Chinese Diabetes Society Research Articles

Association between metabolic syndrome and knee osteoarthritis: a cross-sectional study

BackgroundOsteoarthritis (OA) is the most prevalent chronic joint disease in China. The aim of this study was to examine the association between metabolic syndrome (MetS) and knee OA in a population-based Chinese study.MethodsData included in this analysis is from a cross-sectional study, i.e., the Xiangya Hospital Health Management Center Study. MetS was diagnosed according to the criteria defined by the Chinese Diabetes Society. Radiographic knee OA was defined as changes equivalent to Kellgren-Lawrence (K-L) grade 2 or above at least one side. Associations between MetS and its components with OA were evaluated by conducting multivariable adjusted logistic regression.ResultsA total of 5764 participants were included in the present study. The unadjusted OR (1.27, 95%CI: 1.10–1.47, P = 0.001), age-sex adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.041) and multivariable adjusted OR (1.17, 95%CI: 1.01–1.36, P = 0.043) all suggested a positive association between MetS and knee OA. Besides, its components (e.g., overweight, hypertension and dyslipidemia) were also associated with the prevalence of radiographic knee OA respectively, after adjusting for some confounding factors. In addition, with the accumulation of MetS components, the prevalence of knee OA increased. Furthermore, MetS as a whole was associated with the prevalence of knee osteophyte (OSP) (OR = 1.72, 95%CI: 1.42–2.09, P < 0.001), but not joint space narrowing (JSN) (OR = 1.06, 95%CI: 0.91–1.23, P = 0.449).ConclusionsThe findings of the present study indicated that there was a positive association between the prevalence of MetS and knee OA. However, MetS as a whole was associated with the higher prevalence of knee OSP, but not JSN, which should shed light on our understanding the association between MetS and OA.

Three novel obese indicators perform better in monitoring management of metabolic syndrome in type 2 diabetes

The present study evaluated the performance of three novel obese indicators, visceral adiposity index (VAI), lipid accumulation product (LAP) and waist circumference-triglyceride index (WTI), for identifying metabolic syndrome(MetS) in type 2 diabetes. A cross-sectional study was conducted on 711 type 2 diabetes in Qinhuangdao. The MetS was defined as the definition of Chinese Diabetes Society. Receiver operating characteristic curve analyses were performed to assess the accuracy of three obese indicators as diagnostic tests for MetS. The prevalence of MetS was 71.3%. In men, among all three obese indicators, the LAP had the highest area under curve (AUC) value (AUC = 0.894), followed by VAI (AUC = 0.860) and WTI (AUC = 0.855). In women, among all three obese indicators, the LAP had the highest AUC value (AUC = 0.906), followed by WTI (AUC = 0.887) and VAI (AUC = 0.881). However. there was no significant difference between the three obese indicators(P > 0.05). Three obese indicators were effective indicators for the screening of MetS, LAP and WTI are more simple.

Recommendations for revision of Chinese diagnostic criteria for metabolic syndrome: A nationwide study.

Diagnostic criteria for metabolic syndrome (MS) proposed by the Chinese Diabetes Society (CDS) may have limitations because an additional 2-h postprandial plasma glucose (2-h PPG) test is required to diagnose hyperglycemia. The aim of this study was to revise the CDS-MS criteria by removing the 2-h PPG test and determining the optimal fasting plasma glucose (FPG) cut-off for a diagnosis of hyperglycemia in the Chinese population. The study population was from the 2007-08 China Diabetes and Metabolic Disorders Study. The optimal FPG diagnostic cut-off value was determined using receiver operating characteristic curves. Hyperglycemia defined using CDS-MS criteria was the end-point. Agreement between different diagnostic methods was assessed using κ values. The study enrolled 46 239 participants (mean age 44.95 years). The optimal diagnostic cut-off for FPG was found to be 5.62 mmol/L, which showed a sensitivity of 66.92%, a specificity of 89.09%, and an area under the curve of 0.848. Using this diagnostic criterion, the standardized prevalence of MS was similar to that using the CDS-MS criteria (18.26% vs 17.89%, respectively), with both values being lower than those obtained using conventional international criteria (20.64-26.67%). Compared with the CDS-MS criteria, the recommended FPG cut-off showed better agreement (κ) with international criteria: 0.695, 0.774, and 0.730 with the International Diabetes Federation (IDF), revised Adult Treatment Panel III, and Joint Interim Statement of the IDF criteria, respectively. We recommend eliminating the 2-h PPG blood test and lowering the FPG diagnostic cut-off value to 5.6 mmol/L in the CDS-MS diagnostic criteria.

Utility of hemoglobin A1c for diagnosing metabolic syndrome in Chinese subjects over 50 years old

Objective: To evaluate glycated hemoglobing A1c (HbA1c) in diagnosing metabolic syndrome (MS) in Chinese subjects aged over 50 years. Methods: A community-based cross-sectional survey was conducted between October 2010 and January 2011 in Shipai community, Guangzhou. A total of 1 494 subjects aged over 50 years were investigated. Questionnaire survey and physical examination were performed among all participants. Fasting blood samples were obtained to measure plasma glucose (FPG), blood lipids and HbA1c. MS was defined by the criteria of International Diabetes Federation (IDF), National Cholesterol Education Program-Adult Treatment Panel Ⅲ (ATP Ⅲ)(2005) and Chinese Diabetes Society (CDS), respectively. Receiver operating characteristic (ROC) curves were plotted to explore the accuracy of HbA1c for diagnosing MS. Results: After excluding subjects with missing data, the remaining 1 473 subjects had a median age of 61 years (55-68 years). An HbA1c threshold of 6.1% yielded the highest combination of sensitivity (52.1%) and specificity (84.3%) for diagnosing MS. Using HbA1c≥5.7% as definition of dysglycemia, the prevalence of MS (IDF), MS (ATP Ⅲ) and MS (CDS) were 48.7%, 57.1% and 50.8%, respectively. The κ coefficients were 0.853, 0.768 and 0.730, respectively. Using HbA1c≥6.1% as definition of dysglycemia, the prevalences of MS (IDF), MS (ATP Ⅲ) and MS (CDS) were 41.2%, 45.8% and 39.1%, respectively. The κ coefficients were 0.923, 0.880 and 0.881, respectively. The optimal HbA1c threshold with the highest level of agreement according to IDF, ATP Ⅲ and CDS criteria were 6.1%, 6.3% and 6.3%, respectively. Conclusions: An HbA1c threshold of 6.1% showed a high specificity for diagnosing MS in Chinese subjects aged over 50 years in community-based setting. The optimal HbA1c threshold may vary according to different criteria and populations.

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus.

BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Case-control study of metabolic syndrome and ovarian cancer in Chinese population

BackgroundRecent studies have proved metabolic syndrome (MetS) was linked to cancer risks. However, few data has examined the relationship between MetS and epithelial ovarian cancer (EOC).MethodsWe conducted a population-based case-control study in Tianjin Medical University Cancer Institute and Hospital, China (2010–2015) that enrolled 573 EOC patients and 1146 matched controls. Data were collected through in-person interviews, anthropometric measurement, and 8-h fasting bloods drawn. MetS was estimated by Chinese Diabetes Society (CDS) definition requiring presence of ≥3 of the following risk factors: 1) body mass index (BMI) ≥25.0 kg/m2,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Statistics were completed using chi-square tests and logistic regression analysis. The survival analysis was conducted by the Kaplan-Meier method and Cox proportional hazard regression models.ResultsMetS was significantly more prevalent among EOC (25.13%) than controls (6.89%). A statistically significant increase risk for EOC was observed for MetS (multivariable-adjusted OR = 3.187; 95% CI: 2.135–4.756). MetS was significantly associated with histological grade (P < 0.001), FIGO stage (P = 0.003), and lymph node (LN) status (P = 0.002) of EOC. In binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327–3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164–5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089–6.160, P = 0.031) of EOC. Moreover, MetS is the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001) in Cox proportional hazard model.ConclusionMetS is obviously related to increased EOC risk. EOC patients with MetS in Chinese population were found to have statistically significant tumor advanced stage, low differentiation, LN metastasis and poor prognosis.

Analysis of Preoperative Metabolic Risk Factors Affecting the Prognosis of Patients with Esophageal Squamous Cell Carcinoma: The Fujian Prospective Investigation of Cancer (FIESTA) Study

Some metabolic factors have been shown to be associated with an increased risk of esophageal cancer; however the association with its prognosis is rarely reported. Here, we assessed the prediction of preoperative metabolic syndrome and its single components for esophageal cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Between 2000 and 2010, patients who underwent three-field lymphadenectomy were eligible for inclusion. Blood/tissue specimens, demographic and clinicopathologic data were collected at baseline. Metabolic syndrome is defined by the criteria proposed by Chinese Diabetes Society. In this study, analysis was restricted to esophageal squamous cell carcinoma (ESCC) due to the limited number of other histological types. The median follow-up in 2396 ESCC patients (males/females: 1822/574) was 38.2months (range, 0.5–180months). The multivariate-adjusted hazard ratio (HR) of metabolic syndrome for ESCC mortality was statistically significant in males (HR, 95% confidence interval, P: 1.45, 1.14–1.83, 0.002), but not in females (1.46, 0.92–2.31, 0.107). For single metabolic components, the multivariate-adjusted HRs were significant for hyperglycemia (1.98, 1.68–2.33, <0.001) and dyslipidemia (1.41, 1.20–1.65, <0.001) in males and for hyperglycemia (1.76, 1.23–2.51, <0.001) in females, independent of clinicopathologic characteristics and obesity. In tree-structured survival analysis, the top splitting factor in both genders was tumor-node-metastasis stage, followed by regional lymph node metastasis. Taken together, our findings demonstrate that preoperative metabolic syndrome was a significant independent predictor of ESCC mortality in males, and this effect was largely mediated by glyeolipid metabolism disorder.

Positive association between the metabolic syndrome and white blood cell counts in Chinese.

The aim was to investigate the association between peripheral circulating white blood cell count (WBC) and the metabolic syndrome among populations in central China. In the present study, 5,278 subjects (2,412 women, 2,866 men) aged 18-75 years were recruited through a health check program in Wuhan, China. Biochemical and haematological parameters were measured by standard methods and the metabolic syndrome diagnosed as defined by the Chinese Diabetes Society criteria for Chinese. Both WBC counts and prevalence of metabolic syndrome were significantly higher in men than in women (p<0.01). Participants in the highest quartile of white blood cell count had significantly higher odds ratio of metabolic syndrome (3.79, 95% CI: 2.64, 5.44), compared with subjects in the lowest quartile. The trend remained significant after adjustment for confounding factors and in further subgroup-analyses. Metabolic syndrome prevalence was significantly and positively correlated with the total white blood cell count in this Chinese population.

Diabetes awareness and screening in high-risk populations in China: a nationwide, population-based survey

BackgroundChina is unlikely to deliver diabetes screening to all adults because of the large size of the population; however, diabetes screening might have substantial public health benefit. Several societies, including China Diabetes Society and American Diabetes Association, recommend universal diabetes screening in older and high-risk adults, but this recommendation has not been well implemented in China. We aimed to investigate—among people recommended for screening and those not recommended—the prevalence of diabetes, the frequency and the determinants of diabetes awareness, and the rate of regular check-ups in those diagnosed with diabetes . MethodsWe analysed data from the 2007 and 2008 China National Diabetes and Metabolic Disorders Survey, in which a nationally representative sample of 46 239 people aged 20 years or older were included using a multi-stage stratified sampling method. The participants included in the screening-recommended group were all high-risk adults, and low-risk older adults. High-risk was defined as a person who was overweight with additional risk factors such as family history of diabetes, physical inactivity, hypertension, dyslipidaemia, or history of cardiovascular disease. Awareness of diabetes was defined as a self-report of any previous diagnosis of diabetes by a health-care professional among the population defined as having diabetes. Diabetes was diagnosed by an oral glucose tolerance test according to WHO diagnostic criteria. Ethical approval was granted by all the attending hospitals. Informed patient consent was given by all participants. Findings30 735 (66·5%) of 46 239 participants were included in the screening recommended group. Of these, 10 787 (35·1%) were designated as high-risk older adults, 12 329 (40·1%) as low-risk older adults, and 7619 (24·8%) as high-risk younger adults. The prevalence of diabetes was 20·5% (2211 of 10 787) in the high-risk older adults, 12·6% (1553 of 12 329) in low-risk older adults, and in 8·3% (632 of 7619) high-risk younger adults, as compared with 2·7% (419 of 15 504) in people not recommended for screening (p<0·0001). Awareness of diabetes in those with diabetes was 971 (43·9%) of 2211 high-risk older adults, 753 (48·5%) of 1553 low-risk older adults, and 173 (27·3%) of 632 high-risk younger adults, as compared with 143 (34·2%) of 419 people not recommended for screening (p<0·0001). Multivariate analysis showed that those recommended for screening had significantly increased diabetes awareness (odds ratio [OR] 1·24, 95% CI 1·16–1·32, p<0·0001) compared with those who were not recommended for screening. However, high-risk younger people did not show a significantly increased awareness of diabetes (OR 0·87, 95% CI 0·66–1·15, p=0·43). Additionally, the proportion of those attending regular health check-ups for the diagnosis of diabetes among those recommended for screening was 11 310 (36·8%) of 30 735, similar to that among those not recommended for screening (5954 [38·4%] of 15 504; p=0·24). InterpretationPeople for whom screening is recommended had a higher prevalence of diabetes compared with those for whom it is not recommended. However, albeit strongly advised, those recommended for screening did not have high diabetes awareness and fewer than half of patients were aware of their disease. More importantly, in the patients who are aware of their diabetes, only around a third had regular health check-ups. China is beginning to recognise the challenge that diabetes poses and it is of great importance to find out the future direction of diabetes solutions in policy areas. Our study suggests that much more attention and strategy is needed in China for diabetes screening in those recommended for screening, particular for high-risk younger people. FundingChinese Medical Association Foundation and Chinese Diabetes Society.

1 year weight losses in the Tianjin Gestational Diabetes Mellitus Prevention Program: a randomised trial

BackgroundGestational diabetes affects about 8% of pregnant women in urban areas of China, and is an important indicator of risks of type 2 diabetes and impaired glucose tolerance later in life. The Tianjin Gestational Diabetes Mellitus Prevention Program aims to investigate the extent to which a postpartum lifestyle intervention given soon after delivery can reduce risk or delay onset of type 2 diabetes in women with gestational diabetes. Here, we report weight loss after the first year of the trial. MethodsThe Tianjin Gestational Diabetes Mellitus Prevention Program is a randomised trial done at Tianjin Women's and Children's Health Center, Tianjin, China. We recruited women (aged >24 years) with gestational diabetes diagnosed on the basis of WHO criteria from six urban districts in Tianjin between July 1, 2005, and June 30, 2009. After participants completed the baseline survey administered by health workers from the study centre, eligible participants were randomly assigned (1:1) to receive a 4 year lifestyle intervention (intervention group) or standard care (control group). Statistical Package for the Social Science (SPSS) was used to generate a list of 1200 random allocation statuses, and the list of random assignments was kept centrally by an independent person. Major elements of the intervention included six face-to-face sessions with study dietitians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Weight loss after the first year of the trial was analysed in patients with complete data. Ethics approval was granted by the human subjects committee of Tianjin Women's and Children's Health Center, and all participants provided written informed consent. This trial is registered with ClinicalTrials.gov, number NCT01554358, and is ongoing. FindingsBetween Aug 1, 2009, and July 31, 2011, we recruited and randomly assigned 1180 women into the intervention group (n=586) or the control group (n=594). At the end of year 1, mean weight loss was 0·8 kg (SD 3·5; 1·1% [SD 5·4] of initial weight) in the intervention group and 0·1 kg (3·3; 0·03% [5·0%] of initial weight) in the control group (p<0·001). In prespecified subgroup analysis, weight loss was more pronounced in women who were overweight (BMI ≥24 kg/m2) at baseline: mean weight loss was 2·0 kg (4·3; 2·9% [6·1%] of initial weight) in the intervention group and 0·44 kg (4·0; 0·5% [5·5%] of initial weight) in the control group (p<0·001). Compared with those in the control group, women in the intervention group had a greater decrease in body fat (0·50% vs 0·05% increase; p=0·001) and waist circumference (1·76 cm vs 0·73 cm; p=0·003). InterpretationThe 1 year lifestyle intervention led to significant weight loss after delivery in women who had gestational diabetes, and such an effect was more pronounced in those who were overweight. Our findings indicate that lifestyle intervention is feasible and effective in women with gestational diabetes. FundingEuropean Foundation for the Study of Diabetes–Chinese Diabetes Society–Lilly programme for Collaborative Research between China and Europe, Tianjin Women's and Children's Health Center, Tianjin Public Health Bureau, and the National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health (R01DK100790).

The prevalence and risk factors of metabolic syndrome in different nationalities in Linxia

A multi-stratified cluster sampling method was used in this study. A total of 1 357 residents who underwent physical examinations in Linxia were included. The prevalence and risk factors of metabolic syndrome(MS)in Lixia was investigated and analyzed according to the modified 2005 National Cholesterol Education Program Adult Treatment Panel Ⅲ(ATP Ⅲ)standard, the 2004 Chinese Diabetes Society(CDS)standard, and the International Diabetes Federation(IDF)Standard. Using the ATP Ⅲ criterion for diagnosis, the total prevalence of MS was 26.01%, and increased with the age. Using the standard CDS, the total prevalence of MS was 12.97%, and fluctuated with aging. Besides, the total prevalence of MS was 12.45% according to IDF standard, and increased with age. Regardless of standard types, the prevalence of MS in males was higher than that in females. Under ATP Ⅲ standards, the prevalences of MS in Han and Hui population were 28.11% and 27.53%, respectively. Dongxiang population had the lowest prevalence of 8.54%. Under CDS standard, the highest prevalence of MS was among Hui population(16.23%), and Tibetan population had the lowest prevalence(5.45%). Furthermore, the prevalence of MS in Han population was the highest of 13.83% and Tibetan people was the lowest of 3.64% when based on the IDF standard. Regardless of standards types, the prevalences of MS in various nationalities were significantly different(P<0.05). Among all the components of MS, hypertriglyceridemia was the highest in male and lower high density lipoprotein-cholesterol, as well as higher rate of elevated blood glucose levels in females. (Chin J Endocrinol Metab, 2016, 32: 837-840) Key words: Metabolic syndrome; Prevalence; Diagnostic standard

Higher Levels of Magnesium and Lower Levels of Calcium in Whole Blood Are Positively Correlated with the Metabolic Syndrome in a Chinese Population: A Case-Control Study

Magnesium (Mg) and calcium (Ca) are essential for numerous kinds of metabolisms in human body. To investigate the associations between Mg and Ca and the ratio of Ca to Mg (Ca/Mg) in whole blood with metabolic syndrome (MetS) in a Chinese population, a matched case-control study including 204 MetS patients and 204 healthy controls (aged 48-89) was carried out in 2011. MetS were diagnosed according to the criteria of Chinese Diabetes Society. Controls had no abnormal metabolic components and were matched with cases by age, gender and region. Blood samples were collected in the morning after an overnight fast. Whole blood Mg and Ca were determined by flame atomic absorption spectrometry. Subjects who were male constituted 44.1% of the part of this study. The average age was 64.0 ± 7.18, and the average body mass index was 24.3 ± 3.75. The MetS group showed significantly higher Mg and lower Ca and Ca/Mg as compared with the control group. Comparing with the bottom tertile (T1) of Mg, increased ORs for MetS were found in median tertile (T2) and top tertile (T3) of Mg. For Ca, T2 and T3 were negatively associated with MetS. Inverse relationship was also found between Ca/Mg ratio and MetS. Our findings suggested that increased Mg and decreased Ca and Ca/Mg in whole blood were correlated with MetS in Chinese adults.

Risk factors of metabolic syndrome and insulin resistance in type 2 diabetic patients

Objective To investigate the risk factors of insulin resistance (IR) and metabolic syndrome (MS) in type 2 diabetic patients. Methods Total 373 type 2 diabetic patients were enrolled from Beijing Anzhen and Cuigezhuang communities, and classified as non-MS and MS based on the criteria of Chinese Diabetes Society. Islet function was measured, and correlation analysis was carried out on two indexes HOMA-IR and HOMA-β among patients with different MS components. Results Among 373 T2DM patients, 255 (68.3%) cases were MS T2DM and 118 (31.7%) were non-MS T2DM. The diabetic patients with MS had higher body mass index(27.21 vs. 23.84, P<0.001)and HOMA-IR(3.3 vs. 2.2, P<0.001), and increased waist circumference, neck circumference, triglyceride, uric acid, and HOMA-β, compared to none of MS diabetic patients(all P<0.05). The high density lipoprotein level in the diabetes patients. with MS was lower than that in non-MS diabetic patients(P<0.05). HOMA-IR was increased with the increasing numbers of MS components. Spearman analysis showed that the numbers of MS components were positively correlated with HOMA-IR and HOMA-β (r=0.238, 0.124, respectively, all P<0.01). Conclusions Diabetic patients with MS have higher body mass index, triglyceride, uric acid and IR, compared to non-MS patients.With the increasing numbers of MS components, insulin resistance becomes more prominent in diabetic patients.The results suggest that comprehensive management of insulin resistance-related factors should be strengthened in addition to blood glucose control in community health service. Key words: Diabetes mellitus, type 2; Metabolic syndrome X; Insulin resistance

Evolution in the Chinese Diabetes Society Standards of Care for Type 2 Diabetes.

China has been experiencing the biggest shift in the world in diabetes and obesity epidemic over the past three decades. Chinese Diabetes Society developed and published four editions of stand of care for type 2 diabetes management as clinical guidance for practice in China in the last twelve years. During the development and implementation of guidelines, the keyword is 'evolution', which includes evolution of evidence, expertise, excellence and endpoints. It will be a complete quality improvement cycle starting with 'understanding the situation' and ending with 'tipping points of diabetes in primary prevention (prevalence), secondary prevention (diabetic complications) and tertiary prevention (diabetes-related death)'. This series of 'Stand of care for type 2 diabetes' allows for a fundamental understanding into the ways in which the domino effects of the epidemic could be curbed. More work for doing with 'Mens et Manus' will be carried out in the near future. This English version will be useful for the international scientific community to glean insights into type 2 diabetes management practices in China, and alternative methods of tackling challenges. © 2016 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.

Why China guidelines for type 2 diabetes represent an opportunity for treating this disease.

More than one quarter of people affected by type 2 diabetes worldwide live in China, where an alarming increase in diabetes incidence is taking place. However, most of the evidence about diabetes management derives from studies conducted on non-Asian people, raising concerns about their validity in other ethnic groups, including the Chinese. The guidelines proposed by the Chinese Diabetes Society suggest tools for medical doctors in China and worldwide to appropriately face diabetes in Chinese people, whose number in non-Chinese countries is continuously increasing. However, additional efforts are still needed to achieve an evidence-based tailored therapy for type 2 diabetes in Chinese people. Copyright © 2016 John Wiley & Sons, Ltd.

Positive association between metabolic syndrome and serum uric acid in Wuhan.

The objective was to determine whether serum uric acid concentrations were associated with metabolic syndrome in a population from Wuhan. 5,628 subjects (2,838 men, 2,790 women) aged 18-80 years were recruited in Wuhan, China. Biochemical parameters of venous blood were measured by standard methods and metabolic syndrome was defined by Chinese Diabetes Society criteria. Association analysis was performed by logistic regression. 8.2% of the included subjects were confirmed as having metabolic syndrome and 14.4% were confirmed as having hyperuricemia. After multivariable adjustment, logistic regression showed the odds ratios of metabolic syndrome for subjects in the highest quartile of serum uric acid concentration was 2.84 (95% CI: 2.09-3.86) compared with those in the lowest quartile and no gender difference was found. For each component of metabolic syndrome, subjects in the highest quartile of serum uric acid concentrations had increased multivariable odds ratios for high BMI (OR: 3.29, 95% CI: 2.71-3.98), for hypertension (OR: 3.54, 95% CI: 2.93-3.86), for dyslipidemia (OR: 2.49, 95% CI: 1.98-3.14), but not for hyperglycemia (OR: 1.21, 95% CI: 0.87-1.67). Odd ratio of metabolic syndrome was significantly positively associated with serum uric acid concentration among the present sample of 5,628 subjects in Wuhan.

Association of Microalbuminuria with Metabolic Syndrome among Aged Population.

Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55–98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226–2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044–1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107–1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348–0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C.

Hot topics on diabetes in China.

China is the country with the largest burden of diabetes worldwide. Action is now taking place at different levels by the Chinese Diabetes Society, which has a major role in coordinating multi-level activities across the country. These include, among others, the implementation of local guidelines for therapy, campaigns for education, trials for type 2 diabetes prevention and the establishment of extensive international collaborations in basic as well as clinical research. In this Special Issue, we briefly report on such initiatives, among which is a scientifically sound approach to exploring Chinese traditional medicine as a therapeutic option for diabetes treatment.

Treatment Patterns and Glycemic Control in Older Adults with Type 2 Diabetes Mellitus Receiving Only Oral Antidiabetes Drugs in China.

Only a few studies have reported the use of oral antidiabetes drugs (OADs) for treating older adults with type 2 diabetes mellitus (T2DM) in China. This study assessed the status of OAD therapy and relevant factors associated with OAD treatment patterns and glycemic control among older patients. We conducted a noninterventional, observational, cross-sectional, multicenter study, which was initiated by the Chinese Diabetes Society, in which 9,872 outpatients with T2DM were recruited who received OADs only. Current antidiabetes treatment regimens and related clinical data were collected from patients' self-reporting and medical records. Participants were divided into two groups: ≥65 years and <65 years. All data were tabulated, and statistical analyses were performed using SPSS version 16 software (SPSS Inc., Chicago, IL). Insulin secretagogues (52.6%): sulfonylureas (SU) (26.6%) and glinides (26.0%) were commonly used as monotherapy in those ≥65 years. The most popular OAD pattern was dual combination therapy (46.8%), with SU plus glucosidase inhibitors (25.1%) being most common in older participants. Age, diabetes duration, body mass index, achieving the glycemic control targets, and hypoglycemia were influencing factors to those ≥65 years in diverse treatment pattern models (P < 0.05). Older patients receiving OADs with triple or more combination treatment and complications were more likely to have substandard glycemic control (hemoglobin A1c level ≥7%). The pattern of OADs alone in older adults with T2DM was significantly different from those <65 years in China. A comprehensive OAD treatment pattern or insulin combination may be necessary for better glycemic control in older patients with multiple combinations of OADs or complications.

Prevalence of the Metabolic Syndrome Among Employees in Northeast China.

Background:The metabolic syndrome is a clustering of metabolic abnormalities and has been associated with increased risk of type 2 diabetes mellitus and cardiovascular disease. This study aimed to estimate the prevalence of the metabolic syndrome among employees in Northeast China.Methods:Totally, 33,149 employees who received health screening in the International Health Promotion Center in the First Hospital of Jilin University were enrolled. Height, weight, waist circumference, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein were recorded. Three definitions for the metabolic syndrome were applied, revised National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) criteria, the International Diabetes Federation (IDF) criteria, and the Chinese Diabetes Society (CDS) criteria.Results:Overall, the age-standardized prevalence of the metabolic syndrome was 22.9%, 20.6%, and 15.3% based on definitions of revised NCEP ATP III criteria, the IDF criteria, and the CDS criteria, respectively. Men had higher age-standardized prevalence than women in all three definitions (P < 0.05). The prevalence was 27.1%, 24.5%, and 20.4% for men; 17.1%, 15.4%, and 8.3% for women, respectively. The most common metabolic component with the metabolic syndrome was overweight (54.7% of men had an elevated body mass index, and 35.9% of women had central obesity).Conclusions:A large proportion of employees among Northeast China have the metabolic syndrome. These findings place emphasis on the need to develop aggressive lifestyle modification for patients with the metabolic syndrome and population level strategies for the prevention, detection, and treatment of cardiovascular risk.