Identifying the unmet needs of individuals with Type 2 diabetes: an international web-based survey

Aim: To identify and understand the main unmet needs of individuals with Type 2 diabetes (T2D). Materials & methods: An online survey was conducted in Brazil, China and Russia of individuals with recently diagnosed T2D. Results: The survey, involving 300 individuals with T2D, identified a need for more information regarding food/diet and for increased awareness of T2D symptoms. While most participants (94%) had experienced symptoms prior to their diagnosis, only 55% of symptomatic individuals sought medical attention. Conclusion: Novel strategies to increase awareness of diabetes should be developed and tested, and may enable earlier diagnosis and improve patients' quality of life.publishersversionpublishe

Disproportionately Elevated Proinsulin Levels as an Early Indicator of -Cell Dysfunction in Nondiabetic Offspring of Chinese Diabetic Patients

Objective. To study the characteristics of -cell dysfunction and insulin resistance (IR) in the first-degree relatives (FDRs) of T2DM in Chinese population and to examine the usefulness of proinsulin (PI) for evaluating -cell dysfunction. Methods. 229 subjects of nondiabetic FDRs, 71 newly diagnosed T2DM, and 114 with normal glucose tolerance (NGT) but not FDRs (NGT-non-FDRs) were verified by a 2-hour oral glucose tolerance test. Specific insulin (SI) and PI were measured by highly sensitive ELISA. Results. Compared to NGT-non-FDRs, NGT-FDRs showed higher levels of fasting and 2-hour PI, fasting PI-to-SI ratio (FPI/SI), and HOMA-IR ( < 0.01). Meanwhile, fasting PI, FPI/SI, and HOMA-IR were increased steadily from NGT-FDRs to prediabetesFDRs and were highest in T2DM group ( < 0.001), whereas a significant decrease in HOMA-B could be observed only in T2DM group. Moreover, a progressive deterioration of -cell function in NGT-FDRs, prediabetes-FDRs, and T2DM could be identified by FPI/SI even after adjusting for HOMA-IR: relative to non-FDRs controls, mean FPI/SI levels were increased 1.5, 2.0, and 4.7-fold, respectively (all < 0.01). Conclusions. -cell dysfunction as assessed by disproportionate secretion of proinsulin and IR by HOMA (using specific insulin assay) already exist in FDRs of T2DM even with normal glucose status. Compared with HOMA-B, FPI/SI could detect -cell failure in earlier stage of diabetes development

Baseline Demographic and Clinical Characteristics of Patients with Adrenal Incidentaloma from a Single Center in China: A Survey

Aim. To investigate the clinical and endocrinological characteristics of patients with adrenal incidentaloma (AI). Materials and Methods. This retrospective study enrolled 1941 AI patients hospitalized at the Department of Endocrinology, Chinese PLA General Hospital, Beijing, China, between January 1997 and December 2016. The patient gender, age at visits, imaging features, functional status, and histological results were analyzed. Results. Of the 1941 patients, 984 (50.70%) were men. The median age was 52 years (interquartile range: 44–69 years). 140 cases had bilateral AI. Endocrine evaluation showed that 1411 (72.69%) patients had nonfunctional tumor, 152 (7.83%) had subclinical Cushing syndrome (SCS), and 82 (4.33%) had primary hyperaldosteronism. A total of 925 patients underwent operation for removal of 496 cortical adenomas (53.62%), 15 adrenal cortical carcinomas (1.62%), and 172 pheochromocytomas (18.59%). The bilateral group had a higher proportion of SCS (18.57% versus 7.10%, P<0.001, P=0.006). A mass size of 46 mm was of great value in distinguishing malignant tumors from the benign tumors, with sensitivity of 88.2% and specificity of 95.5%. Conclusions. We reported the baseline demographic and clinical characteristics of patients with AI in a large series from a single center in China

Comparison of the Effect of Glycemic Control in Type 2 Diabetes Outpatients Treated With Premixed and Basal Insulin Monotherapy in China

Background: Basal and premixed insulin have been widely used for insulin therapy of type 2 diabetes mellitus (T2DM) in China. The aim of this study is to compare the sustained efficacy of basal and premixed insulin therapies in T2DM outpatients with insulin monotherapy.Materials and Methods: The survey was conducted in 602 hospitals across China from April to June in 2013. The participants included outpatients who were receiving basal or premixed insulin monotherapy for more than 3 months, and the outcome was attaining a glycated hemoglobin A1C (HbA1c) of &lt;7.0% as a measure of sustained glycemic control.Results: A total of 49,119 T2DM outpatients on basal (n = 11,967) or premixed insulin (n = 37,152) monotherapy were included in the final analyses. Using multivariable model analysis, patients using premixed insulin exhibited a better glycemic control, with more outpatients achieving the target HbA1c level than those using basal insulin (model 1, OR 0.695, 95%CI 0.664–0.728; model 2, OR 0.708, 95%CI 0.676–0.742; model 3, OR 0.717, 95%CI 0.684–0.752; model 4, OR 0.750, 95%CI 0.715–0.787). Using subgroup analysis stratified by age, sex, duration of diabetes, duration of insulin treatment, and complications, still more outpatients in every subgroup treated with premixed insulin achieved the target HbA1c (HbA1c &lt; 7%) than those receiving basal insulin.Conclusions: Premixed insulin monotherapy had a better glycemic control (HbA1c &lt; 7.0%) than basal insulin monotherapy for Chinese T2DM outpatients in daily

Identification of a novel COL1A1 frameshift mutation, c.700delG, in a Chinese osteogenesis imperfecta family

Osteogenesis imperfecta (OI) is a family of genetic disorders associated with bone loss and fragility. Mutations asso-ciated with OI have been found in genes encoding the type I collagen chains. People with OI type I often produce in-sufficient 1-chain type I collagen because of frameshift, nonsense, or splice site mutations in COL1A1 or COL1A2. This report is of a Chinese daughter and mother who had both experienced two bone fractures. Because skeletal fra-gility is predominantly inherited, we focused on identifying mutations in COL1A1 and COL1A2 genes. A novel muta-tion in COL1A1, c.700delG, was detected by genomic DNA sequencing in the mother and daughter, but not in their relatives. The identification of this mutation led to the conclusion that they were affected by mild OI type I. Open read-ing frame analysis indicated that this frameshift mutation would truncate 1-chain type I collagen at residue p263 (p.E234KfsX264), while the wild-type protein would contain 1,464 residues. The clinical data were consistent with the patients ’ diagnosis of mild OI type I caused by haploinsufficiency of 1-chain type I collagen. Combined with previous reports, identification of the novel mutation COL1A1-c.700delG in these patients suggests that additional genetic and environmental factors may influence the severity of OI

Gender Difference in the Association of Early- vs. Late-Onset Type 2 Diabetes with Non-Fatal Microvascular Disease in China: A Cross-sectional Study

BackgroundThis study aimed to test whether early-onset (defined as &lt;40 years of age) type 2 diabetes mellitus (T2DM) imparted different risks of microvascular disease to Chinese men and women.Methods222,537 Chinese patients with T2DM were recruited in 630 hospitals from 106 cities in 30 provinces of China in 2012 using a cross-sectional design. Logistic regression analysis was performed to obtain odds ratios (ORs) of male vs. female for diabetic retinopathy (DR) and diabetic nephropathy (DN). Additive interaction was used to test whether male gender and early-onset T2DM had interactive effects for DR and DN.ResultsMore men than women with T2DM had DN (4.5 vs. 3.0%, P &lt; 0.0001), DR (5.3 vs. 5.1%, P &lt; 0.0001), and microvascular disease (either DN or DR) (8.4 vs. 7.1%, P &lt; 0.0001). After adjustment for age and levels of hospitals, the effect sizes of early-onset T2DM for microvascular disease were higher in men than in women, with a 2.67 [95% confidence intervals (CI): 2.51–2.85] fold risk in men and a 2.53 (95% CI: 2.35–2.72) fold risk in women. The risk effect sizes were greatly attenuated by further adjusting for diabetes durations and other traditional risk factors, with a 1.28 (95% CI: 1.19–1.37) fold risk in men and a 1.07 (95% CI: 0.99–1.16) fold risk in women. After adjustment for diabetes durations and other traditional risk factors, using women with late-onset T2DM as the reference, co-presence of early-onset and male gender significantly enhanced the ORs of either early-onset alone (1.10, 95% CI: 1.03–1.19) or male gender alone (0.96, 95% CI: 0.93–0.99) to 1.32 (95% CI: 1.24–1.41), with significant additive interaction. Kaplan–Meier analysis showed that in early-onset T2DM, DN developed 5 years earlier in men than in women.ConclusionEarly-onset T2DM increased more risk of microvascular complications in Chinese men than in women, most of increased risks being attributable to longer diabetes durations

Clinical characteristics of type 2 diabetes patients with discordance between HbA1c and fasting plasma glucose in the real world: an analysis of the ORBIT study

Background We aimed to determine the clinical characteristics of type 2 diabetes patients on basal insulin therapy with inadequate glucose control due to discordance between glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) in the real world. Methods This was a retrospective analysis of data from the ORBIT study in China. Clinical characteristics of patients with discordance between HbA1c and FPG at baseline and at the end of 6 months of follow‐up were analysed using multinomial logistic regression in 4 study groups divided by HbA1c and FPG. Results Overall, of 6721 patients initiated on basal insulin, 853 achieved HbA1c < 7% but FPG ≥ 7 mmol/L (group 2), while 997 had FPG < 7 mmol/L but HbA1c ≥ 7% (group 3) at the end of follow‐up. Patients in group 3 had a longer duration of type 2 diabetes compared with those in group 2 (7.22 ± 5.30 vs 6.00 ± 4.80 y, P < .05). Patients on glargine (32.90%) or detemir (36.88%) treatment accounted for a higher proportion of patients with both HbA1c and FPG controlled than those on neutral protamine Hagedorn therapy (23.45%; P < .05). Per the multinomial logistic analysis, higher frequency of self‐monitoring of blood glucose (SMBG) and use of glargine or detemir therapy were significantly inversely associated with risk of discordance between HbA1c and FPG, while dose of insulin was a risk factor for discordance at the end of follow‐up (all P < .05). Conclusions Patients treated with insulin analogues (glargine or detemir), instead of neutral protamine Hagedorn, and with more frequent SMBG are more likely to exhibit concordance between HbA1c and FPG

Thermal inactivation of Cronobacter sakazakii ATCC 29544 in powdered infant formula milk using thermostatic radio frequency

A 27.12 MHz thermostatic radio frequency (RF) system was employed to inactivate Cronobacter sakazakii in powdered infant formula milk. A proportional-integral-derivative controller achieved constant material temperature during the holding period. Hot air and similar dielectric material assistance were used to improve RF heating uniformity. The results showed that the microbial thermal resistance was reduced by increasing temperature (55–70 °C) and water activity (0.2–0.4 at 25 °C). Combined RF and hot air pasteurization (RF-HA) was more effective than single RF and material assistance due to better temperature uniformity. D70°C-value (23.3 min) of Cronobacter sakazakii at water activity of 0.2 from RF-HA was not significantly (P > 0.05) higher than that under hot water treatment (20.8 min), indicating that thermal effect led to microbial inactivation. Flow cytometry and transmission electron microscopy further confirmed that RF had no additional damage to cell membrane. The findings contribute to better understanding of RF pasteurization mechanism