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OBJECTIVE--The purpose of this study was to compare the predictive value for coronary heart disease (CHD) of the International Diabetes Federation (IDF) definition (with Asian criteria for central obesity) of [...]

OBJECTIVE--International guidelines recommend optimal control of risk factors in diabetes to prevent cardiovascular events. We examined risk associations between achieving treatment targets for glycemia, blood pressure and lipid control, and [...]

OBJECTIVE--We sought to develop stroke risk equations for Chinese patients with type 2 diabetes in Hong Kong. RESEARCH DESIGN AND METHODS--A total of 7,209 Hong Kong Chinese type 2 diabetic [...]

OBJECTIVE--Anemia and chronic kidney disease (CKD) are risk factors for cardiovascular diseases in diabetes. We examined the association between hematocrit, stratified by the presence of CKD, and cardiovascular events in [...]

OBJECTIVE--Chronic kidney disease (CKD) predicts cardiovascular disease (CVD) in the general population. We investigated the effects of stages of renal function using the estimated glomerular filtration rate (eGFR) on all-cause [...]

OBJECTIVE--The insertion/deletion (I/D) polymorphism of the ACE gene has been reported to be associated with diabetic microvascular or macrovascular complications. The aim of the present study was to investigate the [...]

We conducted autosomal genome scans to map loci for metabolic syndrome (MES) and related traits in the Hong Kong Family Diabetes Study. We selected 55 families with 137 affected members (121 affected relative pairs) for nonparametric linkage analysis on MES. We also selected 179 families with 897 members (2,127 relative pairs) for variance component-based linkage analyses on seven MES-related traits: waist circumference, systolic and diastolic blood pressure (BP), triglyceride, HDL cholesterol, fasting plasma glucose, and insulin resistance index (insulin resistance index by homeostasis model assessment [HOMA%IR]). Analyses revealed three regions that showed suggestive linkage for MES and also showed overlapping signals for metabolic traits: chromosome 1 at 169.5-181.5 cM (logarithm of odds [LOD] = 4.50 for MES, 3.71 for waist circumference, and 1.24 for diastolic BP), chromosome 2 at 44.1-57.3 cM (LOD = 2.22 for MES, 2.07 for fasting plasma glucose, and 1.29 for diastolic BP), and chromosome 16 at 45.2-65.4 cM (LOD = 1.75 for MES, 1.61 for HOMA%IR, and 1.25 for HDL cholesterol). Other regions that showed suggestive linkages included chromosome 5q for diastolic BP; 2q, 3q, 6q, 9q, 10q, and 17q for triglyceride; 12p, 12q, and 22q for HDL-C; and 6q for HOMA%IR. Simulation studies demonstrated genomewide significant linkage of the chromosome 1 region to both MES and waist circumference ([P.sub.genome-wide] = 0.002 and 0.019, respectively). In summary, we have found a susceptibility locus on chromosome 1q21-q25 involved in the pathogenesis of multiple metabolic abnormalities, in particular obesity. Our results confirm the findings of previous studies on diabetes and related phenotypes. We also suggest the locations of other loci that may contribute to the development of MES in Hong Kong Chinese., The clustering of multiple metabolic abnormalities, including insulin resistance, glucose intolerance, hypertension, dyslipidemia, and obesity, in particular central obesity, is known as syndrome X, or metabolic syndrome (MES) (1-3). MES [...]

We conducted an autosomal genome scan to map loci for type 2 diabetes in a Hong Kong Chinese population. We studied 64 families, segregating type 2 diabetes, of which 57 had at least one member with an age at diagnosis of ≤ 40 years. These families included a total of 126 affected sibpairs and 4 other affected relative pairs. Nonparametric linkage analysis revealed seven regions showing nominal evidence for linkage with type 2 diabetes (logarithm of odds [LOD] >0.59, [P.sub.pointwise] < 0.05): chromosome 1 at 173.9 cM (LOD = 3.09), chromosome 3 at 26.3 cM (LOD = 1.27), chromosome 4 at 135.3 cM (LOD = 2.63), chromosome 5 at 139.3 cM (LOD = 0.84), chromosome 6 at 178.9 cM (LOD = 1.91), chromosome 12 at 48.7 cM (LOD = 1.99), and chromosome 18 at 28.1 cM (LOD = 1.00). Simulation studies showed genome-wide significant evidence for linkage of the chromosome 1 region ([P.sub.genome-wide] = 0.036). We have confirmed the results of previous studies for the presence of a susceptibility locus on chromosome 1q21-q25 (173.9 cM) and suggest the locations of other loci that may contribute to the development of type 2 diabetes in Hong Kong Chinese., Type 2 diabetes is a heterogeneous disease characterized by insulin resistance and pancreatic β-cell dysfunction (1). Genetic factors play an important role in the development of type 2 diabetes. Despite [...]

OBJECTIVE--We investigated the phenotypic features of diabetic microvascular complications and their association with a (CA), microsatellite and a C/T polymorphism at the 5' region of the aldose reductase gene (ALR2) [...]

OBJECTIVE--To examine the relationships between central obesity, insulin resistance index, plasma insulin, growth hormone (GH), and cortisol concentrations in 90 young Chinese type 2 diabetic patients (aged 33 ± 5 [...]

Role of HLA Class II Alleles MHC associations with IDDM in a Chinese population were studied to investigate genetic susceptibility to the disorder. The frequency of HLA-DR3 was significantly higher [...]

The Case: A 62-year-old woman had been admitted to hospital in July 1992 with flu-like symptoms and malaise. At that time, she had a 5-year history of hypertension and newly [...]

THE CASE: A 67-year-old woman was brought to hospital by her husband, who had found her sweaty and unresponsive in the morning. She was hypoglycemic, with a plasma glucose level [...]

Endosulphan is a chlorinated hydrocarbon insecticide with potential toxicity for the respiratory and central nervous systems. Renal toxicity has been rarely reported. We describe a man who developed renal failure due to acute tubular necrosis following a suicidal attempt with endosulphan in the absence of significant hypotension or sepsis., INTRODUCTION Case Report A 72-year-old farmer was admitted because of a suicidal ingestion of insecticide. Six weeks earlier, he was diagnosed as having reactivation of pulmonary tuberculosis and had been [...]

MAGGIE C.Y. NG [1] SHAO-CHIN LEE [1] GARY T.C. KO [1] JUNE K.Y. LI [1] WING-YEE SO [1] YASMEEN HASHIM [2] ANTHONY H. BARNETT [3] IAN R. MACKAY [4] JULIAN [...]

OBJECTIVE -- To examine the factors predicting age at diagnosis of type 2 diabetes in Hong Kong Chinese. RESEARCH DESIGN AND METHODS -- The relationships between age at diagnosis and [...]

A significant association of the ACE insertion/deletion polymorphism with type 2 diabetes OBJECTIVE -- In Chinese populations, hypertension is common and is a major risk factor for cerebrovascular and coronary [...]

Atherosclerotic disease is much less common in Chinese subjects compared with Caucasian subjects. We have previously demonstrated that traditional atherosclerosis risk factors, such as aging and smoking, have less adverse [...]

OBJECTIVE -- We have previously suggested using the paired values of fasting plasma glucose (FPG) and [HbA.sub.1c] to identify potential diabetic subjects. In this article, we followed up on 208 [...]

OBJECTIVE -- To investigate transmission patterns of diabetes and their relationships with clinical characteristics in Hong Kong Chinese patients with late-onset (age ≥35 years) type 2 diabetes. RESEARCH DESIGN AND [...]

OBJECTIVE -- To examine the significance of individual risk factors on the development of diabetes in subjects who underwent screening for diabetes. RESEARCH DESIGN AND METHODS -- A total of [...]

A higher level of antibodies to GAD has been reported in type 1 diabetic patients with peripheral neuropathy than in those without it [1]. However, other researchers [2,3] have not [...]

The renin angiotensin system has diverse effects on metabolism, cardiovascular and renal systems. We examined the relationships between ACE gene polymorphisms and cardiovascular risk factors in 75 young onset([is less [...]

Glucokinase acts as glucose sensor in the regulation of insulin secretion in pancreas. A G [right arrow] A variant at nucleotide -30 of [Beta]-cell glucokinase gene promoter had been found [...]

We examined the clinical characteristics of 71 young Chinese diabetic probands (39% male, mean age:37 [+ or -] 8 years, BMI:25.5 [+ or -] 5.2[kgm.sup.-2]) & 230 siblings (43% male, [...]

We have previously reported that in Hong Kong Chinese with various risk factors for glucose intolerance, the use of paired values of fasting plasma glucose (FPG) of 6.1 mmol/l (the [...]

Type 2 diabetes mellitus is the predominant form of diabetes in Hong Kong Chinese, even amongst those with early onset of disease. Over 50% of these young patients have a [...]

Since 1993, the Diabetes Centre has adopted the EuroDiab Care protocol to assess all new and old patients. In this assessment, we also documented the history of diabetes in parents [...]

We compared the effects of structured, protocol driven care provided at a Diabetes Centre and usual care at a hospital medical clinic. In 1989, 102 hypertensive, Type 2 diabetic patients [...]

Recently there is renewed interest in the association between type 2 diabetes and colorectal carcinoma (1). Some authorities have advocated more intensive colonoscopy screening in patients with diabetes (2). We [...]

Background Understanding factors affecting length of hospital stay (LOS) in patients with severe influenza may improve their management.Methods A retrospective cohort study on laboratory-confirmed, adult influenza patients hospitalized in 2004 and 2005 was conducted. For all influenza cases during that period, immunofluorescence assay on nasopharyngeal aspirate was used for rapid diagnosis, and oseltamivir (75 mg twice daily for 5 days) prescribed if the patient presented within 2 days of symptom onset. Independent factors associated with time to discharge were identified using Cox proportional hazards models. An adjusted hazard ratio (aHR) >1 signifies a higher chance of early discharge. Viral shedding and influenza vaccination history were studied during one ‘flu’ season.Results A total of 356 patients (influenza A 93.5%) were studied. The majority of patients were old (70.2 ±8.4years), had =1 comorbid illness (69.1%) and developed respiratory or cardiovascular complications (69.4%). Oseltamivir initiated within 2 days of illness was associated with shorter total LOS (Kaplan-Meier estimated median 4 versus 6 days [-33%]; aHR for discharge 1.54, 95% confidence intervals [95% CI] 1.23–1.92, P<0.0001). Older age (=70 years), comorbidities and complications were associated with prolonged LOS. Prolonged viral RNA detection >day 4 of illness (23 out of 99 consecutive patients) was also independently associated with longer LOS (aHR 0.36 [95% CI 0.19–0.71], P=0.003), whereas influenza vaccination within 6 months was associated with shorter LOS (aHR 2.14 [95% CI 1.18–3.85], P=0.012).Conclusion Our analyses suggest that timely oseltamivir treatment is independently associated with shorter LOS in patients hospitalized for severe influenza. Efforts to ensure early diagnosis and therapeutic intervention are warranted.

The RENAAL Study has confirmed the renoprotective effects of Losartan in type 2 diabetes. In this subgroup analysis from the RENAAL Study, we hypothesized that the intensive care received by patients in a clinical trial setting also reduced the rate of decline in renal function through optimization of all risk factors.

Objective: To assess the effects of BMI on progression to diabetes in Hong Kong Chinese and to analyze the optimal cutoff for overweight and obesity in Hong Kong Chinese. Research Methods and Procedures: This is a prospective study with a mean follow‐up of 2.1 years (median 1.4 years, range 0.9 to 8.4 years). We recruited 172 nondiabetic high‐risk subjects, of whom 115 had normal glucose tolerance (NGT) and 57 had impaired glucose tolerance (IGT). BMI and 75‐gram oral glucose tolerance tests were assessed at baseline and then at yearly intervals Results: The crude rates of progression to diabetes for subjects with NGT or IGT were 8.4% and 11.5% per year, respectively. For subjects with NGT, the progression rate to diabetes differed with different BMI ranges. For subjects with NGT and BMI ≥ 25 kg/m2, the crude rates of progression to diabetes or glucose intolerance (diabetes or IGT) were 12.5% per year and 14.6% per year, respectively. The corresponding rates for subjects with NGT and BMI ≥ 28 kg/m2were 14.6% and 18.9% per year, respectively. Among subjects with NGT, those with BMI between 25 and 28 kg/m2had the highest Youden index and likelihood ratio to predict the conversion to diabetes or glucose intolerance. Discussion: Obese subjects with NGT had higher rates of progression to diabetes than nonobese subjects. We recommend redefining BMI cutoffs, with 23 kg/m2for overweight and 28 kg/m2for obesity. This definition may be more sensitive to identify at‐risk subjects and more specific to identify “patients” for therapeutic management.

Antibodies to glutamic acid decarboxylase (GAD) are a useful autoimmune marker for type 1 diabetes mellitus in Caucasians. We examined antibodies to GAD and their relationships with clinical features and pancreatic β cell function in 140 young Chinese diabetic patients. Over an 18-month period beginning in 1995, 140 young Chinese diabetic subjects with age of onset of disease ⩽ 35 years and age < 40 years were recruited consecutively, irrespective of their modes of presentation. Clinical features, antibodies to GAD and pancreatic β cell function (using a glucagon stimulation test) were examined. Increased levels of antibodies to GAD (>18 units) were detected in 12·1% (n> = 17) of these subjects. Forty-three (31%) patients had a classical type 1 presentation and 65 (46%) patients were insulin-deficient based on post-glucagon plasma C-peptide levels. Patients who were insulin-deficient and had a type 1 presentation had the highest prevalence of antibodies to GAD (29·0%) compared with patients who had a type 2 presentation and were non-insulin deficient (6·4%, P= 0·003). Patients who had antibodies to GAD had lower body mass index and waist—hip ratio, earlier onset of disease, lower blood pressure, plasma triglyceride and C-peptide, and higher concentrations of plasma high-density lipoprotein cholesterol and glycated haemoglobin, and were more likely to require drug treatment, compared with those without antibodies to GAD. In conclusion, there was a low prevalence of antibodies to GAD in Chinese young diabetic patients although such antibodies remained a relatively specific marker for insulin deficiency and acute presentation. Causes other than autoimmunity should be sought to explain the high prevalence of insulin deficiency in these young Chinese patients.

We examined the reproducibility of oral glucose tolerance tests (OGTT) using the World Health Organization criterion in 212 Chinese subjects (male 149, female 63) who underwent two 75 g OGTTs within a 6-week period. The overall reproducibility was 65.6% (139/212) of which 74 subjects had normal glucose tolerance, 24 had diabetes and 41 had impaired glucose tolerance (IGT) on two occasions. The subjects were divided into three groups [group 1: normal OGTTs on both occasions (n= 74); group 2: one abnormal OGTT (either diabetes or IGT (n= 51); group 3: 2 abnormal OGTTs (n= 87)]. Subjects in group 1 were younger, had lower blood pressure, body mass index (BMI), waist-to-hip ratio (WHR), fasting and 2 h plasma insulin levels, triglyceride, very — low density lipoprotein and apolipoprotein-B concentrations than both groups 2 and 3. Group 2 had similar characteristics as group 3 except for a lower glycated haemoglobin (HbA1c), fasting and 2 h plasma glucose during the two OGTTs. With receiver operating characteristic curve (ROC) analysis, a HbA1c. of 5.3% gave an optimal sensitivity of 70.7% and specificity of 74.3% to predict diabetes as defined by a 2h plasma glucose value ≥ 11.1 mmol/L in the first OGTT. Of the 212 subjects, 73 had HbA1c≥ 5.3%. The reproducibility of OGTT was 56.2% for these 73 subjects. With ROC analysis, a BMI of 25 kg/m2gave an optimal sensitivity of 53.7% and specificity of 56.7% to predict diabetes. For the 36 subjects with BMI ≥ 25 kg/m2, the reproducibility of OGTT was 58.3%. Similarly, for the 140 subjects with WHR ≥ 0.9, the reproducibility of OGTT was 57.9%. These findings confirmed the poor reproducibility of OGTT which was not improved even amongst subjects with high HbA1c, BMI or WHR. Furthermore, subjects with one abnormal OGTT, whether reproducible or not, had a higher cardiovascular risk profile compared to subjects who had two normal OGTTs.

In type 2 diabetes, it is not uncommon to find an elevated serum triglyceride and/or reduced high‐density lipoprotein (HDL) cholesterol levels; elevated total cholesterol levels often occur as well. To evaluate the short‐term efficacy and tolerability of combination therapy with lovastatin and acipimox in Chinese patients with type 2 diabetes who have mixed dyslipidemia, an open‐label 6‐month trial was conducted. All patients had type 2 diabetes (n = 33) with total cholesterol ≥6.2 mmol/L and fasting triglyceride ≥2.8 mmol/L, which had been confirmed twice and persisted for at least 12 weeks after introduction of diet control. After a 4‐week run‐in period, they were given lovastatin 40 mg daily at night for 12 weeks. Acipimox 250 mg three times a day was then added for a further 12 weeks. After 12 weeks of treatment with lovastatin alone, improvement was observed in total cholesterol (21% reduction), triglyceride (32% reduction), low‐density lipoprotein (LDL) cholesterol (5.5% reduction), HDL cholesterol (11.6% elevation), apolipoprotein A‐I (4.6% elevation), and apolipoprotein B (20.5% reduction). The addition of acipimox to lovastatin for an additional 12 weeks further reduced serum total cholesterol, triglyceride, LDL cholesterol, and apolipoprotein B, but this additional decrease was not statistically significant. However, HDL cholesterol and apolipoprotein A‐I levels were significantly increased by the addition of acipimox (a 14.2% and 9.0% elevation, respectively). Serum creatine phosphokinase increased slightly after 12 weeks of lovastatin but decreased to a concentration similar to baseline after 12 weeks of combination treatment. No patients reported muscle pain or weakness or other side effects. Combination treatment with lovastatin and acipimox appears to be a safe and effective therapy in patients with type 2 diabetes and mixed dyslipidemia, and has particular benefit in elevating serum HDL cholesterol and apolipoprotein A‐I levels.

Abstract. The present study was undertaken to examine the cellular control arm of the immune response with regard to T lymphocyte proliferation in euthyroid Graves' ophthalmopathy. Twenty patients with euthyroid Graves' ophthalmopathy (7 on antithyroid drugs and 13 on no treatment) and 18 healthy controls were studied in an infection-free period. Mitogen-stimulated cellular interleukin 2 (IL2) receptor expression, soluble interleukin 2 receptor release, and interleukin 2 production, were studied in peripheral blood mononuclear cells cultured for 24 h. The cellular IL2 receptor expression and soluble IL2 receptor release did not differ between the patients and healthy controls. In contrast, IL2 production in response to pokeweed mitogen stimulation was increased in lymphocytes from patients with Graves' ophthalmopathy. The IL2 release did not correlate with the quantities of cellular and soluble IL2 receptor. The mitogen-stimulated cellular IL2 receptor expression, IL2 receptor release, and IL2 production did not differ between patients with or without carbimazole therapy. Despite a suggested role of autoreactive T cells in mediating the development and propagation of autoimmune thyroid disease, this study fails to demonstrate a defective T lymphocyte activation state in patients with Graves' ophthalmopathy during an euthyroid state.

Four Chinese female patients who suffered from manic-depressive disorder and underlying autoimmune thyroiditis developed transient episodes of thyrotoxicosis during maintenance lithium therapy. Endocrinologically speaking, three of them had “Hashitoxicosis”, while the other had silent lymphocytic thyroiditis. Albeit rare among Western patients, such lithium-associated thyroid dysfunctions appeared to be more likely to occur in Hong Kong Chinese. They seemed to involve multiple aetiological factors, such as autoimmune thyroid disease, the toxic and immunomodulatory roles of lithium and perhaps genetic and dietary factors. Because of their self-limiting nature, the importance of avoiding unnecessary and potentially deleterious antithyroid treatment is emphasised.

The mechanism by which erythrocyte mean corpuscular volume (MCV) is decreased in hyperthyroidism is not known. One possible mechanism is premature aging of erythrocytes in the circulation. Since erythrocyte creatine has been shown to be a good marker of cell senescence, we determined this in hyperthyroid patients and control subjects to examine whether the decrease in MCV is related to senescence. Erythrocyte creatine levels were similar in both hyperthyroid patients and controls, suggesting that premature senescence of erythrocytes does not account for the lower MCV in hyperthyroidism.

Objectives: To document the medical problems of detained Vietnamese boat people admitted to hospital in Hong Kong, and to identify the medical problems or features that may indicate an intention to abscond. Design and setting: A retrospective review of the records of all Vietnamese boat people admitted to the Medical Unit of the Prince of Wales Hospital, Hong Kong, between 1 October 1993 and 30 September 1994. Results: 614 Vietnamese boat people were admitted during the 12 months (comprising 3% of total admissions). 92 (15%) of these absconded from hospital after admission (compared with 0.06% for all other admissions). Gastrointestinal bleeding, clinical sepsis, drug overdose and spontaneous pneumothorax were the most common presentations among those who absconded. One‐third (33.8%) of the 80 patients whose symptoms indicated gastrointestinal bleeding had insignificant endoscopic findings. Needle puncture marks were found in nine of the 75 patients with unexplained bacteraemia and in five of the 12 patients with spontaneous pneumothorax. Conclusions: Clinicians who provide medical care to Vietnamese boat people should be aware of the high incidence of absconding from hospital and that self‐inflicted injuries are not uncommon and may identify intending absconders.

We aimed to evaluate gestational impaired glucose tolerance (GIGT) in untreated patients using umbilical cord blood insulin and connecting peptide (C-peptide) concentrations to indicate fetal hyperinsulinemia. A 75 g, 2-hour oral glucose tolerance test, evaluated using WHO criteria, was performed in 722 antenatal patients. Cord C-peptide (p = 0.001) and insulin (p = 0.008) concentrations were significantly higher in patients with GIGT in comparison to those with normal glucose tolerance. The WHO test failed to identify abnormal C-peptide concentrations (p = 0.057), but did identify abnormal insulin concentrations (p = 0.006) and cases where either or both were raised (p = 0.002), with a low Youden’s index (range 8.1–11.3) in all 3 cases. A significant biochemical difference exists in patients with GIGT. The WHO criteria for GIGT predict abnormal biochemical outcomes, but they do so poorly.