Dr Yu-Min

LinConsultant

Geriatrician

Middlemore

Hospital

Auckland

8:30 - 10:30 WS #6: An Asian Flavour - East Meets West

11:00 - 13:00 WS #13: An Asian Flavour - East Meets West (Repeated)

Dr Pui Ling

ChanEndocrinologist

MacMurray Centre

Auckland

Dr Andrew

ToCardiologist

Director of Cardiac

CT

Multimodality

Imaging

Cardiologist

Auckland

Dr James

LiangClinical and

Pathology

Haematologist

Middlemore

Hospital

Auckland

Dr Donny

WongRespiratory and

General Physician

Waitemata DHB

Auckland

Dr Michelle

WongORL Surgeon

Auckland ENT

Group

Auckland

Dr Derek

LuoConsultant

Gastroenterologist

Director

Greenlane

Medical

Specialists

Auckland

Dr Judy

HuangConsultant

Gastroenterologist

Middlemore Hospital

Auckland

East meets West The Endocrinology perspective

A Chinese Perspective

Dr Pui-Ling Chan

Endocrinologist

7th June 2018

Chinese population in NZ (Auckland)

Stats NZ: New Zealand's Asian population could reach 1.4 million by 2038 (from 540,000) (Source: NZ Herald 3 Oct 2017)

Diabetes – a Chinese perspective

Diabetes in China – a growing problem

• 1 in 10 adults (UK 1 in 20)

• Alarming

• Many still undiagnosed

• Edged ahead of India

• Modernisation, sedentary lifestyle, obesity

• Urban – diabetes hotspots

Risk factors for diabetes epidemic in China

Increasing overall & abdominal obesity• Economic development, lifestyle change, diet

• Increasing prevalence of obesity

• T2D develops at a considerably lower BMI in Chinese

• Attributed to tendency towards visceral adiposity in East Asia population, including Chinese

• East Asian have more serious insulin defect

Genetic factors & Early life risk factors

• Asians are moderately susceptible to T2D

• KCNQ1 is considered the strongest locus for T2D in East Asian

• 8 more new loci were discovered since 2010 that increase the risk of T2D by 18%

• Famine exposure

• Maternal over nutrition, obesity, GDM

• Epigenetic mechanism important in maternal-placental-fetaltransmission of metabolic phenotype

Other risk factors for diabetes in Chinese

• Hypertriglyceridaemia

• NAFLD

Increased risk of T2D by twofold

Current T2D therapy in China

• Chinese have more postprandial hyperglycaemia

• Chinese Diabetes Society guideline:

➢Diet & Exercise are fundamental

➢Metformin is first line

➢Acarbose is also recommended (PP hyperglycaemia)

➢GLP1 RA

➢Insulin

Summary

• China is now an epicentre for diabetes epidemic

• Lifestyle, obesity, genetics

• Clinical utility of genetic info on prediction, early identification & prevention of T2D is still at preliminary stage

• Postprandial hyperglycaemia is an important pathogenesis in Chinese diabetics

• Acarbose is not infrequently used amongst Chinese

Osteoporosis in East Asia• HK, Japan, Korea, Macau, China, Taiwan

• Osteoporosis is a growing problem

• China has the largest aged population (>60) in the world reaching 400 million by year 2050

• By 2050, Japan’s aged population (>65) would have risen from 20% (2005) to 40%

• Exponential increase in hip fracture after age 65

• Under diagnosed, under treated, suboptimal awareness, financial constraints, lack of cost effectiveness analysis

Risk factors for fractures

• Low BMD

• Lack of DXA availability – widespread use of Quantitative ultrasounometry (QUS)

• Osteoporosis Self Assessment Tool for Asians is a simple pre-screening tool

• Clinical risk factors: age, prior #, concomitant illnesses, history of falls, propensity to falls

Inadequate calcium & vitamin D intake

• Prevalent in HK, China, Japan, Taiwan & Korea

• On the whole, East Asian population have lower dietary calcium intake

• Average calcium intake:

➢China <400mg/day

➢Hong Kong 400-600mg/day

(Recommended daily calcium 1000mg/day & vitamin D 800IU/day)

• Patient & Physician are still unaware of importance of calcium & D3 in osteoporosis prevention

Calcium map (source : IOF)

Foods rich in calcium – for Asians

Food Serving size Calcium (mg)

Tofu 120g 126

Wakame 100g 150

Cheddar/Colby/Edam Cheese 30g 240

Almond 30g 75

Soy milk (semi skimmed milk) 200ml 240

Broccoli/Cress 120g 112-188

Sardine in oil (Canned) 60g 240

Yoghurt 150g 207

International Osteoporosis Foundation (IOF)

Summary

• Greatest burden of hip fracture is expected to occur in East Asia(China)

• Relative paucity of information on epidemiology & burden

• Greatly underdiagnosed and undertreated

• Needs improvement in DXA access, increased awareness (public & physician)

• Inadequate calcium & vitamin D intake is still an issue in this region