[Association between side effects of oral anti-diabetic drugs and self-reported mental health and quality of life among patients with type 2 diabetes].

OBJECTIVE: To examine the association between the side effects of oral anti-diabetic drugs (OAD) and self-reported mental health and quality of life among patients with type 2 diabetes mellitus (T2DM). METHODS: An observational, cross-sectional multicenter study with a retrospective medical chart review was conducted at 16 medical centers from around China. The T2DM patients were followed-up and treated with OAD alone prior to the index visit from January to September 2007. All subjects were ≥30 years old at the time of T2DM diagnosis and had received monotherapy or combination therapy of OAD for at least 6 months. Health-related quality of life was measured by the EuroQol-5D (EQ-5D) and Hypoglycemia Fear Survey (HFS)-II. RESULTS: The symptoms of hypoglycemia were reported by 41.8% (n=203) of participants, and 19.2% (n=93) experienced weight gain. For those reporting hypoglycemia, the scores were higher for HFS-II [7.00 (2.00-19.00) vs 0.00 (0.00-7.00), P<0.01] and lower for EQ-5D (0.90±0.12 vs 0.93±0.13, P=0.003) than those without hypoglycemic symptoms. According to the multivariate linear regression analysis, the symptoms of hypoglycemia were positively correlated with HFS-II (ß=5.78, P<0.01) and negatively with EQ-5D (ß=-0.04, P<0.05) after adjusting for patient and disease characteristics. CONCLUSION: There is a high possibility of hypoglycemic risks among T2DM patients on OAD therapy. The self-reported hypoglycemia is associated with health-related quality of life and hypoglycemic fear. They may have an impact on the long-term prognosis.

[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.

Determinants for inadequate glycaemic control in Chinese patients with mild-to-moderate type 2 diabetes on oral antidiabetic drugs alone.

BACKGROUND: Prevalence of inadequate glycaemic control among patients with type 2 diabetes mellitus (T2DM) remains high. We assessed glycaemic control in the real-life practice among people with T2DM in metropolises in China who were treated with oral antidiabetic drugs (OAD) alone and to determine factors associated with inadequate glycaemic control in this population. METHODS: An observational, cross-sectional multicentre study was conducted in 16 metropolitan medical centers. People with T2DM who had been followed-up before the index visit which occurred from January to September 2007 were included in the study. All subjects were ≥ 30 years of age at the time of T2DM diagnosis and had received monotherapy or combination therapy of OAD for at least 6 months. Demographic and clinical data were collected from medical records. The main study outcome was the inadequate glucose control rate, which was calculated by the proportion of patients with haemoglobin A(1C) (HbA(1C)) ≥ 6.5% detected on the index visit. RESULTS: In this cohort of 455 patients with T2DM whose mean age was 60.6 years and mean disease duration was 6.1 years, 45.5% had inadequate glycaemic control. The mean (SD) HbA(1C) was 6.7% (1.3). Multivariate Logistic regression showed that physical inactivity, disease duration > 10 years, body mass index (BMI) ≥ 24 kg/m(2), low homeostasis model assessment of ß-cell function (HOMA-ß) index, less frequency of medical visit and hypertriglyceridaemia were independent determinants of inadequate glycaemic control. Higher incidence of self-reported hypoglycemia experience (47.1% vs. 34.8%, P = 0.008) and more fear of hypoglycemia quantified by Worry subscale of the Hypoglycaemia Fear Survey (HFS) II were happened in subjects with good glycemic control. CONCLUSION: Approximately one half of these outpatients with T2DM from the metropolitan medical centers in China had inadequate glycaemic control treated with OAD alone, which raises the need for more effective educational and therapeutic approaches on management of hypertriglycemia, enhancing physical exercise and weight control, and at the same time, lowering the hypoglycemic risk and diminishing the hypoglycemic fear of patients.