Prevalence,Awareness, Treatment and Control of Diabetes Mellitus in a Chinese Population

ObjectiveThe purpose of this study is to evaluate the prevalence, awareness, treatment and glycemic control of diabetes mellitus (DM) in a Chinese population. The findings from this study are expected to offer scientific evidence to better prevent and control the growing number of reported and untreated cases.MethodsA cross-sectional survey was conducted in Jiangsu, China. We recruited permanent residents over 18 years of age from eight towns in Jintan (JT) and six towns in Yangzhong (YZ) using a three-stage stratified cluster sampling method. The rates of DM prevalence, awareness, treatment and control as well as their related factors were analyzed.ResultsA total number of 15404 people were entered into the analysis. The DM prevalence, awareness, treatment and control rates were 7.31%, 58.35%, 51.87% and 14.12%, respectively. Multivariable logistic regression analysis showed that being female was positively related to prevalence (OR = 1.21, 95% CI: 1.07–1.37), awareness (OR = 1.52, 95% CI: 1.19–1.93), treatment (OR = 1.48, 95% CI: 1.17–1.88) and control (OR = 1.87, 95% CI: 1.30–2.67) of DM. Having a family history of diabetes was significantly correlated with DM risk (OR = 1.86, 95% CI: 1.37–2.54) and increased awareness (OR = 3.12, 95% CI: 2.19–4.47), treatment (OR = 3.47, 95% CI: 2.45–4.90) and control (OR = 1.81, 95% CI: 1.22–2.68) of DM. Former smoking status (OR = 1.82, 95% CI: 1.23–2.71), overweight (OR = 2.11, 95% CI: 1.72–2.60) and obesity (OR = 3.46, 95% CI: 2.67–4.50) were related to the risk of DM. Additionally, we found current drinking status to be positively correlated with DM risk (OR = 1.30, 95% CI: 1.01–1.66) and negatively correlated with DM awareness (OR = 0.41, 95% CI: 0.29–0.59) and treatment (OR = 0.41, 95% CI: 0.29–0.59). Our study highlights the high prevalence and inadequate awareness, treatment and control of DM in the Chinese population.ConclusionsManagement and prevention of DM-related complications should be considered an essential strategy by governments and society. This study assessed the reasons why DM has been increasing and established the first step in determining where to start regarding preventative methods.     

Prevalence,Awareness, Treatment,Control and Risk Factors Associated with Hypertension among Adults in Southern China, 2013

To investigate the prevalence, awareness, treatment, control of hypertension and their associated factors in southern China. A cross-sectional survey was conducted in 5 cities of urban areas and 5 counties of rural areas in Southern China in 2013, a stratified multistage random sampling method was used to select a representative sample. Recruitment included a total of 19254 participants aged 15 or older. Socio-demographic profiles, examinations were administrated on each subject. Multilevel logistic regression models were used to identify the risk factors of hypertension, awareness, treatment, and control. Overall, the prevalence of hypertension and pre-hypertension are 24.59% and 32.11%, respectively in southern China. Among all the hypertensive patients, 67.43% were aware of their condition, 55.76% took anti-hypertension medication recent two weeks, and 30.79% had their blood pressure controlled. Compared with male, female hypertensive patients had higher rates of hypertension awareness, treatment and control. Age, gender, marital status, living areas, education, BMI, waist circumference, visceral adipose index (VAI), high body fat percentage (BFP) and family hypertension history correlated with the prevalence of hypertension. SBP/DBP increased with VAI and BFP increasing. There is an increasing prevalence of hypertension and high pre-hypertension in the general population in southern China, but levels of awareness, treatment, and control remain relatively low, especially for young and middle-aged population. Innovative strategies including of adopting appropriate anti-hypertensive medication therapy and healthy lifestyles should be taken.     

妊娠糖尿病饮食相关危险因素分析

目的：通过分析妊娠糖尿病患者与正常孕妇的饮食行为,探讨妊娠糖尿病发病饮食相关的危险因素,为孕期妇女提供科学 合理膳食指导。方法：采用多阶段连续等比例抽样,选取确诊GDM的孕妇150 例为病例组,同期就诊非GDM孕妇150 例为对照 组,利用24 小时膳食回顾法进行饮食行为和一般情况的问卷调查。采用Logistic 回归筛选GDM 饮食相关危险因素。结果：多因 素Logistic 回归分析显示,怀孕年龄( OR=1.157)、孕前BMI(OR=1.780)、糖尿病家族史(OR=2.448)、产次(OR=1.157)、总能量、水果 摄入量(OR=4.109)、豆类（OR=0.998）与妊娠糖尿病发生相关（OR=0.998）。采用多变量模型具体分析水果的摄入量,同时调整与妊 娠糖尿病发生的相关因素结果显示：与水果摄入量小于200 g/d 相比,水果的摄入量200 ~ 400 g/d,400 ~ 600 g/d 和超过600 g/d 其OR值分别为0.38、2.48、2.63（P<0.01）。结论：除高龄、肥胖、糖尿病家族史等妊娠糖尿病高危因素外,饮食行为与GDM存在一 定的相关性。针对高危人群早期干预,同时对孕期妇女进行科学合理的饮食指导,调整饮食结构,控制食物摄入量,以减少GDM 的发病。     

Awareness,Treatment, and Control of Diabetes in Bangladesh: A Nationwide Population-Based Study

ObjectivesTo examine awareness, treatment, and control of diabetes mellitus among the adult population in Bangladesh.MethodsThe study used data from the 2011 nationally representative Bangladesh Demographic and Health Survey (BDHS). The BDHS sample is comprised of 7,786 adults aged 35 years or older. The primary outcome variables were fasting blood glucose, diagnosis, treatment, and control of diabetes. Multilevel logistic regression models were used to identify the risk factors for diabetes awareness.ResultsOverall, age-standardized prevalence of diabetes was 9.2%. Among subjects with diabetes, 41.2% were aware of their condition, 36.9% were treated, and 14.2% controlled their condition. A significant inequality in diabetes management was found from poor to wealthy households: 18.2% to 63.2% (awareness), 15.8% to 56.6% (treatment), and 8.2% to 18.4% (control). Multilevel models suggested that participants who had a lower education and lower economic condition were less likely to be aware of their diabetes. Poor management was observed among non-educated, low-income groups, and those who lived in the northwestern region.ConclusionsDiabetes has become a national health concern in Bangladesh; however, treatment and control are quite low. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes.     

Allergies and Diabetes as Risk Factors for Dengue Hemorrhagic Fever: Results of a Case Control Study

Background

The physiopathology of dengue hemorrhagic fever (DHF), a severe form of Dengue Fever, is poorly understood. We are unable to identify patients likely to progress to DHF for closer monitoring and early intervention during epidemics, so most cases are sent home. This study explored whether patients with selected co-morbidities are at higher risk of developing DHF.

Methods

A matched case-control study was conducted in a dengue sero-positive population in two Brazilian cities. For each case of DHF, 7 sero-positive controls were selected. Cases and controls were interviewed and information collected on demographic and socio-economic status, reported co-morbidities (diabetes, hypertension, allergy) and use of medication. Conditional logistic regression was used to calculate the strength of the association between the co-morbidities and occurrence of DHF.

Results

170 cases of DHF and 1,175 controls were included. Significant associations were found between DHF and white ethnicity (OR = 4.70; 2.17–10.20), high income (OR = 6.84; 4.09–11.43), high education (OR = 4.67; 2.35–9.27), reported diabetes (OR = 2.75; 1.12–6.73) and reported allergy treated with steroids (OR = 2.94; 1.01–8.54). Black individuals who reported being treated for hypertension had 13 times higher risk of DHF then black individuals reporting no hypertension.

Conclusions

This is the first study to find an association between DHF and diabetes, allergy and hypertension. Given the high case fatality rate of DHF (1–5%), we believe that the evidence produced in this study, when confirmed in other studies, suggests that screening criteria might be used to identify adult patients at a greater risk of developing DHF with a recommendation that they remain under observation and monitoring in hospital.     

新诊断标准下妊娠期糖尿病高危因素研究

目的:调查新诊断标准下国内妊娠期糖尿病(Gestational diabetes mellitus GDM)的发病情况,分析影响GDM发生的高危因素,为新标准下国内GDM孕妇临床早期管理、诊断和干预提供理论依据。方法:对2011年1月至2011年9月我院接受产前建卡检查的所有孕妇1152例进行临床资料的收集及回顾性研究,排除孕前糖尿病患者16例,采用GDM诊断新标准进行"一步法"诊断,收集包括年龄、孕产次、体质指数(body mass index BMI)、糖尿病家族史、多囊卵巢综合征等13种影响GDM发生的危险因素,并综合分析。结果:新标准下GDM检出率为10.39%(118/1136)2)单因素分析结果发现年龄≥35岁(X2=10.2814,P=0.0013)、肥胖(孕前BMI≥28kg/m2()X2=36.2384,P<0.0001)、多囊卵巢综合征(X2=20.6725,P<0.0001)、糖尿病家族史(X2=7.8783,P=0.0050)在GDM组与非GDM组有统计学差异,多因素逐步Logistic回归分析肥胖(OR=7.546 95%CI=2.356~20.129 P=0.0002)、多囊卵巢综合征(OR=6.342 95%CI=1.783~16.329,P=0.0019)、年龄(OR=3.021 95%CI=0.983~6.459 P=0.0108)、糖尿病家族史(OR=2.43895%CI=0.612~5.231 P=0.0256)为GDM的高危因素。结论:新标准下报告GDM检出率为10.39%。肥胖、多囊卵巢综合征、年龄、糖尿病家族史为影响GDM发生的高危因素。加强GDM筛查并对具有高危因素的妊娠期妇女早期诊断,早期干预、早期管理可改善妊娠结局,提高人口素质。     

Abdominal Obesity and Ethnic Differences in Diabetes Awareness,Treatment, and Glycemic Control

Objective: To compare racial/ethnic differences in diabetes awareness, treatment, and glycemic control between non-Hispanic white, non-Hispanic black, and Hispanic Americans. We also determined the impact of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control between these population groups. Research Methods and Procedures: Third National Health and Nutrition Examination Survey (NHANES III) data were utilized for this study. Diabetes awareness was defined as acknowledging diabetic status. Diabetes treatment was defined as current use of anti-diabetic medications, good glycemic control as HbA_1c < 8%, and abdominal obesity as waist circumference larger than expected. The impacts of abdominal obesity on racial/ethnic differences in diabetes awareness, treatment, and glycemic control were assessed using logistic regression analyses. Adjustments were made for age, education, smoking, alcohol intake, and health insurance. Results: Rates of diabetes awareness in whites, blacks, and Hispanics suffering from abdominal obesity were ∼74%, 30%, and 21% in men and 77%, 32%, and 19% in women, respectively. Rates of diabetes treatment were 70%, 23%, and 14% in men and 57%, 45%, and 23% in women, respectively. In men, rates of glycemic control were 64%, 40%, and 30%, and in women, they were 62%, 51%, and 27%, respectively. Abdominal obesity was associated with decreased diabetes awareness and glycemic control in women. Discussion: Subjects with abdominal obesity were found to have poorer glycemic controls compared to those without abdominal obesity. Because diabetes prevalences were partially explained by racial/ethnic differences in diabetes awareness, treatment, and glycemic control, there is a need to craft diabetes awareness, treatment, and control programs along racial/ethnic origins.     

Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors

Objective

The aim of this study was to evaluate the secular trends of incidence of gestational diabetes mellitus (GDM) and insulin treatment for GDM in a Korean population and to determine the factors that contribute to the trends in the incidence of GDM.

Study Design

We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from women who had given birth from 2006 to 2010. We evaluated the trends in the incidence of GDM and GDM requiring insulin treatment and the changes in risk factors.

Results

There were 1,824,913 births during the study period, which included 129,666 cases of GDM, an incidence of 7.11% over this period. The incidence of GDM increased from 3.86% in 2007 to 11.83% in 2010, with a continuous increase after adjustment for age. However, the number of GDM cases that required insulin treatment decreased significantly from 13.87% in 2007 to 5.94% in 2010. The proportion of patients who were at an older age and multiparity, 2 GDM risk factors, increased during the study period.

Conclusions

In Korea, the incidence of GDM, especially mild GDM, increased dramatically during the period from 2006 to 2010. Further efforts are needed to monitor this trend and to identify associated factors.     

2型糖尿病合并下肢动脉粥样硬化的危险因素

下肢动脉粥样硬化是2型糖尿病(T2DM)患者最常见的大血管并发症之一。作为T2DM患者严重的慢并发症之一,下肢动脉粥样硬化可引起糖尿病足的发生,严重情况下可导致足坏疽。因此,阐明T2DM合并下肢动脉粥样硬化的危险因素,早期预防和治疗糖尿病合并下肢动脉粥样硬化症,不仅提高了患者的生活质量,而且减轻了家庭和社会的经济负担,具有较大的现实意义。影响T2DM患者下肢动脉粥样硬化的因素错综复杂,分为不可调控的和可调控的因素,不可调控的危险因素包括年龄、种族、遗传等,可调控的危险因素包括吸烟、高血糖、高血脂、高血压,以及近年提出的肥胖、胰岛素抵抗、高纤维蛋白血症、炎症等。本文就T2DM合并下肢动脉粥样硬化的危险因素做一综述。     

Prevalence of Gestational Diabetes Mellitus and Its Risk Factors in Chinese Pregnant Women: A Prospective Population-Based Study in Tianjin,China

Objective

We compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG).

Methods

In 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ≥7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey.

Results

The adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age≥30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period.

Conclusions

Increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria.     

Health Insurance Coverage and Hypertension Control in China: Results from the China Health and Nutrition Survey

Background

China has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009.

Methods and Findings

We used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5–25.1%) in 1991 to 31.5% (28.5–34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7% (28.7–34.9%) to 51.1% (45.1–57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6–46.7%) compared to propensity-matched individuals not covered by health insurance.

Conclusions

Hypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed.     

移植后糖尿病与钙调神经蛋白免疫抑制剂使用的危险分析

目的:探讨移植后糖尿病(PTDM)的危险因素与钙调神经蛋白免疫抑制剂使用的关系.方法:分析近9年613例同种异体尸体肾移植术后患者年龄、性别、体质量指数(BMI)、糖尿病家族史、钙调神经蛋白免疫抑制剂(环孢霉A,CsA;他克莫司,FK506)使用与PTDM发生的危险程度.结果:PTDM的发生率为24.1%,PTDM发生与患者年龄、糖尿病家族史及BMI明显相关,PTDM患者钙调神经蛋白免疫抑制剂血药浓度剂量比明显高于移植后非糖尿病患者(non PTDM),且服用FK506后空腹血糖高于服用CsA.结论:与患者年龄、糖尿病家族史、BMI相比,服用钙调神经蛋白免疫抑制剂是导致PTDM发生最重要的危险因素,且FK506较CsA更易发生PTDM.     

2型糖尿病发生大血管并发症的危险因素分析

目的:探讨2型糖尿病患者发生大血管并发症的危险因素.方法:选取哈尔滨医科医科大学附属第四医院内分泌科2012年1月至2012年12月住院的2型糖尿病患者共计200例,根据相关辅助检查结果将其分为2型糖尿病无大血管并发症(DMl)组和2型糖尿病合并大血管并发症(DM2)组,比较2组患者血清胆红素水平及相关指标的差异.应用多因素非条件Logistic回归分析法对2型糖尿病大血管并发症危险因素建立方程.结果:2型糖尿病合并大血管并发症组患者血清胆红素水平低于2型糖尿病无大血管并发症组(P＜0.01),以糖尿病合并大血管并发症为因变量,年龄、病程、糖化血红蛋白、低密度脂蛋白胆固醇、甘油三酯、总胆红素、总胆固醇、直接胆红素、间接胆红素水平为自变量,进行Logistic逐步回归分析,结果显示病程、血清低密度脂蛋白胆固醇、年龄和总胆固醇是2型糖尿病合并大血管并发症的独立危险因素,血清胆红素水平是其保护性因素.结论:病程、年龄、血清低密度脂蛋白胆固醇和总胆固醇水平是2型糖尿病合并大血管并发症的独立危险因素,而血清胆红素水平是其保护性因素.     

干休所健康体检人群糖尿病的发病率及相关危险因素分析

目的:探讨健康体检人群中糖尿病的发病率及相关危险因素,为糖尿病的预防提供参考。方法:对参加健康体检的500名离退休人员的空腹血糖(FPG)、餐后2 h血糖(OGTT 2 h)、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度胆固醇(HDL-C)及甘油三脂(TG)进行检测。应用logistic分析糖尿病发生的相关危险因素。结果:500名参加体检的患者中,确诊糖尿病167例,糖尿病的发病率为33.4%,其中男性88例,占52.7%;女性59例,占47.31%。糖尿病患者的SBP、DBP、BMI、TC、LDL-C、HDL-C及TG水平与健康人群呈显著差异,数据具有统计学意义(P0.05)。Logistic分析结果显示血压、血脂异常、体重指数与糖尿病的发生呈正相关(P0.05)。结论:离退休人员发生糖尿病的比例较高,且高血压、高血脂、超重或肥胖等是糖尿病发生的危险因素,应引起临床的重视。     

Micro-RNA Binding Site Polymorphisms in the WFS1 Gene Are Risk Factors of Diabetes Mellitus

The absolute or relative lack of insulin is the key factor in the pathogenesis of diabetes mellitus. Although the connection between loss of function mutations of the WFS1 gene and DIDMOAD-syndrome including diabetes mellitus underpins the significance of wolframin in the pathogenesis, exact role of WFS1 polymorphic variants in the development of type 1 and type 2 diabetes has not been discovered yet. In this analysis, 787 patients with diabetes and 900 healthy people participated. Genotyping of the 7 WFS1 SNPs was carried out by TaqMan assays. Association study was performed by χ²-test in combination with correction for multiple testing. For functional analysis, the entire 3’ UTR of the WFS1 gene was subcloned in a pMIR-Report plasmid and relative luciferase activities were determined. Linkage disequilibrium analysis showed a generally high LD within the investigated region, however the rs1046322 locus was not in LD with the other SNPs. The two miR-SNPs, rs1046322 and rs9457 showed significant association with T1DM and T2DM, respectively. Haplotype analysis also confirmed the association between the 3’ UTR loci and both disease types. In vitro experiments showed that miR-185 reduces the amount of the resulting protein, and rs9457 miRSNP significantly influences the rate of reduction in a luciferase reporter assay. Genetic variants of the WFS1 gene might contribute to the genetic risk of T1DM and T2DM. Furthermore demonstrating the effect of rs9457 in binding of miR-185, we suggest that the optimal level of wolframin protein, potentially influenced by miR-regulation, is crucial in normal beta cell function.     

Preadmission Glycemic Control and Changes to Diabetes Mellitus Treatment Regimen After Hospitalization

ObjectiveTo evaluate treatment patterns associated with diabetes medication regimen changes after hospitalization on the basis on preadmission hemoglobin A_1c levels.MethodsIn this retrospective database analysis, patients with a diabetes diagnosis, hospitalization, and documented hemoglobin A_1c level within the 90 days leading up to hospital admission were identified in an administrative claims database. Treatment regimens were assessed before and after hospitalization. The proportion of patients who had progression, reduction, or no change in therapy was compared across hemoglobin A_1c subgroups: hemoglobin A_1c < 7.0%, hemoglobin A_1c 7.0%-7.9%, and hemoglobin A_1c ≥ 8.0%.ResultsFour hundred patients were included (192 in hemoglobin A_1c < 7.0% group, 94 in hemoglobin A_1c 7.0% 7.9% group, and 114 in hemoglobin A_1c ≥ 8.0% group). Demographically, hemoglobin A_1c subgroups did not differ significantly (mean age, 57 years; 47.5% male). With respect to therapeutic regimen overall, 28%, 24%, and 48% of patients experienced progression, reduction, and no change, respectively. Across hemoglobin A_1c subgroups, 37.7% of patients in the hemoglobin A_1c ≥ 8.0% subgroup had therapy progression compared with 26% and 20.2% in the hemoglobin A_1c < 7.0% and hemoglobin A_1c 7.0%-7.9% subgroups, respectively (P = .032 and P = .006, respectively). Within the progression category, progression via insulin initiation was significantly higher in the hemoglobin A_1c ≥ 8.0% subgroup (55.8%) than in the hemoglobin A_1c < 7.0% subgroup (16%, P < .001), but not significantly higher than in the hemoglobin A_1c 7.0%-7.9% subgroup (36.8%, P = .084). In the hemoglobin A_1c ≥ 8.0% subgroup, a lower percentage of patients, 35.1%, experienced no therapy change than in both the hemoglobin A_1c < 7.0% subgroup (52.6%) and the hemoglobin A_1c 7.0%-7.9% subgroup (54.3%) (P = .003 and P = .006, respectively). There was no difference between subgroups in reduction of therapy.ConclusionsA higher proportion of patients with a hemoglobin A_1c level ≥ 8.0% had progression of their antidiabetes therapy after hospitalization and fewer patients had no change in therapy than those in lower hemoglobin A_1c subgroups. These data suggest that clinicians may be using hemoglobin A_1c measurements to guide discharge planning treatment decisions. (Endocr Pract. 2012;18:371-375)