Feng Hwa Lu

A Population-based Study of the Prevalence and Associated Factors of Diabetes Mellitus in Southern Taiwan

Diabetes mellitus is one of the major health care problems in Taiwan, since the mortality rate has increased from 7.91 per 100 000 in 1980 to 35.1 per 100 000 in 1996. To determine the prevalence of diabetes in southern Taiwan and to investigate possible associated factors, a stratified systematic cluster sampling of 1638 subjects (780 men and 858 women) aged ≥20 years living in Tainan city was investigated with a standard 75‐g oral glucose tolerance test. The crude prevalence of diabetes in Tainan was 9.0 % (10.3 % men and 7.9 % women) and the age‐adjusted prevalence was 9.2 % (10.4 % men and 8.1 % women). The crude prevalence of IGT was 14.0 % (13.8 % men and 14.1 % women), and the age‐adjusted prevalence was 15.5 % (15.0 % men and 15.9 % women). The prevalence of diabetes by using the revised new diagnostic criteria was 7.5%. The prevalence of diabetes and IGT increased significantly with age for both genders, although the rises in prevalence of IGT in women was less consistent. Diabetic and IGT subjects were older and had higher levels of BMI, triglyceride, systolic and diastolic blood pressure, and higher prevalence of obesity, hypertension, and dyslipidemia but indulged in less physical activity than non‐diabetic subjects. The significant factors associated with the newly diagnosed diabetes were age, family history of DM, BMI, systolic blood pressure, physical activity, and serum triglyceride levels.

Correlation between serum lipid concentrations and psychological distress

This study examines the correlations between serum lipid levels and psychological distress. There were 4444 consecutive attendees of general health clinics who participated in the study. Psychological symptoms were measured by the Taiwanese version of the Symptoms Check List 90, revised (T-SCL-90-R). Levels of fasting serum lipids, including total cholesterol, total triglycerides and high-density lipoprotein cholesterol (HDL-C), were determined. Multiple linear regression analyses, with adjustment for confounders, revealed that the concentration of HDL-C had significant inverse associations with scores of depression, somatization and phobic anxiety. Women with an HDL-C level lower than 35 mg/dl scored significantly higher on depression, interpersonal sensitivity, phobia, anxiety, somatization and aggressive hostility, while subjects with a total cholesterol concentration lower than 160 mg/dl scored significantly higher on anxiety, aggressive hostility, phobia, and psychoticism. This study provides, for the first time, comprehensive data derived from the Taiwanese population on the link between lipids and psychological symptoms, revealing a reverse correlation between depression and serum concentrations of HDL-C.

Epidemiologic study of type 2 diabetes in Taiwan

Diabetes mellitus (DM) in adults is a global health problem, although its prevalence varies widely between different populations and the rate has generally increased worldwide. In Taiwan, the mortality rate from DM has almost doubled over the past 10 years. The prevalence of DM in Taiwan was established between 1985 and 1996 and the rates were between 4.9 and 9.2%. The prevalence of impaired glucose tolerance (IGT) was 15.5% (men 15% and women 15.9%). The prevalence of DM and IGT increased significantly with age for both genders. The significant factors associated with newly diagnosed DM were age, BMI, family history of DM, systolic blood pressure (hypertension), physical activity and serum triglyceride levels. The prevalence of large vessel disease (LVD) in DM and non-diabetic subjects were 20.0 and 12.9%, respectively. Among diabetics, 15.8% had ischemic heart disease (IHD), 1.7% leg vessel disease (leg VD), and 2.5% stroke. In non-diabetics, the prevalence of the aforementioned macroangiopathies were 11.5, 0.2 and 1.2%, respectively. The diabetics had a significantly higher prevalence of macrovascular disease than non-diabetic subjects. The most significantly associated with the LVD was serum cholesterol levels. Serum cholesterol and HbA1(c) were significantly associated with the development of IHD. Cigarette smoking and female gender were significantly associated with the leg VD. The prevalence of diabetic retinopathy (DR) was 35.0%. (background DR 30%, preproliferative DR 2.8% and proliferative DR 2.2%, respectively.) The prevalence of DR for previously and newly diagnosed diabetics were 45.2 and 28.3% (men 42.8 vs. 33.3% and women 47.5 vs. 24.8%), respectively. From multiple logistic regression analysis, duration of DM was the most important risk factor related to DR. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control. The prevalence of nephropathy and neuropathy were 12.9 and 23.5%, respectively. For those patients with and those without nephropathy and neuropathy, the duration of DM, percentage of insulin treatment, percentage of hypertension, and fasting plasma glucose were significantly different. Diabetic duration, hypertension, insulin treatment and glycemic control consistently correlated with nephropathy and neuropathy. In conclusion, the prevalence of DM in Taiwan was between 4.9 and 9.2%, and the prevalence of IGT was 15.5%. The possible risk factors of newly diagnosed diabetes were age, family history of DM, BMI, SBP (hypertension), physical activity and triglyceride levels. Diabetes in Chinese subjects share many characteristics similar to other Asian populations. The burden imposed by the chronic complications of diabetes is massive. In Taiwan, the mortality rates from DM have increased greatly over the past 10 years. Reduction of the modificable risk factors such as BMI, hypertenion and dyslipidemia, and increase of physical activity and good glycemic control through public health efforts may help to reduce the risk of DM and its chronic complications.

Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women.

OBJECTIVE: To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors.DESIGN: Cross-sectional study.SUBJECTS: One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI)<30 kg/m2.MEASUREMENTS: Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured.RESULTS: Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors.CONCLUSION: Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

Population-Based Study on the Prevalence and Correlates of Orthostatic Hypotension/Hypertension and Orthostatic Dizziness

There are no epidemiological studies of orthostatic hypotension (OH)/hypertension (OHT) and orthostatic dizziness (OD) in adults across all age groups. The aim of this study is to examine the prevalence and correlates of OH, OHT, and OD in community dwellers aged ≥20 years. OH was defined as a decline in systolic/diastolic blood pressure of ≥20/10 mmHg when a person stood up from a supine position. OHT was a postural increase of ≥20 mmHg in systolic blood pressure. OD was dizziness, lightheadedness, or faintness as the person stood up. A total of 1,638 adults were included. Subjects were classified as normotensive, pre-hypertensive, or hypertensive. The prevalences of OH, OHT, and OD were 15.9, 1.1, and 4.8%, respectively. OD was associated with neither OH nor OHT. None of the subjects aged <40 had OHT; hypertension (p=0.030) and female gender (p<0.001) were the independent correlates of OH and OD, respectively, in that age range. For subjects aged ≥40 years, age (p=0.003), pre-hypertension (p=0.024), hypertension (p=0.008), and diabetes mellitus (p=0.036) were independently related to OH. Age (p<0.001) and supine systolic blood pressure (p=0.023) were the correlates of OHT. Female gender (p<0.001) and sedatives/hypnotics (p=0.040) were associated with OD. In conclusion, age, pre-hypertension, hypertension, and diabetes mellitus were important determinants of OH. OD was more prevalent in women and in subjects using sedatives/hypnotics. The risk of OHT increased with age and with supine systolic blood pressure in adults aged ≥40 years. OH and OHT cannot be determined solely from the presence of OD because of their dissociation.

Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus

U-shaped patterns have been observed for the relationship between sleep duration and diabetes. In addition, prediabetes is associated with the risk of cardiovascular diseases and diabetes. However, there are few studies investigating the relationship between sleep duration and prediabetes/newly diagnosed diabetes. The aim of this study is to examine the relationship between sleep duration and prediabetes/newly diagnosed diabetes in a Taiwanese population. After excluding the subjects with a high risk of obstructive sleep apnea, those with a positive history of diabetes, or those taking hypnotic drugs, a total of 3470 adults were recruited from a health checkup center. Each subject completed a self-administrated structured questionnaire on sleep duration and lifestyle factors. Prediabetes/diabetes was defined following the definition of the American Diabetes Association. Subjects with different sleep durations were classified into short (<6.0 hours), normal (6.0∼8.49 hours), and long sleepers (≥8.5 hours). The proportion of subjects with normal glucose tolerance, prediabetes, and newly diagnosed diabetes was 71.9%, 22.9%, and 5.2%, respectively. There were significant differences in age, sex, weight, education level, body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, alcohol and coffee drinking habits, family history of diabetes, and sleep duration among the 3 glycemic groups. In multinomial regression, both short and long sleepers had a higher risk of newly diagnosed diabetes; and the odds ratio were 1.55 (95% confidence interval, 1.07-2.24) and 2.83 (1.19-6.73), respectively. However, sleep duration was not found to relate to prediabetes. In conclusion, both short and long sleep durations were independently associated with newly diagnosed diabetes, but not with prediabetes.

Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose.

CONTEXT Studies have shown that diabetes mellitus increased brachial-ankle pulse-wave velocity (baPWV), but the impact of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) remains controversial. OBJECTIVE Our objective was to investigate the impact of the different glycemic states on baPWV in a relatively healthy Chinese population. DESIGN, SETTING, AND PATIENTS We enrolled 4938 subjects in the health examination center of the National Cheng Kung University Hospital from October 2006 to August 2009 after excluding those who were under medications for diabetes, hypertension, or hyperlipidemia or had a history of cardiovascular disease. MAIN OUTCOME MEASURES The baPWV values to assess arterial stiffness were calculated as the distance traveled by the pulse wave divided by the time taken to travel the distance. The participants were classified into normal glucose tolerance (NGT; n = 3777), isolated IFG (n = 221), IGT (n = 726), and newly diagnosed diabetes (NDD; n = 214) groups. RESULTS The mean values of baPWV were 1284.9 ± 205.2, 1379.6 ± 226.8, 1408.1 ± 251.7, and 1500.8 ± 282.5 cm/sec in NGT, isolated IFG, IGT, and NDD groups, respectively. The isolated IFG, IGT, and NDD groups had a higher baPWV value as compared with the NGT group. In a multiple linear regression test, both IGT and NDD groups, but not the isolated IFG group, had significantly higher baPWV values after adjustment for age, sex, body mass index, waist to hip ratio, smoking, alcohol consumption, habitual exercise, systolic blood pressure, and lipid profiles. CONCLUSIONS Subjects with IGT and NDD, but not isolated IFG, exhibit a greater arterial stiffness.

The association between self-reported sleep quality and overweight in a Chinese population.

Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population.

Population-Based Study on the Prevalence and Risk Factors of Orthostatic Hypotension in Subjects With Pre-Diabetes and Diabetes

OBJECTIVE—The aim of this study was to investigate the relationship between pre-diabetes and orthostatic hypotension and to examine the prevalence and correlates of orthostatic hypotension in community dwellers with normal glucose tolerance (NGT), pre-diabetes, and diabetes. RESEARCH DESIGN AND METHODS—All participants were classified as having NGT (n = 1,069), pre-diabetes (n = 412), or diabetes (n = 157). Orthostatic hypotension was defined as a decline in systolic/diastolic blood pressure of ≥20/10 mmHg when an individual changed from a supine to a standing position. The cardiovagal response to standing was the ratio between the longest RR interval around beat 30 and the shortest RR interval around beat 15 after standing (30 max–to–15 min ratio). RESULTS—The prevalences of orthostatic hypotension were 13.8, 17.7, and 25.5% in subjects with NGT, pre-diabetes, and diabetes, respectively. For all subjects, age, diabetes, hypertension, and a decreased 30 max–to–15 min ratio, but not pre-diabetes, were independently associated with orthostatic hypotension. Age, hypertension, and 30 max–to–15 min ratio were the correlates of orthostatic hypotension in NGT subjects. Age and hypertension were related to orthostatic hypotension in pre-diabetic subjects. A1C and hypertension were the determinants of orthostatic hypotension in diabetic subjects. Supine blood pressure was related to orthostatic hypotension in all subjects and subgroups. CONCLUSIONS—Pre-diabetic subjects do not have a higher risk of orthostatic hypotension than subjects with NGT, although the risk of orthostatic hypotension is higher in diabetic subjects. Hypertension and supine blood pressure were risk factors for orthostatic hypotension in both pre-diabetic and diabetic subjects. Age and A1C were the correlates of orthostatic hypotension in pre-diabetic and diabetic subjects, respectively. The cardiovagal response to standing is an important determinant of orthostatic hypotension in subjects with NGT but not in pre-diabetic and diabetic subjects.

Activation of opioid μ-receptor by loperamide to lower plasma glucose in streptozotocin-induced diabetic rats

We investigated the effect of loperamide, a selective agonist of opioid μ-receptor, on the plasma glucose in diabetic rats induced by an intravenous injection of streptozotocin (STZ; 60 mg/kg). Intravenous injection of loperamide induced a dose-dependent decrease of plasma glucose in fasting STZ-diabetic rats at 30 min later, but did not modify the plasma glucose level in Wistar rats. Plasma glucose lowering effect of loperamide was abolished by the pretreatment with naloxone or naloxonazine at the dose sufficient to block opioid μ-receptor. In isolated skeletal muscle, loperamide enhanced the glucose uptake into soleus muscles in a concentration-dependent manner. Blockade of this action by naloxonazine indicated the mediation of opioid μ-receptor. These results suggest that an activation of opioid μ-receptor by loperamide can increase the utilization of glucose in peripheral tissue to lower the plasma glucose in STZ-diabetic rats.