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Aims: To demonstrate the noninferiority of alogliptin to acarbose, in terms of antidiabetic efficacy, in Chinese people with uncontrolled type 2 diabetes (T2D) and high cardiovascular risk. Materials and Methods: ACADEMIC (NCT03794336) was a randomized, open‐label, phase IV study conducted at 46 sites in China. Antidiabetic treatment‐naive or metformin‐treated adults with uncontrolled T2D (glycated haemoglobin [HbA1c] 58.0–97.0 mmol/mol) were randomized 2:1 to alogliptin 25 mg once daily or acarbose 100 mg three times daily for 16 weeks. All participants had a documented history of coronary heart disease or high cardiovascular risk at screening and received aspirin (acetylsalicylic acid) 100 mg daily throughout the trial. The primary endpoints were change in HbA1c versus baseline, and the incidence of gastrointestinal adverse events (AEs). Safety and tolerability were also assessed. Results: A total of 1088 participants were randomized. Alogliptin was noninferior to acarbose for the change in Week‐16 HbA1c (least‐squares mean change [standard error] –11.9 [0.4] vs. –11.4 [0.5] mmol/mol, respectively; difference between arms –0.5 [0.7] mmol/mol; 95% confidence interval –1.9 to 0.8 mmol/mol), and was associated with a lower incidence of gastrointestinal AEs (8.9% vs. 33.6%, respectively; P < 0.0001). More alogliptin than acarbose recipients achieved HbA1c <53.0 mmol/mol without gastrointestinal AEs (48.0% vs. 32.7%; P < 0.0001). Discontinuations due to treatment‐related AEs were less frequent with alogliptin than acarbose (0.3% vs. 2.5%). Conclusions: Glycaemic control was comparable between alogliptin and acarbose, but the gastrointestinal tolerability of alogliptin was better. More patients achieved target HbA1c without gastrointestinal AEs with alogliptin, suggesting that this agent may be preferred in clinical practice. [ABSTRACT FROM AUTHOR]

Aims To estimate the long-term cost-effectiveness of exenatide twice daily vs insulin glargine once daily as add-on therapy to oral antidiabetic agents ( OADs) for Chinese patients with type 2 diabetes ( T2DM). Methods The Cardiff Diabetes Model was used to simulate disease progression and estimate the long-term effects of exenatide twice daily vs insulin glargine once daily. Patient profiles and treatment effects required for the model were obtained from literature reviews (English and Chinese databases) and from a meta-analysis of 8 randomized controlled trials comparing exenatide twice daily with insulin glargine once daily add-on to OADs for T2DM in China. Medical expenditure data were collected from 639 patients with T2DM (aged ≥18 years) with and without complications incurred between January 1, 2014 and December 31, 2015 from claims databases in Shandong, China. Costs (2014 Chinese Yuan [¥]) and benefits were estimated, from the payers' perspective, over 40 years at a discount rate of 3%. A series of sensitivity analyses were performed. Results Patients on exenatide twice daily + OAD had a lower predicted incidence of most cardiovascular and hypoglycaemic events and lower total costs compared with those on insulin glargine once daily + OAD. A greater number of quality-adjusted life years (QALYs; 1.94) at a cost saving of ¥117 706 gained was associated with exenatide twice daily vs insulin glargine once daily. (i.e. cost saving of ¥60 764/ QALY) per patient. Conclusions In Chinese patients with T2DM inadequately controlled by OADs, exenatide twice daily is a cost-effective add-on therapy alternative to insulin glargine once daily, and may address the problem of an excess of medical needs resulting from weight gain and hypoglycaemia in T2DM treatment. [ABSTRACT FROM AUTHOR]

Aims: To examine and compare health-related quality of life (HRQoL) in people with previously known diabetes, new screen-detected asymptomatic diabetes and people without diabetes. Methods: HRQoL of 4,613 individuals who participated in a population-based cross-sectional diabetes survey in Qingdao, China, in 2009, was assessed using the 15D instrument. A Tobit regression model to estimate the effects of diabetes on HRQoL separate from effects of other health determinants was constructed. Results: Among the surveyed population, 220 (4.8 %) individuals had previously known diabetes and 531 (11.5 %) individuals had new screen-detected diabetes, defined by fasting plasma glucose ≥7.0 mmol/l and/or 2-h plasma glucose ≥11.1 mmol/l. The age-, gender-, and BMI-adjusted mean 15D score of people without diabetes, with new screen-detected diabetes, and previously known diabetes was 0.975, 0.975, and 0.964, respectively, for urban and 0.971, 0.972, and 0.960, respectively, for rural participants. HRQoL overall and on all the dimensions ( p < 0.05) except for hearing, eating, and speech was worse in the people with previously known diabetes compared to those with new screen-detected diabetes and those without diabetes. Compared to people without diabetes, people with new screen-detected diabetes were worse off on the dimension of usual activities ( p < 0.05). After adjusting for comorbid diseases and other confounders, the impact of diabetes on reduced HRQoL was diminished. Conclusion: Health-related quality of life was impaired in people with previously known diabetes who had co-morbid conditions, but was largely unaltered in people with newly detected asymptomatic diabetes as compared to people without diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the performance and cost-effectiveness of two screening methods to identify undiagnosed diabetes at primary care settings among a Chinese population. Methods: Two screening methods using a fasting capillary glucose (FCG) test or a Chinese diabetes risk score (DRS) at primary care settings followed by diagnostic tests were compared. The performance of FCG and DRS was evaluated by using receiver operating characteristic (ROC) curve analysis. The main economic outcome measures were the total cost of screening per 1000 persons, proportion of undiagnosed diabetes detected, and cost per undiagnosed diabetes identified from the societal perspective. Results: Among all participants, 14.6% (1349/9232) had undiagnosed diabetes defined by fasting plasma glucose ≥7.0mmol/l and/or 2h plasma glucose ≥11.1mmol/l and/or hemoglobin A1c ≥6.5%. At the optimal cutoff point of 6.1mmol/l for FCG and 14 for DRS, the sensitivity was 65.1% and 65.8%, and specificity was 72.4% and 55.2%, respectively. The area under the ROC curve was 75.3% for FCG and 63.7% for DRS (P <0.001). Based on the input costs, the total cost of screening 1000 persons was ¥64,000 ($9143) for FCG and ¥81,000 ($11,571) for DRS. The average cost per case identified was ¥674 ($96) for FCG at cutoff point of 6.1mmol/l and ¥844 ($121) for DRS at score of 14. The incremental cost per case identified was ¥17,000 ($2429) for DRS compared to FCG. The dominance relations between strategies remained with the changed in sensitivity analysis. Conclusions: As a first-line screening tool for undiagnosed diabetes, the FCG test performed better than the DRS in primary care settings in China. The non-invasive and layperson-oriented DRS was feasible and detected more cases but more expensive. No strategy has strong dominance that was both more effective and less costly. The favorable strategy will depend on if the purpose of the screening program is to identify more cases or to have lower cost per case. [Copyright &y& Elsevier]

Aims: Qingdao Diabetes Prevention Program aims to translate the trial experience to real-life settings with goals to: (1) raise the public awareness of diabetes and diabetes risk factors, and promote healthy diet and physical activity; (2) reduce the number of high-risk people developing diabetes through lifestyle counselling; (3) early diagnosis of diabetes; (4) evaluate the effectiveness, cost-effectiveness, feasibility, acceptability and sustainability of the programs.Program Design: The project's first phase (2006-2009) was focused on health promotion targeting at the entire population of 1.94 million, and training of professionals; and the second phase (2009-2012) on lifestyle counselling targeting at individuals with a diabetes risk score of >or=14. The effectiveness of the intervention and the cost-effectiveness of the program between the intervention arm (n=8000) and the control arm (n=4000) who are randomly selected from the project targeting and not-targeting areas will be evaluated with the diabetes incidence as the primary outcome. Milestone achieved from 2006 to 2009: 3993 health professionals finished training courses; 724,130 educational booklets were distributed to families and 318,284 high-risk individuals recorded and 130,164 underwent at least one follow-up counselling session. [ABSTRACT FROM AUTHOR]

Abstract: The current study aimed to evaluate whether individuals with fasting plasma glucose (FPG) of 5.6–6.0mmol/l has a similar risk profiles for diabetes or impaired glucose tolerance (IGT) to those with FPG of 6.1–6.9mmol/l. A community-based cross-sectional survey in Chinese adults (20–74 years) was conducted during April–July in 2002. Participants without a prior history of diabetes underwent a standardized 2-h 75g oral glucose tolerance test. Positive likelihood ratios were calculated to estimate the odds of having diabetes or IGT for subjects with different FPG levels. Among 1856 participants, prevalence of IFG increased from 12.4 to 28.2% with the cut-off value of FPG lowered from 6.1 to 5.6mmol/l. Individuals with FPG of 6.1–6.9mmol/l were more obese and insulin resistant than those with FPG of 5.6–6.0mmol/l. The positive likelihood ratio for diabetes and IGT were 1.83 (1.28–2.61) and 2.60 (1.96–3.44) in subjects with FPG of 6.1–6.9mmol/l, and 0.54 (0.30–0.95) and 1.47 (1.11–1.95) for those with FPG of 5.6–6.0mmol/l, respectively. In conclusion, the likelihood of diabetes and IGT was lower in subjects with FPG of 5.6–6.0mmol/l than in those with FPG of 6.1–6.9mmol/l. The clinical and social implication of labelling more individuals with impaired fasting glucose needs to be further studied. [Copyright &y& Elsevier]

Background and Objectives: Fruit, vegetable, seafood, and dairy intake may reduce the risk of type 2 diabetes, but this relationship is unclear. We aimed to examine the associations between fruit, vegetable, seafood, and dairy intake and type 2 diabetes prevalence in a Chinese population.Methods and Study Design: A total of 4,343 individuals aged 35-74 years participated in a population-based cross-sectional study in Qingdao, China. The frequency and quantity of fruit, vegetable, seafood, and dairy intake were determined using a standard food frequency questionnaire. Diabetes was classified according to the WHO/IDF 2006 criteria. Logistic regression analysis was employed to estimate odds ratio (OR) for type 2 diabetes in relation to fruit, vegetable, seafood, and dairy intake in a multivariable model.Results: The multivariate-adjusted ORs (95% confidence interval) for the presence of type 2 diabetes were 0.68 (0.46-0.98), 0.50 (0.37-0.68), and 0.91 (0.66-1.25), respectively, for the highest versus the lowest groups regarding total fruit and vegetable, fruit or vegetable intake in women. The ORs for type 2 diabetes prevalence regarding the quantity of fruit and vegetable, fruit, and yogurt intake were 0.88 (0.78-0.99), 0.71 (0.61-0.82), and 0.56 (0.32-0.98) in women, but not in men. Seafood consumption was inversely associated with diabetes risk in men, but not in women; the corresponding figures were 0.58 (0.35-0.96) and 0.92 (0.63-1.36), respectively.Conclusions: Fruit, vegetable, and yogurt intake in women and seafood intake in men were inversely associated with type 2 diabetes prevalence in this Chinese population. These findings require confirmation in a prospective study. [ABSTRACT FROM AUTHOR]