Objective:To investigate the impact of hemoglobin glycation index (HGI) on the diagnosis of diabetes mellitus.Methods:Using the baseline data from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: a longitudinal (REACTION) study, 9 705 participants with complete data, who were selected from Pingguoyuan community of the Shijingshan district in Beijing between January and August 2012, received questionnaires, physical examination and laboratory tests. Laboratory tests consisted of fasting plasma glucose (FPG), glycated hemoglobin A 1c (HbA 1c), 2-hour plasma glucose (2hPG), and lipid profile. A linear regression equation was fitted based on the scatter plots of HbA 1c against FPG. The HGI was then calculated as the difference between the measured HbA 1c value and that predicted by plugging FPG in the above equation (HGI=measured HbA 1c-predicted HbA 1c). Ultimately, 8 480 participants of aged ≥ 40 years and no history of diabetes were included in the final analysis. The participants were categorized into three groups according to tertiles (low, moderate and high) of HGI. We compared the prevalence of diabetes among the three HGI groups with chi-square test, using HbA 1c and oral glucose tolerance test (OGTT) criteria respectively, and examined the diagnostic concordance between the two measures by Cohen′s kappa test. Factors associated with the high HGI phenotype were identified by order multi-classification logistic regression model. Results:Participants were categorized into three groups according to their HGI values: low HGI (HGI<-0.197 3, 2 841 cases) group, moderate HGI (-0.197 3≤HGI<0.135 9, 2 979 cases) group, and high HGI (HGI≥0.135 9, 2 660 cases) group. Among patients with diabetes detected by HbA 1c alone, the high HGI group accounted for 74.8% (677/905), which was much higher than the moderate (15.5%, 140 cases) and the low (9.7%, 88 cases) HGI groups. The agreement between HbA 1c and OGTT for the diagnosis of diabetes was poor (κ=0.488), which was mostly influenced by HGI. The high HGI phenotype was correlated with age, female gender, body mass index, low-density lipoprotein cholesterol, 2 h plasma glucose during an OGTT, and lipid-regulating drug. Conclusion:Using HbA 1c alone for diagnosis could lead to overdiagnosis in high HGI patients and underdiagnosis in low HGI patients.

Objective To analyze the clinical characteristics of pituitary stalk interruption syndrome(PSIS). Methods The clinical data including clinical manifestations,laboratory tests,and imaging findings of 114 PSIS patients in our hospital were retrospectively analyzed. Results Of these 114 PSIS patients,102 cases (89.4%) were male. The average age was 21.1?6.1 years. A history of breech delivery was documented in 91 cases (91.9%). Short stature was found in 89 cases (71.8%) and bone age delayed (6.1?5.1) years. Secondary sex characteristics were poor or undeveloped in most patients. The prevalence of deficiencies in growth hormone,gonadotropins,corticotropin,and thyrotropin were 100.0%,94.0%,84.2%,and 74.6%,respectively. Hyperprolactinemia was found in 28.1% of patients. Three or more pituitary hormone abnormalities were found in 105 cases(92.1%). Compared with the 5 cases with history of cephalic delivery,no difference were found in the aspects of height(t=0.297,P=0.634),penile length(t=1.205,P=0.882),testicular volume (U=99.000,P=0.348),growth hormone peak (U=89.000,P=0.186),adrenocorticotropic hormone peak(U=131.000,P=0.967),luteinizing hormone peak(U=98.500,P=0.582),thyroid-stimulating hormone (U=82.000,P=0.162),and the height of anterior pituitary (t=1.676,P=0.107) in the 53 cases with history of breech delivery. Conclusions The clinical manifestations,symptoms,hormone deficiencies were severe in our series. The condition severities were not remarkably different in patients with different delivery ways.

The aims were to compare the appropriate cutoffs of glycated hemoglobin (HbA1c) in a population of varying ages and to evaluate the performance of HbA1c for diagnosing diabetes and prediabetes. A total of 1064 participants in the young and middle-aged group and 1671 in the elderly group were included and underwent HbA1c testing and an oral glucose tolerance test (OGTT). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the optimal HbA1c cutoffs. Kappa coefficients were used to test for agreement between HbA1c categorization and OGTT-based diagnoses. The optimal HbA1c cutoffs for diagnosing diabetes were 5.7% (39 mmol/mol) in the young and middle-aged group with a sensitivity of 66.7%, specificity of 86.7%, and AUC of 0.821 (95% CI: 0.686, 0.955) and 5.9% (41 mmol/mol) in the elderly group with a sensitivity of 80.4%, specificity of 73.3%, and AUC of 0.831 (0.801, 0.861). The optimal cutoffs for diagnosing prediabetes were 5.6% (38 mmol/mol) and 5.7% (39 mmol/mol) in the young and middle-aged group and in the elderly group, respectively. Agreement between the OGTT-based diagnosis of diabetes or prediabetes and the optimal HbA1c cutoff was low (all kappa coefficients <0.4). The combination of HbA1c and fasting plasma glucose increased diagnostic sensitivities or specificities. In conclusion, age-specific HbA1c cutoffs for diagnosing diabetes or prediabetes were appropriate. Furthermore, the performance of HbA1c for diagnosing diabetes and prediabetes was poor. HbA1c should be used in combination with traditional glucose criteria when detecting and diagnosing diabetes or prediabetes.

AIM:To investigate the effect of telmisartan on the lipometabolisms and the proinflammatory factors secreted from 3T3-L1 adipocytes and to explore the possible mechanisms.MATERIALS AND METHODS:Telmisartan was applied to interfere with mature 3T3-L1 adipocytes. The culture's free fatty acids, interleukin 6 (IL-6) and tumor necrosis factor α (TNFα) were evaluated. Oil Red O staining was used to determine the adipogenesis of 3T3-L1 adipocytes. (18)F-FDG uptake levels corrected for protein content were determined by cellular radioactivity. The total RNA was isolated for hybridization experimentation in the microarray.RESULTS:Telmisartan reduced lipid storage and increased (18)F-FDG uptake in a dose-dependent manner, reduced the levels of IL-6 and TNFα and increased those of free fatty acids. One hundred and fifty-seven differentially expressed genes were found by microarray. The mitogen-activated protein kinase (MAPK) signaling pathway involved in the secretion of proinflammatory factor and lipid metabolisms was affected by telmisartan. The expression of endothelial nitric oxide synthetase gene 3 (Nos3) and carnitine palmitoyl transferase 1α (CPT1α) was up-regulated by telmisartan.CONCLUSIONS:Telmisartan affected lipometabolisms and the proinflammatory factors secreted from adipocytes. Nos3, CPT1α and the MAPK pathway being affected by telmisartan may be the underlying cause of the improvement in lipid metabolisms and secretion of proinflammatory factors of differentiated 3T3-L1 adipocytes.

目的 探讨肥胖与老年男性雄激素、雄激素受体(AR)水平及AR基因CAG重复序列多态性的关系.方法 收集323例老年男性,根据腰围不同分为4组,腰围＜85 cm组、腰围85～90 cm组、腰围91～96 cm组和腰围≥97cm组.用化学发光法检测黄体生成素、卵泡刺激素、总睾酮(TT)和雌二醇;用酶联免疫法检测游离睾酮,硫酸脱氢表雄酮和性激素结合球蛋白(SHBG).使用DNA测序方法测定CAG重复序列.结果 与腰围＜85 cm组比较,腰围85～90 cm组、腰围91～96 cm组、腰围≥97 cm组舒张压和雌二醇/睾酮比值逐渐增高,SHBG逐渐降低(P＜0.05,P＜0.01);与腰围85～90 cm组比较,腰围≥97 cm组雌二醇/睾酮比值增高(7.75士3.25) vs (6.34±2.98),SHBG降低[(142.02士71.92)nmol/L vs(177.72±86.27)nmol/L,P＜0.05,P＜0.01].多元线性回归分析显示,腰围与腰臀比、体质量指数和雌二醇呈正相关,腰围与TT呈负相关.结论 肥胖男性TT和SHBG下降,雌二醇和雌二醇/睾酮比值明显升高;AR和AR基因CAG重复多态性与体脂分布无相关性.

OBJECTIVETo investigate the effects of vitamin-mineral supplement on young males with physical overtraining.METHODSTwo hundred and forty male Chinese field artillery personnel who undertook large scale and endurance military training and were on ordinary Chinese diet were randomized to receive a multivitamin/multimineral supplement or a placebo for 1 week. After a 1-week wash-out period, a cross-over with 1 week course of a placebo or multivitamin/multimineral supplement was conducted. Blood and urine samples were analyzed for adrenal, gonadal and thyroid hormones. In addition, cellular immune parameters (CD3+, CD3+CD4+, CD3+CD8+, CD4/CD8, CD3-CD56+, CD3-CD19+) were examined and psychological tests were performed before and after the training program and nutrition intervention.RESULTSAfter a large scale and endurance military training, the participants showed significantly increased thyroid function, decreased adrenal cortex, testosterone and immunological function, and significantly increased somatization, anger and tension. Compared to placebo, multivitamin/ multimineral intervention showed significant effects on functional recovery of the pituitary - adrenal axis, pituitary-gonadal axis, pituitary- thyroid axis and immune system as well as psychological parameters.CONCLUSIONHigh-intensity military operations have significant impacts on the psychology, physical ability and neuroendocrine-immune system in young males. Appropriate supplementation of multivitamin/multimineral can facilitate the recovery of the psychology, physical ability and neuroendocrine-immune system in young males who take ordinary Chinese diet.

Objective To observe the regularity of the changes in neuroendocrine-immune system caused by fatigue due to military operations, and explore the mechanism by which fatigue occurs in military operations. Methods The subjects were 240 soldiers belonging to a field artillery force. The medical history and physical examination were taken before military operations, and fatigue assessment scale was accomplished as well. The following variables were measured in all the subjects: pituitary-adrenal [adrenocorticotropic hormone (ACTH), cortical hormone (B), 24-h urinary free cortisol (UFC)], pituitary-gonadal [luteinizing hormone (LH), testosterone (T), estradiol (E2)], pituitary-thyroid functions [serum thyroid stimulating hormone (TSH), tetraiodothyronine (TT4), triiodothyronine (TT3), free thyroxine (FT4), and free triiodothyronine (FT3)], and cellular immune parameters (CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , B, NK). After 7 d of large-scale and high-intensity field exercises, the above variables were again measured in all the subjects. Results After high-intensity military operations, the unpleasant feelings were significantly increased, and the compulsive and psychotic scores significantly decreased in the soldiers. In addition, the pituitary-adrenal and pituitary-gonadal hormone levels also decreased (all P <0.001), and the pituitary-thyroid hormone level increased ( P <0.05). Moreover, both cellular and humoral immune functions were depressed after high-intensity exercises ( P <0.001). Conclusion The depressed psychological tolerance in soldiers is the psychological factor of fatigue after a high-intensity military operation. The hypocorticoidism and inhibition of hypothalamic-pituitary-gonadal axis are the pathophysiological basis of military operation fatigue. Suppression of immune function is an important reason for an increase of susceptibility to disease after high-intensity military operations.

BACKGROUND Over one million soldiers were treated for battle- or training-fatigue during World War II. Of all ground combat troops, 37% were discharged for psychiatric reasons due to fatigue. The neuroendocrinological and immunological systems played important roles in the work-related fatigue of military personnel. The aim of this study was to investigate the characteristics of fatigue associated with military operations, and we observed changes in the regulatory functions of the neuroendocrinological and immunological systems that may provide theoretical support for improving the combat effectiveness of armies. METHODS A total of 240 soldiers from the Field Artillery regiment were selected as subjects. Researchers and subjects received training before participating in the study. Data of the subjects' medical histories, physical examinations, scores on a fatigue assessment scale, and assessments of pituitary-adrenal hormones (adrenal cortical hormone (ACTH), cortical hormone (F), and 24-hour urine-free cortisol (UFC)), pituitary-gonadal hormones (luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, estradiol (E2), and prolactin (PRL)), pituitary-thyroid hormones (thyroid-stimulating hormone (TSH), thyroxine (TT4), triiodothyronine (TT3), free thyroxine (FT4), and free triiodothyronine (FT3)), and cellular immune parameters (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+), B, and NK cells) were investigated before and after large-scale and high-intensity field exercises. Data were statistically analyzed with Student's t test using SPSS software (version 13.0), and P values < 0.05 were deemed to be significant. RESULTS After the high-intensity military training, the scores on the fatigue scale reflected significant increases of feeling of unpleasantness among soldiers. Additionally, the symptom checklist showed notable increases in somatization scores and significant decreases in psychoticism scores. After intensive military work, levels of plasma ACTH, F, and UFC of soldiers were decreased (P < 0.01). The level of testosterone decreased significantly after the maneuver ((23.51 ± 6.49) versus (18.89 ± 5.89) nmol/L; P < 0.001), whereas the thyroid function (TT3, FT4, and FT3) was markedly increased after the maneuver (P < 0.01). The number of CD3(+), CD4(+), CD4(+)/CD8(+) cells, and B lymphocytes were decreased (P < 0.05), and NK cells were increased (P < 0.001) after the maneuver. CONCLUSIONS Following high-intensity military operations, the psychological tolerance of soldiers was depressed. And the hypoadrenocorticism (the functional decreases of hypothalamic-pituitary-gonadal and abnormal pituitary-thyroid axis) contributed to the increased levels of fatigue. Hypoimmunity may increase the susceptibility to diseases after high-intensity military operations.

Objective To establish the reference range of serum 1,5-anhydroglucitol( 1,5-AG) in healthy people and analyze its correlation with short-term glycemic control.Methods From March to July in 2010,281 individuals with normal glucose regulation,143 men and 138 women aged from 20 to 87 years,were recruited from Gucheng and Pingguoyuan community in Beijing and outpatients of General Hospital of People's Liberation Army(PLA).Serum 1,5-AG levels were measured with glucose kinase-pyranoid sugars oxidase (GK-PROD) methods in these individuals.Thirty-eight outpatients with type 2 diabetes,19 men and 19 women aged 37 to 74 years,were selected from General Hospital of PLA and received mixed protamine zinc recombinant human insulin lispro injection (25R) interventions for 12 weeks.The blood glucose levels in the patients were regularly monitored before and 2h after main meals in order to obtain mean blood glucosc( MBG); and 1,5-AG,glycosylated hemoglobin (HbA1 c)and serum glycated albumin (GA) were measured at week 0,2,4,8 and 12 with clinic visits. Pearson correlation coefficient was used to measure the relation between 1,5-AG,HbA1c,GA and MBG.Results The normal range of serum 1,5-AG for healthy population could be suggested at 68 - 251 μmol/L overall,80 - 267 μmol/L for man and 66 -206 μmol/L for woman.The level of 1,5-AG in man was higher than that in woman,but there was no difference in the whole range of age and body mass index ( BMI ) in subjects. There were significant correlation between 1,5-AG,HbA1c,GA and MBG(r =-0.491,0.563,0.422,all P ＜ 0.01 ). 1,5-AG was most closely associated with 2-week MBG level( r =-0.675,P ＜ 0.01 ),while the correlation between HbA1c and MBG maintained longer than others.After treatment of 2 weeks,1,5-AG increased by 18.8％,but HbA1c and GA decreased by 3.2％ and 6.2％.By week 12,1,5-AG increased by 65.2％,while the HbA1c and GA decreased by 16.1％ and 21.1％.In general,there was satisfactory concordance between longitudinal changes of 1,5-AG,HbA1c,GA and MBG in patients with type 2 diabetes.Conclusions The normal rangc of serum 1,5-AG for normal population could be suggested at 68 -251 μmol/L overall,80 -267 μmol/L for man and 66 -206 μmol/L for woman.1,5-AG was a probably better marker than HbA1c and GA in evaluating short-term glycemic control.

Objective To study the optimal cut point of receiver operating characteristic(ROC) curves for glycosylated serum protein(GSP),glycated albumin(GA-L) and fasting plasma glucose(FPG) when glycated hemoglobin(HbA1c) was used in diagnosis of diabetes mellitus(DM).Methods ROC curves were plotted for 88 patients(54 males and 34 females) with suspicious DM diagnosed following the 2010 American Diabetes Association(ADA) diagnostic criteria.The optimal cut point,sensitivity and specificity of GSP,GA-L and FPG in diagnosis of DM were comparatively analyzed.Results The optimal cut point of ROC curves for GSP in diagnosis of DM was 186.1μmol/L,with a sensitivity of 55%,a specificity of 98%,area of 0.804 under the curve,a positive likelihood ratio of 27.63,a negative likelihood ratio of 0.46,a positive predictive value of 95% and a negative predicative value of 74%.The optimal cut point of ROC curves for GA-L in diagnosis of DM was 16.86%,with a sensitivity of 61%,a specificity of 98%,area of 0.849 under the curve,a positive likelihood ratio of 30.26,a negative likelihood ratio of 0.40,a positive predictive value of 96% and a negative predicative value of 77%.The optimal cut point of ROC curves for FPG in diagnosis of DM was 5.67mmol/L,with a sensitivity of 58%,a specificity of 78% and area of 0.736 under the curve.Conclusion Among the GA-L,GSP and FPG,the specificity and sensitivity of GA-L are the highest in diagnosis of DM.The accuracy of GA-L in diagnosis of DM is higher than that of GSP and FPG since the area under the curve is GA-LGSP FPG.

Objective To study the clinical characteristics of idiopathic hypogonadotropic hypogonadism(IHH) and its related gene mutations in females.Methods Clinical data and laboratory findings about 4 IHH patients were analyzed.Sequences of the GnRHR,KAL1 and FGFR1 genes in 3 patients and controls were detected by PCR.Results No secondary sex characters were found in the 4 female IHH patients who had a normal karyotype,underdeveloped sexual phenotype,low gonadotropic hormones and estradiol levels.Brain MRI showed normal olfactory bulbs and sulci.No mutation was observed in the GnRHR gene.Two nucleotide polymorphisms were detected in KAL1 gene of cases 3 and 4.The 251A in exon 3 of the FGFR1 gene was transformed into T(Glu84Val).Conclusion Mutation of the FGFR1 gene occurred only in 1 of the 3 patients in this study,indicating that other factors may lead to IHH.

Objective To investigate the anti-inflammatory role of angiotensin Ⅱ AT1 receptor antagonist,telmisartan,in LPS-induced 3T3-L1 adipocytes.Methods After differentiated 3T3-L1 adipocytes were exposed to telmisartan(0,0.01,0.1,1 and 10 μg/ml) respectively for 2 h,they were treated with LPS(1 μg/ml) for another 1 h.The cells treated with DMSO served as control.The expression of NF-κBp65,IκBα,p-IκBα,p38MAPK,p-p38MAPK,ERK1/2 and p-ERK1/2 was detected by Western blotting.Results Compared with control group,LPS significantly increased the translocation of NF-κBp65 from the cytoplasm to the nucleus and phosphorylation of IκBα,ERK1/2 and p38MAPK(P<0.05),but telmisartan,especially when at high dose(10 μg/ml) inhibited the above mentioned process significantly(P<0.05).Conclusion In 3T3-L1 adipocytes,telmisartan can inhibit the translocation of NF-κBp65 from cytoplasm to the nucleus and phosphorylation of IκBα,ERK1/2 and p38MAPK,which may explain the anti-inflammation effect of telmisartan.

Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.

Objective To study the effect of telmisartan,an angiotensin Ⅱ receptor antagonist,on production of IL-6 and TNF-α in 3T3-L1 adipose cells of mice.Methods 3T3-L1 adipose cells were randomly divided into control group,lipopolysaccharide(LPS) group,LPS+0.1μg/ml telmisartan group,LPS + 1μg/ml telmisartan group,LPS+10μg/ml telmisartan group.After DMSO was added into LPS group and telmisartan was added into LPS + telmisartan group at different concentrations,the cells were incubated for 2h.Then,1μg/ml LPS was added into LPS group and LPS + telmisartan group,the cells were co-incubated with telmisartan for 1h.The secretion levels of IL-6 and TNF-α were measured by ELISA and the expression of IL-6 and TNF-α mRNA was detected by RT-PCR.Results The secretion level of IL-6 and the expression level of IL-6 mRNA in 3T3-L1 adipose cells were 2.7-fold and 4-fold higher,respectively,in LPS group than in control group after treatment with LPS.The IL-6 level and the IL-6 mRNA expression level were significantly lower in other groups than in LPS group after treatment with telmisartan,which were decreased to 67% and 63%,respectively,after treatment with 10μg/ml telmisartan.The secretion level of TNF-α and the expression level of TNF-α mRNA were 1.3-fold and 3.5-fold higher in LPS group than in control group,and significantly lower in other groups than in LPS group after treatment with telmisartan,which decreased about 85% and 23% after treatment with 10μg/ml telmisartan.Conclusion Telmisartan can exert its anti-inflammation effect by inhibiting the production of inflammatory factors in 3T3-L1 adipose cells,especially when it is used at the concentration of 10μg/ml.

Objective To study the effect of different vacuum blood sampling tubes on whole blood glycohemoglobin(HbAlc) detected by high performance liquid chromatography(HPLC).Methods Venous blood samples were collected from 40 outpatients with 4 kinds of vacuum blood sampling tubes.The samples were frozen and then thawed for measuring HbA1c with the RIO-RAD VariantⅡHPLC analyzer.Results The HbA1c was 7.88%±1.2%,7.96%±1.2%,7.91%±1.2%,and 7.95%±1.2% in samples collected with purple hat(K2-EDTA),gray hat(sodium fluoride/heparin sodium),green hat(heparin lithium) and blue hat(sodium citrate) respectively,which was not significantly different from those collected with vacuum blood sampling tubes(P0.05).After 3 times of freezing and thawing,the HbA1c in samples collected with purple,gray and green hats was significantly different from those collected with different blood sampling tubes(P0.05).Conclusion Vacuum blood sampling tubes can be in collecting whole blood HbA1c samples.Over three times of freezing and thawing of the sample can influence the detection of HbA1c.

BACKGROUND:The accurate and comprehensive assessment of glycemic control in patients with diabetes is important for optimizing glycemic management and for formulating personalized diabetic treatment schemes. This study aimed to analyze the correlation between 1,5-anhydroglucitol (1,5-AG) and glycemic excursions in type 2 diabetic patients.METHODS:Seventy-one outpatients with type 2 diabetes mellitus were randomly recruited from Chinese People's Liberation Army General Hospital. Using a continuous glucose monitoring system (CGMS), these patients' blood glucose levels were monitored for three consecutive days to obtain mean blood glucose (MBG) data. Intraday glycemic excursions were evaluated using the mean amplitude of glycemic excursions (MAGE), the largest amplitude of glycemic excursions (LAGE), standard deviation of blood glucose (SDBG) and the M-value. Interday glycemic excursion was assessed by absolute mean of daily difference (MODD). Postprandial glycemic fluctuations were evaluated using postprandial glucose excursions (PPGE) and postprandial incremental area under the curve (iAUC). Fasting venous blood samples were collected to measure serum 1,5-AG, whole-blood hemoglobin A1c (HbA1c) and serum glycated albumin (GA). Clinical markers of glycemia and parameters of glycemic excursions from CGMS were analyzed using the Pearson correlation coefficient and multivariate stepwise regression.RESULTS:Pearson correlation analysis revealed that 1,5-AG was significantly correlated with MAGE, SDBG, M-value, LAGE, PPGE and iAUC (r values were -0.509, -0.430, -0.530, -0.462, -0.416 and -0.435, respectively, P < 0.01), especially in moderately and well-controlled patients, based on defined HbA1c levels. Multivariate stepwise regression analysis revealed a negative correlation between 1,5-AG and the above parameters, but not HbA1c and GA. Finally, HbA1c and GA were positively correlated with MBG and fasting blood glucose (FBG).CONCLUSIONS:1,5-AG was much better than HbA1c and GA as a marker of glycemic excursions in type 2 diabetic patients. Based on these results 1,5-AG is the best metric for assessing postprandial glucose levels in moderately and well-controlled patients, while HbA1c and GA were superior to 1,5-AG for monitoring MBG and FBG.

Objective To analyze the application of a new reagent in Bio-Rad variant II HbA1c analyzer.Methods Accuracy,linear analysis of diluted sample,whole blood and diluted samples,and stability of diluted samples of the new reagent,as well as its correlation with the old reagent were evaluated.Results The between-run and within-run accuracy of diluted sample was ≤1.4% and ≤0.93%,respectively.The accuracy of whole blood sample was higher than that of diluted sample.The linear theoretical value of diluted sample was well correlated with its measured value(r=0.998 5,P0.01).No statistical difference was found in diluted and whole blood samples(P0.05).However,a statistical difference was observed in diluted and whole blood samples of the old reagent(P0.01).The value of diluted sample was higher than that of whole blood sample.The diluted samples kept at room temperature for 10h were stable,with no difference with those kept at room temperature for 0h(P0.05).A rather good linear correlation was observed between the new and old reagents(r=0.994 2,P0.01 for whole blood;r=0.995 2,P0.01 for diluted blood).No statistical difference was found in whole blood sample of the new and old reagents(P0.05).However,a statistical difference was observed in diluted sample(P0.01).Conclusion The new reagent is better than the old reagent for Bio-Rad Variant II HbA1c assay and can meet clinical requirements better than the old reagent.

Objective To analyze the function of islet(3 cells in population who had normal glucose tolerance(NGT) or impaired glucose regulation(IGR) with hyperinsulinemia(HINS).Methods A total of 634 adults diagnosed as NGT or IGR with HINS by 75g oral glucose tolerance test(OGTT) were included for the analysis of the islet(3 cells function.Results In HINS group,homeostasis model insulin resistance index(HOMA-IR),⊿I_(120)/⊿G_(120),the first and second phase insulin secretion index were significantly higher than those in non-HINS group of non-diabetic population(P0.05),but insulin sensitive index(ISI)-Stumvoll and HOMA beta cells function index/insulin resistance(HBCI/IR) were significantly lower(P0.05).There was no significant difference in⊿I_(120)/⊿G_(120)/IR between the two groups(P0.05).In IGR with HINS group,HBCI,HBCI/IR,and the first and second phase insulin secretion index were significantly lower than those in NGT with HINS group(P0.05).There was no significant difference in HOMA-IR and ISI-Stumvoll between the two groups(P0.05).Conclusions Although the absolute insulin secretion is increasing in the NGT or IGR population with HINS,the isletβcells function decreases gradually.NGT or IGR with HINS are the transition state in the progress of diabetes mellitus,and the early detection and interference are strongly recommended.

Objective To study the feasibility of using the optimal cut points of glycosyted hemoglobin A1c(HbA1c) in diagnosis of type 2 diabetes mellitus(DM) and impaired glucose regulation in the elderly.Methods Cross-sectional epidemiology of the elderly(age≥60 years) in Wanshou Road Community of Beijing was investigated in 2009.Oral glucose tolerance test(OGTT) was performed in 1 674 participants without known DM to measure their fasting blood glucose,2h glucose and HbA1C levels.Values of the optimal HbA1c cut points were calculated and compared with the ADA diagnostic criteria for DM when DM and IGR were diagnosed OGTT.Results Of the 1 674 participants,894 had normal glucose tolerance(NGT),53 had impaired fasting glucose(IFG),369 had impaired glucose tolerance(IGT),87 had IFG and IGT,and 271 had newly diagnosed diabetes(NDD) according to the 1999 WHO diagnostic criteria.The ideal HbA1c cut point value was 5.9% when DM was diagnosed with ROC curve and OGTT,with a sensitivity of 80.1%,a specificity of 73.8%,and an area under the ROC curve of 0.832(95% CI=0.802-0.862),and 5.7% when IGR was diagnosed with ROC curve and OGTT,with a sensitivity of 64.3%,a specificity of 60.9%,and an area under the ROC curve of 0.668(95% CI=0.638-0.698).The Compliance rate of ROC curve and OGTT was 75%,17.3% and 41.7%,respectively,for NDDM,NGT and IGR,with a specificity of 80.1%.The diagnosis rate was 39.1%,0.9% and 4.5%,respectively,for NDDM,NGT and IGR following the ADA criteria at a HbA1c cut point≥5.9%.Conclusion OGTT should be performed to conform the diagnosis of DM when the HbA1c is≥5.9%,with a specificity of 97.8%.However,HbA1c should not be used in screening for IGR.

Objective To identify the optimal HbA1c threshold which as a diagnostic test for type 2 diabetes in middle-age adults.Methods This study included 1059 adults from one institution of higher learning.Without known diabetes who had an oral glucose tolerance test and HbA1c,serum biochemistry indicators were measured on the same day.Make use of receiver operating characteristics curve to detect optimal HbA1c threshold.Results(1)HbA1c levels with age increasing.Under the age of 30,the average of HbA1c is(5.2±0.3)%,while,at the age of 50-80,the average of HbA1c is(5.6±0.6)%.(2)According to ROC,the optimal cut-off point of HbA1c for the diagnosis of diabetes is 5.7%(sensitivity 66.7%,specificity 86.7%),this result mean that 66.7% of diabetic subjects show an HbA1c≥5.7%,while 10.6% NGT and 44.0% IGR subjects have an HbA1c≥5.7%.(3)Similarly,the optimal cut-off point of HbA1c for the diagnosis of IGR is 5.6%(sensitivity 55.8%,specificity 82.8%),this result mean that 56.0% of IGR subjects show an HbA1c≥5.6%,while 16.9% NGT and 73.3% NDD subjects have an HbA1c≥5.6%.(4)The risk factors of metabolic syndrome with HbA1c levels increasing.When HbA1c≥6.0% and HbA1c≥6.2%,there are two or more risk factors of metabolic syndrome in 85.7% NDD and 75% IGR subjects,respectively.Conclusions The optimal cut-off points of HbA1c for the diagnosis of diabetes and IGR is 5.7%,5.6%,respectively.If use the HbA1c 5.7% to separating NDD from NGT,about 10% NGT subjects will be diagnosed NDD.The risk factors of metabolic syndrome is increased obviously when HbA1c≥6.0%.