Correlations of Body Mass Index, Japan-Defined and IDF-Defined Waist Circumference, Visceral and Subcutaneous Fat Area with Metabolic Parameters in Japanese Patients with Type 2 Diabetes

Obesity is included in the definition of metabolic syndrome. However, there are many controversies surrounding the evaluation of obesity such as body mass index (BMI) and waist circumference (WC) in the definition of metabolic syndrome among various populations. To understand precisely how various anthropometric indices of obesity influence metabolic parameters, we studied the correlations of BMI, WC (Japanese criteria), WC (IDF criteria), visceral fat area (VFA), subcutaneous fat area (SFA) and the VFA/SFA ratio with metabolic parameters in patients with type 2 diabetes. The influences of BMI and WC on diastolic blood pressure and HDL-cholesterol were larger than VFA, whereas the influences of visceral fat area on triglyceride, very low-density lipoprotein-cholesterol, C-peptide and high-sensitivity C-reactive protein were larger than BMI and WC. WC (IDF) was the strongest determinant of adiponectin among anthropometric indices. Present study showed significant different associations of BMI, Japan- and IDF-defined WC, VFA, SFA and the VFA/SFA ratio with blood pressure, glucose and lipid metabolism, and adipocytokines in Japanese patients with type 2 diabetes.

Metabolic surgery: A paradigm shift in type 2 diabetes management

Obesity and type 2 diabetes mellitus(T2DM) are major public health issues globally over the past few decades. Despite dietary interventions, lifestyle modifications and the availability of several pharmaceutical agents, management of T2 DM with obesity is a major challenge to clinicians. Metabolic surgery is emerging as a promising treatment option for the management of T2 DM in the obese population in recent years. Several observational studies and a few randomised controlled trials have shown clear benefits of various bariatric procedures in obese individuals in terms of improvement or remission of T2 DM and multiple other health benefits such as improvement of hypertension, obstructive sleep apnoea, osteoarthritis and non-alcoholic fatty liver disease. Uncertainties about the long-term implications of metabolic surgery such as relapse of T2 DM after initial remission, nutritional and psychosocial complications and the optimal body mass index for different ethnic groups exist. The article discusses the major paradigm shift in recent years in the management of T2 DM after the introduction of metabolic surgery.

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m^2:a multi-institutional study

Roux-en-Y gastric bypass surgery（RYGB） has been demonstrated to be successful for treating type-II diabetes2mellitus（T2DM） patients with a body mass index（BMI）,30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission（defined by fasting blood glucose（FBG） level,110 mg/d L and hemoglobin（Hb）A1c level,6.0% at 12 months postoperatively）.Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m（P,0.001）.Fifty-eight（67.4%） patients were not treated by drugs or insulin after surgery,and 20 patients（23.3%） had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.

The relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus： the Desheng Diabetic Eye Study

AIM： To investigate the relationship between insulin resistance （IR）/β-cell dysfunction and diabetic retinopathy （DR） in Chinese patients with type 2 diabetes mellitus （T2DM）, and to explore further whether there were differences in the relationship among diabetic patients with higher and lower body mass index （BMI）. METHODS： Cross-sectional study. A total of 1466 subjects with T2DM were recruited in a local Desheng Community of urban Beijing from November 2009 to June 2012 for the cohort of Beijing Desheng Diabetic Eye Study. Standardized evaluation was carried out for each participant, including questionnaire, ocular and anthropometric examinations, and laboratory tests. Seven fields 30° color fundus photographs were used for DR grading according to the Early Treatment Diabetic Retinopathy Study protocols. Homeostatis Model Assessment （HOMA） method was employed for IR and β-cell function assessment. RESULTS： After excluding those participants who were treated with insulin （n=352） or had missing data of fasting insulin （n=96）, and further excluding those with poor quality of retinal photographs （n=10）, a total of 1008 subjects were included for the final analysis, 406 （40.3%） were men and 602 （59.7%） were women, age ranging fiom 34 to 86 （64.87±8.28）y. Any DR （levels 14 and above） was present in 278 （27.6%） subjects. After adjusting for possible covariates, the presence of any DR did not correlate with HOMA IR [odds ratio （OR） 1.51, 95% confidence interval （Cl） 0.87-2.61, P=0.14] or HOMA β-cell （OR 0.71, 95%CI 0.40-1.26, P=0.25）. After stratification by BMI, the presence of any DR was associated positively with HOMA IR （OR 2.46, 95%CI： 1.18-5.12, P=0.016）, and negatively with HOMA β-cell （OR 0.40, 95%CI： 0.19-0.87, P=0.021） in the group of patients with higher BMI （225 kg/m2）. In the group of patients with lower BMI （〈25 kg/m2）, the presence of any DR was not associated with HOMA IR （OR 1.00, 95%C1： 0.43-2.33, P=I.00） or HOMA β-cell （OR 1.41, 95%CI： 0.60-3.32, P=0.43）. CONCLUSION： The data suggest that higher IR and lower 13-cell function are associated with the presence of DR in the subgroup of diabetic patients with higher BMI. However, this association is not statistically significant in diabetic patients with lower BMI.

Effects of lifestyle interventions on rural patients with type 2 diabetes mellitus

BACKGROUND The prevalence of type 2 diabetes mellitus(T2DM)is rising rapidly in rural areas,and lifestyle interventions can effectively reduce the blood glucose levels of patients with T2DM.However,current dietary and exercise guidelines are still at experimental stages and are difficult for subjects to understand and implement.The Human Metabolism Analyzer provides real life interventions for the prevention and treatment of T2DM,and our pilot research has demonstrated its effectiveness and good compliance.AIM To investigate the effect of and compliance with lifestyle interventions in rural patients with T2DM.METHODS A total of ten rural villages were randomly selected in Chaoshui Township,Penglai City,Shandong Province,China,to conduct health screening among residents aged 50 years or older.Each rural village represented a group,and 12 patients with T2DM were randomly selected from each group(total:120)to participate in this study and receive real life lifestyle interventions and medication guidance.Lifestyle interventions included changing the meal order(A),postprandial activities(B),resistance exercise(C),and reverse abdominal breathing(D).Diabetes education was conducted at least once a month with a weekly phone follow-up to monitor exercise and diet.Waist circumference,blood pressure,body mass index(BMI),motor function,body composition,fasting blood glucose,and glycated hemoglobin(HbA1c)were analyzed before and 3 mo after the intervention.Moreover,patient compliance and adjustments of hypoglycemic drugs were evaluated.RESULTS A total of 109 subjects completed the study.The compliance rates for lifestyle interventions A,B,C,and D were 57.79%,60.55%,64.22%,and 75.23%,respectively.Among the subjects who received hypoglycemic drugs,the dose was reduced 2 to 3 times based on blood glucose in 54(67.50%)subjects and was tapered and discontinued in 5(6.25%)subjects within 3 mo,with no significant fluctuations in blood glucose after dose reduction and withdrawal.After lifestyle interventions,waist circumference,BMI,fasting blood glucose,and HbA1c significantly decreased(P<0.001);motor function and body composition also significantly improved(P<0.001).CONCLUSION For patients with T2DM,compliance to real-life lifestyle interventions is good,and the interventions significantly improve metabolic indicators such as waist circumference,BMI,blood pressure,HbA1c,body composition,and motor function.Some patients are able to taper or discontinue hypoglycemic drugs.

Risk factors of type 2 diabetes in population of Jammu and Kashmir, India

We sought to identify risk factors for type 2 diabetes （T2D） in Jammu and Kashmir populations, India. A total of 424 diabetic and 226 non-diabetic subjects from Jammu, and 161 diabetic and 100 non-diabetic subjects from Kashmir were screened for various parameters including fasting blood glucose level, 2 hour glucose level, urea, creatinine, triglycerides, total cholesterol, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, very low-density lipoprotein （VLDL-C）, uric acid, systolic and diastolic blood pressure lev- el. We found that subjects aged 40-49 years had the highest rate of diabetes, with family income playing not much of a role. Kashmiri migrants or populations with rapid cultural, environmental, social or lifestyle change along with reduced physical activity, obesity and unhealthy lifestyle （smoking and alcohol consumption） were found to have higher rates of diabetes. High blood glucose, triglycerides and low HDL-C levels were found to be con- tributing to disease outcome. High blood pressure also contributed to a higher risk of developing T2D. Our study supports earlier reports confirming the contribution of comfortable life style, Western dietary habits and rapid life style change along with many other factors to the prevalence of diabetes. This may contribute to the epidemic proportion of diabetes in Jammu and Kashmir. Early diagnosis and routine screening for undiagnosed diabetes in obese subjects and subjects with parental diabetes history is expected to decrease the burden of chronic diabetic complications worldwide.

Increased Circulating Myostatin in Patients with Type 2 Diabetes Mellitus

The changes of plasma myostatin levels in patients with type 2 diabetes mellitus(T2D) and their clinical correlation were investigated.We recruited 43 T2D patients and 20 age-matched healthy subjects.Plasma myostatin,lipid and glucose,and serum insulin were determined.T2D patients showed significantly higher fasting plasma glucose(FPG),serum insulin and triglyceride levels,and lower high-density lipoprotein levels than normal control subjects(P<0.01).Mean plasma myostatin level in T2D patients and health controls was(66.5±17.8) and(46.2±13.8) ng/mL,respectively.An unpaired t test showed that the increase of myostatin in the T2D patients was significant(P<0.001).In both healthy control and T2D groups,the female subjects showed higher myostatin levels than the male subjects.In the T2D patients,plasma level of myostatin was negatively correlated with body mass index(BMI,r=-0.42,P<0.01) and FPG(r=-0.51,P<0.01),but positively correlated with insulin resistance index(HOMA-IR,r=0.48,P<0.01).Up-regulation of plasma myostatin in the T2D patients and its correlation with BMI,FPG and blood insulin sensitivity suggests that plasma myostatin may be implicated in the pathogenesis of T2D and thus presented as a therapeutic target for treating the disease.Furthermore,circulating myostatin levels may be used as a biomarker for the disease.

Causal effect of education on type 2 diabetes:A network Mendelian randomization study

BACKGROUND The causality between education and type 2 diabetes(T2DM)remains unclear.AIM To identify the causality between education and T2DM and the potential metabolic risk factors[coronary heart disease(CHD),total cholesterol,lowdensity lipoprotein,triglycerides(TG),body mass index(BMI),waist circumference(WC),waist-to-hip ratio(WHR),fasting insulin,fasting glucose,and glycated hemoglobin]from summarized genome-wide association study(GWAS)data used a network Mendelian randomization(MR).METHODS Two-sample MR and network MR were performed to obtain the causality between education-T2DM,education-mediator,and mediator-T2DM.Summary statistics from the Social Science Genetic Association Consortium(discovery data)and Neale Lab consortium(replication data)were used for education and DIAGRAMplusMetabochip for T2DM.RESULTS The odds ratio for T2DM was 0.392(95%CI:0.263-0.583)per standard deviation increase(3.6 years)in education by the inverse variance weighted method,without heterogeneity or horizontal pleiotropy.Education was genetically associated with CHD,TG,BMI,WC,and WHR in the discovery phase,yet only the results for CHD,BMI,and WC were replicated in the replication data.Moreover,BMI was genetically associated with T2DM.CONCLUSION Short education was found to be associated with an increased T2DM risk.BMI might serve as a potential mediator between them.

Assessing people at risk of developing type 2 diabetes in Freetown, Sierra Leone

Objective:This study aims to estimate the proportion of adults that are at high risk of developing Type 2 diabetes mellitus,and to investigate the association of participants at high risk for developing diabetes with various risk factors.Methods:A 2-yearprospective community based cross-sectional design was carried out in Freetown using the standardized Finnish Diabetes Risk Score assessment questionnaire,at two community pharmacies in the East,Central Freetown,and at a Peripheral Health Unit in the west where participants were randomly selected.Results:The study included a total of 1013 adults(ages 18 years and above)which reveals that 36.5%had a family history of diabetes mellitus and 42.8%were physically inactive.Assessment of obesity depicted 35.4%have class 1–2 obesity,with 19.4%males and 35.4%females having central obesity respectively.In terms of risk score,17.8%of total participants were found to be at high risk for developing type 2 diabetes.Conclusion:There is a high prevalence of risk for developing diabetes among residents of Freetown.Major risk factors such as,age,family history of Diabetes,obesity,high blood pressure contributed to this.Increase in obesity rate was also seen especially among females having a wider waist circumference and Body Mass Index.Interventions to adequately address issues of physical inactivity,poor dietary habits are highly needed to prevent those at high risk of developing type 2 diabetes mellitus.

Urinary C-peptide Creatinine Ratio and Its Correlation with Parameters of Metabolic Syndrome

To assess the correlation between urinary C peptide creatinine ratio with serum C peptide,serum insulin and its correlation with clinical and biochemical parameters of metabolic syndrome.A total of 100 subjects more than 18 years of age with metabolic syndrome according to ATP Ⅲ criteria with 100 controls were included in a prospective observational study for a period of 1.5 years.Individual parameters of metabolic syndrome was higher in females with hypertriglyceridemia was most common and hyperglycaemia least common parameter of metabolic syndrome.Fasting urinary C peptide creatinine ratio and Stimulated urinary C peptide correlate significantly with fasting serum C peptide(p<0.01),stimulated serum C peptide(p<0.01),serum fasting insulin(p<0.01)and HOMA IR(p<0.01).A fasting urinary C peptide creatinine ratio of more than 1.8 nmol/mmol,stimulated urinary C peptide creatinine ratio more than 2.8 nmol/mmol and HOMA IR>2.7 can be used as a parameter to distinguish individual with and without metabolic syndrome.Urinary C peptide creatinine ratio correlate with serum C peptide and parameters of metabolic syndrome and can be used as a non-invasive simple tool to assess insulin resistance and also to distinguish patients with and without metabolic syndrome.

基于Joinpoint分析1990-2019年中国归因于高BMI的2型糖尿病疾病负担

目的 在高体重指数(body mass index, BMI)率快速增长的情况下,分析1990-2019年中国归因于高BMI的2型糖尿病疾病负担。方法 基于2019年全球疾病负担研究数据,分性别、年龄组分析1990-2019年中国因高BMI造成的2型糖尿病疾病负担,并利用Joinpoint回归模型分析标化后的归因死亡率和归因伤残调整寿命年(disability-adjusted life year, DALY)率的变化趋势。结果 1990-2019年间,我国2型糖尿病患病率从2928.78/10万增至6328.79/10万,归因高BMI的2型糖尿病死亡人数从1.05万增至4.75万,标化死亡率从1.25/10万增至2.39/10万;归因DALY从77.18万人年增至373.76万人年,标化后的归因DALY率从80.21/10万增至181.54/10万,早死损失寿命年(years of life lost, YLL)和伤残损失寿命年(year lived with disability, YLD)及其标化率也呈大幅增长。1990-2019年间,我国归因于高BMI的2型糖尿病标化死亡率和标化DALY率的年平均变化百分比分别为2.28%和2.81%,均有统计学意义(P<0.05),且男性均高于女性。男性标化后的归因DALY率和归因死亡率分别在2010年和2014年超过女性。年龄分层结果显示,50岁以上人群高BMI导致的2型糖尿病疾病负担更加严重,15~49岁人群归因于高BMI的YLD率增幅最大,达到323.99%。结论 1990-2019年间,中国归因于高BMI的2型糖尿病疾病负担显著增加。需加大防控力度,有效管理人群体重指数,并对高危人群采取重点干预,以减轻2型糖尿病疾病负担。

基于病例-队列设计的BMI、腰围与高血压、T2DM的关联性分析

目的:基于病例-队列设计分析BMI、腰围与高血压、2型糖尿病(T2DM)的关联。方法:采用中国健康与营养调查2009至2015年数据构建2种疾病的病例-队列,绘制限制性立方样条图评估BMI、腰围与高血压、T2DM患病是否具有线性关系,采用Prentice法加权Cox比例风险回归模型估计BMI、腰围与高血压、T2DM患病风险的关联。结果:病例-队列设计初始共纳入4564人,按19%随机抽取863人为对照组,随访结束,4564人中1167人患高血压(高血压病例组),37人患T2DM(T2DM病例组)。限制性立方样条图显示BMI与高血压患病呈非线性关系,与T2DM患病呈线性关系;腰围与二者均呈线性关系(P<0.05)。Prentice法加权Cox比例风险回归分析结果显示校正混杂因素后,超重和肥胖者患高血压的风险分别是正常人的1.36倍和1.46倍(95%CI分别为1.19~1.54,1.19~1.79),而腰围每增加1 cm,患高血压风险增加1.02倍(95%CI为1.01~1.02)(P<0.05);BMI每增加1 kg/m 2,患T2DM风险增加1.13倍,腰围每增加1 cm,患T2DM风险增加1.06倍(95%CI分别为1.03~1.23,1.03~1.10)(P<0.05)。结论:超重、肥胖者更容易患高血压、T2DM,腰围越大,越容易患高血压、T2DM。

初诊T2DM患者BMI与GA、GA/HbA1c、HOMA-IR的关系

目的探讨不同体重指数(BMI)分级的初诊2型糖尿病(T2DM)患者胰岛素抵抗(HOMA-IR)水平与糖化白蛋白(GA)、糖化血红蛋白(HbA1c)、GA/HbA1c的关系。方法选取120例初诊T2DM患者,根据BMI将其分为正常组(BMI<24 kg·m^(-2),n=40)、超重组(24 kg·m^(-2)≤BMI≤28 kg·m^(-2),n=40)、肥胖组(BMI>28 kg·m^(-2),n=40)。比较3组一般生化指标、GA、HbA1c、GA/HbA1c、HOMA-IR水平;BMI分级与GA、HbA1c、GA/HbA1c、HOMA-IR的关系,3组HOMA-IR与GA、HbA1c、GA/HbA1c的关系均采用Spearman秩相关分析。结果3组空腹胰岛素(Fins)、HOMA-IR、HbA1c、GA、GA/HbA1c水平比较差异有统计学意义(P<0.05);正常组Fins、HOMA-IR高于肥胖组(P<0.05);HbA1c水平比较:超重组与肥胖组差异无统计学意义(P>0.05),超重组与肥胖组均高于正常组(P<0.05)。BMI分级与GA、GA/HbA1c呈负相关(r=-0.482、r=-0.828,P<0.05),与HbA1c呈正相关(r=0.293,P<0.05)。正常组HOMA-IR与GA、HbA1c呈正相关(r=0.407、r=0.546,P<0.05),与GA/HbA1c呈负相关(r=-0.405,P<0.05);超重组HOMA-IR与GA、HbA1c呈正相关(r=0.374、r=0.826,P<0.05),与GA/HbA1c呈负相关(r=-0.630,P<0.05);肥胖组HOMA-IR与HbA1c呈正相关(r=0.596,P<0.05),与GA/HbA1c呈负相关(r=-0.847,P<0.05),但与GA无显著相关性(P>0.05)。结论初诊T2DM患者可以采用GA、GA/HbA1c评估患者血糖情况,且诊疗过程中应考虑BMI对血糖的影响,尤其是肥胖体质患者。

TyG-BMI联合血尿酸对2型糖尿病合并非酒精性脂肪性肝病的预测价值

目的探讨甘油三脂葡萄糖体重指数(TyG-BMI)联合血尿酸(SUA)对2型糖尿病(T2DM)合并非酒精性脂肪性肝(NAFLD)的预测价值。方法回顾T2DM合并NAFLD 84例患者资料作合并组,选取同期未合并NAFLD 52例患者作未合并组。多因素Logistic回归模型分析危险因素。受试者工作特征曲线(ROC)分析预测价值。结果合并组体质量指数(BMI)、腰臀比(WHR)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbAlc)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、SUA、甘油三脂葡萄糖(TyG)、TyG-BMI水平高于未合并组,HDL-C水平低于未合并组(P<0.05)。Logistic回归分析显示,高水平的WHR、HOMA-IR、SUA、TyG、TyG-BMI均是导致NAFLD发生的危险因素(P<0.05)。ROC曲线显示,TyG-BMI联合SUA的AUC为0.905,高于任一单项指标(P<0.05)。结论TyG-BMI联合SUA对预测T2DM发生NAFLD具有较高效能。

Spouses of patients with diabetes mellitus type 2 at increased risk of high blood glucose levels

Introduction: Diabetes mellitus type 2 is a growing threat in developing countries already burdened with high levels of infectious disease. Screening the general population has debatable advantages. This study aims to determine whether spouses of patients with diabetes mellitus have higher random blood glucose (RBG) levels as well as the benefit of RBG testing as a targetted screening tool. Methodology: The survey employed a cross-sectional comparative study of spouses’ of diabetics and non-diabetics attending the general out-patient department of the LagosStateUniversityTeaching Hospital (LASUTH), Ikeja. A modified WHO STEPS Surveillance Instrument and a one-touch Glucometer were used to collect data. Blood pressures and BMI were measured and correlated to blood glucose levels. Results: Prevalence of high RBG was found to be 7% among spouses of diabetics and 3.3% among spouses of non-diabetic patients. Mean RBG was 5.57 mmol/L and 7.7 mmol/L within the age group 40 - 49 years and 50 - 59 years respectively among spouses of diabetic patients compared to 5.4 mmol/L and 5.5 mmol/L within the same age group among the spouses non-diabetics. Spouses of patients with diabetes mellitus had higher systolic and diastolic blood pressures and BMI compared to spouses of non-diabetics. Conclusion: Being male, married to a diabetic patient, lower educational levels and higher body mass index are significantly associated with higher random blood glucose in the spouses of diabetic patients. Random blood glucose measurements are an effective screening tool and spouses of diabetic patients can benefit from targeted screening in controlled clinical settings.

身体质量指数联合三酰甘油与高密度脂蛋白胆固醇比值预测2型糖尿病风险

目的利用体检指标中身体质量指数(BMI)和三酰甘油与高密度脂蛋白胆固醇比值(triglyceride to high-density lipoprotein cholesterol,TG/HDL-C)联合预测2型糖尿病(type 2 diabetes mellitus,T2DM)发病风险。方法基于瑞慈医疗集团2010—2016年体检人群的数据库,通过Cox比例风险模型观测不同BMI的人群基线TG/HDL-C对随访期间T2DM风险的影响,并分析TG/HDL-C与BMI是否存在交互作用。结果在随访期间,13685例研究对象中共有315例最终诊断为T2DM。以BMI=24 kg/m^(2)为界,将所有研究对象分成两个亚组。BMI<24 kg/m^(2)的亚组共有8238例研究对象,96例在随访结束时患T2DM,对潜在的混杂因素进行调整后,升高的TG/HDL-C导致T2DM事件的风险较高[HR 95%CI=1.47(1.23,1.74),P<0.001]。与最低五分位数(Q1)相比,升高的TG/HDL-C五分位数(Q2~Q5)T2DM发病率增加[HR 95%CI分别为:0.73(0.28,1.93)、2.75(1.29,5.85)、2.81(1.28,6.20)和3.91(1.51,10.11)]。BMI≥24 kg/m^(2)的亚组共有5447例研究对象,219例在随访结束时患T2DM。在两个亚组中,随着TG/HDL-C的增加,T2DM患病风险均呈非线性增加,这一变化在BMI<24 kg/m^(2)的亚组更为明显。绘制两个亚组TG/HDLC与3年和5年T2DM发病的ROC曲线,在BMI<24 kg/m^(2)的亚组中,ROC曲线下面积分别为0.72和0.77。在BMI≥24 kg/m^(2)的亚组中,ROC曲线下面积则分别为0.55和0.57。结论在BMI<24 kg/m^(2)的人群中,TG/HDL-C的升高提示T2DM患病风险显著增加。

中老年男性2型糖尿病患者糖化血红蛋白控制水平与性腺激素相关性的分析

目的:探讨中老年男性2型糖尿病患者糖化血红蛋白控制水平对性腺激素、体重指数、血脂、内脏脂肪面积的影响,并对影响睾酮的相关因素进行分析。方法:选择90例中老年2型糖尿病男性患者,收集30例糖化血红蛋白<7%、30例糖化血红蛋白7%~9%、30例糖化血红蛋白>9%,分别收集患者年龄、体重指数、血脂、内脏脂肪面积、性腺激素,对三组数据进行统计学分析;再根据睾酮大于中位数(>4.08 ng/mL)及小于等于中位数(≤4.08 ng/mL)分为两组,对两组之间体重指数、内脏脂肪面积、糖化血红蛋白、血脂等数据进行统计分析。结果:糖化血红蛋白水平与高密度脂蛋白、睾酮呈负相关(P<0.05),而与甘油三酯、总胆固醇、低密度脂蛋白、体重指数、内脏脂肪面积、雌二醇呈正相关(P<0.05),与促卵泡生成素、促黄体生成素、泌乳素水平无关(P>0.05)。睾酮与体重指数、内脏脂肪面积、糖化血红蛋白、甘油三酯,总胆固醇,低密度脂蛋白水平呈负相关(P<0.05),与高密度脂蛋白呈正相关(P<0.05)。Logistic回归分析显示:糖化血红蛋白水平,内脏脂肪面积、体重指数、血脂异常是睾酮减少的危险因素。结论:良好的血糖控制可有效减少男性睾酮下降,促进机体脂质代谢;较高的睾酮水平对血糖、血脂代谢亦起到积极作用;糖化血红蛋白、内脏脂肪面积、体重指数、血脂异常是睾酮减少的危险因素。

中心性肥胖2型糖尿病189例血清微RNA-221表达与微血管并发症的关系

目的探讨中心性肥胖2型糖尿病(T2DM)病人血清微RNA-221(miR-221)表达与微血管并发症的关系。方法将2019年6月至2021年9月聊城市第二人民医院收治的中心性肥胖T2DM病人189例作为观察组,另选取181例健康体检者作为对照组,检测并比较两组的血清miR-221表达水平。根据观察组有无并发微血管并发症将其分为并发组和未并发组,采用多因素logistic回归分析微血管并发症发生的影响因素,并绘制受试者操作特征(ROC)曲线分析相关血清指标对微血管并发症发生的诊断价值。结果观察组腹围、身体质量指数和空腹血糖、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、血尿酸(UA)均高于对照组(P<0.05),血清miR-221水平高于对照组(0.86±0.27比0.32±0.06,P<0.05);观察组微血管并发症发生率为51.32%(97/189);并发组年龄、合并高血压及高脂血症占比、病程、未按时服药占比及空腹血糖、HbA1c、hs-CRP、UA均高于未并发组(P<0.05),血清miR-221水平高于未并发组(0.91±0.25比0.81±0.16,P<0.05),且均是中心性肥胖T2DM病人出现微血管并发症的危险因素(P<0.05);血清miR-221水平诊断中心性肥胖T2DM病人微血管并发症的临界值、灵敏度、特异度、曲线下面积分别为0.83、88.66%、79.35%、0.81,其诊断价值低于HbA1c水平(P<0.05),高于hs-CRP和UA水平(P<0.05),与空腹血糖水平比较差异无统计学意义(P>0.05)。结论血清miR-221水平在中心性肥胖T2DM病人中呈高表达,是微血管并发症发生的危险因素,且对微血管并发症发生具有重要的临床诊断价值。

利拉鲁肽治疗T2DM患者的效果及对胰岛β细胞功能、糖脂代谢指标及BMI的影响

目的:探讨基于胰岛β细胞功能、糖脂代谢指标及体重指数(BMI)变化评价胰高血糖素样肽-1(GLP-1)受体激动剂利拉鲁肽注射液在2型糖尿病(T2DM)患者治疗中的应用效果。方法:选取南宁市第一人民医院内分泌科2021年12月—2022年12月收治的T2DM患者104例作为研究对象,依据入院时间顺序不同,分为对照组(2021年12月—2022年5月)、观察组(2022年6—12月),各52例。两组均接受常规治疗,对照组给予二甲双胍治疗,观察组在对照组基础上加用GLP-1受体激动剂利拉鲁肽注射液治疗。两组均治疗30 d。比较两组临床疗效、治疗前后胰岛β细胞功能[空腹胰岛素(FINS)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、糖代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)]、脂代谢指标[三酰甘油(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)]、BMI变化及不良反应发生率。结果:治疗后,观察组临床总有效率为96.15%,高于对照组的73.08%(P<0.05);治疗后,观察组FINS水平、HOMA-β值均高于对照组(P<0.05),但HOMA-IR值低于对照组(P<0.05)。治疗后,观察组FPG、HbA1c、2 h PG、TC、TG、LDL-C水平均低于对照组(P<0.05)。治疗后,观察组BMI低于对照组(P<0.05)。治疗后,观察组不良反应发生率为11.54%,低于对照组的17.31%,但差异无统计学意义(P>0.05)。结论:对T2DM患者实施利拉鲁肽注射液辅助治疗,治疗效果理想,可有效改善患者胰岛β细胞功能,患者糖脂代谢状况、BMI改善效果亦较好,且未增加不良反应。

1990-2019年中国归因于高体质指数的2型糖尿病疾病负担分析与预测研究

背景中国的糖尿病患者数位居全球首位。近年来糖尿病患病率和死亡率不断上升,威胁人们健康水平,给我国人民群众带来沉重负担。随着肥胖患病率不断上升,预计糖尿病疾病负担将持续上升,糖尿病已成为我国不容忽视的公共卫生问题。目的描述和分析1990—2019年中国归因于高BMI的2型糖尿病疾病负担状况及其变化趋势,预测2020—2024年中国归因于高BMI的2型糖尿病疾病负担状况,旨在为中国2型糖尿病科学防控提供依据。方法于2023年5月,从2019年全球疾病负担(GBD 2019)中提取1990—2019年中国2型糖尿病伤残调整寿命年(DALYs)、DALYs率、标化DALYs率、死亡人数、死亡率及标化死亡率等疾病负担指标的数据,采用联结点回归模型通过年度变化百分比(APC)和平均年度变化百分比(AAPC)分析其变化趋势。基于1990—2016年数据(训练集),构建归因于高BMI的2型糖尿病DALYs率和死亡率的自回归移动平均(ARIMA)模型,利用2017—2019年数据(测试集)进行模型评价。用预测值与实际值得到的相对误差、模型的平均绝对误差(MAE)、平均绝对百分比误差(MAPE)、均方误差(MASE)及均方根误差(RMSE)判断模型预测效果,选择最佳模型预测2020—2024年中国归因于高BMI的2型糖尿病疾病负担。结果1990—2019年:疾病负担整体呈上升趋势(标化DALYs率AAPC=2.85%,标化死亡率AAPC=2.32%,均P<0.05),标化DALYs率从80.21/10万增至181.54/10万,标化死亡率从1.25/10万增至2.39/10万;男性和女性的标化DALYs率和标化死亡率均呈快速上升趋势,与1990年相比,2019年男性标化DALYs率增长了173%,女性增长了89%,男性标化死亡率增长了146%,女性增长了58%;DALYs率和死亡率随年龄增加明显增加,DALYs率在30岁后迅速增加,高峰基本维持在65~69岁(1990年337.47/10万,2019年711.09/10万)和70~74岁年龄组(1990年323.64/10万,2019年730.47/10万),人群死亡率在45岁后迅速增加,高峰维持在95岁以上(1990年12.78/10万,2019年33.29/10万);与全球相比,我国归因于高BMI的2型糖尿病的DALYs率和死亡率整体增速均较高。在1990—2019年中均有4个时间拐点,标化DALYs率和标化死亡率分别在2000—2004年和1996—2004年增速最快。经ARIMA模型预测得到2020—2024年中国归因于高BMI的2型糖尿病标化DALYs率和标化死亡率均呈持续上升趋势,到2024年分别达到205.142/10万(95%CI=189.775/10万~220.508/10万)和2.621/10万(95%CI=2.343/10万~2.900/10万)。结论我国归因于高BMI的2型糖尿病的疾病负担总体呈上升趋势,表现为由伤残导致的疾病负担与死亡人数升高,且增速高于全球。我国男性归因于高BMI的2型糖尿病的疾病负担逐渐高于女性,归因于高BMI的2型糖尿病的DALYs率和死亡率有年轻化趋势,ARIMA模型显示归因于高BMI的2型糖尿病的疾病负担预计将持续上升。为减轻2型糖尿病疾病负担,应该对重点人群(男性、中老年人群)加强健康教育,以提高对糖尿病防治的知晓度,可以通过提倡健康饮食和生活习惯加强体质量管理。