Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China

Association of seafood consumption with cardiovascular disease among adults in Qingdao, China

BACKGROUND AND AIMS

The relationship between seafood consumption and cardiovascular disease (CVD) is controversial, and studies have not considered competing risk events. Our study examined the association between a full range of seafood consumption and CVD incidence and mortality based on the Qingdao Diabetes Prevention Program.

METHODS AND RESULTS

We followed up 5285 participants without CVD at baseline until December 31, 2021. CVD cases and deaths were identified through record linkage with the Qingdao CVD Surveillance System and the Qingdao Death Surveillance System, respectively. Information on seafood consumption was obtained using a food frequency questionnaire. We used the Cox proportional hazard model and the competing risk model to evaluate the association between all types of seafood consumption and CVD incidence and mortality. During a median follow-up of 11.4 years, 122 CVD cases and 75 deaths occurred. After adjustment for potential confounders, compared with nonconsumers, seafood consumption of 300-500 and > 500 g/week was associated with a lower risk of CVD incidence [hazards ratio and 95 % confidence interval (CI): 0.54 (0.29-0.99) and 0.49 (0.26-0.91), respectively]. However, seafood consumption of >500 g/week had a significantly lower risk of CVD mortality [subdistribution hazard ratio and 95 % CI: 0.40 (0.17-0.95)], but it was insignificant in other groups.

CONCLUSION

Seafood consumption of 300-500 g/week and >500 g/week was associated with a lower CVD incidence and mortality. Our findings provide evidence of the recommendations of the 2022 Dietary Guidelines for Chinese residents and may guide the promotion of strategies for CVD prevention.

Differential regulation of the DNA methylome in adults born during the Great Chinese Famine in 1959-1961

BACKGROUND

Extensive epidemiological studies have established the association between exposure to early-life adversity and health status and diseases in adults. Epigenetic regulation is considered as a key mediator for this phenomenon but analysis on humans is sparse. The Great Chinese Famine lasting from 1958 to 1961 is a natural string of disasters offering a precious opportunity for elucidating the underlying epigenetic mechanism of the long-term effect of early adversity.

METHODS

Using a high-throughput array platform for DNA methylome profiling, we conducted a case-control epigenome-wide association study on early-life exposure to Chinese famine in 79 adults born during 1959-1961 and compared to 105 unexposed subjects born 1963-1964.

RESULTS

The single CpG site analysis of whole epigenome revealed a predominant pattern of decreased DNA methylation levels associated with fetal exposure to famine. Four CpG sites were detected with p < 1e-06 (linked to EHMT1, CNR1, UBXN7 and ESM1 genes), 16 CpGs detected with 1e-06 < p < 1e-05 and 157 CpGs with 1e-05 < p < 1e-04, with a predominant pattern of hypomethylation. Functional annotation to genes and their enriched biological pathways mainly involved neurodevelopment, neuropsychological disorders and metabolism. Multiple sites analysis detected two top-rank differentially methylated regions harboring RNF39 on chromosome 6 and PTPRN2 on chromosome 7, both showing epigenetic association with stress-related conditions.

CONCLUSION

Early-life exposure to famine could mediate DNA methylation regulations that persist into adulthood with broad impacts in the activities of genes and biological pathways. Results from this study provide new clues to the epigenetic embedding of early-life adversity and its impacts on adult health.

A Compendium of Perspectives on Diabetes: A Challenge for Sustainable Health in the Modern Era

Diabetes is a chronic illness. Hyperglycemia is the characteristic of this disorder. Diabetes is a global crisis which affects the economy and health of all nations. Over the last decades, the number of individuals living with diabetes has significantly increased worldwide. Asia is a key epicenter of the emerging diabetes epidemic, with China and India the two nations having the highest number of diabetic people. Economic development, modernization, unhealthy diet, population aging, and sedentary lifestyles are the major factors responsible for the increasing diabetes epidemic. Diabetes is associated with several complications, and cardiovascular disease is the most important cause of morbidity and mortality among people with diabetes. These life-threatening problems can be prevented or delayed by proper management of diabetes. Lifestyle modification is an important factor to decrease the diabetes risk. The frequency of diabetic complications will rise if there is a lack of cost-effective and sustainable interventions. Hence, prevention of diabetes and its complications such as diabetic retinopathy and cardiovascular disease should be a crucial part of all future health-related public policies among all nations. This review summarizes current epidemiological aspects of diabetes in the world along with its complications, preventive measures, and treatment.

Synergistic effects of depression and obesity on type 2 diabetes incidence in Chinese adults

BACKGROUND

Cross-sectional studies have supported the association among depression, obesity, and type 2 diabetes, but the causality remains controversial in Chinese adults. In this longitudinal study, we evaluated the synergistic effect of depression and obesity on the risk of type 2 diabetes.

METHODS

This study included 2809 participants randomly selected from the Qingdao Diabetes Prevention Program, and their type 2 diabetes incidence was determined over a follow-up period of 3 years. The WHO 2006 criteria and the Zung Self-Rating Depression Scale score were employed to identify type 2 diabetes and depression at baseline, respectively. Multivariable-adjusted logistic regression was used to evaluate the synergistic effects of depression and obesity indicators on type 2 diabetes, with adjustment for age, sex, family history of diabetes, and other potential risk factors.

RESULTS

During 3-year follow-up, 316 new incident cases were identified. The relative risk and 95% confidence interval of depression for diabetes incidence was 1.52 (1.05-2.21), after controlling for potential confounders. Sensitivity analysis showed that depression was significantly associated with diabetes incidence in women, younger people, and obese people (1.82 [1.14-2.92], 1.94 [1.25-3.02], and 4.29 [1.44-12.78], respectively]. The synergistic effects of positive depression and body mass index ≥30 kg/m² on type 2 diabetes incidence were observed, with a synergy index of 5.49 (1.75-17.19).

CONCLUSIONS

Depression was associated with a 52% increased risk of type 2 diabetes incidence and exerts synergistic effects with obesity on diabetes incidence in Chinese adults. Early identification and intervention for depression and obesity can reduce the risk of diabetes.

Famine Exposure in Early Life and Risk of Metabolic Syndrome in Adulthood: Comparisons of Different Metabolic Syndrome Definitions

This study examined the association between famine exposure in early life and the risk of metabolic syndrome (MetS) in adulthood during the 1959-1961 Chinese Famine. Two cross-sectional surveys involving randomly selected Chinese adults aged 35-74 years in the Qingdao area were conducted. A total of 9,588 individuals were grouped into four birth cohorts of unexposed (born between January 1, 1962, and December 31, 1975), fetal-exposed (born between January 1, 1959, and December 31, 1961), childhood-exposed (born between January 1, 1949, and December 31, 1958), and adolescence/adult-exposed cohorts (born between January 1, 1931, and December 31, 1948). We assessed the prevalence rate of MetS in relation to famine exposure according to three definitions of MetS by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), and China Diabetes Society (CDS). According to the CDS criterion, the prevalence rates of MetS were 17.8%, 25.7%, 31.1%, and 45.3% in the unexposed, fetal-, childhood-, and adolescence/adult-exposed cohorts, respectively (P < 0.001). For the CDS criteria, compared with individuals without famine exposure, odds ratios (95% confidence interval) for MetS were 1.36 (1.02-1.81), 1.36 (1.06-1.75), and 1.60 (1.06-2.41) in women and 1.10 (0.79-1.53), 1.07 (0.79-1.42), and 1.21 (0.74-1.99) in men who were exposed in the fetal, childhood, and adolescence/adult periods, respectively, after adjustment for age, study cohorts, residential areas, education levels, income levels, current smoking, and current drinking. The same trend was observed in fetal and childhood exposure for the NCEP-ATP III and IDF definitions, except for a marginal effect in adolescence/adult exposure. Sensitivity analysis revealed that the odds ratios for MetS prevalence for the CDS definition were 1.37 (1.03-1.82), 1.40 (1.09-1.79), and 1.58 (1.04-2.40) among fetal, childhood, and adolescence/adult exposure in rural areas, respectively. The CDS definition is superior to the other definitions for determining the association between famine exposure and MetS with respect to early life. Famine exposure in early life is associated with an increased risk of MetS in later life, especially in women. Early-life malnutrition and later life overnutrition were critical in determining adulthood metabolic disorders.

Epidemic T2DM, early development and epigenetics: implications of the Chinese Famine

The gene-environment interactions resulting from famine and the subsequent increased intergenerational risk of type 2 diabetes mellitus (T2DM) have contributed to the current epidemic of T2DM in China, which poses major social, health and economic challenges. The epidemic of T2DM could threaten national development in China through premature morbidity and mortality from T2DM and associated non-communicable diseases. The Chinese Famine (1959-1961), as a contributor to the nation's current national T2DM epidemic, provides an important and urgent public health warning. The effects of the famine give a strong message that research and actions that address the prevention of T2DM cannot be confined to lifestyle measures, as used in the landmark Da Qing study and the lifestyle prevention programmes and pharmaceutical interventions used in Western nations. To stem the T2DM epidemic, a new paradigm for prevention of T2DM must be developed. This paradigm should include a very strong emphasis on pregnancy planning and maternal and child health during and after the pregnancy. Without action, intergenerational cycles initiated by epigenetic modifications resulting from adverse environmental stimuli during the critical window of early development in utero might continue to fuel the T2DM epidemic in future generations.

Diabetes Mellitus Among Adults in Herat, Afghanistan: A Cross-Sectional Study

INTRODUCTION

Diabetes is reaching epidemic levels in Afghanistan. This study identifies the risk factors associated with diabetes in Herat City, Afghanistan, and explores the prevalence of previously undiagnosed diabetes.

METHODS

A cross-sectional study was conducted using multistage cluster sampling by adopting the World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS). We enrolled 1129 participants aged 25-70 years between May and June of 2015 (47.4% males, 52.6% females). A structured questionnaire was used for data collection of demographic, socioeconomic, and behavioral factors. Investigators collected anthropometric measurements and blood samples from study participants. A multivariable logistic regression model was used to identify factors associated with diabetes prevalence.

RESULTS

We found that the prevalence of diabetes in Herat City was 9.9% (9.8% in males and 10.1% in females). Of the 1129 respondents, only 3.3% were previously diagnosed with diabetes or were under treatment, whereas 6.6% of respondents were previously undiagnosed. The multivariable analyses showed that age, frequency of rice consumption, type of cooking oil, and systolic blood pressure were associated with diabetes.

CONCLUSIONS

This is one of the first studies to discuss the high prevalence of undiagnosed diabetes in Herat, Afghanistan. This study found several modifiable factors that were associated with diabetes in Herat, Afghanistan. Future reduction of disease burden should focus on these factors in the development of the most optimal diabetes prevention programs.

Red cell distribution width as a significant indicator of medication and prognosis in type 2 diabetic patients

Whether red cell distribution width (RDW) can be a potential indicator for diabetic nephropathy (DN) is unknown. A total of 809 type 2 diabetes mellitus (T2D) patients were divided into 4 groups according to the quartiles (Q) of the RDW (%): Q1 ≤ 12.4 (n = 229), 12.4 < Q2 ≤ 12.9 (n = 202), 12.9 < Q3 < 13.5 (n = 168), Q4 ≥ 13.5 (n = 210). Results showed that the levels in Q4 group was higher in age, disease duration, systolic blood pressure, blood urea nitrogen, creatinine, uric acid and proteinuria but lower in hemoglobin, serum albumin and glycosylated hemoglobin compared to Q1 group. Furthermore, the incidences of DN, diabetic peripheral neuropathy, hypertension and coronary heart disease in the Q3 or Q4 group were higher compared to Q1 group. Medications including calcium channel blockers and antiplatelet therapy also showed higher frequencies in Q3 or Q4 group compared to Q1. Logistic regression indicated that the antiplatelet therapy (OR = 2.065), hypertension (OR = 2.819), creatinine (OR = 4.473) and proteinuria (OR = 2.085) were positively associated with level of Q4 group, but higher hemoglobin (OR = 0.021) and serum Ca²⁺ (OR = 0.178) were negatively associated with Q4. This data suggest that high level of RDW in T2D patients indicates a higher risk and a poor prognosis for DN.

Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review

BACKGROUND

China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan.

METHODS

We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis.

RESULTS

Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age.

CONCLUSIONS

This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.

What next after basal insulin? Treatment intensification with lixisenatide in Asian patients with type 2 diabetes mellitus

There is increasing evidence that the pathophysiology of type 2 diabetes mellitus (T2DM) in Asian patients differs from that in Western patients, with early phase insulin deficiencies, increased postprandial glucose excursions, and increased sensitivity to insulin. Asian patients may also experience higher rates of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as nausea and vomiting, compared with their Western counterparts. These factors should be taken into consideration when selecting therapy for basal insulin treatment intensification in Asian patients. However, the majority of studies to establish various agents for treatment intensification in T2DM have been conducted in predominantly Western populations, and the levels of evidence available in Chinese or Asian patients are limited. This review discusses the different mechanisms of action of short-acting, prandial, and long-acting GLP-1RAs in addressing hyperglycemia, and describes the rationale and available clinical data for basal insulin in combination with the short-acting prandial GLP-1RA lixisenatide, with a focus on treatment of Asian patients with T2DM.

The utility of diabetes risk score items as predictors of incident type 2 diabetes in Asian populations: An evidence-based review

BACKGROUND

The prevalence of type 2 diabetes mellitus is rising, with many Asian countries featured in the top 10 countries with the highest numbers of persons with diabetes. Reliable diabetes risk scores enable the identification of individuals at risk of developing diabetes for early intervention.

OBJECTIVES

This article aims to identify common risk factors in the risk scores with the highest discrimination; factors with the most influence on the risk score in Asian populations, and to propose a set of factors translatable to the multi-ethnic Singapore population.

METHODS

A systematic search of PubMed and EMBASE databases was conducted to identify studies published before August 2016 that developed risk prediction models for incident diabetes.

RESULTS

12 studies were identified. Risk scores that included laboratory measurements had better discrimination. Coefficient analysis showed fasting glucose and HbA1c having the greatest impact on the risk score.

CONCLUSION

A proposed Asian risk score would include: family history of diabetes, age, gender, smoking status, body mass index, waist circumference, hypertension, fasting plasma glucose, HbA1c, HDL-cholesterol and triglycerides. Future research is required on the influence of ethnicity in Singapore. The risk score may potentially be used to stratify individuals for enrolment into diabetes prevention programmes.

Ideal cardiovascular health status and its association with socioeconomic factors in Chinese adults in Shandong, China

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. In 2010, a goal released by the American Heart Association (AHA) Committee focused on the primary reduction in cardiovascular risk.

METHODS

Data collected from 7683 men and 7667 women aged 18-69 years were analyzed. The distribution of ideal cardiovascular health metrics based on 7 cardiovascular disease risk factors or health behaviors in according to the definition of AHA was evaluated among the subjects. The association of the socioeconomic factors on the prevalence of meeting 5 or more ideal cardiovascular health metrics was estimated by logistic regression analysis, and a chi-square test for categorical variables and the general linear model (GLM) procedure for continuous variables were used to compare differences in prevalence and in means among genders.

RESULTS

Seven of 15350 participants (0.05 %) met all 7 cardiovascular health metrics. The women had a higher proportion of meeting 5 or more ideal health metrics compared with men (32.67 VS.14.27 %). The subjects with a higher education and income level had a higher proportion of meeting 5 or more ideal health metrics than the subjects with a lower education and income level. A comparison between subjects with meeting 5 or more ideal cardiovascular health metrics with subjects meeting 4 or fewer ideal cardiovascular health metrics reveals that adjusted odds ratio [OR, 95 % confidence intervals (95 % CI)] was 1.42 (0.95, 2.21) in men and 2.59 (1.74, 3.87) in women for higher education and income, respectively.

CONCLUSIONS

The prevalence of meeting all 7 cardiovascular health metrics was low in the adult population. Women, young subjects, and those with higher levels of education or income tend to have a greater number of the ideal cardiovascular health metrics. Higher socioeconomic status was associated with an increasing prevalence of meeting 5 or more cardiovascular health metrics in women but not in men. It's urgent to develop comprehensive population-based interventions to improve the cardiovascular risk factors in Shandong Province in China.

Are We in the Same Risk of Diabetes Mellitus? Gender- and Age-Specific Epidemiology of Diabetes in 2001 to 2014 in the Korean Population

In the early 2000s, the prevalence of diabetes in adults aged ≥30 years in Korea was about 9% to 10%, and it remained stable. However, a nationwide survey showed that this prevalence increased over the past few years. After age-standardization using the Korean population of the year 2010, the prevalence of diabetes in adults aged ≥30 years was 10.0% to 10.8% between 2001 and 2012, which increased to 12.5% in 2013 and 11.6% in 2014. During that period, there have been changes in the gender- and age-specific prevalence of diabetes in Korean adults. The prevalence of diabetes in the elderly population increased significantly, while this prevalence in young adults, especially in young women, did not change significantly. The contribution of each diabetic risk factor, such as obesity, β-cell dysfunction, sarcopenia, and socioeconomic status, in developing diabetes has also changed during that period in each gender and age group. For young women, obesity was the most important risk factor; by contrast, for elderly diabetic patients, sarcopenia was more important than obesity as a risk factor. Considering the economic burden of diabetes and its associated comorbidities, a public health policy targeting the major risk factors in each population might be more effective in preventing diabetes.

Epidemiology of Diabetes-Status of a Pandemic and Issues Around Metabolic Surgery

The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes, such as genetic, lifestyle, and behavioral risk factors, has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes and must recognize its heterogeneity. Future research needs to be directed at improved understanding of the potential role of determinants, such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programs. Equally important is a better understanding of the role of metabolic surgery in helping to address the management both of persons with type 2 diabetes and of those persons in the community who are at higher risk for type 2 diabetes, particularly in emerging nations where the diabetes epidemic is in full flight.

Impact of classical risk factors of type 2 diabetes among Asian Indian, Chinese and Japanese populations

AIMS

This review investigated the population impact of major modifiable type 2 diabetes (T2D) risk factors, with special focus on native Asian Indians, to estimate population attributable risks (PARs) and compare them with estimates from Chinese and Japanese populations.

METHODS

Information was obtained on risk factors in 21,041 Asian Indian, 17,774 Chinese and 17,986 Japanese populations from multiple, large, cross-sectional studies (the DECODA project) of T2D. Crude and adjusted PARs were estimated for the major T2D risk factors.

RESULTS

Age had the highest crude and adjusted PARs among Asian Indians and Chinese in contrast to waist-hip ratio among Japanese. After adjusting for age, the PAR for body mass index (BMI) in Asian Indians (41.4% [95% CI: 37.2%; 45.4%]) was second only to triglycerides (46.4% [95% CI: 39.5%; 52.8%]) compared with 35.8% [95% CI: 29.9%; 41.4%] in Japanese and 38.4% [95% CI: 33.5%; 43.2%] in Chinese people. The PAR for BMI adjusted for age, LDL and triglycerides (39.7% [95% CI: 31.6%; 47.2%]) was higher than for any other factor in Asian Indians, and was much higher than in the Chinese (16.8% [95% CI: 3.0%; 30.9%]) and Japanese (30.4% [95% CI: 17.5%; 42.2%]) populations.

CONCLUSION

This review provides estimates of the association between major risk factors and prevalences of T2D among Asian populations by examining their PARs from large population-based samples. From a public-health point of view, the importance of BMI in Asian Indians is especially highlighted in comparison to the other Asian populations. Given these results and other recent findings on the causality link between BMI and T2D, it can be postulated that obesity may be involved in the aetiology of T2D through interaction with ethnic-specific genetic factors, although ethnicity itself is not a direct risk factor for T2D as people of all ethnic backgrounds develop diabetes.

Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Hyperlipidemia in China

Background

We explored the prevalence of and risk factors for type 2 diabetes in the adult population of Shanghai (China) with and without dyslipidemia.

Material/Methods

We conducted a cross-sectional survey including 14 385 adults (aged 16 to 88 years) in Shanghai using a stratified, multistage cluster sampling approach.

Results

Type 2 diabetes and hyperlipidemia were found in 1456 (10.1%) and 4583 (31.9%) subjects, respectively. Type 2 diabetes was more common in males (11.4%) than in females (9.2%, P<0.01), in the elderly (> or =65 years, 22.5%) than in younger (<55 years, <10%, P<0.01) individuals, and in urban (12.8%) than in rural populations (5.2%, P<0.01). Diabetes incidence was higher among patients with hyperlipidemia than in controls (16.9% vs. 7.0%, P<0.01; OR=2.72, 95% CI 2.44–3.03). Compared with controls, the risk for diabetes in subjects with isolated hypertriglyceridemia, isolated hypercholesterolemia, and mixed hyperlipidemia increased 1.75-fold (95% CI 1.53–1.99), 1.53-fold (95% CI 1.17–2.01), and 2.93-fold (95% CI 2.37–3.63), respectively. The fasting plasma glucose (FPG) and 2h-postprandial plasma glucose (2h-PG) increased with age in both sexes. The age- and sex-adjusted FPG and 2h-PG levels in hyperlipidemia were significantly higher than in controls (P<0.01).

Conclusions

A high prevalence of type 2 diabetes in hyperlipidemia patients exists in Shanghai. Hyperlipidemia is associated with elevated blood glucose levels and therefore requires prompt intervention for prevention and treatment of diabetes in patients with dyslipidemia.

Low economic status is identified as an emerging risk factor for diabetes mellitus in korean men aged 30 to 59 years in korean national health and nutrition examination survey 2008 to 2010

BACKGROUND

We compared the association between economic status and the prevalence of diabetes mellitus (DM) using large nationwide datasets covering the previous 10 years in Korea.

METHODS

We analyzed the association between economic status and DM using Korean National Health and Nutrition Examination Survey (KNHANES) data from 2001 to 2010 weighted to represent the Korean population between 30 and 59 years of age. The economic status of participants was classified into quartiles according to monthly family income with an equivalence scale.

RESULTS

In men, the prevalence of diabetes in the lowest income quartile (Q1) was significantly higher than that in the other quartiles in 2008 (age and body mass index-adjusted odds ratio [OR], 1.846; 95% confidence interval [CI], 1.126 to 3.027; P=0.015), 2009 (OR, 1.706; 95% CI, 1.094 to 2.661; P=0.019), and 2010 (OR, 1.560; 95% CI, 1.024 to 2.377; P=0.039) but not in 2001 or 2005. The data indicated that classification in the lowest economic status was an independent risk factor for diabetes even after adjusting for abdominal obesity, dyslipidemia, hypertension and education level in men of KNHANES 2008 to 2010. Although economic status was significantly associated with abdominal obesity, hypertriglyceridemia, and hypertension in women (P<0.001), there was no significant association between economic status and DM in women.

CONCLUSION

Korean men between 30 and 59 years of age with the lowest economic status had a significantly higher prevalence of DM in 2008 to 2010 even after adjusting for other risk factors.

The incidence and prevalence of diabetes mellitus and related atherosclerotic complications in Korea: a National Health Insurance Database Study

AIMS/INTRODUCTION

The incidence and prevalence of type 2 diabetes mellitus (T2DM) and related macrovascular complications in Korea were estimated using the Health Insurance Review and Assessment (HIRA) database from 2007-2011, which covers the claim data of 97.0% of the Korean population.

MATERIALS AND METHODS

T2DM, coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease (PAD) were defined according to ICD-10 codes. We used the Healthcare Common Procedure Coding System codes provided by HIRA to identify associated procedures or surgeries. When calculating incidence, we excluded cases with preexisting T2DM within two years before the index year. A Poisson distribution was assumed when calculating 95% confidence intervals for prevalence and incidence rates.

RESULTS

The prevalence of T2DM in Korean adults aged 20-89 years was 6.1-6.9% and the annual incidence rates of T2DM ranged from 9.5-9.8/1,000 person-year (PY) during the study period. The incidence rates of T2DM in men and women aged 20-49 years showed decreasing patterns from 2009 to 2011 (P<0.001); by contrast, the incidence in subjects aged 70-79 years showed increased patterns from 2009 to 2011 (P<0.001). The incidence rates of CAD and CVD in patients newly diagnosed with T2DM were 18.84/1,000 PY and 11.32/1,000 PY, respectively, in the year of diagnosis. Among newly diagnosed individuals with T2DM who were undergoing treatment for PAD, 14.6% underwent angioplasty for CAD during the same period.

CONCLUSIONS

Our study measured the national incidences of T2DM, CAD, CVD, and PAD, which are of great concern for public health. We also confirmed the relatively higher risk of CAD and CVD newly detected T2DM patients compared to the general population in Korea.

Evaluating the Phase II drugs currently under investigation for diabetic neuropathy

Introduction: The worldwide number of patients suffering from diabetes mellitus (DM) is projected to approach 552 million by the year 2030. As diabetic neuropathy (DN) is present in 8% of new diabetic patients at the time of diagnosis and occurs in ∼ 50% of all patients with established DM, the number of patients who will develop painful DN will also increase. The suboptimal efficacies of currently approved drugs have prompted investigators to develop new therapeutic agents for the management of painful DN. Areas covered: In this review, the authors present and elucidate the current status of drugs under investigation for the treatment of painful DN. A short synopsis of currently approved drugs is also given. Literature information and data analysis were retrieved from PubMed, the American Diabetes and Neurological Associations Websites and ClinicalTrials.gov. The keywords used in the search included: DM, DN, painful diabetic neuropathy. Expert opinion: In addition to treating the pain associated with DN, the actual causes of the disease should also be targeted for improved management. It is hoped that drugs which improve vascular blood flow, induce neural regeneration, reduce hyperglycemia, oxidative stress and inflammation can be more effective for the overall treatment of painful DN.

Prevalence of Risk Factors for Non-Communicable Diseases in the Adult Population of Urban Areas in Kabul City, Afghanistan

BACKGROUND

Non-Communicable diseases (NCDs) are a major global problem. This study aims to estimate the prevalence of common risk factors for NCDs among the adult population in urban areas of Kabul city, Afghanistan.

METHODS AND MATERIALS

This study was conducted from December 2011 through March 2012 and involved a survey of 1169 respondents, aged 40 years and above. Multistage cluster sampling was used for participant selection, followed by random sampling of the participants. The World Health Organization STEPwise approachfor Surveillance (STEPS) was modified and used for this study.

RESULTS

The overall prevalence of smoking was 5.1% (14.7% men versus 0.3% women) and using mouth snuff was 24.4% in men and 1.3% in women. The prevalence of obesity and hypertension were 19.1% and 45.2 % in men and 37.3% and 46.5% in women. Prevalence of diabetes was 16.1% in men and 12% in women. The overall prevalence of obesity, hypertension and diabetes mellitus was 31.2%, 46% and 13.3%, respectively. On average, subjects consumed 3.37 servings of fruit and 2.96 servings of leafy vegetables per week. Mean walking and sitting hours per week (as proxies for physical activity) were 19.4 and 20.5, respectively. A multivariate model demonstrated that age was a significant risk factor for obesity (OR=1.86), diabetes (OR=2/09) and hypertension (OR=4.1). Obesity was significantly associated with sex (OR=1.65).

CONCLUSION

These results highlight the need for interventions to reduce and prevent risk factors of non-communicable diseases in urban areas of Kabul City, Afghanistan.

Diabetes: a 21st century challenge

The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes (eg, genetic, lifestyle, and behavioural risk factors) has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes, taking into account its many origins and heterogeneity. Thus, research needs to be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programmes.

Trends in the prevalence of type 2 diabetes and prediabetes in community-dwelling Japanese subjects: The Hisayama Study

Aims/Introduction

We examined secular trends in the prevalence of type 2 diabetes and prediabetes in community‐dwelling Japanese subjects.

Materials and Methods

A total of 2,490 subjects in 1988 and 2,852 subjects in 2002 aged 40–79 years underwent a 75‐g oral glucose tolerance test, and their glucose tolerance status was defined by the 1998 World Health Organization criteria.

Results

The age‐adjusted prevalence of type 2 diabetes increased significantly from 1988 to 2002 in men (14.6% in 1988 to 20.8% in 2002, P < 0.001) and women (9.1% in 1988 to 11.2% in 2002, P = 0.002). A significant rise in the age‐adjusted prevalence of prediabetes was also observed in both sexes (26.2% in 1988 to 35.3% in 2002, P < 0.001 for men; 22.5% in 1988 to 25.1% in 2002, P = 0.04 for women). In age‐stratified analysis, the prevalence of type 2 diabetes increased markedly over time in men aged 60–69 and 70–79 years (both P < 0.001) and women aged 70–79 years (P = 0.02). The prevalence of overall and central obesity increased significantly in men aged 60–69 and 70–79 years, and women aged 70–79 years from 1988 to 2002, whereas the frequency of regular exercise decreased significantly in men aged 70–79 years between the surveys.

Conclusions

Our findings suggest that the prevalence of type 2 diabetes and prediabetes increased significantly in both sexes from the 1980s to the 2000s in a general Japanese population, and that the increasing prevalence of obesity and the decline in physical activity exerted an influence on this rising trend.

Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients

BACKGROUND

Individually, diabetes mellitus, hypertension, and dyslipidemia have been shown to increase the risk of cardiovascular disease. While traditional management of Type 2 diabetes has focused mainly on glycemic control, robust evidence supports the integration of hypertension and dyslipidemia management to reduce the risk of cardiovascular disease. The primary objective of this study was to assess the level of control of blood glucose, blood pressure, and blood lipids (3Bs) among patients with type 2 diabetes. An additional objective was to investigate the impact of hospital type, physician specialty, treatment pattern, and patient profile on clinical outcomes.

METHODS

This was a cross-sectional, multicenter observational study. A nationally representative sample of outpatients with established type 2 diabetes were enrolled at hospitals representative of geographic regions, tiers, and physician specialties in China. Main clinical measurements were the levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals.

RESULTS

A total of 25,817 adults with type 2 diabetes (mean age 62.6 years, 47% male) were enrolled at 104 hospitals. Seventy-two percent reported comorbid hypertension, dyslipidemia, or both. Patients with concurrent type 2 diabetes, hypertension, and dyslipidemia were 6 times more likely to report a prior history of cardiovascular disease compared with those with type 2 diabetes alone. The mean HbA1c level was 7.6%. While 47.7%, 28.4%, and 36.1% of patients achieved the individual target goals for control of blood glucose (HbA1c <7%), blood pressure (systolic blood pressure <130 mm Hg, diastolic blood pressure <80 mm Hg), and blood lipids (total cholesterol <4.5 mmol/L), respectively, only 5.6% achieved all 3 target goals. Lower body mass index (<24 kg/m(2)), no active smoking or drinking, higher education, and diabetes duration <5 years were independent predictors of better cardiovascular disease risk control.

CONCLUSION

Achieving adequate control of risk factors for cardiovascular disease in patients with type 2 diabetes remains a clinical challenge. Interventions to achieve control of 3Bs coupled with modification of additional cardiovascular disease predictors are crucial for optimization of clinical outcomes in patients with type 2 diabetes.

Changes in cardiovascular risk factors in relation to increasing ethnic inequalities in cardiovascular mortality: comparison of cross-sectional data in the Health Surveys for England 1999 and 2004

OBJECTIVES

Reducing disease inequalities requires risk factors to decline quickest in the most disadvantaged populations. Our objective was to assess whether this happened across the UK's ethnic groups.

DESIGN

Secondary analysis of repeated but independent cross-sectional studies focusing on Health Surveys for England 1999 and 2004.

SETTING

Community-based population level surveys in England.

PARTICIPANTS

Seven populations from the major ethnic groups in England (2004 sample sizes): predominantly White general (6704), Irish (1153), Chinese (723), Indian (1184), Pakistani (941), Bangladeshi (899) and Black Caribbean (1067) populations. The numbers were smaller for specific variables, especially blood tests.

OUTCOME MEASURES

Data on 10 established cardiovascular risk factors were extracted from published reports. Differences between 1999 and 2004 were defined a priori as occurring when the 95% CI excluded 0 (for prevalence differences), or 1 (for risk ratios) or when there was a 5% or more change (independent of CIs).

RESULTS

Generally, there were reductions in smoking and blood pressure and increases in the waist-hip ratio, body mass index and diabetes. Changes between 1999 and 2004 indicated inconsistent progress and increasing inequalities. For example, total cholesterol increased in Pakistani (0.3 mmol/L) and Bangladeshi men (0.3 mmol/L), and in Pakistani (0.3 mmol/L), Bangladeshi (0.4 mmol/L) and Black Caribbean women (0.3 mmol/L). Increases in absolute risk factor levels were common, for example, in Pakistani (five risk factors), Bangladeshi (four factors) and general population women (four factors). For men, Black Caribbeans had the most (five factor) increases. The changes relative to the general population were also adverse for three risk factors in Pakistani and Black Caribbean men, four in Bangladeshi women and three in Pakistani women.

CONCLUSIONS

Changes in populations with the most cardiovascular disease and diabetes did not decline the quickest. Cardiovascular screening programmes need more targeting.

Prevalence and comorbidities of known diabetes in northeastern Italy

AIMS/INTRODUCTION

We aimed at estimating the prevalence and at identifying the frequent comorbidities of diabetes mellitus in a region of northeastern Italy from administrative health data.

MATERIALS AND METHODS

The prevalence was estimated according to two disease definitions, based on administrative health data. Association rule mining was used to detect comorbid diagnoses that coexisted with a diagnosis of diabetes among patients admitted to the regional hospitals.

RESULTS

The prevalence of known diabetes in 2010 was 6.0-8.1%, with great variations by age class (from approximately 2% <60 years to more than 20% in some elderly age groups). Of 155,494 patients admitted to the hospital in 2011, 9,358 had a diagnosis of diabetes. A total of 12 rules satisfied our criteria for support (>0.5%) and confidence (>5%), and identified nine frequent isolated comorbidities and three pairs of comorbid diagnoses. The rule with the highest support (2.4%) and confidence (39.5%) identified the combination of diabetes and essential hypertension.

CONCLUSIONS

Association rule mining was useful, because it showed the complexity of diabetic patients. Clinical management of those patients cannot neglect comorbidities.

Joint effect of family history of diabetes with obesity on prevalence of type 2 diabetes mellitus among Chinese and Finnish men and women

OBJECTIVE

To study joint effect of family history of diabetes (FHD) with obesity on prevalence of type 2 diabetes mellitus in the Chinese and in the Finns.

METHODS

A total of 1091 Chinese men and 1706 women, 1472 Finnish men and 1694 women, 45-74 years of age were studied. The probability and odds ratio (OR) of having diabetes were estimated using logistic regression analysis. The synergy index (SI) and relative excess risk due to interaction (RERI) of FHD with body mass index (BMI) or waist circumference (WC) was calculated.

RESULTS

Age-standardized prevalence of diabetes was higher in individuals with FHD than in those without in both the Chinese and Finns. Compared with individuals without FHD and with BMI <30 kg/m(2), ORs (95% confidence intervals [CI]) for diabetes were 2.7 (1.8, 4.0), 2.8 (1.9, 4.0), 9.1 (5.9, 13.9), respectively, in Finnish men with BMI ≥30 kg/m(2) alone, with FHD alone and with both (SI [95% CI] = 2.4 [1.4, 3.9], RERI = 4.6 [1.3, 8.0]); the corresponding figures were 1.7 (1.0, 2.9), 2.7 (1.8, 4.2) and 4.4 (1.9, 10.4) in Chinese men (SI = 1.4 [0.4, 4.9] RERI = 1.0 [-2.9, 5.0]). They were 3.5 (2.1, 5.8), 2.1 (1.3, 3.4) and 6.8 (4.1, 11.2) in Finnish women (SI = 1.6 [0.9, 2.8], RERI = 2.2 [-0.4, 4.9]), and 1.6 (1.1, 2.2), 2.1 (1.5, 3.0), 3.5 (1.9, 6.4) in Chinese women (SI = 1.5 [0.6, 3.8], RERI = 0.8 [-1.4, 3.0]). The pattern of synergistic effect of FHD with WC on diabetes was similar to that seen with BMI in the Finns but no effect was seen in the Chinese.

CONCLUSIONS

Both obesity and FHD are independent risk factors for diabetes, but their joint effect is significant only in Finnish men.

Association between HbA1c and cardiovascular disease mortality in older Hong Kong Chinese with diabetes

OBJECTIVE

To examine the association between baseline HbA(1c) level and mortality attributable to all-cause, cardiovascular disease, coronary heart disease and stroke.

METHODS

A total of 2137 Chinese aged 65 years or above attending the Elderly Health Service, Department of Health, Hong Kong, with diagnosed diabetes had HbA(1c) measured during 1998 to 2000 and were followed up to 2009. Information on socio-economic position, lifestyle factors and disease history was collected. Hazard ratios and 95% confidence intervals with adjustment for potential confounders were calculated using Cox's proportional hazards models.

RESULTS

After an average of 7.9 years of follow-up, 540 participants had died. After adjusting for potential confounders, higher HbA(1c) (≥ 69 mmol/mol, 8.5%) increased the risk of cardiovascular disease (hazard ratio 2.11;95% CI 1.37-3.25) and stroke mortality (hazard ratio 2.43; 95% CI 1.06-5.55) compared with HbA(1c) of 58-68 mmol/mol (7.5-8.4%), and increased the risk of all-cause (hazard ratio 1.41; 95% CI 1.06-1.86) and coronary heart disease mortality (hazard ratio 2.44; 95% CI 1.11-5.37) compared with HbA(1c) of 48 mmol/mol (6.5%) or less. Analysis of HbA(1c) as a continuous variable showed that every XX mmol/mol (1%) increase in HbA(1c) decreased stroke mortality risk by 51% in those with HbA(1c) level less than 48 mmol/mol (6.5%) and increased stroke mortality risk by 30% in those with an HbA(1c) level of 48 mmol/mol (6.5%) or higher, suggesting a U-shaped association between HbA(1c) and stroke mortality.

CONCLUSION

High HbA(1c) predicted excess risk of all-cause, cardiovascular disease, coronary heart disease and stroke mortality. The question of whether low HbA(1c) increases mortality in older patients with diabetes needs further investigation.

The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives

Over the past three decades, the number of people with diabetes mellitus has more than doubled globally, making it one of the most important public health challenges to all nations. Type 2 diabetes mellitus (T2DM) and prediabetes are increasingly observed among children, adolescents and younger adults. The causes of the epidemic of T2DM are embedded in a very complex group of genetic and epigenetic systems interacting within an equally complex societal framework that determines behavior and environmental influences. This complexity is reflected in the diverse topics discussed in this Review. In the past few years considerable emphasis has been placed on the effect of the intrauterine environment in the epidemic of T2DM, particularly in the early onset of T2DM and obesity. Prevention of T2DM is a 'whole-of-life' task and requires an integrated approach operating from the origin of the disease. Future research is necessary to better understand the potential role of remaining factors, such as genetic predisposition and maternal environment, to help shape prevention programs. The potential effect on global diabetes surveillance of using HbA(1c) rather than glucose values in the diagnosis of T2DM is also discussed.

Prevalence of metabolic syndrome in rural and urban Chinese population in Qingdao

AIMS

To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population.

SUBJECTS AND METHODS

A population-based crosssectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35-74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEPATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used.

RESULTS

The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6%in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria.

CONCLUSIONS

Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

Fresh vegetable intake and prevalence of diabetes in a Chinese population in Qingdao

OBJECTIVE

To investigate the association of fresh vegetable consumption with the risk of diabetes in a Chinese population.

METHODS

Data from 2386 individuals aged 35-74 years who participated in a population-based cross sectional diabetes survey in Qingdao, China were analyzed. Frequency of vegetable intake was obtained using a food frequency questionnaire. Diabetes was defined as self-reported diabetes or undiagnosed diabetes determined by 2-h 75 g oral glucose tolerance test or fasting capillary blood glucose test. Multivariate-adjusted odds ratio (OR) for the presence (vs. the absence) of diabetes in association with the frequency of fresh vegetable intake was estimated using logistic regression analysis.

RESULTS

The OR for the presence of diabetes was 1.17 (95% CI 0.66, 2.05) in men and 0.50 (95% CI 0.33, 0.77) in women who ate fresh vegetables more than 14 times/week as compared with those who ate fresh vegetables less than 7 times/week after adjustment for age, family history of diabetes, BMI, systolic blood pressure, 24-h energy intake, physical activity and smoking and drinking.

CONCLUSIONS

Consumption of fresh vegetables was associated with a low risk of having diabetes in women but not in men in this Chinese population.

Elevated serum uric acid predicts impaired fasting glucose and type 2 diabetes only among Japanese women undergoing health checkups

AIM

This study assessed whether or not elevated serum uric acid can predict impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM) in Japanese people undergoing health checkups.

METHODS

Altogether, 7114 male and 5529 female participants in both 2000 and 2005 were targeted for the study. After excluding those with IFG and T2DM, multiple logistic-regression analyses of 6408 men and 5309 women-average ages 48.4±10.2 and 50.0±9.1 years, respectively-were performed to identify independent risk factors for newly diagnosed IFG and T2DM in 2005, after adjusting for age, parental history of diabetes, body mass index (BMI), elevated blood pressure or hypertension, fatty liver, hypertriglyceridaemia, alcohol consumption and smoking status.

RESULTS

Prevalence rates for IFG and T2DM, and values for BMI, systolic and diastolic blood pressure, fasting blood glucose and triglycerides, showed significantly increasing trends in relation to serum uric acid quartiles in both genders. IFG and T2DM were newly diagnosed in 8.1% of men and 4.0% of women in 2005. Using multivariate models, the highest quartile of serum uric acid and increases in serum uric acid were independent risk factors, but only in women. Serum uric acid was not a risk factor in men when categorized by the cut-off values of 4.8 mg/dL, the limit for the highest quartile in women, and of 7.0 mg/dL.

CONCLUSION

Elevated serum uric acid predicted IFG and T2DM only in Japanese women undergoing regular health checkups.

Glucose intolerance and cardiovascular risk factors in Hong Kong: data from two occupation-based cross-sectional surveys

AIMS

To examine the distribution of plasma glucose and related cardiovascular risk factors in two occupation-based cross-sectional surveys in a Chinese ethnic population.

METHODS

Two cross-sectional surveys in a Hong Kong working population. In 1990, 1496 participants aged 18-66 years underwent an OGTT, anthropometric, and other biochemical measures. Identical measures were collected from 534 participants aged 20-72 years in 2001-2003. Data were direct age-standardised to compare CVD risk factor prevalence. Linear regression modelling was used to examine the distribution of continuous CVD risk factors.

RESULTS

Mean (SD) 2-h plasma glucose values were 5.6mmol/l (2.1) in 1990 and 6.5mmol/l (2.5) in 2001-2003, an apparent increase of 0.5mmol/l (95% CI 0.3 to 0.7, p<0.001) after age and sex adjustment. However, there was no significant difference in the age-standardised prevalence of glucose intolerance, overweight or obesity. There were significantly smaller proportions of women with hypertension and hyperlipidaemia and male smokers in the second compared to the first survey.

CONCLUSIONS

We observed a relatively adverse glycaemia profile, which may have worsened over time, in two healthy populations of survey respondents, with comparatively low rates of most CVD risk factors. This has implications for the future burden of disease associated with hyperglycaemia in this population.

A large-scale diabetes prevention program in real-life settings in Qingdao of China (2006-2012)

AIMS

Qingdao Diabetes Prevention Program aims to translate the trial experience to real-life settings with goals to: (1) raise the public awareness of diabetes and diabetes risk factors, and promote healthy diet and physical activity; (2) reduce the number of high-risk people developing diabetes through lifestyle counselling; (3) early diagnosis of diabetes; (4) evaluate the effectiveness, cost-effectiveness, feasibility, acceptability and sustainability of the programs.

PROGRAM DESIGN

The project's first phase (2006-2009) was focused on health promotion targeting at the entire population of 1.94 million, and training of professionals; and the second phase (2009-2012) on lifestyle counselling targeting at individuals with a diabetes risk score of >or=14. The effectiveness of the intervention and the cost-effectiveness of the program between the intervention arm (n=8000) and the control arm (n=4000) who are randomly selected from the project targeting and not-targeting areas will be evaluated with the diabetes incidence as the primary outcome. Milestone achieved from 2006 to 2009: 3993 health professionals finished training courses; 724,130 educational booklets were distributed to families and 318,284 high-risk individuals recorded and 130,164 underwent at least one follow-up counselling session.

Worsening trend of central obesity despite stable or declining body mass index in Hong Kong Chinese between 1996 and 2005

We analyzed the obesity trends in Hong Kong using data from a health assessment program. We recruited 84 357 subjects (27 452 men and 56 905 women; age: mean+/-s.d. 49.0+/-14.7 years, range 20-98 years) in three phases: (1) April 1996 to August 1997 (n=17 119); (2) February 2001 to December 2002 (n=16 978); and (3) January 2004 to December 2005 (n=50 260). Waist circumferences were available only in phases 2 and 3. Central obesity was defined as waist > or =90 cm in men and > or =80 cm in women. Overweight and obesity (general) were defined as body mass index (BMI) > or =23 and > or =25 kg/m(2), respectively. The age-standardized rate (95% CI) of general obesity was stable in men (31.6% (29.6, 33.7) in 1996 vs 31.0% (30.0, 32.0) in 2005, P: NS) but declined in women (22.4% (21.3, 23.5) in 1996 vs 18.8% (18.2, 19.4) in 2005, P<0.05). The prevalence of central obesity increased from 23.0% (20.6, 25.4) in 2001 to 26.9% (26.0, 27.8) in 2005 in men (P<0.05) and remained stable in women, with corresponding rates of 27.5% (25.8, 29.3) and 26.6% (26.0, 27.3), respectively (P: NS). In summary, despite stable or declining BMI, age-standardized central obesity failed to decline in Hong Kong Chinese women and continued to increase in Chinese men over a 10-year period.

Performance of an A1C and fasting capillary blood glucose test for screening newly diagnosed diabetes and pre-diabetes defined by an oral glucose tolerance test in Qingdao, China

OBJECTIVE The study's goal was to evaluate the performance of A1C and fasting capillary blood glucose (FCG) tests as mass screening tools for diabetes and pre-diabetes, as determined by the standard oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS Data from 2,332 individuals aged 35-74 years who participated in a population-based cross-sectional diabetes survey in Qingdao, China, were analyzed. A 2-h 75-g OGTT was used to diagnose diabetes. The performance of A1C and FCG was evaluated against the results of the OGTTs by using receiver operating characteristic curve (ROC) analysis. RESULTS The prevalence of newly diagnosed diabetes and pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) was 11.9 and 29.5%, respectively. For subjects with newly diagnosed diabetes, the area under the ROC curve was 0.67 for A1C and 0.77 for FCG (P < 0.01) in men and 0.67 and 0.75 (P < 0.01) in women, whereas for pre-diabetes, these values were 0.47 and 0.64 (P < 0.001) in men and 0.51 and 0.65 (P < 0.001) in women. At the optimal A1C cutoff point of > or =5.6% for newly diagnosed diabetes, sensitivities (specificities) were 64.4% (61.6%) for men and 62.3% (63.3%) for women. CONCLUSIONS As a screening tool for newly diagnosed diabetes and pre-diabetes, the FCG measurement performed better than A1C in this general Chinese population.