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Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual's health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique "continuous glucose monitoring" (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes (P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI (P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.
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Humanos , Glucosa , Glucemia , Resistencia a la Insulina/fisiología , Diabetes Mellitus Tipo 2/diagnóstico , Automonitorización de la Glucosa Sanguínea , Factores de Tiempo , InsulinaRESUMEN
Objective:To evaluate the impacts of resistance training(RT)and aerobic training(AT)for 24 months on the risk of type 2 diabetes in patients with pre-diabetes.Methods:Two hundred forty-eight pre-diabetic patients were enrolled in this multi-center randomized controlled trial. All patients were randomly divided into 3 groups: RT( n=82), AT( n=83), and control( n=83)groups. The participants in RT and AT groups undertook moderate RT or AT 3 times a week(150 minutes/week)under supervision in 3 research centers for 24 months. Elastic bands were used in each session of RT, with intensity of 60% 1RM(maximum weight that muscle can lift at once). Patients in AT group performed aerobic dance at 60%-70% of maximum heart rate. Assessments for each subject were made at baseline and by the end of 6, 12 and 24 months. Primary outcomes were changes in the risk of type 2 diabetes. Secondary outcomes included changes in blood glucose, blood lipids, and blood pressure. Results:There were 217, 206, and 173 subjects who completed the follow-up of 6, 12, and 24 months, respectively. The mean ages of RT, AT, and control groups at baseline were(59.91±5.92), (60.93±5.71), and(60.73±5.83)years. Compared to control group, both RT and AT groups revealed a significant reduction in HbA 1C( P<0.05), and a significant increase in homeostasis model assessment for β-cell function index(HOMA2-β, P<0.01)by the end of 12 and 24 months. Adjusted for age, gender, statin use, lipid profile, blood pressure, and body mass index, COX regression analysis showed that RT and AT reduced the risk of type 2 diabetes by 55.6%( P=0.012)and 59.8%( P=0.010). Conclusions:This study demonstrates that 24-month moderate RT and AT have comparable effects on reducing insulin resistance, improving β-cell function, blood glucose and lipid, and reducing the risk of type 2 diabetes.
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Objective@#To study the association of single nucleotide polymorphism (SNP)276 in adiponectin gene with essential hypertension in population with impaired glucose regulation in Han people of Shanxi region.@*Methods@#The study population consisted of 216 Chinese Hans residents with impaired glucose regulation (IGR) in Shanxi province. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied to test the adiponectin SNP276G/T polymorphism.@*Results@#The distributions of genotypes and alleles of SNP276 both displayed significant difference between the IGR complicating norm tension group and the hypertension group (P=0.025, P=0.007). Compared with the TT genotype, the SNP276 non-TT (GT+ GG) genotype was associated with increased risk of complicating with hypertension (OR=3.346, 95% CI: 1.115-8.986, P=0.037), while after age- , sex- and BMI-adjusted, there was no significant difference between the 2 groups (P=0.349).@*Conclusions@#SNP276 in adipose most abundant gene transcript 1 (APM1) was associated with the susceptibility to be complicating essential hypertension in population with impaired glucose regulation in Han people of Shanxi region.
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Objective To study the association of single nucleotide polymorphism (SNP)276 in adiponectin gene with essential hypertension in population with impaired glucose regulation in Han people of Shanxi region.Methods The study population consisted of 216 Chinese Hans residents with impaired glucose regulation (IGR) in Shanxi province.Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied to test the adiponectin SNP276G/T polymorphism.Results The distributions of genotypes and alleles of SNP276 both displayed significant difference between the IGR complicating norm tension group and the hypertension group (P =0.025,P =0.007).Compared with the TT genotype,the SNP276 non-TT (GT + GG) genotype was associated with increased risk of complicating with hypertension (OR =3.346,95％ CI:1.115-8.986,P =0.037),while after age-,sex-and BMI-adjusted,there was no significant difference between the 2 groups (P =0.349).Conclusions SNP276 in adipose most abundant gene transcript 1 (APM1) was associated with the susceptibility to be complicating essential hypertension in population with impaired glucose regulation in Han people of Shanxi region.
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Objective To explore whether serum potassium can influence insulin secretion ability in pa tients with impaired glucose regulation (IGR).Methods 320 subjects with IGR were enrolled in our study.All subjects underwent a standard OGTT.Their clinical and biochemical parameters were measured.Insulin secretion indices were measured by DI0,DI30,and DI120.Results In IGR,DI0 was negatively correlated with BMI (r=-0.122,P=0.015),total cholesterol (TC) (r=-0.182,P=0.032),low density lipoprotein-cholesterol (LDL-C) (r=-0.1 78,P=0.026) and triglyceride (TG) (r=-0.179,P=0.01 1).DI30 was negatively correlated with TC (r=-0.146,P=0.001),TG(r=-0.192,P=0.027)and LDL-C(r=-0.134,P=0.014).DI120 was negatively correlated with TC(r=-0.222,P＜ 0.001),TG(r=-0.209,P＜0.001)and LDL-C (r=-0.183,P＜0.001) while postively correlated with serum potassium (r=0.208,P＜0.001).The multiple regression model analysis showed that serum potassium (β=0.380,P＜0.001) was independently correlated to DI120.Conclusion In patients with IGR,serum potassium is associated with insulin secretion ability,which may provide a new treatment strategy for preventing IGR into T2DM.
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Impaired glucose regulation(IGR,also named prediabetes)is an abnormal condition and important period for dia?betes mellitus. The period includes impaired fasting glucose or/and impaired glucose tolerance. IGR should be screened promptly and be interfered by life style and drugs to recover normal condition,or to delay and control the development of diabetes mellitus for de?creasing the highrisk of diabetes mellitus and cardiovascular disease. The paper reviews the literature about antiglycemic drugs and tra?ditional Chinese medicine interventions for IGR in China in the recent ten years,and summarizes some characters of these drugs to provide some help for prediabetes.
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<p><b>OBJECTIVE</b>To examine the association of genetic variants with characteristic symptoms of type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>A matched case-control study was performed to investigate the association between common variants in four genes (CDKAL1, GLIS3, GRK5, and TCF7L2) and symptoms of T2DM. Symptoms were examined with questionnaire for 710 subjects. Genomic DNA was extracted from peripheral blood mononuclear cell by salting-out procedure. Genotyping was carried out by direct sequencing of the unpurified polymerase chain reaction products.</p><p><b>RESULT</b>Most of the T2DM patients pressented characteristic symptoms, such as feeling weak in limbs (P =0.0057), hand tremor (P =0.0208), bradymasesis (P =0.0234), and polyuria (P =0.0051). Some of the T2DM patients shared characteristic symptoms, such as desire for cold drinks (P =0.0304), polyphagia (P =0.0051), and furred tongue (P =0.028). The impaired glucose regulation (IGR) cases took only one characteristic symptom of frequent micturition (P =0.0422). GLIS3 rs7034200 and GRK5 rs10886471 were significantly associated with increased T2DM risk (GLIS3 rs7034200 under dominant model: P=0.0307; GRK5 rs10886471 under recessive model: P=0.0092). However, only the rs10886471 polymorphism in GRK5 showed a significant effect on both differentiated symptoms and T2DM risk. The C-allele was involved in both dampness-heat encumbering Pi (Spleen) syndrome (P =0.047) and qi-yin deficiency syndrome (P =0.002) via increased GRK5 expression.</p><p><b>CONCLUSIONS</b>Both T2DM and IGR exhibited its corresponding characteristic symptoms. The variants of GRK5 were involved with both qi-yin deficiency syndrome and dampness-heat encumbering Pi syndrome.</p>
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Objective To explore the association of NH2-terminal pro-B-type natriuretic peptide ( NT-proBNP) with the risk of type 2 diabetes.Methods One hundred and twenty-six impaired glucose regulation( IGR) participants from Diabetic Identification Center of Tianjin Metabolic Diseases Hospital were included.NT-proBNP was measured in plasma samples collected from participants at baseline condition.Results At baseline, NT-proBNP was inversely associated with body mass index, waist circumference, fasting glucose, insulin and low-density lipoprotein-cholesterol( LDL-C) levels.During a follow-up of 2 years, 51 participants reported a new diagnosis of diabetes from OGTT.Baseline quartiles of NT-proBNP were inversely associated with diabetes risk, even after multivariable adjustment.Theadjustedrelativerisksfordiabeteswere1.0(reference),0.83(95%CI0.74-0.96),0.78(95%CI 0.68-0.90), 0.74 (95%CI 0.64-0.87) for the 1st, 2nd, 3rd, and 4th quartiles of baseline NT-proBNP, respectively ( P<0.01 ) .Conclus ion In IGRpopulation , lowlevels of NT-proBNP were associated with a significantly increased risk of type 2 diabetes.
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Objective_ To investigate the effect of resting heart rate on the progression to diabetes in impaired glucose regulation patients. Methods A total of 638 patients with impaired glucose regulation, from January 2011 to December 2012 in our endocrinology clinic, were selected for the study. According to the resting heart rate, patients were divided into four groups:75 beat/min groups. All patients'baseline data were collected. The incidences of diabetes in different resting heart rate groups were compared, and the relationship between resting heart rate and the progression to diabetes was estimated using multiple regression analysis. Results In 704 patients with impaired glucose regulation, 636 patients have been completed 2 years follow-up, or reached the end of follow-up ( diagnosed as diabetes ) , the follow-up rate was 90. 34%. During two years follow-up, the incidence of diabetes of75 beat/min group were 16. 2%, 19. 4%, 25. 0%, and 33. 0%, respectivlely. And the Cochran Armitage trend test showed that χ2 =11. 109, P=0. 001, the difference was statistically significant ( P<0. 05). According to blood glucose monitoring, the 636 patients with impaired glucose regulation were divided into impaired fasting glucose group, impaired glucose tolerance group and impaired fasting glucose combined with impaired glucose tolerance group:the Cochran Armitage trend test showed that, with the resting heart rate accelerating, the incidence of diabetes increased. The incidence of diabetes in impaired fasting glucose combined with impaired glucose tolerance group was higher than that of impaired fasting glucose group and impaired glucose tolerance group ( P=0. 062, 0. 113). The average resting heart rate in 68 impaired glucose regulation patients progressed to diabetes was (79.8±8.3)beat/min,andin568non-diabetescases,itwas(74.5±7.2)beat/min(t=-5.043,P<0.01). With the use of patients progressing to diabetes as the dependent variable, different resting heart rate group as independent variables, and resting heart rate<66 beat/min group as a reference, the logistic regression analysis showed that the risk of the progression to diabetes increased with the resting heart rate levels. Conclusion Higher resting heart rate is linked to higher risk of diabetes in patients with impaired glucose regulation.
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Objective To investigate the relationship between leptin level of IGR patients and intima-media thickness (IMT) of carotid arterial. Methods One hundred and eighteen IGR patents were enrolled into the following three groups according to the result of oral glucose tolerance test (OGTT): 38 cases of the purely impaired fasting glucose (IFG) group, 42 cases of the purely impaired glucose tolerance (IGT) group and 42 cases of the IFG combining with IGT (IFG + IGT) group. Thirty-eight cases with normol glucose tolerance (NGR) were enrolled in the NGR group. The blood fat, fasting blood-glucose (FBG), fasting insulin (insulin), fasting C peptide , 2 h-postprandial blood glucose , 2 h-insulin , 2 h-C peptide , glycosylated hemoglobin (HbA1C), C-reactive protein (CRP), body mass index (BMI), leptin and IMT were determined in patients of the three groups and the healthy controls. The multiple linear regression was used to analyze the relationship between leptin level and IMT , and person correlation was further used to analyze the affinity degree between leptin level and IMT. Results Compared with the NGT group, the inter-group comparison showed that leptin level was significantly increased in the IFG, IGT and (IFG + IGT) groups (P < 0.05, respectively). Compared with the IFG and IGT groups, IMT and the leptin level were increased in the (IFG + IGT) group (P < 0.05, respectively). The multiple linear regression analysis showed that leptin level was correlated with the increase of IMT in the (IFG + IGT) group (P < 0.05), but not in the IFT group and the IGT group. Conclusion The leptin level in the IGR group and the IMT in the IFG + IGT ) group were significantly increased , the leptin level was closely associated with IMT.
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Objective To investigate the effect of dietary glycemic load (GL) on the blood glucose level in women with impaired glucose regulation. Methods A total of 120 women with impaired glucose regulation aged from 40 to 79 were enrolled from Guangzhou community to participate in the epidemiological survey on dia-betes mellitus, and were followed up for 12 months. Continues 24 -hour dietary review of 3 days were completed before and after intervention. The dietary GI, GL and the changes of blood glucose level during the 12-month follow-up were analyzed. Results Ninety-nine subjects completed the 12-month follow-up. According to the GL change percentage (ΔGL), all of the subjects were divided into three groups, including group Ⅰ(ΔGL < -30%)、group Ⅱ(ΔGL -30% ~ -10%) and group Ⅲ (ΔGL≥-10%). The reductions of HbA1c in group Ⅰ and groupⅡ were greater than that in group Ⅲ (P < 0.05). Conclusion To lowering dietary GL at 10% or more should be conductive to reduce HbA1C of women with inpaired glucose regulation.
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Objective To study the relationship between IGF-1, IGFBP-3 and prostatic volume (PV) by examining the levels of insulin and insulin-like growth fator-1 (IGF-1) and insulin-like growth factor binding protein-3 ( IGFBP-3 ) and other indicators in patients with impaired glucose regulation and benign prostate hypertrophy. Methods According to 75 g oral glucose tolerance test (OGTT) results, 109 BPH patients aged over 50 years were divided into three groups: normal glucose tolerance (NGT) group (n = 56), impaired fasting glucose (IFG) group (n = 14), impaired glucose tolerance (IGT group, n = 39). The biochemical indicators and postatic hyperplasia related factors and IGF-1, GFBP-3 were measured. Results There were no statistical differences between the three groups in terms of blood lipids, homocysteine, urinary inhibition C, fasting insulin (FINS), glycosylated hemoglobin, IGF-1 and IGFBP-3 (P > 0.05). There were no significant differences between the groups in terms of PV, prostate specific antigen, the quality of life score and the international prostate symptom score (P > 0.05). Fasting plasma glucose and insulin resistance index (HOMA IR) were higher in IFG group than NGT group (P′ < 0.017) and IGT group (P′ < 0.017). 2-hour plasma glucose and 2-hour insulin were higher in IGT group than NGT group (P′ < 0.017) and IFG group (P′ < 0.017). PV was positively correlated with FINS but not correlated with IGF-1, IGFBP- 3 by multiple multiple step wise regression analysis. Conclusion Oyperinsulinemia is a risk factor in the development of BPH with IGR, and IGF-1 and IGFBP-3 are not associated with BPH risk. Further investigation is needed to elucidate the role of the IGF-1 and IGFBP-3 in BPH.
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Objective To investigate the status of dietary fiber ( DF ) and dietary glycemic load ( GL ) in middle-aged and elderly population, and to analyze the correlation of DF and GL with abnormal glucose metabolism. Methods Subjects aged 40-79 years came from Guangzhou community. Dietary nutrients intakes were assessed by continuous 24 hours review for 3 days. Correlation of abnormal glucose metabolism with GL and DF and their interaction were analyzed as quintiles of the distribution. Results Of 1 832 subjects, there were 990 subjects (54. 0%) with normal glucose tolerance, 640 (34. 9%) with IGR, and 202 (11. 0%) newly-diagnosed diabetes mellitus(DM). AverageDFintakeofsubjectswas(11.5±4.5)g/dandaverageGLintakewas(181.0±7.5)/d. Compared with the highest quintile group of total DF intake, the risk of abnormal glucose metabolism in the lowest quintile group was increased[OR=1. 99, 95% CI (1. 48,2. 67)], with increased IGR risk[OR=1. 85, 95% CI (1.34,2.57)]andDMrisk[OR=2.36,95% CI(1.50,3.73)]. ComparedwiththelowestquintilegroupofGL intake, the risk of abnormal glucose metabolism in the highest quintile group was increased [ OR=1. 58, 95% CI (1. 18, 2. 13)], and with increased IGR risk[OR=1. 75, 95%CI(1. 26, 2. 42)] and DM risk[OR=1. 22, 95%CI(0. 77, 1. 94)]. The lowest quintile of DF and the highest quintile of GL was associated with the risk of increased abnormal glucose metabolism[OR=3. 43, 95%CI(1. 41, 8. 36)]. Conclusion Abnormal glucose metabolism was negatively related with DF and positively related with GL.
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Objective To identify the relationship between impaired glucose regulation of neuronal apoptosis in hip-pocampus and the ability of learning/memory in rats.Methods The model rats were made by high fat and sugar diet;The morris water maze was used to detect the learning and memory function;The TUNEL method was used to detect neuronal apoptosis in hippocampus .Expression of Bcl-2/Bax and Bcl-2 mRNA/Bax mRNA factor in hippo-campus neurons was detected with immunohistochemistry and in situ hybridization .Results Compared with NGT group, in IGR group the learning and memory ability were meaningfully decreased (P<0.05);the number of neuro-nal apoptosis in hippocampus was increased significantly ( P<0.05 ); the expression of Bcl-2 and Bcl-2 mRNA in hippocampus decreased significantly ( P<0.05);the expression of Bax and Bax mRNA in hippocampus increased sig-nificantly ( P<0.05 );The ability of learning and memory was positively correlated with expression of Bcl -2 ( P<0.05) and negatively correlated to the expression of Bax (P<0.05).Conclusions There is a relationship between impaired glucose regulation and the ability of learning and memory in rats , its mechanism may be potentially related to hippocampal neuronal apoptosis .
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Objective To investigate the difference of adiponectin ,glycosylated hemoglobin (HbA1c) ,blood lipid and body mass index(BMI)in individuals with impaired glucose regulation(IGR) and type 2 diabetes mellitus (T2DM ) ,and to predict their effect in development of IGR 、T2DM .Methods Medical examination objects were selected and divided into three groups :145 patients with newly diagnosed T2DM group ,128 patients with impaired glucose regulation(IGR group) ,160 individuals with normal glucose tol‐erance (NGT group ,as control) .Fasting adiponectin ,HbA1c ,total cholesterol (TC ) ,triglyceride (TG ) ,low density lipoprotein (LDL‐C) ,high density lipoprotein cholesterol(HDL‐C) were determined .We measured body height ,body weight to compute body mass index(BMI) .Results The levels of HbA1c ,TC ,TG ,LDL‐C ,BMI were significantly higher in T2DM group than those in NGT group(P< 0 .05) ,the levels of HDL‐C and adiponectin were more declined in T2DM group than those in NGT group (P<0 .05) .The levels of HbA1c ,TC ,TG ,LDL‐C ,BMI were significantly higher in IGR group than those in NGT group(P< 0 .05) ,the levels of HDL‐C and adiponectin were more declined in IGR group than those in NGT group (P < 0 .05) .The levels of HbA1c , TC ,TG ,LDL‐C ,BMI were significantly higher in T2DM group than those in IGR group(P < 0 .05) ,the levels of HDL‐C and adi‐ponectin were more declined in T2DM group than those in IGR group (P < 0 .05) .Conclusion During the course of disease from NGT to IGR to T2DM ,plasma adiponectin levels are decreasing ,however HbA1c ,TC ,TG ,LDL‐C are increasing gradually while BMI were increasing .Therefore it has very important effect and significance in controlling BMI and plasma adiponectin levels to pre‐vent and cure IGR ,T2DM and plasma lipid disorder .
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Objective To investigate the prevalence rates of diabetes and pre-diabetes among migrating population in Inner Mongolia.Methods Using stratified cluster sampling on different industries.Each industry would have the same sample size.Questionnaire survey was performed together with anthropometric data gathered and laboratory tests completed.Results The prevalence rates of diabetes and impaired glucose regulation (IGR) among the migrating population in Inner Mongolia were 12.5％ and 12.8％ with the age-standardized rate as 9.9％ and 9.9％.The prevalence of diabetes increased significantly along with the increase of age among both males and females (x2=11.162,P=0.001),but was significantly higher in males.The prevalence of IGR in females was significantly higher than in males.The prevalence of diabetes among the construction industry workers was 19.2％,which was the highest among all the industries.The prevalence of diabetes was higher in the inter-province pre-migrating group,while the prevalence of IGR was increasing along with the duration of migration in the intra-province migration group with the trend as x2=9.989,P=0.002.Conclusion The prevalence of diabetes among the migrating population in Inner Mongolia seemed to be high,close to the level of urban residents.The prevalence rates of diabetes in the population of middle-aged and aged population as well as workers at the construction industry were higher than that in the other populations.The prevalence of diabetes and IGR among the migration population were related to the area where the migration population the in-coming areas Inter-provincial migration had a higher contribution to the prevalence of diabetes.
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Objective To explore the levels of serum 25(OH)D in glomerular disease patients and investigate its influence on the impaired glucose metabolism after treated with glucocorticoid. Methods A total of 61 patients with glomerular disease confirmed by clinical diagnosis and renal biopsy were included in the case group before receiving steroid therapy. 16 cases were selected as control at the same period. Before and six weeks after the treatment of glucocorticoid, all subjects took oral glucose tolerance test (OGT). According to the results of OGT, patients were divided into normal glucose regulation (NGR) group, impaired glucose regulation (IGR) group and steroid diabetes mellitus (SDM) group. Serum 25(OH)D levels were detected with enzyme?linked immunosorbent assay (ELISA), and other clinical data including albumin(Alb), Scr and urine protein were collected. Results (1) Before treated with glucocorticoid, the serum 25(OH)D levels in the control group [(64.09±13.53) nmol/L]were significantly higher than that in NGR group [(50.81 ± 12.44) nmol/L], while the latter was significantly higher than that in IGR group [(42.71 ± 8.09) nmol/L, all P5.6% increased the risk of developing steroid diabetes 5.586 and 5.197 times, respectively. Age increased 10 years or insulin resistance index increased one, the risk of occurred SDM increased 2.443 and 2.755 times, respectively. Conclusions Most glomerular disease patients are serum 25 (OH)D deficiency or insufficiency. Low level of serum 25(OH)D is one of the main risk factors of steroid diabetes in patients with glomerular disease when treated with glucocorticoid.
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Objective To investigate the change of the first-phase insulin secretion in impaired glucose regulation and its influencing factors.Methods The investigation was performed in 1024 subjects who were selected by cluster sampling.The body waist circumference (WC) was examined in these subjects.Oral glucose tolerance test was performed,and fasting plasma glucose,fasting insulin as well as 30-,60-,and 120-minute plasma glucose and insulin after glucose intake were also tested.All the 1024 subjects were divided into 5 groups based on the results of oral glucose tolerance test:normal glucose tolerance group,impaired fasting glucose group,impaired glucose tolerance group,impaired fasting glucos/impaired glucose tolerance group,and diabetes mellitus group.First-phase insulin secretion index (the ratio of change in insulin to change in glucose during the first 30 minutes after glucose ingestion was calculated.Results Compared with normal glucose tolerance group (1.96 ± 1.03),the first-phase insulin secretion index significantly decreased in the impaired fasting glucose group (1.79 ±0.91) (P =0.007),the impaired glucose tolerance group (1.81 ± 0.97) (P =0.007),the impaired fasting glucose / impaired glucose tolerance group (1.59 ± 0.85) (P =0.005),and the diabetes mellitus group (1.30 ± 0.60) (P =0.004).Logistic regression analysis showed that WC was the strongest influencing factor of first-phase insulin secretion (β =0.716,P =0.000).Conclusions The firstphase insulin secretion index has already dropped in the stage of impaired glucose regulation.WC can be a useful indicator for evaluating first-phase insulin secretion.
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Objective To research community residents TCM constitution and impaired glucose regulation and diabetes,for providing the basis of the community carrying out the adjustment of biased constitution,prevention and treatment of impaired glucose regulation and diabetes.Methods The cross-sectional survey was conducted in Hualin Street,Liwan District,Guangzhou,and 1882 cases of elderly residents over the age of 45 were surveyed on their TCM constitution and blood sugar.According to the Chinese constitution scale survey all cases were divided into gentleness type,yang-deficiency type,qi-deficiency type,dampness-heat type,phlegm-dampness type,yin-deficiency type,qi-depression type,blood-stasis type,and special diathesis type.Divided according to the level of their blood glucose,all cases were classified to normal blood glucose,impaired glucose regulation and diabetes.Logistic regression analysis was conducted to study the relation between TCM constitution and impaired glucose regulation and diabetes mellitus.Results The ratio of phlegm-dampness type in glucose regulation damage and diabetes was much higher than normal blood sugar,the value was 10.07％,19.10％ and 4.98％ respectively.The ratio ofyin deficiency type in diabetes was higher than normal blood sugar,the value was 16.85％and 12.27％,respectively.Compared with gentleness type,a logistic regression analysis model showed that the risk of impaired glucose regulation of phlegm (OR 2.08; 95％CI 1.80 to 2.36) and diabetes (OR 4.39; 95％CI 3.56 to the risk of 5.42) were significantly increased in phlegm-dampness type,and the risk of diabetes (OR 1.62; 95％CI 1.31 to 1.99) was significantly increased in yin deficiency type.Excluded the influence of gender,age,eating habits,the second models showed similar results to the first model,with the phlegm of impaired glucose regulation (OR 1.95,95％CI 1.68 to 2.27),diabetes (OR 4.01,95％CI 3.22 to 5.00),yin deficiency diabetes (OR 1.55,95％CI 1.25 to 1.93) all similar to the first model.Conclusion Phlegm-dampness type and yin-deficiency type are the main TCM constitutions that influencing glucose regulation impairment and diabetes.
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<p><b>OBJECTIVE</b>To investigate the optimal glycated haemoglobin (HbA1c) cut off points and evaluate the impact of HbA1c on diabetes and pre-diabetes in middle-aged and elderly population.</p><p><b>METHODS</b>Subjects were recruited from Shanghai Changfeng Study. A total of 1973 community-based participants (age ⋝45) without known diabetes underwent oral glucose tolerance test (OGTT) by using a 75-g oral glucose load and HbA1c was measured by using high performance liquid chromatography (HPLC). Subjects were classified as normal glucose tolerance (NGT), pre-diabetes(impaired glucose regulation, IGR) and new diagnosed diabetes (NDD) per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve (ROC).</p><p><b>RESULTS</b>Among 1973 subjects, 271 (13.7%) were diagnosed as NDD and 474 (24.0%) as IGR by using OGTT. HbA1c was 5.7%±0.7% in this population. Use of 6.5% as the HbA1C cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population (AUC 0.829, 95% CI 0.798-0.860, P<0.001) with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity (44.9%) and specificity (66.7%) with an AUC of 0.571 for HbA1c when 5.8% was used as the cutoff point. Participants detected with HbA1c⋝6.0% were associated with nearly the same metabolic characteristics, including body mass index (BMI), blood pressure, lipid profile and urine albumin-creatinine ratio (uACR) compared with diabetic subjects detected by OGTT.</p><p><b>CONCLUSION</b>The optimum HbA1c cutoff point for diabetes in our study population was lower than ADA criteria, and HbA1c may not be used to identify IGR.</p>