Limits...
A prospective study of impaired fasting glucose and type 2 diabetes in China

View Article: PubMed Central - PubMed

ABSTRACT

The worldwide prevalence and incidence of diabetes and obesity are increasing in pandemic proportions. This is particularly relevant for China, where an extremely large population is growing, aging, and urbanizing. We thus conducted a prospective study to examine the prevalence and incidence of impaired fasting glucose (IFG) and diabetes, the rate at which fasting blood glucose rises, and the major modifiable risk factors associated with these outcomes in a large Chinese population from the Kailuan prospective study.

A prospective cohort included 100,279 Chinese participants, aged 18 years or more, who had available information on fasting blood glucose concentrations at the start of the study (2006). Examination surveys were conducted every 2 years in 2008 and 2010. For the analyses of incident diabetes, we included 76,869 participants who were free of diabetes, cardiovascular disease, and cancer at the baseline and participants in the 2008 and/or 2010 follow-up. Diabetes was defined by a fasting blood glucose concentration ≥7 mmol/L, self-reported history, or active treatment with insulin or any oral hypoglycemic agent. IFG was defined by a fasting blood glucose concentration between 5.6 and 6.9 mmol/L.

During the 4-year study, the prevalence of diabetes and IFG rose from 6.6% to 7.7%, and 17.3% to 22.6%, respectively. There were 17,811 incident cases of IFG and 4867 incident cases of diabetes. The age-standardized incident rate of IFG and diabetes were 62.6/1000 person-years (51.2/1000 person-years in women and 73.8/1000 person-years in men) and 10.0/1000 person-years (7.8/1000 person-years in women and 12.1/1000 person-years in men), respectively. We observed steady increases in fasting blood glucose with body anthropometrics and in every defined category of body mass index, including in those traditionally considered to be well within the “normal” range.

In this large longitudinal study of Chinese adults, we observed a high prevalence and incidence of IFG and diabetes over 4 years of follow-up. Our findings are alarming for Chinese public health since steady rises in fasting blood glucose were seen across all permutations of body habitus, even apparently very lean individuals.

No MeSH data available.


Related in: MedlinePlus

Hazard ratio of diabetes (panel A: men and B: women) and impaired fasting glucose (panel C: men and D: women) according to the joint classification of body mass index and waist circumference in men and women, adjusting for age (y), education (illiteracy/primary, high school or college, or above), working environment (working on the ground, underground, not exposure to dust, or underground, exposure to dust), family history of diabetes (yes/no), smoking (never, past smoker, current smoker 1–19 cigarettes/d, or current smoker 20+ cigarettes/d), alcohol drinking (never, past drinker, current drinker <1 time/d, or current drinker 1+ times/d), hypertension (yes/no), and fasting plasma glucose (mmol/L).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120921&req=5

Figure 3: Hazard ratio of diabetes (panel A: men and B: women) and impaired fasting glucose (panel C: men and D: women) according to the joint classification of body mass index and waist circumference in men and women, adjusting for age (y), education (illiteracy/primary, high school or college, or above), working environment (working on the ground, underground, not exposure to dust, or underground, exposure to dust), family history of diabetes (yes/no), smoking (never, past smoker, current smoker 1–19 cigarettes/d, or current smoker 20+ cigarettes/d), alcohol drinking (never, past drinker, current drinker <1 time/d, or current drinker 1+ times/d), hypertension (yes/no), and fasting plasma glucose (mmol/L).

Mentions: To better appreciate how body habitus contributes to the incidence of IFG and diabetes, we categorized BMI to approximately represent notable WHO cutoffs for Asian and non-Asian populations.[14] Although higher BMI was associated with faster increases in blood glucose concentrations (P < 0.0001 in both men and women), we observed steady increases in fasting blood glucose concentrations across each BMI category, including those traditionally considered to be well within the “normal” range (with BMI < 23 kg/m2) (Fig. 2). We further examined the prediction of IFG and diabetes as a function of body habitus as represented by BMI and WC and once again observed that even those with traditionally “normal” BMI and WC in non-Chinese populations displayed a significantly higher risk of developing IFG or diabetes with higher BMI and WC (Fig. 3, panels A–D). We observed similar patterns for the associations between BMI/WC and annual increase in fasting blood glucose over 4 years of follow-up in both men and women (eFigure 3).


A prospective study of impaired fasting glucose and type 2 diabetes in China
Hazard ratio of diabetes (panel A: men and B: women) and impaired fasting glucose (panel C: men and D: women) according to the joint classification of body mass index and waist circumference in men and women, adjusting for age (y), education (illiteracy/primary, high school or college, or above), working environment (working on the ground, underground, not exposure to dust, or underground, exposure to dust), family history of diabetes (yes/no), smoking (never, past smoker, current smoker 1–19 cigarettes/d, or current smoker 20+ cigarettes/d), alcohol drinking (never, past drinker, current drinker <1 time/d, or current drinker 1+ times/d), hypertension (yes/no), and fasting plasma glucose (mmol/L).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120921&req=5

Figure 3: Hazard ratio of diabetes (panel A: men and B: women) and impaired fasting glucose (panel C: men and D: women) according to the joint classification of body mass index and waist circumference in men and women, adjusting for age (y), education (illiteracy/primary, high school or college, or above), working environment (working on the ground, underground, not exposure to dust, or underground, exposure to dust), family history of diabetes (yes/no), smoking (never, past smoker, current smoker 1–19 cigarettes/d, or current smoker 20+ cigarettes/d), alcohol drinking (never, past drinker, current drinker <1 time/d, or current drinker 1+ times/d), hypertension (yes/no), and fasting plasma glucose (mmol/L).
Mentions: To better appreciate how body habitus contributes to the incidence of IFG and diabetes, we categorized BMI to approximately represent notable WHO cutoffs for Asian and non-Asian populations.[14] Although higher BMI was associated with faster increases in blood glucose concentrations (P < 0.0001 in both men and women), we observed steady increases in fasting blood glucose concentrations across each BMI category, including those traditionally considered to be well within the “normal” range (with BMI < 23 kg/m2) (Fig. 2). We further examined the prediction of IFG and diabetes as a function of body habitus as represented by BMI and WC and once again observed that even those with traditionally “normal” BMI and WC in non-Chinese populations displayed a significantly higher risk of developing IFG or diabetes with higher BMI and WC (Fig. 3, panels A–D). We observed similar patterns for the associations between BMI/WC and annual increase in fasting blood glucose over 4 years of follow-up in both men and women (eFigure 3).

View Article: PubMed Central - PubMed

ABSTRACT

The worldwide prevalence and incidence of diabetes and obesity are increasing in pandemic proportions. This is particularly relevant for China, where an extremely large population is growing, aging, and urbanizing. We thus conducted a prospective study to examine the prevalence and incidence of impaired fasting glucose (IFG) and diabetes, the rate at which fasting blood glucose rises, and the major modifiable risk factors associated with these outcomes in a large Chinese population from the Kailuan prospective study.

A prospective cohort included 100,279 Chinese participants, aged 18 years or more, who had available information on fasting blood glucose concentrations at the start of the study (2006). Examination surveys were conducted every 2 years in 2008 and 2010. For the analyses of incident diabetes, we included 76,869 participants who were free of diabetes, cardiovascular disease, and cancer at the baseline and participants in the 2008 and/or 2010 follow-up. Diabetes was defined by a fasting blood glucose concentration &ge;7&#8202;mmol/L, self-reported history, or active treatment with insulin or any oral hypoglycemic agent. IFG was defined by a fasting blood glucose concentration between 5.6 and 6.9&#8202;mmol/L.

During the 4-year study, the prevalence of diabetes and IFG rose from 6.6% to 7.7%, and 17.3% to 22.6%, respectively. There were 17,811 incident cases of IFG and 4867 incident cases of diabetes. The age-standardized incident rate of IFG and diabetes were 62.6/1000 person-years (51.2/1000 person-years in women and 73.8/1000 person-years in men) and 10.0/1000 person-years (7.8/1000 person-years in women and 12.1/1000 person-years in men), respectively. We observed steady increases in fasting blood glucose with body anthropometrics and in every defined category of body mass index, including in those traditionally considered to be well within the &ldquo;normal&rdquo; range.

In this large longitudinal study of Chinese adults, we observed a high prevalence and incidence of IFG and diabetes over 4 years of follow-up. Our findings are alarming for Chinese public health since steady rises in fasting blood glucose were seen across all permutations of body habitus, even apparently very lean individuals.

No MeSH data available.


Related in: MedlinePlus