Prevalence of Type 2 Diabetes in Mongolia: Results from Population-Based Survey Compared with 1999 Study.

Purpose: The burden of diabetes in Mongolia has risen tremendously over the last three decades, and an individually tracked, national registry of diabetes is lacking. Therefore, we aim to investigate diabetes prevalence in Mongolia and analyze some associated factors. Materials and Methods: A cross-sectional, nationally representative, population-based survey was carried out in Mongolia. We recruited participants from randomly selected six different clusters for the required 3113 ± 311 sample size. We collected detailed demographics, diabetes condition and medications, anthropometric measurements, body composition, and glucose profiles. Oral glucose tolerance tests were used to diagnose diabetes using the International Diabetes Federation algorithm. Chi-square and multinomial logistic regression tests were used to determine associated factors. Age-standardized prevalence rates were estimated. Results: We recruited 3272 participants in the study between June and October 2019. Crude prevalence rates for prediabetes and diabetes were 10.8% (95% CI; 9.8-11.9) and 11.2% (95% CI; 10.1-12.3), respectively. Sixty-one adults were newly diagnosed with diabetes. Age-standardized prediabetes and diabetes prevalence rates were 9.8% (95% CI; 8.5-11.1) and 10.0% (95% CI; 8.7-11.3) among adults 30 or older. Higher BMI, central obesity, diabetes inheritance, sedentary habitus, and hypertension are significantly associated with diabetes in adjusted analysis for sex and age group. Conclusion: The prevalence of diabetes has increased at least threefold since 1999 in Mongolia. In addition, numerous modifiable risk factors were associated with diabetes. Therefore, future investigations and programs should focus on combating obesity and sedentary lifestyles and propose dietary recommendations in the context of expanding diabetes in Mongolia.

Myeloid HMG-CoA (3-Hydroxy-3-Methylglutaryl-Coenzyme A) Reductase Determines Atherosclerosis by Modulating Migration of Macrophages.

Objective- Inhibition of HMGCR (3-hydroxy-3-methylglutaryl-coenzyme A reductase) is atheroprotective primarily by decreasing plasma LDL (low-density lipoprotein)-cholesterol. However, it is unknown whether inhibition of HMGCR in myeloid cells contributes to this atheroprotection. We sought to determine the role of myeloid HMGCR in the development of atherosclerosis. Approach and Results- We generated mice with genetically reduced Hmgcr in myeloid cells ( Hmgcr m-/m-) using LysM (Cre) and compared various functions of their macrophages to those of Hmgcr fl/fl control mice. We further compared the extent of atherosclerosis in Hmgcr m-/ m- and Hmgcr fl/fl mice in the absence of Ldlr (LDL receptor). Hmgcr m-/ m- macrophages and granulocytes had significantly lower Hmgcr mRNA expression and cholesterol biosynthesis than Hmgcr fl/fl cells. In vitro, Hmgcr m-/ m- monocytes/macrophages had reduced ability to migrate, proliferate, and survive compared with Hmgcr fl/fl monocytes/macrophages. However, there was no difference in ability to adhere, phagocytose, store lipids, or polarize to M1 macrophages between the 2 types of macrophages. The amounts of plasma membrane-associated small GTPase proteins, such as RhoA (RAS homolog family member A), were increased in Hmgcr m-/ m- macrophages. In the setting of Ldlr deficiency, Hmgcr m-/ m- mice developed significantly smaller atherosclerotic lesions than Hmgcr fl/fl mice. However, there were no differences between the 2 types of mice either in plasma lipoprotein profiles or in the numbers of proliferating or apoptotic cells in the lesions in vivo. The in vivo migration of Hmgcr m-/ m- macrophages to the lesions was reduced compared with Hmgcr fl/fl macrophages. Conclusions- Genetic reduction of HMGCR in myeloid cells may exert atheroprotective effects primarily by decreasing the migratory activity of monocytes/macrophages to the lesions.

Distinct association of serum FGF21 or adiponectin levels with clinical parameters in patients with type 2 diabetes.

Fibroblast growth factor 21 (FGF21) has been identified as a novel metabolic regulator. This cross-sectional study was performed to clarify how serum FGF21 levels were associated with clinical parameters in Japanese subjects with type 2 diabetes (n=139). Anthropometric and blood biochemical parameters, uses of drugs for diabetes, hypertension and dyslipidemia were examined regarding associations with fasting serum FGF21 concentrations. FGF21 levels were 6-times higher in those subjects taking fibrates. However, a use of thiazolidinediones did not affect serum FGF21 levels while it induced higher serum adiponectin levels. In univariate analyses, FGF21 levels showed associations with a use of fibrates, triglyceride levels, creatinine levels, waist circumference, and BMI. Multiple regression analyses adjusted for age, gender and BMI showed that a use of fibrates, triglyceride levels and creatinine levels were strong contributors to serum FGF21 levels. In contrast, a use of thiazolidinediones, HDL-cholesterol levels and fasting insulin levels were strong contributors to serum adiponectin levels. This study revealed that serum FGF21 levels were biochemical indicators correlating to a set of essential metabolic parameters, which was distinct from that correlating to serum adiponectin levels in subjects with type 2 diabetes.