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Lessons learned from young-onset diabetes in China

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Abstract

The prevalence of young-onset diabetes is rapidly rising in China. Young-onset diabetes is etiologically and phenotypically heterogeneous. Thirty percent to 50% of these patients have insulin secretory failure owing to autoimmune or monogenic or other yet to be identified forms of diabetes. Others have a strong family history of diabetes and exhibit features of the metabolic syndrome. Management of these young patients poses major diagnostic and therapeutic challenges, which require a multidisciplinary and holistic approach to ensure that these subjects are identified early and managed appropriately. Understanding the molecular basis of diabetes in these subjects may also eventually lead to improvement in diagnosis, classification, and treatment.

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References and Recommended Reading

  1. Zimmet P, Alberti KG, Shaw J: Global and societal implications of the diabetes epidemic. Nature 2001, 414:782–787.

    Article  CAS  PubMed  Google Scholar 

  2. King H, Aubert RE, Herman WH: Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections. Diabetes Care 1998, 21:1414–1431.

    Article  CAS  PubMed  Google Scholar 

  3. Ko GT, Li JK, Cheung AY, et al.: Two-hour post-glucose loading plasma glucose is the main determinant for the progression from impaired glucose tolerance to diabetes in Hong Kong Chinese. Diabetes Care 1999, 22:2096–2097.

    Article  CAS  PubMed  Google Scholar 

  4. Wat NM, Lam TH, Janus ED, Lam KS: Central obesity predicts the worsening of glycemia in southern Chinese. Int J Obes Rel Meta Disord 2001, 25:1789–1793.

    Article  CAS  Google Scholar 

  5. Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.

    Article  CAS  PubMed  Google Scholar 

  6. Cockram CS, Chan JC: The epidemiology of diabetes in the Western Pacific Region (excluding Japan). In Diabetes in the New Millennium. Edited by Turtle JR. Sydney: Pot Still Press; 1999:11–22.

    Google Scholar 

  7. Ko GT, Chan JC, Tsang LW, et al.: Outcomes of screening for diabetes in high-risk Hong Kong Chinese subjects. Diabetes Care 2000, 23:1290–1294.

    Article  CAS  PubMed  Google Scholar 

  8. Pan XR, Yang WY, Li GW, Liu J: Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care 1997, 20:1664–1669.

    Article  CAS  PubMed  Google Scholar 

  9. Cockram CS, Woo J, Lau E, et al.: The prevalence of diabetes mellitus and impaired glucose tolerance among Hong Kong Chinese adults of working age. Diabetes Res Clin Pract 1993, 21:67–73.

    Article  CAS  PubMed  Google Scholar 

  10. Lam TH, Liu LJ, Janus ED, et al.: Fibrinogen, other cardiovascular risk factors and diabetes mellitus in Hong Kong: a community with high prevalence of type 2 diabetes mellitus and impaired glucose tolerance. Diabet Med 2000, 17:798–806.

    Article  CAS  PubMed  Google Scholar 

  11. Tan CE, Emmanuel SC, Tan BY, Jacob E: Prevalence of diabetes and ethnic differences in cardiovascular risk factors. The 1992 Singapore National Health Survey. Diabetes Care 1999, 22:241–247.

    Article  CAS  PubMed  Google Scholar 

  12. Rocchini AP: Childhood obesity and a diabetes epidemic. N Engl J Med 2002, 346:854–855.

    Article  PubMed  Google Scholar 

  13. Rosenbloom AL, Jow JR, Young RS, Winter WE: Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999, 22:345–354.

    Article  CAS  PubMed  Google Scholar 

  14. Sung RY, Tong PC, Yu CW, et al.: High prevalence of insulin resistance and metabolic syndrome in overweight/obese preadolescent Hong Kong Chinese children aged 9-12 years. Diabetes Care 2003, 26:250–251.

    Article  PubMed  Google Scholar 

  15. Yang Z, Wang K, Li T, et al.: Childhood diabetes in China: enormous variation by place and ethnic group. Diabetes Care 1998, 21:525–529.

    Article  CAS  PubMed  Google Scholar 

  16. Lee WR: The changing demography of diabetes mellitus in Singapore. Diabetes Res Clin Pract 2000, 50(suppl 2):S35-S39.

    Article  PubMed  Google Scholar 

  17. Leung SS, Lau JT, Tse LY, Oppenheimer SJ: Weight-for-age and weight-for-height references for Hong Kong children from birth to 18 years. J Paediatr Child Health 1996, 32:103–109.

    CAS  PubMed  Google Scholar 

  18. Kitagawa T, Owada M, Urakami T, Yamauchi K: Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila) 1998, 37:111–115.

    Article  CAS  Google Scholar 

  19. Ko GT, Chan JC, Yeung VT, et al.: Antibodies to glutamic acid decarboxylase in young Chinese diabetic patients. Ann Clin Biochem 1998, 35:761–767.

    PubMed  Google Scholar 

  20. Thai AC, Ng WY, Loke KY, et al.: Anti-GAD antibodies in Chinese patients with youth and adult-onset ID DM and NIDDM. Diabetologia 1997, 40:1425–1430.

    Article  CAS  PubMed  Google Scholar 

  21. Banerji MA, Chaiken RL, Huey H, et al.: GAD antibody negative NIDDM in adult Black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4. Flatbush Diabetes. Diabetes 1994, 43:741–745.

    Article  CAS  PubMed  Google Scholar 

  22. Tan KC, Mackay IR, Zimmet PZ, et al.: Metabolic and immunologic features of Chinese patients with atypical diabetes mellitus. Diabetes Care 2000, 23:335–338.

    Article  CAS  PubMed  Google Scholar 

  23. Li JK, Chan JCN, Zimmet PZ, et al.: Young Chinese adults with new onset of diabetic ketoacidosis-clinical course, autoimmune status and progression of pancreatic beta-cell function. Diabet Med 2000, 17:295–298.

    Article  CAS  PubMed  Google Scholar 

  24. Bell GI, Polonsky KS: Diabetes mellitus and genetically programmed defects in beta cell function. Nature 2001, 414:788–791.

    Article  CAS  PubMed  Google Scholar 

  25. Chan JC, Cheung CK, Swaminathan R, et al.: Obesity, albuminuria and hypertension among Hong Kong Chinese with noninsulin-dependent diabetes mellitus (NIDDM). Postgrad Med J 1993, 69:204–210.

    Article  CAS  PubMed  Google Scholar 

  26. Lee SC, Ko GT, Li JK, et al.: Factors predicting the age when type 2 diabetes is diagnosed in Hong Kong Chinese subjects. Diabetes Care 2001, 24:646–649.

    Article  PubMed  Google Scholar 

  27. Ng MC, Li JK, So WY, et al.: Nature or nurture-an insightful illustration from a Chinese family with hepatocyte nuclear factor-1 alpha diabetes (MODY3). Diabetologia 2000, 43:816–818.

    Article  CAS  PubMed  Google Scholar 

  28. Fajans SS, Bell GI, Polonsky KS: Molecular mechanisms and clinical pathophysiology of maturity onset diabetes of the young. N Engl J Med 2001, 345:971–980. A excellent review on the clinical features, pathogenesis, and diagnosis of MODY.

    Article  CAS  PubMed  Google Scholar 

  29. Ng MC, Cockburn BN, Lindner TH, et al.: Molecular genetics of diabetes mellitus in Chinese: identification of mutations in glucokinase and hepatocyte nuclear factor-1 alpha genes in patients with early-onset type 2 diabetes mellitus/MODY. Diabet Med 1999, 16:956–963.

    Article  CAS  PubMed  Google Scholar 

  30. Ng MC, Lee SC, Ko GT, et al.: Familial early-onset type 2 diabetes in Chinese patients: obesity and genetics have more significant roles than autoimmunity. Diabetes Care 2001, 24:663–671.

    Article  CAS  PubMed  Google Scholar 

  31. Xu JY, Chan V, Zhang WY, et al.: Mutations in the hepatocyte nuclear factor-1 alpha gene in Chinese MODY families: prevalence and functional analysis. Diabetologia 2002, 45:744–746.

    Article  CAS  PubMed  Google Scholar 

  32. Jap TS, Wu YC, Chiou JY, Kwok CF: A novel mutation in the hepatocyte nuclear factor-1 alpha/MODY3 gene in Chinese subjects with early-onset type 2 diabetes mellitus in Taiwan. Diabet Med 2000, 17:390–393.

    Article  CAS  PubMed  Google Scholar 

  33. Smith PR, Dronsfield MJ, Mijovic CH, et al.: The mitochondrial tRNA Leu(UUR) A to G 3243 mutation is associated with insulin dependent and non insulin dependent diabetes in a Chinese population. Diabet Med 1997, 14:1026–1031.

    Article  CAS  PubMed  Google Scholar 

  34. Xiang K, Wang Y, Wu S, et al.: Mitochondrial tRNA Leu(UUR) gene mutation diabetes mellitus in Chinese. Chin Med J (Engl) 1997, 110:372–378.

    CAS  Google Scholar 

  35. Ng MC, Yeung VT, Chow CC, et al.: Mitochondrial DNA A3243G mutation in patients with early- or late-onset type 2 diabetes mellitus in Hong Kong Chinese. Clin Endocrinol 2000, 52:557–564.

    Article  CAS  Google Scholar 

  36. Lee SC, Hashim Y, Li JK, et al.: The islet amyloid polypeptide (amylin) gene S20G mutation in Chinese subjects: evidence for associations with type 2 diabetes and cholesterol levels. J Endocrinol 2001, 54:541–546.

    CAS  Google Scholar 

  37. Li JK, Chiu CK, Ng MC, et al.: Clustering of cardiovascular risk factors amongst siblings of Chinese young-onset diabetic patients [abstract]. Diabetes 2000, 49(suppl 1):A388.

    Google Scholar 

  38. Chan JC, Cheung JC, Lau EM, et al.: The metabolic syndrome in Hong Kong Chinese: the interrelationships among its components analyzed by structural equation modeling. Diabetes Care 1996, 19:953–959.

    Article  CAS  PubMed  Google Scholar 

  39. Lee ZS, Critchley JA, Ko GT, et al.: Obesity and cardiovascular risk factors in Hong Kong Chinese. Obes Rev 2002, 3:178–182. Provides supporting evidence for the reclassification of obesity in Asians by using lower BMI and waist circumference, and their close association with cardiovascular risk factors and development of metabolic syndrome.

    Article  Google Scholar 

  40. Ko GT, Chan JC, Woo J, et al.: Simple anthropometric indexes and cardiovascular risk factors in Chinese. Int J Obes Relat Meta Disord 1997, 21:995–1001.

    Article  CAS  Google Scholar 

  41. International Obesity Task Force: The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Edited by Inoue S, et al. Australia: World Health Organization, Western Pacific Region; 2000.

    Google Scholar 

  42. He M, Tan KC, Li ET, Kung AW: Body fat determination by dual energy X-ray absorptiometry and its relation to body mass index and waist circumference in Hong Kong Chinese. Int J Obes Relat Metab Disord 2001, 25:748–752.

    Article  CAS  PubMed  Google Scholar 

  43. Ko GT, Tang J, Chan JC, et al.: Lower BMI cut off value to define BMI obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedence. Br J Nutr 2001, 85:239–242.

    CAS  PubMed  Google Scholar 

  44. Lee ET, Lu M, Bennett PH, Keen H: Vascular disease in younger-onset diabetes: comparison of European, Asian and American Indian cohorts of the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001, 44(suppl 2):S78-S81. Highlights the ethnic differences as well as high incidence of various cardiovascular and renal diseases in young-onset diabetes in different populations.

    Article  PubMed  Google Scholar 

  45. Yokoyama H, Okudaira M, Otani T, et al.: High incidence of diabetic nephropathy in early-onset Japanese NIDDM patients. Risk analysis. Diabetes Care 1998, 21:1080–1085.

    Article  CAS  PubMed  Google Scholar 

  46. Chan JC, Cheung CK, Cheung MY, et al.: Abnormal albuminuria as a predictor of mortality and renal impairment in Chinese patients with NIDDM. Diabetes Care 1995, 18:1013–1014.

    Article  CAS  PubMed  Google Scholar 

  47. Ko GT, Chan JC, Lau M, Cockram CS: Diabetic microangiopathic complications in young Chinese diabetic patients: a clinic-based cross-sectional study. J Diabetes Complications 1999, 13:300–306.

    Article  CAS  PubMed  Google Scholar 

  48. Chan JC, Tong PC, Critchley JA: The insulin resistance syndrome-mechanism of clustering of cardiovascular risk. In Seminars in Vascular Medicine. Edited by Yudkin JS, Stehouwer CDA. New York: Thieme Medical Publishers; 2002:45–57. Summarizes recent evidences for the roles of neurohormonal control of adiposity, iron overload, liver dysfunction, socioeconomics, in utero environment, and genetics in the pathogenesis of insulin resistance syndrome. The authors suggest that various hypotheses may be integrated by factor analysis or structural equation modeling to unravel the complex nature of this disease.

    Google Scholar 

  49. Mi J, Law C, Zhang KL, et al.: Effects of infant birthweight and maternal body mass index in pregnancy on components of the insulin resistance syndrome in China. Ann Intern Med 2000, 132:253–260.

    CAS  PubMed  Google Scholar 

  50. Lee ZS, Chan JC, Yeung VT, et al.: Plasma insulin, growth hormone, cortisol, and central obesity among young Chinese type 2 diabetic patients. Diabetes Care 1999, 22:1450–1457.

    Article  CAS  PubMed  Google Scholar 

  51. Lee ZS, Critchley JA, Tomlinson B, et al.: Urinary epinephrine and norepinephrine interrelations with obesity, insulin and the metabolic syndrome in Hong Kong Chinese. Metabolism 2000, 50:135–143.

    Article  Google Scholar 

  52. Pradhan AD, Manson JE, Rifai N, et al.: C-reactive protein, interleukin 6 and risk of developing type 2 diabetes mellitus. JAMA 2001, 286:327–334.

    Article  CAS  PubMed  Google Scholar 

  53. Ferrannini E: Insulin resistance, iron, and the liver. Lancet 2000, 355:2181–2182.

    Article  CAS  PubMed  Google Scholar 

  54. Lao TT, Ho LF: Alpha-thalassaemia trait and gestational diabetes mellitus in Hong Kong. Diabetologia 2001, 44:966–971.

    Article  CAS  PubMed  Google Scholar 

  55. Tong PC, Ng MC, Ho CS, et al.: C reactive protein and insulin resistance in subjects with thalassemia minor and a family history of diabetes. Diabetes Care 2002, 25:1480–1481.

    Article  PubMed  Google Scholar 

  56. Tong PC, Lee ZS, Sea MM, et al.: The effect of orlistat-induced weight loss, without concomitant hypocaloric diet, on cardiovascular risk factors and insulin sensitivity in young obese Chinese subjects with or without type 2 diabetes. Arch Intern Med 2002, 25:2428–2435.

    Article  Google Scholar 

  57. Chan JC, Cockram CS: Diabetes in the Chinese population and its implications for health care. Diabetes Care 1997, 20:1785–1790.

    CAS  PubMed  Google Scholar 

  58. Chan JC, Ng MC, Critchley JA, et al.: Diabetes mellitus-a special medical challenge from a Chinese perspective. Diabetes Res Clin Pract 2001, 54(suppl 1): 19–27.

    Article  Google Scholar 

  59. Chan WB, Chan JC, Chow CC, et al.: Glycemic control in type 2 diabetes: the impact of body weight, beta cell function and patient education. Q J Med 2000, 93:183–190.

    CAS  Google Scholar 

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Authors and Affiliations

  1. 9/F, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China

    Juliana C. N. Chan MD, FRCP

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  1. Juliana C. N. Chan MD, FRCP
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  2. Maggie C. Y. Ng PhD
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Chan, J.C.N., Ng, M.C.Y. Lessons learned from young-onset diabetes in China. Curr Diab Rep 3, 101–107 (2003). https://doi.org/10.1007/s11892-003-0032-y

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