Age Of Diabetes Onset Research Articles

Body Mass Index and Mortality in Individuals With Type 1 Diabetes.

The relationship between body mass index (BMI) and mortality may differ between patients with type 1 diabetes and the general population; it is not known which clinical characteristics modify the relationship. Our aim was to assess the relationship between BMI and mortality and the interaction with clinically meaningful factors. This prospective study included 5836 individuals with type 1 diabetes from the FinnDiane study. We retrieved death data for all participants on 31 December 2015. We estimated the effect of BMI on the risk of mortality using a Cox proportional hazards model with BMI as a restricted cubic spline as well as effect modification by adding interaction terms to the spline. During a median of 13.7 years, 876 individuals died. The relationship between baseline BMI and all-cause mortality was reverse J-shaped. When analyses were restricted to those with normal albumin excretion rate, the relationship was U-shaped. The nadir BMI (BMI with the lowest mortality) was in the normal weight region (24.3 to 24.8 kg/m2); however, among individuals with diabetic nephropathy, the nadir BMI was in the overweight region (25.9 to 26.1 kg/m2). Diabetic nephropathy, diabetes-onset age, and sex modified the relationship between BMI and mortality (Pinteraction < 0.05). Normal weight is optimal for individuals with type 1 diabetes to delay mortality, whereas underweight might be an indication of underlying complications. Maintaining normal weight may translate into reduced risk of mortality in type 1 diabetes, particularly for individuals of male sex, later diabetes-onset age, and normal albumin excretion rate.

Dementia complicating type 2 diabetes and the influence of premature mortality: the Fremantle Diabetes Study.

To investigate risk factors for, and the influence of premature mortality on, dementia complicating type 2 diabetes. Participants with type 2 diabetes in the community-based observational Fremantle Diabetes Study Phase 1 (n = 1291, mean age 64.0years) were followed from 1993 to 1996 to end-June 2012. Incident dementia was identified from validated health databases. Dementia risk was assessed using Cox proportional hazards modelling supplemented by competing risk regression modelling in the total cohort and sub-groups defined by age of diabetes onset as mid-life (< 65years) or late-life (≥ 65years). During mean ± SD follow-up of 12.7 ± 5.9 years, 717 participants (55.5%) died and 180 (13.9%) developed dementia. Overall, few risk factors predicted incident dementia and most predicted time to death. In mid-life diabetes, incident dementia was predicted by diabetes duration, cerebrovascular disease, schizophrenia, antipsychotic medication and the APOE ε4 allele. In late-life diabetes, risk factors were peripheral neuropathy, lack of exercise, lower fasting serum glucose, no antihypertensive therapy and the APOE ε4 allele. Competing risk analysis showed age to be a positive predictor compared with the inverse association in Cox models that suggested survivor bias in an older community-based cohort. Dementia in type 2 diabetes is multifactorial. An association with diabetes duration, independent of most possible confounders, suggests that one or more unmeasured processes specific to diabetes may be implicated in the pathogenesis. The risk factors for dementia were also associated with an increased risk of death. This suggests that recently reported improvements in mortality in type 2 diabetes may be accompanied by reductions in dementia incidence.

The impact of autoimmune thyroiditis on skin microcirculation in children with non-complicated type 1 diabetes mellitus

BackgroundThe impairment of endothelial function in type 1 diabetes mellitus (DM1) is considered as the basis of microvascular complications. In DM1 patients autoimmune thyroiditis is a frequent comorbidity which may be responsible for further deterioration of microcirculation function. In studies investigating the relationship between cardiovascular risk factors and microvascular function, skin microcirculation is widely used. The aim of our study was to evaluate the impact of coexisting autoimmune thyroiditis on skin microcirculation in children with type I diabetes mellitus. SubjectsThe study group consisted of 25 pediatric DM1 patients, 25 pediatric patients with type 1 diabetes and autoimmune thyroiditis (DM1 + AIT) and 29 control subjects matched for age and gender. The DM1 and DM1 + AIT patients were also matched for age at onset of DM and diabetes duration. MethodsPerformed capillaroscopy studies employed non-selective stimuli such as post-occlusive reactive hyperemia (PORH) and venous occlusion (VO) tests. The relative area covered by capillaries (coverage) and the distance between capillaries were assessed. These measurements were performed before tests as well as after PORH and VO. ResultsCoverage at baseline, after PORH and VO and distance after VO differ significantly between control subjects and the group DM1 + AIT. The coverage at baseline, after PORH and VO were significantly smaller in DM1 + AIT compared with the control group. Post-hoc analysis after controlling for lipids levels showed that differences between the DM1 + AIT and control group were remained only for coverage at baseline and after VO. Significant differences between DM1 + AIT and DM1 and control group for coverage after VO were also presented. ConclusionsCoexisting autoimmune thyroiditis significantly deteriorates skin microcirculation function in pediatric non-complicated type 1 diabetic patients. This process is independent of patient age, diabetes duration and age of diabetes onset.

Youth With Type 1 Diabetes Taking Responsibility for Self-Management: The Importance of Executive Functioning in Achieving Glycemic Control: Results From the Longitudinal DINO Study.

Successful self-management of type 1 diabetes requires cognitive skills such as executive functioning (EF). In the transition to adolescence, youth take over responsibility for diabetes management. We set out to test: 1) the association between EF and glycemic control over time and 2) whether this association was moderated by: a) youth, shared, or parent responsibility for diabetes management and b) youth's age. Within the Diabetes IN DevelOpment study (DINO), parents of youth with type 1 diabetes (8-15 years at baseline; N = 174) completed a yearly assessment over 4 years. Glycemic control (HbA1c) was derived from hospital charts. Youth's EF was measured using the Behavior Rating Inventory of Executive Functioning (BRIEF)-parent report. The Diabetes Family Responsibility Questionnaire (DFRQ)-parent report was used to assess diabetes responsibility (youth, shared, and parent). Linear generalized estimating equations were used to analyze data including youth's sex, age, and age of diabetes onset as covariates. Relatively more EF problems are significantly associated with higher HbA1c over time (β = 0.190; P = 0.002). More EF problems in combination with less youth responsibility (β = 0.501; P = 0.048) or more parental responsibility (β = -0.767; P = 0.006) are significantly associated with better glycemic control over time. Only age significantly moderates the relationship among EF problems, shared responsibility, and glycemic control (β = -0.024; P = 0.019). Poorer EF is associated with worse glycemic control over time, and this association is moderated by responsibility for diabetes management tasks. This points to the importance of EF when youth take over responsibility for diabetes management in order to achieve glycemic control.

Metabolomic Profile Predicts Development of Microalbuminuria in Individuals with Type 1 Diabetes

Elevated urinary albumin excretion (microalbuminuria) is an early marker of diabetic nephropathy, but there is an unmet need for better biomarkers that capture the individuals at risk with higher accuracy and earlier than the current markers do. We performed an untargeted metabolomic study to assess baseline differences between individuals with type 1 diabetes who either developed microalbuminuria or remained normoalbuminuric. A total of 102 individuals progressed to microalbuminuria during a median follow-up of 3.2 years, whereas 98 sex-, age- and body mass index (BMI) matched non-progressors remained normoalbuminuric during a median follow-up of 7.1 years. Metabolomic screening identified 1,242 metabolites, out of which 111 differed significantly between progressors and non-progressors after adjustment for age of diabetes onset, baseline glycosylated hemoglobin A1c (HbA1c), and albumin excretion rate (AER). The metabolites that predicted development of microalbumiuria included several uremic toxins and carnitine metabolism related molecules. Iterative variable selection indicated erythritol, 3-phenylpropionate, and N-trimethyl-5-aminovalerate as the best set of variables to predict development of microalbuminuria. A metabolomic index based on these metabolites improved the prediction of incident microalbuminuria on top of the clinical variables age of diabetes onset, baseline HbA1c and AER (ROCAUC = 0.842 vs 0.797), highlighting their ability to predict early-phase diabetic nephropathy.

Genetic variation of SORBS1 gene is associated with glucose homeostasis and age at onset of diabetes: A SAPPHIRe Cohort Study

The SORBS1 gene plays an important role in insulin signaling. We aimed to examine whether common single-nucleotide polymorphisms (SNPs) of SORBS1 are associated with prevalence and incidence of diabetes, age at onset of diabetes, and the related traits of glucose homeostasis. A total of 1135 siblings from 492 ethnic Chinese families were recruited at baseline, and 630 were followed up for 5.19 ± 0.96 years. Nine SNPs including rs7081076, rs2281939, rs3818540, rs2274490, rs61739184, rs726176, rs2296966, rs17849148, and rs3193970 were genotyped and examined. To deal with correlated data of subjects within the same families, the generalized estimating equations approach was applied throughout all association analyses. The GG genotype of rs2281939 was associated with a higher risk of diabetes at baseline, an earlier onset of diabetes, and higher steady-state plasma glucose levels in the modified insulin suppression test. The minor allele T of rs2296966 was associated with higher prevalence and incidence of diabetes, an earlier onset of diabetes, and higher 2-h glucose during oral glucose tolerance test. These two SNPs revealed independent associations with age of diabetes onset as well as risk of diabetes at baseline. These findings supported that SORBS1 gene participates in the pathogenesis of diabetes.

Glycemic control is related to cognitive dysfunction in Chinese children with type 1 diabetes mellitus.

Type 1 diabetes mellitus (T1DM) is considered a risk factor for the development of cognitive difficulties. The present study examined whether the cognitive performance of Chinese children with T1DM differs from that of healthy control (HC) children, and whether cognitive dysfunction is related to glycemic control. Using a cross-sectional design, cognitive tests were administered, including general intelligence tests, to pediatric T1DM patients (n = 105) and HCs (n = 90). The effects of specific diabetes-related variables, including an earlier diabetes onset (<7 years of age), severe hypoglycemia, chronic hyperglycemia, and diabetic ketoacidosis (DKA), on cognitive outcomes were examined. The T1DM group had lower IQ (P = 0.001) and attention (P = 0.018) scores than the HC group. Among T1DM patients, a younger age of diabetes onset was related to poorer performance on the visuospatial perception test (P = 0.017) and delayed logical memory (P = 0.012). Greater exposure to hyperglycemia over time was associated with lower visuospatial perception (P = 0.029), and DKA had a negative effect on the IQ score (P = 0.024). Compared with the late severe hypoglycemia subgroup, the early severe hypoglycemia subgroup (<7 years old) performed worse on both immediate (P = 0.001) and delayed (P = 0.049) visual memory tests. Chinese children with T1DM showed deficits in IQ and attention. Earlier age of diabetes onset, chronic hyperglycemia, and DKA affected particular cognitive domains. Early exposure to severe hypoglycemia had negative effects on visual memory.

Functional and association analysis of an Amerindian-derived population-specific p.(Thr280Met) variant in RBPJL, a component of the PTF1 complex

PTF1 complex is critical for pancreatic development and maintenance of adult exocrine pancreas. As a part of our ongoing studies to identify genetic variation that contributes to type 2 diabetes (T2D) in American Indians, we analyzed variation in genes that form this complex, namely PTF1A, RBPJ, and its paralogue RBPJL. A c.839C>T (p.(Thr280Met)) variant (rs200998587:C>T, risk allele frequency = 0.03) in RBPJL, identified only in Amerindian-derived populations, associated with T2D (OR = 1.60[1.21–2.13] per Met allele, P = 0.001) and age of diabetes onset (HR = 1.40[1.14–1.72], P = 0.001). Knockdown of Rbpjl in mouse pancreatic acinar cells resulted in a significant decrease in the mRNA expression of genes encoding exocrine enzymes including Ctrb. CTRB1/2 is an established T2D locus where the protective allele associates with increased GLP-1-stimulated insulin secretion and higher expression of CTRB1/2. In vitro studies show that cells expressing the Met280 allele had lower RBPJL protein levels than cells expressing the Thr280 allele, despite having comparable levels of RNA, suggesting that the Met280 RBPJL is less stable. Additionally, luciferase assays in HEK293 cells which examined two different RBPJL responsive promoters, including the promoter for CTRB1, also identified reduced transactivation by the Met280 RBPJL. Similarly, overexpression of both Met280 and Thr280 RBPJL in mouse pancreatic acinar cells identified a significant impairment in the expression of Cel when transactivated by the Met280 RBPJL. In summary, we identified a functional, Amerindian-derived population-specific c.839C>T (p.(Thr280Met)) variant in the pancreas specific RBPJL that may modify T2D risk by regulating exocrine enzyme expression.

Development and validation of a risk prediction model for end-stage renal disease in patients with type 2 diabetes

The aim of this study is to develop a prediction model for ESRD in patients with type 2 diabetes. A retrospective cohort study was conducted, consisting of 24,104 Chinese patients with type 2 diabetes. We adopted the procedures proposed by the Framingham Heart Study to develop a prediction model for ESRD. Participants were randomly assigned to the derivation and validation sets at a 2:1 ratio. The Cox proportional hazard regression model was used for model development. A total of 813 and 402 subjects (5.06% and 5.00%, respectively) developed ESRD in the derivation and validation sets over a mean follow-up period of 8.3 years. The risk-scoring systems included age, gender, age of diabetes onset, combined statuses of blood pressure and anti-hypertensive medication use, creatinine, variation in HbA1c, variation in systolic blood pressure, diabetes retinopathy, albuminuria, anti-diabetes medications, and combined statuses of hyperlipidemia and anti-hyperlipidemia medication use. The area under curves of 3-year, 5-year, and 8-year ESRD risks were 0.90, 0.86, and 0.81 in the derivation set, respectively. This risk score model can be used as screening for early prevention. The risk prediction for 3-year, 5-year, and 8-year period demonstrated good predictive accuracy and discriminatory ability.

A Systematic Review and Meta-analysis of Executive Function Performance in Type 1 Diabetes Mellitus.

The aims of the study were to examine the current evidence for executive function (EF) performance differences between groups with type 1 diabetes mellitus (T1DM) and nondiabetic control groups during adolescence and early adulthood and to explore the relationships between EF and diabetes-related risk factors. A systematic review of the literature examining EF performance in groups with T1DM was conducted according to the PRISMA guidelines. Electronic database searches for published and unpublished literature yielded a final set of 26 articles after application of inclusion and exclusion criteria. A meta-analysis was conducted on a subset of these articles (n = 17) comparing EF performance in T1DM and control groups, across a total sample size of 1619. Sixteen of 26 studies found significantly lower EF on at least one task in groups with T1DM. Meta-analyses of the performance difference between T1DM groups and control groups without diabetes showed that inhibition (g = -0.28, p < .001), working memory (g = -0.34, p < .001), set-shifting (g = -0.31, p = .012), and overall EF performance across these domains (g = -0.42, p < .001) were all significantly lower in groups with T1DM. Performance on specific EF domains also seemed to be differentially associated with early age of diabetes onset, chronic hyperglycemia and its complications, and severe hypoglycemia. T1DM and its associated risk factors are related to subtle impairments across the inhibition, working memory, and set-shifting domains of EF. Lower EF may be a key factor contributing to behavioral and clinical problems experienced by individuals with T1DM.

The characteristics of newly diagnosed adult early-onset diabetes: a population-based cross-sectional study

To investigate the characteristics of newly diagnosed early-onset diabetes in the Chinese population, 2801 newly diagnosed diabetes participants without known diabetes or pre-diabetes in a national cross-sectional survey were analysed. Participants were divided into quartiles (22–43, 44–52, 53–61 and >61 years) according to age of diabetes onset and the first group were defined as early-onset diabetes group. Early-onset diabetes group had lower systolic blood pressure (SBP), total cholesterol, low density lipoprotein cholesterol, 2-hour post prandial blood glucose and urine albumin creatinine ratio. There was no difference in body mass index, Homeostasis model assessment (HOMA) of beta cell function and diabetes family history between early-onset diabetes participants and any other age groups. HOMA of insulin resistance (IR) scores and disposition index 30 minutes after glucose load (DI30) were increased in early-onset diabetes participants. The beta cell function declination was more deteriorated in early-onset diabetes participants. Male gender, triglycerides, HOMA-IR and DI30 were positively associated with an earlier age at diagnosis. In conclusion, patients diagnosed with diabetes at a younger age are characterized by a similar cardiovascular risk profile with increased insulin resistance and more severe beta cell failure than patients diagnosed at a later age.

Diabetes mellitus increases the risk of hepatocellular carcinoma in treatment-naïve chronic hepatitis C patients in China.

We investigated the link between diabetes mellitus (DM) and hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) risk in treatment-naïve chronic hepatitis C (CHC) patients in China.To examine the association between DM and HCC, we conducted a case–control study of 300 Chinese CHC patients with HCC, compared to an age- and sex-matched control group of 517 CHC patients not diagnosed with HCC.We found that DM was more prevalent in the HCC patient group (18.7%) than in the CHC-only patient group (10.8%). We conducted logistic regression analyses adjusting for demographics features and other HCC risk factors and found that DM increased the risk of HCC development nearly 2-fold [adjusted odds ratio (AOR), 95% confidence interval (95% CI), 1.80 (1.17–2.75)]. Meanwhile, the proportion of HCC patients and CHC-only patients with liver cirrhosis were 79.3% and 46.2%, respectively, yielding an AOR of 4.62 (95% CI, 3.31–6.46). Multivariate analyses comparing the risk of HCV-related HCC development in DM patients with and without liver cirrhosis revealed that the estimated AOR (95% CI) for those with liver cirrhosis was 5.60 (2.25–13.96). However, the HCC risk decreased significantly with a later age of diabetes onset (AOR [95% CI], 0.94 [0.89–0.99]).DM was associated with an increased risk for HCC development in treatment-naïve CHC patients in China. Furthermore, liver cirrhosis and an early DM diagnoses further increased the risks of HCC development in patients diagnosed with both CHC and DM.

Data collection on retinopathy as a public health tool: The Hubble telescope equivalent of looking back in time

ObjectiveTo test whether the rate of diabetic retinopathy development in a population calculated from the prevalence of retinopathy and duration of diabetes can be used to assess their prior glycemic control. Research Design and Methods9281 patients with type 2 diabetes (T2DM) were grouped by duration of diabetes and plotted against the % of retinopathy in each band. The slope was used to calculate retinopathy development/year (RD/y). We correlated the RD/y with updated HbA1c within groups of different ethnicity, age of diabetes onset, year of the eye examination, socio-economic status and fluency in English. ResultsDifferences in ethnicity, age of diabetes onset and year of the eye examination affect RD/y to a degree predictable from their respective updated HbA1c. No such relationship with updated HbA1c was evident when a factor has no apparent effect on RD/y. ConclusionsThis relationship between prevalence of retinopathy and duration of diabetes can be used to assess future retinopathy burden. Perhaps more intriguing, the camera can be reversed to allow an estimate of prior glycemic control of a population from its retinopathy prevalence. Health care organizations can use this method to project future needs and to assess adequacy of prior glycemic control.

Prevalence of diabetic retinopathy among 13473 patients with diabetes mellitus in China: a cross-sectional epidemiological survey in six provinces

ObjectiveTo describe the prevalence and severity of diabetic retinopathy (DR) and sight-threatening DR (STDR) among Chinese adults with diabetes.Design, setting and participantsA cross-sectional epidemiological survey across Mainland China (N=13 473)....

Comparative analysis of glycemic control effectiveness and microvascular complications in patients with type 1 diabetes mellitus, treated with genetically engineered human insulin or human insulin analogues: A 10-year retrospective observational study

The treatment of diabetes mellitus generally involves genetically engineered human insulin (GICH) or genetically engineered analogues of human insulin (AIC). Compared to GICH, AIC better physiologically mimics endogenous insulin functionally. It would thus be logical to assume that long-term (multi-year) application of AIC leads to a lower incidence of diabetic angiopathy compared to GICH. To date, however, no long-term comparisons of both classes of insulin preparations (in terms of efficacy of glycemic control or incidence of microvascular complications in patients with type 1 diabetes) have been performed.&#x0D; Aims. To retrospectively compare the efficacy of glycemic control and incidence of microvascular complications (nephropathy and retinopathy) in patients with type 1 diabetes treated for at least 10 years with either GICH or AIC.&#x0D; Materials and methods. Based on data from electronic databases (diabetes registry) from several regions within the Russian Federation, the following patient samples were examined (n=260): group 1 received GICH for 10 years (n = 130) and group 2 received AIC for 10 years (n = 130). Patients in both groups underwent pairwise matching for baseline clinical characteristics (sex, age of diabetes onset, duration of disease and HbA1clevel). All patients were observed by endocrinologists in the clinic.&#x0D; Results. After 10 years of follow up, HbA1с levels declined more significantly in group 2 than in group 1 (1.30% vs. 0.81%, respectively, P 0.05). By the end of the observation period, the presence of diabetic retinopathy (any stage) increased in both groups and was not significantly different between groups; the presence of diabetic nephropathy was also increased in both groups, but the increase was significantly lower in group 2 than in group 1 (20.5% vs. 33.9%, respectively, P 0.05). Overall, the risk of microvascular complications was significantly higher in group 1 than in group 2 [HR (hazard ratio): 1.84; 95% CI: 1.372.48), specifically, the risk of diabetic retinopathy (HR: 1.37; 95% CI: 0.981.90).&#x0D; Conclusions. A 10-year retrospective analysis of patients treated with AIC for type 1 diabetes in the clinic showed a significantly more effective reduction in HbA1c levels and a lower incidence of diabetic nephropathy, compared with patients treated with GICH.

Aspects of Humoral Immunity in a Group of Children With Type 1 Diabetes and Thyroid Disorders

Patients with diabetes have a high prevalence of thyroid disease compared with non-diabetic population. In the case of type 1 diabetes, it is often associated with autoimmune endocrine and systemic diseases as: Graves-Basedow disease, autoimmune chonic thyroiditis (ACT), Addison's disease, celiac disease, pernicious anemia, myasthenia gravis, vitiligo, etc.. The purpose of this study is to determine the main aspects of humoral immunity in a group of children with type 1 diabetes and thyroid disorders. The studied group was represented by 83 cases (71 girls and 12 boys), aged between 7-17 years. They were used clinical, imaging, biochemical, hormonal and immunological parameters. Results: Prevalence of positive anthyroid antibodies (ACAT) in the study group was: Basedow – Graves disease – 100% (both), ACT - 85.18% antiTPO and 83.33% antiTg, euthyroid difusse goiter – 0% (both). In the case of children and adolescents with type 1 diabetes and ACT with positive antiTPO AB we notice that they had a younger onset age of diabetes (4.86 ± 3.94 vs. 8.62 ± 0.51 years), a longer duration of diabetes (9.23 ± 4.05 vs. 8.12 ± 0.64 years), elevated HbA1c values (8.91 ± 2.03 vs.7, 55 ± 1.96%) and lower TSH values (12.00 ± 23.7 vs. 14.77 ± 17.03 mIU/ml) than those negative. Conclusions: It is recommended determination of antithyroid antibodies, particularly those antiTPO in children and adolescents with type 1 diabetes at onset of diabetes, or before puberty and, if they are positive should be tested the thyroid function annually to minimize the risk of undiagnosed hypothyroidism.

Diabetes Onset at 31-45 Years of Age is Associated with an Increased Risk of Diabetic Retinopathy in Type 2 Diabetes.

This hospital-based, cross-sectional study investigated the effect of age of diabetes onset on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. A total of 5,214 patients with type 2 DM who were referred to the Department of Ophthalmology at the Shanghai First People’s Hospital from 2009 to 2013 was eligible for inclusion. Diabetic retinopathy status was classified using the grading system of the Early Treatment Diabetic Retinopathy Study (ETDRS). Logistic and hierarchical regression analyses were used to identify independent variables affecting the development of DR. Upon multiple logistic regression analysis, patient age at the time of diabetes onset was significantly associated with development of DR. Further, when the risk of retinopathy was stratified by patient age at the onset of diabetes, the risk was highest in patients in whom diabetes developed at an age of 31–45 years (odds ratio [OR] 1.815 [1.139–2.892]; p = 0.012). Furthermore, when patients were divided into four groups based on the duration of diabetes, DR development was maximal at a diabetes onset age of 31–45 years within each group. A diabetes onset age of 31–45 years is an independent risk factor for DR development in Chinese type 2 DM patients.

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 3.The regression and promoting factors of diabetic retinopathy and diabetic macular edema in Chinese type 2 diabetes patients

Background Long-term study on type 2 diabetes discovered that some patients with diabetic retinopathy (DR) or diabetic macular edema (DME) appear regression of lesions without invasive ocular intervention but only systemic medication.These mechanisms remain unclear. Objective This study was to survey the regression rate and relevant factors of DR and DME in type 2 diabetic patients. Methods A prospectively observational study was performed.Totally 778 patients who met the inclusion criteria participated in this consecutive 5-year survey.The demographic information of the patients was collected, and the systemic and ophthalmological examinations were carried out, and the fundus photography was identified by 2 doctors by blind method.DR was graded into non-, mild-, moderate-, severe-nonproliferation DR and proliferative DR based on international clinical classification, and DME was graded into non-, mild-, moderate-and severe-DME.DR improvement and DME regression were served as the outcome variables and defined as the grading of DR or DME in lateral eyes lowering by at least 1 grade and without development of DR or DME in fellow eyes.The influences of age, gender, education level, diabetes onset age, diabetes course, obesity and serum creatinine, triacylglycerol, total cholesterol and glycosylated hemoglobin levels were evaluated by Logistic regression analysis. Results Four hundred and fifty-six patients appeared DR in the initial examination, of which 139 patients appeared regression of DR severity with the regression rate of 30.48%.Both low blood glucose level and low serum creatinine level at initial examination were independent risk factors associated with DR regression (blood glucose level: odds ratio(OR)=0.53, 95% confidence interval [CI]: 0.45-0.63, P<0.01; serum creatinine level: OR=0.98, 95%CI: 0.97-0.99, P<0.01). One hundred and fifty-eight patients were found to have DME at the initial examination, of which 20 had a regression of DME severity throughout the follow-up duration, with the regression rate 12.66%.High baseline blood glucose level was found to be the only independent risk factor associated with DME regression (OR=1.47, 95%CI: 1.14-1.91, P<0.01). Conclusions Effective control of blood glucose and serum creatinine levels is a favorable factor for the regression of DR, and the rapid drop of blood glucose level is beneficial to the regression of DME. Key words: Diabetes, type 2/complications; Retinopathy, diabetic; Macular edema, diabetic

Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: findings from the China Kadoorie Biobank Study

BackgroundAlthough fresh fruit consumption has well recognised health benefits, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, the risks of death and vascular complications. We aimed to assess the associations of fresh fruit consumption with the risk of incident diabetes and diabetic vascular complications. MethodsThe China Kadoorie Biobank Study is a prospective cohort study with 512 891 Chinese adults aged 30–79 (mean 51·5, SD 10·7) years recruited from ten diverse localities across China between June 25, 2004, and July 15, 2008. At baseline and during the two subsequent resurveys (conducted from June to October, 2008, and from August, 2013, to September, 2014), data on fresh fruit consumption were collected with interviewer-administered electronic questionnaires. Deaths and information on hospital admissions were collected through linkages with death and disease registries and national health insurance claim databases. For each disease endpoint (including incident diabetes and, among baseline diabetics, mortality and hospital admissions of diabetic vascular complications) associated with fresh fruit consumption, we used Cox regression analysis to derive adjusted hazards ratios (HRs), adjusting for age, sex, region, education, income, smoking, alcohol consumption, physical activity, survey season, family history of diabetes, BMI, and consumption of meat, dairy products, and preserved vegetables. Ethics approval was granted by ethics committees or institutional review boards at the University of Oxford, the Chinese Center for Disease Control and Prevention, the Chinese Academy of Medical Sciences, and all participating regions, and all participants provided written informed consent. FindingsDuring a mean of 7·2 years (SD 1·3) of follow-up, 9504 new diabetes cases were recorded in 482 591 participants without self-reported or screen-detected diabetes at baseline. In 30 300 (5·9%) participants who had diabetes at baseline, 3389 deaths, 9746 macrovascular events requiring hospital admission, and 1345 microvascular events were recorded. 96 586 (18·8%) of all participants reported daily consumption of fresh fruit (consumers) and 32 775 (6·4%) never or rarely consumed fresh fruit (non-consumers). The proportion of non-consumers was about three times higher in participants with baseline self-reported diabetes (17·9% [2893 of 16 162]) than in those with screen-detected diabetes (6·8% [958 of 14 138]) or no diabetes (6·0% [28 924 of 482 591]). In participants without diabetes at baseline, the adjusted HR for incident diabetes was 0·88 (95% CI 0·83–0·93) for daily consumers versus non-consumers, with a clear dose–response relation with the amount consumed. This association was consistent across subgroups of participants at different levels of diabetes risk. In participants with diabetes at baseline, increased fresh fruit consumption was associated with reduced risks of death and major vascular diseases, with adjusted HRs per daily portion being 0·83 (0·74–0·93) for all-cause mortality, 0·87 (0·82–0·93) for macrovascular complications, and 0·72 (0·61–0·87) for microvascular complications. The associations were similar in patients with self-reported diabetes and those with screen-detected diabetes, and were not modified by diabetes onset age, duration, or treatment. InterpretationIn Chinese adults, higher fresh fruit consumption was associated with a significantly lower risk of diabetes and, in those who already had diabetes, lower risks of death, and major vascular complications. FundingKadoorie Charitable Foundation (Hong Kong, China), UK Wellcome Trust, Chinese National Natural Science Foundation, British Heart Foundation, UK Medical Research Council, and Cancer Research UK.

Clinical and Genetic Characteristics of Non-Insulin-Requiring Glutamic Acid Decarboxylase (GAD) Autoantibody-Positive Diabetes: A Nationwide Survey in Japan.

AimsGlutamic acid decarboxylase autoantibodies (GADAb) differentiate slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) from phenotypic type 2 diabetes, but many GADAb-positive patients with diabetes do not progress to insulin-requiring diabetes. To characterize GADAb-positive patients with adult-onset diabetes who do not require insulin therapy for >5 years (NIR-SPIDDM), we conducted a nationwide cross-sectional survey in Japan.MethodsWe collected 82 GADAb-positive patients who did not require insulin therapy for >5 years (NIR-SPIDDM) and compared them with 63 patients with insulin-requiring SPIDDM (IR-SPIDDM). Clinical and biochemical characteristics, HLA-DRB1-DQB1 haplotypes, and predictive markers for progression to insulin therapy were investigated.ResultsCompared with the IR-SPIDDM group, the NIR-SPIDDM patients showed later diabetes onset, higher body mass index, longer duration before diagnosis, and less frequent hyperglycemic symptoms at onset. In addition, C-peptide, LDL-cholesterol, and TG were significantly higher in the NIR-SPIDDM compared to IR-SPIDDM patients. The NIR-SPIDDM group had lower frequency of susceptible HLA-DRB1*04:05-DQB1*04:01 and a higher frequency of resistant HLA-DRB1*15:01-DQB1*06:02 haplotype compared to IR-SPIDDM. A multivariable analysis showed that age at diabetes onset (OR = 0.82), duration before diagnosis of GADAb-positive diabetes (OR = 0.82), higher GADAb level (≥10.0 U/ml) (OR = 20.41), and fasting C-peptide at diagnosis (OR = 0.07) were independent predictive markers for progression to insulin-requiring diabetes. An ROC curve analysis showed that the optimal cut-off points for discriminating two groups was the GADAb level of 13.6 U/ml, age of diabetes onset of 47 years, duration before diagnosis of 5 years, and fasting C-peptide of 0.65 ng/ml.ConclusionsClinical, biochemical and genetic characteristics of patients with NIR-SPIDDM are different from those of IR-SPIDDM patients. Age of diabetes onset, duration before GADAb-positivity, GADAb level, and fasting C-peptide at diagnosis must be carefully considered in planning prevention trials for SPIDDM.