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Objective To investigate the risk factors and appropriate screening methods for diabetic peripheral neuropathy (DPN ). Methods This research is a multicenter ,randomized ,cross-sectional study. Questionnaires ,physical examinations and laboratory tests were performed on 1054 elderly diabetic outpatients at 13 hospitals in urban and rural areas of Beijing. Patients were screened for DPN with the five physical examinations recommended by the Diabetes Branch of the Chinese Medical Association. They were divided into a confirmed DPN group(n=449 ,42.6％ ) ,a suspected DPN group(n=276 ,26.2％ ) ,and a non-DPN group(n=329 ,31.2％ ).Multivariate logistic regression was used to analyze risk factors for DPN.The sensitivity ,specificity ,Youden index ,and area under the receiver operating characteristic (ROC)curve were calculated and used for evaluating each test and their combinations in screening DPN and for choosing the opitmal test combination. Results The differences in age ,family income ,duration of diabetes ,glycated hemoglobin(HbA1c) ,hypoglycemia ,and dyslipidemia among three groups were statistically significant (all P<0.01). The decision whether or not to initiate metformin therapy ,metformin doses and DPN prevalence in patients on long-term metformin therapy showed statistically significant differences among three groups (all P<0.01). The differences in the prevalences of cerebral infarction ,diabetic retinopathy ,and peripheral vascular disease among three groups were statistically significant (all P< 0.05).Multivariate Logistic regression analysis suggested that levels of HbA1c ,hypoglycemia ,LDL cholesterol ,whether or not metformin use , metformin dose ,and duration of metformin use were risk factors for DPN in elderly diabetics (all P<0.05) . The combined methods of ankle reflex ,vibratory sensation and temperature sensation used for screening DPN showed the best results with a sensitivity of 94.1％ ,specificity of 75.3％ ,an area under the ROC curve of 0.847 ,and a Yoden index of 0.6945. Conclusions The prevalence of DPN in elderly diabetic outpatients at third-level referral hospitals in Beijing is high. Poor glycaemic control ,repeated episodes of hypoglycemia , metformin use and its daily dose and duration are risk factors for DPN in elderly diabetics.We should focus on strengthening the DPN screening and management of high-risk population.Symptoms of peripheral neuropathy plus ankle reflex ,vibratory and temperature sensations are simple ,rapid and reliable DPN-screening methods ,and can be promoted in outpatient department and primary hospitals.
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Objective To investigate the association between serum total testosterone (TT ) levels and type 2 diabetes(T2DM )and any gender differences in elderly patients. Methods Based on the Aging Health database built from 2008 to 2012 ,935 elderly individuals over 60 years old with a mean age of 65.8 years receiving physical examinations were included.According to the 1999 WHO criteria for diabetes ,participants were assigned into four groups :a T2DM group(n＝298) ,an impaired fasting glucose(IFG)group(n＝26) ,an impaired glucose tolerance(IGT)group(n＝121) ,and a normal glucose regulation(NGR)group(n ＝ 490).We measured serum TT by ELISA and analyzed the distribution patterns in the groups.Furthermore ,we examined the gender-specific correlation of TT with T2DM and homeostasis model assessment of insulin resistance (HOMA-IR). Results The prevalence of T2DM in the participants was 31.9%(298/935).One-way ANOVA analysis showed that the TT level was higher in the NGR group than in the T2DM and IGT groups (PANOVA＝ 0.001) . Logistic regression analysis indicated a significant protective association between TT and T 2DM in the elderly.Every one unit of increase in the SD of the TT level was accompanied by a 23% reduction in the risk for T2DM (P＝ 0.001).Further gender-stratification analysis suggested that the protective role of TT against T2DM only existed in males (OR＝ 0.55 ,95% CI :0.44-0.68 ;P＜ 0.001).After adjustment for age ,blood pressure ,blood lipids ,and waist circumference ,the protective role of TT against T2DM in males still remained (OR ＝ 0.68 ,95% CI :0.53-0.86 ;P ＝ 0.002 ).Pearson correlation analysis also indicated a significant negative correlation between TT and HOMA-IR in older males(P＝0.002).As for older females ,no significant correlation of TT with T2DM and HOMA-IR was found. Conclusions The serum TT level might be an independent protective factor for T 2DM in older males ,as evidenced by its correlation with improved insulin resistance status ,which is not present in older females.
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Objective To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing,and analyze the changes of body composition and resting metabolic rate with age.Methods From November 2014 to December 2015,body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years,including 760 men,98 women,who received physical examination at Beijing Hospital.Results The overweight rate was 51.4％,and the obesity rate was 16.9％.The overweight rate was 26.5％ and the obesity rate was 14.3％ in women,significantly lower than those in men (54.6％ and 17.2％) (P＜0.001).The distribution of skeletal muscle volume,muscle index,body fat percentage,visceral fat area and resting metabolic rate in different age groups were different (P＜0.001).In the normal weight group,the skeletal muscle volume,muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P＜0.05).At the same time,the body fat percentage and visceral fat area increased obviously (P＜0.05).However,the skeletal muscle volume,muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70-years (P＜0.05),and the decrease in age group ≥80 years was more obvious.At the same time,body fat percentage and visceral fat area increased significantly in age group 70-years (P＜ 0.05).Conclusion The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing,and the rates were higher in men than in women.With the increase of age,the skeletal muscle volume,muscle index and resting metabolic rate gradually decreased,while the percentage of body fat and visceral fat area increased;Overweight and obese people had earlier changes in body composition and resting metabolic rate.
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Objective To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing,and analyze the changes of body composition and resting metabolic rate with age.Methods From November 2014 to December 2015,body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years,including 760 men,98 women,who received physical examination at Beijing Hospital.Results The overweight rate was 51.4％,and the obesity rate was 16.9％.The overweight rate was 26.5％ and the obesity rate was 14.3％ in women,significantly lower than those in men (54.6％ and 17.2％) (P＜0.001).The distribution of skeletal muscle volume,muscle index,body fat percentage,visceral fat area and resting metabolic rate in different age groups were different (P＜0.001).In the normal weight group,the skeletal muscle volume,muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P＜0.05).At the same time,the body fat percentage and visceral fat area increased obviously (P＜0.05).However,the skeletal muscle volume,muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70-years (P＜0.05),and the decrease in age group ≥80 years was more obvious.At the same time,body fat percentage and visceral fat area increased significantly in age group 70-years (P＜ 0.05).Conclusion The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing,and the rates were higher in men than in women.With the increase of age,the skeletal muscle volume,muscle index and resting metabolic rate gradually decreased,while the percentage of body fat and visceral fat area increased;Overweight and obese people had earlier changes in body composition and resting metabolic rate.
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Objective To investigate the correlation between 25-hydroxyvitamin D [ 25 ( OH ) D ] and indicators of glucose metabolism in inpatients with type 2 diabetes mellitus .Method We retrospectively ana-lyzed the clinical records of 214 inpatients with type 2 diabetes mellitus , including age , body mass index (BMI), systolic blood pressure, diastolic blood pressure, and laboratory test results such as serum parathyroid hormone (PTH), 25(OH)D, creatinine, calcium, phosphorus, glycosylated hemoglobin A1c (HbA1c), fast-ing blood glucose , and fasting insulin .Results The prevalence of vitamin D deficiency was high in these pa-tients, with 47.2%of them having a serum 25(OH)D concentration lower than 10 ng/ml.Using 25(OH)D level less than 10 ng/ml as the cut-off point, the patients were divided into vitamin D severe deficiency (Vit-SD) group and vitamin D non-severe deficiency (Vit-NSD) group.Compared with the Vit-NSD group, the Vit-SD group had younger age [ (55.27 ±13.71) years vs.(60.76 ±12.32) years, P=0.001] and higher HbA1c level [ (9.00 ±2.01)% vs.(8.45 ±1.86)%, P=0.025].BMI [ (25.09 ±4.01) kg/m2 vs.(25.39 ± 3.53) kg/m2, P=0.523], fasting blood glucose [ (8.91 ±3.31) mmol/L vs.(8.16 ±3.02) mmol/L, P=0.063], fasting serum insulin [ (21.32 ±32.50) mIU/L vs.(21.92 ±26.95) mIU/L, P=0.873] and homeostasis model assessment of insulin resistance index (97.60 ±8.92 vs.7.53 ±9.39, P=0.954) in these two groups were with no statistically significant difference .The association analyses showed that HbA 1c was sig-nificantly negatively correlated with 25 ( OH ) D ( r =-0.190 , P=0.003 ) and not correlated with serum PTH, calcium, or phosphorus , after adjusting for age and creatinine .Multiple linear regression revealed that HbA1c had a significantly negative correlation with age (β=-0.220, P=0.000) and 25 (OH) D (β=-0.184 , P=0.000 ) .Conclusions There is high prevalence of vitamin D deficiency in inpatients with type 2 diabetes mellitus, which is even higher in relatively young patients .Serum 25 (OH) D may be negatively correlated with HbA1c in these patients independently from age , BMI, fasting serum insulin, and homeostasis model assessment of insulin resistance index .
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Objective To analyze the impact of atorvastatin on blood lipids and arterial media thickness(IMT)in new-onset type 2 diabetes patients. Methods 333 patients,30-70 years old and diagnosed within one year as type 2 diabetes,were selected from the Chinese Diabetes Complication Prevention Study(CDCPS)to take part in this study. Changes of blood lipids and IMT of carotid, femoral and iliac artery pre and post the administration of atorvastatin were tested and followed for 24 months. Results Total cholesterol,triglycerides and low-density lipoprotein decreased significantly (P=0.000)and maintained at a low level. The carotid artery IMT decreased significantly(P=0.022) at the end of this study,but the femoral and iliac artery IMT did not show any obvious change. There were no serious adverse events noticed,during the study period. Conclusion Long-term use of atorvastatin seemed to be safe and effective in reducing blood lipids in patients with type 2 diabetes thus could delay the development of atherosclerosis.
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Objective To analyze the impact of atorvastatin on blood lipids and arterial media thickness(IMT)in new-onset type 2 diabetes patients. Methods 333 patients,30-70 years old and diagnosed within one year as type 2 diabetes,were selected from the Chinese Diabetes Complication Prevention Study(CDCPS)to take part in this study. Changes of blood lipids and IMT of carotid, femoral and iliac artery pre and post the administration of atorvastatin were tested and followed for 24 months. Results Total cholesterol,triglycerides and low-density lipoprotein decreased significantly (P=0.000)and maintained at a low level. The carotid artery IMT decreased significantly(P=0.022) at the end of this study,but the femoral and iliac artery IMT did not show any obvious change. There were no serious adverse events noticed,during the study period. Conclusion Long-term use of atorvastatin seemed to be safe and effective in reducing blood lipids in patients with type 2 diabetes thus could delay the development of atherosclerosis.
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<p><b>OBJECTIVE</b>To analyze the impact of atorvastatin on blood lipids and arterial media thickness (IMT) in new-onset type 2 diabetes patients.</p><p><b>METHODS</b>333 patients, 30-70 years old and diagnosed within one year as type 2 diabetes, were selected from the Chinese Diabetes Complication Prevention Study (CDCPS) to take part in this study. Changes of blood lipids and IMT of carotid, femoral and iliac artery pre and post the administration of atorvastatin were tested and followed for 24 months.</p><p><b>RESULTS</b>Total cholesterol, triglycerides and low-density lipoprotein decreased significantly (P = 0.000) and maintained at a low level. The carotid artery IMT decreased significantly (P = 0.022) at the end of this study, but the femoral and iliac artery IMT did not show any obvious change. There were no serious adverse events noticed, during the study period.</p><p><b>CONCLUSION</b>Long-term use of atorvastatin seemed to be safe and effective in reducing blood lipids in patients with type 2 diabetes thus could delay the development of atherosclerosis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Atorvastatin , Diabetes Mellitus, Type 2 , Drug Therapy , Follow-Up Studies , Heptanoic Acids , Therapeutic Uses , Lipids , Blood , Pyrroles , Therapeutic Uses , Tunica Media , PathologyABSTRACT
Objective To analyze the initial treatment strategies, blood glucose control and reaching standard status of newly diagnosed type 2 diabetes mellitus (T2DM) in the middle-aged and elderly. Methods The 771 patients diagnosed with T2DM newly or within one year, aged 50-70 years, selected from Chinese Diabetes Complication Prevention Study (CDCPS) were enrolled in this study. The correlations of initial treatment strategies with blood glucose control (target value of glycated hemoglobin was less than 7.0%) and reaching standard status were analyzed retrospectively. Based on the same lifestyle intervention, the therapy was further divided into group A (without medication), group B (single oral hypoglycemic agent), group C (combined oral hypoglycemic agents), group D (treatment including insulin). Results Although receiving the different treatments, the 771 patients had a similar mean glycated hemoglobin level, from 7.2% to 7.7%, among the four kinds of intervention before entering the study. The increased intensity and complexity after therapy adjustment along with the increased glycated hemoglobin level was observed at baseline. The corresponding relationships between medication and HbA1c were as follow: without medication-6.1%, single oral hypoglycemic agent-7.2%, combined oral hypoglycemic agents-7.7%, treatment including insulin-9.2%. After 20 months of follow-up, the mean fasting glucose and glycated hemoglobin were 6.6 mmol/L and 6.2%, separately. According to the target glycated hemoglobin level of less than 7.0%, all four-kinds of therapies had high achievement rates, which were all above 80% except that was 63.2% in group D. Sulphonylurea and biguanide as initial single oral hypoglycemic agent therapy had the similar effectiveness on glucose control and target glycated hemoglobin achievement. Conclusions According to the levels of glucose and glycated hemoglobin, multiple individual therapies should be enacted at the beginning of treatment. The strategy mainly based on sulphanylurea and biguanide is proved to be persistently effective in newly-diagnosed middle-aged and elderly diabetic patients in China.
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The impact of hypofunction of kidney on evaluating of islets β cell function in patients with type 2 diabetes was investigated. 635 type 2 diabetic patients with normal liver function were grouped using Cockcroft-Gault. Following the decrease in kidney function, blood C-peptide concentration was increased with decreased urinary exeretion of C-peptide(P<0. 05). It is proposed to pay an attention to renal function while evaluating islets β cell function in the patients.
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Objective To evaluate lipid profile and its relationship with body mass index (BMI)in 4784 elderly male subjects. To explore the possibility of using an improvemem of dyslipidemia as an alternative target in the weight control in elderly male population. Methods 4784 elderly male subjects were surveyed with, the measurement of blood lipids and were grouped according to age (60-69, 70-79, 80-96 yrs) and BMI (＜18.5, 18.5-23.9, 24.0-27.9, ≥28.0 kg/m2), respectively.Results The mean levels of TC, LDL-C, TG and HDL-C (mmol/L) were (5.1±0.9)mmol/L,( 3.0±0. 8)mmol/L, (1.5±1.0)mmol/L and (1.3±0. 3)mmol/L, respectively. The prevalence of dyslipidemia was 44.8% (2141 cases) in this population, with specific abnormality rates in TC,LDLC, TG, HDL-C being 10. 4% (497 cases), 9.3% (445 cases), 29.8% (1425 cases) and 19.4% (928cases), respectively. Within all age groups, TG decreased dramatically and HDL-C incre ased with increasing age (P＜0.01), while the 60-69 yrs age group versus other age groups showed a tendency to an increment of TG, and a decrement of HDL-C. (P＜0. 05). Prevalences of overweight and obesity were 46.8% and 15.5% in the elderly male subjects, respectively. The level of TC increased with the increasing BMI, while HDL-C decreased. The differences in TG and LDL-C among various BMI groups were of no statistical significances. High TG and low HDL-C were predominant abnormalities amongst the oldest old, whose lipid profile resembled that of the 70-79 yrs age group.Whilst, the prevalences of overweight and obesity were at the lowest levels of 44.6% (228 cases) and 11.9% (61 cases), respectively. Conclusions High TG and low HDL-C are predominant abnormalities in elderly male subjects. TC level in the current population is higher than that from the national census in 2002. Prevalences of overweight and obesity are close to that in developed countries.TC and LDL-C levels are negatively related to age in the elderly male population, contrasting the correlation between HDL-C and age.