PREVALENCE AND RISK FACTORS OF PERIPHERAL ARTERIAL DISEASE IN DIABETIC PATIENTS OVER 50 YEARS OLD IN CHINA

Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.

Efficacy and Safety of Avandamet or Uptitrated Metformin Treatment in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Alone： A Multicenter, Randomized,Controlled Trial

Background：At present,China has listed the compound tablet containing a fixed dose ofrosiglitazone and metformin,Avandamet,which may improve patient compliance.The aim of this study was to evaluate the efficacy and safety of Avandamet or uptitrated metformin treatment in patients with type 2 diabetes inadequately controlled with metformin alone.Methods：This study was a 48-week,multicenter,randomized,open-labeled,active-controlled trial.Patients with inadequate glycaemic control （glycated hemoglobin [HbA1c] 7.5-9.5%） receiving a stable dose of metformin （≥1500 mg） were recruited from 21 centers in China （from 19 November,2009 to 15 March,2011）.The primary objective was to compare the proportion of patients who reached the target of HbA1c ≤7% between Avandamet and metformin treatment.Results：At week 48,83.33% of patients reached the target of HbA 1 c ≤7% in Avandamet treatment and 70.00% in uptitrated metformin treatment,with significantly difference between groups.The target of HbAlc ≤6.5% was reached in 66.03% of patients in Avandamet treatment and 46.88% in uptitrated metformin treatment.The target of fasting plasma glucose （FPG） ≤6.1 mmol/L was reached in 26.97% of patients in Avandamet treatment and 19.33% in uptitrated metformin treatment.The target of FPG ≤7.0 mmol/L was reached in 63.16% of patients in Avandamet treatment and 43.33% in uptitrated metformin treatment.Fasting insulin decreased 3.24 ±0.98 μU/ml from baseline in Avandamet treatment and 0.72 ＆#177; 1.10 μU/ml in uptitrated metformin treatment.Overall adverse event （AE） rates and serious AE rates were similar between groups.Hypoglycaemia occurred rarely in both groups.Conclusions：Compared with uptitrated metformin,Avandamet treatment provided significant improvements in key parameters ofglycemic control and was generally well tolerated.Registration number：ChiCTR-TRC-13003776.

Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital

Background:Recent cardiovascular outcome trials(CVOTs)changed the therapeutic strategy of guidelines for type 2 diabetes.We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials.Methods:This electronic medical record(EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1,2011,to June 30,2019.We identified patients meeting the inclusion criteria of a pragmatic randomized trial(EMPA-REG OUTCOME)based on EMRs and compared their baseline characteristics with those of the trial participants.The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation.Results:We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389(17.4%)inpatients and 2646(7.2%)outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial.Compared with the trial population,the realworld inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age,blood pressure,and lipid profiles but comprised of fewer males,metformin users,anti-hypertensive drug users,and aspirin users,and had a lower body mass index.The group of outpatients meeting the eligibility criteria had fewer males,similar age,fewer metformin users,fewer insulin users,fewer anti-hypertensive drug users,and fewer aspirin users compared with the trial population.Conclusions:The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center.Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.