Risk Evaluation Of cAncers In Chinese diabeTic Individuals : A lONgitudinal Research Articles

Association between heme oxygenase-1 and hyperlipidemia in pre-diabetic patients: a cross-sectional study

BackgroundAlthough the importance and benefit of heme oxygenase-1 (HO-1) in diabetes rodent models has been known, the contribution of HO-1 in the pre-diabetic patients with hyperlipidemia risk still remains unclear. This cross-sectional study aims to evaluate whether HO-1 is associated with hyperlipidemia in pre-diabetes.MethodsSerum level of HO-1 was detected using commercially available ELISA kit among 1,425 participants aged 49.3–63.9 with pre-diabetes in a multicenter Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) prospective observational study. Levels of total cholesterol (TC) and triglyceride (TG) were measured and used to defined hyperlipidemia. The association between HO-1 and hyperlipidemia was explored in different subgroups.ResultThe level of HO-1 in pre-diabetic patients with hyperlipidemia (181.72 ± 309.57 pg/ml) was obviously lower than that in pre-diabetic patients without hyperlipidemia (322.95 ± 456.37 pg/ml). High level of HO-1 [(210.18,1,746.18) pg/ml] was negatively associated with hyperlipidemia (OR, 0.60; 95% CI, 0.37–0.97; p = 0.0367) after we adjusted potential confounding factors. In subgroup analysis, high level of HO-1 was negatively associated with hyperlipidemia in overweight pre-diabetic patients (OR, 0.50; 95% CI, 0.3–0.9; p = 0.034), especially in overweight women (OR, 0.42; 95% CI, 0.21–0.84; p = 0.014).ConclusionsIn conclusion, elevated HO-1 level was negatively associated with risk of hyperlipidemia in overweight pre-diabetic patients, especially in female ones. Our findings provide information on the exploratory study of the mechanism of HO-1 in hyperlipidemia, while also suggesting that its mechanism may be influenced by body weight and gender.

Gestational hyperglycemia and the risk of cardiovascular diseases among elderly Chinese women: Findings from the REACTION study.

Gestational hyperglycemia increases the risk of diabetes in later life. However, the risk of future cardiovascular diseases (CVD) related to gestational hyperglycemia remains inconclusive. The purpose of this study was to investigate the impact of gestational hyperglycemia on the subsequent risk of CVD and its modifying factors among elderly Chinese women. We conducted a case-control study of elderly women from the baseline survey of Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Women with gestational hyperglycemia (n=82), and controls matched by age and study site (n=410) were included. Information on CVD, including reported coronary heart disease, stroke, or myocardial infarction, was collected through an interviewer-assisted questionnaire. Women with gestational hyperglycemia were more likely to develop diabetes (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.18) and CVD (OR, 1.98; 95% CI, 1.05-3.74). Even without progressing to type 2 diabetes, gestational hyperglycemia was associated with an increased risk of CVD (OR, 2.88; 95% CI, 1.18-7.00). However, subgroup analysis indicated that compared with those without gestational hyperglycemia or hypertension, women with both gestational hyperglycemia and hypertension had higher risk of CVD (OR, 3.98; 95% CI, 1.65-9.58), whereas the risk estimate did not significantly change in women with gestational hyperglycemia alone (OR, 2.15; 95% CI, 0.71-6.57). Stratified analysis indicated that among those with overweight/obesity, inactive physical activity, or unhealthy dietary habits, gestational hyperglycemia increased the risk of CVD. In elderly Chinese women, gestational hyperglycemia was associated with an increased risk of CVD in later life. This association was independent of the progression to diabetes and might be modified by lifestyle factors and hypertension.

Nomogram Predicting the Risk of Progression from Prediabetes to Diabetes After a 3-Year Follow-Up in Chinese Adults

PurposeTo develop a nomogram for predicting the risk of progression from prediabetes to diabetes and provide a quantitative predictive tool for early clinical screening of high-risk populations of diabetes.Materials and MethodsThis study was a retrospective cohort study and part of the investigation conducted for the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 1857 prediabetic participants at baseline underwent oral glucose tolerance test and hemoglobin A1c (HbA1c) testing after 3 years. The areas under the receiver operating characteristic curves (AUCs) were adopted to measure the predictive value of progression to diabetes, using baseline fasting plasma glucose (FPG), 2-hr postprandial plasma glucose (2hPG), HbA1c or combined models. Decision curve analysis determined the model with the best discriminative ability. A nomogram was formulated and internally validated, providing an individualized predictive tool by calculating total scores.ResultsAfter 3 years, 145 participants developed diabetes, and the annual incidence was estimated to be 2.60%. Among the three single indicators and four combined models, model 4 combined of FPG, 2hPG, and HbA1c showed the best performance in risk predication, with an AUC of 0.742. The nomogram constructed via model 4 was validated and demonstrated good prediction for the risk of diabetes. The nomogram score/predicted probability was a numeric value representing the prediction model score of individual patients. Notably, all nomogram scores showed relatively high negative predictive values.ConclusionThe nomogram constructed in this study effectively predicts and quantifies the risk of progression from prediabetes to diabetes after a 3-year follow-up and could be adopted to identify Chinese patients at high risk for diabetes in order to provide timely interventions.

The Incidence of Metabolic Syndrome and the Valid Blood Pressure Cutoff Value for Predicting Metabolic Syndrome Within the Normal Blood Pressure Range in the Population Over 40 Years Old in Guiyang, China.

PurposeThe study was conducted to investigate metabolic syndrome (MS) incidence within the normal blood pressure (BP) range in a population over 40 years old in an urban area of Guiyang, Guizhou Province, China, and to identify a valid BP cutoff value for predicting MS.Materials and MethodsData from this study are based on the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. In total, 2935 subjects in the normal BP range and without MS (795 males, 2140 females) aged 40–80 years were included in this study. Follow-up subjects were classified by baseline BP and grouped by age. After the 3-year follow-up, the MS incidence and valid BP cutoff value for predicting MS were calculated for subjects within the normal BP range.ResultsAfter the 3-year follow-up study, the crude and standardized MS incidences in the cohort were 19.83% and 16.89% for follow-up subjects, respectively, with incidences of 10.94% and 10.50% for males and 23.13% and 20.66% for females. The incidence of MS in normotensive subjects (15.53%) was lower than that in subjects with high-normal BP (29.08%). After adjusting for age, sex, BMI, smoking, and drinking, the risk of having MS in the high-normal BP group was 1.823-fold [HR 1.823 95% CI (1.538–2.162)] higher than that in the normotensive group. The ROC curve showed that the BP cutoff values were more than 117/74 mmHg in males and 112/74 mmHg in females.ConclusionWhen BP was within the normal range, the incidence of MS in participants was very high. The MS incidence was higher among high-normal BP subjects than among normotensive subjects, as was the risk of having MS. The valid BP cutoff value for predicting MS in the population was 117/74 mmHg in males and 112/74 mmHg in females. Currently, epidemiological investigations are needed to determine whether a lower BP cutoff value is needed in diagnosing MS.

Association of the Ratio of Triglycerides to High-Density Lipoprotein Cholesterol Levels with the Risk of Type 2 Diabetes: A Retrospective Cohort Study in Beijing.

Background Previous studies have shown that the ratio of triglyceride to high-density lipoprotein cholesterol level (TG/HDL-C) is a risk factor for type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the nonlinear relationship between TG/HDL-C and the incidence of T2DM in a Chinese population. Methods We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the incidence of T2DM among 7,791 participants from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) cohort study at baseline. Results After adjusting for age, sex, body mass index, smoking status, alcohol intake, low-density lipoprotein cholesterol level, strenuous activity, education level, family histories of T2DM and tumors, and the presence of hypertension, tumor, stroke, and coronary heart disease, we showed that TG/HDL-C was positively associated with the incidence of T2DM at the 4-year follow-up (OR = 1.49, 95%CI = 1.26–1.78). TG/HDL-C and incidence of T2DM showed a nonlinear relationship; the inflection point of TG/HDL-C was 1.50. The ORs (95% CI) on the left and right sides of the inflection point were 2.50 (1.70–3.67) and 0.96 (0.67–1.37), respectively. After adjusting for age, sex, and body mass index (BMI) in the linear relationship, the OR of the incidence of T2DM was 1.60 (95%CI = 1.37–1.87). When the TG/HDL-C was less than 1.50 or greater than 1.76, the ORs (95% CI) were 2.41 (1.82–3.18) or 0.81 (0.53–1.25), respectively. Subgroup analysis showed no relationships of T2DM incidence with sex, BMI, family history of T2DM, or TG/HDL-C. Conclusion TG/HDL-C is positively associated with diabetes risk. In our study, with each increasing quintile, the risk of T2DM after 4 years was 1.60 or 1.49 depending on the variables adjusted. In addition, our cohort study showed a nonlinear relationship between TG/HDL-C and T2DM incidence, with an inflection point of 1.76 or 1.50, depending on the variables adjusted. When the TG/HDL was less than 1.50, the ORs (95% CI) were 2.41 (1.82–3.18) and 2.50 (1.70–3.67). When the TG/HDL-C was greater than 1.76 or 1.50, there was no significant difference in the change in OR.

Association between obesity and urinary albumin-creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study

ObjectiveThe relationship between obesity and albuminuria has not been clarified. This study aimed to investigate the correlation between obesity and the urinary albumin-creatinine ratio (UACR) in Southern and Northern China.DesignA...

Irisin plays an important role in the outcomes of newly diagnosed prediabetes in adults in Guiyang, China.

Aims/IntroductionTo explore the potential role of irisin in the outcomes of newly diagnosed prediabetes.Materials and MethodsData were obtained from the Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 2,530 participants had newly diagnosed prediabetes at baseline and completed follow up. The nested 1:1 case–control study included 161 participants who developed diabetes mellitus at follow up, and 161 age‐ and sex‐matched controls. The follow‐up study included 86 matched case–control pairs. Fasting serum irisin levels were measured using enzyme‐linked immunosorbent assay.ResultsBaseline serum irisin levels were higher in the cases than in the controls (P = 0.002); high baseline serum irisin levels were an independent risk factor for the development of diabetes (odds ratio 1.235, 95% confidence interval 1.025–1.488). After adjustment for age, sex, body mass index, glycated hemoglobin (HbA1c), smoking, exercise, and family history of diabetes, subjects in the highest quartile of irisin levels had a higher risk of diabetes than those in the lowest quartile (odds ratio 3.065, 95% confidence interval 1.511–6.218). The extent of decrease in irisin levels during follow‐up was greater in the cases than in the controls (P < 0.001). Baseline serum irisin levels were positively correlated with the extent of decrease in irisin during follow‐up (r = 0.773, P < 0.001). After adjustment for confounding factors, subjects with a decrease of irisin above the median had much higher risk for diabetes (odds ratio 5.077, 95% confidence interval 2.112–12.206).ConclusionsIrisin might play an important role in the outcomes of newly diagnosed prediabetes in adults in Guiyang, and can predict the risk for developing diabetes in these individuals.

Elevated triglyceride-glucose (TyG) index predicts incidence of Prediabetes: a prospective cohort study in China

BackgroundPrediabetes has become a pandemic. This study aimed to identify a better predictor for the incidence of prediabetes, which we hypothesize to be the triglyceride-glucose (TyG) index, a simplified insulin resistance index. We compared its predictive value with the other common risk factors of prediabetes.MethodsThe participants of this analysis were derived from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. A total of 4543 participants without initial prediabetes or diabetes were followed up for 3.25 years. Using multivariate logistic regression model, the associations between baseline obesity, lipid profiles and non-insulin-based insulin resistance indices with the incidence of prediabetes were analyzed. To assess which is better predictor for the incidence of prediabetes, the area under curves (AUCs) calculated from the receiver operating characteristic curve analyses were used to evaluate and compare with the predictive value of the different indices.ResultsDuring the 3.25 years, 1071 out of the 4543 participants developed prediabetes. Using the logistic regression analysis adjusted for some potential confounders, the risk of incidence of prediabetes increased 1.38 (1.28–1.48) fold for each 1–SD increment of TyG index. The predictive ability (assessed by AUCs) of TyG index for predicting prediabetes was 0.60 (0.58–0.62), which was superior to the indices of obesity, lipid profiles and other non-insulin-based insulin resistance indices. Although the predictive ability of the TyG index was overall similar to fasting plasma glucose (FPG) (P = 0.4340), TyG index trended higher than FPG in females (0.62 (0.59–0.64) vs. 0.59 (0.57–0.61), P = 0.0872) and obese subjects (0.59 (0.57–0.62) vs. 0.57 (0.54–0.59), P = 0.1313). TyG index had superior predictive ability for the prediabetic phenotype with isolated impaired glucose tolerance compared with FPG (P < 0.05) and other indices. Furthermore, TyG index significantly improved the C statistic (0.62 (0.60–0.64)), integrated discrimination improvement (1.89% (1.44–2.33%)) and net reclassification index (28.76% (21.84–35.67%)) of conventional model in predicting prediabetes than other indices.ConclusionsTyG could be a potential predictor to identify the high risk individuals of prediabetes.

Predictive values of ANGPTL8 on risk of all-cause mortality in diabetic patients: results from the REACTION Study

BackgroundAngiopoietin-like protein 8 (ANGPTL8), an important regulator of lipid metabolism, is increased in diabetes and is associated with insulin resistance. However, the role of ANGPTL8 in the outcomes of diabetic patients remains unclear. This study aimed to investigate circulating levels of ANGPTL8 in participants with and without diabetes and its potential associations with clinical outcomes in a 5 year cohort study.MethodsPropensity-matched cohorts of subjects with and without diabetes from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: A longitudinal (REACTION) study were generated on the basis of age, sex and body mass index at baseline. The primary outcome was all-cause mortality. The secondary outcomes were a composite of new-onset major adverse cardiovascular events, hospitalization for heart failure, and renal dysfunction (eGFR < 60/min/1.73 m2).ResultsWe identified 769 matched pairs of diabetic patients and control subjects. Serum ANGPTL8 levels were elevated in patients with diabetes compared to control subjects (618.82 pm 318.08 vs 581.20 pm 299.54 pg/mL, p = 0.03). Binary logistic regression analysis showed that elevated ANGPTL8 levels were associated with greater risk ratios (RRs) of death (RR in quartile 4 vs. quartile 1, 3.54; 95% CI 1.32–9.50) and renal dysfunction (RR in quartile 4 vs. quartile 1, 12.43; 95% CI 1.48–104.81) only in diabetic patients. Multivariable-adjusted restricted cubic spline analyses revealed a significant, linear relationship between ANGPTL8 and all-cause mortality in diabetic patients (p for nonlinear trend = 0.99, p for linear trend = 0.01) but not in control subjects (p for nonlinear trend = 0.26, p for linear trend = 0.80). According to ROC curve analysis, the inclusion of ANGPTL8 in QFrailty score significantly improved its predictive performance for mortality in patients with diabetes.ConclusionSerum ANGPTL8 levels were associated with an increased risk of all-cause mortality and could be used as a potential biomarker for the prediction of death in patients with diabetes.

The circulating ANGPTL8 levels show differences among novel subgroups of adult patients with diabetes and are associated with mortality in the subsequent 5\xa0years

ANGPTL8, an important regulator of glucose and lipid metabolism, is associated with diabetes, but the role of ANGPTL8 in the outcomes of novel subgroups of diabetes remains unclear. To assess the circulating ANGPTL8 levels in novel subgroups of diabetes and their association with health outcomes, we performed a data-driven cluster analysis (k-means) of patients with newly diagnosed diabetes (741 patients enrolled from 2011 through 2016) from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: a longitudinal (REACTION) study. The primary outcomes were mortality from all causes and cardiovascular diseases (CVD), and the secondary outcome was any cardiovascular event. Comparisons among groups were performed using the Kruskal–Wallis test, and the correlations between variables were assessed using the Pearson correlation test. Logistic regression was used to detect associations between the risk of outcomes and the ANGPTL8 levels. We identified four replicable clusters of patients with diabetes that exhibited significantly different patient characteristics and risks of all-cause mortality. The serum ANGPTL8 levels in the cluster of mild age-related diabetes (MARD), severe insulin-resistant diabetes (SIRD), and severe insulin-deficient diabetes (SIDD) were significantly higher than those in the mild obesity-related diabetes (MOD) cluster (685.01 ± 24.50 vs. 533.5 ± 18.39, p < 0.001; 649.69 ± 55.83 vs. 533.5 ± 18.39, = 0.040; 643.29 ± 30.89 vs. 533.5 ± 18.39, p = 0.001). High circulating ANGPTL8 levels were more highly associated with a greater hazard of all-cause mortality (quartile 4 vs 1: risk ratio [RR] 3.23, 95% CI 1.13–9.22; per unit increase in the Z score: RR 1.53, 95% CI 1.17–2.01) than low circulating ANGPTL8 levels. In conclusion, this 5-year follow-up REACTION study revealed that the circulating ANGPTL8 levels show differences among novel subgroups of adult patients with diabetes and are associated with all-cause mortality in the subsequent 5 years.

Association between birth weight and diabetes: Role of body mass index and lifestyle in later life.

This study investigated the association between birth weight and diabetes in a Chinese population, and the effects of body mass index (BMI) and lifestyle factors in later life on this association. Data from 49 118 participants aged ≥40 years with recalled birth weight from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, a nationwide population-based cohort, were used. Diabetes diagnosis was based on oral glucose tolerance tests and HbA1c measurements. Logistic regression models were used to evaluate the association of birth weight and risk of diabetes in later life. Increased risk of diabetes was associated with lower or higher birth weight. Compared with individuals with a birth weight of 2500 to 3499 g, the odds ratios (ORs) and 95% confidence intervals (CIs) of diabetes for individuals with a birth weight of <2500, between 3500 and 3999, and ≥4000 g were 1.28 (1.11-1.47), 1.11 (1.04-1.19), and 1.20 (1.07-1.34), respectively. Significant associations were prominent in participants with a current BMI ≥24 kg/m2 , but not detected in those with a normal BMI (OR 1.20 [95% CI 0.96-1.49], 1.11 [95% CI 0.98-1.25], and 1.10 [95% CI 0.89-1.37], respectively). Moreover, there was no increased risk of diabetes in individuals with a low birth weight but with healthy dietary habits (OR 0.94; 95% CI 0.68-1.29) or ideal physical activity (OR 1.41; 95% CI 0.97-2.04). A U-shaped association was observed between birth weight and the risk of diabetes. Healthy lifestyles (healthy dietary habits or ideal physical activity) may eliminate the negative effects of low birth weight in the development of diabetes, but not the effect of high birth weight.

Elevated triglycerides rather than other lipid parameters are associated with increased urinary albumin to creatinine ratio in the general population of China: a report from the REACTION study

BackgroundDyslipidaemia has always been regarded as the cornerstone of arteriosclerosis and is related to the pathogenesis of renal insufficiency. However, it is unclear which routinely available lipid parameter is related to urinary albumin to creatinine ratio (UACR). The purpose of this study was to examine the lipid abnormalities associated with UACR in the general population in China.MethodsThe present study was nested in an ongoing Risk Evaluation of cAncers in Chinese diabetic Individuals: A lONgitudinal (REACTION) study, which was designed to demonstrate the association of abnormal glucose metabolism with the risk of cancer in the Chinese population. This cross-sectional study included 34, 569 subjects (11, 390 males and 23, 179 females) from 8 different regional community cohorts, with an average age of 57.9 years. The UACR data were divided into the < 25% group, the 25–49% group, the 50–74% group, and the ≥ 75% group according to the quartile division of the centre where the subjects visited. The lipid classes were defined according to the guidelines for the prevention and treatment of dyslipidaemia in Chinese adults. Multiple logistic regression analysis was used to evaluate the association of the lipid parameters and UACR.ResultsMultivariable regression analysis revealed that compared with the other lipid parameters, triglycerides (TG) showed an adjusted odds ratio that was significant in model 1–4. This relationship was attenuated after adjusting for Haemoglobin A1c (HbA1c) and blood pressure (BP), but TG ≥ 2.3 mmol/L was still significantly associated with UACR in total subjects and in both men and women (OR: 1.131, 95% CI 1.065–1.203, P < 0.001 in total subjects; OR: 1.134, 95% CI 1.022–1.258, P = 0.017 in men; OR: 1.129, 95% CI 1.046–1.219, P = 0.002 in women). In the stratified analysis, elevated TG was significantly associated with increased urinary albumin in subjects with eGFR ≥ 90 mL/min per 1.73 m2, 5.6 ≤ FBG < 7.0 or 7.8 ≤ PBG < 11.1 mmol/L, 24 ≤ BMI < 28 kg/m2, 120 ≤ SBP < 140 and/or 80 ≤ DBP < 90 mmHg.ConclusionsWe conclude that high TG levels rather than total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol levels are associated with UACR in the general population in China.

Circulating ANGPTL8 and ANGPTL4 Levels Are Increased in Patients with Hyperglycemia Combined Dyslipidemia

Context: Angiopoietin-like protein 8 (ANGPTL8) and Angiopoietin-like protein 4 (ANGPTL4) are regarded as protein regulating triglyceride (TG) metabolism in mice. However, whether ANGPTL8/4 are involved in glucose and/or lipid metabolism in human remain unclear. Objective: To examine circulating ANGPTL8/4 levels in subjects with hyperglycemia and/or dyslipidemia and their correlation with glucose and lipid metabolism. Design, Setting and Participants: Serum ANGPTL8/4 levels were measured using ELISA in age-, sex-, and BMI- matched healthy control subjects (CON) (n=92), subjects with isolated hyperglycemia (IHG) (n=87), with isolated dyslipidemia (IDL)(n=86) and hyperglycemia combined dyslipidemia (HCD)(n=99) from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Results: Serum ANGPTL8 and ANGPTL4 levels were both elevated in patients with HCD compared to CON subjects. After controlling for age, sex and blood lipid, ANGPTL8 levels positively correlated with fasting plasma glucose (FPG) (partial r = 0.154), HbA1c (partial r = 0.110) and triglycerides and glucose (TyG) index (age, sex adjusted)(partial r = 0.224). After controlling for age, sex and FPG, ANGPTL8 levels positively correlated with TG (r = 0.163), TG/HDL (r = 0.147) and non-HDL/HDL (r = 0.134). ANGPTL4 were positively correlated with FPG, 2h-glucose, HbA1c and TyG index. Among lipid-related variables, ANGPTL4 were positively correlated with TG, TG/HDL, non-HDL/HDL and negatively correlated with HDL-cholesterol. After controlling for related variables, the correlations were the same. Conclusion: Circulating ANGPTL8 and ANGPTL4 levels were increased in patients with HCD and might play an important role in linking glucose and lipid metabolism. Disclosure X. Yu: None. P. Lu: None. X. Chen: None.

Association between smoking and glycemic control in diabetic patients: Results from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study.

A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the effect of active smoking and smoking cessation on glycemic control in patients with diabetes. The aim of this study was to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients. The present was a cross-sectional study of 10 551 men and 15 297 women with diabetes from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Risk factors for glycemic control and the association of active smoking with glycemic control were evaluated using logistic regression models. Poor glycemic control was defined as HbA1c ≥7.0%. Current smokers have an increased risk of poor glycemic control, and the multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) of HbA1c ≥7.0% with current smoking were 1.49 (1.35-1.66) in men and 1.56 (1.13-2.15) in women. Further analysis demonstrated a dose-dependent relationship between active smoking and the risk of poor glycemic control in men. Former smokers who quit smoking for <10 years remained at increased risk of poor glycemic control, with the risk leveling off after 10 years of smoking cessation compared with non-smokers, but risk in former smokers was significantly lower than that in current smokers. Active smoking is a modifiable risk factor for poor glycemic control in Chinese diabetic patients.

Neck Circumference, a Novel Indicator for Hyperuricemia.

Background: Waist circumference has been correlated with the risk of hyperuricemia. Whether neck circumference is also associated with hyperuricemia has not been assessed. This study aimed to investigate whether neck circumference is associated with hyperuricemia.Methods: This study population from Beijing is part of the larger China-wide Risk Evaluation of Cancers in Chinese Diabetic Individuals: a lONgitudinal (REACTION) study. For this Beijing sub-center cross-sectional study, a total of 8971 subjects were recruited. Gender-specific multivariable-adjusted regression analyses were conducted to analyze the association of neck circumference and waist circumference with hyperuricemia and the association of neck circumference with serum uric acid levels in the non-hyperuricemia population.Results: After adjusting for confounding variables, regression analyses showed that neck circumference was positively associated with hyperuricemia [OR, 2.61 (1.86–3.67) for males and 3.27 (2.53–4.22) for females] in both genders; further, neck circumference was also positively associated with serum uric acid levels in non-hyperuricemia subjects [b, 2.58 (1.76–3.39) for males and 4.27 (3.70–4.84) for females] in both genders. Additionally, we demonstrated that neck circumference was similar to waist circumference in terms of the strength of association (OR, 3.03 for waist circumference vs. 2.61 for neck circumference in males, and 3.50 vs. 3.27 for females) with hyperuricemia and the ability to predict hyperuricemia (AUC, 0.63 for waist circumference vs. 0.61 for neck circumference in males, and 0.66 vs. 0.66 in females).Conclusion: Neck circumference is positively and independently associated with hyperuricemia in both genders and is also associated with serum uric acid levels in the non-hyperuricemia population.

Glycemic status and chronic kidney disease in Chinese adults: Findings from the REACTION study.

Diagnosed diabetes has been associated with chronic kidney disease (CKD). However, the association between non-diabetic hyperglycemia and CKD remained uncertain. The aim of the present study was to investigate the association between different glycemic status and CKD in Chinese adults and to assess the prevalence and control of diabetes among individuals with CKD. In all, 250 752 adults aged ≥40 years were selected from the baseline cohort of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Plasma glucose concentrations and biochemical and other clinical data were collected; CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 . The prevalence of CKD increased gradually with deterioration of glucose metabolic status in both men and women ( P trend < 0.001 for both). Compared with individuals with normal glucose regulation, men with prediabetes and diabetes had higher risks of prevalent CKD (prediabetes odds ratio [OR] 1.15, 95% confidence interval [CI] 1.02-1.32; newly diagnosed diabetes OR 1.27, 95% CI 1.08-1.49; previously diagnosed diabetes OR 2.05, 95% CI 1.78-2.35). Similar results were observed in women, but not among those with prediabetes. In male CKD patients with diabetes, 52.1% received antidiabetic treatment and 41.8% of those treated had effective glycemic control, higher than values for females. Prediabetes and diabetes were associated with an increased risk of CKD in Chinese men. Control of diabetes among Chinese CKD patients is far from optimal.

Diabetes and cancer: Findings from the REACTION study 糖尿病与恶性肿瘤：来自REACTION研究的发现

Diabetes and cancer: Findings from the <scp>REACTION</scp> study 糖尿病与恶性肿瘤：来自REACTION研究的发现

The relationship between insulin-sensitive obesity and cardiovascular diseases in a Chinese population: Results of the REACTION study

ObjectiveObesity and insulin resistance are risk factors for cardiovascular diseases. Whether insulin-sensitive obese individuals are at higher risk for cardiovascular diseases is still debated. We aim to investigate whether insulin-sensitive obesity associates with prevalent cardiovascular diseases and 10-year coronary heart disease (CHD) risk. Research design and methodsAt the baseline of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, 211,641 participants aged 40years or older were recruited from 25 communities across the China mainland, in 2011 to 2012. Participants were categorized by insulin-sensitive/resistant and general/abdominal obese status. Cardiovascular diseases included CHD, stroke, and myocardial infarction. Framingham risk score (FRS) was calculated according to National Cholesterol Education Program-Adult Treatment Panel III and FRS greater than 20% or cardiovascular diseases were identified as high risk for 10-year CHD. ResultsControlling for potential confounders, compared with insulin-sensitive normal weight individuals, insulin-sensitive general obese individuals had increased risks for prevalent cardiovascular diseases (men: OR, 2.55, 95% CI, 2.04–3.18; women: 1.73, 1.45–2.06) and 10-year Framingham risk for CHD (men: 2.26, 1.86–2.76; women: 1.73, 1.46–2.06). Compared with insulin-sensitive normal waist subgroup, insulin-sensitive abdominal obesity was associated with higher risks for prevalent cardiovascular diseases (men: 1.32, 1.20–1.46; women: 1.36, 1.27–1.47) and 10-year Framingham risk for CHD (men, 1.34, 1.23–1.45; women, 1.37, 1.27–1.47). ConclusionBoth general and abdominal obesity were associated with elevated prevalent cardiovascular diseases and 10-year CHD risk, regardless of the presence or absence of insulin resistance.

Translational research in type 2 diabetes

The risk factors for type 2 diabetes, and the association between diabetes and cancer are two hot topics in translational endocrinology that have caused researchers’ high attention. Bisphenol A (BPA) is one of the world’s highest production volume chemical in use. People widespreadly and continuously expose to BPA, and whether BPA associates with human health needs further research. The association between diabetes and cancer has been realized as a very important issue in the field of diabetes and diabetes care. However, how diabetes is linked with cancer and whether the duration of diabetes, as well as the degree of glycemic controls modify the risk of cancer are not well defined. We recruited 3423 participants aged 40 years or older from Songnan Community, Baoshan District, Shanghai, and all the participants were underwent a 75-gram oral glucose tolerance test and blood and urine samples were collected. Risk evaluation of cancers in Chinese diabetic Individuals: a longitudinal (REACTION) study is an effort to evaluate thoroughly the risk of site specific cancers in Chinese diabetic individuals. In 2011, a study population of 250,000 people was identified from 25 communities across China, aims to research the interaction between type 2 diabetes and cancer, as phase I of a prospective study. Our study showed that the detection rate of urinary BPA was 87.7%, with a median value of 0.81 ng/mL. Higher levels of urinary BPA associated with a higher prevalence of type 2 diabetes (OR:1.37, 95%CI: 1.08-1.74), generalized obesity(OR: 1.50, 95%CI: 1.15-1.97), abdominal obesity(OR:1.28, 95%CI: 1.03-1.60), insulin resistance(OR: 1.37, 95%CI: 1.06-1.77), and low-grade albuminuria (OR: 1.23, 95%CI: 1.13-1.34). Urinary BPA was positively associated with free triiodothyronine (FT3) (men: β = 0.011, P = 0.003; women: β = 0.013, P < 0.001) and negatively associated with thyroid-stimulating hormone (TSH) (men: β = -0.065, P = 0.002; women: β = -0.11, P < 0.001), and higher urinary BPA was associated with high thyroid function (OR: 1.68, 95% CI: 1.24-2.27). Results from the REACTION study indicated that type 2 diabetes associated with higher prevalence of all types of cancer and digestive system malignant tumors. BPA might be a risk factor for endocrine diseases, and people should eliminate BPA exposure in daily life. The REACTION study will provide clinical evidence for the interaction between diabetes and cancers.

Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study

Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study