Yang L

Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial

BACKGROUNDnEarly intensive insulin therapy in patients with newly diagnosed type 2 diabetes might improve beta-cell function and result in extended glycaemic remissions. We did a multicentre, randomised trial to compare the effects of transient intensive insulin therapy (continuous subcutaneous insulin infusion [CSII] or multiple daily insulin injections [MDI]) with oral hypoglycaemic agents on beta-cell function and diabetes remission rate.nnnMETHODSn382 patients, aged 25-70 years, were enrolled from nine centres in China between September, 2004, and October, 2006. The patients, with fasting plasma glucose of 7.0-16.7 mmol/L, were randomly assigned to therapy with insulin (CSII or MDI) or oral hypoglycaemic agents for initial rapid correction of hyperglycaemia. Treatment was stopped after normoglycaemia was maintained for 2 weeks. Patients were then followed-up on diet and exercise alone. Intravenous glucose tolerance tests were done and blood glucose, insulin, and proinsulin were measured before and after therapy withdrawal and at 1-year follow-up. Primary endpoint was time of glycaemic remission and remission rate at 1 year after short-term intensive therapy. Analysis was per protocol. This study was registered with ClinicalTrials.gov, number NCT00147836.nnnFINDINGSnMore patients achieved target glycaemic control in the insulin groups (97.1% [133 of 137] in CSII and 95.2% [118 of 124] in MDI) in less time (4.0 days [SD 2.5] in CSII and 5.6 days [SD 3.8] in MDI) than those treated with oral hypoglycaemic agents (83.5% [101 of 121] and 9.3 days [SD 5.3]). Remission rates after 1 year were significantly higher in the insulin groups (51.1% in CSII and 44.9% in MDI) than in the oral hypoglycaemic agents group (26.7%; p=0.0012). beta-cell function represented by HOMA B and acute insulin response improved significantly after intensive interventions. The increase in acute insulin response was sustained in the insulin groups but significantly declined in the oral hypoglycaemic agents group at 1 year in all patients in the remission group.nnnINTERPRETATIONnEarly intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favourable outcomes on recovery and maintenance of beta-cell function and protracted glycaemic remission compared with treatment with oral hypoglycaemic agents.

Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) is increasing rapidly among Chinese adults, and limited data are available on T2DM management and the status of glycemic control in China. We assessed the efficacy of oral antidiabetes drugs (OADs), glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin for treatment of T2DM across multiple regions in China.MethodsThis was a multicenter, cross-sectional survey of outpatients conducted in 606 hospitals across China. Data from all the patients were collected between April and June, 2011.ResultsA total of 238,639 patients were included in the survey. Eligible patients were treated with either OADs alone (n=157,212 [65.88%]), OADs plus insulin (n=80,973 [33.93%]), or OADs plus GLP-1 receptor agonists (n=454 [0.19%]). The OAD monotherapy, OAD + insulin, and OAD + GLP-1 receptor agonist groups had mean glycosylated hemoglobin (HbA1c) levels (±SD) of 7.67% (±1.58%), 8.21% (±1.91%), and 7.80% (±1.76%), respectively. Among those three groups, 34.63%, 26.21%, and 36.12% met the goal of HbA1c <7.0%, respectively. Mean HbA1c and achievement of A1c <7.0% was related to the duration of T2DM.ConclusionsLess than one third of the patients had achieved the goal of HbA1c <7.0%. Glycemic control decreased and insulin use increased with the duration of diabetes.

Standards of care for type 2 diabetes in China

Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Department of Endocrinology, Peking University People’s Hospital, Beijing, China Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China Department of Endocrinology, Chinese People’s Liberation Army General Hospital, Beijing, China Institute of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital and the Diabetes Center, Central South University, Changsha, China Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China Department of Endocrinology, Qilu Hospital of Shandong University, Ji’nan, China Department of Endocrinology, Beijing Hospital, Beijing, China Department of Endocrinology, Peking University First Hospital, Beijing, China Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi’an, China Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China Department of Endocrinology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China Department of Endocrinology, The First Hospital of China Medical University, Shenyang, China Department of Endocrinology, Affiliated Hospital of Guiyang Medical University, Guiyang, China Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China Department of Endocrinology, Heilongjiang Provincial Hospital, Harbin, China Department of Endocrinology, China Japan Friendship Hospital, Beijing, China

Dipeptidyl peptidase-4 inhibitors: multitarget drugs, not only antidiabetes drugs.

Dipeptidyl peptidase (DPP)‐4 inhibitors are a new class of antidiabetic agents that reduce blood glucose by preventing the degradation of the endogenous incretin hormones glucagon‐like peptide‐1 and glucose‐dependent insulinotropic polypeptide. Protection by DPP‐4 inhibitors of β‐cell function has been demonstrated in patients with type 2 diabetes. Because DPP‐4 is an enzyme widely expressed in humans, DPP‐4 inhibitors are speculated to be multitarget agents. However, other potential therapeutic benefits of DPP‐4 inhibitors remain unknown. Recently, some therapeutic effects of DPP‐4 inhibitors, such as immune regulation, cardiovascular protection, and anti‐inflammatory effects, have been observed. This article provides a systematic and comprehensive review of current research into the newly found effects and mechanism of action of DPP‐4 inhibitors in a therapeutic context.

Glycemic Control Rate of T2DM Outpatients in China: A Multi-Center Survey

Background Type 2 diabetes mellitus (T2DM)-associated mortality and morbidity are strongly dependent on glycemic control. With T2DM prevalence increasing in China, we aimed to assess glycemic control rates in Chinese T2DM outpatients. Material/Methods A total of 9065 adult T2DM outpatients (5035 men) were assessed in 26 Chinese medical centers between August 2010 and April 2012. Patients were stratified according to BMI (kg/m2): <24, 24–28, and >28. Successful glycemic control was defined as glycated hemoglobin A1c (HbA1c) ≤7% or fasting plasma glucose (FPG) <7.0 mmol/L. Results Among the participants included in this study, 2939 had BMI <24, 3361 had BMI of 24–28, and 2764 had BMI >28. The glycemic control rate was only 32.6%, and the triple control rate for glycemia, blood pressure, and lipidemia was only 11.2%. Glycemic control rates by BMI group were 33.7% (<24), 33.8% (24–28), and 30.2% (>28) (p=0.005), and corresponding incidences of cardiovascular diseases (CVD) were 12.2%, 15.7%, and 15.9% (p<0.001). Multivariate logistic regression analysis demonstrated that older age (p<0.001), higher BMI (p=0.026), larger waist circumference (p<0.001), less education (p<0.001), and recent diagnosis (p<0.001) were independent risk factors for poor glycemic control. Conclusions The T2DM glycemic control rate in China is currently low, especially in older obese patients with poor education and recent diagnosis.

Glutamic acid decarboxylase autoantibodies are dominant but insufficient to identify most Chinese with adult-onset non-insulin requiring autoimmune diabetes: LADA China study 5.

AimsAdult-onset autoimmune diabetes is prevalent in China, in contrast to childhood-onset type 1 diabetes mellitus. Islet autoantibodies are the most important immune biomarkers to diagnose autoimmune diabetes. We assayed four different islet autoantibodies in recently diagnosed adult non-insulin-requiring diabetes Chinese subjects to investigate the best antibody assay strategy for the correct diagnosis of these subjects.MethodsLADA China study is a nation-wide multicenter study conducted in diabetes patients from 46 university-affiliated hospitals in China. Non-insulin-treated newly diagnosed adult diabetes patients (nxa0=xa02388) were centrally assayed for glutamic acid decarboxylase autoantibody (GADA), protein tyrosine phosphatase-2 autoantibody (IA-2A), and zinc transporter 8 autoantibody (ZnT8A) by radioligand assay and insulin autoantibody (IAA) by microtiter plate radioimmunoassay. Clinical data were determined locally.ResultsTwo hundred and six (8.63xa0%) subjects were autoantibody positive, of which GADA identified 5.78xa0% (138/2388) of the total, but only 67xa0% (138/206) of the autoimmune cases. IA-2A, ZnT8A, and IAA were found in 1.51, 1.84, and 1.26xa0% of the total study subjects, respectively. When assaying three islet autoantibodies, the most effective strategy was the combination of GADA, ZnT8A, and IAA, which could identify 92.2xa0% (190/206) autoimmune diabetes patients. The clinical data showed that those subjects with positive GADA had lower random C-peptide than autoantibody negative subjects (Pxa0<xa00.05).ConclusionsAs with Europeans, GADA is the dominant autoantibody in this form of autoimmune diabetes in China, but in contrast to Europeans, screening should include other diabetes-associated autoantibodies.

Low-grade albuminuria associated with brachial-ankle pulse wave velocity in young adults with type 2 diabetes mellitus in China

Cardiovascular disease is prevalent in type 2 diabetics, and microalbuminuria is associated with cardiovascular disease morbidity. We aimed to investigate the potential association between low‐grade albuminuria and arterial stiffness in patients with type 2 diabetes.

Relationship between glycated hemoglobin A1c and cognitive function in nondemented elderly patients with type 2 diabetes

Elderly patients with type 2 diabetes are at a greater risk for cognitive decline. The purpose of this study was to assess the relationship between the degree of hyperglycemia and cognitive status in nondemented, elderly diabetics. Between Jan 2013 and Dec 2014, 1174 geriatric patients with type 2 diabetes were enrolled in the study (579 males; ageu2009≥u200960xa0years; from Fuzhou, Fujian, China). Cognitive function was measured with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A statistically significant, age-adjusted association was observed between the A1C levels and the scores on two cognitive tests (MMSE and MoCA). Specifically, a 1xa0% higher A1C value was associated with a 0.21-point lower MMSE score (95xa0% CI; compare −0.11to −0.28; Pu2009<u20090.0001), as well as a 0.11-point lower MoCA score (95xa0% CI; compare −0.10 to −0.38; Pu2009<u20090.0001). Higher A1C levels were not significantly associated with lower MMSE and MoCA test scores after adjusting for all variables. No significant correlation was found between the two variables in patients older than 80xa0years of age (nu2009=u2009215; ORu2009=u20091.019; 95xa0% CIu2009=u20090.968u2009−u20091.099; pu2009=u20090.251). Evidence strongly suggests that chronic hyperglycemia is associated with a decline in cognitive function in nondemented elderly patients with type 2 diabetes. When cognitive assessments are made, comprehensive factors such as advanced age, education level, duration of diabetes, hypertension and other vascular risks should be taken into account. For older geriatric patients (age ≥80xa0years), there is no significant correlation between A1c levels and cognitive function.

Osteocalcin Improves Metabolic Profiles, Body Composition and Arterial Stiffening in an Induced Diabetic Rat Model

Recent studies have demonstrated the benefits of osteocalcin (OCN) on glucose homeostasis and metabolic dysregulation. However, its role in body composition and vascular function remains unknown. This study was designed to examine changes in metabolic parameters and body composition as well as arterial stiffness after OCN treatment in type 2 diabetic rats. Adult male Sprague Dawley (SD) rats were fed chow or high fat diet (HFD) for 8 weeks, and then diabetes was induced with an injection of low-dose streptozotocin (STZ) and treated daily with intraperitoneal injections of OCN for 12 weeks. Our data showed that OCN treatment improved glucose homeostasis and lipid metabolism. Further analysis revealed that OCN treatment resulted in increased insulin sensitivity. In addition, untreated diabetic rats experienced significant weight loss, whereas OCN-treated rats better maintained body weight (300.75±38.14u2009g vs. 335.50±23.70, p=0.005). OCN also changed body composition, as evidenced by reduced body fat mass, specifically abdominal fat mass. OCN-treated diabetic rats also demonstrated decreased pulse-wave velocity, indicating of improved arterial stiffness. Taken together, our findings in the current study revealed that OCN therapy prevents arteriosclerosis in an induced diabetic rat model by exerting beneficial effects on glucose levels, insulin sensitivity, lipid metabolites, and body composition changes.

[Association between HLA-DQ gene polymorphisms and different outcomes of hepatitis B virus infection].

OBJECTIVEnTo understand the association between two single-nucleotide polymorphism (HLA-DQ rs28567185 and rs9275572) and different outcomes of hepatitis B virus (HBV) infection.nnnMETHODSnA total of 825 HBV infection related cases were enrolled, and peripheral blood samples were collected from them for DNA extraction. The single-nucleotide polymorphism in HLA-DQ region were genotyped by using matrix-assisted laser desorption/ionization time of flight mass spectrometry. Logistic regression analysis was conducted to evaluate the association between HLA-DQ gene polymorphism and different outcomes of hepatitis B virus infection.nnnRESULTSnOur study indicated that cases with HLA-DQ rs2856718G (524 cases) and rs9275572A (369 cases) had reduced susceptibility to HBV infection (OR=0.702, 95%CI: 0.558-0.856, P=0.001; OR=0.548, 95%CI:0.365-0.847, P=0.005) and higher HBV natural clearance (OR=0.589, 95%CI: 0.478-0.892, P=8.81 × 10(-3); OR=0.673, 95%CI: 0.457-0.860, P=0.014). Moreover, rs9275572A was also associated with the lower risk of the development of hepatocellular carcinoma (OR=0.759, 95%CI: 0.538-0.914, P=0.041).nnnCONCLUSIONnOur study suggested that HLA-DQ loci might be associated with the different outcomes of HBV infection in Chinese in Han ethnic group in northern China, rs2856718G and rs9275572A might be protective factors for HBV infection, HBV natural clearance and HBV-related disease progress.