Community-based study of cataracts among type 2 diabetics in Kinmen

The purpose of this study was to assess the prevalence and risk factors of each type of cataract among type 2 diabetics in Kinmen, Taiwan. There were 971 type 2 diabetics ascertained from a community-based mass screening between 1991 and 1993. In 1999, a total of 578 (59.5%) patients with type 2 diabetes were examined with an eye screening performed by two senior ophthalmologists using a 45-degree thin slit-lamp biomicroscopy and ophthalmoscopy to examine the lens after dilating the pupils. The overall prevalence, including subjects with or without surgery, was 31.0% (179/578, 95% CI: 27.3–34.7%), and had a statistically significant difference for gender (χ²=8.78, p = 0.003) and age (χ²-trend = 11.89, p < 0.0001). Based on multiple logistic regression, the significant risk factors of all types of cataracts were age (OR = 1.16, 95% CI: 1.12–1.20), lower diastolic blood pressure (DBP) at baseline (OR = 0.47, 95% CI: 0.25–0.88), and higher triglyceride at baseline (OR = 2.19, 95% CI: 1.07–4.45). In conclusion, our results found that in addition to age, lower DBP and higher triglyceride at baseline may increase the risk of prevalent cataracts in type 2 diabetics.     

Community-based study on summer-winter differences of component of metabolic syndrome in Kinmen, Taiwan

BACKGROUND: A community-based study was conducted to investigate summer-winter differences of component of metabolic syndrome in Kinmen, Taiwan. METHODS: A total of 8251 residents aged 40 and over were enrolled in the mass survey in Kinmen. They were investigated while on summer (July and August) and winter vacation (January and February) during 2000-2003. Demographics, physical examination findings, lifestyle variables and biochemical data were collected. RESULTS: After controlling for age, body mass index, diet, lifestyle and other risk factors for component of metabolic syndrome, there were independent and significant relationships between summer-winter difference and component of metabolic syndrome. Winter season was positively correlated with blood pressure, fasting plasma glucose level, high-density lipoprotein-cholesterol (HDL-C) and waist circumference, but was negatively associated with fasting triglycerides and metabolic syndrome. CONCLUSIONS: Summer season is positively associated with hypertriglyceridemia, low HDL-C and metabolic syndrome. These findings imply that cross-sectional, experimental and cohort studies of component of metabolic syndrome or metabolic syndrome should take season into account as possible confounding effects.     

Anonymity in epidemiological surveys: study and initiation of a new method

The authors propose a system of registering epidemiological data which ensures strict observation of anonymity. Data are made anonymous at the source: the practitioners who possess the medically confidential information themselves compute the code number creating anonymity through a nonreversible calculation formula: it is impossible to work back from the number to the patient's identity, even if one has the formula and powerful computer resources. This method differs from simple data encoding whose key could either be discovered or revealed: it requires neither keys nor a secret but effects a definitive and irreversible transformation. In compliance with the recommendations of the committee on Ethics, of the French "Ordre des Médecins" and of the Law on Data Processing and Liberties, the method was subjected to a double test for reliability, experimental and theoretical.     

Reproducibility of the new diagnostic criteria for impaired glucose tolerance

Sixty-seven subjects with impaired glucose tolerance and 136 normoglycemic individuals defined according to the diagnostic criteria of the European Association for the Study of Diabetes were selected from among persons aged 40-59 years who participated in a health examination survey in Naples in 1980. A second oral glucose tolerance test was given under identical conditions between two and four months later with the participants having no knowledge of the results of the first test. Venous whole blood was utilized for blood glucose determination. At the second test, 93% of the control group were confirmed to be normoglycemic, but only 56% of the impaired glucose tolerance group were still intolerant. Reproducibility was poorest among subjects with blood glucose two hours after load of less than 140 mg/dl. Among these subjects, 47% reverted to normoglycemia at the second test. In contrast, 15% of those with blood glucose greater than or equal to 140 mg/dl two hours after load reverted to normoglycemia (chi 2 = 6.29, p less than 0.05). Subjects with impairment of glucose tolerance at the second test were reclassified according to the diagnostic criteria of the National Diabetes Data Group and the World Health Organization (WHO). Only 22 (46%) of the 48 individuals classified in the impaired glucose tolerance group according to the criteria of the European Association for the Study of Diabetes were so classified by the criteria of both the National Diabetes Data Group and WHO. The disagreement between the three diagnostic criteria was maximal in the lowest blood glucose range. It is concluded that the diagnosis of impaired glucose tolerance, despite the new diagnostic criteria, still has little reproducibility and uniformity.     

Economic evaluation of screening for diabetic retinopathy among Chinese type 2 diabetics: a community-based study in Kinmen, Taiwan

Background

This community-based study conducted in Kinmen aimed to discover whether screening for diabetic retinopathy (DR) among Chinese with type 2 diabetes was economically feasible and clinically effective.

Methods

A total of 971 community-dwelling adults previously diagnosed with type 2 diabetes in 1991-1993 underwent DR screening in 1999-2002 by a panel of ophthalmologists, who used on-site indirect ophthalmoscopy and 45-degree color fundus retinal photographs. Economic evaluation included estimates for cost effectiveness and the cost utility of screening for DR.

Results

For each DR case, screening efficacy and utility decreased, while cost increased with the length of the screening interval. The cost per sight year gained in the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were New Taiwan dollars (NT$) 20962, NT$ 24990, NT$ 30847, NT$ 37435, NT$ 44449, and NT$ 83411, respectively. The cost per quality-adjusted life year gained by the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were NT$ 21924, NT$ 25319, NT$ 30098, NT$ 35106, NT$ 40037, and NT$ 61542, respectively. Threshold values indicate that the screening programs are highly sensitive to screening cost in the plausible range.

Conclusion

Screening for DR is both medically and economically worthwhile. Annual screening for DR among Chinese with type 2 diabetes should be conducted. Prevention programs aimed at improving eye care for patients with type 2 diabetes result in both substantial federal budgetary savings and highly cost-effective health care.Key words: Population, Diabetic Retinopathy, Costs and Cost Analysis, Mass Screening, Diabetes Mellitus Type 2     

社区流行病学研究是探索恶性肿瘤病因和评估预防控制效果的关键

随着人口老龄化程度的加深,心脑血管疾病和恶性肿瘤已经是我国人口主要死亡原因。恶性肿瘤是人群平均寿命之前,尤其是工作人群(≤60岁)的主要死亡原因。从人群疾病控制角度来看,恶性肿瘤分三大类。第一类是高度恶性肿瘤,如胰腺癌、肝癌、消化道印戒细胞癌和小细胞肺癌等。这类恶性肿瘤进展快、治疗效果差,对这类种类防制的重点是对高危人群进行病因预防,即一级预防,以降低人群发病率;第二类是中等恶性肿瘤,如结直肠癌、非小细胞肺癌、乳腺癌等,这类肿瘤进展较慢,对治疗反应较好,而且均有明显的癌前病变,通过对癌前病变的治疗如手术切除可以降低癌症发病率,这类肿瘤适合早期筛查、早期诊断和早期治疗,即二级预防,以降低人群死亡率;第三类是低度恶性(惰性)肿瘤,如前列腺癌、甲状腺癌等,这类肿瘤基本上对人群期望寿命不造成损害,积极治疗也难以提升患者的有效生存,对这类肿瘤防制的重点是治疗转移,即三级预防。对恶性肿瘤不加以分类地进行过度诊断和过度治疗不但对患者造成精神损伤和经济负担,而且对有效生存无益,浪费医疗资源。阐明恶性肿瘤病因,评估恶性肿瘤的流行状况、疾病负担、预防效果甚至各种临床治疗方案的效果均依赖于以社区为主的肿瘤流行病学研究。     

Community-based recruitment strategies for a longitudinal interventional study: the VECAT experience

This article examines different recruitment strategies for the VECAT Study, a 4-year, double-masked, placebo-controlled, randomized clinical trial of vitamin E in the prevention of cataract and age-related maculopathy. Five recruitment methods were employed: newspaper advertising, radio advertising, approaches to community groups, approaches via general practices, and an electoral roll mail-out. Participants (1204) from the community in Melbourne, Australia were recruited and enrolled within 15 months (age range: 55-80 years, mean 66 years; gender ratio: 57% female, 43% male). The electoral roll mail-out and newspaper advertising were the most efficient methods of recruitment in terms of absolute numbers of participants recruited and cost per participant. Recruitment for the VECAT study was successfully completed within the planned period. Although the electoral roll mail-out and newspaper advertising were the most efficient for this study, other methods may be of value for studies with different subject selection criteria.     

Use of glucose,insulin, and C-reactive protein to determine need for glucose tolerance testing

OBJECTIVE: Glucose intolerance has been shown to be a better predictor of morbidity and mortality than impaired fasting glucose. However, glucose tolerance tests are inconvenient and expensive. This study evaluated the relative frequencies of glucose intolerance and impaired fasting glucose and sought to determine if 2-hour glucose could be predicted from simple demographic and laboratory data in an obese population. RESEARCH METHODS AND PROCEDURES: Eighty-nine obese subjects (median BMI 35 kg/m(2), range 30 to 40 kg/m(2)) underwent glucose tolerance testing. Using step-wise linear and logistic regression analysis, fasting glucose, high-sensitivity C-reactive protein (hsCRP), fasting insulin, high-density lipoprotein cholesterol, triglycerides, weight, height, BMI, waist circumference, hip circumference, waist-to-hip ratio, sex, and age were assessed as predictors of glucose intolerance. RESULTS: Impaired glucose tolerance was more prevalent (27%) than impaired fasting glucose (5.6%). Only fasting glucose and hsCRP were significant (p < 0.05) independent predictors of impaired 2-hour glucose (>140 mg/dL). A fasting glucose > or =100 mg/dL or an hsCRP > 0.32 mg/dL (upper quartile of the normal range) detected 81% (sensitivity) of obese subjects with impaired glucose tolerance; however, specificity was poor (46%). Fasting insulin > or =6 micro U/mL had better sensitivity (92%) but poorer specificity (30%). DISCUSSION: Impaired glucose tolerance is more common than impaired fasting glucose in an obese population. Possible strategies to avoid doing glucose tolerance tests in all obese patients would be to do glucose tolerance testing only in those whose fasting glucose is > or =100 mg/dL or whose hsCRP exceeds 0.32 mg/dL or those whose fasting insulin is > or =6 micro U/mL.     

Lea''s Shield, a new barrier contraceptive preliminary clinical evaluations three-day tolerance study

In this study the Lea's Shield® was evaluated for its tolerance by women who wore the device for three consecutive days. Ten women who wore the Lea's Shield® for 72 hours completed the tolerance study without adverse effects. Examination of the cervix and vagina revealed that the device did not provoke any significant cellular or microbial changes among the wearers. No major changes in the appearance or prevalence of vaginal flora occurred in the women after three days of wearing the device. A gradient in the pH could be detected between the contents of the vagina, which was more acidic than the contents of the bowl of the device. The range of cervical shapes and vaginal morphology among the study participants has had no influence upon the ability of the device to remain in its proper position. The device “settles in place” as it is pushed in, thereby obviating any special maneuvers for proper positioning. No vaginal nor cervical trauma occurred. We have concluded from these basic clinical evaluations that Lea's Shield® is well tolerated during three days of use. Efficacy trials in women at risk recently completed have confirmed the high degree of acceptability and that the device can function adequately as one size fits all.     

Evaluation of insulin response in glucose tolerance test in a patient with Werner's syndrome: a 16-year follow-up study

To clarify the effect of Werner's syndrome (WS) on beta-islet cell function, the oral glucose tolerance test (OGTT) was repeatedly performed over a period of 16 years in one patient with WS. The data obtained on insulin secretion were assessed in this study. The patient was a 50-yr-old woman of consanguineous parentage. She presented with gray hair, cataracts, a beak-shaped nose and high-pitched voice. She was diagnosed as WS on the basis of her characteristic appearance. OGTT was performed 14 times during 9 admissions to our hospital. After ingestion of glucose, plasma glucose (PG) levels and immuno-reactive insulin (IRI) at 0, 30, 60, 90, 120 and 180 min were determined. PG levels during OGTT gradually increased during dietary therapy and, at the age of 48, insulin treatment was started [PG level at 120 min during OGTT at 46 yr (before treatment) was 1.5 times that at 34 yr]. Insulin secretion had also gradually decreased during the follow-up period (sum of IRI at 34 yr during OGTT post-treatment; 550.8 IU/ml, sum of IRI at 50 yr during OGTT post-treatment; 244.5 IU/ml). However, the insulinogenic indices were maintained at almost the same level value. Our results indicate that insufficient insulin secretion, which could not overcome insulin resistance, might play a crucial role in the pathophysiology and progression of diabetes in WS along with insulin resistance due to a post-receptor defect.     

Prevalence of gallstone disease in relation to smoking, alcohol use, obesity, and glucose tolerance: a study of self-defense officials in Japan.

Risk factors of gallstone disease were investigated in male self-defense officials who received, between October 1986 and December 1990, a retirement health examination at the Self-Defense Forces Fukuoka Hospital, Fukuoka, Japan. Gallbladder ultrasonography, successfully performed with 2,739 of 2,756 men, found 61 men with gallstones and 38 men with previous removal of the gallbladder; the overall prevalence of gallstone disease was 3.6%. Multiple logistic regression analysis assessed the risk of gallstone disease in relation to smoking, alcohol use, body mass index, glucose tolerance, and rank. Alcohol use was associated with a decreased risk, and body mass index was positively related to gallstone disease. Men with impaired glucose tolerance had a slightly elevated risk, whereas diabetes mellitus was not associated with gallstone disease. Analysis for prevalent gallstones and the postcholecystectomy state showed an inverse association of alcohol use with the latter; a positive association with impaired glucose tolerance was also confined primarily to the latter condition. These findings provide little support for a protective effect of alcohol use in the formation of gallstones. It was inconclusive whether impaired glucose tolerance was associated selectively with postcholecystectomy.     

Impaired glucose tolerance, diabetes mellitus, and gallstone disease: An extended study of male self-defense officials in Japan

Few studies have investigated the relation between glucose tolerance status and ultrasonographically determined gallstone disease. Using a 75-g oral glucose tolerance test, we examined the association of impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) with gallstone disease in Japanese men. Subjects were men aged 48 to 59 of the Japan Self-Defense Forces who received a preretirement health examination between October 1986 to December 1994. After exclusion of 12 men under insulin treatment in the consecutive series of 7637 men, 174 were found to have gallstones; 103 were at the state of postcholecystectomy, and 6899 had normal gallbladder. IGT and NIDDM were associated with a modestly increased risk of gallstone disease; adjusted odds ratios were 1.3 (95% confidence interval [CI]: 0.9–1.8) for IGT and 1.3 (95% CI: 0.8–2.0) for NIDDM after adjustment for hospital, rank, smoking, alcohol use, and body mass index. Adjusted odds ratio for IGT and NIDDM combined was 1.3 (95% CI: 1.0–1.7, p=0.08). When prevalent gallstones and postcholecystectomy were considered separately, NIDDM showed a significant, positive association with postcholecystectomy, but not with prevalent gallstones. The findings add to evidence that glucose intolerance is associated with a modest increase in the risk of gallstone disease.     

Bulinus forskalii: a new potential intermediate host for Schistosoma haematobium in Niger

Malacological monitoring of two irrigated areas in Niger highlighted the natural susceptibility of Bulinus forskalii to infection with Schistosoma haematobium when the parasitic load is high. This first report of S. haematobium infection in B. forskalii, which is an abundant snail in irrigated areas, has been confirmed experimentally.     

Plasma adiponectin levels in high risk African-Americans with normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes

OBJECTIVE: We studied plasma adiponectin, insulin sensitivity, and insulin secretion before and after oral glucose challenge in normal glucose tolerant, impaired glucose tolerant, and type 2 diabetic first degree relatives of African-American patients with type 2 diabetes. RESEARCH METHODS AND PROCEDURES: We studied 19 subjects with normal glucose tolerance (NGT), 8 with impaired glucose tolerance (IGT), and 14 with type 2 diabetes. Serum glucose, insulin, C-peptide, and plasma adiponectin levels were measured before and 2 hours after oral glucose tolerance test. Homeostasis model assessment-insulin resistance index (HOMA-IR) and HOMA-beta cell function were calculated in each subject using HOMA. We empirically defined insulin sensitivity as HOMA-IR<2.68 and insulin resistance as HOMA-IR>2.68. RESULTS: Subjects with IGT and type 2 diabetes were more insulin resistant (as assessed by HOMA-IR) when compared with NGT subjects. Mean plasma fasting adiponectin levels were significantly lower in the type 2 diabetes group when compared with NGT and IGT groups. Plasma adiponectin levels were 2-fold greater (11.09+/-4.98 vs. 6.42+/-3.3811 microg/mL) in insulin-sensitive (HOMA-IR, 1.74+/-0.65) than in insulin-resistant (HOMA-IR, 5.12+/-2.14) NGT subjects. Mean plasma adiponectin levels were significantly lower in the glucose tolerant, insulin-resistant subjects than in the insulin sensitive NGT subjects and were comparable with those of the patients with newly diagnosed type 2 diabetes. We found significant inverse relationships of adiponectin with HOMA-IR (r=-0.502, p=0.046) and with HOMA-beta cell function (r=-0.498, p=0.042) but not with the percentage body fat (r=-0.368, p=0.063), serum glucose, BMI, age, and glycosylated hemoglobin A1C (%A1C). DISCUSSION: In summary, we found that plasma adiponectin levels were significantly lower in insulin-resistant, non-diabetic first degree relatives of African-American patients with type 2 diabetes and in those with newly diagnosed type 2 diabetes. We conclude that a decreased plasma adiponectin and insulin resistance coexist in a genetically prone subset of first degree African-American relatives before development of IGT and type 2 diabetes.     

High-dose thiamine supplementation improves glucose tolerance in hyperglycemic individuals: a randomized, double-blind cross-over trial

Purpose

To assess the effect of high-dose oral thiamine supplements on glucose tolerance in patients with impaired glucose metabolism.

Methods

Twelve hyperglycemic subjects (10 cases of impaired glucose tolerance and 2 new cases of type 2 diabetes) completed this randomized, double-blind trial, where all participants received both placebo and thiamine capsules (3 × 100 mg/day) for 6 weeks in a cross-over manner. The main endpoint was changes in 2-h plasma glucose. Fasting plasma glucose and insulin, 2-h plasma insulin, the hemostatic model assessment of insulin resistance (HOMA-IR), renal function measurement and thiamin status were also evaluated at the commencement and completion of each treatment period.

Results

Thiamine supplementation resulted in significant decrease in 2-h plasma glucose relative to baseline (8.78 ± 2.20 vs. 9.89 ± 2.50 mmol/l, p = 0.004), with no significant change in the placebo arm. Fasting plasma glucose and insulin, and HOMA-IR increased significantly from baseline after 6 weeks in the placebo arm (p = 0.003, p = 0.04 and p = 0.02, respectively). These variables did not change with thiamine supplementation. There were no significant changes in 2-h plasma insulin or renal function marker, within or between arms.

Conclusion/interpretation

Supplementation with high-dose thiamine may prevent deterioration in fasting glucose and insulin, and improve glucose tolerance in patients with hyperglycemia. High-dose thiamine supplementation may prevent or slow the progression of hyperglycemia toward diabetes mellitus in individuals with impaired glucose regulation.     

Characteristics of non-participants and reasons for non- participation in a population survey in Kin-Hu, Kinmen

The aim was to characterize non-participants and to investigate reasons for non-participation in a health survey in Kin-Hu township, Kinmen, Republic of China. The non-participants represented 25.6% of the target population of 4451 registered residents aged 30 and older. Baseline demographic characteristics and two-year mortality for the participants and non-participants were compared. A house-to-house visit was attempted to all of the non-participants for reasons of refusal. The mean age of the non- participants was significantly older than that of the participants (54.3 versus 48.5 years, p < 0.001). The response rate for women was significantly higher than that for men (77.2% versus 71.6%, p < 0.001). The probability of death was significantly different between the two groups (1.2% versus 8.8% for participants and non-participants, respectively, p < 0.001). Major reason for not having participated in the health survey was not notified or informed of the examination (32.7%). These data suggest that non-participants were less healthy.     

Post-challenge glucose concentration, impaired glucose tolerance, diabetes, and cancer mortality in men.

The possibility that diabetes is associated with an elevated risk of cancer mortality has been discussed for many years. Recently, Levine et al. (Am J Epidemiol, 1990; 131:254-62) approached this issue by relating post-load plasma glucose concentration to cancer mortality. For men, there appeared to be a positive association between post-load glucose and mortality from cancer for all sites combined and for some specific sites. However, that analysis was based on only 298 cancer deaths among 11,521 men followed for 12 years. The current authors explored this issue in a cohort of 18,274 male civil servants, among whom there were 1,282 cancer deaths over 18-20 years of follow-up. There was no association between post-load glucose and cancer mortality, except for pancreatic cancer. A role for asymptomatic hyperglycemia in the etiology of cancer is not supported by the results of the present study.