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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]

Introduction: We explored the impact of a temporary tobacco-free public policy for the 2008 Summer Olympics on the smoking prevalence and secondhand smoke exposure among the population of a co-hosting city, Qingdao, China.Methods: The Qingdao Diabetes Survey was analyzed for 2006 (n = 4599) and 2009 (n = 4680), which are survey years before and after the tobacco-free Olympics public policy period (July 2007 to January 2009). We analyzed the differences in self-reported smoking prevalence and exposure to secondhand smoke at home and/or workplace, and compared odds of smoking by survey year and of exposure to secondhand smoke among nonsmokers.Results: From 2006 to 2009, the male smoking prevalence declined from 51.4% (95% confidence interval [CI] = 49.0% to 53.9%) to 42.6% (95% CI = 40.2% to 45.1%), and the proportion of lighter smokers decreased more. Among nonsmokers, the secondhand smoke exposure rate declined from 62.2% (95% CI = 60.5% to 63.9%) to 56.8% (95% CI = 55.1% to 58.6%). Regression analyses show 34% lower odds of men smoking after Olympics (OR = 0.66, 95% CI = 0.57% to 0.77%). Rural residents and individuals who are not retired were more likely to smoke. Female nonsmokers report 17% less exposure to secondhand smoke after Olympics (OR = 0.83, 95% CI = 0.70% to 0.98%). Urban nonsmokers were more likely to be exposed than their rural counterparts.Conclusions: Smoking prevalence among men and secondhand smoke exposure among women significantly decreased in Qingdao, China, after the tobacco-free Olympics public policy period. As only the proportion of lighter smokers decreased, this may help explain why urban nonsmokers reported increased exposure. Unintended increased secondhand smoke exposure and cessation support need to be addressed in large-scale policy campaigns.Implications: Hosting the Olympic Games can help to initiate large-scale tobacco-free public policies for hosting cities. Although previous studies have demonstrated reduction in nonsmoker exposure to secondhand smoke, the impact on the hosting city's smoking prevalence or exposure rates is unclear. After the Olympic Games in Qingdao, China, smoking prevalence among men significantly decreased, mostly due to light smokers. Secondhand smoke exposure at home and/or workplace significantly decreased among female nonsmokers. Urban nonsmokers had an unintended consequence of increased secondhand smoke exposure after the tobacco-free Olympic policy period. Concurrent promotion of cessation support for heavier smokers may be needed. [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]

Urinary tract infections (UTIs) are common nosocomial infections. This study evaluated the prevalence, pathogens, antibiotic resistances, clinical outcomes, and hospitalization costs associated with complicated UTIs in southern China, and risk factors delaying patient discharge. We retrospectively reviewed electronic medical records of 4,284 (61.4% women) complicated UTI-related hospitalizations from 2008 to 2013. Average patient age was 61.1 years and median hospital stay was 11 days. Pathogens were isolated from 1,071 urine and 148 blood specimens. Gram-negative bacteria were the most frequent and included Escherichia coli (48.2%), Klebsiella pneumoniae (9.5%), Pseudomonas aeruginosa (4.9%), and Proteus mirabilis (4.6%), while Enterococcus spp. (14.4%) was the most common Gram-positive bacteria causing UTIs. Both E. coli and K. pneumoniae showed high resistance rates (>45%) to wide-spectrum penicillins, cephalosporins, aztreonam, and ciprofloxacin. Resistances to beta-lactamase inhibitor/beta-lactam antibiotic combination were relatively lower. Imipenem, meropenem, and amikacin had the greatest activity against E.coli and K. pneumoniae. Recurrent infection was a risk factor for mortality. Age, sex, previous surgery, diabetes, and renal insufficiency were significant risk factors for delayed discharge (P<0.01). Response to initial treatment was associated with a lower cost. Initial empiric use of antibiotics least associated with resistance may reduce costs and medical resource usage. [ABSTRACT FROM AUTHOR]

Objective: This study aims to propose a data-driven framework that takes unstructured free text narratives in Chinese Electronic Medical Records (EMRs) as input and converts them into structured time-event-description triples, where the description is either an elaboration or an outcome of the medical event. Materials and Methods: Our framework uses a hybrid approach. It consists of constructing cross-domain core medical lexica, an unsupervised, iterative algorithm to accrue more accurate terms into the lexica, rules to address Chinese writing conventions and temporal descriptors, and a Support Vector Machine (SVM) algorithm that innovatively utilizes Normalized Google Distance (NGD) to estimate the correlation between medical events and their descriptions. Results: The effectiveness of the framework was demonstrated with a dataset of 24,817 de-identified Chinese EMRs. The cross-domain medical lexica were capable of recognizing terms with an F1-score of 0.896. 98.5% of recorded medical events were linked to temporal descriptors. The NGD SVM description-event matching achieved an F1-score of 0.874. The end-to-end time-event-description extraction of our framework achieved an F1-score of 0.846. Discussion: In terms of named entity recognition, the proposed framework outperforms state-of-the-art supervised learning algorithms (F1-score: 0.896 vs. 0.886). In event-description association, the NGD SVM is superior to SVM using only local context and semantic features (F1-score: 0.874 vs. 0.838). Conclusions: The framework is data-driven, weakly supervised, and robust against the variations and noises that tend to occur in a large corpus. It addresses Chinese medical writing conventions and variations in writing styles through patterns used for discovering new terms and rules for updating the lexica. [ABSTRACT FROM AUTHOR]

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]

OBJECTIVE--The study's goal was to evaluate the performance of A1C and fasting capillary blood glucose (FCG) tests as mass screening tools for diabetes and pre-diabetes, as determined by the standard oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS--Data from 2,332 individuals aged 35-74 years who participated in a population-based cross-sectional diabetes survey in Qingdao, China, were analyzed. A 2-h 75-g OGTT was used to diagnose diabetes. The performance of A1C and FCG was evaluated against the results of the OGTTs by using receiver operating characteristic curve (ROC) analysis. RESULTS--The prevalence of newly diagnosed diabetes and pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) was 11.9 and 29.5%, respectively. For subjects with newly diagnosed diabetes, the area under the ROC curve was 0.67 for A1C and 0.77 for FCG (P < 0.01) in men and 0.67 and 0.75 (P < 0.01) in women, whereas for pre-diabetes, these values were 0.47 and 0.64 (P < 0.001) in men and 0.51 and 0.65 (P < 0.001) in women. At the optimal A1C cutoff point of ≥5.6% for newly diagnosed diabetes, sensitivities (specificities) were 64.4% (61.6%) for men and 62.3% (63.3%) for women. CONCLUSIONS--As a screening tool for newly diagnosed diabetes and pre-diabetes, the FCG measurement performed better than A1C in this general Chinese population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the association of fresh vegetable consumption with the risk of diabetes in a Chinese population. Methods: Data from 2386 individuals aged 35–74 years who participated in a population-based cross sectional diabetes survey in Qingdao, China were analyzed. Frequency of vegetable intake was obtained using a food frequency questionnaire. Diabetes was defined as self-reported diabetes or undiagnosed diabetes determined by 2-h 75g oral glucose tolerance test or fasting capillary blood glucose test. Multivariate-adjusted odds ratio (OR) for the presence (vs. the absence) of diabetes in association with the frequency of fresh vegetable intake was estimated using logistic regression analysis. Results: The OR for the presence of diabetes was 1.17 (95% CI 0.66, 2.05) in men and 0.50 (95% CI 0.33, 0.77) in women who ate fresh vegetables more than 14 times/week as compared with those who ate fresh vegetables less than 7 times/week after adjustment for age, family history of diabetes, BMI, systolic blood pressure, 24-h energy intake, physical activity and smoking and drinking. Conclusions: Consumption of fresh vegetables was associated with a low risk of having diabetes in women but not in men in this Chinese population. [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]

Complicated intra-abdominal infection (cIAIs) are a common and important cause of morbidity worldwide. In this study, the clinical features, microbiological profiles, antimicrobial patterns and treatments of 3233 cIAI patients (mean age, 47.6 years; 54.7% male) with 3531 hospitalisations from 2008–2013 were retrospectively investigated. The most commonly isolated bacteria were Escherichia coli (47.6%), Klebsiella pneumoniae (16.9%), Enterococcus faecalis (10.4%) and Pseudomonas aeruginosa (8.8%). Ciprofloxacin, aminoglycoside (gentamicin), piperacillin/tazobactam and carbapenems exhibited activity against 53%, 76%, 88% and 100% of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae isolates, respectively. Pseudomonas aeruginosa isolates exhibited 100%, 95%, 88%, 71% and 76% susceptibility to aminoglycoside (gentamicin), ciprofloxacin, meropenem, imipenem and ceftazidime, respectively, and Enterococcus remained 100% susceptible to vancomycin and linezolid. β-Lactam antibacterials other than penicillin (specifically third-generation cephalosporins) and imidazole derivatives (ornidazole and metronidazole) were the most common first-line treatments. Patients subjected to regimen change after initial antibiotic treatment had predisposing conditions (e.g. older age, more severe co-morbidities) and a higher incidence of P. aeruginosa infection; in addition, these patients encountered a higher average cost of care and worse clinical outcomes compared with those without medication modification. Taken together, these findings indicate the importance of appropriate initial empirical therapy and suggest the use of combination therapy comprising cephalosporins and metronidazole. [ABSTRACT FROM AUTHOR]

Introduction: Comparisons between brand and biosimilar basal insulin in hospitalized patients are lacking. We aimed to compare the efficacy and safety of brand insulin glargine vs. biosimilar insulin glargine in non-critical hospitalized patients with type 2 diabetes mellitus (T2DM)., Methods: This retrospective study was conducted using the electronic medical records of 194,006 patients at the Qingdao Endocrine and Diabetes Hospital between January 2006 and December 2017. A total of 476 patients diagnosed with T2DM, hospitalized, and treated with subcutaneous insulin glargine were included. After propensity score matching (1:3), patients who received biosimilar insulin glargine (Basalin) (n = 34) were compared to a matched group of patients who received brand insulin glargine (Lantus) (n = 101). Outcome measures were changes in fasting blood glucose (FBG), the incidence of hypoglycemia, and insulin dose., Results: Compared to patients who received Basalin, patients who received Lantus achieved more reduction in FBG during insulin treatment (- 1.24 mmol/L vs. - 2.20 mmol/L; p = 0.04) and had a lower mean FBG at the end of treatment (8.20 mmol/L vs. 7.26 mmol/L; p = 0.12). Patients in Basalin and Lantus groups had a comparable mean daily dose of basal insulin at initiation (0.19 vs. 0.18 IU/kg; p = 0.30) and end of treatment (0.21 vs. 0.21 IU/kg; p = 0.99), and a similar duration of basal insulin treatment (16.4 vs. 15.3 days; p = 0.74). Hypoglycemia was infrequent in both Basalin and Lantus treatment (one vs. four patients, respectively; p = 1.00) and no severe hypoglycemic events were reported., Conclusion: In a non-critical hospital setting, subcutaneous treatment with Lantus brought significant FBG improvement without increased hypoglycemic risk.

Complicated skin and soft tissue infections (cSSTI) are some of the most commonly treated infections in hospitals, and place heavy economic burdens on patients and society. Here we report the findings from an analysis of cSSTI based on a retrospective study which was conducted within the Chinese inpatient population. We focused our research on the analysis of the patient population, antibiotic treatment, clinical outcome and economic burden. The study population comprised 527 selected patients hospitalized between 2008 and 2013. Among the hospitalizations with microbiological diagnoses, 61.41% (n = 113) were diagnosed as infected with Gram-positive bacteria, while 46.20% (n = 85) were infected with Gram-negative bacteria. The most commonly found Gram-positive bacteria was Staphylococcus aureus (40.76%, n = 75), and the most common Gram-negative bacteria was Escherichia coli (14.13%, n = 26). About 20% of the Staphylococcus aureus were methicillin-resistant. The resistance rate of isolated Staphylococcus aureus or Escherichia coli to penicillin was around 90%; in contrast, the resistance rate to vancomycin, linezolid or imipenem was low (<20%). A large percentage of patients were treated with cephalosporins and fluoroquinolones, while vancomycin and imipenem were also included to treat drug-resistant pathogens. Over half of the hospitalizations (58.43%, n = 336) experienced treatment modifications. The cost to patients with antibiotic modifications was relatively higher than to those without. In conclusion, our study offers an analysis of the disease characteristics, microbiological diagnoses, treatment patterns and clinical outcomes of cSSTI in four hospitals in Guangdong Province, and sheds lights on the current clinical management of cSSTI in China.

Objective: Since the incidence rates and risk factor for type 2 diabetes in Chinese populations had not been well known, the aim of this study was to evaluate the impact of weight change and other risk factors on incident type 2 diabetes in Qingdao, China., Methods: A prospective population-based cohort study was carried out, based on subjects aged 35-74 years who participated in the 'Qingdao Diabetes Survey' in 2006. Subjects were free of diabetes at baseline. A total of 1 294 subjects attended the follow up survey between 2009 and 2011. The diagnostic criteria for Diabetes was classified according to both the World Health Organization and the International Diabetes Federation 2006. A logistic regression was built using the backward stepwise selection to assess the effects of risk factors on the incident type 2 diabetes., Results: During a 4-year follow up period, 120 cases with incident type 2 diabetes were identified, with cumulative incidence of diabetes as 11.8% . Participants who developed type 2 diabetes were significantly older, having significantly higher age-adjusted BMI/waist circumference/systolic blood pressure and total cholesterol, than those subjects who remained non-diabetic both in urban and rural areas. Among individuals with no diabetes at the baseline, factors as age, living in the rural areas, baseline BMI and weight change had all independently contributed to the development of diabetes. The multivariate adjusted relative risks (95%CIs) related to the incidence of diabetes were 1.45 (1.13-1.87), 1.93 (1.12-3.34), 1.46 (1.05-2.03) and 1.49 (1.18-1.88), respectively, for a one standard deviation increase in continuous variables. Compared with the reference group of non-obese and with stable weight, factor as weight loss >5% and BMI <28 kg/m² were independently associated with a 67% (RR = 0.33, 95% CI: 0.11-0.97)reduction in the risk of type 2 diabetes, while BMI >28 kg/m² could increase the risk across the levels of weight change. Similar trends were observed in higher waist and weight gain at baseline., Conclusion: This study confirmed the critical importance of obesity in the development of type 2 diabetes. Baseline BMI and weight gain appeared independent predictors on type 2 diabetes.

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 © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Objective: To study joint effect of family history of diabetes (FHD) with obesity on prevalence of type 2 diabetes mellitus in the Chinese and in the Finns., Methods: A total of 1091 Chinese men and 1706 women, 1472 Finnish men and 1694 women, 45-74 years of age were studied. The probability and odds ratio (OR) of having diabetes were estimated using logistic regression analysis. The synergy index (SI) and relative excess risk due to interaction (RERI) of FHD with body mass index (BMI) or waist circumference (WC) was calculated., Results: Age-standardized prevalence of diabetes was higher in individuals with FHD than in those without in both the Chinese and Finns. Compared with individuals without FHD and with BMI <30 kg/m(2), ORs (95% confidence intervals [CI]) for diabetes were 2.7 (1.8, 4.0), 2.8 (1.9, 4.0), 9.1 (5.9, 13.9), respectively, in Finnish men with BMI ≥30 kg/m(2) alone, with FHD alone and with both (SI [95% CI] = 2.4 [1.4, 3.9], RERI = 4.6 [1.3, 8.0]); the corresponding figures were 1.7 (1.0, 2.9), 2.7 (1.8, 4.2) and 4.4 (1.9, 10.4) in Chinese men (SI = 1.4 [0.4, 4.9] RERI = 1.0 [-2.9, 5.0]). They were 3.5 (2.1, 5.8), 2.1 (1.3, 3.4) and 6.8 (4.1, 11.2) in Finnish women (SI = 1.6 [0.9, 2.8], RERI = 2.2 [-0.4, 4.9]), and 1.6 (1.1, 2.2), 2.1 (1.5, 3.0), 3.5 (1.9, 6.4) in Chinese women (SI = 1.5 [0.6, 3.8], RERI = 0.8 [-1.4, 3.0]). The pattern of synergistic effect of FHD with WC on diabetes was similar to that seen with BMI in the Finns but no effect was seen in the Chinese., Conclusions: Both obesity and FHD are independent risk factors for diabetes, but their joint effect is significant only in Finnish men., (Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the synergistic effect between diabetes family history and abnormal waist-to-hip ratio (WHR) on the incidence of type 2 diabetes., Methods: Population-based case-control study was conducted. The interaction between diabetes family history and abnormal WHR was analysed by an additive model., Results: After adjusting confounding factors by multiple logistic regression analysis, the synergy index was 5.63, the attributable risk was 1.49, and the attributable interaction percent was 52.9%., Conclusion: There was a synergistic effect between diabetes family history and abnormal WHR on the incidence of type 2 diabetes.

Objective: To assess the association of serum uric acid (UA) with components of metabolic syndrome (MetS) in different ethnic groups., Methods: Nondiabetic men (3285) and nondiabetic women (4078) aged 25 to 74 years without a history of cardiovascular disease and gout from Mauritius and Qingdao China, comprising Mauritian Indians, Mauritian Creoles, and an urban Chinese population, were studied. The top quintile of waist circumference, body mass index (BMI), blood pressure, serum total cholesterol and triglycerides, plasma glucose levels, and the bottom quintile of HDL cholesterol was defined as the metabolic disorder. Hyperuricemia was defined if UA values were in the top quintile., Results: In a multivariate model (adjusted for age, cohort, smoking, and alcohol consumption), waist circumference, BMI, and serum triglycerides appeared to be independently associated with hyperuricemia in both sexes and in all ethnic groups except in Chinese women. Multivariate adjusted odds ratios (95% confidence intervals [CIs]) for having three or more metabolic disorders vs fewer than three, corresponding to a one SD increase in serum UA concentration, were 1.75 (1.51 to 2.02), 2.19 (1.71 to 2.82) and 2.30 (1.68 to 3.16) in Indian, Creole, and Chinese men, respectively, and 1.74 (1.52 to 2.00), 1.75 (1.40 to 2.19) and 1.72 (1.37 to 2.16) in Indian, Creole, and Chinese women, respectively., Conclusions: In nondiabetics of Asian and African ancestry, elevated serum UA was closely associated with components of MetS, but whether UA provides additional information to the definition of the MetS in predicting future cardiovascular disease and diabetes needs to be studied.

Objective: Serum uric acid (UA) is reported as an important marker of hypertension, coronary heart disease, and diabetes; diabetic subjects have low UA levels. The relationship between UA and fasting plasma glucose (FPG) and 2-h plasma glucose concentrations in non-diabetic subjects as well as in diabetic subjects in general population is not well known. This was investigated in a general Chinese population., Methods: A stratified, random cluster sampling method was performed to select a representative sample of general population aged 20-74 years in Qingdao in 2002. A total of 1288 men and 2344 women participated in the survey. The mean UA concentration was calculated for small glucose intervals and the trend was tested using general linear model., Results: The mean concentrations of UA were 381, 393, 371, and 345 micromol/l in men with FPG of <6.1, 6.1-6.9, > or =7.0 mmol/l (newly diagnosed diabetes), and in those with prior history of diabetes. They were 308, 322, 301, and 293 micromol/l, respectively, in women. The UA levels declined with increasing FPG levels in individuals with newly diagnosed diabetes, with standardized coefficient of -0.26 in men and -0.20 in women, after multivariate adjustment for age, body mass index, triglycerides, and cardiovascular disease history. The relationship between 2-h glucose and UA was not as clear as that for FPG., Conclusion: Serum UA levels tended to increase with increasing FPG levels in non-diabetic individuals, but decrease in diabetic individuals.

Objective: Hyperuricemia and gout have shown an increase worldwide. Data are lacking for the prevalence of hyperuricemia and gout and their correlates in China. We studied the occurrence of these conditions in Chinese adults in the city of Qingdao., Methods: A population-based cross-sectional survey for hyperuricemia and gout was performed among 2438 adults (1535 women, 903 men; aged 20-74 yrs) in 2002. Fasting serum uric acid (UA) and lipid profiles were determined, as well as height, weight, and blood pressure. Hyperuricemia was defined as serum UA levels >or= 420 micromol/l in men and >or= 360 micromol/l in women. Diagnosis of gout was self-reported. Complete biochemical and questionnaire data were available for analysis from 1303 women and 720 men., Results: The age-standardized prevalence was 25.3% for hyperuricemia and 0.36% for gout in adults aged 20 to 74 years. Hyperuricemia was more prevalent in men than in women (32.1% vs 21.8%; p < 0.001). Age-adjusted mean serum UA level was 389.3 micromol/l in men and 315.7 micromol/l in women. Serum UA increased with age in women only (p for trend < 0.001). Body mass index and serum triglycerides had the strongest associations with serum UA in both genders, followed by alcohol drinking and diastolic blood pressure in men, and systolic blood pressure and total cholesterol in women., Conclusion: The prevalence of hyperuricemia in the urban adult population in Qingdao city is high, while the frequency of gout is lower. Obesity, hypertension, and dyslipidemia are the major factors associated with hyperuricemia in this study.

Objective: To report the age- and sex-specific prevalence of diabetes and impaired glucose regulation (IGR) according to revised World Health Organization criteria for diabetes in Asian populations., Research Design and Methods: We performed 11 studies of 4 countries, comprising 24,335 subjects (10,851 men and 13,484 women) aged 30-89 years who attended the 2-h oral glucose tolerance test and met the inclusion criteria for data analysis., Results: The prevalence of diabetes increased with age and reached the peak at 70-89 years of age in Chinese and Japanese subjects but peaked at 60-69 years of age followed by a decline at the 70 years of age in Indian subjects. At 30-79 years of age, the 10-year age-specific prevalence of diabetes was higher in Indian than in Chinese and Japanese subjects. Indian subjects also had a higher prevalence of IGR in the younger age-groups (30-49 years) compared with that for Chinese and Japanese subjects. Impaired glucose tolerance was more prevalent than impaired fasting glycemia in all Asian populations studied for all age-groups., Conclusions: Indians had the highest prevalence of diabetes among Asian countries. The age at which the peak prevalence of diabetes was reached was approximately 10 years younger in Indian compared with Chinese and Japanese subjects. Diabetes and IGR will be underestimated in Asians based on the fasting glucose testing alone.