Mortality Rates in Diabetic Patients from a Community-based Population Compared to Local Age/Sex Matched Controls

Using a population-based cohort from 10 general practices in East Dorset, the mortality rate of diabetic patients compared to non-diabetic controls was investigated during 8 years follow-up. From a total population of 90660, 917 diabetic patients were identified; 693 (75 %) with non-insulin-dependent (Type 2) diabetes and 224 (25 %) with insulin-dependent (Type 1) diabetes. A control group of 917 non-diabetic subjects were selected, matched by age and sex. After 8 years, significantly more diabetic patients (334 or 36.4 %) had died than controls (219 or 24 %), (odds ratio (OR) 1.99, 95 % CI 1.60–2.47). Compared with the controls, the odds ratio of all causes of mortality for diabetic men was 1.89 (CI 1.4–2.54) and for diabetic women 2.16 (CI 1.57–2.96). Compared with controls, the odds ratio for mortality from circulatory disease was significantly increased for diabetic patients 2.0 (CI 1.5–2.6) but mortality for respiratory disease or neoplasms was not significantly different (OR 0.7, CI 0.4–1.2 and OR 0.7, CI 0.6–1.0, respectively). Control data were lower than would be expected from national database data. The diabetic population had a significantly higher mortality than controls, both from all causes and circulatory diseases. Our data incidentally show the importance of appropriate controls for estimating the impact of a chronic disease. © 1997 by John Wiley & Sons, Ltd.     

Early mortality from the time of diagnosis of Type 2 diabetes: a 5-year prospective cohort study with a local age- and sex-matched comparison cohort.

AIMS: To study patterns and predictors of early mortality in individuals with a new diagnosis of Type 2 diabetes, compared with a local age- and sex-matched comparison cohort. METHODS: A total of 736 individuals diagnosed with Type 2 diabetes between 1 May 1996 and 30 June 1998 and non-diabetic age- and sex-matched control subjects were studied. Follow-up was 5.25 years. Age- and gender-specific all-cause mortality odds ratios were calculated for the diabetic cohort compared with the non-diabetic comparator group. Mortality odds ratios were ascertained using conditional logistic regression. RESULTS: There were 147 deaths in the diabetic cohort [cardiovascular (42.2%), cancer (21.1%)]. Compared with the non-diabetic cohort, mortality odds more than doubled [odds ratio (OR) 2.47; 95% confidence interval (CI) 1.74, 3.49]. These increased odds were present in all age bands (including those aged > 75 years at diagnosis) for both cardiovascular and non-cardiovascular causes. In women, a new diagnosis of Type 2 diabetes was associated with a sevenfold increase in mortality odds in those aged 60-74 years (OR 7.00; 95% CI 2.09, 23.47). CONCLUSIONS: Type 2 diabetes is associated with a 2.5-fold increase in the odds of mortality in both men and women over the first 5 years from diagnosis. Our data strongly support the contention that the mortality risk associated with Type 2 diabetes essentially exists from, or may even predate, the time of diagnosis.     

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.     

Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain

Objectives To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory‐confirmed A(H1N1)pdm09 infections in Spain during 2009. Methods Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD‐9‐CM code 488·1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in‐hospital case fatality risk, length of hospital stay, and costs. Results The total number of persons hospitalized with A(H1N1)pdm09 was 11 499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26·8%), and for Type 1 renal disease (10·3%). In‐hospital mortality was 2·1% among Type 1 patients, 3·8% among Type 2 patients, and 2·3% among non‐diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1·03; 95% CI1·01–1·05), hematological disorders (OR 3·49; 95% CI, 1·46–8·37), and obesity (OR 1·88; 95% CI1·07–3·92). Conclusions Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age‐specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.     

Clinical and biochemical outcomes of Type 2 diabetes mellitus in Canterbury, New Zealand: a 6-year cohort study

There is a paucity of data regarding outcomes of Type 2 diabetes mellitus. A cohort of 447 Type 2 diabetic subjects (208 male, 239 female; age range 30–82 years, median 62 years; and of predominantly European origin) was characterised in a clinic survey in 1989. Individual status (dead or alive) at 1 June 1995 was ascertained. At 6 years, 289 subjects were confirmed as alive and 133 as dead—only 25 were untraceable. Of those subjects identified as alive, follow-up clinical and biochemical data were obtained for 253 (87.5%) individuals. In those subjects, glycated haemoglobin deteriorated from 63.1±18.7 mmol/mol haem in 1989 to 71.7±24.4 in 1995, P<0.0001. An increased prevalence of retinopathy was evident at 6-year follow-up, 59.7% cases in 1995 compared with 39.5% in 1989, P<0.001. Similarly there was an increased prevalence of coronary artery disease (CAD) (33.6 vs 18.2% of cases), albuminuria (26.5 vs 19% of cases; P<0.001), and hypertension (71.5 vs 54.9% of cases; P<0.001) in 1995 vs 1989, respectively. Multiple logistic regression analysis showed that glycated haemoglobin (odds ratio (OR) for 18 mmol/mol haem change, 1.78; 95% CI, 1.15–2.85), hypertension (OR, 3.33; 95% CI, 1.40–8.41) and known duration of diabetes (OR for 7 year change, 2.12; 95% CI, 1.24–3.80) were predictors for development of retinopathy. There is therefore a deterioration in glycaemic control in Type 2 diabetes over 6 years and an increased prevalence of complications that present strategies in a multidisciplinary specialist diabetes clinic are unable to prevent on a sustainable basis.     

Low faecal elastase 1 concentrations in type 2 diabetes mellitus

BACKGROUND: Previous studies have suggested an association between impaired pancreatic exocrine function and diabetes, but the evidence is weak because the invasive nature of the tests used to define exocrine function has led to small studies on selected patients. The availability of faecal elastase 1 as a non-invasive test has aided the detection of impaired exocrine function in population studies. We describe the association between levels of faecal elastase 1 and Type 2 diabetes. METHODS: 544 Type 2 diabetic patients (age: 63 +/- 8 years) were randomly selected from local diabetes registers in Cambridgeshire, UK and individually matched for age, sex and practice to 544 controls in whom diabetes was excluded by HbA1c measurement. RESULTS: Faecal elastase 1 concentrations were significantly lower in cases than controls (median: cases 308 microg/g; controls 418 microg/g; P < 0.01). Low levels of faecal elastase 1 (< 100 microg/g) were found in 11.9% of cases and 3.7% of controls (age-sex-adjusted odds ratio; 95% CI: 3.6; 2.2-6.2). After adjustment for potential confounding factors, the OR was 4.5 (2.6-8.3). Among patients with diabetes, poor glycaemic control (HbA1c > or = 7%) was associated with a higher risk of low elastase 1 level (OR 5.6; 1.5-37). No significant association was found with diabetes duration, peripheral neuropathy, alcohol intake, or prior gastrointestinal diseases. CONCLUSIONS: Faecal elastase 1 concentrations are lower in Type 2 diabetic patients than in non-diabetic controls, suggesting the co-existence of diabetes and impaired pancreatic exocrine function. Among the diabetic patients, the risk of having low elastase 1 levels was associated with glycaemic control.     

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.     

Lipid but not glycaemic parameters predict total mortality from Type 2 diabetes mellitus in Canterbury,New Zealand

A cohort of 447 subjects with Type 2 diabetes mellitus (208 male, 239 female; age range 30–82, median 62 years; and of predominantly European origin) was characterized in a clinic survey in 1989. Individual status (dead or alive) at 1 June 1995 was ascertained. Mortality rates were compared with the general New Zealand population by calculating standardized mortality ratios (SMR) and the hazard ratio (HR) of prognostic factors evaluated with Cox’s proportional hazards model. At 6 years, 289 subjects were confirmed as alive and 133 as dead; only 25 were untraceable. Six-year survival for the cohort was 70 % (95 % CI 66–74). SMR was 2.53 (95 % CI 1.99–2.68) for the female cohort and 2.03 (95 % CI 1.60–2.59) for the male cohort. Factors assessed at baseline (1989) that were independently prognostic of total mortality included age, male sex, pre-existing coronary artery disease (CAD) (HR 2.2, 95 % CI 1.5–3.3) and plasma cholesterol (HR for 1.4 mmol l⁻¹ change: 1.49, 95 % CI 1.2–1.9). HDL-cholesterol was protective in women (HR for 0.4 mmol l⁻¹ change: 0.72, 95 % CI 0.51–1.00) but not men. Glycated haemoglobin was not a significant predictor of total mortality. Predictors of CAD mortality (in those subjects free of CAD in 1989) included plasma cholesterol (HR for 1.4 mmol l⁻¹ change: 1.86 95 % CI 1.20–2.89), glycated haemoglobin (HR for 1.8 % change: 1.9 95 % CI 1.04–3.47), male sex, peripheral vascular disease, and smoking. There is therefore increased mortality in Type 2 diabetic subjects in Canterbury, New Zealand. HDL-cholesterol is protective against total mortality in females. © 1998 John Wiley & Sons, Ltd.     

Prevalence and risk factors for asymptomatic bacteriuria in women with Type 2 diabetes mellitus.

AIMS: Asymptomatic bacteriuria (ASB) has been considered as a complication in diabetic women. The reported data on the prevalence and various risk factors for ASB appear to be conflicting. Consequently, we investigated the prevalence and major risk factors of ASB in women with Type 2 diabetes mellitus. METHODS: A total of 411 non-pregnant women (aged 59.6 +/- 10.8 years) with Type 2 diabetes, and 160 women without diabetes (aged 53.3 +/- 15.1 years) assigned as controls, attending an outpatient endocrine clinic in a university-affiliated teaching hospital, were included. All participating women were interviewed and screened for the presence of ASB. In all participants, fasting blood glucose, HbA(1c) and renal function were measured. Complications of diabetes were also assessed. RESULTS: Of the 411 diabetic women, 25 (6.1%) had ASB, compared with four of 160 (2.5%) in control women (P = 0.07). Independent risk factors for the presence of ASB were albuminuria > 150 mg/24 h [odds ratio (OR) 4.96 (95% CI 1.64-15.0, P = 0.005)] and serum creatinine [OR 3.5 (95% CI 1.4-8.8, P = 0.008)]. No significant association was evident with age, BMI, duration of disease, glycaemic control assessed by HbA(1c) or chronic complications of diabetes, namely macrovascular disease, neuropathy and retinopathy. CONCLUSIONS: Women with Type 2 diabetes are not at higher risk of developing ASB than non-diabetic women. Independent and significant risk factors for ASB are macroalbuminuria and serum creatinine. The low prevalence of ASB found in this study may be as a result of the ethnic origin of these women and the circumcised state of their partners.     

Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved beta-cell function.

AIM: To evaluate factors predictive of insulin discontinuation in subjects with ketosis-prone Type 2 diabetes. METHODS: One hundred and six subjects with ketosis-prone Type 2 diabetes were recruited during the index episode of diabetic ketoacidosis (DKA). All subjects were followed in a special clinic for at least 6 months. If the subject's glycaemic control reached specified glycaemic goals, exogenous insulin was gradually decreased until discontinuation. Baseline and follow-up characteristics were compared between the off-insulin and the on-insulin groups. RESULTS: At the end of the follow-up period (915+/-375 days) insulin was discontinued in 47% subjects. Subjects in the off-insulin group were significantly older at the time of diagnosis of diabetes. In the off-insulin group the majority of subjects were newly diagnosed with diabetes. After 6 months of follow-up, subjects in the off-insulin group had significantly lower mean HbA(1c), higher mean C-peptide-to-glucose ratio and had more clinic visits per year. In the proportional hazard analysis, new-onset diabetes [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.02-2.45], and a higher C-peptide-to-glucose ratio at 6 months of follow-up (HR 1.77; 95% CI 1.22-2.63) were significant predictors of insulin discontinuation. CONCLUSIONS: In subjects with ketosis-prone Type 2 diabetes, the best predictors of insulin discontinuation are having new-onset diabetes, and higher beta-cell functional reserve (as measured by the C-peptide-to-glucose ratio).     

Feeding in infancy and the risk of type 1 diabetes mellitus in Finnish children. The 'Childhood Diabetes in Finland' Study Group.

In a case-control design the feeding in infancy of newly diagnosed 7- to 14-year-old diabetic children (n = 426) was compared with that of age- and sex-matched non-diabetic children (n = 426) randomly selected from the Finnish population registry. All 7- to 14-year-old diabetic children diagnosed from September 1986 to the end of April 1989 from all hospitals which treat diabetic children in Finland were invited to participate in the study. Breast-feeding was initiated in almost all children, but during the birth years of this study population (1972-1982), an increase was observed in the duration of breast-feeding (whether alone or in combination with supplementary feeding) and in the age of introduction of supplementary milk feeding. The risk of Type 1 diabetes was decreased in the children who were totally breast-fed for at least 2 months (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42-0.98) or 3 months (OR 0.67, 95% CI 0.48-0.95) or exclusively breast-fed for at least 2 months (OR 0.60, 95% CI 0.41-0.89) or 3 months (OR 0.63, 95% CI 0.43-0.93). Those children who were younger than 2 months (OR 1.54, 95% CI 1.08-2.18) or 3 months (OR 1.52, 95% CI 1.11-2.08) at the time when supplementary milk feeding was begun had an increased risk of Type 1 diabetes. These associations remained significant after adjusting for the mother's education. The results suggest that early infant feeding patterns are associated with the risk of Type 1 diabetes developing at the age of 7 to 14 years.     

Glycemic control is an important modifiable risk factor for uveitis in patients with diabetes: A retrospective cohort study establishing clinical risk and ophthalmic disease burden

Aim

To characterize the risk uveitis, scleritis or episcleritis in relation to diabetes, glycaemic control, and co-existence of retinopathy.

The 16-year incidence,progression and regression of diabetic retinopathy in a young population-based Danish cohort with type 1 diabetes mellitus: The Danish cohort of pediatric diabetes 1987 (DCPD1987)

The aim was to investigate the long-term incidence of proliferative diabetic retinopathy (PDR), and progression and regression of diabetic retinopathy (DR) and associated risk factors in young Danish patients with Type 1 diabetes mellitus. In 1987–89, a pediatric cohort involving approximately 75 % of all children with Type 1 diabetes in Denmark <19 years of age was identified (n = 720). In 1995, 339 (47.1 %) were re-studied with retinopathy graded and all relevant diabetic parameters assessed. Of those, 185 (54.6 %) were evaluated again in 2011 for the same clinical parameters. All retinal images were graded using modified early treatment of DR study for 1995 and 2011. In 1995, mean age was 21.0 years and mean diabetes duration 13.5 years. The 16-year incidence of proliferative retinopathy, 2-step progression and 2-step regression of DR was 31.0, 64.4 and 0.0 %, respectively, while the incidence of DR was 95.1 %. In a multivariate logistic regression model, progression to PDR was significantly associated with 1995 HbA_1c (OR 2.61 per 1 % increase, 95 % CI 1.85–3.68) and 1995 diastolic blood pressure (OR 1.79 per 10 mmHg increase, 95 % CI 1.04–3.07). Two-step progression of DR was associated with male gender (OR 2.37 vs. female, 95 % CI 1.07–5.27), 1995 HbA_1c (OR 3.02 per 1 % increase, 95 % CI 2.04–4.48) and 1995 vibration perception threshold (OR 1.19 per 1 Volt increase, 95 % CI 1.02–1.40). In conclusion, one in three progressed to PDR and two in three had 2-step progression despite young age and increased awareness of the importance of metabolic control. After 30 years duration of diabetes, the presence of DR is almost universal.     

Prevalence and associated factors of non‐alcoholic fatty liver disease in patients with type‐2 diabetes mellitus

Background/Aims: Diabetic patients have an increased prevalence and severity of non‐alcoholic fatty liver disease (NAFLD). We aimed to investigate the prevalence and the factors associated with the presence of ultrasonographic NAFLD in type‐2 diabetic individuals. Methods: In a cross‐sectional design study, 180 type‐2 diabetic patients were submitted to a complete clinical and laboratory evaluation and abdominal ultrasonography for NAFLD detection and grading. Statistical analysis included bivariate tests, analysis of variance (anova , for increasing severity of steatosis) and multivariate logistic regression. Results: The prevalence of ultrasonographic NAFLD was 69.4% [95% confidence interval (CI): 58.3–82.7%]. Patients with NAFLD were more obese, had a higher waist circumference and serum triglyceride and alanine aminotransferase (ALT) levels than those without steatosis. Neither diabetic degenerative complication, nor glycaemic control was associated with liver steatosis. On multivariate analysis, a high serum triglycerides level [>2.82 mmol/L, odds ratio (OR): 3.7–4.1, 95% CI: 1.2–13.3] and a high‐normal ALT level (≥40 U/L, OR: 2.5–2.7, 95% CI: 1.2–5.9) were independently associated with hepatic steatosis, together with either the presence of obesity (OR: 7.1, 95% CI: 3.0–17.0) or of increased waist circumference (OR: 4.8, 95% CI: 1.9–12.2). Conclusions: Type‐2 diabetic patients have a high prevalence of ultrasonographic NAFLD and its presence is associated with obesity, mainly abdominal, hypertriglyceridaemia and high‐normal ALT levels. Non‐alcoholic fatty liver disease in diabetic patients may develop and progress independent of the diabetes progression itself.     

Early life factors and Type 2 diabetes in south India: Do the associations change with age?

Background: Studies since the early 1990s have shown that birth size can be a predictor of the development of Type 2 diabetes mellitus (T2DM). In the present study, we evaluated changes in the strength of associations between T2DM and birth size and maternal weight with age. Methods: In 1993–1994 (t₀), 509 men and women (mean age 46 years) who had been born in Holdsworth Memorial Hospital were screened for diabetes, with increased diabetes risk identified in those who were shorter at birth and those born to heavier mothers. Ten years later (t₁₀), the screening was repeated in 266 subjects who were non‐diabetic at t₀ (70% of survivors). Results: At t₁₀, 56 new cases of diabetes were found. The incidence of diabetes decreased with increasing birth length (odds ratio (OR) = 0.90, 95% confidence interval (CI) 0.84–0.97/cm birth length; P = 0.006) after adjustment for sex, age, socioeconomic status, family history, and current body mass index. Overall, there were no significant differences in OR for the association between birth length and diabetes at t₀ compared with t₁₀, but limiting analysis to subjects with normal glucose tolerance at t₀ resulted in a stronger association at t₁₀ (OR = 0.71, 95% CI 0.58–0.87) than at t₀ (OR = 0.95, 95% CI 0.86–1.05; P = 0.015 for the difference). There was a positive correlation between maternal weight and incident disease at t₀ (OR = 1.08, 95% CI 1.03–1.14; P = 0.001), but not at t₁₀ (OR = 0.98/kg, 95% CI 0.92–1.05; P = 0.6; P = 0.02 for the difference). Conclusions: Short birth length remains a risk factor for diabetes. Changes in the effects of birth length and maternal weight on diabetes risk with age may indicate different causal pathways. These findings require replication in studies with more accurate dating of the onset of diabetes.     

Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients

Ankle brachial pressure index (ABPI) is a non-invasive marker of atherosclerosis, helpful to identify subjects at high-risk for coronary heart disease (CHD) among large populations with cardiovascular disease (CVD) risk factors. The diagnostic role of ABPI has been also recognized in patients with diabetes. In the present study, the role of an ABPI score < 0.90 in predicting CHD has been evaluated in a large series of patients with Type 2 diabetes mellitus and compared to other known CVD risk factors. Nine hundred and sixty-nine (mean age was 66.1 yr) consecutive patients with Type 2 diabetes mellitus were evaluated. The patients were followed-up for 18.3+/-5.2 months (range 12- 24) and all events of CHD, defined as myocardial infarction, unstable and resting angina or coronary atherosclerosis at the instrumental investigation (at the coronary angiography and/or perfusion stress testing) were recorded. A rate of 17.5% of CHD events were recorded in diabetic population during the follow-up period. The relative risk of CHD was significantly increased for male patients [odds ratio (OR): 1.6; 95% confidence interval (CI): 1.1-2.2], patients with age > or = 66 yr (OR: 1.8; 95% CI: 1.3-2.5), body mass index (BMI) > 30 (OR: 1.5; 95% CI: 1.1-2.1), waist circumference > 88 cm for females and 102 cm for males (OR: 1.5; 95% CI: 1.0-2.1), proteinuria > or = 30 microg per min (OR: 1.6; 95% CI: 1.1-2.3), LDL-cholesterol > or = 100 mg/dl (OR: 2.1; 95% CI: 1.5-3.0), glycated hemoglobin > 7% (OR: 1.6; 95% CI: 1.1-2.3), insulin therapy (OR: 1.9; 95% CI: 1.3-2.9), and ABPI < 0.90 (OR: 3.7; 95% CI: 2.2- 6.2). BMI was higher in patients with ABPI < 0.90 than in those with ABPI > or = 0.90 (p<0.05). At the multivariate analysis, ABPI < 0.90 was the best factor independently associated with CHD (p<0.001). APBI < 0.90 is strongly associated to CHD in Type 2 diabetic patients. We recommend to use ABPI in diabetic patients and to carefully monitor diabetic subjects with an ABPI lower than 0.90.     

肥胖、2型糖尿病与大肠腺瘤腺癌的相关性研究

目的 初步探讨体质量指数（BMI）、2型糖尿病与大肠腺瘤腺癌的相关性.方法 2008年7月至2009年7月间,选择年龄为20～86岁的大肠镜检查患者971例,测量身高、体重,并记录有无糖尿病及病程.根据肠镜检查及活检病理结果纳入研究组（即腺瘤腺癌组,总计471例）和正常对照组（500例）.利用多因素Logistic回归进行相关性分析.结果 调整了可能的混杂因素后,肥胖组患大肠腺瘤腺癌的危险度是正常组的2.55倍,其中肥胖组男性患大肠腺瘤腺癌的危险度是正常组的3.32倍,而女性中不同BMI指数大肠腺瘤腺癌的患病率差异无统计学意义.超重组差异无统计学意义.2型糖尿病的患者引起大肠腺瘤腺癌的危险度是无糖尿病患者的约2.10倍,其中,病程〈6年引起大肠腺瘤腺癌的危险度是病程≥6年的约3.00倍,且风险与性别无关.糖尿病合并肥胖患者患大肠腺瘤腺癌的危险度是糖尿病无合并肥胖患者的3.05倍.结论 肥胖与大肠腺瘤腺癌的发生显著相关,肥胖男性患病风险明显大于女性.2型糖尿病患者患大肠腺瘤腺癌的风险较高,且糖尿病合并肥胖的患者患大肠腺瘤腺癌的风险显著高于糖尿病无肥胖的患者.     

Prevalence of the diabetic foot syndrome at the primary care level in Germany: a cross-sectional study

Aims The diabetic foot syndrome (DFS) is an important complication of diabetes mellitus resulting in amputations, disability and reduced quality of life. DFS is preventable. The aim was to investigate the prevalence of the DFS at the primary care level in Germany. Methods This was a cross-sectional study of the prevalence of DFS, associated factors and glycaemic control at the primary care level in Germany. We examined an unselected sample of participants with known diabetes who were insured by Deutsche BKK, a large healthcare insurer. Results Three hundred and forty-one general practitioners examined 4778 participants with diabetes mellitus: 366 (7.7%) participants (mean age 49 ± 16 years) had Type 1 and 4412 participants (mean age 66 ± 10 years) had Type 2 diabetes. DFS was diagnosed in 138 patients, resulting in a prevalence of 3.6%[95% confidence interval (CI) 1.9, 6.0] in Type 1 and 2.8% (95% CI 2.3, 3.4) in Type 2 diabetes. DFS was independently associated with age, duration of diabetes, height, current smoking and insulin therapy. There was no significant effect of glycaemic control on the risk of DFS. The prevalence of other abnormal foot findings was: peripheral neuropathy 9.7%, peripheral arterial disease 14.8% (absent dorsalis pedis), 12.4% (absent tibialis posterior), acute diabetic foot ulcer 0.8%, amputations of lower extremities 1.5%, and amputations limited to toes 0.5%. Conclusions The prevalence of the DFS at the primary care level in Germany is 2.9%. Almost 50% of patients with DFS had major or minor amputations. Common risk factors such as hyperkeratosis and poor glycaemic control can be modified. Effective therapeutic approaches in addition to methods for primary and secondary prevention of DFS should be used more widely.     

Glycaemic control, disease duration and beta-cell function in patients with Type 2 diabetes in a Swedish community. Skaraborg Hypertension and Diabetes Project.

AIMS: To examine determinants for glycaemic control in primary care patients with Type 2 diabetes. METHODS: In a community-based surveillance of primary care patients with Type 2 diabetes, 190 men and 186 women were consecutively identified and examined for cardiovascular risk factors. Insulin resistance and beta-cell function were estimated using homeostasis model assessment (HOMA). Good glycaemic control was defined as HbA(1c) < 6.5%. RESULTS: Following adjustment for age and gender, HbA(1c) > or = 6.5% was associated with duration of diabetes (10.6 vs. 6.4 years, P < 0.001), lower levels of serum insulin (6.3 vs. 8.0 mU/l, P = 0.012), higher serum triglyceride levels (2.0 vs. 1.7 mmol/l, P = 0.002) and impairment of beta-cell function (HOMA index 19.5 vs. 45.8, P < 0.001). The association between HbA(1c) levels and duration remained with adjustment for age, gender, waist-hip ratio (WHR) and serum triglycerides (odds ratio (OR) for HbA(1c) > or = 6.5% by 5 years diabetes duration = 1.7; 95% confidence interval (CI) 1.4--2.1) but was lost following additional adjustment for beta-cell function (OR for HbA(1c) > or = 6.5% = 1.3; 95% CI 0.96-1.7). In a separate linear regression with beta-cell function as the dependent variable there was a significant association with HbA1c after adjustments for differences in age, gender, WHR, serum triglyceride levels and diabetes duration (P < 0.001). CONCLUSIONS: Increasing HbA1c by time was associated with declining beta-cell function.     

Lack of synergism between long-term poor glycaemic control and three gene polymorphisms of the renin angiotensin system on risk of developing diabetic nephropathy in Type I diabetic patients

Aims/hypothesis. Reports on a putative synergism between poor glycaemic control and carriage of the angiotensin II type 1 receptor (AGTR1) C¹¹⁶⁶-allele and risk of diabetic nephropathy have been conflicting. Therefore, we investigated the interaction between long-term glycaemic control and three polymorphisms in the genes coding for AGTR1 (A¹¹⁶⁶→C), angiotensin converting enzyme (ACE/ID) and angiotensinogen (M235T) on risk of developing diabetic nephropathy. Furthermore, we investigated the relation between a random measurement and long-term measurements of haemoglobin A_{1 c} (HbA_{1 c}).¶Methods. We studied Caucasian patients with Type I (insulin-dependent) diabetes mellitus and nephropathy (120 men 74 women, age 41.1 ± 9.6 years, diabetes duration 28 ± 8 years) and long-standing Type I diabetic patients with persistent normoalbuminuria (112 men 69 women, age 42.5 ± 10.0 years, diabetes duration 27 ± 9 years). Genotyping was PCR-based and metabolic control estimated from all measurements of HbA_{1 c} done in each patient [average (range) n = 31 (6–74)]. The median observation time (range) was 13.5 (2–14) years.¶Results. Type I diabetic patients with a history of poor glycaemic control (HbA_{1 c} above the median, 8.7 %) had an increased risk of diabetic nephropathy compared with patients with a better metabolic control, OR (95 % CI): 9.2 (5.8–14.7). The magnitude of this risk was similar in carriers and non-carriers of the mutations. The risk of nephropathy in patients with HbA_{1 c} above compared with below the median in carriers of the mutant C¹¹⁶⁶-allele, D-allele, or T235-allele were 7.6 (95 % CI: 3.9–14.8), 10.4 (6.0–17.8) and 9.8 (5.4–17.9), respectively. A significant correlation (r = 0.74, p < 0.001) existed between a random and long-term measurements of HbA_{1 c} with a small mean difference (limits of agreement) [0.2 (–1.8 to 2.1) %] between the two estimates.¶Conclusion/interpretation. Poor metabolic control is a major risk factor for diabetic nephropathy in Caucasian Type I diabetic patients. This risk was similar in carriers and non-carriers of the mutant alleles of the AGTR1(A¹¹⁶⁶→C), ACE/ID and angiotensinogen-M235T polymorphisms. The HbA_{1 c} value measured at random reflects rather closely average long-term HbA_{1 c} values. [Diabetologia (2000) 43: 794–799]