Novel clusters of newly-diagnosed type 2 diabetes and their association with diabetic retinopathy: a 3-year follow-up study

Variations in blood pressure after a 75g oral glucose load and their implications for detecting hypertension and postprandial hypotension in Chinese adults: a cross-sectional study

AIMS

Current hypertension guidelines fail to discriminate between fasting and postprandial blood pressure (BP) measurements. Meal ingestion often triggers a marked increase in splanchnic blood flow, potentially inducing a sustained fall in systolic BP of ≥20mmHg, termed postprandial hypotension (PPH). This study aimed to evaluate BP responses to a 75g glucose drink and its implications for detecting hypertension and PPH in community-dwelling adults.

METHODS

A stratified multi-stage random sampling method was used to obtain a nationally representative sample of 4429 adult residents between April 2020 and January 2021 in China. BP and heart rate (HR) were measured before, and 1 and 2 hours after, a 75g glucose drink.

RESULTS

When fasting, 38.4% of the study population had high BP (BP ≥140/90mmHg). Following the glucose drink, SBP and DBP decreased (SBP by 6.2 [95% CI: 5.8-6.6]mmHg and 8.1 [7.7-8.5]mmHg, DBP by 4.7 [4.4-4.9]mmHg and 6.1 [5.8-6.4]mmHg), and HR increased (by 4.3 [4.0-4.5]bpm and 2.6 [2.4-2.9]bpm) at 1 and 2 hours (P <0.001 for all), with only 30.9% and 27.0% of the study population having high BP at 1 and 2 hours, respectively. After adjustment for age and sex distribution, 19.9% of the general population was estimated to have PPH. PPH was associated with an increased risk of combined cardiovascular disease and stroke.

CONCLUSIONS

Ingestion of a 75g glucose drink often lowers BP, frequently leading to PPH and influencing the detection of hypertension. Accordingly, guidelines for measurements of BP and interpretation of outcomes should consider the potential impact of meal ingestion on BP.

Cluster-based subgroups of prediabetes and its association with prediabetes progression and regression: a prospective cohort study

BACKGROUND

Cluster analysis provides an effective approach in stratifying prediabetes into different subgroups; however, the association of the cluster-based subgroups with prediabetes progression and regression has not been investigated. We aimed to address this issue in a Chinese population.

METHODS

A total of 4,128 participants with prediabetes were included to generate cluster-based subgroups of prediabetes based on age, body mass index (BMI), triglyceride-and-glucose (TyG) index, and hemoglobin A1c (HbA1c), using a k-means clustering model. Among them, 1,554 participants were followed-up for about three years to ascertain prediabetes progression and regression. Their association with the cluster-based subgroups of prediabetes was assessed using multinomial logistic regression analyses.

RESULTS

Three clusters of prediabetes were identified among the 4,128 participants, with cluster 0, 1 and 2 accounting for 28.0%, 31.4% and 40.6%, respectively. Participants with prediabetes were featured by the youngest age and the lowest HbA1c in cluster 0, the highest BMI and TyG index in cluster 1, and the oldest age and the lowest BMI in cluster 2. After multivariable-adjustment, both cluster 1 [odds ratio (OR) 3.31, 95% confidence interval (CI): 2.01-5.44] and cluster 2 (OR 2.58, 95% CI: 1.60-4.18) were associated with increased odds of progression to diabetes when compared with cluster 0. They were also associated with decreased odds of regression to normoglycemia (OR 0.54, and 0.56, respectively).

CONCLUSIONS

Prediabetes participants featured by older age, higher degree of insulin resistance, higher BMI and worse glycemic condition had higher probability of progression to diabetes but lower chance of regression to normoglycemia.

Association between night blindness history and risk of diabetes in the Chinese population: a multi-center, cross sectional study

AIMS

Night blindness (NB), an important manifestation of VA deficiency, may be associated with the odds of diabetes. The aim of this study was to explore the probable association between NB history and diabetes in Chinese community-dwelling adults.

METHODS

This multi-center, cross-sectional study enrolled a total of 5664 participants aged 18-82 years from eight sites in China. Information on demographics and medical history was collected using a standardized questionnaire. Diabetes was diagnosed based on the oral glucose tolerance test or a self-reported history. NB history was ascertained by a face-to-face interview with reference to the recommendation by the World Health Organization. Logistic regression analysis was used to evaluate the association between NB history and the odds of diabetes.

RESULTS

A total of 5049 participants were finally included, with 252 ascertained with NB history and 1076 with diabetes. The mean age of included participants was 52.9 years, and the percentage of participants with NB history was significantly higher in participants with diabetes than those without (7.0% vs. 4.5%). The multivariable adjusted odds ratio for diabetes was 1.41 (95% confidence interval 1.06, 1.89) in participants with NB history compared with those without. Furthermore, mediation analysis showed that obesity, as assessed by waist-height ratio, partially mediated the relationship between NB history and increased odds of diabetes.

CONCLUSIONS

The results suggest that NB history might be associated with increased odds of diabetes in Chinese community-dwelling adults.

Dark tea consumption is associated with a reduced risk of dysglycaemia and increased urinary glucose and sodium excretion in Chinese adults

AIM

To examine the associations of tea consumption (both frequency and type) with (1) prediabetes and diabetes and (2) urinary glucose and sodium excretion in Chinese community-dwelling adults.

MATERIALS AND METHODS

In 1923 participants (457 with diabetes, 720 with prediabetes, and 746 with normoglycaemia), the frequency (occasional, frequent, daily, or nil) and type (green, black, dark, or other) of tea consumption were assessed using a standardized questionnaire. Morning spot urinary glucose and urine glucose-to-creatinine ratios (UGCRs) were assessed as markers of urinary glucose excretion. Tanaka's equation was used to estimate 24-h urinary sodium excretion. Logistic and multivariate linear regression analyses were performed.

RESULTS

Compared with non-tea drinkers, the corresponding multivariable-adjusted odds ratios (ORs) for prediabetes and diabetes were 0.63 (95% confidence interval [CI] 0.48, 0.83) and 0.58 (95% CI 0.41, 0.82) in participants drinking tea daily. However, only drinking dark tea was associated with reduced ORs for prediabetes (0.49, 95% CI 0.36, 0.66) and diabetes (0.41, 95% CI 0.28, 0.62). Dark tea consumption was associated with increased morning spot urinary glucose (0.22 mmol/L, 95% CI 0.11, 0.34 mmol/L), UGCR (0.15 mmol/mmol, 95% CI 0.05, 0.25 mmol/L) and estimated 24-h urinary sodium (7.78 mEq/day, 95% CI 2.27, 13.28 mEq/day).

CONCLUSIONS

Regular tea consumption, especially dark tea, is associated with a reduced risk of dysglycaemia and increased urinary glucose and sodium excretion in Chinese community-dwelling adults.

Can the postload-fasting glucose gap be used to determine risk of developing diabetes in chinese adults: A prospective cohort study

OBJECTIVE

To evaluate the relationship between fasting plasma glucose (FPG) and 2-hour postload plasma glucose (2hPG) measured during an oral glucose tolerance test, and the risk of developing diabetes in Chinese adults.

METHODS

We followed 3,094 participants without diabetes, categorizing them based on their oral glucose tolerance test (OGTT) results into low post load (2hPG ≤ FPG) and high post load (2hPG > FPG) at baseline. We monitored the incidence of diabetes, incidence of prediabetes, disease progression from prediabetes to diabetes and disease reversal from prediabetes to normal glucose tolerance (NGT) over an average of 3.2 years of follow-up. After the Schoenfeld residual test, Cox's time-varying covariate (Cox-TVC) models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) to compare the different clinical events between low and high post load groups.

RESULTS

In the cohort study, of the 3,094 participants, 702 (22.7 %) had low post load (2hPG ≤ FPG, mean postload-fasting gap: -0.8 ± 0.7 mmol/L) and 2,392 (77.3 %) had high post load (2hPG > FPG, mean postload-fasting gap: 1.8 ± 1.2 mmol/L). Over 3.2 ± 0.2 years of follow-up, 282 (9.1 %) developed diabetes. In the low post load group, the incidence rates per 1,000 person-years were: diabetes was 7.9, prediabetes was 70.0, disease progression from prediabetes to diabetes was 23.4 and disease reversal to NGT was 327.2. For the high post load group, incidence rates for diabetes was 13.9, prediabetes was 124.3, disease progression was 59.5 and disease reversal was 238.6 per 1,000 person-years. Participants with high post load showed higher incidence rates of diabetes, prediabetes, and progression from prediabetes to diabetes compared to those with low post load. HRs were significantly higher for incident diabetes and prediabetes, and disease progression from prediabetes to diabetes, whereas disease reversal was lower.

CONCLUSION

The risk of developing prediabetes/diabetes after 3.2 years of follow-up was higher in the participants with high post load. It suggested that postload-fasting gap may be a simple tool to predict the risk of developing prediabetes, diabetes or reversal to NGT.

Association between Regular Exercise and Urinary Uric Acid Excretion in Chinese Adults: A Cross-sectional Study

ABSTRACT

Regular exercise decreases the risk of hyperuricemia, which is related to reduced urinary uric acid excretion (UUA/UAE). However, few studies have assessed the association between regular exercise and UAE. We conducted this study to investigate their associations in the general population. This was a cross-sectional study that involved a total of 5513 Chinese community-dwellers, who reported data on physical exercise. Fasting morning spot urine was used to measure UUA and creatinine. UAE was primarily assessed by UUA to creatinine ratio (UCr) and secondly by excretion of uric acid per volume of glomerular filtration (EurGF) and fractional excretion of uric acid (FEua). Linear regression analysis was used to assess their associations. Of the included participants, their mean age was 55.1 ± 13.0 years, and 1984 (36.0%) undertook regular exercise. Compared with participants with regular exercise, those with irregular exercise or no exercise had higher UUA/UCr (0.36 ± 0.15 vs. 0.39 ± 0.15, P < 0.001), EurGF (0.23 ± 0.10 vs. 0.24 ± 0.11 mg/dL, P < 0.001), and FEua (0.07 ± 0.04 vs. 0.08 ± 0.04, P = 0.006). These associations remained significant after controlling for multivariable including serum uric acid (SUA) or upon the exclusion of participants with renal dysfunction or urinary tract infection. In conclusion, regular exercise might be associated with decreased UAE, independent of SUA, in Chinese community-dwellers.

Prevalence of Gastrointestinal Symptoms in Chinese Community-Dwelling Adults with and without Diabetes

BACKGROUND

Gastrointestinal symptoms have been reported to occur frequently in diabetes, but their prevalence in Chinese community-dwelling individuals with diabetes is unknown. The present study aimed to address this issue and explore the risk factors for gastrointestinal symptoms.

METHODS

A total of 1304 community-dwelling participants (214 with diabetes, 360 with prediabetes and 730 with normoglycemia) were surveyed for gastrointestinal symptoms using the Diabetes Bowel Symptom Questionnaire. Logistic regression analyses were applied to identify risk factors for gastrointestinal symptoms.

RESULTS

Of the overall study population, 18.6% reported at least one gastrointestinal symptom, without a significant difference between subjects with normoglycemia (17.7%), prediabetes (19.7%) and diabetes (20.1%). In all three groups, lower gastrointestinal symptoms, particularly diarrhea and constipation, were the most frequent. There was an interaction between age (≥65 years) and diabetes on the prevalence of at least one gastrointestinal symptom (p = 0.01) and of constipation (p = 0.004), with these being most frequent in subjects with diabetes aged ≥ 65 years. After multivariable adjustment, female gender and older age were associated with increased odds of at least one gastrointestinal symptom, specifically lower gastrointestinal symptoms. Older age was also associated with an increase in upper gastrointestinal symptoms.

CONCLUSIONS

Gastrointestinal symptoms are common in Chinese community-dwelling adults with and without diabetes. Females, and the elderly with diabetes, are at an increased risk of symptoms.