The bidirectional association of C-peptide with cardiovascular risk in nondiabetic adults and patients with newly diagnosed type 2 diabetes mellitus: a retrospective cohort study.

BACKGROUND: Recent literature reported the biological role of C-peptide, but this role is still controversial and unclear. The primary aim of this study was to investigate associations between C-peptide and cardiovascular biomarkers as well as events. METHODS: A total of 55636 participants who had a health examination from 2017 to 2021 were included. Of them, 6727 participants visited the hospital at least twice. Cardiovascular biomarkers like high-sensitivity C-reactive protein (hs-CRP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured and their relationships with fasting C-peptide were evaluated for all participants. Cardiovascular events were obtained during the last visit and their associations with C-peptide were evaluated for those participants who visited the hospital at least twice. RESULTS: Among the included participants, 11.1% had a previous type 2 diabetes mellitus (T2DM). In the participants without previous T2DM, the relationships between fasting C-peptide and hs-CRP and hs-cTnT were negative if the value of fasting C-peptide was < 1.4 ng/mL and positive if the value was ≥ 1.4 ng/mL. These relationships remained significant after adjusting for hemoglobin A1c, insulin resistance index, and its interaction with C-peptide, even if the participants were stratified by glucose metabolism status or levels of insulin resistance index. Hazard ratios of cardiovascular events were first decreased and then increased with the increasing of baseline C-peptide levels, though these associations became unsignificant using the multivariate Cox regression model. Unlike the participants without previous T2DM, the associations of C-peptide with cardiovascular biomarkers and events were not significant in the patients with previous T2DM. CONCLUSIONS: The associations of C-peptide with cardiovascular biomarkers and events were different between the participants without previous T2DM and those with previous T2DM. The effect of C-peptide on cardiovascular risk may be bidirectional, play a benefit role at a low level, and play a harmful role at a high level in the nondiabetic adults and the patients with newly diagnosed T2DM.

Characteristics of repaglinide and its mechanism of action on insulin secretion in patients with newly diagnosed type-2 diabetes mellitus.

This study aims to compare the effect of repaglinide and metformin among Chinese patients with newly diagnosed diabetes, and explore the possible mechanisms by which repaglinide alters insulin secretion.Sixty subjects with glycated hemoglobin (HbA1c) < 10.0% were randomly selected to receive repaglinide or metformin monotherapy for 15 weeks. Blood glucose levels, glycemic variability, ß-cell function, and first-phase insulin secretion were compared between these 2 groups at baseline and at 15 weeks. Mouse insulinoma (MIN-6) cells were divided into 3 groups: low glucose, high glucose, and repaglinide 50 nm groups. Cells and cell culture mediums were collected at different timepoints. The expression of pericentrin (PCNT), F-actin, and insulin were tested with immunofluorescence and enzyme-linked immunosorbent assay.All glycemic parameters and variability indexes significantly decreased from baseline to 15 weeks, while no significant difference was found between these 2 groups at baseline or at 15 weeks. Furthermore, there was no significant difference found in fasting insulin and postprandial insulin at baseline and at 15 weeks, while homeostasis model assessment ß significantly increased. The first-phase glucose and insulin secretion of the intravenous glucose tolerance test improved in both groups, especially in the repaglinide group. Insulin, PCNT, and F-actin expression in MIN-6 cells decreased after 15 minutes of stimulation with repaglinide, while no difference was observed at 2, 6, and 12 hours. The insulin levels of the cell medium in the repaglinide group remained significantly higher at all timepoints.This study manifests that repaglinide has a noninferiority effect on the glycemic parameters of Chinese patients with newly diagnosed diabetes, when compared with metformin. The PCNT-F-actin pathway plays an important role in the repaglinide regulation process of on-demand insulin secretion.

Effects of body mass index and weight change on mortality in older men with impaired glucose regulation.

OBJECTIVES: To assess the effect of baseline body mass index (BMI) status and weight change on mortality in older men with impaired glucose regulation (IGR). METHODS: Eight hundred eighty-five men with IGR aged 60 to 90 were included. Baseline and endpoint weight were measured. All-cause and cardiovascular mortality were observed during a median follow-up period of 10years. Multivariate Cox regressions were used to estimate associations between BMI, weight change and mortality. RESULTS: Relative to normal weight, overweight was associated with lower all-cause mortality (hazard ratios, HRs [95% confidence interval, 95% CI]: 0.57 [0.41, 0.78]) and cardiovascular mortality (0.52 [0.29, 0.93]), whereas obesity did not significantly decrease or increase the mortality risk. Furthermore, compared to weight stability, all types of weight change led to increased mortality risk, except small weight gain. Specifically, after adjustment for covariates and the initial weight, the HRs (95% CI) of large weight loss were 1.64 (1.15, 2.34) for all-cause mortality and 1.85 (1.10, 3.14) for cardiovascular mortality, and the HRs (95% CI) of large weight gain were 1.55 (1.01, 2.40) for all-cause mortality and 2.11 (1.04, 4.30) for cardiovascular mortality. Similar associations were observed when weight change was redefined in sensitivity analyses. CONCLUSIONS: Both BMI at baseline and weight change have independent U-shaped associations with all-cause and cardiovascular mortality among older men with IGR. The present study suggests that older men with IGR may ensure their best survival by being overweight at baseline or by maintaining their weight regardless of their baseline weight status.

Clinical and pathological analysis of renal damage in elderly patients with type 2 diabetes mellitus.

The aim of this study was to investigate the causes and influential factors of renal damage in elderly patients with type 2 diabetes mellitus (T2DM). Clinical data and pathological findings at autopsy of 161 elderly T2DM patients died between October 1994 and August 2011 were retrospectively reviewed. The mean age of these patients was 80.8 ± 8.3 years (range 60-105 years). The incidences of diabetic nephropathy (DN), non-diabetic renal diseases (NDRD), and DN complicated with NDRD were 31.1, 62.7, and 16.2 %, respectively. In patients with NDRD, the incidence of hypertensive renal damage (HRD) was 54.7 %. In the factors causing renal damage, DN and NDRD accounted for 1/3 and 2/3, respectively. HRD accounted for the largest proportion of NDRD. Blood pressure control may provide additional benefits for elderly T2DM patients by preventing and delaying the occurrence and development of renal disease.

The cutoffs and performance of glycated hemoglobin for diagnosing diabetes and prediabetes in a young and middle-aged population and in an elderly population.

The aims were to compare the appropriate cutoffs of glycated hemoglobin (HbA1c) in a population of varying ages and to evaluate the performance of HbA1c for diagnosing diabetes and prediabetes. A total of 1064 participants in the young and middle-aged group and 1671 in the elderly group were included and underwent HbA1c testing and an oral glucose tolerance test (OGTT). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the optimal HbA1c cutoffs. Kappa coefficients were used to test for agreement between HbA1c categorization and OGTT-based diagnoses. The optimal HbA1c cutoffs for diagnosing diabetes were 5.7% (39 mmol/mol) in the young and middle-aged group with a sensitivity of 66.7%, specificity of 86.7%, and AUC of 0.821 (95% CI: 0.686, 0.955) and 5.9% (41 mmol/mol) in the elderly group with a sensitivity of 80.4%, specificity of 73.3%, and AUC of 0.831 (0.801, 0.861). The optimal cutoffs for diagnosing prediabetes were 5.6% (38 mmol/mol) and 5.7% (39 mmol/mol) in the young and middle-aged group and in the elderly group, respectively. Agreement between the OGTT-based diagnosis of diabetes or prediabetes and the optimal HbA1c cutoff was low (all kappa coefficients <0.4). The combination of HbA1c and fasting plasma glucose increased diagnostic sensitivities or specificities. In conclusion, age-specific HbA1c cutoffs for diagnosing diabetes or prediabetes were appropriate. Furthermore, the performance of HbA1c for diagnosing diabetes and prediabetes was poor. HbA1c should be used in combination with traditional glucose criteria when detecting and diagnosing diabetes or prediabetes.

Association of calpain-10 rs2975760 polymorphism with type 2 diabetes mellitus: a meta-analysis.

Type 2 diabetes mellitus (T2DM) accounts for the majority of diabetes cases and affects a significant proportion of the adult population worldwide. Calpain-10 has been implicated in the development of type 2 diabetes, and some polymorphisms in the CAPN10 gene have been associated with an increased risk of developing this disease. Several molecular epidemiological studies were conducted in recent years to evaluate the association between the CAPN10 rs2975760 polymorphism and T2DM risk in diverse populations. However, the results remain conflicting rather than conclusive. We performed a meta-analysis of 8 case-control studies that included 2758 T2DM cases and 2762 case-free controls. We assessed the strength of the association, using odds ratios (ORs) with 95% confi dence intervals (CIs). Overall, this meta-analysis showed that the CAPN10 rs2975760 polymorphism was not associated with a significantly type 2 diabetes risk in three genetic models. However, after excluding two study for its heterogeneity, a significantly increased risk was found in all comparisons (for C vs T: OR=1.14, 95% CI=1.03-1.27, I (2)=0, P heterpgeneity=0.420, P b=0.012; for TC vs TT: OR=1.15, 95% CI=1.01-1.30, I (2)=3.8%, P heterpgeneity=0.392, P b=0.030; for CC+TC vs TT: OR=1.16, 95% CI=1.03-1.31, I (2)=3.7%, P heterpgeneity=0.393, P b=0.015). No publication bias was found in the present study. This meta-analysis suggests that the C allele of the CAPN10 rs2975760 polymorphism is associated with an increased T2DM risk. Further large and well-designed studies are needed to confi rm this association.

MiR-199a is overexpressed in plasma of type 2 diabetes patients which contributes to type 2 diabetes by targeting GLUT4.

Decreased GLUT4 expression and impaired GLUT4 cell membrane translocation are involved in type 2 diabetes mellitus (T2DM) pathogenesis so the factors impacting GLUT4 expression may be associated with T2DM. In this study, we identified four miRNAs: miR-31, miR-93, miR-146a, and miR-199a which suppress GLUT4 expression in HEK293T cells. Subsequently, we determined expression of these four miRNAs in plasma samples of T2DM patients, T2DM susceptible individuals, and healthy controls and found miR-199a was overexpressed in patients' plasma compared with healthy control. Because the miR-199a binding site in GLUT4 3'UTR is highly conserved among vertebrates, we detected the glucose uptake in rat L6 myoblast cells through gain- and loss-of-function of miR-199a. We found that miR-199a can repress glucose uptake in L6 cells, which was rescued by GLUT4 overexpression. These results indicate that T2DM patients may have a high level miR-199a that reduce GLUT4 expression and contribute to the insulin resistance. Hence, miR-199a may be a novel biomarker for risk estimation and classification in T2DM patients.

Association between glycemic indices and beta cell function in patients with newly diagnosed type 2 diabetes.

OBJECTIVE: To identify the relationship between glycemic indices and ß cell function in patients with newly diagnosed type 2 diabetes. METHODS: The cross-sectional analysis included 61 patients with newly diagnosed type 2 diabetes who received continuous glucose monitoring (CGM) for 72 hours. The association between ß cell function and glycemic indices including A1C and glycemic variability was investigated. RESULTS: A1C (r = -0.405, p = 0.001) and standard deviation of blood glucose (SDBG, r = -0.274, p = 0.032) were significantly correlated to HOMA-ß cell function (HBCI), whereas mean amplitude of glycemic excursions (MAGE, r = -0.210, p = 0.104) was not informative. After multiple confounders adjustments, A1C (ß = -7.35, p < 0.001), MAGE (ß = -4.64, p = 0.040), and SDBG (ß = -12.3, p = 0.012) were associated with HBCI. CONCLUSION: A1C and glycemic variability were both associated with ß cell function in patients with newly diagnosed type 2 diabetes. The main limitations of the present study are the cross-sectional design in nature and the limited sample size.

[Correlation of sex hormones and parathyroid hormone with biochemical markers of bone turnover in aged men].

OBJECTIVE: To investigate the correlation of serum sex hormones and parathyroid hormone (PTH) with the biochemical markers of bone turnover in aged men. METHODS: We collected the laboratory data of 465 men aged 60- 93 (73. 1 +/- 8. 3) years old, who came for routine physical examinations in our hospital. We obtained the levels of serum follicle- stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG), PTH, 25-hydroxy-vitamin D3 (25(OH) D3), and bone turnover markers C-terminal telopeptide of type I collagen (CTX), osteocalcin (OC) and amino-terminal propeptide of type I procollagen (PINP). We also determined free testosterone (FT) , bioactive testosterone (BT) , testosterone secretion index (TSI) and FT index (FTI), and analyzed the correlation of each index with the biochemical markers of bone turnover. RESULTS: The concentrations of serum FSH, LH, and SHBG increased, while the levels of FT, BT, TSI, FTI, PTH, CTX, OC and PINP decreased with age, especially in those over 80 years old (P <0.05). PTH was positively correlated with CTX, OC and PINP (r =0. 227, 0. 269 and 0. 162, P <0. 01), even after the adjustment for age, while SHBG negatively correlated with OC (r = -0. 100, P <0.05). The bone turnover markers increased with the elevation of the PTH quartiles, with significant differences between the first and the fourth quartile (P <0. 01). Multiple stepwise regression analysis showed that age was correlated inversely with CTX, OC and PINP ( beta = -0. 126, -0. 141 and -0. 122, P <0.05) , PTH positively with the three markers (beta = 0. 196, 0.279 and 0.189; P <0. 001), and SHBG negatively with OC ( beta = -0. 100, P <0.05) . CONCLUSION: Aging is the fundamental cause of reduced bone turnover in aged men. The levels serum PTH and SHBG are significantly associated with the biochemical markers of bone turnover.

Comparison of repaglinide and metformin monotherapy as an initial therapy in Chinese patients with newly diagnosed type 2 diabetes mellitus.

BACKGROUND: We aimed to compare the effect of repaglinide and metformin monotherapy as an initial therapy in Chinese patients with newly diagnosed type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: In this 15-week, open-labelled, parallel-controlled, randomised study, 60 Chinese drug-naive patients with newly diagnosed T2DM were randomised (2:1) to receive repaglinide or metformin monotherapy. Primary endpoint was change in HbA1c from baseline to the end of the trial. Secondary endpoints included changes in glycaemic variability, insulin sensitivity and ß-cell function. RESULTS: Patients in both repaglinide and metformin groups achieved significant reductions in HbA1c (-1.8 ± 1.5 vs -1.6 ± 1.5%), FPG (fasting blood glucose) (-1.7 ± 1.7 vs -2.1 ± 1.7  mmol/l) and 2-h PPG (post-prandial glucose) (-3.8 ± 3.1 vs -3.8 ± 3.6  mmol/l), with no statistical differences between the groups. Glycaemic variability, glucose infusion rate and ß-cell function were all significantly improved from baseline in the two groups (all P<0.05), without any statistical differences in the improvement between the groups. CONCLUSIONS: Repaglinide and metformin achieved comparable efficacy in improving glycaemic control, reducing glycaemic variability, enhancing insulin sensitivity and ameliorating ß-cell function. Therefore, repaglinide is an optional agent for initial therapy in Chinese patients with newly diagnosed T2DM.

Insulin resistance correlates with the arterial stiffness before glucose intolerance.

OBJECTIVE: The elevated plasma glucose level and/or insulin resistance in diabetes or impaired glucose tolerance play important roles in the pathogenesis of arterial stiffness. The present study investigated whether insulin resistance correlated with arterial stiffness before the development of glucose intolerance. METHODS: We conducted a cross-sectional analysis in 872 young to middle-age individuals with normal glucose tolerance (aged 36.2±8.5 years, BMI 24.6±3.1 kg/m2 [mean±SD]). The homeostasis model assessment (HOMA) index was used as a quantitative assessment of the fasting insulin resistance (FIR), and the plasma insulin level after glucose loading was adopted as an index of the post-challenge insulin resistance (PIR). The Matsuda index [ISI (composite)] was used as a measurement of the insulin sensitivity. The arterial stiffness assessed by the brachial-ankle pulse wave velocity (baPWV) was adopted to quantify its independent associations with insulin resistance. RESULTS: The univariate linear regression analysis indicated that the fasting plasma glucose level (FPG, ß = 68.2; 95% CI 40.9, 95.6; p<0.001), post-challenge plasma glucose level (PPG, ß = 25.3; 95% CI 15.6, 35.0; p<0.001), FIR (ß = 24.5; 95% CI 14.1, 35.0; p<0.001), PIR (ß=1.30; 95% CI 0.87, 1.73; p<0.001) and ISI (composite) (ß = -3.55; 95% CI -5.02, -2.07; p<0.001) were all significantly correlated with the baPWV. After adjustment for sex, age, BMI, heart rate, smoking, systolic blood pressure, total cholesterol, LDL-cholesterol and family history of diabetes, the multivariate linear regression analysis demonstrated that the PIR (model 1, ß = 0.39, p=0.038; model 2, ß = 0.39, p=0.035; model 3, ß = 0.39, p=0.035) was an independent contributor to the baPWV, while the FIR, FPG, PPG and ISI (composite) failed to show any significant contribution. CONCLUSION: The insulin resistance correlated with the arterial stiffness before glucose intolerance.

[The compliance in elderly male with osteoporosis treated with oral alendronate].

OBJECTIVE: To explore the compliance in elderly male with osteoporosis treated with oral alendronate and analyze the factors which affect the therapeutic compliance. METHODS: A total of 145 elderly male patients diagnosed with osteoporosis who had been initiated the treatment of oral alendronate in our clinic during January to June in 2011 were enrolled in the study. The medication compliance of one year was investigated. According to the different medication possession ratio (MPR), MPR ≥ 80% was considered as adherent and MPR < 80% was considered as non-adherent. The difference in the two groups was compared and the factors which affect the therapeutic compliance were analyzed. RESULT: A total of 139 patients had been followed up with 32 adherent cases (23.02%) and 107 non-adherent cases (76.98%). Logistic regression analysis showed the factors which affected the therapeutic compliance as the following: ostealgia (OR = 0.69, P = 0.043), no-reminder (OR = 1.37, P = 0.025), concern about drug related side effect (OR = 1.49, P = 0.018), more than 7 kinds of drugs (OR = 1.30, P = 0.036) and uncertain long-term effect (OR = 1.39, P = 0.021). CONCLUSIONS: Compliance of oral alendronate to treat osteoporosis in elderly male patients is poor. Ostealgia can promote the drug compliance. The factors which could decrease the drug compliance are no-reminder, concern about drug related side effect, more than 7 kinds of drugs and uncertain long-term efficacy.

[Influencing factors of glycemic variability in elderly patients with type 2 diabetes].

OBJECTIVE: To explore the influencing factors of glycemic variability in elderly patients with type 2 diabetes. METHODS: A total of 337 elderly patients received continuous glucose monitoring (CGM) from January 2007 to January 2011. The evaluation variables of glycemic variability included standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursion (MAGE), absolute means of daily differences (MODD) and postprandial glucose excursion (PPGE). The normal reference value of glycemic variability was defined according to the diagnostic criteria of Chinese Diabetes Society guideline. RESULTS: The difference of glycemic variability was compared by gender, age and diabetic duration. The values of SDBG, MAGE, MODD and PPGE in females were all higher than those in males (P < 0.05) and no difference existed between various age groups. The level of glycemic variability increased gradually with the extension of diabetic duration (P < 0.01). Logistic regression analysis showed that gender (MAGE: OR = 0.44, P = 0.023; SDBG: OR = 0.39, P = 0.023), diabetic duration (MAGE: OR = 1.58, P = 0.006; SDBG: OR = 2.42, P < 0.001) and HbA1c (MAGE: OR = 2.44, P < 0.001; SDBG: OR = 2.68, P < 0.001) were significant influencing factors of glycemic variability (MAGE/SDBG) in elderly patients with type 2 diabetes (P < 0.05), but not age, body mass index (BMI) or diabetic neuropathy. CONCLUSION: Gender, diabetic duration and HbA1c are significant influencing factors of glycemic variability while age, BMI or diabetic neuropathy has no association with glycemic variability in elderly patients with type 2 diabetes.

[Different establishing conditions of hyperinsulinemic-euglycemic clamp technique among different groups].

OBJECTIVE: To compare the different establishing conditions of hyperinsulinemic-euglycemic clamp technique among the groups of normal glucose tolerance (NGT), hyperinsulinemia with normal glucose (HINS) and impaired glucose tolerance (IGT). METHODS: The hyperinsulinemic-euglycemic clamp technique was applied to the study of methodology in 10 NGT, 11 HINS and 10 IGT subjects. Different establishing conditions were compared through variance analysis (ANOVA) among three groups. And the influencing factors resulting in these differences were analyzed through stepwise regression analysis. RESULTS: The serum insulin concentration of three groups were acutely raised and maintained at above 100 mU/L. During the steady stage, the blood glucose level remained stable and all coefficient variations were under 5%. The secretion of endogenous insulin and hepatic glucose production were completely inhibited during the test. Under these steady-state hyperinsulinemic-euglycemic conditions, the glucose infusion rate (M value) was equal to glucose disposal rate by all tissues in body, M value of three groups were as follows: (11.6 ± 1.7), (6.1 ± 1.9) and (6.0 ± 1.5) mg×kg(-1)×min(-1). During clamping, the peak and steady-state serum insulin concentrations of IGT and HINS groups were significantly higher than those of NGT group. Although the peak and steady-state serum insulin concentration of HINS group were higher than those of IGT group, the differences had no statistical significance (P = 0.34, 0.11). The independent influencing factor of peak serum insulin concentration was waist-to-hip ratio (WHR) while the independent influencing factors of steady-state serum insulin concentration included insulin metabolic clearance rate (MCR) and body mass index (BMI). The peak and steady-state serum insulin concentrations were not the independent influencing factors of M value. CONCLUSION: During the establishment of hyperinsulinemic-euglycemic clamp technique, the differences in peak and steady-state serum insulin concentrations existed among NGT, HINS and IGT groups. But the differences do not influence the use of M value in the evaluation of insulin resistance.

Influence of glycemic variability on the HbA1c level in elderly male patients with type 2 diabetes.

OBJECTIVE: To investigate the influence of glycemic variability on the HbA1c level in elderly male patients with type 2 diabetes (T2DM). METHODS: The 24-h glucose profiles were obtained using a continuous glucose monitoring system in 291 elderly male type 2 diabetic patients. The relationship between the glycemic variability and HbA1c level was assessed in these patients. RESULTS: The mean amplitude of glycemic excursions (MAGE) in patients with HbA1c ≥7.0% was significantly higher than in patients with HbA1c <7.0% (4.33±1.67 vs. 3.48±1.46 mmol/L, p<0.001). A simple (Pearson's) correlation analysis indicated that the MAGE was significantly correlated with the HbA1c (r=0.229, p<0.001). Compared with the lowest quartile, the highest quartile of the MAGE was associated with a significantly increased risk of having a HbA1c ≥7.0% after multiple adjustments (p (for trend) <0.001). CONCLUSION: The glycemic variability had a significant influence on the HbA1c level in elderly male patients with T2DM. The present data suggests that patients with higher glycemic variability might have higher HbA1c levels.

[Different prevalence of impaired glucose tolerance between hyperinsulinemic and normoinsulinemic subjects].

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 (OGTT)] 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 (HOMA-IR) 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 ß-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) vs 5.17 (1.04, 65.09); 7.66 (0.99, 28.40) vs 17.56 (4.18, 96.46), all P values < 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 ß cell function and prevent the progression to T2DM.

[Risks of type 2 diabetes mellitus and impaired glucose regulation among elderly patients with essential hypertension: a 10-years cohort study].

OBJECTIVE: To explore the incidence of type 2 diabetes mellitus (T2DM) and impaired glucose regulation (IGR) among elderly patients with and without hypertension during a follow-up period of 10 years. METHODS: The subjects were elderly patients (> 60 years old) undergoing annual health examinations at our hospital. And the previously diagnosed T2DM and IGR patients were excluded. And the incidence and risk factors were analyzed by Kaplan-Meier method and COX's proportional hazard. RESULTS: Among a total of 1136 subjects, 582 were enrolled. They were divided into essential hypertension group (HT, n = 384) and non-essential hypertension group (NHT, n = 198) (including new-onset 67 subjects). During a 10-year follow-up, the incidence of new-onset diabetes was 27.6% in HT group and 18.7% in NHT group (HR = 1.48; 95%CI: (1.07 - 2.04), P < 0.05). And the incidence density of T2DM were 33.8‰ and 20.6‰ respectively in two groups. There was no difference in the prevalence of IGR among HT and NHT groups and no difference was found in the prevalence of T2DM or IGR among new-onset HT and NHT groups. The independent risk factors of T2DM was dyslipidemia (HR = 1.459; 95%CI: 1.027 - 2.072, P < 0.05) and hypertension (HR = 1.516; 95%CI: 1.039 - 2.212, P < 0.05) based upon the COX's proportional hazard analysis. Dyslipidemia (HR = 1.545; 95%CI: 1.087 - 2.195, P < 0.05) and hypertension (HR = 1.524; 95%CI: 1.044 - 2.224, P < 0.05) were also independent risk factors of abnormal glycometabolism (T2DM and IGR). Kaplan-Meier analysis indicated that the accumulative incidence of DM and abnormal glycometabolism was different between the HT and NHT groups. CONCLUSION: The DM risk is 1.516 folds higher in elderly patients with HT than in those without. According to multivariate analysis, hypertension and dyslipidemia are independent risk factors of T2DM and abnormal glycometabolism (T2DM and IGR).

[The correlation between hyperinsulinemia and pulse wave velocity].

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 normoinsulinemic (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.

[Comparison of postprandial insulin and fasting insulin on the evaluation of cardiovascular risk factors].

OBJECTIVE: To study the feasibility of using postprandial insulin (2hINS) and fasting insulin (FINS) on evaluation of insulin resistance, comparison was conducted between 2hINS and FINS on evaluation of cardiovascular risk factors. METHODS: A survey were conducted among individuals in the community in May 2008 and data of routine clinical examination were collected. All subjects were investigated and received 75 g oral glucose tolerance test (OGTT), and fasting and OGTT2 h blood glucose as well as insulin concentrations were determined. Hyperinsulinemia was defined as a FINS or 2hINS concentration at or above the 95th percentile of the distribution among normal glucose tolerance individuals. RESULTS: 1148 individuals were investigated and insulin concentration in male was similar to female. Prevalence of 2hHINS (40.8%) in individuals with abnormal glucose metabolism was higher than FHINS (18.4%, P < 0.01). The number of metabolic risk factors in subjects with 2hHINS was similar to subjects with FHINS. After adjustment by sex, age, BMI and waist circumference, partial correlation analysis showed that the correlation between 2hINS and 2hPG (r = 0.370) was higher than that of FINS and FPG (r = 0.104); FINS was higher correlated with TG and HDL- cholesterol than 2hINS, however, 2hINS was higher correlated with diastolic blood pressure, total cholesterol and LDL-cholesterol than FINS. Logistic regression analysis showed that FHINS and 2hHINS were both the independent risk factor of metabolic syndrome, the OR (95%CI) were 5.11 (2.953 - 8.842) and 3.46 (2.109 - 5.687). CONCLUSION: 2hINS and FINS were both closely associated with cardiovascular risk factors. The correlation was inconsistent when 2hINS and FINS were related to different risk factors. The combination of 2hINS and FINS might be more helpful on evaluation of insulin resistance.

[The clinical characteristics and trend of conversion to type 2 diabetes mellitus of individuals with normal glucose tolerance-hyperinsulinemia].

OBJECTIVE: To study the outcomes and influencing factors of the conversion from normal glucose tolerance-hyperinsulinemia (NGT-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 ß-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 ß-cell function. Therefore, individuals with NGT-HINS should be paid attention to in diabetes prevention study.