Effectiveness of different waist circumference cut-off values in predicting metabolic syndrome prevalence and risk factors in adults in China.

OBJECTIVE: To study the effectiveness of waist circumference cut-off values in predicting the prevalence of metabolic syndrome (MetS) and risk factors in adults in China. METHODS: A cross-sectional survey was condcuted in 14 provinces (autonomous region, municipality) in China. A total of 47,325 adults aged⋝20 years were selected by multistage stratified sampling, and questionnaire survey and physical and clinical examination were conducted among them. MetS was defined according to the International Diabetes Federation (IDF) criteria and modified IDF criteria. RESULTS: The age-standardized prevalence of MetS was 24.2% (22.1% in men and 25.8% in women) and 19.5% (22.1% in men and 18.0% in women) according to the IDF criteria and modified IDF criteria respectively. The age-standardized prevalence of pre-MetS was 8.1% (8.6% in men and 7.8% in women) according to the modified IDF criteria. The prevalence of MetS was higher in urban residents than rural residents and in northern China residents than in southern China residents. The prevalence of central obesity was about 30% in both men and women according to the ethnicity-specific cut-off values of waist circumference for central obesity (90 cm for men and 85 cm for women). Multivariate regression analysis revealed no significant difference in risk factors between the two MetS definitions. CONCLUSION: Using both the modified IDF criteria and ethnicity-specific cut-off values of waist circumference can provide more useful information about the prevalence of MetS in China. Conclusion Using both the modified IDF criteria and ethnicity-specific cut-off values of waist circumference can provide more useful information about the prevalence of MetS in China.

Elevated urinary level of vitamin D-binding protein as a novel biomarker for diabetic nephropathy.

Improving the early prediction and detection of diabetic nephropathy (DN) remains a great challenge in disease management. The aim of this study was to evaluate the early detection power of urinary vitamin D-binding protein (VDBP) for the diagnosis of DN. Urine samples were obtained from 45 healthy volunteers and 105 diabetic patients with normoalbuminuria (DM group), microalbuminuria (DN1 group) and macroalbuminuria (DN2 group) (n=35 per group). The VDBP expression patterns in urine from patients and controls were quantified by western blot analysis. The excretion levels of urinary VDBP were quantified with enzyme-linked immunosorbent assay. The quantification results were obtained by correcting for creatinine expression and showed that urinary VDBP levels were significantly elevated in the patients of the DN1 and DN2 groups compared with those of the DM group and normal controls (1,011.33±325.30 and 1,406.34±239.66 compared with 466.54±213.63 and 125.48±98.27 ng/mg, respectively) (P<0.001). Receiver operating characteristic analysis of urinary VDBP levels for the diagnosis of DN rendered an optimum cut-off value of 552.243 ng/mg corresponding to 92.86% sensitivity and 85.00% specificity, which also showed an area under the ROC curve of 0.966. In conclusion, the findings of the present study suggest that urinary VDBP may be a potential biomarker for the early detection and prevention of DN. Further studies are required to examine the pathogenic mechanisms of elevated VDBP levels and their role in the diagnosis of DN.

Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables.

BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) is increasing rapidly among Chinese adults, and limited data are available on T2DM management and the status of glycemic control in China. We assessed the efficacy of oral antidiabetes drugs (OADs), glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin for treatment of T2DM across multiple regions in China. METHODS: This was a multicenter, cross-sectional survey of outpatients conducted in 606 hospitals across China. Data from all the patients were collected between April and June, 2011. RESULTS: A total of 238,639 patients were included in the survey. Eligible patients were treated with either OADs alone (n=157,212 [65.88%]), OADs plus insulin (n=80,973 [33.93%]), or OADs plus GLP-1 receptor agonists (n=454 [0.19%]). The OAD monotherapy, OAD + insulin, and OAD + GLP-1 receptor agonist groups had mean glycosylated hemoglobin (HbA1c) levels (±SD) of 7.67% (±1.58%), 8.21% (±1.91%), and 7.80% (±1.76%), respectively. Among those three groups, 34.63%, 26.21%, and 36.12% met the goal of HbA1c <7.0%, respectively. Mean HbA1c and achievement of A1c <7.0% was related to the duration of T2DM. CONCLUSIONS: Less than one third of the patients had achieved the goal of HbA1c <7.0%. Glycemic control decreased and insulin use increased with the duration of diabetes.

Vitamin D intake and type 2 diabetes risk: a meta-analysis of prospective cohort studies.

BACKGROUND: The findings form studies on the relationship between vitamin D and type 2 diabetes were inconsistent. OBJECTIVES: To elucidate the association between vitamin D consumption and type 2 diabetes risk by conducting a meta-analysis. METHODS: We conducted a systematic literature search to identify prospective cohort studies of vitamin D intake and type 2 diabetes risk prior to November 2012. Eligible studies were retrieved via both computer searches and manual review of references. The summary risk estimates were calculated based on the highest versus the lowest categories. RESULTS: Meta-analysis of 4 prospective cohort studies involving 187, 592 participants and 9, 456 incident cases showed an absence of significant association between total vitamin D intake and type 2 diabetes risk. The combined RR was 0.93 (95% CI: 0.85-1.01). The associations were similar for subgroup analyses, a combined RR respectively was 0.94 (95% CI: 0.77-1.08), 0.91 (95% CI: 0.77-1.08), 0.93 (95% CI: 0.84-1.02), and 0.92 (95% CI: 0.84-1.01) for the intake of dietary vitamin D, supplemental vitamin D, total vitamin D in USA and total vitamin D for women only. CONCLUSIONS: Our results support that there was no association between vitamin D intake and type 2 diabetes.

[Improvement in blood glucose fluctuations of insulin-treated type 1 diabetic patients with additional use of acarbose and assessed by continuous blood glucose monitoring program].

OBJECTIVE: To investigate the effect of combined use of insulin and acarbose on glucose excursion in type 1 diabetic patients. METHODS: 120 cases were randomly divided into control group and observation group. The control group received preprandial ultra-short effect insulin and long-acting insulin before bedtime while the observation group received acarbose 50 mg added to the medicine taken by the control group. Continuous Glucose Monitoring System (CGMS) was used to watch the blood glucose fluctuations. Data related to blood glucose level, glucose excursions after meals and hypoglycemia at night were compared between patients in the two groups. RESULTS: The average blood glucose (9.37 ± 1.70) mmol/L, the largest amplitude of glycemic excursions (LAGE) (11.42 ± 2.73) mmol/L, hyperglycemia-area under curve 0.89 ± 0.54, mean amplitude of glycemic excursions (MAGE) (5.13 ± 2.23) mmol/L, M-value (18.93 ± 11.43) mmol/L and insulin dosage (42.11 ± 14.42) U/day of observation group were significantly lower than in the control group (P < 0.05). Glucose excursions after meals and the times (0.33 ± 0.50)/day, the maintenance time (43.75 ± 43.50)/min and low glycemic index (LBGI) (0.005 ± 0.002) mmol/L of hypoglycemia at night were also significantly lower than in the control group, with statistically significant (P < 0.05) differences. CONCLUSION: The blood glucose fluctuation was significantly improved, with the decrease of insulin dosage while both glucose excursions and hypoglycemia at night reduced in patients with type1 diabetes mellitus after the acarbose treatment.We suggested that this program deserve further observation.

[Secretion and action of insulin among Han and Uygur subjects with impaired fasting glucose and impaired glucose tolerance from Xinjiang].

OBJECTIVE: To compare insulin secretion and action with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and combined glucose intolerance (CGI, IFG and IGT) between Han and Uygur populations living in Xinjiang. METHODS: A multicenter cross-section survey (The Third Diabetes Epidemiological Survey in China) was conducted in Xinjiang from 2007 to 2008 including 2203 subjects (Han 1118, Uygur 1085) underwent an oral glucose test (OGTT). Homeostasis model assessment on insulin resistance (HOMA-IR) and ß cell function (HOMA-ß) were calculated. The ratio of incremental insulin (ΔI30) and glucose (ΔG30) response was used to evaluate the early insulin secretion. ΔI30/ΔG30/HOMA-IR was used to evaluate the glucose disposition index (DI). RESULTS: There were differences noticed regarding the waist circumstances (WC), body mass index (BMI), lipids, 0 and 120 min insulin levels in different glucose tolerance status between the Hans and Uygurs. Data related to NGT, IFG, CGI, WC from the Uygurs was significantly different from that of the Hans (P < 0.01), while the NGT, IFG, IGT and 120-minute plasma insulin levels of the Hans were significantly different from that of the Uygurs (P < 0.01). HOMA-IR and HOMA-ß in Hans were significantly different from those of the Uygurs (P < 0.01). There were significant differences noticed on data related to ΔI30/ΔG30, and DI among the two populations with different ethnicities. CONCLUSION: Regarding the regulation of impaired glucose, the insulin resistance among the Hans was significantly different from that of the Uygurs, while there seemed to be a compensatory secretion of pancreatic ß cells which played the role of maintaining blood glucose homeostasis.

Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007-2008 China National Diabetes and Metabolic Disorders Study.

AIMS: Cardiovascular disease (CVD) is now the most prevalent and debilitating disease affecting the Chinese population. The goal of the present manuscript was to analyse cardiovascular risk factors and the prevalence of non-fatal CVDs from data gathered from the 2007-2008 China National Diabetes and Metabolic Disorders Study. METHODS AND RESULTS: A nationally representative sample of 46 239 adults, 20 years of age or older, was randomly recruited using a multistage stratified design method. Lifestyle factors, diagnosis of CVD, stroke, diabetes, and family history of each subject were collected, and an oral glucose tolerance test or a standard meal test was performed. Various non-fatal CVDs were reported by the subjects. SUDAAN software was used to perform all weighted statistical analyses, with P < 0.05 considered statistically significant. The prevalence of coronary heart disease, stroke, and CVDs was 0.74, 1.07, and 1.78% in males; and 0.51, 0.60, and 1.10% in females, respectively. The presence of CVDs increased with age in both males and females. The prevalence of being overweight or obese, hypertension, dyslipidaemia, or hyperglycaemia was 36.67, 30.09, 67.43, and 26.69% in males; and 29.77, 24.79, 63.98, and 23.62% in females, respectively. In the total sample of 46 239 patients, the prevalence of one subject having 1, 2, 3, or ≥4 of the 5 defined risk factors (i.e. smoking, overweight or obese, hypertension, dyslipidaemia, or hyperglycaemia) was 31.17, 27.38, 17.76, and 10.19%, respectively. Following adjustment for gender and age, the odds ratio of CVDs for those who had 1, 2, 3, or ≥4 risk factors was 2.36, 4.24, 4.88, and 7.22, respectively, when compared with patients with no risk factors. CONCLUSION: Morbidity attributed to the five defined cardiovascular risk factors was high in the Chinese population, with multiple risk factors present in the same individual. Therefore, reasonable prevention strategies should be designed to attenuate the rapid rise in cardiovascular morbidity.