| | - Janaka Karalliedde
- Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK.
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231
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Jacobs B, Men C, Bigdeli M, Hill PS. Limited understanding, limited services, limited resources: patients' experiences with managing hypertension and diabetes in Cambodia. BMJ Glob Health 2017; 2:e000235. [PMID: 29291130 PMCID: PMC5717921 DOI: 10.1136/bmjgh-2016-000235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Health system responses to the emergence of non-communicable diseases (NCDs) in many Southeast Asian nations, Cambodia included, have been insufficient. Little is known about how people suffering from such conditions behave in constrained contexts. We examined the experience of patients with NCDs as they seek care for their conditions and manage them. METHODS In-depth interviews with 28 purposively selected patients with hypertension and/or diabetes using an interview guide to capture the trajectory followed by interviewees from the development and recognition of symptoms to adherence to treatment. A general outline of major topics to be discussed was used instead of a predetermined list of specific questions. RESULTS All interviewees had experienced symptoms for a substantial period of time, sometimes many years, before being diagnosed. Initial treatment focused on symptoms instead of underlying conditions, often at considerable financial cost. Following diagnosis, many struggled to take medicines daily for their condition and adhering to the required behaviour changes. Many resorted to complementary medicine. Lack of financial resources was a common reason to discontinue treatment. Many reported loss of income and assets such as livestock and productive land and increasingly relied on others. CONCLUSION In order to assist people with NCDs in Cambodia, there is a need for a multipronged approach focusing on communities and healthcare providers. Information campaigns could focus on the timely recognition by communities of symptoms indicative of the conditions, together with instigating demand for routine screening at qualified health providers. Peer support is considerable, and locally adjusted approaches based on this principle should be considered.
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Affiliation(s)
- Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
| | | | - Maryam Bigdeli
- Department for Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Peter S Hill
- Department of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Liu C, Zhang X, Liu C, Ewen M, Zhang Z, Liu G. Insulin prices, availability and affordability: a cross-sectional survey of pharmacies in Hubei Province, China. BMC Health Serv Res 2017; 17:597. [PMID: 28836974 PMCID: PMC5571633 DOI: 10.1186/s12913-017-2553-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Poor access to affordable insulin results in serious and needless complications and premature deaths for those with diabetes who need this essential medicine. To help address this issue, we assessed insulin availability, prices, affordability and price components in Hubei Province as China has the heaviest burden of diabetes globally. METHODS In 2016, insulin availability and price data was collected in the capital and five other cities. A total of 30 public sector outlets (hospitals and primary care institutions) and 30 private pharmacies were sampled, using an adaptation of the World Health Organization/Health Action International methodology, Data was collected for all human and analogue insulins in stock, then analyzed by type (prandial, basal or pre-mixed) and duration of action. Prices were expressed as Median Price Ratios (MPRs) to Australian PBS prices. Price components were tracked for five insulin products in two cities.. Affordability was assessed as the number of days' wages of the lowest paid unskilled government worker needed to purchase 10 ml 100 IU/ml (approximately 30 days' supply). RESULTS Mean availability was highest in public hospitals for prandial (70%), basal (80%) and pre-mixed insulin (90%). In primary care institutions and private pharmacies mean availability ranged from 10% to 33%. Median prices of all insulin types were higher that Australian PBS prices in all three sectors for human and analogue insulins (ranging from1.36-2.59 times). Patients have to pay 4 to 16 days' wages to purchase a month's treatment depending on the insulin type and sector. The largest component of the patient price was the manufacturers' selling price (60%). Taxes in the form of import duties and VAT are applied in some sectors. CONCLUSIONS The availability of insulin in primary care institutions and private retail pharmacies was very low in Hubei. Only public hospitals had good insulin availability. Insulin prices were high in all sectors making this life-saving medicine unaffordable, especially for those on low incomes. Governments should consider using its bargaining power to reduce prices, abolish taxes on essential medicines such as insulin, and develop strategies for more equitable access to insulin.
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Affiliation(s)
- Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province China
| | - Chaojie Liu
- China Health Program, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, VIC 3086 Australia
| | - Margaret Ewen
- Health Action International, Overtoom 60-2hg, Amsterdam, 1054 HK The Netherlands
| | - Zinan Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province China
| | - Guoqin Liu
- School of Management, Zunyi Medical University, No.201 Dalian Road, Zunyi, Guizhou Province China
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Sequeira IR, Poppitt SD. Unfolding Novel Mechanisms of Polyphenol Flavonoids for Better Glycaemic Control: Targeting Pancreatic Islet Amyloid Polypeptide (IAPP). Nutrients 2017; 9:E788. [PMID: 28754022 PMCID: PMC5537902 DOI: 10.3390/nu9070788] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes (T2D) is characterised by hyperglycaemia resulting from defective insulin secretion, insulin resistance, or both. The impact of over-nutrition and reduced physical activity, evidenced by the exponential rise in obesity and the prevalence of T2D, strongly supports the implementation of lifestyle modification programs. Accordingly, an increased consumption of fruits and plant-derived foods has been advocated, as their intake is inversely correlated with T2D prevalence; this has been attributed, in part, to their contained polyphenolic compounds. Over the last decade, a body of work has focussed on establishing the mechanisms by which polyphenolic compounds exert beneficial effects to limit carbohydrate digestion, enhance insulin-mediated glucose uptake, down-regulate hepatic gluconeogenesis and decrease oxidative stress; the latter anti-oxidative property being the most documented. Novel effects on the inhibition of glucocorticoid action and the suppression of amylin misfolding and aggregation have been identified more recently. Amyloid fibrils form from spontaneously misfolded amylin, depositing in islet cells to elicit apoptosis, beta cell degeneration and decrease insulin secretion, with amyloidosis affecting up to 80% of pancreatic islet cells in T2D. Therefore, intervening with polyphenolic compounds offers a novel approach to suppressing risk or progression to T2D. This review gives an update on the emerging mechanisms related to dietary polyphenol intake for the maintenance of glycaemic control and the prevention of T2D.
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Affiliation(s)
- Ivana R Sequeira
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
- High-Value Nutrition National Science Challenge, Auckland 1142, New Zealand.
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
- High-Value Nutrition National Science Challenge, Auckland 1142, New Zealand.
- Department of Medicine, University of Auckland, Auckland 1142, New Zealand.
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234
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New-onset diabetes in HIV-treated adults: predictors, long-term renal and cardiovascular outcomes. AIDS 2017; 31:1535-1543. [PMID: 28398958 DOI: 10.1097/qad.0000000000001496] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART). DESIGN Prospective study conducted between July 1996 and 30 April 2015. METHODS A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126 mg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus. RESULTS During a median follow-up of 9 years (16 274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25 kg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, P = 0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, P = 0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60 ml/min/1.73 m) (15.3 vs. 1.9%, P < 0.001) over total follow-up. CONCLUSION In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essential.
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Kim G, Oh S, Jin SM, Hur KY, Kim JH, Lee MK. The efficacy and safety of adding either vildagliptin or glimepiride to ongoing metformin therapy in patients with type 2 diabetes mellitus. Expert Opin Pharmacother 2017; 18:1179-1186. [PMID: 28714741 DOI: 10.1080/14656566.2017.1353080] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the effects of either vildagliptin or glimepiride on glycemic variability, oxidative stress, and endothelial parameters in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone. METHODS In this randomized, open-label, parallel study, 34 patients with T2DM being treated with metformin having an HbA1c of 7.0-10.0% were allocated into either the vildagliptin or glimepiride group. A mixed-meal tolerance test and 72-hour continuous glucose monitoring were conducted, and urinary 8-iso-prostaglandinF2α (PGF2α) and endothelial-dependent flow-mediated dilatation (FMD) were evaluated at baseline and after 12 weeks of treatment. RESULTS Similar significant improvements in HbA1c level were shown in both vildagliptin (-0.8%) and glimepiride (-0.9%) groups after treatment (Ps<0.001). The mean amplitude of glycemic excursions (MAGE) and the mean of daily differences (MODD) were significantly decreased by vildagliptin (P = 0.044 and P = 0.031, respectively) but not by glimepiride. Glimepiride was significantly associated with a higher incidence of hypoglycemia than vildagliptin (P = 0.005). There were no significant differences in urinary 8-iso-PGF2α or FMD between the two groups. CONCLUSIONS Vildagliptin effectively improved glucose level with a significantly greater reduction in glycemic variability and hypoglycemia than glimepiride in patients with T2DM ongoing metformin therapy. The two drugs showed no significant differences in urinary 8-iso-PGF2α and FMD. TRIAL REGISTRATION NCT01404676.
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Affiliation(s)
- Gyuri Kim
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Sewon Oh
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Sang-Man Jin
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Kyu Yeon Hur
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Jae Hyeon Kim
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Moon-Kyu Lee
- a Division of Endocrinology and Metabolism, Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
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Sheu WH, Ji L, Lee WJ, Jabbar A, Han JH, Lew T. Efficacy and safety of premixed insulin analogs in Asian patients with type 2 diabetes: A systematic review. J Diabetes Investig 2017; 8:518-534. [PMID: 27930869 PMCID: PMC5497049 DOI: 10.1111/jdi.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/23/2016] [Accepted: 11/27/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION The primary aim of this systematic review was to provide an overview of the efficacy and safety of premixed insulin analogs in Asians, specifically East Asians, with type 2 diabetes. MATERIAL AND METHODS The MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases were searched from 1 January 1995 to 26 November 2015. Randomized controlled trials involving East Asians with type 2 diabetes treated with any premixed insulin analog were included. Major comparator treatments were basal insulin and basal-bolus insulin. Comparisons were also made between East Asian and Caucasian patients. The primary efficacy outcome was glycated hemoglobin change from baseline to end-point. The primary safety outcome was the incidence of hypoglycemia. RESULTS A total of 21 studies were included; most (n = 14) were carried out in China or Japan. The duration of treatment ranged from 12 to 48 weeks. The glycated hemoglobin mean/least squares mean change from baseline to end-point after treatment with premixed insulin analogs ranged from -0.12 to -4.2% (improvement was generally more pronounced with insulin initiation vs intensification). The incidence of hypoglycemia ranged from 8.3 to 72.0% in most studies, with the variability reflecting the definition of hypoglycemia used. Efficacy and safety outcomes for premixed insulin analogs were generally similar to those for basal or basal-bolus insulin. Limited evidence suggests that dosing, efficacy and safety profiles might differ slightly between East Asian and Caucasians receiving premixed insulin analogs. CONCLUSIONS These results support the current use of premixed insulin analogs for managing East Asian patients with type 2 diabetes.
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Affiliation(s)
- Wayne H‐H Sheu
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- College of MedicineNational Defense Medical CenterTaipeiTaiwan
| | - Linong Ji
- Department of EndocrinologyPeking University People's HospitalBeijingChina
| | - Woo Je Lee
- Department of Internal MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | | | | | - Thomas Lew
- Eli Lilly and Company (Taiwan) Inc.TaipeiTaiwan
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237
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Yoon S, Cho H, Kim J, Lee DW, Kim GH, Hong YS, Moon S, Park S, Lee S, Lee S, Bae S, Simonson DC, Lyoo IK. Brain changes in overweight/obese and normal-weight adults with type 2 diabetes mellitus. Diabetologia 2017; 60:1207-1217. [PMID: 28447116 DOI: 10.1007/s00125-017-4266-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/01/2017] [Indexed: 01/21/2023]
Abstract
AIMS/HYPOTHESIS Overweight and obesity may significantly worsen glycaemic and metabolic control in type 2 diabetes. However, little is known about the effects of overweight and obesity on the brains of people with type 2 diabetes. Here, we investigate whether the presence of overweight or obesity influences the brain and cognitive functions during early stage type 2 diabetes. METHODS This study attempted to uncouple the effects of overweight/obesity from those of type 2 diabetes on brain structures and cognition. Overweight/obese participants with type 2 diabetes had more severe and progressive abnormalities in their brain structures and cognition during early stage type 2 diabetes compared with participants with normal weight. Relationships between each of these measures and disease duration were also examined. RESULTS Global mean cortical thickness was lower in the overweight/obese type 2 diabetes group than in the normal-weight type 2 diabetes group (z = -2.96, p for group effect = 0.003). A negative correlation was observed between disease duration and global mean white matter integrity (z = 2.42, p for interaction = 0.02) in the overweight/obese type 2 diabetes group, but not in the normal-weight type 2 diabetes group. Overweight/obese individuals with type 2 diabetes showed a decrease in psychomotor speed performance related to disease duration (z = -2.12, p for interaction = 0.03), while normal-weight participants did not. CONCLUSIONS/INTERPRETATION The current study attempted to uncouple the effects of overweight/obesity from those of type 2 diabetes on brain structures and cognition. Overweight/obese participants with type 2 diabetes had more severe and progressive abnormalities in brain structures and cognition during early stage type 2 diabetes compared with normal-weight participants.
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Affiliation(s)
- Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hanbyul Cho
- The Brain Institute, University of Utah, Salt Lake City, UT, USA
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Do-Wan Lee
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
| | - Geon Ha Kim
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
| | - Young Sun Hong
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sohyeon Moon
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sunho Lee
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Interdisciplinary Program in Neurosciences, Seoul National University, Seoul, South Korea
| | - Suji Lee
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sujin Bae
- Department of Psychiatry, Chung Ang University Hospital, Seoul, South Korea
| | - Donald C Simonson
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, South Korea.
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea.
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea.
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238
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Nishikawa E, Oakley L, Seed PT, Doyle P, Oteng-Ntim E. Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK. PLoS One 2017. [PMID: 28640854 PMCID: PMC5480876 DOI: 10.1371/journal.pone.0179332] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes. Study design Analysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy. Results The prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women. Conclusions This study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.
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Affiliation(s)
- Erin Nishikawa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Oakley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Paul T. Seed
- Women's Health Academic Centre, King’s College London, London, United Kingdom
| | - Pat Doyle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eugene Oteng-Ntim
- Department of Women's Health, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Xiao D, Chenhong W, Yanbin X, Lu Z. Gestational diabetes mellitus and first trimester pregnancy-associated plasma protein A: A case-control study in a Chinese population. J Diabetes Investig 2017; 9:204-210. [PMID: 28387061 PMCID: PMC5754543 DOI: 10.1111/jdi.12672] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/17/2017] [Accepted: 04/03/2017] [Indexed: 12/30/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the relationship between pregnancy-associated plasma protein A (PAPP-A) and gestational diabetes mellitus (GDM), and to determine whether PAPP-A has improved value for predicting GDM in a Chinese population. MATERIALS AND METHODS Clinical data for 599 GDM patients and 986 unaffected pregnant women undergoing both antenatal examinations and delivery were retrospectively analyzed. First-trimester serum PAPP-A levels were compared between the groups. Binary logistic regression analysis was used to explore the risk factors for GDM, and the area under the receiver operating characteristic curve was used to determine the value of PAPP-A for predicting GDM. RESULTS GDM-affected and unaffected pregnant women were significantly different in terms of age (P < 0.001), BMI (P < 0.001), family history of diabetes (P = 0.002), α-thalassemia trait (P < 0.01), parity (P < 0.001), conception methods (P < 0.001), gestational weeks at the time of labor (P < 0.001) and corrected PAPP-A multiples of the median values (P < 0.001). Binary logistic regression analysis showed that PAPP-A levels were negatively related to the subsequent development of GDM (odds ratio 0.798, 95% confidence interval 0.647-0.984). The area under the receiver operating characteristic curve for maternal factors was 0.684 (95% CI: 0.657-0.711), and did not significantly differ from that for the combination of maternal factors and serum PAPP-A levels, which was 0.686 (95% CI: 0.660-0.713; χ2 = 0.625, P = 0.429). CONCLUSIONS Serum PAPP-A was an independent factor for the development of GDM in pregnant Chinese women. Serum-PAPP-A does not have improved value with respect to predicting GDM when combined with other maternal factors.
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Affiliation(s)
- Di Xiao
- Department of Obstetrics and Gynecology, Maternal and Child Healthcare Hospital of Shenzhen City, Southern Medical University, Shenzhen, Guangdong, China
| | - Wang Chenhong
- Department of Obstetrics and Gynecology, Maternal and Child Healthcare Hospital of Shenzhen City, Southern Medical University, Shenzhen, Guangdong, China
| | - Xu Yanbin
- Department of Obstetrics and Gynecology, Maternal and Child Healthcare Hospital of Shenzhen City, Southern Medical University, Shenzhen, Guangdong, China
| | - Zhou Lu
- Department of Obstetrics and Gynecology, Maternal and Child Healthcare Hospital of Shenzhen City, Southern Medical University, Shenzhen, Guangdong, China
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Sabanayagam C, Yip W, Gupta P, Mohd Abdul RBB, Lamoureux E, Kumari N, Cheung GCM, Cheung CY, Wang JJ, Cheng CY, Wong TY. Singapore Indian Eye Study-2: methodology and impact of migration on systemic and eye outcomes. Clin Exp Ophthalmol 2017; 45:779-789. [DOI: 10.1111/ceo.12974] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Charumathi Sabanayagam
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Centre for Quantitative Medicine; Duke-NUS Medical School; Singapore
| | - Wanfen Yip
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
| | | | - Ecosse Lamoureux
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Neelam Kumari
- Department of Ophthalmology and Visual Sciences; Khoo Teck Puat Hospital; Hong Kong
| | - Gemmy CM Cheung
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences; Chinese University of Hong Kong Eye Centre; Hong Kong
| | - Jie Jin Wang
- Centre for Vision Research; University of Sydney; New South Wales Australia
| | - Ching-Yu Cheng
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program; Duke-NUS Medical School; Singapore
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Akhter J, Ahmed A, Mawani M, Lakhani L, Kalsekar A, Tabassum S, Islam N. Patterns, control and complications of diabetes from a hospital based registry established in a low income country. BMC Endocr Disord 2017; 17:30. [PMID: 28583113 PMCID: PMC5460467 DOI: 10.1186/s12902-017-0179-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 05/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes registry enables practitioners to measure the characteristics and patterns of diabetes across their patient population. They also provide insight into practice patterns which can be very effective in improving care and preventing complications. The aim of this study was to assess the patterns, control levels and complications at the baseline of the patients attending clinic at the large tertiary care hospital in Karachi, Pakistan with the help of the registry. This can be used as a reference to monitor the control and also for a comparison between peer groups. METHODS This was a cross sectional study with the data obtained from diabetes registry collected with the help of pre-designed questionnaire. HbA1c was used as a central diabetes measure and other related factors and complications were assessed with it. RESULTS Only 16.6% of the participants had optimal HbA1c ≤ 7.0%. 52.9% of the patients were classified as having poor control defined by HbA1c of >8%. Three fourth of the study population were obese according to Asian specific BMI cutoffs and majority had type 2 diabetes with duration of diabetes ranging from less than one to about 35 years, mean(SD) duration being 7.6 years (7.1). Overall only 4% of the patients were on combine target of HbA1c, LDL and BP. Results of multivariable logistic regression showed that the odds of having optimal glycemic control increased by 3% with every one year increase in age. In addition, having longer duration of diabetes was associated with 56% lower odds of having good glycemic control. Moreover, having higher triglyceride levels was associated with 1% lower odds of having good glycemic control. CONCLUSION This highlights the large burden of sub optimally controlled people with diabetes in Pakistani population, a low income country with huge diabetes prevalence and ineffective primary health care system creating enormous health and economic burden.
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Affiliation(s)
- Jaweed Akhter
- SETMA Diabetes Center, Beaumont, TX USA
- Aga Khan University, Karachi, Pakistan
| | - Asma Ahmed
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
- Endocrine & Diabetes Section, Department of Medicine, The Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi, 74800 Pakistan
| | - Minaz Mawani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ayaz Kalsekar
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Shehla Tabassum
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Najmul Islam
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Echeverria SE, Mustafa M, Pentakota SR, Kim S, Hastings KG, Amadi C, Palaniappan L. Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014. Prev Med 2017; 99:222-227. [PMID: 28219784 DOI: 10.1016/j.ypmed.2017.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 12/24/2016] [Accepted: 02/17/2017] [Indexed: 12/17/2022]
Abstract
Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m2 and Asian-specific cut points (BMI≥25kg/m2) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.
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Affiliation(s)
- Sandra E Echeverria
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Mehnaz Mustafa
- New Jersey Department of Health and Human Services, United States
| | - Sri Ram Pentakota
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NY, United States.
| | - Soyeon Kim
- Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NY, United States.
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
| | - Chioma Amadi
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Latha Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
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Unnikrishnan R, Pradeepa R, Joshi SR, Mohan V. Type 2 Diabetes: Demystifying the Global Epidemic. Diabetes 2017; 66:1432-1442. [PMID: 28533294 DOI: 10.2337/db16-0766] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023]
Abstract
Type 2 diabetes (T2D) has attained the status of a global pandemic, spreading from affluent industrialized nations to the emerging economies of Asia, Latin America, and Africa. There is significant global variation in susceptibility to T2D, with Pacific Islanders, Asian Indians, and Native Americans being considerably more prone to develop the disorder. Although genetic factors may play a part, the rapidity with which diabetes prevalence has risen among these populations reflects the far-ranging and rapid socioeconomic changes to which they have been exposed over the past few decades. Traditionally, obesity and its correlate, insulin resistance, have been considered the major mediators of T2D risk; however, recent evidence shows that early loss of β-cell function plays an important role in the pathogenesis of T2D, especially in nonobese individuals such as South Asians. Knowledge of the modifiable risk factors of T2D is important, as it forms the basis for designing cost-effective preventive and therapeutic strategies to slow the epidemic in populations at increased risk. Lessons learned from randomized prevention trials need to be implemented with appropriate cultural adaptations, accompanied by empowerment of the community, if the diabetes epidemic is to be slowed or halted.
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Affiliation(s)
- Ranjit Unnikrishnan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes and WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, Chennai, India
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244
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Chen Y, Wu F, Saito E, Lin Y, Song M, Luu HN, Gupta PC, Sawada N, Tamakoshi A, Shu XO, Koh WP, Xiang YB, Tomata Y, Sugiyama K, Park SK, Matsuo K, Nagata C, Sugawara Y, Qiao YL, You SL, Wang R, Shin MH, Pan WH, Pednekar MS, Tsugane S, Cai H, Yuan JM, Gao YT, Tsuji I, Kanemura S, Ito H, Wada K, Ahn YO, Yoo KY, Ahsan H, Chia KS, Boffetta P, Zheng W, Inoue M, Kang D, Potter JD. Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium. Diabetologia 2017; 60:1022-1032. [PMID: 28265721 PMCID: PMC5632944 DOI: 10.1007/s00125-017-4229-z] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS The aims of the study were to evaluate the association between type 2 diabetes and the risk of death from any cancer and specific cancers in East and South Asians. METHODS Pooled analyses were conducted of 19 prospective population-based cohorts included in the Asia Cohort Consortium, comprising data from 658,611 East Asians and 112,686 South Asians. HRs were used to compare individuals with diabetes at baseline with those without diabetes for the risk of death from any cancer and from site-specific cancers, including cancers of the oesophagus, stomach, colorectum, colon, rectum, liver, bile duct, pancreas, lung, breast, endometrium, cervix, ovary, prostate, bladder, kidney and thyroid, as well as lymphoma and leukaemia. RESULTS During a mean follow-up of 12.7 years, 37,343 cancer deaths (36,667 in East Asians and 676 in South Asians) were identified. Baseline diabetes status was statistically significantly associated with an increased risk of death from any cancer (HR 1.26; 95% CI 1.21, 1.31). Significant positive associations with diabetes were observed for cancers of the colorectum (HR 1.41; 95% CI 1.26, 1.57), liver (HR 2.05; 95% CI 1.77, 2.38), bile duct (HR 1.41; 95% CI 1.04, 1.92), gallbladder (HR 1.33; 95% CI 1.10, 1.61), pancreas (HR 1.53; 95% CI 1.32, 1.77), breast (HR 1.72; 95% CI 1.34, 2.19), endometrium (HR 2.73; 95% CI 1.53, 4.85), ovary (HR 1.60; 95% CI 1.06, 2.42), prostate (HR 1.41; 95% CI 1.09, 1.82), kidney (HR 1.84; 95% CI 1.28, 2.64) and thyroid (HR 1.99; 95% CI 1.03, 3.86), as well as lymphoma (HR 1.39; 95% CI 1.04, 1.86). Diabetes was not statistically significantly associated with the risk of death from leukaemia and cancers of the bladder, cervix, oesophagus, stomach and lung. CONCLUSIONS/INTERPRETATION Diabetes was associated with a 26% increased risk of death from any cancer in Asians. The pattern of associations with specific cancers suggests the need for better control (prevention, detection, management) of the growing epidemic of diabetes (as well as obesity), in order to reduce cancer mortality.
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Affiliation(s)
- Yu Chen
- Department of Population Health, New York University School of Medicine, 650 First Avenue, Room 510, New York, NY, 10016, USA.
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo Park, NY, 10987, USA.
| | - Fen Wu
- Department of Population Health, New York University School of Medicine, 650 First Avenue, Room 510, New York, NY, 10016, USA
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo Park, NY, 10987, USA
| | - Eiko Saito
- AXA Department of Health and Human Security, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yingsong Lin
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Minkyo Song
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hung N Luu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Akiko Tamakoshi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Woon-Puay Koh
- Duke-NUS Medical School Singapore, Singapore, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Yong-Bing Xiang
- Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yasutake Tomata
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Kemmyo Sugiyama
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chisato Nagata
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yumi Sugawara
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - You-Lin Qiao
- Cancer Foundation of China, Beijing, People's Republic of China
| | - San-Lin You
- School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
- Big Data Research Centre, Fu-Jen Catholic University, Taipei, Taiwan
| | - Renwei Wang
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | | | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jian-Min Yuan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Division of Cancer Control and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Yu-Tang Gao
- Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Ichiro Tsuji
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Seiki Kanemura
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Hidemi Ito
- Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Keiko Wada
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yoon-Ok Ahn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Young Yoo
- Armed Forces Capital Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Manami Inoue
- AXA Department of Health and Human Security, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - John D Potter
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Centre for Public Health Research, Massey University, Wellington, New Zealand
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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245
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Kim G, Lee YH, Lee BW, Kang ES, Lee IK, Cha BS, Kim DJ. Diabetes self-assessment score and the development of diabetes: A 10-year prospective study. Medicine (Baltimore) 2017; 96:e7067. [PMID: 28591043 PMCID: PMC5466221 DOI: 10.1097/md.0000000000007067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To verify that the Korean Diabetes Score (KDS), a self-assessment, predicts the risk of diabetes in various comprehensive risk models, and to investigate factors that enhance its predictive ability in a large cohort. We analyzed 8735 adults without diabetes in the Korean Genome and Epidemiology Study, an ongoing large community-based 10-year cohort study. Incident diabetes was defined as fasting blood glucose ≥126 mg/dL or postload 2-hour glucose ≥200 mg/dL by 75 g oral glucose tolerance test conducted biennually, or currently taking medication for diabetes. Hazard ratios (HRs) using Cox regression were calculated for relative risk of developing diabetes as associated with the KDS, and performance of risk models was assessed by area under the receiver-operating characteristic curve (AUC). Of 8735 participants, 1497 (17.1%) developed diabetes over 10 years. The prevalence of incident diabetes was 10.3% in people with a KDS <5 and was 21.8% in those with KDS ≥5 (P < .001). Increasing KDS was significantly associated with developing diabetes (adjusted HR: 1.13; 95% confidence interval:1.09,1.18). The comprehensive prediction model with KDS added to fasting glucose, glycated hemoglobin, postload 2-hour glucose, and triglyceride showed a markedly higher AUC (0.782) compared to KDS alone (0.641). A low insulinogenic index (IGI) level, but not insulin resistance, was a significant determinant of developing diabetes in subjects who had baseline KDS < 5. We confirmed that KDS as a 10-year risk model to predict diabetes becomes more potent when added to relevant laboratory parameters. Beta-cell function as assessed by IGI should be taken into account when predicting diabetes using the KDS.
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Affiliation(s)
- Gyuri Kim
- Department of Internal Medicine, Yonsei University College of Medicine
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul
| | - Yong-ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul
| | - In-Kyu Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
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246
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Aftab H, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC, Christensen DL. Comparative study of HbA 1c and fasting plasma glucose vs the oral glucose tolerance test for diagnosis of diabetes in people with tuberculosis. Diabet Med 2017; 34:800-803. [PMID: 28326618 DOI: 10.1111/dme.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
Abstract
AIM To compare HbA1c and fasting plasma glucose assessment, with the 2-h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis. METHODS Individuals (N=268) with newly diagnosed smear-positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA1c and ≥7.0mmol/l for fasting plasma glucose. RESULTS The proportion of participants diagnosed with diabetes was 4.9% (n =13) by oral glucose tolerance test, while 11.9% (n =32) and 14.6% (n =39) were diagnosed with diabetes using HbA1c and fasting plasma glucose criteria, respectively. The area under the receiver-operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests (P=0.07). CONCLUSIONS HbA1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA1c may be a more reliable test in individuals with transient hyperglycaemia.
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Affiliation(s)
- H Aftab
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Ambreen
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - M Jamil
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - P Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - J H Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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247
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Ito Y, Ambe K, Kobayashi M, Tohkin M. Ethnic Difference in the Pharmacodynamics-efficacy Relationship of Dipeptidyl Peptidase-4 Inhibitors Between Japanese and non-Japanese Patients: A Systematic Review. Clin Pharmacol Ther 2017; 102:701-708. [PMID: 28378919 DOI: 10.1002/cpt.692] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/16/2017] [Accepted: 03/14/2017] [Indexed: 12/29/2022]
Abstract
A systematic review of the differences in the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors between Japanese and non-Japanese subjects was conducted. We searched for randomized controlled trials in patients with type 2 diabetes mellitus (T2DM) that studied the intervention of a DPP-4 inhibitor once-daily vs. placebo, as monotherapy or as add-on therapy. Data regarding placebo-corrected HbA1c reduction and trough DPP-4 inhibition rate after ≥12 weeks' treatment were extracted. In the 12 eligible studies, linear regression analysis revealed that the hemoglobin A1c (HbA1c) reduction at each DPP-4 inhibition level was larger in studies involving Japanese patients than in studies involving non-Japanese patients, with statistical significance between the two groups (P < 0.0001). Sensitivity analysis excluding studies of add-on therapies supported the robustness of the result. Our study indicated that DPP-4 inhibitors show greater efficacy in Japanese patients than in non-Japanese patients, which may be an important consideration in the global development strategy of new diabetic medications.
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Affiliation(s)
- Y Ito
- Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - K Ambe
- Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - M Kobayashi
- Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
| | - M Tohkin
- Department of Regulatory Science, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
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248
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Faster eating rates are associated with higher energy intakes during an ad libitum meal, higher BMI and greater adiposity among 4·5-year-old children: results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort. Br J Nutr 2017; 117:1042-1051. [PMID: 28462734 DOI: 10.1017/s0007114517000848] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Faster eating rates are associated with increased energy intake, but little is known about the relationship between children's eating rate, food intake and adiposity. We examined whether children who eat faster consume more energy and whether this is associated with higher weight status and adiposity. We hypothesised that eating rate mediates the relationship between child weight and ad libitum energy intake. Children (n 386) from the Growing Up in Singapore Towards Healthy Outcomes cohort participated in a video-recorded ad libitum lunch at 4·5 years to measure acute energy intake. Videos were coded for three eating-behaviours (bites, chews and swallows) to derive a measure of eating rate (g/min). BMI and anthropometric indices of adiposity were measured. A subset of children underwent MRI scanning (n 153) to measure abdominal subcutaneous and visceral adiposity. Children above/below the median eating rate were categorised as slower and faster eaters, and compared across body composition measures. There was a strong positive relationship between eating rate and energy intake (r 0·61, P<0·001) and a positive linear relationship between eating rate and children's BMI status. Faster eaters consumed 75 % more energy content than slower eating children (Δ548 kJ (Δ131 kcal); 95 % CI 107·6, 154·4, P<0·001), and had higher whole-body (P<0·05) and subcutaneous abdominal adiposity (Δ118·3 cc; 95 % CI 24·0, 212·7, P=0·014). Mediation analysis showed that eating rate mediates the link between child weight and energy intake during a meal (b 13·59; 95 % CI 7·48, 21·83). Children who ate faster had higher energy intake, and this was associated with increased BMI z-score and adiposity.
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249
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Kasuga Y, Hata K, Tajima A, Ochiai D, Saisho Y, Matsumoto T, Arata N, Miyakoshi K, Tanaka M. Association of common polymorphisms with gestational diabetes mellitus in Japanese women: A case-control study. Endocr J 2017; 64:463-475. [PMID: 28202837 DOI: 10.1507/endocrj.ej16-0431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gestational diabetes (GDM) and type 2 diabetes (T2DM) share part of pathomechanism and several T2DM susceptibility genes are demonstrated to be associated with GDM. No information on the genetics of GDM, however, was available in Japanese women. In this study, T2DM risk variants (45 single nucleotide polymorphisms [SNPs] from 36 genes) identified in previous studies were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in a cohort of 171 Japanese women with GDM and 128 normal glucose tolerance (NGT) diagnosed by the new International Association of Diabetes in Pregnancy Study Group criteria. Of 45 SNPs, three genetic variants were nominally associated with the development of GDM: rs266729 (p = 0.013, odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.10-2.23) in ADIPOQ, rs10811661 (p = 0.035, OR: 1.46, 95% CI: 1.03-2.08) in CDKN2A/2B, and rs9505118 (p = 0.046, OR: 1.41, 95% CI: 1.01-1.97) in SSR1-RREB1. There was a significant difference in the number of risk alleles of three variants between women with GDM and NGT (3.79 ± 1.33 vs. 3.05 ± 1.41, p = 6.0 × 10-6). In combined analysis of three genetic variants, women with five or more risk alleles had a 7.32-fold increased risk of GDM (p = 5.6 × 10-5, 95% CI: 4.54-11.96), compared with those having no more than one risk allele. Our results suggest several risk variants of T2DM had cumulative effects on the development of GDM in Japanese women.
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Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo 157-8583, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo 157-8583, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tadashi Matsumoto
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoko Arata
- Department of Women's Health, National Center for Child Health and Development, Tokyo 157-8583, Japan
| | - Kei Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
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250
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Kerrison G, Gillis RB, Jiwani SI, Alzahrani Q, Kok S, Harding SE, Shaw I, Adams GG. The Effectiveness of Lifestyle Adaptation for the Prevention of Prediabetes in Adults: A Systematic Review. J Diabetes Res 2017; 2017:8493145. [PMID: 28567425 PMCID: PMC5439262 DOI: 10.1155/2017/8493145] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/26/2017] [Indexed: 01/01/2023] Open
Abstract
Diabetes prevalence is increasing exceptionally worldwide and with this come associated healthcare costs. The primary outcome of this systematic review was to assess glycaemic control and incidence of Type 2 diabetes mellitus (T2DM) diagnosis after exercise and dietary intervention (measured with any validated scale). The secondary outcome assessed body mass index change, weight change, and physical exercise capacity after diet and exercise intervention (measured with any validated scale). 1,780 studies were identified from searching electronic databases. Relevant studies went through a selection process. The inclusion criteria for all studies were people with prediabetes diagnosed by either impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Lifestyle adaptation reduced the incidence of diabetes development more than standard treatment. Furthermore, better glycaemic control, improved physical exercise capacity, and increased weight reduction were observed with lifestyle intervention over standard treatment. Finally, improvements over the long term deteriorated, highlighting problems with long-term adherence to lifestyle changes. Overall, cumulative incidence of diabetes is drastically reduced in the intervention groups compared to control groups (standard care). Furthermore, glycaemic control was improved in the short term, with many participants reverting to normoglycaemia.
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Affiliation(s)
- George Kerrison
- School of Health Sciences, Faculty of Medicine South Block, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
| | - Richard B. Gillis
- School of Health Sciences, Faculty of Medicine South Block, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
| | - Shahwar I. Jiwani
- School of Health Sciences, Faculty of Medicine South Block, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
| | - Qushmua Alzahrani
- School of Health Sciences, Faculty of Medicine South Block, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
| | - Samil Kok
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
- Department of Food Engineering, Faculty of Engineering & Architecture, Abant İzzet Baysal University, Gölköy, 14280 Bolu, Turkey
| | - Stephen E. Harding
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
| | - Ian Shaw
- Faculty of Medicine and Health Sciences, University Park, University of Nottingham, Nottingham NG7 2RD, UK
| | - Gary G. Adams
- School of Health Sciences, Faculty of Medicine South Block, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
- University of Nottingham, Sutton Bonington Campus, NCMH Building, Sutton Bonington, Leicestershire LE12 5RD, UK
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