Comparison of effects of obesity and non-alcoholic fatty liver disease on incidence of type 2 diabetes mellitus

AIM: To compare and analyze the effects of obesity and non-alcoholic fatty liver disease(NAFLD) on the incidence of type 2 diabetes mellitus(T2DM) in Chinese subjects.METHODS: In 2008, a population of 4847 subjects was randomly sampled from 17 medical units for enrollment in this cohort study. Baseline information was obtained via a questionnaire on general information, physical examination(height, weight, and blood pressure), laboratory tests(triglycerides, total cholesterol, fasting blood glucose, alanine aminotransferase(ALT), uric acid, and creatinine), B-mode ultrasound, and ECG screening. The incidence of T2 DM after four years of follow-up was calculated. Numeric variable data was tested for normality, with the data expressed as mean ± SD. Kaplan-Meier analysis was performed to calculate the cumulative incidence. The Cox proportional hazards model was used to analyze the relative risk(RR) of different body mass index(BMI) levels and NAFLD on T2 DM, as well as analyzingthe RR adjusted for age, sex, blood pressure, lipids, transaminases, uric acid, and creatinine.RESULTS: A total of 4736(97.71%) subjects completed 4-year follow-up, with a median follow-up time of 3.85 years, totaling 17223 person-years. 380 subjects were diagnosed with T2 DM, with a cumulative incidence of 8.0%. The cumulative incidence of T2 DM in the NAFLD and control groups was 17.4% vs 4.1%(P < 0.001), respectively, while the incidence in overweight and obese subjects was 11.0% vs 15.8%(P < 0.001), respectively. The incidence of T2 DM increased with an increase in baseline BMI. Cox regression analysis showed that the risk of T2 DM in the NAFLD group(RR = 4.492, 95%CI: 3.640-5.542) after adjustment for age, sex, blood pressure, lipids, ALT, uric acid, and creatinine was 3.367(2.367-4.266), whi le t he value(RR, 95%CI) in overweight and obese subjects after adjustment for age, sex, BMI, blood pressure, lipids and other factors was 1.274(0.997-1.629) and 1.554(1.140-2.091), respectively. Stratification of three BMI levels(BMI < 24 kg/m2, 2 4 k g / m2 ≤ B M I < 2 8 k g / m2, B M I ≥ 2 8 k g / m2) showed that the risk of T2 DM in the NAFLD group was significantly higher than that in the control group(RR = 3.860, 4.049 and 3.823, respectively).CONCLUSION: Compared with BMI, NAFLD could be better at forecasting the risk of T2 DM in Chinese subjects, and may be a high risk factor for T2 DM, independent of overweight/obesity.

Situational Analysis of Low-density Lipoprotein Cholesterol Control and the Use of Statin Therapy in Diabetes Patients Treated in Community Hospitals in Nanjing, China

Background：Comprehensive management of diabetes should include management of its comorbid conditions,especially cardiovascular complications,which are the leading cause of morbidity and mortality among patients with diabetes.Dyslipidemia is a comorbid condition of diabetes and a risk factor for cardiovascular complications.Therefore,lipid level management is a key of managing patients with diabetes successfully.However,it is not clear that how well dyslipidemia is managed in patients with diabetes in local Chinese health-care communities.This study aimed to assess how well low-density lipoprotein cholesterol （LDL-C） was managed in Nanjing community hospitals,China.Methods：We reviewed clinical records of 7364 diabetic patients who were treated in eleven community hospitals in Nanjing from October 2005 to October 2014.Information regarding LDL-C level,cardiovascular risk factors,and use of lipid-lowering agents were collected.Results：In patients without history of cardiovascular disease （CVD）,92.1% had one or more CVD risk factors,and the most common CVD risk factor was dyslipidemia.The overall average LDL-C level was 2.80 ± 0.88 mmol/L,which was 2.62 ± 0.90 mmol/L and 2.82 ± 0.87 mmol/L in patients with and without CVD history respectively.Only 38% of all patients met the target goal and 37.3% of patients who took lipid-lowering agents met target goal.Overall,24.5% of all patients were on lipid-lowering medication,and 36.3% of patients with a CVD history and 20.9% of patients without CVD history took statins for LDL-C management.The mean statin dosage was 13.9 ± 8.9 mg.Conclusions：Only a small portion of patients achieved target LDL-C level,and the rate of using statins to control LDL-C was low.Managing LDL-C with statins in patients with diabetes should be promoted,especially in patients without a CVD history and with one or more CVD risk factors.