Adiposity,synonymous with obesity,is prevalent among both children and adults with type 1 diabetes in China.Recent literature underscored the pathophysiological and socioeconomic factors associated with adiposity,and ...Adiposity,synonymous with obesity,is prevalent among both children and adults with type 1 diabetes in China.Recent literature underscored the pathophysiological and socioeconomic factors associated with adiposity,and consistently highlighted its impact on cardiovascular,kidney,and metabolic diseases among Chinese individuals with type 1 diabetes.Addressing and managing adiposity in individuals with type 1 diabetes are complicated and entail comprehensive approaches including lifestyle modifications,cognitive-behavioral therapy,insulin dose titration,and other diabetes treatment medications.The condition calls for coordination among policymakers,researchers,clinicians,and patients.展开更多
Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vita...Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear.The study aimed to investigate the association between serum 25-hydroxyvitamin D(25[OH]D)levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition.Methods:In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors(SPECT-China)cohort,1862 participants free of T2DM at baseline were included.A weighted genetic risk score was calculated with 28 variants associated with T2DM.Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM.Results:After a 5-year follow-up,132 cases of T2DM were documented.We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment(χ^(2)=0.571,P_(for trend)=0.426).Compared to those in the lowest quartile of 25(OH)D,the odds ratios(ORs)(95%confidence interval[CI])for participants with increased quartiles were 1.29(0.74-2.25),1.35(0.77-2.36),and 1.27(0.72-2.24),respectively.We observed a positive association of glycated hemoglobin(HbA1c)with 25(OH)D at baseline(β=1.752,P=0.001)and after follow-up(β=1.385,P=0.003),and a negative association of ln conversion homeostasis model assessment(HOMA)-βwith 25(OH)D at baseline(β=-0.982,P=0.021).There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM(χ^(2)=2.710,P_(for interaction)=0.100).The lowest OR(95%CI)of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D(0.17[0.05-0.62]).Conclusion:Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.展开更多
Background:Stroke is the leading cause of death in China,and predicting the stroke burden could provide essential information guiding the setting of medium-and long-term health policies and priorities.The study aimed ...Background:Stroke is the leading cause of death in China,and predicting the stroke burden could provide essential information guiding the setting of medium-and long-term health policies and priorities.The study aimed to project trends associated with stroke burden in China through 2050,not only in terms of incidence and mortality but also for prevalence and disability-adjusted life years(DALYs).Methods:Data on stroke rates in incidence,prevalence,deaths,and DALYs in China between 1990 and 2019 were obtained from a recent Global Burden of Disease study.Demographic-specific trends in rates over time were estimated using three models:the loglinear model,the Lee-Carter model,and a functional time series model.The mean absolute percentage error and the root mean squared error were used for model selection.Projections up to 2050 were estimated using the best fitting model.United Nations population data were used to project the absolute numbers through 2050.Results:From 2019 to 2050,the crude rates for all measures of the stroke burden are projected to increase continuously among both men and women.We project that compared with those in 2019,the incidence,prevalence,deaths,and DALYs because of stroke in China in 2050 will increase by 55.58%,119.16%,72.15%,and 20.04%,respectively;the corresponding increases in number were 2.19,34.27,1.58,and 9.21 million.The age-standardized rate is projected to substantially decline for incidence(8.94%),death(40.37%),and DALYs(43.47%),but the age-standardized prevalence rate is predicted to increase by 10.82%.By 2050,the burden of stroke among the population aged≥65 years will increase significantly:by 104.70%for incidence,by 218.48%for prevalence,by 100.00%for death,and by 58.93%for DALYs.Conclusions:With the aging population in China increasing over the next three decades,the burden of stroke will be markedly increased.Continuous efforts are needed to improve stroke health care and secondary prevention,especially for older adults.展开更多
Diabetic cardiomyopathy is defined as abnormal structure and function of the heart in the setting of diabetes,which could eventually develop heart failure and leads to the death of the patients.Although blood glucose ...Diabetic cardiomyopathy is defined as abnormal structure and function of the heart in the setting of diabetes,which could eventually develop heart failure and leads to the death of the patients.Although blood glucose control and medications to heart failure show beneficial effects on this disease,there is currently no specific treatment for diabetic cardiomyopathy.Over the past few decades,the pathophysiology of diabetic cardiomyopathy has been extensively studied,and an increasing number of studies pinpoint that impaired mitochondrial energy metabolism is a key mediator as well as a therapeutic target.In this review,we summarize the latest research in the field of diabetic cardiomyopathy,focusing on mitochondrial damage and adaptation,altered energy substrates,and potential therapeutic targets.A better understanding of the mitochondrial energy metabolism in diabetic cardiomyopathy may help to gain more mechanistic insights and generate more precise mitochondria-oriented therapies to treat this disease.展开更多
China faces a substantial burdensome pandemic of obesity.Recent data from the Chinese Centre for Disease Control and Prevention suggested that over an estimated 8.1%of Chinese adults(85 million Chinese adults)had obes...China faces a substantial burdensome pandemic of obesity.Recent data from the Chinese Centre for Disease Control and Prevention suggested that over an estimated 8.1%of Chinese adults(85 million Chinese adults)had obesity in 2018,which was three times the level in 2004.[1]To understand the trends of overweight and obesity in China,we accessed the country/territory-level year-specific data of age-standardized summary exposure value(SEV,standing for the pooled proportion among the population),deaths,and disability-adjusted life of years(DALYs)for high body mass index(BMI,high BMI was defined as the BMI level higher than theoretical minimum risk exposure level[25 kg/m2])and its associated diseases for 204 countries/territories between 1990 and 2019 using data from the Global Burden of Disease Collaborative Network.[2]Previous literature described detailed methods for the data synthesis.[3,4]Using the country/territory-level data by year,we calculated the estimated annual percentage changes(EAPCs)with 95%uncertainty intervals(UI)to estimate the annual changing patterns of age-standardized SEV,death,and DALY rates among 204 countries/territories.To compare statistics from China and other regions,we calculated the corresponding estimates from regions including global,North Africa and Middle East,Sub-Saharan Africa,Western Pacific Region,European Union,Latin America and Caribbean,and South Asia.展开更多
Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of dia...Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.展开更多
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 part...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.展开更多
基金Supported by 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYYC24001.
文摘Adiposity,synonymous with obesity,is prevalent among both children and adults with type 1 diabetes in China.Recent literature underscored the pathophysiological and socioeconomic factors associated with adiposity,and consistently highlighted its impact on cardiovascular,kidney,and metabolic diseases among Chinese individuals with type 1 diabetes.Addressing and managing adiposity in individuals with type 1 diabetes are complicated and entail comprehensive approaches including lifestyle modifications,cognitive-behavioral therapy,insulin dose titration,and other diabetes treatment medications.The condition calls for coordination among policymakers,researchers,clinicians,and patients.
基金Clinical Research Plan of SHDC(No.SHDC2020CR4006)Shanghai Ninth People’s Hospital(No.YBKB202218)+1 种基金Shanghai Municipal Human Resources and Social Security Bureau(No.2020074)National Natural Science Foundation of China(No.82170870)
文摘Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear.The study aimed to investigate the association between serum 25-hydroxyvitamin D(25[OH]D)levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition.Methods:In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors(SPECT-China)cohort,1862 participants free of T2DM at baseline were included.A weighted genetic risk score was calculated with 28 variants associated with T2DM.Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM.Results:After a 5-year follow-up,132 cases of T2DM were documented.We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment(χ^(2)=0.571,P_(for trend)=0.426).Compared to those in the lowest quartile of 25(OH)D,the odds ratios(ORs)(95%confidence interval[CI])for participants with increased quartiles were 1.29(0.74-2.25),1.35(0.77-2.36),and 1.27(0.72-2.24),respectively.We observed a positive association of glycated hemoglobin(HbA1c)with 25(OH)D at baseline(β=1.752,P=0.001)and after follow-up(β=1.385,P=0.003),and a negative association of ln conversion homeostasis model assessment(HOMA)-βwith 25(OH)D at baseline(β=-0.982,P=0.021).There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM(χ^(2)=2.710,P_(for interaction)=0.100).The lowest OR(95%CI)of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D(0.17[0.05-0.62]).Conclusion:Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.
基金National Key R&D Program of China(Nos.2019YFC1709804 and 2017YFC1700406)National Natural Science Foundation of China(Grant No.72004149)+2 种基金China Medical Board(Grant No.CMB19-324)Sichuan Youth Science and Technology Innovation Research Team(No.2020JDTD0015)1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(No.ZYYC08003)
文摘Background:Stroke is the leading cause of death in China,and predicting the stroke burden could provide essential information guiding the setting of medium-and long-term health policies and priorities.The study aimed to project trends associated with stroke burden in China through 2050,not only in terms of incidence and mortality but also for prevalence and disability-adjusted life years(DALYs).Methods:Data on stroke rates in incidence,prevalence,deaths,and DALYs in China between 1990 and 2019 were obtained from a recent Global Burden of Disease study.Demographic-specific trends in rates over time were estimated using three models:the loglinear model,the Lee-Carter model,and a functional time series model.The mean absolute percentage error and the root mean squared error were used for model selection.Projections up to 2050 were estimated using the best fitting model.United Nations population data were used to project the absolute numbers through 2050.Results:From 2019 to 2050,the crude rates for all measures of the stroke burden are projected to increase continuously among both men and women.We project that compared with those in 2019,the incidence,prevalence,deaths,and DALYs because of stroke in China in 2050 will increase by 55.58%,119.16%,72.15%,and 20.04%,respectively;the corresponding increases in number were 2.19,34.27,1.58,and 9.21 million.The age-standardized rate is projected to substantially decline for incidence(8.94%),death(40.37%),and DALYs(43.47%),but the age-standardized prevalence rate is predicted to increase by 10.82%.By 2050,the burden of stroke among the population aged≥65 years will increase significantly:by 104.70%for incidence,by 218.48%for prevalence,by 100.00%for death,and by 58.93%for DALYs.Conclusions:With the aging population in China increasing over the next three decades,the burden of stroke will be markedly increased.Continuous efforts are needed to improve stroke health care and secondary prevention,especially for older adults.
基金Yunnan Provincial Cardiovascular Disease Clinical Medical Center Project(Nos.FZX2019-06-01,2022YFKY078)Key Research and Development Program of Sichuan Province(Nos.2022YFS0132,2022YFS0198 and 2023YFS0295)National Natural Science Foundation of China(Nos.81970715 and 82370260)
文摘Diabetic cardiomyopathy is defined as abnormal structure and function of the heart in the setting of diabetes,which could eventually develop heart failure and leads to the death of the patients.Although blood glucose control and medications to heart failure show beneficial effects on this disease,there is currently no specific treatment for diabetic cardiomyopathy.Over the past few decades,the pathophysiology of diabetic cardiomyopathy has been extensively studied,and an increasing number of studies pinpoint that impaired mitochondrial energy metabolism is a key mediator as well as a therapeutic target.In this review,we summarize the latest research in the field of diabetic cardiomyopathy,focusing on mitochondrial damage and adaptation,altered energy substrates,and potential therapeutic targets.A better understanding of the mitochondrial energy metabolism in diabetic cardiomyopathy may help to gain more mechanistic insights and generate more precise mitochondria-oriented therapies to treat this disease.
基金West China Hospital of Sichuan University(1.3.5 Project for Disciplines of Excellence,Nos.ZYGD18022 and 2020HXF011).
文摘China faces a substantial burdensome pandemic of obesity.Recent data from the Chinese Centre for Disease Control and Prevention suggested that over an estimated 8.1%of Chinese adults(85 million Chinese adults)had obesity in 2018,which was three times the level in 2004.[1]To understand the trends of overweight and obesity in China,we accessed the country/territory-level year-specific data of age-standardized summary exposure value(SEV,standing for the pooled proportion among the population),deaths,and disability-adjusted life of years(DALYs)for high body mass index(BMI,high BMI was defined as the BMI level higher than theoretical minimum risk exposure level[25 kg/m2])and its associated diseases for 204 countries/territories between 1990 and 2019 using data from the Global Burden of Disease Collaborative Network.[2]Previous literature described detailed methods for the data synthesis.[3,4]Using the country/territory-level data by year,we calculated the estimated annual percentage changes(EAPCs)with 95%uncertainty intervals(UI)to estimate the annual changing patterns of age-standardized SEV,death,and DALY rates among 204 countries/territories.To compare statistics from China and other regions,we calculated the corresponding estimates from regions including global,North Africa and Middle East,Sub-Saharan Africa,Western Pacific Region,European Union,Latin America and Caribbean,and South Asia.
基金National Key R&D Program of China(No.2018YFC2SSlSSX)the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Nos.ZYGD18022 and 20HXFH011)。
文摘Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.
基金by grants from the Sichuan Science and Technology Program(No.2019YFH0150)the 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(Nos.ZYGD18022 and 2020HXF011)+1 种基金She-Yu Li also received grants from the National Natural Science Foundation of China(No.21534008)the Chief Scientist Office Project(No.CGA/19/10).
文摘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.
