Incidence and outcomes of diabetes mellitus in elderly people: report from the Canadian Study of Health and Aging

BACKGROUND: The epidemiology of diabetes in elderly people is not well understood. The purpose of this study was to estimate the incidence of diabetes mellitus among elderly people in Canada and the relative risks of death and admission to an institution among elderly diabetic patients. METHODS: The study was a secondary analysis of data for a community-dwelling sample from the Canadian Study of Health and Aging, a nationwide representative cohort study of 9008 elderly people (65 years of age or older at baseline) in Canada. Diabetes was identified primarily by self-reporting, and a clinician's diagnosis and the presence of treatments for diabetes were used to identify diabetic patients who did not report that they had the condition. RESULTS: The reliability of self-reported diabetes (the kappa statistic) was 0.85. The estimated annual incidence of diabetes was 8.6 cases per thousand for elderly Canadians. Incidence decreased with age, from 9.5 for subjects 65-74 years of age, to 7.9 for those 75-84 years of age and then to 3.1 for those 85 years of age and older. Diabetes was associated with death (relative risk 1.87, 95% confidence interval 1.59-2.19) and admission to an institution (relative risk 1.58, 95% confidence interval 1.28-1.94). INTERPRETATION: Diabetes mellitus is common among elderly people, but the incidence declines among the very old.     

2013—2019年流感季北京市住院老年人流感疫苗接种趋势分析

目的: 分析2013—2019年北京市≥60岁老年人流感疫苗接种情况,探究因不同疾病住院老年人的接种趋势变化。方法: 从2013—2019年北京市老年人流感疫苗接种信息登记数据库和2013—2019年北京市城镇职工基本医疗保险数据库分别提取老年人流感疫苗接种信息和住院信息后合并分析,比较因不同疾病住院的老年人的流感疫苗接种趋势,并描述2018—2019年流感季接种人群的分布情况。结果: 北京市因心血管疾病、脑血管疾病、呼吸系统疾病和糖尿病住院的老年人的流感疫苗接种率分别为14.6%、13.4%、13.4%和11.8%,其中因心血管疾病住院老年人连续六个流感年度接种率均保持在最高,因糖尿病住院人群流感疫苗接种率保持在最低且年均下降幅度最大(-7.85%)。2018—2019年流感疫苗接种人群分布情况在不同年龄、性别、住院结局和合并症严重程度中差异有统计学意义。在因4种疾病住院的老年人中,70~79岁老年人接种率均为最高,而60~69岁老年人接种率均为最低。在因呼吸系统疾病住院的老年人中男性流感疫苗接种率优于女性,而在因糖尿病或心血管疾病住院的人群则表现相反。住院结局较差的老年人接种率更低。糖尿病患者中无共病的接种率最低(7.9%)。结论: 北京市2013—2019年因不同疾病住院的≥60岁老年人流感疫苗接种率整体呈下降趋势,应重点关注糖尿病和60~69岁老年人群的流感疫苗接种,并开展更多流感疫苗保护作用研究以支持流感疫苗在慢性病人群中的普及。     

Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation

INTRODUCTION: We investigated the prevalence of type 2 diabetes mellitus and its relationship between gender, urbanisation, education, marital status and occupation in the Iranian population. METHODS: A total of 3,778 men and women aged between 15 and 64 years were recruited by using a cluster-stratified sampling method from Khorasan province, northeast Iran. Using an interviewer-administrated questionnaire, demographical data including gender, urbanisation, education, marital status and occupation was collected. Anthropometrical and biochemical measurements were taken for each subject. Associations of type 2 diabetes mellitus and other variables were tested for significance. RESULTS: The prevalence of diabetes mellitus (defined as fasting blood sugar equal to or more than 126 mg/dL) was 5.5 percent, and the prevalence in men and women was 5.1 percent and 5.8 percent, respectively, with a significantly higher prevalence among urban dwellers (seven percent) compared to that of the rural subgroup (three percent, p-value is less than 0.001). Diabetes mellitus was found to be most prevalent among the older age group (age more than 60 years, 10.9 percent), those who were retired (14.4 percent), and illiterate (6.1 percent, p-value is less than 0.001). Marital status was not significantly related to diabetes mellitus (p-value equals 0.09). CONCLUSION: The prevalence of diabetes mellitus is related to some sociodemographical factors within the Iranian population. Thus the preventive strategies should be based on the affective factors. The urbanisation of the population with the migration of people from rural to urban areas may account in part for the increasing prevalence of type 2 diabetes mellitus in Iran.     

中国多囊卵巢综合征患者妊娠并发症发生率的Meta分析

目的：采用Meta分析的方法评价我国多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者妊娠并发症 的发生现状。方法：系统检索PubMed,Web of Science,Embase,Medline,Cochrane协作网,中国知网,重庆维普及 中国生物医学文献数据库等从建库至2017年4月1日前公开发表的、报道中国PCOS患者妊娠并发症发生率的文献。 采用随机效应模型估计合并率及95%可信区间。以纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)为标准对最终 纳入的文献进行质量评价。采用亚组分析评价孕前超重/肥胖及胰岛素抵抗对PCOS孕妇妊娠并发症发生率的影响。 结果：最终纳入文献59篇,合计PCOS孕妇13 378例,非PCOS孕妇49 395例。PCOS孕妇中各种妊娠并发症的发生率分 别为：妊娠糖尿病20.26%、妊娠高血压13.94%、剖宫产64.16%、早产13.35%、巨大儿9.84%、低出生体重儿5.88%、小 于胎龄儿5.25%、大于胎龄儿8.45%、新生儿畸形1.93%、围产儿死亡0.88%、新生儿窒息3.71%,且PCOS孕妇中妊娠糖 尿病、妊娠高血压、剖宫产、早产、巨大儿及新生儿窒息的发生率明显高于非PCOS孕妇(P<0.05)。亚组分析结果显 示：超重/肥胖的PCOS孕妇中妊娠糖尿病、巨大儿及大于胎龄儿的发生率明显高于BMI正常的PCOS孕妇(均P<0.05); 孕前合并胰岛素抵抗的PCOS孕妇中妊娠糖尿病、早产、巨大儿的发生率明显高于未合并胰岛素抵抗的PCOS孕妇(均 P<0.05)。结论：PCOS可导致孕妇妊娠并发症的发生风险增加,是妊娠并发症发生的一个重要危险因素。     

Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec

BACKGROUND: The prevalence of gestational diabetes mellitus has been reported to vary widely in aboriginal populations. Most of the data have come from the United States. To help determine the extent of gestational diabetes in Canada's aboriginal population, the authors assessed the prevalence in a population of Cree women in northern Quebec. METHODS: A cross-sectional study was conducted using the National Diabetes Data Group (NDDG) criteria. Information was obtained from patient charts on pregnancies between January 1995 and December 1996 among women residing in 9 Cree communities in the eastern James Bay region of northern Quebec. Women who were not Cree, had pre-existing diabetes, had spontaneous abortion or were receiving glucocorticoid treatment were excluded. RESULTS: Data on 654 pregnancies that met the inclusion criteria were available. Results of the screening oral glucose challenge test were available for 579 of the pregnancies; the remaining 75 were excluded. The mean gestational age at screening was 28.3 (standard deviation 2.6) weeks. The prevalence of gestational diabetes was 12.8% (74/579) (95% confidence interval [CI] 10.1%-15.5%). The prevalence in the inland communities was twice as high as that in the coastal communities (18.0% v. 9.3%, p = 0.002). Women with gestational diabetes or impaired glucose tolerance tended to be older, have had more pregnancies, weigh more before pregnancy and have heavier babies than those with a normal glycemic status. INTERPRETATION: The prevalence of gestational diabetes among James Bay Cree women in northern Quebec is twice as high as that among women in the general North American population and the second highest reported in an aboriginal group worldwide.     

Correlates of body mass index in the 1990 Ontario Health Survey.

OBJECTIVES: To determine the average body mass index (BMI) and the prevalence of overweight and obesity among people aged 20 to 64 years, to identify sociodemographic, lifestyle and health variables that correlate with overweight and obesity, and, through a comparison of the results with those from an earlier survey, to determine whether prevalence has changed over time. DESIGN: Cross-sectional survey. SETTING: Ontario. PARTICIPANTS: The 1990 Ontario Health Survey surveyed 61,239 people representative of the Ontario population. The authors' analyses were restricted to those aged 20 to 64 years, excluding pregnant women. In the multivariate analyses they included only people with no missing values for any of the variables in the models (n = 26,306). OUTCOME MEASURES: BMI (weight in kilograms divided by height in metres squared) was used to measure healthy weight (BMI between 20 and 25), overweight (BMI greater than 25) and obesity (BMI greater than 27). RESULTS: The prevalence of obesity among men and women was 33.6% and 22.8% respectively (adjusted odds ratio [OR] 1.78, 95% confidence interval [CI] 1.63 to 1.95). There was a positive relation with age (adjusted OR 1.53 [95% CI 1.24 to 1.89] for age 25 to 29 years and 2.78 [95% CI 2.20 to 3.51] for age 50 to 54 years compared with age 20 to 24 years) and an inverse relation with education level (postsecondary education v. primary education: adjusted OR 0.65 [95% CI 0.54 to 0.79]). Analysis of birthplace showed that the prevalence of obesity was lowest among those born in Asia (compared with Canadian born: adjusted OR 0.36 [95% CI 0.27 to 0.47]). The prevalence was higher among former smokers than among those who had never smoked (adjusted OR 1.20 [95% CI 1.18 to 1.22]). People with more health problems and those who rated their health as fair or poor were more likely to be obese. The estimates of the prevalence of obesity were higher than those reported in the 1985 Health Promotion Survey for both sexes in all three age groups examined. CONCLUSIONS: These self-reported data indicate that overweight and obesity remain important health problems in Ontario, and the prevalence appears to be increasing.     

安岳县农村50岁以上中老年人糖尿病患病率及影响因素分析

目的 了解安岳县农村50岁以上人群糖尿病的患病情况并分析其危险因素.方法 采用普查法对2014年1~12月安岳县农村50岁以上的447390名中老年人群进行问卷调查及体检,调查内容包括家族中2型糖尿病患病情况、肥胖、个人生活习惯及特殊嗜好(包括劳动量、饮食习惯、吸烟、饮酒情况等)、有无合并症等生活史及遗传史,并现场抽取血液进行血糖检测.分析统计各年龄段人群糖尿病患病率及与生活习惯的相关性.结果 调查显示,我县农村50岁以上人群糖尿病患病率为4.49%(20088名),男性总体患病率为3.32%(7733/233254),女性为5.77%(12355/214136),男性高于女性,且随人群年龄的增加,男女患病率均明显增高;2型糖尿病的发生与年龄、肥胖、饮酒、饮食、家族史及合并症等明显相关(P<0.05).结论 安岳县50岁以上人群2型糖尿病整体患病率低于全国平均水平,该地区2型糖尿病的患病危险因素主要为肥胖、饮酒等不良生活习惯及家族遗传史.     

营口市妊娠糖尿病发病相关危险因素分析

目的：调查分析营口市妊娠糖尿病（GDM）的流行病学情况,为妊娠糖尿病的个体化预防提供依据。方法共纳入营口市24～28周孕妇2319例,以问卷调查的方收集包括年龄、文化程度、职业、体重指数（BMI）、多囊卵巢综合征（PCOS）、甘油三酯（TG）、总胆固醇（TC）、妊娠次数、糖尿病家族史、肿瘤家族史等情况。采用Logistic回归分析对妊娠糖尿病的相关危险因素进行分析。结果妊娠糖尿病的知晓率为67.8%,发病率为8.4%。单因素Logistic回归分析结果显示年龄≥25岁、BMI≥25 kg/m 2、PCOS、中心性肥胖、糖尿病家族史、高胆固醇血症、恶性肿瘤家族史均会明显增加GDM的发生风险（P<0.05）。多因素Logistic回归分析显示PCOS、糖尿病家族史是GDM发生的最重要危险因素（P<0.05）。结论营口市妊娠糖尿病发病率为8.4%,其中PCOS、糖尿病家族史是GDM患者需要重点干预的危险因素。     

Determinants of plasma glucose level and diabetic status in a northern Canadian Indian population.

We conducted a cross-sectional survey of 704 Indians aged 20 to 64 years in six remote communities in northern Ontario and Manitoba to determine the factors associated with the fasting plasma glucose and glycosylated hemoglobin levels and diabetic status, defined by past history and current fasting plasma glucose level. Multivariate analyses for the 671 subjects with complete data showed that triglyceride level, age and body mass index (BMI) were significant predictors of the log fasting plasma glucose level and the log glycosylated hemoglobin level; for the latter, waist/hip ratio, history of diabetes mellitus among first-degree relatives and low level of education were additional predictors. Significant risk factors for diabetes as a dichotomous variable included triglyceride level, age, BMI and family history of diabetes. Although energy intake per unit of body weight was lower among subjects with diabetes than those without diabetes, possibly reflecting the lower physical activity level of diabetic subjects, the former consumed significantly more "calorie-adjusted" protein and less carbohydrate than the latter. The findings are consistent with studies in other populations. Further study is needed to determine the natural history of diabetes and its metabolic consequences and to assess the effect of dietary alteration and promotion of physical activity on the incidence of the disease.     

成都地区老年人群糖尿病的流行状况及危险因素分析

目的探讨成都城乡地区老年人群糖尿病流行状况,为今后成都市老年人群糖尿病防治奠定基础。方法 2008年在成都地区调查老年人群糖尿病患病率、知晓率、治疗率及控制率,分析老年人群糖尿病的危险因素。样本的获取采用分层整群抽样的方法,以社区（村）为单位,抽取成都市2008年城乡社区60～79岁人群1951人进行糖尿病及相关因素的调查。结果成都地区老年人群糖尿病患病率27.73%,标准化率为22.98%。糖尿病患病率随年龄增大而逐渐增高,75岁以上的老年人1/3有糖尿病。成都地区老年人群糖尿病知晓率55.3%、治疗率43.7%.控制率21.9%。城市老年人群糖尿病知晓率63.5%、治疗率52.3%、控制率33.2%,明显高于农村34.6%、28.1%、10.5%的知晓率、治疗率及控制率,均P〈0.01。结论成都地区老年人群糖尿病患病率高,知晓率、治疗率、控制率低,腹型肥胖是糖尿病最重要的危险因素。老年人群应作为血糖监测重点人群。尚需进一步加强成都地区的社区老年糖尿病防治工作,特别是农村地区。     

The epidemiology of diabetes mellitus in Jamaica and the Caribbean: a historical review

Epidemiological studies on diabetes mellitus (DM) have been conducted in the Caribbean for more than four decades. In Jamaica, the estimated prevalence of DM among adults ranged from 1.3% in 1960 to 17.9% in 1995. Part of the variation in estimates has been due to the differing age groups that have been studied. The 2007-8 Jamaica Health and Lifestyle Survey (JHLS-2) reported prevalence estimates of 7.9% for diabetes mellitus and 2.8% for impaired fasting glucose in persons 15-74 years old. Across the Caribbean, the overall prevalence of diabetes mellitus is estimated at about 9%. In addition to the high burden of prevalent diabetes, there is also a high burden of complications. In Barbados, the incidence of diabetic foot complications has been found to be second only to a population of Native Americans in Najavo. The Barbados Eye Study revealed that among persons 40-84 years old in Barbados, 28.5% had evidence of diabetic retinopathy on fundus photographs. Regionally, the impact of DM on cardiovascular diseases (CVD) has not been adequately reported. With regards to diabetes care, poor control rates and inadequate surveillance for complications have been reported in Barbados, Trinidad and Tobago, Tortola and Jamaica. The JHLS-2 showed that while more than 70% of persons with diabetes were aware of the condition less than 50% were under control. In light of the expected increase in the number of people with diabetes mellitus, healthcare planners and researchers will need to redouble their efforts to both prevent as well as limit the impact of diabetes mellitus and its complications in Caribbean populations.     

Prevalence of diabetes mellitus among the James Bay Cree of northern Quebec.

OBJECTIVE: To determine the prevalence of diabetes mellitus among the James Bay Cree in northern Quebec. DESIGN: Chart survey of physician-diagnosed cases of diabetes. The biochemical criteria of the World Health Organization were used to confirm the diagnoses. SETTING: Eight James Bay Cree communities: six remote and two rural. SUBJECTS: All James Bay Cree with diabetes whose names were in a chronic disease registry or on a diabetes clinic list kept at each community clinic. OUTCOME MEASURES: Prevalence rates, both crude and standardized to the 1986 Canadian population, were estimated by sex, age group and type of diabetes. RESULTS: A total of 235 cases of diabetes were confirmed, for a crude prevalence of 2.7%. The age-standardized rate of non-insulin-dependent diabetes mellitus was 6.6% among people 20 years and over. The prevalence increased as the latitude decreased. CONCLUSIONS: Our crude prevalence resembles that in similar native linguistic and cultural groups elsewhere in Canada. Diabetes is becoming an important disease in the Cree population of Quebec. A better understanding of the sociocultural changes in this population is necessary.     

云南省纳西族居民糖尿病患病、知晓、治疗和控制率的变化趋势研究

  目的  分析云南省纳西族糖尿病患病、知晓、治疗和控制率的变化趋势。  方法  采用重复横断面设计,于2013年和2018年采用多阶段分层随机抽样方法在云南玉龙县分别抽取1402名和1426名35岁及以上常住纳西族居民进行问卷调查和体格检查。  结果  2018年调查人群糖尿病前期和糖尿病患病率分别为19.5%和8.6%,知晓、治疗和控制率分别为52.8%、89.2%和29.2%。2013年1～2月至2018年1～2月期间,调查人群糖尿病前期患病率无明显变化,但65岁及以上老年人、初中及以上学历者和人均收入高者糖尿病前期患病率分别从21.5%、17.7%和17.9%上升至28.9%、22.3%和23.6%（P < 0.05）;糖尿病患病率由4.1%增长至8.6%（P < 0.001）,且分性别、年龄段、文化程度和家庭人均收入的糖尿病患病率也呈上升趋势（均P < 0.05）;糖尿病知晓率由69.0%下降至52.8%;糖尿病治疗率和控制率无明显变化（均P > 0.05）,但女性、55-64岁、小学及以下学历和人均收入低的糖尿病患者治疗率分别从71.4%、62.5%、57.9%和71.4%上升至93.9%、95.0%、88.9%和90.5%（均P < 0.05）。  结论  纳西族居民糖尿病的患病率呈上升趋势,而知晓率呈下降趋势,治疗率和控制率无明显变化。应根据不同特征人群采取有效措施降低糖尿病前期和糖尿病的患病率,提高知晓率和控制率,延缓糖尿病的发生和发展。     

Foetomaternal complications in pregnancies with diabetes mellitus: association with the amount of insulin requirement, mean terminal blood glucose and HbA1C levels

Pregnancy hyperglycaemia can lead to foetomaternal complications. Normoglycaemia with exercise, diet and/or insulin can alter outcomes. The insulin requirement itself may alter outcomes independently. Two hundred and forty patients of pregnancy with diabetes mellitus were selected of which 176 belonged to gestational diabetes mellitus and 64 pregestational diabetes mellitus groups. Insulin requirement of pregestational diabetes mellitus group was 1.8 times higher than the gestational diabetes mellitus group. There were no insulin related increased complications in either group. The foetal complications were higher in pregestational diabetes mellitus group (62.5%) than in the gestational diabetes mellitus group (27.3 and 40% in < 15 units or > or = 15 units insulin requirement respectively). The terminal glycaemic parameters (fasting plasma glucose, 2 hours postprandial plasma glucose, HbA1C%) were not different in case of gestational diabetes mellitus between those with and without foetal complications, except for fasting plasma glucose where 'with complications' fasting plasma glucose was lower than without (79.4 +/- 13.14 versus 75.28 +/- 3.68 mg/dl). For pregestational diabetes mellitus patients those without complications had a significantly lower level of all the parameters (fasting plasma glucose 69.75 +/- 0.5 versus 122 +/- 14.14 mg/dl, postprandial plasma glucose 95 +/- 7.4 versus 131.5 +/- 12.02 mg/dl; HbA1C 6.8 +/- 0.28 versus 7.3 +/- 3.6%) compared with those having complications. Maternal complications could not be segregated as all the subgroups had a very incidence of caesarean section (60%-100%). However, when lower segment caesarean section was excluded and maternal complications segregated, for gestational diabetes mellitus patients, only fasting plasma glucose was significantly lower in cases without complications while in pregestational diabetes mellitus patients the fasting plasma glucose as well as HbA1C were significantly lower in cases without complications.     

昆明市不同血糖情况孕妇人口统计学特征、孕期保健及围生期结局的比较研究

目的　比较昆明市不同血糖情况孕妇的人口统计学特征、孕期保健及围生期结局,以期指导孕妇孕前准备及孕期保健,降低母婴不良事件的发生,改善母婴结局。方法　收集2005—2013年于昆明医科大学第一附属医院定期产检至分娩单胎的21 767例孕妇为研究对象,分为正常糖耐量（NGT）组、妊娠期糖尿病（GDM）组及孕前糖尿病（PGDM）组3组。比较3组人口统计学特征、孕期保健情况、新生儿一般情况及围生期结局。结果　GDM和FGDM组平均年龄高于NGT组,GDM组平均身高低于NGT组,GDM组孕前/OGTT时/分娩前BMI高于NGT组,FGDM组孕前/OGTT时/分娩前BMI高于NGT和GDM组、受教育年限低于NGT和GDM组（P<0.05）;GDM组年龄≥35岁、孕前BMI≥25 kg/m2、有DM家族史者占比高于NGT组,FGDM组孕前年龄≥35岁、BMI≥25 kg/m2、有DM家族史、受教育年限≤12年者占比高于NGT和GDM组（P<0.016 7）。GDM组孕期增重、分娩孕周小于NGT组,PGDM组孕期增重、产检次数、分娩孕周小于NGT和GDM组（P<0.05）;GDM和PGDM组由外院转入者占比高于NGT组（P<0.016 7）。GDM组出生体质量、身长小于NGT组,PGDM组身长小于NGT和GDM组（P<0.05）。GDM组母亲子痫前期、妊娠高血压疾病、新生儿大于胎龄儿、巨大儿、早产、入住新生儿重症监护病房、低血糖、黄疸需蓝光治疗、围生儿死亡者占比高于NGT组,PGDM组母亲剖宫产、新生儿大于胎龄儿者占比大于NGT组,PGDM组母亲子痫前期、妊娠高血压疾病、新生儿早产、入住新生儿重症病房、低血糖、黄疸需蓝光治疗者占比高于NGT和GDM组（P<0.016 7）。结论　即使给予PGDM组规范的治疗与干预,母婴结局的负面影响仍明显高于NGT和GDM组,因此应强调孕前保健及PGDM早期识别的重要性。     

对583例孕妇行妊娠期糖尿病筛查的临床研究

目的初步了解本地妊娠期糖耐量降低(GIGT)和妊娠期糖尿病(GDM)的患病率;分析适合本地GDM筛查的GCT切点和孕妇高危年龄界定.方法对583例孕妇以口服50g葡萄糖负荷试验(GCT)的方法行GDM筛查,取1h静脉血糖值≥7.8mmol/L为阳性.阳性者不控制饮食3d后行口服葡萄糖耐量实验(OGTT),若2项或2项以上等于或超过上限值诊断为GDM;4项中有1项≥上限值或第2小时在6.7～9.1mmol/L之间,诊断为GIGT.结果 (1)GCT阳性率24.01%,确诊GDM15例,GIGT61例,GDM和GIGT患病率分别为2.57%和10.46%.若取8.3mmol/L为GCT切点,将减少25.71%的OGTT检查率而能发现100%的GDM和91.8%的GIGT.(2)有DM家族史者66.67%发生不同程度糖耐量异常;且有DM家族史者占GDM组患者的7/15(46.67%),DM家族史为高危因素之首.(3)年龄≥25岁者占74.96%;而68.88%集中在25～30岁之间.结论本地GIGT和GDM有相当的患病率,应加强筛查工作.GDM筛查GCT的切点取值以8.3mmol/L为宜.高危年龄界定在≥25岁漏诊率最低.为减少漏诊,建议在城市实行普遍筛查.     

妊娠期糖尿病妇女再次妊娠时糖尿病的发生状况及相关危险因素分析

目的探讨妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病的发生状况及相关危险因素。方法选择两次分娩,且前次妊娠为妊娠期糖尿病的产妇中,随机抽取100例作为研究对象。根据研究对象再次妊娠时的75 g口服葡萄糖耐量试验结果,血糖异常的孕妇作为血糖异常组,血糖正常的孕妇作为血糖正常组。采用单因素分析法比较2组孕妇的体质量指数、年龄、孕前体质量、胰岛功能、初次妊娠时血糖水平、初次妊娠时是否使用胰岛素、两次妊娠的间隔时间、初次妊娠时胰岛素抵抗指数。采用多因素logistic回归分析法分析妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病发生的危险因素。结果妊娠期糖尿病妇女再次妊娠时血糖异常的发生率为72.00%,单因素分析结果显示,血糖异常组再次妊娠前体质量、再次妊娠前体质量指数、初次妊娠时空腹胰岛素水平、初次妊娠时餐后1 h胰岛素水平、初次妊娠时胰岛素抵抗指数、初次妊娠时采用胰岛素治疗率均高于血糖正常组（P < 0.05~P < 0.01）。多因素logistic回归分析结果显示,再次妊娠前体质量>55 kg、再次妊娠前体质量指数>24 kg/m2、初次妊娠时采用胰岛素治疗、初次妊娠时胰岛素抵抗指数>2.7可能是妊娠糖尿病妇女再次妊娠时发生妊娠糖尿病的危险因素（OR=2.184,12.147,7.767,7.448,P < 0.05~P < 0.01）。结论妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病发生率较高,妊娠前体质量过重、体质量指数过高、胰岛素抵抗、初次妊娠时采用胰岛素治疗是再次妊娠时发生妊娠期糖尿病的危险因素。     

Rates and outcomes of diabetic end-stage renal disease among registered native people in Saskatchewan.

OBJECTIVE: To determine the rates and outcomes of diabetic end-stage renal disease (ESRD) among registered native people and non-native people in Saskatchewan. DESIGN: Retrospective population-based study using data from the Canadian Organ Replacement Registry. SETTING: Saskatchewan. PATIENTS: All patients with diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990. MAIN OUTCOME MEASURES: Incidence rates of diabetic ESRD in the general population, rates of diabetic ESRD among patients with diabetes mellitus, nature of initial dialysis treatment, length of survival from start of dialysis, cause of death and renal transplant rates. RESULTS: The 10-year incidence rates of diabetic ESRD were higher among all age groups among registered native people than among non-native people. The overall relative risk ratio for native people was 16.2. When a higher prevalence of diabetes among native people was taken into account, native diabetic people were still seven times as likely as non-native diabetic people to manifest diabetic ESRD. The median survival from start of dialysis was under 2 years in both groups, but more native people died of stroke and more non-native people died of heart disease. Non-native diabetic people were more likely than native diabetic people to receive renal transplants. CONCLUSIONS: Although the overall incidence of diabetic ESRD in Saskatchewan is increasing, registered native people have a disproportionate risk for this serious complication.     

End-stage renal disease in Canada: prevalence projections to 2005

BACKGROUND: The incidence and prevalence of end-stage renal disease (ESRD) have increased greatly in Canada over the last 2 decades. Because of the high cost of therapy, predicting numbers of patients who will require dialysis and transplantation is necessary for nephrologists and health care planners. METHODS: The authors projected ESRD incidence rates and therapy-specific prevalence by province to the year 2005 using 1981-1996 data obtained from the Canadian Organ Replacement Register. The model incorporated Poisson regression to project incidence rates, and a Markov model for patient follow-up. RESULTS: Continued large increases in ESRD incidence and prevalence were projected, particularly among people with diabetes mellitus. As of Dec. 31, 1996, there were 17,807 patients receiving renal replacement therapy in Canada. This number was projected to climb to 32,952 by the end of 2005, for a relative increase of 85% and a mean annual increase of 5.8%. The increased prevalence was projected to be greatest for peritoneal dialysis (6.0% annually), followed by hemodialysis (5.9%) and functioning kidney transplant (5.7%). The projected annual increases in prevalence by province ranged from 4.4%, in Saskatchewan, to 7.5%, in Alberta. INTERPRETATION: The projected increases are plausible when one considers that the incidence of ESRD per million population in the United States and other countries far exceeds that in Canada. The authors predict a continued and increasing short-fall in resources to accommodate the expected increased in ESRD prevalence.