The medications and health care utilization of patients newly diagnosed with type 2 diabetes mellitus: A nationwide population-based cohort study.

BACKGROUND/PURPOSE: The prevalence of young-onset diabetes (YOD) is increasing in Asia, but little is known about the metabolic control, associated complications, or medical behavior in this population. Our aim was to assess the prevalence of young-onset and late-onset type 2 diabetes mellitus (T2DM) and their associated risk factors and medical behaviors in Taiwan. METHODS: Data were collected from the National Health Insurance Research Database of Taiwan on 11,244 patients from 2008 to 2013. We classified patients with young-onset diabetes if they were diagnosed before 40 years of age and late-onset diabetes (LOD) if diagnosed at 40 years of age or older. We analyzed the prevalence, medication, and medical behaviors between these groups. RESULTS: We enrolled 2556 newly diagnosed T2DM patients in 2012. Demographics and comorbidities were recorded from YOD (n = 311) and LOD (n = 2245) patients. Most newly diagnosed patients started with monotherapy and almost half of them with sulfonylurea. The prevalence of YOD in Taiwan is up to 12%. In terms of treatment, 42% of T2DM patients are treated in clinics, 58% in hospital, and 25.2% by an endocrinologist. CONCLUSION: Our study highlights the rising trend of YOD in Taiwan. National endeavors are urgently needed for early diagnosis, effective management, and primary prevention of diabetes.

Sarcopenia among the Elderly Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose. This systematic review and meta-analysis was conducted to explore the effect of protein intake on the prevention and improvement of sarcopenia. Methods. We searched the Cochrane Library, PubMed, and EMBASE from inception to 20 May 2021. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Results. There were 12 studies that met the selection criteria among 53 eligible publications. The results of the study show that the protein intake has no significant effect on the physical performance-4 m gait speed, chair rise test, short physical performance battery, muscle mass-skeletal muscle mass index, and muscle strength-hand grip strength. Conclusion. Protein supplementation had no significant effect on 4 m gait speed and on improving skeletal muscle mass index, hand grip strength, chair rise test, and short physical performance battery. Additional randomized controlled trials are warranted to adequately assess the effect of protein supplementation on elderly sarcopenia.

Community-based study on summer-winter difference in insulin resistance in Kin-Chen, Kinmen, Taiwan.

BACKGROUND: The aim of this community-based study was to explore the summer-winter difference in insulin resistance in Kin-Chen, Kinmen. METHODS: A total of 2,412 residents aged 40 and over was enrolled in a mass survey in Kin-Chen, Kinmen, by the Yang-Ming Crusade, a volunteer organization of well-trained medical students from National Yang-Ming University. All participants were investigated in winter (first phase, January and February, before Chinese New Year) and summer (secondary phase, July and August) in 2002. Structured questionnaires, demographic and physical data, lifestyle, and blood chemistry parameters were collected. RESULTS: Higher levels of fasting insulin, HOMA-insulin resistance and triglycerides, but lower levels of high-density lipoprotein cholesterol were found in summer than in winter. The prevalence of metabolic syndrome was higher in summer than in winter, with differences of 7.7% in both genders (p = 0.0092 in men, p = 0.0037 in women). Body mass index (BMI), age and physical activity were significantly correlated with metabolic syndrome. After controlling for BMI and other risk profiles, summer was independently and positively associated with fasting insulin and insulin resistance regardless of metabolic syndrome. CONCLUSION: Fasting insulin, insulin resistance and prevalence of metabolic syndrome were higher in summer than in winter. BMI and season were 2 major determinants of the variation in fasting insulin. The contextual impacts of seasonal variation in shaping metabolic syndrome or insulin resistance in populations need to be reemphasized.

Glycaemic responses in Asian and non-Asian people with type 2 diabetes initiating insulin glargine 100 units/mL: A patient-level pooled analysis of 16 randomised controlled trials.

AIMS: To compare outcomes between Asian and non-Asian patients with type 2 diabetes (T2D) inadequately controlled on oral antidiabetic drugs (OADs) initiating insulin glargine 100 units (U)/mL (Gla-100) in randomised controlled clinical trials. METHODS: Post hoc analysis of patient-level data (Asian n = 235; non-Asian n = 3351) from 16 trials. RESULTS: At baseline, Asian patients were younger with lower body mass index (BMI), fasting C-peptide, and fasting plasma glucose (FPG) than non-Asian patients (all P < .001). Asian patients had a higher mean glycosylated haemoglobin (HbA1c) at Week 24 and less reduction in HbA1c from baseline (7.4% vs. 7.2%; -1.3% vs. -1.6%, respectively; P = .0001), and were less likely to achieve HbA1c <7.0% (40% vs. 47%; P = .002) than non-Asian patients. Reductions in FPG and rates of hypoglycaemia were similar between Asian and non-Asian patients. Asian patients had less weight gain than non-Asian patients (+1.3 vs. +1.9 kg, respectively, P = .013). CONCLUSIONS: In our post hoc meta-analysis, Gla-100 effectively lowers HbA1c and FPG in Asian patients with T2D uncontrolled on OADs with similar incidence of hypoglycaemia and less absolute weight gain compared with non-Asian patients. At a similar FPG reduction, fewer Asian patients achieved HbA1c target <7.0%, suggesting that prandial glucose needs to be addressed.

A community-based study of chronic kidney disease among type 2 diabetics in Kinmen, Taiwan.

Diabetic nephropathy is the major cause of end-stage renal disease. Many studies show that chronic kidney disease can be prevented, or its progression to end-stage renal disease delayed, by effective intervention. The aim of this study was to estimate the prevalence of proteinuria and renal impairment in patients with type 2 diabetes. A community-based screening for chronic kidney disease in type 2 diabetic patients was conducted in 1999-2001. Proteinuria was defined in terms of urine protein-to-creatinine ratio. The glomerular filtration rate per 1.73m(2) body surface area was calculated using an equation from the Modification of Diet in Renal Disease Study. The overall response rate was about 78.6%. Prevalence rates of proteinuria and renal impairment were 29.4% and 15.1%, respectively. Females had higher prevalence of proteinuria and renal impairment than males. And prevalence increased with increasing age. Hypertension was associated with both proteinuria and renal impairment. Only 43.0% of patients with stages 3-5 chronic kidney disease had proteinuria. Proteinuria and renal impairment screening may identify different segments of the diabetic population. Both a glomerular filtration rate and proteinuria test are recommended as screening tools for early detection of chronic kidney disease in type 2 diabetics.

A community-based study of the relationship between insulin resistance/beta-cell dysfunction and diabetic retinopathy among type II diabetics in Kinmen, Taiwan.

PURPOSE: To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan. METHODS: A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45 degrees color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction. RESULTS: Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62-3.05), 2.37 times (95% CI: 1.19-4.69), and 4.16 times (95% CI: 2.15-8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%-82%), 82% (95% CI: 58%-92%), and 82% (95% CI: 60%-92%) compared to that in the 1st quartile, respectively. CONCLUSIONS: Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes.

Interrelationship between insulin resistance and menopause on the metabolic syndrome and its individual component among nondiabetic women in the kinmen study.

BACKGROUND: The literature to date is not clear as to whether any interactive effect exists between insulin resistance and menopause on the metabolic syndrome and its individual components. We explored this issue in 4107 homogeneous, nondiabetic Chinese women in the Kinmen Study. METHODS: Overnight fasting blood samples were drawn for glucose, insulin, lipid, and other biochemical measurements. Demographic and clinical variables including body mass index, waist circumference, and blood pressure were measured and documented during face-to-face interviews with structured questionnaires. Menstrual history was used to define menopause as the absence of menses for 12 consecutive months. RESULTS: Approximately 16% of premenopausal women (390/2423) were insulin-resistant. After adjustment for age, body mass index, lifestyle, and diet, both menopause and insulin resistance were independently and significantly correlated with metabolic syndrome. For each component of the metabolic syndrome, besides the main effect, the interaction (insulin resistance x menopause) had significant correlation with systolic blood pressure, diastolic blood pressure, and waist circumference. CONCLUSIONS: Both insulin resistance and menopause have significant effects on metabolic syndrome independent of age and obesity. In premenopausal and nondiabetic women, various degrees of insulin resistance exist. The synergistic contribution of insulin resistance and menopause to components of the metabolic syndrome were observed with systolic blood pressure, diastolic blood pressure, and waist circumference. This requires further study.

Optimizing Glycemic Control Through Titration of Insulin Glargine 100 U/mL: A Review of Current and Future Approaches with a Focus on Asian Populations.

Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulin-an issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors' clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizing the dose of basal insulin, enabling a larger number of patients in Asia to reach their target glycemic goals with improved outcomes.

Presence and progression of abdominal obesity are predictors of future high blood pressure and hypertension.

BACKGROUND: General obesity and its progression are major predictors of future hypertension. It has not been established whether abdominal obesity contributes to the development of hypertension. METHODS: A community-based study population of 2377 normotensive nondiabetic Chinese adults aged >or=30 years were re-examined 10 years after their baseline examination. RESULTS: The 10-year cumulative incidence of hypertension was 25.9%. The standardized parameters for the prediction of follow-up systolic blood pressure (BP) for baseline body mass index (BMI), change in BMI, baseline homeostasis model assessment of insulin resistance (HOMA-IR), change in HOMA-IR, baseline waist circumference (WC), and change in WC were 0.19 (P < .001), 0.09 (P < .001), 0.11 (P < .001), 0.08 (P < .001), 0.16 (P < .001), and 0.07 (P < .001), respectively, when age, sex, and baseline systolic BP were accounted for. By stepwise linear regression analysis, age, baseline systolic BP, baseline BMI, change in BMI, baseline WC, and change in WC were significant predictors of the follow-up systolic BP. Both baseline WC and change in WC were significant predictors of follow-up systolic BP or incident hypertension when age, sex, baseline systolic BP, BMI, and change in BMI were accounted for. In a subgroup of younger adults with normal BMI and BP<130/85 mm Hg, baseline systolic BP, change in HOMA-IR, baseline WC, and change in WC were significantly independent predictors of follow-up systolic BP. CONCLUSION: Abdominal obesity and its progression are predictors of future BP and hypertension incidence, independent of the effects of general obesity.

Metabolic characteristics and insulin resistance of impaired fasting glucose among the middle-aged and elderly Taiwanese.

Impaired fasting glucose (IFG), a newly defined category of glycemic metabolism, has gained extensive attentions after the introduction of the diagnostic criteria of diabetes mellitus (DM) by the American Diabetes Association. To explore the metabolic characteristics of IFG, we conducted this prospective community-based study among people aged more than 40 years residing in three major townships of I-Lan, an agricultural county in Taiwan. People attending the annual health examinations in community health stations were recruited for study. Experienced research staff recorded the past medical history, performed comprehensive physical examinations, and drew blood for further laboratory tests for each subject. Insulin resistance was evaluated by homeostasis model assessment (HOMA), and the renal hemodynamics was evaluated by estimated glomerular filtration rate (GFR). In total, 824 subjects (mean age=64.4+/-11.3 years, M:F=366:458) participated this study, the overall prevalence of DM was 15.3% (8.7% previously undiagnosed), and the prevalence of IFG was 7.2%. Lipid profiles including serum levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride of subjects with IFG were basically indistinguishable from subjects with DM. Insulin resistance was significantly associated with the progression of glycemic metabolism (HOMA-IR of subjects with normal fasting glucose, IFG, and DM were 1.12+/-1.24, 1.88+/-1.64, 4.47+/-5.12, P<0.001). However, the prevalence of metabolic syndrome was similar among subjects of IFG and DM (86.4 versus 85.6%). The prevalence of overt proteinuria was significantly increased as the glycemic metabolism progressed. The mean GFR was slightly increased in subjects with IFG, which may represent hyperfiltration in this category. In conclusion, metabolic characteristics of IFG were complex. Lipid profile and prevalence of metabolic syndrome of IFG were indistinguishable from DM, but renal hemodynamics and prevalence of overt proteinuria were intermediate between NFG and DM. To prevent or delay the onset of type 2 DM, aggressive lifestyle modifications should be engaged in our clinical practice for subjects with IFG.

Predictors of incident diabetes, metabolic syndrome in middle-aged adults: a 10-year follow-up study from Kinmen, Taiwan.

AIMS/HYPOTHESIS: The aim of this prospective study was to assess a population-based cohort for the predictors of incident diabetes and metabolic syndrome, which is most likely to lead to cardiovascular disease. METHODS: We compared the baseline individual components of metabolic syndrome, adopted from the NCEP ATP III for Asians, in 3629 subjects who developed diabetes, metabolic syndrome, or diabetes and metabolic syndrome to those who remained free of diabetes and metabolic syndrome for 10 years. RESULTS: The incidence rate of diabetes was 7.8% (9.8% in men and 6.3% in women, respectively), and metabolic syndrome was 24.2% (23.4% in men and 24.7% women, respectively). Eighty-five men and 99 women developed diabetes and metabolic syndrome, which yielded incidence rates of 5.7% in men and 4.7% in women. After adjustment for related covariable factors, each component of metabolic syndrome in women, higher triglyceride and greater waist circumference in men, independently predicted future incident diabetes and metabolic syndrome as compared with those who remained free of diabetes and metabolic syndrome. CONCLUSIONS/INTERPRETATION: These findings suggest that several components of metabolic syndrome independently precede the development of diabetes and metabolic syndrome. Further intervention studies are required to demonstrate the benefits of intervention with all aspects in decreasing the incidence of diabetes and metabolic syndrome in the general population.

Increased circulatory MMP-2 and MMP-9 levels and activities in patients with type 1 diabetes mellitus.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder of unknown etiology. It has been suggested that metalloproteinases (MMPs) play important roles in the development and complications of autoimmune disorders. This article presents our research on the expression or activities of MMPs in Taiwanese T1DM patients. METHODS: Levels and activities of plasma MMP-2 and MMP-9 in patients with T1DM were investigated and compared to those of control individuals by enzyme-linked immunosorbent assay and zymography. RESULTS: Circulatory levels and activities of MMP-2 and MMP-9 in patients with T1DM were significantly higher than those in control subjects. CONCLUSIONS: MMP expression and activities are significantly increased in patients with T1DM. Our results not only document plasma MMPs levels and activities in the Taiwanese population (with a very low type 1 diabetic incidence), but also suggest that MMP expression and activity are elevated before the onset of complications in diabetic patients.

Treatment of type 2 diabetes mellitus in a primary care setting in Taiwan: comparison with secondary/tertiary care.

BACKGROUND: This study investigated the status of diabetes control and management in patients treated in a primary healthcare setting and compared the results with data previously obtained for secondary/tertiary care patients in Taiwan. METHODS: This study was conducted at 51 primary healthcare stations randomly selected island-wide in Taiwan in 2001. A total of 1302 type 2 diabetes patients who had been followed-up for more than 1 year were included. Blood was collected for centralized HbA1c assay. The remaining data and information were collected by review of medical records and patient interview. RESULTS: Compared with the results of a previous study on patients treated in a secondary/tertiary care setting, a significantly smaller percentage of primary care patients were receiving insulin therapy. Primary care patients also had a shorter duration of diabetes, a higher HbA1c level, better blood pressure control and a lower prevalence of complications. The proportion of patients achieving optimal control of glycemia and blood pressure was low. Patients aged < 65 years had a significantly shorter duration of diabetes, poorer diabetes control and better blood pressure control than elderly patients aged > or = 65 years. Primary care patients aged > or = 65 years had a significantly higher frequency of stroke than those aged < 65 years. The elderly group of secondary/tertiary care patients had a significantly higher frequency of coronary heart disease and stroke. Duration of diabetes and hypertension were the leading risk factors for complications in diabetes patients treated in both primary and secondary/tertiary care settings. CONCLUSION: Diabetes control was poorer in primary care than in secondary/tertiary care patients, but control of blood pressure was better in primary care patients. The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged < 65 years compared with their elderly counterparts might be related to a lower prevalence of complications.

Persistent impaired glucose tolerance, insulin resistance, and beta-cell dysfunction were independent predictors of type 2 diabetes.

BACKGROUND AND OBJECTIVE: To compare clinical profiles and risk of diabetes between subjects with transient (trIGT) and persistent (pIGT) impaired glucose tolerance in Taiwan. STUDY DESIGN AND SETTING: In the pIGT group, IGT was diagnosed in two consecutive periods (1992-1994 and 1995-1996); in the trIGT group, the diagnosis was IGT at the baseline but normal glucose tolerance in the second period. The normal group was defined by fasting plasma glucose < 6.1 mmol/L and 2-hour post-load plasma glucose < 7.8 mmol/L in both periods. All three groups were considered eligible subjects for further follow up (1998-1999). RESULTS: Among 298 nondiabetic subjects at baseline, there were 29 new cases of diabetes diagnosed according to 1999 WHO criteria in 1,614.3 person-years of follow-up (1.79%/year; 95% CI = 1.14-2.44%/year). Among subjects with normal, trIGT, or pIGT, the incidence rates were 0.73%/year (8/1,093.0; 95% CI = 0.22-1.24%/year), 2.57%/year (7/272.2; 95% CI = 0.67-4.47%/year), and 5.62%/year (14/249.1; 95% CI = 2.68-8.56%/year), respectively. CONCLUSION: The group with trIGT had abnormal glucose tolerance and beta-cell dysfunction, which may represent an earlier stage than the group with pIGT in development of type 2 diabetes. Moreover, pIGT, insulin resistance, and beta-cell dysfunction played independent roles in the deterioration from IGT to diabetes.

Serum insulin, insulin resistance, beta-cell dysfunction, and gallstone disease among type 2 diabetics in Chinese population: a community-based study in Kinmen, Taiwan.

AIM: To explore the association of serum insulin, insulin resistance, and beta-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and beta-cell dysfunction (HOMA beta-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4(th) vs 1(st) quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4(th) vs 1(st) quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA beta-cell function was significantly related to decreased risk of GSD [4(th) vs 1(st) quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA beta-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and beta-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.

National Variations in Comorbidities, Glycosylated Hemoglobin Reduction, and Insulin Dosage in Asian Patients with Type 2 Diabetes: The FINE-Asia Registry.

INTRODUCTION: The First Basal Insulin Evaluation (FINE) Asia study was a prospective, observational registry evaluating basal insulin initiation in Asian patients with type 2 diabetes mellitus inadequately controlled by oral antihyperglycemic agents. METHODS: The objective of this post hoc analysis was to observe and report the findings from individual participating countries. The primary endpoint was change in glycosylated hemoglobin (HbA1c) from baseline to month 6 after basal insulin initiation. Secondary endpoints included change in fasting blood glucose (FBG), percent of patients achieving target HbA1c and FBG levels, average insulin doses, and hypoglycemic events. RESULTS: The study included 2921 patients from 11 Asian countries at baseline, 2679 (92%) of whom had evaluable data. Following initiation of basal insulin (neutral protamine Hagedorn insulin, glargine, or detemir), there was a significant (P < 0.001) difference in HbA1c reduction and proportions of patients meeting HbA1c and FBG targets (<7% and <110 mg/dL, respectively) across all country cohorts by month 6. Glycemic control also varied greatly, with 7.4% (Taiwan) to 71.5% (China) of patients reaching target HbA1c <7% levels. Mean (±standard deviation) insulin dose increases over the 6-month period ranged from 0.5 ± 3.1 U (Pakistan) to 6.0 ± 8.6 U (Thailand). Hypoglycemia rates also varied, with 7.1% (India) to 27.3% (China) of patients experiencing one or more events. CONCLUSIONS: Data from the FINE-Asia registry study show widely varying degrees of baseline comorbidities and glycemic control in patients among the country cohorts observed. Countries with >9 years of diabetes prior to insulin initiation had the lowest reductions in HbA1c and proportions of patients achieving HbA1c and FBG targets, suggesting that earlier basal insulin initiation may afford better glycemic control in these patients. FUNDING: This study was funded by Sanofi.

Glycosylated hemoglobin level and number of oral antidiabetic drugs predict whether or not glycemic target is achieved in insulin-requiring type 2 diabetes.

AIMS: Factors predicting success (glycosylated hemoglobin (A1C)<7%) with insulin therapy in patients with insulin-requiring type 2 diabetes need to be identified. METHODS: A retrospective, multi-center, observational study was conducted for outpatients with oral antidiabetic drug (OAD)-treated type 2 diabetes whose A1C levels remained above 7%. Patients were begun on basal insulin between January 2005 and December 2006. Biochemical variables and demographic data were collected before and after 52 weeks of insulin therapy. RESULTS: A total of 565 patients (age, 60.4±11.9 years; A1C levels, 10.11 ±1.81%; duration of diabetes, 11.5±6.8 years) were studied. By study end, 63 patients (11.2%) had achieved the glycemic goal (A1C<7%). The glycemic goal attainment rate was only 9.1% in patients with A1C>8.8% and who were taking >2 OADs at baseline. The highest rate (32.7%) of successful glycemic control was observed in the group of patients with A1C ≤ 8.8% and who used ≤ 2 OADs at baseline. CONCLUSIONS: Insulin-naïve diabetic patients with A1C>8.8%, especially those who are taking >2 OADs, have small chance to achieve good glycemic control with adding only basal insulin therapy.

Comparison of metabolic risk profiles between subjects with fasting and 2-hour plasma glucose impairment: The Kinmen Study.

A two-step screening strategy was used to compare the metabolic risk profiles between subjects from Kinmen, Taiwan, who had fasting and 2-hr plasma glucose impairment and were considered at high risk of diabetes due to a fasting plasma glucose (FPG) between 5.6 and 7.8 mmol/l at the baseline screening. 1855 subjects without a previous diagnosis of diabetes who had an FPG of 5.6-7.8 mmol/l at the first step of screening were invited to undergo an Oral Glucose Tolerance Test (OGTT) for the second step of screening, and 1456 of these subjects (774 males and 682 females) completed the OGTT. Subjects who completed the OGTT were classified into normal, isolated impaired fasting glucose (isolated IFG), isolated impaired glucose tolerance (isolated IGT), both IFG and IGT, or undiagnosed diabetes groups. Sex-specific, age-adjusted mean values of metabolic risk profiles for various categories of glucose intolerance were calculated. The results for IFG and IGT agreed in only 20.8% of subjects. The clinical features of subjects with IGT (2-hr glucose impairment) were associated with cardiovascular risk profiles, while those subjects with isolated IFG (fasting glucose impairment only) were not. If the definition of IFG alone had been used for glucose intolerance screening, about 66.6% of subjects with IGT (i.e., isolated IGT with 2-hr glucose impairment and a normal fasting state) who had cardiovascular risk profiles would have been undetected.

Relative role of insulin resistance and beta-cell dysfunction in the progression to type 2 diabetes--The Kinmen Study.

This study compared the relative role of insulin resistance and beta-cell dysfunction (both assessed using the HOMA method) with glucose intolerance conditions in the progression to type 2 diabetes among a high risk group of subjects with fasting plasma glucose (FPG) 5.6-7.0 mmol/l in Kinmen, Taiwan. Data were collected during a continuing prospective study (1998-99) of a group of Taiwanese subjects at high-risk of developing type 2 diabetes who had fasting hyperglycemia (5.6-7.0 mmol/l) and exhibited 2-h postload glucose concentrations <11.1 mmol/l from 1992-94 to 1995-96. Among 644 non-diabetic subjects at baseline, 79.8% (514/644) had at least one follow-up examination. There were 107 new cases of diabetes diagnosed by 1999 WHO criteria in 2918.7 person-years of follow-up. The incidence rate was 3.67%/year (107/2918.7). After adjustment for other possible associative variables, including gender, age, BMI, waist circumference, insulin resistance, and beta-cell dysfunction, Cox's hazard model showed that those individuals with isolated IFG (impaired fasting glucose) and those individuals with isolated IGT (2-h glucose impairment) exhibited similar risk of developing diabetes. Those individuals with isolated IFG and isolated IGT showed a comparable impairment of basal or hepatic insulin sensitivity, but those individuals with isolated IFG had a greater beta-cell dysfunction by the HOMA method.

Predicting factors associated with costs of diabetic patients in Taiwan.

This study examined healthcare costs for medication-using diabetic patients in Taiwan and predicted which factors were associated with costs. We analyzed claims data from the National Health Insurance (NHI) program in Taiwan from 1998 to 1999. The approach included estimates of costs attributable to diabetes, diabetes-related complications, comorbidity incurred by diabetic patients. A multiple regression model was used to assess the contribution of patients' characteristics in 1998 on outpatient, inpatient, and total costs in 1998 and 1999. The prevalence of medication-using patients with diabetes was 2.6% in 1998 and 2.8% in 1999. Costs of healthcare were 13.3% of total costs of NHI in 1998 versus 13.0% in 1999. Health services delivered near the end of life consumed large portions of medical dollars. The three most prevalent clinical associations of diabetes were congestive heart failure, neuropathy, and ischemic heart disease. Adjusted for demographic and clinical characteristics in 1998, this model could explain 8.0, 9.3, and 12.5%, respectively, of the cost variation in outpatient, inpatient, and total costs in 1999.