Routine diagnosis of Type 2 diabetes mellitus in general practice and hospitals: how do patients differ?

OBJECTIVE: To study how Type 2 diabetic patients diagnosed by routine case-finding in primary care differ from patients diagnosed in secondary care with regard to clinical characteristics, symptom-burden and prevalence of complications. RESEARCH DESIGN AND METHODS: A Danish population-based sample of 1633 newly diagnosed Type 2 diabetic patients, of whom we had detailed information of sociodemographic and clinical characteristics, biochemical measurements, and complications among 1381. Blood and urine analyses were centralized. RESULTS: Of the patients, 76.8% were diagnosed in general practice. Compared with those diagnosed in secondary care, patients diagnosed in general practice on average had higher levels of cardiovascular risk factors (BMI: 29.8 vs. 28.5 kg/m2, P < 0.001; systolic blood pressure: 149.4 vs. 143.2 mmHg, P < 0.001; diastolic blood pressure: 85.2 vs. 82.5 mmHg, P < 0.001; haemoglobin A(1c): 10.1 vs. 8.4%, P < 0.0001; total cholesterol: 6.4 vs. 6.1 mmol/l, P < 0.01), more frequently presented with hyperglycaemic symptoms (80.1 vs. 63.4%, P < 0.0001), while fewer had macrovascular complications (28.5 vs. 43.6%, P < 0.0001). CONCLUSIONS: Judged from their risk profile, Type 2 diabetic patients diagnosed in primary care are at no less risk of developing diabetic complications than those diagnosed in secondary care.     

Diabetic retinopathy is associated with subclinical atherosclerosis in newly diagnosed type 2 diabetes mellitus

Aims

We aimed to evaluate the association between diabetic microangiopathy and subclinical atherosclerosis as a marker of cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes.

Methods

A total of 142 newly diagnosed type 2 diabetics who were free from CVD underwent evaluation of diabetic microangiopathy. Subclinical atherosclerosis was assessed by measuring carotid intima-media thickness (IMT), and the 10-year absolute risk of CVD was estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine.

Results

Subclinical atherosclerosis was found in 27 subjects (19.0%). The rates of hypertension and diabetic retinopathy were significantly higher among patients with subclinical atherosclerosis. The UKPDS 10-year risk for CVD was significantly increased in subjects with subclinical atherosclerosis. Old age, hypertension and the presence of diabetic retinopathy showed a significant association to subclinical atherosclerosis after further adjustments for gender, body mass index, smoking status, HbA1c, HDL cholesterol, LDL cholesterol and the presence of diabetic nephropathy.

Conclusions

This study shows that diabetic retinopathy is an independent risk marker for subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes. We suggest that a diagnosis of diabetic retinopathy may warrant a more careful cardiovascular assessment even in the early stages of diabetes.     

Increased prevalence of cardiovascular disease in Type 2 diabetic patients with non-alcoholic fatty liver disease.

AIMS: To estimate the prevalence of cardiovascular disease (CVD) in Type 2 diabetic patients with and without non-alcoholic fatty liver disease (NAFLD), and to assess whether NAFLD is independently related to prevalent CVD. METHODS: We studied 400 Type 2 diabetic patients with NAFLD and 400 diabetic patients without NAFLD who were matched for age and sex. Main outcome measures were prevalent CVD (as ascertained by medical history, physical examination, electrocardiogram and echo-Doppler scanning of carotid and lower limb arteries), NAFLD (by ultrasonography) and presence of the metabolic syndrome (MetS) as defined by the World Health Organization or Adult Treatment Panel III criteria. RESULTS: The prevalences of coronary (23.0 vs. 15.5%), cerebrovascular (17.2 vs. 10.2%) and peripheral (12.8 vs. 7.0%) vascular disease were significantly increased in those with NAFLD as compared with those without NAFLD (P < 0.001), with no differences between sexes. The MetS (by any criteria) and all its individual components were more frequent in NAFLD patients (P < 0.001). In logistic regression analysis, male sex, age, smoking history and MetS were independently related to prevalent CVD, whereas NAFLD was not. CONCLUSIONS: The prevalence of CVD is increased in patients with Type 2 diabetes and NAFLD in association with an increased prevalence of MetS as compared with diabetic patients without NAFLD. Follow-up studies are necessary to determine whether this higher prevalence of CVD among diabetic patients with NAFLD affects long-term mortality.     

The relationship of cardiovascular risk factors to the prevalence of coronary heart disease in newly diagnosed Type 2 (non-insulin-dependent) diabetes

Summary The relationship of cardiovascular risk factors to the prevalence of coronary heart disease was examined in 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic patients (70 men, 63 women) aged from 45 to 64 years and in 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age. The prevalence of coronary heart disease in diabetic patients, defined by symptoms and ischaemic ECG abnormalities in resting or exercise ECG, was more than threefold that in non-diabetic subjects. In multiple logistic analyses (including age, history of smoking, hypertension (+/-), serum cholesterol, HDL-cholesterol, triglycerides, 2-h post-glucose serum insulin, body mass index and diabetes (+/-)) carried out separately for men and women, diabetes showed an independent, significant association to coronary heart disease in both sexes. In addition, age and hypertension had a borderline association to coronary heart disease in men, whereas smoking and high 2-h postglucose serum insulin level showed a significant association in women.     

Incidence,prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country,Spain

Aims/hypothesis The aim of this study was to determine the incidence, prevalence and coronary heart disease risk in patients with known Type 2 (non-insulin-dependent) diabetes mellitus in a Basque Country sentinel practice network study.Methods During the year 2000 we did a survey among sentinel practitioners who registered information about previously and newly diagnosed Type 2 diabetic patients older than 24 years of age. We studied 65,651 people attending a primary care service in the Basque Country Health Service-Osakidetza. We collected information about diabetic complications and cardiovascular risk factors and measured the coronary heart disease risk in these patients.Results In the year 2000, the standardized cumulative incidence and prevalence of known Type 2 diabetes were 5.0 per 1000 (CI 95%: 4.9–5.1) and 4.6% (CI 95%: 4.5–4.7) respectively. Macroangiopathy was the most frequent complication both in the newly diagnosed (21.6%) and previously known Type 2 diabetic patients (33%). Total cholesterol 5.17 mmol/l and LDL cholesterol 2.58 mmol/l were found in 75% and 90% of newly diagnosed and 65% and 85% of previously diagnosed Type 2 diabetic patients respectively. Of the Type 2 diabetic patients 42% were obese and 80% had high blood pressure. More than 55% of the men compared with 44% of the women with Type 2 diabetes had high or very high risk of coronary heart disease (p<0.05).Conclusion/interpretation We report new epidemiological data on known Type 2 diabetes in the Basque Country. These patients have a high frequency of cardiovascular risk factors causing a high coronary heart disease risk.Abbreviations WHO MSVDD Word Health Organization Multinational Study of Vascular Disease in Diabetes - UKPDS United Kingdom Prospective Diabetes Study - MRFIT Multiple Risk Factor Intervention TrialThe authors wrote this article on behalf of and with the assistance of the Basque Country Sentinel Practice Surveillance Network: see acknowledgements for list of investigators     

Sex-differences in prevalence of electrocardiographic left ventricular hypertrophy in Type 2 diabetes: the Casale Monferrato Study.

AIMS Although left ventricular hypertrophy (LVH) defined by either standard 12-lead ECG or echocardiography strongly predicts cardiovascular mortality, its prevalence in Type 2 diabetes is largely unknown. We have assessed prevalence of ECG-LVH and its relationship with clinical and metabolic variables in an Italian population-based cohort of subjects with Type 2 diabetes. METHODS The study-base was 965 (61.3%) subjects with Type 2 diabetes of the population-based cohort living in Casale Monferrato (Italy). LVH was defined by ECG Cornell voltage-duration product. All measurements were centralized. RESULTS ECG-LVH was diagnosed in 165/965 subjects, giving a prevalence of 17.1% (95% CI 14.7-19.5). Large sex differences were found, with higher prevalence in women (23.5%, 19.9-27.0) than in men (8.4%, 5.6-11.0), even after adjustment for age, BMI and hypertension (OR 3.83, 95% CI 2.5-5.9). At the examination, subjects with ECG-LVH were older than those without it. Similar age- and sex-adjusted values of HbA(1c), plasma lipids, fibrinogen, uric acid and creatinine were found in the two subgroups. No differences in prevalence of hypertension, CHD, increased QT duration or dispersion, micro- and macro-albuminuria were found between subjects with ECG-LVH and those without it. In logistic regression analysis, variables independently associated with ECG-LVH, after age-adjustment, were sex and diastolic blood pressure. CONCLUSIONS: This population-based study shows: (i) a high prevalence of ECG-LVH in Type 2 diabetic subjects; (ii) 3-fold higher risk in women than in men, independently of age, BMI, and blood pressure; (iii) an independent association between ECG-LVH and diastolic blood-pressure. Screening for ECG-LVH in diabetic subjects is therefore recommended, particularly in diabetic women.     

Hypertension in diabetic clinic patients and their siblings

Summary The prevalence of hypertension was investigated in a systematically chosen sample of patients attending a diabetic clinic. One hundred ninety-one patients were classified as Type 1 (insulin-dependent), 183 were classified as Type 2 (non-insulin-dependent) and 12 were deemed unclassifiable. Two hundred fifty-five control subjects attending non-medical out-patient clinics were also examined under similar conditions. Hypertension was significantly (p<0.001) more common among Type 2 patients (38%) than among Type 1 patients (15%) or control subjects (16%). The difference between Type 2 patients and control subjects, but not between Type 2 and Type 1 patients, persisted when the influences of age and body mass index were controlled. We also investigated the prevalence of hypertension among the siblings of the hypertensive patients identified, together with a matched normotensive group. One hundred eighty-eight siblings were examined and historical details were obtained for a further 451 siblings. When age and body mass index were controlled for in examined siblings, the risk of hypertension was greater in those with a hypertensive proband than in those with a normotensive proband, in the control (p<0.06) and Type 1 (p<0.02) groups. Among the siblings of Type 2 probands, however, the risk of hypertension in those with a normotensive proband Was at least as great as in those with a hypertensive proband, and greater than in those with a normotensive proband in the control (p<0.10) or Type 1 (p<0.05) groups. The prevalence of cardiovascular deaths was also similar in the siblings of normotensive and hypertensive Type 2 probands. We conclude that in our diabetic clinic there is an excess of hypertension among Type 2 patients. There may also be an excess of hypertension among the siblings of Type 2 patients.     

Diabetic retinopathy is associated with an increased incidence of cardiovascular events in Type 2 diabetic patients

Aims We investigated the association of diabetic retinopathy with the risk of incident cardiovascular disease (CVD) events in a large cohort of Type 2 diabetic adults. Methods Our study cohort comprised 2103 Type 2 diabetic outpatients who were free of diagnosed CVD at baseline. Retinal findings were classified based on fundoscopy (by a single ophthalmologist) to categories of no retinopathy, non‐proliferative retinopathy and proliferative/laser‐treated retinopathy. Outcomes measures were incident CVD events (i.e. non‐fatal myocardial infarction, non‐fatal ischaemic stroke, coronary revascularization procedures or cardiovascular death). Results During approximately 7 years of follow‐up, 406 participants subsequently developed incident CVD events, whereas 1697 participants remained free of diagnosed CVD. After adjustment for age, body mass index, waist circumference, smoking, lipids, glycated haemoglobin, diabetes duration and medications use, patients with non‐proliferative or proliferative/laser‐treated retinopathy had a greater risk (P < 0.001 for all) of incident CVD events than those without retinopathy [hazard ratio 1.61 (95% confidence interval 1.2–2.6) and 3.75 (2.0–7.4) for men, and 1.67 (1.3–2.8) and 3.81 (2.2–7.3) for women, respectively]. After additional adjustment for hypertension and advanced nephropathy (defined as overt proteinuria and/or estimated glomerular filtration rate ≤ 60 ml/min/1.73 m²), the risk of incident CVD remained markedly increased in those with proliferative/laser‐treated retinopathy [hazard ratio 2.08 (1.02–3.7) for men and 2.41 (1.05–3.9) for women], but not in those with non‐proliferative retinopathy. Conclusions Diabetic retinopathy (especially in its more advanced stages) is associated with an increased CVD incidence independent of other known cardiovascular risk factors.     

Prognostic value of the Framingham cardiovascular risk equation and the UKPDS risk engine for coronary heart disease in newly diagnosed Type 2 diabetes: results from a United Kingdom study.

AIMS: To determine the prognostic value of the Framingham equation and the United Kingdom Prospective Diabetes Study (UKPDS) risk engine in patients with newly diagnosed Type 2 diabetes. METHODS: A community-based cohort (n=428; aged 30-74 years) free of clinically evident CVD and newly diagnosed with Type 2 diabetes were studied over a median 4.2 (sd+/-0.62) years. Predicted (using baseline variables at diagnosis) and observed proportions of primary CVD and CHD events were compared using the Framingham equations and the UKPDS risk engine (only CHD events). The discrimination (c-statistic) and calibration (HLchi2) of the risk equations were calculated. The sensitivity and specificity of the Framingham equation at a 15%, 10-year CHD risk threshold (NICE guidelines) was compared with that of the ADA lipid threshold (LDLc>or=2.6 mmol/l or triglycerides>or=4.5 mmol/l). RESULTS: The Framingham equations underestimated the overall number of cardiovascular events by 33% and coronary events by 32% and showed modest discrimination and poor calibration for CVD [c=0.673; HLchi2=32.8 (P<0.001)] and CHD risk [c=0.657; HLchi2=19.8 (P=0.011)]. Although the overall underestimate was lower and non-significant with the UKPDS risk engine for CHD (13%), its performance in terms of discrimination and calibration were similar [c=0.670; HLchi2=17.1 (P=0.029)]. The 15%, 10-year CHD risk threshold with both the Framingham and UKPDS risk engines had similar sensitivity for primary CVD as the lipid level threshold [85.7 and 89.8% vs. 93.9% (P=0.21 and 0.34)] and both had greater specificity [33.0 and 30.3% vs. 12.1% (P<0.001 and P<0.001)]. CONCLUSIONS: In people with newly diagnosed Type 2 diabetes, both the Framingham equation and UKPDS risk engine are moderately effective at identifying those at high-risk (discrimination) and are poor at quantifying risk (calibration). Nonetheless, at a population level, a 15% 10-year CHD risk threshold using either risk calculator has similar sensitivity as an approach based on a single lipid risk factor level and may have benefits in terms of cost-effectiveness given the improved specificity.     

老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

Socio-economic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain.

AIMS: To establish the relationship between socio-economic status and the prevalence of known Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications. METHODS: In 2000, a cross-sectional survey was conducted among 61 general practitioners (GPs) who studied 65 651 people older than 24 years. Of those, 2985 known Type 2 diabetic patients were registered. The main outcome measures were: diabetes prevalence, major cardiovascular risk factors, chronic diabetic complications and primary care services utilization in Type 2 diabetic patients. Socio-economic status was based on area-based socio-economic measures. RESULTS: The prevalence of known Type 2 diabetes was higher in patients of lower socio-economic status (OR: 2.17, 95% CI: 1.77-2.28), especially among women (OR: 2.28, 95% CI: 1.91-2.73). In Type 2 diabetes patients, obesity, sedentary lifestyle, and abnormal levels of low-density lipoprotein (LDL) cholesterol and HbA(1c) were more prevalent among those from lower socio-economic status. Macroangiopathy was inversely associated with socio-economic status after adjustment for clinical and demographic variables. Patients of lower socio-economic status more frequently visited primary care services than those of higher status. CONCLUSIONS: This study shows an association between deprivation and Type 2 diabetes prevalence, cardiovascular risk factors and chronic diabetic complications in Type 2 diabetes patients. Despite a greater use of health services by less wealthy patients, they showed worse glycaemic control and more chronic complications. Besides clinical variables, socio-economic status and environmental information need to be considered in the assessment of risk profile of diabetic patients by health professionals and by health service planners.     

Screening for peripheral arterial disease by means of the ankle-brachial index in newly diagnosed Type 2 diabetic patients.

AIM: To evaluate the prevalence of peripheral arterial disease (PAD) with the ankle-brachial index (ABI) in newly diagnosed Type 2 diabetic subjects. METHODS: Between autumn 2002 and spring 2003, 2559 newly diagnosed Type 2 diabetic subjects (about 15% of the cases/year in Italy) were enrolled in 265 diabetology centres. Family history of diabetes, smoking, height, weight, waistline, fasting glycaemia, glycosylated haemoglobin, total and HDL-cholesterol and triglyceride values were collected. Claudication, cyanosis, cold foot, foot hair anomalies, skin thinning and femoral, popliteal, posterior tibial and dorsalis pedis pulses were assessed. The ABI was measured with a portable Doppler continuous-wave instrument. RESULTS: An ABI < 0.9 was found in 539 (21.1%) patients. Claudication was present in 187 (7.3%). Femoral pulse was absent in 218 (8.5%), popliteal in 316 (12.3%), tibial in 563 (22.0%) and dorsalis pedis in 578 (22.6%). Foot cyanosis was observed in 88 (3.4%), cold foot in 359 (13.9%), skin thinning in 468 (18.3%) and hair anomalies in 857 (33.5%). Multivariate analysis of the variables associated with ABI < 0.9 in the univariate analysis confirmed the independent role of age [relative risk (RR) 1.02, P < 0.001, confidence interval (CI) 1.01, 1.04], claudication (RR 4.53, P < 0.001, CI 2.97, 6.93), absence of tibial pulse (RR 3.45, P < or = 0.001. CI 2.54, 4.68) and pedis pulse (RR 1.96, P < or = 0.001, CI 1.4, 2.68). CONCLUSIONS: PAD, as represented by ABI < 0.9, is common in newly diagnosed Type 2 diabetic patients.     

Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC-HTA study

The aim of this study is to assess the relationship among metabolic syndrome (MS), target organ damage (TOD) and established cardiovascular disease (CVD) in non-diabetic hypertensive elderly patients. ERIC-HTA is cross-sectional, multicentre study carried out in primary care, on hypertensive patients aged 55 or older. MS was defined by the NCEP-ATP III criteria, using body mass index (>28.8 kg/m(2)) instead of abdominal perimeter. In 8331 non-diabetic hypertensive patients (3663 men and 4668 women, mean age 67.7 years), the prevalence of MS was 32.6% (men: 29.0%; women: 36.8%). A linear association was observed between a greater number of components of MS and a greater prevalence of left ventricle hypertrophy (LVH) on the electrocardiogram (p<0.001), impaired kidney function (p<0.001) and established CVD (p = 0.001). In a multivariate model, MS in non-diabetic hypertensive patients was related to a greater prevalence of LVH (OR 1.31 [95% CI: 1.15-1.48]), impaired kidney function (OR 1.45 [95% CI: 1.29-1.63]) and established CVD (OR 1.22 [95% CI: 1.08-1.37]). This relationship persisted after stratifying by gender. In conclusion, in this elderly non-diabetic hypertensive population, the presence of MS was independently related to a greater prevalence of hypertensive TOD and established CVD, suggesting a role of MS as a cardiovascular risk marker in hypertension.     

Prevalence of coronary heart disease,left ventricular failure and hypertension in middle-aged,newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects

Summary The prevalence of coronary heart disease, left ventricular failure and hypertension was examined in a representative group of 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects (70 men, 63 women), aged 45 to 64 years, and in a group of 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age group. The prevalence of previous myocardial infarction (major Q-QS abnormalities in resting ECG and/or myocardial infarction verified at hospital) was increased 1.7-fold in male (NS) and 4.4-fold in female (p = 0.007) diabetic patients compared with that found in non-diabetic subjects. Chest pain symptoms and ischaemic ECG abnormalities were about twice as common among diabetic than among non-diabetic subjects. The frequency of coronary heart disease defined by chest pain symptoms and ECG abnormalities was 3.5 times higher in male (p = 0.001) and 3.1 times higher in female (p = 0.001) diabetic patients than in the respective non-diabetic subjects. The frequency of current digitalis therapy was increased 3.3-fold in male (p = 0.006) and 3.9-fold in female (p = 0.001) diabetic patients suggesting an increased frequency of left ventricular failure among diabetic subjects. The prevalence of hypertension, based on the elevated blood pressure levels and/or current use of antihypertensive drugs, was increased 1.6–1.7-fold among the diabetic patients.     

Hypertension, anti-hypertensive drug therapy and erectile dysfunction in diabetes.

AIMS: Erectile dysfunction (ED) is common in diabetes and may be related to the high prevalence of hypertension and consequent anti-hypertensive drug therapy in diabetic patients. The risk factors for ED were studied with particular reference to hypertension and anti-hypertensive drugs. METHODS: We performed a retrospective case note analysis of 763 consecutive male patients (34% Type 1 diabetes, 65% Type 2 diabetes) attending an adult diabetic clinic to collect data on risk factors for ED. We specifically recorded the use of anti-hypertensive drugs. RESULTS: Two hundred and ninety-nine (39%) patients had ED. Mean age of patients with ED (61 years) was higher than those without (mean age 51 years, P < 0.001). The mean age of hypertensive patients was also significantly higher than those without. On multivariate regression analysis, age (P < 0.001), macrovascular disease (P < 0.001), sensorimotor neuropathy (P < 0.001) and HbA1c (P < 0.05) predicted ED. Neither hypertension nor any anti-hypertensive medication independently predicted ED. CONCLUSION: Our data suggest that ED in diabetic patients with hypertension may be related to the higher age and prevalence of macrovascular disease rather than hypertension or its treatment.     

Helicobacter pylori prevalence in diabetic patients and its relationship with dyspepsia and autonomic neuropathy

AIMS: We evaluated the prevalence of Helicobacter pylori (HP) in Type 2 diabetic patients and its relationship with dyspeptic symptoms and complications of diabetes. MATERIALS AND METHODS: Seventy-eight Type 2 diabetic patients (54 females, 24 males, mean age: 51.9 +/- 10.6 yr) and 71 non-diabetic control subjects were involved in the study. Patients were questioned for dyspeptic symptoms. Cardiovascular autonomic neuropathy, nephropathy and retinopathy were investigated in diabetic patients. Upper gastrointestinal tract endoscopy was performed for all patients and gastric biopsies were obtained and searched for HP. RESULTS: Helicobacter pylori prevalence was significantly higher in diabetic patients than in control subjects (75.6 vs 46%, p < 0.05). No differences were found between women and men with regard to HP infection status in diabetic patients. There was no relation between HP and diabetic complications, nephropathy and retinopathy. Helicobacter pylori prevalence was significantly higher in diabetic patients with cardiovascular autonomic neuropathy than in diabetic patients without cardiovascular autonomic neuropathy (90.6 vs 44.0%, p < 0.02). Forty-seven subjects with diabetes had symptoms of dyspepsia (60.3%) and the prevalence of HP was higher in these patients (p < 0.002). CONCLUSION: There is a high prevalence of HP infection in diabetic patients and it is correlated with dyspeptic symptoms. Diabetic subjects complicated with cardiovascular autonomic neuropathy and dyspepsia are at high risk of HP infection and should be carefully investigated and considered for eradication therapy.     

Sex‐Specific Differences in Cardiovascular Risk Factors and Blood Pressure Control in Hypertensive Patients

Cardiovascular disease (CVD) and cardiovascular risk factors are frequently undertreated in women. However, it is unclear whether the prevalence of additional cardiovascular risk factors and the total cardiovascular risk differ between hypertensive men and women. There are also limited data regarding rates of blood pressure control in the two sexes outside the United States. The authors aimed to compare the cardiovascular risk profile between sexes. A total of 1810 hypertensive patients (40.4% men, age 56.5±13.5 years) attending the hypertension outpatient clinic of our department were studied. Men were more frequently smokers than women and were more heavy smokers than the latter. Serum high‐density lipoprotein cholesterol levels were lower and serum triglyceride levels were higher in men. On the other hand, abdominal obesity and chronic kidney disease were more prevalent in women. The estimated cardiovascular risk was higher in men than in women but the prevalence of established CVD did not differ between the sexes. The percentage of patients with controlled hypertension and the number of antihypertensive medications were similar in men and women. In conclusion, hypertensive men have more adverse cardiovascular risk factor profile and greater estimated cardiovascular risk than women. However, the prevalence of established CVD does not differ between sexes. These findings further reinforce current guidelines that recommend that management of hypertension and of other cardiovascular risk factors should be as aggressive in women as in men in order to prevent cardiovascular events.     

Fibrinogen, other cardiovascular risk factors and diabetes mellitus in Hong Kong: a community with high prevalence of Type 2 diabetes mellitus and impaired glucose tolerance.

AIMS: To determine the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and their relationships to fibrinogen and other cardiovascular risk factors in Hong Kong Chinese. METHODS: A probability sample of 1,316 men and 1,348 women aged 25-74 years were examined in a population-based cross-sectional study. RESULTS: A total of 3.0% (95% confidence interval 2.1-3.9) of men had previously diagnosed (known) and 6.4% (5.0-7.8) newly diagnosed (unknown) diabetes, 14.4% (12.4-16.5) had IGT and 79.2% were normal by 1985 WHO diagnostic criteria; corresponding prevalences in women were 3.7% (2.7-4.7), 5.9% (4.6-7.2), 17% (14.8-19.2) and 73.4%. The age-standardized prevalence of Type 2 diabetes for the 35-64 age group was 9.5% (7.5-11.6) in men and 10.2% (8.0-12.4) in women. Age-adjusted mean fibrinogen levels in these four groups (normal/IGT/unknown diabetes/known diabetes) with decreasing degrees of glucose tolerance (diabetes status) were 2.80, 2.57, 2.51 and 2.47 g/l (P = 0.003) in men, and 2.86, 2.72, 2.67, 2.61 g/l (P = 0.005) in women. Age, obesity, systolic blood pressure and triglycerides were significantly associated with diabetes status in both sexes, fibrinogen in men only and high density lipoprotein cholesterol negatively in women. CONCLUSIONS: The prevalence of Type 2 diabetes mellitus was very high especially in older subjects, and fibrinogen was associated with increasing glucose intolerance in men but not in women. The detection and better control of cardiovascular risk factors, particularly hypertension in this developed Chinese community with a high prevalence of diabetes and glucose intolerance, is particularly important.     

A prospective study of cardiovascular disease in patients with Type 2 diabetes. 6.3 years of follow-up

OBJECTIVE: Type 2 diabetes mellitus (DM-2) is an important cardiovascular risk factor, although hardly any data are available in our country. Therefore, we decided to study the incidence of cardiovascular disease (CVD) and the related variables with its appearance in a group of patients with DM-2. RESEARCH DESIGN AND METHODS: 176 DM-2 patients without CVD at baseline (63.6% women, mean age 54+/-8.9), mean follow-up 6.3 years. We collected data at 6-month intervals concerning new micro- and macrovascular complications, glucose, HbA(1C), lipid profile, and renal function. We analyzed values at baseline and at the end of follow-up. For numeric variables, the mean value during follow-up was calculated. In renal function variables, we also worked out the difference between baseline and final values, considering the time until the first episode of CVD as the independent variable. Kaplan-Meier analysis was used in categorical variables and Cox regression tests for numeric data and also for multivariate analysis. In multivariate analysis, we included significant data in the univariate analysis, excluding those from the end of the follow-up with the aim of having some predictive meaning in our results. RESULTS: New episodes of CVD were detected in 28 patients (15.9%). These events were statistically related with baseline diagnosed hypertension, presence of diabetic nephropathy and retinopathy, HbA(1C), and total cholesterol. Among mean values during follow-up, the association was with HbA(1C), cholesterol, urinary albumin excretion rate (UAER), glomerular filtration rate (GFR), and systolic arterial pressure. There was also a relationship of CVD events with the new appearance or worsening of diabetic retinopathy or nephropathy, creatinine and UAER increase and the decrease of GFR and effective renal plasma flow (ERPF), during follow-up. In the multivariate analysis, we found an independent association with the appearance of CVD and mean HbA(1C), mean UAER and the presence of proliferative diabetic retinopathy at baseline. CONCLUSIONS: We have a rather low incidence of CVD in our patients with DM-2. The appearance of CVD is independently related with HbA(1C), the level of UAER, and the presence at baseline of diabetic retinopathy.     

UK Prospective Diabetes Study. IV. Characteristics of Newly presenting Type 2 Diabetic Patients: Male Preponderance and Obesity at Different Ages

The characteristics of newly presenting Type 2 diabetes mellitus have been examined in 1857 newly diagnosed diabetic patients aged 25–65 years inclusive. The males were less obese than the females (121% vs 141% IBW, respectively), but a male-dominated sex ratio of 1.54 was found. Taking into account the prevalence of obesity in the general population, males had a 2.5-fold relative risk of presenting with diabetes, although with increasing obesity the male preponderance was lost. Presentation increased with age up to the age of 55 years. Patients presenting at all ages had similar glycaemia and were similarly obese. Those presenting at a younger age were usually particularly obese in relation to the general population. Obese patients were less physically active than normal weight patients. Type 2 diabetes had a seasonal variation of presentation with a peak in January to April.