Jungong Zhao

Serum fibroblast growth factor 21 levels is associated with lower extremity atherosclerotic disease in Chinese female diabetic patients

BackgroundFibroblast growth factor 21 (FGF21) is an emerging metabolic regulator associated with glucose and lipid metabolism, and it is still unclear whether FGF21 is related to atherosclerosis. Here, we explored the potential link between FGF21 and lower extremity atherosclerotic disease (LEAD) in type 2 diabetic patients.MethodsA cross-sectional study was conducted on 504 type 2 diabetic patients (283 men, 221 women). LEAD was defined by Ankle-brachial index (ABI) <0.9 and lower extremity arterial plaque evaluated by color Doppler ultrasound. Serum FGF21 concentrations were quantified by a sandwich enzyme-linked immunosorbent assay.ResultsThe total FGF21 levels of male and female patients had no significant differenence ((299.14(177.31-534.49) vs 362.50(214.01-578.73), P=0.516). Serum FGF21 levels in LEAD group were significantly higher than non-LEAD group in females (385.34(243.89-661.54) vs 313.13(156.38-485.79), P=0.006), while not in male patients (295.52(177.09-549.64) vs 342.09 (198.70-549.87), P=0.613). In diabetic women, subjects with LEAD had significantly higher serum FGF21 regardless of non-alcoholic fatty liver disease (NAFLD) (P < 0.05). And serum FGF21 levels were positively correlated with waist circumference and systolic blood pressure after adjusted for age and BMI (r=0.198, P=0.004; r=0.152, P=0.027; respectively). Moreover, FGF21 was independently tied to femoral intima-media thickness (FIMT) (β=0.208, P=0.031). After adjusted for other LEAD risk factors, FGF21 was demonstrated to be an independent risk factor for LEAD in type 2 diabetic women (OR, 1.106; 95%CI 1.008-1.223; P=0.028). In addition, FGF21 was negatively correlated with estradiol in premenopausal diabetic women (r=−0.368, P=0.009). After adjusted for estradiol, serum FGF21 levels were still positively associated with FIMT in premenopausal diabetic women (r=0.381, P=0.007). In diabetic men, serum FGF21 levels were correlated with triglyceride and C-reactive protein even after adjusted for age and BMI (r=0.204, P=0.001; r=0.312, P < 0.001; respectively). However, serum FGF21 was not an independent impact factor for LEAD in men (P > 0.05).ConclusionsSerum FGF21 level independently and positively links LEAD in Chinese women with type 2 diabetes. The gender difference may be due to different estrogen levels.

Cystatin C: a strong marker for lower limb ischemia in Chinese type 2 diabetic patients?

Objective Cystatin C is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum cystatin C levels and peripheral arterial disease and to explore its diagnostic value for lower limb ischemia (LLI) in type 2 diabetic population. Methods A total of 1609 T2DM patients were included in this cross-sectional study. Their clinical and biochemical characteristics, ankle-brachial index (ABI), carotid and lower extremity arterial ultrasound were detected. LLI was defined by ABI <0.9 and lower extremity arterial stenosis >50% by ultrasound examination. Patients were divided to two groups: with LLI and without. The risk factors of LLI were explored by binary logistic regression analysis. Results The serum concentrations of cystatin C were 1.53±0.60 and 1.08±0.30 mg/L in patients with and without LLI, respectively. Binary logistic regression analysis showed that the significant risk factors were cystatin C (P = 0.007, OR = 5.081), the presence of hypertension (P = 0.011, OR = 3.527), age (P<0.001, OR = 1.181), GA (P = 0.002, OR = 1.089) and diabetes duration (P = 0.008, OR = 1.074). The prevalence of coronary artery disease, cerebral infarction and LLI increased with cystatin C (P<0.01), and the prevalence of LLI in patients with cystatin C >1.2 mg/L was much higher than other three quartile groups. Receiver operating characteristic curve analysis revealed the cut point of cystatin C for LLI was 1.2 mg/L. The risk of LLI dramatically increased in patients with cystatin C >1.2 mg/L (OR = 21.793, 95% confidence interval 10.046−47.280, P<0.001). After adjusting for sex, age, duration, HbA1c, GA and hypertension, its OR still remained 3.395 (95% confidence interval 1.335–8.634). Conclusions There was a strong and independent association between cystatin C and limb arterial disease in diabetic population, and cystatin C >1.2 mg/L indicated a great increased risk of LLI.

Association between serum cystatin C and diabetic peripheral neuropathy: a cross-sectional study of a Chinese type 2 diabetic population.

OBJECTIVE Serum cystatin C (CysC) is a sensitive marker of kidney function and recent studies have shown that CysC plays a critical role in degenerative diseases in both the central and the peripheral nervous systems. The aim of this study was to explore the relationship between serum CysC and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes. METHODS In total, 937 type 2 diabetic patients were enrolled in this cross-sectional study. Serum CysC concentration was measured by immunoturbidimetry. DPN was evaluated by neurological symptoms, neurological signs, neurothesiometer, and electromyogram. RESULTS Serum CysC levels were significantly higher in DPN patients (1.3 (1.1-1.5) mg/l) compared with patients with signs of DPN (1.1 (0.9-1.3) mg/l, P<0.001) and non-DPN patients (1.0 (0.9-1.3) mg/l, P<0.001). Multiple regression analysis revealed that DPN was associated with age, diabetes duration, HbA1c, and serum CysC. Spearmans correlation analysis showed that serum CysC was closely related with age, sex, diabetes duration, hypertension, glomerular infiltration rate, and serum creatinine (Cr) level. The patients were divided into quartiles according to the serum CysC levels. Compared with quartile 1 (referent), the risk of DPN was significantly higher in quartile 2 (odds ratio (OR), 1.753; 95% CI, 1.055-2.912; P<0.05), quartile 3 (OR, 2.463; 95% CI, 1.445-4.917; P<0.01), and quartile 4 (OR, 5.867; 95% CI, 2.075-16.589; P<0.01). Receiver-operating characteristic analysis revealed that the optimal cutoff point of serum CysC to indicate DPN was 1.25 mg/l in male patients and 1.05 mg/l in female patients. High serum CysC level indicated a onefold higher risk of DPN. CONCLUSIONS High serum CysC level is closely associated with DPN and may be a potential biomarker for DPN in type 2 diabetic patients.

High Ankle–Brachial Index Indicates Cardiovascular and Peripheral Arterial Disease in Patients With Type 2 Diabetes:

We assessed the association between high ankle–brachial index (ABI) and cardiovascular disease (CVD) and peripheral arterial disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM). The ABI was measured, and foot inspection was performed in 2080 outpatients with T2DM. The clinical characters in different ABI levels were analyzed, and the diagnostic value of high ABI to CVD and PAD was determined. Compared with the normal ABI group, the high ABI (>1.3) group had a higher prevalence of CVD and PAD but less than the low ABI (≤0.9) group. High ABI was an independent risk factor for the development of CVD and PAD. Receiver–operating characteristic curve analysis showed that the optimal cutoff of high ABI to predict CVD and PAD was 1.43 and 1.45, respectively. The odds ratio of high ABI for CVD and PAD was 2.25 and 6.97, respectively, after adjusting for other confounding risk factors. In conclusion, high ABI indicated the risk of CVD and PAD in Chinese populations with T2DM.

High cystatin C levels predict severe retinopathy in type 2 diabetes patients.

Diabetes mellitus affects over 18.2 million people (or 6.3 % of the total population) in the US and over 800,000 new cases of type 2 diabetes are diagnosed every year [1]. Meanwhile, diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes, resulting in blindness for over 10,000 people with diabetes per year [1]. Cystatin C is a member of the cystatin superfamily of cystine protease inhibitors, which are produced by nucleated cells at a constant rate [2]. Evidences have shown that serum cystatin C could predict early prognostic stages of diabetic nephropathy (DN) [3] and was implicated in the mechanism of age-related macular degeneration (AMD) [4]. Charumathi et al. recently reported that elevated levels of serum cystatin C were associated with prediabetes in a nationally representative sample of nonobese US adults [5]. In order to investigate the relationship between cystatin C and diabetic retinopathy (DR) to clarify the predictive value of cystatin C for DR, we recruited a total of 954 type 2 diabetes mellitus patients from Shanghai Clinical Medical Center of Diabetes from January 2012 to November 2012. Type 2 diabetes mellitus was diagnosed according to the 1999 World Health Organization criteria and 2012 American Diabetes Association standards [6]. Patients of type 1 diabetes mellitus or specific types of diabetes mellitus, acute complications of diabetes, fundus lesions owing to orbital tumor, trauma or other definite causes and secondary nephropathy caused by acute glomerulonephritis, pyelonephritis and nephrolithiasis were excluded. Written informed consents were obtained from all participants. The study was approved by the Human Research and Ethics Committee of Shanghai Sixth People’s Hospital and adhered to the tenets of the Declaration of Helsinki. Totally, 544 males (57.02 %) and 410 females (42.98 %) were enrolled at an average age of 57.44 ± 11.24 years and the mean diabetes duration of 8.75 ± 6.43 years. Information on sex, age, duration of diabetes, and the history of smoking, coronary artery disease, hypertension and cerebral apoplexy were obtained using a questionnaire. Anthropometric measurement included weight, height and body mass index (BMI). Venous blood was drawn from all patients after an overnight fast. The levels of serum cystatin C were measured using high sensitive latex-enhanced immunoturbidimetric method and patients were categorized in quartiles based on the serum cystatin C (mg/L) as: Q1 (Quartiles 1, cystatin C B 0.8) (n = 175), Q2 (Quartiles 2, 0.9 B cystatin C B 1.0) (n = 329), Q3 (Quartiles 3, 1.1 B cystatin C B 1.2) (n = 227) and Q4 (Quartiles 4, cystatin C C 1.3) (n = 223). Other laboratory parameters included total cholesterol Rui He and Jing Shen have contributed equally to this work.

Vitamin D deficiency increases the risk of peripheral neuropathy in Chinese patients with Type 2 diabetes

Vitamin D deficiency was reported to be associated with diabetic peripheral neuropathy. But the association in Chinese population and the screening value of vitamin D deficiency for diabetic peripheral neuropathy were unknown.

A high thyroid stimulating hormone level is associated with diabetic peripheral neuropathy in type 2 diabetes patients.

AIM The association between thyroid stimulating hormone (TSH) and type 2 diabetes mellitus (T2DM) is well known. However, whether TSH is related to diabetic peripheral neuropathy (DPN) has not been studied. The aim of this study was to explore the relationship between TSH and DPN in Chinese patients with T2DM. METHODS In this cross-sectional study, 605 patients with T2DM were enrolled. Subclinical hypothyroidism (SCH) was defined as an elevated TSH level (>4.0mIU/L) and a normal free thyroxine level. DPN was evaluated by neurological symptoms, neurological signs, and electromyogram. RESULTS Serum TSH levels were significantly higher in DPN and signs of DPN compared with non-DPN T2DM patients (both P<0.01).The prevalence of DPN and signs of DPN in SCH subjects was higher than that in euthyroid subjects (both P<0.01). Spearmans correlation analysis showed that the serum TSH level was positively associated with DPN (r=0.172, P<0.01). A significant independent association between TSH and DPN was found by multiple logistic regression analysis after adjusting for potential confounding variables [odds ratio (OR)=1.365, P<0.01]. The patients were sequentially assigned to quartiles according to TSH level. Compared with quartile 1, patients in quartile 2 (P<0.01), quartile 3 (P=0.01), and quartile 4 (P<0.01) had a higher risk of DPN. Receiver-operating characteristic curve analysis revealed that the optimal cutoff point of TSH to indicate DPN was 3.045mIU/L in men and 2.94mIU/L in women. CONCLUSION TSH level is independently associated with DPN in Chinese population with T2DM. A high serum TSH level may be a potential risk factor for DPN.

Vibration perception threshold for sight- threatening retinopathy screening in type 2 diabetic outpatients

We investigated the relationship between vibration perception threshold and diabetic retinopathy and verified the screening value of vibration perception threshold for severe diabetic retinopathy.

Negative Pressure Wound Therapy Inhibit Inflammation by Up-regulating ATF-3 and Down-regulating Nuclear Factor-κB in diabetic patients with foot ulcerations.

Negative pressure wound therapy (NPWT) is one of the most important treatments for diabetic foot, but the underlying mechanisms of its benefits still remain elusive. This study aims to evaluate the inflammatory signals involved in the effects of negative pressure therapy on diabetic foot ulcers.

Pancreatic volume is reduced in patients with latent autoimmune diabetes in adults

This study aimed to compare pancreatic volume and its clinical significance among patients with type 2 diabetes mellitus (DM), adult‐onset type 1 DM and latent autoimmune diabetes in adults (LADA).