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Huang SJ, Zhang Y, Wang GH, Lu J, Chen PP, Zhang JX, Li XQ, Yuan BY, Liu XQ, Jiang TT, Wang MY, Liu WT, Ruan XZ, Liu BC, Ma KL. Deposition of platelet-derived microparticles in podocytes contributes to diabetic nephropathy. Int Urol Nephrol 2023; 55:355-366. [PMID: 35931920 DOI: 10.1007/s11255-022-03332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in the developed world. Podocyte injury is a critical cellular event involved in the progression of DN. Our previous studies demonstrated that platelet-derived microparticles (PMPs) mediated endothelial injury in diabetic rats. This study aimed to investigate whether PMPs are deposited in podocytes and to assess their potential effects on podocyte injury in DN. METHODS The deposition of PMPs in podocytes was assessed by immunofluorescent staining and electron microscopy. The changes in renal pathology and ultra-microstructure were assessed by periodic acid-Schiff staining and electron microscopy, respectively. The expression of inflammatory cytokines and extracellular matrix proteins was measured by immuno-histochemical staining and western blot. RESULTS PMPs were widely deposited in podocytes of glomeruli in diabetic patients and animal models and closely associated with DN progression. Interestingly, aspirin treatment significantly inhibited the accumulation of PMPs in the glomeruli of diabetic rats, alleviated mesangial matrix expansion and fusion of foot processes, and decreased the protein expression of inflammatory cytokines and extracellular matrix secretion. An in vitro study further confirmed the deposition of PMPs in podocytes. Moreover, PMP stimulation induced the phenotypic transition of podocytes through decreased podocin protein expression and increased protein expression of α-SMA and fibronectin, which was correlated with increased production of inflammatory cytokines. CONCLUSION Our findings demonstrated for the first time that the deposition of PMPs in podocytes contributed to the development of DN.
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Affiliation(s)
- Si Jia Huang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yang Zhang
- Renal Department, Nanjing First Hospital, Nanjing, 210006, China
| | - Gui Hua Wang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Jian Lu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Pei Pei Chen
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Jia Xiu Zhang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Xue Qi Li
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Ben Yin Yuan
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Xiao Qi Liu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Ting Ting Jiang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Meng Ying Wang
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Wen Tao Liu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Xiong Zhong Ruan
- John Moorhead Research Laboratory, Department of Renal Medicine, University College London (UCL) Medical School, Royal Free Campus, London, NW3 2PF, UK
| | - Bi Cheng Liu
- Institute of Nephrology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Kun Ling Ma
- Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Gan J, Zheng Y, Yu Q, Zhang Y, Xie W, Shi Y, Yu N, Yan Y, Lin Z, Yang H. Serum Lipocalin-2 Levels Are Increased and Independently Associated With Early-Stage Renal Damage and Carotid Atherosclerotic Plaque in Patients With T2DM. Front Endocrinol (Lausanne) 2022; 13:855616. [PMID: 35547005 PMCID: PMC9081837 DOI: 10.3389/fendo.2022.855616] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Diabetic nephropathy (DN), one of the major complications of diabetes mellitus, is the major cause of end-stage renal failure that finally increases the risk of cardiovascular disease and mortality. The aim of this study is to explore the relationship between serum lipocalin-2 (LCN-2) levels and DN and carotid atherosclerotic plaque (CAP) in patients with type 2 diabetes mellitus (T2DM). METHODS We have performed a prospective study of 749 T2DM patients with or without DN. Blood samples were collected and used to test serum LCN-2 levels, renal function, as well as biochemical parameters. CAP in these subjects was determined by ultrasonography. RESULTS In these 749 subjects with T2DM, an increased morbidity of CAP was observed in T2DM patients with DN as compared with those without this complication (P < 0.05). Interestingly, serum LCN-2 levels were significantly increased in T2DM patients with DN or CAP compared with T2DM alone [97.71 (71.49-130.13) vs. 77.29 (58.83-115.05) ng/ml, P < 0.001]. In addition, serum LCN-2 levels in T2DM patients with DN and CAP were significantly higher than that of T2DM patients with DN or CAP [131.37 (101.43-182.04) vs. 97.71(71.49-130.13) ng/ml, P < 0.001]. Furthermore, serum LCN-2 levels were positively correlated with hemoglobin A1c, systolic blood pressure, hypertension, CAP, and DN, as well as renal function factors including uric acid, creatinine, the estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio, respectively (P < 0.05), but negatively correlated with HDL-c (P < 0.05). The multinomial logistic regression analysis showed that serum LCN-2 was independently associated with DN and CAP in patients with T2DM after the adjustment for risk factors (P < 0.001). CONCLUSIONS Early-stage renal damage is a risk factor associated with the incidence of CAP in patients with T2DM. Serum LCN-2 is significantly increased and associated with early-stage renal damage and the incidence of CAP in patients with T2DM.
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Affiliation(s)
- Jing Gan
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Zheng
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongli Yu
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
| | - Yingchao Zhang
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
| | - Wei Xie
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
| | - Yaru Shi
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
| | - Ning Yu
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
| | - Yu Yan
- The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhuofeng Lin
- School of Pharmaceutical College, Wenzhou Medical University, Wenzhou, China
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Laboratory Animal Center of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Zhuofeng Lin, ; Hong Yang,
| | - Hong Yang
- The 3rd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Zhuofeng Lin, ; Hong Yang,
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Madrim MF, Ja'afar MH, Hod R. Prevalence of abnormal urinary cadmium and risk of albuminuria as a primary bioindicator for kidney problems among a healthy population. PeerJ 2021; 9:e12014. [PMID: 34466292 PMCID: PMC8380425 DOI: 10.7717/peerj.12014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background The prevalence of chronic kidney disease is increasing globally, ranking 27th as the cause of death in the 1990s, rising to 18th in 2010 and 10th in 2019. Non-communicable diseases such as diabetes and hypertension have been identified as the common contributing factors, while there is also evidence linking environmental pollutants, especially cadmium, to kidney disease. This study aimed at investigating the level of urinary cadmium and its relationship to albuminuria as an early indicator of kidney problems in the Kepong community. Methods Respondents were surveyed as part of several health-related programs organized by the Kepong District Health Office involving local communities in and around the district from April 2019 to December 2019. Urinalysis of two urine samples was carried out using a Mission reagent strip and an Inductively Coupled Plasma Mass Spectrometry (ICP-MS) test to detect the presence and level of urinary cadmium. Results A total of 240 respondents were enrolled from April 2019 to December 2019. Urinalysis of two urine samples was carried out using a Mission reagent strip and an Inductively Coupled Plasma Mass Spectrometry (ICP-MS) test to detect the level of urinary cadmium. The respondents’ average age was 41-year-old (±13.23). Among them, 49.6% were male, 85.0% Malay, 5.8% Chinese and 8.3% Indian. 55.0% had background of tertiary, 39.6% secondary and 5.4% primary level of education. 52.1% were categorized in B40, 34.6% in M40 and 13.3% in T20 based on monthly household income category. 26.7% were hypertensive, 6.7% diabetic, 4.2% had dyslipidemia, 51.7% had urinary cadmium above the alert level, and 27.1% had albuminuria. Discussion Risk factors for albuminuria that have been identified are age with adjusted odds ratio (AOR) 3.53 (1.41–8.83; p < 0.05), highest educational level with AOR 2.18 (1.14–4.17; p < 0.05), diabetes with AOR 3.36 (1.07–10.52; p < 0.05), and urinary cadmium with AOR 4.72 (2.33–9.59; p < 0.001), with future screening programs placing greater attention to those at risk and further research is required to determine the cause of exposure to cadmium.
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Affiliation(s)
- Mohd Faizal Madrim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.,Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Hasni Ja'afar
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
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Natesan V, Kim SJ. Diabetic Nephropathy - a Review of Risk Factors, Progression, Mechanism, and Dietary Management. Biomol Ther (Seoul) 2021; 29:365-372. [PMID: 33888647 PMCID: PMC8255138 DOI: 10.4062/biomolther.2020.204] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) leads to many health problems like diabetic nephropathy (DN). One of the key factors for chronic kidney disease and end-stage renal disease (ESRD) is T2DM. Extensive work is being done to delineate the pathogenesis of DN and to extend possible remedies. This review is intended to understand the nature of DN risk factors, progression, effects of glycemic levels, and stages of DN. We also explored the novel diagnostic and therapeutic approaches for DN such as gene therapy and stem cell treatments.
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Affiliation(s)
- Vijayakumar Natesan
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608002, Tamilnadu, India
| | - Sung-Jin Kim
- Department of Pharmacology and Toxicology, Metabolic Diseases Research Laboratory, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
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Chan FL, Li YC, Chen XRC. Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors. BMC FAMILY PRACTICE 2021; 22:118. [PMID: 34148542 PMCID: PMC8215779 DOI: 10.1186/s12875-021-01455-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Therapeutic inertia (TI), defined as physicians' failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. METHODS This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients' demographic and clinical parameters and the working profile of the attending doctors were explored. Student's t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. RESULTS Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients' systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor's year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. CONCLUSIONS TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.
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Affiliation(s)
- Fu Leung Chan
- Department of Family Medicine and General Out-Patient Clinics, Kowloon Central Cluster, Hospital Authority, Rm 807, Block S, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
| | - Yim Chu Li
- Department of Family Medicine and General Out-Patient Clinics, Kowloon Central Cluster, Hospital Authority, Rm 807, Block S, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Xiao Rui Catherine Chen
- Department of Family Medicine and General Out-Patient Clinics, Kowloon Central Cluster, Hospital Authority, Rm 807, Block S, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Lin YK, Gao B, Liu L, Ang L, Mizokami-Stout K, Pop-Busui R, Zhang L. The Prevalence of Diabetic Microvascular Complications in China and the USA. Curr Diab Rep 2021; 21:16. [PMID: 33835284 DOI: 10.1007/s11892-021-01387-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Diabetes can lead to development of devastating microvascular complications, such as nephropathy, retinopathy, and peripheral sensory and autonomic neuropathy. While China and the USA both face the threat of this major public health challenge, the literature is limited in describing similarities and differences in the prevalence, and risk factors for the development, of diabetic microvascular complications between these two countries. RECENT FINDINGS The current review discusses the following: (1) the most recent evidence on prevalence of diabetic microvascular complications in China and the USA (including downtrends of diabetes retinopathy and neuropathy in the USA); (2) differences in patient risk factors of these complications; (3) challenges and current knowledge gaps (such as lacking national epidemiological data of diabetic complications in China); and (4) potential future clinical and research opportunities (including needs in diabetes evaluation and management in remote areas and standardization of methods in evaluating diabetic complications across countries). Diabetic microvascular complications remain to be health threats in both China and the USA. Further investigations are needed for comprehensive understanding and effect prevention and management of these complications.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Brehm Tower 5119, 1000 Wall Street, Ann Arbor, MI, USA.
| | - Bixia Gao
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Lili Liu
- Department of Medicine, Peking University First Hospital, Beijing, China
| | - Lynn Ang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Key Laboratory of Renal Disease, National Health Commission of the People's Republic of China, Beijing, China.
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
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Shahwan MJ, Gacem SA, Zaidi SK. Prevalence of Diabetic Nephropathy and associated risk factors among type 2 diabetes mellitus patients in Ramallah, Palestine. Diabetes Metab Syndr 2019; 13:1491-1496. [PMID: 31336511 DOI: 10.1016/j.dsx.2019.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
AIMS Albuminuria is an established marker for endothelial dysfunction and cardiovascular risk in diabetes and prediabetes. So we aimed to explore the prevalence of albuminuria (microalbuminuria and macroalbuminuria) in patients with type2 diabetes mellitus (DM) in the Palestinian community and to determine the association between albuminuria and other health care and biochemical indicators. MATERIALS AND METHODS A cross-sectional study was carried out at private health care center. A total of 550 diabetic patients aged 35 years and above with type 2 diabetes mellitus who attended the clinic from May 2017 through February 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS, version 23). RESULTS Out of the 550 patients recruited, the mean age and duration of diabetes were 57.8 years and 9.5 years, respectively. Approximately 62% were being managed by oral hypoglycemic agents alone, 4.3% by insulin alone, 31.7% were on a combination of oral hypoglycemic agents and insulin and slightly less than 2% were on dietary measures alone. The mean value for HbA1c was 7.71%. The overall prevalence of albuminuria among participants was found to be 34.6%; microalbuminuria (29.3%) and macroalbuminuria (5.3%). CONCLUSION Albuminuria is highly prevalent among Palestinian population with type 2 diabetes. This calls for early and universal screening of urinary albumin. There is also an urgent need for measures that target tight glycemic and optimal blood pressure control and the use of renin-angiotensin system blockade.
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Affiliation(s)
- Moyad Jamal Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates.
| | - Sabrina Ait Gacem
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Syed K Zaidi
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Saudi Arabia
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Yao L, Li J, Li L, Li X, Zhang R, Zhang Y, Mao X. Coreopsis tinctoria Nutt ameliorates high glucose-induced renal fibrosis and inflammation via the TGF-β1/SMADS/AMPK/NF-κB pathways. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:14. [PMID: 30630477 PMCID: PMC6327481 DOI: 10.1186/s12906-018-2410-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coreopsis tinctoria Nutt is an ethnomedicine widely used in Xinjiang, China. It is consumed as a herbal tea by local Uyghur people to treat high blood pressure and diarrhea. Our previous study confirmed that the ethyl acetate extract of Coreopsis tinctoria (AC) had a protective effect on diabetic nephropathy (DN) in an in vivo experiment. Here we aim to elucidate the protective mechanism of AC and marein, the main ingredient in Coreopsis tinctoria on renal fibrosis and inflammation in vitro under high glucose (HG) conditions. METHODS A HG-induced barrier dysfunction model in rat mesangial cells (HBZY-1) was established. The cells were exposed to AC and marein and/or HG for 24 h. Then, the renal protective effects of AC and marein via transforming growth factor-β1 (TGF-β1)/Smads, AMP-activated kinase protein (AMPK), and nuclear factor kappa beta (NF-κB) signaling were assessed. RESULTS Both AC and marein suppressed rat mesangial cell hyperplasia and significantly attenuated the expression of HG-disrupted fibrotic and inflammatory proteins in HBZY-1 cells. It was also confirmed that AC and marein remarkably attenuated HG-induced renal inflammation and fibrosis by regulating the AMPK, TGF-β1/Smads, and NF-κB signaling pathways. CONCLUSION These results indicated that AC and marein may delay the progression of DN, at least in part, by suppressing HG-induced renal inflammation and fibrosis. Marein may be one of the bioactive compounds in AC.
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Affiliation(s)
- Lan Yao
- College of Traditional Chinese Medicine, Xinjiang Medical University, No. 4 Liyushan Park, Urumuqi, 830011 China
| | - Jie Li
- College of Traditional Chinese Medicine, Xinjiang Medical University, No. 4 Liyushan Park, Urumuqi, 830011 China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, No. 88 Yuquan Road, Nankai District, Tianjing, 300000 China
| | - Linlin Li
- College of Basic Medicine, Xinjiang Medical University, No. 393 Xinyi Street, Urumuqi, 830011 China
| | - Xinxia Li
- Center of Analysis and Test, Xinjiang Medical University, No. 393 Xinyi Street, Urumuqi, 830011 China
| | - Rui Zhang
- College of Basic Medicine, Xinjiang Medical University, No. 393 Xinyi Street, Urumuqi, 830011 China
| | - Yujie Zhang
- College of Traditional Chinese Medicine, Xinjiang Medical University, No. 4 Liyushan Park, Urumuqi, 830011 China
| | - Xinmin Mao
- College of Traditional Chinese Medicine, Xinjiang Medical University, No. 4 Liyushan Park, Urumuqi, 830011 China
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Man REK, Gan ATL, Fenwick EK, Gupta P, Wong MYZ, Wong TY, Tan GSW, Teo BW, Sabanayagam C, Lamoureux EL. The Relationship between Generalized and Abdominal Obesity with Diabetic Kidney Disease in Type 2 Diabetes: A Multiethnic Asian Study and Meta-Analysis. Nutrients 2018; 10:nu10111685. [PMID: 30400648 PMCID: PMC6266073 DOI: 10.3390/nu10111685] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
This study examined the associations of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) with diabetic kidney disease (DKD) in a clinical sample of Asian patients with type 2 diabetes (T2DM); substantiated with a meta-analysis of the above associations. We recruited 405 patients with T2DM (mean (standard deviation (SD)) age: 58 (7.5) years; 277 (68.4%) male; 203 (50.1%) with DKD) from a tertiary care centre in Singapore. DKD was defined as urinary albumin-creatinine ratio >3.3 mg/mmoL and/or estimated glomerular filtration rate <60 mL/min/1.73 m2. All exposures were analysed continuously and categorically (World Health Organization cut-points for BMI and WC; median for WHR and WHtR) with DKD using stepwise logistic regression models adjusted for traditional risk factors. Additionally, we synthesized the pooled odds ratio of 18 studies (N = 19,755) in a meta-analysis of the above relationships in T2DM. We found that overweight and obese persons (categorized using BMI) were more likely to have DKD compared to under/normal weight individuals, while no associations were found for abdominal obesity exposures. In meta-analyses however, all obesity parameters were associated with increased odds of DKD. The discordance in our abdominal obesity findings compared to the pooled analyses warrants further validation via longitudinal cohorts.
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Affiliation(s)
- Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Alfred Tau Liang Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
| | - Eva Katie Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
| | - Mark Yu Zheng Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
- Singapore National Eye Centre, Singapore 168751, Singapore.
| | | | - Boon Wee Teo
- Department of Nephrology, University Medicine Cluster, National University Health System, Singapore 119074, Singapore.
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
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Wu Z, Jin T, Weng J. A thorough analysis of diabetes research in China from 1995 to 2015: current scenario and future scope. SCIENCE CHINA-LIFE SCIENCES 2018; 62:46-62. [DOI: 10.1007/s11427-018-9377-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
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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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Ahmad T, Ulhaq I, Mawani M, Islam N. Microalbuminuria in Type-2 Diabetes Mellitus; the tip of iceberg of diabetic complications. Pak J Med Sci 2017; 33:519-523. [PMID: 28811763 PMCID: PMC5510095 DOI: 10.12669/pjms.333.12537] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine the prevalence of microalbuminuria and its association with hypertension and other diabetic complications among Type-2 diabetic patients attending at Aga Khan University Hospital Karachi. METHODS 1280 Type-2 diabetes patients who visited the outpatient department of Aga Khan University Hospital from September 2014 to August 2016 were included in the study. Microalbuminuria was diagnosed if spot urinary microalbumin excretion was confirmed to be more than 20mg/l. Hypertension was diagnosed if BP >140/90 or already on antihypertensive medications. Other demographic, clinical and laboratory data were also recorded. RESULTS Microalbuminuria was diagnosed in 404(31.56%) patients and among these albuminuric patients 335(82.9%) had hypertension. They were also dyslipidemic, having raised triglyceride levels, lower HDL levels, with more prevalence of background diabetic retinopathy and peripheral neuropathy. They also showed higher HbA1C levels and longer duration of diabetes. CONCLUSION The prevalence of the microalbuminuria in our patients with Type-2 diabetes is 31.56% and is not only an early sign of diabetic nephropathy but also a host of other diabetic complications and should be dealt early with strict control of their hyperglycemia and hypertension to help prevent the future complications.
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Affiliation(s)
- Tauseef Ahmad
- Dr. Tauseef Ahmad, FCPS. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Imran Ulhaq
- Dr. Imran Ulhaq, FCPS. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Minaz Mawani
- Minaz Mawani, M.Sc. (Epidemiology and Biostatistics). Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Dr. Najmul Islam, FRCP. Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Kuwata H, Okamura S, Hayashino Y, Tsujii S, Ishii H. Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15). PLoS One 2017; 12:e0172890. [PMID: 28257419 PMCID: PMC5336240 DOI: 10.1371/journal.pone.0172890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/10/2017] [Indexed: 11/18/2022] Open
Abstract
We assessed the prospective association between baseline levels of physical activity (PA) and the incidence of newly developed diabetic retinopathy (DR) in patients with type 2 diabetes. Data from 1,814 patients with type 2 diabetes without DR were obtained from a Japanese diabetes registry at Tenri Hospital, Nara, Japan. To assess the independent correlations between baseline PA levels and newly developed DR, the participants were divided into five categories based on their PA levels. A Cox proportional hazards model with time-varying exposure information was used and adjusted for potential confounders to assess the independent correlations. At baseline, the mean age, BMI, and hemoglobin A1c levels of the patients were 65.5 years, 24.5 kg/m2, and 7.2% (54 mmol/mol), respectively. After 2 years, newly developed DR was confirmed in 184 patients (10.1%). Patients with newly developed DR had longer duration of type 2 diabetes (14.7 versus 11.0 years, p < 0.0001), higher systolic blood pressure (139.2 versus 135.1 mmHg, p = 0.0012), lower estimated glomerular filtration rate (74.0 versus 77.1 mL/min/1.73 m2, p = 0.0382), greater urinary albumin-creatinine ratio (4.00 versus 2.45 mg/mmol, p < 0.0039), and higher HbA1c levels (7.5 versus 7.2%, p = 0.0006) than those without newly developed DR. The multivariable-adjusted hazard ratios for DR development were 0.87 (95% CI, 0.53-1.40; p = 0.557), 0.83 (95% CI, 0.52-1.31; p = 0.421), 0.58 (95% CI, 0.35-0.94; p = 0.027), and 0.63 (95% CI, 0.42-0.94; p = 0.025)for the second, third, fourth, and fifth PA categories, respectively, compared with the reference category of patients with a mean PA of 0 metabolic equivalent of task-hours/week). Higher PA levels are independently associated with a lower incidence of DR in Japanese patients with type 2 diabetes.
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Affiliation(s)
- Hirohito Kuwata
- Department of Diabetology, Nara medical University, Kashihara, Nara, Japan
| | - Shintaro Okamura
- Department of Endocrinology, Tenriyorozu Hospital, Tenri, Nara, Japan
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenriyorozu Hospital, Tenri, Nara, Japan
| | - Satoru Tsujii
- Department of Endocrinology, Tenriyorozu Hospital, Tenri, Nara, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara medical University, Kashihara, Nara, Japan
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Risk Factors of Microalbuminuria and Macroalbuminuria in Type 2 Diabetic Patients in North of Iran - Rasht. Nephrourol Mon 2016. [DOI: 10.5812/numonthly.40031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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15
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Gluhovschi C, Gluhovschi G, Petrica L, Timar R, Velciov S, Ionita I, Kaycsa A, Timar B. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy. J Diabetes Res 2016; 2016:4626125. [PMID: 27413755 PMCID: PMC4927990 DOI: 10.1155/2016/4626125] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022] Open
Abstract
Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition-mainly cardiovascular ones-and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new "gold standard" biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN.
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Affiliation(s)
- Cristina Gluhovschi
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
- *Cristina Gluhovschi:
| | | | - Ligia Petrica
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Romulus Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Silvia Velciov
- Division of Nephrology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Adriana Kaycsa
- Department of Biochemistry, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, University of Medicine and Pharmacy “V. Babes”, 300041 Timisoara, Romania
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16
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Li MF, Feng QM, Li LX, Tu YF, Zhang R, Dong XH, Lu JX, Bao YQ, Jia WP, Hu RM. High-normal urinary albumin-to-creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross-sectional community-based study. J Diabetes Investig 2015; 6:354-9. [PMID: 25969722 PMCID: PMC4420569 DOI: 10.1111/jdi.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/01/2014] [Accepted: 11/03/2014] [Indexed: 12/03/2022] Open
Abstract
Aims/Introduction Microalbuminuria is positively related to metabolic syndrome (MetS). Our aim was to investigate whether urinary albumin-to-creatinine ratio (UACR) within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes. Materials and Methods A total of 514 participants (206 males and 308 females; mean age 66 years) with UACR less than 3.5 mg/mmol were enrolled from two downtown areas of Shanghai. The participants were stratified into quartiles according to UACR levels. The prevalence of MetS was assessed and compared among the four groups by binary logistic regression. Results Compared with participants with UACRs in the first quartile, the other quartiles had a higher prevalence of MetS (65.9%, 74.4% and 81.3%, respectively, P = 0.001) after adjustment for sex and age. After adjusting for potential confounders, participants in the second to the fourth quartile group had a 1.36-, 1.84- and 2.73-fold risk of MetS, respectively, relative to those in the lowest quartile. Furthermore, UACR, whether as quartile groups or as a continuous variable, is an independent predictor of MetS after fully adjusting for other variables. Conclusions These results suggest that UACR even within the normal range is independently associated with MetS in Chinese community-based patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mei-Fang Li
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China ; Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Qi-Ming Feng
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Xue-Hong Dong
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University Shanghai, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus Shanghai, China
| | - Ren-Ming Hu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University Shanghai, China
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17
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Lee JJ, Yang IH, Kuo HK, Chung MS, Chen YJ, Chen CH, Liu RT. Serum uric acid concentration is associated with worsening in severity of diabetic retinopathy among type 2 diabetic patients in Taiwan--a 3-year prospective study. Diabetes Res Clin Pract 2014; 106:366-72. [PMID: 25108898 DOI: 10.1016/j.diabres.2014.07.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 07/20/2014] [Indexed: 12/13/2022]
Abstract
AIMS To explore the role of serum uric acid (SUA) concentration in diabetic retinopathy (DR) for patients with type 2 diabetes mellitus (T2DM). METHODS A 3-year prospective study in 749 patients with T2DM and without proliferative diabetic retinopathy (PDR) was conducted at a medical center. Baseline SUA concentration and parameters of glycemic control, blood pressure, kidney disease, and lipid profiles were analyzed to determine their contribution to DR. RESULTS Fundus examination showed that 184 patients (24.6%) had non-proliferative retinopathy and 565 (75.4%) without DR at baseline. After 3 years, increase in the severity of DR was recognized in 103 patients (13.8%), including 81 patients with newly developed DR. Patients with increase in severity of DR positively associated with duration of DM (11.9 vs. 9.4 years, p = 0.001), HbA1c (7.6 vs. 7.2%, p = 0.001), albuminuria (45.5 vs. 31.0%, p = 0.006), and SUA (6.47 vs. 5.87 mg/dl, p<0.001) than did those without change in DR stage. Cox regression showed that patients with SUA in the 3rd (5.9-6.9 mg/dl) and 4th (≥ 7.0mg/dl) quartiles had hazard ratios for DR worsening of 2.57 and 3.66 (95% C.I. 1.30-5.08 and 1.92-7.00) when compared with patients with SUA in the 1st quartile (<4.9 mg/dl). CONCLUSIONS SUA concentration is associated with the increase in severity of DR over a 3-year period in patients with T2DM. Further study is required to define the exact role of SUA in DR.
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Affiliation(s)
- Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Ming-Shien Chung
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Yung-Jen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Chih-Hsin Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Rue-Tsuan Liu
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
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Association of the TLR4 signaling pathway in the retina of streptozotocin-induced diabetic rats. Graefes Arch Clin Exp Ophthalmol 2014; 253:389-98. [PMID: 25359392 DOI: 10.1007/s00417-014-2832-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 08/21/2014] [Accepted: 10/06/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is severe damage to the retina caused by complications of diabetes, and is the prevailing cause of blindness. Accumulating evidence from both animal models and humans suggests that the inflammatory process plays a key role in the development of diabetic retinopathy and is facilitated by innate immune response. The aim of this study was to examine whether the TLR4 signaling pathway was involved in the streptozotocin-induced diabetic rat retina. METHODS Diabetes was induced by a single intraperitoneal injection of streptozotocin, and rat diabetic retinopathy was examined at 4 weeks of diabetes duration. Then the accumulated leukocytes were counted in vivo by acridine orange leukocyte fluorography, and the retinal vascular permeability was measured by the Evans blue assay. The expressions of TLR4 and its downstream signaling molecules were measured by RT-PCR or Western blot respectively. To evaluate the effect of blocking TLR4 on diabetic retinopathy, TAK-242, a selective TLR4 antagonist, was administered by intraperitoneal injection. RESULTS Our results showed that the retina of diabetic rats demonstrated accumulated leukocytes and retinal vascular permeability. The mRNA and protein expressions of TLR4 were upregulated in streptozotocin-treated diabetic rat retina. Furthermore, the protein levels of TLR4 downstream signaling molecules were significantly increased in streptozotocin-treated animals. In addition, the protein levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and interferon (IFN)-β, three downstream proinflammatory cytokines of TLR4 signal transduction pathway, were also markedly increased in diabetic rats. Administration of TAK-242 attenuated leukocytes accumulated and retinal vascular permeability, and decreased TLR4 downstream signaling molecules and proinflammatory cytokines in streptozotocin-induced animals. CONCLUSIONS Together, these data have demonstrated that TLR4 has a critical role in streptozotocin-induced diabetic retinopathy at the level of inflammatory cytokine induction, in both the MyD88-dependent and MyD88-independent pathways. TLR4 may become a new potential pharmacological target for treating diabetic retinopathy.
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Yan L, Ma J, Guo X, Tang J, Zhang J, Lu Z, Wang H, Cai X, Wang L. Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study. BMC Nephrol 2014; 15:165. [PMID: 25308236 PMCID: PMC4209030 DOI: 10.1186/1471-2369-15-165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/08/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population. METHODS This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria. RESULTS The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria. CONCLUSIONS Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.
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Affiliation(s)
- Liuxia Yan
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Jixiang Ma
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Xiaolei Guo
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Junli Tang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Jiyu Zhang
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Zilong Lu
- />Academy of Preventive Medicine, Shandong University, Jinan, 250014 China
- />Shandong Center for Disease Control and Prevention, Jinan, 250014 China
| | - Huicheng Wang
- />Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Xiaoning Cai
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
| | - Linhong Wang
- />National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050 China
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Chen F, Yang W, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, Lu J. Albuminuria: Prevalence, associated risk factors and relationship with cardiovascular disease. J Diabetes Investig 2014; 5:464-71. [PMID: 25411608 PMCID: PMC4210073 DOI: 10.1111/jdi.12172] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To investigate the prevalence and associated risk factors of microalbuminuria, and to explore the relationship between albuminuria and cardiovascular disease (CVD). MATERIALS AND METHODS A nationally representative sample of 38,203 Chinese participants was categorized by different levels of urinary albumin-to-creatinine ratio (ACR; 0 -10 mg/g, 10 -20 mg/g, 20 -30 mg/g, 30 -300 mg/g). The prevalence of albuminuria was compared by using a single urinary ACR cut-off point and by sex-specific ACR cut-off points. Factors associated with the presence of albuminuria, and the relationship between albuminuria and CVD were analyzed by logistic regression. RESULTS Prevalence of albuminuria as measured by a single ACR cut-point was significantly lower for men compared with women (13.9% vs 19.1% in the normal glucose tolerance group; 20.8% vs 26.8% in the impaired glucose tolerance group, P < 0.01). The prevalence of albuminuria, as measured by sex-specific ACR cut-points, was higher for men than women (31.4% vs 29.6% in the normal glucose tolerance group; 42.2% vs 39.3% in the impaired glucose tolerance group, P < 0.01). The independent risk factors for the presence of albuminuria were aging, female sex, hypertension, hyperglycemia, obesity, dyslipidemia, insulin resistance and metabolic syndrome. The subdivided normal ACR group did not show a linear or statistically significant relationship with CVD after adjusting for conventional CVD risk factors (P > 0.05). CONCLUSIONS The prevalence of albuminuria was high in the general Chinese population. Aging, female sex, hypertension, hyperglycemia, dyslipidemia, insulin resistance, obesity and metabolic syndrome were all independent risk factors for albuminuria. The causal relationship between ACR and CVD might require further follow-up investigation.
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Affiliation(s)
- Fang Chen
- Department of Endocrinology and Metabolism Chinese PLA General Hospital Beijing China
| | | | - Jianping Weng
- Sun Yat-sen University Third Hospital Guangzhou China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Linong Ji
- Peking University People's Hospital Beijing China
| | | | - Zhongyan Shan
- First Affiliated Hospital Chinese Medical University Shenyang Liaoning China
| | - Jie Liu
- Shanxi Province People's Hospital Taiyuan Shanxi China
| | - Haoming Tian
- West China Hospital, Sichuan University Chengdu Sichuan China
| | - Qiuhe Ji
- Xijing Hospital Fourth Military Medical University Xi'an Shaanxi China
| | - Dalong Zhu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Jiapu Ge
- Xinjiang Uygur Autonomous Region's Hospital Urmqi Xinjiang China
| | - Lixiang Lin
- Fujian Provincial Hospital Fuzhou Fujiang China
| | - Li Chen
- Qilu Hospital of Shandong University Jinan Shandong China
| | - Xiaohui Guo
- Peking University First Hospital Beijing China
| | - Zhigang Zhao
- Henan Province People's Hospital Zhengzhou Henan China
| | - Qiang Li
- Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | | | - Guangliang Shan
- Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences School of Basic Medicine Peking Union Medical College Beijing China
| | - Juming Lu
- Department of Endocrinology and Metabolism Chinese PLA General Hospital Beijing China
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The significance of screening for microvascular diseases in Chinese community-based subjects with various metabolic abnormalities. PLoS One 2014; 9:e97928. [PMID: 24835219 PMCID: PMC4023981 DOI: 10.1371/journal.pone.0097928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the association of albuminuria and retinopathy with metabolic syndrome (MetS) and the related metabolic components defined by various criteria in Chinese community-based subjects. METHODS A total of 3240 Chinese subjects were recruited from urban communities and classified into subgroups with isolated or concomitant state of the two microvascular diseases. MetS was defined according to the standard of International Diabetes Federation, the National Cholesterol Education Program's Adult Treatment Panel III and Chinese Diabetes Society (CDS), separately. Albuminuria was defined as an elevated morning urine albumin-to-creatinine ratio. Retinopathy were identified with nonmydriatic retinal photographs according to the Diabetic Retinopathy Disease Severity Scale. Logistic regression was performed to analyze the contributive risk factors. RESULTS The subgroup of isolated retinopathy was the oldest (P<0.05), with higher blood pressure (P<0.001) and larger waist circumference (P<0.05). After adjusting for age, sex and other metabolic components, individuals with blood pressure over 130/85 mmHg were prone to have isolated albuminuria (OR: 1.51, P = 0.0001); while individuals with fasting plasma glucose over 5.6 mmol/L were in high risk of retinopathy concomitant with albuminria (OR: 3.04, P = 0.006). Larger waist circumference was a potential risk factors for isolated albuminuria and isolated retinopathy, though not significant after further adjustment of other metabolic components. The risk for albuminuria and retinopathy increased with the aggregation of three or more metabolic components. However, the MetS per se did not have synergic effect and only the MetS defined by CDS remained as a risk factor. CONCLUSIONS Albuminuria and retinopathy were highly associated with accumulated metabolic abnormalities including sub-clinical elevated blood pressure and elevated fasting plasma glucose.
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22
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Ye Z, Wang S, Yang Z, He M, Zhang S, Zhang W, Wen J, Li Q, Huang Y, Wang X, Lu B, Zhang Z, Su Q, Hu R. Serum lipocalin-2, cathepsin S and chemerin levels and nonalcoholic fatty liver disease. Mol Biol Rep 2014; 41:1317-23. [PMID: 24390241 DOI: 10.1007/s11033-013-2977-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/24/2013] [Indexed: 12/20/2022]
Abstract
Several novel circulating adipokines are associated with insulin resistance and inflammation. Little information exists in NAFLD about three recently recognized adipokines lipocalin-2, cathepsin S and chemerin. To assess the relationship between serum lipocalin-2, cathepsin S and chemerin levels and the development of non-alcoholic fatty liver in Chinese subjects, we measured serum lipocalin-2, cathepsin S and chemerin levels in 903 Chinese subjects by ELISA. Among the study population, 436 patients are with B-mode ultrasound-proven NAFLD and 467 controls. Levels of lipocalin-2, but not cathepsin S and chemerin, were significantly elevated in NAFLD versus control [lipocalin-2, 89.67 ± 4.47 vs. 68.70 ± 3.65 ng/mL (p < 0.001)]. After stepwise linear regression analysis adjusting for potential cofounders, further revealed that serum lipocalcin-2 was an independent predictor of NAFLD in whole cohort (standardized β = 0.114, t = 2.347, p = 0.02). Lipocalin-2 levels correlated with insulin resistance (homeostasis model assessment of insulin resistance) and inflammation (CRP) in whole cohorts and NAFLD, whereas cathepsin S and chemerin only correlated positively with insulin resistance and inflammation in whole cohorts. Our results indicated that circulating lipocalin-2, produced by adipocytes, are elevated and may contribute to the development of NAFLD. Serum lipocalin-2, which correlates with inflammation and insulin resistance, may have a direct pathogenic link to disease progression.
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Affiliation(s)
- Zi Ye
- Institute of Endocrinology and Diabetology at Fudan University, Huashan Hospital, Fudan University, Shanghai, 200040, China,
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Lapice E, Cocozza S, Riccardi G, Vaccaro O. Comment on: Zhang et al. Peroxisome proliferator-activated receptor γ polymorphism Pro12Ala is associated with nephropathy in type 2 diabetes: evidence from meta-analysis of 18 studies. Diabetes Care 2012;35:1388-1393. Diabetes Care 2013; 36:e18. [PMID: 23264301 PMCID: PMC3526245 DOI: 10.2337/dc12-1993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Emanuela Lapice
- From the Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Sara Cocozza
- From the Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Gabriele Riccardi
- From the Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
| | - Olga Vaccaro
- From the Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
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Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: The ENTRED surveys (2001 and 2007). DIABETES & METABOLISM 2012; 38:558-66. [DOI: 10.1016/j.diabet.2012.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/12/2012] [Accepted: 08/01/2012] [Indexed: 11/23/2022]
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Alrawahi AH, Rizvi SGA, Al-Riyami D, Al-Anqoodi Z. Prevalence and risk factors of diabetic nephropathy in omani type 2 diabetics in Al-dakhiliyah region. Oman Med J 2012; 27:212-6. [PMID: 22811770 DOI: 10.5001/omj.2012.48] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/14/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess the prevalence and risk factors of diabetic nephropathy among Omani type 2 diabetics in Al-Dakhiliyah region of the Sultanate of Oman. METHODS A cross-sectional and a case control study designs were used to assess the prevalence and risk factors respectively. For the prevalence study a sample of 699 diabetic subjects were selected randomly from two polyclinics in Al-Dakhiliyah region; Sumail and Nizwa polyclinics. For the case control study, a sample consisting of 215 cases and 358 controls were randomly selected from those who were included in the cross-sectional study. A well designed questionnaire has been used to collect data regarding the disease and risk factors. Data was analyzed using SPSS19 statistical program. RESULTS Total prevalence of diabetic nephropathy was calculated as 42.5% (95% C.I: 38.83% - 46.15%). The difference in the prevalence in the two polyclinic catchment area was not significant. The prevalence was significantly higher among males (51.6%) compared to females (36.5%). Crude analysis of the risk factors showed significant association between diabetic nephropathy and the following factors; male gender, decreased literacy, long duration of diabetes mellitus, hypertension, retinopathy, neuropathy, family history of diabetic nephropathy, poor glycemic control (high HbA1c), and hypertriglyceridemia. Multivariate analysis showed the following factors to be independent risk factors; male gender, decreased literacy, long duration of diabetes, family history of diabetic nephropathy and poor glycaemic control (high HbA1c). CONCLUSION The prevalence of diabetic nephropathy in this study was 42.5% and the significant risk factors associated with it included male gender, decreased literacy, long duration of diabetes, family history of diabetic nephropathy and poor glycemic control (high HbA1c).
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Shen FC, Lee CT, Sun CK, Chung MS, Lee JJ, Chang HW, Hsieh CJ, Yang KD, Liu RT. Prevalence of haematuria positively associated with urine albumin excretion in Type 2 diabetes. Diabet Med 2012; 29:1178-83. [PMID: 22313158 DOI: 10.1111/j.1464-5491.2012.03608.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Some guidelines or studies consider haematuria an indication for renal biopsy or a potential cause of albuminuria that precludes accurate assessment of urinary albumin excretion. This study examined the justification of excluding haematuria in interpreting urinary albumin excretion in patients with Type 2 diabetes and its associations with other diabetes-related variables. METHODS Between May and November 2008, patients with Type 2 diabetes at a single centre with data on urinary albumin excretion and urinalysis in the same urine sample were recruited. Urinary albumin excretion was determined by urine albumin/creatinine ratio in spot urine. Diagnosis of haematuria was made by positive urine occult blood from 1+ to 4+ and/or presence of more than nine red blood cells/ml in urinalysis. Demographic, anthropometric, clinical and laboratory variables and diabetes-associated complications were analysed. RESULTS In total, 743 patients were enrolled. Prevalence of haematuria among patients with normoalbuminuria, microalbuminuria, or macroalbuminuria was 8.7% (n = 13), 16.1% (n = 67) and 35.8% (n = 64), respectively. Urine albumin/creatinine ratio was significantly higher, while macroalbuminuria was more common in patients with haematuria (n = 144) than in those without (n = 599). Multiple regression analysis identified urine albumin/creatinine ratio (odds ratio 1.33, P = 0.01) and macroalbuminuria (odds ratio 2.66, P = 0.01) as the only independent predictors of haematuria. Moreover, urine albumin/creatinine ratio was an independent predictor of haematuria in the macroalbuminuria subgroup (odds ratio 1.30, P = 0.04). CONCLUSIONS Increased urine albumin/creatinine ratio and macroalbuminuria were the only independent predictors of haematuria in patients with Type 2 diabetes, raising questions on the justifications of excluding haematuria in interpreting urinary albumin excretion in patients with Type 2 diabetes and including haematuria as an indication for renal biopsy in those with macroalbuminuria.
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Affiliation(s)
- F-C Shen
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Zhang H, Zhu S, Chen J, Tang Y, Hu H, Mohan V, Venkatesan R, Wang J, Chen H. Peroxisome proliferator-activated receptor γ polymorphism Pro12Ala Is associated with nephropathy in type 2 diabetes: evidence from meta-analysis of 18 studies. Diabetes Care 2012; 35:1388-93. [PMID: 22619290 PMCID: PMC3357218 DOI: 10.2337/dc11-2142] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance plays a part in diabetic nephropathy (DN). The association between the peroxisome proliferator-activated receptor γ Pro to Ala alteration at codon 12 (Pro12Ala) polymorphism and the risk of insulin resistance has been confirmed. The association between the polymorphism and DN risk has also been widely studied recently, but no consensus was available up to now. RESEARCH DESIGN AND METHODS A systematic search of electronic databases (MEDLINE, Embase, and China National Knowledge Infrastructure) and reference lists of relevant articles was carried out, and then 18 case-control studies involving 3,361 DN cases and 5,825 control subjects were identified. RESULTS In the overall analysis, the Ala12 variant was observed to be significantly associated with decreased DN risk (odds ratio 0.76 [95% CI 0.61-0.93]). Some evidence of heterogeneity among the included studies was detected, which could be explained by the difference of ethnicity and stage of DN. Subgroup analyses stratified by ethnicity and stage of DN were performed, and results indicated the Pro12Ala polymorphism was associated with the risk of DN in Caucasians but no similar association was observed in Asians. Additionally, we observed that Ala12 was associated with decreased risk of albuminuria. With only a few of subjects were available, we failed to detect statistically significant association between the polymorphism and end-stage renal disease (ESRD). CONCLUSIONS Our results indicated that the Ala12 variant is a significantly protective factor for DN. Future research should focus on the effect of Pro12Ala polymorphism on ESRD and gathering data of Africans.
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Affiliation(s)
- Hui Zhang
- Division of Geriatric Nephrology, Medical and Health Care Center, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
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Serum uric acid level and its association with metabolic syndrome and carotid atherosclerosis in patients with type 2 diabetes. Cardiovasc Diabetol 2011; 10:72. [PMID: 21816063 PMCID: PMC3163178 DOI: 10.1186/1475-2840-10-72] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 08/04/2011] [Indexed: 11/18/2022] Open
Abstract
Objective We aimed to investigate whether elevated serum uric acid concentrations are associated with higher risk of metabolic syndrome (MetS) and carotid atherosclerosis in patients with type 2 diabetes. Methods We conducted a population-based cross-sectional survey in Shanghai, with a total of 395 men and 631 women age 41 to 92 years. The carotid artery intima-media thickness (IMT) and carotid atherosclerotic plaques (PLQ) were measured by B-mode ultrasound. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Results Uric acid levels were negatively associated with duration of diabetes, fasting plasma glucose, glycohemoglobin, eGFR, HDL-cholesterol (all P < 0.001) and positively with BMI, CRP, waist circumference, triglycerides, systolic blood pressure, ACR, HOMA-IR and IMT (all P < 0.05). In the highest quartile of uric acid levels, the risks were substantially higher for MetS [odds ratio 3.97, (95% confidence interval 2.58-6.13)] (P < 0.001 for trend) and PLQ [odds ratio 2.71 (95% confidence interval 1.62-4.47)] (p = 0.013 for trend) compared with that in the lowest quartile of uric acid levels after multiple adjustment. These associations remained significant after further adjustment for potential confounders. Conclusions Serum uric acid level is associated with MetS and is an independent risk factor for carotid atherosclerosis in patients with type 2 diabetes.
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Lu B, Zhang S, Wen J, Yang Y, Yang Z, Zhang Z, Wang X, Hu R. The New Unified International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute Metabolic Syndrome definition: does it correlate better with C-reactive protein in Chinese patients diagnosed with type 2 diabetes? J Int Med Res 2011; 38:1923-32. [PMID: 21226995 DOI: 10.1177/147323001003800605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the association between high-sensitivity C-reactive protein (hsCRP) and metabolic syndrome, defined by the definition proposed by the International Diabetes Federation (IDF), American Heart Association (AHA) and National Heart, Lung, and Blood Institute (NHLBI) versus the older IDF definition, in 506 Chinese patients with type 2 diabetes. Anthropometric and biochemical parameters were compared and analysed using multivariate linear regression models. Serum hsCRP was higher in patients with metabolic syndrome compared with those without metabolic syndrome for both definitions and increased as the number of components of metabolic syndrome increased (after adjusting for age, gender and smoking). Patients with metabolic syndrome according to the IDF/AHA/NHLBI but not the IDF definition had significantly higher hsCRP levels than those not meeting either definition and similar hsCRP levels to those meeting both definitions. Serum hsCRP levels were significantly associated with metabolic syndrome according to the IDF definition after adjusting for age, gender and smoking. Adding metabolic syndrome status according to the IDF/AHA/NHLBI definition significantly increased the fit of the multivariate linear regression model. The new IDF/AHA/NHLBI definition of metabolic syndrome may have a stronger relationship with serum hsCRP than the IDF definition.
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Affiliation(s)
- B Lu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Shanghai, China
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Lu B, Yang Z, Wang M, Yang Z, Gong W, Yang Y, Wen J, Zhang Z, Zhao N, Zhu X, Hu R. High prevalence of diabetic neuropathy in population-based patients diagnosed with type 2 diabetes in the Shanghai downtown. Diabetes Res Clin Pract 2010; 88:289-94. [PMID: 20359765 DOI: 10.1016/j.diabres.2010.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/21/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
AIMS To determine the prevalence of diabetic peripheral neuropathy (DPN) and risk factors associated with DPN in type 2 diabetic patients. METHODS 435 diabetic patients were evaluated on complete foot examination. Body mass measurements, resting blood pressure, fasting blood measures, urinary albumin-to-creatinine ratio (ACR) and the digitally stored fundus images were investigated. RESULTS (1) The prevalence of DPN was 61.8% among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown, 59.1% with vibration perception threshold > or =25 V and 13.8% with inability to feel the monofilament. (2) DPN was significantly associated with age (beta: 0.068, S.E.: 0.013, OR: 1.070, CI: 1.043-1.098, P<0.001) and HbA1c (beta: 0.224, S.E.: 0.081, OR: 1.251, CI: 1.067-1.466, P=0.006) by a logistic regression analysis. (3) The percentage of diabetic retinopathy (DR) in the DPN group (26.5%) was significantly higher than that in the non-DPN group (15.2%). (4) The percentage of macroalbuminuria in the DPN group (9.0%) was significantly higher than that in the non-DPN group (1.8%). CONCLUSIONS The prevalence of DPN observed in the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown reached up to 61.8% though the observations in our study might be representative of the diabetic patients of the Shanghai downtown.
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Affiliation(s)
- Bin Lu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Shanghai 200040, China
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Use of eye care services among diabetic patients in urban and rural China. Ophthalmology 2010; 117:1755-62. [PMID: 20471689 DOI: 10.1016/j.ophtha.2010.01.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 01/07/2010] [Accepted: 01/07/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the use of eye care and its predictors among diabetic patients in China. DESIGN Cross-sectional, clinic-based study. PARTICIPANTS Diabetic patients 18 years of age or older were recruited consecutively from an urban tertiary and community hospitals and from a rural clinic in Guangdong, China. METHODS Information obtained by questionnaire and chart review included: demographic and socioeconomic status, knowledge about diabetic retinopathy (DR), and ocular and medical history. MAIN OUTCOME MEASURES Self-reported or chart history of an eye examination ever or within the preceding 12 months. RESULTS The participation rate among 889 eligible subjects was 92.7%. Among 824 participants (mean age, 62.6+/-12.9 years; 58.8% female), 550 (66.7%) had not been examined in the last year as recommended by the American Academy of Ophthalmology, and 356 (43.2%) had never been examined. For the rural hospital, these figures were 81.1% and 68.7%, respectively. In regression analyses, factors associated with having an eye examination in the last year were: attendance at urban hospitals (odds ratio [OR], 3.46 [P<0.001] and 1.76 [P = 0.021] for the tertiary and community hospitals, respectively, compared with the rural clinic), higher DR knowledge score (OR, 1.24; P = 0.001), greater concern about vision loss (OR, 1.22; P = 0.007), and recommendation of regular eye examinations by the provider (OR, 2.36; P = 0.011). Predictors of ever having an eye examination were similar. Monthly income and health insurance status were not predictive of being examined. CONCLUSIONS These results suggest that the low proportion of diabetic receiving recommended annual eye examinations in China may be improved through patient and physician education.
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Lu B, Gong W, Yang Z, Yang Z, Yang Y, Wen J, Zhao N, Zhu X, Hu R. An evaluation of the diabetic kidney disease definition in chinese patients diagnosed with type 2 diabetes mellitus. J Int Med Res 2010; 37:1493-500. [PMID: 19930856 DOI: 10.1177/147323000903700526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The concomitant presence of retinopathy may be helpful in discriminating kidney pathology in type 2 diabetes. This cross-sectional study evaluated the ability to predict the likelihood of patients having diabetic kidney disease (DKD) by comparing the percentage incidence of diabetic retinopathy in different subgroups of Chinese patients with type 2 diabetes (n = 668). The prevalence of chronic kidney disease in the patients was 63.3% (6.6% with DKD, 41.0% with possible DKD and 15.7% with non-diabetic renal disease [NDRD]). The percentage of patients with diabetic retinopathy in the DKD group (63.6%) was significantly higher than in the possible DKD group (24.9%) and the NDRD group (19.0%). DKD was independently associated with diabetic retinopathy based on logistic regression analysis. The likelihood of DKD occurrence as defined by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative of the USA is applicable to Chinese patients with diabetes. Diabetic retinopathy was more prevalent in patients with DKD compared with patients with possible DKD or NDRD.
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Affiliation(s)
- B Lu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology, Department of Endocrinology and Metabolism, Shanghai Medical College, Fudan University, Shanghai, China
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Halvatsiotis I, Tsiotra PC, Ikonomidis I, Kollias A, Mitrou P, Maratou E, Boutati E, Lekakis J, Dimitriadis G, Economopoulos T, Kremastinos DT, Raptis SA. Genetic variation in the adiponectin receptor 2 (ADIPOR2) gene is associated with coronary artery disease and increased ADIPOR2 expression in peripheral monocytes. Cardiovasc Diabetol 2010; 9:92. [PMID: 21167068 PMCID: PMC3020174 DOI: 10.1186/1475-2840-9-92] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/19/2010] [Indexed: 01/27/2023] Open
Abstract
Background There is debate as to whether the association between C-reactive protein (CRP) and insulin resistance is independent of body fatness, particularly central obesity. Therefore, the association among CRP, insulin resistance and obesity was analyzed in Chinese patients with type 2 diabetes. Methods The study included 520 Chinese patients diagnosed with type 2 diabetes with CRP levels not exceeding 10 mg/L. The degree of insulin resistance was determined with the homeostasis model assessment of insulin resistance (HOMA-IR). The CRP levels were categorized into quartiles from the lowest to the highest concentrations (Q1-Q4). Results Body mass index (BMI) and waist circumference (WC) were both higher in Q4, Q3 and Q2 than those in Q1. HOMA-IR was higher in Q2, Q3 and Q4 than that in Q1 (Q1 vs Q4, P < 0.001; Q1 vs Q3, P < 0.001; Q1 vs Q2, P = 0.028). Log CRP was significantly correlated with log HOMA-IR (correlation coefficient: 0.230, P < 0.001) and BMI (correlation coefficient: 0.305, P < 0.001) and WC (correlation coefficient: 0.240, P < 0.001) by Spearman correlation analysis. Multiple linear regression analysis adjusting for age, gender and components of metabolic syndrome, log CRP was also independently associated with log HOMA-IR (β coefficient, 0.168; P < 0.001) and WC (β coefficient, 0.131; P = 0.006). Conclusion These findings showed that insulin resistance was associated with CRP levels independent of abdominal obesity in Chinese patients with type 2 diabetes, suggesting that abdominal obesity could only partly explain the link between subclinical inflammation and insulin resistance.
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Affiliation(s)
- Iosif Halvatsiotis
- Hellenic National Centre for Research, Prevention and Treatment of Diabetes Mellitus and its Complications (HNDC), Athens, Greece
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Liu L, Zheng T, Wang F, Wang N, Song Y, Li M, Li L, Jiang J, Zhao W. Pro12Ala polymorphism in the PPARG gene contributes to the development of diabetic nephropathy in Chinese type 2 diabetic patients. Diabetes Care 2010; 33:144-9. [PMID: 19837787 PMCID: PMC2797960 DOI: 10.2337/dc09-1258] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Oxidative stress is a major contributing factor in the development of diabetic nephropathy. Peroxisome proliferator-activated receptor gamma heterozygous mice and Pro12Ala polymorphism in PPARG exhibited increased resistance to oxidative stress. Smoking increases the production of reactive oxygen species, which accelerates oxidative stress under hyperglycemia. To determine whether the Pro12Ala polymorphism, alone or in combination with smoking, contributes to the development of diabetic nephropathy, a case-control study was performed in 760 Chinese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Among patients, 532 had diabetic nephropathy with microalbuminuria (n = 245) or overt albuminuria (n = 287), and 228 did not show either of these symptoms but had had diabetes for > or =10 years and were not undergoing anti-hypertension treatment. RESULTS After adjustment for confounders, the Pro/Pro genotype was significantly associated with diabetic nephropathy (odds ratio 2.30 [95% CI 1.18-4.45], P = 0.014); smoking was also an independent risk factor for diabetic nephropathy (1.99 [1.08-3.68], P = 0.029). In addition, we identified possible synergistic effects; i.e., the high-risk group (smokers with the Pro/Pro genotype) showed 4.52 times higher risk (1.78-11.48, P = 0.002) of diabetic nephropathy than the low-risk group (nonsmokers with the Pro/Ala genotype) in a multiple logistic regression analysis controlled for the confounders. CONCLUSIONS Our results indicated that the Pro/Pro genotype and smoking were significant independent risk factors for diabetic nephropathy. The possible synergistic effects of genotype and smoking may aggravate oxidative stress and contribute to the development of diabetic nephropathy.
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Affiliation(s)
- Limei Liu
- Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai, China.
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Jia W, Gao X, Pang C, Hou X, Bao Y, Liu W, Wang W, Zuo Y, Gu H, Xiang K. Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS). Nephrol Dial Transplant 2009; 24:3724-31. [PMID: 19617258 DOI: 10.1093/ndt/gfp349] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes is a major risk factor for the development of kidney disease. We aimed to determine the prevalence of albuminuria and chronic kidney disease (CKD) in Chinese subjects with diabetes and pre-diabetes and the risk factors for kidney disease. METHODS An urban community-based sample of 3714 adults in Shanghai was classified into normal glucose tolerance (NGT), impaired glucose regulation (IGR) and diabetes. The estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (ACR) were applied to designate renal function and albuminuria, respectively. Binary logistic regression was performed to analyse the contribution of risk factors to CKD. Polynominal regression was used to determine the trends of eGFR with the increment of ACR. RESULTS The prevalence of microalbuminuria, macroalbuminuria and CKD in subjects with diabetes was 22.8%, 3.4% and 29.6%, respectively, which was significantly higher than that in non-diabetes subjects. After adjustment for age, the odds ratio of hypertension for albuminuria and renal insufficiency (eGFR <60 mL/min/1.73 m(2,) stages 3-5 of CKD) were 1.23 (P = 0.000) and 2.55 (P = 0.000). Diabetes and cardiovascular disease (CVD) both increased the risk for albuminuria significantly, with the odds ratio of 1.22 (P = 0.04) and 1.36 (P = 0.006), respectively. Diabetes and CVD were not independent risk factor for renal insufficiency. Although the worsening trends of eGFR are similar in diabetes and IGR subjects, IGR was not a significant risk factor for albuminuria and renal insufficiency. CONCLUSION Screening for albuminuria and eGFR is highly recommended for older patients with diabetes, hypertension and CVD to prevent end-stage kidney disease.
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Affiliation(s)
- Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
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Fu CC, Wu DA, Wang JH, Yang WC, Tseng CH. Association of C-reactive protein and hyperuricemia with diabetic nephropathy in Chinese type 2 diabetic patients. Acta Diabetol 2009; 46:127-34. [PMID: 18853099 DOI: 10.1007/s00592-008-0069-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 09/12/2008] [Indexed: 02/07/2023]
Abstract
To investigate the relationship of micro-albuminuria with C-reactive protein (CRP) and hyperuricemia in Chinese patients with type 2 diabetes. All patients with type 2 diabetes, 40 years old and over were recruited consecutively from diabetic clinics at a medical center. Serum lipid, creatinine, uric acid, CRP, HbA(1C) and urinary albumin concentration were measured. A total of 515 patients, aged 60.3 +/- 10.7 years were recruited and the number (rate) of micro- and macro-albuminuria were 109 (21.2%) and 55 (10.7%). The prevalence of micro-albuminuria for the quartiles of CRP levels demonstrated a meaningful trend of increases between groups from 17.4, 21.1, 30.3, and 31.2% (P trend = 0.002). Besides, the median CRP concentrations was significantly higher in the patients with micro- and macro-albuminuria than those with non-albuminuria. Stepwise logistic regression analysis revealed that CRP was significantly associated with abnormal albuminuria (OR = 1.36, 95% CI = 1.12-1.64, P = 0.002). After excluding those subjects with angiotensin-converting enzyme inhibitors/angiotension II receptor blockers or/and statin usage, the observed relationship between serum CRP levels and albuminuria was still persistent (OR = 1.61, 95% CI = 1.24-2.08, P < 0.001). In addition, hyperuricemia were significantly associated with abnormal albuminuria in the patients without diuretics, uricosuric agents or alcohol usage. Both serum CRP levels and hyperuricemia were significantly related to the presence of albuminuria in patients with diabetes. In addition, Chinese type 2 diabetic patients with serum CRP levels in the lower range as other ethnic groups can lead to the development of micro-albuminuria.
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Affiliation(s)
- Chen-Chung Fu
- Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Sect. 3, Chung Yang Road, Hualien, Taiwan.
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Nelson PT, Smith CD, Abner EA, Schmitt FA, Scheff SW, Davis GJ, Keller JN, Jicha GA, Davis D, Wang-Xia W, Hartman A, Katz DG, Markesbery WR. Human cerebral neuropathology of Type 2 diabetes mellitus. BIOCHIMICA ET BIOPHYSICA ACTA 2009; 1792:454-69. [PMID: 18789386 PMCID: PMC2834412 DOI: 10.1016/j.bbadis.2008.08.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/09/2008] [Accepted: 08/14/2008] [Indexed: 12/15/2022]
Abstract
The cerebral neuropathology of Type 2 diabetes (CNDM2) has not been positively defined. This review includes a description of CNDM2 research from before the 'Pubmed Era'. Recent neuroimaging studies have focused on cerebrovascular and white matter pathology. These and prior studies about cerebrovascular histopathology in diabetes are reviewed. Evidence is also described for and against the link between CNDM2 and Alzheimer's disease pathogenesis. To study this matter directly, we evaluated data from University of Kentucky Alzheimer's Disease Center (UK ADC) patients recruited while non-demented and followed longitudinally. Of patients who had come to autopsy (N = 234), 139 met inclusion criteria. These patients provided the basis for comparing the prevalence of pathological and clinical indices between well-characterized cases with (N = 50) or without (N = 89) the premortem diagnosis of diabetes. In diabetics, cerebrovascular pathology was more frequent and Alzheimer-type pathology was less frequent than in non-diabetics. Finally, a series of photomicrographs demonstrates histopathological features (including clinical-radiographical correlation) observed in brains of persons that died after a history of diabetes. These preliminary, correlative, and descriptive studies may help develop new hypotheses about CNDM2. We conclude that more work should be performed on human material in the context of CNDM2.
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Affiliation(s)
- Peter T Nelson
- Department of Pathology, Division of Neuropathology, University of Kentucky Medical Center, Sanders-Brown Center on Aging and Alzheimer's Disease Center, University of Kentucky, Lexington, KY 40536-0230, USA.
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Aekplakorn W, Srivanichakorn S, Sangwatanaroj S. Microalbuminuria and metabolic risk factors in patients with type 2 diabetes in primary care setting in Thailand. Diabetes Res Clin Pract 2009; 84:92-8. [PMID: 19168252 DOI: 10.1016/j.diabres.2008.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 12/16/2008] [Accepted: 12/29/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of microalbuminuria and associated risk factors in patients with type 2 diabetes in primary care. METHODS Clinical information of diabetic patients in 70 primary care units in Thailand was collected in a cross-sectional survey. Multinomial logistic regression model was used to examine several clinical risk factors with microalbuminuria and macroalbuminuria. RESULTS A total of 4162 patients were included. The prevalence of microalbuminuria was 39.12% and macroalbumninuria was 7.83%. The proportion of patients with HbA1c<7% was 37.9%. Independent risk factors for microalbuminuria and macroalbuminuria included HbA1c (adjusted OR 1.54, 95%CI 1.30-1.83 and 2.06, 95%CI 1.49-2.84 per unit increase in HbA1c, respectively), triglyceride >/=1.7mmol/L (1.31, 1.11-1.56 and 1.44, 1.06-1.98), hypertension (1.31, 1.10-1.54 and 1.64, 1.23-2.20), and duration of diabetes >/=5 years (1.31, 1.11-1.55 and 2.39, 1.74-3.28). Metabolic syndrome was associated with macroalbuminuria (OR 1.36, 95%CI 1.01-1.84). CONCLUSION The high prevalence of microabuminuria and suboptimal glycemic control for the diabetic patients were found to highlight the need to improve in control of glycemia and metabolic risk factors.
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Affiliation(s)
- Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Rama 6 Rd., Rajdevi, Bangkok 10400, Thailand.
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Pan CY, Ho LT, Soegondo S, Prodjosudjadi W, Suwanwalaikorn S, Lim SC, Chan TM, Chow KWS, Thoenes M, Choi DS. Prevalence of albuminuria and cardiovascular risk profile in a referred cohort of patients with type 2 diabetes: an Asian perspective. Diabetes Technol Ther 2008; 10:397-403. [PMID: 18715217 DOI: 10.1089/dia.2007.0296] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Microalbuminuria (MA) is a risk marker for diabetic nephropathy and cardiovascular (CV) disease (CVD) in patients with diabetes. This study aimed to describe the prevalence of albuminuria, CV risk factors, and treatments for renal and CV protection in an Asian population with type 2 diabetes. METHODS This cross-sectional study conducted in eight Asian countries enrolled normotensive/hypertensive adults with type 2 diabetes without known proteinuria and/or non-diabetic kidney disease. Exclusion criteria were type 1 diabetes, menstruation, pregnancy, and acute fever. A single random urinary albumin/creatinine test was carried out in all patients. RESULTS Of 8,561 patients, 14% had diabetic retinopathy, and 17% and 21% had history of CV disease and smoking, respectively. Normoalbuminuria was seen in 44%, MA in 44%, and macroalbuminuria in 12%. Target glycosylated hemoglobin (HbA1c) (<7%) was reached in only 37% of 3,834 patients with available values. Diabetes was managed by diet alone in 6%, while others received oral hypoglycemic drugs and/or insulin. In total, 75% did not reach target blood pressure (BP) of <or=130/80 mm Hg. Antihypertensive drugs were prescribed to 52%, with the number of drugs increasing as the level of systolic BP increased. Drugs blocking the renin-angiotensin system were most commonly prescribed, followed by calcium channel blockers. Lipid-lowering drugs and anticoagulant/antiplatelet agents were used in about 30% and 25% of patients, respectively. CONCLUSIONS Asian patients with type 2 diabetes had a high prevalence of MA and reduced kidney function. Furthermore, BP and HbA1c control was only achieved in a minority of patients. Aggressive risk management by administration of reno- and cardioprotective treatments is urgently needed.
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Affiliation(s)
- C Y Pan
- Chinese PLA General Hospital, Beijing, People's Republic of China.
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