Background Given the pace with which standards of care have changed, timely assessment of their impact on routine clinical practice and patient outcomes is needed. In coordination with the Chinese Diabetes Society （...Background Given the pace with which standards of care have changed, timely assessment of their impact on routine clinical practice and patient outcomes is needed. In coordination with the Chinese Diabetes Society （CDS）, we developed a quantitative survey to explore the implementation of standards of care for type 2 diabetes （T2D） in China. Methods A national online survey of physicians involved in the management of T2D in China was conducted over a 4-week period in 2012. Completed responses were obtained from 1 028 physicians. Participants responded to 52 questions designed to capture information relating to their demographic and clinical practice profiles. The questionnaire was divided into three sections： basic information, diagnosis practices and screening methods on main complications, and treatment and control practices. The questionnaire was developed in conjunction with the CDS. Results Overall, 83% of surveyed physicians were at least ＂aware＂ of the CDS guidelines on standards of care for T2D. Level of awareness was directly related to hospital grade, specialty, geographic location, professional rank and participation in CDS training. The 2-hour oral glucose tolerance test was reported as the most ever-used approach across all three hospital grades and physician specialties, with a usage rate of 97%. Respondents selected their choice of primary treatment for newly diagnosed T2D patients. Just over half （52%） indicated the use of oral anti-diabetic drugs （OAD） monotherapy, in line with CDS recommendations. However, OAD use varied considerably between different regions and city tiers. Despite hemoglobin Alc being defined as the gold standard for glucose control, it was not universally measured, with more physicians indicating routine use of glucose before fasting and glucose non-fasting. Conclusion The standards-of-care analysis has provided important insights into the current management of T2D among physicians in China across different geographical regions, hospital grades, specialties, professional statuses, and levels of CDS guideline awareness and training.展开更多
Type 2 diabetes （T2D） is now considered a pandemic noncommunicable disease, and the prevalence is still increasing steadily worldwide. Several lines of evidence, including T2D, is an aging-related disease, and the p...Type 2 diabetes （T2D） is now considered a pandemic noncommunicable disease, and the prevalence is still increasing steadily worldwide. Several lines of evidence, including T2D, is an aging-related disease, and the phenomenon of the metabolic memory and developmental origins of adult diabetes argues that epigenetic disorder plays critical roles in the development of T2D. Environmental factors can affect epigenetics during early fetal life until adulthood. Altered epigenetics can be maintained during mitosis and meiosis, so that the subsequent response to environ- mental cue in later life has also been altered. Epigenetic aberra- tions affect miRNA expression and functions, and altered miRNA expression can also affect expression of many genes including those relevant to epigenetics. Thus, the development of T2D is an accumulative process that may involve complex interactions be- tween altered transcription factors, miRNA functions, and in- creased epigenetics disorder in response to environmental stimuli during different stages of life.展开更多
文摘Background Given the pace with which standards of care have changed, timely assessment of their impact on routine clinical practice and patient outcomes is needed. In coordination with the Chinese Diabetes Society （CDS）, we developed a quantitative survey to explore the implementation of standards of care for type 2 diabetes （T2D） in China. Methods A national online survey of physicians involved in the management of T2D in China was conducted over a 4-week period in 2012. Completed responses were obtained from 1 028 physicians. Participants responded to 52 questions designed to capture information relating to their demographic and clinical practice profiles. The questionnaire was divided into three sections： basic information, diagnosis practices and screening methods on main complications, and treatment and control practices. The questionnaire was developed in conjunction with the CDS. Results Overall, 83% of surveyed physicians were at least ＂aware＂ of the CDS guidelines on standards of care for T2D. Level of awareness was directly related to hospital grade, specialty, geographic location, professional rank and participation in CDS training. The 2-hour oral glucose tolerance test was reported as the most ever-used approach across all three hospital grades and physician specialties, with a usage rate of 97%. Respondents selected their choice of primary treatment for newly diagnosed T2D patients. Just over half （52%） indicated the use of oral anti-diabetic drugs （OAD） monotherapy, in line with CDS recommendations. However, OAD use varied considerably between different regions and city tiers. Despite hemoglobin Alc being defined as the gold standard for glucose control, it was not universally measured, with more physicians indicating routine use of glucose before fasting and glucose non-fasting. Conclusion The standards-of-care analysis has provided important insights into the current management of T2D among physicians in China across different geographical regions, hospital grades, specialties, professional statuses, and levels of CDS guideline awareness and training.
文摘Type 2 diabetes （T2D） is now considered a pandemic noncommunicable disease, and the prevalence is still increasing steadily worldwide. Several lines of evidence, including T2D, is an aging-related disease, and the phenomenon of the metabolic memory and developmental origins of adult diabetes argues that epigenetic disorder plays critical roles in the development of T2D. Environmental factors can affect epigenetics during early fetal life until adulthood. Altered epigenetics can be maintained during mitosis and meiosis, so that the subsequent response to environ- mental cue in later life has also been altered. Epigenetic aberra- tions affect miRNA expression and functions, and altered miRNA expression can also affect expression of many genes including those relevant to epigenetics. Thus, the development of T2D is an accumulative process that may involve complex interactions be- tween altered transcription factors, miRNA functions, and in- creased epigenetics disorder in response to environmental stimuli during different stages of life.
