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Yeung R.O.,Chinese University of Hong Kong | Zhang Y.,Chinese University of Hong Kong | Luk A.,Prince of Wales Hospital | Yang W.,China Japan Friendship Hospital | And 40 more authors.
The Lancet Diabetes and Endocrinology | Year: 2014

Background: The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort. Methods: JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants' first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes. Findings: Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41 029 patients (15 341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years [SD 5·7] versus 53·9 years [9·0] with late-onset diabetes (n=33 548). Those with young-onset diabetes had longer disease duration (median 10 years [IQR 3-18]) than those with late-onset diabetes (5 years [2-11]). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%; p<0·0001) Patients with young-onset diabetes had higher mean concentrations of HbA1c (mean 8·32% [SD 2·03] vs 7·69% [1·82]; p<0·0001), LDL cholesterol (2·78 mmol/L [0·96] vs 2·74 [0·93]; p=0·009), and a higher prevalence of retinopathy (1363 [20%] vs 5714 (18%); p=0·011) than those with late-onset diabetes, but were less likely to receive statins (2347 [31%] vs 12 441 [37%]; p<0·0001) and renin-angiotensin-system inhibitors (1868 [25%] vs 9665 [29%]; p=0·006). Interpretation: In clinic-based settings across Asia, one in five adult patients had young-onset diabetes. Compared with patients with late-onset diabetes, metabolic control in those with young-onset diabetes was poor, and fewer received organ-protective drugs. Given the risk conferred by long-term suboptimum metabolic control, our findings suggest an impending epidemic of young-onset diabetic complications. Funding: The Asia Diabetes Foundation (ADF) and Merck. © 2014 Elsevier Ltd.

Yu Y.,Jiangsu Province Institute of Geriatrics | Yu Y.,Jiangsu Province Official Hospital | Ouyang X.-J.,Jiangsu Province Institute of Geriatrics | Ouyang X.-J.,Jiangsu Province Official Hospital | And 17 more authors.
Korean Journal of Internal Medicine | Year: 2012

Background/Aims: The application of glycated hemoglobin (HbA 1c) for the diagnosis of diabetes is currently under extensive discussion. In this study, we explored the validity of using HbA 1c as a screening and diagnostic test in Chinese subjects recruited in Nanjing, China. Methods: In total, 497 subjects (361 men and 136 women) with fasting plasma glucose (PG) ≥ 5.6 mmol/L were recruited to undergo the oral glucose tolerance test (OGTT) and HbA 1c test. Plasma lipid, uric acid, and blood pressure were also measured. Results: Using a receiver operating characteristic curve, the optimal cutoff point of HbA 1c related to diabetes diagnosed by the OGTT was 6.3%, with a sensitivity and specificity of 79.6% and 82.2%, respectively, and the area under the curve was 0.87 (95% confidence interval, 0.83 to 0.92). A HbA 1c level of 6.5% had a sensitivity and specificity of 62.7% and 93.5%, respectively. When comparing the HbA 1c ≥ 6.5% or OGTT methods for diagnosing diabetes, the former group had significantly higher HbA 1c levels and lower levels of fasting and 2-hour PG than the latter group. No significant difference was observed in the other metabolism indexes between the two groups. Conclusions: Our results suggest that HbA 1c ≥ 6.5% has reasonably good specificity for diagnosing diabetes in Chinese subjects, which is in concordance with the American Diabetes Association recommendations. © 2012 The Korean Association of Internal Medicine.

So W.-Y.,Chinese University of Hong Kong | Raboca J.,Makati Medical Center | Sobrepena L.,Heart of Jesus Hospital | Yoon K.-H.,Catholic University of Korea | And 9 more authors.
Journal of Diabetes | Year: 2011

Background: The aim of the web-based Joint Asia Diabetes Evaluation (JADE) program is to establish a registry for quality assurance, monitoring, and evaluation. Methods: The JADE electronic portal provides templates for data collection, supplemented by risk stratification, care protocols, and decision support. Herein, data from 3687 patients with Type 2 diabetes, enrolled over 15months in 2007-2009 from seven Asian countries, are reported. Results: Of the patients, 46.1% were men, the median (range) age was 58 (15-93years), and median disease duration was 6.5 (0-71) years; 16.2% had at least one cardiovascular-renal complication (10.0% coronary heart disease, 3.3% stroke, 3.1% peripheral vascular disease, 0.4% end-stage renal disease), 20.4% had diabetic retinopathy, 15.0% had sensory neuropathy, 7.5% had chronic kidney disease, and 20.7% of men had erectile dysfunction. Hypertension, dyslipidemia, and central obesity affected 84.6%, 76.8%, and 53.5% of patients, respectively. Treatment targets were HbA1c <7% in 35.3%, blood pressure <130/80mmHg in 32.3%, and low-density lipoprotein-cholesterol <2.6mmol/L in 34.0%. The rate of attaining one, two, and three targets was 38.7%, 23.4%, and 5.4%, respectively. Using the JADE Risk Engine, 60% of patients with clinical complications and 20% of those with multiple risk parameters were predicted to have a major event within 5years. Older age, short disease duration, adherence to diet, control of other risk factors, and not smoking were independently associated with HbA1c <7% (all P<0.05). Conclusions: It is possible to use a web-based protocol to establish a registry for risk stratification and facilitate early intervention. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

Kong A.P.S.,Chinese University of Hong Kong | Yang X.,Chinese University of Hong Kong | Yang X.,Tianjin Medical University | Luk A.,Chinese University of Hong Kong | And 10 more authors.
BMC Endocrine Disorders | Year: 2014

Background: In patients with type 2 diabetes, chronic kidney disease (CKD) is associated with increased risk of hypoglycaemia and death. Yet, it remains uncertain whether hypoglycaemia-associated mortality is modified by CKD.Methods: Type 2 diabetic patients, with or without CKD at enrolment were observed between 1995 and 2007, and followed up till 2009 at hospital medical clinics. We used additive interaction, estimated by relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP) to examine possible synergistic effects between CKD and severe hypoglycaemia (defined as hospitalisations due to hypoglycaemia in the 12 months prior to enrolment) on the risk of death.Results: In this cohort of 8,767 type 2 diabetic patients [median age: 58 (interquartile range: 48 to 68) years; disease duration: 5 (1 to 11) years, men: 47.0%], 1,070 (12.2%) had died during a median follow-up period of 6.66 years (3.42-10.36) with 60,379 person-years.Upon enrolment, 209 patients had severe hypoglycaemia and 194 developed severe hypoglycaemia during follow-up (15 patients had both). In multivariable analysis and using patients without severe hypoglycaemia nor CKD as the referent group (683 deaths in 7,598 patients), severe hypoglycaemia alone (61 deaths in 272 patients) or CKD alone (267 death in 781 patients) were associated with increased risk of death [Hazard ratio, HR: 1.81(95%CI: 1.38 to 2.37) and 1.63 (1.38 to 1.93) respectively]. Having both risk factors (59 deaths in 116 patients) greatly enhanced the HR of death to 3.91 (2.93 to 5.21) with significant interaction (RERI: 1.46 and AP: 0.37, both p-values < 0.05).Conclusions: Severe hypoglycaemia and CKD interact to increase risk of death in type 2 diabetes patients. © 2014 Kong et al.; licensee BioMed Central Ltd.

Brown N.,Asia Diabetes Foundation | Brown N.,Newcastle University | Critchley J.,St George's, University of London | Bogowicz P.,Newcastle University | And 2 more authors.
Diabetes Research and Clinical Practice | Year: 2012

Objective: To systematically review published primary research on the development or validation of risk scores that require only self-reported or available clinical data to identify undiagnosed Type 2 Diabetes Mellitus (T2DM). Methods: A systematic literature search of Medline and EMBASE was conducted until January 2011. Studies focusing on the development or validation of risk scores to identify undiagnosed T2DM were included. Risk scores to predict future risk of T2DM were excluded. Results: Thirty-one studies were included; 17 developed a new risk score, 14 validated existing scores. Twenty-six studies were conducted in high-income countries. Age and measures of body mass/fat distribution were the most commonly used predictor variables. Studies developing new scores performed better than validation studies, with 11 reporting an AUC of >0.80 compared to one validation study. Fourteen validation studies reported sensitivities of <80%. The performance of scores did not differ by the number of variables included or the country setting. Conclusions: There is a proliferation of newly developed risk scores using similar variables, which sometimes perform poorly upon external validation. Future research should explore the recalibration, validation and applicability of existing scores to other settings, particularly in low/middle income countries, and on the utility of scores to improve diabetes-related outcomes. © 2012 Elsevier Ireland Ltd.

Kwan C.M.L.,Asia Diabetes Foundation | Chun K.M.,University of San Francisco | Huang P.,University of California at San Francisco | Chesla C.A.,University of California at San Francisco
Diabetes Spectrum | Year: 2013

Purpose. The purpose of this study was to examine Chinese Americans' beliefs regarding professional Chinese medicine (CM) in diabetes management. Previous research showed substantial variations in Chinese Americans' beliefs about the role of professional CM, such as acupuncture and herbal medicine, in diabetes management. To provide culturally sensitive care, health care providers (HCPs) need a nuanced understanding of patients' beliefs about professional CM. Methods. An interpretive phenomenological study was conducted. The sample included 20 informant couples (40 paired individuals) who were Chinese-American immigrants living with type 2 diabetes. Nineteen additional individuals were enrolled as respondents for member-checking. Semi-structured interviews were conducted in couple, group, and individual formats with informants and in groups only with respondents. Interviews were recorded, translated, transcribed, and coded for narrative and thematic analyses. Respondent responses validated informant findings. Results. Participants reported five concerns about professional CM: low product quality and safety; questionable provider qualifications, ethics, and motives; a lack of scientific evidence for professional CM products and methods; adverse interactions of professional CM products with Western medicine drugs; and cumbersome preparation requirements. Conclusion. Chinese Americans express skepticism about professional CM and are thoughtful when deciding whether it is a viable treatment option. Some concerns appear well-founded. HCPs are encouraged to become familiar with these concerns and to be prepared to discuss them with patients. They are encouraged to support research on CM, thus advancing the knowledge needed for determining the role of CM in diabetes care and improving collaboration with Chinese patients.

Sui Y.,Chinese University of Hong Kong | Zhao H.L.,Chinese University of Hong Kong | Zhao H.L.,Guilin Medical College | Wong V.C.W.,Hong Kong Hospital Authority | And 6 more authors.
Obesity Reviews | Year: 2012

Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) forCHMand/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ≥2 kg or body mass index (BMI) reduction ≥0.5 kg/m2. Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective 'risk ratio' (RR) of 1.84 (95% CI: 1.37-2.46) and 2.14 (95% CI: 1.58-2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03 kg (95% CI: 2.22-5.85) and 2.76 kg (95% CI: 1.61-3.83) and a mean difference in BMI reduction of 1.32 kg m-2 (95% CI: 0.78-1.85) and 2.02 kg m-2(95% CI: 0.94-3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96-1.28) and 1.14 (95% CI: 1.03-1.25) in body weight reduction, mean difference in body weight reduction of 0.08 kg (95% CI: -0.58 to 0.74) and 0.65 kg (95% CI: -0.61 to 1.91), and mean difference in BMI reduction of 0.18 kg m-2 (95% CI: -0.39 to 0.75) and 0.83 kg m-2 (95% CI: 0.29-1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies. © 2012 The Authors.

Kong A.P.S.,Chinese University of Hong Kong | Choi K.C.,Chinese University of Hong Kong | Zhang J.,Chinese University of Hong Kong | Luk A.,Chinese University of Hong Kong | And 6 more authors.
Acta Diabetologica | Year: 2016

Aims: We aimed to explore the associations of sleep patterns during weekdays and weekends with glycemic control in patients with type 2 diabetes. Methods: We examined the association between indices of glycemic control [glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG)] and sleep parameters (sleep duration, bedtime, and differences of sleep duration during weekdays and weekends) from adults with type 2 diabetes recruited in a prospective cohort enrolling from hospital medical clinics. Restricted cubic spline regression was used to examine the relationships between the glycemic indices and sleep parameters.Results: Excluding shift workers, a total of 3508 patients enrolled between July 2010 and July 2014 were included in this analysis. Mean age was 53.9 [standard deviation (SD) 8.7] years, and mean disease duration of diabetes was 8.3 (SD 7.1) years. Fifty-nine percentage were men. Mean sleep duration during weekdays and difference of sleep durations between weekdays and weekends were 7.7 (SD 1.3) hours and 0.6 (SD 1.2) hours, respectively. Mean HbA1c and FPG were 7.6 (1.5) % and 7.6 (2.5) mmol/L, respectively. Using restricted cubic spline regressions with successive adjustments of potential confounders, sleep duration difference between weekdays and weekends remained significantly associated with both HbA1c and FPG in a curvilinear manner. Sleep duration of about 1 h more during weekends when compared to weekdays was associated with beneficial effect in HbA1c (−0.13 %, 95 % confidence interval −0.24 to −0.02).Conclusions: In type 2 diabetes, regular sleeping habit with modest sleep compensation during weekends has positive impact on glycemic control. © 2016 Springer-Verlag Italia

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