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Xu G, Song J. The Association Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in the Japanese Population. Metab Syndr Relat Disord 2024; 22:471-478. [PMID: 38593410 DOI: 10.1089/met.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Abstract Aims: To explore whether the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was independently associated with the risk of incident type 2 diabetes mellitus (T2DM) in a large Japanese cohort. Methods: A secondary analysis was performed using open-access data from a retrospective cohort study. A total of 12,716 eligible participants who had standard medical examinations at the Murakami Memorial Hospital were included in this study. New-onset T2DM was the main outcome during follow-up. The risk of T2DM based on the TG/HDL-C ratio was evaluated using Cox regression analysis and Kaplan-Meier analysis. Subgroup analysis was performed to understand further the significance of the TG/HDL-C ratio in particular populations. To assess the potential of the TG/HDL-C ratio for predicting T2DM, a receiver operating characteristic (ROC) analysis was performed. Results: One hundred fifty new-onset T2DM cases were observed during a median follow-up of 5.39 years. The incidence of T2DM increased with a rise in the TG/HDL-C ratio based on the Kaplan-Meier curves (P < 0.0001). After controlling for potential confounding variables, the TG/HDL-C ratio was positively related to incidence of T2DM (hazard ratio = 1.08, 95% confidence interval: 1.01-1.15, P = 0.0239). In subgroup analysis, those with a body mass index of ≥18.5 and <24 kg/m2 showed a significantly positive relationship. The area under the ROC curve for the TG/HDL-C ratio as a T2DM predictor was 0.684. The optimal TG/HDL-C ratio cutoff value for T2DM was 1.609, with a sensitivity of 54.7% and a specificity of 73.6%. Conclusion: The authors' results showed a significant relationship between the TG/HDL-C ratio and the incidence of T2DM in the Japanese population.
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Affiliation(s)
- Guojuan Xu
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Song
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Tsoi STF, Lim C, Ma RCW, Lau ESH, Fan B, Chow E, Kong APS, Chan JCN, Luk AOY. Monogenic diabetes in a Chinese population with young-onset diabetes: A 17-year prospective follow-up study in Hong Kong. Diabetes Metab Res Rev 2024; 40:e3823. [PMID: 38821874 DOI: 10.1002/dmrr.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
AIMS Asians have a high prevalence of young-onset diabetes, but the pattern of monogenic diabetes is unknown. We aimed to determine the prevalence of monogenic diabetes in Chinese patients with young-onset diabetes and compare the clinical characteristics and outcome between patients with and without monogenic diabetes. MATERIALS AND METHODS We sequenced a targeted panel of 33 genes related to monogenic diabetes in 1021 Chinese patients with non-type 1 diabetes diagnosed at age ≤40 years. Incident complications including cardiovascular disease (CVD), end-stage kidney disease (ESKD) and all-cause death were captured since enrolment (1995-2012) until 2019. RESULTS In this cohort (mean ± SD age at diagnosis: 33.0 ± 6.0 years, median[IQR] diabetes duration 7.0[1.0-15.0] years at baseline, 44.9% men), 22(2.2%, 95% confidence interval[CI] 1.4%-3.2%) had monogenic diabetes. Pathogenic (P) or likely pathogenic (LP) variants were detected in GCK (n = 6), HNF1A (n = 9), HNF4A (n = 1), PLIN1 (n = 1) and PPARG (n = 2), together with copy number variations in HNF1B (n = 3). Over a median follow-up of 17.1 years, 5(22.7%) patients with monogenic diabetes (incidence rate 12.3[95% CI 5.1-29.4] per 1000 person-years) versus 254(25.4%) without monogenic diabetes (incidence rate 16.7[95% CI 14.8-18.9] per 1000 person-years) developed the composite outcome of CVD, ESKD and/or death (p = 0.490). The multivariable Cox model did not show any difference in hazards for composite events between groups. CONCLUSIONS In Chinese with young-onset non-type 1 diabetes, at least 2% of cases were contributed by monogenic diabetes, over 80% of which were accounted for by P/LP variants in common MODY genes. The incidence of diabetes complications was similar between patients with and without monogenic diabetes.
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Affiliation(s)
- Sandra T F Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Cadmon Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Baoqi Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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3
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Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, Sharman JE, Vogt L, Burrell LM, Korostovtseva L, Zec M, Patil M, Schultz MG, Wallen MP, Renna NF, Islam SMS, Hiremath S, Gyeltshen T, Chia YC, Gupta A, Schutte AE, Klein B, Borghi C, Browning CJ, Czesnikiewicz-Guzik M, Lee HY, Itoh H, Miura K, Brunström M, Campbell NR, Akinnibossun OA, Veerabhadrappa P, Wainford RD, Kruger R, Thomas SA, Komori T, Ralapanawa U, Cornelissen VA, Kapil V, Li Y, Zhang Y, Jafar TH, Khan N, Williams B, Stergiou G, Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens 2024; 42:23-49. [PMID: 37712135 PMCID: PMC10713007 DOI: 10.1097/hjh.0000000000003563] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
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Affiliation(s)
- Fadi J. Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
- Department of Physiology, University of Melbourne, Melbourne, Australia
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Priscilla R. Prestes
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Charlotte Mills
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Francine Z. Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - Lyudmila Korostovtseva
- Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad
- Hypertension and Nutrition, Core Group of IAPEN India, India
| | - Martin G. Schultz
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | | | - Nicolás F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada
| | - Tshewang Gyeltshen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abhinav Gupta
- Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Colette J. Browning
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Marta Czesnikiewicz-Guzik
- School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK
- Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hiroshi Itoh
- Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Norm R.C. Campbell
- Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Praveen Veerabhadrappa
- Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania
| | - Richard D. Wainford
- Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston
- Division of Cardiology, Emory University, Atlanta, USA
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Shane A. Thomas
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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4
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Dwivedi KK, Lakhani P, Sihota P, Tikoo K, Kumar S, Kumar N. The multiscale characterization and constitutive modeling of healthy and type 2 diabetes mellitus Sprague Dawley rat skin. Acta Biomater 2023; 158:324-346. [PMID: 36565785 DOI: 10.1016/j.actbio.2022.12.037] [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: 06/20/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
In type 2 diabetes mellitus (T2DM), elevated glucose level impairs the biochemistry of the skin which may result in alteration of its mechanical and structural properties. The several aspects of structural and mechanical changes in skin due to T2DM remain poorly understood. To fill these research gaps, we developed a non-obese T2DM rat (Sprague Dawley (SD)) model for investigating the effect of T2DM on the in vivo strain stress state, mechanical and structural properties of skin. In vivo strain and mechanical anisotropy of healthy and T2DM skin were measured using the digital imaging correlation (DIC) technique and DIC coupled bulge experiment, respectively. Fluorescence microscopy and histology were used to assess the collagen and elastin fibers microstructure whereas nanoscale structure was captured through atomic force microscopy (AFM). Based on the microstructural observations, skin was modeled as a multilayer membrane where in and out of plane distribution of collagen fibers and planar distribution of elastin fibers were cast in constitutive model. Further, the state of in vivo stresses of healthy and T2DM were measured using model parameters and in vivo strain in the constitutive model. The results showed that T2DM causes significant loss in in vivo stresses (p < 0.01) and increase in anisotropy (p < 0.001) of skin. These changes were found in good correlation with T2DM associated alteration in skin microstructure. Statistical analysis emphasized that increase in blood glucose concentration (HbA1c) was the main cause of impaired biomechanical properties of skin. The presented data in this study can help to understand the skin pathology and to simulate the skin related clinical procedures. STATEMENT OF SIGNIFICANCE: Our study is significant as it presents findings related to the effect of T2DM on the physiologic stress strain, structural and mechanical response of SD rat skin. In this study, we developed a non-obese T2DM SD rat model which mimics the phenotype of Asian type 2 diabetics (non-obese). Several structural and mechanical characterization techniques were explored for multiscale characterization of healthy and T2DM skin. Further, based on microstructural information, we presented the constitutive models that incorporate the real microstructure of skin. The presented results can be helpful to simulate the realistic mechanical response of skin during various clinical trials.
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Affiliation(s)
- Krashn Kr Dwivedi
- Department of Biomedical Engineering, Indian institute of Technology Ropar, India
| | - Piyush Lakhani
- Department of Mechanical Engineering, Indian institute of Technology Ropar, India
| | - Praveer Sihota
- Department of Mechanical Engineering, Indian institute of Technology Ropar, India
| | - Kulbhushan Tikoo
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Mohali, India
| | - Sachin Kumar
- Department of Mechanical Engineering, Indian institute of Technology Ropar, India.
| | - Navin Kumar
- Department of Biomedical Engineering, Indian institute of Technology Ropar, India; Department of Mechanical Engineering, Indian institute of Technology Ropar, India.
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5
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Ohanyan H, Portengen L, Kaplani O, Huss A, Hoek G, Beulens JWJ, Lakerveld J, Vermeulen R. Associations between the urban exposome and type 2 diabetes: Results from penalised regression by least absolute shrinkage and selection operator and random forest models. ENVIRONMENT INTERNATIONAL 2022; 170:107592. [PMID: 36306550 DOI: 10.1016/j.envint.2022.107592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is thought to be influenced by environmental stressors such as air pollution and noise. Although environmental factors are interrelated, studies considering the exposome are lacking. We simultaneously assessed a variety of exposures in their association with prevalent T2D by applying penalised regression Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest (RF), and Artificial Neural Networks (ANN) approaches. We contrasted the findings with single-exposure models including consistently associated risk factors reported by previous studies. METHODS Baseline data (n = 14,829) of the Occupational and Environmental Health Cohort study (AMIGO) were enriched with 85 exposome factors (air pollution, noise, built environment, neighbourhood socio-economic factors etc.) using the home addresses of participants. Questionnaires were used to identify participants with T2D (n = 676(4.6 %)). Models in all applied statistical approaches were adjusted for individual-level socio-demographic variables. RESULTS Lower average home values, higher share of non-Western immigrants and higher surface temperatures were related to higher risk of T2D in the multivariable models (LASSO, RF). Selected variables differed between the two multi-variable approaches, especially for weaker predictors. Some established risk factors (air pollutants) appeared in univariate analysis but were not among the most important factors in multivariable analysis. Other established factors (green space) did not appear in univariate, but appeared in multivariable analysis (RF). Average estimates of the prediction error (logLoss) from nested cross-validation showed that the LASSO outperformed both RF and ANN approaches. CONCLUSIONS Neighbourhood socio-economic and socio-demographic characteristics and surface temperature were consistently associated with the risk of T2D. For other physical-chemical factors associations differed per analytical approach.
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Affiliation(s)
- Haykanush Ohanyan
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands.
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Oriana Kaplani
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands; Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, Noord-Holland, the Netherlands; Upstream Team, www.upstreamteam.nl. Amsterdam UMC, VU University Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Suastika K, Eliana F, Kshanti IAM, Mardianto M, Mudjarnako SW, Natalia N, HS HN, Sibarani RP, Soewondo P, Soelistijo SA, Tarigan TJE, Zufry H. Expert Opinion on Diabetes Management Challenges and Role of Basal Insulin/GLP-1 RA Fixed-Ratio Combination in People with Type 2 Diabetes from Indonesia. Diabetes Metab Syndr Obes 2022; 15:2977-2990. [PMID: 36193540 PMCID: PMC9526452 DOI: 10.2147/dmso.s367153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/14/2022] [Indexed: 04/20/2023] Open
Abstract
Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.
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Affiliation(s)
- Ketut Suastika
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital Denpasar, Bali, Indonesia
| | - Fatimah Eliana
- Faculty of Medicine, Yarsi University, Jakarta, Indonesia
| | - Ida Ayu Made Kshanti
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Fatmawati General Hospital, Jakarta, Indonesia
| | - Mardianto Mardianto
- Faculty of Medicine, University of Sumatra Utara/Adam Malik Central Hospital, Internal Medicine, Medan, Indonesia
| | - Sony Wibisono Mudjarnako
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nanny Natalia
- Faculty of Medicine, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Heri Nugrohom HS
- Faculty of Medicine, Diponegoro University, Central General Hospital Dr. Kariadi, Semarang, Indonesia
| | | | - Pradana Soewondo
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Soebagijo Adi Soelistijo
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hendra Zufry
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, School of Medicine Universitas Syiah Kuala/Dr. Zainoel Abidin General Teaching Hospital, Banda Aceh, Indonesia
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Chan SP, Aamir AH, Bee YM, Deerochanawong C, Paz-Pacheco E, Tiu F, Foo SH, Tan KEK, Le TQ, Saraswati MR, Bunnag P, Panusunan Sibarani R, Raza SA, Tran NQ. Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus. Diabetes Ther 2022; 13:1511-1529. [PMID: 35767186 PMCID: PMC9309111 DOI: 10.1007/s13300-022-01286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022] Open
Abstract
The global health burden of diabetes is on the rise and has affected more than half a billion people worldwide, particularly in Southeast Asia, North Africa, Africa, and the Western Pacific, Middle East, and South and Central America regions of the International Diabetes Federation (IDF). Despite many new treatments being available for the management of diabetes, glycemic control remains suboptimal in Asia, compared to the rest of the world. Delay in timely insulin initiation and inadequate titration of insulin are regarded to be some of the important reasons for inadequate glycemic control. Additionally, Asian populations have a distinct phenotype, including a younger age of onset and higher glycemic excursions, suggestive of a lower beta-cell function, as compared to non-Asians. Although there are multiple local and international guidelines on insulin initiation and titration, some of these guidelines can be complex. There is an unmet need for guideline recommendations on basal insulin initiation and titration to be simplified and customized for the Asian population with type 2 diabetes mellitus (T2DM). A unified approach would increase adoption of basal insulin initiation by primary care and family medicine physicians, which in turn would help reduce the inertia to insulin initiation. With this background, a consensus-seeking meeting was conducted with 14 experts from seven Asian countries to delineate appropriate practices for insulin initiation and titration in the Asian context. The key objective was to propose a simple insulin titration algorithm, specific for the Asian population, to improve glycemic control and optimize therapeutic outcomes of people with T2DM on basal insulin. Following a detailed review of literature and current guidelines, and potential barriers to insulin initiation and titration, the experts proposed a simplified insulin titration algorithm based on both physician- and patient-led components. The consensus recommendations of the experts related to basal insulin initiation and titration have been summarized in this article, along with the proposed titration algorithm for optimizing glycemic control in the Asian population with T2DM.
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Affiliation(s)
- Siew Pheng Chan
- Subang Jaya Medical Centre, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - Azizul Hasan Aamir
- Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chaicharn Deerochanawong
- Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Elizabeth Paz-Pacheco
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Fatma Tiu
- Diabetes Clinic, University de Zamboanga Hospital, Zamboanga, Philippines
| | | | - Kevin E K Tan
- Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Toan Q Le
- National Hospital of Endocrinology, Hanoi, Vietnam
- University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
| | - Made Ratna Saraswati
- Division of Endocrinology and Metabolism, Internal Medicine Department, Faculty of Medicine, Udayana University/Sanglah Hospital Denpasar-Bali, Denpasar, Indonesia
| | - Pongamorn Bunnag
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Syed Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Nam Quang Tran
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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8
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Cheung JTK, Lau E, Tsui CCT, Siu ELN, Tse NKW, Hui NYL, Ma RCW, Kong APS, Fu A, Lau V, Jia W, Sheu WHH, Sobrepena L, Yoon KH, Tan ATB, Chia YC, Sosale A, Saboo BD, Kesavadev J, Goh SY, Nguyen TK, Thewjitcharoen Y, Suwita R, Luk AOY, Yang A, Chow E, Lim LL, Chan JCN. Combined associations of family history and self-management with age at diagnosis and cardiometabolic risk in 86,931 patients with type 2 diabetes: Joint Asia Diabetes Evaluation (JADE) Register from 11 countries. BMC Med 2022; 20:249. [PMID: 35831899 PMCID: PMC9281062 DOI: 10.1186/s12916-022-02424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Family history (FamH) of type 2 diabetes might indicate shared genotypes, environments, and/or behaviors. We hypothesize that FamH interacts with unhealthy behaviors to increase the risk of early onset of diabetes and poor cardiometabolic control. METHODS In a cross-sectional analysis of the prospective Joint Asia Diabetes Evaluation Register including patients from 427 clinics in 11 Asian countries/regions in 2007-2021, we defined positive FamH as affected parents/siblings and self-management as (1) healthy lifestyles (balanced diet, non-use of alcohol and tobacco, regular physical activity) and (2) regular self-monitoring of blood glucose (SMBG). RESULTS Among 86,931 patients with type 2 diabetes (mean±SD age: 56.6±11.6 years; age at diagnosis of diabetes: 49.8±10.5 years), the prevalence of FamH ranged from 39.1% to 85.3% in different areas with FamH affecting mother being most common (32.5%). The FamH group (n=51,705; 59.5%) was diagnosed 4.6 years earlier than the non-FamH group [mean (95% CI): 47.9 (47.8-48.0) vs. 52.5 (52.4-52.6), logrank p<0.001]. In the FamH group, patients with both parents affected had the earliest age at diagnosis [44.6 (44.5-44.8)], followed by affected single parent [47.7 (47.6-47.8)] and affected siblings only [51.5 (51.3-51.7), logrank p<0.001]. The FamH plus ≥2 healthy lifestyle group had similar age at diagnosis [48.2 (48.1-48.3)] as the non-FamH plus <2 healthy lifestyle group [50.1 (49.8-50.5)]. The FamH group with affected parents had higher odds of hyperglycemia, hypertension, and dyslipidemia than the FamH group with affected siblings, with the lowest odds in the non-FamH group. Self-management (healthy lifestyles plus SMBG) was associated with higher odds of attaining HbA1c<7%, blood pressure<130/80mmHg, and LDL-C<2.6 mmol/L especially in the FamH group (FamH×self-management, pinteraction=0.050-0.001). CONCLUSIONS In Asia, FamH was common and associated with young age of diagnosis which might be delayed by healthy lifestyle while self management was associated with better control of cardiometabolic risk factors especially in those with FamH.
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Affiliation(s)
- Johnny T K Cheung
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Eric Lau
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Cyrus C T Tsui
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Edmond L N Siu
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Naomi K W Tse
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Nicole Y L Hui
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Ronald C W Ma
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Alice P S Kong
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Amy Fu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Vanessa Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Weiping Jia
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Wayne H H Sheu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - K H Yoon
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Alexander T B Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Subang Jaya, Selangor, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Banshi D Saboo
- Dia Care - Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Jothydev Kesavadev
- Jothydev's Diabetes & Research Center, Thiruvananthapuram, Kerala, India
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Raymond Suwita
- Cerebrocardiovascular Diabetes Group Clinic (CDG), Jakarta, Indonesia
| | - Andrea O Y Luk
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Lee Ling Lim
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana C N Chan
- Asia Diabetes Foundation, Shatin, Hong Kong Special Administrative Region, Shatin, China. .,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China. .,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China. .,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China.
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9
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Zhou Y, Yang G, Qu C, Chen J, Qian Y, Yuan L, Mao T, Xu Y, Li X, Zhen S, Liu S. Predictive performance of lipid parameters in identifying undiagnosed diabetes and prediabetes: a cross-sectional study in eastern China. BMC Endocr Disord 2022; 22:76. [PMID: 35331213 PMCID: PMC8952267 DOI: 10.1186/s12902-022-00984-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Dyslipidaemia is a risk factor for abnormal blood glucose. However, studies on the predictive values of lipid markers in prediabetes and diabetes simultaneously are limited. This study aimed to assess the associations and predictive abilities of lipid indices and abnormal blood glucose. METHODS A sample of 7667 participants without diabetes were enrolled in this cross-sectional study conducted in 2016, and all of them were classified as having normal glucose tolerance (NGT), prediabetes or diabetes. Blood glucose, blood pressure and lipid parameters (triglycerides, TG; total cholesterol, TC; high-density lipoprotein cholesterol, HDL-C; low-density lipoprotein cholesterol, LDL-C; non-high-density lipoprotein cholesterol, non-HDL-C; and triglyceride glucose index, TyG) were evaluated or calculated. Logistic regression models were used to analyse the association between lipids and abnormal blood glucose. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to assess the discriminatory power of lipid parameters for detecting prediabetes or diabetes. RESULTS After adjustment for potential confounding factors, the TyG was the strongest marker related to abnormal blood glucose compared to other lipid indices, with odds ratios of 2.111 for prediabetes and 5.423 for diabetes. For prediabetes, the AUCs of the TG, TC, HDL-C, LDL-C, TC/HDL-C, TG/HDL-C, non-HDL-C and TyG indices were 0.605, 0.617, 0.481, 0.615, 0.603, 0.590, 0.626 and 0.660, respectively, and the cut-off points were 1.34, 4.59, 1.42, 2.69, 3.39, 1.00, 3.19 and 8.52, respectively. For diabetes, the AUCs of the TG, TC, HDL-C, LDL-C, TC/HDL-C, TG/HDL-C, non-HDL-C and TyG indices were 0.712, 0.679, 0.440, 0.652, 0.686, 0.692, 0.705, and 0.827, respectively, and the cut-off points were 1.35, 4.68, 1.42, 2.61, 3.44, 0.98, 3.13 and 8.80, respectively. CONCLUSIONS The TyG, TG and non-HDL-C, especially TyG, are accessible biomarkers for screening individuals with undiagnosed diabetes.
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Affiliation(s)
- Yimin Zhou
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, China
| | - Guoping Yang
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China
| | - Chen Qu
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China
| | - Jiaping Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, China
| | - Yinan Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, China
| | - Lei Yuan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, China
| | - Tao Mao
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China
| | - Yan Xu
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China
| | - Xiaoning Li
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China
| | - Shiqi Zhen
- Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China.
| | - Sijun Liu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, China.
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10
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Magkos F, Lee MH, Lim M, Cook AR, Chhay V, Loh TP, Chia KS, Baig S, Ang IYH, Tay JYY, Khoo CM, Halter JB, Toh SA. Dynamic assessment of insulin secretion and insulin resistance in Asians with prediabetes. Metabolism 2022; 128:154957. [PMID: 34942192 DOI: 10.1016/j.metabol.2021.154957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022]
Abstract
AIMS/HYPOTHESIS Prediabetes and type 2 diabetes are highly prevalent in Asia. Understanding the pathophysiology of abnormal glucose homeostasis in Asians will have important implications for reducing disease burden, but there have been conflicting reports on the relative contributions of insulin secretion and action in disease progression. In this study, we aimed to assess the contribution of β-cell dysfunction and insulin resistance in the Asian prediabetes phenotype. METHODS We recruited 1679 Asians with prediabetes (n = 659) or normoglycemia (n = 1020) from a multi-ethnic population in Singapore. Participants underwent an oral glucose tolerance test, an intravenous glucose challenge, and a hyperinsulinemic-euglycemic clamp procedure to determine glucose tolerance, β-cell responsivity, insulin secretion, insulin clearance and insulin sensitivity. RESULTS Participants with prediabetes had significantly higher glucose concentrations in the fasting state and after glucose ingestion than did normoglycemic participants. Insulin sensitivity (M/I ratio) was ~15% lower, acute insulin response (AIR) to intravenous glucose and β-cell responsivity to oral glucose were ~35% lower, but total insulin secretion rate in the fasting state and after glucose ingestion was ~10% greater in prediabetic than in normoglycemic participants. The decrease in β-cell function with worsening glucose homeostasis in Asians with prediabetes was associated with progressively greater defects in AIR rather than M/I. However, analysis using static surrogate measures (HOMA indices) of insulin resistance and β-cell function revealed a different pattern. CONCLUSIONS Lower AIR to intravenous glucose and β-cell responsivity to oral glucose, on a background of mild insulin resistance, are the major contributors to the dysregulation of glucose homeostasis in Asians with prediabetes.
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Affiliation(s)
- Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Michelle H Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maybritte Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Vanna Chhay
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sonia Baig
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, Singapore
| | - Jeffrey B Halter
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Geriatric and Palliative Medicine, University of Michigan, USA
| | - Sue-Anne Toh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NOVI Health, Singapore; Department of Medicine, National University Hospital, Singapore; Regional Health System Office, National University Health System, Singapore; Singapore Population HEalth ImpRovement Centre (SPHERiC), National University Health System, Singapore.
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11
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Williams DM, Jones H, Stephens JW. Personalized Type 2 Diabetes Management: An Update on Recent Advances and Recommendations. Diabetes Metab Syndr Obes 2022; 15:281-295. [PMID: 35153495 PMCID: PMC8824792 DOI: 10.2147/dmso.s331654] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/18/2022] [Indexed: 12/19/2022] Open
Abstract
Previous guidelines for the treatment of people with type 2 diabetes mellitus (T2D) have relied heavily upon rigid algorithms for the sequential addition of pharmacotherapies to achieve target glycemic control. More recent guidelines advocate a personalized approach for diabetes treatment, to improve patient satisfaction, quality of life, medication adherence and overall health outcomes. Clinicians should work with patients to develop personalized goals for their treatment, including targeted glycemic control, weight management, prevention and treatment of associated comorbidities and avoidance of complications such as hypoglycemia. Factors that affect the intensity of treatment and choice of pharmacotherapy should include medical and patient influences. Medical considerations include the diabetes phenotype, biomarkers including genetic tests, and the presence of comorbidities such as cardiovascular, renal, or hepatic disease. Patient factors include their treatment preference, age and life expectancy, diabetes duration, hypoglycemia fear and unawareness, psychological and social circumstances. The use of a personalized approach in the management of people with T2D can reduce the cost and failure associated with the algorithmic "one-size-fits-all" approach, to anticipate disease progression, improve the response to diabetes pharmacotherapy and reduce the incidence of diabetes-associated complications. Ultimately, the use of personalized medicine in people with T2D should improve medication adherence, patient satisfaction and quality of life to reduce diabetes distress and improve physical health outcomes.
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Affiliation(s)
- David M Williams
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
- Correspondence: David M Williams, Diabetes Centre, Morriston Hospital, Swansea, SA6 6NL., UK, Tel +441792704078, Email
| | - Hannah Jones
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
| | - Jeffrey W Stephens
- Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, SA6 8NL, UK
- Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
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12
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Bhori M, Rastogi V, Tungare K, Marar T. A review on interplay between obesity, lipoprotein profile and nutrigenetics with selected candidate marker genes of type 2 diabetes mellitus. Mol Biol Rep 2021; 49:687-703. [PMID: 34669123 DOI: 10.1007/s11033-021-06837-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/12/2021] [Indexed: 12/06/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus, a rapidly growing epidemic, and its frequently related complications demand global attention. The two factors commonly attributed to the epidemic are genetic factors and environmental factors. Studies indicate that the genetic makeup at an individual level and the environmental aspects influence the occurrence of the disease. However, there is insufficiency in understanding the mechanisms through which the gene mutations and environmental components individually lead to T2DM. Also, discrepancies have often been noted in the association of gene variants and type 2 diabetes when the gene factor is examined as a sole attribute to the disease. STUDY In this review initially, we have focused on the proposed ways through which CAPN10, FABP2, GLUT2, TCF7L2, and ENPP1 variants lead to T2DM along with the inconsistencies observed in the gene-disease association. The article also emphasizes on obesity, lipoprotein profile, and nutrition as environmental factors and how they lead to T2DM. Finally, the main objective is explored, the environment-gene-disease association i.e. the influence of each environmental factor on the aforementioned specific gene-T2DM relationship to understand if the disease-causing capability of the gene variants is exacerbated by environmental influences. CONCLUSION We found that environmental factors may influence the gene-disease relationship. Reciprocally, the genetic factors may alter the environment-disease relationship. To precisely conclude that the two factors act synergistically to lead to T2DM, more attention has to be paid to the combined influence of the genetic variants and environmental factors on T2DM occurrence instead of studying the influence of the factors separately.
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Affiliation(s)
- Mustansir Bhori
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
| | - Varuni Rastogi
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
| | - Kanchanlata Tungare
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India.
| | - Thankamani Marar
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
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13
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Can fingernail quality predict bone damage in Type 2 diabetes mellitus? a pilot study. PLoS One 2021; 16:e0257955. [PMID: 34591909 PMCID: PMC8483292 DOI: 10.1371/journal.pone.0257955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/14/2021] [Indexed: 12/03/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken.
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14
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Riandini T, Pang D, Toh MPHS, Tan CS, Liu DYK, Choong AMTL, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore. Diabetologia 2021; 64:1538-1549. [PMID: 33885933 PMCID: PMC8187215 DOI: 10.1007/s00125-021-05441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Diabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population. METHODS This was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation. RESULTS Between 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation. CONCLUSIONS/INTERPRETATION This study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.
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Affiliation(s)
- Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Matthias P H S Toh
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Daveon Y K Liu
- Information Management, Group Health Informatics, National Healthcare Group, Singapore, Republic of Singapore
| | - Andrew M T L Choong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore, Republic of Singapore
| | - Sadhana Chandrasekar
- Department of Vascular Surgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
- Policy Research & Evaluation Division, Ministry of Health, Singapore, Republic of Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
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15
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Sihota P, Yadav RN, Dhaliwal R, Bose JC, Dhiman V, Neradi D, Karn S, Sharma S, Aggarwal S, Goni VG, Mehandia V, Vashishth D, Bhadada SK, Kumar N. Investigation of Mechanical, Material, and Compositional Determinants of Human Trabecular Bone Quality in Type 2 Diabetes. J Clin Endocrinol Metab 2021; 106:e2271-e2289. [PMID: 33475711 DOI: 10.1210/clinem/dgab027] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Increased bone fragility and reduced energy absorption to fracture associated with type 2 diabetes (T2D) cannot be explained by bone mineral density alone. This study, for the first time, reports on alterations in bone tissue's material properties obtained from individuals with diabetes and known fragility fracture status. OBJECTIVE To investigate the role of T2D in altering biomechanical, microstructural, and compositional properties of bone in individuals with fragility fracture. METHODS Femoral head bone tissue specimens were collected from patients who underwent replacement surgery for fragility hip fracture. Trabecular bone quality parameters were compared in samples of 2 groups, nondiabetic (n = 40) and diabetic (n = 30), with a mean duration of disease 7.5 ± 2.8 years. RESULTS No significant difference was observed in aBMD between the groups. Bone volume fraction (BV/TV) was lower in the diabetic group due to fewer and thinner trabeculae. The apparent-level toughness and postyield energy were lower in those with diabetes. Tissue-level (nanoindentation) modulus and hardness were lower in this group. Compositional differences in the diabetic group included lower mineral:matrix, wider mineral crystals, and bone collagen modifications-higher total fluorescent advanced glycation end-products (fAGEs), higher nonenzymatic cross-link ratio (NE-xLR), and altered secondary structure (amide bands). There was a strong inverse correlation between NE-xLR and postyield strain, fAGEs and postyield energy, and fAGEs and toughness. CONCLUSION The current study is novel in examining bone tissue in T2D following first hip fragility fracture. Our findings provide evidence of hyperglycemia's detrimental effects on trabecular bone quality at multiple scales leading to lower energy absorption and toughness indicative of increased propensity to bone fragility.
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Affiliation(s)
- Praveer Sihota
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Ram Naresh Yadav
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Ruban Dhaliwal
- Metabolic Bone Disease Center, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Jagadeesh Chandra Bose
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Neradi
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Karn
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sidhartha Sharma
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vijay G Goni
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishwajeet Mehandia
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Deepak Vashishth
- Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
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Koh ES, Han K, Nam Y, Wittbrodt ET, Fenici P, Kosiborod MN, Heerspink HJL, Yoo S, Kwon H. Renal outcomes and all-cause death associated with sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs (CVD-REAL 3 Korea). Diabetes Obes Metab 2021; 23:455-466. [PMID: 33118320 PMCID: PMC7839503 DOI: 10.1111/dom.14239] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the effectiveness of sodium-glucose co-transporter-2 (SGLT2) inhibitors on the risk of progression to end-stage renal disease (ESRD) and all-cause mortality in a broad range of patients with type 2 diabetes (T2D) using a Korean nationwide cohort. MATERIALS AND METHODS Using data from the Korean National Health Insurance Service database from January 2014 to December 2017, a total of 701 674 patients were identified with T2D. We divided these patients into new users of SGLT2 inhibitors and new users of other glucose-lowering drugs (oGLDs). Using propensity scores, patients in the two groups were matched 1:1. We assessed the risk of ESRD and all-cause death. RESULTS There were 45 016 patients in each group, and baseline characteristics were well balanced between the groups. The patients' mean age was 58.1 ± 10.6 years and mean estimated glomerular filtration rate (eGFR) was 89.2 ± 27.4 mL/min/1.73m2 , and 8% of patients had proteinuria. We identified 167 incident ESRD cases and 1070 all-cause deaths during follow-up. Use of SGLT2 inhibitors versus oGLDs was associated with a lower risk of ESRD (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.34 to 0.65) and all-cause death (HR 0.82, 95% CI 0.73 to 0.93). In a subgroup analysis by eGFR, initiation of SGLT2 inhibitor treatment, compared with oGLD treatment, was associated with lower risk of progression to ESRD among patients with eGFR 60 to 90 mL/min/1.73m2 and those with eGFR < 60 mL/min/1.73m2 , and a lower risk of all-cause death was associated with SGLT2 inhibitors versus oGLDs in patients with eGFR ≥90 and 60 to 90 mL/min/1.73m2 . CONCLUSION In this large nationwide study of Korean patients with T2D, initiation of SGLT2 inhibitors versus oGLDs was associated with lower risk of ESRD and all-cause death.
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Affiliation(s)
- Eun Sil Koh
- Division of Nephrology, Department of Internal MedicineYeouido St. Mary's Hospital, The Catholic University of KoreaSeoulRepublic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulRepublic of Korea
| | - You‐Seon Nam
- Medical AffairsAstraZeneca KoreaSeoulRepublic of Korea
| | | | - Peter Fenici
- BioPharmaceuticals MedicalAstraZenecaCambridgeUK
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart InstituteUniversity of MissouriKansas CityMissouriUSA
| | - Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Soon‐Jib Yoo
- Division of Endocrinology and Metabolism, Department of Internal MedicineBucheon St. Mary's Hospital, The Catholic University of KoreaBucheonRepublic of Korea
| | - Hyuk‐Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal MedicineYeouido St. Mary's Hospital, The Catholic University of KoreaSeoulRepublic of Korea
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Tanoey J, Becher H. Diabetes prevalence and risk factors of early-onset adult diabetes: results from the Indonesian family life survey. Glob Health Action 2021; 14:2001144. [PMID: 34898388 PMCID: PMC8676618 DOI: 10.1080/16549716.2021.2001144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diabetes is increasing rapidly in South-East Asia. Studies have reported typical risk factors associated with all-age adult diabetes and highlighted the roles of economic transition and childhood development factors in diabetes in later life. However, little is known about whether these factors were associated with young adult diabetes risk. OBJECTIVES The study has two main aims: (1) estimate diabetes prevalence among adult participants of the Indonesian Family Life Survey (IFLS), and (2) identify childhood development factors associated with early-onset adult diabetes (diagnosed between age 20 and 40) in Indonesia. METHODS Data were taken from adults participating in 4th and 5th IFLS (in 2007 and 2014) and linked to childhood history from previous surveys. Diabetes was ascertained from self-report and HbA1c testing in a subsample. Diabetes prevalence rates were estimated by age and source of diagnosis. Cox regression analysis was applied to assess potential risk factors for early-onset adult diabetes. RESULTS A total of 34,767 participants were included in the study. Crude total prevalence estimate from self-report was 2,3% and increased with age. Including HbA1c measurements yielded nearly eight times higher prevalence estimates, depending on age. The proportion of yet undiagnosed cases is considerably higher in young age groups. Regression analyses showed that urban childhood residence and high education increased early-onset diabetes risk by 50-70%. Sex, childhood general health, socio-economic level and starvation exposure were not associated with early-onset diabetes risk. CONCLUSION Remarkable differences between diabetes prevalence rates based on self-report and HbA1c measurement indicated the need for better diagnosis, especially in young adults. Urban childhood residence and high education increased early-onset adult diabetes risk. Incorporating these factors and diabetes awareness in existing child health programs, together with screening of individuals at risk, could improve early diabetes detection and prevention strategies among young urban Indonesian adults.
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Affiliation(s)
- Justine Tanoey
- Institute of Medical Biometry and Epidemiology Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Ji L, Chan JCN, Yu M, Yoon KH, Kim SG, Choi SH, Huang C, Te Tu S, Wang C, Paldánius PM, Sheu WHH. Early combination versus initial metformin monotherapy in the management of newly diagnosed type 2 diabetes: An East Asian perspective. Diabetes Obes Metab 2021; 23:3-17. [PMID: 32991073 PMCID: PMC7756748 DOI: 10.1111/dom.14205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes (T2D) in the East Asian population is characterized by phenotypes such as low body mass index, an index of β-cell dysfunction, and higher percentage of body fat, an index of insulin resistance. These phenotypes/pathologies may predispose people to early onset of diabetes with increased risk of stroke and renal disease. Less than 50% of patients with T2D in East Asia achieve glycaemic targets recommended by national or regional guidelines, which may be attributable to knowledge and/or implementation gaps. Herein, we review the latest evidence with special reference to East Asian patients with T2D and present arguments for the need to use early combination therapy to intensify glycaemic control. This strategy is supported by the 5-year worldwide VERIFY study, which reported better glycaemic durability in newly diagnosed patients with T2D with a mean HbA1c of 6.9% treated with early combination therapy of vildagliptin plus metformin versus those treated with initial metformin monotherapy followed by addition of vildagliptin only with worsening glycaemic control. This paradigm shift of early intensified treatment is now recommended by the American Diabetes Association and the European Association for the Study of Diabetes. In order to translate these evidence to practice, increased awareness and strengthening of the healthcare system are needed to diagnose and manage patients with T2D early for combination therapy.
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Affiliation(s)
- Linong Ji
- Department of Endocrinology and MetabolismPeking University People's HospitalPekingChina
| | - Juliana C. N. Chan
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales HospitalHong KongChina
| | - Miao Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of HealthPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Kun Ho Yoon
- Department of Endocrinology and MetabolismThe Catholic University College of MedicineSeoulRepublic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal MedicineKorea University College of MedicineSeoulRepublic of Korea
| | - Sung Hee Choi
- Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Chien‐Ning Huang
- Division of Endocrinology and Metabolism, Department of Internal MedicineChung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
| | - Shih Te Tu
- Division of Endocrinology and Metabolism, Department of MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Chih‐Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal MedicineCollege of Medicine, National Taiwan University Hospital, National Taiwan UniversityTaipeiTaiwan
| | - Päivi Maria Paldánius
- Children's Hospital, Helsinki University HospitalHelsinkiFinland
- Program for Clinical and Molecular MetabolismHelsinki UniversityHelsinkiFinland
| | - Wayne H. H. Sheu
- Division of Endocrinology and Metabolism, Department of Internal MedicineTaichung Veterans General HospitalTaiwan
- Department of Medicine, School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Institute of Medical Technology, College of Life Science, National Chung‐Hsing UniversityTaichungTaiwan
- School of Medicine, National Defense Medical CenterTaipeiTaiwan
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19
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Sihota P, Yadav RN, Poleboina S, Mehandia V, Bhadada SK, Tikoo K, Kumar N. Development of HFD-Fed/Low-Dose STZ-Treated Female Sprague-Dawley Rat Model to Investigate Diabetic Bone Fragility at Different Organization Levels. JBMR Plus 2020; 4:e10379. [PMID: 33103024 PMCID: PMC7574700 DOI: 10.1002/jbm4.10379] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/31/2020] [Indexed: 01/11/2023] Open
Abstract
Type 2 diabetes (T2D) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, and bone fragility is one of them. To simulate human T2D and to investigate diabetic bone fragility, many rodent diabetic models have been developed. Still, an outbred genetically normal nonobese diabetic rat model is not available that can better simulate the disease characteristics of nonobese T2D patients, who have a high prevalence in Asia. In this study, we used a combination treatment of high-fat diet (4 weeks, 58% kcal as fat) and low-dose streptozotocin (STZ; 35 mg/kg i.p. at the end of the fourth week) to develop T2D in female Sprague-Dawley (SD) rats. After 8 weeks of the establishment of the T2D model, the femoral bones were excised after euthanizing rats (animal age approximately 21 to 22 weeks; n = 10 with T2D, n = 10 without diabetes). The bone microstructure (μCT), mechanical, and material properties (three-point bending, cyclic reference point indentation, nanoindentation), mean mineral crystallite size (XRD), bone composition (mineral-to-matrix ratio, nonenzymatic cross-link ratio [NE-xLR], Fourier transform-infrared microspectroscopy), and total fluorescent advanced glycation end products were analyzed. We found that diabetic bone had reduced whole-bone strength and compromised structural properties (μCT). The NE-xLRs were elevated in the T2D group, and strongly and negatively correlated with postyield displacement, which suggests bone fragility was caused by a lack of glycation control. Along with that, the decreased mineral-to-matrix ratio and modulus, increased indentation distance increase, and wider mineral crystallite size in the T2D group were evidence that the diabetic bone composition and material properties had changed, and bone became weaker with a tendency to easily fracture. Altogether, this model simulates the natural history and metabolic characteristics of late-stage T2D (insulin resistance and as disease progress develops, hypoinsulinemia) for nonobese young (and/or adolescent) T2D patients (Asians) and provides potential evidence of diabetic bone fragility at various organization levels. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Praveer Sihota
- Department of Mechanical EngineeringIndian Institute of Technology RoparRupnagarIndia
| | - Ram Naresh Yadav
- Department of Mechanical EngineeringIndian Institute of Technology RoparRupnagarIndia
| | - Sumathi Poleboina
- Department of Pharmacology and ToxicologyNational Institute of Pharmaceutical Education and ResearchMohaliIndia
| | - Vishwajeet Mehandia
- Department of Mechanical EngineeringIndian Institute of Technology RoparRupnagarIndia
| | - Sanjay Kumar Bhadada
- Department of EndocrinologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Kulbhushan Tikoo
- Department of Pharmacology and ToxicologyNational Institute of Pharmaceutical Education and ResearchMohaliIndia
| | - Navin Kumar
- Department of Mechanical EngineeringIndian Institute of Technology RoparRupnagarIndia
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20
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Kaneko K, Yatsuya H, Li Y, Uemura M, Chiang C, Hirakawa Y, Ota A, Tamakoshi K, Aoyama A. Risk and population attributable fraction of metabolic syndrome and impaired fasting glucose for the incidence of type 2 diabetes mellitus among middle-aged Japanese individuals: Aichi Worker's Cohort Study. J Diabetes Investig 2020; 11:1163-1169. [PMID: 32022993 PMCID: PMC7477517 DOI: 10.1111/jdi.13230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION The Japanese government started a nationwide screening program for metabolic syndrome (MetS) to prevent cardiovascular diseases and diabetes in 2008. Although impaired fasting glucose (IFG) is a strong predictor for type 2 diabetes mellitus, the program does not follow up IFG in non-MetS individuals. This study aimed to examine the risk and the population attributable fraction (PAF) of MetS and IFG for incidence of type 2 diabetes mellitus. MATERIALS AND METHODS Japanese workers (3,417 men and 714 women) aged 40-64 years without a history of diabetes were prospectively followed. MetS was defined as either abdominal obesity plus two or more metabolic risk factors, or being overweight in the case of normal waist circumference plus three or more metabolic risk factors. IFG was defined as fasting blood glucose 100-125 mg/dL. RESULTS During a mean 6.3 years, 240 type 2 diabetes mellitus cases were identified. Compared with those without MetS and IFG, the multivariable-adjusted hazard ratios (95% confidence interval) of non-MetS individuals with IFG, MetS individuals without IFG and MetS individuals with IFG for type 2 diabetes mellitus were 4.9 (3.4-7.1), 2.4 (1.6-3.5) and 8.3 (5.9-11.5), respectively. The corresponding PAFs for type 2 diabetes mellitus incidence were 15.6, 9.1 and 29.7%, respectively. CONCLUSIONS IFG represented a higher risk and PAF than MetS for type 2 diabetes mellitus incidence in middle-aged Japanese individuals. The coexistence of MetS and IFG showed the highest risk and PAF for type 2 diabetes mellitus incidence. The current Japanese MetS screening program should be reconsidered to follow up non-MetS individuals with IFG.
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Affiliation(s)
- Kayo Kaneko
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Hiroshi Yatsuya
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Yuanying Li
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Mayu Uemura
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Chifa Chiang
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
| | - Atsuhiko Ota
- Department of Public HealthFujita Health University School of MedicineToyoakeJapan
| | - Koji Tamakoshi
- Department of NursingNagoya University School of Health SciencesNagoyaJapan
| | - Atsuko Aoyama
- Department of Public Health and Health SystemsNagoya University Graduate School of MedicineNagoyaJapan
- Nagoya University of Arts and SciencesNissinJapan
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21
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Wang Y, Koh WP, Sim X, Yuan JM, Pan A. Multiple Biomarkers Improved Prediction for the Risk of Type 2 Diabetes Mellitus in Singapore Chinese Men and Women. Diabetes Metab J 2020; 44:295-306. [PMID: 31769241 PMCID: PMC7188981 DOI: 10.4093/dmj.2019.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Multiple biomarkers have performed well in predicting type 2 diabetes mellitus (T2DM) risk in Western populations. However, evidence is scarce among Asian populations. METHODS Plasma triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), high-sensitivity C-reactive protein (hs-CRP), ferritin, adiponectin, fetuin-A, and retinol-binding protein 4 were measured in 485 T2DM cases and 485 age-and-sex matched controls nested within the prospective Singapore Chinese Health Study cohort. Participants were free of T2DM at blood collection (1999 to 2004), and T2DM cases were identified at the subsequent follow-up interviews (2006 to 2010). A weighted biomarker score was created based on the strengths of associations between these biomarkers and T2DM risks. The predictive utility of the biomarker score was assessed by the area under receiver operating characteristics curve (AUC). RESULTS The biomarker score that comprised of four biomarkers (TG-to-HDL ratio, ALT, ferritin, and adiponectin) was positively associated with T2DM risk (P trend <0.001). Compared to the lowest quartile of the score, the odds ratio was 12.0 (95% confidence interval [CI], 5.43 to 26.6) for those in the highest quartile. Adding the biomarker score to a base model that included smoking, history of hypertension, body mass index, and levels of random glucose and insulin improved AUC significantly from 0.81 (95% CI, 0.78 to 0.83) to 0.83 (95% CI, 0.81 to 0.86; P=0.002). When substituting the random glucose levels with glycosylated hemoglobin in the base model, adding the biomarker score improved AUC from 0.85 (95% CI, 0.83 to 0.88) to 0.86 (95% CI, 0.84 to 0.89; P=0.032). CONCLUSION A composite score of blood biomarkers improved T2DM risk prediction among Chinese.
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Affiliation(s)
- Yeli Wang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Wang Y, Koh WP, Jensen MK, Yuan JM, Pan A. Plasma Fetuin-A Levels and Risk of Type 2 Diabetes Mellitus in A Chinese Population: A Nested Case-Control Study. Diabetes Metab J 2019; 43:474-486. [PMID: 30968617 PMCID: PMC6712221 DOI: 10.4093/dmj.2018.0171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/01/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Fetuin-A is a hepatokine that involved in the pathogenesis of insulin resistance. Previous epidemiological studies have found a positive association between blood fetuin-A and type 2 diabetes mellitus (T2DM) risk among Caucasians and African Americans. We aimed to investigate the prospective relationship between fetuin-A and T2DM in an Asian population for the first time. METHODS A nested case-control study was established within a prospective cohort of Chinese living in Singapore. At blood collection (1999 to 2004), all participants were free of diagnosed T2DM and aged 50 to 79 years. At subsequent follow-up (2006 to 2010), 558 people reported to have T2DM and were classified as incident cases, and 558 controls were randomly chosen from the participants who did not develop T2DM to match with cases on age, sex, dialect group, and date of blood collection. Plasma fetuin-A levels were measured retrospectively in cases and controls using samples collected at baseline. Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval (CI). Restricted cubic spline analysis was used to examine a potential non-linear association between fetuin-A levels and T2DM risk. RESULTS Compared with those in the lowest fetuin-A quintile, participants in the highest quintile had a two-fold increased risk of developing T2DM (OR, 2.06; 95% CI, 1.21 to 3.51). A non-linear association was observed (P nonlinearity=0.005), where the association between fetuin-A levels and T2DM risk plateaued at plasma concentrations around 830 μg/mL. CONCLUSION There is a positive association between plasma fetuin-A levels and risk of developing T2DM in this Chinese population.
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Affiliation(s)
- Yeli Wang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Woon Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jian Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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23
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Wang Y, Shirore RM, Ramakrishnan C, Tan NC, Jafar TH. Adiposity measures and pre‐diabetes or diabetes in adults with hypertension in Singapore polyclinics. J Clin Hypertens (Greenwich) 2019; 21:953-962. [DOI: 10.1111/jch.13587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore Singapore
| | - Rupesh M. Shirore
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore Singapore
| | - Chandrika Ramakrishnan
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore Singapore
| | - Ngiap Chuan Tan
- Health Services Research Centre SingHealth Singapore Singapore
- SingHealth Polyclinics Singapore Singapore
- SingHealth‐Duke NUS Family Academic Clinical Program Singapore Singapore
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research Duke‐NUS Medical School Singapore Singapore
- Health Services Research Centre SingHealth Singapore Singapore
- Department of Renal Medicine Singapore General Hospital Singapore Singapore
- Duke Global Health Institute Duke University Durham North Carolina
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Xie F, Chan JCN, Ma RCW. Precision medicine in diabetes prevention, classification and management. J Diabetes Investig 2018; 9:998-1015. [PMID: 29499103 PMCID: PMC6123056 DOI: 10.1111/jdi.12830] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 12/18/2022] Open
Abstract
Diabetes has become a major burden of healthcare expenditure. Diabetes management following a uniform treatment algorithm is often associated with progressive treatment failure and development of diabetic complications. Recent advances in our understanding of the genomic architecture of diabetes and its complications have provided the framework for development of precision medicine to personalize diabetes prevention and management. In the present review, we summarized recent advances in the understanding of the genetic basis of diabetes and its complications. From a clinician's perspective, we attempted to provide a balanced perspective on the utility of genomic medicine in the field of diabetes. Using genetic information to guide management of monogenic forms of diabetes represents the best-known examples of genomic medicine for diabetes. Although major strides have been made in genetic research for diabetes, its complications and pharmacogenetics, ongoing efforts are required to translate these findings into practice by incorporating genetic information into a risk prediction model for prioritization of treatment strategies, as well as using multi-omic analyses to discover novel drug targets with companion diagnostics. Further research is also required to ensure the appropriate use of this information to empower individuals and healthcare professionals to make personalized decisions for achieving the optimal outcome.
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Affiliation(s)
- Fangying Xie
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
| | - Juliana CN Chan
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- Hong Kong Institute of Diabetes and ObesityPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- Li Ka Shing Institute of Health SciencesPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- CUHK‐SJTU Joint Research Centre in Diabetes Genomics and Precision MedicinePrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
| | - Ronald CW Ma
- Department of Medicine and TherapeuticsPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- Hong Kong Institute of Diabetes and ObesityPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- Li Ka Shing Institute of Health SciencesPrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
- CUHK‐SJTU Joint Research Centre in Diabetes Genomics and Precision MedicinePrince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
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Luo M, Lim WY, Tan CS, Ning Y, Chia KS, van Dam RM, Tang WE, Tan NC, Chen R, Tai ES, Venkataraman K. Longitudinal trends in HbA1c and associations with comorbidity and all-cause mortality in Asian patients with type 2 diabetes: A cohort study. Diabetes Res Clin Pract 2017; 133:69-77. [PMID: 28898713 DOI: 10.1016/j.diabres.2017.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 02/01/2023]
Abstract
AIMS This study examined longitudinal trends in HbA1c in a multi-ethnic Asian cohort of diabetes patients, and the associations of these trends with future risk of acute myocardial infarction (AMI), stroke, end stage renal failure (ESRD) and all-cause mortality. METHODS 6079 participants with type 2 diabetes mellitus in Singapore were included. HbA1c measurements for the five years previous to recruitment were used to identify patterns of HbA1c trends. Outcomes were recorded through linkage with the National Disease Registry. The median follow-up for longitudinal trends in HbA1c was 4.1years and for outcomes was between 7.0 and 8.3years. HbA1c patterns were identified using latent class growth modeling, and associations with outcomes were analyzed using Cox proportional hazards models. RESULTS Four distinct HbA1c patterns were observed; "low-stable" (72·2%), "moderate-stable" (22·0%), "moderate-increase" (2·9%), and "high-decrease" (2·8%). The risk of comorbidities and death was significantly higher in moderate-increase and high-decrease groups compared to the low-stable group; the hazard ratios for stroke, ESRD, and death for moderate increase group were 3.22 (95%CI 1.27-8.15), 4.76 (95%CI 1.92-11.83), and 1.88 (95%CI 1.15-3.07), respectively, and for high-decrease group were 2.16 (95%CI 1.02-4.57), 3.05 (95%CI 1.54-6.07), and 2.79 (95%CI 1.97-3.95), respectively. Individuals in the moderate-increase group were significantly younger, with longer diabetes duration, and greater proportions of Malays and Indians. CONCLUSIONS Deteriorating HbA1c pattern and extremely high initial HbA1c are associated with increased risk of long-term comorbidities and death. Therapeutic interventions to alter longitudinal HbA1c trends may be helpful in reducing this risk.
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Affiliation(s)
- Miyang Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Wei Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore
| | - Yilin Ning
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore; NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore; National University Health System, 1E Kent Ridge Rd, 119228, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north South Tower, # 05-10, 138543, Singapore
| | - Ngiap Chuan Tan
- Singhealth Polyclinics, 167 Jalan Bukit Merah Tower 5, #15-10, 150167, Singapore
| | - Richard Chen
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore; Division of Endocrinology, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 117549, Singapore.
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Wang YL, Koh WP, Talaei M, Yuan JM, Pan A. Association between the ratio of triglyceride to high-density lipoprotein cholesterol and incident type 2 diabetes in Singapore Chinese men and women. J Diabetes 2017; 9:689-698. [PMID: 27573855 PMCID: PMC5332518 DOI: 10.1111/1753-0407.12477] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/15/2016] [Accepted: 08/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) are risk factors for type 2 diabetes (T2D). The relationship between TG:HDL-C ratio and T2D risk is not clear, and it is not known whether the association is modified by gender, body mass index, or fasting status. This study examined the relationship between TG:HDL-C ratio and risk of incident T2D, and the predictive ability of the ratio on top of other diabetes risk factors. METHODS Blood biomarkers were determined in 571 T2D cases and 571 controls nested within a prospective, population-based cohort study, the Singapore Chinese Health Study. Participants were free of diagnosed diabetes, cardiovascular disease, and cancer at the time of blood collection (1999-2004). Incident self-reported T2D cases were identified at follow-up interview (2006-10). Controls were matched 1: 1 for age, sex, dialect group, and date of blood collection. Multivariable logistic regression was used to compute the odds ratio (OR) and 95 % confidence interval (CI). RESULTS The ORs (95 % CI) of T2D per 1-SD increment in TG and TG: HDL-C ratio were 1.70 (1.39-2.09) and 1.72 (1.37-2.17), respectively. The relationships were stronger among females than males (Pinteraction = 0.028 and 0.017, respectively), and stronger among lean (<23 kg/m2 ) than overweight/obese participants (Pinteraction = 0.051 and 0.046, respectively). Both TG and TG: HDL-C improved T2D prediction to a similar degree. CONCLUSIONS Both TG and TG:HDL-C ratio are independent risk factors for incident T2D, and confer greater risk in women and lean participants. The TG: HDL-C ratio is not a better predictor of diabetes than TG alone.
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Affiliation(s)
- Ye-Li Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
- Duke-NUS Graduate Medical School Singapore, Republic of Singapore
| | - Mohammad Talaei
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Republic of Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - An Pan
- Department of Epidemiology and Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Kalra S, Thai HQ, Deerochanawong C, Su-Yen G, Mohamed M, Latt TS, Aye TT, Latif ZA, Katulanda P, Khun T, Satha S, Vongvandy V. Choice of Insulin in Type 2 Diabetes: A Southeast Asian Perspective. Indian J Endocrinol Metab 2017; 21:478-481. [PMID: 28553609 PMCID: PMC5434737 DOI: 10.4103/ijem.ijem_82_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Southeast Asia faces a diabetes epidemic, which has created significant challenges for health care. The unique Asian diabetes phenotype, coupled with peculiar lifestyle, diet, and healthcare-seeking behavior, makes it imperative to develop clinical pathways and guidelines which address local needs and requirements. From an insulin-centric viewpoint, the preparations prescribed in such pathways should be effective, safe, well tolerated, nonintrusive, and suitable for the use in multiple clinical situations including initiation and intensification. This brief communication describes the utility of premixed or dual action insulin in such clinical pathways and guidelines.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Hong Quang Thai
- Vietnamese Association of Diabetes and Endocrinology, Vietnam
| | - Chaicharn Deerochanawong
- Rajavithi Hospital, College of Medicine, Rangsit University, Ministry of Public Health, Bangkok, Thailand
| | - Goh Su-Yen
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Mafauzy Mohamed
- Universiti Sains Malaysia,, Health Campus in Kelantan, Kelantan, Malaysia
| | | | - Than Than Aye
- Department of Medicine, University of Medicine 2, Yangon, Myanmar
| | | | - Prasad Katulanda
- Department of Clinical Medicine, Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Touch Khun
- Diabetology Unit, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Sum Satha
- Department of Medicine, Calmette Hospital, Phnom Penh, Cambodia
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Raman R, Gella L, Srinivasan S, Sharma T. Diabetic retinopathy: An epidemic at home and around the world. Indian J Ophthalmol 2016; 64:69-75. [PMID: 26953027 PMCID: PMC4821125 DOI: 10.4103/0301-4738.178150] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Prevention of blindness due to diabetic retinopathy (DR) requires effective screening strategies, for which eye care providers need to know the magnitude of the burden and the risk factors pertinent in their geographical location. It is estimated that around 72 million of the global adult population (around 8.2%) has diabetes and about one-fifth of all adults with diabetes lives in the South-East Asia. In India, around 65 million people have diabetes. As the global prevalence of diabetes increases, so will the number of people with diabetes-related complications, such as DR; nearly one-third of them are likely to develop this complication. This article reviews the present status of diabetes and DR in India, the current situation of DR services and the projections on the load of morbidity associated with retinopathy. The article compiles the Indian studies elucidating the risk factors for DR.
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Affiliation(s)
- Rajiv Raman
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Goh SY, Ang E, Bajpai S, Deerochanawong C, Hong EG, Hussein Z, Joshi S, Kamaruddin NA, Kho S, Kong APS, Pan CY, Perfetti R, Vichayanrat A, Vlajnic A, Chan JCN. A patient-centric approach to optimise insulin therapy in Asia. J Diabetes Complications 2016; 30:973-80. [PMID: 27288201 DOI: 10.1016/j.jdiacomp.2016.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ernesto Ang
- Cardinal Santos Medical Center, San Juan, Philippines; The Institute for Studies on Diabetes Foundation Inc., Metro Manila, Philippines
| | | | | | - Eun-Gyoung Hong
- Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
| | | | | | | | - Sjoberg Kho
- University of Santo Tomas, Manila, Philippines
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Nanditha A, Ma RCW, Ramachandran A, Snehalatha C, Chan JCN, Chia KS, Shaw JE, Zimmet PZ. Diabetes in Asia and the Pacific: Implications for the Global Epidemic. Diabetes Care 2016; 39:472-85. [PMID: 26908931 DOI: 10.2337/dc15-1536] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world's most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health "tsunami." Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.
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Affiliation(s)
| | - Ronald C W Ma
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | - Juliana C N Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Z Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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