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Hong Wang, Jie Cao, Jian-bin Su, Xueqin Wang, Dong-mei Zhang, and Xiao-hua Wang

Background: Antithrombin 3 (AT3) is a physiological inhibitor of thrombin, and serum AT3 activity was found to be decreased at the status of type 2 diabetes (T2D). T2D was presented with an increased risk of thrombotic complications at the background of impaired insulin sensitivity. The aim of this study was to investigate the relationship between insulin sensitivity indices and serum AT3 activity in patients with T2D.

Methods: We conducted a cross-sectional study in patients with T2D who consented to participate in the study at the Endocrinology Department of Affiliated 2 Hospital of Nantong University from January 2015 to June 2018. All patients received serum AT3 activity test and 75-g oral glucose tolerance test (OGTT). Basal and systemic insulin sensitivity were assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and Matsuda index (ISIMatsuda), respectively, from the OGTT. And other relevant clinical data were also collected.

Results: Total 1612 patients with T2D were enrolled in the study, with a mean age of 58.67±13.09 years and a median diabetes duration of 6 years (interquartile range, 1–10 years). Across ascending quartiles of serum AT3, HOMA-IR progressively decreased, while ISIMatsuda progressively increased (all p for trend <0.001). Moreover, serum AT3 was negatively correlated with HOMA-IR (r= –0.189, p<0.001) and positively correlated with ISIMatsuda (r=0.221, p<0.001). After adjusting for other metabolic risk factors, hemostatic parameters and glucose-lowering therapies by multivariate liner regression analysis, HOMA-IR (β= −0.185, t= −5.960, p<0.001) and ISIMatsuda (β= 0.197, t=6.632, p<0.001) remained independently associated with the serum AT3 activity in patients with T2D, respectively.

Conclusions: Reduced basal and systemic insulin sensitivity are associated with decreased serum AT3 activity in patients with T2D.

Open access

Weidi Wang, Ling-Jun Kong, Hong-Kun Guo, and Xiang-Jin Chen

Background: The presence of clinically negative nodules on the contralateral lobe is common in patients with unilateral papillary thyroid microcarcinoma (PTMC). The appropriate operational strategies of contralateral thyroid nodules remain controversial. In this study, we analyzed clinical features that could be predictors for malignancy of contralateral thyroid nodules coexisting with diagnosed unilateral PTMC.

Methods: The literatures published from January 2000 to December 2019 were searched in PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wan Fang database. Odds ratio (OR) with 95% confidence intervals (CI) were used to describe categorical variables. Heterogeneity among studies was examined by the Q test and I2 test; potential publication bias was detected by Harbord test and ‘trim and fill’ method.

Results: 2541 studies were searched and 8 studies were finally included in this meta-analysis. The results showed that the rate of carcinoma in contralateral nodules was 23% (OR=0.23, 95%CI=0.18-0.29). The pooled data indicated that contralateral malignancy was not associated with age, gender, primary lesion size, ipsilateral central lymph node metastasis and multifocality of contralateral lesion. The following variables have correlations with an increased risk of contralateral malignancy: multifocality of primary carcinomas (OR=3.93, 95%CI=2.70-5.73, p<0.0001), capsular invasion (OR=1.61, 95%CI=1.10-2.36, p=0.01), and Hashimoto's thyroiditis (OR=1.57,95%CI=1.13-2.20, P=0.008).

Conclusions: Based on our meta-analysis, the rate at which contralateral malignancy are preoperatively misdiagnosed as benign is 23%. The risk factors for contralateral malignancy in unilateral PTMC patients with contralateral clinical negative nodules include multifocality of primary carcinomas, capsular invasion, and Hashimoto's thyroiditis.

Open access

Yuan Fang, Xuehong Zhang, Huilin Xu, Stephanie A Smith-Warner, Dongli Xu, Hong Fang, and Wang Hong Xu

The excess risk of cancer observed in patients with type 2 diabetes (T2DM) may have been influenced by detection bias. The aim of this study was to examine the real association by evaluating time-varying site-specific cancer risks in newly diagnosed T2DM patients. A total of 51,324 registered cancer-free individuals newly diagnosed with T2DM between 2004 and 2014 were linked with the Shanghai Cancer Registry and the Vital Statistics through September 2015. A total of 2920 primary, invasive cancer cases were identified during 325,354 person-years period. Within 1 year following diabetes onset, participants with T2DM had higher risks of total, lung and rectal cancer in men and total, liver, pancreas, thyroid, breast and uteri cancer in women. Thereafter the incidence for overall cancer decreased and then increased along with follow-up time, with the upward trend varying by cancer, suggesting potential detection bias. After the initial 1-year period, standardized incidence ratios (SIR) and 95% CIs for overall cancer were 0.80 (95% CI 0.76–0.85) in men and 0.93 (95% CI 0.88–0.99) in women, but a higher risk of breast and thyroid cancers were observed in women, with SIR and 95% CI being 1.13 (1.01, 1.28) and 1.37 (1.11, 1.63), respectively. Our results suggest that T2DM patients are at higher risk of certain cancers; this risk particularly increases shortly after diabetes diagnosis, which is likely to be due to detection bias caused by increased ascertainment. Prevention of female breast and thyroid cancers should be paid attention in Chinese individuals with T2DM.

Open access

Fang Lv, Xiaoling Cai, Chu Lin, Tianpei Hong, Xiaomei Zhang, Zhufeng Wang, Huifang Xing, Guizhi Zong, Juming Lu, Xiaohui Guo, Jing Wu, Leili Gao, Xianghai Zhou, Xueyao Han, and Linong Ji

Aims

To estimate the sex differences in the prevalence of overweight and obesity aged 20–89 in Chinese patients with type 2 diabetes (T2D).

Methods

811,264 patients with T2D from six hospital-based, cross-sectional studies, and 46,053 subjects from the general population were included in our analysis. Prevalence of underweight, overweight, obesity were calculated in each sex.

Results

In patients with T2D, the standardized prevalence of underweight (BMI <18.5 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2), and general obesity (BMI ≥28 kg/m2) were 2.2%, 43.2%, and 11.6%, respectively. Similar trend patterns of the prevalence of underweight and overweight were observed in general and T2D population, in males and females with T2D (all P for trend <0.01). In patients with T2D, patients at a younger age and older age were more likely to be underweight. The prevalence of overweight increased first, then stabilized or decreased with age. However, different trend patterns of the prevalence of obesity in males and females were found. In males, the prevalence of obesity decreased first, and then stabilized after 60 years of age. In females, the prevalence of obesity decreased first, then increased after 50 years of age. In the general population, the prevalence of obesity increased with age in females, while, the trend of prevalence of obesity with age in males was not obvious.

Conclusion

Different trends in the prevalence of obesity with age in different sex were found in Chinese patients with T2D.