Vitamin D deficiency and inflammatory markers in type 2 diabetes: Big data insights.

The objective of this study was to investigate the prevalence of vitamin D deficiency or insufficiency and its association with inflammatory markers and type 2 diabetes. We conducted our research at Qingdao Endocrine and Diabetes Hospital, where serum 25-hydroxyvitamin D3 levels were determined for 2,806 individuals with type 2 diabetes aged 30 and older between January 2018 and December 2019. Medical records were analyzed, and data on health, blood lipids, HbA1c, and inflammation were collected. Our results revealed a high prevalence of vitamin D deficiency in the population. Among male and female patients, median serum 25(OH)D3 levels were 22.46 and 19.00 ng/mL, respectively. More than 60% of female patients had vitamin D deficiency, with over 80% having levels below 30 ng/mL. We observed a favorable connection between high-density lipoprotein cholesterol and 25(OH)D3, while triglycerides and HbA1c showed negative correlations. As 25(OH)D3 levels increased, inflammatory markers such as hypersensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), white blood cell count, neutrophil count, and monocyte count decreased (trend test, p < 0.05), although peripheral blood lymphocytes initially increased and then decreased. After controlling for age and gender, multiple linear regression analysis indicated negative correlations between ESR, hsCRP, and white blood cell count with 25(OH)D3 (p < 0.05). In conclusion, our study demonstrates that individuals with type 2 diabetes often exhibit vitamin D deficiency or insufficiency, which is associated with elevated levels of inflammatory markers in the blood.

Consensus of Chinese experts on strengthening personalized prevention and treatment of type 2 diabetes.

Up to now, there has not yet been guidance or consensus from Chinese experts in the field of personalized prevention and treatment of type 2 diabetes. In view of the above, the endocrinology diabetes Professional Committee of Chinese Non-government Medical Institutions Association, the integrated endocrinology diabetes Professional Committee of the integrated medicine branch of Chinese Medical Doctor Association, and the diabetes education and microvascular complications group of the diabetes branch of the Chinese Medical Association organized relevant experts to discuss and reach the "Chinese expert consensus on strengthening personalized prevention and treatment of type 2 diabetes" for reference in clinical practice.

A Propensity Score Matched Comparison of Brand and Biosimilar Basal Insulin in Non-Critical Hospitalized Patients with Type 2 Diabetes Mellitus.

INTRODUCTION: Comparisons between brand and biosimilar basal insulin in hospitalized patients are lacking. We aimed to compare the efficacy and safety of brand insulin glargine vs. biosimilar insulin glargine in non-critical hospitalized patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study was conducted using the electronic medical records of 194,006 patients at the Qingdao Endocrine and Diabetes Hospital between January 2006 and December 2017. A total of 476 patients diagnosed with T2DM, hospitalized, and treated with subcutaneous insulin glargine were included. After propensity score matching (1:3), patients who received biosimilar insulin glargine (Basalin) (n = 34) were compared to a matched group of patients who received brand insulin glargine (Lantus) (n = 101). Outcome measures were changes in fasting blood glucose (FBG), the incidence of hypoglycemia, and insulin dose. RESULTS: Compared to patients who received Basalin, patients who received Lantus achieved more reduction in FBG during insulin treatment (- 1.24 mmol/L vs. - 2.20 mmol/L; p = 0.04) and had a lower mean FBG at the end of treatment (8.20 mmol/L vs. 7.26 mmol/L; p = 0.12). Patients in Basalin and Lantus groups had a comparable mean daily dose of basal insulin at initiation (0.19 vs. 0.18 IU/kg; p = 0.30) and end of treatment (0.21 vs. 0.21 IU/kg; p = 0.99), and a similar duration of basal insulin treatment (16.4 vs. 15.3 days; p = 0.74). Hypoglycemia was infrequent in both Basalin and Lantus treatment (one vs. four patients, respectively; p = 1.00) and no severe hypoglycemic events were reported. CONCLUSION: In a non-critical hospital setting, subcutaneous treatment with Lantus brought significant FBG improvement without increased hypoglycemic risk.

Switching from biosimilar (Basalin) to originator (Lantus) insulin glargine is effective in Chinese patients with diabetes mellitus: a retrospective chart review.

Background: This study investigated the effectiveness and safety of switching from Basalin® to Lantus® in Chinese patients with diabetes mellitus (DM). Methods:  A retrospective chart review conducted using the electronic medical records of patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2005 to 2016. All patients were diagnosed with DM and underwent switching of insulin from Basalin to Lantus during hospitalization. Data collected included fasting (FBG), pre- and post-prandial whole blood glucose, insulin dose, reasons for insulin switching and hypoglycemia. Four study time points were defined as: hospital admission, Basalin initiation, insulin switching (date of final dose of Basalin), and hospital discharge. Blood glucose measurements were imputed as the values recorded closest to the dates of these four time points for each patient. Results: Data from 73 patients (70 patients with type 2 diabetes, 2 with type 1, and 1 undisclosed) were analyzed. At admission, mean glycated hemoglobin (HbA1c) and FBG were 8.9% (SD=1.75) and 9.98 (3.22) mmol/L, respectively. Between Basalin initiation and insulin switch, mean FBG decreased from 9.68 mmol/L to 8.03 mmol/L (p<0.0001), over a mean 10.8 (SD=6.85) days of Basalin treatment, and reduced further to 7.30 mmol/L at discharge (p=0.0116) following a mean 6.6 (7.36) days of Lantus. The final doses of Basalin and Lantus were similar (0.23 vs. 0.24 IU/kg/day; p=0.2409). Furthermore, reductions in pre- and post-prandial blood glucose were also observed between Basalin initiation, insulin switch and hospital discharge. The incidence of confirmed hypoglycemia was low during Basalin (2 [2.4%]) and Lantus (1 [1.2%]) treatment, with no cases of severe hypoglycemia. Conclusion: In this study population, switching from Basalin to Lantus was associated with further reductions in blood glucose, although the dose of insulin glargine did not increase. Further studies are required to verify these findings and determine the reason for this phenomenon.

Patient characteristics related to metabolic disorders and chronic complications in type 2 diabetes mellitus patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in China.

OBJECTIVE: To study the clinical characteristics related to metabolic disorders and complications in type 2 diabetes mellitus patients hospitalized in the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in Qingdao, China. PATIENT POPULATION AND METHODS: Data from 14,289 (51% males) type 2 diabetes mellitus patients hospitalized between 2006 and 2012 were collected and analysed. Information on patients' demographic, anthropometric, laboratory and disease histories were extracted from electronic medical records. RESULTS: The mean age of the patients was 60.5 years, with median diabetes duration of 9.0 years. Mean haemoglobin A1c was 8.4%, where <30.0% of patients had haemoglobin A1c <7.0%. In all, 34.5% of patients had low-density lipoprotein cholesterol lower than 2.6 mmol/L and 31.9% had hypertriglyceridaemia. Retinopathy was diagnosed in 51.1% of patients, nephropathy in 21.6%, neuropathy in 50.4%, hypertension in 77.4%, coronary heart disease in 27.6% and peripheral vascular disease in 58.6%. Once hospitalized, 71.1% of patients underwent insulin injection treatments, either mono-therapy or combined with other anti-diabetic drugs. Metformin was prescribed to 36.9% of patients, followed by acarbose 29.9%, thiazolidinediones 18.1%, meglitinides 14.8% and sulfonylureas 10.7%. CONCLUSION: Inadequate control of hyperglycaemia, poor metabolic profiles and diabetic complications were common challenges for long-term diabetes management in Chinese patients with type 2 diabetes mellitus.

[The safety and effectiveness of once daily detemir in patients with type 2 diabetes previously failing oral agents: the Chinese cohort from SOLVE(TM) observational study].

OBJECTIVE: Study of Once-daily LeVEmir(®) (SOLVE(TM)) was a 24-week international observational study to evaluate the safety and effectiveness of initiating once-daily insulin detemir (Levemir) as add-on therapy in patients with type 2 diabetes mellitus (T2DM) who failed treatment of oral anti-diabetic drugs (OAD). METHODS: The present study was derived from the data of Chinese cohort. A total of 3272 patients with T2DM failing OAD were enrolled in the study. Determir were prescribed to the patients by the decision of the physician. Clinical data were collected at baseline, week 12 and week 24 to evaluate the safety and effectiveness of detemir. RESULTS: The age of the patients was (56.2 ± 10.8) years with a diabetes duration of (7.1 ± 5.2) years. Their BMI was (25.3 ± 3.3) kg/m(2). No patient experienced any major or nocturnal hypoglycaemic event during the study. After 24 weeks of treatment, the glycosylated hemoglobin A1c (HbA1c) decreased from (8.33 ± 1.69)% to (7.16 ± 1.18)% with a mean change of -1.17%, the fasting plasma glucose decreased from (9.52 ± 2.59) mmol/L to (6.84 ± 1.42) mmol/L with a mean change of -2.7 mmol/L, and the 7-point blood glucose profile improved overall. Totally 49.1% of patients achieved HbA1c < 7%. The mean body weight decreased by 0.15 kg. CONCLUSIONS: Insulin detemir administered once daily as add-on therapy in patients with T2DM failing OAD regimen significantly reduces the risk of major hypoglycemia, improves glycemic control, increases the percentage of patients achieving treatment target with neutral effect on body weight.

[The relationship between waist to stature ratio and hypertension, diabetes, and dyslipidemia in Qingdao].

OBJECTIVE: To evaluate the relationship between waist to stature ratio (WSR) and hypertension, diabetes, dyslipidemia in Qingdao. METHODS: Data were collected from a 2001 - 2007 Qingdao area diabetes survey, population-based cross-sectional study, and 30 712 Chinese adults aged>18 years old were enrolled. Correlation analysis of BMI, WSR, hip circumference, waist circumference, waist to hip ratio (WHR) with blood glucose, blood pressure, blood lipid were conducted. ROC curve analysis in diabetes, hypertension, dyslipidemia and multivariate logistic regression analysis were also conducted. RESULTS: Anthropometric indicators were related with hypertension, diabetes and dyslipidemia in both men and women. Comparing with other anthropometric indicators, WSR was found to have the largest area under the ROC curve and the best cut-off point of WSR was 0.52. Multivariate logistic regression analysis showed that, after controlling age, disease history, physical activity, sex, the diabetes hypertension and dyslipidemia risk OR of WSR ≥ 0.52 were largest. CONCLUSIONS: Anthropometric indicators intimately related with cardiovascular risk factors in Qingdao region, and may predict and evaluate the risk of cardiovascular disease. WSR may be the best index for predicting cardiovascular risk factors in Qingdao area. The optimal WSR cut off point for identifying cardiovascular risk factors clustering is 0.52.

[The baseline characteristics of patients with type 2 diabetes initiating insulin detemir : the Chinese cohort from the SOLVE(TM) study].

OBJECTIVE: To characterize the baseline status of Chinese diabetic patients based on data derived from Chinese cohort from SOLVE(TM) study. METHODS: Patients with type 2 diabetes initiating basal insulin detemir at the decision of the physician were eligible for the study. Data on demographics, medical history, glycemic profile and treatment regimen at baseline were collected by physicians. RESULTS: A total of 3272 patients [female 42%, male 58%, mean age (56.2 ± 10.8) years] were included in the study. Their BMI was (25.3 ± 3.3) kg/m(2). The duration of diabetes was 4.0 (0.1 - 27.0) years, and the duration of treatment with oral antidiabetic drugs (OADs) was 3.0 (0.0 - 20.2) years. The proportions of subjects with diabetic macro- and micro-vascular complications were 15.8% (515 cases) and 27.1% (866 cases), respectively. The hemoglobin A1c (HbA1c) at baseline was (8.33 ± 1.70)%, and the fasting blood glucose (FPG) was (9.5 ± 2.6) mmol/L. CONCLUSIONS: A large proportion of patients with type 2 diabetes remain in poor glycemic control, and the prevalence of diabetic complications is high, which requires optimal therapeutic strategy for the patients with suboptimal glycemic control.

Distinct ethnic differences in lipid profiles across glucose categories.

CONTEXT: Dyslipidemia coexists with hyperglycemia. However, little is known about the ethnic differences in lipid profiles at comparable glucose tolerance status. OBJECTIVE: The aim was to study ethnic differences in lipid profiles stratified by glucose levels. DESIGN AND SETTING: Data from 31 study cohorts of 12 countries, consisting of 24,760 men and 27,595 women aged 25-74 yr, were compared. The odds ratio for having dyslipidemia was estimated for each ethnic group stratified by glucose categories. RESULTS: Compared with central and northern Europeans, multivariable adjusted odds ratios (95% confidence intervals) for having lower high-density lipoprotein-cholesterol were 4.74 (4.19-5.37), 5.05 (3.88-6.56), 3.07 (2.15-4.40), and 2.37 (1.67-3.35) in Asian Indian men, but 0.12 (0.09-0.16), 0.07 (0.04-0.13), 0.11 (0.07-0.20), and 0.16 (0.08-0.32) in Chinese men who had normoglycemia, prediabetes, and undiagnosed and diagnosed diabetes, respectively. Similar results were obtained for women. The prevalence of low high-density lipoprotein-cholesterol remained higher in Asian Indians (62.8% of the nondiabetic and 67.4% of the diabetic) than in central and northern Europeans (20.3 and 37.3%), Japanese (25.7 and 34.1%), or Qingdao Chinese (15.7 and 17.0%), even in individuals with low-density lipoprotein-cholesterol of less than 3 mmol/liter. CONCLUSION: There are distinct patterns of lipid profiles associated with ethnicity regardless of the glucose levels, suggesting that ethnic-specific strategies and guidelines on risk assessment and prevention of cardiovascular disease are required.

Serum uric acid and components of the metabolic syndrome in non-diabetic populations in Mauritian Indians and Creoles and in Chinese in Qingdao, China.

OBJECTIVE: To assess the association of serum uric acid (UA) with components of metabolic syndrome (MetS) in different ethnic groups. METHODS: Nondiabetic men (3285) and nondiabetic women (4078) aged 25 to 74 years without a history of cardiovascular disease and gout from Mauritius and Qingdao China, comprising Mauritian Indians, Mauritian Creoles, and an urban Chinese population, were studied. The top quintile of waist circumference, body mass index (BMI), blood pressure, serum total cholesterol and triglycerides, plasma glucose levels, and the bottom quintile of HDL cholesterol was defined as the metabolic disorder. Hyperuricemia was defined if UA values were in the top quintile. RESULTS: In a multivariate model (adjusted for age, cohort, smoking, and alcohol consumption), waist circumference, BMI, and serum triglycerides appeared to be independently associated with hyperuricemia in both sexes and in all ethnic groups except in Chinese women. Multivariate adjusted odds ratios (95% confidence intervals [CIs]) for having three or more metabolic disorders vs fewer than three, corresponding to a one SD increase in serum UA concentration, were 1.75 (1.51 to 2.02), 2.19 (1.71 to 2.82) and 2.30 (1.68 to 3.16) in Indian, Creole, and Chinese men, respectively, and 1.74 (1.52 to 2.00), 1.75 (1.40 to 2.19) and 1.72 (1.37 to 2.16) in Indian, Creole, and Chinese women, respectively. CONCLUSIONS: In nondiabetics of Asian and African ancestry, elevated serum UA was closely associated with components of MetS, but whether UA provides additional information to the definition of the MetS in predicting future cardiovascular disease and diabetes needs to be studied.

The likelihood of diabetes based on the proposed definitions for impaired fasting glucose.

The current study aimed to evaluate whether individuals with fasting plasma glucose (FPG) of 5.6-6.0 mmol/l has a similar risk profiles for diabetes or impaired glucose tolerance (IGT) to those with FPG of 6.1-6.9 mmol/l. A community-based cross-sectional survey in Chinese adults (20-74 years) was conducted during April-July in 2002. Participants without a prior history of diabetes underwent a standardized 2-h 75 g oral glucose tolerance test. Positive likelihood ratios were calculated to estimate the odds of having diabetes or IGT for subjects with different FPG levels. Among 1856 participants, prevalence of IFG increased from 12.4 to 28.2% with the cut-off value of FPG lowered from 6.1 to 5.6 mmol/l. Individuals with FPG of 6.1-6.9 mmol/l were more obese and insulin resistant than those with FPG of 5.6-6.0 mmol/l. The positive likelihood ratio for diabetes and IGT were 1.83 (1.28-2.61) and 2.60 (1.96-3.44) in subjects with FPG of 6.1-6.9 mmol/l, and 0.54 (0.30-0.95) and 1.47 (1.11-1.95) for those with FPG of 5.6-6.0 mmol/l, respectively. In conclusion, the likelihood of diabetes and IGT was lower in subjects with FPG of 5.6-6.0 mmol/l than in those with FPG of 6.1-6.9 mmol/l. The clinical and social implication of labelling more individuals with impaired fasting glucose needs to be further studied.

Diabetes associated with a low serum uric acid level in a general Chinese population.

OBJECTIVE: Serum uric acid (UA) is reported as an important marker of hypertension, coronary heart disease, and diabetes; diabetic subjects have low UA levels. The relationship between UA and fasting plasma glucose (FPG) and 2-h plasma glucose concentrations in non-diabetic subjects as well as in diabetic subjects in general population is not well known. This was investigated in a general Chinese population. METHODS: A stratified, random cluster sampling method was performed to select a representative sample of general population aged 20-74 years in Qingdao in 2002. A total of 1288 men and 2344 women participated in the survey. The mean UA concentration was calculated for small glucose intervals and the trend was tested using general linear model. RESULTS: The mean concentrations of UA were 381, 393, 371, and 345 micromol/l in men with FPG of <6.1, 6.1-6.9, > or =7.0 mmol/l (newly diagnosed diabetes), and in those with prior history of diabetes. They were 308, 322, 301, and 293 micromol/l, respectively, in women. The UA levels declined with increasing FPG levels in individuals with newly diagnosed diabetes, with standardized coefficient of -0.26 in men and -0.20 in women, after multivariate adjustment for age, body mass index, triglycerides, and cardiovascular disease history. The relationship between 2-h glucose and UA was not as clear as that for FPG. CONCLUSION: Serum UA levels tended to increase with increasing FPG levels in non-diabetic individuals, but decrease in diabetic individuals.

The prevalence of hyperuricemia in a population of the coastal city of Qingdao, China.

OBJECTIVE: Hyperuricemia and gout have shown an increase worldwide. Data are lacking for the prevalence of hyperuricemia and gout and their correlates in China. We studied the occurrence of these conditions in Chinese adults in the city of Qingdao. METHODS: A population-based cross-sectional survey for hyperuricemia and gout was performed among 2438 adults (1535 women, 903 men; aged 20-74 yrs) in 2002. Fasting serum uric acid (UA) and lipid profiles were determined, as well as height, weight, and blood pressure. Hyperuricemia was defined as serum UA levels >or= 420 micromol/l in men and >or= 360 micromol/l in women. Diagnosis of gout was self-reported. Complete biochemical and questionnaire data were available for analysis from 1303 women and 720 men. RESULTS: The age-standardized prevalence was 25.3% for hyperuricemia and 0.36% for gout in adults aged 20 to 74 years. Hyperuricemia was more prevalent in men than in women (32.1% vs 21.8%; p < 0.001). Age-adjusted mean serum UA level was 389.3 micromol/l in men and 315.7 micromol/l in women. Serum UA increased with age in women only (p for trend < 0.001). Body mass index and serum triglycerides had the strongest associations with serum UA in both genders, followed by alcohol drinking and diastolic blood pressure in men, and systolic blood pressure and total cholesterol in women. CONCLUSION: The prevalence of hyperuricemia in the urban adult population in Qingdao city is high, while the frequency of gout is lower. Obesity, hypertension, and dyslipidemia are the major factors associated with hyperuricemia in this study.

[Influence of catecholamines on myocardium in experimental septic shock].

OBJECTIVE: To study the influence of catecholamine on myocardium in rats with septic shock and its mechanism by biochemical and pathophysiological methods to evaluate the underlying pathophysiologic mechanism of myocardial damage and the influence of catecholamine on the myocardial injury. METHODS: Septic shock was replicated in rats by cecal ligation and puncture (CLP). Dobutamine (DB), norepinephrine (NE) and combination of DB and NE were used in the lowest dose. The rats were randomly divided into sham operations, CLP control group, CLP+DB group, CLP+NE group and CLP+DB+NE group, 8 rats in each group. Troponin I (cTnI) and total creatine kinase (CK) were measured, and myocardial tissue was examined under light microscopy and electron microscopy. RESULTS: An significantly increased cTnI level was found in CLP septic shock rats, compared with sham rats (P<0.05). In the present study, the use of DB or NE alone, or the combination of the two drugs, was not found to influence the cTnI levels. But, the total CK levels in catecholamine-treated group were significantly increased (P<0.05). There was no statistically significant correlation between cTnI and CK levels. Morphological study confirmed the results of cTnI. Findings that were common in the myocardium of CLP septic shock rats included extracellular and intracellular edema as well as mitrochondrial injury. However, no conclusive evidence was found for the influence of catecholamine on myocardial damage. CONCLUSION: No evidence of the influence of catecholamine on myocardial damage is found. Pathological study suggests that myocardial injury is the result of ischemia.

Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts.

OBJECTIVE: To report the age- and sex-specific prevalence of diabetes and impaired glucose regulation (IGR) according to revised World Health Organization criteria for diabetes in Asian populations. RESEARCH DESIGN AND METHODS: We performed 11 studies of 4 countries, comprising 24,335 subjects (10,851 men and 13,484 women) aged 30-89 years who attended the 2-h oral glucose tolerance test and met the inclusion criteria for data analysis. RESULTS: The prevalence of diabetes increased with age and reached the peak at 70-89 years of age in Chinese and Japanese subjects but peaked at 60-69 years of age followed by a decline at the 70 years of age in Indian subjects. At 30-79 years of age, the 10-year age-specific prevalence of diabetes was higher in Indian than in Chinese and Japanese subjects. Indian subjects also had a higher prevalence of IGR in the younger age-groups (30-49 years) compared with that for Chinese and Japanese subjects. Impaired glucose tolerance was more prevalent than impaired fasting glycemia in all Asian populations studied for all age-groups. CONCLUSIONS: Indians had the highest prevalence of diabetes among Asian countries. The age at which the peak prevalence of diabetes was reached was approximately 10 years younger in Indian compared with Chinese and Japanese subjects. Diabetes and IGR will be underestimated in Asians based on the fasting glucose testing alone.