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Volume 41(2); April 2017
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Reviews
Clinical Care/Education
A Clinical Practice Guideline to Guide a System Approach to Diabetes Care in Hong Kong
Ip Tim Lau
Diabetes Metab J. 2017;41(2):81-88.   Published online April 14, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.81
  • 3,802 View
  • 55 Download
  • 33 Web of Science
  • 33 Crossref
AbstractAbstract PDFPubReader   

The Hospital Authority of Hong Kong is a statutory body that manages all the public medical care institutions in Hong Kong. There are currently around 400,000 diabetic patients under its care at 17 hospitals (providing secondary care for 40%) and 73 General Outpatient Clinics (providing primary care for 60%). The patient population has been growing at 6% to 8% per year over the past 5 years, estimated to include over 95% of all diagnosed patients in Hong Kong. In order to provide equitable and a minimal level of care within resources and local system factors constraints, a Clinical Practice Guideline on the management of type 2 diabetes mellitus was drawn in 2013 to guide a system approach to providing diabetes care. There is an algorithm for the use of various hypoglycemic agents. An organizational drug formulary governs that less expansive options have to be used first. A number of clinical care and patient empowerment programs have been set up to support structured and systematic diabetes care. With such a system approach, there have been overall improvements in diabetes care with the percentage of patients with glycosylated hemoglobin <7% rising from 40% in 2010 to 52% in 2015.

Citations

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  • Greater variability in lipid measurements associated with kidney diseases in patients with type 2 diabetes mellitus in a 10-year diabetes cohort study
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  • Age‐specific associations of glycated haemoglobin variability with cardiovascular disease and mortality in patients with type 2 diabetes mellitus: A 10‐ year cohort study
    Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Florence Ting Yan Ng, Shu Ming Cheryl Chia, Ian Chi Kei Wong, Esther Wai Yin Chan, Cindy Lo Kuen Lam
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  • The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study
    Eric Yuk Fai Wan, Weng Yee Chin, Esther Yee Tak Yu, Ian Chi Kei Wong, Esther Wai Yin Chan, Shirley Xue Li, Nico Kwan Lok Cheung, Yuan Wang, Cindy Lo Kuen Lam
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  • Greater variability in lipid measurements associated with cardiovascular disease and mortality: A 10‐year diabetes cohort study
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  • Age at diagnosis, glycemic trajectories, and responses to oral glucose-lowering drugs in type 2 diabetes in Hong Kong: A population-based observational study
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  • Age‐Specific Associations Between Systolic Blood Pressure and Cardiovascular Disease: A 10‐Year Diabetes Mellitus Cohort Study
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  • Associations between usual glycated haemoglobin and cardiovascular disease in patients with type 2 diabetes mellitus: A 10‐year diabetes cohort study
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  • Cultural adaptation and psychometric properties of the Chinese Burden of Treatment Questionnaire (C-TBQ) in primary care patients with multi-morbidity
    Weng Yee Chin, Carlos King Ho Wong, Cherry Cheuk Wai Ng, Edmond Pui Hang Choi, Cindy Lo Kuen Lam
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  • Association of Blood Pressure and Risk of Cardiovascular and Chronic Kidney Disease in Hong Kong Hypertensive Patients
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  • Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients
    Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Daniel Yee Tak Fong, Edmond Pui Hang Choi, Eric Ho Man Tang, Cindy Lo Kuen Lam
    Journal of the American Society of Nephrology.2019; 30(10): 1991.     CrossRef
  • Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study
    Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Colman Siu Cheung Fung, Daniel Yee Tak Fong, Edmond Pui Hang Choi, Anca Ka Chun Chan, Cindy Lo Kuen Lam
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  • 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 C.N. Chan
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  • Relation between HbA1c and incident cardiovascular disease over a period of 6 years in the Hong Kong population
    E.Y.F. Wan, E.Y.T. Yu, C.S.C. Fung, W.Y. Chin, D.Y.T. Fong, A.K.C. Chan, C.L.K. Lam
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  • Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses—A Population-Based and Propensity-Matched Cohort Study
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    Eric Yuk Fai Wan, Esther Yee Tak Yu, Colman Siu Cheung Fung, Weng Yee Chin, Daniel Yee Tak Fong, Anca Ka Chun Chan, Cindy Lo Kuen Lam
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Pathophysiology
Role of NO/VASP Signaling Pathway against Obesity-Related Inflammation and Insulin Resistance
Yu Mi Kang, Francis Kim, Woo Je Lee
Diabetes Metab J. 2017;41(2):89-95.   Published online November 15, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.89
  • 4,561 View
  • 60 Download
  • 22 Web of Science
  • 20 Crossref
AbstractAbstract PDFPubReader   

Obesity has quickly become a worldwide pandemic, causing major adverse health outcomes such as dyslipidemia, type 2 diabetes mellitus, cardiovascular disease and cancers. Obesity-induced insulin resistance is the key for developing these metabolic disorders, and investigation to understand the molecular mechanisms involved has been vibrant for the past few decades. Of these, low-grade chronic inflammation is suggested as a critical concept in the development of obesity-induced insulin resistance, and the anti-inflammatory effect of nitric oxide (NO) signaling has been reported to be linked to improvement of insulin resistance in multiple organs involved in glucose metabolism. Recently, a body of evidence suggested that vasodilatory-stimulated phosphoprotein (VASP), a downstream mediator of NO signaling plays a crucial role in the anti-inflammatory effect and improvement of peripheral insulin resistance. These preclinical studies suggest that NO/VASP signaling could be an ideal therapeutic target in the treatment of obesity-related metabolic dysfunction. In this review, we introduce studies that investigated the protective role of NO/VASP signaling against obesity-related inflammation and insulin resistance in various tissues.

Citations

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Editorial
Obesity and Metabolic Syndrome
Association between Blood Mercury Level and Visceral Adiposity in Adults
Seong-Su Moon
Diabetes Metab J. 2017;41(2):96-98.   Published online April 14, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.96
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PDFPubReader   

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Original Articles
Clinical Care/Education
Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus
So Young Park, Sun Young Kim, Hye Mi Lee, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee, Kang-Hee Sim, Sang-Man Jin
Diabetes Metab J. 2017;41(2):99-112.   Published online March 3, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.99
  • 4,299 View
  • 44 Download
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability.

Methods

The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93).

Results

The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32).

Conclusion

The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.

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Obesity and Metabolic Syndrome
Association between Blood Mercury Level and Visceral Adiposity in Adults
Jong Suk Park, Kyoung Hwa Ha, Ka He, Dae Jung Kim
Diabetes Metab J. 2017;41(2):113-120.   Published online December 21, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.113
  • 4,969 View
  • 46 Download
  • 38 Web of Science
  • 39 Crossref
AbstractAbstract PDFPubReader   
Background

Few studies have examined the association between mercury exposure and obesity. The aim of this study is to investigate the association between blood mercury concentrations and indices of obesity in adults.

Methods

A total of 200 healthy subjects, aged 30 to 64 years, who had no history of cardiovascular or malignant disease, were examined. Anthropometric and various biochemical profiles were measured. Visceral adipose tissue (VAT) was measured using dual-energy X-ray absorptiometry (DXA).

Results

All subjects were divided into three groups according to blood mercury concentrations. Compared with the subjects in the lowest tertile of mercury, those in the highest tertile were more likely to be male; were current alcohol drinkers and smokers; had a higher body mass index (BMI), waist circumference (WC), and VAT; had higher levels of blood pressure, fasting glucose, and insulin resistance; and consumed more fish. The blood mercury concentration was significantly associated with anthropometric parameters, showing relationships with BMI, WC, and VAT. After adjusting for multiple risk factors, the odds ratios (ORs) for high mercury concentration was significantly higher in the highest VAT tertile than in the lowest VAT tertile (OR, 2.66; 95% confidence interval, 1.05 to 6.62; P<0.05).

Conclusion

The blood mercury concentration was significantly associated with VAT in healthy adults. Further studies are warranted to confirm our findings.

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Obesity and Metabolic Syndrome
Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density?
Mi Jang, So-Young Park, Yong-Woon Kim, Seung-Pil Jung, Jong-Yeon Kim
Diabetes Metab J. 2017;41(2):121-127.   Published online December 16, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.121
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AbstractAbstract PDFPubReader   
Background

The proportion of saturated fatty acids/unsaturated fatty acids in the diet seems to act as a physiological regulation on obesity, cardiovascular diseases, and diabetes. Differently composed fatty acid diets may induce satiety of the hypothalamus in different ways. However, the direct effect of the different fatty acid diets on satiety in the hypothalamus is not clear.

Methods

Three experiments in mice were conducted to determine whether: different compositions of fatty acids affects gene mRNA expression of the hypothalamus over time; different types of fatty acids administered into the stomach directly affect gene mRNA expression of the hypothalamus; and fat composition changes in the diet affects gene mRNA expression of the hypothalamus.

Results

The type of fat in cases of purified fatty acid administration directly into the stomach may cause changes of gene expressions in the hypothalamus. Gene expression by dietary fat may be regulated by calorie amount ingested rather than weight amount or type of fat.

Conclusion

Therefore, the calorie density factor of the diet in regulating hypothalamic gene in food intake may be detrimental, although the possibility of type of fat cannot be ruled out.

Citations

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  • Letter: Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density? (Diabetes Metab J 2017;41:121-7)
    Bo Kyung Koo
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  • Response: Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density? (Diabetes Metab J2017;41:121-7)
    Mi Jang, So-Young Park, Yong-Woon Kim, Seung-Pil Jung, Jong-Yeon Kim
    Diabetes & Metabolism Journal.2017; 41(3): 225.     CrossRef
Complications
Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy
Sabitha Palazhy, Vijay Viswanathan
Diabetes Metab J. 2017;41(2):128-134.   Published online January 11, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.128
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AbstractAbstract PDFPubReader   
Background

Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with and without nephropathy and analyzed the factors associated with nephropathy among them.

Methods

In this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n=89) and without nephropathy were enrolled in the control group (n=92). Both groups were matched for age and duration of diabetes. Data on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea and creatinine were collected from the case sheets. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL) and estimated glomerular filtration rate (eGFR) were calculated using equations. Multivariate analysis was done to determine the factors associated with eGFR.

Results

Dyslipidemia was present among 56.52% of control subjects and 75.28% of nephropathy subjects (P=0.012). The percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) was 14.13 among controls and 14.61 among nephropathy subjects. Though serum creatinine was not significantly different, mean eGFR value was significantly lower among nephropathy patients (P=0.002). Upon multivariate analysis, it was found that TC (P=0.007) and HDL-C (P=0.06) were associated with eGFR among our study subjects.

Conclusion

Our results show that dyslipidemia was highly prevalent among subjects with nephropathy. Regular screening for dyslipidemia may be beneficial in controlling the risk for adverse events among diabetic nephropathy patients.

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Addition of Ipragliflozin to Metformin Treatment in Korean Patients with Type 2 Diabetes Mellitus: Subgroup Analysis of a Phase 3 Trial
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AbstractAbstract PDFPubReader   
Background

This is a subgroup analysis of Korean patients from a phase 3 clinical trial investigating the efficacy and safety of ipragliflozin in patients with type 2 diabetes mellitus inadequately controlled with metformin.

Methods

This multicenter, placebo-controlled, double-blind, parallel-group study was carried out between November 2011 and January 2013. Patients entered a 2-week placebo pretreatment period, followed by a 24-week treatment period with either ipragliflozin (50 mg/day) or placebo, while continuing metformin. Efficacy outcomes (glycosylated hemoglobin [HbA1c], fasting plasma glucose [FPG], and body weight) and safety outcomes (treatment-emergent adverse events [TEAEs]) were measured and compared between the two treatment groups for patients enrolled in all 18 study sites in Korea.

Results

Eighty-two Korean patients received ipragliflozin (n=43) or placebo (n=39) during the study period. Mean changes in HbA1c levels from baseline to the end of treatment were –0.97% in the ipragliflozin group and –0.31% in the placebo group, with an adjusted between-group difference of –0.60% (P<0.001). Compared to placebo, FPG and body weight also decreased significantly (both P<0.001) from baseline after treatment in the ipragliflozin group, with between-group differences of –21.4 mg/dL and –1.53 kg, respectively. Decreased weight was the most common TEAE in the ipragliflozin group (7.0%); there were no reports of genital and urinary tract infection.

Conclusion

Ipragliflozin treatment in addition to metformin led to significant improvement in glycemic outcomes and reduction in body weight in Korean patients with type 2 diabetes mellitus, compared with metformin treatment alone; the safety profile was comparable in both groups.

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Brief Report
Obesity and Metabolic Syndrome
A Cutoff for Age at Menarche Predicting Metabolic Syndrome in Egyptian Overweight/Obese Premenopausal Women
Ibrahim Elsehely, Hala Abdel Hafez, Mohammed Ghonem, Ali Fathi, Rasha Elzehery
Diabetes Metab J. 2017;41(2):146-149.   Published online November 30, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.146
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AbstractAbstract PDFPubReader   

Previous studies showed that early age at menarche is associated with increased risk of metabolic syndrome. However, the definition of early menarche at these studies was based on background data in the communities at which these studies was carried on. The aim of this work is to determine a cutoff for age at menarche discriminating presence or absence of metabolic syndrome in overweight/obese premenopausal women. This study included 204 overweight/obese women. Metabolic syndrome was defined according to NCEP-ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Of a total 204 participants, 82 (40.2%) had metabolic syndrome. By using receiver operating characteristic analysis, age at menarche ≤12.25 year discriminated individuals with from those without metabolic syndrome. The area under the curve was 0.76 (95% confidence interval, 0.70 to 0.83). Sensitivity, specificity, negative predictive value, and positive predictive value were 82%, 70%, 85%, and 64%, respectively. Age at menarche ≤12.25 years predicts the presence of metabolic syndrome in overweight/obese women.

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Letter
Response
Response: Efficacy of Moderate Intensity Statins in the Treatment of Dyslipidemia in Korean Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2017;41:23-30)
Sung Hye Kong, Bo Kyung Koo, Min Kyong Moon
Diabetes Metab J. 2017;41(2):152-153.   Published online April 14, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.152
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