Background: The second to fourth digit ratio (2D:4D) is assumed to be a biomarker of prenatal sex steroid exposure, correlating negatively with prenatal testosterone and positively with prenatal estrogen. The ratio has been suggested to be influenced by endocrine disrupting chemicals (EDCs). However, evidence regarding effects of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on 2D:4D of children was sparse. Objectives: We investigated the associations between prenatal exposure to PBDEs and 2D:4D of children aged 4 years. Methods: Participants were mother-child pairs from the Shanghai-Minhang Birth Cohort Study (S-MBCS) which enrolled pregnant women at 12-16 weeks of gestation from April to December 2012. Nine PBDE congeners in venous umbilical cord plasma of 340 children were measured. Digit lengths were measured using a vernier caliper in children aged 4 years and 2D:4D for left and right hands and average 2D:4D value of both hands were calculated. A total of 281 children (160 boys and 121 girls) who had data on both 2D:4D and PBDE concentrations were included in the final analysis. Associations between prenatal PBDE exposures and 2D:4D were investigated using multiple linear regression models. Results: Among the nine congeners, BDE-47 had the highest detection rate of 86.12% with the highest median concentration of 0.20 ng/ml lipid. Five PBDE congeners with detection rates greater than or close to 50% (BDE-28,-47,-99,-100 and -153) and Sigma 5PBDEs (the sum of them) were included in final analysis. For girls, a consistent pattern for the positive associations between prenatal PBDE exposures and 2D:4D of children was observed mainly for the left hand, where those in the highest exposure groups had higher 2D:4D compared to the lowest exposure groups (a feminizing effect), with statistically significant associations observed for BDE-47 (beta = 0.0247, 95% confidence interval (CI): 0.0017, 0.0477), -100 (beta = 0.0264, 95% CI: 0.0087, 0.0441) and Sigma 5PBDEs (beta = 0.0201, 95% CI: 0.0027, 0.0374). For boys, compared with the lowest exposure groups, statistically significantly higher (feminized) 2D:4D for both hands was observed in those with the highest exposure levels of BDE-100 (beta = 0.0147, 95% CI: 0.0005, 0.0289 for the left hand; beta = 0.0182, 95% CI: 0.0046, 0.0318 for the right hand) and those with the middle and the highest exposure levels of BDE-153 (middle vs. undetected, beta = 0.0215, 95% CI: 0.0072, 0.0358 for the left hand; beta = 0.0155, 95% CI: 0.0015, 0.0295 for the right hand; highest vs. undetected, beta = 0.0162, 95% CI: 0.0017, 0.0307 for the left hand; beta = 0.0152, 95% CI: 0.0011, 0.0294 for the right hand). Conclusions: Our study provides preliminary evidence that prenatal exposure to PBDEs might be associated with higher 2D:4D in boys and girls.

Abstract Background Evidence on the association between exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) and blood glucose concentrations in pregnant women is inconsistent. This study aimed to examine the association between PFAS exposure and the concentrations of fasting plasma glucose (FPG) and one-hour plasma glucose (1 h-PG) after a 50-g oral glucose tolerance test in pregnant women. Methods The study was based on the Shanghai-Minhang Birth Cohort, in which 1292 pregnant women were recruited. Among them, 981 women provided blood samples (at 12–16 gestational weeks) for PFAS measurement. FPG data collected from 856 women at 12–20 GW and 1 h-PG data collected from 705 women at 20–28 GW were obtained through medical records from the routine prenatal care system. High FPG or 1 h-PG was defined as ≥90th percentile of FPG or 1 h-PG. The analysis of eight PFASs was conducted in this study: perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUdA), perfluorododecanoic acid (PFDoA), and perfluorotridecanoic acid (PFTrDA). The odds ratios (ORs) and associated 95% confidence intervals (CIs) were estimated to determine the associations of each PFAS compound with high FPG and 1 h-PG from a logistic regression model. Results After adjustment for potential confounders, most PFASs were positively associated with high 1 h-PG concentrations. The OR for high 1 h-PG concentrations was 1.87 (95% CI: 1.15–3.05) with a one log unit increase of PFOS; similar associations were observed for PFNA (OR: 2.15, 95% CI: 1.24–3.74), PFDA (OR: 1.61, 95% CI: 1.10–2.44), PFUdA (OR: 1.71, 95% CI: 1.12–2.62), and PFDoA (OR: 1.34, 95% CI: 1.00–1.81). When the PFAS concentrations were categorized into three groups by tertiles, the highest tertiles of PFOS, PFOA, PFNA, PFDA, PFDoA, and PFTrDA had a statistically significant increase in the risk of high 1 h-PG concentrations compared with the lowest tertiles. No statistically significant association was observed between PFAS exposure and high FPG. Conclusion PFAS exposure was associated with an increased risk of high 1 h-PG among pregnant women, but no such association was observed for FPG.

Objective Studies on the effect of prenatal exposure to magnetic field (MF) on fetal growth is inconclusive and subject to some methodological limitations, particularly in measurement of MF exposure. The present study aimed to examine the association between maternal extremely low frequency MF (ELF-MF) exposure during pregnancy and fetal growth in offspring. Methods A total of 128 pregnant women were recruited at their 3rd trimester and asked to wear an EMDEX Lite meter for 24 h to capture daily ELF-MF exposure. Time-weighted average (TWA), P50, and P75 of personal 24-h measurements were used to evaluate prenatal ELF-MF exposure. The medians of these measurements were used as cut-off points of high and low prenatal ELF-MF exposure. Fetal growth was measured by infant’s birth weight, skinfold thickness of triceps, abdomen, and back, and circumference of head, upper arm, and abdomen. These measures were conducted within 24-h after birth. Generalized Linear Model was used to examine the association between maternal ELF-MF level and fetal growth indices after potential confounders were adjusted for. Results Compared with girls with lower prenatal ELF-MF exposure, girls with higher exposure had a lower birth weight, thinner skinfold of triceps, abdomen and back, and smaller circumference of head, upper arm and abdomen in all three ELF-MF matrices. The differences were statistically significant for birth weight and most other growth measurements ( P < 0.05). These measures had no significant difference between higher and lower prenatal ELF-MF exposure in boys except back skinfold thickness. Conclusion Prenatal exposure to higher ELF-MF levels was associated with decreased fetal growth in girls, but not in boys.

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are persistent pollutants and have endocrine disruptive and neurotoxic effects. The association between maternal PFAS concentrations and neuropsychological development in children is inconclusive. The present study aimed to examine the effect of maternal PFAS concentrations on neuropsychological development in 4-years-old children. We used data from Shanghai-Minhang Birth Cohort, which recruited pregnant women at 12–16 gestational weeks. Among 981 women having PFAS measurement, 533 mother-child pairs were included in the study. A total of eight PFASs were measured, including perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUdA), perfluorododecanoic acid (PFDoA), and perfluorotridecanoic acid (PFTrDA). When infants turned 4 years old, mothers were asked to complete the Ages and Stages Questionnaires® (ASQ) to assess neuropsychological development of their children. Poisson regression model with robust variance estimates was used to examine the association between maternal PFAS concentrations and each developmental subscale of the ASQ. Prenatal plasma concentrations of most PFASs tended to be associated with increased risk of development problem in personal-social skills, including PFHxS, PFOS, PFOA, PFNA, PFDA, and PDUdA, and the associations for PFNA and PFDA were significant (per natural log unit increase: RRPFNA = 1.92, 95% CI: 1.21, 3.05; RR PFDA = 1.66, 95% CI: 1.17, 2.37). In stratified analyses by child’ sex, the consistent pattern of higher risk of developmental problems in personal-social skills associated with most PFASs was mainly observed among girls (RRPFOS = 2.56, 95% CI: 1.20, 5.45; RRPFOA = 9.00, 95% CI: 3.82, 21.21; RRPFNA = 3.11, 95% CI: 1.36, 7.13; RRPFDA = 2.20, 95% CI: 1.21, 4.00; RRPFUdA = 2.44, 95% CI: 1.14, 5.20; RRPFDoA = 1.62, 95% CI: 1.04, 2.54). Boys with higher maternal PFOA concentrations had a decreased risk of developmental problems in gross motor skills (RR = 0.47, 95% CI: 0.25, 0.89). Prenatal plasma PFAS concentrations were associated with neuropsychological development in girls at 4 years of age, mainly in the subset of personal-social skills.

Aims: Serum uric acid (SUA) and bilirubin at high levels had both pro-oxidant and anti-oxidant properties. The present study aimed to examine additive interactions between SUA and total bilirubin (TBIL) for the risk of micro-vascular disease (MVD) in type 2 diabetes mellitus (T2DM). Methods: A cross-sectional survey of 6713 inpatients with T2DM was conducted in 81 tertiary care hospitals in China. MVD was defined as having either prior diabetic retinopathy (DR) or diabetic nephropathy (DN). Binary logistic regression was used to estimate odds ratios of SUA and TBIL for MVD. Additive interaction was measured by three indices, i.e., relative excess risk due to interaction, attributable proportion due to interaction and synergy index. Results: Among 6713 inpatients, 408 (6.08%) suffered from MVD. SUA 283 mu mol/l (i.e., its media) was defined as high SUA, and TBIL <11.5 mu mol/l (n = 2290 or 34.11%) was defined as low TBIL Overall, 621 patients were exposed to co-presence of high SUA and low TBIL. The co-presence of both factors greatly increased the effect sizes from 1.03(95%Cl: 0.72-1.46) (high SUA alone) or 0.70(95%Cl: 0.48-1.05) (low TBIL alone) to 1.90 (95%CI: 1.26-2.87) for MVD in multivariable analysis. The additive interaction of both factors was significant for MVD in both univariable analysis and multivariable analysis. Conclusions: Co-presence of both high SUA and low TBIL indentified a group of patients at a markedly increased risk of MVD in high-risk Chinese patients with T2DM. (C) 2018 Elsevier Inc. All rights reserved.

250; Main body text word count:3364; Number of Tables: 3; Number of Figures: 1; 2 Number of appendix tables: 2; Number of appendix figures: 2; Number of References: 19

BACKGROUND:The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women. METHODS:From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4-12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24-28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM. RESULTS:Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m2 . If BMI <22.5 kg/m2 and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m2 (multivariable OR 1.76; 95%CI 1.47-2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31-1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m2 and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44-3.28), with significant additive interaction. CONCLUSIONS:Body mass index ≥22.5 kg/m2 and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.

Smoking is a well-known risk factor of reproductive health. However, the effect of paternal smoking on fertility has been less extensively examined. We conducted a cross-sectional study in a mountainous area of South-West China to assess the effect of male smoking on couples′ fertility. A total of 8200 couples aged 18-49 years in the study area were invited to participate in the study. An in-person interview was performed to collect demographic characteristics of the couples, and husbands′ life style factors including smoking and drinking habits. Information on time to pregnancy (TTP) was collected retrospectively. Infertility was defined as failure to achieve clinical pregnancy after regular unprotected intercourse for ≥12 months. Logistic regression model was used to estimate the association between male smoking and infertility. A total of 7025 couples were included in the final analysis. After adjusting for potential confounders, the couples were more likely to suffer from infertility if the husbands smoked (adjusted odds ratio [aOR] =1.28, 95% CI: 1.08-1.52) before the first pregnancy. After the analyses were performed according to husbands′ smoking duration, an increased risk started at a relatively longer smoking duration of 5-10 years (aOR = 1.58, 95% CI: 1.26-1.99) and a stronger association (aOR = 3.34, 95% CI: 2.45-4.56) was observed in the group of ≥10 years. Similar patterns were found for the number of cigarettes smoked per day and the total amount of cigarettes smoked. From our findings, we conclude that male smoking may have an adverse impact on couples′ infertility.

BACKGROUND:There are inconsistent findings regarding associations between triglyceride levels and cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). This study aimed to test whether the association between triglycerides and CVD depends upon duration of diabetes.METHODS:From April 1, 2012, to June 30, 2012, we conducted a cross-sectional survey of 223 612 patients with T2DM from 630 hospitals in China. Cardiovascular disease was defined as having either prior coronary heart disease or stroke, or diabetic foot. Binary logistic regression was used to estimate odds ratios of triglyceride for CVD. Relative excess risk due to interaction, attributable proportion due to interaction, and synergy index were used to estimate effect size of additive interaction between low triglyceride, ie, <1.7 mmol/L, and duration of diabetes, ie, ≥15 years.RESULTS:Among 223 612 T2DM patients, 31 898 (14.27%) suffered from CVD. A low level of triglyceride was associated with decreased risk of CVD (univariable OR, 0.91, 95% CI, 0.88-0.93; multivariable OR, 0.94, 95% CI, 0.92-0.97) among patients with <15 years of duration of diabetes but increased risk of CVD (univariable OR, 1.12, 95% CI, 1.04-1.21; multivariable OR, 1.18, 95% CI, 1.09-1.27) among those patients with 15 and more years of duration of diabetes with significant additive interactions (relative excess risk due to interaction, 0.39, 95% CI, 0.25-0.52; attributable proportion due to interaction, 0.20, 95% CI, 0.14-0.27; and synergy index, 1.80, 95% CI, 1.43-2.28).CONCLUSIONS:Whereas a high triglyceride level was associated with increased risk of CVD in short-term T2DM, low triglyceride was associated with increased CVD risk in long-term T2DM. Low triglyceride may be a marker of CVD risk in Chinese patients with long-term T2DM.

Aims: To investigate the risk of Chinese females versus males for non-fatal coronary heart disease (CHD) due to long exposure to type 2 diabetes mellitus (T2DM). Methods: 223,612 Chinese patients with T2DM were recruited from China in 2012. Binary logistic regression analysis was performed to obtain odds ratios (OR) of females versus males for non-fatal CHD. Additive interaction was used to test whether female gender and long exposure to T2DM (>= 15 years) had a synergistic effect for non-fatal CHD. Significant relative excess risk due to interaction (RERI > 0), attributable proportion due to interaction (AP > 0) or synergy index (SI > 1) suggest a significant additive interaction. Results: More females than males with T2DM had non-fatal CHD (11.3% versus 10.6%, P < .0001). Females had slightly higher risk of non-fatal CHD since 5-10 years of diabetic duration and the effect size became larger since 15 years and onwards. Overall effect of females versus males for non-fatal CHD was 1.04 (95% CI: 1.01-1.08) among patients with < 15 years of duration while the effect size increased to 1.17 (95% CI: 1.07-1.28) among patients with >= 15 years of duration. Using males with < 15 years of duration as the reference, females with >= 15 years of duration were at 1.82-fold (95% CI: 1.70-1.95) non-fatal CHD risk while males with >= 15 years of duration were only at 1.56 (95% CI: 1.45-1.68) fold non-fatal CHD risk, with significant additive interaction (all three measures < 0.05). Conclusions: Long exposure to T2DM imparted a larger risk of non-fatal CHD to Chinese females than to Chinese males. (C) 2017 Elsevier B.V. All rights reserved.

Background The age of onset of type 2 diabetes is decreasing. Because non-Chinese patients with early-onset type 2 diabetes (defined here as diagnosis at <40 years) have increased risk of vascular complications, we investigated effects of early-onset versus late-onset type 2 diabetes on risk of non-fatal cardiovascular diseases in China.Methods We did a cross-sectional survey using data from the China National HbA(1c) Surveillance System (CNHSS), including 222 773 Chinese patients with type 2 diabetes in 630 hospitals from 106 cities in 30 provinces of China in 2012. We documented demographic information and clinical profiles. Non-fatal cardiovascular disease was defined as non-fatal coronary heart disease or non-fatal stroke. Prevalence of non-fatal cardiovascular diseases was standardised to the Chinese population in 2011. We did logistic regression analysis to obtain odds ratios (ORs) for the risk of cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Because the CNHSS did not contain patients on diet or lifestyle treatment alone, and did not capture information on smoking or lipid or antihypertensive treatment, we validated our findings in another dataset from a cross-sectional, multicentre observational study (the 3B study) of outpatients with type 2 diabetes to confirm that exclusion of patients with diet treatment only and non-adjustment for lipid-lowering and antihypertensive drugs did not introduce major biases in the main analysis.Findings Of 222 773 patients recruited from April 1, 2012, to June 30, 2012, 24 316 (11%) had non-fatal cardiovascular disease. Patients with early-onset diabetes had a higher age-adjusted prevalence of non-fatal cardiovascular disease than did patients with late-onset diabetes (11.1% vs 4.9%; p<0.0001). After adjustment for age and sex, patients with early-onset type 2 diabetes had higher risk of non-fatal cardiovascular disease than did those with late-onset type 2 diabetes (OR 1.91, 95% CI 1.81-2.02). Adjustment for duration of diabetes greatly attenuated the effect size for risk of non-fatal cardiovascular disease (1.13, 1.06-1.20). Results of the validation study showed that exclusion of patients with diet only and non-adjustment for lipid-lowering and antihypertensive drugs resulted in marginal changes in ORs for risk of non-fatal cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Early-onset type 2 diabetes remained associated with increased risk of cardiovascular disease, attributable to longer duration of diabetes.Interpretation Chinese patients with early-onset type 2 diabetes are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes.

BACKGROUND:This study aimed to explore independent associations between serum uric acid and hypoglycaemia, and whether mildly increased serum uric acid exacerbated the association between mild decline in estimated glomerular filtration rate (eGFR) and hypoglycaemia.METHODS:A cross-sectional survey of 6713 inpatients with type 2 diabetes and eGFR ≥60 mL/min/1.73 m2 and admitted to 81 tertiary care hospitals in China was conducted. Self-reported asymptotic hypoglycaemia with plasma glucose ≤3.9 mmol/L, hypoglycaemia episodes with symptoms in 1 month or hypoglycaemia that needed assistance from other people in 3 months before hospitalization was used to define hypoglycaemia. Binary logistic regression was used to estimate odds ratios of serum uric acid for hypoglycaemia. Three measures, that is, relative excess risk due to interaction (RERI), attributable proportion due to interaction and synergy index (S) were used to estimate the effect of mildly decreased eGFR on the association of serum uric acid with hypoglycaemia.RESULTS:Serum uric acid was associated with hypoglycaemia in an ordinal manner (P for trend <0.01) with an odds ratio of top quartile versus the lowest quartile up to 3.03 (95% confidence interval: 2.13-4.32). The odds ratio of serum uric acid levels ≥ versus <283 µmol/L (i.e. the median) was 1.98 (95% confidence interval:1.58-2.48). Serum uric acid levels ≥ versus <283 µmol/L greatly enhanced the association between mild decline in eGFR (eGFR < 90 mL/min/1.73 m2 ) and hypoglycaemia from 0.94 (0.36-2.43) to 3.90 (2.55-5.95), with a significant additive interaction (P < 0.05 for RERI, AP and S).CONCLUSIONS:Mildly increased serum uric acid was associated with increased risk of hypoglycaemia and enhanced the association between mildly decreased eGFR and hypoglycaemia in type 2 diabetes. Copyright © 2016 John Wiley & Sons, Ltd.

BackgroundCoronary heart disease generally occurs more frequently in men than in women. Findings from small studies (n<5000) in white populations suggest that type 2 diabetes imparts a higher risk of coronary heart disease to women than to men. We aimed to investigate this association in Chinese women versus men.MethodsWe did a cross-sectional national survey in 223 612 Chinese patients (age ≥18 years; 120 252 men and 103 360 women) with type 2 diabetes in 630 hospitals from 106 cities in 30 provinces of China in 2012. Demographic information, medical history, and drug use were documented. Coronary heart disease was defined as ischaemic heart disease with abnormal electrocardiogram (ECG) or stress test, myocardial infarction with typical changes in ECG and plasma enzyme testing, coronary revascularisation, percutaneous transluminal coronary angioplasty, or coronary atherectomy. We used multivariable binary logistic regression analysis to obtain odds ratios (ORs) for coronary heart disease in women versus men, controlling for age, hospital level, BMI, glucose monitoring at home, diabetes medications, diabetic nephropathy, HbA1c, systolic blood pressure, diastolic blood pressure, LDL cholesterol, HDL cholesterol, and triglyceride. We used additive interaction to test whether sex and exposure time to diabetes had a synergistic effect on the risk of coronary heart disease. Ethics approval was granted by the Ethics Committee of the Chinese People's Libration Army General Hospital, and all participants provided written informed consent.FindingsCompared with men, women had lower HbA1c, lower systolic and diastolic blood pressure, and similar low-density lipoprotein cholesterol levels. However, 11 684 (11·3%) of 103 360 women who had type 2 diabetes had coronary heart disease, compared with 12 758 (10·6%) of 120 252 men (p<0·0001). Subgroup multivariable analyses by duration of diabetes showed that women had a slightly higher risk of coronary heart disease than men after 5–10 years of exposure, and the effect size became larger from 15 years onwards. The overall effect of women versus men for coronary heart disease was 1·04 (95% CI 1·01–1·08) in patients who had diabetes for less than 15 years, and the effect size increased to 1·17 (1·07–1·28) in those with at least 15 years of diabetes. Compared with men who had diabetes for less than 15 years, the risk of coronary heart disease in those with at least 15 years of diabetes was increased by 1·82 times (95% CI 1·70–1·95) in women and by 1·56 times (1·51–1·73) in men. All three additive interaction measures were significant: the attributable proportion due to interaction was 0·12 (95% CI 0·03–0·20), relative excess risk due to interaction was 0·21 (0·05–0·37), and the synergy index was 1·35 (1·07–1·71).InterpretationExposure to type 2 diabetes for 15 years or more imparts a larger risk of coronary heart disease to Chinese women than to Chinese men. The excessive risk in women could not be explained by conventional risk factors of coronary heart disease.FundingNovo Nordisk China.

Serum uric acid (SUA) at high levels and bilirubin at low levels were potent antioxidant but it was uncertain that whether SUA and total bilirubin (TBIL) had additive interaction for the risk of CVD in type 2 diabetes mellitus (T2DM). We conducted a cross-sectional survey of 6713 inpatients with T2DM and admitted to 81 tertiary care hospitals. CVD was defined as having either prior coronary heart disease or stroke or peripheral arterial disease. Binary logistic regression was used to estimate odds ratios of SUA and TBIL for CVD. The effect size of additive interaction was estimated by three measures, i.e., relative excess risk due to interaction, attributable proportion due to interaction and synergy index. Among 6713 patients with T2DM, 561 (8.36%) suffered from CVD. Using ≥283 umol/L (median) to define high SUA and <11.5 umol/L (n = 2290 or 34.11%) to define low TBIL, copresence of both factors (n = 621 or 9.25%) was associated with 5.18-fold (95% CI, 4.00–6.72) risk of CVD with significant additive interactions in multivariable analysis as compared to absence of both risk factors. The copresence of both high SUA and low TBIL was associated with a large increased risk of CVD in high-risk Chinese patients with type 2 diabetes.

AIMS:The present study aimed to examine the nonlinear associations between risk factors and mild hypoglycemia in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS:From May 2013 to August 2013, we conducted a cross sectional survey of 6633 inpatients with T2DM and without severe hypoglycemia, aged 21-77 years, from 81 top tertiary hospitals in China. Mild hypoglycemia was defined as having hypoglycemia with symptoms in one month. Binary logistic regression analysis with restricted cubic splines was used to estimate odds ratio curves of non-linear risk factors for mild hypoglycemia. RESULTS:Increasing body mass index was associated with decreasing risk of mild hypoglycemia in a linear manner while age, duration of diabetes, glycated hemoglobin (HbA1c), mean artery pressure and lipids were associated with mild hypoglycemia in non-linear manners. Age ≥40 years, duration ≥2 years, HbA1c ≥7.0-<11.5% (≥53-<102 mmol/mol), triglyceride ≥1.7-<3.6 mmol/L, low-density lipoprotein cholesterol (LDL-C) ≥2.6-<4.8 mmol/L, and high-density lipoprotein cholesterol (HDL-C) ≥1.2-<4.8 mmol/L were associated with increased risks of mild hypoglycemia. CONCLUSIONS:Chinese T2DM patients with age≥40 years, duration of diabetes ≥2-<6 years, HbA1c ≥7.0-<11.5% (≥53-<102 mmol/mol), LDL-C ≥2.6-<4.8mmol/L, HDL-C ≥1.2-<4.8 mmol/L or triglyceride ≥1.7-<3.6 mmol/L were at particularly high risk for mild hypoglycemia.