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OBJECTIVEThe objective of this study was to evaluate the effect of maternal hyperglycemia during pregnancy on cardiometabolic risk in offspring during early childhood.RESEARCH DESIGN AND METHODSA total of 970 mothers who had joined the Hyperglycemia and Adverse Pregnancy Outcome study were reevaluated, together with their child born during the study period, 7 years after delivery.RESULTSOffspring born to mothers diagnosed with gestational diabetes mellitus (GDM), as defined by the World Health Organization 2013 GDM criteria, had higher rates of abnormal glucose tolerance (4.7% vs. 1.7%; P = 0.04), higher rates of overweight or obesity, greater BMI, higher blood pressure (BP), lower oral disposition index, and a trend toward reduced β-cell function compared with those born to mothers without GDM. For each SD increase in maternal fasting, 1-h, and 2-h glucose levels on oral glucose tolerance tests (OGTTs) between 24 and 32 weeks of the index pregnancy, the risk of abnormal glucose tolerance in the offspring showed a corresponding increase (adjusted odds ratio [OR] 1.85–2.00). The associations were independent of BMI before pregnancy, childhood obesity, or being born large for gestational age. The area under the curve for glucose levels during the five-point OGTT increased to a similar extent in boys and girls with each SD increase in maternal 1-h and 2-h plasma glucose on OGTTs during pregnancy. All three maternal glucose levels were also associated with increased adjusted ORs for childhood overweight or obesity and adiposity among girls, but not boys.CONCLUSIONSMaternal hyperglycemia in pregnancy is independently associated with offsprings’ risk of abnormal glucose tolerance, obesity, and higher BP at 7 years of age. Its effect on childhood adiposity was apparent only in girls, not boys.

OBJECTIVE -Chronic kidney disease (CKD) predicts cardiovascular disease (CVD) in the general population. We investigated the effects of stages of renal function using the estimated glomerular filtration rate (eGFR) on all-cause mortality and cardiovascular end points in a prospective cohort of Chinese type 2 diabetic patients. -Between 1995 and 2000, 4,421 patients without macrovascular disease or end-stage renal disease were recruited. Renal function was assessed by eGFR, as calculated by the abbreviated Modification of Diet in Renal Disease Study Group formula. Clinical end points included all-cause mortality, cardiovascular end point (cardiovascular death, new admissions due to angina, myocardial infarction, stroke, revascularization, or heart failure), and renal end point (reduction in eGFR by Ͼ50%, progression of eGFR to stage 5, or dialysis or renal death). RESEARCH DESIGN AND METHODS RESULTS-After a median follow-up period of 39.4 months (interquartile range 20.3-55), all-cause mortality rate increased from 1.2% (95% CI 0.8 -1.7) to 18.3% (9.1-27.5) (P for trend Ͻ0.001) as renal function deteriorated from stage 1 (eGFR Ն90 ml/min per 1.73 m 2 ) to stage 4 (15-29 ml/min per 1.73 m 2 ). The respective rate of new cardiovascular end points also increased from 2.6% (2.0 -3.3) to 25.3% (15.0 -35.7) (P for trend Ͻ0.001). After adjustment for covariates (age, sex, albuminuria, use of renin-angiotensin-aldosterone system [RAAS] inhibitors, lipids, blood pressure, and glycemic control), hazard ratios across different stages of eGFR (Ն90, 60 -89, 30 -59, and 15-29 ml/min per 1.73 m 2 ) for all-cause mortality were 1.00, 1.27, 2.34, and 9.82 (P for trend Ͻ0.001), for cardiovascular end points were 1.00, 1.04, 1.05, and 3.23 (P for trend Ͻ0.001), and for renal end points were 1.00, 1.36, 3.34, and 27.3 (P for trend Ͻ0.001), respectively. CONCLUSIONS -Chinese type 2 diabetic patients with reduced eGFR were at high risk of developing cardiovascular end points and all-cause mortality, independent of albuminuria and metabolic control. Diabetes Care 29:2046 -2052, 2006I n the general population, chronic kidney disease (CKD) predicts occurrence of cardiovascular disease (CVD), but similar information in the diabetic population is limited (1-3). Diabetes is the most common cause of end-stage renal disease, accounting for nearly 50% of all new cases of renal replacement therapy in most developed countries (3,4). Asians have a high risk of developing nephropathy, which affects 60% of hypertensive type 2 diabetic patients (5). In the World Health Organization Multinational Study of Vascular Disease in Diabetes (4), 10 -15% of diabetic patients in China and Japan died from end-stage renal disease in contrast to Ͻ5% in North America and Europe, possibly due to genetic influence (6), environmental factors yet to be identified, and limited access to renal replacement therapy. Although large-scale studies have suggested that Asians might have a lower risk of developing CVDs compared with Caucasians (7), given their predilection for...

Background: Diabetes reduces life expectancy by 10 to 12 years, but whether death can be predicted in type 2 diabetes mellitus remains uncertain.Methods: A prospective cohort of 7583 type 2 diabetic patients enrolled since 1995 were censored on July 30, 2005, or after 6 years of follow-up, whichever came first. A restricted cubic spline model was used to check data linearity and to develop linear-transforming formulas. Data were randomly assigned to a training data set and to a test data set. A Cox model was used to develop risk scores in the test data set. Calibration and discrimination were assessed in the test data set.Results: A total of 619 patients died during a median follow-up period of 5.51 years, resulting in a mortality rate of 18.69 per 1000 person-years. Age, sex, peripheral arterial disease, cancer history, insulin use, blood he-moglobin levels, linear-transformed body mass index, random spot urinary albumin-creatinine ratio, and estimated glomerular filtration rate at enrollment were predictors of all-cause death. A risk score for all-cause mortality was developed using these predictors. The predicted and observed death rates in the test data set were similar (PϾ.70). The area under the receiver operating characteristic curve was 0.85 for 5 years of follow-up. Using the risk score in ranking cause-specific deaths, the area under the receiver operating characteristic curve was 0.95 for genitourinary death, 0.85 for circulatory death, 0.85 for respiratory death, and 0.71 for neoplasm death.Conclusions: Death in type 2 diabetes mellitus can be predicted using a risk score consisting of commonly measured clinical and biochemical variables. Further validation is needed before clinical use.