Improvement in diet habits,independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men

AimsTo assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance (IGT) in India.MethodsThis analysis was based on a 2 year prospective, randomized controlled primary prevention trial in a cohort of Asian Indian men with IGT (n = 537) (Clinical Trial No: NCT00819455). Intervention and control groups were given standard care advice at baseline. Additionally, the intervention group received frequent, mobile phone based text message reminders on healthy lifestyle principles. Dietary intake and physical activity habits were recorded by validated questionnaires. The lifestyle goals were: reductions in consumption of carbohydrates, oil, portion size and body mass index of at least 1 unit (1 kg/m²) from baseline and maintenance of good physical activity. The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses. Changes in insulin sensitivity (Matsuda's insulin sensitivity index) and oral disposition index during the follow-up were assessed.ResultsAt the end of the study, 123 (23.8%) participants developed diabetes. The mean lifestyle score was higher in the intervention group compared with control (2.59 ± 1.13 vs. 2.28 ± 1.17; P = 0.002). Among the 5 lifestyle variables, significant improvements in the 3 dietary goal were seen with intervention. Concomitant improvement in insulin sensitivity and oral disposition index was noted. Higher lifestyle score was associated with lower risk of developing diabetes (odds ratio: 0.54 [95% CI: 0.44–0.70]; P < 0.0001).ConclusionsBeneficial effects of intervention were associated with increased compliance to lifestyle goals. The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation.     

Role of various indices derived from an oral glucose tolerance test in the prediction of conversion from prediabetes to type 2 diabetes

AimsThe clinical implications of prediabetes for development of type 2 diabetes may differ for Asian ethnicity. We investigated various indices derived from a 2-h oral glucose tolerance test (OGTT) in people with prediabetes to predict their future risk of diabetes.MethodsWe recruited 406 consecutive subjects with prediabetes from 2005 to 2006 and followed them up every 3–6 months for up to 9 years. Prediabetes was defined as isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), combined glucose intolerance (CGI), or isolated elevated HbA1c (5.7–6.4%, 39–46 mmol/mol) without IFG or IGT. The rate of diabetes conversion was compared between prediabetes categories. The association of glycemic indices with development of diabetes was also investigated.ResultsEighty-one patients were diagnosed with diabetes during the 9-year follow-up (median 46.0 months). The rate of diabetes conversion was higher in subjects with CGI (31.9%), or isolated IGT (18.5%) than in those with isolated IFG (15.2%) or isolated elevated HbA1c (10.9%). Surrogate markers reflecting β-cell dysfunction were more closely associated with diabetes conversion than insulin resistance indices. Subjects with a 30-min postload glucose ≥165 mg/dL and a 30-min C-peptide <5 ng/mL had 8.83 times greater risk (95% confidence interval 2.98–26.16) of developing diabetes than other prediabetic subjects.ConclusionsIn Asians, at least Koreans, β-cell dysfunction seems to be the major determinant for diabetes conversion. A combination of high glucose and low C-peptide levels at 30 min after OGTT may be a good predictor for diabetes conversion in this population.     

血清SF水平与糖尿病前期的相关性分析

目的：分析糖尿病前期状态患者血清铁蛋白（SF）水平变化及两者的相关性。方法：选取本院确诊为糖尿病前期患者30例为糖尿病前期组,设同期来院体检正常者30例为对照组,取两组空腹12h肘静脉血,测定血清铁蛋白（SF）、空腹血糖（FBG）、血清总胆固醇（TC）、甘油三酯（TG）、C反应蛋白（CRP）,并采用多因素分析采用多元回归分析各项指标的相关分析。结果：糖尿病前期组SF明显高于对照组,差异有统计学意义（P〈0.05）;经多元回归分析发现,糖尿病前期组血清SF水平与FBG、TC、TG均明显正相关（r=0.30,P〈0.001;r=0.09,P〈0.01;r=0.07,P〈0.05）。结论：糖尿病前期状态患者血清SF明显升高,且二者呈正相关,临床上对血清SF水平测定,有助于早期的发现潜在的DM患者,对DM防治意义重大。     

糖尿病前期人群不同管理模式干预效果的比较研究

目的探索不同管理模式对糖尿病前期人群生活方式干预效果的影响。方法采取前瞻性观察研究的方法,将1182名糖尿病前期患者随机分为单独访谈组、集体宣教组、通讯访谈组3个干预组和1个对照组,对干预组进行健康教育与指标控制相结合的为期2年的生活方式干预,多组比较采用方差分析或χ2检验,组间的两两比较采用q检验。结果干预组空腹血糖、餐后2小时血糖均呈下降趋势（P〈0．05）。三个干预组之间的两两比较,干预6个月以后单独访谈组、集体宣教组的空腹血糖均值明显低于通讯访谈组,干预24个月以后单独访谈组的空腹血糖均值开始低于集体宣教组（P〈0．05）。干预组转为理想血糖的百分比远远高于对照组,同时发展为糖尿病的百分比远远低于对照组。接受不同干预方案后与对照组相比,3个干预组的血压、三酰甘油、胆固醇、肌酐等指标有显著性改善,肥胖的发生率也显著下降（P〈0．05）;心电图、动脉硬化程度则无明显变化（P〉0．05）。3种不同管理模式的干预效果比较,单独访谈组和集体宣教组均明显优于通讯访谈组,但单独访谈组的依从性最差。结论对糖尿病前期患者实施健康教育与指标控制相结合的生活方式干预,能预防或延缓糖尿病的发生。综合评价3种不同管理模式,医院体检中心与体检客户联手的集体宣教是较佳的干预管理模式。     

Epidemiology of Diabetes in Adults Aged 35 and Older from Shanghai,China

Objective This study aimed to investigate the epidemiology of diabetes in adults from Shanghai, aged 35 and older, in 2013.
Methods We estimated the diabetes prevalence in a representative sample of 18,736 adults who were selected through a multistage stratified cluster sampling process. A standard questionnaire containing questions about demographic characteristics and lifestyle factors was distributed. After an overnight fast of at least 10 hours, a venous blood sample was collected from each participant. For each patient without a history of diabetes, another blood sample was drawn 120 min after an oral glucose tolerance test to identify undiagnosed diabetes and prediabetic condition.
Results Among Shanghai residents aged 35 and above, the overall weighted prevalence of diabetes was 17.6%[95%confidence interval (CI):16.4%-18.8%]. The prevalences were 19.3%in men and 15.8%in women as well as 19.1%, 15.4%, and 16.1%in urban, suburban, and rural residents, respectively. In addition, the weighted prevalence of prediabetes was 16.5% (95% CI: 15.3%-17.8%), with the prevalences of 16.5%in men, 16.6%in women, 15.2%in urban residents, 18.0%in suburban residents, and 18.5% in rural residents. Among all patients with diabetes, 68.1% (95% CI: 64.3%-71.6%) were aware of their status, 63.5%(95%CI:60.0%-66.9%) received diabetes treatment, but only 35.1%(95%CI:32.4%-37.8%) had adequate glycemic control.
Conclusion In Shanghai, diabetes and prediabetes are highly prevalent. However, 1/3rd of diabetes cases are undiagnosed, and the rate of glycemic control is low.     

Early diagnosis and prevention of diabetes in developing countries

Type 2 diabetes has an insidious onset with a long latent period of dysglycaemia. By the time the diagnosis of diabetes is made, diabetes-related tissue damage occurs in nearly half of the patients. Even after diagnosis, the glycaemic control is suboptimal in more than 50%, leading to the vascular complications. Evidences suggest that early detection of diabetes by appropriate screening methods, especially in subjects with high risk for diabetes will help to prevent or delay the vascular complications and thus reduce the clinical, social and economic burden of the disease. There are also evidences to show that intervention at the prediabetic stage is superior to diagnosis of diabetes.     

糖尿病前期人群疾病知识、自我管理现状及自我管理影响因素分析张莉萍1,田静2

背景 糖尿病前期是指血糖超过正常水平但未达到糖尿病诊断标准,处于此血糖状态人群的糖尿病、心血管等疾病患病风险增高。但也有研究表明经严格自我管理可逆转最终结局。目前针对糖尿病前期人群的自我管理影响因素调查研究较少,且该人群对糖尿病前期相关疾病知识认识不足。 目的 评估糖尿病前期人群对于疾病知识的掌握度、自我管理现状,并分析影响自我管理能力的因素,为糖尿病前期人群早期防治糖尿病提供科学依据。方法 抽取2020年1月至2020年12月在内蒙古医科大学附属医院内分泌门诊就诊和体检中心参检的152例糖尿病前期患者作为研究对象,使用统计软件SPSS24.0进行数据分析,一般情况调查表中的计数资料,使用频数和百分比描述;糖尿病前期患者疾病知识问卷得分、糖尿病前期自我管理量表得分使用x±s描述;使用t检验或单因素方差分析评估一般资料与糖尿病前期自我管理能力的相关性;使用多元线性回归分析糖尿病前期患者自我管理影响因素。以检验水准α=0.05,P＜0.05为差异有统计学意义。结果 糖尿病前期患者疾病知识平均分为（7.7±2.20）分,自我管理平均分为（73.06±7.72）分,均处于较低水平。多元线性回归方程F＝5.922,P＜0.001,调整后的R2为0.37。多元线性回归结果显示大于60岁（β＝0.383,P＝0.009）、文化程度为大专学历（β＝3.294,P＝0.001）和本科学历（β＝3.019,P＝0.003）、有糖尿病家族史（β＝0.316,P＜0.001）、有糖尿病健康教育接受史（β＝0.154,P＝0.029）的糖尿病前期患者自我管理得分更高。结论 年龄、文化程度、糖尿病家族史及糖尿病健康教育接受史是糖尿病前期患者自我管理的影响因素。     

Correlation between pancreatic mast cells and the low grade inflammation in adipose tissue of experimental prediabetes

The role of mast cells (MCs) in prediabetes (Pre-DM) is not clearly elucidated. In the current study rats (n?=?22 each) were divided equally into; control and Pre-DM (received high fat diet, HFD) groups. Samples from pancreas as well as from visceral adipose tissue (VAT) were studied for the consequent changes.We detected a significantly increased mast cell count (MCC) in the pancreas of Pre-DM compared to that of control. Frequent degranulation of MC granules was observed in Pre-DM. VAT of the Pre-DM had significantly increased (p?<?0.05) macrophages (CD68⁺) and mast cells (tryptase⁺) compared to that of the control. A significant increase (p?<?0.05) in CD68 mRNA expression as well as in the level of IL-1 β, IL-6, TNF-α and TGF- β1 was detected in VAT of Pre-DM with a significant positive correlation (p?<?0.05) with the MCC. All these findings may indicate a potential role of MC in the low grade inflammation of VAT in Pre-DM.