Asia ; epidemiology ; Diabetes Mellitus ; epidemiology ; etiology ; prevention & control ; Humans ; Morbidity ; Risk Factors ; Socioeconomic Factors ; Survival Rate

OBJECTIVEThis review examines the evidence that: Diabetes is a state of DNA damage; pathophysiological factors in diabetes can cause DNA damage; DNA damage can cause mutations; and DNA mutation is linked to carcinogenesis.

DATA SOURCESWe retrieved information from the PubMed database up to January, 2014, using various search terms and their combinations including DNA damage, diabetes, cancer, high glucose, hyperglycemia, free fatty acids, palmitic acid, advanced glycation end products, mutation and carcinogenesis.

STUDY SELECTIONWe included data from peer-reviewed journals and a textbook printed in English on relationships between DNA damage and diabetes as well as pathophysiological factors in diabetes. Publications on relationships among DNA damage, mutagenesis, and carcinogenesis, were also reviewed. We organized this information into a conceptual framework to explain the possible causal relationship between DNA damage and carcinogenesis in diabetes.

RESULTSThere are a large amount of data supporting the view that DNA mutation is a typical feature in carcinogenesis. Patients with type 2 diabetes have increased production of reactive oxygen species, reduced levels of antioxidant capacity, and increased levels of DNA damage. The pathophysiological factors and metabolic milieu in diabetes can cause DNA damage such as DNA strand break and base modification (i.e., oxidation). Emerging experimental data suggest that signal pathways (i.e., Akt/tuberin) link diabetes to DNA damage. This collective evidence indicates that diabetes is a pathophysiological state of oxidative stress and DNA damage which can lead to various types of mutation to cause aberration in cells and thereby increased cancer risk.

CONCLUSIONSThis review highlights the interrelationships amongst diabetes, DNA damage, DNA mutation and carcinogenesis, which suggests that DNA damage can be a biological link between diabetes and cancer.

Animals ; DNA Damage ; genetics ; Diabetes Mellitus, Type 2 ; genetics ; metabolism ; Humans ; Neoplasms ; genetics ; metabolism ; Oxidative Stress ; genetics ; physiology ; Reactive Oxygen Species ; metabolism

Primary endocrine therapy (PET) is often included as a treatment option in elderly women with operable breast cancer. Elderly women tend to have pre-existing comorbidities and are often reluctant to undergo surgery. The benefit of surgery needs to be weighed against a relatively higher potential for operative morbidity and mortality, and a limited life expectancy. But while PET can provide relatively good locoregional control, it is not curative in nature and the possibility of local complications and metastasis remains. We retrospectively reviewed the outcome of PET in a series of 19 elderly women, older than 70 years of age, who had presented with operable non-metastatic breast cancer. Only about a third of these women were deemed medically unfit for surgery; the rest had declined surgery. Compliance was an issue, with almost half of these patients defaulting treatment and follow-up. Local control was achieved in most patients, but disease progression did occur in 5 patients. Three of these patients received additional treatment; which included surgery in 1 patient. PET should therefore not be considered an equivalent alternative to surgery in elderly women who were fi t to undergo surgery. However, having observed that only 1 of the 6 deaths in our study was related to breast cancer, PET does have a role in women whose life expectancy is more likely to be limited by coexisting morbidities than the breast cancer itself.
Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal ; therapeutic use ; Breast Neoplasms ; drug therapy ; Drug Therapy ; utilization ; Female ; Humans ; Retrospective Studies ; Tamoxifen ; therapeutic use

BACKGROUNDThere are studies suggesting smoking may increase the risk of type 2 diabetes. Effects of smoking on insulin secretion and insulin resistance (IR) are, however, controversial.

METHODSThis is a cross-sectional study. Since there were very few smokers among Hong Kong Chinese women, only men (n = 1068) were analyzed in this report. Fasting and 2-hour plasma glucose and insulin were measured. Insulinogenic index as well as beta-cell function and IR based on homeostatic model assessment (HOMA) by computer model (HOMA Calculator v2.2) were calculated.

RESULTSOf the 1068 men, 147 had newly diagnosed diabetes, 131 newly diagnosed impaired glucose tolerance (IGT) and 790 were non-diabetic normal controls. Smokers had similar fasting and 2-hour insulin levels, insulinogenic index and HOMA derived beta-cell function as compared to non-smokers in the groups with diabetes, IGT or normal oral glucose tolerance test (OGTT). IR was also similar between smokers, ex-smokers and non-smokers in those with normal OGTT. In men with IGT or diabetes, after adjustment for age and body mass index, smokers were more insulin resistant as compared to non-smokers (IR, IGT: 1.59 +/- 1.07 vs 1.03 +/- 0.54, P < 0.05; diabetes: 1.96 +/- 1.36 vs 1.06 +/- 0.45, P < 0.01). With Logistic regression analysis, comparing smokers and non-smokers, IR was independently associated with smoking (odds ratio (95% CI), IGT: 2.23 (1.05, 4.71); diabetes: 3.92 (1.22, 12.58)). None of the other insulin parameters enter into the model among those with normal OGTT or comparing ex-smokers and non-smoker or smokers and ex-smokers.

CONCLUSIONSIn Chinese men, smoking did not show any direct association with insulin levels and pancreatic insulin secretion. Smoking men with IGT or diabetes appeared more insulin resistant than their non-smoking counterparts.

Adult ; Female ; Glucose Intolerance ; metabolism ; Humans ; Insulin ; secretion ; Insulin Resistance ; Insulin-Secreting Cells ; secretion ; Male ; Middle Aged ; Smoking ; metabolism

INTRODUCTIONTraditional Chinese Medicine or Traditional Complementary Medicine (TCM) is commonly used in our culture. There are several concerns regarding its use in patients undergoing conventional treatments for breast cancer. In this study, we aimed to evaluate the prevalence and pattern of TCM use among our breast cancer patients, and to identify patients who were most likely to choose TCM.

MATERIALS AND METHODSA total of 300 patients on active follow-up with Breast Service at Tan Tock Seng Hospital were interviewed using a structured questionnaire.

RESULTSA total of 35% (104 of 296) of patients reported using TCM. The majority of the patients were introduced to TCM by family and friends following the diagnosis of breast cancer. All except 3 patients continued with recommended conventional therapy although most did not inform their clinicians of TCM use. None of the patients reported any serious adverse events and 75% of them perceived a benefit from TCM use. Younger patients and those of Chinese ethnicity were more likely to use TCM (P <0.01 and P = 0.03 respectively). There was no significant difference in the dialect group, religious beliefs and educational level between the 2 groups (P >0.05).

CONCLUSIONTCM use is common among our breast cancer patients, particularly the younger women. However, most patients do not inform their clinicians of TCM use while on recommended conventional therapies. It is therefore important for clinicians to initiate discussions regarding TCM use in order to be aware of potential unwanted drug interactions.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; therapy ; Female ; Humans ; Medical Oncology ; Medicine, Chinese Traditional ; utilization ; Middle Aged

BACKGROUNDObesity is now an epidemic in most parts of the world. In this cross sectional study, we report the most recent data on obesity in Hong Kong Chinese working population and compare the changes over 10 years.

METHODSBetween July 2000 and March 2002, 5882 adult subjects from the working class in Hong Kong were recruited (2716 men (46.2%) and 3166 women (53.8%)). They were randomly selected using computer generated codes according to the distribution of occupational groups. Results of this study were compared with the data collected from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population conducted in 1990 (1513 subjects, 910 men (60.1%) and 603 women (39.9%)).

RESULTSStandardized percentages of overweight, obesity, and central obesity, in Hong Kong Chinese working population were 59.7%, 35.0%, 26.7% in men and 32.0%, 21.7%, 26.7% in women. Compared to the data collected in 1990, the percentage of obesity increased by 5% in men and reduced by 6% in women. The percentage of central obesity doubled in men (from 12.2% to 26.7%) but remained stable in women.

CONCLUSIONSThere is a doubling of the percentage of central obesity in Hong Kong Chinese working men over previous decade. Education and proper lifestyle modification program to tackle this social health issue are urgently indicated.

Adolescent ; Adult ; Aged ; Female ; Hong Kong ; epidemiology ; Humans ; Male ; Middle Aged ; Obesity ; epidemiology ; Time Factors ; Work

Adolescent ; Adult ; Aged ; Blood Glucose ; analysis ; Cross-Over Studies ; Diabetes Mellitus ; blood ; drug therapy ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Insulin ; analogs & derivatives ; therapeutic use ; Insulin Lispro ; Male ; Middle Aged

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 greater insulin 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 risk of cardiovascular and renal complications, with cancer emerging as an important cause of morbidity and mortality. The experience from Hong Kong had demonstrated that a multifaceted approach, involving team-based integrated care, information technological advances, and patient empowerment programs were able to reduce the incidence of diabetic complications, hospitalizations, and mortality. System change and public policies to enhance implementation of such programs may provide solutions to combat the burgeoning health problem of diabetes at a societal level.
Architectural Accessibility* ; Asia ; Asian Continental Ancestry Group ; Delivery of Health Care ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Health Expenditures ; Hong Kong* ; Hospitalization ; Humans ; Incidence ; Insulin Resistance ; Mortality ; Obesity, Abdominal ; Patient Participation ; Prevalence ; Public Policy

PURPOSETo review evidence-based management of nephropathy in patients with type 2 diabetes.

DATA SOURCESA literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.

DATA EXTRACTIONData and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.

RESULTSHypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions.

CONCLUSIONSDiabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.

Albuminuria ; diagnosis ; therapy ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; epidemiology ; therapy ; Dietary Proteins ; administration & dosage ; Humans ; Hyperlipidemias ; therapy ; Hypertension ; therapy

INTRODUCTION: Advanced breast cancer (ABC) remains common in Singapore. In 2019, 22.1% of breast cancer patients presented with ABC in our institution. Despite increasing affluence and the advent of national mammographic screening, the incidence of ABC has not changed significantly. This suggests inherent differences in women who present late. We aim to explore the socio-economic background, knowledge and attitudes of women who present with ABC. METHODS: Between December 2013 and July 2015, 100 patients who presented consecutively with ABC in a tertiary institution in Singapore were recruited to participate in an interviewer-led questionnaire exploring psychosocial and economic issues. RESULTS: Among the 100 patients, 63 and 37 presented with stages 3 and 4 breast cancer respectively. Median age was 57 (27-86), 52% had at least secondary education, 53% had no formal employment and 71% were married; 88% were aware of breast cancer symptoms, 82% were aware that mammography can help detect cancer, 82% believed that current treatment modality for breast cancer is effective, 96% had never undergone a mammography and 52.9% felt mammograms were unnecessary. A total of 64% presented symptomatic from the breast tumour, with a median duration of 3 months. Many of the patients were aware of breast cancer symptoms and the utility of mammography. However, a group of patients did not comply with screening. This may be due to poor understanding about breast screening and detection in its asymptomatic phase. CONCLUSION Further public education to improve understanding of breast cancer and screening mammography may help to improve rates for earlier detection of breast cancer.