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Gestational diabetes mellitus (GDM) is closely related to adverse pregnancy outcomes and other diseases. Early intervention in pregnant women who are at high risk of developing GDM could help prevent adverse health consequences. The study aims to develop a simple model using the stacking ensemble method to predict GDM for women in the first trimester based on easily available factors. We used the data from the Chinese Pregnant Women Cohort Study from July 2017 to November 2018. A total of 6,848 pregnant women in the first trimester were included in the analysis. Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) were considered as base learners. Optimal feature subsets for each learner were chosen by using recursive feature elimination cross-validation. Then, we built a pipeline to process imbalance data, tune hyperparameters, and evaluate model performance. The learners with the best hyperparameters were employed in the first layer of the proposed stacking method. Their predictions were obtained using optimal feature subsets and served as meta-learner’s inputs. Another LR was used as a meta-learner to obtain the final prediction results. Accuracy, specificity, error rate, and other metrics were calculated to evaluate the performance of the models. A paired samples t-test was performed to compare the model performance. In total, 967 (14.12%) women developed GDM. For base learners, the RF model had the highest accuracy (0.638 (95% confidence interval (CI) 0.628–0.648)) and specificity (0.683 (0.669–0.698)) and lowest error rate (0.362 (0.352–0.372)). The stacking method effectively improved the accuracy (0.666 (95% CI 0.663–0.670)) and specificity (0.725 (0.721–0.729)) and decreased the error rate (0.333 (0.330–0.337)). The differences in the performance between the stacking method and RF were statistically significant. Our proposed stacking method based on easily available factors has better performance than other learners such as RF.

Selenium nanoparticles (Se NPs) have potential antitumor activity and immune properties. However, the mechanism between its antitumor activity and nanoparticle morphology has not been evaluated. Therefore, a simple method was used to synthesize three special shapes of Se NPs, which are fusiform, flower and spherical. Compared with fusiform selenium nanoparticles (Se NPs (S)) and flower-shaped selenium nanoparticles (Se NPs (F)), spherical selenium nanoparticles (Se NPs (B)) have better cell absorption effect and stronger antitumor activity. HRTEM showed that Se NPs (B) entered the nucleus through endocytosis and inhibited tumor angiogenesis by targeting basic fibroblast growth factor (bFGF). Se NPs (B) can competitively inhibit the binding of bFGF to fibroblast growth factor receptor through direct binding to bFGF, down-regulate the expression of bFGF in human umbilical vein endothelial cells (HUVEC), and significantly reduce the MAPK/Erk and P13K/AKT pathways activation of signaling molecules to regulate HUVEC cell migration and angiogenesis. These findings indicate that Se NPs have a special role in antitumor angiogenesis. This research provides useful information for the development of new strategies for effective drug delivery nanocarriers and therapeutic systems.

Background People with diabetes are at a higher risk of influenza infections and severe complications. The vaccination of close contacts could offer indirect protection to people with diabetes; this is known as “herd immunity.” The aim of this study is to investigate the vaccination rates of people with diabetes and their household contacts in Hong Kong. Research design and methods Face-to-face interviews with 158 patients diagnosed with Type 2 diabetes and aged ⩾65 years were conducted in clinics. Telephone interviews were then conducted with 281 adult household contacts. Results Seasonal influenza vaccination rates were 54.5% and 27.4%, in people with diabetes and their contacts, respectively. The vaccination status of patients was not significantly associated with the vaccination of their household contacts ( p = 0.073). Among household contacts, children or the elderly, the partners or couples of patients, and those with more hours of daily contact, or with chronic conditions, were associated with higher vaccination rates. However, only age remained significant after adjusting for confounding factors in logistic regression models. Conclusions The low vaccination rates of people with diabetes and their close contacts highlight the need to promote vaccination in susceptible populations and to educate the public about herd immunity.

In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63.0 (±10.8) years and mean DM duration of 7.4 (±6.4) years. Of them 9,386 (29.7%) had CKD and 7,452 (23.6%) had micro- or macro-albuminuria. After adjustment for multiple demographic and lifestyle confounders, we identified several modifiable risk factors associated with higher rate of CKD: obesity (OR = 1.54), current smoking (OR = 1.33), higher systolic blood pressure (OR = 1.01), dyslipidemia (OR = 1.32 and 0.61 for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)), hyperglycemia (OR = 1.11 for HbA1c), diabetic retinopathy (OR = 1.36 and 2.60 for non-sight and sight threatening retinopathy), and stroke (OR = 1.43). The risk factors of lower dialytic blood pressure and coronary heart disease were identified only in men, whereas peripheral arterial disease only in women. In conclusion, several modifiable and gender specific risk factors were significantly associated with higher prevalence of CKD in Chinese adults with T2DM. The high-risk populations identified in this study shall receive regular screening for renal functions to achieve better patient management in primary care settings.

Quality of life (QoL) is frequently considered an important endpoint, in addition to biomedical outcomes, in clinical trials, and its assessment is becoming increasingly commonplace in routine clinical practice. The past few decades have demonstrated the value of QoL measurement for various purposes: to identify the holistic impact of chronic medical conditions, to determine ways to improve medical treatments, and to guide the selection, rationalization, and evaluation of treatments and regimens. In this chapter, we examine QoL – how it is conceptualized, operationalized, and measured in research and practice. Given that life expectancy has increased significantly in the past century, and an increasing number of people are living with one or more medical conditions, the effects of chronic care management and collaborative approaches to healthcare delivery are discussed alongside behavioral interventions to improve QoL. With the growing emphasis on QoL in clinical care and recent policy initiatives, considerations for how to integrate QoL into a complex environment are introduced and explored.

BACKGROUND: With China's rapid economic growth in the past few decades, there is currently an emerging focus on happiness. Cross-cultural validity studies have indicated that the four-item Subjective Happiness Scale (SHS) has high internal consistency and stable reliability. However, the psychometric characteristics of the SHS in broader Chinese community samples are unknown. PURPOSE: We evaluated the factor structure and psychometric properties of the SHS in the Hong Kong general population. METHODS: The Chinese SHS was derived using forward-backward translation. Of the Cantonese-speaking participants aged >/=15 years, 2,635 were randomly selected from the random sample component of the FAMILY Cohort, a territory-wide cohort study in Hong Kong. In addition to the SHS, a single-item overall happiness scale, the Patient Health Questionnaire-9 (PHQ-9), the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR) scale, and the Medical Outcomes Study 12-item short-form version 2 (SF-12) mental and physical health scales were administered. RESULTS: Exploratory and confirmatory factor analyses supported a single factor with high loadings for the four SHS items. Multiple group analyses indicated factor invariance across sex and age groups. Cronbach's alpha was 0.82, and 2-week test-retest reliability (n = 191) was 0.70. The SHS correlated significantly with single-item overall happiness (Spearman's rho [rho] = 0.57), Family APGAR (rho = 0.26), PHQ-9 (rho = -0.34), and mental health-related quality of life (rho = 0.40) but showed a lower correlation with physical health (rho = 0.15). A regression model that included the PHQ-9 and Family APGAR scores explained 37 % of the variance in SF-12 mental health scores; adding the SHS raised the variance explained to 41 %. CONCLUSIONS: Our results support the reliability and validity of the SHS as a relevant component in the measurement battery for mental well-being in a Chinese general population., published_or_final_version

Passive smoking increased type 2 diabetes mellitus risk, but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM.From 2010 to 2012, 12 786 Chinese women underwent a 50-g 1-hour glucose challenge test at 24 to 28 weeks of gestation and further underwent a 75-g 2-hour oral glucose tolerance test if the glucose challenge test result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut points. Self-reported passive smoking during pregnancy was collected by a questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI 0, AP 0, or S 1 indicated additive interaction.A total of 8331 women (65.2%) were exposed to passive smoking during pregnancy. More women exposed to passive smoking developed GDM than nonexposed women (7.8% versus 6.3%, P = 0.002) with an adjusted OR of 1.29 (95%CI, 1.11 to 1.50). Compared with nonobesity and nonpassive smoking, prepregnancy obesity and passive smoking was associated with GDM risk with an adjusted OR of 3.09 (95%CI, 2.38-4.02) with significant additive interaction (P .05 for RERI and AP).Passive smoking during pregnancy increased GDM risk in Chinese women independently and synergistically with prepregnancy obesity.

Background: The aim of the web-based Joint Asia Diabetes Evaluation (JADE) program is to establish a registry for quality assurance, monitoring, and evaluation. Methods: The JADE electronic portal provides templates for data collection, supplemented by risk stratification, care protocols, and decision support. Herein, data from 3687 patients with Type 2 diabetes, enrolled over 15 months in 2007–2009 from seven Asian countries, are reported. Results: Of the patients, 46.1% were men, the median (range) age was 58 (15–93 years), and median disease duration was 6.5 (0–71) years; 16.2% had at least one cardiovascular–renal complication (10.0% coronary heart disease, 3.3% stroke, 3.1% peripheral vascular disease, 0.4% end-stage renal disease), 20.4% had diabetic retinopathy, 15.0% had sensory neuropathy, 7.5% had chronic kidney disease, and 20.7% of men had erectile dysfunction. Hypertension, dyslipidemia, and central obesity affected 84.6%, 76.8%, and 53.5% of patients, respectively. Treatment targets were HbA1c

Aims: To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population. Subjects and methods: A population-based cross-sectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35–74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEP-ATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used. Results: The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6% in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria. Conclusions: Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

The objective of this study was to investigate the association of serum UA with either FPG or 2hPG levels among Chinese adults in Qingdao, China. A population-based survey for diabetes was performed in 2006 in Qingdao. The survey included 1,490 men and 2,325 women aged 35—74 years who had data stored as required for the current data analysis. The association of mean UA with plasma glucose was tested using a linear regression model. Serum UA concentration raised with increasing FPG levels up to FPG of 7.0 mmol/l, but significantly decreased thereafter with further increase in FPG levels. The multivariate adjusted β coefficient between FPG and UA in individuals with newly diagnosed diabetes was —0.20 for men and —0.27 for women (p

Objective To investigate the major risk factors and their association with the dramatic increase in the prevalence of diabetes from 2001–2002 to 2006 in Qingdao, China. Methods Population-based cross-sectional studies on diabetes were performed in 4598 men and 7026 women aged 35–74 years. The 2006 World Health Organization diagnostic criteria for diabetes were used. Results The crude prevalence of diabetes was 11.3% in both men and women in urban areas and 5.3% and 8.9% in rural areas in 2001–2002. This increased to 19.2% and 16.1% in urban areas and 14.2% and 13.8% in rural areas in 2006 for men and women, respectively. The increase in diabetes prevalence from 2001–2002 to 2006 was paralleled by an increased body mass index in rural areas but not in urban areas. The major risk factors associated with diabetes were age, family history of diabetes, obesity, hypertension and high triglycerides. The multivariate adjusted odds ratio and 95% confidence interval for diabetes corresponding to a one standard deviation increase in waist circumference was 1.81 (1.47, 2.23) in urban men, 1.64 (1.26, 2.13) in rural men, 1.98 (1.66, 2.37) in urban women and 2.02 (1.63, 2.51) in rural women. Low socio-economic classes had a higher risk for diabetes in urban areas but a lower risk in rural areas, both associated with increased waist circumference. Conclusion Established risk factors are of great importance for the prevalence of diabetes in the urban and rural Chinese populations and changes in these factors could explain the recent dramatic increase in diabetes prevalence, particularly in rural areas. Considering the high prevalence of obesity and physical inactivity, intervention is urgently required in China.

Aims To determine the secular trend of prevalence of Type 2 diabetes and pre-diabetes in a Chinese population from 2001 to 2006. Methods Two consecutive population-based surveys for diabetes were conducted in a randomly selected population aged 35–74 years and living in Qingdao, China in 2001–2002 (n = 10854) and 2006 (n = 4416). All participants underwent standardized 2-h 75-g oral glucose tolerance tests (OGTTs), along with fasting capillary plasma glucose (FCG) tests in 2006. One urban community underwent OGTTs directly in 2002 (n = 1815), while a two-step screening strategy using FCG as a first-line screening test followed by OGTTs was used in 9039 individuals in 2001. Diabetes and pre-diabetes was defined according to the 2006 World Health Organization/International Diabetes Federation criteria. Results Based on the results of direct OGTTs, the age-standardized prevalence of diabetes and pre-diabetes in urban areas was 12.2 and 15.4% in 2002, whereas the prevalences were 18.8 and 28.7% in urban areas and 14.1 and 20.2% in rural areas in 2006 (P

Comparison of BMI with waist circumference, waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) as a predictor of hypertension incidence.A total of 1658 men and 1976 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25-74 years, free of hypertension, diabetes, cardiovascular disease, and gout at baseline in 1987 or 1992, were re-examined in 1992 and/or 1998 using the same survey methodology. Hazard ratios (HRs) for hypertension incidence were estimated applying an interval censored survival analysis (R program) using age as timescale based on baseline obesity indicators.A total of 787 incident hypertension cases were identified during the follow-up. HRs for hypertension incidence adjusting for baseline systolic blood pressure and cohort corresponding to a 1 SD increase in BMI, waist circumference, WHR, and WSR were 1.20 (1.24), 1.19 (1.21), 1.14 (1.10), and 1.20 (1.26) in Mauritian Indian men (women) and 1.23 (1.32), 1.34 (1.23), 1.41 (1.13), and 1.43 (1.33) in Mauritian Creoles, respectively, indicating that all obesity indicators significantly predicted hypertension incidence except for WHR in Mauritian Creole women. Paired homogeneity tests showed that there was no difference between BMI and the other three indicators for most of the comparisons with two exceptions: WSR was stronger than BMI (P = 0.002) in Mauritian Creole men but BMI was stronger than WHR (P = 0.047) in Mauritian Indian women in predicting the incident cases of hypertension.The relation of the development of hypertension with BMI was as strong as that with central obesity indicators in the population studied.

Objective To investigate the predictive value of serum uric acid (UA) for the development of diabetes in Asian Indians and Creoles living in Mauritius. Methods A total of 1941 men (1409 Indians, 532 Creoles) and 2318 non-pregnant women (1645 Indians, 673 Creoles), aged 25–74 years and free of diabetes, cardiovascular disease and gout at baseline examinations in 1987 or 1992, were re-examined in 1992 and/or 1998. Diabetes was determined according to WHO/IDF 2006 criteria. The relationship between baseline UA and the development of diabetes during the follow-up was estimated using interval censored survival analysis. Results In this cohort 337 (17.4%) men and 379 (16.4%) women developed diabetes during the follow-up. Individuals who developed diabetes during the follow-up had a lower serum UA levels at follow-up compared with their baseline UA levels, but this is not observed for post-menopausal women. Multivariate adjusted hazard ratios (HRs) (95% CIs) for the development of diabetes corresponding to one S.D. increase in UA concentration at baseline were 1.14 (1.01, 1.30) in Indian men and 1.37 (1.11, 1.68) in Creole men. They were 1.07 (0.95, 1.22) and 1.01 (0.84, 1.22), respectively, in Indians and Creole women. Conclusion Elevated serum UA is an independent risk marker for future diabetes in Mauritian men, whereas the prediction is weak in women.

Background The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) scale for depression screening in Hong Kong Chinese patients with type 2 diabetes remains unknown. We aimed to validate CES-D, compare its psychometric properties with the 9-item Patient Health Questionnaire (PHQ-9), and explore whether one of the two is more suitable for depression screening in Chinese patients with type 2 diabetes. Methods Between June 2010 and July 2011, 545 consecutive Chinese patients with type 2 diabetes who underwent structured comprehensive assessments completed the CES-D and PHQ-9. Forty patients were retested within 2–4 weeks by telephone interview and 97 patients were randomly selected to undergo the Mini International Neuropsychiatric Interview (MINI) by psychiatrists for clinical diagnosis of depression. Results The internal consistency (Cronbach’s α) of CES-D was 0.85, with a test-retest correlation coefficient of 0.64. The area under the curve for CES-D compared to the clinical diagnosis of major depression was 0.85. A cut-off score of ≥21 for CES-D provided the optimal balance between sensitivity (78.3 %) and specificity (74.3 %) and identified 17.8 % (n = 97) of patients with depression. CES-D and PHQ-9 showed moderate agreement in depression screening (Cohen’s Kappa: 0.45). Compared to non-depressed patients, those who screened positive by PHQ-9 had a higher HbA1c whereas the glycemic differences were not significant when using CES-D. Conclusion The CES-D is a valid screening tool for depression in Chinese type 2 diabetic patients although the PHQ-9 was more discriminative in identifying those with suboptimal glycemic control.

Diabetes and depression provide a model for understanding the comorbidity of mental and physical disorders, as each influences the other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. Diabetes and depression may be viewed as: (1) categories or dimensions, (2) single problems or parts of broader categories, e.g. metabolic/cardiovascular abnormalities or negative emotions, (3) separate comorbidities or integrated so that depression is seen as part of the comprehensive, normal clinical picture of diabetes, and (4) expressions of a shared, complex biosocial propensity to chronic disease and psychological distress. Interventions should reflect the commonalities among chronic mental and physical disorders and should include integrated clinical care and self-management programs along with population approaches to prevention and management. Among these, peer support, self-management and problem solving, and programs for whole communities are promising approaches. Self-management and problem solving may also provide a coherent framework for integrating the diverse management of tasks and objectives of those affected by diabetes and depression and as a model for prevalent multimorbidity.

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.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.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 loss5% and BMI28 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 BMI28 kg/m² could increase the risk across the levels of weight change. Similar trends were observed in higher waist and weight gain at baseline.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 determine the prevalence of diabetes in the Chinese adult population in rural and urban areas of Qingdao city. Methods A population-based cross-sectional study of diabetes was performed in 12 436 (5346 men) Chinese adults (20–74 years old) from 2001 to 2002. Fasting capillary whole blood glucose test (FCG) was performed in all participants and a 2-h 75-g oral glucose tolerance test in those with FCG ≥ 6.1 mmol/l following initial screening. The 1999 World Health Organization diagnostic criteria for diabetes were used. Results The age-standardized prevalence of diabetes was 6.1% (4.1% for undiagnosed and 2.1% for previously known diabetes) in adults aged 20–74 years. Diabetes prevalence increased with age up to the oldest age group (70–74); in subjects over 50 years of age, the prevalence reached 10%. Men tended to have a higher prevalence of known diabetes than women, whereas the prevalence of undiagnosed diabetes was lower in men than in women (4.6% vs. 3.3%, d.f. = 1, P = 0.001). Diabetes was more prevalent in the urban than in the rural population (6.9% vs. 5.6%, d.f. = 1, P < 0.001). However, the proportion of undiagnosed diabetes was higher in the rural than in the urban areas (70.5% vs. 58.0%, d.f. = 1, P < 0.001). Conclusions The prevalence of Type 2 diabetes in Qingdao city is moderately high, but much higher than reported in 1996. The large proportion of undiagnosed cases of diabetes indicates the lack of public awareness of diabetes and shortage of medical facilities. In view of the huge population in China, the results of this study emphasize the need to improve the early detection and prevention of diabetes in China to prevent the emerging diabetes epidemic.

OBJECTIVE To validate a Chinese version of the Diabetes Distress Scale (CDDS). RESEARCH DESIGN AND METHODS The CDDS was derived using forward-backward translation and administered in 189 Chinese type 2 diabetic patients with evaluation of its psychometric properties. RESULTS On the basis of principal-component analysis, three factors of the 15-item version of the CDDS (CDDS-15) accounted for 63% of the variance. The correlation coefficient between the original 17-item and 15-item scales was 0.99. The Cronbach α for internal consistency was 0.90, and the test-retest reliability coefficient was 0.74. The CDDS-15 score was significantly associated with glycemic control, obesity, depressive symptoms, and quality of life. CONCLUSIONS The CDDS-15 is a valid and reliable instrument to assess diabetes-related distress.

Background Passive smoking increased type 2 diabetes mellitus risk, but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM. Methods From 2010 to 2012, 12 786 Chinese women underwent a 50-g 1-hour glucose challenge test at 24 to 28 weeks of gestation and further underwent a 75-g 2-hour oral glucose tolerance test if the glucose challenge test result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut points. Self-reported passive smoking during pregnancy was collected by a questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI > 0, AP > 0, or S > 1 indicated additive interaction. Results A total of 8331 women (65.2%) were exposed to passive smoking during pregnancy. More women exposed to passive smoking developed GDM than nonexposed women (7.8% versus 6.3%, P = 0.002) with an adjusted OR of 1.29 (95%CI, 1.11 to 1.50). Compared with nonobesity and nonpassive smoking, prepregnancy obesity and passive smoking was associated with GDM risk with an adjusted OR of 3.09 (95%CI, 2.38-4.02) with significant additive interaction (P

Background Polyphenols identified in tea, such as catechins and epigallocatechin gallate, have been reported to be protective to diabetes in cell-based and animal studies. However, the association between tea consumption and incidence of type 2 diabetes in human beings is unclear. Our study aimed to assess the association between tea consumption and type 2 diabetes in people living in China, where tea is a commonly consumed beverage. Methods Participants were from the Chinese Health and Nutrition Survey, covering nine provinces (Heilongjiang, Liaoning, Shandong, Henan, Jiangsu, Hubei, Hunan, Guizhou, and Guangxi) of China. Our study included people aged at least 18 years who provided valid responses in the questionnaire with regards to tea consumption (n=12 771). Data for tea consumption and other participant characteristics were collected in 1997, 2000, 2004, 2006, and 2009, while data for incidence of self-reported type 2 diabetes was collected in 2000, 2004, 2006, 2009, and 2011. Interval-censored Cox regression with time-varying covariates was used to estimate the hazard ratio (HR) of tea consumption on incidence of type 2 diabetes. The HR was adjusted for age, sex, education level, smoking status, alcohol consumption, coffee consumption, physical activity, BMI, and hypertension. Findings Mean follow-up was 3·8 times over 8·5 years. 177 patients reported type 2 diabetes. At baseline, 8281 (65%) people drank no tea, 1 294 (10%) drank less than one cup (240 ml) per day, 1 054 (8%) drank one to two cups, and 2142 (17%) drank more than two cups. Compared with those who did not drink tea, those who drank less than one cup of tea per day had an adjusted HR for type 2 diabetes of 1·22 (95% CI 1·11–1·35), those who drank one to two cups had an adjusted HR of 1·35 (95% CI 1·23–1·49), and those who drank two or more cups had an adjusted HR of 1·39 (95% CI 1·30–1·48). Informed patient consent was given by all participants Interpretation Tea consumption was positively associated with risk of type 2 diabetes in Chinese adults. The main strength of the study was the multiple follow-ups on tea consumption, which allowed us to track the longitudinal changes among the participants. A major limitation was the self-reporting nature of the type 2 diabetes diagnosis. Further studies on the effects of tea constituents, other than polyphenols, on type 2 diabetes are warranted. Funding None.

Background: Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression. Methods: A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2–4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9. Results: The internal consistency of the PHQ-9 was 0.86 and test–retest reliability was 0.70. The 3 somatic items explained 53.6% of the PHQ-9 score. The optimal cutoff value was 7 with 82.6% sensitivity and 73.7% specificity, giving a depression prevalence of 18.3% (n¼107). Of these, 18.7% had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.8071.86% versus 7.4371.29%, [61.7720.4 versus 57.8714.1 mmol/mol], Po0.05), reduced likelihood of achieving HbA1c target of o7.0% (33.6% versus 41.8%, Po0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7% versus 6.7%, Po0.01). Limitation: A small sample was used in the criterion validation and the cross-sectional design precludes causal inference. Conclusions: PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.

The aim of the web-based Joint Asia Diabetes Evaluation (JADE) program is to establish a registry for quality assurance, monitoring, and evaluation. The JADE electronic portal provides templates for data collection, supplemented by risk stratification, care protocols, and decision support. Herein, data from 3687 patients with Type 2 diabetes, enrolled over 15 months in 2007-2009 from seven Asian countries, are reported.Of the patients, 46.1% were men, the median (range) age was 58 (15-93 years), and median disease duration was 6.5 (0-71) years; 16.2% had at least one cardiovascular-renal complication (10.0% coronary heart disease, 3.3% stroke, 3.1% peripheral vascular disease, 0.4% end-stage renal disease), 20.4% had diabetic retinopathy, 15.0% had sensory neuropathy, 7.5% had chronic kidney disease, and 20.7% of men had erectile dysfunction. Hypertension, dyslipidemia, and central obesity affected 84.6%, 76.8%, and 53.5% of patients, respectively. Treatment targets were HbA1c7% in 35.3%, blood pressure130/80 mmHg in 32.3%, and low-density lipoprotein-cholesterol2.6 mmol/L in 34.0%. The rate of attaining one, two, and three targets was 38.7%, 23.4%, and 5.4%, respectively. Using the JADE Risk Engine, 60% of patients with clinical complications and 20% of those with multiple risk parameters were predicted to have a major event within 5 years. Older age, short disease duration, adherence to diet, control of other risk factors, and not smoking were independently associated with HbA1c7% (all P 0.05). It is possible to use a web-based protocol to establish a registry for risk stratification and facilitate early intervention.

Background Serum gamma-glutamyltransferase (GGT) and C-reactive protein(CRP) have been previously shown to be associated with impaired fasting glucose/impaired glucose tolerance (IFG/IGT), but such an association has not been well verified, and is examined in a non-diabetic Chinese population. Methods A population-based cross-sectional study was conducted in 2006 in Qingdao, China. Data of 1143 men and 1689 women aged 35–74 years and free of diabetes at baseline were analyzed. Multivariable logistic regression analysis was performed to estimate the odds ratio (OR) and its 95% confidence interval (CI). Results Compared with the lowest quartile, the ORs (95%CI) for IFG/IGT corresponding to the highest quartile were 0.89(0.61,1.28) in men and 0.87(0.64,1.18) in women for CRP and 2.12(1.40,3.38) and 1.87(1.32,2.62) for GGT, when the two were fitted simultaneously in a model adjusting for age, school years, alcohol-drinking, smoking, family history of diabetes, systolic blood pressure, waist circumference, triglycerides and high-density lipoprotein. Conclusions The elevated GGT, but not CRP, was independently associated with the presence of the IFG/IGT in both genders in this Chinese population.

Diabet. Med. 27, 274–281 (2010) Abstract Aims A diabetes risk score for screening undiagnosed diabetes was constructed and validated in Chinese adults. Methods Two consecutive population-based diabetes surveys among Chinese adults aged 20–74 years were conducted in 2002 (n = 1986) and 2006 (n = 4336). Demographic and anthropometric measures were collected following similar procedures. Standard 2-h 75-g oral glucose tolerance tests (OGTTs) were performed to diagnose diabetes in both surveys. Fasting capillary plasma glucose (FCG) and glycated haemoglobin (HbA1c) were also measured together with the OGTTs on the same day of the 2006 survey. Beta coefficients estimated using logistic regression analysis derived from data of the 2002 survey were used to develop the risk assessment algorithm. The performance of the algorithm was validated in the study population of the 2006 survey. Results Of all the variables tested, waist circumference, age and family history of diabetes were significant predictors of diabetes and were used to construct the risk assessment score. The score, ranging from 3 to 32, performed well when applied to the study population of the 2006 survey. The area under the receiver operating characteristic curve was 67.3% (95% CI, 64.9–69.7%) for the score, while it was 76.3% (73.5–79.0%) for FCG alone and 67.8% (64.9–70.8%) for HbA1c alone. At a cut-off point of 14, the sensitivity and specificity of the risk score were 84.2% (81.0–87.5%) and 39.8% (38.2–41.3%). Conclusions The risk score based on age, waist circumference and family history of diabetes is efficient as a layperson-oriented diabetes screening tool for health promotion and for population-based screening programmes.

Aims. To investigate the association of C-reactive protein (CRP) and gamma glutamyltransferase (GGT) concentrations with newly diagnosed diabetes defined by either glucose or HbA1c criteria in Chinese adults.Methods. A population-based cross-sectional study was conducted in 2006. Data from 1167 men and 1607 women aged 35–74 years were analyzed. Diabetes was defined according to either glucose or HbA1c criteria alone.Results. Compared with nondiabetes, multivariate-adjusted OR (95%CI) was 1.13 (0.90,1.42) in men and 1.21 (1.00,1.45) in women for CRP and 1.42 (1.18,1.72) and 1.57 (1.31,1.87) for GGT, respectively. Neither CRP nor GGT was associated with the presence of diabetes defined by the HbA1c criterion.Conclusions. The effect of elevated CRP on diabetes defined by the glucose criterion was mediated through obesity, but elevated GGT was an independent risk factor for diabetes in this Chinese population. None of the two was, however, associated with the elevated HbA1c concentrations.

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 ≥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.

To assess the association of serum uric acid (UA) with components of metabolic syndrome (MetS) in different ethnic groups.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.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.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.

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.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 levelsor= 420 micromol/l in men andor= 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.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%; p0.001). 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 trend0.001). 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.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.

The current study aimed to evaluate whether individuals with fasting plasma glucose (FPG) of 5.6–6.0 mmol/l has a similar risk profiles for diabetes or impaired glucose tolerance (IGT) to those with FPG of 6.1–6.9 mmol/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 75 g 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 5.6 mmol/l. Individuals with FPG of 6.1–6.9 mmol/l were more obese and insulin resistant than those with FPG of 5.6–6.0 mmol/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 6.1–6.9 mmol/l, and 0.54 (0.30–0.95) and 1.47 (1.11–1.95) for those with FPG of 5.6–6.0 mmol/l, respectively. In conclusion, the likelihood of diabetes and IGT was lower in subjects with FPG of 5.6–6.0 mmol/l than in those with FPG of 6.1–6.9 mmol/l. The clinical and social implication of labelling more individuals with impaired fasting glucose needs to be further studied.

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.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.The mean concentrations of UA were 381, 393, 371, and 345 micromol/l in men with FPG of6.1, 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.Serum UA levels tended to increase with increasing FPG levels in non-diabetic individuals, but decrease in diabetic individuals.

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 ∼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.