U-shaped association between serum IGF2BP3 and T2DM: A cross-sectional study in Chinese population.

The authors aimed to determine whether 2 functional polymorphisms in the heme oxygenase-1 (HO-1) gene promoter are associated with type 2 diabetes mellitus (T2DM). A Chinese case-control study involving 1,103 newly diagnosed T2DM patients, 371 patients with impaired glucose regulation (IGR), and 1,615 controls was performed (December 2004-December 2007). A (GT)(n) microsatellite polymorphism and a single nucleotide polymorphism, T(-413)A, were genotyped, and their functional relevance was evaluated by examining the level of HO-1 protein expression. For the (GT)(n) microsatellite polymorphism, genotypes with the L (GT)(n) allele (>or=25 GT repeats) were associated with increased odds of IGR or T2DM compared with the S/S genotype (<25 GT repeats) (S/L genotype: odds ratio (OR) = 1.35, P = 0.048; L/L genotype: OR = 1.65, P = 0.006). Subsequent haplotype analysis showed that haplotype TL contributed to increased odds of IGR or T2DM compared with haplotype TS (OR = 1.56, P = 0.003). In functional analyses, HO-1 expression level was significantly reduced in persons with IGR and T2DM carrying the L/L (GT)(n) genotype compared with persons with the S/S genotype. Further haplotype combination assay confirmed the functional dominance of the (GT)(n) microsatellite polymorphism over the T(-413)A single nucleotide polymorphism. These results support an association between the HO-1 (GT)(n) microsatellite polymorphism, HO-1 expression levels, and the odds of T2DM.

Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non-diabetic obese controls. One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m(2), blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non-diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m(2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e') and late (a') myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e') served as an index of LV filling pressure. T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e' (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a' (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e' (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure. Compared to a non-diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM.

To examine the association between the weight-adjusted waist index (WWI) and the odds of type 2 diabetes mellitus(T2DM)among U.S. adults. Data from the National Health and Nutrition Examination Survey (NHANES) spanning six years (2007-2018) were utilized, encompassing 31001 eligible participants. Weighted multivariate logistic regression models and smoothed fit curves were employed to assess the association between WWI and the odds of T2DM, as well as dose-response relationships in the overall population and the odds of T2DM in various subgroups. In the fully adjusted continuous model, each one-unit increase in WWI was associated with a 1.14-fold increase in the odds of T2DM within the entire study population (2.14 [1.98,2.31], P < 0.0001). In the fully adjusted categorical model, when using the lowest tertile of WWI (T1) as the reference group, the second tertile (T2) and the third tertile (T3) were associated with a 0.88-fold (1.88 [1.64,2.17], P < 0.0001) and a 2.63-fold (3.63 [3.11,4.23], P < 0.0001) increase in the odds of T2DM. These findings indicated a positive correlation between WWI values and the odds of T2DM, aligning with the results of the smoothed-fitted curves. In the analysis of subgroups, in addition to maintaining consistency with the overall population results, we found interactions between age and hypertension subgroups. In conclusion, WWI was found to be positively associated with the odds of T2DM in U.S. adults.

The association of ozone with type 2 diabetes mellitus (T2DM) is uncertain. Moreover, the moderating effect of physical activity on this association is largely unknown. This study aims to evaluate the independent and combined effects of ozone and physical activity on T2DM and fasting blood glucose (FBG) in a Chinese rural adult population. A total of 39,192 participants were enrolled in the Henan Rural Cohort Study. Individual ozone exposure was assessed by using a satellite-based random forest model. The logistic regression and generalized linear models were used to evaluate the associations of ozone and physical activity with T2DM and FBG, respectively. Interaction plots were used to visualize the interaction effects of ozone and physical activity on T2DM or FBG. An interquartile range (IQR) increase in ozone exposure concentration was related to a 53.3% (odds ratio (OR),1.533; 95% confidence interval (CI), 1.426, 1.648) increase in odds of T2DM and a 0.292 mmol/L (95%CI, 0.263, 0.321) higher FBG level, respectively. The effects of ozone on T2DM and FBG generally decreased as physical activity levels increased. Negative additive interactions between ozone and physical activity on T2DM risk were observed (relative excess risk due to interaction (RERI), -0.261; 95%CI, -0.473, -0.048; attributable proportion due to interaction (AP), -0.203; 95%CI, -0.380, -0.027; synergy index (S), 0.520; 95%CI, 0.299, 0.904). The larger effects of ozone were observed among elderly and men on T2DM and FBG than young and women. Long-term exposure to ozone was associated with higher odds of T2DM and higher FBG levels, and these associations might be attenuated by increasing physical activity levels. In addition, there was a negative additive interaction (antagonistic effect) between ozone exposure and physical activity level on T2DM risk, suggesting that physical activity might be an effective method to reduce the burden of T2DM attributed to ozone exposure. Trail registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015, http://www.chictr.org.cn/showproj.aspx?proj=11375.

Objective: To analyze the association between different types of obesity, BMI, and waist circumference (WC) and the risk of type 2 diabetes mellitus (T2DM) in Chinese adults. Methods: Based on the China Health and Nutrition Survey data in 2018, different types of obesity were defined across different BMI and WC combinations based on Criteria of weight for adults (WS/T 428-2013), including non-obesity, simple general obesity, simple central obesity, and complex obesity. The associations of different types of obesity, BMI, and WC with T2DM risk were explored using two-level mixed-effects logistic regression and restricted cubic spline models. Results: A total of 7 030 subjects aged 18-65 were included in this study. The prevalence of general obesity and central obesity were 16.29% (502/3 082), 42.28% (1 303/3 082) in males, and 14.41% (569/3 948), 37.87% (1 495/3 948) in females. The prevalence of complex obesity was 14.70% and 12.97% in males and females, respectively. The prevalence of T2DM was 11.28% in participants, and the prevalence in complex obesity (18.98%, 22.07%) was higher than in simple central obesity (16.24%, 15.26%) and non-obesity (9.65%, 5.18%) in males and females, respectively. Multilevel regressions showed that males with simple central obesity and complex obesity had 1.61 (95%CI: 1.24-2.08) and 2.11 (95%CI: 1.56-2.86) times the odds of T2DM, respectively, as compared with the non-obesity; and the odds of T2DM in females were 2.70 (95%CI: 1.16-6.28) times for simple general obesity, 2.62 (95%CI: 2.01-3.40) times for simple central obesity, and 4.47 (95%CI: 3.35-5.98) times for complex obesity. A nearly linear positive association was observed between BMI and T2DM risk. WC was also positively associated with T2DM risk and a non-linearly increased risk in females (P for non-linear=0.024). The risk of T2DM increased when BMI ≥22.5 kg/m2 and 23.0 kg/m2, WC ≥85.0 cm and 80.0 cm in males and females, respectively. Conclusions: Complex obesity adults are more likely to suffer from T2DM. The risk of T2DM increases significantly when BMI is at the normal high values and waist circumference at the stage of pre-central obesity.

BackgroundEthnic diversity is increasing through migration in many developed countries. Evidence indicates that type 2 diabetes mellitus (T2DM) prevalence varies by ethnicity and socio-economic status (SES), and that in many settings, migrants experience a disproportionate burden of disease compared with locally-born groups. Given Australia’s multicultural demography, we sought to identify groups at high risk of T2DM in Victoria, Australia.MethodsUsing population data from the Australian National Census and diabetes data from the National Diabetes Services Scheme, prevalence of T2DM among immigrant groups in Victoria in January 2010 was investigated, and prevalence odds versus Australian-born residents estimated. Distribution of T2DM by SES was also examined.ResultsPrevalence of diagnosed T2DM in Victoria was 4.1% (n = 98671) in men and 3.5% (n = 87608) in women. Of those with T2DM, over 1 in 5 born in Oceania and in Southern and Central Asia were aged under 50 years. For both men and women, odds of T2DM were higher for all migrant groups than the Australian-born reference population, including, after adjusting for age and SES, 6.3 and 7.2 times higher for men and women born in the Pacific Islands, respectively, and 5.2 and 5.0 times higher for men and women born in Southern and Central Asia, respectively. Effects of SES varied by region of birth.ConclusionsLarge socio-cultural differences exist in the distribution of T2DM. Across all socio-economic strata, all migrant groups have higher prevalence of T2DM than the Australian-born population. With increasing migration, this health gap potentially has implications for health service planning and delivery, policy and preventive efforts in Australia.

Identifying type 2 diabetes mellitus (T2DM) is a prerequisite for the institution of preventive measures to reduce future micro and macrovascular complications. Approximately 50% of people with T2DM are undiagnosed, challenging the assumption that a traditional primary healthcare setting is the most efficient way to reach people at risk of T2DM. A setting of this kind may be even more suboptimal when it comes to reaching immigrants, who often appear to have inferior access to healthcare and/or are less likely to attend routine health checks at primary healthcare centres. The objective of this study was to identify the best strategy to reach individuals at high risk of T2DM and thereby cardiovascular disease in a heterogeneous population. All 18-65-year-old inhabitants in the Swedish municipality of Södertälje ( n∼51,000) without known T2DM and cardiovascular disease were encouraged to complete the Finnish Diabetes Risk Score (FINDRISC: score > 15 indicating a high and > 20 a very high risk of future T2DM and cardiovascular disease) through the following communication channels: primary care centres, workplaces, Syrian orthodox churches, pharmacies, crowded public places, mass media, social media and mail. Data collection lasted for six weeks. The highest response rate was obtained through workplaces (27%) and the largest proportion of respondents at high/very high risk through the Syrian orthodox churches (18%). The proportion reached through primary care centres was 4%, of whom 5% were at elevated risk. The cost of identifying a person at elevated risk through the Syrian orthodox church was €104 compared with €8 through workplaces and €112 through primary care centres. The choice of communication channels was important to reach high/very high-risk individuals for T2DM and for screening costs. In this immigrant-dense community, primary care centres were inferior to strategies using workplaces and churches in terms of both the proportion of identified at-risk individuals and costs.

Objectives: To determine whether vitamin D status in childhood and adolescence (herein collectively referred to as youth) and the long-term status from youth to adulthood is associated with risk of developing type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) in adulthood.Materials and methods: This was a 31-year follow-up study of 2300 participants aged 3–18 years. Multinomial logistic regression was used to assess the association of both (a) baseline 25-hydroxyvitamin D (25OHD) levels and (b) the mean of baseline and the latest follow-up 25OHD levels (continuous variable and quartiles) with incident T2DM and IFG (cut-off = 5.6 mmol/L) in adult life.Results: High serum 25OHD levels in youth and also mean values from youth to adulthood were associated with reduced risk of developing T2DM in adulthood (odds ratio, 95% confidence interval= 0.73, 0.57–0.95 and 0.65, 0.51–0.84, respectively, for each SD increment in 25OHD). Compared to Q1, a dose-dependent negative association was observed across other quartiles of youth 25OHD, while the strongest association was found in the Q3 for the mean 25OHD levels. Neither youth nor the mean 25OHD was associated with IFG.Conclusions: High serum 25OHD levels in youth, and from child to adult life, were associated with a reduced risk of developing T2DM in adulthood.Key MessagesHigh serum 25OHD levels in youth, and between youth and adulthood, were associated with a lower risk of T2DM in adulthood.Each SD (15.2 nmol/L) increment in youth serum 25OHD levels was associated with a 26% reduction in odds for T2DM, which was independent of a number of confounding variables and other risk factors for T2DM. A similar magnitude of association was observed for the long-term 25OHD levels between youth and adulthood.These findings suggest a potentially simple and cost-effective strategy for reducing adulthood risk of T2DM starting in an earlier stage of life – improving and maintaining vitamin D status throughout youth and early adulthood.

The role of serum fatty acids in Type 2 diabetes mellitus (T2DM) remains unclear. We aimed to assess and compare the associations of multiple serum unsaturated fatty acids with the prevalence of T2DM to elucidate their heterogeneous relationship profiles. This study used the data from the National Health and Nutrition Examination Surveys (2003-2004 and 2011-2012). Weighted proportional and multivariate logistic regression analyses were conducted to evaluate the associations of serum polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) with T2DM status and to adjust for potential confounders. The study included 3760 individuals. Results of the multivariate logistic regression analyses showed that among the serum PUFAs, docosapentaenoic acid (DPAn3) (22:5 n3) was associated with lower odds of T2DM (odds ratio [OR]: 0.595, 95% CI: 0.375-0.942, P trend = 0.028). Arachidonic acid (AA) (20:4(20: 4 n6) and linoleic acid (LA) (18:2 n6) were negatively associated with T2DM prevalence (OR in quintile 5: AA [20:4 n6] = 0.396, 95% CI: 0.232-0.674, P trend = 0.002; LA (18:2 n6) = 0.277, 95% CI: 0.163-0.472, P trend < 0.001). Moreover, among the MUFAs, oleic acid (OA) (18:1 n9) and eicosenoic acid (EA) (20:1 n9) were associated with increased odds of T2DM, whereas nervonic acid (NRA) (24:1 n9) was associated with decreased odds of T2DM. Furthermore, nonlinear analyses showed that the n-6 PUFAs dihomo-γ-linolenic acid (DGLA) (20:3 n6) and AA (20:4 n6), as well as the n-9 MUFA EA (20:1 n9), had nonlinear associations with T2DM. Our findings suggest that several serum n-3 and n-6 PUFAs are inversely associated with T2DM prevalence, whereas some n-9 MUFAs are positively associated with T2DM prevalence. These findings provide comprehensive descriptive data on the serum fatty acid profile in relation to T2DM and underscore the heterogeneity of associations across individual fatty acid species.

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition that has been attributed to social factors; however, the cumulative effect of social determinants of health (SDOH) on T2DM incidence is not known. Objective: The aim of the present study was to examine the association between T2DM and the cumulative burden of multiple SDOH. Design: The study is a retrospective cohort study with a baseline between 2008 and 2009 and a ten-year follow-up between 2010 and 2019. Setting: The study was conducted using data from the United States Veterans Health Administration (VHA). Participants: Out of 10,537,027 patients treated in the VHA between 2010 and 2019, 6,518,102 patients were selected who had no evidence of T2DM or Elixhauser comorbidities at baseline (2008–2009). Measurements: Over 10 years following baseline, the exposure consisted of seven types of SDOH occurring in structured data: social isolation, financial stress, employment issues, food insecurity, transportation insecurity, unstably housed, and psychosocial need. Incidence of T2DM in the ten-year follow-up window was the primary outcome. Results: Veterans with ≥3 SDOH doubled their adjusted odds of T2DM (2.07; CI: 2.05–2.09). There were significant racial differences in cumulative SDOH, with 8.8% of Black individuals having the highest burden of ≥3 SDOH compared with 3.8% of White individuals. Transportation insecurity, psychosocial need, and financial stress significantly increased the odds of T2DM across all racial and ethnic groups. Black individuals had the highest T2DM odds ratio for psychosocial need (OR = 1.58; CI: 1.56, 1.60). Limitations: The Veteran population is predominantly male, limiting generalization to the wider population. Conclusions: With each additional SDOH burden, the odds of T2DM increased, and ≥3 SDOH doubled the odds. The cumulative SDOH burden and associated disparities warrant investigation to reduce T2DM incidence.

Physical activity as a moderator of the association between central obesity and Type 2 diabetes in Asian American older adults

BackgroundRisk of type 2 diabetes mellitus (T2DM) is increased in metabolically obese but normal-weight people. However, we have limited knowledge of how to prevent T2DM in normal-weight people. We aimed to evaluate the association between triglyceride glucose (TyG) index and incident T2DM among normal-weight people in rural China.MethodsWe included data from 5706 people with normal body mass index (BMI) (18.5–23.9 kg/m2) without baseline T2DM in a rural Chinese cohort followed for a median of 6.0 years. A Cox proportional-hazard model was used to assess the risk of incident T2DM by quartiles of TyG index and difference in TyG index between follow-up and baseline (TyG-D), estimating hazard ratios (HRs) and 95% confidence intervals (CIs). A generalized additive plot was used to show the nonparametric smoothed exposure–response association between risk of T2DM and TyG index as a continuous variable. TyG was calculated as ln [fasting triglyceride level (mg/dl) × fasting plasma glucose level (mg/dl)/2].ResultsRisk of incident T2DM was increased with quartiles 2, 3 and 4 versus quartile 1 of TyG index (adjusted HR [aHR] 2.48 [95% CI 1.20–5.11], 3.77 [1.83–7.79], and 5.30 [2.21–12.71], Ptrend < 0.001 across quartiles of TyG index). Risk of incident T2DM was increased with quartile 4 versus quartile 1 of TyG-D (aHR 3.91 [2.22–6.87]). The results were consistent when analyses were restricted to participants without baseline metabolic syndrome and impaired fasting glucose level. The generalized additive plot showed cumulative increased risk of T2DM with increasing TyG index.ConclusionsRisk of incident T2DM is increased with increasing TyG index among rural Chinese people, so the index might be an important indicator for identifying people at high risk of T2DM.

Female-specific risk factors warrant attention in the prevention and control of type 2 diabetes mellitus (T2DM). The study aimed to investigate the relationships of hysterectomy, bilateral oophorectomy, and hormone replacement therapy (HRT) with the risk of T2DM in postmenopausal women. We included 127,514 postmenopausal women without T2DM at baseline from the UK Biobank. Hysterectomy, bilateral oophorectomy, and HRT were self-reported at baseline, and incident T2DM was identified using ICD-10 code E11 during the follow-up period. Compared to no hysterectomy/bilateral oophorectomy, hysterectomy alone (HR, 1.20; 95%CI: 1.09, 1.32) and combined hysterectomy and bilateral oophorectomy (HR, 1.19; 95%CI: 1.08, 1.32) were associated with higher risks of incident T2DM. Independent of other factors, the history of HRT was associated with a higher risk of T2DM (HR, 1.08; 95%CI: 1.03, 1.14), but this positive association was observed only in women without no hysterectomy or bilateral oophorectomy. Within the women without surgical procedures, the association between HRT and T2DM existed only in those younger than 45 years (HR, 1.27; 95%CI: 1.14, 1.41), but not in the older (HR, 1.03; 95%CI: 0.96, 1.09). Hysterectomy, regardless of bilateral oophorectomy status, was associated with a higher risk of T2DM. The HRT use, particularly early use in women without surgical interventions, was associated with a high risk. Our findings indicate that female-specific risk factors such as hysterectomy and bilateral oophorectomy and HRT use should be incorporated into the assessments for potential risk of T2DM in postmenopausal women.

The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown. The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March. Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups (p overall association < 0.05 and p nonlinearity ≤ 0.05). This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

BackgroundSeveral reports discussed a connection between CD36 genotypes associated with obesity, influencing the development of Type 2 diabetes mellitus (T2DM). Therefore, this study examines the prognostic value of CD36 polymorphism rs1761667 (G/A) in individuals with obese T2DM. The investigation also explores the correlation between this genetic variation and the clinical/biochemical parameters of the subjects.MethodsBlood samples of a total of 475 subjects from north India were collected from the outpatient unit (OPD), Department of Medicine, KGMU, Lucknow as per inclusion/exclusion criteria. Anthropometric details of study subjects were recorded and biochemical parameters were estimated in 250 T2DM cases, 75 obese T2DM cases, and 150 controls. The CD36 gene variant rs1761667 (G/A) was subject to genotypic analysis using the polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) method, utilizing specific primers and HhaI enzyme. All statistical analysis was done using SPSS (ver. 21.0) and Prism (5.01) software.ResultsFasting plasma glucose (FPG), systolic blood pressure (SBP), post-prandial glucose (PPG) were significant in T2DM subjects. Lipid profile such as Total Cholesterol (TC), Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL) were also found significantly associated with obese T2DM cases. GA and AA genotypes of rs1761667 (G/A) showed significant associations in obese T2DM cases. The GA genotype demonstrated a considerable association (P < 0.001) with a 2.77-fold increased susceptibility to the high risk of T2DM. The AA genotype was found to be significantly associated (P = 0.008) with 2.94-fold higher risk of T2DM in obesity while 9.33 folds significant risk of developing obesity in T2DM cases.ConclusionsThe risk of obesity in T2DM cases can be assessed by genotyping the CD36 genetic variant rs1761667 (G/A). However, raised FPG, PPG, TC, LDL, and VLDL showed poor prognosis in obese T2DM cases. CD36 gene variant can be proposed as a prognostic biomarker for risk prediction of T2DM and obesity, while anthro-biochemical risk factors as preventive biomarker.