Xixing Zhu

High prevalence of chronic kidney disease in population-based patients diagnosed with type 2 diabetes in downtown Shanghai

OBJECTIVE This study aimed to evaluate the prevalence of chronic kidney disease (CKD) and the risk factors associated with CKD among Chinese patients diagnosed with type 2 diabetes aged over 30 in downtown Shanghai and to assess the relationship between CKD and diabetic retinopathy (DR). METHODS We investigated 1039 Chinese patients diagnosed with type 2 diabetes aged over 30 by randomized cluster sampling in downtown Shanghai, and 1009 patients in this study were analyzed based on data integrity. Body measurements including height, weight, waist circumference and hip circumference, resting blood pressure, fasting blood measures, and urinary albumin-to-creatinine ratio (ACR), as well as the digitally stored fundus images, were investigated. Glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault equation. The prevalence of CKD was calculated, and the risk factors associated with CKD were evaluated using stepwise logistic regression. The relationship between CKD and DR was evaluated using Spearman correlation and the chi-square test. RESULTS The following were the results found in this study: (a) The prevalence rate of CKD (Stages 1-5) was 63.9% in Chinese patients diagnosed with type 2 diabetes, 8.8% in those with CKD Stage 1, 22.3% in those with CKD Stage 2, and 32.8% in those with CKD Stages 3-5 (GFR<60 ml/min/1.73 m(2)). The prevalence of CKD increased with age. (b) CKD patients were older and had higher duration of diabetes, systolic blood pressure, urea nitrogen, uric acid, creatinine, and ACR of the first urine than those without CKD. (c) Male patients had a higher percentage of CKD Stages 3-5, and female patients had a higher percentage of CKD Stages 1-2. (d) CKD was significantly associated with duration of diabetes, older age, systolic blood pressure, and serum urea nitrogen based on logistic regression analysis. (e) Of the patients without CKD, 15.6% had DR, and of those with CKD, 27.6% had DR. The decrease in GFR was significantly correlated with DR after controlling for sex, age, and albuminuria staging. CONCLUSION The high prevalence of CKD observed in Chinese patients diagnosed with type 2 diabetes aged over 30 in downtown Shanghai was similar to that in Western patients, and the cause of CKD is likely to be any of the following: type 2 diabetes, IgA nephropathy, hypertension, or any combination of these. The screening program for GFR in type 2 diabetic patients should be performed even on those with normoalbuminuria. The decrease in GFR might predict the occurrence of DR among patients diagnosed with type 2 diabetes.

High prevalence of diabetic neuropathy in population-based patients diagnosed with type 2 diabetes in the Shanghai downtown

AIMS To determine the prevalence of diabetic peripheral neuropathy (DPN) and risk factors associated with DPN in type 2 diabetic patients. METHODS 435 diabetic patients were evaluated on complete foot examination. Body mass measurements, resting blood pressure, fasting blood measures, urinary albumin-to-creatinine ratio (ACR) and the digitally stored fundus images were investigated. RESULTS (1) The prevalence of DPN was 61.8% among the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown, 59.1% with vibration perception threshold > or =25 V and 13.8% with inability to feel the monofilament. (2) DPN was significantly associated with age (beta: 0.068, S.E.: 0.013, OR: 1.070, CI: 1.043-1.098, P<0.001) and HbA1c (beta: 0.224, S.E.: 0.081, OR: 1.251, CI: 1.067-1.466, P=0.006) by a logistic regression analysis. (3) The percentage of diabetic retinopathy (DR) in the DPN group (26.5%) was significantly higher than that in the non-DPN group (15.2%). (4) The percentage of macroalbuminuria in the DPN group (9.0%) was significantly higher than that in the non-DPN group (1.8%). CONCLUSIONS The prevalence of DPN observed in the Chinese patients diagnosed with type 2 diabetes aged over 30 in the Shanghai downtown reached up to 61.8% though the observations in our study might be representative of the diabetic patients of the Shanghai downtown.

Early-stage atherosclerosis in newly diagnosed, untreated type 2 diabetes mellitus and impaired glucose tolerance

AIM The aim of this study was to investigate early-stage atherosclerosis in newly diagnosed, untreated type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT). METHODS The study subjects underwent an oral glucose tolerance test (OGTT) and were then divided into three groups, according to plasma glucose level: those in the normal glucose tolerance (NGT) group had fasting plasma glucose (FPG)<6.1mmol/L and 2h postload glucose (2hPPG)<7.8mmol/L; those in the IGT group had FPG<6.1mmol/L and 2hPPG>or=7.8mmol/L; and those in the T2DM group had FPG>or=7.0mmol/L or 2hPPG>or=11.1mmol/L. Haemodynamic variables and brachial-ankle pulse-wave velocities (baPWV) in the three groups were compared. RESULTS The baPWV value increased with increases in plasma glucose, and was significantly and positively correlated to age, FPG, 2hPPG, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference and waist-to-hip ratio. Significant differences were found between the baPWV values in the NGT and IGT groups (1602+/-347 vs 1707+/-351cm/s, respectively; P=0.005), and between the NGT and DM groups (1602+/-347 vs 1762+/-381, respectively; P<0.001). The results of multiple regression analyses showed that 2hPPG was closely related to baPWV as well as to SBP and DBP. CONCLUSION Early-stage atherosclerosis is present in newly diagnosed, untreated T2DM and IGT patients, and it may be that its early assessment, along with good control of hypertension and hyperglycaemia, will help to delay its progression.

Diagnostic potential of serum protein pattern in Type 2 diabetic nephropathy

Aims  Microalbuminuria is the earliest clinical sign of diabetic nephropathy (DN). However, the multifactorial nature of DN supports the application of combined markers as a diagnostic tool. Thus, another screening approach, such as protein profiling, is required for accurate diagnosis. Surface enhanced laser desorption/ionization time‐of‐flight mass spectrometry (SELDI‐TOF‐MS) is a novel method for biomarker discovery. We aimed to use SELDI and bioinformatics to define and validate a DN‐specific protein pattern in serum.

Performance and comparison of the Cockcroft-Gault and simplified Modification of Diet in Renal Disease formulae in estimating glomerular filtration rate in a Chinese Type 2 diabetic population.

Aims  Our aim was to assess performances of the Cockcroft–Gault and simplified Modification of Diet in Renal Disease (MDRD) formulae in estimating glomerular filtration rate (GFR) in Chinese diabetic populations and their association with vascular risks.

An Evaluation of the Diabetic Kidney Disease Definition in Chinese Patients Diagnosed with Type 2 Diabetes Mellitus

The concomitant presence of retinopathy may be helpful in discriminating kidney pathology in type 2 diabetes. This cross-sectional study evaluated the ability to predict the likelihood of patients having diabetic kidney disease (DKD) by comparing the percentage incidence of diabetic retinopathy in different subgroups of Chinese patients with type 2 diabetes (n = 668). The prevalence of chronic kidney disease in the patients was 63.3% (6.6% with DKD, 41.0% with possible DKD and 15.7% with non-diabetic renal disease [NDRD]). The percentage of patients with diabetic retinopathy in the DKD group (63.6%) was significantly higher than in the possible DKD group (24.9%) and the NDRD group (19.0%). DKD was independently associated with diabetic retinopathy based on logistic regression analysis. The likelihood of DKD occurrence as defined by the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative™ of the USA is applicable to Chinese patients with diabetes. Diabetic retinopathy was more prevalent in patients with DKD compared with patients with possible DKD or NDRD.

The Association of Dysglycaemia and Cardiovascular Disease in Patients with Metabolic Syndrome

The objective of this study was to investigate the relationship between increased prevalence of cardiovascular disease and glucose regulation status in Chinese patients with metabolic syndrome (MetS). All patients underwent an oral glucose tolerance test (2-h post-load plasma glucose) to determine their glucose regulation status and had their brachial–ankle pulse wave velocity (baPWV) measured. Of the 590 patients included in the study, 115 (19.5%) had normal glucose tolerance, 114 (19.3%) had impaired fasting glucose (IFG) alone, 38 (6.4%) had impaired glucose tolerance (IGT) alone, 197 (33.4%) had diabetes mellitus and 126 (21.4%) had combined glucose intolerance (CGI; IFG plus IGT). Patients with diabetes mellitus had a significantly higher baPWV compared with all other groups and patients with CGI had a significantly higher baPWW compared with patients with IFG. Dysglycaemia was common in patients with MetS. An increased prevalence of cardiovascular disease in patients with MetS was related to their glucose regulation status.