Early onset of type 2 diabetes among visible minority and immigrant populations in Canada

Objectives: Type 2 diabetes is a chronic condition that affects nearly over three million Canadians, including immigrants. The timing of the first onset of diabetes has been linked to several other severe diseases. Yet, there is a dearth of empirical studies that examine the timing of the first onset of diabetes among Canadians, in general, and among immigrants and ethnic minority populations within Canada, in particular.

Design: Applying event history techniques to the 2013 Canadian Community and Health Survey, we address this research void by examining factors that contribute to the first onset of diabetes among immigrant and visible minority populations in Canada (N?=?8905). Given the gendered patterns in the epidemiology of diseases and the differences in risk factors for men and women, gender-specific models were estimated.

Results: Results showed that South Asian, Black and Filipino women developed diabetes earlier, compared to women from the UK. Similarly, South Asian, Chinese, Filipino, Black, South East Asian and Arab men developed diabetes earlier than men from the UK. A significant and important finding of this analysis was that the risks of developing diabetes vanished completely for Black and Filipino women, after accounting for lifestyle factors. For South Asian women, however, there was significant attenuation in their risks after accounting for lifestyle factors. The findings were strikingly different for immigrant men. Specifically, their risks of developing diabetes increased after accounting for lifestyle factors.

Conclusions: These results suggest the development of gender-specific and lifestyle interventions, targeted at specific immigrant groups with increased risks of developing diabetes earlier in the life course.     

Ⅱ型糖尿病发病危险因素病例-对照研究

据世界卫生组织(WHO)报告，1998年全球的糖尿病患总数约为1．43亿，预计到2025年将上升到3亿，糖尿病已成为继心血管病、脑血管病、癌症之后的第四号杀手。糖尿病中最主要的有非胰岛素依赖型(Ⅱ型)和胰岛素依赖型(Ⅰ型)糖尿病两种，其中大多数患是Ⅱ型糖尿病。Ⅰ型糖尿病的病因较明确，但Ⅱ型糖尿病的病因尚不很清楚，多认为与饮食等因素有关。本采用病例-对照研究拟对Ⅱ型糖尿病的发病危险因素进行初步探讨。     

早发2型糖尿病的临床特点

目的 研究早发2型糖尿病（T2DM）患者的临床特点。方法 将305例分为早发T2DM（EOD组120例）、晚发T2DM（LOD组185例）和年轻非糖尿病对照组（YN组25例）3组，探讨EOD组在血压、BMI、腰围、WHR、FPG、FINS、FC—P、HbA1c、血脂、HOMAIR、HOMAIS等方面的特点。结果 和LOD组相比，EOD组糖尿病家族史阳性率较高（P〈0.01），和YN组相比，EOD组腰围、WHR、TG、LDL、FINS、HOMAIR、HbA1c、FPG水平较高；和LOD相比，EOD组FPG、HbA1C、TG、HOMAIR水平较高；二分类Logistic逐步回归分析发现糖尿病家族史、高WHR、高TG、高FINS和低HDL可能是早发糖尿病发生的危险因素。结论 尽早识别糖尿病家族史、高WHR、高TG、高FINS和低HDL等危险因素，对于早发T2DM的早期预防具有重要的意义；同时在早发T2DM的治疗过程中要注意控制血糖、纠正血脂紊乱，保护胰岛β细胞功能。     

Age of onset of obesity and risk of type 2 diabetes

Objective : To compare a simple measure ‐ age of onset of obesity ‐ to an obese‐years construct (a product of duration and magnitude of obesity) as risk factors for type 2 diabetes. Method : Participants from the Framingham Heart Study who were not obese and did not have diabetes at baseline were included (n=4,320). The Akaike Information Criterion (AIC) was computed to compare four Cox proportional hazards models with incident diabetes as the outcome and: (i) obese‐years; (ii) age of onset of obesity; (iii) body mass index (BMI); and (iv) age of onset of obesity plus magnitude of BMI combined, as exposures. Results : AIC indicated that the model with obese‐years provided a more effective explanation of incidence of type 2 diabetes compared to the remaining three models. Models including age of onset of obesity plus BMI were not appreciably different from the model with BMI alone, except in those aged ≥60. Conclusions : While obese‐years was the optimal obesity construct to explain risk of type 2 diabetes, age of onset may be a useful, practical addition to current BMI in the elderly. Implications : Where computation of obese‐years is not possible or impractical, age of onset of obesity combined with BMI may provide a useful alternative.     

Early recognition of heart failure in patients with diabetes type 2 in primary care. A prospective diagnostic efficiency study. (UHFO-DM2)

Background  

We hypothesize that the prevalence of unknown heart failure in diabetic patients aged 60 years and over is relatively high (15% or more) and that a cost-effective strategy can be developed to detect heart failure in these patients. The strategy is expected to include some signs and symptoms (such as dyspnoea, orthopnoea, pulmonary crepitations and laterally displaced apical beat), natriuretic peptide measurements (Amino-terminal B-type natriuretic peptide) and possibly electrocardiography. In a subset of patients straightforward echocardiography may show to be cost-effective. With information from our study the detection of previously unknown heart failure in diabetic patients could be improved and enable the physician to initiate beneficial morbidity and mortality reducing heart failure treatment more timely.     

Effect of high intakes of fruit and vegetables on redox status in type 2 onset diabetes: a pilot study

Evidence has accumulated indicating that oxidative stress may play a key role in the etiology of diabetic complications and the protective effects of antioxidant nutrients are a topic of intense research. The purpose of this study was both to obtain preliminary data on the effect of a diet high in fruit and vegetables on metabolic control and the oxidative status of patients with type 2 onset diabetes, and to identify the most useful biochemical parameters for future research. At the beginning of the study all subjects were asked to follow their usual diet and keep a seven-day food diary. Diabetic patients then received a dietary treatment designed to ensure a daily intake of 700-1000 g of fruit and vegetables; no dietary advice was given to controls. Dietary antioxidants, redox status markers, and parameters of metabolic control were measured in plasma and erythrocytes before and after the diet. Before following the diet, diabetic patients had lower levels of ascorbic acid, beta-carotene, and alpha-tocopherol/cholesterol ratio than controls. After the diet these parameters increased and there was also a reduction in total antioxidant capacity, uric acid, and malondialdehyde and a rise in reduced glutathione accompanied by a reduction in body mass index and cholesterol. In conclusion, a high consumption of fruit and vegetables by diabetic patients not receiving pharmacological treatment, seems to produce an improvement in some redox status parameters.     

Unmasking in an observational vaccine safety study: Using type 2 diabetes mellitus as an example

BackgroundIn observational vaccine safety studies, diagnosis codes assigned prior to or on the day of vaccination (Day 0) are often excluded from analysis of safety signals since they usually represent pre-existing conditions. The limitations of this approach have been described for autoimmune conditions but not for other chronic conditions. We draw on our experience in a post-licensure quadrivalent human papillomavirus vaccine (HPV4) safety study to examine the effectiveness of exclusion of pre-existing and Day 0 diagnoses of type 2 diabetes mellitus (T2DM) in excluding prevalent T2DM.MethodsSubjects included all 117,402 females ages 9–26 years who received HPV4 August 2006–March 2008 in Kaiser Permanente Southern California. We identified potential incident T2DM cases using ICD9 code 250.xx associated with inpatient and emergency room visits during the 60 days following each HPV4 dose, excluding those with this code prior to their first HPV4 dose. Electronic medical records were reviewed to determine the dates of symptom onset, diagnostic labs, vaccine administration and T2DM diagnosis.ResultsOf 33 potential incident T2DM cases identified using automated data, 4 (12%) were confirmed to have new onset T2DM after medical record review. Nineteen cases were excluded that did not have T2DM or had T2DM diagnosed before Day 0; nine had an abnormal fasting blood sugar (FBS) ordered on Day 0, prompting subsequent evaluation and diagnosis of T2DM; and one had elevated FBS and glucosuria prior to the first dose of HPV4 but T2DM diagnosed at a visit following vaccination.ConclusionThese results suggest that among adolescents and young adults, the workup and subsequent diagnosis of pre-existing conditions may result from a visit at which a vaccination is administered. This “unmasking” phenomenon is not entirely eliminated by exclusion of pre-existing and Day 0 diagnoses. Medical record review should be considered in the evaluation of potential safety signals.     

基层2型糖尿病筛查专家共识

  目的  评价不同社区糖尿病筛查方法的筛查效果和实用意义,为社区糖尿病筛查流程的确立提供依据。  方法  于2017年10 — 12月采用多阶段整群随机抽样方法在上海市抽取23 940名 ≥ 35岁中老年社区居民进行问卷调查、体格检查和血糖测定,通过比较早发现流程、风险评分法、空腹静脉血糖（FPG）等筛查方法的灵敏度、特异度、约登指数、受试者工作特征曲线下面积（AUROC）以及筛查过程中需要进行FPG和口服葡萄糖耐量试验（OGTT）检测比例评价不同筛查方法的筛查效果及可操作性。  结果  最终纳入分析的17981名既往未确诊糖尿病者中,新诊断糖尿病前期者4129例,糖尿病前期患病率为22.96 %;新诊断出糖尿病者2213例,新诊断糖尿病患病率为12.31 %。早发现流程筛查未诊断糖尿病人群和糖尿病前期人群的灵敏度、特异度、约登指数、AUROC分别为87.3 %、60.2 %、0.479、0.858和61.0 %、58.9 %、0.199、0.620,风险评分法分别为96.7 %、15.2 %、0.119、0.680和93.3 %、15.8 %、0.091、0.602,FPG法分别为82.5 %、87.5 %、0.700、0.922和 47.8 %、86.0 %、0.338、0.708。早发现流程FPG和OGTT 2h静脉血糖（2h PG）需检测人数比例为45.7 %和42.6 %,风险评分法均为86.3 %,FPG法分别为100.0 %和21.1 %。  结论  早发现流程可在获得较高糖代谢异常人群检出率的同时,最大程度减少静脉血糖检测人数,简化现场实施流程,可作为大规模社区人群糖尿病及糖尿病前期筛查的有效工具。     

Management of diabetes mellitus in three settings in Jamaica.

OBJECTIVES: To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13%) of diabetes. METHODS: During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients' median age ranged from 56 years at SPMC and PRMC to 63 years at PUBMC. Median follow-up had been 6.0 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10% of the patients were controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46%), compared to 7% each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40% of the patients had satisfactory blood glucose control (< 8 mmol/L fasting or < 10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P = 0.26). A blood glucose measurement had been recorded in the preceding year in 84% of the patients at SPMC, 79% at PRMC, and 67% at PUBMC. Glycosylated hemoglobin was infrequently measured: 16% at SPMC, 10% at PRMC, and 0% at PUBMC. Overall, 96% of patients had had surveillance for hypertension, and 81% had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinic records most commonly at SPMC (14% for foot complications, and 13% for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes.     

Early infant feeding and type 1 diabetes

Background  Infant feeding practices, particularly the type of milk feeding, have been associated with the development of type 1 diabetes. Aim of the study  We studied the relationship between early infant feeding (during the first year of life) and diabetes in a large population-based cohort. Methods  In 1994–1995, 6,209 healthy full-term newborns participated in a study examining the effect of supplementary feeding, on development of allergy to cow’s milk, in maternity hospitals. All supplements in the maternity hospitals were known. Mothers recorded the feeding of infants prospectively at home. In August 2006, from a nationwide diabetes registry, 45 children from our cohort were listed as having type 1 diabetes. Results  The distribution of cases was similar in the randomized feeding groups: 9/1,789 in the group that received adapted cow’s milk-based formula; 12/1,737 in those who received extensively hydrolyzed formula; 16/1,859 in those who received banked human milk; and 8 among those 824 exclusively breast-fed in the hospital. When children who had received cow’s milk-based formula in the maternity hospital were compared with those without such exposure, less number of children in the former group had diabetes by age 8 (P = 0.026), but by the end of the follow-up (11.5 years) the difference disappeared (P = 0.16). Length of breast-feeding and introduction of cereals and other solid foods were similar among those developing type 1 diabetes and those remaining healthy, while early regular daily feeding with cow’s milk-based formula tended to associate with lower risk for type 1 diabetes (OR 0.66; 95% confidence interval 0.38–1.13; P = 0.08). Conclusions  In an extended, secondary analysis of a population-based cohort, very early exposure to cow’s milk is not a risk factor for type 1 diabetes; it may in fact diminish its appearance before age 8.     

2型糖尿病患者发病年龄、病程、糖化血红蛋白与缺血性脑卒中发病风险的前瞻性队列研究

目的 分析江苏省2型糖尿病患者发病年龄、病程和糖化血红蛋白（HbA1c）与缺血性脑卒中（IS）发病风险的关联。方法 研究对象来自江苏省社区糖尿病综合干预及应用研究,2013年12月至2014年1月开展基线调查,本研究随访数据截至2021年12月31日,剔除基线诊断为脑卒中以及发病年龄、病程和HbA1c信息缺失的参与者后,最终共纳入17 576名研究对象。采用Cox比例风险回归模型计算发病年龄、病程、HbA1c与IS发病的风险比（HR）值及其95%CI。结果 研究对象中位随访时间8.02年,期间共登记IS新发病例2 622名。多因素Cox比例风险回归分析显示,糖尿病发病年龄每延迟5年,IS发病风险降低5%（HR=0.95,95%CI：0.92~0.99）,糖尿病病程每增加5年,IS发病风险增加5%（HR=1.05,95%CI：1.02~1.10）,较高的HbA1c（每增加1个标准差：HR=1.17,95%CI：1.13~1.21）与IS发病风险增加相关。结论 2型糖尿病患者较早的发病年龄、更长的病程和较高水平的HbA1c均与IS发病风险增加相关。     

2型糖尿病的全基因组关联研究进展

2型糖尿病是环境和遗传因素共同作用的结果,遗传因素的研究在2006年以前主要是基于连锁分析和候选基因策略,近年来全基因组关联研究的出现使2型糖尿病遗传易感性的研究进入了一个崭新的阶段,发现了很多新的易感基因或区域,为其病因学研究及防治提供新的思路.     

The burden of type 2 diabetes: strategies to prevent or delay onset

Type 2 diabetes is widespread and its prevalence is increasing rapidly. In the US alone, approximately 41 million individuals have prediabetes, placing them at high risk for the development of diabetes. The pathogenesis of type 2 diabetes involves inadequate insulin secretion and resistance to the action of insulin. Suggestive data link insulin resistance and accompanying hyperglycemia to an excess of abdominal adipose tissue, a link that appears to be mediated partially by adipocyte secretion of multiple adipokines that mediate inflammation, thrombosis, atherogenesis, hypertension, and insulin resistance. The adipokine adiponectin has reduced expression in obesity and appears to be protective against the development of type 2 diabetes. Current recommendations to prevent type 2 diabetes center on lifestyle modifications, such as diet and exercise. Clinical trials have established the efficacy of lifestyle intervention, as well as pharmacologic interventions that target glycemic control or fat metabolism. However, diabetes did develop in a substantial percentage of individuals who received intensive intervention in these trials. Thus there is an unmet need for additional strategies in high-risk individuals. Recent data suggest thiazolidinediones and blockade of the endocannabinoid system represent novel therapeutic approaches that may be used for the prevention of diabetes.