老年2型糖尿病肾功能异常的相关影响因素分析

目的探讨老年2型糖尿病（T2DM）肾功能异常的相关影响因素及临床意义。方法回顾性分析1997-2006年在解放军总医院住院治疗的老年T2DM患者临床资料,根据其肾小球滤过率（GFR）水平分为：GFR≥90（A组）、60～90（B组）、〈60（C组,肾功能异常组）ml/（min.1.73m^2）。对各组临床及实验室指标进行比较。结果共收集老年T2DM病例525例,A组159例（30.3%）,B组239例（45.5%）,C组127例（24.2%）。临床诊断糖尿病肾病（DN）者占13.7%,合并高血压者占71.05%;肾功能异常组中,DN仅占29.9%。在老年T2DM中,高血压病程、收缩压（SBP）、舒张压（DBP）、餐后2h血糖（2hPBG）、血清总胆固醇（TC）、血尿酸（BUa）为肾功能异常的独立相关影响因素,且高血压对其肾功能的影响更为显著。随血压水平增高、DM病程延长、尿白蛋白/肌酐比值（Alb/Cr）增加,GFR下降,肾功能异常发生率增加。血压〈130/80mmHg、≥130/80mmHg者,肾功能异常发生率分别为4.09%、41.72%;DM病程〈5年、5～10年、〉10年者,肾功能异常发生率依次为18.64%、26.09%和28.90%;尿Alb/Cr〈30、30～299、≥300mg/g者,肾功能异常发生率分别为10.53%、40.38%和75%。结论老年T2DM肾功能异常的影响因素较多,高血压病程、SBP、DBP、2hPBG、TC、BUa与之独立相关,高血压对其影响更为显著。血压、血糖控制良好为保护因素,针对上述影响因素的综合治疗对预防及延缓肾功能异常的发生、发展有重要的临床意义。     

Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics

To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA₁c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA₁c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA₁c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID {"type":"clinical-trial","attrs":{"text":"NCT03707379","term_id":"NCT03707379"}}NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.     

Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: The SEARCH for Diabetes in Youth Study

Youth with diabetes are at an increased risk of cardiovascular disease (CVD). Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to improve CVD risk. In this study, we evaluated whether changes in diet quality as characterized by DASH are associated with changes in CVD risk factors in youth with diabetes over time. Longitudinal mixed models were applied to data from 797 participants in the SEARCH for Diabetes in Youth Study representing three time points: baseline, 12- and 60-month follow-up. Data were restricted to youth whose diabetes was first diagnosed in 2002–2005. DASH-related adherence was poor and changed very little over time. However, an increase in DASH diet score was significantly associated with a decrease in HbA_1c levels in youth with type 1 diabetes (β=−0.20, P-value=0.0063) and a decrease in systolic blood pressure among youth with type 2 diabetes (β=−2.02, P-value=0.0406). Improvements in dietary quality may be beneficial in youth with type 1 or type 2 diabetes. However, further work in larger groups of youth with type 1 and 2 diabetes is desirable.     

Clustering of cardiovascular risk factors in type 2 diabetes mellitus: prognostic significance and tracking

Summary
Aim   Little attention has been paid to the prognostic significance and tracking effect of risk factor clusters characteristic of type 2 diabetes mellitus. We studied the clustering of eight cardiovascular risk factors (smoking, high body mass index, elevated systolic blood pressure, high serum, low density lipoprotein (LDL) cholesterol, high serum LDL triglycerides, low serum, high density lipoprotein (HDL) cholesterol, high fasting blood glucose and high plasma insulin concentration) and their effect on the prognosis and the tracking effect.
Methods   This study is a population-based prospective follow-up of newly diagnosed type 2 diabetic subjects (n = 133, aged 45–64 years) in Eastern Finland. The following end points were used: all-cause mortality, cardiovascular mortality, and incidences of first myocardial infarction and first stroke. Furthermore, we studied the 'tracking effect' of the risk factor clusters during the 10-year follow-up period.
Results   When the clustering of risk factors typical of type 2 diabetes mellitus was taken into account, all-cause mortality increased from 28.6% to 50.0% (p < 0.05) and cardiovascular disease mortality increased from 14.3% to 50.0% (p < 0.01) depending on the number of risk factors present. The incidence of first myocardial infarction increased from 0% to 40.0% (p < 0.05) as the number of risk factors increased from 0 to 5. In survivors, the proportion of individuals with no risk factors decreased and the proportion on individuals with three to four risk factors increased during the 10-year follow-up period despite the high mortality among the group with many risk factors.
Conclusions   The risk factor clusters among type 2 diabetic subjects are of great predictive value and when not aggressively treated, show a relentless increase despite selective mortality.     

Lipoprotein risk factors for cardiovascular disease in patients with type 2 diabetes mellitus treated with oral antihyperglycaemic agents

Aims:  To compare lipoprotein risk factors for cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (DM) treated with a sulphonylurea (SU) compound only, metformin (MET) only, or combined SU + MET.
Methods:  The study population consisted of 62 patients with type 2 DM, whose antihyperglycaemic treatment program had been stable for at least 3 months, divided into three groups: 26 patients in the SU group, 17 patients in the MET group and 19 patients in the SU + MET group. None of the patients were taking lipid-lowering drugs. Fasting venous blood samples were taken to measure concentrations of glucose, total cholesterol, triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and remnant lipoprotein-cholesterol (RLP-C) as well as for determination of LDL particle diameter.
Results:  The three groups were similar in terms of age, gender, body mass index and fasting plasma glucose concentrations. Total cholesterol concentrations were significantly lower (p < 0.05 for trend) in those treated with SU + MET as compared with the other two groups. However, there were no significant differences between the three groups in their plasma concentrations of TG, LDL-C, HDL-C or RLP-C; furthermore, the proportion of individuals within each treatment group with small LDL particle diameter was also not different.
Conclusions:  The lipoprotein profile of patients with type 2 DM, matched for level of fasting hyperglycaemia, was similar irrespective of treatment with SU alone, MET alone or SU + MET. Thus, we could not identify any changes in lipoprotein metabolism that could account for differences in risk of CVD as a function of treatment.     

老年2型糖尿病患者高尿酸血症患病率及其影响因素

目的 调查老年2型糖尿病（T2DM）患者高尿酸血症（HUA）的患病率,分析其影响因素。方法 选择2019年1月—2021年4月于四川大学华西广安医院诊治的老年T2DM患者。收集患者的人口学信息,检测空腹血糖（FBG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）、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）、三酰甘油（TG）、血尿素氮（BUN）、血肌酐（Scr）、预估肾小球滤过率（eGFR）、尿微量白蛋白（UMalb）和血尿酸水平。统计患者的HUA患病率并分析其影响因素。结果 共纳入216例老年T2DM患者,年龄60～87岁,平均（74.3±5.2）岁,HUA患病率为35.65%。不同年龄、居住地区老年T2DM患者HUA患病率及血尿酸水平差异有统计学意义（P<0.05）,而不同性别的患者HUA患病率及血尿酸水平差异无统计学意义（P> 0.05）。HUA组的体质量指数（BMI）、TG、BUN、Scr和UMalb水平高于非HUA组,HDL-C和eGFR水平低于非HUA组,2组其余生化指标差异无统计学意义（P> 0.05）。L...     

2型糖尿病尿微量白蛋白与心血管病危险因素的研究

目的探讨2型糖尿病（T2DM）患者尿微量白蛋白与心血管病危险因素（血糖、血脂、血压、尿酸等）的关系。方法选择192例确诊为T2DM住院患者,分为微量白蛋白尿（MAU）组（n=60）和正常微量白蛋白尿（NAU）组（n=132）,检测患者体质指数（BMI）、血脂、血压、尿酸等相关危险因素,并进行对比分析;同时以尿微量白蛋白为因变量,各相关危险因素为自变量进行了多元线性回归分析,以明确影响2型糖尿病患者尿微量白蛋白增加的因素。结果 MAU组糖化血红蛋白水平（HbA1c）、入院时收缩压（SBP）、舒张压（DBP）水平、血肌酐（Cr）、尿酸（UA）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平及TC、LDL-C、UA、SBP和DBP的异常率明显高于NAU组,而高密度脂蛋白胆固醇（HDL-C）水平明显低于NAU组（P〈0.05～0.01）,多元线性回归分析发现MAU与BMI、SBP、DBP、TC、TG、LDL-C、HbA1c、UA和Cr呈正相关,而与HDL-C呈负相关（P〈0.05～0.01）。结论血脂、血压等多种危险因素的异常影响T2DM患者尿微量白蛋白水平。     

Use of sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors: An Asian perspective and expert recommendations

Diabetes mellitus in Asia accounts for more than half of the global prevalence. There is a high prevalence of cardiovascular disease (CVD) in the region among people with type 2 diabetes mellitus (T2DM) and it is often associated with multiple risk factors including hypertension, renal disease and obesity. The early onset of T2DM and the eventual long disease duration portends an increasing proportion of the population to premature CVD. In addition to lowering blood glucose, sodium-glucose co-transporter-2 (SGLT-2) inhibitors exert favourable effects on multiple risk factors (including blood pressure, body weight and renal function) and provide an opportunity to reduce the risk of CVD in patients with T2DM. In this article, we consolidated the existing literature on SGLT-2 inhibitor use in Asian patients with T2DM and established contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, published data from clinical trials in the Asian population (dapagliflozin, canagliflozin, empagliflozin, ipragliflozin, luseogliflozin and tofogliflozin), CVD outcomes trials (EMPAREG-OUTCOME, CANVAS and DECLARE-TIMI 58) and real-world evidence studies (CVD-REAL, EASEL, CVD-REAL 2 and OBSERVE-4D). A series of clinical recommendations on the use of SGLT-2 inhibitors in Asian patients with T2DM was deliberated among experts with multiple rounds of review and voting. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for the primary prevention of heart failure hospitalization and secondary prevention of CVD in patients with T2DM, and should be considered early on in the treatment algorithm for patients with multiple risk factors, or those with established CVD.     

Comorbid conditions and glycemic control in elderly patients with type 2 diabetes mellitus, 1988 to 1994 to 1999 to 2004

OBJECTIVES: To compare the prevalence of type 2 diabetes mellitus in the U.S. elderly population between 1988 to 1994 and 1999 to 2004 and to assess glycemic control and comorbid conditions in this population.
DESIGN: Serial U.S. population-based cross-sectional surveys.
SETTING: National Health and Nutrition Examination Surveys (1988–1994 and 1999–2004).
PARTICIPANTS: Survey participants aged 65 and older with type 2 diabetes mellitus.
MEASUREMENTS: Glycemic control, measured as hemoglobin A1C (hA1C) less than 7%, prevalence of comorbid conditions, pharmacologic treatment rate, blood pressure, and serum cholesterol.
RESULTS: The prevalence of diagnosed type 2 diabetes mellitus in the U.S. elderly population increased from 12.0% to 14.1% ( P =.004) between 1988 and 2004. Many patients had comorbid conditions; in 1999 to 2004, 36.7% had nephropathy, 31.5% renal insufficiency, 20.2% history of myocardial infarction, and 17.9% heart failure. The proportion of patients treated with antihyperglycemic medication increased from 75.1% in 1988 to 1994 to 85.6% in 1999 to 2004 ( P <.001), and glycemic control rates also improved, from 44.7% to 54.8% ( P <.001). Greater improvement in glycemic control rates was evident in patients without comorbidities ( P <.001). Adjusted for patient characteristics, including duration of diabetes mellitus, patients with nephropathy or renal insufficiency were 40% less likely to achieve controlled hA1C as those without.
CONCLUSION: Despite improvements in the rates of treatment and glycemic control, approximately half of elderly patients diagnosed with type 2 diabetes mellitus have hA1C levels of 7% or higher. Many patients suffer from comorbid conditions, which may present a challenge for successful diabetes mellitus management.     

2型糖尿病家系发病特征与危险因素初步调查

Objective To explore the characteristics and risk factors of type 2 diabetes mellitus (T2DM) onset in pedigrees. Methods A total of 865 subjects were screened and diagnosed by oral glucose tolerance test (OGTT) based on American Diabetes Association (ADA) criteria. Type 1 diabetes mellitus (T1DM) , maturity onset diabetes of the young (MODY) and chondriosome diabetes were excluded by clinical features and laboratory test of insulin and autoantibodies including glutamic acid decarboxylase antibody, insular cellular antibody and insulin autoantibody. A total of 182 pedigrees of T2DM were obtained. Results No gender difference was found in the prevalence of T2DM (42. 59% in male and 48. 18% in female respectively, P ＞0. 05) , nor was the newly diagnosed rate(9. 89% in male and 11. 82%in female, P ＞ 0. 05). The onset age was (63. 3 ± 12. 4) years old in the first generation [(64. 4 ± 12. 5)years in male and (62. 3 ± 10. 3) years in female] , (47. 1 ± 8. 7) years old in the second generation [(48. 2 ±9. 3)years in male and (46. 1 ± 8. 1) years in female] , (29. 6 ± 10. 2) years old in the third generation [(28. 9 ±9. 5)years in male and (30. 0 ± 10. 4)years in female]. Compared with normal glucose tolerance (NGT) subjects , newly diagnosed T2DM and impaired glucose regulation (IGR) subjects had higher prevalence of hypertension, hyperlipidemia and smoking but less physical activities. Statistical differences were shown in body weight five years before diagnosis, one years before diagnosis and at diagnosis in newly diagnosed T2DM[(68. 4 ±12. 4)kg, (69. 5 ± 11. 0)kg and (69. 1 ±9. 6)kg] and IGR[(66. 1 ±10.7)kg, (65.9 ± 10.7) kg and(65.7 ± 10.4) kg] , when compared with NGT [(61.0 ± 10.2) kg,(59. 5 ±11.0) kg and (60. 1 ± 10. 4) kg, all P ＜ 0. 05] . The same results were obtained with waist circumference and waist-hip ratio [(4. 1 ± 12. 5) cm and 0. 92 ± 0. 36 in newly diagnosed T2DM while (89. 1 ± 10. 7) cm and 0. 90 ± 0. 64 in IGR] , when compared with NGT[(82. 5 ± 10. 1) cm and 0. 82 ±0. 25] , all P ＜0. 05. Conclusions No gender difference was found in the onset characteristics of T2DM.High prevalence of obesity, hypertension, hyperlipidemia and smoking with less physical activities were associated with T2DM.     

2型糖尿病家系发病特征与危险因素初步调查

Objective To explore the characteristics and risk factors of type 2 diabetes mellitus (T2DM) onset in pedigrees. Methods A total of 865 subjects were screened and diagnosed by oral glucose tolerance test (OGTT) based on American Diabetes Association (ADA) criteria. Type 1 diabetes mellitus (T1DM) , maturity onset diabetes of the young (MODY) and chondriosome diabetes were excluded by clinical features and laboratory test of insulin and autoantibodies including glutamic acid decarboxylase antibody, insular cellular antibody and insulin autoantibody. A total of 182 pedigrees of T2DM were obtained. Results No gender difference was found in the prevalence of T2DM (42. 59% in male and 48. 18% in female respectively, P ＞0. 05) , nor was the newly diagnosed rate(9. 89% in male and 11. 82%in female, P ＞ 0. 05). The onset age was (63. 3 ± 12. 4) years old in the first generation [(64. 4 ± 12. 5)years in male and (62. 3 ± 10. 3) years in female] , (47. 1 ± 8. 7) years old in the second generation [(48. 2 ±9. 3)years in male and (46. 1 ± 8. 1) years in female] , (29. 6 ± 10. 2) years old in the third generation [(28. 9 ±9. 5)years in male and (30. 0 ± 10. 4)years in female]. Compared with normal glucose tolerance (NGT) subjects , newly diagnosed T2DM and impaired glucose regulation (IGR) subjects had higher prevalence of hypertension, hyperlipidemia and smoking but less physical activities. Statistical differences were shown in body weight five years before diagnosis, one years before diagnosis and at diagnosis in newly diagnosed T2DM[(68. 4 ±12. 4)kg, (69. 5 ± 11. 0)kg and (69. 1 ±9. 6)kg] and IGR[(66. 1 ±10.7)kg, (65.9 ± 10.7) kg and(65.7 ± 10.4) kg] , when compared with NGT [(61.0 ± 10.2) kg,(59. 5 ±11.0) kg and (60. 1 ± 10. 4) kg, all P ＜ 0. 05] . The same results were obtained with waist circumference and waist-hip ratio [(4. 1 ± 12. 5) cm and 0. 92 ± 0. 36 in newly diagnosed T2DM while (89. 1 ± 10. 7) cm and 0. 90 ± 0. 64 in IGR] , when compared with NGT[(82. 5 ± 10. 1) cm and 0. 82 ±0. 25] , all P ＜0. 05. Conclusions No gender difference was found in the onset characteristics of T2DM.High prevalence of obesity, hypertension, hyperlipidemia and smoking with less physical activities were associated with T2DM.     

Predictors of poor glycemic control among type 2 diabetes mellitus patients treated with antidiabetic medications: A cross-sectional study in China

This study aimed to clarify of the predictors of poor glycemic control in type 2 diabetes mellitus (T2DM) patients treated with antidiabetic medications in China.This study was a retrospective, cross-sectional study based on SuValue database. T2DM patients aged 18 years or older performing glycosylated hemoglobin A1c (HbA1c) examinations from January 1st, 2018 to December 31st, 2018 were included and have been treated with antidiabetic medications for at least 6 months. HbA1c < 7.0% was defined as adequate glycemic control. Multivariate analysis was performed for the factors associated with poor glycemic control.A total of 13972 T2DM patients were included in this study. The adequate glycemic control rate was 44.04% (n = 6153). In the multivariate analysis, predictors of poor glycemic control include longer T2DM duration (5–10 years vs <5 years and >10 years vs <5 years, odds ratio [OR] = 1.499 and 1.581, P < .001 and P = .008), myocardial infarction (OR = 1.141, P = .041), diabetic neuropathy (OR = 1.409, P < .001), secondary hospital (OR = 1.877, P < .001), underdeveloped regions (OR = 1.786, P < .001), insulin only (OR = 3.912, P < .001), combination of oral antidiabetic agents and/or insulin use (P < .001).In conclusion, longer T2DM duration, secondary hospital, myocardial infarction, diabetic neuropathy, undeveloped regions and use of polypharmacy and insulin were associated with poor glycemic control among T2DM patients treated with antidiabetic medications. Patient education and training of health care providers may be short-term strategy to achieve adequate glycemic control.     

糖尿病肾病和血糖控制的关系及相关危险因素分析

目的探讨糖尿病肾病(DKD)与血糖控制指标关系以及相关危险因素。方法回顾性分析2010年3月至2016年12月在西京医院老年病科住院且使用持续血糖监测系统(CGMS)的2型糖尿病(T2DM)患者142例,根据是否伴有DKD分为DKD组(n=54)和非DKD组(n=88)。收集患者一般临床资料、实验室指标及CGMS结果,分析DKD与血糖控制指标关系并对其危险因素进行综合分析。采用SPSS 19.0统计软件对数据进行分析,组间比较采用t检验、非参数检验或χ~2检验。Spearman秩相关分析两变量相关性,多因素分析采用逐步二元logistic回归分析。结果相比非DKD组,DKD组患者年龄偏大、病程长、高血压病史比例较高、高密度脂蛋白胆固醇(HDL-C)水平偏低、双胍类降糖药物使用率明显降低,糖化血红蛋白A1c(Hb A1c)水平、完整24 h高血糖时间波动百分比、高血糖曲线下面积(AUC)、餐后2 h血糖(2h-PBG)和24 h平均血糖水平(MBG)显著升高,差异有统计学意义(P0.05);胱抑素C(Cys C)、尿素氮(BUN)、血肌酐(SCr)水平显著高于非DKD组,估算肾小球滤过率(e GFR)显著低于非DKD组,差异有统计学意义(P0.001)。Spearman相关分析结果显示,DKD与年龄、病程、高血压史、Hb A1c、24 h高血糖时间波动百分比、高血糖AUC、24 h MBG、2h-PBG均呈正相关,与HDL-C呈负相关(r=-0.205,P=0.014)。逐步二元logistic回归分析结果显示年龄(OR=1.048,95%CI 1.022~1.074;P=0.000)和Hb A1c(OR=1.569,95%CI 1.212~2.031;P=0.001)与DKD呈正相关。结论 Hb A1c是T2DM患者发生DKD的主要危险因素,DKD的发生与血糖波动并无显著相关。     

老年2型糖尿病高尿酸血症相关因素分析

目的探讨老年2型糖尿病高尿酸血症的相关因素。方法将2013-01~2016-01该院住院治疗的240例60岁以上2型糖尿病老年患者,按血尿酸水平分为高尿酸(HUA)组(A组)45例,非高尿酸(NUA)组(B组)195例,分析两组体重指数(BMI)、血压、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、尿素氮(BUN)、血肌酐(Scr)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平差异。结果老年2型糖尿病高尿酸血症患病率18.7%。高尿酸血症与TG、TC、BMI、血压密切相关。结论应控制体重,降低TG,积极预防老年2型糖尿病高尿酸血症。     

2型糖尿病家系发病特征与危险因素初步调查

Objective To explore the characteristics and risk factors of type 2 diabetes mellitus (T2DM) onset in pedigrees. Methods A total of 865 subjects were screened and diagnosed by oral glucose tolerance test (OGTT) based on American Diabetes Association (ADA) criteria. Type 1 diabetes mellitus (T1DM) , maturity onset diabetes of the young (MODY) and chondriosome diabetes were excluded by clinical features and laboratory test of insulin and autoantibodies including glutamic acid decarboxylase antibody, insular cellular antibody and insulin autoantibody. A total of 182 pedigrees of T2DM were obtained. Results No gender difference was found in the prevalence of T2DM (42. 59% in male and 48. 18% in female respectively, P ＞0. 05) , nor was the newly diagnosed rate(9. 89% in male and 11. 82%in female, P ＞ 0. 05). The onset age was (63. 3 ± 12. 4) years old in the first generation [(64. 4 ± 12. 5)years in male and (62. 3 ± 10. 3) years in female] , (47. 1 ± 8. 7) years old in the second generation [(48. 2 ±9. 3)years in male and (46. 1 ± 8. 1) years in female] , (29. 6 ± 10. 2) years old in the third generation [(28. 9 ±9. 5)years in male and (30. 0 ± 10. 4)years in female]. Compared with normal glucose tolerance (NGT) subjects , newly diagnosed T2DM and impaired glucose regulation (IGR) subjects had higher prevalence of hypertension, hyperlipidemia and smoking but less physical activities. Statistical differences were shown in body weight five years before diagnosis, one years before diagnosis and at diagnosis in newly diagnosed T2DM[(68. 4 ±12. 4)kg, (69. 5 ± 11. 0)kg and (69. 1 ±9. 6)kg] and IGR[(66. 1 ±10.7)kg, (65.9 ± 10.7) kg and(65.7 ± 10.4) kg] , when compared with NGT [(61.0 ± 10.2) kg,(59. 5 ±11.0) kg and (60. 1 ± 10. 4) kg, all P ＜ 0. 05] . The same results were obtained with waist circumference and waist-hip ratio [(4. 1 ± 12. 5) cm and 0. 92 ± 0. 36 in newly diagnosed T2DM while (89. 1 ± 10. 7) cm and 0. 90 ± 0. 64 in IGR] , when compared with NGT[(82. 5 ± 10. 1) cm and 0. 82 ±0. 25] , all P ＜0. 05. Conclusions No gender difference was found in the onset characteristics of T2DM.High prevalence of obesity, hypertension, hyperlipidemia and smoking with less physical activities were associated with T2DM.     

Undetected type 2 diabetes in older adults

Background: early detection and prompt treatment of type 2 diabetesmellitus (T2D) may reduce the complications and burden associatedwith the disease. Objective: to evaluate the rate of undetected T2D (UT2D) amongolder adults who were screened 25 years ago, identify the characteristicsof UT2D patients and suggest a high-risk profile most suitablefor screening. Methods: a cross-sectional study of a group of 623 older adultsurvivors of 25-year cohort, 53.5% males, aged 58– 93years in a personal interview on lifestyle habits, morbidityand medication use. Self-administered measurement of subjectivehealth perception. Anthropometric measurements, laboratory examinationsof 12-h fasting venous blood and 2-h oral glucose tolerancetests were carried out. Results: the prevalence of previously diagnosed diabetes was18.9% and of UT2D 13.2%. The likelihood of having UT2D was higherfor males, those with systolic blood pressure 130 mmHg, triglycerides1.7 mmol/l (150 mg/dl) and large waist circumference; all arecomponents of the metabolic syndrome. Compared to known diabeticpatients, the undetected were predominantly males, slightlyyounger, rated their health status more favourably and had lesscomorbidities. Conclusion: a large proportion of older adults with T2D wereundiagnosed. Screening efforts for T2D should address thoseexhibiting characteristics of the metabolic syndrome in a seeminglyhealthy population of older adults.     

The risks and benefits of implementing glycemic control guidelines in frail older adults with diabetes mellitus

OBJECTIVES: To determine the hypo‐ and hyperglycemic outcomes associated with implementing the American Geriatrics Society (AGS) guideline for a glycosylated hemoglobin (HbA1c) level of less than 8% in frail older adults with diabetes mellitus (DM). DESIGN: Guideline implementation. SETTING: Program of All‐Inclusive Care for the Elderly. PARTICIPANTS: All participants in the before (October 2002–December 2004, n=338), early (January 2005–June 2006, n=289) and late (July 2006–December 2008, n=385) periods of guideline implementation with a diagnosis of DM and at least one HbA1c measurement. INTERVENTION: Clinician education in 2005 with annual monitoring of the proportion of each clinician's patients with DM with HbA1c less than 8%. MEASUREMENTS: Hypoglycemia (blood glucose<50 mg/dL), hyperglycemia (blood glucose>400 mg/dL), and severe hypoglycemia (emergency department (ED) visit for hypoglycemia). RESULTS: Participants in the before, early, and late periods were similar in age, race and ethnicity, comorbidities, and functional dependence. Antihyperglycemic medication use was greater in the late period, with more participants using metformin (28% before, 42% late, P<.001) and insulin (23% before, 34% late, P<.001) and achieving the AGS glycemic target of HbA1c of less than 8% (74% before, 84% late, P<.001). Episodes of hyperglycemia (per 100 person‐years) were dramatically lower in the late period (159 before, 46 late, P<.001), and episodes of hypoglycemia were similar (10.1 before, 9.3 late, P=.50). There were more episodes of severe hypoglycemia in the early period (1.1 before, 2.9 early, P=.03). CONCLUSION: Implementing the AGS glycemic control guideline for frail older adults led to fewer hyperglycemic episodes but more severe hypoglycemic episodes requiring ED visits in the early implementation period. Future glycemic control guideline implementation efforts should be coupled with close monitoring for severe hypoglycemia in the early guideline implementation period.     

An Australian cardiovascular risk equation for type 2 diabetes: the Fremantle Diabetes Study

Background: There is no valid cardiovascular disease (CVD) risk prediction equation for Australians with diabetes. The aim of this study is to develop and validate a multivariate risk function for 5‐year cardiovascular risk prediction in Australian type 2 diabetes patients. Methods: The Fremantle Diabetes Study is a community‐based longitudinal observational study. A total of 1240 type 2 diabetic patients (95.8% of the baseline cohort) with all required risk factor data were followed from baseline (1993–1996) for 5 years or until they experienced a cardiovascular event or died, whichever came first. CVD during follow up was defined as hospitalization for/with myocardial infarction or stroke, and death from cardiac or cerebrovascular causes or sudden death. Validation of the algorithm was performed on an independent diabetic cohort from the Busselton Health Study. Results: During 5570 patient‐years of follow up, 185 (14.9%) had at least one CVD event and 175 (14.1%) died (57.7% from CVD). Variables in the final model comprised age, sex, prior CVD, ln(urinary albumin : creatinine ratio), lnHbA_1c, ln(high density lipoprotein‐cholesterol), Southern European ethnic background and Aboriginality. The mean 5‐year predicted risk of a CVD event was 15.5%. Applied to the Busselton cohort, discrimination of the model was good (AUC = 0.84, P < 0.001) as was the goodness‐of‐fit (Hosmer–Lemeshow Ĉ‐test, P= 0.85) and accuracy (mean squared error (95% confidence interval) = 0.09 (0–0.76)). The positive and negative predictive values for a 10% 5‐year CVD risk cut‐off were 23.4% and 97.7% respectively. Conclusion: This simple diabetes‐specific 5‐year CVD risk equation is the first validated, population‐based Australian model. It should have a role in diabetes management in primary and specialist care.