Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort.

BACKGROUND: The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort. METHODS: JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants' first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes. FINDINGS: Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41,029 patients (15,341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years [SD 5·7] versus 53·9 years [9·0] with late-onset diabetes (n=33,548). Those with young-onset diabetes had longer disease duration (median 10 years [IQR 3-18]) than those with late-onset diabetes (5 years [2-11]). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%; p<0·0001) Patients with young-onset diabetes had higher mean concentrations of HbA1c (mean 8·32% [SD 2·03] vs 7·69% [1·82]; p<0·0001), LDL cholesterol (2·78 mmol/L [0·96] vs 2·74 [0·93]; p=0·009), and a higher prevalence of retinopathy (1363 [20%] vs 5714 (18%); p=0·011) than those with late-onset diabetes, but were less likely to receive statins (2347 [31%] vs 12,441 [37%]; p<0·0001) and renin-angiotensin-system inhibitors (1868 [25%] vs 9665 [29%]; p=0·006). INTERPRETATION: In clinic-based settings across Asia, one in five adult patients had young-onset diabetes. Compared with patients with late-onset diabetes, metabolic control in those with young-onset diabetes was poor, and fewer received organ-protective drugs. Given the risk conferred by long-term suboptimum metabolic control, our findings suggest an impending epidemic of young-onset diabetic complications. FUNDING: The Asia Diabetes Foundation (ADF) and Merck.

To assess the correlation between the skin microvasculary damages and the reticular pathology due to diabetes

Results of the biopsies from 55 diabetes patients with damage of capillary system on the skin were classified by Larsson’s scale. The state was mainly 2nd grade (41.8%), 1st grade and 3rd grade 29.1%. No case of 4th grade damage. The capillary damage was strictly assosciated to diabetes retinian capillary damage. The damage of skin capillary developed earlier considerably than that of the retine. The damage of capillary system on skin can be considered golden criterion for diagnosis of early damage of the capillary vessel in diabetes.

Study on relationship between being ill times with skin chip lesion and urinary micro albumin in diabetes

55 diabetes patients has negative urine protein 24 hours in 2 consecutive examinations. Among them, 22 had urine aminoalbumin  20 microgram/minute (MAU +), which account for 40%. Their 58.3% of patient had type 1 diabetes and 34.9% type 2. Damage of skin microvascular occurred early, it had a close relation with microalbumin secretory level in urine with r=0.55. Damage of microvascular had close relation with the duration of the disease and it is a most subjective standard for assessing the impairment of microvascularity in diabetic patients

Some remark on Nelson's syndrome

A case of Nelson syndrome was presented. Male patient of 26 years old suffering from Cushing disease underwent an bilateral epinephrectomy, after that, Nelson syndrome developed and the patient was treated by Cobalt 60, the skin was discolored and head pain was relieved. Nelson syndrome is caused by total epinephrectomy E in Cushing disease’s patient, its clinical manifestation is typically a leader skin, head pain, high blood concentration of ACTH. The treatment of choice for this syndrome is an operation of pyfrophyse through sphenoidal bone or irradiation into hypophysal hole

Diagnostic of Cushing's syndrome

From the year 1989 to December 1994, 59 patients with Cushing syndrome (12 males, 47 females aged 15-46) were investigated. Clinical symptoms: central obesis, round face, weakness, high blood pressure, cracked skin, mental disorder, acnea, hirsulism. Laboratory examinations: high level of urine 17OHCS, cortisol secretion increasing in 8 and 20 o’clock and loss of secretion. Morphological examinations: X-ray radiography of hypophysal hole, ultrasound of surrenal gland, CT scan of hypophysal hole. Causes: 79.7% is Cushing disease, 11.8% adenoma od surrenal gland, 8.5% surrenal cancer