Shih-Tzer Tsai

Different association of hypertension and insulin-related metabolic syndrome between men and women in 8437 nondiabetic Chinese

Insulin resistance may cause a metabolic syndrome but whether insulin resistance causes hypertension is very controversial. Furthermore, it remains unclear whether the link between the insulin-resistance-related metabolic syndrome and hypertension is different between men and women. We examined fasting insulin, glucose, triglyceride and high-density lipoprotein (HDL)-cholesterol levels, systolic blood pressure, body mass index, and waist-to-hip ratio in a dataset from 8437 nondiabetic residents (age range, 30 to 89 years) in Kinmen. Factor analysis, a multivariate correlation statistical technique, was used to investigate the clustering and interdependence of these risk variables. Factor analysis identified two factors for men (n = 3659) and three factors for women (n = 4778, respectively. In men, a cluster of insulin, triglyceride, HDL-cholesterol, body mass index, and waist-to-hip ratio (metabolic syndrome) accounted for 29.7%, and a cluster of systolic blood pressure and glucose (hyperglycemia plus hypertension) accounted for 18.1% of the total variance in all variables considered. In women, a cluster of insulin, triglyceride, body mass index, waist-to-hip ratio, and systolic blood pressure (metabolic syndrome plus hypertension) accounted for 29.4%, a cluster of systolic blood pressure, glucose, and triglyceride (hyperglycemia plus hypertension plus dyslipidemia) accounted for 14.0%, and a cluster of triglyceride and HDL-cholesterol (dyslipidemia) accounted for 16.2% of the total variance. In conclusion, a distinct insulin-resistance-related metabolic syndrome characterized by hyperinsulinemia, dyslipidemia, and obesity was observed for both men and women in this Chinese population. However, hypertension was linked to the metabolic syndrome in women only.

Progression to type 2 diabetes among high-risk groups in Kin-Chen, Kinmen. Exploring the natural history of type 2 diabetes.

OBJECTIVE To examine the natural history of 654 high-risk subjects (340 men and 314 women) with fasting hyperglycemia (first fasting plasma glucose [FPG] level 5.6–7.8 mmol/1) who also exhibited 2-h postload glucose concentrations <11.1 mmol/1 and an FPG level <7.8 mmol/1 in a 75-g oral glucose tolerance test (OGTT). We were particularly interested in comparing the likelihood of developing type 2 diabetes for those with persistent fasting hyperglycemia (PFH), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). PFH is a relatively new definition, and those with PFH used to be defined as NGT according to WHO criteria. RESEARCH DESIGN AND METHODS Subjects were located in a 1992–1994 community-based population survey and followed up and reexamined during 1995–1996. An OGTT was used to determine who had progressed to type 2 diabetes. Risk factors predictive of subsequent progression to type 2 diabetes were determined by comparing baseline variables from the 1992–1994 survey with data of those who had or had not progressed to type 2 diabetes in 1995–1996. RESULTS Of 654 high-risk subjects screened in the baseline survey 481 (73.5%, 255 men and 226 women) were followed up. Of these, 8.1% had progressed to diabetes (4.1% progression/year, 95% Cl 2.3–5.9). Of 131 baseline IGT subjects, 17.6% progressed to diabetes (8.8% progression/year, 6.3–11.3), but only 7.4% of 95 PFH subjects (3.7% progression/year, 2.0–5.4) and 3.5% of 255 NGT subjects (1.8% progression/year, 0.1–3.0) progressed to diabetes. CONCLUSIONS The rates of progression to type 2 diabetes were lowest from the NGT subgroup, highest from the IGT group, with the PFH group in the middle, suggesting that PFH might be a transitional condition that precedes IGT and diabetes. Other significant predictors of subsequent diabetes were baseline BMI, baseline hyperuricemia, baseline FPG, and 2-h plasma glucose concentration.

The impact of years since menopause on the development of impaired glucose tolerance.

This is a community-based population survey carried out by the Yang-Ming Crusade to investigate the impact of years since menopause on the development of glucose intolerance in post-menopausal women. A total of 5412 women were screened with fasting plasma glucose. Those with fasting plasma glucose levels between 5.5 and 7.8 mM were given an oral glucose tolerance test. Among the 5412 women screened, 2039 (37.7%) were post-menopausal with a median age at menopause of 49 years. Pre-menopausal women showed impaired glucose tolerance (IGT) and diabetes mellitus (DM) prevalences of 3.7% and 3.1% respectively, whereas the corresponding figures for post-menopausal women were 8.4% and 17.6%, respectively. Comparing DM versus normal glucose tolerance (NGT) and IGT versus NGT as dependent variables in logistic regression analysis, menopause status was significantly associated with DM and IGT. In post-menopausal women, after maintaining body mass index, waist-hip ratio, systolic blood pressure, diastolic blood pressure, family history of DM, age at menopause, cholesterol, high density lipoprotein cholesterol and triglycerides as controls, years since menopause was the only significant factor associated with IGT (OR = 1.05, 95%CI 1.01-1.08) and years since menopause was not associated with DM. Further analysis indicated years since menopause (OR = 1.06, 95%CI, 1.01-1.11) was the only factor significantly associated with IGT for women whose age at menopause was greater than 49 years. Our study indicates that in subjects who have not undergone hormone replacement therapy and whose age at menopause is greater than 49 years, an increase in years since menopause confers a negative influence on glucose tolerance and increases the risk of IGT by 6% for each year after menopause.

Direct costs-of-illness of patients with diabetes mellitus in Taiwan

The purpose of the present study was to examine the characteristics of healthcare costs for diabetic patients in Taiwan. The study analyzed claim data from the Bureau of National Health Insurance for the period from July 1997 to June 1998. There were 536159 documented diabetic patients who were treated within the universal healthcare system in Taiwan during this study period. The annual number of visits of these diabetic patients was 6.2% of the total outpatient visits of all patients due to all causes during the one-year study period. Diabetes-related problems were the causes of 25.2% of outpatient visits among diabetic patients, while 74.8% of visits were for causes unrelated to diabetes. The distribution of treatment for the diabetic patients was by oral hypoglycemic agents 88.3%, insulin only 6.9%, and a combination of insulin and oral agents 4.8%. Diabetic patients accounted for 4,724,711 hospital inpatient days during the study period, which was 22.1% of the total inpatient days in Taiwan. Of the inpatient admissions, 13.9% were for diabetes as the principal cause, 23.4% were for diabetes-related disease, and 62.7% were for causes unrelated to diabetes. The direct costs of healthcare for the documented diabetic patients was 11.5% of the total costs of healthcare in Taiwan, and was 4.3 times higher than the average costs of care for non-diabetic individuals.

A Population Survey on the Prevalence of Diabetes in Kin-Hu, Kinmen

OBJECTIVE To investigate the prevalence of non-insulin-dependent-diabetes mellitus in Kin-Hu, Kinmen. RESEARCH DESIGN AND METHODS This is a community-based population survey. The target population are residents ≥30 years of age in Kin-Hu, Kinmen, according to the official household registry in 1990. Face to face interviews were conducted by the Yang-Ming Crusade in 1991 using a structured questionnaire. Fasting blood samples were drawn by public health nurses, and a 75-g oral glucose tolerance test was performed for definite diagnosis of diabetes. RESULTS ; There were 4,097 eligible subjects (2,026 men and 2,071 women), and 3,236 had complete fasting plasma glucose data (1,536 men and 1,700 women). The response rate was 79% (76% for men and 82% for women). The age-specific response rates were 81% for the 30- to 39-year and 50- to 59-year age-groups, 84% for the 40- to 49-year age-group, and 69% for the ≥60-year age-group. The crude prevalence of diabetes in Kin-Hu was 6.5% (2.0% previous and 4.5% new). With the standard world population of Segi, the age-adjusted prevalence rate was 4.9% (4.5% for men and 5.4% for women). The prevalence rate of diabetes increased significantly with age. The prevalence of previously diagnosed diabetes accounted for less than one third of the total rate. CONCLUSIONS The population survey in Kin-Hu, Kinmen, had a high response rate of 79%. The crude prevalence rate of diabetes was 6.5%, and the age-adjusted prevalence rate was 4.9%. The low ratio of previously diagnosed to newly diagnosed diabetic cases may be due to lack of public awareness and medical services in this community.

Relative role of insulin resistance and β-cell dysfunction in the progression to type 2 diabetes—The Kinmen Study

This study compared the relative role of insulin resistance and beta-cell dysfunction (both assessed using the HOMA method) with glucose intolerance conditions in the progression to type 2 diabetes among a high risk group of subjects with fasting plasma glucose (FPG) 5.6-7.0 mmol/l in Kinmen, Taiwan. Data were collected during a continuing prospective study (1998-99) of a group of Taiwanese subjects at high-risk of developing type 2 diabetes who had fasting hyperglycemia (5.6-7.0 mmol/l) and exhibited 2-h postload glucose concentrations <11.1 mmol/l from 1992-94 to 1995-96. Among 644 non-diabetic subjects at baseline, 79.8% (514/644) had at least one follow-up examination. There were 107 new cases of diabetes diagnosed by 1999 WHO criteria in 2918.7 person-years of follow-up. The incidence rate was 3.67%/year (107/2918.7). After adjustment for other possible associative variables, including gender, age, BMI, waist circumference, insulin resistance, and beta-cell dysfunction, Coxs hazard model showed that those individuals with isolated IFG (impaired fasting glucose) and those individuals with isolated IGT (2-h glucose impairment) exhibited similar risk of developing diabetes. Those individuals with isolated IFG and isolated IGT showed a comparable impairment of basal or hepatic insulin sensitivity, but those individuals with isolated IFG had a greater beta-cell dysfunction by the HOMA method.

The impact of diabetes on economic costs in dialysis patients: experiences in Taiwan

Diabetes mellitus carries a great burden on healthcare costs due to its growing population and high co-morbidity. This adverse effect sustains even when patients develop end-stage renal disease (ESRD). We here present data showing the effect of diabetes on economic costs in dialysis therapy in Taiwan. As of the end of 1997, we have 22,027 ESRD patients with a prevalence and incidence rate of 1013 and 253 per million populations, respectively. Diabetic nephropathy is the second most common cause of the underlying renal diseases, but accounts for 24.8% of the prevalent patients and 35.9% of the incident cases. The diabetic patients engendered 11.8% more expense for care of dialysis than the non-diabetic patients (US

Correlation of fasting serum C-peptide and insulin with markers of metabolic syndrome-X in a homogeneous Chinese population with normal glucose tolerance

26,988 vs. US

Epidemiology of type 2 diabetes in Taiwan

24,146 per patient-year). Higher inpatient cost mainly account for the difference. As compared to non-diabetic patients, the diabetic patients had 3.5 times more inpatients costs (US

Comparison of the prevalence in two diabetes surveys in Pu-Li, Taiwan, 1987–1988 and 1991–1992

1325 vs. US