A greater glycemic load reduction was associated with a lower diabetes risk in pre-diabetic patients who consume a high glycemic load diet.

Few prospective studies evaluating the association between dietary glycemic load (GL) and diabetes have accounted for changes in GL. However, the diet of patients could be modified in response to an awareness of pre-diabetes. The aim of this study was to examine the longitudinal associations between changes in GL and the incidence of diabetes among pre-diabetic patients. We hypothesized that subjects with low and high baseline GL would show different correlations with diabetes. A total of 493 pre-diabetic patients (142 men and 351 women) between 40 and 79 years of age were included in this study. Dietary records and oral glucose tolerance tests were conducted every year. The participants were divided into low- and high-GL groups based on baseline GL. During a median 4 years of follow-up, 108 incident cases of diabetes were identified. Among participants with a high baseline GL, the incidence of diabetes increased with decreasing GL reduction, and the multivariate-adjusted HR (95% CI) was 2.34 (1.27-4.29) when comparing the lowest to the highest tertiles; however, among those with a low baseline GL, no significant association was observed. Regardless of baseline GL status, the incidence of diabetes was higher in individuals with a high follow-up GL than in those with a low follow-up GL, and the multivariate-adjusted HR (95% CI) was 1.64 (1.09-2.45). In conclusion, a greater GL reduction was associated with a lower diabetes risk in pre-diabetic patients with a high dietary GL. In patients with pre-diabetes and a low dietary GL, further reductions in GL did not show any additional effects.

Association between obesity measures and albuminuria: A population-based study.

AIMS: The effects of obesity on the micro vascular diseases have drawn much attention. The aim of the study was to investigate the relationship between obesity measures and albuminuria in Chinese population. METHODS: We conducted a population-based cross-sectional study in 8600 subjects aged 40 years or older from a community in Guangzhou. Urinary albumin excretion and creatinine were measured and urinary albumin-to-creatinine ratio (ACR) was calculated as urinary albumin divided by creatinine. Low-grade albuminuria was classified as the highest quartile of ACR in participants without increased urinary albumin excretion. Increased urinary albumin excretion was defined according to the ACR ranges greater or equal than 30 mg/g. RESULTS: Pearson's correlation analysis and multivariate linear regression analysis revealed that body mass index (BMI), waist circumference and body fat content were significantly correlated with ACR (all P<0.01). Prevalence of low-grade albuminuria and increased urinary albumin excretion gradually increased across the BMI, waist circumference and body fat content quartiles (all P for trend<0.0001). Compared with participants in quartile 1 of BMI, waist circumference and body fat content, participants in quartile 4 had increased prevalence of low-grade albuminuria and increased urinary albumin excretion in logistic regression analysis after adjustment for age, sex, physical activity, fasting plasma glucose, triglycerides, low-density lipoprotein cholesterol and HbA1c (all P<0.05). CONCLUSION: Obesity measures are associated with urinary albumin excretion in middle-aged and elderly Chinese.

Prevention of macrovascular disease in patients with short-duration type 2 diabetes by multifactorial target control: an 8-year prospective study.

A longitudinal prospective study was undertook to investigate the effect of multifactorial target control, recommended by the American Diabetes Association (ADA), on macrovascular disease in patients with short-duration type 2 diabetes. Patients who were newly diagnosed with type 2 diabetes or within 1 year and had no previous vascular diseases or atherosclerosis plaques were enrolled in the present study. All patients received multifactorial intervention, with pharmacologic therapy targeting hyperglycemia, hypertension, dyslipidemia, along with secondary prevention of vascular disease with aspirin when necessary according to the ADA recommendation. Patients were followed up for 8 years (2002-2010). The ultrasounds of arteries (carotid, iliac and femoral arteries) were measured every year. The primary endpoint was the time to the first occurrence of atherosclerosis plaques of the arteries. The second endpoint was clinical evidence of cardiovascular diseases. One hundred and forty-three patients were recruited, and the mean age was 50 (6.92) years. During the study, atherosclerosis plaques occurred in 49 patients. Systolic blood pressure less than 130 mmHg [hazard ratio (HR), 0.236; 95 % confidence interval (CI) 0.076-0.734; P = 0.013] and fasting plasma glucose less than 7 mmol/l (HR, 0.457; 95 % CI 0.210-0.994; P = 0.048) were significantly associated with decreased onset of atherosclerosis plaques. Simultaneous target control of systolic blood pressure and fasting plasma glucose reduced the risk of atherosclerosis plaques by 18 % (P = 0.097) and cardiovascular diseases by 16 % (P = 0.046). Multifactorial target treatment in patients with short-duration type 2 diabetes can effectively reduce the risk of macrovascular complications.

[New index of using serum sodium and potassium and urine sodium and potassium jointly in screening primary aldosteronism in hypertensive patients].

OBJECTIVE: Although the aldosterone-to-renin ratio (ARR) is valuable in the screening for primary aldosteronism (PA). However, the hormonal determinations are both time-consuming and expensive. So we tried to use new indexes of serum sodium to urinary sodium to serum potassium to urinary potassium (SUSPUP) and serum sodium to urinary sodium to (serum potassium)2 to urinary potassium (SUSPPUP) in screening of PA. METHODS: The present study included 39 patients with PA, 296 patients with essential hypertension and 158 normosensitive subjects. Serum potassium and sodium, urine potassium and sodium were measured by ion-selective electrodes. In addition, serum aldosterone concentration and plasma rennin activity after staying upright for one hour were measured by radioimmunoassay. The serum potassium and sodium, urine potassium and sodium in these groups were evaluated in the screening of SUSPPUP for differentiating PA from hypertensive patients. RESULTS: (1) Compared with healthy volunteers, the essential hypertension patients had lower levels of both serum potassium and urine sodium, higher levels of serum sodium. Compared with healthy volunteers and primary hypertension patients, the PA patients had the lowest serum potassium and highest serum sodium, urine potassium resulting in the highest SUSPUP and SUSPPUP ratio. (2) The AUCs of SUSPUP and SUSPPUP were 0.824 and 0.840 respectively according to the ROC curve. The optimal cutoffs of SUSPUP and SUSPPUP were 14.44 and 4.08 respectively. CONCLUSION: The SUSPUP and SUSPPUP ratios are rapid and inexpensive indices to assess the extent of mineralocorticoid excess. Therefore they may be employed to screen PA in hypertensive patients.

[Insulin sensitivity and pancreatic beta cell function changes during the transformation from normal to impaired glucose tolerance].

OBJECTIVE: To investigate the roles of insulin sensitivity and pancreatic beta cell function in the pathogenesis of type 2 diabetes. METHODS: 70 subjects were recruited in a 3-year prospective study. During this period 9 subjects progressed from normal glucose tolerance (NGT) to impaired glucose tolerance (IGT) (progressing group), 45 remained same (remaining group) and 16 improved from IGT to NGT (improving group). Acute insulin secretion response (AIR(3 - 5)) during intravenous glucose tolerance test (IVGTT) was adopted to indicate the first phase insulin secretion with the ratio of insulin change from 0 min to 30 min to that of blood glucose from 0 min to 30 min (DeltaI(30)/DeltaG(30)) as the indicator of early insulin secretion and insulin sensitivity (ISI) was analyzed by the formula suggested by Cederholm during oral glucose tolerance (OGTT). RESULTS: (1) For AIR(3 - 5), there were no differences of the baseline level and the 3-year follow-up state between the progressing group and remaining group; neither there were differences between the baseline level and the 3-year follow-up state in both groups. Meanwhile, in the improving group, AIR(3 - 5) increased after the 3-year follow-up time as compared with that at the baseline, but without significance. (2) For DeltaI(30)/DeltaG(30), there were no differences of the baseline level and the follow-up state between the progressing group and remaining group; neither there were differences between the progressing group and remaining group baseline level and the 3-year follow-up state in both groups. Meanwhile, in the improving group, there was no difference between that at baseline and at the follow-up. (3) For ISI, although there was no significant difference between the progressing group and remaining group at the baseline level, yet that at the 3-year follow-up state was different between the progressing group and remaining group with ISI in the progressing group decreased significantly; ISI in improving group increased significantly at the 3-year follow-up state as compared with that at the baseline level and there was significant difference between that in progressing group and remaining group at the 3-year follow-up state. (4) Only ISI, but neither AIR(3 - 5) nor DeltaI(30)/DeltaG(30), had effect on the change of glucose tolerance by logistic regressive analysis. CONCLUSIONS: The ISI was the main change during the progress of NGT to IGT and the improvement of IGT to NGT, indicating that during the early progressive stage of type 2 diabetes, insulin sensitivity (insulin resistance) may play an important role.

[A multicenter clinic study of slow-release-gliclazide in type 2 diabetes mellitus].

OBJECTIVE: To evaluate the efficacy and safety of 30 mg slow-release-gliclazide (Diamicron MR) on type 2 diabetes patients with the level of blood glucose poorly controlled formerly. METHODS: 154 type 2 diabetes patients with the level of blood glucose poorly controlled formerly were enrolled and treated with Diamicron MR for 16 weeks. The efficacy of slow-release-gliclazide was evaluated through HbA1c, FPG and 2 h PBG after 16 weeks of treatment period. The safety was evaluated through the adverse events including hypoglycemic episodes and the change of vital signs and clinic laboratory parameters. RESULTS: After 16 weeks of treatment period, the HbA1c, FPG and 2 h PBG were decreased by 1.89%, 2.31 mmol/L and 3.94 mmol/L respectively, cutting down 21.6%, 24.5% and 27.8% relatively in comparison with pre-treatment. Glucose metabolism could be significantly improved by taking once-daily Diamicron MR. CONCLUSION: Slow-release-gliclazide offers the significant treatment safely, which is important to optimize type 2 diabetes mellitus management.