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Gu W.,Shanghai JiaoTong University | Huang Y.,Shanghai JiaoTong University | Huang Y.,Fudan University | Zhang Y.,Shanghai JiaoTong University | And 6 more authors.
Diabetic Medicine | Year: 2014

Aim: To compare the carotid intima-media thickness in patients with newly diagnosed Type 1 or Type 2 diabetes ranging from 14 to 30 years of age. Methods: Demographic, anthropometric and laboratory data were obtained from 404 adolescents and young adults (103 subjects with Type 1 diabetes, 94 with Type 2 diabetes, 153 obese subjects and 54 normal control subjects). Carotid intima-media thickness was assessed based on Doppler ultrasound examination and compared among the four groups. Results: Our data showed significant increases in carotid intima-media thickness in subjects with Type 1 diabetes, Type 2 diabetes and obese subjects compared with the control subjects, with those in the group with Type 2 diabetes demonstrating the greatest change (P < 0.001). Age, BMI, percentage of fat, waist-hip ratio and total triglycerides were significantly correlated with both common and internal carotid intima-media thickness segments. From a stepwise multiple linear regression model, the independent determinants of common carotid intima-media thickness were age, BMI, HbA1c and HDL cholesterol (adjusted R2 = 0.152, P < 0.001). After adjustment for age, sex and HbA1c, the odds ratio for increased carotid intima-media thickness was 1.67 (95% CI 1.19-2.33, P = 0.003) for obese subjects, 2.38 (95% CI 1.59-9.47, P = 0.001) for subjects with Type 1 diabetes and 3.93 (95% CI 1.90-6.07, P = 0001) for subjects with Type 2 diabetes compared with the control subjects. Conclusions: Compared with young control subjects, we found significant increases in carotid intima-media thickness in patients with newly diagnosed Type 1 diabetes and Type 2 diabetes, with patients with Type 2 diabetes showing greater carotid intima-media thickness. Traditional cardiovascular risk factors, such as obesity, dyslipidaemia, hypertension and hyperglycaemia, could cause vessel changes even in adolescents and young adults. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.


Zhang Y.,Endocrine and Metabolic stitutes of Shanghai Universities | Zhang Y.,Shanghai JiaoTong University | Hong J.,Endocrine and Metabolic stitutes of Shanghai Universities | Hong J.,Shanghai JiaoTong University | And 9 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2014

Background: Dipeptidyl peptidase-IV (DPP-4) inhibitors and sulfonylureas are two important second-line anti-diabetic agents. The objective of this research was to evaluate the efficacy and safety of DPP-4 inhibitors compared with sulfonylureas by meta-analytic approach of available randomized studies. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases up to 30 June 2013, collecting all randomized clinical trials with a treatment duration of ≥18weeks. Data on glycated haemoglobin (HbA1c), body weight, hypoglycaemia, total adverse events, and cardiovascular events were retrieved and analysed. Results: The analysis included 12 randomized studies comprising 10982 patients with type 2 diabetes mellitus. On the basis of meta-analysis, sulfonylureas lowered HbA1c significantly more than DPP-4 inhibitors with weighted mean difference (WMD) of 0.105 [95% confidence interval (CI) 0.103 to 0.107]. The results were consistent in trials with longer (>32weeks) or shorter (≤32weeks) duration; however, DPP-4 inhibitors showed greater reduction in HbA1c compared with the second-generation sulfonylureas and in patients with baseline eGFR<50mL/min/1.73m2. Patients treated with DPP-4 inhibitors are less likely to achieve HbA1c<7% compared with sulfonylureas [Mantel-Haenszel odds ratio (MH-OR) 0.91; 95% CI 0.84 to 0.99]. DPP-4 xinhibitors were associated with a reduction in body weight (WMD -1.652; 95% CI -1.658 to -1.646) and lower risk of hypoglycaemia (MH-OR, 0.13; 95% CI 0.11 to 0.16), total adverse events (MH-OR, 0.79; 95% CI 0.72 to 0.87), and cardiovascular events (MH-OR, 0.53; 95% CI 0.32 to 0.87) compared with sulfonylureas. Conclusion: Although DPP-4 inhibitors are less efficacious compared with sulfonylureas, they demonstrate a beneficial effect on body weight, episodes of hypoglycaemia, and total adverse events. © 2013 John Wiley & Sons, Ltd.


Wang L.,Shanghai JiaoTong University | Wang L.,Endocrine and Metabolic stitutes of Shanghai Universities | Zhang J.,Shanghai JiaoTong University | Zhang J.,Endocrine and Metabolic stitutes of Shanghai Universities | And 10 more authors.
Endocrine | Year: 2013

To explore the relationship between serum liver enzymes and both the glucose tolerance status and insulin secretion in young obese patients. A total of 734 young obese patients (BMI ≥ 25 kg m-2) and 231 lean healthy volunteers matched in age (BMI < 23 kg m-2) were enrolled in this cross-sectional observational study. The 734 obese patients were subdivided to three groups (OB-NGR, OB-IGR, and OB-DM) according to their glucose tolerance status. FSIVGTT was performed to assess the degree of insulin sensitivity (SI) and islet secretion function (AIRg). The disposition index (DI; product of SI and AIRg) was calculated as an integrated measurement of insulin secretion and insulin action after compensating for insulin resistance. The extent and distribution of hepatic fat infiltration was assessed using the liver/spleen ratio (L/S ratio) with CT scan. ALT and GGT levels in OB-NGR, OB-IGR, and OB-DM groups were significantly increased compared to the normal controls, and were incrementally increased in turn in the three groups, whereas DI decreased at the same time. One standard deviation increment in ALT and GGT increased the risk of β-cell dysfunction after controlling for potential confounders such as sex, age, BMI, waist-hip ratio, and blood pressure. Even after the adjustment of the serum lipid profile and L/S ratio, the odds ratio of ALT remained statistically significant (OR, 1.603; 95 % CI, 1.225-2.096). Serum levels of liver enzymes showed an independent close relationship with insulin secretion capacity. Excluding the impact of a fatty liver, increased ALT and GGT levels indicated a significant association with the attenuation of pancreatic β-cell function. This study provides the possibility that elevated liver enzymes might be treated as simple biomarkers of early insulin secretion deficit in type 2 diabetes, especially in young obese patients. © 2013 Springer Science+Business Media New York.

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