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Objective:To investigate the relationship between glycemic variability and glycosylated hemoglobin (HbA1c) level during follow-up in elderly male patients with type 2 diabetes.Methods:Retrospective cohort study. A total of 200 elderly male patients who received continuous glucose monitoring from January 2007 to January 2011 were recruited in the Second Medical Center of PLA General Hospital. The subjects were divided into two groups according to baseline mean amplitude of glycaemic excursion (MAGE) level, including MAGE <3.9 mmol/L group ( n=114) and MAGE ≥3.9 mmol/L group ( n=86). The correlation between baseline MAGE and mean HbA1c during follow-up were evaluated by univariate Pearson correlation analysis and multivariate linear regression analysis. Results:Baseline characteristics including age, body mass index, waist circumference, smoking, drinking, fasting blood glucose, blood lipid and blood pressure were comparable between MAGE <3.9 mmol/L group and MAGE ≥3.9 mmol/L group. The average follow-up period was 12.5 years. The mean HbA1c during follow-up in MAGE ≥3.9 mmol/L group was significantly higher than that in MAGE <3.9 mmol/L group (7.23%±0.72% vs. 6.91%±0.77%, t=-2.94, P=0.004). The proportion of mean HbA1c <7.0% during follow-up in MAGE ≥3.9 mmol/L group was 44.2% (38/86), which was significantly lower than that in MAGE <3.9 mmol/L group [60.5% (69/114), χ 2=5.26, P=0.022]. In univariate analysis, MAGE at baseline was correlated with the mean HbA1c during follow-up ( r=0.306, P<0.001). Multivariate linear regression analysis suggested that the baseline MAGE remained an independent influential factor of mean HbA1c ( β=0.09, 95% CI: 0.03 to 0.15, P=0.006, R2=0.31) after several confounding factors were adjusted. Conclusions:With the increased glycemic variability at baseline, mean HbA1c level during follow-up is accordingly elevated. The glycemic variability at baseline is independently related to mean HbA1c level during follow-up in elderly male patients with type 2 diabetes.
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Objective The aim of the study was to evaluate the association of fasting plasma glucose (FPG) level over 5.3 mmol/L to the development of abnormal glucose metabolism and cardiovascular diseases (CVD).Methods This was a retrospective cohort study with 1 064 non-diabetic subjects(980 males;84 females) aged 60 or over, who carried out annual health check-up in Chinese PLA General Hospital from May, 1996 to May, 2015.Based on the average FPG level of 3 years before enrollment, the subjects were divided into four groups : ＜ 5.3 mmol/L, 5.3-＜ 5.6 mmol/L, 5.6-＜ 6.1 mmol/L and 6.1-＜ 7.0 mmol/L.Glucose metabolic changes, complications and mortality were follow-up until May, 2015.Results (1)The initial 3-year average FPG levels were (4.9 ±0.4) mmol/L in the total 1 064 subjects.Among them, 126 subjects developed diabetes mellitus (DM) and 144 subjects developed impaired glucose regulation (IGR) during the follow-up visits.The proportions of IGR and diabetes increased with the FPG levels (P ＜ 0.05).The risk for developing IGR was significantly higher in subjects with FPG≥5.3 mmol/L than in those with FPG ＜ 5.3 mmol/L (RR =3.08, 95％ CI 2.02-4.81, P ＜0.01).The risk for incident DM was markedly increased in subjects with FPG ≥ 5.6 mmol/L than in those with FPG ＜5.6 mmol/L (RR =6.73, 95％ CI 3.90-11.52, P ＜0.01);(2)The risk for CVD was eight folds higher in subjects with FPG ≥5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L (RR =8.42,95％ CI 5.11-13.82, P ＜ 0.05);(3) Survival analysis showed that the risk of death was 1.47 times higher in subjects with FPG ≥ 5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L after years of followed-up (RR=l.47, 95％CI 1.09-1.98, P=0.0127).Conclusion The risks for IGR, CVD and mortality are higher in the elderly with FPG ≥5.3 mmol/L, which highlights the importance for the disease prevention in elder people with FPG 5.3 mmol/L or more.
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Eleven old male patients with hyperuricemia were collected ( hyperuricemia group,65-90 years old ).10 healthy middle-aged males ( middle-aged group,30-40 years old) and 10 healthy old males ( older group 60-70 years old ) with normal blood uric acid level were used as controls.All of the subjects were given low purine content diet ( 250 mg/d ) for 3 days followed by high purine content diet ( 800 mg/d ) consecutively for another three days.The samples of fasting blood and 24 h urine were collected for assay.The results showed that there were no significant changes of serum uric acid ( UA ) concentration in three groups after low purine content diet.But the levels of serum UA in three groups all increased significantly after high purine content diet,and the change was higher in hyperuricemia group than middle-aged group [ ( 507.7 ± 108.1 vs 378.9 ± 80.1 ) μmol/L,P＜0.05 ].24 h urine uric acid excretion in three groups was all significantly decreased after low purine content diet and increased after high purine content diet.After high purine content diet,24 h urine uric acid was lower in hyperuricemia group than middle-aged group [ ( 2.99 ± 1.21 vs 3.62 ± 1.02 ) mmol/24 h,P＜0.05 ].Blood urea nitrogen levels in all subjects decreased after low purine content diet and increased after high purine content diet ( P＜0.05 or P＜0.01 ).Creatinine clearance rate in hyperuricemia group was decreased after high purine content diet compared with baseline [ (75.3 ± 20.3 vs 80.7 ±20.0) ml/min ],and there were no significant changes in other groups after low and high purine content diet.24 h urine protein in hyperuricemia group was higher than middle-aged group ( P＜0.05 ),and increased after high purine content diet with significant difference ( P＜0.05 ).These results suggest that high purine content diet and decreased by renal uric acid clearance mainly contribute to hyperuricemia in old people.
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Objective To study the impact of different insulin levels on the conversion from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM),through analysis of different glycometabolism condition among quinquagenarian population.Methods Subjects enrolled were Beijing habitants who received annual physical examination [ including oral glucose tolerance test (OGTI) ] in the Chinese PLA General Hospital from 2005-2007.According to the OGTT results,the subjects were divided into three groups,including normal glucose tolerance-non-hyperinsulinemia group (NGT-NHIns),IGT-hyperinsulinemia group (IGT-Hins) and IGT-non-hyperinsulinemia group (IGT-NHINS).The prognosis between the year 2009 and 2010 of the three groups was observed.Hyperinsulinemia was diagnosed with fasting serum insulin ≥ 15 mU/L and/or 2-hour serum insulin ≥ 80 mU/L after glucose loading.Results The rate of case number of conversion to T2DM in IGT-NHIns group (42/133) was higher than that in IGT-Hins group (24/154) or NGT-NHIns group (12/126).The HOMA insulin resistance index (HOMAIR) of individuals with IGT-NHIns was lower than that of IGT-Hins [ 0.96 (0.40,3.53 ) vs 2.04 (0.59,23.20),P ＜ 0.05 ],while whole body insulin sensitivity index (WBISI) was higher than that of IGT-Hins [ 7.48 (3.20,31.35 ) vs 3.28 ( 0.86,7.67 ),P ＜ 0.05 ].Modified β-cell function index ( MBCI ) and insulin secretion index (ISI) in IGT-NHIns was poorer than that of IGT-Hins respectively [ 2.57 (0.58,10.98) vs5.17(1.04,65.09); 7.66 (0.99,28.40) vs 17.56 (4.18,96.46),allPvalues ＜0.01].Conclusions The risk of IGT-NHIns progressing into T2DM is higher than that of IGT-Hins. For the prevention of T2DM,individuals with IGT-NHIns should be paid more attention than keeping an eye on IGT-Hins patients.Early control of risk factors could protect β cell function and prevent the progression to T2DM.
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Objective To study the correlation between hyperinsulinemia (HIns) and arteriosclerosis in one community in Beijing. Methods Subjects who received arteriosclerosis screening in physical examination annually were studied. All subjects were received 75g oral glucose tolerance test (OGTT) to evaluate glucose metabolic level, and brachial-ankle pulse wave velocity (baPWV) examination to evaluate arteriosclerosis. The correlation between hyperinsulinemia and pulse wave velocity was analyzed. Results Among all the 1046 subjects under investigation, baPWV of subjects with HIns was higher than subjects with normoinsulinemia (NIns) in different glucose metabolism status [normal glucose tolerance, ( 1381.2 ±280. 8) cm/s vs ( 1280. 3 ±218. 7) cm/s; imparied glucose regulation, ( 1557. 5 ±319.3) cm/s vs (1474.7 ±305. 1) cm/s; diabetes, (1764.3 ±476.6) cm/s vs (1664.2 ±374.6)cm/s], especially in subjects with normal glucose tolerance ( P ＜ 0.01 ). The prevalence of cardiovascular risk factors in subjects with HIns was much higher than subjects with NIns ( P ＜ 0.01 ). Multiple logistic regression analysis showed that hyperinsulinemia was the risk factor of arteriosclerosis, and the OR (95%CI) of subjects with HIns was 1.91 (1. 169-3. 105, P ＜0.01 ) as compared to the subjects with NIns. Conclusion The subjects with HIns suffered from much more metabolic risk factors than NIns.Hyperinsulinemia that closely correlated with baPWV was a risk factor of arteriosclerosis.
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Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.
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Objective To study the outcomes and influencing factors of the conversion from normal glucose tolerance -hyperinsulinemia (NCT-HINS) to diabetes in the population of a community in Beijing.Methods All the subjects investigated received 75 g oral glucose tolerance test (OGTT) for diabetes screening carried out in May, 2006 and May, 2008. Data were calculated to analyze the outcomes and influencing factors of the conversion. HINS was diagnosed if fasting serum insulin & 15 mIU/L and/or 2-hour serum insulin after glucose loading ≥ 80 mIU/L Results The prevalence of NGT-HINS in the community in 2006 and 2008 was 5.28% and 8.67% (P<0.01) respectively and that of diabetes mellitus (DM) and impaired glucose regulation (IGR) was 3.52% , 6.56% in 2006 and 4.42% ,6.47% in 2008.The probability of the conversion from NGT-HINS to IGR and DM was 18.6% and 2.3% , being much higher than that from normal glucose tolerance- normoinsulinemia (NGT-NINS) (5.4% and 0.7% , P <0.01). However, the probability of the conversion from NGT-HINS to DM was 2.3% , which was much lower than that from IGR (26.3% , P <0.01). The reason might be that individuals with NGT-HINS had a higher waist circumference, BMI, fasting plasma glucose, 2 h plasma glucose and TG but a lower HDL-C than individuals with NGT-NINS in 2006. The HOMA β-cell function index/HOMA insulin resistance index (HBCI/IR) of individuals with NGT-HINS was much lower than that of individuals with NGT-NINS, but much higher than that of individuals with IGR. Logistic regression analysis showed that age, TG and HBCI/IR were the major influencing factors of the conversion from NGT to glucose metabolic disorders.Conclusions The probability of conversion from NGT to DM was increased remarkably when HINS was diagnosed. The reason might be that individuals with NGT-HINS suffered more metabolic risk factors and had a decreased β-cell function. Therefore, individuals with NGT-HINS should be paid attention to in diabetes prevention study.
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Objective To investigate the different clinical features of metabolic syndrome(MS)in middle-aged and elderly patients.Methods Data were collected from 947 MS patients,for whom the diagnosis was established based on the Chinese criteria.Of them,679 were elderly people and 268 were in middle-age.Laboratory examination and medical history were analyzed.BMI,blood glucose,blood pressure(BP)and lipid profile were measured.Patients were divided into different groups according to age and sex.Results In the elderly group,the age of male and female patients was 81.5?6.5 and 74.5?8.8 years,respectively.BMI of elderly males were higher than that of middle-aged males(27.14?2.51 vs 25.98?2.38).All the elderly patients had higher systolic BP,but lower triglyceride level than that of the middle aged patients.In middle-aged group,female patients had higher high-density lipoprotein.Fasting blood glucose level in all the investigated subjects was correlated with postprandial glucose(for male R2=0.463,P
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Objective To analyze the significance of the waistline (WC), body mass index (BMI) and hyperinsulinaemia (HIns) on evaluating the metabolic syndrome. Methods The data of routine clinical examination were collected from the mid-aged and senile individuals (middle-senile group) who received oral glucose tolerance test (OGTT) for diabetes screening, and from a group of subjects who received annual OGTT for diabetes screening (mature group). Data were collected by a specialized person, input into a special computer database, and then analyzed with SAS 5.0 software by specialized staffs. Abnormal WC and BMI were determined according to IDF and CDS criteria. HIns was determined if fasting insulin (FIns) ≥15mU/L and 2-hour insulin after glucose burdening (2hPIns) ≥80mU/L. Results In the middle-senile group, the abnormality frequencies of WC and HIns as well as overall insulin level were obviously higher than that in the mature young group. The abnormality frequency of BMI was higher in mature young group. A higher detection rate of HIns existed in intolerance glucose test (IGT) and normal glucose test (NGT). The coincidence of WC and BMI diagnostic criteria were 77.5% and 74.3%, respectively, on evaluating with or without obesity in the middle-senile group and mature young group. When only WC criterion was used for evaluating the existence of insulin resistance, there would be 28.2% of missed diagnosis rate for MS patients. Conclusion WC, BMI and HIns are all risk factors for abnormal glucose metabolism, hypertension and dyslipidemia. There is different prevalence among different populations. The combination of WC, BMI and HIns might be more helpful for identifying MS at early stage.
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Objective To investigate the prevalence of metabolic syndrome (MS) and its risk factors in the population of age between 21 to 78 years in Beijing, and to study the clinical significance of evaluation of MS and hyperinsulinaemia by the use of waist circumference and body mass index (BMI). Methods A standard questionnaire and 75g oral glucose tolerance test (OGTT) were used in the investigation. All the data, including plasma glucose (fasting blood glucose level and postprandial glucose level), blood levels of insulin, blood lipid, blood uric acid, and creatinine, as well as height, weight, waist circumference (WC), blood pressure, body mass, were determined or measured. Obesity was defined by WC and BMI value. The incidence of obesity complicated with two abnormal metabolic disorders (IDF), as well as hyperinsulinaemia in these subjects, were analyzed. Results The prevalence of obesity as determined by WC and BMI were 20.6% and 41.5%, respectively, in the said popalation of Beijing (P0.05) in subjects of obesity complicated with two other metabolic abnormality as defined by WC and BMI criteria, accounting for 1.37% and 3.13% of the whole investigated population (P