Outcome of intensive integrated intervention in participants with impaired glucose regulation in China.

INTRODUCTION: This study investigated the outcomes and identified influencing factors of intensive integrated intervention over 2 years in Chinese patients with impaired glucose regulation (IGR). METHODS: Adults in Beijing, China, were screened for IGR using the 75 g oral glucose tolerance test. Participants with IGR received lifestyle and health education; those who still had IGR after 1 year were randomly assigned to either a routine care group or to an intensive integrated intervention group. RESULTS: Of 2344 adults screened, 463 had IGR. Of these, 210 adults had IGR after 1 year and were therefore recruited and randomized to an intensive integrated intervention group (n=106) or a control group (n=104). The percentage of patients who reached the set targets of plasma glucose, blood pressure, body mass index, or triglycerides was significantly higher in the intensive integrated intervention group. None of the patients within the intensive integrated intervention group progressed to diabetes, whereas eight (9.3%) cases of the control group developed type 2 diabetes mellitus (T2DM). Logistic regression analysis showed that both an increase in waist circumference and systolic blood pressure (SBP) were positively correlated with the development of T2DM, whereas improvement in islet beta cell function was negatively correlated with the development of T2DM. CONCLUSIONS: Intensive integrated intervention may significantly decrease the conversion rate of IGR to T2DM, and increase the conversion ratio to normal glucose tolerance. The increase of waist circumference or SBP and the deterioration of islet beta cell function may be important risk factors for progression from prediabetes to diabetes.

[Association between chronic kidney disease and cardiovascular events in middle-to-old-aged Chinese population].

OBJECTIVE: This study aimed to determine the relationships between estimated glomerular filtration rate (eGFR) and cardiovascular events. METHODS: 2500 residents aged more than 40 years old were selected from Shougang community, Shijingshan district, in Beijing. 2315 of them took part in the survey. First morning urinary sample was collected for all the participants. Albumin and creatinine were measured and eGFR was calculated using simplified MDAD formula. Cardiovascular risk factors were also investigated. The participants were followed up for 4 years, and all-cause mortality and cardiovascular events were collected. The subjects were divided into three groups according to eGFR [ml/(min·1.73 m(2))]: < 60, 60 - 90, > 90. Cox regression model was used to analyze the relationships between eGFR, all events, and cardiovascular events after adjusting for confounders. RESULTS: The prevalence of eGFR < 60 was 3.3%. The incidence rates of cardiovascular events were 43.9, 21.8 and 11.5/1000 person-years among three groups, and the incidence rates of all events (all-cause mortality and cardiovascular events) were 53.7, 28.8 and 14.6/1000 person-years, respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, diabetes mellitus, cardiovascular disease, the hazard risk (HR) for cardiovascular events was 1.29 (95%CI: 0.85 - 1.96) in eGFR < 60 group and 2.14 (95%CI: 1.02 - 4.50) in 60 ≤ eGFR < 90 group, when compared with the eGFR > 90 group; the HR for all events were 1.25 (95%CI: 0.86 - 1.81) and 1.95 (95%CI: 1.00 - 3.80), respectively. CONCLUSION: In the population studied, eGFR < 60 seemed an independent predictor for cardiovascular events and all-cause events.

[A community-based study on relations between metabolic syndrome and carotid atherosclerosis in a middle-aged population].

OBJECTIVE: To explore the association between metabolic syndromes (MS) and carotid atherosclerosis and to estimate the predictive effects of MS under 3 different definitions. METHODS: A cross-sectional study was conducted in 2 community-based populations in Beijing, in 2008. 1266 subjects (598 men, 668 women), aged 45 - 69, were included in the analyses. MS was defined by the criteria of International Diabetes Federation (IDF), the revised NCEP ATP III (ATPIII-R) and "The Guidelines of Dyslipidemia Control for Chinese Adult" ("Guidelines") in 2007. RESULTS: The prevalence rates of MS by the 3 criteria were 39.0%, 43.3% and 30.9% respectively. The Kappa value for the measure of the agreement between each pair of the 3 definitions were 0.911, 0.719 and 0.730 respectively. The intima-media thickness in common carotid artery (CCA-IMT) was significantly higher (P < 0.001) in all MS groups than in non-MS groups, diagnosed with the 3 criteria independent of age, gender, LDL-C, and current smoking status. After adjustment of age, gender, LDL-C, and current smoking status, the classification of MS significantly increased the risk of prevalence of carotid atherosclerotic plaques, compared to the non-MS group. OR value were 1.499 (95%CI: 1.157 - 1.942) for IDF, 1.696 (95%CI: 1.314 - 2.189) for NCEP-R, 1.763 (95%CI: 1.344 - 2.312) for "Guideline" respectively. CONCLUSION: Our research findings indicated that, when MS were defined with the 3 definitions, prediction on the risk of sub-clinical atherosclerosis would work beyond some of the conventional cardiovascular risk factors such as smoking, LDL-C. There might exist some differences in gender issue on the strength of association between MS when diagnosed by different criteria and carotid plaque.

[Two-year follow-up for patients with pre-diabetes that reverted to normal glucose in the first year].

OBJECTIVE: To investigate the natural outcome in the second year of the patients with impaired glucose regulation (IGR) that reverted to normal glucose tolerance (NGT). METHODS: 463 adults diagnosed as with IGR in the baseline survey based on the criteria of America Diabetic Association 2003 underwent treatment including health education. One and 2 years later blood samples were collected to examine the glucose and lipids. Blood pressure, heart rate, waist, and hip were examined. Questionnaire survey was conducted. RESULTS: One year later 55 of the patients (32.5%) were diagnosed as with isolated impaired glucose tolerance (I-IFG), 86 (50.9%) with I-IGT, and 28 (16.6%) with IFG/IGT at the baseline survey had their diseases reverted to NGT. 53.3% of them remained to be with NGT, 45.6% of them showed the diagnosis transformed into IGR, and the disease in 1.2% of them progressed into diabetes mellitus. In the second year, insulin resistance was significantly relieved and islet beta cell function was significantly improved in the pattern IGR--->NGT-->NGT. Stepwise logistic regression analysis showed that fasting plasma glucose (FPG) in the baseline survey and 1 year later were negatively correlated and HBCI were positively correlated with the reversion and maintenance of NGT. In the second year, the ratio of elevated waist circumference, elevated blood pressure, elevated TG, reduced HDL-c, elevated FPG, more than two metabolic abnormalities and metabolic syndrome of the IGR-->NGT-->NGT group were significantly lower than in the IGR-->NGT-->IGR group ( all P < 0.05). CONCLUSION: FPG, islet beta cell function and TG can be considered as indicators for reversion from IGR to NGT and maintenance of NGT. Those with less metabolic abnormalities at baseline and with more obvious improvement would be more likely to revert to and maintain NGT.

[Major causes of death among male steelworkers in Beijing: a prospective study].

OBJECTIVE: To evaluate the major causes of death and risk factors among male steelworkers in Beijing. METHODS: The study included 5137 men from the cohort of Beijing Capital Steel and Iron Company. The baseline survey was performed in 1974, 1979 and 1980 and the final follow-up evaluation was made in 2001 with a mean follow-up of 20.8 years. Causes of death were coded according to the Ninth Revision of International Classification of Diseases (ICD-9). The mortality was calculated by person-years of follow-up and age-standardized according to the 2000 census data in China. Cox proportional-hazards models adjusting for risk factors were used to estimate the relative risk of death. RESULTS: There is 760 deaths during follow-up. Age-standardized mortality from all causes was 643.0 per 100,000 person-years. The three leading causes of death were malignant neoplasms (mortality, 231.3 per 100,000 person-years), cerebrovascular diseases (mortality, 139.3 per 100,000 person-years) and heart diseases (mortality, 96.4 per 100,000 person-years). The multivariate-adjusted relative risk of death and the population attributable risk proportion for risk factors were as follow: cigarette smoking (95% CI, 1.174 to 1.765); hypertension (95% CI, 1.370 to 1.904) and hypercholesterolemia (95% CI, 1.057 to 1.537). CONCLUSIONS: Our study indicates that malignant neoplasms, cerebrovascular diseases and heart diseases were major causes of death among male steelworkers. Furthermore, cigarette smoking, hypertension and hypercholesterolemia are leading preventable risk factors for death.

[Comparison of the diagnostic criteria of metabolic syndrome by International Diabetes Federation and that by Chinese Medical Association Diabetes Branch].

OBJECTIVE: To compare the accordance between the diagnostic criteria of metabolic syndrome (MS) by International Diabetes Federation (IDF) and that by Chinese Medical Association (CMA) Diabetes Branch. METHODS: An epidemiological survey on diabetes mellitus (DM) was conducted among 2344 residents in Shijingshan community, Beijing, aged >or= 40. 1870 of these 2344 people, 901 males and 969 females, without DM underwent physical examination, laboratory tests, questionnaire survey and oral glucose tolerance test so as to screen the MS patients by both diagnostic criteria. The accordance of these 2 criteria was analyzed statistically by using the STATA7.0 software. RESULTS: The accordance rate of these 2 MS diagnostic criteria was 79.95%. If the criterion for fasting blood glucose in the China criteria was adjusted to 5.6 mmol/L, the accordance increased to 81.39%. 1091 persons were diagnosed as with central obesity according to the IDF criteria, 626 of which could be diagnosed as central obesity according to the China criteria with an accordance rate of 57.38%. Out of these 1091 persons 578 (92.3%) had the BMI >or= 25 kg/m(2). Out of the 779 persons that failed to be diagnosed as with central obesity 113 persons were diagnosed as with central obesity according to the China criteria. Fifty of these 113 persons had the BMI >or= 25 kg/m(2). 111 persons diagnosed as with MS did not have BMI abnormality. According to the IDF criteria, the morbidity of myocardial infarction (MI) and/or cerebral stroke in those with MS was 19.87%, significantly higher than in those without MS (14.86%, P = 0.004), and according to the China criteria, the morbidity of myocardial infarction (MI) and/or cerebral stroke in those with MS was 19.52%, significantly higher than in those without MS (15.21%, P = 0.013) as well. There was no significant difference in the morbidity of MI and cerebral stroke between the IDF criteria and China criteria (P = 0.092). According to the IDF criteria the morbidity of microalbuminuria in the MS patients was 8.59%, significantly higher than that in the persons without MS (4.28%, P = 0.000). According to the China criteria the morbidity of microalbuminuria in the MS patients was 8.55%, significantly higher than that in the persons without MS (4.49%, P = 0.000). There was no significant difference in the morbidity of microalbuminuria between these 2 criteria (P = 0.976). There were no significant difference in the morbidity of microalbuminuria in the persons with central obesity and those with the BMI >or= 25 kg/m(2) between these 2 criteria (P = 0.77). CONCLUSION: The MS diagnostic criteria of IDF and that of CMA Diabetes Branch are in good accordance.

[A 20-year prospective study on risk factors for myocardial infarction of 5,137 men in Capital Steel and Iron Company].

OBJECTIVE: To identify independent risk factors for myocardial infarction (MI) in Chinese men and to develop a model to predict risk profile of an individual suffering MI. METHODS: Study sample included 5 137 men aged 45.2 +/- 7.8 years who came from a cohort in Beijing Capital Steel and Iron Company, based on the three surveys on coronary heart disease conducted in 1974, 1979 and 1980, respectively. Demographic data and other risk factors, such as life style, medical history, blood pressure, total serum cholesterol level (TC), etc. were collected according to the same protocol in 1980. All the participants were followed up for MI in an average period of 20.84 years until 2001. RESULTS: (1) There were 122 cases with MI identified during the period of follow-up, with an incidence of MI 117.4 per 100 000 person-years. Age of more than 50, smoking, higher systolic and diastolic blood pressure (SBP and DBP) levels, higher TC all were identified as important risk factors of MI. (2) Incidence of MI increased with TC. An increment of 0.52 mmol/L of TC significantly increased relative risk of MI by approximately 40% after adjusted for age, blood pressure and smoking. (3) An increment of 20 mm Hg in SBP or 10 mm Hg in DBP associated with a 40% increase in incidence of MI, adjusting for age, TC and smoking. (4) Smoking was the most risky factors for MI. Smokers had 2.3 times risk of MI, after as compared to non-smokers (or its incidence increased by 137%), after adjusting for blood pressure, TC and age, etc. (5) Incidence of MI increased by 20% with increment of five-year of age in those aged over 50 (P < 0.05), after adjusting for blood pressure, TC and smoking. And, (6) finally, based on multivariate logistic and Cox regression analyses, a model containing several risk factors, such as age, blood pressure, TC and smoking, was developed to predict individual's risk for afflicting MI. CONCLUSIONS: Results of this prospective study showed several established risk factors for MI, including age, blood pressure, TC and smoking all as independent predictors of MI in Chinese men. It is clear and rational that intervention and modification of those traditional risk factors can lead to a decrease in coronary events in Chinese population.