Hairong Nan

Cancer Incidence and Mortality in Patients with Type 2 Diabetes Treated with Human Insulin: A Cohort Study in Shanghai

Aim The aim was to investigate the association between human insulin and cancer incidence and mortality in Chinese patients with type 2 diabetes. Methods We recruited 8,774 insulin-naïve diabetes patients from the Shanghai Diabetes Registry (SDR). The follow-up rate was 85.4%. All subjects were divided into the insulin use cohort (n = 3,639) and the non-insulin use cohort (n = 5,135). The primary outcome was the first diagnosis of any cancer. The secondary outcome was all-cause mortality. Cox proportional hazards model was used to estimate the relative risk (RR) of cancer and mortality. Results We observed 98 cancer events in the insulin use cohort and 170 in the non-insulin use cohort. Cancer incidence rates were 78.6 and 74.3 per 10,000 patients per year in the insulin users and the non-insulin users, respectively. No significant difference in cancer risk was observed between the two cohorts (adjusted RR = 1.20, 95% CI 0.89–1.62, P = 0.228). Regarding site-specific cancers, only the risk of liver cancer was significantly higher in the insulin users compared to that in the non-insulin users (adjusted RR = 2.84, 95% CI 1.12–7.17, P = 0.028). The risks of overall mortality (adjusted RR = 1.89, 95% CI 1.47–2.43, P<0.0001) and death from cancer (adjusted RR = 2.16, 95% CI 1.39–3.35, P = 0.001) were all significantly higher in the insulin users than in the non-insulin users. Conclusion There was no excess risk of overall cancer in patients with type 2 diabetes who were treated with human insulin. However, a significantly higher risk of liver cancer was found in these patients. Moreover, insulin users showed higher risks of overall and cancer mortality. Considering that individuals treated with insulin were more likely to be advanced diabetic patients, caution should be used in interpreting these results.

Effects of depressive symptoms and family satisfaction on health related quality of life: The Hong Kong FAMILY study

Objective To examine the effect of depressive symptoms and satisfaction with family support (FS) on physical and mental Health Related Quality of Life (HRQoL). Methods Data were obtained from the Hong Kong FAMILY Project baseline survey in 2009–2011, which included 16,039 community residents (age ≥20). The FS was measured using the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR, range 0–10) Questionnaire. HRQoL were assessed using the SF-12 version 2. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived neighborhood cohesion were also assessed. Results In a multilevel regression model, socio-demographic and behavioral variables explained 21% and 19% of the variance in physical and mental HRQoL. The presence of depressive symptoms (PHQ-9 score ≥10, standardized coefficients, β of −1.73) and high FS (APGAR score 7–10, 1.15) were associated with mental HRQoL, after adjustment for age, education, household monthly income, drinking status, physical activity, chronic conditions, life stress and neighborhood cohesion. Not FS but the presence of depressive symptoms (β of −0.88) was associated with physical HRQoL. The presence of depressive symptoms in women than men were more associated with a poorer physical HRQoL (p<0.01) while depressive symptoms in men were associated with a decrease in mental HRQoL (p<0.001). The interaction between FS and depressive symptoms was nonsignificant in relation to HRQoL. Among those with depressive symptoms, high FS was associated with a better mental HRQoL (41.1 vs. 37.9, p<0.001) in women but not contribute to variance in men. Conclusions Higher FS and presence of depressive symptoms were significantly associated with HRQoL in general population in Hong Kong. Among those with depressive symptoms, high FS was associated with a favorable mental HRQoL in women but not men.

Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample

BackgroundDepression is predicted to become one of the two most burdensome diseases worldwide by 2020 and is common in people with chronic physical conditions. However, depression is relatively uncommon in Asia. Family support is an important Asian cultural value that we hypothesized could protect people with chronic physical conditions from developing depression. We investigated depressive symptom prevalence and risk factors in a Chinese sample with chronic medical conditions, focusing on the possible protective role of family relationships.MethodsData were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009–2011, which included 6,195 participants (age ≥15) with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were assessed. Factors associated with a non-somatic (PHQ-6) depression score were also examined.ResultsThe prevalence of depressive symptoms (PHQ-9 scores ≥5) was 17% in those with one or more chronic conditions, and was more prevalent in women than in men (19.7% vs. 13.9%; p < 0.001). In multilevel analyses, life stress, number of chronic conditions and satisfaction with family support explained 43% of the variance in PHQ-9 scores (standardized regression coefficients of 0.46, 0.15, and −0.12 respectively, all p <0.001). Body mass index, problem alcohol drinking, physical activity, and unmarried status were significantly associated with PHQ-9 scores, although these associations were weak. Variables associated with depression explained 35% of the variance in non-somatic (PHQ-6) depression scores. Satisfaction with family support played a stronger protective role against depressive symptoms (both PHQ-9 and PHQ-6 scores) among women than men (p < 0.05).ConclusionsAcute life stress and the number of chronic conditions, together with socio-demographic factors, explain most variance in depressive symptoms among chronically ill Chinese individuals. Somatic items in the PHQ-9 increased the depression scores but they did not alter the pattern of predictors. Family support appears to be an important protective factor in Chinese cultures for individuals with chronic conditions.

For non-exercising people, the number of steps walked is more strongly associated with health than time spent walking

OBJECTIVE This study examined the associations between walking (number of steps and minutes spent) and seven health indicators, including chronic health conditions, depressive symptoms, and blood pressure, among nonexercising people who did not regularly engage in any non-walking moderate-to-vigorous physical activity in Hong Kong. DESIGN Under the FAMILY project, the number of steps per day and minutes spent walking were measured using an accelerometer. Participants (n=2417) whose only form of physical activity was walking were included in the present analysis. METHODS Three indicators of walking (number of steps, minutes spent walking at moderate intensity, and minutes spent walking at light intensity) was measured by accelerometer. Associations between these indicators and seven health conditions were measured by the difference in z scores for those with, and those without, each health condition, adjusted for age and sex. RESULTS The number of steps per day was significantly and inversely associated with hypertension (difference in z=-0.22, p<0.01), cancer (difference in z=-0.43, p<0.05), stroke (difference in z=-0.63, p<0.01), depressive symptoms (difference in z=-0.15, p<0.01), health-related quality-of-life (difference in z=-0.13, p<0.05), and pulse rate (difference in z=-0.11, p<0.01). By contrast, time spent walking as measured by accelerometer was associated only with a single health indicator (hypertension, difference in z=-0.14, p<0.05). CONCLUSIONS Even among non-exercising people, accumulating number of steps appears to be related to fewer health problems and should be promoted as an accessible form of exercise, especially for those who lack the time or ability to engage in physical activity of at least moderate intensity.

Passive smoking increased risk of gestational diabetes mellitus independently and synergistically with prepregnancy obesity in Tianjin, China

Passive smoking increased type 2 diabetes mellitus risk, but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM.

Conceptual perspectives on the co-occurrence of mental and physical disease: Diabetes and depression as a model

Diabetes and depression provide a model for understanding the comorbidity of mental and physical disorders, as each influences the other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. Diabetes and depression may be viewed as: (1) categories or dimensions, (2) single problems or parts of broader categories, e.g. metabolic/cardiovascular abnormalities or negative emotions, (3) separate comorbidities or integrated so that depression is seen as part of the comprehensive, normal clinical picture of diabetes, and (4) expressions of a shared, complex biosocial propensity to chronic disease and psychological distress. Interventions should reflect the commonalities among chronic mental and physical disorders and should include integrated clinical care and self-management programs along with population approaches to prevention and management. Among these, peer support, self-management and problem solving, and programs for whole communities are promising approaches. Self-management and problem solving may also provide a coherent framework for integrating the diverse management of tasks and objectives of those affected by diabetes and depression and as a model for prevalent multimorbidity.

Quality of Life and Person-Centered Outcomes: Considerations for Behavioral Medicine

Quality of life (QoL) is frequently considered an important endpoint, in addition to biomedical outcomes, in clinical trials, and its assessment is becoming increasingly commonplace in routine clinical practice. The past few decades have demonstrated the value of QoL measurement for various purposes: to identify the holistic impact of chronic medical conditions, to determine ways to improve medical treatments, and to guide the selection, rationalization, and evaluation of treatments and regimens. In this chapter, we examine QoL – how it is conceptualized, operationalized, and measured in research and practice. Given that life expectancy has increased significantly in the past century, and an increasing number of people are living with one or more medical conditions, the effects of chronic care management and collaborative approaches to healthcare delivery are discussed alongside behavioral interventions to improve QoL. With the growing emphasis on QoL in clinical care and recent policy initiatives, considerations for how to integrate QoL into a complex environment are introduced and explored.

Tea consumption and risk of type 2 diabetes: a longitudinal study with data from the Chinese Health and Nutrition Survey

Abstract Background Polyphenols identified in tea, such as catechins and epigallocatechin gallate, have been reported to be protective to diabetes in cell-based and animal studies. However, the association between tea consumption and incidence of type 2 diabetes in human beings is unclear. Our study aimed to assess the association between tea consumption and type 2 diabetes in people living in China, where tea is a commonly consumed beverage. Methods Participants were from the Chinese Health and Nutrition Survey, covering nine provinces (Heilongjiang, Liaoning, Shandong, Henan, Jiangsu, Hubei, Hunan, Guizhou, and Guangxi) of China. Our study included people aged at least 18 years who provided valid responses in the questionnaire with regards to tea consumption (n=12 771). Data for tea consumption and other participant characteristics were collected in 1997, 2000, 2004, 2006, and 2009, while data for incidence of self-reported type 2 diabetes was collected in 2000, 2004, 2006, 2009, and 2011. Interval-censored Cox regression with time-varying covariates was used to estimate the hazard ratio (HR) of tea consumption on incidence of type 2 diabetes. The HR was adjusted for age, sex, education level, smoking status, alcohol consumption, coffee consumption, physical activity, BMI, and hypertension. Findings Mean follow-up was 3·8 times over 8·5 years. 177 patients reported type 2 diabetes. At baseline, 8281 (65%) people drank no tea, 1 294 (10%) drank less than one cup (240 ml) per day, 1 054 (8%) drank one to two cups, and 2142 (17%) drank more than two cups. Compared with those who did not drink tea, those who drank less than one cup of tea per day had an adjusted HR for type 2 diabetes of 1·22 (95% CI 1·11–1·35), those who drank one to two cups had an adjusted HR of 1·35 (95% CI 1·23–1·49), and those who drank two or more cups had an adjusted HR of 1·39 (95% CI 1·30–1·48). Informed patient consent was given by all participants Interpretation Tea consumption was positively associated with risk of type 2 diabetes in Chinese adults. The main strength of the study was the multiple follow-ups on tea consumption, which allowed us to track the longitudinal changes among the participants. A major limitation was the self-reporting nature of the type 2 diabetes diagnosis. Further studies on the effects of tea constituents, other than polyphenols, on type 2 diabetes are warranted. Funding None.