Tai Ty

The status of diabetes control in Asia—a cross‐sectional survey of 24 317 patients with diabetes mellitus in 1998

Aims To establish the status of diabetes control in Asia, the Diabcare‐Asia 1998 study collected data from 230 diabetes centres in Bangladesh, Peoples Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998.

High frequency of two mutations in codon 778 in exon 8 of the ATP7B gene in Taiwanese families with Wilson disease.

The gene for Wilson disease (WD) has been cloned as a P type copper transporter gene (ATP7B). To elucidate the possible genetic mechanism for the diversity of clinical manifestations, we characterised 22 Taiwanese families with WD by microsatellite haplotyping of close DNA markers D13S314-D13S301-D13S316. We also screened for mutations of codon 778 in the transmembrane region. There were at least 15 haplotypes within eight broad subgroups observed among 44 WD chromosomes. Among the 22 unrelated patients, we found that six patients (27%) carried a codon 778 mutation. Nucleotide sequence analysis showed there were two different mutations: the previously reported Arg778Leu mutation in four patients and Arg778Gln, a new mutation, in two patients. The two different mutations of the same codon occurred in two distinct microsatellite haplotypes.

The current state of diabetes management in Taiwan

The aim of this study was to provide an overview of diabetes management and complication status in Taiwan. A cohort of 2446 patients (from 25 diabetic centers) with more than 12 months of diabetes management participated and data were collected by interviews and reviewing the medical records. Overall, 97% were diagnosed as type 2 diabetes, with a mean age (+/-S.D.) of 61.6+/-11.3 years, duration of diabetes of 10.3+/-7.3 years and age at onset of diabetes of 51.5+/-11.8 years. Mean BMI was 25.1+/-3.6 kg/m(2) and about 50% had BMI>25 kg/m(2). Majority (75%) were treated with oral hypoglycemic agents (OHAs), 14% with insulin and 10% with combination of insulin and OHA. Mean HbA(1c) was 8.1+/-1.6% and 59% had HbA(1c) >7.4% (1% above the upper limit of normal range, 4.7-6.4%). Mean FBG was 9.0+/-3.3 mmol/l and 59% had FBG>7.8 mmol/l. Of all the patients who had screening for complications, cataract (38%), neuropathy (30%), proteinuria (17%) and stroke (6%) were the most frequently reported eye, feet, kidney and late complications. We conclude that the majority of patients involved in this study had unsatisfactory glycaemic control which may lead to diabetes complications.

Secular trend for mortality from breast cancer and the association between diabetes and breast cancer in Taiwan between 1995 and 2006

Aims/hypothesisStudies have identified an association between diabetes and breast cancer in postmenopausal women in Western countries. Such an association needs to be confirmed in an Asian population. The aim of this study was to evaluate the secular trend for breast cancer mortality in Taiwanese women in the general population and the mortality rate ratios between diabetic patients and the general population.MethodsAge-specific mortality rates for the general population, categorised into groups aged 25–54, 55–64, 65–74 and ≥75xa0years, were calculated for the years between 1995 and 2006 (inclusive) from vital statistics published by the Taiwanese government. Linear regression was used to test the trends. A total of 131,573 diabetic women aged ≥25xa0years from a national cohort recruited between 1995 and 1998 (inclusive) were followed prospectively for vital status, determined from the National Register of Deaths. Mortality rates and mortality rate ratios (mortality rate in diabetic women vs the average and highest mortality rates for the general population) were calculated.ResultsA total of 14,230 women aged ≥25xa0years in the general population died of breast cancer between 1995 and 2006. A trend for an increase in the annual rate was observed for all age groups. A total of 482 diabetic women died of breast cancer, with a crude mortality rate of 45.7 per 100,000 person-years. Compared with the general population the relative risk of mortality for those with diabetes ranged from 1.37 (for the group aged 55–64xa0years) to 2.43 (for the group aged 25–54xa0years).Conclusions/interpretationWe identified a secular trend of an increase in the rate of breast cancer mortality in the Taiwanese general population. Our data suggest a higher risk of breast cancer mortality in diabetic patients in all age groups.

Abnormal Peripheral Microcirculation in Seemingly Normal Subjects Living in Blackfoot-Disease-Hyperendemic Villages in Taiwan

Blackfoot disease (BFD) is an endemic peripheral arterial disease confined to the southwestern coast of Taiwan. The cause of the disease has been ascribed to the high-arsenic artesian well water. The purpose of this study was to examine the possible association between the long-term exposure to artesian well water and the change in microvascular circulation in the absence of peripheral arterial insufficiency. A total of 45 men living in the BFD-hyperendemic villages and another 51 age- sex- body-mass index-matched men who lived in nonendemic villages nearby were recruited into this study. All subjects were free from peripheral vascular disease (resting ankle-brachial index > 1.00), clinical claudication, cigarette smoking, diabetes mellitus, hypertension, ischemic heart disease, cerebral infarction and obesity. Laser Doppler flowmetry was used to measure the peripheral microcirculation on the big toes both at 36 degrees C (basal perfusion, Pb) and after a hyperthermic test at 42 degrees C (Ph). The time required to reach Ph (T), and the average rate (R) of increase from Pb to Ph measured by (Ph-Pb)/T were also calculated. Results showed that those living in the BFD-hyperendemic area had a lower Pb [32.8 +/- 6.0 perfusion units (PU) vs. 67.0 +/- 4.3 PU, p < 0.001], a lower Ph (193.2 +/- 13.6 vs. 231.1 +/- 6.3 PU, p < 0.005), a longer T (3.04 +/- 0.19 vs. 1.31 +/- 0.08 min, p < 0.001) and a slower rate of increase from Pb to Ph (48.0 +/- 4.8 vs. 76.2 +/- 5.4 PU/min, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adiponectin mRNA levels in the abdominal adipose depots of nondiabetic women

BACKGROUND: The human adiponectin gene has been implicated in the pathophysiology of obesity, type II diabetes mellitus, dyslipidemia and atherosclerosis. Investigation of the physiological functions of the adiponectin gene in humans was mainly conducted at the levels of plasma proteins or DNA polymorphisms. The depot-specific adiponectin mRNA levels also could be relevant to these physiological functions.OBJECTIVES: The relation between the adipose depot-specific adiponectin mRNA expression levels and various metabolic factors, including BMI, fasting plasma glucose, insulin, triglycerides (TGs) and HDL-cholesterol and insulin resistance index by HOMA, was investigated among 66 nondiabetic women using quantitative real-time PCR.RESULTS: The subcutaneous relative adiponectin mRNA levels (SRAmR) correlated significantly with the omental relative adiponectin mRNA levels (ORAmR) (γ=0.468, P=0.0001). The SRAmR correlated inversely with the fasting plasma glucose with a borderline significance (γ=−0.35, P=0.058). On the other hand, the ORAmR correlated negatively with serum TG levels with the adjustment for age (γ=−0.33, P=0.007) or age plus BMI (γ=−0.27, P=0.027).CONCLUSION: These results indicate that the adiponectin mRNA levels in different adipose depots were at least related to certain phenotypes of metabolic syndrome. The expression levels of adiponectin in the omental adipose depots are related to TG metabolism.

The incidence of type 2 diabetes mellitus in Taiwan

Currently, diabetes mellitus is the fifth leading cause of death in Taiwan. The trends of diabetes mortality is increasing steadily. Epidemiologic studies also showed increasing prevalence of diabetes mellitus over the past few decades. The incidence of diabetes mellitus in Taiwan has only been studied in recent 10 years. The areas that have been included as study areas for diabetes incidence are Kin-Chen (Kinmen), Chu-Dung, Pu-Tzu, Pu-Li and Pu-Tai. The reported incidence rates ranged from 1.0 to 4.0% per year for people with varying degrees of baseline plasma glucose levels not reaching the diagnosis of diabetes mellitus according to the criteria of the World Health Organization. Age, baseline glucose level, and obesity are important predictors for the development of diabetes mellitus. In the Pu-Tai study, which was aimed at following a group of people who had been living in the hyperendemic villages of blackfoot disease and had been exposed to arsenic from drinking artesian well water, the incidence of diabetes mellitus was calculated to be 27.4 per 1000 person years. The incidence of diabetes mellitus in these arseniasis-hyperendemic villages correlated with age, body mass index and cumulative arsenic exposure.

The Diabcare-Asia 1998 Study -Outcomes on Control and Complications in Type 1 and Type 2 Diabetic Patients

Summary The aim of this study was to describe the glycaemic and metabolic control and diabetes-related complications in type 1 and type 2 Asian patients. Methods: Data of diabetes patients from 230 diabetes centres in 12 Asian regions were collected on a retrospective-prospective basis through review of medical records, interview and laboratory assessments. Analysis of glycated haemoglobin (HbA1c) was carried out in central laboratories appointed by Bio-Rad. The data collection case record forms were scanned electronically. Results: 22177 patients with valid data made up the analysis population. Among patients with type 1 and type 2 diabetes, there was a higher proportion of women than men (53% vs. 47% for type 1 patients and 56% vs. 44% for type 2 diabetes). Hypertension (61%) and overweight (40% with BMI >25 kg/m2) were common in type 2 patients. Dyslipidaemia was also present in at least half of both types of patients. Control of glycaemia (mean HbA1c and fasting blood glucose [FBG]) was poor in type 1 (9.9u2009±u20092.5%; 10.2u2009±u20095.2 mmol/l) and type 2 patients (8.5u2009±u20092.0%; 8.9u2009±u20093.4 mmol/l). Glycaemia in the majority of both types of patients fell short of those stipulated by various guidelines. In type 2 patients, glycaemia deteriorated (HbA1c > 7.5%, FBG > 7.0mmol/l) with duration of diabetes > 7 years. Both types of diabetes appear to share a similar high prevalence of complications of cataract, retinopathy and neuropathy, although the prevalence of cataract (27%) and neuropathy (35%) was higher in type 2 diabetes. Screening for microalbuminuria was not common. Conclusions: The inadequate metabolic and hypertension control, especially in type 2 patients, needs to be addressed.

A case-control study on risk factors for Type 1 diabetes in Taipei City

To search for non-genetic risk factors for Type 1 diabetes among Chinese, a total of 117 Type 1 diabetes patients identified from the Taipei Type 1 Diabetes Registry and 193 frequency-matched controls with normal glucose tolerance were recruited. The controls were selected from classmates or colleagues of cases with similar distributions of age, sex, and parental and individual educational levels. Information on Type 1 diabetes risk factors was obtained through standardized interviews according to a structured questionnaire administered by two trained nurses. In the univariate analyses, the order of pregnancy of the study subject, the number of spontaneous and induced abortions reported by the mother before giving birth to the study subjects, the duration of breast-feeding and monthly family income were significantly associated with Type 1 diabetes in a dose-response manner. There was a U-shaped relationship with Type 1 diabetes for birth weight and paternal age at the conception of the study subjects. After further adjustment for multiple risk factors through logistic regression analysis, the biological gradient for pregnancy order, duration of breast-feeding, and the U-shaped relationship for paternal age remained statistically significant.

HLA DRB1/DQA1/DQB1 haplotype determines thyroid autoimmunity in patients with insulin‐dependent diabetes mellitus

OBJECTIVEu2003Thyroid autoimmunity is frequently associated with insulin‐dependent diabetes mellitus (IDDM). The genetic factors which contribute to thyroid autoimmunity and IDDM have been described but vary between different races. We have therefore investigated the effect of class II HLA genes at both loci and the HLA haplotypes on the presence of autoimmunity in patients with IDDM in Taiwan.