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Objective: The goal of this study was to compare measures of weight regain (WR) and their association with the glucose metabolism deterioration within 3 years following bariatric surgery among Chinese patients with obesity and type 2 diabetes mellitus (T2DM). Methods: Among a retrospective cohort of 249 patients with obesity and T2DM who underwent bariatric surgery and were followed up to 3 years, WR was assessed by weight changes, BMI changes, percentage of presurgery weight, percentage of nadir weight, and percentage of maximum weight lost (%MWL). Glucose metabolism deterioration was defined as a change from an absence of antidiabetic medication use to use, or absence of insulin use to use, or an increase in glycated hemoglobin by at least 0.5% to 5.7% or greater. Results: A comparison of C‐index of glucose metabolism deterioration indicated %MWL had better discriminatory ability versus weight change, BMI change, percentage of presurgery weight, or percentage of nadir weight (all p < 0.01). The %MWL also had the highest prediction accuracy. The optimal %MWL cutoff point was 20%. Conclusions: Among Chinese patients with obesity and T2DM who underwent bariatric surgery, WR quantified as %MWL predicted 3‐year postoperative glucose metabolism deterioration better than the alternatives; 20% MWL was the optimal cutoff point. [ABSTRACT FROM AUTHOR]

Purpose: Roux-en-Y gastric bypass (RYGB) is widely used as an effective treatment for type 2 diabetes (T2D) patients with obesity; long-term (> 5 years) diabetes remission (DR) rates have been less frequently reported. To date, there is no validated model to guide procedure selection based on long-term glucose control in patients with T2D. The purpose of this study is to establish a new tool for predicting long-term DR with a nomogram. Materials and Methods: One hundred five individuals with complete preoperative information and undergoing RYGB in a university hospital were enrolled in this retrospective study. DR criteria after bariatric surgery were defined according to the 2009 ADA guideline. Fifteen individuals were lost to 5-year follow-up. Thus, 90 individuals were available and seen at the end of follow-up. The baseline and 5-year data of these 90 individuals were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors for long-term DR, and these predictors were used to create a nomogram. Results: Preoperative glycated hemoglobin (A1C) and diabetes duration were identified as independent influential factors that could be combined for precise prediction of long-term complete DR. We created a nomogram by using these 2 factors. The area under the curve was 0.78 (95% confidence interval 0.67–0.89). The Hosmer–Lemeshow X2 value of nomogram was 3.86 (P = 0.87) and indicated consistency between predicted and observed remission. Conclusion: Our nomogram was a novel and useful tool for accurate prediction of long-term DR after RYGB. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy and safety of polyethylene glycol loxenatide (PEX168), a new glucagon‐like peptide‐1 receptor agonist, as an add‐on to metformin therapy in Chinese patients with type 2 diabetes (T2D). Materials and methods: This was a multicentre, randomized, double‐blind, placebo‐controlled phase 3b trial. After metformin monotherapy (≥1500 mg/day) for 8 weeks or more, patients with uncontrolled T2D (HbA1c of 7.0%‐10.5%) from 44 sites were randomized (1:1:1) to metformin + placebo, metformin + PEX168 100 μg, and metformin + PEX168 200 μg. The core treatment period lasted for 24 weeks, followed by a 28‐week extension period. The primary endpoint was the change in HbA1c levels at week 24. The main secondary endpoint was the proportion of patients with an HbA1c of less than 7.0% at week 24. Results: The least‐square mean (standard error) change in HbA1c levels was significantly greater (P <.001 for superiority) in the PEX168 groups (−1.16% [0.08%] and −1.14% [0.08%] with 100 and 200 μg, respectively) than in the placebo group (0.35% [0.08%]). The proportion of patients with an HbA1c of less than 7.0% at week 24 was significantly higher in the PEX168 100 μg (37.4%) and PEX168 200 μg (40.6%) groups than in the placebo group (16.8%; both P <.001). The gastrointestinal reactions were mild; the risks of hypoglycaemia and weight gain did not increase. Anti‐PEX168 antibodies were noted in less than 2% of patients. No treatment‐emergent serious adverse events occurred. Conclusion: The subcutaneous injection of PEX168 once a week can effectively, continuously and safely improve HbA1c levels in patients with T2D when combined with metformin. [ABSTRACT FROM AUTHOR]

Background: RYGB was considered as an effective treatment for obese patients with T2D. However, 5-year outcomes including T2D remission after surgery have not been adequately studied in Chinese patients. Objectives: Our aim is to evaluate metabolic outcomes of RYGB in 5-year follow-up. Methods: We retrospectively divided 59 Chinese patients into two groups, namely BMI groups (group A: BMI < 28 kg/m2; group B: BMI ≥ 28 kg/m2) and A1C groups (group C: A1C < 7%; group D: A1C ≥ 7%). Their medical records were collected and cardiovascular risk and medications were evaluated in 5 years after RYGB. Results: Thirty patients were female (30/59, 50.85%). RYGB was performed laparoscopically without mortality or major complications. The mean BMI in 59 patients decreased from 30.89 ± 3.12 to 25.04 ± 3.48 in the fifth year. No one was lost to follow-up in 5 years. There were significant reductions in BMI, A1C, and oral medication or insulin in all groups. Diabetes remission rates in the first, third, and fifth years postoperation were 77.97, 61.02, and 49.15%. T2D relapse and requirement for antihypertensive agents increased in the third and fifth years. Larger quantity of subcutaneous fat area (SFA) and shorter duration of T2D preoperation were more likely to achieve remission of T2D postoperation. Conclusions: This study has confirmed that RYGB is an effective treatment for obese Chinese patients with T2D, resulting in diabetes remission, metabolic disorder control, and cardiovascular risk reduction. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass (RYGB) is a major type of bariatric surgery. Various models have been established for facilitating clinical decision-making and predicting outcomes after RYGB; the ABCD, DiaRem, advanced-DiaRem (Ad-DiaRem), and DiaBetter scores are among the most commonly used risk prediction models. However, these models were primarily developed based on retrospective analyses of patients from Western countries at 1 year after RYGB. The present study was to assess the performance of these models and identify the optimal model, for predicting postoperative diabetes remission in diabetic Chinese patients. Methods: The present study included a total of 253 RYGB patients; 214 completed a 1-year follow-up and 131 completed a 3-year follow-up. The assessments and comparisons of the predictive performance of the four models were based on both discrimination and calibration measures. Discrimination was assessed according to the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by Hosmer-Lemeshow goodness-of-fit tests and predicted-to-observed ratios. Results: One hundred thirteen (52.8%) in the 1-year follow-up group and 59 (45.0%) in the 3-year follow-up group achieved complete diabetes remission. Although all models showed similar discriminatory capacity and good calibration, the DiaBetter model exhibited the best predictive performance (1-year follow-up, AUC 0.760, 95% confidence interval [CI] 0.697–0.815, predicted-to-observed ratio 1.04; 3-year follow-up, AUC 0.804, 95% CI 0.726–0.868, predicted-to-observed ratio 0.95). Conclusions: The present results indicated that the DiaBetter model is the optimal model for predicting postoperative diabetes remission in diabetic Chinese individuals, due to its excellent predictive accuracy and ready availability for use in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Clinical and basic investigations have indicated a significant association between circulating growth differentiation factor 15 (GDF15) and cardiovascular disease; however, the relationship between GDF15 and lower extremity atherosclerotic disease (LEAD) has been less studied. The present study aimed to explore the association between GDF15 and LEAD in Chinese patients with type 2 diabetes mellitus (T2DM). Considering that obesity is an important factor associated with circulating GDF15 levels, whether the relationship between serum GDF15 levels and LEAD is affected by body mass index (BMI) was also analysed. Methods: A total of 376 hospitalized T2DM patients were enrolled (161 with LEAD and 215 without LEAD). A sandwich enzyme-linked immunosorbent assay was used to detect the serum GDF15 levels. The femoral intima-media thickness (F-IMT) and LEAD were assessed by ultrasonography. Results: Patients with LEAD had significantly higher serum GDF15 levels than those without LEAD, regardless of whether their BMI was < 25 kg/m2 or ≥ 25 kg/m2 (both P < 0.05). Serum GDF15 levels were independently positively related to the F-IMT (standardized β = 0.162, P = 0.002). After adjusting for confounding factors, per 1-standard deviation (SD) increase in the serum GDF15 levels was significantly related to an approximately 1.4-fold increased risk of LEAD in the total population (P < 0.05). Regardless of whether the BMI was < 25 kg/m2 or ≥ 25 kg/m2, this association remained significant, with approximately 1.6- and 1.4-fold increased risks of LEAD, respectively (both P < 0.05). Conclusions: High serum GDF15 levels were significantly correlated with an increased risk of LEAD in T2DM patients, and this relationship was independent of BMI. [ABSTRACT FROM AUTHOR]

Aims/Introduction It has not been reported whether chronic hepatitis B virus infection ( CHB) is associated with a specific type of diabetes. We sought to investigate the prevalence of CHB status in different diabetes subtypes among a Chinese population. Materials and Methods This was a cross-sectional study. A total of 381 patients with adult-onset autoimmune diabetes, 1,365 patients with type 2 diabetes and 1,365 non-diabetic controls were recruited from June 2005 to February 2014. The exclusion criteria included: (i) hepatitis C virus antibody positive; (ii) hepatic cirrhosis; and (iii) malignant neoplasm and severe renal dysfunction (serum creatinine >450 μmol/L). Patients were grouped as hepatitis B virus-negative and CHB status. Results Patients with type 2 diabetes had a higher prevalence of CHB than the controls in the overall population (13.5 vs 10.0%, P = 0.004) and among patients with normal hepatic function (13.3 vs 8.8%, P = 0.002). There was no difference in the prevalence of CHB status between patients with adult-onset autoimmune diabetes and the controls. Multiple logistic regression analysis showed that the odds ratio of CHB increased by ~1.5-fold in patients with type 2 diabetes than in the control group after adjustment for age, sex and body mass index, regardless of hepatic function status. Conclusions CHB status was more prevalent in patients with type 2 diabetes than in individuals with adult-onset autoimmune diabetes and the controls among the Chinese population. Further research is required to ascertain whether CHB status increases the risk of developing type 2 diabetes, or whether type 2 diabetes, but not adult-onset autoimmune diabetes, increases the risk of CHB. [ABSTRACT FROM AUTHOR]

Aims: To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients. Methods: This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild-moderate (DR I-II), and sight-threatening (DR III-IV). BMI (kg/m) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP). Results: DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m, P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m interval) and DR was U-shaped; patients with BMI 28-29.9 kg/m had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I-II (OR 0.76), and DR III-IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles. Conclusion: Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the effect of the E23K variant of the potassium inwardly rectifying channel, subfamily J, member 11 ( KCNJ11) gene on gliclazide modified release ( MR) treatment in newly diagnosed patients with type 2 diabetes mellitus (T2 DM). A total of 108 diabetic patients with no history of antidiabetic medication was treated with gliclazide MR for 16 weeks and underwent follow up at Weeks 2, 4, 8, 12 and 16. All patients were genotyped for KCNJ11 E23K (rs5219). At baseline, patients with the KK genotype had higher blood glucose and lower serum insulin levels after oral glucose administration than patients with the EE and EK genotypes ( P < 0.05 for all). During treatment, individuals with the KK genotype had lower fasting glucose levels and were more likely to attain the target fasting glucose level ( Plog rank = 0.028) than E allele carriers. Patients with the KK genotype had larger augmentations in changes (Δ) in acute insulin response ( P = 0.049) and Δ body mass index ( P = 0.003). Moreover, patients with the EK genotype had a lower variance in changes in fasting insulin levels ( P = 0.049) and homeostasis model assessment of β-cell function (P = 0.021) than those with the KK genotype. The findings of the present study suggest that the KCNJ11 E23K variant is associated with a greater effect of sulphonylurea treatment in newly diagnosed Chinese patients with T2 DM. [ABSTRACT FROM AUTHOR]

Background: To assess the association of albuminuria and retinopathy with metabolic syndrome (MetS) and the related metabolic components defined by various criteria in Chinese community-based subjects. Methods: A total of 3240 Chinese subjects were recruited from urban communities and classified into subgroups with isolated or concomitant state of the two microvascular diseases. MetS was defined according to the standard of International Diabetes Federation, the National Cholesterol Education Program's Adult Treatment Panel III and Chinese Diabetes Society (CDS), separately. Albuminuria was defined as an elevated morning urine albumin-to-creatinine ratio. Retinopathy were identified with nonmydriatic retinal photographs according to the Diabetic Retinopathy Disease Severity Scale. Logistic regression was performed to analyze the contributive risk factors. Results: The subgroup of isolated retinopathy was the oldest (P<0.05), with higher blood pressure (P<0.001) and larger waist circumference (P<0.05). After adjusting for age, sex and other metabolic components, individuals with blood pressure over 130/85 mmHg were prone to have isolated albuminuria (OR: 1.51, P = 0.0001); while individuals with fasting plasma glucose over 5.6 mmol/L were in high risk of retinopathy concomitant with albuminria (OR: 3.04, P = 0.006). Larger waist circumference was a potential risk factors for isolated albuminuria and isolated retinopathy, though not significant after further adjustment of other metabolic components. The risk for albuminuria and retinopathy increased with the aggregation of three or more metabolic components. However, the MetS per se did not have synergic effect and only the MetS defined by CDS remained as a risk factor. Conclusions: Albuminuria and retinopathy were highly associated with accumulated metabolic abnormalities including sub-clinical elevated blood pressure and elevated fasting plasma glucose. [ABSTRACT FROM AUTHOR]

Background: Urinary albumin excretion rate (UAER) is a remarkable index reflecting the progression of kidney disease in diabetic subjects. The link between UAER and lipid metabolism is still unclear. The correlation of Apolipoprotein B (ApoB) to albuminuria has been investigated. The National Cholesterol Education Program-Adult Treatment Panel III recommends that clinicians consider non–high-density lipoprotein cholesterol (non-HDL-c) as a surrogate marker for ApoB. Objective: We sought to evaluate the relationship of UAER with lipid profile, especially with non-HDL-c in type 2 diabetic patients without renal dysfunction. Methods: A total of 507 type 2 diabetic patients with normal renal function participated in this study. Demographic and anthropometric data were collected; 24-hour urine samples were collected for UAER measurement. Blood samples were collected for lipid parameters and HbA1c measurement. Results: The patients with albuminuria had greater levels of non–HDL-c and ApoB. The frequencies of albuminuria among the four quartiles of lipid parameters, ie, triglycerides, total cholesterol, non-HDL-c, and ApoB, demonstrated significantly linearly increasing (P for trend <.01). After adjustment, UAER was significantly correlated with total cholesterol, triglycerides, ApoB, and non-HDL-c but not with low-density lipoprotein cholesterol (LDL-c) or lipoprotein(a) [Lp(a)]. Stepwise regression analysis showed that age (β = .255, P = .000), systolic blood pressure (β = .261, P = .000), non-HDL-c (β = .164, P = .000), and duration of diabetes (β = .105, P = .024) were independently correlated with UAER in diabetic patients without renal dysfunction. Conclusion: Compared with the lipid parameters of total cholesterol, triglycerides, HDL-c, LDL-c, ApoB, Apolipoprotein A-I (ApoA-I), and Lp(a), non-HDL-c was more closely associated with albuminuria in Chinese type 2 diabetic patients without impaired renal function. [Copyright &y& Elsevier]

OBJECTIVE--Hepatocyte nuclear factor 1β (HNF1β) is a transcription factor that is critical for pancreatic cell formation and glucose homeostasis. Previous studies have reported that common variants of HNF1β were associated with type 2 diabetes in Caucasians and West Africans. However, analysis in the subjects from the Botnia study and Malmö Preventive Project produced conflicting results, and the role for HNF1β in type 2 diabetes susceptibility remains unclear. We therefore investigated common variants across the HNF1β gene in a Chinese population. RESEARCH DESIGN AND METHODS--Fifteen tagging single nucleotide polymorphisms (SNPs) were analyzed for association with type 2 diabetes in subjects with type 2 diabetes (n = 1,859) and normal glucose regulation (n = 1,785). RESULTS--Consistent with the initial study, we observed evidence that the risk G allele of rs4430796 in intron 2 was significantly associated with type 2 diabetes (odds ratio 1.16 [95% CI 1.05-1.29], P = 0.0035, empirical P = 0.0475). Furthermore, the at-risk G allele was associated with earlier age at diagnosis in the type 2 diabetic subjects (P = 0.0228). CONCLUSIONS--The result of this study provides evidence that variants in the HNF1β region contribute to susceptibility to type 2 diabetes in the Chinese population. Diabetes 58:1023-1027, 2009 [ABSTRACT FROM AUTHOR]

Background: Diabetes is associated with genetic susceptibility, and family history is a risk factor. The study investigated the association between different family history risk levels and the prevalence of diabetes in a multi high-risk cohort and evaluated the impact of family history of diabetes on insulin secretion and insulin sensitivity.Materials and Methods: We analyzed data from 9754 adults who participated in the Shanghai High-Risk Diabetic Screen Project between 2002 and 2012. The association among three family history risk levels (mild, moderate, and high) with the prevalence of diabetes, insulin secretion, and insulin sensitivity was evaluated in the multi high-risk cohort.Results: Overall, 69.6%, 24.8%, and 5.6% of participants were categorized as having mild, moderate, and high familial risk, respectively. The standardized prevalence was higher in the high family history risk group (43.1%) than in the moderate group (37.3%) and in the mild group (23.5%) (P < 0.001). The odds ratios (ORs) were significantly increased in the moderate group (OR 1.27, 95% confidence interval [CI] 1.15-1.40, P < 0.05) and in the high group (OR 1.69, 95% CI 1.41-2.02, P < 0.05). Among the 3245 normal glucose tolerance participants, insulin secretion significantly declined with increasing levels of family history risk, but there were no significant differences in insulin sensitivity among the three groups.Conclusion: The prevalence of diabetes was independently associated with an increasing family history risk level among multi high-risk Chinese populations. Subjects with moderate and high familial history of diabetes displayed a significant decrease in insulin secretion. [ABSTRACT FROM AUTHOR]