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Purpose. This systematic review and meta-analysis was conducted to explore the effect of protein intake on the prevention and improvement of sarcopenia. Methods. We searched the Cochrane Library, PubMed, and EMBASE from inception to 20 May 2021. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Results. There were 12 studies that met the selection criteria among 53 eligible publications. The results of the study show that the protein intake has no significant effect on the physical performance—4 m gait speed, chair rise test, short physical performance battery, muscle mass—skeletal muscle mass index, and muscle strength—hand grip strength. Conclusion. Protein supplementation had no significant effect on 4 m gait speed and on improving skeletal muscle mass index, hand grip strength, chair rise test, and short physical performance battery. Additional randomized controlled trials are warranted to adequately assess the effect of protein supplementation on elderly sarcopenia.

To compare outcomes between Asian and non-Asian patients with type 2 diabetes (T2D) inadequately controlled on oral antidiabetic drugs (OADs) initiating insulin glargine 100 units (U)/mL (Gla-100) in randomised controlled clinical trials.Post hoc analysis of patient-level data (Asian n = 235; non-Asian n = 3351) from 16 trials.At baseline, Asian patients were younger with lower body mass index (BMI), fasting C-peptide, and fasting plasma glucose (FPG) than non-Asian patients (all P .001). Asian patients had a higher mean glycosylated haemoglobin (HbA1c) at Week 24 and less reduction in HbA1c from baseline (7.4% vs. 7.2%; -1.3% vs. -1.6%, respectively; P = .0001), and were less likely to achieve HbA1c7.0% (40% vs. 47%; P = .002) than non-Asian patients. Reductions in FPG and rates of hypoglycaemia were similar between Asian and non-Asian patients. Asian patients had less weight gain than non-Asian patients (+1.3 vs. +1.9 kg, respectively, P = .013).In our post hoc meta-analysis, Gla-100 effectively lowers HbA1c and FPG in Asian patients with T2D uncontrolled on OADs with similar incidence of hypoglycaemia and less absolute weight gain compared with non-Asian patients. At a similar FPG reduction, fewer Asian patients achieved HbA1c target7.0%, suggesting that prandial glucose needs to be addressed.

Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulin—an issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors’ clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizing the dose of basal insulin, enabling a larger number of patients in Asia to reach their target glycemic goals with improved outcomes. Electronic supplementary material The online version of this article (doi:10.1007/s13300-017-0322-z) contains supplementary material, which is available to authorized users.

Factors predicting success (glycosylated hemoglobin (A1C)7%) with insulin therapy in patients with insulin-requiring type 2 diabetes need to be identified.A retrospective, multi-center, observational study was conducted for outpatients with oral antidiabetic drug (OAD)-treated type 2 diabetes whose A1C levels remained above 7%. Patients were begun on basal insulin between January 2005 and December 2006. Biochemical variables and demographic data were collected before and after 52 weeks of insulin therapy.A total of 565 patients (age, 60.4±11.9 years; A1C levels, 10.11 ±1.81%; duration of diabetes, 11.5±6.8 years) were studied. By study end, 63 patients (11.2%) had achieved the glycemic goal (A1C7%). The glycemic goal attainment rate was only 9.1% in patients with A1C8.8% and who were taking2 OADs at baseline. The highest rate (32.7%) of successful glycemic control was observed in the group of patients with A1C ≤ 8.8% and who used ≤ 2 OADs at baseline.Insulin-naïve diabetic patients with A1C8.8%, especially those who are taking2 OADs, have small chance to achieve good glycemic control with adding only basal insulin therapy.

Type 2 diabetes mellitus (T2DM) is a global health-care and national policy issue. As fluctuating glycemic control in diabetes often results in serious complications, we must encourage the diabetes educators' efforts at long-term follow-up among patients with T2DM. Therefore, certified diabetes educators (CDEs) play the most pivotal roles as life-long protectors for patients with T2DM. In the past 15 years, more than 4,000 CDEs have been trained and qualified, including health professionals such as physicians, nurses, dieticians, and pharmacists. The most important initiation of diabetes share care in Taiwan was originated in I-Lan County. Initiated to provide regional diabetes care, the name of this program is the Lan-Yang Diabetes Shared Care System. In 2006, the Taiwanese Association of Diabetes Educators (TADE) carried out a nationwide survey to evaluate the status of diabetes control in Taiwan, focusing on the "ABC" goal (A: HbA1c7.0%, B: blood pressure130/80 mmHg, C: LDL-cholesterol100 mg/dl/total cholesterol160 mg/dl). The results revealed that the percentage of patients with diabetes who fulfilled all ABC goals was only 4.1%. Five years later, in 2011, TADE compared two nationwide surveys and found total ABC attainment rates of 4.1% and 8.6%, respectively. The team-care approach to T2DM has been underway for over 20 years in Taiwan. Future interventions and treatment algorithms with team-based education should aim at preventing acute and chronic complications, which remains a long-term challenge in Taiwan.

Background: The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin-naive Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation. Methods: Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician’s discretion to reflect real-life practice. Results: Patients (n = 2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3 ± 6.5 years; weight 68.1 ± 12.7 kg; A1c 9.8 ± 1.6%). After 6 months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7 ± 1.4%; 33.7% patients reached A1c

We undertook nationwide surveys to evaluate the status of diabetes control in 7541 diabetes subjects among 114 accredited Diabetes Health Promotion Centers in Taiwan in 2006, focusing on characteristics of those who attained the "ABC" goals (n=310). The mean age was 62.8+/-12.4 years (mean+/-SD), BMI 25.9+/-0.4 kg/m(2) and HbA1c levels 7.9+/-1.7%. The percentage of subjects whose HbA1c levels met ADA goals was less than 7% (A), and both SBP and DBP less than 130/80 mmHg (B), total cholesterol less than 160 mg/dl or LDL cholesterol levels less than 100mg/dl (C) were 32.4%, 30.9% and 35.3%, respectively. Overall, the percentage of examined diabetic subjects who fulfilled current recommended ABC goals was 4.1% (95% CI, 3.66-4.56%). Results of logistic regression analysis that indicated factors significantly associated with ABC goals are diagnosis of type 1 diabetes (p=0.025), BMI less than 23 kg/m(2) (p=0.022) and subjects not requiring insulin (p=0.006). In conclusion, only 4.1% of subjects reached all ABC goals. Diabetic individuals with diagnosis of type 1 diabetes, lesser BMI and those not using insulin were more likely to attain all ABC goals.

The purpose of this study is to explore whether it is worthwhile to launch a routine diabetic retinopathy (DR) screening for blindness pre-vention among Chinese type 2 diabetes from different perspective based on the popula-tion-based study in Kinmen, Taiwan. A total of 971 community dwelling adults previously di-agnosed with type 2 diabetes in 1991-1993 un-derwent DR screening in 1999-2002 by a panel of ophthalmologists using on-site indirect oph-thalmoscopy and 45-degree color fundus retinal photographs. The cost-benefit analysis is used to evaluate the DR screening. In terms of bene-fit-cost ratio, the different screening programs for DR could save New Taiwan Dollars (NTD) from 14.38 to 36.83 in discounted costs for each dollar incurred in different screening years from the societal viewpoint for Taiwan and save NTD from 0.81 to 1.80 in different screening years from health care payer’s perspective. The av-erage estimate of willingness-to-pay to translate into benefit yields NTD from 937.8 to 4,689 be- nefits per case due to DR screening in different screening years during 10-year follow-up. The net present value of the DR screening were NTD from -167,318 to -307,251.2 in different screening years. In conclusion, it is worthwhile to initial a routine DR screening of Chinese type 2 diabetes for blindness prevention from the societal per-spective but not from consumer decision based on the willingness-to-pay perspective.

Background: The aim of this community-based study was to explore the summer-winter difference in insulin resistance in Kin-Chen, Kinmen. Methods: A total of 2,412 residents aged 40 and over was enrolled in a mass survey in Kin-Chen, Kinmen, by the YangMing Crusade, a volunteer organization of well-trained medical students from National Yang-Ming University. All participants were investigated in winter (first phase, January and February, before Chinese New Year) and summer (secondary phase, July and August) in 2002. Structured questionnaires, demographic and physical data, lifestyle, and blood chemistry parameters were collected. Results: Higher levels of fasting insulin, HOMA-insulin resistance and triglycerides, but lower levels of high-density lipoprotein cholesterol were found in summer than in winter. The prevalence of metabolic syndrome was higher in summer than in winter, with differences of 7.7% in both genders (p = 0.0092 in men, p = 0.0037 in women). Body mass index (BMI), age and physical activity were significantly correlated with metabolic syndrome. After controlling for BMI and other risk profiles, summer was independently and positively associated with fasting insulin and insulin resistance regardless of metabolic syndrome. Conclusion: Fasting insulin, insulin resistance and prevalence of metabolic syndrome were higher in summer than in winter. BMI and season were 2 major determinants of the variation in fasting insulin. The contextual impacts of seasonal variation in shaping metabolic syndrome or insulin resistance in populations need to be reemphasized. [J Chin Med Assoc 2008;71(12):619–627]

Aims/hypothesis The aim of this prospective study was to assess a population-based cohort for the predictors of incident diabetes and metabolic syndrome, which is most likely to lead to cardiovascular disease. Methods We compared the baseline individual components of metabolic syndrome, adopted from the NCEP ATP III for Asians, in 3629 subjects who developed diabetes, metabolic syndrome, or diabetes and metabolic syndrome to those who remained free of diabetes and metabolic syndrome for 10 years. Results The incidence rate of diabetes was 7.8% (9.8% in men and 6.3% in women, respectively), and metabolic syndrome was 24.2% (23.4% in men and 24.7% women, respectively). Eighty-five men and 99 women developed diabetes and metabolic syndrome, which yielded incidence rates of 5.7% in men and 4.7% in women. After adjustment for related covariable factors, each component of metabolic syndrome in women, higher triglyceride and greater waist circumference in men, independently predicted future incident diabetes and metabolic syndrome as compared with those who remained free of diabetes and metabolic syndrome. Conclusions/interpretation These findings suggest that several components of metabolic syndrome independently precede the development of diabetes and metabolic syndrome. Further intervention studies are required to demonstrate the benefits of intervention with all aspects in decreasing the incidence of diabetes and metabolic syndrome in the general population.

Purpose: The purpose of this study was to explore whether there were gender differences in the relation of insulin resistance and β-cell dysfunction to diabetic retinopathy among type 2 diabetic patients. Methods: From 1999 to 2002, a screening regimen for diabetic retinopathy was performed by a panel of ophthalmologists using ophthalmoscopy and 45-degree color fundus photography to examine the fundus in a total of 971 type 2 diabetic patients examined between 1991 and 1993 in Kinmen, Taiwan. Seven hundred and twenty-five type 2 diabetic patients (301 males and 424 females) attended ophthalmological fundus checkup. Results: The response rate in males and females was 71.3 and 77.2%. The proportion of diabetic retinopathy at the first eye screening was 16.3% in males and 20.1% in females. From the multiple logistic regression, the type of diabetes (known cases vs. new cases) was a significant factor of diabetic retinopathy in both males (OR = 3.65, 95% CI: 1.59–8.37) and females (OR = 3.66, 95% CI: 2.01–6.70). Diabetic retinopathy was also strongly affected by the homeostasis model assessment of insulin resistance (HOMA IR) and homeostasis model assessment of β-cell dysfunction (HOMA β-cell) (p < 0.0001 for trend test). In males, those who were in the 2nd quartile, 3rd quartile, and 4th quartile of HOMA IR had 4.87 times (95% CI: 1.18–20.11), 6.83 times (95% CI: 1.91–24.46), and 10.15 times (95% CI: 2.42–42.56) the risk for diabetic retinopathy as compared to those in the 1st quartile. There was a reduced risk for diabetic retinopathy in relation to HOMA β-cell for the 2nd quartile, 3rd quartile, and 4th quartile of 86% (95% CI: 37–97%), 95% (95% CI: 77–99%), and 96% (95% CI: 78–99%) as compared to that in the 1st quartile. Only the 4th quartile had a significant risk (OR = 2.62, 95% CI: 1.17–5.86) for diabetic retinopathy as compared to that in the 1st quartile in females. The reduced risk for diabetic retinopathy found in relation to HOMA β-cell for the 3rd and 4th quartiles were 66% (95% CI: 6–88%) and 66% (95% CI: 10–87%) as compared to that in the 1st quartile. Conclusions: Gender differences in the relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy were demonstrated in type 2 diabetic patients.

Background: This study investigated the status of diabetes control and management in patients treated in a primary healthcare setting and compared the results with data previously obtained for secondary/tertiary care patients in Taiwan. Methods: This study was conducted at 51 primary healthcare stations randomly selected island-wide in Taiwan in 2001. A total of 1302 type 2 diabetes patients who had been followed-up for more than 1 year were included. Blood was collected for centralized HbA(subscript 1c) assay. The remaining data and information were collected by review of medical records and patient interview. Results: Compared with the results of a previous study on patients treated in a secondary/tertiary care setting, a significantly smaller percentage of primary care patients were receiving insulin therapy. Primary care patients also had a shorter duration of diabetes, a higher HbA(subscript 1c), level, better blood pressure control and a lower prevalence of complications. The proportion of patients achieving optimal control of glycemia and blood pressure was low. Patients aged ＜65 years had a significantly shorter duration of diabetes, poorer diabetes control and better blood pressure control than elderly patients aged ≥65 years. Primary care patients aged ≥65 years had a significantly higher frequency of stroke than those aged ＜65 years. The elderly group of secondary/tertiary care patients had a significantly higher frequency of coronary heart disease and stroke. Duration of diabetes and hypertension were the leading risk factors for complications in diabetes patients treated in both primary and secondary/tertiary care settings. Conclusion: Diabetes control was poorer in primary care than in secondary/tertiary care patients, but control of blood pressure was better in primary care patients. The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged ＜65 years compared with their elderly counterparts might be related to a lower prevalence of complications.

Prevalence of autoantibodies against IA-2 (IA-2A), glutamic acid decarboxylase (GADA), and type II DNA topoisomerase (TopIIA) of Taiwanese type 1 diabetes mellitus (T1DM) patients was investigated. Correlations of these autoantibodies with patients’ clinical manifestations were also analyzed. Prevalence of IA-2A, GADA, and TopIIA in our patients was 23.6%, 47.1%, and 55.2%, respectively. Eighty percent of the IA-2A recognized the carboxyl terminus of the IA-2 protein tyrosine phosphatase-like domain. Average disease duration of IA-2A + patients was significantly shorter than that of IA-2A − patients [3.76 ± 0.42 vs. 4.98 ± 0.34 years, p =0.028]. Presence of GADA was correlated with the mean age of onset [10.82 ± 0.76 vs. 8.38 ± 0.77 years for GADA + and GADA − patients, p =0.026]. Patients with adolescent onset have higher GADA prevalence and better residual β-cell functions. TopIIA and GADA are suggested to be better markers for Taiwanese T1DM patients because of their higher prevalence and persistence.

This study compared the relative role of insulin resistance and beta-cell dysfunction (both assessed using the HOMA method) with glucose intolerance conditions in the progression to type 2 diabetes among a high risk group of subjects with fasting plasma glucose (FPG) 5.6-7.0 mmol/l in Kinmen, Taiwan. Data were collected during a continuing prospective study (1998-99) of a group of Taiwanese subjects at high-risk of developing type 2 diabetes who had fasting hyperglycemia (5.6-7.0 mmol/l) and exhibited 2-h postload glucose concentrations

A two-step screening strategy was used to compare the metabolic risk profiles between subjects from Kinmen, Taiwan, who had fasting and 2-hr plasma glucose impairment and were considered at high risk of diabetes due to a fasting plasma glucose (FPG) between 5.6 and 7.8 mmol/l at the baseline screening. 1855 subjects without a previous diagnosis of diabetes who had an FPG of 5.6-7.8 mmol/l at the first step of screening were invited to undergo an Oral Glucose Tolerance Test (OGTT) for the second step of screening, and 1456 of these subjects (774 males and 682 females) completed the OGTT. Subjects who completed the OGTT were classified into normal, isolated impaired fasting glucose (isolated IFG), isolated impaired glucose tolerance (isolated IGT), both IFG and IGT, or undiagnosed diabetes groups. Sex-specific, age-adjusted mean values of metabolic risk profiles for various categories of glucose intolerance were calculated. The results for IFG and IGT agreed in only 20.8% of subjects. The clinical features of subjects with IGT (2-hr glucose impairment) were associated with cardiovascular risk profiles, while those subjects with isolated IFG (fasting glucose impairment only) were not. If the definition of IFG alone had been used for glucose intolerance screening, about 66.6% of subjects with IGT (i.e., isolated IGT with 2-hr glucose impairment and a normal fasting state) who had cardiovascular risk profiles would have been undetected.

In the face of the growing worldwide prevalence of type 2 diabetes, effective methods of preventing further increases in prevalence are needed. In this paper, we review the community-based epidemiologic studies of diabetes in Taiwan published during the last decade, and look at the effectiveness of a two-stage screening protocol for identifying subjects at risk for progression to type 2 diabetes. The results of these studies indicate that the age-adjusted prevalence rate of undiagnosed diabetes in Taiwan is stable, at around 4.0%, while the annual incidence rate is about 1.8%. The results of several studies strongly suggest that a two-step screening strategy, in which only subjects with a fasting plasma glucose level of 5.6–7.8 mmol/l receive the oral glucose tolerance test, may be an effective means of identifying diabetics and persons at high risk for progression to type 2 diabetes and, ultimately, slowing the increase in the prevalence of this disease.

The purpose of the present study was to examine the characteristics of healthcare costs for diabetic patients in Taiwan. The study analyzed claim data from the Bureau of National Health Insurance for the period from July 1997 to June 1998. There were 536159 documented diabetic patients who were treated within the universal healthcare system in Taiwan during this study period. The annual number of visits of these diabetic patients was 6.2% of the total outpatient visits of all patients due to all causes during the one-year study period. Diabetes-related problems were the causes of 25.2% of outpatient visits among diabetic patients, while 74.8% of visits were for causes unrelated to diabetes. The distribution of treatment for the diabetic patients was by oral hypoglycemic agents 88.3%, insulin only 6.9%, and a combination of insulin and oral agents 4.8%. Diabetic patients accounted for 4,724,711 hospital inpatient days during the study period, which was 22.1% of the total inpatient days in Taiwan. Of the inpatient admissions, 13.9% were for diabetes as the principal cause, 23.4% were for diabetes-related disease, and 62.7% were for causes unrelated to diabetes. The direct costs of healthcare for the documented diabetic patients was 11.5% of the total costs of healthcare in Taiwan, and was 4.3 times higher than the average costs of care for non-diabetic individuals.

This is a community-based population survey carried out by the Yang-Ming Crusade to investigate the impact of years since menopause on the development of glucose intolerance in post-menopausal women. A total of 5412 women were screened with fasting plasma glucose. Those with fasting plasma glucose levels between 5.5 and 7.8 mM were given an oral glucose tolerance test. Among the 5412 women screened, 2039 (37.7%) were post-menopausal with a median age at menopause of 49 years. Pre-menopausal women showed impaired glucose tolerance (IGT) and diabetes mellitus (DM) prevalences of 3.7% and 3.1% respectively, whereas the corresponding figures for post-menopausal women were 8.4% and 17.6%, respectively. Comparing DM versus normal glucose tolerance (NGT) and IGT versus NGT as dependent variables in logistic regression analysis, menopause status was significantly associated with DM and IGT. In post-menopausal women, after maintaining body mass index, waist–hip ratio, systolic blood pressure, diastolic blood pressure, family history of DM, age at menopause, cholesterol, high density lipoprotein cholesterol and triglycerides as controls, years since menopause was the only significant factor associated with IGT (OR = 1.05, 95%CI 1.01–1.08) and years since menopause was not associated with DM. Further anlaysis indicated years since menopause (OR = 1.06, 95%CI, 1.01–1.11) was the only factor significantly associated with IGT for women whose age at menopause was greater than 49 years. Our study indicates that in subjects who have not undergone hormone replacement therapy and whose age at menopause is greater than 49 years, an increase in years since menopause confers a negative influence on glucose tolerance and increases the risk of IGT by 6% for each year after menopause.

In this population-based survey, we investigated the prevalence of varying degrees of glucose tolerance among residents of Kin-Chen, Kinmen, as well as the association of glucose tolerance status with potential risk factors for type 2 diabetes and cardiovascular disease (CVD). We focused particularly on subjects with normal 2-h postload glucose level (

The objective of this study was to investigate the prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in Pu-Li, Taiwan from 1991-1992, and to compare the results with a similar study conducted in 1987-1988. We also wished to compare different approaches in asking about patient history and to determine how this effects data authenticity. Both were community-based cross-sectional studies with stratified cluster sampling of residents age > or = 30. Blood samples were taken for screening and 75 g oral glucose tolerance tests were performed for diagnosis. The total number of eligible subjects in the second study was 2719 (1424 men, 1295 women). Complete data and samples were collected for 1118 (536 men, 582 women). The response rate was 41.1% (37.6% for men, 44.9% for women). The crude prevalence was 10.3% (5.6% known, 4.7% new). Using standard world population (Segi), the age-adjusted prevalence rate was 8.3% (4.0% known, 4.3% new). The 1991-1992 study had a response rate (crude 41.1%, adjusted 51.3%) which was slightly lower than the 1987-1988 study (crude 44.8%, adjusted 55.9%). The age-adjusted prevalence rates for new NIDDM were similar (4.4 vs. 4.3%) while the age-adjusted prevalence of known NIDDM in the second survey (4.0%) was lower than the first survey (6.9%), which apparently was overestimated due to the simplicity of questions regarding history. In conclusion, prevalence of new DM in this area appears to be stable, and when doing a survey regarding previous DM, it is better to include treatment history rather than depending on self-reporting of NIDDM alone.

Purpose: To explore whether it is worthwhile to launch a routine gallstone disease screening for cholecystectomy prevention among Chinese population from different perspective in Taiwan. Methods: The study cohort was conducted with a total of 2,386 healthy adults voluntarily admitted to a teaching hospital for a physical check-up in 2002 in Taiwan. Annual follow-up screenings of gallstone disease then were until 31 December, 2007. The cost-benefit analysis tool of screening for gallstone disease is based on TreeAge software for medical decision analysis. A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone disease. Results: In terms of benefit-cost ratio, the different screening programs for gallstone disease could save New Taiwan Dollars (NTD) from 19.61 to 63.41 in discounted costs for each dollar incurred in different screening years from the societal viewpoint for Taiwan and save NTD from 2.89 to 4.71 in different screening years from health care payer's perspective. The average estimate of willingness-to-pay to translate into benefit yields NTD from 807.8 to 4,039 benefits per case due to gallstone disease screening in different screening years during 10-year follow-up. The net present value of the gallstone disease screening were NTD from −133,736 to −217,689.2 in different screening years. Conclusion: It is worthwhile to initial a routine gallstone disease screening of Chinese population for cholecystectomy prevention from the societal perspective but not from consumer decision based on the willingness-to-pay perspective.

We constructed two chimeric toxins; one composed of epidermal growth factor (EGF) and pseudomonas exotoxin A (PE), designated EGF-PE and the other composed of EGF and PE with a deletion of the Ia domain (cell-binding domain), designated EGF-PE (delta Ia). Both chimeric toxins reacted with anti-EGF and anti-PE antibodies. The cell-killing experiments showed that EGF-PE, but not EGF-PE (delta Ia), was cytotoxic to the murine fibroblast cell line NR6, which carried the PE receptor, but not the EGF receptor. However, after NR6 was transfected with DNA for the expression of human EGF receptor, the transfected cell line, designated NRHER5, over-expressed human EGF receptors and became sensitive to EGF-PE(delta IA). The cytotoxicity of EGF-PE(delta Ia), but not EGF-PE, to NRHER5 can be completely blocked by an excess amount of EGF. To completely reverse the cytotoxicity of EGF-PE on NRHER5, both the EGF receptor pathway and the PE receptor pathway need to be blocked. These results suggest that EGF-PE exhibits both EGF and PE binding activities, while EGF-PE(delta IA) possesses only EGF binding activity. Thus, EGF-PE(delta Ia) may be a better chimeric toxin than EGF-PE in terms of target specificity to EGF receptor bearing cells. We, therefore, examined the cytotoxicity of EGF-PE(delta Ia) to various human cancer cell lines. We find that human cancer cells containing more EGF receptors are more sensitive to EGF-PE(delta Ia).

Aims/hypothesis Our aim was to determine the predictive values on the all-cause and cardiovascular mortality and the future risks of hypertension and diabetes of the metabolic syndrome defined by the third report of the National Cholesterol Education Program's Adult Treatment Panel in the absence of established hypertension and diabetes (who may still have elevated blood pressure within 130–139/85–89 mmHg and/or elevated fasting blood glucose within 5.5–6.9 mmol/L (100–125 mg/dL)). Methods A community-based population of 11,058 Chinese aged 30 years and above in Kinmen island was followed up for 10.6 years. All-cause and cardiovascular mortality and incidence of hypertension and diabetes mellitus were determined. Results The hazard ratios and 95% confidence intervals for all-cause and cardiovascular mortality in subjects with metabolic syndrome but without hypertension and diabetes versus subjects without metabolic syndrome, hypertension, and diabetes, were 0.81 (0.51–1.30) and 0.89 (0.57–1.37) in men, and 1.14 (0.45–2.92) and 0.73 (0.27–2.68) in women, respectively. In the non-diabetic non-hypertensives at baseline, the odds ratios and 95% confidence intervals for predicting hypertension and diabetes for subjects with versus without the metabolic syndrome were 2.25 (1.80–2.82) and 3.12 (2.30–4.24), respectively. Conclusions/interpretation In this Chinese population, metabolic syndrome in the absence of hypertension and diabetes was not associated with increased risk of all-cause or cardiovascular mortality. In contrast, the presence of metabolic syndrome predicted future risk of hypertension and diabetes. Therefore, the intervention strategies for subjects with metabolic syndrome may be focused on the prevention of hypertension and diabetes.

To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan.A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45 degrees color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction.Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62-3.05), 2.37 times (95% CI: 1.19-4.69), and 4.16 times (95% CI: 2.15-8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%-82%), 82% (95% CI: 58%-92%), and 82% (95% CI: 60%-92%) compared to that in the 1st quartile, respectively.Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes.

Background The literature to date is not clear as to whether any interactive effect exists between insulin resistance and menopause on the metabolic syndrome and its individual components. We explored this issue in 4107 homogeneous, nondiabetic Chinese women in the Kinmen Study. Methods Overnight fasting blood samples were drawn for glucose, insulin, lipid, and other biochemical measurements. Demographic and clinical variables including body mass index, waist circumference, and blood pressure were measured and documented during face-to-face interviews with structured questionnaires. Menstrual history was used to define menopause as the absence of menses for 12 consecutive months. Results Approximately 16% of premenopausal women (390/2423) were insulin-resistant. After adjustment for age, body mass index, lifestyle, and diet, both menopause and insulin resistance were independently and significantly correlated with metabolic syndrome. For each component of the metabolic syndrome, besides the main effect, the interaction (insulin resistance × menopause) had significant correlation with systolic blood pressure, diastolic blood pressure, and waist circumference. Conclusions Both insulin resistance and menopause have significant effects on metabolic syndrome independent of age and obesity. In premenopausal and nondiabetic women, various degrees of insulin resistance exist. The synergistic contribution of insulin resistance and menopause to components of the metabolic syndrome were observed with systolic blood pressure, diastolic blood pressure, and waist circumference. This requires further study.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder of unknown etiology. It has been suggested that metalloproteinases (MMPs) play important roles in the development and complications of autoimmune disorders. This article presents our research on the expression or activities of MMPs in Taiwanese T1DM patients.Levels and activities of plasma MMP-2 and MMP-9 in patients with T1DM were investigated and compared to those of control individuals by enzyme-linked immunosorbent assay and zymography.Circulatory levels and activities of MMP-2 and MMP-9 in patients with T1DM were significantly higher than those in control subjects.MMP expression and activities are significantly increased in patients with T1DM. Our results not only document plasma MMPs levels and activities in the Taiwanese population (with a very low type 1 diabetic incidence), but also suggest that MMP expression and activity are elevated before the onset of complications in diabetic patients.

A 65 year-old man with long-standing rheumatoid arthritis (RA) developed pure red cell aplasia (PRCA), which was apparently not caused by drugs or viral infections. The condition responded favorably to danazol in combination with sulfasalazine. This was probably the 2nd case of RA with PRCA in a male patient.

To explore the association of serum insulin, insulin resistance, and beta-cell dysfunction with gallstone disease (GSD) in type 2 diabetics.We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and beta-cell dysfunction (HOMA beta-cell).We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4(th) vs 1(st) quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4(th) vs 1(st) quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA beta-cell function was significantly related to decreased risk of GSD [4(th) vs 1(st) quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA beta-cell was observed among males.Serum insulin, insulin resistance, and beta-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.

Diabetic nephropathy is the major cause of end-stage renal disease. Many studies show that chronic kidney disease can be prevented, or its progression to end-stage renal disease delayed, by effective intervention. The aim of this study was to estimate the prevalence of proteinuria and renal impairment in patients with type 2 diabetes. A community-based screening for chronic kidney disease in type 2 diabetic patients was conducted in 1999-2001. Proteinuria was defined in terms of urine protein-to-creatinine ratio. The glomerular filtration rate per 1.73m(2) body surface area was calculated using an equation from the Modification of Diet in Renal Disease Study. The overall response rate was about 78.6%. Prevalence rates of proteinuria and renal impairment were 29.4% and 15.1%, respectively. Females had higher prevalence of proteinuria and renal impairment than males. And prevalence increased with increasing age. Hypertension was associated with both proteinuria and renal impairment. Only 43.0% of patients with stages 3-5 chronic kidney disease had proteinuria. Proteinuria and renal impairment screening may identify different segments of the diabetic population. Both a glomerular filtration rate and proteinuria test are recommended as screening tools for early detection of chronic kidney disease in type 2 diabetics.

General obesity and its progression are major predictors of future hypertension. It has not been established whether abdominal obesity contributes to the development of hypertension.A community-based study population of 2377 normotensive nondiabetic Chinese adults agedor=30 years were re-examined 10 years after their baseline examination.The 10-year cumulative incidence of hypertension was 25.9%. The standardized parameters for the prediction of follow-up systolic blood pressure (BP) for baseline body mass index (BMI), change in BMI, baseline homeostasis model assessment of insulin resistance (HOMA-IR), change in HOMA-IR, baseline waist circumference (WC), and change in WC were 0.19 (P.001), 0.09 (P.001), 0.11 (P.001), 0.08 (P.001), 0.16 (P.001), and 0.07 (P.001), respectively, when age, sex, and baseline systolic BP were accounted for. By stepwise linear regression analysis, age, baseline systolic BP, baseline BMI, change in BMI, baseline WC, and change in WC were significant predictors of the follow-up systolic BP. Both baseline WC and change in WC were significant predictors of follow-up systolic BP or incident hypertension when age, sex, baseline systolic BP, BMI, and change in BMI were accounted for. In a subgroup of younger adults with normal BMI and BP130/85 mm Hg, baseline systolic BP, change in HOMA-IR, baseline WC, and change in WC were significantly independent predictors of follow-up systolic BP.Abdominal obesity and its progression are predictors of future BP and hypertension incidence, independent of the effects of general obesity.

Impaired fasting glucose (IFG), a newly defined category of glycemic metabolism, has gained extensive attentions after the introduction of the diagnostic criteria of diabetes mellitus (DM) by the American Diabetes Association. To explore the metabolic characteristics of IFG, we conducted this prospective community-based study among people aged more than 40 years residing in three major townships of I-Lan, an agricultural county in Taiwan. People attending the annual health examinations in community health stations were recruited for study. Experienced research staff recorded the past medical history, performed comprehensive physical examinations, and drew blood for further laboratory tests for each subject. Insulin resistance was evaluated by homeostasis model assessment (HOMA), and the renal hemodynamics was evaluated by estimated glomerular filtration rate (GFR). In total, 824 subjects (mean age=64.4+/-11.3 years, M:F=366:458) participated this study, the overall prevalence of DM was 15.3% (8.7% previously undiagnosed), and the prevalence of IFG was 7.2%. Lipid profiles including serum levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride of subjects with IFG were basically indistinguishable from subjects with DM. Insulin resistance was significantly associated with the progression of glycemic metabolism (HOMA-IR of subjects with normal fasting glucose, IFG, and DM were 1.12+/-1.24, 1.88+/-1.64, 4.47+/-5.12, P0.001). However, the prevalence of metabolic syndrome was similar among subjects of IFG and DM (86.4 versus 85.6%). The prevalence of overt proteinuria was significantly increased as the glycemic metabolism progressed. The mean GFR was slightly increased in subjects with IFG, which may represent hyperfiltration in this category. In conclusion, metabolic characteristics of IFG were complex. Lipid profile and prevalence of metabolic syndrome of IFG were indistinguishable from DM, but renal hemodynamics and prevalence of overt proteinuria were intermediate between NFG and DM. To prevent or delay the onset of type 2 DM, aggressive lifestyle modifications should be engaged in our clinical practice for subjects with IFG.

A 7-year followup study among hyperuricemic subjects was conducted to investigate the association between longterm hyperuricemia and subsequent hyperglycemia and diabetes mellitus. The possible sex difference was also investigated.A total of 641 hyperuricemic subjects aged 30 years and over (391 men, 250 women) screened from the community-based Kinmen Study in 1991-92 (the baseline study) were followed in 1997-98, with 75% followup rate. Demographic, clinical, and biochemical data were collected in both baseline and followup periods.After followup for 7 years, the distribution of plasma glucose concentrations changed moderately among male hyperuricemic subjects, but increased markedly among female subjects. The increase of uric acid levels during the followup period was correlated with subsequent diabetes only among hyperuricemic women. Moreover, a relatively higher incidence of diabetes was found in postmenopausal hyperuricemic women after 7-year followup.Although the direct role and causality played by uric acid cannot be confirmed by this study, the findings, as applicable to a Chinese nondiabetic population, show that specific progressions of plasma glucose concentrations were significantly different between male and female hyperuricemic subjects. Hyperuricemia and persistent increase in uric acid levels among postmenopausal women should alert physicians to the possibility of subsequent hyperglycemia and diabetes.

The age-adjusted mortality rate on the island of Quemoy was the lowest of any county in Taiwan in the years 2000-2001. However, the island's rate of mortality due to cardiovascular diseases fluctuates widely. This fluctuation suggests that Quemoy may be issuing inaccurate death certificates.To assess the quality of death certificates from Quemoy, 123 (15.3%) medical records for 800 deaths between 1994 and 1998 were reviewed by 3 medical specialists. The underlying cause of death from the original death certificate was compared to the underlying cause of death determined by 3 reviewers based on review of all available medical records.The agreement index for all causes of death was 72.4%. Neoplasms had the highest sensitivity and positive predictive value for correct determination of underlying cause of death. Cardiovascular diseases had higher sensitivity, but lower positive predictive value than respiratory diseases. Neoplasms were under-reported by 25.5% but cardiovascular diseases were over-reported by 34.3%.Therefore, mortality statistics in Quemoy, which are based on death certificate data, may underestimate the frequency of neoplasms and overestimate cardiovascular diseases as underlying causes of death. Our findings also suggest that researchers should exercise considerable caution when using death certificate data to determine cause of death in etiologic studies, especially in neoplasms and cardiovascular diseases.

To compare clinical profiles and risk of diabetes between subjects with transient (trIGT) and persistent (pIGT) impaired glucose tolerance in Taiwan.In the pIGT group, IGT was diagnosed in two consecutive periods (1992-1994 and 1995-1996); in the trIGT group, the diagnosis was IGT at the baseline but normal glucose tolerance in the second period. The normal group was defined by fasting plasma glucose6.1 mmol/L and 2-hour post-load plasma glucose7.8 mmol/L in both periods. All three groups were considered eligible subjects for further follow up (1998-1999).Among 298 nondiabetic subjects at baseline, there were 29 new cases of diabetes diagnosed according to 1999 WHO criteria in 1,614.3 person-years of follow-up (1.79%/year; 95% CI = 1.14-2.44%/year). Among subjects with normal, trIGT, or pIGT, the incidence rates were 0.73%/year (8/1,093.0; 95% CI = 0.22-1.24%/year), 2.57%/year (7/272.2; 95% CI = 0.67-4.47%/year), and 5.62%/year (14/249.1; 95% CI = 2.68-8.56%/year), respectively.The group with trIGT had abnormal glucose tolerance and beta-cell dysfunction, which may represent an earlier stage than the group with pIGT in development of type 2 diabetes. Moreover, pIGT, insulin resistance, and beta-cell dysfunction played independent roles in the deterioration from IGT to diabetes.

This study examined healthcare costs for medication-using diabetic patients in Taiwan and predicted which factors were associated with costs. We analyzed claims data from the National Health Insurance (NHI) program in Taiwan from 1998 to 1999. The approach included estimates of costs attributable to diabetes, diabetes-related complications, comorbidity incurred by diabetic patients. A multiple regression model was used to assess the contribution of patients’ characteristics in 1998 on outpatient, inpatient, and total costs in 1998 and 1999. The prevalence of medication-using patients with diabetes was 2.6% in 1998 and 2.8% in 1999. Costs of healthcare were 13.3% of total costs of NHI in 1998 versus 13.0% in 1999. Health services delivered near the end of life consumed large portions of medical dollars. The three most prevalent clinical associations of diabetes were congestive heart failure, neuropathy, and ischemic heart disease. Adjusted for demographic and clinical characteristics in 1998, this model could explain 8.0, 9.3, and 12.5%, respectively, of the cost variation in outpatient, inpatient, and total costs in 1999.

AIM: To investigate the prevalence and the risk factors of glucose intolerance in Chinese patients with chronic hepatitis C and to evaluate the relationship between interferon (IFN) treatment and glucose intolerance in these patients. METHODS: Prospective cross-sectional study was done to evaluate the prevalence of glucose intolerance in Chinese patients with chronic hepatitis C virus (HCV) infection from the outpatient clinic of Department of Family Medicine, Taipei Veterans General Hospital. Chronic hepatitis C was defined as persistent presence of anti-HCV and persistent elevation of liver transaminase for at least 1.5 folds for at least 6 months. Moreover, patients were further categorized into normal fasting glucose and glucose intolerance (diabetes mellitus (DM) and impaired fasting glucose) according to the diagnostic criteria of American Diabetic Association. RESULTS: Totally, 359 Chinese patients with chronic hepatitis C were enrolled (212 males and 147 females, mean age = 58.1 ± 13.0 years). One hundred and twenty-three patients (34.3%) had received various forms of IFN treatment. One hundred and twenty-five patients (34.6%) had glucose intolerance, including 99 patients (27.6%) with DM and 26 patients (7.0%) with impaired fasting glucose. In comparison with those with normal fasting glucose levels, patients with chronic hepatitis C with glucose intolerance were significantly older, had a significantly higher body mass index, and they were more likely to suffer from obesity, to have family history of diabetes and to have had previous IFN treatment. Stepwise multivariate logistic regression revealed significantly that age 57 years, obesity, previous history of IFN treatment and the presence of family history of diabetes were independent risk factors associated with the presence of glucose intolerance in chronic hepatitis C patients. CONCLUSION: In conclusion, 34.6% of Chinese patients with chronic hepatitis C had glucose intolerance. Chronic hepatitis C patients who were older in age, obese, had previous IFN treatment history and had family history of diabetes were prone to develop glucose intolerance. To our knowledge, this is the first population-based report to confirm that interferon treatment to be an independent risk factor to develop glucose intolerance.

Diabetes mellitus carries a great burden on healthcare costs due to its growing population and high co-morbidity. This adverse effect sustains even when patients develop end-stage renal disease (ESRD). We here present data showing the effect of diabetes on economic costs in dialysis therapy in Taiwan. As of the end of 1997, we have 22 027 ESRD patients with a prevalence and incidence rate of 1013 and 253 per million populations, respectively. Diabetic nephropathy is the second most common cause of the underlying renal diseases, but accounts for 24.8% of the prevalent patients and 35.9% of the incident cases. The diabetic patients engendered 11.8% more expense for care of dialysis than the non-diabetic patients (US$26 988 vs. US$24 146 per patient-year). Higher inpatient cost mainly account for the difference. As compared to non-diabetic patients, the diabetic patients had 3.5 times more inpatients costs (US$1325 vs. US$4677 per patient-year), and higher proportion of inpatient-to-annualized cost ratio (5.5 vs. 17.3%) resulting from their more frequent hospitalization (0.59 vs. 1.13 times per patient-year) and longer hospital stay (6.7 vs. 18.9 days per patient-year). The major causes responsible for a more frequent hospitalization were cardiovascular disease, poorly controlled hyperglycemia, sepsis and failure of vascular access. The annualized costs for care of dialysis patients in Taiwan, including inpatient and outpatient costs, averaged US$25 576 per patient-year. This value is approximately half of that in most of the western countries and Japan. Thus, a more cost-effective way to achieve savings is to reduce the high incidence rate of dialysis population and to maximize the quality of dialysis treatment for avoiding hospitalization. Recent studies had shown that tight blood pressure control, intensive glycemic control, and use of angiotensin converting enzyme inhibitors in diabetic patients significantly reduced not only the rate of progressive renal failure, but also substantially reduced the cost of complications and led to higher cost effectiveness. Once diabetic patients reach stage of ESRD, an optimized pre-ESRD care and consideration of kidney transplantation are essential in terms of better patient survival and cost savings.

Some environmental and genetic factors play important roles in etiopathogenesis of type 1 or insulin-dependent diabetes mellitus (IDDM). HLA genes, the IDDM1 locus located the human chromosome 6, were found to be associated with insulin-dependent diabetes mellitus. However, the incidence of IDDM varied greatly among various populations. To evaluate the pathogenetic factors contributing to the development of IDDM in Taiwan, HLA typing was performed in a group of IDDM unrelated individuals and IDDM pedigrees along with the normal controls from the northern Taiwan. DNA genotypes of class II HLA were done by polymerase-chain-reaction based oligotyping techniques. We confirmed that class II HLA genes were significantly associated with IDDM in Taiwan. To study detailed molecular structure of class II HLA molecules and disease association, we examined several amino acid residues on DQα and DQβ chains and the molecular mechanisms to explain the heterozygotic effect of the DR3/DR4 and DR3/DR9 in the Chinese population. Linkage analysis in our pedigrees confirmed the association between HLA and IDDM in population association studies. Among the several class II alleles, a closer segregation of HLA-DQB1*0401 to the affected persons might suggest that HLA-DQB1*0401 itself or an allele closely linked to the DQB1 locus was the IDDM-predisposing allele in Taiwanese. For IDDM2 ( INS ) region, association with IDDM was not found due to that more than 90% of the population carried class I alleles. In our collection of IDDM, we found few cases (2.4%) carried mitochondrial DNA mutation. Our studies in Taiwanese confirm a multigenetic nature for IDDM.

OBJECTIVE: In a preliminary cross-sectional study, we discovered that DNA topoisomerase II autoantibodies (anti-TopII) were detected in 49.2% of 195 Chinese type 1 diabetes mellitus (type 1 DM) patients with a mean age of 14.5 years and a mean duration of disease of 4.6 years. In order to demonstrate the relationship between anti-TopII and other immunological characteristics in Chinese type 1 DM patients, and to evaluate its putative prediction efficacy in Chinese patients, we simultaneously examined the frequency of anti-glutamic acid decarboxylase autoantibodies (anti-GAD), anti-TopII, antithyroglobulin/antimicrosomal autoantibodies (ATA/AMiA) and C-peptide concentrations in our patients in the present study. DESIGN AND METHODS: The frequency of anti-GAD and C-peptide levels, anti-TopII, and ATA/AMiA were examined in our patients by radioimmunoassay, enzyme-linked immunosorbant assay and hemagglutination respectively. Univariate comparisons were performed using Student's t-test for normal distributed data and Chi-square test for diclomatous data. Multivariate analysis was used for interpreting the independent risk factors which increased the incidence of anti-TopII. RESULTS AND CONCLUSIONS: The positivities for anti-GAD, anti-TopII, ATA/AMiA and C-peptide were 45.8%, 50.2%, 13.4% and 11.4% respectively. Anti-GAD and anti-TopII frequencies in our patients were similar when we stratified the patients by age, age at onset and duration. These observations imply that anti-GAD and anti-TopII remain persistent in Chinese patients with long-term type 1 DM duration. The most interesting finding is that anti-TopII frequency is more persistent than anti-GAD in our patients, especially when the diabetic duration is longer than 11 years. This indicates that anti-TopII, rather than anti-GAD, might act as a better indicator for monitoring the pathogenesis of Chinese type 1 DM patients especially in patients with a long-standing duration of disease. The late age of onset (>18 years) is a risk factor which increased the incidence of anti-TopII according to multivariate analysis. We further analyzed different manifestations between the youth- and adult-onset type 1 DM and found that adult-onset type 1 DM is characterized by better preservation of residual beta-cell function and higher frequencies of autoantibodies.

The objective of this study was to compare the results between two diagnostic criteria by ADA (1997) and WHO (1985) among those with fasting plasma glucose (FPG) level 5.6-7.8 mmol/l from a community-based survey in Kin-Hu and Kin-Chen, Kinmen conducted in 1991-94. According to official household registry, 10,797 residents aged over 30 were eligible for screening. 7580 had completed FPG screening and 1855 with FPG 5.6-7.8 mmol/l were invited to receive a 75-g oral glucose tolerance test (OGTT). 78.5% (1456/1855) had completed OGTT. The prevalence of impaired fasting glucose (IFG, by ADA) was 15.7%; the prevalence of impaired glucose tolerance (IGT, by WHO) was 22.7%; the prevalence of undiagnosed diabetes was 7.4% by ADA criteria and 10.9% by WHO criteria. It should be noticed that, among subjects with FPG 5.6-7.8 mmol/l, 50.3% of individuals with undiagnosed diabetes and 67.6% of individuals with IGT by WHO criteria would be missed by ADA criteria. Based on the above findings, the two-step screening strategy using FPG as the first line screening and OGTT for high-risk group (FPG 5.6-7.8 mmol/l) only was recommended in epidemiological study and case finding in consideration of feasibility and validity.

We surveyed 1447 men and 1800 women aged 30 years (mean 46.7 years) with normal glucose tolerance in Kin-Chen, Kinmen. Correlations of fasting serum insulin and C-peptide with various clinical and biochemical parameters were analyzed by multiple linear regression analysis. Women had significantly higher levels of insulin than men (98+/-43 vs. 91+/-43 pM, p

A 36-year-old G5 P2AB2 woman was admitted to our hospital due to nausea, vomiting and severe epigastric pain for one day at 24 weeks gestation. She had a history of diabetes for one year, but was not receiving any medical treatment. The patient also denied any other drug history or alcohol drinking. Physical examination revealed a blood pressure of 150/100 mmHg, body temperature 37°C, weight 60 kg, and height 159 cm. Cutaneous eruptions or xanthomas were not seen. The epigastric tenderness was severe, but without rebounding pain or muscle rigidity. Pelvic examination was unremarkable. Fundus height was 22 cm and foetal heart rate 140 beats/min. Laboratory studies showed a serum amylase level of 457 U/l (normal range

To search for non-genetic risk factors for Type 1 diabetes among Chinese, a total of 117 Type 1 diabetes patients identified from the Taipei Type 1 Diabetes Registry and 193 frequency-matched controls with normal glucose tolerance were recruited. The controls were selected from classmates or colleagues of cases with similar distributions of age, sex, and parental and individual educational levels. Information on Type 1 diabetes risk factors was obtained through standardized interviews according to a structured questionnaire administered by two trained nurses. In the univariate analyses, the order of pregnancy of the study subject, the number of spontaneous and induced abortions reported by the mother before giving birth to the study subjects, the duration of breast-feeding and monthly family income were significantly associated with Type 1 diabetes in a dose–response manner. There was a U-shaped relationship with Type 1 diabetes for birth weight and paternal age at the conception of the study subjects. After further adjustment for multiple risk factors through logistic regression analysis, the biological gradient for pregnancy order, duration of breast-feeding, and the U-shaped relationship for paternal age remained statistically significant.