北京市2型糖尿病高危险年龄人群危险因素特征

目的:调查并分析北京市高危险年龄人群2型糖尿病患病的危险因素。方法:①于1997-08/1998-08采用随机整群抽样方法,横断面调查北京市城乡4个社区40岁以上常住居民2354人。均对调查项目知情同意。②依据“我国2型糖尿病流行病学研究操作手册”[卫生部老年卫生工作领导小组办公室编(1997)],调查纳入对象的性别、年龄、2型糖尿病家族史、2型糖尿病病史及有关干预治疗措施、糖尿病并发症发生情况、其它患病史、吸烟状况、饮酒状况、体力活动、强度、脑力活动强度、业余运动强度等。③用统一的方法测量纳入对象的身高、体质量、腰围、臀围、血压,计算体质量指数=体质量(kg)/身高(m)2。④采用世界卫生组织推荐的口服75g葡萄糖耐量试验,测定纳入对象的空腹血糖及餐后2h血糖。按照世界卫生组织1999年糖尿病的诊断标准确诊2型糖尿病和糖耐量低减。⑤计数和计量资料差异比较采用χ2和t检验,用非条件Logistic回归分析筛选与2型糖尿病密切相关的指标。结果:①共纳入2型糖尿病高危险年龄常住居民2354人,资料完整者2186人(2型糖尿病患者231人,糖尿病减低者268人,血糖正常者1687人)进入结果分析。②糖尿病和糖耐量低减患者年龄、腰围、臀围、体质量指数、腰臀比和收缩压明显高于血糖正常者(P≤0.05～0.01);体质量和舒张压差异不明显。③18个分析因素与2型糖尿病的关系的非条件Logistic回归分析结果,年龄、城乡、糖尿病家族史、体质量指数、腰围、收缩压、高血压和职业性体力劳动8个因素在糖尿病患者与血糖正常者间差异明显(P<0.05～0.01);其中职业性体力劳动OR=0.7262,为保护因素;其余7个因素OR=1.0116～2.7385,为危险因素。④18个分析因素与糖耐量低减的关系的非条件Logistic回归分析结果:年龄、腰围、收缩压、高血压、体质量指数5个因素在糖耐量低减患者与血糖正常者间差异明显(OR=1.226～1.896,P<0.05～0.01)。结论:北京市2型糖尿病高危险年龄人群中危险因素有7项,包括年龄增长、城市生活、糖尿病家族史、体质量指数、腰围、收缩压和高血压。因此有效地进行2型糖尿病高危人群的筛查,控制已知的2型糖尿病的危险因素,将会有利于预防和减少2型糖尿病的发生。     

乌鲁木齐市部分社区人群发生2型糖尿病的危险因素分析

目的：探讨乌鲁木齐市社区人群2型糖尿病的主要危险因素，为城市社区人群制定预防和干预措施提供依据。方法：采用分层整群抽样方法，于2002—05／09在乌鲁木齐市社区人群中进行2型糖尿病流行病学调查，对可能的危险因素因素进行单因素和多因素非条件Logistic回归分析。结果：采用单因素非条件Logistic回归分析方法的结果表明，人体质量指数(BMI)、腰围、腰臀比、高血压史、糖尿病家庭史及收缩压、三酰甘油7个因素与2型糖尿病有显著性相关(P&;lt;0．05)。采用多因素非条件Logistic回归分析方法的结果表明，腰围、腰臀比、收缩压、糖尿病家族史、三酰甘油、年龄与2型糖尿病有显著性相关(P&;lt;0．05)。结论：在进行健康教育和临床工作中，重点监护高危人群、控制血压、防止肥胖、积极治疗高血脂是降低糖尿病发病率，改善糖尿病症状、控制其进展、延缓其并发症发生的重要措施。     

乌鲁木齐市部分社区人群发生2型糖尿病的危险因素分析

目的:探讨乌鲁木齐市社区人群2型糖尿病的主要危险因素,为城市社区人群制定预防和干预措施提供依据。方法:采用分层整群抽样方法,于2002-05/09在乌鲁木齐市社区人群中进行2型糖尿病流行病学调查,对可能的危险因素因素进行单因素和多因素非条件Logistic回归分析。结果:采用单因素非条件Logistic回归分析方法的结果表明,人体质量指数(BMI)、腰围、腰臀比、高血压史、糖尿病家庭史及收缩压、三酰甘油7个因素与2型糖尿病有显著性相关(P<0.05)。采用多因素非条件Logistic回归分析方法的结果表明,腰围、腰臀比、收缩压、糖尿病家族史、三酰甘油、年龄与2型糖尿病有显著性相关(P<0.05)。结论:在进行健康教育和临床工作中,重点监护高危人群、控制血压、防止肥胖、积极治疗高血脂是降低糖尿病发病率,改善糖尿病症状、控制其进展、延缓其并发症发生的重要措施。     

大连地区2型糖尿病危险因素的非条件Logistic回归分析

背景：糖尿病是环境因素、遗传因素等多种因素所导致的慢性全身性代谢疾病，其病因仍不十分清楚。探讨上述危险因素在糖尿病发病中的作用，对制定糖尿病的一、二级预防措施有重要意义。目的：探讨2型糖尿病危险因素，为制定适宜的干预措施提供依据。设计：以诊断为依据的横断面研究。单位：一所大学的流行病学教研室、一所大学医院的内分泌科。对象：采取分层、整群的随机抽样方法，在大连城乡居住5年以上、年龄在40岁以上的常住居民中，按城市和乡村分两层，每层抽取1250人，两层共抽取2500人。被抽中的原糖尿病患者亦予以统计。方法：问卷调查，同时进行身高、体质量、腰围、臀围、血压及血糖等项目的体检。以2型糖尿病患者做为病例组，正常人做为对照组，采用单因素及多因素非条件Logistic回归分析方法进行分析。主要观察指标：与2型糖尿病发病相关因素的单因素及多因素非条件Logistic回归分析。结果：糖尿病家族史(OR=2．339)、肥胖(体质量指数，OR=1．462)、收缩压升高(OR=1．016)、高血脂(OR=1.615)、年龄(OR=1．043)是2型糖尿病的主要危险因素。结论：糖尿病家族史、收缩压升高、肥胖、高血脂及年龄是2型糖尿病的危险因素，对高危人群及全人群采取措施适当控制体质量、血压等是预防该病发生的重要手段。     

2型糖尿病年轻化的相关危险因素调查

1 对象和方法1.1 对象 收集 1998-02～2002-12初诊2型DM 499例,男314例,女185例。年龄18～85岁,平均(48.63±16.50)岁。两年龄段例数见表1。1.2 方法 ①问卷调查;职业、DM家族史、饮食习惯及体力活动、DM病程、最高体重及持续时间;②体格检查:血压、身高、体重;③疑似1型DM者,作ICA及GAD排除。1.3 统计学处理 采用 SPSS for windows 10.0软件进行统计学处理。数值变量资料结果以x±s表示,组间均数比较采用t检验;分类变量资料组间构成比比较采用X~2检验。     

大连地区2型糖尿病危险因素的非条件Logistic回归分析

背景糖尿病是环境因素、遗传因素等多种因素所导致的慢性全身性代谢疾病,其病因仍不十分清楚.探讨上述危险因素在糖尿病发病中的作用,对制定糖尿病的一、二级预防措施有重要意义.目的探讨2型糖尿病危险因素,为制定适宜的干预措施提供依据.设计以诊断为依据的横断面研究.单位一所大学的流行病学教研室、一所大学医院的内分泌科.对象采取分层、整群的随机抽样方法,在大连城乡居住5年以上、年龄在40岁以上的常住居民中,按城市和乡村分两层,每层抽取1 250人,两层共抽取2 500人.被抽中的原糖尿病患者亦予以统计.方法问卷调查,同时进行身高、体质量、腰围、臀围、血压及血糖等项目的体检.以2型糖尿病患者做为病例组,正常人做为对照组,采用单因素及多因素非条件Logistic回归分析方法进行分析.主要观察指标与2型糖尿病发病相关因素的单因素及多因素非条件Logistic回归分析.结果糖尿病家族史(OR=2.339)、肥胖(体质量指数,OR=1.462)、收缩压升高(OR=1.016)、高血脂(OR=1.615)、年龄(OR=1.043)是2型糖尿病的主要危险因素.结论糖尿病家族史、收缩压升高、肥胖、高血脂及年龄是2型糖尿病的危险因素,对高危人群及全人群采取措施适当控制体质量、血压等是预防该病发生的重要手段.     

2型糖尿病患者并发脑卒中的危险因素

目的：研究2型糖尿病并发脑卒中的危险因素，探讨其发病机制。方法：将96例2型糖尿病患者分为两组：伴有脑卒中的2型糖尿病患者50例(患者组)和不伴有脑卒中的2型糖尿病患者46例(对照组)，测定两组患者的空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B以及体质量、血压，行Logistic多元逐步回归，筛选脑卒中的危险因素。结果：患者组糖尿病病程(DR，2．16；95％CI，1．31～4．23)、舒张压(OR，1．85；95％CI，1．25～3．89)、糖化血红蛋白(OR，3．94；95％CI，2．89～4．56)、总胆固醇(OR，1.72；95％CI，1．09～3．49)是脑卒中的独立危险因素，载脂蛋白A(OR，0．33；95％CI，0．25～0．89)是脑卒中的保护因素。结论：控制血糖、血压、血脂，可以有效降低脑卒中的发生率，改善糖尿病患者的生活质量。     

2型糖尿病患者周围神经病变危险因素分析

[目的]探讨2型糖尿病周围神经病变(DPN) 的相关临床危险因素.[方法]对180例2型糖尿病患者进行四肢神经传导速度检测,并将其分为DPN组和非DPN组.同时测定患者的空腹血糖、糖化血红蛋白、甘油三酯等指标,对病程、血生化等各指标进行单因素分析,然后进行多因素Logistic回归分析.[结果]在单因素分析中,DPN组...     

2型糖尿病患者并发脑卒中的危险因素

目的:研究2型糖尿病并发脑卒中的危险因素,探讨其发病机制。方法:将96例2型糖尿病患者分为两组:伴有脑卒中的2型糖尿病患者50例(患者组)和不伴有脑卒中的2型糖尿病患者46例(对照组),测定两组患者的空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B以及体质量、血压,行Logistic多元逐步回归,筛选脑卒中的危险因素。结果:患者组糖尿病病程(OR,2.16;95%CI,1.31～4.23)、舒张压(OR,1.85;95%CI,1.25～3.89)、糖化血红蛋白(OR,3.94;95%CI,2.89～4.56)、总胆固醇(OR,1.72;95%CI,1.09～3.49)是脑卒中的独立危险因素,载脂蛋白A(OR,0.33;95%CI,0.25～0.89)是脑卒中的保护因素。结论:控制血糖、血压、血脂,可以有效降低脑卒中的发生率,改善糖尿病患者的生活质量。     

2型糖尿病合并骨质疏松症患者的相关危险因素分析

目的:探讨2型糖尿病合并骨质疏松的发病率并分析其发生的相关因素。方法:利用超声骨密度测定仪,检测2型糖尿病患者的骨质疏松情况,通过对2型糖尿病合并骨质疏松患者的年龄、病程、糖化血红蛋白(glucosylatedhemoglobin,HbA1c)、胰岛素敏感性指数(insulinsensitivityindex,ISI)、体质量指数(bodymassindex,BMI)、尿微量白蛋白等指标的分析,以了解2型糖尿病合并骨质疏松的危险因素。结果:在所有患者中,2型糖尿病合并骨质疏松患者平均空腹血糖、平均HbA1c犤(11.9±3.1)mmol/L,(9.9±1.3)%犦与未合并骨质疏松患者犤(9.3±2.2)mmol/L,(8.7±1.0)%犦比较,差异有显著性意义(t=2.13,2.09,P<0.05);合并与未合并骨质疏松患者平均病程、BMI比较,差异有显著性意义(t=2.18,2.33,P<0.05)。结论:高血糖、低BMI和病程长为2型糖尿病合并骨质疏松的高危险因素。     

2型糖尿病大血管并发症相关危险因素的特征

目的：分析2型糖尿病大血管并发症的相关危险因素，进一步分析其特征。 方法：选择2001—10／2002-08河北医科大学第三医院收治的2型糖尿病患者118例，按有无大血管并发症分为2个亚组；进一步结合体质量指数（≥25kg／m^2为肥胖，〈25kg／m^2为非肥胖）分为4个亚组；以58名健康人为正常对照组。各亚组及对照组患者的纤溶酶原激活物抑制物1水平用ELISA法、血浆凝血因子Ⅶ的凝血活性用一期生化法检测，同时比较各组临床、生化指标。 结果：176例全部进入结果分析。①2型糖尿病组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于对照组[（86．27&;#177;26．65），（62．10&;#177;24．18）μg/L，t=5．80，P〈0．01；（123．02&;#177;20．27）％，（105．64&;#177;16．88）％，t=5．64，P〈0．01]，血压、空腹血糖、空腹胰岛素、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇也明显高于正常对照组（P〈0．01）。②糖尿病并大血管并发症组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于无大血管并发症组[（92．17&;#177;26．88），（80．65&;#177;23．95）μg/L，t=2．46，P〈0．05；（124．22&;#177;20．89）％，（113．52&;#177;21．28）％，t=2．75，P〈0．01]，年龄、血压、腰臀比、腰股比、总胆固醇及低密度脂蛋白胆固醇均高于无大血管并发症组（P〈0．05，0．01），而胰岛素敏感性指数低于无大血管并发症组（P〈0．05）。③血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性在肥胖组高于非肥胖组，并且在同等体质量指数水平的2型糖尿病合并大血管并发症组高于无大血管并发症组（P〈0．05）。 结论：糖尿病合并大血管病变的患者比无大血管病变者胰岛素抵抗特征（中心性肥胖、血压升高、脂代谢异常等）更明显，并且血凝及纤溶系统的异常亦与大血管疾病的发生发展有关。     

2型糖尿病大血管并发症相关危险因素的特征

目的:分析2型糖尿病大血管并发症的相关危险因素,进一步分析其特征。方法:选择2001-10/2002-08河北医科大学第三医院收治的2型糖尿病患者118例,按有无大血管并发症分为2个亚组;进一步结合体质量指数(≥25kg/m2为肥胖,<25kg/m2为非肥胖)分为4个亚组;以58名健康人为正常对照组。各亚组及对照组患者的纤溶酶原激活物抑制物1水平用ELISA法、血浆凝血因子Ⅶ的凝血活性用一期生化法检测,同时比较各组临床、生化指标。结果:176例全部进入结果分析。①2型糖尿病组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于对照组[(86.27±26.65),(62.10±24.18)μg/L,t=5.80,P<0.01;(123.02±20.27)%,(105.64±16.88)%,t=5.64,P<0.01],血压、空腹血糖、空腹胰岛素、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇也明显高于正常对照组(P<0.01)。②糖尿病并大血管并发症组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于无大血管并发症组[(92.17±26.88),(80.65±23.95)μg/L,t=2.46,P<0.05;(124.22±20.89)%,(113.52±21.28)%,t=2.75,P<0.01],年龄、血压、腰臀比、腰股比、总胆固醇及低密度脂蛋白胆固醇均高于无大血管并发症组(P<0.05,0.01),而胰岛素敏感性指数低于无大血管并发症组(P<0.05)。③血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性在肥胖组高于非肥胖组,并且在同等体质量指数水平的2型糖尿病合并大血管并发症组高于无大血管并发症组(P<0.05)。结论:糖尿病合并大血管病变的患者比无大血管病变者胰岛素抵抗特征(中心性肥胖、血压升高、脂代谢异常等)更明显,并且血凝及纤溶系统的异常亦与大血管疾病的发生发展有关。     

中国人群2型糖尿病患者并发脑卒中危险因素的Meta分析

目的对中国人群2型糖尿病患者并发脑卒中的危险因素进行系统分析,为2型糖尿病患者的脑卒中预防提供依据。方法检索PubMed、EMBASE、Web of Science、中国知网(CNKI)、万方数据库,获得己公开发表的关于中国人群2型糖尿病患者并发脑卒中相关危险因素的病例对照研究文献。筛选出符合纳入标准的文献,采用RevMan 5.3软件进行Meta分析,并统计各危险因素的合并SMD和95%CI。结果共纳入10篇文献,累计观察组729例、对照组778例。中国人群2型糖尿病并发脑卒中的各危险因素的合并SMD值(95%CI)分别为,空腹血糖:0.69(0.38,1.00)P0.0001;餐后2h血糖:1.22(0.44,2.00)P=0.002;甘油三酯:1.64(0.88,2.39)P0.0001;总胆固醇:0.72(0.34,1.10)P=0.0002;高密度脂蛋白:-0.95(-1.62,-0.28)P=0.005;低密度脂蛋白:0.50(0.24,0.77)P=0.0002;糖化血红蛋白:0.88(0.59,1.18)P0.00001;体质量指数:0.35(0.20,0.50)P0.00001;收缩压:0.84(0.18,1.51)P=0.01;舒张压:0.80(0.15,1.44)P=0.02;糖尿病病程(年):0.34(0.16,0.53)P=0.0003;年龄(岁):0.11(-0.02,0.23)P=0.09;吸烟年限(年):0.67(0.37,0.97)P0.0001。结论中国人群2型糖尿病患者并发脑卒中的危险因素主要是空腹血糖、餐后2h血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、体质量指数、收缩压、舒张压、糖尿病病程和吸烟年限。     

Management of cardiovascular risk factors in type 2 diabetes mellitus

Cardiovascular disease is by far the major cause of morbidity and mortality in subjects with diabetes mellitus type 2. The risk of cardiovascular disease in persons with type 2 diabetes is greater for any given risk factor, alone or in combination, than it is in persons without diabetes. Independent risk factors for cardiovascular disease in type 2 diabetes are hyperglycemia, hypertension, dyslipidemia and smoking. Subjects with diabetes mellitus type 2 benefit from cardiovascular risk factor modification, either as a primary or secondary intervention, as much as or more than those without diabetes. Risk factor modification includes behavioral modification to affect regular physical activity, healthy diet, weight loss, and smoking cessation. In addition, an optimal glycemic control with HbA1c < 7% is crucial and, aggressive management of hypertension (< 130/80 mmHg) and dyslipidemia are particularly important. Finally, aspirin (100 mg/d) is standard in secondary prophylaxis of cardiovascular events and should strongly be considered in primary prophylaxis if subjects have more than 1 concomitant cardiovascular risk factors.     

Genetic risk reclassification for type 2 diabetes by age below or above 50 years using 40 type 2 diabetes risk single nucleotide polymorphisms

OBJECTIVE

To test if knowledge of type 2 diabetes genetic variants improves disease prediction.

RESEARCH DESIGN AND METHODS

We tested 40 single nucleotide polymorphisms (SNPs) associated with diabetes in 3,471 Framingham Offspring Study subjects followed over 34 years using pooled logistic regression models stratified by age (<50 years, diabetes cases = 144; or ≥50 years, diabetes cases = 302). Models included clinical risk factors and a 40-SNP weighted genetic risk score.

RESULTS

In people <50 years of age, the clinical risk factors model C-statistic was 0.908; the 40-SNP score increased it to 0.911 (P = 0.3; net reclassification improvement (NRI): 10.2%, P = 0.001). In people ≥50 years of age, the C-statistics without and with the score were 0.883 and 0.884 (P = 0.2; NRI: 0.4%). The risk per risk allele was higher in people <50 than ≥50 years of age (24 vs. 11%; P value for age interaction = 0.02).

CONCLUSIONS

Knowledge of common genetic variation appropriately reclassifies younger people for type 2 diabetes risk beyond clinical risk factors but not older people.A genetic risk score built with 18 type 2 diabetes genetic loci predicted new diabetes cases (1), though it did not add to common diabetes clinical risk factors that usually appear during adulthood (1–3). In recent years, the number of genetic loci convincingly associated with diabetes has doubled (4–10). Here, we test two hypotheses: an updated genetic risk score incorporating a larger number of common diabetes-associated single nucleotide polymorphisms (SNPs) improves ∼8-year risk prediction of diabetes beyond common clinical diabetes risk factors; and the predictive ability is better in younger subjects in whom early preventive strategies could delay diabetes onset (11).     

Attenuating cardiovascular risk factors in patients with type 2 diabetes

Patients with type 2 diabetes (formerly known as non-insulin-resistant diabetes) have a significantly increased risk of developing cardiovascular disease. Once clinical cardiovascular disease develops, these patients have a poorer prognosis than normoglycemic patients. By inducing endothelial changes, hyperglycemia contributes directly to atherosclerosis. Type 2 diabetes is also associated with atherogenic dyslipidemias. This form of diabetes, or the precursor state of insulin resistance, commonly occurs as a metabolic syndrome (formerly known as syndrome X) consisting of hypertension, atherogenic dyslipidemia and a procoagulant state, in addition to the disorder of glucose metabolism. All cardiovascular risk factors except smoking are more prevalent in patients with type 2 diabetes. In addition to exercise, weight control, aspirin therapy and blood pressure control, therapy to modify lipid profiles is usually necessary. The choice of agent or combination of statin, bile acid sequestrant, fibric acid derivative and nicotinic acid depends on the lipid profile and characteristics of the individual patient.     

Comparison of near-patient capillary glucose measurement and a risk assessment questionnaire in screening for type 2 diabetes in a high-risk population in rural India

OBJECTIVE

To assess the utility of a point-of-care (POC) capillary blood glucose measurement as compared with routine clinical parameters in predicting undiagnosed diabetes in a low-resource rural India setting.

RESEARCH DESIGN AND METHODS

Nine hundred and ninety-four participants aged >30 years and stratified by age and sex were randomly selected from 20 villages in India. A clinical questionnaire, sampling for laboratory venous fasting plasma glucose (FPG), and POC capillary blood glucose assay were performed simultaneously. Diabetes diagnosis was based on the World Health Organization (WHO) definition using FPG. The capacity of the POC glucose to predict the presence of diabetes was assessed and compared with the questionnaire using area under the receiver operating characteristic curves (AUCs).

RESULTS

The AUC for POC glucose alone in predicting diabetes was 0.869 (95% CI 0.810–0.929). This was significantly better (P < 0.001 for AUC comparison) than the models based upon clinical variables alone (AUC for the best clinical model including age, BMI, hypertension, waist circumference: 0.694 [95% CI 0.621–0.766]). POC glucose appropriately reclassified the risk of up to one-third of participants ranked according to the clinical models. Adding the clinical variables to the POC glucose assay did not significantly improve the discriminatory capability beyond that achieved with the POC glucose measurement alone (all P > 0.37).

CONCLUSIONS

POC glucose testing appears to be a simple and reliable tool for identifying undiagnosed diabetes in a high-risk, resource-poor rural population. However, studies evaluating the cost effectiveness of introducing POC glucose testing are needed prior to widespread implementation.The prevalence of type 2 diabetes is rapidly increasing around the world (1). Developing countries are facing the largest increases both in absolute and relative terms (1). It is predicted that this will have devastating consequences on the economies and health systems of these countries. Successful prevention and early management of diabetes is therefore a major health priority (1,2).In many regions, up to 50% of people with diabetes remain undiagnosed (1,3,4). Failure to improve these levels of detection will mean that the opportunity to improve health outcomes with early intervention will be lost. Early treatment with successful glucose control significantly reduces the morbidity and mortality associated with diabetes (5,6). Earlier detection of diabetes also allows for the implementation of other treatments that reduce the vascular complications of diabetes (5,6).Universal screening for diabetes is not currently recommended due to a lack of good evidence for an accurate test. However, targeted screening is advocated in certain ethnic groups deemed at increased risk of diabetes (2). For some ethnic groups, implementation of targeted screening may require the entire population to be screened. This applies for instance to Asian Indian populations, which are at greater risk of developing diabetes (7) and have a high prevalence of diabetes both in urban (4) and rural settings (3). However to successfully apply screening to such populations requires accurate, safe, and low-cost diagnostic strategies that are easy to implement (8).In resource-poor settings, clinical variables–based risk assessment questionnaires or point-of-care (POC) glucose analysis may be reasonable screening tools (9). Both require little expertise and allow an individual''s risk of having undiagnosed diabetes to be immediately determined so that only those at high risk require a confirmatory diagnostic test. However, the value of risk assessment questionnaires (9–13) and POC glucose analysis (14–16) in resource-poor settings remains unclear. Additionally the performance of these different screening methods has not been compared in rural Asian Indian populations.The aim of this study was to quantify and compare the accuracy of strategies based on POC glucose, clinical variables, and the combination of both in predicting undiagnosed diabetes in an asymptomatic, resource-poor rural Asian Indian population.     

Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors

OBJECTIVE—To test the hypothesis that age of type 2 diabetes onset influences inherent susceptibility to diabetic retinopathy, independent of disease duration and degree of hyperglycemia.RESEARCH DESIGN AND METHODS—Retinopathy data from 624 patients with a type 2 diabetes duration of 20–30 years (group A) were analyzed by stratifying patients according to age of onset of diabetes and glycemic control. Retinopathy status was scored clinically as per a modified Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. To obviate possible bias due to a higher attrition from comorbidities in those with later-onset diabetes and retinopathy, 852 patients with type 2 diabetes of shorter duration (10–12 years, group B) were similarly studied.RESULTS—Prevalence and severity of retinopathy was significantly higher in the younger-onset, group A patients. When further stratified according to mean A1C, retinopathy risk remained increased in younger-onset patients. The greatest impact was seen in those with a mean A1C >9% (odds ratio [OR] for retinopathy 16.6, 7.5, and 2.7 for age of diagnosis <45, 45–55, and >55 years, respectively, P = 0.003). By logistic regression, earlier type 2 diabetes onset is associated with increased retinopathy risk, independent of traditional risk factors (OR of retinopathy 1.9, 1.1, and 1 for age of onset <45, 45–55, and >55 years, respectively). Similar results were found in group B patients.CONCLUSIONS— These data suggest an increased inherent susceptibility to diabetic retinopathy with earlier-onset type 2 diabetes. This further supports the importance of delaying development of diabetes and also implies a need for more stringent metabolic targets for younger individuals.Superimposed on the worldwide epidemic of diabetes that we are currently facing is the demographic trend to an ever younger age of diagnosis of type 2 diabetes (1). In recent studies, type 2 diabetes constitutes up to 45% of incident pediatric diabetes, and 7–22% of adolescent diabetes presents with diabetes-specific complications at diagnosis (2,3). To date, few studies have examined long-term outcomes as a function of age of diagnosis in type 2 diabetes, and even fewer have looked at the development of retinopathy specifically. There is some limited data suggesting that young-onset diabetes is associated with an increased risk for complications compared with later-onset diabetes (4) and that the development and progression of complications might be particularly rapid in early-onset disease (2). What is hitherto unknown is whether the increased prevalence of complications associated with early-onset disease is simply a consequence of the longer duration of disease, a consequence of a more severe metabolic phenotype, or in fact something specific to the diabetic milieu in younger patients that makes tissues more inherently susceptible to hyperglycemic damage.We therefore explore the hypothesis that in type 2 diabetes, susceptibility to retinopathy is dependent on age of diabetes onset. The isolated effect of age of diabetes onset on long-term retinopathy status was examined independent of duration of diabetes and glycemic control, the two most important risk factors for retinopathy.     

2型糖尿病并发眼底病的危险因素分析

目的探讨2型糖尿病（T2DM ）眼底病变并发症的危险因素,同时探讨可能的机制。方法将195例T2DM患者按照是否出现眼底病变分为2组,分别比较其一般资料,包括年龄、性别、血压、糖尿病病程、身高体质量指数（BMI）等;生化指标,包括三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血糖（GLU）、C-肽、胰岛素（INS）、尿素（Urea）、肌酐（Cr）、尿微量清蛋白（mALB）、糖化血红蛋白（HbA1c）等;对其进行单因素χ2检验与Logistic逐步回归分析,寻找与 T2DM 眼底病变可能相关的危险因素。结果 T2DM眼底病变的发生与患者年龄、糖尿病发生的病程、TG、TC、LDC-C、HbA1c、Cr、mALB等生化指标的水平有一定关联（P＜0．05）;Logistic逐步回归分析显示均有统计学意义（P＜0．05）,为 T2DM 并发眼底病的重要危险因素。结论患者年龄、糖尿病发生的病程、LDL-C、TC、TG、HbA1c、Cr、mALB等指标,都可能是T2DM 易发眼底病变的主要危险因素,应持续监测。