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Liao YS, Tsai WC, Chiu LT, Kung PT. Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program. Health Policy 2023; 138:104917. [PMID: 37776765 DOI: 10.1016/j.healthpol.2023.104917] [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] [Received: 02/05/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program-providing comprehensive, continuous medical care-has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002-2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.
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Affiliation(s)
- Yi-Shu Liao
- Department of Pathology, Taichung Armed Forces General Hospital, National Defense Medical Center, Taiwan; Department of Public Health, China Medical University, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taiwan; Department of Medical Research, China Medical University Hospital, Taiwan.
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Lin CC, Lee CY, Huang JY, Hsu SM, Hung JH, Yang SF. Trends in diabetic eye disorders and associated comorbidities in Taiwan: a 10-year nationwide population-based cohort study. Br J Ophthalmol 2023; 107:1303-1310. [PMID: 35396213 DOI: 10.1136/bjophthalmol-2021-320917] [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] [Received: 12/09/2021] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS In-depth analysis is needed to investigate trends in diabetic retinopathy (DR), diabetic macular oedema (DME) and associated comorbidities in patients with type 2 diabetes mellitus (T2DM) so that we can better understand their prevalence and incidence. METHODS A retrospective population-based study was conducted using data from Taiwan's National Health Insurance Research Database from 2005 to 2015, and T2DM, DR and associated comorbidities were identified based on diagnostic codes. We used a standardised incidence rate with age and sex adjustment to estimate the prevalence and incidence of DR, proliferative DR (PDR), advanced PDR (aPDR) and DME, while the difference in each study period was calculated as the annual percentage change. We used the absolute standardised difference to analyse changes in related comorbidities in different periods. RESULTS The population of patients with DM increased over 50% between 2005 and 2015, while the prevalence and incidence of DR decreased, as did the incidence of PDR and aPDR. However, the prevalence and incidence of DME increased over the course of 10 years, with an upward trend in all forms of DR. The percentage of patients with hyperlipidaemia in DME and all DR increased, and the percentage of patients with end-stage renal disease (ESRD) was also elevated in DME. CONCLUSION The prevalence and incidence of DR, PDR and aPDR decreased with time in patientsT2DM, while the ratio of DME increased gradually. The incidence of hyperlipidaemia also increased in all forms of diabetic eye disorders, while ESRD increased solely in DME.
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Affiliation(s)
- Chia-Chen Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Wu SY, Chen WM, Chen YC, Chiang MF, Lee MC, Soong RS. Effects of H1-Antihistamines on hepatocellular carcinoma risk in patients with type 2 diabetes mellitus. DIABETES & METABOLISM 2023; 49:101393. [PMID: 36170945 DOI: 10.1016/j.diabet.2022.101393] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE H1-antihistamines (AHs) may exert protective effects against cancer. We investigated the association of AH use with hepatocellular carcinoma (HCC) risk in type 2 diabetes mellitus (T2DM) patients without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. METHODS The data of patients with T2DM enrolled from Taiwan's National Health Insurance Research Database were examined for the period of January 1, 2008, to December 31, 2018. We used the Kaplan-Meier method and Cox proportional hazards regression to evaluate the AH use-HCC risk association. RESULTS After 1:1 propensity score matching was performed, the two cohorts were each divided into AH users (n = 47,990) and nonusers (n = 47,990). The risk of HCC was significantly lower in AH users than in AH nonusers (adjusted hazard ratio [aHR]: 0.55 95% confidence interval [95% CI], 0.46 to 0.67; IRR: 0.70; 95% CI, 0.60 to 0.84), respectively. The dose-response relationship between AH use and HCC risk was also observed (aHRs: 0.58, 0.56, 0.50, and 0.41 for 28-35, 36-49, 50-77, and >77 cumulative defined daily doses of AH, respectively). CONCLUSION AH use can reduce HCC risk in T2DM patients without HBV or HCV infection in a dose-dependent manner.
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Affiliation(s)
- Szu-Yuan Wu
- 1Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wan-Ming Chen
- 1Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Chan Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ming-Feng Chiang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
| | - Ming-Che Lee
- Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ruey-Shyang Soong
- Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Zhou YY, Zhou TC, Chen N, Zhou GZ, Zhou HJ, Li XD, Wang JR, Bai CF, Long R, Xiong YX, Yang Y. Risk factor analysis and clinical decision tree model construction for diabetic retinopathy in Western China. World J Diabetes 2022; 13:986-1000. [PMID: 36437866 PMCID: PMC9693737 DOI: 10.4239/wjd.v13.i11.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/20/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the driving force of blindness in patients with type 2 diabetes mellitus (T2DM). DR has a high prevalence and lacks effective therapeutic strategies, underscoring the need for early prevention and treatment. Yunnan province, located in the southwest plateau of China, has a high pre-valence of DR and an underdeveloped economy.
AIM To build a clinical prediction model that will enable early prevention and treatment of DR.
METHODS In this cross-sectional study, 1654 Han population with T2DM were divided into groups without (n = 826) and with DR (n = 828) based on fundus photography. The DR group was further subdivided into non-proliferative DR (n = 403) and proliferative DR (n = 425) groups. A univariate analysis and logistic regression analysis were conducted and a clinical decision tree model was constructed.
RESULTS Diabetes duration ≥ 10 years, female sex, standing- or supine systolic blood pressure (SBP) ≥ 140 mmHg, and cholesterol ≥ 6.22 mmol/L were risk factors for DR in logistic regression analysis (odds ratio = 2.118, 1.520, 1.417, 1.881, and 1.591, respectively). A greater severity of chronic kidney disease (CKD) or hemoglobin A 1c increased the risk of DR in patients with T2DM. In the decision tree model, diabetes duration was the primary risk factor affecting the occurrence of DR in patients with T2DM, followed by CKD stage, supine SBP, standing SBP, and body mass index (BMI). DR classification outcomes were obtained by evaluating standing SBP or BMI according to the CKD stage for diabetes duration < 10 years and by evaluating CKD stage according to the supine SBP for diabetes duration ≥ 10 years.
CONCLUSION Based on the simple and intuitive decision tree model constructed in this study, DR classification outcomes were easily obtained by evaluating diabetes duration, CKD stage, supine or standing SBP, and BMI.
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Affiliation(s)
- Yuan-Yuan Zhou
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Tai-Cheng Zhou
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Nan Chen
- Department of Endocrinology and Metabolism, The Frist People’s Hospital of Anning City, Anning City 650300, Yunnan Province, China
| | - Guo-Zhong Zhou
- Department of Endocrinology and Metabolism, The Frist People’s Hospital of Anning City, Anning City 650300, Yunnan Province, China
| | - Hong-Jian Zhou
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Xing-Dong Li
- Department of Endocrinology and Metabolism, The Sixth Affiliated Hospital of Kunming Medical University, The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Jin-Rui Wang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Chao-Fang Bai
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Rong Long
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Yu-Xin Xiong
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
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Huang LY, Chen FY, Jhou MJ, Kuo CH, Wu CZ, Lu CH, Chen YL, Pei D, Cheng YF, Lu CJ. Comparing Multiple Linear Regression and Machine Learning in Predicting Diabetic Urine Albumin–Creatinine Ratio in a 4-Year Follow-Up Study. J Clin Med 2022; 11:jcm11133661. [PMID: 35806944 PMCID: PMC9267784 DOI: 10.3390/jcm11133661] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
The urine albumin–creatinine ratio (uACR) is a warning for the deterioration of renal function in type 2 diabetes (T2D). The early detection of ACR has become an important issue. Multiple linear regression (MLR) has traditionally been used to explore the relationships between risk factors and endpoints. Recently, machine learning (ML) methods have been widely applied in medicine. In the present study, four ML methods were used to predict the uACR in a T2D cohort. We hypothesized that (1) ML outperforms traditional MLR and (2) different ranks of the importance of the risk factors will be obtained. A total of 1147 patients with T2D were followed up for four years. MLR, classification and regression tree, random forest, stochastic gradient boosting, and eXtreme gradient boosting methods were used. Our findings show that the prediction errors of the ML methods are smaller than those of MLR, which indicates that ML is more accurate. The first six most important factors were baseline creatinine level, systolic and diastolic blood pressure, glycated hemoglobin, and fasting plasma glucose. In conclusion, ML might be more accurate in predicting uACR in a T2D cohort than the traditional MLR, and the baseline creatinine level is the most important predictor, which is followed by systolic and diastolic blood pressure, glycated hemoglobin, and fasting plasma glucose in Chinese patients with T2D.
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Affiliation(s)
- Li-Ying Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Department of Medical Education, Fu Jen Catholic University Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (L.-Y.H.); (F.-Y.C.); (C.-H.K.); (D.P.)
| | - Fang-Yu Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Department of Medical Education, Fu Jen Catholic University Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (L.-Y.H.); (F.-Y.C.); (C.-H.K.); (D.P.)
| | - Mao-Jhen Jhou
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
| | - Chun-Heng Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Department of Medical Education, Fu Jen Catholic University Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (L.-Y.H.); (F.-Y.C.); (C.-H.K.); (D.P.)
| | - Chung-Ze Wu
- Division of Endocrinology, Department of Internal Medicine, Shuang Ho Hospital, New Taipei City 23561, Taiwan;
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Yen-Lin Chen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Dee Pei
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Department of Medical Education, Fu Jen Catholic University Hospital, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24352, Taiwan; (L.-Y.H.); (F.-Y.C.); (C.-H.K.); (D.P.)
| | - Yu-Fang Cheng
- Department of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua 50051, Taiwan;
| | - Chi-Jie Lu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Department of Information Management, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Correspondence: ; Tel.: +886-2-2905-2973
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Circulating Growth Differentiation Factor 15 Is Associated with Diabetic Neuropathy. J Clin Med 2022; 11:jcm11113033. [PMID: 35683420 PMCID: PMC9180959 DOI: 10.3390/jcm11113033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Growth differentiation factor (GDF15) is a superfamily of transforming growth factor-beta which has been suggested to be correlated with various pathological conditions. The current study aimed to investigate the predicted role of circulating GDF15 in diabetic metabolism characteristics and diabetic neuropathy. Methods: 241 diabetic patients and 42 non-diabetic subjects were included to participate in the study. The plasma GDF15 levels were measured using ELISA. Chronic kidney disease and albuminuria were defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline. The nerve conductive study (NCS) was performed with measurement of distal latency, amplitude, nerve conduction velocity (NCV), H-reflex, and F-wave studies. Results: The diabetic group had a significantly higher prevalence of chronic kidney disease and higher plasma GDF15 level. After adjusting for age and BMI, GDF15 was significantly positively correlated with waist circumference (r = 0.332, p = <0.001), hip circumference (r = 0.339, p < 0.001), HbA1c (r = 0.302, p < 0.001), serum creatine (r = 0.146, p = 0.017), urine albumin/creatinine ratio (r = 0.126, p = 0.040), and HOMA-IR (r = 0.166, p = 0.007). As to NCS, GDF15 was significantly correlated with all latency and amplitude of sensory and motor nerves, as well as F-wave and H-reflex latencies. The area under the curve (AUC) in predicting tibial motor nerve neuropathy (MNCV) in all subjects and in the diabetic group for GDF15 was 0.646 (p = 0.001) and 0.610 (p = 0.012), respectively; for HbA1c was 0.639 (p = 0.001) and 0.604 (p = 0.018), respectively. Predicting ulnar sensory nerve neuropathy for GDF15 was 0.639 (p = 0.001) and 0.658 (p = 0.001), respectively; for HbA1c was 0.545 (p = 0.307) and 0.545 (p = 0.335), respectively. Predicting median sensory nerve neuropathy for GDF15 was 0.633 (p = 0.007) and 0.611 (p = 0.032), respectively; for HbA1c was 0.631 (p = 0.008) and 0.607 (p = 0.038), respectively. Predicting CKD for GDF15 was 0.709 (95% CI, 0.648−0.771), p < 0.001) and 0.676 (95% CI, 0.605−0.746), p < 0.001), respectively; for HbA1c was 0.560 (95% CI, 0.493−0.627); p = 0.080) and 0.515 (95% CI, 0.441−0.588); p = 0.697), respectively. Conclusions: We suggest that there is a significant association between the increased serum GDF-15 level and metabolic parameters and diabetic neuropathy. Plasma GDF15 may be an independent predictor of diabetic neuropathy.
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Wang CS, Pai YW, Lin CH, Lee IT, Chang MH. Renal impairment is one of appropriate predictors of future diabetic peripheral neuropathy: a hospital-based 6-year follow-up study. Sci Rep 2022; 12:5240. [PMID: 35347201 PMCID: PMC8960825 DOI: 10.1038/s41598-022-09333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
The relationship between renal impairment and diabetic peripheral neuropathy (DPN) remains inconclusive. We aim to investigate the risk factors for the occurrence of DPN in Taiwanese adults with type 2 diabetes mellitus (T2DM) and focus on renal impairment. A hospital-based study was conducted from 2013 to 2019 and 552 Taiwanese people who had T2DM without DPN at baseline were enrolled. DPN was diagnosed using the Michigan Neuropathy Screening Instrument. Potential risk factors were recorded, including patient’s sociodemographic factors, current medication usage and biochemical markers. As of 2019, 73 developed DPN and 479 had no DPN. The cumulative incidence during the 6-year period was 13.22%. Multivariable logistic regression analysis revealed that lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.98, p = 0.005), advanced age (OR 1.06, p = 0.001), increased body weight (OR 1.04, p = 0.018), duration of DM (OR 1.05, p = 0.036) and male gender (OR 3.69, p = 0.011) were significantly associated with future DPN. In addition, patients with T2DM under the age of 65 with higher serum creatinine concentration (OR 8.91, p = 0.005) and higher baseline HbA1C (OR 1.71, p < 0.001) revealed significantly associated with future DPN. In conclusion, this is the first large scaled hospital-based study with long term follow-up to investigate risk factors for DPN in Taiwanese. Lower eGFR and higher serum creatinine concentration, particularly in people under the age of 65, are predictors of future DPN in Taiwanese people with T2DM. Other predictors included advanced age, increased body weight, duration of DM, male gender for all ages and HbA1c in enrolled patients under the age of 65. Our study not only confirms the association between renal impairment and future DPN but also provides a commonly available assessment to predict the future DPN.
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Affiliation(s)
- Chi-Sheng Wang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC.,Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Road, Taichung City, 40201, Taiwan, ROC
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City, 40705, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, No 145, XingDa Road, South Dist., Taichung, Taiwan, ROC.
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Chou PL, Chiang IH, Lin CW, Wang HH, Wang HK, Huang CH, Chang CS, Huang RY, Lin CY. Newly Diagnosed Type 2 Diabetes Care between Family Physicians, Endocrinologists, and Other Internists in Taiwan: A Retrospective Population-Based Cohort Study. J Pers Med 2022; 12:jpm12030461. [PMID: 35330461 PMCID: PMC8955527 DOI: 10.3390/jpm12030461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: We aimed to determine whether physicians of different specialties perform differently in the monitoring, cost control, and prevention of acute outcomes in diabetes care. (2) Methods: Using data from the Health and Welfare Data Science Center, participants with newly diagnosed type 2 diabetes (n = 206,819) were classified into three cohorts based on their primary care physician during the first year of diagnosis: family medicine (FM), endocrinologist, and other internal medicine (IM). The three cohorts were matched in a pairwise manner (FM (n = 28,269) vs. IM (n = 28,269); FM (n = 23,407) vs. endocrinologist (n = 23,407); IM (n = 43,693) vs. endocrinologist (n = 43,693)) and evaluated for process indicators, expenditure on diabetes care, and incidence of acute complications (using subdistribution hazard ratio; sHR). (3) Results: Compared to the FM cohort, both the IM (sHR, 1.26; 95% CI, 1.08 to 1.47) and endocrinologist cohorts (sHR, 1.57; 95% CI, 1.38−1.78) had higher incidences of acute complications. The FM cohort incurred lower costs than the IM cohort (USD 487.41 vs. USD 507.67, p = 0.01) and expended less than half of the diabetes-related costs of the endocrinology cohort (USD 484.39 vs. USD 927.85, p < 0.001). (4) Conclusion: Family physicians may provide better care at a lower cost to newly diagnosed type 2 diabetes patients. Relatively higher costs incurred by other internists and endocrinologists in the process of diabetes care may be explained by the more frequent ordering of specialized tests.
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Affiliation(s)
- Pei-Lin Chou
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (P.-L.C.); (I.-H.C.); (C.-W.L.); (C.-H.H.)
| | - I-Hui Chiang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (P.-L.C.); (I.-H.C.); (C.-W.L.); (C.-H.H.)
| | - Chi-Wei Lin
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (P.-L.C.); (I.-H.C.); (C.-W.L.); (C.-H.H.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (H.-H.W.); (H.-K.W.); (C.-S.C.)
| | - His-Hao Wang
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (H.-H.W.); (H.-K.W.); (C.-S.C.)
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- Department of Medical Quality, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Hao-Kuang Wang
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (H.-H.W.); (H.-K.W.); (C.-S.C.)
- Department of Neurosurgery, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Chi-Hsien Huang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (P.-L.C.); (I.-H.C.); (C.-W.L.); (C.-H.H.)
| | - Chao-Sung Chang
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (H.-H.W.); (H.-K.W.); (C.-S.C.)
- Committee for Advanced Medical Technology, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Ru-Yi Huang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; (P.-L.C.); (I.-H.C.); (C.-W.L.); (C.-H.H.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; (H.-H.W.); (H.-K.W.); (C.-S.C.)
- Correspondence: (R.-Y.H.); (C.-Y.L.)
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (R.-Y.H.); (C.-Y.L.)
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Wu CC, Lee CH, Hsu TW, Yeh CC, Lin MC, Chang CM, Tsai JH. Is Colectomy Associated with the Risk of Type 2 Diabetes in Patients without Colorectal Cancer? A Population-Based Cohort Study. J Clin Med 2021; 10:jcm10225313. [PMID: 34830601 PMCID: PMC8622203 DOI: 10.3390/jcm10225313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes might be influenced by colonic disease; however, the association between colonic resection and type 2 diabetes has rarely been discussed. This population-based cohort study explored the association between colectomy and type 2 diabetes in patients without colorectal cancer. A total of 642 patients who underwent colectomy for noncancerous diseases at any time between 2000 and 2012 in the National Health Insurance Research Database of Taiwan were enrolled. The enrolled patients were matched with 2568 patients without colectomy at a 1:4 ratio using a propensity score that covered age, sex, and comorbidities. The risk of type 2 diabetes was assessed using a Cox proportional hazards model. The mean (standard deviation) follow-up durations in colectomy cases and non-colectomy controls were 4.9 (4.0) and 5.6 (3.6) years, respectively; 65 (10.1%) colectomy cases and 342 (15.5%) non-colectomy controls developed type 2 diabetes. After adjustment, colectomy cases still exhibited a decreased risk of type 2 diabetes (adjusted HR = 0.80, 95% CI: 0.61–1.04). A stratified analysis for colectomy type indicated that patients who underwent right or transverse colectomy had a significantly lower risk of developing type 2 diabetes (adjusted HR = 0.57, 95% CI: 0.34–0.98). In the present study, colectomy tended to be at a reduced risk of type 2 diabetes in patients without colorectal cancer, and right or transverse colectomies were especially associated with a significantly reduced risk of type 2 diabetes.
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Affiliation(s)
- Chin-Chia Wu
- Division of Colorectal Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan; (C.-C.W.); (T.-W.H.)
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-H.L.); (C.-C.Y.)
| | - Cheng-Hung Lee
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-H.L.); (C.-C.Y.)
- Division of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
| | - Ta-Wen Hsu
- Division of Colorectal Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan; (C.-C.W.); (T.-W.H.)
- College of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chia-Chou Yeh
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 970, Taiwan; (C.-H.L.); (C.-C.Y.)
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chun-Ming Chang
- College of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of General Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Correspondence: (C.-M.C.); (J.-H.T.)
| | - Jui-Hsiu Tsai
- College of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan
- Ph.D. Program in Environmental and Occupation Medicine, National Health Research Institutes and Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (C.-M.C.); (J.-H.T.)
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Tu CL, Sue SP, Hsu WH, Huang HY, Wen WL, Lin IT, Chen KH, Sheu NW, Huang SH, Lee MY. Causes of in-hospital death in patients with type 2 diabetes with microvascular and macrovascular complications in Taiwan. Int J Clin Pract 2021; 75:e14491. [PMID: 34115914 DOI: 10.1111/ijcp.14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Diabetes mellitus is a major cause of death worldwide, including Taiwan. The mortality data of the subsets of patients who suffered from microvascular or macrovascular complications is limited. The aim of this study was to investigate the causes of in-hospital death of patients with type 2 diabetes, especially the patients with microvascular, macrovascular and both micro-macrovascular complications. METHODS A total of 12 159 patients with type 2 diabetes were identified from the Taiwan National Health Insurance Research Database (NHIRD) to analyse the causes of death. Type 2 diabetic subjects with microvascular, macrovascular and both micro-macrovascular complications were further classified and compared to patients without microvascular and macrovascular complications in the logistic regression analysis of the risk of death. RESULTS Pneumonia increased risk of in-hospital death in patients with microvascular, macrovascular and both micro-macrovascular complications, with adjusted odds ratios (AORs) of 2.13 (95% confidence interval [CI] 1.09-4.18), 3.26 (1.71-6.24) and 3.96 (2.17-7.22), respectively. Septicaemia increased risk of in-hospital death in patients with macrovascular (AOR 2.57 [1.31-5.04]) and both micro-macrovascular complications (AOR 4.69 [2.58-8.50]). CONCLUSION Pneumonia increased risk of in-hospital death among the type 2 diabetic patients with microvascular, macrovascular and both micro-macrovascular complications. Therefore, efforts aim at preventing pneumonia or decreasing its severity may increase survival.
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Affiliation(s)
- Ching-Ling Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Ping Sue
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Hao Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsing-Yi Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Lun Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ting Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuan-Hsuan Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Nai-Wei Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Heng Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis. J Clin Med 2020; 9:jcm9093012. [PMID: 32962006 PMCID: PMC7565280 DOI: 10.3390/jcm9093012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.
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Su CL, Wang L, Ho CC, Nfor ON, Hsu SY, Lee CT, Ko PC, Lin YT, Liaw YP. Physical activity is associated with lower health care costs among Taiwanese individuals with diabetes mellitus. Medicine (Baltimore) 2020; 99:e19613. [PMID: 32243386 PMCID: PMC7440055 DOI: 10.1097/md.0000000000019613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/03/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022] Open
Abstract
The economic burden of diabetes has increased over time with disease severity. Previous publications investigating the effects of physical activity (PA) on medical costs have made use of small sample sizes. We assessed the relationship between PA and 1-year medical expenditure among Taiwanese patients with type-2 diabetes mellitus (T2DM).Data were recruited from three governmental databases, including the 2012 adult preventive health service database. Participants were grouped as inactive (no exercise), insufficiently active (exercise < 150 minutes/week), and sufficiently active (exercise >150 minutes/week) individuals. Patients were stratified according to age and Charlson score. Multivariate linear regression models were used to determine β-coefficients and their P values.Overall, 218,960 individuals were identified with diabetes. The prevalence of the disease was 13.1% among sufficiently active, 35% among insufficiently active, and 51.9% among physically inactive adults. In general, patients who had exercise >150 minutes/week had lower health care spending (i.e., US$ 755.83) followed by those who had less than 150 minutes/week (US$ 880.08) when compared with inactive patients (P < .0001). Moreover, health care costs derived from outpatient or inpatient care were lower for sufficiently active than inactive participants (P < .0001).Compared with being sedentary, PA was associated with lower health care costs of Taiwanese adults with diabetes mellitus.
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Affiliation(s)
- Chun-Lang Su
- Department of Public Health and Institute of Public Health
- School of Medicine, Chung Shan Medical University, Taichung City
- Department of Physical Medicine and Rehabilitation, Yuan Sheng Hospital, Yuanlin City
| | - Lee Wang
- Department of Public Health and Institute of Public Health
| | - Chien-Chang Ho
- Department of Physical Education, Fu Jen Catholic University, New Taipei City
- Research and Development Center for Physical Education, Health and Information Technology, Fu Jen Catholic University, New Taipei City
| | | | - Shu-Yi Hsu
- Department of Public Health and Institute of Public Health
| | - Chun-Te Lee
- School of Medicine, Chung Shan Medical University, Taichung City
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung City
| | - Pei-Chieh Ko
- Department of Public Health and Institute of Public Health
| | - Yi-Tien Lin
- Department of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan
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Nfor ON, Ndzinisa NB, Tsai M, Hsiao CH, Liaw YP. Interactive Effect of IGF2BP2 rs4402960 Variant, Smoking and Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:5097-5102. [PMID: 33408493 PMCID: PMC7779857 DOI: 10.2147/dmso.s289642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/10/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Genetic and environmental factors are related to type 2 diabetes (T2D). Genetic modifiers of T2D have not been widely determined among smoking individuals. In this population-based study, we investigated the interactive association between rs4402960 polymorphism of the insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) gene and smoking with T2D among Taiwanese adults. MATERIALS AND METHODS We obtained genetic data collected between 2008 and 2018 for 22,039 participants (aged 30-70 years) from the Taiwan Biobank (TWB) database. These data were analyzed using the t-test, Chi-square (χ 2) test, and multiple logistic regression. RESULTS The mean ages for participants with and without diabetes were 58.11±8.75 and 48.58±11, respectively. Compared with the rs4402960 GG genotype, the odds ratio (OR) for T2D was 1.261 among GT and 1.545 among TT genotype individuals (p<0.05). Current smokers compared to nonsmokers were associated with a higher risk of T2D (OR=1.266, p=0.0404). There was a significant interaction between the IGF2BP2 rs4402960 variant and smoking on T2D (p = 0.0497). After stratification by rs4402960 genotypes and smoking status, the OR was substantial only in current smokers with GG genotype (OR, 1.663, p = 0.0008). CONCLUSION This population-based study indicated that the risk for T2D was stronger among current smoking rs4402960 GG individuals recruited between 2008 and 2019 in Taiwan.
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Affiliation(s)
- Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City40201, Taiwan
| | - Nokuphila Balindile Ndzinisa
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City40201, Taiwan
| | - Meng‑Hsiun Tsai
- Department of Management Information Systems, National Chung Hsing University, Taichung, Taiwan
| | - Chih-Hsuan Hsiao
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City40201, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City40201, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City40201, Taiwan
- Correspondence: Yung-Po Liaw Department of Public Health and Institute of Public Health, Chung Shan Medical University, No. 110, Sec. 1 Jianguo N. Road, Taichung City40201, TaiwanTel +886-4-24730022 ext.11838Fax +886-4-23248179 Email
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Chen HY, Pan HC, Chen YC, Chen YC, Lin YH, Yang SH, Chen JL, Wu HT. Traditional Chinese medicine use is associated with lower end-stage renal disease and mortality rates among patients with diabetic nephropathy: a population-based cohort study. Altern Ther Health Med 2019; 19:81. [PMID: 30943956 PMCID: PMC6448220 DOI: 10.1186/s12906-019-2491-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/24/2019] [Indexed: 11/13/2022]
Abstract
Background Diabetic nephropathy (DN) is a common complication of diabetes mellitus (DM) that imposes an enormous burden on the healthcare system. Although some studies show that traditional Chinese medicine (TCM) treatments confer a protective effect on DN, the long-term impact remains unclear. This study aims to examine end-stage renal disease (ESRD) and mortality rates among TCM users with DN. Methods A total of 125,490 patients with incident DN patients from 2004 to 2006 were identified from the National Health Insurance Research Database in Taiwan and followed until 2012. The landmark method was applied to avoid immortal time bias, and propensity score matching was used to select 1:1 baseline characteristics-matched cohort. The Kaplan–Meier method and competing-risk analysis were used to assess mortality and ESRD rates separately. Results Among all eligible subjects, about 60% of patients were classified as TCM users (65,812 TCM users and 41,482 nonusers). After 1:1 matching, the outcomes of 68,882 patients were analyzed. For the ESRD rate, the 8-year cumulative incidence was 14.5% for TCM users [95% confidence interval (CI): 13.9–15.0] and 16.6% for nonusers (95% CI: 16.0–17.2). For the mortality rate, the 8-year cumulative incidence was 33.8% for TCM users (95% CI: 33.1–34.6) and 49.2% for nonusers (95% CI: 48.5–49.9). After adjusting for confounding covariates, the cause-specific hazard ratio of ESRD was 0.81 (95% CI: 0.78–0.84), and the hazard ratio of mortality for TCM users was 0.48 (95% CI: 0.47–0.50). The cumulative incidence of mortality increased rapidly among TCM users with ESRD (56.8, 95% CI: 54.6–59.1) when compared with TCM users without ESRD (30.1, 95% CI: 29.4–30.9). In addition, TCM users who used TCM longer or initiated TCM treatments after being diagnosed with DN were associated with a lower risk of mortality. These results were consistent across sensitivity tests with different definitions of TCM users and inverse probability weighting of subjects. Conclusions The lower ESRD and mortality rates among patients with incident DN correlates with the use of TCM treatments. Further studies about specific TCM modalities or medications for DN are still needed. Electronic supplementary material The online version of this article (10.1186/s12906-019-2491-y) contains supplementary material, which is available to authorized users.
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Yang QH, Zhang Y, Zhang XM, Li XR. Prevalence of diabetic retinopathy, proliferative diabetic retinopathy and non-proliferative diabetic retinopathy in Asian T2DM patients: a systematic review and Meta-analysis. Int J Ophthalmol 2019; 12:302-311. [PMID: 30809489 DOI: 10.18240/ijo.2019.02.19] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022] Open
Abstract
AIM To investigate the pooled prevalence of diabetic retinopathy (DR), proliferative DR (PDR) and nonproliferative DR (NPDR) in Asian type 2 diabetes mellitus (T2DM) patients. METHODS We performed a systematic search online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies that reported the prevalence of DR, PDR and NPDR in Asian T2DM patients. Effect size (ES) with 95% confidence interval (CI) was used to evaluate the prevalence of DR, PDR and NPDR in Asian T2DM patients, respectively. RESULTS There were 41 references and 48 995 T2DM patients involved in this study. The prevalence of DR, PDR, and NPDR was 28%, 6%, and 27% in T2DM patients, respectively; while the prevalence of PDR and NPDR in DR patients was 17% and 83%, respectively. Subgroup analysis showed that prevalence of DR in T2DM patients from Singaporean, Indian, South Korean, Malaysian, Asian, and Chinese was 33%, 42%, 16%, 35%, 21% and 25%, respectively. In T2DM patients with NPDR from Indian, South Korean, Malaysian, Asian, Chinese, higher prevalence was found than that in PDR patients (45% vs 17%, 13% vs 3%, 30% vs 5%, 23% vs 2% and 22% vs 3%), as well as in DR patients (74% vs 26%, 81% vs 19%, 86% vs 14%, 92% vs 8% and 85% vs 15%). The prevalence of PDR in T2DM from India was higher than patients from other locations of Asia, and the same results were also observed in NPDR patients. CONCLUSION In either T2DM Asian patients or DR patients, NPDR is more common than PDR. Based on our results, we should pay more attention to NPDR screening and management in T2DM patients, and we also recommend suitable interventions to prevent its progression.
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Affiliation(s)
- Qian-Hui Yang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Yan Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
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Tseng MY, Huang YF, Liang J, Wang JS, Yang CT, Wu CC, Cheng HS, Chen CY, Lin YE, Wang WS, Shyu YIL. Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes. Exp Gerontol 2019; 119:168-173. [PMID: 30738920 DOI: 10.1016/j.exger.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES To explore the impact of diabetic peripheral neuropathy (DPN) on the recovery of older persons with diabetes mellitus (DM) after hip-fracture surgery. DESIGN, SETTING, PARTICIPANTS Secondary data for this study came from a clinical trial on the effectiveness of a DM-specific care model for 176 older persons (age ≥ 60) with DM over 2 years following hip-fracture surgery at a medical center in Taiwan. In the original trial, the experimental group (n = 88) received DM-specific care comprising diabetes care plus subacute care, and the control group (n = 88) received only usual care. MEASUREMENTS DPN was assessed using the Michigan Neuropathy Screening Instrument. Outcomes of self-care ability in activities of daily living (ADL), health-related quality of life (HRQoL), and depressive symptoms were assessed 1, 3, 6, 12, 18, 24 months following hospital discharge using the Chinese Barthel Index and Chinese-version instrumental ADL (IADL) scale; the SF-36 Taiwan version; and the Chinese-version Geriatric Depression Scale, short form, respectively. RESULTS After controlling for covariates, participants with DPN had 8.38 fewer points in ADL performance, 0.49 fewer points in IADL performance, and 2.33 fewer points in the physical component summary (PCS) of HRQoL than participants without DPN at 3 months following discharge. During the first year following discharge, the rate of improvement increased less for PCS (β = -0.45, p < 0.05), but more for the mental component summary (β = 0.49, p < 0.05) for those with DPN than for those without. During the second year, the rate of decline in physical function-related HRQoL increased slightly more for those with DPN than for those without (β = 0.03, p < 0.05). CONCLUSION DPN adversely affected ADL performance, IADL performance, and physical function-related health outcomes for older persons recovering from hip-fracture surgery. These results suggest that older patients with DM recovering from hip-fracture surgery should be assessed and managed for DPN.
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Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, Meiho University, 23 Pingguang Road, Neipu, Pingtung 91202, Taiwan.
| | - Yueh-Fang Huang
- Department of Nursing, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan
| | - Jersey Liang
- School of Public Health, University of Michigan, 1420 Washington Heights, SPH II M3007, Ann Arbor, MI 48109, USA.
| | - Jong-Shyan Wang
- Graduate Institute of Rehabilitation Science, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Ching-Yen Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1st Road, Anle District, Keelung 20445, Taiwan
| | - Yueh-E Lin
- Department of Nursing, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
| | - Woan-Shyuan Wang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan.
| | - Yea-Ing L Shyu
- Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosng District, Kaohsiung 83301, Taiwan; Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan 33303, Taiwan.
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Bulut MN, Göktaş E, Çallı Ü, Bulut K, Akçay G, Arslan G, Sargın M, Arsan AK, Özertürk Y. Screening for diabetic retinopathy by non-mydriatic fundus camera in a Turkish population. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cheng SW, Wang CY, Chen JH, Ko Y. Healthcare costs and utilization of diabetes-related complications in Taiwan: A claims database analysis. Medicine (Baltimore) 2018; 97:e11602. [PMID: 30075532 PMCID: PMC6081128 DOI: 10.1097/md.0000000000011602] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To estimate the healthcare utilization and costs of major diabetes mellitus (DM)-related complications in Taiwan in the year of first occurrence and in subsequent years.This study is a retrospective claim database analysis using the longitudinal cohort of diabetes patients (LHDB) with 2012 as the base year. Occurrences of 8 DM-related complications of interest were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Annual healthcare costs and utilization of these DM-related complications in the LHDB cohorts of the years 2004 to 2009 were examined, and the generalized linear model was used to estimate annual total healthcare costs for each complication.DM patients with complications were more likely to have at least 1 emergency room (ER) visit and at least 1 hospitalization (both P < .001), and they also had more outpatient visits, higher hospitalization costs, higher outpatient costs, and higher ER costs (all P < .001) than those without. The mean annual total healthcare cost of the patients with DM-related complications was US $4189, whereas the mean annual cost of those patients without complication was $1424 (P < .001). The complications with the greatest event costs were amputation ($7877; 95% confidence interval [CI]: $6628-$9322) and fatal MI ($4067; 95% CI: $3001-$5396) while the complication with the greatest state costs was end-stage renal disease (ESRD) ($2228; 95% CI: $2155 to $2302).DM-related complications could significantly increase healthcare utilization and costs. The results of this study provide data that are useful for local economic evaluations of DM treatments.
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Affiliation(s)
- Ssu-Wei Cheng
- Department of Pharmacy, Shin Kong Wu Ho-Su Memorial Hospital
| | - Chin-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital
| | - Jin-Hua Chen
- Biostatistics Center/Masters Program in Big Data Technology and Management, College of Management
| | - Yu Ko
- Department of Pharmacy
- Research Center of Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Hung CS, Tseng PH, Tu CH, Chen CC, Liao WC, Lee YC, Chiu HM, Lin HJ, Yang WS, Chen MF, Wu MS. Increased Pancreatic Echogenicity with US: Relationship to Glycemic Progression and Incident Diabetes. Radiology 2018; 287:853-863. [PMID: 29613841 DOI: 10.1148/radiol.2018170331] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To evaluate the association between increased pancreatic echogenicity (IPE) and the risk of glycemic progression and incident diabetes. Materials and Methods This retrospective study was approved by the institutional review board, with waiver of informed consent. Consecutive individuals who had undergone abdominal ultrasonography as part of a health examination at a tertiary hospital between January 2005 and December 2011 were included. IPE was defined as increased echogenicity of the pancreas compared with that of the left lobe of liver. Glycemic progression was defined as the development of new prediabetes or diabetes in normoglycemic participants or as new diabetes in prediabetic participants during the follow-up period (median, 3.17 years; interquartile range, 2.01-4.67 years). The occurrence of incident diabetes, defined as a new diagnosis of diabetes during follow-up, was also analyzed. Results Mean age of the 32 346 participants was 50.4 years ± 12.2, and 48% (15 489 of 32 346) were female. The prevalence of IPE and nonalcoholic fatty liver disease (NAFLD) was 8.4% (2720 of 32 346) and 41.4% (13 389 of 32 346), respectively. A total of 8856 participants were included in the follow-up analysis. During the 29 819.2 person-years of follow-up, 1217 (13.7%) and 449 (5.1%) of the 8856 participants developed glycemic progression and new diabetes, respectively. IPE was associated with more glycemic progression (hazard ratio, 1.54; 95% confidence interval: 1.23, 1.92; P < .001) and incident diabetes (hazard ratio, 1.49; 95% confidence interval: 1.05, 2.11; P = .024) after adjustment for confounders, HbA1c concentration, and NAFLD. Conclusion Increased pancreatic echogenicity is associated with deteriorating glycemic parameters and higher risk of glycemic progression and incident diabetes, independent of HbA1c concentration and NAFLD. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Chi-Sheng Hung
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Ping-Huei Tseng
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Chia-Hung Tu
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Chien-Chuan Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Wei-Chih Liao
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Yi-Chia Lee
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Han-Mo Chiu
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Hung-Ju Lin
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Wei-Shiung Yang
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Ming-Fong Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
| | - Ming-Shiang Wu
- From the Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd, Taipei, Taiwan (C.S.H., P.H.T., C.H.T., C.C.C., W.C.L., Y.C.L., H.M.C., H.J.L., W.S.Y., M.S.W.); Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (C.H.T., W.S.Y.); and Clinical Outcome Research and Training Center and Cardiovascular Center, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan (M.F.C.)
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Trends in the pervasiveness of type 2 diabetes, impaired fasting glucose and co-morbidities during an 8-year-follow-up of nationwide Korean population. Sci Rep 2017; 7:46656. [PMID: 28425463 PMCID: PMC5397969 DOI: 10.1038/srep46656] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/28/2017] [Indexed: 01/19/2023] Open
Abstract
The prevalence and incidence of type 2 diabetes, impaired fasting glucose, and co-morbidities from 2006 to 2013 in the population aged ≥30 years were estimated using the Korean NHIS database. The prevalence of type 2 diabetes increased 0.2–0.5% annually, from 5.6% in 2006 to 8% in 2013. The prevalence of type 2 diabetes was higher in men than in women and increased with age. The incidence of type 2 diabetes was 0.81% in 2013 and was 1.4 times higher in men than in women and increased with age. An overall decrease in the incidence rate occurred from 2006 to 2013(from 0.95 to 0.81%), which was mirrored in all age groups except the 30–39-year-old group. The prevalence of IFG was 25% in 2013. The prevalence of hypertension(62.5 vs 16.9%) and dyslipidemia(49.5 vs 9.7%) were more prevalent in patients with type 2 diabetes compared to non-diabetic cases. This study shows that type 2 diabetes is both common and increasing and that one-quarter of the Korean adult population has IFG. We also confirmed that the prevalence of hypertension and dyslipidemia are 3.7-fold and 5.1-fold higher, respectively, in diabetic patients than in non-diabetic adults.
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Jeng CJ, Hsieh YT, Yang CM, Yang CH, Lin CL, Wang IJ. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression. PLoS One 2016; 11:e0161897. [PMID: 27564383 PMCID: PMC5001700 DOI: 10.1371/journal.pone.0161897] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/12/2016] [Indexed: 12/13/2022] Open
Abstract
The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68-5.37) and 9.7 (95% CI = 8.15-11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68-3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10-1.38 with NPDR; HR = 1.33, 95% CI = 1.02-1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72-2.41 in NPDR; HR = 2.95, 95% CI = 2.16-4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87-2.48) or progression (HR = 0.37, 95% CI = 0.11-1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation.
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Affiliation(s)
- Chi-Juei Jeng
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University, Taichung, Taiwan
- * E-mail: (CLL); (IJW)
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, School of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- * E-mail: (CLL); (IJW)
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Chen SY, Hsu YM, Lin YJ, Huang YC, Chen CJ, Lin WD, Liao WL, Chen YT, Lin WY, Liu YH, Yang JS, Sheu JC, Tsai FJ. Current concepts regarding developmental mechanisms in diabetic retinopathy in Taiwan. Biomedicine (Taipei) 2016; 6:7. [PMID: 27154195 PMCID: PMC4859317 DOI: 10.7603/s40681-016-0007-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy (DR) is one of the most feared complications of diabetes and is a leading cause of acquired blindness in working adults. The prevalence of undiagnosed diabetes in Taiwan is about 4%, and the annual incidence of T2D (Type 2 Diabetes) in Taiwan is 1.8% following the 1985 WHO criteria. Multiple mechanisms have been shown in T2DR with some signaling pathways, including the polyol pathway, PKC pathway, AGEs pathway, and MAPK pathway. However, the cause of vision loss in diabetic retinopathy is complex and remains incompletely understood. Herein, we try to fully understand the new concepts regarding hyperglycemia-induced biochemical pathways contributing to DR pathophysiology. Our work may be able to provide new strategies for the prevention and treatment of diabetic vascular complications.
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Affiliation(s)
- Shih-Yin Chen
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Yuan-Man Hsu
- Department of Biological Science and Technology, China Medical University, 404, Taichung, Taiwan
| | - Ying-Ju Lin
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Yu-Chuen Huang
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Chao-Jung Chen
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Wei-De Lin
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Wen-Lin Liao
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Yng-Tay Chen
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Wei-Yong Lin
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Yu-Huei Liu
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan
| | - Jai-Sing Yang
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan
| | - Jinn-Chyuan Sheu
- Institute of Biomedical Sciences, National Sun Yat-sen University, 804, Kaohsiung, Taiwan
| | - Fuu-Jen Tsai
- Genetics Center, Department of Medical Research, China Medical University Hospital, No. 2 Yuh Der Road, 404, Taichung, Taiwan.
- School of Chinese Medicine, China Medical University, 404, Taichung, Taiwan.
- Department of Medical Genetics, China Medical University Hospital, 404, Taichung, Taiwan.
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Nocturia indicates a poor health status and increases mortality in male patients with type 2 diabetes mellitus. Int Urol Nephrol 2016; 48:1209-1214. [DOI: 10.1007/s11255-016-1310-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Hung SC, Chang YK, Liu JS, Hsu CC, Tarng DC. Mortality and metformin use in patients with advanced chronic kidney disease--Authors' reply. Lancet Diabetes Endocrinol 2015; 3:681. [PMID: 26298571 DOI: 10.1016/s2213-8587(15)00287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Kang Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Jia-Sin Liu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Institutes of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Der-Cherng Tarng
- Institutes of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan; Physiology, National Yang-Ming University, Taipei City, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Li TC, Kardia SLR, Li CI, Chen CC, Liu CS, Yang SY, Muo CS, Peyser PA, Lin CC. Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes. Metabolism 2015; 64:1013-21. [PMID: 26026367 DOI: 10.1016/j.metabol.2015.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/10/2015] [Accepted: 05/05/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The relationship between glycemic control and adverse outcomes found in a population with diabetes has seldom been evaluated in patients with type 2 diabetes. We explored the association between hemoglobin A1c (HbA1c) and hospitalization risks within one-year and eight-year follow-up periods. METHODS We conducted a retrospective cohort study on 57,061 patients with type 2 diabetes from National Diabetes Case Management Program during 2002-2004 in Taiwan. HbA1c at baseline and in-hospital mortality, all-cause and cause-specific hospitalization over one year and eight years were analyzed. RESULTS After multivariate adjustment, one-year risk was higher for cases with HbA1c level <6%, 9-10%, ≥10% versus 6-7% for all-cause hospitalization (hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 1.03-1.20; 1.08, 1.01-1.16, and 1.19, 1.12-1.26, respectively) and for ≥10% for diabetes-related hospitalization (1.68, 1.46-1.92). Yet each 1-step increment in HbA1c category (<6.0, 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-9.9 and ≥10.0%) showed linkage with lower risk of hypoglycemia hospitalization (0.81, 95% CI: 0.74-0.88). For eight-year risk, subjects with HbA1c level <6%, and ≥10% were more likely to have in-hospitality mortality (1.16, 1.03-1.31, and 1.23, 1.11-1.35, respectively). Each 1-step increment in HbA1c category showed an association with higher risks of all-cause and diabetes-related hospitalization (1.04, 1.03-1.05, and 1.15, 1.14-1.17, respectively). CONCLUSIONS Higher HbA1c level correlated with lower one-year risk due to hypoglycemia hospitalization but increased one-year and eight-year risks due to all-cause and diabetes-specific hospitalization among Chinese people with type 2 diabetes in Taiwan. Future study must ascertain how to meet HbA1c targets and improve outcome without risk to this population.
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Affiliation(s)
- Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Sharon L R Kardia
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan; Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sing-Yu Yang
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chin-Shin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Patricia A Peyser
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Cheng-Chieh Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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Li CI, Li TC, Liu CS, Lin WY, Chen CC, Yang SY, Lin CC. Extreme values of hemoglobin a1c are associated with increased risks of chronic obstructive pulmonary disease in patients with type 2 diabetes: a competing risk analysis in national cohort of Taiwan diabetes study. Medicine (Baltimore) 2015; 94:e367. [PMID: 25569658 PMCID: PMC4602831 DOI: 10.1097/md.0000000000000367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the relationship between glycated hemoglobin (HbA1c) and chronic obstructive pulmonary disease (COPD) in patients with type 2 diabetes.We conducted a retrospective cohort study involving 45,753 patients with type 2 diabetes, who participated in the National Diabetes Case Management Program in Taiwan. HbA1c at baseline and COPD events over the subsequent years were analyzed.After multivariate adjustment, the COPD risk increased among patients with HbA1c levels <6.0%, compared with that in patients with HbA1c levels ranging from 6.0% to 7.0% (hazard ratio: 1.19, 95% confidence interval (CI): 1.06-1.34). Similarly, high HbA1c levels (≥10%) were independently associated with COPD (1.19, 95% CI: 1.06-1.32). A U-shaped relationship was observed between HbA1c levels and COPD incidence.HbA1c levels lower than 6.0% and higher than 10% are associated with an increased risk of COPD in patients with type 2 diabetes. These findings suggest that meeting the recommended HbA1c targets might reduce the risk of COPD, but care should be taken not to pose risks to this population.
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Affiliation(s)
- Chia-Ing Li
- From the Department of Medical Research (C-IL, C-SL, C-CL), China Medical University Hospital; School of Medicine (C-IL, C-SL, W-YL, C-CL), College of Medicine; Graduate Institute of Biostatistics (T-CL, S-YY), College of Management, China Medical University; Department of Healthcare Administration (T-CL), College of Health Science, Asia University; Department of Family Medicine (C-SL, C-CL, W-YL); Division of Endocrinology and Metabolism (C-CC), Department of Medicine, China Medical University Hospital; and School of Chinese Medicine (C-CC), College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Lee JJ, Yang IH, Kuo HK, Chung MS, Chen YJ, Chen CH, Liu RT. Serum uric acid concentration is associated with worsening in severity of diabetic retinopathy among type 2 diabetic patients in Taiwan--a 3-year prospective study. Diabetes Res Clin Pract 2014; 106:366-72. [PMID: 25108898 DOI: 10.1016/j.diabres.2014.07.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/16/2014] [Accepted: 07/20/2014] [Indexed: 12/13/2022]
Abstract
AIMS To explore the role of serum uric acid (SUA) concentration in diabetic retinopathy (DR) for patients with type 2 diabetes mellitus (T2DM). METHODS A 3-year prospective study in 749 patients with T2DM and without proliferative diabetic retinopathy (PDR) was conducted at a medical center. Baseline SUA concentration and parameters of glycemic control, blood pressure, kidney disease, and lipid profiles were analyzed to determine their contribution to DR. RESULTS Fundus examination showed that 184 patients (24.6%) had non-proliferative retinopathy and 565 (75.4%) without DR at baseline. After 3 years, increase in the severity of DR was recognized in 103 patients (13.8%), including 81 patients with newly developed DR. Patients with increase in severity of DR positively associated with duration of DM (11.9 vs. 9.4 years, p = 0.001), HbA1c (7.6 vs. 7.2%, p = 0.001), albuminuria (45.5 vs. 31.0%, p = 0.006), and SUA (6.47 vs. 5.87 mg/dl, p<0.001) than did those without change in DR stage. Cox regression showed that patients with SUA in the 3rd (5.9-6.9 mg/dl) and 4th (≥ 7.0mg/dl) quartiles had hazard ratios for DR worsening of 2.57 and 3.66 (95% C.I. 1.30-5.08 and 1.92-7.00) when compared with patients with SUA in the 1st quartile (<4.9 mg/dl). CONCLUSIONS SUA concentration is associated with the increase in severity of DR over a 3-year period in patients with T2DM. Further study is required to define the exact role of SUA in DR.
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Affiliation(s)
- Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Ming-Shien Chung
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Yung-Jen Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Chih-Hsin Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan
| | - Rue-Tsuan Liu
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
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Lin CC, Li CI, Hsiao CY, Liu CS, Yang SY, Lee CC, Li TC. Time trend analysis of the prevalence and incidence of diagnosed type 2 diabetes among adults in Taiwan from 2000 to 2007: a population-based study. BMC Public Health 2013; 13:318. [PMID: 23570503 PMCID: PMC3626657 DOI: 10.1186/1471-2458-13-318] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 04/02/2013] [Indexed: 12/18/2022] Open
Abstract
Background The prevalence of type 2 diabetes has rapidly increased in the Taiwanese population with the increasing prevalence of a sedentary lifestyle and high-calorie dietary intake. This study aims to determine the annual trends of the prevalence and incidence of diagnosed type 2 diabetes among adults in Taiwan from 2000 to 2007. Methods A population-based study of all residents aged 20 years and over (12,191,076 in 2000 and 18,772,180 in 2007) enrolled in the National Health Insurance (NHI) program, the database of which was used to identify patients diagnosed with type 2 diabetes. The annual prevalence and incidence of diagnosed type 2 diabetes were estimated using the International Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes based on age, gender, insurance premium, and urbanization degree. Logistic regression was used to estimate the odds ratios (OR) of risk factors, as well as to examine the trend in the annual prevalence or incidence of diagnosed type 2 diabetes from 2000 to 2007. Results The crude annual prevalence of diagnosed type 2 diabetes increased significantly from 5.79% in 2000 to 8.30% in 2007. The increase was highest in 2007, among men, individuals aged ≥ 80 years, and individuals residing in aging society areas [OR (95% CI): 1.416 (1.412–1.420), 1.033 (1.032–1.034), 31.810 (31.690–31.931), and 1.090 (1.085–1.094), respectively]. The crude incidence fluctuated throughout the study period, ranging from 7.72 per 1,000 in 2006 to 8.98 per 1,000 in 2000. The decrease was highest in 2006, among individuals with an insurance premium ≥ median value [0.933 (0.925–0.942) and 0.810 (0.805–0.815), respectively]. The greatest increase was among men, individuals aged 60 to 79 years, and individuals residing in aging society areas [1.150 (1.145–1.155), 15.452 (15.329–15.576), and 1.127 (1.113–1.142), respectively]. Conclusion This study demonstrated the substantial increase in annual prevalence of diagnosed type 2 diabetes among adults in Taiwan from 2000 to 2007. The incidence fluctuated between 2000 and 2007.
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Affiliation(s)
- Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Ma RCW, Chan JCN. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci 2013; 1281:64-91. [PMID: 23551121 PMCID: PMC3708105 DOI: 10.1111/nyas.12098] [Citation(s) in RCA: 539] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular-renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.
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Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China.
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Sheu SJ, Liu NC, Ger LP, Ho WL, Lin JY, Chen SC, Horng YH, Lam HC. High HbA1c level was the most important factor associated with prevalence of diabetic retinopathy in Taiwanese type II diabetic patients with a fixed duration. Graefes Arch Clin Exp Ophthalmol 2013; 251:2087-92. [PMID: 23504104 DOI: 10.1007/s00417-013-2310-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/07/2013] [Accepted: 03/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To identify the prevalence and related risk factors for diabetic retinopathy (DR) in non-insulin dependent diabetes in Taiwan. METHODS A retrospective review of type II diabetic patients in the Diabetes Shared Care System database of our Hospital enrolled from 2002 to 2009. A retinopathy severity score was assigned according to fundus examination by indirect ophthalmoscopy or binocular biomicroscopy. RESULTS Data was collected on 901 subjects, 497 males and 404 females. Of these, 230 (25.53 %) had DR at enrolment. Compared with patients without DR, those with DR were more likely to be female (p = 0.03) or have higher HbA1c (p < 0.001), longer duration of diabetes (p < 0.001), hypertension (p < 0.001), higher systolic blood pressure (p < 0.001), higher diastolic blood pressure (p = 0.05), as well as impaired renal function (p = 0.001). In subgroup analysis stratified by diabetes duration, HbA1c was the most consistent independent risk factor associated to the prevalence of DR. Higher systolic blood pressure and female sex were significantly independent risk factors only in patients with a duration of diabetes < 4 years. On the contrary, old onset age showed a protective effect against DR only in those with a disease duration > 8 years. CONCLUSIONS High HbA1c level was the most important factor associated with prevalence of DR in Taiwanese type II DM patients with a fixed duration.
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Affiliation(s)
- Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan,
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Hu P, Yin Q, Deckert F, Jiang J, Liu D, Kjems L, Dole WP, He YL. Pharmacokinetics and Pharmacodynamics of Vildagliptin in Healthy Chinese Volunteers. J Clin Pharmacol 2013; 49:39-49. [DOI: 10.1177/0091270008325152] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Huang MC, Hung CH, Stocker J, Lin LC. Outcomes for type 2 diabetes mellitus patients with diverse regimens. J Clin Nurs 2013; 22:1899-906. [PMID: 23461390 DOI: 10.1111/jocn.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To compare the levels of self-care behaviour, social support and quality of life among type 2 diabetes mellitus patients who underwent three regimens: taking medicine, taking-medicine-while dieting and taking-medicine-while-dieting-with exercise. BACKGROUND Diabetes treatment is a critical concern worldwide. However, studies on self-care behaviour, social support and quality of life based on diabetes patients' diverse regimens are few. DESIGN This study was a cross-sectional design. METHODS We enrolled 127 outpatients aged over 40 years who visited a metabolism clinic at a medical centre in Southern Taiwan. The Self-care Behaviour Scale, Social Support Scale and Quality of Life Scale were used to collect data. RESULTS The results indicated that patients with a combined regimen of taking-medicine-while-dieting-with-regular exercise had the highest score at the levels of social support, self-care behaviour and quality of life. CONCLUSION The study results could offer evidence-based knowledge for healthcare professionals to guide and promote social support, self-care behaviour and quality of life for people diagnosed with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE These findings will help healthcare professionals to establish appropriate nursing strategies for type 2 diabetes patients who need to exercise regularly as part of their daily care to enhance their self-care behaviour, social support and quality of life.
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Affiliation(s)
- Mei-Chuan Huang
- School of Nursing, Tzu Hui Institute of Technology, Pingtung, Taiwan
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Kataoka M, Venn BJ, Williams SM, Te Morenga LA, Heemels IM, Mann JI. Glycaemic responses to glucose and rice in people of Chinese and European ethnicity. Diabet Med 2013. [PMID: 23181689 DOI: 10.1111/dme.12080] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Diabetes rates are especially high in China. Risk of Type 2 diabetes increases with high intakes of white rice, a staple food of Chinese people. Ethnic differences in postprandial glycaemia have been reported. We compared glycaemic responses to glucose and five rice varieties in people of European and Chinese ethnicity and examined possible determinants of ethnic differences in postprandial glycaemia. METHODS Self-identified Chinese (n = 32) and European (n = 31) healthy volunteers attended on eight occasions for studies following ingestion of glucose and jasmine, basmati, brown, Doongara(®) and parboiled rice. In addition to measuring glycaemic response, we investigated physical activity levels, extent of chewing of rice and salivary α-amylase activity to determine whether these measures explained any differences in postprandial glycaemia. RESULTS Glycaemic response, measured by incremental area under the glucose curve, was over 60% greater for the five rice varieties (P < 0.001) and 39% greater for glucose (P < 0.004) amongst Chinese compared with Europeans. The calculated glycaemic index was approximately 20% greater for rice varieties other than basmati (P = 0.01 to 0.05). Ethnicity [adjusted risk ratio 1.4 (1.2-1.8) P < 0.001] and rice variety were the only important determinants of incremental area under the glucose curve. CONCLUSIONS Glycaemic responses following ingestion of glucose and several rice varieties are appreciably greater in Chinese compared with Europeans, suggesting the need to review recommendations regarding dietary carbohydrate amongst rice-eating populations at high risk of diabetes.
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Affiliation(s)
- M Kataoka
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Pregnancy outcomes of anti-hypertensives for women with chronic hypertension: a population-based study. PLoS One 2013; 8:e53844. [PMID: 23405075 PMCID: PMC3566173 DOI: 10.1371/journal.pone.0053844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 12/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The impact of anti-hypertensive treatment on fetus was unclear, and hence, remains controversial. We set out in this study to estimate the prevalence of adverse pregnancy outcomes, including low birth weight, preterm delivery and small for gestational age amongst women with chronic hypertension, and to determine whether the use of anti-hypertensive drugs increases the risk of such adverse pregnancy outcomes. METHODOLOGY/PRINCIPAL FINDINGS A total of 2,727 hypertension mothers and 8,181 matched controls were identified from the population-based cohort. These hypertension women were divided into seven sub-groups according to different types of prescribed anti-hypertensive drugs. Multivariable logistic regressions were conducted to estimate the risk of low birth weight, preterm birth and small for gestational age. Increased risk of low birth weight (OR = 2.29, 95% CI = 1.95-2.68), preterm birth (OR = 2.18, 95% CI = 1.89-2.52) and small for gestational age (OR = 1.62, 95% CI = 1.45-1.81) were all discernible within the hypertension group after adjusting for potential confounding factors. The increased ORs were found to differ with different types of anti-hypertensive drugs. Women who received vasodilators were associated with the highest risk of low birth weight (OR = 2.96, 95% CI = 2.06-4.26), preterm birth (OR = 2.92 95% CI = 2.06-4.15) and small for gestational age (OR = 2.12, 95% CI = 1.60-2.82). CONCLUSIONS/SIGNIFICANCE This finding is important for practitioners, because it indicates the need for caution while considering the administration of anti-hypertensive drugs to pregnant women. These observations require confirmation in further studies that can better adjust for the severity of the underlying HTN.
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Kao CH, Sun LM, Chen PC, Lin MC, Liang JA, Muo CH, Chang SN, Sung FC. A population-based cohort study in Taiwan--use of insulin sensitizers can decrease cancer risk in diabetic patients? Ann Oncol 2013; 24:523-530. [PMID: 23110810 DOI: 10.1093/annonc/mds472] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of the study was to explore the possible association between the use of insulin sensitizers (thiazolidinediones, TZDs) and the risk of cancer in Taiwanese diabetic patients. PATIENTS AND METHODS From the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22 910 diabetic patients newly diagnosed from 2001 to 2009 and 91 636 non-diabetic comparisons frequency matched with age, sex, and calendar year, excluding those with cancer at the baseline. Among the diabetics, 4159 patients were treated with TZDs and the rest of 18 752 patients were on other anti-diabetic medications (non-TZDs). RESULTS In comparison to the non-diabetes group, the non-TZDs group had an increased risk of developing cancer [the adjusted hazard ratio (HR): 1.20 and 95% confidence interval (CI) = 1.11-1.30]. The TZDs group had a HR of 1.18 (95% CI = 0.98-1.42). Analysis of site-specific cancer risks showed that both TZDs and non-TZDs groups with elevated risks of colorectal and pancreatic cancer. However, the non-TZDs group had an increased risk of liver cancer when comparing with TZD and non-diabetes groups. CONCLUSION This study suggests that patients with diabetes are at an elevated risk of cancer (especially in colorectal and pancreatic cancers), and the use of TZDs might decrease the liver cancer risk in diabetic patients. Further investigation using large samples and rigorous methodology is warranted.
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Affiliation(s)
- C-H Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.
| | - L-M Sun
- Department of Radiation Oncology, Zuoying Armed Forces General Hospital, Kaohsiung
| | - P-C Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipe
| | - M-C Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung
| | - J-A Liang
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine; Department of Radiation Oncology
| | - C-H Muo
- Management Office for Health Data; Department of Public Health, College of Public Health
| | - S-N Chang
- Department of Public Health, College of Public Health; The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - F-C Sung
- Department of Public Health, College of Public Health
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Chen PC, Chan YT, Chen HF, Ko MC, Li CY. Population-based cohort analyses of the bidirectional relationship between type 2 diabetes and depression. Diabetes Care 2013; 36:376-82. [PMID: 23150281 PMCID: PMC3554286 DOI: 10.2337/dc12-0473] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study addresses the strength of association for the bidirectional relationship between type 2 diabetes and depression. RESEARCH DESIGN AND METHODS We used two cohort studies with the same source of database to determine the link between depression and type 2 diabetes. The data analyzed included a random sample of 1 million beneficiaries selected from the National Health Insurance claims in 2000. The analysis of diabetes predicting the depression onset consisted of 16,957 diabetic patients and the same number of sex- and age-matched nondiabetic control subjects. The analysis of depression predicting diabetes onset included 5,847 depressive patients and 5,847 sex- and age-matched nondepressive control subjects. The follow-up period was between 2000 and 2006, and onset of end points was identified from ambulatory care claims. The Cox proportional hazards regression model adjusted for potential confounders was used to estimate relative hazards. RESULTS The first cohort analysis noted an incidence density (ID) of 7.03 per 1,000 person-years (PY) and 5.04 per 1,000 PY for depression in diabetic and nondiabetic subjects, respectively, representing a covariate-adjusted hazard ratio (HR) of 1.43 (95% CI 1.16-1.77). The second cohort analysis noted an ID of 27.59 per 1,000 PY and 9.22 per 1,000 PY for diabetes in depressive and nondepressive subjects, respectively. The covariate-adjusted HR was stronger at 2.02 (1.80-2.27) for incident diabetes associated with baseline depression. CONCLUSIONS The two cohort studies provided evidence for the bidirectional relationship between diabetes and depression, with a stronger association noted for the depression predicting onset of diabetes.
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Affiliation(s)
- Pei-Chun Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
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Chen ST, Hsueh C, Chiou WK, Lin JD. Disease-specific mortality and secondary primary cancer in well-differentiated thyroid cancer with type 2 diabetes mellitus. PLoS One 2013; 8:e55179. [PMID: 23383099 PMCID: PMC3561360 DOI: 10.1371/journal.pone.0055179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/19/2012] [Indexed: 12/11/2022] Open
Abstract
Background Increased body mass index is related to the incidence of thyroid cancer. However, the presentation and therapeutic outcomes of different thyroid cancers and type 2 diabetes mellitus (DM) have not been studied. This study investigated the effect of type 2 DM on the clinical presentations and therapeutic outcome of well-differentiated thyroid cancer. Methods and Findings A retrospective analysis of adult thyroid cancer patients with or without type 2 DM admitted between January 2001 and December 2010 was performed at an institution. A total of 1,687 well-differentiated thyroid cancer patients with different histological patterns were enrolled. Among these subjects, 122 were type 2 DM patients. Patients with thyroid cancer and type 2 DM were significantly older than non-DM patients. After a mean follow-up period of 5.6±0.1 years, patients with thyroid cancer and type 2 DM showed a higher percentage of disease progression than non-DM patients (24.6% vs. 17.4%). In addition, disease-specific mortality was higher in the type 2 DM group (10.7% vs. 3.8%). Thyroid cancer patients with type 2 DM showed a higher percentage of secondary primary cancers than those without DM (10.7% vs. 4.9%). Thyroid cancer-specific survival rates in the type 2 DM and non-DM groups were 82.2% and 94.9% at 5 years, 72.9% and 91.4% at 10 years, and 36.5% and 61.3% at 20 years, respectively. Multivariate analysis showed that type 2 DM was independent of thyroid cancer-specific mortality. Conclusion Patients with type 2 DM and well-differentiated thyroid cancer had an advanced tumor-node-metastasis stage at the time of diagnosis and an increased disease-specific mortality. Aggressive surgical procedures and close follow-up for well-differentiated thyroid cancer patients with type 2 DM are therefore necessary.
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Affiliation(s)
- Szu-Tah Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Wen-Ko Chiou
- Department of Industrial Design, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Jen-Der Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
- * E-mail:
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Cheng KC, Chen YL, Lai SW, Tsai PY, Sung FC. Risk of esophagus cancer in diabetes mellitus: a population-based case-control study in Taiwan. BMC Gastroenterol 2012; 12:177. [PMID: 23234272 PMCID: PMC3531311 DOI: 10.1186/1471-230x-12-177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 12/07/2012] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes mellitus (DM) has been associated with the cancer risk. This study investigated relationship between DM and esophageal cancer using Taiwan’s insurance data. Methods We identified 549 patients with esophageal cancer newly diagnosed in 2000-2009 and randomly selected 2196 controls without any cancer, frequency matched by sex, age and diagnosis year of cases. Logistic regression model estimated odds ratios (ORs) and 95% confidence intervals (CI) of esophageal cancer associated with DM, sex, age. co-morbidities and medications. Results Cases were more prevalent than controls for alcoholism and esophageal disorders and using nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors but not DM. Esophageal cancer had no association with DM (OR 0.99, 95% CI 0.71-1.37), but significantly associated with alcoholism (OR 14.1, 95% CI 7.87-25.4), esophageal ulcer (OR 10.1, 95% CI 5.70-17.9), esophageal reflux (OR 3.47, 95% CI 2.14-5.26) and uses of NSAIDs (OR 2.73, 95% CI 1.80-4.13). An elevated risk of esophageal cancer appeared in DM patients taking insulin (OR 2.57, 95% CI 1.08-6.15) or sulfonyurea (OR 3.80, 95% CI 1.16-12.5). Conclusions Patients with DM are not at higher risk for esophagus cancer. However, esophageal disorders and anti-diabetic drugs are associated with the risk of the disease.
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Affiliation(s)
- Kao-Chi Cheng
- Department of Family Medicine, China Medical University Hospital, Taichung404, Taiwan
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Huang YY, Lin KD, Jiang YD, Chang CH, Chung CH, Chuang LM, Tai TY, Ho LT, Shin SJ. Diabetes-related kidney, eye, and foot disease in Taiwan: An analysis of the nationwide data for 2000–2009. J Formos Med Assoc 2012; 111:637-44. [DOI: 10.1016/j.jfma.2012.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022] Open
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Lin CC, Chen CC, Kung PT, Li CI, Yang SY, Liu CS, Lin WY, Lee CC, Li TC, Kardia SLR. Joint relationship between renal function and proteinuria on mortality of patients with type 2 diabetes: the Taichung Diabetes Study. Cardiovasc Diabetol 2012; 11:131. [PMID: 23083001 PMCID: PMC3515506 DOI: 10.1186/1475-2840-11-131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/18/2012] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) is a powerful predictor of mortality in diabetic patients with limited proteinuria data. In this study, we tested whether concomitant proteinuria increases the risk of mortality among patients with type 2 diabetes. METHODS Participants included 6523 patients > 30 years with type 2 diabetes who were enrolled in a management program of a medical center before 2007. Renal function was assessed by eGFR according to the Modification of Diet in Renal Disease Study equation for Chinese. Proteinuria was assessed by urine dipstick. RESULTS A total of 573 patients (8.8%) died over a median follow-up time of 4.91 years (ranging from 0.01 year to 6.42 years). The adjusted expanded cardiovascular disease (CVD)-related mortality rates among patients with proteinuria were more than three folds higher for those with an eGFR of 60 mL/min/1.73 m2 or less compared with those with an eGFR of 90 mL/min/1.73 m2 or greater [hazard ratio, HR, 3.15 (95% confidence interval, CI, 2.0-5.1)]. The magnitude of adjusted HR was smaller in patients without proteinuria [1.98 (95% CI, 1.1-3.7)]. An eGFR of 60 mL/min/1.73 m2 to 89 mL/min/1.73 m2 significantly affected all-cause mortality and mortality from expanded CVD-related causes only in patients with proteinuria. Similarly, proteinuria affected all outcomes only in patients with an eGFR of <60 mL/min/1.73 m2. CONCLUSION The risks of all-cause mortality, as well as expanded and non-expanded mortality from CVD-related causes associated with proteinuria or an eGFR of 90 mL/min/1.73 m2 or greater are independently increased. Therefore, the use of proteinuria measurements with eGFR increases the precision of risk stratification for mortality.
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Affiliation(s)
- Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Lai MS. National health insurance and the way leading to better diabetes care in Taiwan. Is there a role of comprehensive analyses of the claims data? J Formos Med Assoc 2012; 111:587-8. [PMID: 23217593 DOI: 10.1016/j.jfma.2012.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 08/23/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Mei-Shu Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
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Liu L, Wu X, Liu L, Geng J, Yuan Z, Shan Z, Chen L. Prevalence of diabetic retinopathy in mainland China: a meta-analysis. PLoS One 2012; 7:e45264. [PMID: 23028893 PMCID: PMC3447927 DOI: 10.1371/journal.pone.0045264] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022] Open
Abstract
Background Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-analysis to investigate the pooled prevalence of DR in mainland China. Methodology/Principal Findings We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline, EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the pooled general population was 1.3% (95%CI: 0.5%–3.2%), 1.1% (95%CI: 0.6%–2.1%), and 0.1% (95%CI: 0.1%–0.3%), respectively, but was 23% (95%CI: 17.8%–29.2%), 19.1% (95%CI: 13.6%–26.3%), and 2.8% (95%CI: 1.9%–4.2%) in the diabetic group. The prevalence rate of DR in the pooled rural population was higher than that in the urban population, 1.6% (95%CI: 1.3%–2%), and the diabetic population, 29.1% (95%CI: 20.9%–38.9%). The prevalence of DR was higher in the Northern region compared with the Southern region. Conclusions/Significance The prevalence of DR in mainland China appeared a little high, and varied according to area. NPDR was more common. This study highlights the necessity for DR screening in the rural areas of China.
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Affiliation(s)
- Lei Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Limin Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jin Geng
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhe Yuan
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhongyan Shan
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lei Chen
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
- * E-mail:
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Lin TL, Chen GD, Chen YC, Huang CN, Ng SC. Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes. Taiwan J Obstet Gynecol 2012; 51:381-6. [DOI: 10.1016/j.tjog.2012.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 10/27/2022] Open
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Tseng PH, Lee YC, Chiu HM, Chen CC, Liao WC, Tu CH, Yang WS, Wu MS. Association of diabetes and HbA1c levels with gastrointestinal manifestations. Diabetes Care 2012; 35:1053-60. [PMID: 22410812 PMCID: PMC3329853 DOI: 10.2337/dc11-1596] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the prevalence of gastrointestinal (GI) manifestations associated with diabetes mellitus (DM) in a Taiwanese population undergoing bidirectional endoscopies. RESEARCH DESIGN AND METHODS Subjects voluntarily undergoing upper endoscopy/colonoscopy as part of a medical examination at the National Taiwan University Hospital were recruited during 2009. Diagnosis of DM included past history of DM, fasting plasma glucose ≥ 126 mg/dL, or glycated hemoglobin (HbA(1c)) ≥ 6.5%. Comparisons were made between diabetic and nondiabetic subjects, subjects with lower and higher HbA(1c) levels, and diabetic subjects with and without complications, respectively, for their GI symptoms, noninvasive GI testing results, and endoscopic findings. RESULTS Among 7,770 study subjects, 722 (9.3%) were diagnosed with DM. The overall prevalence of GI symptoms was lower in DM subjects (30.3 vs. 35.4%, P = 0.006). In contrast, the prevalence of erosive esophagitis (34.3 vs. 28.6%, P = 0.002), Barrett's esophagus (0.6 vs. 0.1%, P = 0.001), peptic ulcer disease (14.8 vs. 8.5%, P < 0.001), gastric neoplasms (1.8 vs. 0.7%, P = 0.003), and colonic neoplasms (26.6 vs. 16.5%, P < 0.001) was higher in diabetic subjects. Diagnostic accuracy of immunochemical fecal occult blood test for colonic neoplasms was significantly decreased in DM (70.7 vs. 81.7%, P < 0.001). Higher HbA(1c) levels were associated with a decrease of GI symptoms and an increase of endoscopic abnormalities. Diabetic subjects with complications had a higher prevalence of colonic neoplasms (39.2 vs. 24.5%, P = 0.002) than those without. CONCLUSIONS DM and higher levels of HbA(1c) were associated with lower prevalence of GI symptoms but higher prevalence of endoscopic abnormalities.
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Affiliation(s)
- Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Surv Ophthalmol 2012; 57:347-70. [PMID: 22542913 DOI: 10.1016/j.survophthal.2012.01.004] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 01/10/2023]
Abstract
The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.
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Affiliation(s)
- Sobha Sivaprasad
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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Mu YM, Misra A, Adam JMF, Chan SP, Chow FCC, Cunanan EC, Deerochanawong C, Jang HC, Khue NT, Sheu WHH, Tan KEK. Managing diabetes in Asia: overcoming obstacles and the role of DPP-IV inhibitors. Diabetes Res Clin Pract 2012; 95:179-88. [PMID: 22019271 DOI: 10.1016/j.diabres.2011.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/13/2011] [Accepted: 09/20/2011] [Indexed: 10/16/2022]
Abstract
Asia bears the world's greatest burden of type 2 diabetes (T2DM) and prevalence is increasing rapidly. Compared to other races, Asians develop T2DM younger, at a lower degree of obesity, suffer longer from its complications and die earlier. Curbing this epidemic requires an integrated, risk-based, and multidisciplinary approach. Inadequately managed T2DM has macrovascular and microvascular sequelae, Asians with T2DM being particularly susceptible to diabetic nephropathy. Earlier and more intensive monitoring and management of risk factors are required, especially for patients with, or at risk of, renal impairment. Particular challenges of T2DM management in Asia include: lack of access to specialist healthcare, insufficient clinical evaluation and delayed diagnosis. As in Caucasians, conventional treatment modalities are limited by deteriorating glycaemic control with disease progression and there is an unmet need for efficacious, safe, cost-effective and convenient pharmacotherapies for treating different stages of T2DM and preventing its complications, particularly in high-risk patients. There is a trend towards increasing use of DPP-IV inhibitors, which are no less efficacious and safe in Asians than Caucasians and may have some advantages over existing oral antidiabetic agents, particularly for certain high-risk groups. Such agents may play a significant future role in the management of T2DM.
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Affiliation(s)
- Yi-Ming Mu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
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Lin CH, Lee YY, Liu CC, Chen HF, Ko MC, Li CY. Urbanization and prevalence of depression in diabetes. Public Health 2011; 126:104-11. [PMID: 22178148 DOI: 10.1016/j.puhe.2011.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 06/13/2011] [Accepted: 10/27/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. STUDY DESIGN A descriptive correlation study design relating urbanization and prevalence of depression. METHODS Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. RESULTS The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (β = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. CONCLUSIONS There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.
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Affiliation(s)
- C H Lin
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
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Wang CC, Chen WL, Kao TW, Chang YW, Loh CH, Chou CC, Chou CC. Incidence of cardiovascular events in which 2 thiazolidinediones are used as add-on treatments for type 2 diabetes mellitus in a Taiwanese population. Clin Ther 2011; 33:1904-13. [PMID: 22118894 DOI: 10.1016/j.clinthera.2011.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thiazolidinediones (TZDs) are oral antihyperglycemic drugs that are used to treat insulin resistance. Rosiglitazone is a TZD that has been found to increase the risk of cardiovascular events, especially of myocardial ischemic events. OBJECTIVE The aim of this study was to conduct a direct comparison of TZDs (pioglitazone and rosiglitazone) and their relationship to cardiovascular events (myocardial infarction [MI], angina, congestive heart failure [CHF], and cerebral vascular accident [CVA]) in Taiwanese patients with type 2 diabetes mellitus (DM). METHODS A retrospective study with second data analysis was performed from January 1, 1998, to December 31, 2006. We selected those who were prescribed only 1 kind of TZD for at least 120 days in the 180-day period; those who switched to another TZD during the above-mentioned periods and had cardiovascular events before the use of TZD were excluded. Stringent definitions for MI, angina, CHF, and CVA were set, and survival analysis was performed. RESULTS A total of 7725 type 2 DM cases were included in the final analysis. In our model, the hazard ratio (HR) for development of MI in rosiglitazone-treated patients was 0.539 (95% CI, 0.327-0.889; P = 0.015) compared with pioglitazone-treated patients for whom age, gender, medical specialist, duration of DM, and histories of antihypertensive, statin, and fibrate medications were controlled. There were no significant differences in HRs among angina (HR = 0.543; 95% CI, 0.293-1.006; P = 0.052), CHF (HR = 0.820; 95% CI, 0.619-1.086; P = 0.166), and CVA (HR = 0.949; 95% CI, 0.724-1.244; P = 0.705) groups. Antihypertensive and statin therapy led to significantly different HRs for cardiovascular events depending on when they were first prescribed. If statins were prescribed after TZD, the HR relative to patients who never used statins was 3.896 for MI (95% CI, 2.071-7.328; P < 0.001), 3.194 for angina (95% CI, 1.514-6.737; P = 0.002), and 1.303 for CHF (95% CI, 1.011-1.678; P = 0.041). If antihypertensives were prescribed after TZD, the HR relative to patients never treated with antihypertensives was 7.654 for angina (95% CI, 1.922-32.921; P = 0.004), 3.900 for CHF (95% CI, 2.437-6.242; P < 0.001), 2.242 for CVA (95% CI, 1.613-3.116; P < 0.001), and 2.325 for MI (95% CI, 1.109-4.873; P = 0.026). CONCLUSIONS Our data suggested that, as an add-on treatment for diabetic patients, rosiglitazone had significantly lower HRs for MI compared with those for pioglitazone. Diabetic hypertensive patients treated with TZD were at a high risk for angina, CHF, CVA, and MI, whereas statin use increased the risk for MI, angina, and CHF. There are some potential limitations to this study owing to the analysis methodology and retrospective design. In addition, all enrolled type 2 DM patients were treated with TZD medications, but diabetes patients treated with nonpharmacologic therapy, including lifestyle modifications, were not included.
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Affiliation(s)
- Chung-Ching Wang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Effects of the Hb E, Hb H and Hb G-Taichung variants on HbA1c values by the Bio-Rad variant™ II turbo analyzer. Clin Biochem 2011; 44:1338-42. [DOI: 10.1016/j.clinbiochem.2011.08.907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/25/2011] [Accepted: 08/06/2011] [Indexed: 11/22/2022]
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Kim JH, Kwon HS, Park YM, Lee JH, Kim MS, Yoon KH, Lee WC, Cha BY, Son HY. Prevalence and associated factors of diabetic retinopathy in rural Korea: the Chungju metabolic disease cohort study. J Korean Med Sci 2011; 26:1068-73. [PMID: 21860558 PMCID: PMC3154343 DOI: 10.3346/jkms.2011.26.8.1068] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022] Open
Abstract
This study was aimed to investigate the prevalence of diabetic retinopathy and its associated factors in rural Korean patients with type 2 diabetes. A population-based, cross-sectional diabetic retinopathy survey was conducted from 2005 to 2006 in 1,298 eligible participants aged over 40 yr with type 2 diabetes identified in a rural area of Chungju, Korea. Diabetic retinopathy was diagnosed by a practicing ophthalmologist using funduscopy. The overall prevalence of diabetic retinopathy in the population was 18% and proliferative or severe non-proliferative form was found in 5.0% of the study subjects. The prevalence of retinopathy was 6.2% among those with newly diagnosed type 2 diabetes and 2.4% of them had a proliferative or severe non-proliferative diabetic retinopathy. The odds ratio of diabetic retinopathy increased with the duration of diabetes mellitus (5-10 yr: 5.2- fold; > 10 yr: 10-fold), postprandial glucose levels (> 180 mg/dL: 2.5-fold), and HbA1c levels (every 1% elevation: 1.34-fold). The overall prevalence of diabetic retinopathy in rural Korean patients was similar to or less than that of other Asian group studies. However, the number of patients with proliferative or severe non-proliferative diabetic retinopathy was still high and identified more frequently at the time of diagnosis. This emphasizes that regular screening for diabetic retinopathy and more aggressive management of glycemia can reduce the number of people who develop diabetic retinopathy.
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Affiliation(s)
- Ji-Hyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hee Lee
- The Catholic Institute of Ubiquitous Healthcare, Seoul, Korea
| | - Man-Soo Kim
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kun-Ho Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Yun Cha
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Young Son
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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