Diabetes epidemic in China and its economic impact

Association of the Onset of Self-Feeding With Subsequent Suspected Developmental Coordination Disorder: A Prospective Cohort Study in China

BACKGROUND

Successful self-feeding reflects the readiness of early motor development and environmental impacts, and the onset of self-feeding as a developmental milestone might be a predictor of subsequent motor development in children. In this study, we explored the association between the onset of self-feeding and childhood risk of Developmental Coordination Disorder in children from one-child and two-child families.

METHODS

We conducted a data-linkage prospective cohort study from 38 kindergartens in 6 cities in China. A total of 11,727 preschoolers aged 3-6 years old were included in the final analysis and were assessed with the Movement Assessment Battery for Children-second edition (MABC-2) Test. The information on early self-feeding onset was obtained from parents. The mixed and multi-level logistic models utilizing a random intercept were used to investigate the associations between the onset time of self-feeding and subsequent motor performance.

RESULTS

The results showed that, compared with those beginning self-feeding at or younger than 12 months of age, children starting self-feeding at 13-24, 25-36, and later than 36 months, showed a decrease in their total MABC-2 scores of 2.181, 3.026, and 3.874, respectively; and had an increased risk of suspected DCD by 36.0, 101.6, 102.6%, respectively; they also had 30.2, 46.6, 71.2% increased prevalence of at risk of suspected DCD, when adjusting for both child and family characteristics (each p < 0.05). Significant associations were observed in fine motor, gross motor, and balance subtests (each p < 0.05) in groups with a delayed onset of self-feeding. However, the strength of the associations was mitigated in the fine motor and balance subtests in children with a sibling.

CONCLUSION

The delayed onset time of self-feeding acts as an early behavioral marker for later childhood motor impairment. Moreover, children with a sibling may benefit from additional interaction and their motor developmental pattern may be affected by the presence of a sibling.

Association of CLTA-4 Gene Polymorphisms with Diabetes Mellitus: A Study Based on the Han Population of Northern China

OBJECTIVE

This study aimed to investigate the association of CLTA-4 gene polymorphism with Type 1 and 2 diabetes mellitus (DM) (T1DM and T2DM) in the Han population of northern China.

METHODS

A total of 234 Chinese Han DM patients and 187 non-diabetic subjects were included in the study. Two gene polymorphisms of the CLTA-4, including CTLA-4+49A/G (rs231775) and CTLA4-318C/T (rs5742909), were studied using polymerase chain reaction-restriction endonuclease fragment length polymorphism (PCR-RFLP) analysis. Chi-square analysis and Student's t-test were performed to determine the distribution of the gene polymorphism and alleles at the locus of CTLA4-318C/T and CTLA4+49A/G among T1DM and T2DM patients with or without diabetic ketosis (DK), diabetic nephropathy (DN) or autoantibodies (Ab).

RESULTS

Our results indicated that the distribution frequencies of genotypes and alleles at the CTLA-4+49A/G and CTLA4-318C/T loci of T1DM patients were not significantly different from those of the controls. However, the distribution frequencies of genotypes and alleles at the CTLA-4+49A/G loci of T2DM patients were significantly different from the controls (P=0.024 for genotypes and P=0.004 for A and G alleles). Besides, the A and G alleles at the CTLA4-318C/T loci of T2DM DK+ patients showed significantly different distribution frequencies compared to those of the T2DM DK patients (P=0.001).

CONCLUSION

Our data suggest that the gene polymorphisms of CTLA-4, including CTLA-4+49A/G and CTLA4-318C/T, are important predictors of DM. CTLA-4 may be a susceptibility gene for T2DM. Patients with T2DM carrying the T allele at the CTLA4-318 C/T locus are more predisposed to diabetic ketosis.

Hydrophobic recognition allows the glycosyltransferase UGT76G1 to catalyze its substrate in two orientations

Diets high in sugar are recognized as a serious health problem, and there is a drive to reduce their consumption. Steviol glycosides are natural zero-calorie sweeteners, but the most desirable ones are biosynthesized with low yields. UGT76G1 catalyzes the β (1-3) addition of glucose to steviol glycosides, which gives them the preferred taste. UGT76G1 is able to transfer glucose to multiple steviol substrates yet remains highly specific in the glycosidic linkage it creates. Here, we report multiple complex structures of the enzyme combined with biochemical data, which reveal that the enzyme utilizes hydrophobic interactions for substrate recognition. The lack of a strict three-dimensional recognition arrangement, typical of hydrogen bonds, permits two different orientations for β (1-3) sugar addition. The use of hydrophobic recognition is unusual in a regio- and stereo-specific catalysis. Harnessing such non-specific hydrophobic interactions could have wide applications in the synthesis of complex glycoconjugates.

Safety and Efficacy of High Versus Standard Starting Doses of Insulin Glargine in Overweight and Obese Chinese Individuals with Type 2 Diabetes Mellitus Inadequately Controlled on Oral Antidiabetic Medications (Beyond VII): Study Protocol for a Randomized Controlled Trial

BACKGROUND

Treatment with basal insulin in Chinese populations is currently sub-optimal, with delayed initiation of insulin treatment and inadequate dose titration. Increasing the initial dose of insulin may be a practicable and effective solution to the problem of titration. A higher initial dose will be helpful for patients to achieve the blood glucose target and improve treatment satisfaction and compliance as well require fewer steps to titrate. Considering that overweight and obese patients usually require higher insulin doses because of insulin resistance, a higher initial dose of the basal insulin is feasible in overweight and obese patients with type 2 diabetes. However, safety is an important issue needing to be considered for higher initial dose treatment. The aim of this study is to assess the safety and efficacy of higher (0.3 U/kg) compared with standard (0.2 U/kg) starting doses of basal insulin in overweight and obese Chinese patients with type 2 diabetes who have failed to achieve glycaemic control using oral antidiabetic drugs (OADs).

METHODS

This is a phase IV, randomized, non-inferiority, open-label trial that will be conducted at approximately 50 centers in China. Eight hundred eighty overweight and obese adult Chinese patients with type 2 diabetes will be randomized to receive higher (0.3 U/kg) or standard (0.2 U/kg) starting doses of basal insulin glargine (100 U/ml) during a 16-week period. The primary endpoint is whether a higher initial dose of basal insulin (0.3 U/kg) is non-inferior to a standard initial dose (0.2 U/kg) based on the percentage of patients with at least one episode of hypoglycaemia (≤ 3.9 mmol/l or severe) over 16 weeks. Secondary endpoints include evaluation of glycosylated haemoglobin A1c (HbA1c), fasting blood glucose, postprandial blood glucose, insulin dose and safety.

DISCUSSION

This study is the first randomized-controlled study to evaluate the safety and efficacy of basal insulin treatment with a higher starting dose versus standard starting dose in overweight and obese Chinese patients with type 2 diabetes. Results of this study could generate evidence to support the feasibility of a higher starting dose of basal insulin in diabetes management of overweight and obese Chinese patients, therefore providing an easy approach to improve diabetes management.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT02836704. Registered on July 7th 2016.

FUNDING

Sanofi China.

Ethnic Disparity in Annual Healthcare Expenditures for Type 2 Diabetes Mellitus in Ningxia, China

BACKGROUND

The incidence of type 2 diabetes mellitus (T2DM) and its complications has been increasing worldwide with an increasing provision of long-term medications and health services. This study aimed to assess the healthcare costs for T2DM patients for vulnerable ethnic minority.

METHODS

A cross-sectional study was conducted from October 13, 2016, to June 19, 2017, in two public hospitals in Ningxia, China. Eligible Hui and Han inpatients were recruited and interviewed. Ethnic disparities in annual healthcare expenditures for T2DM measured from a societal perspective and its associations of expenditures with other factors were analyzed by linear and quantile regressions.

RESULTS

Ethnic disparities in annual healthcare expenditures for T2DM were demonstrated, mainly reflecting differences in the cost of productivity loss. The quantile of annual healthcare expenditure showed significant ethnic disparities in T2DM patients with complications. At the 10th to 50th quantiles of healthcare expenditures, Hui patients had significantly lower expenditures than Han patients in both unadjusted and adjusted models. Non-significant difference in expenditures between Hui and Han patients was found at the 90th quantile of expenditure in the unadjusted model, but significantly higher expenditures for Hui patients were shown when adjusted for socioeconomic and clinical factors.

CONCLUSION

T2DM Hui patients faced significantly higher expenditures than Han patients when the costs of healthcare were high. Appropriate national policy considering the issue of ethnic minority should be further explored to improve health and subsidize economic burden for T2DM patients.

Glycaemic control in type 2 diabetes patients and its predictors: a retrospective database study at a tertiary care diabetes centre in Ningbo, China

OBJECTIVES

The objectives of the study were to assess glycaemic control in patients with type 2 diabetes (T2DM) at a tertiary care diabetes centre in Ningbo, China and to determine factors that independently predict their glycaemic control.

DESIGN

Retrospective cross-sectional study using an existing database, the Diabetes Information Management System.

SETTING

Tertiary care diabetes centre in Ningbo, China.

PARTICIPANTS

The study included adult patients with T2DM, registered and received treatment at the diabetes centre for at least six consecutive months. The study inclusion criteria were satisfied by 1387 patients, from 1 July 2012 to 30 June 2017.

PRIMARY OUTCOME MEASURE

Glycaemic control (poor was defined as glycated haemoglobin (HbA1c)>=7% or fasting blood glucose (FBG)>7.0 mmol/L).

RESULTS

In terms of HbA1c and FBG, the 5-year period prevalence of poor glycaemic control was 50.3% and 57.3%, respectively. In terms of HbA1c and FBG, the odds of poor glycaemic control increased with the duration of T2DM (>1 to 2 years: OR 1.84, 95% CI 1.06 to 3.19; >2 to 4 years: 3.32, 1.88 to 5.85 and >4 years: 5.98, 4.09 to 8.75 and >1 to 2 years: 2.10, 1.22 to 3.62; >2 to 4 years: 2.48, 1.42 to 4.34 and >4 years: 3.34, 2.32 to 4.80) and were higher in patients residing in rural areas (1.68, 1.24 to 2.28 and 1.42, 1.06 to 1.91), with hyperlipidaemia (1.57, 1.12 to 2.19 and 1.68, 1.21 to 2.33), on diet, physical activity and oral hypoglycaemic drug (OHD) as part of their T2DM therapeutic regimen (1.80, 1.01 to 3.23 and 2.40, 1.36 to 4.26) and on diet, physical activity, OHD and insulin (2.47, 1.38 to 4.41 and 2.78, 1.58 to 4.92), respectively.

CONCLUSIONS

More than half of patients with T2DM at the diabetes centre in Ningbo, China have poor glycaemic control, and the predictors of glycaemic control were identified. The study findings could be taken into consideration in future interventional studies aimed at improving glycaemic control in these patients.

Hospitalization of elderly diabetic patients: characteristics, reasons for admission, and gender differences

Background

Understanding the differences in characteristics, gender, and common causes for admission in hospitalized elderly diabetic patients provides a theoretical basis for their successful management. This study explored the reasons and gender differences in hospitalizations of elderly patients with diabetes mellitus.

Methods

Patients aged ≥60 years who had received a diagnosis of diabetes by the time of discharge, from 1 January 2011 to 1 January 2014, were retrospectively enrolled. Hospitalization data of the patients were collected, and reasons for hospitalization were analyzed based on chief complaints and principle diagnosis.

Results

The most frequent reasons stated for admission were related to the chronic complications of diabetes (42.1 %), seconded by hyperglycemia (26.4 %) and infection (15.7 %). Ketonuria, ketonemia, or diabetic ketoacidosis was more commonly seen in women than men, whereas diabetic nephropathy and neoplasms were more frequently found in men than women. Regarding infection as a cause of hospitalization, the 4 main types were respiratory tract (44.5 %), urinary tract (20.3 %), gastrointestinal (14.8 %), and skin and soft tissue (10.9 %). Respiratory tract infection was significantly more common in men (61.4 %) than women (31 %, P = 0.001), whereas urinary tract infection was more frequent in women (29.6 %) than men (8.8 %, P = 0.004).

Conclusion

The most frequent reasons for hospital admission in elderly diabetic patients were chronic complications of diabetes, hyperglycemia, and infection. Men and women differed in reasons for hospital admission.

Mortality rates and the causes of death related to diabetes mellitus in Shanghai Songjiang District: an 11-year retrospective analysis of death certificates

BACKGROUND

China is one of the countries with the highest prevalence of diabetes in the world. We analysed all the death certificates mentioning diabetes from 2002 to 2012 in Songjiang District of Shanghai to estimate morality rates and examine cause of death patterns.

METHODS

Mortality data of 2654 diabetics were collected from the database of local CDC. The data set comprises all causes of death, contributing causes and the underlying cause, thereby the mortality rates of diabetes and its specified complications were analysed.

RESULTS

The leading underlying causes of death were various cardiovascular diseases (CVD), which collectively accounted for about 30% of the collected death certificates. Diabetes was determined as the underlying cause of death on 28.7%. The trends in mortality showed that the diabetes related death rate increased about 1.78 fold in the total population during the 11-year period, and the death rate of diabetes and CVD comorbidity increased 2.66 fold. In all the diabetes related deaths, the proportion of people dying of ischaemic heart disease or cerebrovascular disease increased from 18.0% in 2002 to 30.5% in 2012. But the proportions attributed directly to diabetes showed a downtrend, from 46.7-22.0%.

CONCLUSIONS

The increasing diabetes related mortality could be chiefly due to the expanding prevalence of CVD, but has nothing to do with diabetes as the underlying cause. Policy makers should pay more attention to primary prevention of diabetes and on the prevention of cardiovascular complications to reduce the burden of diabetes on survival.

Prevalence, trends and risk factors for the diabetes epidemic in China: a systematic review and meta-analysis

AIMS

To describe the prevalence and trends of diabetes and to quantitatively assess its risk factors in mainland China.

METHODS

Thirty-one epidemiological studies were identified by a systematic search of four databases. Prevalence estimates were mapped and summarized by meta-analysis in each region of China. The pooled ORs and 95% CIs of risk factors for diabetes were also calculated.

RESULTS

There was a large geographical imbalance with regard to the prevalence of diabetes. Region-pooled prevalence was highest in the eastern region (8.0%, 95% CI: 6.1-10.0%) and lowest in the western region (4.6%, 95% CI: 3.3-6.0%), which was consistent with regional levels of economic development. The overall prevalence of diabetes has been increasing since 1980. Traditional risk factors such as age, family history of diabetes, obesity, hypertension and elevated triglycerides were found to be associated with diabetes. In addition, urban residence and being from ethnic minorities were also significantly associated.

CONCLUSION

Based on the meta-analyses, we found that the prevalence of diabetes is different in different parts of China but it has been increasing sharply during the last three decades. Some risk factors were quantitatively derived in the study, which are free from the diversity of a single sample.