Multifaceted Determinants for Achieving Glycemic Control : The International Diabetes Management Practice Study (IDMPS)

Chan, Juliana C.N.,Gagliardino, Juan Jose,Baik, Sei Hyun,Chantelot, Jean-Marc,Ferreira, Sandra R.G.,Hancu, Nicolae,Ilkova, Hasan,Ramachandran, Ambady,Aschner, Pablo American Diabetes Association 2009 Diabetes care Vol.32 No.2

<P><B>OBJECTIVE</B>—The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.</P><P><B>RESEARCH DESIGN AND METHODS</B>—Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (<I>n</I> = 3,519), Asia (<I>n</I> = 5,888), Latin America (<I>n</I> = 2,116), and Africa (<I>n</I> = 276).</P><P><B>RESULTS</B>—Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (<I>n</I> = 696) and 3.6% of type 2 diabetic (<I>n</I> = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucose–lowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.</P><P><B>CONCLUSIONS</B>—In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control.</P>

Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective study

Cho, Nam H.,Chan, Juliana C. N.,Jang, Hak Chul,Lim, Soo,Kim, Hyung L.,Choi, Sung Hee Blackwell Publishing Ltd 2009 Clinical endocrinology Vol.71 No.5

<P>Summary</P><P>Objectives </P><P>We investigated the association between smoking and its additive effects with insulin resistance and &bgr;-cell function on the incidence of type 2 diabetes in a prospective population-based cohort study.</P><P>Design and method </P><P>A total of 10 038 subjects were recruited from rural and urban areas. All subjects underwent 75 g oral glucose tolerance tests and full biochemical assessments at baseline and during 4-year follow-up period. The final analysis was limited to 4041 men due to the low smoking rates in women.</P><P>Results </P><P>The ex- and heavy current smokers had the highest incidence of diabetes of 12·5% and 11·1% respectively, compared with never-smokers (7·9%) during 4 years. After multivariate adjustment by Cox-proportional hazard model, ex- and current smokers reveal a relative risk of 1·60 (95% CI: 1·07–2·39), 2·06 (1·35–3·16, for <20 cigarettes/day) and 2·41 (1·48–3·93, for ≥20 cigarettes/day) respectively compared with never smokers. The risk of new onset diabetes was the highest in those with low homeostasis model assessment for beta cell function (HOMA-&bgr;) and high homeostasis model assessment for insulin resistance (HOMA-IR) group in both smokers and never smokers.</P><P>Conclusions </P><P>Smoking is an independent risk factor for type 2 diabetes mellitus and showed synergistic interaction with the status of low insulin secretion and high insulin resistance for developing diabetes. Given the high rates of smoking and growing burden of diabetes in the world, cessation of smoking should be considered as one of the key factors for diabetes prevention and treatment programmes.</P>

Use of SGLT-2 Inhibitors in Patients with Type 2 Diabetes Mellitus and Abdominal Obesity: An Asian Perspective and Expert Recommendations

Wayne Huey-Herng Sheu,Siew Pheng Chan,Bien J. Matawaran,Chaicharn Deerochanawong,Ambrish Mithal,Juliana Chan,Ketut Suastika,Chin Meng Khoo,Huu Man Nguyen,Ji Linong,Andrea Luk,윤건호 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.1

The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.

Genetic Defects in the Cholesterol Ester Transfer Protein Gene in Hong Kong Chinese

tomllneon,Brian,Ma,Yanqing,Thomas,G . Nell,Chan,Juliana C . N .,Critchley,Julian A . J . H . 한국지질학회 2001 韓國脂質學會誌 Vol.11 No.3

Evolution of Diabetes Care in Hong Kong: From the Hong Kong Diabetes Register to JADE-PEARL Program to RAMP and PEP Program

Ivy H.Y. Ng,Kitty K.T. Cheung,Tiffany T.L. Yau,Elaine Chow,Risa Ozaki,Juliana CN Chan 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.1

The rapid increase in diabetes prevalence globally has contributed to large increases in health care expenditure on diabetic complications,posing a major health burden to countries worldwide. Asians are commonly observed to have poorer β-cell function and greaterinsulin resistance compared to the Caucasian population, which is attributed by their lower lean body mass and central obesity. This “double phenotype” as well as the rising prevalence of young onset diabetes in Asia has placed Asians with diabetes at high riskof cardiovascular and renal complications, with cancer emerging as an important cause of morbidity and mortality. The experiencefrom Hong Kong had demonstrated that a multifaceted approach, involving team-based integrated care, information technologicaladvances, and patient empowerment programs were able to reduce the incidence of diabetic complications, hospitalizations, andmortality. System change and public policies to enhance implementation of such programs may provide solutions to combat the burgeoninghealth problem of diabetes at a societal level.

Chronic Kidney Disease and Associated Cardiovascular Risk Factors in Chinese with Type 2 Diabetes

Qing-Lin Lou,Xiao-Jun Ouyang,Liu-Bao Gu,Yong-Zhen Mo,Ronald Ma,Jennifer Nan,Alice Kong,Wing-Yee So,Gary Ko,Juliana Chan,Chun-Chung Chow,Rong-Wen Bian 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.6

Background: To determine the frequency of chronic kidney disease (CKD) and its associated risk factors in Chinese type 2 diabetic patients, we conducted a cross-sectional study in Nanjing, China, in the period between January 2008 and December 2009. Methods: Patients with type 2 diabetes under the care by Jiangsu Province Official Hospital, Nanjing, China were invited for assessment. CKD was defined as the presence of albuminuria or estimated glomerular filtration rate <60 mL/min/1.73 m2. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g. Results: We recruited 1,521 urban Chinese patients with type 2 diabetes (mean age, 63.9±12.0 years). The frequency of CKD and albuminuria was 31.0% and 28.9%, respectively. After adjusted by age and sex, hypertension, anemia and duration of diabetes were significantly associated with CKD with odds ratio (95% confidence interval) being 1.93 (1.28 to 2.93), 1.70 (1.09 to 2.64), and 1.03 (1.00 to 1.06), respectively. Conclusion: In conclusion, CKD was common in the urban Nanjing Chinese with type 2 diabetes. Strategies to prevent or delay progression of kidney disease in diabetes should be carried out at the early disease course of type 2 diabetes.

Implication of Genetic Variants Near <i>TCF7L2</i> , <i>SLC30A8</i> , <i>HHEX</i> , <i>CDKAL1</i> , <i>CDKN2A/B</i> , <i>IGF2BP2</i> , and <i>FTO</i> in Type 2 Diabetes and Obesity in 6,719 Asians

Ng, Maggie C.Y.,Park, Kyong Soo,Oh, Bermseok,Tam, Claudia H.T.,Cho, Young Min,Shin, Hyoung Doo,Lam, Vincent K.L.,Ma, Ronald C.W.,So, Wing Yee,Cho, Yoon Shin,Kim, Hyung-Lae,Lee, Hong Kyu,Chan, Juliana American Diabetes Association 2008 Diabetes Vol.57 No.8

<P><B>OBJECTIVE—</B> Recent genome-wide association studies have identified six novel genes for type 2 diabetes and obesity and confirmed <I>TCF7L2</I> as the major type 2 diabetes gene to date in Europeans. However, the implications of these genes in Asians are unclear.</P><P><B>RESEARCH DESIGN AND METHODS—</B> We studied 13 associated single nucleotide polymorphisms from these genes in 3,041 patients with type 2 diabetes and 3,678 control subjects of Asian ancestry from Hong Kong and Korea.</P><P><B>RESULTS—</B> We confirmed the associations of <I>TCF7L2</I>, <I>SLC30A8</I>, <I>HHEX</I>, <I>CDKAL1</I>, <I>CDKN2A</I>/<I>CDKN2B</I>, <I>IGF2BP2</I>, and <I>FTO</I> with risk for type 2 diabetes, with odds ratios ranging from 1.13 to 1.35 (1.3 × 10<SUP>−12</SUP> < <I>P</I><SUB>unadjusted</SUB> < 0.016). In addition, the A allele of rs8050136 at <I>FTO</I> was associated with increased BMI in the control subjects (<I>P</I><SUB>unadjusted</SUB> = 0.008). However, we did not observe significant association of any genetic variants with surrogate measures of insulin secretion or insulin sensitivity indexes in a subset of 2,662 control subjects. Compared with subjects carrying zero, one, or two risk alleles, each additional risk allele was associated with 17% increased risk, and there was an up to 3.3-fold increased risk for type 2 diabetes in those carrying eight or more risk alleles. Despite most of the effect sizes being similar between Asians and Europeans in the meta-analyses, the ethnic differences in risk allele frequencies in most of these genes lead to variable attributable risks in these two populations.</P><P><B>CONCLUSIONS—</B> Our findings support the important but differential contribution of these genetic variants to type 2 diabetes and obesity in Asians compared with Europeans.</P>