Relationship between waist circumference and elevation of carotid intima-media thickness in newly-diagnosed diabetic patients.

OBJECTIVE: Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness (C-IMT), as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. METHODS: Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination (for measurement of waist circumference) and carotid ultrasonography (for measurement of C-IMT) were performed. RESULTS: After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles (90.7±9.8 cm and 90.8±9.6 cm) was significant higher than in 1st and 2nd quartiles (P<0.05). When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively (P<0.05). Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference (P<0.01). C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23±0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P<0.05), while no significant difference was detected in the group with baseline waist circumference less than 90 cm (P=0.27). Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 (95% CI 1.043-1.431, P<0.05). CONCLUSION: Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.

[Relationship between glycated albumin level and pancreatic ß cell function in newly diagnosed type 2 diabetics].

OBJECTIVE: To explore the relationship between glycated albumin (GA) level and pancreatic ß cell function in newly diagnosed type 2 diabetics. METHODS: The subjects sought the confirmation of diabetes diagnosis or underwent diabetes screening tests in high-risk patients from January 2008 to October 2010. All of them underwent 75 g oral glucose tolerance test (OGTT) and insulin releasing test. The levels of GA and hemoglobin A1c (HbA1c) were analyzed by liquid enzymatic method and high performance liquid chromatography respectively. Homeostasis model assessment (HOMA) was used to evaluate the basal insulin resistance (HOMA-IR) and pancreatic ß cell function (HOMA-ß). ΔI30/ΔG30 was used to evaluate early-phase insulin secretion after a glucose load. RESULTS: (1) Among 500 type 2 diabetics according to the diagnostic criteria of WHO (1999), 279 were males and 221 were females. Average age was 56.3 ± 12.3, GA (21.1 ± 5.4)% and HbA1c (7.0 ± 1.3)%. (2) A significantly positive relationship was shown between HbA1c and GA (r = 0.691, P < 0.01). GA was also positively correlated with fasting plasma glucose (FPG), 0.5 hPG, 1 hPG, 2 hPG and 3 hPG after a glucose load of OGTT test (r = 0.511 - 0.627, P < 0.01). (3) GA was negatively correlated with body mass index (BMI) (r = -0.112, P < 0.01), HOMA-ß (r = -0.350, P < 0.01) and ΔI30/ΔG30 (r = -0.263, P < 0.01). (4) Multivariant stepwise regression analysis showed that HbA1c, FPG, 3 hPG and ΔI30/ΔG30 were independent factors of GA level. CONCLUSION: Glycated albumin level is closely correlated with the function of early-phase insulin secretion in newly diagnosed type 2 diabetics.

Liver enzymes concentrations are closely related to prediabetes: findings of the Shanghai Diabetes Study II (SHDS II).

OBJECTIVE: To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. METHODS: A total of 3 756 participants were enrolled. Each participant underwent an oral glucose tolerance test and completed a questionnaire. Anthropometric indices were recorded and serum samples were collected for measurement. RESULTS: Liver enzymes concentrations were independently associated with i-IGT, IFG+IGT, and diabetes. With the increase of ALT and GGT concentrations, ORs for i-IGT, IFG+IGT, and diabetes increased gradually. By comparing patients in the highest quartile of GGT concentrations or ALT concentrations with those in the lowest quartile (Q1), ORs for i-IGT, IFG+IGT, or diabetes was significant after adjustment. Both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [ALT OR (95% CI): 2.56 (1.51-4.34) P=0.00; GGT OR (95% CI): 2.66 (1.53-4.65) P=0.00]. CONCLUSION: Serum ALT and GGT concentrations were closely related to pre-diabetes and diabetes in the Shanghai population and positively associated with insulin resistance.

[Combined utility of hemoglobin A1c and glycated albumin in diabetic screening].

OBJECTIVE: To assess the validity of combined detection of hemoglobin A1c (HbA1c) and glycated albumin (GA) in diabetic screening. METHODS: A total of 1480 subjects at our out-patient department from March 2007 to December 2009. Those suspected of diabetes or at a high risk of diabetes were enrolled. The study population included 677 males and 803 females with a mean age of 52.7 years. All subjects received an oral glucose tolerance test (OGTT) after a 10-hour fasting. Glycated albumin (GA) and hemoglobin A1c (HbA1c) were measured with liquid enzyme method and high pressure liquid chromatography respectively. RESULTS: (1) According to World Health Organization diabetes diagnosis criteria, there were 562 subjects with normal glucose tolerance (NGT), 411 subjects with impaired glucose regulation (IGR) and 507 subjects with newly diagnosed diabetes mellitus (DM). The level of HbA1c and GA had a rising tendency among NGT, IGR and DM groups (P < 0.01). (2) Pearson correlation analysis demonstrated that HbA1c had a positive association with GA (r = 0.75, P < 0.01). (3) Using OGTT as golden standard of diabetic diagnosis, receiver operator characteristic (ROC) curve indicated that HbA1c and GA were strong predictors of diabetes. The area under curve (AUC) was 0.882 and 0.881 respectively with no significant difference (P > 0.05). (4) The sensitivity of combined use of HbA1c and GA at optimal cut-off points of 6.1% and 17.1% was significantly higher than that of single use of HbA1c or GA in diabetic screening (94.7% vs 81.1%, 88.4%, P < 0.01). CONCLUSION: A combined detection of HbA1c and GA may improve the efficacy of diabetic screening. The subject with HbA1c ≥ 6.1% or GA ≥ 17.1% is recommended to undergo OGTT for confirming a diagnosis of diabetes.

Combined assessment of glycated albumin and fasting plasma glucose improves the detection of diabetes in Chinese subjects.

1. The aim of the present study was to assess the validity of glycated albumin (GA) and fasting plasma glucose (FPG) as a screening tool for the early detection of diabetes in Chinese subjects. 2. A total of 1971 outpatient subjects underwent a 75 g oral glucose tolerance test (OGTT) and GA measurement. The receiver operating characteristic curve (ROC) was plotted to examine the sensitivity, specificity, and positive and negative predictive values of GA and FPG in detecting undiagnosed diabetes at the different cut-off levels. 3. The prevalence of impaired glucose regulation and diabetes was 27.40% and 38.30%. For these diabetic individuals, 4.64% had isolated fasting hyperglycemia, 50.86% had isolated postprandial hyperglycemia and 44.50% had both. Using ROC analysis, a GA of 17.1% gave an optimal sensitivity of 76.82% (95% confidence interval: 73.64-79.79%) and specificity of 76.89% (74.42-79.23%) for the diagnosis of diabetes. Likewise, a FPG of 6.1 mmol/L gave an optimal sensitivity of 80.93% (77.94-83.67%) and specificity of 85.94% (83.86-87.84%). If subjects met both criteria, they were regarded as having diabetes; the positive predictive value of the combined criteria, FPG ≥ 6.1 mmol/L and GA ≥ 17.1%, was relatively high (84.79% (81.62-87.60%)), and this would have avoided 76% of the OGTT in our survey. 4. In conclusion, a GA value of 17.1%, an optimal cut-off in Chinese subjects, identified a high proportion of potential diabetic individuals. Simultaneous measurement of FPG and GA would enhance the sensitivity of diabetes screening in our population and avoid 76% of OGTT.

Characteristics of obesity and its related disorders in China.

Obesity is a medical condition with excess body fat accumulation to the extent which leads to serious health consequences. Abdominal obesity, also known as central obesity, refers to the presence of excess fat in the abdominal area. Obesity, especially abdominal obesity, contributes to many metabolic disorders including metabolic syndrome (MetS), type 2 diabetes (T2DM) and cardiovascular diseases (CVD). The incidence of obesity has increased dramatically in recent years worldwide. In China, more than one-third of adults are overweight or obese and 10%-20% of all adults are affected by MetS. The pathogenesis underlying the abdominal obesity remains unclear. The ultimate health outcome of obesity and its related metabolic disorders haveprompted physicians to take aggressive treatments (lifestyle changes, pharmacological interventions and surgical therapies) before a serious consequence becomes clinically apparent. In this review, we discuss the prevalence, pathogenesis and clinic features of obesity in China.

[Relation between the level of serum CA19-9 and glucose control in inpatients with diabetes].

OBJECTIVE: To investigate the effect of hemoglobin A1c (HbA1c) and glycated albumin (GA) on serum CA199 in diabetic patients. METHODS: 29 NGT matched control subjects and 371 hospitalized diabetic patients were enrolled. Diabetic patients were divided into satisfactory group (< 6.5%), general group (6.5%-7.5%) and dissatisfactory group (> 7.5%) by the level of HbA1c. The levels of serum CA199 among three groups were compared. The relationship between HbA1c and CA199, GA and CA199 was analysed. Multiple stepwise regression analysis was performed to compare the effect of different variables on CA199 as the independent variables were sex, age, duration, TC, TG, HDL, LDL, FBG, PBG, HbA1c and GA. RESULTS: (1) CA199 level of the group of HbA1c above 7.5% was significantly higher than the group of HbA1c between 6.5% and 7.5% and the group of HbA1c less than 6.5%. (2) The coefficient of correlation between HbA1c and CA199 was 0.394 (P = 0.000), and that was 0.381 between GA and CA199 (P = 0.000). (3) Multiple stepwise regression analysis show standard regression coefficient of HbA1c is 0.364 (P = 0.000). CONCLUSION: (1) CA199 level of diabetic patient in poor glucose control was significantly higher than the patient in good control. (2) CA199 was positively correlated with FBG, PBG, HbA1c and GA. (3) HbA1c is the independent risk factor of CA199. The elevated CA199 in diabetic patient has close relationship with poor glucose control in a long period.

[Study on prevalence and risk factors of fatty liver of patients with type 2 diabetes].

OBJECTIVE: To study the prevalence and risk factors of nonalcoholic fatty liver (NAFL) of patients with type 2 diabetes. METHODS: A total of 1335 patients with type 2 diabetes were divided into NAFL group and control group according to type B ultrasonic tomography results. RESULTS: (1) The prevalence of NAFL in type 2 diabetic patients was 42.1%. Among the patients younger than 50 years old, the prevalence of NAFL in males was higher than that in females. However, among the patients older than 50 years old, the case was just the opposite, higher in females. (2) The prevalences of overweight/obesity, dyslipidemia, hypertension, and metabolic syndrome (MS) of NAFL group were 59.4%, 66.4%, 57.7% and 71.7% respectively, all significantly higher than those of control group (P < 0.01). The risk for NAFL paralled with the increment of number of components of MS. Those patients with four components of MS had higher risk of NAFL than those patients with isolated type 2 diabetes (OR = 11.1 and 10.6, both P < 0.001). (3) The body mass index, diastolic blood pressure, fasting plasma glucose, hemoglobin A(1)c, total cholesterol, triglyceride, C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase, the level of serum uric acid and C-peptide of NAFL group were all higher than those of control group (P < 0.05 - 0.01). The level of serum high density lipoprotein-cholesterol and the AST/ALT rate were lower than those of control group (P < 0.05 - 0.01). Triglyceride, body mass index, CRP, the level of postprandial C-peptide at 30 min and fasting plasma glucose were the risk factors of NAFL. (4) The incidence of type 2 diabetic patients with increased CRP levels were 29.1% in male and 33.8% in female. patients with increased CRP levels had higher incidence of NAFL (54.4% vs 35.3% in male, 62.0% vs 38.4% in female, both P < 0.01). CONCLUSIONS: (1) About 2/5 of in-patients with type 2 diabetes had NAFL, and NAFL was closely associated with MS. (2) The increased level of CRP, as well as obesity, hyperglycemia, dyslipidemia and the increased level of postprandial C-peptide might increase the risk of NAFL in the patients with type 2 diabetes.

[Glycated albumin level and its influential factors in type 2 diabetes mellitus].

OBJECTIVE: To provide evidence for assessing glycated albumin (GA) appropriately cliniccally through determining the GA level of type 2 diabetes mellitus (DM) patients and analyzing its influential factors. METHOD: Continuous glucose monitor system was used to monitor the levels of fasting plasmic glucose (FPG), 2-hour post-prandial plasmic glucose (2hPG), GA, and glycated hemoglobin (HbA1c) in 445 type 2 DM in-patients. RESULTS: (1) The mean GA value was 24.9% +/- 7.0% and the mean HbA1c was 8.9% +/- 2.2%. (2) GA value was associated with HbA1c (P < 0.001). GA was positively correlated with FPG, 2hPG, and mean blood glucose (MBG) (all P < 0.01). (3) GA value was negatively correlated with BMI (P < 0.01). (4) Multiple stepwise regression analysis showed that HbA1c, BMI, and FPG were the main influential factors of GA. CONCLUSION: (1) GA value has good relationship with HbA1c, a golden standard to reflect the glycemic control in a long period. (2) BMI should be concerned when assessing GA value of DM patients, especially of the obese and thin subjects.