One-hour post-load plasma glucose level predicts future type 2 diabetes in a community-based study of Hong Kong Chinese workforce.

BACKGROUND: We compared performance of high 1-hour PG level, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in predicting type 2 diabetes in a longitudinal community-based cohort of Hong Kong Chinese. METHODS: Between 2001 and 2003, 472 adults aged 18-55 years without diabetes underwent 75-gram oral glucose tolerance test (OGTT). Between 2012 and 2014, progression to diabetes was ascertained by reviewing medical records or repeating OGTT and HbA1c. We defined high 1-hour PG as PG ≥ 8.6 mmol/L at 1-hour. RESULTS: In this cohort, 23.5% had normal glucose tolerance and high 1-hour PG, 10.0% had isolated IGT, 4.2% had isolated IFG. Over 12-year follow-up, 9.3% developed type 2 diabetes. In logistic regression, high 1-hour PG was associated with progression to type 2 diabetes with adjusted odds ratio (95% CI) of 4.20 (1.60, 12.40), independent of IFG, IGT and other clinical variables. Areas under ROC (95% CI) for type 2 diabetes were similar between 1-hour (0.84 [0.78, 0.89], 2-hour (0.79 [0.72, 0.86]) and fasting PG (0.79 [0.71, 0.86]). CONCLUSION: High 1-hour PG identified young Chinese with 5-fold increased risk of type 2 diabetes independent of other intermediate hyperglycaemia status and clinical factors. 1-hour PG is similar to fasting and 2-hour PG in predicting type 2 diabetes.

Intrarenal arterial resistance is associated with microvascular complications in Chinese type 2 diabetic patients.

BACKGROUND: Increased renal arterial resistance is associated with various types of chronic renal parenchymal diseases. A resistance index (RI) > 0.8 predicts deterioration in renal function in diabetic subjects. However, the association between renal RI and other diabetic complications has not been investigated. In this study, we examined the association between intrarenal arterial RI and diabetic complications in Chinese type 2 diabetic subjects. METHODS: Three hundred and eighty-seven Chinese type 2 diabetic patients were recruited from a structured assessment programme to evaluate their risk factors and complications as a part of the quality improvement programme at the Prince of Wales Hospital. All subjects underwent ultrasound examinations for the assessment of intrarenal arterial RI of both kidneys. Clinical and biochemical parameters, including diabetes-related microvascular complications (nephropathy, retinopathy and sensory neuropathy) and macrovascular diseases, were examined. RESULTS: The mean RI of patients with any microvascular complications (0.70 ± 0.09 versus 0.65 ± 0.06) such as nephropathy (0.71 ± 0.09 versus 0.66 ± 0.06), retinopathy (0.71 ± 0.08 versus 0.67 ± 0.08) and sensory neuropathy (0.75 ± 0.07 versus 0.68 ± 0.08) and with any macrovascular complications (0.71 ± 0.09 versus 0.68 ± 0.08) was higher than those without (P < 0.05). On multivariate analysis, after controlling for confounding variables, an RI ≥0.75 was associated with microvascular complications, nephropathy, retinopathy and sensory neuropathy, with odds ratio of 4.02 [95% confidence interval (CI) 1.72-9.4], 4.99 (2.61-9.56), 2.78 (1.52-5.09) and 5.74 (1.8-18.3), respectively. The association of RI with macrovascular complications was not significant in multivariate analysis. CONCLUSION: Increased intrarenal arterial resistance was independently associated with an increased risk of microvascular complications including diabetic nephropathy, diabetic retinopathy and diabetic sensory neuropathy in Chinese type 2 diabetic patients.

Prediction of women's long-term cardiometabolic risks using glycemic indices during pregnancy.

AIMS: To study the prediction of abnormal glucose tolerance (AGT), diabetes mellitus (DM), hypertension (HT) and metabolic syndrome (MetS) among Chinese women using glycemic indices in the mid-trimester of pregnancy. METHODS: A cohort of Chinese women who had had either normal glucose tolerance or gestational diabetes mellitus (GDM) during a pregnancy were assessed at a median of 8 and 15 years post-delivery. All women underwent a 50-g glucose challenge test (GCT) and a 75-g oral glucose tolerance test in the mid-trimester of the index pregnancy. A receiver operating characteristic curve was used to assess the prediction of AGT, DM, HT and MetS. RESULTS: All glycemic indices were significant predictors of AGT and DM, and the 2-h plasma glucose (PG) and GCT were predictive of HT, at both 8 and 15 years post-delivery. MetS can only be predicted by the fasting plasma glucose (FPG) and was confined to 15 years post-delivery. After adjustment for confounding variables, all glycemic indices were still independent predictors of AGT and DM at both 8 and 15 years post-delivery, except for FPG in predicting DM at 8 years, while only the 2-h PG remains an independent predictor of HT at 15 years. The optimal cut-off values for FPG, 2-h PG and GCT are 4.2 mmol/L, 7.2 mmol/L and 7.7 mmol/L, respectively; all are lower than the current cut-off thresholds for the screening and diagnosis of GDM. CONCLUSIONS: Women who had a glycemic level below the criteria for a positive screening test and below the diagnostic threshold for GDM still have a significant cardiometabolic risk.

Cardiometabolic risk in Chinese women with prior gestational diabetes: a 15-year follow-up study.

AIMS: The progression to type 2 diabetes mellitus (DM) and other long-term cardiometabolic risks in Chinese women with prior history of gestational diabetes (GD) was studied at 15 years postpartum. METHODS: 139 Chinese women (45 with GD and 94 with normal glucose tolerance (NGT) at the index pregnancy) who had their insulin sensitivity and ß-cell functions examined at 8 years postpartum were again followed up at 15 years for the investigation of the rate of type 2 DM, hypertension and metabolic syndrome. RESULTS: Women with prior history of GD had a significantly higher rate of hypertension (35.6% vs. 16.0%, p = 0.01), type 2 DM (24.4% vs. 5.3%, p < 0.001) and impaired glucose regulation (26.6% vs. 14.9%, p < 0.001) than women with NGT during the index pregnancy. The Matsuda insulin sensitivity index and the quantitative insulin sensitivity check index at 8 years postpartum were independent predictors of both DM and metabolic syndrome at 15 years postpartum. CONCLUSIONS: The conversion rate of type 2 DM increased at an average rate of 1.6% per year after a pregnancy affected by GD. Insulin resistance at 8 years postpartum could refine a future diabetic risk in women with prior history of GD.

Treatment of metabolic syndrome in peritoneal dialysis patients.

Metabolic syndrome (MetS) occurs in about 50% of peritoneal dialysis (PD) patients. It encompasses a cluster of major risk factors for cardiovascular diseases. A modified National Cholesterol Education Program Third Adult Treatment Panel guideline for the diagnosis of MetS in PD patients has been proposed. Preliminary data suggest that PD patients with MetS in our cohort have an increased risk of cardiovascular mortality. The proinflammatory effects of adipose tissue are one of the reasons for poor outcome in obese PD patients. Lifestyle modification, including appropriate dietary restriction and exercise, especially reduction of fat mass in obese patients, has been one of the major areas proposed for managing patients with MetS. Individual therapeutic trials are treating hyperglycemia, hypertension, and dyslipidemia in dialysis patients. Evidence in PD patients that interventions targeting MetS can improve outcomes is still lacking. Large-scale studies with data on the clinical outcome for MetS intervention in PD patients are needed.

Association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes.

AIMS/INTRODUCTION: Higher hedonic hunger has been observed in obese individuals compared with those without obesity, but little is known about its association with glycemic management. We aimed to examine the association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes. MATERIALS AND METHODS: Between April and November 2016, a total of 211 type 2 diabetes patients who underwent comprehensive diabetes assessments at a university-affiliated hospital were recruited into two groups according to body mass index: non-obese (body mass index 18.5-24.9 kg/m2 ) and obese (body mass index ≥30 kg/m2 ) groups. All participants completed the Chinese version of the Power of Food Scale (PFS) for assessment of hedonic hunger. Good glycemic control was defined as glycated hemoglobin <7.0%. RESULTS: Compared with the non-obese group, the obese group showed higher PFS aggregated and subscale 'food available' scores (both P < 0.05). After adjustment for age, sex, disease duration of diabetes and insulin use, there were positive associations of glycated hemoglobin with PFS aggregated, subscale 'food available' and 'food present' scores in the obese group (all P for trend <0.05). The PFS aggregated score was negatively associated with good glycemic control in obese type 2 diabetes patients after adjustment using logistic regression analysis (adjusted odds ratio 0.42, 95% confidence interval 0.20-0.91, P = 0.027). By contrast, such associations were not observed in non-obese type 2 diabetes patients. CONCLUSIONS: Hedonic hunger had an independent and inverse association with good glycemic control in obese Chinese patients with type 2 diabetes, but not in their counterparts without obesity.

High prevalence of metabolic syndrome in Hong Kong Chinese--comparison of three diagnostic criteria.

The World Health Organisation (WHO), European Group for the Study of Insulin Resistance (EGIR) and National Cholesterol Education Program (NCEP) Expert Panels had introduced definitions for the metabolic syndrome (MES). We aimed to estimate the prevalence of MES in a working population in Hong Kong using the three definitions for MES and compare their relative significance. The data are obtained from a prevalence survey for glucose intolerance and lipid abnormality in a Hong Kong Chinese working population. The distribution of occupational groups in these subjects was similar to that recorded in the Hong Kong Census (1991) and representative of the Hong Kong working population. Definition of obesity was modified using the Asian criterion of body mass index (BMI)> or =25 kg/m 2, waist circumference>80 cm in women and >90 cm in men. Of the 1513 subjects, 910 (60.1%) were men and 603 (39.9%) were women. The mean age was 37.5+/-9.2 (median 37.0 years, range 18-66 years). Using the Asian definition for obesity, the prevalence of MES using the WHO criterion was the highest (WHO versus EGIR versus NCEP-overall: 13.4% versus 8.9% versus 9.6%, p<0.001; under age of 40 years: 7.9% versus 4.9% versus 5.4%, p=0.017; age of 40 years or above: 21.9% versus 14.9% versus 16.0%, p=0.003). The prevalence of different components of the MES ranged from 6 to 38%. In subjects aged less than 50 years, there was a male preponderance for MES (male versus female-WHO: 9.5% versus 6.2%, p=0.007; EGIR: 7.9% versus 6.2%, p=0.235; NCEP: 9.5% versus 6.2%, p=0.030) but this trend was reversed after the age of 50 years (WHO: 29.3% versus 31.9%, p=0.721; EGIR: 13.1% versus 34.8%, p=0.001; NCEP: 19.2% versus 23.2%, p=0.533). The prevalence of MES in Hong Kong Chinese of working age ranges from 6.1 to 13.4% depending on various diagnostic criteria. There was a male preponderance before the age of 50 years and a female-preponderance after the age of 50 years. The inclusion of albuminuria and insulin resistance by the WHO has made it the most discriminative criterion in identifying at risk individuals in all age groups.

The association between in utero hyperinsulinemia and adolescent arterial stiffness.

AIM: To determine the relationship between in utero hyperinsulinemia and children's arterial stiffness at adolescence. METHODS: Indices of arterial stiffness were measured using the SphygmoCor apparatus in 129 adolescents (42 offsprings of mother with gestational diabetes and 87 offsprings of mother with normal glucose tolerance during pregnancy) at 15 years of age. RESULTS: Adolescent of mothers with gestational diabetes had similar central aortic blood pressure, augmentation pressure (AP), augmentation index (AI), and carotid-femoral pulse wave velocity (PWV) as that of controls. However, both umbilical cord C-peptide and insulin levels correlated positively AI (R=0.28 and 0.24; p=0.011 and 0.035, respectively), and umbilical insulin level correlated positively with AP (R=0.25; p=0.025). The correlations were significant between umbilical cord C-peptide and AP (R=0.24; p=0.035) and AI (R=0.29; p=0.011) after adjustment for subjects' age, sex, body weight and height. Adolescents who had umbilical cord C-peptide levels at highest quartile (n=25), based on the reference ranges of the original cohort, had a significant greater PWV (5.26±0.12 m/s vs 4.98±0.12 m/s; p=0.0049) than those with C-peptide levels at the lower 3 quartiles (n=57) after adjustment for age, sex, body weight and height. CONCLUSIONS: In utero hyperinsulinemia appears to increase the offspring's arterial stiffness at early adolescence.

Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis.

OBJECTIVE: To evaluate the prevalence of the metabolic syndrome in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). METHODS: Consecutive patients with RA, AS, or PsA who attended our outpatient arthritis clinics between July and November 2009 were recruited for a study of atherosclerotic risk factors and the metabolic syndrome, defined according to the 2009 joint statements using the Asian criteria for central obesity. RESULTS: Nine hundred thirty patients were studied (699 with RA, 122 with AS, and 109 with PsA; 70% women, mean±SD age 51.1±12.7 years). The mean±SD disease duration for patients with RA, AS, and PsA was 5.3±5.4, 6.0±5.6, and 3.6±3.1 years, respectively. The prevalence of metabolic syndrome was significantly higher in PsA (38%) than RA (20%) or AS (11%; P<0.001). The odds ratios (ORs) for the metabolic syndrome compared to age- and sex-matched controls were 0.98 (95% confidence interval [95% CI] 0.78-1.23, P=0.88), 0.59 (95% CI 0.30-1.15, P=0.12), and 2.68 (95% CI 1.60-4.50, P<0.001), respectively, for RA, AS, and PsA. Patients with PsA had a significantly higher prevalence of impaired fasting glucose (30%; P<0.001), low high-density lipoprotein (HDL) cholesterol (33%; P<0.001), high triglycerides level (21%; P=0.008), central obesity (65%; P<0.001), and high blood pressure (56%; P=0.045). In a logistic regression model, the adjusted OR for the metabolic syndrome in PsA was 2.44 (95% CI 1.48-4.01, P<0.001) relative to RA or AS. The adjusted ORs for central obesity, impaired fasting glucose, hypertriglyceridemia, and low HDL cholesterol were also significantly higher in PsA patients. CONCLUSION: Patients with PsA, but not RA or AS, have a significantly higher prevalence of the metabolic syndrome compared to the general population. Among the 3 diseases studied, PsA has the highest prevalence of the metabolic syndrome and is associated with the highest cardiovascular risk.

Glucose intolerance and cardiometabolic risk in adolescents exposed to maternal gestational diabetes: a 15-year follow-up study.

OBJECTIVE: Adolescent offspring of women with a history of gestational diabetes (GD) were evaluated for their cardiometabolic risks at a mean age of 15 years. RESEARCH DESIGN AND METHODS: One hundred and twenty-nine adolescents who were assessed for their cardiometabolic risks at 8 years of age were reassessed at 15 years of age. RESULTS: Adolescent offspring of mothers with GD had similar blood pressure, plasma lipid profile, and a rate of abnormal glucose tolerance as control subjects. In utero hyperinsulinemia was associated with a 17-fold increase in metabolic syndrome and a 10-fold increase in overweight at adolescence, independent of birth weight, Tanner stage, maternal GD status, and mother's BMI. CONCLUSIONS: In utero environment of hyperinsulinemia, irrespective of the degree of maternal GD, was associated with increased risk of overweight and metabolic syndrome during early adolescence in the offspring.

Effects of systolic and diastolic blood pressures on incident coronary heart disease and all-cause death in Chinese women with Type 2 diabetes: the Hong Kong Diabetes Registry.

BACKGROUND: Elevated blood pressure (BP) is an important risk factor for the development of coronary heart disease (CHD), although the threshold above which the risk increases has not been clearly defined. The aim of the present study was to examine the full-range association between BP and CHD. METHODS: A prospective cohort of 3861 Chinese women with Type 2 diabetes mellitus (T2DM) was followed for a median of 5.61 years. Restricted cubic spline analysis was used to examine the relationship between BP and CHD. RESULTS: Subjects who developed CHD were older, more likely to be smokers, had a significantly longer duration of diabetes, higher systolic BP (SBP), glycated hemoglobin, albuminuria, low-density lipoprotein-cholesterol, and triglycerides, and lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol. Mortality was higher in those who developed CHD compared with those who did not, with all-cause death in 30.2% and 7.8% of patients, respectively. Over 21,641 and 22 049 person-years follow up, 4.4% of patients (n = 169) developed CHD and 8.8% (n = 340) died, respectively. The relative risk of SBP for CHD was constant up to 120 mmHg, after which it started to rise: from 130 mmHg, each 10-mmHg increase in SBP was associated with a 1.13-fold increased risk of CHD. CONCLUSIONS: We identified 130 mmHg as the threshold of SBP for increased risk of CHD in Chinese female patients with T2DM. It appears that 67-77 mmHg is the optimal range for diastolic BP, within which the risk of CHD is lowest.

Metabolic syndrome in peritoneal dialysis patients.

Cardiovascular morbidity and mortality are common in peritoneal dialysis patients. Metabolic syndrome (MES) is a medical condition with a clustering of major risk factors for cardiovascular diseases. In this review article, the various diagnostic criteria used in MES are discussed. It is proposed to use a modified National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria for the diagnosis of MES in peritoneal dialysis (PD) patients taking into consideration the scientific evidence and practicality. When three or more of the following criteria are satisfied in PD patients, obesity, high triglyceride, low high-density lipoprotein cholesterol (HDL-C), hypertension or dysglycaemia, they are diagnosed as having MES. Body mass index (BMI) with reference to ethnicity is suggested to replace waist circumference for diagnosing obesity. Epidemiology and outcome of PD patients with MES are highlighted. The adverse sequelae of obesity appear to be primarily due to fat mass rather than non-fat mass, possibly related to the pro-inflammatory effect of adipose tissue. Whilst there are therapies to tackle MES in PD patients, more conclusive data in human studies to see clinically improved outcomes with such strategies are needed.

Glucose intolerance and cardiometabolic risk in children exposed to maternal gestational diabetes mellitus in utero.

OBJECTIVE: The goal was to examine the carbohydrate tolerance and cardiometabolic risk among children exposed to maternal gestational diabetes mellitus in utero. METHODS: In this study, 164 Chinese children whose mothers had participated in a previous study on the screening and diagnosis of gestational diabetes mellitus (63 had gestational diabetes mellitus and 101 had normal glucose tolerance during the index pregnancies) underwent follow-up evaluations at a median age of 8 years (range: 7-10 years). Children's weight, height, hip and waist circumferences, and blood pressure were measured, and weight-adjusted oral glucose tolerance tests were performed. RESULTS: Six children (3.7%) demonstrated impaired glucose regulation or diabetes mellitus at the follow-up evaluation. Children exposed to maternal gestational diabetes mellitus had significantly higher systolic (94+/-1.2 vs 88+/-0.9 mmHg) and diastolic (62+/-0.8 vs 57+/-0.6 mmHg) blood pressure values and lower high-density lipoprotein cholesterol (1.58+/-0.04 vs 1.71+/-0.03 mmol/L) levels, after adjustment for age and gender. A high (>or=90th percentile) umbilical cord insulin level at birth was associated with abnormal glucose tolerance in the offspring. CONCLUSIONS: Maternal gestational diabetes mellitus increases the offspring's cardiometabolic risk, and in utero hyperinsulinemia is an independent predictor of abnormal glucose tolerance in childhood.

Erectile dysfunction predicts coronary heart disease in type 2 diabetes.

OBJECTIVES: We examined the predictive power of erectile dysfunction (ED) on coronary heart disease (CHD) events in Chinese men with type 2 diabetes. BACKGROUND: Subjects with diabetes are prone to develop cardiovascular complications. Erectile dysfunction is strongly associated with CHD in cross-sectional studies, but prospective data are lacking. METHODS: A consecutive cohort of men with no clinical evidence of cardiovascular disease underwent comprehensive assessments for diabetic complications. Erectile dysfunction was defined according to the definition of the National Institutes of Health Consensus Conference 1992. Coronary heart disease events were censored with centralized territory-wide hospital databases in 2005. RESULTS: Of 2,306 subjects (age: 54.2 +/- 12.7 years; follow-up: 4.0 [range 1.7 to 7.1] years), 26.7% had ED at baseline. The incidence of CHD events was higher in men with ED than those without (19.7/1,000 person-years, 95% confidence interval [CI] 14.3 to 25.2 person-years vs. 9.5/1,000 person-years, 95% CI 7.4 to 11.7 person-years). Men who developed CHD events were older; had a higher frequency of ED and microvascular complications; had longer duration of diabetes; and had higher blood pressure, total cholesterol, low-density lipoprotein cholesterol, and urinary albumin/creatinine ratio but lower high-density lipoprotein cholesterol and estimated glomerular filtration rate than those without CHD events. Erectile dysfunction remained an independent predictor for CHD events (hazard ratio 1.58, 95% CI 1.08 to 2.30, p = 0.018) after adjustment for other covariates along with age, duration of disease, and use of antihypertensive agents and albuminuria. CONCLUSIONS: In type 2 diabetic men without clinically overt cardiovascular disease, the presence of ED predicts a new onset of CHD events. Symptoms of ED should be independently sought to identify high-risk subjects for comprehensive cardiovascular assessments.

Overweight, family history of diabetes and attending schools of lower academic grading are independent predictors for metabolic syndrome in Hong Kong Chinese adolescents.

BACKGROUND: Overweight and metabolic syndrome (MES) are emerging in both adult and paediatric populations. AIMS: To study the prevalence of and associated risk factors for the MES, using the National Cholesterol Education Program definition, among Hong Kong Chinese adolescents studying in secondary schools. METHODS: This was a cross-sectional, population-based study. A sample of 2115 Chinese adolescents was randomly selected from 14 secondary schools throughout Hong Kong. Data on anthropometric parameters, fasting blood and urine samples were collected in the school setting. Information regarding the adolescent's family history of diabetes, perinatal history, socioeconomic status and school grading was evaluated. RESULTS: The prevalence of MES was 2.4% (95% confidence interval (CI) 1.8 to 3.1), with no significant difference between boys (2.9%) and girls (2%). The prevalence of various components of MES was 32.2% (30.2 to 34.2) for hypertension, 10.9% (9.6 to 12.2) for increased triglyceride, 9.0% (7.8 to 10.2) for central adiposity, 2.4% (1.7 to 3) for low high-density lipoprotein cholesterol and 0.3% (0.1 to 0.6) for impaired fasting glucose. On multivariate analysis, overweight (odds ratio 32.2; 95% CI 13.2 to 78.4), positive family history of diabetes (4.3; 1.3 to 14.1) and studying at schools of lower academic grading (5.5; 2.2 to 13.7) were found to be independent risk factors for MES. CONCLUSION: A comparable prevalence of MES (2%) is observed in our study group Chinese adolescent girls and in US girls (2.1%), but a lower prevalence in Chinese boys (2.9%) than in US boys (6.1%). In our study, 41.8% harbour at least one component of the syndrome. Both families and schools should be alerted to this growing epidemic.