OBJECTIVETo investigate the association between diabetes and risks of primary liver cancer.

METHODSA Meta-analysis was performed to estimate the pooled relative risk (RR) to evaluate the relationship between diabetes and the risk of primary liver cancer from cohort studies, which were identified by searching in Medline, Chinese CNKI and Wanfang databases from January 1989 to February 2010. A total of 28 publications were found according to this method. Adjusted RRs and their corresponding 95% confidence intervals (95%CI) were calculated by using the fixed-effect and random-effect model in our analysis. We also conducted a number of sub-groups analysis stratified by some important variables, such as source, gender, region and quality of study.

RESULTSA total of 3800 cases of liver cancer and 3 672 248 study subjects from 14 prospective cohorts were included in our analysis. The pooled RR of primary liver cancer was 3.33 (95%CI: 1.82 - 6.10) for persons with diabetes when compared to subjects without diabetes. The results showed a significant association between diabetes and the risk of primary liver cancer based on these cohort studies. Subgroup analysis indicated that the pooled RRs for diabetes were 3.76 (95%CI: 1.69 - 8.38) in the population-based cohorts and 2.41 (1.34 - 4.32) in the hospital-based cohorts. In terms of the sex groups, the pooled RRs for diabetes were 2.32 (95%CI: 1.70 - 3.17) for males and 1.63 (95%CI: 1.08 - 2.47) for females, respectively.

CONCLUSIONAs one of independent risk factors, diabetes was associated with an increased risk of primary liver cancer.

China ; epidemiology ; Cohort Studies ; Diabetes Complications ; physiopathology ; Diabetes Mellitus ; epidemiology ; physiopathology ; Female ; Humans ; Liver Neoplasms ; epidemiology ; Male ; Risk Factors

OBJECTIVETo study and analysis prevalence and incidence of target organ injury and the relative factors for isolated systolic hypertension (ISH) in Beijing.

METHODS1002 cases aged 80 to 99 years were investigated in 28 cadre retirement centers in Beijing. Blood pressure was taken for three times with mercurial sphygmomanometer in every person, the mean values were recorded and the relative material was gathered according to questionnaire after the health education. Physical examination form of outpatient department and inpatient case history in fixed hospital were analyzed.

RESULTSIn 1002 very old persons, there were 673 hypertensive patients (67.2%) and 455 ISH (45.4%). Among all hypertensive patients, the rate of ISH was 67.6% and double hypertension was 32.4%. Awareness rate was 87.90% and 97.71%, taking antihypertensive drug rate was 77.58% and 80.73%, control rate was 58.68% and 62.84% in ISH and in double hypertension group, respectively, which were no significant differences between the two groups. There was no significant difference in morbidities of cardiac heart disease, myocardial infarction and chronic renal insufficiency between the two groups. The incidences of heart failure, cerebrovascular disease, disability and dementia were 4.62% and 8.72%, 41.54% and 55.50%, 10.55% and 16.06%, 8.57% and 12.84% in ISH and double hypertension group, respectively, which were significant differences between the two groups (P < 0.01). The susceptible age period for ISH was 70 to 79 years in this study.

CONCLUSIONISH is more common in hypertensive patients in very old persons at 28 cadre retirement centers in Beijing. Morbidity of heart failure, cerebrovascular disease, disability and dementia were higher in double hypertension group compared with those in ISH group. The results showed that increase of both systolic and diastolic blood pressure was more dangerous than that of systolic pressure only for very old persons. The improvement of small arterial plastic and the control of blood pressure to target level (< 140/90 mm Hg) in very old hypertensive patients are very important for decreasing the incidence of target organ injury and increasing their life quality and late survival rate.

Aged, 80 and over ; Cardiovascular Diseases ; epidemiology ; Cerebrovascular Disorders ; epidemiology ; China ; epidemiology ; Diabetes Mellitus ; epidemiology ; Female ; Humans ; Hyperlipidemias ; epidemiology ; Hypertension ; epidemiology ; physiopathology ; Kidney Failure, Chronic ; epidemiology ; Male ; Prevalence ; Systole

INTRODUCTIONDiabetes mellitus (DM) is a serious chronic illness that has a major impact on the quality of life of the individuals. Our aim was to examine the determinants of health-related quality of life (HRQOL) in patients with DM.

MATERIALS AND METHODSAdult outpatients attending a Diabetes Centre were recruited on consecutive basis between August 2006 and February 2007. Clinical data were collected from interviews with the subjects and from medical records. Assessment of depressive symptoms was done using the Center for Epidemiologic Studies Depression Scale (CES-D) and HRQOL using the Short Form 36 Health Survey (SF-36). A two-step regression analysis was conducted for identifying factors affecting patients' quality of life.

RESULTSFive hundred and thirty-seven patients participated in the study. The mean (SD) age of the participants was 54.7 (13.3) years and 315 (58.7%) were males. The prevalence of depressive symptoms was 31.1% (n = 167). After adjusting for other variables, the effects of depressive symptoms persisted for all the 8 domains of SF-36 (P <0.001 for all). The medical factors that were negatively associated with HRQOL were a diagnosis of Type 1 DM, duration of the illness of more than 10 years, HbA1c levels of ≥7%, and comorbidity of stroke and retinopathy. Being male and a regular exerciser had a positive effect on HRQOL.

CONCLUSIONThese findings highlight the importance of detecting and treating comorbid depression in DM.

Adult ; Aged ; Depression ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 1 ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; psychology ; Female ; Health Status ; Health Surveys ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Quality of Life ; Singapore ; epidemiology

BACKGROUNDCoronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.

METHODSA total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.

RESULTSThe incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P < 0.05). The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) = 1.058, P < 0.0001, 95% confidence interval (CI): 1.036 - 1.080). Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β = 0.476, P < 0.0001). The best predictive value of urinary albumin excretion rate was 10.45 µg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively.

CONCLUSIONSThe occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

Aged ; Albuminuria ; epidemiology ; physiopathology ; urine ; Coronary Artery Disease ; epidemiology ; physiopathology ; urine ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; urine ; Female ; Humans ; Male ; Middle Aged ; Risk Factors

INTRODUCTIONObesity affects about 10% to 15% of our school-going population in Singapore and is a risk factor for development of obstructive sleep apnoea hypopnoea syndrome (OSAHS). This article reviews the prevalence, aetiology, pathophysiology, diagnosis, complications and treatment of obese children with OSAHS with particular reference to children in Singapore.

METHODSReview of articles or conference papers reporting data with regards to OSAHS in Singapore children.

RESULTSPrevalence of OSAHS was high in obese children in Singapore and was more common in males with no racial predisposition. Hypersomnolence as a presenting symptom was uncommon. Cognitive function, behaviour, attention and processing speed was affected and improved after intervention. Abnormalities of glucose metabolism were also found with the respiratory disturbance index (RDI) as an independent predictor of insulin resistance. Tonsillectomy and or adenoidectomy was efficacious as treatment and risk of complications was low. No significant increase in weight occurred post intervention in those enrolled in concurrent weight management programmes.

CONCLUSIONSPrevalence of OSAHS is high in obese Singapore children and many are 'asymptomatic'. A low threshold for evaluation is necessary for early diagnosis and intervention for prevention of morbidity. Tonsillectomy and/or adenoidectomy is safe and efficacious and remains the first-line treatment in most obese patients.

Adenoidectomy ; Child ; Diabetes Mellitus ; epidemiology ; Disorders of Excessive Somnolence ; epidemiology ; Humans ; Obesity ; epidemiology ; Prevalence ; Quality of Life ; Singapore ; epidemiology ; Sleep Apnea Syndromes ; epidemiology ; Sleep Apnea, Obstructive ; epidemiology ; physiopathology ; Tonsillectomy

OBJECTIVETo analyze the risk factors affecting the glomerular filtration rate (GFR) in type 2 diabetic patients without albuminuria.

METHODSA total of 131 type 2 diabetic patients with normal urinary albumin excretion rate (UAER) were divided into normal GFR group and decreased GFR group. The factors relevant to GFR were analyzed by multiple factors regression.

RESULTSAge, course of diabetes, systolic blood pressure, prevalence of hypertension, the level of serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid (UA) were significantly higher in decreased GFR group than in normal GFR group. Multivariate regression showed that SCr, age, systolic blood pressure, and UA were negatively correlated to GFR.

CONCLUSIONReduced GFR occurs in some type 2 diabetic patients without albuminuria. SCr, age, systolic blood pressure and UA are the major factors related to decreased GFR. The degree of early renal damage in diabetic patients can be better evaluated by combining GFR and UAER.

Adult ; Aged ; Albuminuria ; complications ; physiopathology ; Diabetes Mellitus, Type 2 ; complications ; epidemiology ; physiopathology ; Diabetic Nephropathies ; physiopathology ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; physiopathology ; Male ; Middle Aged ; Prevalence ; Risk Factors

Obstructive sleep apnoea (OSA) and Type 2 diabetes mellitus (T2DM) are common diseases. The global prevalence of OSA is between 2% and 7% in general population cohorts. The worldwide prevalence of T2DM among adults (aged 20-79 years) was estimated to be 6.4%. The concurrent presence of OSA and T2DM can be expected in the same patient, given their high prevalence and similar predisposition. We reviewed the overlapping pathophysiology of OSA and T2DM in this article.
Adult ; Aged ; Continuous Positive Airway Pressure ; Diabetes Mellitus, Type 2 ; complications ; epidemiology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; complications ; epidemiology ; physiopathology ; therapy ; Young Adult

BACKGROUNDDiabetic retinopathy (DR) has emerged as a leading cause of visual impairment and blindness in the working-aged population worldwide. This study aimed to assess frequency and associated factors of progression of DR in subjects with known diabetes in a population-based setting.

METHODSThe Beijing Eye Study is a population based study performed in Greater Beijing in 2001 and 2006. The present investigation included all subjects with known diabetes mellitus in 2001, who participated in the follow-up examination in 2006. Fundus photographs were assessed.

RESULTSThe study included 170 subjects; 51 (30%) subjects showed signs of DR in 2001 and were re-examined in 2006, 36 (21.2%) subjects (18 subjects with DR present at baseline, 18 subjects with newly diagnosed DR in 2006) showed a progression of DR during follow-up. Progression of DR was associated with rural region (odds ratio (OR): 5.43, P = 0.001) and self-reported arterial hypertension (OR: 3.85, P = 0.023). In the non-progressive subgroup, presence of DR was associated with different levels of education (< middle school, middle school, college or higher, OR: 0.30, P = 0.023), treatment modes of diabetes mellitus (OR: 10.24, P = 0.003) and cataract surgery (OR: 9.14, P = 0.007).

CONCLUSIONSIn a population-based setting in Greater Beijing, progression of DR occurred in 35% of subjects with pre-existing DR and overall in 21% of subjects with known diabetes within a 5-year period. Progression of DR was significantly associated with rural region and self-reported arterial hypertension. In the stable subjects, presence of DR was significantly associated with poor educational level, insulin treatment of diabetes and cataract surgery.

Adult ; Aged ; Aged, 80 and over ; China ; Diabetes Mellitus ; drug therapy ; physiopathology ; Diabetic Retinopathy ; epidemiology ; pathology ; Female ; Humans ; Hypertension ; physiopathology ; Insulin ; therapeutic use ; Male ; Middle Aged ; Multivariate Analysis

PURPOSE: Koreans have been undergoing rapid lifestyle changes that may have an effect on patterns of cerebral artery atherosclerosis. This study was aimed at determining the frequency and distribution of atherosclerosis in the cerebral arteries and associated temporal changes over the past eight-year period among Korean stroke patients. MATERIALS AND METHODS: By using stroke registry data registered between April 1999 and March 2007, we investigated the presence, severity, and location of cerebral artery atherosclerosis as determined by angiographic findings. Their annual patterns and association with vascular risk factors were investigated. RESULTS: Of 1,955 patients, 1,517 patients (77.6%) demonstrated atherosclerosis in one or more arteries. A significantly increasing trend of atherosclerosis was observed during the past eight years, which was ascribed to an increase of combined extracranial (EC) and intracranial (IC) atherosclerosis. The number of atherosclerotic arteries increased as the number of risk factors increased. In the multivariate analysis, the year and vascular risk factors were independent predictors of the presence of atherosclerosis. CONCLUSION: We found that the atherosclerotic burden has been increasing for the past eight years in Korean stroke patients, particularly the combined EC and IC subtype. Lifestyle changes and increase in vascular risk factors may be contributing factors.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; *Cost of Illness ; Diabetes Mellitus/epidemiology/physiopathology ; Female ; Humans ; Hypertension/epidemiology/physiopathology ; Intracranial Arteriosclerosis/*epidemiology/etiology/pathology ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Young Adult

PURPOSE: Koreans have been undergoing rapid lifestyle changes that may have an effect on patterns of cerebral artery atherosclerosis. This study was aimed at determining the frequency and distribution of atherosclerosis in the cerebral arteries and associated temporal changes over the past eight-year period among Korean stroke patients. MATERIALS AND METHODS: By using stroke registry data registered between April 1999 and March 2007, we investigated the presence, severity, and location of cerebral artery atherosclerosis as determined by angiographic findings. Their annual patterns and association with vascular risk factors were investigated. RESULTS: Of 1,955 patients, 1,517 patients (77.6%) demonstrated atherosclerosis in one or more arteries. A significantly increasing trend of atherosclerosis was observed during the past eight years, which was ascribed to an increase of combined extracranial (EC) and intracranial (IC) atherosclerosis. The number of atherosclerotic arteries increased as the number of risk factors increased. In the multivariate analysis, the year and vascular risk factors were independent predictors of the presence of atherosclerosis. CONCLUSION: We found that the atherosclerotic burden has been increasing for the past eight years in Korean stroke patients, particularly the combined EC and IC subtype. Lifestyle changes and increase in vascular risk factors may be contributing factors.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; *Cost of Illness ; Diabetes Mellitus/epidemiology/physiopathology ; Female ; Humans ; Hypertension/epidemiology/physiopathology ; Intracranial Arteriosclerosis/*epidemiology/etiology/pathology ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Young Adult