Prevalence and associated factors for pterygium in a Chinese rural population with type 2 diabetes in a cross-sectional study: Jiangsu Diabetic Eye Disease Study (JDEDS).

PURPOSE: To investigate the pterygium prevalence and evaluate risk factors of pterygium in rural type 2 diabetic (D2M) patients aged 50 years and above in Funing Country, Jiangsu Province, China. METHODS: A cross-sectional ophthalmic survey was conducted in type 2 diabetes mellitus (D2M) patients aged ≥ 50 years in Funing County, Jiangsu Province, China, which was named Jiangsu Diabetic Eye Disease Study (JDEDS). All participants underwent a comprehensive questionnaire and ocular examination. Pterygium was diagnosed by slit lamp examination. The risk factors associated with pterygium were evaluated with logistic regression models. RESULTS: The prevalence of pterygium was 22.37% (n = 427) and 95% confidence interval (CI) (20.50-24.24%) in D2M patients aged 50 years and above in JDEDS. The prevalence of pterygium was 18.32% (95% CI 15.33-21.32%) in men and 24.43% (95% CI 22.06-26.80%) in women. Women had a higher prevalence than men (p = 0.001). Multivariate analysis showed, for male participants with D2M, pterygium was independently associated with increasing age [70-79 years: OR and 95% CI 2.49(1.20-5.18), p = 0.014; ≥ 80 years: 4.84(2.04-11.47), p < 0.001], while cigarette smoking was the protective factors, especially in current smoker [OR and 95% CI 0.79(0.67-0.92); p = 0.003]. For female participants with D2M, age [60-69 years OR and 95% CI 1.68(1.07-2.62), p = 0.023; 70-79 years: 2.62(1.69-4.06), p < 0.001; ≥ 80 years:3.24(1.70-5.90), p < 0.001], hypertension [OR and 95% CI 1.40(1.05-1.87), p = 0.024], BMI 24-27.9 [OR and 95% CI 1.20(1.00-1.44), p = 0.047], higher HbA1c [(5.6-7.9) % OR and 95% CI 1.42(1.10-1.82), p = 0.006; (8.0-9.9) %: 1.32(1.10-1.58), p = 0.003] were risk factors. CONCLUSIONS: D2M patients aged over 50 years has a high prevalence of pterygium in JDEDS. The pterygium prevalence is higher in female D2M participants. Diabetes and related factors may be risk factors of pterygium in female D2M patients. Further studies are needed to explore the gender difference in the pathogenesis of pterygium in D2M subjects.

Surrogate markers and predictors of endogenous insulin secretion in children and adolescents with type 1 diabetes.

BACKGROUND: No studies have examined endogenous insulin secretion in pediatric patients with type 1 diabetes in China using the gold-standard mixed-meal tolerance test. Because the latter is labor-intensive, we examined simpler surrogate markers of endogenous insulin secretion in Chinese youth, as previously reported for a European population. METHODS: Participants were 57 children and adolescents with type 1 diabetes aged 4.4-16.8 years (56% females). We performed 120-minute mixed-meal tolerance tests with serum C-peptide (CP) measurements every 30 minutes. Severe insulin deficiency (SID) was defined as CP peak < 0.2 nmol/L. Urine CP and creatinine levels were measured at 0 and 120 minutes. RESULTS: Twenty-five (44%) patients had SID. Fasting CP levels missed one case (96% sensitivity) with no false positives (100% specificity). While the 120-minute urine CP/creatinine had 100% sensitivity, it yielded markedly lower specificity (63%). Every 1-year increase in diabetes duration and 1-year decrease in age at diagnosis were associated with 37% (P < 0.001) and 20% (P = 0.005) reductions in serum CP area-under-the-curve, respectively. Thus, 86% of children aged < 5 years had SID compared to none among patients aged ≥ 11 years. CONCLUSIONS: Simple fasting CP measurements could be used to detect most SID cases in Chinese youth with type 1 diabetes. Fasting CP is a far more reliable measure of endogenous insulin secretion than the more commonly used insulin dose. Therefore, it could more precisely determine insulin secretory capacity to target those who could benefit, if treatments to preserve residual insulin secretion are developed.

[The prevalence of appositional angle closure among adults aged 50 years or above in Funing county Jiangsu Province].

OBJECTIVE: The purpose of the study is to determine the prevalence of appositional angle closure in persons aged 50 or above in Funing County. METHODS: Cluster sampling randomly selected residents in Funing County aged 50 years or above. From March to May 2010, 484 eyes of 243 patients with the shallow peripheral anterior chamber and the anatomic narrow chamber angle, which was determined by Van Herick technique and gonioscopy, were collected from 5202 individuals. The presence of appositional angle closure and the angle-opening distance (AOD) was determined with photopic and scotopic ultrasound biomicroscopy (UBM) in eight positions. Paired χ² test and paired t test (SPSS 17.0) were used to determine any significant differences at P < 0.05. RESULTS: The prevalence of appositional angle closure was found at least one position in 337 eyes (69.6%) by scotopic UBM and in 116 eyes (24.0%) by photopic UBM. The prevalence of appositional angle closure was significantly higher by scotopic UBM than by photopic UBM (χ² = 204.36, P < 0.001 respectively), and was the highest in superior quadrant. The AOD varied significantly among the eight positions and was significantly narrower by scotopic UBM than by photopic UBM (t = 6.039, 6.883, 11.612, 11.157, 4.732, 6.798, 5.156, 4.071; P < 0.001). Since 197 persons (81.07%) were found anterior angle closure by scotopic UBM, we estimated the prevalence of appositional angle closure was 5.40% (95% CI: 4.80%-6.05%) among adults aged 50 or above in Funing County. CONCLUSIONS: The prevalence of appositional angle closure was higher than previous surveys, the possible reason is that scotopic UBM could find early appositional angle closure more preferably.

[Study on gene-gene, gene-environmental interactions of DNA repair genes related with age-related cataract].

OBJECTIVE: To investigate the interaction between polymorphisms and environment factors in age related cataract (ARC). METHODS: Population-based case-control study. All of 448 cataract cases were selected from cataract eye database and 248 controls were recruited from Funing county. All 18 single nucleotide polymorphism (SNPs) of WRN, OGG1, BLM and ERCC6 genes were genotyped using real-time fluorescent quantitative PCR. The possible risk of ARC was estimated by unconditional Logistic regression. The interaction effects between gene-gene and gene-environment were evaluated by use of multifactor dimensionality reduction (MDR). RESULTS: Risk of ARC in illiterate group was significantly increased (OR = 1.53, P < 0.05), compared to no illiterate group. The risk of cataract in farmers was significantly high with ORs of 3.75. Long exposure to sunlight may increase cataract risk. Factors such as smoking, drinking, hypertension had no relationship with ARC (P > 0.05). WRN-rs11574311 was still associated with ARC with statistical significance after Bonferroni correction (OR = 1.98, Pa<0.018). There was no evidence for any association at a significance level of P < 0.05 for the remaining alleles. MDR analysis showed a significant interaction model among the six factors: education, solar radiation, WRN-rs11574311, WRN-rs1801195, WRN-rs4733220 and BLM-rs17273206 (consistency inspection accuracy of 0.683 on average, cross validation at 10/10, P = 0.005). Logistic regression model showed that the "high-risk" individuals had a significantly increased risk of ARC, compared to those "low- risk" individual classified by the MDR mode mentioned above(OR = 5.51, P < 0.05). CONCLUSION: WRN-rs11574311 allele was the risk factor for ARC, and individuals who carried WRN-rs1801195, WRN-rs4733220 and BLM-rs17273206 allele and low level of education, long sunlight time significantly increased the risk of the ARC.

[Cataract risk factor survey in Funing county of Jiangsu province].

OBJECTIVE: To investigate the risk factors of cataract among people aged 50 years and above in Funing county of Jiangsu province. METHODS: Case-control study. All of 1 488 cataract cases were selected from cataract patients' database and 1 821 subjects without visual impairment were recruited as controls from Funing county who were examined between June 2010 and May 2011. Unconditional logistic regression was used to analyze possible risk factors of cataract such as socioeconomic status, lifestyles, history of chronic disease, and history of exposure to sunlight. RESULTS: The univariate analysis results showed that the risk of cataract on-set was higher with aging. Odds ratios (ORs) for people aged 60 to <70 years, 70 to <80 years, and ≥ 80 years were 6.88, 87.66, and 416.19 respectively with statistical significance comparing to people aged 60 years and below. Female had 12% higher risk of getting cataract than male (OR = 1.24, P = 0.003). Compared with the illiterate, the ORs with educational background of elementary school, junior high school, and high school and above were 0.44 (P < 0.01), 0.42 (P < 0.01) and 0.09(P < 0.01) respectively. The risk of cataract in farmers, smokers, people with high blood pressure or diabetes were significantly high with OR of 3.13 (P < 0.01), 1.23(P = 0.003), 1.44 and 1.92(P < 0.01), respectively. Long time exposure to sunlight increased cataract risk. The ORs of sunlight exposure during 3 to <4 hours, 4 to <6 hours and ≥ 6 hours were 2.09 (P < 0.01), 2.89 (P < 0.01), and 6.52 (P < 0.01) respectively comparing to exposure less than 3 hours per day. Marital status and alcohol drinking were not associated with cataract (P > 0.05). Multiple logistic regression analysis showed that the risk factors of cataract were the age (comparing the age of 50 to <60 years, the OR values of 60 to <70 years, 70 to <80 years and ≥ 80 years were 6.83, 132.39, 868.68 respectively with P < 0.01), the gender (OR = 2.29 for females, P < 0.01) , sunlight exposure (the OR for 3 to <4 hours exposure, 4 to <6 hours exposure and ≥ 6 hours exposure were 2.88, 5.99 and 13.28 respectively comparing to people with less than 3 hour exposure per day), smoking (OR = 1.87, P = 0.019) and diabetes (OR = 1.31, P = 0.029). Education was a protective factor with OR of 0.64,0.41 and 0.31 (P < 0.01) for elementary school, junior high school and high school respectively. CONCLUSION: Senior people, female, low level of education, smoking, history of diabetes and long time exposure to sunlight are risk factors of cataract among elderly people aged 50 years and above in Funing country.

[Prevalence and surgical status of cataract among adults aged 50 years or above in rural Jiangsu Province].

OBJECTIVE: To survey the prevalence, operative status, surgical coverage rate and social burden rate of cataract blindness among older adults aged 50 years or above in 2 typical counties (district) of Jiangsu Province, China in 2010. METHODS: Cluster sampling was used in randomly selected 12 867 individuals aged 50 years or above in 58 clusters in Funing County of Northern Jiangsu and Binhu District of Southern Jiangsu. Among them, 12 053 individuals received visual acuity and eye examinations (response rate 93.8%). Lens and cataract operative status were evaluated by slit-lamp biomicroscope. Data bank was established by Epidata3.0 Software. Statistical analyses were performed with Stata/SE Statistical Software, version 10.0. Confidence intervals and P values (significant at P < 0.05) for prevalence of cataract, surgical coverage rate of cataract, social burden rate and surgical outcomes of cataract blindness were calculated with adjustment for clustering effects and stratification associated with the sampling design. RESULTS: Among 12 503 individuals, there were 2208 cases of cataract with a prevalence of 18.3%. The prevalence of cataract was higher in the aged, female and lower-income persons (P < 0.05). Among 2208 cataract patients, cataract surgery was performed in 263 cases (11.9%). The surgical coverage rate of cataract was 59.7% and the social burden rate of cataract blindness 1.93%. The social burden rate of cataract blindness was higher in the aged persons (P < 0.01). In 357 eyes with cataract surgery, the rate of intraocular lens implantation was 85.7%. At Binhu, 71.0% of eyes with cataract surgery underwent phacoemulsification. At Funing, 73.6% of eyes underwent modern extra-capsular surgery respectively. Post-operative presenting and best corrected visual acuity over 0.7 was 11.2% and 19.6% of operated eyes respectively. The main causes of post-operative eyes with worse visual acuity (< 0.3) were post-capsular opacity and retinal disorders. CONCLUSION: Cataract is the most common and important eye disease that may lead into blindness and severe visual impairment among older adults aged 50 years or above. The coverage rate of cataract surgery is higher in Jiangsu province than in other provinces. The visual outcomes of surgery is less than ideal. An important task in blindness prevention of Jiangsu province still is the elimination of cataract blindness and the improvement of visual outcomes for cataract surgery in the future.