BACKGROUND: The epidemiological pattern and disease burden of type 2 diabetes have been shifting in China over the past decades. This analysis described the epidemiological transition of type 2 diabetes in the past three decades and projected the trend in the future three decades in China. METHODS: Age-, sex-, and year-specific incidence, prevalence, death, and disability-adjusted life years (DALYs) for people with 15 years or older and diabetes or high fasting glucose in China and related countries from 1990 to 2021 were obtained from the Global Burden of Disease. We obtained the trends of age-, sex-, and year-specific rates and absolute numbers of incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes in China from 1990 to 2021. Using the Lee-Carter model, we projected the incidence, prevalence, death, and DALYs attributable to type 2 diabetes to 2050 stratified by age and sex. RESULTS: The age-standardized incidence of type 2 diabetes was 341.5 per 100,000 persons (1.6 times in 1990) and the age-standardized prevalence was 9.96% (9960.0 per 100,000 persons, 2.5 times in 1990) in China 2021. In 2021, there were 0.9 million deaths and 26.8 million DALYs due to type 2 diabetes or hyperglycemia, as 2.9 and 2.7 times the data in 1990, respectively. The age-standardized rates of type 2 diabetes and hyperglycemia were projected to raise to 449.5 per 100,000 persons for incidence, 18.17% for prevalence, 244.6 per 100,000 persons for death, and 4720.2 per 100,000 persons for DALYs by 2050. The incidence of type 2 diabetes kept growing among individuals under the age of 20 years in the past three decades (128.7 per 100,000 persons in 1990 and 439.9 per 100,000 persons in 2021) and estimating 1870.8 per 100,000 in 2050. CONCLUSIONS The incidence, prevalence, and disease burden of type 2 diabetes grew rapidly in China in the past three decades. The prevention of type 2 diabetes in young people and the care for elder adults will be the greatest challenge for the country.
Humans ; Diabetes Mellitus, Type 2/mortality* ; China/epidemiology* ; Prevalence ; Female ; Male ; Incidence ; Middle Aged ; Adult ; Aged ; Adolescent ; Young Adult ; Disability-Adjusted Life Years ; Aged, 80 and over

OBJECTIVE: To analyze the influence of type 2 diabetes mellitus (DM) on the prognosis of oral squamous cell carcinoma (OSCC) patients with surgical treatment. METHODS: The clinical data of 309 patients, who were diagnosed with OSCC and admitted to the same ward of Peking University Hospital of Stomatology from January 2014 to December 2017 were retrospectively reviewed, of whom, 104 were classified into DM group and 205 into non-DM group. The basic clinical data and follow-up results of the patients were analyzed and compared. Propensity score matching (PSM) was used to reduce confounding bias between the DM group and the non-DM group. Kaplan-Meier was used to calculate the survival rate of the two groups. Proportional hazards model was used to analyze the independent prognostic factors. The effect of glucose level on survival was analyzed. RESULTS: After PSM, 77 patients in each group were matched and the variables were balanced. There were statistically significant differences in postoperative oral dysplasia and local recurrence between the two groups (P < 0.05). There was no significant difference in survival analysis between the two groups, but the survival rate of the DM group had the tendency to be lower than that of the non-DM group after matching. Univariate analysis and multiva-riate analysis both revealed that the tumor stage was an independent factor influencing the overall survival rate and tumor-specific survival rate of the OSCC patients (P < 0.05), while diabetes had no significant influence on the survival of the OSCC patients (P>0.05). Multivariate analysis showed that tumor stage, triglyceride level, preoperative mean capillary fasting blood glucose, postoperative mean postprandial blood glucose were indepen-dent prognostic factors for overall survival in the DM group. Tumor stage and mean postoperative postprandial blood glucose were independent prognostic factors for tumor-specific survival in the DM group. The risk of postoperative complications and distant metastasis in the DM group with poor glycemic control was higher than that in the good glycemic controls. CONCLUSION There is no significant difference in overall survival and tumor-specific survival of the patients with or without DM. However, the possibility of mucosal dysplasia or local recurrence in the DM group is higher than that in the non-DM group. The tumor stage, triglyceride level and glycemic control of the patients with DM may affect their prognosis.
Humans ; Diabetes Mellitus, Type 2/complications* ; Mouth Neoplasms/mortality* ; Retrospective Studies ; Prognosis ; Carcinoma, Squamous Cell/mortality* ; Male ; Female ; Survival Rate ; Neoplasm Recurrence, Local ; Propensity Score ; Proportional Hazards Models ; Blood Glucose/analysis* ; Middle Aged ; Kaplan-Meier Estimate

A third of men with type 2 diabetes (T2DM) have hypogonadotrophic hypogonadism (HH) and associated increased risk of cardiovascular and all-cause mortality. Men with HH are at increased risk of developing incident T2DM. We conducted MEDLINE, EMBASE, and COCHRANE reviews on T2DM, HH, testosterone deficiency, cardiovascular and all-cause mortality from May 2005 to October 2017, yielding 1,714 articles, 52 clinical trials and 32 randomized controlled trials (RCT). Studies with testosterone therapy suggest significant benefits in sexual function, quality of life, glycaemic control, anaemia, bone density, fat, and lean muscle mass. Meta-analyses of RCT, rather than providing clarification, have further confused the issue by including under-powered studies of inadequate duration, multiple regimes, some discontinued, and inbuilt bias in terms of studies included or excluded from analysis.
Bias (Epidemiology) ; Bone Density ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Humans ; Hypogonadism ; Male ; Mortality ; Quality of Life ; Testosterone*

The prevalence of type 2 diabetes mellitus (T2DM), which is associated with cardiovascular morbidity and mortality, is increasing worldwide. Although there have been advances in diabetes treatments that reduce microvascular complications (nephropathy, neuropathy, retinopathy), many clinical studies have found that conventional oral hypoglycemic agents and glucose control alone failed to reduce cardiovascular disease. Thus, incretin-based therapies including glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2Is) represent a new area of research, and may serve as novel therapeutics for treating hyperglycemia and modifying other cardiovascular risk factors. Recently, it has been confirmed that several drugs in these classes, including canagliflozin, empagliflozin, semaglutide, and liraglutide, are safe and possess cardioprotective effects. We review the most recent cardiovascular outcome trials on GLP-1RAs and SGLT-2Is, and discuss their implications for treating patients with T2DM in terms of protective effects against cardiovascular disease.
Canagliflozin ; Cardiovascular Diseases ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Glucagon-Like Peptide 1 ; Glucose ; Heart Failure ; Humans ; Hyperglycemia ; Hypoglycemic Agents ; Liraglutide ; Mortality ; Myocardial Ischemia ; Prevalence ; Risk Factors

Cancer incidence appears to be increased in both type 1 and type 2 diabetes mellitus (DM). DM represents a risk factor for cancer, particularly hepatocellular, hepatobiliary, pancreas, breast, ovarian, endometrial, and gastrointestinal cancers. In addition, there is evidence showing that DM is associated with increased cancer mortality. Common risk factors such as age, obesity, physical inactivity and smoking may contribute to increased cancer risk in patients with DM. Although the mechanistic process that may link diabetes to cancer is not completely understood yet, biological mechanisms linking DM and cancer are hyperglycemia, hyperinsulinemia, increased bioactivity of insulin-like growth factor 1, oxidative stress, dysregulations of sex hormones, and chronic inflammation. However, cancer screening rate is significantly lower in people with DM than that in people without diabetes. Evidence from previous studies suggests that some medications used to treat DM are associated with either increased or reduced risk of cancer. However, there is no strong evidence supporting the association between the use of anti-hyperglycemic medication and specific cancer. In conclusion, all patients with DM should be undergo recommended age- and sex appropriate cancer screenings to promote primary prevention and early detection. Furthermore, cancer should be screened in routine diabetes assessment.
Breast ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Early Detection of Cancer ; Gastrointestinal Neoplasms ; Gonadal Steroid Hormones ; Humans ; Hyperglycemia ; Hyperinsulinism ; Incidence ; Inflammation ; Mass Screening ; Mortality ; Obesity ; Oxidative Stress ; Pancreas ; Primary Prevention ; Risk Factors ; Smoke ; Smoking

PURPOSE: To report our initial experience with laparoscopic mini-gastric bypass (LMGB) in Korean obese patients.MATERIALS AND METHODS: From July 2016 to February 2018, 14 male patients underwent LMGB for morbid obesity at a single institution. Five trocars were placed in a U-shape formation and 1 trocar was placed at the epigastrium as a liver retractor; a window was created between the vagal nerve and lesser curvature at the gastric angle for entering the lesser sac; a narrow gastric tube (~100–120 ml volume) was made; a linear-stapled gastrojejunostomy was created after bypassing the jejunum 200 cm from the Treitz' ligament; and the Petersen defect was closed to prevent internal hernia. Patient demographics, operative time, estimated blood loss, postoperative hospital stay, complications, weight loss, and resolution of comorbidities were evaluated during 1 year of follow-up.RESULTS: All procedures were successful by laparoscopy. The average age was 29 (19–49) years; weight, 164.9 (127-250) kg; and body mass index, 51.0 (42.4–81.6) kg/m². In 1 case, nephrectomy was simultaneously performed for early renal cell carcinoma. The mean operative time was 148.8 (120-175) min. The mean postoperative hospital stay was 1.9 (1–4) days. The percentage excess weight loss at 1, 3, 6, 9, and 12 months was 16.6%, 31.0%, 41.4%, 45.4%, and 50.4%, respectively. The resolution rate of type 2 diabetes mellitus, hypertension, and dyslipidemia was 75%, 40%, and 66.7%, respectively. There was no major complication including mortality during the follow-up.CONCLUSION: LMGB is a technically simple, safe, and effective procedure in Korean obese patients.
Bariatric Surgery ; Body Mass Index ; Carcinoma, Renal Cell ; Comorbidity ; Demography ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Follow-Up Studies ; Gastric Bypass ; Hernia ; Humans ; Hypertension ; Jejunum ; Laparoscopy ; Length of Stay ; Ligaments ; Liver ; Male ; Mortality ; Nephrectomy ; Obesity, Morbid ; Operative Time ; Peritoneal Cavity ; Postoperative Hemorrhage ; Surgical Instruments ; Weight Loss

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

Although overweight/obesity is a major risk factor for the development of type 2 diabetes mellitus, there is increasing evidence that overweight or obese patients with type 2 diabetes mellitus experience lower mortality compared with patients of normal weight. This paradoxical finding, known as the “obesity paradox,” occurs in other chronic diseases, and in type 2 diabetes mellitus is particularly perplexing given that lifestyle intervention with one goal being weight reduction is an important feature of the management of this condition. We summarize in this review the findings from clinical and epidemiologic studies that have investigated the association between overweight and obesity (usually assessed using body mass index [BMI]) and mortality in type 2 diabetes mellitus and discuss potential causes of the obesity paradox. We conclude that most studies show evidence of an obesity paradox, but important conflicting findings still exist. We also evaluate if potential bias might explain the obesity paradox in diabetes, including, for example, the presence of confounding factors, measurement error due to use of BMI as an index of obesity, and reverse causation.
Bias (Epidemiology) ; Body Mass Index ; Chronic Disease ; Diabetes Mellitus, Type 2* ; Epidemiologic Studies ; Epidemiology ; Humans ; Life Style ; Mortality ; Obesity* ; Overweight ; Risk Factors ; Weight Loss

In Korea, by 2060, the proportion of the elderly population will be 40.1%, and at least one in three persons will have diabetes. Elderly patients with diabetes mellitus have higher rates of premature death, functional disability, and coexisting illnesses such as atherosclerotic cardiovascular disease than those without diabetes. In addition, the risk of geriatric syndrome, such as depression, cognitive dysfunction, urinary incontinence, falls, pain, and polypharmacy, is much higher in those with diabetes. The functional status of each elderly person varies greatly, such that comprehensive geriatric assessments for medical, psychological, functional, and social domains are needed. The goals and methods of diabetes management should be individualized according to the results of these assessments. In the treatment of vulnerable elderly patients with diabetes, hypoglycemia or overtreatment should be avoided.
Accidental Falls ; Aged* ; Cardiovascular Diseases ; Depression ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Geriatric Assessment ; Humans ; Hypoglycemia ; Korea ; Medical Overuse ; Mortality, Premature ; Polypharmacy ; Urinary Incontinence

The management of type 2 diabetes mellitus should comprise healthy lifestyle modifications along with tailored pharmacologic treatment. Traditionally, the American Diabetes Association (ADA)'s Diabetes Management Guidelines have not prioritized specific anti-diabetic drugs over others with regard to cardiovascular disease (CVD) and mortality prevention. Recently, two novel anti-diabetic medications proved to be significantly protective against future CVD and mortality, regardless of the glycemic levels achieved in type 2 diabetic patients with pre-existing CVD. The 2018 ADA Guidelines recommend SGLT2 inhibitor and/or GLP-1 receptor agonist be used for type 2 diabetes patients with atherosclerotic CVD after metformin monotherapy failure. Considering the value of CVD protection in the management of diabetes mellitus, this minor guideline adjustment could have far-reaching implications.
Cardiovascular Diseases ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Glucagon-Like Peptide-1 Receptor ; Humans ; Life Style ; Metformin ; Mortality ; Sodium-Glucose Transporter 2