High prevalence of metabolic syndrome in Hong Kong Chinese--comparison of three diagnostic criteria.

The World Health Organisation (WHO), European Group for the Study of Insulin Resistance (EGIR) and National Cholesterol Education Program (NCEP) Expert Panels had introduced definitions for the metabolic syndrome (MES). We aimed to estimate the prevalence of MES in a working population in Hong Kong using the three definitions for MES and compare their relative significance. The data are obtained from a prevalence survey for glucose intolerance and lipid abnormality in a Hong Kong Chinese working population. The distribution of occupational groups in these subjects was similar to that recorded in the Hong Kong Census (1991) and representative of the Hong Kong working population. Definition of obesity was modified using the Asian criterion of body mass index (BMI)> or =25 kg/m 2, waist circumference>80 cm in women and >90 cm in men. Of the 1513 subjects, 910 (60.1%) were men and 603 (39.9%) were women. The mean age was 37.5+/-9.2 (median 37.0 years, range 18-66 years). Using the Asian definition for obesity, the prevalence of MES using the WHO criterion was the highest (WHO versus EGIR versus NCEP-overall: 13.4% versus 8.9% versus 9.6%, p<0.001; under age of 40 years: 7.9% versus 4.9% versus 5.4%, p=0.017; age of 40 years or above: 21.9% versus 14.9% versus 16.0%, p=0.003). The prevalence of different components of the MES ranged from 6 to 38%. In subjects aged less than 50 years, there was a male preponderance for MES (male versus female-WHO: 9.5% versus 6.2%, p=0.007; EGIR: 7.9% versus 6.2%, p=0.235; NCEP: 9.5% versus 6.2%, p=0.030) but this trend was reversed after the age of 50 years (WHO: 29.3% versus 31.9%, p=0.721; EGIR: 13.1% versus 34.8%, p=0.001; NCEP: 19.2% versus 23.2%, p=0.533). The prevalence of MES in Hong Kong Chinese of working age ranges from 6.1 to 13.4% depending on various diagnostic criteria. There was a male preponderance before the age of 50 years and a female-preponderance after the age of 50 years. The inclusion of albuminuria and insulin resistance by the WHO has made it the most discriminative criterion in identifying at risk individuals in all age groups.

The metabolic effects of insulin and rosiglitazone combination therapy in Chinese type 2 diabetic patients with nephropathy.

BACKGROUND: Few studies have examined the efficacy and safety of thiazolidinedione use in patients with diabetic nephropathy. Our goal was to examine the metabolic effects and tolerability of combination therapy with rosiglitazone and insulin in type 2 diabetic patients with nephropathy and renal failure. MATERIAL/METHODS: We evaluated the metabolic effects and tolerability of rosiglitazone as an add-on therapy to insulin in 12 Chinese type 2 diabetic patients (5 males and 7 females) with nephropathy and renal impairment. The mean age of these patients was 65+/-8.3 years, and the mean duration of disease was 16.5+/-8.6 years. The initial daily dosage of rosiglitazone, 2 mg daily, was increased to 4 mg if their fasting plasma glucose concentrations were above 10 mmol/L after 4 weeks. RESULTS: Over a mean period of 15.5 months, HbA1c improved significantly following the addition of rosiglitazone, from 8.57+/-1.42% to 7.48+/-1.3% (p=0.01). There was a trend towards improved lipid profile with this combination therapy, but it was not statistically significant. There was no major adverse events except for minimal weight gain (71.7+/-13.6 kg vs 73.9+/-13.1 kg, p=0.08). CONCLUSIONS: Combination therapy with rosiglitazone and insulin has beneficial metabolic effects and is generally well tolerated in type 2 diabetic patients with nephropathy and mild to moderate renal failure.

Endothelium-dependent and -independent vascular dysfunction in type 1 diabetes: role of conventional risk factors, sex, and glycemic control.

OBJECTIVE: Defective NO release/response may contribute to increased coronary risk and the loss of sex difference in coronary heart disease in diabetes. We aimed to determine whether NO release/response is impaired in type 1 diabetes and whether any defects are greater in women than men. METHODS AND RESULTS: Forearm blood flow response to vasoactive drugs was assessed by venous plethysmography in 88 diabetic and 69 control subjects aged 30 to 53 years. In diabetic patients, response was 18% lower for acetylcholine (ACh) (P=0.002), 6% lower for bradykinin (P=0.14), and 17% lower for glyceryl trinitrate (GTN) (P<0.001). Women had a higher response to ACh than men (17%, P=0.006). The diabetes-associated defect in ACh was greater in women (25% lower, P=0.01) than men (13% lower, P=0.08), although not significantly (P=0.26 for the interaction). Poorer glycemic control was associated with ACh response (P=0.003) and contributed to the greater defect in diabetic women than men. CONCLUSIONS: The diabetes-associated defect in GTN response was similar in men and women. Established coronary heart disease risk factors did not explain any of the defects in ACh or GTN response associated with diabetes. Type 1 diabetes is associated with impaired responsiveness to NO and with an impairment in ACh-stimulated NO release.