Flavonoid-containing supplements for preventing acute respiratory tract infections: A systematic review and meta-analysis of 20 randomized controlled trials.

BACKGROUND: This systematic review and meta-analysis was conducted to investigate the efficacy and safety of flavonoid-containing supplements in preventing acute respiratory tract infection (ARTI). METHODS: Randomized controlled trials (RCTs) investigating the effects of flavonoid-containing supplements on ARTI prevention in the aspects of ARTI incidence, mean ARTI sick days, symptoms, bio-immune markers, and adverse effects were searched in 5 databases. Data were searched from inception to November 26, 2021. Stata 16.0 was used to perform the meta-analysis. RESULTS: Twenty RCTs (n = 4521) were included in this systematic review and meta-analysis. Pooled results showed that in the flavonoid-containing supplement group, the ARTI incidence and mean ARTI sick days were significantly decreased compared to those in the control group (RR = 0.81, 95% CI: 0.74-0.89, p < 0.001; WMD = -0.56, 95% CI: -1.04 to -0.08, p = 0.021; respectively). In 8 RCTs, flavonoids were singly used for interventions, ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.85, 95% CI: 0.72-1.00, p = 0.047). In ten RCTs, flavonoid-containing mixtures were applied for interventions, and ARTI incidence in the experimental group significantly decreased compared to that in the control group (RR = 0.79, 95% CI: 0.71-0.89, p < 0.001). Furthermore, the ARTI incidence and mean ARTI sick days were significantly decreased in the experimental group compared to those in the control group in the flavan-3-ols subgroup (RR = 0.79, 95% CI: 0.67-0.92, p = 0.002; WMD = -2.75, 95% CI: -4.30 to -1.21, p < 0.001; respectively) and the multiple subclasses subgroup (RR = 0.75, 95% CI: 0.63-0.88, p = 0.001; WMD = -0.56, 95% CI: -1.11 to -0.01, p = 0.046; respectively). However, the bio-immune markers including interleukin-6, hypersensitive-c-reactive-protein, tumor necrosis factor-α, and interferon-γ did not differ between the flavonoid group and the control group. Moreover, in the flavonoid-containing supplement group, the incidence of adverse reactions did not increase compared to that in the control group (RR = 1.16, 95% CI: 0.78-1.73, p = 0.469). CONCLUSIONS: This systematic review and meta-analysis showed that flavonoid-containing supplements were efficacious and safe in preventing ARTIs. The most important limitations result from the small number of trials, poor quality of some included RCTs, differences in the composition and types of interventions, principal subclasses of flavonoids, methods of administration, and methodology. Moreover, only a few RCTs conducted independent verification of the flavonoid supplements used in the trial in terms of purity and potency, which may lead to a potential source of bias. Thus, larger and better-designed studies are needed to further verify this conclusion.

Flavonoids for Treating Viral Acute Respiratory Tract Infections: A Systematic Review and Meta-Analysis of 30 Randomized Controlled Trials.

BACKGROUND: This meta-analysis aimed to investigate the efficacy and safety of flavonoids in treating viral acute respiratory tract infections (ARTIs). METHODS: Randomized controlled trials (RCTs) were entered into meta-analyses performed separately for each indication. Efficacy analyses were based on changes in disease-specific symptom scores. Safety was analyzed based on the pooled data from all eligible trials, by comparing the incidence of adverse events between flavonoids and the control. RESULTS: In this study, thirty RCTs (n = 5,166) were included. In common cold, results showed that the flavonoids group decreased total cold intensity score (CIS), the sum of sum of symptom intensity differences (SSID) of CIS, and duration of inability to work vs. the control group. In influenza, the flavonoids group improved the visual analog scores for symptoms. In COVID-19, the flavonoids group decreased the time taken for alleviation of symptoms, time taken for SARS-CoV-2 RT-PCR clearance, the RT-PCR positive subjects at day 7, time to achievement of the normal status of symptoms, patients needed oxygen, patients hospitalized and requiring mechanical ventilation, patients in ICU, days of hospitalization, and mortality vs. the control group. In acute non-streptococcal tonsillopharyngitis, the flavonoids group decreased the tonsillitis severity score (TSS) on day 7. In acute rhinosinusitis, the flavonoids group decreased the sinusitis severity score (SSS) on day 7, days off work, and duration of illness. In acute bronchitis, the flavonoids group decreased the bronchitis severity score (BSS) on day 7, days off work, and duration of illness. In bronchial pneumonia, the flavonoids group decreased the time to symptoms disappearance, the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). In upper respiratory tract infections, the flavonoids group decreased total CIS on day 7 and increased the improvement rate of symptoms. Furthermore, the results of the incidence of adverse reactions did not differ between the flavonoids and the control group. CONCLUSION: Results from this systematic review and meta-analysis suggested that flavonoids were efficacious and safe in treating viral ARTIs including the common cold, influenza, COVID-19, acute non-streptococcal tonsillopharyngitis, acute rhinosinusitis, acute bronchitis, bronchial pneumonia, and upper respiratory tract infections. However, uncertainty remains because there were few RCTs per type of ARTI and many of the RCTs were small and of low quality with a substantial risk of bias. Given the limitations, we suggest that the conclusions need to be confirmed on a larger scale with more detailed instructions in future studies.Systematic Review Registration: inplasy.com/inplasy-2021-8-0107/, identifier: INPLASY20218010.

Factors associated with improvement in waist-to-height ratio among newly diagnosed type 2 diabetes patients treated with acarbose or metformin: A randomized clinical trial study.

BACKGROUND: The waist-to-height ratio (WHtR) is a promising anthropometric measure used to evaluate cardiovascular risk in diabetes and metabolic syndrome patients. The metformin and acarbose in Chinese as the initial hypoglycaemic treatment trial demonstrated that acarbose and metformin reduced the WHtR after 24 wk of treatment. AIM: To investigate the factors associated with a decrease in the WHtR in newly diagnosed Chinese type 2 diabetes patients receiving acarbose or metformin monotherapy. METHODS: At 24 wk, 343 patients in the acarbose treatment and 333 patients in the metformin treatment were included in this analysis. On the basis of the reduction in the WHtR, these participants were divided into the following two groups: Low ΔWHtR group and high ΔWHtR group. Metabolic and related parameters associated with a high ΔWHtR were investigated using univariate and multivariate logistic regression analyses. RESULTS: A significant decrease in the WHtR was observed in both treatment groups (acarbose: -0.015, 95% confidence interval [CI]: -0.018 to -0.012, P < 0.001; metformin: -0.013, 95%CI: -0.016 to -0.010, P < 0.001). In both the acarbose and metformin groups, the WHtR of the women was more likely to be reduced than that of the men. In the acarbose group, a lower baseline area under the curve of glucagon-like peptide 1 (AUCGLP-1) was associated with a high ΔWHtR (odds ratio [OR] = 0.796, P < 0.001), while a higher baseline AUCGLP-1 was associated with a high ΔWHtR in the patients treated with metformin (OR = 1.133, P = 0.025). Regarding the changes from baseline, an increase in AUCGLP-1 was associated with a high ΔWHtR in the acarbose (OR = 1.121, P = 0.016) but not metformin group. A higher reduction in high-density lipoprotein cholesterol/non-high-density lipoprotein cholesterol was also associated with a high ΔWHtR in the acarbose arm (OR = 20.735, P = 0.001). In the metformin arm, a higher reduction in fasting plasma glucose (OR = 0.843, P = 0.039) and total cholesterol was associated with a high ΔWHtR (OR = 0.743, P = 0.013). CONCLUSION: A lower glucagon-like peptide 1 level and higher increase in glucagon-like peptide 1 are associated with a high reduction in the WHtR in newly diagnosed Chinese diabetes patients receiving treatment with acarbose.

MARCH: factors associated with weight loss in patients with newly diagnosed type 2 diabetes treated with acarbose or metformin.

INTRODUCTION: In this secondary analysis of the Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment (MARCH) trial, we evaluated what demographic and clinical factors were associated with reduction in weight. We also assessed the effects of acarbose and metformin treatment on weight reduction. MATERIAL AND METHODS: We analyzed the demographic and clinical laboratory values from the 784 patients with type 2 diabetes of the MARCH study who were treated for 48 weeks with acarbose or metformin. We determined the association of the different parameters with a weight reduction of ≥ 2 kg in patients using univariate and multivariate analysis. RESULTS: In patients treated with acarbose, males were less likely than females to lose ≥ 2 kg of weight (p = 0.025). Higher baseline HbA1c levels and lower decreases from baseline in fasting plasma glucose (FPG) levels after 48 weeks of treatment were negatively associated with losing ≥ 2 kg of weight (both, p < 0.05). Higher baseline glucagon AUC was also positively associated with reducing weight by ≥ 2 kg (p = 0.010). In patients treated with metformin, change from baseline in whole body insulin sensitivity increased the odds of having a weight reduction of ≥ 2 kg (p = 0.014). CONCLUSIONS: This study found that for both acarbose and metformin, control of FPG significantly impacted weight loss. Baseline AUC for glucagon in patients treated with acarbose and an increase of whole body insulin sensitivity after 48 weeks of treatment with metformin were important factors for weight reduction.

Associations between changes in glucagon-like peptide-1 and bodyweight reduction in patients receiving acarbose or metformin treatment.

BACKGROUND: The present post hoc analysis investigated whether changes in endogenous glucagon-like peptide-1 (∆GLP-1) levels are associated with weight loss in newly diagnosed diabetes patients. METHODS: In all, 784 subjects from the Metformin and AcaRbose in Chinese as initial Hypoglycemic treatment (MARCH) study were stratified according to ∆GLP-1. Changes in clinical and physiological parameters were evaluated across ∆GLP-1 subgroups (low, medium, and high) to assess correlations between ∆GLP-1 and weight loss in acarbose- versus metformin-treated groups. RESULTS: After 24 weeks treatment, greater ∆GLP-1 was associated with significantly greater weight loss (-2 vs -1 kg in the medium/high vs low ∆GLP-1 groups, respectively) and reduction in body mass index (BMI; -0.88, -0.83, and -0.69 kg/m2 in the high, medium, and low ∆GLP-1 groups, respectively). In the acarbose-treated group, there was a significant association between ∆GLP-1 and BMI reductions, and greater ∆GLP-1 across the high, medium, and low ∆GLP-1 groups was correlated with greater weight loss (-2.8, -2.1, and -1.9 kg, respectively) and reductions in fasting plasma glucose (-1.57, -1.28, and -1.02 mmol/L, respectively) at Week 24. No significant differences were found across ∆GLP-1 subgroups in metformin-treated patients (P > 0.05). Multivariate linear regression analysis revealed that gender, baseline BMI, and ∆GLP-1 at Week 24 were associated with weight loss. Baseline BMI and ∆GLP-1 in the acarbose-treated group and baseline BMI in the metformin-treated group predicted weight loss at Week 24. CONCLUSION: Changes in GLP-1 levels are associated with weight loss in newly diagnosed Chinese diabetes patients receiving acarbose.

Improvement in insulin sensitivity following intensive insulin therapy and association of glucagon with long-term diabetes remission.

Objective To investigate the role of the acute glucagon response in the long-term remission of newly diagnosed type 2 diabetes mellitus following short-term intensive insulin therapy (IIT). Methods Ten patients with newly diagnosed type 2 diabetes mellitus received IIT. Intravenous glucose tolerance tests and the clamp technique were performed pre- and post-IIT. Remission was defined as maintenance of target glycaemic control without anti-diabetic agents for 1 year. Results The remission rate was 50% (5/10). There were no differences in the acute insulin response or glucose infusion rate between groups. The acute glucagon response (AGR) in the remission group pre-IIT was significantly higher than that in the non-remission group (mean 163.02 pg/mL/min vs. mean 16.29 pg/mL/min). The mean AGR post-IIT was lower in the remission group than that in the non-remission group (0 pg/mL/min vs. 19.91 pg/mL/min). Spearman analysis indicated that the AGR pre-IIT and the change in the AGR were correlated with remission (r = 0.731). Conclusion The insulin-mediated glucose disposal rate was significantly improved with the normalization of blood glucose levels following transient IIT. Subjects with a higher AGR pre-IIT and a greater AGR decrease post-IIT displayed a greater likelihood of long-term remission.

Efficacy of acarbose and metformin in newly diagnosed type 2 diabetes patients stratified by HbA1c levels.

BACKGROUND: The aim of the present study was to investigate whether the therapeutic efficacy of acarbose and metformin is correlated with baseline HbA1c levels in Chinese patients with newly diagnosed type 2 diabetes mellitus (T2DM). METHODS: Data for 711 subjects were retrieved from the MARCH (Metformin and AcaRbose in Chinese as initial Hypoglycemic treatment) trial database and reviewed retrospectively. Patients were grouped according to baseline HbA1c levels (<7%, 7%-8%, and >8%) and the results for these three groups were compared between acarbose and metformin treatments. RESULTS: Acarbose and metformin treatment significantly improved T2DM-associated parameters (weight, fasting plasma glucose [FPG], postprandial glucose [PPG], glucagon-like peptide-1 [GLP-1], HOMA-IR, and total cholesterol) across all HbA1c levels. Acarbose decreased PPG and HOMA-ß significantly more than metformin, but only in subjects with lower baseline HbA1c (PPG in the <7% and 7%-8%, HOMA-ß in the <7% groups; all P < 0.05). Acarbose decreased triglyceride (TG) levels, and the areas under the curve (AUC) for insulin and glucagon more than metformin at all HbA1c levels (P < 0.05). After 24 weeks treatment, metformin decreased FPG levels significantly more than acarbose for all baseline HbA1c groups (all P < 0.001). With the exception of FPG, PPG, and TG levels, differences between the two treatment groups observed at 24 weeks were not detected at 48 weeks. CONCLUSIONS: Acarbose decreased PPG and TG and spared the AUC for insulin more effectively in patients with low-to-moderate baseline HbA1c levels, whereas metformin induced greater reductions in FPG. These results may help guide selection of initial therapy based on baseline HbA1c.

[Efficacy of tianmaixiaoke tablets in the treatment of newly diagnosed type 2 diabetes mellitus in China].

OBJECTIVE: To explore the efficacy and influencing factors of chromium picolinate (tianmaixiaoke tablet) in the treatment of newly diagnosed type 2 diabetes mellitus in China. METHODS: A total of 84 outpatients with newly diagnosed type 2 diabetes mellitus visiting 4 hospitals in Beijing were randomly divided into two equal groups: study group receiving tianmaixiaoke tablet 240 mg bid for 24 weeks (n = 42) and control group sitagliptin 100 mg qd for 24 weeks (n = 42). The levels of fasting plasma glucose (FPG), plasma glucose 2 h after meal (PG2 h) and glycated hemoglobin (HbA1c) were detected before and 24 weeks after treatment. The serum levels of chromium and insulin were detected. RESULTS: Study was completed in 76 patients. The serum level of chromium was significantly lower in the diabetes group than in the normal group at baseline ((56 ± 28) µg/L vs (112 ± 21) µg/L, P = 0.00). At 24 weeks after treatment, the levels of HbA1c, FPG and PG2 h decreased while the serum level of chromium increased significantly in both groups. There were 11 patients with changed HbA1c from baseline (ΔHbA1c) ≥ 1% in the study group. At 24 weeks after treatment, HbA1c decreased by 1.61% (from 8.38% ± 0.72% to 6.77% ± 0.62%) and serum level of chromium increased by 35.14 µg/L in the ΔHbA1c ≥ 1% group with a low baseline serum level of chromium ((36.2 ± 18.0) µg/L). Both study group and control group were divided into three subgroups according to baseline serum level of chromium. ΔHbA1c reduced with the increase in baseline serum level of chromium in study group, while in control group, ΔHbA1c was unrelated with baseline serum level of chromium. At 24 weeks after treatment, insulin resistance index (HOMA-IR) reduced, ß cell function index (HOMA-ß) and insulinogenic index (IGI) increased in both groups. Multiple linear regression showed that the variables significantly associated with ΔHbA1c were baseline HbA1c and the baseline serum level of chromium. CONCLUSIONS: Chromium is commonly deficient in the newly diagnosed type 2 diabetics in China. HbA1c decreases and serum chromium increases significantly after chromium supplementation in the patients with a low baseline serum level of chromium.

[Ageing related changes of insulin secretion and insulin sensitivity among normal glucose tolerance individuals in China].

OBJECTIVE: To explore the aging-related changes of insulin secretion and insulin sensitivity among normal glucose tolerance (NGT) individuals in China. METHODS: A total of 34 293 individuals were recruited. All of them were described as NGT by 75 g oral glucose tolerance test (75 g OGTT) according to the diagnostic criterion of WHO, 1999. HOMA-ß, ΔI(30)/ΔG(30), InsAuc30/GluAuc30, InsAuc120/GluAuc120 were calculated to estimate insulin secretion; HOMA-IR and Matsuda index measured to estimate insulin sensitivity; Disposition index: DI(30) and DI(120) were used to estimate ß-cell function. RESULTS: HOMA-ß, ΔI(30)/ΔG(30), InsAuc30/GluAuc30 and InsAuc120/GluAuc120 were all lower in the elder group then the younger group (P trend < 0.05). The mean HOMA-ß dropped from 192 ± 16 (20 - 29 years) to 115 ± 7 (70 or elder) among men and from 162 ± 8 (20 - 29 years) to 120 ± 12 (70 or elder) among women. The mean ΔI(30)/ΔG(30) dropped from 20.0 ± 2.0 (20 - 29 years) to 8.6 ± 0.6 (70 or elder) among men and from 22.4 ± 1.6 (20 - 29 years) to 12.5 ± 1.7 (70 or elder) among women. The above index were negatively correlated with age in univariate linear regression (P < 0.05), the results among men and overall still existed after adjusted for BMI and waist circumference in multivariate linear regression, while the relation between HOMA-ß and age disappeared among women. Matsuda Index was positively correlated with age (ß = 0.02, P = 0.001) and HOMA-IR were negatively correlated with age (ß = -0.01, P = 0.001) among men even after adjusted for BMI and waist circumference and the above correlation between Matsuda Index/HOMA-IR and ageing was not significant until adjusted for BMI and waist circumference in multivariate linear regression. Among women HOMA-IR (ß = -0.01, P = 0.000), Matsuda index (ß = 0.03, P = 0.000). DI(30) and DI(120) were negatively correlated with age in both univariate and multivariate linear regression. CONCLUSIONS: The basal, postchallenge insulin secretion and postchallenge islet compensatory function decreases with ageing, while insulin sensitivity does not deteriorate with ageing and its related change of body composition and weight gain.

A case of Klinefelter's syndrome with type 1 diabetes mellitus.

Klinefelter's syndrome (KS) is the most common sex chromosome disease in men. Classical features of the syndrome include a eunuchoidal body habitus, small testes and hypergonadotrophic hypogonadism. There has been an increased risk of diabetes mellitus and autoimmune disease for KS patients. This paper reports a case of KS in association with type 1 diabetes mellitus. The patient was a 21-year-old man, who has been confirmed by absolute insulin deficiency and positive IA-2 autoantibody. The hyperinsulinemic euglycemic clamp test indicated his insulin sensitivity in normal range, and his blood glucose was controlled well by the insulin therapy.

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.

Association between glucose variability and adverse in-hospital outcomes for Chinese patients with acute coronary syndrome.

OBJECTIVE: To investigate the association between mean blood glucose (MBG) and glucose variability (GV) during hospitalization, and adverse in-hospital outcomes for patients with acute coronary syndrome (ACS). METHODS: This is a retrospective cohort study and conducted in 2 tertiary hospitals in Beijing, China. All data were collected from the medical records concerning ACS patients admitted to the hospital between January 2003 to December 2006. Hyperglycemia was related to clinical outcomes (including major adverse cardiovascular events [MACEs] and in-hospital death) using coefficient of variation of blood glucose (GluCV) or mean blood glucose (MBG). Total cohort was stratified by GluCV or MBG quartiles. Diabetic and non-diabetic subgroups were then separately analyzed. Multivariate logistic regression analysis was performed to evaluate the independent risk factor of in-hospital death. RESULTS: A total of 1756 cases were enrolled in this study. For total cohort or non-diabetic cohort, prevalence of adverse outcomes was higher in patients with higher MBG or GluCV (p for trend <0.001). For diabetic ACS patients, MACEs were found more common in MBG or GluCV quartiles (p for trend <0.001), in-hospital mortality increased across MBG (p for trend <0.001), or GluCV quartiles (p for trend=0.004). Multivariate logistic regression analysis showed that GluCV (odds ratio: 1.29) was a stronger predictor of in-hospital death than MBG (odds ratios: 1.20). CONCLUSION: The GluCV is a better discriminator of in-hospital mortality than MBG in ACS patients.

[Post-hoc analyses of type 2 diabetes patients switch from premixed insulin regimen to basal insulin plus oral hypoglycemic agents regimen].

OBJECTIVE: To compare characteristics of better responders to new regimen therapy with non-responders. METHODS: In a 12-week, two-center, open, parallel group clinical trial, 80 type 2 diabetic patients treated with twice-daily premixed 30 R insulin with or without OAD (s) [fasting blood glucose (FBG) 7.8 - 16.7 mmol/L, HbA1c 7% - 10%] were randomized to once-daily morning insulin glargine plus glimepiride 3 mg or premixed 30 R insulin (70/30) twice-daily plus glimepiride 3 mg. Insulin dosage was titrated to target FBG 8.0% vs 8.9%-->7.8%, P > 0.05). However, hypoglycemic episodes were significantly higher in premixed-insulin-treated subjects than in glargine-treated subjects [total: 123 vs 57; proved hypoglycemic episodes 94 (76%) vs 21 (47%), chi(2) = 23.692, P < 0.01], The frequency of hypoglycemia before lunch was especially greater in premixed-insulin-treated subjects 64 (52%) vs 17 (30%), chi(2) = 7.762, P = 0.005. Several subjects from the premixed arm experienced too frequent hypoglycemic episodes to be recorded during 10AM-11AM almost every day. Subgroup analysis for patients treated with glargine: 28.2% (11 cases) of the patients in this group attained HbA1c 8.5% at 12 weeks, mean daily dosage for glargine were (0.66 +/- 0.30) U.kg(-1).d(-1). There were significant differences of baseline HbA1c, diabetes duration and baseline postprandial C-peptide between the two subgroups in glargine arm (HbA1c: 8.1% +/- 0.8% vs 9.6% +/- 1.2%; duration: 10 (6 - 14.5) years vs 13 (8 - 19.5) years; postprandial c peptide: 2.5 nmol/L (1.4 - 3.3) vs 1.4 (1.2 - 2.6) nmol/L, all P < 0.05). CONCLUSION: Type 2 diabetic patients treated with twice-daily injection of premixed 30 R insulin with or without OAD (s) can be effectively and safely switched to basal insulin plus OAD. Pretreatment HbA1c, diabetes duration and postprandial C peptide are the key factors that closely related to efficacy of this new regimen.

[The optimal waist circumference cut-off point for identifying cardiovascular risk factors clustering among Chinese adults].

OBJECTIVE: The waist circumference (WC) cut-off point for abdominal obesity is gender and ethnic-group specific. The aim of the study was to explore the best WC cut-point for identifying cardiovascular risk factors clustering among Chinese adults. METHOD: The data from 15,628 Chinese adults aged > or = 25 years in 1994 National Diabetes Mellitus Survey were reanalyzed. Odds ratios for different WC categories (stratified in units of 5 cm) were calculated with the first stratum (WC < 70 cm) as reference category. Receiver Operator Characteristic curve (ROC) analysis was employed to determine the optimal WC cut-point for detecting multiple cardiovascular disease risk factors. RESULTS: The prevalences of insulin resistance, dyslipidemia, hypertension and hyperglycemia were higher among higher WC categories for both men and women. Odds ratios for metabolic syndrome significantly increased from the WC category of > or = 85 cm in man (OR = 2.08, 95% CI: 1.80 - 2.39) and > or = 80 cm in women (OR = 1.66, 95% CI: 1.41 - 1.97). The ROC analysis showed that the optimal WC cut-point was 85 cm in men with the sensitivity of 60.79% and specificity of 69.66%, and 80 cm in women with sensitivity of 59.88% and specificity of 65.35%. CONCLUSION: The best WC cut-point is 85 cm in men and 80 cm in women for identifying Chinese adults at high risk of cardiovascular disease.

[Clinical application of acupuncture for treatment of heroin withdrawal syndrome].

OBJECTIVE: To make technical standard of acupuncture manipulation for acupuncture treatment of heroin withdrawal syndrome. METHODS: Two hundred and twenty cases of heroin withdrawal syndrome were randomly divided into an acupuncture group of 111 cases and a control group of 109 cases. They were respectively treated with acupuncture and oral administration of lofexidine hydrochloride, and their therapeutic effects were observed. RESULTS: The heroin dependence (acute stage) were effectively withdrawn in the two groups. The treatment group in change of total scores for withdrawal symptoms before and after treatment, the total scores for withdrawal symptoms at the 4th and 5th days, treatment of insomnia and the score for self-Hamilton Anxiety Scale and the score after at the 4th day was superior to the control group (P < 0.05, P < 0.01, P < 0.001). CONCLUSION: Acupuncture has a satisfactory, rapid, safe and reliable clinical therapeutic effect.

[Glucocorticoid-induced diabetes in severe acute respiratory syndrome: the impact of high dosage and duration of methylprednisolone therapy].

OBJECTIVE: Over-dose glucocorticoid was frequently used in patients with severe acute respiratory syndrome (SARS), the aim of the present study is to investigate the frequency and risk factors of corticosteroid-induced diabetes in this situation. METHODS: One hundred thirty-three cases of SARS admitted from May to June 2003 in our hospital were included in the study. Maximal dose, average daily dose, treatment course and fasting plasma glucose level (FPG) were recorded. Corticosteroid-induced diabetes was diagnosed if FPG was equal to or higher than 7 mmol/L twice or more after the administration of glucocorticoids. RESULTS: Ninety five patients (71.9%) were prescribed with glucocorticoid among the 132 patients. Thirty-three patients (36.3%) were diagnosed as corticosteroid-induced diabetes according to the FPG. Significant differences were found in daily maximal dosage, duration of treatment and average dosage of methylprednisolone between the patients with and without corticosteroid-induced diabetes (275 mg/d vs 136 mg/d, 24 d vs 16 d, 139 mg/d vs 91 mg/d, P < 0.01). As compared with the lowest tertile, the frequency of diabetes in SARS patients treated with highest tertile of maximal daily dosage, treatment duration, average dosage or total dosage were significantly higher (64.7% vs 13.0, 61.9% vs 17.4%, 62.5% vs 21.7%, and 59.2% vs 13.6%, P < 0.05 for all comparisons). If the patients were treated with an average dose less than 90 mg/d and treatment duration shorter than 15 days, the diabetes incidence was 10.5%. After adjusting age and sex, the daily maximal dosage of methylprednisolone was the only factor that might predict the occurrence of diabetes. CONCLUSIONS: Over-dose administration of methylprednisolone in SARS patients leads to a high frequency of diabetes. Decreasing the daily maximal dosage may be beneficial to the reduction of corticosteroid-induced of diabetes.

[Impact of lowering the cut-point for impaired fasting glucose on the distribution of impaired glucose regulation subcategories in Chinese adult population].

OBJECTIVE: To evaluate the impact of lowering of cut-point value for impaired fasting glucose (IFG) from 6.1 mmol/L to 5.6 mmol/L. by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, US, on the prevalence rates of different impaired glucose regulation (IGR) subcategories in Chinese adults, and to explore the ability of the new cut-point to diagnose IGR. METHODS: The data of 15 564 persons undergoing standard 75 g oral glucose tolerance test (OGTT) in the National Diabetes Mellitus Survey (1994) in Chinese adults (>or= 25 years) were reanalyzed. The prevalence of isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and combined IFG and IGT (IFG/IGT) were calculated by the new criteria of 5.6 mmol/L

[The distributive characteristics of impaired glucose metabolism subcategories in Chinese adult population].

OBJECTIVE: To clarify the frequencies and clinical features of different impaired glucose metabolism subcategories in Chinese adults. METHODS: A cross-sectional analysis of the data of 15,637 Chinese adults (aged >or= 25 years) who underwent standard 75 g oral glucose tolerance test from the National Diabetes Mellitus Survey (1994) was conducted. According to the 1999 WHO criteria for diabetes, the subjects were divided into 7 groups: normal glucose tolerance (NGT, FPG < 6.1 mmol/L and PG 2 h < 7.8 mmol/L), isolated impaired fasting glucose (i-IFG, 6.1 or= 7.0 mmol/L and PG 2 h < 11.1 mmol/L), isolated postload hyperglycemia (IPH, FPG < 7.0 mmol/L and PG 2 h >or= 11.1 mmol/L), and combined IFH and IPH (IFH/IPH, FPG >or= 7.0 mmol/L and PG 2 h >or= 11.1 mmol/L). The frequencies of the above subcategories were calculated and the clinical characteristics were compared. RESULTS: (1) The frequencies of NGT, i-IFG, i-IGT, IFG/IGT, IFG, IPH, and IFH/IPH were 50.8%, 8.8%, 12.3%, 6.1%, 6.4%, 5.2%, and 10.4% respectively. (2) The frequencies of i-IGT, IFG/IGT, IPH, and IFH/IPH increased with age, whereas the frequencies of i-IFG and IFH tended to plateau in the age groups of 25 - 34 years and 55 - 64 years. (3) The mean age and blood pressure were significantly lower in the i-IFG group (vs the i-IGT or IFG/IGT group) and the IFH group (vs IPH or IFH/IPH group). Compared with the IPH group, the IFH group had higher homeostasis model assessment (HOMA) insulin resistance index (HOMA-IR) and lower beta cell function index (BCI). CONCLUSIONS: i-IGT is the most common impaired glucose regulation (IGR) subcategory, and IFH/IPH is the most common diabetes subcategory in Chinese adults. The frequencies of i-IGT and IFH/IPH increase with age. The clinical features of i-IFG (IFG) are greatly different from those of i-IGT (IPH), suggesting that the determinants of FPG and PG 2 h differ.