Diabetes prevalence and determinants in adults in China mainland from 2000 to 2010: a systematic review

Trends of diabetes in Beijing, China

BACKGROUND

The global rise in diabetes prevalence is a pressing concern. Despite initiatives like "The Healthy Beijing Action 2020-2030" advocating for increased awareness, treatment, and control, the specific situation in Beijing remains unexplored. This study aimed to analyze the trends in diabetes prevalence, awareness, treatment, and control among Beijing adults.

METHODS

Through a stratified multistage probability cluster sampling method, a series of representative cross-sectional surveys were conducted in Beijing from 2005 to 2022, targeting adults aged 18-79 years. A face-to-face questionnaire, along with body measurements and laboratory tests, were administered to 111,943 participants. Data from all survey were age- and/or gender-standardized based on the 2020 Beijing census population. Annual percentage rate change (APC) or average annual percentage rate change (AAPC) was calculated to determine prevalence trends over time. Complex sampling logistic regression models were employed to explore the relationship between various characteristics and diabetes.

RESULTS

From 2005 to 2022, the total prevalence of diabetes among Beijing adults aged 18-79 years increased from 9.6% (95% CI: 8.8-10.4%) to 13.9% (95% CI: 13.1-14.7%), with an APC/AAPC of 2.1% (95% CI: 1.1-3.2%, P <0.05). Significant increases were observed among adults aged 18-39 years and rural residents. Undiagnosed diabetes rose from 3.5% (95% CI: 3.2-4.0%) to 7.2% (95% CI: 6.6-7.9%) with an APC/AAPC of 4.1% (95% CI: 0.5-7.3%, P <0.05). However, diabetes awareness and treatment rates showed annual declines of 1.4% (95% CI: -3.0% to -0.2%, P <0.05) and 1.3% (95% CI: -2.6% to -0.2%, P <0.05), respectively. The diabetes control rate decreased from 21.5% to 19.1%, although not statistically significant (APC/AAPC = -1.5%, 95% CI: -5.6% to 1.9%). Overweight and obesity were identified as risk factors for diabetes, with ORs of 1.65 (95% CI: 1.38-1.98) and 2.48 (95% CI: 2.07-2.99), respectively.

CONCLUSIONS

The prevalence of diabetes in Beijing has significantly increased between 2005 and 2022, particularly among young adults and rural residents. Meanwhile, there has been a concerning decrease in diabetes awareness and treatment rates, while control rates have remained stagnant. Regular blood glucose testing, especially among adults aged 18-59 years, should be warranted. Furthermore, being male, elderly, overweight, or obese was associated with higher diabetes risk, suggesting the needs for targeted management strategies.

Analysis of risk factors and clinical implications for diabetes in first-degree relatives in the northeastern region of China

Background

The prevalence of diabetes has risen fast with a considerable weighted prevalence of undiagnosed diabetes or uncontrolled diabetes. Then it becomes more necessary to timely screen out and monitor high-risk populations who are likely to be ignored during the COVID-19 pandemic. To classify and find the common risks of undiagnosed diabetes and uncontrolled diabetes, it's beneficial to put specific risk control measures into effect for comprehensive primary care. Especially, there is a need for accurate yet accessible prediction models.

Objective

Based on a cross-sectional study and secondary analysis on the health examination held in Changchun City (2016), we aimed to evaluate the factors associated with hyperglycemia, analyze the management status of T2DM, and determine the best cutoff value of incidence of diabetes in the first-degree relatives to suggest the necessity of early diagnosis of diabetes after first screening.

Results

A total of 5658 volunteers were analyzed. Prevalence of T2DM and impaired fasting glucose were 8.4% (n=477) and 11.5% (n=648), respectively. There were 925 participants (16.3%) with a family history of T2DM in their first-degree relatives. Multivariable analysis demonstrated that family history was associated with hyperglycemia. Among the 477 patients with T2DM, 40.9% had not been previously diagnosed. The predictive equation was calculated with the following logistic regression parameters with 0.71 (95% CI: 0.67-0.76) of the area under the ROC curve, 64.0% of sensitivity and 29% of specificity (P < 0.001): P = \frac{1}{1 + e^{-z}}, where z = -3.08 + [0.89 (Family history-group) + 0.69 (age-group)+ 0.25 (BMI-group)]. Positive family history was associated with the diagnosis of T2DM, but not glucose level in the diagnosed patients. The best cutoff value of incidence of diabetes in the first-degree relatives was 9.55% (P < 0.001).

Conclusions

Family history of diabetes was independently associated with glucose dysfunction. Classification by the first-degree relatives with diabetes is prominent for targeting high-risk population. Meanwhile, positive family history of diabetes was associated with diabetes being diagnosed rather than the glycemic control in patients who had been diagnosed. It's necessary to emphasize the linkage between early diagnosis and positive family history for high proportions of undiagnosed T2DM.

Speed of aging of populations by socioeconomics subgroups in China: A cross-sectional study of cognitive performance

Objectives

Although there is an association between socioeconomic factors and cognition, there are shortcomings in terms of examining the age of onset of decline between people with varying social backgrounds. This study aims to present the disparities in cognitive performance among older adults by simultaneously integrating health status, social characteristics, and age into an understandable metric.

Study design

This study is cross-sectional.

Methods

A sample of 3422 adults aged at least 60 was utilised from the 2015 wave of the China Health and Nutrition Survey to analyse the trajectories of cognitive ageing through the Characteristics approach. This approach generates an age-differential schedule whereby, as a hypothetical example, the cognition level Z of an individual aged 60 who has not completed schooling is demonstrated at age 66 by someone who has completed secondary schooling.

Results

There was an increasing advantage with cognitive performance as the level of education completed increased; men aged 61.9 with a primary level of schooling and those aged 67.8 with postsecondary qualifications exhibit the same cognition performance as those aged 60 with no completed schooling. The observation also suggested that cognition advantages diminish through age. In terms of income, the age-differential schedule follows a similar pattern. albeit lower outcomes, to that of education differentials.

Conclusion

When comparing education and income levels and their respective impacts on cognitive functioning, the former has been noted to have a larger effect. Education's effect has continuity in that it can influence opportunities until later ages.

Incidence of maternal venous thromboembolism in China: A systematic review and meta-analysis

BACKGROUND

Venous thromboembolism (VTE) is one of the primary causes of maternal death. Although many studies have reported maternal VTE, no study has estimated the incidence of it in China.

OBJECTIVES

The aim of this work was to estimate the incidence of maternal VTE in China and to compare the risk factors for it.

SEARCH STRATEGY

The authors searched eight platforms and databases including PubMed, Embase, and Cochrane Library from inception to April 2022, with the search terms "venous thromboembolism" AND "puerperium (pregnancy)" AND "incidence" AND "China."

SELECTION CRITERIA

Studies provide data to calculate the incidence of maternal VTE among Chinese patients.

DATA COLLECTION AND ANALYSIS

The authors made a standardized table to collect data and calculated the incidence and 95% confidence intervals (CIs), founding source of heterogeneity by subgroup analysis and meta-regression and judging publication bias by funnel plot and Egger test.

MAIN RESULTS

The included 53 papers with a total sample size of 3 813 871 patients had 2539 cases of VTE, and the incidence of maternal VTE in China was 0.13% (95% CI, 0.11-0.16; P < 0.001).

CONCLUSIONS

The trend in the incidence of maternal VTE in China is stable. Cesarean section and advanced age are associated with a higher incidence of VTE.

Prevalence of Cardioprotective Medication Use in Coronary Heart Disease Patients in South America: Systematic review and Meta-Analysis

Background:

Coronary heart disease (CHD) is the most common cause of death globally, and clinical guidelines recommend cardioprotective medications for patients with established CHD. Suboptimal use of these medications has been reported, but information from South America is scarce.

Methods:

We conducted a systematic review on prevalence of secondary prevention medication in South America. We pooled prevalence estimates, analysed time-trends and guideline compliance, and identified factors associated with medication use with meta-regression models.

Results:

73 publications were included. Medication prevalence varied by class: beta-blockers 73.4%(95%CI 66.8%–79.1%), ACEI/ARBs 55.8%(95%CI 49.7%–61.8), antiplatelets 84.6%(95%CI 79.6%–88.5%), aspirin 85.1%(95%CI 79.7%–89.3%) and statins 78.9%(95%CI 71.2%–84.9%). The use of beta-blockers, ACEI/ARBs and statins increased since 1993. Ten publications reported low medication use and nine reported adequate use. Medication use was lower in community, public and rehabilitation settings compared to tertiary centres.

Conclusion:

Cardioprotective medication use has increased, but could be further improved particularly in community settings.

Trehalose Ameliorates Diabetic Cardiomyopathy: Role of the PK2/PKR Pathway

Ample clinical case reports suggest a high incidence of cardiomyopathy in diabetes mellitus (DM). Recent evidence supports an essential role of trehalose (TLS) in cardiomyocyte survival signaling. Our previous study found that prokineticin2 (PK2) was involved in the process of diabetic cardiomyopathy (DCM). The present study examined the protective effects and mechanisms of TLS on DM-induced cardiomyocyte injury in mice and H9c2 cardiomyocytes. C57BL/6J mice were intraperitoneally injected with 50 mg·kg⁻¹·d⁻¹ streptozotocin for five consecutive days to establish an experimental diabetic model and then administered TLS (1 mg·g⁻¹·d⁻¹, i.p.) for two days every 4 weeks and given 2% TLS in drinking water for 24 weeks. Echocardiography, myocardial structure, apoptosis, pyroptosis, autophagy, and the PK2/PKR pathway were assessed. Cardiomyocytes exposed to high glucose (HG) were treated with TLS in the absence or presence of the PK2 antagonist PKRA7, and proteins involved in apoptosis, autophagy, and pyroptosis and the PK2/PKR pathways were evaluated using Western blot analysis. Diabetic mice demonstrated metabolic disorder, abnormal myocardial zymograms, and aberrant myocardial systolic and diastolic function, which were accompanied by pronounced apoptosis, pyroptosis, and dampened autophagy. TLS treatment relieved these effects. PK2 and receptor expressions were downregulated in diabetic mice, and TLS nullified this effect. PKRA7 eliminated the impact of TLS on cardiomyocytes. This evidence suggests that TLS rescues DM-induced myocardial function, pyroptosis, and apoptosis, likely via the PK2/PKR pathway.

Budget Impact of the Flash Continuous Glucose Monitoring System in Medicaid Diabetes Beneficiaries Treated with Intensive Insulin Therapy

Objective: We assessed the economic impact of using the newest flash continuous glucose monitoring (CGM) among Medicaid beneficiaries with diabetes treated with intensive insulin therapy (IIT). Research Design and Methods: A budget impact analysis was created to assess the impact of increasing the proportion of Medicaid beneficiaries with diabetes on IIT, who use flash CGM by 10%. The analysis included glucose monitoring device costs, cost savings due to reductions in glycated hemoglobin, severe hypoglycemia events, and hyperglycemic emergencies such as diabetic ketoacidosis. The net change in costs per person to adopt flash CGM for three populations treated with IIT (adults with type 1 diabetes [T1D] or type 2 diabetes [T2D], and children and adolescents with T1D or T2D) was calculated; these costs were used to estimate the impact of increasing flash CGM use by 10% to the U.S. Medicaid budget over 1-3 years. Results: The analysis found that flash CGM demonstrated cost savings in all populations on a per patient basis. Increasing use of flash CGM by 10% was associated with a $19.4 million overall decrease in costs over the year and continued to reduce costs by $25.3 million in years 2 and 3. Conclusions: Our results suggest that the new flash CGM system can offer cost savings compared to blood glucose monitoring in Medicaid beneficiaries treated with IIT, especially T1D adults, and children and adolescents. These findings support expanding access to CGM by Medicaid plans.

The effect of underlying inflammation on iron metabolism, cardiovascular risk and renal function in patients with type 2 diabetes

Aim

To investigate the impact of inflammation on iron metabolism, cardiovascular risk and renal function in type 2 diabetes (T2D).

Methods

A total of 50 patients with T2D were included in this study. The patients were stratified into two groups based on their levels of C-reactive protein (CRP), namely normal and high levels (n = 25/group). All laboratory tests were measured using standardised methods.

Results

Fasting plasma glucose levels were elevated in patients with high CRP when compared to those with normal levels (p = 0.0413). Total serum iron levels were lower in patients with high CRP levels (12.78 ± 3.50) when compared to those with normal levels (15.26 ± 4.64), p = 0.0381. However, ferritin and transferrin levels were comparable between the groups (p > 0.05). The mean cell volume (MCV) in the high CRP group was lower (87.66 ± 3.62) than the normal level group (90.79 ± 4.52), p = 0.0096, whilst the lipograms were similar (p > 0.05). The estimated glomerular filtration rate (eGFR) was lower in the high CRP group (98.06 ± 11.64) than the normal level group (104.7 ± 11.11), p = 0.046. Notably, CRP levels were negatively associated with serum iron levels (r = -0.38, p = 0.0061), MCV (r = -0.41, p = 0.0031), potassium (r = -0.37, p = 0.0086) and sodium levels (r = -0.28, p = 0.0471). Regression analyses showed that only CRP (β = -0.16, standard error [SE]: 0.06, p = 0.0125) and sodium (β = 0.51, SE: 0.25, p = 0.0434) levels contributed significantly to the prediction of serum iron levels.

Conclusion

Underlying inflammation in T2D is associated with increased incidence of hypertension and reduced levels of serum iron, MCV and renal function. Although there was no apparent clinical anaemia or renal dysfunction in these patients, mitigating inflammation may be effective in circumventing the ultimate development of iron deficiency anaemia and chronic kidney disease in T2D.

MicroRNA-140-5p ameliorates the high glucose-induced apoptosis and inflammation through suppressing TLR4/NF-κB signaling pathway in human renal tubular epithelial cells

Hyperglycemia-induced renal tubular cell injury is thought to play a critical role in the pathogenesis of diabetic nephropathy (DN). However, the role of miRNAs in renal tubular cell injury remains to be fully elucidated. The aim of the present study was to investigate the role and mechanisms of miRNAs protecting against high glucose (HG)-induced apoptosis and inflammation in renal tubular cells. First, we analyzed microRNA (miRNA) expression profiles in kidney tissues from DN patients using miRNA microarray. It was observed that miRNA-140-5p (miR-140-5p) was significantly down-regulated in kidney tissues from patients with DN. An inverse correlation between miR-140-5p expression levels with serum proteinuria was observed in DN patients, suggesting miR-140-5p may be involved in the progression of DN. HG-induced injury in HK-2 cells was used to explore the potential role of miR-140-5p in DN. We found that miR-140-5p overexpression improved HG-induced cell injury, as evidenced by the enhancement of cell viability, and inhibition of the activity of caspase-3 and reactive oxygen species (ROS) generation. It was also observed that up-regulation of miR-140-5p suppressed HG induced the expressions of pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 in HK-2 cells. In addition, TLR4, one of the upstream molecules of NF-κB signaling pathway, was found to be a direct target of miR-140-5p in the HK-2. Moreover, the HG-induced activation of NF-κB signaling pathway was inhibited by miR-140-5p overexpression. These results indicated that miR-140-5p protected HK-2 cells against HG-induced injury through blocking the TLR4/NF-κB pathway, and miR-140-5p may be considered as a potential prognostic biomarker and therapeutic target in the treatment of DN.

Factors associated with the utilization of community-based diabetes management care: A cross-sectional study in Shandong Province, China

Background

Community-based diabetes management is known to be an important strategy for global diabetes control. In China, community-based diabetes management care, including regular blood glucose tests and guidance on medicine use, dietary control, and physical exercise provided by primary health institutions (PHIs), as one of the key contents of the national essential public health services (EPHS), was implemented since 2009 when the new round of health system reform was initiated. This study aimed to investigate the utilization of community-based diabetes management care services, and explore the factors influencing utilization from both patients’ and providers’ points of view.

Methods

In total, 2520 type-2 diabetes mellitus (DM) patients registered for EPHS were selected from 63 PHIs in eight counties of Shandong province, China, using multi-stage stratified sampling. Of those, 2166 patients (response rate: 85.4%) completed face-to-face structured questionnaires on their utilization of community-based diabetes management care services. Further, 63 PHIs were surveyed on diabetes care delivery, and 444 primary healthcare providers were purposively sampled from those PHIs to measure their knowledge of diabetes management care delivery, using a self-developed questionnaire. Descriptive statistics were used to analyze the delivery and utilization of diabetes management care services. Multilevel logistic regression models were used to analyze the factors associated with patients’ utilization of diabetes management services.

Results

All 63 PHIs reported that all the required four diabetes management services were provided through EPHS. However, only 49.6% of the patients reported they fully used these services, with no statistically significant difference between urban and rural patients. Patients who had higher knowledge of diabetes and better self-efficacy in controlling the condition, were more likely to fully utilize diabetes management care. A larger number of PHI health staff per 1000 population was associated with better utilization of care.

Conclusion

Although community-based diabetes management services are well available to Chinese DM patients under the framework of EPHS, the actual utilization of diabetes management services among the patients was poor. The size of the PHI workforce, patients’ knowledge and self-efficacy in controlling diabetes, were important predictors of utilization, and could be enhanced to improve control of diabetes.

Efficacy and safety of ertugliflozin in East/Southeast Asian patients with type 2 diabetes mellitus

AIM

Post-hoc analysis of the efficacy and safety of ertugliflozin in East/Southeast (E/SE) Asian patients with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Efficacy evaluations used data from randomized, double-blind, phase 3 studies: a pool of two 26-week placebo-controlled studies and one 52-week active-comparator (glimepiride) study. Least squares mean change from baseline was calculated for HbA1c, fasting plasma glucose (FPG), body weight (BW) and systolic blood pressure (SBP). Safety evaluation included overall and prespecified adverse events based on pooled data (broad pool) from seven phase 3 studies (including studies in the efficacy analysis).

RESULTS

Among 161 E/SE Asian patients in the placebo pool (ertugliflozin, n = 106), ertugliflozin reduced HbA1c, FPG, BW and SBP from baseline at week 26. The placebo-adjusted changes from baseline for ertugliflozin 5 and 15 mg were: HbA1c, -0.9% and -1.0%; BW, -2.1 and -1.9 kg; and SBP, -3.3 and -3.5 mmHg, respectively. Among 174 E/SE Asian patients in the active-comparator study (ertugliflozin, n = 118), HbA1c changes from baseline at week 52 were -0.6%, -0.6% and -0.7% for ertugliflozin 5 mg, 15 mg and glimepiride, respectively. Ertugliflozin 5 and 15 mg reduced BW from baseline by -4.3 and -4.1 kg, respectively, and SBP by -7.4 and -9.3 mmHg, respectively, compared with glimepiride. Safety findings were generally consistent with overall ertugliflozin safety data published to date.

CONCLUSIONS

Treatment with ertugliflozin was associated with reductions in HbA1c, FPG, BW and SBP, and was generally well tolerated in E/SE Asian patients with T2DM. ClinicalTrials.gov identifier: NCT01986855, NCT01999218, NCT01958671, NCT02099110, NCT02036515, NCT02033889, NCT02226003.

The prevalence of undiagnosed type 2 diabetes and prediabetes in Eastern Mediterranean region (EMRO): A systematic review and meta-analysis

BACKGROUND

Previous studies of diabetes in Eastern Mediterranean Region (EMRO) did not assess the prevalence of either unknown diabetes or prediabetes. We conducted a systematic review and meta-analysis to estimate the prevalence of undiagnosed type 2 diabetes and prediabetes as well as variations by region in EMRO, using the relevant publications since 2000.

METHODS

We carried out a comprehensive electronic search on electronic databases from January 1, 2000 to March 1, 2018. We selected cross-sectional and cohort studies reporting the prevalence of undiagnosed type 2 diabetes, prediabetes, or both. Two independent reviewers initially screened the eligible articles; then, synthesized the target data from full papers. Random- or fixed-effect models, subgroup analysis on Human Development Index (HDI), and publication year and sensitivity analysis to minimize the plausible effect of outliers were used.

RESULTS

Amongst 849 identified citations, 55 articles were entered into meta-analysis, involving 567,025 individuals. The forest plots estimated 5.46% (confidence intervals [CI]: 4.77-6.14) undiagnosed diabetic and 12.19% (CI: 10.13-14.24) prediabetics in EMRO. Low HDI countries and high HDI countries had the highest (7.25%; CI: 4.59-9.92) and the lowest (3.98%; CI: 3.11-4.85) undiagnosed diabetes prevalence, respectively. Very high HDI countries and low HDI countries had the highest (13.50%; CI: 8.43-18.57) and the lowest (7.45%; 1.20-13.71) prediabetes prevalence, respectively. In addition, meta-regression analysis showed a statistically significant association between publication year and prevalence of prediabetes (Reg Coef = 0.059, P = 0.014). But such finding was not observed for undiagnosed diabetes and publication year (Reg Coef = 0.034, P = 0.124), prediabetes and HDI (Reg Coef = 0.128, P = 0.31) and undiagnosed diabetes and HDI (Reg Coef = - 0.04, P = 0.96).

CONCLUSION

The prevalence of undiagnosed diabetes and prediabetes was high and increasing. The notion of universal health coverage is a priority; that is the integration of the primary, secondary and tertiary health levels, as well as employing the available action plans. Therefore, future studies, using identical screening tool and diagnostic criteria, are warranted to make an accurate picture of diabetes in EMRO.

The cost-effectiveness of metformin in pre-diabetics: a systematic literature review of health economic evaluations

Objectives: Our aim was to systematically identify and appraise cost-effectiveness studies of metformin in prediabetic subjects.Methods: A systematic literature review was conducted and reported according to standard guidlines. The search was conducted in PubMed, Embase, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) presentation database and the Cost-Effectiveness Analysis (CEA) and Center for Reviews and Dissemination (CRD) registries. All cost-effectiveness studies assessing metformin in prediabetic patients were included.Results: Twenty-three reports were included. Metformin and intensive lifestyle changes (ILC) interventions were always cost-effective compared to placebo. ILC was cost-effective and sometimes dominant compared to metformin. Metformin was cost-saving compared to ILC in the short and medium-term. Although, in the long term, metformin was more expensive than ILC in terms of direct medical costs, when indirect non-medical costs are included, metformin less expensive than ILC. One study reported that for patients with Body Mass Index (BMI) higher than 30 kg/m2, metformin is a cost-effective strategy compared to placebo and ILC. However, this finding was not confirmed by other retrieved studies.Conclusion: ILC is cost-effective compared to metformin and, both of them are cost-effective compared to placebo. Metformin may be cost-saving in the short- to medium-term and possibly in the long-term.

Safety and efficacy of ertugliflozin in Asian patients with type 2 diabetes mellitus inadequately controlled with metformin monotherapy: VERTIS Asia

AIM

Phase III, randomized, double-blind study evaluating the efficacy and safety of ertugliflozin in Asian patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin, including evaluation in the China subpopulation.

MATERIALS AND METHODS

A 26-week, double-blind study of 506 Asian patients (80.2% from mainland China), randomized 1:1:1 to placebo, ertugliflozin 5- or 15 mg, was performed. Primary endpoint was change from baseline in HbA1c at week 26. Secondary endpoints were change from baseline at week 26 in fasting plasma glucose (FPG), body weight (BW), systolic/diastolic blood pressure (SBP/DBP), and proportion of patients with HbA1c <7.0%. Hypotheses for the primary endpoint and FPG and BW secondary endpoints were tested in the China subpopulation.

RESULTS

At week 26, least squares mean (95% CI) change from baseline HbA1c was significantly greater with ertugliflozin 5- and 15 mg versus placebo: -1.0% (-1.1, -0.9), -0.9% (-1.0, -0.8), -0.2% (-0.3, -0.1), respectively. Ertugliflozin significantly reduced FPG, BW and SBP. Reductions in DBP with ertugliflozin were not significant. At week 26, 16.2%, 38.2% and 40.8% of patients had HbA1c <7.0% with placebo, ertugliflozin 5- and 15 mg, respectively. 59.3%, 56.5% and 53.3% of patients experienced adverse events with placebo, ertugliflozin 5- and 15 mg, respectively. Incidence of symptomatic hypoglycaemia was higher for ertugliflozin 15 mg vs placebo. Results in the China subpopulation were consistent.

CONCLUSIONS

Ertugliflozin significantly improved glycaemic control and reduced BW and SBP in Asian patients with T2DM. Ertugliflozin was generally well-tolerated. Results in the China subpopulation were consistent with the overall population. ClinicalTrials.gov: NCT02630706.

Sex-Based Differences in Diabetes Prevalence and Risk Factors: A Population-Based Cross-Sectional Study Among Low-Income Adults in China

Aims: The prevalence of diabetes mellitus (DM) among adults has reached epidemic proportions worldwide, including China. In China, sex-based differences in the prevalence and risk factors of DM may exist, particularly among low-income individuals. Thus, we assessed these differences in the prevalence of DM and its risk factors in a low-income Chinese population. Materials and Methods: Residents aged ≥45 years without histories of strokes or cardiovascular disease were recruited for this study. Multivariate logistic regression analyses were performed to assess the association of risk factors with DM prevalence. Results: This study included 3,725 participants (41.2%, men; 58.8%, women). The mean age of the women (61.12 years) was higher than that of the men (59.14 years, P < 0.001). There was no significant sex-based difference in DM prevalence (men, 14.1%; women, 14.5%). Overweight, obesity, high triglyceride levels, and hypertension were independent risk factors for DM in both sexes. However, high-density lipoprotein-cholesterol levels were negatively associated with DM risk among men [odds ratio (OR), 0.544; 95% confidence interval (CI), 0.355-0.833; P = 0.005]. Among women, advanced age and high low-density lipoprotein-cholesterol levels were independent risk factors for DM; there was a higher DM risk for women aged 55-74 years than for those aged 45-54 years; however, physical activity was associated with an increased risk of DM (OR, 1.705; 95% CI, 1.195-2.432; P = 0.003). Conclusions: These findings suggest a crucial need to implement individualized blood pressure, weight, and lipid managements in low-income populations in China to reduce the burden of DM, especially among older women.

Insulin Injection Technique in China Compared with the Rest of the World

INTRODUCTION

Approximately 9 million people in China use insulin but little is known of their injection techniques (IT). Our aim was to understand IT in China via direct examination and a detailed survey.

METHODS

Injection Technique Questionnaire (ITQ) results of 3853 patients from 20 representative centers in China were compared with the Rest of World (ROW).

RESULTS

Insulin pens are used by 92% of Chinese insulin injectors, with > 3/4 using 4- or 5-mm pen needles. This is consistent with Chinese BMI values (and thus subcutaneous fat thickness) being lower than in ROW, raising the risk of IM (intramuscular) injections with longer needles. Total daily insulin dose is ~ 33 IU in China vs. 45 IU elsewhere. Lipohypertrophy (LH) rates are lower than in ROW, but still found in at least 25% of Chinese patients. Patients apparently do not realize they have LH or are unaware of the hazards of injecting into LH since many of them do so, and those who do use a mean of 11 IU more of insulin than non-LH patients. This incremental insulin use possibly costs the Chinese health care service around 2 billion RMB annually. Needle reuse is also frequent in China (78% vs. 48% ROW), and the high cost of pen needles is the main reason patients cite for reusing (25% use a single needle > 10×).

CONCLUSION

This study reveals many areas in which Chinese professionals and patients can optimize injection practices and thereby improve outcomes and reduce costs. The official guidelines of the Chinese Diabetes Society, based on the FITTER recommendations, offer a roadmap for reaching this goal.

FUNDING

BD Diabetes Care. Plain language summary available for this article.

Why patients prefer high-level healthcare facilities: a qualitative study using focus groups in rural and urban China

INTRODUCTION

Despite policy measure to strengthen and promote primary care, Chinese patients increasingly choose to access higher level hospitals. The resulting overcrowding at higher level hospitals and underutilisation of primary care are viewed to diminish the effects of the continuing health system investments on population health. We explore the factors that influence the choice of healthcare facility level in rural and urban China and aim to reveal the underlying choice processes.

METHODS

We conducted eight semistructured focus group discussions among the general population and the chronically ill in a rural area in Chongqing and an urban area in Shanghai. Respondents' discussions of (evidence-based) factors and how they influenced their facility choices were analysed using qualitative analysis techniques, from which we elicited choice process maps to capture the partial order in which the factors were considered in the choice process.

RESULTS

The factors considered, after initial illness perception, varied over four stages of health service utilisation: initial visit, diagnosis, treatment and treatment continuation. The factors considered per stage differed considerably between the rural and urban respondents, but less so between the general population and the chronically ill. Moreover, the rural respondents considered the township health centres as default and prefer to continue in primary care, yet access higher levels when necessary. Urban respondents chose higher levels by default and seldom moved down to primary care.

CONCLUSIONS

Disease severity, medical staff, transportation convenience, equipment and drug availability played important roles when choosing healthcare facilities in China. Strengthening primary care correspondingly may well be effective to increase primary care utilisation by the rural population but insufficient for the urban population. The developed four-stage process maps are general enough to serve as the basis for (partially) ordering factors influencing facility level choices in other contexts.

Liver Enzymes, Fatty Liver and Type 2 Diabetes Mellitus in a Jinchang Cohort: A Prospective Study in Adults

OBJECTIVES

It is unclear whether liver enzymes or the interactions of various liver enzymes is a predictor of type 2 diabetes mellitus (T2DM), which is independent of fatty liver.

METHODS

A total of 48,001 subjects participated in baseline examinations. Among the subjects, 33,355 were followed for an average of 2.2 years. Cox proportional hazard models were used to examine the adjusted associations of AST, GGT and ALT with T2DM.

RESULTS

The cumulative incidence of T2DM was 8.05% to 9.02% for fatty liver and 2.25% to 4.10% for non-fatty liver, both showing statistically significant differences. Compared with the normal liver enzyme levels in the group with fatty liver, the adjusted incident hazard ratios in T2DM were: ALT 1.23 (95% CI 1.10 to 1.50); AST 1.30 (95% CI 1.07-1.59); and GGT 1.34 (95% CI 1.08 to 1.65). In addition, compared with the normal liver enzyme levels in the group with non-fatty liver, the adjusted incident hazard ratios in type 2 diabetes were: ALT 1.27 (95% CI 1.02 to 1.59); AST 1.33 (95% CI 1.02 to 1.59); and GGT 1.53 (95% CI 1.19 to 1.98). There are significant interactions of T2DM hazard ratios between GGT and ALT and between GGT and AST in addition to ALT and AST.

CONCLUSIONS

Our results suggest that the incidence of T2DM in the group with fatty liver is significantly higher than that in the normal population, and the rise of serum AST, GGT and ALT levels are risk factors independent of fatty liver for the development of T2DM after adjusting for confounding factors.

Prevalence and treatment of diabetes mellitus and hypertension among older adults with intellectual disability in comparison with the general population

BACKGROUND

Diabetes mellitus and hypertension are risk factors for cardiovascular disease, which is the most common cause of death in the world. People with intellectual disability (ID) have been reported to have high rates of both these disorders. The aim of this study was to describe and compare prevalence ratios of diabetes mellitus and hypertension between older adults with ID and their age peers in the general population, and to describe and compare treatment patterns in these two groups.

METHODS

This is a Swedish register-based study, in which we established a cohort of people aged 55+ years and who had received support for those with ID in 2012 (n = 7936). We also established a same-sized referent cohort from the general population matched by sex and year of birth. Information on diagnoses of diabetes mellitus and hypertension, and prescription of drugs for these disorders, were collected from national registers for the period 2006-2012. The two cohorts were compared using generalized linear models (GLM).

RESULTS

People with ID were 20% more likely than the general population to have a diagnosis of diabetes mellitus, and 26% more likely to have prescription of drugs for diabetes mellitus. People in the general population were 81% more likely to have a diagnosis of hypertension, and 9% more likely to have a prescription of drugs for hypertension. Among those with diabetes, ID was associated with higher occurrence of prescription of insulin combination drugs and sulfonylureas, but lower occurrence of prescription of dipeptidyl peptidase (DPP) 4-inhibitors and exenatide/liraglutide. Among those with hypertension, ID was associated with higher occurrence of prescription of diuretics, but lower occurrence of prescription of calcium channel blockers and angiotensin II antagonists.

CONCLUSIONS

Treatment regimens among people with ID tended to include older types of medication compared with what was prescribed in the general population. To ensure that this is medically appropriate and not due to failure to update the treatment regimen, it is important to investigate if the people with ID and diabetes mellitus or hypertension are subjected to the same regular drug reviews that are recommended for older adults in general.

Prevalence, Awareness and Associated Risk Factors of Diabetes among Adults in Xi'an, China

The study aimed to investigate the prevalence, awareness, treatment and glycaemic control of diabetes and its associated risk factors among adults in Xi’an, China. We collected data among participants aged 18 years or older through a self-developed questionnaire and an additional health examination. A total of 8150 participants were included, with an overall prevalence of diabetes of 8.0%. Among 655 participants with diabetes, 52.5% were aware they had diabetes, 48.1% took antidiabetic treatment, and 19.1% had their fasting blood glucose level at less than 7.0 mmol/l. Older age, lower educational level, higher body mass index, larger waist circumference, having an unhealthy diet and having more comorbidities were positively associated with the risk of diabetes. Participants who were older, who had higher education and who had more comorbidities were more aware that they had diabetes. Being older age, having higher education and having more comorbidities were also factors for better treatment. Participants who were older were more likely to have their glucose level controlled. The prevalence of diabetes among adults in Xi’an is high, with suboptimal awareness, treatment, and glycaemic control rates. Comprehensive integrated strategies based on risk factors should be implemented to improve the prevention and glycaemic control of diabetes.

Association between Toenail Magnesium and Type 2 Diabetes in Chinese Adults

Previous studies have showed an inverse association between magnesium level and type 2 diabetes, but the results are inconsistent, and the evidence relates only to dietary and serum magnesium. Moreover, it is not certain how these findings are applicable to Asian people. This study was designed to examine the association between toenail magnesium and type 2 diabetes in Chinese adults. The sample was 5683 adults aged 18 years or older from the 2009 China Health and Nutrition Survey. We used hemoglobin A1c equal to or greater than 6.5% as the diagnostic criterion for type 2 diabetes. Inductively coupled plasma–mass spectrometry determined toenail magnesium. Mean toenail magnesium in participants with and without type 2 diabetes was 263.0 ± 170.9 and 282.3 ± 191.9 micrograms per gram, respectively. The multivariable-adjusted odds ratio for type 2 diabetes comparing the highest to the lowest quartile of toenail magnesium was 0.72 (95% confidence interval, 0.52–0.99). We found a statistically significant interaction between toenail magnesium and geographic region on the prevalence of type 2 diabetes (p for interaction = 0.009). Our findings suggest that toenail magnesium is inversely associated with the prevalence of type 2 diabetes. Promoting the intake of magnesium-rich foods may bring considerable benefits for the prevention of type 2 diabetes, especially in those at high risk.

Secular trends in the prevalence of type 2 diabetes in adults in China from 1995 to 2014: A meta-analysis

BACKGROUND

The aim of the present study was to estimate trends in the prevalence of type 2 diabetes mellitus (T2DM) in adults in China.

METHODS

A systematic search was conducted for studies of T2DM prevalence in adults in China from 2000 to 2014. Pooled prevalence was calculated by a random-effects model. Subgroup and sensitivity analyses were performed. Chi-squared and Cochran-Mantel-Haenszel tests were used to assess differences among subgroups and pooled prevalence, respectively.

RESULTS

Forty-six studies (data from 1995 to 2014; 1 463 079 adults) were included in the meta-analysis. The overall prevalence of T2DM was 7.9 %. The pooled prevalence overall and by location (urban and rural), gender (male and female), and age category (18-39, 40-59, and ≥60 years) was 4.5 %, 5.1 % and 3.0 %, 4.0 % and 4.2 %, and 1.4 %, 5.0 %, and 10.3 %, respectively, from 1995 to 1999; 6.6 %, 9.3 % and 5.6 %, 7.4 % and 7.5 %, and 1.8 %, 5.9 %, and 12.4 %, respectively, from 2000 to 2004; 10.3 %, 11.8 % and 6.8 %, 10.0 % and 8.6 %, and 2.8 %, 10.3 %, and 20.0 %, respectively, from 2005 to 2009; and 8.3 %, 12.5 % and 7.6 %, 8.6 % and 8.0 %, and 3.5 %, 8.5 %, and 15.3 %, respectively, from 2010 to 2014. The prevalence increased from 5.8 % to 11.6 % with per-capita gross domestic product and differed by diagnostic criteria.

CONCLUSIONS

There was a trend of increasing prevalence of T2DM in adults in China from 1995 to 2009, with a decrease in 2010-14 and a greater increase over time in urban versus rural areas, males versus females, and older versus younger adults.

Prevalence of cardiovascular medication on secondary prevention after myocardial infarction in China between 1995-2015: A systematic review and meta-analysis

BACKGROUND

Myocardial Infarction (MI) has become a major cause of morbidity and mortality in China, but little is known about the prevalence of guideline-recommended cardiovascular medications after MI events over the last two decades. This systematic review and meta-analysis aims to summarize cardiovascular medication use between 1995-2015 and to assess factors in associated with the trends in cardiovascular medications.

METHOD

A systematic search was conducted in four databases (Pubmed, Embase, CENTRAL, and CNKI) to obtain observational studies published between 1995 and 2015, reporting on the use of cardiovascular medications in China. Risk of bias of individual studies was appraised and selected studies were pooled for estimated prevalence of cardiovascular medication. Prevalence of cardiovascular medication use for 1995 and 2015 was estimated by random effects meta-regression model.

RESULTS

From 13,940 identified publications, 35 studies, comprising 28,000 patients, were included. The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, ACE-Inhibitor/ARBs and nitrates was 92% [95% confidence interval (CI): 0.89-0.95], 63% (95% CI: 0.57-0.69), 72% (95% CI: 0.60-0.82), 49% (95% CI: 0.41-0.57), 59% (95% CI: 0.48-0.69) and 79% (95% CI: 0.74-0.91), respectively. A significant increase in beta-blocker and statin use and a decrease of nitrate use was observed over time. The estimated prevalence of beta-blockers, statins, and nitrates was 78%, 91.1%, and 59.3% in 2015, compared to 32%, 17% and 96% in 1995, respectively.

CONCLUSION

Cardiovascular medication use after MI is far from optimal in Chinese patients, even though the prevalence of use increased over the period 1995-2015. With a rapidly increasing number of MI patients in China, a comprehensive strategy on secondary prevention is warranted.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42015025246).

The prevalence of thalassemia in mainland China: evidence from epidemiological surveys

Comprehensive data regarding the epidemiology and prevalence of thalassemia in mainland China are lacking. To assess the prevalence of thalassemia, we performed a meta-analysis including 16 articles published from 1981 to 2015. The overall prevalence of α-thalassemia, β-thalassemia and α + β-thalassemia was 7.88%, 2.21% and 0.48%, respectively. Trends in thalassemia prevalence in mainland China were not steady; a prevalence map based on a geographic information system (GIS) showed that the geographic distribution of thalassemia was highest in the south of China and decreased from south to north. Additionally, the most common α- and β-globin gene mutation was --^SEA and CD41/42, respectively. The current study provides valuable information regarding epidemiology and intervention and supports the planning, implementation and management of prevention programmes for public health.

Occupational metal exposures, smoking and risk of diabetes and prediabetes

BACKGROUND

Metal exposure and tobacco smoking have been independently associated with diabetes, but no study has been conducted to investigate the interaction between them on the risk of diabetes.

AIMS

To investigate the effect of occupational exposure to metals, and potential effect modification by smoking, on the risk of diabetes and prediabetes in a cohort of Chinese male workers.

METHODS

We assessed metal exposure and tobacco smoking at baseline in the Jinchang Cohort of male workers. We used Poisson regression analyses to estimate the interaction between smoking and metal exposures based on occupations, which we grouped according to the measured urinary metal levels.

RESULTS

Among the 26008 study subjects, compared with non-smokers, the adjusted prevalence ratio (PR) for diabetes was 1.8 [95% confidence interval (CI) 1.3-2.4] for smokers of >40 pack-years. The adjusted PRs were 1.2 (95% CI 1.1-1.4) among mining/production workers and 2.7 (95% CI 2.4-3.0) among smelting/refining workers, both compared with office workers. There was significant effect modification under the additive model between smoking and metal exposure on the prevalence of diabetes (Pinteraction = 0.001), with an adjusted PR of 3.6 (95% CI 2.4-5.4) for those with >40 pack-years of smoking who had the highest metal exposures, whereas no significant interaction was observed for prediabetes.

CONCLUSIONS

Both exposure to metals and heavy smoking were associated with an increased prevalence of diabetes in this large cohort of male workers. There was also strong interaction between these two exposures in affecting diabetes risk that should be confirmed in future studies.

Epidemic trend of periodontal disease in elderly Chinese population, 1987-2015: a systematic review and meta-analysis

Periodontal disease is a common oral health problem in the elderly population. The prevalence varied substantially due to absence of a universal diagnostic criteria. We conducted a systematic review to identify the epidemiological characteristics of periodontal diseases among Chinese elderly people. A total of 19 articles were included. The pooled detection rates for three indicators, including bleeding on probing (BOP), pocket depth (PD) and clinical attachment loss (CAL), were 53.9% (95% CI: 43.8-63.9%), 57.0% (50.8-63.2%), and 70.1% (65.4-74.8%), respectively. No significant differences in these indicators between urban and rural population. When stratified by gender, BOP (+) detection rates did not show any differences, but the detection rates of PD ≥ 4 mm and CAL ≥ 4 mm were significantly higher in males than in females (59.3% [53.4-65.2%] versus 50.8% [43.5-58.0%], RRPD = 1.13 [1.01-1.26]; 73.8% [70.0-77.7%] versus 65.2% [60.2-70.2%], RRCAL = 1.21 [1.11-1.32]). No statistically significant differences were observed between CAL ≥ 4 mm and PD ≥ 4 mm (RR = 1.12, [0.83-1.50]). A geographical map based on available data during 1987-2015 showed wide variations of periodontal disease across the mainland China. Some factors such as heterogeneity of case definitions, no specific diagnosis of periodontitis, and variable quality of the included studies could affect the final results. Hence, further high-quality epidemiological studies with standardized diagnostic criteria are needed.

The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis

Background

The global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them.

Objective

The aim of this study was to calculate the average point incidence of PPH in women with placenta previa.

Methods

A systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard.

Results

From 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8–28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%).

Conclusions

The summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies.

The Dynamics of Type 2 Diabetes Mellitus Prevalence and Management Rates among Rural Population in Henan Province, China

The aim of this study was to estimate the dynamics of type 2 diabetes mellitus (T2DM) prevalence and management rates based on a rural cohort study in Henan Province of China. The rural prospective study was conducted for 20194 Chinese population ≥18 years in 2007-2008 and followed during 2013-2014. A total of 14009 individuals were recruited for the prospective analysis ultimately. Over 5.74 years of follow-up, the age-standardized prevalence, awareness, treatment, and control of T2DM increased from 6.18%, 44.41%, 34.39%, and 19.08% at baseline to 7.87%, 59.64%, 52.17%, and 26.52% at follow-up in total population, respectively. Similar changes were found in men and women except the age-standardized control in men. The four parameters of T2DM were higher among various factors at follow-up than those at baseline. There was no statistical difference in awareness (P = 0.089) and treatment (P = 0.257) in the newly diagnosed T2DM compared with the rates at baseline. The current study indicated that the prevalence, awareness, treatment, and control of T2DM displayed chronological increasing trends while the awareness, treatment, and control of T2DM were still disproportionally low in central China. More works are needed urgently to popularize public health education and improve the quality of medical care in T2DM.

Additive Interaction of MTHFR C677T and MTRR A66G Polymorphisms with Being Overweight/Obesity on the Risk of Type 2 Diabetes

Although both methylenetetrahydrofolate reductase (MTHFR) C677T and methionine synthase reductase (MTRR) A66G polymorphisms have been associated with type 2 diabetes (T2D), their interactions with being overweight/obesity on T2D risk remain unclear. To evaluate the associations of the two polymorphisms with T2D and their interactions with being overweight/obesity on T2D risk, a case-control study of 180 T2D patients and 350 healthy controls was conducted in northern China. Additive interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). After adjustments for age and gender, borderline significant associations of the MTHFR C677T and MTRR A66G polymorphisms with T2D were observed under recessive (OR = 1.43, 95% CI: 0.98-2.10) and dominant (OR = 1.43, 95% CI: 1.00-2.06) models, respectively. There was a significant interaction between the MTHFR 677TT genotype and being overweight/obesity on T2D risk (AP = 0.404, 95% CI: 0.047-0.761), in addition to the MTRR 66AG/GG genotypes (RERI = 1.703, 95% CI: 0.401-3.004; AP = 0.528, 95% CI: 0.223-0.834). Our findings suggest that individuals with the MTHFR 677TT or MTRR 66AG/GG genotypes are more susceptible to the detrimental effect of being overweight/obesity on T2D. Further large-scale studies are still needed to confirm our findings.

Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis

BACKGROUND

The prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001.

METHODS

A critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001-2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time.

RESULTS

Factors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts.

CONCLUSIONS

This study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.

Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

AIM

To synthesize the effects of theory-based self-management educational interventions on patients with type 2 diabetes (T2DM) in randomized controlled trials.

BACKGROUND

Type 2 diabetes is a common chronic disease causing complications that put a heavy burden on society and reduce the quality of life of patients. Good self-management of diabetes can prevent complications and improve the quality of life of T2DM patients.

DESIGN

Systematic review with meta-analysis of randomized controlled trials following Cochrane methods.

DATA RESOURCES

A literature search was carried out in the MEDLINE, EMBASE, CINAHL, PSYCINFO, and Web of Science databases (1980-April 2015).

REVIEW METHODS

The risk of bias of these eligible studies was assessed independently by two authors using the Cochrane Collaboration's tool. The Publication bias of the main outcomes was examined. Statistical heterogeneity and random-effects model were used for meta-analysis.

RESULTS

Twenty studies with 5802 participants met the inclusion criteria. The interventions in the studies were based on one or more theories which mostly belong to mid-range theories. The pooled main outcomes by random-effects model showed significant improvements in HbA1c, self-efficacy, and diabetes knowledge, but not in BMI. As for quality of life, no conclusions can be drawn as the pooled outcome became the opposite with reduced heterogeneity after one study was excluded. No significant publication bias was found in the main outcomes.

CONCLUSION

To get theory-based interventions to produce more effects, the role of patients should be more involved and stronger and the education team should be trained beyond the primary preparation for the self-management education program.

Changes in adiposity in an older Chinese population in rapid economic transition

OBJECTIVE

To examine the changes in body mass index (BMI) and waist circumference (WC) in Guangzhou, South China, which is probably experiencing the most rapid economic transition in history.

METHODS

In this study, 17,786 Chinese aged 50+ years were recruited from 2003 to 2008 and followed up until 2012. BMI and WC were measured at two time points.

RESULTS

During the mean follow-up of 3.6 years (median = 3, interquartile = 1), age-adjusted mean BMI increased only slightly. By contrast, mean WC increased sharply by 0.94 cm (95% confidence interval 0.93-0.94) annually in men and 1.29 cm (1.28-1.29) annually in women. In 77% of women and 69% of men, WC increased, and among them, the mean annual increase was 2.01 cm and 1.70 cm, respectively. Among healthy, never-smoking participants, the incidence of central obesity was 29.0% (36.4% in women and 14.2% in men). The incidence of general obesity was 1.9% and was similarly low in both men and women (2.1% vs. 1.8%). Conversely, 20.3% of individuals with general obesity became nonobese, and 12.8% of individuals with central obesity returned to normal.

CONCLUSIONS

Central obesity has risen sharply in this cohort. Such increases may have been greatly underestimated previously and should form the basis of an even stronger warning for regions undergoing economic transitions in China and elsewhere.

Traditional Risk Factors for Stroke in East Asia

Stroke is one of the leading causes of death and morbidity worldwide. The occurrence of stroke is strongly dependent on well-known vascular risk factors. After rapid modernization, urbanization, and mechanization, East Asian countries have experienced growth in their aged populations, as well as changes in lifestyle and diet. This phenomenon has increased the prevalence of vascular risk factors among Asian populations, which are susceptible to developing cardiovascular risk factors. However, differing patterns of stroke risk factor profiles have been noted in East Asian countries over the past decades. Even though the prevalence of vascular risk factors has changed, hypertension is still prevalent and the burden of diabetes and hypercholesterolemia will continue to increase. Asia remains a high tobacco-consuming area. Although indicators of awareness and management of vascular risk factors have increased in many East Asian countries, their rates still remain low. Here we review the burdens of traditional risk factors, such as hypertension, diabetes, hypercholesterolemia, and smoking in East Asia. We will also discuss the different associations between these vascular risk factors and stroke in Asian and non-Asian populations.

The Diabetes Epidemic in Korea

Diabetes is one of the foremost public health issues worldwide that can lead to complications in many organ systems, and has become a significant cause of morbidity and mortality in Korea. According to data from the National Health Insurance Service (NHIS), about 2.7 million Koreans (8.0%) aged 30 years or older had type 2 diabetes mellitus (T2DM) in 2013. The prevalence of T2DM increased with age and rose from 5.6% in 2006 to 8.0% in 2013. Using data based on The Health Screening Service of the NHIS, 25% of Korean adults were reported to have prediabetes in 2013. The prevalence of an impaired fasting glucose tended to increase over time from 21.5% in 2006 to 25.0% in 2013. Even though nationwide health screening has been regularly conducted as a public service, the proportion of undiagnosed cases of diabetes was still reported to be on the higher side in the latest study. Based on the results of these epidemic studies, further actions will be needed to effectively implement lifestyle changes on a social level and increase measures for the early detection of diabetes to stem the tide of the epidemic.

Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus

AIM

To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender.

RESULTS

Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95%CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95%CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95%CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%CI, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR.

CONCLUSION

Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR.

Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015

Although anxiety disorders (ADs) have been recognized as one of the most prevalent mental disorders in mainland China, the prevalence of ADs has not been reported until now. The lack of a consolidated and comparable review on the prevalence of ADs in mainland China necessitated this meta-analysis to measure the prevalence. To identify the relevant studies on ADs for the analysis, we searched published studies in electronic databases up to July 2015. The pooled prevalence in the overall population and the prevalences by gender and location were estimated. A total of 21 studies were included in the analysis. The pooled current/lifetime prevalences of ADs, generalized AD, non-specific AD, panic disorder, social phobia, agoraphobia, specific phobia, post-traumatic stress disorder, and obsessive-compulsive disorder were 24.47‰/41.12‰, 5.17‰/4.66‰, 8.30‰/6.89‰, 1.08‰/3.44‰, 0.70‰/4.11‰, 0.19‰/2.15‰, 0.63‰/19.61‰, 0.49‰/1.83‰, and 0.90‰/3.17‰, respectively. Subgroup analyses indicated that compared with males, females had a consistently significantly higher prevalence of ADs. However, no difference was observed between those in urban and rural areas. The pooled prevalence of ADs was relatively lower than those of some other countries. A higher prevalence of ADs in women than in men was commonly observed, whereas the prevalences in urban and rural areas were nearly the same.

Prevalence of hypertriglyceridemic waist and association with risk of type 2 diabetes mellitus: a meta-analysis

INTRODUCTION

A meta-analysis of studies assessing the prevalence of hypertriglyceridemic waist and an association with risk of type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science, CNKI, CQVIP and Wanfang databases were searched for studies of the prevalence of hypertriglyceridemic waist or association with risk of T2DM. Reference lists of each original article were also searched. A random-effects model was used to synthesize the combined prevalence and odds ratios. Publication bias and substantial heterogeneity were examined.

RESULTS

Twenty-five eligible studies involving 93 194 participants (93 194 for prevalence and 34 199 for odds ratios): 17 articles of prevalence, and 8 of both prevalence and risk of T2DM. Prevalence of hypertriglyceridemic waist ranged from 4% to 47%, with pooled prevalence of 18% (95% CI 13-23%), overall: 18% (95% CI 13-23%) for men and 19% (95% CI 13-24%) for women. Odds ratios ranged from 2.8 to 9.6 for T2MD in overall, with pooled odds ratios of 4.18 (95% CI 3.55-4.92), overall: 3.55 (95% CI 2.93-4.31) for men and 4.18 (95% CI 3.43-5.09) for women.

DISCUSSION/CONCLUSION

The prevalence of hypertriglyceridemic waist has reached an alarming level and is closely associated with increased risk of T2DM in the general population, particularly among women and among brown-skinned men and women.

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

Aims/Introduction

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

Materials and Methods

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

Results

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

Conclusions

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

Prevalence, Awareness, Treatment and Control of Diabetes Mellitus in a Chinese Population

OBJECTIVE

The purpose of this study is to evaluate the prevalence, awareness, treatment and glycemic control of diabetes mellitus (DM) in a Chinese population. The findings from this study are expected to offer scientific evidence to better prevent and control the growing number of reported and untreated cases.

METHODS

A cross-sectional survey was conducted in Jiangsu, China. We recruited permanent residents over 18 years of age from eight towns in Jintan (JT) and six towns in Yangzhong (YZ) using a three-stage stratified cluster sampling method. The rates of DM prevalence, awareness, treatment and control as well as their related factors were analyzed.

RESULTS

A total number of 15,404 people were entered into the analysis. The DM prevalence, awareness, treatment and control rates were 7.31%, 58.35%, 51.87% and 14.12%, respectively. Multivariable logistic regression analysis showed that being female was positively related to prevalence (OR=1.21, 95% CI: 1.07-1.37), awareness (OR=1.52, 95% CI: 1.19-1.93), treatment (OR=1.48, 95% CI: 1.17-1.88) and control (OR=1.87, 95% CI: 1.30-2.67) of DM. Having a family history of diabetes was significantly correlated with DM risk (OR=1.86, 95% CI: 1.37-2.54) and increased awareness (OR=3.12, 95% CI: 2.19-4.47), treatment (OR=3.47, 95% CI: 2.45-4.90) and control (OR=1.81, 95% CI: 1.22-2.68) of DM. Former smoking status (OR=1.82, 95% CI: 1.23-2.71), overweight (OR=2.11, 95% CI: 1.72-2.60) and obesity (OR=3.46, 95% CI: 2.67-4.50) were related to the risk of DM. Additionally, we found current drinking status to be positively correlated with DM risk (OR=1.30, 95% CI: 1.01-1.66) and negatively correlated with DM awareness (OR=0.41, 95% CI: 0.29-0.59) and treatment (OR=0.41, 95% CI: 0.29-0.59). Our study highlights the high prevalence and inadequate awareness, treatment and control of DM in the Chinese population.

CONCLUSIONS

Management and prevention of DM-related complications should be considered an essential strategy by governments and society. This study assessed the reasons why DM has been increasing and established the first step in determining where to start regarding preventative methods.

The prevalence of type 2 diabetes among older people in Africa: a systematic review

Little information is available on the prevalence of diabetes in people aged 55 years or older living on the African continent. We did a systematic review of the prevalence of type 2 diabetes in studies reported from Jan 1, 2000, to June 30, 2015, to provide accurate data for monitoring future trends. We did a comprehensive literature search using an African search filter and extracted and synthesised data from full papers. Among 1473 identified citations, 41 studies providing 49 separate data contributions involving 16 086 individuals met the inclusion criteria. The overall prevalence of diabetes was 13·7% (95% CI 11·3-16·3) and was higher in studies based on the oral glucose tolerance test (23·9%, 17·7-30·7, 12 contributions with 3415 participants) than fasting blood glucose criteria (10·9%, 8·9-13·0, 37 contributions with 12 671 participants; p<0·001). Prevalence was also higher in non-STEPS than in STEPS studies (17·1%, 95% CI 13·6-20·9) vs 9·6%, 6·6-13·0, p=0·003) and in urban than in rural settings (19·7%, 15·0-24·9 vs 7·9%, 4·6-12·0, p=0·0002), but did not differ significantly across age groups, sex, sample size, year of publication, region, or population coverage. These data highlight the need to reduce diabetes risk factors and implement adequate management strategies. In addition, they suggest that uniform diagnostic methods should be used across African countries and elsewhere to enable assessment of trends in diabetes prevalence and the success of diabetes prevention strategies. A collaborative initiative is required between key international and national diabetes and geriatric organisations to improve diabetes care for the older population in Africa and worldwide.

Diabetes in Asians

The prevalence of diabetes is increasing globally, particularly in Asia. According to the 2013 Diabetes Atlas, an estimated 366 million people are affected by diabetes worldwide; 36% of those affected live in the Western Pacific region, with a significant proportion in East Asia. The reasons for this marked increase in the prevalence of diabetes can be extrapolated from several distinct features of the Asian region. First, the two most populated countries, China and India, are located in Asia. Second, Asians have experienced extremely rapid economic growth, including rapid changes in dietary patterns, during the past decades. As a result, Asians tend to have more visceral fat within the same body mass index range compared with Westerners. In addition, increased insulin resistance relative to reduced insulin secretory function is another important feature of Asian individuals with diabetes. Young age of disease onset is also a distinctive characteristic of these patients. Moreover, changing dietary patterns, such as increased consumption of white rice and processed red meat, contributes to the deteriorated lifestyle of this region. Recent studies suggest a distinctive responsiveness to novel anti-diabetic agents in Asia; however, further research and efforts to reverse the increasing prevalence of diabetes are needed worldwide.

The prevalence of benign prostatic hyperplasia in mainland China: evidence from epidemiological surveys

The epidemiological characteristics of benign prostate hyperplasia (BPH) in mainland China are not completely understood. We performed this meta-analysis to assess the prevalence of BPH from 1989 through 2014. A total of 14 articles and 19 datasets were included. The pooled overall prevalence of BPH among men aged 40 years and older was 36.6% [95% CI, 32.3–44.8]. The occurrence rate of BPH in the age groups 40–49 years, 50–59 years, 60–69 years, 70–79 years and 80 years and older was 2.9%, 29.0%, 44.7%, 58.1% and 69.2%, respectively. The pooled occurrence rate of BPH was 41.5% [95% CI, 34.5–48.4] in urban areas and 38.6% [95% CI, 22.7–54.6] in rural areas; this difference in prevalence was not statistically significant [OR, 1.51; 95% CI, 0.97–2.36]. BPH is highly prevalent in mainland China, and its prevalence increased with age. The trend in the prevalence of BPH in mainland China was not steady; the prevalence map based on a geographic information system (GIS) showed an unequal geographic distribution. High-quality surveys on BPH with a larger sample size are needed throughout mainland China to confirm these findings.

Socioeconomic Status and the Prevalence of Type 2 Diabetes Among Adults in Northwest China

PURPOSE

The purpose of the study was to investigate (1) the associations of socioeconomic status, lifestyle risk factors, and the prevalence of newly diagnosed type 2 diabetes and (2) the mediating effects of lifestyle risk factors on the association of socioeconomic status and the prevalence of newly diagnosed type 2 diabetes among Chinese adults in northwest China.

METHODS

Based on a correlational design and random multistage sampling in communities (N = 3243), data were collected through face-to-face interviews and anthropometric measurements. Education, occupation, and income were considered indicators of socioeconomic status.

RESULTS

Approximately 7.5% persons interviewed had newly diagnosed type 2 diabetes. Chi-square analyses showed that higher socioeconomic indicators (higher income, nonmanual occupation) were associated with increased risk. Lifestyle risk factors, including alcohol use, unhealthy diet, and higher body mass index, were significantly positively associated with type 2 diabetes. Adjusting for demographic characteristics, hierarchical logistic regression analyses showed that unhealthy diet and high body mass index were significantly associated with type 2 diabetes.

CONCLUSIONS

Higher incomes and nonmanual occupations were related to a greater prevalence of type 2 diabetes, and high body mass index mediated these associations. These findings suggest that interventions for type 2 diabetes in China should be targeted at populations with high socioeconomic status and nonmanual occupations to reduce lifestyle risk factors and prevent diabetes.

Spatiotemporal variation in diabetes mortality in China: multilevel evidence from 2006 and 2012

Background

Despite previous studies reporting spatial in equality in diabetes prevalence across China, potential geographic variations in diabetes mortality have not been explored.

Methods

Age and gender stratified annual diabetes mortality counts for 161 counties were extracted from the China Mortality Surveillance System and interrogated using multilevel negative binomial regression. Random slopes were used to investigate spatiotemporal variation and the proportion of variance explained was used to assess the relative importance of geographical region, urbanization, mean temperature, local diabetes prevalence, behavioral risk factors and relevant biomarkers.

Results

Diabetes mortality tended to reduce between 2006 and 2012, though there appeared to be an increase in diabetes mortality in urban (age standardized rate (ASR) 2006–2012: 10.5–13.6) and rural (ASR 10.8–13.0) areas in the Southwest region. A Median Rate Ratio of 1.47, slope variance of 0.006 (SE 0.001) and covariance of 0.268 (SE 0.007) indicated spatiotemporal variation. Fully adjusted models accounted for 37 % of this geographical variation, with diabetes mortality higher in the Northwest (RR 2.55, 95 % CI 1.74, 3.73) and Northeast (RR 2.68, 95 % CI 1.70, 4.21) compared with the South. Diabetes mortality was higher in urbanized areas (RR tertile 3 versus tertile 1 (‘RRt3vs1’) 1.39, 95 % CI 1.17, 1.66), with higher mean body mass index (RRt3vs1 1.46, 95 % CI 1.18, 1.80) and with higher average temperatures (RR 1.05 95 % CI 1.03, 1.08). Diabetes mortality was lower where consumption of alcohol was excessive (RRt3vs1 0.84, 95 % CI 0.72, 0.99). No association was observed with smoking, overconsumption of red meat, high mean sedentary time, systolic blood pressure, cholesterol, and diabetes prevalence.

Conclusions

Declines in diabetes mortality between 2006 and 2012 have been unequally distributed across China, which may imply differentials in diagnosis, management, and the provision of services that warrant further investigation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1982-0) contains supplementary material, which is available to authorized users.

Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative

BACKGROUND

The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources.

DISCUSSION

We showed data from 11 countries participating in the Global Nutrition and Epidemiologic Transition Initiative, a collaborative effort across countries at various stages of the nutrition-epidemiologic transition whose mission is to reduce diabetes by improving the quality of staple foods through culturally-appropriate interventions. We depicted the epidemiologic transition using demographic and mortality data from the World Health Organization, and the nutrition transition using data from the Food and Agriculture Organization food balance sheets. Main staple foods (maize, rice, wheat, pulses, and roots) differed by country, with most countries undergoing a shift in principal contributors to energy consumption from grains in the past 50 years. Notably, rice and wheat products accounted for over half of the contribution to energy consumption from staple grains, while the trends for contribution from roots and pulses generally decreased in most countries. Global Nutrition and Epidemiologic Transition Initiative countries with pilot data have documented key barriers and motivators to increase intake of high-quality staple foods. Global research efforts to identify and promote intake of culturally-acceptable high-quality staple foods could be crucial in preventing diabetes. These efforts may be valuable in shaping future research, community interventions, and public health and nutritional policies.

Breastfeeding and maternal hypertension and diabetes: a population-based cross-sectional study

OBJECTIVE

This study aimed to assess the association of breastfeeding and maternal hypertension and diabetes in Beijing, China.

SUBJECTS AND METHODS

A cross-sectional study was conducted in four urban communities of Beijing, China, with 9,128 parous women 40-81 years of age who had had only one lifetime birth. Each participant completed a detailed survey and accepted blood pressure measurement and blood glucose testing. Moreover, self-reported hypertension and diabetes were confirmed by review of medical records.

RESULTS

After the analysis was adjusted for the potential confounders, including age, body mass index (BMI), waist to hip ratio (WHR), working status, educational level, drinking, smoking, family history of hypertension, age of menarche, menopause, oral contraceptive use, age of child-bearing, and postpartum BMI, the odd ratio (OR) of hypertension was 1.18 (95% confidence interval [CI], 1.05-1.32) for women who did not breastfeed, compared with women who did. In addition, the ORs for >0 to 6 months, >6 to 12 months, and >12 months of breastfeeding were 0.87 (95% CI, 0.76-0.99), 0.83 (95% CI, 0.68-1.00), and 0.79 (95% CI, 0.65-0.97), respectively, compared with women who did not breastfeed. With adjustment for age, WHR, working status, educational level, family history of diabetes, and postpartum BMI, women who did not breastfeed increased the risk of diabetes (OR=1.30; 95% CI, 1.11-1.53) compared with women who did. Moreover, women who breastfed for >0 to 6 months (OR=0.81; 95% CI, 0.67-0.98) and >6 to 12 months (OR=0.46; 95% CI, 0.26-0.84) had a lower risk of diabetes, compared with women who did not breastfeed.

CONCLUSIONS

Chinese mothers who did not breastfeed were more likely to develop hypertension and diabetes in later life.