Monitoring in the diabetic clinic

Left ventricular mass and correlated atherosclerotic risk factors in young adolescents: report from Chin-Shan community cardiovascular study in Taiwan

Various subclinical disease indicators can be used as an early stage marker of atherosclerosis. Left ventricular (LV) mass has been related to cardiovascular morbidity and mortality. The distribution of LV mass in Chinese is rarely studied and nothing is known about its relationships with various atherosclerotic risk factors in young teenagers, in particular, aspects of lipid profiles. We performed a community-based survey of 523 males and 555 females, aged 12-15, in Chin-Shan, a suburb area near Taipei, Taiwan. LV mass was calculated from the Penn convention. Normalized LV mass by height with power of 2.7 was defined. LV mass and normalized LV mass were significantly greater in males than in females. There were significant positive correlation coefficients between LV mass and age, blood pressure, body mass index, low density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) B, fasting insulin levels and significant negative correlation coefficients between LV mass and high density lipoprotein cholesterol (HDL-C) and Apo A1 level in both genders. Multiple linear regression models showed gender and body mass index (BMI) were important factors associated with LV mass or normalized values for adolescents. Age and systolic blood pressure were also significant predictors of LV mass, but not of normalized LV mass values. LV mass values were found to be negatively associated with HDL-C values at marginal statistically significant level. Age and BMI are the most significant factors of echocardiographic LV mass distributions in young adolescent in Taiwan. LV mass may also be associated with atherosclerotic risk factors.

Hyperinsulinemia and Related Atherosclerotic Risk Factors in the Population at Cardiovascular Risk: A Community-based Study

Background: A population-based study was conducted in Taiwan to investigate the prevalence of insulin resistance and high serum insulin concentrations and their relationships with potential atherosclerotic risk factors.

Methods: We studied 2165 subjects, ages >35, from a community cohort.

Results: The distributions of fasting insulin were skewed to the right, with higher concentrations in women than in men. As age increased, insulin increased in women, but decreased in men. As fasting insulin concentrations increased, postloading insulin, glucose, blood pressure, body mass index, waist-to-hip ratio, total cholesterol, triglycerides, LDL-cholesterol, apoprotein B, plasminogen activator inhibitor 1, tissue plasminogen activator, and fibrinogen increased, but lipoprotein(a), HDL-cholesterol, and apoprotein A1 decreased. Multiple logistic regression showed that obesity, high LDL-cholesterol, and low HDL-cholesterol were significant predictors of hyperinsulinemic status.

Conclusion: The study subjects with insulin resistance syndrome and related risk factors may be at risk for atherosclerosis, thrombosis, and other coronary heart diseases.

Lipoprotein (a) level in the population in Taiwan: relationship to sociodemographic and atherosclerotic risk factors

To examine the lipoprotein(a) (Lp(a)) level in the Taiwanese population and its association with cardiovascular risk factors, 1703 men and 1899 women aged 35 years and above were enrolled in a community-based study cohort established between 1990 and 1991. The distributions of Lp(a) levels were skewed to the right, and females were more likely than males to have Lp(a) levels greater than 30 mg/dl (14.3% versus 11.6%, P < 0.05). The Lp(a) level increased with age. Socioeconomic status did not seem to have consistent influence on the level of Lp(a). Smoking and alcohol use also had no effect on Lp(a) levels. Multivariate analysis indicated that older age and high level of low-density-lipoprotein cholesterol corresponded to an elevated Lp(a) level, while hypertriglyceridemia, low high-density-lipoprotein cholesterol level, obesity and high insulin resistance corresponded to a lower Lp(a) level. In univariate analysis, hyperinsulinemia was negatively associated with Lp(a) level (-0.107, P < 0.01) only in males. In females, use of oral contraceptive lowered Lp(a) levels, but menopause did not change Lp(a) levels. We also found that different correlation patterns existed for selected coagulation profiles between sexes. There was a significant correlation between Lp(a) and fibrinogen levels in males (0.154, P < 0.001) but not in females (0.007, P > 0.05). These data provided clues for investigating atherosclerotic risk factors and coagulation parameters for the Taiwanese population.

Random blood glucose estimation in type 2 diabetes: does it reflect overall glycaemic control?

The relationship between clinic-measured random blood glucose and glycated haemoglobin was investigated in 204 non-insulin-dependent diabetic patients to determine the value of random blood glucose on management decisions in these patients. Treatment was with diet alone in 104 patients (51%: Group 1), and diet and oral hypoglycaemic agents in 100 patients (49%: Group 2). Random blood glucose and glycated haemoglobin were lower in Group 1 than Group 2 (10.9 +/- 4.0 vs 13.0 +/- 4.0 mmol l-1, p < 0.001, and 8.5 (7.8-10.2) vs 9.6 (8.1-11.0)%, p < 0.01, respectively), and there was a positive correlation between random blood glucose and glycated haemoglobin in both groups (rGroup1 = 0.76, and rGroup2 = 0.54, both p < 0.001). In Group 1, 48 (46%) patients had a random blood glucose < 10 mmol l-1 and all but 2 of these had a glycated haemoglobin of < 10%. Thus, random blood glucose < 10 mmol l-1 was 96% sensitive for glycated haemoglobin < 10%. In Group 2 the same sensitivity was 92%. These data suggest that clinic-measured random blood glucose levels below 10.0 mmol l-1 predict acceptable overall glycaemic control in non-insulin-dependent diabetic patients, particularly in those on diet alone. However, a clinic-measured random blood glucose above 10 mmol l-1 was of limited value in predicting glycated haemoglobin values above 10% and a blood glucose cut-off of 14 mmol l-1 appeared more useful. Where resources are limited, clinic random blood glucose estimation may allow clinicians to use glycated haemoglobin measurements more discriminately.

Within-clinic glycosylated haemoglobin measurement

The performance of the Diamat HPLC analyser (Bio Rad Instruments) was assessed, and the effect of this on-site HbA1 assay on the therapeutic decisions made at the diabetic clinic evaluated. The intra-assay CV for HbA1 at concentrations of 8.3 and 13.4% was 3.8 and 0.4%, respectively, with inter-assay CV of 5.0 and 3.0%. On a single day 82 HbA1 tests on consecutive patients were performed at the clinic. In 43 insulin-treated patients and 79 non-insulin-treated diabetic patients the HbA1 result changed the management decision in 25 and 18% of patients, respectively. The relationship between HbA1 and self blood glucose monitoring (SBGM) results in the previous 6-week period were also evaluated. In 41% of patients with insulin-treated diabetes who produced SBGM diaries there was a discrepancy between categories of blood glucose control, all of these patients having better SBGM than HbA1 values. This study highlights the feasibility and value of a within-clinic HbA1 assay for clinical decision-making and its usefulness in identifying problems of agreement with self-monitored tests.