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1.
J Diabetes ; 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31222955

RESUMO

BACKGROUND: Because there has been no quality improvement initiatives targeting patients with type 2 diabetes (T2D) receiving basal insulin therapy, this study evaluated the effectiveness of physician-targeted education for optimizing glycemic management in these patients in China. METHODS: This multicenter open-label observational study conducted across China had a baseline sample survey, followed by a 6-month education program, and ended with a post-education sample survey. Education based on T2D treatment guidelines was given at Months 1 and 3, and was reinforced by self-audit every month. Each hospital enrolled 100 patients with T2D receiving basal insulin at both the baseline and post-education survey. The primary outcome was the proportion of hospitals meeting individual improvement goals. The goal setting was based on the proportion of patients achieving HbA1c <7.0% in each hospital at the time of the baseline survey. RESULTS: Overall, the individual improvement goal was achieved by 35 centers (49%). Hospitals with poor glycemic management at the baseline survey had higher possibility to improve at post-education survey. Two large sample surveys at baseline and post-education showed improved glucose management among these hospitals. A higher proportion of patients achieved HbA1c <7.0% in the post-education survey (27.2% vs 36.5%; P < 0.001) with reduced HbA1c levels (8.10% vs 7.72%; P < 0.001). Questionnaires from 723 physicians showed that confidence and practice of basal insulin use were significantly improved. CONCLUSIONS: Physician-targeted education improved glycemic management of patients with T2D in 71 hospitals in China, and was more effective at hospitals with poor glycemic management at the baseline survey.

2.
Geriatr Gerontol Int ; 19(8): 786-791, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31199567

RESUMO

AIM: To assess whether elderly patients are prioritized under the emergency triage system in Guangzhou, China. METHODS: This was a cross-sectional survey of clinical data from adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University between 1 August 2015 and 31 December 2017. The primary end-point was receiving the first medical service within the target waiting time, which varied according to the triage level of the patient. Multivariate logistic regression was used to determine whether age was an independent predictor of a shorter waiting time. RESULTS: Data from 262 282 emergency patients were analyzed. The mean age of patients was 35.97 years, and 7.5% were aged ≥65 years. In total, 88.3% of patients received medical service within the target waiting time, and 87.4% of elderly patients received medical service within the target waiting time. Multivariate logistic regression analysis showed that advanced age was independently associated with receiving medical service within the target waiting time (adjusted odds ratio 1.258, 95% confidence interval 1.198-1.321; P < 0.001). The triage level, type of emergency subdivision, availability of outpatient services and time of day were also associated with receiving medical service within the target waiting time. CONCLUSION: Under the emergency triage system of the hospital, older adults are more likely to receive medical service within the target waiting time than younger patients. Geriatr Gerontol Int 2019; 19: 786-791.

3.
Sci China Life Sci ; 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31197759

RESUMO

Continuous subcutaneous insulin infusion (CSII) is an effective therapy to control hyperglycemia in both patients with type 1 diabetes and type 2 diabetes. However, there is little data investigating the insulin dose setting during CSII therapy in type 2 diabetes to achieve optimal glycemic control and avoid the risk of hypoglycemia. Thus, this study is aimed to assess the dose characteristics of insulin requirement and explore the related clinical factors in patients with type 2 diabetes who were treated with CSII. A total of 327 patients (195 males) aged 52.9±12.5 years old were included in this study. Patients were treated with CSII to achieve the target fasting capillary blood glucose (4.4-7.0 mmol L-1) and 2-h postprandial capillary blood glucose (4.4-10.0 mmol L-1) by adjusting insulin infusion according to the seven-point capillary blood glucose profiles. Total daily insulin dose (TDD), total daily insulin dose per kilogram (TDD kg-1) and the ratio of total basal insulin dose (TBD) to TDD (%TBa) were calculated after patients achieved the glucose targets for at least 3 days via 1-2 weeks of CSII treatment. And insulin dose, insulin dosing patterns and the relevant clinical factors were analyzed. The mean ratio of basal/bolus insulin distribution of all patients was 40%:60%. Patients with central obesity needed more TDD (51.3±17.1 U versus 43.5±14.0 U, P<0.05) and TDD kg-1 (0.8±0.3 U kg-1 versus 0.7±0.2 U kg-1, P<0.05) than those without central obesity. Pearson's correlation analysis demonstrated that TDD was positively correlated with body mass index (BMI), waist circumference (WC), baseline fasting plasma glucose (FPG), fasting C-peptide level, 2 h-postprandial C-peptide level and time to achieve glycemic target (all P<0.05); TDD kg-1 was positively correlated with waist-to-hip ratio (WHR), baseline FPG, glycosylated hemoglobin A1c (HbA1c), fasting C-peptide level and time to achieve glycemic target, and negatively correlated with BMI (all P<0.05). Multiple linear regression analyses revealed that BMI (ß=1.796, P<0.01), WC (ß=0.709, P<0.01), baseline FPG (ß=1.459, P<0.01) and HbA1c (ß=0.930, P=0.021) were independently related to TDD. Gender (ß=-0.107, P=0.003), WC (ß=0.005, P=0.029), baseline FPG (ß=0.025, P<0.01) and HbA1c (ß=0.016, P=0.007) were independently associated with TDD kg-1. Gender (ß=-0.015, P=0.048) and disease duration (ß=0.134, P=0.029) were independently associated with %TBa. %TBa is around 40% in Chinese patients with type 2 diabetes treated with CSII when glycemic control is achieved. In addition to body weight or BMI, WC and glucose levels before CSII should be considered to set TDD. Patients with central obesity or poor glycemic control might need more TDD. Higher %TBa should be considered in female patients or patients with longer disease duration.

4.
J Diabetes Investig ; 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31161658

RESUMO

AIMS/INTRODUCTION: Data of nationwide glycemic control and hypoglycemic treatment patterns in newly diagnosed type 2 diabetes patients in China are absent. The aim of this study was to assess the evolution of treatment patterns for newly diagnosed type 2 diabetes patients and the clinical outcomes during 12-month follow up. MATERIALS AND METHODS: This is an observational prospective cohort study with 12 months of follow up. Patients with a diagnosis of type 2 diabetes for <6 months were enrolled. Glycated hemoglobin A1c (HbA1c) levels and hypoglycemic treatment patterns were collected at baseline and at every 3 months of follow up. RESULTS: A total of 79 hospitals were recruited, consisting of 5,770 participants. The mean HbA1c was 8.4 ± 2.5% at baseline, and decreased to 6.7 ± 1.2% at 12 months with 68.5% of patients achieving HbA1c <7%. At baseline, 44.6% of the patients were without hypoglycemic medications, 37.7% had oral hypoglycemic agents and 17.7% received insulin treatment. Determinants of change in HbA1c were treatment patterns, comorbidities, baseline characteristics such as obesity and smoking, regions, and tiers of hospitals. Associated factors with treatment alterations were time of follow up, treatment patterns, patient-reported reasons such as the economic factors and poor efficacy. CONCLUSIONS: In newly diagnosed type 2 diabetes patients, compared with patients without medications, patients with one oral hypoglycemic agent had higher possibilities of reaching glycemic control, whereas patients using insulin had lower possibilities of reaching the target. Factors associated with change in HbA1c and treatment alterations were also revealed.

5.
Sci Rep ; 9(1): 7709, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118445

RESUMO

Nationwide data on glycemic control, blood pressure (BP) control and lipid control in patients with newly diagnosed type 2 diabetes were vacant in China. The aim of this study was to assess the clinical outcomes for these patients. This is an observational prospective cohort study with 12 months of follow up. Patients with a diagnosis of type 2 diabetes less than 6 months were enrolled. Hemoglobin A1c (HbA1c) levels, BP levels and lipid levels were collected at baseline and the follow-ups. This study was registered at www.clinicaltrials.gov (NCT01525693). A total of 5770 participants from 79 hospitals across six geographic regions of China were recruited. After 12 months of treatment, 68.5% of these patients achieved HbA1c <7.0%; 83.7% reached BP <140/90 mmHg; 48.2% met low density lipoprotein cholesterol (LDL-c) <2.6 mmol/L; and 29.5% of patients reached the combined three therapeutic targets. Compared to those patients with baseline HbA1c <7.0%, patients with baseline HbA1c ≥7.0% had higher failure rate to reach glycemic control (relative risk (RR) = 2.04, p < 0.001), BP control (RR = 1.21, p < 0.001) and LDL-c control (RR = 1.11, p < 0.001). Obese patients had higher possibilities of failure in glucose control (RR = 1.05, p = 0.004), BP control (RR = 1.62, p < 0.001) and lipid control (RR = 1.09, p = 0.001) than patients with normal weight. The active smokers were more likely to fail in glycemic control than non-smokers (RR = 1.06, p = 0.002), and patients with physical activities were less likely to fail in lipid control than patients without exercises (RR = 0.93, p = 0.008). This study outlined the burdens of glycemic control, blood pressure control, lipid control in newly diagnosed type 2 diabetic patients in China, identified gaps in the quality of care and risk-factor control and revealed the factors influencing these gaps.

6.
Diabetes Metab Res Rev ; 35(6): e3152, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30884108

RESUMO

Blood glucose monitoring is an important part of diabetes management. Continuous glucose monitoring (CGM) technology has become an effective complement to conventional blood glucose monitoring methods and has been widely applied in clinical practice. The indications for its use, the accuracy of the generated data, the interpretation of the CGM results, and the application of the results must be standardized. In December 2009, the Chinese Diabetes Society (CDS) drafted and published the first Chinese Clinical Guideline for Continuous Glucose Monitoring (2009 edition), providing a basis for the standardization of CGM in clinical application. Based on the updates of international guidelines and the increasing evidence of domestic studies, it is necessary to revise the latest CGM guidelines in China so that the recent clinical evidence can be effectively translated into clinical benefit for diabetic patients. To this end, the CDS revised the Chinese Clinical Guideline for Continuous Glucose Monitoring (2012 Edition) based on the most recent evidence from international and domestic studies.

7.
Diabetes Metab Res Rev ; 35(6): e3158, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30908791

RESUMO

The prevalence of diabetes in China has increased rapidly from 0.67% in 1980 to 10.4% in 2013, with the aging of the population and westernization of lifestyle. Since its foundation in 1991, the Chinese Diabetes Society (CDS) has been dedicated to improving academic exchange and the academic level of diabetes research in China. From 2003 to 2014, four versions of Chinese diabetes care guidelines have been published. The guidelines have played an important role in standardizing clinical practice and improving the status quo of diabetes prevention and control in China. Since September 2016, the CDS has invited experts in cardiovascular diseases, psychiatric diseases, nutrition, and traditional Chinese medicine to work with endocrinologists from the CDS to review the new clinical research evidence related to diabetes over the previous 4 years. Over a year of careful revision, this has resulted in the present, new version of guidelines for prevention and care of type 2 diabetes in China. The main contents include epidemiology of type 2 diabetes in China; diagnosis and classification of diabetes; primary, secondary, and tertiary diabetes prevention; diabetes education and management support; blood glucose monitoring; integrated control targets for type 2 diabetes and treatments for hyperglycaemia; medical nutrition therapy; exercise therapy for type 2 diabetes; smoking cessation; pharmacologic therapy for hyperglycaemia; metabolic surgery for type 2 diabetes; prevention and treatment of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes; hypoglycaemia; chronic diabetic complications; special types of diabetes; metabolic syndrome; and diabetes and traditional Chinese medicine.

8.
Endocr Pract ; 25(5): 454-460, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30720350

RESUMO

Objective: Epidemiologic studies on the relationship between iodine and thyroid antibodies are inconsistent. Iodine nutrition, genetic, and environmental factors have been shown to modify the effects of iodine on thyroid autoimmunity. We investigated the relationship between urinary iodine concentration (UIC) and thyroglobulin antibodies (TgAbs) in individuals living in iodine-sufficient areas in this cross-sectional study. Methods: A total of 15,008 participants were recruited according to the age range of the population of China in our study. An oral questionnaire was administered to collect basic demographic information. Serum thyrotropin (TSH), thyroid peroxidase antibodies (TPOAbs), TgAbs, and UIC were measured, and thyroid ultrasonography was performed in all subjects. Participants were further divided according to the level of UIC and the status of TgAb, and logistic regression was applied to determine the relationship between UIC and TgAbs. Results: The median UIC of the study population was 205.23 (95% confidence interval [CI], 65.7 to 537.67) µg/L. A total of 17.6% of participants had UIC <100 µg/L. With the increase in UIC, the prevalence of positive TgAbs decreased gradually. UIC level was lowest in subjects with high TgAb titer (median, 182.36 µg/L; 95% CI, 52.88 µg/L to 506.71 µg/L) and highest in the TgAb-negative group (median, 207.16 µg/L; 95% CI, 66.94 µg/L to 538.72 µg/L). Multilinear correlation analysis showed that gender (ß = 37.632; P<.001), age (ß = 0.467; P = .038), TSH (ß = 13.107; P<.001), TPOAb (ß = 1.150; P<.001), thyroid volume (ß = 2.883; P<.001), and UIC (ß = -0.047; P = .032) were independent predictors of TgAb variations. Low UIC (<100 µg/L) was associated with increased risk of positive TgAbs (adjusted odds ratio = 1.255 [1.004 to 1.568]). Conclusion: Low UIC is an independent risk factor for positive TgAb in individuals living in iodine-sufficient areas. Abbreviations: CI = confidence interval; CV = coefficient of variation; FT3 = free triiodothyronine; FT4 = free thyroxine; OR = odds ratio; TgAb = thyroglobulin antibody; TPOAb = thyroid peroxidase antibody; TSH = thyrotropin; UIC = urinary iodine concentration; USI = universal salt iodization.


Assuntos
Tireoglobulina/imunologia , China , Estudos Transversais , Humanos , Iodo , Tireotropina , Tiroxina
9.
Hepatology ; 69(5): 2304-2305, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30729549

RESUMO

We sincerely thank Dr. Sikarin Upala for his interest in our article and for sharing his experience in the treatment of nonalcoholic fatty liver disease (NAFLD). NAFLD is prevalent in patients with type 2 diabetes mellitus (T2DM), yet only preliminary evidence are available on the effect of anti-diabetic agents to NAFLD in T2DM patients. According to clinical practice guidelines for NAFLD management (1,2) , no pharmacotherapies are approved for the treatment of NAFLD. There is neither proper therapy for patients with T2DM and NAFLD. So we designed this 26-week comparative trial, aiming to evaluate the efficacy and safety of liraglutide, sitagliptin, and insulin glargine as an add-on treatment to metformin in patients with T2DM and NAFLD. This article is protected by copyright. All rights reserved.

10.
J Diabetes ; 2018 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-30520243

RESUMO

BACKGROUND: The weight reduction effect of exenatide has been well proved, which may concern physicians about too much weight loss in patients with normal weight. This study evaluated the effects of exenatide monotherapy on glycemic control and weight change among normal-weight, overweight, and obese patients with newly diagnosed type 2 diabetes (T2D). METHODS: In this multicenter, prospective study, 29 normal-weight, 54 overweight, and 27 obese newly diagnosed and drug-naive patients with T2D were treated with exenatide for 48 weeks. The primary efficacy endpoint was the effect of baseline body mass index (BMI) on glycemic control, measured as the change from baseline in glycosylated hemoglobin A1c (HbA1c) at week 48 compared among different BMI groups. Other endpoints included comparisons of exenatide's effects on fasting plasma glucose, postprandial plasma glucose, body weight, and other metabolic indices. RESULTS: After 48-week treatment, the estimated mean HbA1c changes were -1.9%, -1.8% and -1.5% in normal-weight, overweight and obese patients (P=0.290 among groups after adjusted for baseline values). Fasting, 0.5h and 2h postprandial plasma glucose decreased similarly among groups. The weight reductions (decreased by 2.2 kg, 3.9 kg and 4.0 kg, respectively, P=0.104) as well as the waist circumference changes (decreased by 2.2cm, 3.2cm, and 5.6cm, respectively, P=0.078) presented non-significantly increasing trends from normal-weight, overweight to obese patients. CONCLUSIONS: Baseline BMI had no impact on glycemic control, weight change, or other metabolic indices with exenatide monotherapy. Normal-weight patients with T2D would benefit from exenatide as much as the overweight or obese patients on glucose control, without increased risk of excess weight loss. This article is protected by copyright. All rights reserved.

11.
J Diabetes Res ; 2018: 2791584, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30420969

RESUMO

Aims: Basal insulin plus oral hypoglycemic agents (OHAs) has not been investigated for early intensive antihyperglycemic treatment in people with newly diagnosed type 2 diabetes. This study is aimed at comparing the short-term (over a period of 12 days) effects of basal insulin glargine plus OHAs and continuous subcutaneous insulin infusion (CSII) on glycemic control and beta-cell function in this setting. Methods: An open-label parallel-group study. Newly diagnosed hospitalized patients with type 2 diabetes and fasting plasma glucose (FPG) ≥11.1 mmol/L or glycated hemoglobin (HbA1c) ≥9% (75 mmol/mol) were randomized to CSII or insulin glargine in combination with metformin and gliclazide. The primary outcome measure was the mean amplitude of glycemic excursions (MAGE), and secondary endpoints included time to reach glycemic control target (FPG < 7 mmol/L and 2-hour postprandial plasma glucose < 10 mmol/L), markers of ß-cell function, and hypoglycemia. Results: Subjects in the CSII (n = 35) and basal insulin plus OHA (n = 33) groups had a similar significant reduction from baseline to end of treatment in glycated albumin (-6.44 ± 3.23% and- 6.42 ± 3.56%, P = 0.970). Groups A and B have comparable time to glycemic control (3.6 ± 1.2 days and 4.0 ± 1.4 days), MAGE (3.40 ± 1.40 mmol/L vs. 3.16 ± 1.38 mmol/L; p = 0.484), and 24-hour mean blood glucose (7.49 ± 0.96 mmol/L vs. 7.02 ± 1.03 mmol/L). Changes in the C-peptide reactivity index, the secretory unit of islet in transplantation index, and insulin secretion-sensitivity index-2 indicated a greater ß-cell function improvement with basal insulin plus OHAs versus CSII. Conclusions: Short-term insulin glargine plus OHAs may be an alternative to CSII for initial intensive therapy in people with newly diagnosed type 2 diabetes.

12.
Neurosci Bull ; 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30430334

RESUMO

The influence of ß-cell function on cardiovascular autonomic neuropathy (CAN), an important diabetes-related complication, is still unclear. In this study, we aimed to investigate the association between residual ß-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN+ group (diabetic patients with CAN, n = 20) and a CAN- group (diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured. Homeostasis model assessment-beta cells (HOMA-B) and HOMA-insulin resistance (IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN- group, the CAN+ group had significantly lower fasting plasma insulin (6.60 ± 4.39 vs 10.45 ± 7.82 µ/L, P = 0.029), fasting C-peptide (0.51 ± 0.20 vs 0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B (21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio (r = 0.24, P = 0.043) and the 30:15 test (r = 0.26, P = 0.023). Further analysis showed that fasting C-peptide (OR: 0.041, 95% CI 0.003-0.501, P = 0.012) and HOMA-B (OR: 0.965, 95% CI 0.934-0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values < 0.67 nmol/L were more likely to have CAN than those with C-peptide levels ≥0.67 nmol/L (OR: 6.00, 95% CI 1.815-19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased ß-cell function was closely associated with CAN in this population.

13.
Diabetes Obes Metab ; 2018 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-30471182

RESUMO

AIMS: We previously reported in China, using a hospital-based national survey, a high frequency of adult-onset autoimmune diabetes. Here, in a population-based, multicenter nation-wide study, in phenotypic type 2 diabetes (T2D) patients, we investigate the prevalence of adult-onset autoimmune diabetes (ADM) and predisposition to autoimmune diseases by quantifying serum organ-specific autoantibodies MATERIALS AND METHODS: We included a nationally representative sample of 46 239 adults aged 20 years or older from 14 provinces, of whom 4671 had diabetes plus 1000 control subjects with normal glucose tolerance (NGT). Participants were screened centrally for autoantibodies to glutamic acid decarboxylase (GADA), protein tyrosine phosphatase-like protein (IA2A), and zinc transporter isoform-8 (Znt8A) and designated ADM where positive. We then assayed autoantibodies to thyroid peroxidase (TPOA), tissue transglutaminase (tTGA), and 21-hydroxylase (21-OHA) in randomly-selected subjects with ADM and age-, sex-matched non-ADM T2D controls plus NGT controls RESULTS: Post-normalization, standardized prevalence of ADM was 6.0 (5.3-6.8) % in initially non-insulin-requiring adult-onset diabetes subjects, corresponding to 6 million adults in China, in whom adjusted antibody positivity was TPOA 16.3(10.8-21.8) %, tTGA 2.1(0.0-4.2) %, and 21-OHA 1.8 (-0.2-3.8) %. Those GADA-positive ADM subjects had high risk for TPOA positivity (odds ratio 2.39; p=0.0031) and tTGA positivity (6.98; p=0.027), while those positive for IA2A had high risk for tTGA positivity (19.05; p=0.001). CONCLUSIONS: A proportion of phenotypic T2D patients in China have adult-onset autoimmune diabetes with diabetes-associated autoantibodies and they may be at risk of developing other organ-specific autoimmune diseases. Therefore, it may be clinically relevant to consider screening such Chinese populations. This article is protected by copyright. All rights reserved.

14.
Thyroid ; 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30351201

RESUMO

BACKGROUND: The fact that serum thyrotropin (TSH) levels increase with age may influence the diagnosis of thyroid diseases in older adults. This study aimed to establish an age-specific serum TSH reference range, examine the prevalence of thyroid diseases in older adults ≥65 years, and analyze the risk factors. METHODS: A cross-sectional study of adult populations in 10 cities in China was conducted from 2010 to 2011. A total of 15,008 subjects were randomly selected and completed the present study. Urinary iodine concentration, serum TSH, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) titers were measured. Thyroid ultrasonography and questionnaires were completed by all the subjects. When the TSH level was abnormal, free thyroxine and/or free triiodothyronine levels were measured. RESULTS: When the reference range of the general population was used, the prevalence rates of overt hypothyroidism (Ohypo) and subclinical hypothyroidism (Shypo) in older adults ≥65 years were significantly higher than those in younger adults <65 years (2.09% vs. 0.80% and 19.87% vs. 16.23%, respectively; p < 0.001). Positive TPOAb and positive TgAb were associated with the prevalence of Shypo in older adults. An age-specific serum TSH reference range was formulated according to guidelines set forth by the National Academy of Clinical Biochemistry. Both the median and upper limit values of serum TSH in older adults were higher than those in younger adults (2.58 [0.75-8.86] mIU/L vs. 2.38 [0.76-6.57] mIU/L; p < 0.001). Using the age-specific serum TSH reference range, the prevalence of Shypo in older adults was 3.3%, which was significantly lower than the prevalence based on the reference range of the general population (3.3% vs. 19.87%). The prevalence rates of Ohypo, overt hyperthyroidism (Ohyper), and subclinical hyperthyroidism (Shyper) did not change much (Ohypo: 1.6% vs. 2.09%; Ohyper: 0.7% vs. 0.52%; and Shyper: 3.8% vs. 0.73%). Positive TPOAb, but not positive TgAb, was also associated with the prevalence of Shypo as diagnosed with the age-specific serum TSH reference range. CONCLUSION: The serum TSH level increases with age, which may represent a normal compensatory phenomenon in older adults ≥65 years. To prevent misdiagnosis and mistreatment, the use of an age-specific serum TSH reference range is recommended in older adults for the diagnosis of thyroid diseases.

15.
Hepatology ; 2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30341767

RESUMO

To investigate the effect of anti-diabetic agents on nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes (T2DM), 75 patients with T2DM and NAFLD under inadequate glycemic control by metformin were randomized (1:1:1) to receive add-on liraglutide, sitagliptin, or insulin glargine. The primary endpoint was the change in intrahepatic lipid (IHL) from baseline to week 26 as quantified by magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF). Secondary endpoints included changes in abdominal adiposity (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT]), glycated hemoglobin (HbA1c), and body weight from baseline to week 26. We analysed data from intent-to-treat population. MRI-PDFF, VAT, and weight decreased significantly with liraglutide (15.4% ± 5.6% to 12.5% ± 6.4%, P < 0.001; 171.4 ± 27.8 to 150.5 ± 30.8, P = 0.003; 86.6 ± 12.9 kg to 82.9 ± 11.1 kg, P = 0.005, respectively) and sitagliptin (15.5% ± 5.6% to 11.7% ± 5.0%, P = 0.001; 153.4 ± 31.5 to 139.8 ± 27.3, P = 0.027; 88.2 ± 13.6 kg to 86.5 ± 13.2 kg, P = 0.005, respectively). No significant change in MRI-PDFF, VAT, or body weight was observed with insulin glargine. SAT decreased significantly in the liraglutide group (239.9 ± 69.0 to 211.3 ± 76.1; P = 0.020) but not in the sitagliptin and insulin glargine groups. Changes from baseline in MRI-PDFF, VAT, and body weight were significantly greater with liraglutide than insulin glargine but did not differ significantly between liraglutide and sitagliptin. CONCLUSION: Combined with metformin, both liraglutide and sitagliptin, but not insulin glargine, reduced body weight, IHL and VAT in addition to improving glycemic control in patients with T2DM and NAFLD. This article is protected by copyright. All rights reserved.

16.
Exp Ther Med ; 16(3): 2717-2724, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30186503

RESUMO

MicroRNAs (miRs) post-translationally regulate gene expression by specifically binding to the mRNA of their target genes. The aim of the present study was to determine the effect of miR-192 on pancreatic ß-cell development. The serum levels of miR-192 in type 1 diabetes mellitus (T1DM) and streptozotocin-induced rats were determined, and were revealed to be elevated compared with those in healthy patients and normal rats, respectively. Western blot and reverse transcription-quantitative polymerase chain reaction analysis indicated that miR-192 suppressed the expression of glucagon-like peptide-1 (GLP-1), a potent insulin secretagogue. Ectopic expression of miR-192 inhibited cell proliferation and promoted apoptosis of NIT-1 cells, while miR-192 inhibitor had the opposite effect. Collectively, the present results revealed that miR-192 was elevated in T1DM, and is implicated in pancreatic ß-cell development through regulation of cell proliferation and apoptosis, thereby suppressing insulin secretion. Furthermore, miR-192 suppressed GLP-1 expression, thereby further promoting T1DM. The present study suggested that miR-192 is a novel molecular target for the management or prevention of T1DM.

17.
Sci China Life Sci ; 2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30267261

RESUMO

The prevalence of diabetes has increased dramatically over the past three decades, and currently, China has the largest number of diabetics worldwide; this number continues to grow and puts ongoing strains on the medical resources. In this review, we reviewed the diabetes research conducted in China from 1995 to 2015 with the aim of providing new insights regarding the current status and future perspectives for researchers, diabetes health providers, and respective policy-makers. Remarkable progress has been made in diabetes research in China during the past two decades in terms of both the quantity and publication influence. The progress, however, struggles to adequately manage diabetes in China. Here we addressed opportunities to strengthen researches, including new drug development, high quality studies on health economics, and healthcare quality improvement studies. As the expected wave of diabetic complications is upcoming and overwhelming, we therefore recommend that immediate improvements are required to implement the researches regarding their prevention and treatment.

18.
J Diabetes Investig ; 2018 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-30079578

RESUMO

AIMS/INTRODUCTION: To investigate the direct medical costs for patients with type 2 diabetes in China and to examine the influencing factors. MATERIALS AND METHODS: In the present multicenter study, 1,070 patients with type 2 diabetes from 16 tertiary hospitals in 14 major cities of China were enrolled. Patient data and direct medical costs were collected during a follow-up period of 6 months at intervals of 1 month. The log-transformed direct medical costs were fitted by a generalized estimation equation to indicator variables for demographics, metabolic control, treatments, complications and comorbidities. RESULTS: Data of 871 participants were included in the analysis. The mean annual total direct medical costs and outpatient medical costs were $1,990.20 and $1,687.20 respectively. The average costs per inpatient per admission were $2,127.10. The share of out-of-pocket for total medical costs, outpatient costs and cost per inpatient per admission were 45.4, 46.3 and 26.0% respectively. Independent determinants of total medical costs were diabetes duration, dyslipidemia and diabetic complications, such as neuropathy and nephropathy, as well as diabetes treatment, such as the use of glucagon-like peptide-1 receptor agonists. Costs showed prominent variation across centers. CONCLUSIONS: Diabetes is imposing a growing economic burden in patients with type 2 diabetes in China. Diabetes-related complications and comorbidities have a great impact on the medical costs. As different health policies, economic development and regional health inequalities also have an important influence on the direct medical cost, healthcare reform needs to optimize resource allocation in health service delivery systems, and provide more equitable and affordable healthcare.

19.
Cell Signal ; 47: 65-78, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29596872

RESUMO

Lipotoxicity leads to insulin secretion deficiency, which is among the important causes for the onset of type 2 diabetes mellitus. Thus, the restoration of ß-cell mass and preservation of its endocrine function are long-sought goals in diabetes research. Previous studies have suggested that the membrane protein caveolin-1 (Cav-1) is implicated in ß-cell apoptosis and insulin secretion, however, the underlying mechanisms still remains unclear. Our objective is to explore whether Cav-1 depletion protects pancreatic ß cells from lipotoxicity and what are the underlying mechanisms. In this study, we found that Cav-1 silencing significantly promoted ß-cell proliferation, inhibited palmitate (PA)-induced pancreatic ß-cell apoptosis and enhanced insulin production and secretion. These effects were associated with enhanced activities of Akt and ERK1/2, which in turn downregulated the expression of cell cycle inhibitors (FOXO1, GSK3ß, P21, P27 and P53) and upregulated the expression of Cyclin D2 and Cyclin D3. Subsequent inhibition of PI3K/Akt and ERK/MAPK pathways abolished Cav-1 depletion induced ß-cell mass protection. Furthermore, under PA induced endoplasmic reticulum (ER) stress, Cav-1 silencing significantly reduced eIF2α phosphorylation and the expression of ER stress-responsive markers BiP and CHOP, which are among the known sensitizers of lipotoxicity. Our findings suggest Cav-1 as potential target molecule in T2DM treatment via the preservation of lipotoxicity-induced ß-cell mass reduction and the attenuation of insulin secretion dysfunction.

20.
J Clin Endocrinol Metab ; 103(4): 1320-1329, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29370422

RESUMO

Context: New strategies and biomarkers are needed in the early detection of ß-cell damage in the progress of type 1 diabetes mellitus (T1DM). Objective: To explore whether serum microRNAs (miRNA) should be served as biomarkers for T1DM. Design, Settings, and Patients: The miRNA profile was established with miRNA microarray in discovery phase (six T1DM, six controls). A miRNA-based model for T1DM diagnosis was developed using logistic regression analysis in the training dataset (40 T1DM, 56 controls) and then validated with leave-one-out cross validation and another independent validation dataset (33 T1DM, 29 controls). Main Outcome Measures: Quantitative reverse transcription polymerase chain reaction was applied to confirm the differences of candidate miRNAs between T1DM and controls. Area under the receiver-operating characteristic (ROC) curve (AUC) was used to evaluate diagnostic accuracy. INS-1 cells, streptozotocin-treated mice (n = 4), and nonobese diabetic (NOD) mice (n = 12) were used to evaluate the association of miRNAs with ß-cell damage. Results: A miRNA -based model was established in the training dataset with high diagnostic accuracy for T1DM (AUC = 0.817) based on six candidate differential expressed miRNAs identified in discovery phase. The validation dataset showed the model's satisfactory diagnostic performance (AUC = 0.804). Secretions of miR-1225-5p and miR-320c were significantly increased in streptozotocin-treated mice and INS-1 cells. Noteworthy, the elevation of these two miRNAs was observed before glucose elevation in the progress of diabetes in NOD mice. Conclusions: Two miRNA biomarkers (miR-1225-5p and miR-320c) related to ß-cell damage were identified in patients with recent-onset T1DM. The miRNA-based model established in this study exhibited a good performance in diagnosis of T1DM.


Assuntos
Diabetes Mellitus Experimental/diagnóstico , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/genética , MicroRNAs/sangue , Adolescente , Adulto , Animais , Biomarcadores/sangue , Estudos de Casos e Controles , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Tipo 1/patologia , Diagnóstico Precoce , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Células Secretoras de Insulina/patologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos NOD , MicroRNAs/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Sensibilidade e Especificidade , Adulto Jovem
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